bluuebunny/crossref_metadata_2025 huggingface dataset:
BOOK REVIEWS
Authors: Barzel Uriel S. , Finucane Thomas E.
Published: April 2015

Setting Limits. By Callahan D. Simon & Schuster, 1987, 256 pages, $18.95.
BOOK REVIEWS
Authors: Rossman Isadore
Published: April 2015

Primary Care in the Home. By Bernstein LH, Grieco AJ, and Dete MK. Philadelphia, J.B. Lippincott, 1987, 397 pages, $32.50.
Deciding About Resuscitation in a Nursing Home Theory and Practice
Authors: Finucane Thomas E. , Denman Susan J.
Published: April 2015

This study examines how plans about cardiopulmonary resuscitation (CPR) were made, what relevant orders were written, and what actual events occurred at the time of death in a nursing home. A chart review of 119 residents who died in a 233‐bed nursing home in 1987 found one who underwent (unsuccessful) CPR. Nine records were unusable. The remaining 109 cases, none of which involved CPR, were studied. Documentation of discussions about CPR between physicians and residents or their surrogates was present in 90 charts. Of 85 residents with cognitive impairment, four were included in the CPR discussion and surrogates were consulted for 66. In 15, no discussion was documented. Of 24 residents without documented cognitive impairment, 11 were consulted. For nine others, surrogates were asked, and in four no discussion was recorded. One resident and three surrogates requested CPR. All others who were asked accepted a do‐not‐resuscitate (DNR) order. For 67 residents DNR orders were written. In six of these cases, physicians wrote the order without documenting consultation with resident or surrogate. For five residents orders to resuscitate (full code orders) were written. For 37 residents no order about CPR was recorded. Of the 42 residents who died without a DNR order, 37 were found dead by nursing staff, but in only one case was a physician contacted urgently. In this nursing home advance planning about CPR was frequently undertaken. Regardless of planning or the orders in the chart, CPR was a rare event.
Screening for Alzheimer's Disease by Clock Drawing
Authors: Wolf‐Klein Gisele P. , Silverstone Felix A. , Levy Arnold P. , Brod Meryl S. , Breuer Joseph
Published: April 2015

The fear of Alzheimer's disease for both patients and families is growing along with the increasing evidence of the disease itself. This study (N = 312) of the validity of the clock drawing test in screening patients with probable Alzheimer's disease was conducted in an active outpatient geriatric clinic. Clock drawings by patients with normal mental status or depression were essentially normal. Alzheimer's patients were unable to complete a normal clock and demonstrated five characteristically abnormal patterns. As a test for Alzheimer's disease, clock drawing had a sensitivity of 86.7% and a specificity of 92.7%. There was correct identification in 97.2% of normals. These findings indicate that the clock drawing test, an easily administered, low cost screening tool, can be useful to health care professionals in characterizing cognitive loss in a general geriatric clinic population.
Alzheimer's Dementia and Binding to Alpha2 Adrenoreceptors in Platelets
Authors: Adunsky Abraham , Hershkowitz Moshe , Rabinowitz Marian
Published: April 2015

Seventy‐five patients with probable Alzheimer's disease were screened for binding of alpha2 receptors (A2R) to their platelet membranes; the results were compared with 51 age‐ and sex‐matched controls. Receptor binding assays were performed using [3H] Yohimbine as the radioligand. The results showed a higher binding capacity in the demented population as compared to the control group (2.18 ± 0.15 fmol/mg protein, as compared to 1.73 ± 0.13, P < 0.03). This increased binding to platelets in the demented patients was more prominent in demented females: 34% higher binding as compared with female controls (2.06 ± 0.5 vs 1.54 ± 0.04). The difference between demented and normal males was less (2.34 ± 0.05 vs 1.88 ± 0.05). The results indicate an involvement of the A2R system, either primarily or secondarily, in the disease process. Since there is an overlap between results from the patients with Alzheimer's disease and the normal subjects, A2R may serve as only a supportive marker for Alzheimer's disease.
The Effect of Visual Deprivation and Proprioceptive Change on Postural Sway in Healthy Adults
Authors: Ring C. , Nayak U. S. L. , Isaacs B.
Published: April 2015

In 39 healthy active people aged 17 to 79 who had not fallen, anteroposterior sway during quiet standing increased slightly with age; there was no increase with age in lateral sway. Sway increased on deprivation of visual information and altered proprioception due to foot pressure sensory change in all age groups, and especially when both forms of sensation were altered concurrently; but the increase of sway on pressure sensory change was no greater in the older than in the younger subjects.
Hypertension in the Aging Patient Implications for the Selection of Drug Therapy
Authors: Bursztyn Michael , Gavras Irene , Gavras Haralambos
Published: April 2015

Although earlier debates had questioned the wisdom of treating hypertension in elderly patients, it is now becoming apparent that such treatment is warranted. Systolic hypertension, which prevails in this population, is more closely correlated to hypertensive complications than is diastolic blood pressure. Recent multicenter trials have demonstrated that in this age group, as in younger patients, control of hypertension can significantly decrease the rate of cardiovascular and cerebrovascular events. Many effective antihypertensive agents are available today, but elderly patients, because of their hemodynamic and biochemical characteristics, are particularly vulnerable to the common side effects of most drugs. However, the two newer classes of drugs (the angiotensin‐converting enzyme inhibitors and the calcium channel blockers) offer several advantages in terms of favorable hemodynamic and biochemical profiles, convenience of dosing, and maintenance of quality of life. These characteristics justify choosing these agents as first‐line therapy for hypertension.
BOOK REVIEWS
Authors: Brink T.L.
Published: April 2015

Grief and the Loss of an Adult Child. Edited by Margolis OS, Kutscher AH, Marcus ER, Raether HC, Pine VR, Seeland IB, and Cherico DJ. The Foundation of Thanatology Series, Vol 8. New York: Praeger Publishers, 1988, $39.95.
Clinical Evaluation of Serum Fructosamine in Monitoring Elderly Outpatient Diabetics
Authors: Cefalu William T. , Prather Kaye L. , Murphy William A. , Parker Trudy B.
Published: April 2015

Recently, new serum glycated protein assays (ie, serum fructosamine) have been developed. Fructosamine assays objectively monitor short‐term glycemic control and, when used in conjunction with HgA1C, enhance the clinical information obtained and greatly aid in the clinical management of diabetes. Because they rely on glycation of serum proteins, the clinical utility of these assays in the elderly may be altered secondary to the hypoproteinemia that often is seen in these states. Therefore, we investigated the role of glycated serum proteins (ie, fructosamine level) in monitoring elderly diabetics over a 4‐month period of observation. We found that the fasting blood glucose over the 4‐month period correlated well with the serum fructosamine activity (r = 0.79, P < .001) and HgA1C (r = 0.78, P < .001). In addition, we found that the mean daily glucose, as determined by outpatient monitoring, correlated well to both the fructosamine activity (r = 0.66, P < .001) and HgA1C (r = 0.74, P < .001). We found no effect on the measurement of the fructosamine assay by the level of albumin seen in these patients. Our study suggests that serum fructosamine and HgA1C are equally effective in monitoring the elderly patient, as has been established in the younger diabetic, and no correction need be made in the fructosamine assay to compensate for variable serum protein levels seen clinically in the elderly.
Incidence of Hypertension in an Ambulatory Elderly Population
Authors: Davidson Richard A. , Hale William E. , Moore Mary T. , May Franklin E. , Marks Ronald G. , Stewart Ronald B.
Published: April 2015

Investigations of the natural history of blood pressure have generally evaluated mean systolic and diastolic pressure changes. While informative, this information is not directly applicable to clinical practice settings, in which patients are usually classified as normotensive or hypertensive. We measured the actual incidence of hypertension, using two different definitions, in an ambulatory elderly population of 2,584 individuals over an 8‐year period. Using the less stringent blood pressure definition (systolic blood pressure >140 mmHg and diastolic blood pressure ≥90 mmHg), 884 (34.2%) participants were normotensive and 1,700 (65.8%) were hypertensive at an initial screening. The average annual incidence of hypertension over the subsequent eight years was 13.2%, and life tables demonstrated a gradual risk of developing hypertension. The development of hypertension was not associated with gender or age; while older age groups had a greater chance of developing hypertension than younger, the difference did not reach statistical significance.
Geriatrics: An Updated Bibliography
Authors: Rosenthal Mark J.
Published: April 2015

This is the author's fifth revision of a geriatrics bibliography. Approximately one‐third of the previous references have been replaced by more current or more delimited articles. Because the literature pertinent to geriatrics has continued to grow ever more rapidly, it has been necessary to omit many informative articles from the bibliography. Preference is given to recent publications; almost all of the references date from the past four years. Some articles were selected to highlight current controversies or changes in viewpoint.

Most of the references deal specifically with an elderly patient population, though few use a multidisciplinary approach. Studies of the elderly are confounded by concomitants of aging frequent but not universal in our society: inactivity, obesity, malnutrition, and psychosocial trauma. The articles cited are primarily concerned with medical ailments of the elderly; legal, ethical, and sociological topics receive more limited coverage.

The references are divided into categories. The first set (I) deals with some possible causes of aging; the second (II) with physiologic decline accompanying aging; the third (III) with the atypical and nonspecific characteristics of illness among geriatric patients; the fourth (IV) with the elderly and society; and the fifth (V) with care options. The remainder of the references are cited by pertinent medical specialty. Within each category, references are divided by disease process. Articles are further subgrouped by aspects of those diseases such as evaluation or therapy.
BOOK REVIEWS
Authors: Rhymes Jill
Published: April 2015

Life‐Styles for Long Life: Longevity in Bulgaria. Translated and Edited by Lesnoff‐Caravaglia G. By Hadjihristev AK. Springfield, Illinois, Charles C. Thomas, 1988. 96 pages. $26.75.
Intermittent Urethral Catheterization in the Elderly
Authors: Terpenning Margaret S. , Allada Ravi , Kauffman Carol A.
Published: April 2015

Thirty‐five elderly patients receiving intermittent urethral catheterization in a Veterans Administration Hospital and attached nursing home care unit were prospectively studied for development of bacteriuria and/or urinary tract infection. Thirty‐one of the 35 patients (88.6%) developed urinary tract colonization. The mean time from initiation of catheterization to development of colonization was 5.7 ± 1.3 days. Persistent bacteriuria with one or several different microorganisms developed in 17 patients. The most common colonizing organisms were coagulase negative staphylococci, Klebsiella pneumoniae, and enterococcus. Four patients (11%) developed symptomatic urinary tract infection. Although urinary tract colonization was common in patients receiving intermittent urethral catheterization, especially in those with poor functional status, infection was uncommon. Based on these results, intermittent urethral catheterization appears to be a safe and effective method of bladder drainage in elderly male patients when performed with sterile techniques over short periods of time in the nursing home or hospital setting.
Nicergoline in Mild to Moderate Dementia: A Multicenter, Double‐Blind, Placebo‐Controlled Study
Authors: Battaglia Angelo , Bruni Giancarlo , Ardia Alfredo , Sacchetti Gabriele ,   On behalf of the Italian Nicergoline Study Group:, Baroni A. , Cisbani R. , Bovi P. , Roncolato G. , Del Dotto M. , Frascella G. , Gardelli G , Mordenti I. , Gentili G. , Santilli D. , Granata M. , Tomasinelli R. , Biase G. Iezzi , Izzi M. , Chittolina C. , Pirotti P. , Machi A. , Benigno P. , Monaco P. , Daricello B. , Pennisi F. , Nico F. , Cordelli S. , Notarbartolo A. , Montalto G. , Pasetti C. , Di Lorenzo G. , Perbellini G. , De Nardi F. , Poli G. , Roccatagliata G. , Albano C. , Astengo F. , Scardigli G. , Baldassini F. , Tucci G. , Trentini M. , Vecchi G.P. , Cortelloni C. , Neri M. , Battaglia A. , Bruni G. , Ardia A. , Sacchetti G.
Published: April 2015

In view of some controversies still existing about the real efficacy of ergot derivatives in the management of dementia, a double‐blind, randomized, parallel group trial extending up to 6 months was carried out to compare the effects of nicergoline, 60 mg daily, and placebo in 315 patients suffering from mild to moderate dementia. Clinical evaluation was performed by the SCAG scale. The trial, which included a 1‐month placebo run‐in period, showed that both placebo and nicergoline were associated with some degree of improvement. The effect of nicergoline, however, was significantly greater and more sustained, steadily increasing with time. In particular, the difference between nicergoline and placebo in mean total SCAG score was 5.5 at 3 months (95% confidence interval: 3.6–7.4) and increased to 9.8 at 6 months (95% confidence interval: 7.8–11.8). A comparison of nicergoline versus placebo in the frequencies of changes in each item of the SCAG showed also a significant difference at 6 months, the percent of patients displaying an improvement by at least 2 points ranging from 13.5 (bothersome) to 30.2 (disorientation) in nicergoline group, against 4.1 (self‐care) to 14.3 (fatigue) in placebo group. The safety of nicergoline, as judged by hemodynamic changes and drug‐related adverse reactions, was quite satisfactory.
Implementing A “Do‐Not‐Resuscitate” (DNR) Policy in a Nursing Home
Authors: Fader Andrew M. , Gambert Steven R. , Nash Maureen , Gupta Krishan L. , Escher Jeffrey
Published: April 2015

During implementation of a new Do‐Not‐Resuscitate (DNR) policy in New York State, decisions by 233 nursing home patients of their surrogates were evaluated. Eighteen patients with capacity (mean age ± SD = 76.4 ± 12.1 years) chose DNR; 30 patients with capacity (mean age ± SD = 76.2 ± 10.7 years) chose to be resuscitated (CODE); 54 patients without capacity, (mean age ± SD = 86.1 ± 9.1 years) had surrogates who chose DNR; and 131 patients without capacity and with surrogates (mean age ± SD = 81.9 ± 9.8 years) remained CODE. Most patients with capacity who chose DNR had multiple sclerosis, while most choosing CODE had strokes. Most patients who lacked capacity had dementia. Forty‐five percent of surrogates did not respond regarding CODE status during the three‐month study interval, and 10% wanted additional time to decide. Patient age appeared to be a factor in surrogate choice for DNR but not in patients with capacity making their own decision. Reasons for patients with capacity choosing DNR are discussed; perceived quality of life and premorbid feelings by patients help in the decision‐making process.
Aging and Postural Hypotension
Authors: Mader Scott L.
Published: April 2015

Postural hypotension is a common clinical problem in elderly patients. Reported studies have investigated the epidemiology and mechanisms of this disorder. However, many of these data are based on subjects with diseases and medications also known to cause this disorder, which confuses the relative contributions of normal aging, disease, and medication effects. This review critically evaluates published studies on measurement, epidemiology, and mechanisms of postural hypotension in screened and unscreened elderly populations. Pertinent age‐related changes in physiology and the relationship of postural hypotension in the elderly to other models of postural hypotension are reviewed. Areas of current and future research are outlined.
Survival After Cancer Surgery of Elderly Patients in New Mexico, 1969–1982
Authors: Becker Thomas M. , Goodwin James S. , Hunt William C. , Key Charles R. , Samet Jonathan M.
Published: April 2015

To examine the effects of advancing age, sex, and ethnicity on estimated 30‐day survival after surgery for cancer, we reviewed population‐based data on 16,130 cancer cases collected by the New Mexico Tumor Registry from 1969–1982. For surgery at most sites, mortality increased with increasing age. The highest mortality was observed for sites requiring laparotomy or thoracotomy. Sex and ethnicity (Hispanic versus non‐Hispanic white) had little effect on short‐term survival. Comparison of short‐term survival for two time periods, 1969–1975 and 1976–1982, showed a strong trend of improving survival for many sites.
An In Vitro Analogue of Immune Dysfunction with Altered Immunoglobulin Production in the Aged
Authors: Crawford Jeffrey , Dates Scott , Wolfe Lawrence A. , Cohen Harvey Jay
Published: April 2015

