Infrequent use of antidepressants in depressed individuals (an interview and prescription database study in a defined Swedish population 2001-2002).

PURPOSE: To investigate whether antidepressants are over-used, under-used, or misused, by determining to what extent the depressed individuals in a defined population are treated with antidepressant medication and, from the other end, to what extent prescribed antidepressants are aimed for the treatment of depression. SUBJECTS AND METHOD: From an individual based prescription database in the County of Jämtland, 2048 individuals representative for the general population were selected. The presence of current depression in these individuals was screened by a mailed self-screening questionnaire. Individuals with depression according to the questionnaire were interviewed by a psychiatrist using a structured interview (SCAN) to confirm the diagnosis. Their use of antidepressants was obtained from the prescription database. RESULTS: Sixty-two (4.5%) out of 1375 were diagnosed with depression and 17 (27%) of these were taking an antidepressant. In addition 44 individuals, currently not depressed, were taking antidepressants. Twenty-five of these were interviewed per telephone and it was found that the indications for 18 of them were continuation treatment of depression, and for seven of them pain, sleep disturbance or anxiety. CONCLUSION: Antidepressants appear to be under-used in the population. Only one in four of the depressed individuals was treated with antidepressant medication. Those who had antidepressant medication without being currently depressed had, with few exceptions, either continuation treatment for depression in remission or treatment on other approved indications.

Hip fractures, nocturia, and nocturnal polyuria in the elderly.

This study was undertaken to evaluate the relation between hip fractures and nocturnal micturition habits in elderly men and women. A questionnaire survey was undertaken among 10,216 elderly subjects. The mean (+/-S.D.) ages of the men and women were 73.0+/-6.0 and 72.6+/-6.7 years, respectively. A hip fracture during the past five years had occurred in 97 (3.9%) of the men and 175 (4.6%) of the women and the occurrence increased with increasing age in both sexes. In both men and women nocturnal micturition increased with age. Among men, passing of subjectively large amounts of urine at night was reported to occur never or very seldom in 63.3% and rather seldom, rather often, and very often in 21.9%, 12.7%, and 2.1%, respectively. The corresponding frequencies in women were 65.1%, 17.2%, 13.7%, and 3.9%, respectively. Multiple logistic regression analysis with sex, nocturia, and nocturnal voided volumes as independent variables and occurrence of hip fracture during the last five years as the dependent variable showed that the risk of having had a hip fracture was increased by nocturia three or more episodes versus two or fewer; odds ratio (OR) 1.8, confidence interval (CI) 1.1-3.0, and by large nocturnal urine volumes, very often versus very seldom or never; (OR 3.5; CI 1.8-7.3). One can conclude that in these elderly subjects the risk of hip fractures during a five-year period was increased independently by increased nocturnal micturition and increased nocturnal urine output.

Waiting for surgery; living a life on hold--a continuous struggle against a faceless system.

This interpretive-phenomenological study examined the lived experience of being on the waiting list for arthroplastic surgery of the knee or hip. Interviews reveal that respondents experience suffering in different ways: illness-, caring- and life-suffering. Suffering leads to a struggle in order to have their caring needs met and the struggle is often fruitless-against a faceless enemy-"the system". No one is there to answer their plea or the frustration they experience. This in combination with their present life situation may lead to a disrupted self-image. Finding or creating meaning in suffering appears to be a crucial issue in the struggling process. Respondents who are able to preserve or create meaning in life are able to reformulate their life-world and live a full life, in spite of severe pain and disability.

Nocturia and the burning mouth syndrome (BMS) in the elderly.

The aim of this study was to assess the relationship between BMS and nocturnal micturition in a group of elderly men and women. The study comprised 6103 elderly men and women recruited from a group of pensioners by means of a questionnaire (n=10,216; response rate 61.3%). The mean (+/-S.D.) ages of the men and women were 73.0+/-6.0 years and 72.6+/-6.7 years, respectively. The questionnaire included questions on their health, diseases and symptoms, drugs, sleep habits and the number of nocturnal voiding episodes. BMS was reported by 2.4% of the men and 8.5% of the women (p<0.0001). The occurrence of BMS was unaffected by age in both sexes. In women, but not in men, there was a stepwise increase in BMS in parallel with increased nocturnal micturition. There was a strong relation between nocturnal thirst and drinking on the one hand, and reports on BMS on the other hand. BMS was also increased in diuretics users in both sexes. The results may indicate that negative fluid balance as a consequence of nocturnal polyuria is an overlooked pathogenetic mechanism in the genesis of BMS in the elderly.

Visual impairment, sleep and nocturia in the elderly.

The aim of this study was to determine whether there was a relationship between visual impairment and nocturia in a group of elderly men and women. A questionnaire survey was undertaken among 10,216 elderly subjects. The mean (+/-S.D.) ages of the men and women were 73.0+/-6.0 and 72.6+/-6.7 years, respectively. Visual impairment was reported by 20.9% of the men and 32.9% of the women and was twice as common in men and 1.8 times more common in women of ages > or =80 as in those of ages <70 years. Occurrence of three or more nocturnal micturition episodes was 1.7 (1.2-2.3) times higher in men and 1.9 (1.5-2.4) times in women with visual impairment. In a multiple logistic regression analysis, significant independent correlates of three or more nocturnal micturition episodes versus two or fewer such episodes in men were: age, 70-79 years versus <70 years (odds ratio [OR] 1.6; confidence interval [CI] 1.1-2.6), age > or =80 years versus <70 years (1.7; 1.0-3.0), sleep, poor versus good (2.1; 1.4-3.2), and poor vision (1.8; 1.2-2.7). The corresponding odds ratios in women were: age 70-79 years versus <70 years (1.9; 1.3-2.7), age > or =80 years versus <70 years (2.1; 1.3-3.2), sleep, poor versus good (2.8; 2.1-3.7), and vision, poor versus good (1.6; 1.2-2.1).

Nocturia in the elderly in relation to thirst, dry mouth and dry eyes.

OBJECTIVE: To assess the relationship between nocturia, thirst and the perception of dryness in the eyes and mouth in a group of elderly men and women. MATERIALS AND METHODS: The study comprised 6103 elderly men and women recruited by a questionnaire from a group of pensioners (n=10216; response rate 61.3%). The age of the men and the women was 73.0 (6.0) and 72.6 (6.7) years, respectively. The questionnaire included questions on their health, diseases and symptoms, drugs, sleep habits and the number of nocturnal voiding episodes. RESULTS: Dryness of the eyes increased from 6.5% in men without nocturnal micturition to 15.8% (p < 0.05) in those with > three nocturnal voids, and correspondingly from 9.9% to 33.1% (p < 0.0001) in women. Dryness of the mouth increased similarly from 15.7% to 37.3% (p < 0.001) in the men and from 17.0% to 56.7% (p < 0.0001) in the women. Multiple logistic regression analyses revealed that dry eyes and dry mouth increased with increasing nocturnal micturition independently of the influence of age, sex, analgesics and the use of diuretics. CONCLUSION: Nocturia is associated with a significant increase in the occurrence of dry eyes and dry mouth among the elderly. The results may indicate that nocturnal polyuria is an overlooked pathogenetic mechanism in these symptoms.

Nocturia and depression.

OBJECTIVE: To assess the possible relationship between major depression (MD) and nocturia. SUBJECTS AND METHODS: An unselected group of adult men and women, living in the city of Ostersund, Sweden, were sent a postal questionnaire containing questions on somatic and mental health, sleep, sleepiness and nocturia. For depression diagnostics the Major Depression Inventory (MDI) was used. RESULTS: The mean (sd) ages of the men and women were 48.0 (18.2) and 50.1 (19.1) years, respectively. Two or more nocturnal micturition episodes occurred in 15.6% of the men and 16.5% of the women. In a multiple logistic regression analysis independent correlates (with 95% confidence intervals) for >/= 2 nocturnal voids in men were: MD 6.5 (2.6-15.6); health, fair vs good, 1.8 (1.0-3.9); health, poor vs good, 2.7 (1.1-4.8); age, 60-74 vs 18-29, 3.6 (1.5-8.4) and age >/= 75 vs 18-29 6.7 (2.6-17.4); and in women: MD 2.8 (1.3-6.3); health, fair vs good, 1.9 (1.1-3.2); health, poor vs good, 4.3 (2.6-8.2); age, 60-74 vs 18-29, 3.8 (1.8-7.8), and age >/= 75 vs 18-29, 8.6 (4.0-18.6). Age < 60 years was deleted by the logistic model in both sexes. CONCLUSION: MD is associated with a six-fold increase in nocturia in men and a three-fold increase in women, after accounting for age and health. Possible pathogenetic mechanisms of this relationship may involve both increased nocturnal diuresis via a disturbed 24-h rhythm of antidiuretic hormone secretion, and a decrease in nocturnal bladder capacity through a central and/or peripheral serotonergic effect.

Nocturia, nocturnal polyuria, and sleep quality in the elderly.

Nocturia is a common symptom in the elderly, which profoundly influences general health and quality of life. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g., fall injuries, are increased both at night and in the daytime in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, a reduced bladder capacity, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, such as diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. In the nocturnal polyuria syndrome (NPS), the 24-h diuresis is normal or only slightly increased, while there is a shift in diuresis from daytime to night. NPS is caused by a disturbance of the vasopressin system, with a lack of nocturnal increase in plasma vasopressin or, in some cases, no detectable levels of the hormone at any time of the 24-h period. The calculated prevalence of NPS is about 3% in an elderly population, with no gender difference. In NPS, there are serious sleep disturbances, partly due to the need to get up for micturition, but there is also increased difficulty in falling asleep after nocturnal awakenings and increased sleepiness in the morning. The treatment of NPS may include avoidance of excessive fluid intake, use of diuretics medication in the afternoon rather than the morning, and desmopressin orally at bedtime.

Nocturia in relation to body mass index, smoking and some other life-style factors in women.

OBJECTIVE: To analyze the relationship of nocturnal micturition to body mass index (BMI), smoking, regular exercise, coffee and tea drinking, parity, and menopausal transition in women. METHODS: A questionnaire study was carried out in 3669 respondents among 6000 women, i.e. 1200 randomly selected from each 5-year age group between 40 and 64 years in the County of Jämtland, Sweden. The questions concerned number of nocturnal voiding episodes, health, childbirths, occurrence of somatic diseases and symptoms, habits and medication. RESULTS: In univariate analyses, body mass index (BMI) > or =30, smoking, lack of regular exercise and menopausal status, but not parity, were associated with an increased number of nocturnal micturition episodes. Nocturia was twice as common in women who drank no evening coffee or tea as in those who drank either of these beverages. In a multiple logistic regression analysis, independent correlates for two or more nocturnal micturition episodes vs. no more than one episode were: smoking 1-15 cigarettes daily vs. no smoking (odds ratio (OR), 1.4; confidence interval (CI), 1.1-1.8), 16 or more cigarettes per day vs. no smoking (OR, 1.8; CI, 1.1-2.8), <5 years after menopause vs. before (OR, 2.0; CI, 1.4-2.7), 5-9 years after vs. before (OR, 2.3; CI, 1.6-3.2) and > or =10 years after vs. before (OR, 3.5; CI, 2.6-4.7), BMI > or =30 vs. <20 (OR, 3.5; CI, 2.6-4.7). BMI in the ranges 20-24.9 and 25-29.9 showed no independent influence on nocturia. CONCLUSIONS: Nocturnal micturition was increased by smoking and raised BMI and decreased by regular exercise, but was not influenced by childbirth.

Sleep and sleepiness 1 and 9 months after cataract surgery.

