bluuebunny/crossref_metadata_2025 huggingface dataset:
Poisoning in the Elderly
Authors: KLEIN‐SCHWARTZ WENDY , ODERDA GARY M. , BOOZE LISA
Published: April 2015

A prospective evaluation of poison exposure calls, in reference to persons ≥60years of age, was performed at the Maryland Poison Center during a six‐month period in 1981. Each call was examined with respect to location of exposure, caller, circumstance, treatment location, and final outcome. The study group consisted of 237 persons, of whom 66 per cent were women. The majority of callers were not medical personnel, and the most common location for exposure was the home. Most exposures occurred by the oral route and were the result of an accident (83.1 per cent) as opposed to suicide (14.8 per cent) or drug abuse (1.7 per cent), which are more frequent inyounger adults. Although only 27.4 per cent of the study population received treatment in an emergency room or required hospital admission, the probability of admission for the elderly person seen in the emergency room was significantly greater than that foryounger adults and children. Of the four fatalities that occurred, three were classified as suicides and one as an accident.
General Hospital Geriatric Psychiatric Treatment: A Follow‐up Study
Authors: SADAVOY JOEL , REIMAN‐SHELDON EDITH
Published: April 2015

Fifty‐two patients previously treated and discharged from an acute‐care general hospital ward were followed up for an average of 30.5 months. The results show that while it is true that depressive episodes in the elderly are often easily and rapidly treated, many of these patients do poorly in the long term for a variety of reasons related to depressive dysphoria, organic brain syndrome, and physical disability. Depressive or dysphoric relapse in the community seems to go largely unrecognized. It is suggested that follow‐up must be done soon after discharge to prevent the high level of rejection of the treatment team that may occur once the patient loses contact. Follow‐up must in part be done initially through home visits, and a firm institutional liaison established for the large group that will need ongoing care.
A Geriatric Rehabilitation and Assessment Unit in a Community Hospital
Authors: APPLEGATE WILLIAM B. , AKINS DERENE , ZWAAG ROGER VANDER , THONI KEVIN , BAKER MARION G.
Published: April 2015

This report describes functional status at admission, discharge, and six months later for 100 elderly persons treated at a community hospital assessment and rehabilitation unit. The goal of the unit is to prevent institutionalization of frail elderly persons considered at risk for nursing home placement. Characteristics of the first 100 admissions include the following: average age, 79 years; female, 77 per cent; length of stay, 23 days; average number of admitting diagnoses, 3.4. Ninety‐one new diagnoses of treatable conditions were made. On admission, 81 per cent of patients were confined to bed or chair or needed assistance with ambulation, compared with 27 per cent at discharge and 22 per cent at six months. Activities showing significant improvement include dressing, housekeeping, use of toilet, and ambulation. At six months, 15 per cent had died, 67 per cent were living in the community, and 19 per cent were institutionalized. It is concluded that care at the geriatric unit probably resulted in improved function and decreased nursing home placement.
A Randomized Trial of Cadexomer Iodine in Decubitus Ulcers
Authors: MOBERG SVEN , HOFFMAN LENA , GRENNERT MARIE‐LOUISE , HOLST ANITA
Published: April 2015

Thirty‐four patients with decubitus ulcers were studied in a randomized trial to compare topical cadexomer iodine with the standard decubitus ulcer treatments used in the participating hospitals. There was a significant reduction of ulcer area with both treatments within three weeks; however, eight of 16 patients treated with cadexomer iodine had a reduction of ulcer area of more than 50 per cent, compared with one of 18 patients treated with the standard treatment (P < 0.01). Twenty‐seven patients continued the same treatment for five more weeks, during which time six in the cadexomer iodine group healed, compared with one in the standard treatment group (P < 0.05). Cadexomer iodine was superior to the standard treatment in removing pus and debris from the ulcer surface and in reducing pain at the ulcer site. It was found to be easy both to apply and to remove from the ulcers and did not stain skin or clothing. Transient smarting during the first hour after application was reported by three patients, and one patient complained of skin irritation. The results show that cadexomer iodine applied daily has a debriding effect on decubitus ulcers and accelerates healing.
Stress Urinary Incontinence: A Simple and Practical Approach to Diagnosis and Treatment
Authors: MOHR JOHN A. , ROGERS JAMES , BROWN TERRY N. , STARKWEATHER GEORGE
Published: April 2015

A study to evaluate the efficacy of a simple and inexpensive diagnostic and therapeutic approach to stress incontinence in 46 elderly women is described. The treatment had two aspects: estrogens, both orally and topically, and a pelvic floor exercise program. The study shows that stress incontinence and stress incontinence with urgency incontinence in noninstitutionalized, ambulant elderly women can be diagnosed and successfully treated in the great majority of cases without the need for expensive and potentially hazardous diagnostic and therapeutic modalities.
The Correlation of Increased Serum Prolactin Levels with Decreased Sexual Desire and Activity in Elderly Men
Authors: WEIZMAN ABRAHAM , WEIZMAN RONIT , HART JACOB , MAOZ BENJAMIN , WIJSENBEEK HENRICUS , DAVID MENASHE BEN
Published: April 2015