The consequences of aging of the immune system include impaired T‐lymphocyte responsiveness and aberrant immunoglobulin production. Although T cells from elderly individuals have a well‐described defect in lymphoblastic transformation in response to some polyclonal mitogens, immunoglobulin abnormalities have lacked a clear in vitro model. Peripheral blood mononuclear cells from 13 young and 13 old healthy donors were cultured with phytohemagglutinin (PHA) or pokeweed mitogen (PWM). Old‐donor‐cell phytohemagglutinin (PHA), but not PWM, cultures had significantly lower lymphoblastic transformation compared with young donor cultures. IgG, IgA, and IgM production tended to be lower in old‐versus young‐donor PWM cell cultures. By contrast, despite lower lymphoblastic transformation in old‐donor PHA cell cultures, immunoglobulin production was higher for old‐ versus young‐donor cell cultures. No significant age differences were present in initial lymphocyte counts, percent B cells, T cells or monocytes, or helper /suppressor ratios to explain this enhancement in immunoglobulin production. PHA‐stimulated mononuclear cell cultures in the aged demonstrate not only a defect in proliferation but also increased immunoglobulin production. This in vitro system may be useful to characterize further the pathogenesis of altered immunoglobulin production in the elderly.
Serum Fatty Acid Profile of Elderly Tube‐Fed Men in a Nursing Home
Authors: Rudman Daniel , Mattson Dale E. , Feller Axel G.
Published: April 2015

Severely dependent tube‐fed elderly men with dementia in this VA nursing home are nourished exclusively with Isocal, which provides only four fatty acids in amounts over 1% of the total (palmitic, oleic, linoleic, and alpha‐linolenic). It has not been proven that the frail elderly can efficiently convert linoleic to arachidonic acid, and alpha‐linolenic to eicosapentanoic and docosahexaenoic acids. Therefore, we compared the serum profile of fatty acids in six of the tube‐fed elderly men with the profile of six healthy young men eating mixed foods ad lib. Expressed as percent of total fatty acids, arachidonic, eicosapentanoic and docosahexaenoic acids did not differ significantly between the two groups. The data show that linoleic and alpha‐linolenic acids satisfy the requirements for ω6 and ω3 fatty acids, respectively, in severely impaired elderly men.
Use of the Functional Assessment Inventory to Distinguish Among the Rural Elderly in Five Service Settings
Authors: Pfeiffer Barbara A. , McClelland Tina , Lawson Joan
Published: April 2015

This replication study further supports the hypothesis that the Functional Assessment Inventory (FAI) can reliably distinguish between the elderly in different service settings. The five settings studied include a state mental health facility, a nursing home, a visiting nurse service, a senior center, and a control group of well elderly. The inclusion of the home care and control groups in this study provide new tests of the applicability of the FAI. The sample consisted of 125 elderly individuals with 25 subjects in each of the five groups. The FAI questionnaire was administered to the subjects and/or an informant when necessary. Results of a multivariate analysis of variance (MANOVA) revealed that the more functionally impaired individuals were utilizing the more care‐intensive settings. The FAI identified three distinct “cluster groups”: an institutional cluster (state mental health facility and nursing home), a home care cluster (visiting nurse service), and a community cluster (senior center and control group). Analysis of the subscale scores reveals discrete differences between each of the groups. Implications of the study findings are discussed.
The Influence of Oral Glucose Loading on Baroreflex Function in the Elderly
Authors: Jansen René W. M. M. , Hoefnagels Willibrord H. L.
Published: April 2015

Blood pressure in the elderly may decrease after a meal or after oral glucose loading. It has been suggested that eating may affect blood pressure homeostasis through an insulin‐induced blunting of baroreflex sensitivity. We investigated the effects of oral glucose loading on baroreflex sensitivity in young normotensives and in elderly normo‐ and hypertensive subjects. Blood pressure was measured by a new noninvasive device, Finapres, which measures blood pressure continuously in the finger. Baroreflex sensitivity was estimated with the phenylephrine and nitroglycerin method. In both elderly groups mean arterial pressure fell significantly after the glucose load (11 ± 1 mm Hg, P < .001 in the hypertensives, and 8 ± 2 mm Hg, P < .01 in the normotensive subjects), whereas no change in blood pressure was found in the young group. Baroreflex sensitivity was lower in both elderly groups than in young normotensives. Glucose loading had no influence on baroreflex sensitivity in the three groups. Therefore, we conclude that other factors are involved in the phenomenon of postprandial hypotension in the elderly. J Am Geriatr Soc 37:1017–1022, 1989
Prompted Voiding Treatment of Urinary Incontinence in Nursing Home Patients
Authors: Schnelle John F. , Traughber Belinda , Sowell V. A. , Newman Daniel R. , Petrilli Cheryl O. , Ory Marcia
Published: April 2015

This study evaluated a treatment procedure in which 126 incontinent nursing home patients were checked on an hourly basis, asked if they needed toileting assistance (prompted), and socially reinforced for appropriate toileting. Urodynamic analysis (including cystometrogram), provocative stress test, and behavioral assessment revealed that the nursing home patients were severely debilitated, with 65% demonstrating bladder abnormalities, 87% incapable of independent toileting, and 25% failing to score on the Mini‐Mental Status Exam (average score, 8.0). The treatment procedures were evaluated with a multiple baseline design in which subjects were randomly divided into immediate or delayed treatment groups after a baseline observation period. During treatment, the frequency of incontinence per 12 hours changed from a baseline average of 3.85 to a treatment average of 1.91. Three behavioral measures that can be easily collected by nursing staff significantly predicted continence levels during treatment (multiple R, 0.79) and change in incontinence during treatment (multiple R, 0.64). These prognostic criteria offer nursing staff a cost‐effective method for selecting the most responsive patients for prompted‐voiding treatment.
The Effect of Dietary Salt Ingestion on Blood Pressure of Old‐Old Subjects A Double‐Blind, Placebo‐Controlled, Crossover Trial
Authors: Palmer Robert M. , Osterweil Dan , Loon‐Lustig Gail , Stern Naftali
Published: April 2015

