Biomedical subjects

W E Hale

Publications and source records attributed to W E Hale.

At least 19 recordsLinked to original sources

PubMed1995

A longitudinal evaluation of dipyridamole drug use in an ambulatory elderly population.

STUDY OBJECTIVE: To determine the pattern of dipyridamole use over the past 14 years. DESIGN: A longitudinal health screening program of ambulatory elderly participants was used to study changes in dipyridamole drug use. Participants included all subjects screened in the Florida Geriatric Research Program since 1978. The main outcome measure in this study was self-reported dipyridamole use at every visit to the program since August 1, 1978. RESULTS: A total of 3.6% of men (mean age, 82.6 years) and 3.4% of women (mean age, 80.8 years) reported the use of dipyridamole in the 1991-1992 period. The prevalence of dipyridamole use ranged from a low of 1.6% in 1978-1979 to a high of 7.3% in 1986-1987. There was a significant increase in the use of this drug from 1978-1979 to 1991-1992 (p < 0.038). Over the 14-year period of study, the percent of subjects using dipyridamole concurrently with coumarin anticoagulants ranged from a low of 5.8% to a high of 17.9%. CONCLUSIONS: The level of dipyridamole use in this elderly population has increased since 1978-1979. The only FDA indication for this drug is in combination with coumarin anticoagulants to prevent postoperative thromboembolic complications of cardiac valve replacement. Less than 20% of patients in this study used the drug in combination with coumarin anticoagulants. Educational programs are needed to improve the prescribing of dipyridamole.

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PubMed1993

Medical conditions associated with driving cessation in community-dwelling, ambulatory elders.

The decision to stop driving leads to severe contraction of independence, and most localities do not curtail driving privileges in impaired elders. In a population of community-based, ambulatory individuals 70-96 years old, annual medical screening showed that 276 of 1,656 (16.7 +/- 1.8%) who reported driving regularly in the past do not currently drive. The cessation of driving behavior was examined in terms of specific medical conditions occurring within the past 5 years. Retired drivers were disproportionately female, and driving cessation risk rose with age. Age-sex-adjusted logistic regression found that six conditions explained about 50 percent of the decisions to stop driving: macular degeneration; retinal hemorrhage; any deficit in Activities of Daily Living; Parkinson's disease; stroke-related residual paralysis or weakness; and syncope. Strikingly, only 1.8 percent of those who stopped driving had ever had a license revoked; 58.7 percent reported voluntarily stopping; 31.9 percent gave health or medical reasons. Clearly, the decision to cede driving privileges is complex and not dependent solely on medical problems.

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PubMed1993

Suicide in the elderly: staying in control.

Suicide remains one of the major causes of death among the fastest growing segment of the US population--the elderly aged 65 and over. Individuals 65 and over comprised 12.4% of the population in 1988, but accounted for 20.9% of all reported suicides (McIntosh, 1992). The purpose of this qualitative study was to explore the meaning of suicide to the elderly and how suicide becomes an alternative for them. Results indicate that elderly subjects gave considerable thought to the end of their lives--including planning for death. For them, suicide was frequently viewed as a way of maintaining control over the dying process. In this study, the elderly described their views on who makes the decision about when death will occur, when suicide is acceptable, and how they would like others to respond to their suicidal ideation. Risk factors and causes of suicide in the elderly emerged from the data.

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PubMed1992

Aging and total cholesterol levels: cohort, period, and survivorship effects.

This analysis describes the association of age with the serum total cholesterol level in 5,010 participants in a geriatric health screening program. Cholesterol levels were measured annually in participants monitored for up to 12 years. The association of age with cholesterol level is described via three approaches: cross-sectional analysis, descriptive longitudinal analysis, and longitudinal analysis using statistical modeling. The results were compared to examine the influence of cohort, period, and survivorship effects on the association between age and cholesterol. In cross-sectional analysis, the cholesterol level was fairly constant for the ages of 65 to 75 years, but decreased by 21% over the age range from 75 to 95 years. Descriptive longitudinal analysis suggested that both cohort and period effects were influencing the cross-sectional findings. In longitudinal analysis adjusting for both cohort and period effects, the findings were similar to those from cross-sectional analysis for the ages of 65 to 75 years, but from the ages of 75 to 95 years, cholesterol decreased by only 9%--half as great a decline as that estimated from cross-sectional analysis. When longitudinal data were limited to those with complete follow-up, the predicted decline for the age range from 75 to 95 years was only 6%. Although this flattening of the age trend was suggestive, there was no conclusive evidence that it reflected an association between baseline cholesterol and loss to follow-up.

