bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Cortisol Response to Acute Myocardial Infarction in the Aged
Authors: Adair Richard , Kasahara Masayuki
Published: April 2015

The adrenocortical response to acute myocardial infarction in aged patients was studied by measuring serum cortisol concentration (radioimmunoassay) at the time of hospital admission. The mean serum cortisol level in 9 patients over 80 years old was similar to that in 5 patients less than 60 years old. In all patients who died, or in whom shock developed, the serum cortisol concentration was significantly elevated.
Prosopo‐Affective Agnosia and Computerized Tomography Findings in Patients with Cerebral Disorders
Authors: Kurucz Janos , Soni Anant , Feldmar Gabriel , Slade Walter R.
Published: April 2015

Thirty‐nine male patients (median age 61, range 19–92) from a neurologic ward were examined by a test for prosopo‐affective agnosia (PAA), i.e., impairment in the recognition of facial affect (emotions) with no impairment in the recognition of facial features (PA, prosopo‐agnosia). The scores for patients without hemispheric damage were close to those of normal subjects; the scores for patients with right or left hemispheric disease were lower; and the worst performers were patients with diffuse bilateral disease. The relative independence of PAA from PA was re‐affirmed. The neurologic findings on 21 patients were confirmed by computerized tomography (CT). On the PAA test, patients with negative CT results had scores close to those of normal subjects; patients with right or left hemispheric disease had lower scores; and the worst performers were patients with diffuse cortical atrophy. All patients who scored 87.5 percent or lower showed positive results with the CT scan, indicating that the PAA test may have some value in predicting positive CT findings. A significant deterioration in the ability to recognize facial affect was evident in the group of 15 patients aged 65 or older.
Thyroid Hormone Metabolism in Patients with Liver Cirrhosis, as Judged by Urinary Excretion of Triiodothyronine
Authors: Aizawa Toru , Yamada Takashi , Tawata Masato , Shimizu Takuo , Furuta Seiichi , Kiyosawa Kendo , Yakata Minoru
Published: April 2015

This study included 35 patients with liver cirrhosis, 23 patients with hyperthyroidism, 12 with hypothyroidism, and 3 with other endocrine disorders. In the various endocrine disorders an appreciable amount of triiodothyronine (T3) was excreted into the urine but the daily excretion was fairly constant in each patient. Urinary excretion of T3 was negligible or depressed in hypothyroidism, but increased with a rise in the serum level of T3. Serum and urinary T3 decreased in liver cirrhosis, but the serum thyroxine (T4) level was within the normal range. When the cirrhosis patients were divided into 3 groups according to the urinary excretion of T3, a decrease of urinary T3 was associated with a decrease in the serum levels of T3 and free T3. An increase of serum thyroid‐stimulating hormone (TSH) either before or after injection of thyrotropin‐releasing hormone (TRH) was inversely correlated with a decrease of serum and urinary T3. The decrease of serum and urinary T3 was correlated with the magnitude of liver damage as judged by indocyanine green retention and a decreased urinary excretion of cyclic adenosine 3',5'‐monophosphate. In vitro experiments indicated that rat liver, as compared to the kidney, heart and skeletal muscle, strongly converts T4 to T3, but this activity is greatly reduced by liver damage induced by ligation of the bile duct. It is suggested that patients with liver cirrhosis are, to some extent, in a state resembling subclinical hypothyroidism because of inability of the liver to metabolize a sufficient amount of T3 from T4.
Geriatric Paranoia: Case Report Illustrating Behavioral Management
Authors: Brink T. L.
Published: April 2015

Paranoid thinking is a defense mechanism against feelings of inferiority and humiliation. Paranoid behavior serves as a means of getting attention, sympathy and help. A case study of an 81‐year‐old woman illustrates the nature of geriatric paranoia and the roles of interpersonal relationships, rigid personality, depression, and the impairment of sensory and memory functions. The problem proved to be the effects on the family and neighbors of the patient's verbally expressed paranoid delusions. Treatment consisted of reducing the frequency of these paranoid complaints by means of reality therapy and verbal non‐reinforcement.
Peripheral Neuropathy in the Elderly: A Clinical and Electrophysiologic Study
Authors: Huang C. Y. , Med M
Published: April 2015

Fifty‐nine elderly patients with clinical and neurophysiologic evidence of peripheral neuropathy were reviewed. Diabetes, alcoholism and malignancy were the important etiologic factors, but other causes of acquired neuropathy such as drugs, autoimmune disease, and acute or chronic demyelinating neuropathy continue to warrant attention. Postural hypotension associated with neuropathy occurred in three patients with diabetes and one patient with lymphoma. Prognosis for the neuropathies did not seem to be adversely affected by age.
Shoulder‐Hand Syndrome: Importance of Early Diagnosis and Treatment
Authors: Chu Dong S. , Petrillo Claudio , Davis Sanders W. , Eichberg Rodolfo
Published: April 2015

If the shoulder‐hand syndrome is left without special care, it may lead to severe painful disabilities of the upper extremity. Early recognition of the clinical signs and symptoms and aggressive total care are essential for successful treatment and for the prevention of severe flexion contractures of the hand and shoulder, especially in patients whose symptoms have developed after a cerebrovascular accident. An outline is given of the treatment modalities (corticosteroids, physiotherapy and mechanical devices) used at the Institute for Rehabilitation Medicine (NYU) for obtaining maximum function of the involved upper extremity.
Endoscopic Papillotomy in the Geriatric Patient with Complicated Biliary‐Tract Disease
Authors: Kozarek R. A. , Sanowski R. A.
Published: April 2015

