bluuebunny/crossref_metadata_2025 huggingface dataset:
Extending the Extenders: Compromise for the Geriatric Specialization‐Manpower Debate
Authors: Romeis James C. , Schey Harry M. , Marion Gail S. , Keith Julian F.
Published: April 2015

This pilot study reports on issues germane to the geriatric specialization‐manpower debate. The study found that a large amount of the functional responsibility required by older adults in an urban clinic setting could be delegated to physician extenders. Other findings included shorter hospitalizations, increased feelings of well‐being, and high patient satisfaction with physician extended care. The implications are that rather than develop a new physician specialty, more geriatric manpower needs could be met by delegating responsibility to appropriately trained and supervised physician extenders. J Am Geriatr Soc 33:559, 1985
Tuberculosis in a Geriatric Unit
Authors: Rudd A.
Published: April 2015

All cases of tuberculosis admitted to a geriatric unit over five years were reviewed. The problems involved in diagnosing and managing the disease in the elderly are discussed, emphasizing the importance of diagnosing a treatable disease that may otherwise be fatal. J Am Geriatr Soc 33:566, 1985
Increasing the Pneumococcal Vaccination Rate of Elderly Patients in a General Internal Medicine Clinic
Authors: Siebers Michael J. , Hunt Vernon B.
Published: April 2015

To improve the pneumococcal vaccination status of an elderly patients group, those older than 64 years of age were identified from a computer file of all continuing care patients in a general internal medicine clinic. In a randomly chosen study group (N = 163), 91 elderly patients (56 per cent) had received the pneumococcal vaccine. Factors associated with a higher rate of pneumococcal vaccination included receiving the previous year's influenza vaccine, a medical problem list attached to the patient's chart, active clinic status (i.e., seen in the year before the study began), and more than two problems listed in the computer record. Letters encouraging pneumococcal vaccination were then sent to patients who had not been vaccinated. Twenty of 72 patients (28 per cent) who received the letter were vaccinated during the next year; 8 per cent of control patients (three of 39) who did not receive the letter were vaccinated. The 95 per cent confidence limit for the relative difference between the study and control group is 6 to 53 per cent. The relative difference was also significant for influenza vaccination between the intervention group and the portion of the control group that had not been vaccinated at the first chart review. Factors associated with pneumococcal vaccination rate following the mailing of the reminder letter were active clinic status and being up to date for either influenza or tetanus vaccination. The incidence of complete vaccination (pneumococcal, influenza, and tetanus) did not improve significantly in the study population. It is concluded that pneumococcal vaccination prevalence increases significantly when patients are sent letters encouraging vaccination.
Relationship of Long‐Term and Acute‐Care Facilities: The Problem of Patient Transfer and Continuity of Care
Authors: Tresch Donald D. , Simpson William M. , Burton John R.
Published: April 2015

Approximately 17% of patients residing in an extended‐care facility—which provides close physician‐patient contact and strong affiliation with an acute‐care hospital, although does not have the capacity for intravenous therapy—required admission to an acute‐care hospital during a one‐year period. The most common medical problem necessitating transfer to the acute‐care hospital was an infectious process. Most infections were correctly diagnosed in the extended‐care facility, but due to the inability to administer intravenous therapy, transfer was thought mandatory. The acute‐care hospital stay was short, which is thought to reflect partially the close affiliation between the extended‐care facility and acute‐care hospital. Complications occurred while patients were in the acute‐care hospital with 30% demonstrating new pressure sores upon their return to the extended‐care facility. Repeated acute‐care hospital admissions were not uncommon, usually occurring within a short period after the patient's return to the extended‐care facility, and commonly related to the same medical disorder that caused the initial admission. Prognosis was poor in patients who required admission to the acute‐care hospital and mortality rate increased to approximately 50% in patients requiring multiple admissions. It is concluded that an extended‐care facility that provides a high level of physician‐patient contact and a close affiliation with an acute‐care hospital is advantageous in providing efficient and continual care for the elderly. Provisions for the administration of intravenous therapy might even increase the efficiency of such a facility. J Am Geriatr Soc 33:819, 1985
Inpatient Accidents in Hospitals
Authors: Udén Giggi
Published: April 2015

In patients admitted to the hospital in the city of Malmö altogether 499 accidents occurred in one year. More than half of the accidents occurred in patients in geriatric care. Seventy‐two percent of the patients were unobserved when the accident occurred. Thirty percent had fallen at least once in the last two months. There were 299 fractures—127 were hip fractures—contributing about one‐fourth of all hip fractures in the city. The mortality of the hospital accident group was twice as high as in age‐ and sex‐matched hospital controls and three times as high as in the population of Sweden. The accident patients more often than hospital controls had suffered from dizziness and confusion but were more mobile. More or less obvious environmental factors were involved in one‐third of the accidents. Hospital care may not protect the mentally and physically incapacitated elderly patients from all accidents unless special measures are taken, measures that may interfere with the personal integrity of the patients and with the ultimate goals of rehabilitation. J Am Geriatr Soc 33:833, 1985
OARS Methodology
Authors: George Linda K. , Fillenbaum Gerda G.
Published: April 2015

