bluuebunny/crossref_metadata_2025 huggingface dataset:
An Attributional Approach to Psychotherapy with the Aged
Authors: SPARACINO JACK
Published: April 2015

ABSTRACT: The continued growth of the number of aged persons potentially requiring psychotherapeutic service should be met with a concomitant increase in relevant theory and research. An attribution theory approach to individual psychotherapy with the aged is suggested insofar as it: 1) is explicitly responsive to the possible negative consequences of the old person's diminished use of social consensus to validate the interpretation of behavioral events, 2) is relatively concrete in terms of implementation, and 3) may be used on a short‐term basis.
Occult Cardiac Arrhythmias Associated with Falls and Dizziness in the Elderly: Detection by Holter Monitoring
Authors: GORDON MICHAEL
Published: April 2015

ABSTRACT: Sixteen elderly patients with occult cardiac arrhythmias presented with signs of neurologic dysfunction that often had led to traumatic falls. Holter electrocardiographic monitoring was a valuable tool in defining the arrhythmia for which specific treatment was successful.
Erythrocyte Parameters in the Elderly: An Argument Against New Geriatric Normal Values*
Authors: HTOO MARK S. H. , KOFKOFF RICHARD L. , FREEDMAN MICHAEL L.
Published: April 2015

Erythrocyte parameters in 292 unselected geriatric patients were studied retrospectively. Statistically significant mean decreases compared to the laboratories' normal mean values were found in the red blood cell count (RBC), hemoglobin level, hematocrit, and mean corpuscular hemoglobin concentration; there also was a slight increase in mean corpuscular volume and mean corpuscular hemoglobin. However, when 17 patients with a hemoglobin level less than 10 gm/dl or a hematocrit reading less than 35 percent were excluded, all of the mean values for erythrocyte parameters fell within the normal range. In 71 percent of these 17 patients the etiology of the anemia was documented. Although one cannot definitely exclude a slight change in erythrocyte parameters with aging, it is concluded that the establishment of so‐called new geriatric norms is premature, as the population studied included patients with various diseases. Good medical practice dictates continued evaluation and monitoring of patients in whom erythrocyte values are outside the established normal ranges.
Epidemiology of Hyperuricemia in an Ambulatory Elderly Population
Authors: STEWART RONALD B. , YOST RICHARD L. , HALE WILLIAM E. , MARKS RONALD G.
Published: April 2015

The relationship of serum uric acid concentration to age and sex was assessed in 1,701 participants in a geriatric multiphasic screening clinic. Included were 1,067 women and 634 men. The mean uric acid level for men was 6.35 mg/100 ml compared to 5.44 mg/100 ml for women. No statistically significant increases in serum uric acid between age groups were apparent, except for women over 84 years of age. The mean serum urate concentrations found in this geriatric study are higher than those reported for other population groups, suggesting a higher normal value for the elderly.
Hospitalization of the Elderly Patient for Acute Illness
Authors: Munoz Rodrigo A. , Mesick Betty
Published: April 2015

There is a paucity of studies on the characteristics of elderly patients who are admitted for treatment of acute disorders, even though their utilization of hospitals is high. This study involved 828 older persons admitted to a general hospital during a period of six months, for the treatment of acute illness. The typical patient appeared to be a woman in her 70's who entered the medical department because of a cardiovascular or a gastrointestinal disturbance, stayed no longer than 10 days, and returned home to live with her spouse. Though such a person apparently needed minimal assistance in readjusting successfully to the community, there were some exceptions, especially among those who had been living alone or with persons other than a spouse. There was minimal utilization of professional services that might help to assure an optimal post‐hospital readjustment.
Preservation of Sexual Potency in Prostatic Cancer Patients after 125I Implantation
Authors: HERR HARRY W.
Published: April 2015

ABSTRACT: Sexual histories were obtained in 51 men with prostatic cancer and their spouses, before and after pelvic lymphadenectomy and retropubic 125I implantation. The average age of the patients was 64.7 years. Sexual activity was retained in 40 of the 41 patients who were sexually active before operation. Ten patients had been sexually inactive before operation—4 with diminished potency and 6 with complete erectile impotence. Sexual dysfunction was most often pyschogenic. At six months after the operation, 5 of these patients had resumed satisfactory sexual intercourse as a result of reassurance, encouragement and education of the remaining sexual potential. No patient was rendered completely impotent as a result of the procedure. Preservation of sexual potency represents a significant advantage of 125I implantation over other therapeutic modalities in the treatment of localized prostatic carcinoma.
Erythrocyte Folate Levels in Young and Old
Authors: WEBSTER S. G. P. , LEEMING J. T.
Published: April 2015

ABSTRACT: Erythrocyte folate levels were compared among 25 young healthy subjects (mean age, 27 years), 29 healthy subjects aged over 75 living in the community, 62 subjects (mean age, 75) admitted to a geriatric assessment ward (acute illnesses), and 32 subjects (aged over 65) in a ward for long‐term physical or mental illnesses. Overall, the female/male sex ratio varied from 2:1 to 3:1. For the three elderly groups, the incidence of low erythrocyte folate levels (less than 100 mμg/100 ml) were 24 percent, 16 percent, and 18 percent, respectively. For the young group, the mean value would be be over 296 mμg/100 ml. Dietary folate deficiency may often account for low folate blood levels in the elderly, but other factors should also be implicated, e.g., the ability to absorb folate.
Central‐Nervous‐System Stimulants: Appraisal of Use in Geropsychiatric Patients
Authors: CROOK THOMAS
Published: April 2015

