A longitudinal evaluation of drug use in an ambulatory elderly population.

Participants in a geriatric health screening program were studied longitudinally to determine the patterns of drug use over a 10 year period. There were 314 (34.0%) men and 610 (66.0%) women who completed 10 yearly health screening evaluations. The mean number of prescribed and non-prescribed drugs used per participant increased from 2.90 in 1978-79 to 4.08 in 1987-88 (p less than 0.0001). There was no significant difference between men and women in the rate of increased drug use. There was no significant increase in the mean number of drug ingredients per participant used over the 10 year period. The most frequently reported therapeutic categories for 1978-79 were antihypertensives, analgesic-antipyretics, antirheumatics, multiple vitamins, cathartics and vitamin E, which represented 10.2, 7.2, 6.5, 4.9, 4.8 and 3.8% of all categories used. There was a decline in all of these categories between interval 1 and 10. Increased use of drugs, particularly prescribed medications, by the elderly population may present problems of adverse drug reactions, drug interactions and medication compliance in the future. Changing patterns of drug use may have resulted, in part, from introduction of new therapeutic classes and from new treatment concepts over the 10 year study period.

A longitudinal evaluation of dipyridamole drug use in an ambulatory elderly population.

STUDY OBJECTIVE: To determine the pattern of dipyridamole use over the past 14 years. DESIGN: A longitudinal health screening program of ambulatory elderly participants was used to study changes in dipyridamole drug use. Participants included all subjects screened in the Florida Geriatric Research Program since 1978. The main outcome measure in this study was self-reported dipyridamole use at every visit to the program since August 1, 1978. RESULTS: A total of 3.6% of men (mean age, 82.6 years) and 3.4% of women (mean age, 80.8 years) reported the use of dipyridamole in the 1991-1992 period. The prevalence of dipyridamole use ranged from a low of 1.6% in 1978-1979 to a high of 7.3% in 1986-1987. There was a significant increase in the use of this drug from 1978-1979 to 1991-1992 (p < 0.038). Over the 14-year period of study, the percent of subjects using dipyridamole concurrently with coumarin anticoagulants ranged from a low of 5.8% to a high of 17.9%. CONCLUSIONS: The level of dipyridamole use in this elderly population has increased since 1978-1979. The only FDA indication for this drug is in combination with coumarin anticoagulants to prevent postoperative thromboembolic complications of cardiac valve replacement. Less than 20% of patients in this study used the drug in combination with coumarin anticoagulants. Educational programs are needed to improve the prescribing of dipyridamole.

The Dunedin program, a Florida geriatric screening process: design and initial data.

The Dunedin program was started in 1975 for the purpose of screening participants over the age of 65, for medical disorders. Data are collected on family history, past medical history, drug history, current symptoms and disorders, and numerous biochemical and physiologic factors. In the past four years, 4,363 participants have been evaluated and a large data base has been derived concerning the 65+ age group. It is hoped that data from this program will facilitate the future assessment, treatment and care of the elderly.

Drug use in a geriatric population.

Drug usage was studied in a geriatric hypertension-screening program. A questionnaire was used to collect the required information from patients visiting the clinic during three successive years. The study included 1,711 patients, of whom 76.6 percent were regularly using a drug preparation. A consistent increase was noted in the average number of drug categories used with increasing age, from 1.6 in patients under 70 to 2.6 in patients over 84 years old. The most common drug categories involved were antihypertensive agents, cardiovascular drugs, vitamins, and internal analgesics.

Central nervous system symptoms of elderly subjects using antihypertensive drugs.

The effects of antihypertensive agents on the frequencies of reported fainting, dizziness, losses of consciousness, and bone fractures were studied in a large, ambulatory elderly population. The frequencies of these symptoms were compared for subjects who used one or more of nine different antihypertensive agents and for subjects who were not using these medications and who served as a control group. Over 40 per cent of the total population were using at least one of the nine drug groups. Women who used antihypertensive medications reported significantly more fainting (P less than 0.001), dizziness (P less than 0.005) and "blacking-out spells" (P less than 0.002) but significantly fewer bone fractures (P less than 0.02) compared with women who were not using such medication in the control group. For men, the use of only one drug group, propranolol, was associated with a significant increase in fainting and dizziness but not blacking-out spells compared with men in the control. These results suggest that elderly persons may be subject to a variety of central nervous system side effects induced by antihypertensive drugs.

Screening for hypertension in an elderly population: report from the Dunedin Program.

Hypertension detection and follow-up programs have recently received increased attention. The authors studied the effect of screening for hypertension in a geriatric screening program for a large ambulatory elderly population in Dunedin, Florida, over a three-year period. Of the 4,247 participants initially screened, 39 percent had some form of hypertension, and 15.6 percent of these had not received any form of treatment. At the time of the first year follow-up, the proportion of participants with treated, controlled hypertension had increased from 14.7 to 21 percent. These data lend support to the value of hypertension screening among persons over 65 years of age.

Symptom prevalence in the elderly. An evaluation of age, sex, disease, and medication use.

