bluuebunny/crossref_metadata_2025 huggingface dataset:
Pseudo‐Senility: Acute and Reversible Organic Brain Syndromes*
Authors: LIBOW LESLIE S.
Published: April 2015

The cerebral blood flow in healthy elderly men is not notably different from that in 20‐year‐old control subjects. Only in the presence of a significant degree of arteriosclerosis is there a decrease in cerebral blood flow. Eventually there is a decrease in cerebral metabolic function associated with a decline in mentation. To explain much of the early mental change in many elderly persons, the environment must be assessed. In an 11‐year NIMH study of more than 600 variables, 2 factors proved to be accurate predictors of survival and mortality in the healthy elderly: (a) a new health indicator, viz, the organization of the subject's daily behavior; and (b) the presence or absence of chronic cigarette smoking. Behavior patterns of today's elderly are discussed.

Pseudosenility, i.e., acute and potentially reversible mental change, is common in the elderly and may often be overlooked or misdiagnosed. Some causes are: medications, metabolic imbalance, depression, malnutrition, malignancy, hepatic disease, diminished cardiac output, cerebrovascular syndromes, febrile conditions, and chronic lung disease. Chronic, possibly reversible, mental syndromes include the depressions, dementias, deficiency states, and alcoholic encephalopathies. The treatment is outlined.
Why More of the Aged with Auditory Deficits Do Not Wear Hearing Aids
Authors: WEISS CURTIS E.
Published: April 2015

The information in this article regarding aural rehabilitation was obtained directly and indirectly from aged persons with impaired hearing, from their families, and from nurses and assistants in several nursing homes and extended care facilities. Although many elderly persons with auditory deficits have had successful experiences with hearing aids, many others have not. The possible reasons are discussed, as are ways of overcoming prevalent negative attitudes by study of the psychosocial aspects and the careful assessment of individual patients by qualified personnel.
Cardiovascular Adaptation to Twelve Minutes of Mild Daily Exercise in Middle‐Aged Sedentary Men*
Authors: TERJUNG R. L. , BALDWIN K. M. , COOKSEY J. , SAMSON B. , SUTTER R. A.
Published: April 2015

A group of sedentary middle‐aged men (N=15) completed a 6‐week exercise program that involved two 6‐minute daily exercise bouts of running‐in‐place. Total body weight, skinfold thickness and serum triglyceride levels were not altered by this mild exercise program. However, increases in the subjects' work capacity and decreases in systolic blood pressure and heart rate for a given work load were observed. The results of measuring systolic time intervals by a noninvasive technique suggested that myocardial contractility at rest had increased after the 6‐week period. These results indicate that a beneficial adaptation of cardiovascular function can occur in sedentary middle‐aged men in response to a mild form of activity that can be accomplished with a minimum of time, inconvenience and facilities. In addition, the use of noninvasive techniques in measuring systolic time intervals appears to be a useful means of evaluating changes in cardiovascular function induced by exercise training.
Fasting Serum Cholesterol and Triglyceride Levels in the Elderly: Relation to Glucose Homeostasis*
Authors: WILMSHURST ERROL G. , ZEYTINOGLU IBRAHIM Y. , KAUFMANN ROBERT L. , GHERONDACHE CONSTANTIN N. , SOELDNER J. STUART
Published: April 2015

In 62 elderly subjects (age range, 66 to 100 years), fasting serum cholesterol and triglyceride concentrations were determined after three days of a high carbohydrate diet. Mean cholesterol levels were within accepted normal limits for the lower age groups and did not differ significantly between the age groups studied. Mean triglyceride levels were highest in the 70–79 age group and significantly lower in older subjects. Serum triglyceride values greater than 200 mg/100 ml were always associated with carbohydrate intolerance, and there was a highly significant correlation between fasting triglyceride concentration and fasting glucose concentration in the subjects with the more severe degrees of carbohydrate intolerance. There was no evidence of induction of hypertriglyceridemia by the high carbohydrate diet in these subjects.
Introductory Remarks at the Inaugural Meeting of the Western Division of the American Geriatrics Society, Los Angeles, California
Authors: GRIFFITH GEORGE C.
Published: April 2015

The inaugural meeting of the Western Division of the American Geriatrics Society was held on October 10, 1972 in the Los Angeles Hilton Hotel, Los Angeles, California. These introductory remarks outline the purposes of the American Geriatrics Society, as part of the plan for better health care that should not wait for government implementation. These efforts are particularly pertinent for the southwestern United States where so many elderly people have moved. Mental and physical health and continued productivity are the goals.
An Ergot Alkaloid Preparation (Hydergine) versus Papaverine in Treating Common Complaints of the Aged: Double‐Blind Study
Authors: BAZO ALBERT J.
Published: April 2015

Sixty‐six geriatric patients with various “complaints of the aged” attributable to cerebral arteriosclerosis with cerebrovascular insufficiency received standard dosages of Hydergine (an ergot alkaloid preparation) or papaverine for twelve weeks in a double‐blind study. No adverse reactions occurred in patients taking either drug. Ratings of symptom severity, overall clinical condition, global therapeutic change, and mental status evaluations showed that the Hydergine group consistently improved more than the papaverine group. Hydergine was significantly superior to papaverine in relieving impaired mental alertness, confusion, irritability, hostility, emotional lability, depressive mood, and lack of motivation. Time‐response analyses indicated that the therapeutic effects of Hydergine were steadily progressive during the trial, whereas the effects of papaverine tended to become manifest only late in the 12‐week trial, if at all. The greatest benefits of Hydergine therapy seemed to be in the areas of intellectual function or cognition.
Lingual‐Facial‐Buccal Movements in the Elderly. I. Pathophysiology and Treatment
Authors: WEINER WILLIAM J. , KLAWANS HAROLD L.
Published: April 2015

The syndrome of lingual‐facial‐buccal movements (dyskinesia) in the elderly involves the dopaminergic neuronal system and particularly the dopamine receptor sites of the corpus striatum. On the basis of experience with similar movements observed in other diseases and of the interpretation of animal studies on amphetamine‐induced stereotyped behavior, agents that block dopamine receptor sites, e.g., chlorpromazine or haloperidol, are the treatment of choice for this syndrome. Anticholinergic drugs should not be used.
Etiology of Obesity — The QQF Theory*
Authors: SCHAUF GEORGE EDWARD
Published: April 2015

The QQF theory for the etiology of obesity is contrasted with the traditional caloric theory. QQF represents (Q) the quality of food as well as (Q) the quantity of food, and (F) the frequency of ingestion. The QQF approach to the treatment of obesity (over 900 cases) is based on the differential between lipogenesis and triglyceride storage on the one hand, and lipolysis and fatty‐acid oxidation on the other.
Remotivation Therapy
Authors: BIRKETT DAVID PETER , BOLTUCH BRUCE
Published: April 2015

Remotivation therapy is widely used in U. S. mental hospitals and is supposed to be particularly useful in the treatment of the chronically ill. Ward aides are used as therapists. A controlled trial of remotivation therapy versus conventional group therapy in thirty‐nine ambulant geriatric in‐patients is described. The outcome, as measured by the Palo Alto Scale and the Remotivation Technique, showed some advantage for remotivation therapy, but the difference was not statistically significant.
Fluorescein Circulation Time and the Treatment of Hypertension in the Aged*
Authors: FISHBACK DAVID B.
Published: April 2015

ABSTRACT: An objective test for circulation time was performed in rabbits with the use of various dyes, of which the best was 10% fluorescein. The average circulation time in rabbits was 5–6 seconds. Serum from hypertensive patients injected intravenously into rabbits usually prolonged the circulation time. Differences in the results based on the age of the patients indicated a more benign type of hypertension in the elderly.

An outline is given of the treatment of hypertension in the aged. Many cases respond fairly well to reassurance, a low‐salt diet, and weight reduction when the patient is obese. If additional measures are needed, diuretics are effective, especially furosemide (40 mg once or twice daily). In moderate or severe hypertension with renal parenchymal disease and a high level of blood urea nitrogen, methyldopa (250 mg two to four times daily) is of value. Potassium supplements should be given along with diuretics. In the Philadelphia Geriatric Center there are 325 residents, nearly all between the ages of 70 and 100; and more than 140 of them have hypertension. There are about 100 cases of depression (present or past), 75 cases of hiatal hernia (some with ulcer), and 53 cases of peptic ulcer. Since reserpine can aggravate peptic ulcer and can precipitate or aggravate depression, it should not be used to treat hypertension in the aged; nor should guanethidine be used for this purpose, since it can cause weakness and cerebrovascular insufficiency. High blood pressure should be reduced slowly in the aged, to avoid untoward effects.
Relationships between Age, Sex and Symptomatology in Psychiatric Outpatients
Authors: PLUTCHIK ROBERT , CONTE HOPE R.
Published: April 2015

ABSTRACT: Three hundred and twenty psychiatric outpatients whose ages ranged from 8 to 80 years, were evaluated by five psychiatrists according to a standard checklist describing symptoms and social strengths. The analyses compared the patients over age 50 with those under age 50, on the basis of 22 symptoms and 11 strengths. A finer analysis also was made by dividing all patients into four age groups: under 20, 21–35, 36–50, and 51 or over. A study of male‐female differences showed very few systematic changes in symptoms or strengths that were related to age. The observed systematic changes indicated that “family conflicts” decreased with age, and that “relates easily” and “good adjustment” increased with age. The findings indicate that the younger males tended to manifest more schizophrenic symptoms, whereas the older males appeared more depressed than schizophrenic. Apparently age was unrelated to symptomatology in the female groups. In all age groups, the females possessed a greater number of strengths than did the males. Thus aging per se does not necessarily lead to an increase of symptoms or a decrease of social strengths in psychiatric outpatients. This conclusion, however, must be qualified in terms of the possibility of a selective dropout rate for certain types of patients connected with clinics.
Long‐Term Cholesterol‐Lowering Effect of Colestipol Resin in Humans*
Authors: GROSS LUDWIG , FIGUEREDO ROLAND
Published: April 2015

In a double‐blind study, colestipol resin was administered to hypercholesterolemic patients for periods ranging from one to three years. Twenty‐two patients received colestipol, and 22 placebo; all received the usual American diet. This medical interruption of the enterohepatic circulation of bile acids significantly lowered the concentration of serum cholesterol within a month, and maintained it at that level during the period of study. The effect on the triglyceride level was not so marked, though there was a tendency toward elevation. Side effects from the placebo were similar to those from the drug. This cholesterol‐lowering action of colestipol may be of importance in relation to arteriosclerosis.
Behavioral Effects of Drug Therapy on Psychogeriatric Inpatients. II. Multivitamin Supplement
Authors: ALTMAN HAROLD , MEHTA DINESH , EVENSON RICHARD C. , SLETTEN IVAN W.
Published: April 2015

