Frequency, characteristics and consequences of falls in a cohort of institutionalized elderly patients

OBJECTIVE: Falls in the elderly are a major problem because of their high morbility and mortality rates and health expenditures. However, there are few studies about this problem in our country. The purpose of the present study was to know the frequency, features and consequences of falling among institutionalized elders. METHODS: We carried out a prospective cohort study using a sample of 190 persons aged 65 years and older living in two nursing homes. All subjects underwent a comprehensive evaluation at the onset of the study. During a mean follow-up period of 310 days, all falls were recorded. RESULTS: There were a total of 121 falls in 72 (37.9%) subjects, twenty five of whom (34.7%) experienced two or more falls. The fall incidence per person-year was 0.75. As compared with males, females had a density ratio (DR) of 2 (1.2-3.2; 95% confidence interval-CI). Falling was more frequent in the bedrooms and living rooms (43.8%). DISCUSSION: This results agree with others studies about the high fall incidence in the elderly and bring out new features about circumstances and consequences of falls.     

Safety and immunogenicity of a respiratory syncytial virus subunit vaccine (PFP-2) in the institutionalized elderly

The safety and immunogenicity of purified fusion protein (PFP-2) respiratory syncytial virus (RSV) vaccine was evaluated in an open label study in 37 frail institutionalized persons over age 65. Vaccination was well tolerated without significant side-effects. Thirty-six of 37 volunteers completed the study. Nineteen of 36 (53%) vaccinees had a greater than or equal to fourfold increase in IgG to F protein at 4 weeks and 17 (47%) had a greater than or equal to fourfold rise in neutralizing titers to either group A or B virus. Although response rate to PFP-2 vaccine in the frail elderly was somewhat diminished compared to results in the healthy elderly, the vaccine was well tolerated and relatively immunogenic.     

Health status of the over 60 years of age population and its relationship with sociodemographic factors (ANCO Project)

OBJECTIVE: To describe the health status of a population over 60 years and to study their relationship with several socio-demographic variables. DESIGN: A cross-sectional study, population based. SETTINGS: A community. PARTICIPANTS: A randomized sample of 1,103 non institutionalized people over 60 years living in the city of Cordoba (Spain). MEASUREMENTS AND MAIN RESULTS: By mean of a personal interview at home we used the OARS-MFAQ-VE questionnaire. Low self-rated health was associated with the age, to be female sex, a low cultural background, and a low income. Only 5.2% of the study people do not suffered any illness and 56% state that their health problems are major problems for doing their current activities. 4.9% declared to have some degree of physical incapacity. 3.7% of elderly population has an important cognitive deficit. CONCLUSIONS: The majority of elderly people has good health. Age is related with a poor health. Women have more health problems than men.     

Prevalence of associated diseases in different types of dementia among elderly institutionalized patients: analysis of 3447 records

OBJECTIVE: To determine the prevalence of dementia in a population of hospitalized or institutionalized elderly patients, and that of associated diseases according to dementia type. DESIGN: Retrospective analysis of a database of diagnostic codes. SUBJECTS: All patients admitted to 1 of the 4 geriatric units participating in the study at the Charles Foix Hospital between 1980 and 1989. MEASUREMENTS: All diagnoses mentioned in the discharge summary that could cause or contribute to hospitalization were recorded for each patient. A final list of 54 different diagnoses could be recorded for each patient. Dementia was subdivided into 3 subtypes: Alzheimer dementia (DAT), vascular dementia (VD), and other types of dementia (unclassifiable dementia). MAIN RESULTS: The study involved 3447 patients aged 81.0 +/- 8.3 years, of whom 27.7% were men. Dementia was the most frequent disease in this population (34.3%); Alzheimer disease was responsible for 15%, vascular dementia for 9.5%, and other types for 9.8%. The average number of associated diseases was 3.23 +/- 2.10 in the Alzheimer dementia group, 4.73 +/- 2.38 in the vascular dementia group, and 3.96 +/- 2.26 in the nondemented group. Parkinson disease was present in 15.5% of patients with unclassifiable dementia, compared with 7.6% in the nondemented group (P < 0.001). There were significantly more diseases commonly seen in bedridden patients in the group of patients with both other types of dementia and Parkinson disease than in the group of other types of dementia patients without Parkinson disease (P < 0.01). CONCLUSION: Dementia was the most common disease observed in our elderly institutionalized population. Alzheimer patients had significantly fewer associated diseases than nondemented patients, whereas the reverse was found in the vascular dementia group. The co-existence of Parkinson disease and dementia in our population was associated with the poorest health status, as these patients were more likely to present simultaneously such conditions as pressure sores, incontinence, dehydration, or iatrogenesis.     

A functional analysis of Notch mutations in Drosophila

In 1900, the world population was less than 1.7 billion people; the United Nations projects that in 2000 it will be 6.2, and in 2020, 7.9 billion. The proportion of the elderly (65 years and over), will increase from 5.1% (1950) to 6.8% by the year 2000 and to 8.8% by 2020, when out of an elderly population of 796 million people, 124 million are projected to be 80 years and over. Due to an increasing gender inequality in life expectation, the majority of the elderly will be women. An aged population is a basically new feature in the history of humanity, the implications of which are-as yet-incompletely understood. It is clear, however, that the last years of life are accompanied by an increase in disability and sickness, with very high demands for health and social services. Hence, the soaring elderly population will raise major social, economic and ethical issues worldwide and may strain to the limit the ability of health, social and economic infrastructures of many countries. It may also result in an increasingly large proportion of humanity (the elderly in general and elderly women, in particular) living in absolute poverty. The demographic, health, socioeconomic and ethical dimensions of the problem are discussed with particular emphasis on the situation of elderly women and a plea is made for greatly increased medical and socioeconomic research.     

Contraceptive risk-taking in a medically-underserved, low-income population

The United States end-stage renal disease (ESRD) population is growing progressively older. As a percentage of the overall ESRD population, the number of patients 65 years of age and older approached 40% by 1989. However, the percentage of ESRD patients with a functioning transplant was only 2.7% in this age group. Success of transplantation in geriatric ESRD patients over the last decade is due to improved patient selection as well as the use of cyclosporine A and lower doses of corticosteroids, with the achievement of 1-year patient and graft survival rates of 85% and 75%, respectively. For patients older than 60 or 65 years, the 5-year "functional" graft survival is 55% to 60%. Although overall results are excellent, the management of transplantation in the elderly requires an understanding of pharmacology, immunology, and physiology peculiar to this age group. Since the elderly have a degree of immune incompetence, they require less aggressive immunotherapy. Elderly patients have decreased hepatic enzyme activity, especially the P450 system, and therefore require a lower cyclosporine dose. Although elderly patients experience less rejection episodes than younger patients, graft loss in the elderly transplant recipient is due mainly to patient death. Most common causes of death in the elderly transplant recipient are cardiovascular disease and infection related to peaks of immunosuppression. Shortage of cadaver kidneys and limited life expectancy of the geriatric ESRD patient make allocation of cadaver kidneys to patients over 70 years (and even 65 years) a controversial issue and an ethical dilemma. Use of elderly cadaver donors (over 55 to 60 years) is associated with inferior success rates and is not an optimal solution to shortage of cadaver kidneys.     

Functional recovery after operative treatment of femoral neck fractures in an institutionalized elderly population

Agreement that hip fracture is best treated surgically stems from the fact that early mobilization of the patient reduces morbidity and mortality. This concept was tested in 54 elderly, institutionalized patients with femoral neck fractures who were operatively treated. The patients were reviewed within 12 months after being injured. Their average age was 81.2 years, and 94% of the patients were women. Seventy-five percent of the study population had neurological disease or heart disease and were thus limited in their motivation or ability to participate in a rehabilitation program. Only 16.7% of the patients regained their overall functional ability and only 12.9% returned to their pre-injury, ambulatory status. The therapeutic concept should be reviewed and the conservative approach be given serious consideration.     

No increased incidence of Alzheimer's disease in elderly schizophrenics

There is currently controversy as to the morphological basis of cognitive impairment in elderly schizophrenics. In contrast to previous findings, recent studies have found no increased frequency of Alzheimer's disease (AD) pathology in elderly schizophrenics. We examined 99 consecutive autopsy cases of patients over the age of 55 years from a psychiatric hospital who met the DSM-III-R and ICD.10 criteria for schizophrenia (mean age 69.5 +/- 8.25 years; mean duration of illness 35.15 +/- 10.1 years), 56% showing moderate to severe dementia. All brains were blindly reviewed for evidence of AD using CERAD criteria and Braak staging of neuritic AD lesions. "Definite" AD (CERAD C, Braak stage V) was seen in 2 cases aged 56 and 67 years, respectively [2% of total or 1/68 (1.4%) of those over age 65]. "Probable" AD (CERAD B, Braak stages IV-V) were seen in 5 cases aged 71-89 years (mean 79 years; 5% of total or 7.3% of those over age 65), and 1 case each with multiple cerebral infarcts and with Parkinson's disease pathology. In addition, 2 females aged 82 and 89 years, respectively, revealed senile dementia with tangles (NIA, CERAD negative; Braak stage IV), 1 with hippocampal sclerosis. The total incidence of definite and probable AD in this cohort was 7.1% or 8.7% for those over age 65. This is in line with other recent studies showing that the frequency of AD in elderly schizophrenics may be equal or even less than in the general population. The reasons for this negative association and the basis of cognitive deficits in elderly schizophrenics--those with dementia usually showing significantly lower brain weight--await further elucidation.     

Clinical assessment of extrapyramidal signs in nursing home patients given antipsychotic medication

BACKGROUND: We sought to quantify the relationship between antipsychotic drug use and clinical evidence of extrapyramidal dysfunction in a large population of elderly nursing home patients. METHODS: Subjects were 251 residents (mean age, 84.1 years; range, 65 to 105 years) who were taking psychoactive drugs in 12 long-term care facilities. Patient characteristics and all medication use (both scheduled and as needed) were measured during a 1-month observation period. We then performed neuropsychological and functional testing on residents who received any psychoactive medications during the study month. The presence of rigidity, bradykinesia, or masklike facies was assessed in each patient by a research assistant who was unaware of diagnoses and medication use. RESULTS: The parkinsonian signs studied were found in 127 (50.6%) of these residents. Using logistic regression modeling to adjust for potential confounding, we found this outcome to be increased more than threefold in patients who took low-potency neuroleptics (odds ratio [OR], 3.49 for > or = 50 mg/d of chlorpromazine-type drugs; 95% confidence interval [CI], 1.28 to 9.57) and more than sixfold for use of 1 mg/d or more of haloperidol (OR, 6.42; 95% CI, 2.16 to 19.04). Age, gender, and use of nonneuroleptic psychoactive drugs were not associated with an increase in parkinsonian signs. CONCLUSIONS: Clinical evidence of extrapyramidal dysfunction is three to six times more common in institutionalized elderly patients given antipsychotic medication than in comparable patients not using such drugs. Its risk is substantially increased even in patients given low-potency chlorpromazine-type drugs, as well as those taking haloperidol. The effect is not explained by age or mental status and is not seen with other psychoactive medications. The expected frequency of parkinsonian symptoms can help to inform the balancing of risks vs therapeutic effect when the use of all drugs in this class is considered.     

