Showing papers in "Journal of the American Geriatrics Society in 1985"
TL;DR: Serial creatinine clearances were obtained for 446 normal volunteers in the Baltimore Longitudinal Study of Aging followed between 1958 and 1981 and there was a small group of patients who showed a statistically significant increase (P < 0.05) in Creatinine clearance with age.
Abstract: Serial creatinine clearances (5 to 14 studies) were obtained for 446 normal volunteers in the Baltimore Longitudinal Study of Aging followed between 1958 and 1981. When those subjects with possible renal or urinary tract disease and subjects on diuretics and antihypertensives were removed from the study, leaving a group of 254 "normal" subjects, the mean decrease in creatinine clearance was 0.75 ml/min/year. The slopes of the creatinine clearance vs. time fell into a normal (Gaussian) distribution around this mean. One third of all subjects followed had no absolute decrease in renal function (positive slope of creatinine clearance vs. time) and there was a small group of patients who showed a statistically significant increase (P less than 0.05) in creatinine clearance with age.
1,433 citations
TL;DR: Stature is an important variable in several indices of nutritional status that are applicable to elderly persons, however, it is difficult or impossible to measure in the nonambulatory elderly person, or its value may be spurious if measured in those elderly persons with excessive spinal curvature.
Abstract: Stature is an important variable in several indices of nutritional status that are applicable to elderly persons. However, stature is difficult or impossible to measure in the nonambulatory elderly person, or its value may be spurious if measured in those elderly persons with excessive spinal curvature. Simple equations are presented for estimating the stature of elderly men from a recumbent measure of knee height and for elderly women from a recumbent measure of knee height and age. The 90 per cent error bounds for these equations for an individual are about plus or minus 6.0 cm. Knee height is highly correlated with stature.
783 citations
TL;DR: A risk profile made up of the major cardiovascular risk factors was better for predicting IC than for predicting coronary heart disease, and mortality was increased two‐ to fourfold in men and women, respectively, mainly because of coexistent cardiovascular disease.
Abstract: During 26 years of surveillance of the Framingham Study Cohort of 5,209 subjects, 176 men and 119 women developed occlusive peripheral arterial disease manifested as intermittent claudication (IC). The incidence increased sharply with age until the age of 75, with about a twofold male predominance at all ages. An incidence of IC comparable to that of angina pectoris was obtained ten years later in life than for angina pectoris. Cigarette smoking, impaired glucose tolerance, and hypertension were powerful predisposing factors. Impaired glucose tolerance was a greater risk in women than in men, and glycosuria carried a greater risk than other indicators of impaired glucose tolerance. Cigarette smoking had about the same impact in men and women, approximately doubling the risk, and the impact was discernible into advanced age. Hypertension increased risk 2.5- to fourfold, respectively, in men and women. A low vital capacity was associated with a substantial excess risk. Electrocardiographic evidence of left ventricular hypertrophy predicted IC in both sexes. Serum cholesterol, relative weight, and hematocrit were weak risk factors. A risk profile made up of the major cardiovascular risk factors was better for predicting IC than for predicting coronary heart disease. Mortality was increased two- to fourfold in men and women, respectively, mainly because of coexistent cardiovascular disease.
720 citations
TL;DR: In order to determine the meaning of cognitive impairment in community dwelling elderly, 3,481 adults were interviewed in their homes using the Mini‐Mental State Examination and individuals with low scores were suffering from a variety of psychiatric disorders including dementia.
Abstract: In order to determine the meaning of cognitive impairment in community dwelling elderly, 3,481 adults were interviewed in their homes using the Mini-Mental State Examination. Ninety-six per cent of the population aged 18-64 scored 23 or higher, whereas 80 per cent of the population 65 and over scored 23 or higher. Individuals with low scores were suffering from a variety of psychiatric disorders including dementia. Thirty-three per cent of the elderly population scoring in the range of 0-23 had no diagnosable DSM-III condition. Prevalence of dementia from all causes was 6.1 per cent of the population over age 65. Two per cent of the population over age 65 were diagnosed as having Alzheimer's disease.
543 citations
TL;DR: A brief, valid, and reliable five‐item screener based on instrumental activities of daily living which can rapidly identify elderly community residents with impaired functional capacity, and which, because of its substantial correlation with physical health, mental health, and predictability of death, can identify those for whom more extensive assessment is warranted.
