Assessment of biophysical skin properties at different body sites in hospitalized old patients: results of a pilot study.

BACKGROUND: Skin aging is a risk factor for a decubitus and biophysical skin properties could help to identify persons at risk. Whether such biophysical properties of aged human skin differ between areas is undetermined. OBJECTIVE: To investigate whether viscoelasticity, hydration or friction differ between important areas for decubitus risk. METHODS: Pilot study in 32 (18 female, 14 male) acute and subacute old patients aged 81.9 ± 5.9 years (±SD), without active skin disease after an average of 10 days of stay. Assessment of skin resilience/viscoelasticity (E) and hydration (H) at the volar forearm (VF), trochanter (TR) and the sacrum (SA), nutrition by a Mini Nutritional Assessment (MNA), total body water (TBW), lean body mass (LBM), % body fat (%F) by bioimpedance and routine laboratory parameters (hemoglobin, hematocrit, leukocytes, C-reactive protein, serum proteins and creatinine). RESULTS: Mean body mass index (27 ± 4.2), MNA (22.5 ± 2.9), Braden score (20 ± 2.5), E (68.5 ± 6.0%) and H (38.3 ± 6.7) at any site and laboratory parameters did not differ by sex. Men had more TBW (+12 ± 1.5 liters), LBM (+9 ± 2 kg), less %F (-8.8 ± 2.1%), increased H-TR (+7.11 ± 2.8) and H-SA (+5.68 ± 2.5). Overall E-VF correlated significantly with E-TR (r(2) = 0.40, p < 0.0001) and E-SA (r(2) = 0.40, p < 0.0001). In contrast, skin hydration was not correlated. CONCLUSION: Results of forearm elasticity experiments can be used as a model for other body sites at risk for the development of pressure ulcers.

Healthcare-associated infections and antibiotic use in long-term care residents from two geographical regions in Switzerland.

BACKGROUND: The burden of healthcare-associated infections (HAIs) and antimicrobial use in Swiss long-term care facilities (LTCFs) is currently unknown. This study assessed the prevalence of HAIs and antibiotic use among LTCF residents in Switzerland. METHODS: A point-prevalence study was undertaken in LTCFs in eastern and western Switzerland from August to October 2019 according to the 'Healthcare-associated infections in long-term care facilities' (HALT) protocol. Characteristics of residents (age, sex, wounds, dementia, indwelling catheters) and institutions (specific factors, geographic region) were assessed. LTCF residents were screened for HAIs and current antibiotic treatment. Personal and institutional factors associated with HAIs were assessed. RESULTS: In total, 1185 residents from 16 LTCFs (eight per geographic region) were screened for HAIs and antibiotic treatment. Median age was 87 years (interquartile range 79-91) and 71% were female. The prevalence of HAIs was 4.2% (west 4.3% vs east 4.2%; P=0.93), with mucocutaneous skin infections (36%) and respiratory tract infections (30%) being the most common. Independent risk factors for the presence of HAIs were presence of a chronic wound [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1-5.0; P=0.02] and being immobile (OR 1.8, 95% CI 1.0-3.3; P=0.04). Antibiotics were given to 2.9% of residents (west 3.9% vs east 1.8%; P=0.05) on the day of the survey. The most commonly prescribed antibiotics were amoxicillin-clavulanic acid and quinolones. CONCLUSIONS: The prevalence of HAIs in Swiss LTCFs is similar to that in other European countries, whereas antibiotic consumption is lower. Further point-prevalence surveys on a broader scale are recommended to improve understanding of the burden of HAIs and antibiotic consumption in this setting.

Skin-textile friction and skin elasticity in young and aged persons.

BACKGROUND/PURPOSE: The mechanical properties of human skin are known to change with ageing, rendering skin less resistant to friction and shear forces, as well as more vulnerable to wounds. Until now, only few and contradictory results on the age-dependent friction properties of skin have been reported. This study has investigated in detail the influence of age on the friction of human skin against textiles. METHODS: In vivo skin-friction measurements on a force plate were combined with skin analyses concerning elasticity, hydration, pH value and sebum content. Thirty-two young and 28 aged persons rubbed their volar forearm in a reciprocating motion against various textiles on the force plate, using defined normal loads and sliding velocities, representing clinically relevant contact conditions. RESULTS: Mean friction coefficients ranged from 0.30 +/- 0.04 (polytetrafluoroethylene) to 0.43 +/- 0.04 (cotton/polyester). No significant differences in the friction properties of skin were found between the age groups despite skin elasticity being significantly lower in the aged persons. Skin hydration was significantly higher in the elderly, whereas no significant differences were observed in either skin pH value or sebum content. CONCLUSION: Adhesion is usually assumed to be the dominant factor in skin friction, but our observations imply that deformation is also an important factor in the friction of aged skin. In the elderly, lower skin elasticity and skin turgor are associated with more pronounced skin tissue displacements and greater shear forces during frictional contact, emphasizing the importance of friction reduction in wound-prevention programmes.

Effects of GH and/or sex steroid administration on abdominal subcutaneous and visceral fat in healthy aged women and men.

Aging is associated with reduced GH, IGF-I, and sex steroid axis activity and with increased abdominal fat. We employed a randomized, double-masked, placebo-controlled, noncross-over design to study the effects of 6 months of administration of GH alone (20 microg/kg BW), sex hormone alone (hormone replacement therapy in women, testosterone enanthate in men), or GH + sex hormone on total abdominal area, abdominal sc fat, and visceral fat in 110 healthy women (n = 46) and men (n = 64), 65-88 yr old (mean, 72 yr). GH administration increased IGF-I levels in women (P = 0.05) and men (P = 0.0001), with the increment in IGF-I levels being higher in men (P = 0.05). Sex steroid administration increased levels of estrogen and testosterone in women and men, respectively (P = 0.05). In women, neither GH, hormone replacement therapy, nor GH + hormone replacement therapy altered total abdominal area, sc fat, or visceral fat significantly. In contrast, in men, administration of GH and GH + testosterone enanthate decreased total abdominal area by 3.9% and 3.8%, respectively, within group and vs. placebo (P = 0.05). Within-group comparisons revealed that sc fat decreased by 10% (P = 0.01) after GH, and by 14% (P = 0.0005) after GH + testosterone enanthate. Compared with placebo, sc fat decreased by 14% (P = 0.05) after GH, by 7% (P = 0.05) after testosterone enanthate, and by 16% (P = 0.0005) after GH + testosterone enanthate. Compared with placebo, visceral fat did not decrease significantly after administration of GH, testosterone enanthate, or GH + testosterone enanthate. These data suggest that in healthy older individuals, GH and/or sex hormone administration elicits a sexually dimorphic response on sc abdominal fat. The generally proportionate reductions we observed in sc and visceral fat, after 6 months of GH administration in healthy aged men, contrast with the disproportionate reduction of visceral fat reported after a similar period of GH treatment of nonelderly GH deficient men and women. Whether longer term administration of GH or testosterone enanthate, alone or in combination, will reduce abdominal fat distribution-related cardiovascular risk in healthy older men remains to be elucidated.

Interrelationships of spontaneous growth hormone axis activity, body fat, and serum lipids in healthy elderly women and men.

Aging is associated with decreased growth hormone (GH) secretion and plasma insulin-like growth factor-I (IGF-I) levels, increased total and abdominal fat, total and low-density lipoprotein (LDL) cholesterol, and triglycerides, and reduced high-density lipoprotein (HDL) cholesterol. Similar changes in lipids and body composition occur in nonelderly GH-deficient adults and are reversed with GH administration. To examine whether GH/IGF-I axis function in the elderly is related to the lipid profile independently of body fat, we evaluated GH secretion, serum IGF-I and IGF binding protein-3 (IGFBP-3) levels, adiposity via the body mass index (BMI), waist to hip ratio (WHR), dual-energy x-ray absorptiometry (DEXA), and magnetic resonance imaging (MRI), and circulating lipids in 101 healthy subjects older than 65 years. Integrated nocturnal GH secretion (log IAUPGH) was inversely related (P < .005) to DEXA total and abdominal fat and MRI visceral fat in both genders. Log IAUPGH was inversely related to visceral fat in women (P < .005) and men (P < .0001), but was not significantly related to total fat in either gender. In women, log IAUPGH was related inversely to total and LDL cholesterol and positively to HDL cholesterol (P < .008). In men, log IAUPGH was inversely related to total cholesterol and triglycerides (P < .005). In women, HDL cholesterol was inversely related to the WHR (P < .005). In men, triglycerides were positively related (P < .001) to the WHR and DEXA abdominal and MRI visceral fat. Multivariate regression revealed log IAUPGH, but not DEXA total body fat, to be an independent determinant of total (P < .001 for women and P = .01 for men) and LDL (P < .007 and P = .05) cholesterol in both sexes and of HDL cholesterol (P < .005) and triglycerides (P < .03) in women. Log IAUPGH, but not DEXA abdominal fat, was related to total (P < .005 and P < .03) and LDL (P < .03 and P = .05) cholesterol in both genders and to HDL in women (P < .05). Log IAUPGH, but not MRI visceral fat, was related to total cholesterol (P < .03 and P = .05) in women and men. Age, IGF-I, and IGFBP-3 were not significantly related to any body fat or lipid measures, except for a positive correlation of IGF-I with triglycerides in men. Thus, endogenous nocturnal GH secretion predicts total, LDL, and HDL cholesterol levels independently of total or abdominal fat, suggesting that it is an independent cardiometabolic risk factor in healthy elderly people.

