bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Aging on the Clinical Significance of Fever in Ambulatory Adult Patients
Authors: KEATING HERBERT J. , KLIMEK JOSEPH J. , LEVINE DONALD S. , KIERNAN FRANCIS J.
Published: April 2015

To study the effect of age on ultimate outcome of febrile illness, the authors prospectively studied 1,202 adult patients who came to an emergency room/walk‐in clinic setting with temperatures of 101.0°F (38.3°C) or more. The patients were divided into four age categories: 17 to 40 years, 40 to 59 years, 60 to 79 years, and 80 years old or older. Advancing age was significantly (P < 0.0005) associated with more serious disease, a higher rate of bacterial pathogen isolation, and a higher rate of life‐threatening or deadly consequences. Of patients 17–39 years old, 58.2 per cent had viral syndromes, otitis media, or pharyngitis as the causes of fever. Of patients aged 40–59 years, only 20.7 per cent had one of these diseases. However, of patients 60 years old or older, only 4.1 per cent (15 of 370) had viral syndromes, otitis media, or pharyngitis, and the overall rate of hospitalization for this group was 92.5 per cent. The authors conclude that febrile patients 60 years old or older seen in emergency room/ambulatory care settings are extremely likely to have serious diseases. Caution should be exercised before concluding that their fevers are of benign origin.
Global Brain Failure in a Nursing Home Resident Population
Authors: PATTEE JAMES J. , GUSTAFSON JUDITH MARSHIK
Published: April 2015

Data from a Minneapolis Professional Standards Review Organization (PSRO) are used to explore the frequency of global brain failure, a group of diseases, in a population of nursing home residents. Findings are related to three other studies of the same or similar phenomena. Approximately 15 per cent of all patients in the Minnesota database exhibit global brain failure as measured by functional impairment on mental and physical indices. Thirty per cent of the patients in the database are incontinent. These findings raise ethical issues concerning the care management of the global brain failure patient who has an irreversible and gradually fatal disease.
The Role of Restriction of Sodium Intake in the Treatment of Heart Failure in the Elderly
Authors: KLEIN LLOYD W. , VISOCAN BARBARA J.
Published: April 2015

For the vast majority of elderly patients with chronic heart failure, clinically effective dietary sodium restriction can be achieved in a diet that remains nutritious and palatable. Obtaining a thorough diet history is the initial step in devising a low‐sodium regimen. Then, the nutritionist and patient can work together to develop a dietary regimen that is culturally, economically, and medically acceptable. Although the availability of potent medications has markedly altered the medical approach to chronic congestive heart failure, their use is not without risk. Thus, dietary management continues to be a useful strategy in the treatment of this condition.
Hearing Assessment in Homes for the Aged: A Comparison of Audiometric and Self‐report Methods
Authors: CORBIN SANDRA , REED MARILYN , NOBBS HOLLY , EASTWOOD KIRSTEN , EASTWOOD M. ROBIN
Published: April 2015

A comparison of audiometric and interview methods to identify hearing impaired elderly was made as part of a study of the relationship between hearing impairment and mental disorders of old age. Of 84 residents of a Home for the Aged examined by an Otolaryngologist and tested by an audiologist, reports of hearing status were incongruent in 41% of the cases. Only 36 residents (43% of the sample) were initially judged capable of reliable response to interview. Twenty‐two residents (26% of the sample) described hearing problems consistent with the type and degree of loss defined audiometrically. The frequency and clinical significance of hearing loss and the questionable reliability of self‐report on hearing argue for inclusion of audiometry in the routine assessment of this population.
Patterns of Utilization, Disposition, and Length of Stay Among Stroke Patients in a Community Hospital Setting
Authors: HERMAN JAMES M. , CULPEPPER LARRY , FRANKS PETER
Published: April 2015

This retrospective descriptive study of stroke patients in a community hospital examined the relationship of discharge disposition and length of stay to sociodemographic variables and use of hospital services. Age‐related patterns emerged. Younger patients were more ambulatory, more frequently discharged to home or rehabilitation units, and used more diagnostic services. Older patients were discharged more frequently to nursing homes and used more social services. Next to level of clinical impairment at discharge, age and admission from home had the greatest effect on whether a patient was discharged to their home. Clinical conditions and the need to await placement in a rehabilitation facility or nursing home correlated with longer lengths of stay.
The Dexamethasone Suppression Test in Patients with Presenile and Senile Dementia of the Alzheimer's Type
Authors: JENIKE MICHAEL A. , ALBERT MARILYN S.
Published: April 2015

The dexamethasone suppression test (DST) was performed on 18 patients with presenile and senile dementia of the Alzheimer's type. Objective cognitive testing showed that 13 patients were mildly to moderately impaired and five were moderately to severely impaired. The Hamilton Depression Scale yielded normal results in all patients. The DST results were abnormal in only one of the mildly impaired patients but in four of the five moderately impaired patients. These data suggest that the DST may be a useful clinical tool in mildly impaired patients with Alzheimer's disease but is likely to be confounded by disease in moderately to severely impaired patients.
Attitudinal Stumbling Blocks to Geriatric Rehabilitation
Authors: Hesse Katherine A. , Campion Edward W. , Karamouz Nassar
Published: April 2015

Attitudes held by geriatric patients, their families, and hospital staff are frequent obstacles to successful rehabilitation following acute illness. These attitudes interfere with patients' motivation for increasing physical independence and result in patients' becoming stranded at a more dependent level of function. Three distinct attitudes frequently encountered in geriatric rehabilitation are identified: the prejudice of ageism, the right of dependency, and the apathy of fatigue. Recognition of these attitudinal syndromes permits effective treatment interventions to enable poorly motivated geriatric rehabilitation patients to progress towards functional independence.
What Should Be Taught in Psychogeriatrics: A Personal Viewpoint
Authors: Shulman Ralph
Published: April 2015

Psychiatry is part of medicine. The goals of medical practice should endorse a biopsycho‐social view of illness, and practitioners should accept responsibility for all phases of illness: from the acute stage through rehabilitation to recovery or chronicity. Bedside instruction should emphasize basic clinical skills in history taking and a standard examination that includes the mental state. Liaison psychiatry offers an opportunity for training in psycho‐geriatrics and for the psychiatrist to re‐enter the medical setting in providing health care to the elderly.
Cryosurgery for Life‐threatening Bleeding Hemorrhoids in the Elderly
Authors: MASHIAH AHARON , MASHIAH TONNI
Published: April 2015

Forty‐three elderly patients with massive bleeding of hemorrhoidal varices were treated by cryosurgery at a single outpatient session, using nitrous oxide gas, without premedication or anesthesia. The results were excellent in all but one patient, who had ulcerative colitis and required another session of cryotherapy following a recurrence of bleeding. There was no morbidity and no mortality. The patients have remained free of symptoms over follow‐up periods ranging from two to five years. The authors believe that cryosurgery is the treatment of choice and indeed may sometimes be life‐saving for elderly, poor‐risk patients who are unfit for general anesthesia and surgical hemorrhoidectomy.
Potassium‐sparing Diuretics: Interaction with Digoxin in Elderly Men
Authors: FINNEGAN TERENCE P. , SPENCE JOHN D. , CAPE RONALD D.
Published: April 2015

The effects of two potassium‐sparing diuretic combination drugs, triamterene‐hydrochlorothiazide and spironolactone‐hydrochlorothiazide, were compared with those of two kaliuretic diuretics, hydrochlorothiazide and furosemide, in order to ascertain the effects of those diuretics on concentrations of serum digoxin, serum potassium, and erythrocyte potassium, and to determine whether any of these diuretics should be preferred for patients taking digoxin. It was concluded that in patients for whom potassium depletion may lead to digoxin toxicity, a potassium‐sparing diuretic may safely be used in order to reduce potassium excretion and thereby reduce the risk of arrhythmias.
Drug Disposition in the Elderly: A Review of the Critical Factors
Authors: SCHMUCKER DOUGLAS L.
Published: April 2015

There are meaningful direct correlations between increasing patient age, the incidence of multiple pathologic conditions, and the implementation of polypharmacy regimens. The latter practice culminates in a significant increase in the incidence of adverse drug reactions in these patients. However, the reason the elderly often respond less favorably to many drugs in comparison with young or mature subjects remains unresolved, although the literature is replete with clinical studies that document this phenomenon. This paper presents the state of our knowledge to date.
A Two‐year Longitudinal Reference Range Study for Selected Serum Enzymes in a Population More than 60 Years of Age
Authors: Tietz Norbert W. , Wekstein David R. , Shuey Denise F. , Brauer Garrett A.
Published: April 2015

The reference ranges for alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and creatine kinase (CK) in a population >60 years were studied using commercially available reagents. All ranges except those for AST and ALT in women were higher than the ranges found in 20–50‐year‐old adults. A two‐year longitudinal study indicated that individuals who had values above those found in younger adults did not show a greater incidence of disease than did individuals who had values in the lower portion of the distribution curve. Comparison of enzyme values at the beginning and at the end of the two‐year study showed that mean ALP, AST, ALT, and LDH values (except for ALT values in men) increased gradually. It was concluded from these two findings that the higher values observed for the aging population were a result of the normal aging process, and thus these values were included in the reference range for this population. The range for CK in individuals >60 years was also higher than that found for younger adults, but the mean value of the group was lower, except in women aged 60–69 years, in whom the mean value showed a slight increase over that found for normal adult women. This was believed to be the result of two independent processes; an increase in enzyme activity due to aging and a decrease in enzyme activity due to reduction in muscle mass as a result of the decreased muscular activity of some volunteers during retirement.
Plasma Norepinephrine Levels of Elderly Men on a Controlled Sodium Intake Diet
Authors: Fiorica Vincent
Published: April 2015

Plasma levels of norepinephrine were compared between young (n = 5) and old (n = 5) men maintained for five days on a diet providing a controlled and uniform sodium intake (2 mEq/kg body weight). The groups were compared after an overnight period of recumbency and fasting (10 hours) and after postural stimulation (20 minutes standing). Plasma norepinephrine concentrations were slightly, though not significantly, higher in older men after prolonged recumbency (older men, 232 ± 39 pg/ml; younger men, 183 ± 24 pg/ml). After postural stimulation, the plasma norepinephrine levels were elevated in both groups, but the measured increase of the older group was significantly greater than that of the younger group (older men, 607 ± 72 pg/ml; younger men, 393 ± 51 pg/ml; P < 0.05). The results of this study suggest the greater response of plasma norepinephrine to postural stimulation observed in elderly men occurred even though the extracellular fluid volume statuses of the older group were comparable to those of the younger group. Whether the exaggerated plasma norepinephrine response of the older men represented a higher degree of sympathetic activity or a diminished plasma clearance of norepinephrine was not established.
Small Intestinal Manometry in Healthy Elderly Subjects
Authors: Anuras Sinn , Sutherland Jean
Published: April 2015

Small intestinal manometry was performed on ten healthy elderly subjects (mean age, 72 years) and ten healthy young‐adult subjects (mean age 25 years). All three phases of the migrating motor complex were observed in both groups during fasting. There were no differences in the motility index between the two groups, the frequency and the mean amplitude of contractions of phases 2 and 3, or the duration and the velocity of propagation of phase 3. After a meal the motility index and the frequency of contractions were significantly lower (P < 0.05) in the elderly group. The results suggest that intestinal motility after a meal is less in the elderly than in young adults.
Quality of Ambulatory Care of the Elderly
Authors: Heller Thomas A. , Larson Eric B. , LoGerfo James P.
Published: April 2015

Twelve hundred twenty‐six (1,226) persons representative of the noninstitutionalized United States population aged 65–74 years were interviewed and examined as part of the 1971—1975 Health and Nutrition Examination Survey (HANES). Using information available in the HANES data base, standards for what could be considered minimally acceptable care were developed for five tracer conditions. Rates of “deficient” care were: angina, 46 percent; dyspnea on exertion, 78 per cent; hypertension, 26 per cent; hearing impariment, 61 per cent; depression, 80 per cent. Deficient care was analyzed by gender, race, income, locale, and self‐rated health status. Only low income emerged as a consistent risk factor for deficient care, with the relative odds for deficient care for poor patients as compared with non‐poor patients ranging from 2.7 to 5.6 (P < 0.05) for four of five conditions. A subgroup analysis attempted to determine whether deficiencies were caused by limited access to physicians, underreporting of symptoms, or barriers that occurred after presenting complaints to a physician. The analysis revealed that for three of four symptomatic conditions, the poor and non‐poor patients were equally likely to report their symptoms, whereas the poor were more likely to receive “deficient” care after presenting complaints to physicians. The ramifications of these findings as they pertain to the present situation are discussed.
Clinical Geriatric Research
Authors: Williams Mark E. , Retch Sheldon M.
Published: April 2015

Clinical investigators face formidable methodologic and ethical challenges in the study of eldery people. To define problems specific to geriatric research the fundamental elements of clinical research are outlined and considerations important to a geriatric study population are identified. Because of the underestimated biologic variation of elderly people, the evaluation of new interventions in one older population may be difficult to generalize to all older people. Inasmuch as older people represent a study population with a lifetime of cumulative exposures for various diseases such as cancer, historical cohort studies are particularly suitable research designs. Despite these advantages, the retrospective study of certain interventions in older people, for example cardiopulmonary resuscitation, requires thoughtful attention to avoid strong and often subtle selection biases. Issues of informed consent and the presence of multiple, comorbid illnesses, especially relevant to clinical trials, are problematic in studying geriatric conditions. Recently, instruments measuring function and disability have been used extensively by investigators in geriatric research, but the precise way to quantify these observations remains controversial. Testing artifacts may be considerably greater in older persons than in many of the populations in which the instruments have been validated. Finally, certain statistical assumptions and inferences may be inappropriate in the study of older people.
Geriatric Sweet Tooth
Authors: Stein Elliott M. , Stein Shayna , Linn Margaret W.
Published: April 2015

Ninety‐three consecutive outpatients receiving tricyclic antidepressants for at least one month were asked about medication side effects, including excessive appetite and craving for sweets. Prevalence of these side effects and their relationship (Pearson r) to type of medication, dosage, patient characteristics, diagnoses, weight gain, and clinical improvement were examined. More than one‐third (38%) reported excessive appetite, 34% had a craving for sweets, and about one‐half (48%) had either one or the other of these reactions. These adverse side effects were related significantly to weight gain (P < .001) and a higher dose of medication, but not to clinical improvement. Clinical improvement was in the moderate‐to‐good range but was not related to medication dose. Because increasing degrees of overweight can pose serious health risks, especially for the elderly, it is critical for future research to examine ways of maintaining therapeutic benefit while minimizing food craving side effects. Methods of dealing with these issues clinically are suggested.
Prognosis of Subjects in the Framingham Study With Rheumatic Heart Disease
Authors: Goetzler Renee , Stokes Joseph , Anderson Keaven
Published: April 2015

One hundred thirteen of the original Framingham Heart Study cohort, aged 30 to 62 years, were identified as having valvular heart disease of presumed rheumatic etiology. All of these subjects, and a sample of age‐ and sex‐matched controls, were accounted for during 34 years between 1950 and 1984. Although subjects with rheumatic heart disease had significantly higher mortality and serious morbidity than did those in the control group, 36 of the 113 (31.9%) rheumatic heart disease subjects survived at the end of this period as compared with 52.7% of the control subjects.
Penile Laceration From a Foley Catheter
Authors: Barnes‐Snow Eleanor , Luchi Robert J. , Doig Robert
Published: April 2015

Traction‐induced penile laceration has not been reported previously as a complication of long‐term indwelling Foley catheterization. Four occurrences of this injury in three elderly, demented patients were observed in an acute‐care Geriatric Evaluation Unit. The most severe case, a nearly complete transverse laceration of the glans, reepithelialized but did not reapproximate. In the other cases, a laceration along the median raphe reapproximated. In all cases, local treatment was successful in effecting healing, and none of the patients exhibited signs or symptoms of systemic illness. These injuries were caused by prolonged traction on the unsecured Foley between the inflated balloon and the weighted collection system producing a local ischemic necrosis. This complication can be prevented by securing the Foley to the patient with tape, ensuring that the drainage system is properly supported, and by attention to patient position.
Geriatric Education
Authors: Barry Patricia P. , Ham Richard J.
Published: April 2015

For a survey of geriatric education in medical schools in the United States in 1983, data were received from one hundred schools. Increasing numbers of schools are providing required geriatric curriculum, and over 80 per cent of schools offer fourth‐year electives. Ninety per cent of schools have physician faculty in geriatrics, affiliated with major departments, for an average of 2.5 full‐time equivalents per school. Training sites are expanding to include many noninstitutional settings. Issues of curriculum content and impact, as well as faculty development, require further investigation. J Am Geriatr Soc 33:133, 1985
Tamper‐resistant Packaging
Authors: Sherman Fredrick T.
Published: April 2015

A tamper‐resistant package has an indicator or barrier to entry that, if breached or missing, can reasonably be expected to provide visible evidence to consumers that tampering has occurred. Regulations to implement tamper‐resistant packaging on all over‐the‐counter drugs and certain cosmetics began in February 1983. Tamper‐resistant packaging, like child‐resistant packaging, may impede access by the elderly and other adults who have mental, motor, and/or sensory disabilities. This article describes: 1) the reasons for the increasing use of over‐the‐counter medications in the prevention and treatment of the major causes of morbidity and mortality in the elderly; 2) the types of difficulties encountered in opening tamper‐resistant packaging; 3) the causes of these inaccessibility problems; 4) the methods to correct them; and 5) testing procedures to determine whether the existing designs of tamper‐resistant packaging are accessible by the elderly and adults with selected disabilities. Testing of individual types of tamper‐resistant packaging, multiple types of tamper‐resistant packagings on the same container, and combinations of tamper‐resistant packagings and child‐resistant packagings on groups of normal elderly people and those with selected disabilities is necessary to guarantee accessibility to the growing number of therapeutically efficacious nonprescription medications used by these populations. J Am Geriatr Soc 33:136, 1985
Management of Urinary Incontinence in Veterans Administration Nursing Homes
Authors: Ouslander Joseph G. , Fowler Evonne
Published: April 2015

Nursing Home Care Units in Veterans Administration Medical Centers across the country were surveyed to determine methods of management of urinary incontinence (UI) in the nursing home (NH) setting. Information was obtained from 90 of the VA NHs on demographic aspects of the NH population, prevalence and severity of urinary and fecal incontinence, common problems encountered, and specific strategies and techniques. Written guidelines for bladder training and catheter care from many of the NHs were analyzed. The results of the survey reinforce the need for research designed to improve the care of the incontinent NH patient. J Am Geriatr Soc 33:33, 1985
Geriatrics: A Selected Up‐to‐date Bibliography
Authors: Rosenthal Mark
Published: April 2015

This is the second annual revision of the Geriatrics Bibliography. Approximately two thirds of the old references have been replaced by more current or more detailed articles. The bibliography has been expanded to include several additional topics and over 200 new references.

Since the literature pertinent to geriatrics is growing ever more rapidly, it has been necessary to omit many informative articles from the bibliography. Almost all of the references date from the past four years. Preference is given to recent publications, since they provide a list of the important earlier articles. Some articles were selected to highlight current controversies or changes in viewpoint. An occasional review article is cited to amplify geriatric aspects of common diseases.

Most of the references deal specifically with an elderly patient population, studies of which, it will be noted, are confounded by questions of “normal” aging as opposed to the concomitants of aging frequent in our society: inactivity, obesity, malnutrition, and psychosocial trauma. A few articles concern diseases remarkably common in the aged but for which no adequate study specifically from a geriatric viewpoint exists; e.g., monoclonal gammopathy, Paget's disease, pulmonary emboli.

The references are divided into categories. The first (I) set deals with some possible causes of aging, the second (II) with physiologic decline accompanying aging, the third (III) with the atypical and nonspecific characteristics of illness among geriatric patients, and the fourth (IV) with non‐physician services available to the elderly, including ethical quandaries. The remainder of the references are cited by pertinent medical specialty. Within each category, references are divided by disease process. Articles are further subgrouped by aspects of those diseases such as evaluation or therapy.
Book Reviews
Authors: Barzel Uriel S.
Published: April 2015

Saunders Dictionary and Encyclopedia of Laboratory Medicine and Technology. Edited by Bennington JL. Philadelphia, W. B.

