bluuebunny/crossref_metadata_2025 huggingface dataset:
Noninvasive Differentiation of Cardiomyopathy from Coronary Disease; Pulse Transmission Time and Systolic Time Intervals*
Authors: BERK STEVEN , KINO MASAYA , SPODICK DAVID H.
Published: April 2015

ABSTRACT: Systolic time intervals and central pulse transmission time were compared in cardiomyopathy (CM) patients and age‐ and sex‐matched patients with coronary artery disease (CAD). Significant differences were found in pulse transmission time [shorter in the CAD patients (p < .001) and in the pre‐ejection period (p < .001)], ejection time index (p < .05), and in the ratio of the pre‐ejection period to the left ventricular ejection time (p < .001); all were markedly abnormal in the CM group. Pulse transmission time differences may have been the result of more generalized arteriosclerotic disease in the CAD patients. It appears that both systolic time intervals and pulse transmission time clearly distinguish CM from CAD.
Urologic Sepsis/Shock*
Authors: SENECA HARRY , GRANT JOHN P.
Published: April 2015

ABSTRACT: At Columbia‐Presbyterian Medical Center during the six‐year period 1968–1973, there were 1236 cases of sepsis from Gramnegative pathogens; 124 of these originated in the urinary tract. Of these 124 patients, 19 died — a mortality rate of 15.3 percent. There were 205 deaths among the 1236 patients with sepsis from Gram‐negative organisms — a mortality rate of 16.6 percent. Previously, in the 1959–1964 and 1965–19067 periods, the mortality rates had been 56.3 percent and 19.6 percent respectively. The lowered mortality rate during 1968–1973 for urologic sepsis/shock was associated with improved management procedures: a) preventive measures such as postponement of urologic instrumentation and surgical intervention in patients infected with drug‐resistant urea splitters, until the infection is under control, with emergency surgical patients being treated by susceptibility‐tested drugs to control possible postoperative complications; b) early diagnosis and treatment of sepsis and immediate administration of bactericidal antibiotics parenterally; c) immediate restoration of fluid/electrolyte balance, with monitoring of renal and pulmonary functions and metabolic acidosis; and d) early administration of large pharmacologic doses of glucocorticoids, with monitoring of the microcirculation and use of β‐adrenergic isoproterenol.
Sleep Deprivation in the Treatment of Elderly Depressed Patients
Authors: COLE M. G. , MÜLLER H. F.
Published: April 2015

ABSTRACT: Fifteen elderly depressed patients were treated by 36‐hour sleep deprivation (SD). The depression was unipolar in 3 cases, bipolar in 3, and secondary in 4. Nine of the 15 patients responded to SD, and 6 had a remission (1 with SD alone and 5 with SD plus an antidepressant drug). Some of the remaining 6 patients might have responded if the treatment had not been interrupted for various reasons. These favorable results in elderly patients were better than anticipated. SD was well tolerated, although in one patient with bipolar depression a manic attack was precipitated. The effectiveness of SD poses interesting theoretic questions.
The Problem of Pressure Sores in a Nursing Home Population: Statistical Data
Authors: MICHOCKI ROBERT J. , LAMY PETER P.
Published: April 2015

ABSTRACT: This study on 93 patients was conducted at a skilled nursing facility. Twenty‐two of the 93 patients had pressure sores; 34 of the 54 sores were present when the patients were admitted and 20 developed after admission. Only 5 of the 54 sores healed. Healing times ranged from 15 to 55 days after the beginning of treatment. Thirteen deaths occurred among the 71 patients without sores, and 17 deaths among the 22 patients with sores. Specific treatment regimens varied (cleaning solutions, antimicrobial drugs, heat, enzymatic debridement) but always included frequent changes in the position of the patient. Ten of the 22 patients with sores were anemic vs. 19 of the 71 patients without sores. Half of the patients with sores were maintained with tube feedings whereas more than half of the patients without sores received regular house diets. Pressure sores are a serious problem among geriatric patients in nursing homes. All those who care for the aged should be fully aware of the procedures involved in the prevention and management of these sores.
Measuring Dementia
Authors: Birkett David Peter , Boltuch Bruce
Published: April 2015

Maudsley Tests of the Sensorium (used by clinicians to assess verbal memory and orientation) and Kendall's Memory for Design (used by psychologists to assess visual memory) were employed to differentiate between elderly patients with organic brain damage (neurologic disease, chiefly stroke) and those with functional psychiatric disorders which had been present in youth. There were 25 patients in each group. Both tests differentiated organic from functional disorders. There was no statistically significant difference in the effectiveness of the two tests.
Age‐Associated Statural Loss and Socioeconomic Status
Authors: Himes John H. , Mueller William H.
Published: April 2015

Associations between socioeconomic score (SES) and age‐related statural loss were investigated in a cross‐sectional sample of 718 adults from rural Colombia. Estimates of statural aging were calculated by estimating the maximum statural attainment of each subject from statural relationships with subischial length. Statural loss was correlated with SES, r = –0.06 (not significant) for men, and r = –0.14 (p < 0.01) for women. Subjects with a high SES tended to lose stature at a slower rate than those with a low SES. For women, the difference in rates of statural loss between the two SES groups was significant (p < 0.05).
Mental Impairment in the Elderly: Medical‐Legal Assessment
Authors: Gunn Albert E.
Published: April 2015

