bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digitalis Use in a Retirement Community
Authors: Schocken Douglas D. , Robinson Bruce E. , Krug‐Fite Jan , Lyman Gary H. , Barry Patricia P. 
Published: April 2015

Complex medical problems of older patients demand that particular care be taken with their use of digitalis, Although accounting for more than 5% of the top ten prescribed drugs in the United States, studies have suggested that digitalis use might be discontinued in some patients without harm. To assess the potential impact of these observations, a survey was conducted to evaluate the extent of digitalis use in a retirement community in Florida.The community under study consisted of approximately 5600 persons, mean age 72.6 years; 97% were over age 55. The sample of 463 telephone respondents reflected the local census. Digitalis preparations had been taken by 11.4% of the sample, of whom 60% (or 6.9% of the total sample) were currently taking them. Persons taking digitalis tended to be older (P < .002) and reported worse overall health status than those not taking the drug (P < .025). Seventeen percent of those who had stopped use of digitalis claimed adverse symptoms or “complications.”Of Florida's 10 million populaton, 23% are over age 60, a proportion increasing yearly. This survey suggests that digitalis use in the elderly is widespread and a potentially important area for investigating management of cardiac problems in the elderly. J Am Geriatr Soc 34:504–506, 1986
Nurses' and Physicians' Attitudes Toward Tube‐Feeding Decisions in Long‐Term Care
Authors: Watts David T. , Cassel Christine K. , Hickam David H. 
Published: April 2015

We studied attitudes of health professionals toward life‐sustaining treatment. A patient management questionnaire sent to staff physicians and nurses in 183 Oregon nursing homes consisted of eight patient sketches which varied age, mental status, and enjoyment of life. Respondents were asked whether they would favor tube‐feeding to correct malnutrition in each case.Nurses showed higher preferences for tube‐feeding than did physicians (P = .05). For both professions, patient happiness was the strongest and most significant (P < .0001) influence upon preferences for tube‐feeding. Both professions also showed a significant (P < .001) tendency to give younger patients higher preferences for tube‐feeding. Physicians showed a significant (P < .0001) influence of patient mental status upon preferences, while patient mental status did not affect nurses' preferences. Identifiable clinical factors appear to influence attitudes of physicians and nurses toward tube‐feeding decisions.
The Safety of ECT in Geriatric Psychiatry
Authors: Burke William J. , Rubin Eugene H. , Zorumski Charles F. , Wetzel Richard D. 
Published: April 2015

Electroconvulsive therapy (ECT) is often described as an effective and safe treatment of depression in the elderly. However, we have previously reported that there may be increased morbidity in this population, particularly in the very old. This paper extends this work to a second, larger sample of 136 subjects of whom 40 are over 60 years of age. We have again found that while ECT is efficacious, complications increase with age (r = .26; P ≤ .003), occurring in 35% of the elderly as opposed to 18% of the younger group. This increased rate of complications appears to be accounted for by problems in the very old; six of eight subjects over 75 years of age had some untoward event. Common complications in the elderly included severe confusion, falls, and cardiorespiratory problems. Complications in the whole sample were related to health status (r = .22; P ≤ .008) which in turn correlated with age (r = .50; P ≤ .0001). Those taking a greater total number of medications and a greater number of cardiovascular medications had significantly more complications during ECT. There was no relationship between either complications and outcome or complications and the number or laterality of treatments.These findings confirm the effectiveness of ECT in the elderly but suggest there may be unappreciated risks of ECT in this population. At particular risk are the very old, those in poor general health, and those taking multiple medications, particularly cardiovascular agents.
The Aging Thyroid: I. A Description of Lesions and an Analysis of Their Age and Sex Distribution
Authors: Blumenthal Herman T. , Perlstein Irving B. 
Published: April 2015

