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G J Izaks

Publications and source records attributed to G J Izaks.

11 recordsLinked to original sources
PubMed2006

[Reference values for anaemia in the elderly].

According to the reference values of the World Health Organization (WHO), anaemia is defined as a haemoglobin (Hb) level < 8.1 mmol/l in men and < 7.5 mmol/l in women. Lower reference values are often used in older patients because many doctors consider a decreased Hb level to be physiological in advanced age. However, Hb values under the WHO reference values are associated with increased mortality in older persons. Moreover, a cause of the anaemia is found in > 80% of older persons with anaemia if further diagnostic tests are done. Decreased Hb levels are also associated with functional impairments such as mobility disorders. These findings apply not only to severely decreased Hb levels but also to Hb levels that are only slightly below the WHO reference values. Correspondingly, increased erythropoietin levels are seen in older persons with severely decreased Hb levels as well as in older persons with slightly decreased Hb levels. Thus, a decrease in the Hb level in advanced age is not physiological and the WHO reference values for anaemia are also valid for older persons.

Age Factors↗
PubMed2003

[The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'; response from clinical geriatrics].

Delirium in elderly people is a severe condition that requires vigorous medical attention. Therefore, the Dutch College of General Practitioners has duly chosen to develop a practice guideline 'Delirium in elderly people'. It is likely that many general practitioners are only partly familiar with delirium in elderly people because the prevalence of delirium in general practice is low. Therefore, one of the objectives of the practice guideline should be to improve the diagnostic process. However, several diagnostic issues merit further attention. For example, the guideline does not contain a diagnostic algorithm and the description of the clinical presentation of a delirium is brief. In addition, the guideline lacks a clear overview of the most important risk factors for a delirium as well as a careful description of the difference between delirium and dementia.

Aged↗
PubMed2003

[Osteoporosis in elderly women should always be treated, despite the new professional guideline from the Dutch Institute for Health Care Improvement (CBO)].

According to the Dutch Institute for Healthcare Improvement [Dutch acronym: CBO] professional guideline 'Osteoporosis' (second revision), the treatment of osteoporosis should be based on the patient's age because bone loss at an advanced age is thought to be partly physiological. It is recommended that women < 70 years old are treated if the bone mineral density T-score is below -2.5. For women > or = 70 years of age, a lower cut-off point has been chosen, i.e. a Z-score below -1. However, bone strength is dependent on bone mineral density and the fracture risk doubles if the bone mineral density decreases by one standard deviation. Therefore at an advanced age, any bone loss experienced increases the fracture risk, whether or not the mineral loss is physiological. Moreover, most elderly people carry additional risk factors that increase fracture risk. Therefore in women > or = 70 years of age, the treatment of osteoporosis should be considered if the T-score is below -2.5. In this situation, use of the Z-score is not appropriate.

Age Factors↗
PubMed2000

The effect of geographic origin on the frequency of HLA antigens and their association with ageing.

The association between HLA antigens and ageing is not clear. Ageing in women was associated with B40 and DR5 in a recent study, but other studies yielded conflicting results. In none of the studies, however, did the young and elderly samples originate from the same homogeneous population. Homogeneity is dependent on geographic origin. The aim of this study was to investigate whether differences in geographic origin between age groups could explain the age-associated differences in the frequencies of B40 and DR5. The authors used the new design of a 'birth-place-restricted comparison' in which the origin of all subjects was ascertained. The total study population comprised 1010 young women aged 25-40 years and 660 elderly women aged 85 years and older. The 'birth-place-restricted comparison' included 66 young and 285 elderly women from one geographic area (Leiden, the Netherlands). Men were not included because ageing in men was not associated with HLA antigens in a recent study. In the total population, the frequency of B40 in young women of different origin varied between 16 and 28%, and the frequency of DR5 between 11 and 23%. Similar differences were observed in the elderly women. In the 'birth-place-restricted comparison', the frequency of B40 was 15% in the young women and 11% in the elderly women (difference 4%, 95% confidence interval, -5 to 13%). The frequency of DR5 was 20% in the young women, and 28% in the elderly women (difference 8%, 95% confidence interval, -4 to 19%). Thus, marked differences in HLA antigen frequency were found between populations of various geographic origins. Definition and ascertainment of the target population are therefore necessary in genetic studies of ageing. In such a 'birth-place-restricted comparison', the authors confirmed that ageing in women was negatively associated with HLA-B40 and positively associated with HLA-DR5.

Adult↗
PubMed1999

The definition of anemia in older persons.

CONTEXT: Whether hemoglobin concentrations defined as anemia by the World Health Organization (WHO) are associated with increased mortality in older persons is not known. OBJECTIVE: To investigate the association between hemoglobin concentration and cause-specific mortality in older persons. DESIGN: Community-based study conducted from 1986 to 1996 (follow-up period, 10 years). SETTING: Leiden, the Netherlands. PARTICIPANTS: A total of 1016 community residents aged 85 years and older were eligible and 872 agreed to have a blood sample taken. Hemoglobin concentration was measured in 755 persons (74%). MAIN OUTCOME MEASURES: Hemoglobin concentration, 10-year survival, and primary cause of death. According to the WHO criteria, anemia was defined as a hemoglobin concentration below 7.5 mmol/L (120 g/L) in women and below 8.1 mmol/L (130 g/L) in men. RESULTS: Compared with persons with a normal hemoglobin concentration, the mortality risk was 1.60 (95% confidence interval [CI], 1.24-2.06; P<.001) in women with anemia, and 2.29 (95% CI, 1.60-3.26; P<.001) in men with anemia. In both sexes, the mortality risk increased with lower hemoglobin concentrations. In persons without self-reported clinical disease at baseline, the mortality risk of anemia was 2.21 (95% CI, 1.37-3.57; P=.002). Mortality from malignant and infectious diseases was higher in persons with anemia. CONCLUSIONS: Anemia defined by the WHO criteria was associated with an increased mortality risk in persons aged 85 years and older. The criteria are thus appropriate for older persons. A low hemoglobin concentration at old age signifies disease.

Aged↗
PubMed1998

Blood pressure and mortality in elderly people aged 85 and older: community based study.

OBJECTIVE: To determine whether the inverse relation between blood pressure and all cause mortality in elderly people over 85 years of age can be explained by adjusting for health status, and to determine whether high blood pressure is a risk factor for mortality when the effects of poor health are accounted for. DESIGN: 5 to 7 year follow up of community residents aged 85 years and older. SETTING: Leiden, the Netherlands. SUBJECTS: 835 subjects whose blood pressure was recorded between 1987 and 1989. MAIN OUTCOME MEASURE: All cause mortality. RESULTS: An inverse relation between blood pressure and all cause mortality was observed. For diastolic blood pressure crude 5 year all cause mortality decreased from 88% (52/59) (95% confidence interval 79% to 95%) in those with diastolic blood pressures <65 mm Hg to 59% (27/46) (44% to 72%) in those with diastolic pressures >100 mm Hg. For systolic blood pressure crude 5 year all cause mortality decreased from 85% (95/112) (78% to 91%) in those with systolic pressures <125 mm Hg to 59% (13/22) (38% to 78%) in those with systolic pressures >200 mm Hg. This decrease was no longer significant after adjustment for indicators of poor health. No relation existed between blood pressure and mortality from cardiovascular causes or stroke after adjustment for age and sex, but after adjustment for age, sex, and indicators of poor health there was a positive relation between diastolic blood pressure and mortality from both cardiovascular causes and stroke. CONCLUSION: The inverse relation between blood pressure and all cause mortality in elderly people over 85 is associated with health status.

Age Distribution↗
PubMed1997

The association between human leucocyte antigens (HLA) and mortality in community residents aged 85 and older.

