Epidemiology of diabetes mellitus in the elderly in northern Greece: a population study

This population based study was undertaken to ascertain the overall prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the elderly using the WHO criteria. The role of obesity in the development of DM or IGT has been investigated for both sexes per decade of age. Furthermore the potential for DM to increase with age, as has been suggested before, has been evaluated using the IGT as a proportion of total glucose intolerance (IGT/TGI) for the same parts of the tested sample. From the 647 persons registered as elderly people in a small town in northern Greece (total population 5875 people), 66 persons did not participate in this survey. Fifty-six subjects (9.7%) had previously diagnosed DM. The remainder were tested using fasting blood glucose measurements or an oral glucose tolerance test (OGTT). The prevalence of previously undiagnosed DM according to fasting blood glucose values or after 2 h of 75 g load values was 10.1% and 9.3%, respectively. Thus the overall prevalence of DM was 29.1% and of IGT was 15.1%. These data support an increased frequency of DM (65% previously undiagnosed) and IGT in the elderly, whereas this population's susceptibility seems to decline in the older groups for both sexes. Obesity remains a risk factor for DM and IGT particularly among the younger groups although its role has been found to decline with age.     

Occurrence of dementia and depression in an elderly Danish population

A community survey of all Danish speaking residents above the age of 64 in a geographically delimited area was performed. The aim of the survey was to establish the prevalence of dementia disorders and depression by the use of international screening tools: the Mini Mental State Examination for dementia and the Beck's Depression Inventory for depression. The screening was performed during the period of one year in the municipality of Karlebo and the interviews took place in the homes of the participants. Six hundred and sixty-four (66%) of the 1,008 eligible persons entered the study. Six percent were residents in nursing homes. Thirteen point seven percent were found to be suffering from dementia. Nine point six percent had symptoms of depression. These prevalences would indicate that more than 6,000 persons in Frederiksborg county suffer from dementia while more than 4,000 might be suffering from depression. The study confirms knowledge obtained in other studies, indicating that one out of seven of the elderly suffers from dementia. We do not conclude, however, that nine point six percent suffer from depression, but rather that they need further examination to make it possible to decide whether they are indeed depressed.     

Postural hypotension and dizziness in a general aged population: a four-year follow-up of the Helsinki Aging Study

OBJECTIVE: To evaluate the frequency, risk factors, and prognostic significances of postural hypotension (PH) and dizziness on postural testing (DPT). DESIGN: A prospective cohort study. SETTING: General community, The Helsinki (Finland) Aging Study. SUBJECTS: Persons of three age cohorts (75, 80, and 85 years, n = 569) were chosen randomly and followed for 4 years. MEASURES: Postal questionnaires, structured interview, extensive clinical and laboratory examinations, blood pressure (BP) changes in a postural test using different definitions for PH, history of dizziness, dizziness on testing postural blood pressure reactions (DPT), and date of death during a 4-year follow-up. RESULTS: The frequency of a fall in systolic blood pressure greater than 20 mm Hg or a fall in diastolic pressure greater than 10 mm Hg (PH-I) was 30.3%. Both criteria occurred simultaneously (PH-II) in 7.5%, and if dizziness on postural testing (DPT) was an additional symptom (PH-III), the prevalence was 2.6%. The overall prevalence of DPT was 19.7%. PH-I, PH-II, and DPT were also frequent among the healthy aged (26.6%, 6.6%, and 17.3%, respectively). The postural change in BP correlated inversely with the initial supine BP levels (systolic r = -.149, P < .001 and diastolic r = -.218, P < .001), but in persons with isolated systolic hypertension PH was rather less frequent (21.9% and 2.3%). DPT was more common in the subjects with heart failure (26.3%, P < .05), impaired exercise tolerance (NYHA III-IV) (33.7%, P < .05), and PH-II (37.2%, P < .05) compared with the healthy controls (17.3%). The 1-year mortality was higher in subjects with than without DPT (7.1% vs 4.8%, P < .05), but the difference was not significant after controlling for age and gender. PH-I, PH-II, and PH-III were not significantly related to 4-year mortality. CONCLUSIONS: In this study of older people in Helsinki, Finland, asymptomatic hypotensive postural BP reactions and DPT were found frequently among healthy older people, and they tended to be increased in people with some diseases. Neither PH nor DPT were of prognostic significance for mortality in this population.     

An overview of depression in the elderly: a US perspective

Surnames are the result of historic and cultural processes which give information about the ethnic composition and genetic structure of populations. Based on the use of isolation and sedentarisness estimators, obtained from surnames frequency and distribution, the population dynamics of highland communities located at the Province of Jujuy (Northwest of Argentina), situated in two ecologically different regions, was analysed. Surnames were obtained from register of electors (1982) and they correspond to 67 villages of Quebrada of Humahuaca and Puna Juje?a. The surnames were analysed exactly as they were registered (NM = Non-merged) and merged according to their spelling and or similarity in pronunciation (M = Merged). The following estimators were used: 1) percentage of the population covered by unique surnames; 2) percentage of the population covered by the most frequent surnames; 3) ratio between number of individuals and number of surnames. Inter-population differences were detected by means of non-parametric tests. It was observed that, in general, there are no statistically significant differences between NM and M data and among the towns in Quebrada de Humahuaca and Puna, but there were differences according to whether they were located on or away from the main road between regions. These results were compared with those of other populations and we conclude that the simultaneous use of the 4 estimators, to characterize the isolation or sedentarisness of vast population groups, show highly consistent results.     

Cognitive impairment and social distress as different pathways to depression in the elderly: a cross-sectional study

BACKGROUND: The qualities of visual perception and of motor reaction to the visual stimulus have never been studied in reference to the type of video-camera system (2-D vs 3-D) used during laparoscopy. METHODS: The study was designed in two parts. The first evaluated the ability of the eye to discriminate how objects are spaced relative to one another. The second investigated the motor reaction to the visual stimulus in an environment where depth was the preponderent cue. The tests were performed in a pelvi-trainer in which were inserted different modules built either for visual observation (Part 1) or for evaluation of motor ability (Part 2). Variables studied during Part 1 were the time required to do the test and the number of errors committed during its performance. The variable evaluated during Part 2 was the time needed to terminate the test. Each of these two parts of the study were completed alternating the 2-D and 3-D systems. A total of 304 observations were recorded. Statistics used were the paired t-test, the independent group t-test, and the Newman-Keuls multiple comparisons test. RESULTS: Results of Part 1 of the study confirm that visual perception varies significantly among individuals (n = 10) (p < 0.05) and that a true 3-D video-camera system facilitates visual perception when compared to a 2-D system (p < 0.001). Results of Part 2 of the study also show significant differences among participants (n = 9)(p < 0.05). The true 3-D system allowed significantly faster motor performances than the 2-D system (p < 0.001). CONCLUSION: Our experiment shows that the 3-D system allowed significant improvements in the execution of the evaluated parameters. Also noted were significant differences among participants in term of visual and motor skills.     

Major depression and medication adherence in elderly patients with coronary artery disease.

Little is known about the effects of depression on adherence to medical treatment regimens in older patients with chronic medical illnesses. Poor adherence may explain the increased risk of medical morbidity and mortality found in depressed medical patients. Ten of 55 patients over the age of 64 with coronary artery disease met the criteria for major depression from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., American Psychiatric Association, 1987). All patients were prescribed a twice-per-day regimen of low dose aspirin to reduce their risk for myocardial infarction. Medication adherence was assessed for 3 weeks by an unobtrusive electronic monitoring device. Depressed patients adhered to the regimen on 45% of days, but nondepressed patients, on 69% (p?     

The elderly in nursing homes: a special population

The ear-xiphisternum distance (EXD, the distance from the low edge of the ear to the xiphisternal basis in supine position) was used as a reference value for esophageal catheter insertion. ECGs recorded in the esophagus with bipolar electrocardiography using standard limb lead (ESLL) and conventional unipolar lead (ECUL) were compared. 112 patients with sinus rhythm and 76 patients during paroxysmal supraventricular tachycardia (PSVT) whose P-wave and QRS complex did not overlap were studied. The results suggested that in sinus rhythm the amplitude of the P-wave in ESLL was larger and the T-wave was smaller than in ECUL. During PSVT, the P-wave was much clear and higher in each lead of ESLL than that in ECUL. The ideal range of esophageal ECG recording was situated between the end of EXD and 6.5 cm proximal to it.     

The relationship between depression and marital maladjustment in a clinic population: A multitrait-multimethod study.

