bluuebunny/crossref_metadata_2025 huggingface dataset:
Transtracheal Aspiration in the Severely Ill Elderly Patient with Bacterial Pneumonia
Authors: BERK S. L. , HOLTSCLAW S. A. , KAHN A. , SMITH J. K.
Published: April 2015

ABSTRACT: Transtracheal aspiration was performed in 32 elderly hypoxic patients with bacterial pneumonia. No morbidity or mortality was associated with the procedure. Gram stains of the transtracheal aspirate provided rapid, accurate delineation of the etiologic pneumonic agent, and were particularly valuable in indicating mixed bacterial infections. These included 5 cases of Streptococcus pneumoniae plus Gram‐negative bacillary pneumonia. The safety and value of transtracheal aspiration in the severely ill elderly patient are discussed.
Predictability of Methenamine Efficacy Based on Type of Urinary Pathogen and pH
Authors: NAHATA MILAP C. , CUMMINS BRITT A. , McLEOD DON C. , BUTLER RICHARD
Published: April 2015

ABSTRACT: This study involved 27 geriatric patients with asymptomatic chronic bacteriuria; all had indwelling Foley catheters. The treatment regimens (daily oral dosage) were: methenamine mandelate (MM) granules, 4 gm; MM, 4 gm, plus ascorbic acid, 4 gm; and MM, 4 gm, plus ascorbic acid, 4 gm, plus cranberry cocktail, 1 liter—administered according to a cross‐over design. Proteus vulgaris, Pseudomonas aeruginosa and E. coli were the most common urinary organisms. Proteus organisms were more often found in alkaline than in acidic urines, but the type of pathogen had no influence on urinary pH. Urinary formaldehyde concentration [HCHO] was lower in patients with Proteus infection (17.7 μg/ml) than in those with Pseudomonas (21.9 μg/ml) or E. coli infection (21.8 μg/ml). However, for Proteus infection, [HCHO] was higher in patients receiving MM plus ascorbic acid than in those receiving MM alone. Addition of cranberry cocktail to ascorbic acid did not enhance urinary pH, [HCHO] or methenamine efficacy. Our data suggest that in Foley catheter patients with chronic asymptomatic bacteriuria secondary to Proteus, Pseudomonas or E. coli infection, the type of urinary pathogen or the urinary pH cannot be used to predict the efficacy of methenamine therapy either with or without urinary acidifying agents.
Paraplegia and Quadriplegia in the Elderly Due to Spinal Cord Lesions: Association with Malignancy
Authors: COX MARIA L. , OGLE SUSAN J. , HODKINSON H. MALCOLM
Published: April 2015

A retrospective study showed that paraplegia and quadriplegia due to spinal cord lesions occurred with a frequency of 1 in 500 admissions to a geriatric department. These cases predominantly were caused by malignant disease, particularly of the bronchus. However, elderly patients presenting to other hospital departments included a far higher proportion of cases with benign causes, particularly cervical spondylosis which affects patients of lower average age. Male patients predominated in both malignant and benign categories.
Alcohol Problems in the Elderly
Authors: WATTIS JOHN P.
Published: April 2015

Seven case reports of alcoholism in the elderly are presented. These patients formed a significant proportion of 108 patients seen in the first eight months of a new comprehensive psychiatric service for the elderly. None of them initially presented as alcohol abusers; three were first seen by geriatricians because of repeated falls, and four who came directly to psychiatrists were referred for atypical dementia, confusion or self‐neglect. Three patients had started to abuse alcohol only late in life; the remainder were life‐long heavy drinkers. In three instances, close relatives who abused alcohol themselves, were in collusion. The diagnosis of alcohol abuse in these elderly patients depended upon the recognition of such manifestations as repeated falls, confusion, and self‐neglect. The prognosis was influenced by age at onset, social and family factors, and the presence or absence of brain damage. In two of the patients, a poor prognosis was linked to collusion by alcohol‐abusing children.
Ethical Confrontations in the Incapacitated Aged*
Authors: GOLDMAN RALPH
Published: April 2015

ABSTRACT: Effective factors that have made it possible for an increasing proportion of the population to reach old age have nevertheless presented society with new problems and ethical dilemmas. Several questions that arise include: 1) What are the responsibilities of the medical profession in providing medical care or supervision for patients who manifest irreversible decremental processes associated with old age?; 2) Under what circumstances is there a moral imperative to preserve life, especially in patients who manifest an irreversible loss of awareness or are sustained by purely mechanical means?; 3) What are the limits of the resources which can be allocated to health care in general, and to the aged in particular, in a society in which resources are no longer infinite and allocations may become necessary?; 4) What is the profession's responsibility for identifying decremental aging changes and characterizing them, even if this information is personally threatening and socially disturbing to those who would prefer to consider them diseases, and thus reversible by traditional means?; and 5) Is there a moral mandate to identify mechanisms of aging and techniques for slowing the process, in order to prolong life beyond what appears to be the normal biologic limit of three generations?
Multiple Lesions in Stroke Patients: A Study in Morbid Anatomy
Authors: HOWELL TREVOR H.
Published: April 2015

