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Objectives. One can conceptualize adaptive technology as a resource used by disabled older adults in order to maintain competence in everyday life. This study examined the independent relationships between optical and adaptive device utilization and change in functional disability and depression among older adults with age-related vision impairments. Methods. We interviewed older adults (n = 438) with a recent vision impairment applying for vision rehabilitation services both pre-service and at the 6-month follow-up. We conducted hierarchical regression analyses with functional disability and depressive symptoms as criteria. In order to identify their independent direct effects, we entered optical and adaptive device use into the final step, preceded by Time 1 criterion scores, demographics, baseline disability or depression (depending on criterion), and total rehabilitation service hours. Results. Optical, but not adaptive, device use was significantly associated with declines in functional disability and depressive symptoms over time. Discussion, We propose that these differential effects result from the fact that optical devices optimize residual vision and thus allow for greater continuity in the way tasks are accomplished (i.e., reading still performed visually), whereas use of adaptive aids (e.g., talking books) involves learning new methods in order to compensate for lost functions and thus is not as desirable either functionally or psychologically.

The metabolic syndrome is a complex construct with interrelated factors of obesity, blood pressure, lipids, and glucose. It is a risk factor for a number of chronic diseases in late life. This study tested a model in which the relationship between stress and the metabolic syndrome was mediated by appraisal, coping, and affect. Data were collected from 518 male participants in the Normative Aging Study ([X.sub.age] = 68.17 years). The model was partially confirmed. Relationships among stress, appraisal, coping, and affect were valenced along positive and negative pathways. However, affect was not directly related to the metabolic syndrome. The metabolic syndrome was related to positive coping as operationalized by self-regulatory strategies. The results of this study suggest that the influence of coping on physical health may occur through emotional regulation.

Advances in the treatment of respiratory diseases that affect elderly people are discussed. Topics include chronic obstructive pulmonary disease, tuberculosis, lung cancer, asthma, non-tuberculous lung diseases, and respiratory rehabilitation.

Research presented concerns the diagnosis and treatment of Helicobacter pylori infections in elderly patients, focusing on diseases associated with H. pylori. Topics addressed include how to treat H. pylori in patients with peptic ulcer disease, gastric cancers, and gastro-oesophageal reflux diseases.

The relationship between psychosocial factors and the occurrence and aggravation of peptic ulcer was studied in elderly people. Thirty-nine (14 male) ulcer patients and 79 (30 male) elderly people aged 65 years and over and living in the community were tested. Information on health status, medication, lifestyle, and psychosocial status was obtained by means of interviews using a questionnaire and from the clinical records of the ulcer patients. The same questionnaire was distributed to the residents. Logistic regression analysis adjusting for age disclosed that peptic ulcer was significantly associated with having an occupation and low exercise practice in men. However, the relationship weakened below statistical significance after adjusting for some physical risk factors besides age. Low education was significant but low instrumental support felt short of statistical significance with peptic ulcer in women even after adjustment for several physical risk factors besides age. Thus, the specific psychosocial factors might be independently associated with the occurrence and aggravation of peptic ulcer in at least elderly women.

Psychologists are trained to evaluate memory problems and changes in cognitive functioning among older adults. For clinical neuropsychologists who are tasked to assess dementia and age-related cognitive decline, a set of guidelines has been developed. The guidelines, which conform with the 'Ethical Principles of Psychologists and Code of Conduct' of the American Psychological Assn, are aimed at enhancing the expertise and proficiency of neuropsyhologists as they evaluate dementia and age-related cognitive decline among older adults in clinical practice.

Introduction Since the first successful culture of spiral bacteria from the human stomach in 1982 [1], Helicobacter pylori has been increasingly recognized to be one of the most common bacterial [...]

Keywords: coeliac disease, gluten-sensitive enteropathy, old age Introduction Coeliac disease has been viewed as a disease of children and young adults, presenting with weight loss, steatorrhoea, anaemia and evidence of [...]

Introduction Delirium, or acute confusional state, is a common and serious complication of hospitalization in elderly patients. Studies using formal diagnostic criteria for delirium have shown that between 10 and [...]

The potential of the testing-the-limits of cognitive reserve capacity method as a psychological diagnostic strategy for the early identification of Alzheimer's disease is evaluated. Findings showed that the method determined more variance in the mental health status of subjects. When the range of cognitive reserve capacity or plasticity is measured using cognitive training, early detection of Alzheimer's disease becomes possible.

Introduction In 1894, Otto Binswanger described Encephalitis Subcorticalis Chronica Progressiva [1], a form of dimentia characterized by slowly progressive intellectual deterioration starting in the sixth decade, with intercurrent stroke-like events [...]

Introduction The prevalence of asthma in the population has risen in recent decades, particularly among children and young people |1-3~, and the use made of both hospital and outpatient services [...]

A study was conducted on 41 patients over two periods, each six months long to evaluate the reliability of echocardiographic diagnosis in comparison with clinical diagnosis. Both types of diagnosis had a 75% agreement in most cases although clinical diagnosis for aortic stenosis was unsatisfactory in the first period. Symptoms of aortic stenosis may be undetected until the critical stage of the disease. Echocardiography may facilitate the discovery of aortic stenosis and other heart diseases thereby enhancing clinical diagnosis to prevent fatal outcomes in elderly patients.

Introduction Demand for the assessment of newly diagnosed dementing illness and memory disorders is growing. The recognition of cognitive impairment in elderly patients by general practitioners has virtually quadrupled between [...]

Introduction There are many causes of progressive leg weakness in elderly people, and to this list must be added spinal dural arteriovenous malformations (SDAVMs) a pathological entity first described in [...]

Some foundations are laid for a social-psychological theory of dementia care. Central to this is a conceptualisation of personhood, in which both subjectivity and intersubjectivity are fully recognised. Evidence is brought forward concerning relative well-being even in those who are, from a cognitive standpoint, severely demented. In the light of this it is argued that the key psychological task in dementia care is that of keeping the sufferer's personhood in being. This requires us to see personhood in social rather than individual terms.

Described is the development and evaluation of a three hour multimedia community education program on alcohol problems in later life. Designed for families, older adults and service providers, the program provides information and skills needed to recognize and to take appropriate action with regard to alcohol abuse among the elderly. Compared to a control group, program participants had significant gains in knowledge and in their intent to take appropriate action in response to alcohol problems.

The prevalences of peptic ulcer and smoking were assessed by a questionnaire sent to 6726 residents of Gothenburg selected at random from the birth cohorts 1945, -35, -25, -15, and -05. The point prevalence of peptic ulcer was in all age groups significantly higher among smokers than among non-smokers. The incidence of peptic ulcer in 1985 was deduced from records of ulcers detected at gastroscopy and/or radiography and/or emergency surgey (n + 1402). Smoking habits and previous episodes of peptic ulcer disease were evaluated. The estimated risk of getting peptic ulcer was significantly higher among smokers in all age groups and of both sexes than among non-smokers. Among non-smokers the risk of getting peptic ulcer was significantly higher in men than in women, whereas the risk among smokers showed no sex difference. In people aged 35-84 years, 25.4% (n = 101) of ulcers diagnosed for the first time and 42.0% (n = 246) of relapsing ulcers were estimated to be caused by smoking. The number of smoking years, however, could not be shown to influence the risk of peptic ulcer.

A cross-sectional survey of an age- and sex-satisfied random sample of the elderly population living in Southampton was undertaken with the object of measuring the frequency of cardiovascular disease by questionnaire and examination, and assessing cardiac anatomy and physiological function by noninvasive methods. The response rate was 64% and 259 men and women aged between 65 and 95 years were interviewed and examined and had a twelve-lead ECG and chest radiograph. Forty per cent of men and 47% of women reported a diagnosis of one or more cardiovascular diseases, of which high blood pressure 33%, coronary heart disease 14% (angina pectoris 11% and myocardial infarction 8%), peripheral arterial disease of the lower limbs 7%, and cerebrovascular disease 6% occurred most frequently. With the exception of high blood pressure, which women reported more frequently than men (40% vs 27%), the prevalence of these diagnoses by sex was similar. The self-administered WHO questionnaires gave point prevalence estimates for angina pectoris of 13%, possible myocardial infarction 7% and intermittent claudication 5%, which were similar to reported prevalences of these diseases, although disagreement in the classification of individuals for each disease was common. When comparing the WHO chest pain questionnaire with the doctors' independent diagnosis of angina pectoris in this population, the sensitivity of the WHO questionnaire was 79%, with a specificity of 98% and a predictive value of 88%. For each sex the sensitivity of the WHO chest pain questionnaire was similar but specificity and predictive value were both lower for women. Thirty-four per cent of men and 41% of women reported taking cardiovascular drugs, of which diuretics and beta-blockers were the most commonly prescribed.