Depression of young and elderly patients

OBJECTIVE: To compare the presentation and outcome of depression between young and elderly patients. DESIGN: The clinical presentation, treatment and outcome of 47 young patients (21 to 64 years) were compared with 58 elderly (65 years and older) patients admitted to a general hospital psychiatric ward for the treatment of depressive disorders (based on ICD-10). SUBJECTS: There was no significant difference between the sexes in each age group. The majority of the elderly were either widowed (36%) or married (53%) while 45% of the young were single and 51% married. Seventy per cent of the elderly had retired while 64% of the young were in full-time employment. Most patients lived with their families (87% young and 96% elderly). All but one elderly suffered at least one physical disorder with two-thirds having two or more physical disorders; this contrasts greatly to young patients who were physically healthier (p < 0.001). RESULTS: In clinical presentation and symptomatology, the young patients had significantly more suicide ideation (p < 0.003) and psychomotor retardation (p < 0.001) but there was no difference in suicidal attempt, delusion, hallucination or agitation. More young patients (36%) had a past psychiatric illness (often depressive disorders) than elderly patients (8%) (p < 0.001), more elderly patients (88%) were treated with antidepressants than the young patients (62%) (p < 0.002). At one year follow-up, more elderly patients (46%) recovered compared with the young patients (23%) (p < 0.05). CONCLUSION: There were some differences in the symptomatology of depression between young and elderly patients, but the prognosis was better for elderly patients.     

Outcome and cost of trauma among the elderly: a real-life model of a single-payer reimbursement system

BACKGROUND: As our population ages, the number of elderly trauma patients (age > or = 65 years) increases. Studies have demonstrated increased mortality and cost for a given injury severity in the elderly compared with younger patients. The financial viability of trauma centers in the United States has been an area of concern for many years. As reimbursement diminishes for privately insured patients, the ability to finance the care of the indigent is jeopardized. Medicare, the single-payer insurance plan for the elderly, reimburses at a lower rate than standard private insurance carriers. We examined the differences in outcome and cost between the elderly and younger patients and the financial burden imposed by care for elderly trauma. Our hypothesis was that elderly trauma patients would have poorer outcomes, higher cost, and generate greater financial losses than younger patients. METHODS: All patients admitted to the University of Virginia Trauma Service from July 1, 1994, to July 1, 1997 were included. Trauma registry and patients records were examined. Patients with incomplete financial data (cost, reimbursement, and payer source) were excluded. Patients were grouped by age (18-64 and > or =65 years), Injury Severity Score, and payer source. RESULTS: One thousand one hundred twenty-seven patients met the entry criteria. One hundred forty patients had incomplete financial or patient data and were excluded. Nine hundred eighty-seven patients were included in the study, of which 159 were elderly and 828 were 18 to 64 years of age. Injury Severity Scores were significantly higher in the elderly group. Only 2% of elderly patients were uninsured (76% were insured by Medicare), whereas 25% of younger patients were uninsured. Medicare reimbursement rates actually exceeded those of all other carriers (114% of costs). Elderly patients had a higher mortality rate, but the z score did not reach significance. The W score, however, indicated that there were more unexpected, negative outcomes among elderly patients. As injury severity increased, profit per case increased in the elderly and decreased in the younger group. CONCLUSION: Despite higher injury severity and lower survival probability for the elderly, the length of hospital and intensive care unit stays, as well as the percentage of admissions to the intensive care unit, were similar. The per capita cost of hospital care for the elderly was lower than for younger patients, whereas reimbursement was higher, primarily because 98% of elderly patients were insured. Medicare, the single-payer insurance plan for the elderly, adequately reimburses for elderly trauma care. This implies that universal insurance coverage for all trauma patients would be desirable, even if reimbursement rates decreased significantly. The increased mortality in the elderly requires continued study and diligence.     