As life expectancy has lengthened, research has been increasingly directed toward improving the quality of life in old age. Social agencies work in the field of socioeconomic factors, and medical research seeks the causes and remedies for mental deterioration. It is time to review the legal status of the mentally impaired elderly and to ensure that our lawmakers are cognizant of the changing situation. Before any characterization of mental capacity is made, a comprehensive investigation should be carried out to make sure that no potentially correctable physical disorder underlies perceived mental disabilities. In the past, the law has taken a global view of mental capacity. A person was adjudged either competent for all purposes or incompetent on a similar universal basis. A system is suggested to change this outdated approach and to assess separately the divisible components of mental capability. This would permit the courts to delineate their judgments and allow persons with partial mental incapacities to live a fuller life than if they had been declared totally incompetent.
Psychologic and Behavioral Assessment of Geriatric Patients: A Review†
Authors: Goga John A. , Hambacher William O.
Published: April 2015

A review of the literature and a study conducted at a state hospital indicated that valid psychologic test results on geriatric patients are often difficult to obtain. Reasons most frequently offered by psychometricians for inconclusive or incomplete findings were the patient's uncooperativeness, unavailability, or severity of physical/mental dysfunction. A need was apparent for alternate assessment instruments for measuring current and potential levels of functioning in the elderly. In the investigation, attention was focused on the following areas: 1) studies in which the more traditional measurements were used, 2) articles stressing the need for caution in using the traditional techniques, and 3) studies in which behavioral rating scales and checklists were used as the evaluative devices. A large number of checklists and behavioral rating scales were found to be relevant and applicable to an institutional setting. Five were selected and are reviewed in depth.
Attempted Suicide Among the Aged
Authors: Sendbuehler J. M. , Goldstein S.
Published: April 2015

Although the rate for suicide in old age is high, the rate for attempted (unsuccessful) suicide is low. Among the elderly, suicide‐attempt groups have more physical disorders, more psychoses, and more psychopathologic findings, and are under‐represented demographically. Fifty percent of the elderly suicide attempters have organic brain syndrome (OBS), compared to only 5–10 percent of the “normal” population over age 60. Among what might be expected to be a high‐risk suicide population, OBS apparently interferes with the success of suicide attempts by impairing coordination, planning, determination, and awareness of reality.
An Evaluative Study of Silver's Cerebral Function Test
Authors: Ross Nola , de L. Horne David J.
Published: April 2015

The aim of this study was to evaluate the usefulness of Silver's Cerebral Function Test in predicting the management and placement of patients admitted to a psychogeriatric hospital. Overall, 205 consecutively admitted patients and 54 age‐matched controls living in the community were examined, thereby greatly extending the normative data for the test. The results indicated that this brief, easily administered test could distinguish the patients from the controls. Also, the selected cut‐off score of 28 significantly differentiated between patients able to benefit from rehabilitation and occupational therapy programs and those who required primarily maintenance care. The test‐retest reliability of the test was good (r = 0.91).
Identifying Needs and Services for the Aged†
Authors: Bayne J. R. D. , Caygill J.
Published: April 2015

The Assessment and Placement Service (APS) of the Hamilton‐Wentworth District Health Council assists health professionals in identifying the needs of persons with chronic disabling diseases, and in finding appropriate resources or programs. More than 80 percent of the 9,300 persons referred between September 1971 and December 1975 were over the age of 64. Although most referrals were local, some came from as far away as British Columbia and Florida for persons wishing placement locally. Of the 2,005 persons referred and placed in 1975, 1,063 came from acute disease hospitals, 201 from other institutions, 628 from the community within this District, and the remainder from elsewhere. There were 1,187 women, of whom 89.5 per cent were over the age of 64, and 811 men, of whom 65.8 per cent were over that age. In the opinion of their physicians, only 20 percent of all persons referred had normal memory, and only 13 percent had normal judgment. In the 64+ age group, 71.1 percent of the women were widows, and 25.9 percent of the men were widowers. One‐third of those referred were living alone, and one‐fourth with a spouse only. For placement, 453 patients went to private residences or boarding homes, often with the support of community services, and the remainder went to various institutions according to identified needs. Follow‐up contact one month later showed conditions to be satisfactory in most instances. Deficiencies in the health care system were identified and reported to the Health Council.
Increased Appetite (Bulimia) in Parkinson's Disease
Authors: Rosenberg P. , Herishanu Y. , Beilin B.
Published: April 2015

Five patients with Parkinson's disease, when first seen, manifested an abnormal increase in appetite. This bulimia decreased concomitantly with clinical improvement in the parkinsonism during treatment with L‐dopa plus a decarboxylase inhibitor. A possible role of dopamine in the central control of appetite is discussed. Abnormally increased appetite (bulimia) is proposed as a new autonomic sign in Parkinson's disease.
Effect of Age and Weight on Plasma Glucose and Insulin Responses in the Rat†
Authors: Bracho‐Romero Enoc , Reaven Gerald M.
Published: April 2015