ABSTRACT: In a series of 302 autopsies, 47 elderly subjects during life had shown signs or symptoms suggesting cerebrovascular accidents. At autopsy they showed no less than 506 pathologic lesions, an average of 10.7 per patient. Of these lesions, 36.5 percent were cardiovascular, 15.8 percent pulmonary, 11.0 percent renal, 9.0 percent cerebral, 8.3 percent hepatic, 6.5 percent gastrointestinal or pancreatic, 5.0 percent genital, 3.5 percent splenic, and 4.4 percent in other tissues. Multiple autopsy findings are the rule and not the exception in patients of the age group in which strokes are liable to occur.
Bromocriptine and Its Use in Parkinsonism
Authors: HOEHN MARGARET M.
Published: April 2015

ABSTRACT: Bromocriptine is a potent dopamine agonist which directly stimulates dopamine receptors. In the corpus striatum, this action results in alleviation of many of the signs and symptoms of parkinsonism. The effectiveness of bromocriptine may persist for at least one to two years; results of more prolonged treatment are not available. Adverse reactions are common and often severe, but safety in dosages up to 100 mg daily for one to two years has been adequately established. Bromocriptine is qualitatively and quantitatively similar to levodopa in both beneficial and adverse effects. However, because of variations in individual response, bromocriptine sometimes ameliorates the problems of prolonged levodopa therapy, i.e., declining efficacy, fluctuations in therapeutic response, and the development of disabling abnormal involuntary movements. Thus bromocriptine is a valuable adjunct in the treatment of parkinsonism.
Perhexiline Maleate As a Cause of Reversible Parkinsonism and Peripheral Neuropathy
Authors: GORDON MICHAEL , GORDON ALLAN S.
Published: April 2015

ABSTRACT: In a 78‐year‐old woman receiving perhexiline maleate for intractable angina pectoris, a syndrome of parkinsonism and peripheral neuropathy developed. The neuropathy was confirmed by electromyographic and nerve conduction studies. The parkinsonism and peripheral neuropathy disappeared when perhexiline maleate was discontinued.
Monitoring Digoxin Therapy in Two Long‐Term Facilities
Authors: CARTER BARRY L. , SMALL RALPH E. , GARNETT WILLIAM R.
Published: April 2015

ABSTRACT: Digoxin monitoring was examined according to 13 criteria in two nursing homes: 1) an intermediate care facility (ICF) with private physicians, and 2) a skilled care (SCF) plus ICF with 3 housestaff physicians from a medical college. The digoxin review was a retrospective chart analysis to: 1) identify all patients receiving digoxin, 2) evaluate dosage patterns, 3) evaluate monitoring patterns, and 4) detect possible toxic reactions and determine whether management was appropriate. The calculated correct dosage of digoxin was administered to 82 percent of patients in the SCF and to 40 and 48 percent in both ICFs. More frequent monitoring of serum creatinine and potassium levels was associated with fewer symptoms of toxicity. Possible toxicity occurred in 46 percent of the SCF and in 68 and 71 percent of patients in the ICFs. Documented toxicity occurred in 18 percent of the SCF patients and in 16 and 10 percent of the ICF patients. Eighty percent of patients who had symptoms of digoxin toxicity were not examined or managed appropriately in the SCF, and 43 and 33 percent in the ICFs. Often standing orders had been assigned for drugs to treat nausea, vomiting or diarrhea. A number of possible drug interactions with digoxin were discovered. The participation of the pharmacist in nursing home care is discussed.
Selected Physiologic and Drug Effects on Serum Uric Acid Levels in an Elderly Population
Authors: YOST RICHARD L. , STEWART RONALD B. , HALE WILLIAM E. , MARKS RONALD G.
Published: April 2015

ABSTRACT: A total of 2,923 elderly subjects were studied to determine the relationship between obesity, hypertension, thyroid disease, renal function, alcohol consumption, selected drugs, and the serum uric acid level. Comparison of the serum uric acid levels with indices of obesity demonstrated a strong correlation in normotensive (p < .0001) and hypertensive (p < .001) subjects. The serum creatinine level, when used alone, was not a reliable indicator of renal function. Of the drugs evaluated, diuretics had the most pronounced effect upon the serum uric acid level.
Fatal Digoxin‐Quinidine Interaction in an Elderly Woman
Authors: Pieroni Robert E. , Marshall James
Published: April 2015

The medical records of an elderly woman revealed strong evidence of a lethal digoxin‐quinidine interaction. This case and several problems contributing to digitalis toxicity are presented. Physicians should be more aware of the potential toxicities involved in cardioactive drug therapy in the elderly. Current concepts of the quinidine‐digoxin interaction are discussed.
Geriatric Hypochondriasis: Situational Factors
Authors: Brink T. L. , Janakes C. , Martinez N.
Published: April 2015

The hypochondriacal attitudes of 53 aged community residents were studied. No significant correlations were found with situational stress, sex, or ethnicity (English‐speaking vs Spanish‐speaking). The levels of hypochondriasis appeared to be inversely related to self‐evaluation of memory ability. There was no indication of an inherent iatrogenic effect. It was concluded that hypochondriacal behavior is chiefly a function of the underlying personality, which may influence the perception of events as stressful.
Pneumonia in the Later Years*
Authors: AUSTRIAN ROBERT
Published: April 2015

