bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Behavior Management Program to Increase Social Responses in Psychogeriatric Patients
Authors: Nigl Alfred J. , Jackson Basil 
Published: April 2015

ABSTRACTAlthough increased numbers of psychogeriatric patients have been placed in proprietary nursing homes in recent years, many facilities have not been able to accommodate the behavioral problems involved. This study summarizes the results of a behavior management program for improving the social functioning and social behaviors of 6 psychogeriatric patients in a nursing home. The use of reinforcement by tokens substantially improved social behavior over a 10‐day period; during a 10‐day withdrawal of reinforcement, the level dropped precipitantly; but during the subsequent 10‐day reinforcement period, substantial improvement in social functioning again was observed. Four of the 6 patients improved significantly, and after one year could be placed in a higher‐level unit of the nursing home. The findings suggest that behavior management programs can be used successfully to improve the social functioning of psychogeriatric patients.
A Brief Life‐Graph Technique for Work with Geriatric Patients*
Authors: Rakowski William , Hickey Tom 
Published: April 2015

ABSTRACTPatients aged 60 or older from the practice of a private physician (n = 32) and from a geriatric outpatient clinic (n = 132) responded to a questionnaire designed to assess perceived present and future health, treatment expectations, and general future projection. Of interest was the extent to which present health, as measured by a brief life‐graph technique, might be predictive of perceptions in these other areas. Results from the two samples were consistent in suggesting that present health ratings were related to anticipated future health, general future projection, and certain treatment expectations. However, expectations of when benefits from treatment would begin, and of the probable duration of treatment, were not predicted in either sample. The life‐graph technique seems useful for practitioners' interactions with older patients and for understanding these patients' extended views of their health.
The Aging Game: A New Teaching Method in Geriatric Medicine
Authors: ROBERTSON DUNCAN , BROCKLEHURST JOHN 
Published: April 2015

ABSTRACTThe aging game, a simple yet effective educational method for teaching gerontology and geriatric medicine, is described. Groups of up to 20 students participate. A series of 100 cards bearing statements about old age, some of which are true and some of which are false, are distributed among them. By exchanging cards and by gradual grouping of the students, the participants endeavor to secure a hand in which all the statements are true. The game ends with all cards being reviewed by the teacher and the participants together. The aging game has been used with physicians, medical students, nurses, therapists, social workers and mixed groups of health professionals. A modified version has been used in pre‐retirement education and public education on aging.
Effectiveness of a Service Workers' Action Team (SWAT) for the Elderly*
Authors: Stein Shayna R. , Linn Margaret W. , Weiner Audrey S. 
Published: April 2015

ABSTRACTThe Service Workers Action Team (SWAT) is a three‐year, community‐based demonstration project for the elderly, with the primary goal of improving or maintaining psychosocial and physical functioning. With baseline scores and selected demography data as covariates, 243 experimental SWAT recipients were compared (manova) with 158 controls after six months, with respect to: 1) Hopkin's Symptom Checklist, 2) Social Participation Scale, 3) Life Satisfaction Scale, 4) Self‐Esteem Scale, 5) Activities of Daily Living, and 6) four selected health‐related questions. The frequency of responses for the experimental elderly were computed for program satisfaction at the time of follow‐up. In terms of psychosocial functioning, the experimental group fared significantly better at six months than did the control group. In terms of health, both groups declined in functional status, as evidenced by their scores on Activities of Daily Living, though the experimental subjects still were significantly better than the controls. The majority of the experimental group found the program to be helpful, with suggestions made for program expansion.
The Consultant Pharmacist and Analgesic/Anti‐Inflammatory Drug Usage in a Geriatric Long‐Term Facility*
Authors: Wilcher Debra Elaine , Cooper James W. 
Published: April 2015

ABSTRACTThe contribution of a consultant pharmacist to a 33‐month study of analgesic and anti‐inflammatory drug usage by 210 elderly long‐term patients was evaluated by a fifth‐year pharmacy student. In the 143 patients who used analgesics and anti‐inflammatory agents, significant changes were noted, viz, decreased use of codeine (p = .002); increased use of acetaminophen (p = .003) and anti‐inflammatory agents (p = .020); increased regular scheduling of aspirin and acetaminophen; and an overall decrease in total drug usage from 7.2 to 4.8 drugs per patient. No effect was noted on the number of analgesics per patient, and the percentage of aspirin or propoxyphene or acetaminophen combinations used. A protocol was established for pain therapy, including a system of stop orders for propoxyphene and codeine.
Local Treatment (Electrocoagulation) for Carcinoma of the Rectum in the Elderly*
Authors: Gingold Bruce S. 
Published: April 2015

ABSTRACTFor more than 70 years, surgical excision with permanent colostomy has been the most common operation for adenocarcinoma of the rectum. Local treatment has been advocated by some surgeons, but most prefer radical surgery. Abdominoperitoneal resection often diminishes the risk of local recurrence, but mortality and morbidity rates are very high, especially in the elderly. Although local treatment for rectal cancer remains controversial, the author believes that the elderly constitute a separate category of patients because their mortality and morbidity rates are high and because they usually are unable to care for a colostomy. Local treatment seems a much more desirable form of therapy. A series of 6 elderly patients (average age, 77) were treated by local electrocoagulation followed by radiation therapy, for biopsy‐proven adenocarcinoma of the rectum; one died after nine months from liver metastases (present at the time of diagnosis), and one had to undergo a colostomy after 19 months. For the 4 remaining patients, follow‐up has ranged from three years to nine months. To date there has been no recurrence, no evidence of metastases, and no mortality or morbidity. In the author's opinion, the results of electrocoagulation‐radiation treatment of small rectal adenocarcinomas are superior to the results of radical surgery in elderly patients.
Bronchogenic Carcinoma Associated with Chronic Lymphatic Leukemia
Authors: Shankar Patil S. 
Published: April 2015

ABSTRACTThis report pertains to the development of bronchogenic carcinoma in 4 elderly patients with chronic lymphatic leukemia. The abnormal radiologic shadows in the lung (confined to the upper lobes and hili) were noted 30–60 months after recognition of the hematologic abnormality. Spread to ipsilateral or contralateral lymph nodes was common. After the appearance of lung carcinoma, the patient's course was downhill, with an average survival period of 2 months. The development of a new pulmonary lesion in any patient with chronic lymphatic leukemia should arouse the suspicion of malignancy and lead to prompt investigation.
ABSTRACTS*
Authors: IRVINE PATRICK 
Published: April 2015

Osteomyelitis beneath pressure sores. Sugarman B, Hawes S, Musher DM, et al. Arch Intern Med 143: 683, 1983 (21 references)Sometimes pressure sores fail to heal despite aggressive treatment. When that occurs, clinicians need to seek underlying contributing disorders. Sugarman et al. prospectively evaluated pressure sores that had not healed after two weeks of therapy. Osteomyelitis was associated with nine of 28 lesions, and “pressure‐related” bone changes were present in 14. The authors stress the use of radiographs and nuclear medicine scanning in the diagnosis of osteomyelitis; but they also caution that the diagnosis can be made with certainty only by histologic examination. When possible, antimicrobial therapy should be based on microbial culture of bone tissue and susceptibility testing of suspected organisms. Clearly, when pressure sores fail to heal as expected, osteomyelitis should be considered.
Lean Body Mass is a Predictor of the Daily Requirement for Thyroid Hormone in Older Men and Women
Authors: CUNNINGHAM JOHN J. , BARZEL URIEL S. 
Published: April 2015