Your Parent's Keeper: A Handbook of Psychiatric Care for the Elderly By J. D. Lieff.

Nursing Administration of Long‐Term Care. By C. Eliopoulos.
Septic Arthritis in the Elderly
Authors: McGuire Nancy M. , Kauffman Carol A.
Published: April 2015

The clinical and microbiologic features of septic arthritis in 23 elderly patients are reviewed. Fifteen patients had pre‐existing joint diseases, predominantly osteoarthritis and rheumatoid arthritis. Eight patients had underlying systemic illnesses, and eight patients were receiving systemic corticosteroid therapy prior to the development of septic arthritis. The knee was the joint most commonly infected. Although Staphylococcus aureus was the major pathogen (52.2 per cent of patients), enteric gram‐negative bacilli were found in seven of 23 patients (30.4 per cent). Five patients died (21.7 per cent mortality), two as a result of their infection and three of nosocomial Pseudomonas sepsis. Eight of the 18 survivors (44.4 per cent) developed osteomyelitis in the contiguous bone. Return of joint function was slow in all patients. Septic arthritis in the elderly is difficult to treat and has a poor outcome, possibly because pre‐existing joint disease is very common and enteric gram‐negative bacilli are often the causative organisms.
Relationship Between Age at Diagnosis and Treatments
Authors: Mor Vincent , Masterson‐Allen Susan , Goldberg Richard J. , Cummings Francis J. , Glicksman Arvin S. , Fretwell Marsha D.
Published: April 2015

Increases in cancer incidence and mortality reflect the larger numbers of elderly in the population. Using a mortality sample of 1891 biopsy‐confirmed cancer patients, analyses reveal older breast, prostate, and cervical‐uterine cancer victims were more likely to be diagnosed with metastases. Logistic regression analyses of subsamples of breast (N = 224), lung (N = 513), and colorectal (N = 299) cancer patients indicate that age is significantly inversely related to receipt of both subsequent chemotherapy and radiation therapy, controlling for stage of disease and presence of co‐morbid disease. Exceptions to this relationship are the use of radiation therapy among nonmetastatic lung cancer patients and all breast cancer patients. The implications of these findings for current cancer control programs are discussed.
Community‐Based Geriatric Assessment
Authors: Martin David C. , Morycz Richard K. , McDowell B. Joan , Snustad Diane , Karpf Michael
Published: April 2015

A comprehensive review of the multidisciplinary functional assessment and treatment of 800 patients seen at a community‐based geriatric assessment center was performed to profile clinical characteristics of patients attending such a program and to evaluate possible predictors of institutionalization. The most common problems addressed were senile dementia (46%), hypertension (31%), clinically significant depression (30%), and burdened caregiver (24%). More than 90% of patients were able to remain in the community after multidisciplinary treatment of their problems and marshalling of support services. The most potent predictors of institutionalization in rank order of predictive value were: falls or unstable gait, senile dementia, caregiver strain, lack of support services, and moderate to severe impairment of ability to perform activities of dally living (multiple R = 0.45; P = .001). Advantages and impediments to community‐based assessment are discussed.
The House Call
Authors: Burton John R.
Published: April 2015

There are many advantages in the performance of house calls by physicians for home bound, frail elderly patients: a needed service is provided; assessment of the “non‐medical” aspects important in geriatric health care is readily accomplished; physician—patient relations will improve; the role of the physician as advisor and educator is emphasized; deep gratification to the physician results; and the physician will have better working relationships with other health professionals providing home services. House calls should be part of the curriculum of training programs. More house calls are advocated in order to provide quality care for the frail elderly and to offer them an option to institutionalization.
l‐Tryptophan as a Hypnotic in Special Patients
Authors: Fitten L. J. , Profita J. , Bidder T. G.
Published: April 2015

The authors briefly review prevalence and current treatment trends of sleep disorders in the elderly, underlining the need for the development of a more suitable hypnotic for this population. The use of l‐tryptophan (LT) as a physiologic hypnotic in aged responders is considered and the hypnotic effect of 1‐ to 4‐g bedtime doses on ten male inpatients and outpatients aged 30 to 72 years is evaluated. Results suggest a dramatic and sustained relief of insomnia for 3 weeks in 30 per cent of the patients and the absence of side effects in 90 per cent of those who took the agent. The authors conclude that despite its long therapeutic history, l‐tryptophan has not been more successful because only a minority of humans appear to be responsive to its hypnotic actions. They point to the need to replicate their current preliminary observations in a larger controlled geriatric population and to delineate biochemical characteristics of LT responders in order to increase LT sensitivity in some patients and convert nonresponders to responders.
Chronic Atrial Fibrillation in the Elderly: Risks vs. Benefits of Long‐term Anticoagulation
Authors: Wilson D. Barry
Published: April 2015

