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The article discusses the causes, symptoms, diagnosis and treatment of epistaxis, which occurs in nearly 60% of the population during their lifetime and is more prevalent among children less than 10 years of age and adults over 35. A case of a 61-year-old man is highlighted to better understand the reasons for epistaxis and guidelines for treatment.

The number of deaths in England and Wales associated with gastrointestinal pathogens, norovirus in particular, in persons [greater than or equal to] 65 years was estimated for 2001-2006. Regression analysis [...]

We evaluated the impact of AIDS among older persons in Italy and compared these cases with cases among younger persons. The data source was Italy's National AIDS Registry. We considered adults diagnosed with AIDS between 1982 and 2005. Older adults were defined as those aged 50 years or older at diagnosis. Of the total adult cases, 8.8% were among older adults. This proportion increased over time, from 4.9% in 1982-1990 to 15.9% in 2000-2005. Among older adults, the most represented exposure category (80.8%) was sexual intercourse (heterosexual and homosexual). At AIDS diagnosis, older adults, compared to younger adults, had a higher risk of developing AIDS dementia complex or wasting syndrome, and of presenting multiple AIDS-defining illnesses. A significantly lower proportion of older adults were undergoing antiretroviral therapy, compared to younger adults. Among older adults, 67.2% were late testers, compared to 32.8% of younger adults. Most of the older adults acquired the infection through sexual contact; approximately two thirds of them were diagnosed late (i.e., first HIV-positive test 6 months or less before AIDS diagnosis); and only one fourth were undergoing antiretroviral therapy at diagnosis. These observations stress the need to more seriously consider the possibility of HIV infection among older individuals and to collect more detailed information on their sexual behavior.

Patients of all ages are prone to tooth wear and acid erosion, and diagnosing its causes such as extrinsic and intrinsic acids can prevent furter damage to teeth. The clinical appearance of erosive tooth wear, the outcomes associated with it, its pathogenesis and etiology, and the preventive measures such as limiting the use of flouride toothpastes, are discussed.

Dry mouth, also known as salivary hypofunction or xerostomia, is common among older people, has varied causes such as local salivary disorders and it can lead to oropharyngeal disorders. Correcting the causes of dry mouth and/or enhancing salivation are the main purposes of treatment, and early intervention is essential. Studies on the diagnosis, etiology, treatment and oral sequelae of dry mouth in elderly patients are reviewed.

Older adults are more prone to systemic diseases compared to other age groups, and dentists should understand how these diseases can affect their dental care. A dentist may consult their aging patient's attending physician to create a treatment plan that is appropriate to the patient's special needs. The dental health management issues concerning systemic diseases such as head and neck cancer are reviewed.

The dental problems of elderly patients like xerostomia, dental caries, periodontal diseases and loss of teeth are discussed. The role of dentists in educating patients in oral health care management is discussed.

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.

ABSTRACT Background Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 y of age in at least three continents. Choroidal neovascularization (CNV) is the process [...]

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.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.06.031 Byline: Jiska Cohen-Mansfield (a)(b), Aleksandra Parpura-Gill (a), Hava Golander (c) Keywords: Dementia; Self-identity; Roles; Adult daycare center; Nursing home; Self and informant ratings; USA Abstract: In this study, we explored perceptions of the salience of self-identity in persons suffering from dementia as perceived by the participants themselves, by family, and by staff caregivers. Four types of role-identity were explored: professional, family role, hobbies/leisure activities, and personal attributes. Participants were 104 persons with dementia, 48 of whom attended six adult day care centers while 56 resided in two nursing homes in the Washington, DC metropolitan area. Participants, relatives, and staff members were interviewed to obtain information about past and present self-identity roles of participants and attitudes toward these roles. Findings demonstrate that the importance of role identities decreases over time and with the progression of dementia. The family role was found to be the most important and salient role identity according to all the informant groups. The professional role was the one that showed the steepest decline in importance from past to present. Gender differences were detected for the importance of professional role identity. Participants rated their roles in the past as less important and those in the present as more important compared to family members. Family members reported greater decline in the importance of role identities for those participants with greater cognitive impairment. Participants with moderate cognitive impairment reported greater decline in the importance of role identities than did the participants with severe cognitive impairment. Understanding the past and present self-identities of persons with diminished cognitive abilities is crucial in the effort to provide individualized care and enhance participant experiences. Author Affiliation: (a) Research Institute on Aging of the Hebrew Home of Greater Washington, 6121 Montrose Road, Rockville, MD 20852, USA (b) Department of Health Care Sciences, George Washington University Medical Center, USA (c) Department of Nursing, Tel-Aviv University, Tel-Aviv, Israel Article Note: (footnote) [star] This study was funded by Alzheimer's Association Grant #II-99-1558.

