Showing papers in "Journal of the American Geriatrics Society in 1974"
TL;DR: The statistical findings indicated that SCAG is a valid and reliable instrument for assessing psychopathology in the elderly.
Abstract: The importance of diagnostic differentiation between early senile deterioration and depressive disorders in the aged led to the development of Sandoz Clinical Assessment—Geriatric (SCAG) as a new rating instrument especially applicable to the elderly. It is composed of 18 symptom areas rated on a 7-point format. Study 1 was carried out on 51 geriatric subjects (25 volunteers and 26 hospital inpatients at a health center), tested by SCAG and also by the widely used MSER (Mental Status Examination Record). In Study 2, data were obtained on 8 subjects tested by 4 psychiatrists, to determine interrater reliability. The statistical findings indicated that SCAG is a valid and reliable instrument for assessing psychopathology in the elderly.
288 citations
TL;DR: The negative view of old age with its outworn stereotypes (particularly “senility”) must be changed if the elderly are to have more opportunities for successful aging.
Abstract: The negative view of old age with its outworn stereotypes (particularly “senility”) must be changed if the elderly are to have more opportunities for successful aging. It is time for a more balanced attitude. Health in old age involves mental and social as well as physical well-being. There is a distinct difference between the intrinsic features of aging and the reactions of the elderly to their lives. Old age is a period in which unique developmental work can be accomplished. Life review therapy and life-cycle group therapy are effective aids in this direction.
280 citations
TL;DR: The biological aspects of the field including hypotheses, the aging of cultured human cells, the inverse relationship between donor age and cell longevity, the senescence of cultured normal cells derived from different animal species, the latent period of explanted cells versus donor age, progeria and Werner's syndrome, and the future of gerontological research are summarized.
Abstract: Research in aging is now becoming firmly rooted in the scientific method. If it receives the support it deserves, it may produce the next major advance in biology. This article summarizes some of the biological aspects of the field including hypotheses, the aging of cultured human cells, the inverse relationship between donor age and cell longevity, the senescence of cultured normal cells derived from different animal species, the latent period of explanted cells versus donor age, progeria and Werner's syndrome, and the future of gerontological research. Life expectancy at birth has increased in recent years, but at age 65–70 it has remained virtually fixed. The human lifespan will not be changed significantly until the underlying biological causes of senescence are slowed or stopped. Since support for research in this field is almost non-existent, it is more important to concentrate our efforts on increasing research support for gerontology than on increasing the mean lifespan of man. Without the former, the latter will never be improved.
114 citations
TL;DR: The fact that 48 per cent of the series could be maintained without digitalis indicates the need for periodic re‐evaluation under such circumstances, and perhaps the drug was started originally because of transient cardiac stress induced by an acute illness, from which the patient recovered.
Abstract: :
In a survey of an institutional geriatric population of 403 patients it was found that among 88 patients who were being maintained with digitalis, 31 had been receiving it for at least a year although currently there was no evidence of heart disease. A study was conducted to ascertain whether or not it was necessary to continue digitalis. Pertinent clinical and laboratory baseline data included serum digoxin levels and creatinine clearance; the remainder of the determinations were repeated three weeks and seven weeks after omission of digitalis. Baseline serum digoxin levels ranged from a trace to 2.7 ng/ml. Of the 31 patients, 15 (48 per cent) were successfully maintained without digitalis for four months. Because of slight signs of cardiac decompensation, digitalis was started again in the other 16 patients within three to twenty-one days. However, the fact that 48 per cent of the series could be maintained without digitalis indicates the need for periodic re-evaluation under such circumstances. Perhaps the drug was started originally because of transient cardiac stress induced by an acute illness, from which the patient recovered. In such cases, withdrawal of digitalis therapy may prove beneficial.
74 citations
54 citations
TL;DR: Sexual activity may continue to play a significant role in the life of the elderly person and the physician should take these needs into consideration when counseling or when planning programs to improve the quality of life in the later years.
Abstract: Sexual activity may continue to play a significant role in the life of the elderly person. At age 68 about 70 per cent of men still regularly partake in sexual activity, and even at age 78 about 25 per cent are sexually active. For men, the married state is not a necessary factor, whereas for women it makes all the difference. Very few unmarried older women report regular sexual activity. Unavailability of a sanctioned sexual partner is the chief determinant. The ratio of available older women to available older men may approach 4:1 in many environments. Sexual expression requires privacy, an aspect of life that is often neglected for the aged. The physician should take these needs into consideration when counseling or when planning programs to improve the quality of life in the later years.
48 citations
TL;DR: The geriatric patient responds differently to some drugs than does the younger adult, and consequently certain precautions should be taken when prescribing a therapeutic regimen for the elderly.
Abstract: The geriatric patient responds differently to some drugs than does the younger adult, and consequently certain precautions should be taken when prescribing a therapeutic regimen for the elderly. Increasing age is accompanied by functional changes in many of the systems that control the way a drug is metabolized and the response that it evokes. Apparently it is these changes which underlie the modified effect seen clinically in geriatric patients. Age tends to reduce and delay the absorption of substances from the gastrointestinal tract, impair and delay drug clearance and excretion by the kidneys, and reduce the rate of enzyme destruction. The plasma half-life of penicillin, digoxin, antipyrine, or phenylbutazone is extended significantly in the aged so that higher circulating concentrations are maintained for longer periods. Other age-related changes influence the effect of a drug once it has combined with its receptor. These include an altered number of receptor sites, a decrease in the transmitter content of affected tissues, an increase in the rigidity of responsive tissues, and an overall decline in homeostatic capability.
41 citations
TL;DR: Pulmonary embolism is a serious and highly lethal disorder which is greatly underdiagnosed and undertreated, and in elderly patients it is a common and often fatal complication of thrombotic disease.
Abstract: Pulmonary embolism is a serious and highly lethal disorder which is greatly underdiagnosed and undertreated. In elderly patients it is a common and often fatal complication of thrombotic disease. It is not described in the ancient literature, nor thereafter until the chair became universally used in our civilization. Present habits of prolonged sitting, as during travel, entertainment, study, and certain forms of work, contribute to venous stasis and secondary pulmonary embolism. Etiologic factors are reviewed and new iatrogenic factors discussed. Modern techniques increase the accuracy of diagnosis, but a strong index of suspicion on the part of the physician and a careful history still play a major role. Prophylactic and treatment measures are highly effective if used early and adequately. The prevention of venous stasis is important in prophylaxis. Anticoagulant drugs, notably heparin and the coumarin compounds, are the most effective weapons in the majority of cases.
38 citations
TL;DR: Fifty patients who received a new hypocholesterolemic agent, probucol, in a dosage of 0.5 gm twice daily, were studied for one year; significant changes were noted in the serum lipoprotein patterns; the majority of type 2 and type 3 changed to the non‐definitive pattern, but the most of type 4 and type 5 remained unchanged.
Abstract: :
Fifty patients who received a new hypocholesterolemic agent, probucol, in a dosage of 0.5 gm twice daily, were studied for one year. Mean pretreatment serum cholesterol and triglyceride values were 329 mg/100 ml and 360 mg/100 ml respectively. Baseline lipoprotein electrophoreses showed 17 Fredrickson phenotypic patterns of type 2, 6 of type 3, 10 of type 4, 3 of type 5, and 14 non-definitive patterns. After twelve months of treatment with probucol, the mean serum cholesterol level was 263 mg/100 ml (a minus 20 per cent change) and the mean triglyceride level was 293 mg/100 ml (a minus 19 per cent change) for all patients. The median baseline cholesterol level was 311 mg/100 ml and the median cholesterol value during twelve months of therapy was 252 mg/100 ml, a reduction of 19 per cent. The median baseline triglyceride level was 174 mg/100 ml and the median triglyceride value during twelve months of therapy was 147 mg/100 ml, a reduction of 16 per cent. Significant changes were noted in the serum lipoprotein patterns; the majority of type 2 and type 3 changed to the non-definitive pattern, but the majority of type 4 and type 5 remained unchanged. Seven patients had xanthelasmas, but all these lesions decreased in size and 3 lesions disappeared during probucol therapy. Side effects were minimal. About a third of the patients had mild transient flatulence or slight transient eosinophilia. There was no effect on prothrombin time.
Probucol appears to be a safe and effective hypolipidemic agent. It can also induce changes in serum lipoprotein patterns and markedly reduce the size of xanthelasmas.
33 citations
TL;DR: There was a dramatic reduction in the use of chloral hydrate to induce sleep and there also was an increase in congenial interpersonal communication, suggesting wine may play a significant role in treatment programs for the elderly.
Abstract: The therapeutic effects of wine were studied in 80 long-term psychogeriatric patients in two hospital wards each containing 20 men and 20 women. One ward was run on a Token Economy Program (TEP) and the other on a Free Enrichment Program (FEP). Under TEP, wine (limit, two servings of 1 1/2 ounces each) was purchasable with tokens earned by good behavior; under FEP, the wine was free regardless of behavior. The study lasted ten weeks, with a six-month follow-up. After the introduction of wine, there was a dramatic reduction in the use of chloral hydrate to induce sleep. There also was an increase in congenial interpersonal communication. The earning of wine tokens was a positive element in improving the behavior of some patients on the TEP ward, although it was a less effective behavioral reinforcement than cigarettes. Thus wine may play a significant role in treatment programs for the elderly. The subject needs further investigation.
30 citations
TL;DR: A critical range of bone mass can be defined in which the abnormality (bone loss) is clearly recognized in the radius and the prevention of further bone loss at this stage should markedly lower the incidence of both the “crushed vertebrae syndrome” and femoral‐neck fracture.
Abstract: One of the most remarkable manifestations of the normal aging process is loss of bone after age 45–50 in apparently normal women The magnitude of this loss is such that after the age of 80 virtually all women have bone masses that are smaller than those of normal women before the age of 45, ie, the two populations with respect to bone mass are entirely different The relationship of such “physiologic” bone loss to structural failure (vertebral compressions, fractured femoral necks) is discussed by comparing the radiologically measured bone mineral mass in the proximal radius in normal women throughout the adult age range with that in a group of 71 women with vertebral compressions and 36 women with femoral-neck fractures At a time of life when the incidence of structural failure is still low, a critical range of bone mass can be defined in which the abnormality (bone loss) is clearly recognized in the radius The prevention of further bone loss at this stage should markedly lower the incidence of both the “crushed vertebrae syndrome” and femoral-neck fracture This approach is particularly appropriate for those geriatric female patients who still enjoy active life, including sports and travel
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TL;DR: Geriatricians should be reminded that many old people are still capable of experiencing sexual pleasure, and sexual experiences can have generally favorable effects, and they should be encouraged under appropriate circumstances.
Abstract: Geriatricians should be reminded that many old people are still capable of experiencing sexual pleasure. Since sexual experiences can have generally favorable effects, they should be encouraged under appropriate circumstances. Certain enhancements are discussed. At any rate, sexuality in the aged should not be rigidly suppressed in wholesale fashion as it is at present in most nursing homes and other institutions.
TL;DR: The patient reported here (an 85‐year‐old man) had the foregoing abnormal form of venous return, which presented great difficulty when insertion of a transvenous pacemaker was attempted, and postmortem examination revealed massive thrombosis of the coronary sinus.
Abstract: Persistent left superior vena cava associated with lack of a right superior vena cava constitutes a rare anomalous pathway of venous return to the heart; drainage is usually into the coronary sinus. The patients often are asymptomatic and the anomaly is detected only accidentally during catheterization of the right heart. The patient reported here (an 85-year-old man) had the foregoing abnormal form of venous return, which presented great difficulty when insertion of a transvenous pacemaker was attempted. Subsequently the patient died from bronchopneumonia, and postmortem examination revealed massive thrombosis of the coronary sinus. This may be the first report of such a complication of intravenous pacemaker implantation. Complete occlusion of the coronary sinus in this situation may prevent venous return from the upper part of the body. The literature is reviewed and recommendations are made for alternative management of this unusual problem.
TL;DR: The hypothesis is proposed that hypertriglyceridemia associated with hyperuricemia is the result of a primary alteration in carbohydrate metabolism, and the clinical importance of determining the serum uric acid level in cases of hyperlipidemia is stressed.
Abstract: This article stresses the clinical importance of determining the serum uric acid level in cases of hyperlipidemia, particularly hypertriglyceridemia, since there is a direct application to the management of coronary heart disease. The hypothesis is proposed that hypertriglyceridemia associated with hyperuricemia is the result of a primary alteration in carbohydrate metabolism.
TL;DR: A double-blind cross-over study was made of the effects of betahistine hydrochloride in 50 patients who had symptoms and signs of vertebrobasilar insufficiency associated with dementia, confirmed by detailed neurologic and clinical investigation.
Abstract: A double-blind cross-over study was made of the effects of betahistine hydrochloride in 50 patients who had symptoms and signs of vertebrobasilar insufficiency associated with dementia, confirmed by detailed neurologic and clinical investigation. They were treated for six weeks by oral administration of either betahistine-HCl (32 mg daily in four doses) or an identical-appearing placebo, and then for six weeks by these preparations in reverse order. Evaluations made initially and at six-week intervals included detailed assessment of neurologic functions rated according to a quantitative scale. A series of neuropsychologic tests was also given before and after each treatment period. Statistical analyses of neurologic and of psychologic status showed significant improvement with betahistine-HCl therapy, particularly with respect to verbal and nonverbal cognition, memory, language use, spatial construction, perceptual-motor coordination and perception. Measurements of regional and mean cerebral blood flow indicated a significant increase with betahistine therapy.
TL;DR: Adults, given a constant diet, can favorably alter their fat‐free weight and fat weight by participating in regular physical exercise, under adequate medical supervision.
Abstract: Twenty-four adult men were assigned to an experimental weight-training group (N=10), or to an experimental jogging group (N=8), or to an active control group (N=6). Height, weight, skinfold thickness (ten sites), girth (four sites), and total body potassium (4 0 K) were assessed before and after the exercise programs. After eight weeks of training, the weight-training group had gained significantly more weight than the jogging group had lost, the jogging and weight-training groups had lost significantly more fat than the control group, and the weight-training group showed an increase in fat-free weight which was significantly different from the changes in fat-free weight for the other two groups. There were no differences between the three groups for any of the skinfold or girth measurements. Thus adults, given a constant diet, can favorably alter their fat-free weight and fat weight by participating in regular physical exercise, under adequate medical supervision.
TL;DR: In the author's studies of hundreds of women with menopausal headaches, such hormones administered by pellet implantation gave beneficial results superior to those obtained by oral or parenteral administration.
Abstract: :
Constant, adequate dosages of estrogen, androgen or estrogen-androgen combinations provide relief from the migraine and migrainoid headaches often experienced by menopausal women. This form of therapy employs natural physiologic hormones in preference to synthetic nonphysiologic agents such as ergotamines, barbiturates or addictive drugs. In the author's studies of hundreds of women with menopausal headaches, such hormones administered by pellet implantation gave beneficial results superior to those obtained by oral or parenteral administration.
TL;DR: Analysis of Lineweaver‐Burk and Dixon plots obtained by determining the velocity of oxidation of kynuramine with various concentrations of substrate and inhibitor, showed that GH3 was a fully competitive inhibitor of MAO.
Abstract: The mechanism by which Gerovital H3 (GH3), a specially stabilized form of procaine hydrochloride, produces a weak inhibition of the enzyme, monoamine oxidase (MAO), was studied by several methods. Purified rat-brain mitochondrial MAO was used as the enzyme source and the reaction velocities were determined by quantitating the rate of appearance of 4-hydroxyquinoline from kynuramine. Data on dilutional studies with pre-incubated enzyme-inhibitor complexes, as well as other data, strongly indicated that GH3 was a reversible inhibitor of MAO. Analysis of Lineweaver-Burk and Dixon plots obtained by determining the velocity of oxidation of kynuramine with various concentrations of substrate and inhibitor, showed that GH3 was a fully competitive inhibitor of MAO. The weak, reversible, fully competitive inhibition of MAO produced by GH3 is in marked contrast to the potent, irreversible inhibition of MAO produced by currently available agents. The mechanism by which GH3 inhibits MAO may help to explain the absence of severe adverse reactions with GH3 that are traditionally associated with irreversible MAO inhibitors in the treatment of depressive illness. Because of these characteristics of GH3 as an inhibitor of MAO, assessment of its activity in vivo may not be easily accomplished, despite its pronounced pharmacologic effects.
TL;DR: Of 43 residents in a hospital geriatric ward for regressed and disabled persons, only 3 were found to engage in some purposeful daily activity; the rest were relatively inactive; the program generated considerable staff enthusiasm and increased the likelihood of the use of similar activity programs on other hospital wards.
Abstract: :
Of 43 residents in a hospital geriatric ward for regressed and disabled persons, only 3 were found to engage in some purposeful daily activity; the rest were relatively inactive. Under a regimen of programmed activities (e.g., bingo games) for one hour each afternoon, the daily average number of residents engaged in purposeful behavior rose to 13, but dropped to 3 again when the daily activities were discontinued. The program generated considerable staff enthusiasm and increased the likelihood of the use of similar activity programs on other hospital wards.
TL;DR: Comparison of “before” and “after” intelligence‐test results revealed substantial improvement, particularly in tests concerned with short‐term memory and visual organization, in subjects given hyperbaric oxygen.
Abstract: Twenty subjects (average age, 67.9 years) were given hyperbaric oxygen (100% at 2 atmospheres pressure) for 15 daily sessions of two hours each. Comparison of “before” and “after” intelligence-test results revealed substantial improvement, particularly in tests concerned with short-term memory and visual organization. The subjects who benefited most were those whose “before” Wechsler Memory Quotients were between 70 and 110. There was no indication that the improvement reached a plateau after 15 sessions.
TL;DR: The importance of recognizing the possibility of food aspiration in cases of sudden death from food aspiration is emphasized, as immediate bronchial aspiration or tracheostomy is the only life‐saving procedure.
Abstract: During the year 1973, sudden death from food aspiration was identified in 3 patients of a geriatric hospital population. The correct diagnosis was made only at autopsy. As is usual under these circumstances, the clinical diagnosis had been myocardial infarction. This article emphasizes the importance of recognizing the possibility of food aspiration in these cases, as immediate bronchial aspiration or tracheostomy is the only life-saving procedure.
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TL;DR: Sexual activity in the aged is not exceptional and may give serenity to aging and medical, social and psychologic prophylactic counselling should be applied as early as possible by geriatricians in collaboration with sexologists.
Abstract: Sexual activity and habits in the aged are analyzed on the basis of the pertinent literature and also personal observations on 85 subjects (53 males and 32 females) whose ages ranged from 62 to 81 years. The importance of diseases and of environmental, social and psychologic factors is discussed in connection with the impairment of sexual activity in old people. Sexual activity in the aged is not exceptional and may give serenity to aging. Medical, social and psychologic prophylactic counselling should be applied as early as possible by geriatricians in collaboration with sexologists.
TL;DR: Rectal sensitivity to distention was lower in the constipate patients than in those who were not constipated and the desire to defecate was correlated with the levels of intrarectal pressure, rectal diameter and rectal tension.
Abstract: A study was made of the defecatory sensation in 130 patients with normal rectums. By means of a specially designed balloon inserted into the rectum, determinations were made of intrarectal pressure, rectal diameter and rectal tension. The desire to defecate was correlated with the levels of these measurements. There was a progressive rise with age in the threshold for these factors. Rectal sensitivity to distention was lower in the constipated patients than in those who were not constipated.
TL;DR: The high incidences of atrial fibrillation, left anterior hemiblock, extra systoles and delayed AV conduction were probably a result of the widespread use of digitalis.
Abstract: The electrocardiograms of 100 men and women, all past the age of 90, were analyzed for conduction times, axis deviation, summed frontal QRS and T amplitudes. The ECG patterns were classified, and limited clinical correlations were made. The heart rate, R-T and QRS intervals remained virtually unchanged with age. An increase in PR intervals, a left axis shift and a reduction in summed frontal T values were noted. The high incidences of atrial fibrillation, left anterior hemiblock, extra systoles and delayed AV conduction were probably a result of the widespread use of digitalis. The two most common ECG abnormalities were left ventricular hypertrophy (evidently a natural consequence of advanced age) and myocardial infarction (often undiagnosed clinically).
TL;DR: A way is indicated whereby a pathologic state may be distinguished from the aging process.
Abstract: The application of standardized multi-test data to the study of aging is explored through age-prevalence patterns and two theoretical models. In 1350 subjects, the age-prevalence of raised blood pressure, abnormal electrocardiograms, hypertriglyceridemia, hypercholesterolemia, and 2-hour hyperglycemia, as indicators of cardiovascular disease, were studied in relation to decreases in hearing and vision, as indicators of sensory neural impairment. The age-dependent changes in special-sense function occurred independently of cardiovascular abnormalities. Thus a way is indicated whereby a pathologic state may be distinguished from the aging process.
TL;DR: A project was started for the purpose of testing the cost effectiveness of other forms of primary care, i.e., care delivered by the nurse practitioner and the social worker, to measure the effectiveness of different combinations of these services in improving the patients' level of functioning and behavior.
Abstract: In an effort to find alternatives to the current abandonment of the nursing-home patient, a project was started for the purpose of testing the cost effectiveness of other forms of primary care, i.e., care delivered by the nurse practitioner and the social worker. The goal of the three-year demonstration project is to measure the effectiveness of different combinations of these services in improving the patients' level of functioning and behavior. Preliminary one-year results are presented regarding changes in drug regimens, record keeping, and the care provided by nursing-home staffs.
TL;DR: A survey was made of the records of 200 patients aged 70 or older who had undergone repair of groin hernias, finding that femoralHernias were the most common and bowel strangulation in association with femoral hernia was the most serious complication.
