bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Influencing Admission or Nonadmission of the Aged to the Hospital
Authors: GREENBERG NAOMI SCHUBIN , ROSIN ARNOLD J.
Published: April 2015

A prospective study was carried out to determine which social, functional, or medical factors influenced the decision to admit or not to admit aged people to a general hospital in Israel. The study also focused on characteristics of patients admitted to the geriatric ward of the medical division as distinct from those sent to the internal medicine ward. Two hundred patients over the age of 65 were examined during ten consecutive intake days for the internal medicine ward over a period of five weeks. One hundred and sixty‐seven were interviewed in the emergency departments, and the others after transfer from other departments by prearranged consultation. Thirty‐five per cent were not admitted, 28 per cent were admitted to internal medicine, and 26 per cent were admitted to the geriatric department. Social factors played little part in the selecting process, the dominant need being acuteness and severity of illness. However, patients in the geriatric ward were found to be functionally much more disabled in regard to mobility, mental state, and incontinence. This was also reflected in a longer average stay of 15 days compared with nine in internal medicine, a higher mortality (19 per cent as against 7 per cent) and a higher degree of disability on discharge from hospital.
Depression in the Elderly: Pharmacologic Considerations in Treatment
Authors: ROSSMAN ISADORE , VEITH RICHARD C.
Published: April 2015

The pharmacologic treatment of depression in the aged is complicated by an increased frequency of concurrent medical disease and multiple drug use. In addition, age‐related physiologic changes may alter the pharmacokinetics and pharmacodynamics of the antidepressant medications. As a consequence, the variability of response and the incidence of adverse effects are increased in the elderly. The clinical implications of these factors and guidelines for the use of antidepressants in the elderly are discussed.
Adenocarcinoma of the Appendix in Older Patients
Authors: RUGGIERO ROBERT P. , COSTANTINO GEORGE
Published: April 2015

Acute inflammation of the appendix secondary to luminal obstruction is the chief reason for appendectomy. The rare association of a malignant neoplastic process with the inflammatory process is usually an unexpected finding and is often not diagnosed until the histologic study has been completed. Two patients with adenocarcinoma of the appendix are presented. They exemplify the diverse situations of intraoperative recognition with immediate definitive treatment, or surgical management after appendectomy alone. A review of the literature confirms the rarity of appendiceal adenocarcinoma in older patients. In this report, the pathophysiology of appendiceal carcinoma and guidelines for therapy are outlined. Emphasis is placed on the possible occurrence of a malignant appendiceal lesion in the elderly patient with acute appendicitis.
Regular Source of Care and the Minority Aged
Authors: BERK MARC L. , MHSA AMY B., Bernstein
Published: April 2015

Data from the National Medical Care Expenditure Survey are used to examine the access of elderly minorities to a regular source of medical care. The findings suggest that such elderly persons are about as likely as the white elderly to have a routine point of entry into the medical care system. There are, however, differences in the type of setting at which care is received. Compared with the elderly population of whites, the elderly population of minorities is more likely to have a regular source of care in an institutional setting and less likely to have a regular source of care that provides house calls or emergency services. The absence of a usual source of care may be a contributing factor to the difference in use of health services between the white and the nonwhite elderly populations.
Alzheimer's Disease: Assessment of Functional Status
Authors: WINOGROND IRIS R. , FISK ALBERTA.
Published: April 2015

The initial assessments of cognitive, psychologic, and behavioral functioning of 17 adults enrolled in a day care program for victims of Alzheimer's disease are described. These evaluations by the staff, the patients themselves, and their primary caregivers made use of standardized quantitative measures, thus permitting correlational analysis of the data. Little information is available on the relationships between these areas of function in Alzheimer's disease. Such data are useful in determining realistic expectations of patient function by family and staff. They also provide a data base for the longitudinal study of the effects of the disease on these functional areas. Testing established a strong statistically significant association between cognitive and behavioral functions, and between morale and behavioral function. However, only modest correlations between cognitive and psychologic functions were evidenced.
An Interdisciplinary Geriatric Consultation Service: A Controlled Trial
Authors: CAMPION EDWARD W. , JETTE ALAN , BERKMAN BARBARA
Published: April 2015

The structure and function of a newly created interdisciplinary Geriatric Consultation Team (GCT) are described. The GCT was introduced on a single medical unit, where consultations were given to 46 consecutive patients aged 75 years and over. The GCT patients had, on the average, 5.5 illnesses and were receiving 3.7 medications. Anemia (50 per cent), hypoalbuminemia (65 per cent), and elevated blood urea nitrogen (BUN) (58 per cent) were frequent. Functional assessment showed frequent dependence on others for assistance with ambulation (59 per cent), transfers (54 per cent), and dressing (52 per cent); cognitive impairment was found in 52 per cent and clinical depression in 11 per cent of the patients. In comparison with control units, the GCT increased use of physical therapy by 357 per cent, occupational therapy by 390 per cent, and speech therapy by 300 per cent without increasing length of stay. In comparison with control subjects, GCT patients had no decrease in hospital readmission rates (43 per cent) over 10.5 months of follow up. It was concluded that a GCT in an acute‐care hospital promotes geriatrics, teaches interdisciplinary teamwork, improves awareness of functional problems of patients, and increases use of rehabilitative services, but does not decrease the high rate of readmission of hospitalized geriatric patients.
The Relationship Between Cutaneous Cellular Immune Responsiveness and Mortality in a Nursing Home Population
Authors: COHN JOHN R. , HOHL CAROLE A. , BUCKLEY C. EDWARD
Published: April 2015

The survival over 18 months of 29 nursing home residents was compared with results of cutaneous testing of cell‐mediated immunity at the start of the period of observation. Eight antigens were used to evaluate immunity by intradermal injection of each antigen and measurement of the areas of induration at 48 and 72 hours. A difference in responses was seen between the survivors and those who died, although this difference was statistically significant at 72 hours only. As expected, survivors had more (3.1, compared with 1.47) and larger (8.6 mm, compared with 3.2 mm) reactions at 72 hours than those who died.
Sexual Incidents in an Extended Care Unit for Aged Men
Authors: SZASZ GEORGE
Published: April 2015

A survey was conducted among the nursing staff of a 400‐bed extended‐care unit for aged men by questionnaire to find out what patient behaviors were identified as sexual by the staff and how they reacted to these behaviors. Three types of behavior were identified as sexual and as “causing problems”: sex talk (e.g., using foul language); sexual acts (e.g., touching or grabbing, exposing genitalia); and implied sexual behavior (e.g., openly reading pornographic magazines). As many as 25 per cent of the residents were thought to create such incidents. Acceptable sexual behavior identified by the staff were limited to hugging and kissing on the cheek, although their answers implied that residents could need more intimate touching and affection. The survey raised questions about the nature and causes of different types of sexual behavior in the institutionalized elderly and about the roles nursing staff, physicians, and administrators can play in recognizing individual needs while safeguarding both the residents and the staff from the consequences of unacceptable incidents.
Depressive Symptoms and Health Service Utilization among the Community Elderly
Authors: WAXMAN HOWARD M. , CARNER ERWIN A. , BLUM ADAM
Published: April 2015

The relationship between depression and complaints of physical disease in the elderly is often discussed but has received little documentation. The authors administered questionnaires to 88 elderly volunteers to assess two common psychologic diagnoses, affective disorders and organic brain syndrome, and three common cardiovascular symptoms, pain or numbness in the jaw or arm, pressure in the chest, and difficulty in breathing. Data on utilization of health care professionals and demographic information were also obtained. A significant correlation between reports of depression and complaints of cardiovascular symptoms was seen. While the volunteers with depressive symptoms also visited their physicians more often than did the other volunteers, they did not seek the help of mental health professionals. This raises the larger issue that elderly persons who have mild to moderate depression present to our health care system.
Aging and Hypertension: Hemodynamic Implications of Systolic Pressure Trends
Authors: HICKLER ROGER B.
Published: April 2015

The progressive rise in systolic pressure throughout life is accepted as a phenomenon of “normative aging,” although elevated systolic pressure is established as an independent risk factor for untoward cardiovascular events. An analysis of published data for many thousands of individuals indicates comparable average systolic pressure increments of approximately 20 mm Hg between the ages of 40 and 65 years for both normotensives and hypertensives. In both groups there is a disproportionate rise in systolic pressure, that is, systolic increases more than mean and diastolic pressures. In a young person with a normally elastic arterial system an increase in total peripheral resistance (TPR) produces the same increments in systolic, diastolic, and mean arterial pressures; a decrease in arterial distensibility (AD), on the other hand, increases systolic pressure and decreases diastolic pressure to the same extent, leaving mean pressure unchanged. Thus, the proportion of the systolic pressure rise resulting from increased TPR is equal to the increase in the mean pressure (Δ mean); the remainder of the increase (Δ systolic minus Δ mean) is caused by the only other variable that could account for an additional increase in systolic pressure with advancing age, a decrease in AD. Application of this formulation to published blood pressure data shows that in normotensives the ratio of the contribution toward rising systolic pressure of ↓ AD to ↑ TPR is 1:1 between the ages of 40 and 65 years, whereas in hypertensives it is 2:1. Thus, the natural history of essential hypertension, once established, is one of accelerated arterial stiffening, a mechanism that would contribute importantly to the increasing prevalence of “systolic hypertension” with advancing age.
Effects of Geriatric Education on the Attitudes of Medical Students
Authors: WARREN DAWN L. , PAINTER ALBERT , RUDISILL JOHN
Published: April 2015

This study investigated the effects of an educational program in geriatrics on the attitudes of a group of third‐year medical students. A survey designed to measure attitudes toward geriatric patient care, aging, and older people was administered to all students before and after their participation in a 25‐hour geriatrics education component of a Family Practice Clerkship. Results showed the students' attitudes were significantly improved following the geriatrics training program. Prior training in geriatrics and their specialty preference were also found to have an impact on attitude. The implications of the study for medical education and research are discussed.
Problems of the Health‐impaired Elderly: A Foundation's Experience in Geriatrics
Authors: CLUFF LEIGHTON E.
Published: April 2015

Elderly people, particularly those over age 75, are subject to problems of access to needed health services, of the appropriateness of these services in relation to their needs, and of increasing infirmity, disability and dependency, with loss of their natural support systems. The proportion of health expenditures deployed to deal with the institutionalization and long‐term requirements of elderly people is increasing in a national climate characterized by tightening constraints on public expenditures for health care under Medicare and Medicaid. The Robert Wood Johnson Foundation has accepted objectives and roles to find better ways to use what we already know to improve elderly people's access to health care, to improve their functional effectiveness, and to make their health care more affordable. The results of some of the programs it has supported represent innovative approaches and demonstrate ways in which we may accomplish these objectives.
Bronchogenic Cancer, Metastases, and Aging
Authors: ERSHLER WILLIAM B. , SOCINSKI MARK A. , GREENE CAROLYN J.
Published: April 2015

Previously reported large autopsy series have indicated that elderly patients who die of cancer are less likely to have metastatic disease than their younger counterparts. This observation could be explained if survival were shorter in the elderly population and patients died with smaller tumor burdens. The authors analyzed Medical Center Hospital of Vermont (MCHV) Tumor Registry data on primary lung cancer with respect to age. As in the reported autopsy series, at the time of diagnosis elderly patients were less likely to have metastatic disease. Further analysis was undertaken of the patients from this series who died and were autopsied at MCHV. Although the total numbers were small, survival was not shorter in the advanced age groups. The authors suggest that elderly patients have slower tumor growth and less metastatic disease, not because of earlier diagnosis and shorter survival, but because of senescent host factors that impede aggressive tumor growth and spread.
Vitamin D Deficiency: A Risk Factor for Osteomalacia in the Aged
Authors: BARZEL URIEL S.
Published: April 2015

Deficiency of vitamin D is rare in the general population of the North American continent because of the availability of sunlight, vitamin D‐fortified milk, and over‐the‐counter preparations containing the vitamin. Yet there are among the aged those who are at risk of developing a deficiency of the vitamin because of lack of exposure to sunlight and failure to ingest milk or vitamin supplements containing vitamin D. Four cases of vitamin D‐deficiency osteomalacia are described, demonstrating the various findings in the patient history and the physical, radiologic, and laboratory evaluation. In all cases physiologic doses of the vitamin corrected the abnormality quickly and fully. Vitamin D deficiency can be prevented prophylactically once the gerontologist is alert to the fact that some elderly people, who are easily identifiable by history alone, are likely to develop such deficiencies.
Decisions to Withhold Treatment from Nursing Home Residents
Authors: BESDINE RICHARD W.
Published: April 2015

Although the ethical issues in clinical care of severely impaired elderly nursing home residents may appear to be the same as those encountered in the acute hospital, they are not. In particular, “do not resuscitate” orders are not of central importance in the nursing home. For the individuals being considered, decisions about limiting routine treatments and whether treatment should include hospitalization are crucial. Establishing an ethical issues team is one means of increasing awareness of ethical issues in patient care and of dealing with these difficult issues more successfully.
An Evaluation of the Reliability and Validity of the Functional Assessment Inventory
Authors: CAIRL RICHARD E. , PFEIFFER ERIC , KELLER DONALD M. , BURKE HENRY , SAMIS HARVEY V.
Published: April 2015

The reliability of the Functional Assessment Inventory (FAI) was evaluated using a sample of VA domiciliary and nursing home patients. The interobserver and interrater reliability coefficients of the summary rating scales, based on a single assessment, tended to be higher than their test‐retest reliability coefficients, based on two independent assessments separated by a modal four‐week interval. Validity coefficients, using the OARS instrument ratings as criteria, also based on two independent assessments several weeks apart, were, on the average, as high as the test‐retest reliability coefficients. More specifically, the mental health, physical health, and activities of daily living rating scales, along with the objectively scored Short Portable Mental Status Questionnaire and Short Psychiatric Evaluation Schedule, tended to yield relatively similar scores with repeated measurement, while the social resources and economic resources scales were somewhat less stable, a discrepancy possibly explained by the homogeneous nature of the social and economic status of most of the patients (institutionalized veterans). Thus the reliability and validity of the FAI are satisfactory, but the stability of some of its scales requires further investigation.
Respite Admissions and the Disabled Elderly
Authors: DUNN REBECCA B. , MacBEATH LYN , ROBERTSON DUNCAN
Published: April 2015

A retrospective descriptive study of the elderly patients served by a respite admission program in a teaching hospital is described. Data were collected by health record review and interviews with the program social worker. In the three years covered by the study there were 28 patients, with a mean age of 80.5 years. Fifty‐seven per cent were male, 68 per cent, married, 29 per cent, widowed, and 3 per cent, single. When first admitted they were all living in their own homes or the home of a child. Seventy‐nine per cent of the patients had moderate or severe dementia, with or without physical disability. Family members were the main caregivers and home care services provided support in 54 per cent of cases. Ninety‐three per cent of the patients attended the geriatric day hospital. The patients received respite admissions for a mean of 10.8 months. At the end of the study more than a third of the patients were still living at home and half had entered long‐term care facilities. By means of respite admissions supplemented by day hospital attendance it has been possible to maintain in the community disabled elderly patients who might otherwise have required immediate institutionalization. The need for more respite care and in‐home services is discussed and a role for long‐term care facilities as major providers of respite care suggested.
The Medical Evaluation and Management of the Elderly Surgical Patient
Authors: JOHNSON JERRY C.
Published: April 2015

