bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex and the Aging Process*
Authors: Masters William H. , Johnson Virginia E.
Published: April 2015

The elderly tend to be victims of “age‐ism,” a false concept that discourages consideration of sexual activity in old age. Geriatric sexual activity is a vital issue, however, and proper management of attendant problems has great bearing upon mental and physical health. The inevitable processes of aging necessitate adjustments, but these can be accomplished satisfactorily by enlightened understanding between sexual partners.
Assessment of Elderly Patients at Home: A Report of Fifty Cases*
Authors: Currie C. T. , Moore James T. , Friedman S. William , Warshaw Gregg A.
Published: April 2015

Fifty elderly patients were assessed at home by physicians trained in geriatric medicine. The patients had been referred by physicians, relatives, or community services. Reasons for referral usually were nonspecific and involved either a request for overall assessment or recommendations about placement. Assessment included medical, psychiatric, social and functional components. Mental impairment and impairment in the activities of daily living were common. New medical or psychiatric diagnoses were contributed in 36 instances. The most frequent previously unnoticed pathologic disorders were mental impairment and depression. Assessment resulted in specialists' advice concerning such matters as the medication program, placement, increased support, further diagnostic work and, in two instances, prompt admission to a hospital.
Hemodynamics of the Carotid‐Artery Circulation in the Elderly “Dizzy” Patient
Authors: Weinberger Jesse , Biscarra Victoria , Weisberg Michael K.
Published: April 2015

One hundred and one consecutive patients complaining of dizziness were assessed by noninvasive carotid‐artery testing, including oculoplethysmography, supraorbital directional Doppler and direct carotid flow Doppler. Hemodynamically significant carotid disease was found in 8 of 34 patients with the nonspecific complaint of “lightheadedness,” in 4 of 21 patients with syncope, in 3 of 12 patients with vertebrobasilar insufficiency, and in 7 of 27 patients with associated focal cerebral signs or symptoms. None of 7 patients with vertigo alone were affected. In summary, 21 of the 101 patients with dizziness had hemodynamically significant obstruction to flow in the carotid‐artery circulation. These findings suggest that in a fairly large proportion of patients complaining of dizziness, the symptoms may be the result of decreased cerebral perfusion due to carotid‐artery occlusive disease. In these patients, noninvasive carotid‐artery testing appears to be useful in identifying those with significant obstruction to blood flow in the carotid‐artery circulation.
Overdiagnosis of Dementia
Authors: Garcia Carlos A. , Reding Michael J. , Blass John P.
Published: April 2015

Accurate diagnosis of the dementias is difficult. Of 100 patients referred to a specialized outpatient dementia clinic, at least 26 were not demented. Fifteen had depression, 7 had miscellaneous other neuropsychiatric disorders, and 4 were normal. Specialized dementia clinics help to improve diagnostic accuracy. Three diagnostic errors appeared particularly important: failure to recognize depression, especially in the presence of mild organic brain disease; equating brain atrophy on the computerized tomogram with clinical dementia; and failure to distinguish focal from global intellectual impairment. For confirmation, the diagnosis of dementia requires follow‐up evaluation, brain biopsy, or autopsy.
Importance of Resident Placement within a Skilled Nursing Facility
Authors: Wiltzius Francille , Gambert Steven R. , Duthie Edmund H.
Published: April 2015

Specific attention to the placement of nursing‐home residents within a skilled nursing facility is often neglected. A study was made of the effects on mental and emotional status, sensory perception, and capability for the needs of daily living when a mentally incompetent resident was placed as a room‐mate with a competent resident. By means of a rating scale designed for this study, the mentally competent subjects were assessed before and after this type of placement. A significant change occurred in mental and emotional status (p < 0.001) but there was no change in either sensory perception or the ability to perform the tasks of daily living. The data suggest that the placement of a mentally incompetent resident with one who is mentally competent may result in an alteration of mental and emotional status for the latter. It is important that placement conditions be considered in the initial processing of all nursing‐home residents.
Quinidine Therapy and Digitalis Toxicity
Authors: Manyari Dante E. , Patterson Christopher , Johnson David E. , Melendez Libardo J.
Published: April 2015

In a 90‐year‐old man undergoing prolonged digitalis therapy, digitalis toxicity was precipitated by the administration of quinidine. The electrocardiogram revealed supraventricular bidirectional tachycardia, a rare but characteristic arrhythmia associated with digitalis toxicity. Upon withdrawal of digoxin, the clinical and ECG signs disappeared. A diagnosis of digitalis toxicity rather than quinidine intolerance led to appropriate treatment.
Intermittent Claudication: Importance of Etiologic Differentiation as an Aid in Selecting Therapy
Authors: Massey E. Wayne , Scherokman Barbara
Published: April 2015

Intermittent claudication in the lower extremities is often manifested in either of two treatable forms, i.e., neurogenic or vascular. A thorough history and examination are necessary to distinguish between these two types. The main differential point is whether pain (vascular type) or a neurologic deficit (neurogenic type) develops as the patient exercises.
The Diagnosis of Osteoporosis
Authors: GRUBER HELEN E. , BAYLINK D. J.
Published: April 2015

