Showing papers in "Zeitschrift für Gerontologie in 1989"

Diarrhea and fecal impaction in elderly long-stay patients.

Abstract: A retrospective screening of one year's duration was carried out on 245 permanently hospitalized geriatric patients to study the frequency and cases of periods of at least three days' diarrhea. Such periods were suffered by 65/245 patients and 32% had recurrencies. Fecal impaction was the most common cause of diarrhea (in 55%). Diarrhea was induced by laxatives in 20%. Gastrointestinal infections caused 5% of the diarrhea cases. Immobility and fecal incontinence were strongly associated with fecal impaction in cases of diarrhea. Urinary tract infections treated with antibiotics in the patients with fecal impaction and diarrhea almost were twice as frequent as in patients with other causes of diarrhea or patients with no diarrhea. This retrospective investigation emphasizes the importance of the recognition and proper treatment of constipation, especially in bedridden or chairbound elderly persons with fecal incontinence and diarrhea.

Delusional depression in the elderly: a community study.

Abstract: The prevalence of delusional depression, its symptoms and signs, and social and health status of delusional depressives were studied in a Finnish population aged 60 years or over. The prevalence was six per 1,000 men, 12 per 1,000 women, and 10 per 1,000 for both sexes. The overall symptomatology of delusional depressives was more severe than that of nondelusional major depressives or of all nondelusional depressives. The mean age at the onset of depression and the mean duration of depression did not differ between delusional and nondelusional major depressives. Although delusional depressed elderly did not significantly differ statistically from nondelusional major depressives in social status, somatic health status, functional capacity, or occurrence of social or health stress factors; they tended to have a better somatic health status and they tended to be more lonely. The small number of delusional depressives does not give us the opportunity to draw straightforward conclusions about whether elderly delusional depressives are a subcategory differing from other elderly major depressives.

Subjective time estimation in relation to age, health, and interhemispheric brain asymmetry.

Abstract: The subjective estimation of time was studied in the population sample of 256 subjects aged 20 to 80 years. Among the elderly, a group of patients with cerebral atherosclerosis and a group of apparently healthy persons were selected. The study also involved 48 patients with remaining manifestations of right- and left-sided stroke. The unoccupied time interval and the interval occupied with performance of verbal tasks were estimated. In both cases, interval durations were 45 s. There was an underestimation of the unoccupied interval in the young group and it was overestimated by the elderly group. With the performance of verbal tasks, the age differences were insignificant. Occupied interval vs unoccupied interval was underestimated to a greater degree. No sex differences were noted. Time estimation in cerebral atherosclerosis without focal disturbances was analogous to the pattern being observed in aging. In left-sided stroke, underestimation of time and estimation accuracy exceeded similar indices in other groups. The relationship was established of the subjective time estimation with non-verbal intellect and several characteristics of brain asymmetry, but not with handedness.

Relationships between nutrient intake, nutritional status and activity levels in an elderly and in a younger population; a comparison of physically more active and more inactive people.

Abstract: Differences in absolute nutrient intakes, nutrient densities, and nutritional status between more physically active and more physically inactive elderly persons were analyzed from data of the Heidelberg-Michelstadt-Berlin Study. Comparisons were made in the different sex groups for older persons, the same comparisons were made for a group of younger persons. Although there was no significant statistical difference, the active persons had higher absolute energy intakes compared with inactive persons in all groups, except in the younger female group. Active older women have statistically significant higher vitamin B2, iodine, and calcium intakes than less active older women. Active older men have higher energy, carbohydrate, carotene, vitamin E, vitamin C, and calcium intakes than the less active older men. A totally different pattern of intakes is seen in the group of younger persons. The more active younger women show lower absolute intakes of vitamin A, vitamin E, vitamin B1, niacin, vitamin B6, vitamin B12, and sodium in comparison with the less active young women. Active young men show higher iodine intakes compared with the inactives. The differences in intakes however are not reflected in the nutritional status. The nutritional status of more active people is therefore neither endangered nor improved in comparison with less active.

The frequency of unsuspected tuberculosis found post-mortem in a geriatric population.

Abstract: Over a period of 14.5 years, 1911 complete autopsies were performed consecutively in two divisions of the same University Department of Geriatric Care, i.e., the Geriatric Hospital and the Center for Continuous Care. Sixty cases of active tuberculosis were observed, of which 37 cases (mean age of 84.51 years) had been clinically undiagnosed. Comparison with other published series indicate that the risk of unsuspected active (in fact, reactivated) tuberculosis mainly concerns "high age". The conditions which favor the disease are mainly in the context of immunodeficiency. Those which hinder the diagnosis are various, e.g., non-indicative tuberculin test, frequent impossibility to perform eye fundus examination or more aggressive investigations, frequency of cancer, and frequency of dementia in elderly people.

