Psychotropic Medication and Stroke Outcome RAIVIO, MINNA M.; LAURILA, JOUKO V.; STRANDBERG, TIMO E. ...
The American journal of psychiatry,
05/2005, Letnik:
162, Številka:
5
Journal Article
Squalene, a key intermediate of cholesterol synthesis, is present especially in olive oil. Regulation of cholesterol metabolism by dietary squalene in man is unknown, even though olive oil users in ...Mediterranean areas have low serum cholesterol levels. We have investigated absorption and serum levels of squalene and cholesterol and cholesterol synthesis with the sterol balance technique and serum levels of cholesterol precursors in humans during squalene feeding (900 mg/d for 7-30 days). The results were compared with those during cholestyramine treatment. Fecal analysis suggested that about 60% of dietary squalene was absorbed. Serum squalene levels were increased 17 times, but serum triglyceride and cholesterol contents were unchanged. The squalene feeding significantly (P less than 0.05) increased serum levels of free (1.7-2.3 times) and esterified (1.9-2.4 times) methyl sterol contents, while elevations of free and esterified delta 8-cholesterol and lathosterol levels were inconsistent. Cholestyramine treatment modestly augmented free methyl sterol levels (1.3-1.7 times), less consistently than those of esterified ones, while, in contrast to the squalene feeding, serum contents of free and esterified delta 8-cholesterol and lathosterol were dramatically increased (3.3-8 times). Neither of the treatments significantly affected serum plant sterol and cholestanol levels. The squalene feeding had no consistent effect on absorption efficiency of cholesterol, but significantly increased (paired t-test, P less than 0.05) the fecal excretions of cholesterol and its nonpolar derivatives coprostanol, epicoprostanol, and coprostanone (655 +/- 83 SE to 856 +/- 146 mg/d) and bile acids (212 +/- 24 to 255 +/- 24 mg/d), indicating an increase of cholesterol synthesis by about 50%. We suggest that a substantial amount of dietary squalene is absorbed and converted to cholesterol in humans, but this squalene-induced increase in synthesis is not associated with consistent increases of serum cholesterol levels. The clearly increased serum contents of esterified methyl sterols may reflect stimulated tissue acyl CoA: cholesterol acyltransferase (ACAT, EC 2.3.1.26) activity during squalene feeding as these sterols are not esterified in serum.
Hypertension is an established risk factor of cardiovascular diseases, and in clinical studies its treatment has reduced cardiovascular complications in subjects up to 80 years of age. In the older ...age groups, prognostic data on blood pressure is sparse. We evaluated the prognostic significance of different blood pressure levels and the history of elevated blood pressure in an older population.
In the Helsinki Ageing Study random individuals 75, 80, and 85 years of age (n = 521) were evaluated at baseline using postal questionnaires, structured interviews, clinical examinations, laboratory investigations, and blood pressure measurements (supine, seated, standing). Date of death during a 5-year follow-up was verified using computerized registers, and thus the follow-up was 100% complete. The data were analysed using life-table analyses and Cox proportional hazards models.
At 5 years, 240 subjects (40%) had died, 50% of them of cardiovascular disease. In crude analyses, an inverse relationship between both systolic and diastolic blood pressure and mortality was observed in all groups combined (P < 0.01), and separately in the 80 and 85-year-old groups. However, a J-shaped link between diastolic blood pressure and mortality was found in the 75-year-old group. After controlling for age, gender and the presence of clinically significant diseases (in 72% of subjects) baseline blood pressure was associated with favourable 5-year survival. The risk ratios of systolic (per 10 mmHg) and diastolic blood pressure (per 5 mmHg) were 0.90 (95% CI 0.85-0.96) and 0.92 (95% CI 0.86-0.99), respectively. Neither isolated systolic hypertension nor a history of hypertension treatment were associated with 5-year survival.
At the population level, among subjects aged 75 years and over, favourable 5-year survival is indicated by a high, but not a low, blood pressure.
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.
MEASUREMENTS: Self‐reported physical functioning, need for assistance in daily living, and attitudes toward life.
RESULTS: Among 85‐year‐olds born in 1914 there was a significantly larger proportion able to go outdoors compared with 85‐year‐olds born in 1904 (72.9% vs 60.6% in women (P < .01) and 84.6% vs 63.6 % in men (P < .01), respectively). Similar trends were observed between the oldest cohorts concerning the need for assistance. The amount of publicly funded domestic help had reduced in the two oldest cohorts in 1999 compared with 1989 (20.3% vs 29.8% in 85‐year‐old women born in 1914 vs 1904 (P < .05); and 10.2 % vs 25.0% in 85‐year‐old men born 1914 vs 1904 (P < .05), but at the same time 75‐year‐old women born in 1924 had increased the use of private domestic help compared with 75‐year‐old women born in 1914. Significantly larger proportions of both men and women had plans for the future in all the cohorts in 1999 than in 1989.
CONCLUSIONS: Consistent yet small differences between the corresponding cohorts suggest that physical functioning and more‐optimistic attitude toward life have increased and need for assistance has decreased over 10 years in the older population up to the age of 85.
