bluuebunny/crossref_metadata_2025 huggingface dataset:
Geriatric Psychopathology — Internal or External?*
Authors: FEIGENBAUM ELLIOTT M.
Published: April 2015

ABSTRACT: The major psychiatric illness is depression. In the elderly this may be precipitated by internal psychic problems, but external complications can be added by ineffectual attempts to help by inadequately trained health professionals. The low utilization of psychiatric services by the aged may be explained on the basis of the attitudes of both patients and clinicians. Three main factors determine the patient's decision to consult a physician. The patient must recognize that: 1) a psychiatric disturbance is present, 2) that this disturbance is alien, and 3) that help is available. When such services are offered, the elderly will recognize their need for them. Two specific areas of clinical practice with geriatric patients are stressed; these involve drug problems and sexual problems. When stereotyped attitudes are replaced by attention to the underlying pathology, and treatment goals are formulated in the context of good psychiatric practice, the elderly will profit by psychiatric therapy and have a better life in their remaining days. The rates of success in treatment are just as high as with younger patients.
Hemolytic and Conglutinating Complement in Normal and Pathologic Human Sera
Authors: KALLIOMÄKI J. L. , MUSTAKALLIO E. , MUSTAKALLIO‐COOK SOLE
Published: April 2015

ABSTRACT: A simultaneous determination of the hemolytic (CH) and conglutinating complement (Cc) was made on 587 “healthy” sera [Blood Transfusion Service (BTS) material] and 1036 pathologic sera [hospital material]. Sex, blood group and erythrocyte sedimentation rate did not affect the titer distribution. Older subjects, however, tended to show higher titers than did the young. Both for CH and Cc, the titers in the hospital patients were distinctly higher than in the BTS subjects. In patients with glomerulonephritis, both the CH and Cc titers were decreased whereas in patients with systemic lupus erythematosus only the CH titers were low. In leukemia, both the CH and Cc titers were higher than normal; in myelofibrosis, only the CH titers. In rheumatoid arthritis, the distribution of CH titers did not differ from that in the general hospital material, whereas the Cc titers were elevated. According to a previous concept, the conglutinating complement involves C142 activity. On the basis of present findings, this concept should be re‐evaluated by means of modern methods, especially taking into account the role of immunoconglutinins in the functioning of the complement system. The method used in this study—simultaneous titration of CH and Cc in the same series of tubes—is well adapted to routine use.
Werner's Syndrome: Autopsy Report of One Case, with a Review of Pathologic Findings Reported in the Literature
Authors: Ishii Toshiharu , Hosoda Yasuhiro
Published: April 2015

The autopsy findings in a 29‐year‐old male with Werner's syndrome are presented, with a review of similar data on 17 autopsy cases reported in the literature. The pathologic findings in this new case were scleroderma‐like skin atrophy, arteriosclerosis, and atrophy of the endocrine glands (including the genital organs). In the reported cases of Werner's syndrome, as in the present example, the authors were unable to identify any responsible organ or system. However, they suggest that connective tissue, widely distributed throughout the entire body, may play an important role. The possible abnormal metabolism of connective tissue in Werner's syndrome deserves further study.
Correlates of the Echocardiographic Waves of the Mitral Valve in Normal Subjects of Various Ages
Authors: Luisada A. A. , Watanabe K. , Bhat P. K. , Rao D. B. , Knighten V.
Published: April 2015

A cardiographic study was performed on 71 subjects including 14 children, 42 young and middle‐aged adults, and 15 old persons without evidence of heart disease. The echocardiogram of the mitral valve was recorded in the A mode by an analog method and was compared with the electrocardiogram, phonocardiogram, apex cardiogram, and carotid and jugular tracings, simultaneously obtained. The intervals between the various waves recorded by these methods were measured and the results were compared with those reported in the literature. A comparison of the duration of the intervals in the various age groups showed statistically significant differences. In particular, the intervals between the second heart sound and the peak of the E‐wave and the E‐F interval in the echogram were longer in adults than in children and also longer in old persons than in younger adults. This important age difference should always be taken into account before attributing any echocardiographic deviations to disease.
A Small Pliable Humidity Sensor, with Special Reference to the Prevention of Decubitus Ulcers
Authors: Trandel Richard S. , Lewis David W.
Published: April 2015

In an investigation of some of the external causes of decubitus ulcer, a small flexible sensor has been developed as a clinical device to measure the relative humidity (RH) of the environment between the patient and the surface on which he lies. The sensor (described in detail) can indicate RH in the range of 20 to 90 per cent by a color‐matching method (chemically impregnated circles); accuracy is within 5 to 10 per cent. In a preliminary study on 28 patients, the readings showed that RH was higher in the sacral region than in the scapular region, and higher for patients who were inactive than for those who were active. The device was well accepted by both patients and nurses.
Medical Experimentation in the Elderly
Authors: Bernstein Joel E. , Nelson F. Kirk
Published: April 2015

