bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypochondriasis and the Elderly
Authors: GOLDSTEIN S. E. , BIRNBOM F.
Published: April 2015

ABSTRACT: Hypochondriasis is poorly understood and poorly treated. Attempts to classify it have been unsatisfactory except for Pilowsky's division into primary and secondary groups. Twenty consecutive cases of hypochondriasis in elderly patients were studied; 4 were of the primary type and 16 of the secondary type. For the primary group, neither family therapy nor hospitalization was needed, and the prognosis was good. In contrast, hospitalization was always advised for the secondary group, and such patients improved while in the hospital. Psychotropic drugs, a therapeutic milieu, and often electroshock therapy were needed to treat depression. After discharge, successful treatment necessitated Day Care programs and the long‐term use of family therapy. Treatment was unsuccessful in 8 patients characterized by refusal to become involved in post‐discharge Day Care programs and family therapy.
The Changing Pattern of Bacterial Sepsis Since the Introduction of Antibiotic Therapy*
Authors: SENECA HARRY , GRANT JOHN P.
Published: April 2015

ABSTRACT: During the six‐year period, 1968–1973, sepsis developed in 1 of every 80 patients admitted to the Presbyterian Hospital, New York. In 1 of 133 patients the sepsis was due to Gram‐positive organisms, and in 1 of 188 patients to Gram‐negative organisms. The mortality rate for Gram‐positive cases was 4.4 percent, for Gram‐negative cases 19.1 percent, and for urologic cases 15.3 percent (versus 56.25 percent in 1959–1964). Data are presented on the relative incidences of involved pathogens in 1740 cases of Gram‐positive sepsis (78 deaths), and in 1236 cases of Gram‐negative sepsis (205 deaths). The lowering of the sepsis mortality rate has been the result of preventative measures, early diagnosis, and vigorous treatment. Treatment includes the correction of acidosis and anoxia, early administration of bactericidal antibiotics, and restoration of the microcirculation by administration of corticosteroids, β‐adrenergic drugs, and appropriate diuretics.
Elderly Applicants to Long‐Term Care Institutions. II. The Application Process; Placement and Care Needs*
Authors: KRAUS A. S. , SPASOFF R. A. , BEATTIE E. J. , HOLDEN D. E. W. , LAWSON J. S. , RODENBURG M. , WOODCOCK G. M.
Published: April 2015

ABSTRACT: As part of a study of long‐term institutional care of the elderly, this report presents salient data concerning 193 elderly applicants. Physicians play an important role in decisions to apply for such care. More than half of the applicants and about 80 percent of their family members approved of the proposed move. The number applying to homes for the aged vs. other institutions seemed much greater than appropriate; many of these applicants appeared more eligible for placement in foster homes and specialized facilities for the demented, or for remaining in their own homes. About a fifth of the applicants could have continued living independently if they had received a reasonable amount of community assistance. Action implications include: 1) expansion and more informed use of community services, 2) more programs of supervised foster homes for the elderly, 3) construction of specialized institutions for the demented, and 4) a greater effort by institutions to satisfy the desire of many new residents to be involved there in useful tasks.
Cardiovascular Effects of Levodopa in Aged versus Younger Patients with Parkinson's Disease
Authors: WENER J. , ROSENBERG G. , GRAD B. , WENER S.
Published: April 2015

ABSTRACT: The cardiovascular effects of prolonged administration of levodopa were studied in 54 men and women with Parkinson's disease; 23 of them were younger than 70 and 31 were 70 or older. The patients were evaluated clinically before treatment was started and at regular intervals thereafter. The average optimal dosage of levodopa for both age groups was 3.0 and 2.5 gm per day, respectively, during an average treatment period of 20.7 months. Eleven patients showed hypotension (systolic BP of 105 mm Hg or less) that was not related to dosage; in only 6 did the drug have to be permanently discontinued because of syncope; 3 of this group had an associated psychiatric disorder. Four patients had pretreatment hypertension; in 3 the BP fell to normal during therapy; in the remaining patient the hypertension persisted and was successfully treated by an antihypertensive drug. In 5 patients an occasional atrial or ventricular ectopic beat was noted both before and during levodopa therapy but no therapeutic intervention was required. Thirty of the 46 patients with adequate ECG follow‐up did not show any significant changes; 5 others showed an increase, and 11 a decrease in myocardial ischemia. Thus the administration of levodopa in elderly patients with or without heart disease is a relatively safe procedure. The only exception would be patients over 70 years of age with a history of previous myocardial infarction. In this group there seems to be a higher incidence of clinically significant hypotension. In such patients, levodopa therapy should be carried out with great caution.
Free Radical Theory of Aging: Inhibition of Amyloidosis in Mice by Antioxidants; Possible Mechanism*
Authors: HARMAN DENHAM , EDDY DENNIS E. , NOFFSINGER JAMES
Published: April 2015

