bluuebunny/crossref_metadata_2025 huggingface dataset:
State Initiatives in Geriatric Education
Authors: Weiler Philip G. , Orgren Rosemary A. , Smukler Charles
Published: April 2015

Although the basic requisites of curricula in geriatrics and gerontology have been well developed, and the need for such programs is well established, the support for development of geriatric academic programs has not been commensurate with the need. Barriers to the development of such programs include ageism, financial disincentives., scientific underdevelopment, a dearth of trained faculty, the lack of institutional support, and the declining federal role.

One attempt to overcome these barriers and address the tremendous need is the development of state initiatives. In the last decade, several state legislatures have begun to provide support for geriatric education. The purpose of this paper is to analyze the initiatives of state funded university programs in geriatrics and gerontology, with particular emphasis on the California experience.

A survey involving 50 states was conducted using two rounds of structured telephone interviews. The survey results found that 44 states did not have any legislatively initiated support for geriatric programs in higher education. Six states did have such programs, they included: Ohio, North Carolina, Kansas, New York, Kentucky, and California. The components of the California program are discussed in further detail. The conclusions were that although these states provide paradigms for the rest of the nation, much more still needs to be done. Several issues raised by the state programs are discussed.
Assessing Health Differences in an Elderly Population: A Five‐year Follow‐up
Authors: Minkler Meredith , Langhauser Carol
Published: April 2015

A sample of several hundred elderly residents of Alameda County was recontacted after 5 years to determine the effects over time of different social support and demographic variables on health status.

The follow‐up investigation demonstrated a strong relationship between respondents' social support resources in 1980 and their subsequent self‐rated health. Indeed, social contacts in 1980, together with age and financial need, enabled us to correctly “predict” respondents' subsequent health status in close to two‐thirds of the cases. As anticipated, however, the variable most strongly associated with self‐rated health in the earlier cross‐sectional study — illness of a mate during the preceding 6 months — disappeared as a predictor variable in the longitudinal study. This finding is in keeping with the literature on bereavement and other stressful life events which demonstrates that the health impact of such stressors is in most cases time‐limited.

The study findings support earlier research demonstrating the important role of social support for health maintenance and disease prevention in the elderly. They further underscore the need for intervention strategies designed to strengthen the network resources of those elders at high risk for social isolation.
AIDS as a Cause of Dementia in the Elderly
Authors: Weiler Philip G. , Mungas Dan , Pomerantz Sandy
Published: April 2015

It has been recognized that AIDS can present initially as dementia without other neurological or clinical manifestations. In addition, HIV‐contaminated blood transfusions in the elderly seem to be underreported. Because of these findings, dementia in the elderly may be misdiagnosed as Alzheimer's disease or other causes of senile dementia. This paper reports on one patient who presented with a diagnosis of Alzheimer's disease and was later found to have AIDS.
Risk Factors for Dehydration Among Elderly Nursing Home Residents
Authors: Lavizzo‐Mourey Risa , Johnson Jerry , Stolley Paul
Published: April 2015

Dehydration is the most common fluid and electrolyte disorder among the elderly, yet risk factors are not known. This study identifies risk factors for dehydration in acutely ill nursing home residents. All 339 elderly residents of two nursing homes who developed an acute illness requiring hospitalization during 1984 were included in the study. The 173 patients having a serum Na < 150 mg/dL and blood urea nitrogen to creatinine ratio (BUN:Cre) < 20 were designated controls; 91 patients having a serum Na > 150 mg/dL or a serum BUN:Cre > 25 were designated cases. Odds ratios (OR) and confidence intervals were calculated for age, sex, chronic conditions, acute illnesses, medications, functional status measures, and season. Acutely ill dehydrated patients were female (OR, 3.3); over 85 years old (OR, 2.2); had more than four chronic conditions (OR, 4.0); took more than four medications (OR, 2.8); and were bedridden (OR, 2.9). Among the most severely dehydrated (serum Na > 150 mg/dL and BUN:Cre > 25), the odds ratios for the above factors were strengthened and other factors, such as inability to feed oneself and type of acute diagnosis, emerged as risk factors. Among the variables unrelated to functional status, laxatives (OR, 3.2) and chronic infections (OR, 1.8) were risk factors. We conclude that a group at high risk for dehydration can be defined and that they are better characterized by the number of chronic diseases and debilitated functional status than by acute disease processes.
Evaluation of Chemstrip LN® in a Male Geriatric Population
Authors: Gelbart S. M. , Prabhudesai M. M.
Published: April 2015

A dipstick method for bacteriologic screening of urine using a combination of leukocyte esterase and nitrite indicators, Chemstrip LN®, was evaluated in a male inpatient geriatric population. Three hundred seventy‐five urine samples from 198 symptomatic patients (age range, 45 to 98 years; mean, 69.6) were tested by LN and cultured using standard methods. LN showed 169 negatives, but in 7 of these cases, the culture was positive (≥5 × 104 col/mL). Organisms recovered from these cultures were Candida (not albicans), Group B Streptococcus, Staphylococcus aureus, and in four cases, Pseudomonas aeruginosa. In the four cases of missed Pseudomonas the patients were receiving aminoglycoside therapy for 2 to 6 days and/or drugs that dye the urine. Despite the fact that many patients were on medications known to interfere with the test strips, the negative predictive value was still 96.0% showing that the strips may be suitable for use with this population given the understanding that certain antibiotics and/or substances that dye the urine may give false negative results.
Psychotropic Drug Practice In Nursing Homes
Authors: Buck Jeffrey A.
Published: April 2015