ABSTRACT: CNS stimulants such as methylphenidate and pentylenetetrazol are currently prescribed for the treatment of aged persons with symptoms of senility. A review of clinical studies conducted with these compounds indicates that firm evidence of efficacy is lacking. Because of the risks associated with high doses of such stimulants in the aged, it would seem that these compounds are of limited utility in geriatric psychiatry.
Nutritional Deficiencies and Nutritional Support Therapy in Geriatric Cancer Patients*
Authors: CHING NATHANIEL , GROSSI CARLO , ZURAWINSKY HELEN , JHAM GULAB , ANGERS JOHN , MILLS CHRISTOPHER , NEALON THOMAS F.
Published: April 2015

ABSTRACT: Nutritional deficits and their correction were studied in 45 cancer patients (age range, 60–86 years) who were undergoing various modalities of cancer therapy. Their nutritional status was maintained with a variety of commercially available special diets, and serum albumin concentrations were sequentially determined in order to gauge the efficacy of the nutritional support. Serum albumin levels were preserved when nutritional support was employed in surgical therapy. However, patients undergoing palliative chemotherapy or radiotherapy responded only to adequate levels of the standard hospital diet with or without supplements of special enteral diets. In the survivors, albumin levels were maintained; in the nonsurvivors, albumin levels decreased. This group of older patients tolerated nutritional support therapy, especially when it was carefully monitored. Satisfactory nutritional therapy can be achieved by use of appropriate enteral formulas. The method lends itself to adequate management in the outpatient or nursing‐home situation during certain phases of cancer.
Familial Achalasia of the Esophagus in Mother and Son: A Possible Pathogenetic Relationship
Authors: CHAWLA KIRAN , CHAWLA SATISH K. , ALEXANDER LESLIE L.
Published: April 2015

ABSTRACT: Familial achalasia most often has been recorded in siblings, and only rarely (twice previously) in a parent and offspring. This report concerns a third case of achalasia in a parent and offspring (mother and son). Clinical and radiographic features of the esophageal achalasia are presented. The possibility that genetic factors may play a role in the etiology of this disorder is discussed.
Myocardial Infarction in the Differential Diagnosis of Dementias in the Elderly
Authors: HONTELA S. , SCHWARTZ G.
Published: April 2015

ABSTRACT: The incidence of cerebral lesions in relation to myocardial infarction (MI) was evaluated on the basis of data obtained from medical records and autopsy reports on 269 psychogeriatric patients, in a 13‐year retrospective study. Among 84 demented patients with MI, brain infarcts and hemorrhages were found in 42 percent, and Alzheimer's disease in 17 percent; (combination in 8 percent). In contrast, among 70 demented patients without MI, brain infarcts and hemorrhages were found in 11 percent, and Alzheimer's disease in 43 percent; (combination in 6 percent). Therefore, when it is difficult to differentiate senile dementia (Alzheimer's disease) from dementia due to cerebrovascular impairment, data on the presence or absence of myocardial infarction may prove useful.
Chronic and Acute Disease Problems in Rural Nursing Home Patients
Authors: DAHLSTEN JOHN , SHANK J. CHRISTOPHER
Published: April 2015

ABSTRACT: The patients of a rural nursing home in Iowa were surveyed according to age and sex, plus chronic and acute disease problems. With use of the International Classification of Health Problems in Primary Care, the diagnoses were organized by major disease category and by specific diagnosis. Of the 66 patients, 76 percent were age 75 or older. Women comprised 61 percent of the group, and men 39 percent. Overall, the mean age was 79.1 years. Senility was the most common diagnosis for chronic diseases, and genitourinary infections for acute diseases. Circulatory system disorders comprised the largest category of chronic diseases, whereas genitourinary disorders comprised the largest category of acute diseases. Overall, there were 4.2 chronic disorders per patient. Although the data compare favorably with those in the National Health Survey of nursing homes, more research is needed to prepare medical personnel for the problems associated with a rapidly expanding population of elderly patients.
Systolic Hypertension: Occurrence and Treatment in a Defined Community*
Authors: SELIGMANN ARTHUR W. , ALDERMAN MICHAEL H. , DAVIS TONI K.
Published: April 2015

ABSTRACT: Systolic hypertension, a disorder occurring predominantly in the elderly, is associated with an increased incidence of stroke and coronary artery disease. Based on the supposition that it is a risk factor, many authorities have urged that it be treated. This report concerns an experience in treating systolic hypertension in a defined ambulatory population of 898 hypertensive subjects in a work‐site program. The systolic hypertension group (N = 39) was compared with a matched diastolic hypertension group and with a matched systolic/diastolic hypertension group (N = 39 each). The patients with systolic hypertension responded to standard treatment (chiefly with diuretics), but less satisfactorily than did the patients with diastolic hypertension. Side effects or toxicity were uncommon and did not interfere with the therapeutic regimen. However, the ultimate value of such therapy in the prevention of vascular complications remains to be determined.
The Elderly Patient in the Coronary Care Unit. II. Incidence and Treatment of Arrhythmias
Authors: BERMAN NEIL D.
Published: April 2015

ABSTRACT: In 1976, 130 patients aged 70 or older were admitted to the Coronary Care Unit (CCU) at Toronto Western Hospital. Arrhythmias were noted in all but 24 percent. Digoxin was given to 53 patients, lidocaine to 24, propranolol to 28, and quinidine to 11. In 2 patients, cardioversion by direct current was required for supraventricular arrhythmias. In 26 patients, temporary pacemakers were used. Of 13 patients who experienced at least one cardiac arrest in the CCU, 10 survived to be discharged to the ward. In total, only 12 of the 130 elderly patients died in the hospital, and in only 3 of these was arrhythmia the primary cause of death. The treatment of arrhythmias in the elderly is as successful and rewarding as in younger patients. Indications for the various antiarrhythmic drugs are similar. Except for digoxin, the dosages of such drugs for the elderly are the same as those for younger patients. Adverse effects apparently are not more common in the elderly.
Bacterial Pneumonia in the Elderly: A Reappraisal of Conventional Therapy, with a Note on Cefamandole
Authors: GLECKMAN RICHARD A. , ESPOSITO ANTHONY L.
Published: April 2015

ABSTRACT: Community‐acquired bacterial pneumonia in the elderly has for years been attributed almost exclusively to Streptococcus pneumonias. Recent technical advances have provided bacteriologic and epidemiologic data demonstrating that other pathogens are important causes of pulmonary infection in older patients. This report reviews these data and reappraises the conventional therapy of community‐acquired bacterial pneumonia in geriatric patients. Some properties of a new antibiotic, cefamandole nafate, are described.
Counseling the Isolated Elderly*
Authors: RATHBONE‐McCUAN ELOISE , CLAYMON CAMILLE
Published: April 2015

ABSTRACT: Increasing interest is manifest in the development of alternative models of counseling for older persons. Irrespective of the particular model used, the counseling of aged persons who have emotional and psychologic problems may require a treatment plan for health, mental health, and social services, to resolve the problems and to assess the functional limitations. Health and mental health centers employing both professional and nonprofessional counselors need to determine the value of adding outreach components to their services, and agencies which already have outreach programs may need to determine their relevance and effectiveness. Effective outreach requires a high level of gerontologic knowledge and clinical skills with aged patients. Agencies and clinics can design and implement mechanisms for supporting the elderly as they make use of multiple sources of service. Mobilization of the family and other informal helping networks in the community, the establishment of better coordination mechanisms within clinic and service programs, and multipleservice integration will improve the efficiency and effectiveness of long‐term community care and follow‐up programs.
Sensory Deprivation and Homeostasis
Authors: OSTER CLAUDE
Published: April 2015

ABSTRACT: Most afferent inputs are sensory stimulants, and physical activity is probably one of the most significant of all sensory stimulations. Gravity is a constant stimulus. These demands are also known as stress, and the stressor effect as the general adaptation syndrome (Selye). In this study, these demands are called sensory afferent stimuli, which are necessary triggers to start the hypothalamus‐pituitary‐adrenal mechanism and thus maintain the general mechanical, autonomic and metabolic functions of the body in the state of homeostasis. If the sensory stimulus is removed, there is no stressor effect and the cycle of response is eliminated. This results in a decreased hypothalamuspituitary response and a decreased production of ACTH and corticoids. A decrease in the sensory input creates changes in the central nervous system and in the musculoskeletal system which are compatible with lack of the hypothalamus‐pituitary response. When a person becomes ill, physical inactivity as well as sensory and perceptual deprivation are at a maximum, and the absence of these stimuli interrupts the cycle of homeostasis. Physical activity is one of the most important stressors (sensory input) or triggering mechanisms for the cycle of homeostasis (hypothalamus‐pituitary‐adrenal cycle). Therefore, it is imperative to provide the patient with physical activities which ensure motion and take into account the effect of gravity. This is best accomplished by a program of physical, occupational and recreational therapy.
Bronchoextrapleural Fistula after Extrapleural Pneumonolysis
Authors: BANSAL SUDHIR , DEVANARYANAN PADMANABHAN , NAPODANO RUDOLPH J.
Published: April 2015

ABSTRACT: This case illustrates the development of a bronchoextrapleural fistula 40 years after extrapleural pneumonolysis with placement of a paraffin pack. The various diagnostic possibilities in the presence of such a radiographic presentation are reviewed.
Erythrocyte Sedimentation Rate and Disease in the Elderly
Authors: RAI G. S.
Published: April 2015

ABSTRACT: The erythrocyte sedimentation rate (ESR) is not always elevated in relation to disease. Of 188 elderly autopsy patients studied, 125 had nonmalignant disease and 63 had malignant disease. Of the patients with malignant disease, 13 percent had a clinical ESR of less than 10 mm/hr and 26 percent a rate of less than 20 mm/hr, the upper level of normal for the elderly. Of the patients with nonmalignant disease, 9.6 percent had an ESR of less than 10 mm/ hr and 25.6 percent a rate of less than 20 mm/hr. Thus, in about a quarter of the patients, the ESR was below the top normal level for the elderly. Moreover, the ESR may be as high as 35–40 mm/hr in healthy aged persons. Therefore, the ESR is unreliable as a test for the presence of disease (malignant or nonmalignant) in the elderly.
Survival in the Elderly with Acute Leukemia*
Authors: HOLMES FREDERICK F. , HEARNE ERWIN , CONANT MERRILL , GARLOW WILLIAM
Published: April 2015

