Death In Older People Research Articles

Self-rated health and mortality in a prospective Chinese elderly cohort study in Hong Kong

ObjectivesIn the West, self-rated health reliably predicts death, but conceptualizations of health and cause-composition of mortality may be contextually specific. Little is known as to how self-rated health predicts death in non-Western settings. MethodsMultivariable Cox regression analysis was used to assess the adjusted associations of age-comparative and self-comparative self-rated health with death from all- and specific-causes using a population-based cohort of 66,820 Chinese (65+years) enrolled from 1998 to 2001 at 18 Elderly Health Centers in Hong Kong, and followed until May 31, 2012. ResultsDuring an average of 10.9years follow-up, 19,845 deaths occurred with 6336 from cancer. Worse age-comparative self-rated health, compared with better, was positively associated with death from all-causes (hazard ratio 1.68, 95% confidence interval 1.59, 1.77), cardiovascular disease (hazard ratio 1.83, 95% confidence interval 1.66, 2.02), stroke (hazard ratio 1.93, 95% confidence interval 1.63, 2.29), ischemic heart disease (hazard ratio 1.77, 95% confidence interval 1.51, 2.08), cancer (hazard ratio 1.17, 95% confidence interval 1.06, 1.30) and respiratory disease (hazard ratio 2.25, 95% confidence interval 2.01, 2.52), adjusted for age and sex. Self-comparative self-rated health was not associated with higher mortality. ConclusionAge-comparative self-rated health predicted death in older people from a non-Western setting although the association was less marked than in Western settings.

Deaths of obstructive lung disease in the Yangpu district of Shanghai from 2003 through 2011: a multiple cause analysis

Background Obstructive lung disease (OLD, chronic obstructive pulmonary disease or asthma) is an important cause of death in older people. There has been no exhaustive population-based mortality study of this subject in Shanghai. The objective of this study was to use a multiple cause of death methodology in the analysis of OLD mortality trends in the Yangpu district of Shanghai, from 2003 through 2011. Methods We analyzed death data from the Shanghai Yangpu District Center for Disease Control and Prevention for Medical Cause of Death database, selecting all death certificates for individuals 40 years or older on which OLD was listed as a cause of death. Results From 2003 to 2011, there were 8 775 deaths with OLD listed, of which 6 005 (68%) were identified as the underlying cause of death. For the entire period, a significantly decreasing trend of age standardized rates of death from OLD was observed in men (-6.2% per year) and in women (-5.7% per year), similar trends were observed in deaths with OLD. The mean annual rates of deaths from OLD per 100 000 were 161.2 for men and 80.8 for women from 2003 to 2011. While, as the underlying cause of death, the main associated causes of death were as follows: cardiovascular diseases (70.7%), cerebrovascular diseases (13.3%), diabetes (8.6%), and cancer (4.3%). The associated causes and the principal overall underlying causes of death were cardiovascular diseases (37.0%), cancer (30.3%), and cerebrovascular disease (15.3%). A significant seasonal variation, with the highest frequency in winter, occurred in deaths identified with underlying causes of chronic bronchitis, other obstructive pulmonary diseases, and asthma. Conclusions Multiple cause mortality analysis provides a more accurate picture than underlying cause of total mortality attributed on death certificates to OLD. The major comorbidities associated with OLD were cardiovascular disease, cancer, and cerebrovascular disease. From 2003 to 2011, the mortality rate from OLD decreased substantially in the Yangpu district of Shanghai.

New IDF Guideline for managing type 2 diabetes in older people

Just over 8.3% of the global population has diabetes [1]. Increasing age is a significant risk factor for type 2 diabetes but the diagnosis is often missed or delayed because the clinical presentation is different from that in younger people. Diabetes is a major cause of complications, reduced quality of life and changed physical and mental functioning in older people [2–4]. It is also a leading cause of death in older people from cardiovascular and other related medical co-morbidities. In addition, many older people have additional risk factors for diabetes and may have undiagnosed complications.

Atypical Manifestation of Myocardial Ischemia in the Elderly

Often, elderly patients have atypical clinical picture for myocardial ischemia, or are asymptomatic. This review intends to re-examine the pathophysiology of atypical manifestation in elderly persons, its prognostic and therapeutic implications. The coronary atherosclerotic disease is an increasing public health problem, of particular importance in higher age groups. Its prevalence increases significantly at the sixth decade of life, becoming the leading cause of death in older people, as well as the greatest responsible for hospitalization and invasive procedures1. The absent or atypical clinical signs in elderly persons hinder the management of coronary atherosclerotic disease. The cases of myocardial ischemia without pain, the so-called asymptomatic or silent ischemia, it is more frequent in elderly patient2. Considering patients with acute coronary syndrome, as myocardial infarction with ST-segment elevation, among those under 65 years of age, only 11.1% do not have precordial pain, unlike those over 85 years old, among which 43.2% have precordial pain3. Similarly, among elderly patients with Q wave in electrocardiogram (ECG), 78% did not have symptoms of precordial pain4 (Figure 1). Figure 1 Clinical presentation of acute myocardial infarction according to age. Bayer AJ, Chadha JS, Farag RR, Pathy MS. J Am Geriatr Soc. 1986; 34:263-6. Diabetes mellitus has been considered the biggest factor related to asymptomatic ischemia in patients with stable coronary disease. However, several studies found no such association5. These studies indicate that the only independent factor for silent ischemia is advanced age. In fact, progressive increase occurs in the interval between the beginning of ST segment depression and the onset of angina with increased age6, indicating increased pain threshold among elderly. When an episode of coronary blood flow reduction occurs, the first alteration is the suffering of myocyte, following changes of myocardial relaxation and ST segment depression. Pain is the last manifestation of myocardial ischemia7. The higher prevalence of asymptomatic myocardial ischemia or with atypical symptoms in elderly is explained by increased pain threshold related to nociceptive changes and by the great prevalence of diseases such as depression and diabetes mellitus. Increased beta-endorphins levels have also been described in patients with asymptomatic myocardial ischemia8. However, there are studies with different findings9,10. Additionally, patients suffering from silent ischemia have central nervous activation different from those with angina when subjected to ischemic dobutamine stress, predominating the frontal cortex and ventral temporal activation11. Interestingly, the thalamic area, which is responsible for the recognition of pain, had similar activation in patients with and without angina12. On the other hand, the elderly patients have comorbidities that may influence the clinical manifestation of myocardial ischemia. Even the diabetes mellitus is a condition whose prevalence increases with age, as well as diabetic neuropathy. Fibromyalgia and depression are neuropsychiatric conditions that interfere with the painful sensation. Sometimes, elderly persons complain of precordial pain, with rejected diagnosis of myocardial ischemia, improve with antidepressants. The opposite can also occur, with elderly people with atypical pain for myocardial ischemia, generally attributed to depression, having significant coronary disease. The relationship between depression and coronary atherosclerotic disease is well defined13. However, there are several reasons why depression increases the occurrence of coronary disease. Patients with depression have less treatment adherence to drug and lifestyle changes. Additionally, depression14 can cause change of endothelial function, deregulation of the hypothalamic-pituitary-adrenal axis, increased platelet reactivity and inflammatory markers with interleukin 6. Memory changes, which are frequent in elderly patients, as Alzheimer's disease and vascular dementia, are characterized by the loss of short term memory. Consequently, in these patients, the reliable reporting of symptoms of recent onset is affected. Both Alzheimer's disease and vascular dementia have risk factors similar to those of coronary disease. As a result, besides frequent concomitance, memory deficit causes elderly to have memorization difficulty and describe the pain resulting from myocardial ischemia. Among elderly patients with heart failure, 50-70% have myocardial ischemia as etiology, and considerable part of them have prior myocardial revascularization. Both heart failure15 and myocardial revascularization reduce cognitive performance, especially in the field of attention. Thus, if a patient has myocardial ischemia, this cognitive deficit can impair description of the pain characteristics. In conclusion, elderly patients with myocardial ischemia often have atypical clinical manifestations, due to comorbidities as diabetes mellitus, nociceptive changes, depression and dementia. Therefore, in elderly patients, atypical symptoms of coronary insufficiency should be valued, and to confirm or not diagnosis of myocardial ischemia, the search through additional tests should be more rigorous. Additionally, these research tests on myocardial ischemia also identify patients at higher risk that should be treated more intensively.

