New reference limits for cardiac troponin T and N-terminal b-type natriuretic propeptide in elders

BACKGROUND AND AIMS

Our aim was to define reference limits for cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (proBNP) that would better reflect their concentrations in older people. In addition, the incidence of acute myocardial infarctions (AMIs) was studied using these reference limits in an older population with and without previous heart diseases.

MATERIALS AND METHODS

A population-based study with a ten-year follow-up. The reference population was formed by 763 individuals aged over 64 years, with no diagnoses of heart or kidney diseases.

RESULTS

There was a significant increase in cTnT and proBNP concentrations with age. The 99 % reference limits for cTnT were 25 ng/L, 28 ng/l, 38 ng/l, and 71 ng/l for men in five-year-intervals starting from 64 to 69 years to 80 years and older, and 18 ng/L, 22 ng/l, 26 ng/l, and 52 ng/L for women, respectively. The 97.5 % reference limits for proBNP were 272 ng/L, 287 ng/l, 373 ng/l and 686 ng/L for men, and 341 ng/L, 377 ng/l, 471 ng/l, and 794 ng/L for women, respectively. Elevated proBNP was statistically significantly associated with future AMIs in subjects with and without a previous heart disease.

CONCLUSIONS

Age-specific reference limits for cTnT and proBNP are needed to better evaluate cardiac symptoms.

Chronic conditions and multimorbidity associated with institutionalization among Finnish community-dwelling older people: an 18-year population-based follow-up study

Aim

The aim of the study is to assess the association of chronic conditions and multimorbidity with institutionalization in older people.

Findings

Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization.

Message

These risk factors should be recognized in primary care when providing and targeting care and support for home-dwelling older people.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41999-021-00535-y.

Purpose

The ageing population is increasingly multimorbid. This challenges health care and elderly services as multimorbidity is associated with institutionalization. Especially dementia increases with age and is the main risk factor for institutionalization. The aim of this study was to assess the association of chronic conditions and multimorbidity with institutionalization in home-dwelling older people, with and without dementia.

Methods

In this prospective study with 18-year follow-up, the data on participants’ chronic conditions were gathered at the baseline examination, and of conditions acquired during the follow-up period from the municipality’s electronic patient record system and national registers. Only participants institutionalized or deceased by the end of the follow-up period were included in this study. Different cut-off-points for multimorbidity were analyzed. Cox regression model was used in the analyses. Death was used as a competing factor.

Results

The mean age of the participants (n = 820) was 74.7 years (64.0‒97.0). During the follow-up, 328 (40%) were institutionalized. Dementia, mood disorders, neurological disorders, and multimorbidity defined as five or more chronic conditions were associated with a higher risk of institutionalization in all the participants. In people without dementia, mood disorders and neurological disorders increased the risk of institutionalization.

Conclusion

Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization. These risk factors should be recognized when providing and targeting care and support for older people still living at home.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41999-021-00535-y.

Subjective and objective health predicting mortality and institutionalization: an 18-year population-based follow-up study among community-dwelling Finnish older adults

BACKGROUND

Objective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults. Also, self-reported assessment of health by simple self-rated health (SRH) has been shown to predict mortality and institutionalization. The aim of this study was to assess the association of objective and subjective health with mortality and institutionalization in Finnish community-dwelling older adults.

METHODS

In this prospective study with 10- and 18-year follow-ups, objective health was measured by registered illnesses and subjective health was evaluated by simple SRH, self-reported walking ability (400 m) and self-reported satisfaction in life. The participants were categorized into four groups according to their objective and subjective health: 1. subjectively and objectively healthy, 2. subjectively healthy and objectively unhealthy, 3. subjectively unhealthy and objectively healthy and 4. subjectively and objectively unhealthy. Cox regression model was used in the analyses. Death was used as a competing factor in the institutionalization analyses.

RESULTS

The mean age of the participants (n = 1259) was 73.5 years (range 64.0-100.0). During the 10- and 18-year follow-ups, 466 (37%) and 877 (70%) died, respectively. In the institutionalization analyses (n = 1106), 162 (15%) and 328 (30%) participants were institutionalized during the 10- and 18-year follow-ups, respectively. In both follow-ups, being subjectively and objectively unhealthy, compared to being subjectively and objectively healthy, was significantly associated with a higher risk of institutionalization in unadjusted models and with death both in unadjusted and adjusted models.

CONCLUSIONS

The categorization of objective and subjective health into four health groups was good at predicting the risk of death during 10- and 18-year follow-ups, and seemed to also predict the risk of institutionalization in the unadjusted models during both follow-ups. Poor subjective health had an additive effect on poor objective health in predicting mortality and could therefore be used as part of an older individual's health evaluation when screening for future adverse outcomes.

Frailty, walking ability and self-rated health in predicting institutionalization: an 18-year follow-up study among Finnish community-dwelling older people

Background

In clinical practice, there is a need for an instrument to screen older people at risk of institutionalization.

Aims

To analyze the association of frailty, walking-ability and self-rated health (SRH) with institutionalization in Finnish community-dwelling older people.

Methods

In this prospective study with 10- and 18-year follow-ups, frailty was assessed using FRAIL Scale (FS) (n = 1087), Frailty Index (FI) (n = 1061) and PRISMA-7 (n = 1055). Walking ability was assessed as self-reported ability to walk 400 m (n = 1101). SRH was assessed by a question of general SRH (n = 1105). Cox regression model was used to analyze the association of the explanatory variables with institutionalization.

Results

The mean age of the participants was 73.0 (range 64.0‒97.0) years. Prevalence of institutionalization was 40.8%. In unadjusted models, frailty was associated with a higher risk of institutionalization by FS in 10-year follow-up, and FI in both follow-ups. Associations by FI persisted after age- and gender-adjustments in both follow-ups. By PRISMA-7, frailty predicted a higher risk of institutionalization in both follow-ups. In unadjusted models, inability to walk 400 m predicted a higher risk of institutionalization in both follow-ups and after adjustments in 10-year follow-up. Poor SRH predicted a higher risk of institutionalization in unadjusted models in both follow-ups and after adjustments in 10-year follow-up.