Contrary to earlier findings, elderly patients are not at significantly greater risk of perioperative morbidity or mortality than younger patients simply because of advanced age. Increased risk, when present, is attributable to pathologic changes that are not uniformly seen in all geriatric patients. Most perioperative morbidity is caused by cardiovascular and pulmonary complications. The author discusses an appropriate preoperative evaluation and recommends selective ancillary tests to screen for high‐risk patients.
A Randomized Placebo‐controlled Trial of Ultraviolet Light in the Treatment of Superficial Pressure Sores
Authors: WILLS E. ELIZABETH , ANDERSON TERENCE W. , BEATTIE B. LYNN , SCOTT ANNE
Published: April 2015

Ultraviolet (UV) light treatment of pressure sores enjoyed widespread popularity for many years, but recently its effectiveness has been increasingly questioned. Surprisingly, it appears that this form of treatment has never been tested by a randomized placebo‐controlled trial. Eighteeen patients residing in the Extended Care Unit of the Health Sciences Centre Hospital at the University of British Columbia and suffering from superficial pressure sores of recent onset were therefore randomly assigned to active and placebo treatment groups. Since treatment procedures appeared identical in both groups, both patients and hospital staff were blind as to individual allocation. Sixteen patients completed the study. Mean time to complete healing was 6.3 weeks in the UV treated group, significantly (P < .02) less than the mean of 8.4 weeks in the placebo group. This difference persisted unchanged when each patient's age and the initial size of the sore were taken into account by an analysis of covariance. Thus, in spite of growing skepticism about its effectiveness, it appears that UV light may play a useful role in the treatment of pressure sores, and a systematic evaluation of different treatment protocols seems to be justified.
Biomedical and Social Determinants of Cognitive Impairment in the Elderly
Authors: AVORN JERRY
Published: April 2015

Studies in age‐related cognitive changes do not necessarily take into account the clinical and social phenomena associated with age that may have more effect on cognition than does psychologic senescence. Clinically inapparent biologic deterioration, drugs, mild dementia, and atypically presenting depression may influence cognition. Selection bias may skew the results of studies on the elderly when control groups are made up of undergraduates or of “normal” elderly whose normality is taken for granted rather than verified. The epiphenomena of aging, such as retirement, social isolation, and bereavement, which are not inherent in the aging process, influence cognition, as do labeling and learned helplessness. Laboratory‐based tests of cognition may not sufficiently resemble real‐life conditions to have validity. Future research will be shaped by how we conceptualize the relation between aging and intellectual function.
Persistent Cutaneous Cellular Immune Responsiveness in a Nursing Home Population
Authors: COHN JOHN R. , BUCKLEY C. EDWARD , HOHL CAROLE A. , TYSON GLADYS B. , NEISH DONALD D.
Published: April 2015

Mantoux‐type skin tests were applied to 29 elderly residents of an intermediate care floor of a nursing home. Eight antigens were used with each resident, and the size of the reactions was measured at 6, 24, 48, and 72 hours. All but one resident had at least one response ≥ 3 mm at 48 or 72 hours, and most had more than one response of that size. At 48 compared with 72 hours, there was one more responder and the mean size of the reactions to each antigen was greatest. However, there were two responders at 72 hours who did not react at 48 hours, and the total number of reactions in the group was greater at the later reading. Only one resident did not produce any response at either 48 or 72 hours. The minimum number of antigens needed to identify all responsive subjects was five (PPD‐Avian, coccidioidin, histoplasmin, streptokinase‐streptodornase, and trychophytin). The purified protein derivative of tuberculin skin test was repeated on subjects who had an initial response < 10 mm, and one increase of more than 6 mm was observed in a resident who was initially unresponsive to that antigen.
Effects of Chronic Medical Illness and Dementia on the Dexamethasone Suppression Test
Authors: CARNES MOLLY , SMITH JANE C. , KALIN NED H. , BAUWENS STEVEN F.
Published: April 2015

The dexamethasone suppression test (DST) was performed on 26 elderly male outpatients in a geriatric medical clinic. Patients with depression were excluded. All patients had two or more medical diagnoses. Fourteen patients also met DSM‐IM criteria for dementia. No patient had an abnormal DST result. The authors suggest that neither chronic medical illness nor dementia causes false‐positive DST results in this patient population in an outpatient setting, and discuss the findings in relation to previous reports.
Medical Students' Attitudes Toward the Elderly
Authors: GREEN SUSAN K. , KEITH KARLA J. , PAWLSON L. GREGORY
Published: April 2015

