Aging Clinical and Experimental Research

Petit, Anne; Constans, Thierry; Chavanne, Dominique; Praline, Julien; Mondon, Karl; Hommet, Caroline

doi: 10.1007/BF03325271pmid: 23238315

Myasthenia gravis is not a frequent disease in the elderly. The diagnosis of this neuromuscular junction disease in the elderly is difficult because of comorbidities and the broad differential diagnosis. We report here the case of a 86-year-old woman referred to hospital for loss of weight and difficulties in feeding. She was cachectic and had been suffering from dysphagia for several weeks. One week later, her clinical state worsened with the appearance of ptosis and oropharyngeal dysfunction, disturbing eating and talking. Myasthenia gravis was suspected and confirmed by a positive acetylcholine receptor antibody titer. The clinical state of the patient unfortunately worsened, with acute respiratory insufficiency, causing death. Myasthenia gravis must be suspected in a context of dysphagia, swallowing difficulties and loss of weight. This diagnosis leads to specific and symptomatic treatment and allows neuromuscular blockade-inducing drugs to be avoided.

Tennant, Kathleen; Takacs, Steven; Gau, Jen-Tzer; Clark, Brian; Russ, David

doi: 10.3275/8054pmid: 22027409

Background and aims: The purpose of this study was to evaluate the prevalence of symptomatic fatigue and its relation to physical function and self-perceived health in a sample of older, rural community-dwelling adults with commonly-used clinical fatigue scales. Methods: This is an exploratory, descriptive study of 30 subjects from 4 rural counties. All subjects were 70+ years of age and had no recent history of hospitalization. Subjects were assessed in their homes and completed a standard test of physical function, twelve functional assessment instruments, and two commonly-used clinical fatigue scales: the Fatigue Severity Scale and the Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Results: Depending on the fatigue instrument and criteria used, 23–47% of subjects exhibited symptomatic fatigue. Regardless of the scale, fatigue was associated with several negative consequences: decreased physical function performance, lower morale, and reduced physical composite scores on the Short Form-36 quality of life questionnaire. Of note, these differences remained significant even after accounting for depression scale scores. In addition, fatigue was associated with a greater incidence of risk for malnutrition. Conclusions: Together, these findings suggest that symptomatic fatigue may be quite prevalent in older individuals in rural settings, and warrants further consideration when presented in the clinical setting, as it may be associated with several negative health outcomes.

Bonsdorff, Mikaela; Seitsamo, Jorma; Ilmarinen, Juhani; Nyg⇘rd, Clas-H⇘kan; Bonsdorff, Monika; Taina, Rantanen

doi: 10.3275/8107pmid: 22102525

Background and aims: Lower occupational class correlates with a higher disability risk later in life. However, it is not clear whether the demands made by mental and physical work relative to individual resources in midlife predict well-being in old age. This study investigated prospectively whether work ability in midlife predicts disability severity in activities of everyday living in old age. Methods: Data come from the population-based 28-year follow-up called Finnish Longitudinal Study of Municipal Employees. A total of 2879 occupationally active persons aged 44–58 years answered a questionnaire on work ability at baseline in 1981 and activities of daily living in 2009. At baseline, perceived work ability relative to lifetime best was categorized into excellent, moderate, and poor work ability. At follow-up, disability scales were constructed based on the severity and frequency of difficulties reported in self-care activities of daily living (ADL) and instrumental activities of daily living (IADL). Results: There was a graded prevalence of ADL and IADL disability severity, according to excellent, moderate and poor midlife work ability (p<0.001). Employees with moderate midlife work ability had an 11 to 20% higher mean ADL or IADL disability severity score, compared with those with excellent midlife work ability (reference), incidence rate ratios (IRR) ranging from 1.11 (95% CI 1.01–1.22) to 1.20 (95% CI 1.10–1.30). Those with poor midlife work ability had a mean ADL or IADL disability severity score 27 to 38% higher than the referent, IRRs ranging from 1.27 (95% CI 1.09–1.47) to 1.38 (95% CI 1.25–1.53). Adjusting for socio-economics, lifestyle factors and chronic diseases only slightly attenuated the associations. Conclusions: Work ability, an indicator of the demands made by mental and physical work relative to individuals’ mental and physical resources, predicted disability severity 28 years later among middle-aged municipal employees.

