Self-rated health and survival: a 7-year follow-up study of Australian elderly

OBJECTIVES

This study tested the hypothesis, from North American findings, that global self-ratings of health predict survival for older Australians.

METHODS

A stratified sample of Australians 60 years of age and older surveyed in 1981 was resurveyed in 1988. Cox proportional hazard general linear models were constructed separately for men and women to predict survival over 7 years.

RESULTS

Better self-ratings of health had an incremental association with survival for women, but only men with poor ratings had significantly worse survival than others. After major illnesses, comorbidities, disability, depression, and social support were controlled for, poor ratings of health for both men and women were not significantly different from excellent ratings in predicting survival. Only women's good and fair health ratings remained significant predictors.

CONCLUSIONS

People rate their health as poor on the objective basis of illness and disability. Australian findings show gender differences relative to North American results; methodological differences and site and gender variability in health profiles are discussed as reasons for the varying results.

Listening to local voices: adapting rapid appraisal to assess health and social needs in general practice

OBJECTIVES

To explore the use of rapid appraisal in defining the health and social needs of a community and to formulate joint action plans between the residents and service providers.

DESIGN

Collection of data by an extended primary care team from three sources: existing documents about the neighbourhood, interviews with a range of informants, and direct observations to build a profile of the community.

SETTING

Council estate of 670 homes in Edinburgh.

MAIN OUTCOME MEASURES

Perceived problems of the community and suggestions for change.

RESULTS

The interviews and focus groups identified six priorities for change, many of which were not health related. These changes have been or are being implemented.

CONCLUSIONS

An expanded primary care team can use rapid appraisal as a first step in identifying and meeting local health needs. It facilitates a multidisciplinary approach and complements quantitative methods of assessing need.

Pyrido[2,3-d]pyrimidine angiotensin II antagonists

A series of pyrido[2,3-d]pyrimidine angiotensin II (A II) antagonists was synthesized and tested for antagonism of A II. Compounds with a biphenylyltetrazole pharmacophore and small alkyl groups at the 2- and 4-positions of the pyridopyrimidine ring were found to be the most potent in an AT1 receptor binding assay and in blocking the A II pressor response in anesthetized, ganglion-blocked A II-infused rats. 5,8-Dihydro-2,4-dimethyl-8-[(2'-(1H-tetrazol-5-yl) [1,1'-biphenyl]-4-yl)methyl]pyrido[2,3-d]pyrimidin-7(6H)-one (4a) was one of the more potent compounds in the binding assay and was the most efficacious compound in the A II-infused rat model. Further study of 4a in Goldblatt (2K-1C) rats showed the compound to have oral bioavailability and to be an efficacious and potent compound in a high renin form of hypertension.

Non-steroidal anti-inflammatory drugs and hypertension in the elderly: a community-based cross-sectional study

1. Whether non-steroidal anti-inflammatory drug (NSAID) usage in the elderly elevates blood pressure or antagonises the blood pressure-lowering effect of antihypertensive medication is presently unknown. The primary aims of this study were to estimate the prevalence of NSAID usage, to evaluate the prescription of NSAIDs for arthritis and to determine whether NSAID usage was an independent predictor of hypertension in a large elderly community. 2. All non-institutionalised elderly (> 60 years) residents of Dubbo, NSW who attended for a baseline assessment were enrolled (1237 males, 1568 females). A questionnaire was administered and blood pressure was measured according to the Prineas protocol. The frequency of NSAID usage was determined, with stratification by age, sex, blood pressure group and history of arthritis. 3. NSAID usage was 26% overall (females 28%, males 23%), increased with age and was higher in females than males for every age group studied. Amongst patients with a past history of 'arthritis', 45% were using NSAIDs. Twelve percent were taking NSAIDs and antihypertensive medication concurrently, constituting the population at risk of an adverse drug-drug interaction. Employing a multiple logistic regression model which adjusted for several confounders in the cross-sectional analysis, NSAID usage significantly predicted the presence of hypertension (odds ratio: 1.4, 95% confidence interval: 1.1-1.7) with an attributable risk of 29%. 4. Amongst non-institutionalised elderly persons, NSAID usage may be an independent risk factor for hypertension. Considering the substantial consumption of NSAIDs by elderly patients, physicians should review their NSAID prescribing patterns for this community group.

Pharmacokinetics, absorption, distribution and disposition of [125I]-defibrotide following intravenous or oral administration in the rat

Defibrotide (D) was labelled with 125I. The radiolabelled compound ([125I]-Defibrotide ([125I]-D)) retained the same profibrinolytic activity as the parent drug. Following single intravenous administration of [125I]-D the half lives of radioactivity associated with D components in plasma were 9.45 min and 11.27 h for alpha and beta phases respectively. Following single oral administration of [125I]-D the half life of radioactivity associated with D components in plasma was 12.83 h for the elimination phase. Bioavailability was apparently 58%. The areas under plasma total radioactivity versus time curves were dose-dependent following both intravenous and oral administration. No significant accumulation of total radioactivity in plasma was observed following multiple oral administration of [125I]-D. Following single intravenous administration of [125I]-D a larger proportion of administered radioactivity was excreted via urine than faeces while following single oral administration excretion via urine and faeces accounted for similar proportions of administered radioactivity. Following both single and oral administration the levels of total radioactivity in tissues and organs examined were generally highest in highly perfused organs and were very high in the thyroid despite pretreatment with non-radiolabelled potassium iodide. Radioactivity was also found to be associated with the aorta wall.

Lipoprotein(a) is not associated with coronary heart disease in the elderly: cross-sectional data from the Dubbo study

Lipoprotein(a) (Lp(a)) may be an independent risk factor for cardiovascular disease. We have examined Lp(a) concentration in 1202 males and 1512 females, aged 60 years and older, who were participants in an ongoing prospective study of cardiovascular disease in the elderly. This report relates to cross-sectional data at study entry. Median Lp(a) concentration was significantly higher in females than in males (P < 0.001), but did not vary with age. Lp(a) concentration rank was significantly correlated with total (r = 0.16, P < 0.001) and LDL cholesterol (r = 0.19, P < 0.001), but this relationship disappeared after adjustment of LDL cholesterol for Lp(a) cholesterol content. Twenty-four percent of males and 17% of females had prevalent coronary heart disease (CHD) at study entry based on non-invasive criteria. Median Lp(a) concentration was slightly higher in those subjects with CHD, compared with those without CHD, but the difference was not statistically significant (P > 0.20). In a multiple logistic model, the following variables were independent predictors of CHD in this elderly population: age, hypertension (males only), family history of CHD, HDL cholesterol and triglycerides (females only), but not total cholesterol or Lp(a). These relationships were similar whether or not the model included Lp(a) concentration. The findings do require confirmation in the prospective study now in progress.

Multiple medication use in the elderly. Use of prescription and non-prescription drugs in an Australian community setting

OBJECTIVE

To document the extent of polypharmacy or multiple medication use in the elderly.

DESIGN

Cross-sectional examination of an age cohort of a community.

SETTING

Community-based study in Dubbo, NSW, in 1988-1989.

SUBJECTS

All non-institutionalised residents aged 60 years and over, numbering 1237 men and 1568 women.

MAIN OUTCOME MEASURES

Assessment of use of prescription and non-prescription drugs, recent hospitalisation, years of education, psychosocial variables.

RESULTS

18% of men and 25% of women were currently using three or more classes of prescription drugs. The corresponding values for two or more classes of non-prescription drugs were 29% and 44%. Of those who were using multiple prescription drugs 56% of men and 76% of women were also using multiple non-prescription drugs. In a multiple logistic model, the following possible predictors of multiple drug use were included: hospitalisation in the last six months, age, sex, depression, life satisfaction and education. Multiple prescription drug use was significantly predicted by recent hospitalisation (odds ratio [OR] = 2.40; 95% confidence interval [CI], 1.63-3.56), increasing age (e.g. 70-79 years versus 60-69 years; OR = 2.54; CI, 1.97-3.25), female sex (OR = 1.59; CI, 1.25-2.01) and increasing depression (e.g. highest tertile of depression scale versus lowest; OR = 2.52; CI, 1.84-3.42). Multiple non-prescription drug use was significantly predicted by female sex (OR = 2.38; CI, 1.95-2.92) and increasing depression (OR = 2.77; CI, 2.16-3.56). For prescription items, non-prescription items, and both categories in combination levels of use 20% above the population average have been documented.

CONCLUSIONS

Polypharmacy in the elderly population appears to be predicted by recent hospitalisation, increasing age, female sex and increasing depression. There is potential for drug-drug interaction to occur, but the findings suggest target areas for preventive action.

Health status and lifestyle in elderly Hawaii Japanese and Australian men. Exploring known differences in longevity

OBJECTIVE

To contrast health status and lifestyle in two elderly populations with differing longevity.

DESIGN

Comparison of two cross-sectional data sets.

SETTING

Non-institutionalised subjects.

SUBJECTS

Men aged 60-81 years resident in Dubbo, New South Wales (n = 1183, 1988-1989) and Japanese men of the same ages resident in Hawaii (n = 1376, 1980-1982).

MAIN OUTCOME MEASURES

Cardiovascular and non-cardiovascular disease prevalence, risk factors, social and health status.

RESULTS

A history of heart attack, angina and stroke was twice as prevalent in Dubbo men as in Hawaii Japanese. Other diseases were many times more prevalent in Dubbo--liver disease sixfold, prostate and renal disease twofold, and arthritis 1.5-fold. Hypercholesterolaemia and untreated hypertension were more prevalent in Dubbo (threefold and 1.5-fold respectively). Current smoking was similar in both groups, while diabetes was twice as prevalent in the Hawaii Japanese. More Dubbo men were widowed or lived alone, and fewer remained in paid employment. Dubbo men had more limited physical mobility.

CONCLUSIONS

Elderly Dubbo men have an excess of cardiovascular disease and associated risk factors, as well as an excess of non-cardiovascular disease, compared with Hawaii Japanese. This may account, in part, for a higher total mortality rate in elderly Australians compared with Japanese. Some of this disease burden may be amenable to risk factor intervention.

Dubbo Study of the elderly: hypertension and lipid levels

Untreated hypertension in age groups below 60 years has been shown to be associated with significant elevations in serum cholesterol and triglyceride levels. Drug therapy of hypertension has also been shown to have adverse effects on lipoproteins. We have investigated lipid and lipoprotein levels in a community-based sample of men and women 60 years and older belonging to one of the following groupings: (a) normal blood pressure (n = 1075); (b) untreated hypertension (n = 329); (c) drug-treated hypertension (n = 880). Serum lipid, lipoprotein, apolipoprotein or plasma glucose levels did not vary significantly between untreated hypertensives and normotensives of either sex. In a multiple regression model controlling for possible influences of age, overweight, alcohol and tobacco usage, and presence of coronary heart disease, anti-hypertensive drug therapy significantly predicted increased serum triglycerides (P less than 0.001) and reduced high density lipoprotein (HDL) cholesterol levels (P less than 0.01) in both sexes, reduced apolipoprotein A-I levels in males (P less than 0.001), and increased apolipoprotein B (P less than 0.01) and plasma glucose levels (P less than 0.001) in females. Adjusted triglycerides were 20% higher and HDL cholesterol was 7% lower in the presence of anti-hypertensive drug therapy. These effects were partially consistent with the known actions of thiazide diuretics and beta-blockers which were used by more than 50% and 40% of subjects, respectively.

Dubbo study of the elderly: sociological and cardiovascular risk factors at entry

A prospective study of elderly Australians commenced in 1988 in Dubbo, NSW. Its goals are to identify predictors of mortality, hospitalisation and placement in long-term care, with special focus on risk factors for cardiovascular disease. The study population were non-institutionalised subjects, comprising 1237 males and 1568 females 60 years and over. This report describes the baseline findings: demographic, educational and economic data; tobacco and alcohol usage, self-medication and other habits; medical contacts and past diagnosis; prescribed medication and in study diagnosis; psychosocial variables, functional health and social support; blood lipid and lipoprotein data; blood pressure, spirometry and glucose data; heights and weights. Where comparison has been feasible, the findings in Dubbo closely resemble those obtained from the rest of Australia. The findings presented provide the basis for aetiological studies of future outcomes.

The Dubbo study of the health of elderly: correlates of coronary heart disease at study entry

A prospective study of the health of elderly Australians recently commenced in Dubbo, NSW, the study population comprising 1,237 males and 1,568 females 60 years and older. The prevalence rates of coronary heart disease (CHD) and its associated risk factors have been examined in the baseline data. The age-standardized rate of CHD was 23.8/100 in males and 18.1/100 in females. The prevalence rate increased with age until 79 years in males, thereafter declining. The rate increased steadily with age in females. In a multiple logistic model, the following possible predictors of CHD were included: age, cigarette smoking, use of alcohol, exercise, religiosity, years of education, hypertension, diabetes, family history of CHD, body mass index, lipid and lipoprotein variables. The presence of CHD in males was significantly predicted by age, hypertension (odds ratio, OR = 1.40), family history (OR = 2.05), and high density lipoprotein (HDL) cholesterol (OR = 0.78). The significant predictors in females were age, years of education (OR = 0.82), hypertension (OR = 1.45), family history (OR = 1.77), serum triglycerides (OR = 1.30), and HDL cholesterol (OR = 0.73). Hypertension was found to be a stronger predictor of CHD in the younger age group (60-69 years), while diabetes was a predictor of CHD in older males (70-79 years). Our findings require confirmation in the prospective study now in progress.

The Dubbo study: an Australian prospective community study of the health of elderly

The proportion of Australian population over 60 years has risen progressively over the last 40 years and this growth is projected to continue. Major health problems of the elderly include coronary heart disease, cerebro-vascular disease, osteoporosis and fracture. The risk factors for coronary heart disease and stroke in middle-aged subjects have been extensively documented in prospective studies in Australia and elsewhere, and include lipid disorders, hypertension, cigarette smoking, diabetes and family history. Few prospective studies have been targeted exclusively on the elderly and information available with respect to vascular risk factors is fragmentary and contradictory. This is the background to a new prospective study of the health of elderly Australians now under way in Dubbo, NSW. The goals of the Dubbo Study are to identify predictors of mortality, hospitalisation and placement in long-term care, while specific aims are the study of risk factors for chronic diseases and disability. This report describes the study rationale, reasons for selecting Dubbo as the study site, methods and measures, participation rates and demography. The target population included all non-institutionalised subjects 60 years and over, domiciled in Dubbo, and is comprised of 1693 males and 2167 females. The attendance rate for an extensive medical and sociological baseline assessment over a 13 months' period was 73% for both sexes. The prospective study is now in place and within three to five years will be generating definitive information in the elderly.

Ethnicity and stress among older Australians

The impact of ethnicity on the stress process in old age was examined using two surveys of Australians aged 60 years and older. Four different "ethnic strata" were defined: namely, mainstream Australians, British migrants, and non-British migrants--who were split on the basis of whether their English proficiency was good or poor. The ethnic stratum most different from mainstream Australian, non-British migrants with poor English proficiency, was a significant predictor of psychological distress in the context of other relevant variables. Within the four "ethnic" strata, network variables were significantly related to psychological distress only for non-British migrants, with relatives being important for those with poor English and nonrelatives for those with good English. For mainstream Australians, female gender, poor health, and specific living arrangements were significant predictors of psychological distress.

Factors affecting the work status of older Australians. An interdisciplinary approach

With the declining work force participation in developed countries of older men over the last decade, the study of factors affecting their status became of major interest in economic analyses. It is argued here that social constraints, as well as economic incentives and individual preferences, are important factors in retirement behaviour. Both trivariate and bivariate logit analyses of Australian data confirm the significance of variables indicating social constraint on work related to age and gender. An entirely different model emerged for predicting part-time work status compared to the model for full-time work status. It is argued that the task of analysing survey data requires an interdisciplinary approach to deal with applied problems.

Hilar gland tuberculosis in Nepalese adults masquerading as malignant lymphoma

We report two Nepalese patients with tuberculosis, in whom the sole chest X-ray abnormality was hilar lymphadenopathy. This rare variant of tuberculosis, not previously described in Nepalese patients, may easily be mistaken for malignant lymphoma.

Polyresistant malaria in Gurkha soldiers returning from Papua New Guinea: treatment and prevention

Two company strength exercises to Papua New Guinea produced 21 malaria casualties of whom 16 had potentially fatal falciparum infections. The chemotherapy and prevention of polyresistant malaria from Papua New Guinea and the threat posed to the Hong Kong environment regarding malaria re-introduction are discussed.

Bereavement in the elderly

One hundred bereaved spouses aged 65 and over were interviewed six months after the death for symptoms of depression. Twenty-nine were still depressed. Depression was not commoner with advancing age but was more frequent in men. Unexpected death was associated with more depression than if it was expected. Many derived benefit from supporting services.

Treatment of postoperative cerebrospinal fluid fistulas by subarachnoid drainage

✓ The authors report the details of the successful treatment of 11 of 12 patients with postoperative cerebrospinal fluid fistulas. Continuous lumbar or ventricular fluid drainage was used.