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Purpose: Older adults living with HIV infection may be doubly stigmatized, as they are branded by both age as well as HIV status. Through semistructured interviews, this study sought to examine whether older adults with HIV/AIDS experience both ageism and HIV stigma and how those experiences manifest in their lives. Design and Methods: This was a qualitative study in which 25 in-depth interviews were completed with adults aged 50 years and older who were living with HIV or AIDS. Purposive sampling was used to recruit these individuals who shared their experiences. Open coding and axial coding of interview transcripts were completed on all interviews, resulting in the development of a framework of these experiences. Results: The majority (68%) of the respondents experienced both ageism and HIV-associated stigma. The experiences were often separate, although some interrelated stigma did occur. Nine themes emerged from the interviews, including rejection, stereotyping, fear of contagion, violations of confidentiality, and internalized ageism. All themes fell into four categories: social discrimination, institutional discrimination, anticipatory stigma, and other. Implications: The research identified themes that may be sources of felt as well as enacted stigma and discrimination related to both aging and HIV. This concept of double jeopardy exists in the lives of the majority of people interviewed and has relevance to the creation of appropriate intervention strategies. Key Words: Ageism, Discrimination, HIV/AIDS, Qualitative methods, Stigma

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.

Background. Adverse drug reactions (ADR) negatively impact life quality and are sometimes fatal. This study examines the incidence and predictors of all and preventable ADRs in frail elderly persons after hospital discharge, a highly vulnerable but rarely studied population. Methods. The design was a prospective cohort study involving 808 frail elderly persons who were discharged from 11 Veteran Affairs hospitals to outpatient care. The main outcome measure was number of ADRs per patient as determined by blinded geriatrician and geropharmacist pairs using Naranjo's ADR algorithm. For all ADRs (possible, probable, or definite), preventability was assessed. Discordances were resolved by consensus conferences. Results. Overall, 33% of patients had one or more ADRs for a rate of 1.92 per 1000 person-days of follow-up. The rate for preventable ADRs was 0.71 per 1000 person-days of follow-up. Independent risk factors for all ADRs were number of medications (adjusted [Adj.] hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.05-1.10 per medication), use of warfarin (Adj. HR, 1.51; 95% CI, 1.22-1.87), and (marginally) the use of benzodiazepines (Adj. HR, 1.23; 95% CI, 0.95-1.58). Counterintuitively, use of sedatives and/or hypnotics was inversely related to ADR risk (Adj. HR, 0.14; 95% CI, 0.04-0.57). Similar trends were seen for number of medications and warfarin use as predictors of preventable ADRs. Conclusions. ADRs are very common in frail elderly persons after hospital stay, and polypharmacy and warfarin use consistently increase the risk of ADRs.

Background. The metabolic syndrome (MetS) is represented by a duster of risk factors for cardiovascular diseases (CVDs). In spite of its high frequency and strong association with morbidity and mortality in the adult population, little is known about its magnitude in elderly persons. Methods. We assessed the prevalence of MetS by diabetic status and sex in the participants in the Italian Longitudinal Study on Aging (ILSA), a population-based study on a sample of 5632 individuals 65-84 years old at baseline (1992). We measured the association of MetS with stroke, coronary heart disease, and diabetes at baseline and with CVD mortality at 4-year follow-up. Results. The prevalence of MetS was 25.9% in nondiabetic men and 55.2% in nondiabetic women; in diabetic individuals it was 64.9% and 87.1% in men and women, respectively. At baseline, in both men and women there was a significant association with stroke (odds ratio [OR] = 1.67, 95% confidence interval [ICI], 1.02-2.75 in men and OR = 1.72, CI, 1.01-2.93 in women) and diabetes (OR = 4.58, CI, 3.12-6.74 in men and OR = 5.15, CI, 3.23-8.20 in women). A significant association with chronic heart disease was found in men only (OR = 1.40; CI, 1.02-1.97). During the approximately 4-year follow-up, nondiabetic men with MetS had a risk of CVD mortality 12% higher compared to those without MetS, whereas no significant differences were found in women. Conclusions. MetS is very common in aged Italians, and it is associated with stroke and diabetes in both sexes, and with chronic heart disease in men. In men, it increases significantly the risk of CVD mortality.

