bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in Mortality Patterns of Coronary Heart Disease and Cerebrovascular Lesions
Authors: SIGURJONSSON JULIUS
Published: April 2015

ABSTRACT: The common statement that cardiovascular diseases (CVD) are causing an ever‐increasing mortality in the more affluent societies is somewhat misleading since the rise is generally fully accounted for by one category only of CVD, i. e., coronary heart disease (CHD), and is often confined to males. Concurrently with an increasing trend in coronary mortality there has been a decline in deaths from cerebrovascular lesions (CVL). Unlike the rates for CHD—often with two to four times as high death rates for males as for females at ages 35–64 — the rates for CVL have usually shown little sex difference. In Iceland (1951–1960) the urban rates of death from CHD were more than twice as high as the rural ones, but the rates for CVL showed only a relatively slight urban excess. These dissimilarities in mortality patterns of CHD and CVL are indicative of differences in the importance of the various risk factors relating to the two disorders.
Psychoneuroses and Neurotic Reactions in Old Age*
Authors: MEYER J. E.
Published: April 2015

ABSTRACT: Chronic psychoneuroses that have developed in earlier life are mitigated in the senium. New psychogenic syndromes in old age are either acute reactions to life stress or character developments which accentuate former personality features. The acute psychogenic reactions are manifested as depressive or hypochondriac syndromes, clearly related regarding time and content to the situational burden. Psychiatrists seldom see new psychoneuroses and neurotic reactions in the elderly and such patients are seldom admitted to psychiatric institutions. It is noteworthy that few of these new psychoneuroses are linked to the nearness of death.
Validation and Standardization of a Goal‐Oriented, Quick‐Screening Geriatric Scale*
Authors: MILLER EVA RUTH , PARACHEK JOANNE FRAZIER
Published: April 2015

ABSTRACT: A quick‐screening device for use with geriatric patients was validated and standardized. The population consisted of 150 geriatric patients at Arizona State Hospital. All were screened, and a stratified random sample of 40 patients was drawn for the study. Ratings were obtained on the Parachek Geriatric Behavior Rating Scale (the experimental device) and the Plutchik Geriatric Rating Scale (the shortest recognized geriatric screening device currently in use), before and after treatment. Correlation of the the Parachek scale with the recognized scale was −.88, validating the Parachek scale as a shorter alternate. Criterion validity was also checked when results were compared to the therapists' judgment. Expectancy tables yielded cutting scores for future use of the Parachek scale in classifying patients for treatment programs. These cutting scores predicted correct placement for 74.5 per cent of the subjects tested. This scale provides a basis for goal‐oriented treatment plans, and also for long‐term statistical records of geriatric patients.
Sexuality in Old Age*
Authors: COMFORT A.
Published: April 2015

ABSTRACT: Geriatricians should be reminded that many old people are still capable of experiencing sexual pleasure. Since sexual experiences can have generally favorable effects, they should be encouraged under appropriate circumstances. Certain enhancements are discussed. At any rate, sexuality in the aged should not be rigidly suppressed in wholesale fashion as it is at present in most nursing homes and other institutions.
A Mental Health Unit in a Skilled Nursing Facility*
Authors: COLTHART SHIRLEY M.
Published: April 2015

ABSTRACT: An outline is given of the services available in a 44‐bed Mental Health Unit of a skilled nursing facility. Statistics on 103 patients are presented. The majority of the patients in the Unit respond to treatment by some increase in then‐activities and improved feelings of dignity and self‐esteem. Concerns presented are: 1) adaptation of the staff in shifting focus from impairments of the patient (as needed for the problem‐oriented record) to the abilities of the patient to function, 2) the requirement that patients can only receive Medicare benefits if they have been in a hospital for seventy‐two hours, 3) the lack of nursing‐home beds for the continued care of Medicaid patients, 4) the lack of adjunctive services (e.g., day‐care center, workship, transportation), and 5) the tendency toward overspecialization and “buck‐passing.” Physicians, psychiatrists, nurses, social workers, other therapists, patients, and their families must work together. Whether based in a Community Mental Health Center or elsewhere, a Geriatric Team gains expertise in providing service to the patients, consultation with other agencies, liaison with other medical facilities and in locating community resources.
Hyperosmolar Nonketotic Diabetic Coma: Vascular Complications
Authors: TCHERTKOFF VICTOR , NAYAK SHAILA V. , KAMATH CHOLPADY , SALOMON MARDEQUEO I.
Published: April 2015

ABSTRACT: Serious vascular complications can be readily overlooked in cases of hyperosmolar nonketotic diabetic coma. They were found by the authors in 3 of 5 autopsy cases. Such a high proportion attests to the importance of early recognition, not only of the type of coma but the presence of life‐threatening vascular complications.
Successful Aging and the Role of the Life Review*
Authors: BUTLER ROBERT N.
Published: April 2015

ABSTRACT: The negative view of old age with its outworn stereotypes (particularly “senility”) must be changed if the elderly are to have more opportunities for successful aging. It is time for a more balanced attitude. Health in old age involves mental and social as well as physical well‐being. There is a distinct difference between the intrinsic features of aging and the reactions of the elderly to their lives. Old age is a period in which unique developmental work can be accomplished. Life review therapy and life‐cycle group therapy are effective aids in this direction.
The Evoked Cortical Potential in Macular Degeneration*
Authors: ORPIN JOHN A. , ORPIN ELIZABETH , McCULLOCH CLEMENT
Published: April 2015

ABSTRACT: Macular degeneration causes a profound loss of visual acuity due to inadequate blood circulation in the capillaries of the choroid plexus and pigment epithelium of the important pattern‐recognizing area of the retina. This disease is the cause of half the blindness in people over the age of 65 and of nearly one‐third of all blindness. In this study an important new technique was added to six tests already in use to assess retinal disease. Data on 10 patients were collected by the following methods: 1) optic disc photography; 2) fluorescein angiography; 3) visual acuity testing; 4) visual fields; 5) foveal sensitivity; 6) electroretinography with automatic analysis of the record by use of an electronic sampling filter and a specially built computer to measure the total electrochemical energy released by the retina; and 7) the evoked cortical response (as indicated in the electroencephalogram) to the stimulus of an alternating chess‐board pattern. This new technique tests the total system for visual pattern recognition. The results indicate that the evoked cortical response is the best objective test of visual acuity.
Surgical Aspects of Peripheral Vascular Disease*
Authors: IMBEMBO ANTHONY L. , SMITH GARDNER W.
Published: April 2015

ABSTRACT: This article reviews current surgical concepts regarding the management of elderly patients with peripheral vascular disease. The indications for surgical reconstruction may be either relative or absolute, but only absolute indications (e.g., incipient gangrene) apply in the elderly. A review of the natural history of the disease shows that although some cases remain stable for long periods, many progress to a state of serious deterioration with painful intermittent claudication, incipient gangrene and threatened loss of the limb. The mechanisms of deterioration include thrombosis, embolism and minor trauma. Peripheral vascular occlusive disease is only one manifestation of a generalized disease process, and vascular reconstruction is only a palliative measure. However, since high morbidity and mortality are associated with amputation, reconstruction should always be considered, even in the geriatric patient. The aorto‐iliac reconstruction technique is associated with a fairly low mortality rate and a limb‐salvage rate of 85 per cent; simpler alternatives are available in high‐risk patients. For femoro‐popliteal procedures the mortality rate is low and the limb‐salvage rate is 75 per cent. Such results emphasize that vascular reconstruction usually is preferable to amputation. Measures for conservative management, particularly in aged patients, are discussed.
Eating Habits of the Dentist and His Wife: Daily Consumption of Vitamin E
Authors: CHERASKIN E. , RINGSDORF W. M. , HICKS B. S.
Published: April 2015

ABSTRACT: An epidemiologic survey of the dietary habits of 369 dentists and 288 wives indicated that about 50 per cent of them consume suboptimal amounts of vitamin E, according to the conservative estimates of the Food and Nutrition Board of the National Academy of Sciences‐National Research Council. By means of simple health education measures, it seems possible to increase significantly the consumption of vitamin E and, in association, to reduce reported cardiovascular findings.
Pharmacodynamic Principles of Drug Therapy in the Aged*
Authors: BENDER A. DOUGLAS
Published: April 2015

The geriatric patient responds differently to some drugs than does the younger adult, and consequently certain precautions should be taken when prescribing a therapeutic regimen for the elderly. Increasing age is accompanied by functional changes in many of the systems that control the way a drug is metabolized and the response that it evokes. Apparently it is these changes which underlie the modified effect seen clinically in geriatric patients. Age tends to reduce and delay the absorption of substances from the gastrointestinal tract, impair and delay drug clearance and excretion by the kidneys, and reduce the rate of enzyme destruction. The plasma half‐life of penicillin, digoxin, antipyrine, or phenylbutazone is extended significantly in the aged so that higher circulating concentrations are maintained for longer periods. Other age‐related changes influence the effect of a drug once it has combined with its receptor. These include an altered number of receptor sites, a decrease in the transmitter content of affected tissues, an increase in the rigidity of responsive tissues, and an overall decline in homeostatic capability.
Sleep, Periodic Breathing and Snoring in the Aged: Control of Ventilation in the Aging and Diseased Respiratory System*
Authors: CARROLL DOUGLAS
Published: April 2015

ABSTRACT:The mechanical characteristics of the human lung have been well studied in relation to aging, under conditions of rest, exercise and various stresses, including the effect of drugs. The few studies that have been made on the control of ventilation with aging have not revealed any loss of response of the “respiratory centers” in normal elderly people. The ventilatory response to inhalation of high concentrations of CO2is depressed under conditions believed to act centrally on the “respiratory centers,” e.g., during sleep. Normal aging may be associated with loss of CNS cells as well as sleep disturbances, but there is no proof that it is associated with abnormalities of ventilatory response. The ventilatory response to CO2inhalation is influenced also by peripheral factors; even normal persons respond inadequately if the work of breathing is increased by introducing resistance into the respiratory circuit. This matter requires further study in the aged. The clinical impression is yet to be established that Cheyne‐Stokes breathing and snoring are more common in elderly normal subjects. In the person who snores, the sensitivity of the “respiratory centers” is reduced by sleep and the work of breathing is increased by upper‐airway obstruction; a study of blood gases might indicate insensitivity of the respiratory center to CO2. To date there is no firm evidence that normal old age under ordinary conditions of living is associated with impaired regulation of respiration.
The “Nona” Electrocardiogram: Findings in 100 Patients of the 90+ Age Group
Authors: GOLDEN GRANT S. , GOLDEN LAWRENCE H.
Published: April 2015

The electrocardiograms of 100 men and women, all past the age of 90, were analyzed for conduction times, axis deviation, summed frontal QRS and T amplitudes. The ECG patterns were classified, and limited clinical correlations were made. The heart rate, R‐T and QRS intervals remained virtually unchanged with age. An increase in PR intervals, a left axis shift and a reduction in summed frontal T values were noted. The high incidences of atrial fibrillation, left anterior hemiblock, extra systoles and delayed AV conduction were probably a result of the widespread use of digitalis. The two most common ECG abnormalities were left ventricular hypertrophy (evidently a natural consequence of advanced age) and myocardial infarction (often undiagnosed clinically).
The Psychogenic and Endocrine Aspects of Sexual Behavior*
Authors: GREENBLATT ROBERT B.
Published: April 2015

ABSTRACT: Defective sexual adjustment can be managed more easily when there is some understanding of the respective roles of psychogenic and endocrine factors in sexual behavior. Millions of men and women are in need of help. The problems are discussed under the headings of maleness and femaleness, sex interest in the female, sexual inadequacy, and sexual gluttony. Only after differentiation of the psychogenic and endocrine factors can proper therapy be started.
Restructuring Medical Education for Management of the Chronically Ill Aged*
Authors: MILLER MICHAEL B.
Published: April 2015

ABSTRACT: The present system of medical education and practice often is more concerned with disease than with patients. Diagnosis‐oriented physicians usually have neither the inclination nor the training to be involved in the complex team system required in care of the chronically ill aged. The personalized patient‐physician contract tends to be deflected by preoccupation with laboratory and diagnostic procedures and the patient often is denied the supporting structure of the Aesculapian authority. A high level of medical care for the chronically ill aged requires a different type of physician, primarily oriented toward treatment and management. When the diagnosis‐oriented and the management‐oriented physicians are mutually supportive, the patient will be the beneficiary. The basis and the nature of a restructured medical educational curriculum are described.
Pulmonary Infections in Elderly Patients: Treatment with Cefazolin†
Authors: Katz David , Eliasson Gudmundur
Published: April 2015

The effects of cefazolin were studied in 15 hospital patients (average age, 67) with respiratory‐tract infections. The infections were chiefly bronchopneumonia caused by organisms such as D. pneumoniae, Staph. aureus, or E. coli. In 13 of the 15 patients the results were excellent to good (eradication of the primary pathogen and clinical improvement); in the other 2 patients the response was fair. Intramuscular injection was well tolerated and only one patient complained of pain at the site of injection; no other adverse clinical effects were observed. In the laboratory determinations, including liver and kidney function tests, the only abnormalities were 2 cases in which the Coombs' test gave positive results without hemolysis. Cefazolin seems to be a safe and effective antibiotic for the treatment of respiratory‐tract infections caused by cefazolin‐susceptible organisms.
Prevalence of Hypertension among the Elderly in an Urban Community
Authors: Cohen Carl I.
Published: April 2015

The results of a hypertension screening project conducted in senior citizen agencies in Manhattan are presented. The prevalence of hypertension among elderly females tended to conform to the data of the Nation Health Survey of 1960–62, but the prevalence among elderly males was much higher than in the National Survey. The prevalence of hypertension varied inversely with the educational level. Various implications for future medical evaluations of the elderly are discussed, based on the clinical and social data obtained.
Important Factors in the Examination and Care of Old Patients
Authors: Schouten J.
Published: April 2015

The author emphasizes the importance of certain factors in the initial assessment of geriatric patients. The geriatrician should be a keen observer, and not neglect simple tests. Thus diagnostic mistakes will be kept to a minimum and he will be rewarded by the improved welfare of his patients.
Gero‐Education†
Authors: Ross C. Howard
Published: April 2015

The official representative of the American Geriatrics Society reports on the 27th Annual Conference on Aging held at Ann Arbor, Michigan, August 5–7, 1974. The subject matter revolved about the aged population and State‐wide systems of education. Plenary sessions, workshops, seminars and discussion groups filled three busy days. Higher education played a most important role in planning the training of professional and administrative personnel in the various fields of gerontology. Research programs were emphasized, as were educational opportunities for the elderly.
Primordial Follicles with Normal Oocytes in the Ovaries of Postmenopausal Women†
Authors: Costoff Allen , Mahesh Virendra B.
Published: April 2015

In ultrastructural studies, the ovaries of postmenopausal women were compared with those of pre‐ and perimenopausal women. Primordial follicles containing apparently normal oocytes were found in all postmenopausal ovary samples. Differentiating follicles were often found in these samples, but they were in various states of atresia. The findings suggest that the menopause does not result exclusively from exhaustion of the primordial follicles.
Bilateral Lymphosarcoma of the Breast
Authors: Case Thomas C.
Published: April 2015

A case is presented of bilateral lymphosarcoma of the breast in a 77‐year‐old woman. The pre‐admission surgical history recorded a mastectomy in July 1972, for lymphosarcoma of the right breast. She had been well until shortly before admission in March 1974 because of a tumor in her left breast. This proved to be lymphosarcoma. Treatment consisted of a left mastectomy. At that time there were no signs of axillary or systemic involvement. Later, evidence of systemic lymphosarcomatosis necessitated starting chemotherapy.
Improvement of Physical Function after Stroke: Surgical and Orthotic Management†
Authors: Waters Robert , Rhoades Marques , Montgomery Jacqueline
Published: April 2015

Initial and subsequent programs for the orthotic and surgical management of the post‐stroke patient are outlined, particularly with regard to impairment of the lower extremities in hemiplegic patients. New developments in functional electrical stimulation are described.
Management of Gallstones in the Aged†
Authors: Ratner Jack T. , Rosenberg Gilbert M.
Published: April 2015

Calculous gallbladder disease is the most common indication for intra‐abdominal surgery in the elderly. Feeding bile salts may possibly increase the solubility of cholesterol in bile and may cause diminution in the size of radiolucent gallstones, the principal ingredient of which is cholesterol. However, indications for such treatment are still not clear, and long‐term effectiveness and safety still have to be evaluated. If the aged patient with gallstones has severe symptoms, is a good medical risk and is not demented, surgical treatment should not be denied because of advanced age. If the patient has “silent” or “dyspeptic” gallstones and is a poor risk or demented, surgical therapy should be postponed at least temporarily, in the hope that medical methods for dissolving gallstones soon will be perfected.
Day Care Services: An Alternative to Institutional Care†
Authors: Mehta Nitin H. , Mack Christopher M.
Published: April 2015

The day care program at St. Camillus Nursing Home in Syracuse, New York is described. The growth rate of the program, the observed benefits to the participants, and acceptance by their family members indicate its value to the community. The admission criteria are well defined and non‐restrictive, and there is a wide scope of services. However, a greater number of participants and expansion of the services would be feasible if Medicare patients could be included in the program besides the present Medicaid and private physician referrals. Such reimbursement should be provided for the sake of participants and their families, as well as for the economics of the total health structure. This would open the doors for day care programs in many other communities across the nation.
Auditory and Visual Memory Losses in Aging Populations
Authors: Boyle Edwin , Aparicio Adolfo M. , Kaye Jonas , Acker Marjorie
Published: April 2015

Seventy‐four men and women (age range, 44–77 years) were tested for short‐term auditory and visual memory as part of a larger series of memory and cognitive function tests. All test scores for visual memory, including facial photograph recognition when a sequence requirement was adhered to, showed a significant decline (p < .05) in a comparison of subjects aged 44–54 and subjects aged 55–64. This decline was not observed with the two tests of auditory memory. Thus the data indicate that short‐term visual memory may be more susceptible to aging than is auditory memory.
Ibuprofen versus Buffered Phenylbutazone in the Treatment of Osteoarthritis: Double‐Blind Trial
Authors: Moxley Thomas E. , Royer George L. , Hearron Martha S. , Donovan James F. , Levi Leon
Published: April 2015

In a double‐blind multiclinic trial, a new nonsteroidal anti‐inflammatory agent (ibuprofen) was compared with an established therapeutic agent (phenylbutazone‐alka) for the treatment of osteoarthritis. Of the 159 patients from the 17 contributing clinics, 144 completed the four weeks of therapy. More than 60 per cent of them reported improvement in exercise‐related pain by week 4, and there was no significant difference between treatment groups. The patients' and the physicians' evaluations of the total state of disease, as well as range‐of‐motion and functional tests, demonstrated similar degrees of improvement in both treatment groups. The incidence of side effects was within acceptable limits, and the frequency distribution was similar in both groups. Of the 70 reported side effects, 29 were considered by the investigator (blind trial) to be drug‐related—11 in association with ibuprofen and 18 with phenylbutazone‐alka. Hematologic and blood chemical studies, as well as urine and stool examinations, yielded normal results with the exception of a reduced mean value for serum uric acid and a slightly elevated mean value for SGPT in the phenylbutazone‐alka group.
Iatrogenic and Nurisgenic Effects of Prolonged Immobilization of the Ill Aged†
Authors: Miller Michael B.
Published: April 2015

The kinesio, psychopathologic and psychosocial effects of prolonged immobilization of the ill aged are outlined. The iatrogenic (physician‐induced) and nurisgenic (nurse‐induced) factors related to such functional disabilities are described. Illustrative case histories are given. The syndrome is reversible. Thus physicians and nurses have a continued responsibility to support a sustained rehabilitation program for these patients. The biochemical effects of prolonged inactivity indicate that immobilization of the elderly patient results in adverse physical and psychologic phenomena.
Failure by a Group of Elderly Men to Use a Preventive Health Service
Authors: Elwood Thomas W. , Oakes Thomas W.
Published: April 2015

The perceptions of 25 white males (age range, 53–62) were studied in relation to use of multiphasic screening. Each of these men had been urged repeatedly to take advantage of this service but had failed to do so. The multiphasic examination itself was free, so cost was not an inhibiting feature. This report deals with the proffered reasons why these men did not take the screening examination. The factors could be classified as: 1) social influences, 2) health care setting, 3) beliefs about health, 4) use of alternative forms of care, 5) the time involved for testing, and 6) disinterest. A discussion of some individual responses is included. Recommendations are made for structuring more effective delivery of health care services for the elderly.
Left Ventricular End‐Diastolic Pressure in Anginal Patients: Lack of Correlation with New York Heart Association's Functional Classification
Authors: Prakash Ravi , Aronow Wilbert S. , Khemka Mahaveer
Published: April 2015

The New York Heart Association (NYHA) recently designated functional classifications I, II, and III for angina. In the authors' series of 80 male anginal patients, observations were made on the mean left ventricular end‐diastolic pressure (LVEDP) at rest and after left ventriculography, and on the percentage of anginal patients with an abnormal LVEDP under these respective circumstances. The findings indicated no significant differences on the basis of NYHA classifications I, II, and III. In the authors' opinion, the NYHA functional classification cannot be used to distinguish the presence or absence of abnormal left ventricular function in Class I, II, and III anginal patients.
Operative and Nonoperative Risks in the Cardiac Patient†
Authors: Sapala James A. , Ponka Joseph L. , Duvernoy Wolf F. C.
Published: April 2015

Four hundred and sixteen patients with documented arteriosclerotic heart disease (ASHD) underwent 424 diagnostic and therapeutic surgical procedures during the year 1970 at the Henry Ford Hospital. They were classified according to the specific clinical manifestation of their cardiac abnormality. Patients with a history of old, well‐compensated myocardial infarction, and those with cardiac arrhythmia, bundle‐branch block, congestive heart failure and A‐V block (pacemaker‐protected) but no evidence of previous myocardial infarction fared almost as well as subjects of the same age without cardiac disease, and were considered to run the lowest operative risk. Patients with angina, especially if there was a history of infarction, were an intermediate risk in terms of complications and mortality. Patients with a history of previous infarction complicated at the time of the surgical procedure by arrhythmia, A‐V block, bundle‐branch block, or congestive heart failure were in the “highest risk” category. A severe A‐V block indicated the need for insertion of a “prophylactic” pacemaker before any attempt at a diagnostic or therapeutic procedure. No patient with clinical or electrocardiographic evidence of a recent infarction (less than three months' duration) should undergo any elective surgical procedure under any form of anesthesia unless the surgeon is prepared for a high mortality rate that may approach 90 percent. In contrast, the patient with old, well‐compensated myocardial infarction and no evidence of dysrhythmia, block or congestive failure can tolerate even a major surgical operation under any form of anesthesia extremely well.
A Treatment Typology for the Elderly Alcohol Abuser†
Authors: Rathbone‐McCuan Eloise , Bland John
Published: April 2015

Alcohol abuse is a serious, though often unrecognized and untreated, problem among the elderly. Treatment is handicapped by the clinician's frequent failure to understand all aspects of alcoholism, and by the lack of adequate treatment resources. Physical, mental and social problems complicate the situation. The Levindale Geriatric Research Center has developed a diagnostic and treatment typology which involves problems with alcohol, health, and the social support system in determining the appropriate environment and treatment resources for these patients. This method has immediate value for clinical practice, and has long‐range value as a framework for planning integrated and comprehensive treatment services.
A Short Portable Mental Status Questionnaire for the Assessment of Organic Brain Deficit in Elderly Patients†
Authors: Pfeiffer Eric
Published: April 2015

Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10‐item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.
Effect of Age on Intravenous Glucose Tolerance and Insulin Secretion*
Authors: FELDMAN JEROME M. , PLONK JAMES W.
Published: April 2015

ABSTRACT: Twenty‐seven normal volunteers whose ages ranged from 22 to 67 (mean, 37 years) were given intravenous glucose tolerance tests (IVGTT). Age was not correlated with the glucose disposal rate constant (KG), incremental insulin secretion (ΔI), or the “insulinogenic index (ΔI/ΔG). The volunteers were divided into three age groups: 1) mean age 25 years, 2) mean age 42 years, and 3) mean age 62 years. Groups 2 and 3 did not differ from Group 1 with respect to the mean level of fasting plasma glucose, KG, or ΔI/AG. Group 2 (but not Group 3) had a greater mean ΔI than Group 1, and Group 3 (but not Group 2) had a higher mean fasting insulin concentration than Group 1. No significant deterioration was detected in the intravenous glucose tolerance of healthy volunteers up to age 67. This may be attributable to the previously described feed‐back system that calibrates the pancreatic beta‐cell response according to the insulin sensitivity of the peripheral tissues.
Some Cerebral Proteins and Enzyme Systems in Alzheimer's Presenile and Senile Dementia
Authors: DEN VELDE W. OP , STAM F. C.
Published: April 2015

