bluuebunny/crossref_metadata_2025 huggingface dataset:
Genitourinary Disorders of Old Age: Therapeutic Considerations Including Counseling for Sexual Dysfunction
Authors: FINKLE ALEX L.
Published: April 2015

ABSTRACT: Genitourinary tissues undergo physical changes with advancing age, due partly to hormonal alterations. However, the greatest influence on continuing sexual function during aging is emotional and is directly related to the psychologic history of the individual patient. The interested professional can help his patient substantially by simply taking time to listen, a process which permits identification of any psychogenic basis for the sexual dysfunction. The entire approach and method of counseling presuppose that psychogenic impotence is the most common form of the problem. This preliminary effort can do no harm. Should it fail, the patient can be referred to other consultants who use more protracted or sophisticated modalities. With the elderly, the clinician can advise patients to share interpersonal warmth and to enjoy the satisfaction of body contact at any age at which this desire and capacity persist. To the aging person, the totality of sexual meaning is more significant than performance or technique. The sympathetic counselor who renders supportive reassurance to the patient usually can expect beneficial results.
Health Habits in Relation to Aging*
Authors: McGLONE FRANK B. , KICK ELLA
Published: April 2015

ABSTRACT: A review of the literature and a study of 52 patients of the 80+ age group confirmed the premise that good health habits have a positive effect on the quantity and quality of life. Not all persons can live beyond 80, but those who do can lead a better life if they live properly. A profile of these 52 subjects aged 80 or older revealed that they were of average size or thin, and of a happy temperament; they ate well and regularly, slept adequately, avoided excessive amounts of alcohol, did not smoke, used drugs sparingly, and led an active life, physically and mentally. Also, it was apparent that the rugged elderly can withstand the impact of a major illness or a surgical operation with associated anesthesia. The following factors are important for longevity: 1) pick the right grandparents, 2) keep active physically and mentally, 3) eat properly, 4) stay thin, 5) drink alcohol moderately if at all, and 6) do not smoke.
Appraisal of Codeine as an Analgesic in Older Patients*
Authors: JOCHIMSEN PETER R. , YES RUSSELL NO
Published: April 2015

ABSTRACT: In an investigation of a new oral analgesic agent, codeine was chosen as the reference drug because of its established reputation as an effective agent for the relief of pain. Thirty‐five patients with cancer pain were studied. Their average age was 58 years. During a 5‐day hospital stay they received, on each of three days, either codeine (120 mg or 60 mg) or placebo. At hourly intervals after ingestion the nurse observer collected data on pain intensity and the degree of pain relief, and the patients independently charted the hourly intensity. Statistical analysis failed to show any significant superiority of either dose of codeine over placebo. Moreover, codeine is known to have a constipating effect. Re‐appraisal of the value of codeine as an analgesic agent in elderly patients seems justified.
Pathology of Centenarians. III. Osseous System, Malignant Lesions, and Causes of Death
Authors: ISHII TOSHIHARU , STERNBY NILS H.
Published: April 2015

ABSTRACT: This third autopsy study of 23 centenarians (7 men and 16 women) included the pathologic examination of bone, the detection of malignant neoplasms, and the determination of the main and contributory causes of death. (Previous studies concerned the lungs and the cardiovascular, urogenital and digestive systems.) The vertebral bone specimens showed definite osteoporosis in 14 of the 23 subjects. In some cases it was associated with kyphosis or scoliosis of the spine or a history of femoral fracture. Eight malignant neoplasms were observed in six patients. Prostatic cancers were found in three of the seven men. All the cancers were well differentiated structurally. Four latent cancers were detected at autopsy. Most of these centenarians died of bronchopneumonia or myocardial fibrosis. Death from a malignant neoplasm was uncommon, and usually the cancer was only a contributory cause. The importance of atherosclerosis prevention is stressed by the fact that atherosclerosis was the basic cause of the cardiovascular lesions that constituted a main cause of death.
Review of Laxative Utilization in a Skilled Nursing Facility
Authors: LAMY PETER P. , KRUG BRUCE H.
Published: April 2015

ABSTRACT: Laxatives are the most frequently prescribed drugs in long‐term care facilities. Of all nursing home patients, 58 percent receive laxatives—often more than one, and usually on a “prn” basis. This pattern of dosage is probably used in an effort to prevent constipation. Selection of a laxative should be based on careful evaluation of the cause of constipation, with due consideration being given to differences in drug effectiveness and the incidence of side effects. A review of laxative utilization among 73 elderly patients in a large metropolitan skilled nursing facility showed a rational use of these drugs. However, more attention should have been paid to the dietary management of constipation.
Nurses' Notes on Nursing Home Patients: Are They Effective?
Authors: HOWARD JOHN B. , STRONG KENNETH E.
Published: April 2015

ABSTRACT: The notes written by nurses in a level‐Ill nursing home were reviewed in detail. They were found to be neither pertinent nor meaningful in most cases. The daily writing of these notes required a large percentage of the nurses' time but they were seldom, if ever, read by physicians. An alternate system of writing notes on a weekly basis is suggested.
Organ Weights in Nonagenarians1
Authors: HOWELL TREVOR H.
Published: April 2015

