Journal of American Geriatrics Society

PFEIFFER, ERIC

doi: 10.1111/j.1532-5415.1974.tb05834.xpmid: 4417681

ABSTRACT: Sexual activity may continue to play a significant role in the life of the elderly person. At age 68 about 70 per cent of men still regularly partake in sexual activity, and even at age 78 about 25 per cent are sexually active. For men, the married state is not a necessary factor, whereas for women it makes all the difference. Very few unmarried older women report regular sexual activity. Unavailability of a sanctioned sexual partner is the chief determinant. The ratio of available older women to available older men may approach 4:1 in many environments. Sexual expression requires privacy, an aspect of life that is often neglected for the aged. The physician should take these needs into consideration when counseling or when planning programs to improve the quality of life in the later years.

TAHERI, S. A.; OSWAKS, ROY M.

doi: 10.1111/j.1532-5415.1974.tb05835.xpmid: 4420533

ABSTRACT: Popliteal aneurysms are more common than generally believed and they give rise to more complications than do aneurysms in other locations. Even when these aneurysms are asymptomatic there is danger of limb loss; when symptomatic they can be a threat to life. Too many limbs and lives are still being lost by conservative treatment or emergency operations for this lesion. When surgical treatment is elective, before complications develop, the mortality is low. The preferred technique is the bypass procedure accomplished by means of an autogenous saphenous‐vein graft. Old people tolerate this operation well despite the frequency of associated cardiovascular disease. An important point in management is early diagnosis by routine aortography whether or not the aneurysm is palpable. If the aortogram reveals a good outflow tract, an excellent result can be anticipated. The authors present data on their series of cases and review the data of other surgeons.

GRAD, BERNARD; WENER, JOSEPH; ROSENBERG, GILBERT; WENER, STEPHEN W.

doi: 10.1111/j.1532-5415.1974.tb05836.xpmid: 4418704

ABSTRACT: The systolic and diastolic blood pressure (BP), with the patient in the standing, sitting and recumbent positions, and the pulse rate were determined at various time intervals in 51 parkinsonian patients during prolonged levodopa therapy. Hypotension was observed in 10 patients (19.6 per cent). In 5 of these cases it was clinically significant and associated with syncope, so the drug had to be discontinued after two to sixteen weeks of therapy. In the other 5 cases the hypotension was transitory and not clinically significant, so the drug did not have to be discontinued. These 5 cases were included with the 46 cases subjected to statistical analysis. In the 46 cases, both the analysis of variance and the correlation coefficients showed that the dosages of levodopa had no significant effect either on the BP or the pulse. In attempting to produce a clinically significant therapeutic effect with a minimum of toxic effects it was found that a statistically significant lower dosage of levodopa was necessary for the “older” subjects (those over age 70) as compared to the “younger” subjects (those aged 70 or younger). Furthermore, such dosage differences appeared to be more marked in women than in men. In both the normotensive and the hypotensive responses to levodopa, no orthostatic effect was observed nor was there a dose‐related response of the BP within the dosage range used in this study (a maximal level between 2.0 and 4.0 gm daily).

ROSIN, ARNOLD J.

doi: 10.1111/j.1532-5415.1974.tb05837.xpmid: 4421024

ABSTRACT: The etiology of buccal‐lingual masticatory dyskinesia is varied. A study is presented of 16 cases, of which 15 were in old people. In cerebral arteriosclerosis this form of dyskinesia may appear as a passing phenomenon and as a sign of further neurologic damage. In the setting of a cerebrovascular accident, it may be a discrete sign. It may appear in cases of senile chorea, and sometimes after brain‐stem operations. It can be caused by administration of L‐dopa or phenothiazines. The etiology of dyskinesia is discussed in relation to excess dopamine effect, and it is proposed that a restoration of the dopamine‐cholinergic balance (? by physostigimine) might result in diminution of the movements. Brain damage contributes to the genesis of the involuntary movements through disturbance of the biochemical balance in the midbrain basal nuclei. Graded doses of haloperidol or reserpine, or even perphenazine, may constitute effective therapy, when indicated.

MILLER, MICHAEL B.

doi: 10.1111/j.1532-5415.1974.tb05838.xpmid: 4371580

ABSTRACT: The present system of medical education and practice often is more concerned with disease than with patients. Diagnosis‐oriented physicians usually have neither the inclination nor the training to be involved in the complex team system required in care of the chronically ill aged. The personalized patient‐physician contract tends to be deflected by preoccupation with laboratory and diagnostic procedures and the patient often is denied the supporting structure of the Aesculapian authority. A high level of medical care for the chronically ill aged requires a different type of physician, primarily oriented toward treatment and management. When the diagnosis‐oriented and the management‐oriented physicians are mutually supportive, the patient will be the beneficiary. The basis and the nature of a restructured medical educational curriculum are described.

STERNLIEB, CHERYL M.; KASHAN, FAIZ

doi: 10.1111/j.1532-5415.1974.tb05839.xpmid: 4423906

ABSTRACT: The case is presented of an elderly woman with severe recurrent attacks of asthma refractory to vigorous medical treatment. A careful history revealed that the attacks chiefly occurred at night and awakened the patient. An x‐ray (barium) examination showed only a small hiatal hernia, but an additional water siphonage test demonstrated a large amount of gastroesophageal reflux which could cause aspiration when the patient was in the horizontal position. After repair of the hernia, the reflux stopped and all respiratory symptoms disappeared. For cases such as this, the term “gastroesophageal asthma” is suggested. Early identification is important as it is a potentially curable form of respiratory disease. It should always be considered in the differential diagnosis, particularly in elderly patients.

PLUTCHIK, ROBERT; DiSCIPIO, WILLIAM J.

doi: 10.1111/j.1532-5415.1974.tb05840.xpmid: 4422927

ABSTRACT: The personality profiles of three groups of long‐term hospital patients were obtained by means of the Emotions Profile Index, a personality test designed to measure 8 basic traits. The study groups were as follows: 1) patients with severe chronic alcoholism who showed definite evidence of Korsakoff's syndrome, 2) patients with chronic schizophrenia, and 3) geriatric patients with chronic brain syndrome. All these groups were in state hospitals. The Korsakoff‐alcoholic patients appeared to be gregarious, obedient, timid, and poorly self‐controlled. Then‐profile was different from those of normal subjects and of patients with schizophrenia. However, their profile was similar to that of geriatric patients with chronic brain syndrome who were not alcoholic. The basic similarity between Korsakoff‐alcoholic patients and geriatric‐CBS patients suggests that there is not a unique alcoholic personality.

BHAT, PACHALLA K.; WATANABE, KAZUMI; RAO, DODDA B.; LUISADA, ALDO A.

doi: 10.1111/j.1532-5415.1974.tb05841.xpmid: 4214474

ABSTRACT: Four hundred and fifty‐five patients over age 65 with atrioventricular and intraventricular conduction defects were studied for periods of from two to five years (average, twenty‐six months). Data on the overall incidence of conduction defects, the sex incidence, the type of block, and the associated electrocardiographic abnormalities are presented. There was no ECG evidence of extension of the blocks based on prolongation of the P‐R interval, a shift or an increase in axis, a shift of the block from one branch to another, or an increase in width of the QRS complex. Left bundle‐branch block and left anterior hemiblock, either alone or in association with any other fascicular block, were more common in the female patients whereas right bundle‐branch block was more common in the male patients.

OBLEY, FRED A.; PREISER, FRANKLIN M.

doi: 10.1111/j.1532-5415.1974.tb05842.xpmid: 4214296

ABSTRACT: ABSTRACT: Fifty‐nine patients (ages, 51–58) with chronic obstructive pulmonary disease took part for nine months in a comprehensive outpatient respiratory program that involved training in various factors of daily living but stressed retraining in breathing, airway hygiene and respiratory efficiency. The patients were followed closely by means of pulmonary function and other tests. Subjectively, 55 patients noted functional improvement and an increased feeling of well‐being. Objectively, 49 patients showed increased endurance and physical capacity. In 7 cases, pulmonary function tests showed an improvement of 30 per cent or more. In general, there was a significant increase in walking distance, chest expansion and body hydration, and a reduction in the use of corticosteroids and the rate of hospital admissions. These results indicate the desirability of having such a program available in every community to patients with chronic obstructive pulmonary disease.

FINKELSTEIN, MILDRED; ROSENBERG, GILBERT

doi: 10.1111/j.1532-5415.1974.tb05843.xpmid: 4214063

ABSTRACT: The aged patient in an institution can be helped to develop a new lifestyle. A structured atelier workshop is described. A key factor in success is to raise the patient's standard of work so that he can perform as an artisan and sell products of professional quality, thereby earning money. The patient benefits by the tangible recognition that he is a part of the working force. This knowledge makes it easier for the patient to accept the institution as his community.