ABSTRACT: The antioxidants, α‐tocopherol acetate and a quinolone derivative (Santoquin), inhibited the development of amyloidosis when added to the diet of casein‐injected C3HeB/FeJ male mice. Santoquin, and to a lesser extent butylated hydroxytoluene (BHT), also depressed the appearance of a plasma protein fraction in these mice; the effect of α‐tocopherol was not determined. Consideration of the current knowledge of amyloid, in the light of these antioxidant studies, prompted the following hypothesis. Amyloidosis is largely the result of an enhanced rate of oxidative degradation of a connective‐tissue glycoprotein(s) coupled with oxidative/enzymatic changes in the plasma, both of the tissue‐derived substances and of immunoglobulins, to form the amyloid fibril protein subunits (AL and AA) which subsequently aggregate to form the amyloid fibrils.
The Care of Decubitus Ulcers (Pressure Sores)
Authors: MICHOCKI ROBERT J. , LAMY PETER P.
Published: April 2015

ABSTRACT: Despite a large volume of literature particularly directed toward treatment, pressure sores (including decubitus ulcers) remain a difficult problem, especially in the nursing home environment. The treatment of pressure sores is somewhat controversial and quite diversified. Selection of a successful therapeutic modality must be preceded by correct evaluation, i.e., whether the sore is superficial or deep, open or closed. The treatment of superficial sores is conservative and directed toward cleanliness, relief of pressure, and exposure to air. Surgical debridement may be indicated. Proteolytic enzymes often are employed as adjunctive therapy, although there are some major drawbacks to their use. The plethora of therapeutic agents suggested for the treatment of deep pressure sores probably is related to the difficulties in achieving success. Surgical debridement is indicated, and proteolytic enzymes are widely used. Possible interactions and factors leading to the inactivation of these enzymes are discussed, as is the use of various solutions, ointments, gold leaf, oxygen, dry heat, and other adjunctive devices. Of paramount importance in the management of pressure sores is the maintenance of cleanliness and dryness.
Myasthenia Gravis in the Elderly
Authors: HERISHANU Y. , ABRAMSKY O. , FELDMAN S.
Published: April 2015

ABSTRACT: During a 15‐year period in Jerusalem, myasthenia gravis was diagnosed in 15 patients aged 60 or older. At this age, diagnosis is difficult because of such possible associated conditions as cerebrovascular and cardiovascular arteriosclerotic diseases or bronchopulmonary disorders. The clinical course often is complicated by these associated conditions, and also by their treatment. Seven of the patients died within 4 years of the onset of their illness, but only 5 because of myasthenia gravis. This disease represents an important diagnostic and therapeutic problem in elderly patients.
Carcinoma of the Vulva
Authors: WRIGHT V. CECIL
Published: April 2015

ABSTRACT: Carcinoma of the vulva often presents as a large ulcerating or fungating tumor with considerable destruction of the vulva and surrounding tissues. The area usually is very painful and foul smelling. Most such tumors are of the squamous‐cell variety. Despite the degree of histologic differentiation, the lymph nodes are involved in more than 50 percent of the cases. The best therapeutic results are obtained with radical vulvectomy and groin node dissection “en bloc.” Occasionally treatment should be modified in the geriatric patient because of associated medical problems. Various techniques are discussed. Since the disease is rare, best results are achieved by referral to a specialized treatment center.
Free Radical Theory of Aging: Effect of Dietary Fat on Central Nervous System Function*
Authors: HARMAN DENHAM , HENDRICKS SHELTON , EDDY DENNIS E. , SEIBOLD JON
Published: April 2015

ABSTRACT: Free radical reactions have been implicated in aging. A rise in the level of random free radical reactions in a biologic system might have a greater effect on the central nervous system (CNS) than elsewhere, partly because of the presence of glial cells and the unique connections between neurons. To evaluate this possibility, some animal experiments were conducted. The initial experiment involved old male Sprague‐Dawley rats fed (since shortly after weaning) with semisynthetic diets characterized by fat differing in amount or degree of unsaturation. The number of errors made in a Hebb‐Williams maze was determined and found to be higher as the amount or degree of unsaturation of the fat was increased. Likewise rats aged 6 and 9 months, fed semisynthetic diets containing 20 percent by weight of lard, oleinate, or safflower oil+α‐tocopherol performed significantly better in a discrimination learning situation (Skinner box) than did rats fed a diet containing 20 percent by weight of safflower oil. The diets employed in these studies did not have a significant effect on the mortality rates. These results are compatible with the possibility that enhancing the level of lipid peroxidation has an adverse effect on the CNS, out of proportion to the effect on the body as a whole, as measured by the mortality rate.
Procaine Hydrochloride as a Monoamine Oxidase Inhibitor: Implications for Geriatric Therapy
Authors: Fuller Ray W. , Roush Betty W.
Published: April 2015

The results of in vitro experiments showed that inhibition by procaine hydrochloride of monoamine oxidase (MAO) from either rat brain or liver was substrate‐dependent. Procaine was more effective in inhibiting serotonin oxidation than phenylethylamine oxidation and had an intermediate effect on tryptamine oxidation. MAO activity in tissue homogenates from rats treated with procaine (150 mg/kg intraperitoneally) was inhibited most in liver, less in heart, and only very slightly in brain for a duration of up to 8 hours. Procaine injected in that dose did not alter brain norepinephrine levels and elevated only slightly the brain serotonin levels. It did not protect against the degradation of exogenous radioactive tryptamine in brain. These data confirm and extend prior observations on in vitro inhibition of MAO by procaine and suggest that in high doses procaine may inhibit MAO weakly in vivo. If the reported usefulness of procaine preparations in treating geriatric patients indeed depends upon MAO inhibition, more effective inhibitors would seem to be available.
A Clinical Psychogeriatric Unit: Organization and Function†
Authors: Poliquin Nicole , Straker M.
Published: April 2015