ABSTRACT: Psychogeriatric inpatients were treated with a B‐complex and C vitamin preparation (Albee with C) for six weeks in a double‐blind study. (Total N = 132.) They were rated on the MIBS, a new inpatient behavior form that involves 11 factored scales. One clinically and statistically significant finding emerged: there was a striking decrease in pathologic manifestations on the MIBS Excitement scale for a non‐schizophrenic subgroup of the vitamin‐treated sample compared to the placebo sample. Implications of this finding are discussed in terms of a detailed examination of the Excitement scale and in terms of a literature review of the effects of vitamin therapy on the behavior of psychogeriatric patients.
Factors Affecting Care of the Patient: Clients, Government Policy, Role of the Family and Social Attitudes*
Authors: SHANAS ETHEL
Published: April 2015

ABSTRACT: There will be no lessening of the demand for long‐term care facilities, despite the increase in home care and community services. The subject is discussed with regard to the statistics on admission to these facilities, government attitudes toward alternative modes of care, family relationships, and social attitudes. The quality of care in nursing homes will be enhanced by the continuing education of the staff and the public concerning the potentialities for enriching the lives of the aged residents.
Sex in Retrospect
Authors: WILSON JAMES M.
Published: April 2015

ABSTRACT: The author presents a brief survey of sexual mores through the ages from the points of view of biology and society, and more specifically, sex and love.
A New Scale for Clinical Assessment in Geriatric Populations: Sandoz Clinical Assessment – Geriatric (SCAG)*
Authors: Shader Richard I. , Harmatz Jerold S. , Salzman Carl
Published: April 2015

The importance of diagnostic differentiation between early senile deterioration and depressive disorders in the aged led to the development of Sandoz Clinical Assessment—Geriatric (SCAG) as a new rating instrument especially applicable to the elderly. It is composed of 18 symptom areas rated on a 7‐point format. Study 1 was carried out on 51 geriatric subjects (25 volunteers and 26 hospital inpatients at a health center), tested by SCAG and also by the widely used MSER (Mental Status Examination Record). In Study 2, data were obtained on 8 subjects tested by 4 psychiatrists, to determine interrater reliability. The statistical findings indicated that SCAG is a valid and reliable instrument for assessing psychopathology in the elderly.
Cardiorespiratory Failure in the Elderly Patient
Authors: Sternlieb Cheryl M.
Published: April 2015

Cardiorespiratory failure is relatively common in the geriatric population. Although heart disease is the most frequent cause, the specific etiology should be established for each patient. An unusual cause of cardiorespiratory failure is illustrated in a case report on a 71‐year‐old woman with progressive exertional dyspnea whose symptoms were erroneously assumed to be solely on the basis of hypertensive cardiovascular disease and heart failure whereas actually they were on the basis of tracheal compression due to a large thyroid mass in the superior mediastinum. The more common causes of cardiorespiratory failure in the elderly are discussed.
The Efficacy of Digitalis Withdrawal in an Institutional Aged Population
Authors: FONROSE HAROLD A. , AHLBAUM NEAL , BUGATCH EPHRAIM , COHEN MURRAY , GENOVESE CARMEL , KELLY JOHN
Published: April 2015

In a survey of an institutional geriatric population of 403 patients it was found that among 88 patients who were being maintained with digitalis, 31 had been receiving it for at least a year although currently there was no evidence of heart disease. A study was conducted to ascertain whether or not it was necessary to continue digitalis. Pertinent clinical and laboratory baseline data included serum digoxin levels and creatinine clearance; the remainder of the determinations were repeated three weeks and seven weeks after omission of digitalis. Baseline serum digoxin levels ranged from a trace to 2.7 ng/ml. Of the 31 patients, 15 (48 per cent) were successfully maintained without digitalis for four months. Because of slight signs of cardiac decompensation, digitalis was started again in the other 16 patients within three to twenty‐one days. However, the fact that 48 per cent of the series could be maintained without digitalis indicates the need for periodic re‐evaluation under such circumstances. Perhaps the drug was started originally because of transient cardiac stress induced by an acute illness, from which the patient recovered. In such cases, withdrawal of digitalis therapy may prove beneficial.
Geriatrics and the Elderly Woman*
Authors: ROSS C. HOWARD
Published: April 2015

The official representative of the American Geriatrics Society reports on the 26th Annual Conference on Aging at Ann Arbor, Michigan, September 10–12, 1973. The subject was “Women: Life Span Challenges.” In the various addresses, workshops, seminars and discussions, national recognition was given to the needs and potentialities of the elderly woman.
Human Spermhormone
Authors: SENECA HARRY , HENDERSON EDWARD
Published: April 2015

By a described process, spermhormone (an aqueous factor) was prepared from pooled human seminal fluid rich in spermatozoa. Tests were made in batches of white mice aged from 4 to 6 weeks. In each group tested there were 20 males, 20 females and 5 controls. The dose of spermhormone was 1 mg injected intraperitoneally twice a week for as long as twenty weeks. The females did not manifest any significant changes, but the males were hyperactive sexually and always fighting other males. At autopsy, the testes and seminal vesicles were found to be much larger than in the controls. The seminiferous tubules were packed with spermatozoa. Active spermatogenesis was evident. The Leydig cells were increased in number and size. Both female and male mice were fertile, but there was no evidence that spermhormone had estrogenic activity. Thus a lipopolysaccharide extracted from human spermatozoa stimulated spermatogenesis, the Leydig cells, the seminal vesicles, and the growth of male mice.
The Role of Natural Consequences in the Changing Death Patterns*
Authors: BARNES BRODA O. , RATZENHOFER MAX , GISI RICHARD
Published: April 2015

A comparison of the causes of death listed in autopsy protocols at Graz, Austria, for 1930 and 1970 showed that the major change was a marked decrease in deaths from tuberculosis and a marked rise in deaths from myocardial infarction. In 1930, patients over 50 years of age dying with tuberculosis had advanced coronary atherosclerosis which soon would have caused death if tuberculosis had not won the race. Myocardial infarction did not start its explosive rise until the introduction of specific drugs against the tubercle bacillus. This began in 1946 at a time when the diet was low in cholesterol, smoking was at a low ebb, sedentary life was unknown, and stress was decreasing as the war ended. Moreover, during the early years of the rise in myocardial infarction there was evidence of active or healed tuberculosis in postmortem studies. It appears that a major factor in the rise of coronary disease was prolongation of the life of patients with tuberculosis or a susceptibility to it. Coronary disease and emphysema accounted for 90 per cent of the increase in degenerative diseases. Prostatic cancer, juvenile cancer and lung cancer together accounted for 86 per cent of the rise in malignant diseases. Thus the law of chance did not control the distribution of the causes of death among those escaping death from infections. In myocardial infarction, the preponderance of males is similar to that in tuberculosis, indicating that supply and demand may be to blame. Any theory about the changing death patterns should take into account the factor of natural consequences, as may be revealed in autopsy studies.
Pulmonary Embolism: A Most Underdiagnosed and Untreated Disorder*
Authors: WRIGHT IRVING S.
Published: April 2015

ABSTRACT: Pulmonary embolism is a serious and highly lethal disorder which is greatly underdiagnosed and undertreated. In elderly patients it is a common and often fatal complication of thrombotic disease. It is not described in the ancient literature, nor thereafter until the chair became universally used in our civilization. Present habits of prolonged sitting, as during travel, entertainment, study, and certain forms of work, contribute to venous stasis and secondary pulmonary embolism. Etiologic factors are reviewed and new iatrogenic factors discussed. Modern techniques increase the accuracy of diagnosis, but a strong index of suspicion on the part of the physician and a careful history still play a major role. Prophylactic and treatment measures are highly effective if used early and adequately. The prevention of venous stasis is important in prophylaxis. Anticoagulant drugs, notably heparin and the coumarin compounds, are the most effective weapons in the majority of cases.
Involutional (Physiologic) Bone Loss in Women and the Feasibility of Preventing Structural Failure*
Authors: MEEMA H. ERIK , MEEMA SILVIA
Published: April 2015

ABSTRACT: One of the most remarkable manifestations of the normal aging process is loss of bone after age 45–50 in apparently normal women. The magnitude of this loss is such that after the age of 80 virtually all women have bone masses that are smaller than those of normal women before the age of 45, i.e., the two populations with respect to bone mass are entirely different. The relationship of such “physiologic” bone loss to structural failure (vertebral compressions, fractured femoral necks) is discussed by comparing the radiologically measured bone mineral mass in the proximal radius in normal women throughout the adult age range with that in a group of 71 women with vertebral compressions and 36 women with femoral‐neck fractures. At a time of life when the incidence of structural failure is still low, a critical range of bone mass can be defined in which the abnormality (bone loss) is clearly recognized in the radius. The prevention of further bone loss at this stage should markedly lower the incidence of both the “crushed vertebrae syndrome” and femoral‐neck fracture. This approach is particularly appropriate for those geriatric female patients who still enjoy active life, including sports and travel.
Non‐Fatal Ketoacidosis in a 94‐Year‐Old Diabetic Patient
Authors: CAMPBELL IAN W.
Published: April 2015

ABSTRACT: A 94‐year‐old insulin‐dependent diabetic female was successfully treated for ketoacidosis precipitated by streptococcal cellulitis, cardiac failure and bronchopneumonia. This patient appears to be the oldest to have survived an episode of ketoacidosis. In elderly patients with severe diabetic metabolic decompensation, multiple precipitating factors are common. Reversible causes, especially infection, must be actively treated.
Another Culture, Another Time
Authors: SPEISER ABRAHAM M.
Published: April 2015

ABSTRACT: The case histories of 3 experiences with geriatric Navajo Indians are presented. They illustrate cultural and physical differences which affected therapy.
Procaine (Gerovital H3) Therapy: Mechanism of Inhibition of Monoamine Oxidase
Authors: MacFARLANE M. DAVID , BESBRIS HOWARD
Published: April 2015

ABSTRACT: The mechanism by which Gerovital H3 (GH3), a specially stabilized form of procaine hydrochloride, produces a weak inhibition of the enzyme, monoamine oxidase (MAO), was studied by several methods. Purified rat‐brain mitochondrial MAO was used as the enzyme source and the reaction velocities were determined by quantitating the rate of appearance of 4‐hydroxyquinoline from kynuramine. Data on dilutional studies with pre‐incubated enzyme‐inhibitor complexes, as well as other data, strongly indicated that GH3 was a reversible inhibitor of MAO. Analysis of Lineweaver‐Burk and Dixon plots obtained by determining the velocity of oxidation of kynuramine with various concentrations of substrate and inhibitor, showed that GH3 was a fully competitive inhibitor of MAO. The weak, reversible, fully competitive inhibition of MAO produced by GH3 is in marked contrast to the potent, irreversible inhibition of MAO produced by currently available agents. The mechanism by which GH3 inhibits MAO may help to explain the absence of severe adverse reactions with GH3 that are traditionally associated with irreversible MAO inhibitors in the treatment of depressive illness. Because of these characteristics of GH3 as an inhibitor of MAO, assessment of its activity in vivo may not be easily accomplished, despite its pronounced pharmacologic effects.
Hyperbaric Oxygenation and the Cognitive Functioning of the Aged
Authors: EDWARDS ALLAN E. , HART GEORGE M.
Published: April 2015

ABSTRACT: Twenty subjects (average age, 67.9 years) were given hyperbaric oxygen (100% at 2 atmospheres pressure) for 15 daily sessions of two hours each. Comparison of “before” and “after” intelligence‐test results revealed substantial improvement, particularly in tests concerned with short‐term memory and visual organization. The subjects who benefited most were those whose “before” Wechsler Memory Quotients were between 70 and 110. There was no indication that the improvement reached a plateau after 15 sessions.
Preventive Aspects of Geriatric Medicine*
Authors: ANDERSON W. FERGUSON
Published: April 2015

ABSTRACT: A program for the practice of preventive medicine in the 70+ age group is outlined. This type of work is extremely satisfactory, as in all countries it is essential not only to treat illness but to keep the population as healthy as possible. Old age can be a time of great pleasure and enjoyment and should not be associated in the public mind with either poverty or ill health. In essence, it is postulated that the positive planning of activities with a purpose clearly understood by the elderly will improve their physical, mental and social health. Such activities will provide a place and life purpose for older citizens in the community and will ensure their continued integration as a useful and essential part of society.
Vertebrobasilar Arterial Insufficiency with Dementia. Controlled Trials of Treatment with Betahistine Hydrochloride*
Authors: RIVERA VICTOR M. , MEYER JOHN STIRLING , BAER PAUL E. , FAIBISH GEORGE M. , MATHEW NINAN T. , HARTMANN ALEXANDER
Published: April 2015

ABSTRACT: A double‐blind cross‐over study was made of the effects of betahistine hydrochloride in 50 patients who had symptoms and signs of vertebrobasilar insufficiency associated with dementia, confirmed by detailed neurologic and clinical investigation. They were treated for six weeks by oral administration of either betahistine‐HCl (32 mg daily in four doses) or an identical‐appearing placebo, and then for six weeks by these preparations in reverse order. Evaluations made initially and at six‐week intervals included detailed assessment of neurologic functions rated according to a quantitative scale. A series of neuropsychologic tests was also given before and after each treatment period. Statistical analyses of neurologic and of psychologic status showed significant improvement with betahistine‐HCl therapy, particularly with respect to verbal and nonverbal cognition, memory, language use, spatial construction, perceptual‐motor coordination and perception. Measurements of regional and mean cerebral blood flow indicated a significant increase with betahistine therapy.
Postoperative Pulmonary Complications in the Geriatric Age Group*
Authors: GRODSINSKY C. , BRUSH B. E. , PONKA J. L.
Published: April 2015

ABSTRACT: Postoperative pulmonary complications are a serious danger to any patient who undergoes surgery. The increase in geriatric surgery has brought into focus certain marginal factors that can spell the difference between success and failure. In a series of 300 elderly patients who underwent major surgery at the Henry Ford Hospital, there were 34 in whom clinical and radiologic evidence of atelectasis developed. In 19 others, x‐ray examination of the chest showed various infiltrates suggesting pneumonitis, and sputum cultures grew coliform bacteria. Despite appropriate treatment, 5 patients died from postoperative pulmonary complications. Illustrative cases of hypoventilation, atelectasis, pneumonia and pneumothorax are presented. Recommendations are made for the care of the elderly undergoing major surgery, including the preoperative identification of chronic lung disease, determination of the respiratory reserve, preoperative exercises in deep breathing and coughing for use after operation, adequate oxygenation during the surgical procedure, close supervision of postoperative respiratory ventilation for the first seventy‐two hours, selective use of mechanical respiratory assistance, and emphasis on early ambulation.
Importance of Immediate Gram‐Stain Examination of the Sputum in Infections of the Lower Respiratory Tract
Authors: GORDON M. , RUDENSKY B. , MENCZEL Prof. J. , GOLDSTEIN M. S.
Published: April 2015

ABSTRACT: A study was made of 20 patients (average age, 74) admitted to the Internal Medicine Service from the emergency ward because of acute infections of the lower respiratory tract, to determine the degree of correlation between the findings upon immediate Gram‐stain examination of the sputum and the subsequent findings upon examination of the sputum culture. It was found that the choice of initial antibiotic therapy could be made on the basis of the immediate Gram‐stain examination and the clinical picture. There was a high incidence of pneumonia from nosocomial Gram‐negative organisms in the hospital population of elderly debilitated patients who usually had several chronic diseases. This characteristic made careful examination of the Gram‐stain sputum preparation an essential part of the initial evaluation of all patients admitted with acute infections of the lower respiratory tract, in order to reduce the excessive mortality associated with these initial infections.
Sexuality in the Aging Individual*
Authors: PFEIFFER ERIC
Published: April 2015

ABSTRACT: Sexual activity may continue to play a significant role in the life of the elderly person. At age 68 about 70 per cent of men still regularly partake in sexual activity, and even at age 78 about 25 per cent are sexually active. For men, the married state is not a necessary factor, whereas for women it makes all the difference. Very few unmarried older women report regular sexual activity. Unavailability of a sanctioned sexual partner is the chief determinant. The ratio of available older women to available older men may approach 4:1 in many environments. Sexual expression requires privacy, an aspect of life that is often neglected for the aged. The physician should take these needs into consideration when counseling or when planning programs to improve the quality of life in the later years.
Clinical Features, Etiology and Treatment of Facial Dyskinesias in the Elderly
Authors: ROSIN ARNOLD J.
Published: April 2015

ABSTRACT: The etiology of buccal‐lingual masticatory dyskinesia is varied. A study is presented of 16 cases, of which 15 were in old people. In cerebral arteriosclerosis this form of dyskinesia may appear as a passing phenomenon and as a sign of further neurologic damage. In the setting of a cerebrovascular accident, it may be a discrete sign. It may appear in cases of senile chorea, and sometimes after brain‐stem operations. It can be caused by administration of L‐dopa or phenothiazines. The etiology of dyskinesia is discussed in relation to excess dopamine effect, and it is proposed that a restoration of the dopamine‐cholinergic balance (? by physostigimine) might result in diminution of the movements. Brain damage contributes to the genesis of the involuntary movements through disturbance of the biochemical balance in the midbrain basal nuclei. Graded doses of haloperidol or reserpine, or even perphenazine, may constitute effective therapy, when indicated.
Conduction Defects in the Aging Heart
Authors: BHAT PACHALLA K. , WATANABE KAZUMI , RAO DODDA B. , LUISADA ALDO A.
Published: April 2015

ABSTRACT: Four hundred and fifty‐five patients over age 65 with atrioventricular and intraventricular conduction defects were studied for periods of from two to five years (average, twenty‐six months). Data on the overall incidence of conduction defects, the sex incidence, the type of block, and the associated electrocardiographic abnormalities are presented. There was no ECG evidence of extension of the blocks based on prolongation of the P‐R interval, a shift or an increase in axis, a shift of the block from one branch to another, or an increase in width of the QRS complex. Left bundle‐branch block and left anterior hemiblock, either alone or in association with any other fascicular block, were more common in the female patients whereas right bundle‐branch block was more common in the male patients.
Uric Acid and Coronary Heart Disease
Authors: HALPERN Manuel. J. , MIGUEL M. S. PEREIRA
Published: April 2015

ABSTRACT: This article stresses the clinical importance of determining the serum uric acid level in cases of hyperlipidemia, particularly hypertriglyceridemia, since there is a direct application to the management of coronary heart disease. The hypothesis is proposed that hypertriglyceridemia associated with hyperuricemia is the result of a primary alteration in carbohydrate metabolism.
Wine in the Treatment of Long‐Term Geriatric Patients in Mental Institutions
Authors: MISHARA BRIAN L. , KASTENBAUM ROBERT
Published: April 2015

ABSTRACT: The therapeutic effects of wine were studied in 80 long‐term psychogeriatric patients in two hospital wards each containing 20 men and 20 women. One ward was run on a Token Economy Program (TEP) and the other on a Free Enrichment Program (FEP). Under TEP, wine (limit, two servings of 1 1/2 ounces each) was purchasable with tokens earned by good behavior; under FEP, the wine was free regardless of behavior. The study lasted ten weeks, with a six‐month follow‐up. After the introduction of wine, there was a dramatic reduction in the use of chloral hydrate to induce sleep. There also was an increase in congenial interpersonal communication. The earning of wine tokens was a positive element in improving the behavior of some patients on the TEP ward, although it was a less effective behavioral reinforcement than cigarettes. Thus wine may play a significant role in treatment programs for the elderly. The subject needs further investigation.
Mental Decline in the Elderly: Pharmacotherapy (Ergot Alkaloids versus Papaverine)
Authors: Rosen Herbert J.
Published: April 2015

This is the first double‐blind study in outpatients to evaluate the effectiveness of dihydrogenated ergot alkaloids (DEA) (Hydergine) versus papaverine in the treatment of selected symptoms associated with mental aging. In addition, this is the first study comparing these two pharmacologic agents in relatively young geriatric patients, with a mean age in the mid‐sixties. After twelve weeks of treatment, ratings of overall clinical condition and global change showed that the 26 patients given DEA improved more than twice as much as the 27 patients given papaverine. Of the 14 individual symptoms rated, 13 improved significantly more in the DEA group than in the papaverine group. These symptoms included confusion, dizziness, unsociability, depressive mood, and mental alertness. Other data confirmed the generally superior results with DEA.