This study examined the administration of psychotropic medication to Medicaid recipients who resided continuously in an Illinois nursing home during 1984. Of these residents, 20,037 (60%) received at least one such medication during the year, with administration most likely for those from the ages of 45 to 74 years. Haloperidol, thioridazine, and flurazepam were the most frequently prescribed drugs of those examined.

The study also investigated the relationship of demographic and institutional variables to the probability of drug administration and the amount administered. These variables were most strongly related to the probability of antipsychotic, antiparkinson, and antimanic (lithium) administration. The association of these variables with the amount of drug administered was strongest for antimanic and antipsychotic medications, particularly the latter. In all analyses, the addition of institutional variables increased goodness of fit minimally over that produced by demographic variables alone. This finding supports the conclusion that the prescription of psychotropic medication is more influenced by individual patient characteristics than by the nature of the institutional setting in which the patient resides.
Acute Effects of Exercise on Neuropsychological Function in Elderly Subjects
Authors: Molloy D. W. , Beerschoten D. A. , Borrie M. J. , Crilly R. G. , Cape R. D. T.
Published: April 2015

Fit elderly score higher on tests of fluid intelligence than aged‐matched sedentary controls. Elderly patients who have taken part in exercise programs have shown improvement in mental function. We compared the effects of 45 minutes of exercise on memory, mood, and cognitive function in elderly subjects to a control intervention using a randomized control study design. Neuropsychological tests employed where the color slide test, digit symbol test, digit span test, logical memory test, word fluency test, and the Mini‐Mental State Examination. We measured mood using a mood test and geriatric depression scale. Each subject was tested before, and immediately after, control and exercise sessions. Fifteen elderly subjects [ten men and five women; mean age, 66 years, (range, 60 to 85 years)] completed the study. There was a greater improvement in six of the eight scores of cognitive function following exercise, compared to control. These differences were significantly greater following exercise for the logical memory test score (P ≤ 0.02) and Mini‐Mental State Examination (P ≤ 0.025) compared with the control intervention.
Predictors of Immediate and 6‐Month Outcomes in Hospitalized Elderly Patients
Authors: Narain Prakash , Rubenstein Laurence Z. , Wieland G. Darryl , Rosbrook Brad , Strome L. Sandra , Pietruszka Fern , Morley John E.
Published: April 2015

This article presents results of a prospective multivariate study of hospitalized elderly patients at an acute‐care Veterans Administration (VA) hospital to identify factors on hospital admission predictive of several short‐ and long‐term outcomes: in‐hospital and 6‐month mortality, immediate and delayed nursing home admission, length of hospital stay, and 6‐month rehospitalization. All patients aged 70 years and over admitted to acute‐care beds on the medical service wards during a 1‐year period were included in the study (N = 396). Factors most predictive of 6‐month mortality (using logistic regression) were decreased functional status, admitting diagnosis, and de creased mental status. Factors most predictive of nursing home admission were decreased functional status, living location, and decreased mental status. Functional status was a stronger predictor of length of stay, mortality, and nursing home placement than was principal admitting diagnosis — of relevance to the current emphasis on diagnosis‐related groups (DRGs). These data may be helpful in improving discharge planning, in resource allocation, and in targeting patients for different specialized geriatric programs.
Troublesome and Disruptive Behaviors in Dementia
Authors: Swearer Joan M. , Drachman David A. , O'Donnell Brian F. , Mitchell Ann L.
Published: April 2015

Patients with dementia often manifest troublesome and disruptive behaviors in addition to intellectual impairments. This study evaluated behavioral disturbances in 126 demented patients examined sequentially, using questionnaires administered to primary caregivers to quantify the types and severity of behavioral disturbances. Eighty‐three percent of the patients exhibited one or more of the targeted behaviors. The most common troublesome and disruptive behaviors clustered into three categories: aggressive, ideational, and vegetative. The prevalence and severity of the behaviors increased with global severity of dementia, but did not differ in either frequency or type when patients with three diagnoses were compared: Alzheimer's disease (AD), multi‐infarct dementia (MID), and mixed AD and MID (MIX). The occurrence and severity of the target behaviors correlated modestly with the severity of dementia. Impairments of mental status correlated weakly with only a single troublesome and disruptive behavior—assaultiveness.

