Mortality trends of elderly people in Taiwan from 1974 to 1994.

BACKGROUND: the hypothesis that disability and death will eventually be compressed to a period late in life needs empirical confirmation. OBJECTIVES: we have examined the secular trends of life expectancy and common causes of death in the aged population of Taiwan. METHOD: we compared the life expectancy, causes of death and probability of death for people at birth, at age 65 and at age 85 for both sexes from 1974 to 1994 using data from Taiwan government statistics. RESULTS: there has been a substantial gain in life expectancy, especially for men age 85 and over, in the past 20 years. .Mortality due to stroke, ischaemic heart disease, hypertension and chronic pulmonary disease has declined. There has been a steep increase in cancer deaths and deaths associated with diabetes mellitus. Tuberculosis and injury-related deaths have declined but pneumonia deaths have increased. For elderly people, the probability of dying from cancer and ischaemic heart disease increased with time. However, the probability of dying from stroke decreased. Although there was a decrease in probability of deaths associated with falls, there was an increase of deaths due to 'frailty' (as judged by falls, pneumonia and septicaemia). CONCLUSIONS: cancer is a major cause of death in the elderly population of Taiwan. This rapidly expanding elderly population seemed to suffer from poorer health in the later period of their life.     

Syncope in the elderly: new trends in diagnostic approach and nonpharmacologic management

Syncope in the elderly is an important health care issue because of the large patient population, challenging diagnostic and therapeutic approaches, and potentially devastating consequences. Significant comorbidity and atypical clinical presentations render a precise determination of the cause of syncope difficult. Recent studies suggest that noninvasive tests, such as carotid sinus massage or tilt-table testing, can be helpful in the diagnostic workup. It has been shown that permanent pacemaker therapy benefits elderly patients with carotid sinus hypersensitivity, and younger patients with recurrent vasovagal syncope. The implantable wireless loop recorder can be effective in documenting transient arrhythmias as causes of syncope in selected patients. Elderly patients with syncope and a low ejection fraction are at increased risk of sudden death due to malignant ventricular arrhythmia. Electrophysiologic study and electrophysiology-guided therapy should be considered in this segment of the population.     

Hypertension in the elderly: treatment

Hypertension in the elderly is a common problem confronting the practitioner today. The rationale for treating hypertensive elderly patients is presented in this article. Guidelines for the use of specific agents for the treatment of older patients are also discussed.     

Hypertension magnitude and management in the elderly population of Spain

OBJECTIVE: The present study assessed the prevalence, awareness, treatment and control of hypertension among the elderly population of Spain. DESIGN: Based on a nationally representative sample of 4009 individuals aged 60 years, two sets of six blood pressure measurements were obtained by trained observers at each subject's home, using standardized methods. In each set, three mercury-based measurements were alternated with three automated measurements. RESULTS: The mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was 143/79 mmHg, and the pulse pressure was 64 mmHg. The prevalence rate of hypertension (SBP 140 mmHg, DBP 90 mmHg, or current drug treatment) was 68.3%. No result obtained was sensitive to a particular measurement device. Of the hypertensives, 65% were aware of their condition, 55.3% were treated and 16.3% were controlled. Among treated hypertensives, SBP control (32.2%) was much lower than DBP control (82.3%). Control was lower in men than in women, in older than in younger subjects, and in those with lowest than in those with higher educational levels. About 57% of uncontrolled treated hypertensives were on monotherapy. Weight loss was among the least heeded items of advice (39% among overweight hypertensives). CONCLUSIONS: Hypertension is a major public health problem in elderly Spaniards. Most hypertensives had their hypertension uncontrolled. Greater emphasis should be laid on the most disadvantaged (the older, men, and those with lowest education) in terms of hypertension management, and on reinforcing weight loss and combining drugs for enhanced hypertension control.     

Appropriate drug prescribing in the elderly

PURPOSE: The frequency of chronic illness and the expenditure of medications increase with the older age. If drug-prescribing is very often beneficial for the patients, elderly subjects are particularly exposed to the side-effects of medications, and to their consequences. Although the age in itself do not generally forbid a medication, it can modify some of the objectives and the modality of the treatment. CURRENT KNOWLEDGE AND KEY POINTS: Four main factors explain the growing frequency of the iatrogenic pathology in the old age: polymedication, pharmacological modifications that occur with the ageing process, lack of coordination between different prescribers, and physical and psycho-social deficiencies which are the keys for identifying the "frail elderlies". FUTURE PROSPECTS AND PROJECTS: In regard to the frequent polypathological conditions of the oldest patients, one does not have to consider a sum of sicknesses, but a global situation, and one needs to replace a condition in a general context, and to establish priorities in the goals of the treatment. Appropriate drug-prescribing also needs to take account of the latest medical recommendations concerning numbers of medications, and a more frequent involving of elderly subjects in clinical trials.     

Hypertension in the elderly

Current data indicate that most patients over age 60 with systolic blood pressure greater than 160 mm Hg and diastolic blood pressure greater than 90 mm Hg should be treated. The current data support the use of a thiazide and potassium-sparing diuretic with the addition of a centrally acting antiadrenergic drug as needed to reduce the blood pressure to less than 160/90 mm Hg. This will reduce the morbidity and mortality, especially cerebrovascular events, severe congestive heart failure, development of severe or accelerated hypertension, nonfatal myocardial infarction, and sudden death. Those unable to take these medications or who do not have satisfactory reduction in blood pressure should have other antihypertensive drugs added or substituted to lower blood pressure to less than 160/90 mm Hg.     

Hypertension in the elderly

The decade of the 1990s has clarified the perspective on treating hypertension in the elderly and provided a wealth of evidence to assist in the treatment of elevated blood pressure in older persons. Despite this wealth of information, important questions remain about treatment of hypertension in the elderly.     

Hypertension in the elderly

High blood pressure, once believed to represent a normal and progressive component of the aging process, is now recognized as a manifestation of structural and physiologic abnormalities of aortic function. Elevated systolic blood pressure and increased pulse pressure unquestionably increase the risk of both fatal and nonfatal cardiovascular events, including stroke, myocardial infarction, and heart failure. Isolated systolic hypertension, defined as a systolic blood pressure ≥ 140 mm Hg with a diastolic blood pressure < 90 mm Hg, affects most individuals aged 60 years and older. Several clinical trials have clearly demonstrated that treatment of hypertension significantly reduces the cardiovascular event rate. However, controversy continues as to the choice of antihypertensive agents and combinations of agents. It is both appropriate and necessary to treat elderly hypertensives aggressively to the same target blood pressures identified for younger patients. It is also appropriate to initiate treatment with lower doses of antihypertensive agents and to bring the pressure down more slowly, monitoring for orthostatic hypotension, impaired cognition, and electrolyte abnormalities.