George J. Caranasos

Medication Compliance in the Elderly

Patient compliance with physicians medication instructions has been a growing concern for nearly two decades. Elderly patients are thought to have more difficulty following prescription instructions because they generally have more medications prescribed, often suffer from cognitive decline, and frequently have physical limitations such as failing eyesight and hearing. Exhibiting a genuine concern to patients for the importance of drug therapy and adherence to directions is the first step to improve compliance. Providing adequate verbal and written medication instruction, and implementing routine assessment of medication compliance should greatly improve response to drug therapy and decrease adverse effects.

Immune Function, Autoimmunity, and Selective Immunoprophylaxis in the Aged

Many changes occur in the immune system with age. The involution of the thymus plays a major role in immune senescence. Related to this event are the altered ratio of helper to suppressor T-lymphocyte subsets, decrease in immune response by both cell-mediated and humoral branches of the immune system, and increase in autoimmune activity. The clinical implications of these changes are the elderly persons increased susceptibility to infections such as pneumococcal pneumonia, influenza A, and tetanus as well as increased autoimmune activity, reflected by pernicious anemia. Other changes may be increased susceptibility to neoplasms and perhaps acceleration of the aging process. A high index of suspicion should be present for the diagnosis of pernicious anemia in the elderly population. Knowledge of the many autoantibodies that might be present without illness is important when evaluating for disease processes. The relationship of the senescent immune system to the aging process is still unknown. Investigations of this matter, as well as of the function of immune system components and their relationship to disease processes, are continuing. Most methods proposed for enhancing the immune system are still experimental. However, immunizations have been proved to be an effective means of reducing morbidity and mortality from certain infectious diseases in the elderly. Therefore, it is strongly recommended that all elderly persons who are at risk for pneumococcal pneumonia, influenza, and tetanus receive the proper immunizations.

Effect of Dose and Ointment Application Technique on Nitroglycerin Plasma Concentrations

Each of ten non‐smoking, healthy male volunteers between the ages of 20 and 30 and within 10% of their ideal body weight received four nitroglycerin ointment (NTG‐O) treatments: ½″ NTG‐O over 3.94 in2 and 7.88 in2, and 1″ NTG‐0 over 3.94 in2 and 7.88 in2 in a randomized order. Eleven blood samples and 22 determinations of heart rate and blood pressure were obtained over each 6‐hour study period. Nitroglycerin plasma concentrations were determined by gas‐liquid chromatography with electron capture detection. Area under the nitroglycerin plasma concentration‐time curve (AUC), peak plasma concentration (Cmax), and time to peak concentration (Tmax) were determined for each study. Cmax and AUC values were corrected for the actual dose applied. Differences between AUC, Cmax and Tmax were tested using repeated measures analysis of variance. Change in surface area had no statistically significant effect on AUC, Cmax and Tmax. Mean AUC for the ½″ and 1″ doses differed (648 vs 2003 ng.ml−1 min, p = 0.016), as did Cmax (4.6 vs 12.4 ng.ml−1, p = 0.022); however, there was no correlation between individual doses and AUCs. Generally, NTG plasma concentrations within the proposed therapeutic range of 1.2–11.1 ng.ml−1 were detectable throughout each study interval. These data suggest that continuous absorption occurred throughout the 6‐hour dosing interval, that a trend toward increased AUC and Cmax occurred with the larger surface area, and that, in general, doubling the dose of NTG‐O doubles the AUC.

Alzheimer's Disease: An Annotated Bibliography of Recent Literature

In recent years, Alzheimers disease has become well known both to the medical profession and to laymen as an increasingly important cause of morbidity and mortality in the elderly. As interest in the disease has grown, so has the scientific literature. In the past four years, over 400 journal articles in the English language alone have been published on various aspects of Alzheimers disease.

Training Law Enforcement Officers to Assist the Demented Elderly

In times of crisis involving the unmanageable behavior of the elderly with Alzheimers disease or related disorders, families often request assistance from law enforcement officers who have little training specific to dealing with such emergencies. This study involves the design and implementation of such training with a sample of 78 officers. Tabulations from completed pretests (N = 63) and posttests (N = 58) examined with Students t tests showed an overall significant difference (p = .001) between the pretest and posttest means. Also, the training was evaluated as excellent/good and helpful and was well received These findings indicate that training for law enforcement officers can result in significant, useful learning for handling emergencies with the demented elderly.

Biblical Quotes on Growing Old

home care and broadly based competency, forces cohere to shape geriatrics into a traditional specialty. A truism holds that form should follow function. Those of us involved in geriatric medicine recognize that caring for older persons is really different from caring for younger persons. Additional skills and sensitivities are required. Furthermore, geriatrics evoke a different kind of care model than that generally espoused by the traditional medical specialties. Geriatric medicine means continuity of care, not episodic fragmented consultations. Geriatric medicine means emphasis on maintenance of functional status rather than diagnosis of disease category. Geriatric medicine means health care as an integrated whole in which many care givers participate. For these special qualities special training programs should be planned. As one would not expect a cardiac surgical resident to succeed without a great deal of operating room experience, it is equally valid to expect that someone pursuing a career in geriatrics would have a primary base in the community, and not in the intensive care unit, or research laboratory, or even in the nursing home where only a small fraction of health care of