Took depression and marital maladjustment measures of all 154 couples attending a clinic. Average age for men was 38 yrs, for women 35 yrs; average length of marriage was 19 yrs. A significant correlation between depression and marital maladjustment was found for self-report data and was replicated by therapists' ratings. Women were significantly more depressed than men though similar in average ratings of marital adjustment. Women's depression ratings were minimally related to their own their husbands' marital ratings. Men's depression ratings were related to both their own and their wives' marital ratings. Convergent validity was demonstrated for the Locke and Wallace Marital-Adjustment Test and the Beck Depression Inventory. Clinical implications of findings concerning both depression and marital maladjustment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lithium in depression: a biochemical study

Two groups of depressed subjects, one with a history of recurrent depression, the other with a history of persistent apathy, were given lithium carbonate 1,200 mg q.i.d. and supplementart potassium 1,200 mg t.d.s. for 1 week. Measurements were made before and after the lithium treatment of total body water (tritium space), extracellular fluid (sulphate space), total exchangeable sodium (Nae) and total exchangeable potassium (Ke) using sodium-24 and potassium-42 multiple isotope dilution techniques. Prior to treatment when compared with a group of normal subjects, both depressed groups showed changes in body fluid volumes and electrolyte levels. Total body water, intracellular fluid and intracellular potassium were lowered, while electrolyte levels. Total body water, intracellular fluid and intracellular potassium were lowered, while intracellular sodium was raised. After treatment with lithium the values in the apathetic group showed little change but the group with recurrent depression showed a significant increase in intracellular fluid (p less than 0.025), Ke (p less than 0.001), intracellular potassium (p less than 0.025) and a significant decrease in Nae (p less than 0.05). There was a marked increase in mood in the group with recurrent depression but not in the apathetic group following lithium treatment. These findings suggest that recurrent depression, both in clinical improvement, mood and also correction of water and also correction of water and electrolyte disturbances arise, but not in patients with long-standing apathy.     

Measuring depression in a clinical population using the MMPI.

When the Minnesota Multiphasic Personality Inventory (MMPI) has been compared with other objective depression measures in terms of validity, results have been inconsistent. Administering the MMPI to samples of 72 clinically depressed and 61 clinically nondepressed inpatients and comparing scores from its Depression scale with scores from the Beck Depression Inventory was the purpose of this study. A positive linear relation between the two measures and their ability to discriminate between depressed and nondepressed groups was demonstrated. When obvious subscale items were removed from the MMPI Depression scale and were analyzed separately, results improved on a hit rate of 70% for depression in this population. Research findings based on MMPI Depression scale data from clinical populations may be misleading unless variance due to face-valid or obvious items is taken into account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dependency and self-criticism in depression: Evaluation in a clinical population.

The validity of Blatt's (1974) model of depression was explored in a clinical population. Subjects included 63 female outpatients with major depression and 15 women with no lifetime history of psychopathology. All subjects received structured diagnostic and family history interviews and completed the Depressive Experiences Questionnaire (DEQ), which was developed to assess Blatt's concepts of anaclitic and introjective depression. In addition, the depressives received extensive follow-up assessments 6 months later. The depressives had significantly higher levels of anaclitic and introjective traits, respectively. Dependency and, to a lesser extent, self-criticism appeared to be influenced by clinical state, as recovered depressives' scores exhibited a greater decline between the initial and follow-up assessments than did nonrecovered patients' scores. Finally, analyses examining the relation between dependency and self-criticism and a broad range of clinical, family history, and short-term outcome variables provided little support for Blatt's (1974) model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tianeptine therapy for depression in the elderly

PURPOSE: Data on patients with cancer of the larynx are analyzed using statistical models to estimate the effect of gaps in the treatment time on the local control of the tumor. METHODS AND MATERIALS: Patients from four centers, Edinburgh, Glasgow, Manchester, and Toronto, with carcinoma of the larynx and treated by radiotherapy were followed up and the disease-free period recorded. In all centers the end point was control of the primary tumor after irradiation alone. The local control rates at > or = 2 years, Pc, were analyzed by log linear models, and Cox proportional hazard models were used to model the disease-free period. RESULTS: T stage, nodal involvement, and site of the tumor were important determinants of the disease-free interval, as was the radiation schedule used. Elongation of the treatment time by 1 day, or a gap of 1 day, was associated with a decrease in Pc of 0.68% per day for Pc = 0.80, with a 95% confidence interval of (0.28, 1.08)%. An increase of 5 days was associated with a 3.5% reduction in Pc from 0.80 to 0.77. At Pc = 0.60 an increase of 5 days was associated with an 7.9% decrease in Pc. The time factor in the Linear Quadratic model, gamma/alpha, was estimated as 0.89 Gy/day, 95% confidence interval (0.35, 1.43) Gy/day. CONCLUSIONS: Any gaps (public holidays are the majority) in the treatment schedule have the same deleterious effect on the disease free period as an increase in the prescribed treatment time. For a schedule, where dose and fraction number are specified, any gap in treatment is potentially damaging.     

