bluuebunny/crossref_metadata_2025 huggingface dataset:
Social and Psychologic Correlates of Problem Drinking in Old Age
Authors: MEYERS ALLAN R. , HINGSON RALPH , MUCATEL MARC , GOLDMAN ELI
Published: April 2015

A study of the drinking behavior of 928 noninstitutional residents of Boston, aged 60 or older, showed that 53 per cent were abstainers; 26 per cent had less than one drink per day; 16 per cent, one to two drinks; and 6 per cent, two or more drinks. Nine subjects (1 per cent) were self‐reported problem drinkers, and another 31 (3 per cent) reported that drinking had diminished the quality of their lives. Problem drinkers and those with alcohol‐related problems were likely to be young‐old native‐born men. They were less likely to be satisfied with their relationships with family members, spouses, and close friends. All problem drinkers had long‐term drinking problems. Most had sought treatment, but only one was being treated at the time of the study. The data suggest that current theories do not adequately explain late‐life problem drinking and that current initiatives do not adequately address the needs of the elderly population at large.
Care of Elderly Patients in a Special Hypertension Clinic
Authors: PEITZMAN STEVEN J. , BODISON WILHELMINA , ELLIS IDA
Published: April 2015

In a special hypertension clinic, 35 hypertensive elderly men (mean age, 72 years) and 29 hypertensive younger men (mean age, 45 years) were studied. In the clinic, nurse‐clinicians evaluated and treated the patients under physician supervision, and compared the findings in the two groups. The same success in blood pressure control was achieved in both groups. Syncope or serious dizziness was uncommon in either group. A slight rise in the serum creatinine level over time was observed in both the older and the younger patients, but was greater in the elderly (mean increment 0.27 mg/dl, elderly; 0.096 mg/dl, younger). Compliances with medication schedules (diuretics, or a diuretic and methyldopa) were equally good in the two groups. The rates of required clinic visits were the same, but the elderly had a better attendance record. It is concluded that the treatment of elderly hypertensive patients is feasible and may be carried out in a focused “hypertension clinic.” Including older persons in such programs can be expected to result in their protection from cardiovascular complications, as well as other indirect health benefits.
An Evaluation of Falls, Syncope, and Dizziness by Prolonged Ambulatory Cardiographic Monitoring in a Geriatric Institutional Setting
Authors: GORDON MICHAEL , HUANG MICHAEL , GRYFE CYRIL I.
Published: April 2015

Fifty‐nine patients living in a geriatric residential setting underwent prolonged ambulatory cardiographic monitoring with the Holter monitor (AHM) as part of an investigation of falls, dizziness, and syncope. In 16 instances, cardiac arrhythmias were a contributing factor; in 12, the diagnostic AHM recordings were associated with unrevealing standard electrocardiographic (ECG) tracings. In 12 patients who had fallen, cardiac arrhythmias played a contributing role, but in only two of these cases was the ECG diagnostic. The value of the AHM for use in managing elderly patients, whose cardiac complaints may be vague, and especially in managing those who have sustained falls, is emphasized.
Combination Therapy for Osteoporosis with Estrogen, Fluoride, and Calcium*
Authors: ALOIA JOHN F. , ZANZI ITALO , VASWANI ASHOK , ELLIS KENNETH , COHN STANTON H.
Published: April 2015

Nine women with postmenopausal spinal osteoporosis were treated with combination therapy consisting of estrogen, fluoride, and calcium. Their data were compared with those of a control group treated with fluoride and calcium without estrogen. Bone mass was measured about every six months by photon absorptiometry [bone mineral content/bone width (BMC/BW)] and total‐body neutron activation analysis [total‐body calcium (TB Ca)]. Time‐trend analysis revealed positive slopes for TB Ca (P = 0.002) and BMC/BW (P = N.S.) for the combination therapy group. The change in BMC/BW in the combination therapy group was significantly different from the response in the fluoride‐calcium group. These data suggest that combination therapy may be successful in increasing bone mass in postmenopausal osteoporosis. A clinical trial to establish efficacy and examine risk/benefit ratios should be performed.
Faculty Resources for Teaching Geriatric Medicine
Authors: COE RODNEY M. , MILLER DOUGLAS K. , PRENDERGAST JOHN M. , GROSSBERG GEORGE
Published: April 2015

Self‐administered questionnaires were sent to all faculty and staff members of the departments of internal medicine and psychiatry in a school of medicine. The questionnaires asked for information about personal characteristics, practice characteristics, and interest in teaching geriatrics. Included also were measures of knowledge about aging and attitudes toward the elderly. Responses were received from 25 per cent of the faculty. Results indicated that 40 per cent wanted no involvement in teaching geriatrics. Of the remainder, most preferred a consultant's role on a clinical service. Despite extensive experience with elderly patients, respondents showed modest scores on knowledge, but there was little stereotyping of elderly patients. Implications for establishing a training program in geriatrics are discussed.
Another Cause of Reversible Dementia: Sleep Deprivation due to Prostatism
Authors: KELLY JEREMIAH , FEIGENBAUM LAWRENCE Z.
Published: April 2015

A case history is presented of a patient with treatable dementia of unusual pathogenesis. Fear of urinary incontinence associated with nocturia and urgency caused the patient to deprive himself of sleep, resulting in slowed mentation and apathy that was diagnosed as chronic organic brain syndrome for approximately one year. When his benign prostatic hypertrophy was surgically corrected, the patient allowed himself normal sleep, and the “chronic brain syndrome” cleared completely.
The Geriatric Team in the Acute Care Hospital: An Educational and Consultation Modality
Authors: BLUMENFIELD SUSAN , MORRIS JANE , SHERMAN FREDRICK T.
Published: April 2015

Increasing numbers of older patients with acute, subacute, rehabilitative, and chronic problems are being cared for in acute care hospitals. Health care professionals working in the acute care hospital have not had the training necessary to deal with this particular population. This article discusses the conception and implementation of a multidisciplinary educational and consultation team on an acute care medical unit in an academic medical center.
Gentamicin Pharmacokinetics
Authors: BAUER LARRY A. , BLOUIN ROBERT A.
Published: April 2015

The effects of aging on gentamicin total‐body clearance, volume of distribution, and half‐life were examined in 173 febrile patients with gram‐negative infections. All had normal renal function, normal hematocrit levels, near‐ideal body weights, and were not receiving concurrent penicillin therapy. In the 51 patients who were 20–39 years old, the mean clearance of gentamicin was 1.29 ml/min/kg, the volume of distribution was 0.23 l/kg, and the half‐life was 2.2 hours. In the 59 patients 40–59 years old, these values were 1.35 ml/min/kg, 0.27 l/kg, and 2.1 hours; in the 63 patients 60–79 years old, they were 1.31 ml/min/kg, 0.26 l/kg, and 2.4 hours. No significant difference was observed for any of the measures among the three age groups (P > 0.05, analysis of variance). Linear regression revealed poor correlations between the individual measures and age. Since there is no change in gentamicin pharmacokinetics with aging, dosages do not need to be changed arbitrarily for older patients who have normal renal function.
Female Preponderance in Diuretic‐associated Hypokalemia
Authors: CLARK BEVERLY G. , WHEATLEY ROBERT , RAWLINGS JOHN L. , VESTAL ROBERT E.
Published: April 2015

A retrospective review of the medical records of 161 geriatric nursing‐home patients receiving diuretics alone or in combination with potassium supplements or potassium‐sparing diuretics revealed a 13.7 per cent overall prevalence of hypokalemia. The prevalences of hypokalemia in patients receiving diuretics alone, diuretics with potassium supplements, and potassium‐sparing diuretics with kaliuretic diuretics were similar. However, there was a significantly higher prevalence of hypokalemia in women (16.4 per cent) compared with men (3.0 per cent), P < 0.05. In patients taking non‐chloride salts of potassium, there was a significantly higher prevalence of hypokalemia than in those taking the chloride salt (31.6 per cent vs. 8 per cent, P < 0.025). Seven per cent of patients taking diuretics with potassium supplements and 11.5 per cent of patients taking potassium‐sparing diuretics had hyperkalemia. Thus, although many elderly women taking diuretics may have hypokalemia, routine potassium supplementation for all non‐digitalized geriatric patients receiving diuretics does not seem to be indicated.
Intentional Prescription Nonadherence (Noncompliance) by the Elderly
Authors: COOPER JAMES K. , LOVE DAVID W. , RAFFOUL PAUL R.
Published: April 2015

Prescription drugs are not always taken as directed. When there is a discrepancy between the use of a drug and the prescription directions, the drug‐taking behavior is considered “nonadherent.” To determine the extent of prescription nonadherence by old persons and the reasons for nonadherence, an in‐home survey was made of 111 elderly subjects who were taking prescription drugs. Drug‐taking behavior was compared with the behavior implied by the prescription instructions, and reasons for the differences were sought. Of the study sample, 43 per cent showed such differences in use of one or more prescription drugs. The chief type of discrepancy was underuse (90 per cent of nonadherence). No difference was observed in most of the psychosocial variables studied between those who took drugs as directed and those who did not. Hypertensive subjects did not differ from those without hypertension. A large proportion of nonadherence (73 per cent) was intentional. Intentional nonadherence was more likely to occur in subjects who used two or more pharmacies and two or more physicians. Traditional efforts aimed at reducing the incidence of forgetting to take medicines would not seem to be helpful in cases of intentional nonadherence.
Knowledge of and Compliance with Drug Regimens in the Elderly
Authors: GERMAN PEARL S. , KLEIN LAWRENCE E. , McPHEE STEPHEN J. , SMITH CRAIG R.
Published: April 2015

In an interview study of 545 patients recently discharged from The Johns Hopkins Hospital, data were collected on the patients' knowledge of their diseases, knowledge of drug purpose, and compliance with the prescribed drug regimen. The interrelationships of these variables were compared in patients under age 65 and patients aged 65 or older. Age‐related factors and trends were sufficiently important to warrant further investigation. Knowledge of and compliance with drug regimens may reflect doctor‐patient relationships. Understanding the patterns of drug use offers a potential for appropriate strategies in clinical practice.
The Thymus Gland and Reproduction: Do Thymic Peptides Influence the Reproductive Lifespan in Females?
Authors: REBAR ROBERT W.
Published: April 2015

Thymic hormones may play an important role in determining the reproductive lifespan in females. Thymic peptides can release gonadotropin‐releasing hormone (GnRH) from the hypothalamus and thus luteinizing hormone (LH) from the pituitary gland in vitro. Independent data are also accumulating to show that gonadotropins may be necessary to prevent atresia of primordial follicles in utero. It is possible that thymic peptides regulate the release of GnRH‐LH in utero in women and are important in determining the rate at which primordial follicles and oogonia are lost. Thus, thymic peptides may play a role in fixing the number of oocytes available for ovulation during the reproductive lifespan.
Arteriosclerosis, Infarcts, and Dementia
Authors: BIRKETT DAVID PETER , RASKIN ALLEN
Published: April 2015

A study was made of 343 elderly mental‐hospital patients whose mental disorder had begun late in life. Of the 31 brains examined at autopsy, 14 showed cerebral infarcts without senile brain disease and ten showed senile brain disease without infarcts. The amounts of arteriosclerosis in the two groups were compared. The microscopic evidence was not treated statistically, but the macroscopic evidence was subjected to Fisher's exact test and chi‐square for comparison of the amounts of arteriosclerosis noted at the base of the brain and the number of plaques on the named arteries within the brain. The results showed an overwhelming preponderance of arteriosclerosis in the infarct patients compared with the senile brain disease patients. It is concluded that in elderly patients with mental disorders, brain infarcts occur in close and causal relationship with cerebral arteriosclerosis. The bearing of this observation upon the concept of multi‐infarct dementia is discussed.
A Survey of Generic Drug Legislation and Geriatric Pharmacotherapy: Opinions of Those Who Generate the Literature
Authors: MORGAN JOHN P. , SCHWARTZ LEROY L. , SHERMAN FREDRICK T.
Published: April 2015

Eighty‐three authors who had published papers within the last five years on pharmacologic therapy in aged humans were surveyed by written questionnaire and their responses analyzed. The survey sought opinions on the scientific, clinical, and social context of legislation on drug product selection (generic legislation) and its relationship to geriatric pharmaco‐therapeutics. The majority of respondents: 1) were generally unaware of the content of the clinical or scientific opinion offered on the subject of drug product selection as part of the legislative process; 2) felt that potential cost savings for elderly people was a factor in advancing this legislation; 3) wrote prescriptions so that product substitution could occur despite their ambivalence about such substitutions and about the knowledge of pharmacist and physician concerning product substitution and drug equivalence for the elderly. Clinical pharmacologists and geriatricians, however, were less likely than other respondents to permit substitution. The implications of current opinions and practices regarding drug product selection for geriatric patients are discussed.
The Use of Reserpine for Elderly Hypertensive Patients
Authors: LUXENBERG JAY , FEIGENBAUM LAWRENCE Z.
Published: April 2015

Antihypertensives are among the most commonly prescribed drugs for the elderly. Several studies have discussed the benefits of stepped‐care drug therapy for hypertension in the elderly, and propranolol, methyldopa, and more recently, clonidine and prazosin have been recommended as step‐two antihypertensive drugs. Recent articles omit reserpine as an alternative. A case is made for the use of reserpine by comparing factors of special importance to most elderly: cost, side‐effects, frequency of dosage, number of tablets, and the effect of omitted doses.
ABSTRACTS*
Authors: IRVINE PATRICK
Published: April 2015

Osteomyelitis beneath pressure sores. Sugarman B, Hawes S, Musher DM, et al. Arch Intern Med 143: 683, 1983 (21 references)

Sometimes pressure sores fail to heal despite aggressive treatment. When that occurs, clinicians need to seek underlying contributing disorders. Sugarman et al. prospectively evaluated pressure sores that had not healed after two weeks of therapy. Osteomyelitis was associated with nine of 28 lesions, and “pressure‐related” bone changes were present in 14. The authors stress the use of radiographs and nuclear medicine scanning in the diagnosis of osteomyelitis; but they also caution that the diagnosis can be made with certainty only by histologic examination. When possible, antimicrobial therapy should be based on microbial culture of bone tissue and susceptibility testing of suspected organisms. Clearly, when pressure sores fail to heal as expected, osteomyelitis should be considered.
Oral Assessment of the Edentulous Elderly Patient
Authors: GORDON STEVEN R. , JAHNIGEN DENNIS W.
Published: April 2015

While the need for regular oral examinations increases in the aged, edentulous elderly persons generally see their dentists rarely, while most see their physicians relatively frequently. If these patients cannot be convinced to see a dentist, the physician should perform regular oral screening examinations. A technique is described for accomplishing this.
Hallucinations in Patients Admitted to a Geriatric Psychiatry Service
Authors: EASTWOOD M. R. , CORBIN S.
Published: April 2015

Although hallucinatory experiences may be relatively common among the elderly, isolated, and infirm, their frequency has been the subject of little research. Patient records of admissions to a 12‐bed geriatric psychiatry service over three and a half years were reviewed for documented presence of hallucinatory symptoms. Hallucinations were documented in 15 per cent of the cases. Although acute and chronic brain syndromes and schizophrenic disorders were disproportionately represented in the hallucinating sample, affective disorders were also represented. A significant number of persons in this sample were single and had been living alone prior to admission and were described by family members or others as having “independent” or “reclusive” personality styles. In the majority of cases there was no history of psychiatric illness, and the individuals were distressed by the hallucinatory experiences. Symptom management is discussed in the context of factors that appear to affect occurrences and types of hallucinations and the responses to hallucinations in elderly patients.
Aging and Infective Endocarditis
Authors: CANTRELL MIRA , YOSHIKAWA THOMAS T.
Published: April 2015