Background. Aging is associated with insulin resistance, primarily as a result of physical inactivity and increased abdominal obesity. We hypothesized that aerobic (AEX) or resistive (RT) exercise training would result in comparable improvements in glucose disposal in older men, but that there would be different metabolic adaptations in skeletal muscle. Methods. Thirty-nine older (63 [+ or -] 1 years, mean [+ or -] standard error of the mean), overweight and obese (body mass index = 30.3 [+ or -] 0.4 kg/[m.sup.2]) men were assigned to AEX (treadmill walking and/or jogging, n = 19) or RT (upper and lower body, n = 20) programs 3 d/wk for 6 months, with 9 completing AEX and 13 completing RT. Testing before and after the exercise programs included body composition, euglycemic--hyperinsulinemic clamps, and vastus lateralis muscle biopsies. Results. Maximal oxygen consumption (V[O.sub.2max]) increased by 16% after AEX (p < .01), while leg and arm muscle strength increased by 45 [+ or -] 5% and 27 [+ or -] 5% after RT (p < .0001). Although participants were monitored to maintain their body weight during the exercise program, body weight decreased by 2% after AEX (p < .05), and increased by 2% after RT (p < .05). Whole-body glucose disposal, determined during the last 30 minutes of a 2-hour 480 pmol/[m.sup.2]/min euglycemic--hyperinsulinemic clamp, increased comparably by 20%-25% after AEX (51 [+ or -] 5 to 61 [+ or -] 5 [micro]M/[kg.sub.fat-free mass]/ min, p < .05) and RT (49 [+ or -] 3 to 58 [+ or -] 3 [micro]M/[kg.sub.fat-free mass]/min, p < .05). The increase in vastus lateralis muscle glycogen synthase fractional activity in response to insulin stimulation was significantly higher after AEX compared to after RT (279 [+ or -] 59% compared to 100 [+ or -] 28% change, p < .05). Neither AEX nor RT altered muscle glycogen synthase total activity, glycogen content, or levels of phosphotidylinositol 3-kinase. Conclusion. These results suggest that AEX and RT result in comparable improvements in glucose metabolism in older men, whereas an increase in insulin activation of glycogen synthase occurred only with AEX. These improvements in insulin sensitivity could reduce the risk of metabolic syndrome and type 2 diabetes and attenuate the development of cardiovascular disease.

Contrary to common belief, HIV and AIDS are prevalent in the older adult population. Currently, between ten to fifteen percent of HIV/AIDS new cases occur in individuals fifty and older (Chiao, Ries, & Sande, 1999). With the aging of the baby boomer generation, and the introduction of erectile dysfunction medications, such statistics are guaranteed to increase at alarming rates. This population also faces hazardous risk factors that increase its possibility of contracting the disease. Stereotypes and lack of information continue to limit older adults from receiving the medical, educational, and psychological attention they need to avoid and to combat the virus. This article discusses the rising trends in the fifty and older population as well as some of the factors that increase the prevalence of HIV/AIDS among this population. Prevention, assessment, and treatment practices are also outlined; if instituted, these interventions may help promote a significant reduction in the rate of HIV/AIDS infection in the older adult population. KEYWORDS. HIV, AIDS, older adult, elderly, sexually transmitted disease

Purpose. This study examined verbal aggression in a sample of community dwelling older adults with Alzheimer's Disease (AD) using the Risk and Vulnerability model as a means for identifying factors associated with verbal mistreatment in caregiver/patient dyads. Design and Methods. Subjects were recruited in the State of Florida through their association with state-funded memory disorder clinics or with local chapters of the Alzheimer's Association. The sample for this analysis consisted of 254 caregivers who completed both a questionnaire and an in-home interview between the years 1998 and 2002. Verbal mistreatment was measured using the verbal aggression sub-scale of the Conflict Tactics Scale and logistic regression analysis was used to examine factors associated with increased risk. Results. Verbal aggression as a conflict resolution style was self reported by 60.1% of caregivers, and was reported as a technique used against them by 74.8% of family members with AD. Logistic regression analysis suggests that factors associated with increased risk for verbal aggression by caregivers included being female, providing care to verbally aggressive elders, caregiver's diminished cognitive status, high levels of psychiatric symptoms, depression, or experiencing a high degree of caregiver hassle. Additionally, a significant interaction effect was found between levels of depression in caregivers and dementia symptoms in elders, as well as between levels of psychiatric symptoms in caregivers, feelings of caregiver hassle, and depression in care recipients and risk for verbal mistreatment. Implications. This study highlights the importance of both risks and vulnerabilities in the outcome of verbal mistreatment, and identifies that in many cases verbal mistreatment may be a reciprocal phenomenain dyads of caregivers and persons with AD. [Article copies available for a fee from The Haworth Document Delivery, Service: 1-800-HAWORTH. E-mail address: Website: [C] 2005 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. Psychological, emotional, abuse, aged, dementia