Abstract: Although multidimensional functional assessment may be the route of choice in determining the personal status of the elderly and the services they need, the majority of the elderly are well and competent, making it hard to justify routine extensive assessment with its attendant costs. Described herein is a brief, valid, and reliable five-item screener based on instrumental activities of daily living which can rapidly identify elderly community residents with impaired functional capacity, and which, because of its substantial correlation with physical health (r = .54 to .55), mental health (r = .54 to .60), and predictability of death can identify those for whom more extensive assessment is warranted. Use of such a brief screener should result in better targeting of elderly in need of service, facilitate coordinated and efficient health care delivery, and maintain the functional independence of the elderly.
512 citations
TL;DR: The hypothesis arises, therefore, that several of the geriatric changes in structure and function result at least in part from GH deficiency, and could be reversed by continuing treatment with human GH (hGH) at physiologic or replacement doses.
Abstract: For many years, it has been known that the composition of the human body changes with advancing age. In healthy youth, about 10% of the body weight is bone, 30% is muscle, and 20% is adipose tissue. After about age 50, these ratios change progressively. At age 75, a typical composition is 8% bone, 15% muscle, and 40% adipose tissue. The loss of bone mass predisposes to fractures of the spine and extremities. Loss of muscle mass reduces strength and endurance. Simultaneously, the functional capacities of most organ systems decline. We do now know the cause for these age-related, undesirable changes in body composition and in physiologic functions. Recently, a new aspect of the geriatric endocrine system was discovered that may provide both a partial explanation and a treatment. After about age 50, the secretion of growth hormone (GH) gradually declines and ultimately stops in many individuals. About half of our citizens over age 65, therefore, are partially or totally deficient in GH. Growth hormone has powerful effects on body composition and on the functions of most organs except the nervous system. Many of these somatotropic effects are opposite in direction to the geriatric declines in structure and function. Thus, GH causes enlargement of muscles, liver, kidneys, bones, and lymphoid organs; shrinkage of adipose mass; and increases in renal blood flow and glomerular filtration rate. The hypothesis arises, therefore, that several of the geriatric changes in structure and function result at least in part from GH deficiency, and could be reversed by continuing treatment with human GH (hGH) at physiologic or replacement doses.
359 citations
260 citations
TL;DR: This study indicates that community‐acquired pneumonia is a serious illness and that an algorithm approach to diagnosis and treatment of such pneumonia is necessary.
Abstract: The authors studied 138 patients, 57 of whom were younger than 65 years of age and 81 who were 65 years of age and older, with community-acquired pneumonia to determine whether or not such pneumonia is different in the elderly and to define how such patients are investigated and treated. Pneumonia in the elderly was characterized by a higher mortality, 30 v 10%; more likely to be of unknown etiology, 54 v 30%; and more likely to show radiographic progression after the patient had been admitted to the hospital, 48 v 11%. In addition, elderly patients were more likely to be afebrile when admitted, 57 v 26%. Twenty-seven etiologic categories were present in 77 patients in whom a cause for the pneumonia was established. Streptococcus pneumoniae accounted for 9.4% of the pneumonia overall and for 27% of the pneumonia among patients who had sputum cultures performed before antibiotic therapy. The diagnostic yield was 11.6% for blood cultures, 38.2% for sputum cultures, 2.3% for throat washing, and 22.1% for serological studies. Twenty-seven percent of patients were receiving antibiotics of the time of admission to the hospital. Most (79%) received more than one antibiotic after admission. This study indicates that community-acquired pneumonia is a serious illness and that an algorithm approach to diagnosis and treatment of such pneumonia is necessary.
238 citations
TL;DR: Preliminary data suggest that hospital readmission among the aged is a complex multifaceted phenomena.
Abstract: This paper investigates the six-month hospital readmission rates among 444 patients 65 years of age or older admitted to a large metropolitan teaching hospital who had a primary discharge diagnosis of cerebrovascular disease, hip fracture, or congestive heart failure. Twenty-four percent were readmitted to the same institution one or more times during the six-month follow-up. Striking variability was observed in use of hospitals across these diagnostic groups. Patients with a primary diagnosis of congestive heart failure were at highest risk of hospital readmission (36%). Multiple readmissions among the congestive heart failure group were prevalent. These preliminary data suggest that hospital readmission among the aged is a complex multifaceted phenomena.
