bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital Use by the Extremely Elderly (Nonagenarians): A Two‐year Study
Authors: PATTERSON CHRISTOPHER , CRESCENZI CAROLINE , STEEL KNIGHT 
Published: April 2015

ABSTRACT:Eighty‐seven community‐dwelling nonagenarians provided with extensive medical and social services as needed were followed for two years. Fifty‐one subjects were admitted to an acute care hospital at least once. Total durations of hospitalization for those who required it averaged 44 days per individual over the two years. This represents about 13 hospital days per year per nonagenarian. Since it is likely that few, if any, hospitalizations would have been preventable by additional services, these data suggest that at a minimum one hospital bed would be continuously occupied for every 28 persons of this age and of this degree of infirmity. In these times of fiscal restraint it is especially important that the government and third‐party payers determine the level of funding for expensive services such as acute hospitalization by assessing the needs of those who use them.
Geriatric Consultation: A Functional Approach
Authors: LICHTENSTEIN HOWARD , WINOGRAD CAROL HUTNER 
Published: April 2015

ABSTRACT:Eighty‐one geriatric consultations conducted on behalf of 71 patients (mean patient age 78 years, range 59–99; M34, F37) at San Francisco General Hospital were analyzed. Seventy‐nine per cent of requests were for medical or psychiatric evaluation; 19 per cent social; and 3 per cent rehabilitation. The authors made 50 new diagnoses, many of which identified conditions that adversely affected patients' functional levels, including cardiovascular disorders (8), medication effects (8), malnutrition (7), misdiagnosis of dementia (7), and gait disorders (4). Recommendations focused on treating those conditions whose alleviation could improve self‐care ability: medication adjustment (62 per cent), management of dementia, delirium, or depression (59 per cent), rehabilitation (32 per cent), and treatment of malnutrition (30 per cent). Geriatric consultations resulted in rerouting 18 patients (51 per cent) from nursing homes to lower levels of care. Fourteen of these eventually returned home. By focusing on reversible conditions that affect patients' functional levels, geriatric consultation can improve the management of elderly patients and prevent unnecessary nursing home placement.
Categories of Family‐mediated Abuse and Neglect of Elderly Persons
Authors: O'MALLEY TERRENCE A. , O'MALLEY HELEN C. , EVERITT DANIEL E. , SARSON DEBORAH 
Published: April 2015

ABSTRACT:The records of 22 cases of family‐mediated abuse and neglect of elderly persons were retrospectively reviewed by the physician and nurse responsible for their care using a modification of the OARS Multidimensional Functional Assessment form. Cases were divided into three categories: Category I cases (n = 4) involved extremely impaired elders who received extensive care from the individuals responsible for the abuse or neglect. Category II cases (n = 9) involved impaired elders who received inadequate or intermittent care. Category III cases (n = 9) involved independent elders whose only care needs resulted from threats or violence from relatives. Among the statistically significant differences found between these categories were the age of the abuser, the manifestations of abuse or neglect, the interventions offered, the durations of abuse, and the outcomes of the cases. The results suggest that these three categories represent different subgroups of abused and neglected elderly persons, all with different implications for identification, intervention, and outcome.
Association of Hypertension with Increased Atrophy of Brain Matter in the Elderly
Authors: HATAZAWA JUN , YAMAGUCHI TATSUO , ITO MASATOSHI , YAMAURA HARUTSUGU , MATSUZAWA TAIJU 
Published: April 2015

ABSTRACT:Atrophy of brain matter in hypertensive and normotensive subjects was studied by quantitative measurements of brain volume and cranial cavity volume using x‐ray computed tomography. The 123 normotensive subjects ranged in age from 20 to 79 years and were divided into six ten‐year age groups. The 67 hypertensive subjects ranged in age from 40 to 83 years and were divided into four age groups. Values of the brain volume index (BVI), the ratio of brain matter volume to cranial cavity volume, for hypertensives and normotensives in the same age groups were compared. Mean BVI values were significantly lower in hypertensives in the fifth (P < 0.01), sixth (P < 0.01), seventh (P < 0.05) and eighth and ninth decades of life (P < 0.001). Systemic hypertension, which may induce various diseases in the elderly, had a striking effect on atrophic changes of brain matter in elderly subjects.
Physicians' Knowledge of Prescribing for the Elderly
Authors: Ferry Margaret E. , Lamy Peter P. , Becker Lome A. 
Published: April 2015

The 143 physicians who returned to Temple University Medical School a questionnaire on knowledge of prescribing for the elderly constituted 25% of a stratified random sample of general practitioners (GPs), family practitioners (FPs), and practitioners in internal medicine (IMs) reimbursed under Medicare in Pennsylvania in 1979. The mean score on the 23‐item drug questionnaire was significantly lower (P < .05) than the score deemed adequate by a panel of six experts in the field.Five variables, identified by survey questions, were positively associated with physicians' test scores: importance of professional meetings, perception of need for continuing medical education, board eligiblity/certification, group practice, and a practice in which the elderly constitute 25 to 49% of all patients. Two variables were negatively associated: number of years since date of licensure and the importance of drug advertisements.Respondents and nonrespondents were compared on nine variables for which American Medical Association (AMA), American Osteopathic Association (AOA), or Blue Shield data were available. Pennsylvania graduates were significantly overrepresented in the respondent group. The only other significant difference found was in field of practice, where findings differed by source of information. There was no significant difference in mean scores of early and late respondents.The research findings support those of three previous studies, not limited to the elderly, which found prescribing knowledge inadequate. They suggest the need for examining/improving the opportunities for medical students and physicians to increase their knowledge of geriatric pharmacology.
Geriatrics
Authors: Rosenthal Mark 
Published: April 2015

This is the author's third revision of a geriatrics bibliography. Approximately two thirds of the old references have been replaced by more current or more detailed articles. The bibliography has been expanded to include several additional topics and over 250 new references from 135 different journals.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 the 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.
Prevalence of Thyroid Disease and Abnormal Thyroid Tests in Older Hospitalized and Ambulatory Persons
Authors: Livingston Edward H. , Hershman Jerome M. , Sawin Clark T. , Yoshikawa Thomas T. 
Published: April 2015

To determine the utility of laboratory tests for diagnosing thyroid disease in the hospitalized elderly, we measured serum thyroid‐stimulating hormone (TSH), thyroxine (T4), free thyroxine index (FT4I), triiodothyronine (T3), and free triiodothyronine index (FT3I) in 125 geriatric inpatients, mostly men, and compared the results to those in elderly ambulatory patients. Hypothyroidism (TSH > 10 μU/mL with a low T4 and FT4I or clinical findings) was present in 7.8% (nine of 116) of male inpatients compared to only 0.7% of male ambulatory controls (P < 0.01). Only a few women were studied but 17% (two of 12) were hypothyroid compared to 2.4% of ambulatory elderly women. Three of the hypothyroid inpatients had no clinical clue to their hypothyroidism. Further, decreased thyroid reserve or subclinical hypothyroidism (TSH > 10 μU/mL with a normal T4 and FT4I and no overt clinical findings), a condition which may lead to overt hypothyroidism, was more common in male inpatients (4.3%) than in male ambulatory controls (1.8% [P < 0.01]). Thus, a clearly elevated serum TSH (> 10 μU/mL) was more common in inpatient (12.1%) than in ambulatory (2.4%) elderly men (P < 0.01).Four inpatients and nine ambulatory controls had an elevated T4 and FT4I, but in only one (0.8%) inpatient and one (0.6%) control was a final diagnosis of hyperthyroidism made; the others had no clinical findings and a normal or low T3 and FT3I.A low T3 and FT3I or T4 and FT4I occurred with equal prevalence in inpatient (19%) as in ambulatory older men (14.9%); three of 12 women inpatients also had a low T3 and FT3I. This finding did not aid in diagnosing thyroid dysfunction.Because of the high prevalence of thyroid disease, predominantly hypothyroidism, in the inpatients (9.4%, or 14.1% if decreased thyroid reserve is included) and the difficulty in detecting thyroid disease on clinical grounds (27% of inpatients with thyroid disease had no specific clinical manifestation), we recommend that geriatric patients, including men, be screened for thyroid dysfunction by measurements of serum TSH and T4 (or FT4I) upon hospital admission.
Two‐Stage Tuberculin Testing With Control Antigens in Patients Residing in Two Chronic Disease Hospitals
Authors: Barry M. Anita , Regan Anne Marie , Kunches Laureen M. , Harris Marjorie E. , Bunce Sally A. , Craven Donald E. 
Published: April 2015

We studied the prevalence of tuberculin reactivity and anergy in 360 elderly patients residing in two municipal chronic disease hospitals. Eighty‐five (26%) of the 323 patients tested had a positive reaction to a stage 1 tuberculin test and 12 (6%) of the 207 stage 1 tuberculin‐negative patients exhibited a booster response to a stage 2 tuberculin test. Thirty percent of the same 207 patients had no response to an anergy panel of skin test antigens that included Candida, mumps, and trichophyton.Nonresponders to tuberculin and the anergy panel had significantly higher one‐year mortality rates compared to responders (44 v 20%, P= 0.001). Tuberculin‐positivity among the 770 employees working in these facilities was 43%; 12 (4%) had a booster response. A survey of 29 randomly selected long‐term care facilities in the Boston area indicated that all had a policy for pre‐employment screening of employees, but less than 50% had a policy for patients and only one institution used two‐stage testing. Routine tuberculin testing is recommended for long‐term care facilities and the two‐stage method is preferable in institutions with adequate resources.
The Aging Thyroid: II. An Immunocytochemical Analysis of the Age‐Associated Lesions
Authors: Blumenthal Herman T. , Perlstein Irving B. 
Published: April 2015

This study utilizing immunocytochemical techniques consists of two segments, 1) an analysis of the changes with age in the hormone content of normal, involuting, macro‐and microfollicles, as well as calcitonin (C) cells, and 2) an analysis of the components of the lesion characteristic of lymphocytic thyroiditis.Involuting and macro‐ (cystic) follicles show a decline in hormone content with age, while microfollicles show a variable pattern with some showing a high and others a low content, as well as some showing an absence of hormone. There also appears to be an increase with age in hormone‐containing C cell micronodules, but we were unable to demonstrate a decline in hormone content of individual C cells.Studies on the in vivo binding of immunoglobulins, as an indicator of thyroid antibody binding, showed an increase with age in IgG and IgM binding to follicular epithelium. Much stronger reactions were observed in the epithelium of microfollicles than in that of involuting or macrofollicles. There were also examples of presumptive in vivo antibody binding by C cell micronodules.We were unable to demonstrate an imbalance of helper/suppressor T cell ratio in the thyroiditis lesion, but did find that some lymphocytes contain thyroid hormones, suggesting that the latter may act as cytokines and assist in the perpetuation of the lesion. The epithelial expression of human lymphocyte antigens (HLA) was strong in microfollicles and weak or absent in involuting or macrofollicles in sections with lymphocytic thyroiditis. It was also strong in the epithelium of a microfollicular adenoma without a lymphocytic infiltrate while weak or absent in the epithelium of adjacent normal follicles.These observations have led to the proposal that the lesion of lymphocytic thyroiditis may be initiated by an age‐associated proliferation of “not self” dysplastic microfollicles which express the HLA surface antigen, and that the early lymphocytic infiltrate is targeted against these microfollicles in the form of an antibody mediated cytotoxic reaction. J Am Geriatr Soc 35:855–863, 1987
The Impact of Age on Utilization of Intensive Care Resources
Authors: McClish Donna Katzman , Powell Stephen H. , Montenegro Hugo , Nochomovitz Michael 
Published: April 2015

The impact of age on admission practices and pattern of care were examined in 599 admissions to a medical intensive care unit (MICU) and 290 patients on the conventional medical care divisions of the same hospital. Four age groups were compared: under 55, 55 to 64, 65 to 74, and 75 years of age and over. Severity of illness and prior health were assessed using the Acute Physiology Score (APS) and the Chronic Health Evaluation (CHE) instruments. Resource utilization was assessed using the Therapeutic Intervention Scoring System (TISS) and hospital charges.Patients 65 years of age and over comprised 48% of the MICU sample. The distribution of CHE was different among the four groups. Twenty‐one percent of patients under 55 years of age had no prior chronic illness, as compared to less than 8% of older patients. The APS at admission was similar for all age groups, as was admission, daily, and total TISS. Hospital survival declined with age from 85% to 70%, while the likelihood of being designated do not resuscitate (DNR) increased from 10% to 24%. Differences in hospital survival disappeared when controlling for severity of illness and prior health, but differences in DNR status did not. Still, elderly DNR patients received as much resources as younger DNR patients and this was more than non‐DNR patients.The sample of patients treated on conventional medical divisions had age distribution similar to the MICU sample. There was some evidence that admission APS (median, 5, 5, 6, 6, respectively, P = .055) and maximum APS (median, 5, 5, 7, 8, respectively, P = .023) differed slightly across age groups. Yet elderly patients admitted to the MICU from the divisions were no sicker than younger patients (median, 19.0, 17.0, 17.5, 18.0, P = .9713). We conclude that there were no selective barriers restricting access of the elderly to the MICU and that once admitted to the MICU, treatment patterns differed only in the application of DNR status. J Am Geriatr Soc 35:983–988, 1987
UCLA Geriatric Grand Rounds Sexual Dysfunction in the Elderly Male
Authors: Morley John E. , Korenman Stanley G. , Mooradian Arshag D. , Kaiser Fran E. 
Published: April 2015

