ABSTRACT
BACKGROUND: Polypharmacy is an important concern for patient safety and has been associated with increased adverse drug reactions, hospitalization and mortality in the elderly. OBJECTIVE: In light of the above, the present study aimed to assess the major characteristics associated with polypharmacy (≥ 4 drugs) in a larger population of apparently healthy older subjects over 60 years. STUDY-DESIGN: Cross-sectional study. SETTING: The preventive medical center (CMP) in Nancy. PARTICIPANTS: 2,545 volunteers (1,175 women, 1,370 men) aged 60 years and older (66 ± 4.8 years) were included from the Senior health examination study. MEASUREMENTS: All subjects underwent clinical, biological examinations. Sociodemographic data, practice of regular physical activity and drug intake data were collected. A self-administered questionnaire of health status, psychological status and questions regarding falls were collected. RESULTS: The prevalence of polypharmacy in this study was 29.9%. The number of drugs in polymedicated people was 5.67 ± 1.82 versus 1.32 ± 1.11 in non polymedicated people; p≤0.01. Multivariate analyses identified 6 independent variables associated with polypharmacy: age over 65 years (OR = 1.58 95% CI: [1.05 - 2.38]; p = 0.03), poor self-perceived health status (2.79 [1.80 - 4.31]; p ≤ 0,01), history of falls (1.66 [1.02 - 2.71]; p = 0.04), lack of a physical activity (1.50 [1.001 - 2.26]; p = 0.049), metabolic syndrome (3.17 [1.95 - 5.15]; p ≤ 0,01), low or medium education level (2.20 [1.24 - 4.30]; p = 0.02). CONCLUSION: Among community-dwelling people aged 60 years and over, in addition to the presence of several diseases and advanced age, the psychological and socio-educative factors may influence drug intake and polypharmacy in the elderly. Physicians should be take into account these considerations before issuing any prescriptions and review all medications used at every visit to avoid unnecessary addictions or dangerous drug-drug interactions.
Subject(s)
Accidental Falls , Educational Status , Geriatric Assessment , Health Status , Perception , Polypharmacy , Sedentary Behavior , Age Factors , Aged , Aged, 80 and over , Cross-Sectional Studies , Exercise , Female , Health Care Surveys , Humans , Male , Mental Health , Metabolic Syndrome/complications , Middle Aged , Multivariate Analysis , Odds Ratio , Residence Characteristics , Risk Factors , Surveys and QuestionnairesABSTRACT
OBJECTIVE: In recent years, the Mini-Mental State Examination (MMSE) has been widely used and has been proposed for cognitive decline screening in the framework of a systematic geriatric evaluation in health centers. The aim of the present longitudinal study was to identify the potential determinants of MMSE score and its evolution over a 4-year period in a population aged over sixty years with good general health without dementia and consulting for a health check-up. DESIGN: Longitudinal study. SETTING: The preventive medical center (CMP) in Nancy. PARTICIPANTS: 687 subjects over 60 years of age (mean age 65.6 ± 5.07 years) were included from the Senior health examination study. MEASUREMENTS: All subjects underwent 2 visits over a period of 4 years. MMSE measurement and a self-administered questionnaire of emotional and psychological state were evaluated at baseline and at the follow-up visit. RESULTS: The major components of total variance of baseline MMSE were represented by education level, practice of regular physical activity, nervousness and despair. Multivariate analysis identified 3 variables at baseline visit that independently predicted annual changes in MMSE: MMSE score, education level and "Difficulty in social relations" (r= -0.222, 0.154 and -0.255 respectively). CONCLUSIONS: Education level and several psychological factors may influence MMSE score and its evolution over time in community-dwelling subjects aged over 60 years without dementia. In these subjects, a low MMSE score does not predict cognitive decline over a period of 4 years. Therefore, the reliability of MMSE in this type of population is questionable.
Subject(s)
Affective Symptoms/diagnosis , Cognition Disorders/diagnosis , Cognition , Dementia , Geriatric Assessment/methods , Mental Status Schedule/standards , Aged , Anxiety/diagnosis , Cognition Disorders/psychology , Educational Status , Exercise , Female , Health Status , Humans , Interpersonal Relations , Longitudinal Studies , Male , Mass Screening , Mental Health , Middle Aged , Multivariate Analysis , Nervous System Diseases/diagnosis , Reference Values , Reproducibility of Results , Stress, PsychologicalABSTRACT
PURPOSE: The prevalence or hypertension increases with aging, reaching more than 50% in people aged 60 years and older. The increase of systolic blood pressure is a major risk of cardiovascular event. METHODS: With the aim of assessing risk factors in old people "in apparent good health", we analysed blood pressure and treatments in people aged 60 years and older who had a periodic check-up that was adapted to older people. RESULTS: This check-up concerned, between April and December 2003, 1638 people with a mean age of 68 years (SD 5.7): 815 men and 823 women. Fourty percent had a systolic blood pressure (SBP) >or=140 mmHg (44% of men, 36% of women); 6% (8% of men, 4% of women) had a diastolic blood pressure (DBP) >or=90 mmHg. A treatment for hypertension was followed by 473 people: 31% of men and 26% of women. Fifty percent were controlled for the SBP and the DBP. Fourty-two percent were not controlled for the SBP, but were controlled for the DBP. Seven percent were not controlled for the SBP nor the DBP. Only 3 subjects (<1%) were not controlled for the DBP, whereas they were controlled for SBP. CONCLUSION: These results, combined with data of literature on the predominant role of SBP in cardio-vascular risk, as compared with DBP, underline the need for a better treatment of systolic hypertension in older people.