摘要:

Abstract:The problems of old age demand better attempts at solution. Some factors to be considered are: the difference between chronological and biological aging; the multiplicity, duplicity and chronicity of the diseases associated with old age (the law of geriatrics); the high incidence of drug reactions among elderly patients; and the possibility of overlooking acute illnesses in old people. Examples are given. Some recent advances in the treatment of disorders of carbohydrate, lipid and uric acid metabolism, and of the cardiovascular, renal and musculoskeletal systems are outlined. However, injudicious neglect is a continuing danger to the older patient, and calls for further efforts in research and its applications, with increasing emphasis on the holistic approach to therapeutic management.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00735.x

年代:1968

数据来源: WILEY

摘要:

Abstract:The development of unexplained thrombophlebitis and puzzling systemic disorders within one to several years after elective vasectomy is reported. The systemic features included prolonged fever, generalized lymph node enlargement, various skin eruptions, arthropathy, recurrent infections, glomerulonephritis, interstitial pulmonary fibrosis, neuropsychiatric features, increased BSP retention, an elevated level of circulating globulins, and a biologic false‐positive serologic reaction. The frequency of concomitant severe reactive hypoglycemia due to diabetogenic hyperinsulinism in these patients also was noteworthy. The possible pathogenetic mechanisms are discussed, including induced hormonal imbalances, autosensitization to testicular nucleoproteins, and altered blood coagulation in the hyperinsulinized‐diabetic state.These observations challenge the presumed innocuousness of elective vasectomy. The challenge assumes even greater significance in view of the current wholesale performance of vasectomy in an affluent society that is increasingly stigmatized by the hyperinsulinized‐diabetic state. If catastrophic iatrogenic damage is to be averted, it appears mandatory to ascertain the true incidence of delayed systemic complications in the large numbers of vasectomized American men who have chosen this procedure for the purpose of family limit

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00736.x

年代:1968

数据来源: WILEY

摘要:

Abstract:A survey was made of the records of 119 patients aged 50 or over who had undergone arthrotomy for meniscal lesions during the period 1951–1965. The predominant complaint at the time of admission to the hospital was pain, and half the patients had had knee symptoms for at least six months. In about half the cases there was no history of injury or of injury severe enough to cause meniscal tear, yet at operation about 80 per cent of the cases showed a torn meniscus.Meniscus tears in the knee joints of elderly patients occur with sufficient frequency to merit detailed study. Delay in necessary surgery may produce or aggravate degenerative joint disease. The symptoms and signs of meniscus lesions in the elderly are virtually the same as in younger patients. When the diagnosis is in doubt, double contrast arthrograms may be helpful. Elderly patients tolerate arthrotomy well, without an undue increase in the incidence of complications as compared to the incidence in younger person

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00737.x

年代:1968

数据来源: WILEY

摘要:

Abstract:The problems of retirement are discussed from the viewpoints of aging, pre‐retirement reactions, psychological factors, clinical findings, and therapeutic approach.Successful adjustment to the later years may be contingent upon the elderly person's ability to recognize his limitations, to give up work gradually, and to devote an increasing proportion of his time to leisure activitie

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00738.x

年代:1968

数据来源: WILEY

摘要:

Abstract:The question of whether rehabilitation programs should be included in nursing‐home care has been answered affirmatively, both in the professional literature of the past decade and by recent legislative action which focuses on the healthcare problems of the elderly. The major issue at present is the breadth and intensity of such programs.As this brief review of the literature has indicated, the success of rehabilitation goals is conditioned by the following factors: the mental and physical status and the social situation of the patient; the experience, professional training and rehabilitation‐oriented outlook of the attending personnel; the rehabilitation resources available in the nearby community; and the ability of the nursing home to afford the costs of the rehabilitation program in terms of dollars, personnel, time, professional services, and equipment.However, even when the breadth of a nursing‐home rehabilitation program has to be restricted because of any of the foregoing factors, the program can at least focus on aiding patients to regain some personal, though minimal, independence. This accomplishment has benefits for both the patient and the nursing home: the patient benefits from the improvement in his psychological if not physical state, and the nursing home benefits because more of the personnel's time is available for other patient‐care s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00739.x

年代:1968

数据来源: WILEY

摘要:

Abstract:On the basis of interviews with 129 elderly people in the Long Beach Jewish Community Center, the most impressive finding was that, with the exception of some widows and persons with serious health problems, these men and women were content with life and did not have many unmet needs or difficulties with adjustment to old age. They did not consider their life idyllic, however. Transportation was a real problem for some, and medical expenses for others. Incomes were usually too low to allow for much of the travel so many of them wished to experience. Some had difficulties in interpersonal relationships. Failing health was the greatest single problem; more than half of the group had had a major health impairment and one‐fourth had been in a hospital during the previous year. Nevertheless, in general this population of aged people was emotionally healthy, optimistic and interested in life and the opportunities it afforded them. It should be emphasized that this group was not typical of all the aged in the country. The study demonstrated, however, that in this society, old age can be a highly rewarding period of life.It would be most desirable to find some explanation for the diversity of attitudes observed in various reports in the literature and in the present report. Over‐all conclusions can be rendered meaningless if the aged in some of the groups and areas studied are unhappy and dissatisfied whereas those in other groups and areas are radically different in their reactions. Another factor in the diverse findings may be the ecological or social concentrations of different personality ty

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00740.x

年代:1968

数据来源: WILEY

摘要:

Abstract:The efficacy of anabolic steroid therapy has often been challenged because of equivocal clinical evidence of weight gain. In view of this challenge, 21 chronically underweight, geriatric patients in a state hospital were chosen for a study to determine the effect of a new synthetic anabolic preparation, norbolethone. Long‐term weight charts were used to determine confidence limits. After a one‐month placebo trial, placebo responders were identified; then the active preparation was given for fourteen weeks. The data indicated that spurious results can be obtained if strict criteria are not used for changes in body weight. Of the 21 study patients, as many as 18 could have been reported as showing a weight gain if only a short pre‐study period had been used for the baseline. However, when the placebo responders and yearly weight fluctuations were accounted for, only 4 patients showed significant gains in weight, and only 2 of these maintained their gains until the completion of the anabolic phase of the study.Unless stringent criteria are applied, gross body weight alone cannot be used as a reliable index of the therapeutic effect of anabolic ste

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00741.x

年代:1968

数据来源: WILEY

摘要:

Abstract:In a random sample of sera from a predominantly male group of hospital patients with an average age of 67, complement‐fixing antibodies were found in 20 per cent toM. hoministype 1, in 16 per cent to Unknown Strain CE 5, in 1 per cent toM. pharyngisand in 2 per cent toM. pneumoniae.These percentages are lower than those reported in the literature for younger populations of patients. Thus the immunological experience with mycoplasmas (pleuropneumonia‐like organisms) varies from one population to another. In general, however, the incidence of mycoplasmal infection seems to be lower in older than in younger populations.The findings also indicate that the mere isolation of these organisms from the sera of patients who manifest a disease process does not constitute evidence of an etiological relationship unless other correlates can be establis

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00742.x

年代:1968

数据来源: WILEY

摘要:

Abstract:In a Veterans Administration hospital, repeated cultures were made of body fluids from 92 elderly male patients who had acute illnesses during the observation period of twenty‐eight months. The urinary and respiratory tracts were the most common sites of bacterial infection.The pneumococcus was the most common cause of respiratory‐tract infection, but in a surprisingly large number of cases the offenders were the Klebsiella‐aerobacter group, Staphylococcus aureus, Proteus mirabilis and Escherichia coli. Tracheostomy favored the growth of Pseudomonas. Escherichia coli was the most common cause of urinary‐tract infection. Next in order were Pseudomonas aeruginosa, Proteus mirabilis and the Klebsiella‐Aerobacter group. The presence of an indwelling catheter favored the growth of Pseudomonas, Staph. aureus, Paracolobactrum aerogenes and Proteus species. Staphylococcus aureus was the most common cause of skin infections. Escherichia coli was the organism most frequently found in septicemia.Tables are presented showing the sensitivity of various bacteria to 14 selected antibiotics. The findings indicate that the term “broad spectrum” should be used with great circumspection and possibly be restricted at present to such agents as kanamycin and ch

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00743.x

年代:1968

数据来源: WILEY

摘要:

Abstract:During a three‐month study period, folic‐acid therapy was prescribed for 10 selected office patients (3 males and 7 females) with chronic leg ulcers. The average age was 61. Six of the 10 patients had venous stasis ulcers of various sizes. Four patients had ischemic ulcers. Folic acid was administered orally (as tablets) to all the patients in a dosage of 15 mg three times daily for twelve weeks. Four patients (2 with large varicose ulcers and 2 with ischemic ulcers) received an additional 20‐mg dose of folic acid twice weekly, intravenously.In the first weeks of therapy most of the patients showed marked improvement. In 9 of the 10 cases, complete healing was achieved in six to twelve weeks. In the tenth case there was definite improvement but not complete healing of a toe ulcer.Folic acid plays a dual role in the healing of leg ulcers. It is an effective vasodilator for the microcirculation, and a contributor to adequate protein metab

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb00744.x

年代:1968

数据来源: WILEY