Nancy Weintraub

Development and Validation of a Geriatrics Attitudes Scale for Primary Care Residents

OBJECTIVE: To develop and validate an instrument measuring attitudes toward older persons and caring for older patients.

Apathy: a common psychiatric syndrome in the elderly.

Apathy, or a lack of motivation, has been increasingly recognized as a distinct psychiatric syndrome. Apathy is primarily a dysfunction of the frontal-subcortical circuit and is associated with various neuropsychiatric disorders including Alzheimers disease. Apathy is associated with a number of adverse outcomes, including apparent cognitive impairment, decreased daily function, poor insight into ones own functional and cognitive impairment, and poor outcome from rehabilitation treatment. Furthermore, the degree of caregivers burden in these patients is significant. This article reviews the definition of apathy, prevalence and associated adverse outcomes, causation, the approach to patients with apathy, and available treatment options with particular attention to studies conducted in a nursing home setting. The purpose of this article is to increase the recognition of apathy by physicians working in the nursing home.

Nonsurgical Treatment for Rotator Cuff Injury in the Elderly

Shoulder pain is a common musculoskeletal complaint in the general population. The elderly population is often afflicted, and rotator cuff problems are among the most common causes of shoulder pain seen in primary care practices. The prevalence of shoulder pain in the elderly has been estimated to range from 21% to 27%, and the prevalence of rotator cuff tear increases with advanced age. The etiology of rotator cuff disease is likely multifactorial, including both extrinsic and intrinsic factors. Rotator cuff dysfunction encompasses a spectrum of pathological changes, ranging from impingement syndrome to rotator cuff tendonitis to rotator cuff tendon tear. In the elderly population, the clinical manifestations from rotator cuff dysfunction can translate into significant morbidity and disabilities, interfering with ability for self care and functional independence. The goals of managing rotator cuff disease are to regain normal shoulder function and biomechanics, and to improve functional abilities in elderly patients. Treatment can consist of various conservative therapies (including ice, simple exercises, medications), and progress to more intensive physical therapy and/or corticosteroid injections. Rotator cuff dysfunction is a common musculoskeletal disorder in elderly patients and is often underdiagnosed and undertreated. Physicians should be aware of the prevalence of rotator cuff disease in this population and provide early diagnosis and treatment to help preserve the functional ability and independence of older patients.

Development and Validation of a Geriatrics Knowledge Test for Primary Care Residents

This study reports the development and preliminary validation of an instrument to measure geriatrics knowledge of primary care residents. A 23-item test was developed using questions selected from the American Geriatrics Societys Geriatrics Review Syllabus. Ninety-six internal medicine and family practice residents, 14 geriatrics fellows, and 11 geriatrics faculty members participated in the study. Findings support the reliability (Cronbachs α=0.66) and validity (content and “known groups”) of this short test. Predictive validity and sensitivity of the test to changes in knowledge will have to be further explored as residents progress through their training.

Pernicious Anemia in the Demented Patient Without Anemia or Macrocytosis: A Case for Early Recognition

It is well known that the neurologic manifestations of vitamin B12 deficiency can occur in the absence of anemia. The authors recently observed two elderly patients who presented to a chronic care institution with the diagnosis of dementia, and in both individuals low serum B12 levels were found in conjunction with abnormal Schilling tests. In neither of these two patients was there anemia or macrocytosis. After receiving parenteral B12 injections there was improvement noted in cognitive functions as well as in activities of daily living. The authors are reporting these patients to alert clinicians to the fact that pernicious anemia in the elderly can first present with low serum B12 levels and neurologic abnormalities in the absence of anemia or macrocytosis.

Do SSRIs Play a Role in Decreasing Bone Mineral Density

Osteoporosis is expected to increase as our population pyramid shifts toward old age. It is associated with increased risk of fractures, leading to complications of limitation of ambulation, loss of independence, and chronic pain. Depression is also a common occurrence in the elderly population. Currently, up to 35% of residents in long term care may experience either major depression or clinically significant depressive symptoms. Selective serotonin receptor inhibitors constitute 62% of all antidepressant drug prescribing. Recently, serotonin transporters have been described in bone, raising the question of whether medications that block serotonin reuptake could affect bone metabolism and ultimately affect osteoporosis-related fractures. Current evidence suggests that depression, particularly in the setting of selective serotonin receptor inhibitors use, should be considered as an addition to the list of risk factors prompting clinicians to evaluate bone health status.

The Use, Benefits, and Costs of Cholinesterase Inhibitors for Alzheimer's Dementia in Long-Term Care: Are the Data Relevant and Available?

Alzheimer’s disease (AD) is a progressive dementia that affects memory and other cognitive domains, and that is often associated with behavioral and functional problems. The most common dementing disorder, AD affects an estimated 4 million people in the United States. Approximately 6% to 8% of all persons older than 65 years have AD, and the prevalence of the disease nearly doubles every 5 years after the age of 60 such that over 40% of all persons older than 85 years could have AD. As the population ages, epidemiologists predict there will be 14 million persons with AD by the year 2040. The economic costs associated with AD are high, and nursing home expenses account for a significant portion of AD costs. Estimates of the cost to society of AD indicate that annual direct and indirect costs could be as high as

Current Controversies in Endocrinology: Screening of Asymptomatic Elderly for Subclinical Hypothyroidism

100 billion, making AD third after cancer and coronary heart disease in terms of total costs to society. Dementia is one of the most common diagnoses in nursing homes because it could occur in over 50% of these patients. Institutionalized patients with AD tend to have more comorbidities, more functional deficits, and more behavioral problems than community-dwelling patients with AD. In the first part of this article, we provide an overview of the evidence for the clinical benefits of cholinesterase inhibitor therapy in the general population of patients with AD across cognitive, behavioral, and functional domains. In the second part, we provide an overview of economic studies, with an emphasis on the relevance and applicability to longterm care. We examine the efficacy of the three main currently used cholinesterase inhibitors: donepezil, galantamine, and rivastigmine.

The Prevention for Elderly Persons (PEP) Program: A Model of Municipal and Academic Partnership to Meet the Needs of Older Persons for Preventive Services

Thyroid disorders are common in elderly patients. In fact, the most common form of thyroid dysfunction in the elderly is subclinical hypothyroidism. Subclinical hypothyroidism is a biochemical state characterized by an increased serum thyroid-stimulating hormone and normal levels of serum-free T4 and free T3. Much attention has been focused on this clinical entity recently, but it remains controversial whether early thyroid replacement therapy improves outcomes in elderly patients with asymptomatic subclinical hypothyroidism. There is a dearth of critical evidence on the effects of subclinical hypothyroidism on target tissues, the natural history of early thyroid dysfunction, and the net benefits and harms of long-term treatment with thyroid hormones. This article reviews the available information on the aging thyroid gland, subclinical hypothyroidism, and issues concerning treatment in asymptomatic elderly patients.

Development and Validation of a Geriatrics Knowledge Test to Evaluate Geriatrics Fellowship Programs

OBJECTIVE: To create a program to identify preventive needs for community‐dwelling older persons and incorporate intervention strategies to improve implementation of these services.