Inappropriate drug prescribing in home-dwelling, elderly patients: a population-based survey.

Background: In 1997, a US expert panel developed explicit criteria on potentially inappropriate drugs for the general elderly population.

Objective: To investigate the proportion of inappropriate medications among home-dwelling, elderly patients in Helsinki, Finland, between November 1, 1998, and March 31, 1999.

Methods: A cross-sectional mail survey was sent to a random sample of 3921 elderly urban residents aged 75, 80, 85, 90, and 95 years.

Activity level and balance in subjects with mild Alzheimer's disease.

To clarify if Alzheimer's disease has an impact on activity level and postural control, we examined 17 elderly diagnosed with mild Alzheimer's disease (MMSE scores 21-29) and 18 age- and gender-matched healthy controls (MMSE scores 27-30) using the Frenchay Activities Index, Bergs Balance Scale, Timed Up & Go and Walking in a Figure of Eight. Mild AD subjects were less active and had lower scores on Bergs Balance Scale, performed Timed Up & Go in longer time and took more steps outside the Figure of Eight, as compared to healthy elderly. This study shows that motor performance is affected already at mild stages of Alzheimer's disease and also that functional performance other than gait may also be impaired.

Isolated diastolic hypertension, pulse pressure, and mean arterial pressure as predictors of mortality during a follow-up of up to 32 years.

Objective: To compare mortality associated with various blood pressure components in middle-aged men during up to 32 years of follow-up.

Design: A prospective cohort study.

Setting: Helsinki, Finland.

Clinical utility of the Canadian Occupational Performance Measure--Swedish version.

The Canadian Occupational Performance Measure (COPM) is an individualised outcome measure intended to detect change in a client's perception of occupational performance over time. The aim of this study was to test the clinical utility of the Swedish version of the COPM. Data was collected from 27 occupational therapists in six focus groups.

Multifactorial cardiovascular disease prevention in patients aged 75 years and older: A randomized controlled trial: Drugs and Evidence Based Medicine in the Elderly (DEBATE) Study.

Background: The number of patients aged 75+ years with cardiovascular diseases (CVD) is increasing, but few studies of secondary prevention in this age group exist. The aim of the Drug and Evidence Based Medicine in the Elderly (DEBATE) study is to test the applicability and effectiveness of established CVD treatments in elderly patients.

Methods: From 1998 to 2000, population-based postal surveys were performed in Helsinki, Finland, including the age groups 75, 80, 85, 90, and 95 years (n = 4821).

Use of cardiovascular drugs by home-dwelling coronary patients aged 75 years and older. A population-based cross-sectional survey in Helsinki, Finland.

Objective: Elderly individuals constitute an increasing proportion of coronary patients, and up-to-date information is needed of their treatments in the community.

Methods: A random sample of 75-, 80-, 85-, 90- and 95-year-old residents (n = 3,921) of Helsinki, Finland, was studied during 1998-1999. They were sent a postal questionnaire with questions about health, diseases and current drug use.

Secular trends in self-reported functioning, need for assistance and attitudes towards life: 10-year differences of three older cohorts.

Objectives: To compare the self-reported functional status of cohorts, born 10 years apart, when they were at equivalent ages: 75, 80, or 85.

Design: Cross-sectional mailed survey of three birth cohorts in 1989 and 1999.

Participants: Random samples of older home-dwelling residents from birth cohorts 1904, 1909, and 1914 in 1989 ( N = 685) and the birth cohorts 1914, 1919, and 1924 in 1999 ( N = 2,047) were asked the same questions.

Is it possible to reduce polypharmacy in the elderly? A randomised, controlled trial.

Objective: The present trial was originally designed to investigate the effectiveness of comprehensive day hospital care in chronically ill elderly patients. Another aim, reported here, was to investigate to what extent it is possible to reduce polypharmacy and simplify drug regimens during the short term tight control conditions of day hospital care.

Patients: All home care patients (n = 174, mean age 77 years) in a rural area, Kirkkonummi-Siuntio, in Finland.

Bone mineral density and body composition in underweight and normal elderly subjects.

The importance of malnutrition as a risk factor in osteoporosis is emphasized by the evidence that patients with fractures of the proximal femur are often undernourished. In this study, nutritional status, bone mineral mass and its association with body composition were investigated in underweight and normal weight elderly subjects. Moreover the hypothesis that malnutrition in elderly is associated with a higher risk of osteoporosis was tested.

A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients.

Objective: to prove the effectiveness of geriatric evaluation and management for elderly, hospitalized patients, combined with post-discharge home intervention by an interdisciplinary team.

Design: randomized controlled trial with outcome and costs assessed for 12 months after the date of admission.

Setting: university-affiliated geriatric hospital and the homes of elderly patients.

Participation in a diabetes education and care program: experience from the diabetes care for older adults project.

There is very little reported information concerning the participation of older adults in diabetes education and care programs, factors related to their attendance, and the influence of attendance on program outcomes. In this study, which was part of a larger study of insulin therapy, subjects (> or = 65 years old) assigned to the intensive management group (n = 53) were provided with educational sessions during the 18-month study period. Data for this group were examined to determine factors that influenced enrollment and attendance.

A 12-month, randomized, placebo-controlled trial of propentofylline (HWA 285) in patients with dementia according to DSM III-R. The European Propentofylline Study Group.

Alzheimer's disease (AD) and vascular dementia (VaD) share several features such as overactivation of microglial cells, damage induced by free radicals, glutamate and calcium overload. Propentofylline (HWA 285) has shown beneficial effects on all of these common elements, thus favouring its use in both subtypes of dementia. In a multinational, randomized, 12-month, double-blind, parallel-group study 260 out-patients with mild to moderate AD or VaD received 300 mg propentofylline (n = 129) or placebo (n = 131) three times daily 1 h before meals.

Laboratory values, symptoms and survival in an 80-year-old population.

Medical, psychological and sociological factors were related to laboratory values in an 80-year-old population encompassing 211 persons. 21% of the men and 17% of the women had elevated ESR. 36% had elevated blood glucose (7% had diabetes).

Fibrinolytic treatment with ultra-high streptokinase infusion via the dorsalis pedis vein offers no advantage over systemic infusion via the brachial vein in patients with deep vein thrombosis of the leg.

The present study into the fibrinolytic therapy of deep vein thrombosis (DVT) considers whether streptokinase infusion into the dorsalis pedis vein of the affected leg (ipsipedal infusion) yields higher lysis rates than systemic infusion via the brachial vein (systemic infusion). In both cases the dosage regimen selected was a short-term ultra-high streptokinase (UHSK) infusion of 1.5 million IUSK/hour over a period of 6 hours (total SK dose: 9 million IU).

Medical, psychological, and sociological aspects of drug treatment in 80-year-olds.

The use of drugs was related to medical, psychological, and sociological parameters in an 80-year-old population. Use of drugs on the whole, as well as the use of specific drug categories such as digitalis, diuretics, other cardiovascular drugs, hypnotics, sedatives, analgesics and laxatives were related to an impaired quality of life. However, the use of vitamins and herbal pills was not related to an impaired quality of life.

Depression in stroke patients with left and right hemisphere lesions. A study in geriatric rehabilitation in-patients.

To analyze possible differences in depression rate and symptomatology in stroke patients with left and right hemisphere lesions, ninety-three patients in geriatric rehabilitation wards with a mean age of 76 years were studied. A clinical psychiatric examination was used together with two depression rating scales. Depression prevalence was 46%, and there was no difference between left and right hemisphere lesions.

Improvement of oral mucosa with mucin containing artificial saliva in geriatric patients.

In elderly individuals the saliva production is often decreased, leading to dry mucosal membranes and predisposition to local infections, as well as other oral problems. Eighty-five hospitalized geriatric patients, with a multitude of disabling diseases, participated in a double blind placebo-controlled study when mucin-containing artificial saliva and a placebo liquid was given. In the patients treated with the artificial saliva a considerable improvement in the condition of oral mucosa was seen.

Safety and effectiveness of low-dose clozapine in psychogeriatric patients: a preliminary study.

The short- and long-term treatment tolerance of low-dose clozapine was retrospectively investigated in 18 psychogeriatric patients. Discontinued use of the drug because of side effects or inefficiency was required for only four patients. In the long-term treatment group leukopenia was not observed, and disturbances of liver function appeared to be very infrequent.

Inverse correlation between essential antioxidants in plasma and subsequent risk to develop cancer, ischemic heart disease and stroke respectively: 12-year follow-up of the Prospective Basel Study.

There is accumulating evidence that free radicals may contribute to various diseases such as cancer or cardiovascular disease. Possible health hazards can to some extent be prevented by the body's multilevel defense system against free radicals, which comprises, besides others, antioxidant vitamins. The 12-year mortality follow-up of 2,974 participants of the Basal Study allowed to test the hypothesis that low antioxidant vitamin plasma concentrations (vitamin A, C, E and carotene) were associated with increased death from cancer of various sites and death from atherosclerosis such as ischemic heart disease and stroke, respectively.

Plasma antioxidant vitamins and subsequent cancer mortality in the 12-year follow-up of the prospective Basel Study.

Plasma antioxidant vitamins A, C, and E and carotene were measured in a group of 2,974 men participating in the third examination of the prospective Basel Study in 1971-1973. In 1985, the vital status and mortality of all participants were assessed. A total of 204 men had died from cancer, including 68 with bronchus cancer and 37 with gastrointestinal cancer (20 with stomach cancer and 17 with large bowel cancer excluding cancer of the rectum).

Pharmacokinetics of alprazolam in geriatric patients with neurotic depression.

The pharmacokinetics of alprazolam was studied in 10 geriatric patients (5 males, 5 females) with neurotic depression during a 6-week period. After 0.5 mg of alprazolam on Day 1 the mean elimination half-life was 11.

Beta-carotene and cancer prevention: the Basel Study.

In 1971-1973 at the third examination of the Basel Study started in 1959, the major antioxidant vitamins and carotene were measured in the plasma of 2974 men. A subsample and their families were reinvestigated in 1977-79. During the 12-y observation period (1973-85) 553 men died, 204 of cancer (lung cancer 68, stomach cancer 20; colon cancer 17, all other malignancies 99).

Differential inhibition of thromboxane A2 and prostacyclin synthesis by low dose acetylsalicylic acid in atherosclerotic patients.

Differential inhibition of thromboxane A2 (TxA2) and prostacyclin (PGI2) biosynthesis has an antithrombotic potential, since it may change the TxA2/PGI2 formation ratio in a favourable direction. Very low doses of acetylsalicylic acid (ASA) have been demonstrated to elicit differential inhibition of TxA2 and PGI2 formation in healthy subjects; whether a similar effect can be obtained in patients with atherosclerosis is still an open question. We addressed this by analyzing the urinary excretion of the 2,3-dinor-metabolites of TxA2 (Tx-M) and PGI2 (PGI-M) in 10 patients with severe atherosclerosis during 10 consecutive days.