ABSTRACT: The main organs in a series of 39 nonagenarians were weighed at autopsy. The weights varied widely from subject to subject. Compared with average weights in younger subjects, the brains, livers, spleens, kidneys and lungs weighed less than usual in the majority of nonagenarians examined. However, the hearts often were heavier than normal and many of them were hypertrophied.
Stress Management Training for the Elderly: A Psychoeducational Approach
Authors: GARRISON JOHN E.
Published: April 2015

ABSTRACT: A procedure is described for teaching elderly persons the use of relaxation as a coping skill. The procedure, called Stress Management Training, seeks to provide the client with: 1) a cognitive understanding of stress and relaxation, 2) the ability to relax by controlling muscle tension and sympathetic‐nervous‐system activity, and 3) the ability to extend the relaxation skill to real‐life stress situations. A case report demonstrates the process, which is an educational model rather than a medical model. The role of the psychotherapist as an educator and the potential usefulness of the social learning theory as a basis for conceptualizing mental health problems are discussed.
Topical Fluorouracil Therapy for Precancers and Cancers of the Skin
Authors: CULLEN STANLEY I.
Published: April 2015

Topical fluorouracil (FU) is an extremely effective agent for treating multiple actinic keratoses. It is also of value in the treatment of Bowen's disease, actinic cheilitis, arsenical keratoses, radiodermatitis, X‐ray‐induced keratoses, leukoplakia, and the erythroplasia of Queyrat. Topical FU may be successful in the treatment of superficial basal‐cell carcinomas, but should not be used for nodular carcinomas of the face or neck except under unusual circumstances and with mandatory histologic follow‐up evaluation. The usual method of treatment is twice daily application of a 1 percent FU solution in propylene glycol. Several modifications of various types of commonly employed preparations and the manner in which each is used are described, along with the respective indications. The considerable discomfort associated with the use of topical FU can be lessened by the stepwise approach outlined—a method extraordinarily valuable for older patients. Occasional complications are primary irritant dermatitis and allergic contact dermatitis; these must be recognized promptly and treated, as must other less frequent side effects. Topical FU appears to be of great value in the destruction of existing precancerous skin lesions. When used repeatedly, it may postpone indefinitely the development of significant precancerous and cancerous skin lesions.
Age‐Related Changes in Endocrine and Renal Function in Patients with Essential Hypertension
Authors: Yamada Takashi , Endo Toyoshi , Ito Kazuki , Nagata Hajime , Izumiyama Tomio
Published: April 2015

Endocrine and renal functions were studied in 149 patients with essential hypertension by measuring plasma electrolytes, renin activity, creatinine and aldosterone, as well as the urinary excretion of creatinine and sodium chloride, before and during treatment for hypertension. Half of the patients responded to trichlormethiazide (thiazide‐responsive group) but the other half did not (thiazide‐unresponsive group). Systolic and diastolic blood pressures increased progressively with age in the thiazide‐unresponsive group, but were lower and did not progress with age in the thiazide‐responsive group. There was no consistent difference in plasma renin activity between the thiazide‐responsive and the thiazide‐unresponsive groups. The fluctuation of plasma renin activity in response to an excess of sodium chloride or to thiazide treatment was reduced progressively with age. Creatinine clearance decreased and the blood urea nitrogen level increased with age. The age‐related decrease of plasma renin activity is discussed in the light of the age‐related impairment in the ability of the kidney to excrete sodium and water.
Depression in the Elderly
Authors: GOLDSTEIN STANLEY E.
Published: April 2015

ABSTRACT: Depression in the elderly is difficult to classify and may be more of a symptom than a disease entity. The core problem with the elderly is inability to handle multiple losses. Feelings of helplessness and reduced self‐esteem are significant. The resultant depression often appears mild but the risk of suicide cannot be ignored. The family physician is the key person in the diagnosis of depression. The close relationship between physical factors and depression may make differentiation difficult. Treatment involves a sympathetic but firm approach, particularly when dealing with the hypochondriacal patient. Regression in the elderly is a serious problem that requires staff teamwork. Reactivation techniques which combat feelings of helplessness and hopelessness are of particular importance. When the patient no longer responds well to appropriate drugs, electroconvulsive treatment may be of value. Family and marital therapy should not be overlooked. The nihilist has no place in geriatric medicine.
Comparison of Mortality Rates for Various Surgical Operations According to Age Groups, 1951–1977*
Authors: ZIFFREN SIDNEY E.
Published: April 2015

ABSTRACT: A comparison was made of the mortality rates for various surgical operations, by age groups and by time periods. The age groups were: under 60, 60–69, 70–79, and 80 or over. The three time periods were: 1951–1955, 1956–1967, and 1967–1977. Only slight improvement was noted in these mortality rates despite the fact that during the 1951–1977 period many improvements were made in anesthesia, surgical techniques, antibiotic therapy, intensive‐care units, and presumably the better understanding of disease. Further improvements will depend almost exclusively upon studying the basic problems of old age, chiefly atherosclerosis with its effects on the heart, blood vessels, brain, respiratory system and urinary tract. Unless this is done, there is no prospect of great improvement in operative results, and no basis for believing that the operative risk in the aged is the same as in the young. Unless the physiologic reserves of the aged can be improved, the surgical mortality rates likely will remain static.
Simultaneous Development of Autoimmune Disease and Malignancy in Two Elderly Patients
Authors: LIPSMEYER ELEANOR A.
Published: April 2015