These results suggest that troublesome and disruptive behaviors are a very frequent component of dementing disorders, are related to disease severity, and parallel (but are probably not determined by) intellectual deficit.
The Aging Driver Medicine, Policy, and Ethics
Authors: Reuben David B. , Silliman Rebecca A. , Traines Mark
Published: April 2015

With the graying of America, more older persons will be driving. Physiological changes associated with normal aging and diseases that commonly affect the elderly may compromise their ability to drive safely. Although all states have regulations governing driving licensure, few offer specific guidelines regarding older persons. Accordingly, much of the responsibility for determining medical competence to drive and counseling patients in this regard is left to physicians.

Normal physiologic changes may limit sensory information, particularly visual, available to the driver. In addition, chronic diseases in older persons including coronary artery disease, dementia and other neurologic disorders, diabetes mellitus, and drug use may increase the risk of crashes while driving. Once the question of competence to operate an automobile has been raised, ethical dilemmas must be addressed regarding the benefit of continued driving for the individual versus the risk to that person and society as a whole.

In this article, we review the medical grounds for determining competence to drive, discuss ethical implications, and report current legal regulations for physicians and aging drivers. Future directions and possible areas for further research are outlined.
Depression in Family Members Caring for a Relative With Alzheimer's Disease
Authors: Cohen Donna , Eisdorfer Carl
Published: April 2015

The reformulated learned helplessness model of depression was tested in a study of families caring for relatives with Alzheimer's disease who did not participate in family support groups or have access to respite care. Family members who identified themselves as major caregivers, ie, those providing daily assistance to the patient, received a clinical psychiatric interview, the Beck Self‐Report Depression Scale, and a modified Hammen and deMayo Attributional Style Questionnaire. The results showed that 55% of major caregivers, primarily spouses, living with an older relative with dementia experienced clinical depression. Depressed caregivers were more likely to perceive a lack of control over their situation than those who were not depressed. Contrary to the reformulated learned helplessness hypothesis, they did not perceive their situation to be the result of internal, stable, and global attributions. The results suggest the need to study depression in ecologically stressful natural settings and to develop effective clinical intervention strategies.
Severe Illness in Older Patients: The Association Between Depressive Disorders and Functional Dependency During the Recovery Phase
Authors: Harris Rosemary E. , Mion Lorraine C. , Patterson Marian B. , Frengley J. Dermot
Published: April 2015

An association between depression and physical dependency arising from a recent illness has been generally accepted. To clarify this relationship over time, 30 medical rehabilitation patients aged 54 to 94 years were assessed 1 week after admission and at discharge to quantify symptoms of depression, physical dependency, and cognitive functioning using the Hamilton Depression Scale (HAM‐D), the Geriatric Depression Scale (GDS), the Barthel Index for physical function, and the Mini‐Mental State Examination (MMSE). Significant depressive symptomatology was found by HAM‐D in 25 patients on admission and 14 on discharge. No significant associations were present between either admission or discharge depression scores and all other variables. The HAM‐D change score was significantly correlated with the Barthel change score (r — 0.57, P < 0.001) and with the MMSE change score (r = 0.48, P = 0.01). All patients whose mood improved also improved in physical functioning, whereas 75% of those whose mood did not improve failed to make headway in physical functioning. This implies that it is not the degree of physcial incapacity but rather the failure to regain prior abilities which is strongly associated with persisting depression following a catastrophic illness. Furthermore, characteristics found commonly in the group whose mood did not improve included physicians' failure to diagnose and treat depression or a setback from a significant medical or surgical complication.
The Prevalence and One‐year Outcome of Limb Arterial Obstructive Disease in a Nursing Home Population
Authors: Paris Barbara E. Cammer , Libow Leslie S. , Halperin Jonathan L. , Mulvihill Michael N.
Published: April 2015

To assess the utility of bedside diagnostic measures to detect prognostically significant peripheral vascular disease, we examined 60 nursing home residents by physical examination, Doppler sphygmomamometry and pneumatic oscillometry, and recorded the clinical history. Eighty‐eight percent of the cases had tibial/brachial arterial systolic pressure indices below 0.95, the lower limit traditionally considered normal. Yet, no more than 5% of the patients carried a previous diagnosis of peripheral vascular disease or had intermittent claudication, leg ulcers or gangrene. Approximately half of the patients had tibial/brachial pressure indices less than 0.7, and one year later in these cases, there was significantly greater morbidity and nearly twice the mortality of patients with less severe disease. We conclude that simple bedside diagnostic tests of arterial disease used in this study discloses a high prevalence of disease in institutionalized elderly patients and identifies a group at particular risk for morbid complications.
High‐Dose Naloxone in Older Normal Subjects: Implications for Alzheimer's Disease
Authors: Tariot Pierre N. , Gross Michael , Sunderland Trey , Cohen Martin R. , Weingartner Herbert , Murphy Dennis L. , Cohen Robert M.
Published: April 2015

The behavioral and cognitive effects of naloxone HCl, in doses of 5 μg/kg, 0.1 mg/kg, and 2.0 mg/kg administered as an IV bolus, were assessed in a double‐blind, placebo‐controlled, randomized study of eight normal subjects ranging in age from 44 to 74 years (mean 63). Naloxone produced mild behavioral effects with slight cognitive impairment after the 2.0 mg/kg dose only. The threshold, dose dependency, characteristics, and magnitude of these behavioral effects were similar to what has previously been reported in young normal subjects, but markedly different from those observed in patients with dementia of the Alzheimer type (DAT) matched in age to the current study sample. These data suggest that the metabolic fate of naloxone is not substantially affected by age within the range studied. The findings of this study provide further support for a role for endogenous opiate systems in the modulation of behavior and cognition, and suggest that the unusual behavioral sensitivity of patients with DAT to naloxone cannot be accounted for by the effect of age.
Education to Assist Spouses in Coping with Alzheimer's Disease A Controlled Trial
Authors: Chiverton Patricia , Caine Eric D.
Published: April 2015

This study investigates whether a brief educational program, provided to spouses of patients with Alzheimer's disease, improved the caregivers' coping skills; it also questions whether the gender of the spouse had an effect on coping ability. The sample consisted of 40 spouses who were caring for the Alzheimer patient at home, 20 who participated in the educational program, and 20 controls. The instrument used for the study was the Health Specific Family Coping Index (HSFCI). This instrument provided a quantitative assessment of overall family coping with both potential and actual health problems in the psychosocial and physical domains of health. It is rated in nine domains: physical independence, therapeutic competence, knowledge of the condition, application of principles of personal hygiene, attitude toward health care, emotional competence, family living patterns, physical environment, and use of community resources. A home visit was made by a registered nurse prior to the educational intervention and at the end of the four‐week intervention period. The HSFCI was completed at each visit. There were no pretreatment differences between the intervention and control groups in coping ability. Findings indicate that the educational program was beneficial in assisting spouses to feel greater competence in the face of the disease process and to function with greater independence. In the treatment group, the greatest significant increase was in the knowledge domain, followed by therapeutic competence and emotional competence. There was no overall relationship between gender of the spouse and coping ability.
An Approach to Assessing the Reliability of Anthropometrics in Elderly Patients
Authors: Sullivan Dennis H. , Patch Gillian A. , Baden Alice L. , Lipschitz David A.
Published: April 2015

Although anthropometrics have traditionally been utilized in the assessment of protein‐energy malnutrition, little is known of the reliability of these measurements in elderly patient populations. In this study, the reliability of an anthropometric measurement protocol, designed for ease in measurement of both independent and functionally debilitated elderly patients, is evaluated. An analysis of variance technique was used to calculate the test‐retest variance for each of three observers. Although the experience of the three observers was equivalent, the precision of their measurements varied considerably. After repeat practice sessions, improved measurement reliability was demonstrated. For all the observers, the test‐retest variance was found to be proportional to the size of the measurement and to be influenced by the accuracy in which the site for each measurement was located. Based on this study, we conclude that when using anthropometrics it is important to know the reliability of each observers' measurements. Because of the correlation between the test‐retest variance and the measurement value, we suggest that the variance be expressed as a percentile. A method for transforming the variances is presented.
Financing Long‐Term Care The Growing Dilemma
Authors: Pawlson L. Gregory
Published: April 2015

The financing of long‐term care is one of the largest and most vexing health care problems facing our society. The problem will be further exacerbated when the rate of growth in the number of persons needing long‐term care is further accelerated by the graying of those in the “baby boom” generation. The current financing mechanism, which relies almost entirely on concurrent funding through either a means tested welfare program (Medicaid) or self‐pay, is inequitable and inadequate even for our present needs. Despite the magnitude of the problem, only recently has sufficient attention been focused on finding alternatives to the current means of financing long‐term care. The search for a solution has been hampered by multiple, and sometimes conflicting, policy and political considerations. After reviewing the demographic and social roots of our current dilemma and listing the major alternatives for financing long‐term care, a series of basic principles and definitions are reviewed. These elements are meant to serve as guidelines to compare and evaluate the growing number of proposals which seek to create a more effective and equitable system for financing long‐term care. Future articles in this section will detail some of the more promising approaches to the dilemma of financing long‐term care.
Tying Down the Elderly
Authors: Evans Lois K. , Strumpf Neville E.
Published: April 2015

The apparently widespread practice of physical restraint of the elderly has received little systematic research, despite reported clinical awareness of its iatrogenic effects on frail elders. Prevalence rates in various settings range between 6% and 86%, with cognitive impairment an important risk factor for restraint. Despite strongly held beliefs, efficacy of restraints for safeguarding patients from injury has not been demonstrated clinically. This paper reviews the current status of knowledge regarding physical restraint use with the elderly and suggests a research agenda and implications for ethical practice.
The Renin‐Angiotensin System Normal Physiology and Changes in Older Hypertensives
Authors: Hall John E. , Coleman Thomas G. , Guyton Arthur C.
Published: April 2015