Participation in human experimental research constitutes a major problem for the geriatric subject. Because there is a high incidence of noncontagious disease in the elderly, they are the group most useful for the study of new therapeutic agents or procedures. However, normal aging processes, often coupled with disease of the central nervous system, render elderly persons less able to comprehend the nature and risks of such studies. These factors permit easy exploitation of geriatric subjects in medical experimentation, with possible exposure to a significant risk of serious drug reactions and unnecessary hospitalization. Recent federal regulations have given “special protections” to children, prisoners and the mentally infirm in experimental research, to guard against abuse of their human rights. A basic requirement is that informed consent be carefully obtained and documented. Such “special protections” should now be extended to geriatric subjects so that there will be no further exploitation in the course of valid clinical research.
Effects of A Procaine Preparation (Gerovital H3) in Hospitalized Geriatric Patients: A Double‐Blind Study
Authors: Zwerling Israel , Plutchik Robert , Hotz Margaret , Kling Ruth , Rubin Leo , Grossman Joel , Siegel Barbara
Published: April 2015

The effects of Gerovital H3 (a specially stabilized form of procaine hydrochloride) on geriatric psychiatric patients were assessed in a double‐blind study at Bronx State Hospital. The mean age of the subjects was 73 years and the average rating for the severity of organic symptoms was “moderate.” During the first six weeks of study, the patients were each given a 5‐ml injection of either Gerovital or placebo (saline) intramuscularly three times a week. This dosage was doubled to 10 ml per injection during the second six weeks. Nine Gerovital and 10 control subjects completed the first six weeks; and 6 Gerovital and 7 control subjects completed the entire 12‐week study. Objective rating scales were used to evaluate patients on measures of interpersonal functioning, cognitive ability, psychiatric symptoms, and urine and blood chemical findings. All subjects were assessed before treatment and at six weeks and twelve weeks of the study. Side effects were recorded at two‐week intervals.

On most measures the variability between subjects was quite large, whereas differences between average scores for the two groups usually were small The few significant differences showed no systematic pattern and would be expected to occur by chance alone when so many statistical comparisons are made. The overall results of this double‐blind study strongly indicated that, among these hospitalized geriatric patients with organic symptoms, Gerovital H3 had no ameliorative effect on either psychologic or physiologic functioning.
The Course of Life for Old People†
Authors: Wolk Robert L. , Reingold Jacob
Published: April 2015

Various aspects of institutional living for old people are discussed, particularly the imposition of a lifestyle completely foreign to their previous way of existence. Old people who have been living in one manner for about seventy years cannot be expected to adjust readily to another rhythm. The clash of lifestyles creates maladaptive behavior and adjustment problems that have not been adequately studied. Suggestions are made for approaches to resolve these difficulties. In essence, the techniques include reprogramming of institutional living for old people so that they have an opportunity to maintain their customary lifestyle. Examples of such programming are presented.
The Autopsy in Geriatrics†
Authors: Freeman Joseph T.
Published: April 2015

The marked decline in the autopsy rate is a serious matter that is not receiving enough attention in the present medical system. Before 1940, a high rate of postmortem examinations was a mark of distinction for a hospital and the findings contributed greatly to our knowledge of disease. This should continue. In geriatrics, a valuable goal is the differentiation of pathologic processes from the process of aging. One outstanding factor in the neglect of the autopsy is the cost to the hospital or other institution; moreover, the cost is not reimbursable by third‐party insurance payers. The Pathology Resource Center is proposed as a solution for the problem. Regional autopsy centers could serve the surrounding institutions with greater competence and economy. Medicine should no longer be restricted regarding the valuable contributions to knowledge provided by autopsy findings.
The Pathologist and the Geriatric Autopsy†
Authors: Hofman Walter I.
Published: April 2015

In the past forty years the autopsy rate in many large institutions has fallen drastically to a level of only 20–25 per cent. The large number of diagnostic errors revealed in autopsy records is in itself a cogent reason for a return to higher standards. The inhibitory effect of high cost would be modified by the use of central regional pathology services and by reimbursement from third‐party insurance carriers. The end‐result would be a higher quality of medical care for all patients, not excepting those in the geriatric age group.
Haloperidol Parenterally for Treatment of Vomiting and Nausea from Gastrointestinal Disorders in a Group of Geriatric Patients: Double‐Blind, Placebo‐Controlled Study
Authors: Robbins E. Lee , Nagel J. David
Published: April 2015

Twenty‐eight geriatric residents of a nursing home participated in a double‐blind study to compare the 12‐hour therapeutic effectiveness of a single intramuscular injection (1.0 mg) of haloperidol with that of placebo for the relief of vomiting and nausea due to gastrointestinal disorders. Significantly fewer episodes of vomiting occurred in the haloperidol group than in the placebo group. Nausea also was less frequent in the haloperidol group. After four hours, symptoms recurred much more often in the placebo group. Global evaluations showed that a significantly greater number of haloperidol patients inproved markedly than did those given placebo. There were no clincially significant changes in vital signs throughout the study in the haloperidol group. In 1 placebo patient the pulse rate was significantly increased; otherwise no adverse reactions were reported for this group. Thus, in a nursing‐home population of geriatric patients who experienced vomiting and nausea due to gastrointestinal disorders, haloperidol administered parenterally proved to be a safe and highly effective antiemetic agent.
Evaluation of a Multidisciplinary Care Program for Stroke Patients in a Day Care Center†
Authors: Oster Claude , Kibat Wendy H.
Published: April 2015

With funds received by the Rehabilitation Center at Martin Place Hospital East from the Michigan Association of Regional Medical Programs, a Rehabilitation Day Care Center was established. Initially it was called the Stroke Day Care Center (SDCC). Its purpose was to provide comprehensive care to patients with disabilities due to stroke and related diseases according to the “day at the hospital, night at home” concept. A complex of medical and allied services was furnished, based upon the patient's attendance at the SDCC from one to five days a week. The goal was to promote for the patient an earlier return of functional, vocational, social and home activities by effectively providing him and his family with multidisciplinary care. In this SDCC program the main emphasis was on testing the feasibility of lowering the cost of stroke‐patient care by: a) shortening the hospital stay; b) reducing the need for in‐patient care in facilities for non‐acute illness; c) shortening the stay in extended care facilities; d) returning younger stroke victims earlier to the labor force; e) identifying the number of stroke patients who could live at home if provided with a modified day care program; and f) assessing the need for purely recreational and social activities in future programs. The evaluation was based on a comprehensive study of 108 patients during the period February 1972 to June 1973. This project is offered as a model for the development and expansion of rehabilitation‐recreation day care centers for the handicapped of all ages.
Hyperlipidemia and Its Significance in the Aged Population†
Authors: Woldow Asher
Published: April 2015

Starting in childhood, blood lipid levels rise progressively with each ten‐year period until age 70, when cholesterol and triglyceride levels begin to stabilize and then decline. By age 80 there is a precipitous drop to approximately the values noted in persons of the 20–30 age group. Data on 195 residents of a geriatric center are included. Despite the lower average lipid levels, 30 per cent of the elderly show some lipid abnormality. There is a definite increase in the risk of death from coronary artery disease in hyperlipidemic persons as compared to those who are normolipidemic, even during the eighth and ninth age decades. Hyperlipidemia appears to be a significant risk in the elderly, as in persons of any age, and should be treated accordingly.
Sex in Geriatrics: Myth or Miracle?
Authors: West Norman D.
Published: April 2015

For many younger people, what is currently referred to as “sex,” is regarded as literally a monopoly within their group. According to their way of thinking, sexual activity diminishes after age 50 and ceases after age 60. Older people become the butt of many cruel jokes about the status of their sexual prowess; if some of them report sexual interest they are liable to be labeled “dirty old men” (or women). A 12‐year experience in working with geriatric residents of a nursing home has revealed interesting information which may be of some value in reassessing our concepts of the sexual needs of older people and understanding the appropriate modifications they may use to fulfill these needs.
Morgagni on Disease in Old Age
Authors: Howell Trevor H.
Published: April 2015

Giovanni Battista Morgagni published his life work at the age of 80, consisting of 70 letters on medical cases and their autopsies. He is considered the founder of pathologic anatomy. Many of the entities which he described were found in aged subjects. Modern geriatric medicine owes much to this great medical observer.
Glucocorticoid Therapy in Sepsis/Shock Caused by Gram‐Negative Microorganisms†
Authors: Seneca Harry , Grant John P.
Published: April 2015

A review of the literature reveals that glucocorticoids have: 1) a protective effect both in vitro and in vivo against bacterial endotoxins and exotoxins, and 2) a protective or therapeutic effect in sepsis/shock caused by Gram‐negative microorganisms. At the Columbia Presbyterian Medical Center, the 1968–1973 mortality rate for general sepsis/shock due to Gram‐negative organisms was 16.6 percent and for urologic sepsis/shock 15.3 percent. This low rate was the result of early diagnosis and early use of massive dosages of glucocorticoids (hydrocortisone, methylprednisolone, dexamethasone), beta‐adrenergic isoproterenol, and bactericidal antibiotics (gentamicin, kanamycin, carbenicillin, cephalothin‐cefazolin, ampicillin).
Lipidemia—A Multigeneration Predictability Study†
Authors: Woldow Asher
Published: April 2015

This study involved a 1st generation of 194 aged residents at the Philadelphia Geriatric Center plus 2nd and 3rd generations of 357 and 306 offspring, respectively. Serum cholesterol levels (including type of abnormality) and triglyceride levels were determined. The results suggest that hyperlipidemia at all ages is related to a familial genetic problem. The data on each generation, starting even with the 80‐year‐old parents, could be used to predict lipid abnormalities in each succeeding generation. However, when comparing the 1st generation with the 3rd generation, predictability was lacking, probably because of the inclusion of two sets of spouses and many environmental factors that altered the situation. In the 2nd generation, 40 per cent of the subjects had an elevated lipid level compared to 30 per cent in the 1st and 3rd generations. The higher concentrations in the 2nd generation probably reflected increased risk factors such as improper diets, smoking, hypertension, obesity and stress at that age level. Hyperlipidemia in the aged apparently is not just a metabolic degenerative abnormality. It should be treated, as in younger people. Data on risk factors such as a high blood lipid level may help not only the aged, but succeeding generations.
Hepatic Infarction Associated with Terminal Hemorrhagic Necrotizing Enteropathy (THNE): Case Report
Authors: Ishii Toshiharu , Hosoda Yasuhiro , Yakumaru Kazuhiro
Published: April 2015

