摘要:

Objective:To investigate whether influenza A‐specific cytotoxic T lymphocyte (CTL) activity is reduced in elderly compared with younger adults.Design:Case series comparing outcomes in young and elderly cohorts.Setting:Saint Louis University Division of Geriatric Medicine.Participants:Healthy adult outpatients and staff members aged65 (elderly) years.Methods:Peripheral blood mononuclear cells were assayed for CTL activity by a51chromium release assay following 1 week of in vitro stimulation with influenza A/PR/8/34 (H1N1) virus.Measurements:Percent specific lysis of autologous and allogeneic influenza virus‐infected target cells.Main Results:Specific lysis of autologous A/PR‐infected targets was significantly lower in elderly compared to young subjects (P<0.01), and exceeded 10% in a significantly lower proportion of elderly compared with younger subjects (P<0.05), but was not influenced by a history of vaccination within the preceding 12 months. Cytotoxic effectors were class I human leukocyte antigen (HLA)‐restricted and displayed heterosubtypic cross‐reactivity but were unable to lyse influenza B‐infected targets.Conclusions:These results demonstrate an age‐related decline of influenza A virus‐specific CTL activity and suggest that CTL responses to inactivated virus vaccine are of

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05938.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:Define the range of community seating heights available for use by older adults; test whether raising chair height by small increments facilitates chair‐rise performance; and heighten physician and furniture industry awareness of discrepancies that may exist between actual and acceptable chair heights for older adults.Design:Phase 1: Survey of commercially available chair heights. Phase 2: Cross‐sectional descriptive study of chair‐rise ability.Setting:Phase 1: Local furniture stores, physician offices, hospital waiting areas, and nursing homes. Phase 2: Postural Control Lab.Participants:Twenty‐two volunteers (nursing home residents and community dwellers). Exclusion criteria: inability to stand independently and inability to bear full weight on the lower extremities in the standing position.Measurements:Chair rise success at six heights (17–22 inches), self‐reported difficulty (visual analogue scale), change in minimum hip angle and maximum shoulder angle during rise, using motion analysis.Results:Phase 1: Community chair heights ranged from 12 to 18 inches, with a mean of 16.3 in physician offices, 16.6 in nursing homes, 16.4 in hospitals, 17.3 in “kitchens” and 15 in “living rooms.” Phase 2: As chair height increased from 17 to 22 inches, chair rise effort decreased, as shown by near doubling of percent successful rises, decline in mean self‐reported difficulty score, increase in mean minimum hip angle, and decrease in mean maximum shoulder angle.Conclusions:Seating height may need to be more closely scrutinized in areas frequented by frail elders. Augmentation of seat height by small increments facilitates c

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05939.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To define the prevalence of monoclonal immunoglobulin (Ig) proteins and quantitative serum immunoglobulin levels in elderly Japanese in comparison with elderly Caucasians as possible factors related to the reported lower incidence of multiple myeloma in elderly Japanese than in elderly Caucasians.Design:Survey studySetting:Community Center in Yokohama, Japan and Retirement Community in the United States.Participants:Convenience sample of community‐dwelling elderly subjects (age 63–95) presenting for health screening examinations in each setting. Frozen serum samples were obtained from routine screening from 146 consecutive Japanese subjects and 111 US subjects.Intervention:NoneMeasurements:Presence of monoclonal immunoglobulin protein determined by serum protein electrophoresis and immunofixation and quantitative Ig by laser nephelometry.Results:Four (2.7%) of the Japanese cohort had monoclonal gammopathies compared with 11 (10%) of the American cohort. Two of the monoclonal gammopathies were IgG Kappa and two were IgG Lambda. No cases of multiple monoclonal gammopathy were identified in the Japanese group, compared with 25% of the monoclonal gammopathies in the American group. The mean quantitative serum IgG level for the Japanese group was 1,685 ± 520 mg/dL versus 1,118 ± 402 mg/dL for the American group; mean quantitative IgA levels were 283 ± 116 mg/dL versus 226 ± 116 mg/ dL (P<0.001). Albumin levels were normal in both populations, suggesting that there was not an increase in occult inflammatory disorders in the Japanese population.Conclusion:The low prevalence of monoclonal gammopathy in elderly Japanese is consistent with the reported lower frequency of multiple myeloma. The reason for the higher quantitative immunoglobulin levels in this population is unclear. Further cross‐cultural investigation is warranted to explore the genetic influences on altered immune regulation w