Age Factors↗

PubMed1992

Health style.

Explore the source record for details and available documents.

Health Behavior↗

PubMed1992

Nocturia: a risk factor for falls in the elderly.

OBJECTIVE: To determine if nocturia is a risk factor for reported falls and bone fractures in older persons. DESIGN: Cross-sectional study comparing falls in men and women with and without nocturia. SETTING: Longitudinal health screening program of ambulatory elderly participants. PARTICIPANTS: Participants included 988 (65.5%) women and 520 (34.5%) men who had completed their tenth annual visit to the program. MAIN OUTCOME MEASURES: Reported falls in the past year and reported bone fractures in the past 5 years. RESULTS: Participants who reported nocturia at least twice during the night were at significantly greater risk to report falls (Odds Ratio = 1.84; 95% CI = 1.05-3.22), and the risk increased in subjects reporting more than three nocturia events (Odds Ratio = 2.15; 95% CI = 1.04-4.44). The significant increase in falls reported by nocturia participants did not result in an increase in reported bone fractures in the past 5 years (P < 0.4360). CONCLUSIONS: Nocturia is an important risk factor for falls in ambulatory elderly persons. Preventive measures should be taken to decrease nocturia events and to decrease the risk of falling during these nocturia events.

Accidental Falls↗

PubMed1992

Acute confusional states in older adults and the role of polypharmacy.

Cognitive impairment resulting from drug therapy in older persons has been well documented for numerous classes of drugs. Unfortunately, the problem of ACS caused by polypharmacy is rarely reported in the medical literature, although we believe that it occurs frequently. Health professionals need more education concerning the risks of drug therapy in older persons and methods of reducing the use of multiple drug therapy. Finally, more research is needed to identify patient and drug factors that lead to drug-induced ACS and cognitive decline in the elderly.

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PubMed1992

Lack of association of nonsteroidal anti-inflammatory drug use and cognitive decline in the elderly.

Folstein Mini-Mental State Examination (MMSE) scores obtained in an ambulatory elderly population were used to examine the effect of nonsteroidal anti-inflammatory drug (NSAID) use on cognitive performance. There were 1,310 participants who met the inclusion criteria for the study, of whom 873 (66.6%) were women and 437 (33.3%) were men. There were no differences in mean MMSE scores or in the five dimensions of cognitive function measured by the MMSE for subjects reporting NSAIDs or aspirin use.

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PubMed1992

Correlates of constipation in an ambulatory elderly population.

Constipation is a common and often perplexing problem for elderly people. The prevalence of self-reported constipation and factors associated with constipation were investigated in 3,166 people over age 65. Twenty-six percent of women and 15.8% of men reported recurrent constipation (p less than 0.0001). There was a significant increase in reported constipation with increasing age (p less than 0.0001). Multiple factors were found to correlate with self-reported constipation. A logistic regression model revealed 13 factors of significance in predicting constipation. The most important factors were age, sex, total number of drugs taken, pain in the abdomen, and hemorrhoids (p less than 0.0001). Specific drugs do not appear to be important factors in constipation in the elderly. Elderly people who report the use of multiple drugs, pain in the abdomen, and hemorrhoids are at increased risk for constipation.

Age Factors↗

PubMed1991

Effect of psyllium hydrophilic mucilloid on serum cholesterol in the elderly.

The effect of psyllium hydrophilic mucilloid (PHM) when used as a laxative and/or stool softener on serum cholesterol concentrations was examined in 176 ambulatory elderly participants attending a health screening program. The change in one-year serum cholesterol concentration in subjects using PHM was compared with the change in cholesterol in 741 participants who did not report the use of PHM. Serum cholesterol concentration decreased by 0.073 mmol/liter (2.82 mg/dl) in the treatment group compared with a decrease of 0.036 mmol/liter (1.39 mg/dl) in the control group. After adjusting for confounding factors, excluding psyllium dose, by using a multiple regression model there was no significant difference in the change in serum cholesterol concentration (P = 0.935). PHM dosage information was available for 158 participants. After adjusting for baseline serum cholesterol and confounding factors using multiple regression analysis, it was found that the dose of PHM administered was significantly correlated with the change in serum cholesterol (P = 0.0120). For every 1-g increase in daily PHM dose there was a 0.022 mmol/liter (0.84 mg/dl) decrease in serum cholesterol concentration.

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PubMed1991

A longitudinal evaluation of drug use in an ambulatory elderly population.

Participants in a geriatric health screening program were studied longitudinally to determine the patterns of drug use over a 10 year period. There were 314 (34.0%) men and 610 (66.0%) women who completed 10 yearly health screening evaluations. The mean number of prescribed and non-prescribed drugs used per participant increased from 2.90 in 1978-79 to 4.08 in 1987-88 (p less than 0.0001). There was no significant difference between men and women in the rate of increased drug use. There was no significant increase in the mean number of drug ingredients per participant used over the 10 year period. The most frequently reported therapeutic categories for 1978-79 were antihypertensives, analgesic-antipyretics, antirheumatics, multiple vitamins, cathartics and vitamin E, which represented 10.2, 7.2, 6.5, 4.9, 4.8 and 3.8% of all categories used. There was a decline in all of these categories between interval 1 and 10. Increased use of drugs, particularly prescribed medications, by the elderly population may present problems of adverse drug reactions, drug interactions and medication compliance in the future. Changing patterns of drug use may have resulted, in part, from introduction of new therapeutic classes and from new treatment concepts over the 10 year study period.

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PubMed1991

Changing patterns of therapeutic agents in the elderly: a ten-year overview.

Drug use patterns in a large ambulatory elderly population were studied cross-sectionally over a 10-year period. There were 24192 drug histories obtained on 4509 individuals during the period from 1 August 1978 to 31 July 1988. The average number of drugs used per person increased from 3.22 in 1978-9 to 3.94 in 1987-8. Prescribed drug use increased by 0.52 per person compared with an increase of 0.21 for nonprescribed medication. Analysis of two mutually exclusive groups of participants from 1978-9 and 1987-8 revealed a significant (p less than 0.0001) increase in the use of nonprescribed medication but no significant increase in the use of prescribed medication after adjusting for age and sex effects. The four most frequently used therapeutic classes of drugs in 1978-9 as a percentage of all drugs used were antihypertensives (10.8%), analgesic-antipyretics (6.4%), antirheumatic (6.4%), and cathartics (5.4%) compared with the antihypertensives (9.5%), analgesic-antipyretics (5.9%), anticoagulants (5.5%), and antirheumatic (4.6%) for the 1987-8 period.

Age Factors↗

PubMed1991

Correlates of cognitive dysfunction in an ambulatory elderly population.

Mini-Mental State Examination (MMSE) scores were studied in an ambulatory elderly population to identify correlates with self-reported signs, symptoms, diseases, drugs and laboratory values. A total of 1,264 subjects were studied including 844 women and 420 men. In this study, 5.0% of men and 5.3% of women scored less than 24 on the MMSE. A linear-regression model revealed eleven factors of significance in predicting scores on the MMSE. The most important predictors were age (p less than 0.0001), self-reported memory loss (p less than 0.0001), complaints of swollen feet or ankles (p less than 0.0010), the total number of diseases reported (0.0006) and the serum lactate dehydrogenase concentration (p less than 0.0098). Results suggest that cognitive function in the elderly is not related to the general level of health or consistently affected by specific disease states.

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PubMed1991

Correlates of Beck Depression Inventory scores in an ambulatory elderly population: symptoms, diseases, laboratory values, and medications.

