Geriatric education. Part II: The effect of a well elderly program on medical student attitudes toward geriatric patients.

OBJECTIVE: To assess impact of exposure to healthy elderly on medical students' attitudes toward the elderly. DESIGN: Prospective, randomized, controlled intervention trial. SETTING: Community-based Well Elderly Program. PARTICIPANTS: Ninety-three fourth year medical students on a required Geriatric Medicine clerkship who were assigned to either a tertiary care university medical center or a teaching nursing home. INTERVENTION: Thirty-five students were randomly assigned to participate in a Well Elderly Program and were compared to a control group of 58 students at equivalent sites who did not participate. MEASUREMENTS: Pre- and post-rotation, students were given the Aging Semantic Differential (ASD), a validated geriatric attitudinal scale. MAIN RESULTS: By repeated measures analysis of variance, the difference between pre- and post-rotation ASD scores were most significant for students who participated in the Well Elderly Program; site did not exert a significant interaction effect. CONCLUSION: These results underscore the importance of exposure to healthy older people on effecting positive attitude changes among medical students on geriatrics rotations.

Geriatric education. Part I: Efficacy of a mandatory clinical rotation for fourth year medical students.

OBJECTIVES: To describe the curriculum of a mandatory, fourth-year geriatrics clerkship and assess its impact on medical students' knowledge of geriatric medicine and attitudes toward the elderly. DESIGN: One group, before/after trial. SETTING: Mount Sinai School of Medicine of the City University of New York. PARTICIPANTS: Entire fourth year class of medical students (n = 127). INTERVENTION: Four-week-long clinical geriatrics clerkship. MEASUREMENTS: Pre- and post-rotation: test of knowledge; Aging Semantic Differential (ASD) attitude scale; Modified Maxwell-Sullivan attitude scale; questionnaire. MAIN RESULTS: Seventy percent of students found the rotation to be educationally valuable; however, only one-third of students would have taken the clerkship had it not been required. Mean geriatric knowledge score increased by 18.7% (P less than 0.001). Mean ASD attitude score did not change significantly (130.5 +/- 19.2 pre-rotation versus 126.6 +/- 18.8 post-rotation, P = 0.15), but students started the rotation with a neutral attitude. Over 90% of students agreed they would welcome elderly into their future practice. CONCLUSION: If a national curricular goal is to improve medical students' knowledge of geriatric medicine, required rather than elective rotations may be in order.

Changes in serum high density lipoproteins in women on oral contraceptive drugs.

Serum lipids, lipoproteins, and lipoprotein subfractions were measured in a group of 18 women aged 20 through 39 who were users of oral contraceptive drugs, and in 19 age-matched controls. Concentrations of the major lipid and lipoprotein classes were higher in the users, but the elevation was statistically significant only in the case of the high density lipoproteins. This increase was shown to be due to a highly significant increase (275 +/- 9 vs. 223 +/- 9 mg/100 ml, (p less than 0.005) in the denser high density lipoprotein subfraction (HDL3). Levels of the other subfraction (HDL2) were similar in users and controls. Thus, anovulatory steroids have selective effects on individual types of high density lipoproteins. Studies of such specific effects may help to further define the functional properties of the high density lipoproteins such as their apparent protective role in atherosclerosis.

Geropsychology and neuropsychological testing: role in evaluation and treatment of patients with dementia.

Cognitive loss in the aged should be evaluated as early as possible, since some causes of impairment may be reversible. Neuropsychological testing is probably the most sensitive method of detecting early or mild dementia. On completion of the evaluation, the first meeting with the patient and family is critical in laying the groundwork for subsequent interventions. Frankness in discussing the diagnosis of dementia is advocated, as it facilitates patient self-determination and enhances confidence in the health-care provider. Interventions, including psychotherapy, are presented in a psychoeducational framework, where the aim is to provide information to the patient and/or family while monitoring and responding to emotional reactions and defenses. Conceptualizing dementia as a chronic mental illness may be helpful to the health-care provider. Although there is no cure for Alzheimer's disease or for multi-infarct dementia, treatments are available in the psychological and psychosocial domain. These have enormous potential for alleviating suffering and improving the quality of life of patients and their families, and therefore should not be overlooked.

Psychological aspects of aging: when does memory loss signal dementia?

With aging comes a normal decline in intelligence and specific cognitive functions such as memory. Distinguishing age-related memory loss from that due to a disease process such as dementia, especially in its early stages, can be difficult. Neuropsychological assessment is probably the most sensitive method of making this determination. A diagnosis of dementia requires impairment in memory plus impairment in at least one more area of cognitive function, such as language or conceptualization. Once the diagnosis of dementia is established, your role is to carefully explain it to the patient and family and answer their questions about causes and possible interventions.

Selective attention skills in Alzheimer's disease: performance on graded cancellation tests varying in density and complexity.

Nine selective cancellation tasks were administered to nine subjects with Alzheimer's disease (AD), nine elderly control, and eight depressed subjects. Each task consisted of an 8 1/2 x 11 sheet of paper containing line drawings of geometric shapes that were identified as either targets or distractors. The nine forms of the task varied along two independent graded dimensions: (1) the total number of items in the field (Density: 3 levels) and (2) the number of different distractors in the surround (Complexity: 3 levels). Performance of the AD group was worse than that of the other groups, and performance for all groups declined with density. Error analysis of the impaired performance of the AD subjects showed that they made errors of omission that differed significantly as a function of density. There was no evidence that they could adopt a chunking strategy to accommodate the increased load.