bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleep Disturbances in a Series of Elderly Patients: Polysomnographic Findings
Authors: Reynolds Charles F. , Coble Patricia A. , Black Ronald S. , Holzer Barry , Carroll Richard , Kupfer David J.
Published: April 2015

A group of 27 elderly patients with complaints of either chronic insomnia or excessive daytime sleepiness were studied in the Sleep Evaluation Center of Western Psychiatric Institute and Clinic during the period January 1977–June 1979. On the basis of anamnestic data from patients and bedroom partners, together with polysomnographic findings, sleep disturbances were classified according to the nosology of the Association of Sleep Disorders Centers. Of the 27 patients, 19 had disorders of initiating or maintaining sleep (DIMS), 7 had disorders of excessive somnolence (DOES), and 1 had parasomnia (episodic nocturnal wandering). Of the 19 DIMS patients, two‐thirds had either a primary affective disorder (depression) or a persistent psychophysiologic disturbance. Of the 7 DOES patients, 6 had a primary sleep disorder such as a sleep apnea syndrome or narcolepsy‐cataplexy. Additional electroencephalographic sleep data are presented on elderly patients with primary nonpsychotic depression. The latency of rapid eye movements (REM) in the depressed patients was shorter (p < 0.05) than in patients with a persistent psychophysiologic disturbance. The percentage of REM sleep was significantly elevated (p < 0.05) in the depressed group, and intermittent wakefulness was decreased (p < 0.01). The causes of sleep disturbance in the elderly are both heterogeneous and complex. The need for accurate differential diagnosis and a multiaxial approach is stressed.
Noninvasive Detection and Prevention of Deep‐Vein Thrombosis in the Geriatric Patient
Authors: Lee Bok Y. , Thoden William R. , Trainor Frieda S. , Kavner David
Published: April 2015

Noninvasive methods for the early detection of, and prevention of deep‐vein thrombosis can significantly reduce postoperative morbidity and mortality in the elderly due to venous thromboembolism. The technique of venous impedance plethysmography provides a rapid means of assessing the patency of the venous system by detecting changes in venous volume and maximum venous outflow, thus providing for early detection of deep‐vein thrombosis. Prevention of deep‐vein thrombosis can be accomplished through use of external intermittent pneumatic compression. This technique prevents venous stasis and stimulates the natural fibrinolytic activity of the vein‐wall endothelium.
Physician Acceptance of Clinical Pharmacy Service in a Skilled Nursing Home
Authors: Taylor A. Thomas , Martell Pamela H.
Published: April 2015

A study was made of physician acceptance of pharmacist‐recommended changes in the drug therapy of elderly institutionalized patients. The records of 92 such patients were reviewed by the pharmacist. In 33 instances the pharmacist recommended changes in drug therapy. In 75.8 percent (25 of these 33 patients) the recommendations were judged appropriate and were accepted by the physician concerned.
Lack of Effect of Ascorbic Acid, Hippuric Acid, and Methenamine (Urinary Formaldehyde) on the Copper‐Reduction Glucose Test in Geriatric Patients
Authors: Nahata Milap C. , McLeod Don C.
Published: April 2015

Ascorbic acid and hippuric acid (from cranberry juice) are commonly used to acidify the urine for the purpose of enhancing the degradation of therapeutic methenamine mandelate to urinary formaldehyde. A study was made of 27 nondiabetic geriatric patients with indwelling Foley catheters and chronic bacteriuria who were treated with methenamine mandelate (4 gm), ascorbic acid (4 gm), and cranberry cocktail (1 liter) daily. All of 972 urine samples showed formaldehyde in mean concentrations between 14 and 25 μg/ml. No glucose was found when the urine was tested by the copper‐reduction method. In vitro false positive reactions reported in the literature do not appear to be duplicated as an in vivo problem.
Presenile Dementia—A Form of Lafora Disease
Authors: Stam F. C. , Wigboldus J. M. , Bots G. Th. A. M.
Published: April 2015

The autopsy findings on a 60‐year‐old man with progressive disturbances of gait, presenile dementia and incontinence, showed Lafora bodies in numerous ganglion cells of the cerebral cortex and in many nuclei of the brain stem. Histochemical analysis of the Lafora bodies revealed the presence of a polysaccharide‐protein complex containing phosphate groups. The case closely resembled the one described by Suzuki et al. It is suggested that this type of presenile dementia may be a presenile form of Lafora disease.
Early Failures of Permanently Implanted Transvenous Pacemaker Systems: Spontaneous Recovery of Sensing Function in Three of Twelve Cases
Authors: Goldberg E. , Edery T. , Delfin L. , Berger M. , Jelveh M.
Published: April 2015

An analysis of 12 early pacemaker failures in a series of 128 transvenous implants is reported. Spontaneous recovery, maintained during long‐term follow‐up of 3 patients with isolated transient sensing failure, suggested the possibility of a transient loss of sensing voltage amplitude, or slew rate (dv/dt), or both. Conservative management is frequently indicated in these cases. In 62 patients in whom a “tined” lead was used, there were no early pacemaker failures.
Vitamin B12 Status of Elderly Persons from Urban Low‐Income Households
Authors: Bailey L. B. , Wagner P. A. , Christakis G. J. , Araujo P. E. , Appledorf H. , Davis C. G. , Dorsey E. , Dinning J. S.
Published: April 2015

