Karolina Piotrowicz

The prevalence of falls and their relation to visual and hearing impairments among a nation-wide cohort of older Poles

Falls are a geriatric syndrome which affects the physical and psychological well-being of the aged. So far, in Poland there have not been any population-based data on the prevalence of falls among the elderly. The aim of this analysis was to assess the prevalence of falls, their circumstances and consequences in the Polish population aged 65 years and older in comparison to younger respondents aged 55-59 years, and the relation of falls to visual and hearing deficits. Mean age of the 4920 elderly subjects (51.6% men) was 79.4±8.7 years. Falls in the past year were reported by 10.4% of the younger and 19.1% of the older subjects. In both groups falls occurred more frequently in women (11.9% vs. 8.7%, p=0.03 in the younger and 22.7% vs. 13.2%, p<0.001 in the older group). In the group of older subjects falls occurred most often during walking (66.7% vs. 50.7% in the group of 55-59 years old), p=0.005), while the younger more often fell while practicing sports (5.48% vs. 0.8% in the group 65+, p<0.001) and risky activities (respectively: 13.7% vs. 4.9%, p=0.002). A similar percentage of younger and older fallers reported one (44.0% and 46.1% respectively) or more falls (56.1% and 53.9%; p=0.6). The percentage of recurrent fallers grew with increasing age (Cc=0.177; p<0.001). The prevalence of injurious falls was similar in the younger and older groups (45.4% and 42.8%, p=0.53). In both genders fall-related injuries were more frequent in younger elderly (65-74 years old) and in subjects 90 years old and older. In the non-standardized analysis and after adjustment for age and gender visual and hearing impairments and its degree were associated with falls but both relations lost statistical significance after adjustment for a set of explanatory variables. Despite somewhat lower estimates, falls in older Poles are no less an important factor influencing overall health than in other populations. The higher prevalence of multiple falls should draw attention of the health-care policy makers. Sensory impairment may add to the risk of falls and should be adequately taken care of, however the priority in the future fall prevention initiative should be given to stronger factors, such as age, type of activity, overall health, cognitive function and functional status.

The assessment of cognitive impairment suspected of dementia in Polish elderly people: results of the population-based PolSenior Study.

The growing incidence of dementia in ageing societies is a major concern of health care organizations. Because of its detrimental influence on the mental and functional statuses of elderly people, it leads to increased economic burdens caused by the social and financial needs of patients with dementia and their caregivers. There has been no data concerning the prevalence of dementia in the elderly in the general Polish community so far. The main aim of the study was to assess the prevalence of cognitive impairment suspected of dementia among the Polish elderly and the relationships between cognitive performance and age, gender, place of residence and educational status. The presented data was the result of nationwide, multicentre PolSenior Study conducted from 2007 to 2011 in the Polish elderly population. Cognitive functions were evaluated using Mini-Mental State Examination (MMSE) performed by pre-trained nurses. The result of MMSE lower than 24 points was classified as cognitive impairment suspected of dementia and divided according to its severity into three stages: mild, moderate and severe dementia. The results were analysed in two ways: raw MMSE and MMSE scores after Mungas adjustment (MMSEadj), that is, corrected for age and educational level, and these were compared. To verify the suspicion of dementia an assessment was complemented by an interview of carers for the occurrence and course of memory disorders, treatment of dementia and by functional status assessment. In order to assess the prevalence of suspicion of dementia in the general Polish population, statistical analyses based on weighting were done. The suspicion of dementia on the basis of raw MMSE was made in 20.4% of respondents aged 65years and more, and after Mungas adjustment in 12.1% of older subjects. The prevalence of cognitive impairment grew with increasing age, as well as depending on the educational status of elderly respondents in both types of analyses; raw MMSE and MMSEadj. There was no significant difference in the prevalence of cognitive impairment according to gender in the general population (raw MMSE); however in analyses including MMSEadj results, the suspicion of dementia was made more often among men. Suspicion of dementia based on raw MMSE and MMSEadj results was made significantly more often among men than women at the age of 65-69years, and significantly more often among the oldest women, aged 90years and more. Suspicion of dementia was diagnosed more often in respondents living in rural communities (based on raw MMSE, but not on MMSEadj), which might be related to the differences in their educational status.

Reduced functionality in everyday activities of patients with self-reported heart failure hospitalization — Population-based study results

AIM To assess daily functioning and geriatric conditions of older subjects suffering from heart failure (HF) as compared to the general population. METHODS AND RESULTS The data were collected as part of the nationwide PolSenior project (2007-2011). Of 4979 individuals (age range 65-104 years), data on self-reported HF hospitalization were available for 4795 subjects (96%). Geriatric assessment (GA) included functional status (ADL, Activities of Daily Living and IADL, Instrumental ADL scales), cognitive function, mood disorders, sensory organ impairment, falls and comorbidity. Mean age ± SD of the study population was 73.8 ± 6.5 years; 62% were female. The proportion of subjects with HF hospitalizations increased from 8% in subjects aged 65-69 years up to 13% in the age group of 85-89 years, and decreased in nonagenarians (11%). Subjects with the HF hospitalization were older, used more drugs, and were characterized by a higher prevalence of comorbid conditions, mood disorders, hearing impairment and functional limitations. In logistic regression, HF hospitalization increased the age-sex adjusted risk of disability by 40%, both in ADL and IADL. After adjustment to other clinical and geriatric conditions, HF hospitalization remained an independent predictor of disability in both ADL (OR=1.36, 95%CI: 1.00-1.84) and IADL (OR=1.40, 95%CI: 1.01-1.93). CONCLUSIONS Older people who reported HF admissions had a higher number of comorbidities and geriatric conditions: mood disorders, hearing impairment and functional limitations. Besides, in our study, HF hospitalization independently and significantly increased the risk of limitations in IADL and ADL. Therefore, further studies are needed to evaluate the benefits of GA in patients with HF.

Clustering of geriatric deficits emerges to be an essential feature of ageing - results of a cross-sectional study in Poland

The majority of old people suffer from various clinical conditions that affect health, functioning and quality of life. This research is a part of a cross-sectional, nationwide PolSenior Study that provides a comprehensive assessment of eight geriatric impairments and their co-occurrence in a representative sample (3471 participant aged 65-104 years, mean age 78.3 years) of the old adults living in the community in Poland. The participants were recruited randomly from all administrative regions of Poland by a three-stage, proportional, stratified-by-age group selection process. Eight geriatric conditions were assessed: falls, incontinences, cognitive impairment, mood disorders, vision and hearing impairments, malnutrition, and functional dependence. We showed that the most common deficits causing disability were vision and hearing impairments, and mood disorders, with more than two thirds of the participants presented at least one geriatric deficit. We showed that presence any of the analyzed conditions significantly increased the risk for co-occurrence of other examined weaknesses. The highest prevalence odds ratios were for functional dependence and, respectively: malnutrition (8.61, 95%CI:4.70-15.80), incontinences (8.0, 95%CI:5.93-10.70), and cognitive impairment (7.22; 95%CI:5.91-8.83). We concluded that the majority of the old people living in the community present various clinical conditions that prompt disability.The majority of old people suffer from various clinical conditions that affect health, functioning and quality of life. This research is a part of a cross-sectional, nationwide PolSenior Study that provides a comprehensive assessment of eight geriatric impairments and their co-occurrence in a representative sample (3471 participant aged 65-104 years, mean age 78.3 years) of the old adults living in the community in Poland. The participants were recruited randomly from all administrative regions of Poland by a three-stage, proportional, stratified-by-age group selection process. Eight geriatric conditions were assessed: falls, incontinences, cognitive impairment, mood disorders, vision and hearing impairments, malnutrition, and functional dependence. We showed that the most common deficits causing disability were vision and hearing impairments, and mood disorders, with more than two thirds of the participants presented at least one geriatric deficit. We showed that presence any of the analyzed conditions significantly increased the risk for co-occurrence of other examined weaknesses. The highest prevalence odds ratios were for functional dependence and, respectively: malnutrition (8.61, 95%CI: 4.70-15.80), incontinences (8.0, 95%CI:5.93-10.70), and cognitive impairment (7.22; 95%CI:5.91-8.83). We concluded that the majority of the old people living in the community present various clinical conditions that prompt disability.

Blood Pressure Target: High Time That We Finally Agreed What Is Healthy.