To study the effect of dietary salt restriction and supplementation on blood pressure of elderly subjects, we performed a randomized, placebo‐controlled, double‐blind, crossover trial. Seven healthy subjects living in a long‐term care facility, with a mean age of 85 and normal to borderline‐hypertensive blood pressures, completed a 16‐week protocol. During the double‐blind cycles, subjects consumed either a low sodium (43 mmol/day) or a high sodium diet (175 mmol/day) for four weeks supplemented with placebo or salt capsules, with crossover to the other diet. Sitting diastolic blood pressure was significantly lower during the low sodium diet (69.86 mmHg ± 3.80 vs 78.71 mmHg ± 3.99, P < .01), with all subjects showing decreases. Supine plasma renin activity and plasma aldosterone were significantly lower during the high sodium diet. Both low and high sodium diets were well‐tolerated by subjects. Symptomatic postural hypotension and hyponatremia were not observed. We conclude that old‐old subjects with borderline hypertension demonstrate salt‐dependent increases in blood pressure. Without additional supportive studies, however, these results should not be generalized to any specific cohort of elderly individuals.
The Senior Care Study
Authors: Owens Norma J. , Sherburne Nancy J. , Silliman Rebecca A. , Fretwell Marsha D.
Published: April 2015

Geriatric assessment units have improved pharmacotherapy for their patients by decreasing the number of medications prescribed. The Senior Care Study, a randomized controlled trial, compared a multidisciplinary‐team approach to patient care to the standard medical practice of the institution. As a part of the trial, the effectiveness of an interdisciplinary team intervention in improving the use of medications was studied. Study goals were to decrease medications used, decrease unnecessary medications, and improve medication choices in our acutely ill inpatient population. A pharmacist interviewed all experimental patients and patient records, and presented medication concerns and recommendations at a team conference. Medications were counted on admission and on the third day, sixth week, and third month after randomization. Medications were paired with patient problems. Medication:problem pairs were judged as inappropriate choices if there were potential side effects that would affect patient function, and if better alternatives were available.

The 215 control and 221 experimental patients in the study were similar in age, sex, place of origin, and number of medications on admission. Experimental patients took fewer medications than controls on the third day (5.3 versus 5.9, P < .05). Experimental patients received fewer multiple unpaired medications (11% versus 19%, P < .025) and fewer inappropriate medication choices (20% versus 37%, P < .005). The results suggest that the team intervention was effective in improving pharmacotherapy in the acute‐care setting.
Timed Manual Performance In a Community Elderly Population
Authors: Williams Mark E. , Gaylord Susan A. , McGaghie William C.
Published: April 2015

The extent of functional disability measured by performance of a series of simple manual tasks was determined in 1,286 elderly people, aged 66 to 98, who resided in central North Carolina. Missing data left 1,106 subjects for analysis. Poor manual performance was defined by either of two criteria: (1) inability to complete all the test items, or (2) taking longer than 350 seconds to complete the test. Using the first criterion, 113 persons (10.2%) were poor performers. When the two writing items were omitted from the analysis, 28 persons (2.4%) were in the poor performance group. Of the 993 persons who completed all items, 59 persons (5.9%) performed poorly. Using both criteria, the extent of functional disability was 16.1%; excluding the writing items, the extent of poor performance was 8.3%. Compared to those who performed well, those who performed poorly were older, poorer, less educated, more likely to be black, and less healthy. Because manual ability correlates highly with functional dependency and identifies those at risk for increased care needs, the magnitude of manual dysfunction noted in this survey has important implications for care providers and policy‐makers.
The Age‐Associated Decline in Glomerular Filtration in Healthy Normotensive Volunteers
Authors: Danziger Robert S. , Tobin Jordan D. , Becker Lewis C. , Lakatta Edward E. , Fleg Jerome L.
Published: April 2015

Whether the well‐documented age‐associated decline in the glomerular filtration rate, manifest as a decline in creatinine clearance, is secondary to an age‐related change in cardiovascular performance is at present unknown. To answer this question, we measured arterial blood pressure, 24‐hour creatinine clearance, and cardiac output determined from gated cardiac blood pool scans in the sitting position in healthy normotensive men (n = 75) and women (n = 42) (ages 25 to 82 years), from the Baltimore Longitudinal Study on Aging. These subjects were selected for the absence of cardiovascular disease, renal disease, and confounding medications. By linear regression analysis, creatinine clearance, expressed in mL/min/m2, declined cross‐sectionally with age (creatinine clearance = 90 – 0.33[age], r = .31, P < .001), whereas systolic blood pressure in mm Hg increased with age (systolic blood pressure = 111 + 0.27[age], r = .30, P < .001); cardiac output in L/min/m2 did not vary with age (r = .03, P = .74). In stepwise multiple regression analysis with age, cardiac index, and systolic blood pressure as independent variables and creatinine clearance as the dependent variable, only age was a significant predictor of creatinine clearance. (F = 11.31, DF + 116, r = .30, P < .001). Thus, the age‐associated decline in creatinine clearance is not modulated by changes in cardiac index or systolic blood pressure in healthy normotensive subjects.
Renal Biopsy in Patients 65 Years of Age or Older An Analysis of the Results of 334 Biopsies
Authors: Preston Richard A. , Stemmer Craig L. , Materson Barry J. , Perez‐Stable Eliseo , Pardo Victoriano
Published: April 2015

We studied the clinical and pathological data for 334 patients age 65 or more who underwent renal biopsy for acute renal failure (ARF, n = 55), subacute renal failure (SRF, n = 72), chronic renal failure (CRF, n = 57), proteinuria (n = 137), and hematuria (n = 13). Tissue diagnoses were glomerulopathy (n = 252, 75.4%), acute tubular lesions (n = 18), interstitial nephritis (n = 23), vascular diseases (n = 36, including 14 with cholesterol emboli), and five miscellaneous diagnoses. Of the 55 patients with ARF, 23 had a glomerular lesion, 15 had acute tubular necrosis, and 8 had acute interstitial nephritis. Of 72 patients with SRF, 49 had a glomerulopathy, 12 had a vascular disorder, and six had acute interstitial nephritis. Hence, patients with ARF or SRF exhibited a high potential for reversible lesions. Only 11.3% of patients with CRF had potentially reversible causes. The most common causes of proteinuria were membranous glomerulopathy (34.3%), minimal change disease (14.6%), focal segmental sclerosis (11.7%), and amyloidosis (8.8%). Of the 25 patients with advanced nephrosclerosis, 24 had renal failure, 20 were hypertensive, and 13 had cholesterol emboli. Of 33 patients with diabetes mellitus, 66.7% were found to have lesions not related to diabetes. We conclude that renal biopsy is most useful in older patients with ARF or SRF because of potentially reversible renal disease. Old age alone is not a contraindication to performing a renal biopsy.
Does the Williams Manual Test Predict Service Use Among Subjects Undergoing Geriatric Assessment?
Authors: Scholer Susan G. , Potter Jane F. , Burke William J.
Published: April 2015

This study examines the utility of the Williams Manual Test (WMT) in predicting those older patients who will eventually require formal services. One hundred seventeen older subjects underwent comprehensive geriatric assessment that included administration of the WMT and questionnaires assessing current service use. Study participants returned at 6 and 12 months for repeat measurement of study variables. The WMT was found to be a significant predictor of additional service use at 12 months (χ2 = 6.4, P < .01). The test had high specificity (83%) but relatively low sensitivity (40%). The lack of sensitivity in this study group was likely due to high levels of stress among caregivers whose relative was otherwise not predicted to need services. When the WMT was repeated after 6 and 12 months, the results were highly reproducible. The WMT appears to be a useful predictor of increasing formal service use. However, in certain study groups, its predictive ability may be affected by high levels of caregiver stress.
Aeromonas hydrophila Diarrhea in a Long‐Term Care Setting
Authors: Bloom Harrison G. , Bottom Edward J.
Published: April 2015

Infectious diarrheal diseases can be a serious problem in long‐term care institutions. Aeromonas hydrophila, a facultative, anaerobic gram‐negative rod, has not been implicated previously in an acute diarrheal outbreak in this setting. We report 17 patients with this disorder all characterized by the acute onset of painless, nonbloody diarrhea. Thirteen of 17 (76%) patients had two to four loose bowel movements and a duration of illness of less than 48 hours. Eleven of 17 (65%) patients were afebrile. Stool cultures were obtained in 11 patients; 4 (36%) were positive for A. hydrophila. The disease was fatal in one patient who experienced profuse diarrhea and developed fever, tachycardia, and hypotension. The original source of the A. hydrophila was not identified but transmission is known to be water‐ or food‐borne. Although usually mild and self‐limited, A. hydrophila infection as noted in one patient can be fulminant and severe. A. hydrophila diarrhea responds to antibiotic therapy; it is important to consider in the differential diagnosis of acute diarrheal illness among older persons in an institutional setting.
Segmental Neurofibromatosis in an Octogenarian
Authors: Smith Stacy , Heymann Warren R.
Published: April 2015

A case of segmental neurofibromatosis (SNF) in an octogenarian is presented. The patient's lesions were first noted when he was 74 years of age. This variant of neurofibromatosis (Riccardi's classification, NF‐V) is most typically seen in childhood or young adulthood. To the best of our knowledge, our patient's SNF is the first case to present in the eighth decade of life. Physicians working with geriatic patients should be aware of this entity and its lack of genetic heritability or systemic manifestations.
The Very Low Prevalence of Polymyalgia Rheumatica in Blacks May Be an Artifact
Authors: Goodwin James S.
Published: April 2015

This article discusses the possibility that the reported low prevalence of polymyalgia rheumatica in blacks might be because of an underrecognition of the disease in this racial group.
The Effect of Volume Expansion on Atrial Natriuretic Peptide and Cyclic Guanosine Monophosphate Levels in Young and Aged Subjects
Authors: Tan Adriaan C.I.T.L. , Hoefnagels Willibrord H.L. , Swinkels Leon M.J.W. , Kloppenborg Peter W.C. , Benraad Theo J.
Published: April 2015

The relationship between atrial natriuretic peptide (ANP) and age was studied. In elderly subjects (65 to 84 years) higher basal ANP levels were found as compared with those found in young subjects (21 to 23 years). Volume loading (750 mL 0.9% NaCl in 60 minutes) increased ANP levels only in the aged group, and plasma renin activity decreased only in the young subjects. Plasma aldosterone levels did not change. Basal cyclic guanosine monophosphate values did not differ in either group, and rose to a similar extent during volume loading. High pressure liquid chromatography analysis did not suggest different molecular forms of immunoreactive ANP in elderly subjects. The main circulating component both basal and after stimulation corresponds to the (99–126)hANP form.
Incidence and Prognosis of Acute Renal Failure in Older Patients
Authors: Pascual J. , Orofino L. , Liaño F. , Marcén R. , Naya M. T. , Orte L , Ortuño J.
Published: April 2015