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05940.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:In a preliminary study in our laboratory, healthy elderly people had a higher heart rate during treadmill walking than during corridor walking at the same speed. The objective of this study was to determine whether this initial observation, (1) persisted after repeated testing, (2) was present in younger adults, (3) was due to wearing a mouthpiece during treadmill walking, or (4) was due to a change in gait.Design:A study of elderly and young volunteers undergoing repeated testing, with comparison of treadmill walking with corridor walking.Setting:The Royal Free Hospital School of Medicine.Participants:Twelve healthy elderly (71–80 years) and 12 healthy young (21–37 years) volunteers.Main Outcome Measures:Heart rate (beats/min) and step rate (steps/min) during comfortable self‐paced corridor walking and during treadmill walking at the same speed.Main Results:The elderly subjects had higher heart rates during treadmill walking than during corridor walking at the same speed (mean difference = 6 beats/min, 95% Confidence Interval (CI) = 1 to 10). This difference increased (to a mean of 11 beats/min, 95% CI = 5 to 16) when a mouthpiece was worn on the treadmill. These differences persisted after repeated testing. The young subjects did not have higher heart rates on the treadmill, (with or without the mouthpiece). In both groups, step rate was lower (95% CI = ‐9 to ‐2, elderly; ‐5 to ‐2, young) during treadmill walking, corresponding to a 3% increase in stride length.Conclusion:The heart rate response to treadmill walking in healthy elderly people may be less representative of the “real life” situation than

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05941.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:The aim of the present study was to evaluate whether alterations in postprandial hemodynamics in the elderly were associated with changes in cerebral perfusion assessed by transcranial Doppler ultrasonography.Design:Time series, ie, post‐intervention compared to pre‐intervention with no‐intervention controls.Participants:Ten elderly institutionalized subjects (4 women, 6 men, mean age 84.9 years). Three subjects had a history of syncope.Setting:A 725‐bed academic long‐term care facility.Intervention:A 400‐kcal mixed meal.Measurements:Heart rate, blood pressure, and blood flow velocity in the middle cerebral artery by transcranial Doppler recording, before the test meal and at 5‐minute intervals for 60 minutes afterwards.Results:Systolic, diastolic, and mean arterial blood pressure declined significantly from baseline between 30 and 55 minutes after the meal (P<0.05, ANOVA); however, maximum and mean blood flow velocity did not change. The pulsatility index (end diastolic to peak systolic amplitude divided by mean velocity) increased significantly (P<0.05, ANOVA) between 30 and 55 minutes after the meal, suggesting increased arteriolar resistance. There were no significant changes in blood pressure, blood flow velocity, and pulsatility index during a control study conducted with four subjects under identical conditions but without a meal.Conclusions:The results of this study suggest a small, unexpected increase in resistance of the intracranial circulation following a meal in elderly people with postprandial hypotension. Although the clinical significance of this finding is not known, the occurrence of postprandial arteriolar vasoconstriction may lead to cerebral ischemia during periods of marked blood pre

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05942.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:This study sought to determine the kind of health care that professional and family caregivers viewed as appropriate for end‐stage dementia patients.Design:Survey.Participants:All 819 physician members and 1,000 randomly selected non‐physician members of the Gerontological Society of America and 500 families of demented relatives from the Alzheimer's Association.Measures:Respondents chose the appropriate level of care from five choices on a continuum from highly aggressive to palliative.Results:The majority of physicians who cared for elders (61%), gerontologists from other professions (55%), and families (71%) chose palliative care only. Increased age of the respondent and experience with terminal care choices were associated with the choice of palliative care. The majority favored hospice care for patients with end‐stage dementia.Conclusions:Professional and family members of demented individuals, especially if they have experience in terminal care decisions, strongly favor palliative care for end‐stage dementia. These findings may be helpful to professionals and families dealing with these