ABSTRACT: Two elderly patients who presented with symptoms of “systemic rheumatic or autoimmune disease” had high serum titers of fluorescent anti‐nuclear antibody (ANA). Signs of malignancy were evident at the time of the first examination. T‐cell dysfunction in the aged may permit the simultaneous development of autoimmunity and neoplasia. When rheumatic symptoms with a high titer of fluorescent ANA develop in elderly patients, an exhaustive search for malignancy should be considered.
Identification of Normal Aging and Disease‐Related Processes by Health Care Professionals
Authors: DYE CAROL J. , SASSENRATH DOROTHY
Published: April 2015

ABSTRACT: A 40‐item quiz on aging was given to 46 health care professionals, before they participated in a workshop dealing with the care of the elderly patient. In the quiz, they were asked to identify physiologic and functional conditions either as normal aging processes or disease‐related processes. In general the results indicated that disease processes were the easier entities to identify, and that the workshop experience enhanced this effect. Ability to identify functional disorders correctly did not differ significantly from the ability to identify physiologic symptoms correctly. Implications for the general health and the mental health of older adults are discussed.
Update on the Male and Female Climacteric*
Authors: GREENBLATT R. B. , NEZHAT C. , ROESEL R. A. , NATRAJAN P. K.
Published: April 2015

ABSTRACT: The gonadal steroids—estrogens and androgens—appear to have a mood‐elevating, psychotonic effect. The improved sense of well‐being and increased vigor probably is engendered by restoration of somatic efficiency and psychic equilibrium. 1. The male climacteric, as observed in a limited number of men, is associated with a low level of serum testosterone. The levels of follicle‐stimulating hormone and luteinizing hormone are not elevated because estrogen concentration continues unaltered well into old age. Androgen replacement therapy often lessens fatigue, depression and headaches, and improves libidinous drives. 2. In the aging female, many climacteric symptoms other than those due to vasomotor instability were heretofore considered merely coincidental. Recent studies suggest that the metabolism of cerebral hormones is markedly influenced by endogenous and exogenous gonadal steroids. Thus, postmenopausal depression, headaches, and nervousness may be hormone‐dependent symptoms. 3. The incidence of endometrial cancer is no greater and is probably less in estrogen‐treated women than in women not treated with estrogen, if regular cyclic courses of an oral progestogen are added to the regimen.
Rapid Slide Technique with Dextranomer Beads for Bacteriologic Assessment of Wounds in the Elderly: Comparison with Quantitative Biopsy Method
Authors: HEGGERS JOHN P. , ROBSON MARTIN C. , FRANK DAVID H. , KO FRANCIS
Published: April 2015

ABSTRACT: A rapid slide technique to provide quantitative bacteriologic assessment of wounds in elderly and debilitated patients is described. It involves the use of material from dextranomer‐bead (Debrisan) wound dressings to replace tissue biopsy for deciding when a wound is ready for closure or when a specific therapy is no longer efficacious. In 27 patients an 81 percent correlation was demonstrated between the bacterial count as determined by the new method and that determined by the more complicated tissue biopsy.
Dihydroergotoxine: 6‐Mg versus 3‐Mg Dosage in the Treatment of Senile Dementia. Preliminary Report*
Authors: YESAVAGE JEROME A. , HOLLISTER LEO E. , BURIAN ERNST
Published: April 2015

ABSTRACT: In 14 patients with senile dementia, a study was made of two dosage levels (3 mg or 6 mg daily) of dihydroergotoxine mesylate (DEM, Hydergine). Only a nonstatistically significant trend was found for superiority of the higher dosage. However, one patient showed remarkable clinical improvement during the 6‐mg period; the mechanism remains unexplained. Further studies are needed with this higher dosage in less impaired patients and in those with well‐defined cerebral pathologic changes.
Drug Utilization and Prescribing Patterns in a Skilled Nursing Facility: The Need for a Rational Approach to Therapeutics
Authors: SEGAL JACK L. , THOMPSON JOHN F. , FLOYD RONALD A.
Published: April 2015

ABSTRACT: A study was made of 50 patients drawn at random from a Skilled Nursing Facility (SNF) attended by seven physicians. For 59 percent of these patients, polypharmacy was practiced but no substantiating diagnoses were recorded. Approximately half of the drugs were administered pro re nata. More drugs were prescribed in potentially toxic dosages than in subtherapeutic dosages. The risk of an adverse drug reaction (ADR) was most often associated with anticholinergic agents, sedative‐hypnotic drugs, and neuroleptics (thioridazine and chlorpromazine), particularly when prescribed concurrently. Risk of an ADR was highest when a drug was prescribed without recording a definite diagnostic indication. Lack of consistency by individual physicians in their approaches to the therapy of similar disease entities in comparable patients tended to support the concept of peer review in SNFs and also the need for teaching a rational approach to therapeutics in SNFs based on clinical pharmacology as applied to the elderly.
Institutionalized Older Adults and Their Future Orientation
Authors: HUGHES ELIZABETH
Published: April 2015

