bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperparathyroidism in the Elderly*
Authors: Fiatarone Maria A. , Steel Knight , Egdahl Richard H. 
Published: April 2015

ABSTRACTA survey was made of the records of 40 patients aged 60 or older who were operated on at Boston University Medical Center over a 10‐year period for suspected primary hyperparathyroidism. Mild or “asymptomatic” presentation was virtually the rule, with many patients having become accustomed to some degree of decreased well‐being. The findings were compared with those in other reviews of the clinical manifestations of hyperparathyroidism, in both general and elderly populations of patients. Issues of screening for mild or asymptomatic disease, especially among the elderly, are discussed.
The Adaptive Function of the Menopause: A Devil's Advocate Position
Authors: Alington‐Mackinnon Diane , Troll Lillian E. 
Published: April 2015

ABSTRACTThe menopause may be adaptive, in that it minimizes exposure to endogenous estrogen. However, ageist and sexist assumptions have distorted society's perceptions so that the menopause has come to be viewed as a “deficiency disease,” best treated through the routine prescription of estrogen replacement therapy. Recent evidence suggests that menopausal discomfort has been exaggerated, and that most reported symptoms are not directly attributable to declining estrogen levels but to other biologic and social variables. A change in perspective might have the beneficial consequence of providing women with more effective, and probably safer, forms of therapeutic intervention.
Urinary‐Tract Infections: Etiology, Microbiology, Pathophysiology, Diagnosis and Management
Authors: Seneca Harry 
Published: April 2015

ABSTRACTThe increased incidence of urinary‐tract infections (UTI) may be due to prolonged human longevity, increased drug resistance of pathogens, poor resistance of the urothelium, and the existence of bacterial L forms. About 95 percent of recurrent infections are re‐infections. The most common uropathogen is Escherichia coli, and the most virulent is Pseudomonas. UTI may be manifested as: a) asymptomatic bacteriuria, b) acute uncomplicated infection, c) acute complicated infection, or d) recurrent infection. Recurrent infections usually are refractory to treatment, and are caused by a pathogen different from the original one. Upper‐tract (kidney) infections are difficult to cure, whereas bladder infections respond favorably. Prostatitis also responds poorly because effective drug levels are difficult to attain in prostatic tissue. Results of the antibody‐coated bacteria test (ACB) and the bladder‐washout test are helpful in locating the site of infection. Detailed outlines concerning diagnosis, management, chemotherapy and prophylaxis provide data on various types of infection and the effects of specific antimicrobial agents and other drugs at different sites in the urinary tract. A current plan for short‐course prophylaxis does not fulfill expectations.
The Future for the Elderly*
Authors: ARIE TOM 
Published: April 2015

ABSTRACTThis tentative look into the future for the elderly covers such aspects as population statistics, the unique role of Medicine in contributing to the quality of life, the problems engendered by dementia patients and the “staff factor” involved in their care. The development of personality in the aged is stressed. Being attractive to others in the time of disability and old age is a valuable asset. There is great need for education of the public about the elderly.
Ethical Considerations in Critical and Terminal Illness in the Elderly*
Authors: LEVENSON STEVEN A. , LIST NOEL D. , ZAW‐WIN BO 
Published: April 2015

ABSTRACTIn a Baltimore geriatric center and hospital, a program was developed to individualize the treatment of critically and terminally ill patients. Part of this program was an effort to involve the patients themselves in the discussion of their personal wishes, and the provision of a set of guidelines for staff members to help them individualize the care of the patients. Some of the practical problems involved in the application of these ethical ideals are discussed. Merely implementing the protocol helped staff members to become more aware of these complex questions. Physicians should deal forthrightly with “right‐to‐die” and associated issues. The decision‐making should remain in medical hands, and out of the courts and legislatures.
Treatment Results at a Multi‐Specialty Clinic for the Impaired Elderly and Their Families*
Authors: REIFLER BURTON V. , LARSON ERIC , COX GARY , FEATHERSTONE HARVEY 
Published: April 2015

