Health status of the aged: medical profile of a group of functional elderly

By studying a group of very elderly but generally functional people, we have compiled a medical profile that helps describe health-related characteristics of effective aging. We obtained functional, nutritional, and biochemical information regarding 61 men and women (mean age 86.8 years) attending a veterans' convention. Twenty-three out of 60 (38%) reported a fall in the previous year, with those who were less physically active falling more than the most active. Many of the men were thin or had lost weight, but at most 3 of the 25 male subjects were clinically malnourished. Many of the women were heavy but were otherwise healthy. Of the 36 women, 6 (17%) had an elevated level of thyroid-stimulating hormone (TSH). Five of 58 (9%) had low vitamin B12 levels. Even in the older old who seem to be aging well, falling is relatively common, and screening for certain laboratory abnormalities has a reasonably high yield.

Drug use among functionally active, aged, ambulatory people

BACKGROUND AND METHODS

Only a few pharmacoepidemiology studies have included very old subjects and most studies included both healthy and very ill people. Interpretation of data from these investigations is limited because of the mix of health status in the populations studied. We examined drug use in a group of active, relatively healthy, older people. Sixty-one attendees at a national convention, aged 76-96 years, volunteered to participate in a study on health status in a very old, ambulatory population. Medication histories, selected blood biochemistry analyses, a mental status examination, and other data were collected.

RESULTS

The mean number of prescription and nonprescription drugs used per person was 2.02 and 1.85, respectively. More than a quarter of the sample population took no prescription medications and two-thirds used two or fewer prescription drugs. Sixteen percent of those taking prescription medications experienced adverse effects from their current drug regimens. Although falling was prevalent among our study subjects, there were similar drug-use patterns in those who did and who did not fall.

CONCLUSIONS

In a group of relatively healthy and functional very old people, we found that drug use was not excessive, although adverse effects were still prevalent. In addition, most subjects were knowledgeable about their medications. These studies demonstrate that extreme age alone does not always result in sickness, frailty, and overuse of medications.

Decreasing medication use in a nursing-home patient-care unit

The effect of a computerized drug regimen review and expanded clinical pharmacy services on medication use in a nursing-home care unit was studied. A full-time pharmacist assigned to the 120-bed nursing-home care unit of a Veterans Affairs medical center initiated a program to reduce medication use to an average of 6.1 medications per patient. The pharmacist used a monthly, computer-generated drug regimen review report to document the number of medications per patient and recommend decreases in medication use to physicians. Initiation of a standing-order policy, whereby nurses can initiate the use of specific medications, helped to reduce the number of as-needed (p.r.n.) orders and also decreased use of these medications. Within one year, the number of p.r.n. and scheduled medications used per patient was reduced from 7.20 to 5.34. Use of routinely scheduled medications was reduced by about 30%. Based on an average cost of medications administered ($0.24/dose), we calculated a cost savings of about $27,400. By reviewing patients' drug regimens, establishing a standing-order policy, and targeting scheduled medications for discontinuation, a pharmacist reduced medication use in a nursing home.

Dehydration in the elderly: insidious and manageable

Dehydration in the elderly results from inadequate water replacement, and associated mortality may be high when dehydration is severe. The elderly are at an elevated risk for dehydration, due to decreased thirst perception, decreased water intake, abnormal vasopressin responses to osmotic stimuli, and a predisposition to mild nephrogenic diabetes insipidus. In addition, elderly patients with chronic physical and/or mental disabilities are often unable to drink or obtain water themselves. For these high-risk patients, the physician's role is to initiate measures to prevent dehydration, including fluid orders and intake documentation.

Dexamethasone aerosol use in an asthmatic nursing-home patient with Parkinson's disease and dementia

Management of asthmatic or emphysematous elderly patients who cannot use metered-dose inhalers with spacers because of severe physical and mental disabilities is difficult. We report a case of a nursing-home patient with dementia and Parkinson's disease who required aerosolized corticosteroids to avoid repeated systemic corticosteroid courses for asthmatic exacerbations. The patient was unable to use a triamcinolone metered-dose inhaler with spacer devices because of his impairments. Therefore, nebulized dexamethasone solution was prepared and administered. Since initiation of nebulized dexamethasone, the patient has not required systemic corticosteroids. In addition, his hypopituitary adrenal axis has remained intact as evidenced by provocative cosyntropin testing. Therefore, nebulized dexamethasone solution may be an alternative to the aerosol corticosteroid metered-dose inhaler when patients are too impaired to use inhalers, even with spacers.

Vitamin D deficiency in Florida, the Sunshine State

Several years may be required for development of clinically evident osteomalacia in previously healthy subjects deprived of exposure to sunlight or enriched dietary sources of vitamin D. In a survey of residents of a 120 bed VA nursing home who had been patients there for two to six years, 17 were found to have x-ray or laboratory findings suggestive of the presence of vitamin D deficiency. Bone biopsy in eight of these 17 patients revealed definite osteomalacia in three patients. Thus, vitamin D deficiency may develop in confined, nonvitamin D fortified patients in Florida just as in more northern climes. Daily exposure for 30 minutes to sunshine or oral administration of 2.5 mg of vitamin D2 or D3 twice yearly has been recommended to prevent deficiency of this vitamin.