See related article, pp 1110–1114 Over the past 60 years, we learnt not only to appreciate the risk associated with elevated blood pressure (BP), but also to implement efficient therapeutic modalities capable of markedly reducing the risk of cardiovascular complications. However, such seemingly simple matter as deciding the exact therapeutic goals to which BP should be lowered to reduce the risk of events is probably as far from being universally agreed on as it must have been in the fifties. The recent versions of major guideline documents1,2 indicate that for low- to moderate-risk adults <60 years of age, BP should be lowered to <140 mm Hg systolic and <90 mm Hg diastolic. This also applies to patients with coronary artery disease, diabetes mellitus, and chronic kidney disease (Table).1,2 The goal for diastolic blood pressure is <90 mm Hg (<85 mm Hg in diabetes mellitus).2 View this table: Table. Therapeutic Goal for Systolic Blood Pressure in Hypertensive Patients, by Age, Added Risk, and Presence of Frailty However, essential hypertension is to a large extent a disease affecting older adults. It was shown that in this particular group of male patients, the risk of death associated with level of blood pressure raises at ≈160 mm Hg,6 and as further elegantly indicated by Zanchetti et al,7 until recently, there have been no data from randomized clinical trials to indicate that lowering of systolic BP (SBP) to <140 mm Hg could lead to benefit in this subgroup of hypertensive patients.7 The elderly are heterogeneous group, where the ability to cope impacts heavily on survival. Recently, Benetos et al proposed that in the elderly frail patients, the therapeutic goal should revolve about the value …

Breast Cancer, Age, and Hypertension: A Complex Issue

See related article, pp 205–211 It has been estimated that 124 cases of breast cancer occur annually per 100 000 women in the United States alone, and 23.5 of 100 000 die every year despite the advances in therapeutic options that took place over the past decades. The absolute estimates for 2011 show 230 480 new cases, with 39 520 prospected fatal cases.1 This establishes breast cancer as the most frequent malignancy and at the same time the second leading cause of cancer mortality in women. The risk of fatal outcome in women treated for breast cancer is related to cancer biology, which determines the choice of and response to therapy, as well as to comorbid conditions and age. Age plays a special role in epidemiological considerations because it is regarded to be the strongest predictor of both morbidity and mortality in both sexes, irrespective of baseline medical status. However, ways by which ageing affects prognosis in a patient diagnosed with breast cancer have not yet been fully elucidated. Hypertension is the most important modifiable risk factor for vascular events. According to the World Health Organization, it is the top leading cause of death in all societies, irrespective of level of income. Hypertension has been found to lead to accelerated senescence of the cardiovascular system, a notion confirmed by observations from hypertensive animals of an increased turnover of cells, and reduced half-life of DNA, accompanied by the presence of shorter telomere fragments in kidneys of spontaneously hypertensive rats.2 On the other hand, prevalence of hypertension increases with advancing age, with age-related changes in cardiovascular structure and function, ranging from derangement of paracrine regulation in endothelium to large arterial stiffening, establishing the pathophysiologic background for the age-dependent increase in prevalence of hypertension. The high prevalence of hypertension implies that …

Socioeconomic determinants of prostate-specific antigen testing and estimation of the prevalence of undiagnosed prostate cancer in an elderly Polish population based on the PolSenior study

Introduction Socioeconomic determinants of prostate-specific antigen (PSA) testing and prevalence of undiagnosed prostate cancer (PCa) in the Polish population are poorly understood. The aim of this study was to identify factors associated with PSA testing in elderly Polish men, and estimate the size of the population at risk of PCa related to PSA non-testing. Material and methods We analyzed questionnaire-derived data concerning PSA testing, obtained in 2567 elderly and 332 younger (age: 55–59) participants of the population-based PolSenior study. Additionally, PSA was measured in 2414 subjects. Results The PSA had previously been tested in 41.2% of elderly and in 24.8% of younger participants. Non-smoking status (OR = 2.06, p < 0.001), higher personal income (OR = 1.56, p < 0.001), better education (OR = 1.49, p = 0.001), previous white-collar work (OR = 1.37, p = 0.005), alcohol abstinence (OR = 1.28, p = 0.02), married status (OR = 1.24, p = 0.04), dependence in Instrumental Activities of Daily Living (IADL) but not in Activities of Daily Living (ADL) (OR = 0.65, p < 0.001), and dependence in ADL (OR = 0.55, p < 0.001) were independent predictors of previous PSA testing in elderly participants. There were 31 elderly previously treated for PCa (calculated standardized prevalence: 935 per 100,000 elderly population). The PSA levels > 4 ng/ml were found in 12.8% of 65–74-year-old and 4.5% of 55–59-year-old previously non-tested participants. We calculated the standardized prevalence rate of undiagnosed PCa as approximately 1370 and 2352 cases per 100,000 population aged 55–59 and 65–74 years, respectively. Conclusions In Poland, 58.8% of elderly men have never had PSA tested. These were less likely to be functionally independent, married, better educated, non-smokers or to have previous office employment or higher than average personal income. Our data suggest substantial underdiagnosis of prostate cancer among Polish men.