Pharmacologic management of depression in the elderly

Depression, the most common geriatric psychiatric disorder, is a disabling mood disorder that impairs one's well-being and may even threaten a sufferer's life. Severely depressed elderly persons are more likely to kill themselves than individuals in any other age group. However, geriatric depression is, for the most part, a treatable and manageable illness. Antidepressant medication can be very effective in treating major depressive disorder (MDD). Because age-related physical changes in the elderly produce pharmacokinetics that are often different than that experienced by younger adults, different doses are often necessary. This article summarizes recommendations for selecting and initiating appropriate antidepressant therapy in elderly persons suffering from MDD. The benefits and drawbacks of tricyclic antidepressant agents, and other atypical antidepressant agents are discussed. Phases of treatment, drug selection, dosing, and educational tips for pharmacotherapy are presented.     

Anormative study of Russell's variant of the Wechsler Memory Scale in a healthy elderly population.

E. W. Russell's (see record 1976-08657-001) variant of the Wechsler Memory Scale was administered to 175 elderly individuals in 4 age groups (65–69, 70–74, 75–79, and 80+ yrs) to provide normative data in a superior aged population and to determine if memory skills deteriorate with age even when chronic medical problems are not present. A clear age-related decline was present for the Visual Reproduction subtest, and a similar but less marked age effect was observed for Logical Memory. Delayed recall was consistently poorer than immediate recall for all age groups on both subtests. However, there were no age-related effects for the Percentage Retained variables, suggesting that aging does not affect the memory loss over a 30-min delay. Results demonstrate that verbal and spatial memory abilities progressively decline after age 65 yrs even in an aged population without medical problems and with above-average education and income. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Uncontrollability and self-blame in depression: Investigation of the paradox in a college population.

The so-called paradox in depression, that depressives blame themselves for events over which they feel no control, received empirical support in this study of 80 undergraduates. Scores on the Beck Depression Inventory were positively correlated with the ratings of helplessness and guilt perceived in various self-roles. Perceptions of helplessness and guilt covaried positively across roles for almost all Ss, but particularly for depressives. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical impairments in the elderly population

The model presented here provides a starting point for considering the physical impediments that accompany biologic aging. The scientific challenge for the future is to identify how specific modifiable variables can attenuate these physical impediments and distinguish them from those changes that are truly irreversible accompaniments of aging. The humanitarian challenge facing all health care professionals is to provide compassionate care, emotional support, and unfailing commitment to aging persons as they experience changes in physical function and role performance.     

Comorbidity of unipolar depression: I. Major depression with dysthymia.

The degree of current and lifetime comorbidity between major depressive disorder (MDD) and dysthymia (DY) was examined in large community samples of older adolescents (n?=?1,710) and adults (n?=?2,060). DY was highly comorbid with MDD (lifetime odds ratio of 3.4 for adolescents and 1.6 for adults) and was more likely to precede than to follow MDD, especially in persons who became depressed early in life. MDD was by far the more frequent form of depression: Approximately 80% of the depressed persons experienced only MDD, 10% experienced only DY, and 10% experienced both MDD and DY. The large number of persons who had become depressed twice experienced MDD in the 2nd episode, regardless of the nature of the 1st depression. History of depression was associated with a greater probability for other mental disorders in both adolescents and adults; however, the rates of comorbidity for MDD did not differ from rates for DY or for both MDD and DY. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive performance in a high-functioning community-dwelling elderly population

BACKGROUND: The purpose of this study was to examine the role of demographic factors as predictors of cognitive performance in a high-functioning, community-dwelling elderly population. METHODS: The study cohort consisted of 1,192 community-dwelling subjects, who were selected to represent the highest third of an elderly population with respect to physical and cognitive functioning. A neuropsychological battery, including 5 cognitive performance subtests (confrontation naming, delayed recognition span, similarities, figure-copying, and incidental delayed recall) was administered to the subjects in their homes. RESULTS: A summary measure of the 5 neuropsychological subtest scores, the total cognitive score, arrayed the study group across a broad range of difficulty, creating a near-normal distribution. Education, income, and race had statistically significant associations with the total score and the individual subtests. The effect of education was the most striking finding, explaining 30% of the variance in the total score. Education was most strongly related to the abstraction (partial R2 = .11) subtest, and least related to the memory subtests, delayed recognition (R2 = .02) and delayed recall (R2 = .01). CONCLUSIONS: Demographic factors are important predictors of cognitive performance in this high-functioning cohort. Education had the strongest influence on overall cognitive performance, and particularly notable associations with subtests that depended upon the use of previously learned materials. Longitudinal follow-up, now underway, will help to determine whether high levels of education help to maintain cognitive performance with age.