The elderly may have multiple problems including diabetes mellitus and pneumonia. This study was undertaken to evaluate the effect of hyperglycemia on the length of stay (LOS) and mortality of elderly veterans admitted for pneumonia. Forty-seven and forty-eight patients over the age of 60 admitted for the diagnosis of pneumonia at the Lexington, Kentucky and Iron Mountain, Michigan VAMC's respectively were evaluated. The mean age at Lexington was 72 and at Iron Mountain was 73.9. At Lexington the mean LOS was 39.5 days with a standard deviation of 9.2 for those with hyperglycemia (n = 18) and 16.5 days with a standard deviation of 2.5 for those without hyperglycemia (n = 29). At Iron Mountain the mean LOS was 21.5 days with a standard deviation of 3.3 for those with hyperglycemia (n = 10) and 13.6 days with a standard deviation of 1.2 for those without (n = 38). These differences were significant at p less than .01 using the 2-sample independent t-test. At Iron Mountain 5 of 38 (13%) of the patients with normoglycemia died during the hospital stay compared to 3 of 10 (30%) those with hyperglycemia. For Lexington the figures were 4 of 29 (13%) and 6 of 18 (33%) respectively. These differences were significant at p less than .05. Age did not have any significant effect on either mortality or length of stay. Hyperglycemia appears to be a significant predictor of a longer hospital course and increased mortality in elderly veterans hospitalized for pneumonia.

A social and clinical evaluation was performed on thirty Kentucky centenarians. The majority of the subjects were women (19/30), white (27/30), either widows or widowers (26/30), and lived in long term care facilities (15/30). Only one of thirty had ever smoked cigarettes and there was an absence of excessive alcohol use. Medication use varied from 0 to 9 medications. Digitalis, diuretics, and anti-inflammatory medications were common (12; 16; 15 respectively) while major and minor tranquilizers were less frequently used (7 and 4). Hypertension was present in 48%. Although rarely functionally significant, clinically evident cardiac disease was present in 38%. Ninety-three percent lacked vibratory sensation at the ankles while ankle jerks were absent in 82%. Functionally significant diminished vision and hearing were frequent (40% and 60% respectively). Functional assessment demonstrated moderate to nearly complete independence in 57%, while the remaining 43% were significantly to nearly totally dependent on others. The primary conclusion is that for all they have in common, centenarians remain unique individuals with a tremendous variability among themselves.

Over 50% of cancer deaths occur in persons aged over 65 years, but because of presumed increased toxicity of chemotherapeutic agents in the elderly, they are frequently treated with reduced doses. However, a review of the literature suggests that chronological age alone does not account for increased toxicity in the elderly. If changes in physiological function, the presence of other illness, and the use of concomitant drugs are taken into consideration, chemotherapy can be used safely and effectively in the elderly. However, this knowledge must be used with the understanding that while response rates are not lower in the elderly, the cancers most commonly encountered are notoriously unresponsive to chemotherapy. Thus, a strategy to use chemotherapy safely and effectively in the elderly involves careful selection of those cancers to be treated, full assessment of the patient's physiological functions, and a knowledge of the adverse effects of the individual agents used. Finally, the use of a limited treatment plan and an understanding of the principles of symptom relief can help optimise treatment throughout the course of the cancer.

Two cases of type A botulism in elderly patients are presented, followed by an overview of the disease. Typical features demonstrated by these patients included home food preservation, multiple cases, and early GI tract symptoms followed by diplopia, ptosis, generalized weakness, and respiratory impairment while sensation and deep tendon reflexes remained intact. Fatal outcomes are more likely in the elderly. The CDC should be contacted early in cases of suspected botulism.