Vitamin B12 status was evaluated in 111 noninstitutional elderly persons (age range, 60–87 years) living in an urban poverty area. The sample was predominantly black (90 subjects); the rest were Spanish Americans. Serum vitamin B12 levels were all normal (>200 pg/ml) and ranged from 226 to 1200 pg/ml (mean ± SD = 700 ± 191 pg/ml). The findings indicate that vitamin B12 deficiency was not a problem in this elderly population.
Persistent Dislocation of the Shoulder in Elderly Patients
Authors: Ganel A. , Horoszowski H. , Heim M. , Engel J. , Farine I.
Published: April 2015

Four elderly patients with longstanding unrecognized dislocation of the shoulder were treated by physiotherapy only. Good functional results, associated with a greatly increased range of pain‐free motion, demonstrate the usefulness of conservative treatment in cases of persistent dislocation of the shoulder in the elderly.
Serum Glucagon after Arginine Infusion in Aged and Young Subjects
Authors: Ferrero Enrico , Casale Giorgio , De Nicola Pietro
Published: April 2015

In 12 aged nondiabetic subjects, 10 aged diabetic subjects, and 6 young nondiabetic subjects the glucose, insulin, glucagon and growth hormone responses to the intravenous administration of arginine were studied. A prompt increase in the levels of blood glucose, serum insulin and serum glucagon was observed, but the glucose and glucagon peaks were significantly higher in the aged nondiabetic and diabetic subjects. Growth hormone secretion did not differ between the nondiabetic aged and young subjects. These findings suggest the hypothesis that glucose intolerance in old age is due to increased release of glucagon.
Perspective of Health in Old Age†
Authors: Cape Ronald D. T. , Henschke Philip J.
Published: April 2015

The elderly are often depicted as a deprived, disabled group of depressed people. A group of 385 elderly subjects drawn at random from those who lived in their own homes in the City of London, Ontario, or in Grey and Bruce Counties in Southwestern Ontario, were studied to assess their degree of disability, consumption of drugs, and need for health care. The method of sampling is described in detail. The proportion of cooperative subjects in the available chosen samples ranged from 80 to 92 percent. The results showed that disability, as assessed by lack of competence in five activities of daily living, ranged from about 6 percent at age 65 to over 35 percent at age 85. Within the previous year, only 15 percent of the subjects had not seen their family physician, and 36 percent had visited the doctor's office three or more times. Those living at home consumed an average of 1.6 drugs per person. In an institutional sample of 100 subjects, 12 percent were fully independent and had no obvious need to be in an institution; their consumption of drugs was more than twice that in the community sample. Old age is not necessarily a disabling period of life. On balance, it can offer more hope and fulfillment than despair.
Modalities of Psychotherapy with the Elderly
Authors: Karpf Ronald J.
Published: April 2015

Emphasized is the view that geriatric psychotherapy can be effectively administered only with knowledge of the biology, psychology, and sociology of old age. The concepts of transference, countertransference, interpretation, conflict and defense mechanisms are crucial for understanding the various treatment modalities. Five intervention patterns are offered for the therapeutic approaches, i.e., interpretation, suggestion, reinforcement, confrontation, and clarification. The different modalities of geriatric psychotherapy may be viewed as variations of different clusters of these interventions, e.g., psychoanalysis makes most use of interpretation whereas group therapy makes most use of confrontation and clarification. For the psychologic treatment of disorders in late life, there are five basic modalities and one adjunct. The basic psychotherapies are classified as psychoanalytic, supportive, group, family, and behavioral; the adjunct is psychopharmacologic treatment, which is not a substitute for effective psychotherapy. Much semantic confusion has centered around this adjunctive treatment. Conceptual confusions about the meaning of the word “cure” are discussed.
Ischemic and Hypertensive Heart Disease in the Aged: Prognostic and Therapeutic Factors†
Authors: Rodstein Manuel
Published: April 2015

The prognostic significance of risk factors for ischemic and hypertensive heart disease in the aged differs in many respects from that in younger persons. In old age, most risk factors for ischemic heart disease such as an elevated level of total serum cholesterol, cigarette smoking, obesity, Type A personality and abnormal glucose tolerance have a less adverse effect on morbidity and mortality from ischemic heart disease, while an elevated level of high‐density lipoprotein, and moderation in the use of alcohol each have a favorable effect. A high level of low‐density lipoprotein cholesterol exerts an adverse effect. Both systolic and diastolic hypertension have an adverse influence on morbidity and mortality from ischemic and hypertensive heart disease, as does the electrocardiographic pattern of left ventricular strain. Long‐term controlled studies are needed to determine the effects on mortality and morbidity of the modification of risk factors by means of drugs, diet, and change of lifestyle. Such studies are necessary if we are to determine whether hoped‐for favorable changes are offset by potential side effects on physical and mental health.
Effects of Aging on Hydroxyproline in Human Heart Muscle
Authors: Ito Akihiko , Yamagiwa Hirotsugu , Sasaki Rikuro
Published: April 2015