ABSTRACT: This study hypothesized: 1) that as the duration of institutional living increases, the future orientation of active older adults contracts; and 2) that this constriction in future temporal orientation means less opportunity for interaction in the institutional environment. To test the first hypothesis, 100 active female residents in six institutions for the aged were evaluated regarding future orientation, by means of Cottle's Experiential Inventory. The opportunity for interaction was measured by Pincus's Psychosocial Dimensions in the Institutional Environment. The findings indicated that, irrespective of age, the residents became less futureoriented or their orientation became less recent, as the length of institutional residence increased. The second hypothesis was not supported; in fact, the reverse was true.
Age‐Related Changes in Rat and Primate Plasma Cholesterol Metabolism
Authors: LACKO ANDRAS G. , DAVIS JERRY L.
Published: April 2015

ABSTRACT: Plasma lipids, lipoproteins and the enzyme, lecithin:cholesterol acyltransferase (LCAT), were studied in three age groups of Sprague‐Dawley rats and non‐human primates (Macaca nemestrina). In the rats, serum cholesterol levels did not change significantly from 2 months (82 ± 6 mg/dl) to 12 months of age (88 ± 9 mg/dl) but increased sharply by 24 months (173 ± 85 mg/ dl). LCAT activity (cholesterol esterified per ml per hr) decreased slightly, but a more significant decrease with age was noted in the fractional rate of cholesterol esterification (percent cholesterol esterified per hr). Fasting resulted in a progressive decrease in the serum cholesterol level, usually accompanied by an increase in the fractional rate of cholesterol esterification. In the primate study, three age groups were used. On each serum sample, the following determinations were made: free and total cholesterol, triglycerides, high‐density lipoprotein (HDL) cholesterol, and LCAT. In the serum from 4‐year, 10‐year and 20‐year‐old animals, only a few significant changes were observed. There was a slight tendency for the levels of serum cholesterol and triglycerides to increase with age, but larger changes were noted in high‐density and low‐density lipoprotein (LDL) compartments. HDL cholesterol increased while LDL cholesterol decreased with age. The significance of these findings in relation to human cholesterol metabolism, atherosclerosis, and aging is discussed.
Behavioral Improvement in Long‐Term Geriatric Patients during an Age‐Integrated Psychosocial Rehabilitation Program*
Authors: ABRAHAMS JOEL PETER , WALLACH HOWARD F. , DIVENS SHIRLEY
Published: April 2015

ABSTRACT: A study was made of the effects of a psychosocial rehabilitative program on the behavioral functioning of elderly chronically ill patients. High school students served as remotivation and socialization therapists in a supervised structured process designed to improve the quality of life for the participating nursing‐home residents. The participants were 12 long‐term patients whose ages ranged from 62 to 99 years (mean, 73.2 years). The effectiveness of the program was evaluated by means of the Sickness Impact Profile (SIP), a questionnaire designed to assess the effect of a physical illness on daily activities, psychosocial skills and mental status. The results demonstrated that the rehabilitative program had a significant impact on several dimensions of the lives of the participants. As a consequence of the interaction with the students, there was an increase in social interaction, a reduction in daytime sleeping and an increase in mobility. The results reported here extend the successful use of remotivation techniques to areas of overt behavioral functioning not previously assessed.
Incorporation of Gerontology into Medical Education
Authors: HALL GEORGIA G. , STARKMAN MONICA N.
Published: April 2015

ABSTRACT: Despite the increasing importance of gerontology to medical practice, it has been difficult to incorporate it into the curriculum of most medical schools. The aim of this project was to explore the feasibility of introducing gerontology into medical education by utilizing the framework of an existing clinical program. A gerontologist used the structure and resources of a Psychiatry Consultation‐Liaison Program for this purpose. Three groups of target trainees were identified: psychiatry residents on their Liaison rotation; junior medical students on their psychiatry clerkship; and medical‐surgical house officers in the general hospital. The objectives were to impart didactic information and to counteract negative attitudes leading to disinterest in evaluating and treating the elderly. The results indicated a positive impact on all three trainee groups, and a diffusion of the gerontologic innovation from the initial locus of a clinical sub‐unit into the medical center and the medical school.
Drug Use in a Geriatric Population
Authors: HALE WILLIAM E. , MARKS RONALD G. , STEWART RONALD B.
Published: April 2015

ABSTRACT: Drug usage was studied in a geriatric hypertension‐screening program. A questionnaire was used to collect the required information from patients visiting the clinic during three successive years. The study included 1,711 patients, of whom 76.6 percent were regularly using a drug preparation. A consistent increase was noted in the average number of drug categories used with increasing age, from 1.6 in patients under 70 to 2.6 in patients over 84 years old. The most common drug categories involved were antihypertensive agents, cardiovascular drugs, vitamins, and internal analgesics.
Alcohol Use Among Older Persons: Findings from a Western New York State General Population Survey
Authors: BARNES GRACE M.
Published: April 2015

ABSTRACT: This report on the drinking patterns of older persons is based upon a cross‐sectional probability sample of 1,041 adults aged 18 years or older living in Erie and Niagara Counties in Western New York State. The rates of drinking‐, heavy drinking, and alcohol‐related problems were considerably lower among persons aged 60 or older than among those aged 50–59 (approaching old age), or among those aged 18–49 (the younger comparison group). Although heavy drinking was almost nonexistent among the elderly women, sizable proportions of the older men (e.g., about a quarter of the men in the 60–69 age group) were heavy drinkers. Previous reports concluding that the stresses of aging, such as widowhood and retirement, are associated with increased problem drinking were not confirmed in this study. More definitive, longitudinal research is needed to develop a better understanding of the relationships between drinking patterns and the aging process.
The Type A (Coronary‐Prone) Behavior Pattern, Aging, and Mortality
Authors: SPARACINO JACK
Published: April 2015