Prevalence of reported symptoms was studied in 1927 women and 1140 men over 65 years of age in an ambulatory health screening program. Reports of 28 common symptoms were obtained from a standardized questionnaire completed by participants at the time of their fourth annual visit to the program. A comparison was made of the prevalence of specific symptoms by sex, age, disease states, and drug use patterns. The most common symptoms reported by women were nocturia (80.4%), swollen feet or ankles (30.5%), cold feet and/or legs (28.6%), and irregular heartbeat (23.2%), whereas men complained most often of nocturia (79.8%), irregular heartbeat (24.8%), cold feet and/or legs (23.6%), and tinnitus (23.1%). Women reported a mean of 3.99 symptoms compared with 3.22 reported by men (P less than .0001). In women their was a statistically significant association for most symptoms in subjects reporting the use of medication compared with a group who did not use medication. In men the use of medication was less highly correlated with reports of symptoms. Nearly 100% of participants reported having at least one disease state. The number of symptoms reported was strongly related to the number of disease states, and after adjusting for diseases, women reported more symptoms than men. The best predictor of symptom prevalence was the number of disease states followed by the number of drugs used and then age.

Meprobamate use in the elderly. A report from the Dunedin program.

Meprobamate use was studied in an ambulatory elderly population in Dunedin, Florida. All participants taking this medication were mailed a questionnaire concerning their pattern of use. From 2,278 subjects, 30 (1.3%) reported the use of this drug. The average age of participants using this drug was 81.3 years. Five participants began using the drug over 27 years ago and over one-half of the respondents reported using the drug on a regular basis for over 10 years. With this type of history of meprobamate use, one might expect to encounter a large number of patients in the future who, in a similar manner, have been using benzodiazepines for many decades.

Nocturia: a risk factor for falls in the elderly.

OBJECTIVE: To determine if nocturia is a risk factor for reported falls and bone fractures in older persons. DESIGN: Cross-sectional study comparing falls in men and women with and without nocturia. SETTING: Longitudinal health screening program of ambulatory elderly participants. PARTICIPANTS: Participants included 988 (65.5%) women and 520 (34.5%) men who had completed their tenth annual visit to the program. MAIN OUTCOME MEASURES: Reported falls in the past year and reported bone fractures in the past 5 years. RESULTS: Participants who reported nocturia at least twice during the night were at significantly greater risk to report falls (Odds Ratio = 1.84; 95% CI = 1.05-3.22), and the risk increased in subjects reporting more than three nocturia events (Odds Ratio = 2.15; 95% CI = 1.04-4.44). The significant increase in falls reported by nocturia participants did not result in an increase in reported bone fractures in the past 5 years (P < 0.4360). CONCLUSIONS: Nocturia is an important risk factor for falls in ambulatory elderly persons. Preventive measures should be taken to decrease nocturia events and to decrease the risk of falling during these nocturia events.

Epidemiology of hyperuricemia in an ambulatory elderly population.

The relationship of serum uric acid concentration to age and sex was assessed in 1,701 participants in a geriatric multiphasic screening clinic. Included were 1,067 women and 634 men. The mean uric acid level for men was 6.35 mg/100 ml compared to 5.44 mg/100 ml for women. No statistically significant increases in serum uric acid between age groups were apparent, except for women over 84 years of age. The mean serum urate concentrations found in this geriatric study are higher than those reported for other population groups, suggesting a higher normal value for the elderly.

Use of nutritional supplements in an ambulatory elderly population.

The use of nutritional supplements by 3,192 ambulatory elderly participants in a health screening program is described. The 2,009 women used vitamin (45.5 per cent) and mineral (22.4 per cent) products with significantly greater frequencies than did the 1,183 men (34.0 per cent and 15.0 per cent, respectively); chi-square, P less than 0.01. The most commonly used vitamin products were multiple vitamins, multiple vitamins with minerals, vitamin E, and vitamin C; for minerals, the ranking was potassium chloride, calcium salts, and ferrous sulfate. Eighty-two participants (2.5 per cent) reported the use of four or more supplements. Many older Americans are spending a great deal of money for nutritional supplements, whereas it would seem that the money could be better spent to improve the quality of their diet.

Selected physiologic and drug effects on serum uric acid levels in an elderly population.

A total of 2,923 elderly subjects were studied to determine the relationship between obesity, hypertension, thyroid disease, renal function, alcohol consumption, selected drugs, and the serum uric acid level. Comparison of the serum uric acid levels with indices of obesity demonstrated a strong correlation in normotensive (p less than .0001) and hypertensive (p less than .001) subjects. The serum creatinine level, when used alone, was not a reliable indicator of renal function. Of the drugs evaluated, diuretics had the most pronounced effect upon the serum uric acid level.

Incidence of hypertension in an ambulatory elderly population.

Investigations of the natural history of blood pressure have generally evaluated mean systolic and diastolic pressure changes. While information, this information is not directly applicable to clinical practice settings, in which patients are usually classified as normotensive or hypertensive. We measured the actual incidence of hypertension, using two different definitions, in an ambulatory elderly population of 2,584 individuals over an 8-year period. Using the less stringent blood pressure definition (systolic blood pressure greater than 140 mmHg and diastolic blood pressure greater than or equal to 90 mmHg), 884 (34.2%) participants were normotensive and 1,700 (65.8%) were hypertensive at an initial screening. The average annual incidence of hypertension over the subsequent eight years was 13.2%, and life tables demonstrated a gradual risk of developing hypertension. The development of hypertension was not associated with gender or age; while older age groups had a greater chance of developing hypertension than younger, the difference did not reach statistical significance.

Benzodiazepine use in an ambulatory elderly population: a 14-year overview.

A survey on use of benzodiazepines was conducted among participants in the Florida Geriatric Research Program. In 1978-79, benzodiazepine use was reported by 14.4% of 1448 women and 9.7% of 855 men; in 1984-85, by 12.0% of 1429 women and 5.9% of 784 men; and in 1991-92, by 13.4% of 1124 women and 6.6% of 497 men. The changes were not significant. During this period the mean ages of the women increased from 74.6 to 78.1 years and the men from 75.0 to 80.2 years. Chlordiazepoxide, diazepam, and flurazepam accounted for 98.1% of all benzodiazepines used in 1978-79 and for 35.5% in 1991-92, when alprazolam, lorazepam, and temazepam accounted for 47.1% of benzodiazepines used.

Cataracts in Dunedin Program participants: an evaluation of risk factors.

A geriatric health screening program in Dunedin, Florida, was used to evaluate risk factors leading to development of cataracts. A total of 2,787 participants completed the fourth yearly visit to the program. At the time of the fourth visit, 49.3% of women (mean age 75.1 years) and 38.2% of men (mean age 75.4 years) reported the presence of cataracts. Age was found to be the most significant risk factor in cataract development (P less than .0001). Both men and women with cataracts had significantly lower serum cholesterol concentrations than subjects without cataracts. After adjusting for age and sex, diazepam (P less than .03), furosemide (P less than .04), isosorbide (P less than .003), and ibuprofen (P less than .03) were found to be positively associated with cataracts; triamterene (P less than .05) had a negative association, indicating a protective relationship. Aspirin was not shown to have a protective effect on reported cataracts.

Vitamin E effect on symptoms and laboratory values in the elderly.

The effect of vitamin E use on selected medical disorders and laboratory parameters was studied in a large ambulatory elderly population. Information obtained from a standardized questionnaire concerning reports of numerous clinical disorders, such as hypertension, fatigue, and vaginal bleeding, was used to determine whether the use of vitamin E predisposed to those conditions. During a 2-year period, information was available on 369 vitamin E users and 1,861 non-users. No differences were noted in the prevalence of reported clinical disorders between the two groups, except that men using vitamin E complained more often of shortness of breath (p less than .04) and angina (p less than .03). There were no significant differences between vitamin E users and controls in any hematologic parameters studied. After the groups had been adjusted for age and sex differences, only one biochemical parameter, serum glutamic-oxaloacetic transaminase (SGOT) in men, was found to be significantly different in vitamin E users as compared with controls. Use of vitamin E by the participants in this study appeared to have little influence on clinical disorders or hematologic or biochemical parameters.

Correlates of Beck Depression Inventory scores in an ambulatory elderly population: symptoms, diseases, laboratory values, and medications.

BACKGROUND: Depression is one of the most important psychiatric disorders of older people. Between 1% and 5% of elderly persons who live in the community have major depression. Depressed elderly people are thought to be more likely to complain of symptoms such as headache, constipation, and pain than of disordered mood. The purpose of this study was to determine whether certain symptoms, diseases, or drugs used by older people correlate with scores on the Beck Depression Inventory. METHODS: Beck Depression Inventory scores were obtained in an ambulatory elderly population to identify correlates with self-reported signs, symptoms, diseases, drugs, and laboratory values. A total of 1048 participants were studied, including 712 women and 336 men. RESULTS: In this study, 13.7% of the men and 20.7% of the women had scores suggesting possible depression. A linear regression model revealed eight factors of significance in predicting scores on the Beck Depression Inventory. The most important predictors were the total number of symptoms reported by the patient (P less than .0001), and subjective complaints of memory loss (P less than .0003) and of pain in the abdomen (P less than .0004). CONCLUSIONS: Clinically, the results of this study suggest that depression is underdiagnosed in older patients and that multiple somatic symptoms are the best indicator of depression in this population.

Suicide in the elderly: staying in control.

Suicide remains one of the major causes of death among the fastest growing segment of the US population--the elderly aged 65 and over. Individuals 65 and over comprised 12.4% of the population in 1988, but accounted for 20.9% of all reported suicides (McIntosh, 1992). The purpose of this qualitative study was to explore the meaning of suicide to the elderly and how suicide becomes an alternative for them. Results indicate that elderly subjects gave considerable thought to the end of their lives--including planning for death. For them, suicide was frequently viewed as a way of maintaining control over the dying process. In this study, the elderly described their views on who makes the decision about when death will occur, when suicide is acceptable, and how they would like others to respond to their suicidal ideation. Risk factors and causes of suicide in the elderly emerged from the data.