bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic Papillotomy in the Geriatric Patient with Complicated Biliary‐Tract Disease
Authors: Kozarek R. A. , Sanowski R. A. 
Published: April 2015

ABSTRACTBiliary‐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

ABSTRACTSenile 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

ABSTRACTThe 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

ABSTRACTTwo 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.
Quantitative Bone Assessments: Applications and Expectations
Authors: SANDLER RIVKA BLACK , HERBERT DAVID L. 
Published: April 2015

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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.
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

ABSTRACTTo 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

ABSTRACTThis 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

ABSTRACTThe 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

ABSTRACTIn 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

ABSTRACTIn 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

ABSTRACTResults 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.
Symptomatic Pyelonephritis in Elderly Men
Authors: GLECKMAN RICHARD , BLAGG NOEL , HIBERT DEBRA , HALL ARTHUR , CROWLEY MONIQUE , PRITCHARD ANNE , WARREN WILLIAM 
Published: April 2015

ABSTRACT: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

ABSTRACT: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.
The Nonuse of Urethral Catheterization in the Management of Urinary Incontinence in the Teaching Nursing Home
Authors: MARRON KATHLEEN R. , FILLIT HOWARD , PESKOWITZ MYRA , SILVERSTONE FELIX A. 
Published: April 2015

A survey of all patients in a 527‐bed skilled nursing facility was carried out to determine the prevalence of bladder catheterization. The institution surveyed is a teaching nursing home and rehabilitation center comprising three intermediate‐stay and rehabilitation units of 126 beds and nine long‐term care units.The institutional prevalence of recurrent urinary incontinence was 46 per cent, or 243 patients. The prevalence of chronic indwelling urethral catheters was 2.5 per cent, or 13 patients. The prevalence of urethral catheterization was further reduced to 1.5 per cent on the long‐term care units, where the rate of recurrent urinary incontinence exceeded 60 per cent.The results of our survey were then compared with similar surveys at the institution during the years 1975 through 1980. Despite a fluctuating but increasing prevalence of incontinence over the years studied, a favorable trend was shown toward a reduction in the number of patients with indwelling urethral catheters.This study indicates that unless specific complicating factors are present, urinary incontinence in all but a very few of the elderly can be successfully managed without chronic indwelling catheterization. The authors believe that the introduction and growth of an education and research program in the nursing home environment has led to improvement in the standards of medical and nursing care.
A Community‐based Psychogeriatric Service
Authors: WASYLENKI DONALD A. , HARRISON MARY K. , BRITNELL JUDY , HOOD JANE 
Published: April 2015

ABSTRACT:The elderly are most susceptible to mental illness, and they receive inadequate mental health services. The authors developed a community‐based program to meet the needs of the psychiatrically impaired elderly by providing a multiplicity of indirect services to community caregivers. A psychiatrist and two clinical specialists in psychiatric nursing provide consultation, education, collaboration, and coordination to individuals and agencies dealing directly with elderly clients in the community. Evaluation of data show a high degree of consultee satisfaction, few recommendations for institutional care, satisfactory client outcomes, and a significant impact achieved by a formal educational program for community practitioners.
Problems of Antiarthritic Therapy in the Elderly
Authors: BROOKS P. M. , KEAN W. F. , KASSAM Y. , BUCHANAN W. W. 
Published: April 2015

ABSTRACT:Rheumatic diseases are prevalent in the elderly population, resulting in high morbidity caused mainly by lack of mobility. Consequently, the use of antirheumatic drugs in older persons is extensive. This review outlines some of the hazards encountered in the use of antirheumatic drugs in the elderly. Analgesics such as propoxyphene and acetaminophen are useful adjuncts to the treatment of arthritic pain, but propoxyphene has been associated with respiratory depression, and renal clearance of acetaminophen is reduced in elderly subjects. Salicylates may cause deafness, and like the other nonsteroidal anti‐inflammatory drugs, may cause salt and water retention resulting in congestive cardiac failure. Phenylbutazone should not be used because of the risk of blood dyscrasia, and indomethacin has been reported as interfering with the antihypertensive effect of β‐blockers. Chloroquine levels may be raised in patients with impaired renal function, and there is increased risk of retinal damage with the drug in elderly subjects. Injectable gold compounds and penicillamine are not contraindicated in the elderly, because they are just as efficacious as in younger persons for the treatment of rheumatoid arthritis. Toxicity due to gold compound is not increased in the elderly, but skin rashes and abnormalities of taste do occur more commonly in elderly patients treated with penicillamine. Corticosteroids do not affect disease progression and therefore should be used only in acute severe disease for short periods of time. As in the younger population, treatment of gout in the elderly is dependent on renal function. The treatment of rheumatic diseases in the elderly requires careful consideration of the metabolic consequences before a regimen of drug therapy is introduced. Properly managed drug therapy in the elderly arthritic patient will result in considerable improvement in mobility, thus greatly enhancing the quality of life.
Extraordinary Nutritional Support: A Case Study and Ethical Analysis
Authors: WATTS DAVID T. , CASSEL CHRISTINE K. 
Published: April 2015

ABSTRACT:Ethical issues surrounding decisions to limit treatment often focus on dramatic and highly technical interventions, such as mechanical ventilation. Many less dramatic forms of therapy are considered routine,1 and ethical aspects of their use may be less closely examined. Nutritional support can be crucially important in elderly patients, especially the very frail. Yet, appropriate use of nutritional therapy must consider the circumstances of an individual patient. Where severe underlying illness cannot be reversed, technical means of providing nutrition can represent extraordinary rather than ordinary means of prolonging life. The following case examines the ethical issues in respecting the apparent refusal of nutritional support by a severely debilitated geriatric patient.
The Immune Status of Healthy Centenarians
Authors: THOMPSON JOHN S. , WEKSTEIN DAVID R. , RHOADES JOSEPH L. , KIRKPATRICK CHARMAINE , BROWN STEPHEN A. , ROSZMAN THOMAS , STRAUS ROBERT , TIETZ NORBERT 
Published: April 2015

ABSTRACT:The immune status of 17 healthy individuals 100–103 years of age (centenarians) was investigated. Qualitative values for immunoglobulins IgG, IgM, IgA, and IgE were within normal ranges for subjects more than 60 years of age with the exception of elevated IgM in one individual. Cell marker studies employing a panel of 27 monoclonal antibodies delineating T and B lymphocytes, monocytes, natural killer cells, granulocytes, and functional and developmental subsets of each were performed to phenotype the peripheral blood leukocytes. Although the total lymphocyte count was normal in every subject, the numbers of T4‐positive helper–inducer T lymphocytes were profoundly depressed, as were responses to the mitogen phytohemagglutinin and interleukin‐2 production. Activated immature T lymphocytes and the number of cells bearing the phenotype of natural killer cells were increased, but natural killer cell activity was normal. Early B lymphocytes were also increased. The relative concentration of monocytes was normal. Taken together these findings indicate that the immune system in centenarians is similar to that in younger but still elderly individuals, i.e., discriminating T‐lymphoid functions are reduced in association with an apparent failure of some T, B, and natural killer cells to differentiate to functional maturity.