Serum prolactin levels and sexual function were evaluated in 28 men from 60 to 64 years of age and in 44 men from 65 to 70 years of age. All subjects were married, physically healthy, and had no psychopathology or marital problem. About a third of the men aged 60 to 70 years suffered from impotence. No obvious correlation between elevated levels of serum prolactin and impotence was obtained. Subjects aged 65 to 70 who had decreased libido exhibited a significant elevation of serum prolactin levels, while subjects of the same age group who had reserved (normal) libido appeared to have low serum prolactin levels. Nine of ten men aged 60 to 70 years with serum prolactin levels above 40 ng/ml reported decreased libido. Potent men of both age groups (60–70 years) with high prolactin levels showed a tendency to have a decrease in frequency of sexual intercourse. Thus, it seems that mild hyperprolactinemia in aging men may be associated with decreased sexual desire and frequency of sexual activity.
Referral of Patients from Long‐term to Acute‐care Facilities
Authors: GILLICK MURIEL , STEEL KNIGHT
Published: April 2015

Medical care available to residents of nursing homes and chronic‐care hospitals was assessed by studying transfers of such persons to the emergency room of an acute‐care hospital. One hundred patients transferred from nursing homes and 16 patients transferred from chronic‐care hospitals were compared with 338 elderly patients from home (control group). Elevated temperature (≥102°F) was found in 17.3 per cent of nursing home patients and 30.0 per cent of chronic‐case hospital patients, compared with 1.8 per cent of controls (P < .05); mental status abnormalities were found in 66.1 per cent of patients from nursing homes and in 90.9 per cent of those from chronic‐care hospitals, compared with 36.2 per cent of controls (P < .025). In addition, patients from chronic‐care hospitals, but not those from nursing homes, often showed substantial abnormalities of blood pressure and pulse. Thus, the patients from nursing homes tended to be slightly sicker than controls, and those from chronic‐care hospitals considerably sicker. The probability of requiring admission to the hospital was the same for residents of nursing homes and persons living at home (44.0 per cent and 43.2 per cent, respectively), but was higher for persons from chronic‐care hospitals (81.3 per cent, P < .005).

It was also determined whether a disproportionately large percentage of transfers from extended‐care facilities occurred at night or on weekends. Among nursing home patients, 12.6 per cent of emergency room visits occurred on weekends, compared with 20.0 per cent of chronic‐care hospital patients and 24.3 per cent of controls. Thus, no evidence for “dumping” of patients was found.

It was concluded that utilization of a hospital emergency room by nursing home patients is very similar to that by home residents, suggesting an inadequacy of on‐site medical services, whereas that by chronic‐care hospital patients is restricted to major illness, which is entirely appropriate.
Sleep Disturbances in the Institutionalized Aged
Authors: COHEN DONNA , EISDORFER CARL , PRINZ PAT , BREEN ALAN , DAVIS MARK , GADSBY ANGELA
Published: April 2015

One hundred eighty nursing home residents, not psychotic or demented, average age 82 years, were administered a 30‐minute structured interview to identify and characterize their sleeping patterns, health status, medications, psychosocial environment, and living conditions. In addition, both the residents and the night nurses rated quality of sleep on a five‐point scale. Residents and nurses on all shifts also rated appetite and exercise on five‐point scales. Residents were classified as having a sleep disturbance if they met at least one of the following criteria and reported poor sleep quality: onset of sleep latency greater than 30 minutes, three or more nighttime awakenings, and less than six hours sleep per night. Forty‐five per cent of the residents met at least one clinical research criterion. Residents with sleep disturbance rated their sleep quality significantly lower than their peers not meeting research criteria. However, the nurses' ratings did not discriminate problem sleepers, and they correlated poorly with the residents' ratings. These subjective patient evaluations are discussed in relation to nursing evaluations, prescription of hypnotic medications, and other variables.
Geriatric Medical Education: A Project in Faculty Development
Authors: WALLACE ROSEMARY KOVACH , FORD AMASA B. , WALLACE ROBERT W.
Published: April 2015

To increase the competence of physicians to practice and teach geriatric medicine, the Office of Geriatric Medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio, offered an 11‐week course to interested physicians on the faculty. This course, “Medical Management of the Aged—A State of the Art Symposium for Medical Faculty,” was conducted as part of an overall plan of the Office to enhance faculty and curriculum development in geriatrics within the School. The weekly sessions consisted of clinical and research information presented by recognized experts in the field of geriatric medicine. Of the 52 formal registrants, 79 per cent were physicians and were from such fields of specialization as internal medicine, family medicine, and psychiatry. The mean attendance was 37. An overview and evaluation of the geriatric faculty development program is given.
Cultural Factors Affecting Nursing Home Care for Minorities: A Study of Black American and Japanese‐American Groups
Authors: CHEE PETER , KANE ROBERT
Published: April 2015

In a pilot study of two nursing homes serving primarily different ethnic groups, differences were found in the importance black patients and their relatives attached to the ethnic character of the institution compared with respondents in a Japanese home. The latter placed more emphasis on all aspects of ethnic programming and homogeneity of patients and staff. The blacks placed more emphasis on access to family than on ethnic orientation per se.
Demography and Old Age
Authors: GRUNDY EMILY
Published: April 2015