ABSTRACT: The water‐soluble proteins of the cerebral gray matter and some enzyme systems (cholinesterase, acetylcholinesterase, lactate dehydrogenase, malate dehydrogenase, acid phosphatase) were studied in 9 autopsy cases of Alzheimer's presenile or senile dementia, 1 case of Pick's disease and 1 case of cerebral arteriosclerosis. The proteins and enzyme patterns were visualized on polyacrylamide gradient gels after electrophoresis. In all patients studied, the profiles of cerebral gray‐matter proteins were normal. In the patients with advanced dementia, the enzyme patterns usually were abnormal. Particularly in Alzheimer's disease, the activity of malate dehydrogenase was markedly increased.
Effect of Normalization of Hypometabolic State on Blood Pressure in Spontaneously Hypertensive Rats and in Patients with Essential Hypertension*
Authors: KOIZUMI YOICHI , AIZAWA TORU , TAWATA MASATO , YAMADA TAKASHI , YAMORI YUKIO , OKAMOTO KOZO
Published: April 2015

ABSTRACT: Spontaneously hypertensive rats (SHR) manifest a hypothyroid state as evidenced by increased thyroid weight, an increased level of plasma thyroid‐stimulating hormone (TSH) and a decreased level of plasma thyroxine (T4) and triiodothyronine (T3). In 18 patients with essential hypertension, plasma TSH, T4 and T3 concentrations were all within the normal range, but the T4 level was significantly lower than in the controls. Among 21 hypothyroid patients, 2 had essential hypertension. Administration of thyroid hormone brought the metabolic state to normal in SHR and in hypothyroid patients but failed to affect the blood pressure. It is suggested that abnormality of thyroid function is neither the cause nor the accentuating factor in the development of hypertension in SH rats and in man.
Physicians' Attitudes Toward the Ill Aged and Nursing Homes*
Authors: MILLER DULCY B. , LOWENSTEIN REGINA , WINSTON RICKY
Published: April 2015

ABSTRACT: A survey of physicians in private practice (exclusive of pediatricians) was conducted in a medium sized suburban city in the New York metropolitan area, to determine whether physicians' attitudes toward the ill aged and nursing homes were predictors of the quality of medical care available to area nursing home patients. Questionnaires were circulated to 302 practitioners. Of the 28 percent who responded, 32 percent were psychiatrists, 15 percent primary care physicians and 8 percent orthopedists. Physicians felt competent to manage the ill aged, although 50 percent had had no significant degree of exposure to geriatric medicine in their medical education, and 70 percent of the primary care group had had none. Primary care and older physicians were more likely to treat patients in nursing homes. Almost 40 percent viewed the nursing home as a place to die. Although 85 percent stated that physicians should be involved in the nursing home placement process, only 21 percent believed that they continued to be in charge of their patients after placement. The findings demonstrate generalized medical disinterest in the care of ill aged patients in institutions. The persons responsible for awarding government grants and those involved in planning medical school curricula should pay more attention to the needs of the chronically ill aged.
Effect of Size on the Function of Three Day Hospitals: The Case for the Small Unit
Authors: MARTIN ANTHONY , MILLARD PETER H.
Published: April 2015

ABSTRACT: The work load of three day hospitals attached to active departments of Geriatric Medicine was studied over a one‐year period. A significant difference in the functional efficiency of the three units was noted. The smaller 12‐place and 15‐place units provided effective short‐term rehabilitation, whereas the 28‐place unit did not. Size seemed to be the major factor in the success or failure of a given unit. This study throws serious doubts upon the wisdom of a policy of building large day hospitals with all their accompanying problems of staffing and transport. An effective unit for out‐patient rehabilitation can be provided with 10 to 15 places per day if the staff members are chiefly remedial therapists. In the districts studied, a provision of 0.5 place per 1,000 of the population aged 65 or older would have been sufficient to meet the perceived need for rehabilitation. However, this would not have been sufficient to satisfy the requirement for out‐patient investigation and medical treatment on a day basis.
Sona Rosa Burstein: Gerontologist in Motley
Authors: FREEMAN JOSEPH T.
Published: April 2015

ABSTRACT: This review of the life and works of Sona Rosa Burstein (1897–1971) attests to her well earned niche in the annals of anthropology, poetry and gerontology.
Community‐Based Residential Care for the Minimally Impaired Elderly: A Survey Analysis*
Authors: BRADSHAW BARBARA R. , VONDERHAAR WILLIAM P. , KEENEY VIRGINIA T. , TYLER LUCY S. , HARRIS SUSAN
Published: April 2015