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

Age-related macular degeneration (AMD) is a late-onset, multifactorial, neurodegenerative disease of the retina and the leading cause of irreversible vision loss in the elderly in the Western world. We describe here a murine model that combines three known AMD risk factors: advanced age, high fat cholesterol-rich (HF-C) diet, and apolipoprotein E (apoE) genotype. Eyes of aged, targeted replacement mice expressing human apoE2, apoE3, or apoE4 and maintained on a HF-C diet show apoE isoform-dependent pathologies of differential severity. ApoE4 mice are the most severely affected. They develop a constellation of changes that mimic the pathology associated with human AMD. These alterations include diffuse sub-retinal pigment epithelial deposits, drusenoid deposits, thickened Bruch's membrane, and atrophy, hypopigmentation, and hyperpigmentation of the retinal pigment epithelium. In extreme cases, apoE4 mice also develop marked choroidal neovascularization, a hallmark of exudative AMD. Neither age nor HF-C diet alone is sufficient to elicit these changes. We document choroidal neovascularization and other AMD-like ocular pathologies in an animal model that exploits known AMD risk factors. The model is additionally attractive because it is not complicated by invasive experimental intervention. Our findings in this model implicate the human apoE E4 allele as a susceptibility gene for AMD and support the hypothesis that common pathogenic mechanisms may underlie AMD and Alzheimer's disease. amyloid | choroidal neovascularization | macula | retinal pigment epithelium | cholesterol

Advanced glycation endproduct (AGE) formation is a trigger for the onset of age-related disease. To evaluate AGE-induced change in the ocular fundus, 5-mo-old C57BL/6 mice were given low-dose D-galactose (D-gal) for 8 wk and evaluated by AGE fluorescence, electroretinography (ERG), electron microscopy, and microarray analysis for 20 wk. Although AGE fluorescence was increased in D-gal-treated retinal pigment epithelium (RPE)-choroid compared with controls at all time points, ERG showed no AGE-induced functional toxicity. Progressive ultrastructural aging in the RPE-choroid was associated temporally with a transcriptional response of early inflammation, matrix expansion, and aberrant lipid processing and, later, down-regulation of energy metabolism genes, up-regulation of crystallin genes, and altered expression of cell structure genes. The overall transcriptome is similar to the generalized aging response of unrelated cell types. A subset of transcriptional changes is similar to early atherosclerosis, a chronic inflammatory disease characterized by matrix expansion and lipid deposition. These changes suggest an important contribution of a single environmental stimulus to the complex aging response. transcriptome | basal deposit | Bruch's membrane

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

We used the Temporal Exposure Response Surfaces modeling technique to examine the association between gastroenteritis-related emergency room visits and hospitalizations in the elderly and drinking water turbidity before and during [...]

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.

Social workers provide senior citizens with varied services in diverse settings and are in a position to assume leadership in slowing the spread of AIDS among this age group. Unfortunately older people often do not receive the knowledge needed to protect themselves against infection. Historically, older Americans have been largely ignored by HIV/AIDS prevention programs. The major risk behaviors among senior citizens include sexual activity without using condoms, alcohol and drug use, blood transfusions received before 1985, and misdiagnosed opportunistic illness such as Alzheimer's, Parkinson's, respiratory disease, and sexually transmitted diseases. The article discusses guidelines that can help social workers provide prevention education to older Americans. Social work's primary prevention AIDS education efforts can help older adults safely live out the rest of their lives secure in the understanding that they possess the knowledge to protect themselves from HIV/AIDS infection. Key words: education; elderly people; HIV/AIDS; primary prevention; risk, It has become increasingly apparent that social workers who provide services to elderly people (defined by the Centers for Disease Control and Prevention [CDC] as 50 years or older) must […]

The meaning of osteoarthritis symptoms for older people with this disease is discussed. While senior citizens portrayed these symptoms as a normal part of aging, they also described how much they disturbed daily life.

