bluuebunny/crossref_metadata_2025 huggingface dataset:
Age Effects on Alpha‐1‐Acid Glycoprotein Concentration and Imipramine Plasma Protein Binding
Authors: Abernethy Darrell R. , Kerzner Lawrence
Published: April 2015

Alpha‐1‐acid glycoprotein concentration and imipramine binding to plasma proteins were determined in a cohort of 69 subjects, aged 20–97 years. No subject had evidence of acute or chronic inflammatory disease or malignancy, or was receiving tricyclic antidepressant therapy. Alpha‐1‐acid glycoprotein concentration increased significantly with increasing age (r = 0.28; P < 0.02). Imipramine percentage not bound to plasma proteins was negatively related to alpha‐1‐acid glycoprotein concentration (r = −0.30; P < 0.01); however, there was no relationship between subject age and percentage imipramine unbound. Though alpha‐1‐acid glycoprotein concentration increases with advancing age, because only a small proportion of the variability is explained by age, with other undefined factors being more important, drugs predominantly bound to alpha‐1‐acid glycoprotein such as imipramine may not have a clinically or statistically significant change in protein binding with increasing age in the absence of overt clinical illness.
The Attitudinal Impact of Training in Gerontology/Geriatrics in Medical School: A Review of the Literature and Perspective
Authors: Coccaro Emil F. , Miles Anne M.
Published: April 2015

The authors review the literature regarding the effect of education on medical student attitudes toward patient care and toward geriatric patient care in particular. The ability of gerontologic/geriatric programs to foster positive attitudes toward the elderly has been modest. Empathically oriented programs that stress the establishment of contact with healthy, functioning older persons, however, may be twice as effective as cognitively oriented programs that stress the acquisition of technical knowledge. The societal, institutional, and intra/interpersonal forces that work to facilitate or limit the impact of such programs are discussed, and the potential for educational intervention is assessed.
Central Nervous System Symptoms of Elderly Subjects Using Antihypertensive Drugs
Authors: HALE WILLIAM E. , STEWART RONALD B. , MARKS RONALD G.
Published: April 2015

The effects of antihypertensive agents on the frequencies of reported fainting, dizziness, losses of consciousness, and bone fractures were studied in a large, ambulatory elderly population. The frequencies of these symptoms were compared for subjects who used one or more of nine different antihypertensive agents and for subjects who were not using these medications and who served as a control group. Over 40 per cent of the total population were using at least one of the nine drug groups. Women who used antihypertensive medications reported significantly more fainting (P < 0.001), dizziness (P < 0.005) and “blacking‐out spells” (P < 0.002) but significantly fewer bone fractures (P < 0.02) compared with women who were not using such medication in the control group. For men, the use of only one drug group, propranolol, was associated with a significant increase in fainting and dizziness but not blacking‐out spells compared with men in the control. These results suggest that elderly persons may be subject to a variety of central nervous system side effects induced by antihypertensive drugs.
Multiple Sclerosis with Onset after Age 60
Authors: MARRA THOMAS R.
Published: April 2015

The onset of multiple sclerosis (MS) after age 60 is uncommon. The clinical features of three such cases are described. Considerable diagnostic delay was seen in each case as symptoms were initially attributed to other conditions that more commonly afflict the elderly, including atypical facial pain, neuropathy, peripheral and cerebral vascular disease, arthritis, benign prostatic hypertrophy, and ischemic optic neuropathy. Although MS should be considered a diagnosis of exclusion in this age group, cerebral evoked potentials and CSF immunoglobulin studies can increase the diagnostic yield and may be helpful in the appropriate clinical context.
Geriatrics: A Selected Up‐to‐date Bibliography
Authors: ROSENTHAL MARK
Published: April 2015

This is the first annual revision of the Geriatrics Bibliography. Rather than publish only new references, the previous list has been totally revised. Approximately one quarter of the old references have been replaced by more current or more detailed articles. In addition, the bibliography has been expanded to include a number of new topics, with over one hundred more references.

In preparing this revised list, many good articles were, of necesssity, excluded. The number of publications pertinent to clinical geriatrics has grown quickly over the past year. Preference, as before, was given to recent publications, since they usually provide a list of the important earlier articles. Most of the references are less than five years old; the exceptions deal with specific issues not covered as well in the subsequent literature. An occasional review article is cited to cover gaps in the geriatric literature or merely to amplify aspects of common diseases that have been widely ignored outside of geriatric medicine.

Most of the references selected deal specifically with an elderly patient population. Exceptions include those dealing with diseases remarkably common in the aged but for which no adequate study from a geriatric viewpoint exists, e.g., monoclonal gammopathy, Paget's disease, pulmonary emboli. All studies in geriatrics are confounded by questions of “normal” aging as opposed to the concomitants of aging frequent in our society: inactivity, relative obesity, malnutrition, and psychosocial trauma.

The first set of references (I) includes synopses on the causation of aging, the second (II) on the systems known to degenerate with advancing age. The next two topics (III, IV) are clinically related: one deals with the basic distinctions of the geriatric patient and the other with the ancillary services available. As geriatrics is basically a multidisciplinary field, the bulk of the references are cited by pertinent specialty.
Medical Care for Elderly Patients with Diminished Competence: An Ethical Analysis
Authors: McCULLOUGH LAURENCE B.
Published: April 2015

The moral responsibilities of physicians caring for elderly patients of diminished or marginal competence are analyzed. In the context of two case studies, it is argued that these responsibilities are not grounded simply in the patient's best interests as the physician understands them. Instead, they should be grounded in the patient's past autonomy, that is, the values and beliefs that the patient held prior to the loss of competence. Family members have a key role to play in assisting the physician to construct this “value history.” An important role for the patient's primary care physician is also identified, namely, developing the patient's value history in advance with the patient while he or she is competent, and recording that history in the patient's chart.
Clinical Pharmacists Prescribing Drug Therapy in a Geriatric Setting: Outcome of a Trial
Authors: THOMPSON JOHN F. , McGHAN WILLIAM F. , RUFFALO RICHARD L. , COHEN DAVID A. , ADAMCIK BARBARA , SEGAL JACK L.
Published: April 2015

Clinical pharmacists, under the supervision of a family practitioner physician, assumed responsibility for drug management of geriatric patients in a Los Angeles skilled nursing facility. In a quasi‐experimental, pretest‐post‐test control group design, outcome criteria were measured. Compared with the control group which received traditional patient care, the prescribing clinical pharmacists' group had a significantly lower number of deaths (P = 0.05), a significantly higher number of patients being discharged to lower levels of care (P = 0.03), and a significantly lower average number of drugs per patient (P = 0.04). The lower number of patients hospitalized approached significance (P = 0.06) in the prescribing clinical pharmacists' group. The practice of having clinical pharmacists prescribe drug therapy and render general care, under the supervision of a physician, has the potential for saving the health care system approximately $70,000 per year per 100 skilled nursing facility beds.
Double‐blind Clinical and Psychologic Study of Ergoloid Mesylates (Hydergine®) in Subjects with Senile Mental Deterioration
Authors: van Loveren‐Huyben C. M. S. , Engelaar H. F. W. J. , Hermans M. B. M. , van der Bom J. A. , Leering C. , Munnichs J. M. A.
Published: April 2015

A double‐blind study of 24 weeks' duration was conducted to investigate the effects of ergoloid mesylates (Hydergine®) on symptoms of senile mental deterioration. Fifty‐eight residents of old people's homes were included in the trial. Thirty were treated with ergoloid mesylates and 28 with placebo, and the effects of treatment were determined by means of medical and psychological examinations. On the Sandoz Clinical Assessment Geriatric Scale, the group receiving ergoloid mesylates showed significant improvement in all items. The group receiving placebo showed slight deterioration. Psychological examination showed that no changes were observed for either group in quantitative psychometric test results, although qualitative aspects of performance such as attention and concentration did improve. There was a close correlation between improved cognitive function scores on the SCAG and improved evaluations of behavior during the psychological examinations. There were marked individual differences in the degrees of improvement.
Limited‐Treatment Policies in Long‐Term Care Facilities
Authors: Miles Steven H. , Ryden Muriel B.
Published: April 2015

Two‐thirds of the long‐term care facilities in Minnesota accept do‐not‐resuscitate (DNR) orders and 73% accept care plans to limit medical treatment. The major objectives for limited‐treatment plans cited by the 16.3% of facilities with administrative protocols for such plans was to provide for the resident's physical and emotional comfort and dignity. Nearly half of the protocols said limited treatment plans were intended to limit emergency care or hospitalization or to allow death to occur. Protocols advocated the alleviation of physical discomfort, anxiety, and social isolation. Tube feedings were not recommended when oral feeding became impossible. Airway suctioning, oxygen, or antibiotic treatment was suggested only as needed to alleviate suffering. Only a fourth of the protocols described a primary role for the resident in these decisions. This study demonstrates that nursing homes are developing administrative protocols for the formulation of limited‐treatment plans and suggests that model policy statements describing key decision‐making principles, issues, and procedural safeguards could play a constructive role in this process.
Book Reviews
Authors: Binder Morton A.
Published: April 2015

Handbook of Diseases of Aging. Edited by Blumenthal HT. New York, Van Nostrand Reinhold Company, 1983, 530 pages, $36.50
Comparison of the Use of Reserpine Versus Alpha‐methyldopa for Second Step Treatment of Hypertension in the Elderly
Authors: Applegate William B. , Carper Eleanor R. , Kahn Sherman E. , Westbrook Laura , Linton Mack , Baker Marion G. , Runyan John W.
Published: April 2015

A retrospective chart analysis was conducted on all new elderly hypertensive patients referred to a community hypertension clinic who were being treated with either reserpine or alpha‐methyldopa plus a diuretic. There were no significant differences between the two groups on entry in age, gender, co‐mobid diagnoses, or systolic or diastolic blood pressure. There were no significant differences between the two groups in terms of side effects over three years, but the proportion of persons having compliance problems was significantly lower in the reserpine group. Mean diastolic pressures were significantly lower after one, two, and three years, and systolic pressures were lower after one and two years in the reserpine group. Reserpine is at least as effective as alpha‐methyldopa in treating hypertension in the elderly and is associated with fewer problems in compliance. J Am Geriatr Soc 33:109, 1985
Aging in Rodents Fed Restricted Diets*,†
Authors: Weindruch Richard
Published: April 2015

Section Editor's Note:

This is the first article of a new permanent section of the journal, “Geriatric Bioscience.” The Editor and the Section Editor wish to use this section to present “work in progress” and/or state of the art reviews in areas of basic science of relevance to clinicians dealing with geriatric patients. We hope this can he a mechanism to help the clinician keep abreast of new information from the fields of physiology, anatomy, molecular and cell biology, neurobiology, immunology, etc. that are likely to impact upon our care of the geriatric patient now or in the future.