Our experience with silicone in rhinomentoplasty

Twelve young (mean age 23 years, range 18-28) and 12 elderly (mean age 76 years, range 65-89) volunteers were given a single oral dose of 80 mg valsartan after an overnight fast. Each group consisted of six male and six female subjects. Mean systemic exposure to valsartan was higher in the elderly when compared with the young (AUC(0-24 h), 52% increase and AUC(0-infinity), 70% increase). Variability, as shown by the coefficient of variation (CV), was larger for the elderly subjects and ANOVA of the log transformed AUC showed a significant difference between the two groups. This difference was largely brought about by five elderly subjects (one male, four females), whose AUC was about 2-fold higher than the rest of the group. For the remaining elderly subjects, plasma valsartan AUC was similar to that observed for the young volunteers. This higher systemic exposure in five of the elderly subjects is not thought to be of clinical relevance when data from the patient population are considered. Other covariates--such as body weight, comedication, creatinine clearance, valsartan kinetics (absorption rate, distribution, and elimination)--did not explain the higher AUC in this subset of the elderly group. Data from the present study were compared with population kinetic data obtained from larger clinical trials including hypertensive patients in all age groups. Using this population approach, there was no difference in the pharmacokinetics of valsartan between male and female patients. Also, a relationship between plasma clearance of valsartan and age was established. The median age of patients in the hypertensive pool was 55 years. For an average 70-year-old patient, plasma clearance of valsartan is predicted to fall by 22% compared with an average 55-year-old. For the population this difference is not sufficient to warrant initial dose adjustment based on age per se. The covariate age, does not completely explain the variability in the pharmacokinetics of valsartan within the general population. The treatment was well tolerated.     

Prevalence of serious eye disease and visual impairment in a north London population: population based, cross sectional study

OBJECTIVE: To estimate the magnitude of serious eye disorders and of visual impairment in a defined elderly population of a typical metropolitan area in England, and to assess the frequency they were in touch with, or known to, the eye care services. DESIGN: Cross sectional survey using two stage cluster random sampling. SETTING: General practices in north London. SUBJECTS: Random sample of people aged 65 and older, drawn from a defined population of elderly people registered with 17 general practice groups. MAIN OUTCOME MEASURES: Proportions and population prevalence estimates were determined for visual acuity, assessed with the person's own spectacles (if any), classified into four categories: prevalence of cataract, age related macular degeneration, and refractive error causing visual impairment and of definite primary open angle glaucoma; and status of contact with eye services. RESULTS: 1547 of 1840 (84%) eligible people were examined. The population prevalence of bilateral visual impairment (visual acuity <6/12) was 30%, of which 72% was potentially remediable. 92 of these 448 cases (21%) had visual acuity <6/60 ("blindness") in one or both eyes. Prevalence of cataract causing visual impairment was 30%; 88% of these people were not in touch with the eye services. The prevalence of vision impairing, age related macular degeneration was 8% and of glaucoma (definite cases) was 3%. Three quarters of the people with definite glaucoma were not known to the eye services. CONCLUSIONS: Untreated visual impairment and eye disorders affect a substantial proportion of people aged 65 years and older. These findings should contribute to the setting up of future strategies for preservation of sight and eye health services in general.     

Self-reported assessment of visual function in a population-based study: the SEE project. Salisbury Eye Evaluation

PURPOSE: To report on the usefulness of the Activities of Daily Vision Scale (ADVS) questionnaire for assessing visual functioning, a population-based sample of elderly Americans. METHODS: The ADVS questionnaire was administered to a population-based sample of 2520 community-dwelling individuals 65 to 84 years of age in Salisbury, MD. Items and subscales were evaluated for internal consistency, item discrimination, and content validity. Published subscale groupings and item associations in our population were compared for coherence using correlation, factor, and cluster analyses. Whole-sample and race- and gender-specific analyses were conducted. External validity was explored by regressing ADVS scores on standard psychophysical vision measures. RESULTS: ADVS scores were skewed to high visual functioning levels; approximately 60% of the population had function scores of 95 or better (of a possible 100). The overall, night driving, and near vision scales were internally consistent and had strong item-subscale associations; the day driving and glare subscales were not acceptable regarding these properties. The far vision subscale was acceptably scalable but only weakly differentiated from the other subscales. Overall, night driving, near vision, and far vision scores were all statistically and independently associated with multiple psychophysical vision measures. Findings were consistent across race and gender subgroups. CONCLUSIONS: As assessed by the ADVS, reported visual functioning is high in our representative older population. The overall scale and selected subscales effectively distinguish persons along a spectrum of ability. They correlate with measures of visual impairment in a reasonable way and thus hold promise for risk factor investigations. The published day driving and glare subscales should be examined for relevance and consistency before being applied in population-based settings. Methods specific to population-based settings should be investigated for their ability to better elicit additional visual function dimensions and early visual disability.     