ABSTRACT:Levothyroxine (T4) replacement need in adults with primary hypothyroidism has recently been reported to fall with age. Previous studies have demonstrated that the resting metabolic rate falls with age in euthyroid adults and that this fall is proportional to a reduction in lean body mass (LBM). Since LBM is correlated also with 24‐hour energy expenditure, this study examined the possibility that LBM might be an accurate predictor of T4 requirement. Seventy‐five hypothyroid adults receiving full replacement therapy, ranging in age from 24 to 88 years, were studied retrospectively. Lean body mass was found to be a better predictor of T4 requirement than age or weight for the entire group as well as for subgroups of men and women 51 years old and older. The age‐related reduction in LBM may be responsible for the reported decrease in the rate of fractional thyroxine degradation with age.
Dr. Marjory Warren and the Origin of British Geriatrics
Authors: Matthews Dale A. 
Published: April 2015

ABSTRACT:The life and works of the pioneer British geriatrician, Marjory Warren, are worthy of closer examination. The transformation of a Public Assistance Institution into her unit at the West Middlesex Hospital in 1935 represented the first organized geriatric medicine service in the United Kingdom. She promoted multidisciplinary rehabilitation and holistic appreciation of elderly patients, and emphasized the economic, social, and moral problems associated with their care. She was particularly concerned with the rehabilitation of hemiplegics and amputees, preventive medicine, patient responsibility, and home nursing. She underscored the need for geriatrics to maintain a close link with general medicine and its training programs. Her innovative methods, influential writings, committee work, and personal force were instrumental in the evolution of modern British geriatrics and rehabilitation medicine.
Aggressive Chemotherapy for Diffuse Histiocytic Lymphoma in the Elderly: Increased Complications with Advancing Age
Authors: ARMITAGE JAMES O. , POTTER JANE F. 
Published: April 2015

ABSTRACT:Twenty patients ≥70 years of age were included in a study of the treatment of diffuse histiocytic lymphoma utilizing cyclophosphamide, adriamycin, vincristine, and prednisone. These patients ranged in age from 70 to 94 years (median 75 years). There were also 55 younger patients (age range 33 to 69 years) in the treatment trial. There were no dose adjustments for age. The complete remission rate in the elderly patients (45 per cent) was not different from that in the younger patients (53 per cent). The overall survival in the elderly patients (median 13 months) was somewhat shorter than that in the younger patients (medians 22 months for patients 56–69 years of age and 41 months for patients 33–55 years of age), but not significantly different. Death during the first two treatment cycles from causes other than lymphoma occurred in 25 per cent of the patients ≥70 years of age versus 2 per cent of younger patients (P < 0.01). In addition, three other patients aged 79, 65, and 59 years died in the fourth or fifth cycles of treatment from causes other than lymphoma. Thus, 30 per cent of patients ≥70 years of age died during therapy from causes other than lymphoma, versus 5 per cent of younger patients (P < 0.01). Whether this altered ability to tolerate therapy in the older patients reflected decreased marrow function, altered drug metabolism, other effects of aging, or a combination of these factors is not clear. It might be appropriate to alter drug doses when treating elderly patients, and particular attention to supportive measures seems appropriate.
Low Triiodothyronine and Raised Reverse Triiodothyronine Levels in Patients Over Fifty Years of Age Who Have Type II Diabetes Mellitus: Influence of Metabolic Control, Not Age
Authors: KABADI UDAYA M. , PREMACHANDRA BHARTUR N. 
Published: April 2015

ABSTRACT:Several studies have demonstrated that the uncontrolled diabetic state in both type I as well as type II diabetes mellitus is characterized by altered thyroid hormone metabolism, which results in the lowering of serum triiodothyronine (T3) levels and a reciprocal elevation of T3 (rT3) levels. Because the majority of type II diabetics are over 50 years of age and because numerous previous reports have implicated aging as a cause of low T3 and high rT3 levels, we studied 220 type II diabetics from 40–85 years of age to assess the influence of aging and metabolic control on thyroid hormone levels. Serum thyroxine (T4) free T4, T3 resin uptake, and thyroid‐stimulating hormone (TSH) measurements in diabetic patients were not significantly altered compared with 37 young normal control subjects, irrespective of age or the grade of metabolic control. Serum T3 levels declined and rT3 levels rose in the diabetic patients with worsening of the metabolic control. However, with comparable metabolic control, the levels were not significantly different from the younger patients. Therefore, low T3 and high rT3 levels observed in patients of any age who have type II diabetes mellitus may be exclusively caused by deranged metabolic control of their disease.
The Headache of Temporal Arteritis
Authors: Solomon Seymour , Cappa Karen Guglielmo 
Published: April 2015

Patients with temporal arteritis may be misdiagnosed because the headache does not affect the temples. The records of 24 patients with biopsy proven temporal arteritis were reviewed to determine the site and other qualities of headache. Past reports of the sites of headache in this disease were also reviewed.The temporal area was the sole site of headache in only six of 24 patients; the temple was included in pain that affected the frontal, vertex, and occipital areas in another seven patients. Two patients had generalized headaches. The headache did not involve the temple in seven patients and two patients did not experience headaches.Temporal arteritis should be considered in every elderly individual who begins to complain of headache, no matter what the site, quality, severity, or time pattern.
Geriatrics An Updated Bibliography
Authors: Rosenthal Mark J. 
Published: April 2015

This is the author's fourth revision of a geriatrics bibliography. Approximately one‐third of the previous references have been replaced by more current or more detailed articles. Because the literature pertinent to geriatrics has continued to grow ever more rapidly, it has been necessary to omit many informative articles from the bibliography. Preference is given to recent publications; almost all of the references date from the past four years. Some articles were selected to highlight current controversies or changes in viewpoint. An occasional unrefereed article is cited to amplify geriatric aspects of common diseases.Most of the references deal specifically with an elderly patient population, though few use a multidisciplinary approach. Studies of the elderly are confounded by concomitants of aging frequent but not universal in our society: inactivity, obesity, malnutrition, and psychosocial trauma. The articles cited concern primarily medical ailments of the elderly but legal, ethical, and sociologic topics are also covered.The references are divided into categories. The first (I) set deals with some possible causes of aging, the second (II) with physiologic decline accompanying aging, the third (III) with the atypical and nonspecific characteristics of illness among geriatric patients, the fourth (IV) with the elderly and society, and the fifth (V) with care options. The remainder of the references are cited by pertinent medical specialty. Within each category, references are divided by disease process. Articles are further subgrouped by aspects of those diseases such as evaluation or therapy.
State Initiatives in Geriatric Education
Authors: Weiler Philip G. , Orgren Rosemary A. , Smukler Charles 
Published: April 2015

Although the basic requisites of curricula in geriatrics and gerontology have been well developed, and the need for such programs is well established, the support for development of geriatric academic programs has not been commensurate with the need. Barriers to the development of such programs include ageism, financial disincentives., scientific underdevelopment, a dearth of trained faculty, the lack of institutional support, and the declining federal role.One attempt to overcome these barriers and address the tremendous need is the development of state initiatives. In the last decade, several state legislatures have begun to provide support for geriatric education. The purpose of this paper is to analyze the initiatives of state funded university programs in geriatrics and gerontology, with particular emphasis on the California experience.A survey involving 50 states was conducted using two rounds of structured telephone interviews. The survey results found that 44 states did not have any legislatively initiated support for geriatric programs in higher education. Six states did have such programs, they included: Ohio, North Carolina, Kansas, New York, Kentucky, and California. The components of the California program are discussed in further detail. The conclusions were that although these states provide paradigms for the rest of the nation, much more still needs to be done. Several issues raised by the state programs are discussed.
Assessing Health Differences in an Elderly Population: A Five‐year Follow‐up
Authors: Minkler Meredith , Langhauser Carol 
Published: April 2015