Biliary‐tract disease is not only more common in the geriatric population but carries an increased surgical risk. Described is a series of 10 middle‐aged and elderly patients who had stones in the common bile duct associated with significant underlying medical illness or peri‐ampullary pathologic changes. They were successfully treated by endoscopic papillotomy. The 80 percent success rate in such critically ill patients suggests that endoscopic papillotomy might be used as the initial treatment modality in aging patients with amenable biliary‐tract disease.
Senile Dementia, Alzheimer's Type: The Family and the Health Care Delivery System
Authors: ARONSON MIRIAM K. , LIPKOWITZ ROCHELLE
Published: April 2015

Senile dementia is one of the most important medical‐social‐economic problems facing our society, estimated to affect some 60 percent of nursing home patients and of persons residing in the community. The course of dementia in these patients is affected not only by their age, medical complications, and the disease itself, but also by where and with whom they live. A study was made of patients with senile dementia, Alzheimer's type (SDAT) in the community, and the kinds of caretakers involved. The implications of these patterns for management of the patients are discussed.
Sleep‐Wake Disorders in the Elderly: A Polysomnographic Analysis
Authors: COLEMAN RICHARD M. , MILES LAUGHTON E. , GUILLEMINAULT CHRISTIAN C. , ZARCONE VINCENT P. , van den HOED JOHANNA , DEMENT WILLIAM C.
Published: April 2015

The experience with 83 patients aged 60 or older from the Stanford Sleep‐Wake Disorders Clinic is compared with that in 423 younger clinic patients seen during the same two‐year period. Each patient received a medical, psychologic and polysomnographic evaluation. The final diagnoses were recorded according to the Diagnostic Classification System of the Association of Sleep Disorders Centers. The most common major diagnoses in the elderly group were sleep apnea syndrome (39 percent) and periodic movements‐restless legs syndrome (18 percent). These syndromes showed a significantly greater prevalence in the older than in the younger patients (p < .001), and were found in 68 percent of the elderly group. The elderly manifested more objective signs of sleep disturbance, including more wake time after sleep onset, and more frequent and longer awakenings; moreover, fewer of them experienced stage‐4 sleep. The diagnostic findings seemed to indicate that complaints about sleep‐wake functioning in many elderly patients may be a result of specific pathologic sleep disturbances.
Porphyria in the Elderly: Case Reports
Authors: PEARCE V. R. , PAYNE B.
Published: April 2015

Two cases of porphyria in octogenarians are presented. Both had atypical features. The first resembled acute intermittent porphyria without skin lesions, in association with a primary hepatic malignant lesion. The second patient had erythropoietic protoporphyria with hemolytic anemia and progressive hepatic failure. In neither instance was there a positive family history. Porphyria, though rare in the elderly, should be considered in differential diagnosis, as it is often associated with hepatic dysfunction and other disorders.
Abuse of the Elderly—The Hidden Agenda. I. The Caretakers and the Categories of Abuse
Authors: KIMSEY LARRY R. , TARBOX ARTHUR R. , BRAGG DAVID F.
Published: April 2015

ABSTRACT: An overview of the problem of abuse of the elderly is presented in an effort to guide future research. Categories of caretakers for the aged include formal (i.e., institutional settings) and informal (e.g., family, neighbors, sitters). Data are presented from a task force report on the status of nursing homes in the State of Texas. Categories of abuse are discussed under four divisions: physical, psychologic, material, and fiscal. Deliberate physical abuse by formal caretakers was the least common; physical neglect was far more common, e.g., the development of decubitus ulcers, inadequate nutrition, improper medication, and vermin infestation. Psychologic abuse was most frequent in the area of benign neglect, with patients regarded as “going to die anyway.” A tendency toward infantilization by formal caretakers was observed. Material abuse included primarily theft, chiefly of personal items rather than medication items. Fiscal abuse included embezzlement of patients' trust funds, improper charges for service, failure to notify the State of the death or departure of a patient, abuse of drugs, and artificial upgrading of Medicaid recipients' classifications. Possible causes of abuse are reviewed.
Diagnosis of Occult Gastrointestinal Lesions by Stool Guaiac Testing in a Geriatric Hospital
Authors: MANGLA JAGDISH C. , PEREIRA MARK , MURPHY JOHN
Published: April 2015

ABSTRACT: In a long‐term care facility, the fecal guaiac test for occult blood was used as a screening method to detect gastrointestinal (GI) bleeding lesions. The study involved 450 chronically ill hospitalized patients whose average age was 70 years. Each underwent 6 fecal guaiac tests for three consecutive days while receiving a standardized meat‐free, high‐fiber diet. The 21 patients in whom the fecal hemoccult test yielded positive findings were further studied with x‐ray upper GI series, barium enema, and fiberoptic examination of the upper and lower GI tract when necessary. In 4.7 percent of this population, the guaiac test gave positive results, which usually involved only 1 or 2 of the 6 guaiac slides. On further study it was found that 2 patients had large‐bowel tumors, 5 had duodenal ulcers, 1 had gastric cancer, and 7 had diverticulosis. The incidence of colon cancer in this population was the same as that reported in other studies, but the incidence of duodenal ulcers was high. In 20 of the 21 patients with positive test findings, a lesion of the GI tract was found. The therapeutic implications of such screening are important. This study emphasizes the value of routine fecal hemoccult testing of whole institutional populations once or twice a year.
Cerebral Amyloid Angiopathy in the Elderly
Authors: TOMONAGA MASANORI
Published: April 2015