[Growth hormone and prevention in elderly patients--fantasy and reality]. / Wachstumshormon und Prävention im Alter--Dichtung und Wahrheit.

Human growth hormone is one of the hormones used most frequently in the setting of so-called anti-aging strategies. To date, the preventive value of such a hormone replacement therapy in relatively healthy and well functioning middle aged persons is unknown. Although growth hormone leads to significant alterations in body composition and changes in serum cholesterol levels in patients with adult growth hormone deficiency, there are currently no data supporting the hypothesis that growth-hormone in non deficient persons prolongs life span or reduces morbidity. Aging is associated with a reduction of GH-secretion, serum levels of insulin like growth factor I (IGF-I) and alterations in body composition and function. Based on the many clinical similarities between aging and acquired growth hormone deficiency, several studies have assessed the effects of growth hormone administration in healthy aged women and men. Only a few studies have addressed functional outcomes in a more frail population. These studies suggest that a defined group of older individuals with functional limitation might benefit from GH as a strategy to prevent further functional decline and delay nursing home admission. Because of the lack of proof in frail patients, uncertain long-term effects and high treatment costs GH-administration in the aged should currently be restricted to research questions. Future studies should address the question whether growth hormone alone or in combination with established strategies, such as exercise or improvement in nutrition will serve as a measure to prevent functional decline in frail geriatric patient populations.

[Perioperative myocardial infarction and cardiac complications after noncardiac surgery in patients with prior myocardial infarction. III: Troponin T--a significant diagnostic alternative in perioperative myocardial infarction?]. / III: Troponin T--eine sinnvolle diagnostische Alternative beim perioperativen Myokardinfarkt?

UNLABELLED: Diagnosis of a perioperative myocardial infarction (PMI) on the basis of measurement of the creatine kinase MB fraction (CKMB) alone is not always easy. Surgical traumatisation of muscle fibres can lead to false-positive elevations. Newly introduced laboratory tests for cardiac troponins seem to facilitate the diagnosis of PMI. We measured serum values of cardiac troponin T in 139 patients described in detail in part I and compared them with common diagnostic tools for myocardial infarction. METHODS: In all, 139 patients were enrolled (part I). Clotted serum samples were taken preoperatively and daily until day 3, centrifuged, and stored at -20 degrees C until analysis. Our Department of Clinical Biochemistry and Haematology used a commercially available sandwich immunoassay (Troponin T ELISA, Boehringer, Mannheim, Germany). The measurements of CK and CKMB were performed with an automated analyser (CK, CK-MB, Boehringer, Mannheim, Germany). Serum values of troponin T were defined according to company recommendations: detection level: 0.04 ng/ml, threshold value for myocardial ischaemia: > or = 0.2 ng/ml, value for diagnosis of non-Q-wave infarction: > or = 1.0 ng/ml, and value for diagnosis of Q-wave infarction: > or = 3.0 ng/ml. We therefore assumed a value of > or = 1.0 ng/ml troponin T as being positive for MI, comparable with a CKMB value > or = 6% of total CK (part I). Statistical analysis was the same as described in part I. RESULTS: Six of the 139 patients had a perioperative infarction, 3 of them had CKMB levels > or = 6%, 3 had an elevation of troponin T > or = 1.0 ng/ml. The sensitivity was 50% for both troponin T and CKMB. Values for specificity were 98% for troponin T and 95% for CKMB. Two of 8 patients with troponin T levels > or = 0.2 ng/ml preoperatively had a reinfarction (Table 5). Three of 8 patients with preoperative elevations of cardiac troponin T > or = 0.2 ng/ml versus 4 of 131 others had left ventricular failure postoperatively (P < 0.05). On day 3 significantly more patients with pathological levels of troponin T had left ventricular failure (5 of 12 vs. 0 of 127, P < 0.05). Patients with pathological depression of the ST segment on Holter ECG more often had elevations of troponin T values on day 3 than patients without (3 of 25 vs. 4 of 75, P = 0.048). There was an unexplained coincidence of elevated preoperative serum creatinine levels > 120 mumol/l and troponin T values (Table 6). CONCLUSION: Troponin T is a highly specific marker for perioperative myocardial cell necrosis. Patients with raised levels preoperatively seem to be at higher risk for postoperative reinfarction and left ventricular failure. The prognostic value of such an elevation is not clearly defined, especially in patients with chronic renal failure.