ABSTRACT: This lecture presents an outline of early historical observations on pulmonary disorders in relation to age, as well as current studies on respiratory‐tract defense mechanisms, with particular reference to pneumonia. Special attention is paid to the prevention of pneumococcal pneumonia by means of vaccines. Although much remains to be learned about this vaccine and its efficacy in some segments of the population at high risk from pneumococcal infection, current knowledge regarding its safety and efficacy warrants its more extensive use. Included are interesting notes on Osier's ambivalent attitude toward pneumonia in old age and his stimulating ideas on retirement, patterned after Trollope's writings, which contain an early cost‐benefit analysis for events set in 1980
The Interaction of Age, Performance and Hypnotics in the Sleep of Insomniacs*
Authors: BONNET MICHAEL H. , KRAMER MILTON
Published: April 2015

ABSTRACT: Scant attention has been paid to the objective evaluation of insomnia as a function of age, particularly with reference to increased drug sensitivity and resulting loss in balance performance. Therefore, the electroencephalographic sleep and the balance‐board performance of 10 young and 12 geriatric insomniacs were studied under baseline and hypnotic drug (ketazolam) conditions. In terms of objectively measured sleep, the geriatric insomniacs had worse sleep on every dimension except sleep latency and percentage of stage‐2 sleep. These differences between aged and young insomniacs, however, were no greater than might be expected as a function of normal aging. Drug‐age interactions indicated that ketazolam differentially increased sleep efficiency, decreased the percentage of REM sleep, and eliminated any learning improvement on the balance board in geriatric versus young insomniacs. The findings indicate that the geriatric subjects were more sensitive to the hypnotic drug, in that their sleep improved to a greater extent. However, an important loss in balance performance was also observed.
Dementia and Other Competing Risks for Mortality in the Institutionalized Aged*
Authors: VITALIANO PETER PAUL , PECK ARTHUR , JOHNSON DONALD A. , PRINZ PATRICIA N. , EISDORFER CARL
Published: April 2015

ABSTRACT: The relative importance of dementia, gender, age and functional status (FS) was examined for relationships to mortality within five years after admission of the subjects to a New York City nursing home for the aged. Using a random sample of 212 of the nursing home's patients, a statistical model was developed to estimate the relative risk of mortality. When this model was cross‐validated on an independent sample of 118 residents, it failed to show significant lack of fit. Given these results, an international model was developed by combining the New York City samples (N = 330) and comparing them to a sample (N = 363) from a nursing home in Tokyo, Japan. In the New York model, gender was the most important predictor, with age and dementia next in importance; FS was not a significant predictor. Despite the apparent differences in the types of dementia in the New York and Tokyo nursing homes, the mortality patterns were similar.
Adverse Drug Reactions Among the Elderly: A Reassessment
Authors: KLEIN LAWRENCE E. , GERMAN PEARL S. , LEVINE DAVID M.
Published: April 2015

ABSTRACT: The elderly are widely believed to be predisposed to adverse drug reactions, chiefly because of the large quantities of drugs they consume, combined with the effects of aging on distribution, metabolism, and the patterns of drug usage. These beliefs affect the physician's prescribing behavior. To study the validity of these concepts, the supporting medical literature was reviewed. Existing studies of the rates of adverse drug reactions have several methodologic limitations, including inadequate control for disease severity, the use of calculation denominators which overestimate incidence, and dependence upon definitions of medication error rates which do not adequately reflect the potential for adverse outcome. Further studies are needed for clarification of drug‐use patterns and problems among the elderly.
Self‐Ratings of Memory versus Psychometric Ratings of Memory and Hypochondriasis
Authors: BRINK T. L.
Published: April 2015

ABSTRACT: Self‐ratings of memory were studied in 69 institutionalized women. The patients also were evaluated by means of three screening tests for organic brain syndrome (OBS) and a hypochondriasis scale. A negative correlation existed between self‐rating of memory and actual memory as measured by the screening tests for OBS, but it was significant (p < .05) for only one of the tests. There was also a negative correlation (p < .01) between memory rating and scores on the hypochondriasis scale. Therefore, clinicians should not take patients' memory complaints as valid indicators of OBS, but as possible indicators of hypochondriasis.
Grandparents and Their Children
Authors: GOLDSTEIN STANLEY E.
Published: April 2015

Old age brings about radical changes in the relationship between the elderly and their children. The latter are part of the “sandwich generation.” At a time when their own children are making increasing emotional, physical and financial demands, they must cope with the increased dependence of their parents. The alteration in the equilibrium of needs between the various generations leads to difficulties for which those involved are rarely prepared. To be truly helpful, the geriatrician or gerontologist must be cognizant of the changes in family dynamics.
Brain Tumors and the Geriatric Patient
Authors: Salcman Michael
Published: April 2015

The prognosis, site of occurrence, and histologic type of primary brain tumors are age‐dependent phenomena. In general, the incidence of meningiomas, acoustic Schwannomas, and glioblastomas increases with advancing age until the end of the eighth decade. Of 99 patients consecutively admitted to an aggressive multimodality treatment program for glioblastoma multiforme, 18 per cent were in the 61–70 age group and 4 per cent in the 71–80 group; the oldest was 85. The operative mortality was only 4 per cent. In 16 patients over 65, the 6‐ and 12‐month calculated survival probabilities were 0.65 and 0.31, respectively. The Kaplan‐Meier survival curve for these patients was significantly different from that for 26 patients under the age of 40. Grade 4 astrocytomas were present in 62 per cent of patients under 40 but in 83 per cent of patients over 61. In all glioblastoma populations, age is the most significant prognostic variable. The incidence of metastic brain tumors also increases with age, and all of the usual primary sites are represented. The prognosis for elderly patients with metastatic brain tumor is uniformly worse than that for younger patients, even though modern diagnostic and operative techniques carry virtually the same morbidity and mortality rates in older patients as in younger ones. It is vitally important, therefore, that the clinical effects of treatable intracranial tumors in the elderly are not ascribed to dementia, the aging process, the systemic effects of cancer, or the side effects of cancer therapy, without suitable diagnostic investigation.
Clinicopathologic Study of Progressive Subcortical Vascular Encephalopathy (Binswanger Type) in the Elderly
Authors: Tomonaga Masanori , Yamanouchi Hiroshi , Tohgi Hideo , Kameyama Mazakuni
Published: April 2015

