Journal of American Geriatrics Society

Goldman, Ralph

doi: 10.1111/j.1532-5415.1970.tb02829.xpmid: N/A

Abstract Several extracardiac age changes may affect cardiovascular efficiency. Extracellular fluid and blood volume are relatively increased with age. The loss of aortic elasticity results in a rise in systolic pressure when work produces increases in cardiac output. The vascular rigidity further consumes energy by loss of the propulsive effect of elastic recoil. Finally, peripheral resistance increases due to arteriolar constriction; this appears to be under reversible physiologic control. The sum of these normal changes contributes to the functional decrement of aging; it is more universal and more important than atherosclerosis, yet has commanded inadequate attention.

Sherman, E. David

doi: 10.1111/j.1532-5415.1970.tb02830.xpmid: 5457318

Abstract This review outlines the problems associated with retirement and some of the vital factors in their solution. A study of the psychological aspects indicates that often psychiatric illness is diagnosed in elderly persons when the real issue is low morale. Retirement is discussed under the headings of timing, type (compulsory or voluntary), programs, mental health, self‐employment, retirement occupations, preventive medicine, and medico‐social aspects. Society must strive to attain a goal in which each older worker approaching the stage of retirement is afforded the opportunity to choose between an economically secure and purposeful role in retirement, or a similar role in employment if he is able and willing to work. This objective can be achieved only when there is a flexible program for retirement with adequate pension plans, both public and private, and a pre‐retirement program which assists older workers to prepare adequately for constructive roles in retirement.

Behan, Peter O.; Feldman, Robert G.

doi: 10.1111/j.1532-5415.1970.tb02831.xpmid: 4917538

Abstract Serum protein analysis in 60 patients with histologically confirmed Alzheimer's disease (Group A) and in 60 others with clinical dementia and radiographic evidence of diffuse cerebral atrophy compatible with Alzheimer's disease (Group B) revealed a decrease in albumin and an increase in alpha‐1 antitrypsin, alpha‐2 macroglobulin and haptoglobin fractions. These abnormalities occurred in 66 per cent of these two groups, but in only 13 per cent of a third group of patients with dementia of the non‐Alzheimer type. In addition, the highest values for alpha‐2 macroglobulin were found in Groups A and B. The possible relationships of these findings to amyloidosis of the central nervous system is discussed. The significance of these data may lie in their value as an aid in making the diagnosis of Alzheimer's disease in vivo, in the absence of a brain biopsy. Further study is needed to confirm these observations.

Seneca, Harry

doi: 10.1111/j.1532-5415.1970.tb02832.xpmid: 4917539

Abstract This survey includes discussion on: 1) the physiological and pathological characteristics of the elderly, particularly regarding their reactions to infections; 2) how the required specificity of antimicrobial therapy is achieved in cases of infection; 3) how antimicrobial therapy has affected mortality rates; 4) adverse drug reactions in the aged, 5) general principles of chemotherapy, and 6) the limitations of use for prophylaxis. The guiding principle for the therapeutic use of antibiotics and antibacterials is that the drug should be specific, i.e., chosen on the basis of its effect on the pathogens in susceptibility tests. A close watch should be kept for adverse effects.

Ivan, L. P.

doi: 10.1111/j.1532-5415.1970.tb02833.xpmid: 4917540

Abstract Irreversible brain damage in respirator‐treated coma patients is discussed from both the theoretical and practical points of view. In relation to postmortem organ transplantation, certain problems arise: 1) the conflicting interests between donor and recipient teams, 2) what constitutes the best possible care of the patient, 3) the criteria for the diagnosis of irreversible brain damage, 4) explaining the situation to the relatives, and 5) the pronouncement of death. The author proposes some helpful criteria that involve the “time of death by consultation” followed by the phase of “postmortem maintenance of organs.”

Lawton, M. Powell; Yaffe, Silvia

doi: 10.1111/j.1532-5415.1970.tb02834.xpmid: 5457319

Abstract In this study there was no statistical difference in mortality rates that could be ascribed to the voluntary relocation of a group of relatively independent older people as compared with two non‐relocated groups of older people individually matched for age, sex, and initial functional health status—a total of 103 matched “triplets.” Two similarly matched, 77‐member groups of relocated and non‐relocated older people whose health was evaluated over a twelve‐month period showed no increased morbidity due to moving, as judged by behavioral and subjective health indices. Physicians' ratings of functional health in the two groups showed both improvements and declines among the relocatees. Although the small number of subjects makes caution imperative, the data suggest that relocation is stressful for some elderly people, but felicitous for others. The voluntary nature of the move may account for the lack of major negative relocation effects.

Ficarra, Bernard J.

doi: 10.1111/j.1532-5415.1970.tb02835.xpmid: 5457320

Abstract Although cholecystectomy is the procedure of choice for cholelithiasis with stone impacted in the cystic duct, there are occasions in the management of this disease in geriatric patients when cholecystostomy with removal of the impacted stone is preferable. The surgeon must be guided in his decision by the physical status of the elderly patient, the anesthesia tolerance, and the findings at the time of starting the operation. When in doubt, perform a cholecystostomy. The gallbladder can always be removed at a later date if necessary. Though it may be more impressive to remove the gallbladder, simple drainage with removal of the stone may be life‐saving.

Chaitin, Horace; Wienick, Leopold

doi: 10.1111/j.1532-5415.1970.tb02836.xpmid: 5457321

Abstract The diagnosis and management of peritonitis are becoming more and more important because of the great increase in our geriatric population. The mortality rate is particularly high among the aged. A series of 600 cases during a three‐year period is reported. The differential diagnosis involves numerous other diseases which may predominate in various age groups. It is essential to establish the cause of the peritonitis since the type of therapy depends upon the correct diagnosis. In cases of appendicitis, gall‐bladder disease, perforated peptic ulcer and mesenteric thrombosis, immediate operation is the treatment of choice. Conservative therapy gives the best results in pancreatitis or diverticulitis.

doi: 10.1111/j.1532-5415.1970.tb02837.xpmid: N/A

doi: 10.1111/j.1532-5415.1970.tb02838.xpmid: N/A