The Older Americans Resources and Services (OARS) methodology was designed to assess functional capacity in five dimensions (social resources, economic resources, mental health, physical health, and activities of daily living) and to measure use of and need for 24 types of generic services. The OARS questionnaire now has been used in more than 150 research and practice settings. Recent refinements in the OARS methodology include new information about validity and reliability, computerized summary ratings for the five dimensions of functional status, and eleven scales that measure specific aspects of functioning within the five dimensions. This paper describes the conceptual foundation, appropriate uses, psychometric properties, and recent refinements in the OARS methodology. Empirical data from a geriatric clinic population are used for purposes of illustration. The paper presents an assessment of the strengths and limitations of the OARS methodology based on more than a decade of experience. Particular attention is paid to the degree to which the measures of functional status can be related to health service use measures to inform geriatric research and practice.
The Role of Lumbar Puncture in the Evaluation of Dementia: The Durham Veterans Administration/Duke University Study
Authors: Becker Peter M. , Feussner John R. , Mulrow Cynthia D. , Williams Brett C. , Vokaty Kathryn A.
Published: April 2015

The use of lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis in the routine, initial evaluation of patients with dementia continues to be questioned. This is especially true in the investigation of infectious causes of dementia. To explore this question further, the authors performed a retrospective analysis of 672 hospitalized patients specifically evaluated for dementia. LP and CSF analysis were performed on 402 patients (60 per cent); routine bacteriologic, acid‐fast, and fungal cultures were also obtained for 333 of these patients. Most patients were white (64 per cent) and male (63 per cent), their mean age being 66 ± 11 years. Four patients were diagnosed as having meningitis—two with Cryptococcus neoformans, one with apparent Mycobacterium tuberculosis, and one with coagulase‐positive Staphylococcus aureus. These patients were characterized by a subacute change in mental status, fever or meningismus, and CSF pleocytosis with abnormal CSF chemistries. None of the patients were found to have newly diagnosed neurosyphilis. The authors conclude that LP and CSF analysis should not be part of the routine evaluation of patients with dementia and should be performed only in the presence of such indications as a subacute duration of dementia, fever, and signs of meningeal irritation. J Am Geriatr Soc 33:392, 1985
Adverse Drug Reactions in Long‐term Care Facility Residents
Authors: Budden Frances
Published: April 2015

The study of 72 long‐term care facility residents admitted to an acute geriatric ward was undertaken to determine the incidence of adverse drug reactions (ADRs) and to establish whether this was a higher incidence than previously reported for this age group and level of care. An ADR incidence of 26 per cent was identified according to the WHO definition and scored by a probability scoring scale. The patients in this study were elderly (mean age 80 years) with many diagnoses and many medications, well known precipitators of ADR in the elderly. The fact that there is a high incidence of ADRs in the long‐term care resident has been established, but the reasons for this phenomenon are still not clear. ADRs appear to contribute to the need to admit long‐term care facility residents to acute geriatric wards.
Integrated University Training Program in Geriatric Medicine Accredited and Evaluated by the Royal College of Physicians and Surgeons of Canada
Authors: Cape Ronald D. T. , MacDonell Jack A.
Published: April 2015

The Federated Council for Internal Medicine recommended in 1981 “increased emphasis on geriatric medicine in the medical school curriculum, the medical residency, and continuing medical education.”1 In the same year the first examination for a Certificate of Special Competence in Geriatric Medicine was held in Canada. This was the culmination of a process begun in 1974 to establish the subject as a subspecialty within Internal Medicine. The Royal College of Physicians and Surgeons of Canada set up a Specialty Committee which developed criteria for the accreditation of training programs. Candidates have to be eligible to sit for the certification examination in Internal Medicine before they can sit for the Certificate of Special Competence in Geriatric Medicine which is awarded only after passing both examinations. Thirty‐nine individuals sat for the examination in its first five years of whom 26 were successful. These now form a nucleus of well‐qualified internist‐geriatricians who are developing academic programs in geriatric medicine in Canadian Medical Schools.
Decision Analysis for Tuberculosis Preventive Treatment in Nursing Homes
Authors: Cooper James K.
Published: April 2015

There are differing opinions on whether or not to use isoniazid (INH) preventive treatment in older people with significantly reactive (“positive”) tuberculin skin tests and fibrotic changes on chest roentgenogram. To assist the clinician facing this decision, a Decision Analysis was completed. Using available data, it is seen that using INH will not have much impact on five‐year survivorship, but will reduce the number of tuberculosis disease cases, thus having an overall beneficial impact. Where tuberculosis incidence is higher, the benefit of INH preventive treatment is correspondingly higher. J Am Geriatr Soc 34:814–817, 1986
Acquired Factor VIII Deficiency in an Elderly Woman on Tamoxifen
Authors: Barlas A. H.
Published: April 2015

A case is presented and acquired factor VIII deficiency is discussed. The studied patient was elderly and had cancer of left breast, cancer of the head of the pancreas, history of blood transfusions, and was on tarnoxifencitrate therapy for breast cancer. Any one of the above factors could have been responsible for production of factor VIII deficiency.
Predictors of Institutionalization Among Caregivers of Patients With Alzheimer's Disease
Authors: Colerick Elizabeth J. , George Linda K.
Published: April 2015

The treatment aim of medical care for home‐based patients with Alzheimer's disease is to maximize the functioning level of the patient without jeopardizing quality of life for the caregiver. Most demented elderly live in the community with their families who, until coping becomes ineffective, usually prefer to keep their relatives out of institutions for as long as possible. In the present study, the question of why some families continue to shoulder the burden of care, often beyond healthful limits, while others relinquish care to professionals is examined longitudinally in a sample of 209 caregivers. Using logistic regression techniques, caregiver characteristics and caregiver well‐being, rather than patient characteristics, emerge as important predictors of placement decisions. Results suggest that practitioners, in evaluating the family's need for institutionalization, must move beyond duration of illness and current cognitive functioning to aspects of the caregiver support system. J Am Geriatr Soc 34:493–498, 1986
Temperature Lowering After Iced Water: Enhanced Effects in the Elderly
Authors: Sugarek Nancy J.
Published: April 2015

Oral temperature has long been used as a basis for clinical decisions. The ingestion of cold liquids such as iced water, which are frequently found at patients' bedsides or in clinic waiting areas, has been believed to potentially lower oral temperature readings. The degree and duration of this effect, however, has not been well established. This study examined the effect of iced water on oral temperature as measured with a standard electronic thermometer. Ninety‐two afebrile adults were stratified into three age groups. Their temperatures were measured every two minutes for ten minutes to establish a baseline. Subjects then drank 9 oz of iced water over two minutes and their temperatures were again taken every two minutes for the next half hour. The overall mean initial change was −2.4F (P < .001; range, +0.1 to −8.2°). Although no differences existed at baseline, temperature decreases and recovery time were strongly related to age. Mean decreases were −3.1F for persons 60 years or older, −2.4F for those between 40 and 59 years, and −1.6F for those less than 40 years of age (P = .0001). Median times for return to baseline temperature were 26, 18, and 14 minutes, respectively. On the basis of these findings it is recommended that oral temperature not be measured immediately after iced water ingestion. It is further recommended that oral temperature readings be delayed at least 15 minutes in people under the age of 40 years, 20 minutes in those who are 40 to 59 years, and 30 minutes in persons aged 60 and older. J Am Geriatr Soc 34:526–529, 1986
Low‐Dose Captopril in Mild to Moderate Geriatric Hypertension
Authors: Tuck M. L. , Katz L. A. , Kirkendall W. M. , Koeppe P. R. , Ruoff G. E. , Sapir D. G.
Published: April 2015

The safety and efficacy of Captopril in geriatric patients with mild to moderate hypertension was examined in an eight‐week multicenter study of 99 patients. Following a placebo period, patients were treated with Captopril 25 mg twice daily. Patients who were uncontrolled after two weeks of active therapy were randomized to either Captopril 25 mg plus hydrochlorothiazide 15 mg or Captopril 50 mg twice daily. The average decrease in blood pressure at study completion was ‐16.9/11.9 mmHg. At the conclusion of the trial, 75.8% of patients responded to therapy. Captopril was well tolerated and believed to be a good therapeutic alternative for treating hypertension in the elderly population.
Systemic Antibiotic Use in Nursing Homes: A Quality Assessment
Authors: Zimmer James G. , Bentley David W. , Valenti William M. , Watson Nancy M.
Published: April 2015

In this evaluation of the prevalence and quality of systemic antibiotic use in nursing homes, 42 skilled nursing facilities (SNFs) and their 11 attached intermediate care facilities (ICFs) were surveyed. A random sample of 2238 patients (51%) from the total of 4378 beds was selected and of these, 7.7% of the total (8.6% of the SNF and 4.5% of the ICF) patients were on systemic antibiotics on the day of the survey. The most common suspected sites of infection were urinary tract (58.4%), lower respiratory tract (19.1%), and skin or subcutaneous tissue (4.6%). Criteria for appropriateness of initiating systemic antibiotics, for adequacy of initial diagnostic workup, and for appropriate specific antibiotics were developed by the authors, with input from a group of medical directors of nursing homes, based on Centers for Disease Control and Federal Drug Administration guidelines. Evidence to start an antibiotic was judged adequate in 62.4% of cases. Workups were considered inadequate in a high proportion of cases. For example, urinalysis was ordered in only 23.8% and urine culture in 57.4% of suspected urinary tract infections; chest x‐ray was ordered in 24.2% and sputum culture in 3.0% of suspected lower respiratory infections. Recommendations are made as to minimum adequate workup for suspected infections and appropriate evidence to justify start of a systemic antibiotic, recognizing the limitations in diagnostic modalities in the nursing home setting and the special problems of their resident populations.
Agitated Behaviors in the Elderly: I. A Conceptual Review
Authors: Cohen‐Mansfield Jiska , Billig Nathan
Published: April 2015