[Ondansetron versus droperidol. Postoperative treatment against nausea and vomiting. Comparison of action, adverse effects and acceptance by gynecologic inpatients]. / Ondansetron versus Droperidol. Postoperativer therapeutischer Einsatz bei Nausea und Erbrechen. Vergleich von Wirkung, Nebenwirkungen und Akzeptanz bei gynäkologischen, stationären Patientinnen.

INTRODUCTION: Ondansetron is more effective than a placebo in treating postoperative nausea and vomiting (PONV), but it has not been proved to be superior to established antiemetics for prophylaxis or therapy. We compared ondansetron vs droperidol for the treatment of PONV. METHODS: Our prospective, randomized double-blind study was performed between 15 October 1992 and July 1993; it included 271 gynaecological ASA I-III inpatients who had been operated on under general anaesthesia with intubation. Patients were excluded if: there was no informed consent; it was an ambulatory or emergency operation; the patient was pregnant or breast feeding; allergies were being treated with antihistamines; drug addiction was present or convulsions or Parkinson's disease; any pre- or intraoperative antiemetic medication had been administered. All patients wishing an antiemetic and/or suffering from at least one emetic episode during the first 24 h postoperatively received either 8 mg ondansetron or 1.25 mg droperidol from identical 4 ml ampoules intravenously. The verbal nausea score (1 = none, 2 = mild, 3 = moderate, 4 = severe) was recorded every 30 min for 4 h, then before and 2 h after each antiemetic dose. All emetic episodes and the interval between administration and effect were also noted. Patients were interviewed 36-48 h postoperatively on subjective effects, side-effects and individual acceptance. After oral premedication with diazepam, anaesthesia was induced with thiopental, in a few cases with etomidate or propofol. Relaxation was achieved with pancuronium or atracurium and, when indicated, with succinylcholine. Muscular relaxation was antagonized with neostigmine and glycopyrrolate. Gastric content was aspirated once after intubation. Anaesthesia was maintained with nitrous oxide/oxygen, enflurane, halothane or isoflurane and fentanyl up to 0.3 mg. Statistical evaluation was performed by the unpaired Student's t-test and the Mann-Whitney U test. Categoric variables were examined by the chi 2 test. Significance was defined as P < 0.05. RESULTS: Of 271 patients, 100 (37%) experienced PONV. The groups were statistically comparable with respect to demographic data, type and duration of operation, emesis record, perioperative uterotonic medication. Twenty patients in the ondansetron group and 27 in the droperidol group received the first antiemetic within 2 h, the other patients up to 17 h after extubation. Nausea scores and emetic episodes were identical before antiemetic medication. The reduction of these parameters after medication was similar. Complete response over 6 h was 60% in the ondansetron and 68% in the droperidol group. In both groups the first medication failed in 4 cases during the initial 2 h. Twenty of the ondansetron and 16 of the droperidol patients needed a second dose; among these 2 and 4, respectively, a third ampoule. No rescue medication was necessary over 24 h and a mean of 1.4 ampoules was administered in both groups. Onset and quality of emetic action were identical in both groups. It was not possible to evaluate 25 interviews due to linguistic or amnestic problems. Multiple side-effects were noted frequently. Injection pain was reported significantly more often in the droperidol, pruritus in the ondansetron group. Ninety-three percent of the ondansetron and 85% of the droperidol patients opted for the same drug for future PONV treatment. CONCLUSIONS: Ondansetron (8 mg) and droperidol (1.25 mg) proved to be equally effective when used as a postoperative antiemetic. Both drugs showed similar side-effects. Due to differences in methods it was difficult to compare our results to those obtained in other studies.

