摘要:

ABSTRACT:An accepted method of measuring exercise tolerance was applied exclusively to geriatric practice for the purpose of exercise prescription. This stress testing was performed to minimize the risks of introducing exercise in an elderly population, and to restore or maintain elderly persons at their own optimal level of function, for life. As no geriatric testing protocol was available, two standardized protocols were chiefly used to start the trial program in March, 1978. A geriatric modification devised by the author is described. During the first month of the study, in a physician's office, ECG‐monitored treadmill testing was conducted without mishap in 175 patients (age range, 60–89 years). All but 4 of the subjects (98 percent) led habitually sedentary lives, and documented coronary heart disease was present in about one‐fourth of the series. The initial test data in this proposed continuing study are summarized. The methods for candidate selection, the safety precautions, and the test procedure are outlined. The distinction is made between testing by functional grades and testing to maximal levels. Information obtained from this stress test is an integral part of the individualized exercise prescription for each geriatric su

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06054.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:Community‐acquired bacterial pneumonia in the elderly has for years been attributed almost exclusively to Streptococcus pneumonias. Recent technical advances have provided bacteriologic and epidemiologic data demonstrating that other pathogens are important causes of pulmonary infection in older patients. This report reviews these data and reappraises the conventional therapy of community‐acquired bacterial pneumonia in geriatric patients. Some properties of a new antibiotic, cefamandole nafate, are descri

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06055.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:As part of an interdisciplinary study of organic dementia, a psychologic test for assessing the degree of dementia—the Extended Scale for Dementia—was developed through the expansion and rescoring of the original Mattis Dementia Scale. Statistical analyses of the 23 test items resulted in a scoring scheme which includes the “weighting” of items for scoring purposes. The test was successfully administered to 90 subjects from 6 hospitals in the London (Ontario) region. With use of the Extended Scale, it was possible to discriminate between dementia and non‐dementia groups of psychogeriatric inpatients and to correlate the findings closely with those of another measure of the degree of dementia, viz, the London Psychogeriatric Rating Scale (Ment.). Dementia patients who were retested after 6‐month and 12‐month intervals showed a significant decline in scores. No significant scoring differences were noted between males and females or between Alzheimer dementia and multiinf

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06056.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:Increasing interest is manifest in the development of alternative models of counseling for older persons. Irrespective of the particular model used, the counseling of aged persons who have emotional and psychologic problems may require a treatment plan for health, mental health, and social services, to resolve the problems and to assess the functional limitations. Health and mental health centers employing both professional and nonprofessional counselors need to determine the value of adding outreach components to their services, and agencies which already have outreach programs may need to determine their relevance and effectiveness. Effective outreach requires a high level of gerontologic knowledge and clinical skills with aged patients. Agencies and clinics can design and implement mechanisms for supporting the elderly as they make use of multiple sources of service. Mobilization of the family and other informal helping networks in the community, the establishment of better coordination mechanisms within clinic and service programs, and multipleservice integration will improve the efficiency and effectiveness of long‐term community care and follow‐up progr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06057.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:A group of 182 elderly subjects (91 females, 91 males; 94 blacks, 88 whites) were interviewed with respect to background data, dietary habits, and health variables. Analysis of variance showed race and sex differences with respect to meal patterns and quality of diet. In addition, correlational analyses revealed associations between quality of diet and social class, education, health status, and the smoking of cigarettes. Associations were strongest for the black subjects.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06058.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:Most afferent inputs are sensory stimulants, and physical activity is probably one of the most significant of all sensory stimulations. Gravity is a constant stimulus. These demands are also known as stress, and the stressor effect as the general adaptation syndrome (Selye). In this study, these demands are called sensory afferent stimuli, which are necessary triggers to start the hypothalamus‐pituitary‐adrenal mechanism and thus maintain the general mechanical, autonomic and metabolic functions of the body in the state of homeostasis. If the sensory stimulus is removed, there is no stressor effect and the cycle of response is eliminated. This results in a decreased hypothalamuspituitary response and a decreased production of ACTH and corticoids. A decrease in the sensory input creates changes in the central nervous system and in the musculoskeletal system which are compatible with lack of the hypothalamus‐pituitary response. When a person becomes ill, physical inactivity as well as sensory and perceptual deprivation are at a maximum, and the absence of these stimuli interrupts the cycle of homeostasis. Physical activity is one of the most important stressors (sensory input) or triggering mechanisms for the cycle of homeostasis (hypothalamus‐pituitary‐adrenal cycle). Therefore, it is imperative to provide the patient with physical activities which ensure motion and take into account the effect of gravity. This is best accomplished by a program of physical, occupational and recreationa

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06059.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:Despite the increasing importance of gerontology to medical practice, it has been difficult to incorporate it into the curriculum of most medical schools. The aim of this project was to explore the feasibility of introducing gerontology into medical education by utilizing the framework of an existing clinical program. A gerontologist used the structure and resources of a Psychiatry Consultation‐Liaison Program for this purpose. Three groups of target trainees were identified: psychiatry residents on their Liaison rotation; junior medical students on their psychiatry clerkship; and medical‐surgical house officers in the general hospital. The objectives were to impart didactic information and to counteract negative attitudes leading to disinterest in evaluating and treating the elderly. The results indicated a positive impact on all three trainee groups, and a diffusion of the gerontologic innovation from the initial locus of a clinical sub‐unit into the medical center and the medical s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06060.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:Drug usage was studied in a geriatric hypertension‐screening program. A questionnaire was used to collect the required information from patients visiting the clinic during three successive years. The study included 1,711 patients, of whom 76.6 percent were regularly using a drug preparation. A consistent increase was noted in the average number of drug categories used with increasing age, from 1.6 in patients under 70 to 2.6 in patients over 84 years old. The most common drug categories involved were antihypertensive agents, cardiovascular drugs, vitamins, and internal analgesic

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06061.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:This case illustrates the development of a bronchoextrapleural fistula 40 years after extrapleural pneumonolysis with placement of a paraffin pack. The various diagnostic possibilities in the presence of such a radiographic presentation are reviewed.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06062.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:The erythrocyte sedimentation rate (ESR) is not always elevated in relation to disease. Of 188 elderly autopsy patients studied, 125 had nonmalignant disease and 63 had malignant disease. Of the patients with malignant disease, 13 percent had a clinical ESR of less than 10 mm/hr and 26 percent a rate of less than 20 mm/hr, the upper level of normal for the elderly. Of the patients with nonmalignant disease, 9.6 percent had an ESR of less than 10 mm/ hr and 25.6 percent a rate of less than 20 mm/hr. Thus, in about a quarter of the patients, the ESR was below the top normal level for the elderly. Moreover, the ESR may be as high as 35–40 mm/hr in healthy aged persons. Therefore, the ESR is unreliable as a test for the presence of disease (malignant or nonmalignant) in the elderl

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb06063.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY