Prevalence of cancer in older persons living at home and in institutions.

Even though the elderly have the greatest risk of developing and dying of cancer, screening for cancer occurs less often in older persons. Cancer screening is appropriate for nursing home residents with the cognitive ability to understand the screening method and its implications, who do not have comorbid illnesses that would preclude treatment, and who have at least a five-year life expectancy. Screening recommendations are provided for cancers of the breast, cervix, prostate, colon, skin, and mouth.

Introducing ambulatory care during the medicine clerkship: impact on evaluation and attitudes.

This article assesses student attitudes and the overall educational impact after a major curriculum change that implemented ambulatory care in an internal medicine clerkship. The study was cross-sectional with a historical comparison group and took place in a university teaching program with third-year students from three time periods. The 8-week clerkship was changed from 8 weeks of inpatient ward medicine to 4 weeks each of inpatient and ambulatory care in both primary care and subspecialty clinics. When students' responses before and after the curriculum change were compared, there was a significant improvement in evaluation of the clerkship experience (P = 0.001). Attitudes improved toward a general internal medicine career (P = 10(-5)) and there was improvement in evaluation of the inpatient experience (P = 0.01). Attitudes toward careers in subspecialty internal medicine and National Board examination scores were unchanged. The institution of ambulatory care into this internal medicine clerkship resulted in several significantly positive outcomes without a negative impact on the internal medicine knowledge base.

Reduction of caregiver stress by respite care: a pilot study.

The purpose of this study was to determine whether providing respite care to persons with Alzheimer's disease and other dementias decreased stress and mood disturbances in caregivers. Caregivers of persons receiving respite care (n = 7), and not receiving respite care (n = 8) were tested at entry into the study and at 5 weeks and 10 weeks, using the Profile of Mood States and the Relative's Stress Scale. Using repeated measures analysis of variance, a downward trend for study subjects and an upward trend for controls was found for Relative's Stress Scores. Similar trends were found on the Personal Distress Subscale of the Relative's Stress Scale. No difference occurred in rates of institutionalization between those receiving and not receiving day care. Our study suggests that respite care for demented persons living at home significantly reduces the stress among caregivers.

Neuropsychiatric effects of drugs in the elderly.

Since the elderly consume large numbers of drugs, drug-induced disease must be high on the list as a suspected cause of changes in behavior. Neuropsychiatric side effects of drugs in the elderly are not rare events. While proceeding to investigate medical, neurological, and psychiatric causes of a change in the cognitive status or behavior in an elderly patient, it is important to consider a possible psychotoxic drug as an offender or co-offender. Failing to do so may lead to inappropriate testing and further unnecessary and possibly deleterious therapeutic measures. In the case of dementia, the worst treatment would be institutionalization before identifying a drug as the cause of the cognitive dysfunction.

Problems with gait in older persons.

Gait problems are frequently encountered in elderly patients. Assessment can be made with tests that do not require complex equipment or excessive amounts of time. Most gait disorders result from the interplay of many factors but can respond to medical management, physical therapy, gait training, and correct use of adaptive devices.

Acute bacterial sialadenitis: a study of 29 cases and review.

Acute bacterial parotitis (ABP) used to be described as a nosocomial postoperative infection associated with a high mortality. A review of the literature on acute bacterial sialadenitis (ABS) revealed Staphylococcus aureus as the most common pathogen. Between 1970 and 1988, 17 patients with ABP and 12 with acute bacterial submandibular sialadenitis (ABSS) were admitted to a university hospital. Cultures of purulent discharge from the salivary ducts of these patients revealed S. aureus in 53% and viridans streptococci in 31%. During the study period, only six nosocomial cases of ABP occurred out of 289,234 admissions. S. aureus was the organism isolated most frequently in the nosocomial cases. There were no deaths, and all patients recovered following antibiotic treatment without surgical drainage. Advances in antimicrobial therapy and fluid management of hospitalized patients have made nosocomial ABS a rare disease with a favorable prognosis. S. aureus remains the most common pathogen causing ABS even in nosocomially infected patients who are not critically ill.

Medication compliance in the elderly.

Patient compliance with physician's medication instructions has been a growing concern for nearly two decades. Elderly patients are thought to have more difficulty following prescription instructions because they generally have more medications prescribed, often suffer from cognitive decline, and frequently have physical limitations such as failing eyesight and hearing. Exhibiting a genuine concern to patients for the importance of drug therapy and adherence to directions is the first step to improve compliance. Providing adequate verbal and written medication instruction, and implementing routine assessment of medication compliance should greatly improve response to drug therapy and decrease adverse effects.

Evaluating the interview performance of internal medicine interns.

Limited primary data are available to indicate in which areas physicians' interview performances are deficient. Videotaped recordings of 48 house officers performing a complete medical history were evaluated using a checklist to assess content, questioning technique, and interview style. Frequent deficiencies included inadequate social, psychiatric, and drug reaction histories. Several house officers demonstrated a marked tendency toward an overly directed interview style. The use of a detailed checklist during the observation of a complete medical history facilitates both accurate evaluation and specific detailed feedback to house officers.

Health team networking: Alzheimer's disease care.

The expected increased incidence of Alzheimer's disease and related dementias in the next century will impact heavily on the care of physicians to involved families. Physicians alone cannot provide the assistance required by these families and need to access other health professionals and resources to assist these families. Responding to the desperate need for information by families concerned with Alzheimer's disease, physicians and other health professionals in North Central Florida networked to develop, implement, and evaluate a responsive strategy, a community forum on Alzheimer's disease and related dementias. The two-hour daytime program with small discussion groups and a panel of experts for a question-answer session was highly successful and replicated.

Should the elderly hypertensive be treated? Evidence from clinical trials.

Clinical trials for over 15 years have addressed the therapeutic utility of treating elderly hypertensives. Many early trials showed no treatment effects. Because of the recent publication of new information, a review of available evidence concerning this issue was undertaken. Eight randomized clinical trials were assessed regarding trial design. The studies varied according to generalizability, diagnostic criteria, choice of therapy, outcome measures assessed, evaluation of compliance, methods of analysis, duration of follow-up, determination of side effects, and ability to exclude a type 2 error. While many of the earlier studies found no treatment effects, they lacked methodologic rigor; more recent studies demonstrated positive treatment effects. Pooling of results from similar trials supports a notable treatment effect in the prevention of stroke. There is also evidence that the elderly are not more susceptible to side effects of antihypertensive drugs, as is generally believed. The best evidence suggests the hypertensive elderly should be treated.

Immune function, autoimmunity, and selective immunoprophylaxis in the aged.

Many changes occur in the immune system with age. The involution of the thymus plays a major role in immune senescence. Related to this event are the altered ratio of helper to suppressor T-lymphocyte subsets, decrease in immune response by both cell-mediated and humoral branches of the immune system, and increase in autoimmune activity. The clinical implications of these changes are the elderly person's increased susceptibility to infections such as pneumococcal pneumonia, influenza A, and tetanus as well as increased autoimmune activity, reflected by pernicious anemia. Other changes may be increased susceptibility to neoplasms and perhaps acceleration of the aging process. A high index of suspicion should be present for the diagnosis of pernicious anemia in the elderly population. Knowledge of the many autoantibodies that might be present without illness is important when evaluating for disease processes. The relationship of the senescent immune system to the aging process is still unknown. Investigations of this matter, as well as of the function of immune system components and their relationship to disease processes, are continuing. Most methods proposed for enhancing the immune system are still experimental. However, immunizations have been proved to be an effective means of reducing morbidity and mortality from certain infectious diseases in the elderly. Therefore, it is strongly recommended that all elderly persons who are at risk for pneumococcal pneumonia, influenza, and tetanus receive the proper immunizations.

Influence of age on serum protein binding of propranolol.

The extent of propranolol protein binding was determined in three different age groups of healthy drug-free caucasian males. Volunteers selected for study were 6-15 years old, 25-36 years old and 68-76 years old. Ten milliliters of blood were obtained via venipuncture and collected in glass tubes from the subjects after an overnight fast. Binding determinations were performed by equilibrium dialysis using radiolabelled propranolol. Serum albumin and alpha 1-acid glycoprotein concentrations were determined in all subjects by radial immunodiffusion. The results obtained showed wide intersubject variability in the binding ratio of propranolol and serum concentrations of alpha 1-acid glycoprotein. Mean albumin serum concentration was found to be significantly lower in the elderly group as compared to the adult and pediatric groups (p less than 0.02). A positive correlation was found between the binding ratio of propranolol and the serum concentration of alpha 1-acid glycoprotein in all the subjects (r = + 0.66, p less than 0.005). No significant correlation was found between the binding ratio of propranolol and the serum concentration of albumin (r = -0.03, p less than 0.88). These data suggest that the extent of propranolol binding is influenced primarily by serum concentrations of alpha 1-acid glycoprotein and not by differences in age.