Health Problem In Elderly People Research Articles

“The Lower the BP the Better” Paradigm in the Elderly

If a man will begin with certainties, he shall end in doubts; but if he will be content to begin with doubts, he shall end in certainties.— —Francis Bacon, The Advancement of Learning, year 1605 Hypertension is a growing public health problem in elderly people, with a prevalence up to 80% in individuals aged ≥70 years. Isolated systolic hypertension accounts for 60% to 75% of cases, systolic blood pressure (BP) being the dominant prognostic marker.1 Unfortunately, the rate of hypertension control only minimally improved over last year’s in elderly subjects when compared with the younger people.2 Several randomized clinical trials tested the benefit of treatment in elderly patients with isolated systolic hypertension or systolic-diastolic hypertension. Staessen et al3 reviewed 8 randomized clinical trials carried out in patients with isolated systolic hypertension and aged ≥60 years. Active treatment reduced total mortality by 13%, cardiovascular (CV) mortality by 18%, all CV complications by 26%, stroke by 30%, and coronary events by 23%. The benefits of treatment in octogenarians remained unproved for years up to the results of the Hypertension in the Very Elderly Trial, in which 3845 patients aged ≥80 years with systolic BP ≥160 mm Hg were randomized to indapamide or placebo. Perindopril or matching placebo was added if necessary to achieve the target BP of 150/80 mm Hg. The trial was stopped after less than 2 years of follow-up because of a beneficial effect of treatment on several outcomes including all-cause mortality, although the primary study outcome, fatal or nonfatal stroke, was only marginally reduced (by …

Dermatological findings in the senior population of nursing homes in Turkey

As the elderly population grows, the problems including skin diseases become more and more frequent. This study involved 300 elderly patients living in 3 nursing homes in Ankara. Their average age was 76.4 years. The average period of time they had lived in the nursing homes was 48.7 months, 25.7% of the cases were bedridden, and 274 cases (91.3%) had at least one systemic disease. Details of the past medical history and the consumed drugs were recorded. The dermatological examination of all cases was performed. Age and sex-dependence of the findings was statistically evaluated, and the risk factors for dermatological diseases were analyzed. The most frequent diseases of the elderly people were: fungal infections and xerosis, with prevalence of 49.7% and 45.3%, respectively. Dermatitis and pruritus were less prevalent (11.0% and 10.3%, respectively). Fungal infections and varicosities were detected more frequently in males, than females. The only risk factor detected for fungal infections was the male sex. We conclude that this study contributes to the identification of the health problems of elderly people, representing a growing proportion of the population in the near future.

'Justifiable depression': how primary care professionals and patients view late-life depression? a qualitative study

Depression is the commonest mental health problem in elderly people and continues to be underdiagnosed and undertreated. To explore the ways that primary care professionals and patients view the causes and management of late-life depression. A qualitative study using semistructured interviews. One Primary Care Trust in North West England. Fifteen primary care practitioners comprising nine GPs, three practice nurses, two district nurses and one community nurse; twenty patients who were over the age of 60 and who were participating in a feasibility study of a new model of care for late-life depression [PRIDE Trial: PRimary care Intervention for Depression in the Elderly (a feasibility study in Central Manchester funded by the Department of Health)]. Primary care practitioners conceptualized late-life depression as a problem of their everyday work, rather than as an objective diagnostic category. They described depression as part of a spectrum including loneliness, lack of social network, reduction in function and viewed depression as 'understandable' and 'justifiable'. This view was shared by patients. Therapeutic nihilism, the feeling that nothing could be done for this group of patients, was a feature of all primary care professionals' interviews. Patients' views were characterized by passivity and limited expectations of treatment. Depression was not viewed as a legitimate illness to be taken to the GP. Primary care professionals recognized that managing late-life depression did fall within their remit, but identified limitations in their own skills and capabilities in this area, as well as a lack of other resources to which they could refer patients. This study highlights the complicated nature of the diagnosis and management of late-life depression. Protocols for the diagnosis and treatment of depression emphasis the biomedical model which does not fit with the everyday experience of GPs or elderly patients who share the views of primary care professionals that depression is a consequence of social and contextual issues. There is a need for the development of evidence-based provision for older people with depression within primary care, but also a need for elderly patients to be made aware of the legitimacy of presenting low mood and misery to their primary care professional.

Association of the OGG1 Ser326Cys polymorphism with tooth loss

Although tooth loss is a serious health problem for elderly people, little is known about the genetic basis for susceptibility to it. In the present study we aimed to find a single nucleotide polymorphism (SNP) associated with tooth loss. DNA samples from 119 outpatients (mean age=78.8 years) were genotyped on seven polymorphisms (tumor necrosis factor-alpha -1031T/C, interleukin-1beta -511C/T, interleukin-6 -634C/G, macrophage migration inhibitory factor -173G/C, interleukin-1 receptor antagonist variable number of tandem repeat in intron 2, matrix metalloproteinase-1 -16071G/2G, and oxoguanine glycosylase 1 (OGG1) Ser326Cys (1245C/G)), and the results were statistically evaluated. Of the seven polymorphisms tested, only OGG1 Ser326Cys was revealed to associate with tooth loss at a statistically significant level (P=0.0086). In addition, a multivariate logistic regression analysis in which age, gender, body mass index (BMI), and ischemic heart disease were included as independent variables indicated that Ser326Cys could be an independent factor affecting tooth loss (OR, 3.191; 95%CI, 1.174-8.672). The data suggest that the OGG1 Ser326Cys polymorphism may be associated with tooth loss.

Vitamin D insufficiency in Japanese populations: from the viewpoint of the prevention of osteoporosis

Low levels of vitamin D nutrition (i.e., vitamin D insufficiency), which potentially cause osteoporosis, have been recognized as a common health problem for elderly people in European and North American countries, but there have been no studies on the prevalence of vitamin D insufficiency in Japan until recently. The aim of this article was to review descriptive features of serum 25-hydroxyvitamin D [25(OH)D] levels and vitamin D insufficiency in Japanese subjects. Reviewing 15 studies pertaining to vitamin D nutritional status recently published for various Japanese populations revealed that: (1) the prevalence of vitamin D insufficiency in active elderly people was as low as 5% or less; (2) the prevalence of vitamin D insufficiency was much higher (up to about 50%) in inactive elderly people than in active elderly people, depending on activities of daily living (ADL); (3) frequent fish consumption helps increase serum 25(OH)D concentrations, especially in winter; and (4) vitamin D nutrition in young women was poorer than people in middle and advanced ages, which may adversely affect bone metabolism. Future studies should focus on the effects of low vitamin D status on bone mass and fractures in Japanese subjects.

Managing delirium in older people

Learning objectives After reading this article it is anticipated the reader will be able to: 1.identify drugs that may contribute to a delirium 2.recognise different ways in which delirium can present 3.describe the main objectives of management 4.describe the main interventions to manage delirium 5.outline some of the interpersonal issues in managing delirium Delirium—also known as Acute Confusional State—is a common health problem in elderly people, with those in care settings at particular risk. is an acute, largely reversible, disorder of cognition marked by impaired attention, fluctuations in the presentation, and frequently disturbances of, perception. A clinical syndrome rather than a discrete disorder, it is not dementia. Often misidentified, with delirium are frequently mis-treated, even when symptoms are recognised. The cause of much distress and disability, it impairs cognitive and physical function and can lead to death. Although it will be briefly addressed here, the recognition of delirium is dealt with more completely in Delirium in older people (Harding 2004) and elsewhere. can arise with almost any medical condition or treatment and may be the only indicator of the presence of physical disorder. Though it rarely has a single cause, many potential causes or risk factors are readily identified and should be addressed as part of appropriate management. The introduction of routine cognitive screening—with appropriate investigation of sudden changes in cognition and function—would improve the identification of cognitive impairment in general and acute cognitive change in particular. People involved in the treatment and care of older may then consider delirium as a cause for cognitive or functional change before deciding that someone is demented.

Promoting influenza vaccination of elderly patients in primary care

Though influenza is a serious health problem for elderly people, their influenza vaccination rate remains low in Switzerland. Our aim was to assess the impact of an intervention combining multiple strategies to promote influenza vaccination of elderly patients in primary care. We conducted a pre-/post-intervention study in a university-based primary care clinic in Geneva, Switzerland, where an annual community-wide campaign promotes influenza vaccination of people at high risk. We included 318 and 346 patients aged over 64 years attending the clinic during the last trimesters of 1995 and 1996, respectively. The intervention included: patient information by leaflets and posters, a walk-in vaccination clinic, a training workshop for physicians, record reminders and peer comparison feedback on vaccination performance. Using the computerized database, medical records and the vaccination register, we measured influenza immunization rates and relative benefits (RBs) of the intervention. Influenza vaccine uptake globally increased from 21.7% before the intervention to 51.7% thereafter. Among 144 patients attending in both phases, the immunization rate rose from 29.2 to 69.4% [matched RB estimate (<RB>) = 2.4; 95% confidence interval (CI) 1.9-3.0]; vaccine uptake increased particularly among all chronic patients (<RB> = 3.2; 95% CI 2.2-4.6), cardiac patients (<RB> = 3.4; 95% CI 2.1-5.4) and diabetics (<RB> = 3.3; 95% CI 1.9-5.9). For 376 patients attending in a single phase, the vaccination rate rose from 15.5 to 39.1% (adjusted RB = 2.8; 95% CI 1.8-4.4), particularly among the elderly aged 65-75 years (adjusted RB = 5.7; 95% CI 2.7-12.4). An intervention combining strategies targeting patients, physicians and care delivery significantly increased influenza vaccine uptake of elderly patients in primary care, particularly those at high risk.

Survey into health problems of elderly people: a comparison of self-report with proxy information.

This study was conducted as part of the Medical Research Council Cognitive Function and Ageing Study. To compare information given by elderly people on their past and current health and family history of illness with similar information obtained from a relative, friend or carer. Screening and assessment stages of a prevalence study. Three urban and two rural areas of England and Wales. A subsample weighted by age and cognitive status of random population samples of people >/=65 years, living in their own home or in a residential or nursing home, interviewed between 1991 and 1994. A relative, friend or carer identified by each elderly person to provide proxy information. INTERVIEW: Computerized schedules including items on demographic details, cognitive function, lifetime illnesses, current health problems and family history of illness. The rate of proxy 'don't know' responses and the agreement between the elderly person and their proxy were calculated for each item, both for the overall sample and for subgroups based on characteristics of the respondent and of the proxy and on the relationship between them. Higher 'don't know' rates were found to be particularly associated with more distant relationships, questions on family history, a shorter length of time known and a lack of co-residence. Agreement was strongly related to the nature of the question and less to co-residence, with other factors such as relationship having much smaller effects. Proxy information on past and current health problems can be almost complete and in good agreement with self-report, particularly where the proxy lives with the respondent. On family history of illness, history of head injury or boxing and current sleep problems, proxy information is likely to be less complete and show poor agreement. A proxy who is not a close relative is likely to give less complete information but agreement will not be substantially lower.

Survey into health problems of elderly people: multivariate analysis of concordance between self-report and proxy information.

In many cases probands are unable to give information about their own history. Our objective was to compare information given by elderly people on their past and current health and family history of illness with similar information given by a relative, friend or carer. In three urban and two rural areas of England and Wales a sub-sample, weighted by age and cognitive status, was drawn from random population samples of people aged >/=65, not permanently living in hospital, and interviewed between 1991 and 1994, plus for each of these a relative, friend or carer. The relation between the reports of probands and informants on cognitive function, lifetime illnesses, current health problems, and family history of illness was analysed using multiple regression of agreement, measured using Cohen's kappa, and logistic regression of bias and of proportion of 'not known' responses. Potential explanatory variables used were: centre, proband cognitive function, proband sex, informant sex, proband age, difference in age (generation), relationship, frequency of contact, period known, modality of informant interview. Overall agreement per interview measured by kappa between informant and proband was lower for older probands, probands who were cognitively impaired, and those who saw one another less often; each effect adjusted for all the others using multiple regression. Informants tended to over-report relative to probands if the proband was cognitively impaired, male, they themselves were female, of a younger generation, and co-resident; each effect adjusted for all the others using logistic regression. Interviews were more likely to be missing at least one item if the informant was not the spouse, had known the proband for less time, and was not co-resident; each effect adjusted for all the others using logistic regression. There is reasonable accord between probands and informants which is enhanced by close contact, long period of knowledge, and a female informant. Degree of kinship is not critical. Informant interviews may be conducted by telephone rather than face-to-face without serious loss of quality.

Fall Injuries among Elderly Persons Living at Home

Falls and their consequences are a major health problem for elderly people. The aim of this study is to describe and analyse registered fall injuries in people 65 years and older, living in their own homes, during one year. In a local health care district, injuries of such severity as to require the attention of a doctor were registered. A form designed according to the National Swedish Board of Health and Welfare classification for registration of accident injuries was used. The computer program Epiinfo was used for processing and analysis. One thousand six hundred and thirty-nine fall injuries among elderly people living at home were registered. The women accounted for 70%. The injuries occurred mostly at home or in the home area during daytime and in connection with daily routines. Fractures accounted for 46.4% of the injuries. Of the victims, 44.4% needed to make only one visit to a doctor. Additional visits and admission to hospital were more common among the women. The study reveals that most of those injured were women, and that the falls occurred during their daily routines. Registration of this kind tells nothing about the persons and the circumstances behind the accidents. In order to gain deeper knowledge, complementary investigations are necessary.

The mental health problems of elderly people living on London's streets

AbstractThere are inconsistent research findings regarding the prevalence of mental illness in homeless individuals of all ages. Most studies, both in Britain and in America, have concentrated on homeless persons in hostels or shelters. A few American works have examined individuals sleeping on the streets but this is a neglected area of research in Britain. Very few studies have examined the prevalence of mental illness in elderly homeless persons. This article reports findings from a recent investigation of the mental health problems of elderly homeless people who were sleeping on the streets in central London. Through observation and interviews it appeared that a high proportion of these individuals had mental health problems. Whereas nearly half of the elderly men appeared to be depressed, the majority of women either portrayed thought disturbances or were identified as having severe memory problems.

Delirium in the Elderly: A Brief Overview

Organic mental disorders with cognitive impairment constitute an important medical and public health problem in elderly people. The emergence of severe acute psychiatric manifestations of delirium as a consequence of structural brain disease or cerebral dysfunction related to some other physical illness is well known in clinical practice. After a long period of nosological inconsistency, the DSM-111, and now the DSM-111-R, present operational diagnostic criteria for delirium emphasizing the cognitive symptoms of the disorder. At the same time different psychomotor symptoms in, for example, hyperkinetic, mixed, or silent delirium are also being recognized. In addition, many clinical studies have illustrated the wide variation in predisposing, precipitating, and sustaining factors for delirium, thus providing a basis for etiological hypotheses.

Challenging the old age myths.

The myth of inevitable decline in old age was challenged last week with the launch of a new Open University course looking at the mental health problems of elderly people.