A clinicopathologic study was made of 45 elderly persons whose autopsied brains showed the pathologic changes of progressive subcortical vascular encephalopathy (Binswanger type). Progressive subcortical vascular encephalopathy (PSVE) was observed in 3.8 per cent of all autopsied brains of elderly persons and in 6.7 per cent of the brains of those with cerebrovascular diseases. White matter lesions were graded from I to III (slight to severe). Small infarcts in the basal ganglia, thalamus, and pons were common, but the cerebral cortex was usually preserved. Neuropsychiatric symptoms included dementia, urinary incontinence, hemiplegia, pseudobulbar palsy, psychosis, parkinsonism, and mutism. In the Grade III group there was a high incidence of pseudobulbar palsy, parkinsonism, and mutism. Pathologic study showed marked cerebral arteriosclerosis in almost all cases. Angionecrosis was observed in 60 to 80 per cent. Fibrotic and stenotic changes of the blood vessels in the deep white matter were also noted, particularly in 90 per cent of the Grade III cases. A suggested explanation for the pathogenesis of PSVE is based on the effects of various complications such as hypertension, cardiac disease and malnutrition which may play an important role in PSVE when they occur in elderly persons with a history of longstanding hypertension, marked cerebral arteriosclerosis, and arteriolar changes in the cerebral white matter.
BOOK REVIEWS
Authors: Gordon Michael
Published: April 2015

Eldercare, a Guide to Clinical Geriatrics. Edited by O'Hara‐Devereaux M and Andrus LH. New York, Grune & Stratton, 1981, 368 pp, $22.00
Cimetidine Impairs Clearance of Antipyrine and Desmethyldiazepam in the Elderly
Authors: DIVOLL MARCIA , GREENBLATT DAVID J. , ABERNETHY DARRELL R. , SHADER RICHARD I.
Published: April 2015

Sixteen young (21‐40 years) and nine elderly (65–78 years) volunteers received single intravenous doses of antipyrine on two occasions: once in the control state, and again while receiving therapeutic doses of cimetidine (300 mg every six hours). In the control state, antipyrine half‐life was longer in elderly than in young subjects (16.4 vs 11.0 hours), and metabolic clearance lower (0.48 vs 0.72 ml/min/kg). However, coadministration of cimetidine prolonged antipyrine half‐life to a similar extent in elderly and in young groups (150 and 153 per cent of control), and reduced metabolic clearance to a similar extent in both groups (79 vs 69 per cent of control). Three young and six elderly volunteers received a single 15 mg oral dose of clorazepate, a precursor of desmethyldiazepam, with and without cimetidine. As in the case of antipyrine, cimetidine prolonged desmethyldiazepam half‐life similarly in young and elderly groups (175 vs 164 per cent of control) and similarly reduced metabolic clearance (51 vs 65 per cent of control). The elderly population may already have an impaired capacity to oxidize drugs. This capacity is further impaired by coadministration of cimetidine.
Atypical Lymphoproliferative Reaction to Antibiotic Therapy
Authors: GORDON MICHAEL , LUK S. C.
Published: April 2015

A case of atypical lymphoproliferative reaction in lymph nodes caused by combined ampicil‐lin and sulfisoxazole therapy is presented. Withdrawal of these drugs resulted in resolution of the lesion as well as in the disappearance of associated eosinophilia.
Establishment of a Geriatrics Curriculum
Authors: CAMPBELL EARL W. , SHANAHAN PATRICIA M. , MULROW PATRICK J.
Published: April 2015

In 1977 the Ohio State Legislature directed all Ohio medical schools to establish offices of geriatrics/gerontology supported with specific funds. The offices were given the responsibility to institute curricular changes that would establish a focus upon aging and health problems of the elderly. By 1981, extensive curricular enrichment was apparent at the Medical College of Ohio in all phases of medical education, from the preclinical years through residency training programs and into continuing medical education.
Reversible Intellectual Impairment: An Internist's Perspective
Authors: WOLFF MICHAEL L.
Published: April 2015