Visual acuity and refractive errors in the elderly in nursing homes.

Abstract: A total of 268 elderly persons living in eight nursing homes in northern Finland (participation rate 100%) were examined by an ophthalmologist in 1980-1983 in order to describe visual acuity and the occurrence of refractive errors. Uncorrected distant visual acuity in the better eye was less than 0.4 in 76% of the men and 68% of the women, being worse in older subjects than in younger ones. Uncorrected near visual acuity in the better eye was less than 0.1 in 24% of the men and 25% of the women. Hyperopia was found in 78% of the men and 77-78% of the women and myopia in 14-15% of the men and 15-16% of the women. Hyperopia decreased and myopia increased with age. Astigmatism was uncommon and its prevalence figure was not related to sex or age. Only 3% of men and 5% of women were emmetropic. We may conclude that uncorrected distant visual acuity of the population was low, and three out of every four men and two out of every three women were unable to manage their daily activities without difficulties due to the low visual acuity. Also uncorrected near visual acuity was low, and one out of every four persons was practically blind.

Changes in time perspectives in advanced age

Abstract: Three hypotheses on changes in the time perspective of elderly people and their behavioral consequences are discussed: firstly, Kuhlen's hypothesis of an increasing sensitivity for the passing of time with increasing age, secondly that of a de-differentiation of future time perspective in old age, and finally the thesis that only normative-prescriptive approaches are appropriate in the study of coping with finitude. The three hypotheses are either rejected or modified on the basis of research data. Time perspective in old age is the outcome of continuous life-long changes and adaptations in the temporal and social orientation of man.

[Malnutrition in the aged--effect of physical, mental, psychological and social factors].

Abstract: The elderly are considered a risk group for malnutrition, due not only to poor nutrition, but also to other aspects of daily life which affect food intake and nutritional status. In this study 11 factors of physical, mental, psychical, and social origin have been defined as risk-factors leading to malnutrition. Their appearance in a group of 100 geriatric patients above the age of 75 years has been examined. Immobility and difficulties with chewing were found in nearly 50% of the patients. Social problems were observed in 22%-31%. In contrast, there was usually a daily hot meal available to those studied. The relation between the number of risk factors and the nutritional status was obvious. None of the 23 underweight patients was without a risk factor. In 17 (74%) of these patients four or more risk factors were found. For an amelioration of the nutritional situation not only a well balanced diet should be available but the elderly person's complete life situation must be considered.

[Dietary habits of the aged--frequency of intake of foods of high nutritive value].

Abstract: The high rate of malnutrition in the elderly suggests the need for increased availability of high nutrient density foods such as fruits, vegetables, milk, and whole grain products. An analysis of nutritional habits of 100 persons 75+ years showed that 75% had insufficient intake of whole grain products, 50% an insufficient intake of milk and dairy products, and 25% an insufficient intake of fruits and vegetables. Food intake was shown to be largely independent of such factors as sex, age, or life situation. Only for milk and dairy products could a better supply be shown for institutionalized persons than for independent-living persons. The results of the study emphasize the need for better nutritional information and education of the elderly regarding the importance of high nutrient density foods.

Intergenerational transfers: aging parents living with adult children and vice versa.

Abstract: The family remains important for care of the elderly; less well understood is the significance of even aging parents for their offspring, which may be more so today than in the past and more so in the welfare states--with 'resourceful' old people--than in the less affluent societies. This study tries to verify this by an analysis of coresidence patterns between generations, with particular emphasis on the younger one. In particular, men with various handicaps may more often find refuge with their family of origin than do others, and more often today than they did in the not-so-distant past.

Changes of organ indices of CBA/Ca inbred mice as function of age.

Abstract: Weight changes of seven organs: brain, heart, lungs, liver, spleen, small intestine, and kidneys, were analyzed during aging of male CBA/Ca inbred mice. Data were collected as absolute organ weights, organ weights related to body, as well as brain weights. It was established that most organs increase their weight up to nearly two years of age, after which there is a dramatic decline. Body weight shows a distinct plateau or constancy along the lifespan of the animals; consequently, body weight seems to be generally the most favorable reference point to express some of the physiological changes and parameters of the aging organism. Variation coefficients of the organ weights generally become higher with age.

Social class and social mobility--effects on survival. A study of an entire birth cohort during an 80-year life span.

Abstract: The effects of social class and social mobility on mortality are examined using data for a cohort of 489 individuals born in 1902 and 1903 in Sweden who were followed up to age 80. No significant differences in mortality by social class were observed. "Concerning social mobility when males and females were analyzed separately those men with no mobility had a significantly lower survival rate than those with downward or upward mobility. For women there was no such difference in survival. In a multivariate survival analysis among eight social factors sex and marital status had the greatest effect on survival between 20-80 years of age. Widows and widowers had unexpectedly a higher survival compared to married and never married persons." (EXCERPT)

Adjustment to early retirement in males

Abstract: The article deals with pre-retirement as a critical life-event in the livespan of men. The empirical study shows modes of experiencing and adapting to pre-retirement. The predictors of adjustment to and satisfaction with retirement, as well as consequences of retirement in social participation are discussed.

[Sports in the aged--sociologic and social psychological aspects].

Abstract: In a standardized oral interview of 75 athletic seniors (men and women) from Saarland, (average age: 67.15 years), the following relations were examined: a) what is the relation between a high-level of activity and the overall satisfaction with the quality of life? b) how far do biographical-, sex- and class-specific variables influence the possible continuity of a lifelong engagement in physical activity (sports)?; and, c) what are the specific characteristics of the motivation of older people to participate in senior sports? The results were, among others: a) those who participate in sports at an advanced age often have been engaged in physical activities throughout their lives (this applies more to men to than women); b) a high individual level of activity (low disengagement) and a high subjective satisfaction with the quality of life have a positive correlation; c) the socialization to engage in sports because of physical education classes in school influences the continuity of a lifelong engagement in sports; and d) the motivation of older people to engage in physical activity is marked by three essential features: an expressive-emotional one (pleasure in physical exercise), a social-integrative one (camaraderie, social life, etc.), and an instrumental one (physical activity for reasons of health).

[Normal pressure hydrocephalus in geriatric patients--a treatable form of dementia].

Abstract: Six geriatric patients are presented who were treated because of normal pressure hydrocephalus. A tentative diagnosis was made if dementia, gait disturbance, and incontinence together with a typical CAT-scan were present. In these cases an operation was carried out. After ventriculo-peritoneal shunting clinical improvements were seen in four patients. Postoperative complications were hygromas in three patients and a shunt-dislocation in another patient. A chronic subdural bleeding was recorded also in one of these patients with only a temporary success in this case. Two patients showed no clinical improvement at any time. However, in these cases additional neurologic symptoms together with typical CAT-scan changes were present. Before making a decision for an operation vascular processes and Alzheimer's disease should be ruled out.

Contact and emotional relations between married children and their parents

Abstract: In a two-stage project we investigated the dimensions of the emotional relationship between married children and their parents, as well as the connection with different areas of interaction. Both generations classify their relationship as positive and close, basically formed by trust and understanding. Dependencies do not impair the core of the relationship. Frequent contact indicates a good relationship, if not solely motivated by help. The frequency of help rendered gives only little evidence about the quality of the relation; also barely significant is absence of divergent viewpoints or the exchange of caresses. More significantly, open communication, requests for help, positive reaction to caresses, and voluntary contact point to a positive relation.

Preparing for retirement. Aspects of didactic adult education

Abstract: The beginning of the post-professional lifetime is one of the most significant transition points in human biography. Adult education is a central institution which prepares people for important changes of their living conditions after retirement. This article gives a description of motivations for an institutional preparation for retirement and shows its possible limitations. It introduces the elementary didactic categories of a differential pedagogical concept as participant-orientation and experience-orientation and shows their effects on planning, arrangement, and practice of special educational offers.

The relation between suicide and psychiatric disease in advanced age

Abstract: This report addresses the relation of suicide to mental illness in the elderly. Our investigation of this relation proceeds from the following two points of view: First we asked whether the fact that the elderly are most at risk from suicide is enhanced by their increased psychiatric morbidity. Secondly, sought to determine to what extent suicides of older mentally ill persons are definitely a result of their mental illness. The sample includes 310 suicides of psychiatric inpatients. These were investigated in the course of a multicenter study of six psychiatric State Hospitals in southern West Germany. The method of analysis involved the motives of the suicidal acts. Results demonstrate that age is an autonomous risk factor and not affected by psychiatric morbidity. Psychiatric morbidity of older persons is not sufficient to explain the suicidal act. Moreover, we found that if mental illness played a part, motives reflecting aspects of chronicity predominated motives reflecting psychopathology (i.e., being presecuted, losing one's mind) of the suicidal patients. Results are discussed with special reference to prevention and management of suicide risk factors in the elderly. Language: de

[Recall and reproduction of words: age-dependent activation of context information in recalling episodic memory contents].

Abstract: Older people tend to have more problems with the retrieval of episodic memory contents than younger people. One hypothesis to explain this phenomenon refers to age deficits in activating specific pieces of contextual information concerning the learning episode. This hypothesis was submitted to an experimental test for 60 old (about 70 years) and 60 young (about 25 years) adults using the recognition failure paradigm. In this paradigm memory performance is assessed by a cued recall test as well as by an unexpected recognition test. The amount of recognition failure served as the central dependent variable; the length of the retention interval and a strategy instruction (given vs not given) were manipulated as independent variables. Various predictions were derived from the central hypothesis and from typical findings in the literature. They are tested by means of statistical hypotheses on planned a priori contrasts. On the whole, the results confirm the hypothesis concerning age deficits in activating context information during retrieval. Implications for models of gerontological changes in episodic memory are discussed within the framework of Tulving's Synergistic Ecphory model.