This article discusses the relationship between aging, disease, and genetics. An analysis of blood pressure, glucose tolerance, and geriatric research is presented.

Objective: To examine the relationship between body mass index (BMI) at age 70, weight change between age 70 and 75, and 15 y mortality. Design: Cohort study of 70-y-olds. Setting: Geriatric Medicine Department, Goteborg University, Sweden. Subjects: A total of 2628 (1225 males and 1403 females) 70-y-olds examined in 1971-1981 in Gothenburg, Sweden. Results: The relative risks (RRs) for 15 y mortality were highest in the lowest BMI quintiles of males 1.20 (95% CI 0.96-1.51) and females 1.49 (95% CI 1.14-1.96). In non-smoking males, no significant differences were observed across the quintiles for 5, 10 and 15 y mortality. In non-smoking females, the highest RR (1.58, 95% CI 1.15-2.16) for 15 y mortality was in the lowest quintile. After exclusion of first 5 y death, no excess risks were found in males for following 5 and 10y mortality across the quintiles. In females, a U-shaped relation was observed after such exclusions. BMI ranges with lowest 15y mortality were 27-29 and 25-27 kg/[m.sup.2] in non-smoking males and females, respectively. A weight loss of [greater than or equal to] 10% between age 70 and 75 meant a significantly higher risk for subsequent 5 and 10y mortality in both sexes relative to individuals with &apos;stable&apos; weights. Conclusion: Low BMI and weight loss are risk factors for mortality in the elderly and smoking habits did not significantly modify that relationship. The BMI ranges with lowest risks for 15 y mortality are relatively higher in elderly. Exclusion of early deaths from the analysis modified the weight-mortality relationship in elderly males but not in females. Sponsorship: See Acknowledgements. Descriptors: BMI; weight change; mortality; elderly European Journal of Clinical Nutrition (2001) 55, 482-492, Introduction Epidemiologic studies on relation between the body mass index (BMI) and mortality in elderly have most often described three major types--direct positive association (Calle et al, 1999), U- or [...]

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.

Aortic medial amyloid is a form of localized amyloid that occurs in virtually all individuals older than 60 years. The importance and impact of the amyloid deposits are unknown. In this study we have purified a 5.5-kDa aortic medial amyloid component, by size-exclusion chromatography and RP-HPLC, from three individuals, and we have shown by amino acid sequence analysis that the amyloid is derived from an integral proteolytic fragment of lactadherin. Lactadherin is a 364-aa glycoprotein, previously known to be expressed by mammary epithelial cells as a cell surface protein and secreted as part of the milk fat globule membrane. The multidomain protein has a C-terminal domain showing homology to blood coagulation factors V and VIII. We found that the main constituent of aortic medial amyloid is a 50-aa-long peptide, here called medin, that is positioned within the coagulation factor-like domain of lactadherin. Our result is supported by the specific labeling of aortic medial amyloid in light and electron microscopy with two rabbit antisera raised against two synthetic peptides corresponding to different parts of medin. By using in situ hybridization we have shown that lactadherin is expressed by aortic medial smooth muscle cells. Furthermore, one of the synthetic peptides forms amyloid-like fibrils in vitro. Lactadherin was not previously known to be an amyloid precursor protein or to be expressed in aortic tissue. The structure of lactadherin may implicate an important regulatory function in the aorta.

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.

Aging is associated with changes in body composition and energy and protein metabolism that are due both to the direct effects of aging and to the effect of age-related diseases. We have recently differentiated these changes under three categories: wasting, cachexia, and sarcopenia. We have defined wasting as unintentional loss of weight, including both fat and fat-free compartments. Experience in the HIV epidemic suggests that wasting is driven largely by inadequate dietary intake. Cachexia, on the other hand, refers to loss of fat-free mass, and especially body cell mass, but with little or no weight loss. The metabolic hallmarks of cachexia are hypermetabolism and hypercatabolism, driven by inflammatory cytokine-mediated acute phase responses. Finally, sarcopenia refers to loss of muscle mass specifically, and seems to be an intrinsic age-related condition. In the elderly, wasting as defined here is at the extreme end of the spectrum, but generally develops in the setting of pre-existing sarcopenia and cachexia. The challenges before us now are to better define these conditions, establish guidelines for their recognition, and develop better methods for intervening when appropriate. KEY WORDS: wasting; elderly; sarcupenia; body composition