A review of the relevant literature was stimulated by recent publications urging extensive laboratory assessment of elderly patients presenting with intellectual impairment. Published data regarding reversible causes of impairment are limited and exist only for hospitalized patients, with rare exceptions. The frequencies of azotemia, hyponatremia, volume depletion, hypoglycemia, cardiac arrhythmia, cerebrovascular disease, sensory impairment, hypercarbia, congestive heart failure, infections, subdural hematoma, and chemical intoxications as causes of intellectual impairment are entirely unknown. It is reported that 8 per cent of patients hospitalized for dementia are depressed; alcoholism is causative in 8 to 13 per cent of patients with mental impairment; normal pressure hydrocephalus is reported in 7 to 12 per cent. The frequency of the latter conditions in outpatients is not known. While estimates exist for the frequencies of hypothyroidism, hyperparathyroidism, neurosyphilis, and vitamin B,2 and folate deficiencies among the elderly, no prevalence data exist for these disorders among the intellectually impaired.
Relationship of Psychopathology to Insomnia in the Elderly
Authors: ROEHRS T. , LINEBACK W. , ZORICK F. , ROTH T.
Published: April 2015

Three groups of 18 volunteers each (nine men and nine women) were selected on the basis of age and the response to a sleep status questionnaire. Younger subjects (mean age, 43.8 years) who complained of difficulty in falling asleep or in staying asleep or of awakening too early were compared for evidence of psychopathologic signs with older subjects (mean age, 68.5 years) who had sleep‐related complaints and with older subjects (mean age, 71.3 years) who did not have sleep‐related complaints. Older subjects with insomnia complained more frequently of having trouble staying asleep and of awakening too early (P < 0.05), whereas the younger subjects with insomnia complained primarily about difficulty in falling asleep (P < 0.005). On a short form of the Minnesota Multiphasic Personality Inventory (MMPI‐168), the number of elevated scores indicating pathologic disturbances (T score >70) was higher (p < 0.05) for the younger subjects with insomnia (2.5 high scores) than for older subjects with insomnia (0.7 high scores) or for older normal sleepers (0.4 high scores). These results imply that although in younger persons psychopathologic disorders often are associated with insomnia, psychopathic disorders usually are not the cause of insomnia in the elderly.
Prevalence of Hepatitis B in an Adult Psychiatric Hospital
Authors: FENG CHI SHUN
Published: April 2015

The prevalence of hepatitis B infection among 697 patients in an adult psychiatric hospital was determined by testing for hepatitis B surface antigen (HBsAg) and its antibody (anti‐HBs). The test results were 0.86 per cent positive for HBsAg and 20 per cent positive for anti‐HBs. This assessment of the prevalence of hepatitis B in a group of elderly long‐term institutional patients may be used as a guide when hepatitis B vaccination is being considered for use in a psychiatric hospital. It is noteworthy that the elimination of overcrowding in psychiatric hospitals has contributed significantly to the decline of hepatitis B infection in recent years.
Studies in Geriatric Education: II. Educational Materials and Programs
Authors: ROBBINS ALAN S. , FINK ARLENE , KOSECOFF JACQUELINE , VIVELL SUSAN , BECK JOHN C.
Published: April 2015

There has recently been an increase in educational programs and materials in geriatrics, but their quality and content have not been adequately assessed. This study concerns important objectives and core contents in geriatric education, with a review of training programs, books, and audiovisual materials. Specific areas of need for printed and audiovisual materials are identified. Medical student and graduate level programs were found to address relatively few objectives. Geriatric fellowship programs, although having more extensive coverage, had some notable deficiencies. This information may be of use to those conducting training programs or preparing educational material in geriatrics.
Adenocarcinoma of the Vermiform Appendix
Authors: WITT CHARLES B. , HERRMANN VICTOR A.
Published: April 2015

Primary carcinoma of the appendix, though rare, occurs often enough to warrant its inclusion in diagnostic possibilities when the symptoms of acute appendicitis, without leukocytosis, are present in geriatric patients. A case of mucinous adenocarcinoma of the appendix in an 88‐year‐old white woman is presented. The substantial relief following right hemicolectomy has persisted for several months of follow‐up.
Prevention of Influenza in the Elderly
Authors: RUBEN FREDERICK L
Published: April 2015

A gradual evolution has occurred in the development of influenza vaccines to their present highly purified state. Although studies are limited and vaccines are far from perfect, influenza vaccines should be used in the geriatric age group. Chemoprophylaxis is currently available against influenza A; however, studies should be made of its safety and efficacy in the elderly. Because of the severe consequences of influenza in aged persons, there is need for continued evaluation of vaccines, improved delivery, improved education, and new strategies for the prevention of influenza in the elderly.
Cardiovascular Effects of Caffeine in Elderly Men
Authors: CONRAD KENNETH A. , BLANCHARD JAMES , TRANG JOHN M.
Published: April 2015

Ten healthy elderly male volunteers were given 4 mg/kg of caffeine by intravenous infusion on three separate occasions. This resulted in mean peak plasma concentrations of caffeine of 7.4 ± 0.7 μg/ml. Immediately after each of the three caffeine infusions, the mean systolic blood pressures increased 14, 7, and 16 mm Hg, and the mean diastolic blood pressures increased 7, 4, and 7 mm Hg, respectively. Both the systolic and the diastolic blood pressures returned to preinfusion values within 4 hours. The QS2 index and the left ventricular ejection time (LVET) index increased after caffeine, probably as a result of the caffeine‐induced increase in arterial blood pressure. The pre‐ejection period (PEP), the PEP/LVET ratio, and the diastolic time remained unchanged. Caffeine, in doses equal to those contained in 2 to 3 cups of coffee, produces an increase in blood pressure but has no demonstrable positive inotropic effect in healthy elderly men.
The Changing Demography and Its Challenges for the Academic Medical Center
Authors: BUTLER ROBERT N. , KETY SEYMOUR S.
Published: April 2015

