Effect of psyllium hydrophilic mucilloid on serum cholesterol in the elderly.

The effect of psyllium hydrophilic mucilloid (PHM) when used as a laxative and/or stool softener on serum cholesterol concentrations was examined in 176 ambulatory elderly participants attending a health screening program. The change in one-year serum cholesterol concentration in subjects using PHM was compared with the change in cholesterol in 741 participants who did not report the use of PHM. Serum cholesterol concentration decreased by 0.073 mmol/liter (2.82 mg/dl) in the treatment group compared with a decrease of 0.036 mmol/liter (1.39 mg/dl) in the control group. After adjusting for confounding factors, excluding psyllium dose, by using a multiple regression model there was no significant difference in the change in serum cholesterol concentration (P = 0.935). PHM dosage information was available for 158 participants. After adjusting for baseline serum cholesterol and confounding factors using multiple regression analysis, it was found that the dose of PHM administered was significantly correlated with the change in serum cholesterol (P = 0.0120). For every 1-g increase in daily PHM dose there was a 0.022 mmol/liter (0.84 mg/dl) decrease in serum cholesterol concentration.

Prehospital use of nifedipine for severe hypertension.

The prehospital management of severe hypertension is limited by a paucity of pharmacologic agents suitable for field use. This prospective study was designed to test the safety and efficacy of intraoral nifedipine therapy in 50 patients with severe hypertension being transported by an urban emergency medical service system. Ten milligrams of nifedipine were administered. Serial blood pressure determinations were obtained at 3, 5, 10, and 15 minutes and patients were observed for possible side effects. A marked effect on systolic blood pressure (SP), diastolic blood pressure (DP), and mean arterial pressure (MAP) was evident and was statistically significant in all three categories by 3 minutes. MAP decreased from 169 to 129 mm Hg (delta MAP of 40 mm Hg) at 15 minutes with parallel changes in the SP (55 mm Hg) and delta DP (32 mm Hg). These changes were highly significant (P less than .01) when compared with those of 50 historical controls. No evidence of severe adverse effects were noted. Nifedipine appears to be a promising agent for the prehospital treatment of severe hypertension, but its proper role is not yet defined.

Nutritional supplements in the ambulatory elderly population: patterns of use and requirements.

Older persons are thought to be the most frequent consumers of vitamin and mineral supplements. In this review, the use of nutritional supplements by the elderly was found to be common but was not greatly different from other age groups. Elderly persons living in Dunedin, Florida, reported nutritional supplement use less frequently than a random sample of registered nurses. Neither the Food and Nutrition Board of the National Academy of Sciences/National Research Council nor the World Health Organization has recognized the need for increasing the vitamin and mineral allowances for healthy elderly adults above those recommended for healthy young adults. It is important to recognize, however, that the elderly are at greater risk of developing nutritional deficiencies as a result of acute and chronic diseases, drug use, and social isolation, and they require careful monitoring.

Effect of zinc supplementation on the development of cardiovascular disease in the elderly.

Supplemental zinc intake by an ambulatory elderly population was examined. Health questionnaire, electrocardiogram, laboratory, and medication use data from a geriatric health screening program were compared for 69 participants who were taking zinc supplements and 1,832 participants who were not taking zinc supplements during 1985. A major purpose of this study was to evaluate whether ingestion of zinc supplements by elderly persons is a risk factor for development of cardiovascular disease. No association between zinc supplementation and increased risk of developing cardiovascular disease was found for the indices examined. More information is needed to resolve the question of whether or not zinc supplementation is a risk factor for the development of cardiovascular disease. It is important that elderly persons be provided information to evaluate the possible risk versus benefit of taking zinc supplements.

Drug use in an ambulatory elderly population: a five-year update.

Drug usage was studied in an ambulatory elderly population in Dunedin, Florida. Prescription and nonprescription drug use in these 2834 participants was compared with use during a period five years earlier. The average number of medications increased from 3.2 in 1978-80 to 3.7 in 1983-85. The most commonly prescribed medications in this population were hydrochlorothiazide-triamterene (13.5 percent), digoxin (9.6 percent), and hydrochlorothiazide (8.4 percent). There was a large increase in the use of nutritional supplements in the past five years, with 18.0 percent of these subjects reporting the use of vitamin E and 15.7 percent taking vitamin C. The general philosophy in geriatrics is to use the fewest drugs possible; however, it appears that the elderly are, in fact, receiving an increasing number of medications.

Dietary salt and doca-salt treatments modify ethanol self-selection in rats.

The effect of a salt supplemented diet on the voluntary intake of ethanol in male Wistar rats was examined in two experiments. In Experiment 1, the addition of 3% sodium chloride to the diet selectively increased the intake of moderately concentrated ethanol solutions (3 and 6%) while leaving the choice of a 12% solution unaffected. The choice and intake of water in the two former groups declined. In a second experiment four different groups of rats were offered the 3% salt supplemented diet in combination with daily injections of the synthetic salt-retaining mineralocorticoid desoxycorticosterone acetate (0.5, 1.5, and 6.0 mg/day). Ethanol intake again tended to increase in the 3 and 6% groups but in contrast to the results of Experiment 1 water intake also increased significantly. When desoxycorticosterone was administered without the salt supplemented diet, ethanol intake was significantly depressed while water intake increased. These findings indicate that a salt supplemented diet can significantly and selectively enhance the intake of moderately concentrated ethanol solutions and that while the addition of desoxycorticosterone injections to this diet has its effect primarily on water intake, these injections alone can also suppress ethanol intake indirectly by shifting the animals choice toward water and away from ethanol.

Diuretic use in an ambulatory elderly population.

The nature and extent of diuretic use and the effect of diuretics on clinical laboratory values were studied in a retirement community. Study participants completed health questionnaires and provided information on all prescription and nonprescription medications regularly used. Subjects using diuretics were categorized according to product(s) used; a control group used no diuretics. Results for diuretic users who used potassium supplements were analyzed separately. Data were collected on 2009 women and 1183 men over 65 years old. At least one diuretic drug was used by 40.2% of the women and 29.5% of the men. In most cases, the diuretic was used daily (81.1%) and had been used for longer than two years (72.5%). Approximately one third of the subjects had hypertension. Serum potassium values for users of chlorthalidone and thiazide diuretics showed the greatest difference from the control group, while users of the combination of hydrochlorothiazide and spironolactone showed the greatest difference in serum sodium concentrations. Particularly in furosemide users, uric acid, BUN, and creatinine concentrations were significantly different from control. When serum potassium values of subjects using both diuretics and potassium supplements were analyzed, values were lower in participants using supplements. In many cases, significantly different laboratory values were still within normal limits. Long-term diuretic use in this ambulatory elderly population was high and was associated with numerous alterations in biochemical values.

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.