229 citations
TL;DR: It is with interest that the position paper of the American College of Physicians with regard to long-term care of the elderly is read and the statement that “certification in internal medicine reflects expertise in geriatric medicine” hard to accept.
Abstract: To the Editor:-It is with interest that I read the position paper of the American College of Physicians with regard to long-term care of the elderly. I must admit that I found the statement that “certification in internal medicine reflects expertise in geriatric medicine” hard to accept. While I never trained in the United States, I believe internal medicine training in Canada is fairly equivalent. From my own experience in both internal medicine and geriatric medicine, I feel the training in internal medicine does not in itself give “expertise” in geriatric care. In the internal medicine training programs that I have been associated with in Canada, there has been no emphasis on geriatrics. Dr. W. B. Dalziel reviewed the geriatric content in major Canadian examinations for the Canadian Society of Geriatric Medicine. He found that in the Royal College speciality examinations for internal medicine between the years 1979 and 1983 (inclusive), questions pertaining to health care of the elderly made up between 2.4 and 4.6 per cent of the multiple choice questions. This examination is to be a comprehensive evaluation of the knowledge base of individuals sitting the examination. If the relative importance of a topic is related to the number of questions asked, then geriatric care, at least in the Canadian internal medicine examinations, has relatively little importance.
210 citations
TL;DR: The conceptual foundation, appropriate uses, psychometric properties, and recent refinements in the OARS methodology are described and an assessment of the strengths and limitations of the Oars methodology is presented.
Abstract: The Older Americans Resources and Services (OARS) methodology was designed to assess functional capacity in five dimensions (social resources, economic resources, mental health, physical health, and activities of daily living) and to measure use of and need for 24 types of generic services. The OARS questionnaire now has been used in more than 150 research and practice settings. Recent refinements in the OARS methodology include new information about validity and reliability, computerized summary ratings for the five dimensions of functional status, and eleven scales that measure specific aspects of functioning within the five dimensions. This paper describes the conceptual foundation, appropriate uses, psychometric properties, and recent refinements in the OARS methodology. Empirical data from a geriatric clinic population are used for purposes of illustration. The paper presents an assessment of the strengths and limitations of the OARS methodology based on more than a decade of experience. Particular attention is paid to the degree to which the measures of functional status can be related to health service use measures to inform geriatric research and practice.
TL;DR: Rates of cognitive impairment increase markedly with age and high rates of this disorder were found among those never married, separated, divorced, or widowed, and implications for understanding mental morbidity among the elderly and issues for future planning are discussed.
Abstract: An extensive analysis of prevalence rates of cognitive impairment and other mental morbidities was carried out as part of a five-site national study on the health and mental health of an ambulatory population. This study reports on prevalence rates contrasted by age across the 18 and over population for cognitive impairment and other diagnoses in the Baltimore, Maryland, site of this study. Differences in prevalence rates by age are striking. Eight conditions have rates above 1 per cent among those 64 and younger: phobia (13.8 per cent), alcohol use disorder (6.5 per cent), obsessive compulsive disorder (2.2 per cent), schizophrenia (1.4 per cent), and panic disorder (1.2 per cent). For the older group, 65 to 74 years, five conditions have such prevalence rates: phobic disorder (12.1 per cent), severe cognitive impairment (3.0 per cent), alcohol use disorder (2.1 per cent), obsessive compulsive disorder (2.2 per cent), and dysthymia (1.0 per cent). For the oldest group, those 75 and over, only four conditions have rates of 1 per cent or more. These are: phobic disorders (10.1 per cent), severe cognitive impairment (9.3 per cent), major depression (1.3 per cent), and dysthymia (1.1 per cent). Rates of cognitive impairment increase markedly with age and high rates of this disorder were found among those never married, separated, divorced, or widowed. Implications of these findings for understanding mental morbidity among the elderly and issues for future planning are discussed.
TL;DR: The functional and clinical burdens of low back pain in this population of rural elderly were substantial and require further evaluation of risk factors and impact on health status.