Plasma glucose and insulin responses to orally administered glucose were determined in rats of varying ages and weights. The results indicated that glucose tolerance tends to deteriorate as rats grow from 1 month to 9 months of age. This change in glucose tolerance was associated with an increase in the response of plasma insulin to glucose, consistent with the hypothesis that the decline in glucose tolerance is due to a loss of normal insulin sensitivity. The changes in glucose and insulin responses could not be explained entirely on the basis of the associated weight gain. They seemed to be at least partially secondary to either age or an age‐related factor other than obesity.
Acute Drug Testing with Nitrates: Angina Relief during Treadmill Exercise
Authors: Fletcher Gerald F. , Alimurung Benjamin , Watt Edward
Published: April 2015

To evaluate the effect of sublingual nitroglycerin (N) and chewable isosorbide dinitrate (I) in patients with angina pectoris, 12 subjects underwent treadmill exercise to the point of onset of angina. At that juncture, N or I or placebo (P) was administered and walking was continued until moderately severe angina recurred. For those patients who completed the initial 10‐minute exercise period, testing was repeated until moderately severe angina recurred or until a total test time of three hours elapsed. Retesting ensured that each patient was tested separately with N, I and P within a two‐week period. Within the I group, four patients experienced the onset of angina relief (AR) at 10 minutes (′) 6 seconds (″) ± 3′ 4″ with a mean recurrence time (RT) of 154′ 3″ ± 4′ 27″ (P ≤ 0.05), for a significant difference. Within the N group, six patients had AR of 8′ 3″ ± 1′ 1″ with an RT of 49′ 39″ ± 1′ 15″ (P ≤ 0.01), for a significant effect. Within the P group, only one patient experienced AR. For all other patients in each group, testing was terminated because of moderately severe angina in the 5–8′ period of the first test. In comparing subgroups for RT during I therapy (4 patients) versus N therapy (6 patients), a significant difference was noted (154′ 3″ ± 27″ versus 49′ 39″ ± 1′ 15″) (P < 0.05). The data suggest a possible benefit of I in selected patients. The effect may last as long as three to four hours. There is also an enhanced benefit of N with the patient in the upright position. This effect may last as long as 40–50′. Treadmill testing is recommended with nitrate administration to determine which drug (I or N) is the more suitable for the specific patient.
Incidence of Polypharmacy in a Long‐Term Care Facility
Authors: Kalchthaler Thomas , Coccaro Emil , Lichtiger Simon
Published: April 2015

The incidence of polypharmacy was investigated in a 200‐bed long‐term care facility. One hundred residents were drawn at random for the study. The average number of drugs prescribed per patient was 3.33, and the average number of pills was 6.34 daily. The most frequently prescribed drugs were the analgesics, followed in order by antihypertensive agents, cardiotonic preparations and antimicrobials. The literature is reviewed with respect to the incidence, causes and end‐results of polypharmacy. It is recommended that long‐term care facilities develop enlightened and aggressive pharmacy committees to monitor and evaluate drug use routinely in an institutional setting.
Reactivation of Tuberculosis in Old Age
Authors: Geboes Karel , Bossaert Herman
Published: April 2015

Reactivation of tuberculosis in old age has been reported by several authors. This article confirms these findings and presents another 5 examples. Lack of adequate chemotherapy during the first clinical episode may be an important factor in reactivation, especially in debilitated patients.
Utilization of Hospital In‐Patient Services by the Elderly
Authors: Polliack M. R. , Shavitt N.
Published: April 2015

A survey was made of the patterns of hospital admission for patients aged 65 or older in an urban practice under the management of a primary care team composed of a family physician, nurse, and medical social worker. Results showed that the elderly used a higher percentage of in‐hospital facilities than did the younger age groups. However, admission rates were significantly lower than the local national rates, and involved relatively fewer cases of long‐term illness. No patients over 65 were admitted for psychiatric care during the one‐year period of observation. This was attributed to the provision of planned domiciliary programs for supervision of patients with long‐term illness within a coordinated framework of primary medical care.
The Second Heart Sound in Old Age
Authors: Luisada Aldo A. , Knighten Vincent , Rao Dodda B.
Published: April 2015

The second heart sound was studied by phonocardiography and carotid tracings in 103 elderly subjects without overt evidence of heart disease. Their ages ranged from 60 to 99 years. A normal type of splitting was found in 55.3 percent, and a single sound in 41.7 percent. The difference between these percentages and those found in 60 normal younger persons was not significant. Thus, a single second sound should not be considered a typical finding in old age. However, a reverse type of splitting, noted in only 3 patients, should be regarded as evidence of severe latent heart disease.
Pathways to the Decisive Extension of the Human Specific Lifespan†
Authors: Bjorksten Johan
Published: April 2015

Three approaches to reversal or removal of gerogenic aggregations of macromolecules have shown promise. Of these the enzyme approach is the most gentle, and can be made specific. Aside from this, the lower the molecular weight of an enzyme, the better chance it will have to be immunologically tolerated as well as replicated synthetically in whole or in part. The chelating approach provides a powerful means for removing a single class of unwanted, random crosslinkages, i.e., those due to extraneous polyvalent metals such as lead, cadmium and aluminum. The free hydroxyl radical approach is the most penetrant and most versatile means for removing otherwise insoluble aggregates, but its very lack of specificity will demand great foresight in control and use. Together, these three methods, when properly applied, might bring some principal objectives of gerontology within closer range.
Primary Health Care Provided to the Elderly by a Nurse Practitioner/Physician Team: Analysis of Cost Effectiveness†
Authors: Schultz Phyllis R. , McGlone Frank B.
Published: April 2015