[Lipogenesis, aging and hormonal regulation].

Abstract: Thyroid hormones stimulate hepatic synthesis of fatty acids as well as activities of lipogenic enzymes. According to the present study, there also partially exists an age dependency. In livers of 3- and 18-month-old rats of the Wistar strain both the velocity of fatty acid synthesis and the activities of lipogenic enzymes were measured in dependence on thyroid function. An impaired stimulation of malic enzyme activity under hyperthyreosis conditions was found in the older animals. The velocity of fatty acid synthesis was diminished in the group of 18-month-old rats, but there was no age dependence with respect of the effect of a variation in thyroid status. In the adipose tissue of the older animals, the activities of lipogenic enzymes were lowered. In this tissue no effects of thyreohormones in either young or old rats were observed.

[The chronobiology of aging: changes in the temporal-periodic order].

Abstract: Within an organism the sequence of events and processes during development, maturation, and aging is determined by endogenous and exogenous factors. The endogenous factors consist of oscillatory as well as of unidirectional mechanisms. An individual temporal order ("Eigenzeit") is the result of coupling between various oscillators, interactions between oscillators, and unidirectional processes and of stochastic events. Age-dependent changes of the diurnal rhythms in man and mammals serve as an example for age-dependent changes of the individual temporal order. The parameter of the endogenous (= circadian) diurnal rhythms are changed during embryogenesis, postnatal development, adolescence and aging: amplitude and phase delay increase during development and decrease with age. A higher frequency (ultradian) component predominates in childhood and old age. From experiments with model oscillators, lesioned central clocks in the hypothalamus of mammals and with an arrhythmic mutant of Drosophila, it is concluded that the changes of the temporal order are due to changes in the coupling properties of circadian and higher frequency oscillators. This may be true for the coupling between exogenous periodicities ("Zeitgeber") and endogenous clocks, their mutual interaction and their coordinative function. At present, it is not known whether these changes have consequences for human well-being and health. This may be the case, however, as concluded from indirect evidence.

[Objective assessment of biological aging in the human: results].

Abstract: From a population sample of 139 healthy persons, six specially selected aging parameters were tested for their significance to vitality, by means of four mathematical models referring to the concept of vitality. As reference values, tm, is the age expressed in years when maximal vitality occurs, and the aging constant is beta, also known as an aging factor. Our results for tm extended from 16.6 to 39.6 years, depending on the respective mathematical model applied. We find a similar characteristic for the beta-values. A comparison with results in other publications on the subject, obtained by processing a considerably larger number of variables than we did, underlined the utility of our parameters. This is also shown by the quality of results we obtained by regression analysis, by the adjustment to the functions of the vitality concept and by the simplicity of the required laboratory methods of analysis.

Geriatrics in the acute care hospital

Abstract: Since 1985, a graded system of medical care has served as a model at the III. Medical Clinic, Antonius hospital, Velbert-Neviges, FRG; Geriatric I (diagnostic, therapeutic, and intensive medicine), Geriatric II (therapy unit), and Geriatric III (day clinic) have not only reflected diagnostic and therapeutic improvements but they have also changed daily hospital operational requirements. Because of the structural adjustment of the hospital geriatric patients receive better care and patient-care costs are reduced.

[Malnutrition in geriatric patients: the Bethanien nutritional study].

Abstract: Demographic developments in the Federal Republic of Germany indicate a future marked increase in the aged population. With this, there will be an increase in elderly patients. Malnutrition can contribute to disease as well as result from it. While most urgent nutritional problems of the population in general reside in the areas of increased intakes of energy and certain nutrients, nutritional deficiencies are frequent in older citizens, and in particular, geriatric patients. These deficiencies may result from psycho-social factors such as isolation, depression, or chronic brain failure, as well as from clinical factors (diseases which increase nutritional requirements or utilization of nutrients, drug/nutrient-interactions, etc.). The following questions are addressed: 1) How frequent is malnutrition in geriatric patients and which forms of malnutrition can be found? 2) What are the causes of malnutrition? 3) What is the relationship between malnutrition and mortality? 4) Which strategies for prevention and treatment of malnutrition can be developed from the above findings? The study is performed in Bethanien-Hospital, Heidelberg, FRG, a geriatric hospital and day clinic. Three hundred patients aged 75 years or older (representative sample) were included. Nutrition and nutritional status are determined and related to health, drug therapy and other psycho-social conditions in the very old. The prospective part of the study is planned for 18 months and this will also be the duration of the intervention phase.