ABSTRACTGeriatric and Family Services at the University of Washington provides a comprehensive evaluation and treatment program for the impaired elderly, and also offers support, counseling and practical advice for their families. Although most of the 76 patients in this first‐year study had cognitive impairment, about one‐fourth of them showed unequivocal motor, cognitive and/or affective improvement with treatment for previously undetected illnesses. The rating of “unequivocal improvement” required objective data, as well as corroboration by the patient and family. These therapeutic gains and the increased public interest led to expansion of the program.
Subcutaneous Infusions in the Elderly
Authors: SCHEN RAFAEL J. , SINGER‐EDELSTEIN MAIA 
Published: April 2015

ABSTRACT1,850 subcutaneous infusions were given to 270 elderly patients (average age, 82) in a hospital geriatric department and in two nursing homes. The side effects were few and not serious. In 4 patients there was anasarca of the gluteal and genital regions but this disappeared promptly after giving diuretics. In a case of disseminated intravascular coagulation, ecchymoses appeared in the thighs. Sepsis, shock, tissue necrosis and other dangerous side effects mentioned in textbooks were not observed. The method is acceptable to most elderly patients and causes less discomfort than does the intravenous method. Since the infusion lasts only 2 to 4 hours, it enables the patient to be out of bed most of the day. Infusion by the subcutaneous route can be safely administered by trained nurses in institutions without a resident medical staff. It seems to be the method of choice for giving fluid supplements to elderly patients in nonemergency situations.
Plasma Aldosterone Response to Angiotensin II in Sodium‐Restricted Elderly Subjects with Essential Hypertension
Authors: MORIMOTO SHINPEI , UCHIDA KENZO , MIYAMOTO MASAJI , KIGOSHI TOSHIKAZU , MORISE TOSHIO , TAKIMOTO HIROAKI , TAKEDA RYOYU 
Published: April 2015

ABSTRACTThe plasma aldosterone (PA) response to sodium restriction (25 mEq daily for 4 days) and to graded infusions of angiotensin II (AH, 2, 4 and 8 ng/kg/min each for 30 min) during a low‐sodium intake were studied in 15 elderly subjects with mild essential hypertension versus 10 elderly normotensive subjects. The PA reponse to sodium restriction relative to changes in plasma renin activity (PRA) was estimated by the ratio of PA increment to PRA increment after sodium restriction (ΔPA/ΔPRA). The PA response to graded AII infusions was determined by the increment of PA above the basal level after each dose of AII. In 10 of the 15 elderly hypertensive subjects whose PRAs responded normally to sodium restriction, the ΔPA/ΔPRA ratios and PA increments during the graded AII infusions were similar to those in the elderly normotensive subjects. However, in the remaining 5 elderly hypertensive subjects whose PRAs responded subnormally to sodium restriction, the ΔPA/ΔPRA ratios were high and the PA increments greater during the graded AII infusions. The increments of mean blood pressure during the graded AII infusions were similar in the foregoing 10 of 15 hypertensive subjects, and significantly greater during the AH infusion rates of 4 and 8 ng/kg/min in the remaining 5 hypertensive subjects when compared with those in the normotensive subjects. Apparently some elderly subjects with essential hypertension, whose PRAs respond subnormally to sodium restriction, have an abnormally enhanced adrenal responsiveness to AII under the condition of low‐sodium intake.
Detrimental Incidents, Including Falls, in an Elderly Institutional Population
Authors: BERRY GLENICE , FISHER RORY H. , LANG SANDRA 
Published: April 2015

ABSTRACTIn a Canadian geriatric hospital, the report forms on the 2,177 untoward incidents occurring during the 1976–78 period were analyzed. The incident and fall rates were respectively 51.1 and 42.7/10,000 patient‐days. Falls were the most common incident (82.9 percent). Of the patients who fell, 40.4 percent were over the age of 80 and another 27.5 percent were in the 71–80 age group. The majority fell more than once. Most falls occurred during the waking activity hours, and many were associated with the changing of position or posture, notably in the course of using a wheelchair. Alcohol was a factor in 4.2 percent of the incidents. Nevertheless, the rates for mortality and serious morbidity were low. Patients' rooms and toilets should receive extra surveillance, and the caretaker staff should exercise special care in the use of wheelchairs and assistive devices. More attention should be given to recording cases of postural hypotension, cardiac arrhythmias or drug side effects.
Synchronous Dual Primary Lung Carcinomas
Authors: SHANKAR PATIL S. 
Published: April 2015