A case of hepatic infarction associated with terminal hemorrhagic necrotizing enteropathy (THNE) in an 84‐year‐old woman with cardiac failure is presented. The autopsy showed hepatic infarction, THNE, fibrous endocarditis, generalized arteriosclerosis, myocardial hypertrophy, liver congestion, and other findings as described. Both rare infarctions (hepatic and intestinal) seemed to have originated not only as a result of impaired systemic circulation due to cardiac failure, but also from liver congestion due to peripheral circulatory deficiency through the portal vein. The circulatory correlation between these infarcts of the liver and intestine is discussed.
A Psychogeriatric Assessment Program. II. Clinical and Laboratory Findings†
Authors: Hontela S. , Müller H. F. , Grad B. , Derkevorkian K.
Published: April 2015

In a Psychogeriatric Assessment Program, the statistical evaluation of clinical and laboratory data related to thyroid function in 80 patients led to the conclusion that: 1) differences in thyroid function between psychogeriatric patients of the organic and functional types were only slight, as determined by clinical symptoms and thyroxine blood levels, and 2) factor analysis for 53 selected variables indicated that loading for “gross disturbance of psychobiologic function” may be related to the symptom complex of hyperthyroidism/hyperadrenergism, and particularly to psychobiologic symptoms rather than purely somatic symptoms of hyperthyroidism. In comparison with a group of 60 healthy old people, the psychogeriatric patients showed many more signs of hyperactivity and other characteristics of this symptom complex. The results supported the preliminary impression of an energetic (hyperthyroid‐sympathicotonic) reaction to mental decline, accompanied by plasma corticosteroid and electroencephalographic changes.
Treatment of Anemia in the Aged: A Common Problem and Challenge†
Authors: Harant Z. , Goldberger J. V.
Published: April 2015

The occurrence of anemia in a group of aged persons residing in a home for the aged and in a chronic disease hospital was reviewed with regard to etiology, choice of treatment, and therapeutic response. Of the 484 patients, 151 (31 per cent) had anemia or were receiving antianemia therapy. Iron‐deficiency anemia was the most common type, and iron was the most common form of treatment. Seventy‐eight patients were given antianemia therapy in 97 courses, and a good therapeutic result was achieved in about one‐fourth of the courses. The most frequent error in iron therapy was its use in the anemia associated with chronic disorders. Often there was a combination deficiency of iron, vitamin B12 and folic acid. The response to iron in the elderly can be very slow, so therapy should not be discontinued too soon. Anemia may directly contribute to other serious pathologic conditions, especially in aged persons with impaired circulation. In some cases the physiologic concentration of hemoglobin may be higher than the accepted “normal” value. The course of the anemia in relation to the general state of the patient is more significant than any laboratory data in choosing antianemia therapy. Practical laboratory screening procedures for elderly anemic patients are discussed.
How the Human Brain Responds to Aging
Authors: SAMORAJSKI T.
Published: April 2015

ABSTRACT: The characteristic morphologic changes frequently observed in the brain of an old adult include a decrease in weight and volume, a change in the pattern of cerebral cortical convolutions, and an increase in ventricular size. Cell loss varies from region to region in the brain, and may be intensified in Alzheimer's disease and other disorders associated with senile dementia. Among the neuroglial cells, the microglia undergo the most significant changes with age. Although senile brain disease previously has been regarded as secondary to atherosclerosis, recent neuropathologic studies indicate that only 30 to 40 percent of senile brain disease arises from cerebrovascular pathologic lesions. The dilemma remains, however, of how much of the deterioration observed in the aged is related to disease and how much to senescence. The interaction between gene expression and environmental conditions in aging is another important question for the geriatrician. Progress in the control and treatment of disorders associated with old age depends upon further research into the mechanisms that underlie the process of aging in the brain.
Treatment of the Aging Skin by Dermatologic Methods*
Authors: LUBOWE IRWIN I.
Published: April 2015

ABSTRACT: Adverse physiologic and biochemical changes in the aging skin are aggravated by unprotected, continuous or repeated exposure to the harmful rays of the sun. Waning hormonal activity contributes to these changes. The associated clinical entities are skin dryness, accentuation of facial lines and wrinkles, hyper‐pigmentation, and multiple benign or malignant growths. The skin should be protected by sunscreening and sunblocking agents. Overexposure to the sun must be avoided. Repeated applications of moisturizing creams, vegetable oils, and appropriate hormonal cosmetics may be helpful in hydrating the skin and thus improving its external appearance. Chemosurgery (peeling) and dermabrasion may reduce hyperpigmentation and fine facial lines and wrinkles. New growths can be removed by various surgical methods. Biopsy should be performed to determine the presence of a malignant lesion requiring additional x‐ray therapy.
Paraesophageal Hiatus Hernia in the Aged
Authors: WEINSTEIN EUGENE C. , KOHN BYRON S.
Published: April 2015

ABSTRACT: A review of the records of Granada Hills Hospital revealed 4 documented cases of paraesophageal hiatus hernia. One of these geriatric patients presented with incarceration of the gastric fundus, and required an emergency thoracotomy for relief. Paraesophageal hiatus hernia, unlike sliding hiatal hernia, often gives rise to acute surgical problems secondary to incarceration, obstruction, gangrene, perforation or hemorrhage. The approach to the repair operation may be either abdominal or thoracic, dependent upon the need to correct other associated gastrointestinal pathologic lesions. Unless severe debilitating medical diseases are present, operative intervention is recommended.
Benjamin Franklin and Geropsychiatry: Vignettes for the Bicentennial Year
Authors: SHERR VIRGINIA T.
Published: April 2015

ABSTRACT: It is timely in this Bicentennial year for readers of a journal devoted to geriatrics to refer to the wisdom of an older leader of the Revolution of 1776. So provocative was his thinking that Dr. Benjamin Franklin might well have inspired today's writers in the field, as demonstrated by relevant gleanings from articles in the recent literature.
The Clinical Gerontologist
Authors: HARMAN DENHAM
Published: April 2015

ABSTRACT: A major objective now and in the future should be that of maximizing health and well‐being during our essentially fixed span of life. It is proposed that this objective be delegated to a new field of medicine, perhaps to be known as clinical gerontology — a combination of preventive medicine and geriatrics.
Bilateral Breast Metastases from Oat‐Cell Lung Carcinoma in a Man Treated with Diethylstilbestrol for Prostatic Adenocarcinoma
Authors: GIARELLI LUIGI , FERLITO ALFIO
Published: April 2015

ABSTRACT: A case report is presented of bilateral breast metastases originating from oat‐cell carcinoma of the lung in a man treated with diethylstilbestrol for carcinoma of the prostate. The metastatic spread to both breasts apparently was related to the estrogen therapy.
Reaction Time as a Diagnostic Measure in Senility*
Authors: FERRIS STEVEN , CROOK THOMAS , SATHANANTHAN GREGORY , GERSHON SAMUEL
Published: April 2015

ABSTRACT: Both simple and disjunctive reaction times (RT) are known to slow with aging but there is a paucity of information on RT changes in senility. Since disjunctive RT involves cognition in addition to the sensory‐motor speed and attentional components of simple RT, it was hypothesized that disjunctive RT would be a reliable index of age‐related mental decline. To test this prediction, simple and disjunctive RT were measured in matched groups of 20 normal and 20 cognitively impaired elderly. Simple RT was slower in the senile patients than in the normal subjects, but this difference was accounted for by differences in disjunctive RT. The senile patients showed a much larger performance decrement with respect to disjunctive RT than did the normal subjects — a difference which was not accounted for by differences in simple RT. In a discriminant function analysis, disjunctive RT alone correctly identified the senile patients and the normal subjects with 86 percent accuracy. Thus, this measure proved to be a reliable index of age‐related mental decline. Preliminary data indicate that disjunctive RT slowing is correlated with non‐memory mental decline, and that poor performance is related to the need for care and supervision.
Potassium, Glucose and Insulin Administration in Acute Myocardial Infarction: A Five‐Year Study
Authors: MACHTEY I. , SYRKIS I. , NISSIMOV M. R. , LÖBEL H.
Published: April 2015

ABSTRACT: Two hundred and twelve patients with acute myocardial infarction were treated for 14 days with daily doses of potassium (3 gm orally), glucose (280 gm orally) and regular insulin (16 units subcutaneously), all given in 4 fractional doses. The incidences of arrhythmias, heart failure and systolic blood pressure below 70 mm Hg, as well as the mortality rate, were compared with those for another group of 600 myocardial infarction patients who were not given this treatment. Though there was some reduction in the incidence of cardiac arrhythmias, it was not statistically significant. However, there was a strikingly significant decrease in the incidences of heart failure and blood pressure below 70 mm, as well as in the early mortality rate. Our findings should encourage the continued use of potassium, glucose and insulin therapy in acute myocardial infarction.
A Low‐Vision Clinic at a Home for the Aged*
Authors: KORNZWEIG ABRAHAM L.
Published: April 2015

ABSTRACT: The objective of a low‐vision clinic developed at the Jewish Home and Hospital for Aged was to improve the visual capabilities of the residents who were not helped by the regular eye clinics. Eighty‐three patients (72 women, 11 men) were examined the first year. Ages ranged from 71 to 101 years. The causes of poor vision were mainly senile macular degeneration, cataract formation, chronic glaucoma, severe myopia, aphakia, and combinations of these diseases. Vision ranged from 10/50 at 10 feet (20/100 at 20 feet) in the better eye, to only the ability to distinguish hand movements or to perceive light. With the use of visual aids such as distance or reading glasses and various forms of magnifying glasses, some improvement occurred in 61 of the 83 patients. The follow‐up examination was within one year in most cases. It was concluded that in order to examine and treat such patients properly, much more time and patience were required than is usually possible in a regular eye clinic. This involved the help of more social workers and volunteer assistants. Nevertheless, the results were worthwhile for this type of patient.
Therapeutic Group Process with the Institutional Elderly
Authors: MAIZLER JAN S. , SOLOMON JEFFREY R.
Published: April 2015

ABSTRACT: This paper reviews the status of geriatric group psychotherapy and the experience with such programs at the Miami Jewish Home and Hospital for the Aged. Specific ways are suggested for enhancing the administration of group psychotherapy programs in the geriatric institutional setting. Group therapy techniques adapted to the specialized needs of the aged are of definite therapeutic benefit.
Asymptomatic Calcified Thrombus in a Coronary Aneurysm
Authors: NAPOLITANO JOSEPH V. , SALOMON MARDOQUEO I. , TCHERTKOFF VICTOR
Published: April 2015