Persons age 50 and over have consistently accounted for 10-15% of all cases of AIDS in the United States reported to the Centers for Disease Control and Prevention. With increased longevity due to antiretroviral medications, we can expect to see increasing numbers of older adults living with HIV and AIDS in the coming years. This newly emerging vulnerable population requires an understanding and sound clinical response that incorporates the needs of both older adults in general and persons living with HIV/AIDS. If older adults with HIV/AIDS are to receive sound assessments from professional social workers, an integration of knowledge from these two, up to now, different arenas of practice will need to occur. KEYWORDS. Aging, older adults, older persons, HIV/AIDS, HIV disease, geriatric assessment, vulnerable populations, at-risk populations, interdisciplinary, social work

Background. Muscle complaints are frequent among older adults, but histological data in this setting are scarce. Our objective was to detect the major categories of muscle diseases in the elderly population based on histological study. Methods. We reviewed all muscle biopsies performed in our hospital on patients older than the age of 65 during a 10-year period (1988-1997). As a control group, we included the next patient younger than 65 who underwent muscle biopsy after each elderly patient. We recorded demographic, clinical, and histological data of the patients, as well as the final diagnosis. Concordance between pre- and postbiopsy diagnosis was also analyzed. Results. We included 239 muscle biopsies corresponding to elderly patients and 239 to controls. Compared with the control group, elderly patients more frequently exhibited type II fiber atrophy and were diagnosed with a specific myopathy. The latter was achieved in 86 cases (36%), idiopathic inflammatory myopathies and vasculitis being the most frequent diagnoses. Interestingly, in about one quarter of the elderly patients in whom a definite diagnosis of muscle disease was achieved, this diagnosis had not been clinically suspected prior to muscle biopsy. Overall, in 60 out of 239 elderly patients (25%), a specific therapeutic regimen could be instituted on the basis of the muscle biopsy results. Conclusions. Muscle diseases are not rare in elderly patients. Therefore, muscle biopsy constitutes a safe and useful tool for diagnosis because, if not performed, some potentially treatable diseases may be undiagnosed or misdiagnosed.

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 purpose of this article is to review current knowledge regarding potential neural mechanisms of delirium. A MEDLINE search for relevant English language articles was undertaken using various combinations of delirium (including cognitive disorders, encephalopathy, and confusion) with pathogenesis and pathophysiology. These articles were scanned for content related to hypotheses concerning the neurobiology of delirium. Additional references were obtained from a manual search of the bibliography of these articles. A secondary MEDLINE search of delirium with the mechanism in question (i.e., serotonin, acetylcholine, etc.) was then undertaken. Literature review was last updated as of April 1998. Despite being a common problem among elderly patients, the mechanisms of delirium are poorly understood. Delirium is a syndrome that may occur as the result of multiple complex interacting neurotransmitter systems and pathologic processes. The neurotransmitters acetylcholine and serotonin may play particularly important roles in common medical and surgical delirium. Other neurotransmitters such as dopamine and gamma-aminobutyric acid each may be involved in the development of delirium under special conditions. Other neurobiologic factors such as cytokines, cortisol abnormalities, and oxygen free radicals will require further study to define their role in delirium. Distinct neuropathologic processes leading to delirium are beginning to be defined. Such mechanisms may differ in various clinical settings. There is probably no final common pathway to delirium, but rather, delirium is the final common symptom of multiple neurotransmitter abnormalities. Further situation-specific studies of delirium pathophysiology should lead to more effective prevention and treatment strategies.

