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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were in the psychiatric sphere; they occurred in 23 patients early in treatment and were not age-related; the drug was withdrawn.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.

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 In men there were fewer constipated days and need for aperients after the bran was withdrawn.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.