Hydroxyproline concentration in the NaCl‐soluble, TCA‐soluble, and residual fractions of heart muscle was chemically determined in 40 autopsy subjects (25 men and 15 women), to study the effects of aging. In the left ventricle, the total hydroxyproline content of the endocardium and papillary muscle increased significantly in relation to age; the increase was greatest in the TCA‐soluble fraction, followed by the residual fraction. Statistical analysis revealed that hydroxyproline in the residual fraction increased from the epicardium to the endocardium and then to the papillary muscle. Significant negative correlations were found between heart weight and total hydroxyproline in the epicardium and endocardium. In the right ventricle, a significant negative correlation was noted between heart weight and total hydroxyproline content. Though no correlations were evident between age and hydroxyproline content in females, significant correlations were observed between age and the total hydroxyproline content of the endocardium and papillary muscle in males. Furthermore, soluble collagen increased in most parts of the heart in females, but insoluble collagen increased in all parts of the heart in males. It is concluded that the hydroxyproline content of heart muscle increases in proportion to age and is in inverse proportion to heart weight. The increase occurs in the TCA‐soluble and residual fractions, and extends from the endocardium to the papillary muscle. More profound changes in collagen metabolism are observed in males.
Thyroid Status and the Depressed Elderly
Authors: Gambert Steven R. , Pontzer Carol P. , Dagon Eugene M.
Published: April 2015

Although many studies have been devoted to linking thyroid status and depression, the results have been conflicting. This review concerns types of depression and suggests a paradigm that could encompass the role of the thyroid in aging and depression. Also discussed are thyroid function and its modification in the treatment of depression. Special precautions should be taken with the use of tricyclic antidepressants and with the enhanced cardiotoxic effects when combined with certain thyroid factors in the treatment of depression alone in the elderly.
Goals in Hemiplegia Care†
Authors: Rogers Eugene J.
Published: April 2015

Physicians should assume leadership and a greater role in the post‐stroke management of the hemiplegic patient, so that the recipient of care becomes an active participant in the treatment team. The patient should be fully aware of his condition, and partake in establishment of the goals together with subsequent evaluation of accomplishments and progress. Some short‐term and some longer‐term goals are outlined as a guide. A method for performance scoring is suggested. These performance ratings may assist in establishing priorities for discharge planning and continuation of care. They also may permit more accurate assessment and documentation of the patient's capacities and the efficacy of the various approaches to adequate care.
Nursing Home Candidates: Hospital Inpatient Trial to Identify Those Appropriately Assignable to Less Intensive Care
Authors: Sloane Philip D.
Published: April 2015

Primary care physicians are often confronted with demands that elderly patients be institutionalized. Patients who appear to have no new medical problems present a therapeutic dilemma. Should they be admitted to a general hospital or should they be placed directly in a nursing home? This longitudinal prospective study involved 29 consecutive elderly patients judged to be in need of nursing home placement but who were without medical indications for admission. They were assessed and treated in a 30‐bed ward of a general hospital. The mean length of stay was 19 days. Of the 29 patients, 8 (24 percent) benefited from the hospitalization; the outcome was placement and retention at a level of care less intensive than that in a nursing home. On admission to this special ward, the presence of 2 of the following 3 characteristics identified the patients who would benefit from this preplacement hospitalization (with 75 percent sensitivity and 86 percent specificity): 1) a score of A or B (Katz Scale) for activities of daily living; 2) a score of 3 or fewer errors on the mental status scale (Pfeiffer); and 3) the presence of family members willing to care for the patient, although unable to do so at the time of admission. These 3 factors constitute a screening tool to differentiate elderly patients who will benefit most under a regimen of intensive rehabilitation from those who will be inevitable recipients of long‐term care.
Cancer Stage‐to‐Age Relationship: Implications for Cancer Screening in the Elderly*
Authors: Holmes Frederick F. , Erwin Hearne
Published: April 2015

In a study specifically addressing the age‐stage relationship, the authors examined the distribution of 30,991 cancers by disease‐stage versus patient‐age at the time of diagnosis. For cancer of the bladder, breast, cervix, ovary and uterus (endometrium), a highly significant positive relationship was found between advancing stage and advancing age (P < 0.001). For cancer of the kidney and stomach, the relationship held but was less significant (P < 0.05). For colorectal cancer, no relationship was evident. For bronchial cancer there was a highly significant inverse relationship (P < 0.001). After the site of origin of the cancer, the stage at the time of diagnosis was the next most important determinant for treatment and survival. These data emphasize the importance of periodic pelvic examination as a means of screening for asymptomatic cervical, ovarian, or other uterine (endometrial) cancer in elderly women. Also, the data support the importance of breast self‐examination and mammography in screening for breast cancer in older women. The inverse relationship of age to stage in bronchial cancer suggests that screening by periodic chest roentgenograms and cytologic sputum examinations may be more appropriate for elderly than for younger populations in whom these screening methods have proved disappointing.
Problems of Families Caring for Alzheimer Patients: Use of a Support Group
Authors: Barnes Robert F. , Raskind Murray A. , Scott Monte , Murphy Colleen
Published: April 2015

