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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.

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 [...]

Physiologic changes linked to aging, dementia, depression as well as medical, social and environmental factors can be the cause of eating disorders and malnutrition in the elderly. Environmental, behavior or therapeutic changes may improve the well being of the patient and food intake may increase. Ethical and cultural issues should be considered when tube feeding is considered.

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.

Nutrition can play a role in slowing the aging process and reducing the risk of certain age-related diseases. Loss of bone mineral or muscle mass, osteoporosis, vision impairments such as cataracts, cardiovascular and cerebrovascular disease, and changes in metabolism are all age-related problems that may be treatable through nutritional intervention. This type of research could prove particularly valuable in a country such as Mexico, in which life expectancy is increasing and the elderly segment of the population is expanding dramatically.

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 [...]

Elderly Americans are at a high risk for hypertension and early diagnosis and treatment is an important factor in health care management for the older population. Physiological changes, functional difficulties, and use of a wider range of prescription drugs are some contributing factors to hypertension in the elderly population. Health care providers should educate themselves about current diagnosis and treatment techniques for elderly patients.

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.

Jaw pain in the elderly may have many causes. Dentists' diagnoses are complicated by patients' underlying medical conditions, age-associated physical changes, and the increased rate of some jaw diseases in the elderly. Facial pain may result from brain tumors that encroach on the neurologic structures or from a bone infection called osteomyelitis. Chest pain caused by insufficient blood flow to the heart radiates to the jaw in 9% to 18% of cases. Symptoms of gastroesophageal reflux may mimic chest pain and can affect the jaw. Diseases that involve the nerves and jaw fractures can cause facial pain. Cranial arteritis is an inflammation of the blood vessels in the head that may produce pain in the chewing muscles. Arthritis may develop in the temporomandibular joint, producing pain. Changes in dentition and oral habits developed to support ill-fitting dentures may produce jaw pain. Jaw pain may also be a physical manifestation of depression.

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.

Doctors appear to be performing gallbladder surgery on patients with less severe gallstone disease since the introduction of laparoscopic cholecystectomy. Laparoscopic cholecystectomy is a less invasive method of removing gallstones than traditional open surgery. Researchers tracked the rate of gallstone surgery in Medicare patients between 1986 and 1993 in Pennsylvania hospitals. After laparoscopic surgery was introduced in 1989, the rate of gallstone surgery increased 22%. Patients who had laparoscopic surgery were younger and had less severe gallstone disease. They were more likely to be scheduled for elective surgery and had lower 30-day mortality rates. The higher costs associated with a higher rate of gallstone surgery may be offset by the fact that patients who have laparoscopic surgery can be discharged quickly and return to work sooner than patients who have open surgery., Objectives.--To determine whether cholecystectomy rates among the elderly increased following the introduction of laparoscopic cholecystectomy in 1989, and to assess whether changes in rates were accompanied by lower clinical thresholds for performing cholecystectomy. Design.--Time-series quasi-experimental design based on quarterly observations from 1986 to 1993. Data were obtained from Medicare hospital discharge files for Pennsylvania. Patients.--Medicare patients aged 65 years or older who resided in Pennsylvania, did not have end-stage renal disease, and underwent cholecystectomy in Pennsylvania from 1986 to 1993. Main Outcome Measures.--Cholecystectomy rates per 1000 elderly Medicare beneficiaries, stage of gallstone disease (uncomplicated vs complicated) at cholecystectomy, type of admission (elective vs urgent/emergent), patient age and comorbidities, and 30-day postoperative mortality. Results.--Cholecystectomy rates increased 22% from 1989 to 1993. The proportions of cholecystectomy patients with uncomplicated gallstone disease and with elective admissions declined from 1986 to 1989 but then increased rapidly after laparoscopic cholecystectomy was introduced. In contrast, the age distribution and comorbidities of cholecystectomy patients did not change during the study period. Postoperative mortality rates were stable from 1986 to 1989 but decreased thereafter. Conclusions.--Growth in cholecystectomy rates following the introduction of laparoscopic cholecystectomy was accompanied by evidence of lower clinical thresholds for performing surgery. The normative, or prescriptive, implications of lower cholecystectomy thresholds require further analyses that consider lower direct medical costs and indirect costs and reduced postoperative morbidity after laparoscopic cholecystectomy. (JAMA. 1995; 273:1581-1585)

The epidemiologic risk factors in elderly African-American population for major chronic diseases are higher than the elderly white population. African-American elderly women are 1.5 to 2.5 times more susceptible to chronic illnesses than white women. Moreover, the African-American elderly population is growing at a faster rate than elderly white population. Diseases like cancer, cerebrovascular disease, hypertension and diabetes, that are responsible for causing the maximum number of deaths, are analyzed.

Marital status and indices of social support are associated with mortality due to coronary heart disease and stroke. This association seems not entirely due to differences in recognised cardiovascular disease risk factors. The Western Sydney Stroke Risk in the Elderly Study examined the relationship between marital status, living arrangements, widowhood and extent of social support, and risk factors for cardiovascular disease in men and women aged over 65 years. Unmarried men had the lowest mean HDL-C levels. Men living alone had the highest mean systolic blood pressures. The lower mean HDL-C levels and higher DBP levels seen among widows were not statistically significant after adjustment for differences in past medical history and education levels. The extent of social support was not associated with any significant differences in cardiovascular risk factor levels among men or women. We conclude that some of the increased risk of cardiovascular disease associated with socio-demographic factors among men in this age-group may be due to differences in primary cardiovascular disease risk factors. However, some of the mechanisms underlying risk of cardiovascular disease in this age-group remains obscure. Key words - social support, heart disease, stroke, cardiovascular risk, elderly

Optic nerve decompression surgery (ONDS) for nonarteritic anterior ischemic optic neuropathy (NAION) does not appear to improve vision and may harm patients. NAION is a common eye disease in the elderly characterized by sudden vision loss in one eye and swelling of the optic disc. ONDS is a procedure to reduce pressure around the optic nerve. Researchers examined and tested the vision of 237 NAION patients aged 50 and older before and after treatment. Of these, 115 underwent ONDS while the other 122 received standard non-surgical observation. At the six-month follow-up, 32.6% of ONDS-treated patients and 42.7% of the other patients were able to read at least three more lines on the vision chart. The risk of visual deterioration was greater in ONDS-treated patients than in the other patients at the three, six, and 12 month follow-ups. ONDS-treated patients experienced more adverse effects during and after surgery than the other patients., Objective.--To assess the safety and efficacy of optic nerve decompression surgery compared with careful follow-up alone in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Design.--The Ischemic Optic Neuropathy Decompression Trial (IONDT) is a randomized, single-masked, multicenter trial. Setting.--Twenty-five US clinical centers. Participants.--The IONDT ceased recruitment on October 20, 1994, on the recommendation of its Data and Safety Monitoring Committee. The preliminary results presented herein are based on data as of September 8, 1994, from 244 patients with NAION and visual acuity of 20/64 or worse. One hundred twenty-five patients had been randomized to careful follow-up, and 119 had been randomized to surgery, with 91 and 95, respectively, having completed 6 months of follow-up. Intervention.--Patients in the surgery group received optic nerve decompression surgery and follow-up ophthalmologic examinations; those in the careful follow-up group received ophthalmologic examinations at the same times as the surgery group. Main Outcome Measures.--Gain or loss of three or more lines of visual acuity on the New York Lighthouse chart at 6 months after randomization, as measured by a technician masked to treatment assignment. Results.--Patients assigned to surgery did no better when compared with patients assigned to careful follow-up regarding improved visual acuity of three or more lines at 6 months: 32.6% of the surgery group improved compared with 42.7% of the careful follow-up group. The. odds ratio (OR) for three or more lines better, adjusted for baseline visual acuity and diabetes, was 0.74 (95% confidence interval [CI], 0.39 to 1.38). Patients receiving surgery had a significantly greater risk of losing three or more lines of vision at 6 months: 23.9% in the surgery group worsened compared with 12.4% in the careful follow-up group. The 6-month adjusted OR for three or more lines worse was 1.96 (95% Cl, 0.87 to 4.41). No difference in treatment effect was observed between patients with progressive NAION and all others. Conclusion.--Results from the IONDT indicate that optic nerve decompression surgery for NAION is not effective, may be harmful, and should be abandoned. The spontaneous improvement rate is better than previously reported.