A study was designed to examine the relationship between students' attitudes, their willingness to work with elderly patients, and the impact of a geriatric rotation on a randomly selected subset of the group. A pretest/post‐test design was used in which 148 third‐year medical students completed a multidimensional questionnaire on two occasions eight weeks apart. Highly significant correlations were found between the expressed intention of the student to work with the elderly and positive feelings about previous professional contact (r = .26, P < .001), previous personal contact (r = .17, P < .002), belief that working with the elderly is rewarding (r = .30, P < .0001), high degree of comfort in working with the elderly (r = .21, P < .01), and positive stereotypes about the elderly (r = .14, P < .05). Despite the students' positive rating of the geriatric rotation, multiple regression analysis indicated that the best predictor of an index of intentions to work with elderly patients on the post‐test was this same index of intentions on the pretest (multiple r = .58, P < .001). These findings, as well as the actual attitudes and stereotypes held by the students, have major implications for the planning and development of medical students' experiences in geriatrics.
Earlobe Type, Race, and Age: Effects on Earlobe Creasing
Authors: OVERFIELD THERESA , CALL ERIC B.
Published: April 2015

There has been much discussion of the utility and validity of the earlobe crease as a warning sign of cardiovascular disease. The authors postulated that the mixed findings were due to the neglect of three variables: age, race, and earlobe shape. Age and earlobe shape were studied in 324 healthy adult subjects from three racial groups: southwestern Alaskan Eskimos (70), Navajos (167), and whites (87). It was found that creases develop with age in healthy adults, that creasing is related to earlobe shape, that the age of onset of creasing varies according to race, and that the frequencies of occurrence of different earlobe shapes differ by race. Future studies of earlobe creases should therefore include the variables of age, race, and earlobe shape.
Physical Rehabilitation of the Old, Old Patient
Authors: PARRY FRAZER
Published: April 2015

An increasing number of persons over the age of 85 are surviving acute illnesses and are being referred for physical rehabilitation. There have been no reports in the United States literature about the effectiveness of rehabilitation for this age group. Results of treatment of 97 patients (one hundred consecutive admissions) who were referred by four general hospitals to a suburban physical rehabilitation center were examined and the patients followed for six to 18 months. Seventy‐nine per cent of the patients showed improvement, 18 per cent stayed the same, and 3 per cent worsened. Seventy‐one per cent either returned to the same setting as before hospitalization or moved in with family members after treatment. These results show that well‐planned rehabilitation is effective in the very old patient.
Secretion and Hepatic Extraction of Insulin in Nondiabetic, Obese, Aged Subjects
Authors: BONORA ENZO , COSCELLI CARLO , BUTTURINI UGO
Published: April 2015

Considerable evidence suggests that glucose tolerance deteriorates with age, in spite of a generally normal insulin response to the oral glucose tolerance test (OGTT). However, several metabolic events besides pancreatic secretion are known to influence the peripheral insulin concentration. Thus, C‐peptide is considered a more reliable index of beta cell activity than insulin. Moreover, the simultaneous assay of C‐peptide and insulin in peripheral blood provides a noninvasive method to estimate the hepatic removal of insulin. In this study, insulin and C‐peptide responses to the OGTT were evaluated in a group of 12 nondiabetic, obese, aged subjects and in a group of 12 sex‐ and weight‐matched young controls. Compared with younger subjects, older subjects showed significantly higher glucose levels and incremental areas in spite of comparable concentrations of C‐peptide and insulin. Ratios of C‐peptide to insulin, both in the fasting state and after glucose load, did not differ in elderly and young subjects. The results suggest that the higher glucose levels in the aged are not due to decreased insulin secretion by the beta cell or to alterations in the hepatic catabolism of insulin. The discrepancy of normal insulin concentrations and elevated glucose levels may be interpreted as the result of an age‐related decrease in insulin sensitivity. However, the differences in glucose concentrations in old and young subjects also might be due to (1) an age‐related reduction in the size of those tissues that dispose of very large amounts of glucose or (2) an age‐related impairment in those gastrointestinal factors that promote the uptake of orally administered glucose by the liver.
The Desk Directory of Social Resources: A Physicians' Reference Guide to Social and Community Services for the Aged
Authors: COHEN DONNA , EISDORFER CARL , HEGARTY JUDITH
Published: April 2015

Physicians not only have a responsibility for the diagnosis and management of illness in the aged but also must address the patient's emotional needs, functional status, and psychosocial problems. The Institute of Medicine Report on Geriatric Medical Education has emphasized the need to train physicians to understand how the social components of care enhance the course and outcome of treatment. A physician's reference guide to social and community services should be developed to provide information that will enable clinicians to integrate medical and community health services into their practice.
Myasthenia Gravis in the Elderly: Report of 37 Cases
Authors: EVOLI AMELIA , TONALI PIETRO , SCOPPETTA CIRIACO , DAVID PASQUALE
Published: April 2015