The frequency and the possible age-related characteristics of gastro-oesphageal reflux disease (GORD) were investigated in 195 consecutive elderly subjects (mean age 74 years), referred to endoscopy for abdominal symptoms or sideropenic anaemia. In the 105 of these patients in whom there was any suspicion of GORD, 24-hour pH monitoring was carried out. All the patients were interviewed before the examinations. Erosive or complicated (grade 2-4) oesophagitis was found in 18% of patients. The main symptoms in these patients were dysphagia, respiratory symptoms and vomiting. Chronic cough, hoarseness or wheezing were present in 57% of patients with oesophagitis compared with 33% of those without oesophagitis (p

In an attempt to evaluate the clinical significance of fructosamine (F) and glycated haemoglobin (HbA1c) values in elderly diabetic patients, 49 patients with mean age 72.0 years and 58 patients with mean age 51.6 years (control group) were studied. No difference was found in F and HbA1c between the two groups, when the degree and duration of glycaemic failure was equal. However, on extrapolating from the two groups those patients with total protein [is less than or equal to]6.0 g/d1, it was observed that these subjects had F values significantly lower than the other patients studied (p

This study was carried out to estimate the prevalence of respiratory symptoms among people aged 65 years and older and assess the value of a postal survey in obtaining this information. A questionnaire was sent to 2011 subjects (957 men) drawn by age-stratified random sampling from the age-sex registers of four New Forest group practices (1:3.3 sample). A total of 1803 replied, a 96.2% response after excluding 136 who has died or moved from the area. The accuracy of replies was verified for 355 (20%) randomly selected subjects. Forty per cent had no respiratory symptoms. Exertional breathlessness was common (38%), increasing in prevalence with age but not with smoking history, and was the only symptom reported by 10% of subjects. Only 14.2% were current smokers; more of the subjects aged 85 years and over were lifelong non-smokers. Two hundred and ninety-six (16.4%) had chronic bronchitis, which was more common among smokers; 151 (8.4%) gave a history of asthma, of whom half (76) had active asthma, which was slightly less common among the very elderly subjects. Only 489 (27%) of subjects has seen their doctors with chest symptoms during the preceding 2 years.

The most common ages for the onset of Parkinson's disease (PD) lie between 60 and 65 years. However, it is estimated that some 5 to 7 percent of all cases begin before 40 years of age. Curiously, the rate of such ''young-onset'' PD is roughly twice as great in Japan. It must be mentioned, however, that such estimates are always based on patients who seek help for symptoms, and are not based on community surveys; they are therefore subject to some sampling error. Nevertheless, it may be estimated that the incidence of PD between 35 and 39 years of age is about 0.15 cases per 100,000 cases per year, roughly one-tenth the rate for the peak years. Young-onset PD is defined as occurring between the ages of 21 and 39 years; some authors also distinguish a juvenile-onset Parkinson's which occurs prior to 21 years of age, but there is serious concern about whether the diagnosis of Parkinson's is appropriate at all for these patients. Young-onset PD differs from the older onset variety in its clinical picture, in the progression of the disease, and in the problems faced by its victims. Dystonia, or abnormal muscle tone, is more common as an early symptom among younger patients, and tremor occurs as an early symptom less often. The progression of PD seems to be slower among younger patients. However, it also seems that young patients are more vulnerable to movement disorders in response to levodopa treatment. There are no striking differences between young-onset PD and the older onset variety in the pathological features visible upon examination at autopsy. Young-onset PD shows the Lewy bodies typical of PD neuropathology. One study showed that the substantia nigra in the brain of younger patients with PD showed 24 percent fewer remaining neurons than did those of the older patients. However, the small number of such cases that have come to autopsy prevent attaching any significance to these figures just yet. When the symptoms of PD are encountered in a younger patient, several more conditions must be included in the differential diagnosis. Wilson's disease must always be considered, as it is amenable to treatment. Even in cases which respond to levodopa, magnetic resonance imaging or CT scan is always indicated for the younger patient with PD. (Consumer Summary produced by Reliance Medical Information, Inc.)