We wish to encourage the submission of papers for this section that will summarize recently published work from individual investigators or investigative groups and place it in the perspective of the general state of work in the field. We welcome very broad participation in this series and also solicit the readership's views on topics or work of interest that might be commissioned for this series.

Harvey Jay Cohen, MD

Section Editor
Update on Some Epidemiologic Features of Intermittent Claudication: The Framingham Study
Authors: Kannel W. B. , McGee D. L.
Published: April 2015

During 26 years of surveillance of the Framingham Study Cohort of 5,209 subjects, 176 men and 119 women developed occlusive peripheral arterial disease manifested as intermittent claudication (IC). The incidence increased sharply with age until the age of 75, with about a twofold male predominance at all ages. An incidence of IC comparable to that of angina pectoris was obtained ten years later in life than for angina pectoris. Cigarette smoking, impaired glucose tolerance, and hypertension were powerful predisposing factors. Impaired glucose tolerance was a greater risk in women than in men, and glycosuria carried a greater risk than other indicators of impaired glucose tolerance. Cigarette smoking had about the same impact in men and women, approximately doubling the risk, and the impact was discernible into advanced age. Hypertension increased risk 2.5‐ to fourfold, respectively, in men and women. A low vital capacity was associated with a substantial excess risk. Electrocardiographic evidence of left ventricular hypertrophy predicted IC in both sexes. Serum cholesterol, relative weight, and hematocrit were weak risk factors. A risk profile made up of the major cardiovascular risk factors was better for predicting IC than for predicting coronary heart disease. Mortality was increased two‐ to fourfold in men and women, respectively, mainly because of coexistent cardiovascular disease. J Am Geriatr Soc 33:13, 1985
Clinical Studies of the Cholinergic Deficit in Alzheimer's Disease
Authors: Davis Bonnie M. , Mohs Richard C. , Greenwald Blaine S. , Mathé A. A. , Johns Celeste A. , Horvath Thomas B. , Davis Kenneth L.
Published: April 2015

Autopsy studies indicating that cholinergic neurons are selectively lost in patients with Alzheimer's disease (AD) and senile dementia of the Alzheimer type (SDAT) suggest that peripheral markers for central cholinergic activity would be useful in diagnosis. The present studies found that cerebrospinal fluid (CSF) concentrations of acetylcholine (ACh) correlated with the degree of cognitive impairment (r = .70) in a sample of carefully diagnosed patients with AD/SDAT, but metabolites of other neurotransmitters were not related to cognitive state; this suggests that CSF ACh may be a valid measure of cholinergic degeneration. cortisol and growth hormone were measured in plasma samples drawn from patients and controls every 30 minutes from 2100 to 1100 hours the next day. Mean plasma cortisol concentrations were higher in patients with AD/SDAT than in controls and correlated inversely with CSF methoxy‐hydroxyphenylglycol (MHPG) (r = .61) and positively with degree of cognitive impairment (r = +.53); as anticholinergic drugs suppress cortisol this finding indicates that cortisol dysregulation may be a marker for abnormalities in other neurotransmitter systems, particularly the noradrenergic system. Growth hormone secretion was not different in patients and controls but was positively correlated with CSF MHPG (r = + .63).
Clinical Studies of the Cholinergic Deficit in Alzheimer's Disease
Authors: Mohs Richard C. , Davis Bonnie M. , Greenwald Blaine S. , Mathé A. A. , Johns Celeste A. , Horvath Thomas B. , Davis Kenneth L.
Published: April 2015

Two studies investigated the ability of physostigmine, given both intravenously and orally, to reduce symptoms of Alzheimer's disease. Intravenous physostigmine significantly and reliably enhanced memory in 13 of 16 patients tested, but the dose producing the improvement varied among patients. Oral physostigmine decreased overall symptom severity in a reliable way in seven of 12 patients tested. The extent of improvement was correlated with the increase in mean cortisol secretion produced by physostigmine, suggesting that the drug improved behavior and cognition only to the extent that it had a specific central cholinomimetic effect. There was no significant association between response to physostigmine and results of a dexamethasone suppression test and physostigmine had no effect on growth hormone secretion.
Left Ventricular Diastolic Function in a Population of Healthy Elderly Subjects
Authors: Manyari Dante E. , Patterson Christopher , Johnson David , Belenkie Israel , Anderson Perry , Melendez Libardo , Cape Ronald
Published: April 2015

Diastolic left ventricular function was comparatively assessed in 19 healthy elderly individuals (mean age 71 years) and in 20 young normal subjects (mean age 26 years), using digitized echocardiograms. Peak and average filling rates were slower in the group of elderly subjects than in the younger population (128 ± 26 and 75 ± 11v182 ± 37 and 92 ± 17 mm per second, respectively,P< .001). The duration of the rapid filling phase and the time to peak filling rate were significantly longer in the older than in the younger population (207 ± 39 and 125 ± 21v174 ± 38 and 90 ± 26 ms, respectively,P< .01). The atrial contribution to total ventricular filling was 18 ± 6% in the elderly and 10 ± 3% in the young (P< .001). The group differences of most of these measurements of diastolic function retained statistical significance after correction for heart rate. Measurements of left ventricular systolic function were similar in both age groups. The authors conclude that aging is associated with a decline of left ventricular compliance, unrelated to heart rate or systolic performance. The contribution of atrial contraction to ventricular filling is quantitatively larger in elderly individuals.
Performance of Candidates on the Geriatric Medicine Items of the American Board of Internal Medicine Certifying Examination
Authors: Norcini John J. , Lipner Rebecca S. , Steel Knight
Published: April 2015

The performance of candidates on the geriatric medicine items on the American Board of Internal Medicine's 1980, 1981, and 1982 Certifying Examinations was analyzed. For the 1981 and 1982 examinations, candidates who trained in residency programs having a special emphasis on geriatric medicine performed significantly better on the geriatric items than did candidates who attended other residency programs, regardless of overall medical knowledge. This finding suggests the efficacy of training in geriatric medicine as measured by a written examination.
Hallucinations of Widowhood
Authors: Olson P. Richard , Suddeth Joe A. , Peterson Patricia J. , Egelhoff Claudia
Published: April 2015

Widowed residents of two nursing homes who were oriented to person, time, and place were interviewed to determine the extent to which they had hallucinatory experiences of their deceased spouse. Fifty‐two interviews were completed with 46 widows and six widowers. Results are reported for the widows. Twenty‐eight (61%) of the widows reported hallucinatory experiences of their deceased spouse. Twenty‐four (86%) of the widows described the experiences as good or helpful. Thirteen (46%) reported that the experiences continue to happen. Nineteen (54%) of the widows had never discussed the experiences with anyone before this study. These results are surprisingly similar to previously published findings by Rees in Wales and suggest that these experiences are more common in the United States than has been recognized.
Legal and Ethical Standards in Geriatric Medicine
Authors: Kapp Marshall B.
Published: April 2015

Several examples of physicians' ethical and legal responsibilities toward older individuals desiring medical care are discussed. The focus is on the older person's ethical and legal right to access to medical services, and on the extent of corresponding obligations of physicians to actuate and fulfill the older person's access rights. The impact of current cost constraints in carrying out these obligations is also discussed.
Copper and Zinc Levels in “Healthy” and “Sick” Elderly
Authors: Murphy P. , Wadiwala I. , Sharland D. E. , Rai G. S.
Published: April 2015

Healthy elderly as a group have a wider range for serum copper, ceruloplasmin, and serum zinc than the adjusted ranges for the laboratory. In disease serum copper and/or ceruloplasmin act as acute‐phase reactants in vascular disease, inflammation, and malignancy. Serum zinc values likewise are affected by the presence of inflammation and malignancy. The reported low level of copper in patients with osteoporosis was not confirmed by the present study. Neither was there any evidence found for zinc deficiency in patients with dementia. J Am Geriatr Soc 33:847, 1985
Fever and Aging
Authors: Norman Dean C. , Grahn Dale , Yoshikawa Thomas T.
Published: April 2015

The pathogenesis and clinical relevance of fever is reviewed. The interrelationship between fever and other biologic responses to infection is summarized. A blunted or absent fever response to infections observed in some elderly patients may be due to defects in thermoregulation. These abnormalities in thermoregulation may include impairment of both behavioral and physiologic responses. J Am Geriatr Soc 33:859, 1985
Custodial Nursing Home Care: Setting Realistic Goals
Authors: Sloane Philip D. , Pickard C. Glenn
Published: April 2015

Despite concerted effort to rehabilitate and return patients to their homes, the majority of nursing home patients are destined to spend the remainder of their days in institutional settings. These custodial care patients are elderly, have many functional disabilities, and are often demented. The traditional medical approach to care, which emphasizes diagnosis and treatment of specific diseases, is often not appropriate for these patients. Instead, physicians should focus their attention on functional assessment and treatment, nontechnologic management of acute problems, humane terminal care, and the development of an efficient caregiving system within the nursing home. J Am Geriatr Soc 33:864, 1985
Assessment of Cognitive Deficit in Geriatric Patients
Authors: McCartney James R. , Palmateer Linda M.
Published: April 2015

A crucial factor in promoting a vigorous quality of life in the aging population is assessment and treatment of cognitive deficits. A very high percentage of delirium and at least 20% of dementia is eminently treatable. This study of patients over 65 years of age admitted to a university general hospital reveals that 79% of cognitive deficits were missed by the examining physicians. Furthermore, in 394 examinations of 165 patients, only four mental status examinations were recorded. A clear‐cut cognitive deficit on admission was predictive of later acute episodes of confusion. The global techniques of evaluation deserve remediable action by medical schools and hospital training programs if the medical care of the elderly is to be improved.
Imaging the Centenarian Brain
Authors: Goldstein Steven J. , Wekstein David R. , Kirkpatrick Charmaine , Lee Charles , Markesbery William R.
Published: April 2015

Ten healthy and mentally alert centenarians underwent cranial computed tomography (CT) using a fourth‐generation CT scanner. The subjects ranged in age from 100 to 102 years, and included six women and four men. Two of them used alcohol on a daily basis and five had systolic blood pressures of at least 160 mmHg. The CT scans demonstrated considerable variation in the degree of cerebral atrophy, which had no relation to either sex, alcohol use, or hypertension. Three of the centenarians had evidence of mild periventricular white matter lucency. Although progressive cerebral atrophy is an integral aspect of the normal aging process in the very elderly, its exact relationship to cognitive function remains unclear.
“I Don't Know” Responses in Elderly Depressives and in Dementia
Authors: Young R. C. , Manley M. W. , Alexopoulos G. S.
Published: April 2015

“I don't know” responses were recorded during administration of the Mini‐Mental State Examination in elderly patients with primary degenerative dementia and primary major depression. More “I don't know” responses were given by patients with degenerative dementia; however, demented patients did not differ overall from depressives in the proportion of Not Correct responses consisting of “I don't know” responses. These responses were positively correlated with age and with Hollingshead education and social class scores in depressives but not in demented patients. A higher proportion of Not Correct responses consisting of “I don't know” responses needs to be demonstrated in depressive pseudomentia than in degenerative dementia if this clinical sign is to be used in helping to differentiate the two disorders.
Epidemic Tuberculosis in a Nursing Home: A Retrospective Cohort Study
Authors: Narain Jai P. , Lofgren J. P. , Warren E. , Stead W. W.
Published: April 2015

In a retrospective study, the results of tuberculin skin tests done in a nursing home were examined, where most residents admitted during 1972–1981 were tested using purified protein derivative of tuberculin administered intradermally. Of 514 residents who were tested at least once during the study period, results of the admission skin test were available for 254 and follow‐up skin test results were available for 226. On admission, 13 per cent (35/254) were skin‐test positive (≥10 mm induration at 48 hours). Skin test positivity for males was 16 per cent, females, 11 per cent, nonwhites, 19 per cent, and whites, 12 per cent. Highest skin test positivity was for persons received as transfers from other nursing homes (24 per cent) and lowest was for those entering from individual homes (8 per cent, P = 0.016, Fisher's Exact Test). On follow‐up, 38/226 (17 per cent) residents who had been tuberculin‐negative on at least two previous occasions were found to be positive; 24 (63 per cent) of these conversions occurred in a single year (1975) following detection of an infectious patient. The infection rate for persons residing in the nursing home during that year was 28 per cent (28/99) compared with 7.9 per cent (10/127) for persons either discharged before or admitted after 1975 (relative risk = 3.6, P < 0.001). Ten to 15 per cent of new residents are tuberculin‐positive (harbour a dormant tuberculous infection), leaving 85–90 per cent of newly admitted persons who are tuberculin‐negative and thus susceptible to infection if exposed. The study shows that tuberculosis must be considered as a potential nosocomial infection in nursing homes. The source of infection may be a person who has not been recognized as having tuberculosis. Five to 10 per cent of newly infected persons (PPD converters) can be expected to develop tuberculosis if not given preventive therapy with isoniazid (7.2 per cent in a recent study).
Lack of Effect of Influenza Vaccine on Theophylline Levels and Warfarin Anticoagulation in the Elderly
Authors: Gomolin Irving H. , Chapron Dennis J. , Luhan Patricia A.
Published: April 2015

Steady state theophylline concentrations were prospectively measured in 13 elderly institutionalized individuals following influenza vaccination. Vaccine‐mediated increase in concentrations could not be identified. In seven individuals receiving warfarin, no change in prothrombin or partial thromboplastin times occurred following vaccination. No adverse drug reactions were observed. The following year 14 individuals receiving theophylline and 12 receiving warfarin were vaccinated without adverse drug reactions noticed. These data fail to support previous reports of influenza vaccine inhibition of theophylline metabolism or vaccine‐enhanced anticoagulation and are consistent with recent reports on younger subjects.
Effect of Habitual Physical Activity on Regulation of Insulin‐stimulated Glucose Disposal in Older Males
Authors: Hollenbeck C. B. , Haskell W. , Rosenthal M. , Reaven G. M.
Published: April 2015

The goal of this study was to evaluate the effect of differences in habitual level of physical activity on insulin action in healthy males between 60 and 75 years of age. The study population consisted of 20 non‐obese individuals with normal glucose tolerance: 13 older subjects (68 ± 4 years) not exercising regularly and 7 older subjects (66 ± 3 years) who exercised regularly. Measurements were made of body mass index (BMI), percentage body fat by underwater weighing, maximal O2 consumption by bicycle ergometry (V̇O2max), and insulin‐stimulated glucose disposal by the insulin clamp technique. The results demonstrated that insulin‐stimulated glucose disposal was significantly increased (P < 0.001) in the normal older subjects who exercised regularly. Furthermore, a direct relationship (r = 0.74, P < 0.001) existed between maximal aerobic capacity and in vivo insulin action, which was independent of either BMI or percentage body fat. These data are consistent with the view that the extensive variation previously noted in in vivo insulin‐stimulated glucose disposal of older subjects is related to differences in habitual physical activity.
Efficacy of Routine Annual Studies in the Care of Elderly Patients
Authors: Wolf‐Klein Gisele P. , Holt Timmothy , Silverstone Felix A. , Foley Conn J. , Spatz Murry
Published: April 2015

The authors reviewed the results of annual laboratory screening (SMA 20, T3, T4, UA, EKG, chest x‐ray) performed on a population of 500 institutionalized and ambulatory patients retrospectively followed from 1 to 19 years. With 30 laboratory values recorded for each annual exam, there were an average of 1.56 new abnormal laboratory findings per year per patient. A sample of 100 patients was further reviewed to determine the incidence of new diagnoses and treatment initiated by the appearance of new abnormal laboratory findings; 756 new abnormalities were recorded out of a possible 15,000, and 66 medical work‐ups were initiated, which lead to new diagnoses in 21 cases and a treatment plan in 12 cases. The authors suggest that, in view of the rapid increase in the number of elderly persons and the consequent need to conserve limited health care resources, “standard” laboratory screening may not be warranted on a yearly basis in the elderly population.
Alzheimer's Disease: An Annotated Bibliography of Recent Literature
Authors: Busby Jan , Bonelli Andres , Vargas Lillian , Stirna John , Caranasos George
Published: April 2015

In recent years, Alzheimer's disease has become well known both to the medical profession and to laymen as an increasingly important cause of morbidity and mortality in the elderly. As interest in the disease has grown, so has the scientific literature. In the past four years, over 400 journal articles in the English language alone have been published on various aspects of Alzheimer's disease.

Those participating in the Geriatric Medicine Fellowship Program at the Gainesville VA Medical Center have compiled an annotated list of 92 important references on Alzheimer's disease. These are classified into six major groups: General Review, Etiology, Pathophysiology, Diagnosis, Treatment, and Epidemiology.

It is important for the practicing physician to be able to quickly find references to recent studies on various aspects of Alzheimer's disease, especially those related to treatment possibilities. Family members of Alzheimer's patients are particularly well informed about this disease and are anxious to learn about the latest research advances from their physicians.
Nutritional Assessment of Community‐Living Well Elderly
Authors: Burns Robert , Nichols Linda , Calkins Evan , Blackwell Sylvia , Pragay Desider
Published: April 2015

Nutritional assessment parameters were studied in a sample of 132 community‐living well elderly. Results are presented for biochemical parameters of serum albumin, hemoglobin, and total lymphocyte count and anthropometric parameters of height, weight, mid‐arm circumference, and triceps skinfold. The data show that, although there are some differences between age groups (young‐old and old‐old), all values remain well within normal limits established for younger individuals.
Two‐Year Follow‐Up of Elderly Patients With Mixed Depression and Dementia: Clinical and Electroencephalographic Sleep Findings
Authors: III Charles F. Reynolds , Kupfer David J. , Hoch Carolyn C. , Stack Jacqueline A. , Houck Patricia R. , Sewitch Deborah E.
Published: April 2015

In a two‐year follow‐up of 16 patients with mixed symptoms of depression and dementia, eight showed clinical improvement and eight showed deterioration. Improvement at two‐year follow‐up was associated with several baseline measures: a Folstein Mini‐Mental State score of 21 or greater, a Hamilton Depression score of 21 or greater, and a sleep efficiency of less than 75%. These findings suggest that in the elderly with mixed symptoms of depression and dementia, a more favorable outcome is associated with initially greater depressive symptomatology, higher cognitive function, and moderate sleep continuity disturbance (“early morning awakening”).
Fundic Atrophic Gastritis in an Elderly Population: Effect on Hemoglobin and Several Serum Nutritional Indicators
Authors: Krasinski Stephen D. , Russell Robert M. , Samloff I. Michael , Jacob Robert A. , Dallal Gerard E. , McGandy Robert B. , Hartz Stuart C.
Published: April 2015

The ratio of pepsinogen I to pepsinogen II in the circulation decreases progressively with increasing severity of atrophic gastritis of the fundic gland mucosa. Fasting blood was obtained from 359 free‐living and institutionalized elderly people (age range, 60 to 99 years). A pepsinogen ***I/pepsinogen II ratio less than 2.9, indicating atrophic gastritis, was found in 113 (31.5%) subjects. The prevalence of atrophic gastritis increased significantly with advancing age (P <.05). Within the atrophic gastritis group, 84 had a pepsinogen I level greater than or equal to 20 μg/L, indicating mild to moderate atrophic gastritis, and 29 had a pepsinogen I level less than 20 μg/L, indicating severe atrophic gastritis or gastric atrophy. A significant increase in the prevalences of elevated serum gastrin levels (P <.005), low serum vitamin B12 levels (P <.005), circulating intrinsic factor antibody (P <.005), and anemia (P <.025) was observed with stepwise increases in severity of atrophic gastritis. Subjects with atrophic gastritis exhibited a lower mean serum vitamin B12 level (P <.05) and a higher mean folate level (P <.05), but no difference was detected in mean hemoglobin levels or serum levels of iron, ferritin, retinal or α‐tocopherol. It is concluded that serum pepsinogen I and pepsinogen II levels can be used to determine the prevalence and severity of atrophic gastritis, that atrophic gastritis is common in an elderly population, and that atrophic gastritis is associated with vitamin B12 deficiency and anemia. Further, higher folate levels in atrophic gastritis may be related to an accumulation of 5‐methyl tetrahydrofolate in serum due to vitamin B12 deficiency and/or greater folate synthesis by the intestinal flora resulting from bacterial overgrowth secondary to hypo‐ or achlorhydria.
The Choice Not To Be Resuscitated
Authors: Schwartz David A. , Reilly Philip
Published: April 2015

We studied the use of the do not resuscitate (DNR) order among general medical patients. During the six‐month study period, of 2431 admissions there were 95 patients (3.9%) declared DNR. Of 105 deaths, 69 (66%) occurred among DNR patients. Twenty‐seven percent of the DNR patients left the hospital alive. In 90% of the cases the medical intern initiated the DNR discussion, and in 60% of the cases a decision was reached in less than 24 hours. Two‐thirds of the DNR orders were consented to by family members, and one‐third of all DNR orders had a discernible impact on nonresuscitative care. Less aggressive therapy accounted for 60% of these restrictions, whereas the remainder involved limitations in diagnostic evaluations. When compared with age‐ and sex‐matched general adult inpatient control subjects, DNR patients were found to have longer hospitalizations (P = .01), be more likely to reside in a nursing home (RR = 4.2), have a metastatic neoplasm (RR = 3.6), and be admitted with an abnormal mental status (RR = 6.1) or urinary incontinence (RR = 2.9). These differences remained significant when we controlled for the presence of a metastatic neoplasm. Despite a high in‐hospital mortality rate (73%), DNR patients were not admitted more frequently than controls to the intensive care unit. We conclude that the DNR decision is based on clinical prognostic indexes and that once established, this order serves to modify the allocation of medical resources.
Correlates and Consequences of Eating Dependency in Institutionalized Elderly
Authors: Siebens Hilary , Trupe Elizabeth , Siebens Arthur , Cook Francis , Anshen Susan , Hanauer Richard , Oster Gerald
Published: April 2015

Loss of independent eating capacity is a major problem for the institutionalized elderly. Few studies have examined the factors associated with loss of functional eating capacity. The authors cross‐sectionally studied 240 residents of a skilled nursing facility, classified their functional eating status, identified correlated deficits, and followed these residents for six months. Information was gathered through questionnaires, chart review, and physical examinations. Residents were stratified into independent (68%, N = 264) and dependent (32%, N = 76) eating status groups according to the need for physical assistance during meals. Dependency status did not correlate with age (P = .88) or weight loss (P = .27). Loss of independence in eating was associated with impaired mobility (P =.0001), impaired cognition (P =.0001), modified consistency diets (P = .0001), upper extremity dysfunction (P = .0001), abnormal oral‐motor examinations (P = .0002), absence of teeth and dentures (P = .002), behavioral indicators of abnormal oral and pharyngeal stages of swallowing (P = .0001), and increased mortality within six months (P = .0001). Eating dependency is therefore associated with multiple impairments and early mortality.
Isolated Systolic Hypertension in the Elderly: A Placebo‐Controlled, Dose‐Response Evaluation of Chlorthalidone
Authors: Morledge John H. , Ettinger Bruce , Aranda Juan , McBarron Frank , Barra Peter , Gorwit Jeffrey , Davidov Michael
Published: April 2015

One hundred seventy‐one patients, 60 years of age or older with isolated systolic hypertension, were randomly assigned to receive chlorthalidone 12.5, 25.0, or 50.0 mg or placebo once daily for 12 weeks. The majority of the patients receiving chlorthalidone 12.5 mg achieved therapeutic success with no clinically significant biochemical changes or side effects. The 50.0‐mg dose level enhanced efficacy only minimally over the 25.0‐mg dose level. Drug‐related side effects were significantly more prevalent in the chlorthalidone 50.0‐mg group than in the placebo group. The data suggest that most elderly patients with isolated systolic hypertension, regardless of the severity, could be treated effectively and safely with chlorthalidone 12.5 mg per day.
Applicability of Depression Scales to the Old Old Person
Authors: Weiss Irwin K. , Nagel Cheryl L. , Aronson Miriam K.
Published: April 2015

Depression is a major health problem in the elderly. The existing literature indicates that depression may be qualitatively different in this population. For example, a condition said to be prevalent among the elderly is masked depression which is marked by a cluster of vegetative symptoms without prominent dysphoria or guilt. Specific symptoms of depression reported most commonly in the elderly include loss of self‐esteem, feelings of helplessness, and complaints of cognitive deficit. Based on this information, the contents of six currently used depression rating scales were compared. It was found that although these scales are responsive to standard DSM‐III criteria for depression, for the most part they do not address the symptoms reported to be more common among depressed elderly. In addition, they had not been validated on the old old and therefore seem to have limited applicability as a sensitive screening tool for this rapidly growing segment of the population.
Left Atrial Myxoma in the Elderly
Authors: Davison Edward T. , Mumford David , Zaman Qamar , Horowitz Richard
Published: April 2015