The long‐term effects of angiotensin (ANGII) on arterial pressure regulation appear to be closely linked to volume homeostasis, via the renal‐pressure natriuresis mechanism, both in normal humans and in older hypertensives. In response to disturbances such as increased sodium intake, suppression of ANGII and aldosterone formation greatly amplifies the effectiveness of the pressure natriuresis mechanism, thereby preventing large increases in body fluid volumes and minimizing the rise in blood pressure needed to maintain sodium balance. When ANGII levels are inappropriately elevated, the antinatriuretic effects of ANGII cause increased arterial pressure, which then serves to maintain sodium and water balance via the pressure natriuresis mechanism. The primary intrarenal and extrarenal mechanisms by which ANGII controls renal excretion and arterial pressure include: (1) a direct effect of ANGII on tubular sodium transport; (2) a preferential constrictor action of ANGII on efferent arterioles, which increases sodium reabsorption by altering peritubular capillary physical forces (efferent arteriolar constriction also prevents excessive decreases in glomerular filtration rate when renal perfusion is compromised, such as in renal artery stenosis); and (3) extrarenal effects of ANGII, including stimulation of aldosterone secretion. Current evidence suggests that the direct effects of ANGII on the kidney are quantitatively more important than indirect effects mediated by aldosterone. In older hypertensives, plasma renin activity and aldosterone concentration are often suppressed, perhaps due to loss of functional nephrons and increased sodium chloride delivery to the macula densa of the remaining nephrons. The observation that converting enzyme inhibition lowers arterial pressure in older hypertensives, even when plasma renin activity is normal or slightly reduced, suggests that even small amounts of ANGII may be important in maintaining arterial pressure.
BOOK REVIEWS
Authors: Heller Warren
Published: April 2015

The Elderly: Victims and Deviants. Edited by Chamber CD, Lindquist JH, White OZ, and Hartner MT. Athens, Ohio, Ohio University Press, 1987. 219 pages. Hardcover $39.95. Softcover $19.95.
Constipation in the Elderly Living at Home
Authors: Whitehead William E. , Drinkwater Donald , Cheskin Lawrence J. , Heller Barbara R. , Schuster Marvin M.
Published: April 2015

The prevalence of self‐reported constipation and the factors which contribute to it were investigated in a door‐to‐door survey of 209 people aged 65 to 93. Thirty percent of men and 29% of women described themselves as constipated at least once a month. However, elderly people define constipation differently than do their physicians: only 3% of men and 2% of women in the community sample reported that their average stool frequency was less than three per week, the customary medical criterion for constipation. The primary symptom which elderly people used to define constipation was having to strain in order to defecate. Multiple factors were found to influence self‐reports of constipation. The amount of liquids consumed was significantly related to longest period without a bowel movement in men, but fiber and liquids were not related to self‐reported constipation in either sex. The number of chronic illnesses and the number of nonlaxative medications were significantly related to constipation in women but not men, and the number of psychological symptoms correlated significantly with self‐reports of constipation in both men and women. Age was not significantly related to self‐reported constipation in men or women over the age of 65.
Methods Used to Manage Urinary Incontinence by Older Adults in the Community
Authors: Herzog A. Regula , Fultz Nancy H. , Normolle Daniel P. , Brock Bruce M. , Diokno Ananias C.
Published: April 2015

This paper addresses the ways that noninstitutionalized older adults deal with involuntary urine loss. The data come from a 1983–1984 sample survey of Washtenaw County, Michigan residents aged 60 and over. Five hundred twelve self‐reported incontinent respondents are included in the analyses. About a quarter of the incontinent respondents had discussed their condition with a doctor in the previous year, while 66% used one or more methods to control urine loss. Respondents preferred using absorbent products (47% of those who used some method) and locating a toilet upon reaching a destination (42%). Fewer respondents manipulated their voiding patterns (29%) or diet and fluid intake (17%), or did pelvic muscle exercises (10%). Only 7% were taking medication for their incontinence. Logistic regression analyses were performed to identify factors associated with the choice of actions. Predictors were taken from theoretical models of health service utilization and health behavior, and included predisposing characteristics, health beliefs, enabling factors, and illness variables. Illness variables, particularly severity and type of incontinence, were the best predictors of consultation with a doctor and use of any urine control method. The predictors were less useful for understanding the choice of a specific method.
Chronic Salicylate Intoxication
Authors: Bailey Robert B. , Jones Stephen R.
Published: April 2015

We reviewed the clinical profile of adults with chronic salicylate intoxication by evaluating the experience of our community teaching hospital between 1977 and 1987. Data on similar patients reported was obtained from an English‐language literature search using MEDLINE (1966–88) and bibliographic reviews of textbooks and review articles. We also examined the impact of education and incentive on increasing the awareness and ability of physicians to diagnose the disorder. Chronic salicylate intoxication was defined by 1) a compatible clinical syndrome; 2) a serum level in the toxic range; and 3) improvement with withdrawal of the drug. Patients with chronic salicylism represent a cross‐section of an elderly population. Our review suggests that diminished body mass, concurrent administration of drugs and conditions which exacerbate renal insufficiency may predispose to salicylate intoxication; however, few specific precipitants of chronic salicylism were recognized. Salicylate intoxication should be considered in all elderly patients with delirium and/or dementia.
Hearing Impairment as a Determinant of Function in the Elderly
Authors: Bess Fred H. , Lichtenstein Michael J. , Logan Susan A. , Burger M. Candice , Nelson Eugene
Published: April 2015

This clinical, practice‐based study explores the research question: Is there a relationship between hearing loss and functional disturbance in elderly patients? We analyzed the impact of hearing impairment on 153 patients over 65 years of age screened in primary care practice. Functional and psychosocial impairment were measured using the Sickness Impact Profile (SIP), a standardized measure for assessing sickness related dysfunction. Hearing level was determined with pure tone audiometry.