ABSTRACT: In this study an attempt was made to determine the relationship between cerebral amyloid angiopathy (AA) and other cerebrovascular lesions in the aged. The brains of 128 autopsy patients over 60 years of age were examined by both light and electron microscopy. The frequency of cerebral AA increased with age and was 58 percent in patients over the age of 90. The change was observed more often in women than in men. In 7 cases of severe AA, the temporal or occipital cortex was the most common site. Most cases of AA were complicated by the formation of senile plaques in the cortex. Electron microscopic examination revealed amyloid fibrils deposited in clusters in the media and adventitia of the vessels, destroying their structure. Some blood vessels on the surface of the cortex showed hyalinosis, angionecrosis, duplication of the wall, or fibrotic occlusion. AA is sometimes a cause of cerebral bleeding. Five cases of massive cerebral bleeding were found among patients aged 90 or older, including a temporal hematoma in a 92‐year‐old woman which was believed to be due to the marked AA noted in the temporal lobes. Small cortical infarctions were common in the temporal lobes.
Mortality among Elderly Psychiatric Patients: Basis for Preventive Intervention
Authors: CRAIG THOMAS J. , LIN SHANG P.
Published: April 2015

ABSTRACT: Analysis of cause‐specific death rates among 750 elderly psychiatric inpatients revealed a markedly increased risk of death from pneumonia and a lesser but still substantial risk of death from cardiovascular disorders during the first year of hospitalization. Although the risks of cardiovascular death are considerably less among longer‐stay patients, the pneumonia risks remain high. This suggests differing preventive strategies. To help prevent cardiovascular deaths, more attention should be paid to avoiding transfer trauma and its attendant stress. To help prevent pneumonia deaths, high priority should be given to an aggressive program of immunization, adequate nutrition, reduction of hospital overcrowding, and recognition of early pneumonia symptoms.
Prevalence of Knee Chondrocalcinosis in Hospital and Clinic Patients Aged 50 or Older*
Authors: ELLMAN MICHAEL H. , BROWN NANCY L. , LEVIN BERTRAM
Published: April 2015

ABSTRACT: The prevalence of chondrocalcinosis was studied in 574 hospital and clinic patients aged 50 or older who had undergone x‐ray examination of the knee. Chondrocalcinosis was found in 9.6 percent of all these patients, in 5 percent of the 50–64 age group, and in 14.6 percent of the 65–94 age group. The prevalence of knee chondrocalcinosis increased in stepwise fashion between the ages of 65 and 80. A review of the literature and of the data on our few patients over the age of 80 suggests the existence of an even higher prevalence among persons of this advanced age group.
Perforated Peptic Ulcer in the Elderly
Authors: KANE EDWIN , FRIED GREGORY , McSHERRY CHARLES K.
Published: April 2015

ABSTRACT: From 1973 through 1979, 32 patients over 60 years of age were admitted to the Beth Israel Medical Center, New York, because of a perforated gastric or duodenal ulcer. In many of them, the symptoms and physical findings were minimal. In abdominal roentgenograms (subject erect or supine), only 17 (60 percent) of these patients showed free intraperitoneal air. Among the 29 surgically treated patients, plication of the ulcer was performed in 28 and hemigastrectomy‐vagotomy in one. The postoperative morbidity rate was 62 percent, and the mortality rate 17 percent. In 3 of the 32 patients, the diagnosis of perforated ulcer was established only at autopsy. Thus, failure to diagnose this condition accurately may be the principal cause of death in elderly patients with a perforated peptic ulcer. The increased use is recommended of contrast roentgenograms of the stomach and duodenum and of endoscopy, in an effort to improve diagnostic accuracy in dealing with perforated peptic ulcers.
Quantitative Bone Assessments: Applications and Expectations
Authors: SANDLER RIVKA BLACK , HERBERT DAVID L.
Published: April 2015

Although, with the newer and more sophisticated radiologic methods the precision of bone mass measurement has been greatly improved, it is still impossible to predict the imminence of osteoporotic fractures, for two main reasons. First, current radiologic methods measure bone mass accurately only in appendiceal bone (largely cortical and regularly shaped) and not in axial bone (largely trabecular and irregularly shaped). However, most clinically significant fractures occur in the axial skeleton and involve trabecular bone, which is more prone than cortical bone to resorptive losses. Second, because of large differences in body habitus, the normal range of bone densities varies widely in any cohort of the same sex and race. Thus, although bone density measurements cannot be used to predict osteoporotic fractures, they have an important application in monitoring changes in skeletal mass for therapeutic and prophylactic purposes.
Acute and Rapidly Progressive Forms of Glomerulonephritis in the Elderly
Authors: MONTOLIU JESÚS , DARNELL ALEJANDRO , TORRAS ALBERTO , REVERT LUIS
Published: April 2015