Demography is of great importance for those involved in caring for the elderly or in planning services. In this paper, current and future variations in the proportions of elderly people around the world are reviewed. The determinants of age structure are considered, and aging and aged populations are defined and discussed. The consequences of population aging extend into every sphere of life; particular attention is paid to the health service and economic implications. Attitudes to population aging and some of the special characteristics of the elderly in the West today are also considered. The paper concludes with a discussion of probable future trends in both the developed and the less developed parts of the world.
Impending Death and the Use of Hospitals by the Elderly
Authors: SHAPIRO EVELYN
Published: April 2015

Much attention is now focused on high users of health care. The literature indicates that elderly decedents are more often hospitalized than survivors, but little is known about the relationship of age, sex, and decedence to hospital usage. This paper uses the Manitoba Longitudinal Study on Aging to compare the hospital utilization patterns of elderly survivors and decedents. The results show that (1) the 5 per cent of the elderly who died accounted for 20 per cent of all the hospital days used by all the elderly; (2) impending death was associated with a substantial increase in the relative odds of being hospitalized and of using more than 18 hospital days; and (3) once hospitalized, the youngest decedents, who make up the largest proportion of the elderly population, spent more time in the hospital than those who were older. The findings underline the need for research into what hospitals are doing for decedents and into the quality of decedents' hospital stays.
Age‐related Sleep—Wake Disorders at a Sleep Disorder Center
Authors: ROEHRS TIMOTHY , ZORICK FRANK , SICKLESTEEL JEANNE , ROTH THOMAS , WITTIG ROBERT
Published: April 2015

The specific sleep disorders of 97 patients 61–81 years old were compared with those of 264 middle‐aged (41–60 years old) and 202 young (20–40 years old) patients. Sleep disorder diagnoses were made according to the Diagnostic Classification of the Association of Sleep Disorders Centers based on evaluations consisting of mental and physical examinations and all‐night sleep recordings. Most young and middle‐aged patients complained of excessive daytime sleepiness; the elderly complained of insomnia as often as excessive daytime sleepiness. The evaluations revealed objective findings in 93 per cent of the elderly, but only 77 per cent of younger patients. Nocturnal myoclonus or restless leg syndrome was the diagnosed cause of 23 per cent of elderly patients' sleep—wake problems, but only 11 per cent of middle‐aged and 4 per cent of young patients had this problem. Respiratory disorders of sleep were found in 27 per cent of elderly, 35 per cent of middle‐aged, and 20 per cent of young patients. Elderly patients (6 per cent) had psychiatric disorders diagnosed as the causes for their problems less frequently than did younger patients (22 per cent).
Pneumococcal Bacteremia in Adults
Authors: FINKELSTEIN MARTIN S. , PETKUN WILLIAM M. , FREEDMAN MICHAEL L , ANTOPOL STEPHEN C.
Published: April 2015

In order to evaluate the effect of age on the presentation of and response to acute bacterial infection, the hospital charts of 187 adult patients with community‐acquired pneumococcal bacteremia admitted to Bellevue Hospital over a nine‐and‐a‐half year period were reviewed. Compared with younger patients, older patients (aged 65 or older) more frequently had (1) a lower fever in response to the infection, (2) an unclear history of illness, (3) a delay in diagnosis and/or therapy, and (4) a higher risk of dying. On admission, their leukocyte counts and heart rates were similar to those in a group of younger patients, which was composed largely of alcoholic patients and those addicted to intravenous drugs. Response to therapy was also similar in surviving older patients. Lower temperature and an unclear history were features most commonly associated with both delayed diagnosis and higher mortality. When patients with a history of alcohol abuse and those dying shortly after admission (i.e., presenting in a moribund state) were eliminated from the analysis, many of these age‐related differences in presentation and outcome became even more evident.
Biologic Mechanisms in Aging
Authors: SCHIMKE ROBERT T. , AGNIEL MADELYN
Published: April 2015

This conference summary outlines the inventory of facts now known about the process of aging for interested scientist researchers, for persons who might be contemplating doing research in gerontology, and for teachers who wish to have available a source of current research and a discussion of possible new directions for adding to the science base of geriatric medicine. Phenomena of the aging process are considered from the following standpoints: mechanisms of aging and the human condition; dynamic aspects of senescence; pathology of DNA and the biology of aging; the influence of aging on protein synthesis; post‐translational changes in cells and tissues; immunologic aspects of aging; and neural and endocrine mechanisms in aging. Also included is a short paper dealing with aging phenomena in plants.
Sigmoidal and Rectal Motility in Healthy Elderly
Authors: Loening‐Baucke Vera , Anuras Sinn
Published: April 2015

Motility in the sigmoid, rectosigmoid, and rectum was studied before, during, and after a 900‐kcal meal in 18 healthy elderly and 18 healthy young adults. Three intraluminal pressure transducers spaced 5 cm apart were used for the recording. No differences existed in the percentage activities and the surface areas under the contraction curves (SA) for the corresponding measurements during fasting, during eating, and after consumption of a meal in the elderly and young adults (P > 0.1). A 900‐kcal meal significantly increased percentage activity and SA in all three recording areas in both the elderly and young adults (P < 0.02). Percentage activity and SA returned to fasting levels immediately after consumption of the meal. Percentage activity and SA were highest 15 cm above the anal verge in both elderly and young adults. These findings suggest that age and gender do not affect sigmoidal, rectosigmoidal, and rectal motility.
The Functional Approach to the Care of the Elderly
Authors: Becker Peter M. , Cohen Harvey J.
Published: April 2015