Nutritional status predicts preterm death in older people: A prospective cohort study

There is an association between malnutrition and mortality. However, it is uncertain whether this association is independent of confounders. The aim of the present study was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in people 65 years and older. This prospective cohort study included individuals aged ≥65 years who were admitted to hospital between March 2008 and May 2009 and followed-up after 50 months (n = 1767). Nutritional status was assessed with the MNA, and possible risk factors associated with malnutrition were recorded during participants hospital stay. Main outcome measure was overall survival. Based on the MNA definitions, 628 (35.5%) were well-nourished, 973 (55.1%) were at risk of malnutrition, and 166 (9.4%) of the participants were malnourished at baseline. During the follow-up period 655 (37.1%) participants died. At follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants (p < 0.001). After adjusting for confounders the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18-2.07) in the group at risk of malnutrition and 3.71 (2.28-6.04) in the malnourished group. Nutritional status defined according to the three categories in the full MNA independently predicts preterm death in people aged 65 years and older. These findings are clinically important and emphasise the usefulness of the MNA for screening of nutritional status.

Death rate in older people with schizophrenia elevated compared with the general population

QUESTION Question: How do the death rate and cause of death in older people with schizophrenia compare with the general population? Population: 9461 Adults aged over 65 on 1 January...

Trends in aortic aneurysm- and dissection-related mortality in the state of São Paulo, Brazil, 1985-2009: multiple-cause-of-death analysis.

BackgroundAortic aneurysm and dissection are important causes of death in older people. Ruptured aneurysms show catastrophic fatality rates reaching near 80%. Few population-based mortality studies have been published in the world and none in Brazil. The objective of the present study was to use multiple-cause-of-death methodology in the analysis of mortality trends related to aortic aneurysm and dissection in the state of Sao Paulo, between 1985 and 2009.MethodsWe analyzed mortality data from the Sao Paulo State Data Analysis System, selecting all death certificates on which aortic aneurysm and dissection were listed as a cause-of-death. The variables sex, age, season of the year, and underlying, associated or total mentions of causes of death were studied using standardized mortality rates, proportions and historical trends. Statistical analyses were performed by chi-square goodness-of-fit and H Kruskal-Wallis tests, and variance analysis. The joinpoint regression model was used to evaluate changes in age-standardized rates trends. A p value less than 0.05 was regarded as significant.ResultsOver a 25-year period, there were 42,615 deaths related to aortic aneurysm and dissection, of which 36,088 (84.7%) were identified as underlying cause and 6,527 (15.3%) as an associated cause-of-death. Dissection and ruptured aneurysms were considered as an underlying cause of death in 93% of the deaths. For the entire period, a significant increased trend of age-standardized death rates was observed in men and women, while certain non-significant decreases occurred from 1996/2004 until 2009. Abdominal aortic aneurysms and aortic dissections prevailed among men and aortic dissections and aortic aneurysms of unspecified site among women. In 1985 and 2009 death rates ratios of men to women were respectively 2.86 and 2.19, corresponding to a difference decrease between rates of 23.4%. For aortic dissection, ruptured and non-ruptured aneurysms, the overall mean ages at death were, respectively, 63.2, 68.4 and 71.6 years; while, as the underlying cause, the main associated causes of death were as follows: hemorrhages (in 43.8%/40.5%/13.9%); hypertensive diseases (in 49.2%/22.43%/24.5%) and atherosclerosis (in 14.8%/25.5%/15.3%); and, as associated causes, their principal overall underlying causes of death were diseases of the circulatory (55.7%), and respiratory (13.8%) systems and neoplasms (7.8%). A significant seasonal variation, with highest frequency in winter, occurred in deaths identified as underlying cause for aortic dissection, ruptured and non-ruptured aneurysms.ConclusionsThis study introduces the methodology of multiple-causes-of-death to enhance epidemiologic knowledge of aortic aneurysm and dissection in São Paulo, Brazil. The results presented confer light to the importance of mortality statistics and the need for epidemiologic studies to understand unique trends in our own population.

The Tale of the Telomeres Gets Ever-More Complex

The Tale of the Telomeres Gets Ever-More Complex

Influenza-related deaths - available methods for estimating numbers and detecting patterns for seasonal and pandemic influenza in Europe

Two methodologies are used for describing and estimating influenza-related mortality: Individual-based methods, which use death certification and laboratory diagnosis and predominately determine patterns and risk factors for mortality, and population-based methods, which use statistical and modelling techniques to estimate numbers of premature deaths. The total numbers of deaths generated from the two methods cannot be compared. The former are prone to underestimation, especially when identifying influenza-related deaths in older people. The latter are cruder and have to allow for confounding factors, notably other seasonal infections and climate effects. There is no routine system estimating overall European influenza-related premature mortality, apart from a pilot system EuroMOMO. It is not possible at present to estimate the overall influenza mortality due to the 2009 influenza pandemic in Europe, and the totals based on individual deaths are a minimum estimate. However, the pattern of mortality differed considerably between the 2009 pandemic in Europe and the interpandemic period 1970 to 2008, with pandemic deaths in 2009 occurring in younger and healthier persons. Common methods should be agreed to estimate influenza-related mortality at national level in Europe, and individual surveillance should be instituted for influenza-related deaths in key groups such as pregnant women and children.

Fall-risk screening system framework for physiotherapy care of elderly

In 2008 the global older population (aged 65 and over) was estimated to be about 7% of the world’s population; it is estimated to reach 2 billion by 2050 accounting for 22% of the world total population. This demographic trend sets new challenges to health services and policies, and imposes a significant financial and social burden on economies as a whole. The decline in musculoskeletal system in the aging population is the biggest cause of injury death in older people who require effective physiotherapy treatment. However the current demand for physiotherapists outstrips current supply. To address this problem this paper described an innovative approach which consists of a screening risk assessment of the elderly which can be combined with a case based reasoning system to support physiotherapist in managing the care of the elderly following a fall. Although the study is based on a small cohort of the Thai population it is believed that this approach can address the shortage of physiotherapists and bring a significant improvement in the health care of older people.

Risk of pneumonia in patients taking statins: population-based nested case-control study

Community-acquired pneumonia is one of the most common causes of hospitalisation and death in older people. Recent research suggests that statins might improve the outcome of infectious diseases because of their anti-oxidative and anti-inflammatory properties. To estimate the association between current statin use and the risk of community-acquired pneumonia. Nested case-control study of 443 general practices in the UK within the QResearch® database. Individuals with newly recorded pneumonia, diagnosed between 1996 and 2006 and aged 45 years and older, were matched with up to five controls by age, sex, general practice, and calendaryear Odds ratios for pneumonia associated with statin use were adjusted for smoking status, deprivation, comorbidities, use of acid-lowering drugs, influenza, and pneumococcal vaccines. The analysis found a decreased risk of pneumonia in patients prescribed statins in the year prior to diagnosis (adjusted odds ratio = 0.78, 95% confidence interval [CI] = 0.74 to 0.83), particularly in patients with prescriptions in the last 28 days (adjusted odds ratio = 0.68, 95% CI = 0.63 to 0.73). Atorvastatin and simvastatin had similar associations with pneumonia risk. Analysis repeated on lobar and pneumococcal pneumonia cases showed comparable results. In this large population-based case-control study, current exposure to statins was associated with a reduced risk of pneumonia. The findings were similar to other observational population-based studies, but further randomised controlled trials are necessary before recommending statins to patients at high risk of pneumonia.