ABSTRACTSynchronous dual primary lung carcinomas were found in 8 of 482 patients with lung cancer, an incidence of 1.6 percent. Of the 8 cases, 7 were unilateral and one bilateral. Three showed dissimilar histologic patterns occurring in combinations of squamous‐cell carcinoma and adenocarcinoma. In 5 cases, two separate tumors were noted with identical histologic patterns in combinations of squamous‐cell, giant‐cell, large‐cell, adeno‐. and undifferentiated carcinoma. The patients were heavy smokers and this possibly may have been a factor in the development of carcinoma at more than one site.
The “Elephant Man” of Cambridge. A Case Report of Neurofibromatosis
Authors: RAI G. S. , CONI N. K. 
Published: April 2015

ABSTRACT:The case is presented of a 65‐year‐old man with neurofibromatosis manifesting facial and skeletal features resembling those of the “elephant man” described by Sir Frederick Treves. Autopsy revealed not only a pheochromocytoma (a common accompaniment of neurofibromatosis), but an enlarged infarcted spleen and a subphrenic abscess. These findings have not been described previously in a patient with neurofibromatosis.
Sex and the Aging Process*
Authors: Masters William H. , Johnson Virginia E. 
Published: April 2015

ABSTRACTThe elderly tend to be victims of “age‐ism,” a false concept that discourages consideration of sexual activity in old age. Geriatric sexual activity is a vital issue, however, and proper management of attendant problems has great bearing upon mental and physical health. The inevitable processes of aging necessitate adjustments, but these can be accomplished satisfactorily by enlightened understanding between sexual partners.
Assessment of Elderly Patients at Home: A Report of Fifty Cases*
Authors: Currie C. T. , Moore James T. , Friedman S. William , Warshaw Gregg A. 
Published: April 2015

ABSTRACTFifty elderly patients were assessed at home by physicians trained in geriatric medicine. The patients had been referred by physicians, relatives, or community services. Reasons for referral usually were nonspecific and involved either a request for overall assessment or recommendations about placement. Assessment included medical, psychiatric, social and functional components. Mental impairment and impairment in the activities of daily living were common. New medical or psychiatric diagnoses were contributed in 36 instances. The most frequent previously unnoticed pathologic disorders were mental impairment and depression. Assessment resulted in specialists' advice concerning such matters as the medication program, placement, increased support, further diagnostic work and, in two instances, prompt admission to a hospital.
Hemodynamics of the Carotid‐Artery Circulation in the Elderly “Dizzy” Patient
Authors: Weinberger Jesse , Biscarra Victoria , Weisberg Michael K. 
Published: April 2015

ABSTRACTOne hundred and one consecutive patients complaining of dizziness were assessed by noninvasive carotid‐artery testing, including oculoplethysmography, supraorbital directional Doppler and direct carotid flow Doppler. Hemodynamically significant carotid disease was found in 8 of 34 patients with the nonspecific complaint of “lightheadedness,” in 4 of 21 patients with syncope, in 3 of 12 patients with vertebrobasilar insufficiency, and in 7 of 27 patients with associated focal cerebral signs or symptoms. None of 7 patients with vertigo alone were affected. In summary, 21 of the 101 patients with dizziness had hemodynamically significant obstruction to flow in the carotid‐artery circulation. These findings suggest that in a fairly large proportion of patients complaining of dizziness, the symptoms may be the result of decreased cerebral perfusion due to carotid‐artery occlusive disease. In these patients, noninvasive carotid‐artery testing appears to be useful in identifying those with significant obstruction to blood flow in the carotid‐artery circulation.
Overdiagnosis of Dementia
Authors: Garcia Carlos A. , Reding Michael J. , Blass John P. 
Published: April 2015

ABSTRACTAccurate diagnosis of the dementias is difficult. Of 100 patients referred to a specialized outpatient dementia clinic, at least 26 were not demented. Fifteen had depression, 7 had miscellaneous other neuropsychiatric disorders, and 4 were normal. Specialized dementia clinics help to improve diagnostic accuracy. Three diagnostic errors appeared particularly important: failure to recognize depression, especially in the presence of mild organic brain disease; equating brain atrophy on the computerized tomogram with clinical dementia; and failure to distinguish focal from global intellectual impairment. For confirmation, the diagnosis of dementia requires follow‐up evaluation, brain biopsy, or autopsy.
Importance of Resident Placement within a Skilled Nursing Facility
Authors: Wiltzius Francille , Gambert Steven R. , Duthie Edmund H. 
Published: April 2015