OBJECTIVE: The association between Human Leucocyte Antigens (HLA) and aging was investigated. It is possible that HLA antigens are associated with longevity, either indirectly through disease associations or directly through involvement in the aging mechanism. DESIGN: Community-based follow-up study. SETTING: Leiden, the Netherlands. PARTICIPANTS: A total of 919 subjects were HLA typed in this community-based study. All subjects were aged 85 and older and were white. Seventy-two percent of the cohort was female. MEASUREMENTS: Age- and sex-adjusted Mortality Rate Ratios (MRR) were estimated for 79 antigens by the subject-years method. HLA-A, -B and -C typing was performed with the standard NIH lymphocytotoxicity test, HLA-DR and -DQ typing was performed with the two-color fluorescence test. Homozygosity for HLA-A, -B, and -DR was defined as only one detectable antigen at a locus. RESULTS: The mean follow-up period (SD) was 5.0 (0.6) years. At the end of the follow-up, 70% of the subjects had died. The MRR (95% CI) for B60 was 0.96 (0.75-1.23), and for DR11 it was 0.82 (0.66-1.01). For A2 and A26 only, the MRR (95% CI) was significantly different from 1: 0.85 (0.73-0.99), P = .04 and 1.45 (1.06-1.99), P = .02, respectively (P values not corrected for the number of antigens tested). Homozygosity was not associated with mortality. CONCLUSIONS: HLA was not associated with mortality after the age of 85. Therefore, direct involvement of HLA in aging is unlikely. We suggest that the findings of previous studies are attributable to methodological shortcomings such as small sample size and differences in genetic background of the subjects.

Aged↗
PubMed1995

Three-year follow-up of Mini-Mental State Examination score in community residents aged 85 and over.

The objective of this study was to describe over time the course of cognitive function of elderly without cognitive impairment and of elderly with different stages of impairment, and to assess if the change in cognitive function was dependent on the initial level of function. The Mini-Mental State Examination (MMSE) was used at two time points. The first assessment (MMSE-1) was part of a community-based study and was obtained from 871 subjects. For the second assessment (MMSE-2) a sample of 166 subjects was drawn from the subjects alive at follow-up who had an MMSE-1 score. This sample was stratified by MMSE-1 score to avoid oversampling of subjects with high MMSE-1 scores. A second MMSE score was obtained from 134 elderly, whereas 18 subjects refused participation and 14 subjects were not traceable. The median age at first assessment was 89 years (25th percentile 87, 75th percentile 92), the mean follow-up period (S.D.) was 3.3 (0.5) years. The median change in MMSE score was minus 4 points (95% confidence interval (CI) -7 to -2) and the slope of the regression line of MMSE-2 on MMSE-1 was 1.1 (95% CI 0.9-1.3). It is likely that the slope was underestimated due to a floor effect, regression to the mean and missing observations. However, the probability of decline decreased if MMSE-1 was higher. Nevertheless, the probability ranged from 27 to 59% for subjects with the highest MMSE-1 scores aged 85 and 95 years respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

A community based study of the incidence of dementia in subjects aged 85 years and over.

The aim was to investigate the incidence rate of dementia for community residents aged 85 years and over. It was a two wave community study of 224 subjects (community residents including those residing in a nursing home) older than 85 years, restudied 4.1 years after a community prevalence study. A two stage method was used, comprising the mini mental state examination followed in a stratified sample by the geriatric mental state schedule (A3)/AGECAT. Incidence rates were based on person-years at risk. The overall incidence of dementia was 6.9 (95% confidence interval (95% CI) 4.8-9.1) per 100 person-years at risk. The incidence was significantly higher for women than for men; respectively 8.9 (95% CI 5.9-11.9) v 2.7 (95% CI 0.5-4.9) per 100 person-years at risk. In the fastest growing age group seven out of 100 persons develop dementia each year. Women, who constitute two thirds of the oldest old, seem to have a higher risk. Further research is needed into the risk factors for dementia in this age group.

Aged↗