bluuebunny/crossref_metadata_2025 huggingface dataset:
The Psychiatric Symptoms of Alzheimer's Disease
Authors: Merriam Arnold E. , Aronson Miriam K. , Gaston Patricia , Wey Su‐Ling , Katz Ira
Published: April 2015

The authors used a semistructured interview administered to primary family caregivers to assess the prevalence and nature of psychiatric pathology in 175 well‐diagnosed community‐residing Alzheimer's disease patients. Symptoms that are indicative of depression in the cognitively intact were virtually ubiquitous in this demented population. A variety of psychotic features were also regularly reported. The implications of these findings for the recognition and treatment of reversible psychiatric impairment are discussed.
Unrecognized Cognitive Impairment in Cardiac Rehabilitation Patients
Authors: Barclay Laurie L. , Weiss Ellen M. , Mattis Steven , Bond Oliver , Blass John P.
Published: April 2015

To determine the prevalence of unrecognized brain dysfunction accompanying chronic severe cardiac disease, we examined 20 clinically stable consecutive admissions to a cardiac rehabilitation service who were free of known stroke or dementia. Age range was 47 to 85 years (mean ± SEM, 72.5 ± 2.1 years), the male: female ratio was 10:10. Multiple cognitive deficits including significant memory impairment and disorientation were present in eight patients (40%), and seven of these eight patients were unable to administer their own medications reliably. An additional six patients (30%) showed milder impairments. One patient was found to be normal after neurological examination, four showed evidence of a single brain lesion, and 15 of 20 (75%) had multiple neurological abnormalities suggesting multifocal brain disease. The mechanism of cognitive deficits in cardiac patients is unclear, and it may be related to multiple infarcts, or acute or chronic hypoxic damage secondary to arrhythmias, cardiac failure, or small vessel disease of the brain. The term “circulatory dementia” is proposed to describe patients with vascular disease and non‐Alzheimer type dementia. Patients with cardiac disease should undergo cognitive screening, as early identification of patients at risk of progressive intellectual loss may allow early use of preventive therapy.
Reduction of Urinary Incontinence in Nursing Homes: Does It Reduce or Increase Costs?
Authors: Schnelle John F. , Sowell V. A. , Hu T. W. , Traughber B.
Published: April 2015

Labor and supply costs associated with the care of urinary incontinent patients in three nursing homes were measured. First, normal nursing home changing patterns and their associated costs were measured. Second, the costs were documented when patients were checked by research staff and changed on an hourly basis as needed. Nursing home staff changed patients significantly less frequently than patient voiding as detected by the hourly checking system. Thus, cost of incontinence during the hourly checking condition ($3.35) per 12‐hour patient‐day was significantly higher than the cost normally incurred in nursing homes ($1.52) per 12‐hour patient‐day. The cost of an incontinence rehabilitation program, which significantly reduced incontinence episodes, was contrasted to the cost of incontinence as measured under both of the previous conditions. The rehabilitation program produced significant labor and supply savings only when compared with the hourly checking and changing system. Maintaining patients in a more continent condition costs significantly more than the direct incontinence cost normally incurred by the nursing home. Quality of life and other second‐order benefits must be considered if continence rehabilitation is to be judged cost‐effective.
Erectile Failure in the Aged: Evaluation and Treatment
Authors: Mulligan Thomas , Katz P. Gary
Published: April 2015

With aging, there are changes in both libido and erectile function. Although the majority of aged men remain interested in sex, less than 15% report continued sexual intercourse. The cause of this “libido‐potency gap” is due primarily to erectile failure.

Penile erection is dependent upon a complex interaction of the autonomic nervous system, cardiovascular system, and local neurotransmitters such as acetylcholine and vasoactive intestinal polypeptide. Sexual stimulation causes augmented blood flow into the corpora cavernosa, and restricted outflow, resulting in penile rigidity. With aging, there is a decline in gonadal steroids, nerve conduction velocity, and vascular compliance, any of which could interfere with normal erections. When disease is superimposed on the normal changes of aging, erectile function is further impaired.

Evaluation of an elderly male with impotence may consist of a detailed drug history and trial of alternate therapy, as in the case of adverse drug reactions. More often, evaluation entails hormonal assays, penile vascular assessment, neurologic assessment, and an evaluation of nocturnal erectile function. Based on the results of these assessments, appropriate treatment alternatives can be chosen. With the availability of multiple treatment options, patients and physicians can now choose from a range of noninvasive or invasive alternatives depending upon the etiology, associated disorders, and preference of the patient.
Recovery of Function After Hip Fracture The Role of Social Supports
Authors: Cummings Steven R. , Phillips Susan L. , Wheat Mary E. , Black Dennis , Goosby Eric , Wlodarczyk Dan , Trafton Peter , Jergesen Harry , Winograd Carol Hutner , Hulley Stephen B.
Published: April 2015