A psychogeriatric unit in Brentwood VA hospital is described with regard to function and organization. Its clinical task is to evaluate the elderly veteran in several dimensions. Then a comprehensive plan emerges for continuing care, to which each professional staff member contributes his own experience. The presenting problems are given priorities, and needed services are coordinated. This process involves staff roles and training, the needs of the population served, diagnostic and treatment procedures, and aftercare programs. Liaison with other agencies addressing the problems of aging provides support in policy‐making, consultation and education for the proprietors of homes accepting placement of elderly veterans. It is hoped that the findings of this report (including a clinical study of 47 patients) may serve as a stimulus to others who contribute to the care of the aged.
The Climacteric Disease
Authors: Livesley Brian
Published: April 2015

Evidence is provided to show that the account of “The Climacteric Disease” given in 1813 by Sir Henry Halford, Physician to King George III, was his interpretation that the King's illness was due to aging as a disease. This laid foundations upon which are placed the unfavorable attitudes toward Geriatric Medicine today, and which may affect the provision of medical care for the elderly and aged tomorrow.
Metabolic Behavior of α‐Ray Activity in Large Human Arteries: Relationship to Atherosclerosis
Authors: Elkeles Arthur
Published: April 2015

The paradoxic biologic behavior of tissue calcium metabolism is emphasized. Although calcium salts are essential for the development of bones, they also contribute to aging of the large human arteries. The heavy elements providing α‐ray activity tend to be metabolized like calcium. The concept of an osteoporosis‐atherosclerosis relationship led to a series of investigations in which ash content and α‐ray activity were examined in abdominal aortas, coronary arteries, pulmonary arteries and, for comparison, in bones and ventral costal cartilages. Both ash content and α‐ray activity rise with age in the aorta and in the coronary arteries, but there is no such increase in the pulmonary arteries. A statistically significant correlation between ash content and α‐ray activity has been found only in aortas and coronary arteries. This correlation is even closer in the coronary arteries of subjects who die of coronary artery disease and in the aortas of the elderly. Wet tissue α‐ray activity in an aorta with severe atherosclerosis may be 220 times higher than in an aorta without significant atherosclerosis. Alpha‐activity in bones and in ventral costal cartilages tends to decline in advancing years, though in the cartilages the calcium deposits increase with age. Our studies reveal a close relationship between atherogenesis and the unique metabolic behavior of α‐ray radiation in the large human arteries.
A Memory Assessment Technique for Use in Geriatric Psychopharmacology: Drug Efficacy Trial with Naftidrofuryl
Authors: Branconnier Roland J. , Cole Jonathan O.
Published: April 2015

This study was conducted to compare an automated test of paced stimulus material (Sperling's Perceptual Trace, SPT) with several other standard memory scales. Sixty patients with mild senile organic brain syndrome were divided into two groups of 30; one group was treated for 90 days with 300 mg daily of naftidrofuryl (Praxilene), and the other group received placebo. The patients were tested before treatment and at 30, 60 and 90 days after the beginning of treatment. The data indicated that the SPT indirectly assesses short‐term memory, is resistant to practice effects, and is drug‐sensitive. It is suggested that the SPT might become the test of choice in the indirect assessment of short‐term memory in the elderly.
Free Radical Theory of Aging: Effect of Age, Sex and Dietary Precursors on Rat‐Brain Docosahexanoic Acid†
Authors: Eddy Dennis E. , Harman Denham
Published: April 2015

Increasing the peroxidizability of dietary fat has an adverse effect on the function of the central nervous system (CNS) in the rat. This effect may be influenced by the level of docosahexanoic acid, a highly unsaturated fatty acid, selectively concentrated in the phospholipids of brain membranes. This study was aimed at determining the influence of age, sex, and the nature of a dietary lipid supplement – linolenic acid (18:3ω3), docosahexanoic acid (22:6ω3), or the same amount of 22:6ω3 in the form of menhaden oil triglycerides — on the rate of increase in the percentage of 22:6ω3 in the whole‐brain fatty acids of rats between the ages of 1 and 12 months. The dietary lipid supplements were reflected in linear increases in the brain 22:6ω3 of female rats throughout the study. Between 6 and 12 months of age, the rate of incorporation of dietary 22:6ω3 and its precursors into the brain 22:6ω3 of male rats dropped. At 12 months it was about half that for females in the case of 22:6ω3 and menhaden oil, and about zero for 18:3ω3. It is suggested that dietary 22:6ω3 and its precursors may modify CNS function by altering membrane function and peroxidizability through changes in the concentration of 22:6ω3 in membrane phospholipids.
Procainamide‐Induced Systemic Lupus Erythematosus with Hypocomplementemia
Authors: Rao K. V. R. Mohan , Diaz Roberto , Quigley Thomas J.
Published: April 2015

Procainamide‐induced systemic lupus erythematosus (SLE) is a well recognized clinical syndrome believed to be characterized by normocomplementemia. However, in 7 cases of drug‐induced SLE recorded in the literature, hypocomplementemia was found. The present report concerns a well documented case of procainamide‐induced SLE with hypocomplementemia. The patient improved and complement values returned to normal after procainamide therapy was discontinued and replaced by digitalis and steroid therapy.
Some Risk Factors in Pathologic Aging†
Authors: Ždichynec B. , Stransky P. , Hartmann M. , Holas V. , Konrad J. , Hogen J. , Svatos Z. , Sabl J.
Published: April 2015

A clinico‐epidemiologic prevalence survey was conducted in the submountainous area of Northern Bohemia, which is distinguished by the highest proportion of aged people in Bohemian countries. It involved 6057 persons of the 70–79 age group, 1718 persons of the 80–89 age group and 139 persons of the 90+ group, plus control subjects in various other groups. In this study an attempt was made to find an effective measure of the presumed risk factors of pathologic aging in persons of the 70–105 age group. The data were analyzed by the method of coincidence of two parameters of binomial decomposition on the computer Odra. The quantity dependence of the signs was determined, and an index of the compound‐risk factor of pathologic aging was calculated. When the numerical value of the index is lower than 56.9 ± 4.36 for a group of males or 50.3 ± 3.55 for a group of females, the probability is that a given person in those groups will survive to an advanced age. The total risk is higher for the male sex. Of considerable importance are the genetic burden, external environmental causes, harmful habits, certain “civilization”. diseases, and other factors such as disturbed social contacts and defective nutrition.
The Restless Legs of a Nantucket Farmer
Authors: Freeman Joseph T.
Published: April 2015

Ekbom's syndrome of restless legs is common but not restricted primarily to the elderly. Records of familial occurrence and association with several pathologic disorders preclude exclusive age‐association. Most cases of the syndrome in the general population are seen in persons of middle or old age. Lack of awareness of the frequency of the syndrome and lack of an adequate dependable form of treatment attest the need for additional study. Historical documentation is one way of alerting the profession to the nature, frequency and lineage of a clinical disorder that requires an accepted form of amelioration. Notes from the 1870–73 diary of a Nantucket farmer are presented.
A Program of Balanced Physical Fitness in the Preventive Care of Elderly Ambulatory Patients
Authors: De Carlo Thomas J. , Castiglione Lawrence V. , Cavusoglu Melmet
Published: April 2015

A program of balanced physical fitness incorporated into a medical “team” approach to treatment contributed significantly to the general health of elderly ambulatory patients. Each week for eleven months, 13 patients were given one hour of balanced exercise and encouraged to perform it for two additional hours per week. Initial differences favoring the control group (13 subjects) in their general state of health were reversed during the exercise program. Physicians’ single‐blind assessment of the two groups resulted in significantly better health ratings for the patients who had received the therapeutic exercise program than for those who did not participate.
Signs of Sensory Deprivation versus Cerebral Injury in Post‐Hip‐Fracture Patients
Authors: Oster Claude
Published: April 2015

Patients with a primary diagnosis of “postoperative hip fracture” often have a poor prognosis because of their inability to participate in rehabilitation programs. They tend to remain in a state of physical inactivity and sensory deprivation. The signs and symptoms of head injury associated with the hip fracture may be overlooked and attributed to sensory deprivation. Thirty‐nine patients with fractured hip and 18 with multiple fractures were studied by means of electroencephalography, echoencephalography, and computer axial tomography. In 7, the findings indicated a cerebral lesion. At operation, a subdural hematoma was found in 5 patients and a tumor in 2; all but one made a dramatic recovery. Thus, after hip fracture, it is important that the patient be tested appropriately so that signs and symptoms of sensory deprivation may not be confused with those of an occult head injury. When indicated, surgical intervention may be a life‐saving process.
Incidence of Mental Illness in the Aged: Unmasking the Effects of a Diagnosis of Chronic Brain Syndrome
Authors: Ernst Philip , Badash Deena , Beran Barbara , Kosovsky Ruth , Kleinhauz Moris
Published: April 2015

A combination of three psychiatric screening tests was used to uncover the extent of affective‐psychotic symptoms, the indications of “chronic brain syndrome,” and the perceptual limitations among two selected populations of elderly persons. It was found that 25 percent of 48 residents in a home for the aged, and 9 percent of 45 members in a social club, had four or more affective‐psychotic complaints. In the former group, 75 percent had symptoms of moderate to severe “chronic brain syndrome,” versus 7 percent in the latter group. Among the residents of the home, 10 percent had serious disturbances as measured by all three tests. The significant number of affective‐psychotic symptoms found in this population with extensive manifestations classifiable as “chronic brain syndrome” indicates that this diagnosis should not be allowed to preclude regular psychiatric evaluation of these elderly patients. When a specific diagnosis is established, available treatment modalities should be provided as needed.
Sexual Psychodynamics of Aging: Urologic Perspectives†
Authors: Finkle Alex L.
Published: April 2015

The urologist is often the first clinician to whom an impotent male patient is sent. To establish an accurate composite diagnosis, the urologist must be familiar with the many emotional and organic factors influencing sexual function. Research being carried on at various centers involves efforts toward better differentiation, or linkage, of psychogenic and organic impotence. The author has previously reported acceptable rates of successful therapy of psychogenic impotency in men. The technique consists essentially of attentive listening and emotional support. Treatment usually can be accomplished within three sessions at weekly intervals–a much shorter time than that involved in other current methods. Psychogenic impotency may be treated primarily by the urologist, or he may refer the patient to an appropriate consultant. Not all patients require or will respond to the same therapeutic approach.
Speech and Hearing Problems in the Geriatric Patient
Authors: Von Leden Hans
Published: April 2015