This study was undertaken to analyze sleep development in a group of patients during the first 9 months after cataract extraction. Men and women (n=407) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during two periods in 2000-2002 were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 and 9 months after the operation. The response rate was 90.8%. The mean ages of the participating men and women were 74.5 and 75.6 years, respectively. One week after cataract extraction the visual acuity in the treated eye was 0.67 (+/-0.31) in men and 0.69 (+/-0.28) in women (NS), and showed an inverse relationship to age in both men (P<0.01) and women (P<0.0001). One month after cataract extraction 28.3% of the men and 37.5% of the women experienced poor sleep, and after 9 months the figures were 15.8 and 31.4%, respectively. Frequent awakenings and difficulty in falling asleep after nocturnal awakenings improved correspondingly. Being well rested in the morning increased and daytime sleepiness decreased. The results indicate that in elderly persons with cataract sleep is improved 1 month after cataract extraction and further improvement during the first 9 months may be experienced.

Nightmares, sleep and cardiac symptoms in the elderly.

BACKGROUND: Sleep complaints and various sleep symptoms are common in elderly persons with cardiac diseases. Nightmares are associated with profound sleep disturbances. METHODS: The present questionnaire survey with questions on sleep symptoms, nightmares and cardiac symptoms comprised 6103 elderly subjects (39.5% men). RESULTS: Nightmares occurred rather often in 6.9% and very often in 2.1% of the men. The corresponding frequencies in women were 9.6 and 2.3%, respectively. Irregular heart beats were reported by 11.8% of the men and 131% of the women (NS). Spasmodic chest pain occurred in 12.9 and 10.6%, respectively (p < 0.01). Irregular heart beats increased in association with increasing nightmares in both men (p < 0.01) and women (p < 0.0001). The percentages of men and women with both irregular heart beats and spasmodic chest pain were three times and seven times higher, respectively, among those who had nightmares very often than among those who very seldom or never had nightmares. The increase in cardiac symptoms in nightmare sufferers was not attributable to an increase in medication with cardiac drugs. CONCLUSION: In this group of elderly men and women increased nightmares were associated with an increase in irregular heart beats and spasmodic chest pain.

Sleepiness and sleep in elderly subjects with hearing complaints.

The aim of this study was to evaluate the relation of hearing complaints to daytime sleepiness and sleep in a group of elderly men and women. A questionnaire survey was undertaken among 10,216 elderly subjects in northern Sweden. The mean (+/- S.D.) ages of the men and women were 73.0 +/- 6.0 and 72.6 +/- 6.7 years, respectively. Poor hearing was reported by 43.1% of the men and 22.8% of the women. The relative numbers with hearing complaints increased with age. Daytime sleepiness (DS) was reported by 32.9% of the men and 23.2% of the women. In a multiple logistic regression analysis significant independent correlates of daytime sleepiness in men were: hearing, good versus poor (odds ratio [OR] 1.5; confidence interval [CI] 1.2-1.8), health, good versus poor (3.3; 2.6-4.4), sleep, good versus poor (2.1; 1.6-2.8) and age, > or =80 years versus < 70 years (1.5; 1.1-2.1). The corresponding correlates in women were: hearing (1.4; 1.1-1.8), health (4.3; 3.4-5.4), sleep (2.2; 1.6-2.8) and age (1.6; 1.3-2.2). Thus, poor hearing was associated with increased daytime sleepiness independently of health, sleep status and age. Also subjects with hearing complaints more often slept poorly, woke up more often and had more difficulty in falling asleep after waking.

Sleepiness and sleep in elderly persons with tinnitus.

The aim of this study was to evaluate the relation of tinnitus to sleep and daytime sleepiness (DS) in a group of elderly men and women. A questionnaire survey was undertaken among 10,216 elderly subjects in northern Sweden. The mean (+/-s.d.) ages of the men and women were 73.0+/-6.0 and 72.6+/-6.7 years, respectively. Tinnitus was reported by 14.9% of the men and 12.0% of the women. The relative number with tinnitus was not related to age in men, but increased with age in women. Poor sleep was reported by 14.4% of the men and 27.9% of the women. Among subjects with tinnitus poor sleep and frequent waking were more common in both sexes, while difficulties in falling asleep after awakening at night were reported more often by women. DS was more common in subjects with tinnitus and the frequency was even more increased in those with both tinnitus and poor sleep. There was no further increase in DS in men and women on sleep medication. Thus, DS in elderly persons with tinnitus may due both to tiring effect of the annoying sound itself but also the negative effect by tinnitus on sleep.

Nightmares, cardiac symptoms and the menopause.

OBJECTIVE: To analyze the relationship between nightmares, some cardiac symptoms and the menopause in 40-64-year-old women. METHODS: A general health questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about the state of health, cardiac symptoms (irregular heart beat and spasmodic chest pain), sleep, nightmares, menstrual status and medication. RESULTS: Eighty-one per cent of the women reported a good night's sleep. Nightmares at least once weekly occurred in 10.4%. The prevalence of spasmodic chest pain and irregular heart beat increased with increasing number of nights a week disturbed by nightmares. The prevalence of spasmodic chest pain and irregular heart beat was increased after the menopause. In a multiple logistic regression analysis, independent correlates for spasmodic chest pain were: nightmares at least once a week versus more seldom or never (odds ratio (OR) 2.3; 95% confidence interval (CI) 1.2-4.5), sleep, poor versus good (OR 1.8; 95% CI 1.0-3.3) and postmenopausal state (OR 6.6; 95% CI 2.8-15.4). Independent correlates for irregular heart beat were: nightmares (OR 2.0; 95% CI 1.4-2.8) and poor sleep (OR 2.5; 95% CI 1.9-3.2), but not menopause. CONCLUSION: The occurrence of perceived spasmodic chest pain and of irregular heart beat is increased in 40-64-year-old women with frequent nightmares and poor sleep. The occurrence of spasmodic chest pain is further increased after the menopause.

Diuresis pattern, plasma vasopressin and blood pressure in healthy elderly persons with nocturia and nocturnal polyuria.

BACKGROUND: Nocturia, a common symptom in the elderly, is often caused by increased urine production at night. METHODS: The present study comprised 17 men and six women aged 68.1 +/- 4.7 (mean +/- SD) years with nocturia (> or = 2 nocturnal voids) and nocturnal polyuria (nocturnal urinary output of > or = 0.9 mL min(-1)). A physical examination, measurements of recumbent blood pressure after a 15-minute rest, plasma AVP assay at noon and midnight, and urine collection performed during a 24-hour period. RESULTS: The daytime urine output was 1358 +/- 664 mL, and the nocturnal urine output 796 +/- 312 mL. The AVP level was lower at midnight than at noon in 17 persons, and higher at midnight in six persons. Blood pressure was 142.0 +/- 15.7/87.4 +/- 9.1 mmHg. Systolic (but not diastolic) blood pressure increased with decreasing nocturnal plasma AVP. Increasing nocturnal diuresis rate (r2= 0.26; p < 0.01) but not plasma AVP was associated with increasing systolic blood pressure. CONCLUSION: In elderly persons with nocturia and nocturnal polyuria, the plasma AVP is low and does not rise nocturnally. The systolic blood pressure is increased with increasing diuresis but unaffected by plasma AVP.

Nocturia in relation to sleep, somatic diseases and medical treatment in the elderly.

OBJECTIVE: To assess the influence of somatic diseases, symptoms and medication on nocturnal micturition in an elderly population. SUBJECTS AND METHODS: All 10 216 members of the pensioners' association in two Swedish counties were asked to participate in a questionnaire survey. The questions concerned their general state of health, occurrence of somatic diseases and symptoms, number of voiding episodes per night, and the use of drugs. RESULTS: There were 6143 evaluable questionnaires, of which 39.5% were from men. The mean (sd) age of the men and women participating were 73.0 (6.0) and 72.6 (6.7) years, respectively. In a multivariate logistic model, significant independent correlates of having > or = 3 nocturnal voids (vs < or = 2 voids) were: being 70-79 years vs < 70 years (odds ratio, OR, 1.7, 95% confidence interval, CI, 1.3-2.2), being > or = 80 years old vs < 70 years (OR, 1.9, CI, 1.3-2.5) and poor sleep vs good sleep (OR, 2.6, CI, 2.1-3.2), sequelae after stroke (OR, 2.0, CI, 1.1-3.6), irregular heart beats (OR, 1.6, CI, 1.2-2.1) and diabetes (OR, 1.5, CI, 1.1-2.3). Sex, spasmodic chest pain and snoring were all deleted by the logistic model. CONCLUSION: Increasing age, poor sleep, irregular heart beats, diabetes and stroke are associated with an increase in nocturnal micturition in the elderly.

The development of sleep in persons undergoing cataract surgery.

This study was undertaken in order to analyse sleep in a group of patients who were operated on for cataract. All patients (n=328) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during a 4-month period were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 month after the operation. Twelve persons were unable or declined to participate. The response rate was 97.2%. The mean ages of the participating men and women were 74.5 and 76.3 years, respectively. Pre-operative visual acuity in the operated eye was 0.16 in men and 0.18 in women. After cataract extraction sleep was improved in 12.0% of the men and in 26.3% of the women. Nevertheless poor sleep 1 month post-operatively was reported by 29.3% of the men and 42.6% of the women (P<0.05). There was no age-related increase in sleep complaints. The results indicate that in elderly persons with cataract sleep is impaired, and that 1 month after cataract extraction improved sleep may be experienced.

Sleep complaints in women of ages 40-64 years in relation to sleep in their parents.

Objective: To study the occurrence of sleep complaints in women in relation to such complaints in their parents.Background: Sleep complaints are common and may be affected by many somatic, mental, and life-style and environmental factors.Methods: A cross-sectional questionnaire survey was undertaken among 3669 randomly selected women of ages 40-64 years. The women were asked about their own health and sleep and their recollection of the sleep of their parents.Results: The frequency of poor sleep was low among women reporting that neither parent had sleep disturbances. Sleep disturbances in the father, mother and both parents implied a 2.5 (95% confidence interval, 2.0-3.2), 2.5 (2.1-3.0) and 4.8-fold (3.4-6.8) increase in sleep complaints in the investigated women, respectively. The frequencies of numerous awakenings, difficulty in falling asleep again and too little sleep increased similarly. A series of logistic regression analyses revealed that all sleep characteristics were evaluated more negatively in women who reported sleep disturbances in their parents and also reported themselves to be in poor health. All sleep variables deteriorated with age. Because data regarding parent sleep was based on subjects' recall of that sleep, the results should be interpreted with some caution.Conclusions: The frequency of sleep complaints in women aged from 40 to 64 years was increased if sleep disturbances were reported in their parents.

Nocturia and health in women aged 40-64 years.

To analyse the relationship between nocturnal micturition and health in 40- to 64-year-old women. A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about the general health status of health, health development during the last 5 years, nocturnal micturition, parity, menstrual status, menopausal symptoms, hormone replacement therapy, cardiac diseases, diabetes and snoring. Poor health was reported by 10.4%. In 24.1% of the women health development had been unfavourable in the last 5 years. Poor health was reported by 4.7% of women without nocturnal micturition, and by 11.2, 20.1 and 39.0% (P<0.0001) of women with one, two, and three or more nocturnal voiding episodes, respectively. In a multiple logistic regression analysis significant independent correlates of health were: one versus no nocturnal micturitions (odds ratio [OR] 2.2; confidence interval [CI] 1.5-3.3), two versus none (OR 3.2; 1.9-5.3), and three or more versus none (OR 6.5; 3.5-11.9), spasmodic chest pain (OR 6.6; CI 3.0-14.5), irregular heart beats (OR 3.0; CI 2.1-4.3), diabetes (OR 5.1; CI 2.8-9.4), leg oedema> or =6 days/month versus <6 days/month (OR 23; CI 1.6-3.3), snoring: < or =3 times/week versus never (OR 1.4; CI 1.0-2.0), snoring 4-7 times/week versus never (OR 1.6; CI 1.1-2.2), being<5 years after versus being before the menopause (OR 1.6; 95% CI 1.0-2.5), 5-9 years after versus before the menopause (OR 1.7; CI 1.0-2.9), > or =10 years after versus before the menopause (OR 2.2; CI 1.3-3.7), diuretic treatment (OR 2.8; CI 1.7-4.6). The perceived state of health in 40- to 64- year-old women is profoundly affected by nocturia, independently of heart diseases, diabetes, snoring, age and menopausal status.