Elderly Male Population Research Articles

Comparison of alpha1 Adrenoceptors in the Prostate Capsule of Men with Symptomatic and Asymptomatic Benign Prostatic Hyperplasia

The objective of this study was to compare the binding and functional properties of alpha 1 adrenoceptors in prostate capsules obtained from men with symptomatic and asymptomatic benign prostatic hyperplasia (BPH) undergoing simple retropubic prostatectomy and cystoprostatectomy respectively. Saturation experiments using 125I-Heat demonstrated that the density and binding affinity of alpha 1 adrenoceptors in the prostate capsules obtained from men with symptomatic and asymptomatic BPH were similar. Non-cumulative dose response experiments using phenylephrine demonstrated that the magnitude of the contractile response to phenylephrine was 4-fold greater in the prostate capsules from men with symptomatic BPH than from those with asymptomatic BPH. The EC50 of phenylephrine in the prostate capsules of men with symptomatic and asymptomatic BPH was similar. A correlation between alpha 1 adrenoceptor density and phenylephrine Emax was not observed, implying that either alpha 1 adrenoceptors are not localised exclusively to the prostate smooth muscle or that spare alpha 1 adrenoceptors exist. This study suggests that the neuropharmacological properties of the prostate capsule may play a significant role in the development of infravesical obstruction in the ageing male population.

Management of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia is a significant cause of morbidity in the elderly male population. The standard therapy for symptomatic prostatic obstruction has been prostatectomy by transurethral resection (TURP) or, less frequently, by open surgery. Innovative alternative treatments of benign prostatic hyperplasia, both surgical and nonsurgical, will be discussed. Additionally, an appraisal of TURP will be made.

Role of alpha-adrenergic blockers in the treatment of benign prostatic hyperplasia

The dynamic component of infravesical obstruction in men with symptomatic benign prostatic hyperplasia (BPH) is determined by alpha 1-adrenoceptor-mediated contractions of the prostatic capsule, prostate adenoma, and bladder neck. Since alpha 1-adrenoceptors are sparse in the bladder, medical therapy aimed at blocking the alpha receptor will relieve bladder outlet obstruction without inhibiting bladder function. Numerous clinical studies have evaluated the use of various alpha blockers for the treatment of BPH. Although the majority of these trials involved limited numbers of patients treated for only short periods, their results have consistently shown that alpha blockers improve urinary flow rates. Adverse reactions appear to be more frequent and more serious with the use of nonselective alpha blockers than with selective alpha 1 blockers, such as terazosin or prazosin. Terazosin offers the additional advantage of once-daily dosing. The common association of hypertension, hyperlipidemia, and symptomatic BPH in the aging male population may provide further impetus for initiating treatment with alpha blockers because alpha blockers are effective antihypertensive agents and may favorably alter lipid profiles.

Sleeping and waking-state measurement of erectile function in an aging male population.

Sleeping and waking-state erectile ability and sexual adjustment in 58 men aged 50 to 79 years was evaluated using the Snap Gauge measure of nocturnal penile tumescence (NPT). The data indicated that 50% of the sample failed to demonstrate nocturnal erections of sufficient rigidity to activate the Snap-Gauge. Nevertheless, these men did not differ from those who did activate the device on 11 out of 13 self-report measures of daytime sexual functioning. The two exceptions to the negative findings were significant differences in frequency of morning erections and sexual desire. The findings cast further doubt on the neurophysiological equivalence of sleep and waking-state erections and on the clinical utility of NPT monitoring for differentiating psychogenic from organically based erectile dysfunction in aging men. In psychological assessment, different measurement methods frequently yield inconsistent results. This is often evident in research on male erectile function, where both self-report and physiological measurements are used and where results from nocturnal penile tumescence (NPT) monitoring can differ from results obtained using measures of waking-state erectile performance (Barry, Blank, & Boileau, 1980; Karacan, 1970; Libman & Fichten, 1987; Marshall, Morales, Phillips, & Fenemore, 1983). Periodic nocturnal tumescence is a naturally occurring phenomenon associated with the REM stage of the sleep cycle in males of all ages. This fact has led researchers to investigate the usefulness of NPT monitoring as a clinical tool in the evaluation of erectile dysfunction (Karacan, 1970). The procedure is based on the assumption that if erectile impairment is psychogenic, the emotional, interpersonal, and attitudinal factors that impair sexual responding during the waking state should gener

Sleeping and waking-state measurement of erectile function in an aging male population.

Sleeping and waking-state measurement of erectile function in an aging male population.

The relationship of growth hormone to alveolar ridge atrophy in an older male nursing home population

Alveolar bone development has been shown by other investigators to be sensitive to growth hormone concentration in both humans and rodents. Many elderly people are deficient in growth hormone. The cyclic variation in plasma growth hormone concentration that complicates growth hormone measurement is not seen in the plasma somatomedin C (SmC) concentration. Furthermore, SmC is a dependable indicator of growth hormone secretion. It has been established that an SmC level of 0.24 or less is associated with decreased muscle mass and kidney size. We have investigated the relationship of the alveolar bone/supporting (basal) bone (A/B) ratio to the SmC in an elderly male population. These data suggest that growth hormone secretion is not the sole determinant of alveolar bone retention.

Physical activity and coronary heart disease in middle-aged and elderly men: the Honolulu Heart Program.

The relationship of physical activity to the development of definite coronary heart disease was examined separately in middle-aged (45-64 years) and elderly men (65-69 years) participating in the Honolulu Heart Program. After 12 years of follow-up, results indicate that increased levels of physical activity reported at study entry were inversely related to the risk of definite coronary heart disease in both age groups. In particular, among those aged 45 to 64 years, the rate of definite coronary heart disease in men who led active life styles was 30 per cent lower than the rate experienced by those who were less active (relative risk, 0.69; 95% confidence interval, 0.53, 0.88). In those older than 64 years, the rate of definite coronary heart disease in active men was less than half the rate experienced by those who led more sedentary life styles (relative risk, 0.43; 95% CI, 0.19, 0.99). These results continued to hold up when controlling for several cardiovascular risk factors and potentially confounding variables, supporting earlier observations that physical activity is beneficial in middle-age, and further suggesting that benefits may extend to the elderly male population as well.

Evaluation of creatinine clearance estimation in an elderly male population.

Thirty-one medically stable, elderly males (age 75 +/- 8.3 yrs) participated in a prospective study evaluating the accuracy of 16 methods of estimating creatinine clearance. Serum creatinine values were determined on the mornings of days 1, 4, and 5 to assure stable renal function. On the morning of day 3, a 24-hour urine collection was initiated. A statistically significant correlation existed between the measured and estimated clearance values for all 16 formulas. The correlation (r less than 0.65) was lower than that in previously published studies, however. Five of the formulas (1A, 5A, 5B, 7A, 7B) demonstrated no statistical difference between mean measured and estimated values. In this population, formula 2B was the least biased and formula 9B the most accurate. For all 16 methods, the bias was minimal and the relative accuracy of the estimated methods was comparable. The results support using methods to estimate creatinine clearance only as a rough bedside prediction of renal function in elderly males.

Pneumococcal bacteremia. Update from an adult hospital with a high rate of nosocomial cases.

Eighty-nine episodes of pneumococcal bacteremia were reviewed over a 66-month period at a Veterans Administration Medical Center. Forty-one percent of these episodes were nosocomial in origin, and 59% of the patients were elderly (60 years of age or older). Nosocomial infection occurred more often in the elderly (55%) compared to those less than 60 years of age (32%; P less than 0.05). Within the elderly group, those older than 75 years of age had a higher rate of nosocomial bacteremia than those 60 to 75 years of age (76 versus 44%; P less than 0.05). The clinical presentation of the elderly and younger groups was not significantly different. All but one patient had serious underlying diseases. Eighty-three percent of the episodes were due to pneumonia, and penicillin alone was prescribed for only 21% of all cases. The mortality rate directly due to the bacteremia was 22%, while the overall mortality during the hospitalization was 47%. In the elderly, the percentage of deaths due to infection was similar to the younger group, but overall mortality during the hospitalization was significantly higher in the elderly (74 versus 26%; P less than 0.01). Physicians showed poor recognition of the significance of pneumococcal disease, as demonstrated by inclusion of the diagnosis of pneumococcal infection or bacteremia in only 27% of the discharge summaries and by predischarge vaccination of only 7% (6 of 82) of those without previous pneumococcal vaccination. In conclusion, the rate of nosocomial pneumococcal bacteremia was high in a predominantly elderly male population; it may be appropriate to consider a hospital-based vaccine program in similar populations.

Cross-sectional prevalence of major ECG abnormalities in an elderly finnish male population

Cross-sectional prevalence of major ECG abnormalities in an elderly finnish male population

Prevalence of depressive and other symptoms in elderly Finnish men.

The prevalence of depressive and other symptoms were studied in Finnish men aged 65 to 84 years and living either in eastern (n = 310) or in southwestern (n = 378) Finland. The Zung self-rating depression scale showed depressed affect, fatigue and suicidal thoughts to be more common in the east, but indecisiveness to be more prevalent in the south-west. The mean of the sum scores in the Zung scale was 37.8 (+/- 8.4) for the eastern and 37.2 (+/- 8.3) for the south-western population, and no differences were found between the areas in this respect. However, many of the other symptoms, including somatic and psychosomatic (such as pains, dyspnea, nausea, impaired memory, apathy, itching skin and sight disturbances) were more common among men living in eastern Finland. The former findings support the idea that there are differences in the affects between men living in the east and men living in the south-west, but, as a whole, depressive symptoms are equally prevalent in both elderly male populations. The latter finding may reflect the well-known differences in the prevalences of somatic diseases between these two areas.

Relationship between suicide, homicide and accidental deaths among the aged in Finland in 1951-1979.

Time trends for suicide, homicide and accident mortality among the Finnish population 65 years or over in 1951-1979 are presented. From 1951 to 1967 suicide, motor-vehicle accident mortality and overall accident mortality among elderly males tended to follow more or less similar patterns. In 1951-1979 male suicide rates correlated positively and significantly over time with male motor-vehicle accident mortality and with male total accident mortality. The results from this mortality analysis in the elderly population are compared with those obtained by Holinger et al. in the total population. There is also a brief discussion of the methodological problems of the study. The results suggest that self-destructive tendencies are not a central variable in female accident mortality among the aged population. On the other hand, it is possible that they play some role in motor-vehicle accident mortality in the aged male population. No suggestions about self-destructive tendencies in homicides among the aged could be made.

Change in risk factors for coronary heart disease during 10 years of a community intervention programme (North Karelia project).

A comprehensive community based programme to control cardiovascular diseases was started in North Karelia, Finland, in 1972. Reductions in smoking, serum cholesterol concentrations, and blood pressure were among the central intermediate objectives. The effect of the programme during the 10 year period 1972-82 was evaluated by examining independent random population samples at the outset (1972) and five (1977) and 10 (1982) years later both in the programme and in a matched reference area. Over 10 000 subjects were studied in 1972 and 1977 (participation rate about 90%) and roughly 8000 subjects in 1982 (participation rate about 80%). Analyses were conducted of the estimated effect of the programme on the risk factor population means by comparing the baseline and five year and 10 year follow up results in the age range 30-59 years. The effect of the programme (net reduction in North Karelia) at 10 years among the middle aged male population was estimated to be a 28% reduction in smoking (p less than 0.001), a 3% reduction in mean serum cholesterol concentration (p less than 0.001), a 3% fall in mean systolic blood pressure (p less than 0.001), and a 1% fall in mean diastolic blood pressure (p less than 0.05). Among the female population the reductions were respectively, 14% (NS), 1% (NS), 5% (p less than 0.001), and 2% (p less than 0.05). During the first five years of the project (1972-7) the programme effectively reduced the population mean values of the major coronary risk factors. At 10 years the effects had persisted for serum cholesterol concentrations and blood pressure and were increased for smoking.

8 Arterial disease as a cause of impotence

The traditional views on the aetiology of impotence, attributing more than 90 per cent of all cases of impotence to psychic pathogenesis, have changed. Measurement of penile blood pressure, nocturnal penile tumescence studies (NPT) and especially new techniques of arteriographic examination of the arterial bed supplying the cavernous bodies have shown that the majority of cases have an organic basis affecting the haemodynamics of erection (limitation of arterial inflow into the cavernous bodies and/or their excessive venous drainage). Arterial disease, which is the most frequent affection in the middle-aged and elderly male population, is also largely implicated in the pathogenesis and aetiology of impotence. Recognition of this role of arterial disease is important not only with respect to the treatment of impotence but above all with respect to prevention of even more serious complications of the former condition such as IHD and MI, cerebrovascular disease and stroke, or intermittent claudication and gangrene.

Raised serum alpha-2 globulins as an independent risk factor of coronary heart disease

Epidemiological results both retrospective and prospective in a working middle aged male population show alterations of the serum electrophoretic protein fractions in men with coronary heart disease (CHD) and men who will develop CHD. The α 2 protein fraction appears as a risk factor of CHD independently of clinical diabetes and the standard CHD risk factors as hypercholesterolemia, high blood pressure, tobacco consumption and ECG abnormalities.

Age-grading in the social interaction of an elderly male population.

Age-grading in the social interaction of an elderly male population.

A comparison of the coloured progressive matrices (CPM) with the Wechsier adult intelligence sclae (WAIS) in a normal aged white male population.

A comparison of the coloured progressive matrices (CPM) with the Wechsier adult intelligence sclae (WAIS) in a normal aged white male population.