ABSTRACT: Young and middle‐aged persons displaying the Type A (coronary‐prone) behavior pattern have been shown repeatedly to be at substantially increased risk of coronary heart disease. A review of recent empirical research regarding adaptability and survival among the elderly suggests the hypothesis that the clinical significance of Type A behavior may shift radically in old age. Thus, compared to Type B (not coronary‐prone) subjects, Type As may be at lesser rather than greater risk of impairment and death.
Health‐Seeking Behavior and Social Networks of the Aged Living in Single‐Room Occupancy Hotels
Authors: COHEN CARL I. , SOKOLOVSKY JAY
Published: April 2015

ABSTRACT: The elderly who reside in single‐room occupancy (SRO) hotels often have been depicted as “isolates,” lacking the interest or ability to engage primary or secondary support systems. This characterization has not enhanced understanding of how the SRO aged are able to survive in the community. With the use of network analysis techniques, this study demonstrates the inaccuracy of the assertion that these old persons lack significant social support. The data pointed to differences in network size, complexity, intensity, connectedness, and directionality in relation to varying degrees of physical and psychiatric health.
An Alternative Model in Geriatric Care
Authors: INGMAN STANLEY R. , McDONALD CATHERINE A. , LUSKY RICHARD
Published: April 2015

ABSTRACT: An analysis is presented of one long‐term care facility's attempt to develop a comprehensive geriatric program including care of the patient in a hospital, a skilled nursing home, a day hospital, or a clinic for care of the ambulatory aged. The goal was to raise issues for debate and discussion, especially in terms of the evolving role of medical directors in long‐term care. The need for group professionalism in cooperation with the Board of citizens in community geriatric practice is emphasized.
Hyponatremia As Observed in a Chronic Disease Facility
Authors: KLEINFELD MORRIS , CASIMIR MIRTHA , BORRA SONIA
Published: April 2015

ABSTRACT: A random sampling of 160 patients in a chronic disease facility showed that 36 patients (22.5 percent) had chronic hyponatremia. Their mean age was 72 years (range, 42–94 years); 75 percent of the patients were more than 65 years old. Women comprised 57 percent of the group. The mean serum sodium level was 120 mEq/L (range, 109–135 mEq/L). The mean serum osmolarity was 270 mOsm/L (range, 251–294 mOsm/L). Of the 36 patients, 9 were asymptomatic. Symptoms were associated with underlying disorders rather than with hyponatremia, although in 9 patients the hyponatremia appeared to have intensified existing symptoms. The most common cause of hyponatremia (in 41.6 percent of 20 overhydrated patients) was inappropriate secretion of antidiuretic hormone (IADH syndrome). Factors accounting for the high incidence of IADH were the age of the patient and the nature of the underlying disorders, particularly diseases associated with aging. Simple measures were used to manage the hyponatremia, e.g., water restriction for patients who were overhydrated; replacement of sodium chloride for patients who were losing salt excessively and had a low sodium intake; and control of hyperglycemia in the pseudohyponatremic patients with hyperglycemia. No treatment was required for pseudohyponatremia associated with hyperlipidemia. When hyponatremia was due to drug‐induced ADH excess, the involved drug was discontinued. Emphasis on management of the patients' primary disorders also ameliorated the hyponatremic state.
Attitudes of Health Workers Toward Old People*
Authors: SOLOMON KENNETH , VICKERS RAYMOND
Published: April 2015

ABSTRACT: The Tuckman‐Lorge Questionnaire was used to study the attitudes of three groups of health workers toward old people and to test their acceptance of geriatric stereotypes. The health workers tested were medical students, house staff members, and members of a mobile psychogeriatric screening team. Many significant differences were found between and within the groups tested, as well as between male and female subjects. The female house‐ staff had extremely high and significantly different scores from all other groups. The geriatric staff adhered least to the stereotypes. The results are discussed in the framework that the attitudes of care givers are directly related to the quality of the care provided. It is hypothesized that female house staff members have special difficulties with role conflicts that cause them to adhere to stereotypes of the aged. The milieu of geriatric treatment, rather than knowledge of statistics about old people, is the most effective background for positive changes in attitudes toward the elderly.
Experience with an Incontinence Clinic*
Authors: Overstall P. W. , Rounce K. , Palmer J. H.
Published: April 2015

In an “incontinence clinic,” a study of 309 elderly patients showed the most common causes of incontinence to be: unstable bladder (57 percent), outflow obstruction (13 percent), and atonic bladder (7 percent). Pure stress incontinence was rare (2 percent). One third of the patients improved, one third had to be catheterized, and one third did not improve. An individually designed program of bladder retraining for the patient, coupled with support and instruction for the relatives and for the professional care providers, offered the best chance of success.
Psychotropic Drug Prescriptions for Elderly Patients in a General Hospital
Authors: Salzman Carl , Kolk Bessel Van Der
Published: April 2015