ABSTRACT: A rational approach to the diagnosis of osteoporosis by the primary care physician is outlined, with emphasis on the patient who presents with chronic back pain and a vertebral compression fracture. The basic information includes data from the patient's history and physical examination, laboratory, x‐ray and bone biopsy studies, and determination of bone mineral content (BMC) by photon absorptiometry. Characteristic radiologic features associated with bone loss, BMC changes, and bone biopsy findings are illustrated. This diagnostic approach, summarized in a flow diagram, poses a series of questions; the answer to each question leads either to a diagnostic conclusion or to further questions which must be answered. This permits decision as to whether a compression fracture is due to trauma, local osteoporosis, osteomalacia, secondary osteoporosis or primary osteoporosis. In the study population (150 subjects), 80 percent of patients presenting with vertebral compression fractures had primary osteoporosis.
Improved Care for Patients on a New Geriatric Evaluation Unit*
Authors: RUBENSTEIN LAURENCE Z. , ABRASS ITAMAR B. , KANE ROBERT L.
Published: April 2015

ABSTRACT: An analysis is presented of a geriatric evaluation unit (GEU) established at the Sepulveda VA Medical Center in 1979 to provide comprehensive interdisciplinary assessment and treatment of geriatric inpatients. The data on 74 patients admitted during the first year show that major improvements can occur in several outcome areas. Placement location was improved over expectations in 48.4 percent of patients, thus permitting a higher level of independence with a lower level of care requirements. Functional status (Katz ADL scale) improved in two‐thirds of the patients who could have shown improvement. An average of almost four new treatable disorders not noted by previous physicians were diagnosed per patient. The mean daily number of prescribed drugs was reduced by 32 percent per patient, and the total number of drug doses by 43 percent. Though limited by the unique aspects of the VA situation and by lack of a control group, the findings lend support to the efficacy and value of the GEU concept. (A randomized controlled study is in progress.)
Effect of Nafronyl on Lactate and Pyruvate in the Cerebrospinal Fluid of Patients with Senile Dementia
Authors: YESAVAGE JEROME A. , TINKLENBERG JARED R. , HOLLISTER LEO E. , BERGER PHILIP A.
Published: April 2015

In a single‐blind study, 12 men (mean age 63 years) with senile dementia were given nafronyl in a dosage of 100 mg eight times daily for a week, followed by 100 mg four times daily for 12 weeks. Rigorous clinical, laboratory and psychometric assessments revealed no toxicity and no significant effects on vital functions. In the cerebrospinal fluid, the ratio of lactate to pyruvate decreased—a finding consistent with an increase in the aerobic metabolism of glucose.
Prevalence of Psychologic Impairment in an Advanced‐age Population
Authors: LUKE ELIZABETH , NORTON WILLIAM , DENBIGH KATHRYN
Published: April 2015

Interviews were conducted in the homes of 200 persons aged 80 years or older; 100 lived in Vancouver and 100 in Victoria, B. C. Between 15 and 27 per cent showed psychologic impairment, as measured by self‐reporting of symptoms, including use of prescribed psychotropic drugs. A comparison of those who were psychologically impaired with those who were psychologically healthy demonstrated that accidents, eye problems, and dearth of social contacts were significantly associated with the former group. In 74 per cent of the sample, activities were restricted in varying degrees because of health problems, and there was a surprising degree of social isolation. On the Social Interaction Index, low scores were significantly more common among the psychologically impaired, and a similar relationship between poor physical health and social isolation was demonstrated with a multiple regression analysis. The findings suggest that poor social interaction, particularly, and poor health may be predictors of psychologic distress. Extended family support is weakening, and planned programs are needed to improve the lifestyles of the aged and to prevent loneliness and alienation.
Training Health Professionals in the Care of the Elderly
Authors: PANNETON PAUL E. , MORITSUGU KENNETH P. , MILLER ADELE M.
Published: April 2015

Twenty‐seven projects for the development of interdisciplinary geriatric curricula were supported by the Health Resources Administration's Bureau of Health Professions in fiscal 1979. A variety of clinical training sites were used (e.g., university gerontology centers, VA medical centers, senior citizen facilities, adult health care centers), and innovative teaching approaches were developed. For example, a combined medical/dental/optometry clinic is conducted by students at the three professional schools; medical students accompany volunteers serving Meals on Wheels; and dental students treat patients in nursing homes in a mobile dental unit. Students have gained insights into the problems of the elderly and the roles of other health professionals through the interdisciplinary‐team training courses. Nurse‐practitioner programs to prepare nurses to provide primary health care to the elderly were also supported by the Bureau, as were special projects to develop short‐term in‐service basic training programs for nurses' aides and orderlies in nursing homes, to upgrade the skills of the paraprofessionals who care for the elderly. In other projects, the geriatric educational needs of pharmacy students were assessed, and dental schools promoted remote‐site training to improve access to dental care for the elderly.
Screening for Depression in Hospitalized Geriatric Medical Patients
Authors: KITCHELL MARGARET A. , BARNES ROBERT F. , VEITH RICHARD C. , OKIMOTO JOSEPH T. , RASKIND MURRAY A.
Published: April 2015

As part of an effort to improve the detection of depression in geriatric hospitalized medical patients, the validity of two self‐rating depression scales, the Zung Self‐rating Depression Scale (SDS) and the Popoff Index of Depression (ID), was evaluated. These two scales were completed by 42 medical inpatients whose mean age was 68 years. A psychiatrist who was “blind” to scale results interviewed each patient and diagnosed the presence or absence of depression according to the Diagnostic and Statistical Manual‐III (DSM‐III) criteria for Major Depressive Episode. On both the SDS and the ID, there was significant agreement between the scale results and the interview diagnosis. Compared with the interview diagnosis, the SDS had a sensitivity of 58 per cent and a specificity of 87 per cent, and it correctly identified 74 per cent of the patients as being either depressed or nondepressed. The ID had a sensitivity of 88 per cent and a specificity of 52 per cent, and it correctly identified 66 per cent of the patients. Although performance on both scales is reduced compared with that of younger depressed patients, these self‐rating scales appear to be useful aids for the detection of depression in geriatric medical patients.
Measurement of Gait and Balance in the Elderly
Authors: Nayak U. S. L. , Gabell A. , Simons M. A. , Isaacs B.
Published: April 2015

A description is given of the gait and balance laboratory of the Department of Geriatric Medicine of the University of Birmingham, and of the program of tests devised for use in elderly persons. These can be undertaken without discomfort or anxiety to the subjects. They are yielding data that should assist in the management of disorders of gait and balance in the elderly.
Psychiatric Diagnoses Among Geriatric Patients Seen in an Outreach Program
Authors: Reifler Burton , Raskind Murray , Kethley Alice
Published: April 2015

Over 2300 patients referred to a geriatric outreach program were evaluated for the relationships between diagnosis and (1) referral reason, (2) referral source, and (3) age. Referral reason was only a clue to the eventual diagnosis. Patients referred for depression received a diagnosis of depression in only 46 per cent of such referrals, and patients referred for forgetfulness or confusion received a diagnosis of dementia in only 37 per cent of these referrals. Families were most likely to refer demented patients, and health agencies to refer depressed patients. Apartment managers and housing authority representatives were least likely to refer depressed patients and most likely to refer paranoid patients. The rate for diagnosis of dementia increased with age, whereas the rates for diagnoses of depression and alcohol/drug abuse decreased with age.
Left Ventricular Function in Hospitalized Geriatric Patients
Authors: LUCHI ROBERT J. , SNOW ELEANOR , LUCHI JEAN MARIE , NELSON CYNTHIA L , PIRCHER FELIX J.
Published: April 2015

Left ventricular ejection fraction was measured by gated wall motion in 62 patients, 75 years old or older, admitted to a Geriatric Acute Assessment Ward. From this group, 42 patients not taking digitalis or other cardioactive medication were selected for analysis. Thirty of them had clinically identifiable heart disease, whereas 12 did not. Resting left ventricular ejection fractions in the 12 patients without clinically identifiable heart disease averaged 0.60 ± 0.09. None had an ejection fraction below 0.50. In the 30 patients with clinically identifiable heart disease, mean ejection fraction was 0.49 ± 0.15 (range 0.17‐0.84), P < 0.01. In the patients with heart disease, reduction of ejection fraction was correlated with either cardiac enlargement or congestive heart failure. Neither age nor electrocardiographic abnormalities added to the strength of this correlation. Fifty‐eight per cent of patients with congestive heart failure had ejection fractions 3=0.40, suggesting that congestive heart failure in this age group is frequently related to diastolic left ventricular dysfunction unaccompanied by major systolic dysfunction. The prognosis of patients with congestive heart failure and ejection fractions above 0.35 was significantly better than of patients with congestive heart failure and ejection fractions below 0.35. From these data and other data available in the literature, it is proposed that the lower limit for ejection fraction be 0.50 for patients 75 years old or older. Congestive heart failure in patients 75 years old or older appears to be associated with relatively higher ejection fractions or even with ejection fractions within the normal range. In these patients, digitalis may not be indicated, and short term‐prognosis is relatively favorable.
The Role of Electroconvulsive Therapy in the Treatment of Depression in the Elderly
Authors: WEINER RICHARD D.
Published: April 2015

Electroconvulsive therapy (ECT) is the most effective form of treatment of major depressive episodes available today. In particular, ECT appears to be at least as effective in the elderly as in younger depressed patients. Although a number of special factors must be considered and modifications in technique occasionally be made, ECT is generally also a relatively safe therapeutic tool in this age group.
Treating Geriatric Depression: A 26‐week Interim Analysis
Authors: JARVIK LISSY F. , MINTZ JIM , STEUER JOANNE , GERNER ROBERT
Published: April 2015

Two concurrent studies of geriatric outpatients who received diagnoses of depression were conducted. In the first, patients were treated with one of two tricyclic antidepressants or with a placebo. In the second, patients were assigned to groups receiving either psychodynamic group therapy or cognitive‐behavioral group therapy. Patients in the placebo group showed the least improvement; most patients receiving group psychotherapy showed some improvement, but only 12% had full remissions; by contrast, 45% of patients receiving imipramine or doxepin had full remissions, while 36% of them experienced little or no benefit. An early response to tricyclic antidepressant drugs was a reliable predictor of continued improvement.
Memory Function and the Clinical Differentiation of Dementing Disorders
Authors: SHUTTLEWORTH EDWIN C.
Published: April 2015

For the demented patient, relatively accurate bedside diagnosis is feasible by use of a carefully designed neurologic examination coupled with an understanding of the neuroanatomy of memory and related cognitive processes. Further confirmation of the clinical diagnosis by the application of selected laboratory diagnostic procedures can then result in an appropriate plan of treatment. With the promise of continued development of new therapeutic modalities for specific dementing illnesses such as Alzheimer's disease, a parallel improvement in diagnostic precision seems mandatory in order to permit detection of the disease at an earlier stage. A clinical anatomic approach with special emphasis on the understanding and assessment of memory function is suggested as a starting point. It is hoped that the serial examination of a significant number of patients by this method will eventually yield clues to aid in the earlier differential diagnosis of dementia.
The Rapid Disability Rating Scale—2
Authors: LINN MARGARET W. , LINN BERNARD S.
Published: April 2015

A revised version of the Rapid Disability Rating Scale (RDRS‐2) is presented. Item definitions have been sharpened and directions expanded to indicate that ratings are based upon the patient's performance in regard to behavior, and that prostheses normally used by the patient should be included in the assessment. Three items have been added to increase the breadth of the scale. Response items have been changed from three‐point to four‐point ratings in order to increase group discrimination and make the scale more sensitive to changes in treatment. The new appraisals of reliability, factor structure, and validity are reported, along with the potential uses of the scale.
Effect of Aging on the Cardiothoracic Ratio of Men
Authors: POTTER JANE F. , ELAHI DARIUSH , TOBIN JORDAN D. , ANDRES REUBIN
Published: April 2015

The potential usefulness of chest radiographs in the assessment of physical dimensions was examined in 243 men (age range 20–95 years) who had been followed up for an average of 12.3 years. From 1,124 of these films, measurements of cardiac diameter (CD) and thoracic diameter (TD) were made, and the cardiothoracic ratio (CTR) was calculated. Cross‐sectional age differences were associated with a tendency toward increases in the CD and CTR throughout the lifespans of the 243 men, regardless of the presence or absence of heart disease. The thoracic diameter (TD) was greater in middle‐aged than in young subjects, but less in the oldest than in the middle‐aged subjects. Cumulative percentage curves for the CTR showed a shift to higher fiftieth to ninetieth percentile values with age. However, among the subjects free of heart disease, only one (age 95) had a CTR exceeding 50 per cent. Longitudinal analysis data agreed with the cross‐sectional data. Forty‐nine deceased subjects were matched with living subjects of the same heart disease classifications. Increases in the CD and CTR were predictive of death in the group with heart disease but not in the group without identifiable heart disease. An increase in CD was not correlated with an increase in systolic blood pressure. The decline in TD appeared to reflect a decline in rib‐cage mobility with aging.
The White Nails of Old Age
Authors: HORAN MICHAEL A. , PUXTY JOHN A. , FOX ROY A.
Published: April 2015

Nail changes similar to those reported by Terry and Lindsay were defined in an elderly in‐patient population. Two hundred fifty‐eight patients were studied, and an overall incidence of 19 per cent was found. There was no significant difference between men and women. The only significant correlations in this study were with osteoporosis and thin skin. Eight men with nail changes were compared with seven men without such changes by calculating the metacarpal index of cortical bone mass. The index was much lower in patients with nail changes (t = 2.64; P < 0.01). All patients with nail changes had thin skin. No correlations were found with serum albumin, liver function, or kidney function. These nail changes are less frequent in the “less frail” elderly living in the community. Changes of the Terry type are common in children but disappear by early adult life. It is suggested that the nail changes are age‐related phenomena and that they may reflect an underlying disturbance of collagen being manifested as changes in the nail bed, skin, and bone.
Delayed Hypersensitivity Skin Reactions in the Elderly
Authors: LICHTENSTEIN HOWARD , SCHWARTZBORD SARAH F. , DREW W. LAWRENCE , FEIGENBAUM LAWRENCE Z. , BROWNSTEIN HAROLD
Published: April 2015

A delayed hypersensitivity response to skin tests was observed in 47 healthy elderly participants in a geriatric screening clinic. Forty‐four subjects (94 per cent) reacted to at least one antigen. It was concluded that anergy is uncommon in the healthy elderly and should not be considered a normal aging phenomenon.
Clinical Features That Predict Potentially Reversible Progressive Intellectual Deterioration
Authors: FREEMON FRANK R. , RUDD STEVEN M.
Published: April 2015

The records of 110 patients with progressive intellectual deterioration were reviewed, to identify any clinical features that might predict the presence of an underlying disease potentially reversible with specific medical, surgical, or psychiatric therapy. The 16 patients in whom the intellectual deterioration was caused by such underlying disorders showed a shorter duration of symptoms and less cortical atrophy on a computed tomographic scan than did patients with idiopathic dementia. The average for the patients with a treatable cause of progressive intellectual deterioration was not significantly different from the average age for patients with idiopathic dementia.
A Long‐term Geriatric Teaching Ward in an Acute‐care Hospital: A Three‐year Experience
Authors: CLARFIELD A. M.
Published: April 2015