Previous studies have found that social support may reduce mortality after myocardial infarction and reduce overall mortality among the elderly. To determine whether social support also influences the recovery of function among patients who have had hip fractures and to describe other potential predictors of recovery after hip fractures, 111 patients with hip fractures were interviewed and examined before discharge from the hospital. The functional status of surviving patients was assessed again 6 months later. Patients who had a greater number of social supports had more complete recovery of their prefracture level of function (r = .21; P = .04). This association was strongest for patients over 60 years old (r = .31; P = .006); among these patients, this association remained statistically significant after adjustment for other significant (P < .05) predictors of recovery: arm strength, mental status, and serum albumin. Additional studies should be done to test whether interventions to increase social supports can improve the recovery of function among elderly patients with hip fractures and other illnesses. In the meantime, health professionals should counsel elderly patients about the potential rehabilitative and preventive benefits of social supports.
Occurrence and Predictors of Pressure Sores in the National Health and Nutrition Examination Survey Follow‐up
Authors: Guralnik Jack M. , Harris Tamara B. , White Lon R. , Cornoni‐Huntley Joan C.
Published: April 2015

The occurrence of pressure sores during a follow‐up period of approximately 10 years is documented for a US nationwide cohort aged 55 to 75 years at baseline. Using data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow‐up Study, those who developed pressure sores were identified through death certificates, hospital discharge summaries and self‐report or proxy‐report. During the follow‐up period, pressure sores were identified in 113 of the 5,193 respondents (2.2%) for whom follow‐up information was available. Incidence over the follow‐up period was 1.7% for those aged 55 to 69 at baseline and rose to 3.3% for those 70 to 75 years old. Risk factors for pressure sore development were evaluated using data collected in NHANES I at baseline. Those with identified pressure sores were compared with the remainder of their cohort and also with a control group matched on age and length of longest hospitalization or nursing home admission. Significantly increased risk for pressure sore development was found for those who at baseline were current smokers, reported being relatively inactive, had poor self‐assessed health status and who were found on physician's exam to have dry or scaling skin. Neurologic abnormality on the physician's exam and anemia at baseline were also associated with increased risk of pressure sores, although these associations were of borderline statistical significance.
Pap Smear Screening in Women 65 and Older
Authors: Wheat Mary E. , Mandelblatt Jeanne S. , Kunitz Gretchen
Published: April 2015

Pap smear screening in women 65 years of age and older is controversial. To assess the need to offer screening in this group, we examined Pap results of women 65 and older whose charts were reviewed as part of a cancer screening study in two San Francisco hospitals. Two hundred thirty women (41%) were 65 years of age or older (mean age, 73). Compared with younger women, they were less likely to have had a Pap smear during the past 3 years (61% versus 72%), less likely to have seen a gynecologist (24% versus 34%), and were more likely to have refused Pap screening (11% versus 5%).

Of the 140 women who had Paps, five showed atypia (class 11). None exhibited dysplasia or carcinoma in situ. Those with atypia were all nonwhite. One had had a hysterectomy; two had a history of previously abnormal Paps. Overall, women with a history of abnormal Paps were far more likely to be screened (91% versus 58%). Those who had had a hysterectomy were significantly less likely to be screened (51% versus 68%).

These results showed a low rate of cervical dysplasia/ carcinoma in older, low‐income women. Although our sample was small, the low rate of abnormals may reflect the relatively high rate of prior screening in this population. Because older women are not likely to see gynecologists, primary care physicians should continue Pap screening in older women (including those with a history of hysterectomy) until a history of repeated, technically adequate, normal Pap smears is documented.
Acute Renal Failure in the Elderly Treated by One‐Time Peritoneal Dialysis
Authors: Sonnenblick M. , Slotki I. N. , Friedlander Y. , Kramer M. R.
Published: April 2015

To determine the factors affecting outcome of acute renal failure (ARF) in the elderly, we retrospectively studied 44 patients over the age of 65 who had undergone acute peritoneal dialysis. Thirteen patients (29%) survived 2 months or longer after dialysis treatment (“survivors”). Thirty‐one patients (71%) died within this period (“nonsurvivors”). The main factor distinguishing survivors was the frequency of sepsis (none of 13 survivors vs 17 of 31 nonsurvivors). Preexisting malignancy and total number of acute insults to renal function were signficantly less frequent, and immediate clinical and biochemical outcome of dialysis significantly better in survivors. The overall complication rate of dialysis was high (31 of 44 patients), but was significantly lower in survivors. Acute peritoneal dialysis is a useful procedure in the management of ARF in the elderly. However, we suggest that elderly patients in whom sepsis is a contributory factor to the development of ARF do not benefit from peritoneal dialysis therapy.
Antibody Response of an Elderly Population to a Supplemental Dose of Influenza B Vaccine
Authors: Peters Nancy L. , Meiklejohn Gordon , Jahnigen Dennis W.
Published: April 2015

Recent reports have suggested that the antibody response of elderly persons to standard doses of influenza vaccine is depressed. We examined the effect of an additional threefold dose of influenza B vaccine on the antibody response in elderly, ambulatory veterans.

One hundred thirty‐one male subjects aged 70 years and older were randomized to receive one of three influenza vaccine regimens: Group I received standard trivalent influenza vaccine containing 15 micrograms of B/USSR/100/83 in one arm and placebo in the other; Group II received standard trivalent vaccine in one arm and a supplemental dose of 45 micrograms of B/USSR in the other; Group III received the same dose as group II combined in one arm with a placebo in the other.

Antibody levels were measured at baseline, 1 month, and 5 months.

Nearly 80% of the participants achieved levels of antibody to B/USSR considered protective; seroconversion rates varied from 40% to 61%. No significant differences in antibody response to B/USSR occurred among the vaccine groups, and there were more side effects at higher doses. The higher dose groups did, however, achieve greater antibody levels to the drifted influenza B virus which circulated during the year of the study. Response to the influenza A components of the vaccine, however, may have been blunted in Group III which received a large dose of A and B antigens all at one site.
Validity of a Brazilian Version of the Older Americans Resources and Services (OARS) Mental Health Screening Questionnaire
Authors: Blay Sergio Luis , Ramos Luiz Roberto , de Mari Jair Jesus
Published: April 2015

A validity study of the Brazilian version of the 15‐item Short Psychiatric Evaluation Schedule (SPES), included in the mental health assessment of Older Americans Resources and Services (OARS), designed to detect psychiatric disorders in the elderly, against the “caseness” criterion suggested by Cooper and Schwarz was carried out with a community sample, as part of a survey to study health and living conditions of the elderly in a large urban center of a developing country, Sao Paulo, Brazil. The screening questionnaire was completed by 292 subjects, and 91 were selected for the psychiatric interview. The validity coefficients were as follows: sensitivity 61%, specificity 89%, positive predictive value 66%, negative predictive value 87% and misclassification rate 18%. A discriminant analysis using a stepwise procedure was then applied to select the best item discriminators of the screening questionnaire. The best set of discrimination comprised six items leading to the following validity coefficients: sensitivity 82%, specificity 77%, positive predictive value 58%, negative predicitive value 92% and misclassification rate 21%. The possible factors related to false positive and false negative responses on the screening are discussed.
Behavioral Training for Urinary Incontinence in Elderly Ambulatory Patients
Authors: Burton John R. , Pearce K. Lynette , Burgio Kathryn L. , Engel Bernard T. , Whitehead William E.
Published: April 2015

Research questions addressed by this study were: 1) Is the treatment of chronic urinary incontinence (UI) in elderly, nondemented ambulatory patients using bladder‐sphincter biofeedback as effective when performed by an internist/geriatrician and a nurse practitioner as that reported by behavioral scientists?; and 2) how does bladder‐sphincter biofeedback compare to a program of behavioral training that does not utilize biofeedback? Twenty‐seven patients with ill were assigned based on the number of baseline accidents documented in a self‐maintained log, their sex, and the predominant pattern of symptoms (urge or stress) to one of two treatment groups: biofeedback (13 patients) or behavioral training not utilizing biofeedback (14 patients). Patients were given up to six treatments. Patients in both groups achieved a highly significant (P < .001) reduction in urinary accidents 1 month following treatments compared with their baseline number of accidents. The average reduction of accidents over this time period was 79% for the biofeedback group and 82% for the group receiving behavioral training without biofeedback. All patients showed improvement and no patient experienced any side effect. A internist /geriatrician and a geriatric nurse practitioner may achieve success utilizing behavioral therapy with or without biofeedback for the treatment of chronic urinary incontinence for ambulatory elderly patients.
Are Physicians Sensitive to the Special Problems of Older Patients?
Authors: Radecki Stephen E. , Kane Robert L. , Solomon David H. , Mendenhall Robert C. , Beck John C.
Published: April 2015

The sensitivity of primary care physicians to the health care needs of older patients was explored by means of an analysis of the use of diagnostic tests and therapeutic procedures during ambulatory visits. Survey data on a total of 28,265 visits to internists, family and general practitioners were examined to determine possible age‐related differences in care. The study found that diagnostic testing falls off significantly for patients 75 years of age or older and that internists use substantially more tests for each age group than do family and general practitioners. The pattern of use of diagnostic tests in this secondary analysis does not address the issue of “appropriateness” but does suggest a pattern that makes little sense based on the known distribution of disease and functional disability in aging populations.
An Evaluation of Increased Mortality Rates in Wisconsin Nursing Homes
Authors: Sager Mark A. , Easterling Douglas V. , Leventhal Elaine A.
Published: April 2015

We reviewed mortality data from 80 nonprofit and government‐owned skilled nursing facilities (SNFs) to evaluate previously reported increases in deaths occurring in Wisconsin nursing homes since 1983. Comparing nursing home mortality data for 1982 and 1985, we found a 16.6% increase in overall nursing home mortality rates. The increased mortality rates occurred in the sample SNFs regardless of ownership, Medicare certification, bed size, metropolitan area and hospital affiliation. There were two explanations for the increased mortality rates. First, the number of residents dying within 30 days after nursing home admission increased 59%. The majority of these short‐lived residents had been discharged from hospitals indicating a transfer of terminally ill patients into nursing homes just prior to death. Second, there was a 27% increase in the mortality rate of residents living in the nursing home for 1 to 5 years suggesting that the population had become sicker between 1982 and 1985. These data reflect both the impact of Medicares Prospective Payment System (PPS) on the study nursing homes and an increase in the severity of illness of Wisconsin's nursing home population between 1982 and 1985. The findings document an increased role for nursing homes in caring for more acutely ill patients since the passage of the PPS, and have implications for nuring home reimbursement policies and quality of care.
Survival and Health Care Utilization in Elderly Medical Inpatients With Major Depression
Authors: Koenig Harold G. , Shelp Frank , Goli Veeraindar , Cohen Harvey J. , Blazer Dan G.
Published: April 2015

Forty‐one elderly medical inpatients with active major depression were matched with nondepressed controls from the same population. Survival and health care utilization were examined during a mean follow‐up period of five months. Cases and controls were matched by age, functional status, severity and type of medical illness, and extent of disease. In‐hospital mortality was significantly higher among depressed compared with nondepressed controls (6 vs 0 deaths, P=.03). For patients discharged from the hospital alive, however, depression did not have a substantial impact on mortality (31.4% cases, 31.7% controls). Health care utilization—in terms of days of inpatient care—was significantly higher both during the index admission (25 vs 14 days, P < .005) and during the follow‐up period (16 vs 7 days, P < .05) for depressed patients compared with controls. Hence, older medically ill patients with major depression consume more healthcare resources and experience greater mortality during their initial hospital stay. After discharge, while survival is little affected, excess resource utilization persists among those with depression.
Dangerous Behavior in a Demented Patient
Authors: Watts David T. , Cassel Christine K. , Howell Timothy
Published: April 2015

When a cognitively‐impaired elderly man nearly caused a serious fire at home through his inappropriate use of a gas oven, the incident raised questions about his capacity to live alone. Although he clearly wanted to preserve his independence, the health care team felt obligated to assure his safety. The following discussion of dangerous behavior in a demented elderly man elicits and portrays these conflicting values, and highlights the physician's obligations in such ethically and legally complex situations.
Benefit from Admission to a Geriatric Assessment and Rehabilitation Unit
Authors: Caradoc‐Davies T. H. , Dixon G. S. , Campbell A. J.
Published: April 2015

To determine differences in perception of benefit from a patient's admission to a geriatric Assessment and Rehabilitation Unit, we asked both medical and nursing staff (health team) and the patient and carer (clients) for their evaluation after discharge. The areas studied were functional ability, relief of the principal symptom, education about the principal problem, and development of coping skills. Of 94 patients studied, 58 patients were discharged to the community (52 to carers, 6 to live alone) and 36 to institutions. In the former group, the health team had a consistently higher perception of benefit than the clients (P < .001). Factors positively predicting health team perception of benefit were a higher carer happiness, improvement in patient independence, and internalization of the patient's locus of control. A negative predictor was an increase in patients' responsibilities. Client perception of benefit was positively predicted by fewer problems with companionship and communication with others. The health team's perception rated the adequacy of patient education and development of coping skills more highly than did the clients. In the patients discharged to the community, their perception of benefit at 1 week was a good predictor of survival in the community to 6 weeks. The possible reasons for these differences in perception of benefit and their implications are discussed.
Chronic Oral Physostigmine Without Lecithin Improves Memory in Alzheimer's Disease
Authors: Thal Leon J. , Masur David M. , Blau Alan D. , Fuld Paula A. , Klauber Melville R.
Published: April 2015

Sixteen patients with early Alzheimer's disease (AD) completed a 3‐month outpatient double‐blind parallel trial of oral physostigmine versus placebo. Ten subjects received drug; six received placebo. After a dose‐titration phase, each patient was placed on his or her best dose of drug or placebo. Subjects were evaluated with both memory and nonmemory tasks. Seven of the ten drug‐treated patients, but none of the six placebo‐treated patients, demonstrated improvement on a selective reminding task, a test of verbal memory. Family members reported improvement in six of ten drug‐treated patients and none of six placebo‐treated individuals. There was a trend toward greater improvement with increasing drug dose. There was no improvement on the nonmemory tests administered. The data indicate that oral physostigmine improves memory but not other areas of cognition.
Renal Function in Aging
Authors: Meyer B. Robert
Published: April 2015

A variety of age‐related anatomic and functional alterations in the kidney have been described. Anatomic abnormalities in the aging kidney include a decrease in kidney size, increased glomerular sclerosis, altered tubular structure, and an altered pattern of vascular flow. These anatomic abnormalities are associated with renal functional abnormalities, including decreased renal blood flow, and glomerular filtration rate. Altered renal tubular function, including impaired handling of water, sodium, acid, and glucose, may also be present. Impaired “endocrinologic” functioning manifested by changes in the renin‐angiotensin system, vitamin D metabolism, and antidiuretic hormone responsiveness have been reported. The kidney is constantly exposed to the effects of a variety of potentially toxic processes. These range from environmental toxins and drugs, to a variety of chronic medical illnesses including hypertension, diabetes, and atherosclerotic disease. In this context, differentiation of “aging” effects from nephrotoxic effects resulting from these other processes is difficult. It has been argued that hypertension is an important factor in the development and progression of renal insufficiency in the elderly. The relationship between hypertension, glomerular hyperfiltration, atherosclerosis, and progressive renal dysfunction needs further study. Further research may allow the rational recommendation of interventions designed to control age‐associated changes in renal function.
BOOK REVIEWS
Authors: Barzel Uriel S. , Espino David V.
Published: April 2015

The Physician and the Hopelessly Ill Patient: Legal, Medical and Ethical Guidelines. New York, Society for the Right to Die, 1985 (supplement 1988). 92 pages, softcover, $5.00; supplement 40 pages, softcover $4.00
BOOK REVIEWS
Authors: Barzel Uriel S. , Slade Walter R.
Published: April 2015

Neurology for Non‐Neurologist, 2nd Edition. Edited by Wiederhold WC. Philadelphia, Grune & Stratton, 1988. 356 pages. $39.50.
Treatment of Osteoporosis
Authors: Gold Deborah T. , Bales Connie W. , Lyles Kenneth W. , Drezner Marc K.
Published: April 2015

Participants in a therapeutic program for osteoporosis were studied to determine if program participation improved psychological outcomes. The 4‐day program included intensive education about the disease and its prognosis, physical therapy education, nutritional counseling, and medical evaluation and treatment. All therapeutic patients enrolled in the program over a one‐year period (N = 38) were interviewed individually pre‐ and post‐participation. Knowledge of osteoporosis, level of social support, coping styles, and perceptions of the impact of pain and chronicity were assessed. Patients reported improved future outlook despite continued concern about pain and chronicity. Mention of depression was reduced, and knowledge of osteoporosis increased significantly. In addition, there were meaningful changes in patients' understanding of disease management. These included knowing when to make specific changes and avoid harmful actions. The findings suggest that an educational program can have a positive impact on patients' coping. Educational efforts may be an important component in the management of chronic disease.
The Value of Holter Monitoring in Evaluating the Elderly Patient Who Falls
Authors: Rosado Juan A. , Rubenstein Laurence Z. , Robbins MPH, Alan S. , Heng Ming K. , Schulman Barbara L. , Josephson Karen R.
Published: April 2015

Ambulatory cardiac (Holter) monitoring is often recommended in the routine evaluation of patients who fall; however, the prevalence of arrhythmias in old people is high, and the usefulness of such monitoring is unproven. As part of a large study of institutionalized elderly fallers, we compared Holter findings of fallers (N = 51) with a group of nonfallers (N = 27) having similar medical and demographic characteristics. Prevalence of ventricular arrhythmias was 82% in each group, and all patients had supraventricular arrhythmias. The mean number of ventricular and supraventricular couplets and runs did not differ between groups. There was no difference in severity of arrhythmias between fallers and nonfallers; in fact, fallers had slightly fewer Lown 4B arrhythmias than nonfallers (10% vs 18%, NS). Prevalence of heart disease was 78% in both groups and was associated with increased ventricular ectopy in the form of runs and couplets (P < .05). No symptoms were reported during the Holter monitoring. We conclude that Holter monitoring should not be a routine part of the work‐up of the patient who falls.
Effect of Timing and Number of Baseline Blood Pressure Determinations on Postural Blood Pressure Response
Authors: Mader Scott L. , Palmer Robert M. , Rubenstein Laurence Z.
Published: April 2015

We hypothesized that the blood pressure response to standing may depend on the method of establishing baseline blood pressure. Three hundred elderly subjects previously completed a postural blood pressure protocol with three supine baseline blood pressure readings obtained two minutes apart prior to standing. Comparison of the readings showed a significant drop between the first and the second (P < .001) but not between the second and third supine systolic blood pressures. The difference between the first supine systolic blood pressure and the one minute standing blood pressure was significantly greater than that between the third supine systolic blood pressure and the one minute standing blood pressure (P < .001). A second group was prospectively studied to determine whether the change in blood pressure after standing was greater if only a single baseline reading was taken rather than multiple readings, and whether the decline in blood pressure over three readings was related to duration supine or to the number of blood pressures taken. This group also demonstrated a decline in systolic blood pressure with three serial readings. We conclude that supine blood pressure declines significantly between the first and second readings taken two minutes apart and is secondary to the repetition of readings and not the duration supine. However, this change in supine blood pressure does not significantly alter the blood pressure response to standing. Thus, it appears that a single baseline supine blood pressure measurement is adequate for determining the postural blood pressure response, and that pooling of multiple baseline readings may not be appropriate.
Characteristics, Diagnosis, and Treatment of Alcoholism in Elderly Patients
Authors: Curtis J. Randall , Geller Gail , Stokes Emma J. , Levine David M. , Moore Richard D.
Published: April 2015

The purpose of this study is to examine the ability of physicians to diagnose alcoholism in the elderly patient and to define characteristics specific to the elderly patient with alcoholism. During a 3‐month period, all new admissions to the medical service of The Johns Hopkins Hospital were screened for alcoholism with two screening tests (the CAGE questionnaire and Short Michigan Alcohol Screening Test). The prevalence of screen‐positive alcoholism was 27% in patients under 60 years of age and 21% in patients 60 years and older. Elderly patients with alcoholism were more likely to be black (P < .01), but did not differ significantly in any other way from elderly patients who did not have alcoholism. Although 60% of screen‐positive young patients with alcoholism were identified by their houseofficers, only 37% of elderly patients with screenpositive alcoholism were so identified (P < .05). The elderly patients with alcoholism were significantly less likely to be diagnosed by their houseofficer if they were white, female, or had completed high school (P < .01). Even when diagnosed, elderly patients with alcoholism were less likely than younger patients with alcoholism to have treatment recommended by their houseofficers (P < .05) and, if treatment were recommended, it was less likely to be initiated (P < .05). These data suggest that current medical education is deficient in providing physicians with the skills to detect and treat elderly patients with alcoholism.
Drug‐Induced Illness as a Cause for Admission to a Community Hospital
Authors: Colt Henri G. , Shapiro Alvin P.
Published: April 2015

To assess the rate of occurrence of drug‐induced illness as a cause for admission to the general medicine service of a community hospital, charts were reviewed retrospectively of all patients admitted to the service over two randomly selected one‐month periods. Statistical analysis was performed on patients over and under the age of 65, and on iatrogenic and noniatrogenic admissions. Twenty‐three of 244 patients (9.4%) were admitted with drug‐induced illness. Patients with drug‐induced illness had 5.7 medications as compared to 3.2 medications per patient admitted for other reasons (P < .05). A single drug was responsible for 61% of all drug‐induced illness admissions. Aspirin and other nonsteroidal anti‐inflammatory agents were most often implicated. Eighteen of 155 elderly patients (11.7%) were admitted with drug‐induced illness. These patients were on an average of 6.3 medications as compared with 3.8 medications per elderly patient admitted for other causes (P < .005). Polypharmacy and a preponderantly elderly population may explain the substantial number of admissions caused by adverse drug reactions. Further research to assess the role of patient age and the number and type of medications involved in the event of drug‐induced illness requires standardization of definition and diagnostic criteria.
41‐Month Follow‐Up of Risk Factors Correlated With New Coronary Events in 708 Elderly Patients
Authors: Aronow Wilbert S. , Herzig Abbe H. , Etienne Fritzner , D'Alba Peter , Ronquillo Jocelyn
Published: April 2015

A prospective study correlated coronary risk factors with new coronary events in 192 elderly men and 516 elderly women, mean age 82 ± 8 years. Follow‐up was 41 ± 6 months (range 24–44). Coronary events (myocardial infarction, primary ventricular fibrillation, and sudden cardiac death) occurred in 64 of 192 men (33%) and in 149 of 516 women (29%), P not significant. Using univariate analysis, significant risk factors for coronary events were antecedent coronary artery disease, cigarette smoking, hypertension, diabetes mellitus, serum total cholesterol (TC) ≥ 200 mg/dL and ≥ 250 mg/dL, serum high‐density lipoprotein cholesterol (HDL‐C) < 35 mg/dL, and serum TC/HDL‐C ≥ 6.5 in men and women, and obesity in women. Using multivariate analysis, significant risk factors for coronary events were age, antecedent coronary artery disease, cigarette smoking, hypertension, diabetes mellitus, and serum TC in men and women and serum HDL‐C and serum triglycerides in women. Using univariate analysis, significant risk factors for coronary events in men and women with antecedent coronary artery disease were cigarette smoking, diabetes mellitus, serum TC ≥ 250 mg/dL, and serum TC/HDL‐C ≥ 6.5. Using multivariate analysis, significant risk factors for coronary events in men and women with antecedent coronary artery disease were age, cigarette smoking, diabetes mellitus, serum TC, serum HDL‐C, and serum triglycerides. Using univariate analysis, significant risk factors for coronary events in men and women without antecedent coronary artery disease were cigarette smoking, hypertension, diabetes mellitus, serum, TC ≥ 200 mg/dL and ≥ 250 mg/dL, serum HDL‐C < 35 mg/dL, serum TC/HDL‐C ≥ 6.5, and hypertriglyceridemia. Using multivariate analysis, significant risk factors for coronary events in men and women without antecedent coronary artery disease were age, cigarette smoking, hypertension, diabetes mellitus, serum TC, serum HDL‐C, and serum triglycerides.
Hypochondriasis in the Elderly Depressed
Authors: Kramer‐Ginsberg Elisse , Greenwald Blaine S. , Aisen Paul S. , Brod‐Miller Claudine
Published: April 2015

The significance of hypochondriacal complaints in elderly depressives was explored. Sixty percent of patients had such symptoms on admission. Twelve percent were delusional. At discharge, hypochondriasis was present in 40% of the sample, with 0% delusional. Hypochondriasis was associated with anxiety (P < .05) and somatic concerns (P < .001), but not with complaints of depressed mood, suicidality, or short‐term outcome. In dependent physical illness ratings did not correlate with hypochondriasis, however nonpsychotropic medication use did (P < .01). Improvement in hypochondriacal complaints with treatment, yet persistence of less intense hypochondriacal concerns after remission suggests that these features may represent an admixture of state and trait phenomena in elderly depressives.
Rate of Progression of Alzheimer's Disease
Authors: Ortof Elizabeth , Crystal Howard A.
Published: April 2015