In 1982, The Mount Sinai School of Medicine inaugurated the Gerald and May Ellen Ritter Department of Geriatrics and Adult Development. On December 7th, Robert N. Butler, M.D., was invested as the first Brookdale Professor of Geriatrics and Adult Development and Chairman of this new department. Seymour S. Kety, M.D., Professor of Neuroscience in Psychiatry at the Harvard School of Medicine and Director, Laboratories for Psychiatric Research, Mailman Research Center, The McLean Hospital, delivered the guest address. The following remarks were delivered by Dr. Butler and Dr. Kety at the investiture ceremony.
Surgical Stress in the Healthy Elderly
Authors: LINN BERNARD S. , LINN MARGARET W. , JENSEN JOERG
Published: April 2015

Surgery has sometimes been studied as a stressful event. The aim here was to determine the relationship between degrees of anxiety before surgery and postoperative outcomes in healthy old and young men. Old and young men were selected if they had no illnesses or prior surgery and were scheduled for elective hernia repair. Levels of anxiety were measured preoperatively along with other physiologic, psychologic, and immunologic modalities. Operative data and follow‐up data for 30 days were obtained. Old and young men did not differ significantly before surgery. When age groups were divided by preoperative anxiety and their postoperative outcomes compared, more anxiety was associated with more pain‐relieving medications and more disability days in each age group. Furthermore, the old anxious had even more disability days and complications than did other groups. The study points to the need to prepare the old, even those essentially in very good health, for even a minor surgical stress in order to improve their overall health outcomes.
The Elderly, Undernutrition, and Pharmacokinetics
Authors: LAMY PETER P.
Published: April 2015

There is good evidence that malnutrition may alter the pharmacokinetic parameters and, thus, actions of several drugs. The elderly are probably most at risk, as malnutrition tends to affect factors already altered by primary and secondary aging.
Management of the Dying Elderly Patient
Authors: FISHER RORY H. , NADON GRANT W. , SHEDLETSKY RALPH
Published: April 2015

The relative merits of the hospice, palliative care units, and geriatrics departments as settings for management of the dying patient are considered.
Iron Status and Anemia in the Elderly: New Findings and a Review of Previous Studies
Authors: GARRY PHILIP J. , GOODWIN JAMES S. , HUNT WILLIAM C.
Published: April 2015

Iron status was determined in 280 free‐living and healthy elderly men (n = 131) and women (n = 149) by assessing dietary and supplemental iron intake as well as ten biochemical measures of iron nutriture (erythrocyte count, hemoglobin level, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, plasma iron level, total iron‐binding capacity, per cent transferrin saturation, and ferritin level). Subject ages ranged from 60 to 93 years with a median age of 72 years for both women and men. For comparison purposes, iron status measures in an unselected group of younger men (n = 107) and women (n = 164) between the ages of 20 and 39 years were also obtained. None of the elderly women and only two (1.2 per cent) of the younger women had low hemoglobin levels (less than 12.0 g/dl). Three (2.3 per cent) of the elderly men and none of the younger men had low hemoglobin levels (less than 14 g/dl). Other iron status measures revealed that anemia or iron deficiency was no more prevalent in the healthy elderly population than in the younger adult population when identical criteria were used to assess iron nutriture. The genesis of anemia often seen in the elderly is not completely understood. Reported evidence suggests the presence of anemia in the elderly is a result of overall reduction of hematopoietic reserves. Because of the potentially serious consequences of this assumption about anemia to the treatment of the elderly, the authors critically review some of the studies that have been designed in the past to determine the prevalence and etiology of anemia in the aged. They suggest that health status, race, socioeconomic status, diet, and region are more important than age as explanations for the high prevalence of anemia seen in many previous studies.
Fecal Incontinence
Authors: SMITH ROGER G.
Published: April 2015

Fecal incontinence is frequently seen in elderly patients, particularly in association with dementia. It can result from underlying disease, fecal stasis, or neurologic disorders, some of which are reversible. With proper care and treatment, it is possible to reduce the prevalence of fecal incontinence in elderly patients.
Suicide in the Elderly: The Limits of Paternalism
Authors: BROMBERG SHIRLEY , CASSEL CHRISTINE K.
Published: April 2015

It is the authors' premise that caregivers of the suicidal elderly patient are at times guided by a paternalism that is not always in the best interests of the patient. They advocate instead care based on greater respect for the autonomy of the patient. A case of a suicidal, recently widowed man is presented, and historical and ethical considerations of bereavement and suicide are discussed.
Success With an Inpatient Geriatric Unit: A Controlled Study of Outcome and Follow‐up
Authors: LEFTON EVA , BONSTELLE SANDRA , FRENGLEY J. DERMOT
Published: April 2015

To assess the worth of a newly established geriatric unit, outcomes for 50 subject patients cared for on this unit were compared with outcomes for 50 control patients. Both groups of patients were hospitalized in Highland View Hospital, the chronic illness and rehabilitation section of a major teaching hospital in Cleveland, Ohio. Analysis of admission data showed the two groups to be closely comparable. All patients were managed by multidisciplinary teams, and the length of stay of both groups was comparable. The discharge data showed that the subject patients were more independent, with significantly greater numbers improving in ambulation and significantly more subject patients being discharged to a home setting. Although the patients in the control group were discharged at lower levels of function, they showed improvement at follow‐up. Follow‐up data also showed that both groups largely remained in their discharge environments. Explanations for these findings are discussed. The results of this study support the establishment of geriatric inpatient units.
Screening for Cognitive Deficits in a Sample of Hospitalized Geriatric Patients: A Re‐evaluation of a Brief Mental Status Questionnaire
Authors: OMER HAIM , FOLDES JOSEPH , TOBY MARTIN , MENCZEL JACOB
Published: April 2015

