bluuebunny/crossref_metadata_2025 huggingface dataset:
Habit Training and Oxybutynin for Incontinence in Nursing Home Patients: A Placebo‐controlled Trial
Authors: Ouslander Joseph G. , Blaustein Jenna , Connor Amy , Pitt Audrey
Published: April 2015

In order to determine if a bladder‐relaxant drug could enhance the effectiveness of a toileting program for incontinence among functionally impaired nursing home patients, 15 patients with detrusor hyperreflexia were enrolled in a 6‐week trial during which they were put on a habit training protocol alone for 2 weeks, habit training (HT) and a placebo for 2 weeks, and then HT and oxybutynin for 2 weeks (2.5 mg three times daily for 1 week, then 5 mg three times daily for 1 week). Bacteriuria, which was present without other symptoms in 11 of the 13 patients who completed the trial, was treated before HT began. Eradication of the bacteriuria resulted in a small, statistically significant increase in cystometric bladder capacity (44 mL; 95% confidence interval 16 to 72 mL), but the detrusor hyperreflexia and frequent episodes of incontinence persisted. HT alone reduced the mean percentage of every‐two‐hour checks which were wet from 43% to 32% (95% confidence interval of the difference −1% to −21%; P = .04 by a paired t test); addition of placebo and active drug did not result in any further reduction. Cystometric bladder capacity had not changed significantly by the end of the trial (measured while patients were still on active drug), and there was no consistent relationship between changes in bladder capacity and changes in wet checks. Although our sample size is small, the data are consistent with other studies in similar populations. The relatively practical and inexpensive interventions we employed in this study will need to be modified or intensified in order to substantially reduce the frequency of incontinence among functionally disabled nursing home patients.
Hemodynamic Responses to Positional Change in Habitually Physically Active and Inactive Older Men
Authors: Stretcher W. , Mistier J. E. , Bloomfield D. K. , Massey B. H.
Published: April 2015

This study explored hemodynamic responses to positional change in 11 habitually physically active and 11 physically inactive healthy older men (mean age 70 years). Data were collected in the supine, sitting, standing, and 70° upright tilt positions over a 10‐minute period (long‐term response). Dependent variables were heart rate, stroke volume, cardiac output, total peripheral resistance, and blood pressure. Stroke volume, cardiac output, and total peripheral resistance were expressed per unit body surface area. The results of this study indicated that the physically active older men had significantly lower resting heart rates and significantly higher stroke volume indices in all four positions compared with the physically inactive men. The physically active men also tended to have lower total peripheral resistance indices and higher cardiac indices in all four positions, but the differences were not statistically significant. However, physically active and inactive older men reacted similarly (with respect to all hemodynamic variables except the stroke volume index) in the sitting, standing, and 70° upright tilt positions as compared with the supine; the stroke volume index decreased significantly more compared with that of the supine in the physically active men.
Treatment Decisions for Infections Occurring in Nursing Home Residents
Authors: Mott Peter D. , Barker William H.
Published: April 2015

This retrospective study examines the effect of guidelines on clinical decision‐making in the treatment of acute infections in nursing home residents. Among 110 patients followed over 7 years, infections caused 54% of acute medically attended problems, 48% of hospitalizations, and 63% of deaths. Patients designated to receive comfort care, when compared with maximum care patients, had a higher percentage of acute problems, hospitalizations, and deaths caused by infections. Antibiotic treatment was given far less often to comfort care patients with respiratory, urinary tract, and skin infections. Implications of such an intervention in nursing home care are discussed.
Fibromyalgia Syndrome Among the Elderly
Authors: Yunus Muhammad B. , Holt Gregory S. , Masi Alfonse T. , Aldag Jean C.
Published: April 2015

Thirty‐one elderly fibromyalgia (EFM) patients (60 years of age and older) were studied by protocol and compared with 63 younger fibromyalgia (YFM) patients with this syndrome. Common and characteristic features of fibromyalgia among the elderly included diffuse musculoskeletal aching and stiffness at multiple sites; modulation of aches and pains by physical fatigue, poor sleep and weather factors; associated symptoms of general fatigue, poor sleep, anxiety/tension and subjective soft tissue swelling; and multiple tender points on physical examination. These features were similar to those among the younger patients, with the exception of chronic functional headaches, self‐assessed anxiety/tension, and symptom aggravation by weather factors, mental stress, and by poor sleep, all of which were significantly less common among the elderly (P < .05). Importantly, fibromyalgia was recognized by referring physicians in only 17% of the elderly patients with this condition. Misdiagnoses and inappropriate treatment were common among these patients, with corticosteroid therapy in 40% before their rheumatology consultation.
Clinical Determinants of Biomechanics Platform Measures of Balance in Aged Women
Authors: Lichtenstein Michael J. , Shields Sharon L. , Shiavi Richard G. , Burger M. Candice
Published: April 2015

The cross‐sectional associations between clinical variables and biomechanics platform measures of balance (sway) were determined in a random sample of 50 aged single women living in high rise apartment buildings. A history of falling in the previous year was associated with increased areas of sway. Increased body mass was associated with decreased velocity of sway. Poor near, but not far, visual acuity was associated with increased areas of sway. A postural drop of 10 mmHg or more in diastolic pressure was associated with increased velocity of sway. The associations between these variables and the balance measures persisted after adjustment for age and each other to adjust for potential confounding.

