The care of elderly patients by elderly physicians

To examine the content of care that elderly patients receive from physicians greater than or equal to 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 greater than or equal to 75 years of age and more likely to discharge patients greater than or equal to 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 physician's age.     

Malignant diseases in the elderly. The elderly tumor patient

Zum Thema Aufgrund der demographischen Entwicklung in der Bundesrepublik wird die Inzidenz von Tumorerkrankungen besonders auch im hohen Alter in den n?chsten Jahren deutlich zunehmen. Bislang allerdings ist die Versorgung gerade des ?lteren Tumorpatienten jedoch h?ufig noch mangelhaft, sodass oftmals immer noch z?gerlich und inad?quat diagnostiziert und therapiert wird. Spezielle Studien zur Therapie ?lterer Tumorpatienten fehlen, sodass eine Unsicherheit in Bezug auf die geeignete Therapie besteht. Der vorliegende Beitrag beschreibt M?glichkeiten einer verbesserten onkologischen Therapieführung im Alter, die neben dem Einsatz alternativer Substanzen bei der Chemotherapie auch supportive und additive Ma?nahmen wie beispielsweise den Einsatz von Wachstumsfaktoren umfassen.     

Primary glomerular diseases in the elderly Glomerulonephritis in the elderly

Recent studies have pointed out that the incidence of primary glomerular diseases is similar in the elderly and in younger populations. However the clinical characteristics of the different subtypes may be different in the advanced age. Minimal change nephropathy responds favorably to corticosteroids and/or cyclophosphamide, but many untreated or non-responder patients progress to end-stage renal disease or die from nephrotic complications. Focal and segmental glomerulosclerosis also has a severe prognosis in older patients but some 50% of patients may attain remission of the nephrotic syndrome with a prolonged corticosteroid treatment. The responders tend to maintain normal renal function over time. Membranoproliferative glomerulonephritis and IgA nephritis have a severe prognosis and do not respond to treatment. The clinical presentation and the outcome of membranous nephropathy are similar in the elderly and in younger adults. Corticosteroids are of little benefit while a 6-month treatment with chlorambucil and methylprednisolone may obtain remission of the nephrotic syndrome in about 2/3 of older patients. Crescentic glomerulonephritis has an ominous prognosis in older patients but some patients may improve if treatment with methylprednisolone pulses is started early. Acute postinfectious glomerulonephritis is often associated with renal failure in older patients. The prognosis may be severe.     

Tuberculosis in elderly

We compared patients with active tuberculosis treated at Kurume University Hospital between cases 65 years and above and below 65. The comparison included immunologic and clinical features. Anergy to tuberculin skin tests with purified protein derivative (PPD) was evident in 7% of patients under 65 and in 14% of those over 65. Older patients had fewer lymphocytes in peripheral blood and lower serum concentrations of interferon (IFN)-gamma than younger patients. Complications were more frequently seen in patients above 65, but the time required for negative conversion of sputum cultures did not differ by age. Adequacy of the regimen of chemotherapy and the sensitivity to anti-mycobacterial drugs were the most important determinants of the time for negative conversion of sputum culture. Major clinical problems of old tuberculosis patients were concurrent diseases, bed ridden states, necessity of nursing care, and poor performance status of patients.     

The elderly travellers

As the population increases, older people have the opportunity to travel for longer periods and to destinations that are quite different from what they are used to. Older people do indeed have more ongoing medical issues and some limitations due to the aging process. Most of the time these chronic conditions are not a contraindication to travel. Preparing for travel frequently involves starting an exercise program, updating routine immunizations such as tetanus, pneumonia, and influenza as well as getting destination specific immunizations such as hepatitis, yellow fever and typhoid. Medications should be reviewed as they relate to altitude, climate and concurrent travel medications including malaria prophylaxis. There are many organizations and foundations that deal with travel and specific medical problems such as diabetes, asthma, dialysis and for those with spinal cord injuries. The traveler would be wise to seek the advice of specialists related to their specific medical condition as well as a travel medical physician. One should also be sure that their medical insurance would cover them in a foreign country.     

The elderly foot

The aged foot suffers physiologic changes in form and structure to make it substantially more sensible for daily stress. Pathologic changes especially of the forefoot lead to stress-induced pain until final incapacity for stress. Special importance is due to a well-adapted clothing of the foot with a smooth-bedded sole of the foot. The operative treatment of forefoot diseases as there are hallux valgus, claw-toes and splayfoot leads to excellent functional results.     

Renal sodium transport in healthy elderly and elderly with systolic hypertension

It is accepted that lithium clearance expresses the delivery of sodium and water. This study was designed to investigate renal sodium transport in healthy and hypertensive elderly using lithium clearance (Cli) and fractional lithium clearance (FEli). The clearance studies were performed and analyzed in young healthy volunteers (n = 29, 26.2 ± 3.7 years), elderly with normal blood pressure (n = 49, 67.8 ± 6.1 years) and elderly with systolic hypertension (n = 37, 68.5 ± 7.2 years, blood pressure ≥ 160/95 mmHg). FE_Na of healthy elderly group was greater than that of young group (1.36 ± 0.49% vs. 1.06 ± 0.54%, P < 0.05), but there was no difference between the healthy elderly group and hypertensive elderly group. In the healthy elderly with normal GFR (subgroup 1, n = 27), FE_Li was still significantly higher than that of young group (26.1 ± 10.0 vs. 18.6 ± 4.0%, P < 0.001). The absolute proximal reabsorption of sodium (APR_Na) and the fractional proximal reabsorption of sodium (FDR_Na) in subgroup 1 were obviously lower than that of the young group (11.9 ± 1.8 vs. 13.3 ± 3.1 mmol/min, P < 0.05 and 76.5 ±6.4% vs. 81.5 ± 4.0%, P < 0.005). On the other hand, no significant difference was found in absolute or fractional distal reabsorption of sodium (ADR_Na or FDR_Na) between subgroup 1 and the young group. ADR_Na/filtered sodium load (FL_Na) in subgroup 1 was significantly higher than that of the young group (22.6 ± 6.8% vs. 17.6 ± 3.9%, P < 0.05), whereas there were no differences in C_Li, FE_Li, APR_Na, ADR_Na, FDR_Na or ADR_Na/FL_Na between the healthy elderly group and the aged systolic hypertensive group. It is concluded that in ageing, sodium reabsorption in the proximal nephron is reduced alone with a relative enhancement of sodium reabsorption in distal nephron, which might be a compensation in sodium balance of old persons. Abnormalities of sodium reabsorption were unlikely to be responsible for systolic hypertension in the elderly.     

Comparison of acute coronary syndromes among elderly African Americans,elderly whites,and elderly patients of other races

The purpose of this study was to investigate acute coronary syndromes (ACS) in elderly persons of different races. A prospective study was performed in which 177 consecutive unselected patients aged > or = 70 years hospitalized for ACS had coronary angiography. The patients included 11 blacks, 140 whites, and 26 patients of other races. Obstructive coronary artery disease (CAD) was present in 8 of 11 blacks (73%), 121 of 140 whites (86%), and 25 of 26 patients of other races (96%) (P < 0.05 comparing black patients with those of other races). Left main CAD was present in 0 of 11 blacks (0%), 9 of 140 whites (6%), and in 1 of 26 patients of other races (4%) (P not significant). Left anterior descending or diagonal CAD was present in 4 of 11 blacks (36%), 96 of 140 whites (67%), and 18 of 26 patients of other races (69%) (P < 0.05 comparing blacks with whites). Left circumflex or obtuse marginal disease was present in 5 of 11 blacks (45%), 72 of 140 whites (51%), and in 17 of 26 patients of other races (65%) (P not significant). Right CAD was present in 5 of 11 blacks (45%), 81 of 140 whites (58%), and 18 of 26 patients of other races (69%) (P not significant). Coronary revascularization was performed in 7 of 11 blacks (64%), 72 of 140 whites (52%), and 17 of 26 patients of other races (66%) (P not significant).     

Development of elderly diabetes burden scale for elderly patients with diabetes mellitus

Background:   The purpose of the present paper was to validate an elderly diabetes burden scale (EDBS) and to assess its correlates in elderly patients with diabetes mellitus.
Methods:   Comprehensive questionnaires about both diabetes-specific and non-specific quality of life (QOL) were given by an interviewer to 455 elderly diabetic patients aged > 65 years. To assess diabetes-specific QOL, the EDBS was developed. The internal consistency and test–retest reliability of the EDBS were assessed. The validity of the EDBS was assessed with the correlation with the Philadelphia Geriatric Center morale scale, the mini-mental state examination (MMSE) and diabetic complications, treatment of diabetes, hemoglobin (Hb) A1c, frequency of hypoglycemia, and socioeconomic factors.
Results:   Factor analysis of the 23 items on EDBS produced six reliable components (Cronbach's α): symptom burden (0.55), dietary restrictions (0.89), social burden (0.89), worry about diabetes (0.85), treatment dissatisfaction (0.85), and burden by tablets or insulin (0.77). It was found that the EDBS and its six subscales had good test–retest reliability ( r  = 0.94–0.99). However, the EDBS correlated significantly with the morale scale but not with MMSE, suggesting convergent and discriminant validity. The high scores of some subscales and total EDBS were significantly associated with high HbA1c level, frequency of hypoglycemia, and insulin therapy, showing construct validity. Multivariate analyses revealed that hyperglycemia, frequency of hypoglycemia, insulin treatment, the presence of microangiopathy, and low positive social support were independently associated with increased elderly diabetes burden scores.
Conclusion:   The EDBS is a simple but reliable and valid measure of diabetic-specific QOL in elderly people with diabetes mellitus.     

正常老年人与阿尔茨海默病患者尿甲醛浓度的研究

目的探讨正常老年人与阿尔茨海默病(Alzheimer’s disease,AD)患者的尿甲醛浓度。方法随机选取年龄≥65岁的正常老年人(正常组)和确诊为AD患者-(AD组)各30例,对2组患者的尿甲醛浓度进行测定分析。结果 AD组患者尿甲醛浓度(0.26±0.22)mmol/L,显著高于正常组(0.04±0.02)mmol/L,差异有统计学意义(t=-5.269,P0.01)。结论机体内甲醛浓度超标可能是老年人发生AD的一个原因。     

Care for the elderly,care by the elderly: The role of elderly women in a changing Tswana society

With increasing urbanization and migration in Botswana and an increasing number of children born to unwed mothers, the grandmother (especially maternal) has become a key figure in many households. She is often the main care provider for children of absent daughters: a phenomenon observed elsewhere in Africa. But what happens when the grandmother herself is in need of care? There are indications that the elderly, especially old women, may have less access to modern health care facilities than the rest of the population. This article focuses on the family and resources available for care of the elderly, and presents preliminary results from an ongoing multidisciplinary project.     

Depression of elderly outpatients

Objective:To determine primary care physicians’ attitudes and practice patterns concerning the diagnosis and treatment of depression in elderly outpatients. Design:Survey of primary care physicians’ attitudes using a 22-item questionnaire. Current practice patterns were identified from a computerized medical record system. Setting:Academic primary care group practice at an urban ambulatory care clinic. Patients/participants:Thirty-five faculty general internists and 118 resident internal medicine physicians who had cared for 2,759 patients 65 years of age and older in the previous year. Measurements and main results:Attitudes: Eighty percent of all physicians considered the diagnosis and treatment of depressed elderly patients to be their responsibility. Fifty-five percent of the internists felt confident in accurately diagnosing depression, and 35% felt confident in prescribing antidepressants for this population. Residents reported more difficulties in dealing with depressed elderly patients than did faculty. Practice patterns: Of patients ≥ 65 years old, 8% were prescribed antidepressants, 5.4% had current diagnoses of depression, and 2% were seen for evaluation by psychiatry professionals. Age was negatively correlated with depression diagnosis, antidepressant drug use, and psychiatry evaluation. Conclusions:Internists in this primary care group practice accept responsibility for the treatment of depressed elderly patients but perceive their clinical skills as inadequate and are frustrated with their practice environment. Interventions aimed at improving the diagnosis and treatment of depressed elderly patients may be more effective if they are able to improve knowledge, attitudes, and the practice environment. Received from the Departments of Medicine and Psychiatry, Indiana University School of Medicine, and the Regenstrief Institute for Health Care, Indianapolis, Indiana. Supported by a grant from the John A. Hartford Foundation, Inc., New York, NY.     

Nutrition in the elderly

Malnutrition is more common in elderly persons than in younger adults. Ageing itself, however, neither leads to malabsorption nor to malnutrition with the exception of a higher frequency of atrophic gastritis in older persons. Malnutrition in elderly people is therefore a consequence of somatic, psychic or social problems. Typical causes are chewing or swallowing disorders, cardiac insufficiency, depression, social deprivation and loneliness. Undernutrition is associated with a worse prognosis and is an independent risk factor for morbidity and mortality. Awareness of this problem is therefore important. For the evaluation of nutritional status, it must be remembered that most normal values are derived from younger adults and may not necessarily be suitable for elderly persons. Suitable tools for evaluating the nutritional status of elderly persons are e.g. the body mass index, weight loss within the last 6 months, the Mini Nutritional Assessment (MNA) or the Subjective Global Assessment (SGA). An improvement in the nutritional status can be achieved by simple methods such as the preparation of an adequate diet, hand feeding, additional sip feeding or enteral nutrition.