Chronic atrial fibrillation is generally thought to cause stroke by atrial thrombus formation with subsequent embolization. Rheumatic heart disease previously led to most cases of atrial fibrillation, but recent substantial declines in the incidence of rheumatic fever have changed the distribution of causes of atrial fibrillation. Elderly patients have an appreciable prevalence of chronic atrial fibrillation. The risks and potential benefits of long‐term anti‐coagulation for elderly patients with atrial fibrillation are discussed and the quality of the evidence assessed. It is concluded that the evidence is sufficiently incomplete and imperfect for a large, well‐designed trial to be needed; however, this would be difficult and expensive.
Biofeedback Treatment of Fecal Incontinence in Geriatric Patients
Authors: Whitehead William E. , Burgio Kathryn L. , Engel Bernard T.
Published: April 2015

Eighteen fecally incontinent geriatric patients were first treated for constipation as a possible cause of incontinence, and the 13 who remained incontinent were provided sphincter biofeedback training. Half the patients were instructed to perform 50 sphincter exercises per day for a four‐week period prior to the start of biofeedback training to determine whether such exercises would improve bowel control in the absence of biofeedback training. Sphincter exercises alone did not produce clinical improvements and did not significantly increase the strength of sphincter contractions. Biofeedback training did significantly augment sphincter strength and was associated with greater than 75 per cent decreases in incontinence for 10 (77 per cent) of the patients. Improvements were maintained in 60 per cent at six months and in 42 per cent at one year. Thus biofeedback training appears to be of specific value in the treatment of fecal incontinence in geriatric patients.
Social Structure and Intracohort Variation in Physical Fitness Among Elderly Males in a Traditional Third World Society
Authors: Beall Cynthia M. , Goldstein Melvyn C. , Feldman Edward S.
Published: April 2015

This paper examines the relationship between physical fitness and activity among elderly males in the traditional rural community of Chetbesi, Nepal. It takes advantage of the unique character of the Hindu caste system to implement a quasiexperimental research design that approximates random assignment to high and low activity levels. The members of the Sarki caste have lower heart rates and systolic blood pressure, relative to other castes, at each of three submaximal workloads and during recovery from bicycle ergometer exercise. Direct observation and physiologic monitoring show that the Sarkis engage in more frequent and extended periods of heavy labor. Thus intracohort variation in physical fitness and activity patterns among the Chetbesi elderly is a function of birth into a socially defined group rather than of self‐selection. This pattern of differential fitness may typify the process of aging in many stratified traditional and modernizing societies where socially delimited segments of the population perform the bulk of the hard work. Intrapopulation differences aside, comparison of Sarkis and non‐Sarkis with other samples reveals that both lie within the reported range of variation. The rural, unmechanized, agricultural lifestyle and mountain environment of Chetbesi do not result in exceptional fitness for residents. The Chetbesi data suggest that the popular notion that aging is less debilitating in traditional agrarian societies located in rugged mountain terrains may be a myth. The demonstration of the influence of social forces on physical fitness suggests that future research might concentrate profitably on identifying social structures that produce high levels of physical fitness.
Effects of Age and Blood Pressure on the Cardiovascular Responses to the Valsalva Maneuver
Authors: Shimada Kazuyuki , Kitazumi Tadao , Ogura Hisakazu , Sadakane Noriko , Ozawa Toshio
Published: April 2015

The present study was performed to obtain basic information as to the influences of two fundamental variables, age and blood pressure, on the circulatory responses during the Valsalva maneuver. Although a positive linear relationship between age and resting systolic blood pressure was present in the study population of 90 normal and uncomplicated hypertensive subjects, the pressure overshoot and the change in R‐R intervals during phase 4 in the Valsalva maneuver were significantly inversely related to age or resting systolic blood pressure independently of each other variable. Furthermore, age was related negatively to the maximum R‐R interval in phase 4 and positively to the decline of blood pressure post‐Valsalva release in phase 3 even after adjusting for the effect of blood pressure, but age‐independent relationships between these two indexes and resting systolic blood pressure were not statistically significant. The data indicate that changes in circulatory responses to the Valsalva maneuver occur with aging and high blood pressure, suggesting that the sympathetic vasoregulation and the baroreflex control of heart rate in the maneuver are impaired by these two variables. Such alterations appear to be more strongly related to age than to blood pressure level. J Am Geriatr Soc 34:431–434, 1986
Plasma Lipids and Lipoproteins in Elderly Japanese‐American Men
Authors: Curb J. David , Reed Dwayne M. , Yano Katsuhiko , Kautz Judith A. , Albers John J.
Published: April 2015

Knowledge about blood lipids in older individuals is limited. In the Lipoprotein Study of the Honolulu Heart Program, plasma cholesterol, triglyceride, and high‐density lipoprotein (HDL) were measured during 1980 and 1981 in Japanese‐American men over 60 years of age. In addition, low‐density lipoprotein cholesterol (LDL‐C) was estimated via a regression model. Age‐related differences in mean lipid levels between the youngest (60 to 64 years) and the oldest (75 years and older) groups included a decrease in total cholesterol from 214 to 207 mg/dL and plasma triglyceride from 188 to 144 mg/dL. High density lipoprotein cholesterol rose from 47 to 49 mg/dL and LDL was relatively stable (137 and 135 mg/dL, respectively). Age‐adjusted total cholesterol tended to significantly increase with increasing body mass index and hematocrit but was not significantly related with systolic blood pressure, physical activity index, cigarettes per day, or alcohol intake. Among those variables HDL‐C decreased significantly with increasing body mass index and hematocrit and increased significantly with increasing alcohol intake. Compared with elderly white men in the Lipid Research Clinic Program, total cholesterol values tended to be slightly higher and triglyceride values were substantially higher, whereas HDL and LDL values were appreciably lower. Both cholesterol and triglyceride values were substantially higher than values reported from Japan from men in these age groups.
Changing Presentation of Myocardial Infarction With Increasing Old Age
Authors: Bayer Antony J. , Chadha Joginder S. , Farag Raafat R. , Pathy M. S. John
Published: April 2015

The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized patients are reviewed. Their ages ranged from 65 to 100, with a mean of 76.0 years. The spectrum of presentation changed significantly with increasing age. Chest pain or discomfort were less frequently reported, although present in the majority of patients up to 85 years. Syncope, stroke, and acute confusion became more common and were often the sole presenting symptom. Shortness of breath, although the most frequently reported symptom in the absence of chest pain, was equally common at all ages. Thus, in patients aged 85 years or over, “atypical” presentation of myocardial infarction became the rule, and in the very old the clinician must be prepared to screen for the diagnosis in most acutely ill patients.
Effect of Age and Environmental Factors on Glucose Tolerance and Insulin Secretion in a Worker Population
Authors: Zavaroni I. , Dall'Aglio E. , Bruschi F. , Bonora E. , Alpi O. , Pezzarossa A. , Butturini U.
Published: April 2015

The effect of age on glucose tolerance, as differentiated from the effects of obesity, work and leisure physical activity, family history of diabetes, and the use of drugs known to adversely affect glucose tolerance and/or insulin secretion, has been analyzed in 732 factory workers aged 22 to 73 years. Glucose tolerance, as evaluated by the plasma glucose response to 75 g of oral glucose deteriorated with age, associated with an increase in plasma insulin levels. However, the age‐related decrease in glucose tolerance also correlated significantly with degree of obesity, leisure‐time physical activity, and the use of potential diabetogenic drugs. Partial correlation coefficients were calculated to define the effect of age per se on glucose tolerance, controlling for the presence of these other age‐related variables. When this was done, the degree of correlation between age and glucose tolerance was reduced, particularly in women, to where it became of marginal statistical significance. The effect of age on insulin response was affected to a greater degree by age‐related variables, and was no longer statistically significant when these other factors were taken into consideration. These data suggest that the elevation in plasma glucose and insulin levels associated with age are to a certain extent due to age‐related environmental factors, and the deterioration in glucose tolerance with age is relatively modest in magnitude in a generally healthy population.
Assessment of Depression and Cognitive Impairment After Hip Fracture
Authors: Billig Nathan , Ahmed Susan W. , Kenmore Peter , Amaral Donna , Shakhashiri Maha Z.
Published: April 2015

Fifty patients, over 60 years of age, were evaluated for mental status change at the time of hip fracture. Specifically, demographic and historical data were gathered and patients were given an assessment battery to evaluate depression and cognitive impairment during hospitalization for femoral fracture. Prevalence of depression was 28%, and cognitive impairment was present in 40% of the patients evaluated. Pre‐fracture activities of daily living were estimated. These data provide the first systematically accumulated baseline data for patients in the immediate post‐hip fracture period. Patients will be reassessed at three‐month intervals to quantify mental status change and to evaluate its effects on morbidity, mortality, and rehabilitative success. J Am Geriatr Soc 34:499–503, 1986
Digitalis Use in a Retirement Community
Authors: Schocken Douglas D. , Robinson Bruce E. , Krug‐Fite Jan , Lyman Gary H. , Barry Patricia P.
Published: April 2015

Complex medical problems of older patients demand that particular care be taken with their use of digitalis, Although accounting for more than 5% of the top ten prescribed drugs in the United States, studies have suggested that digitalis use might be discontinued in some patients without harm. To assess the potential impact of these observations, a survey was conducted to evaluate the extent of digitalis use in a retirement community in Florida.

The community under study consisted of approximately 5600 persons, mean age 72.6 years; 97% were over age 55. The sample of 463 telephone respondents reflected the local census. Digitalis preparations had been taken by 11.4% of the sample, of whom 60% (or 6.9% of the total sample) were currently taking them. Persons taking digitalis tended to be older (P < .002) and reported worse overall health status than those not taking the drug (P < .025). Seventeen percent of those who had stopped use of digitalis claimed adverse symptoms or “complications.”

Of Florida's 10 million populaton, 23% are over age 60, a proportion increasing yearly. This survey suggests that digitalis use in the elderly is widespread and a potentially important area for investigating management of cardiac problems in the elderly. J Am Geriatr Soc 34:504–506, 1986
Clinical Zinc Deficiency During Long‐Term Total Enteral Nutrition
Authors: Jhangiani Sunil , Prince Laura , Holmes Rosemarie , Agarwal Nanak
Published: April 2015

Zinc deficiency during long‐term total parenteral nutrition has been well reported in the literature. However, there is limited information available on zinc deficiency occurring during total enteral nutrition. Two cases of clinical zinc deficiency in patients on long‐term enteral feedings are presented. Nutritional assessment of these two patients on admission revealed hypoalbuminemic malnutrition. Nutritional support in the form of nasogastric tube feedings were initiated in both patients due to altered mental status. The formula used was Ensure (Ross Labs, Columbus, OH), which provided greater than 150% of the RDA for zinc. However, four months and seven months after initiation of adequate nutritional support, both patients developed skin rashes around the groin and under the breasts and axilla. Serum zinc levels were depressed in both patients, to 42 and 54 mg/dL, respectively (normal for the authors' laboratory, 66 to 120 mg/dL). Supplementation with zinc sulfate 220 mg per day via nasogastric tube resulted in disappearance of the rash with return of serum zinc to normal levels. The authors suggest close observation of patients on long‐term enteral nutrition for clinical manifestation of zinc deficiency, especially an unexplained skin rash. Further studies are needed to establish minimum daily zinc requirements in patients on long‐term enteral feedings. J Am Geriatr Soc 34:385–388, 1986
Selected Bibliography of Recent Articles in Ethics and Geriatrics
Authors: Cassel Christine K. , Meier Diane E. , Traines Mark L.
Published: April 2015

The disciplines of bioethics and geriatrics have had parallel development in recent years. From small and relatively esoteric fields 15 or 20 years ago, both have grown enormously. Although the numbers of geriatricians and ethicists in practice or in academic centers have increased substantially, these disciplines represent areas in which better understanding is sorely needed. This bibliography is intended to assist the clinician in locating salient literature concerning bioethical issues in geriatric medicine and research. It is highly selective; it does not attempt to cover all the literature on bioethics. There are several excellent general bioethics bibliographies for clinicians in the recent literature, as well as even broader bioethics bibliographies (not limited to clinical journals or clinical topics), some of which are included in section 13 for the reader's further information. The ethical issues that arise in geriatric medicine are similar to those that arise in the care of younger patients, but certain kinds of problems happen with far greater frequency. Dilemmas concerning decisions about care at the end of life are particularly relevant in geriatrics, as persons of extreme old age are often presented with choices about life‐sustaining therapy when critical illness occurs. This includes decisions about cardiopulmonary resuscitation and nutritional support. When these clinical decisions arise in the care of patients who cannot decide for themselves, the question arises as to what role the assessment of “quality of life” ought to play in decisions to pursue or to forego life‐sustaining therapy. Informed consent to treatment and to participation in research has been an important area of ethical investigation. Dilemmas about consent to treatment are complicated in some elderly populations because of the higher incidence of cognitive impairment and the higher incidence of the clinician's suspicion (or assumption) of cognitive impairment. In consent to research, there are additional issues of voluntariness and equitable selection, especially when subjects are residents of nursing homes. Because of the increasing numbers of elderly persons in our society, and because of the role of social resources (federal, state, and local) in acute and long‐term medical care, the issue of justice in the allocation of resources is of major concern in gerontologic bioethics. The topic headings for this bibliography reflect these common issues which arise in the care of the elderly. J Am Geriatr Soc 34:399–409, 1986
Mobility of Elderly Patients in Bed
Authors: Barbenel J. C. , Ferguson‐Pell M. W. , Kennedy R.
Published: April 2015

Measurements were made of the overnight mobility of a group of elderly hospital patients whose clinical status had been assessed using the Norton clinical assessment score. The number of movements on the first two nights after admission differed from subsequent nights. There was a significant correlation between mobility and patient condition on all nights except the second. Patients assessed as being at high risk of developing pressure sores made fewer movements; mobility criteria are presented for detecting these individual patients.
Plasma Lipoproteins and Platelet Aggregation During Alimentary Lipemia
Authors: Winterstein Giora , Brook J. Gerald , Pillar Thomas , Aviram Michael
Published: April 2015

Ten healthy women in their tenth decade of life were compared with ten healthy women in their fourth decade of life regarding the response of plasma lipoproteins and platelet aggregation to one meal rich in saturated fats. In the elderly group, plasma cholesterol decreased in the postprandial state three hours after the meal in comparison to no significant changes in the younger group. This resulted from reduction in plasma lipoprotein cholesterol levels, except for the high‐density lipoprotein (HDL) cholesterol, which was enhanced. A similar pattern was found for plasma lipoprotein levels. The increase in plasma triglyceride concentration in the elderly women was less than in the younger women, as fewer changes in their plasma triglyceride‐rich lipoproteins (chylomicrons and very‐low‐density lipoprotein) were observed. Platelet aggregation in response to collagen was reduced in the elderly women, whereas in the younger group, increased platelet aggregation in the postprandial state was found. Our study thus demonstrates a clear advantage of the elderly women in comparison to the younger ones in reducing atherosclerosis and thrombotic risks. The elderly group responded to the saturated fat‐rich meal by minimal plasma triglyceride elevation, an increase in HDL cholesterol concentration, and reduced platelet aggregation.