Abstract: As part of an interview survey of a defined population of 3,097 rural persons 65 years and older (the Iowa 65 + Rural Health Study), the prevalence and functional correlates of specifically defined low back pain were studied. Low back pain was reported by 23.6 per cent of the women and 18.4 per cent of the men in the year prior to the survey, with prevalence rates declining with age. Forty per cent of those with low back pain noted its presence at the time of the interview. Over half had used analgesics. Use of medical and chiropractic services for this symptom was nearly 75 per cent; 25 per cent had at least one hospitalization directly related to low back pain and over 5 per cent had low back surgery. Limitation of walking, sitting, bending over, and performing household chores was reported by 15 to 40 per cent, and 21 per cent attributed sleep disturbance to the low back pain. Nearly 75 per cent of subjects with low back pain reported first onset of the problem prior to age 65, which has important implications for pathogenesis and prevention. The functional and clinical burdens of low back pain in this population of rural elderly were substantial and require further evaluation of risk factors and impact on health status.
TL;DR: Logistic regression analyses of subsamples of breast, lung, and colorectal cancer patients indicate that age is significantly inversely related to receipt of both subsequent chemotherapy and radiation therapy, controlling for stage of disease and presence of co‐morbid disease.
Abstract: Increases in cancer incidence and mortality reflect the larger numbers of elderly in the population. Using a mortality sample of 1891 biopsy-confirmed cancer patients, analyses reveal older breast, prostate, and cervical-uterine cancer victims were more likely to be diagnosed with metastases. Logistic regression analyses of subsamples of breast (N = 224), lung (N = 513), and colorectal (N = 299) cancer patients indicate that age is significantly inversely related to receipt of both subsequent chemotherapy and radiation therapy, controlling for stage of disease and presence of co-morbid disease. Exceptions to this relationship are the use of radiation therapy among nonmetastatic lung cancer patients and all breast cancer patients. The implications of these findings for current cancer control programs are discussed.
TL;DR: Biofeedback training did significantly augment sphincter strength and was associated with greater than 75 per cent decreases in incontinence for 10 patients, and appears to be of specific value in the treatment of fecal incontinent in geriatric patients.
Abstract: Eighteen fecally incontinent geriatric patients were first treated for constipation as a possible cause of incontinence, and the 13 who remained incontinent were provided sphincter biofeedback training. Half the patients were instructed to perform 50 sphincter exercises per day for a four-week period prior to the start of biofeedback training to determine whether such exercises would improve bowel control in the absence of biofeedback training. Sphincter exercises alone did not produce clinical improvements and did not significantly increase the strength of sphincter contractions. Biofeedback training did significantly augment sphincter strength and was associated with greater than 75 per cent decreases in incontinence for 10 (77 per cent) of the patients. Improvements were maintained in 60 per cent at six months and in 42 per cent at one year. Thus biofeedback training appears to be of specific value in the treatment of fecal incontinence in geriatric patients.
TL;DR: It is concluded that incontinence is more commonly a by‐product of immobility and dependency than of involvement of the neurologic pathways, and most of it is transient.
Abstract: The incidence of incontinence in a series of 135 consecutive stroke patients was 51% (urine) and 23% (feces) within one year. In 75% the urinary incontinence started within the first two weeks, and in 41% it had cleared during that time. Incontinence at onset is associated with measures of severity of stroke (and of immobility for fecal incontinence). Among 92 survivors at one year, 15% were incontinent of urine, a proportion that rose in two- and three-year survivors to 23 to 24%, but by four years was again 14%, a level similar to that of the general elderly population. It is concluded that incontinence is more commonly a by-product of immobility and dependency than of involvement of the neurologic pathways, and most of it is transient.
TL;DR: It is concluded that the level‐of‐orientation screening examination used by clinicians to detect dementia is unacceptably insensitive, and a composite decision rule including nonorientation items achieves high sensitivity with relatively high specificity.
Abstract: Investigators have reported poor recognition of dementia by primary physicians. For this reason, mental status examinations were performed on 72 demented and 144 nondemented medical inpatients to assess the sensitivity, specificity, and predictive value of components of this examination in the diagnosis of dementia. Sensitivity of individual level-of-orientation items was low (15.3 to 56.9%), though specificity was high (91.7 to 100%). Sensitivity of several nonorientation items was high (80.6 to 100%), though specificity was low. A multivariate discriminant equation using both orientation and nonorientation items achieved high sensitivity (89.6% test cases, 87.5% validation cases) and specificity (78.1% test cases, 87.5% validation cases). Adding the easily obtained patient characteristic of age to the equation further increased sensitivity (95.8%, 91.3%), while maintaining specificity (82.3%, 85.4%). From these results, it is concluded that the level-of-orientation screening examination used by clinicians to detect dementia is unacceptably insensitive. In contrast, a composite decision rule including nonorientation items achieves high sensitivity with relatively high specificity.