The development and management of a long‐term geriatric ward in an acute‐care teaching hospital are described. Structure, function, and costs are discussed, and issues of service and medical education are emphasized. A full geriatric team (physician, nurse, social worker, physiotherapist, and occupational therapist) assessed 165 long‐term patients in the general wards of the hospital and accepted 98 for admission to the new long‐term geriatric ward. Of these, 31 were discharged; 29 per cent went to a facility that encouraged more independent living. Eighteen patients died during their stay in the geriatric ward; autopsies were obtained in 33 per cent—a higher autopsy rate than the average for general hospitals. General hospitals may continue to have large populations of chronically ill patients. This model for a geriatric ward may offer a way of dealing with a difficult situation.
Arguments for Abandoning the Term Pseudodementia
Authors: REIFLER BURTON V.
Published: April 2015

The term pseudodementia should be avoided in clinical practice. Its importance lies in the fact that it has alerted clinicians to the existence of potentially reversible, or at least treatable, cases of intellectual dysfunction. However, two major problems are associated with its use. First, it implies that the patient has either an organic or a functional illness, whereas many patients have elements of both, especially when depression is superimposed on a true dementia. Second, the term is often mistakenly used diagnostically, whereas it is only descriptive. The term cognitive impairment is preferable to pseudodementia.
Werner's Syndrome: Twenty‐four Cases with a Review of the Japanese Medical Literature
Authors: MURATA KATSUMI , NAKASHIMA HIROAKI
Published: April 2015

Twenty‐four cases of Werner's syndrome were studied to define the clinical manifestations in comparison with those found in a clinical review of 153 cases in the Japanese medical literature. The conspicuous characteristics of the 24 patients were short stature, stocky trunk with thin limbs, low body weight, bird‐like or “masked” face, early graying or loss of hair, high‐pitched or hoarse voice, bilateral cataracts, and various scleroderma‐like signs. Three signs not stressed previously were hyperreflexia, flat feet, and irregular dental development. The onsets and incidences of these manifestations during the seven‐year serial study are described.
L‐Dopa Treatment of Parkinson's Disease
Authors: BAUER RAYMOND B. , STEVENS CARL , REVENO WILLIAM S. , ROSENBAUM HERBERT
Published: April 2015

A ten‐year follow‐up study of parkinsonian patients treated with L‐dopa is presented. Originally 130 patients entered the study, and previous reports were presented in 1971 and 1973. This report concerns the 47 remaining patients now available for examination. The effectiveness of L‐dopa diminished over the ten‐year period, so that the disability states of these patients are now similar to those prevailing just before the study began ten years ago. Despite the decline, the interim improvement and the patients' relatively asymptomatic existence for part of the time confirm the effectiveness of L‐dopa therapy in the treatment of Parkinson's disease.
Effect of Age on Glucose Tolerance, Insulin Secretion, and in Vivo Insulin Action
Authors: ROSENTHAL MARK , DOBERNE LEONARD , GREENFIELD MICHAEL , WIDSTROM ANDRES , REAVEN GERALD M.
Published: April 2015

The effect of age on glucose tolerance, insulin secretion, and in vivo insulin action (insulin clamp) was studied in 48 nonobese subjects, all of whom were fully ambulatory and in good general health. The observed age‐related increase in fasting plasma glucose (r = 0.35, P < 0.01) was not due to an increase in relative body weight (RBW). Plasma insulin levels, both fasting and postprandial, tended to rise with age, but these changes were not significant. There was a marginally significant correlation (r = −0.21) between age and insulin‐stimulated glucose utilization, which fell to −0.13 when controlled for RBW. However, steady‐state insulin levels during the insulin‐clamp period were higher in the older subjects, suggesting that age leads to an impairment in insulin catabolism; thus it is likely that the impairment of in vivo insulin action with age was underestimated. The variation in in vivo action between individuals was much greater among the older subjects. It was concluded that the glucose intolerance associated with aging is of relatively minor magnitude when ambulatory, generally healthy, nonobese, and nondiabetic subjects are studied. The cause of the glucose intolerance associated with aging seems to be loss of normal in vivo insulin action. On the other hand, this defect is not shared by all older persons, and in many over the age of 70, glucose transport is as efficient as in persons in their 20s.
The Dangerous Wheelchair
Authors: HARTIGAN JOHN D.
Published: April 2015

The wheelchair is now commonly used as a place for lengthy sitting. The construction of the collapsible wheelchair provides a hard unyielding seat, with no support for the patient's head and shoulders. Thus, the radial nerve is dangerously exposed to damage, and the development of gluteal pressure ulcers is encouraged. Case reports are presented, and proposals are made for improvements in wheelchair design.
Age Does Not Alter Acetaminophen Absorption
Authors: DIVOLL MARCIA , AMEER BARBARA , ABERNETHY DARRELL R. , GREENBLATT DAVID J.
Published: April 2015

Twenty‐eight healthy volunteers (age range, 22–78 years) received 650 mg of acetaminophen (AAP) on three separate occasions. The modes of administration were 1) intravenous, 5‐minute infusion; 2) oral, with two 325‐mg tablets; and 3) oral, with 650 mg as an elixir preparation. Plasma levels of AAP were determined in blood samples drawn up to 12 hours after the dose. The mean (±SD) kinetic variables for absorption of AAP from tablets in young and elderly were peak plasma concentration, 11.8 (±4.2) vs 10.9 (±4.1) μg/ml; peak time, 0.79 (±.54) vs 0.69 (±.40) hours after the dose; absorption half‐life, 12.6 (±9.8) vs 8.2 (±5.3) minutes; and absolute systemic availability, 79 (±9) vs 72 (±11) per cent. For AAP elixir, the corresponding values were 12.6 (±5.4) vs 13.7 (±6.0) μg/ml; 0.52 (±.24) vs 0.54 (±.51) hours; 8.6 (±6.2) vs 6.1 (±6.6) minutes; and 87 (±9) vs 80 (±9) per cent. Absolute bioavailability of both oral dosage forms was significantly less than 100 per cent in all groups. Elderly subjects tended to show lower availability of both oral preparations, but the difference was of borderline significance (P < .05). Age did not influence any other measures of absorption. Since the absorption rate of acetaminophen may be indicative of the gastric emptying rate, age does not appear to alter this rate‐limiting step in drug absorption.
Historical Antecedents of Normative vs Pathologic Perspectives in Aging
Authors: PETERSON MARVELU , ROSE CHARLES L.
Published: April 2015

Differing concepts of aging, i.e., a normative versus a pathologic process, are presented in historical perspective and are traced through selected writings from ancient China, India, Egypt, and Greece into more modern times. There is no consistent shift across epochs from one to the other perspective, and mixed perspectives often appear. Ideas regarding the aging process and age‐related disease are influenced by the changing medical state of the art in various eras. Because of the still incomplete knowledge of the basic mechanisms involved, the current status of medical knowledge has not yet resolved the “aging vs disease dilemma.” History, however, does reveal insights that promote respect for prescientific observations and intuitions, provide a contextual background for progress achieved, and foreshadow current trends in the theory and practice of geriatrics.
A Comparison of Placement Outcomes of Geriatric Cohorts Receiving Care in a Geriatric Assessment Unit and on General Medicine Floors
Authors: TEASDALE TOM A. , SHUMAN LISA , SNOW ELEANOR , LUCHI ROBERT J.
Published: April 2015

To assess whether care in a geriatric assessment unit using a multidisciplinary team approach with rehabilitative emphasis impacted on patient placement outcomes, a historical prospective study was initiated using records of geriatric assessment unit patients admitted during a one‐year period (n = 62). A second, diagnostically similar general medicine unit cohort was also sampled (n = 62). Placement outcomes of the two groups were compared. All study patients were 75 years of age or older, stratified by source of admission, and controlled for comparability using diagnostic grouping. The geriatric assessment unit admitted 92 per cent of its patients from home; the general medicine unit, 82 per cent. As a result of expanded rehabilitative, respite, and terminal care promoted by the geriatric assessment unit staff, mean length of stay was 36 days, whereas it was 13 days in the general medicine unit (P < 0.001). There was no significant difference between the two units with respect to hospital deaths, post‐hospitalization discharges to home or nursing homes, or patient locations (home versus nursing home) six months after admission. Although improvements in patient independence may have been achieved through the efforts of a multidisciplinary team approach utilizing the geriatric assessment unit, they were not sufficient to significantly increase the proportion of patients placed at home. Superiority in placement outcome may be demonstrated only by geriatric assessment unit use of selective admission criteria.
Reductions in Regional Cerebral Blood Flow Associated with Chronic Consumption of Alcohol
Authors: ROGERS ROBERT L. , MEYER JOHN STIRLING , SHAW TERRY G. , MORTEL KARL F.
Published: April 2015

Neurotoxic effects of habitual alcohol consumption were investigated by correlating the subjects' estimates of abstinence or frequency and amount of alcohol consumed with measurements of gray matter blood flow utilizing the 133Xe inhalation method. Two hundred and twenty‐two subjects were studied, including 136 healthy subjects, 82 subjects with well‐established risk factors for stroke (hypertension, hyperlipidemia, heart disease, and diabetes mellitus), and four subjects with chronic alcoholic dementia of the Wernicke‐Korsakoff type. Subjects were classified according to average quantitative amounts of alcohol consumed per day, week, or month for the past five years. Comparisons of mean values for hemispheric gray matter blood flow indicated significant inverse relationships with the average amounts of alcohol consumed. This linear relationship occurred regardless of whether or not other risk factors were present and indicated that alcohol itself was a risk factor reducing gray matter blood flow and had additive effects of reducing cerebral blood flow further when combined with other risk factors. Patients who had chronic Wernicke‐Korsakoff syndrome had the most severely reduced blood flow levels, as might be predicted from extrapolation of the regression line comparing cerebral blood flow values with the degree of chronic alcohol consumption.
A Controlled Long‐term Study with Ergoloid Mesylates (Hydergine®) in Healthy, Elderly Volunteers: Results after Three Years
Authors: SPIEGEL RENÉ , HUBER FRITZ , KÖBERLE SUSE
Published: April 2015

A long‐term clinical comparison of the effects of ergoloid mesylates and placebo on 148 healthy elderly volunteers of both sexes was analyzed after three years of study. At that point, 99 subjects (53 receiving ergoloid mesylates and 46, placebo) were still being treated under double‐blind conditions, while the remainder either had dropped out or continued to participate under open conditions. Many subjects in both groups were healthier after the three years than they had been at the onset of the study: subjective symptoms such as tiredness and dizziness were reduced, performances on tests of intelligence were improved, and some abnormal laboratory values had normalized. Blood pressures increased on the average during the investigational period and pulse rates became slower. The ergoloid mesylate regimen was well tolerated objectively and subjectively. Additional medical and psychologic improvements were noted in the group treated with ergoloid mesylates concerning cardiovascular parameters, cholesterol levels, subjective symptoms, and performances on tests of intelligence. These intermediate findings are interpreted as showing a preventive effect of ergoloid mesylates against some of the debilitating physical and psychologic concomitants of aging.
Obtaining Informed Consent in the Teaching Nursing Home
Authors: HOFFMAN PAMELA B. , MARRON KATHLEEN R. , FILLIT HOWARD , LIBOW LESLIE S.
Published: April 2015