The clinical features, diagnosis, treatment, and prevention of infective endocarditis in the elderly are reviewed. In elderly persons with infective endocarditis, the clinical diagnosis is often difficult, complications are frequent, and mortality rate is high.
What Older People Do About Their Day‐to‐day Mental and Physical Health Symptoms
Authors: BRODY ELAINE M. , KLEBAN MORTON H. , MOLES ELIZABETH
Published: April 2015

In four detailed “yesterday” interviews, old people (n = 132) were studied to identify their day‐to‐day mental and physical symptoms. Previous reports have described the nature, frequency, and severity of the symptoms reported. This paper describes the actions taken by old people to alleviate discomfort from their symptoms. Some action was taken to treat four fifths of the complaints but virtually none of the symptoms were reported to health care professionals. Among the authors' findings are that about 20 per cent of the drug doses taken by the interviewees could not be identified and the remaining 80 per cent were divided equally between prescription drugs and over‐the‐counter medications. It is evident that there is a world of day‐to‐day health experiences and practices of which health care professionals are unaware. Sensitive questioning is needed to elicit information about that world from elderly patients, who in turn are often in considerable need of health education from professional sources.
Hospice: Lessons for Geriatricians
Authors: GREER DAVID S.
Published: April 2015

Hospice is a new system of medical care provision that has undergone remarkable growth and received widespread support in the United States in less than a decade. Its success is apparently related to an accurate reading of social trends and the ability to fill a widely perceived void in the medical profession. Geriatric medicine is developing in the same environment and has not yet established its social or professional role. A review of the hospice experience suggests directions for the development of geriatric medicine that could promote its growth as a socially useful and professionally desirable new approach to medical education and service.
Estimation of Surgical Risk in the Elderly: A Correlative Review
Authors: MOHR DAVID N.
Published: April 2015

Age continues to be a risk factor for overall mortality in elective and emergency surgical procedures. Postoperative pneumonias, life‐threatening cardiac complications, and malignancy‐related complications account for most deaths. Heart disease, dementia, and diabetes confer an additional surgical risk for elderly patients. Careful preoperative assessment, however, can categorize elderly patients into groups that are at no additional risk. Factors other than age should be considered in estimating surgical risk in the elderly.
Red Blood Cell Glucose‐6‐phosphate Dehydrogenase Activity in Aged Humans
Authors: RODGERS GRIFFIN P. , LICHTMAN HERBERT C. , SHEFF MICHAEL F.
Published: April 2015

The enzyme glucose‐6‐phosphate dehydrogenase (G6PD) was assayed in the circulating erythrocytes of 38 20‐ to 30‐year‐old subjects and 29 80‐ to 90‐year‐old subjects. The red blood cell G6PD activity of an aged‐unbiased erythrocyte population in the young group was found to be significantly higher than in the older group (5.46 ± 1.06) vs (4.31 ± 0.99) (P < 0.001), respectively (mean ± sd). No significant difference was observed between the mean enzyme values of the male and female subjects in the two age groups. Since the mature red blood cell is devoid of regenerative capabilities, one may propose an explanation for this observation that implicates either an alteration in G6PD synthesis in the erythrocyte precursor cells in aged hosts, and/or the presence of an inhibitory factor that has the effect of decreasing the assayed activity for this enzyme.
Geriatric Profile of Eleanor Roosevelt (1884–1962)
Authors: SHERMAN E. DAVID
Published: April 2015

During the 17 years following the death of her husband, President Franklin D. Roosevelt, Eleanor Roosevelt immersed herself in many activities on a national and international scale, activities that justly earned her the title of First Lady of the World. The period of these activities spans her 61st to 78th years of life, a time when most people are retired. Her activities in later life reflect the internal development and political experience acquired with her husband in her earlier years. Eleanor Roosevelt's broad concepts and her philosophy of living the various phases of life, including aging, and her views on health, retirement, and death remain timely and in consonance with the teachings of modern gerontology. The life of this extraordinary woman was marked by intense motivation, multiple interests, vitality, and a large capacity for work and play. These attributes are important factors in living a full and productive life.
Brief and Appendix for Amicus Curiae:
Authors: Lynn Joanne
Published: April 2015

In February 1984, the following “friend of the court” (amicus curiae) brief was submitted to the New Jersey Supreme Court by the American Geriatrics Society to assist in the Court's deliberation in the case known as In re Claire C. Conroy. The Board of Directors of the AGS had decided to undertake this endeaver because the reasoning adopted by the Appellate Division in this case would, if affirmed by the Supreme Court, greatly diminish the capacity of physicians to serve their patients, especially their older patients. The brief was prepared by AGS member Joanne Lynn, MD, and was critiqued, revised, and finally approved by all of the members of the Executive Committee of the Board of Directors. A New Jersey attorney, Mr. Charles Deubel, III, filed the brief and the necessary associated papers on behalf of the AGS and without charge. Expenditures by the AGS in this endeavor totalled less than £300. The Editors of the Journal and the Board of Directors of the AGS would welcome comments from the membership and other concerned persons concerning the content of the brief and the process of developing and submitting it.
Lean Body Mass is a Predictor of the Daily Requirement for Thyroid Hormone in Older Men and Women
Authors: CUNNINGHAM JOHN J. , BARZEL URIEL S.
Published: April 2015

