Background:Deathbed wills by their nature are susceptible to challenge. Clinicians are frequently invited to give expert opinion about a dying testator's testamentary capacity and/or vulnerability to undue influence either contemporaneously, when the will is made, or retrospectively upon a subsequent challenge, yet there is minimal discourse in this area to assist practice.Methods:The IPA Capacity Taskforce explored the issue of deathbed wills to provide clinicians with an approach to the assessment of testamentary capacity at the end of life. A systematic review searching PubMed and Medline using the terms: "deathbed and wills," "deathbed and testamentary capacity," and "dying and testamentary capacity" yielded one English-language paper. A search of the individual terms "testamentary capacity" and "deathbed" yielded one additional relevant paper. A focused selective review was conducted using these papers and related terms such as "delirium and palliative care." We present two cases to illustrate the key issues here.Results:Dying testators are vulnerable to delirium and other physical and psychological comorbidities. Delirium, highly prevalent amongst terminal patients and manifesting as either a hyperactive or hypoactive state, is commonly missed and poorly documented. Whether the person has testamentary capacity depends on whether they satisfy the Banks v Goodfellow legal criteria and whether they are free from undue influence. Regardless of the clinical diagnosis, the ultimate question is can the testator execute a specific will with due consideration to its complexity and the person's circumstances?Conclusions:Dual ethical principles of promoting autonomy of older people with mental disorders whilst protecting them against abuse and exploitation are at stake here. To date, there has been scant discourse in the scientific literature regarding this issue.

Background: As people live longer, there is increasing potential for mental disorders to interfere with testamentary distribution and render older people more vulnerable to "undue influence" when they are making a will. Accordingly, clinicians dealing with the mental disorders of older people will be called upon increasingly to advise the courts about a person's vulnerability to undue influence.Method: A Subcommittee of the IPA Task Force on Testamentary Capacity and Undue Influence undertook to establish consensus on the definition of undue influence and the provision of guidelines for expert assessment of risk factors for undue influence.Results: International jurisdictions differ in their approach to the notion of undue influence. Despite differences in legal systems, from a clinical perspective, the subcommittee identified some common "red flags" which might alert the expert to risk of undue influence. These include: (i) social or environmental risk factors such as dependency, isolation, family conflict and recent bereavement; (ii) psychological and physical risk factors such as physical disability, deathbed wills, sexual bargaining, personality disorders, substance abuse and mental disorders including dementia, delirium, mood and paranoid disorders; and (iii) legal risk factors such as unnatural provisions in a will, or provisions not in keeping with previous wishes of the person making the will, and the instigation or procurement of a will by a beneficiary.Conclusion: This review provides some guidance for experts who are requested by the courts to provide an opinion on the risk of undue influence. Whilst international jurisdictions require different thresholds of proof for a finding of undue influence, there is good international consensus on the clinical indicators for the concept.

In infants, vaccines consisting of a carrier protein conjugated to the bacterial capsular polysaccharide (PRP) are far more protective against Hemophilus influenzae type b (Hib) disease than unconjugated PRP. To determine the tolerability and immunogenicity of Hib conjugate vaccines in the elderly, we vaccinated 30 volunteers, aged 69–84 years, with either PRP conjugated to an outer membrane protein complex (PRP-OMP), or PRP oligomers conjugated to CRM197, a nontoxic, mutant diphtheria toxin (HbOC). Prior to vaccination, 40% of subjects had serum anti-PRP antibody levels <1.0 μg ml−1. Four weeks following vaccination, all subjects had concentrations >1.0 μg ml−1, a level generally considered to be protective. The post-vaccination geometric mean concentrations were 35.5 and 50.1 μg ml−1 for the PRP-OMP and HbOC groups, respectively (0.05

The clinical and biological features of Alzheimer disease are not uniform in their expression; heterogeneity is evident in the disease's clinical, anatomic, and physiologic characteristics. The presence of considerable intersubject and intrasubject heterogeneity suggests that subtypes of the disease exist. We define subtypes of Alzheimer disease in regard to the behavioral features (for example, predominant right or left hemisphere, or symmetrical impairment), inheritance (familial or sporadic), dosage of chromosome 21 (presence of the Down syndrome), time course of progression, age of onset (presenile or senile), and presence or absence of motor deficit (myoclonus or signs of an extrapyramidal syndrome). Studies of regional cerebral glucose metabolism with positron emission tomography and [18-fluorine] fluorodeoxyglucose show focal alterations in glucose use, with cerebral metabolic asymmetries in patients with Alzheimer disease that are related to the nature of the cognitive deficit. Serial roentgenographic computed tomographic studies show heterogeneous rates of lateral ventricle enlargement in the disease that are related to rates of cognitive decline. Similar anatomic and physiologic abnormalities are also found in persons 45 years of age or older who have the Down syndrome. Furthermore, patients with Alzheimer disease who have extrapyramidal dysfunction or myoclonus are a distinct subgroup, with specific abnormalities of central monoamine markers of dopamine metabolism, serotonin metabolism, and the hydroxylation cofactor, biopterin. The concept of subtypes in Alzheimer disease serves as a model with which the interactions of genetic influences with environmental factors can be examined.

Journal of the American Geriatrics SocietyVolume 32, Issue 7 p. 546-547 Reversible Long-standing Dementia with Normocalcemic Hyperparathyroidism Jay Luxenberg MD, Jay Luxenberg MD Mount Zion Hospital and Medical Center, San Francisco, California. Fellow in Geriatric Medicine, Mount Zion Hospital and Medical Center, San Francisco, California; Clinical Instructor of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.Search for more papers by this authorLawrence Z. Feigenbaum MD, Corresponding Author Lawrence Z. Feigenbaum MD Mount Zion Hospital and Medical Center, San Francisco, California. Associate Chief of Medicine, Medical Training Director, Geriatric Services, Mount Zion Hospital and Medical Center; Clinical Professor of Medicine, University of California, San Francisco, School of Medicine.Associate Chief of Medicine, Medical Training Director, Mount Zion Hospital and Medical Center, Post Office Box 7921, San Francisco, CA 94120.Search for more papers by this authorJeffrey M. Aron MD, Jeffrey M. Aron MD Mount Zion Hospital and Medical Center, San Francisco, California. Associate Chief of Medicine, Mount Zion Hospital and Medical Center; Assistant Clinical Professor of Medicine, University of California, San Francisco, School of Medicine.Search for more papers by this author Jay Luxenberg MD, Jay Luxenberg MD Mount Zion Hospital and Medical Center, San Francisco, California. Fellow in Geriatric Medicine, Mount Zion Hospital and Medical Center, San Francisco, California; Clinical Instructor of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.Search for more papers by this authorLawrence Z. Feigenbaum MD, Corresponding Author Lawrence Z. Feigenbaum MD Mount Zion Hospital and Medical Center, San Francisco, California. Associate Chief of Medicine, Medical Training Director, Geriatric Services, Mount Zion Hospital and Medical Center; Clinical Professor of Medicine, University of California, San Francisco, School of Medicine.Associate Chief of Medicine, Medical Training Director, Mount Zion Hospital and Medical Center, Post Office Box 7921, San Francisco, CA 94120.Search for more papers by this authorJeffrey M. Aron MD, Jeffrey M. Aron MD Mount Zion Hospital and Medical Center, San Francisco, California. Associate Chief of Medicine, Mount Zion Hospital and Medical Center; Assistant Clinical Professor of Medicine, University of California, San Francisco, School of Medicine.Search for more papers by this author First published: July 1984 https://doi.org/10.1111/j.1532-5415.1984.tb02244.xCitations: 13Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume32, Issue7July 1984Pages 546-547 RelatedInformation

Journal of the American Geriatrics SocietyVolume 32, Issue 8 p. 616-617 Low Yield of Screening for Hypothyroidism in Healthy Elderly Lisa E. Heikoff MD, Lisa E. Heikoff MD Fellow in Geriatric Medicine, Mount Zion Hospital and Medical Center, San Francisco.Search for more papers by this authorJay Luxenberg MD, Jay Luxenberg MD Fellow in Geriatric Medicine, Mount Zion Hospital and Medical Center; Clinical Instructor of Medicine, University of California, San Francisco, School of Medicine.Search for more papers by this authorLawrence Z. Feigenbaum MD, Corresponding Author Lawrence Z. Feigenbaum MD Associate Chief of Medicine and Medical Training Director, Geriatric Services, Mount Zion Hospital and Medical Center, San Francisco; Clinical Professor of Medicine, University of California, San Francisco, School of Medicine.Medical Training Director, Geriatric Services, Mount Zion Hospital and Medical Center, Post Office Box 7921, San Francisco, CA 94120.Search for more papers by this author Lisa E. Heikoff MD, Lisa E. Heikoff MD Fellow in Geriatric Medicine, Mount Zion Hospital and Medical Center, San Francisco.Search for more papers by this authorJay Luxenberg MD, Jay Luxenberg MD Fellow in Geriatric Medicine, Mount Zion Hospital and Medical Center; Clinical Instructor of Medicine, University of California, San Francisco, School of Medicine.Search for more papers by this authorLawrence Z. Feigenbaum MD, Corresponding Author Lawrence Z. Feigenbaum MD Associate Chief of Medicine and Medical Training Director, Geriatric Services, Mount Zion Hospital and Medical Center, San Francisco; Clinical Professor of Medicine, University of California, San Francisco, School of Medicine.Medical Training Director, Geriatric Services, Mount Zion Hospital and Medical Center, Post Office Box 7921, San Francisco, CA 94120.Search for more papers by this author First published: August 1984 https://doi.org/10.1111/j.1532-5415.1984.tb06144.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume32, Issue8August 1984Pages 616-617 RelatedInformation

Antihypertensives are among the most commonly prescribed drugs for the elderly. Several studies have discussed the benefits of stepped‐care drug therapy for hypertension in the elderly, and propranolol, methyldopa, and more recently, clonidine and prazosin have been recommended as step‐two antihypertensive drugs. Recent articles omit reserpine as an alternative. A case is made for the use of reserpine by comparing factors of special importance to most elderly: cost, side‐effects, frequency of dosage, number of tablets, and the effect of omitted doses.