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At least 19 recordsLinked to original sources

PubMed1994

[Characteristics of blood pressure regulating endocrinological factors in elderly essential hypertensives].

Plasma renin activity (PRA) was lower in elderly normotensive subjects and essential hypertensives (EHT), and a significant negative correlation was found between PRA and age in both groups. In EHT, the proportion of the low renin group to total EHT increased with aging. There was a significantly positive correlation between plasma norepinephrine (PNE) and age in NT, but not in EHT. The mean value of PNE in young subjects was significantly higher in EHT than in NT, but not in the middle-aged and elderly groups, suggesting the important role of PNE in young EHT. Power spectral analysis revealed a significant reduction of both sympathetic and parasympathetic activity with aging in NT and EHT, indicating much caution may be required if sympathetic nerve activity is evaluated only by PNE levels in elderly EHT. The expanded plasma volume was another characteristic in elderly EHT, and suppressed activity of renal kallikrein-kinin, prostaglandin and dopamine may be involved with its mechanisms. Regarding insulin sensitivity in elderly EHT, it was shown that 1) the reduction of insulin sensitivity plays some role in age related acceleration of hypertension and glucose intolerance, 2) selective insulin resistance with respect to glucose metabolism already exists at lower ages in EHT, and 3) both Na retention and pressor system activation via insulin action might be a cause of blood pressure elevation in EHT.

Adult↗

PubMed1993

[A comparative study of the health conditions of elderly people living alone, elderly couples and the bedridden elderly at home in a rural area of Shiga Prefecture: special reference to morbidity rate and blood pressure, electrocardiograph and blood examination data].

For the purpose of obtaining basic data and for establishing a support system for elderly people with various health and social problems, a population survey was performed in 1990 to investigate the health and living conditions of elderly people living alone, elderly couples and the bedridden elderly in the town of Shigaraki, Shiga Prefecture. A total of 275 subjects (103 male, 172 female) 65 years of age and over were surveyed. The participation rate in this survey was 88.1%. Analysis of health conditions (morbidity rate, blood pressure, electrocardiograph and blood examination data) of elderly people living alone, elderly couples and the bedridden elderly produced the following: 1) Stroke was the main cause of being bedridden in men, while in women, bone and joint disease, especially fracture, was the main cause. 2) The combined prevalence of hypertension and borderline hypertension in elderly people living alone, elderly couples and the bedridden elderly was over 50%. The bedridden elderly had a lower prevalence than elderly people living alone and elderly couples. 3) Men in all of the above mentioned life styles, had a higher tendency of showing ECG abnormalities than women. The tendency for major ECG abnormalities was high for bedridden elderly, both male and female, with the tendency for men being higher. 4) In bedridden elderly, a tendency of higher prevalence of anemia, in both male and females, lower total serum cholesterol and triglyceride in males compared to elderly people living alone and in elderly couples, was observed.

Activities of Daily Living↗

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.

Aged↗

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)

Aged↗

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↗

PubMed1993

Pravastatin experience in elderly and non-elderly patients.

Epidemiologic evidence linking elevated cholesterol concentrations and coronary heart disease (CHD) through the eighth decade of life provides a rationale for lowering cholesterol concentrations to reduce morbidity and mortality from CHD. Pravastatin, a well tolerated HMG CoA reductase inhibitor with a convenient once-daily dosing regimen, has been shown to effectively lower total and low density lipoprotein (LDL) cholesterol. Individual data from more than 1800 hypercholesterolemic patients enrolled in six double-blind, randomized, multicenter studies were pooled and then analyzed to compare the safety and efficacy of pravastatin in the elderly (i.e., patients at least 65 years old) and the non-elderly. In short-term studies (8-16 weeks), response was dose-related and similar in elderly and non-elderly subjects. Pravastatin 20 or 40 mg daily lowered total cholesterol 19-25%, LDL-cholesterol 25-33%, and triglycerides 14-23%; high density lipoprotein (HDL) cholesterol increased 5-10%. During long-term studies, improvements were sustained for more than 24 months in both the non-elderly and elderly. The incidences of adverse drug events and laboratory abnormalities were similar in the elderly and non-elderly patients in all groups (active treatment control with resin, pravastatin alone, or combination therapy). In short-term studies, treatment was discontinued because of adverse events in < 1% of all patients treated with pravastatin (all doses) or placebo. The frequency and profile of adverse events were similar among patients treated with pravastatin or placebo. In long-term studies, treatment was discontinued in 0.4% of patients in the pravastatin group and in 0.3% of the patients in the bile-acid-binding resin group. If drug therapy is warranted, pravastatin appears to be safe and effective for long-term use in elderly patients with hypercholesterolemia.

Adult↗

PubMed1994

[Caregiving burden of elderly caregivers who provide at home care for infirm elderly].

In order to elucidate the degree of feeling burdened and factors affecting caregiving burden of elderly caregivers, a questionnaire survey was performed on 241 female caregivers of infirm elderly. The surveyed group consisted of 138 caregivers under 60 years of age (young group) and 103 aged 60 and over (old group). The major results of this survey were as follows, 1) Conditions perceived as unfavorable in the old group were related to caregiving assistants, number of the family members and health condition of the caregiver. 2) Greater number of infirm elderly with serious ADL problems and higher average body weight of the elderly cared for were seen for the old group than the young group. 3) The old group had a larger number of problem incidents and expressed more eager desire for transfer of elderly to institutional care than providing the young group. 4) A feeling of burden in daily care appeared larger for night care, body discharge disposal and bathing care of the elderly and was more frequent in those above 70 than under 70 years of age. 5) Hours in bed were longer and range of movement by wheel chair was more limited for infirm elderly as the caregiver's age increased. These results suggest that the above-mentioned unfavorable conditions in elderly caregivers promote a state of becoming bedridden and a lowering of ADL ability of infirm elderly.