Agitation is a significant problem for the elderly, their families, and their caretakers. Although much of the literature on agitation is pharmacologic in nature, several papers demonstrate demographic and environmental approaches to the problem. The literature review accentuates the gaps in both assessment and knowledge of the phenomenon. A conceptual framework and a rigorous methodology need to be developed for studying agitation. On these bases, research could explore the manifestations of agitation and the frequency of occurrence, predisposing factors for agitation, precipitating factors which trigger agitation, consequences of agitation for the elderly and for their caretakers, and the efficacy of alternative interventions. This paper proposes a definition of agitation and develops an initial conceptual framework in which to examine it.
Alzheimer's Disease in Down's Syndrome: A Review
Authors: Karlinsky Harry
Published: April 2015

Alzheimer's disease is a progressive dementing illness accompanied by characteristic neuropathologic changes. Although its etiology is unknown, its risk of occurrence increases with age and in relatives of affected individuals. An additional risk factor is the presence of Down's syndrome. Almost all individuals with Down's syndrome over the age of 40 have the characteristic neuropathologic changes of Alzheimer's disease at autopsy. Although clinical evidence for Alzheimer's disease in Down's syndrome is less consistent, the association between Alzheimer's disease and Down's syndrome may contribute to an understanding of Alzheimer's disease in the general population. This article summarizes the neuropathologic and clinical observations of Alzheimer's disease in Down's syndrome and reviews the hypotheses that attempt to account for this association.
Autopsy Proven Pulmonary Embolism Among the Institutionalized Elderly
Authors: Taubman Lowell B. , Silverstone Felix A.
Published: April 2015

The presentation of pulmonary embolism is variable in the elderly as in any age group. Common symptoms such as chest pain, dyspnea, and hemoptysis may be absent. Furthermore, precursors such as phlebitis, malignancy, and recent surgery often may be absent as well. Our intent was to examine the occurrence in a long‐term care institution of pulmonary embolism at autopsy and the extent of missed antemortem diagnosis of this condition, and to compare patients with and without pulmonary embolism by chart and autopsy review. The incidence of pulmonary embolism in our study of elderly patients during a six‐year period in a teaching nursing home was 12.8%. Although our series is small, consisting of 47 autopsies, our results are in accord with reports from other patient sites. Few autopsies are performed on nursing home patients and even fewer have been studied with regard to the occurrence and characteristics of pulmonary embolism in this population. The diagnosis remains difficult and uncertain, especially so in the elderly, because of the variability of presentation and association, the lesser pursuit of aggressive or invasive diagnostic methods, and the paucity of postmortem documentation.
Renal Effects of Nonsteroidal Antiinflammatory Drugs
Authors: Lamy Peter P.
Published: April 2015

America's population is aging, and there is a direct relationship between advancing age and sensitivity to adverse drug reactions (ADRs). The number of the old old, those 85 years and older, will increase by 114% by the year 2000, and by another 44% in the subsequent 20 years.1 The largest absolute and relative increases are seen and will continue to be seen for unmarried women older than 85 years (women are more sensitive to ADRs than are men). Importantly, the population 95 years of age and older has increased by about twice the rate of the aggregate population 85 years and older. Activity limitations among community‐living elderly rise precipitously with age, afflicting about 12% of those 65 to 74 years old but almost 46% of those 85 years and older.2 It has been estimated that approximately 4.6 million community‐living elderly are limited in activities of daily living (ADLs) or instrumental activities of daily living (IADLs, cognitive impairment),3 and that number may double, triple, or even quadruple in the next 50 years.
Surgical Repair of Remediable Postinfarction Cardiogenic Shock in the Elderly: Early and Long‐Term Results
Authors: Weintraub R. M. , Wei J. Y. , Thurer R. L.
Published: April 2015

The in‐hospital mortality associated with acute myocardial infarction rises markedly with advancing age. It is not established whether the elderly may benefit from early surgical repair of postinfarction cardiogenic shock due to ventricular septal defect (VSD), acute severe mitral regurgitation (MR), or left ventricular power failure. Eighteen consecutive patients between the ages of 66 and 79 (mean, 72 years) and in cardiogenic shock underwent surgical repair, most with counterpulsation support, within one week of developing VSD, MR, or left ventricular power failure. Of ten patients with VSD, five (50%) survived. Three of seven patients with MR (43%) and the only patient with power failure survived for an overall survival of 50%. The nine long‐term survivors were followed up for six months to five years (mean 31 months) by personal interviews with the patient or referring physician. There was one late death, due to congestive heart failure, ten months after the operation. Of the remaining eight patients, seven are categorized as New York Heart Association class 1, and one as class II. These patients have all been able to live and function independently after cardiac operation. The authors conclude that older patients with postinfarction cardiogenic shock may benefit from early operation and that advanced age does not preclude successful surgical outcome. Furthermore, operation may result in excellent long‐term quality of life. J. Am Geriatr Soc 34:389–392, 1986
Prevalence Survey of Infections and Their Predisposing Factors at a Hospital‐Based Nursing Home Care Unit
Authors: Franson Timothy R. , Duthie Edmund H. , Cooper James E. , Van Oudenhoven Gary , Hoffmann Raymond G.
Published: April 2015