Background. People with Parkinson's disease (PD) have a progressive loss of function eventually leading to severe disability. Although PD would be expected to have a profound impact on an individual's psychosocial health, them is relatively limited research on its psychosocial effect. The purposes of this study were (a) to examine the relationships between physical disability, depression, and control beliefs and quality of life in people with PD and (b) to characterize how these psychosocial variables differ by stage of disease. Methods. Eighty-six individuals from five stages based on clinical disability, ages 51-87, were interviewed. Established instruments were used to measure physical disability, depression, and control beliefs. Quality of life (QOL) was rated on a 5-point Likert scale. Results. A multivariable regression model including physical disability, stage of disease, depression, mastery, and health locus of control predicted QOL ([R.sup.2] = 0.48), with mastery as the only significant predictor (p = .0001). There were significant differences by PD stage for all variables (p < .05). Conclusions. Mastery predicted quality of life in individuals with PD even when depression and physical disability were included in the model. Differences in psychosocial variables by stage of PD suggest that the psychosocial profile of PD patients may change as the disease progresses.

Background. Parkinsonian signs are commonly found on the neurologic examination of older persons and are associated with morbidity and mortality. The extent to which parkinsonian signs in aging and Alzheimer's disease cluster in groups typical of Parkinson's disease has not been investigated previously. Methods. The motor portion of the Unified Parkinson's Disease Rating Scale (UPDRS), or a version with minor modifications, was administered to more than 2,800 persons in three cohorts: (a) 637 older persons with a wide range of neurologic conditions participating in the Chicago Health and Aging Project, a study of common health problems of a random sample of older persons from a geographically defined biracial community population; (b) 638 relatively healthy and highly educated older persons from 25 Catholic religious communities participating in the Religious Orders Study, a longitudinal clinical-pathologic study of aging; and (c) 1,546 older persons undergoing evaluation for possible dementia at the Rush Alzheimer's Disease Center, an urban, tertiary care center that evaluates persons for possible dementia. Separate factor analyses were performed on each data set. Additional analyses examined the factor structure in subsets by gender and race. Results. A similar grouping of items emerged in each cohort and did not differ substantially by gender or race. The factors corresponded closely with the traditional grouping of parkinsonian signs into bradykinesia, gait disturbance, rigidity, and tremor. Conclusions. The grouping of parkinsonian signs is consistent in diverse samples of older persons and does not vary substantially across gender or race. The results provide an empirical basis for summarizing the principal motoric manifestations of parkinsonism.

Background. Respiratory symptoms are common in older adults. In young populations the predictive value of such symptoms for chronic airflow obstruction and bronchial hyperresponsiveness is low. We investigated whether symptoms predict airflow obstruction and bronchial responsiveness in adults aged 45-86 years. Methods. An age-stratified random sample of white adults aged 45 years and older was obtained from family doctor lists in Central Manchester, UK, and sent a respiratory symptoms questionnaire (exclusions: housebound, confused). Responders were invited to participate in a methacholine challenge (Newcastle dosimeter method; exclusions: ischemic heart disease, oral steroids, anticholinergic or beta-blocker medication). Results. Of 783 eligible subjects, 723 responded (response rate 92.3%). Symptoms were reported by 53.8%. Methacholine challenge was completed by 208 subjects. Sixty-five (26.4%) had chronic airflow obstruction, of whom 76.6% reported respiratory symptoms. Bronchial hyperresponsiveness ([PD.sup.20] [less than or equal to] 100[[micro]gram]) was present in 26.0% of subjects overall, and in 36.8% of symptomatic and 14.6% of asymptomatic subjects (p < .001). Of those with bronchial hyperresponsiveness, 26.4% were asymptomatic. Predictive values of symptoms for chronic airflow obstruction and bronchial hyperresponsiveness were low. Conclusions. Respiratory symptoms, chronic airflow obstruction, and bronchial hyperresponsiveness were all common in this adult population sample. However, the predictive value of symptoms for airflow obstruction/bronchial hyperresponsiveness was low. It was concluded that respiratory symptoms do not identify adults with airflow obstruction or bronchial hyperresponsiveness. Investigation by spirometry and peak flow monitoring is necessary to guide appropriate management.

Background. Although widely believed that co-occurring chronic diseases in elderly persons do not act independently in causing death, there has been little empirical research assessing prognostic interrelationships between comorbidities. Methods. Nonconcurrent prospective follow-up of 3,549 Virginia-resident elderly women diagnosed with a first breast cancer and 2,114 elderly women with no breast cancer history admitted to Virginia hospitals with principal diagnoses of genital prolapse during 1986-1988 was conducted through linkage of cancer registry and Medicare administrative records. Aggregate comorbidity was measured from Medicare claims via the Charlson comorbidity index (CCI). Mortality rates and relative risks were estimated for the breast cancer and non-breast-cancer groups stratified by the presence and level of comorbidity. Proportional hazards models were used to estimate Rothman's synergy index (S) measure of additive interaction. Results. Over full follow-up, the excess mortality rate for women with breast cancer and other comorbidity was 17% greater than expected under the null hypothesis that risks were additive and independent (S = 1.17, p = .12). Stratified analyses revealed a pattern of S estimates across cancer stage subgroups that was biologically sensible, but this pattern was not supported by strong statistical evidence. Conclusions. This study provides the first empirical estimates of statistical interaction between breast cancer and other chronic comorbidity. S index values tended to be small, but these small effects would translate into substantial numbers of deaths attributable to interaction between cancer and comorbidity, Interactions between breast cancer and comorbid disease should be explored further in large studies that can estimate these effects with increased precision.

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 [...]

Background. The general population is aging, and lumbar stenosis is one of the more frequent conditions observed in an orthopedic or neurosurgical practice. Methods. This case presentation is of an 86-year-old male who developed lumbar spinal stenosis with a progressive neurologic deficit that caused severe leg pain, affected bladder function, and affected gait. Relevant medical literature is reviewed. Results, Bladder function and gait returned after spinal surgery, and this patient's pain was greatly reduced. A multidisciplinary team applied therapy after surgery. The medical literature does not concentrate solely upon patients older than 80, but a few are included in studies of younger patients. Conclusions. This case report illustrates that a patient over 80 can have a successful outcome with multidisciplinary medical coverage of medical, surgical, rehabilitative, social, and psychological areas. More studies need to be done of these patients.

Little has been added to what doctors know to prevent failure to thrive (FTT) syndrome since the National Institute on Aging and the Arizona Center on Aging conducted a workshop on the subject in Sept. 1993. The condition is associated with classical nutritional imbalances including marasmus and hypoalbuminemic, inflammation-associated malnutrition. It is also associated with immune activation, physiologic stress response, hormonal changes and chronic-acute phase response. It is not known if FTT is due to starvation, an undiagnosed disease that needs to be treated or factors related to aging.

The National Institute on Aging Geriatrics Program has started a new research program to investigate cancer in elderly persons. Specifically, the study will adopt previous knowledge and well-tested techniques to diagnose, treat or prevent the disease among the aged. Research on this subject becomes more pressing as more Americans reach the age of 65 at which they are most susceptible to the disease. Aging is cancer's greatest single risk factor and data from the National Cancer Institute show that cancer incidence and mortality rates increase as age progresses.

This article examines the prevalence of age-related diseases in different socioeconomic and demographic groups. The study is based on a sample of 267 aged persons (> 60 years) collected through a survey entitled 'Aging and Health Conditions in Rural Area - A Sample Survey, 1990' conducted in the rural areas of the Varanasi district of Uttar Pradesh, a northern province of India. Various socio-behavioral factors are found to play a significant role in determining the health conditions of aged people. Also, illiteracy and poverty are found to have their own impact on health during aging. It is also noted that due to adverse familial relationships, many stress-related disorders occur which may result in the poor health of the elderly. Demands for old age pensions were made by most of the elderly people in the sample.