Discussion

Simple self-reported items of walking ability and SRH seemed to be comparable with frailty indexes in predicting institutionalization among community-dwelling older people in 10-year follow-up.

Conclusions

In clinical practice, self-reported walking ability and SRH could be used to screen those at risk.

Electronic supplementary material

The online version of this article (10.1007/s40520-020-01551-x) contains supplementary material, which is available to authorized users.

A practical laboratory index to predict institutionalization and mortality - an 18-year population-based follow-up study

Background

Previously, several indexes based on a large number of clinical and laboratory tests to predict mortality and frailty have been produced. However, there is still a need for an easily applicable screening tool for every-day clinical practice.

Methods

A prospective study with 10- and 18-year follow-ups. Fourteen common laboratory tests were combined to an index. Cox regression model was used to analyse the association of the laboratory index with institutionalization and mortality.

Results

The mean age of the participants (n = 1153) was 73.6 (SD 6.8, range 64.0–100.0) years. Altogether, 151 (14.8%) and 305 (29.9%) subjects were institutionalized and 422 (36.6%) and 806 (69.9%) subjects deceased during the 10- and 18-year follow-ups, respectively. Higher LI (laboratory index) scores predicted increased mortality. Mortality rates increased as LI scores increased both in unadjusted and in age- and gender-adjusted models during both follow-ups. The LI did not significantly predict institutionalization either during the 10- or 18-year follow-ups.

Conclusions

A practical index based on routine laboratory tests can be used to predict mortality among older people. An LI could be automatically counted from routine laboratory results and thus an easily applicable screening instrument in clinical settings.

Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

BACKGROUND

There is a lack of agreement about applicable instrument to screen frailty in clinical settings.

AIMS

To analyze the association between frailty and mortality in Finnish community-dwelling older people.

METHODS

This was a prospective study with 10- and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used.

RESULTS

Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and FI (5.97 [4.13-8.64], and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10- (4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]).

DISCUSSION

Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people.

CONCLUSIONS

FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.

Biomarkers of kidney function and prediction of death from cardiovascular and other causes in the elderly: A 9-year follow-up study

BACKGROUND

Cystatin C is claimed to be superior to creatinine-based estimates of glomerular filtration rate (eGFRcr). The purpose of the study is to analyze whether cystatin C, creatinine, and/or estimated glomerular filtration rates (eGFR) predicted cardiovascular and/or non-cardiovascular deaths among Finnish elderly.

METHODS

Hazard ratios (HR) of cystatin C, creatinine and eGFRs for cardiovascular and non-cardiovascular deaths.

RESULTS

During a 9-year follow-up, 275 died, 192 deaths were a result of cardiovascular disease. In age-adjusted analyses, cystatin C predicted the risk of non-cardiovascular and cardiovascular death in men (HR for 0.1-unit increase 1.12 [95% CI, 1.04-1.19] for non-CVD deaths and 1.18 [1.09-1.28] for CVD deaths) and women (1.14 [1.07-1.21] and 1.14 [1.06-1.22], respectively). CKD-EPIcr-cyc predicted the risk of CVD deaths in men (HR for 5-unit decrease 1.17 [1.09-1.25]) and women (1.09 [1.02-1.17]) and non-CVD deaths in women (1.07 [1.01-1.14]). Also, MDRD (HR for 5-unit decrease 1.16 [1.05-1.27]) and CKD-EPI (HR for 5-unit decrease 1.15 [1.05-1.25]) predicted CVD deaths among men. After additional adjustments, predictive value of cystatin C remained significant. Also, the predictive value of CKD-EPIcr-cys remained significant in non-CVD deaths among women.

CONCLUSION

Cystatin C was clearly the best predictor for cardiovascular and non-cardiovascular deaths among Finnish elderly. Serum cystatin C is more accurate for clinical decision making than creatinine-based eGFR equations or the combined CKD-EPIcr-cys equation in persons older than 64years.

[Update on Current Care Guidelines: Post-traumatic Stress Disorder]

The updated Current Care Guidelines for ASD and PTSD recommend psychosocial support and careful monitoring for acute stress reaction (ASR) and acute stress disorder (ASD). If symptoms require, short focused cognitive-behavioral psychotherapy can be used for ASD. Medication is rarely necessary. Trauma-focused psychotherapeutic interventions are the first-line treatment for post-traumatic stress disorder (PTSD). Antidepressant medication is an effective second-line treatment. Psychotherapeutic interventions and medication should often be combined. Specific groups, such as children, the elderly, and military and peacekeeping personnel need tailored interventions.

Hearing aid compliance in the elderly

OBJECTIVES

A decreasing but still substantial proportion of elderly persons with hearing aids use them only occasionally. Because the prevalence of age-related hearing loss is increasing, it is important for the hearing rehabilitation process to be effective. The aim of this study was to use a mailed questionnaire to evaluate the rate of hearing aid use and the reasons for minimal use or nonuse.

METHODS

Questions about hearing aid use and associated problems were included in a survey of hearing mailed to 4,067 people in age cohorts of 70, 75, 80 and 85 years in an industrialized urban community in Finland.

RESULTS

In this sample of 249 hearing aid users, 55.4% used their hearing aid daily, and 27.3% used it > 6 hours a day. The percentage of subjects who never used their hearing aid was 10.7%. Use of hearing aids tended to decline with advancing age. The most common reasons for minimal use were disturbing background noise, acoustic feedback problems, battery cost, and a lack of motivation to use the hearing aid.

CONCLUSIONS

Compliance with hearing aid use by the elderly is increasing, but a significant proportion of hearing aids are still used only occasionally or never. We discuss methods to improve compliance in this patient group. Our results may be used to reexamine existing procedures for fitting hearing aids for counseling, which may increase patient compliance with hearing aids, leading to greater benefits from their use.

CNS medications as predictors of precipitous cognitive decline in the cognitively disabled aged: a longitudinal population-based study

BACKGROUND/AIMS

Psychotropics and antiepileptics (AE) are medications commonly used among the aged with cognitive decline or dementia, although they may precipitate further cognitive decline. Our aim was to analyze the relationships between the use of (i) psychotropics (i.e. benzodiazepines or related drugs, BZD, antipsychotics, AP, or antidepressants, AD), opioids (Op), anticholinergics (ACh) or AEs or the concomitant use of two of these drugs, and (ii) the risk of precipitous cognitive decline in an older (≥65 years) cognitively disabled population.

METHODS

A longitudinal population-based study of general aged community-dwelling patients was executed in two phases (1990-1991 and 1998-1999) in Lieto, Finland. Fifty-two individuals cognitively disabled (MMSE score 0-23) at the 1990-1991 baseline form this study's sample. Cognitive abilities were assessed in each phase with the Mini-Mental State Examination (MMSE) and medication utilization data were collected in both phases. The mean follow-up time was 7.6 years. Multivariate models were used to analyze the change in MMSE total score between medication users and non-users.

RESULTS

BZD or any psychotropic use was associated with greater cognitive decline in elders aged ≥75 years compared to non-users (change in MMSE sum score: -8.6 ± 7.0 vs. -3.3 ± 5.6 and -5.9 ± 7.0 vs. -2.7 ± 6.4, respectively). A greater decline was also associated specifically with the concomitant use of BZD and AP (-16 vs. -1.4 ± 7.8); as were BZD and any drug with CNS effects (-9.6 ± 9.9 vs. -1.3 ± 7.2) compared to non-users. The concomitant use of BZD and AD (-10.7 ± 4.7 vs. -3.2 ± 5.6) or ACh (-15.0 ± 8.5 vs. -3.3 ± 5.6) or any drug with CNS effects (-13.3 ± 6.5 vs. -3.3 ± 5.6) was associated with cognitive decline in patients ≥75 years compared to non-users of any drug with CNS effects.

CONCLUSION

The use of a BZD or any psychotropic medication may be an independent risk factor for cognitive decline in the cognitively disabled aged, and patients co-prescribed psychotropic medications had greater cognitive decline. Studies with larger sample sizes and studies on possible pathophysiologic mechanisms are needed.

Use of CNS medications and cognitive decline in the aged: a longitudinal population-based study

Background

Previous studies have found associations between the use of central nervous system medication and the risk of cognitive decline in the aged. Our aim was to assess whether the use of a single central nervous system (CNS) medication and, on the other hand, the combined use of multiple CNS medications over time are related to the risk of cognitive decline in an older (≥ 65 yrs) population that is cognitively intact at baseline.

Methods

We conducted a longitudinal population-based study of cognitively intact older adults. The participants were 65 years old or older and had Mini-Mental State Examination (MMSE) sum scores of 24 points or higher. The study included a 7.6-year follow-up. The use of benzodiazepines and related drugs (BZDs), antipsychotics (APs), antidepressants (ADs), opioids (Ops), anticholinergics (AChs) and antiepileptics (AEs) was determined at baseline and after a 7.6-years of the follow-up period. Cognitive functioning was used as an outcome variable measured with MMSE at baseline and at the mean follow-up of 7.6 years. Control variables were adjusted with analyses of covariance.

Results

After adjusting for control variables, the use of Ops and the concomitant use of Ops and BZDs as well as the use of Ops and any CNS medication were associated with cognitive decline. The use of AChs was associated with decline in cognitive functioning only in men.

Conclusions

Of all the CNS medications analyzed in this study, the use of Ops may have the greatest effect on cognitive functioning in the ageing population. Due to small sample sizes these findings cannot be generalized to the unselected ageing population. More studies are needed concerning the long-term use of CNS medications, especially their concomitant use, and their potential cognitive effects.

Predictors for institutionalization and prosthetic ambulation after major lower extremity amputation during an eight-year follow-up

BACKGROUND AND AIMS

Major lower extremity amputation (LEA) leads to great loss in mobility, exposing old people to the risk of losing their independent living status. This study applies predictors for institutionalization and considers prosthesis use by major lower leg amputees with peripheral arterial disease (PAD).

METHODS

119 PAD patients admitted from home (mean age 73.6, SD 11.5 years, 48% men) underwent their first major LEA, 1998- 2002, and survived at least one month after the operation. Logistic regression analysis was run to clarify institutionalization predictors. Prosthesis use and ambulatory capacity were recorded during the follow-up.

RESULTS

Older age, living alone, and unilateral above-knee amputation (AKA) or bilateral amputation predicted institutionalization. Of prosthesis users, 69% (27/39) were younger than 75 and 44% (17/39) were able to walk both in- and outdoors. Reasons for not receiving a prosthesis after amputation were: 1) short expected survival; 2) old age, combined with unilateral AKA or bilateral amputation; 3) unilateral AKA or bilateral amputation and a comorbid condition such as hemiparesis, paraplegia, uremia, dementia, or alcohol misuse. After one year, 72% (36/50) of amputees who were able to return home and 9% (3/32) of amputees in institutional care used a prosthesis.

CONCLUSION

The majority of amputated patients cannot return home after their first LEA. Comorbid conditions particularly influencing functional capacity also hinder ambulation with a prosthesis.

Association between markers of renal function and C-reactive protein level in the elderly: confounding by functional status

OBJECTIVE

To analyse the cross-sectional association between measures of renal function and inflammation in an elderly population and to evaluate the confounding effect of impaired physical functioning on these relationships.

MATERIAL AND METHODS

Cystatin C and creatinine were measured in serum samples from 1110 elderly subjects in a community-based cross-sectional survey (Lieto Study) in southwestern Finland. Glomerular filtration rate (GFR) was estimated by means of the Modification of Diet in Renal Disease (MDRD) equation. Associations between renal measures and sensitive C-reactive protein (CRP) and the impact of functional status were determined by multivariate linear models.

RESULTS

Based on standardized coefficients, cystatin C (beta 0.19; p<0.001) showed the strongest association with CRP compared to creatinine (beta 0.14; p<0.001) and estimated GFR (beta -0.13; p<0.001). Levels of CRP linearly increased across quintiles of cystatin C, whereas for creatinine and estimated GFR the increase was less graded. Impaired physical functioning was strongly associated with elevated levels of cystatin C (p<0.001) and CRP (p<0.001), but not with creatinine (p = 0.45) or estimated GFR (p = 0.38). For persons with impaired physical functioning, the odds ratio for belonging to the highest compared to the lowest cystatin C quintile was 7.04 (95% confidence interval 3.49-14.9; p<0.001), whereas for creatinine and estimated GFR this difference was not significant.

CONCLUSION

The weaker association observed between CRP and creatinine-based measures, as compared to cystatin C, reflects the misclassification of elderly frail subjects as having normal kidney function rather than suggests cystatin C itself to be a marker of inflammation.

[Post-traumatic stress disorder]

Psychosocial support and careful monitoring are recommended for acute stress reaction (ASR) and acute stress disorder (ASD). If symptoms require, short focused cognitive-behavioural psychotherapy can be used for ASD. Medication is rarely necessary, but sleeping pills can be used for a short period. Trauma-focused psychotherapeutic interventions are first-line treatment for post-traumatic stress disorder. SSRI or SNRI antidepressant medication is also effective. There is less evidence on antipsychotic and antiepileptic medication. Psychotherapeutic interventions and medication can be, and often are, combined. Children, the elderly, and military and peacekeeping personnel need interventions that are tailored to their needs.

Fractures as predictors of excess mortality in the aged-a population-based study with a 12-year follow-up

INTRODUCTION AND OBJECTIVE

The association between fractures and excess mortality in old age is ambiguous. The objective of this study was to analyze the long-term gender-specific association between fractures and mortality among older persons by controlling several survival related confounders.

METHODS

A population-based prospective cohort study in the municipality of Lieto, south-western Finland. Data on health, health behaviour, fractures, and mortality in 482 men and 695 women aged 65 or older was collected from 1991 until 2002. The Cox Proportional Hazards regression model with fractures as time-dependent variables was used in the analyses.

RESULTS

During the 12-year follow-up, 295 (25%) persons sustained at least one fracture. Sustaining any kind of fracture was related to excess mortality both in men (age-adjusted Hazards Ratio, HR 2.2, 95% confidence intervals, CI 1.6-3.1) and in women (HR 1.6, 95% CI 1.3-2.1). In the multivariate analyses, hip fractures in men (HR 8.1, 95% CI 4.4-14.9) and in women (HR 3.0, 95% CI 1.9-4.9), and proximal humerus fractures in men (HR 5.4, 95% CI 1.6-17.7) were related to increased mortality.

CONCLUSION

A hip fracture was a powerful independent predictor of long-term excess mortality in both genders but the risk in men was more than 2-fold compared to women. Proximal humerus fractures were associated with increased mortality in men. Actions to improve prevention, acute care and rehabilitation of fractures are needed in order to reduce excess mortality in older people.

Predictors of fractures among the aged: a population-based study with 12-year follow-up in a Finnish municipality

BACKGROUND AND AIMS

The incidence of fractures is high in older populations. More information is needed about long-term predictors of fractures, for preventive measures. The aim of this study was to analyze gender-specific predictors of fractures among persons aged 65 years or older during a 12- year follow-up.

METHODS

A true cohort study in the municipality of Lieto, southwestern Finland, started in October 1990. Baseline data and information about fractures in 1177 subjects (482 men, 695 women), mean age 73 years (range 65-97), were obtained individually from health care registers during 1991-2002. The mean follow-up period was 8.5 years. Subjects having sustained at least one fracture (n=295) were compared with subjects with no fractures during the follow-up. Predictors of fractures were analyzed using a Poisson regression model, separately by gender.

RESULTS

In multivariate Poisson regression analyses, the following predictors of fractures during the 12-year follow-up were identified: reduced handgrip strength (RR 1.6, 95% CI 1.1-2.3 in middle quartiles, RR 2.2, 95% CI 1.4-3.5 in lowest quartile) and body mass index (BMI) 25-29.9 (RR 1.9, 95% CI 1.3-2.7) or BMI <25 (RR 2.0, 95% CI 1.4-2.9) compared with BMI 30 or over among women, and a large number of depressive symptoms (RR 2.1, 95% CI 1.2-3.6) among men. A compression fracture in one or more thoracic or upper lumbar vertebrae on chest radiography at baseline was associated with fractures in both women (RR 2.0, 95% CI 1.3- 3.0) and men (RR 3.5, 95% CI 1.9-6.7).

CONCLUSIONS

The predictors of fractures among aged persons varied by gender, and were associated with both risk factors of falling and bone fragility.

Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: a randomized controlled trial

The purpose of the study was to assess the effects of 12-month risk-based multifactorial fall prevention program on postural control of the aged. Five hundred and ninety-one (97%) eligible subjects were randomized into an intervention group (IG) (n=293) and a control group (CG) (n=298). The effects of the program were measured on standing, dynamic, and functional balance. In standing balance, the velocity moment of semi-tandem standing decreased in IG (median change -0.54 mm(2)/s) but increased in CG (+3.84 mm(2)/s) among all women (p=0.011) and among the women aged 65-74 years (-1.65 mm(2)/s and +2.80 mm(2)/s, correspondingly) (p=0.008). In a dynamic test, performance distance tended to decrease in IG (-26.54 mm) and increase in CG (+34.10mm) among all women (p=0.060). The women aged 75 years or over, showed marginally significant differences between the groups as regards changes in performance time (-2.66 s and -0.90 s) (p=0.068) and distance (-92.32 mm and +76.46 mm) (p=0.062) of the dynamic balance test in favor of IG. Men showed no significant differences in the changes between the groups in any balance measures.

Incidence of fractures and changes over time among the aged in a Finnish municipality: a population-based 12-year follow-up

BACKGROUND AND AIMS

The incidence of fractures is high in older populations. The aim of this study was to describe the incidence of different fractures and to analyse the changes in age-adjusted yearly incidences among older persons.

METHODS

A prospective true cohort design. Information about fractures in 482 men and 695 women aged 65 or over living in the municipality of Lieto, south-western Finland, was collected from 1991 until 2002. Poisson's regression model was used to analyse changes in yearly incidences.

RESULTS

During 10,040 person years (PY) of follow-up, 307 (26%) persons sustained 425 fractures. The total incidence rate of fractures was 53.4 per 1000 PY (95% confidence intervals: 47.9-59.5) in women, and 24.9 per 1000 PY (20.4-30.4) in men. The age-specific incidence of fractures increased with age in both genders. Rates of hip and wrist fractures tended to be higher in women. 7.2% subjects sustained two or more fractures during follow- up. The majority of fractures resulted from a fall, and only 3.5% were caused by extremely serious accidents. No significant changes in the age-adjusted incidences of all fractures were found in either gender during follow-up.

CONCLUSION

Fractures are common in the aged population, and the incidence of most types of fracture is associated with increasing age. Only a minority of fractures are caused by extremely serious accidents. No significant changes in the age-adjusted yearly incidences of fractures were observed in this aged cohort during a 12-year follow-up.

Stronger symptoms of depression predict high coronary heart disease mortality in older men and women

BACKGROUND

Most cohort studies have found depressive symptoms to be associated with increased cardiovascular mortality in the elderly, but follow-up times have often been short and study populations small.

OBJECTIVES

To describe associations between stronger symptoms of depression and the risk of death from coronary heart disease (CHD) or myocardial infarction (MI) in elderly Finnish subjects free of CHD at the baseline.

METHODS

This study is a prospective population-based epidemiological and clinical twelve-year follow-up study in Lieto Health Centre, Finland. The basic population consisted of 1196 elderly (64 years of age or older) persons who lived in the municipality of Lieto in southwestern Finland in 1990. The occurrence of CHD was determined on the basis of electrocardiographic (ECG) findings, Rose questionnaire and the diagnoses in medical records. The persons with CHD were excluded from the study population. Symptoms of depression at the baseline were measured with the Zung Self-rating Depression Scale (ZSDS). Mortality was followed up for about 12 years.

RESULTS

The Kaplan-Meier survival curves showed stronger symptoms of depression to be related to high risks of mortality from CHD or MI among men and women. According to the Cox model for men significant predictors for higher risk of CHD or MI mortality were stronger symptoms of depression, higher age and a large number of medications in use. When women were examined, significant predictors were stronger symptoms of depression and a large number of medications in use.

CONCLUSIONS

Stronger symptoms of depression are an independent risk factor for high CHD or MI mortality in aged Finnish men and women free of CHD at baseline.

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial

BACKGROUND

This study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months.

METHODS

The study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fisher's exact test, the Mann-Whitney U-test and logistic regression.

RESULTS

In men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group.

CONCLUSION

Fall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women.

Biochemical reference intervals for sex hormones with a new AutoDelfia method in aged men

BACKGROUND

Our aim was to establish sex hormone reference intervals measured with a new AutoDelfia immunoassay method for aged men free of medication and/or conditions known to influence sex hormone levels.

METHODS

The reference population consisted of 466 individuals between 64 and 97 years (mean 72 years) and a mean body mass index (BMI) of 26.9 kg/m(2).

RESULTS AND CONCLUSIONS

Because age correlated significantly with most sex hormones studied, we calculated reference intervals for three age groups (64-69, 70-74 and > or =75 years). In clinical practice, single ranges can be used for men aged 64 years or over for testosterone, estradiol and follicle-stimulating hormone (FSH) with the AutoDelfia method. For free testosterone and luteinizing hormone (LH), separate reference intervals should be used for men aged 64-74 years and those aged 75 years or over. For sex hormone-binding globulin, two separate reference intervals by age (64-69 and > or =70 years) are also needed for aged men. LH and FSH reference ranges should be judged with caution, because they may be too high due to cases of subclinical hypogonadism included in the reference population.

Vitamin B12 deficiency in the aged: a population-based study

BACKGROUND

vitamin B12 deficiency is common in the aged, but it is controversial whether only some risk groups should be investigated instead of screening the entire aged population.

OBJECTIVES

to describe the prevalence of vitamin B12 deficiency in the Finnish aged, and to find out if the subjects especially prone to vitamin B12 deficiency could be identified by the risk factors or clinical correlates.

DESIGN

a cross-sectional, population-based study of 1048 aged subjects (age 65-100 years) was carried out. Data on lifestyle factors and clinical conditions were collected, physical examinations were conducted and laboratory variables related to vitamin B12 were measured.

RESULTS

vitamin B12 deficiency had been previously diagnosed in 27 (2.6%) subjects, and a laboratory diagnosis (total vitamin B12 <150 pmol/l, or total vitamin B12 150-250 pmol/l and holotranscobalamin < or =37 pmol/l and homocysteine > or =15 micromol/l) was made for 97 (9.5%) subjects. Low serum total vitamin B12 (<150 pmol/l) was observed in 6.1% and borderline total vitamin B12 (150-250 pmol/l) in 32% of the subjects. Male gender (OR 1.9, 95% CI 1.2-2.9), age > or =75 (OR 2.2, 95% CI 1.4-3.4) and refraining from milk products (OR 2.3, 95% CI 1.2-4.4) increased the probability for vitamin B12 deficiency. Anaemia (OR 1.3, 95% CI 0.7-2.3) or macrocytosis (OR 1.2, 95% CI 0.6-2.7) did not predict vitamin B12 deficiency.

CONCLUSION

undiagnosed vitamin B12 deficiency is remarkably common in the aged, but no specific risk group for screening can be identified. Thus, biochemical screening of unselected aged population is justified. General practitioners play a key role in diagnosing early vitamin B12 deficiency.

A multifactorial fall prevention programme in home-dwelling elderly people: a randomized-controlled trial

OBJECTIVES

To describe the implementation and the effects of a multifactorial fall prevention trial on the specified risk factors of falling, incidence of falls and injurious falls, and on specified secondary outcome measures; to describe the design of the study and to assess the success of randomization.

STUDY DESIGN

Randomized-controlled trial.

METHODS

Recruitment started in March 2003 and lasted until the end of January 2005, when a total number of 591 participants was reached. Participants were randomized into two age groups (65-74 years and 75 years and over), then into an intensive multifactorial risk-based prevention programme or into a one-time counselling on fall prevention. The intervention included individual geriatric assessment, guidance and treatment, individual guidance on fall prevention, physical exercise in small groups, psychosocial group activities, lectures, home-exercises and home hazards assessment.

RESULTS

A total of 293 people were randomized into the 1-year prevention programme and 298 into the control condition. The mean age was 73.5 years in both groups; 84% of the participants were women. The groups were well balanced at baseline in relation to risk factors of falls, and the only statistically significant difference was found in the amount of regularly taken medicines, which was significantly lower in the control group: mean 3.7 (SD 3.0) vs. 4.2 (SD 3.1), P=0.028.

CONCLUSIONS

Participants were successfully randomized into a multifactorial fall prevention trial.

A multifactorial fall prevention programme in the community-dwelling aged: predictors of adherence

BACKGROUND

Overall adherence rates have usually been reported in fall prevention studies, but predictors of adherence have rarely been described. The aim of this study was to determine the adherence rates and the predictors of adherence in four key activities of a multifactorial fall prevention trial.

METHODS

This study is part of a multifactorial fall prevention programme implemented among the 65-year-old or older community-dwelling aged who had fallen at least once during the previous 12 months. Subjects (n = 591) were randomly assigned to an intensive prevention programme or to a counselling group. Four key activities of prevention programme included physical exercise in small groups, psychosocial group activities, lectures and home exercises. Associations between adherence rates and potential predictors were analysed using cumulative logistic regression.

RESULTS

The mean adherence rate was 58% in the physical exercise groups, 25% in the psychosocial groups and 33% in lectures. Subjects performed home-exercises on average 11 times per month. In multivariate analyses, infrequent feelings of loneliness, low self-perceived probability of falling at home and good physical functional abilities were significant predictors of active physical exercise group adherence. Good physical and cognitive functional abilities predicted active psychosocial group adherence. Female gender and good physical and cognitive functional abilities predicted more active lecture adherence.

CONCLUSION

Persons with the poorest physical, cognitive and psychological functional abilities representing the part of the population at highest risk of falling do not seem reachable in multifactorial risk-based intervention.

Dementia associates with undermedication of cardiovascular diseases in the elderly: a population-based study

OBJECTIVE

To compare medication use in patients suffering from cardiovascular disease with and without dementia.

SUBJECTS

All inhabitants aged 75 and older in Lieto, Finland (n = 462, participation rate 82%).

MEASUREMENTS

Direct standardised assessments of dementia and cardiovascular diseases. Quantification of drug use by self-report and by prescription and drug container checks.

RESULTS

In multivariate analyses, the odds ratio for demented cardiovascular patients receiving any cardiovascular medication (use vs. non-use) was 0.31 (95% confidence interval 0.12-0.82). Compared to the non-demented, demented stroke patients were treated less often with antithrombotic agents (p = 0.041) and demented hypertensive patients less often with beta-blockers (p = 0.045).

CONCLUSION

Demented cardiovascular patients, even mildly to moderately demented, were prescribed fewer evidence-based cardiovascular medications than non-demented patients.

Effects of health advocacy, counseling, and activation among older coronary heart disease (CHD) patients

BACKGROUND AND AIMS

Coronary heart disease (CHD) is common and the majority of CHD patients are 65 years or older. There exist only a few randomized, controlled intervention studies on secondary prevention of CHD among elderly CHD patients. Our study assessed the effects of health advocacy, counseling, and activation programs with outcome variables of changes in the use of fats, lipid-lowering medications, frequency of exercise, cigarette smoking, serum cholesterol and triglyceride concentrations, blood pressure, and symptoms of late-life CHD among CHD patients of the Lieto Study.

METHODS

Randomized, controlled intervention study. Late-life (> or = 65 yrs) CHD patients were randomized into intervention group (IG) (n = 118) and control group (CG) (n = 109). Intervention consisted of 16 lectures by experts, eight group discussions, six group exercise sessions, and three social activity events.

RESULTS

The use of lipid-lowering medications became more common in IG than in CG among men (p = 0.041), with a similar tendency among women. Among women, decreases in the means of total serum cholesterol (p = 0.009) and LDL-cholesterol (p = 0.049) were greater in IG than in CG.

CONCLUSIONS

The program produced no positive effects on health behavior. Positive effects were gained by the increase in lipid-lowering medications, which reduced mean total serum cholesterol and LDL-cholesterol concentrations. More intensive counseling on health behavior should be planned, implemented, and evaluated.

Effects of a health advocacy, counselling, and activation programme on depressive symptoms in older coronary heart disease patients

OBJECTIVES

To describe the effects of a health advocacy, counselling, and activation programme on depressive symptoms among older coronary heart disease (CHD) patients.

METHODS

A randomised, controlled intervention study in Lieto, South-western Finland. Older (65 years and older) patients with CHD were randomly divided into an intervention group (IG) (n = 116) and a control group (CG) (n = 106). Outcome measures comprised changes in depressive symptoms (Zung Self-rating Depression Scale, ZSDS).

RESULTS

Depressive symptoms tended to decrease in IG and to increase in CG among men scoring 45 ZSDS sum points or more at baseline. The differences of the changes between IG and CG were significant in favour of IG. No similar changes were found among women.

CONCLUSIONS

A health advocacy, counselling, and activation programme aimed to increase knowledge about CHD, social activities, contacts, roles, support, and exercising was effective in reducing depressive symptoms among male CHD patients suffering from a moderate or high amount of depressive symptoms.

The effect of thyroid antibody positivity on reference intervals for thyroid stimulating hormone (TSH) and free thyroxine (FT4) in an aged population

Our aims were: 1) to analyze the effect of the methodology used to derive clinically feasible cut-off values for thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), which exhibit highly skewed distributions; and 2) to describe the influence of thyroid antibodies on thyroid stimulating hormone (TSH) and free thyroxine (FT

Renal impairment associated with diabetes in the elderly

OBJECTIVE

To characterize renal impairment associated with diabetes in older adults by serum markers of glomerular filtration rate and microalbuminuria tests.

RESEARCH DESIGN AND METHODS

The study population consisted of 187 diabetic and 1,073 nondiabetic subjects (age range 64-100 years) participating in a cross-sectional, population-based survey in southwestern Finland. Renal function was estimated by serum cystatin C (Cys C), serum creatinine (Cr), and the urinary albumin-to-creatinine ratio, and determinants of elevated levels were assessed by multivariate analysis.

RESULTS

Diabetes, compared to hypertension, was a more powerful determinant of elevated Cys C and Cr levels in the very old (age >or=80 years), whereas the impact of hypertension was more pronounced in the younger group (age <80 years). The prevalence of microalbuminuria among diabetic subjects was 29.7%, and 15% had elevated Cr levels, whereas the prevalence of elevated Cys C levels varied considerably depending on whether adult or age-adjusted reference limits were used (64.7 vs. 21.4%). In 64.1% of diabetic subjects with elevated Cys C levels based on age-adjusted reference limits and in 48.2% of subjects with elevated Cr levels, microalbuminuria was absent.

CONCLUSIONS

The impact of diabetes on renal impairment changes with increasing age. Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population, indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people. The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research.

Estimation of glomerular filtration rate in the elderly: a comparison of creatinine-based formulae with serum cystatin C

OBJECTIVES

To estimate the prevalence of decreased kidney function in an elderly population and to evaluate the impact of using alternative markers of glomerular filtration rate (GFR), focusing on serum cystatin C (Cys C) and the Modification of Diet in Renal Disease (MDRD) Study prediction equation.

DESIGN AND METHODS

In a cross-sectional community-based survey renal function was assessed by serum creatinine (SCreat), Cys C and GFR predicted by the Cockcroft-Gault (CG) and the MDRD Study formulae. Associations with age, gender and proteinuria were analysed by linear models.

SUBJECTS

A total of 1246 elderly residents in Lieto, Finland, 64-100 years of age.

RESULTS

The prevalence of moderately or severely decreased renal function, estimated by the MDRD Study equation, was 35.7%; the CG formula yielded 58.6%. The profile of Cys C performance, including variation across age groups and level of health status, showed greater similarity to GFR estimated using the MDRD Study equation than to SCreat alone, or GFR estimated using the CG formula. Discordance between high Cys C levels and only mildly decreased GFR estimates was observed in subjects with functional limitations. Microalbuminuria was associated with Cys C levels only (P =0.047).

CONCLUSION

Prevalence estimates of decreased renal function amongst the elderly vary considerably depending on prediction formula used. Variation in creatinine metabolism amongst elderly comorbid patients and the critical dependence on the SCreat assay and exact calibration, make the use of creatinine-based formulae to predict GFR questionable in geriatric clinical practice. In this setting, Cys C is a promising alternative.

Diagnosing cognitive impairment and dementia in primary health care -- a more active approach is needed

OBJECTIVE

to determine the documentation rate of dementia in primary health care, the clinical characteristics of patients with documented and undocumented dementia, and the diagnostic evaluations made in cognitive impairment.

DESIGN

cross-sectional population-based study with a retrospective review of medical history.

SETTING

primary health care in the municipality of Lieto, Southwestern Finland.

SUBJECTS

all the inhabitants aged 64 and over in Lieto. Participation rate 82%, numbers = 1260.

MEASUREMENTS

assessment of dementia according to DSM-IV criteria, and severity according to Clinical Dementia Rating. Possible documentation of dementia and evaluations done were reviewed from primary health care medical records.

RESULTS

112 patients with dementia were found. The sensitivity of the general practitioners' judgment of dementia was 48.2% and the specificity 99.6%. The documentation rate of dementia was 73% in severe, 46% in moderate and 33% in mild dementia. A greater proportion of the patients with undocumented dementia were male (P = 0.003), lived at home (P = 0.003), coped better with the instrumental activities of daily living (P = 0.006), had more depression (P = 0.029) and milder dementia (P = 0.005) than patients with documented dementia. Thyroid stimulating hormone was measured in 51% of the patients with suspected memory impairment or dementia, B12 vitamin in 20%, and serum calcium in 18%. Twenty-eight per cent of the patients had been tested for cognitive function, 68% for depressive symptoms, and 88% for social abilities. Forty-two per cent of patients were referred to a specialist, 32% of patients who were over 75 years.

CONCLUSIONS

less than half of the patients with dementia had their diagnosis documented in primary care medical records. Documentation increased in more advanced dementia. The diagnostic evaluations for reversible causes of dementia were insufficient in primary care, and they were done at a late phase of cognitive impairment.

Change in the prevalence of coronary heart disease among Finnish elderly men and women in the 1990s

OBJECTIVE

To characterise the prevalence of, and changes in, coronary heart disease (CHD) among men and women aged between 64 and 71 years in the 1990s.

DESIGN

A study of clinical epidemiology involving two cohorts of elderly persons in 1990-1991 and 1998-1999.

SETTING

Primary health care in the municipality of Lieto in southwestern Finland.

SUBJECTS

Persons between 64 and 71 years of age in the southwest of Finland in 1990-1991 and 1998-1999.

MAIN OUTCOME MEASURES

The occurrences of CHD were estimated using the history of a previous myocardial infarction or coronary revascularisation procedure evident in the medical records and with ischaemia or infarction as established on ECG according to the Whitehall criteria.

RESULTS

The prevalence of 'probable' CHD decreased among men and women aged between 64 and 71 years, whereas the prevalence of 'possible' CHD decreased among women alone. Silent myocardial infarctions were common among women of both cohorts. Many more men of the second cohort, compared to the first one, had undergone a coronary angioplasty or bypass operation.

CONCLUSION

The prevalence of CHD decreased among elderly women more clearly than among young elderly men. The favourable development illustrating a decrease in the prevalence of CHD among women should be sustained, while health promotion activities will need to be directed more actively towards men.

Serum cystatin C in the aged: relationships with health status

BACKGROUND

Serum cystatin C (Cys C) is claimed to be superior to serum creatinine (Cr) in estimating glomerular filtration rate, but its utility in assessing renal function in the polymorbid elderly needs to be evaluated.

METHODS

In a cross-sectional, community-based survey performed in Lieto in southwestern Finland, Cys C, Cr, and urinary albumin-creatinine ratio (ACR) were measured in 1,260 subjects aged 64 to 100 years. Associations of demographic characteristics and health status factors with levels of Cys C, Cr, and ACR were assessed by means of linear models.

RESULTS

In men, hypertension, coronary heart disease, urinary infection, rheumatoid arthritis, glucocorticoid treatment, older age, and lower functional status were found to be significant predictors of higher Cys C values, whereas hypertension, coronary heart disease, urinary infection, older age, and increasing body mass index (BMI) significantly predicted higher Cr values. Among women, corresponding factors were hypertension, glucocorticoid treatment, age, functional status, and BMI for Cys C and hypertension, BMI, and age for Cr. Diabetes was significantly associated only with ACR. These factors explained 35% of variation in Cys C values in men and 34.5% in women versus only 14.8% and 11.3% for Cr, respectively.

CONCLUSION

Glucocorticoid treatment was recognized as an independent Cys C-increasing factor, presumably nonglomerular. In comparison with Cys C, a considerably greater proportion of total variation in Cr values seems to be explained by extrarenal factors.

RIA for serum holo-transcobalamin: method evaluation in the clinical laboratory and reference interval

BACKGROUND

Decreased serum holo-transcobalamin (holoTC) could be the earliest marker of cobalamin (Cbl) deficiency, but there has been no method suitable for routine use. We evaluated a new commercial holoTC RIA, determined reference values, and assessed holoTC concentrations in relation to other biochemical markers of Cbl deficiency.

METHODS

The reference population consisted of 303 individuals 22-88 years of age, without disease or medication affecting Cbl or homocysteine metabolism. In elderly individuals (>or=65 years), normal Cbl status was further confirmed by total homocysteine (tHcy; <19 micro mol/L) and methylmalonic acid (MMA; <0.28 micro mol/L) concentrations within established reference intervals. HoloTC in Cbl deficiency was studied in a population of 107 elderly individuals with normal renal function. The Cbl deficiency was graded as potential (total Cbl <or=150 pmol/L or tHcy >or=19 micro mol/L), possible (total Cbl <or=150 pmol/L and either tHcy >or=19 micro mol/L or MMA >or=0.45 micro mol/L), and probable (tHcy >or=19 micro mol/L and MMA >or=0.45 micro mol/L).

RESULTS

The intra- and between-assay imprecision (CV) for the holoTC RIA were 4-7% and 6-8%, respectively. A 95% central reference interval for serum holoTC was 37-171 pmol/L. All participants (n = 16) with probable Cbl deficiency, 86% of those with possible, and 30% of those with potential Cbl deficiency had holoTC below the reference limit (<37 pmol/L). The holoTC correlated with total Cbl (r(s) = 0.80; P <0.0001) and inversely with MMA (r(s) = -0.52; P <0.0001). HoloTC concentrations were significantly (P = 0.01) higher in women than in men.

CONCLUSIONS

The new holoTC RIA is precise and simple to perform. Low holoTC is found in individuals with biochemical signs of Cbl deficiency, but the sensitivity and specificity of low holoTC in diagnosis of Cbl deficiency need to be further evaluated.

Psychotropics among the home-dwelling elderly--increasing trends

OBJECTIVE

To assess the level of and changes in the use of psychotropics among the home-dwelling elderly in the 1990s.

METHODS

A descriptive analysis based on data from two cross-sectional interview and health examination surveys of elderly persons aged 64 years or over conducted in Lieto, a typical semi-rural Finnish municipality, in 1990-91 and 1998-99. National prescription data were utilized to compare the use of psychotropics in the late 1990s by all Finnish home-dwelling elderly and the elderly in Lieto. In Lieto drug information was obtained from 1131 persons in 1990-91 and from 1197 in 1998-99, and the mean age of the informants was 73 years in both surveys. The brand names of the prescription drugs (both irregular and regular medication) taken by each interviewee during seven days prior to the interview were recorded and categorized by the Anatomical Therapeutic Chemical (ATC) classification system.

RESULTS

Every fourth person was taking at least one psychotropic drug in both surveys. Most users were on regular psychotropic medication. The use of hypnotics and antidepressants increased most during the study period. Polypharmacy and the use of psychotropics were most prevalent among those aged 85 years or over, with women predominating. Concomitant use of two or more psychotropics increased statistically significantly from 7% to 10% between the surveys. The young elderly, aged 64-71 years, used cyclic antidepressants equally commonly in both surveys. None of the young elderly used new atypical antipsychotics in 1998-99.

CONCLUSIONS

Psychotropics tend to be overprescribed and overused among the elderly, a group at the highest risk of adverse drug reactions. The tendency of prescribing for the elderly is not going in a better direction. New-generation psychotropics were not used. The need for long-standing use of psychotropics should be assessed regularly.

Use of medications and polypharmacy are increasing among the elderly

To assess changes in medicine use and polypharmacy, two cross-sectional surveys were carried out among community-dwelling persons aged 64 years or over in 1990-91 (n = 1,131) and 1998-99 (n = 1,197) in the municipality of Lieto in southwestern Finland. In addition to drug use, the questionnaire included items on social background, quality of life, and home nursing services. Among those surveyed, 78% in 1990-1991 and 88% in 1998-1999 (P =.001) used prescription drugs during 7 days prior to the interview. The most commonly used medications were for the cardiovascular and central nervous systems. The number of medications per person increased from 3.1 (SD 2.8) to 3.8 (SD 3.1) (P =.0001), and polypharmacy (concominant use of over five medications) increased from 19 to 25% (P =.006). These changes were most prominent among persons aged 85 years or over, especially among women. Polypharmacy is a complex and worrying phenomenon that merits more research.