An eight‐week support group program was conducted for 15 members of the families of Alzheimer patients still living at home. It became clear that caring for an Alzheimer patient at home created tremendous practical, psychologic and social problems for family members. Frequently discussed problems included lack of support and information from physicians, poor understanding of the disease, depression, a trapped feeling, anger and fear about the patient's behavioral problems, isolation, and the caretaker's loss of self‐identity. Group participation was especially beneficial for spouses who functioned as primary care providers. It increased their understanding of the disease, made them feel more supported and less isolated, and helped them resolve some of the feelings created by the illness. It also helped spouses to become more aware of their own needs and to regain some self‐identity in relation to the patient. Such family support programs offer a way to strengthen the emotional well‐being and treatment skills of the care‐providing family and are an important aid to treatment in Alzheimer's disease.
A Behavior Management Program to Increase Social Responses in Psychogeriatric Patients
Authors: Nigl Alfred J. , Jackson Basil
Published: April 2015

Although increased numbers of psychogeriatric patients have been placed in proprietary nursing homes in recent years, many facilities have not been able to accommodate the behavioral problems involved. This study summarizes the results of a behavior management program for improving the social functioning and social behaviors of 6 psychogeriatric patients in a nursing home. The use of reinforcement by tokens substantially improved social behavior over a 10‐day period; during a 10‐day withdrawal of reinforcement, the level dropped precipitantly; but during the subsequent 10‐day reinforcement period, substantial improvement in social functioning again was observed. Four of the 6 patients improved significantly, and after one year could be placed in a higher‐level unit of the nursing home. The findings suggest that behavior management programs can be used successfully to improve the social functioning of psychogeriatric patients.
A Brief Life‐Graph Technique for Work with Geriatric Patients*
Authors: Rakowski William , Hickey Tom
Published: April 2015

Patients aged 60 or older from the practice of a private physician (n = 32) and from a geriatric outpatient clinic (n = 132) responded to a questionnaire designed to assess perceived present and future health, treatment expectations, and general future projection. Of interest was the extent to which present health, as measured by a brief life‐graph technique, might be predictive of perceptions in these other areas. Results from the two samples were consistent in suggesting that present health ratings were related to anticipated future health, general future projection, and certain treatment expectations. However, expectations of when benefits from treatment would begin, and of the probable duration of treatment, were not predicted in either sample. The life‐graph technique seems useful for practitioners' interactions with older patients and for understanding these patients' extended views of their health.
The Aging Game: A New Teaching Method in Geriatric Medicine
Authors: ROBERTSON DUNCAN , BROCKLEHURST JOHN
Published: April 2015

The aging game, a simple yet effective educational method for teaching gerontology and geriatric medicine, is described. Groups of up to 20 students participate. A series of 100 cards bearing statements about old age, some of which are true and some of which are false, are distributed among them. By exchanging cards and by gradual grouping of the students, the participants endeavor to secure a hand in which all the statements are true. The game ends with all cards being reviewed by the teacher and the participants together. The aging game has been used with physicians, medical students, nurses, therapists, social workers and mixed groups of health professionals. A modified version has been used in pre‐retirement education and public education on aging.
What Is Geriatrics? The Swiss Experience
Authors: JUNOD Dr. J. P. , LEVY Ph. M.
Published: April 2015

ABSTRACT: For the Geriatric Institutions of Geneva, geriatrics is not just a convenient term for concealing large gaps in present medical knowledge, but a specialized branch of medicine specifically adapted to the urgent needs of the growing older adult population. These Institutions constitute a 276‐bed hospital, an 80‐bed extended‐care facility, and a large consultation service for ambulatory patients. The staff comprises over 50 physicians and psychiatrists, multidisciplinary paramedical personnel, and a large complement of social workers. The three main goals are to: 1) address the complex medical needs of the older patient; 2) motivate the staff about the specific problems of the elderly and how to deal with them; and 3) promote awareness in the community of the complexity of problems associated with geriatric patients. The model of geriatric healthcare delivery developed and practiced in Geneva is “Integrated Medicine.” This is not simply a multidisciplinary approach to the multiple disorders of elderly patients, but also a particular philosophy of management with objectives specifically adapted to their unique pathophysiologic, psychiatric and social needs. The model is described as it pertains to preventive medicine, diagnosis, therapeutics, and prognosis. Integrated Medicine is not a panacea, yet it constitutes a step toward developing a health‐care delivery system specifically adapted to the geriatric patient.
Left Atrial Myxoma in the Elderly: Diagnosis by M‐Mode and Bidimensional Echocardiography
Authors: GUILLET PHILIPPE , BACONNET Ch. , LABROUSSE A. , AIGUEPERSE I. , ANDRE A. , GROSGOGEAT Y. , LAURENCEAU J. L. , TEMKINE J. , VANETTI A.
Published: April 2015

ABSTRACT: Two cases are reported of left atrial myxoma in elderly patients, diagnosed by combined M‐mode and bidimensional echocardiography. One patient was an 80‐year‐old man presenting with typical signs of mitral obstruction by an atrial tumor. His symptoms were erroneously attributed to chronic bronchitis until an echocardiogram was obtained. The other patient was a 70‐year‐old woman with atrial fibrillation of one year's duration. Left atrial myxoma, although rarely observed in the elderly, may be diagnosed easily by means of echocardiography. Some cases may prove amenable to surgical treatment.
Hairy Cell Leukemia Presenting in a Patient Aged 90
Authors: BETESH JOEL , MAJOR DAVID
Published: April 2015