Aims To investigate the changes in blood pressure and their causes in an elderly population. Methods Orthostatic blood pressure measurements were performed in randomly in four birth cohorts (years ...65–, 75–, 80– and 85, n=773) at 5-year intervals. Results Both systolic and diastolic blood pressures decreased in both genders and all age groups. The falls in blood pressure related closely to initial blood pressure values and to the thickness of the left ventricular posterior wall of the heart. The changes in supine (r=0·118,P=0·007) and standing systolic blood pressure (r=0·123,P=0·005), as well as supine (r=0·148,P<0·001) and standing diastolic blood pressure (r=0·186,P<0·001) correlated with changes in body weight. Changes in supine diastolic blood pressure also related to changes in serum cholesterol (r=0·207,P=0·002) and triglycerides (r=0·160,P=0·016). Changes in supine and standing systolic and standing diastolic blood pressures also related to changes in dehydroepiandrosterone sulphate (r=0·161,P<0·05; r=0·205,P<0·01; r=0·140,P<0·05, respectively). Changes in blood pressure also correlated with self-estimated poor health after 5 years (r for supine systolic blood pressure=−0·133,P<0·001, for standing systolic blood pressure=−0·135,P<0·001, for supine diastolic blood pressure=−0·111,P<0·002). Patients who were institutionalized during the follow-up or who had severely impaired performance capacity after 5 years, displayed the most marked decline in blood pressure. Declining systolic blood pressure was also related to impaired survival prognosis. According to the logistic regression analyses the baseline blood pressure, antihypertensive drugs and changes in dehydroepiandrosterone sulphate and cholesterol explained over 30% of the changes in blood pressure. In the logistic models, declining blood pressure was associated with baseline blood pressure, antihypertensive treatment, poor health after 5 years, and decreasing cholesterol and triglycerides. Conclusion Decline in blood pressure in old age is associated with deteriorating health and is only partly explained by the use of antihypertensive drugs.
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.
All home care patients (n = 174, mean age 77 years) in a rural area, Kirkkonummi-Siuntio, in Finland.
Patients were randomised into 2 groups, one of which was offered a 2-month period of day hospital care. Patients assumed to be noncompliant (because they did not want day hospital care) were also included in order to see the effect of intervention in 'real-life'. The medications of all participants were reviewed and counted during an in-home assessment by a home nurse. In the intervention group, necessary revisions (dose reduction, discontinuation, possible additions) were performed through the tight monitoring of day hospital care and in co-operation with the patient. The patients were followed up for 10 months after completion of the intervention programme.
Number of prescribed medications, number of over-the-counter (OTC) drugs, number of doses taken daily by the patients. Assessments were performed at baseline, and after 2, 5 and 12 months.
There were no significant changes in the number of prescribed medications. In patients in day hospital care, the number of doses was reduced significantly (p = 0.02) during the 2-month day hospital period compared with the control group. However, the patients compensated for the reductions by increasing the use of OTC drugs during the day hospital period (p = 0.05). In addition, only 3 months after the trial, the number of drugs had already returned to the baseline level.
In real life it seems to be difficult to reduce polypharmacy in the elderly. Some drug reductions may be achieved with tight control under trial conditions, but when the intervention ceases the number of drugs used soon returns to its earlier level.
Background: The growth of life-sustaining medical technology and greater attention to medical care at the end of life have provoked interest in issues related to advance care planning. Objective: To ...investigate how having a living will (LW), resuscitation preferences, health condition, and life attitudes are related in home-dwelling elderly people. Methods: In a cross-sectional descriptive study, detailed assessments were made of 378 home-dwelling elderly individuals participating in a cardiovascular prevention study (DEBATE Study). The participants were inquired about a preexistence of a written document (LW) concerning life-sustaining care, preferences of cardiopulmonary resuscitation (CPR) in their current situation, and attitudes towards life. General health, physical and cognitive functioning, the presence of depression, and quality of life were also assessed. Results: Forty-four of the 378 participants (12%) had a LW. As compared with those without one (n = 334), there were more women 82% (36/44) vs. 63% (210/334) and widows 57% (25/44) vs. 41% (135/334) among those with a LW. They were also more educated and considered their health to be better. Despite having a LW, 46% (20/44) of them preferred CPR in their current condition, a proportion not statistically different from the 58% (194/334) of the individuals without a LW. In the whole sample, 39% (149/378) of the individuals preferred to forgo CPR. As compared with those preferring CPR, they were older, more often women, and widowed. Participants preferring to forgo CPR had a poorer quality of life, were more lonely, and showed signs of depression more often than those preferring CPR. The preference to forgo CPR was related to attitudes towards life regardless of physical or cognitive functioning. Conclusions: Having a LW does not reduce the reported preference of CPR which is related more to current mental status and life attitudes. In-depth assessment of the patient’s preferences should be performed in any comprehensive care plan.
Dehydroepiandrosterone sulfate (DHEAS) was measured in a five-year follow-up study of random persons of three age cohorts (75-, 80-, and 85-years, N = 571) in order to investigate its associations ...with clinical diseases and their risk indicators, as well as its prognostic significance in old age. DHEAS was higher in men (3.1 mumol/L) than in women (1.9 mumol/L) in the 75-year age group. It decreased in men up 85 years. Compared to healthy men, DHEAS was lower in men with a history of or manifest vascular diseases, presence of dementia, diabetes mellitus, malignancies and musculoskeletal disorders, but was similar in all these disease groups. No differences were found in women. DHEAS did not relate to cardioechographic findings, cardiovascular risk factors or predictors of impaired survival prognosis. After controlling for age, DHEAS tended to be lower in the non-surviving than in the surviving men (2.28 mumol/L vs 2.65 mumol/L, p = 0.065). After controlling for disease, DHEAS did not predict increased risk of all-cause or cardiovascular mortality during the 5-year follow-up. In this study, gender differences in DHEAS persisted up to the age of 75 years. Low plasma DHEAS appears to be a secondary phenomenon rather than a specific risk indicator of common diseases in old age.
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