Raimo Isoaho

Use of medications and polypharmacy are increasing among the elderly.

To assess changes in medicine use and polypharmacy, two cross-sectional surveys were carried out among community-dwelling persons aged 64 years or over in 1990-91 (n = 1,131) and 1998-99 (n = 1,197) in the municipality of Lieto in southwestern Finland. In addition to drug use, the questionnaire included items on social background, quality of life, and home nursing services. Among those surveyed, 78% in 1990-1991 and 88% in 1998-1999 (P =.001) used prescription drugs during 7 days prior to the interview. The most commonly used medications were for the cardiovascular and central nervous systems. The number of medications per person increased from 3.1 (SD 2.8) to 3.8 (SD 3.1) (P =.0001), and polypharmacy (concominant use of over five medications) increased from 19 to 25% (P =.006). These changes were most prominent among persons aged 85 years or over, especially among women. Polypharmacy is a complex and worrying phenomenon that merits more research.

Estimation of glomerular filtration rate in the elderly: a comparison of creatinine-based formulae with serum cystatin C

Objectives.  To estimate the prevalence of decreased kidney function in an elderly population and to evaluate the impact of using alternative markers of glomerular filtration rate (GFR), focusing on serum cystatin C (Cys C) and the Modification of Diet in Renal Disease (MDRD) Study prediction equation.

Serum cystatin C in the aged: relationships with health status

BACKGROUND Serum cystatin C (Cys C) is claimed to be superior to serum creatinine (Cr) in estimating glomerular filtration rate, but its utility in assessing renal function in the polymorbid elderly needs to be evaluated. METHODS In a cross-sectional, community-based survey performed in Lieto in southwestern Finland, Cys C, Cr, and urinary albumin-creatinine ratio (ACR) were measured in 1,260 subjects aged 64 to 100 years. Associations of demographic characteristics and health status factors with levels of Cys C, Cr, and ACR were assessed by means of linear models. RESULTS In men, hypertension, coronary heart disease, urinary infection, rheumatoid arthritis, glucocorticoid treatment, older age, and lower functional status were found to be significant predictors of higher Cys C values, whereas hypertension, coronary heart disease, urinary infection, older age, and increasing body mass index (BMI) significantly predicted higher Cr values. Among women, corresponding factors were hypertension, glucocorticoid treatment, age, functional status, and BMI for Cys C and hypertension, BMI, and age for Cr. Diabetes was significantly associated only with ACR. These factors explained 35% of variation in Cys C values in men and 34.5% in women versus only 14.8% and 11.3% for Cr, respectively. CONCLUSION Glucocorticoid treatment was recognized as an independent Cys C-increasing factor, presumably nonglomerular. In comparison with Cys C, a considerably greater proportion of total variation in Cr values seems to be explained by extrarenal factors.

Fractures as predictors of excess mortality in the aged—A population-based study with a 12-year follow-up

Introduction and objective The association between fractures and excess mortality in old age is ambiguous. The objective of this study was to analyze the long-term gender-specific association between fractures and mortality among older persons by controlling several survival related confounders. Methods A population-based prospective cohort study in the municipality of Lieto, south-western Finland. Data on health, health behaviour, fractures, and mortality in 482 men and 695 women aged 65 or older was collected from 1991 until 2002. The Cox Proportional Hazards regression model with fractures as time-dependent variables was used in the analyses. Results During the 12-year follow-up, 295 (25%) persons sustained at least one fracture. Sustaining any kind of fracture was related to excess mortality both in men (age-adjusted Hazards Ratio, HR 2.2, 95% confidence intervals, CI 1.6–3.1) and in women (HR 1.6, 95% CI 1.3–2.1). In the multivariate analyses, hip fractures in men (HR 8.1, 95% CI 4.4–14.9) and in women (HR 3.0, 95% CI 1.9–4.9), and proximal humerus fractures in men (HR 5.4, 95% CI 1.6–17.7) were related to increased mortality. Conclusion A hip fracture was a powerful independent predictor of long-term excess mortality in both genders but the risk in men was more than 2-fold compared to women. Proximal humerus fractures were associated with increased mortality in men. Actions to improve prevention, acute care and rehabilitation of fractures are needed in order to reduce excess mortality in older people.

Overweight and Obesity in Old Age Are Not Associated with Greater Dementia Risk

OBJECTIVES: To describe the association between body mass index (BMI) and dementia risk in older persons.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND SYMPTOMS RELATED TO DEPRESSION IN ELDERLY PERSONS

In a community study, 61 men and 21 women with mild to severe chronic obstructive pulmonary disease (COPD) were compared with age- and sex-matched controls (183 men and 63 women) to identify and analyze the associations between the occurrence of COPD and depressive symptoms, the occurrence of previous or current psychiatric disorders, the use of psychiatric drugs, and satisfaction with ones marital relationship. In men, no associations between COPD and the above factors were found. More women with COPD than controls reported feelings of dissatisfaction with life. The female patients also tended to be less satisfied with their marital relationship than the controls. Multivariate analysis showed that this disease in women was associated with disability (odds ratio 3.25, 95% confidence interval 1.17–9.06), feelings of dissatisfaction with life (odds ratio 3.56, 95% confidence interval 1.23–10.34), and low satisfaction with ones marital relationship (odds ratio 3.23, 95% confidence interval 1.10–9.47). These results seem to suggest that elderly female patients with COPD have more mental health problems than male patients and these will require more attention from the primary care providers.

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial.

BackgroundThis study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months.MethodsThe study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fishers exact test, the Mann-Whitney U-test and logistic regression.ResultsIn men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group.ConclusionFall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women.

RIA for Serum Holo-Transcobalamin: Method Evaluation in the Clinical Laboratory and Reference Interval

BACKGROUND Decreased serum holo-transcobalamin (holoTC) could be the earliest marker of cobalamin (Cbl) deficiency, but there has been no method suitable for routine use. We evaluated a new commercial holoTC RIA, determined reference values, and assessed holoTC concentrations in relation to other biochemical markers of Cbl deficiency. METHODS The reference population consisted of 303 individuals 22-88 years of age, without disease or medication affecting Cbl or homocysteine metabolism. In elderly individuals (>or=65 years), normal Cbl status was further confirmed by total homocysteine (tHcy; <19 micro mol/L) and methylmalonic acid (MMA; <0.28 micro mol/L) concentrations within established reference intervals. HoloTC in Cbl deficiency was studied in a population of 107 elderly individuals with normal renal function. The Cbl deficiency was graded as potential (total Cbl <or=150 pmol/L or tHcy >or=19 micro mol/L), possible (total Cbl <or=150 pmol/L and either tHcy >or=19 micro mol/L or MMA >or=0.45 micro mol/L), and probable (tHcy >or=19 micro mol/L and MMA >or=0.45 micro mol/L). RESULTS The intra- and between-assay imprecision (CV) for the holoTC RIA were 4-7% and 6-8%, respectively. A 95% central reference interval for serum holoTC was 37-171 pmol/L. All participants (n = 16) with probable Cbl deficiency, 86% of those with possible, and 30% of those with potential Cbl deficiency had holoTC below the reference limit (<37 pmol/L). The holoTC correlated with total Cbl (r(s) = 0.80; P <0.0001) and inversely with MMA (r(s) = -0.52; P <0.0001). HoloTC concentrations were significantly (P = 0.01) higher in women than in men. CONCLUSIONS The new holoTC RIA is precise and simple to perform. Low holoTC is found in individuals with biochemical signs of Cbl deficiency, but the sensitivity and specificity of low holoTC in diagnosis of Cbl deficiency need to be further evaluated.

Undiagnosed Diseases in Patients with Dementia – A Potential Target Group for Intervention

Objective: To study undiagnosed diseases in older people with and without dementia. Design: Cross-sectional population-based study in Lieto, southwestern Finland. Participants: All the inhabitants aged 64 and more in Lieto. Participation rate was 82% (n = 1,260). Measurements: Dementia and its subtypes were diagnosed according to prevailing criteria. Medical conditions were assessed in clinical examinations and from medical records. Results: 112 patients with dementia were found; 66% of them had at least 1 undiagnosed disease compared to 48% of the non-demented group (p = 0.041). The demented subjects had more undiagnosed hypercholesterolaemia (p = 0.039) and undiagnosed hypothyroidism (p = 0.032) than the controls. Conclusion: Undiagnosing is more common among patients with dementia. Screening strategies should be developed further to find these patients.

Sedative Drug Use in the Home-Dwelling Elderly

BACKGROUND The elderly use more sedatives than other populations. Reports on the sedative load of drugs and their associations with health items are scarce. OBJECTIVE To investigate the prevalence of sedatives and drugs with sedative properties and the associations between those drugs and demographic or health items in the home-dwelling elderly in a cross-sectional community survey. METHODS Information was obtained from 1197 persons (43% men) aged 64 years in the Finnish municipality of Lieto in 1998–1999. The brand names of the prescription drugs taken by each interviewee during one week prior to the interview were recorded. The classification created in a previous study, where the drugs used in Finland were divided into 4 groups by their sedative properties, was utilized to determine associations with health items. RESULTS A total of 88% (n = 1056) of the participants used some drug. Forty percent (n = 422 persons) of the drug users took sedatives or drugs with sedative properties. The oldest individuals (80 y), women, those with low education, smokers, those with poor self-perceived health, people with dementia and mobility problems, and especially those with depression had an independent association with the simultaneous use of many (2) sedatives or drugs with sedative properties. CONCLUSIONS In a population of home-dwelling elderly patients, abundant sedative drug use was common and especially associated with high age, female gender, poor basic education, poor health habits (eg, smoking), depression, dementia, or impaired mobility. Users also had poor self-perceived health. The need to further develop the classification will be a major challenge, and the classification needs to be updated every year. More studies are needed in this field.