Acute neurohumoral and cardiovascular effects of idarubicin in leukemia patients

To examine the nature of asthma in the elderly, we compared older (group 1: 65 years or older, n = 50) with younger patients (group 2: <40 years, n = 99) and to determine the influence of long-standing disease, elderly asthmatics with early onset (group A: onset before 40, n = 22) were compared with patients developing symptoms later in their lives (group B: onset after 40, n = 22). Blood eosinophilia and IgE value >/=100 IU/l were more frequent in younger patients. Short symptom-free periods were more frequent among older asthmatics (78.5 vs. 45.4%, p < 0.001). Only 31.2% of older patients had only mild symptoms. Requirement of systemic steroids was higher in the elderly population. The worst FEV1 was lower in older patients (54.4 +/- 17.3 vs. 71.8 +/- 18.5%, p 相似文献   

Mortality of the institutionalized old-old hospitalized with congestive heart failure

BACKGROUND: Congestive heart failure is a major cause of mortality and morbidity in the elderly but the disease impact on the oldest and sickest population has not been defined. OBJECTIVES: To review the mortality and hospital readmission rate of institutionalized elderly persons with congestive heart failure and to examine the relation of baseline characteristics to subsequent clinical outcomes. METHODS: This was a retrospective analysis based on chart review of 231 residents of the Philadelphia (Pa) Geriatric Center (63 congregate housing tenants and 168 nursing home residents) 80 years and older, hospitalized with congestive heart failure from 1989 to 1995. Patients' demographic data and clinical, electrocardiographic, and echocardiographic findings were obtained from their initial (index) hospitalization records. Subsequent outcomes were obtained from their outpatient (nursing home or office) records. RESULTS: Thirteen percent died during the index hospitalization but the total mortality during the follow-up period was 87%. One hundred forty-six patients (63%) died in the first year with a mean +/- SD survival of 4+/-4 months and a readmission rate of 3.9 per patient-year. Eighty-five patients survived the first year with a readmission rate of 1.2 per patient-year and 54 patients subsequently died, with a mean +/- SD survival of 28+/-12 months. The first-year decedents and survivors were comparable in sex, age, medical history, and electrocardiographic findings. However, patients who died in the first year, compared with survivors, were more likely to be nursing home residents (81% vs 59%), have New York Heart Association class IV heart failure (54% vs 32%), have impaired left ventricular function by echocardiogram (53% vs 32%), and have renal insufficiency (32% vs 11%). CONCLUSIONS: Very elderly persons with congestive heart failure had a guarded long-term prognosis. Nursing home residency, class IV heart failure, impaired left ventricular function, and renal insufficiency were associated with higher risk for early death and repetitive hospitalizations.     

Favorable results of implantable cardioverter-defibrillator implantation in patients older than 70 years

BACKGROUND: The clinical results of implantable cardioverter-defibrillator (ICD) implantation in the elderly have received limited documentation. As the longevity of the U.S. population has increased, so has the need for ICD implantation in the elderly. We evaluated the efficacy and outcome of ICD implantation in elderly patients (>70 years) compared with younger patients. METHODS: The case records of all consecutive patients who underwent ICD implantation at our institution between 1986 and 1994 were reviewed. Of a total of 238 patients, 78 patients were 70 years of age or older and 160 patients were younger than 70 years of age. RESULTS: The mean age of the younger group was 58 years and that of the elderly group was 74 years. There were no statistical differences in the presence of coronary artery disease, left ventricular systolic function, the inducibility of arrhythmias, or the history of sudden cardiac death. The hospital morbidity rate was similar in both groups (6.9% in the younger group and 7.7% in the elderly group; p = not significant). The operative mortality rate was 1.9% for the younger group and 1.3% for the elderly group (p = not significant). At a mean follow-up of 33 +/- 26 months, Kaplan-Meier survival curves demonstrated similar survival rates, with 93%, 82%, and 65% of the patients alive at 1, 3, and 6 years, respectively. CONCLUSIONS: Implantable cardioverter-defibrillator implantation was equally effective in the treatment of patients older than 70 years as in younger patients. No differences in theoretic survival or morbidity were observed.     

The provision of influenza vaccine to patients over 65 years by general practitioners

Influenza vaccination for all elderly persons is cost effective. Guidelines in Ireland recommend the vaccine for those with chronic illness and to the elderly in care. The aims of this study are to identify how influenza vaccine is provided to elderly patients and to get GPs opinions on what barriers there are to providing the vaccine to persons 65+ years. Of the 143 GPs contacted 117 (81.8%) replied, of whom 116 (99.1%) provide the vaccine to their patients. Ninety nine (85.3%) believe it to be effective in preventing influenza, and only 8 (6.9%) have reservations about the vaccine. Eighteen (15.5%) GPs had a difficulty in identifying those to be vaccinated and only 11 (9.5%) had a computerised system to assist them. Twenty two (19.0%) GPs had difficulty in getting sufficient vaccine for their patients. Ninety six (82.8%) GPs make the vaccine available to those for whom it is recommended and of these 61 make it available to all patients over 65 years. The main patient barriers to an influenza vaccination programme are the patients fear of getting influenza from the vaccine and that many patients do not consider the vaccine to be of value. Barriers identified for GPs are the low level of reimbursement to GPs for vaccinating eligible patients and the lack of proper systems that help identify and contact those who should be getting the vaccine. All of the barriers identified should be easy to overcome so that those who require influenza vaccine can reap the health and social gains that our health services advocate.     

Interaction of prescribed drugs in a population over 65 years of age

OBJECTIVE: To assess the prevalence and the types of drug to drug interactions in a population 65 years and over and to identify the factors associated to the occurrence of interactions. DESIGN: Cross sectional study ("Aging in Leganés"), a community survey. SETTING: Community level. Leganés (Madrid). PATIENTS AND OTHER PARTICIPANTS: People 65 years and over (n = 1284, response rate 83%). MEASUREMENTS AND MAIN RESULTS: Information on use of health services and medication use was collected through home interviews. Drugs were classified by its active components and into therapeutic categories. Drug to drug interactions were identified using Hansten's classification. Bivariate and multivariate analysis were carried out to identify factors associated to the frequency of interactions. RESULTS: The prevalence of drug to drug interactions was estimated as 13.6%. Interactions of clinical significance occurred in 9.9% of the population 65 and over. Hypertension, diabetes, Parkinson and cardiovascular diseases are significatively associated to interactions. The number of visits to the specialists was a risk factor (OR = 2.1 for those with five or more visits), after controlling for specific chronic conditions. Contacts with primary care, age and sex of the elderly were not associated to the frequency of interactions. DISCUSSION: The frequency of interactions is associated to preventable factors. Improvements in the communication between specialists and primary care and cooperation with pharmacists could result in better monitoring of medication use in the elderly.     

The prevalence of dementia in Belgium: a population-based door-to-door survey in a rural community

The project Epidemiology Research on Dementia in Antwerp (ERDA) estimated the prevalence of dementia in a random, population-based sample, stratified for age and sex. The sample of 1,736 elderly was screened at home with the Mini-Mental State Examination. All elderly under the cutoff of 23-24/30 got a diagnostic examination with the Cambridge Mental Disorders of the Elderly Examination and the DSM-IIIR criteria. The prevalence of dementia in the population above 65 years was estimated at 9%. The following age-specific prevalences of dementia (included mild dementia) were found in the age-groups 65-69, 70-74, 75-79, 80-84, 85+: 0.6, 5.1, 7.6, 16.2 and 33.6%. The prevalence of at least moderate dementia was 0.3, 3.9, 4.0, 11.2 and 25.0%, respectively. The prevalence of dementia, vascular dementia and dementia of the Alzheimer type was markedly higher in women than in men.