Multiple linear regression was used to adjust for patient case‐mix differences and other clinical variables. After adjustment, a 10 dB increase in hearing loss was found to result in a 2.8 point increase in Physical SIP scores (95% confidence interval = 1.8–3.8), a 2.0 point increase in psychosocial SIP scores (95% confidence interval = 0.8–3.2) and a 1.3 point increase in overall SIP scores (95% confidence interval = 0.1–2.5). Poor hearing was associated with higher SIP scores and increased dysfunction. Thus, hearing impairment is an important determinant of function in the elderly.
Clinical Significance of Sleep‐Disordered Breathing in Alzheimer's Disease
Authors: Hoch Carolyn C. , Reynolds Charles F. , Nebes Robert D. , Kupfer David J. , Berman Susan R. , Campbell Donna
Published: April 2015

In a study of 15 probable Alzheimer's patients and 12 healthy elderly control subjects, Alzheimer's patients had a significantly higher apnea index (patients versus controls, mean ± SD: 6.3 ± 6.6 vs 1.8 ± 2.7, P < .05) and greater maximal duration of apnea (patients versus controls, median: 50.0 vs 28.5 seconds, P < .001), but no significant increase in oxyhemoglobin desaturation compared with controls. (The accepted normal threshold for abnormality is an apnea index more than 5.) Although three of seven psychometric tests (odd‐even, category retrieval, face‐hand test) showed diurnal effects on one or more of their subscores, with Alzheimer's patients having significantly poorer scores at the AM than at PM testing, overnight change scores in the psychometric tests were not significantly correlated with severity of sleep‐disordered breathing. Further, only 18.1% of the disruptive (ie, requiring intervention) nocturnal behaviors of the Alzheimer's patients were temporally linked to sleep‐disordered breathing. The current data suggest that sleep‐disordered breathing in nonmedicated Alzheimer's patients is relatively mild and is not a predictor of either overnight mental status changes, of disruptive nocturnal behaviors, or of daytime behavioral fluctuations. Additional studies of more severely demented patients and possibly of sleeping pill effects would be useful in further evaluating the role of sleep apnea in Alzheimer behavioral changes.
Penile Encrustation Due to a Condom Catheter
Authors: Ragi Gangaram , Kalb Robert E. , Klaus Maria V.
Published: April 2015

We report a 68‐year‐old man with penile encrustation caused by a condom catheter used for urinary incontinence. High‐resolution x‐ray crystallographic analysis of the encrustation revealed struvite [MgNH4PO4. 6H2O] and apatite [Ca5 (PO4)3(OH)]. Physicians should be aware that penile encrustation may occur as a complication of condom catheter use. The problem of encrustation is discussed. A brief review of condom catheter complications is presented.
Effect of Habitual Physical Activity on Age‐Related Glucose Intolerance
Authors: Wang J.T. , Ho L.T. , Tang K.T. , Wang L.M. , Chen Y.‐D.I. , Reaven G.M.
Published: April 2015

Plasma glucose and insulin responses to a standard oral glucose challenge and a mixed meal were determined for two groups of male volunteers (office workers and laborers) and a group of female housewives or office workers. Although glucose tolerance declined with age to a certain degree in all three groups, the age‐related change varied as a function of both level of habitual physical activity and gender. Specifically, the decline in glucose tolerance was greatest in the male office workers and least in the females. The plasma insulin responses did not increase with age in any of the groups. These results suggest that glucose tolerance decreases with age because there is a decline in insulin action, which is not compensated for by an increase in insulin secretion. Insulin sensitivity appears to be enhanced in females as compared with males. Sensitivity is also enhanced in males habitually engaged in physical labor; thereby accounting for the age‐related decline being greatest in the male office workers. Finally, the results showed that although the loss of glucose tolerance with age varied from group to group, the quantitative nature of the change was modest in all three groups. These data further emphasize that very little change in glucose tolerance is associated with aging in generally healthy, nonobese individuals.
Geriatric Medicine in the United States
Authors: Siu Albert L. , Ke Gina Y. , Beck John C.
Published: April 2015

To improve the health care received by frail older persons, an effort has been made in the United States to increase the number of physicians trained in geriatric medicine and geropsychiatry. The goal of training has been to create leaders in education, research, and patient care. To assess the progress of this effort, we surveyed physicians (284 in geriatric medicine and 91 in geropsychiatry) who graduated from U.S. geriatrics fellowship programs. Responses were obtained from 224 medicine (79% response) and 59 psychiatry fellows (65% response). Sixty‐five percent of former geriatric medicine fellows report spending 10% or less time on teaching; 44% report doing no research, and 44% report spending more than half their time in patient care. Compared to other primary care specialties, the geriatricians reported caring for larger proportions of older patients and spending more time per patient visit. However, their role in teaching, research, and long‐term care is minimal.
A Further Exploration of the Use of Physical Restraints in Hospitalized Patients
Authors: Mion Lorraine C. , Frengley J. Dermot , Jakovcic Cheryl A. , Marino John A.
Published: April 2015