A survey was made of drug prescriptions written for all medical/surgical patients in a general hospital on a single weekday in 1978. Of these 348 patients, 195 were over the age of 60. In this elderly group, 62 (32 percent) were receiving psychoactive drugs. Flurazepam was the drug most commonly prescribed (in 63 percent of the patients). Diazepam was the most frequently prescribed nonhypnotic psychoactive drug (in 29 percent). Neuroleptic drugs and phenothiazine anti‐emetics (in 52 percent) were not prescribed for psychosis but for augmenting analgesia and sedation and for reducing nausea. The average daily doses were about 20 percent of those used to treat psychotic young adults. All antidepressants (in 9.7 percent) had been prescribed before admission. No monoamine oxidase inhibitors were used, and doses of tricyclic antidepressants were half to one‐third lower than those used to treat younger depressed adults. Antidepressants, which pose a risk to the elderly patient, were overprescribed and underdosed.
Surgical Procedures Involving Cardiopulmonary Bypass in Patients Aged 70 or Older†
Authors: Berman Neil D. , David Tirone E. , Lipton Irving H. , Lenkei Susan C.
Published: April 2015

Cardiac surgery was performed in 27 patients whose ages ranged from 70 to 78 years (mean, 72). In 17 of these patients, the operation was coronary artery bypass grafting without other procedures. There were 3 operative deaths (17.6 percent) but no late deaths during a mean follow‐up period of 14 months, and all the 14 surviving patients were improved symptomatically. In the other 10 of the 27 patients, the operation was valve replacement. There was no operative mortality among the 6 aortic valve patients and 1 operative death among the 4 mitral valve patients; the corresponding late deaths were 2 and 1, respectively, during a mean follow‐up period of 41.3 months. Improvements in operative management and improved criteria for the selection of patients should afford benefits and risks for elderly cardiac patients similar to those for younger cardiac patients.
Group Rehabilitation for the Vascular‐Disease Amputee
Authors: Kerstein Morris D.
Published: April 2015

Group therapy for lower‐extremity, vascular‐disease amputees was successful in the return of these patients to their normal milieu. Thirty men (mean age, 63 years) were studied during a one‐year period. The group meetings progressed from a phase of directed therapy to one of nondirected therapy. This group of hospitalized amputees was chosen specifically because of its social, economic and medical identity. After a self‐identified adequate period of therapy, all patients returned to their former places in society.
Permanent Gastrostomy As a Solution to Some Nutritional Problems in the Elderly†
Authors: Pomerantz Marc A. , Salomon Jacob , Dunn Robert
Published: April 2015

The number of elderly patients living in institutions is increasing. Many of them are unable to maintain an adequate nutritional status because of: 1) neurologic deficits that preclude normal swallowing; 2) obstruction of the upper gastrointestinal tract; or 3) a systemic disease that has produced profound anorexia. This report presents the data on 106 permanent‐feeding gastrostomies, performed with low morbidity and low mortality. Use of a gastrointestinal anastomotic stapling device greatly facilitated the operation. The permanent gastrostomy offers an effective means of providing adequate nutrition for elderly patients who otherwise cannot maintain the necessary nutritional status.
Proteinuria and Renal Function During Antihypertensive Treatment for Essential Hypertension
Authors: Yamada Takashi , Ishihara Masaki , Ichikawa Kazuo , Hiramatsu Kunihide
Published: April 2015

In an attempt to determine the effects of antihypertensive treatment on proteinuria and renal function, these factors were studied in 155 patients with essential hypertension, before and during antihypertensive therapy. Slight renal impairment tended to increase with the progress of hypertension, as evidenced by a slight but significant increase in the levels of blood urea nitrogen (BUN) and serum creatinine, and by a progressive decrease in creatinine clearance. A decrease in proteinuria appeared as early as one month after initiation of treatment and continued for at least two years during treatment. Apparently the proteinuria was caused by increased glomerular pressure and by vascular damage in the glomerular vessels. In 7 patients, normalization of blood pressure resulted in an elevation of BUN and creatinine concentrations, although initial renal function did not differ significantly from that in other groups who did not show such derangement during treatment. Thus, a reduction of proteinuria seems to be a good criterion for predicting beneficial results from antihypertensive treatment.
Diagnosing Mental Illness in the Elderly
Authors: Gaitz Charles M.
Published: April 2015

Diagnosing mental illness in the elderly is difficult because changes in physical and psychologic functioning may mimic psychiatric disorders. The reverse is also true. Although chronologic age is not related directly to predisposition to mental illness, the stresses experienced by elderly persons as a result of declining health and loss of social status may result in mental disorders. Accurate diagnosis, which takes all these factors into account, is particularly important for the rational treatment of elderly patients.
Subdural Hematoma: A Clinical Approach
Authors: Rosin Arnold J. , Dijk Y. M. Van
Published: April 2015

Subdural hematoma (SDH) in the elderly often occurs following a relatively mild fall. Compared to the old person's high risk of falling, SDH is relatively uncommon and the diagnosis may be elusive. Five cases are presented, two in detail. In one, despite the acute onset within hours and manifestations of an ipsilateral neurologic deficit, operative removal of the SDH gave excellent results. The second patient represented a dementia assessment problem prior to admission to an institution. Inpatient observation eventually revealed a deteriorating neurologic state and led to the correct diagnosis of SDH. The patient returned home, fully recovered, two weeks after the appropriate surgical procedure. The pathogenesis of SDH is discussed. Clinical suspicion of its presence should prompt the performance of an echoencephalogram and a computerized axial tomogram of the brain.
Diagonal Ear Lobe Crease and Coronary Risk Factors
Authors: Shoenfeld Y. , Mor R. , Weinberger A. , Avidor I. , Pinkhas J.
Published: April 2015