Regardless of the physical and mental health of any elderly person, verbal communications tend to deteriorate with advancing years. A significant loss of hearing occurs in 30–50 percent of persons over age 65, and voice changes are virtually inevitable after the age of 60. These alterations in the organs of communication increase markedly in incidence and degree after age 70. Deafness is a symptom and not a disease. Presbycusis is the result of degenerative changes affecting the organ of Corti and its central connections. The effects of aging on the expressive system of human communications may take different forms, including changes in the pitch, intensity, and quality of the voice. Therapy consists of rehabilitation, substitution, and amplification for the preservation and maintenance of communications. For patients with presbycusis, rehabilitation may include speech reading, auditory training, speech improvement, hearing‐aid instruction, and guidance in social adjustment. Patients with speech and voice impairment need re‐education by a skilled speech pathologist. With the aid of communication specialists, the geriatric patient can attain a high level of satisfaction from the give‐and‐take of personal communications.
The Role of Geriatrics in a Family Practice Residency Program†
Authors: Kalchthaler Thomas
Published: April 2015

In an attempt to clarify the role of geriatrics in family practice, the program at St. Joseph's Hospital and Nursing Home of Yonkers is outlined. The objective of this Family Practice Program are: 1) to assist in identifying needs in a target population and in developing and providing services to meet these needs; 2) to train and educate the Family Practice resident in the multiple medical, social and psychiatric problems of late life; 3) to indoctrinate this resident in the unique and numerous needs of the institutional elderly and of the institution in which they reside; and 4) to develop new and comprehensive systems of health care that will permit the marginally ill elderly to remain in the community as long as possible.
Rest: Its Use and Abuse in the Aged†
Authors: Goldman Ralph
Published: April 2015

Rest is essential, even though its exact physiologic functions and quantitative requirements are far from clear. Sleep appears to be the primary and most imperative form of rest. The nature, the role, and the necessity for rest as simple relaxation and leisure are elusive and poorly defined. The rejuvenating effects of leisure and diversion are apparent, over and above the pleasure and enjoyment they bring to life. Absolute rest has in the past been an important component of therapy for disease and injury. Relatively recent evidence that bed rest may prolong invalidism and contribute to complications, combined with the development of more specific therapies, has reduced both the necessity and prescription for bed rest. However, it should be emphasized that the data are incomplete, and in some situations such as myocardial disease or hepatitis, there is no final proof that early activity does not have late effects. This article presents a perspective and a classification that can serve as a more precise and restrictive context in which the concept of rest can be used and prescribed. Further study is necessary to establish whether rest which is not sleep, not diversion, nor a discredited prescription of immobility, is physiologically or psychologically valid, and to determine a more precise measure of required “dosage.”
Regression of Metastatic Hypernephroma
Authors: Dubrow Edward L.
Published: April 2015

A 71‐year‐old woman had massive pulmonary metastases from a right hypernephroma, as shown by a chest roentgenogram. Nine days after nephrectomy, there was no roentgenographic evidence of such metastases. This represents the most rapid regression of clear‐cell pulmonary metastases ever reported. Metastases reappeared six months postoperatively and the patient died of widespread metastatic disease 18 months after nephrectomy. The unpredictable behavior of metastatic hypernephroma is discussed.
Proceedings of the American Geriatrics Society Conferences on Geriatric Education
Authors: Reichel William
Published: April 2015

Two Conferences on Geriatric Education have been conducted by the American Geriatrics Society with contractual support from the National Institute on Aging. At the first Conference, an Advisory Committee defined various models and strategies of geriatric education, which were then presented to representatives of major physician organizations at the second Conference. The Final Recommendations which emerged from the meeting of March 4–5, 1977 threw additional light on this important subject. The Conferences represent the first major attempt at clarifying alternative models and strategies in relation to geriatric education. The American Geriatrics Society intends, through its future conferences, publications, and liaison relationships with other organizations, to continue to move forward, finding solutions which will improve education related to geriatrics, and thus improve the health care of the senior citizens of this nation. (A Summary of the Final Recommendations appears in the current Journal “Contents.”)
Three Score and Ten Plus More†
Authors: Stare Fredrick J.
Published: April 2015

The elderly in our society are required to make many social and psychologic adjustments. In addition, they have to cope with the inevitable physiologic changes associated with the aging process. These alterations in lifestyle and in body functioning call for modified dietary patterns during this phase of life. In particular, older persons should reduce caloric intake while maintaining a highly nourishing diet. Other recommended dietary modifications include a shift toward smaller meals eaten more frequently, and the use of generous amounts of fiber and liquid to avoid constipation. As a result of growing community awareness, some programs have been started to assist the elderly in overcoming problems that may cause poor nourishment.
Perceptions of Urban versus Rural Hospital Patients about Return to Their Communities†
Authors: Costello T. Patrick , Pugh Richard C. , Steadman F. Bruce , Kane Rosalie A.
Published: April 2015