A sample of several hundred elderly residents of Alameda County was recontacted after 5 years to determine the effects over time of different social support and demographic variables on health status.The follow‐up investigation demonstrated a strong relationship between respondents' social support resources in 1980 and their subsequent self‐rated health. Indeed, social contacts in 1980, together with age and financial need, enabled us to correctly “predict” respondents' subsequent health status in close to two‐thirds of the cases. As anticipated, however, the variable most strongly associated with self‐rated health in the earlier cross‐sectional study — illness of a mate during the preceding 6 months — disappeared as a predictor variable in the longitudinal study. This finding is in keeping with the literature on bereavement and other stressful life events which demonstrates that the health impact of such stressors is in most cases time‐limited.The study findings support earlier research demonstrating the important role of social support for health maintenance and disease prevention in the elderly. They further underscore the need for intervention strategies designed to strengthen the network resources of those elders at high risk for social isolation.
Psychotropic Drug Practice In Nursing Homes
Authors: Buck Jeffrey A. 
Published: April 2015

This study examined the administration of psychotropic medication to Medicaid recipients who resided continuously in an Illinois nursing home during 1984. Of these residents, 20,037 (60%) received at least one such medication during the year, with administration most likely for those from the ages of 45 to 74 years. Haloperidol, thioridazine, and flurazepam were the most frequently prescribed drugs of those examined.The study also investigated the relationship of demographic and institutional variables to the probability of drug administration and the amount administered. These variables were most strongly related to the probability of antipsychotic, antiparkinson, and antimanic (lithium) administration. The association of these variables with the amount of drug administered was strongest for antimanic and antipsychotic medications, particularly the latter. In all analyses, the addition of institutional variables increased goodness of fit minimally over that produced by demographic variables alone. This finding supports the conclusion that the prescription of psychotropic medication is more influenced by individual patient characteristics than by the nature of the institutional setting in which the patient resides.
Troublesome and Disruptive Behaviors in Dementia
Authors: Swearer Joan M. , Drachman David A. , O'Donnell Brian F. , Mitchell Ann L. 
Published: April 2015

Patients with dementia often manifest troublesome and disruptive behaviors in addition to intellectual impairments. This study evaluated behavioral disturbances in 126 demented patients examined sequentially, using questionnaires administered to primary caregivers to quantify the types and severity of behavioral disturbances. Eighty‐three percent of the patients exhibited one or more of the targeted behaviors. The most common troublesome and disruptive behaviors clustered into three categories: aggressive, ideational, and vegetative. The prevalence and severity of the behaviors increased with global severity of dementia, but did not differ in either frequency or type when patients with three diagnoses were compared: Alzheimer's disease (AD), multi‐infarct dementia (MID), and mixed AD and MID (MIX). The occurrence and severity of the target behaviors correlated modestly with the severity of dementia. Impairments of mental status correlated weakly with only a single troublesome and disruptive behavior—assaultiveness.These results suggest that troublesome and disruptive behaviors are a very frequent component of dementing disorders, are related to disease severity, and parallel (but are probably not determined by) intellectual deficit.
The Aging Driver Medicine, Policy, and Ethics
Authors: Reuben David B. , Silliman Rebecca A. , Traines Mark 
Published: April 2015

With the graying of America, more older persons will be driving. Physiological changes associated with normal aging and diseases that commonly affect the elderly may compromise their ability to drive safely. Although all states have regulations governing driving licensure, few offer specific guidelines regarding older persons. Accordingly, much of the responsibility for determining medical competence to drive and counseling patients in this regard is left to physicians.Normal physiologic changes may limit sensory information, particularly visual, available to the driver. In addition, chronic diseases in older persons including coronary artery disease, dementia and other neurologic disorders, diabetes mellitus, and drug use may increase the risk of crashes while driving. Once the question of competence to operate an automobile has been raised, ethical dilemmas must be addressed regarding the benefit of continued driving for the individual versus the risk to that person and society as a whole.In this article, we review the medical grounds for determining competence to drive, discuss ethical implications, and report current legal regulations for physicians and aging drivers. Future directions and possible areas for further research are outlined.