ABSTRACTSpecific attention to the placement of nursing‐home residents within a skilled nursing facility is often neglected. A study was made of the effects on mental and emotional status, sensory perception, and capability for the needs of daily living when a mentally incompetent resident was placed as a room‐mate with a competent resident. By means of a rating scale designed for this study, the mentally competent subjects were assessed before and after this type of placement. A significant change occurred in mental and emotional status (p < 0.001) but there was no change in either sensory perception or the ability to perform the tasks of daily living. The data suggest that the placement of a mentally incompetent resident with one who is mentally competent may result in an alteration of mental and emotional status for the latter. It is important that placement conditions be considered in the initial processing of all nursing‐home residents.
Quinidine Therapy and Digitalis Toxicity
Authors: Manyari Dante E. , Patterson Christopher , Johnson David E. , Melendez Libardo J. 
Published: April 2015

ABSTRACTIn a 90‐year‐old man undergoing prolonged digitalis therapy, digitalis toxicity was precipitated by the administration of quinidine. The electrocardiogram revealed supraventricular bidirectional tachycardia, a rare but characteristic arrhythmia associated with digitalis toxicity. Upon withdrawal of digoxin, the clinical and ECG signs disappeared. A diagnosis of digitalis toxicity rather than quinidine intolerance led to appropriate treatment.
Intermittent Claudication: Importance of Etiologic Differentiation as an Aid in Selecting Therapy
Authors: Massey E. Wayne , Scherokman Barbara 
Published: April 2015

ABSTRACTIntermittent claudication in the lower extremities is often manifested in either of two treatable forms, i.e., neurogenic or vascular. A thorough history and examination are necessary to distinguish between these two types. The main differential point is whether pain (vascular type) or a neurologic deficit (neurogenic type) develops as the patient exercises.
Left Ventricular Function in Hospitalized Geriatric Patients
Authors: LUCHI ROBERT J. , SNOW ELEANOR , LUCHI JEAN MARIE , NELSON CYNTHIA L , PIRCHER FELIX J. 
Published: April 2015

ABSTRACT:Left ventricular ejection fraction was measured by gated wall motion in 62 patients, 75 years old or older, admitted to a Geriatric Acute Assessment Ward. From this group, 42 patients not taking digitalis or other cardioactive medication were selected for analysis. Thirty of them had clinically identifiable heart disease, whereas 12 did not. Resting left ventricular ejection fractions in the 12 patients without clinically identifiable heart disease averaged 0.60 ± 0.09. None had an ejection fraction below 0.50. In the 30 patients with clinically identifiable heart disease, mean ejection fraction was 0.49 ± 0.15 (range 0.17‐0.84), P < 0.01. In the patients with heart disease, reduction of ejection fraction was correlated with either cardiac enlargement or congestive heart failure. Neither age nor electrocardiographic abnormalities added to the strength of this correlation. Fifty‐eight per cent of patients with congestive heart failure had ejection fractions 3=0.40, suggesting that congestive heart failure in this age group is frequently related to diastolic left ventricular dysfunction unaccompanied by major systolic dysfunction. The prognosis of patients with congestive heart failure and ejection fractions above 0.35 was significantly better than of patients with congestive heart failure and ejection fractions below 0.35. From these data and other data available in the literature, it is proposed that the lower limit for ejection fraction be 0.50 for patients 75 years old or older. Congestive heart failure in patients 75 years old or older appears to be associated with relatively higher ejection fractions or even with ejection fractions within the normal range. In these patients, digitalis may not be indicated, and short term‐prognosis is relatively favorable.
The Role of Electroconvulsive Therapy in the Treatment of Depression in the Elderly
Authors: WEINER RICHARD D. 
Published: April 2015