A prevalence survey was performed at a Veterans Administration nursing home care unit to detect the frequency, demographics, features, and potential risk factors associated with infections, compare different methods for calculating infection rates, and compare prevalence data with routine physician reporting of infections during a one‐month period. In 176 evaluable residents, 22 nursing home‐acquired infections were detected, with rates of 12.5% by infections per residents at risk, and 4.6% by infections per 1000 resident‐days. Fifty percent of these infections (11 of 22) involved the urinary tract, seven of which were associated with indwelling catheters. Factors potentially associated with increased overall infection rates included immobility (P < .02), acute‐care hospitalization in the 28 days preceding the study (P < .01), and antibiotics given preceding the infection (P < .001). An indwelling urinary catheter (P < .01) potentially was associated with an increased urinary tract infection rate. During the concurrent period, routine physician reporting of infection detected four of the 22 infections (18%) that were identified by the survey. These findings suggest that physician reporting of infection underestimates infection risk as compared with conventional surveillance practices, and that hospital‐based care units may have infection problems more similar to acute‐care hospitals than to community nursing homes. Identification of potential risk factors is critical in planning preventive practices based on institution‐specific needs.
Prevalence and Prognostic Significance of Hypertension in the Elderly
Authors: Borhani Nemat O.
Published: April 2015

Understanding the problem of hypertension in the elderly calls not only for an understanding of the physiologic phenomenon involved, but of the statistics currently available pertaining to this widespread disorder. In the age group 60 to 69 years, more than 25% of the population screened by the Hypertension Detection and Follow‐Up Program (HDFP) had isolated systolic hypertension; ie, a systolic blood pressure greater than or equal to 140 mmHg with a diastolic blood pressure less than 90 mmHg. Setting the criterion for definition at a systolic blood pressure greater than or equal to 160 mmHg, the prevalence in this age group was almost 10%. Prevalence of diastolic hypertension, ie, diastolic blood pressure greater than or equal to 90 mmHg in this age group was more than 40%. Data from that same study show also that elevated systolic blood pressure in the face of a normal diastolic blood pressure was associated significantly with increased mortality. In the HDFP, stepped‐care treatment reduced the five‐year incidence of fatal and nonfatal stroke in these individuals by more than 50%. These results were achieved with minimum side effects. Reports of this kind surely will overcome the popular tendency to consider elevated blood pressure in the elderly as a natural phenomenon of aging and, hence, acceptable. There is nothing natural about hypertension in the elderly, nor should it be acceptable. Because it is important to control hypertension before it can cause end‐organ damage, physicians are urged not to postpone treatment of hypertension in the elderly, but to initiate it promptly, keeping in mind the whole physiologic and psychosocial state of the elderly patient with hypertension.
Nutrition, Cancer, and Aging: An Annotated Review
Authors: Balducci Lodovico , Wallace Clinton , Khansur Tawfiq , Vance Ralph B. , Thigpen J. Tate , Hardy Cheryl
Published: April 2015

The interrelationships of diet and carcinogenesis are discussed with the focus on aging. To establish whether the elderly are more susceptible to dietary carcinogens and whether dietary prevention of cancer is a reasonable goal for this population, the mechanisms of chemical carcinogenesis, the age‐related metabolic and physiologic changes, and the current cancer preventive dietary strategies are reviewed. Vulnerability to dietary carcinogens results from a combination of factors that may increase or decrease the occurrence of cancer in the elderly, and it is, therefore, a very individualized feature, unpredictable when based solely on a subject's age. Dietary prevention of cancer may be effective in advanced age, and the dietary guidelines of the National Academy of Sciences should be implemented in this population.
Cognitive Impairment
Authors: Fields Suzanne D. , MacKenzie C. Ronald , Charlson Mary E. , Sax Frederic L.
Published: April 2015

All patients admitted to three medical services at the New York Hospital during a one‐month period were screened with Folstein's Mini‐Mental State Examination. The prevalence of cognitive impairment was 19.8% (23 of 116). Cognitively “impaired” patients, ie, those with a Folstein score less than 24, were older, sicker, and less physiologically stable than the cognitively “intact.” The in‐hospital mortality (17 versus 5%) and morbidity (39 versus 18%) rates were higher for the cognitively “impaired” patients; these differences could be explained by the greater severity of illness, instability, and comorbidity found in these patients. Cognitively “impaired” patients were particularly susceptible to respiratory complications. Cognitively “impaired” patients had longer lengths of hospital stay, spent more time in hospital awaiting placement, and were more likely to be discharged to a nursing home or require home assistance than their cognitively “intact” counterparts. Three‐month mortality rates were also higher for the cognitively “impaired” patients (30 versus 15%). These findings suggest that cognitive impairment on admission may be regarded as a marker for patients with poorer prognoses.
Skills Training With Supporters of the Demented
Authors: Gendron C. E. , Poitras L. R. , Engels M. L. , Dastoor D. P. , Sirota S. E. , Barza S. L. , Davis J. C. , Levine N. B.
Published: April 2015