Few studies have assessed the prevalence and outcome of acute renal failure (ARF) in the elderly. Among 437 ARF cases prospectively studied during a nine‐year period in a nephrology department, 152 (35%) occurred in patients over 70 years of age (Group 1). Patients over 70 account for only 10.5% of all hospital admissions in our country, and prevalence of ARF was 3.5 times higher in these patients than in younger people. Acute tubular necrosis (ATN) was diagnosed in 40% of Group 1 and 52% of the younger patients (Group 2) (P < .05), whereas prerenal ARF was found in 47% and 32%, respectively (P < .001). Dehydration was the most frequent cause of prerenal ARF in the elderly (51%). The etiological distribution of ATN was similar in both groups, being of multifactorial origin in most cases. Oliguria was present in 49% of ATN in Group 1 and in 66% of Group 2 (P < .05). There were no significant differences in dialysis needs.

Mortality was higher in the elderly in all types of ARF, although differences did not reach statistical significance. Need for dialysis, mechanical respiration, decreased level of consciousness, and hypotension were associated with poor prognosis in both groups. Total recovery from ARF in older persons was less frequent and slower than in younger patients.

It may be concluded that patients over 70 years of age are at high risk for developing ARF; nevertheless, age should not be used as a discriminating factor in therapeutic decisions concerning ARF.
Reduced Beta‐Cell Secretion and Insulin Hepatic Extraction in Healthy Elderly Subjects
Authors: Pacini G. , Beccaro F. , Valerio A. , Nosadini R. , Crepaldi G.
Published: April 2015

One factor responsible for the altered carbohydrate metabolism in elderly subjects is impaired insulin release; however, difficulties in directly measuring insulin secretion have limited studies on pancreatic activity and on the contribution of the liver to insulin delivery. This study investigated beta‐cell performance and insulin hepatic extraction under dynamic conditions in normal elderly subjects. Two strictly comparable groups of 12 young controls (Y, 27 ± 1 (SE) years, 73 ± 3 kg) and 12 elderly men (E, 69 ± 2 years, 73 ± 3 kg) were chosen on the basis of normal OGTT and normal insulin sensitivity in order to investigate a “pure” age effect. The subjects underwent a 4‐hour frequently sampled intravenous glucose tolerance test (FSIGT) (dose 0.3 g/kg). Although no significant differences were found between the fasting levels of glucose and insulin (respectively: E: 89 ± 3 mg/dL versus Y: 87 ± 2, P > .1; and E: 5.0 ± 0.5 μU/mL versus Y: 6.8 ± 1.0, P > .05), basal C‐peptide was found to be lower in the old subjects: 0.43 ± 0.06 ng/mL versus 0.70 ± 0.11 (P < .025). The patterns of glucose and insulin during the FSIGT were similar, whereas C‐peptide concentration in E was systematically lower, suggesting a reduced insulin secretion. To verify this hypothesis, we analyzed FSIGT data with a mathematical model‐based method that provides a noninvasive direct measurement of the time courses of insulin secretion and hepatic extraction. Our results showed that age is associated with impaired beta‐cell secretion (the total amount of released hormone in 240 minutes was 4.8 ± 0.6 nM in E versus 7.5 ± 0.9 in Y, P < .025), and also that the hepatic extraction of the hormone was reduced in E compared to that of Y, yielding a total amount of insulin reaching the periphery in 240 minutes of 2.7 ± 0.2 nM, virtually the same as that of Y (2.9 ± 0.3, P > .3). We conclude that the normal peripheral insulin concentration observed during the FSIGT in our elderly subjects was due to a reduced hepatic insulin extraction that counterbalances the reduction in beta‐cell secretion.
Reduced Supine Cardiac Volumes and Diastolic Filling Rates in Elderly Patients with Chronic Medical Conditions
Authors: Lipsitz Lewis A. , Jonsson Palmi V. , Marks Bonita L. , Parker J. Anthony , Royal Henry D. , Wei Jeanne Y.
Published: April 2015

Very elderly individuals with multiple chronic illnesses are at high risk of orthostatic hypotension, falls, and associated morbidity and mortality. Alterations in cardiac volumes and filling characteristics may contribute in part to an increased prevalence of orthostatic hypotension and falls in these people. In this study cardiac function was evaluated with gated radionuclide ventriculography in eight healthy young subjects (19–38 years) and 25 elderly persons with stable chronic illnesses (73–96 years), 14 of whom had a history of recurrent falls. Blood pressure was measured supine during the radionuclide ventriculography, then after one minute of standing. Supine stroke volume index, end diastolic volume index, cardiac index, and peak filling rates were significantly lower in elderly subjects compared to young, and ejection fraction and end systolic volume index (measures of systolic function) were the same in young and old. Compared to the young, elderly subjects had a reduction in ventricular filling during the first third of diastole, but an augmentation in the last third, during atrial contraction.