ABSTRACT: Foster home care for the elderly, as an alternative to living independently, living with relatives or living in an institution, has been a neglected area of investigation, although such care is a nationwide phenomenon. This survey of all licensed Family Care Home operators in the Louisville, Kentucky area provides baseline data regarding the characteristics of providers of adult foster care and the recipients. Data were obtained from 183 persons caring for minimally impaired adults in their own homes and on 422 residents in these foster home settings. Of the residents, 69.5 percent were aged 65 or over. Care providers are described on the basis of age, race, sex, educational level, family size and composition, previous employment, reasons for entering the business, and problems encountered. Residents are described on the basis of age, race, sex, physical condition, care required, and outside contacts. Foster home care for the aged can furnish many advantages if the resident is properly placed and support services are provided. This form of care deserves much greater emphasis in future research on the provision of services for the elderly.
The Problem of Dizziness and Syncope in Old Age: Transient Ischemic Attacks versus Hypersensitive Carotid Sinus Reflex
Authors: UESU CHISHU T. , EISENMAN JACK I. , STEMMER EDWARD A.
Published: April 2015

ABSTRACT: In the elderly, a transient ischemic attack (TIA) and a hypersensitive carotid sinus reflex (HCSR) often co‐exist and can pose a diagnostic challenge. Seven cases are presented. HCSR is a relative condition; besides increased irritability of the receptor or target organs, susceptibility of the nerve center to ischemia probably is induced by a slow heart rate or low blood pressure in any patient with pre‐existing occlusive cerebrovascular disease. Dizziness and syncope of this type represent hemodynamic TIA in contrast to thromboembolic TIA. The carotid sinus massage test is recommended for differentiating the two types of TIA; the treatments differ. At present there is no uniform management that can be applied to either TIA or HCSR routinely. Therefore, treatment should be approached on an individual basis, keeping in mind the different pathophysiologic factors operating in the specific patient.
Hypochondriasis in the Elderly: A Reaction to Social Stress*
Authors: BUSSE EWALD W.
Published: April 2015

ABSTRACT: Hypochondriasis in the elderly is often a preventable or reversible syndrome. It can become chronic if the patient finds no relief from social stress or becomes dependent upon medical services as a source of support. When this is recognized, psychotherapeutic intervention is necessary. Although no socioeconomic group is exempt, hypochondriasis in the elderly occurs more often among the lower social classes. Its higher prevalence in this group is attributable to the frequency and severity of social stress and the loss of alternative social opportunities. If psychotherapeutic intervention is necessary, the elderly hypochondriac patient should be helped to recognize social stress as a major source of the problem and to develop a realistic method of coping with it. Apparently the precipitating factors are often in the socioeconomic sphere; hence, social planners should be aware of this fact if the demands on the health care system are to be reduced.
Progeria: Autopsy Report of One Case, with a Review of Pathologic Findings Reported in the Literature*
Authors: ISHII TOSHIHARU
Published: April 2015

ABSTRACT: An autopsy case of progeria associated with elastotic degeneration of the skin and preservation of the scalp hair, in a 20‐year‐old woman, is presented. The pathologic findings were scleroderma‐like skin atrophy, elastotic degeneration of the skin, arteriosclerosis, atrophy of the endocrine glands, and acute peritonitis after appendectomy. In the reported cases of progeria, as in Werner's syndrome, no responsible parenchymatous organ has been identified. Rather, connective tissue, widely distributed throughout the entire body, may play an important role. The possible abnormal metabolism of connective tissue in progeria deserves further study.
Primary Lymphosarcoma of the Breast: Review of the Literature on Occurrence in Elderly Patients
Authors: SONNENBLICK MOSHE , ABRAHAM ABRAHAM S.
Published: April 2015

ABSTRACT: A case of primary lymphocytic lymphosarcoma of the breast in a 74‐year‐old woman is presented, together with a review of the literature on 23 cases of primary breast lymphosarcoma in patients aged 60 or older. In this age group, simple local excision or mastectomy is probably sufficient.
Aging and the Relativity of Time
Authors: WEBSTER IAN W.
Published: April 2015

ABSTRACT: The perception of passing time is related to life experience. A model for this process, similar to the relationship between stimulation and sensation in the field of physiology, is presented. It is suggested that many of the maladaptive phenomena of aging could be explained by a change in time perception with age.
Effect of Prolonged Bran Administration on Serum Levels of Cholesterol, Ionized Calcium and Iron in the Elderly
Authors: PERSSON I. , RABY K. , FØNSS‐BECH P. , JENSEN E.
Published: April 2015

ABSTRACT: A significant lowering of serum cholesterol, ionized calcium and iron levels was demonstrated in 27 elderly patients given 10 or 20 gm of unprocessed wheat bran daily in the diet for six weeks.
Differential Diagnosis of Rheumatic Disease in the Elderly†
Authors: O'Duffy J. Desmond
Published: April 2015

To illustrate the diagnostic problems of rheumatic disease in patients over 60 years of age, 4 cases are presented: 1) osteoarthritis, 2) late‐onset rheumatoid arthritis, 3) polymyalgia rheumatica, and 4) pseudogout with crystalline synovitis. In each case the correct diagnosis should have been suspected from the history and physical examination alone, with the laboratory and x‐ray findings providing supportive evidence.
The Immunology of Arthritis: Interpretation of Serologic Studies†
Authors: Sharp John T.
Published: April 2015