An experimental design was used to compare the delivery of primary care by two health manpower patterns—the Physician Only (PO) and the Adult Health Nurse Practitioner/Physician (NP/P) Team. The study group consisted of 167 patients in three subgroups (Ambulatory, Homebound, and Nursing Home). The dependent variables were effectiveness and efficiency. Effectiveness was measured by the Goal Attainment Scale. Efficiency was determined by measuring the operational use and cost of the primary and supportive systems for health care delivery. A cost‐effectiveness model was used to facilitate the comparison between the two approaches to primary care. Scientific hypotheses related the measures of the dependent variables to the levels of the independent variable. The conclusions of the study were: 1) The NP/P Team is as effective as the PO but substantially more efficient in its operational use of the systems for health care delivery; 2) Ambulatory patients can make a positive change in the achievement of their health care goals with efficient use of the health care system, if they receive their care on a PO basis; 3) Homebound patients can make a positive change in such achievement if they receive their care from a NP/P Team; and 4) Nursing Home patients can make a positive change in such achievement whether they receive their care from the PO or from the NP/P Team.
Treatment of the Aged Mentally Ill: Further Unmasking of the Effects of a Diagnosis of Chronic. Brain Syndrome
Authors: Ernst Philip , Beran Barbara , Badash Dina , Kosovsky Ruth , Kleinhauz Moris
Published: April 2015

Six elderly persons with a diagnosis of “chronic brain syndrome,” who resided in a home for the aged, received bi‐weekly sensory stimulation and group therapy for three months. This pilot project demonstrated that the symptoms used to classify “chronic brain syndrome” are flexible and can improve with such treatment. Not only does this cast doubt on the accuracy of this diagnosis as used, but it provides further evidence of the utility of such treatment for this type of patient. Since group therapy and sensory stimulation over a relatively short period can result in clinical and testable improvement, the diagnosis of “chronic brain syndrome” in the elderly should not be allowed to preclude the provision of appropriate psychiatric therapy.
Geriatrics Program for Medical Students and Family Practice Residents. I. Establishing Attitudes Toward the Aged
Authors: Holtzman Joseph M. , Beck James D. , Hodgetts Peter G. , Coggan Peter G. , Ryan Nelly
Published: April 2015

This report concerns the initiation of required experience in geriatrics for undergraduate medical students and a program of research designed to evaluate that experience. Through the use of questionnaires, an attempt was made to differentiate between attitudes toward the elderly and their rehabilitation potential as stated by medical students, family practice residents, and professional and nonprofessional nursing‐home staff members. Important differences were found between professional and nonprofessional groups, but no significant differences among professionals. Implications for the training of professional and nonprofessional staff members are discussed, and further research plans specified.
Cyclandelate in the Treatment of Senile Mental Changes: A Double‐Blind Evaluation
Authors: Rao D. B. , Georgiev E. L. , Paul P. D. , Guzman A. B.
Published: April 2015

The treatment of cerebrovascular insufficiency and its many symptoms in the ever‐increasing numbers of the aged, is of major concern to physicians engaged in such care. Despite past skepticism as to the degree of efficacy of cerebral vasodilators, there is renewed interest in this form of therapy. Our investigation was designed to assess the effectiveness of cyclandelate, under strict double‐blind conditions, in 58 geriatric patients. The cyclandelate and placebo groups (32 and 26 patients respectively) received either 1,600 mg/day of cyclandelate in fractional doses, or identical‐appearing placebo capsules — over a period of 12 weeks. During the initial examination and every four weeks thereafter, patients were assessed for possible changes in vital signs and for evidence of adverse reactions. In addition, the Sandoz Clinical Assessment‐Geriatric (SCAG) and the Nurses Observation Scale for Inpatient Evaluation (NOSIE) were completed, with particular attention to symptom clusters. A final global assessment was made in which the physician rated patients according to their overall clinical condition. The results of our study and analysis indicate that cyclandelate is a safe and effective agent for treating certain symptoms of senility in properly selected patients, provided the therapy is carried on for at least eight weeks and, if indicated, for a longer period. Clinical evidence suggests that the prudent use of this drug may definitely delay deterioration.
Physician House Calls: A Complement to Hospital‐Based Medical Care
Authors: Mims Robert B. , Thomas Lorraine L. , Conroy Mary V.
Published: April 2015

A physician‐oriented, hospital‐based Home Care Program (HCP) is described. The staff includes a director, resident physicians, nurses, social workers, and clerical personnel. House calls are made by resident physicians during off‐duty hours, but the patients, their families, and other health professionals may help with their care. Drugs, equipment and supplies are available through the hospital and contract vendors. The most common medical diseases are cardiac and cerebrovascular disorders, arthritis, diabetes mellitus, chronic pulmonary disorders and hypertension. Of 513 patients evaluated in one year, 337 were admitted to the HCP. Two‐thirds were women. Ages ranged from 18 to 106 (median, 68 years). Under the HCP there was significant improvement and control of the medical problems, and a decrease in hospital and emergency room admissions, and clinic visits; 207 of the 337 patients were discharged. The HCP cost less than other outpatient and inpatient services. It proved to be a rewarding, economical and effective means of improving medical care for a metropolitan population dependent upon hospital‐based physicians for medical services.
The Future of Health Care for the Elderly†
Authors: Skelton David
Published: April 2015

Problems facing the modern health care worker are examined. These include population changes, the changing pattern of disease, the psychosocial aspects of aging, and altered pathophysiologic mechanisms. The major future requirements in health care for the elderly are outlined. Greater emphasis should be placed upon education in the disciplines of Gerontology and Geriatric Medicine. Society needs to be made more aware of the realities of aging. Health care professionals need to develop their communication skills and to practice more effective teamwork. Greater coordination of the components of health care delivery systems will be needed in order to provide comprehensive and continuing health services. Research into the true and changing needs of the elderly recipients of health care should be emphasized. Prevention and early detection of disease is an important focus in Geriatric Medicine for the future.
Colestipol Hydrochloride for Treatment of Hypercholesterolemia in a Family Practice: Five‐Year Study
Authors: Ruoff Gary
Published: April 2015

Colestipol hydrochloride (Colestid) lowered the serum cholesterol level significantly more than did placebo in hypercholesterolemic patients (21 colestipol, 19 placebo) treated for up to 5 years. In the 21 colestipol‐treated patients, the average decrease in serum cholesterol levels was 19 percent during the first year and 23 percent during the second through fifth years. Seven patients (age range, 44 to 59 years) took colestipol for the full 5 years. The data showed a consistent lowering of the serum cholesterol level. The only side effect was constipation.
Our Elderly. Who Are They?
Authors: GELPERIN ABRAHAM
Published: April 2015

Why are today's elderly remarkable? They are the small minority who represent the survivors of Americans and immigrants born during the period 1870–1913. The mortality experience during that period shows the dramatic changes that have occurred. The future populations of the elderly are developing with an ever‐increasing number of people kept alive by the mass use of vaccines, the application of new medical, surgical and psychologic diagnoses and therapies, effective antibiotics, rapid communication, proper nutrition, safe water, a high level of health insurance coverage, and available education at all levels for those who want to participate.
Young Adult, Geriatric and Aphasic Group Responses to Simple Analogies
Authors: FARMER ALVIRDA , McLEAN SUZANNE , SPARKS ROBERT , O'CONNELL PAMELIA F.
Published: April 2015

The efficiency of interactive language processing was compared in three groups: 25 young adults, 25 geriatric subjects, and 25 adult aphasic subjects. The task involved simple analogy completion. Data analysis included six categories of responses which represented levels of convergence toward the expected relationships. Results of chi‐square comparisons between groups were all significant, and indicated substantial reductions in interactive processing for geriatric subjects. The findings suggest that a general aging factor may contribute to the poor prognosis in elderly aphasic patients
Tocopherol in Osteoarthritis: A Controlled Pilot Study
Authors: MACHTEY I. , OUAKNINE L.
Published: April 2015

Thirty‐two patients entered a simple‐blind, cross‐over study on the action of tocopherol in osteoarthritis; only 3 did not complete the course. Each patient was randomly assigned either to the tocopherol group (600 mg/day for 10 days) or to the placebo group. After 10 days the groups were transposed. The analgesic and other possible effects of tocopherol vs. placebo were assessed by the patients' daily records, by the physician's personal examination and interview, and by observations on the use of an additionally permitted analgesic (pro re nata). In 52 percent of the 29 patients who completed the study a good tocopherol analgesic effect was noted, but only 4 percent of those receiving placebo reported a similar effect. The difference was statistically significant. Further large‐scale assessment of the influence of tocopherol in osteoarthritis would seem to be justified.
Comparative Psychologic Effects of Estrogen Administration on Institutional and Noninstitutional Elderly Women*
Authors: KANTOR HERMAN I. , MILTON LINDA J. , ERNST MARVIN L.
Published: April 2015

Previous research on elderly women living in institutions has shown a positive relationship between the administration of estrogen and improved psychologic status. In the current 12‐month study, the effects of estrogen therapy were compared in 18 institutional women versus 21 noninstitutional women who volunteered to participate. Both groups received conjugated estrogens (Premarin, 0.3 mg daily) in interrupted courses. Throughout the year, the women were evaluated by means of the Eysenck Personality Inventory, the Profile of Mood States, the Lawson Morale Scale, and various self‐perception items. Statistically significant changes occurred in the areas of neuroticism, tension, morale, and subjective mood states, but the improvement was greater in the institutional subjects. The main conclusion was that estrogen therapy has a positive effect upon psychologic status, particularly for women who reside in an institution.
Death and the Elderly Patient
Authors: ELKOWITZ EDWARD B.
Published: April 2015

More attention should be paid to the profound needs of dying patients. The family physician can guide the family members and others in forming a team to help dying elderly patients in this life crisis, so that they may have a “good death.” The importance of honesty and cooperation by all those involved is emphasized, as is the need to support the patient emotionally and spiritually.
Depression in the Elderly. I. Relationship between Depression, Psychologic Defense Mechanisms and Physical Illness*
Authors: Salzman Carl , Shader Richard I.
Published: April 2015

