摘要:

This study characterizes the time course of the immune response to influenza vaccine in elderly men. Sixty‐two men aged 58 to 91 years (mean, 74.3 years) were vaccinated with trivalent inactivated influenza vaccine in the fall of 1983. Serum hemagglutinin‐inhibiting (HAI) antibody titers were measured at various times up to 24 weeks postvaccination. Seroconversion frequencies determined at single times after vaccination were 28 to 46% of subjects, whereas cumulative seroconversion frequencies were greater than or equal to 70%. Eighteen to 28% of seroconversions occurred later than four weeks, and greater than or equal to 68% of those who seroconverted experienced greater than four‐fold declines in peak HAI antibody titers by 24 weeks after vaccination. Consequently, 31 to 73% of subjects had HAI antibody titers greater than 40 throughout the study period. Measurement of HAI antibody titers at only one time after vaccination may not adequately reflect the immune response of this population or the degree of protection maintained through the influenza s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04335.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

To elucidate the incidence of severe disability due to cerebral stroke and its related factors, prospective data of 1,621 Hisayama residents aged 40 and over were examined. Severe disability resulting from stroke was defined as patients who were unable to dress, take care of their toilet needs, and feed themselves without assistance, or who required a wheel chair for ambulation three months after the most recent episode.During 20 years of follow‐up 255 stroke patients were observed among the sample population. The annual incidence of stroke per thousand was 9.8, and rate of severe disability was 2.8 for men and 6.4 and 2.0 for women, respectively. Of the 74 cases with severe disability, approximately 92% were attributed to cerebral infarction. Related factors to severe disability due to cerebral infarction were recurrent attacks, hypertension, changes in ocular fundi and diabetes mellitus among predispositions and quadriplegia or muscular contraction, and intelligent or mental disorders among inhibiting factors for functional recovery. Furthermore, in 59 autopsy cases with multiple cerebral infarctions, the frequency of disability increased as the number of infarcts increased. Hypertension and diabetes mellitus, as risk factors for cerebral infarction and factors inhibiting postictal functional recovery were discusse

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04336.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

To examine the content of care that elderly patients receive from physicians 5.65 years of age, data from the 1981 National Ambulatory Medical Care Survey were analyzed. Compared to physicians aged 35 to 54 years, elderly physicians devoted a larger proportion of their practices to the care of elderly patients. In caring for these patients, elderly physicians spent more time per visit than did younger physicians and were more likely to conduct general examinations and provide counseling. In contrast, elderly physicians were less likely to perform mental status or vision examinations. Elderly physicians were also less likely to provide telephone follow‐up for those patients ≥ 75 years of age and more likely to discharge patients ≥ 65 years of age without any specific follow‐up planned. These data suggest that the content of care for elderly patients may differ substantially depending upon the physicia

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04337.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Although nursing homes are potentially important sites for geriatric research, previous reports have identified impediments to subject recruitment in this setting. We are conducting five simultaneous clinical studies in a 725‐bed nursing home. Utilizing a systematic subject recruitment methodology designed to minimize patient and staff burden, we have recruited over 100 subjects. The average recruitment rate over two years from nursing home residents meeting study entry criteria was 43%. The rate was highest (81%) for a study of urinary incontinence offering direct benefit to participants, and lowest (28% and 14% respectively) for physiologic studies of vasopressin regulation and dermal vitamin D production, offering no direct benefit. Studies of syncope and dementia which benefitted groups affected by these problems but not controls, had intermediate recruitment rates (46 and 44%, respectively, P<.002 compared to incontinence). Thus, clinically relevant projects, sensitive to the needs of the patient and institution, can recruit subjects from the nursing hom

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04338.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Serum Vitamin B12levels were determined on 378 patients ranging in age from 56 to 104 years with a median age of 77 for both males and females. A radiodilution method was employed for these determinations. This screening procedure identified 26 patients with low serum B12levels. Nineteen of these patients had no other symptoms and were hematologically normal. The B12binding proteins, transcobalamins (TC) I, II, and III were quantitated employing QUSO and DEAE cellulose batch separations. The total number of TC II binding/affinity sites for B12were elevated in both the normal and low B12elderly groups. About 17% of the total serum B12was carried by TC II in the control group while only 4% of the total was carried on TC II in both the normal and low B12elderly. This was accompanied by an increase in unsaturation in TC II for these two groups. The findings suggest that an alteration in the TC II‐B12delivery system has occurred in the elderl

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04339.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A retrospective review of 1,024 charts of Geriatric Screening Clinic patients was carried out to evaluate the prevalence of anemia and degree of correlation of aging with changes in hemoglobin (Hgb) level in a healthy, elderly population (age range, 60 to 96 years; mean age, 70 years). Twelve per cent of participants were anemic overall, although there was a sex difference; more males (17.7%) were anemic than females (8.4%). Mean Hgb levels did not change significantly with age group except in males over 85 years of age. Pearson Correlation Coefficients were small for age versus Hgb in females (‐ 0.10) as well as in males (‐ 0.21). Likewise, linear regression slopes were small for females (‐ 0.01) and males (‐ 0.04). Based on this set of data, one would not expect a change in Hgb with advancing age in healthy elderly p

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04340.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Recognizing the importance of identifying fallers at risk for injury, the author studied factors associated with injury during falls by ambulatory nursing home residents. Forty‐eight of 79 subjects (61%) fell during their first year of residence. Fourteen fallers suffered a serious injury. Among fallers, subjects with lower extremity weakness were more likely to be injured than were fallers without weakness (42 versus 22% injured). On the other hand, injured fallers needed less help than noninjured fallers (14% needed help with at least 2 activities of daily living versus 35%), and were less likely to be depressed than were noninjured fallers (7 versus 38%). Although frequently associated with falling, no injury occurred while rising from a chair. The contribution of environmental hazards was not well defined. The only acute factor distinguishing noninjurious from injurious falls was a recent previous fall (present in 30% of the former and 0% of the latter). The finding that injured fallers tend to be more independent, yet have greater lower extremity weakness, than noninjured fallers suggests that both components of injury, namely force of impact and protective responses of the faller, may contribute to likelihood of injury during a fall. This study suggests that if predictive characteristics of the injury‐prone fuller, or the fall, can be identified, preventive strategies could be targeted at the high risk gr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04341.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04342.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04343.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

On September 11, 1986, the Supreme Judicial Court of Massachusetts, in a 4–3 decision, authorized removal of the artificial feeding tube. It held that the “substituted judgment” of an incompetent person in a persistent vegetative state to refuse artificially administered sustenance must be honored. The Court also refused to compel the hospital in this case to terminate the treatment, but permitted other hospitals to comply with the patient's wishes.We are publishing the amicus curiae brief filed by the Society for the Right to Die, Inc. in the Brophy case. Our purpose in doing this is to stimulate further discussion of the issue of the role of the patients who become incompetent, a matter of major concern to geriatric specialists. This brief has been well‐prepared. It contains a legal and ethical history of considerable merit.It has not, however, been endorsed by the American Geriatrics Society (AGS). Some of the principles the AGS has endorsed can be found on its own brief filed in the Conroy case (published in the December 1984 issue of the Journal).Physicians and medical ethicists in particular may wish to consider the caveats noted by David Thomasma, PhD. in his editorial in this issue of the Journal. We invite further dis

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04344.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY