Jaakko Valvanne

Postural Hypotension and Dizziness in a General Aged Population: A Four-Year Follow-Up of the Helsinki Aging Study

OBJECTIVE: To evaluate the frequency, risk factors, and prognostic significances of postural hypotension (PH) and dizziness on postural testing (DPT).

Correction for age, education and other demographic variables in the use of the Mini Mental State Examination in Finland.

The population‐based Helsinki Aging Study was comprised of three age groups: 75‐, 80‐ and 85‐year‐olds. A random sample of 511 subjects completed the Mini Mental State Examination (MMSE) and were assessed on the Clinical Dementia Rating ‐ scale (CDR). According to the CDR results 446 subjects were screened as non‐demented. Of these subjects 30% scored below or at 24 MMSE points. Age, education and social group had a significant effect on the MMSE scores, even after excluding the demented cases. Together they explained 10% of the total variance within the MMSE. Social group correlated with education. The MMSE scores were corrected according to age and education. Adjustment of the originally used cutpoint of 24 resulted in cutpoints of 25 and 26 among the 75‐year‐olds, in the low and high education groups respectively; 23 and 26 in the 80‐year‐olds; 22 and 23 in the 85‐year‐olds.

Major Depression in the Elderly: A Population Study in Helsinki

The aim of the study was to estimate the prevalence of major depression and to evaluate associated features in random age cohorts of 75, 80, and 85 years (N = 651). A clinical examination was made by experienced health center physicians, and major depression was diagnosed according to DSM-III criteria. The prevalence increased with age and was 1% to 4% in the age groups of 75 and 80 years, but 13% at the age of 85 years. No sex difference was found. The frequency of major depression was fourfold among institutionalized patients (16%) as compared to those living at home (4%). Major depression was strongly associated with objective health, intellectual functioning, and functional capacity. Depression was most common in subjects suffering from poor vision, urinary incontinence, or Parkinsons disease (odd ratios 4.2 to 4.9). Depression was also correlated with musculoskeletal disorders, coronary heart disease, and cerebrovascular diseases (odd ratios 2.5 to 3.4). The survey suggests that major depression is quite rare in healthy elderly people but common in disabled institutionalized patients.

Staging the severity of dementia: comparison of clinical (CDR, DSM-III-R), functional (ADL, IADL) and cognitive (MMSE) scales

The Helsinki Aging Study is based on a random sample of 795 subjects aged 75 years (N = 274), 80 years (N = 266) and 85 years (N = 255). Ninety‐three demented patients were found. All were assessed for severity of dementia by Clinical Dementia Rating (CDR) scale by a general practitioner and according to the DSM‐III‐R criteria by a neurologist. The Mini‐Mental State Examination (MMSE) was carried out by a community nurse and the Index of ADL and the IADL‐scale by a close informant. The correlation of the severity of dementia between the DSM‐III‐R criteria and the CDR scale was moderate. The overall agreement was 64.5° and the Kappa index 0.56. The CDR scale tended to put patients in milder categories than the DSM‐III‐R criteria. The correlation between the clinical scales and categorized MMSE was moderate to fair. The overall agreement between MMSE and DSM‐III‐R criteria was 64% (Kappa 0.44) and between MMSE and CDR scale 55% (Kappa 0.33%). The dispersion of the functional scales (ADL, IADL) was much greater indicating that there were also other factors influencing the functional capacity than the degree of dementia. Different methods in staging dementia give different results thus influencing for instance the results of epidemiological studies. Functional scales are needed in clinical practice in addition to the assessment of the severity of dementia. The CDR scale is useful in assessing the need for support services.

Prevalence of dementia in the city of Helsinki

The Helsinki Aging Study is based on a random sample of 795 subjects aged 75‐years (N = 274), 80‐years (N = 266) and 85‐years (N = 255). A clinical examination including Clinical Dementia Rating (CDR)‐scale was carried out in 82% of the cases. 93 demented subjects were found, 17 of whom had mild dementia. The prevalence of moderate and severe dementia was 2.9%, 10.3% and 23.3% in the age groups of 75‐year‐olds, 80‐year‐olds and 85‐year‐olds, respectively. If we take into account also the mild cases, we get the prevalence of dementia 4.6%, 13.1% and 26.7% in the above mentioned age groups, respectively. The proportion of mild dementias was lower than expected, which probably reflects both the difficulties to recognize mild dementia in an elderly population and the relatively small compensatory capacity of elderly people.

Secular Trends in Self-Reported Functioning, Need for Assistance and Attitudes Towards Life: 10-Year Differences of Three Older Cohorts

OBJECTIVES: To compare the self‐reported functional status of cohorts, born 10 years apart, when they were at equivalent ages: 75, 80, or 85.

Predictors of mortality following primary hip and knee replacement in the aged: A single-center analysis of 1,998 primary hip and knee replacements for primary osteoarthritis

Background and purpose High age is associated with increased postoperative mortality, but the factors that predict mortality in older hip and knee replacement recipients are not known. Methods Preoperative clinical and operative data on 1,998 primary total hip and knee replacements performed for osteoarthritis in patients aged ≥ 75 years in a single institution were collected from a joint replacement database and compoared with mortality data. Average follow-up was 4.2 (2.2–7.6) years for the patients who survived. Factors associated with mortality were analyzed using Cox regression analysis, with adjustment for age, sex, operated joint, laterality, and anesthesiological risk score. Results Mortality was 0.15% at 30 days, 0.35% at 90 days, 1.60% at 1 year, 7.6% at 3 years, and 16% at 5 years, and was similar following hip and knee replacement. Higher age, male sex, American Society of Anesthesiologists risk score of > 2, use of walking aids, preoperative walking restriction (inability to walk or ability to walk indoors only, compared to ability to walk > 1 km), poor clinical condition preoperatively (based on clinical hip and knee scores or clinical severity of osteoarthritis), preoperative anemia, severe renal insufficiency, and use of blood transfusions were associated with higher mortality. High body mass index had a protective effect in patients after hip replacement. Interpretation Postoperative mortality is low in healthy old joint replacement recipients. Comorbidities and functional limitations preoperatively are associated with higher mortality and warrant careful consideration before proceeding with joint replacement surgery.

Usefulness of the Clinical Dementia Rating Scale in Screening for Dementia

The Clinical Dementia Rating (CDR) scale is a qualitative staging instrument that has traditionally been used for assessing the severity of dementia. We used it for screening dementia in a population study of 75-, 80-, and 85-year-old people. The modified CDR scale was easy to establish and it proved to be useful in screening dementia. A more thorough examination is needed in the second phase to identify the false positives. The sensitivity of the CDR scale was 95% and the specificity 94%.

Coexistence of lowered mood and cognitive impairment of elderly people in five birth cohorts.

Using Goldberg’s General Health Questionnaire (GHQ) to identify potential cases of mental disorders, we screened 246 randomly; selected persons among the 116 616 people older than 65 in the metropolitan zone of Guadalajara; 86 subjects (35%) qualified as “cases”; this figure is much higher than that reported (20.8%) in the adult population in a previous study. Among the cases, 69% were female, 66% were widowed, and 50% were divorced; 44% had not finished gradeschool, 42% had no scholastic education, 54% were unemployed, and 40% worked at home. Factors associated with anxiety and severe depression, sleep disorders, psychosomatic symptoms, and problems in interpersonal relations were studied.

The prevalence of potential alcohol–drug interactions in older adults

Abstract Objectives. The aim of this study was to assess the possibility of clinically significant drug–alcohol interactions among home-dwelling older adults aged ≥ 65 years. Design. This study was a cross-sectional assessment of a stratified random sample of 2100 elderly people (≥ 65 years) in Espoo, Finland. The response rate was 71.6% from the community-dwelling sample. The drugs were coded according to their Anatomical Therapeutic Chemical (ATC) classification index (ATC DDD 2012). Significant alcohol interactive (AI) drugs were examined according to the Swedish, Finnish, INteraction X-referencing (SFINX) interaction database, as well as concomitant use of central nervous system drugs, hypoglycaemics, and warfarin with alcohol. “At-risk alcohol users” were defined consuming > 7 drinks/week, or ≥ 5 drinks on a typical drinking day, or using ≥ 3 drinks several times/week, “moderate users” as consuming at least one drink/month, but less than 7 drinks/week, and “minimal/non-users” less than one drink/month. Results. Of the total sample (n = 1395), 1142 respondents responded as using at least one drug. Of the drug users, 715 (62.6%) persons used alcohol. The mean number of medications was 4.2 (SD 2.5) among “at-risk users”, 4.0 (SD 2.6) among “moderate users”, and 5.4 (SD 3.4) among “minimal/non-users” (p < 0.001). The concomitant use of AI drugs was widespread. Among the “at-risk users”, “moderate users”, and “minimal/nonusers” 42.2%, 34.9%, and 52.7%, respectively, were on AI drugs (p < 0.001). One in 10 of “at-risk users” used warfarin, hypnotics/sedatives, or metformin. Conclusions. Use of AI drugs is common among older adults, and this increases the potential risks related to the use of alcohol.