Diagnosis of depression in the elderly is sometimes difficult owing to the presence of ego defensive mechanisms or somatic symptoms that can disguise the affect. Depression also may precede, or be associated with a variety of medical illnesses which are common among older persons. Specific ego defenses and representative medical illnesses are discussed. The concepts of a depressive equivalent and pseudodementia, which particularly act to disguise the depression, are reviewed in detail.
Primary Oat‐Cell Carcinoma of the Larynx Following Supraglottic Laryngectomy for Squamous‐Cell Carcinoma
Authors: Ferlito Alfio
Published: April 2015

An extremely rare case is reported of a primary oat‐cell carcinoma of the larynx in a 70‐year‐old man who had been treated eight years previously for squamous‐cell carcinoma of the larynx by means of supraglottic laryngectomy. A review of the literature revealed only 5 unequivocal previous reports of this primary oat‐cell tumor; the present report makes a total of 6 cases. The morphologic pattern, histogenesis and biologic behavior are discussed. The patient of this report was treated by surgical intervention and radiotherapy. He was well, six months later. Only one of the 5 patients previously reported survived for more than a few months. This type of lesion has a poor prognosis because of its tendency to metastasize early to various organs.
The Evening Meal and Atherosclerosis*†
Authors: Roen Paul B.
Published: April 2015

A trial by any means that can possibly prevent or retard the development of arteriosclerosis is to be recommended. Arteriosclerosis is the chief cause of strokes and heart attacks. The heavy evening meal now in vogue is characteristically rich in animal fats. Normal digestion is at its peak at about the seventh hour, usually during sleep, when the body economy is at its lowest ebb. A large amount of digested material with a high content of lipids is dumped into the slow‐moving circulation. As this material, full of saturated fats, moves slowly through the arteries, the situation is ideal for clot formation, possibly resulting in a stroke, a heart attack, or sudden death. Such a catastrophe can occur in almost anyone, but is more apt to strike the high‐powered executive or the apparently healthy man past 45 who has a voracious appetite. It seems logical to postulate that a light, rather than a heavy evening meal would result in less arteriosclerosis with complications such as heart attacks and strokes.
Bromocriptine: Effect on Serum Prolactin and Growth Hormone in Psychogeriatric Hospital Patients
Authors: Hontela S. , Nair N. P. V. , Rosenberg G. , Schwartz G. , Guyda H.
Published: April 2015

Serum prolactin (PRL) and human growth hormone (HGH) were assessed before, and three hours after oral administration of 2.5 mg of bromocriptine in 39 hospitalized geriatric patients with organic brain syndrome. Serum PRL concentrations decreased significantly irrespective of initial values (also in the 7 geriatric control subjects), but HGH levels were low in all patients and did not change during the three hours after administration of bromocriptine. Closer scrutiny of the HGH responses to bromocriptine in 5 patients and 5 controls showed that the serum HGH response was more variable among the patients than among the controls. The findings are discussed in relation to neuroendocrine changes associated with aging, institutional living, and mental disease.
Sliding Inguinal Hernia in Patients Over 70 Years of Age*
Authors: Ponka Joseph L. , Brush Brock E.
Published: April 2015

In a 1973 study of 200 aged patients with groin hernias, a comparatively high incidence of the type known as sliding hernia was noted. The present study of 60 patients over age 70 seen at the Henry Ford Hospital between the years 1940 and 1972 was devoted specifically to the problem of sliding hernias. The threat of bowel strangulation is often advanced as a reason for the operative repair of such hernias, but this complication is rare. Bowel dysfunction, constipation and local discomfort are far more common, and gave rise to annoying symptoms in 75 percent of the patients studied. Barium enema x‐ray examinations often revealed some degree of bowel obstruction. Most often the sigmoid colon on the left side and the ileocecal segment on the right side constituted the sliding components of the hernia; the bladder was involved less often. Repair of 62 sliding hernias in 60 patients was performed successfully. There were no deaths, and only one recurrence of the hernia.
Centrophenoxine: Effects on Aging Mammalian Brain
Authors: Nandy K.
Published: April 2015

A study was made of the effects of centrophenoxine on the learning and memory of old mice. The results were correlated with changes in neuronal lipofuscin in the cerebral cortex and hippocampus. Old female mice (11–12 months) were treated with centrophenoxine for three months and their learning and memory were tested in a T‐maze. The number of trials required to attain the criterion in the 20 treated old mice were compared with those for 20 untreated mice of the same age and for 20 younger untreated mice. The treated animals learned the task with significantly fewer trials, and also exhibited a reduction of neuronal lipofuscin pigment in both the cerebral cortex and the hippocampus. The changes in lipofuscin were demonstrated by study of the characteristic autofluorescence, and by histochemical and ultrastructural (electron microscope) observations.
Depression in Old Age*
Authors: FASSLER LOUISE B. , GAVIRIA MOISES
Published: April 2015

ABSTRACT: We are increasingly becoming a society of older people. The most prevalent emotional disturbance in this group is depression. Its management is an urgent concern to professionals in the mental health field. A review is presented of the clinical management of depression in old age in the special out‐patient setting of an Affective Disorders Clinic. Sociologic, psychologic, and biologic factors as they affect the aging process are discussed in the frame of a developmental approach to aging. Illustrative clinical material shows the value of this approach in the assessment and management of depression in the aged.
Fatal Cerebral Injury in the Elderly*
Authors: KIRKPATRICK JOEL B. , PEARSON JANE
Published: April 2015