Two types of follicular change in the thyroid are described. The first represents an involutional change in which colloid cysts (macrofollicles) are often found. The second represents a hyperplastic‐dysplastic (microfollicular) lesion. Two types of change in calcitonin (C) cells are also described, one of which may represent an involutional process, although this is not certain. The second is a hyperplastic (micronodular) lesion, but without evidence of dysplasia. An infiltration of lymphocytes is also commonly encountered.Only about 15% of cases after age 60 are free of the follicular and lymphoid lesions. Both the macro‐ and microfollicular lesions show a statistically significant increase with age, as do the lymphoid lesion and its derivative Hashimoto's thyroiditis. C cell micronodules also appear to increase with age, but there are too few such cases for a reliable statistical analysis.An analysis of combinations of the follicular and lymphoid lesions show a particularly frequent association of the microfollicular and lymphoid lesions. Evidence is presented suggesting that many microfollicular lesions may represent clones of mutated cells, and that the lymphocytes may be targeted to these microfollicles. Lymphocytes were rarely found in association with C cell micronodules.Within individual thyroids there is considerable variation in the proportion of each lesion when combinations are present. Thus with advancing age there is. an increasing heterogeneity of thyroid structure that may confound attempts to correlate structural and physiological changes with age. J Am Geriatr Soc 35:843–854, 1987
Brophy v New England Sinai Hospital, Inc.
Authors:   D. PeterSociety for the Right to Die Inc.
Published: April 2015

On September 11, 1986, the Supreme Judicial Court of Massachusetts, in a 4–3 decision, authorized removal of the artificial feeding tube. It held that the “substituted judgment” of an incompetent person in a persistent vegetative state to refuse artificially administered sustenance must be honored. The Court also refused to compel the hospital in this case to terminate the treatment, but permitted other hospitals to comply with the patient's wishes.We are publishing the amicus curiae brief filed by the Society for the Right to Die, Inc. in the Brophy case. Our purpose in doing this is to stimulate further discussion of the issue of the role of the patients who become incompetent, a matter of major concern to geriatric specialists. This brief has been well‐prepared. It contains a legal and ethical history of considerable merit.It has not, however, been endorsed by the American Geriatrics Society (AGS). Some of the principles the AGS has endorsed can be found on its own brief filed in the Conroy case (published in the December 1984 issue of the Journal).Physicians and medical ethicists in particular may wish to consider the caveats noted by David Thomasma, PhD. in his editorial in this issue of the Journal. We invite further discussion.
Dopamine and Serotonin Systems in Human and Rodent Brain: Effects of Age and Neurodegenerative Disease
Authors: Morgan David G. , May Patrick C. , Finch Caleb E. 
Published: April 2015

The nonpathological age‐related changes in the dopamine‐and serotonin‐containing neurotransmitter systems in human and rodent brain are reviewed. The dopamine system exhibits age‐related declines both presynaptically and postsynaptically. Presynaptically, both the levels of dopamine and the number of midbrain dopamine‐containing neurons decline by up to 50% at advanced ages in the absence of neurological disease. Postsynaptically, the density of D‐2 dopamine receptors decreases by 40%, while D‐1 dopamine receptors either increase (man) or remain stable (rodents). Additional reductions of dopamine levels and D‐2 receptors have been reported in Alzheimer's disease (AD), but these changes are relatively small, and not consistently observed.The levels of serotonin appear stable during normal aging, and presynaptic markers such as (3H)imipramine binding may actually increase. In human brain, the two major classes of serotonin receptor (S‐1 and S‐2) decrease by 30 to 50% over the lifespan. In AD, both presynaptic and postsynaptic markers of the serotonin system are reduced, including a loss of the serotonin‐containing raphe neurons. The additional loss of serotonin receptors in AD approaches 80% when compared with young normals.A hypothesis is presented to explain the typically young age at onset of schizophrenia (usually before 30 years of age) and the older age at onset of parkinsonism (rarely before 50 years of age) within the context of normal age‐related declines in the dopamine system occurring in the absence of neurological disorders. The possibility that chronic cocaine abuse might accelerate the development of parkinsonism is discussed.
Targeting the Hospitalized Elderly for Geriatric Consultation
Authors: Winograd Carol Hutner , Gerety Meghan B. , Brown Elizabeth , Kolodny Vita 
Published: April 2015

This empirical study reports the proportion of hospitalized elderly patients who were identified as frail. As a part of a randomized controlled trial, standardized criteria were developed to target the frail hospitalized elderly for geriatric consultation. Twelve‐hundred patients aged 65 years and older admitted to the medical and surgical services at the Palo Alto Veterans Administration Medical Center were screened. Because of administrative exclusions of the randomized controlled trial (eg, short stay, lived too far away), 749 (62%) were excluded from the clinical screening process. The remaining 451 patients received clinical screening. Of these patients, almost two thirds (64%) were considered “too independent” to benefit from geriatric consultation (ie, independent in activities of daily living with short term illness), while 12% were judged “too impaired” to benefit (ie, had severe dementia or terminal cancer). Only 24% of those clinically screened (9% of the entire sample) were considered appropriate for geriatric consultation. Strikingly, over 42% of those patients aged 76 or older, were judged “too independent.”These data suggest that a large majority of the hospitalized elderly may be too well to benefit from geriatric consultation, thus making targeting by age alone inefficient. A realistic estimate of the percentage of hospitalized patients appropriate for geriatric intervention lies somewhere between 18% (the combined percentage of those found appropriate and those already enrolled in geriatric programs) and 24% (the proportion of the clinically evaluated group found appropriate). Targeting of subjects may be accomplished inexpensively using the authors' explicit criteria. Such targeting may help focus the use of interdisciplinary geriatric expertise on those most in need.
Decisions to Leave Home What Will the Neighbors Say?
Authors: Loewy Erich H. 
Published: April 2015

This paper discusses two of the problems encountered when a decision not to institutionalize patients is made. When patient, physician, and family jointly decide to forego institutionalization, the family often subconsciously fears communal censure if it fails to call for help when the end is near. This may, at the last moment, prompt some families to call emergency teams and thwart the original purpose of the decision.Instances in which a previous decision not to institutionalize is justifiably interrupted, are discussed. Such an interruption does not necessarily foil the original plan if it is transient and one to provide comfort.An interactive model in which patients, health‐care workers, families, and the community share is used. It is suggested that when a decision not to institutionalize is well‐discussed, compassiontely made, and carefully implemented, it may itself tend to reshape the communal ethos. As a result, communities, rather than expecting reflex action, are more prone to examine the appropriateness of institutionalization or emergency measures in particular cases and under particular circumstances.
Effects of Iodinated Glycerol on Thyroid Function Studies in Elderly Nursing Home Residents
Authors: Drinka Paul J. , Nolten Wolfram E. 
Published: April 2015

Iodinated glycerol is used as a mucolytic expectorant in the treatment of respiratory disorders. Iodine can inhibit the biosynthesis of thyroid hormone and induce hypothyroidism, particularly in patients with a history of thyroid disease. Such effects have not been reported in individuals without known thyroid disease who are being treated with organically bound iodine in the form of iodinated glycerol. In the course of a thyroid screening program for nursing home residents, eight subjects were identified who were being treated with iodinated glycerol.Five of these were found to have thyrotropin elevations; one showed a low serum thyroxine level and a decreased free thyroxine index. None of these residents had a history of thyroid disease. Abnormalities of thyroid function improved or resolved after discontinuation of therapy. Elderly nursing home residents without known thyroid disease are at risk of thyroid suppression when given iodinated glycerol.
Geriatrics: An Updated Bibliography
Authors: Rosenthal Mark J. 
Published: April 2015

This is the author's fifth revision of a geriatrics bibliography. Approximately one‐third of the previous references have been replaced by more current or more delimited 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.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 are primarily concerned with medical ailments of the elderly; legal, ethical, and sociological topics receive more limited coverage.The references are divided into categories. The first set (I) 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.
The Senior Care Study
Authors: Owens Norma J. , Sherburne Nancy J. , Silliman Rebecca A. , Fretwell Marsha D. 
Published: April 2015

Geriatric assessment units have improved pharmacotherapy for their patients by decreasing the number of medications prescribed. The Senior Care Study, a randomized controlled trial, compared a multidisciplinary‐team approach to patient care to the standard medical practice of the institution. As a part of the trial, the effectiveness of an interdisciplinary team intervention in improving the use of medications was studied. Study goals were to decrease medications used, decrease unnecessary medications, and improve medication choices in our acutely ill inpatient population. A pharmacist interviewed all experimental patients and patient records, and presented medication concerns and recommendations at a team conference. Medications were counted on admission and on the third day, sixth week, and third month after randomization. Medications were paired with patient problems. Medication:problem pairs were judged as inappropriate choices if there were potential side effects that would affect patient function, and if better alternatives were available.The 215 control and 221 experimental patients in the study were similar in age, sex, place of origin, and number of medications on admission. Experimental patients took fewer medications than controls on the third day (5.3 versus 5.9, P < .05). Experimental patients received fewer multiple unpaired medications (11% versus 19%, P < .025) and fewer inappropriate medication choices (20% versus 37%, P < .005). The results suggest that the team intervention was effective in improving pharmacotherapy in the acute‐care setting.
Incidence and Prognosis of Acute Renal Failure in Older Patients
Authors: Pascual J. , Orofino L. , Liaño F. , Marcén R. , Naya M. T. , Orte L , Ortuño J. 
Published: April 2015

Few studies have assessed the prevalence and outcome of acute renal failure (ARF) in the elderly. Among 437 ARF cases prospectively studied during a nine‐year period in a nephrology department, 152 (35%) occurred in patients over 70 years of age (Group 1). Patients over 70 account for only 10.5% of all hospital admissions in our country, and prevalence of ARF was 3.5 times higher in these patients than in younger people. Acute tubular necrosis (ATN) was diagnosed in 40% of Group 1 and 52% of the younger patients (Group 2) (P < .05), whereas prerenal ARF was found in 47% and 32%, respectively (P < .001). Dehydration was the most frequent cause of prerenal ARF in the elderly (51%). The etiological distribution of ATN was similar in both groups, being of multifactorial origin in most cases. Oliguria was present in 49% of ATN in Group 1 and in 66% of Group 2 (P < .05). There were no significant differences in dialysis needs.Mortality was higher in the elderly in all types of ARF, although differences did not reach statistical significance. Need for dialysis, mechanical respiration, decreased level of consciousness, and hypotension were associated with poor prognosis in both groups. Total recovery from ARF in older persons was less frequent and slower than in younger patients.It may be concluded that patients over 70 years of age are at high risk for developing ARF; nevertheless, age should not be used as a discriminating factor in therapeutic decisions concerning ARF.
Reduced Supine Cardiac Volumes and Diastolic Filling Rates in Elderly Patients with Chronic Medical Conditions
Authors: Lipsitz Lewis A. , Jonsson Palmi V. , Marks Bonita L. , Parker J. Anthony , Royal Henry D. , Wei Jeanne Y. 
Published: April 2015

Very elderly individuals with multiple chronic illnesses are at high risk of orthostatic hypotension, falls, and associated morbidity and mortality. Alterations in cardiac volumes and filling characteristics may contribute in part to an increased prevalence of orthostatic hypotension and falls in these people. In this study cardiac function was evaluated with gated radionuclide ventriculography in eight healthy young subjects (19–38 years) and 25 elderly persons with stable chronic illnesses (73–96 years), 14 of whom had a history of recurrent falls. Blood pressure was measured supine during the radionuclide ventriculography, then after one minute of standing. Supine stroke volume index, end diastolic volume index, cardiac index, and peak filling rates were significantly lower in elderly subjects compared to young, and ejection fraction and end systolic volume index (measures of systolic function) were the same in young and old. Compared to the young, elderly subjects had a reduction in ventricular filling during the first third of diastole, but an augmentation in the last third, during atrial contraction.Within the group of elderly subjects, the directional change in systolic blood pressure during orthostasis was significantly correlated with basal supine systolic blood pressure (R = 0.81, P < .0001) and supine cardiac index (R = 0.66, P = .002). Thus, very old people representative of those seen in clinical practice have reduced cardiac volumes and impaired early diastolic filling, a result possibly related to elevations in systolic blood pressure. These changes in cardiac structure and function may contribute, in part, to orthostatic hypotension in advanced age.
Prevalence of Dementia in the ‘Oldest Old’ of a Dutch Community
Authors: Heeren Thea J. , Lagaay Anne M. , Hijmans Willy , Rooymans Harry G. M. 
Published: April 2015

