Peripheral neuropathy: an often-overlooked cause of falls in the elderly

Peripheral neuropathy is common in the elderly and results in impairments in distal proprioception and strength that hinder balance and predispose them to falls. The loss of heel reflexes, decreased vibratory sense that improves proximally, impaired position sense at the great toe, and inability to maintain unipedal stance for 10 seconds in three attempts all suggest functionally significant peripheral neuropathy. Physicians can help their patients with peripheral neuropathy to prevent falls by teaching them and their families about peripheral nerve dysfunction and its effects on balance and by advising patients to substitute vision for the lost somatosensory function, correctly use a cane, wear proper shoes and orthotics, and perform balance and upper extremity strengthening exercises.     

National and international guidelines ignore significant cause of heart failure. Diastolic dysfunction is often the cause of heart failure in the elderly and in women

Comparison of patients treated for chronic heart failure at a large hospital with patients included in major treatment studies published during the past ten years yielded important information. The former series was characterised by greater proportions of the elderly and of women than were the series recruited to the often cited ACE (angiotensin-converting enzyme) inhibitor studies. Although only patients with systolic dysfunction were recruited to the latter studies, a substantial body of evidence suggests the prevalence of severe heart failure among patients with normal systolic function to increase with increasing age. Thus, as many as 50 per cent of all elderly patients with chronic heart failure may have normal systolic function. In most cases, the heart failure is probably due to diastolic dysfunction, a condition that still lacks both a simple diagnostic procedure and a well-documented treatment.     

Lower extremity manifestations of nutritional deficiencies in gastrointestinal disease

Voluminous information can be written on the nutritional deficiencies that are secondary to gastrointestinal disease. This highly complicated system, with its immunologic pathogenesis, can affect every system of the body. This article describes how these manifestations of gastrointestinal disease affect the lower extremities.     

The Nutritional Screening Initiative: meeting the nutritional needs of elders

Nutritional factors are associated with at least 5 of the 10 leading causes of death in the United States. Older persons are especially vulnerable for nutritional problems, usually resulting from inappropriate (usually inadequate) intake of nutrients or increased need for nutrients. Nutritional assessment and interventions are sometimes overlooked in the focus on more complicated medical care. Yet there are many ways in which nurses can intervene to improve patients' nutritional status. One resource for organizing nutritional assessment and interventions is the Nutrition Screening Initiative. This multidisciplinary initiative provides useful guidelines and tools for assessing nutritional status and for planning the most appropriate interventions.     

Epi-macular holes: a cause of decreased vision in the elderly

The development of epi-macular holes in the elderly represent a maculopathy which resembles senile macular hole and surface wrinkling retinopathy. Clinically it is most likely a sub-type of surface wrinkling retinopathy in which a hole forms in the epi-macular membranes. The findings in 11 patients with this condition are described.     

Assessing the nutritional needs of the geriatric patient with diabetes

The 1994 Nutrition Guidelines reinforce that all nutritional plans for people with diabetes should be individualized, which is particularly important and necessary for elderly patients. The geriatric population poses many unique challenges to the healthcare professional due to physiological changes and many other risk factors that affect nutritional status either directly or indirectly. A thorough nutritional assessment that includes an evaluation of the potential nutritional risk factors described in this article can help in developing an effective and realistic nutritional plan for achieving and maintaining good blood glucose control and good nutritional status in geriatric patients with diabetes.     

Community-acquired pneumonia in the elderly. Clinical and nutritional aspects

Community-acquired pneumonia (CAP) in the elderly has a different clinical presentation than CAP in other age groups. Confusion, alteration of functional physical capacity, and decompensation of underlying illnesses may appear as unique manifestations. Malnutrition is also an associated feature of CAP in this population. We undertook a study to assess the clinical and nutritional aspects of CAP requiring hospitalization in elderly patients (over 65 yr of age). One hundred and one patients with pneumonia, consecutively admitted to a 1,000-bed teaching hospital over an 8-mo period, were studied (age: 78 +/- 8 yr, mean +/- SD). Nutritional aspects and the mental status of patients with pneumonia were compared with those of a control population (n = 101) matched for gender, age, and date of hospitalization. The main symptoms were dyspnea (n = 71), cough (n = 67), and fever (n = 64). The association of these symptoms with CAP was observed in only 32 patients. The most common associated conditions were cardiac disease (n = 38) and chronic obstructive pulmonary disease (COPD) (n = 30). Seventy-seven (76%) episodes of pneumonia were clinically classified as typical and 24 as atypical. There was no association between the type of isolated microorganism and the clinical presentation of CAP, except for pleuritic chest pain, which was more common in pneumonia episodes caused by classical microorganisms (p = 0.02). This was confirmed by a multivariate analysis (relative risk [RR] = 11; 95% confidence interval [CI]: 1.7 to 65; p = 0.0099). The prevalence of chronic dementia was similar in the pneumonia cohort (n = 25) and control group (n = 18) (p = 0.22). However, delirium or acute confusion were significantly more frequent in the pneumonia cohort than in controls (45 versus 29 episodes; p = 0.019). Only 16 patients with pneumonia were considered to be well nourished, as compared with 47 control patients (p = 0.001). Kwashiorkor-like malnutrition was the predominant type of malnutrition (n = 65; 70%) in the pneumonia patients as compared with the control patients (n = 31; 31%) (p = 0.001). The observed mortality was 26% (n = 26). Pleuritic chest pain is the only clinical symptom that can guide an empiric therapeutic strategy in CAP (typical versus atypical pneumonia). Both delirium and malnutrition were very common clinical manifestations of CAP in our study population.     

Self-reported energy intake and energy expenditure in elderly women

HLA-DRB1, -DQB1 and -DPB1 allele frequencies were investigated in a sample of the Slovak population by PCR-SSP and PCR-RFLP methods. The most frequent DRB1 alleles were DRB1*1101-5 (0.2038), DRB1*0701-2 (0.1423), and DRB1*1501-2 (0.1231). The most rare alleles found were DRB1*0901 (0.0038), and DRB1*1201 (0.015). The most common DQB1 alleles were DQB1*0301 (0.2448), DQB1*0201 (0.2098), and DQB1*0501 (0.1119), respectively. The alleles with the least occurrence rate were DQB1*0601 (0.0035) and DQB1*0401 (0.007). The most common DPB1 alleles found were DPB1*0401 (0.4329), DPB1*0402 (0.2089), and DPB1*0201 (0.1438), respectively. The least frequent alleles were DPB1*0601, *1101, and *1501 (0.0034). Allele frequencies found in our study were compared to those in Czech, Austrian, and German populations. No statistically significant differences were observed.     

The structure of depression among elderly institution residents: affective and somatic correlates of physical frailty

BACKGROUND: Confounding of depression with somatic illness and anxiety, a problem in any age group, may be especially troublesome in frail older persons. This paper examined this problem in a factor analytic study of the structure of depressive symptomatology, identifying affective and somatic symptom clusters and relating those clusters to health and functional variables cross-sectionally and prospectively over a 1-year interval. METHODS: The factor structure of a DSM-IV symptom checklist was examined among 1,245 elderly long-term care residents. Regression analyses examined the association of resulting factors with cognition, functional disability, self- and physician-rated health, and pain at baseline and a year later. One-year mortality was also examined. RESULTS: Factor analysis revealed three unique symptom clusters: depressed mood, somatic symptoms, and psychic anxiety. Depressed mood and somatic symptoms were associated cross-sectionally with all functional health variables, but psychic anxiety was associated only with pain. Longitudinally, depressed mood was the only independent predictor of decline in cognition, functional ability, physician-rated health, and mortality; the last effect, however, did not withstand control for baseline health and functioning. Somatic symptoms at baseline predicted decrement in self-rated health a year later. Effects varied as a function of cognitive status. CONCLUSIONS: These data suggest that concerns about the confounding role of somatic symptoms in the association of depression with physical health are unfounded. Although somatic symptoms of depression and anxiety were associated with health and functional status cross-sectionally, depressed mood was by far the stronger predictor of health declines over time.     

