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At least 19 recordsLinked to original sources

PubMed1990

[Comments on policy--elderly count for much, or counting the elderly? A new statement on policy for the elderly].

The Dutch government has published a new white paper 'Elderly count for much' on policy for the aged. In this document the central principle for social policy is the integration of the elderly in society. Old age policy is characterized as 'integral policy' that is it tries to integrate the traditional fields of social and economic policy, and as 'complementary' policy, that is it tries to complement general policy. The main characteristics of the action program 1990-1994 include: prevention, the integration of housing and services, care for elderly with chronic diseases, education, strengthening of labor-market participation of 50+, the position of elderly women and societal attitudes towards aging and the elderly. In this comment it is argued that this white paper initiates positive developments, but there remain several minor and major problems. We are critical about the role of education, the instruments for an active labor-market policy, the lack of attention for the European dimension, and about the lack of attention for future developments in generational equity and age-rationing of service allocation. We appreciate the attention for age discrimination, and possibilities for longitudinal research. We conclude that 'integrated policy' is only in its initial phase. In this white paper the government is only successful in an integrated policy in the fields of housing and care, not in other fields like technology, labor and education. 'Complementary' policy is not enough to create a firm infrastructure in the aging field. If initiatives in the field of aging are considered as 'extra's' this policy will soon be confronted with the boundaries it creates itself. Although attention for the challenges of graying is growing, old age policy is still marginal compared to the main general policy.

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PubMed1992

[A comparative study of the characteristics and social backgrounds of frail and elderly persons at home, long-stay elderly hospital patients, and residents of welfare homes for the frail elderly].

Three studies were carried out in Mino City, Osaka Prefecture, on 188 frail and elderly persons living at home (the home group), 61 elderly patients who had been hospitalized more than six months (the inpatient group), and 72 residents of welfare homes for the frail elderly (the resident group). The characteristics and social backgrounds of the three groups were compared. About 30% of each group had suffered a stroke. As for ADL score, moderate disability was dominant in the home group, severe disability in the inpatient group, and slight disability in the resident group. The proportions of those who had been living alone and those who had no spouse were significantly higher in the inpatient group and in the resident group than in the home group. Significantly fewer subjects in the resident group had been living with their offspring than in the home group or in the inpatient group. The percentage of those who did not have their own home was the highest for the resident group. Multivariate analyses using Hayashi's quantification method II were conducted for a comparison between cases belonging to the home group and the inpatient group, and between the home group and the resident group. The analysis of the home group and the inpatient group revealed a relationship of the inpatient group to severe disability in ADL, and living alone. Differences between these two groups were related to such variables as ADL, sex, living or not living alone, living or not living with offspring, and having or not having a spouse.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1990

Neutrophil adhesion in the elderly: inhibitory effects of plasma from elderly patients.

Neutrophil (PMN) adherence is a critical component of host defense against infection. We questioned whether abnormalities of PMN adherence may be responsible, in part, for the increased susceptibility to infection in the elderly. We examined the adherence of 51Cr-labeled PMN from 18 elderly (65-95 years) and 18 younger subjects (18-40 years) to gelatin-coated plastic (gel) and bovine aortic endothelial monolayers (BAEC). There was no difference in unstimulated or baseline adherence of elderly or control PMN to either gel or BAEC substrates. N-Formyl-methionyleucylphenylalanine (FMLP), phorbol myristate acetate (PMA), and calcium ionophore A23187 (CI) significantly increased adherence of elderly PMN to gel and BAEC by 204 and 140% for FMLP, 271 and 263% for PMA, and 211 and 150% for CI, respectively. No differences were observed in the increment in stimulated adherence between young and elderly PMN. In contrast, in 5 of 18 subjects, incubation of elderly or young PMN with 10% elderly plasma resulted in greater than 25% inhibition in baseline adherence to BAEC compared to their sex-matched controls. The effect of elderly plasma was specific for BAEC and not seen with the gel substrate and was also demonstrated using human venous endothelium. When the adherence assay was repeated with varying ratios of elderly and young plasma, PMN adherence to BAEC correlated inversely with the proportion of elderly plasma in the assay. With greater than 70% elderly plasma, adherence was depressed below that observed in the absence of plasma. These data suggest the presence of a factor(s) in elderly plasma which may diminish adherence to endothelium. This factor(s) may be important in the increased risk of infection in a segment of the elderly population.

Aging↗

PubMed1987

Pharmacokinetics of lisinopril (MK521) in healthy young and elderly subjects and in elderly patients with cardiac failure.

