Electrocardiogram, clinical findings and chest x-ray in persons aged 85 years or older

Persons aged 85 years or more (n = 674) living in Tampere, Finland, were surveyed in 1977 and 1978. Five hundred fifty-nine persons (83%) were examined. Electrocardiographic findings, classified according to the Minnesota code, were compared with reported cardiac symptoms, clinical congestive heart failure, clinical coronary heart disease and relative cardiac volume on chest radiograph. Electrocardiographic items had a poor association with cardiac symptoms. ST-segment depression, T-wave inversion, ventricular premature complexes and atrial fibrillation were related statistically highly significantly to clinical congestive heart failure, as were ST-segment depression and T-wave inversion to clinical coronary heart disease. High left R waves, ventricular premature complexes and atrial fibrillation showed a significant association with cardiac enlargement (over 500 ml/m2) and pulmonary congestion in chest radiographs.     

Causes of death in sickle cell disease: an autopsy study

More precise analysis of causes of death is needed to focus research efforts and improve morbidity and mortality in sickle cell disease. In this study, the morphological evidence of the cause of death was studied in 306 autopsies of sickle cell disease, which were accrued between 1929 and 1996. The most common cause of death for all sickle variants and for all age groups was infection (33-48%). The terminal infection was heralded by upper respiratory tract syndromes in 72.6% and by gastroenteritis in 13.7%. The most frequent portal of entry in children was the respiratory tract but, in adults, a site of severe chronic organ injury. Other causes of death included stroke 9.8%, therapy complications 7.0%, splenic sequestration 6.6%, pulmonary emboli/thrombi 4.9%, renal failure 4.1%, pulmonary hypertension 2.9%, hepatic failure 0.8%, massive haemolysis/red cell aplasia 0.4% and left ventricular failure 0.4%. Death was frequently sudden and unexpected (40.8%) or occurred within 24 h after presentation (28.4%), and was usually associated with acute events (63.3%). This study shows that the first 24 h after presentation for medical care is an especially perilous time for patients with sickle cell disease and an acute event. Close monitoring and prompt aggressive treatment are warranted.     

Pulmonary pathology in patients with AIDS: an autopsy study from Mumbai

Objective Although India has a high prevalence of HIV/AIDS, the associated pathologies responsible for morbidity have not been evaluated previously in a representative study. Hence, an autopsy study was carried out to analyse the spectrum of pulmonary lesions in patients with HIV/AIDS. Methods A retrospective and prospective autopsy study was carried out during 1988–2000 at Mumbai, India. Lungs from 143 adults, with at least 10 sections from each case, were examined using routine and special stains. Results The risk factors for 97 men (68%) and 38 women (27%) included: heterosexual sex with multiple partners (135 cases, 95%); blood transfusions (three cases; 2%); sex between men (two cases; 1%); and unknown risk factors (three cases, 2%). Pulmonary pathology was observed in 126 (88%) cases. The lesions identified were tuberculosis (85 cases, 59%), bacterial pneumonia (26 cases, 18%), cytomegalovirus (CMV) infection (10 cases, 7%), cryptococcosis (eight cases, 6%), Pneumocystis carinii pneumonia (seven cases, 5%), aspergillosis (four cases, 3%), toxoplasmosis (two cases, 1%), Kaposi's sarcoma (one case, 1%), squamous cell carcinoma (one case, 1%). Two or more infections were observed in 18 (13%) cases. Conclusions Pulmonary diseases and risk factors among patients with AIDS in India differ from those reported in industrialized countries. Tuberculosis was the most frequently observed pulmonary infection, followed by bacterial pneumonia and CMV pneumonitis. In contrast with industrialized countries, PCP remains less common in our patients. The information on opportunistic infections obtained in this study will be useful for managing HIV/AIDS cases at district level hospitals where diagnosing specific HIV‐associated diseases is not always possible.     

Factors associated with successful aging in persons aged 65 to 75 years

BackgroundWe aimed to identify, among persons aged 65 to 75 years, those presenting successful aging defined with health-related quality of life, and to identify factors associated with successful aging.MethodsThe study design was a cross-sectional study based on healthcare data from 2005, from a representative sample of the French population. Our study population was comprised of subjects aged 65 to75 who completed the Duke Health Profile (DHP). The outcome was successful ageing as defined by a score on the general health dimension of the DHP above the 75th percentile according to sex. Logistic regression was used to investigate the association between successful aging and socio-demographic, psychosocial, physical and behavioural factors.ResultsIn total, 2160 were included in this analysis, average age was 70.1 ± 3.0 years. Overall, 645 (29.9%) presented good quality of life as assessed by the general health dimension, and thereby qualified as successful aging. By multivariable analysis, lower weight (OR = 2.75), regular physical activity (OR = 1.44), and the fact of having religious beliefs (OR = 1.36) were positively associated with successful aging. Conversely, psychological distress, comorbidities, and obesity negatively influenced aging. Social support, smoking status and marital status were not.ConclusionThis study, from a representative sample of the French population, found similar variables related to successful aging as in other studies. Physical and psychological well-being, regular exercise and nutritional status are major determinants of successful aging. It is thus vitally important that healthcare policies and programmes emphasise these elements in order to promote healthy and successful aging.     

Coronary events in persons aged 75 years or older in Finland from 1995 to 2002: the FINAMI study

The authors used population-based myocardial infarction (MI) register data to examine trends in incidence, case fatality, treatment strategies of MI, and coronary heart disease (CHD) mortality in persons aged 75 to 99 years in 4 areas of Finland during 1995 through 2002. This age group contributed 53% (n=13,977) of all CHD events, and 65% occurred in women. CHD mortality declined among men annually by 3.5% and 1.0% in the 75- to 84-year-old and 85- to 99-year-old age groups, respectively. Among women, it declined by 2.2% per year in the 75- to 84-year-old age group but increased by 1.3% per year in the 85- to 99-year-old age group. MI attack rate did not change in men but increased significantly in women aged 85 to 99 years. Clinical management of MI in elderly patients was more conservative than in middle-aged patients. In conclusion, one-half of all CHD events occur among persons aged 75 years or older, and elderly patients with CHD represent an increasing burden to the health care system.     

Cause of death in older patients with anatomo-pathological evidence of chronic bronchitis or emphysema: a case-control study based on autopsy findings

OBJECTIVES: To determine the most frequent causes of death of hospitalized older patients based on anatomo-pathological evidence and to compare the relative frequency of fatal events between patients with and without evidence of either chronic bronchitis (CB) or emphysema (E). DESIGN: Retrospective, case-control study based on a computerized database including anatomo-pathological data of patients deceased and autopsied over a 25-year period. SETTING: Two geriatric hospitals in Geneva. PARTICIPANTS: Not applicable. MEASUREMENTS: Autopsy records for cause(s) of death in patients with CB or E. RESULTS: 3,685 patients deceased in our institution (1,540 men; 2,145 women) were autopsied between 1972 and 1996; mean age at death was 81.5 +/- 8.0 years. Anatomo-pathological evidence of CB or E was found in 983 patients (26.6% of total); 262 (7.2%) had predominantly CB, and 456 (12.3%) predominantly E. Pneumonia was the most frequent cause of death in all patients (21.8%). Myocardial infarction (MI) (17.6% vs 14%), and respiratory failure (5.1% vs 1.5%) occurred more frequently in subjects with CB and/or E than in controls. Fatal pulmonary embolism (PE) was more frequent in patients with E (18.4%) than in patients with CB (10.7%; odds ratio ( OR) = 1.89, P =.008), or in controls (12.7%; OR = 1.56, P =.0008). CONCLUSION: Anatomo-pathological evidence of CB or E is highly prevalent in older patients, suggesting that CB and E are clinically underdiagnosed in this age group. Fatal MI occurred significantly more frequently in older patients with E or CB than in controls. Furthermore, patients with E were at significantly higher risk of fatal PE than patients with CB or controls.     

Analysis of deaths with an unknown cause in epidemiologic analyses of mortality burden

OBJECTIVE: To describe options for analysing deaths with an unknown cause, which often occur in community-based studies that are used to estimate disease-specific mortality burden and trends in low-income countries. METHODS: Mathematical formulae were derived that accommodate deaths with an unknown cause for the disease-specific mortality rate, proportion of deaths attributable to the disease and all-cause mortality rate. Seven specific options are presented, including example calculations from a study of childhood malaria mortality in The Gambia. An algorithm is proposed to help make decisions on analysing deaths with an unknown cause. RESULTS: In the Gambian study, 25.2% of deaths had an unknown cause. Three options would result in 23.6% (minimum), 48.8% (maximum) and 28.7% (probably the best estimate) of deaths attributed to malaria. The best analysis option depends on the disease of interest: diseases for which the diagnostic method has high sensitivity and specificity (e.g., measles, neonatal tetanus) are best analysed assuming that deaths with an unknown cause never have this cause, while diseases for which specificity and/or sensitivity is low (e.g., malaria) are likely to account for some proportion of deaths with an unknown cause. CONCLUSIONS: The most important aspects of analysing deaths with unknown cause are choosing appropriate assumptions, describing them explicitly and performing a sensitivity analysis. Studies of causes of death should report several key pieces of information on deaths with unknown cause to aid interpretation.     