“O Venus, cruel mother of amorous desires, cease attempting to bring under your yoke a man now arrived at his fiftieth year, and therefore stubborn to submit to your voluptuous commands.”To VenusHorace (68 BC)
Report of the Institute of Medicine
Authors:   Committee on Leadership for Academic Geriatric Medicine
Published: April 2015

The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen from their special competencies and with regard for appropriate balance.This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.
Quantifying the Ease or Difficulty Older Persons Experience in Opening Medication Containers
Authors: Keram Stevan , Williams Mark E. 
Published: April 2015

To compare the difficulty experienced by older persons in using various medication containers, 50 noninstitutionalized women and men over 60 years of age were timed while opening 15 containers. Pill and liquid medication bottles with and without child‐resistant closure mechanisms were tested. In addition, other types of medication packaging were evaluated, such as nitroglycerin patches.All subjects could open each of the non‐child‐resistant containers, though none of the child‐resistant containers could be opened by all participants. For child‐resistant containers, dramatic differences were observed in the proportion of subjects who could open the various designs and in the amount of time required. Subjects' comments and observations of subjects' efforts provided possible reasons for some of these differences.The results suggest that when child‐resistant containers are used, consideration of the type of medication container can significantly reduce inconvenience to older persons. Containers without child‐resistant mechanisms provide the best option for elderly people when access by small children is not an issue.
Anthropometric Indicators and Hip Fracture
Authors: Farmer Mary E. , Harris Tamara , Madans Jennifer H. , Wallace Robert B. , Cornoni‐Huntley Joan , White Lon R. 
Published: April 2015

A cohort of 3,595 white women aged 40–77 years was followed for an average of 10 years during which 84 new cases of hip fracture were identified. Triceps skinfold thickness and arm muscle area measured at baseline were examined as possible risk factors for hip fracture controlling for physical activity, height, menopausal status, calcium consumption, and smoking. Of these variables only arm muscle area, triceps skinfold thickness, and activity in recreation were independent predictors of hip fracture incidence using the Cox proportional hazards model. After adjustment, the estimated relative risk of hip fracture was approximately two for an increment of each anthropometric indicator (adjusted for the other) equivalent to comparing those at the 25th percentile to those at the 75th percentile (maximum width of 95% confidence intervals, 1.2–2.9). Risk of hip fracture was approximately two‐fold for persons who reported little recreational exercise compared to persons who reported much recreational exercise (95% confidence interval, 1.2–3.2).Our findings are the first evidence from a prospective study that anthropometric indicators besides body mass index may have an independent relationship to risk of hip fracture.
Musical Hallucinations
Authors: Wengel Steven P. , Burke William J. , Holemon Dawn 
Published: April 2015

Hallucinations may occur in any sensory modality. Auditory hallucinations, usually ascribed to psychiatric illness, take various forms including the perception of voices, cries, noises, or rarely, music. Formed musical hallucinations, (ie, the perception of either vocal or instrumental melodies), reported in the English literature to date have typically been associated with marked hearing loss, advanced age (average 67.8 years), female sex (71%), lack of response to treatment, and general lack of associated psychopathology. We have collected data on seven additional patients with musical hallucinations. The average age of these patients was 72.9 years; all were women. Six had significant hearing problems. All reported onset of musical hallucinations after the age of 60. Interestingly, all seven had major psychiatric illnesses. Four had major depression, two had late‐onset schizophrenia, and one had multi‐infarct dementia. Of the five who had CT scans, one was normal and the rest demonstrated varying degrees of brain pathology. Neuroleptics were used with varying results in three cases; antidepressants were used in two depressed patients and were temporally related to the onset of musical hallucinations in one patient. Electroconvulsive therapy (ECT) was very effective in treating depression and musical hallucinations in the three patients for whom it was used, usually providing relief from hallucinations after only two treatments.Our collection of cases demonstrates that musical hallucinations can occur in association with psychiatric illness, and perhaps unlike the hallucinations associated with isolated hearing loss, may respond to conventional treatments for the underlying psychiatric disorder. Hearing loss is neither a necessary nor sufficient condition for the occurrence of musical hallucinations.