A conceptual framework that is based on the biopsychosocial model and focuses on functional status is proposed for the understanding and teaching of the functional approach to health care. Functional status can be viewed as the composition of various biologic, psychologic, and social capabilities that are integrated in order to perform the activities necessary to ensure an individual's well‐being. When functional status is threatened by aging or by disease‐related deficits, a compensatory response is generated by mobilizing reserve resources/capabilities in an effort to maintain functional status. Since the aging process is characterized by the acquisition of multiple age‐ and disease‐related deficits, primary care providers need to appropriately detect functional impairments through multidimensional assessment and orchestrate compensatory responses in an effort to restore, maximize, and maintain functional status and independence for as long as possible.
Multiple‐monitored Electroconvulsive Therapy: Safety and Efficacy in Elderly Depressed Patients
Authors: MIELKE DAVID H. , WINSTEAD DANIEL K. , GOETHE JOHN W. , SCHWARTZ BARRY D.
Published: April 2015

Forty‐four patients with severe endogenous depression, all of whom had been administered multiple‐monitored electroconvulsive therapy (MMECT), were studied by retrospective chart review. The subjects were divided into two groups, the elderly and the nonelderly, and compared for number of anesthesia inductions (treatment sessions), total number of seizures, total seizure time, and therapeutic outcome. One myocardial infarction occurred in an elderly man, and a confusional state developed whenever MMECT was administered simultaneously with lithium. The conclusions from this project are that MMECT is as safe and efficacious for the elderly as for the nonelderly and that the elderly tolerate many seizures as well as do the nonelderly. While other variables were similar between groups, the overall number of anesthesia inductions in both groups was less than is expected with conventional electroconvulsive therapy.
The Clinical Use of Electroconvulsive Therapy in Old Age
Authors: KARLINSKY HARRY , SHULMAN KENNETH I.
Published: April 2015

A retrospective review was conducted on the charts of 33 elderly inpatients (age range, 62–85 years) who received electroconvulsive therapy (ECT) in a geriatric psychiatry unit of a general hospital. Electroconvulsive therapy was found to be safe but not uniformly effective; only 42.4 per cent of patients obtained an immediate good outcome. The implications of these findings for further evaluations of the indications and efficacy of ECT in old age are discussed.
Nutrition by Hypodermoclysis
Authors: BERGER EUGENE Y.
Published: April 2015

It is possible to administer fluid subcutaneously at a rate so slow that the forces of diffusion and perfusion are able to transfer that fluid to the circulation at a rate equal to the rate of its delivery. In clinical practice, fluid can be delivered subcutaneously in the presence of hyaluronidase at about 1 ml per minute without the accumulation of edema. Thus, 1500 ml can be delivered in 24 hours at a single site, and 3000 ml of fluid can be delivered at two sites in 24 hours. This procedure, called hypodermoclysis, is used for hydration. It is particularly useful for the aged patient in the long‐term care institution when it will save the patient from the dangers of hospitalization and save society from its costs.
The Relationship Between Dietary Intake of Choline, Choline Serum Levels, and Cognitive Function in Healthy Elderly Persons
Authors: SANCHEZ CLARE J. , HOOPER ELIZABETH , GARRY PHILIP J. , GOODWIN JEAN M. , GOODWIN JAMES S.
Published: April 2015

This study was designed to obtain information on normal dietary intake and serum levels of choline in a healthy elderly population and to observe the relationship between blood levels of choline and cognitive function. Two hundred fifty‐eight healthy volunteers with a mean age of 72 years were recruited, and blood samples and dietary histories were obtained. All subjects were ambulatory, living at home, free of serious medical illnesses, and taking no prescription medications. Cognitive abilities were assessed by the Halstead Category Test, a nonverbal test measuring abstract thinking, and the Wechsler Memory Scale, using the multiple scoring method, which measures both long‐ and short‐term memory. The mean value for serum choline was 13.16 μm with a standard deviation of 3.31. Serum choline levels were found to increase with age, but no difference was found between serum choline levels for men and women. There was no association between dietary intake and serum choline levels, nor could a relationship be found between serum choline levels and cognitive function.
Adipocyte Hormone Responsiveness and Aging in the Rat: Problems in the Interpretation of Aging Research
Authors: KIRKLAND JAMES L. , DAX ELIZABETH M.
Published: April 2015

Fat is a metabolically dynamic tissue. Its metabolism is under the control of several well‐characterized hormonal systems. There appear to be changes in the hormonal sensitivity of rat fat with age. No single mechanism has been proved to explain all the changes observed in adipocyte hormonal responsiveness with aging, although it does seem likely that age does have an independent effect on fat metabolism from studies to date.
Effects of a Physician‐led Home Care Team on Terminal Care
Authors: ZIMMER JAMES G. , GROTH‐JUNCKER ANNEMARIE , McCUSKER JANE
Published: April 2015

