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Biomedical subjects

R S Tilvis

Publications and source records attributed to R S Tilvis.

78 records · Page 5Linked to original sources
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Urinary incontinence as a predictor of death and institutionalization in a general aged population.

The prognostic significance of urinary incontinence (UI) was evaluated using the Helsinki (Finland) Aging Study Database, in which a random sample of persons of three age cohorts (75, 80 and 85 years, n=649) was followed for 5 years. The prevalence rates of UI in the three age groups were 10.5%, 20.4% and 28.6%, respectively. UI was also frequent in healthy aged subjects (15.6%), but most common in hospitalized patients (35.3%), in those with severe depression (51.8%), previous stroke (37.6%) or dementia (48.8%). UI had age- and gender-adjusted risk ratios (95% C.I.) for mortality of 1.75 (1.33-2.30) and for long-term institutional care of 2.37 (1.30-3.84). However, after controlling for the presence of dementia, the risk ratios were no longer significant. Thus, UI predicts both death and long-term institutionalization in the general aged population. However, this observation is mainly explained by the close association of UI with dementia.

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How stable is postural hypotension in the general aged population?

Although postural hypotension (PH) is a common clinical symptom in the elderly, nothing is known of its stability in the long run. To investigate this issue we carried out a prospective cohort study in a general aged population as a part of Helsinki (Finland) Aging Study. Random persons of three age cohorts (75-, 80- and 85-years, n = 274) were followed for 5 years. Blood pressure (BP) was measured at supine and standing positions both at entry and after 5 years. Both supine and standing BP levels decreased during 5-year follow-up but the prevalence of PH (decrease in systolic BP > 20 mmHg or that in diastolic BP > 10 mmHg) remained virtually unchanged (28% at entry - 26% after 5 years). There were, however, marked differences in the distributions of individuals in the different categories of PH and only 25.8% of subjects fulfilled the same criteria at 5 years. Only 9% of subjects had significant falls in SBP and DBP both at entry and after 5 years. These persons were characterized by no other clinical features than higher initial supine BP levels. In conclusion, this study shows the instable nature of PH during the 5-year follow-up in the general aged population and challenges the use of blood pressure changes as a sole diagnostic criteria of PH in epidemiological studies.

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Predictors and subjective causes of loneliness in an aged population.

The aim of the study was to examine the prevalence and self-reported causes of loneliness among Finnish older population. The data were collected with a postal questionnaire from a random sample of 6,786 elderly people (>or=75 years of age). The response rate was 71.8% from community-dwelling sample. Of the respondents, 39% suffered from loneliness, 5% often or always. Loneliness was more common among rural elderly people than those living in cities. It was associated with advancing age, living alone or in a residential home, widowhood, low level of education and poor income. In addition, poor health status, poor functional status, poor vision and loss of hearing increased the prevalence of loneliness. The most common subjective causes for loneliness were illnesses, death of a spouse and lack of friends. Loneliness seems to derive from societal life changes as well as from natural life events and hardships originating from aging.

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Long-term changes in mood of an aged population: repeated Zung-tests during a 10-year follow-up.

Associates and predictors of lowered mood were investigated in a 10-year prospective study of 411 random persons of three birth cohorts (aged 75, 80 and 85 years) in Helsinki, Finland. High Zung-score ( > 45 points = lowered mood) was found in 24% of subjects and clearly associated with age. Lowered mood was also associated with pessimistic attitudes towards life and impaired survival prognosis. The mean Zung-score fell drastically during the first follow-up (from 39.1 to 34.6 points, P < 0.001) and remained unchanged thereafter at 10-year examination of the survivors (33.9 points). Lowering mood (increase in Zung-score) was best predicted by low baseline Zung-score (r = -0.673, P < 0.001), high baseline MMSE-score (r = -159. P < 0.05) and simultaneous changes in MMSE-scores (r = 0.269, P < 0.01). The data show that lowered mood is associated with pessimistic attitudes towards life, cognitive impairment and impaired survival and that cognitive impairment exposes a patient to lowering mood. It is possible that a screening program improves the mood of aged population.

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Patient's and general practitioner's different views on patient's depression.

Differences between patient's and general practitioner's view on patient's depressive syndromes was investigated in a prospective birth cohort study of 70 year old people (n=1032) in Turku City, Finland. The aim of this study was to find factors which are typical for people having depressive syndromes in old age and help medical and nursing staff to identify depressive syndromes in the general aged people. The study consisted of a structural postal questionnaire including patient's perception of his depression, an interview made by a public health nurse included mini-mental state examination (MMSE) and the self-rating depression scale of Zung, an interview and comprehensive clinical examination by a general practitioner. Out of the 847 persons who completed the depression test, 12.6% showed symptoms of depressive syndrome. The views of those who scored more than 45 points in the Zung depression scale on their own depressiveness differed from the general practitioner's opinion. In the general practitioner's examination and interview 58% of the subjects had no depressive symptoms even though the test results indicated that they were depressed. The depressed group stood out most clearly in two questions: Do you feel you are needed and do you have future plans? When the same questions were repeated 5 years later, the difference was still statistically significant between depressed and non-depressed group (P<0.0001). The data indicated that medical and nursing staff should take self-assessments seriously and look into them in closer detail. General practitioners and nurses should learn to ask right questions and use short depression scale systematically in order to facilitate the detection of depressive syndromes.

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