Four hundred twenty‐one consecutive patients admitted to an acute general medical ward and two acute rehabilitation medical wards were studied to compare the characteristics and outcomes of physically restrained patients and unrestrained patients. Restraints were used in 35 (13%) of the general medical patients and in 49 (34%) of the rehabilitation patients. The restrained general medical patients had higher mortality and morbidity rates than their unrestrained counterparts. Restrained patients had a higher prevalence of a psychiatric diagnosis, and major tranquilizers were used more than in their unrestrained counterparts in both settings. The general medical patients tended to have more than one type of restraint at a time, whereas the rehabilitation patients were restrained for longer proportions of their hospital stay. Thirty‐three percent of the restrained patients whom we were able to interview expressed negative perceptions about the presence of the physical restraints. Moreover, it was found that the presence of cognitive and physical impairments were highly predictive of restraint use in both populations.
Cognitive Function Testing in Comprehensive Geriatric Assessment
Authors: Ward Harold W. , Ramsdell Joe W. , Jackson J. Edward , Renvall Marian , Swart Jo Anne , Rockwell Enid
Published: April 2015

Tests of cognitive function are frequently used in geriatric assessment, but the effect of test setting has rarely been explored. To determine the effect of testing site on the performance of elderly patients undergoing a comprehensive geriatric assessment, we administered the Mini‐Mental State Exam to 116 geriatric patients in the clinic and at their residence. Their cognitive abilities varied from normal to severely impaired. The patients' scores were 1.5 ± 3.6 (mean ± SD) higher at their residence. The clinical importance of a difference in score of 1.5 is not clear. For this reason a second analysis was performed in which a difference in scores of five points or greater between settings was considered clinically meaningful. Twenty‐five percent (29 of 116) differed by five points or more. Of these 29 patients, 22 (76%) tested better in the residential setting. These differences were statistically significant (P = .001). We conclude that the testing site may affect test performance and that in‐home assessment may reveal the optimal cognitive function of geriatric patients.
An Objective Measure of Physical Function of Elderly Outpatients
Authors: Reuben David B. , Siu Albert L.
Published: April 2015

Direct observation of physical function has the advantage of providing an objective, quantifiable measure of functional capabilities. We have developed the Physical Performance Test (PPT), which assesses multiple domains of physical function using observed performance of tasks that simulate activities of daily living of various degrees of difficulty. Two versions are presented: a nine‐item scale that includes writing a sentence, simulated eating, turning 360 degrees, putting on and removing a jacket, lifting a book and putting it on a shelf, picking up a penny from the floor, a 50‐foot walk test, and climbing stairs (scored as two items); and a seven‐item scale that does not include stairs. The PPT can be completed in less than 10 minutes and requires only a few simple props. We then tested the validity of PPT using 183 subjects (mean age, 79 years) in six settings including four clinical practices (one of Parkinson's disease patients), a board‐and‐care home, and a senior citizens' apartment.

The PPT was reliable (Cronbach's alpha = 0.87 and 0.79, interrater reliability = 0.99 and 0.93 for the nine‐item and seven‐item tests, respectively) and demonstrated concurrent validity with self‐reported measures of physical function. Scores on the PPT for both scales were highly correlated (.50 to .80) with modified Rosow‐Breslau, Instrumental and Basic Activities of Daily Living scales, and Tinetti gait score. Scores on the PPT were more moderately correlated with self‐reported health status, cognitive status, and mental health (.24 to .47), and negatively with age (−.24 and −.18). Thus, the PPT also demonstrated construct validity. The PPT is a promising objective measurement of physical function, but its clinical and research value for screening, monitoring, and prediction will have to be determined.
Electroconvulsive Therapy in Octogenarians
Authors: Cattan Rogelio A. , Barry Patricia P. , Mead Gayle , Reefe William E. , Gay Alix , Silverman Michael
Published: April 2015

Medical records of 81 older patients (65 years of age and over) who underwent electroconvulsive therapy (ECT) at a university‐affiliated private geriatric hospital were reviewed to evaluate the safety and efficacy of this treatment for depression in the “young‐old” (65 to 80 years) compared with the “old‐old” age group (over 80 years), a group that has not yet been adequately studied.

Information was obtained regarding demographics, medical and psychiatric diagnosis, medications, indications for ECT, number and laterality of treatments, outcome, and complications. Thirty‐nine patients 80+ years of age (mean age, 85 ± 3.2) were compared with 42 patients 65 to 80 years of age (mean age, 74 ± 5.2). Statistical analysis was performed using confidence intervals of the difference in proportions of patients in each group. There were no significant differences in the demographics, number and laterality of ECT treatments, indications for ECT treatment, medical diagnosis, medications, or prior history of falls, but psychiatric diagnoses differed slightly. Patients over 80 years had significantly more cardiovascular complications and falls (95% confidence interval) and tended to have a worse ASA (American Society of Anesthesiologists) scale rating and a somewhat less successful outcome.