During a two‐month period in 1976, male patients scheduled to be discharged from two Veterans Administration Hospitals, who were aged 55 or older, chronically ill, able to communicate rationally, and had been hospitalized at least a week for the current illness, were interviewed prior to discharge. Information was sought regarding their feelings about admission and discharge, the availability of and their need for 13 related health‐related services at home, and the informal support systems available to them in their local communities. Comparisons were made between patients from distinctly rural settings (communities with less than 5,000 population) and those from larger towns or cities. Both urban and rural patients were modest in assessment of their own health‐related needs, especially their need for social and ancillary health services. In almost all instances, the perceived availability exceeded perceived needs. Rural dwellers reported somewhat less apprehension about entering the hospital; they also reported more social contact in their home communities despite the fact that in this sample the rural dwellers were more likely to be older, widowed, and living alone. Rural dwellers were slightly more likely to have their own family doctor.
Thyroid Function Tests in Elderly Hyperthyroid Patients
Authors: Caplan Robert H. , Glasser James E. , Davis Kent , Foster Linda , Wickus Gary
Published: April 2015

Several tests of thyroid function were performed in 35 hyperthyroid patients over the age of 65 (elderly). The results were compared to those of similar tests in 48 hyperthyroid patients under the age of 65 (young). Total serum thyroxine (T4) was within the normal range in 14 per cent of the elderly and 11 percent of the young hyperthyroid patients. The free thyroxine index (FTI) was within the normal range in 11 percent of both groups. The triiodothyronine uptake (T3U) proved to be a poor test in both groups. Although elevation of the triiodothyronine (T3) level allowed a diagnosis of “T3‐toxicosis” in 2 elderly and 3 young hyperthyroid patients, the T3 level was normal in 34 percent of the elderly and 13 percent of the young subjects. Correction of the T3 range for age reduced the number of normal T3 values to 12.5 percent in the elderly hyperthyroid patients. The 24‐hour uptake of radioactive iodine was normal in 12 percent of the young hyperthyroid patients, 27 percent of the elderly patients with Graves' disease, and 70 percent of the elderly patients with toxic nodular goiter, despite recent readjustment of the normal range for the test. It is concluded that the diagnosis of hyperthyroidism in the elderly may be difficult and that no single test can be relied upon to exclude the diagnosis.
Hyaluronuria in a Case of Progeria (Hutchinson‐Gilford Syndrome)
Authors: TOKUNAGA M. , WAKAMATSU E. , SATO K. , SATAKE S. , AOYAMA K. , SAITO K. , SUGAWARA M. , YOSIZAWA Z.
Published: April 2015

A classic case of progeria (Hutchinson‐Gilford syndrome) in a 9‐year‐old Japanese boy is presented. The characteristic clinical features in this patient were similar to those reported in the literature. The total amount of acid glycosaminoglycans excreted in the urine was within the normal range, but there was an increase in hyaluronic acid excretion. The hyaluronuria was a novel finding in progeria, providing a common linkage with the hyaluronuria found in Werner's syndrome.
The Social Hour for Geropsychiatric Patients
Authors: CARROLL PAUL J.
Published: April 2015

This study was an attempt to evaluate the effects of a controlled alcohol intake on the socialization of a group of geropsychiatric patients in a clinical setting. Although 47 patients of the Geriatric Unit were involved at various times, 16 remained in the study for the entire eight weeks. The Social Hour consisted of a half‐hour session every weekday. The alcohol served was whisky, gin, vodka, and wine. Soft drinks were available for those who preferred them. Each patient was rated on a 5‐point scale with regard to ward and off‐ward activities. A planned four‐week placebo period met with so much negativism that it had to be shortened to three days. According to our observations, the socialization process was increased significantly for these mentally ill geriatric patients during this type of Social Hour.
Etiology of Primary Osteoporosis: An Hypothesis
Authors: SANDLER RIVKA BLACK
Published: April 2015

By convention, osteoporosis has been described in two categories: 1) primary (involutional or postmenopausal), and 2) secondary, in association with a wide variety of pathologic disorders. Primary osteoporosis is the ultimate consequence of progressive bone loss, which starts in the middle of the fourth decade. Given the apt name of “adult bone loss,” it is considered to be a universal phenomenon in that it afflicts all people of all races and both sexes. However, careful analysis of past studies generates evidence that not every person of advanced age loses bone. The etiology of “adult bone loss,” and thus of primary osteoporosis, is conceded to be unknown or at least controversial. Nevertheless, the complex dependencies of bone metabolism on the functional integrity of major organ systems imply a multifactorial etiology. The age‐related progressive declines in functional reserves of major organ systems may indicate that primary osteoporosis evolves secondarily to a protracted suboptimal metabolic support of bone remodeling. Further confirmation of this hypothesis may have important implications for the prophylactic management of primary osteoporosis.
Bromide Intoxication in the Elderly
Authors: RASKIND MURRAY A. , KITCHELL MARGARET , ALVAREZ CARROL
Published: April 2015

Four patients with dysfunction of the central nervous system secondary to bromide intoxication are reported. Three of them were referred because of symptoms of “senility,” which appeared to preclude further independent living. After diagnosis and treatment of the bromism, they were able to continue living at home. The development of bromide toxicity with relatively low serum bromide levels in the elderly is discussed. The importance of a home visit to establish the diagnosis of drug‐induced cognitive dysfunction is emphasized.
Primary Empty Sella Syndrome and Bipolar Affective Illness: Case Report
Authors: MEHTA DINESH , MEHTA SHOBHANA , MATHEW POYANIL
Published: April 2015