ABSTRACT: A medical examiner's series of 71 elderly patients with fatal internal cerebral injuries demonstrated age differences with respect to the type of cerebral lesion and the causal incident. The elderly showed relatively fewer severe cerebral contusions than did a young group, but a higher incidence of subdural and intraparenchymal hematomas. Falls, the most common cause of injury in the elderly, were often precipitated by physical illness or ingestion of alcohol. Consumption of alcohol was also a prominent factor in the fatal assault cases.
Dopamine and the Aged
Authors: FREED JEFFREY S. , KAYNAN ARIEH , SZUCHMACHER PINKUS H.
Published: April 2015

ABSTRACT: Regardless of the age of the patient, dopamine is a valuable agent for treating shock associated with an abdominal catastrophe. However, when the time is appropriate for withdrawal of dopamine, the aged do not react as do younger patients. Despite apparent adequate hydration, additional volume loading is required to avert renal failure, and the dosage of dopamine has to be decreased gradually until withdrawal is complete.
Geriatrics Program for Medical Students. II. Impact of Two Educational Experiences on Student Attitudes
Authors: HOLTZMAN JOSEPH M. , BECK JAMES D. , COGGAN PETER G.
Published: April 2015

ABSTRACT: In an innovative program in geriatrics for undergraduate medical students, the preliminary report concerned attitudes toward the aged among health care personnel. This follow‐up report concerns the stability of, and changes in medical students' attitudes toward the aged after participation in one of the following types of geriatric educational experience: 1) a Family Practice clerkship, or 2) a selective course in Medical Humanities. Although both experiences resulted in positive changes in general attitudes, the one that emphasized empathy toward the elderly along with observation of healthy aged persons produced more positive feelings about rehabilitation potential. Implications for the geriatric training of physicians are discussed in the light of these findings.
Abdominoperineal Resection in the Octogenarian
Authors: THOMSEN TIMOTHY A. , PRINTEN KENNETH J.
Published: April 2015

ABSTRACT: Traditionally, abdominoperineal resection has been the accepted surgical therapy for anorectal carcinoma. A review is presented of the experience with this procedure at the University of Iowa Hospitals, involving 52 patients (33 men, 19 women) over the age of 80 (median, 81 years). The most common symptoms were: rectal bleeding in 35 patients, change in character of stool in 35, weight loss in 13, and abdominal pain in 7. A rectal mass was palpable in 45 patients and visible by sigmoidoscopy in 3 others. Of the 52 patients, 23 percent (12/52) died before postoperative discharge from the hospital, and 32 percent of the survivors had significant postoperative complications. The most lethal complications were related to problems of surgical technique. The median survival time for patients discharged from the hospital was 22 months, with causes of death being equally distributed between recurrent carcinoma and other disorders. Abdominoperineal resection remains an acceptable method for treatment of anorectal carcinoma in the aged (80 or older) provided it is carried out with meticulous technique and careful selection of the patients.
Comparison of Oxazepam, Flurazepam and Chloral Hydrate as Hypnotic Sedatives in Geriatric Patients
Authors: GOLDSTEIN S. E. , BIRNBOM F. , LANCEE W. J. , DARKE A. C.
Published: April 2015

ABSTRACT: In a four‐week study, a comparison was made of oxazepam, flurazepam and chloral hydrate as hypnotic sedatives in 17 geriatric patients. Each drug was given alone for six nights, with a two‐night placebo interval following each phase. Each patient completed an additional placebo phase (up to six nights) before each drug phase. The number of awakenings per night and the sleep latency (time required to fall asleep) were determined from the patients' reports and from the reports of a nurse‐observer. Only for oxazepam was the number of patient‐reported awakenings per night significantly less than for placebo, although with both oxazepam and flurazepam the awakenings were fewer than with chloral hydrate. According to the patient‐reports, sleep latency was significantly lower with flurazepam than with placebo; for oxazepam and chloral hydrate the latencies were not significantly different from those for flurazepam or placebo. Only for oxazepam were the patients' ratings of sleep quality significantly greater than for placebo. The objective assessment of sleep by the nurse‐observer usually confirmed the patients' assessments. Morning drowsiness was the most common side effect, reported equally for placebo and for the active drugs. Drowsiness during the day was reported less frequently for oxazepam than for flurazepam, chloral hydrate or placebo. It is concluded that oxazepam is safe and efficacious for the short‐term management of insomnia in the elderly.
“Silent” Thyroiditis with Symptomatic Hyperthyroidism in an Elderly Patient
Authors: GORDON MICHAEL
Published: April 2015

ABSTRACT: A 93‐year‐old woman who presented with cardiac and gastrointestinal symptoms was found to have transient hyperthyroidism due to “silent” thyroiditis. The diagnosis was supported by the appropriate correlation between serum thyroid hormone levels and the thyroidal 1–131 uptake and scan.
Senile Confusion: Limitations of Assessment by the Face‐Hand Test, Mental Status Questionnaire, and Staff Ratings
Authors: BRINK T. L. , CAPRI D. , DE NEEVE V. , JANAKES C. , OLIVEIRA C.
Published: April 2015