In view of its demonstrated beneficial clinical actions and of its notable scarcity of contraindications or side effects, DEA appears to represent a significant pharmacologic contribution to the care of elderly persons showing selected symptoms of mental and functional decline.
Effects of Aging on Granulopoietic Activity (Colony‐Stimulating Factor)
Authors: Earney William W. , Earney Adam J. , Graham James D.
Published: April 2015

This investigation was undertaken to determine whether there is a decrease of granulopoietic activity in subjects of the geriatric age group. Colony‐stimulating factor (CSF) is an alpha glycoprotein which causes proliferation of granulocytes in vitro. A study was made of the variation in the level of CSF with age and the state of health in 78 subjects. They were classified into two groups—young (ages 22–60) and old (ages 70–94). The state of health was classified as normal, acute disease, or chronic disease. The results showed that serum CSF does vary with age and health. The CSF levels were higher in the young than in the old. For both age groups, the CSF levels were elevated in acute disease, and subnormal in chronic disease.
Effects of Diphenylhydantoin on Mental Abilities in the Elderly†
Authors: Smith W. Lynn , Lowrey Jack B.
Published: April 2015

An assessment was made of the effects of diphenylhydantoin (DPH) on the mental functions of clinically normal elderly persons. Their basic intelligence levels ranged between normal and bright‐normal and they represented middle and lower‐upper socio‐economic groups. The 10 subjects, 4 male and 6 female volunteers (average age, 69.3 years), were given pretrial intelligence tests, repeated twice during a double‐blind, cross‐over study of drug and placebo effects. Each cross‐over period lasted three weeks. The dosage of DPH (Dilantin) was 100 mg twice daily, and placebo capsules of identical appearance were given on the same schedule. The Wechsler Intelligence Scale series in three alternate forms was used to measure specific mental functions. The weighted scores of the alternate forms were directly compared to measure the difference between drug and placebo conditions.

Significant increases in favor of DPH were observed in the Information, Comprehension, and Digit Symbol subtests, and in the Verbal Scale and Full Scale Intelligence Quotients. The first two measures indicated significant improvement in long‐term memory and social comprehension. The third reflected an increase in the ability to learn new material and increased speed in visual‐motor coordination. The fourth and fifth showed the effectiveness of DPH in improving general mental functioning. Apparently the underlying factor synthesizing these general DPH‐associated improvements is mental concentration.
Anterior Urethral Diverticulum in the Male: Report of Two Cases
Authors: Tanenbaum Barton , Klinger Milton E.
Published: April 2015

Anterior urethral diverticulum in the male is relatively uncommon; 2 additional cases are presented. One of the patients had a unique fusiform dilatation of the urethra, the first to be reported in an adult as an acquired diverticulum. Features distinguishing acquired from congenital urethral diverticula are discussed.
Electroencephalographic and Behavioral Changes Associated with Papaverine Administration in Healthy Geriatric Subjects
Authors: Cole Jonathan O. , Branconnier Roland J. , Martin Gary F.
Published: April 2015

A double‐blind cross‐over procedure was used to evaluate the effects of papaverine hydrochloride on the electroencephalogram (EEG), cognition, mood and psychologic test performance of 10 healthy geriatric volunteers. During the two‐week period, each subject was tested four times: before and after receiving papaverine and before and after receiving placebo. Period analysis revealed that a 300‐mg dose of papaverine (Pavabid Plateau Caps) increased EEG alpha activity (8–13 cycles per second) and decreased the beta2 range (27–40 cps). Baseline values for six mood factors, short‐term memory, complex problem solving, and attention were not altered significantly by either drug or placebo. Results of the Subject Paced Digit Symbol Substitution Test indicated that papaverine may produce some improvement in simple cognitive functioning. No adverse effects were associated with the use of papaverine.
The Brain Ganglioside Pattern in Presenile and Senile Dementia
Authors: Den Velde W. Op , Hooghwinkel G. J. M.
Published: April 2015

Ganglioside lipid fractions in the cerebral gray matter were studied in 13 patients with various forms of dementia. In 2 patients with Alzheimer's disease and 1 with senile dementia an abnormal ganglioside pattern was observed, i.e., a decrease of G1 and G3 in association with an increase of G2. In the light of the total clinical and histologic data on the patients, it would seem that this disturbance in ganglioside metabolism may be a phenomenon accompanying extensive degradation of brain tissue rather than a factor in the etiology of dementia.
Suicide by Overdoses of Medicines Among the Aged†
Authors: Benson Roger A. , Brodie Donald C.
Published: April 2015

The current literature on suicide by medicinal overdose among the elderly population of the United States and Britain is discussed. The older white male is a high risk in this regard. Physical and mental illnesses contribute to the problem of suicide among the aged, and some of the drugs prescribed for treatment (e.g., barbiturates and psychotherapeutic agents) are often accessible to the older person for misuse in suicide. The responsibilities of the prescribing physician and the practices of the dispensing pharmacist are considered in relation to the exposure of the elderly patient to potentially lethal drugs. Prediction of suicidal attitudes in the elderly is complicated by the fact that any attempt at suicide usually is serious and rarely preceded by gestures. Depression, based on social factors, is common among older people. Some of them face problems of declining income and prestige, as well as a loss of physical and mental powers. A change in the attitude of society towards the elderly may help to alleviate the depressive state which so often contributes to the suicidal potential.
The Team Approach in a Psychogeriatric Unit
Authors: Goldstein S. , Birnbom F. , Miller B.
Published: April 2015