This report concerns an elderly woman with primary empty sella syndrome and bipolar affective illness. She had no endocrine, visual, or neurologic dysfunction and had received electroconvulsive therapy with no long‐term adverse effects. Remission of the affective illness has been maintained for five years with lithium carbonate therapy.
Nursing Home Medication Costs
Authors: HOWARD JOHN B. , STRONG KENNETH E. , STRONG KENNETH E.
Published: April 2015

The cost of discarded drugs at a level‐IH nursing home was calculated for a four‐year period. A significant percentage of the cost seemed to be the result of poor prescribing practices. Prescriptions for antibiotics and for psycho‐tropic drugs (particularly PRN orders) are discussed in some detail. Medication policies were developed to improve physicians' prescribing habits in order to reduce these costs without jeopardizing the quality of care.
Lactulose Syrup Assessed in a Double‐Blind Study of Elderly Constipated Patients
Authors: SANDERS JACK F.
Published: April 2015

The laxative effects of 50% lactulose syrup and 50% glucose syrup were compared in a 12‐week, double‐blind study of 47 elderly constipated patients living in a nursing home. The dosage was 30 ml daily taken at bedtime; it was reduced to 15 ml if the initial dosage produced two or more bowel movements daily. The number of bowel movements during treatment in comparison to pretreatment was significantly increased in the 42 patients (19 lactulose, 23 glucose) who completed at least 8 weeks of the study. Lactulose was superior to glucose in the mean number of bowel movements per day (p < 0.02) and in the percentage of days in which at least one bowel movement occurred (p < 0.05). Reduction in the severity of each of 5 symptoms (cramping, griping, flatulence, tenesmus, bloating) was greater with lactulose. For relief of all 5 symptoms, lactulose was significantly more effective than glucose (p < 0.04). The striking reduction in the number of fecal impactions (only 6 in the lactulose patients vs 66 in the controls) was highly significant (p < 0.015). The lactulose patients needed fewer enemas than did the controls. No abnormal values were observed in laboratory tests.
Non‐Threatening Mental Testing of the Elderly
Authors: Comfort Alex
Published: April 2015

Heavyhanded mental testing as part of a geriatric admission examination may seriously prejudice subsequent psychotherapy by the physician, and is unnecessary for the basic intended purpose. Most questions of importance in determining orientation are already part of normal casetaking. Those which are not are least threatening to the patient's morale when included as components of an examination of the central nervous system. This division agrees with the premise that only those persons unable to answer informational questions are likely to prove unable to answer orientational questions.
The Evolution of Geriatric Medicine*
Authors: BROCKLEHURST J. C.
Published: April 2015

ABSTRACT: The evolution of geriatric medicine has been associated with increasing knowledge about aging — social, psychologic and biologic — and its effect on the clinical presentation of illness. It also has been associated with varying patterns of the historical development of medical care in different countries. Overall, two main forms of geriatric medicine are developing worldwide — one an accredited specialty practiced within a State medical service, the other based in large hospitals for the aged where physicians train themselves but are not accredited. The system of geriatric care in Great Britain is described and the importance is emphasized of: 1) assessment before admission, 2) progressive care of the patient, and 3) the day hospital. Future developments in relation to internal medicine and family practice are considered. Research into the causes of atheromatous vascular disease and senile dementia is of fundamental importance for the whole future of geriatric medicine.
Significance of High‐Density Lipoprotein Cholesterol*
Authors: THOMPSON PAUL , BORTZ WALTER M.
Published: April 2015

ABSTRACT: The central importance of elevated blood cholesterol levels in the process of atherosclerotic heart disease (ASHD) is firmly established. Cholesterol is transported in the blood in conjunction with protein as a lipoprotein complex. The low‐density lipoproteins (LDL) carry the bulk of the blood cholesterol. The high‐density lipoproteins (HDL) occur in much smaller amounts. Recently it has been demonstrated that not only is the cholesterol carried in the HDL fraction not harmful, but appears to be protective against the development of ASHD. Data from Framingham and elsewhere seem consistent with this observation. The HDL apparently represent the fraction concerned with the efflux of cholesterol from the tissues, so that higher levels may represent a heightened cholesterol‐riddance mechanism. Thus far, two circumstances seem to be associated with elevated levels of HDL— physical exercise and ethanol ingestion. The importance of these observations in the clinical management of the patient at risk is discussed.
Duodenal Stump Tumor
Authors: GOLDEN RICHARD L. , SOKOL E. MARVIN
Published: April 2015

ABSTRACT: A rare case of duodenal stump tumor is described. The patient was an 84‐year‐old woman who had undergone a subtotal gastrectomy nine years previously. The polypoid tumor of the duodenal stump may have been a factor in the production of extrahepatic biliary obstruction, for which surgical treatment was required. The aged patient withstood the operation well.
Senile‐Presenile Dementia: Follow‐Up Data on an Effective Psychotherapy‐Anticoagulant Regimen*
Authors: WALSH ARTHUR C. , WALSH BERNICE H. , MELANEY CATHERINE
Published: April 2015