We determined rate of cognitive decline in 54 patients with a clinical diagnosis of Alzheimer's disease. Cognitive ability was assessed by score on the Blessed test of orientation, memory, and concentration. Rate of progression was defined as the change in score on the Blessed test per year and was computed using a linear regression analysis. Only patients who had been followed for at least one year and who had at least three separate evaluations were included in the study. The overall rate of progression was 4.1 Blessed points per year. Age of onset, duration of illness, and family history of dementia had no significant influence on rate of progression.
The Safety and Lack of Efficacy of Vinpocetine in Alzheimer's Disease
Authors: Thal Leon J. , Salmon David P. , Lasker Bruce , Bower D. , Klauber Melville R.
Published: April 2015

Fifteen Alzheimer patients were treated with increasing doses of vinpocetine (30, 45, and 60 mg per day) in an open‐label pilot trial during a one‐year period. Patients were assessed seven times both on and off drug with: the Buschke Selective Reminding Task, a letter fluency test, a category fluency test, the Boston Naming Test, a cognitive capacity screening examination, and a clinical global impression. Vinpocetine failed to improve cognition on psychometric testing or overall functioning, as measured by the clinical global impression, at any dose tested. Patients showed significant decline in most measures during the course of the study, at the same rate as a matched control group, consistent with progressive dementia. There were no significant side effects from drug therapy. We conclude that vinpocetine is ineffective in improving cognitive deficits and does not slow the rate of decline in individuals with Alzheimer's disease.
Randomized Clinical Trial of Daily Aspirin Therapy in Multi‐Infarct Dementia
Authors: Meyer John Stirling , Rogers Robert L. , McClintic Karen , Mortel Karl F. , Lotfi Jamshid
Published: April 2015

Seventy multi‐infarct dementia patients were randomized into an aspirin‐treated group and an untreated control group for an exploratory investigation to determine any effects of 325 mg aspirin daily on cognitive performance. The control group did not receive placebo but evaluations were carried out in a blinded manner. The index group (N = 37, mean age 67.1 years) received 325 mg of aspirin by mouth once daily while the control group (N = 33, mean age 67.6 years) was followed and treated in a similar manner except that they received no aspirin. Both groups had comparable risk factors for stroke, which were treated similarly, as well as comparable initial cerebral blood flow values, as measured by the 133xenon inhalation method, and initial scores on Cognitive Capacity Screening Examination testing. Patients were evaluated at intervals of one year. Significant improvements were demonstrated for cerebral perfusion values (P < .0001) and cognitive performance scores (P < .0001) among aspirin‐treated patients compared to untreated controls at each of three annual follow‐up evaluations. Both men and women benefited from aspirin therapy and their quality of life and independence appeared to be improved, which was not apparent in the control group. Daily aspirin appears to improve or stabilize declines in cerebral perfusion and cognition among patients with multi‐infarct dementia.
Hospitalization of Elderly People
Authors: Hendriksen Carsten , Lund Ellinor , Strømgård Edith
Published: April 2015

In a controlled epidemiologic intervention study, preventive home visits to elderly people aged 75 or older were made every third month over 3 years. Two hundred eighty‐five (62% women) elderly participated in the intervention group and 287 (62% women) in the control group. Information about the number of admissions to hospitals, the number of bed days, the main reason for hospitalization, the diagnoses on discharge, and the residence after discharge was collected. Two hundred nineteen admissions (4,884 bed days) were registered for the intervention group compared with 271 (6,442 bed days) for the control group. During the second half of the study, a significant reduction in the number of admissions — especially readmissions — to hospitals was seen in the intervention group. The mean risk per person of being hospitalized was 24%, 20%, and 20% in years 1, 2, and 3, respectively, for the intervention group, and 22%, 25%, and 28% for the controls. The mean number of bed days per admission did not differ between the two groups. Using the results to make a general epidemiologic and longitudinal assessment of the admissions of elderly aged 75 or older, the following can be concluded: 4% of the participants used 42% of the bed days, and most of these people awaited alternative residential accommodation; 62% stayed less than 2 weeks in the hospital. The main reason for hospitalization was fall episodes among women (20%) and dyspnea among men (18%). Approximately three‐fourths were discharged to their own homes or to the family, while 18% died. Preventive home visits seem to be one of the tools to improve the future lives of the elderly in their own homes.
Acute Confusion in Elderly Medical Patients
Authors: Rockwood Kenneth
Published: April 2015

The acute confusional state (delirium) is a common presentation for a wide variety of medical conditions in the elderly. This paper reports a prospective study of acute confusion in elderly people admitted to general medical services in two acute care hospitals in Edmonton, Alberta. Eighty patients were studied, ranging in age from 65–91. Acute confusion was seen in one‐fourth of these patients, who tended to be older, more ill, more likely to have chronic cognitive impairment and a higher mortality rate. In patients admitted with confusion, infection and congestive heart failure predominated. In those who developed confusion after hospitalization, iatrogenic disease was more common. Confusion was a sensitive sign of physical illness, and its resolution accompanied recovery. A diagnosis of the cause of the confusion state could be made in 22 of 24 cases. These findings support the aggressive investigation and treatment of acute confusion in the elderly.
Physical Restraints and Agitation in Nursing Home Residents
Authors: Werner Perla , Cohen‐Mansfield Jiska , Braun Judith , Marx Marcia S.
Published: April 2015