The pharmacokinetics of lisinopril were determined in 6 healthy young, 6 healthy elderly and 6 elderly patients with cardiac failure. Lisinopril (5 mg day-1) was administered for 7 days. Plasma lisinopril concentration was measured at 1, 2, 4, 6, 8 and 24 h on days 1 and 7 of the study. The two elderly groups had higher serum lisinopril concentrations than the healthy young subjects (P less than 0.05). There were no significant differences in any of the areas under the curve (AUC) for lisinopril plasma concentration (over time) between the healthy young and healthy elderly groups. The healthy young patients had AUC values on day 7 lower than elderly patients with cardiac failure (P less than 0.01). Creatinine clearance was correlated with lisinopril clearance (r = 0.63; P = 0.006) and with AUC on day 7 (r = -0.67; P = 0.004). Lisinopril clearance was different in the three groups (P less than 0.05): healthy young patients had the highest and elderly patients with cardiac failure the lowest values. Thus, in the elderly a reduced renal clearance of lisinopril leads to higher and more sustained blood levels. In elderly patients with cardiac failure, renal function should be estimated before lisinopril is prescribed as a reduction in dose may be appropriate.

Adult↗

PubMed1989

[Water and electrolyte metabolism in the elderly with cardiovascular disease--hormonal aspects in elderly hypertension].

Study I: A retrospective survey of the data base on serum electrolyte measurements in our hospital (approximately 50,000 cases) revealed that the incidence of hyponatremia increased with age. Its major cause in the elderly hospital inpatients with cardiovascular disease was congestive heart failure, frequently accompanied by renal dysfunction and the use of diuretics. Another interesting finding from this analysis was that the use of potassium sparing diuretics were often associated with hyperkalemia in elderly patients whose renal functions were apparently normal based on the serum creatinine level. Study II: The resting hemodynamics and the plasma levels of various hormones related to water and electrolyte metabolism were compared between normal elderly and young subjects. The resting hemodynamic parameters, including cardiac index and blood pressure, did not differ between the two normal groups. Plasma atrial natriuretic peptide and norepinephrine levels were significantly higher in the elderly, while plasma renin activity and aldosterone levels were significantly decreased. No differences were observed in antidiuretic hormone levels. The same parameters were then compared between normal and hypertensive elderly subjects. Elderly hypertensives had lower cardiac index and higher peripheral resistance than normal elderly subjects. Plasma norepinephrine level and plasma renin activity were lower, but aldosterone level was not significantly lower in hypertensives than in normotensives. There was no difference in antidiuretic hormone. In the elderly group as a whole, atrial natriuretic peptide correlated positively with blood pressure, and negatively with plasma norepinephrine and renin activity. Multivariate analysis showed that the strongest correlation was that with plasma renin activity. These results suggest that the plasma levels of various hormones related to water and electrolyte metabolism were altered with age and hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1991

Determinants of disease and disability in the elderly: the Rotterdam Elderly Study.

In this paper the Rotterdam Elderly Study is presented. The aim of the study is to investigate determinants of disease occurrence and progression in the elderly. In addition to contributing to our understanding of the etiology of geriatric illnesses, the study is expected to lead to specific recommendations for intervention. The study focuses on causally related determinants of major diseases in the elderly. Fields of interest for the Rotterdam Elderly Study are conditions which interfere the most with the quality of life for the elderly. The aims of the Rotterdam Elderly Study are: (1) To investigate, by means of epidemiologic, clinical and basic research, the determinants of diseases in order to assess their etiologic significance. (2) To investigate potentially modifiable determinants in order to be able to develop preventive strategies by providing specific recommendations for intervention studies. The Rotterdam Elderly Study focuses on four primary areas of research: neurogeriatric diseases, cardiovascular diseases, locomotor diseases and ophthalmologic diseases. It is a prospective follow-up study, in which determinants of disease and determinants of progression of disease will be investigated in the total population of 55 years or over of the district of Ommoord in Rotterdam. It is anticipated that about 10,000 people will participate in the study and they will be examined in the period of 1991 to 1995.

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PubMed1987

The care of elderly patients by elderly physicians.

To examine the content of care that elderly patients receive from physicians greater than or equal to 65 years of age, data from the 1981 National Ambulatory Medical Care Survey were analyzed. Compared to physicians aged 35 to 54 years, elderly physicians devoted a larger proportion of their practices to the care of elderly patients. In caring for these patients, elderly physicians spent more time per visit than did younger physicians and were more likely to conduct general examinations and provide counseling. In contrast, elderly physicians were less likely to perform mental status or vision examinations. Elderly physicians were also less likely to provide telephone follow-up for those patients greater than or equal to 75 years of age and more likely to discharge patients greater than or equal to 65 years of age without any specific follow-up planned. These data suggest that the content of care for elderly patients may differ substantially depending upon the physician's age.

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PubMed1992

Elderly versus younger problem drinker profiles: do they indicate a need for special programs for the elderly?

To address the question, "Do elderly problem drinkers differ from younger ones and therefore might they need special treatment programs?", the descriptive profiles of a representative sample of older and younger persons arrested for drinking and driving in Iowa were compared. Subjects were interviewed by telephone or mail using a structured, clinical interview schedule that was designed to obtain a comprehensive self-report picture of the role of alcohol in their lives. Younger persons (18-54 years old) were compared with two overlapping elderly age groups (55 and over and 65 and over). The elderly subjects were also dichotomized as "early onset" (at least one problem-drinking indicator occurred prior to age 55) and "late onset" (all problem drinking indicators occurred at age 55 or later). Although there were several statistically significant (p < or = .01) differences between the elderly and younger problem drinkers, there was a much, or more, heterogeneity within the elderly groups as there were differences between the elderly and their younger counterparts. Also, the descriptive profile of these at-large elderly problem drinkers differed, depending on whether their alcohol abuse was early- or late-onset.

Adolescent↗

PubMed1992

Measurement of oxybutynin and its N-desethyl metabolite in plasma, and its application to pharmacokinetic studies in young, elderly and frail elderly volunteers.

1. A quantitative h.p.l.c. plasma assay for oxybutynin (OB) and its active metabolite, N-desethyl oxybutynin (DEOB) is described. The method is linear with coefficients of variation ranging between 4 and 11.8% for OB and 4.6-9.1% for DEOB over the typical concentration range measured. Minimum detectable levels were 0.5 and 5 ng/ml for OB and DEOB respectively from a 2 ml sample. 2. Pharmacokinetic parameters were obtained after a single oral dose of OB and after administration two or three times daily to frail elderly and elderly volunteer groups respectively. Single dose results were also compared with data from young healthy volunteers. 3. There was a wide range in peak blood levels and high levels of parent drug were matched by high DEOB metabolite levels. Plasma levels on repeated administration were as would be predicted from the single dose kinetics. 4. Area under the plasma time course curve for DEOB metabolite was less than or equal to 5 than that of the parent drug. 5. A trend of increasing peak plasma levels and bioavailability was observed with increasing age and frailty, with the differences more apparent between the active elderly and frail elderly groups than between the active elderly and young volunteers. 6. Results indicate that for frail elderly patients a lower initial starting dose of 2.5 mg OB given two or three times a day may provide adequate therapeutic blood levels of the drug.

Administration, Oral↗

PubMed1987

A comparative study of the pharmacokinetics and pharmacodynamics of atenolol, hydrochlorothiazide and amiloride in normal young and elderly subjects and elderly hypertensive patients.

Six normal young and six normal elderly volunteers and six elderly hypertensive patients took part in an acute and chronic dose study of a combination capsule containing atenolol (50 mg), hydrochlorothiazide (25 mg) and amiloride (2.5 mg) designed for the treatment of hypertension. No difference in any of the drug pharmacokinetic parameters could be detected between the hypertensives and the normal elderly subjects. The bio-availability and the 24-h blood concentrations of all three drugs, half-life of atenolol and amiloride and the peak concentration of hydrochlorothiazide was significantly greater in the elderly. The 24-h blood concentrations of atenolol and hydrochlorothiazide did not alter with chronic dosing, but amiloride concentrations were significantly higher at this time in all groups. A significant fall in the blood pressure was observed in the hypertensive group. Heart rate fell more in the normal and hypertensive elderly subjects than in the young. The combination has shown to be an effective and well tolerated antihypertensive in the elderly patient with a 24-h duration of action.

Adult↗

PubMedDate not supplied

Diltiazem pharmacokinetics in elderly volunteers after single and multiple doses.

In young healthy volunteers diltiazem does not have linear kinetics between single and multiple doses. Elimination half-life increases and gives AUC's and Cmax higher than those predicted from single dose data. Kinetics of diltiazem were assessed in 16 healthy elderly after a single 60 mg dose and in 24 healthy elderly after 60 mg every 8 h for 7 days. Thirteen participants completed both studies. Elimination half-life, AUC0-24, AUC0-infinity, and Cmax were (mean +/- SE) 7.4 (1.2) h, 349 (34) ng/ml.h, 392 (44) ng/ml.h, and 43 (5) ng/ml respectively after a single dose. After multiple doses elimination half-life, AUC0-48, AUC0-infinity, Cmax and Cmin were respectively 5.7 (0.3) h, 974 (107) ng/ml.h, 1022 (108) ng/ml.h, 102 (7) ng/ml and 43 (5) ng/ml. Exploratory statistics on the 13 volunteers common to both studies showed that the ratio of AUC desacetyl-diltiazem (DAD)/AUC diltiazem rose between single and multiple doses while elimination half-life of both diltiazem and N-desmethyl-diltiazem (MA), tmax, and AUC MA/AUC diltiazem were not affected. The conclusion of this study is that elimination half-life of diltiazem does not increase in elderly between single and multiple doses, possibly due to an increased biotransformation into DAD.

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PubMed1988

The significance of elderly migration to changes in elderly population concentration in the United States: 1960-1980.

Analysis of county level elderly and nonelderly net migration data revealed that, overall, migration was of less importance in explaining changes in elderly population concentration between 1970 and 1980 than it had been in the previous decade. However, because of the spatial restructuring of both elderly and nonelderly migration, the contribution of elderly migration relative to nonelderly migration increased from 1960 to 1980. Recognizable regional variations were apparent. Elderly migration not only remained significant in explaining changes in elderly population concentrations in "traditional" Sunbelt retirement states but also showed increased importance in newly emergent southern retirement states and in several northern states, including a group in New England.

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PubMed1989

Clearance of the antihistamine doxylamine. Reduced in elderly men but not in elderly women.

A single oral dose of doxylamine succinate 25 mg was administered to 21 young (20 to 43 years) and 22 elderly (60 to 87 years) volunteers. Multiple plasma doxylamine concentrations were determined during a 30-hour period after each dose. Elderly and young women did not differ significantly in peak plasma doxylamine concentration (Cmax) [116 vs 103 micrograms/L], time to Cmax (tmax) [2.4 vs 2.4 h], elimination half-life (12.2 vs 10.1 h), volume of distribution (179 vs 176 L) or clearance (191 vs 218 ml/min). Cmax (107 vs 108 micrograms/L) and tmax (2.1 vs 1.6 h) also did not differ between elderly and young men. However, elderly men had reduced doxylamine clearance (174 vs 240 ml/min, p less than 0.02; 2.5 vs 3.2 ml/min/kg, p less than 0.07) and prolonged half-life (15.5 vs 10.2 h, p less than 0.05). The reduced doxylamine clearance and prolonged half-life in elderly men, but not in elderly women, is similar to results for many other drugs which are transformed by oxidation.

Adult↗

PubMed1992

Changing elderly in a changing society. Danish elderly in the next century.

A cross-sectional and multidisciplinary study on the situation of the elderly in Denmark at the beginning of the next century was undertaken in the late 1980s. The intention was to give a picture of the future cohorts of elderly, and their expectations for old age. The study also looked into the ways in which future societal developments might affect the situation of the elderly. In order to test a number of hypotheses on the future elderly and their preferences for life when they grow older, 1200 persons in the age groups 40-44, 50-54, and 60-64 years old were interviewed. Further, a number of studies were commissioned on developments which may affect the elderly with regard to health, housing, family, work and retirement, financial conditions, leisure activities and political participation. A main conclusion is that the future elderly in most areas--be it financial conditions, health, housing education--will be in a more favourable position than their predecessors after retirement. But there will still be a minority who suffer a hard life. They are the people whose finances are weak, whose health is impaired, and who lack social contacts.

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PubMed1991

Isolated systolic hypertension in the elderly: implications of Systolic Hypertension in the Elderly Program (SHEP) for clinical practice and for the ongoing trials.

The Systolic Hypertension in the Elderly Program (SHEP) was a double-blind placebo-controlled outcome trial on the treatment of isolated systolic hypertension (systolic pressure: 160-219 mmHg and diastolic pressure less than 90 mmHg). From 447, 921 screenes (age greater than or equal to 60 years) 4,736 patients were randomised. A significant reduction of non-fatal stroke (37%), non-fatal myocardial infarction (33%) and left ventricular failure (54%) was observed in the active treatment group. By contrast, the reduction in transient ischaemic attacks (25%), and in total (13%), cardiovascular (20%), cerebrovascular (29%) and coronary (20%) mortality did not reach a level of statistical significance. SHEP is a landmark trial on the treatment of isolated systolic hypertension (ISH) in the elderly. However, the question to what extent the SHEP results can be extrapolated to clinical practice remains open for debate. Indeed, it is possible that due to selection, the SHEP patients were not entirely representative of the elderly with ISH in the population at large. By contrast with previous intervention studies in elderly patients with combined systolic and diastolic hypertension, the SHEP trail did not demonstrate a significant beneficial effect of antihypertensive treatment on any of the cardiovascular mortality endpoints. Confirmation or rejection of the SHEP results in other trials, including the Syst-Eur study, conducted by the rejection of the SHEP results in other trials, including the Syst-Eur study, conducted by the European Working Party on High Blood Pressure in the Elderly and the Chinese trial in elderly ISH patients, is now awaited.

