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An oral glucose tolerance test (OGTT, 75 g WHO criteria) was applied to healthy elderly subjects (mean age 76 years) within a week of measurement of random blood glucose and glycosylated haemoglobin (HbA1). The 'Corning' method was used to assay HbA1 (established normal range for our laboratory 5-8%). Sixty-five subjects (38 women) of whom 54 were not diabetic on WHO criteria for OGTT participated in the study. Five of the 54 patients with non-diabetic OGTT results had abnormal HbA1 (greater than 8%). These five subjects had no evidence of impaired glucose tolerance. Eleven subjects had diabetic OGTT results of whom only four had raised HbA1 assay results. Seven subjects had normal HbA1 in spite of diabetic OGTT. The mean HbA1 in the group of subjects with normal OGTT (n = 52) was 6.7% (SD 1.05, range 4.6-8.7%). It appears from our study that the normal range of HbA1 in elderly subjects is not markedly different from established normal values. The poor sensitivity (36%) and predictive value (44%) of abnormal HbA1 in detecting diabetes, as shown in our study, would not permit its use for screening purposes nor as a confirmatory test for diabetes in elderly subjects.

The response of thyrotropin (TSH) to thyrotropin-releasing hormone (TRH) was measured in 70 clinically euthyroid elderly patients who were acutely ill and in 70 age- and sex-matched euthyroid controls who were free of acute disease. The incremental TSH response (delta TSH) was often blunted (less than 2 mU/l) in both groups, though more often in those with acute illness (30%) than in those without (19%). However, in patients from both groups who had a blunted delta TSH, there was often a substantial proportional rise in TSH. A substantial proportional TSH rise may be useful in differentiating between genuine thyroid disease and euthyroid sick syndrome in elderly patients with a blunted delta TSH.

Motor involvement is uncommon in herpes zoster. Of 14 subjects observed over an arbitrary period of five years, nine had flaccid limb paralyses, involving the upper limb in eight patients. Recovery was not always complete and occurred over a period of nine weeks to four years.

Two hundred and eighty-eight patients with colorectal cancer over the age of 65 years admitted to either the geriatric unit or a surgical unit have been compared. Significant differences in presentation and outcome were found and are discussed. Despite adverse factors, acceptable results were obtained for surgical treatment in the geriatric group.

The diagnostic features and outcome of acute myocardial infarction in 100 very elderly (aged 85 years or more) hospitalized patients are reviewed and compared with those in a group of younger elderly (aged 65-84 years). The diagnostic triad of chest pain, sequential ECG changes and raised cardiac enzymes was present in only 24 very elderly patients and in 27 the diagnosis was not initially suspected. Presenting symptoms were often atypical and characteristic ECG changes could not be demonstrated in 25 patients. Very elderly patients had a higher mortality during the first few days in hospital, despite no greater incidence of cardiac failure and similar infarct size to the younger patients. Subsequent in-hospital mortality was similar in both groups. A higher index of suspicion of myocardial infarction in acutely ill very elderly patients should lead to earlier diagnosis, more appropriate management and may improve immediate prognosis.

Of 4100 consecutive admissions to the Department of Geriatric Medicine, 414 patients (10.1%) were identified as having atrial fibrillation (AF); 138 (33%) had transient AF and 276 (67%) had constant AF. In the constant group, 41.7% of patients had had a stroke compared with 26.8% in the transient group (P less than 0.01). A random sample of 200 patients in sinus rhythm from the 4100 admissions had a stroke prevalence of 19%. This study suggests that constant AF has a greater association with stroke than transient AF.

Thyroid function was assessed by measurement of free thyroid hormones and thyrotrophin (TSH) in 78 acutely ill elderly patients and in a control group without acute illness. Abnormal results with any test were more frequently found in the acutely ill group than in controls. In particular, abnormal TSH values were found in 40% of the acutely ill group and in only 8% of controls (p less than 0.001). Seven acutely ill subjects had very low TSH levels (less than 0.04 mU/l) and a blunted response to thyroid-releasing hormone (TRH). With few exceptions these abnormalities could not be attributed to thyroid disease. This suggests that pituitary TSH secretion can be impaired in euthyroid sick old people. High sensitivity TSH assays may therefore be inappropriate as first-line tests of thyroid function, at least in this select group.

