摘要:

Abstract:A five‐hour oral glucose tolerance test and simultaneous determinations of serum immunoreactive insulin were performed on 20 male and 20 female elderly nondiabetic subjects whose ages ranged from 68 to 91 years. Results of the glucose tolerance test were abnormal in 29 of the 40 subjects (72.5 per cent) according to accepted standards for young and middle‐aged normal adults. The abnormalities were similar to those found in cases of diabetes mellitus in young adults. The response to glucose stimulation in these elderly subjects was delayed and less efficient than normal. Significant differences were observed with respect to both serum glucose and immunoreactive insulin, the females exhibiting higher levels than the males. Regression analysis showed no immunoreactive insulin in the serum when the glucose level was less than 50 mg per 100

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04101.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY

摘要:

Abstract:ACTH (40 I.U.) was injected intramuscularly into 30 normal elderly subjects (N), 30 patients with senile psychosis (S), and 30 patients with psychosis due to arteriosclerosis (CAS). The ages of the subjects ranged between 64 and 97 years, the mean ages of the N, S and CAS groups being 74, 79 and 77 years respectively. Blood samples were drawn immediately before the injection and at eight and ten hours afterwards. The plasma cortisol and corticosterone (PC) concentrations were determined by the method of Murphy et al.The time curves for the three groups differed significantly. The PC values were highest in the S patients and lowest in the N subjects at eight and ten hours. Differences between the S and CAS patients were statistically significant, as were the differences between the CAS patients and the N subjects. There was no reliable difference in PC levels between men and women. The PC values in eight and ten hours were significantly higher than those at the zero hour; in addition, the eight‐hour value was significantly higher than the ten‐hour one. However, the sex × time and the disease × sex × time interactions were not significant.The results of these studies provide at least one explanation of why patients with senile or arteriosclerotic brain syndrome are more reactive to stress than are normal aged subjects—their adrenal cortices are more

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04102.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY

摘要:

Abstract:The effect of pentylenetetrazol (Metrazol) on serum cholesterol concentration was studied in 29 patients with initial cholesterol levels of 200 mg per 100 ml or higher. In addition, placebo was administered to 10 suitably matched controls. The dosage of pentylenetetrazol was 200 mg four times daily.In the patients to whom the drug was continuously administered for four weeks, there was a statistically significant fall in the concentration of serum cholesterol at the end of two weeks, but a return to the initial high level at the end of four weeks. In the patients to whom the drug was intermittently administered (for two two‐week periods with a one‐week interval), there was a significant decrease in the concentration of serum cholesterol at the end of each two‐week period. In all cases there were no deleterious effects. The maximal hypocholesterolemic effect of pentylenetetrazol was at the end of two weeks, but this lowering effect disappeared when drug administration was continued.The study shows marked individual variations in the cholesterol‐lowering response of patients to pentylenetetrazol. Thus, with respect to the continuing search for such drugs, it would seem that no one drug will be effective in lowering blood cholesterol concentration in all patients. The type of hypercholesterolemia and the type of response to drug administration will each play i

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04103.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY

摘要:

Abstract:A one‐year controlled study was made of 16 nursing homes containing 1,400 patients, 141 of whom were former patients of the Boston State Hospital. The purpose was to determine the effect of therapeutic activities in these settings. The design of the study is described.Institutional deprivation may be physical, intellectual or spiritual. Deprivation in nursing homes was found to be particularly related to: 1) lack of stimulation, 2) lack of adequate walking space inside and outside the homes, 3) lack of recreational and occupational therapy, 4) lack of space for group socialization and activities, 5) lack of a common dining room, so that patients have to eat off trays in their rooms, 6) absence of volunteer workers from the community, 7) separation of patients on different floors, and 8) minimal socialization between male and female patients. Case reports exemplifying deprivation reactions and regressive behavior (a warning signal of possible organic changes) are presented.Proposed programs for overcoming these problems include: 1) in‐service training of staff, 2) better communication between the state hospital and the nursing home, 3) intervention for emergencies or recurring problems, 4) the establishment of recreational and occupational therapy, and 5) the recruitment of volunteers to visit, conduct group games, and arrange extramural activit

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04104.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY

摘要:

Abstract:Among geriatric patients transferred from mental hospitals to nursing homes, disorientation is common. Visual or aural impairment and short attention span are contributing factors. Suggestions are given for aiding the patients in this respect. Staff members should be on the alert to detect whether or not a physical illness or a drug‐induced change underlies an emotional disturbance in patients who are unable to communicate satisfactorily. Examples are given. Lack of information on the patient from the transferring hospital handicaps the nursing home in treatment. A sample record, containing the type of information required, is presente

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04105.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY

摘要:

Abstract:The nursing supervisor is the key staff member in a nursing home, though subject to control by the administrator and owner. The three general types of nursing supervisor are: 1) permissive, 2) dominant, controlling, and 3) staff‐centered. Under a permissive supervisor, the pervasive indecision leads to an indifferent staff and anxious patients. Under the dominant supervisor, the home is a model of efficiency and neatness but the loss of self‐esteem and interest leads to a high turnover of staff and disregard of patients' emotional needs. Under the staff‐centered supervisor, control and responsibility are shared with the staff. Patients are allowed some self‐expression and are treated with understanding. Yet, this supervisor maintains mastery of the home. What happens to a home when the nursing supervisor leaves without immediate replacement? The deterioration is described. The attitude of student nurses who visit nursing homes as part of their training is often greatly changed in the direction of a better understanding of the problems of geriatric

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04106.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY

摘要:

Abstract:This study was an attempt to determine the unique features of various ethnic groups which affect social relationships in nursing homes. Detailed examples are given of what was observed in the following geriatric groups during visits to nursing homes: Chinese, Armenian, Roman Catholic (one home predominantly Italian, and one run by the Little Sisters of the Poor), Jewish (one efficiently managed, and one less well managed, chiefly for the foreign‐born), predominantly Negro (entire staff and more than half the patients), and Protestant (Puritan type and Currier and Ives type); in addition, an example is given of people who had grown old and were cared for in their own communities by neighbors and relatives. Some of these situations were much better than others, though overall, it was evident that loneliness, aimlessness and monotony tend to dominate the lives of most aged people in institutions. However, those who are strongly bound by ethnic, cultural and religious ties do not feel isolated, abandoned and hopeles

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04107.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY

摘要:

Abstract:Electrocardiographic patterns change with aging, and with several other factors (some transient) that do not indicate disease. It is mandatory that an interpreter of electrocardiograms be aware of these factors. Otherwise, he may be responsible for creating a “cardiac cripple” with all the attendant emotional and familial disturbances which sometimes can be catastrophic. Such a case is presented, as are others from the literature.In conclusion, the author states: “Let us not take from the relatively healthy old person his sense of cardiac security. Let us not label him as a cardiac patient. Let us leave him to live out his years in confidence that his heart, though as old as his years, may carry him to the end of his allotted

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04108.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY

摘要:

Abstract:Eleven elderly patients with arterial insufficiency of the brain (senile dementia, presenile dementia, transient ischemic attacks or recurrent strokes) were treated with an anticoagulant (bishydroxycoumarin) for periods varying from eight years to twenty‐four days. All 11 patients showed improvement. Interruption of treatment proved safe in 2 patients, harmful in 2 others, and fatal in 3 patients. In a case of Alzheimer's disease in which bishydroxycoumarin was stopped four times, the patient deteriorated each time the drug was discontinued and improved each time it was resumed.Anticoagulant therapy appears to be effective in relieving the symptoms of arterial insufficiency of the brain and preventing progression of disability. In a selected group of patients, considerable improvement may be expected. Once relief is obtained, discontinuing anticoagulant therapy (especially within two years) may be very risky since deterioration is likely to occur. The risks of using anticoagulants for this purpose are not discussed but probably they are the same as in the treatment of coronary artery disease. Not using anticoagulants may be more harmful than using them; discontinuation withdraws effective treatmen

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04109.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY

摘要:

Abstract:The prominence of chronic disabling diseases in present‐day medical practice calls for an increase in social service work to help manage the associated psychosocial problems. The four stages of the social worker's in‐hospital treatment for these patients are: 1) encouraging the patient to discuss his problems, 2) stimulating some understanding of how he may overcome these problems, 3) putting this perception into action, and 4) integrating the gains made by the patient. Work with the patient's family is inevitably involved. This kind of planning results increasingly in enabling mental hospitals to carry out their primary purpose of active treatment for the mentally ill and freeing them from the additional responsibilities of domiciliary and hospital care for chronic disease; permitting the chronically disabled to return to their own communities among familiar people and surroundings; and sometimes even accomplishing complete resocialization with return to a full and independent life. The alternative is an isolated, meaningless, dependent institutional life. Two illustrative case histories are presen

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb04110.x

出版商:Blackwell Publishing Ltd    

年代:1969

数据来源: WILEY