Geriatric depression.

In late life, depression is the most prevalent functional psychiatric disorder. Because the presentation may be multicausal and clinically complex, early assessment of biologic and psychosocial factors, diagnosis, and appropriate referral are important in ameliorating the associated morbidity and mortality. Nurses must have current knowledge and skills to assess mood states of elderly persons and to implement appropriate interventions. Successful management of depression in the elderly results in a reformulation of purpose and an enhanced quality of life.

Chemotherapy: how safe for the caregiver?

Antineoplastic drugs are routinely administered by nurses in the home setting. The potential for nurse occupational exposure to these drugs is increased by an inadequate understanding of the risks inherent in administering these agents. This article addresses issues related to safe administration of these drugs in a home environment.

Older women. Sexually transmitted diseases and acquired immunodeficiency syndrome.

Increasingly, American women aged 50 and over are afflicted with sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS). In order to meet the US Public Health Services' Health Objective for the Year 2000, health care workers must address the issues that impact on the older woman's ability to protect herself and others from these highly stigmatized diseases. Nurses must be aware of the potential for STDs and AIDS in this population and appropriately refer individuals for screening and follow-up care. Older women must be empowered economically, legally, and politically so they can assume an assertive role in their own health promotion. Cultural and societal barriers need to be overcome to change stereotypic attitudes about older women's sexuality. Only then can access to health information, health care, and research be assured.

Left ventricular shape-luminal pressure relationship. An open-chest study.

Left ventricular dimensions were measured in Cd2+ arrested (presumably diastolic), open-chest rats. Aortic pressure was maintained at 137 cm H2O (100 mm Hg) and left-ventricular (luminal) pressures were established and maintained at their chosen values, each by means of reservoir systems. The selected left-ventricular pressures were chosen to be within or to even broaden the range of conceivable diastolic pressures (-3 to 48 cm H2O). After in situ fixation with 4% formaldehyde and gelatin embedding, the hearts were serially sectioned in the apex base direction to obtain information at 11 levels (10, 20, . . . 90, 100%). Tracings of selected sections were made along the edge of the left ventricular lumen and the pericardial surface. Volumes, surface areas, and mean external and internal radii of the left ventricle were derived. To quantify the circularity of sections a form factor (FF) was introduced (FF = 1 for a circular cross-section and less than one for other shapes). Ventricular lengths, radial dimensions, endocardial and epicardial surface areas, and total and luminal volumes increased with the increasing intraventricular pressures; as expected, the wall simultaneously thinned. Though its appearance was altered by the wall thinning, the curving muscle fascicular pattern was present over the entire pressure range examined. Endocardial surface areas increased more than did the epicardial surface areas. The endocardial FF value increased (more circular) at each section level as the pressure increased. The epicardial FF relationship was apparently constant (0.798 +/- 0.014) for all section levels from 10% through 90%, regardless of luminal pressure. These results, when taken in conjunction with the results of our previous published studies, prompted the following speculation. The wall of the diastolic ventricle is a fluid-filled chamber with intramyocardial pressures that may be higher than ventricular pressures.

The Apgar score: evolution, limitations, and scoring guidelines.

The Apgar score has been useful for nearly four decades in focusing on five physiological signs (heart rate, respiratory effort, reflex irritability, muscle tone, color) that denote the condition of an infant during the first critical minutes of life. Before the development of the system, narcotic analgesia and sedation during labor, and general anesthesia for vaginal deliveries were commonly used. Research of the scoring method has focused on the effects of these interventions on the fetus and newborn and has been a major impetus for change in obstetric practices. The Apgar score has been used as a predictive index for neonatal mortality and morbidity and for later neurologic or developmental disability. Both the one- and five-minute scores are predictors of mortality in normal-birthweight infants, whereas in high-risk low-birthweight infants their score is limited. The score is an insensitive predictive index of long-term neurologic or mental handicap, and lacks both sensitivity and specificity to reflect accurately the degree of acidosis. It can be used effectively, however, if these limitations are understood and considered.

The relationship between critical power and the onset of blood lactate accumulation.

The purpose of this investigation was to determine the contribution of the onset of blood lactate accumulation (OBLA), the heartrate-workload slope (HR-WL) and the efficiency of electrical activity (EEA = slope of IEMG vs. workload) of the leg extensor muscles to Critical Power (CP). Twelve adult males (mean age +/- SD = 24.5 +/- 2.8 yrs) volunteered as subjects for this study. Zero-order correlations indicated that OBLA was significantly (p less than 0.05) related to CP (r = 0.616) and EEA (r = -0.577). Stepwise multiple regression resulted in a one variable model with OBLA the only significant (p less than 0.05) predictor of CP. Furthermore, a related t-test resulted in a significant difference between the means of the power out-put at CP (mean +/- SD = 230.0 +/- 22.1 watts) and OBLA (179.6 +/- 31.8 watts). The results of this study indicated that the two threshold parameters, CP and OBLA, were significantly related and therefore it is likely that the physiological factors responsible for OBLA also influence CP. However, the significant mean differences indicated that the mechanisms which underly CP and OBLA were not identical. Furthermore, the HR-WL slope (mean +/- SD = 0.343 +/- 0.071 beats per watt) and EEA (0.969 +/- 0.572 microvolts per watt) were not potent predictors of CP.

Sexually transmitted diseases in the elderly--issues and recommendations.

The incidence of sexually transmitted disease (STD) in the elderly population is significant for both newly acquired disease and for residual complications from preceding infections. Every health-care practitioner needs to assume responsibility for the primary prevention of STDs, which focuses on avoiding infection. Primary health education is imperative in the presence of an escalation of sexually transmitted infection for which there is no known curative therapy. The sexual history is an integral component of the routine data base for all geriatric patients. Diagnosis of AIDS in the generally low risk elderly population may be unexpected. Health-care practitioners must be aware of its many forms of presentation.

The AIDS pandemic: a nursing model.

The pandemic of acquired immunodeficiency syndrome (AIDS) calls for global cooperation to develop strategies for interventions both to prevent the disease and to care for persons with it. The conceptual framework "Health for all: A model for nursing's contributions" provides guidance for the processes of assessment, diagnosis, planning, implementation of care, and evaluation of mortality and morbidity related to AIDS. The disease challenges the biologic, sociologic, medical-technical, and environmental determinants as they affect health. Specific recommendations for health care interventions are relevant to each determinate, with community health status as the focus.

Estimating physical working capacity and training changes in the elderly at the fatigue threshold (PWCft).

The test for estimating physical working capacity at the fatigue threshold (PWCft), previously validated for young men, was evaluated for use with elderly men and women. A sample of 27 volunteer subjects (67.6 +/- 5.6 years, 11 male, 16 female) was divided into three matched groups: (1) controls (n = 10), (2) low intensity (70% PWCft) training group (n = 10) and (3) high intensity (85% PWCft) training group (n = 7). The subjects were tested for PWCft before and after 10 weeks of exercise training on cycle ergometers (30 min/day, 3 days/week). Controls did not exercise but met once a week for a health lecture. No significant pre-test to post-test change was noted in the mean PWCft of the control group (78.8-78.5 W); low intensity training resulted in 29.8% improvement in PWCft (81.0 to 105.0 W); and the high intensity group realized an improvement of 38.4% (83.6-115.7 W). One-way ANOVA indicated that the gains made by each of the groups were significantly different (p less than 0.01). Post hoc analysis revealed that the gains made by each exercise training group were significantly greater than controls (p less than 0.05) with no significant difference between high and low intensity groups. Reproducibility of the PWCft was excellent (R = 0.976). Since RPE averaged 14.2 at PWCft and 64% of subjects provided useful data, this test appears to be useful for evaluating the fitness of the elderly.

Physical fitness in the elderly.

Through disuse and aging, many muscles and joints in the elderly lose their flexibility and range of motion. A flexibility testing bench and a stretch bench were designed for measuring flexibility and supporting a variety of exercises to combat inelasticity. Flexibility is an essential component of physical fitness, regardless of age, and fitness programs must be adapted to meet the needs of the elderly.