ABSTRACT: Three of the most common and convenient measures of senile confusion are informal staff ratings, the Face‐Hand Test (FHT) and the Mental Status Questionnaire (MSQ). A group of 112 geriatric patients in two extended care facilities, and a volunteer sample of 40 community aged were examined by means of the FHT and MSQ. These instruments proved valuable in differentiating patients rated as confused from those rated as lucid and alert, and from the community subjects. However, each of these measures, as well as the staff ratings, produced false negative findings. Staff ratings incorrectly identified a hypochondriacal and paranoid patient as confused. The FHT scores of lucid and alert patients with some brain damage were low. MSQ scores of some poorly educated immigrants were very low, even though these patients were rated as lucid and alert by the staff and passed the FHT. One normally lucid and alert patient with a fever and an irregular rapid pulse failed both the FHT and the MSQ. Guidelines for further use of these instruments are presented.
Age‐Dependent Disposition of Amobarbital: Analog Computer Evaluation
Authors: Ritschel W. A.
Published: April 2015

ABSTRACT: Previously published observations on 4‐hour and 24‐hour amobarbital blood levels in two groups of subjects (ages 20‐40 and over‐65) were analyzed with use of an analog computer and literature data for the rate constants of absorption, distribution and metabolism. It was found that the volume of distribution did not change with age, and the increase in biologic half‐life from 22.8 hours in the young subjects to 86.62 in the elderly subjects was due to a decreased rate of metabolism. When the one‐point method is used, the size of the nightly dose of amobarbital should be reduced in elderly subjects from 200 mg to 50 mg in order to maintain the same steady‐state blood levels found in younger subjects.
Leisure Satisfaction and Psychologic Weil‐Being in Old Age: Effects of Health and Income*
Authors: MANCINI JAY A.
Published: April 2015

ABSTRACT: From a study (probability sampling methods) of the response of 74 older adults residing in a high‐rise public housing complex, it was concluded that the association between leisure satisfaction and psychologic well‐being is substantial and seems relatively unaffected by self‐rated levels of health and income.
Hypochondriasis in an Institutional Geriatric Population: Construction of a Scale (HSIG)
Authors: BRINK T. L. , BELANGER J. , BRYANT J. , CAPRI D. , JANAKES C. , JASCULCA S. , OLIVEIRA C.
Published: April 2015

ABSTRACT: The staffs at three extended care facilities identified a group of 10 hypochondriacal patients. The research team asked these 10 patients and 59 controls, 27 questions relating to health attitudes and behaviors. Six items were found to be fairly useful in distinguishing hypochondriacal from non‐hypochondriacal subjects. These six items were taken as the Hypochondriasis Scale for Institutional Geriatric Patients (HSIG), and each patient was scored on the basis of his responses to these six items. This test proved to be one way of distinguishing between hypochondriacal and non‐hypochondriacal groups (P <.005). However, because of the possibility of false positive results, the scale should be used only to confirm staff suspicions of hypochondriasis and should not be used as part of the clinical intake procedure.
Hormones: Beneficial or Dangerous to the Aged?
Authors: LONGCOPE CHRISTOPHER
Published: April 2015

ABSTRACT: Postmenopausal women lose 75–85 percent of estrogen and progesterone production compared with that in their reproductive years. The marked decrease in estrogen results in changes in the uterus, cervix, vaginal lining, glandular breast tissue, and the rate at which bone loses thickness. Some of these changes result in symptoms which range from unpleasant to disabling. Many of the symptoms can be alleviated by treatment with estrogens. However, recent reports have been linking estrogen usage with carcinoma of the uterus. Postmenopausal women should be treated with estrogens when the situation demands, but the dosage should be kept as low as possible and progestational agents should also be administered.
Training Objectives of a Well Developed Geriatrics Program
Authors: PATTEE JAMES J.
Published: April 2015

ABSTRACT: The Department of Family Practice and Community Health of the University of Minnesota Medical School is composed of six affiliated units. Each unit is allied with a hospital complex and operates an independent family practice clinic. Since each unit has unique demographic characteristics, general objectives for training residents in geriatric medicine have been developed. Cognitive, attitudinal and skill objectives also have been identified. The unit director implements the general objectives by using the special strengths of that particular unit.
Albert Mueller‐Deham: Distinguished Geriatric Clinician
Authors: FREEMAN JOSEPH T.
Published: April 2015

ABSTRACT: Modern geriatrics is the product of notable clinicians, past and present. However, recognition has been unequal. Pioneers whose publications were pre‐eminent in their time have not received adequate identification. In consequence, the field is poorer for such neglect. Albert Mueller‐Deham (1881–1971) of Vienna did excellent work in geriatrics. His clinical abilities were based on long staff attendance at a major hospital and by his insistence on attendance, with his staff, at autopsies. His key textbook was published in 1937 in German. His career in Austria was disrupted by political forces but, with energy and ability, he continued it with distinction in the United States. After retirement at age 70, he turned to social writings. A bio‐bibliography of this noteworthy man is based on several letters, a personal narrative that he wrote in response to questions about his years in geriatrics, notes from one of his staff, and recollections by his co‐author in 1942 of the revised American edition of the book. Students of aging can benefit by recourse to his classical text with its group of clinical principles.