Franklin E. May

Nocturia: A Risk Factor for Falls in the Elderly

Objective: To determine if nocturia is a risk factor for reported falls and bone fractures in older persons.

Symptom prevalence in the elderly. An evaluation of age, sex, disease, and medication use.

Prevalence of reported symptoms was studied in 1927 women and 1140 men over 65 years of age in an ambulatory health screening program. Reports of 28 common symptoms were obtained from a standardized questionnaire completed by participants at the time of their fourth annual visit to the program. A comparison was made of the prevalence of specific symptoms by sex, age, disease states, and drug use patterns. The most common symptoms reported by women were nocturia (80.4%), swollen feet or ankles (30.5%), cold feet and/or legs (28.6%), and irregular heartbeat (23.2%), whereas men complained most often of nocturia (79.8%), irregular heartbeat (24.8%), cold feet and/or legs (23.6%), and tinnitus (23.1%). Women reported a mean of 3.99 symptoms compared with 3.22 reported by men (P < .0001). In women there was a statistically significant association for most symptoms in subjects reporting the use of medication compared with a group who did not use medication. In men the use of medication was less highly correlated with reports of symptoms. Nearly 100% of participants reported having at least one disease state. The number of symptoms reported was strongly related to the number of disease states, and after adjusting for diseases, women reported more symptoms than men. The best predictor of symptom prevalence was the number of disease states followed by the number of drugs used and then age.

Drug use in an ambulatory elderly population: a five-year update.

Drug usage was studied in an ambulatory elderly population in Dunedin, Florida. Prescription and nonprescription drug use in these 2834 participants was compared with use during a period five years earlier. The average number of medications increased from 3.2 in 1978–80 to 3.7 in 1983–85. The most commonly prescribed medications in this population were hydrochlorothiazide-triamterene (13.5 percent), digoxin (9.6 percent), and hydrochlorothiazide (8.4 percent). There was a large increase in the use of nutritional supplements in the past five years, with 18.0 percent of these subjects reporting the use of vitamin E and 15.7 percent taking vitamin C. The general philosophy in geriatrics is to use the fewest drugs possible; however, it appears that the elderly are, in fact, receiving an increasing number of medications.

A longitudinal evaluation of drug use in an ambulatory elderly population

Participants in a geriatric health screening program were studied longitudinally to determine the patterns of drug use over a 10 year period. There were 314 (34.0%) men and 610 (66.0%) women who completed 10 yearly health screening evaluations. The mean number of prescribed and non-prescribed drugs used per participant increased from 2.90 in 1978-79 to 4.08 in 1987-88 (p less than 0.0001). There was no significant difference between men and women in the rate of increased drug use. There was no significant increase in the mean number of drug ingredients per participant used over the 10 year period. The most frequently reported therapeutic categories for 1978-79 were antihypertensives, analgesic-antipyretics, antirheumatics, multiple vitamins, cathartics and vitamin E, which represented 10.2, 7.2, 6.5, 4.9, 4.8 and 3.8% of all categories used. There was a decline in all of these categories between interval 1 and 10. Increased use of drugs, particularly prescribed medications, by the elderly population may present problems of adverse drug reactions, drug interactions and medication compliance in the future. Changing patterns of drug use may have resulted, in part, from introduction of new therapeutic classes and from new treatment concepts over the 10 year study period.

Headache in the Elderly: An Evaluation of Risk Factors

SYNOPSIS

Clinical Research in the Elderly: Ethical and Methodological Considerations

Clinically oriented research in the elderly is of growing interest because of increasing numbers of older persons, the relative lack of research data with this population, and recent Food and Drug Administration mandates to study drugs in the elderly. Studies of young, healthy persons cannot necessarily be extrapolated to the elderly due to changes associated with aging and the increased number of concomitant disease states and medications. Subject recruitment may be more time consuming in finding subjects with the appropriate inclusion criteria and lack of exclusion criteria who are willing to participate. Additional concern must be placed on protecting the subjects rights while allowing autonomous decision making. Likewise, protocols may need to be flexible enough to include persons with concomitant disease and medications.

Use of Nutritional Supplements in an Ambulatory Elderly Population

The use of nutritional supplements by 3,192 ambulatory elderly participants in a health screening program is described. The 2,009 women used vitamin (45.5 per cent) and mineral (22.4 per cent) products with significantly greater frequencies than did the 1,183 men (34.0 per cent and 15.0 per cent, respectively); chi‐square, P < 0.01. The most commonly used vitamin products were multiple vitamins, multiple vitamins with minerals, vitamin E, and vitamin C; for minerals, the ranking was potassium chloride, calcium salts, and ferrous sulfate. Eighty‐two participants (2.5 per cent) reported the use of four or more supplements. Many older Americans are spending a great deal of money for nutritional supplements, whereas it would seem that the money could be better spent to improve the quality of their diet.

Psychotropic drug use in an ambulatory elderly population.

Medication histories were obtained from 3,192 ambulatory elderly persons participating in a health screening program. A total of 2,009 (63%) women and 1,183 (37%) men were included in the drug use study. Flurazepam, pentobarbital and the combination of amobarbital and secobarbital were used by 4.5, 0.6 and 0.4% of participants, respectively, and these three agents accounted for 87.6% of all prescribed hypnotic drugs. Diazepam, meprobamate and chlordiazepoxide were the most commonly used minor tranquilizers. Barbiturates were contained in nearly one fourth of minor tranquilizers used by these elderly subjects. Less than 1% (0.5%) of the participants in this program reported the use of a neuroleptic. Approximately 3% of the participants reported the use of an antidepressant drug. Nearly 90% of participants who reported the daily use of a hypnotic agent state they had been using the product on a daily basis for longer than 1 year.

Drug use in the hospital: Evaluation of determinants

Factors influencing drug utilization were studied in 7,575 hospitalized patients on a 65 bed general medical service during a 3½ year period. Nine index drug groups, including analgesic, antacid, antiarrhythmic, antimicrobic, anticoagulant, antihypertensive, anti‐inflammatory, diuretic, and sedative‐tranqUilizer drugs were used to evaluate drug utilization. The average number of drugs received by each patient was 8.04, and the average patient drug exposure for the 9 index drug groups was 4.75. The average patient drug exposure to index therapeutic drug groups was found to be significantly higher during the February‐March and April‐May periods than during the August‐September and December‐January periods of the study. Factors found to have a significant influence on drug use included the formulary system and changes in the availability of drugs. Distribution of a drug letter published by the Pharmacy and Therapeutics Committee did not appear to affect drug prescribing.

Lack of association of nonsteroidal anti-inflammatory drug use and cognitive decline in the elderly

Folstein Mini-Mental State Examination (MMSE) scores obtained in an ambulatory elderly population were used to examine the effect of nonsteroidal anti-inflammatory drug (NSAID) use on cognitive performance. There were 1,310 participants who met the inclusion criteria for the study, of whom 873 (66.6%) were women and 437 (33.3%) were men. There were no differences in mean MMSE scores or in the five dimensions of cognitive function measured by the MMSE for subjects reporting NSAIDs or aspirin use.