Weiss, Carlos; Boyd, Cynthia; Wolff, Jennifer; Leff, Bruce

doi: 10.1007/BF03325268pmid: 23238312

Background and aims: Potential treatment effect modifiers (TEMs) are specific diseases or conditions with a well-described mechanism for treatment effect modification. The prevalence of TEMs in older adults with type 2 diabetes mellitus (DM) is unknown. Objectives were to 1) determine the prevalence of pre-specified potential TEMs; 2) demonstrate the potential impact of TEMs in the older adult population using a simulated trial; 3) identify TEM combinations associated with number of hospitalizations to test construct validity. Methods: Data are from the nationally- representative United States National Health and Examination Survey, 1999–2004: 8646 Civilian, non-institutionalized adults aged 45–64 or 65+ years, including 1443 with DM. TEMs were anemia, congestive heart failure, liver inflammation, polypharmacy, renal insufficiency, cognitive impairment, dizziness, frequent mental distress, mobility difficulty, and visual impairment. A trial was simulated to examine prevalence of potential TEM impact. The cross-sectional association between TEM patterns and number of hospitalizations was estimated to assess construct validity. Results: The prevalence of TEMs was substantial such that 19.0% (95% CI 14.8–23.2) of middle-aged adults and 38.0% (95% CI 33.4–42.5) of older adults had any two. A simulated trial with modest levels of interaction suggested the prevalence of TEMs could nullify treatment benefit in 3.9–27.2% of older adults with DM. Compared to having DM alone, hospitalization rate was increased by several combinations of TEMs with substantial prevalence. Conclusions: We provide national benchmarks that can be used to evaluate TEM prevalence reported by clinical trials of DM, and correspondingly their external validity to older adults.

Bolignano, Davide; Mattace-Raso, Francesco; Torino, Claudia; D’Arrigo, Graziella; ElHafeez, Samar; Provenzano, Fabio; Zoccali, Carmine; Tripepi, Giovanni

doi: 10.1007/BF03325262pmid: 23238306

Making a prognosis is to predict the course of a disease and estimate the probability (or risk) of the appearance of a given outcome in relationship to clinical or non-clinical characteristics. Prognostic assessment is usually modelled by multivariable mathematic equations (prognostic models). In this article we describe what a prognostic model is, how to build a good one, why and how it is important to evaluate its generalizability and accuracy by means of discrimination, calibration and reclassification.

Kollén, Lena; Frändin, Kerstin; Möller, Margareta; Olsén, Monika; Möller, Claes

doi: 10.1007/BF03325263pmid: 23238307

Background and aims: Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis, possibly benign paroxysmal positional vertigo (BPPV). The diagnosis of BPPV is based on medical history and findings after the Dix-Hallpike test. It is sometimes difficult to perform the Dix-Hallpike test in elderly persons, due to the limited range of motion when extending the neck. In this study, we used a side-lying test to stimulate the posterior semicircular canal, while the head and neck were fully supported on the examination table. The aims of this study were to investigate the prevalence of dizziness and/or impaired balance and BPPV in a population of 75-year-olds by means of a questionnaire and clinical tests, and to compare elderly persons with and without BPPV. Methods: A representative population sample of 675 persons completed a questionnaire about dizziness and 571 persons underwent side-lying, static balance and dynamic walking tests. Results: Subjective dizziness and/or impaired balance were found in 36% of subjects, especially when walking outdoors. A significant gender difference was found, with a higher prevalence in women (40%) compared with men (30%) (p<0.01). BPPV was found in 11% and was significantly more common in women (p<0.01). Elderly individuals with BPPV also displayed significantly impaired balance in static and dynamic balance tests compared with persons without BPPV (p<0.01). Persons with BPPV reported significantly more subjective problems with dizziness and balance compared with persons without BPPV (p<0.001). Conclusions: Subjective and objective unsteadiness, dizziness and BPPV are common in the elderly.