The purpose of this study was to determine the usefulness of near-infrared spectroscopy (NIRS) measurements to identify peripheral vascular disease (PVD). Usefulness was determined by the frequency of a successful test, as well as comparison with standard clinical assessments. Study subjects (N = 117, mean age = 67.8 [+ or -] 8.1 yrs) responded to a free screening for PVD. NIRS was used to measure the relative [O.sub.2] saturation of hemoglobin in the soleus muscle. The time to 1/2 recovery of [O.sub.2] saturation ([O.sub.2][T.sub.1/2]) was measured after 1 minute of repeated plantar flexions using a Cybex Eagle seated calf machine. [O.sub.2][T.sub.1/2] was used as many subjects had recovery curves that did not have an exponential line shape. The test was done on both legs and the worst leg was used for analysis. For comparative purposes, a clinical history and physical examination were performed by a physician or nurse practitioner, which included questions on intermittent claudication, examination of peripheral pulses, and questions to identify cardiovascular risk factors. NIRS signals were obtained on 105 of 117 subjects (89% success rate). Subjects with body mass index (BMI) values above 32 appeared to have NIRS [O.sub.2][T.sub.1/2] values that were less reliable than subjects with BMI values [less than or equal to] 32 (77% success rate). The [O.sub.2][T.sub.1/2] was longer in subjects with claudication and reduced pulses than in subjects without these conditions. Sensitivity comparing [O.sub.2][T.sub.1/2] to claudication and reduced pulses varied from 51-76% and specificity from 65-80%, depending on the cutoff value for [O.sub.2][T.sub.1/2] that was used (normal value plus 1 or 2 SD). A longer [O.sub.2][T.sub.sub.1/2] was significantly associated with incidence of diabetes, smoking, hypercholesterol, and coronary bypass surgery. In summary, successful NIRS [O.sub.2][T.sub.1/2] measurements were made in 77% of the subjects, with failure primarily occurring in obese subjects. NIRS [O.sub.2][T.sub.1/2] measurements showed reasonable although not strong agreements with clinical assessments of PVD, and with some risk factors for cardiovascular disease.

Background. It is still unclear whether there is an association between Alzheimer's disease and vitamin B-12 or folate deficiency. This study was designed to investigate whether patients with Alzheimer's disease are particularly prone to metabolically significant cobalamin or folate deficiency as compared to nondemented hospitalized controls and healthy elderly controls living at home. Methods. Evaluation for the diagnosis of Alzheimer's disease, routine laboratory tests, serum folate and vitamin B-12, serum methylmalonic acid (MMA), total homocysteine (tHcy), and radiological tests was performed in 52 patients with Alzheimer's disease (AD), 50 nondemented hospitalized controls, and 49 healthy elderly subjects living at home. Results. Serum vitamin B-12 and folate levels are comparable between patients with AD, hospitalized control patients, and subjects living at home. Patients with AD have the highest serum MMA and tHcy levels. The MMA levels of patients with AD and hospitalized controls are not different, but the mean tHcy level is significantly higher in patients with AD as compared to nondemented patients or subjects living at home. Conclusion. The interpretation of the vitamin B-12 and folate status in patients with AD depends largely on the methodology (i.e., serum vitamin vs metabolite levels) and the selection of the control group. Although patients with AD have the highest tHcy and MMA levels, metabolically significant vitamin B-12 and folate deficiency is also a substantial problem in nondemented elderly patients.

Commonly held notions to the contrary, the elderly are increasingly vulnerable to HIV infection. This paper reviews the latest knowledge on the prevalence, the age-specific vulnerabilities, and the diagnostic complexities of geriatric AIDS. The limited information on psychological and social correlates of AIDS in the elderly is summarized. Practice recommendations tailored to the elderly and elaborating social work functions of education, screening and assessment, case management, counseling, interdisciplinary collaboration, caregiver support, advocacy, and knowledge building are offered. The spread of HIV to older persons is viewed as a challenge to social workers committed to perfecting the profession's biopsychosocial paradigm.

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 [...]

There is an increasing number of older Americans being infected with AIDS. However, society does not seem to recognize the presence of the disease among the elderly due to the apparent conservativeness of their sexual practices. The HIV/AIDS and Aging Task Force was instituted to address the different concerns of the older population regarding AIDS in relation to aging. The goal of the Task Force includes increasing the awareness of society that AIDS should also be acknowledged as an issue relevant to aging.

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.

Gerontologists can effectively assess vision in Alzheimer's disease (AD) and other similar conditions by using tests that do not impose cognitive difficulties on patients. The use of these tests reveals a deficit pattern in color discrimination, stereoacuity, contrast sensitivity and backward masking, which are not observed in healthy elders. Vision disorders are expected to result in the poor performance of AD patients in cognition tests. This emphasizes the importance of understanding visual changes in elderly AD patients.

Logistic regression is used to examine medical service recommendations by staff in California's diagnostic and treatment centers to a clinical, non-random sample of Alzheimer's disease clients (N = 822). Dependent variables include physician consultation, medical clinic, medication management, and psychiatric services. Predictor variables include patients' enabling, need, predisposing characteristics, family considerations, and organization affiliation. Significant predictors include previous service use, patient functioning, family characteristics, and the specific center recommending the service.