Slower hand reaction times and poor hearing were associated with increased areas of sway, but these associations were removed after adjustment for age and near visual acuity. There were no associations between any of the balance measures and postural changes in systolic pressure and heart rate. There were no associations between balance measures and base of support. The observed associations, if causal, can aid in development and testing of effective interventions to improve balance and prevent falls in the elderly.
Effects of Treatment for Isolated Systolic Hypertension on Cognitive Status and Depression in the Elderly
Authors: Gurland Barry J. , Teresi Jeanne , Smith W. McFate , Black Dennis , Hughes Glenn , Edlavitch Stanley
Published: April 2015

The Systolic Hypertension in the Elderly Program (SHEP) was designed as a feasibility study and in part dealt with the effects of the treatment of isolated systolic hypertension on cognitive status and depression. Subjects were 60 years of age or older with a systolic blood pressure of 160 mmHg or greater and diastolic of less than 90 mmHg; free of several specified illnesses or chronic conditions. These volunteers were randomly assigned to treatment (n = 443) and placebo (n = 108) groups. The behavioral assessments at baseline and 1 year later were the SHORT‐CARE instrument for depression, cognitive impairment, and disability and other tests of cognitive status (Digit Symbol Substitution and the Trail Making tests). Although the treatment regime was highly successful in controlling the hypertension, it did not have a significant impact on changes in cognitive function or level of depression; a behavioral benefit was not evident but the results are consistent with the view that an effective treatment regime for isolated systolic hypertension in the elderly can be behaviorally safe.
Proportional Hazards Analysis of Risk Factors for Coronary Heart Disease in Individuals Aged 65 or Older
Authors: Harris Tamara , Cook E. Francis , Kannel William B. , Goldman Lee
Published: April 2015

Risk factors for coronary heart disease were examined in 2,501 individuals in the Framingham Heart Study who survived to the age of 65 without evidence of coronary artery disease. We used a proportional hazards (Cox) analysis that examined risk factors over time and included events through the 16th biennial examination. The independently significant multivariate correlates of the development of coronary heart disease after the age of 65 were sex (incidence rate ratio [RR] for males of 1.7 [95% confidence interval of 1.4,2.0]), left ventricular hypertrophy (RR = 2.4 [1.7,3.5]), systolic blood pressure (RR = 2.2 [1.4,3.3] for systolic blood pressure of 160 mmHg or higher as compared with less than 120 mmHg), casual blood glucose (RR = 2.2 [1.5,3.4] for 175 mg/dL or more as compared with less than 90 mg/dL), Metropolitan relative weight from examination 1 (RR = 1.3 [1.0,1.6] for those 130% or more of ideal weight compared with those less than 110% of ideal), and total serum cholesterol (RR = 1.8 [1.3,2.5] for cholesterol in the 90th percentile or higher compared with less than 200 mg/dL). Controlling for all these risk factors, those smoking 20 cigarettes a day or more were at slightly increased risk of coronary heart disease (RR = 1.2 [.9,1.6]) compared with nonsmokers. These analyses suggest that older persons share the same risk factors for coronary artery disease that are significant in younger populations.
Fall Injuries Among the Elderly
Authors: DeVito Carolee A. , Lambert Deborah A. , Sattin Richard W. , Bacchelli Sandro , Ros Alberto , Rodriguez Juan G.
Published: April 2015

Falls are a leading cause of fatal and nonfatal injuries among the elderly in the United States. Despite the importance of fall injuries, epidemiological studies of falls among the elderly have identified neither their causes nor the methods to prevent them. Therefore, we established a community‐based surveillance system in Miami Beach, Florida, as part of a study to assess falls among the elderly. A total of 1,827 fall injury events occurred in this community between July 1985 and June 1986. More than 85% (1,567) of the persons who fell and received care were seen in an emergency room. The remaining cases were identified from one of the three other sources used: fire rescue reports, inpatient medical records, or medical examiner reports. Most falls (97%) were coded as accidental (E880–E888). More than 100 people sought medical assistance for a fall each month. The time of the injury was known for 68% (1,244) of the people who fell. Seventy‐four percent of these falls (921) occurred during daylight hours. Fifty‐four percent of the falls (986) occurred in and around the home, and 38% of these had a particular area of the home recorded: 42% occurred in the bedroom, 34% in the bathroom, 9% in the kitchen, 5% on the stairs, 4% in the living room, and the remaining 6% in other areas. This surveillance system will help us use the study to clarify the causes of falls in the elderly and identify and evaluate appropriate prevention efforts. It will also help others in designing and implementing other injury surveillance systems.
Driving in Patients with Dementia
Authors: Lucas‐Blaustein Mary Jane , Filipp Laura , Dungan Cheryl , Tune Larry
Published: April 2015

These pilot data suggest that driving among individuals with incapacitating dementing illness may be an unrecognized, potentially serious problem. A simple 20‐item screening questionnaire was administered to 72 referrals to the Dementia Research (outpatient) Clinic of the Johns Hopkins Hospital. Thirty percent of the patient sample had at least one accident since the onset of symptoms of dementia. An additional 11% were reported by caregivers to have “caused” accidents.
Identification of Factors Associated with the Diagnosis of Delirium in Elderly Hospitalized Patients
Authors: Levkoff Sue E. , Safran Charles , PhD Paul D. Cleary , Gallop Jennifer , Phillips Russel S.
Published: April 2015

We analyzed factors associated with the discharge diagnosis of delirium among 1,285 patients admitted to a major teaching hospital during a 2‐year period, developed a model to classify the risk of developing delirium on the basis of clinical and diagnostic data, and tested the model on 471 patients admitted during the subsequent year. Using the multivariate technique of recursive partitioning, we identified four factors that distinguished 80% of all cases of delirium: 1) a urinary tract infection at any time during the hospital stay (odds ratio = 3.1; 95% confidence interval = 2.02–4.58); 2) no urinary tract infection, but low serum albumin on admission (odds ratio = 2.4; 95% confidence interval = 1.43–3.99); 3) neither urinary tract infection nor low serum albumin, but elevated white blood cell count on admission (odds ratio = 1.99; 95% confidence interval = 1.18‐3.37); 4) none of these risk factors, but proteinuria on admission (odds ratio = 1.82; 95% confidence interval = 2.25–2.66). Patients without any of these four risk factors had the lowest probability of developing delirium during their hospital stay. Among individuals with delirium, in‐hospital mortality and hospital charges were higher. The model developed accurately characterized the risk of delirium when it was tested on patients admitted to the same hospital during the subsequent year.
What are the Psychiatric Manifestations of Vitamin B12 Deficiency?
Authors: Hector Melvin , Burton John R.
Published: April 2015

Psychiatric symptoms attributable to vitamin B12 deficiency have been described for decades. The earlier reports are for the most part in accord with more recent ones, despite being diagnostically less specific in psychiatric and hematologic terms. These symptoms seem to fall into several clinically separate categories: slow cerebration; confusion; memory changes; delirium, with or without hallucinations and/or delusions; depression; acute psychotic states; and (more rarely) reversible manic and schizophreniform states.

While there still remain abundant hematologic, psychiatric, neurologic, or nutritional reasons for obtaining a serum vitamin B12 level, its use in the investigation of the etiology of a patient's dementia seems unjustified. However, acute or subacute changes in a demented patient's mental status, specifically a clouding of their consciousness, may make such testing advisable as part of the complete workup of their delirium regardless of a normal hematologic picture.
Increased Utilization of Influenza and Pneumococcal Vaccines in an Elderly Hospitalized Population
Authors: Bloom Harrison G. , Bloom Judy S. , Krasnoff Lawrence , Frank Andrew D.
Published: April 2015

This study compared three interventions designed to increase acceptance of influenza and pneumococcal vaccines among elderly hospitalized patients. All individuals 65 and older able to give informed consent (73 patients) who were admitted to one medical floor of an acute care hospital were randomized to one of three groups. All groups received informational pamphlets explaining influenza and pneumococcal disease, their respective vaccines, and indications for their use. The first group received pamphlets only, the second received nursing follow‐up, and the third received trained volunteer follow‐up. Patients on another medical floor served as controls. The results showed a significant improvement in vaccine acceptance in all three study groups compared to controls for both influenza (78% vs 0%) and pneumococcal (75% vs 0%) vaccines. The differences among the three groups were not significant. No significant differences were found among patients accepting or refusing vaccination with regard to diagnosis, age, length of stay, sex, or having a private physician. We conclude that a simple educational program followed by offering vaccination before hospital discharge can be easily implemented, and dramatically increase immunization rates in this high risk group.
Evaluation and Treatment of Urinary Incontinence in Long Term Care
Authors: Pannill Fitzhugh C. , Williams T. Franklin , Davis Robert
Published: April 2015

All elderly patients with established urinary incontinence residing in an intermediate care facility during one year were evaluated for medical and urological conditions contributing to the incontinence; treatment was initiated for all diagnosed problems if possible. Unstable detrusor function (65%), sphincter weakness (13%), and overflow incontinence (10%) were all frequent urological causes, although several patients required extensive testing in addition to cystometrics to establish a complete diagnosis. Frequent nonurological causes of incontinence included behavioral problems (53%), immobility (45%), medication problems (24%), diabetes (18%), and local pathology (47%). Thirty‐seven percent had three or more conditions identified. Treatment aimed at nonurological causes was more successful in ameliorating incontinence than urological medication; side effects were significant limitations to urological treatment success. Of the 22 patients who completed evaluation, treatment, and follow‐up, five patients (23%) were cured, three (14%) showed at least a 65% decrease in incontinence, four (18%) showed at least a 30% decrease in incontinence, and 10 (45%) showed no change or worsened. We conclude that nonurological problems frequently contribute to urinary incontinence in long term care facilities; incontinence in some of these patients can be improved without urological therapy. Nonurological problems need careful definition and treatment; patients whose incontinence persists require comprehensive urological evaluation and therapy. A complete solution to incontinence in this setting may require safer drugs and better understanding of urinary pathophysiology.
Illness Behavior in the Aged
Authors: Levkoff Sue E. , Cleary Paul D. , Wetle Terrie , Besdine Richard W.
Published: April 2015

A better understanding of the processes through which elderly individuals perceive, evaluate, and act on symptoms will enable physicians to respond more appropriately to the needs of older patients. This paper reviews existing evidence on how the experience of chronic disease and the atypical presentation of symptoms influence symptom recognition and reporting among elderly individuals. A discussion of research on health perceptions suggests that some elderly may inappropriately deny illness and delay seeking medical care, while others with overly negative health perceptions may make excessive physician visits. An overview is presented of the process by which elderly individuals come to seek care from their physicians, combining evidence from the diverse literatures on chronic illness, atypical presentation of disease, and health perceptions. We conclude by discussing the practical implications of this information for clinicians working with the elderly.
Should We Ration Health Care by Age?
Authors: Churchill Larry R.
Published: April 2015

Age‐rationing of health care is beginning to be widely debated. Two recent proposals are examined. It is argued that age‐rationing proposals must be viewed in the light of current rationing practices, and that all such proposals must be placed in the context of a more just overall health care system.
Risk Factors Associated with Immobility
Authors: Selikson Sandra , Damus Karla , Hamerman David
Published: April 2015

In nursing homes, immobility and related complications are major problems with profound health care and financial implications. We conducted a retrospective study to identify risk factors associated with immobility. We compared factors in 34 nonambulatory residents with those in 12 independent ambulatory residents who served as controls. Factors associated with immobility included contractures, severe dementia, poor vision, and history of hip /leg fractures. Factors not associated with immobility included age, osteoarthritis, mild to moderate dementia, weight gain, and broad categories of selected medications. The immobile patients were further analyzed by sub‐grouping into those with and without contractures. Contractures were significantly associated with severe dementia. The finding that immobility was not identified on problem lists for 85% (29) of the immobile residents and that for 29% (10) reasons for immobility could not be ascertained suggest that immobility is frequently not documented as a major problem in medical records nor adequately evaluated.
Do Physicians Spend Less Time with Older Patients?
Authors: Radecki Stephen E. , Kane Robert L. , Solomon David H. , Mendenhall Robert C , Beck John C.
Published: April 2015

In view of the additional time that older persons require for giving and receiving information, as well as for the examination process, it is important for manpower and reimbursement planning to better understand the nature of the physician‐patient encounter with the elderly. We examined a series of national surveys of physicians' professional activities and found that physicians tend to spend less time with their older patients and also that encounter time by physicians in different specialities varies widely. Internists and cardiologists spend substantially more time with patients compared with general and family practitioners. For 65–74‐year‐old ambulatory patients, the average visit lengths are 18.3 minutes for internists, 18.0 for cardiologists, 11.2 for general practitioners, and 12.1 for family practitioners. Compared with ambulatory visit lengths for patients aged 45 to 64 years, average encounter times for 75‐year‐olds with family physicians were 0.8 minutes shorter, with general practitioners 1.2 minutes shorter, with internists 2.3 minutes shorter, and with cardiologists 3.0 minutes shorter. However, when all characteristics of the visit were considered, the effect of patient age remained significant only for general practitioners. A multivariate analysis of factors related to physician time for ambulatory care showed that more time is associated with multiple problems, problem severity, and the use of diagnostic testing. For general and family practice, the greater the number of previous visits for a problem, the shorter the encounter time is. Additional characteristics associated with shorter physician—patient encounter times include the volume of patients per week and the use of physician assistants within the practice. These findings have implications for medical education and manpower projections.
Anergy Testing in Nursing Home Residents
Authors: Delafuente Jeffrey C. , Meuletman John R. , Nelson Richard C.
Published: April 2015

Delayed cutaneous hypersensitivity (DCH) testing is commonly used to determine exposure to Mycobacterium tuberculosis and in the evaluation of cellular‐mediated immunity. Many reports indicate that anergy to ubiquitous antigens is common in the elderly. Recent studies suggest that anergy in the aged is not common when five or more antigens are used. Because it is often difficult to purchase singularly or apply a larger number of quality DCH antigens, we investigated the usefulness of the Multitest CMI in 29 nursing home residents with chronic diseases. This device simultaneously applies seven skin test antigens and a negative control. Ten young healthy subjects served as controls. DCH reactions were scored based on the sum of induration and total number of positive responses. Although elderly subjects had significantly lower scores than the young subjects, only 7% of elderly subjects were anergic. Our data indicate that the Multitest CMI is a highly effective device to test for DCH in geriatric subjects with chronic diseases. Although skin test responses in these subjects were blunted, in most residents cellular‐mediated immunity remained intact.
Vitamin D Deficiency in Elderly Patients in a General Hospital
Authors: Goldray D. , Mizrahi‐Sasson E. , Merdler C. , Edelstein‐Singer M. , Algoetti A. , Eisenberg Z. , Jaccard N. , Weisman Y.
Published: April 2015

Serum 25‐hydroxyvitamin D (25‐OHD) levels were measured in 338 elderly patients admitted to the Geriatric Medicine Departments of a general hospital in Israel in the course of one year. The mean (±SD) serum 25‐OHD levels were significantly lower (P < .01) in the elderly patients (13.5 ± 8.9 ng/mL) than in healthy young controls (24.7 ± 6.1 ng/mL). One hundred ten patients (35.5%) were either vitamin D deficient (25‐OHD < 5 ng/mL) or had borderline serum levels of 25‐OHD (5–9 ng/mL). The mean (±SD) serum 25‐OHD concentration of patients who were completely mobile before hospitalization was 15.5 ± 8.8 ng/mL (n = 239). In patients mainly immobilized but able to leave the house occasionally, it was 10.2 ± 6.3 ng/mL (n = 84) and of bed‐ridden patients, it was 5.2 ± 3.2 ng/mL (n = 15). No correlation was found between serum 25‐OHD levels and the patients' age or serum calcium, phosphorus, alkaline phosphatase, and albumin values. Thus, in order to detect vitamin D deficiency in the elderly, it is necessary to measure serum 25‐OHD concentration. The results demonstrate that vitamin D deficiency is common among elderly patients even in sunny climates and indicate the need for development of effective programs of prevention and treatment.
Drug Compliance and Unreported Drugs in the Elderly
Authors: Spagnoli Alberto , Ostino Giuseppe , Borga Anna Dana , D'Ambrosio Rosa , Maggiorotti Piergiorgio , Todisco Elisabetta , Prattichizzo Wilma , Pia Laura , Comelli Mario
Published: April 2015

A random sample of 46 general practitioners of the Unitá Sanitaria Locale in Torino recruited 802 elderly outpatients and collected information about complaints and current drug treatment. Within a week each patient received a home interview and details were collected on drug compliance and use of drugs other than those reported by the general practitioners. On average, each patient was taking 3.6 drugs, of which 2.9 were correctly reported by the general practitioners and 0.7 were unreported. Among the most prescribed therapeutic groups there were drugs with a narrow therapeutic index (cardiovascular drugs, diuretics, psychotropic agents) and substances whose efficacy has never been fully documented (“cerebroactive‐vasoactive” agents). Age and number of complaints were positively and significantly correlated with number of prescribed drugs. Nearly half of the sample (44.4%)—more frequently women and people with higher education—were taking one or more drugs not detected by the general practitioners, often benzodiazepines taken over a long period for anxiety or insomnia. Full compliance occurred for 81.5% of the prescriptions and 59.9% of patients were correctly taking all prescribed drugs. Compliance was lower for prescriptions of the general practitioners compared with other doctors' prescriptions (eg, hospital doctor, private doctor) and probability of taking correctly all the prescribed drugs decreased with the number of medicines concurrently taken. The most common reason for noncompliance was fear of side effects.
The Value of Age and Severity as Predictors of Costs in Geriatric Head Trauma Patients
Authors: Saywell Robert M. , Woods John R. , Rappaport Stephen A. , Allen Tina L.
Published: April 2015

The costs of inpatient hospital care for treating head trauma were examined in 125 patients over the age of 50. Regression analysis indicated that injury severity, as measured by the admitting Glasgow Coma Scale, was a good predictor of hospital cost, while patient age was unrelated to cost. The regression relationship, however, was quadratic (not linear), indicating that least injured and severely injured patients cost less than moderately injured patients. These findings are in direct contrast with the commonly held belief that the elderly consume more hospital resources than younger patients. They suggest the need for a reexamination of the use of age in setting prospective reimbursement amounts in certain diagnoses, and in making resource allocation decisions relative to geriatric programming at the hospital level. Head trauma patients are costly because they are sick, not because they are old.
Augmentation of Influenza Antibody Response in Elderly Men by Thymosin Alpha One
Authors: Gravenstein Stefan , Duthie Edmund H. , Miller Barbara A. , Roecker Ellen , Drinka Paul , Prathipati Kumara , Ershler William B.
Published: April 2015

Influenza remains a major cause of illness and death in elderly people despite current vaccination programs. One factor is an immunization failure rate in the elderly that may be as high as 50%. To test whether administration of thymosin α 1 would result in greater antibody production, we administered it (900 μg/m2 subcutaneously twice weekly for eight doses) in conjunction with the 1986 trivalent influenza vaccine. Ninety men (65—99 years old, mean age 77.3 years) were randomized double‐blind to receive thymosin α1, or placebo by the same schedule; the sera from 85 of these men were acceptable for analysis. The two groups were similar with respect to underlying disease, medications, and age. No toxicity was observed in either group. Antibody response rate was defined as a four‐fold rise in antibody titer over 3—6 weeks following vaccination and was measured by an enzyme‐linked immunosorbent assay (ELISA). Analysis was performed on treatment groups and subgroups divided by the mean age: the older group consisted of subjects aged 77 years and older, and the younger group those aged from 65—76 years. Baseline and change in absolute antibody levels were compared by t test and using age as a continuous variable by multiple regression analysis. The response was greater in the thymosin α1 treatment group at 6 weeks compared to the placebo group (P = .023), and this difference in absolute amount of antibody produced could be attributed to the greater response to vaccine in the older thymosin α1 treated subjects (P = .039) as no difference was observed between the younger treatment groups, or between the older thymosin α1 treated subjects and the younger subjects. The ability of elderly men receiving thymosin α1 treatment to produce antibody to vaccine similar to their younger counterparts may be of clinical importance.
Instruments for Screening for Depression and Dementia in a Long‐Term Care Facility
Authors: Kafonek Stephanie , Ettinger Walter H. , Roca Robert , Kittner Steven , Taylor Noel , German Pearl S.
Published: April 2015

The high prevalence of mental disorders such as depression and dementia in institutionalized elderly patients warrants screening for psychiatric diagnosis in patients newly admitted to long‐term care facilities. The diagnostic accuracy of the Mini‐Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS) was evaluated against a standardized psychiatric interview. The MMSE was found to be 81% sensitive and 83% specific in screening for dementia using a previously established cutpoint of less than 24/30 points. Adjusting MMSE scores for physical disabilities precluding completion of specific tasks on the MMSE did not significantly change the diagnostic accuracy of the test. The GDS was 47% sensitive and 75% specific in screening for depression using the suggested cutpoint of greater than 13/30 points. The MMSE was significantly correlated with functional status (r = 0.48, P = .0001), but not with the scores on the GDS or the clinical diagnosis of depression. The GDS did not correlate with functional status. In summary, the MMSE is a good screening test for dementia in institutionalized elderly, but the GDS is not sensitive for depression in this population.
Elderly Patients Admitted to the Psychiatric Unit of a General Hospital
Authors: Conwell Yeates , Nelson J. Craig , Kim Kathleen , Mazure Carolyn M.
Published: April 2015

Elderly psychiatric patients who are cared for in general hospital psychiatric settings have not been clearly characterized in the literature in terms of demographics, primary diagnoses, hospital course, and outcome. The authors reviewed charts of 168 patients over the age of 60 years admitted to a general hospital inpatient psychiatry unit over a 5‐year period in order to develop a demographic and clinical profile of this patient population. Results indicated that the large majority of patients had affective syndromes; dementia was the second most common diagnosis. Length of stay correlated with severity of depressive illness, while a diagnosis of dementia was associated with a shorter hospitalization. Outcome measures showed favorable response to treatment in three‐fourths of this population of elderly psychiatric patients. These data suggest that the general hospital acute inpatient setting is well suited to care for the combined medical and mental illnesses of elderly psychiatric patients.
Cortisol Deficient State
Authors: Basavaraju Nerlige , Phillips Steven L.
Published: April 2015

An elderly female who had suffered a stroke was admitted to the Jewish Institute for Geriatric Care (JIGC) for rehabilitation. Three years previously she was found to have a pituitary macroadenoma (prolactinoma) that was treated with radiation therapy. She had been on thyroid replacement for secondary hypothyroidism. Upon admission she was found to have severe cognitive impairment in association with a low plasma Cortisol level. After treatment with prednisone there was a dramatic improvement in cognitive function and the patient was able to participate in a rehabilitation program.
BOOK REVIEWS
Authors: Kunkel M. Elizabeth
Published: April 2015

Growing Younger: Nutritional Rejuvenation for People Over Forty. By Lesser GM. Los Angeles, Jeremy P. Tarcher, Inc, 1987, 237 pages, $15.95.
Influence of Hospitalization on Drug Therapy in the Elderly
Authors: Beers Mark H. , Dang Janice , Hasegawa Janice , Tamai Irene Y.
Published: April 2015

In order to determine whether acute hospitalization leads to changes in the medications used by the elderly after discharge, we studied the medications used at admission and discharge for 197 elderly subjects admitted to one hospital. We found that 40% of all admission medications were discontinued by discharge and 45% of all discharge medications were newly started during the hospitalization. Although the number of drugs used did not increase significantly from admission to discharge (4.50 to 4.80, P = .128), the number of narcotics, laxatives, and antibiotics increased significantly. For those elderly subjects admitted to the hospital taking less than the average number of medications, the overall use of medication increased from admission to discharge (2.89 to 3.75, P < .0001). These “low users” were discharged on more benzodiazepines, narcotics, laxatives, antibiotics, and cardiac medications. Our data suggest that during hospitalization admission medications are discontinued and new medications are started in large numbers and that these changes are accompanied by a tendency towards the increased use of certain categories of medications. These changes may place the elderly patient at increased risk of polypharmacy and its complications.
Dietary Supplement Use in a Randomly Selected Group of Elderly Australians
Authors: Horwath C. C. , Worsley A.
Published: April 2015

The prevalence of dietary supplementation and its relationship to health and dietary habits was investigated in a random mail survey of 2,195 people aged 65 years and over in Adelaide, South Australia. Subjects were selected from the electoral rolls in an urban area, and 77% returned completed survey instruments. Thirty‐five percent of men and 46% of women reported taking some form of supplement at least once a week regularly throughout the year (these are defined as “regular” supplementers). The most popular supplements (in descending order of popularity for the total group) were: unprocessed bran, wheatgerm, vitamin C, and multivitamins or minerals. Thirteen percent of men and 15% of women reported the use of supplements on an occasional basis (once every few months or “now and then”)—these are defined as “irregular” or “occasional” supplementers. Supplement users did not differ from non‐supplementers in their use of medical facilities or in the number of bouts of minor illness they had experienced in the preceding year. Regular supplement users had more favorable dietary habits and higher intakes of several vitamins, minerals, trace elements and fiber than either non‐supplementers or occasional supplementers.
Prospective Evaluation of an Assessment Strategy for Geriatric Urinary Incontinence
Authors: Ouslander Joseph , Leach Gary , Staskin David , Abelson Susan , Blaustein Jenna , Morishita Lynne , Raz Shlomo
Published: April 2015

The objectives of this study were to design and prospectively evaluate a strategy to assess geriatric urinary incontinence in primary care settings. A management plan for urinary incontinence was determined for 264 elderly incontinent patients (205 females and 59 males) based on a clinical evaluation, simple tests of lower urinary tract function, and several criteria for referral for further evaluation derived from the literature on incontinence. Of the 264 patients, 168 (64%) also consented to undergo a urologic and formal urodynamic evaluation. Half of these 168 patients met at least one criterion for referral for further evaluation. At least one‐quarter of the patients who met one or more of the criteria were found not to require surgical intervention, and probably did not benefit from the urologic and urodynamic evaluation. Among 84 patients who did not meet any of the criteria for referral, the urologic and urodynamic evaluation changed the initial treatment plan in only 10 (12%). The risks associated with the treatment plan based on the clinical assessment in these patients were, however, relatively small. While further refinement and testing in larger numbers of incontinent patients are needed, the data presented document that a substantial proportion of elderly patients with a treatable and often ignored problem can be appropriately managed based on a relatively simple and inexpensive assessment, which can easily be carried out in primary care settings.
Clock Drawing in Alzheimer's Disease
Authors: Sunderland Trey , Hill James L. , Mellow Alan M. , Lawlor Brian A. , Gundersheimer Joshua , Newhouse Paul A. , Grafman Jordan H.
Published: April 2015

We have tested a simple and reliable measure of visuospatial ability in Alzheimer patients — the Clock Drawing Test. To determine the usefulness of this measure, we asked 67 Alzheimer patients and 83 normal controls to draw the face of a clock reading the time of 2:45. Six independent observers blindly evaluated the results with ratings from 10 (best) to 1 (worst). The mean performance score of Alzheimer subjects was 4.9 ± 2.7 compared to 8.7 ± 1.1 for normal controls (P < .001). Inter‐rater reliability for the clocks drawn by Alzheimer patients was highly significant (r = 0.86; P < .001), and there was relatively little overlap between ratings for Alzheimer patients and normal controls. Furthermore, correlations were highly significant (P < .001) between the mean score of clock drawings and three independent global measures of dementia severity. Although the Clock Drawing Test is certainly not a definitive indicator of Alzheimer's disease, the test is easy to administer and provides a useful measure of dementia severity for both research and office settings where sophisticated neuropsychological testing is not available.
Effect of Age on Glucose Tolerance and Glucose Uptake in Healthy Individuals
Authors: Reaven G. M. , Chen N. , Hollenbeck C. , Chen Y.‐D. I.
Published: April 2015

Plasma glucose and insulin responses and basal and insulin‐stimulated glucose uptake were determined in 24 non‐obese, healthy, physically active individuals, divided into two groups on the basis of age. The mean (± SEM) age of the younger group was 33 ± 3 years, in contrast to an age of 64 ± 2 years for the older group. Plasma glucose concentrations were significantly higher (two‐way ANOVA, P < .001) for three hours after a 75 g oral glucose challenge in the older group, as was the plasma insulin response (two‐way ANOVA, P < .001). Furthermore, there was a significant correlation between age and total plasma glucose (r = 0.63, P < .001) and insulin (r = 0.44, P < .01) during the glucose tolerance test. However, the magnitude of the decrease in glucose tolerance with age was relatively modest. For example, total plasma glucose response was only 11% higher in the older group, and the plasma glucose concentration 120 minutes after the oral glucose load only increased approximately 2 mg/dL per decade. Glucose uptake during euglycemic clamp studies was also reduced in the older group, and this was true if the clamps were performed at plasma insulin concentration of approximately 10 μU/mL (P < .05) or 60 μU/mL (P < .10). However the differences were relatively modest in magnitude, ie, 10–25%. The fact that the increase in glucose uptake when plasma insulin was raised six‐fold was similar in both groups suggests that insulin sensitivity does not decline with age. These data confirm previous observations that glucose tolerance deteriorates with age, but emphasize that this age‐related decline is modest in magnitude in healthy, non‐obese individuals. Since plasma insulin concentrations also were higher in the older group, the decline in glucose tolerance must be due to an age‐related impairment in glucose uptake.
Mechanisms of Hypertension in the Elderly
Authors: Lakatta Edward G.
Published: April 2015

It has long been recognized that, with advancing age, basal systolic blood pressure increases within the clinically “normal” range in many individuals. Likewise, the prevalence of clinical hypertension, either systolic plus diastolic or isolated systolic, also increases with age. This report reviews the purported mechanisms underlying these types of hypertension and discusses age‐associated changes in the cardiovascular system of normotensive individuals that could plausibly interact with these pathophysiologic mechanisms of hypertension.
Effects of Age on Complications in Adult Onset Diabetes
Authors: Naliboff Bruce D. , Rosenthal Mark
Published: April 2015

The prevalence of diabetes is greatest among older persons, yet few studies have specifically addressed the impact of age on diabetic complications. The present study examines the prevalence of four diabetic complications: retinopathy, peripheral neuropathy, autonomic neuropathy, and hypertension, as well as depression, in older male patients with noninsulin‐dependent diabetes. Participants ranged in age from 53 to 80 years. Multiple risk factors, including age, duration of illness, type of treatment, metabolic control, and obesity were evaluated as predictors of these complications using logistic regression. Results suggest a significant increase in the prevalence of retinopathy with aging, independent of the effects of metabolic control, duration of illness, and other risk variables. Age was also related to prevalence of peripheral neuropathy symptoms, hypertension, and impotence. Current metabolic control was significantly associated with retinopathy, peripheral neuropathy, and hypertension prevalence. Time since diagnosis was only independently related to impotence and hypertension. These findings suggest that the increase in many diabetic complications in older persons cannot be wholely accounted for by simple disease status variables, and may result from an interaction of diabetes variables and general age‐related changes.
Protein Malnutrition in Elderly Navajo Patients
Authors: Williams Robert , Boyce W. Thomas
Published: April 2015

In an examination of Navajo elderly inpatients and outpatients, high rates of protein undernutrition (despite normal caloric stores) were found to be prevalent. The protein malnutrition was present in each of several measures used, covering structural as well as visceral protein. It was more common in males, inpatients, and the aged elderly, but excess rates of undernutrition were found in all groups examined. These rates were higher than those in any comparable group reported to date. With multiple regression analysis, length of stay in the hospital is shown to be related to this undernutrition among inpatients studied.
Cutaneous‐Delayed Hypersensitivity in Nursing Home and Geriatric Clinic Patients
Authors: Rodysill Kirk J. , Hansen Linda , O'Leary James J.
Published: April 2015

Cutaneous‐delayed hypersensitivity was studied by one and two‐step Mantoux‐type skin tests to four standard antigens in 33 elderly nursing home residents, 34 geriatric clinic patients, and 20 healthy young adult controls. Demographic and anthropometric data were collected to determine the effects of nutrition and other variables on cutaneous‐delayed hypersensitivity. Anergy (a lack of response greater than 5 mm of induration when read at 48 hours) to any of the four antigens occurred in 34% of nursing home residents, 17% of geriatric clinic patients, and none of the healthy young adults. Mean and maximal responses were less in the nursing home residents than the clinic patients or controls, even if anergic individuals were excluded from analysis, suggesting both a qualitative and quantitative decline in cell‐mediated immune function in this elderly population. Repeat testing with each antigen for which there was a negative initial response revealed a “booster” affect of 7 to 19% and occurred as commonly in the healthy young adults as in the nursing home residents or geriatric clinic patients. The mumps antigen elicited strong responses in the healthy young adults, but weak reactions in the nursing home residents. An unexpectedly high prevalence of positive tuberculin (PPD) responses occurred in the nursing home residents, suggesting recent exposure. Analysis of anthropometric and demographic characteristics show that neither nutritional status nor age alone can account for differences in cutaneous‐delayed hypersensitivity observed between populations. Cutaneous‐delayed hypersensitivity may vary widely between elderly populations and have important practical implications for the tuberculin test.
BOOK REVIEWS
Authors: Barzel Uriel S.
Published: April 2015

Love is Ageless. Stories about Alzheimer's Disease. Edited by Bryan J. Oakland, California, Serala Press (PO Box 3876, Oakland, CA 94609), 1987, 200 pages, $9.95.

Journey with Grandpa: Our Family's Struggle with Alzheimer's Disease. By Honel RW. Baltimore, The Johns Hopkins University Press, 1988, 243 pages, $16.95.
Familial Aggregation of Multiple Myeloma and Central Nervous System Diseases
Authors: Grufferman Seymour , Cohen Harvey J. , Delzell Elizabeth S. , Morrison Mary C. , Schold S. Clifford , Moore Joseph O.
Published: April 2015

Degenerative central nervous system diseases such as Alzheimer's disease and lymphoreticular malignancies such as multiple myeloma occur with increased frequency with advancing age. Relatives of early‐onset Alzheimer's disease patients may have an increased risk of lymphoreticular malignancies. This led us to evaluate the family history of central nervous system diseases in a case‐control study of multiple myeloma. Thirteen of 439 multiple myeloma cases had one or more first‐degree relatives with degenerative or demyelinating central nervous system disease. In comparison, there were nine “positive” family histories in 1,317 matched hospital controls (relative risk = 4.4, 95% confidence interval = 1.9–10.3). Relative risks for the component categories of Parkinson's disease, multiple sclerosis, and miscellaneous degenerative central nervous system diseases were 3.0, 4.0 and 11.9, respectively. Our findings suggest that the degenerative and demyelinating central nervous system diseases and the lymphoreticular malignancies may comprise an etiologically related group of “protean diseases.” These diseases may have a shared genetic susceptibility, possibly an immunologic abnormality. The varied disease manifestation in family members suggests a second necessary etiologic step of a variable and possibly environmental nature.