TL;DR: The utilization of services by older patients with mental morbidity is examined, drawn from a large, multi‐site study, the Epidemiological Catchment Area studies, and reports on the findings from the Baltimore, Maryland, site, The Eastern Baltimore Mental Health Survey.
Abstract: The utilization of services by older patients with mental morbidity is examined in this paper. The population is drawn from a large, multi-site study, the Epidemiological Catchment Area studies, and reports on the findings from the Baltimore, Maryland, site, The Eastern Baltimore Mental Health Survey. The fact that older individuals with mental disorders are less likely to be seen and treated for these disorders than are younger individuals was substantiated by data from this study. Of those under age 65, 8.7 per cent have made a visit to a specialty or primary care provider for mental health care; for those age 65 to 74, the rate is 4.2 per cent, and of those 75 and over, only 1.4 per cent have had such care. In this last group, 75 and over, not a single person saw a specialty mental health provider. The likeliest source of care for older individuals for emotional or psychiatric problems is their primary care providers within the context of a visit made for physical medical problems. Past work and these data suggest that the factors that influence this low level of care can be found in the characteristics of the population as well as in the characteristics of the health care system. The implications of these findings are discussed.
TL;DR: Results indicated that a relatively short but intensive support experience can have a positive effect in reducing some of the burden and depression associated with the care of a demented relative.
Abstract: The purpose of this study was to investigate the efficacy of a specifically designed group support program for relatives of patients with Alzheimer's disease and related disorders The group program included educational/supportive activities and used basic principles of the cognitive-behavioral approach Twenty-two subjects participated in an eight-session program Eighteen control subjects received no treatment Measures of family burden, levels of depression, and knowledge of dementia were obtained Experimental subjects showed a significant decrease in total family burden, whereas control subjects actually showed a significant increase, experimental subjects also showed reduction in their levels of depression Experimental subjects showed a significantly greater improvement than did control subjects on knowledge of dementia The acquisition of new knowledge was an important ingredient in reducing perception of burden and levels of depression, but other facets of the intervention also accounted for the improvement Results indicated that a relatively short but intensive support experience can have a positive effect in reducing some of the burden and depression associated with the care of a demented relative
TL;DR: A study of patients over 65 years of age admitted to a university general hospital reveals that 79% of cognitive deficits were missed by the examining physicians and a clear‐cut cognitive deficit on admission was predictive of later acute episodes of confusion.
Abstract: A crucial factor in promoting a vigorous quality of life in the aging population is assessment and treatment of cognitive deficits. A very high percentage of delirium and at least 20% of dementia is eminently treatable. This study of patients over 65 years of age admitted to a university general hospital reveals that 79% of cognitive deficits were missed by the examining physicians. Furthermore, in 394 examinations of 165 patients, only four mental status examinations were recorded. A clear-cut cognitive deficit on admission was predictive of later acute episodes of confusion. The global techniques of evaluation deserve remediable action by medical schools and hospital training programs if the medical care of the elderly is to be improved.
TL;DR: The authors conclude that the elderly cancer patient experiences less psychosocial disruption from cancer than do younger individuals.
Abstract: This report examines the psychosocial impact of cancer in 240 men according to age using a recently developed cancer-specific survey instrument. Overall, younger patients experienced more frequent or severe psychosocial and treatment-related problems than the older patients, especially in relation to work and chemotherapy. In addition, younger patients experienced more difficulty dealing with the health care setting. The authors conclude that the elderly cancer patient experiences less psychosocial disruption from cancer than do younger individuals. J Am Geriatr Soc 33:429, 1985
TL;DR: The authors conclude that consideration of quality of life in making life‐and‐death treatment decisions may involve judgments about the value of life, and that responsible consideration requires guidelines grounded in ethical principles.