This study examined the effects of Supporter Endurance Training (SET) on family supporters of elderly demented patients. Single case methodology was used in evaluating the outcome of providing eight supporters with eight weekly training sessions in meditative relaxation and assertiveness. Four such supporters received no special training. A videotape dramatizing typical problem situations encountered with a demented family member was used to elicit information about supporters' coping styles. Post‐training and six‐month follow‐up evaluation indicated improvements among trained individuals on measures related to assertiveness, problem solving, and stress reduction. Trained subjects' estimates of the length of time they would be able to cope with problems involved in caring for their relatives also increased. Few such improvements occurred among untrained subjects. These results suggest the usefulness of brief structured skills training programs in helping supporters to improve their coping abilities.
Hyperthyroidism in the Elderly
Authors: Griffin Margaret A. , Solomon David H.
Published: April 2015

“I fear that our profession as a whole is not even now sufficiently alive to the presence in their clientele of many patients suffering from thyrotoxicosis, camouflaged as heart disease.”1 Hyperthyroidism in the elderly is a great masquerader. We will present a summary of a remarkable patient to serve as a background for an analysis of present knowledge about the diagnosis and treatment of this condition.
Risk Factors for Atherothrombotic Brain Infarction in Persons Over 62 Years of Age in a Long‐Term Health Care Facility
Authors: Aronow Wilbert S. , Starling Laurence , Etienne Fritzner , D'Alba Peter , Edwards Mildred , Lee Neung H. , Parungao Rosalina F. , Sales Francie F.
Published: April 2015

A history of systolic (≥ 160 mm Hg) or diastolic (≥90 mm Hg) hypertension, diabetes mellitus (fasting venous plasma glucose ≥140 mg/dl), a history of cigarette smoking, fasting serum total cholesterol ≥200 mg/dl and ≥250 mg/dl, and obesity (≥20% above ideal body weight) were examined as risk factors for atherothrombotic brain infarction (ABI) in 144 men, mean age 81 ± 8 years, and 391 women, mean age 82 ± 8 years, in a long‐term health care facility. ABI occurred in 33 of 144 men (23%) and in 68 of 391 women (17%), P not significant. A history of systolic or diastolic hypertension correlated with ABI in both men and women (P < 0.001). Diabetes mellitus correlated with ABI in both men and women (P < 0.001). A history of cigarette smoking correlated with ABI in men (P < 0.02) but not in women. Serum total cholesterol ≥200 mg/dl and ≥ 250 mg/dl did not significantly correlate with ABI in men or in women. Obesity did not significantly correlate with ABI in men or in women. Systolic or diastolic hypertension, diabetes mellitus, and cigarette smoking are risk factors for ABI in elderly men. Systolic or diastolic hypertension and diabetes mellitus are risk factors for ABI in elderly women.
A Quantitative Analysis of Palliative Care Decisions in Acute Nonlymphocytic Leukemia
Authors: Neuss Michael N. , Feussner John R. , DeLong Elizabeth R. , Cohen Harvey Jay
Published: April 2015

With the increasing incidence of cancer in elderly patients, decisions to adopt palliative care become particularly relevant to this patient population. In order to define characteristics of decisions to adopt palliative care, including those factors influencing whether a particular patient received palliation, the frequency of this therapeutic posture, and the duration of this treatment period, we performed a retrospective analytical survey of all patients with acute nonlymphocytic leukemia (ANLL) treated at Duke University Medical Center over the past ten years. Logistic regression analysis identified several potentially significant variables influencing the decision to adopt palliative care. Using a stepwise logistic model, the only independent variable associated with adoption of palliative therapy was initial treatment off a research protocol (P = 0.0001). Initial treatment off a research protocol was itself associated with older age (P = 0.0002), nonspontaneous onset of leukemia (P = 0.005), female sex (P = 0.003), and the absence of dependent children (P = 0.01) when examined by multivariate logistic regression. The palliative treatment interval was defined as the time between the discontinuation of aggressive treatment and the patient's death. Fifty‐one percent, 119 of 235 patients, received palliative care; of these, 47% were palliated from the time of diagnosis and 53% were palliated only after receiving remission induction therapy. The median duration for the palliative care period was 46 days (50 days for the initially palliated group, 24 days for the group receiving aggressive therapy). Overall survival was greater for the 119 patients who received palliative therapy (P = 0.03) than for the 116 who did not, though the difference was small. We observed: 1) decisions to adopt palliative care are based predominantly on factors defined at the onset of disease; 2) a majority of patients receive some palliative care; 3) palliation is not associated with decreased survival once disease has recurred.
Recruitment of Long‐Term Care Facilities for Research
Authors: Palumbo Francis B. , Magaziner Jay S. , Tenney James H. , Goren Leslye M. , Warren John W.
Published: April 2015

