摘要:

ABSTRACTThis is a Report presented to and endorsed by the Board of Directors of the American Geriatrics Society (AGS). It deals with developments since the AGS Conferences on Geriatric Education, 1976–77. Summarized is the position adopted by various medical organizations and associations, including the Institute of Medicine, Federated Council for Internal Medicine, American Society of Internal Medicine, and the American Academy of Family Physicians. Their stances essentially agree with that described in the Proceedings of the 1976–77 Conferences (JAGS, November 1977). The consensus arising from discussions by organized medical groups is that creation of a new practice specialty is unnecessary, although development and maintenance of an academic cadre of teachers and researchers is essential. Called for is greater commitment at the medical school level to incorporate geriatrics into the curriculum. The Report also deals with the question of merited recognition for those with special competency or expanded training in geriatrics. Finally, the Report provides support for the Medical Director concept, and looks to the Society's new Section for Long‐Term Care Physicians to provide leadership in emphasizing the role of the physician in long‐term care. The AGS intends, through future reports, publications, conferences, and liaison relationships with other organizations, to continue this advance, seeking solutions designed to improve and extend the health care of the aging pop

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02385.x

年代:1981

数据来源: WILEY

摘要:

ABSTRACTFor more than 70 years, surgical excision with permanent colostomy has been the most common operation for adenocarcinoma of the rectum. Local treatment has been advocated by some surgeons, but most prefer radical surgery. Abdominoperitoneal resection often diminishes the risk of local recurrence, but mortality and morbidity rates are very high, especially in the elderly. Although local treatment for rectal cancer remains controversial, the author believes that the elderly constitute a separate category of patients because their mortality and morbidity rates are high and because they usually are unable to care for a colostomy. Local treatment seems a much more desirable form of therapy. A series of 6 elderly patients (average age, 77) were treated by local electrocoagulation followed by radiation therapy, for biopsy‐proven adenocarcinoma of the rectum; one died after nine months from liver metastases (present at the time of diagnosis), and one had to undergo a colostomy after 19 months. For the 4 remaining patients, follow‐up has ranged from three years to nine months. To date there has been no recurrence, no evidence of metastases, and no mortality or morbidity. In the author's opinion, the results of electrocoagulation‐radiation treatment of small rectal adenocarcinomas are superior to the results of radical surgery in elderly pat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02386.x

年代:1981

数据来源: WILEY

摘要:

ABSTRACTThe importance of depression as a psychopathologic syndrome in the elderly is stressed by the estimate that about 30 percent of persons over the age of 65 may be expected to experience an episode of depression severe enough to interfere with daily functioning. Depression is the chief cause of psychiatric hospitalization among the elderly, and it bears great potential for death through inanition or suicide. Loss of mastery (ability to cope) and the onset of helplessness are frequent dynamic issues in the development of depression or behavioral problems in the elderly. Geriatric sterotypes contribute directly to helplessness by reinforcing such behavior. Stereotypes also minimize the chance of appropriate response outcomes relative to needs. Rolelessness, a partial result of stereotyping, leads to anomie, alienation, and lowered self‐esteem. These issues are discussed and points of interaction among them are examined. The relevance to psychotherapy with older persons is outline

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02387.x

年代:1981

数据来源: WILEY

摘要:

ABSTRACTIn four groups of subjects free of thyroid disease, the following determinations were made: serum concentrations of thyroxine (T4), triiodothyronine (T3), reverse T3(rT3) and diiodothyronine (T2), and calculated indices of free thyroxine (FT4) and free triiodothyronine (FT3). Group A comprised healthy subjects aged 16–64; Group B, 24 healthy elderly subjects aged 68–95; Group C, 23 elderly patients with mild well‐controlled chronic illnesses, aged 70–85; Group D, 40 nursing home residents aged 66–100. Serum T4and T2concentrations and the FT4index were not affected by age; the rT3concentration was slightly but significantly elevated only in Group D patients. Serum T3concentration was significantly lower in all groups of elderly subjects and decreased FT3index measurements were detected after age 75. It was concluded that old age, without complicating illness, is accompanied only by a decrease in the serum level of T3and the FT3index; values for other iodothyronines are unchanged. Clinicians should consider the age‐related changes in T3and FT3values when interpreting thyroid fun

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02388.x

年代:1981

数据来源: WILEY

摘要:

ABSTRACTThe possible role of obesity in the development of hypertension was investigated in two study groups. In a population study of 961 subjects, 739 were found to be normotensive and 222 hypertensive. The prevalence of hypertension was 18.7 percent in the nonobese, and 33.2 percent in the obese subjects. Systolic and diastolic blood pressures increased progressively with the increase of relative body weight in both normotensive and hypertensive subjects. In addition, an endocrinologic study was made of 97 patients with essential hypertension; in 82, plasma renin activity (PRA) was inversely correlated with the increase of relative body weight but not with urinary Na excretion. Despite this decrease of PRA, the level of serum aldosterone was not influenced by relative body weight. Thus, the aldosterone/PRA ratio increased progressively with the increase of relative body weight. Thiazide therapy normalized this inappropriately high ratio, and reduced body weight and blood pressure. Restriction of dietary calories and salt intake had a similar effect. With a high‐salt intake in an obese subject, the aldosterone/PRA ratio is unduly increased. Apparently aldosterone contributes to the additional retention of sodium and water and thereby promotes hypertension in the presence of an expanded fluid volum

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02389.x

年代:1981

数据来源: WILEY

摘要:

ABSTRACTIn a 90‐year‐old man undergoing prolonged digitalis therapy, digitalis toxicity was precipitated by the administration of quinidine. The electrocardiogram revealed supraventricular bidirectional tachycardia, a rare but characteristic arrhythmia associated with digitalis toxicity. Upon withdrawal of digoxin, the clinical and ECG signs disappeared. A diagnosis of digitalis toxicity rather than quinidine intolerance led to appropriate treatm

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02390.x

年代:1981

数据来源: WILEY

摘要:

ABSTRACTIn 15 elderly patients who had seizure disorders, venous blood (standard venipuncture) was compared with capillary blood (finger lancet puncture) as the source of the specimen for determination of serum phenytoin concentration. The values obtained by the two procedures were similar (r = 0.99). The mean serum phenytoin levels in the venous samples was 17.3 μg/ml, and in the capillary samples 17.0 μg/ml; the pairedttest showed no statistical difference. Either method provides an adequate blood sample for determination of phenytoin, and both may be used interchangeably. Capillary samples may be preferable for aged patients in whom venipuncture proves difficult or painfu

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02391.x

年代:1981

数据来源: WILEY

摘要:

ABSTRACTThe hypochondriacal attitudes of 53 aged community residents were studied. No significant correlations were found with situational stress, sex, or ethnicity (English‐speaking vs Spanish‐speaking). The levels of hypochondriasis appeared to be inversely related to self‐evaluation of memory ability. There was no indication of an inherent iatrogenic effect. It was concluded that hypochondriacal behavior is chiefly a function of the underlying personality, which may influence the perception of events as stre

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02392.x

年代:1981

数据来源: WILEY

摘要:

ABSTRACTThis report pertains to the development of bronchogenic carcinoma in 4 elderly patients with chronic lymphatic leukemia. The abnormal radiologic shadows in the lung (confined to the upper lobes and hili) were noted 30–60 months after recognition of the hematologic abnormality. Spread to ipsilateral or contralateral lymph nodes was common. After the appearance of lung carcinoma, the patient's course was downhill, with an average survival period of 2 months. The development of a new pulmonary lesion in any patient with chronic lymphatic leukemia should arouse the suspicion of malignancy and lead to prompt investigatio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02393.x

年代:1981

数据来源: WILEY

摘要:

ABSTRACTIntermittent claudication in the lower extremities is often manifested in either of two treatable forms, i.e., neurogenic or vascular. A thorough history and examination are necessary to distinguish between these two types. The main differential point is whether pain (vascular type) or a neurologic deficit (neurogenic type) develops as the patient exercises.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb02394.x

年代:1981

数据来源: WILEY