scispace - formally typeset
Search or ask a question

Showing papers in "Journal of the American Geriatrics Society in 1975"


Journal ArticleDOI
Eric Pfeiffer1
TL;DR: A 10‐item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated.
Abstract: Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.

4,897 citations


Journal ArticleDOI
TL;DR: Methylphenidate, as compared to placebo, was singularly effective in 44 withdrawn, apathetic geriatric patients and should be considered in the treatment of previously unresponsive or oversedated patients.
Abstract: A double-blind randomized study showed that methylphenidate, as compared to placebo, was singularly effective in 44 withdrawn, apathetic geriatric patients. Study selection and exclusion criteria were rigidly enforced. Patients receiving methylphenidate in a dosage of 20 mg daily improved significantly over a period of six weeks as measured by results of tests for mental status, ward behavior (nursis' rating), target-symptom response, and physician's and nurses' global evaluations. For this reason and because there were no side effects, this form of antidepressant therapy should be considered in the treatment of previously unresponsive or oversedated patients.

104 citations


Journal ArticleDOI
TL;DR: The cause of dementia was studied retrospectively, based on the extent of morphologic changes in the brain, thus classifying dementia into three types: degenerative, vascular, and mixed; Clinically, the mixed type resembled the vascular type with regard to major neurologic signs, and there was some similarity to the degenerative type with Regarding mental features.
Abstract: In a study of senile degenerative lesions-including Alzheimer's neurofibrillary changes, senile plaques and amyloid angiopathy-the hippocampal area of the brain was examined by thioflavine T fluorescence microscopy in 146 consecutive autopsy patients over the age of 49. The incidence and quantity of neurofibrillary changes and senile plaques rose with age, and an approximate positive correlation in quantity was noted among the three kinds of degenerative change. The quantity of neurofibrillary lesions and senile plaques was significantly different between the demented and non-demented patients, but not between the severely and less severly demented patients. The cause of dementia was studied retrospectively, based on the extent of morphologic changes in the brain, thus classifying dementia into three types: degenerative, vascular, and mixed. Clinically, the mixed type resembled the vascular type with regard to major neurologic signs, and there was some similarity to the degenerative type with regard to mental features.

96 citations


Journal ArticleDOI
TL;DR: In ultrastructural studies, the ovaries of postmenopausal women were compared with those of pre‐ and perimenopausal women, suggesting that the menopause does not result exclusively from exhaustion of the primordial follicles.
Abstract: In ultrastructural studies, the ovaries of postmenopausal women were compared with those of pre- and perimenopausal women. Primordial follicles containing apparently normal oocytes were found in all postmenopausal ovary samples. Differentiating follicles were often found in these samples, but they were in various states of atresia. The findings suggest that the menopause does not result exclusively from exhausation of the primordial follicles.

81 citations


Journal ArticleDOI
TL;DR: The prescription and administration of drugs (especially of the neuroactive class) was observed in 131 patients in an extended care facility and Questionable prescribing practices were demonstrated by the fact that 30 patients had prescriptions for 38 “not‐recommended” drugs.
Abstract: The prescription and administration of drugs (especially of the neuroactive class) was observed in 131 patients in an extended care facility. The average number of neuroactive drugs prescribed (2.1) was distinctly different from the average number administered (1.3) because of the large number of pro re nata (prn) prescriptions. More neuroactive substances were prescribed for patients with superior mentation and minimal physical disability; the difference between low and high groups was 1.7 (mentation) and 2.8 (physical status). The most common neuroactive drugs prescribed were: 1) analgesics, 2) major tranquilizers, and 3) hypnotics. Questionable prescribing practices were demonstrated by the fact that 30 patients had prescriptions for 38 "not-recommended"drugs; 23 of these prescriptions were for propoxyphene compound. After requiring physicians to rewrite drug orders every thirty days, a survey made ten months later showed that there was a decline (0.8) in the number of drugs prescribed per patient and a slight increase (0.45) in the number of drugs administered. Professional drug surveillance is crucial for improving the therapeutic process. At least two modifications of current prescribing practices are recommended: 1) a record should always be made of the precise condition(s) under which a drug prescribed "prn" is to be administered; and 2) a strong effort should be made to reduce the total number of drug prescriptions. The results of this survey suggest that certain procedural matters necessitating change are not in themselves the most substantive factors in improvement. Present "third party" review mechanisms likely will not ameliorate the current situation. It will be necessary to implement complex organizational changes in most extended care facilities.