Inconsistent results in studies of cost‐effectiveness of home health care have led to the need for identification of target populations for whom cost‐savings can be anticipated if expanded home care programs are introduced. This analysis of results of a randomized controlled study of efficacy of a physician/geriatric nurse practitioner/social worker home care team identifies such a potential target population. The team provides round‐the‐clock on‐call medical services in the home when needed, in addition to usual nursing and other home care services, to home‐bound chronically or terminally ill elderly patients. Overall health services utilization and estimated costs were not substantially different for the patients who did not die while in the study; however, for those who did die, team patients had considerably lower rates of hospitalization and overall cost than controls, and more frequently died at home. Of 21 team and 12 control patients who died but had at least two weeks of utilization experience in the study, team patients had about half the number of hospital days compared with controls during the terminal two weeks, and although they had more home care services, had only 69 per cent of the estimated total health care costs of the controls. Satisfaction with care received was significantly greater among the total group of team patients, and especially among their family caretakers, than among controls. This model is effective in providing appropriate medical care for seriously ill and terminal patients, and in enabling them to die at home if they so wish, while at the same time reducing costs of care during the terminal period.
Underdiagnosis of Cognitive Impairment in a Rehabilitation Setting
Authors: GARCIA CARLOS A. , TWEEDY JAMES R. , BLASS JOHN P.
Published: April 2015

Of 100 patients consecutively admitted to a rehabilitation hospital, 25 were cognitively impaired. On two brief tests of intellectual function, they scored below the criteria selected by the originators of those tests for clinically significant mental impairment. Nineteen of the 25 had vascular disease of the heart, brain, or peripheral vessels; two had cardiac valvular disease; three had head trauma; and one was mentally retarded. Mental impairment appears to be relatively common among the hospitalized elderly who do not carry the primary diagnosis of “dementia” or “organic brain syndrome.” It appears to be particularly common among those with cardiovascular disease, even without frank stroke. Brief mental status examinations should be part of the routine evaluation of such patients.
Geriatric Psychiatry in the Emergency Department, II: Evaluation and Treatment of Geriatric and Nongeriatric Admissions
Authors: WAXMAN HOWARD M. , DUBIN WILLIAM , KLEIN MELISSA , WEISS KENNETH J. , CARNER ERWIN A.
Published: April 2015

The records of a hospital psychiatric emergency department were reviewed for elderly and middle‐aged patients who were diagnosed with organic brain syndrome (OBS) or psychiatric disorder. These records were then compared with those of elderly patients from the medical emergency department. While elderly medical patients received routine physical evaluations and laboratory testing, elderly psychiatric patients with behavioral symptoms were often referred to psychiatry before they received tests necessary to differentiate physical disorders from functional psychiatric disorders. When tests were administered to psychiatric patients, many abnormal results were apparent, indicating the possible presence of physical disease. It is recommended that all elderly patients with psychiatric symptoms undergo adequate medical evaluations to screen for physical causes of the psychiatric symptoms.
The Effects of Chronic Cigarette Smoking on Cerebrovascular Responsiveness to 5 Per Cent CO2 and 100 Per Cent O2 Inhalation
Authors: ROGERS ROBERT L. , MEYER JOHN STIRLING , SHAW TERRY G. , MORTEL KARL F. , THORNBY JOHN
Published: April 2015

Effects of chronic cigarette smoking on cerebrovascular responsiveness of volunteers at risk for stroke and not at risk for stroke were evaluated by serial measurements of cerebral blood flow using the 133Xe inhalation method. Resting gray matter blood flow values (Fg) measured while breathing room air were compared with Fg values measured during inhalation of either 5 per cent CO2 in air or 100 per cent O2. Changes in Fg values during inhalation of 5 per cent CO2 were used to estimate cerebral vasodilator capacitance, and those during inhalation of 100 per cent O2 were used to estimate cerebral vasoconstrictor capacitance. Results indicated that chronic cigarette smokers have both reduced vasodilator (P < 0.01) and reduced vasoconstrictor (P < 0.02) capacitance when compared with nonsmokers of the same ages regardless of whether or not other risk factors for stroke were present. Vasodilator capacitance to 5 per cent CO2 inhalation was reduced among smokers compared with nonsmokers of the same age by 48 per cent in non‐risk subjects and 56 per cent in risk‐factored subjects, while vasoconstrictor capacitance to 100 per cent O2 inhalation among smokers was decreased by 24 per cent in non‐risk subjects and 34 per cent in risk‐factored subjects. In risk‐factored subjects, combined effects of smoking and other risks appeared to be additive.
Level of Care and Complications Among Geriatric Patients Discharged from the Medical Service of a Teaching Hospital
Authors: DAVIS JAMES W. , SHAPIRO MARTIN F. , KANE ROBERT L.
Published: April 2015

To assess the effects of hospitalization on the subsequent placement and supportive care of elderly patients, the medical records of 233 consecutive patients aged 75 years or older, admitted to the medical service of a university hospital, were reviewed. The level of care on admission and at discharge, hospital‐associated complications, and demographic data were abstracted for each patient. At discharge, 1 per cent returned to a nursing home, 6 per cent were newly placed in a nursing home, 65 per cent returned to the same level of care as on admission, 10 per cent returned home with an increased level of care, and 18 per cent died or were discharged to another acute care facility. Complications occurred in 30 per cent of patients but did not correlate with age, increased level of care at discharge, or increased rate of nursing home placement. Few elderly patients were discharged to nursing homes, and most returned home without arrangements for increased care.
Benefits of Access to On‐site Acute and Critical Care for the Residential Section of a Multi‐level Geriatric Center
Authors: GORDON MICHAEL , VADAS PETER
Published: April 2015