We report the successful recruitment of a stratified random sample of nursing homes in the state of Maryland into three research studies funded by the National Institute on Aging. These studies examine the prevalence of infections and urinary tract instrumentation and the incidence of antimicrobial use in nursing home residents. Following selection of a facility, the administrator was telephoned and a meeting at the home was requested. At this meeting, the project was explained in detail using a packet of promotional information which included a project summary, a listing of project staff and their qualifications, and letters of support from influential organizations. A total of 61 eligible facilities were contacted in order to achieve a group of 53 participating homes with approximately 5000 beds. One hundred percent cooperation was achieved from all strata except small (≤50 beds) proprietary comprehensive care facilities, and homes with both comprehensive and domiciliary beds. A direct, personal approach, backed by carefully prepared study information and the support of medical and nursing home organizations resulted in successful recruitment of 53 (87%) of 61 homes sampled.
The Headache of Temporal Arteritis
Authors: Solomon Seymour , Cappa Karen Guglielmo
Published: April 2015

Patients with temporal arteritis may be misdiagnosed because the headache does not affect the temples. The records of 24 patients with biopsy proven temporal arteritis were reviewed to determine the site and other qualities of headache. Past reports of the sites of headache in this disease were also reviewed.

The temporal area was the sole site of headache in only six of 24 patients; the temple was included in pain that affected the frontal, vertex, and occipital areas in another seven patients. Two patients had generalized headaches. The headache did not involve the temple in seven patients and two patients did not experience headaches.

Temporal arteritis should be considered in every elderly individual who begins to complain of headache, no matter what the site, quality, severity, or time pattern.
Rates of Paget's Disease of Bone Among Hospital Discharges, by Age and Sex
Authors: Polednak Anthony P.
Published: April 2015

Paget's disease of bone (PDB) is of particular public health interest in view of the increasing proportion of elderly persons in Western populations. Data were analyzed on 1,078 hospital discharges with PDB as the principal diagnosis among New York State residents from 1980 to 1983. Rates of PDB per 100,000 total hospitalizations and per 100,000 total population increased with age, and length of hospital stay increased with age in both sexes. These rates were not higher in males than in females except in older age groups. Population rates were similar in blacks and whites except for higher rates among blacks in the ≥80 years of age group, and average length of hospital stay was also significantly longer for blacks in this oldest age group. The magnitude of rates suggests a small impact of PDB on morbidity as assessed by hospitalizations.
Geriatrics An Updated Bibliography
Authors: Rosenthal Mark J.
Published: April 2015

This is the author's fourth revision of a geriatrics bibliography. Approximately one‐third of the previous references have been replaced by more current or more detailed articles. Because the literature pertinent to geriatrics has continued to grow ever more rapidly, it has been necessary to omit many informative articles from the bibliography. Preference is given to recent publications; almost all of the references date from the past four years. Some articles were selected to highlight current controversies or changes in viewpoint. An occasional unrefereed article is cited to amplify geriatric aspects of common diseases.

Most of the references deal specifically with an elderly patient population, though few use a multidisciplinary approach. Studies of the elderly are confounded by concomitants of aging frequent but not universal in our society: inactivity, obesity, malnutrition, and psychosocial trauma. The articles cited concern primarily medical ailments of the elderly but legal, ethical, and sociologic topics are also covered.

The references are divided into categories. The first (I) set deals with some possible causes of aging, the second (II) with physiologic decline accompanying aging, the third (III) with the atypical and nonspecific characteristics of illness among geriatric patients, the fourth (IV) with the elderly and society, and the fifth (V) with care options. The remainder of the references are cited by pertinent medical specialty. Within each category, references are divided by disease process. Articles are further subgrouped by aspects of those diseases such as evaluation or therapy.
BOOK REVIEWS
Authors: Karpf Ronald J.
Published: April 2015

Psychiatry Update. American Psychiatric Association. Annual Review, Vol. 4. Edited by Hales RE and Frances AJ, Washington, DC, American Psychiatric Press, Inc., 1985, 671 pages, Hardcover (with CME Suppl) $49.95, Softcover $34.95.
BOOK REVIEWS
Authors: Patterson Christopher
Published: April 2015

Geriatric Medicine Annual 1986. Edited by Ham RJ. Oradell, New Jersey, Medical Economics Books, 1986, 276 pages, $32.95.
Age‐Related Changes in Postprandial Plasma Glucose, Insulin, and Free Fatty Acid Concentrations in Nondiabetic Individuals
Authors: Fraze Elizabeth , Chiou Y‐A. Melody , Chen Y‐D. Ida , Reaven Gerald M.
Published: April 2015

Plasma glucose, insulin, and free fatty acid (FFA) concentrations were measured from 0800 to 1600 hours in 40 nondiabetic individuals, separated into younger (38 ± 1.4 years) and older (64 ± 1.5 years) age groups. Meals were served at 0800 (20% total daily calories) and 1200 h (40% of total daily calories), and blood drawn just before the 0800 hours meal and at hourly intervals thereafter until 1600 hours. Statistical evaluation of the results of these measurements indicated that day‐long plasma glucose and insulin levels were higher in the older individuals. In contrast, the day‐long FFA response was reduced in this age group. These data suggest that the ability of insulin to maintain normal plasma glucose levels deteriorates with age, whereas regulation of FFA levels does not.
Cervical Cancer Screening in Women Aged 65 and Over
Authors: Weintraub Nancy T. , Violi Elissa , Freedman Michael L.
Published: April 2015

Pap smear screening is an accepted method of detecting cervical dysplasia or malignancy, and use of this test has been shown to reduce the incidence of invasive squamous cervical cancer in young and middle aged women. Conflicting recommendations exist concerning the screening of women over the age of 65, and little information is available concerning the results of screening in this population. Elderly women are routinely omitted from screening, as it is generally believed that they usually refuse testing. This paper reports a study attempting to evaluate the feasibility of screening in women over the age of 64 attending a large urban outpatient geriatric clinic. It demonstrates that pap smear screening is acceptable to this population, particularly if performed by the usual primary care provider. It also confirms previous reports that women in this age group have had very little screening in the past, and that screening uncovers a large number of abnormalities. Of note is the high rate of false positive smears in this population. J Am Geriatr Soc 35: 870–875, 1987
Assessment of Depression in Geriatric Medical Outpatients: The Validity of Two Screening Measures
Authors: Norris Jack T. , Gallagher Dolores , Wilson Anne , Winograd Carol Hunter
Published: April 2015

The validity of two screening measures for depression was assessed in a geriatric medical outpatient population. Sixty‐eight patients completed both questionnaires; 31 also completed a clinical interview allowing for accurate diagnosis. Both screening measures were found to accurately identify those who were depressed. Clinical and research applications are discussed, including the complementary use of these screening measures with the physician's diagnosis.
Factors Associated with Serious Injury During Falls by Ambulatory Nursing Home Residents
Authors: Tinetti Mary E.
Published: April 2015

Recognizing the importance of identifying fallers at risk for injury, the author studied factors associated with injury during falls by ambulatory nursing home residents. Forty‐eight of 79 subjects (61%) fell during their first year of residence. Fourteen fallers suffered a serious injury. Among fallers, subjects with lower extremity weakness were more likely to be injured than were fallers without weakness (42 versus 22% injured). On the other hand, injured fallers needed less help than noninjured fallers (14% needed help with at least 2 activities of daily living versus 35%), and were less likely to be depressed than were noninjured fallers (7 versus 38%). Although frequently associated with falling, no injury occurred while rising from a chair. The contribution of environmental hazards was not well defined. The only acute factor distinguishing noninjurious from injurious falls was a recent previous fall (present in 30% of the former and 0% of the latter). The finding that injured fallers tend to be more independent, yet have greater lower extremity weakness, than noninjured fallers suggests that both components of injury, namely force of impact and protective responses of the faller, may contribute to likelihood of injury during a fall. This study suggests that if predictive characteristics of the injury‐prone fuller, or the fall, can be identified, preventive strategies could be targeted at the high risk group.
Sexuality and the Institutionalized Elderly
Authors: McCartney James R. , Izeman Henry , Rogers Donna , Cohen Norma
Published: April 2015

Sexuality is considered to be among the more disturbing sexual problems in skilled nursing facilities. Staff attitudes and beliefs often lead to discomfort in dealing with the continued sexual interests of patients. It is clear that if sexuality has been an important part of self‐image and of coping, then it remains important. Staff reaction to two cases is used to illustrate the need for programmatic interventions with staff, residents, and families.
Detection of Antigens in Alzheimer Cerebrospinal Fluid by Monoclonal Antibodies
Authors: Thal Leon J. , Davies Peter
Published: April 2015

Monoclonal antibodies raised against cerebrospinal fluid (CSF) and human ventral forebrain from patients with Alzheimer's disease were tested against CSF pools derived from patients with Alzheimer's disease and normal controls. Antibodies that appeared to distinguish the two pools were subsequently tested against 58 CSF samples from individual Alzheimer patients, normal controls, and individuals with other neurologic diseases. The mean CSF content of two antigens was decreased in patients with Alzheimer's disease compared with controls; the mean CSF content of one of these antigens was also decreased in patients with other neurologic diseases. Although group differences could be detected, the degree of overlap did not follow for the separation of individual patients within these three groups.
Unusual Outbreak of Influenza A in a Wyoming Nursing Home
Authors: Meiklejohn Gordon , Hall Hetty
Published: April 2015

An explosive outbreak of Influenza A (H3N2) occurred during early February 1985 among the 55 residents of a nursing home in Douglas, Wyoming. Thirty of the 55 (55%) had febrile respiratory illnesses. Thirty‐six (65%) had received influenza vaccine. The attack rate was 84% in unvaccinated and 39% in vaccinated persons. Vaccine efficacy was estimated to be 54%. There were eight cases of pneumonia in unvaccinated and four in vaccinated persons, three deaths in unvaccinated and one death in vaccinated persons. Complement fixation and hemagglutination inhibition tests on sera from 47 residents confirmed the diagnosis of Influenza A in the great majority of individuals, and furthermore showed very low levels of anti‐body for the Influenza A H1N1 and Influenza B components of the vaccine.