ObjectiveTo estimate the prevalence rate of dementia in subjects 85 years of age and over.DesignA two‐phase design with the Mini‐Mental State Examination (MMSE) in the screening phase and the Geriatric Mental State Schedule (GMS) in the diagnostic phase.SettingCommunity survey including subjects in residential care.SubjectsAll (n = 1,259) inhabitants of Leiden, The Netherlands, aged 85 years and over on December 1, 1986. First phase participation rate was 71% (17% drop‐out due to death); second phase participation rate was 82%.Main Outcome MeasureDSM‐III diagnosis of dementia without further specification of the etiology of the dementia.ResultsAn overall prevalence rate of 23% (95% C.I.: 19%–26%) was found. This included 12% mild dementia, 7% moderate and 4% severe dementia. The prevalence rate was higher among women (24%) than among men (18%). It increased with age from 19% (95% C.I.: 16%–22%) in the group of 85–89 years to 32% (95% C.I.: 26%–39%) in the group of 90–94 years to 41% (95% C.I.: 25%–58%) in the 95+ group.ConclusionA fifth of the 85+ and a third of the 90+ population suffer from dementia with an indication that half of the 95+ population is affected. With the expected steep rise in the number of the oldest old, dementia will stay a major health problem in the near future.
Prevalence and Characteristics of Nursing Home‐Acquired Infections in the Aged
Authors: Magaziner Jay , Tenney James H. , DeForge Bruce , Hebel J. Richard , Muncie Herbert L. , Warren John W. 
Published: April 2015

Objectives: This study provides estimates of the prevalence of infections in all patients from a representative sample of 53 Maryland nursing homes; identifies risk factors for these infections; and describes diagnostic procedures carried out.Methods: The records of 4,259 patients in a stratified random sample of 53 Maryland nursing homes were reviewed for diagnostic procedures, medical, functional, and behavioral status. Infections were identified by signs, symptoms, and laboratory findings.Results: Study patients were characteristic of aged patients in US nursing homes. The prevalence of infections actually acquired in the nursing home (80% of all infections) was 4.4%. Multivariate analysis revealed that skin infections (35% of nursing home‐acquired infections) were associated with skin ulcers and inversely with urine incontinence. Fevers of uncertain source (13%) were associated with bladder catheters. Symptomatic urinary infections (12%) and lower respiratory infections (12%) were associated with bedfast status, and the latter with tracheostomy and lung disease. Skin ulcers, urethral catheters, and bedfast status were markers for nursing home‐acquired infection. The prevalence of infection in patients with all three markers was 32%; in patients with none, 2%.Fewer than a quarter of the four most common nursing home‐acquired infections received an evaluation which met minimal diagnostic criteria established by a panel of infectious disease specialists and geriatricians. Patients with dementia, those in large homes (>150 beds), and those in urban homes were less likely to be evaluated in a manner meeting these criteria.Conclusions: Use of three characteristics (ie skin ulcers, urethral catheters, bedfast status) to identify patients at risk for nursing home‐acquired infections may allow targeted infection surveillance and prevention programs. In addition, nursing home‐acquired infections are not evaluated uniformly across patients and facilities, suggesting the need to establish, through further study, guidelines for such evaluations.