Results of serologic tests in rheumatic disease require good judgment in interpretation, based upon familiarity with the present knowledge of immunologic mechanisms, including the action of antibodies, auto‐antibodies, T‐cells and B‐cells.
Medication Procedures in a Nursing Home: Abuse of PRN Orders
Authors: Howard John B. , Strong Kenneth E. , Strong Kenneth E.
Published: April 2015

Nursing home patients often receive more drugs than needed. Drug incompatibilities frequently are found, and PRN orders are apt to be overused. Regulatory agencies require periodic physician review in the hope of eliminating these loose prescribing habits. A study was made of the drugs prescribed for 98 patients in a proprietary nursing home. The principal findings were that PRN orders can indeed be inappropriate and indiscriminately followed, and that the multiplicity of drugs often prescribed can lead to drug incompatibilities and to additional illness of the patient. Concern is expressed about the medication review process currently in vogue in nursing homes.
The Use of Mechanical and Chemical Restraints in Nursing Homes
Authors: Covert Anthony B. , Rodrigues Theresa , Solomon Kenneth
Published: April 2015

The use of mechanical and chemical restraints in nursing homes is a common practice, fraught with potential abuse. The patient's freedom of movement and right to an adequate medical and psychiatric evaluation are of the utmost importance. Restraints should be used only as a last resort and should not be a substitute for inadequate staffing or incomplete medical appraisal. Guidelines are offered that maximize the patients’ freedom, maintain medical responsibility, and assure safety. Alternatives to the use of restraints are discussed.
Geriatric Profile of Thomas Jefferson (1743–1826)†
Authors: Sherman E. David
Published: April 2015

This geriatric profile specifically reflects the impressive achievements of Thomas Jefferson during the years of his retirement (ages 66–83) following a distinguished political career culminating in the Presidency. President Monroe sought his advice even after the age of 80, and Jefferson's reasoning was instrumental in the formulation of the Monroe Doctrine. Education was a foremost priority in retirement. He was responsible for the establishment of the University of Virginia, in which his versatility was manifested as architect, builder, and fund raiser. Jefferson was a man of breadth and extraordinary vision for his time, and has come to be known as the “Father of American Democracy.” The basic concepts of his philosophy, including the realm of aging, remain valid today—150 years after his passing.
Mental Status Questionnaire for Organic Brain Syndrome, with a New Visual Counting Test
Authors: Fishback David B.
Published: April 2015

Ninety aged patients at the Philadelphia Geriatric Center were asked to give answers to a 35‐item mental status questionnaire which included a new visual counting test. By this means it was found that 20 of the 90 subjects were not mentally impaired, but 34 had mild dementia, 17 moderate dementia, and 19 severe dementia. These results proved to be well correlated with the clinical findings. The test records showed that as dementia develops, the first thing to be forgotten is the awareness of time, place and recognition (in that order). Then the ability to count disappears. As mental oblivion intervenes, the last thing the patient forgets is his/her own name. It was also noted that patients with mild senile dementia fared better when kept with a similar group than with patients who have moderate or severe dementia.
Ear‐Lobe Creases and Heart Disease
Authors: Doering Carmen , Ruhsenberger Chris , Phillips David S.
Published: April 2015

In 50 patients with coronary heart disease (CHD) and 38 controls, comparative data on age, sex, serum cholesterol level, hypertension, obesity, diabetes, smoking habits, and ear‐lobe creases were analyzed statistically. After adjustment for age differences, the factors which chiefly distinguished the two groups were the incidences of smoking, obesity, diabetes, and ear‐lobe creases. Of these, the ear‐lobe crease seemed to be correlated best with CHD, and may prove to be a useful diagnostic sign.
Palindromic Rheumatism: An Allergic Manifestation?
Authors: Margolis Jack , Margolis Lawrence S.
Published: April 2015

A case of palindromic rheumatism is presented in which the arthritic attacks usually were accompanied by an allergic vasculitis and dermatitis. Although this is not proof of the etiology, the constant association is suggestive of an allergic cause. A brief review of palindromic rheumatism is included.
Brief Psychotherapy: A Case Report Illustrating Its Potential Effectiveness
Authors: Brink T. L.
Published: April 2015

The advance of industrialization in Mexico and elsewhere has brought about psychosocial problems of aging similar to those encountered in the United States. A case study is presented of a 64‐year‐old Mexican widow who had suicidal thoughts and feelings of uselessness. External constraints on the therapist dictated that psychotherapy be completed within 15 days. A strategy of brief psychotherapy was adopted. The focus was not on establishing transference, probing the unconscious or reconstructing the patient's personality, but on identifying problems and formulating practical solutions promptly. Four hour‐long sessions were sufficient to gather information and to counsel the patient and her family. The diagnosis was depression. Treatment centered around increasing the quality of the patient's activity. The initial success of these measures made for a good prognosis. Both patient and family were advised of the availability of antidepressant drugs, and advised against relocating the patient.