The treatment of myasthenia gravis in the elderly is controversial. Thirty‐seven myasthenic patients with onset of the disease after the age of 60 were followed for a period of 14 years. All of the 37 patients received anticholinesterase drugs during this period, ten underwent thymectomy, and 24 were treated with corticosteroids. At present, one patient is in remission, 28 are improved, one is unchanged, and seven have died. Only one death was directly related to myasthenia. In the authors' experience thymectomy can be an effective treatment of myasthenia gravis in elderly patients; corticosteroid therapy can also be useful in addition to or as an alternative to surgery. Using a “personalized” schedule the authors obtained good results in 78 per cent of their patients.
Tuberculosis in the Geriatric Patient
Authors: NAGAMI PAMELA H. , YOSHIKAWA THOMAS T.
Published: April 2015

Active tuberculosis is highly prevalent in the geriatric population. The clinical syndromes and diagnostic indications of the different forms of tuberculosis are described. Reactivation pulmonary tuberculosis and miliary tuberculosis in the elderly are particularly difficult to diagnose. A high index of suspicion, a tuberculin skin test, and appropriate laboratory studies are essential for early diagnosis. Therapy for tuberculosis in the elderly must consider efficacy, patient compliance, and toxicity.
A Dose‐response Study with Dihydroergotoxine Mesylate in Cerebrovascular Disturbances
Authors: YOSHIKAWA MASAMI , HIRAI SHUNSAKU , AIZAWA TOYOZO , KUROIWA YOSHIGORO , GOTO FUMIO , SOFUE ITSURO , TOYOKURA YASUO , YAMAMURA HIDEO , IWASAKI YOSHIO
Published: April 2015

Basic pharmacologic evidences have suggested the effects of dihydroergotoxine mesylate (DEM) on neurotransmitters. In its clinical use, however, various therapeutic effects and side effects are observed when the dose is changed, because of the complexity of this compound and the delicate mechanism of neurotransmitters in the brain, especially when modified by aging and vascular lesions.

In order to investigate the optimal dose, a double‐blind study in 550 patients with cerebrovascular disorders was carried out at 68 centers under observation by experienced specialists. Dihydroergotoxine mesylate in sublingual tablets, 3 mg daily, and in oral tablets, 6 mg daily, respectively, was given for 12 weeks, and therapeutic effects at those doses were compared by a double‐blind method. In utility ratings for subjective and psychiatric symptoms, the effects in the oral tablet group at a daily dose of 6 mg were significantly superior to those in sublingual tablet group at a daily dose of 3 mg. There was no significant difference between those two groups in the comparison of side effects.

These results show that the daily oral administration of 6 mg of DEM is more suitable for the improvement of subjective and psychiatric symptoms due to cerebrovascular disorders than is the daily sublingual administration of 3 mg. These results suggest that, despite much complexity in the neurohumoral transmitter mechanism in the brain, relatively simple dose‐dependent efficacy of the drug in the range of the therapeutic doses was confirmed for many subjective and psychiatric symptoms of patients with cerebrovascular disorders.
Coping with Dementia
Authors: LEVINE NORMAN B. , DASTOOR DOLLY P. , GENDRON CAROLE E.
Published: April 2015

Ten supporters of demented elderly dependents were studied in order to examine their coping behavior in the context of caring for their relatives at home. Coping skills were described with respect to problems, solutions, and cognitive aspects of motivation and stress tolerance. The observations made suggested the hypothesis that tolerance of debility in a demented relative is related not only to the number and type of problems in the dependent but also to the availability and quality of coping skills in the supporter. This hypothesis was explored through the elaboration of a skills training program (Supporter Endurance Training), which was designed and employed to improve and expand the coping skills of a supporter. Supporter Endurance Training may prove to be a useful approach to the maintenance of the demented elderly person at home as a possible alternative to institutionalization.
Predictors of Falls among Institutionalized Women with Alzheimer's Disease
Authors: Brody Elaine M. , Kleban Morton H. , Moss Miriam S. , Kleban Ferne
Published: April 2015

Falls among elderly residents are a major concern of facilities caring for the aged. A group of institutionalized women with senile dementia of the Alzheimer type (N = 60; mean age 83) were studied longitudinally and evaluated annually on 21 variables of physical, social, emotional, self‐care, and cognitive functioning. A substudy of falls they experienced used data from two such annual evaluations. Clinical ratings by the interdisciplinary team estimated 1) the women's changes in function during the preceding year and 2) the current levels of the women's functioning. Separate regressions for each of the two years returned identical significant patterns indicating that ratings of physical vigor were significantly related to number of falls. Those women who had been among the most vigorous in the group but who had shown significant declines in the preceding year were the most vulnerable to falls; women who had been rated as the least vigorous but whose levels of vigor had been stable during the year tended to have fewer falls. Falling therefore appears to be related to the process of decline in vigor among those in the group whose levels of vigor were higher initially. There were corresponding significant declines in emotional and cognitive scales.
Evolution of a Geriatric Evaluation Clinic
Authors: Moore James T. , Warshaw Gregg A. , Walden Lesa D. , Rask Kimberly , Clapp‐Channing Nancy E.
Published: April 2015