ABSTRACT: Hairy cell leukemia has been described as chiefly a disease of the middle‐aged. A patient is reported in whom hairy cell leukemia developed at age 90, the oldest age recorded for onset of the disease. An estimation of age‐specific incidence rates revealed no major difference in incidences between the middle‐aged and the elderly populations.
Consistency in Patients' Health and Treatment Expectations at a Geriatric Clinic
Authors: HICKEY TOM , RAKOWSKI WILLIAM
Published: April 2015

ABSTRACT: This study focused on predictors of consistency and inconsistency in health and treatment expectations among 77 new patients (mean age, 73) at a geriatric outpatient clinic. Just before their first appointment, and again one week afterward, the patients were asked about their overall health status, their specific illness complaints, their reasons for visiting the clinic, and their expectations regarding treatment and the future outlook. Few predictors of consistency were found for such outcome measures as the number of health problems reported, present and future health status, and the duration, difficulty and benefits of treatment. Inconsistency and uncertainty were more evident in these geriatric outpatients' perceptions, especially among those with self‐rated poor health and mobility. This study emphasizes: 1) the importance to the treatment context of geriatric patients' inconsistencies about their health, and 2) the additional burden clinicians must bear in dealing with such discrepancies.
Effectiveness of a Service Workers' Action Team (SWAT) for the Elderly*
Authors: Stein Shayna R. , Linn Margaret W. , Weiner Audrey S.
Published: April 2015

The Service Workers Action Team (SWAT) is a three‐year, community‐based demonstration project for the elderly, with the primary goal of improving or maintaining psychosocial and physical functioning. With baseline scores and selected demography data as covariates, 243 experimental SWAT recipients were compared (manova) with 158 controls after six months, with respect to: 1) Hopkin's Symptom Checklist, 2) Social Participation Scale, 3) Life Satisfaction Scale, 4) Self‐Esteem Scale, 5) Activities of Daily Living, and 6) four selected health‐related questions. The frequency of responses for the experimental elderly were computed for program satisfaction at the time of follow‐up. In terms of psychosocial functioning, the experimental group fared significantly better at six months than did the control group. In terms of health, both groups declined in functional status, as evidenced by their scores on Activities of Daily Living, though the experimental subjects still were significantly better than the controls. The majority of the experimental group found the program to be helpful, with suggestions made for program expansion.
The Consultant Pharmacist and Analgesic/Anti‐Inflammatory Drug Usage in a Geriatric Long‐Term Facility*
Authors: Wilcher Debra Elaine , Cooper James W.
Published: April 2015

The contribution of a consultant pharmacist to a 33‐month study of analgesic and anti‐inflammatory drug usage by 210 elderly long‐term patients was evaluated by a fifth‐year pharmacy student. In the 143 patients who used analgesics and anti‐inflammatory agents, significant changes were noted, viz, decreased use of codeine (p = .002); increased use of acetaminophen (p = .003) and anti‐inflammatory agents (p = .020); increased regular scheduling of aspirin and acetaminophen; and an overall decrease in total drug usage from 7.2 to 4.8 drugs per patient. No effect was noted on the number of analgesics per patient, and the percentage of aspirin or propoxyphene or acetaminophen combinations used. A protocol was established for pain therapy, including a system of stop orders for propoxyphene and codeine.
Local Treatment (Electrocoagulation) for Carcinoma of the Rectum in the Elderly*
Authors: Gingold Bruce S.
Published: April 2015

For more than 70 years, surgical excision with permanent colostomy has been the most common operation for adenocarcinoma of the rectum. Local treatment has been advocated by some surgeons, but most prefer radical surgery. Abdominoperitoneal resection often diminishes the risk of local recurrence, but mortality and morbidity rates are very high, especially in the elderly. Although local treatment for rectal cancer remains controversial, the author believes that the elderly constitute a separate category of patients because their mortality and morbidity rates are high and because they usually are unable to care for a colostomy. Local treatment seems a much more desirable form of therapy. A series of 6 elderly patients (average age, 77) were treated by local electrocoagulation followed by radiation therapy, for biopsy‐proven adenocarcinoma of the rectum; one died after nine months from liver metastases (present at the time of diagnosis), and one had to undergo a colostomy after 19 months. For the 4 remaining patients, follow‐up has ranged from three years to nine months. To date there has been no recurrence, no evidence of metastases, and no mortality or morbidity. In the author's opinion, the results of electrocoagulation‐radiation treatment of small rectal adenocarcinomas are superior to the results of radical surgery in elderly patients.
Bronchogenic Carcinoma Associated with Chronic Lymphatic Leukemia
Authors: Shankar Patil S.
Published: April 2015

This report pertains to the development of bronchogenic carcinoma in 4 elderly patients with chronic lymphatic leukemia. The abnormal radiologic shadows in the lung (confined to the upper lobes and hili) were noted 30–60 months after recognition of the hematologic abnormality. Spread to ipsilateral or contralateral lymph nodes was common. After the appearance of lung carcinoma, the patient's course was downhill, with an average survival period of 2 months. The development of a new pulmonary lesion in any patient with chronic lymphatic leukemia should arouse the suspicion of malignancy and lead to prompt investigation.
Abuse of the Elderly—The Hidden Agenda. II. Future Research and Remediation
Authors: BRAGG DAVID F. , KIMSEY LARRY R. , TARBOX ARTHUR R.
Published: April 2015