ABSTRACT: The natural history of acute leukemia in the elderly is not well understood. There is disagreement about the value of treatment other than by supportive measures. In this study, the survival predictive power of 9 variables was analyzed in 103 patients aged 70 or older for whom a bone‐marrow cytologic diagnosis of acute leukemia had been made at a referral hospital during the 30year period, 1947–1976. When given, treatment was uniformly conservative. Blood leukocyte and platelet counts and hematocrit values at the time of diagnosis, sex, treatment, and the calendar year of diagnosis were significant (P < 0.01) predictors of survival duration. Initial hematologic measurements, presumably reflecting the degree of leukemic cell infiltration of the bone marrow, were the strongest predictors of survival, whereas leukemic cell type had no predictive power. Survival increased significantly (P < 0.01) during the 30year period of the study, possibly more attributable to improved supportive care than to specific antileukemic therapy. Apparently survival is at least partly determined at the time of diagnosis, and conservative therapy often may be beneficial rather than detrimental.
The Misplaced‐Objects Task: A Brief Test for Memory Dysfunction in the Aged
Authors: CROOK THOMAS , FERRIS STEVEN , McCARTHY MARTIN
Published: April 2015

ABSTRACT: A brief, simple test for memory dysfunction in the aged is presented. Materials for the test consist of: 1) a board on which the cross‐section of a seven‐room house is imprinted, and 2) representations of 10 objects frequently misplaced in the home (e.g., keys). The task of the subject is to place the objects in rooms on the board and, after an interval of 5–30 minutes, to recall the location of each object. The measure is appropriate for a broad range of aged subjects, since performance requirements are minimal and readily apparent. The task has obvious face validity, which is essential for maintaining appropriate motivation in many aged subjects. Discriminate validity was demonstrated in a study in which significantly fewer objects were recalled by 60 aged persons with memory impairment ( = 6.0) than by 44 unimpaired aged persons ( = 8.9) or 63 young normal persons ( = 9.9). Satisfactory test‐retest reliability was demonstrated by a correlation of .84 between performances on two consecutive days in a subgroup of 20 impaired patients. Subjects appeared to enjoy the game‐like structure of the test and clearly were not threatened by the test procedures. Suggestions are offered for further development of the measure.
Practical Considerations in the Rehabilitation of the Aged†
Authors: Hunt T. E.
Published: April 2015

Enlightened geriatric care provides assistance to the elderly for living independently as long as possible. Essential to this amenity is the high priority placed upon restoration in coordination with other forms of therapy. Medical rehabilitation too often has been associated with employment‐oriented goals and with major physical achievements. Restoration of the young spinal‐injured paraplegic patient has been a model for rehabilitation medicine. The aged, also, often can be restored to optimal levels of functional capacity commensurate with their lesser needs. Rehabilitative principles for the management of disability are the same in old age as at any other time of life. Certain age‐related factors, however, profoundly influence programs of restoration for the elderly. These factors need full consideration when physicians plan appropriate care for their aged patients. A list of guidelines is presented.
Psychosocial Problems of the Aged: A Shared Medical Responsibility
Authors: KRAL V. A.
Published: April 2015

The respective roles of the psychiatrist and the family physician in dealing with the psychologic and some of the social problems of the aged are briefly outlined. By close cooperation of these two groups of physicians, many aged patients can be helped. More important is the fact that both groups of physicians can contribute to a change in attitude toward aging among the younger members of society. This offers hope that many of the psychosocial problems of the aged can be minimized or prevented.
Primary Hodgkin's Disease of the Stomach in a 72‐Year‐Old Man
Authors: Geboes Karel , Bossaert Herman , Dooms Marie‐Therese , Helewaut Johan
Published: April 2015

Primary Hodgkin's disease of the stomach is rare, but it may occur at any age. In surgically treated patients, the prognosis is better than for adenocarcinoma. Therefore, a precise diagnosis of the gastric tumor is paramount. Endoscopic biopsy is a valuable aid. A case report is presented of a 72‐year‐old man in whom a diagnosis of gastric lymphoma was made preoperatively. Results were good one year after surgical therapy.
Relative Mortality of Chronically Ill Geriatric Patients with Organic Brain Damage, Before and After Relocation†
Authors: Csank J. Z. , Zweig J. P.
Published: April 2015

Elderly patients in whom mental impairment is associated with organic brain damage (chronic brain syndrome) usually bear a higher mortality risk than do other sick geriatric patients, especially under the stress of relocation. When Ste. Anne's Hospital moved, the patients with chronic brain syndrome had the highest mortality rate during the following year. Apparently these brain‐damaged subjects failed to cope with the situation until it became real (after relocation). Thus, in a stress prevention program adopted when a geriatric institution plans to move, special attention should be paid to the subpopulation with chronic brain syndrome in the period immediately following the relocation.
Age Differences in the Severity and Outcome of Burns
Authors: Linn Bernard S.
Published: April 2015

This study concerns the relationship between age and injury in 1,297 patients with recent burns who were admitted variously to 73 hospitals. Older patients showed a significantly higher proportion of severe injuries than did middle‐aged and younger groups. Even after adjusting for the severity of injury, the morbidity and mortality were higher in the over‐65 group. These poorer results did not seem to be entirely accounted for by older age and greater severity of the burn. Surgical treatment such as debridement and grafting was used no more frequently in older patients than in younger ones, even though the greater severity of the burns would normally be expected to require more operations. The fact that older patients had more complications could have influenced physicians in their surgical decisions. Also, the attitude that the elderly are less able to tolerate surgical procedures may have played a role in the use of less aggressive treatment in relation to the severity of the burn.
Role of Physical Therapists in Physical Activity Programs in Nursing Homes: A Survey
Authors: Skeist Helen Deborah
Published: April 2015

A survey was conducted to help define the role of physical therapists in physical activity programs in nursing homes. Questionnaires were completed by 64 physical therapists working in nursing homes of 130–150 bed capacity. The major factors studied were employment status, work‐time at the facility, interprofessional relationships, and available equipment and space. Of the respondents, 43.7 percent were involved in physical activity programs, the most common roles being staff instruction and consultation. Only a small percentage of the time was used for programs; most of the time was occupied with individual physical therapy treatment. The principal types of programs with physical therapist involvement were ambulation and gait training, bed exercises, and general group exercises. Equipment and space seemed adequate. Physical therapists were likely to be involved in physical activity programs if: 1) they were employed by the nursing homes, were paid on a salary basis, worked at the nursing homes full‐time or nearly full‐time, and did not work elsewhere; 2) such programs were mentioned during discussion of the work agreement; and 3) the coordinator of the physical activity programs was an occupational therapist or a nurse rather than an activities director or recreational therapist.
Hysteroscopy in the Diagnosis of Endometrial Carcinoma: Case Report
Authors: Poma Pedro A. , Diaz Alfonso
Published: April 2015

The incidence of endometrial carcinoma is particularly high in postmenopausal women. Screening techniques are not yet satisfactory. Postmenopausal anatomic physiologic changes in the genitalia may prevent visualization and exploration of the uterine cervix. A case report is presented of an 87‐year‐old woman with a 6‐month history of genital bleeding. Severe vaginal stenosis prevented diagnostic curettage, even under adequate anesthesia. To perform the indicated hysteroscopy, a panendoscope had to be employed for direct visualization of the cervix and uterine cavity. Selective biopsy specimens revealed endometrial adenocarcinoma. The hysteroscopy technique is easy to learn. However, if the patient's physician has not acquired this experience, a urologist, who must necessarily use endoscopy extensively, can be of great help in the evaluation of gynecologic patients with uterine problems similar to those described in this report.
Gerontologic and Geriatric Training in Medical School: Curricular Preferences Shown by Medical Students, Educators, and General Practitioners
Authors: Levenson Alvin J. , Thornby John I. , Tollett Susan M.
Published: April 2015

The need for incorporating gerontologic and geriatric training into the education of medical students is evident. Two main obstacles are the lack of educator knowledge in planning such training, and negative attitudes toward aging and the aged. Curriculum planning requires a design for the goals/objectives, the content, and the delivery vehicles. This article concerns chiefly the delivery vehicles, a subject which has received little attention in the literature. Negative attitudes on the part of students and their educators may defeat the incorporation of geriatric training into the curriculum. To assist in reducing these obstacles, a study was conducted for the purpose of providing data to educators which might facilitate the design of a delivery component for a medical student curriculum in gerontology and geriatrics. Senior medical students, their educators, and some general practitioners were surveyed in randomized groups, to determine: 1) their preferences for delivery vehicles in such a curriculum, 2) their attitudes toward aging and the aged, and 3) relevant demographic variables. The results are discussed from the viewpoint of the potential impact of these factors on their preferences and on the creation of obstacles to curriculum incorporation.
Paraphrenia: Paranoid States of Late Life. I. European Research
Authors: Bridge T. Peter , Wyatt Richard Jed
Published: April 2015

American psychiatry has traditionally viewed late‐life paranoid states either as rare or not part of the schizophrenic syndrome. European psychiatry has not subscribed to this view. The literature (chiefly European) is reviewed from the standpoints of history of the disorder, diagnostic reliability, pre‐onset sensory loss, the multiple determinants of paranoia, and the response of paraphrenic patients to treatment with phenothiazines. The evidence leads to the conclusion that late‐life paranoid states are not rare, and that the diagnosis “paraphrenia” has real clinical utility. Moreover, there seems to be a substantial relationship between schizophrenia and paraphrenia.
Mechanism of Age‐Related Changes in Renin and Adrenocortical Steroids†
Authors: Saruta Takao , Suzuki Akira , Hayashi Matsuhiko , Yasui Toshiyuki , Eguchi Toyohisa , Kato Eiichi
Published: April 2015

Age‐related changes in plasma renin activity (PRA) and in plasma levels of adrenocortical steroids were studied in 140 normotensive men and 128 normotensive women. All were free of disease, and their ages ranged from 20 to 86 years. PRA decreased gradually with age in both men and women, and was slightly lower in women than in men. In the older subjects, the responses of PRA to the administration of furosemide or to dietary sodium restriction plus the upright position for blood sampling were significantly less than in the younger subjects. Apparently the suppression of PRA with age is due either to dysfunction of the juxtaglomerular cells induced by aging, or to reduction in the number of functioning nephrons. The plasma level of aldosterone was also reduced with age, but the levels of desoxycorticosterone, corticosterone, and cortisol were not significantly affected. The suppression of aldosterone seemed to be chiefly dependent upon the suppression of renin activity. However, the possibility remains that disturbed function of the glomerular cells with aging also is related to the suppression of aldosterone, since the response of aldosterone to dietary sodium restriction (upright position for blood sampling), to angiotensin II, and to potassium were greatly reduced.
Bulk Laxative Ileus
Authors: Berman Joseph I. , Schultz Michael J.
Published: April 2015

In an elderly nursing home resident who had taken excessive dosages of bulk laxative for many years, small‐bowel obstruction developed, requiring surgical intervention. A carcinoma of the ascending colon probably was the immediate cause of the obstruction, which resulted in the accumulation and inspissation of the bulk laxative throughout the small bowel. Great care should be exercised in the long‐term use of these laxatives.
Estrogen Therapy and Breast Cancer in Postmenopausal Women†
Authors: Gambrell R. Don , Massey Fred M. , Castaneda Tristan A. , Boddie Arthur W.
Published: April 2015

During the 6‐year period 1972–1977, 123 postmenopausal women with breast cancer either had the disease diagnosed at Wilford Hall USAF Medical Center or were referred there for therapy. Their ages ranged from 33 to 90 (mean, 56.6 years). Of these women, 64.2 percent had never taken hormones, 25.2 percent were estrogen users, 4.9 percent were estrogen‐progestogen users, 4.9 percent had a history of hormone usage, and 1 patient was using estrogen vaginal cream. In a subgroup of 27 clinic patients (1975–1977 period) during 14,548 patient‐years of observation, breast cancer was diagnosed for an overall incidence of 185.6:100,000 women per year. Among the 27 patients, the annual incidence of breast cancer was highest in the untreated group at 410.5: 100,000 women. In comparison, the incidence in the estrogen users was 137.7: 100,000 women—a significant difference (p < 0.01). The incidence in estrogen‐progestogen users was 155.6:100,000 compared with the incidence in the untreated patients; this difference was also statistically significant (p < 0.05). There was no significant difference in the incidence of breast cancer between the estrogen users (137.7:100,000) and the estrogen‐progestogen users (155.6:100,000). These data indicate that estrogen therapy decreases the risk of breast cancer and that, unlike the situation with adenocarcinoma of the endometrium, progestogens do not offer additional protection from breast carcinoma.
Protein‐Calorie Malnutrition in the Elderly
Authors: Gambert Steven R. , Guansing Alejandro R.
Published: April 2015

Protein‐calorie malnutrition, common among the elderly, often escapes recognition. This article reviews some of the etiologic factors and the clinical manifestations. Ways to assess and prevent protein‐calorie malnutrition are also discussed.
Osteochondritis Dissecans of the Hip: A Rare Disorder in the Aged (Case Report)
Authors: Cohen Samuel L.
Published: April 2015

Osteochondritis dessicans of the hip is rare in comparison with occurrence of the disease in other joints. Only about 50 cases have been reported. The literature is reviewed, and a new case is presented. The patient was a 94‐year‐old Spanish American War veteran who was unusually active and in good health until the onset of osteochondritis dissecans in the right hip (classic clinical and roentgenologic findings). Despite his advanced age and the severe arthritic changes, under conservative therapy he gradually regained a surprising degree of mobility in the affected hip.
Characteristics of Family Practitioners with Large Geriatric Practices
Authors: Haas William H. , Crandall Lee A. , Bain D. J. G.
Published: April 2015

Little has been reported on the characteristics of physicians presently serving the health needs of the elderly. In this report, generated from a survey of Florida family practitioners, physicians with large geriatric practices are compared to physicians with practices composed primarily of younger patients. Family, physicians with large geriatric practices are older, and treat more chronic disease than do their peers. However, they consult the same professional journals and texts in caring for their patients, refer patients to specialists at the same rate, and have the same office facilities as do their colleagues who treat chiefly younger patients. The family physician with a large geriatric case load is less likely to have a predominantly outpatient practice and more likely to be involved with hospitalized patients. Data from the census and health manpower studies suggest that family physicians will care for substantial numbers of elderly patients in the future. Continuing education which addresses issues in geriatrics may help to attain optimal health care for the elderly.
Management of the Mental Health of Ambulatory Elderly Patients
Authors: Portnoi Valery A. , Shriber Linda S.
Published: April 2015

Geriatric health care practice strives to respond to the medical, psychologic and social needs of the elderly person through coordinating the services of the physician and the psychiatric social worker. In a geriatric clinic at the George Washington University Medical Center, the medical regimen for elderly ambulatory patients is supported and augmented by psychotherapy, counseling, behavioral therapy, and instruction of the family about the patient's need for environmental or residential changes. A review of the records of 40 elderly patients initially enrolled in the geriatric clinic program showed that 20 were in need of mental health support. Among these, 8 had a depressive disorder, 1 had paraphrenia, 2 had longstanding schizophrenia, and the rest showed mental decline secondary to organic brain syndrome. The geriatrician and the psychiatric social worker were able to provide sufficient mental health support for these elderly mental patients to permit them to remain in the community for worthwhile periods. Ambulatory geriatric patients, especially those with mental health impairment, can benefit greatly from services offered in a comprehensive fashion by a geriatrician and a psychiatric social worker.
The Clinical Management of Grief
Authors: Jacobs Selby , Ostfeld Adrian
Published: April 2015

The clinical management of grief involves issues that demonstrate the integration of psychosocial risk factors into clinical practice. Recommendations for the clinical management of grief are based on a review of the pattern of morbidity and mortality of bereavement, of the emotional response to conjugal loss, and of several postulated pathogenetic mechanisms.
Alleviation of Constipation in the Elderly by Dietary Fiber Supplementation
Authors: Hull Christine , Greco Roger S. , Brooks Dorothy L.
Published: April 2015

To alleviate the constipation problem among the elderly residents of Essex County Geriatric Center, New Jersey, a fiber‐supplemented dietary regimen was started. Under this regimen, bran was added to the hot breakfast cereal, thus increasing the crude fiber content of the diet to 6–8 gm compared with the former 4–6 gm. As estimated from recent analysis data, the total dietary fiber was increased from 25 to 40 percent by the addition of bran. This amount of fiber proved effective in preventing constipation in 60 percent of the residents even though many of them had previously required laxatives. Additional programs of dietary fiber supplementation were devised for residents who did not respond to the cereal supplementation or who required nasogastric feedings. In the year following initiation of the program at this Center, the use of laxatives was virtually eliminated, and the institution's pharmacy reported a saving of $44,000 in expenditures for laxative drugs. Recipes are included for the bran‐supplemented hot cereal, a special fiber‐prune juice supplement, and a fiber‐rich liquid for tube‐feedings.
Situational Influences on Leisure Satisfaction and Morale in Old Age†
Authors: Mancini Jay A. , Orthner Dennis K.
Published: April 2015

The relationship between leisure satisfaction and morale was examined within the context of leisure behavior, health, age, and socioeconomic status. Interviews were conducted with 104 noninstitutional adults aged 65 or older living in an urbanized area. Leisure satisfaction and morale were substantially related, and remained so when statistically tested with various third factors. Multivariate analysis indicated that the most important predictors of morale were leisure satisfaction and socioeconomic status. Self‐rated health, the illness index, and age were much less significant as predictors.
Burns in Older Patients
Authors: Slater Harvey , Gaisford John C.
Published: April 2015

An increasing percentage of the burn victims admitted to the Western Pennsylvania Hospital and Burn Care Center are aged 65 or older. Among 108 such elderly patients admitted during the past six years, 68 died and 40 survived—a mortality rate of 63 percent. Those who died of burns (average age 76.4) had burns over 44.8 percent of the mean body surface, whereas the survivors (average age 73.5) had burns over a smaller area (16.7 percent). Survival also was related to the presence of significant heart and lung disease which antedated the thermal injury. Treatment of the burns was in keeping with standard recommendations for intravenous fluid resuscitation, wound care, and skin grafting. Cimetadine and antacids proved effective in the prevention of significant gastrointestinal bleeding. Ninety percent of the survivors returned to their homes after treatment. Although the mortality for elderly burn patients remains high, the favorable results in rehabilitation of the survivors are encouraging. Increased attention should be paid to safety programs for the elderly and those who care for them, to prevent such serious accidental injuries.
Laryngeal Carcinoma with Synchronous or Metachronous Bronchogenic Carcinoma
Authors: Shankar Patil S.
Published: April 2015

Primary carcinoma of the lung may accompany or follow primary carcinoma of the larynx. This relationship was noted in 2 patients in whom the tumors occurred synchronously, and in 3 in whom they occurred metachronously. The lung cancer presented with bronchopulmonary symptoms in the synchronous group, and with an abnormal radiographic shadow (1 to 5 years after treatment for laryngeal carcinoma) in the metachronous group. The lung growth (squamous‐cell carcinoma) was confined to the upper lobes. The patients were all heavy cigarette smokers. The epithelium of the entire respiratory tract seems susceptible to malignant change. Patients who have undergone treatment for laryngeal carcinoma should be followed by periodic radiologic examination, as they are at greater risk for the development of a new malignant lesion in the lung. Moreover, patients with bronchogenic carcinoma require routine laryngoscopic examination to discover or rule out any coexistent primary growth in the larynx.
Euthyroid “Thyroxine Toxicosis”
Authors: MANKIKAR G. D. , CLARK A. N. G.
Published: April 2015

A survey was made of thyroid function tests on 1,153 patients screened for thyroid disease during a two‐year period in a Geriatric Department; 13 percent of the test results fell outside the normal range. Of 88 patients who showed above‐normal results, only 12 presented with clinical features of thyrotoxicosis. In 37 patients, the biochemical findings indicated euthyroid “thyroxine toxicosis”; high values were found for serum thyroxine (T4) and the free thyroxine index (FT4I) but there were no clinical signs or symptoms of thyrotoxicosis; the values reverted to normal within one to three weeks. This pattern was seen also in 7 examples of T4‐treated hypothyroidism. (Overall, the test findings indicated 61 cases of hypothyroidism.) The significance of this transient increase in T4 and FT4I values is discussed. The false positive results suggest that, when laboratory findings are not compatible with the clinical signs, the thyroid function tests should be repeated after another two weeks.
Brain Weights in Octogenarians
Authors: HOWELL TREVOR H.
Published: April 2015