Pharmacological Management of Hypertension in the Elderly - Certitudes and Controversies

This paper summarizes the evidence supporting the pharmacological treatment of hypertension in the elderly as well as some the remaining controversies. The world is becoming progressively older and with that, the prevalence of hypertension is increasing. A peculiar form of hypertension, most prevalent among the elderly, is isolated systolic hypertension (ISH). Hypertension in the elderly, especially when systolic blood pressure (SBP) exceeds 160 mm Hg should be treated. Lowering the SBP to less than 150 mm Hg confers substantial cardiovascular protection. This has been demonstrated in both older and newer drugs for ISH and systolo-diastolic hypertension and is beneficial in both younger individuals (60-79 years) and uncomplicated elderly (80+ years) individuals suffering from hypertension. However, a number of issues remain controversial. Firstly, the 140 mm Hg cut-off for SBP cannot be applied to all age groups. It is conceivable that lowering the SBP below 140mm Hg in some patients, particularly in the elderly may not be beneficial. Hence, the generalizations made in clinical trials should be approached with caution. Additionally some drugs, such as beta-blockers, thiazide diuretics may be associated with significantly less benefit in the elderly patients. More research is needed, especially in the areas where we lack data: the first stage of uncomplicated ISH or hypertension in the elderly with associated co-morbidities.

Arterial hypertension after age 65: from epidemiology and pathophysiology to therapy Do we know where we stand?

Arterial hypertension is a prevalent disease with great harming potential. After the age of 55 years the remaining lifetime risk of hypertension amounts to 90%. Despite the constant advances some important issues such as the cut-off blood pressure for the initiation of antihypertensive therapy or the therapeutic goal are debated. In this review, we present - based on the available literature - the current concepts concerning the pathophysiology, epi-demiology and antihypertensive therapy in patients aged 65 years or older. The pathophysiology of hypertension in older patients in principle rests on stiffening of large conduit arteries, which leads to greater systolic and lower diastolic blood pressure. This in most older patients results in isolated systolic hypertension. Additionally most of these patients have low-renin hypertension. Data from large-scale clinical trials indicate that therapy of such individuals with thiazide-like diuretics and long-acting dihydropiridine calcium channel blockers as first-line medications reduces risk of complications. Based on results of recently published trials, meta-analyses, and prospective observations, the optimal on-treatment blood pressure values for most older hypertensive patients should be set within the 130-139 mmHg range. At present, lower values of standard office blood pressure in this group of patients have not been shown to be associ-ated with additional benefits, and may be associated with a greater risk of adverse events. In conclusion, we recommend that for most patients aged 65 years or more, standard office systolic blood pressure should be cautiously reduced to within 140 and 130 mmHg, preferably with a thiazide-like diuretic, long acting dihydropiridine calcium channel blocker or their combination.

Are all the former Siberian deportees with posttraumatic stress disorder patients at risk for unsuccessful aging

Multimorbidity was shown to be related to various unfavorable health‐related outcomes and unsuccessful aging. In Poland, mass deportation of Polish citizens from the Soviet‐ occupied regions deep into the isolated territories of the former Soviet Union, took place from February 1940 to June 1946. The deportees and their children, frequently born on exile, were exposed to chronic stress, psychological and physical violence, extreme climate conditions, abject poverty and famine, infectious and parasitic diseases, and arduous physical labor, all in all, together resulting in cachexia and a wide range of psychiatric and medical stress‐related disorders. However, there has been a limited data on posttraumatic stress disorder (PTSD) and its health and emotional consequences in those who had been deported due to political reasons, as most of the available research has been focused on war veterans or former Nazi camp prisoners. The aim of this study was to assess the frequency of multimorbidity and geriatric impairments in the group of the older Polish deportees to the former Soviet Union who still suffer from posttraumatic stress disorder. The presented results are a part of research on PTSD in the elderly people who or whose relatives had been persecuted for political reasons, and who had been deported to the remote regions of the former Soviet Union in their childhood, or were born in Siberia or Kazakhstan as a child of the deportees; the details of the project were described elsewhere. In brief, the respondents took part in medical (geriatric and psychiatric) and psychological assessment. Posttraumatic stress disorder was diagnosed by a psychiatrist according to the criteria of the Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. The geriatric part included history taking with the use of a detailed questionnaire (incl. questions about 15 chronic diseases), review of past medical records and currently taken drugs, physical examination, and geriatric assessment, conducted by the medical doctors trained in geriatrics. Multimorbidity was defined as the simultaneous presence of two or more health conditions in an individual. Questions about history of chronic pain, falls, dizziness, hearing or vision impairment, memory complaints, and functional dependence were included in the questionnaire. Depressive symptoms were diagnosed according to the Hamilton Rating Scale for Depression; frailty syndrome with the use of the Canadian Study of Health and Aging