A 30‐item screening examination for cognitive deficits was administered to 65 hospitalized elderly patients and to 60 elderly controls. A high proportion (73 per cent) of the hospitalized patients were found to have low cognitive scores indicative of probable organic mental syndrome (OMS). Especially high deficits were found among the patients with orthopedic and cerebrovascular conditions. The test correctly identified the 15 cases of established OMS. The percentage of false positive results in the normal controls was reasonably low. The importance of routine cognitive measurements in medical wards is stressed.
Effects of Age on Responses to Treatment and Survival of Patients with Multiple Myeloma
Authors: COHEN HARVEY JAY , SILBERMAN HAROLD R. , FORMAN WALTER , BARTOLUCCI ALFRED , LIU CHARLENE ,   For the Southeastern Cancer Cooperative Study Group
Published: April 2015

The elderly patient with malignancy is often considered a poor risk for treatment. To assess the effect of age on the treatment of one such disease, multiple myeloma (a disease with increased incidence in the elderly), a study was made of 280 patients treated with 1,3‐bis (2‐chloroethyl)‐1‐nitrosourea (BCNU), cyclophosphamide and prednisone on a Southeastern Cancer Study Group protocol. Initial response rates after six months of treatment were equivalent for the older compared with the younger age groups, with a slightly longer remission duration for those over 70. Likewise, survival was equivalent for the older patients. This was not the result of selection of older patients with less advanced disease, since the proportion with both good and poor risk factors are not significantly different in the various age groups. Moreover, for patients with each of the prognostic factors, older patients responded at least as well as younger patients. There were no significant differences among the age groups in gastrointestinal, skin, hair, or hematologic toxicity, although there was a slightly higher incidence of mild granulocyte and platelet toxicity in patients over 60. These findings are in contrast to the widely held belief that older patients cannot tolerate chemotherapy. On the contrary, they suggest that the elderly patient with myeloma may be expected to respond and survive, without excessive toxicity, at least as well as a younger counterpart with similar prognostic factors.
Treatment of Constipation with High‐bran Bread in Long‐term Care of Severely Demented Elderly Patients
Authors: SANDMAN P.‐O. , ADOLFSSON R. , HALLMANS G. , NYGREN C. , NYSTROM L. , WINBLAD B.
Published: April 2015

Constipation in institutionalized elderly is a common and difficult problem. Thirty‐three institutionalized demented patients with severe constipation were given a high‐bran bread instead of their accustomed laxatives. Changes in defecation habits, food and liquid intake, and metabolic status were registered. During the high‐bran bread treatment period, the number of bowel evacuations and the estimated volume of feces increased. The total laxative consumption (doses given per day) decreased by 93 per cent. Nutritional data and metabolic status were unchanged during the high‐bran bread period except for a reduction of the postprandial blood glucose response after the glucose tolerance test.
Aortic Valve Replacement in the Elderly
Authors: SANTINGA JOHN T. , FLORA JAIRUS , KIRSH MARVIN , BAUBLIS JOAN
Published: April 2015

In order to determine the risk of aortic valve replacement in the elderly, 77 patients over the age of 60 who had undergone this procedure were reviewed. Hypothermic‐hyperkalemic cardioplegia was used in all patients. In 55 patients with isolated aortic valve replacement there were three deaths (5.5 per cent). In the entire series of 77 patients there were 13 deaths (13 per cent). In seven patients with functional class IV there were two deaths (28.6 per cent). Six patients died of failure of an organ other than the heart. In only two patients did the operative death have a myocardial cause. Ninety‐two per cent of the patients were in functional class I or II following surgery. Patients should come to surgery before reaching class IV. Aortic valve replacement can be carried out safely in the elderly, and the indications should be the same as for younger patients.
A Comparison of Clinical Methods for Assessing Dementia
Authors: EASTWOOD M. R. , LAUTENSCHLAEGER E. , CORBIN S.
Published: April 2015

General practice physicians and clinical specialists use various methods for assessing dementia, including the Mental State Questionnaire (MSQ), Face‐Hand Test (FHT), Dementia Rating Scale (DRS), tests for developmental reflexes and focal neurologic signs, and examination for evidence of clinical depression, stroke, or other physical health problems. In order to determine how these various methods concur, a sample of elderly persons living in the community were evaluated on eight indices. When MSQ scores were used as criteria, the DRS and FHT concurred with classification of impairment in 76 per cent and 45 per cent of cases, respectively. Positive focal signs and developmental reflexes were significantly related to cognitive impairment but were not common features in this sample. Physical health, drug use, and demographic variables did not appear to be related to cognitive function. Although dysphoric mood was related to cognitive impairment, pseudodementia was not identified. After one year the subjects were retested with the MSQ and the DRS; 14 per cent and 20 per cent, respectively, had improved, indicating a lack of predictive validity of these measures. Results are discussed in the context of the utility of clinical methods for screening and staging cognitive impairment, and recommendations are made regarding a standardized battery.
Cytofluorographic Analysis of Pokeweed Mitogen‐stimulated Human Peripheral Blood Cells in Culture
Authors: OTTE R. GAIL , WORMSLEY SUSAN , HOLLINGSWORTH J. WILLIAM
Published: April 2015