Of 220 residents living in the residential unit of a multi‐level geriatric center, 95 required a total of 131 transfers to other facilities over a one‐year period. Fifty‐three of these patients were transferred to the associated chronic‐care hospital for short‐term acute medical investigation or treatment. The average length of stay of 17 days was similar to that of patients of comparable age with comparable medical conditions admitted to an affiliated acute general hospital from the community. In addition to continuity of medical care and the social and psychologic advantages of remaining within the geriatric center, this transfer potential resulted in substantial financial savings. The cost of hospitalization in the general hospital would have been more than twice that of the geriatric unit.
Dementia of the Alzheimer Type and Multi‐infarct Dementia
Authors: Bucht Gösta , Adolfsson Rolf , Winblad Bengt
Published: April 2015

Patients who had Alzheimer's disease—senile dementia of the Alzheimer type (AD/SDAT) or multi‐infarct dementia (MID) were compared with a group of controls. Demented patients had approximately the same degree of dementia and the same duration of illness, the MID group had a significantly higher mean age than the AD/SDAT group. Sixty‐three per cent of the AD/SDAT patients were free of other diseases, while 65 per cent of the MID patients had cardiovascular disease. Thirty per cent of the MID patients had a history of previous depression, while only 5 per cent of the AD/SDAT patients had had depression. At the time of the investigation, however, AD/SDAT patients showed significantly more signs of depression than the MID patients. Focal neurologic signs were found in 70 per cent of the MID patients and only 6 per cent of the AD/SDAT patients. The electrocardiogram was normal for every AD/SDAT patient, while 75 per cent of the MID patients had abnormal ECGs. Electroencephalography showed generalized slow frequencies in 79 per cent of the AD/SDAT patients and localized slow frequencies and abnormalities in 65 per cent of the MID patients. Computed tomography of the brain showed that MID patients had significantly greater dilation of the ventricular system, while cortical atrophy did not differ significantly among the three groups. Homovanillic acid in the cerebrospinal fluid was significantly lower in the AD/SDAT group as compared with controls.
A Prospective Study of Nosocomial Infections in a Chronic Care Facility
Authors: Farber Bruce F. , Brennen Carole , Puntereri A. J. , Brody Judith P.
Published: April 2015

To elucidate the epidemiology of nosocomial infections occurring in nursing homes and chronic care facilities, the authors undertook a prospective study of patients requiring two different levels of nursing care. The overall rate of infection was higher on the intermediate care ward than on the nursing home ward (1.35 versus 0.67 infections/100 patient care days). Pneumonias and symptomatic urinary tract infections accounted for 49 per cent of all infections. Eight of ten cases of pneumonia occurring on the nursing home ward were diagnosed in the winter months, and no case was diagnosed in the summer months. Resistance to gentamicin, tobramycin, ampicillin, and trimethoprim—sulfa was common among organisms causing symptomatic urinary tract infections.
Effect of Digoxin on Ejection Fraction in Elderly Patients with Congestive Heart Failure
Authors: Ware J. Anthony , Snow Eleanor , Luchi Jean Marie , Luchi Robert J.
Published: April 2015

To assess the effect of oral digoxin on left ventricular systolic function in elderly patients, radionuclide angiography was performed on 20 patients 74 years old or older before and after several weeks of oral digoxin. The mean age was 83.8 years. All had congestive heart failure or cardiomegaly, and all were in sinus rhythm. The ejection fraction was 0.36 ± 0.10 (mean ± SD) before digoxin; 0.45 ± 0.09 after digoxin (P < 0.01). A comparison group that did not receive digoxin had no significant improvement in ejection fraction. In ten patients serial radionuclide angiograms were repeated after increasing serum digoxin concentrations. Six demonstrated maximal improvement in ejection fraction at serum digoxin concentrations of 0.4–1.0 ng/ml. It is concluded that oral digoxin improves left ventricular ejection fraction in elderly patients with congestive heart failure or cardiomegaly who are in sinus rhythm. Some of these patients achieve maximal improvement in ejection fraction at serum digoxin concentrations of less than 1.0 ng/ml.
Anorectal Manometry in Healthy Elderly Subjects
Authors: Loening‐Baucke Vera , Anuras Sinn
Published: April 2015

Sigmoidal, rectal, and anal functions were studied in ten healthy elderly women and ten healthy young women using a motility probe with three intraluminal transducers. No difference (P > 0.05) was found between elderly and young women in measurements of anal length, anal resting tone, anal squeeze pressure, anal pullthrough pressures at rest, and voluntary squeeze. Sigmoidal and rectal distention was produced by injecting air into balloons placed 16–17 cm and 6–7 cm above the anal verge, respectively. Measured values of anal responses to sigmoidal and rectal distention, and sensation and elasticity of the sigmoidal and rectal walls, were also not different (P > 0.05) between the two groups. These findings suggest that age does not affect sigmoidal, rectal, and anal functions.
Medical Problems of Geriatric Psychiatric Patients and Younger Controls During Electroconvulsive Therapy
Authors: Alexopoulos George S. , Shamoian Charles J. , Lucas John , Weiser Neil , Berger Henry
Published: April 2015