Within the group of elderly subjects, the directional change in systolic blood pressure during orthostasis was significantly correlated with basal supine systolic blood pressure (R = 0.81, P < .0001) and supine cardiac index (R = 0.66, P = .002). Thus, very old people representative of those seen in clinical practice have reduced cardiac volumes and impaired early diastolic filling, a result possibly related to elevations in systolic blood pressure. These changes in cardiac structure and function may contribute, in part, to orthostatic hypotension in advanced age.
Brief Screening Tests versus Clinical Staging in Senile Dementia of the Alzheimer Type
Authors: Davis Paula B. , Morris John C. , Grant Elizabeth
Published: April 2015

Several brief screening tests of cognitive function were compared with a reliable and valid global rating of the presence and severity of senile dementia of the Alzheimer type, the Washington University Clinical Dementia Rating (CDR). The six‐item Short Blessed Test, the Short Portable Mental Status Questionnaire, the 26‐item Blessed Information‐Memory‐Concentration Test, the Blessed Dementia Scale, and the Blessed Dementia Scale‐Cognitive were able to discern both the presence of dementia and its severity. The six‐item Short Blessed Test is preferred as a screening test because of its brevity, administration to the subject only, inclusion of a learning task, reliability, and neuropathologic validity. Evidence is presented for the convergent validity of the Initial Subject Protocol, used to derive the Clinical Dementia Rating.
Hearing Loss in the Nursing Home
Authors: Voeks Susan K. , Gallagher Constance M. , Langer Elizabeth H. , Drinka Paul J.
Published: April 2015

One hundred ninety‐eight nursing home admissions underwent audiometric assessment and answered questions regarding hearing difficulty in common listening situations. Twenty‐four percent demonstrated normal thresholds (0–25 dB) in the speech frequencies with only mild losses at 4000 Hz. Fifty‐four percent had normal thresholds through the speech frequencies with moderate to profound losses at higher frequencies, or mild losses (26–40 dB) in the speech frequencies. Such persons would be at risk in daily listening situations. Twenty‐two percent had moderate or greater losses (> 40 dB) through the entire frequency range. Sixteen percent of this significantly impaired group were not identified as having a hearing loss by either the admitting RN or physician. Sixty percent of residents reported trouble in a group if they could not see the speaker's face, when watching television, and/or when using the telephone. The data indicate that a systematic hearing screening program is the most reliable means of identifying hearing loss and functional hearing handicap on an individual basis. The high prevalence of hearing problems suggests that this handicap also needs to be addressed from the perspective of institutional policy. Staff training and environmental modification should be undertaken to give hearing support to the entire nursing home population.
The Outcome of CPR Initiated in Nursing Homes
Authors: Applebaum Gary E. , King Joyce E. , Finucane Thomas E.
Published: April 2015

To determine outcomes following attempted cardiopulmonary resuscitation initiated in nursing homes, we retrospectively reviewed ambulance and hospital records for all 705 people aged 65 or over who underwent attempted resuscitation by ambulance crews in 1987 in Baltimore City and Baltimore County. From medic unit encounter forms we noted whether or not the address of origin was a nursing home and to what hospital the person was taken. Hospital records were then examined to determine outcomes: death in the emergency room, death during consequent hospitalization, or live discharge. Complete information was obtained for all 117 nursing‐home residents and for 580 of 588 nonresidents. When attempted resuscitation was begun in a nursing home, only two patients survived to hospital discharge, whereas 61 nonresidents (11%) survived after a mean stay of 14 days. Of the 115 nursing‐home residents who did not survive to hospital discharge, 102 (89%) were pronounced dead in the emergency room, two (2%) more died within 24 hours of admission, and the remaining 11 (9%) died after an average stay of five days. Of the 519 nonresidents who died before discharge, 433 (83%) were pronounced dead in the emergency room, 16 (3%) died in the first 24 hours, and 70 (14%) lived an average of nine days. One of the two nursing‐home residents who survived was an 87‐year‐old woman who spent 30 days in the hospital and died eight months after returning to the nursing home, demented, cachectic, with a large sacral pressure sore. The other was an 81‐year‐old man who, after a 60‐day hospitalization, returned to the nursing home and died there 14 days later. We conclude that the benefits of cardiopulmonary resuscitation initiated in nursing homes are extremely limited.
Ventricular Ectopy During Prolonged Ambulatory Electrocardiographic Monitoring in Elderly Hypertensive Subjects
Authors: Kelleher Peter W. , Imperial Elias S. , Burnett Peter , Mitchell Reginald
Published: April 2015

To examine whether ventricular ectopy in hypertensive older people is associated with age, the hypertensive process, or treatment, a 24‐hour ambulatory electrocardiogram recording was obtained in 94 noninstitutionalized subjects aged 60–90 years with isolated hypertension and 136 noninstitutionalized normotensive subjects aged 60–82 years. A significantly higher prevalence of frequent ventricular ectopic beats (VEB > 100 per recording) was found in hypertensive and normotensive groups age ≥ 70 years compared to age 60–69 years (44% vs 15%, P < .01, and 28% vs 9%, P < 01, respectively). Complex ventricular ectopy was found to be significantly increased only in the hypertensive group ≥ 70 years compared to 60–69 years (53% vs 28%, P < .05). No significant difference for any type of ventricular ectopy was found between treated and untreated hypertensive subjects. Analysis of variance of frequent ventricular ectopy showed a significant effect of age (P < .001) but not of hypertension. Multivariate regression analysis with frequent ventricular ectopy as the dependent variable confirmed this relationship. For complex ventricular ectopy, analysis of variance showed a significant effect of hypertension (P < .001) and age (P < .05). Multivariate regression analysis confirmed that complex ventricular ectopy was significantly associated with hypertension (P < .01) and age (P < .05). In elderly subjects aging alone is associated with increased frequency of ventricular ectopy, whereas complex ventricular ectopy is more significantly related to the hypertensive process than to age.