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PubMedDate not supplied

[The "legal rights of the elderly"--is it desirable, to institute special legal provisions for the elderly?].

Legal problems of the elderly are, besides social legislation, a rather small topic of interest in the field of law and jurisprudence in the FRG. There are some provisions in the social legislation (old age insurance; health insurance) but no special provisions in tax law for the needs of the elderly. Most of the interesting legal provisions, even if old-age matters prevail, are general, and not specific old-age-related provisions. But we can see that in the legal practice, especially in the courts, interests of the elderly are sometimes taken in consideration, for example ventue law and in penal law at the prosecution level. One may raise the question whether a new field of "Laws for the Elderly" should be created. Such a specialty could comprise all the legal provisions that concern the elderly, particularly as regards their special age-related needs and problems. A law containing special measures prohibiting old-age-discrimination would be problematic in regards to equal treatment of other population groups, because equal treatment is a general constitutional rule. It seems to be on the right track to include old-age needs and problems in general legal provisions that also cover the population groups which are in similar positions. This is not to say that special provisions for the elderly should not be arranged if only those persons are concerned.

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PubMed1991

Pharmacokinetics of the anti-inflammatory drug ximoprofen in healthy young and elderly subjects: comparison with elderly rheumatic patients.

The pharmacokinetics of ximoprofen were studied in young and elderly subjects after single and repeated doses up to 30 mg. In healthy elderly subjects (30 mg dose), a mean peak plasma drug concentration of 1.78 micrograms ml-1 +/- 0.83 s.d. occurred at a mean time of 1.95 h +/- 1.40 s.d. and, thereafter, concentrations declined monoexponentially with a mean half-life of 3.8 h +/- 1.4 s.d. Comparison of these data with those from younger healthy subjects showed that peak drug concentrations, areas under the curve and half-lives were about two-fold greater in the elderly, these differences probably reflecting a lower systemic drug clearance. Similar results were obtained on comparing data from young healthy subjects and elderly rheumatic patients receiving single and repeated doses of ximoprofen (15 mg twice daily). In patients, the half-life of ximoprofen was 2.5 h +/- 0.7 s.d. Within either group, pharmacokinetic parameters after single or repeated doses were similar: ximoprofen did not accumulate in the plasma of the young or elderly.

Adult↗

PubMed1990

Clinical characteristics, diagnosis and treatment of elderly patients with lung cancer at non-surgical institutions: a multicenter study. North-Eastern Italian Oncology Group. Neoplasms of the Elderly Committee.

A multicenter retrospective study was undertaken in northern Italy to assess clinical characteristics and pattern of care of elderly patients (greater than 70 years) with lung cancer seen in 1984, at 14 non-surgical institutions. Overall, 1 out of 5 patients with lung cancer was elderly. Eighty-four percent of the 264 elderly patients under study were males, and overall, their median age was 76 years. Squamous cell carcinoma was the most frequent histologic type (53%), and most of the patients (61%), after a rather intensive diagnostic workup, had loco-regional disease. Sixty-three percent of patients underwent radiotherapy, which was mostly classified as palliative. Chemotherapy was given to 13% of patients, mostly with small cell histology. Response to radiotherapy and chemotherapy was observed in about 50% of the patients; however, 3 out of 34 (10%) patients treated with chemotherapy died from toxicity. The median survival time from diagnosis was 9.9 months; survival time was not related, in this population of elderly patients, to age. Throughout the study, the quality of data recording during the patient's illness was often found to be suboptimal. In conclusion, elderly patients with lung cancer appear to be actively staged and treated outside a protocol context in the clinical practice of cooperating nonsurgical institutions in northern Italy. This stresses the importance of prospective studies aimed to evaluate the cost/effectiveness of the various procedures used and the impact of treatments used (or even of a policy of no treatment) on the survival and quality of life of these patients.

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