Myxoma of the atrium presents distinctive clinical profile, yet precise diagnosis of the tumor on the basis of clinical findings is often not made in the elderly patient as the symptoms are often attributed to “generalized arteriosclerosis of the elderly.” The authors report the clinical findings in four elderly patients with left atrial myxoma in whom the diagnosis had not been clinically suspected before echocardiographic evaluation.
Association of Atherosclerosis With Increased Atrophy of Brain Matter in the Elderly
Authors: Takeda Shumpei , Watanabe Hiromi , Matsuzawa Taiju
Published: April 2015

The association of atherosclerosis with brain atrophy was studied in 101 subjects (75 men and 26 women) using computed tomography (CT). A calcification index (CI***) was calculated as an indicator of atherosclerosis in the abdominal aorta: the calcified portion along the entire circumference of the abdominal aorta x*** 80. Both the cerebrospinal fluid (CSF) space volume and the volume percentage of the CSF space to the cranial cavity [brain atrophy index (BAI)] were calculated as indicators of brain atrophy. The CSF space volume increased with increasing age after the 70s. The BAI increased with increasing age after the 60s. Both the CSF space volume and the BAI in the 70s were 1.8 times those in the 40s. The CI increased with increasing age after the 50s very rapidly, and the CI in the 70s was 54 times that in the 40s. Both the CSF space volume and the BAI were greater in atherosclerotic (CI greater than or equal to 3.0) than in nonatherosclerotic (CI less than 3.0) subjects in the 60s and the 70s.
Symptom Prevalence in the Elderly
Authors: Hale William E. , Perkins Laura L. , May Franklin E. , Marks Ronald G. , Stewart Ronald B.
Published: April 2015

Prevalence of reported symptoms was studied in 1927 women and 1140 men over 65 years of age in an ambulatory health screening program. Reports of 28 common symptoms were obtained from a standardized questionnaire completed by participants at the time of their fourth annual visit to the program. A comparison was made of the prevalence of specific symptoms by sex, age, disease states, and drug use patterns. The most common symptoms reported by women were nocturia (80.4%), swollen feet or ankles (30.5%), cold feet and/or legs (28.6%), and irregular heartbeat (23.2%), whereas men complained most often of nocturia (79.8%), irregular heartbeat (24.8%), cold feet and/or legs (23.6%), and tinnitus (23.1%). Women reported a mean of 3.99 symptoms compared with 3.22 reported by men (P < .0001). In women there was a statistically significant association for most symptoms in subjects reporting the use of medication compared with a group who did not use medication. In men the use of medication was less highly correlated with reports of symptoms. Nearly 100% of participants reported having at least one disease state. The number of symptoms reported was strongly related to the number of disease states, and after adjusting for diseases, women reported more symptoms than men. The best predictor of symptom prevalence was the number of disease states followed by the number of drugs used and then age.
Pharmacologic Treatment of Agitation Associated With Dementia
Authors: Risse Steven C. , Barnes Robert
Published: April 2015

Pharmacotherapy of aggressive or agitated behaviors in the dementia patient has not been studied extensively, despite the prevalence of this problem. Neuroleptics have the most support for efficacy, with shorter acting benzodiazepines demonstrating benefit on occasion. However, studies done to date indicate that these drugs are effective only for a minority of patients and that side effects frequently make patients worse. Other medications, such as propranolol, carbamazepine, or lithium, may be helpful, but their efficacy in dementia patients has not been demonstrated in placebo‐controlled studies. Until such studies are done, their use is most appropriate in special patient groups or in patients who have failed neuroleptic or benzodiazepine treatment. More studies are needed in elderly patients evaluating effectiveness of pharmacologic agents in specific types of dementia, particularly Alzheimer's disease. Most studies done to date have been of relatively short duration, usually two months or less. Because these medications often are given to dementia patients for prolonged periods, studies are needed to define the long‐term clinical efficacy of these agents. In the clinical setting, these agents should be reduced periodically or discontinued to determine ongoing need. In addition, environmental, social, or behavioral methods of reducing agitated behaviors need to be explored as an adjunct to any medication trial. J Am Geriatr Soc 34:368–376, 1986
New Questions About Steroids
Authors: Finch Caleb E.
Published: April 2015

Recent studies on laboratory rodents demonstrate that steroid hormones can cause irreversible damage and dysfunction on select target cells in the adult brain. During the past 20 years, a careful distinction was proposed between the short‐ and long‐term effects of hormones on the rodent brain. The permanent (organizing) actions of sex steroids on the brain were considered restricted to development and completed by puberty. Thereafter, sex steroids continue to have crucial roles in reproductive physiology and behavior, but the effects were widely considered to be short‐term, lasting weeks or a few months at most. However, a number of researchers have clearly shown that sustained high physiologic levels of steroids have long lasting effects on the adult rodent brain. A portentious example is that prolonged stress with elevated corticosteroids kills specific neurons in the hippocampus if maintained for three months in young rats.1 These same neurons are also commonly lost during aging in rodents and humans. Similar steroid‐dependent mechanisms may be involved in the neuroendocrine changes in aging female rodents that include lactotrophic pituitary tumors and impaired control of prolactin and luteinizing hormone. These same changes are greatly reduced during aging by ovariectomy of rodents when young and, moreover, can be prematurely induced in the young by extended treatments with estrogens.2 The concept that endogenous steroids interact with aging processes is also supported by considerable data showing that hypophysectomy retards many aspects of aging in peripheral cells of rodents.2