Disorders In Older People Research Articles

SUN-106 Characteristics of hospitalized elderly patients with chronic kidney disease: a multicenter retrospective study in China

The proportion of elderly people is steadily rising worldwide, with the most rapid growth in low-income and middle-income countries. Chronic kidney disease (CKD) is a common disorder in older people. However, less is known about the epidemiology of CKD among elderly persons and its relationship with adverse consequences. This study aims to carry out a multicenter epidemiological investigation among hospitalized elderly patients with CKD, providing important information for clinical guidelines and healthcare policies in elderly patients with CKD. We obtained patients’ medical records from a national-wide database including 18 hospitals across China (from 1 January 2009 to 31 December 2011). Only data from adult patients (aged 18 years of older) were included. ICD-10-CM coding system was used as the diagnosis of the disease. The characteristics of CKD in the elderly, including etiology of CKD, pathological types, comorbidity conditions, and in-hospital mortality, were compared with those in younger patients. Logistic multivariate regression analysis was used to identify independent risk factors for death. A total of 380,461 patients were included, of whom 154231 were elderly patients. Among the elderly 6966 were diagnosed as CKD. The top three causes of CKD among the elderly are diabetic nephropathy, hypertension-related renal impairment and primary glomerular disease, accounting for 24.1%, 20.9%, and 11.1%, respectively. Among the elderly patients with primary glomerular disease had a pathological diagnosis, membranous nephropathy is the most common type (54.6%), followed by IgA nephropathy (36.1%) and mesangial proliferative glomerulonephritis (13.6%). 71.6% of the elderly patients with CKD had more than two comorbidities. The in-hospital mortality rate of the elderly with CKD was 3.3%, which was significantly higher than young patients (1.0%). Logistic regression analysis showed age (OR=1.086, 95%CI 1.064-1.108), CKD Stage 5 (OR=2.708,95%CI 1.988-3.787), acidosis (OR=4.430,95% CI 2.223-8.827), cardio-cerebrovascular disease (OR=2.301,95%CI 1.701-3.113), infection (OR=1.867,95%CI 1.124-3.102), tumors (OR=3.782,95%CI 2.434-5.876), dementia (OR=8.281,95%CI 1.593-43.037 were independent risk factor for death among elderly patients with CKD. The CKD etiology of elderly is different from that of non-elderly. Diabetic nephropathy and hypertension-related renal injury are the first two common causes, followed by primary glomerular disease. More than 2/3 of the elderly CKD have comorbid conditions, and the number of comorbidities increased with age.

Crocus Sativus L. (saffron) versus sertraline on symptoms of depression among older people with major depressive disorders–a double-blind, randomized intervention study

BackgroundWhile there is sufficient evidence that Crocus Sativus L. (saffron) improves symptoms of depression in young and middle-aged adults, research on older people are missing. The purpose of the double-blind, randomized intervention study was to compare the effect of saffron and sertraline on MDD among a sample of older people. MethodsA total of 50 older out-patients with MDD (mean age = =65 years; 70% males) were randomly assigned either to the saffron condition (60 mg/d) or to the sertraline condition (100 mg/day) for six consecutive weeks. Experts employed the Hamilton Depression Rating Scale (HDRS) to rate participants’ degree of depression. Timepoints were baseline, week 2, week 4 and week 6, the end of the study. ResultsSymptoms of depression decreased over time, with no advantages or disadvantages for the saffron or sertraline condition. ConclusionThe pattern of results suggests that both saffron and sertraline have the potential to significantly decrease symptoms of depression. The results are clinically relevant, because major depressive disorders in older people is a health concern. The results are further relevant, because saffron appears to be a powerful antidepressant for older people, who might be more reluctant to the use of synthetic drugs.

Antidepressants for major depression disorder in older people: a network meta-analysis

Antidepressants for major depression disorder in older people: a network meta-analysis

Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study

ObjectivesTimely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging...

In Case You Haven't Heard…

Clinicians need to focus more on treating alcohol use disorders in older people. A new study has found that one in 10 older adults is a binge drinker. The study, published in the Journal of the American Geriatrics Society, used National Institute on Alcohol Abuse and Alcoholism definitions of binge drinking: five or more drinks in a sitting for men, and four or more for women. A drink is a can or bottle of beer, a glass of wine, a shot of liquor or a mixed drink. The study used data from the National Survey on Drug Use and Health, which included almost 11,000 adults age 65 or older who reported their drinking habits in the past 30 days.

Pharmacotherapy for mood and anxiety disorders in older people with intellectual disability in comparison with the general population

BackgroundPeople with intellectual disability (ID) have high prevalence of psychiatric disorders, but even higher rates of prescription of psychotropic drugs.MethodsUsing Swedish national registers, we identified a group of older people with ID and diagnosis of mood disorders (ICD-10 codes F32-F39) and/or anxiety (ICD-10 code F4) during 2006–2012 (n = 587) and a referent group of people from the general population with the same diagnoses during the same time period (n = 434). For both groups, we collected information on prescription of anxiolytics, hypnotics and sedatives, antidepressants, and GABA-agonists.ResultsAmong those with a diagnosis of anxiety, people with ID were more likely than those in the general population to be prescribed anxiolytics (Relative Risk 1.32 [95% Confidence Interval 1.19–1.46]) and GABA-agonists (1.10 [1.08–1.31]). Moreover, among those with anxiety but without mood disorders, ID was associated with increased prescription of antidepressants (1.20 [1.03–1.39]). Within the ID cohort, behaviour impairment and MSP (i.e. moderate, severe, or profound) ID was associated with increased prescription of anxiolytics, both among those with anxiety (1.15 [1.03–1.30] for behaviour impairment and 1.23 [1.10–1.38] for MSP ID) and among those with mood disorders (1.14 [0.97–1.35] for behaviour impairment and 1.26 [1.04–1.52] for MSP ID). Moreover, MSP ID was associated with increased prescription of GABA-agonists among those with anxiety (1.23 [1.10–1.38]).ConclusionsThe excess prescription of anxiolytics but not antidepressants may suggest shortages in the psychiatric health care of older people with intellectual disability and mood and anxiety disorders.

The effects of different meditation exercises on sleep quality in older people: a network meta-analysis.

Chronic sleep loss or sleep disorders is a public health problem affecting older people and cause many health problems. We aim to estimate the effects of different meditation exercises on relieving and improvement of sleep disorders in older people using the pairwise and network meta-analyses. Randomized controlled trials, which were published in English and reported on meditation exercises for sleep disorders in the older people, were retrieved from PubMed and EMBASE up to May 2018. Publication bias of the included studies were assessed by the Cochrane Collaboration recommendations. Network meta-analysis was performed by ADDIS, and all test models used random-effects model. Pooled effect sizes were presented with weighted mean differences (WMDs) and 95% confidence interval (CI). A total of ten studies were included in our research. Pairwise comparisons indicated that Qigong could significantly improve the quality of sleep in older people with sleep disorders compared with Activities (WMD = - 4.28, 95% CI - 5.75 to - 2.81). In addition, there were significant differences in Education vs. Usual care (WMD = 2.60, 95% CI 1.03-4.17) and Tai Chi vs. Activities (WMD = - 1.05, 95% CI - 1.73 to - 0.38). With great consistence and convergence, network meta-analysis showed that there was a significant difference in Qigong vs. Activities (WMD = - 4.23, 95% CI - 8.31 to - 0.21). Moreover, Qigong showed a best outcome in relieving sleep disorders, followed by Yoga. Qigong, Yoga, and Tai Chi improved sleep disorders in the older people, and Qigong intervention had the best effect followed by Yoga. A long-term clinical verification should be needed in the future.

The occurrence of comorbidities with affective and anxiety disorders among older people with intellectual disability compared with the general population: a register study

BackgroundLittle is known regarding the burden of comorbidities among older people with intellectual disability (ID) who have affective and anxiety disorders. Therefore, we aimed to investigate the occurrence and risk of psychiatric and somatic comorbidities with affective and/or anxiety disorders in older people with ID compared to the general population.MethodsThis population study was based on three Swedish national registers over 11 years (2002–2012). The ID group was identified in the LSS register, which comprises of data on measures in accordance with the Act Concerning Support and Service for Persons with Certain Functional Impairments (n = 7936), and a same-sized reference cohort from the Total Population Register was matched by sex and year of birth. The study groups consisted of those with affective (n = 918) and anxiety (n = 825) disorder diagnoses. The information about diagnoses were collected from the National Patient Register based on ICD-10 codes.ResultsThe rate of psychiatric comorbidities with affective and anxiety disorders was approximately 11 times higher for people with ID compared to the general reference group. The two most common psychiatric comorbidities occurred with affective and anxiety disorders were Unspecified non-organic psychosis and Other mental disorders due to brain damage and dysfunction and to physical disease (8% for each with affective disorders and 7 and 6% with anxiety disorders, respectively). In contrast, somatic comorbidity comparisons showed that the general reference group was 20% less likely than the ID cohort to have comorbid somatic diagnoses. The most commonly occurring somatic comorbidities were Injury, poisoning and certain other consequences of external causes (49 and 47% with affective and anxiety disorders, respectively) and Signs and symptoms and abnormal clinical and laboratory findings not elsewhere classified (44 and 50% with affective and anxiety disorders, respectively).ConclusionOlder people with ID and with affective and anxiety diagnoses are more likely to be diagnosed with psychiatric comorbidities that are unspecified, which reflects the difficulty of diagnosis, and there is a need for further research to understand this vulnerable group. The low occurrence rate of somatic diagnoses may be a result of those conditions being overshadowed by the high degree of psychiatric comorbidities.

Symptom profiles of late-life anxiety and depression: The influence of migration, religion and loneliness.

To examine (1) clinically relevant anxiety with comorbid depression in an older population, and the presentation of subthreshold symptoms; (2) to assess anxiety and levels of comorbid depression associated with migration, religion, loneliness and long-term illness. Analysis of Wave 1 of The Irish Longitudinal Study on Ageing (TILDA) (2009-2011). Latent class analysis (LCA) was used to define indicative diagnoses of anxiety and depression. We then assessed associations between sociodemographic and socioeconomic factors, past migration, religious practice, social network, loneliness and long-term illness. For those with clinically relevant anxiety, LCA derived three classes of self-reported depression: low, subthreshold and high. Approximately 19% were comorbid, and a further 37% reported subthreshold depression. Compared to those with low/no symptoms of depression, those classed as comorbid were more likely to be male, had lower education levels, had spent more time abroad, lower religious attendance, a limited social network, were lonelier and had a long-term life-limiting illness. Those with subthreshold levels of depression reported a more restricted social network and more moderate levels of loneliness. Findings support the actuality of comorbidity of both disorders. Consequently, government health strategy on detecting and managing social engagement, loneliness, and psychological disorders in older people may require a more granulated approach.

Understanding and managing cognitive impairment in bipolar disorder in older people

SUMMARYBipolar disorder is less prevalent in older people but accounts for 8–10% of psychiatric admissions. Treating and managing bipolar disorder in older people is challenging because of medical comorbidity. We review the cognitive problems observed in older people, explore why these are important and consider current treatment options. There are very few studies examining the cognitive profiles of older people with bipolar disorder and symptomatic depression and mania, and these show significant impairments in executive function. Most studies have focused on cognitive impairment in euthymic older people: as in euthymic adults of working age, significant impairments are observed in tests of attention, memory and executive function/processing speeds. Screening tests are not always helpful in euthymic older people as the impairment can be relatively subtle, and more in-depth neuropsychological testing may be needed to show impairments. Cognitive impairment may be more pronounced in older people with ‘late-onset’ bipolar disorder than in those with ‘early-onset’ disorder. Strategies to address symptomatic cognitive impairment in older people include assertive treatment of the mood disorder, minimising drugs that can adversely affect cognition, optimising physical healthcare and reducing relapse rates.LEARNING OBJECTIVESAfter reading this article you will be able to: •understand that cognitive impairment in euthymic older people with bipolar disorder is similar to that in working-age adults with the disorder, affecting attention, memory and executive function/processing speeds•recognise that cognitive impairment in older people is likely to be a major determinant of functional outcomes•Implement approaches to treat cognitive impairment in bipolar disorder.DECLARATION OF INTERESTB.J.S. consults for Cambridge Cognition, PEAK (www.peak.net) and Mundipharma.

Sarcopenia and swallowing disorders in older people.

Aging is accompanied by several changes which may affect swallowing function. The beginning of these changes, termed presbyphagia, still captures a preserved swallowing function, although burdened by the consequences of the physiological aging process. Several stressors (including diseases and medications) can easily trigger the disruption of this (increasingly weak) equilibrium and lead to overt dysphagia. It is noteworthy that the swallowing dysfunction may be aggravated by the sarcopenic process, characterizing the so-called "sarcopenic dysphagia", potentially responsible for several health-related negative outcomes. The assessment and management of sarcopenic dysphagia largely rely on the evaluation and integrated treatment of both constituting conditions (i.e., sarcopenia and dysphagia). The management of dysphagia requires a multidimensional approach and can be designed as either compensatory (aimed at producing immediate benefit for the patient through postural adjustments, swallowing maneuvers, and diet modifications) or rehabilitative. Interestingly, some evidence suggests that resistance training traditionally applied to tackle the lower extremity in sarcopenia may be simultaneously beneficial for sarcopenic dysphagia. If these preliminary results (discussed in the present review article) will be confirmed, the systemic beneficial effects of physical exercise will be indirectly demonstrated. This will also support the need of promoting healthy lifestyle in all sarcopenic individuals (thus potentially at risk of dysphagia).

Stomatological disorders in older people: An epidemiological study in the Brazil southern.

BackgroundThe aim of this retrospective, cross-sectional and observational study was to perform a survey of the stomatological conditions of elderly patients seen in a period of 40 years at a Stomatology Service in Southern Brazil.Material and MethodsA total of 24,347 medical records were reviewed, of which 5,063 belonged to elderly patients aged 60 to 97 years. The stomatological conditions, systemic conditions, and smoking and alcohol drinking habits as well were recorded.ResultsThe mean age of the patients was 69.29 years, 67.1% were female and 32.9% were male. Variations of normality accounted for 44.5% of the cases. The most prevalent disorders were fungal infections (26.1%), reactive inflammatory lesions (24.6%), burning mouth syndrome (14.9%), benign neoplasms (12.4%), autoimmune disorders (12.3%), premalignant lesions (10.2%) and malignant epithelial neoplasms (7.2%). Regarding biopsied lesions, squamous cell carcinoma was the most prevalent at 30.2%, followed by hyperplasic lesions (28.2%).ConclusionsKnowledge of these physiological and pathological conditions in the oral cavity of the older people is essential for early diagnosis and preventive and therapeutic measures when necessary. Key words:Oral mucosa, aged, oral medicine, elderly, oral lesions.

Pharmacotherapy for bipolar disorder in older people

Pharmacotherapy for bipolar disorder in older people

The Incidence of Nonaffective, Nonorganic Psychotic Disorders in Older People: A Population-based Cohort Study of 3 Million People in Sweden.

BackgroundThere are limited data on the epidemiology of very late-onset schizophrenia-like psychosis (VLOSLP) and how this relates to potential risk factors including migration, sensory impairment, traumatic life events, and social isolation. MethodsWe followed up a cohort of 3 007 378 people living in Sweden, born 1920–1949, from their 60th birthday (earliest: January 15, 1980) until December 30 2011, emigration, death, or first recorded diagnosis of nonaffective psychosis. We examined VLOSLP incidence by age, sex, region of origin, income, partner or child death, birth period, and sensory impairments. ResultsWe identified 14 977 cases and an overall incidence of 37.7 per 100 000 person-years at-risk (95% CI = 37.1–38.3), with evidence that rates increased more sharply with age for women (likelihood ratio test: χ2(6) = 31.56, P < .001). After adjustment for confounders, rates of VLOSLP were higher among migrants from Africa (hazard ratio [HR] = 2.0, 95% CI = 1.4–2.7), North America (HR = 1.4, 95% CI = 1.0–1.9, P = .04), Europe (HR = 1.3, 95% CI = 1.2–1.4), Russian-Baltic regions (HR = 1.6, 95% CI = 1.4–1.9), and Finland (HR = 1.6, 95% CI = 1.5–1.7). VLOSLP risk was highest for those in the lowest income quartile (HR = 3.1, 95% CI = 2.9–3.3). Rates were raised in those whose partner died 2 years before cohort exit (HR = 1.1, 95% CI = 1.0–1.3, P = .02) or whose child died in infancy (HR = 1.2, 95% CI = 1.0–1.4, P = .05), those without a partner (HR = 1.9, 95% CI = 1.8–1.9) or children (HR = 2.4, 95% CI = 2.3–2.5), and those whose child had a psychotic disorder (HR = 2.4, 95% CI = 2.2–2.6). InterpretationWe identified a substantial burden of psychosis incidence in old age, with a higher preponderance in women and most migrant groups. Life course exposure to environmental factors including markers of deprivation, isolation, and adversity were associated with VLOSLP risk.

Body postural sway analysis in older people with different fall histories.

A cross-sectional study of postural sway analysis in older non-fallers, once-fallers and multiple-fallers using five common standing tests was conducted. Eighty-six older subjects with an average age of 80.4years (SD ± 7.9) participated in the study. The angular rotation and velocity of the trunk of the participants in the roll (lateral) and pitch (sagittal) planes were recorded using an inertial sensor mounted on their lower backs. The Gaussian Mixture Models (GMM), Expectation-Maximisation (EM) and the Minimum Message Length (MML) algorithms were applied to the acquired data to obtain an index indicative of the body sway. The standing with feet together and standing with one foot in front, sway index distinguished older fallers from non-fallers with specificity of 75.7% and 77.7%, respectively, and sensitivity of 78.6% and 82.1%, respectively. This compares favourably with the Berg Balance Scales (BBS) with specificity of 70.5% and sensitivity of 75.3%. The results suggest that the proposed method has potential as a protocol to diagnose balance disorder in older people. Graphical abstract.

Behavioral, Psychiatric, and Cognitive Adverse Events in Older Persons Treated with Glucocorticoids.

Background: Since the introduction of glucocorticoids (GCs) in the physician’s pharmacological arsenal, it has been known that they are a cause of behavioral or psychiatric adverse events (BPAE), as well as of cognitive problems. To the best of our knowledge, the relationship between these adverse events and GCs in older persons has never been evaluated, except through case-reports or series with few cases. In this paper, a review of the literature regarding BPAEs and cognitive disorders in older people treated with CSs is undertaken. Methods: A comprehensive literature search for BPAEs was carried out on the three main bibliographic databases: EMBASE, MEDLINE and PsycINFO (NICE HDAS interface). Emtree terms were: Steroid, steroid therapy, mental disease, mania, delirium, agitation, depression, behavior change, dementia, major cognitive impairment, elderly. The search was restricted to all clinical studies and case reports with focus on the aged (65+ years) published in any language since 1998. Results: Data on the prevalence of the various BPAEs in older patients treated with GCs were very scarse, consisting mainly of case reports and of series with small numbers of patients. It was hence not possible to perform any statistical evaluation of the data (including meta-analysis). Amongst BPAEs, he possibility that delirium can be induced by GCs has been recently been questioned. Co-morbidities and polypharmacy were additional risk factors for BPAEs in older persons. Conclusions: Data on BPAEs in older persons treated with GCs, have several unmet needs that need to be further evaluated with appropriately designed studies.

Chinese observational prospective study of ageing population with chronic kidney disease (C-OPTION): a study protocol

IntroductionThe proportion of elderly people is steadily rising worldwide, especially in low-income and middle-income countries, including China. Chronic kidney disease (CKD) is a common disorder in older people. However, little...

Effect of spinal orthoses and postural taping on balance, gait and quality of life in older people with thoracic hyperkyphosis: protocol for a systematic review and meta-analysis

IntroductionThoracic hyperkyphosis is one of the most common spinal disorders in older people, creating impairment, postural instability, gait disorders and a reduced quality of life. The use of spinal orthoses...

A Randomized, Double-Blinded, Clinical Trial on Effects of a Vitis vinifera Extract on Cognitive Function in Healthy Older Adults

Introduction: Gradual population aging is creating a new set of needs in the general population. Memory capacity decreases with age, and memory deficits are considered an early symptom of Alzheimer’s Disease (AD), one of the most prevalent cognitive disorders in older people. Numerous studies have shown that grape polyphenolic compounds (GPs) are able to attenuate cognitive impairment and reduce brain lesions in experimental AD animal models. These GP effects are associated with improvement in brain antioxidant status and prevention of free radical-induced neuronal damage. We designed a randomized, double-blind, placebo-controlled clinical trial to investigate the potential beneficial effects of a Vitis vinifera-based dietary supplement on cognitive function and neuropsychological status in healthy older adults.Methods: One-hundred eleven subjects were recruited and randomly divided in two groups: one group received the V. vinifera-based dietary supplement Cognigrape® for 12 weeks (250 mg/day) and the second group received placebo over the same period of time. Before and after the end of the supplementation period, cognitive function and neuropsychological status were evaluated using the Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HARS), and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) evaluations.Results: MMSE scores were significantly improved after supplementation with Cognigrape® in comparison with baseline levels (p < 0.0001) and placebo (r = 0.59, 0.95% CI 0.11, 1.22; p < 0.0001). Cognigrape® supplementation produced a significant reduction in BDI (-15.8%) and HARS (-24.9%) scores with respect to baseline levels (p < 0.0001) and placebo (p < 0.0001 for BDI and p < 0.05 for HARS). RBANS total score was significantly improved by Cognigrape® with respect to baseline levels and placebo (r = 0.55, 0.95% CI 0.48, 6.07; p < 0.0001). The comparison with the placebo revealed improvements in several parameters among participants receiving Cognigrape®: attention (p < 0.001); language (p < 0.05); immediate memory (p < 0.0001); and delayed memory (p < 0.0001). Visuospatial/constructional abilities were not modified. During the study, no adverse effects were detected.Conclusion: The results show that 12 weeks of Cognigrape® supplementation is safe, can improve physiological cognitive profiles, and can concurrently ameliorate negative neuropsychological status in healthy older adults.

Clinical characteristics of generalized anxiety disorder: older vs. young adults

Background: Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older people. Although GAD in older adults seems to differ in many aspects like clinical presentation, severity and treatment response, there is a paucity of comparative research.Aims: The aim of the study is to compare the clinical presentation of GAD between older and young adults.Methods: One hundred and two non-demented older patients (age ≥65) and 64 young patients (age <45) who were diagnosed with GAD according to the DSM-IV-TR criteria were included to the study. Socio-demographic Data Form, the Structured Clinical Interview for DSM Disorders-1 (SCID-1), the Questionnaire for the Suggested Behavioral Criteria of GAD for DSM-5, the Hamilton Depression Scale (HAM-D), the Generalized Anxiety Disorder Severity Scale (GADSS) and the Sheehan Disability Scale (SDS) were applied to both groups.Results and conclusions: Older GAD patients had more disturbances of sleep, less reassurance seeking behaviors, higher rates of depression and higher depression severity when compared to the young patients. Although older people seemed to have a lower severity of GAD, they had higher disability due to worries. Older patients worried more about their own health and family well-being, whereas young patients worried more about future and other’s health.