Activities of Daily Living↗

PubMed1994

Effect of 'autonomic blockade' on cardiac beta-adrenergic chronotropic responsiveness in healthy young, healthy elderly and endurance-trained elderly subjects.

1. Cardiac chronotropic responses to isoprenaline are reduced with ageing in man. It is unclear whether this is due to reduced cardiac beta-adrenergic sensitivity or to age-associated differences in reflex cardiovascular responses to the vasodilatory effects of isoprenaline. Age-associated changes in physical activity are also reported to influence beta-adrenergic sensitivity. 2. The aim of the present study was to determine the contribution of alterations in reflex changes in para-sympathetic and sympathetic influences and physical fitness to the age-associated reduction in cardiac chronotropic responses to beta-adrenergic agonists. 3. The effect of 'autonomic blockade' with atropine (40 micrograms/kg intravenously) and clonidine (4 micrograms/kg intravenously) on blood pressure, heart rate and chronotropic responses to intravenous bolus isoprenaline doses was determined in eight healthy young (mean age 21 years), nine healthy elderly (72 years) and 10 endurance-trained elderly (69 years) subjects. 4. Elderly subjects had a reduced increase in heart rate after atropine (young, 49 +/- 9 beats/min; elderly, 36 +/- 5 beats/min; endurance-trained elderly, 34 +/- 12 beats/min; P < 0.01) and did not demonstrate the transient increase in systolic blood pressure after clonidine observed in young subjects (young, 11 +/- 10 mmHg; elderly, -12 +/- 16 mmHg; endurance-trained elderly, -18 +/- 11 mmHg; P < 0.01). 5. Cardiac chronotropic sensitivity to isoprenaline after 'autonomic blockade' increased in the young but decreased in the elderly subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

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↗

PubMed1993

Age and typicality judgments of stereotypes of the elderly: perceptions of elderly vs. young adults.

Healthy community-dwelling elderly individuals assessed the typicality and approximate age of individuals representing ten stereotypes of elderly people identified in prior research with young adults. Results showed that, as predicted, the elderly adults saw the stereotypes as less typical of elderly individuals than did the young adults, although both groups agreed on which stereotypes were most typical of the general elderly population. Analysis of age judgments revealed that the elderly respondents, in comparison to the young adults, were more likely to use the old-old age ranges to describe the stereotypes, and much less likely to associate the positive stereotypes with the young-old age ranges. Both elderly and young adults tended to associate negative stereotypes with the older elderly age ranges.

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)

Adult↗

PubMed1994

[Results of superficial temporal artery-middle cerebral artery anastomosis for elderly and non-elderly patients with cerebral ischemia].

A study was performed to compare the follow-up results of superficial temporal artery-middle cerebral artery anastomosis between a group of nine elderly patients (aged 70 years or over) and another group of 24 non-elderly patients (aged less than 70 years) with cerebral ischemia. The 33 patients, comprising 26 males and seven females, were evaluated pre- and postoperatively by four-vessel angiography, CT scan, MRI and cerebral blood flow (CBF) examination using either xenon inhalation or 123I-IMP SPECT. In some patients, additional evaluations were done. For those with dementia, the minimental scale (MMS), P300 event-related potential, the Hachinski ischemia score, and the vowel word counting test (Kaneko's KANAHIROI) were used, and for the hemiplegic, the Barthel index indicating ability of daily life (ADL) was employed. The results of follow-up for periods ranging from 12 to 55 months were "excellent" (returned to previous job) or "good" (able to perform self-care) in 27 of the 33 patients (81.8%) including six (66.6%) of the elderly group and 21 (87.5%) of the non-elderly group. There was no significant difference between the two groups by statistical evaluation. Among the nine patients with dementia (five under 70, four 70 years of age or over), eight (four under 70, four 70 or over) showed "rapid recovery" with improved postoperative MMS, P300, vowel word counting score and CBF. One patient under 70 (Case 5; a 47-year-old male) with a delayed 2-day recovery from general anesthesia, took as long as 6 months to obtain the self-care ability in daily life. Excluding this patient, all of the remaining eight patients responded quickly to surgery and were able to go home with their families after 2 to 4 weeks, there being no significant difference between the two age groups. In the 14 patients with hemiplegia/paresis (nine under 70, five 70 or over), a definitely better result was obtained for the non-elderly group. Eight of the nine non-elderly patients (89%) showed full ADL (Barthel index 100), whereas only one of three elderly patients (33.3%) showed almost full ADL (Barthel index 97). In five progressive stroke patients, (three under 70, two 70 or over) ultra-early bypass was performed within 8 hours postictus. Definitely better results were obtained in the patients aged less than 70, who showed rapid recovery and were able to return to their previous jobs 1 to 3 months after surgery. In contrast, the two patients aged 70 or over showed no improvement. In this report, we discuss the clinical and physiological variables that may be important for selection of elderly patients for cerebrovascular bypass surgery.

Activities of Daily Living↗

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.

Aged↗

PubMed1994

Patterns and determinants of social service utilization: comparison of the childless elderly and elderly parents living with or apart from their children.

Approximately one out of five elderly persons are childless. In the absence of children who provide important emotional and instrumental cohort , are childless elderly more likely to use social services than are elderly parents? Analysis of data from the Longitudinal Survey of Aging shows that the childless elderly were more likely to say that they lacked informal instrumental support at times of illness than were the elderly parents. Nevertheless, the childless were no more likely to use social services than were the elderly parents. Strategies to improve the childless elderly's social service use are recommended.

Activities of Daily Living↗

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.

Aged↗

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↗