The effects of discontinuing long-term diuretic therapy were investigated by means of a double-blind randomized controlled trial. A total of 141 elderly patients in the long-stay wards of six hospitals were found to be taking maintenance diuretics, and for 33 of these the drugs were judged to be mandatory. Of the remaining patients, 52 continued to receive diuretics while 54 were given matching placebo tablets. Eight in the latter group required diuretic therapy to be resumed during the following 12 weeks. The main change observed in patients who completed the trial was a slight increase of ankle oedema in the placebo group. Plasma potassium levels below 3.5 mEq/1 were found in some patients taking diuretics but not when the drugs had been withdrawn for 12 weeks. Blood pressure rose slightly in the placebo group and plasma urea rose slightly in the diuretic group. It was concluded that old people receiving long-term diuretic therapy without obvious current indication should have the drugs withdrawn under careful supervision so that those needing them could be identified.

Defaecation syncope is recorded in seven female and two male patients aged between 63 and 78 years seen over a period of nine years. The tendency for defaecation syncope to occur at night contrasts with the rarity of nocturnal defaecation in most old people. The close similarity with micturition syncope is noted.

Seventy-five consecutive patients discharged from a geriatric medical ward after a proven myocardial infarction and still alive at three months were followed for three years. Twenty-two died. Sixty-five patients replied to a postal questionnaire designed to assess their degree of psychological impairment and disability sent at the end of the first and third month after discharge. The predictive value of an increased independency rating between the two administrations of the questionnaire for survival was 77%. The predictive value of a decreased independency rating for mortality was 52%. The only clinical feature noted on admission, whose frequency differed significantly between the group who died and those who survived, was a systolic blood pressure of 160 mmHg or more on admission but this was a less satisfactory predictor than change in disability status. Patients who improve their disability status in the few months after a myocardial infarction also have a low long-term mortality and can safely be excluded from out-patient follow-up.

The outcome of cardio-pulmonary resuscitation within an acute geriatric unit was studied in 95 patients (mean age 77 years, range 65-90) who were involved in 106 consecutive cardio-respiratory arrest calls. In 58 patients (61%), initial resuscitation was unsuccessful and a further 21 (22%) died later in hospital. Fourteen patients (15%) were alive 3 months after hospital discharge, a success rate comparable to that of published series in younger patients. The probability of successful resuscitation was greater in patients in the High-dependency Unit, and ventricular fibrillation and a short duration of arrest were confirmed as good prognostic factors. Age had no influence on outcome. Although subjective levels of psychological and physical disability of survivors at 3 months were low, their domestic and social life was often excessively restricted. Selective, but positive, use of cardio-pulmonary resuscitation within acute geriatric units will benefit a significant minority of patients, but there is also a need for further measures to reduce unnecessary disability in long-term survivors.

In a prospective, randomized, controlled study an intravenous vitamin B complex and vitamin C preparation was administered pre- and post-operatively to 28 elderly patients with a fractured proximal femur and compared with 32 nonsupplemented postoperative controls. Vitamin supplementation significantly, though only transiently, improved postoperative thiamine status (P less than 0.001), but had no influence on mental state or outcome during the postsurgical period. Therefore, the use of parenteral vitamins for postoperative confusion cannot be justified on a routine basis.

Oral glucose tolerance and the plasma immunoreactive insulin response to oral glucose were measured in 42 elderly hypertensive patients. Twenty-four of these patients showed abnormal glucose tolerance curves an 18 had normal curves. Patients with abnormal glucose tolerance showed significantly lower plasms immunoreactive insulin concentrations at 30 min and 60 min after the glucose load compared with patients with normal glucose tolerance. The patients in the two groups did not appear to differ in any other clinical or biochemical characteristics.

Studies in the United States have suggested that medical students' bias against older patients is not influenced by ad hoc courses in geriatrics. If the suggestion is correct then there should be no difference between the attitudes towards the care of the aged and to a career with elderly patients among students attached to a geriatric and general medical firm. In order to examine the hypothesis, such attitudes were compared among students randomly allocated to geriatric and general medical firms. More of the geriatric firms' students held favourable attitudes towards the care of the aged and were prepared to consider a hospital career with elderly patients. The majority of students in both groups wanted to gain their pre-general practice experience of elderly patients on a geriatric ward. The geriatric firm's students also felt that their training had more adequately prepared them to deal with problems commonly encountered among the elderly in hospital.