Antegonial notching of the mandible: an often overlooked mandibular deformity in congenital and acquired disorders

Mandibular antegonial notching is a concavity of the undersurface of the body just anterior to the angular process (gonion) seen in congenital and acquired disorders. The notch tends to be longer in the congenital than in the acquired state, and the ascending ramus is at a more obtuse angle to the body.     

Fracture of the anterior superior process of the calcaneus: an often misdiagnosed fracture

Fracture of the anterior superior process of the calcaneus has been considered an unusual injury. Following a sudden twist there is immediate pain on the outer aspect of the mid-portion of the foot and discomfort on weight-bearing. Three mechanisms of injury have been reported to cause the fracture. The diagnosis is often missed, and prolonged disability and local pain at the calcaneocuboid joint deserve further consideration. Oblique X-rays of the foot are helpful to visualize the fracture. Type III fractures may cause cartilage lesions and arthrosis; therefore, one should not wait long before excision or refixation of the fragment.     

The elderly homeless men in Bloomsbury hostels: their needs for services

OBJECTIVES: The objectives of this study are: (1) to assess the feasibility and usefulness of using the Needs Schedule on older homeless individuals; (2) to measure the needs of the elderly homeless individual for mental health services and whether these needs could be met by the same services that cater for younger individuals. DESIGN AND SETTING: This article analyses the needs of a subsample of 37 elderly residents in four inner London hostels for homeless people. Their needs were compared with those of 64 younger residents within the same hostels. RESULTS: The data related to demographic characteristics and health problems showed that the elderly homeless were physically frail and socially isolated. This group demonstrated more need for physical health services than the younger sample. However, the needs assessment method used in this study failed to show significant differences between the needs of these elderly and those of the younger residents. CONCLUSIONS: The article discusses ways of improving the assessment of needs for services in the elderly homeless and the way forward in meeting the needs of this disadvantaged group.     

Mental health needs of the chronically mentally ill elderly.

The treatment histories and current social, financial, and clinical status of 111 chronically mentally ill (CMI) persons over the age of 60 were examined. Information was obtained from Ss, family, mental health records, and mental health professionals familiar with Ss. Psychiatric symptoms were observed in 74% of Ss. Many Ss experienced long periods without acute episodes of illness. Recurring episodes eventually appeared in most Ss, however, and ongoing deficits in daily functioning and social contacts were prototypical. Two thirds of the Ss were living in the community, relying heavily on family contacts; the rest lived primarily in nursing homes (23.4%) or psychiatric hospitals (7.2%). Social support was the best predictor of level of functioning. Findings suggest that failure of CMI elderly to use mental health services is not due to lack of need. Mental health services currently do not appear to be meeting the needs of this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Management of mania in the elderly: an update

Twenty-eight genetic loci have been physically mapped to specific large restriction fragments of the Streptococcus mutans GS-5 chromosome by hybridization with probes of cloned genes or, for transposon-generated amino acid auxotrophs, with probes for Tn916. In addition, restriction fragments generated by one low-frequency-cleavage enzyme were used as probes to identify overlapping fragments generated by other restriction enzymes. The approach allowed construction of a low resolution physical map of the S. mutans GS-5 genome using restriction enzymes ApaI (5'-GGGCC/C), SmaI (5'-CCC/GGG), and NotI (5'-GC/GGCCGC).     

Reversible malabsorption of folic acid in the elderly with nutritional folate deficiency

The question of the point of impact of the electric current in the galvanic vestibular test is not solved. An important feature is that, after destruction of both the vestibular end organs, a galvanic nystagmus can still be provoked. The effect of a direct current on the spontaneous nystagmus following partial or total destruction of the vestibular end organs was investigated. The frequency of the spontaneous nystagmus diminishes when the electric stimulus causes an eye movement in the same direction as the fast phase of the nystagmus, the frequency increases when the polarity of the electric stimulation is reversed. Simultaneous application of torsion-swing and electric stimulation causes a summation of the separate effects. Our findings confirm the conculsions drawn by Ledoux (4, 5) from his findings in frogs.