ABSTRACT: A schema for future research and efforts to remediate abuse of the elderly is presented. In the community at large, increased exposure of and education pertaining to the elderly are needed in order to intensify the public/community presence and reduce prejudices. In the medical community, improvements are needed in the extent of geriatric training, the ethics of pronouncement of death, the reliability of clinical documents, and the reporting of suspected cases of abuse. In the legal community, there is need for laws prohibiting abuse and neglect, and providing opportunity for recovery of minimum damages, with covering of attorney's fees and court costs. It is proposed that the administrative process be altered so as to provide either a financial penalty for abuse and neglect, or a reward for providing superior care.
A New Double‐Layered Launderable Bed Sheet for Patients with Urinary Incontinence
Authors: WILLIAMS T. FRANKLIN , FOERSTER JANET E. , PROCTOR JANICE K. , HAHN ALOYSE , IZZO ANTHONY J. , ELLIOTT GERALDINE A.
Published: April 2015

ABSTRACT: In a skilled nursing facility, 36 patients (chiefly elderly) with persistent urinary incontinence were the subjects of this study. In their management, the usual disposable pads were compared with a new launderable bed sheet (Kylie) which absorbs urine in the second layer while maintaining a dry surface next to the patient's skin. There was a 42 percent reduction in the frequency of bedding changes with the new bed sheets. The patients experienced increased comfort due to decreased skin wetness and decreased creasing of the sheets. The reduced frequency of bed linen changes permitted longer undisturbed periods for the patient. Management costs were reduced by 40 percent with the launderable bed sheets. There were no adverse effects on the condition of the patients or in the quality of care.
Changes in the Sleep and Waking EEGs of Nondemented and Demented Elderly Subjects
Authors: PRINZ PATRICIA N. , PESKIND ELAINE R. , VITALIANO PETER P. , RASKIND MURRAY A. , EISDORFER CARL , ZEMCUZNIKOV H NICOLAS , GERBER CARL J.
Published: April 2015

Sleep and waking EEGs from 11 healthy nondemented elderly men and from ten inpatients for whom the diagnosis was probable senile dementia of Alzheimer's type (SDAT), were monitored in the subjects' typical home or ward environments or in the sleep laboratory, according to their customary sleep schedules. Aged normal subjects (age range, 56–85 years) had less Stage 3 and Stage 4 sleep, less REM sleep, and more wakefulness than normally observed in young adults. Patients with SDAT (age range, 56–88 years) had even less Stage 3 sleep, no Stage 4 sleep, and very little REM sleep, and experienced fragmentation of their sleep, with frequent awakenings. These sleep variables were significantly different in the SDAT and control groups (MANOVA). Examination of the 24‐hour plots of sleep/waking patterns revealed prominent fragmentation of the diurnal sleep/waking rhythm in SDAT patients, with frequent daytime napping and nighttime periods of wakefulness. In addition, significant group differences were observed for the EEG variable, dominant occipital frequency. More qualitative EEG variables (diffuse slowing, spindle activity, and paroxysmal discharges) also differed between groups. It is suggested that correlative neuropathologic data might provide an understanding of the basis for the sleep, EEG, and mental‐function factors that undergo change in SDAT.
Efficacy and Toxicity of d‐Penicillamine for Rheumatoid Disease in the Elderly
Authors: KEAN W. F. , ANASTASSIADES T. P. , DWOSH I. L. , FORD P. M. , KELLY W. G. , DOK C. M.
Published: April 2015

The efficacy and the toxicity pattern of d‐penicillamine were studied in patients with rheumatoid disease followed up between April 1975 and March 1979. The population of patients was divided into an elderly group (≥60 years old, mean = 65 years) and a younger group (<60 years old, mean = 41 years). Patients with classic or definite rheumatoid disease not responsive to nonsteroidal drugs were eligible. The mean durations of disease prior to d‐penicillamine therapy were five years in the elderly and seven years in the younger group. Overall, the mean follow‐up time was 11 months. The average dosages of d‐penicillamine were 461 mg/day in the elderly and 520 mg/day in the younger patients. Results indicated that d‐penicillamine was efficacious in 75 per cent of the elderly during all time periods after three months, and in 75 per cent of the younger patients after three months until at least two years. Prior gold‐salt therapy did not influence efficacy. Toxicity was significantly greater in the elderly for overall skin rash (P < 0.01), severe skin rash (P < 0.01), and marked abnormalities in the ability to taste (P < 0.05). The incidence of hematologic toxicity was not increased in the elderly compared with the younger patients. Toxicity in either group was not influenced by prior gold‐salt therapy. It is concluded that d‐penicillamine was equally efficacious in both elderly and younger groups, and that the toxicity patterns were similar except for increased tendencies toward rashes and taste abnormalities in the elderly.
Outcome of Hospital Admission of the Very Elderly
Authors: ROBERTSON DUNCAN , ROCKWOOD KENNETH
Published: April 2015

Hospital utilization by persons aged 85 or older before the development of a specialized geriatric service in a Canadian city is described. Admissions to surgical units slightly outnumbered those to medical units and were more likely to be elective admissions or interhospital transfers. Three fourths of the medical admissions were classified as “emergent,” and half of the admissions came through the emergency department. Although a number of patients, particularly older women, came from extended care facilities, most patients had been living in the community before admission. The mean length of stay was 18.8 days and the in‐hospital mortality rate was 13 per cent. The majority of patients were discharged to the community, and this placement appeared stable, in that less than 10 per cent of those discharged to the community entered an extended care facility within the one‐year follow‐up period.
Aging and Alcohol Abuse
Authors: BRODY JACOB A.
Published: April 2015

Demographic information suggests that the problems of alcohol abuse among the elderly will increase at least in proportion to the population growth of that sector. While fewer older people drink and average consumption declines, four factors that promote alcohol abuse are noted. These are: 1) retirement, with its attendant boredom, change of role status, and loss of income; 2) deaths occurring among relatives and friends and the awareness that more deaths are coming; 3) poor health and discomfort; and 4) loneliness, a particular problem among elderly women. Surveys in older age groups, in addition to being costly, are of questionable value. Anecdotal evidence and several early studies, however, suggest that a high proportion of elderly (10 to 15 per cent) who seek medical attention for any reason have an alcohol‐related problem, and that elderly alcoholics, whether alcoholism is of early or recent onset, are relatively easy to treat. If these findings can be confirmed, then detection during health‐seeking encounters could have great potential value. Research in detection and treatment is critical. A prevention strategy involving the cohort 55 to 64 years of age could have the dual effect of preventing subsequent alcohol problems among these people and offering a message that would be heard by those at older and less accessible ages.
Digoxin Use in the Elderly
Authors: STULTS BARRY M.
Published: April 2015

The current extensive use of digoxin in elderly patients with left ventricular failure and sinus rhythm may not be clinically justifiable; in a significant proportion of these patients the frequency of digitalis toxicity may outweigh the therapeutic benefits of the drug. When digoxin is used in elderly patients, the specific geriatric pharmacology of the drug must be considered. Clinical benefit should be documented before proceeding to long‐term maintenance therapy. In selected elderly patients, withdrawal of digoxin with careful follow‐up may be a worthwhile procedure. Studies are needed comparing the relative benefits and toxicities of digoxin versus diuretics in the management of heart failure in the elderly.
The Role of Estrogens in Mastopathy and Mammary Cancer in Perimenopausal Women
Authors: GREENBLATT ROBERT B. , VASQUEZ JAIME , SAMARAS CONSTANTINE , NEZHAT CAMRON
Published: April 2015

Fibrocystic disease of the breast (FCD) is an exaggeration of the normal physiologic response to cyclic estrogen and progesterone stimulation. The disorder can persist, with much less severity, in the menopausal woman. Whether FCD predisposes to mammary cancer remains moot. A new steroidal agent, danazol, can eliminate nodosities in the majority of women with FCD. Thermography may identify women who are at greater risk because of increased heat production. Mammography should be employed in women with persistently abnormal thermograms, even though no suggestive breast masses are palpable. Needle biopsy or surgical biopsy should be undertaken whenever a firm indurated mass is palpated, regardless of negative findings with a thermogram or mammogram. In a series of 1548 women treated for 10,715 women‐years, the incidence of breast cancer after prolonged estrogen therapy was not increased. Although estrogens and prolactin have been incriminated in the etiology of mammary cancer, no hard facts exist to confirm such allegations.
Acute‐care Hospitalizations and Long‐term Care: An Examination of Transfers
Authors: Stark A. J. , Gutman G. M. , McCashin B.
Published: April 2015

A Long‐term Care Program was introduced throughout British Columbia, Canada, on January 1, 1978. This comprehensive community‐based program emphasizes home care. A longitudinal study was started of all persons (N = 3518) admitted to the program that year in two health districts, one urban and one semirural. An examination of the relationship between acute‐care hospitalization and long‐term care (LTC) involved determining (1) the number of admissions (N = 364) to LTC directly from acute‐care settings versus the number (N = 1287) entering directly from the community, (2) the number of LTC persons who were hospitalized at least once in the first 12 months after admission to LTC, and (3) the outcomes of these hospitalizations. Persons from the urban area who entered the LTC Program from an acute‐care hospital were much more likely to be institutionalized than were those from the semirural area. In the LTC facility group, 388 persons (19.9 per cent) experienced at least one acute‐care hospitalization during the first year of the program. More than 50 per cent of those transferred to an acute‐care hospital for the first time returned to the same location and level of care afterward; 14 per cent died. These descriptive analyses may be of interest to health‐care planners and to those who care for the LTC elderly either at home or in a facility.
Hyperactivity in Senile Dementia
Authors: Finestone Douglas H. , Larson David B. , Whanger Alan D. , Cavenar Jesse O.
Published: April 2015

To illustrate the occurrence of hyperactivity in older adults with senile dementia, three case histories are presented. The clinical features, premorbid history, and therapeutic management are outlined. Difficulties in drug treatment are discussed, with emphasis on scheduling medication to minimize the complications of hyperactivity.
Control of Systolic Blood Pressure in Elderly Black Patients
Authors: APPLEGATE WILLIAM B. , VANDER ZWAAG ROGER , DISMUKE S. EDWARDS , RUNYAN JOHN W.
Published: April 2015

To study what effect the level of control of systolic blood pressure (SBP) has in elderly persons with systolic‐diastolic hypertension, 503 elderly black hypertensive patients were followed up for as long as nine years. The combined rate of hospitalizations and mortality for hypertension‐related disorders was significantly (P < 0.01) higher for the group with inadequate control of SPB (mean, 183.6 mm Hg) than for the group with partial (mean, 151.2 mm Hg) or complete (mean, 131.5 mm Hg) control. The group with complete control of SBP had a significantly (P < 0.005) higher combined rate of hospitalizations and mortality for hypertension‐related disorders than did the group with partial control. This suggests that a target goal for control of systolic as well as diastolic blood pressure should be set for elderly black hypertensive patients. However, the control of SBP should not be too rigorous.
Induced Disability in Nursing Home Patients: A Controlled Trial
Authors: AVORN JERRY , LANGER ELLEN
Published: April 2015

Many performance deficits observed in institutionalized elderly patients may be the result of social and environmental factors rather than disease or the aging process. To test this hypothesis, 72 nursing home residents (mean age, 78 years) were randomly assigned to three groups for training in completion of a simple psychomotor task. In four training sessions, members of Group I (“helped”) were given extensive assistance in completing the task; members of Group II (“encouraged only”) were given verbal encouragement but minimal assistance; members of Group III (“no contact”) received no training sessions and served as controls. All subjects were tested on proficiency in completion of the task (a simple jigsaw puzzle) before and after the intervention period. Completeness of performance by Group II improved during the study, but that of Group I deteriorated significantly (P = 0.04 between groups) to a level even below that of the control group (P = 0.03). Similar differences were found in speed of performance, with Group II performing best, Group I performing worst (P = 0.05), and the control group performing intermediately. Perception of task difficulty was greater (P = 0.02) and self‐confidence was less (P = 0.06) for Group I than for Group II. The psychosocial environment of long‐term facilities can have important effects on the competence of elderly patients. Excessive infantilization of residents and overly intrusive help in self‐care beyond clinical requirements can lead to “learned helplessness,” with further disability.
Brain Weights in Septuagenarians
Authors: HOWELL TREVOR H.
Published: April 2015

The brains of 90 septuagenarians were weighed and examined at autopsy. The heaviest weighed 2110g and the lightest 907g. They were classified by sex and by pathologic changes. Many of the brains were lighter than the accepted normal, the majority being between 1100 and 1199g. This result is compared with the findings among the brains of 102 octogenarians and 29 nonagenarians previously reported.
The Relationship of Self‐help Networks to Physical and Psychosocial Functioning
Authors: STEIN SHAYNA , LINN MARGARET W. , STEIN ELLIOTT M.
Published: April 2015

One hundred fifty‐eight elderly persons living in retirement hotels and apartments were classified by being receivers or givers of help to their neighbors into four groups: givers, getters, both (GG), or neither (NGG). The aim was to determine whether the groups differed in personal characteristics, physical functioning, or psychologic adjustment at baseline and six months later. The groups did not differ in personal characteristics. The NGG group (N = 55) functioned significantly less well, both physically and psychosocially. At six months, with baseline scores adjusted, the givers had fewer illnesses and the GG group had better self‐esteem. Thus, subjects did not change significantly in other variables. Efforts to enhance the ability of the NGG group to form social networks, if applied cautiously, may help to improve their overall adjustment.
Age‐dependent Differences in Outcome of Infections, with Special Reference to Experiments in Mice
Authors: LOURIA DONALD B. , SEN PURNENDU , BUSE MARGA
Published: April 2015

The host defects that increase either the frequency or the severity of certain infections in older persons are reviewed briefly. The major defect is in the functioning of the lymphocyte‐macrophage system; this is expressed as deficits in cutaneous reactivity and T cell response after antigenic stimulation. A review of induced infections in experimental animals shows results generally consistent with the data in humans. Infections due toLis‐teria monocytogenes, Salmonella typhimurium, and Toxoplasma gondii all appear to be worse in senescent mice; each of these organisms is dealt with primarily by the lymphocyte‐macrophage system. We have recently completed studies on aged mice infected with Staphylococcus aureus, an organism dealt with primarily by polymorphonuclear leukocytes rather than the lymphocyte‐macrophage system. Surprisingly, staphylococcal infections were much worse in older animals. These studies suggest that in older mice there may also be a defect either in polymorphonuclear leukocyte mobilization and/or function or in the ability of older mice to resist the lethal effects of staphylococcal toxins.
Shoulder Subluxation in Elderly Inpatients
Authors: CARPENTER G. I. , MILLARD P. H.
Published: April 2015

Examination of the plain chest radiographs of 300 patients consecutively admitted to a department of geriatric medicine revealed that 16 patients had subluxation of the shoulder. Subluxation and excursion of the humeral head were measured, and the results were correlated with the range of movement and the ability to perform the activities of daily living. No significant relationship was found, but there was a tendency toward increased impairment of movement with increased excursion. The causes of shoulder subluxation include rheumatoid arthritis and previous injury, but subluxation may be no more than a reflection of the aging process, lax musculature, or an intrinsic mild abnormality of the joint structure. As it is of little practical significance, treatment should be undertaken only in the presence of troublesome pain.