Howard M. Waxman

Depressive Symptoms and Health Service Utilization among the Community Elderly

The relationship between depression and complaints of physical disease in the elderly is often discussed but has received little documentation. The authors administered questionnaires to 88 elderly volunteers to assess two common psychologic diagnoses, affective disorders and organic brain syndrome, and three common cardiovascular symptoms, pain or numbness in the jaw or arm, pressure in the chest, and difficulty in breathing. Data on utilization of health care professionals and demographic information were also obtained. A significant correlation between reports of depression and complaints of cardiovascular symptoms was seen. While the volunteers with depressive symptoms also visited their physicians more often than did the other volunteers, they did not seek the help of mental health professionals. This raises the larger issue that elderly persons who have mild to moderate depression present to our health care system.

Geriatric Psychiatry in the Emergency Department: Characteristics of Geriatric and Non-geriatric Admissions

A study was made of the Emergency Department records of 49 elderly (65 years old or older) and 49 middle‐aged (40–64 years old) patients seen in an urban hospitals psychiatric emergency service. The data were compared for demographic and admission information, psychiatric treatment history, presenting complaints, symptoms, diagnoses, and final disposition status. For the elderly patients, the referral was more likely to be their first contact with psychiatric treatment, and they were more likely to be referred (accompanied) by family or friends than to be self‐referred. Among the middle‐aged patients, “substance abuse” (e.g., drugs, alcohol) disorders and schizophrenic disorders were more common. The elderly, however, were much more likely to be regarded as having an organic brain syndrome of unspecified cause (34.7 per cent vs 0). Access to treatment was fairly consistent for both groups as measured by the hospitals priority code, total time spent in the emergency department, and final disposition. These results raise important issues concerning the unique psychosocial characteristics and psychiatric treatment needs of elderly patients. This applies particularly to the emergency‐department medical clearance of elderly patients with symptoms of organic brain syndrome.

Withdrawing feeding and withholding artificial nutrition from severely demented patients. Interviews with caregivers

Withdrawing feeding and withholding artificial nutrition from severely demented patients. Interviews with caregivers

Conflicting Attitudes Toward Euthanasia for Severely Demented Patients of Health Care Professionals in Sweden

This survey study of 1,798 Swedish health care workers in 31 acute and chronic institutional settings found considerable disagreement between staff concerning euthanasia. For example, attitudes of aides and LPNs, were significantly (χ2 = 42.0, P < .0001) more favorable toward active euthanasia (38.9% of aides and 28.8% of LPNs were neutral or approved) than were RNs and physicians (20% and 14.9%). This disagreement was most apparent among those staff in institutions with many demented patients. Favorable attitudes were also more frequent among aides experiencing job dissatisfaction and “burnout,” younger staff, and those without a relative in long‐term care. Possible reasons for favorable attitudes toward active euthanasia and staff attitude polarization are discussed along with implications for patient care.

Geriatric Psychiatry in the Emergency Department, II: Evaluation and Treatment of Geriatric and Nongeriatric Admissions

The records of a hospital psychiatric emergency department were reviewed for elderly and middle‐aged patients who were diagnosed with organic brain syndrome (OBS) or psychiatric disorder. These records were then compared with those of elderly patients from the medical emergency department. While elderly medical patients received routine physical evaluations and laboratory testing, elderly psychiatric patients with behavioral symptoms were often referred to psychiatry before they received tests necessary to differentiate physical disorders from functional psychiatric disorders. When tests were administered to psychiatric patients, many abnormal results were apparent, indicating the possible presence of physical disease. It is recommended that all elderly patients with psychiatric symptoms undergo adequate medical evaluations to screen for physical causes of the psychiatric symptoms.

Biochemical and behavioral changes in rats during and after chronic d-amphetamine exposure

Two groups of rats were implanted with ALZET minipumps to deliver vehicle or a theoretical amount of 1 mg/kg per h of d-amphetamine (A) for 12 days. After 3 days of A-exposure, motor movements and stereotypic behavior were markedly increased. Subsequent testing during A-exposure showed that motor movements and stereotypic behavior remained significantly increased but declined. After removal of the pumps, these effects disappeared and no differences at rest, during stress or A challenge, were apparent in either group. Animals sacrificed after 3 days of drug exposure, showed a drastic decrease in cardiac, but not adrenal, catecholamine levels. In the brain, norepinephrine (NE) levels were markedly decreased in the frontal cortex, hypothalamus, caudate, pons-medulla and cerebellum. Epinephrine (E) levels were unaffected and dopamine (DA) levels were decreased in most areas without reaching statistical significance. Plasma corticosterone levels were similar in both groups. Animals in both groups sacrificed about 25 days after pump removal were biochemically similar. Under our conditions, A-exposure produced marked behavioral and biochemical changes but there was no evidence of residual abnormalities after cessation of drug treatment.

Wish to transfer to other jobs among long-term care workers

This study is based on questionnaires that were sent to the homes of health care personnel working in geriatric care (N = 583) and acute care (N = 328). The purpose was to investigate differences between these groups of personnel regarding job assignment, intention to transfer to another job, attitudes towards demented patients, and the experience of burnout. The results showed that more persons working in acute care were self-assigned to their jobs than those working in geriatric care. More persons in geriatric care stated a wish to transfer to another job in the health care field than those in acute care. The personnel who constantly work with demented patients showed the most positive attitudes towards this group of patients. A larger proportion of personnel with high burnout scores wanted to transfer to another job, compared to those with low burnout scores. (Aging 3: 247–256, 1991)

Withdrawing Feeding and Withholding Artificialt Nutrition from Severely Dementeda Patients

Withdrawing feeding and withholding artificial nutrition from severely demented patients. Interviews with caregivers