Sheltered housing or community dwelling: quality of life and ageism among elderly people.

Background: Previous studies have found correlations between negative perceptions of old age and perceived quality of life (QoL) among elderly people. It has also been suggested that a denial of aging mechanism is employed and might support ageist attitudes among private-sheltered housing tenants compared with elderly people who live in the community and experience intra-generational interactions. Therefore, we hypothesized that tenants of sheltered housing will report more ageist attitudes towards people of their own age, and report a lower QoL than elderly people who live in the community.

Delirium in an acute geriatric unit: clinical aspects.

Delirium is a common event in geriatric hospitalized patients. A prospective study was performed in order to characterize predictors, features and outcome in an acute geriatric care unit in a general hospital in Israel. The tools used to detect delirium were the Confusion Assessment Method (CAM) and the Delirium Rating Scale (DRS), supported by clinical observation by an experienced geriatrician.

[Left ventricular outflow tract obstruction without left ventricular hypertrophy treated with ACE inhibitors].

We describe a very unusual case of sudden, severe worsening of congestive heart failure which was caused by ACE inhibitors. Diagnosis was made by echocardiogram showing a typical picture of dynamic, left ventricular outflow tract obstruction without left ventricular hypertrophy, which disappeared on discontinuing ACE inhibitors. This phenomenon has already been described as a complication of other drugs such as nitrates, commonly used as provocative tests for latent obstructive cardiomyopathy.

[Infective endocarditis presenting as polyarticular septic arthritis].

We report acute polyarthritis in an 86-year-old man which was initially considered to be an exacerbation of osteoarthritis. After a delay of a few days a diagnosis of septic polyarthritis as an initial symptom of infective endocarditis was made. Although rheumatic manifestations in infective endocarditis are common, septic polyarthritis is rarely seen.

[Comprehensive geriatric assessment--its clinical, social and economic importance and prospects].

It is well known that many elderly patients are referred to nursing homes because of "functional decline" without being thoroughly investigated. We studied 9 elderly patients, all referred to hospital due to functional decline and diagnosed as follows: spinal stenosis--2 cases, depression--3, thyrotoxicosis--1, Parkinson--1, polypharmacy and congestive heart failure--1 patient each. Proper diagnosis and appropriate treatment prevent unnecessary hospitalization in nursing homes.

[Nursing home-acquired pneumonia--guidelines for hospitalization].

To determine if there are any specific features of nursing-home acquired pneumonia we carried out a retrospective study in a nursing home between 1995-1996, based on clinical and laboratory data. We found no correlation between these findings and the severity of pneumonia, so it would be hazardous to determine rigid guidelines. These patients should be treated in the nursing home as long as conditions allow, in order to avoid hospitalization.

Influence of thiopental and propofol on postoperative cognitive recovery in the elderly patient undergoing general anesthesia.

Study Objective: To assess mental and psychomotor recovery following induction of anesthesia with thiopental or propofol in elderly patients undergoing general anesthesia.

Design: Randomized, prospective, double-blind study.

Setting: Large referral hospital.

Creatine kinase MB isoenzyme of noncardiac origin in elderly patients.

Increased activity of creatine kinase MB (CKMB) isoenzyme is regarded as highly diagnostic for acute myocardial infarction. We report two cases of elderly patients with increased levels of CKMB but no evidence of cardiac injury. We conclude that numerous factors influence CKMB activity and that the suitability of this test for the diagnosis of cardiac muscle damage in the elderly should be viewed with caution.

[Rheumatoid arthritis in the elderly].

Opinions differ as to whether late onset rheumatoid arthritis (RA) represents a clinical subset and whether age at onset involves differences in therapy and prognosis. In this retrospective study we compared 23 patients with early onset RA (average onset 52.8 years; 91.

Clay as a therapeutic tool in group processing with the elderly.

Geriatric rehabilitation includes medical treatment, physical therapy, and therapy in both the psycho-social field and the activities of daily living (ADL). Its objective is to return the individual to independent functioning. This may be achieved through art therapy, which enables verbal and non-verbal communication; the expression of personal feelings; and physical, sensorimotor, and cognitive therapy.

Slowly progressive aphasia, a left temporal variant of probable Pick's disease: 15 years of follow-up.

It is known that word-finding difficulties or anomia are the first signs observed in Pick's disease. We report a 15 year follow-up of a woman who at the age of 52 suddenly developed a speech impairment and only 6 years later showed other cognitive disturbances compatible with Pick's disease. This case demonstrates that nonfluent aphasia and agrammatic aphasia may constitute the first signs of this disease, stressing the importance of prolonged follow-up in such cases.

Primary visual memory of stroke patients.

This matched control group study assesses primary visual memory of stroke patients using the GEMAT visual-memory test. Primary visual memory of 29 stroke patients who scored 24 or more on the MMSE was compared with that of 33 age and sex-matched controls. Patients were recruited from physiotherapy outpatient clinics.

[Multiple myeloma: a geriatric dilemma].

Asymptomatic multiple myeloma was diagnosed in an 80-year-old woman with ischemic heart and cerebrovascular disease. The diagnosis was based on the finding of a rapid sedimentation rate (120 mm in the first hour), paraproteinemia with high levels of monoclonal IgA (4,582 mg%) and the characteristic findings on bone marrow aspiration. There was neither Bence-Jones protein nor hypercalcemia, nor clinical signs of multiple myeloma, such as bone pain, pathological fractures, or recurrent infections.

[Nosocomial acquisition of Clostridium difficile infections].

Clostridium difficile (CD) is associated with diarrhea in hospital patients receiving antibiotic therapy and may be nosocomially acquired. An outbreak of CD diarrhea was observed among elderly patients in acute hospital and geriatric rehabilitation wards. All but 1 patient presenting with diarrhea had a toxin-positive stool culture.

Is renal biopsy justified for the diagnosis and management of the nephrotic syndrome in the elderly?

During the past decade, controversy has raged about the necessity of renal biopsy for the management of the idiopathic nephrotic syndrome. The debate has centered on whether a precise diagnosis is imperative for steroid treatment or whether such therapy can be given blindly. The above question has not been addressed in the elderly.

[Falls in elderly patients in an institution].

Falls among the elderly are a major concern of those caring for them. We studied the incidence of falls in institutionalized elderly, as well as the characteristics of those who fell and the causes of the falls, to determine how to prevent falling. A 2-month survey was conducted in Mishan, an institution in Raanana, and included 144 falls in 108 patients (447 women and 162 men, mean age 84) out of a total of 609 elderly.