ABSTRACT: This report contains follow‐up data on the effects of an anticoagulant‐psychotherapy regimen in presenile and senile dementia. Over a two‐year period, 49 such patients who were seriously ill were treated with a Coumadin‐psychotherapy regimen; 34 (69 percent) improved (4 of them dramatically) and 15 (31 percent) did not improve or became worse. The underlying pathologic processes are discussed, with the rationale for therapy.
Problems in Rehabilitation After Age Sixty‐Five
Authors: HENRIKSEN J. D.
Published: April 2015

ABSTRACT: Of 100 patients on the Rehabilitation Service of a general hospital (New England Memorial), 75 were past 65 years of age. In this age group, recovery from illness or an accident is longer and slower, with many more complications. Rehabilitation that accomplishes independence in daily‐living skills is extremely important for the elderly and those who care for them. Of the 75 elderly in this study, 40 could be discharged to their own homes; 36 had to be transferred to extended care facilities chiefly because of complications secondary to associated disorders. Even the patients who did not attain the conference‐determined rehabilitation goal still benefited from the coordinated rehabilitation procedure. The value of rehabilitation services for the disabled elderly should not be minimized.
Serum Digoxin Levels in Elderly Nursing Home Patients: Appraisal of Routine Periodic Measurements
Authors: DIMANT JACOB , MERRIT WILLIAM
Published: April 2015

ABSTRACT: An assessment was made of the clinical value of routine periodic measurement of serum digoxin levels in 51 elderly nursing home patients with cardiac disease. The findings showed that the serum digoxin level was not correlated with the dosage of digoxin nor the patient's clinical state of digitalization. All patients were effectively digitalized, as judged clinically, and no digitalis toxicity occurred despite a wide range of serum digoxin levels. When adequate medical supervision, electrocardiograms, roentgenograms, serum electrolyte determinations and renal function tests are available, the routine periodic measurement of serum digoxin concentration does not offer any additional benefit in the management of nursing home patients with cardiac disease.
The Black Aged: A Strategy for Future Mental Health Services
Authors: CARTER JAMES H.
Published: April 2015

ABSTRACT: The younger generation of today will become the elderly of tomorrow. The qualitative differences in life experiences of blacks versus whites lead to differences in the manifestations of emotional problems. Thus the need for a special psychiatric strategy for aged blacks in the future. The problems of blacks, regardless of age, are inextricably linked with beliefs regarding illness, health and institutionalized racism. The many psychiatric ghettoes stemming from the depopulation of mental hospitals reflect poor planning and an obvious disregard for the realities of the whole life situations of elderly blacks. There should be an end to living in squalor and being the victims of muggings, rape and all forms of exploitation. Psychiatry should step forward with some careful and significant plans.
Medical Direction in Long‐Term Care
Authors: INGMAN STANLEY R. , LAWSON IAN R. , CARBONI DAVID
Published: April 2015

ABSTRACT: This report presents the views of over 1000 administrators, nurses and physicians with respect to the responsibilities, authority and impact of the medical director in a long‐term care facility (LTCF), as well as the nature and future of long‐term care and geriatric medicine in the USA. Nurses, administrators and physicians were more able to agree on the bureaucratic functions of the medical director than on the functions which might be considered more clinical or activist in terms of the total needs of the LTCF. There was no consensus about the external factors which might determine the future of LTC, i.e., alternatives to institutionalization, public attitudes or community hospital relations. Instead, concern seemed to focus upon the “low level” of funding for LTC. With respect to the nature of LTC itself, most respondents felt that the area was clinically challenging. However, only 40 percent of the physicians believed that clinical skills were more important than a sympathetic regard for patients. As a corollary, physicians were the least supportive of geriatrics as a new specialty in medicine.
Pathology of Centenarians. II. Urogenital and Digestive Systems
Authors: ISHII TOSHIHARU , STERNBY NILS H.
Published: April 2015

ABSTRACT: The urogenital and digestive systems in 23 centenarians (7 males and 16 females) were examined pathologically. In the urogenital system, macroscopic scar formation, chronic pyelonephritis and arterio‐ and arteriolosclerosis of the kidney usually were pronounced. Six instances of prostatic glandular hyperplasia were demonstrated, and three of these were associated with well‐differentiated adenocarcinoma. The testis, ovary and uterus usually showed a strong tendency toward atrophic changes. In the digestive system, senile atrophy of the liver and formation of colonic diverticula were noted. In this series of aged subjects, malignant lesions of the gastrointestinal tract were rare. It is also noteworthy that the unsuspected lesion of massive gastrointestinal hemorrhage associated with the various observed disorders might have been the cause of death in some of these centenarians.
Carcinoma of the Liver: Cytopathologic Diagnosis
Authors: GEBOES KAREL , BOSSAERT HERMAN , NIJS LUC
Published: April 2015

ABSTRACT: Primary cancer of the liver is a rare disease, especially in countries with temperate climates. It is reported to be found in only 0.3 percent of all autopsies in these countries. An exact diagnosis is not always easy, especially in the elderly. In three aged patients, cytologic examination of material obtained from the liver by aspiration after puncture with a thin needle, indicated the diagnosis. Cytologic examination of aspirated liver tissue, although it can never be a substitute for biopsy, may be very useful not only in diagnosis but in monitoring the treatment of obstructive jaundice in elderly patients.