ABSTRACT: A rare case is presented of a patient who survived asymptomatically with an undiagnosed large calcified thrombus in a coronary aneurysm.
Effect of Aging on Thyroid Economy in Man*
Authors: INGBAR SIDNEY H.
Published: April 2015

ABSTRACT: The effects of aging on the thyroid are discussed under the headings of metabolic indices, thyroid function, hormone production, blood concentration, and thyroregulatory mechanisms. Possibly elderly men differ from elderly women with regard to thyroid economy, but the available data are too few and contradictory to permit drawing firm inferences about the effects of aging.
A Psychogeriatric Assessment Program. IV. Interdisciplinary Aspects*
Authors: MÜLLER H. F. , DASTOOR D. P. , HONTELA S. , KACHANOFF R. , KLINGNER A.
Published: April 2015

ABSTRACT: The interdisciplinary aspects of the psychogeriatric assessments described in three previous papers are discussed on the basis of factor‐analysis findings and their significance in diagnosis, treatment, planning and theory. The difference between basic biopsychologic dysfunctions (including pathohistologic changes and various counter‐regulations) and psychosocial dysfunctions (lifestyle) becomes clear statistically as well as clinically. This difference probably is fundamental, in the sense that intact biopsychologic functions are elementary tools for the psychosocial functions.
Immunity and Survival*
Authors: BUCKLEY C. E. , ROSEMAN J. M.
Published: April 2015

ABSTRACT: Studies in human families and in surviving older persons suggest that the immune system may have an important role in the control of survival. Immune response (Ir) genes to infectious agents can be detected in human families. Genetically controlled susceptibility to naturally occurring infectious agents could contribute to the prevalence of disease and early death characteristic of certain human families. Alterations in serum immunoglobulin levels consistent with impaired thymus (T) cell function can be detected in persons surviving to an advanced age. Measurements of serum immunoglobulin levels appear to predict survival better than conventional estimates of risk of disease and death. Similar measurements may help identify those older persons who have the greatest need for health care resources. These observations suggest that the immune system may have a primary permissive role in the regulation of human survival.
Mortality Fluctuations among Chronically Ill Medical Geriatric Patients as an Indicator of Stress before and after Relocation*
Authors: ZWEIG J. P. , CSANK J. Z.
Published: April 2015

ABSTRACT: The effects of mass transfer of a sick geriatric population of war veterans were evaluated to determine the resultant change in mortality. A comparison of mortality patterns by months was made over a six‐year period, centered around the month of the move, July 1971. Analysis of the mortality fluctuations in the 24‐month interval surrounding the move indicated that the course of mortality during this interval was periodic, with four distinguishable phases making up the complete cycle. An attempt was made to link stress‐inducing events before, during and after the relocation with the ensuing mortality. It is important to use planned, low‐key, stress‐prevention measures and continue them for some time after the move, to offset adverse mortality effects from anticipatory anxiety and from the postrelocation release of anxiety‐generated stress.
Involuntary Transfer as a Cause of Death and of Medical Hospitalization in Geriatric Neuropsychiatry Patients*
Authors: WATSON CHARLES G. , BUERKLE HELEN R.
Published: April 2015

ABSTRACT: The effects of mass involuntary transfer on geriatric neuropsychiatric male patients were evaluated by comparing outcomes for three overlapping sets of patients (N = 403, 385, and 378) over several follow‐up periods. One group, the “reorganization” sample, consisted of all patients on three geriatric wards at a time just before the wards were reorganized and 20 percent of the patients were transferred to other buildings. The comparison samples comprised two overlapping groups consisting of all patients on the wards four months earlier and four months later. Neither the short‐term (4‐month) nor the long‐term (12‐month) follow‐ups showed any increase in deaths or in medical ward transfers attributable to the reorganization. These findings indicate that certain types of mass involuntary transfer can be carried out without serious traumatic effects on physical health as reported by some observers. Differences between the relatively modified transfer in this project and the more radical transfers described by others are discussed.
Change in Antikaliuretic Response to Potassium‐Sparing Diuretics in Patients with Cirrhotic Ascites
Authors: RADÓ JÁNOS P.
Published: April 2015

ABSTRACT: In 2 elderly patients with ascites due to hepatic cirrhosis, potassium excretion decreased during re‐administration of potassium‐sparing diuretics after recurrence of ascites following withdrawal of previous prolonged treatment. An exaggerated antikaliuretic response and a paradoxic rise in potassium excretion are “unpredictable” changes which may occur during administration of potassium‐sparing diuretics at different times in the same patient treated with the same drug.
Piperacetazine Versus Thioridazine in the Treatment of Organic Brain Disease: A Controlled Double‐Blind Study
Authors: GOLDSTEIN S. E. , BIRNBOM F.
Published: April 2015

ABSTRACT: in a double‐blind cross‐over study, 50 geriatric patients with organic brain disease were divided into two groups. One group first received piperacetazine for 15 days and then thioridazine for 15 days. For the other group the sequence was reversed. Piperacetazine proved to be at least as effective as thioridazine and seemed to be more effective against certain target symptoms; side effects were less common and less severe.
The Rate of Acetaminophen Metabolism in the Elderly and the Young
Authors: BRIANT ROBIN H. , DORRINGTON ROSEMARY E. , CLEAL JANE , WILLIAMS FAITH M.
Published: April 2015

ABSTRACT: Twenty‐eight elderly volunteers of the 65+ age group and 28 control subjects of the 20–40 age group each received a single oral dose (1 gm) of acetaminophen in powder form. The plasma level of acetaminophen was measured over 6 hours. Plasma half‐life, clearance and relative volume of distribution of the drug were calculated. Within each age group there was a wide (threefold) range of plasma half‐life and clearance rate, with a great deal of overlap between the two groups. However, for the elderly, the group mean half‐life of acetaminophen was 2.17 hours, significantly longer than for the young (1.75 hours). The clearance rate in the elderly was significantly slower than in the young (.254 and .340 L/kg/hour respectively). There was no age‐related difference in volume of distribution of the drug by any measure, and no significant influence of sex.
Colonoscopy in the Management of Diseases of the Colon and Rectum
Authors: JAHADI M. REZA , McGIVNEY JOHN Q.
Published: April 2015

ABSTRACT: This report covers a 2.5‐year experience with colonoscopy in the management of 208 patients (104 men and 98 women, average age 58 years). Colonic bleeding of unknown cause and abnormal barium‐enema findings were the most common indications for colonoscopic examination. During this period, 110 colonoscopic polypectomies were performed. Among the few complications was one case of perforation of the sigmoid from transcolonoscopic removal of a small carcinoma; the perforation was incidentally discovered at the time of subsequent laparotomy. Bleeding occurred in 6 patients, but only one of them required surgical intervention to arrest the hemorrhage. Colonoscopy is a safe, effective and reliable diagnostic and therapeutic procedure. Its use can reduce expense for the patient and obviate a long painful postoperative period.
Analysis of Geriatric Surgical Experience in a Veterans Home
Authors: JAKE R. J.
Published: April 2015

ABSTRACT: Surgical experience at the hospital of a State Veterans Home is reviewed over a period of two and a half years (1973–1975). The average age of the patients was 74 years, and many had severe pulmonary or cardiac disease. Of the operations performed, 283 were major and 301 were minor. For the major operations (including emergencies) the mortality rate was 4.2 percent, for the minor procedures the rate was zero, and for all types of procedures the overall mortality rate was 2 percent. Emergency operations increased the expected mortality tenfold. Colonic and biliary‐tract operations bore the highest mortality. The incidence of malignant lesions was high. In the elderly, indicated surgical procedures are justified, provided they are carried out by an organized, highly trained health team.
Aging*
Authors: OCHSNER ALTON
Published: April 2015

ABSTRACT: Aging, a wearing‐out process which affects everything inanimate and animate, is accelerated by abuse or decelerated by care. The psychologic reactions of aging persons vary considerably. The concept of growing older is much more satisfactory and pleasant than the concept of being old, since the former is applicable to everyone regardless of age whereas the latter carries a finite significance as deterioration progresses. Chronologic age is much less important than biologic age. The desideratum is not longevity but rather a long, useful and meaningful life. Although heredity is of importance in longevity, it is a factor over which at present we have no control. However, we can influence the aging process according to whether we care for or abuse the body. The principal factors in accelerated aging, in order of importance, are: 1) tobacco use (particularly cigarette smoking), 2) lack of exercise, and 3) obesity. Conversely, abstinence from tobacco, exercise within tolerance, and avoidance of obesity not only decelerate aging but result in a better quality of life.
Spiral Aftereffect Test and Rapid Picture Projection Test with Aging Populations
Authors: KAYE JONAS , BOYLE EDWIN , CANOSA FRANK L. , APARICIO ADOLFO M. , MORGAN H. WILLIAM
Published: April 2015

ABSTRACT: Two visual criteria — the Spiral Aftereffect Test (SAET) and the Rapid Picture Projection Test (RPPT) — were used for evaluation of memory and mental impairment in 52 aging subjects. The scores were compared with those obtained on the Wechsler Memory Scale Associate Learning Subtest (WMSALS) and the Orientation Test (OT) (Pfeiffer). A multiple regression analysis of several test variables indicated that the RPPT was the best indicator of verbal memory and that it was highly correlated with OT findings. When the RPPT and SAET were matched with the WMSALS, scores on both were significantly correlated with those on WMSALS verbal memory. SAET performance by the elderly subjects was lower than that by the younger controls in other studies, and often matched that by patients with organic impairment. The chief handicaps identified with both tests were: inefficient eye movements, difficulties in conceptualizing, and inability to transform the visual information to a communicable verbal form. Suggestions are made for the testing of eye movements and eye fixations with the newest oculographic techniques, for the manipulation of some of the testing conditions with the SAET and RPPT, for a procedural variation with memory training, and for a clinical application of the RPPT.
Management of Chronic Non‐Rheumatic Pain in the Elderly*
Authors: HUNT T. E.
Published: April 2015

ABSTRACT: Chronic non‐rheumatic pain in the aged should be viewed in the context of physiologic and clinical alterations due to aging which may create diagnostic problems. In the elderly, the abnormality of the clinical presentation and the patient's failure to remember the time and the nature of the precipitating incident may be extremely misleading. Many clinical features may also be altered by the aging process itself. Thus the unwary physician is apt to be mistaken in establishing the etiologic basis for pain syndromes. Once a diagnosis has been achieved, it should be evaluated in the light of other age‐related disturbances. Treatment should be as simple as possible. The prescription of combination preparations may involve use of a drug that is beneficial for one disorder but harmful for another. Aged persons display a marked tendency toward abnormal reactions to the usual drug regimens. A wise combination of treatment by medical means (including drugs), physiotherapy, and sometimes surgical procedures, usually is effective for the relief of this type of chronic pain.
What Is the Function of a Hospital for Geriatric and Chronic Diseases?
Authors: ROSIN ARNOLD J. , JACOBOWICZ SARA , SINGER‐ZELIGSON SONIA , BINDER DAN , REZNIK RIVKA
Published: April 2015

ABSTRACT: The functioning of a hospital for chronic diseases was examined in terms of the type of patient referred, the course in the hospital and the eventual outcome, in a prospective study of a year's admissions to one department of Harzfeld Hospital in Israel. Of the 191 patients admitted, 55 percent were assessed as possible candidates for rehabilitation, and two‐thirds were discharged. Among those admitted primarily for nursing reasons, the mortality was 76 percent. The average stay was 68 days for the 47 percent who were discharged and 95 days for the 45 percent who died; 8.4 percent remained as long‐stay patients. Mobility improved in 37 percent and deteriorated in 8 percent; independence in self‐care increased from 13 percent on admission to 51 percent on discharge. Thirty percent of the discharges occurred in the first month, and a further 30 percent in the second month; 85 percent of these patients returned to their own homes. The hospital stay exceeded 6 months in 18 percent, of whom 7 percent died and 3 percent were later discharged. The possibility of release from the hospital was influenced by the degree of disability rather than the social circumstances. The best chance for improvement was among the patients who required only partial help on admission. The most important tasks of the hospital were: intensive and sometimes prolonged rehabilitation; basic nursing care; medical re‐evaluation and sometimes referral for surgical salvage operations; attention to acute and subacute medical problems, some of which occurred as complications, including accidents; and the concentration of physiotherapy and occupational therapy where most needed. Achievement of these aims was based on fostering a cooperative spirit between patients and staff, adjusting to the problem of re‐integrating the long‐stay patient, and coordinating specialist services from other hospitals when needed.
Physiologic Responses of Men 49 to 65 Years of Age to Endurance Training*
Authors: POLLOCK M. L. , DAWSON G. A. , MILLER H. S. , WARD A. , COOPER D. , HEADLEY W. , LINNERUD A. C. , NOMEIR M.‐M.
Published: April 2015

ABSTRACT: A study was made of the effects of training for 30 minutes, three days a week for 20 weeks on certain physiologic measures of sedentary men between 49 and 65 years of age. Twenty‐two subjects volunteered for the experimental group, and 8 others for the control group. Exercise sessions were conducted on a quarter‐mile track and consisted of continuous bouts of walking and jogging. The average daily energy expenditures progressed from 228 to 365 kilocalories between weeks 4 and 20. For the same period, average exercise heart rates (HRs) progressed from 149 beats/minute (83 per cent maximum HR) to 155 beats/minute (91 per cent maximum HR). The experimental group showed significant increases in maximum oxygen intake (V̇O2 max) from 2.47 to 2.90 liters/minute (18 per cent) and in maximum pulmonary ventilation (VE max) from 105 to 121 liters/minute (BTPS), and decreases in resting HR, diastolic blood pressure, body weight, skinfold fat, and abdominal girth. Serum cholesterol and triglyceride levels and heart volume remained unchanged. The control subjects showed no significant changes. Regression analysis, with use of age as a covariate, showed a small but significant inverse relationship with changes in V̇O2 max. It was concluded that men of the 49–65 age group respond favorably to endurance exercise and show a magnitude of change similar to that found in previous investigations of similar design with younger subjects.
Errors and Omissions in Diagnostic Records on Admission of Patients to a Nursing Home*
Authors: MILLER MICHAEL B. , ELLIOTT DIAN F.
Published: April 2015

ABSTRACT: The primary and secondary diagnoses for 100 geriatric patients consecutively admitted to a nursing home were reviewed for accuracy and omissions. Primary diagnoses were identified as the direct basis for nursing home admission. Other physical, biochemical or behavioral disorders requiring continued therapeutic care were identified as secondary diagnoses. A comparison was made of the diagnosis offered by the referring physician and the diagnosis as determined by the medical staff of the nursing home immediately after admission. In 64 percent of these 100 patients, the primary admitting diagnosis was inaccurate. In 84 percent, the secondary diagnoses were either lacking or inaccurate. The extraordinarily inadequate medical performance with respect to identifying the primary clinical and therapeutic problems of the chronically ill aged was remarkably consistent, regardless of the source of the patient's referral, whether from a general or psychiatric hospital, a private home, or another nursing home. The results of this study revealed a significant degree of unpreparedness and malaise in some members of the medical profession concerning the care of the chronically ill aged, particularly when such patients demonstrate behavioral disorders superimposed upon physical disease. Failure to identify the patient's needs through diagnosis must result in poor, inadequate or inappropriate treatment programs.