Journal of American Geriatrics Society

SENECA, HARRY; GRANT, JOHN P.

doi: 10.1111/j.1532-5415.1976.tb06799.xpmid: 6504

ABSTRACT: At Columbia‐Presbyterian Medical Center during the six‐year period 1968–1973, there were 1236 cases of sepsis from Gramnegative pathogens; 124 of these originated in the urinary tract. Of these 124 patients, 19 died — a mortality rate of 15.3 percent. There were 205 deaths among the 1236 patients with sepsis from Gram‐negative organisms — a mortality rate of 16.6 percent. Previously, in the 1959–1964 and 1965–19067 periods, the mortality rates had been 56.3 percent and 19.6 percent respectively. The lowered mortality rate during 1968–1973 for urologic sepsis/shock was associated with improved management procedures: a) preventive measures such as postponement of urologic instrumentation and surgical intervention in patients infected with drug‐resistant urea splitters, until the infection is under control, with emergency surgical patients being treated by susceptibility‐tested drugs to control possible postoperative complications; b) early diagnosis and treatment of sepsis and immediate administration of bactericidal antibiotics parenterally; c) immediate restoration of fluid/electrolyte balance, with monitoring of renal and pulmonary functions and metabolic acidosis; and d) early administration of large pharmacologic doses of glucocorticoids, with monitoring of the microcirculation and use of β‐adrenergic isoproterenol.

HARMAN, DENHAM; HENDRICKS, SHELTON; EDDY, DENNIS E.; SEIBOLD, JON

doi: 10.1111/j.1532-5415.1976.tb06800.xpmid: 932378

ABSTRACT: Free radical reactions have been implicated in aging. A rise in the level of random free radical reactions in a biologic system might have a greater effect on the central nervous system (CNS) than elsewhere, partly because of the presence of glial cells and the unique connections between neurons. To evaluate this possibility, some animal experiments were conducted. The initial experiment involved old male Sprague‐Dawley rats fed (since shortly after weaning) with semisynthetic diets characterized by fat differing in amount or degree of unsaturation. The number of errors made in a Hebb‐Williams maze was determined and found to be higher as the amount or degree of unsaturation of the fat was increased. Likewise rats aged 6 and 9 months, fed semisynthetic diets containing 20 percent by weight of lard, oleinate, or safflower oil+α‐tocopherol performed significantly better in a discrimination learning situation (Skinner box) than did rats fed a diet containing 20 percent by weight of safflower oil. The diets employed in these studies did not have a significant effect on the mortality rates. These results are compatible with the possibility that enhancing the level of lipid peroxidation has an adverse effect on the CNS, out of proportion to the effect on the body as a whole, as measured by the mortality rate.

COLE, M. G.; MÜLLER, H. F.

doi: 10.1111/j.1532-5415.1976.tb06801.xpmid: 932379

ABSTRACT: Fifteen elderly depressed patients were treated by 36‐hour sleep deprivation (SD). The depression was unipolar in 3 cases, bipolar in 3, and secondary in 4. Nine of the 15 patients responded to SD, and 6 had a remission (1 with SD alone and 5 with SD plus an antidepressant drug). Some of the remaining 6 patients might have responded if the treatment had not been interrupted for various reasons. These favorable results in elderly patients were better than anticipated. SD was well tolerated, although in one patient with bipolar depression a manic attack was precipitated. The effectiveness of SD poses interesting theoretic questions.

WEBSTER, IAN W.

doi: 10.1111/j.1532-5415.1976.tb06802.xpmid: 932380

ABSTRACT: The perception of passing time is related to life experience. A model for this process, similar to the relationship between stimulation and sensation in the field of physiology, is presented. It is suggested that many of the maladaptive phenomena of aging could be explained by a change in time perception with age.

MELAMED, ELDAD; RECHES, AVINOAM

doi: 10.1111/j.1532-5415.1976.tb06803.xpmid: 932381

ABSTRACT: In 2 elderly male patients, a progressive neurologic deficit and alteration of consciousness developed following substantial head trauma succeeded by an asymptomatic “lucid” interval. The sequence of events and the associated electroencephalographic, echoencephalographic and cerebrospinal fluid findings strongly suggested the presence of an extracerebral hematoma. The cerebral angiographic study, however, disclosed complete occlusion of the extracranial portion of the internal carotid artery in both patients. This report stresses the diagnostic difficulties sometimes encountered in relation to stroke patients.

MICHOCKI, ROBERT J.; LAMY, PETER P.

doi: 10.1111/j.1532-5415.1976.tb06804.xpmid: 932382

ABSTRACT: This study on 93 patients was conducted at a skilled nursing facility. Twenty‐two of the 93 patients had pressure sores; 34 of the 54 sores were present when the patients were admitted and 20 developed after admission. Only 5 of the 54 sores healed. Healing times ranged from 15 to 55 days after the beginning of treatment. Thirteen deaths occurred among the 71 patients without sores, and 17 deaths among the 22 patients with sores. Specific treatment regimens varied (cleaning solutions, antimicrobial drugs, heat, enzymatic debridement) but always included frequent changes in the position of the patient. Ten of the 22 patients with sores were anemic vs. 19 of the 71 patients without sores. Half of the patients with sores were maintained with tube feedings whereas more than half of the patients without sores received regular house diets. Pressure sores are a serious problem among geriatric patients in nursing homes. All those who care for the aged should be fully aware of the procedures involved in the prevention and management of these sores.

GARRISON, JOHN E.; HOWE, JO‐ANN

doi: 10.1111/j.1532-5415.1976.tb06805.xpmid: 932383

ABSTRACT: A technique is described for using the advantages of a social systems approach when working with elderly persons in psychiatric distress. The technique is based on the assumption that the solution to a variety of human predicaments lies within the collective instrumental and affective resources of the client's social network. The vehicle for accomplishing this objective is the “Network Session” during which a mental health professional meets with the elderly person and members of his/her social network to help resolve the difficulty. A case report demonstrating use of the technique is included.

PERSSON, I.; RABY, K.; FØNSS‐BECH, P.; JENSEN, E.

doi: 10.1111/j.1532-5415.1976.tb06806.xpmid: 932384

ABSTRACT: A significant lowering of serum cholesterol, ionized calcium and iron levels was demonstrated in 27 elderly patients given 10 or 20 gm of unprocessed wheat bran daily in the diet for six weeks.

doi: 10.1111/j.1532-5415.1976.tb06807.xpmid: N/A