An observational study was performed to determine whether the use of physical restraints in agitated nursing home residents leads to decreased or increased agitation. Results indicate that restraint use does not decrease agitation in nursing home residents. Residents exhibited either the same amount or more agitated behaviors when they were restrained than when they were not restrained, suggesting that the act of restraining may itself contribute to manifestations of agitation. The implications of the use of restraints in agitated nursing home residents are discussed, with particular reference to the prevention of falls.
A Longitudinal Study of Impaired Glucose Tolerance and Diabetes Mellitus in the Aged
Authors: Grobin Wulf
Published: April 2015

This longitudinal study of glucose tolerance in the residents of a Jewish home for the aged (JHA) is now in its 25th year. Of 1,177 supposedly nondiabetic persons screened on admission from 1965 to 1986, 22.5% had impaired glucose tolerance (IGT), reflecting its undiagnosed prevalence among the Jewish elderly in the community. The incidence of IGT was lower in 1969–1973, when the average age on admission was 77 years, than in 1982–1986, when the average age was 83.5 years. However, aging was not the only factor affecting glucose tolerance (GT). The rise in the residents' age in the last 10 years was not accompanied by an increased rate of deterioration of GT in the annual screenings of 1970–1984, suggesting that there was a delay in the effect of age on IGT and diabetes mellitus (DM). This was attributed mainly to the multimodal antidiabetic regimen (ADR) prevailing in the JHA in those years. Relaxation of this regimen was associated with a marked increase in the incidence of IGT and DM in the screenings of 1985–1987.

When 25 newly diagnosed diabetics were put on a diabetic diet, 60% had normal or improved glucose tolerance tests (GTT) one to five years later. By contrast, in over half of the 80 residents whose first GTT did not indicate diabetes and whose diet was not as strictly controlled, the repeat GTT showed deterioration and was diabetic in 31%.

Conclusions: Screening led to early diagnosis and institution of antidiabetic measures, probably avoiding or postponing the need for antidiabetic medication with its risk of iatrogenic hypoglycemia. Periodic screening is recommended for older persons because of their high risk for DM.
Air‐Fluidized Bed Treatment of Nursing Home Patients with Pressure Sores
Authors: Bennett Richard G. , Bellantoni Michele F. , Ouslander Joseph G.
Published: April 2015

There are no large studies on long‐term treatment of nursing home patients with pressure sores. A 4‐year experience of treating 95 nursing home patients on air‐fluidized beds was reviewed. Treated patients were elderly (median age 73 years) and neurologically impaired (79% with dementia, cerebral vascular accident, or anoxic encephalopathy). The index pressure sores (deepest truncal sore for each patient) were large (median surface area 35.3 cm2) and commonly located on the sacrum (41%) and trochanters (38%). Only 13 of 95 (14%) index sores healed completely, and only two small sores healed in <30 days. No others treated <30 days had ≥ 50% reduction in sore surface area. Patients were grouped according to whether or not treatment was < 30 days, and for those treated ≥ 30 days, according to whether or not ≥ 50% reduction in sore surface area occurred. None of the easily measured patient characteristics examined were associated with longer or more successful treatment. These results indicate that although air‐fluidized beds can be used to treat pressure sores successfully, even in severely debilitated nursing home patients, no simple criteria can be used to predict which patients will benefit from this treatment. Because long periods of time are necessary for treatment [median trial length 79 days and 17 of 95 (18%) trials >180 days], substantial patient‐care expenditures result. Prospective studies comparing other medical and surgical interventions with air‐fluidized bed therapy are needed before these beds are used routinely for long‐term treatment of nursing home patients with severe pressure sores.
History‐Taking in the Elderly With and Without Cognitive Impairment
Authors: Davis Paula B. , Robins Lee N.
Published: April 2015

To assess the usefulness of interviewing older adults with cognitive impairment, we analyzed data from the NIMH Epidemiologic Catchment Area Study. People aged 65 and older with cognitive impairment were twice as likely as age‐matched unimpaired elders to report sufficient symptoms of psychiatric disorders to qualify for a current diagnosis (16% vs 7%), and were also more likely to qualify for a lifetime diagnosis (25% vs 15%). We considered whether this excess could be due to random responses by the impaired, but found the rank order of their symptoms very similar to that of the unimpaired. Although dementia is thought to affect recent more than remote memory, the impaired were no less likely than the unimpaired to report disorders of recent onset. We also compared the cognitively impaired and unimpaired with respect to their reliability as assessed by reinterview one year later and found no significant difference. We conclude that there is no reason to believe that the excess of disorders in the mildly impaired is an artifact caused by their poorer performance as respondents. Interviewing the elderly person with cognitive impairment is a useful way of discovering concurrent disorders that may be treatable.