The authors observed attempts to obtain informed consent for clinical research at the Jewish Institute for Geriatric Care. One study entailed the use of venipuncture, urine collections, urethral catheterizations, and antibiotic therapy. The other required that venipunctures and lumbar punctures be performed on dementia patients. Patients and families were observed to be unwilling to consent to any procedure more invasive than venipuncture. Poor recall and other physical and psychologic factors impaired comprehension of the protocols, and some patients requested second opinions from trusted “others.” Written consent could be refused despite verbal consent. Furthermore, incompetent patients could refuse to participate in protocols for which family members had given consent. The implications of these observations are discussed. Despite concerns, which are enumerated, it is concluded that informed consent can be obtained in the teaching nursing home.
Zinc and Senile Osteoporosis
Authors: ATIK O. SAHAP
Published: April 2015

The zinc ion levels in serum and bone tissue of patients with senile osteoporosis were determined and found to be less than that obtained from normal patients. The results suggest that zinc depletion may have a role in the pathogenesis of senile osteoporosis.
The Elderly Patient in the Coronary Care Unit: III. Factors Affecting Long‐term Prognosis
Authors: BERMAN NEIL D.
Published: April 2015

Patients aged 70 years and older who were admitted to a coronary care unit in 1976 with documented acute myocardial infarction were followed to April 30, 1982. At that time, of the 46 patients who had survived initial hospitalization, 28 had died, 16 were still living, and two were lost to follow up. The actuarial survival rates were 71 per cent, 60 per cent, and 44 per cent for one, three, and five years, respectively. Only two of the variables available by history, physical examination, and clinical course of the patient in the coronary care unit had prognostic significance—complex ventricular premature beats and congestive heart failure of any degree of severity. Patients who suffered congestive heart failure during their hospitalization had a five‐year survival rate of less than 25 per cent, compared with about 60 per cent for those who had neither heart failure nor complex ventricular premature beats. All five patients who had complex ventricular premature beats died within three years.
Correlations between Regional Cerebral Blood Flow and Age‐related Brain Atrophy: A Quantitative Study with Computed Tomography and the Xenon‐133 Inhalation Method
Authors: YAMAGUCHI TATSUO , HATAZAWA JUN , KUBOTA KAZUO , ABE YOSHINAO , FUJIWARA TAKEHIKO , MATSUZAWA TAIJU
Published: April 2015

One hundred and two subjects (40 men and 62 women) neither having a history of neurologic deficits nor showing organic lesions on computed tomographic examination of the brain were studied. Ages of the subjects ranged from 26 to 81 years. Regional cerebral blood flow was measured by the xenon‐133 inhalation method, and the volume percentage of brain with respect to the cranial cavity (craniocerebral index) was calculated by means of computer programs. Regional cerebral blood flow was computed as the fast component of two‐compartmental analysis and as the initial slope index value. The percentage of each subject's craniocerebral index in relation to the standard for subjects with non‐atrophied brains (brain volume index) was calculated as the indicator of brain atrophy. Both the mean brain fast component values and the mean brain initial slope index values correlated closely with the brain volume index in the elderly (r = 0.60, r = 0.62; P < 0.0001 in each correlation coefficient). Low cerebral blood flow values coincided with loss of brain substance in the final stage of age‐related brain atrophy, but not in the intermediate stage.
Intraabdominal Infections in the Elderly
Authors: NORMAN DEAN C. , YOSHIKAWA THOMAS T.
Published: April 2015

Biliary sepsis, appendicitis, diverticulitis, and intraabdominal abscess are intraabdominal infections that are especially relevant to the elderly population. Diagnostic delays, reluctance to perform surgery, presence of underlying disease, and postoperative complications contribute to the higher morbidity and mortality rates seen for elderly patients with these infections.
Motivating the Geriatric Patient for Rehabilitation
Authors: HESSE KATHERINE A. , CAMPION EDWARD W.
Published: April 2015

Geriatric patients often appear unmotivated for rehabilitation, and “poor motivation” is frequently the reason given for excluding them from rehabilitation programs. However, these patients may actually be impeded by specific obstacles to the development of motivation. Appropriate intervention may enable them to make better use of rehabilitation opportunities. In this paper the authors review the concept of human motivation and what is known about aging and motivation. Specific age‐related changes are examined and treatment interventions identified to maximize the patients' participation in rehabilitation toward improved functional ability.
The Drop Attack
Authors: LIPSITZ LEWIS A.
Published: April 2015