72 citations


Journal ArticleDOI
TL;DR: The biochemical effects of prolonged inactivity indicate that immobilization of the elderly patient results in adverse physical and psychologic phenomena and physicians and nurses have a continued responsibility to support a sustained rehabilitation program for these patients.
Abstract: The kinesio, phychopathologic and psychosocial effects of prolonged immobilization of the ill aged are outlined. The iatrogenic (physician-induced) and nurisgenic (nurse-induced) factors related to such functional disabilities are described. Illustrative case histories are given. The syndrome is reversible. Thus physicians and nurses have a continued responsibility to support a sustained rehabilitation program for these patients. The biochemical effects of prolonged inactivity indicate that immobilization of the elderly patient results in adverse physical and psychologic phenomena.

72 citations


Journal ArticleDOI
TL;DR: In 13 elderly patients, 12 of whom had Parkinson's disease, visual hallucinations and delirium developed as a side effect of amantadine hydrochloride (Symmetrel) therapy, and each parkinsonian patient was treated satisfactorily with levo‐dopa.
Abstract: In 13 elderly patients, 12 of whom had Parkinson's disease, visual hallucinations and delirium developed as a side effect of amantadine hydrochloride (Symmetrel) therapy. The symptoms promptly disappearred when amantadine was discontinued. Thereafter, each parkinsonian patient was treated satisfactorily with levo-dopa. Treatment with a combination of amantadine and an anticholinergic agent increases the likelihood of delirium because of the hazard of retention of urine. Although amantadine is effective in the treatment of Parkinson's disease in the elderly, the incidence of delirium as a complication seems higher in this age group.

71 citations


Journal ArticleDOI
TL;DR: In the authors’ recent autopsy study of 100 patients over 60 years of age, 10 had diffuse cardiac amyloidosis with biventricular involvement, and it was difficult to assess the possible contribution of ventricular amyloids to congestive failure since most of the patients also had coronary arteriosclerosis.
Abstract: Cardiac amyloid accumulation is a common autopsy finding in elderly persons, the frequency increasing with each advancing age decade. In most cases the deposits are microscopic, confined to the atrial subendocardium, and of dubious significance. In a few cases, however, there is much more extensive cardiac involvement, with infiltration of the ventricular musculature and intracardiac conduction system. In the authors' recent autopsy study of 100 patients over 60 years of age, 10 had diffuse cardiac amyloidosis with biventricular involvement. Microscopically, the amyloid deposits often resembled foci of interstitial fibrosis. Significant cardiac enlargement (weight greater than 380 gm) was present in only 2 of these patients, and in only one of them were the clinical signs and symptoms clearly attributable attributable to the amyloid infiltration. It was difficult to assess the possible contribution of ventricular amyloid to congestive failure since most of the patients also had coronary arteriosclerosis. In the aged, clinically significant cardiac amyloidosis associated with cardiac enlargement appears to be part of a disease spectrum more commonly characterized by focal, clinically insignificant cardiac amyloid deposits. Yet several features suggest that senile cardiac amyloidosis may differ from the clinically significant cardiac amyloidosis occassionally seen in younger patients.

61 citations


Journal ArticleDOI
TL;DR: The current management of decubitus ulcers, factors in wound healing and the role of enzymes in treatment are discussed and statistical evidence is provided for the conclusion that collagenase ointment is an excellent adjunct to therapy.
Abstract: The current management of decubitus ulcers, factors in wound healing and the role of enzymes in treatment are discussed. The therapeutic benefits of collagenase (Santyl) ointment in 21 patients are described, supplemented by serial color photographs. Statistical evidence is provided for the conclusion that collagenase ointment is an excellent adjunct to therapy.

49 citations


Journal ArticleDOI
TL;DR: A rating scale which can be used not only to help decide the need for institutional care, but also to help determine the most suitable setting for the patient if placement is necessary is validated.
Abstract: This study was carried out to validate a rating scale which could serve as a guide in determining the need for institutional care. The scale assesses the subject's physical and mental disability, balanced against his ability to function and the support available from relatives and community resources. Cut-off points were tested by the use of an 18-month follow-up interval. Initially, 130 aged men and women from three different settings were rated. At the time of follow-up eighteen months later, 83 per cent of the subjects who had obtained an initial score indicative of their inability to function in the community were either dead or in an institution. In contrast, 90 per cent of those who obtained an initial score indicating that they were able to continue in the community, were not in an institution at the time of follow-up. The rating scale can be used not only to help decide the need for institutional care, but also to help determine the most suitable setting for the patient if placement is necessary.

44 citations


Journal ArticleDOI
TL;DR: The principal finding with regard to mortality was a significant decrease of 6.82 per cent after the relocation when compared with the mortality rate for the previous year.
Abstract: The entire general medical unit of Ste. Anne's Hospital for disabled elderly veterans was moved into a new modern building on July 13, 1971. Roughly, about 350 patients were involved. In anticipation of the move, a program of preparation of the patients was organized to prevent if possible the dramatic increases in the mortality rate reported in some earlier studies of relocated geriatric populations. The principal finding with regard to mortality was a significant decrease of 6.82 per cent after the relocation when compared with the mortality rate for the previous year. The highly appreciated air-conditioning system in the new building, representative of modern improvements, may have helped to a minor degree. A much more important factor was the well organized program for preparation of the patients, skillfully carried out by a conscientious staff.

Journal ArticleDOI
TL;DR: After twelve weeks of treatment, ratings of overall clinical condition and global change showed that the 26 patients given DEA improved more than twice as much as the 27 patients given papaverine.
Abstract: This is the first double-blind study in outpatients to evaluate the effectiveness of dihydrogenated ergot alkaloids (DEA) (Hydergine) versus papaverine in the treatment of selected symptoms associated with mental aging. In addition, this is the first study comparing these two pharmacologic agents in relatively young geriatric patients, with a mean age in the mid-sixties. After twelve weeks of treatment, ratings of overall clinical condition and global change showed that the 26 patients given DEA improved more than twice as much as the 27 patients given papaverine. Of the 14 individual symptoms rated, 13 improved significantly more in the DEA group than in the papaverine group. These symptoms included confusion, dizziness, unsociability, depressive mood, and mental alertness. Other data confirmed the generally superior results with DEA. In view of its demonstrated beneficial clinical actions and of its notable scarcity of contraindications or side effects, DEA appears to represent a significant pharmacologic contribution to the care of elderly persons showing selected symptoms of mental and functional decline.

Journal ArticleDOI
TL;DR: Prescription practices relating to the choice of drugs, prevalence of drug use, dosage, combination drug preparations, and antiparkinson agents are discussed in terms of such factors as the patient's age and the diagnosis.
Abstract: A survey conducted at 12 VA hospitals included the collection of detailed information on the use of psychoactive drugs in 1,276 elderly psychiatric patients. On the day of the survey, 61 per cent of the patients were receiving psychoactive drugs. Prescription practices relating to the choice of drugs, prevalence of drug use, dosage, combination drug preparations, and antiparkinson agents are discussed in terms of such factors as the patient's age and the diagnosis. Also discussed is the literature on psychoactive drugs, particularly as it pertains to elderly populations.

Journal ArticleDOI
TL;DR: Gastrointestinal, biliary, and chest procedures carried a much higher mortality than did the other major categories and elderly patients should not be denied surgical intervention, major or minor, on the basis of age alone when the operation can make their remaining years more comfortable.
Abstract: Surgical mortality rates were reviewed for the four-year period 1970-1973, in a series of 2,186 operations. The majority of these operations were performed in patients aged 70 or older; of these, 116 were performed in patients of the 90+ age group. Predictably, the surgical mortality in the older groups was higher than in the younger groups. However, the overall mortality for patients aged 70 or older was 4.9 per cent as compared with 8 to 21 per cent for series reported in the literature. Gastrointestinal, biliary, and chest procedures carried a much higher mortality than did the other major categories. Minor surgical operations in the elderly should be approached with caution since they may be associated with a significant mortality rate. Nevertheless, elderly patients should not be denied surgical intervention, major or minor, on the basis of age alone when the operation can make their remaining years more comfortable.