The importance of a multidisciplinary team approach was recognized when a 14‐bed short‐term Psychogeriatric Unit was opened in a psychiatric hospital. The limited time available to the psychiatrist in charge placed a heavy clinical responsibility on the paramedical personnel who formed the team. Initially, role distinctions were kept vague and regarded as not overly important. Six months after the Unit opened, all the staff members filled out a questionnaire. They felt that communication within the team was good, that they could fulfill the role of primary therapist, and that they understood their own roles and those of others. All regarded the psychiatrist as the head of the team. The psychiatrist felt that he had the ultimate responsibility for over‐all care of the patients, that any attempt to blur roles caused problems, and that there had been a partial regression to more traditional patterns. Members of the Unit regarded themselves as a team, able to work together and pool skills in treating patients, and thus play a significant part in total care. This attitude proved more valuable than attempting to break away from the medical model or decrying the importance of roles.
Soul Foods for Some Older Americans†
Authors: Boykin Lorraine S.
Published: April 2015

The elderly person brings with him a lifetime of food preferences. For him, nutritional adequacy is dependent upon continuation of similar underlying influences and the varying conditions which determine the food intake of any group. The significance of individuality cannot be minimized in assessing nutritional well‐being and in developing a plan of action. Among the factors affecting food acceptance and health status are foods which are considered “soul” by some persons. Recognition of, and respect for, individual food preferences can be invaluable to members of the health professions in providing services to aging Americans.
The Problems of a Medical Editor†
Authors: Lyght Charles E.
Published: April 2015

An editor's problems are real; they are legion; they are unending. They range from such major considerations as the selection or rejection of submitted papers, the maintenance of the Journal's prestige, and the protection of the readers’ interests, to the everyday routine of rendering the written word clear, the thrust of the message effective, and the correction of errors, oversights and omissions. All these objectives must be achieved without altering or trifling with factual content or destroying the author's style. Balancing the problems are the joy and satisfaction inherent in a successful editorial process, together with the expressed appreciation of authors and readers.
Observations on the Psychopharmacology of the Aged†
Authors: Eisdorfer Carl
Published: April 2015

Psychotropic drugs are discussed under the descriptive categories of antipsychotic, antidepressive, antimanic, anti‐anxiety, and cognitive acting. In the antipsychotic classification, special attention is given to side effects (extrapyramidal motor signs, tardive dyskinesias, akathisis) and to dosage for the elderly. The section on cognitive acting drugs includes some pertinent observations on cognitive ability in the aging, the importance of correct diagnosis, and therapeutic strategy. The aged are a population at risk for not only disease, but iatrogenic illness due to direct and indirect drug action. Rational therapy involves understanding the underlying dynamics of the disease and thus the selection of the most effective treatment. Psychotropic drugs in an appropriate program are valuable therapeutic assets.
Effect of Dantrolene Sodium on Spasticity Associated with Hemiplegia†
Authors: Steinberg Franz U. , Ferguson Karen L.
Published: April 2015

The effects of dantrolene sodium (Dantrium) were studied in 23 patients with hemiplegic spasticity, 13 of whom were younger than 50, and 10 older than 50. The dosage of dantrolene ranged from 100 mg per day initially to 600 mg per day maximally. The drug was most effective in reducing or abolishing clonus and somewhat less efficacious in decreasing the resistance to stretch and the tendon reflexes. Functionally, gait was improved and the patients found it easier to take care of their personal needs. In general, motor performance was improved. The observation that patients in the 50+ age group responded less well remains unexplained. Dantrolene sodium is a valuable tool in the management of spasticity due to hemiplegia.
Management of Primary Hyperparathyroidism in the Elderly†
Authors: Block Melvin A. , Xavier Alfredo , Brush Brock E.
Published: April 2015

Of 166 surgical patients for whom the diagnosis of primary hyperparathyroidism was established over a 20‐year period, about one‐third were over 60 years of age. For an additional 9 patients, no operation was advised, usually because of other life‐endangering disease and the presence of only a mild degree of hypercalcemia without complications. In recent years, nearly 50 per cent of the patients did not have renal calculi or osteitis fibrosa cystica; this was unrelated to age. Most of the patients with management problems were seen since 1965. Age alone was not a dominant factor in relation to serious complications from hypercalcemia, the presence of other critical disease increasing the risk of operation, or the development of major postoperative complications. The only death from primary hyperparathyroidism occurred in a 74‐year‐old patient who refused re‐operation and died from an acute hypercalcemic crisis. A liberal, but selective, policy of surgical treatment is justified for primary hyperparathyroidism in the elderly. Patients for whom the diagnosis of primary hyperparathyroidism is established may be separated into three groups: those for whom early operation is indicated, those for whom operation should be delayed to permit recovery from other life‐endangering acute disease, and those for whom operation is unjustified because of minimal uncomplicated hypercalcemia and other serious disease greatly limiting life expectancy. These categories encompass all age groups and are not restricted to the elderly. All patients require periodic re‐evaluation.