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Biomedical subjects

A N Clark

Publications and source records attributed to A N Clark.

14 recordsLinked to original sources
PubMed1979

d-Amphetamine in elderly patients refractory to rehabilitation procedures.

This report concerns the use of d-amphetamine in 88 elderly inpatients who initially failed to respond to rehabilitation procedures. These patients exhibited characteristics of the Poor Motivation Syndrome (PMS), not associated with depression or dementia. The syndrome was seen five times more frequently in women. d-Amphetamine was given for three weeks in increasing dosage (2.5--10.0 mg twice daily). The responses were scored according to mobility, self-care and motivation. Of the 88 patients, 48 improved and another 28 were discharged who would otherwise have remained dependent nursing cases. An unexpected finding was that 17 patients showed an age-related resistance to the effects of the drug (P less than 0.05). The likelihood of a beneficial response also diminished with increasing age (P less than 0.01). Side effects were in the psychiatric sphere; they occurred in 23 patients early in treatment and were not age-related; the drug was withdrawn. Thus treatment with d-amphetamine should be restricted to selected patients who satisfy the diagnostic criteria of PMS, and administration should be carefully supervised. With these safeguards, a substantial proportion of patients previously refractory to rehabilitation will show improvement, become more independent and may be discharged from the hospital in a much more active, less dependent state of mine and body.

Activities of Daily Living↗
PubMed1977

Klinefelter syndrome in the aged.

Three cases of Klinefelter syndrome diagnosed late in life are reported with the clinical and post-mortem findings. The diagnosis was suspected owing to the absence of testes and the presence of associated varied clinical features. The urinary follicle-stimulating hormone levels were not elevated and were very low in two of the cases. Bronchopneumonia, ascending pyelonephritis and cystitis were the main causes of death but there were varied pathological findings in the prostate of benign hyperplasia, carcinoma and prepubertal gland. Marked atherosclerosis of the aorta and the lower-limb vessels were present but the coronary systems were little affected. It is suggested that, because of the presence of two X chromosomes and the absence of testes, this condition may give a female pattern of longevity, many examples being overlooked in old age on account of inadequate clinical examination. Some support for this hypothesis will be found if its incidence in the aged is shown to be greater than in the young.

Aged↗
PubMed1977

Multifocal atrial tachycardia (MAT). The misdiagnosed atrial arrhythmia of old age.

The clinical and electrocardiographic features of multifocal atrial tachycardia are described and illustrated by nine examples. It is almost entirely seen in later life and is often misdiagnosed as atrial fibrillation. It is associated with a high mortality and the majority of the cases described here reverted to sinus rhythm. Little attention has been so far paid to this important arrhythmia in the elderly in standard textbooks of cardiology. The literature is reviewed and management discussed. It is not a rare supreventricular tachycardia in the aged and many examples may be not diagnosed. It merits further study in relation to unanswered questions.

Aged↗
PubMed1976

Molar dosage.

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Calcium Chloride↗
PubMed1976

Wheat bran in dyschezia in the aged.

A trial of wheat bran added to the diet of aged dyschezic hospital patients (12 men, 13 women) is reported. This significantly reduced the need for aperients and suppositories but revealed unexpected differences in response by sex. In men, bran produced more bowel actions, fewer constipated days and an increase in stool size. In women there was much less effect upon the number of bowel actions and reduction of constipated days. In men there were fewer constipated days and need for aperients after the bran was withdrawn. Side-effects were only seen in men. Most patients received 15 g/day (range 5-25 g/day). Although cheap and effective in replacing aperients, there were problems in administration and control of incontinence for the nursing staff. The value of added wheat bran in the bowel management of the long-stay hospital patient is discussed and an effective method of combining bran in the diet (e.g. with bread) might be further investigated.

Aged↗
PubMed1975

SI units.

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Attitude of Health Personnel↗
PubMed1975

Diogenes syndrome. A clinical study of gross neglect in old age.

A study of elderly patients (fourteen men, sixteen women) who were admitted to hospital with acute illness and extreme self-neglect revealed common features which might be called Diogenes syndrome. All had dirty, untidy homes and a filthy personal appearance about which they showed no shame. Hoarding of rubbish (syllogomania) was sometimes seen. All except two lived alone, but poverty and poor housing standards were not a serious problem. All were known to the social-services departments and a third had persistently refused offers of help. An acute presentation with falls or collapse was common, and several physical diagnoses could be made. Multiple deficiency states were found--including iron, folate, vitamin B12, vitamin C, calcium and vitamin D, serum proteins and albumin, water, and potassium. The mortality, especially for women, was high (46%); most of the survivors responded well and were discharged. Half showed no evidence of psychiatric disorder and possessed higher than average intelligence. Many had led successful professional and business lives, with good family backgrounds and upbringing. Personality characteristics showed them to tend to be aloff, suspicious, emotionally labile, aggressive, group-dependent, and reality-distorting individuals. It is suggested that this syndrome may be a reaction late in life to stress in a certain type of personality.

Age Factors↗
PubMed1975

Cardiac effects of carotid sinus massage in old age.

The effects of carotid sinus massage in aged subjects with a high incidence of arteriosclerosis are described. In 71 men and 315 women tested, a slowing of more than 10 per cent of the heart rate was found in 25 per cent of the men and 19 per cent of the women, which is not of statistical significance in relation to sex. Only men showed a significant increase with age and the women had a significant preponderance of a right-sided response. The technique was found to be safe, although a review of reported side-effects suggests care is advisable and carotid compression must not occur. The findings are discussed in relation to those reported in younger subjects and in carotid sinus syndrome with syncope. The fact that men have an acquired increase in response in old age, which is not seen in women, may be a factor of importance in the explanation of why carotid sinus syncope is almost always seen in men. Carotid sinus sensitivity appears to diminish in old age and some of the ageing factors which might influence the carotid sinus reflex are examined.

Age Factors↗