By use of monoclonal antibodies and flow cytometry techniques, peripheral blood mononuclear cells from young (20–30 years) and elderly (70+ years) subjects were analyzed before and after culture with pokeweed mitogen to gain insight into the cellular interactions responsible for the decreased B cell response observed in culture samples from the elderly. Data analysis of surface immunoglobulin‐positive cells demonstrated no difference in the percentage of B cells in the elderly, while both plaque‐forming cell and intracytoplasmic immunoglobulin assays showed significantly reduced B cell maturation (P = <0.01) compared with young controls. The B cell defect was shown to be functional and not a result of failure to proliferate and survive during incubation. Surface marker analysis of T cell sub‐populations demonstrated a definite shift (P = <0.01) in the helper/suppressor T cell ratio in cultured samples from the elderly group (3.9) compared with young subjects (1.2). In addition to the absolute increase in the helper T cell population, forward‐angle light scatter analysis demonstrated that, compared with young controls, a greater portion of the helper T cell population in the elderly subjects had characteristics of activated, blast‐sized cells. The data reported in this study suggest that in the elderly group there is a functional im‐munoregulatory imbalance in the helper T cell subset.
Day Care for Dementia Patients
Authors: Panella John J. , Lilliston Barbara A. , Brush Dorothea , McDowell Fletcher H.
Published: April 2015

A day care program for patients with dementia was developed by the Burke Rehabilitation Center in 1979. Sixty‐nine patients have taken part in the program, some for as long as three years. The majority of patients stay in the program for one to two years. This pilot program was designed to provide a structured series of daily activities for the patient with dementia and to give those responsible for their care at home a period of freedom each week from the responsibilities of care. The program has been well received by the patients and appreciated by their families. It has not altered the steady progression of intellectual decline. It has made it possible for families to continue to keep patients at home and delay nursing placement or the hiring of additional help at home. It is cost effective when compared with the general alternative of nursing home placement. Similar programs could be conducted outside health care facilities at lower cost to patients and their families. Family support group discussions have eased the burden for the caregiver and have been useful in discovering new ideas for better patient management.
The Significance of an Ill Spouse for Assessing Health Differences in an Elderly Population
Authors: SATARIANO WILLIAM A. , MINKLER MEREDITH A. , LANGHAUSER CAROL
Published: April 2015

In a survey of 678 elderly residents of Alameda County, California, it was found that respondents who reported their spouses as being ill in the last six months were more likely to report their own health as poor than those respondents whose spouses were not previously ill. The spouse's health was found to be the best predictor of the respondent's health. Research in this area may lead to a better understanding of the elderly spouse as a source of social support and may provide geriatricians with new insights into the health risks facing the married elderly.
Health Needs of the Hispanic Elderly
Authors: LOPEZ‐AQUERES WALDO , KEMP BRYAN , PLOPPER MICHAEL , STAPLES FRED R. , BRUMMEL‐SMITH KENNETH
Published: April 2015

This paper presents results of a study concerning the health care needs of the Hispanic elderly population of Los Angeles County. By use of the Comprehensive Assessment and Referral Evaluation (CARE) instrument, data on a sample of 704 subjects were employed to compute the scores for 22 Likert‐type scales measuring the prevalence of numerous psychiatric, medical, and social problems. The data indicate that older Hispanics were affected by cognitive impairment (13.8 per cent), depression/demoralization (30.8 per cent), heart disorders (12.8 per cent), stroke effects (11.5 per cent), arthritis (28.3 per cent), hypertension (23.7 per cent), financial hardship (28.0 per cent), fear of crime (38.4 per cent), ambulation problems (17.2 per cent), or activity limitation (24.7 per cent); they also needed assistance (19.3 per cent) or used social services (22.0 per cent). Further analysis revealed that the prevalence of many of these problems varies significantly according to the age, sex, language, and income of respondents. The indicators of health care needs used in the study differed substantially from the more traditional measures based on the person's own perception of his or her health.
Peripheral Catecholamine Enzyme Function and Cognitive Impairment of Elderly Schizophrenics and Controls
Authors: BRIDGE THOMAS PETER , PHELPS BRUCE H. , CUTLER NEAL R. , JESTE DILIP V. , WYATT RICHARD JED
Published: April 2015

Alterations of peripheral and central catecholamine systems are found in both schizophrenic and demented subjects. Reported here are the results of bivariate and multivariate analyses of cognitive function and peripheral catecholamine enzyme activities in a group of elderly schizophrenic patients and controls. The entire sample shows an inverse relationship of platelet monoamine oxidase (MAO) activity with cognitive impairment after controlling for the effects of age, race, and gender. Schizophrenic subjects also demonstrated an inverse relationship of plasma dopamine beta hydroxylase (DBH) activity with cognitive impairment. Demented subjects were characterized in both groups as having increments in platelet MAO activity. Demented schizophrenic subjects also were characterized by increments in plasma DBH activity. Results from this sample are discussed with respect to findings from other studies and future research.