Journal ArticleDOI
TL;DR: Patients with a history of old, well‐compensated myocardial infarction, and those with cardiac arrhythmia, bundle‐branch block, congestive heart failure and A‐V block (pacemaker‐protected) but no evidence of previous myocardials fared almost as well as subjects of the same age without cardiac disease, and were considered to run the lowest operative risk.
Abstract: Four hundred and sixteen patients with documented arteriosclerotic heart disease (ASHD) underwent 424 diagnostic and therapeutic surgical procedures during the year 1970 at the Henry Ford Hospital. They were classified according to the specific clinical manifestation of their cardiac abnormality. Patients with a history of old, well-compensated myocardial infarction, and those with cardiac arrhythmia, bundle-branch block, congestive heart failure and A-V block (pacemaker-protected) but no evidence of previous myocardial infarction fared almost as well as subjects of the same age without cardiac disease, and were considered to run the lowest operative risk. Patients with angina, especially if there was a history of infarction, were an intermediate risk in terms of complications and mortality. Patients with a history of previous infarction complicated at the time of the surgical procedure by arrhythmia, A-V block, bundle-branch block, or congestive heart failure were in the "highest risk" category. A severe A-V block indicated the need for insertion of a "prophylactic" pacemaker before any attempt at a diagnostic or therapeutic procedure. No patient with clinical or electrocardiographic evidence of a recent infarction (less than three months' duration) should undergo any elective surgical procedure under any form of anesthesia unless the surgeon is prepared for a high mortality rate that may approach 90 percent. In contrast, the patient with old, well-compensated myocardial infarction and no evidence of dysrhythmia, block or congestive failure can tolerate even a major surgical operation under any form of anesthesia extremely well.

Journal ArticleDOI
TL;DR: In the reported cases of Werner's syndrome, as in the present example, the authors were unable to identify any responsible organ or system, but they suggest that connective tissue, widely distributed throughout the entire body, may play an important role.
Abstract: The autopsy findings in a 29-year-old male with Werner's syndrome are presented, with a review of similar data on 17 autopsy cases reported in the literature. The pathologic findings in this new case were scleroderma-like skin atrophy, arteriosclerosis, and atrophy of the endocrine glands (including the genital organs). In the reported cases of Werner's syndrome, as in the present example, the authors were unable to identify any responsible organ or system. However, they suggest that connective tissue, widely distributed throughout the entire body, may play an important role. The possible abnormal metabolism of connective tissue in Werner's syndrome deserves further study.

Journal ArticleDOI
TL;DR: The data show a general deterioration in practically all the physiologic functions studied, most pronounced during the last 10 years of the 40‐year period.
Abstract: Reported is the continuation of follow-up investigations of certain physiologic functions in former physical education students. The first follow-up study was conducted about 30 years after the initial measurements. The present follow-up study concerned a re-investigation of the same group (23 men and 11 women), 10 years later, i.e., about 40 years after the first examination. Resting values for heart rate, blood pressure and metabolism were determined, as well as values for lung volume, hand-grip strength, and reaction time. During moderately hard exercise, measurements were made of oxygen uptake, ventilatory equivalents, and heart rate. By extrapolation of these heart-rate determinations to "maximal heart rate," the maximal oxygen uptake was estimated and expressed as L times min-1 and as ml x min-1 and as ml times kg-1 x min-1. The data show a general deterioration in practically all the physiologic functions studied, most pronounced during the last 10 years of the 40-year period.

Journal ArticleDOI
TL;DR: A self‐rating depression scale (D30R) was useful for assessing changes in affective states and in discriminating between the effects of active drug and placebo.
Abstract: Forty male volunteers over the age of 60 took either a daily dose of diazepam (12 mg) or placebo for a two-week period. Differential responses to these compounds partially depended upon age and the initial symptom level. Diazepam produced sedative side effects, a modest antidepressant effect, and a reduction in memory. Placebo had an antianxiety effect in the relatively older subjects, and was associated with decreased fatique, improved memory and improved motor function. Considerable variability was observed in both drug and placebo responses among the elderly. A self-rating depression scale (D30R) was useful for assessing changes in affective states and in discriminating between the effects of active drug and placebo.

Journal ArticleDOI
TL;DR: The foregoing findings led to the development of an Index of Aging in males, based on combined serum lipid and urinary steroid values, which may be a means of differentiating between normal aging and the deviations seen in atherosclerosis and myocardial infarction.
Abstract: Several studies conducted by the authors' group have shown that urinary steroid measurements are a valuable aid in differentiating the normal aging process, the pronounced aging associated with increased risk to coronary heart disease, and the deviations associated with myocardial infarction Data are presented on 428 men in the age range of 30-70 years The study design most effective in elucidating aging and disease patterns involves selection of subjects from a wide age range Data on persons identified as clinically normal can be used to describe physiologic aging Once this is determined, data on persons with disease can be used to identify abnormalities of aging associated with the clinical conditions studied This approach offers a potential method for differentiating between aging effects and disease effects The foregoing findings led to the development of an Index of Aging in males, based on combined serum lipid and urinary steroid values This Index may be a means of differentiating between normal aging and the deviations seen in atherosclerosis and myocardial infarction Current studies are directed toward extending these observations

Journal ArticleDOI
TL;DR: In a nursing‐home population of geriatric patients who experienced vomiting and nausea due to gastrointestinal disorders, haloperidol administered parenterally proved to be a safe and highly effective antiemetic agent.
Abstract: Twenty-eight geriatric residents of a nursing home participated in a double-blind study to compare the 12-hour therapeutic effectiveness of a single intramuscular injection (1.0 mg) of haloperidol with that of placebo for the relief of vomiting and nausea due to gastrointestinal disorders. Significantly fewer episodes of vomiting occurred in the haloperidol group than in the placebo group. Nausea also was less frequent in the haloperidol group. After four hours, symptoms recurred much more often in the placebo group. Global evaluations showed that a significantly greater number of haloperidol patients improved markedly than did those given placebo. There were no clinically significant changes in vital signs throughout the study in the haloperidol group. In 1 placebo patient the pulse rate was significantly increased; otherwise no adverse reactions were reported for this group. Thus, in a nursing-home population of geriatric patients who experienced vomiting and nausea due to gastrointestinal disorders, haloperidol administered parenterally proved to be a safe and highly effective antiemetic agent.

Journal ArticleDOI
T. E. Moxley1, George L. Royer1, Martha S. Hearron1, James F. Donovan1, Leon Levi1 
TL;DR: In a double‐blind multiclinic trial, a new nonsteroidal anti‐inflammatory agent (ibuprofen) was compared with an established therapeutic agent (phenylbutazone‐alka) for the treatment of osteoarthritis, and there was no significant difference between treatment groups.
Abstract: In a double-blind multiclinic trial, a new nonsteroidal anti-inflammatory agent (ibuprofen) was compared with an established therapeutic agent (phenylbutazone-alka) for the treatment of osteoarthritis. Of the 159 patients from the 17 contributing clinics, 144 completed the four weeks of therapy. More than 60 per cent of them reported improvement in exercise-related pain by week 4, and there was no significant difference between treatment groups. The patients' and the physicians' evaluations of the total state of disease, as well as range-of-motion and functional tests, demonstrated similar degrees of improvement in both treatment groups. The incidence of side effects was within acceptable limits, and the frequency distribution was similar in both groups. Of the 70 reported side effects, 29 were considered by the investigator (blind trial) to be drug-related-11 in association with ibuprofen and 18 with phenylbutazone-alka. Hematologic and blood chemical studies, as well as urine and stool examinations, yielded normal results with the exception of a reduced mean value for serum uric acid and a slightly elevated mean value for SGPT in the phenylbutazone-alka group.

Journal ArticleDOI
D. P. Dastoor1, S. Norton1, J. Boillat1, J. Minty1, F. Papadopoulou1, H. F. Müller1 
TL;DR: Assessment of present and past social functioning revealed good agreement between ratings made by different staff members, and a decline in social functioning with time differentiated organic from functional psychiatric illness.
Abstract: Eightly newly admitted psychogeriatric patients were intensively investigated by a variety of disciplines -- medical, laboratory, and psychologic-psychiatric tests, including a Minimal Social Behavior Scale and an Integrative Social Functioning Scale. The sample of patients and methods of study for this 10-month Geriatric Assessment Program are described. Assessment of present and past social functioning revealed good agreement between ratings made by different staff members. A decline in social functioning with time differentiated organic from functional psychiatric illness. Some of the scales employed may be of value for social screening purposes in the community.

Journal ArticleDOI
TL;DR: The evidence indicates that elderly subjects differ strikingly from young subjects in their responses to items in the MMPI self‐ratings of depression.
Abstract: The Depression Scale of the Minnesota Multiphasic Personality Inventory (MMPI) was used as a screening test for healthy volunteers in a psychopharmacologic research study. Data were collected on 43 men and 46 women under age 35 versus 33 men and 43 women over age 65 (plus a subsequent group of 40 men over age 65), and comparisons were made with more extensive data from the Mayo Clinic. The evidence indicates that elderly subjects differ strikingly from young subjects in their responses to items in the MMPI self-ratings of depression. Revised information on normative responses is needed. At present there are too many problems of interpretation when the Depression Scale items are applied to t.he elderly.

Journal ArticleDOI
TL;DR: An assessment was made of the effects of diphenylhydantoin (DPH) on the mental functions of clinically normal elderly persons, whose basic intelligence levels ranged between normal and bright‐normal and they represented middle and lower‐upper socio‐economic groups.
Abstract: An assessment was made of the effects of diphenylhydantoin (DPH) on the mental functions of clinically normal elderly persons. Their basic intelligence levels ranged between normal and bright-normal and they represented middle and lower-upper socio-economic groups. The 10 subjects, 4 male and 6 female volunteers (average age, 69.3 years), were given pretrial intelligence tests, repeated twice during a double-blind, cross-over study of drug and placebo effects. Each cross-over period lasted three weeks. The dosage of DPH (Dilantin) was 100 mg twice daily, and placebo capsules of identical appearance were given on the same schedule. The Wechsler Intelligence Scale series in three alternate forms was used to measure specific mental functions. The weighted scores of the alternate forms were directly compared to measure the difference between drug and placebo conditions. Significant increases in favor of DPH were observed in the Information, Comprehension, and Digit Symbol subtests, and in the Verbal Scale and Full Scale Intelligence Quotients. The first two measures indicated significant improvement in long-term memory and social comprehension. The third reflected an increase in the ability to learn new material and increased speed in visual-motor coordination. The fourth and fifth showed the effectiveness of DPH in improving general mental functioning. Apparently the underlying factor synthesizing these general DPH-associated improvements is mental concentration.

Journal ArticleDOI
TL;DR: A change in the attitude of society towards the elderly may help to alleviate the depressive state which so often contributes to the suicidal potential of older people.
Abstract: The current literature on suicide by medicinal overdose among the elderly population of the United States and Britain is discussed. The older white male is a high risk in this regard. Physical and mental illnesses contribute to the problem of suicide among the aged, and some of the drugs prescribed for treatment (e.g., barbiturates and psychotherapeutic agents) are often accessible to the older person for misuse in suicide. The responsibilities of the prescribing physician and the practices of the dispensing pharmacist are considered in relation to the exposure of the elderly patient to potentially lethal drugs. Prediction of suicidal attitudes in the elderly is complicated by the fact that any attempt at suicide usually is serious and rarely preceded by gestures. Depression, based on social factors, is common among older people. Some of them face problems of declining income and prestige, as well as a loss of physical and mental powers. A change in the attitude of society towards the elderly may help to alleviate the depressive state which so often contributes to the suicidal potential.

Journal ArticleDOI
TL;DR: The section on cognitive acting drugs includes some pertinent observations on cognitive ability in the aging, the importance of correct diagnosis, and therapeutic strategy.
Abstract: Psychotropic drugs are discussed under the descriptive categories of antipsychotic, antidepressive, antimanic, anti-anxiety, and cognitive acting. In the antipsychotic classification, special attention is given to side effects (extrapyramidal motor signs, tardive dyskinesias, akathisis) and to dosage for the elderly. The section on congenitive acting drugs includes some pertinent observations on cognitive ability in the aging, the importance of correct diagnosis, and therapeutic strategy. The aged are a population at risk for not only disease, but iatrongenic illness due to direct and indirect drug action. Rational therapy involves understanding the underlying dynamics of the disease and thus the selection of the most effective treatment. Psychotropic drugs in an appropriate program are valuable therapeutic assets.

Journal ArticleDOI
TL;DR: If the aged patient with gallstones has severe symptoms, is a good medical risk and is not demented, surgical treatment should not be denied because of advanced age, and surgical therapy should be postponed at least temporarily, in the hope that medical methods for dissolving gallstones soon will be perfected.
Abstract: Calculous gallbladder disease is the most common indication for intra-abdominal surgery in the elderly. Feeding bile salts may possibly increase the solubility of cholesterol in bile and may cause diminution in the size of radiolucent gallstones, the principal ingredient of which is cholesterol. However, indications for such treatment are still not clear, and long-term effectiveness and safety still have to be evaluated. If the aged patient with gallstones has severe symptoms, is a good medical risk and is not demented, surgical treatment should not be denied because of advanced age. If the patient has "silent" or "dyspeptic" gallstones and is a poor risk or demented, surgical therapy should be postponed at least temporarily, in the hope that medical methods for dissolving gallstones soon will be perfected.

Journal ArticleDOI
TL;DR: The intervals between the second heart sound and the peak of the E‐wave and the E-F interval in the echogram were longer in adults than in children and also longer in old persons than in younger adults, which should be taken into account before attributing any echocardiographic deviations to disease.
Abstract: A cardiographic study was performed on 71 subjects including 14 children, 42 young and middle-aged adults, and 15 old persons without evidence of heart disease. The echocardiogram of the mitral valve was recorded in the A mode by an analog method and was compared with the electrocardiogram, phonocardiogram, apex cardiogram, and carotid and jugular tracings, simultaneously obtained. The intervals between the various waves recorded by these methods were measured and the results were compared with those reported in the literature. A comparison of the duration of the intervals in the various age groups showed statistically significant differences. In particular, the intervals between the second heart sound and the peak of the E-wave and the E-F intervals in the echogram were longer in adults than in children and also longer in old persons than in younger adults. This important age difference should always be taken into account before attributing any echocardiographic deviations to disease.

Journal ArticleDOI
TL;DR: The inhibitory effect of high cost would be modified by the use of central regional pathology services and by reimbursement from third‐party insurance carriers, and the end‐result would be a higher quality of medical care for all patients, not excepting those in the geriatric age group.
Abstract: In the past forty years the autopsy rate in many large institutions has fallen drastically to a level of only 20-25 per cent. The large number of diagnostic errors revealed in autopsy records is in itself a cogent reason for a return to higher standards. The inhibitory effect of high cost would be modified by the use of central regional pathology services and by reimbursement from third-party insurance carriers. The end-result would be a higher quality of medical care for all patients, not excepting those in the geriatric age group.

Journal ArticleDOI
TL;DR: The occurrence of anemia in a group of aged persons residing in a home for the aged and in a chronic disease hospital was reviewed with regard to etiology, choice of treatment, and therapeutic response, and practical laboratory screening procedures for elderly anemic patients are discussed.
Abstract: The occurrence of anemia in a group of aged persons residing in a home for the aged and in a chronic disease hospital was reviewed with regard to etiology, choice of treatment, and therapeutic response. Of the 484 patients, 151 (31 per cent) had anemia or were receiving antianemia therapy. Iron-deficiency anemia was the most common type, and iron was the most common form of treatment. Seventy-eight patients were given antianemia therapy in 97 courses, and a good therapeutic result was achieved in about one-fourth of the courses. The most frequent error in iron therapy was its use in the anemia associated with chronic disorders. Often there was a combination deficiency of iron, vitamin B12 and folic acid. The response to iron in the elderly can be very slow, so therapy should not be discontinued too soon. Anemia may directly contribute to other serious pathologic conditions, especially in aged persons with impaired circulation. In some cases the physiologic concentration of hemoglobin may be higher than the accepted “normal” value. The course of the anemia in relation to the general state of the patient is more significant than any laboratory data in choosing antianemia therapy. Practical laboratory screening procedures for elderly anemic patients are discussed.