Hoshi, Masayuki; Hozawa, Atsushi; Kuriyama, Shinichi; Nakaya, Naoki; Ohmori-Matsuda, Kaori; Sone, Toshimasa; Kakizaki, Masako; Niu, Kaijun; Fujita, Kazuki; Ueki, Shouzoh; Haga, Hiroshi; Nagatomi, Ryoichi; Tsuji, Ichiro

Uemura, Kazuki; Yamada, Minoru; Nagai, Koutatsu; Mori, Shuhei; Ichihashi, Noriaki

doi: 10.1007/BF03325267pmid: 23238311

Background and aims: For safe locomotion, visual attention must be directed toward not only the central visual field but also the peripheral visual field. This study explored the effect of stepping task on reaction time for the central and peripheral visual fields in young and older adults. Methods: Nine older (mean age 83.8±6.8 years) and 11 young adults (mean age 22.9±1.3 years) participated in this study. Reaction times to press a handheld button in response to stimuli for the central and peripheral visual fields were measured in static standing and stepping task conditions. Results: Vision angle and condition were significantly associated with reaction time in the older group (p=0.006), while reaction time in the young group was affected by vision angle only. Reaction times for visual stimulus at a 45° vision angle were significantly longer in the older group in stepping task conditions than in static standing conditions. Conclusions: Effective visual field may diminish during lightly loaded exercise in older adults.

Catalano, Antonino; Basile, Giorgio; Lasco, Antonino

doi: 10.1007/BF03325272pmid: 23238316

Heart failure, a common condition affecting older patients, is associated with increased hospitalization and mortality rates among geriatric patients. We describe the case of an 86-year-old woman with moderate renal failure, who presented pulmonary edema and severe myocardial dysfunction due to hypocalcemia. Renal failure, but also the combination of additional factors, may have contributed to hypocalcemia, including vitamin D deficiency, loop diuretics and glucocorticoid therapy — which alone can give rise to sodium retention and calciuresis, and worsens hypocalcemia. Although in animal experiments hypocalcemia has been shown to lead to cardiac decompensation, heart failure from hypocalcemia is quite rare in clinical practice. Calcium plays a key role in cardiac muscle contraction and metabolism. It is recommended that physicians check serum calcium levels in the elderly, as hypocalcemia is a reversible cause of heart failure.

Pedraza, Sandra; Snih, Soham; Ottenbacher, Kenneth; Markides, Kyriakos; Raji, Mukaila

doi: 10.3275/8106pmid: 22102513

Background and aims: Sleep complaints and poor sleep quality are common in the elderly population. The aim of this study was to determine factors associated with sleep complaints and poor sleep quality among older Mexican Americans over a 3-year period. Methods: One thousand eighty-five non-institutionalized Mexican American aged 75 years and older. Sociodemographic characteristics, medical conditions, depressive symptoms, disability cognitive impairment, body mass index, sleep problems (trouble falling asleep, waking up several times per night, trouble staying asleep and awaking not rested) and overall sleep quality were obtained. Results: Of 1085 participants, 12.6% reported trouble falling asleep, 30% waking up several times per night, 11.4 % trouble staying asleep, 9.4% awaking not rested and 16.6% poor sleep quality. Depressive symptoms and heart attack predicted trouble falling asleep; diabetes, cancer and obesity predicted waking up several times per night; diabetes, hypertension, cancer and depressive symptoms predicted both trouble staying asleep and awaking not rested. Being female, married, heart attack and depressive symptoms were associated with poor quality sleep. Conclusions: Different risk factors were associated with different aspects of sleep complaints. Since poor sleep has been linked to poor outcomes, a good understanding of these factors may help in designing interventions to improve sleep quality in this population.