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05943.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To determine whether clinical features and rate of cognitive and functional decline differed in cohorts of possible AD (poAD), probable AD (prAD), and mixed dementia (MIX) patients.Design:Cohort study with 1‐year follow‐up examination, comparing three groups of subjects.Setting:Outpatient evaluation at nine California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC).Patients:There were 1701 elderly patients who presented for evaluation of memory complaints.Measurements:Historical, physical, and neurological variables for cross‐sectional comparisons and 1‐year rate of change on the Mini‐Mental State Examination (MMSE), Blessed Information‐Memory‐Concentration test (BIMC), and Blessed Dementia Scale (BDS).Results:Mean initial MMSE scores for poAD (n= 279), prAD (n= 928) and MIX (n= 430) were 17.9 (±7.4), 13.9 (±7.5), and 15.4 (±7.1). Delusions and psychosis occurred in about one‐third of each group, most often in those with moderate dementia (MMSE 11–20). PoAD were distinguished from prAD by significantly more alcohol abuse, physical health problems, and focal motor or sensory findings. MIX differed from AD alone by increased prevalence of cardiovascular disease, hypertension, stroke, TIA, and exposure to general anesthesia, and by a greater frequency on exam of depressed mood, focal motor or sensory findings, and gait disorder. All groups declined by about 2.8 points on the BIMC, 2.9 points on the MMSE, and 1.8 points on the BDS, a functional scale, over 1 year. Neither extrapyramidal signs nor psychosis predicted a more rapid rate of decline.Conclusions:Various features help to distinguish poAD, prAD, and MIX in a large cohort of patients, but do not predict the

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05944.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To further validate an objective measure of physical illness burden, the Cumulative Illness Rating Scale (CIRS).Design:Survey with correlation of CIRS ratings made from physician interviews and review of medical records with postmortem ratings made independently at tissue autopsy.Subjects:Victims of completed suicide investigated by both psychological and tissue autopsy (n= 72).Results:CIRS ratings made by examination of tissue at autopsy were highly predictive of analogous ratings based on historical data, accounting for 75% of the variance in CIRS scores. Taking autopsy findings as the gold standard of objective health assessment, historical ratings tend to underestimate physical illness at high levels of tissue pathology and to overestimate burden at lower levels.Conclusions:The CIRS score, when derived from all available sources of medical information, is a valid objective measure of physical illness burden and has broad applicability to research in geriatrics.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05945.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To ascertain the success of complex reconstructive vaginal surgery in older women.Design:Retrospective review of hospital and outpatient records.Setting:Rural tertiary care referral center, Pennsylvania State University Hospital, Hershey, PennsylvaniaPatients:Twenty‐four patients referred for massive eversion of the vagina and/or complete procidentia.Measurements:Symptoms and anatomic correction of patients' complaints.Results:After surgery, 83 percent were asymptomatic without pelvic relaxation, 4 percent were asymptomatic with pelvic relaxation, 4 percent were symptomatic without pelvic relaxation, and 9 percent were symptomatic with relaxation.Conclusions:Older women can undergo major vaginal reconstructive surgery with relief of symptoms and restoration of vaginal depth and axi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05946.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To study rate of progression and correlates of cognitive and functional/behavioral deterioration in Alzheimer patients.Design:A 1‐year multicenter prospective study.Setting:Outpatients and inpatients at geriatric institutions.Patients:Fifty‐six patients with a clinical diagnosis of Alzheimer's disease according to DSM‐III criteria of Primary Degenerative Dementia.Main Outcome Measures:Blessed Dementia Scale (BDS) and Blessed Information‐Memory‐Concentration test (BIMC) measured at baseline, third, sixth, and twelfth month.Results:The mean annual (±SD) rate of progression of our sample was 3.5 (±3.7) points on the BDS and 2.6 (±4.9) on the BIMC, with a wide range of variability. The level of cognitive impairment (BIMC score) at baseline predicted functional and behavioral deterioration: the better the initial BIMC score, the less the rate of negative change of BDS (r= 0.37,P= 0.006). Furthermore, the younger the patients at the disease onset, the faster the progression of cognitive impairment (r= 0.48,P= 0.0003), with men having a slower rate of progression (P= 0.004) than women.Conclusions:The present study confirms previous findings showing a wide individual variability in rate of progression of cognitive and functional/behavioral impairment as assessed by BIMC and BDS. The cognitive profile may predict the clinical evolution better than the functional and behavioral status, with patients with an earlier onset and women having a faster d

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb05947.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY