The use of reserpine for elderly hypertensive patients.

Antihypertensives are among the most commonly prescribed drugs for the elderly. Several studies have discussed the benefits of stepped-care drug therapy for hypertension in the elderly, and propranolol, methyldopa, and more recently, clonidine and prazosin have been recommended as step-two antihypertensive drugs. Recent articles omit reserpine as an alternative. A case is made for the use of reserpine by comparing factors of special importance to most elderly: cost, side-effects, frequency of dosage, number of tablets, and the effect of omitted doses.

Another cause of reversible dementia: sleep deprivation due to prostatism.

A case history is presented of a patient with treatable dementia of unusual pathogenesis. Fear of urinary incontinence associated with nocturia and urgency caused the patient to deprive himself of sleep, resulting in slowed mentation and apathy that was diagnosed as chronic organic brain syndrome for approximately one year. When his benign prostatic hypertrophy was surgically corrected, the patient allowed himself normal sleep, and the "chronic brain syndrome" cleared completely.

Cognitive impairment on a rehabilitation service.

Many techniques of rehabilitation require that the patient have intact cognition. This study determined the frequency of impaired cognition among the predominantly elderly patients on a community teaching hospital acute rehabilitation ward. The Cognitive Capacity Screening Examination (CCSE) was administered to 81 patients (ages 44 to 99, means 77, male:female 29:52). That 52 patients (64%) scored below 20 on the CCSE suggests significant cognitive impairment. The cognitively impaired patients were older than those with normal CCSE scores (p less than 0.05) and 19 patients had a prior history of chronic dementia. The physicians of 12 of the cognitively impaired patients (15% of all patients screened) were unaware of the impairment prior to their CCSE. Cognitively impaired patients scored similarly irrespective of a prior history of similar impairment (CCSE scores 10.2 +/- 1 for those without a prior history of dementia, 7.3 +/- 1.4 for those with prior dementia, p greater than 0.05). Physicians were more likely to be aware of a patient's current cognitive problems if the patient had a prior history of dementia (19/19 vs 21/33, p less than 0.01). The utility of employing a routinely administered CCSE to all patients accepted by a rehabilitation ward is emphasized. The time, cost, and effort of routinely performing such tests are negligible, and the potential benefits are considerable.

Community resources for frail older patients.

The goal of community-based services for frail older patients is to help them achieve the greatest degree of functional ability and independence. The services available include case management, geriatric assessment, adult day health care, home health services, and the Program for All-inclusive Care for the Elderly (PACE). Definitive criteria for referral have not been established, but without some targeting, the efficacy of these services remains uncertain. Targeting criteria identified include dependency in 2 or more activities of daily living, no family support, dementia, many long-term illnesses, and many hospital stays. Although efficacy and cost-effectiveness remain uncertain, patients, families, and physicians generally report these services to be helpful.

Geriatric education in a teaching hospital: the role of geriatric services.

Geriatric education and training are most successful when taught in a setting that provides the medical and social services that elderly persons often require. At Mount Zion Hospital and Medical Center, medical students and trainees participate in several geriatric services that introduce them to the special health needs of the elderly, including the ambulant and the homebound. In the Mount Zion/University of California, San Francisco, geriatric education and training program, we have defined three principles of geriatric medicine that are unique to the field and are best applied directly within the service setting. This setting emphasizes (1) the special body of knowledge regarding aging and health care of the elderly, (2) the importance of assessing functional capacity and (3) the role of the health team. Our experience indicates that when students and trainees observe the application of these principles in a range of geriatric services they begin to understand the complex health problems with which geriatric medicine is concerned.