Levothyroxine (T4) replacement need in adults with primary hypothyroidism has recently been reported to fall with age. Previous studies have demonstrated that the resting metabolic rate falls with age in euthyroid adults and that this fall is proportional to a reduction in lean body mass (LBM). Since LBM is correlated also with 24‐hour energy expenditure, this study examined the possibility that LBM might be an accurate predictor of T4 requirement. Seventy‐five hypothyroid adults receiving full replacement therapy, ranging in age from 24 to 88 years, were studied retrospectively. Lean body mass was found to be a better predictor of T4 requirement than age or weight for the entire group as well as for subgroups of men and women 51 years old and older. The age‐related reduction in LBM may be responsible for the reported decrease in the rate of fractional thyroxine degradation with age.
Dr. Marjory Warren and the Origin of British Geriatrics
Authors: Matthews Dale A.
Published: April 2015

The life and works of the pioneer British geriatrician, Marjory Warren, are worthy of closer examination. The transformation of a Public Assistance Institution into her unit at the West Middlesex Hospital in 1935 represented the first organized geriatric medicine service in the United Kingdom. She promoted multidisciplinary rehabilitation and holistic appreciation of elderly patients, and emphasized the economic, social, and moral problems associated with their care. She was particularly concerned with the rehabilitation of hemiplegics and amputees, preventive medicine, patient responsibility, and home nursing. She underscored the need for geriatrics to maintain a close link with general medicine and its training programs. Her innovative methods, influential writings, committee work, and personal force were instrumental in the evolution of modern British geriatrics and rehabilitation medicine.
Aggressive Chemotherapy for Diffuse Histiocytic Lymphoma in the Elderly: Increased Complications with Advancing Age
Authors: ARMITAGE JAMES O. , POTTER JANE F.
Published: April 2015

Twenty patients ≥70 years of age were included in a study of the treatment of diffuse histiocytic lymphoma utilizing cyclophosphamide, adriamycin, vincristine, and prednisone. These patients ranged in age from 70 to 94 years (median 75 years). There were also 55 younger patients (age range 33 to 69 years) in the treatment trial. There were no dose adjustments for age. The complete remission rate in the elderly patients (45 per cent) was not different from that in the younger patients (53 per cent). The overall survival in the elderly patients (median 13 months) was somewhat shorter than that in the younger patients (medians 22 months for patients 56–69 years of age and 41 months for patients 33–55 years of age), but not significantly different. Death during the first two treatment cycles from causes other than lymphoma occurred in 25 per cent of the patients ≥70 years of age versus 2 per cent of younger patients (P < 0.01). In addition, three other patients aged 79, 65, and 59 years died in the fourth or fifth cycles of treatment from causes other than lymphoma. Thus, 30 per cent of patients ≥70 years of age died during therapy from causes other than lymphoma, versus 5 per cent of younger patients (P < 0.01). Whether this altered ability to tolerate therapy in the older patients reflected decreased marrow function, altered drug metabolism, other effects of aging, or a combination of these factors is not clear. It might be appropriate to alter drug doses when treating elderly patients, and particular attention to supportive measures seems appropriate.
Low Triiodothyronine and Raised Reverse Triiodothyronine Levels in Patients Over Fifty Years of Age Who Have Type II Diabetes Mellitus: Influence of Metabolic Control, Not Age
Authors: KABADI UDAYA M. , PREMACHANDRA BHARTUR N.
Published: April 2015

Several studies have demonstrated that the uncontrolled diabetic state in both type I as well as type II diabetes mellitus is characterized by altered thyroid hormone metabolism, which results in the lowering of serum triiodothyronine (T3) levels and a reciprocal elevation of T3 (rT3) levels. Because the majority of type II diabetics are over 50 years of age and because numerous previous reports have implicated aging as a cause of low T3 and high rT3 levels, we studied 220 type II diabetics from 40–85 years of age to assess the influence of aging and metabolic control on thyroid hormone levels. Serum thyroxine (T4) free T4, T3 resin uptake, and thyroid‐stimulating hormone (TSH) measurements in diabetic patients were not significantly altered compared with 37 young normal control subjects, irrespective of age or the grade of metabolic control. Serum T3 levels declined and rT3 levels rose in the diabetic patients with worsening of the metabolic control. However, with comparable metabolic control, the levels were not significantly different from the younger patients. Therefore, low T3 and high rT3 levels observed in patients of any age who have type II diabetes mellitus may be exclusively caused by deranged metabolic control of their disease.
Acute Care Hospitals Providing Elderly and Long‐term Care Services: A Survey of the Massachusetts Experience
Authors: Campion Edward W. , Mahoney Ann , Bang Axel
Published: April 2015

To assess the involvement of hospitals in geriatric, community and long‐term care services, a survey was undertaken of the 104 acute care hospitals in Massachusetts. Results show that hospitals (N = 81) are adding geriatric expertise but as yet have taken on community services and long‐term care only to a small extent. Hospitals perceive major deficiencies in physician service to nursing homes (89 per cent) and in availability of inpatient geriatric units (94 per cent). Responding hospitals have targeted for development by 1985 geriatric inpatient units (17 per cent), respite care (16 per cent), and hospice care (16 per cent). The financial implications of the survey results are discussed with respect to prospective reimbursement and public health implications.
Phases of Change in the Patient with Alzheimer's Dementia: A Conceptual Dimension for Defining Health Care Management
Authors: COHEN DONNA , KENNEDY GARY , EISDORFER CARL
Published: April 2015

Since the progressive nature of Alzheimer's disease and related disorders of later life gradually imposes a series of significant limitations upon the patient, a successful clinical management program rests upon a conceptualization of changes in the patient. Postulating psychologic reactions helps professionals to understand and respond to the patient's needs and feelings at different stages of the disease. The phases discussed here provide the basis for defining treatment goals and management plans, selecting therapeutic strategies, identifying needed resources, and evolving innovative approaches to patient care.
Lack of Effect of Indomethacin on Gastric Emptying in Old Men
Authors: CHAUDHURI TAPAN K. , FINK SIDNEY
Published: April 2015

Indomethacin, widely prescribed in the elderly, has a potential for affecting concomitant absorption of other drugs by changing gastric emptying time. A study of basal and post‐indomethacin gastric emptying times (GET) in ten patients aged 69–86 (mean age 77) shows no significant change in GET after indomethacin administration. The data suggest that drugs whose potencies can be altered by gastric retention may be taken concomitantly with indomethacin.
Neurotransmitter Receptors and Aging
Authors: SEVERSON JAMES A.
Published: April 2015

The role of receptors in the central nervous system and effects of aging on the four neurotransmitter receptors most often studied in the context of aging—beta‐adrenergic, cholinergic, benzodiazepine, and dopamine—are discussed.
Ethical Concerns and Guidelines in Research in Geriatric Pharmacology and Therapeutics: Individualization, Not Codification
Authors: WEINTRAUB MICHAEL
Published: April 2015

Compared with people of other ages, the elderly are much more heterogeneous in terms of physical and mental status, and they are subject to more day‐to‐day variability. However, some see the institutionalized elderly as stereotypes, having little autonomy and being easily subjugated such that they will consent to take part in any sort of experiment. Thus, a counter‐productive paternalism may lead them to protect elderly patients by making such choices for them. The interests of the incompetent elderly must be scrupulously protected, but competent elderly potential subjects can appropriately be assumed to be responsible and should be accorded the dignity of making their own choices. The consent process should be individualized rather than codified for the elderly, as for potential subjects of other ages.
Mental Status Tests and the Capacity for Self‐care
Authors: WINOGRAD CAROL HUTNER
Published: April 2015

To test the hypothesis that self‐care capacity can be predicted by tests of mental functioning, the performances of patients in a long‐term care institution on a Self‐Care Scale were compared with their scores on the Short Portable Mental Status Questionnaire (SPMSQ) and a Mental Competence Scale. The Self‐Care Scale measures ability to perform activities of daily living; the SPMSQ assesses memory, orientation, and calculation; and the Mental Competence Scale measures ability to respond sensibly to interview questions and to judge the environment. Many people who had poor scores on the SPMSQ were able to perform activities of daily living in the nursing home setting, but none whose scores on the Mental Competence Scale were fair or poor were independent in activities of daily living. Despite the fact that both the Self‐Care Scale and the Mental Competence Scale are still in the developmental stages, the author concludes that the SPMSQ is not an adequate predictor of capacity for self‐care. Moreover, the ability to respond appropriately to an interview may be more relevant for daily functioning than are tests of mental status. The three methods of assessment used in this study measure distinct yet complementary components of functioning that need to be considered in evaluating a mentally impaired elderly person.
Effects of Aging on Cerebral Blood Flow in Dementia
Authors: TACHIBANA HISAO , MEYER JOHN S. , KITAGAWA YASUHISA , ROGERS ROBERT L. , OKAYASU HIROYUKI , MORTEL KARL F.
Published: April 2015

Regional cerebral blood flow values were measured utilizing the 133Xe inhalation method in patients with multi‐infarct dementia (MID) (n = 22, age 67.4 ± 9.8 years), in patients with senile dementia of Alzheimer type (SDAT) (n = 36, age 63.8 ± 8.0) and in age‐matched normal healthy volunteers (n = 50, age 67.5 ± 9.3). Mean hemispheric gray matter flow values were significantly reduced in MID (P < 0.01) and SDAT (P < 0.01) patients compared with age‐matched normal volunteers. In normal volunteers, mean flow values showed gradual declines with advancing age (r = −0.44, P < 0.005). In MID patients there were significant decreases in flow values with advancing age (r = −0.43, P < 0.05), but flow values were consistently lower than in age‐matched normals. Reductions of flow were most evident in the distribution of both middle cerebral arteries. Unlike MID patients, patients with SDAT had diffusely reduced flow values over all age ranges without correlation with advancing age. Reductions of mean flow values in both dementia groups were significantly correlated with severity of dementia (P < 0.05 for both groups). Cerebral blood flow reductions related to the aging process also contribute to decreased cerebral perfusion in patients with MID. This is not true in SDAT, where the disease process itself pre‐empts cerebral blood flow reductions attributable to aging.
Marathoners Over Sixty Years of Age: Results of a Survey
Authors: HOGAN DAVID B. , CAPE RONALD D.
Published: April 2015

A survey of 32 marathon runners over the age of 60 years was undertaken. The group was predominantly male, well educated, and health conscious. While the injury rate was high, it was comparable to the expected rate in younger runners. Six of the 32 claimed to have an addiction to running.
Cognitive Performance and Functional Competence in Coexisting Dementia and Depression
Authors: BREEN ALAN R. , LARSON ERIC B. , REIFLER BURTON V. , VITALIANO PETER P. , LAWRENCE GEORGE L.
Published: April 2015

Assessment was made of the impact of depression on the intelligence, memory, and functional competence of elderly community residents (aged 57–88 years) with senile dementia of the Alzheimer's type. Outpatients with either dementia (n = 21) or dementia coexisting with depression (n = 14) were given the Wechsler Adult Intelligence Scale (WAIS), Wechsler Memory Scale (WMS), and Dementia Rating Scale (DRS). No significant group differences were found for verbal IQ, performance IQ, or WMS memory quotient. Patients with coexisting dementia and depression earned significantly lower full scale IQ scores than patients with only dementia. Analysis of WAIS and WMS subtest scores and profiles revealed no difference between the two groups. Significant associations were found among the various cognitive measures and functional competence in both groups, but the patterns of these relationships differed. Intellectual measures accounted for the greatest proportion of functional competence variance in the patients with dementia, whereas memory measures accounted for the greatest proportion of variance in the patients with coexisting dementia and depression.
Use of a Structured Functional Assessment Format in a Geriatric Consultative Service
Authors: Katz Paul R. , Dube David H. , Calkins Evan
Published: April 2015

Interdisciplinary team assessment may not be feasible in the consultative setting because of scarce institutional resources. We explored the extent to which a physician‐administered multifaceted assessment could meet the needs of a geriatric consultative service and also provide for the comprehensive functional assessment of elderly patients. Fifty‐one consecutive patients, mean age 78, were evaluated. Domains measured included physical and mental health, socioeconomic resources, and activities of daily living. Despite a majority of consult requests for transfer of seemingly stable patients, unrecognized remediable problems were identified in most cases. Compliance with the consultant's recommendations was consistently poor, averaging less than 33% for all of the domains assessed. Nine of the study patients subsequently were transferred to the care of an interdisciplinary team on the geriatric assessment unit. Numbers and types of problems identified by the geriatric consultant were similar to those identified and managed by the interdisciplinary team. Geriatric consultation using a structured assessment format allows for the comprehensive and efficient disclosure of pertinent management issues. Improved compliance with consultant recommendations may be effected by better education of care providers to the special needs of the geriatric population.
Book Reviews
Authors: Klotz Arthur P.
Published: April 2015

Gastrointestinal Tract Disorders in the Elderly. Medicine in Old Age Series. Edited by Hellemans J and Vantrappen G. New York, Churchill Livingstone, 1984. 271 pages. Hardcover, $37.00
Femoral Neck Fractures in the Geriatric Population
Authors: Zindrick Michael R. , Daley Robert J. , Hollyfield Rebecca L. , Jobski Richard , Kinzler Gordon M. , Schwartz Charles M. , Wood Walter S.
Published: April 2015

The use of a primary prosthetic replacement such as an Austin‐Moore hemi‐arthroplasty in patients sustaining fractures of the femoral neck has been associated with increased post‐operative medical morbidity and mortality. A retrospective review was performed using the medical records of patients greater than 59 years of age who sustained femoral neck fractures and were treated with either internal fixation or primary hemi‐arthroplastic replacement at Loyola University Medical Center between 1969 and 1979. Peri‐operative data were reviewed and evaluated using computer‐aided statistical analysis. Comparing the two forms of surgical treatment, statistically significant factors associated with primary hemi‐arthroplastic replacement included: pre‐injury nursing home residence, pre‐injury ambulation requiring assistance, age greater than 79 years, slight elevation in serum creatinine values, abnormal electrocardiograms in patients over 77 years of age, time from injury to surgery of four or more days, and the use of spinal anesthesia (P < 0.05). Factors associated with internal fixation were: patient age of 79 years or less, independent ambulation, non‐nursing home residence, normal lab values, normal EKGs, less than four days from injury to surgery, and the use of general anesthesia. Within the limits imposed by a retrospective review in this specific patient population, there appears to be a tendency for older, less healthy patients to have been treated with primary hemi‐arthroplasty. Possibly the previously reported increased post‐operative medical morbidity and mortality associated with this procedure, as compared with internal fixation, may be a result of biased patient selection, and not a fault of the procedure. J Am Geriatr Soc 33:104, 1985
Treatment of Diabetic Perforating Ulcers (Mal Perforant) with Local Dimethylsulfoxide
Authors: Lishner Michael , Lang Ruth , Kedar Igal , Ravid Mordchai
Published: April 2015

Perforating foot ulcers constitute a major problem in diabetics with peripheral neuropathy for which no specific therapy is available. Twenty patients with chronic, resistant mal perforant were treated by local application of dimethylsulfoxide (DMSO) solution. Complete healing of the ulcers was achieved in 14 patients following 4–15 weeks of daily treatment. Partial resolution was observed in another four patients, and in the remaining two there was no effect. A control group, equal in number, was treated conventionally. Complete healing of the ulcers took place in only two patients. The therapeutic effect of DMSO most probably results from an increase in tissue oxygen saturation via a combined mechanism of local vasodilatation, decreased thrombocyte aggregation, and increased oxygen diffusion. Local DMSO is effective, simple, devoid of systemic side effects, and inexpensive. It should be employed for diabetic foot ulcers prior to the consideration of surgical measures. J Am Geriatr Soc 33:41, 1985
Assessment of Iron Stores in Anemic Geriatric Patients
Authors: Patterson Christopher , Turpie Irene D. , Benger Ann M.
Published: April 2015

Of patients referred to a geriatric service, 66 were identified who were clearly anemic (hemoglobin less than 12 g in men, less than 11 g in women) but whose cause of anemia was not readily identifiable by noninvasive measures. The difficulty in distinguishing iron deficiency from chronic disease as a cause of anemia by noninvasive means (serum iron, total iron binding capacity, transferrin saturation ratio, and serum ferritin), is highlighted by the poor power of these investigations when compared with bone marrow iron stores. A transferrin saturation ratio of less than 11% and a serum ferritin of less than 45 pg/L serve better than currently accepted values to identify iron deficiency in this population.
Consumer Products and Hospitalized Burn Injuries Among Elderly Massachusetts Residents
Authors: Rossignol Annette MacKay , Locke John A. , Boyle Catherine M. , Burke John F.
Published: April 2015

This study is based on data for Massachusetts residents who were burned between July 1, 1978 and June 30, 1979 and who were treated as hospital inpatients in any of the 240 hospitals participating in the New England Regional Burn Program. Demographic information and information regarding the nature of the burn injury and consumer products involved were obtained by review of the medical record for each case. One hundred seven (9%) of the 1237 burn victims identified were aged 65 years or older, yielding a burn incidence rate equal to 15.5 burns per 100,000 person‐years compared with a rate of 23.8 burns per 100,000 person‐years for younger Massachusetts residents. The burn mortality rate for the elderly who survived long enough to be hospitalized was 2.6 deaths per 100,000 person‐years compared with a rate of 0.4 deaths per 100,000 person‐years for younger individuals. For survivors, the average length of hospital stay for elderly victims was 28.6 days compared with 12.0 days for younger individuals. Clothing ignition, stoves and ovens, smoking materials, and bathroom showers and tubs contributed significantly to the causes of burning among the elderly. In addition, evidence was found suggesting that elderly patients receive medical care relatively later after injury, thus considerably complicating their illness.
Comparison of Hospitalization Between Nursing Home and Community Residents
Authors: Gabow Patricia A. , Hutt David M. , Baker Sandra , Craig Steven R. , Gordon John B. , Lezotte Dennis C.
Published: April 2015

The authors prospectively identified 96 consecutive nursing home residents (NHR) admitted to the medical wards of their affiliated hospitals to determine the outcome of hospitalization for these patients in comparison with 88 admissions in a similarly aged community residents (CR) population. Nursing home and community resident groups were similar in age, sex, marital status, and distribution among the four study hospitals. Dementia was a more common preexisting diagnosis in NHR than in CR. Reasons for admission differed between the two groups. Although NHR experienced a longer hospitalization than CR, frequency and duration of intensive care unit admissions were similar. Fatal outcome occurred more commonly in NHR compared with CR (27 v11%, P< .001). Predictors of mortality were examined. Nursing home residents also experienced a higher mortality than CR within the six months after hospitalization (35 v20%, P< .005). J Am Geriatr Soc 33:524, 1985
Prevalence and Significance of Cardiovascular Disease and Hypertension in Elderly Patients With Dementia and Depression
Authors: Tresch Donald D. , Folstein Marshal F. , Rabins Peter V. , Hazzard William R.
Published: April 2015

The prevalence and significance of clinical heart disease and hypertension were compared in three groups of elderly patients. One group was diagnosed as dementia of an Alzheimer's type (AD), another as multiinfarct dementia (MID), and the third as major depression. Clinical heart disease and hypertension were uncommon in the AD group with the prevalence being lower than that reported in most epidemiologic studies. Four percent of the AD patients had a history of myocardial infarction, 5% angina, 1% arrhythmias, and 3% heart failure. Electrocardiographic changes of an old myocardial infarction were present in 9%, atrial fibrillation in 1%, and left ventricular hypertrophy in 3%. A history of hypertension was present in 24% of the AD patients. In comparison, a history of myocardial infarction, angina, and heart failure was five times greater, and electrocardiographic abnormalities were twice as prevalent in the MID group. A history of hypertension was three times more common and actual blood pressure readings were higher. In the depression group heart disease was not uncommon and the prevalence, in general, was comparable with the MID group. However, a history of increased blood pressure and actual increased blood pressure readings were statistically less than in the MID group. (J Am Geriatr Soc 33:530, 1985)
Unproved Modality in the Treatment of Alzheimer‐Type Dementia
Authors: Cardelli Marcia B. , Russell Mary , Bagne Curtis A. , Pomara Nunzio
Published: April 2015

Despite a dramatic increase in the understanding of the neuropathologic and neurochemical alterations accompanying Alzheimer's disease, by far the largest cause of progressive and incapacitating cognitive dysfunction in the elderly, physicians have as yet no pharmacologic agent that can be prescribed safely either to arrest or reverse this decline. This lack of effective therapeutic agents is contributing to the use by an increasing number of health professionals, including physicians and concerned families, of unproved, costly, and potentially dangerous modalities, such as chelation therapy. The purpose of this paper is to describe some individuals with Alzheimer‐type dementia who have undergone chelation therapy. J Am Geriatr Soc 33:548, 1985