摘要:

ABSTRACT:The evolution of geriatric medicine has been associated with increasing knowledge about aging — social, psychologic and biologic — and its effect on the clinical presentation of illness. It also has been associated with varying patterns of the historical development of medical care in different countries. Overall, two main forms of geriatric medicine are developing worldwide — one an accredited specialty practiced within a State medical service, the other based in large hospitals for the aged where physicians train themselves but are not accredited. The system of geriatric care in Great Britain is described and the importance is emphasized of: 1) assessment before admission, 2) progressive care of the patient, and 3) the day hospital. Future developments in relation to internal medicine and family practice are considered. Research into the causes of atheromatous vascular disease and senile dementia is of fundamental importance for the whole future of geriatric med

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03320.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:The central importance of elevated blood cholesterol levels in the process of atherosclerotic heart disease (ASHD) is firmly established. Cholesterol is transported in the blood in conjunction with protein as a lipoprotein complex. The low‐density lipoproteins (LDL) carry the bulk of the blood cholesterol. The high‐density lipoproteins (HDL) occur in much smaller amounts. Recently it has been demonstrated that not only is the cholesterol carried in the HDL fraction not harmful, but appears to be protective against the development of ASHD. Data from Framingham and elsewhere seem consistent with this observation. The HDL apparently represent the fraction concerned with the efflux of cholesterol from the tissues, so that higher levels may represent a heightened cholesterol‐riddance mechanism. Thus far, two circumstances seem to be associated with elevated levels of HDL— physical exercise and ethanol ingestion. The importance of these observations in the clinical management of the patient at risk is di

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03321.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:A descriptive and quality assessment study was made of 359 elderly patients with a diagnosis of diabetes mellitus in 39 Skilled Nursing Facilities (SNF) in upstate New York. The diagnostic prevalence of diabetes was about 12 percent — similar to that in a National Health Survey of nursing homes, but higher than that reported for the non‐institutional elderly. Greater frequency and severity were observed among the females, but the median age for all the diabetic patients was about the same as that for the general SNF population. Several of the other disorders believed to be associated with diabetes were found to be of greater frequency in the SNF diabetic group, but some were not; also, inadequate control of diabetes was associated with some, but not all of these disorders. The severity of diabetes in this elderly SNF population with adult‐onset diabetes was usually mild, with a low frequency of complications and of poor control. Problems arose with respect to the ascertainment and recording of diagnostic and control data, most often related to the responsibilities of the attending physicians. There were also problems of uncertainty as to the cause‐and‐effect relationship between the control of blood glucose levels and treatment outcomes. The establishment of criteria and standards for medical care evaluation studies is

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03322.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:Genitourinary tissues undergo physical changes with advancing age, due partly to hormonal alterations. However, the greatest influence on continuing sexual function during aging is emotional and is directly related to the psychologic history of the individual patient. The interested professional can help his patient substantially by simply taking time to listen, a process which permits identification of any psychogenic basis for the sexual dysfunction. The entire approach and method of counseling presuppose that psychogenic impotence is the most common form of the problem. This preliminary effort can do no harm. Should it fail, the patient can be referred to other consultants who use more protracted or sophisticated modalities. With the elderly, the clinician can advise patients to share interpersonal warmth and to enjoy the satisfaction of body contact at any age at which this desire and capacity persist. To the aging person, the totality of sexual meaning is more significant than performance or technique. The sympathetic counselor who renders supportive reassurance to the patient usually can expect beneficial results.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03323.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:The results of major gynecologic operations in 160 women over the age of 65 were reviewed and compared with the results in 120 younger women 40–55 years old. Most of the complaints of the elderly group were related to genital prolapse. These conditions caused daily discomfort and anxiety. Contrary to the practice in the younger group, most of the operations in the elderly were vaginal. Vaginal hysterectomy was the preferred procedure in most cases of uterine prolapse. Spinal anesthesia was used, as it is rarely contraindicated in the elderly. Postoperative complications were few and did not cause prolongation of hospital stay. There was only one postoperative death, a mortality rate of 0.6 percent. When care is exercised in medical evaluation, choice of anesthesia, and performance of the operation, the elderly patient usually can tolerate major gynecologic surgical procedures well, and should not be lightly disqualified from receiving the benefit

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03324.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:A rare case of duodenal stump tumor is described. The patient was an 84‐year‐old woman who had undergone a subtotal gastrectomy nine years previously. The polypoid tumor of the duodenal stump may have been a factor in the production of extrahepatic biliary obstruction, for which surgical treatment was required. The aged patient withstood the operation w

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03325.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:This report contains follow‐up data on the effects of an anticoagulant‐psychotherapy regimen in presenile and senile dementia. Over a two‐year period, 49 such patients who were seriously ill were treated with a Coumadin‐psychotherapy regimen; 34 (69 percent) improved (4 of them dramatically) and 15 (31 percent) did not improve or became worse. The underlying pathologic processes are discussed, with the rationale for

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03326.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:We are increasingly becoming a society of older people. The most prevalent emotional disturbance in this group is depression. Its management is an urgent concern to professionals in the mental health field. A review is presented of the clinical management of depression in old age in the special out‐patient setting of an Affective Disorders Clinic. Sociologic, psychologic, and biologic factors as they affect the aging process are discussed in the frame of a developmental approach to aging. Illustrative clinical material shows the value of this approach in the assessment and management of depression in the age

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03327.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03328.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb03329.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY