Journal of American Geriatrics Society

Overstall, P. W.

doi: 10.1111/j.1532-5415.1980.tb01125.xpmid: 7430520

ABSTRACT To prevent falls effectively, one must first understand the underlying reasons. Although environmental factors are sometimes to blame, the fundamental cause is a decline in postural control which is partly age‐related and partly due to pathologic changes in the central nervous system. Dizziness is a common complaint among those who fall, and it is often caused by a central or peripheral vestibular disorder. Many patients who complain of dizziness do not have true vertigo but are expressing a fear of falling. Balance exercises can improve postural control and confidence in these patients. Falls are not inevitable in old age and may be prevented by maintenance of health, mobility and confidence, the avoidance of certain drugs, identification of specific problems such as cardiac arrhythmias or postural hypotension, and attention to environmental hazards.

Aizawa, Toru; Yamada, Takashi; Tawata, Masato; Shimizu, Takuo; Furuta, Seiichi; Kiyosawa, Kendo; Yakata, Minoru

doi: 10.1111/j.1532-5415.1980.tb01126.xpmid: 6253545

ABSTRACT This study included 35 patients with liver cirrhosis, 23 patients with hyperthyroidism, 12 with hypothyroidism, and 3 with other endocrine disorders. In the various endocrine disorders an appreciable amount of triiodothyronine (T3) was excreted into the urine but the daily excretion was fairly constant in each patient. Urinary excretion of T3 was negligible or depressed in hypothyroidism, but increased with a rise in the serum level of T3. Serum and urinary T3 decreased in liver cirrhosis, but the serum thyroxine (T4) level was within the normal range. When the cirrhosis patients were divided into 3 groups according to the urinary excretion of T3, a decrease of urinary T3 was associated with a decrease in the serum levels of T3 and free T3. An increase of serum thyroid‐stimulating hormone (TSH) either before or after injection of thyrotropin‐releasing hormone (TRH) was inversely correlated with a decrease of serum and urinary T3. The decrease of serum and urinary T3 was correlated with the magnitude of liver damage as judged by indocyanine green retention and a decreased urinary excretion of cyclic adenosine 3',5'‐monophosphate. In vitro experiments indicated that rat liver, as compared to the kidney, heart and skeletal muscle, strongly converts T4 to T3, but this activity is greatly reduced by liver damage induced by ligation of the bile duct. It is suggested that patients with liver cirrhosis are, to some extent, in a state resembling subclinical hypothyroidism because of inability of the liver to metabolize a sufficient amount of T3 from T4.

Gral, Thomas; Young, Marilyn

doi: 10.1111/j.1532-5415.1980.tb01127.xpmid: 7430521

ABSTRACT Measured endogenous creatinine clearance (requiring 24‐hour urine collection) was compared to estimated (calculated) creatinine clearance obtained by 2 formulas and a nomogram (without urine collection), in 26 elderly nursing home residents. All were clinically stable and had adequate intakes of food and fluid. Of the 26 subjects, 23 had a “normal” value for serum creatinine concentration (0.7–1.5 mg/dl) with a mean of 1.1 mg/dl. Measured creatinine clearance (Ccr) was reduced in all patients despite a “normal” serum creatinine level. The mean Ccr was 47.2 ml/min, with values as low as 21.6 ml/min. Measured Ccr findings compared well with estimated (calculated) findings, the correlation coefficients being highly significant in all instances. If it is difficult or impossible to collect a 24‐hour urine specimen, a fairly accurate assessment of renal function may be obtained by using a simple formula (or nomogram) for estimating creatinine clearance on the basis of the patient's age, weight (height) and serum creatinine level.

Rogers, Eugene J.

doi: 10.1111/j.1532-5415.1980.tb01128.xpmid: 7430522

ABSTRACT Physicians should assume leadership and a greater role in the post‐stroke management of the hemiplegic patient, so that the recipient of care becomes an active participant in the treatment team. The patient should be fully aware of his condition, and partake in establishment of the goals together with subsequent evaluation of accomplishments and progress. Some short‐term and some longer‐term goals are outlined as a guide. A method for performance scoring is suggested. These performance ratings may assist in establishing priorities for discharge planning and continuation of care. They also may permit more accurate assessment and documentation of the patient's capacities and the efficacy of the various approaches to adequate care.

Adler, Mark K.; Brown, Curtland C.; Acton, Patricia

doi: 10.1111/j.1532-5415.1980.tb01129.xpmid: 7430523

ABSTRACT A retrospective survey was made of the average improvement, length of stay, and discharge placement of 180 stroke patients admitted to a rehabilitation hospital. The patients were divided into four age groups: under 55, 55–65, 66–75, and over 75. A grading system was used for evaluating the patient's ability in ambulation and self‐care. No significant differences were found among the four age groups. The patients were then divided into subgroups depending upon the admission functional score: 0–20, 21–40, 41–60, and over 60. In the subgroups, no statistically significant differences were apparent for the average improvement of patients under age 55 as compared to those over 75, except for those whose initial functional score was 21–40. In this subgroup, the average improvement for patients under age 55 was 26.4 points with a length of stay of 31.9 days, whereas for those over age 75 the average improvement was 15.5 points with a length of stay of 25.9 days. Thus, age per se did not seem to be a determinant factor in successful rehabilitation; rather, the poor showing of the oldest group for the 21–40 score in the sub‐set may have been due to premature discharge.

Scherokman, Barbara; Massey, E. Wayne

doi: 10.1111/j.1532-5415.1980.tb01130.xpmid: 7430524

ABSTRACT In the case of an elderly patient with transient loss of consciousness, the chief differential diagnosis is syncope versus seizure. The most helpful diagnostic aid is a thorough history obtained from both the patient and an observer. The tentative diagnosis based on the history can be confirmed by the findings on physical examination and by such secondary studies as an electroencephalogram and a series of cardiac tests.

Elkowitz, Edward B.; Virginia, Arcilio T.

doi: 10.1111/j.1532-5415.1980.tb01131.xpmid: 7430525

ABSTRACT Coping with depression has always been a central theme in the life of the elderly, and many efforts have been made to develop a valid form of assessment. This article shows that an analysis of compliance may usefully supplement the usual instruments for measuring depression. The study group consisted of 10 widows and 8 widowers (age range, 69–74 years). They were tested by the Zung Depression Scale, particularly for physical and psychologic complaints. The pattern and correlates of these complaints are discussed in relation to depression and sex. The data indicate a relationship between compliance and the severity of depression, and also between sex and the expression of distress feelings.

Sloane, Philip D.

doi: 10.1111/j.1532-5415.1980.tb01132.xpmid: 6776175

ABSTRACT Primary care physicians are often confronted with demands that elderly patients be institutionalized. Patients who appear to have no new medical problems present a therapeutic dilemma. Should they be admitted to a general hospital or should they be placed directly in a nursing home? This longitudinal prospective study involved 29 consecutive elderly patients judged to be in need of nursing home placement but who were without medical indications for admission. They were assessed and treated in a 30‐bed ward of a general hospital. The mean length of stay was 19 days. Of the 29 patients, 8 (24 percent) benefited from the hospitalization; the outcome was placement and retention at a level of care less intensive than that in a nursing home. On admission to this special ward, the presence of 2 of the following 3 characteristics identified the patients who would benefit from this preplacement hospitalization (with 75 percent sensitivity and 86 percent specificity): 1) a score of A or B (Katz Scale) for activities of daily living; 2) a score of 3 or fewer errors on the mental status scale (Pfeiffer); and 3) the presence of family members willing to care for the patient, although unable to do so at the time of admission. These 3 factors constitute a screening tool to differentiate elderly patients who will benefit most under a regimen of intensive rehabilitation from those who will be inevitable recipients of long‐term care.

Habibzadeh, M. A.

doi: 10.1111/j.1532-5415.1980.tb01133.xpmid: 6107314

ABSTRACT During the ninth decade of life, idiopathic hypertrophic subaortic stenosis (IHSS), particularly when associated with other cardiac disorders, presents a confusing clinical problem. Unless the physician has a high index of suspicion, the diagnosis is easily overlooked, and consequently inappropriate management of the patient may lead to serious complications. One such case in an 84‐year‐old man is described. Administration of certain drugs may only intensify symptoms. Echocardiography is invaluable for diagnosis. Pertinent clinical features of IHSS in the eighth and ninth age decades are outlined.

Brink, T. L.

doi: 10.1111/j.1532-5415.1980.tb01134.xpmid: 7430526

ABSTRACT Paranoid thinking is a defense mechanism against feelings of inferiority and humiliation. Paranoid behavior serves as a means of getting attention, sympathy and help. A case study of an 81‐year‐old woman illustrates the nature of geriatric paranoia and the roles of interpersonal relationships, rigid personality, depression, and the impairment of sensory and memory functions. The problem proved to be the effects on the family and neighbors of the patient's verbally expressed paranoid delusions. Treatment consisted of reducing the frequency of these paranoid complaints by means of reality therapy and verbal non‐reinforcement.