BACKGROUND: Depression is one of the most important psychiatric disorders of older people. Between 1% and 5% of elderly persons who live in the community have major depression. Depressed elderly people are thought to be more likely to complain of symptoms such as headache, constipation, and pain than of disordered mood. The purpose of this study was to determine whether certain symptoms, diseases, or drugs used by older people correlate with scores on the Beck Depression Inventory. METHODS: Beck Depression Inventory scores were obtained in an ambulatory elderly population to identify correlates with self-reported signs, symptoms, diseases, drugs, and laboratory values. A total of 1048 participants were studied, including 712 women and 336 men. RESULTS: In this study, 13.7% of the men and 20.7% of the women had scores suggesting possible depression. A linear regression model revealed eight factors of significance in predicting scores on the Beck Depression Inventory. The most important predictors were the total number of symptoms reported by the patient (P less than .0001), and subjective complaints of memory loss (P less than .0003) and of pain in the abdomen (P less than .0004). CONCLUSIONS: Clinically, the results of this study suggest that depression is underdiagnosed in older patients and that multiple somatic symptoms are the best indicator of depression in this population.

Abdominal Pain↗

PubMed1990

Diabetes mellitus and other cardiovascular risk factors in an elderly population.

The purpose of this study was to describe the prevalence of diabetes in a community-dwelling elderly population, and to assess whether other cardiovascular disease risk factors were more frequent in older diabetics than in non-diabetics. Results suggest that, with the exception of hypertension, other cardiovascular disease risk factors are not more prevalent in older diabetics and do not aggregate in older diabetics. However, there was a very high prevalence of hypertension among older diabetics. Of particular concern is the observation that 40% of diabetic individuals under treatment for hypertension still have unacceptably high blood-pressure levels. These results indicate a need for follow-up of high-blood-pressure treatment in older diabetic people.

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PubMed1989

Blood pressure changes with aging: evidence for a cohort effect.

Data from cross-sectional surveys show an increase in systolic blood pressure with increasing age. However, cross-sectional data can be misleading. Our purpose in this study is to prospectively describe changes in systolic and diastolic blood pressure levels over time in community-dwelling elderly persons. The participants were 1,917 men and women aged 65 to 98 yr who had participated at least seven years in the Florida Geriatric Research Program, a community-based, multi-phasic health screening program located in Dunedin, Florida (USA). Our results show that contrary to the cross-sectional data, systolic and diastolic blood pressure levels tend to decrease with increasing age. Mean systolic blood pressure in women at the baseline visit (Visit 2) was 143 mmHg and three years later (Visit 5) it had dropped to 140 mmHg. This downward trend was consistent at all ages and for both men and women. Stratification by use of antihypertensive medication, weight change, and survivorship did not alter this association. Further follow-up of this cohort to Visit 7 revealed a U-shaped trend of blood pressure with aging. There was also clear evidence of a cohort effect, as the age-specific mean systolic blood pressure was consistently lower in each younger 5 yr birth cohort. Our results suggest that in a healthy elderly population, systolic and/or diastolic blood pressure levels do not increase with aging; this finding may have implications for the diagnosis and treatment of hypertension in the elderly.

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PubMed1989

Incidence of hypertension in an ambulatory elderly population.

Investigations of the natural history of blood pressure have generally evaluated mean systolic and diastolic pressure changes. While information, this information is not directly applicable to clinical practice settings, in which patients are usually classified as normotensive or hypertensive. We measured the actual incidence of hypertension, using two different definitions, in an ambulatory elderly population of 2,584 individuals over an 8-year period. Using the less stringent blood pressure definition (systolic blood pressure greater than 140 mmHg and diastolic blood pressure greater than or equal to 90 mmHg), 884 (34.2%) participants were normotensive and 1,700 (65.8%) were hypertensive at an initial screening. The average annual incidence of hypertension over the subsequent eight years was 13.2%, and life tables demonstrated a gradual risk of developing hypertension. The development of hypertension was not associated with gender or age; while older age groups had a greater chance of developing hypertension than younger, the difference did not reach statistical significance.

Age Factors↗

PubMed1989

Resting heart rates in an ambulatory elderly population: an evaluation of age, sex, symptoms, and medication.

In a cross-sectional analysis of 2,301 ambulatory elderly subjects, the mean resting heart rate for women (66.2/min) was significantly higher than for men (63.6/min), p less than 0.0001, and heart rate was positively correlated with age for both men and women. Resting heart rate was positively correlated with the number of drugs used (p less than 0.05), number of symptoms reported (p less than 0.05), systolic (p less than 0.01), and diastolic (p less than 0.0001) blood pressure. Of 975 participants who were followed longitudinally over an 8-year period there was a significant decrease in resting heart rate of approximately 2.75/min, p less than 0.0001.

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