Abstract: Quality-of-life considerations in physicians' decisions on life-sustaining therapy were explored using a patient management problem (PMP) depicting acute respiratory failure in an elderly man with chronic pulmonary disease; 205 internal medicine and family medicine physicians were interviewed. The physicians' perceptions of the patient's quality of life demonstrated marked variability. Physicians considered the patient's quality of life more often to support decisions to withhold therapy than to support decisions to use mechanical ventilation (p less than 0.01). Consideration of quality of life was associated significantly with several PMP components: interpretation of the patient's prior medical experience, management of supplementary case information, attitudes about medical responsibilities/patient rights, and estimates of the patient's survival time. The authors conclude that consideration of quality of life in making life-and-death treatment decisions may involve judgments about the value of life, and that responsible consideration requires guidelines grounded in ethical principles.
TL;DR: The mean monthly census of elderly patients backed up in hospital declined 21 per cent during this period, a reversal of previous rises that could not be explained by any other identifiable factors.
Abstract: Back-up of elderly patients in hospital awaiting long-term placement has become a major problem in some areas of the United States and elsewhere. In 1982, geriatric consultation teams (physician, nurse, and social worker) were introduced into six acute hospitals in Monroe County, New York, to help alleviate the problem through more attention to restoration of patient function and comprehensive discharge planning. Over a six-month period, 4,328 newly hospitalized patients aged 70 or older were screened, and geriatric consultations were provided for 366 (8.5 per cent) who were judged to be at risk of requiring prolonged hospital stays. During this period, the mean monthly census of elderly patients backed up in hospital declined 21 per cent, a reversal of previous rises that could not be explained by any other identifiable factors. The impact was on length of stay on back-up status rather than rate of entry to that status. A variety of medical, rehabilitative, and social interventions accounted for this outcome. A number of health care system barriers to expeditious rehabilitation and discharge of hospitalized elderly patients were identified. Geriatric consultation was deemed useful for implementation in acute hospitals in other settings.
TL;DR: A review of the literature, excluding case reports, since 1952 reveals 21 studies of antipsychotic use in treatment of dementing disorders; the better designed of these studies are reviewed, with emphasis on therapeutic outcome and adverse effects.
Abstract: Interest in dementia is increasing among clinicians and researchers alike; research in dementia, including treatment, has increased dramatically. The major emphasis in the treatment research has been aimed at correcting the cognitive disturbance. While this aspect is certainly important, research into the treatment of the behavioral complications has been relatively neglected. The behavioral complications of dementia (e.g., apathy, agitation, uncooperativeness, wandering, psychosis, etc.) are familiar problems to any clinician caring for demented patients, particularly those in long-term care facilities. Although successful treatment of the cognitive disturbance theoretically might also treat the behavioral complications, this may remain unavailable for many years to come. Currently, antipsychotics remain the mainstay of the treatment for behavioral complications and are in widespread use. The research basis for such use, however, remains limited. Antipsychotics have been used for neuropsychiatric disorders since 1952. A review of the literature, excluding case reports, since that time reveals 21 studies of antipsychotic use in treatment of dementing disorders. In comparison, there are in excess of 30 studies of dihydrogenated ergot alkaloids (Hyderginea) alone2 This review reports on the 21 s t ~ d i e s ~ ~ found in the literature. The better designed of these studies are reviewed in detail below, with emphasis on therapeutic outcome and adverse effects.
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TL;DR: A blunted or absent fever response to infections observed in some elderly patients may be due to defects in thermoregulation, which may include impairment of both behavioral and physiologic responses.
Abstract: The pathogenesis and clinical relevance of fever is reviewed. The interrelationship between fever and other biologic responses to infection is summarized. A blunted or absent fever response to infections observed in some elderly patients may be due to defects in thermoregulation. These abnormalities in thermoregulation may include impairment of both behavioral and physiologic responses.
TL;DR: The primary goal of this article is to develop a hypothesis that explains why the incidence of NIDDM increases with age, and to review available information pertaining to the effect of age on insulin secretion and insulin action and to present current views concerning the pathogenesis.
Abstract: Although insulin-dependent diabetes mellitus (IDDM) can occur in older patients, non-insulindependent diabetes mellitus (NIDDM) is by far the most common form of diabetes present in this age group. The primary goal of this article is to develop a hypothesis that explains why the incidence of NIDDM increases with age. To do so, it will be necessary to review available information pertaining to the effect of age on insulin secretion and insulin action and to present current views concerning the pathogenesis of NIDDM. In addition, attention will be directed to the health-related implications of the changes in insulin secretion and action that occur with aging. The benefit of this presentation to the reader will, it is hoped, be the acquisition of some new insights on an old issue. The benefit to us is considerable and stems from the challenge to prepare a coherent paper on NIDDM in the geriatric population. Since the rostrum is ours, it is only fair that certain prejudices be declared at the outset. Most important, we do not believe that one can develop a thoughtful view concerning the impact of NIDDM in the elderly by considering only the changes in carbohydrate metabolism associated with senescence. To be more specific, events that occur in middle life (excessive weight gain, for example) can have profound clinical effects 20 years later. Limiting discussion to studies of older subjects may be considered “pure” by the professional gerontologist, but we believe that this leads to a distorted view that can adversely affect our ability to minimize the deleterious effects of NIDDM in the older patient. In addition, we think it helpful to integrate information gained from animal studies with the results of clinical investigation. Specifically, questions that are difficult or iinpossible to answer in research on humans can sometimes be answered in animal studies, and the information thus accrued can be extremely useful in a variety
TL;DR: The results demonstrated that insulin‐stimulated glucose disposal was significantly increased in the normal older subjects who exercised regularly, and a direct relationship existed between maximal aerobic capacity and in vivo insulin action, which was independent of either BMI or percentage body fat.
Abstract: The goal of this study was to evaluate the effect of differences in habitual level of physical activity on insulin action in healthy males between 60 and 75 years of age. The study population consisted of 20 non-obese individuals with normal glucose tolerance: 13 older subjects (68 +/- 4 years) not exercising regularly and 7 older subjects (66 +/- 3 years) who exercised regularly. Measurements were made of body mass index (BMI), percentage body fat by underwater weighing, maximal O2 consumption by bicycle ergometry (VO2max), and insulin-stimulated glucose disposal by the insulin clamp technique. The results demonstrated that insulin-stimulated glucose disposal was significantly increased (P less than 0.001) in the normal older subjects who exercised regularly. Furthermore, a direct relationship (r = 0.74, P less than 0.001) existed between maximal aerobic capacity and in vivo insulin action, which was independent of either BMI or percentage body fat. These data are consistent with the view that the extensive variation previously noted in in vivo insulin-stimulated glucose disposal of older subjects is related to differences in habitual physical activity.
TL;DR: The finding of significant impairments for fallers in visual perceptual abilities confirmed a trend previously established by one of the authors (Tobis) and felt that this relatively greater dependence on visual sources may develop in response to impairment of feedback on posture and gait from the kinesthetic and vestibular systems as a result of age and chronic health problems.
Abstract: The authors postulated that older adult fallers show a greater tendency than older adult nonfallers to rely more on visual information sources in maintaining upright posture than on kinesthetic and vestibular cues. This paper presents descriptive statistics on 199 older adults living independently in the community. Their visual perception of the vertical and horizontal was analyzed with respect to age, sex, health status, and severity of injury as a result of a fall. The finding of significant impairments for fallers in visual perceptual abilities confirmed a trend previously established by one of the authors (Tobis). When the visual field entailed only misleading or ambiguous cues in the form of a tilted frame, fallers again showed a larger error than nonfallers in establishing the vertical and horizontal. The authors feel that this relatively greater dependence on visual sources may develop in response to impairment of feedback on posture and gait from the kinesthetic and vestibular systems as a result of age and chronic health problems. Errors in visual perception of the vertical and horizontal intercorrelated with age, sex, and a large number of medical problems. However, visual variables were more important in predicting faller status than physical characteristics.
TL;DR: Widowed residents of two nursing homes who were oriented to person, time, and place were interviewed to determine the extent to which they had hallucinatory experiences of their deceased spouse, suggesting that these experiences are more common in the United States than has been recognized.
Abstract: Widowed residents of two nursing homes who were oriented to person, time, and place were interviewed to determine the extent to which they had hallucinatory experiences of their deceased spouse. Fifty-two interviews were completed with 46 widows and six widowers. Results are reported for the widows. Twenty-eight (61%) of the widows reported hallucinatory experiences of their deceased spouse. Twenty-four (86%) of the widows described the experiences as good or helpful. Thirteen (46%) reported that the experiences continue to happen. Nineteen (54%) of the widows had never discussed the experiences with anyone before this study. These results are surprisingly similar to previously published findings by Rees in Wales and suggest that these experiences are more common in the United States than has been recognized.