老年糖尿病死亡病例分析

目的了解老年糖尿病（DM）住院患者的死亡原因及其死亡危险因素。方法以预设表格方式对哈尔滨医科大学附属第二医院老年病房1993年1月1日至2006年12月31日期间住院的老年DM死亡病例进行回顾性调查。结果①老年DM住院患者死亡86例，占全部死亡病例的20．98％，其中以心血管疾病（33．72％）、脑血管疾病（17．44％）、呼吸系统疾病（13.95％）为前3位最主要死因。②在DM与非DM组的比较中，心血管疾病、脑血管疾病、呼吸系统疾病和泌尿系统疾病较非DM组显著增多，肿瘤患者在非DM组明显增多。③DM病程对高血压、心肌梗死、糖尿病肾病（DN）、脑梗死有显著影响。结论DM是增加老年心血管疾病、脑血管疾病、呼吸系统疾病、泌尿系统疾病的发生率和死亡率的一个重要因素。DM的病程增加也大大增加了高血压、心肌梗死、DN、脑梗死的发生率，从而显著增加了老年人的死亡风险。     

Comparison of prognosis and safety of pacemaker implantation in patients aged less than or 85 years and older

Journal of Interventional Cardiac Electrophysiology - Cardiac conduction disturbance necessitating pacemaker implantation is common among elderly patients. However, patients often have...     

Treatment of hypertension in patients 85 years of age or older: a J-BRAVE substudy

Whether the strict control of blood pressure (BP) of patients with hypertension who are aged 85 years or older is beneficial is unclear. The Japan's Benidipine Research on Antihypertensive Effects in the Elderly study is a prospective, observational 3-year study to evaluate the safety and effectiveness of treatment with a calcium channel blocker benidipine in 8897 hypertensive patients aged 65 years or older as a post-marketing surveillance. We examined the relationship between the achieved BP and cardiovascular events (i.e., stroke, myocardial infarction, and heart failure) in a subgroup of 415 patients aged 85 years or older (mean age 88 years). BP decreased significantly from 165 ± 14/84 ± 10 mmHg to 130 ± 11/71 ± 10 mmHg during treatment in patients with a treated systolic BP (SBP) < 140 mmHg (n = 230) and BP decreased significantly from 169 ± 16/86 ± 12 mmHg to 143 ± 13/75 ± 10 mmHg in those with a treated SBP ≥ 140 mmHg (n = 185). There was a nonsignificant trend toward a lower rate of cardiovascular events and higher rate of total death in patients with a treated SBP < 140 mmHg. On-treatment SBP ≥ 160 mmHg is tended to associate with a higher incidence of cardiovascular events. There was no significant difference in the incidence of adverse reactions between the controlled BP group (3.04%) and the less well controlled BP group (3.24%). In conclusion, although this study was not powered for definitive conclusion, there was a nonsignificant trend toward a lower rate of cardiovascular events and higher total death in patients aged 85 years or older with a treated SBP < 140 mmHg.     

Use of the frailty index in evaluating the prognosis of older people in Beijing: A cohort study with an 8-year follow-up

ObjectiveFrailty is a significant healthcare challenge in China. However, the relationship between frailty and the prognosis of older people in China remains unclear. The present study aimed to evaluate the prevalence of frailty and determine if the frailty index, a comprehensive geriatric assessment, was associated with the prognosis of older people in a Chinese population.MethodsData were drawn from the Beijing Longitudinal Study of Aging, a representative cohort study with an 8-year follow-up. Evaluations based on the use of the frailty index were performed in a cohort of 1808 people aged 60 years and over residing in Beijing urban and rural areas. The initial survey was conducted in 2004, with follow-up surveys at 3, 5, and 8 years. Mortality data for all individuals were collected and analyzed.ResultsThe frailty index and the age of individuals showed the same trend, with a higher frailty index expected as age increased. Respondents with the same frailty index level differed across factors such as sex and location. Male individuals, rural dwellers, and older individuals showed higher frailty rates than female individuals, urban dwellers, and younger individuals.ConclusionsFrailty is a condition associated with problems across multiple physiological systems. The frailty index increases with age, and may be a significant tool for evaluation of the prognosis of older people in China.     

Causes of sudden cardiac death according to age and sex in persons aged 1–49 years

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Partial atrioventricular canal defect in elderly patients (aged 60 years or older)

Partial atrioventricular canal defect in elderly patients (aged 60 years or older) is extremely rare, and surgical results in this select group have not been reported. This report describes in detail the clinical profile of six such patients and the surgical results in four of the six. There was no operative mortality. This experience, albeit based on small numbers, suggests that operation can be performed at low risk with gratifying symptomatic improvement and that surgical repair in symptomatic elderly patients with partial atrioventricular canal detect can be justified.     

Cancer in the aged: an autopsy study of 940 cancer patients.

In an autopsy study of 940 elderly cancer patients, 1,030 cancers were identified. The prevalence rate for overall cancer declined after age 85 in men and after age 75 in women. The chief sites of major cancers were the stomach, lung, esophagus, liver, and pancreas, in that order. Incidental cancers (chiefly of the prostate, thyroid, and colon) were found more often in patients over 80 years old. For multiple primary cancers, the prevalence rate was relatively constant until the age of 70, when it rose to a peak in the 80--84 age group before declining to the original level.