Multidisciplinary geriatric evaluation units are being established in hospitals and, to a lesser extent, as outpatient clinics. This paper presents results of a chart audit of 332 patients seen from 1978 to 1982 at a university based geriatric outpatient evaluation unit. The relationships of clinic staffing to types of referrals and other aspects of clinic operation are investigated. During the time under study, the proportion of patients whose problems were medical rather than psychiatric or social increased. Presenting problems varied by referral source. Family and self referrals were most likely to identify a medical presenting problem, while physician and community agency referrals were most likely to identify a psychiatric problem. Patients frequently received diagnoses in areas of function other than those identified as the presenting problems. For example, medical clinicians made at least one psychiatric diagnoses for 86 per cent of patients they evaluated. Important questions about the potential contribution of such geriatrics clinics to health care of the elderly remain to be answered.
Freedom, Dependency, and the Care of the Very Old
Authors: Thomasma David C.
Published: April 2015

Difficulties exist in making treatment decisions for the very old and dependent patient. In the years to come, these difficulties will increase. It is argued that such persons should not be abandoned to their “rights” as autonomous persons; yet quality of life judgments should also be avoided except in limited circumstances. Since aging is a process of becoming more dependent, the author proposes a dependency rule, by which greater responsibility for treatment decisions falls on care‐givers as a person's dependency increases. In place of quality of life judgments he suggests a medical indications policy, if the latter includes restoration of some affective function. Five kinds of freedom are proposed, of which only some are lost in chronic illness and old age. Finally, it is suggested that life itself involves greater interdependence than the autonomy criterion itself can allow. The author focuses on the problem of dependency in the aged and the role an increase in this dependency plays, with corresponding loss of personal autonomy, in quality of life judgments. These, in turn, form the basis for treatment decisions.
Book Reviews
Authors: Barzel Uriel S.
Published: April 2015

Book reviewed in this article:

Geriatric Emergencies: Brady's Series in Emergency Medicine. By Schwartz G, Bosker G, Grigsby JW. Bowie, Maryland, Robert J. Brady, Co.

The Biomedical Basis of Gerontology. By Hall DA. Littleton

Dying Dignified: The Health Professional's Guide to Care. By Gonda TA, Ruark JE.

Essentials of Clinical Neurology. By Weisberg LA, Strub RL, and Garcia CA.

Nutrition in Gerontology: Vol. 26, Aging Series. Edited by Ordy JM, Harman D, Alfin‐Slater RB.

Laboratory Medicine in Clinical Practice: Practical and Efficient Use of the Laboratory in Patient Management. Edited by Mandell HN. John Wright‐P.S.G.

Long‐term Care: Perspectives from Research and Demonstrations. Edited by Vogel RJ, Palmer HC.

Arteriosclerotic Brain Disease. Edited by Crepaldi G, Fellin R, Olsson AG, Toffano G.

The Mind and Mood of Aging: Mental Health Problems of the Community Elderly in New York and London. By Gurland B, Copeland J, Kuriansky J, Kelleher, M, Sharpe L, Dean LL.
The Lack of Benefit of Modest Sodium Restriction in the Institutionalized Elderly
Authors: HADLER MORRIS H.
Published: April 2015

Modest restriction of sodium intake is commonly prescribed in hypertensive or fluid‐retaining states in the elderly. In recent years this intervention is generally adjunctive to pharmacologic therapy. Its utility was tested by comparison of baseline serum urea nitrogen (BUN) and creatinine levels, weight, and mean blood pressure with these determinations six months after the daily dietary sodium intake was changed from 2 g to 4 g in 38 institutionalized elderly persons. No difference was discernible. In elderly persons in institutions, where diuretic therapy is common and the validity of diagnoses is not tested daily, the modest restriction of sodium intake may accomplish little more than reducing the payability of food.
Follow Up of Patients Referred to a Dementia Service
Authors: REDING MICHAEL J. , HAYCOX JAMES , WIGFORSS KAREN , BRUSH DORETHEA , BLASS JOHN P.
Published: April 2015

Eighty‐five patients referred to a dementia clinic in a prosperous suburban setting were followed for as long as 48 months. Progressive dementia occurred in 55 of the 56 patients in whose cases it was predicted. Three‐year mortality rates were 83 per cent for multi‐infarct dementia, 57 per cent for mixed vascular plus Alzheimer dementia, and 37 per cent for Alzheimer disease. The differences in death rates among the different diagnostic groups support the validity of the clinical distinctions drawn. A subspecialty clinic can accurately identify progressive intellectual impairment in the elderly. The data suggest that patients who have depression complicating organic brain disease are at risk for progressive intellectual impairment, even if not demented when first seen. Intellectual deterioration appears to be a poor prognostic sign in older people.
Management of Hip Fractures in Nursing Home Patients: To Treat or Not to Treat?
Authors: LYON LEONARD J. , NEVINS MICHAEL A.
Published: April 2015

Nursing home patients who sustain hip fractures have a much higher than average complication rate after surgical repair, and few ever walk again. Operation is not necessary to ensure the patient's survival in the postfracture period. The majority of these patients are better off managed without surgery. For patients with little or no chance to walk again, a nonsurgical treatment regimen in the nursing home is safer, more humane, and far less expensive than hospitalization.
Health Experience Learning Program (HELP)
Authors: McDOWELL FLETCHER H. , WATKINS SYLVIA , ALMY THOMAS P.
Published: April 2015