ABSTRACT: The brains of 102 octogenarians were weighed and examined at autopsy. The heaviest weighed 2075 gm, and the lightest 818 gm. They were classified by sex and by the pathologic changes. These brains were definitely lighter than the accepted normal, but somewhat heavier than a previously reported series of nonagenarian brains which showed a greater percentage of pathologic lesions.
Quantitative Clinicopathologic Study of Senile Dementia
Authors: KURUCZ JANOS , CHARBONNEAU RENE , KURUCZ ANNA , RAMSEY PATRICIA
Published: April 2015

ABSTRACT: In a randomized blind study of 69 mental hospital patients over 50 years of age, a highly significant correlation was observed between the clinical symptoms of organic brain disease and the quantity of senile plaques found in the brains at autopsy. A stepwise multiple regression analysis indicated that independent significant predictors of the quantity of plaques were the level of disorientation and the age of the patient. Additional clinical tests for intellectual deterioration, affect lability, and impairment of memory and judgment did not improve the predictive ability. The correlation between incidental pathologic changes unrelated to the senile form of cerebral degeneration and the clinical symptoms was highly significant, though not obvious. Only after removal of the effect of the quantity of plaques on the clinical symptoms (multiple regression analysis) did the effect of other pathologic processes become evident. A significant one‐way fixed‐effect relationship was noted between increasing quantity of symptoms and increasing quantity of plaques in 48 cases of senile dementia correctly diagnosed by the psychiatry staff. In the control group of 21 patients without senile dementia, the quantity of plaques was correlated with the age of the patients but not with their clinical symptoms.
A Standardized Approach to Parenteral Nutrition for the Geriatric Patient
Authors: AUSMAN ROBERT K.
Published: April 2015

ABSTRACT: Parenteral nutrition can be a useful therapeutic and prophylactic tool in managing some geriatric patients who present with nutritional deficiences that accompany acute and chronic diseases. An outline is given of recommended procedures, e.g., solutions, dosages, indications, and contraindications. The techniques described permit a standardized approach to parenteral nutrition for most patients.
Value of Admission Profile Tests for Prognosis in Elderly Patients
Authors: HODKINSON H. MALCOLM
Published: April 2015

ABSTRACT: In a series of 934 elderly patients admitted to the geriatric department of a general hospital, several admission laboratory tests were found to provide prognostic information. When tests were combined as a discriminant function, the matter of death or survival at six weeks after admission was predicted with 84 percent accuracy in women and 77 percent in men. Values for serum sodium, blood urea, triiodothyronine uptake, and hemoglobin contributed significantly to the prediction in both sexes, whereas the values for serum albumin and blood glucose contributed only in women.
Urinary Dysfunction in a Geriatric Long‐Term Care Population: Prevalence and Patterns*
Authors: JEWETT M. A. S. , FERNIE G. R. , HOLLIDAY P. J. , PIM M. E.
Published: April 2015

ABSTRACT: More complete data on the prevalence and types of urinary dysfunction in geriatric institutional patients are essential for the management of their urologic problems. Over a 13‐month period, a prospective study was conducted of all new admissions to a hospital for long‐term care. Eighty percent (277/347) of the newly admitted patients were geriatric (65 or older). Urinary dysfunction was identified in 69.3 percent of the geriatric group; 38.3 percent were incontinent, 20.2 percent bore a urinary diversion device, and 10.8 percent were symptomatic without incontinence. Obtaining reliable information about urologic status posed a significant problem, particularly as 27 percent of the subjects had a mental disorder, including organic brain syndrome or confusion. Thirty percent of all patients questioned were unable to give any history of their own health status. Questioning of both staff and patient to determine reliability of the data revealed that the given information was correct in 77 percent of patients who acknowledged genitourinary dysfunction, and in 83 percent of those who denied it. The study failed to elicit useful data concerning the specificity of symptoms, urologic history, diagnosis and management of urinary dysfunction in this series of geriatric patients under long‐term institutional care.
Clinical Hypothyroidism in the Elderly—A Preventable Disorder?*
Authors: ROSENBAUM ROBERT L. , BARZEL URIEL S.
Published: April 2015

ABSTRACT: Among 27 ambulatory aged patients receiving thyroxine therapy for hypothyroidism, 4 had the “failing thyroid syndrome” (FTS) and 23 had frank clinical hypothyroidism. Patients with FTS are asymptomatic and the subnormal thyroid function is recognized only by a high level of serum thyrotropin (TSH) with a normal level of thyroid hormone (thyroxine or triiodothyronine). They require a smaller dosage of thyroid hormone for replacement initially. Identification of these cases through routine blood analyses for TSH in patients at risk (those with a history of Graves' disease or Hashimoto's thyroiditis) may permit early treatment of incipient hypothyroidism and the prevention of clinical hypothyroidism. Since there is a reduction in the thyroxine dosage required for complete thyroid replacement with age, the expected final replacement dosage when the thyroid fails completely is less than that reported for younger adults. This is true for patients with FTS, for patients with newly diagnosed clinical hypothyroidism, and for patients with long‐established hypothyroidism receiving replacement therapy. The thyroid replacement dosage should be adjusted both for age and for body weight to avoid overdosage and thyroid toxicity, to which the elderly are particularly sensitive.