Medical problems occurring during electroconvulsive therapy were studied in a population of 293 psychiatric inpatients who received 2,809 treatments. Geriatric patients (N = 199) developed significantly more medical problems that required medical treatment or temporary discontinuation of electroconvulsive therapy than did younger controls (N = 94). The most important of these were cardiovascular in nature. Despite their increased frequency, the majority of medical problems that occurred were reversible. Electroconvulsive therapy therefore appeared to be a safe procedure for elderly psychiatric patients.
Aging, Regional Cerebral Blood Flow, and Neuropsychological Functioning
Authors: MacInnes William D. , Golden Charles J. , Gillen Robert W. , Sawicki Robert F. , Quaife Merton , Uhl Henry S. M. , Greenhouse Arnold J.
Published: April 2015

Previous studies found changes in regional cerebral blood flow (rCBF) patterns related to both age and various cognitive tasks. However, no study has yet demonstrated a relationship between rCBF and performance on the Luria‐Nebraska Neuropsychological Battery (LNNB) in an elderly group. Seventy‐nine elderly volunteers (56–88 years old), both healthy and demented, underwent the 133xenon inhalation rCBF procedure and were given the LNNB. The decrements in the gray‐matter blood flow paralleled decrements in performance on the LNNB. Using partial correlations, a significant proportion of shared variance was observed between gray‐matter blood flow and the LNNB scales. However, there was much less of a relationship between white‐matter blood flow and performance on the LNNB. This study suggests that even within a restricted age sample rCBF is related in a global way to neuropsychological functioning.
Folate and Vitamin B12 Status in a Healthy Elderly Population
Authors: Garry Philip J. , Goodwin James S. , Hunt William C.
Published: April 2015

Folic acid and vitamin B12 nutritional status was examined in a group of 270 healthy elderly individuals using both dietary and biochemical measures. Of these 40 per cent had dietary intakes of folic acid that were less than half the recommended dietary allowance of 400 μg/day, and 13 per cent had intakes of less than half the recommended dietary allowance for vitamin B12 (3 μg/day). However, only 8 per cent had low plasma folates (<3.0 ng/ml) and only 3 per cent had RBC folates less than 140 ng/ml. Plasma true cobalamin levels less than 220 pg/ml were found in 3 per cent. None of these individuals showed any clinical signs of folate and/or vitamin B12 deficiency, and mean corpuscular volumes were not significantly greater than those for the entire population (90.8 ± 4.1 fl). The correlations of intakes of folic acid and vitamin B12 with plasma or erythrocyte levels were moderate (about 0.5). It was also clear that those taking supplements had significantly greater blood levels than those not taking supplements, although the benefit of higher plasma or erythrocyte levels of these nutrients is not clear. The data indicate that folate and vitamin B12 status in free‐living healthy elderly is not a major medical problem.
Treatment of Hypertension in the Elderly: A Time for Caution?
Authors: APPLEGATE WILLIAM B. , DISMUKE S. EDWARDS , RUNYAN JOHN W.
Published: April 2015

The authors review recent studies of treatment of hypertension and suggest modified guidelines for the treatment of elderly hypertensive patients. Treatment is recommended for elderly persons with systolic‐diastolic hypertension if the systolic presure is consistently above 160 mm Hg or the diastolic blood pressure is consistently above 100 mm Hg. Treatment of isolated systolic hypertension should not be excessively vigorous, and systolic blood pressure should not be lowered much below 160 mm Hg.
Drug Prescribing for Ambulatory Patients 85 Years of Age and Older
Authors: KNAPP DEE A. , KNAPP DAVID A. , WISER THOMAS H. , MICHOCKI ROBERT J. , NUESSLE SALLY J. , KNAPP WENDY K.
Published: April 2015

Drug prescribing for ambulatory patients ≥85 years of age was studied using data from the 1980 National Ambulatory Medical Care Survey (NAMCS) on office visits to physicians. NAMCS is a survey by the US National Center for Health Statistics, which collected information on office visits and extrapolated the results to the US population. Of the 575.7 million office visits by all ages, 6.8 million (1 per cent) were by persons ≥85 years of age, and 64 per cent involved females. Ninety per cent of the total office visits of those ≥85 years were with a physician who had seen them before; 94 per cent were with MDs as compared with DOs; 56 per cent were with general practitioners or internists; and 95 per cent had some type of follow‐up planned. The most frequent duration of the office visit was 11–15 minutes (36 per cent). The most frequent diagnostic class was diseases of the circulatory system. The survey physicians were asked to list all drugs, new or already in use by the patient, that were ordered, administered, or prescribed during the visit. The authors converted the drug brand names to their nonproprietary or generic name component(s); each active ingredient of combination products was treated as a separate drug entity. All drug analyses used generic names. Thirty‐two per cent of visits did not involve the use of any drug, 21 per cent involved one drug; 12 per cent, two drugs; and 16 per cent, three drugs. Cardiovascular‐renal drugs were the most frequently mentioned. One‐third of the visits involved the use of one or more drugs that have psychologic effects, either intended or as side effects. Three per cent of the office visits involved the use of two or more drugs that had the potential for clinically important interactions.
The Use of Monoamine Oxidase Inhibitors in the Treatment of Elderly, Depressed Patients
Authors: Jenike Michael A.
Published: April 2015

Depression is an extremely common illness in the elderly, and Is, at times, refractory to the usual therapies. The elderly are also particularly prone to develop toxic side effects from standard antidepressive agents. Monoamine oxidase inhibitors are rarely used in this population, although much evidence and clinical experience would indicate that they can be extremely effective and non‐toxic. This paper outlines the indications and precautions for use and side effects of monoamine oxidase inhibitors in the treatment of depression in elderly patients.
Strategies for Obtaining Compliance with Medications Regimens
Authors: Coe Rodney M. , Prendergast Christine G. , Psathas George
Published: April 2015

Case examples of doctor‐patient interactions are used to examine educational strategies employed by physicians to obtain compliance with medication regimens from elderly patients. The problems addressed by the physicians included the complexities of pharmacotherapy in the elderly (the patients each presented multiple problems involving the use of multiple medications), the limited understandings of the drugs shown by patients and their relatives; and the issue of compliance with instructions. Educational strategies that were effective are described.
Use of Benzodiazepines in Primary‐care Geriatric Patients
Authors: Pinsker Henry , Suljaga‐Petchel Kasja
Published: April 2015

From a sample of 257 elderly patients, 93 subjects who had received benzodiazepine (mainly diazepam) prescriptions for one or more years were interviewed about their subjective perception of the drug's effects and their attitudes regarding its use. The subjects were predominantly women: mean age was 72 years. All subjects had begun use of benzodiazepine more than two years earlier, although some had since stopped using the drug; more than a third had used it for more than six years. About half of the subjects said they took no more of the drug than had been initially prescribed, and three quarters reported they took the medications only when a need was felt. The principal indication for use of benzodiazepines was described as tension. Those who were still taking the drug at the time of interview were more likely to live alone and to say that they had the same problems as when they began its use. None of the subjects who had discontinued use of the drugs had been aware of withdrawal symptoms, and there was no evidence that any subject had become addicted, although several expressed a fear of this. It appears that in this age group, prolonged use of benzodiazepine at low doses, with the patients regulating the quantity, is safe and may be helpful. Most subjects, even if not helped, always kept some of the drug at home in case they might need it.
Zoster in the Elderly
Authors: Harnisch James P.
Published: April 2015

Herpes zoster is common in the elderly. Persons over the age of 50 years have an attack rate double that of patients less than 50 years old. In the very aged, this rate nearly doubles again. The loss of cell‐mediated immunity for the VZ virus appears to be the primary factor in the disruption of the dynamic containment process responsible for VZ virus latency within the sensory ganglion. Humoral immunity may play a role in the maintenance of latency, but the degree is unproven, except in the case of dissemination where loss of detectable antibodies seems to correlate with extradermatomal dissemination. Severe forms of the disease and its complications, e.g., postherpetic neuralgia, are likely among the elderly. Direct im‐munofluorescent staining or cytologic examination is useful for early diagnosis, and serologic changes can document the confusing clinical entity of zoster sine herpete.
A Randomized Trial of Intra‐hospital Relocation of Geriatric Patients in a Tertiary‐care Teaching Hospital
Authors: Shamian Judith , Clarfield A. Mark , Maclean Jill
Published: April 2015

Growing numbers of aged patients are being cared for in both acute care and chronic care settings. It is often necessary to relocate elderly patients within the institution. Relocations are generally considered to increase mortality and morbidity among the elderly and to be detrimental to activities of daily living. Effects of relocation on long‐term patients in an acute care institution are examined. Thirty‐six (36) patients were assigned to experimental and control groups. The experimental group (n = 20) was relocated for nine weeks, while members of the control group (n = 16) remained in their original units. The two groups were evaluated for differences in mortality, morbidity, activities of daily living, and drug management. The experimental group was managed by a geriatrics team during the nine‐week relocation period, while the control group remained under the supervision of a general medical surgical team. No statistically significant (P < 0.05) differences were found with respect to mortality and morbidity, activities of daily living, or drug management. Some clinical improvements were noticed in the experimental group under the geriatrics team's supervision. The authors conclude that if careful consideration is given to the relocation of long‐term patients in an acute care setting, detrimental outcomes can be avoided.
The Medicare Prospective Payment System and the Care of the Frail Elderly
Authors: Berenson Robert A. , Pawlson L Gregory
Published: April 2015

The development of the Medicare Prospective Payment System based on diagnosis‐relating groupings is reviewed. Special emphasis is placed on analysis of the provisions that have a potential impact on geriatric medicine and on the care of the frail elderly. The authors conclude that in its present form, the DRG system may systematically undercompensate hospitals for treating the frail elderly and, therefore, result in attempts by some hospitals to reduce or avoid altogether programs in geriatric medicine and admissions of frail elderly persons. These effects, together with federal and state efforts to limit nursing home and home care costs, may result in a major under‐provision of care for the frail elderly and exclusion of clinical geriatric medicine from the medical care system.