This study confirms the role of ECT as a relatively safe and effective treatment, which may be lifesaving in selected depressed older patients. Prospective studies are needed to understand better the long‐term outcome and to prevent the morbidity and mortality associated with ECT in this frail, high‐risk older group.
The Use of Urethral, Condom, and Suprapubic Catheters in Aged Nursing Home Patients
Authors: Hebel J. Richard , Warren John W.
Published: April 2015

In this study of 4,259 aged patients in 53 randomly selected nursing homes in Maryland, we found that 10% of women and 15% of men used a urine collection device. Among bedfast patients, 47% of women and 58% of men and, among patients with decubitus ulcers, 37% of women and 33% of men were using a urine collection device.

The indwelling urethral catheter was the most commonly used device. Indeed, for women, few other options were available: 93% of women used this device. In women, multiple logistic regression analysis indicated that presence of a decubitus ulcer and occupation of a long‐term care bed were the attributes most strongly associated with the use of the urethral catheter. Of men with urine collection devices, 43% were using the urethral catheter; poor mobility status was the characteristic most strongly associated with its use.

Long‐term urethral catheterization has been well studied and is associated with universal bacteriuria and with a number of complications. Options need to be further explored, particularly external urine collection devices for women. Furthermore, because urethral catheterization may be used as a management technique for decubitus ulcers, prevention of the latter may diminish the use of urethral catheters and their subsequent complications.
Lack of Association Between Medication Use and the Presence or Absence of Bacteriuria in Elderly Women
Authors: Tronetti Pamela S. , Gracely Edward J. , Boscia Jerome A.
Published: April 2015

This study was undertaken to determine if there is an association between medication use and the presence or absence of bacteriuria in elderly ambulatory women. Of 198 women who participated in three urine culture surveys (every 6 months) during the 18‐month study period, 66 (34.4%) had bacteriuria on at least one survey. Both univariate and multivariate analyses for the demographics, age, place of residence, and medication use (by drug class) revealed that only place of residence had a significant association with the presence or absence of bacteriuria. In this regard, bacteriuric subjects more commonly resided in the nursing home and less commonly lived in the apartment‐house complex compared with nonbacteriuric subjects (P < .05). Therefore, this study demonstrates that in elderly ambulatory women, medication use does not appear to be associated with the presence or absence of bacteriuria.
Clinically Inapparent (Asymptomatic) Bacteriuria in Ambulatory Elderly Men: Epidemiological, Clinical, and Microbiological Findings
Authors: Mims Adrienne D. , Norman Dean C. , Yamamura Rodney H. , Yoshikawa Thomas T.
Published: April 2015

In a prospective longitudinal study, ambulatory elderly men were followed from 1 to 4.5 years to gain insight into the prevalence rates, clinical characteristics, and patterns of clinically inapparent (asymptomatic) bacteriuria (CIB). The prevalence of CIB was 12% (29/238) and increases with age. Unlike the gram‐negative organisms that cause overt urinary tract infection in this age group, gram‐positive organisms dominated the CIB group. Both the CIB and abacteriuric patients have multiple chronic medical conditions and are indistinguishable on that basis. Twenty‐nine elderly men with bacteriuria and 105 abacteriuric subjects were followed with serial urine cultures. During the study period the bacteriuric subjects exhibited spontaneous temporary or permanent resolution (76%, 22/29), intermittency (21%, 6/29), and probable bacterial persistence (38%, 11/29). No consistent pattern of bacteriuria was evident. Therefore, antimicrobial therapy is not warranted in the treatment of asymptomatic or clinically inapparent bacteriuria in ambulatory elderly men.
Improving Advance Directives for Healthy Older People
Authors: Murphy Donald J.
Published: April 2015

The quality and quantity of advance directives for healthy older people need to increase. Quality will improve with literal interpretations of do‐not‐resuscitate orders and more comprehensive directives. Changing the term “DNR” to “No ACLS (Advanced Cardiac Life Support)” should discourage health‐care providers from subsuming other limitations under the directive to withhold resuscitation. Other aggressive medical and surgical interventions should be prospectively considered in addition to resuscitation. The quantity of advance directives will increase when physicians feel motivated to devote time and expertise to thorough discussions of advance directives. Although education and legislation will motivate physicians to some extent, their roles are limited. Fair reimbursement for this primary‐care service is the most effective motive. The initial investment by Medicare may save large sums in the long run by reducing expensive, undesired care for older people.
BOOK REVIEWS
Authors: Barzel Uriel S. , Koenig Harold G.
Published: April 2015

Terminal Choices: Euthanasia, Suicide, and the Right to Die. By Wennberg RN. Grand Rapids, MI, William B. Erdmans Publishing Company, 1989. 246 pages, $13.95 (paper).