[Recurrent hyponatremia, neurological symptoms and long-term administration of levomepromazine]. / Rezidivierende Hyponatriämien, neurologische Symptomatik und jahrelange Einnahme von Levomepromazin.

We present the case of an 84 year old lady with an episode of marked hyponatremia with acute neurological disturbances which in the latest case resolved completely after a 3 day period of fluid restriction. The more common causes of hyponatremia could be ruled out. There was no evidence for a neuroleptic drug associated change in serum sodium concentration. We conclude that the patient in this study belongs to a subset of geriatric patients in whom there is an intermittent SIADH which only becomes clinically evident when several factors coincide. The underlying mechanisms are not understood but could include the interaction of subclinical cerebrovascular disease and treatment with a neuroleptic drug in an elderly patient whose water and sodium homeostasis is compromised by the changes of normal aging which affect the many systems involved in maintaining water and sodium balance.

[Perioperative myocardial infarction and cardiac complications after noncardiac surgery in patients with prior myocardial infarction. I. Clinical data and diagnosis, incidence]. / Perioperativer Myokardinfarkt und weitere kardiale Komplikationen nach nichtkardialen Wahloperationen bei Patienten nach Myokardinfarkt. I: Klinische Daten und Diagnostik, Inzidenz.

UNLABELLED: Patients with a prior myocardial infarction (MI) have a high risk of perioperative reinfarction compared with the normal population (5%-8% vs. 0.1%-0.7%) [10]. According to Rao [13], a reduction of this risk is possible when patients are monitored invasively and all haemodynamic parameters are kept within the physiological range. In most institutions it is not feasible to treat patients as Rao recommended: this would overstrain both hospital structure and financial resources. We studied the incidence of perioperative MI and other cardiac events in patients with prior MI. During the study period the anaesthesia and intensive care methods of our institution were neither changed nor influenced. In addition to this clinical evaluation, we performed perioperative Holter electrocardiographic monitoring and measured serum levels of the recently introduced marker troponin T (parts II and III). METHODS: Institutional informed consent was obtained. The study was planned prospectively. All patients with prior MI (156) and/or coronary artery bypass grafting (CABG) (4) who were scheduled for elective noncardiac surgery between April 1992 and March 1993 were included. The following information was acquired and tabulated: age, sex, body weight, preoperative risk factors, ASA classification, preoperative blood pressure, pulse rate, and ECG (interpreted by an independent cardiologist), serum electrolytes, haemoglobin, creatine kinase (CK), CKMB faction, creatinine. Preoperative regular medications, type of anaesthesia, type, site, and duration of surgery, and intraoperative haemodynamic changes were documented. The patients were divided into four groups depending on the time interval between MI and surgery (group I: 0-3 months, group II: 3-6 months, group III: > 6 months, group IV silent MI and prior CABG without infarction). We then studied the number of patients who developed a perioperative MI or died of cardiac causes within 7 postoperative days (n = 160). Because of early discharge of 21 patients, we could study the occurrence of cardiac events within 7 postoperative days in 139 patients only. Definitions of perioperative MI included [3]: changes of ST pattern (horizontal ST depression > 0.1 mV or elevation > 0.2 mV) during 30 s and longer; new T-negativation or Q-wave; pathological CKMB fraction (> or = 6% of total CK); and angina pectoris; two of these criteria were required to be positive (WHO). Definitions of cardiac events included: ischaemia: any reversible horizontal depression of the ST segment of more than 0.1 mV or any ST segment rise of more than 0.2 mV. Patients with bundle branch block (BBB) were excluded; angina pectoris: any chest pain that disappered after application of nitroglycerine; arrhythmia: any change from preoperative rhythm or appearence of ventricular premature beats; and left ventricular failure: clinical and radiological signs of ventricular failure. Statistical evaluation of the demographic data was performed by the Kruskall-Wallis test; categoric variables were examined using the chi 2 test and Fisher's exact test. P values of less than 0.05 were considered significant. RESULTS: Six of the 160 patients with prior MI developed a perioperative MI (3.8%); 2 of them (33%) died of cardiac causes (3rd and 6th postoperative day). All of these patients were in groups III or IV (interval > 6 months). Forty-two patients had one or more other cardiac events; arrhythmias (22) and ischaemia (14) were most common. Intraoperative hypotension was associated with postoperative MI (5 of 58 vs. 1 of 102). Preoperative congestive heart failure (4 of 18 vs. 3 of 121) and major surgery (7 of 68 vs. 0 of 71) led more often to postoperative left ventricular failure. Patients who received beta-blocking agents preoperatively had significantly fewer ischaemic cardiac events (0 of 28 vs. 14 of 90, 21 patients excluded with BBB) but differed in mean age (67 vs. 71 years). The use of beta-blocking agents was not associated with a reducti

[Perioperative myocardial infarction and cardiac complications after noncardiac surgery in patients with prior myocardial infarction. II: Perioperative long-term ECG--clinical relevance practicability]. / II: Perioperatives Langzeit-EKG--Klinische Relevanz und Praktikabilität.

UNLABELLED: Perioperative, mostly silent ischaemia in patients with coronary heart disease is difficult to detect by clinical examinations. METHODS: During the clinical evaluation (part I of this study) we monitored patients with prior myocardial infarction (MI) by continuous electrocardiographic (ECG) recording from the evening before until the first 24 h after operation. Excluded from Holter ECG studies were patients with a bundle branch block, pacemaker, valvular heart disease, cardiomyopathy, severe hypokalaemia, and digitalis treatment. Data were recorded with a Holter 8500 recorder (Marquette Electronics) using modified V2, V4, and V5 leads (Fig. 1). Holter tapes were analysed twice with a Holter computing system (Software 5.8, Marquette Electronics), first by a blinded technician and then by the authors themselves. We defined the following criteria as pathological ST segment changes and as ischaemic episodes [7]: horizontal or down-sloping ST depression of at least 1 mm or elevation of 2 mm of at least 1 min duration measured at the J-point plus 60 ms. To quantify individual levels of ischaemia we used the definition "ischaemic load" [3]: ischaemic min/h monitored per patient. The statistic evaluation did not differ from that used in part I. RESULTS: Out of 160 patients, 100 could be examined by Holter monitoring. Because of technical problems we could not record a Holter ECG in 2 of 6 patients with reinfarction. We found one or more perioperative episodes of ST-segment depression in 25 patients (25%). Ischaemic episodes were detected in 15 patients preoperatively, in 12 intraoperatively, and in 10 postoperatively. Three patients had ischaemic episodes during all periods. Patients with pathological ST segments suffered significantly more reinfarctions (3 of 25 vs. 1 of 75 patients) and were older (mean age difference 7 years, P < 0.05). Patients with ischaemic episodes and a clinical diagnosis of reinfarction (n = 3) demonstrated a dramatic postoperative increase in ischaemic load. Preoperative use of beta-blocking agents did not influence the incidence of ischaemic events. The sensitivity of postoperative Holter ECG monitoring in the diagnosis of reinfarction was 50%, the specificity 92%. CONCLUSIONS: Perioperative Holter ECG monitoring is time-consuming, expensive, not very sensitive, and therefore not generally applicable for all patients with prior MI.

Cortisol and GH secretory dynamics, and their interrelationships, in healthy aged women and men.

We studied 130 healthy aged women (n = 57) and men (n = 73), age 65-88 yr, with age-related reductions in insulin-like growth factor I and gonadal steroid levels to assess the interrelationships between cortisol and growth hormone (GH) secretion and whether these relationships differ by sex. Blood was sampled every 20 min from 8:00 PM to 8:00 AM; cortisol was measured by RIA and GH by immunoradiometric assay, followed by deconvolution analyses of hormone secretory parameters and assessment of approximate entropy (ApEn) and cross-ApEn. Cortisol mass/burst, cortisol production rate, and mean and integrated serum cortisol concentrations (P < 0.0005), and overnight basal GH secretion (P < 0.05), were elevated in women vs. men. Integrated cortisol concentrations were directly related to most measures of GH secretion in women (P < 0.01) and with mean and integrated GH concentrations in men (P < 0.05). Integrated GH concentrations were directly related to mean and integrated cortisol levels in women (P < 0.005) and men (P < 0.05), with no sex differences. There were no sex differences in cortisol or GH ApEn values; however, the cross-ApEn score was greater in women (P < 0.05), indicating reduced GH-cortisol pattern synchrony in aged women vs. men. There were no significant relationships of integrated cortisol secretion with GH ApEn, or vice versa, in either sex. Thus postmenopausal women appear to maintain elevated cortisol production in patterns that are relatively uncoupled from those of GH, whereas mean hormone outputs remain correlated.