Abstract: A survey was made of the records of 200 patients (158 men and 42 women) aged 70 or older who had undergone repair of groin hernias. In the aged women, femoral hernias were the most common; indirect hernias were seen much less frequently, and there were no direct hernias. In the aged men, large indirect sliding inguinal hernias and simple indirect inguinal hernias were the most common; direct inguinal hernias were seen less frequently than expected. The most serious and easily overlooked complication of hernia, particularly in old women, is bowel strangulation in association with femoral hernia. The operative procedures were individualized and varied. Local anesthesia was used for all poor-risk patients and was the method of choice in 185 of the 200 patients. A 1% solution of chlorprocaine was the preferred anesthetic agent.
The important complications included wound infection in 7 cases and seroma in 7 cases; infection occurred most frequently in association with gangrenous bowel in the hernial sac. As would be expected, urinary-tract complications were common since nearly half of the men had benign prostatic hypertrophy. One death occurred in the immediate operative period (third postoperative day) from a cerebrovascular accident. Other deaths after postoperative intervals ranging up to fifteen years were caused by concurrent diseases and seemed unrelated to the hernial operation. The postoperative recurrence rate for hernia was 2 per cent. Surgical repair of groin hernia in aged patients can improve the quality of their lives, and in certain cases (e.g., bowel strangulation) can be a life-saving measure.
TL;DR: Of the 37 known survivors, 23 wore their prosthesis for more than six hours daily and used it as their main mode of locomotion; 14 used it only occasionally or not at all.
Abstract: During a five-year period, 90 patients who had undergone lower-extremity amputations when aged 60 or older were treated at the Amputee Clinic of the Jewish Hospital of St. Louis. Seventeen of the 90 were not fitted with prostheses because of various medical contraindications. Thirteen of the remaining 73 patients who were fitted with prostheses had died by the time of follow-up, and 23 others could not be located. Of the 37 known survivors, 23 wore their prosthesis for more than six hours daily and used it as their main mode of locomotion; 14 used it only occasionally or not at all.
Sex and age at the time of amputation were of little value in predicting the success of prosthetic rehabilitation. Patients with below-knee amputations fared much better than those with above-knee amputations. Contraindications to fitting an aged amputee with a prosthesis are mental deterioration, congestive heart failure, severe angina pectoris, and advanced chronic obstructive pulmonary disease. Neurologic disorders such as parkinsonism or stroke with a significant neurologic residual are additional contraindications. Patients who have ulcerations or infections of the remaining extremity or who have severe contractures of the stump usually cannot be fitted with a prosthesis. The ability to use axillary crutches is not a realistic prerequisite for supplying an aged amputee with a prosthesis. A patient who has walked before the amputation and who afterward can walk with a walker, usually will be able to use an artificial limb. Amputees who cannot be expected to use a prosthesis can still be rehabilitated to an independent wheelchair existence.
TL;DR: Patients over age 65 with atrioventricular and intraventricular conduction defects were studied for periods of from two to five years and left bundle‐branch block and left anterior hemiblock, either alone or in association with any other fascicular block, were more common in the female patients.
Abstract: Four hundred and fifty-five patients over age 65 with atrioventricular and intraventricular conduction defects were studied for periods of from two to five years (average, twenty-six months). Data on the overall incidence of conduction defects, the sex incidence, the type of block, and the associated electrocardiographic abnormalities are presented. There was no ECG evidence of extension of the blocks based on prolongation of the P-R interval, a shift or an increase in axis, a shift of the block from one branch to another, or an increase in width of the QRS complex. Left bundle-branch block and left anterior hemiblock, either alone or in association with any other fascicular block, were more common in the female patients whereas right bundle-branch block was more common in the male patients.
TL;DR: Depression is the most important of the various psychiatric illnesses that may develop in old age and the psychiatric skills of the family practitioner are very important in helping the patient to adjust to the crises of old year and in preventing mental illness.
Abstract: Depression is the most important of the various psychiatric illnesses (including organic brain syndromes, schizophrenia, neuroses and personality disorders) that may develop in old age. The symptoms and the relationship to suicide are discussed. Therapeutic efforts (chemotherapy, electroshock, psychotherapy) may be directly affected by the physician's attitude. Drugs for the treatment of depression include the tricyclic antidepressants, MAO inhibitors, amphetamines, phenothiazines, minor tranquilizers (chlordiazepoxide, diazepam) and lithium. Contraindications and the dangers of misuse are emphasized. Electroshock is indicated for suicidal or medically endangered patients or for those who do not respond to chemotherapy. The psychiatric skills of the family practitioner are very important in helping the patient to adjust to the crises of old age and in preventing mental illness.