Since 1976, The Burke Rehabilitation Center has employed undergraduate university and college students as nurses' aides. This experience has enabled many students to make a decision or firm up their decision to go on to medical school. It has also been extremely valuable to the institution to have available for employment this intelligent and highly motivated group of individuals. The program has been mutually beneficial for both parties and could easily be adapted for other health care institutions.
Atypical Presentations of Dementia of the Alzheimer Type
Authors: Shuttleworth E. C.
Published: April 2015

Seven patients who eventually met established criteria for dementia of the Alzheimer type are described to illustrate the variety of atypical clinical presentations of this disorder. The value of a careful history, examination, and follow up in reaching the earliest possible diagnosis is emphasized. In the event of the development of adequate therapy this information will become essential in proper management of these patients.
Twelve‐month Surveillance of Infections in Institutionalized Elderly Men
Authors: Nicolle L. E. , McIntyre M. , Zacharias H. , MacDonell J. A.
Published: April 2015

Surveillance of infectious episodes in institutionalized elderly men permanently resident on two wards of a veterans' hospital was undertaken for a 12‐month period. One‐hundred eleven episodes were identified in 50 residents (74 per cent). The most frequent infections included lower respiratory tract infections (incidence 59/100 patient‐years), febrile episodes with no source (43.4), skin and soft tissue infections (36.5), and gastroenteritis (33). Only pneumonia was associated with significant mortality. A specific etiologic agent was seldom indentified other than for skin and soft tissue infections. Antimicrobial therapy was prescribed for 87 per cent of all infections. Ward staff absenteeism was associated with peak occurrences of infections in residents. Resident characteristics that correlated with infection were incontinence of bladder and of bowel. Mental status or degree of mobility did not correlate. While infections occur frequently in this population, mortality is common only with pneumonia. Infections occur more frequently in residents who have greater functional impairment.
Brain Atrophy During Aging: A Quantitative Study Using Computed Tomography
Authors: Takeda Shumpei , Matsuzawa Taiju
Published: April 2015

Using computed tomography, the authors studied brain atrophy during aging in 483 males and 497 females with no neurologic disturbances, ranging in age from 10 to 88 years. They measured cerebrospinal fluid (CSF) space volume and cranial cavity volume above the level of the tentorium cerebelli and calculated a brain atrophy index (BAI):BAI (%) = 100% × (CSF space volume/cranial cavity volume). Both CSF space volume and the BAI started to increase significantly after the thirties in both men and women (P < 0.001). While the rate with which the brain atrophied accelerated constantly during aging in females, the rate of atrophy in men in their thirties and forties was more than twice that of women of the same age; the rate then declined in men in their forties and fifties. Both CSF space volume and the BAI increased exponentially with increasing age after the thirties, continuing to increase until the eighties in both men and women.
Institutional Prescribing for the Elderly: Patterns of Prescribing in a Municipal Hospital and a Municipal Nursing Home
Authors: Reynolds Michael D.
Published: April 2015

The drugs prescribed for long‐term use by 56 elderly patients while they were under domiciliary care in a municipal hospital were compared with the drugs prescribed for the same patients six months after they had moved to a city nursing home. All patients were at least 65 years old, and were in the hospital for at least six months. Mean numbers of prescriptions per patient were 4.1 in the hospital and 3.7 in the nursing home. Diuretics and potassium chloride were prescribed less often in the nursing home, but the number of patients taking digitalis glycosides increased. Use of tranquilizers and of sedatives and hypnotics was less in the nursing home, whereas a larger proportion of patients were given antidepressant drugs. In the hospital, tranquilizers and nonsteroidal antiinflammatory drugs were usually ordered to be administered routinely, while in the nursing home these drugs were ordered mostly for use as needed. Explanation of the differences between the two institutions in prescribing for the same patients is hindered by the frequent lack of recorded diagnoses accounting for the drugs prescribed in the hospital. The lesser use of tranquilizers in the nursing home may be a result of the difference between the environments there and at the hospital. In comparison with previous reports of institutional prescribing for the elderly, far fewer patients in both the institutions studied were receiving tranquilizers, sedatives, and hypnotics.
Urinary Incontinence in the Geriatric Population of an Acute Care Hospital
Authors: Sullivan Dennis H. , Lindsay Richard W.
Published: April 2015

To determine the incidence, prevalence, and duration of urinary incontinence, a survey was undertaken of all patients aged 65 and over admitted to a university hospital during a six‐week period. The daily prevalence of incontinence, which was 19 per cent for the entire study population, was highly variable from one nursing unit to another. Twenty‐five per cent of those on the acute care general medical units and 17 per cent of those on the general surgical units were incontinent on any given day. The burn unit had the highest daily prevalence of incontinence (75 per cent). The incidence of incontinence per hospital stay, which was determined for the 315 patients who were followed from admission to discharge, was 19 per cent. Of the 348 patients discharged to home during the survey period, 10.9 per cent were incontinent within the 24 hours prior to leaving the hospital, and, of the 27 referred to another institution, 48 per cent had been incontinent during that interval. The authors conclude that a substantial proportion of geriatric patients are incontinent at some stage during their hospital stays.