Walter Pelemans

Prevalence and Causes of Anaemia in a Geriatric Hospitalized Population

Of 732 consecutive patients admitted to an acute geriatric ward, 178 (24%) were found to be anaemic (haemoglobin of 115 g/l or below). An appropriate cause responsible for anaemia was identified in 83%. The anaemia of chronic disorders (ACD) (35%) and iron deficiency anaemia (15%) were the commonest causes. The spectrum of disorders associated with ACD is much broader than the classical category of infectious, inflammatory and malignant disorders. The relatively high prevalence of the myelodysplastic syndrome (5%) is striking and this syndrome as a cause of anaemia in geriatric patients deserves more attention than it has so far received. No obvious cause was found in 17%. The clinical significance of this finding remains unclear.

Relationship Between Baseline Insulin-Like Growth Factor-I (IGF-I) and Femoral Bone Density in Women Aged Over 70 Years: Potential Implications for the Prevention of Age-Related Bone Loss

OBJECTIVE: To test the hypothesis that the decline in femoral bone mass associated with healthy aging is partially accounted for by deficiency of the growth hormone‐insulinlike growth factor‐I (IGF‐I) axis.

Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient.

PURPOSE Iron deficiency anemia is commonly caused by chronic gastrointestinal blood loss, and a thorough examination of the gastrointestinal tract has become standard practice. In contrast, iron deficiency without anemia has hardly been studied, and its causes are less certain. The aim of the present study was to determine the diagnostic value of upper and lower gastrointestinal evaluation in elderly hospitalized patients with iron deficiency, irrespective of the hemoglobin level. PATIENTS AND METHODS In a prospective study, 151 consecutive elderly patients with iron deficiency (serum ferritin level < 50 microg/L at two separate occasions) were investigated using esophagogastroduodenoscopy with colonoscopy (n = 90) or barium enema (n = 61). RESULTS A potential upper gastrointestinal tract lesion was found in 47 (49%) of the 96 anemic patients and in 31 (56%) of the 55 nonanemic patients (P = 0.38). Nonanemic patients had a greater prevalence of erosive gastritis or duodenitis. Anemic patients (72%) were more frequently investigated with a colonoscopy than nonanemic patients (38%, P = 0.001), and a lower gastrointestinal lesion was found in 32% of the anemic patients and 16% of the nonanemic patients (P = 0.03). Cancer was the most common lesion in the colon; 11 of the 18 patients were asymptomatic. Site-specific symptoms, fecal occult blood loss, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) were not associated with the detection of gastrointestinal lesions. In 9.5% of the patients with a benign upper gastrointestinal lesion, a synchronous colonic tumor was found. CONCLUSION Elderly patients with iron deficiency should undergo endoscopic examination, irrespective of the hemoglobin level. The presence of gastrointestinal symptoms, a positive fecal occult blood test, and the use of NSAIDs are of limited value in guiding the diagnostic procedure.

Mechanisms involved in postdeglutition retention in the elderly

Abstract. This study examines possible quantifiable causes of postdeglutition pharyngeal retention in the elderly. Manofluorography and computer processing of video images are performed. Retention in the valleculae and in the piriform sinuses is associated with a markedly reduced pharyngeal shortening, a low tongue driving force (TDF), and a diminished amplitude of the pharyngeal contraction. There is no relationship with the hypopharyngeal suction pump (HSP). Retention limited to the valleculae is associated with a low TDF, and retention restricted to the piriform sinuses is accompanied by a reduced pharyngeal shortening.

Fall Prediction in Inpatients by Bedside Nurses Using the St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) Instrument: A Multicenter Study

OBJECTIVES: To assess the predictive value of the St. Thomass Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) instrument, a simple fall‐risk assessment tool, when administered at a patients hospital bedside by nurses.

Manofluorographic Analysis of Swallowing in the Elderly

This study examined the effect of aging on the mechanisms of swallowing by comparing 16 elderly subjects (80 years±5) with 20 healthy volunteers. Manofluorography was used to obtain quantitative and qualitative data of the pharyngeal swallow. Aging is associated with a significant decrease in the level of negative pressure resulting from the opening of the upper esophageal sphincter and with a substantial number of incomplete relaxations of the sphincter. In addition, several qualitative changes were noted.

Cobalamin absorption and serum homocysteine and methylmalonic acid in elderly subjects with low serum cobalamin

Abstract: We prospectively studied 41 consecutive elderly patients with serum cobalamin (vitamin B12) levels lower than 125 pmol/l. The protein‐bound cobalamin absorption test (PBAT) was performed in 34 of them and in 27 selected elderly control patients. The lower decision limit was 0.18% and an abnormal test was detected in only 9 (26%) of the 34 patients with low serum cobalamin level. When the PBAT was compared to the Schilling (Dicopac method) test, a concordant result was found in 80 %. Serum methylmalonic acid and/or total homocysteine concentrations were elevated in 75% (26/35) of the patients with low serum cobalamin levels but also in 30% (5/17) of the control patients. Of the 12 and 9 cobalamin‐deficient patients with elevated serum levels of methylmalonic acid and homocysteine, normalization after cobalamin therapy was obtained in 11 and 5 respectively. In conclusion, determination of serum metabolites and their response to cobalamin therapy are a sensitive index of significant cobalamin deficiency and a useful means of distinguishing between cobalamin and folate deficiency. The PBAT offers little advantage over the Schilling test in diagnosing cobalamin malabsorption in elderly patients.

Differences in psychosocial and behavioral profiles between heart failure patients admitted to cardiology and geriatric wards

Heart failure represents a growing epidemic, primarily in the elderly. Development and implementation of management programs designed for use in daily clinical practice remains a major challenge.

The effect of different diagnostic criteria on the prevalence of malnutrition in a hospitalized geriatric population

Malnutrition is considered an important clinical problem in geriatric hospitalized patients, but no standard diagnostic criteria are available. The aim of this study was to investigate the effect of 7 different sets of diagnostic criteria (6 in hospitalized elderly and 1 in healthy elderly) from nutritional research studies on the prevalence of malnutrition in 151 elderly patients (49 men, 102 women, mean age 82.8 years) consecutively admitted to an acute geriatric ward. Nutritional status was assessed using anthropometric (body mass index, triceps skinfold thickness, mid arm circumference, arm muscle circumference), and laboratory (serum albumin) parameters, and 1 nutritional questionnaire (Mini Nutritional Assessment). The proportion of patients with malnutrition varied between 6.5 and 85%. It is important to assess the nutritional status in elderly patients because the prevalence of malnutrition in hospitalized elderly patients is substantial whatever criteria are used. However, the criteria for the diagnosis can differ by a factor of more than 10 in the number of patients classified as malnourished. A major goal for further research on malnutrition is to define more standardized and validated criteria in order to make comparisons of prevalence and outcome more meaningful, and ensure that all those who will benefit from a nutritional intervention are identified and treated.

A DOUBLE BLIND CROSSOVER COMPARISON OF LOPERAMIDE WITH DIPHENOXYLATE IN THE SYMPTOMATIC TREATMENT OF CHRONIC DIARRHEA

Loperamide, a novel antidiarrheal agent, was compared with diphenoxylate in a double blind crossover study of 23 patients with chronic diarrhea of various etiologies. Both agents were found to be capable of controlling or greatly reducing chronic diarrhea. Loperamide was superior to diphenoxylate in its abiltiy to decrease the frequency and improve the consistency of the stools, even at a 2.5-fold lower dose level.