The prevalence of urinary incontinence and the use of incontinence aids was investigated in 85-year-old men and women resident in the city of Goteborg. The overall prevalence of urinary incontinence was 37.2%. Urinary incontinence was more prevalent (p less than] 0.001) in women (43.2%) than men (24.0%), and in residents of a nursing home or hospital (83.9%) than in men and women living at home (29.4%). Urinary incontinence was more commonly encountered in men with neurological (p [less than] 0.001) and respiratory (p [less than] 0.05) illnesses, and in women suffering from cardiovascular (p [less than] 0.05), neurological (p [less than] 0.001) and urogenital (p [less than] 0.01) illnesses. Incontinence aids were used more often (p < 0.001) by incontinent women (67.9%) than men (42.9%) living in the community, and were used by 86.4% of the incontinent men and 91.5% of the incontinent women living in an institution. Pads were the commonest form of incontinence aid used, irrespective of whether the men and women lived in the community or in an institution. Indwelling urinary catheters were used by only 2% of the 85-year-old men and women.

Several reports have suggested that the neurodegenerative change in Alzheimer-type dementia (ATD) may be related to alterations in calcium homoeostasis. The absorption of radiocalcium ([sup.45]Ca) in 26 ATD subjects and 11 patients with multi-infarct dementia (M I D) was compared to 24 normal age- and sex-matched controls. The absorption of radiocalcium was significantly lower in both ATD and MID when compared to controls. The reduced ([sup.45]Ca absorption in ATD occurred in the presence of normal plasma concentrations of PTH and vitamin D metabolites and the serum concentrations of calcium and aluminium were in the normal range. The data suggest that the reduced uptake of radioactive calcium observed in ATD is a non-specific derangement.

Summary Bronchopneumonia was the commonest cause of death in 84 elderly patients suffering from Alzheimer's disease. The cause of death as stated on the death certificate agreed with the pathological diagnosis in 77% of cases. In 30%, no mention of the presence of a dementia syndrome was recorded on the death certificate. An increased willingness to record the presence of a dementia syndrome and a higher autopsy rate would increase the accuracy of death certification in Alzheimer's disease.

Summary Rectal motility was assessed in three groups of geriatric patients (faecally incontinent, continent faecally impacted and control patients) to determine whether 'uninhibited' rectal contractions are a cause of faecal incontinence. The incidence of rectal contractions in response to rectal distension did not differ between the three study groups. Two-thirds of the incontinent patients were unable to retain a condom distended with water (soft-stool model) during a proctometrogram. Involuntary expulsion of this device was correlated with the presence of rectal contractions and low anal resting pressure. Involuntary expulsion of an air-filled balloon firm-stool model) from the rectum occurred less frequently and was correlated with low resting pressure but not with rectal contractions. The contribution of 'uninhibited' rectal contractions to faecal incontinence is insignificant except for a minor role in the expulsion of liquid stool.

Summary In a population study of 70-year-old people in Goteborg, Sweden, a representative sample of 449 men and 524 women was followed for nine years. The prevalence of coronary heart disease (CHD) at age 70 was about 30% in both sexes and did not change up to age 79. Myocardial infarction appeared twice as often in men as in women at age 70 but angina pectoris and ST-T changes on ECG showed no sex difference. Myocardial infarction and probable ischaemia on ECG increased significantly between ages 70 and 79 in both sexes. Half of the men with angina pectoris had a history of myocardial infarction and/or probable ischaemia on ECG criteria compared with 23% of the women. The mortality rate was twice as high in men as in women irrespective of CHD. When CHD was present at age 70 the nine-year mortality was doubled. CHD was shown to be a strong independent risk factor for death also in this age group.