ABSTRACT:Electroconvulsive therapy (ECT) is the most effective form of treatment of major depressive episodes available today. In particular, ECT appears to be at least as effective in the elderly as in younger depressed patients. Although a number of special factors must be considered and modifications in technique occasionally be made, ECT is generally also a relatively safe therapeutic tool in this age group.
Treating Geriatric Depression: A 26‐week Interim Analysis
Authors: JARVIK LISSY F. , MINTZ JIM , STEUER JOANNE , GERNER ROBERT 
Published: April 2015

ABSTRACT:Two concurrent studies of geriatric outpatients who received diagnoses of depression were conducted. In the first, patients were treated with one of two tricyclic antidepressants or with a placebo. In the second, patients were assigned to groups receiving either psychodynamic group therapy or cognitive‐behavioral group therapy. Patients in the placebo group showed the least improvement; most patients receiving group psychotherapy showed some improvement, but only 12% had full remissions; by contrast, 45% of patients receiving imipramine or doxepin had full remissions, while 36% of them experienced little or no benefit. An early response to tricyclic antidepressant drugs was a reliable predictor of continued improvement.
Earlobe Creases in a Cohort of Elderly Veterans
Authors: GRAL THOMAS , THORNBURG MONA 
Published: April 2015

Two‐hundred thirty‐four residents (220 male, 14 female) of a Veterans Administration Nursing Home and a Hospital Based Home Care program, 24–99 years old (mean 66), were examined for the presence (or absence) of earlobe creases and their correlation with cardiovascular disease. Unilateral or bilateral earlobe creases were found in 119 patients (55 unilateral, 64 bilateral), or 50.85 per cent. One hundred forty‐two patients had one or more forms of cardiovascular disease: 20 had coronary artery disease, 45 had cerebrovascular disease, 12 had peripheral vascular disease, 48 had atherosclerotic heart disease and/or hypertension, and 17 had “other” cardiovascular disease, mostly congestive heart failure. Seventy‐three of them (51.4 per cent) had earlobe creases. The rest—92 patients—had no clinically apparent cardiovascular disease, and the incidence of earlobe creases in this group was 50 per cent.Cross‐tabulation (chi square) and multivariate (stepwise logistic) regression analyses relating the presence (or absence) of earlobe creases to diagnosis, age, sex, smoking, body weight, height, blood pressure, serum cholesterol, glucose, urea nitrogen, creatinine, uric acid, calcium, phosphorus, albumin, and hemoglobin revealed no significant correlation between the presence of earlobe creases and any of the above parameters. Earlobe creases were present in about half the study group regardless of diagnosis, and only about half the patients with cardiovascular and coronary artery disease had earlobe creases.It was concluded that in our patient population earlobe creases were not specifically associated with cardiovascular disease, as they were associated about equally with both cardiovascular and noncardiovascular disease. Their significance in the diagnosis of coronary artery disease may be greater in a younger age group, because in the elderly these creases may occur as part of skin aging, and they may also accompany noncardiovascular diseases.
The Outcome of Hospitalization for Acute Illness in the Elderly
Authors: LAMONT CAMPBELL T. , SAMPSON SUSAN , MATTHIAS RUTH , KANE ROBERT 
Published: April 2015

The use of acute‐care hospitals by the elderly is rising rapidly, particularly in the age group 75 and older. Any changes that will reduce the length of stay could result in considerable savings in health care costs. It is imperative to look at present policies and explore possible changes that could reduce costs by reducing the total hospital days. A study was conducted in a 290‐bed county‐funded community hospital in California that serves the majority of disadvantaged and poor elderly residing in an area with a population of approximately 300,000 persons. The objective was to determine what demographic, medical, and sociologic characteristics of elderly patients recorded at admission would be of value in predicting those most likely to change their functional status.It was found that the most important predictors of deterioration of function are (1) older age, especially 85 +, and (2) abnormal mental status. Patients admitted from nursing homes had a longer than average length of stay, and those who survived (80 per cent) returned to a nursing home.It was concluded that routine assessment of elderly patients admitted for acute illness or injury could facilitate discharge planning by an early prediction of the level of care that will be required after discharge. This assessment should include preadmission mental and functional status; identification of causes for, and correction of, acute confusional states; and an assessment of the impact of the present illness or injury on future level of function following rehabilitation. This could result in a reduced length of average hospital stay.