This article presents a comparison of acute glomerular nephritis (AGN) with rapidly progressive glomerular nephritis (RPGN) in patients aged 60 or older. In 7 elderly patients with AGN, the renal disease was preceded by skin infection (4 cases), sore throat (2 cases), or pneumonia (1 case). The 7 patients with RPGN had no history of prior infection. Both AGN and RPGN were manifested clinically as acute renal failure, but the RPGN patients had significantly higher serum creatinine levels and lower hematocrit readings. Hypocomplementemia was a feature only of AGN. The biopsy specimens from patients with RPGN showed crescents in 50–100 percent of the glomeruli, whereas specimens from patients with AGN showed no significant extracapillary proliferation. Six AGN patients recovered and 1 died. Despite dialysis, 4 RPGN patients died and the remaining 3 require maintenance dialysis. It is concluded that AGN in the elderly is more common than previously believed, frequently follows skin infections, and has a reasonably good prognosis. In contrast, RPGN, also not rare in the elderly, has a much worse prognosis.
Evaluation of Continuing Education for Long‐Term Care Personnel: Impact upon Attitudes and Knowledge*
Authors: ALMQUIST ELEANOR , STEIN SHAYNA , WEINER AUDREY , LINN MARGARET W.
Published: April 2015

Nursing assistants (aides) and licensed practical nurses (LPNs) from three proprietary nursing homes participated in a continuing education program designed to enhance knowledge and attitudes about the elderly in long‐term care. The program covered six weeks for the initial 115 aides and one full‐day seminar for the 83 LPNs. The content covered knowledge about human anatomy, the physiology of normal aging, physical and psychosocial problems of the elderly and, for the nurses, problems associated with cardiovascular accidents. The final participants (29 aides and 52 LPNs) consisted of those who were tested before and after their training with respect to knowledge, life satisfaction, and attitudes toward the elderly. Results indicated overall favorable changes for both aides and LPNs, particularly in the areas of increased knowledge and more positive attitudes. The data suggest that continuing education is an effective means of influencing the knowledge and attitudes of personnel in long‐term care facilities, and it should be a first step toward improving the quality of care for elderly residents.
Development of a Geriatric Behavioral Self‐Assessment Scale*
Authors: YESAVAGE JEROME A. , ADEY MICHAEL , WERNER PAUL D.
Published: April 2015

ABSTRACT: Described is the development of a self‐rating geriatric behavioral scale modeled after the Sandoz Clinical Assessment‐Geriatric (SCAG). This new Self‐Assessment Scale‐Geriatric (SASG) provides a valid and reliable measure of behavioral pathologic changes for the selective screening of elderly patients who manifest mild to moderate symptoms of dementia. Further use and refinement of this new measuring device are required to confer on it the maximum possible accuracy.
Polymorphonuclear Functions and Aging in Humans*
Authors: Corberand Joël , Ngyen Françoise , Laharrague Patrick , Fontanilles Anne Marie , Gleyzes Bernard , Gyrard Elisabeth , Senegas Chantal
Published: April 2015

To determine whether normal aging interferes with the functional capability of polymorphonuclear leukocytes (PMNs), 6 tests of PMN function were performed in 285 healthy subjects whose ages ranged from 20 to 97 years. A second selection based upon blood measurements and a review of medical histories 6 months later, eliminated 68 subjects. The 217 remaining persons were sub‐classed by age into 7 groups including equal numbers of males and females. The functional properties of PMNs in the aged, when compared to those of younger adults, were characterized by: (a) a decrease in the chemotactic response in the 80+ age group; (b) increased adherence, with onset after age 70, maximal after age 80; (c) a progressive decrease of NBT dye reduction capability, up to age 70–79, followed by an unexplained increase of the mean value after age 80; (d) diminished Candida‐killing activity, appearing in the 60+ group and becoming lowest in the oldest group; and (e) lack of changes in spontaneous migration and endocytosis. The mechanisms by which this impairment occurs are hypothetical. It is proposed that normal PMNs, after leaving the bone marrow, are influenced by various humoral components such as metabolic byproducts or immune processes altered by aging. Thus the defective PMN may represent only another victim of the aging process.
Geriatric Medical Education: Developments Since the American Geriatrics Society Conferences on Geriatric Education, 1976–77*
Authors: Reichel William
Published: April 2015

This is a Report presented to and endorsed by the Board of Directors of the American Geriatrics Society (AGS). It deals with developments since the AGS Conferences on Geriatric Education, 1976–77. Summarized is the position adopted by various medical organizations and associations, including the Institute of Medicine, Federated Council for Internal Medicine, American Society of Internal Medicine, and the American Academy of Family Physicians. Their stances essentially agree with that described in the Proceedings of the 1976–77 Conferences (JAGS, November 1977). The consensus arising from discussions by organized medical groups is that creation of a new practice specialty is unnecessary, although development and maintenance of an academic cadre of teachers and researchers is essential. Called for is greater commitment at the medical school level to incorporate geriatrics into the curriculum. The Report also deals with the question of merited recognition for those with special competency or expanded training in geriatrics. Finally, the Report provides support for the Medical Director concept, and looks to the Society's new Section for Long‐Term Care Physicians to provide leadership in emphasizing the role of the physician in long‐term care. The AGS intends, through future reports, publications, conferences, and liaison relationships with other organizations, to continue this advance, seeking solutions designed to improve and extend the health care of the aging population.
The Depressed Patient: Social Antecedents of Psychopathologic Changes in the Elderly*
Authors: Solomon Kenneth
Published: April 2015

The importance of depression as a psychopathologic syndrome in the elderly is stressed by the estimate that about 30 percent of persons over the age of 65 may be expected to experience an episode of depression severe enough to interfere with daily functioning. Depression is the chief cause of psychiatric hospitalization among the elderly, and it bears great potential for death through inanition or suicide. Loss of mastery (ability to cope) and the onset of helplessness are frequent dynamic issues in the development of depression or behavioral problems in the elderly. Geriatric sterotypes contribute directly to helplessness by reinforcing such behavior. Stereotypes also minimize the chance of appropriate response outcomes relative to needs. Rolelessness, a partial result of stereotyping, leads to anomie, alienation, and lowered self‐esteem. These issues are discussed and points of interaction among them are examined. The relevance to psychotherapy with older persons is outlined.
Serum Concentrations of the Iodothyronines in Elderly Subjects: Decreased Triiodothyronine (T3) and Free T3 Index
Authors: Caplan Robert H. , Wickus Gary , Glasser James E. , Davis Kent , Wahner Heinz W.
Published: April 2015

In four groups of subjects free of thyroid disease, the following determinations were made: serum concentrations of thyroxine (T4), triiodothyronine (T3), reverse T3(rT3) and diiodothyronine (T2), and calculated indices of free thyroxine (FT4) and free triiodothyronine (FT3). Group A comprised healthy subjects aged 16–64; Group B, 24 healthy elderly subjects aged 68–95; Group C, 23 elderly patients with mild well‐controlled chronic illnesses, aged 70–85; Group D, 40 nursing home residents aged 66–100. Serum T4 and T2 concentrations and the FT4 index were not affected by age; the rT3 concentration was slightly but significantly elevated only in Group D patients. Serum T3 concentration was significantly lower in all groups of elderly subjects and decreased FT3 index measurements were detected after age 75. It was concluded that old age, without complicating illness, is accompanied only by a decrease in the serum level of T3 and the FT3 index; values for other iodothyronines are unchanged. Clinicians should consider the age‐related changes in T3 and FT3 values when interpreting thyroid function tests.
Phenytoin Concentrations in Venous versus Capillary Blood of Geriatric Patients
Authors: Umstead Greg S. , McKernan Thomas
Published: April 2015

In 15 elderly patients who had seizure disorders, venous blood (standard venipuncture) was compared with capillary blood (finger lancet puncture) as the source of the specimen for determination of serum phenytoin concentration. The values obtained by the two procedures were similar (r = 0.99). The mean serum phenytoin levels in the venous samples was 17.3 μg/ml, and in the capillary samples 17.0 μg/ml; the paired t test showed no statistical difference. Either method provides an adequate blood sample for determination of phenytoin, and both may be used interchangeably. Capillary samples may be preferable for aged patients in whom venipuncture proves difficult or painful.
Isotopic Scanning of Bone in the Diagnosis of Osteomalacia
Authors: Rai G. S. , Webster S. G. P. , Wraight E. P.
Published: April 2015

Results of a study performed over 18 months in 21 elderly patients showed that isotopic bone scanning is a sensitive technique for the detection of osteomalacia. It can be used not only to indicate the presence of the disease but the response to treatment.
Cimetidine in Elderly Patients
Authors: JENIKE MICHAEL A.
Published: April 2015

Cimetidine is widely prescribed but has numerous potential side effects, especially in elderly patients, who require a lower dosage, e.g., 300 mg twice daily. Antacids may be more effective than Cimetidine in preventing acute gastrointestinal bleeding in critically ill elderly patients. Cimetidine increases the risk of toxicity of other commonly used drugs such as phenytoin, diazepam, chlordiazepoxide, propranolol, theophylline, warfarin, and car‐bamazepine. Elderly patients taking Cimetidine are at risk for neuropsychiatric changes, which may be temporarily reversed by physostigmine. Other side effects and indications for use are reviewed.
Skeletal Deformities in the Elderly and Their Effect on Postural Sway
Authors: Brocklehurst J. C. , Robertson Duncan , James‐Groom Pauline
Published: April 2015

In a group of 151 elderly men and women (age range, 65–85+), postural sway was studied in relation to various physical attributes and skeletal deformities that might be contributory factors. Weight, loss of height (span‐height), scoliosis, grip strength, and the knee angle, measured laterally with the subject erect, all proved to be correlated with postural sway. Kyphosis was related to loss of muscle power and other general indications of frailty. Scoliosis appeared to be related to joint disease in the pelvis and lower limbs.
BOOK REVIEWS
Authors: Dean Ward
Published: April 2015

A New Age Scale for Humans. By Daniel Hershey and Hsuan‐Hsien Wang. Lexington, Massachusetts, Lexington Books, 1980, 156 pp
Symptomatic Pyelonephritis in Elderly Men
Authors: GLECKMAN RICHARD , BLAGG NOEL , HIBERT DEBRA , HALL ARTHUR , CROWLEY MONIQUE , PRITCHARD ANNE , WARREN WILLIAM
Published: April 2015

A prospective study was carried out of the clinical, laboratory, radiologic and therapeutic features of acute, symptomatic, bacterial pyelonephritis as experienced by 12 consecutive elderly, noncatheterized men who required hospitalization. In spite of the advanced ages of the men and the inordinate frequency of bacteremia and septic shock, no patient died. “Appropriate” antibiotic therapy, supportive treatment, and, as importantly, a lack of associated “imminently” or “ultimately” fatal illnesses contributed to the 100 per cent survival rate. Guidelines are provided for the diagnostic evaluation and antibiotic therapy of community‐acquired pyelonephritis in elderly men.
Issues in Clinical Trials with the Depressed Elderly
Authors: ROTHBLUM ESTHER D. , SHOLOMSKAS ALAN J. , BERRY CYNTHIA , PRUSOFF BRIGITTE A.
Published: April 2015

Despite the fact that there is a high prevalence of depression among the elderly, little research on the efficacy of psychotherapy or pharmacotherapy with the elderly has been reported in the literature. This paper describes a sample of 18 elderly patients who received both psychotherapy and pharmacotherapy for the treatment of depression. Psychotherapy involved weekly 30–50 minute sessions of interpersonal psychotherapy with a treating psychiatrist. The drug treatment consisted of random assignment, double‐blind, to either alpra‐zolam, imipramine, or pill‐placebo for six weeks. The focus of therapy was on the attendance, compliance, and symptomatic relief in elderly depressed patients, as well as on the major life problems identified by these patients in psychotherapy. Results indicated that elderly patients respond to community publicity regarding a psychotherapy treatment program. However, the majority are inappropriate referrals for diagnostic reasons. If accepted, elderly patients showed good compliance with drugs, and attendance was comparable to that in younger populations. The elderly patients responded well to treatment, with immediate and marked improvement on the Hamilton and Raskin Depression Scales, which was maintained after treatment. Grief and role transitions specific to life changes were frequent antecedents to depression in this elderly population and thus were the major foci in psychotherapy.
Depression in a Family Practice Elderly Population
Authors: FREEDMAN NORBERT , BUCCI WILMA , ELKOWITZ EDWARD
Published: April 2015

This study addresses several major methodologic issues in the assessment of depressive illness among the elderly family practice patients living in the community. These include the selection of screening locale, the definition of depression in the elderly, and the evaluation of age trends within this group. The family physician's office is viewed as the optimal screening locale; this facility serves as the chief link between the elderly patient and the community health care system, for psychologic as well as physical complaints. In the definition of depression, a type of depressive illness particularly affecting the elderly may be distinguished from a syndrome more characteristic of depression in the population at large. Emphasis is laid on viewing aging as an evolving process rather than as a steady state. A pilot study of 166 chronically ill family practice patients living in the community was conducted. A large proportion of them, all without previously diagnosed psychiatric impairment, had elevated depression scores according to the Zung Depression Status Inventory. Distinct symptom clusters characteristic of depression in the aged were identified. The data also suggested a systematic age trend, with different peaks of depression for men and women within the elderly age range.
Emergency Detention of the Elderly: Demographics, Diagnoses, and Outcome
Authors: SCHIEDERMAYER DAVID L , DUTHIE EDMUND H. , SHELLEY MARY V. , TSITOURAS PANAYIOTIS D. , LUND MARY , GAMBERT STEVEN R.
Published: April 2015

Involuntary medical detention is an increasing problem in many large teaching hospitals. Forty‐two elderly patients involuntarily admitted for protective service to the general medical wards were compared with an age‐matched group of 25 elderly persons voluntarily seeking care in the same institution. The comparison showed that most of the involuntarily admitted patients were more than 70 years of age, and more of them lived alone. On admission they had more dementia and dehydration but less urinary‐tract infection than did the controls. Their hospital stays were longer. There was no difference between the groups with respect to discharge dispositions.
Age‐related Changes of the Cranial Bone Mineral: A Quantitative Study with Computed Tomography
Authors: YAMADA KENJI , ENDO SATOSHI , YOSHIOKA SEIRO , HATAZAWA JUN , YAMAURA HARUTSUGU , MATSUZAWA TAIJU
Published: April 2015

Age‐related changes of the cranial bone mineral in 495 subjects were assessed by computed tomography (CT) in terms of the Hounsfield number. By means of computer programs available in the CT system, the histograms for the bone were obtained. The peak of this histogram for males increased gradually and reached a plateau beyond 20 years of age, while that for females rose rather steeply from age 0 to age 20 and formed a plateau in the 20s and 30s, then declined precipitously from a value of 1164 ±usmn; 143 to a value of 629 ± 119 in the 70s and older. In the 20s and 30s, the peak for females was greater than that for males. The total pixel number of this histogram was constant after the 20s. The pixel number of the peak for males made a plateau after the 10s, but that for females showed a similar pattern until the 40s, then increased steeply after the 50s. The peak may reflect calcium concentration of the cranial bone, and therefore the skull of the female may store more calcium than that of the male in the 20s and 30s.
Geriatric Medicine: A Multidisciplinary Training and Education Model in an Acute Care Medical Center
Authors: CROOKS VALERIE , LEE PATRICIA , YOSHIKAWA THOMAS T.
Published: April 2015

A description of a comprehensive multidisciplinary education and training program in geriatrics in an acute care hospital is presented. A brief review of the history of medical education in geriatrics is examined, and the need for and potential of a hospital‐based training program is discussed. The methods used in implementing an education program that attracts house staff physicians and other health professionals are described. The program incorporates the application of a multidisciplinary team model of patient assessment and treatment, which is augmented by clinical bedside teaching and a broad‐based educational program. Using hospital‐wide faculty, the program includes a geriatrics/gerontology lecture series incorporating presentations on the biopsychosocial aspects of aging and a diversity of subjects relevant to aging. Other programs such as weekly house staff topic sessions on aging, interdisciplinary research seminars, orientations, and special symposia are all part of the education program.
Geriatric Psychiatry in the Emergency Department: Characteristics of Geriatric and Non‐geriatric Admissions
Authors: WAXMAN HOWARD M. , CARNER ERWIN A. , DUBIN WILLIAM , KLEIN MELISSA
Published: April 2015

A study was made of the Emergency Department records of 49 elderly (65 years old or older) and 49 middle‐aged (40–64 years old) patients seen in an urban hospital's psychiatric emergency service. The data were compared for demographic and admission information, psychiatric treatment history, presenting complaints, symptoms, diagnoses, and final disposition status. For the elderly patients, the referral was more likely to be their first contact with psychiatric treatment, and they were more likely to be referred (accompanied) by family or friends than to be self‐referred. Among the middle‐aged patients, “substance abuse” (e.g., drugs, alcohol) disorders and schizophrenic disorders were more common. The elderly, however, were much more likely to be regarded as having an organic brain syndrome of unspecified cause (34.7 per cent vs 0). Access to treatment was fairly consistent for both groups as measured by the hospital's priority code, total time spent in the emergency department, and final disposition. These results raise important issues concerning the unique psychosocial characteristics and psychiatric treatment needs of elderly patients. This applies particularly to the emergency‐department medical clearance of elderly patients with symptoms of organic brain syndrome.
Malnutrition in the Hospitalized Geriatric Patient
Authors: BIENIA RICHARD , RATCLIFF SANDRA , BARBOUR GALEN L. , KUMMER MARY
Published: April 2015

The nutritional status of 59 consecutive geriatric male patients admitted to the medical service of a Veterans Administration Hospital was evaluated and compared with that of 93 younger patients admitted during the same period. Protein‐calorie malnutrition was diagnosed in 61 per cent of patients aged 65 or older compared with 28 per cent of patients younger than 65. The death rate and the incidence of infection were higher in the malnourished geriatric patients, as were the prevalences of anemia and skin‐test anergy. In the well‐nourished geriatric patients, however, there was no increase in the incidences of these abnormal findings compared with well‐nourished patients under the age of 65. The presence of malnutrition on admission, regardless of age, predicted a significant increase in the risk of infection or death during the hospital course.
Spontaneous Cholecystocutaneous Fistula: A Complication of Neglected Biliary Tract Disease
Authors: HOFFMAN LLOYD , BEATON HOWARD , WANTZ GEORGE
Published: April 2015

Spontaneous cholecystocutaneous fistula is rarely seen today because of the relative safety of early treatment of biliary tract disease. Two cases are presented, one complicated by carcinoma of the gallbladder. The literature is reviewed with reference to clinical presentations, diagnosis, and treatment. The long‐standing inflammatory process that precedes such an unusual occurrence makes the problem more common among patients of the geriatric age group.
Senile Cardiomyopathy
Authors: BURCH GEORGE E.
Published: April 2015

The literature on senile cardiomyopathy is selectively reviewed, information gained from the observation of more than 14,000 hearts at autopsy is presented, and suggestions for management of senile cardiomyopathy are given.
Observations on Lithium Disposition in the Elderly
Authors: CHAPRON DENNIS J. , CAMERON IAN R. , WHITE LORRAINE B. , MERRALL PAULINE
Published: April 2015

The disposition kinetics of lithium were studied in six elderly women who had been maintained on this medication for several years. Lithium administration was stopped abruptly. Plasma, whole blood, and erythrocyte half‐lives were then measured, as well as renal plasma clearance and distribution volume. Half‐life values in whole blood and in its components were found to be similar. The plasma lithium half‐life approximated that in younger schizophrenics, but appeared prolonged when compared with half‐lives reported for young normal volunteers. Renal plasma clearance and distribution volume of lithium appeared substantially reduced when compared with published values. The data are consistent with altered lithium disposition in the aged.
Alzheimer's Disease and Maternal Age
Authors: COHEN DONNA , EISDORFER CARL , LEVERENZ JAMES
Published: April 2015

Findings from several studies suggest a relationship between Alzheimer's disease and0020Down's syndrome. It has long been known that advanced maternal age is a risk factor for Down's syndrome, and that mothers who give birth to a child with this syndrome have characteristics consistent with accelerated aging. Little is known about risk factors for Alzheimer's disease, other than age. In this study, documentation is supplied for a hypothesis concerning a relationship between Alzheimer's disease and advanced maternal age.
Small Cell Lung Carcinoma in the Elderly
Authors: CLAMON GERALD H. , AUDEH M. WILLIAM , PINNICK SALLY
Published: April 2015

Twenty‐four patients over the age of 70 with small cell cancer of the lung were studied retrospectively. Ninety‐two per cent of these patients had other concurrent medical disorders; 58 per cent had cardiac disease and 25 per cent had a second malignancy. The median survival of 20 treated patients was ten months, and the one‐year survival was 30 per cent. Such elderly patients with multiple medical problems can benefit from combination chemotherapy.
Can We Learn about Aging from a Study of Werner's Syndrome?
Authors: SALK DARRELL
Published: April 2015

Werner's syndrome, a rare genetic condition, has many features suggestive of rapid, premature aging. However, it differs from normal aging in several important respects. Cultured skin fibroblast‐like cells have markedly reduced growth potential and a characteristic pattern of multiple, variable, stable structural chromosomal rearrangements that are non‐constitutional. Since Werner's syndrome is inherited in an autosomal recessive fashion, there is presumably a single gene defect or a multi‐gene deletion that accounts for its multiple progeroid features. The identification of this defective protein (or proteins) would be of great interest to both basic gerontologic and clinical geriatric research, since it would shed light on the mechanisms underlying the normal aging process and the development of geriatric diseases. It is evident that such a protein(s) is not the sole determinant of youth or longevity, but the many progeroid manifestations of Werner's syndrome indicate that the basic molecular defect resides in or affects some central pathway of cellular control or homeostatic interaction.
Sex Difference in Brain Atrophy During Aging: A Quantitative Study with Computed Tomography
Authors: HATAZAWA JUN , ITO MASATOSHI , YAMAURA HARUTSUGU , MATSUZAWA TAIJU
Published: April 2015

Brain atrophy in 154 men and 147 women without neurologic deficits was quantitatively studied by means of computed tomography. The ages ranged from 20 to 79 years. The volume percentage of brain to cranial cavity (Craniocerebral Index, or CCI) was calculated by means of computer programs available in CT systems. The mean CCI in the 20–39 age group was constant at 98.4 per cent in men and 98.7 per cent in women, and this was considered the standard for the CCI in subjects with nonatrophied brains. The percentage of each subject's CCI in relation to this standard in both sexes (Brain Volume Index, or BVI) was calculated as the indicator of brain atrophy. The normal value for BVI was therefore 100 per cent in both sexes. A clear difference was observed between men and women in the process of brain atrophy with increasing age. In men a significant reduction in BVI began in the sixth decade of life (P < 0.01); thereafter, the decline was gradual and steady through the eighth decade (P < 0.05). In women, a significant reduction in BVI began in the fifth decade (P < 0.01) and remained relatively constant during the fifth and sixth decades but declined significantly again in the seventh and eighth decades. In both sexes, remarkable individual differences in brain atrophy were characteristic.
Improving Survival in Patients with Prostate Cancer Regionally Spread at the Time of Diagnosis
Authors: HOLMES FREDERICK F. , LIU KO JAM
Published: April 2015

In the United States, cancer of the prostate ranks first among malignant neoplasms in elderly men. During the 20‐year period 1960–1979, 5178 men with prostatic cancer were registered at the Cancer Data Service of the University of Kansas. This study concerns 985 of these men in whom the cancer was regionally spread at the time of diagnosis. Survival differences were examined for four periods, i.e., 1960–64, 1965–69, 1970–74, and 1975–79. Highly significant increases were observed in one‐year and three‐year survival (P < 0.003) between the 1965–69 and the 1970–74 groups, seemingly coincident with a marked decrease in the dosage of estrogen as standard therapy. Another noteworthy finding was that the initial use of radiotherapy (alone or combined) increased from 4.5 per cent in 1960–64 to 36.5 per cent in 1975–79, a period when survival had also increased significantly. In this subset of men with prostatic cancer, survival is approaching that for an age‐matched male population as determined by U.S. Life Tables.
Catheter‐related Urosepsis in the Elderly: A Prospective Study of Community‐derived Infections
Authors: GLECKMAN RICHARD , BLAGG NOEL , HIBERT DEBRA , HALL ARTHUR , CROWLEY MONIQUE , PRITCHARD ANNE , WARREN WILLIAM
Published: April 2015

For the period 1979–1980, a prospective study was made of 13 elderly patients with catheter‐related urosepsis, who required hospitalization. Several features appeared to distinguish these patients: (1) a traumatic catheter‐related event invariably preceded the acute symptomatic process, (2) polymicrobic bacteriuria predominated, and (3) the urinary pathogens were often resistant to the antimicrobial agents commonly prescribed for community‐associated symptomatic urinary‐tract infections. A diagnostic and therapeutic approach for these patients is outlined.
Reducing Medication Errors in a Geriatric Population
Authors: MARTIN DAVID C. , MEAD KAREN
Published: April 2015

Three compliance‐improving strategies were tested in an ambulatory geriatric population, and the results were compared with those in a control group. The strategies included standardized instructions with tapes and transcripts, color‐coded pill bottles, and color‐coded pill bottles matched to a color‐coded weekly pill tray. Only in the color‐coded bottles‐tray group were the results significantly better (P < 0.001) than in the controls; on the average, the scores deviated only 1.7 per cent from the ideal pill count compared with 17.1 per cent for the control group.
Electroencephalogram in the Septuagenarian: Studies in a Normal Geriatric Population
Authors: KATZ RICHARD I. , HOROWITZ GARY R.
Published: April 2015

Electroencephalograms (EEGs) of a cohort of 52 septuagenarians rigorously selected for neuropsychiatric “normalcy” were examined, with attention to alpha frequency and focal or diffuse slowing. Contrary to the widely accepted notion of diminution in these EEG signs in patients of this age group, the findings of this study revealed alpha frequencies approximating 10 Hz and no focal or diffuse slowing. These results are discussed in relation to clinical EEG interpretation as well as to the aging process.
Injury in Late Life: II. Prevention
Authors: HOGUE CAROL C.
Published: April 2015

Contemporary, systematic approaches to injury prevention are presented as guides for considering needless death and disability of older people because of falls, burns, and vehicular crashes. Injury results from an unfavorable relationship between etiologic agent and host within a particular environmental setting. Abnormal energy exchange is the agent. Injury prevention strategies are sometimes aimed at the agent and other times at reducing exposure or susceptibility. By considering phases of the injury event (pre‐event, event, and post‐event), and the agent, host, and environment in each phase, a wide variety of options can be developed for preventing injury or minimizing the consequences of those which do occur.