Summary, In order to investigate whether orthostatic hypotension in elderly people is due to autonomic nervous system dysfunction or blood vessel abnormalities, we have measured platelet and lymphocyte adrenoceptor numbers and agonist binding in addition to venous plasma catecholamine concentrations. Eight elderly subjects with orthostatic hypotension and six control elderly subjects were studied. None of the subjects had other symptoms of autonomic failure. There was no significant difference between the heart rate or plasma catecholamine responses to standing of the two groups. The orthostatic hypotension subjects had a significant rise of their plasma vasopressin levels whereas the control group had no significant change. The number of [(alpha).sub.2]-adrenoceptor sites in platelets was lower in the orthostatic hypotensive group compared to the controls and the binding affinity was greater than in the controls. There were no significant differences in (beta)-adrenoceptor binding sites or affinities in isolated lymphocytes between the two groups. The similar changes in heart rate and catecholamines together with the vasopressin changes suggest that, in these elderly patients with an abnormal drop of blood pressure on standing, there is no dysfunction of autonomic pathways concerned with cardiovascular function. The lower numbers of [(alpha).sub.2]-adrenoceptor sites on isolated platelets in subjects with orthostatic hypotension could indicate reduced [(alpha).sub.2]-adrenoceptor numbers on their blood vessels which could contribute to their inability to maintain blood pressure while standing.

Summary Seventeen patients over the age of 60 years, admitted to the Aberdeen Teaching Hospitals between 1980 and mid-1988, were diagnosed as having pyogenic liver abscess. Eleven were women and the mean age was 73.5 years. The diagnosis of liver abscess was made by needle aspiration in seven patients and was an unexpected finding at laparotomy in three. Six patients were thought to be suffering from advanced malignant disease until autopsy. The overall fatality was 53%. Misleading results from special investigations reduced the chance of a correct diagnosis in several patients. Even in frail elderly patients, a filling defect in the liver should not be attributed to metastatic malignancy when there is no known primary site, until liver abscess has been excluded by aspiration biopsy under ultrasound or computerized tomographic scan guidance. The high fatality of pyogenic liver abscess seems to be at least in part due to a lack of clinical suspicion.

Summary The purpose of this study was to describe the prevalence of diabetes in a community-dwelling elderly population, and to assess whether other cardiovascular disease risk factors were more frequent in older diabetics than in non-diabetics. Results suggest that, with the exception of hypertension, other cardiovascular disease risk factors are not more prevalent in older diabetics and do not aggregate in older diabetics. However, there was a very high prevalence of hypertension among older diabetics. Of particular concern is the observation that 40% of diabetic individuals under treatment for hypertension still have unacceptably high blood-pressure levels. These results indicate a need for follow-up of high-bloodpressure treatment in older diabetic people.

Summary A postal questionnaire was sent to 2705 people aged 60 and over requesting information about anginal symptoms, their degree of disability and dependency and the use they made of community services. Those with angina showed marked degrees of disability and dependency and used some services to a considerable extent. Postal questionnaires are a satisfactory screening device for identifying individuals at risk and can assist practitioners in organizing their workload for patients with disabling conditions.

The varying prevalence rates of dementia reported in elderly populations may be partly due to the use of different diagnostic measures. In a recent study in which diagnosis was based on the CAPE, a 12-item questionnaire, the prevalence rate for severe cognitive impairment for the age group 75 years or over was lower than previously reported. In the present study, the performance of the CAPE was examined in an elderly general-practice sample with a higher than usual risk of dementia. The study diagnosis was based on a combination of the diagnosis made by the computer program AGECAT and a clinical diagnosis made by the interviewing psychiatrist. Forty-five per cent of patients with definite or probable dementia, as defined, and 100% of those with possible dementia had scores above the cut-point on the CAPE. The sensitivity of the CAPE was low compared with that of other rating scales. It is concluded that the low reported rate with the CAPE is probably due to only the more severe cases being identified. For comparative purposes it is important to know the level of dementia that the instruments used are detecting.

Introduction Rectus sheath haematoma is an unusual but well-described clinical entity. `Spontaneous' haematoma is more commonly seen in elderly women, particularly if they arc taking anti-coagulants or have a chronic [...]

Introduction The advent of automatic cell counters has made the red cell indices including mean cell volume (MCV) widely available. An elevated MCV (i.e. macrocytosis) can be caused by several [...]

Introduction The importance of atrial fibrillation (AF) as a major independent risk factor for stroke in the elderly population is clearly established [1]. There is now evidence from large randomized [...]

Introduction The diagnosis of Parkinson's disease (PD) may be quite difficult. In a recent study, neuropathological criteria had not been satisfied in 20% of cases diagnosed by experienced neurologists [1]. [...]