The prevalence of ear lobe crease (ELC) was determined in 421 patients with myocardial infarction (MI) and in 421 controls. A higher prevalence (p < 0.05) of ELC was found in MI patients (77 percent) in comparison to controls (40 percent), regardless of age. In addition, a higher prevalence was found in patients in whom MI was combined with diabetic retinopathy or hypertension, and in Ashkenazi Jews compared to non‐Ashkenazi Jews. Ear lobe biopsies in 12 subjects revealed tears of the elastic fibers in all subjects with ELC, and prearteriole wall thickening in subjects with MI and/or ELC, but not in the 2 subjects with neither MI nor ELC. The early appearance of ELC may imply the existence of coronary heart disease with or without coronary risk factors.
Utilization Review Committee As a Peer Review Mechanism
Authors: Pattee James J.
Published: April 2015

The appropriate utilization and the quality of care in long‐term care facilities should be documented and monitored. This is best accomplished at the local level by physicians and other professionals serving on Utilization Review Committees. Paper compliance to regulation of state or federal agencies is a poor substitute for active involvement of the professionals at the local level.
Paraphrenia: Paranoid States of Late Life. II. American Research
Authors: Bridge T. Peter , Wyatt Richard Jed
Published: April 2015

In Part I of this study, a review of the European literature on paraphrenia demonstrated that the disorder affects a significant number of older persons and is probably part of the schizophrenic spectrum. Part II presents the current research evidence and issues concerning paraphrenia, a disorder commonly misdiagnosed or overlooked in the United States. Recommendations are made for a rigorous investigation of this group of patients that American psychiatry has not studied adequately. Comparisons of paraphrenic and schizophrenic patients undoubtedly will provide new insights into both the process of schizophrenia and the process of aging.
Multiple Monitored Electroconvulsive Therapy in the Elderly†
Authors: Yesavage Jerome A. , Berens Eric S.
Published: April 2015

Twenty patients aged 45 or older with the diagnosis of endogenous depression were evaluated in terms of safety and efficacy in their response to multiple monitored electroconvulsive therapy (MMECT) versus single electroconvulsive therapy (SECT). The MMECT group (10 patients) when compared retrospectively with the control SECT group (10 patients) showed a similar record for safety and efficacy. However, the MMECT group required shorter overall duration of treatment, fewer sessions of general anesthesia, and lower dosages of anesthetic agents. The chief benefit of MMECT probably is in the reduction of the time the patient is at risk for suicide.
Reliability of Palpation of Pedal Pulses As Ascertained by the Kappa Statistic
Authors: Lawson Ian R. , Ingman Stanley R. , Masih Younus , Freeman Barbara
Published: April 2015

An improved statistic (weighted Kappa) was tested for reviewing the reliability of the palpation of pedal pulses by three observers. Significant improvement was noted after training. Reliability also persisted with respect to a reduced form of the conventional ordinal grading system. The findings indicated that problems of usefulness or reliability may arise when more than five distinctions are made in describing the pulses or when the data are completely reduced to only a dichotomous (present‐absent) system.
Reference Values for Blood Findings in Relatively Fit Elderly Persons
Authors: Jernigan James A. , Gudat John C. , Blake Jerome L. , Bowen Laura , Lezotte Dennis C.
Published: April 2015

In a retirement community group of 73 relatively fit elderly white persons, a cross‐sectional study of 53 different blood tests was conducted. The five test categories for blood values were hematology, chemistry, thyroid function, protein electrophoresis, and immunology. Fifteen percent of the blood findings were outside the range accepted as normal by the examining laboratories. Most of the subjects showed between 5 and 10 “abnormal” values within the five test categories. Since the findings were fairly predictable in view of the patho‐anatomic changes that accompany aging, and since the manifestations of disease were at most subclinical, only minor alterations in individual management were needed. Subsequent appropriate clinical re‐evaluation of these subjects during a six‐month follow‐up revealed no striking changes. It would appear that the ranges of “normal” reference values may need to be expanded. Although cross‐sectional laboratory studies are useful, longitudinal studies seem essential if clinicians are to attain a more valid perspective.
A Geriatric Evaluation Service: Follow‐Up Survey
Authors: Hughes Elizabeth M. , Lindsey Ada M.
Published: April 2015

A survey was conducted to determine the community resources used by the urban elderly when long‐term care in a mental hospital was deemed inappropriate by a Geriatric Evaluation Team. The follow‐up study of 112 elderly subjects showed that there are alternatives to institutionalization for the majority of elderly persons referred to a geriatric evaluation and screening service. The natural support system (family members) proved to be of significant value, and more than half of the subjects had daily contact with some other person. Available community services, however, were used infrequently.
Ultrasonic Doppler Measurement of Systolic Pressure in the Quantitative Evaluation of Chronic Arterial Occlusions
Authors: Martin M. , Gorgla S.
Published: April 2015

This study deals with a method of performing ultrasonic Doppler measurements in patients with chronic arterial occlusions. Ankle systolic pressures distal to occlusions (as diagnosed by angiography) were sampled and the mean values calculated. Standard deviations of the method were validated. The ultrasonic Doppler method for measurement of systolic pressure is a valuable new tool for assessing peripheral arterial occlusions. Especially in geriatric patients, with their high rate of vascular problems and the lingering danger of heel necrosis in the course of longstanding immobility, this method supplies the attending physician with quantitative data as a basis for diagnosis, prophylaxis, and treatment.
Noninvasive Evaluation of Peripheral Arterial Disease in the Geriatric Patient
Authors: Lee Bok Y. , Thoden William R. , Trainor Frieda S. , Kavner David
Published: April 2015

A progressive increase in the incidence of peripheral arterial occlusive disease is being observed in today's steadily aging population. In recent years, a number of simple noninvasive vascular techniques have become available for the diagnosis of peripheral arterial occlusive disease. These techniques provide the physician with physiologic information about the patient's peripheral circulation which permits discrimination between complaints compatible with the aging process and those indicative of an underlying disease state. This article reviews the noninvasive vascular diagnostic techniques that the authors found useful in evaluating the geriatric patient. These include oculoplethysmography, Doppler ultrasound, photoplethysmography, arterial impedance plethysmography, and electromagnetic flowmetry.
Reduced Aldosterone Secretory Response to Acute ACTH Stimulation in Sodium‐Restricted Elderly Subjects
Authors: Morimoto Shinpei , Takeda Ryoyu , Uchida Kenzo , Miyamori Isamu , Miyamoto Masaji , Mimou Naonori , Kigoshi Toshikazu
Published: April 2015

The plasma aldosterone (PA) response to ACTH stimulation (5 μg/kg, im) under conditions of varied sodium intake was studied in 10 young (20–35 yr), 9 middle‐aged (41–56 yr) and 11 elderly (66–73 yr) normotensive subjects. No differences in serum sodium, serum potassium, plasma Cortisol and urinary sodium excretion were observed among the three groups during both a 130 mEq (normal) intake and a 25 mEq (low) sodium intake for three days. Basal plasma renin activity (PRA) and PA levels were lower in the elderly than in the young or middle‐aged groups. These age‐related decreases were slight with a normal sodium intake and pronounced with a low sodium intake. ACTH administration induced increases in PA in the three groups. However, the maximal net increment of PA above the baseline level after ACTH did not differ among the three groups with a normal sodium intake, but was lower in the elderly than in the young or middle‐aged groups with a low sodium intake. The ACTH‐induced maximal percentage increment of PA did not differ among the three groups during both the normal and the low sodium intakes. A significant positive correlation was found between the maximal net increment of PA and either the basal PRA or PA level in the combined group of young, middle‐aged and elderly subjects. Thus, aging causes a reduced aldosterone secretory response to ACTH, in parallel with decreases in basal PRA and PA levels, under conditions of low sodium intake.
Family Abuse of the Elderly
Authors: Steuer Joanne , Austin Elizabeth
Published: April 2015

In 12 cases of family abuse of disabled elderly persons, the majority of the abused were women. Caretakers included spouses, children, siblings or other relatives. Abuse was both physical and verbal/psychologic. Neglect, the most common form of physical abuse, sometimes resulted in decubitus ulcers and vermin infestation. Misuse of medical therapy and nutrition were other areas of physical abuse. Psychologic abuse included derogation, infantilization, and threats of institutionalization, abandonment, and homicide. Possible causes of abuse included alcoholism in the caretaker, financial concerns, and long‐term family conflicts. Various recommendations are made for the management of abusive families.
Social Issues in Geriatric Psychiatry
Authors: Goldstein Stanley E.
Published: April 2015

In the past decade significant advances have been made in caring for the emotional problems of the elderly. The evolution of the multidisciplinary team and easier access to health care play important roles. Of seminal importance is the emergence of the psychogeriatrician and the establishment of psychogeriatric units. Treatment of the elderly should extend beyond the confines of the hospital to include families, community agencies and community resources.
When Is the Physician “Playing God”?
Authors: Zimring Joseph G.
Published: April 2015

In the author's opinion, the medical profession is committed to the preservation and prolongation of life through use of all ordinary remedies, but is not obliged ethically or morally to apply extraordinary measures when there is no realistic hope of recovery. In addition to the proper medical therapy, the care given during the dying phase of life by the physician includes the responsibility of deciding whether the geriatric patient should be allowed to die in a dignified manner. The question of who should bear this responsibility is discussed.
Health and Medical Care for the Elderly and Aged Population: The State of the Evidence†
Authors: Bloom Bernard S. , Soper Keith A.
Published: April 2015

Emerging statistics emphasize the special needs of the elderly for health and medical care services. A variety of services are being recommended to meet these needs, but few of them have been subjected to rigorous study for determining efficacy, effectiveness or cost. Examination of about 1,000 studies of health and medical services for the elderly published between 1967 and 1978 revealed only 7 that met predetermined criteria for well‐designed and executed investigations. The varied needs of the elderly are finally being recognized, and undoubtedly pressure will be increased for meeting these needs. In this era of finite monetary resources and budgetary restraints, we need better data upon which to base the selection of medical care services for the aged. Resources needed to provide care of known benefit should not be diverted to provide care of unknown benefit.