Lymphocyte beta-adrenoreceptor density in patients with unipolar depression and normal controls.

Values of binding maximum (Bmax) and dissociation constant (Kd) of (-)3-[125I]iodocyanopindolol (ICYP) were determined in beta-adrenergic receptors of membranes of peripheral lymphocytes in 32 patients with unipolar depression (DSM-III-R) and 31 normal controls. Results were analyzed by a two-way Analysis of Covariance method. A significant difference was noted for group assignment (patient versus control, p less than 0.05). Mean Bmax (fmol ICYP bound/mg lymphocyte membrane fraction total protein) of patients was 31.9 +/- 3.84 (SE) and controls 46.3 +/- 3.92 (SE). A significant interaction was found between group membership and gender (p less than 0.05). In the female patient group (n = 14), mean Bmax was 30.5 +/- 5.79 (SE); in female controls, mean Bmax was 56.0 +/- 5.15 (SE). Differences between male patients and male controls were not significant. Mean values of Kd (pmol/liter) showed a trend for patient values to be lower than control values [69.0 +/- 13.66 (SE) versus 108.5 +/- 14.42 (SE), respectively]. A significant inverse relationship was noted between lymphocyte beta-receptor Bmax and frequency of panic attacks during the depressive episode in 18 patients (p = 0.05). No relationship was found between values of Kd and frequency of panic attacks in these patients. Thus, preliminary evidence is provided for relationships among altered beta-adrenergic receptor binding, gender, and indices of panic-anxiety in unipolar depressed patients.

Anemia as a criterion for evaluation of a Special Supplemental Food Program for Women, Infants, and Children.

The background and rationale of the Special Supplemental Food Program for Women, Infants, and Children (WIC) are reviewed. Problems concerning the implementation of the program and the need for evaluation are discussed. The authors selected anemia as a WIC program criterion to evaluate the effectiveness of the program. The reasons for this selection are discussed. The study involves the evaluation of 37 of 311 infants who were enrolled in the WIC program of a local health department. Hemoglobin values were observed at certification and recertification and the expected change vs the observed change in hemoglobin during the six-month period was calculated. In addition to observing change in hemoglobin values, a cost analysis was done. Results showed 27 out of 37 infants had a positive increase in hemoglobin levels. Eight of the 37 infants had a negative hemoglobin level, whereas two of the 37 had a zero change. It is concluded that anemia as a criterion for the WIC program is cost effective if certain considerations and modifications in the anemia criteria are made. It is also pointed out that paired hemoglobin determinations at two separate points and time is the best assessment for changes in hemoglobin levels.

Gender and ethnic differences in the health practices of the elderly poor.

Gender and ethnic differences in personal health practices were examined with a sample of 1021 Medicaid recipients aged 65 years and older. Six different health practices were examined including smoking, drinking, weight control, exercise, and social networks. Although gender differences were noted with respect to all of the health practices examined, neither men nor women were consistently favored in adhering to desired health practices. Perhaps most importantly, women were more apt than men to refrain from smoking and drinking which have been strongly linked to major health consequences. Ethnicity was also a factor in all of the health practices examined. Whereas Hispanic and Black elderly were very similar to White elderly, Asian elderly generally adhered to more desired health practices than did either Whites, Blacks, or Hispanics. The implications of these findings could benefit health promotion programs for the elderly.

State initiatives in geriatric education.

Although the basic requisites of curricula in geriatrics and gerontology have been well developed, and the need for such programs is well established, the support for development of geriatric academic programs has not been commensurate with the need. Barriers to the development of such programs include ageism, financial disincentives, scientific underdevelopment, a dearth of trained faculty, the lack of institutional support, and the declining federal role. One attempt to overcome these barriers and address the tremendous need is the development of state initiatives. In the last decade, several state legislatures have begun to provide support for geriatric education. The purpose of this paper is to analyze the initiatives of state funded university programs in geriatrics and gerontology, with particular emphasis on the California experience. A survey involving 50 states was conducted using two rounds of structured telephone interviews. The survey results found that 44 states did not have any legislatively initiated support for geriatric programs in higher education. Six states did have such programs, they included: Ohio, North Carolina, Kansas, New York, Kentucky, and California. The components of the California program are discussed in further detail. The conclusions were that although these states provide paradigms for the rest of the nation, much more still needs to be done. Several issues raised by the state programs are discussed.

AIDS as a cause of dementia in the elderly.

It has been recognized that AIDS can present initially as dementia without other neurological or clinical manifestations. In addition, HIV-contaminated blood transfusions in the elderly seem to be underreported. Because of these findings, dementia in the elderly may be misdiagnosed as Alzheimer's disease or other causes of senile dementia. This paper reports on one patient who presented with a diagnosis of Alzheimer's disease and was later found to have AIDS.

Relation of cognitive status and abnormal behaviors in Alzheimer's disease.

Some studies suggest that abnormal behaviors are associated with increasing cognitive loss in Alzheimer's disease (AD). Other studies do not show this association. We examined the relation of cognitive loss, represented by Folstein Mini-Mental State Examination (MMSE) score, with abnormal behaviors in 680 patients with probable AD. Six behaviors were examined: agitation/anger, personality change, wandering, hallucinations/delusions, insomnia, and depression. All but depression were associated with declining MMSE score. The number of abnormal behaviors present in each patient was also related to declining MMSE score. Several other associations were also found: hallucinations/delusions were associated with age and race; agitation/anger was related to male gender; and wandering was associated with increased age. Although these data support the general notion that five of the six abnormal behaviors studied are more likely to occur with increasing cognitive loss, the correlations are small and it is suggested that other as yet unproven factors may play an as large or greater role than MMSE score in predicting such behaviors.

Dietary preference for sweet foods in patients with dementia.

Using a telephone survey, patients with probable Alzheimer's disease (n = 31) and vascular dementia (n = 14) were compared with elderly normal controls (n = 43) in preferences for different foods. Patients with Alzheimer's disease had a greater preference than normal controls for relatively high-fat, sweet foods and for high-sugar, low-fat foods, but did not significantly differ in preference for other foods, including those high in complex carbohydrates and protein. Vascular dementia patients showed a similar pattern, not significantly different from that for Alzheimer's patients. Results did not consistently support a hypothesis that increased sweet preference is a nonspecific form of disinhibited behavior related to declining mental status, nor was a hypothesis relating sweet preference to serotonin activity within the brain consistently supported. Results provide preliminary evidence that craving for sweet food may be a significant part of the clinical syndrome of dementia, but further research is needed to delineate the psychological and biological mechanisms accounting for it.

Risk factors associated with senile dementia of the Alzheimer's type.

Significant cognitive impairment affects approximately 15 percent of the U.S. population over age 65. The most prevalent form of irreversible dementia is senile dementia of the Alzheimer's type (SDAT), which accounts for at least 50 percent of nursing home admissions and roughly 10 billion dollars a year in health care costs. In spite of the social, economic, and medical impact of the disease, epidemiological data are scarce concerning risk factors associated with the disease. Until recently, most of the population-based studies of senile dementia in the elderly were carried out in Northern European countries. The methodological problems that arise in performing epidemiologic studies on SDAT may in part explain the lack of sufficient data pertaining to certain risk factors. This paper provides a review of the literature and research on risk factors in dementia in the elderly and discusses directions for future research. The epidemiological issues associated with certain key studies are also discussed. Although the major studies that have attempted to look at risk factors in mental illness in the elderly are beginning to fill in some of the gaps in the understanding of the etiology and epidemiology of the disease, further epidemiologic studies on both institutionalized and community-based elderly populations are needed. These should assess a wide range of possible factors (demographic, psychological, environmental, health practice, and medical) in terms of their association with SDAT. By developing a comprehensive epidemiologic profile of SDAT, possible preventive measures and therapeutic approaches to treating the disease may be identified and hypotheses for future epidemiological and laboratory investigations developed.

Hypertension in elderly people in a preventive health program.

Control of hypertension is increasingly being recognized as a significant component of any preventive health care program for the elderly because of the high prevalence of hypertension in this group and its impact on health, particularly cardiovascular diseases. This study evaluates the hypertension screening component in one of the oldest and largest health promotion programs for the elderly in the United States, the Preventive Health Care for the Aging Program (PHCAP) in California. Our findings show that 26.7% of PHCAP participants had hypertensive readings on examination. Of these, 20% had mild hypertension, 5.6% moderate hypertension, and 1.1% severe hypertension. Urban participants were more likely than rural participants to have hypertension. Of those with severe hypertension, living alone was a significant factor when controlling for other variables. Overall, 40.2% of the hypertensive patients were not aware of their hypertension, and whites and Hispanics were less aware than blacks of their hypertensive status. Men were also less aware than women. These findings suggest ways to improve hypertension control programs for healthy elderly people who are self-referred to community-based preventive health care programs.

Propranolol for the control of disruptive behavior in senile dementia.

Six patients with senile dementia, exhibiting severe, disruptive behavior were effectively treated with propranolol in doses ranging from 80 mg per day to 560 mg per day. All six patients were given a trial of propranolol after conventional therapy had failed, and in all patients, the agitated behavior significantly improved. There were no adverse side effects requiring the discontinuation of the propranolol, and in all cases, the agitated behavior was controlled without inducing general sedation. Both the nursing home staff and the families were pleased with the therapeutic effects. Propranolol represents a possible alternative way of addressing the severe problem of agitated behavior in senile dementia patients.

A statewide preventive health care program for the aged.

Because of the rising percentage of elderly in the population and the cost of health care expenditures, interest has increased in preventive health care services for the aging. Although the effectiveness of such programs is still being discussed by policy makers, the number of preventive health programs for the elderly is increasing. One of the oldest and largest preventive health programs for the elderly in the United States, the California Preventive Health Care for the Aging Program (PHCAP) is analyzed. The typical PHCAP participant was white, female, between 70 and 79 years of age, and living in an urban area. More than half (59 percent) of the PHCAP participants had some kind of private medical insurance in addition to Medicare coverage. Seventy-seven percent of the participants had seen a physician within the previous year. The most frequently reported chronic conditions were arthritis (31 percent), hypertension (24 percent), cardiovascular problems (13 percent), and vision and hearing problems (18 and 11 percent). Twenty-seven percent of the population were hypertensive; 7 percent of these had moderate to severe hypertension. Eighty percent of the participants were identified as having at least one problem; 40 percent were referred to a physician. Frequently, public health programs need to be evaluated without the benefit of a controlled trial design. This analysis of a statewide preventive health care program for the aging, PHCAP, shows the program's effectiveness in detecting a large number of health problems and making extensive referrals to other health professionals, particularly physicians. These findings should be useful to health practitioners and policy makers developing similar statewide programs for the elderly.

Assessing the impact of antihypertensive therapy on quality of life in the elderly.

Quality of life is becoming increasingly important in assessing the impact of therapy for hypertension in elderly persons. Although the concept of quality of life is new and is in need of further definition, good measures already exist to examine the effects of therapy in the major domains of quality of life such as social, physical, emotional, and cognitive functioning. These measures and recent studies addressing this issue are discussed. Because hypertension is frequently asymptomatic and may involve several medications, successful treatment of hypertension in the elderly population requires consideration of its impact on quality of life.

Health promotion for the rural elderly.

There has been increased interest in developing health promotion programs for the rural elderly as a means to foster successful aging. The present study describes one such program and identifies rural and urban differences in health promotion activities. Data come from the California Preventive Health Care for the Aging Program (PHCAP) which is one of the oldest and largest such programs in the United States. A sample of over 5,000 PHCAP clients was drawn from rural, semi-rural and urban projects. Though the rural and urban clients differed significantly with respect to demographic characteristics, differences in health promotion practices were relatively minor. However, the health promotion practices of semi-rural residents differed considerably from that in rural projects. Though less disabled, semi-rural clients received a greater scope of health promotion activities than rural clients. The authors discuss possible site, practitioner and client factors which may have accounted for rural health promotion activities being more restricted. Regardless of project site, the California PHCAP detected many health problems and a majority of clients were referred to other health professionals for treatment.

Investigation of death clusters in a nursing home.

The number of elderly residing in, and dying in, nursing homes is steadily increasing. In 1985, an investigation by the California attorney general's office was undertaken concerning a cluster of deaths in a single rural nursing home. The purpose of this study was to provide information for the investigation. The objectives of the study were to determine if there were excess deaths in the nursing home, and if so, to describe the circumstances surrounding the deaths and the policy implications for the quality of care in nursing homes. All the medical records for patients who died in a single nursing home between January 1, 1983 and April 30, 1985 were examined by the research team. Medical care was compared to desirable standards of care. A majority of the deaths, 52.5%, had major discrepancies from standard care that may have contributed to the patient's death. There were also major discrepancies in the cause of death between the death certificate and evidence from examination of the medical records. The data substantiated an unusual occurrence of deaths in the nursing home at the end of 1983 and again in early 1985, but no single factor or person could be identified as the major cause of the deaths. Although this is an isolated study of one nursing home, it is likely that these problems are not unique and the evaluation approach may be useful in other settings. It is recommended that nursing home deaths be routinely monitored, and that an unusual number of deaths should trigger an extensive investigation.

Differential health screening of the well elderly by gender and age; appropriate care or bias?

We use data from a random sample of 5,454 elderly participants in the California Preventive Health Care for the Aging Program to identify gender and age differences in health screening practices. We present a framework to facilitate an evaluation of current targeting of services by gender and age. This framework clarifies where targeting based on age and gender is appropriate or inappropriate and where more or less targeting might be needed. With use of this framework, some inappropriate age bias is indicated. The oldest-old often receive less health screening than their younger counterparts. Gender-based targeting is less frequent and is usually appropriate when it occurs. We discuss implications for practice and future program evaluations.