Combinations of common drugs increase risk of cognitive impairment and death in older people

Combinations of common drugs increase risk of cognitive impairment and death in older people

Deaths in older adults in England

We will present key results from the report, ‘Deaths in Older Adults in England' produced by the South West Public Health Observatory on behalf of the National End of Life...

Cardiovascular disease and death associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA)

Cardiovascular disease (CVD) and death may be associated with depression and antidepressants, but published findings remain equivocal. The authors aimed to determine the risk of CVD incidence and death associated with several classifications of depression. A prospective cohort study was conducted (1994-2006) in a regionally representative sample of 1000 non-institutionalised older Australians age 65+ years (47% men). Endpoints were non-fatal CVD incidence and death over 10 and 12-years, respectively. Depression incidence was assessed at 2-years. Depression related predictors were defined by symptoms (Psychogeriatric Assessment Scales, depression scale) and/or antidepressants to determine independent and/or joint effects on endpoints. Cox regressions determined unadjusted and multiple-adjusted (for significant covariates) hazard ratios (HR). Baseline response rate was 70.3%. Aggregate dropout rate was approximately 24% for survivors at biennial follow-ups, but death status was ascertained for all participants. Several classifications of depression predicted death in unadjusted analyses (39-60% >1), but effects disappeared in multiple-adjusted analyses (in which all HRs became <1 and non-significant). Depression related predictors were thus not associated with CVD incidence; or death after accounting for confounding mostly by CVD, diabetes and poor functional health covariates. Prevalent arthritis, respiratory disease and daily pain were predictors (P < 0.05) of depression incidence. Depression related predictors were not independently associated with CVD incidence or death in older people. Antidepressants were not associated with CVD or premature death, accounting for whether participants' remained symptomatic or not. Depression co-occurs with and might be partly caused by chronic disease and poor functional health.

Risk of Death Related to Psychotropic Drug Use in Older People During the European 2003 Heatwave: A Population-Based Case–Control Study

The authors investigated the association between death of older people and use of psychotropic drugs before and during the Western European August 2003 heatwave. A retrospective population-based case-control study was conducted using the French social security insurance national database. Exposure to psychotropic drugs in cases aged 70-100 years who died before (N = 2,093) and during (N = 9,531) the August 2003 heatwave was compared with those of survivors matched for age, gender, and presence of chronic illness, by using conditional logistic regressions. The association between death and psychotropic drug use was modified by level of external temperature (Wald chi(2) = 13.1, degree of freedom = 1, p <0.001). Use of any psychotropic drug was associated with a 30% increased risk of death during the heatwave, with a significant dose-response relationship between the number of psychotropic drugs and the risk of death (adjusted odds ratio [aOR] for linear trend 1.25, 95% confidence interval [95% CI]: 1.21-1.29). During the heatwave, therapeutic classes independently associated with an increased risk of death were antidepressants (aOR 1.71, 95% CI: 1.57-1.86) and antipsychotics (aOR 2.09, 95% CI: 1.89-2.35), whereas exposure to anxiolytics/hypnotics use (aOR 0.85, 0.79-0.91) was associated with a decreased risk. Findings remained unchanged after adjustment on cardiotropic, antidementia, or anti-parkinsonian drug use. Our findings suggest that a causal relationship may exist between psychotropic drug use during a heatwave and increased risk of death in older people. The risk/benefit ratio of antidepressant and antipsychotic drugs should be carefully assessed in older people during a heatwave.

Deaths in older people from heat depend on mild winter.

Winters where mortality is low might inflate the pool of older people susceptible to dying from high temperatures the following summer.

Determinants of antidepressant medication prescribing in elderly residents of aged care homes in Australia: A retrospective study

Background: Depression is underrecognized and poorly treated among older people living in aged care homes worldwide. Depression has been associated with higher rates of recurrence, disability, and death in older people. Objectives: The primary objective of this study was to assess the determinants of antidepressant medication prescribing among older people living in aged care homes in Australia. A further objective was to investigate the anti-depressant medications in common use, doses of antidepressants, and concurrent pharmacotherapy among people receiving antidepressants. Methods: A random sample of 500 deidentified medication review reports was extracted from a database containing >165,000 Residential Medication Management Review reports. Residents' demographic and clinical characteristics, medical diagnoses, and prescribed medications were systematically extracted from these reports. Logistic regression models were used to determine factors associated with the prescribing of any antidepressant, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and “other” antidepressants (eg, mianserin, mirtazapine, venlafaxine). Results: The mean (SD) age of the residents was 84.0 (9.0) years. Seventy-five percent were female. The prevalence of antidepressant prescribing among these aged care home residents was 33.0%. SSRIs were more commonly prescribed than TCAs, monoamine oxidase inhibitors, and other antidepressants. Antidepressants were more likely to be prescribed in people treated for dementia with mood disorder (odds ratio [OR] = 9.70; 95% CI, 5.26–17.88), depression (OR = 13.28; 95% CI, 6.44–27.36), and Parkinson's disease (OR = 3.56; 95% CI, 1.37–9.23). SSRI prescribing was associated with dementia with mood disorder (OR = 5.85; 95% CI, 3.19–10.72) and depression (OR = 6.44; 95% CI, 3.38–12.26). TCA prescribing was associated with depression (OR = 2.95; 95% CI, 1.18–7.35) and concurrent benzodiazepine use (OR = 2.43; 95% CI, 1.03–5.72). Other antidepressant prescribing was associated with dementia with mood disorder (OR = 6.53; 95% CI, 3.15–13.50) and depression (OR = 5.00; 95% CI, 2.23–11.19). Conclusions: There was preferential prescribing of SSRI antidepressants among these older aged care home residents with depression. Cognitive impairment alone was not significantly associated with antidepressant prescribing; however, these aged care home residents with dementia and mood disorders had an increased likelihood of being treated with antidepressants. The prescribing of TCAs was significantly associated with concurrent benzodiazepine use.

Causes of death in older people autopsied

Studies of causes of death in autopsied older people are not common in Brazil. The aims were to compare demographic data and causes of death in elderly people autopsied in the 1970s, 1980s, and 1990s and to relate causes of death to age, sex, color, and body mass index. Data survey of the autopsy reports came from the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil. The data were obtained from the autopsied individuals 60 years or older. Median age was 69 years (60-120 years) and was higher in the 1990s than in the 1970s (70.5 vs 68.0, P < .05) and higher in women (70 vs 68 years, P < .05). Men (66.8%) and white people (70.0%) predominated during the period. The most frequent causes of death were cardiovascular (42%) and infectious (33.4%). The percentage of cardiovascular causes of death varied little over the 1970s (41.7%), 1980s (42.3%), and 1990s (42.9%), whereas that of infectious causes decreased (38.0%, 28.6%, and 28.6%, respectively) and that of neoplastic causes increased (10.3%, 12.6%, and 19.6%, respectively, P > .05). Most of the elderly (84.6%) presented a body mass index of less than 22 kg/m2 and malnutrition predominated in the 1980s (48%). Therefore, there was little percentage variation in cardiovascular-related deaths over the 3 decades while the percentage of neoplastic-related deaths increased. Infectious causes of death was associated with the lowest body mass index, and the greatest percentage of cardiovascular and neoplastic-related deaths were in women.

Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study

Objective To study the relation between low walking speed and the risk of death in older people, both overall and with regard to the main causes of death.Design Prospective cohort...

Nurses must be alert to possibility of pulmonary thromboembolism.

Pulmonary thromboembolism (PTE) is one of the leading causes of death in older people. The condition results from a blockage of the pulmonary artery, or its branches, from a venous clot that has dislodged from its site of formation (usually deep veins of the calf or pelvis) and travelled through the venous system.