While the “drop attack” has been described in the British literature as a classic geriatric syndrome accounting for as many as one‐quarter of all falls in their elderly population, it is rarely acknowledged in discussions of falls by physicians in the United States. Is the drop attack a distinct entity that has been overlooked and under‐investigated in this country, or is it perhaps a symptom of a spectrum of diseases? This paper reviews the original descriptions of the drop attack for its characteristic features, and focuses on the epidemiology, etiology and clinical management of this common, but infrequently recognized, event.
Earlobe Creases in a Cohort of Elderly Veterans
Authors: GRAL THOMAS , THORNBURG MONA
Published: April 2015

Two‐hundred thirty‐four residents (220 male, 14 female) of a Veterans Administration Nursing Home and a Hospital Based Home Care program, 24–99 years old (mean 66), were examined for the presence (or absence) of earlobe creases and their correlation with cardiovascular disease. Unilateral or bilateral earlobe creases were found in 119 patients (55 unilateral, 64 bilateral), or 50.85 per cent. One hundred forty‐two patients had one or more forms of cardiovascular disease: 20 had coronary artery disease, 45 had cerebrovascular disease, 12 had peripheral vascular disease, 48 had atherosclerotic heart disease and/or hypertension, and 17 had “other” cardiovascular disease, mostly congestive heart failure. Seventy‐three of them (51.4 per cent) had earlobe creases. The rest—92 patients—had no clinically apparent cardiovascular disease, and the incidence of earlobe creases in this group was 50 per cent.

Cross‐tabulation (chi square) and multivariate (stepwise logistic) regression analyses relating the presence (or absence) of earlobe creases to diagnosis, age, sex, smoking, body weight, height, blood pressure, serum cholesterol, glucose, urea nitrogen, creatinine, uric acid, calcium, phosphorus, albumin, and hemoglobin revealed no significant correlation between the presence of earlobe creases and any of the above parameters. Earlobe creases were present in about half the study group regardless of diagnosis, and only about half the patients with cardiovascular and coronary artery disease had earlobe creases.

It was concluded that in our patient population earlobe creases were not specifically associated with cardiovascular disease, as they were associated about equally with both cardiovascular and noncardiovascular disease. Their significance in the diagnosis of coronary artery disease may be greater in a younger age group, because in the elderly these creases may occur as part of skin aging, and they may also accompany noncardiovascular diseases.
Decreased Thermogenic Response to an Oral Glucose Load in Older Subjects
Authors: GOLAY A. , SCHUTZ Y. , BROQUET C. , MOERI R. , FELBER J. P. , JÉQUIER E.
Published: April 2015

The thermogenic response to a 100 g oral glucose load was studied by indirect calorimetry in 13 older persons (age range, 38–68 years) and compared with that of 16 young matched controls of similar body weight (age range, 19–30 years). The glucose‐induced ther‐mogenesis measured over 180 min and expressed as a per cent of the energy content of the glucose load was found to be reduced in the older subjects, i.e., 5.8 ± 0.3 per cent vs 8.6 ± 0.7 per cent, P < 0.002). This was also accompanied by a significant decrease in the glucose oxidation rate when averaged over the same three‐hour period following the glucose load, i.e., 153 mg/min vs 213 mg/min in the control subjects (P < 0.001) despite a similar time course of glycemia. This study suggests that the thermogenic response to an oral glucose load is blunted in older people, and this may represent an additional factor that contributes to the decreased energy requirement with age and therefore to the increased propensity to obesity if energy intake is not adjusted.
The Outcome of Hospitalization for Acute Illness in the Elderly
Authors: LAMONT CAMPBELL T. , SAMPSON SUSAN , MATTHIAS RUTH , KANE ROBERT
Published: April 2015

The use of acute‐care hospitals by the elderly is rising rapidly, particularly in the age group 75 and older. Any changes that will reduce the length of stay could result in considerable savings in health care costs. It is imperative to look at present policies and explore possible changes that could reduce costs by reducing the total hospital days. A study was conducted in a 290‐bed county‐funded community hospital in California that serves the majority of disadvantaged and poor elderly residing in an area with a population of approximately 300,000 persons. The objective was to determine what demographic, medical, and sociologic characteristics of elderly patients recorded at admission would be of value in predicting those most likely to change their functional status.

It was found that the most important predictors of deterioration of function are (1) older age, especially 85 +, and (2) abnormal mental status. Patients admitted from nursing homes had a longer than average length of stay, and those who survived (80 per cent) returned to a nursing home.

It was concluded that routine assessment of elderly patients admitted for acute illness or injury could facilitate discharge planning by an early prediction of the level of care that will be required after discharge. This assessment should include preadmission mental and functional status; identification of causes for, and correction of, acute confusional states; and an assessment of the impact of the present illness or injury on future level of function following rehabilitation. This could result in a reduced length of average hospital stay.
Neurotransmitter Deficits in Alzheimer's Disease: Criteria for Significance
Authors: GREENWALD BLAINE S. , MOHS RICHARD C. , DAVIS KENNETH L.
Published: April 2015

A series of histopathologic, morphologic, and pharmacologic criteria are proposed to establish the significance of neurochemical deficits in Alzheimer's disease. The underlying pathogenic biochemistry of a better understood neurotransmitter‐deficiency syndrome, Parkinson's disease, validates these criteria. The major neurotransmitter systems are evaluated against these guidelines. Only the cholinergic system fulfills all the criteria. Noradrenergic mechanisms are also implicated. Subsequent neurochemical abnormalities found in the brains of patients with Alzheimer's disease can be evaluated against these criteria.