News and Reviews
Bone health: the womb and environmentFactors affecting bone health have been investigated in 171 men and 218 women between the ages of 49 and 51 years (J Epidemiol 2005; 59: 475–80). Density measured by X-ray absorptiometry had a negative correlation with fetal factors such as position in a family along with weight and social class at birth. Important correlates in adult life were social class, alcohol intake, smoking and poor nutrition, with positive correlates with exercise, weight and hormone replacement in women. Clearly, achieving maximum bone density is going to be a complex task.
Reduction in falls and Tai Chi
Though exercise reduces the risk of falls, the challenge is finding a programme that interests participants. Tai Chi, with its oriental overtones, may be such a candidate. This has recently been evaluated in a group of active individuals between the ages of 70 and 92 years (J Gerontol Med Sci 2005; 60A: 187–94). Participants received three sessions of the exercise per week over 6 months when they were compared with a control group. They proved to have a lower incidence of falls and improved measures of balance.
Increasing concern is being expressed about the high incidence of nosocomial infections in UK hospitals. In a recent review of units in southwest England, it was found that nosocomial gastro-enteritis was present in 171 hospital inpatient units and 11 community hospitals (J Hosp Infect 2005; 60: 135–43). The risk was particularly high in geriatric units (hazard ratio 2.6, 95% CI 1.1–4.3) and moderately increased in general medical ones (hazard ratio 1.7, 95% CI 1.1–2.6). The risk of infection increased with the size of the unit. Measures suggested to prevent cross-infection have included bringing back matrons and employing better cleaning companies. Whether such measures would work remains to be seen.
Amphotericin B lipid complex (ABLC) in elderly patients
Systemic ABLC is effective against many fungal infections but has a wide range of side-effects, including renal failure. A study has recently been conducted of patients treated with ABLC in 160 hospitals (J Infect 2005; 50: 277–87). There were 572 patients over the age of 65 years and 2,930 aged 65 or under. Fifty-six per cent of older patients and 51% of younger patients showed a satisfactory response to treatment and both experienced only a marginal rise in serum creatinine levels during treatment. It would appear that while ABLC should be used with caution, it is no more dangerous in old age.
Prevention of thrombo-embolism in hip fractures
Thrombo-embolism is a common cause of death after a hip fracture. An increasingly popular method of reducing this risk is to apply intermittent pressure to the lower limbs. There is a recent account of a Venflow compression system being used on both lower limbs in 200 patients with hip fractures (Orthop Trauma 2000; 19: 234–40). Sixty-seven were also receiving aspirin while the remainder were on warfarin. The total incidence of deep leg thrombosis was 3.5% with no episode of pulmonary embolism. These results are extremely encouraging but should be followed up with controlled trials for confirmation.
Prevalence of falls in accident and emergency units
There is a concern that the incidence of falls in patients attending an accident and emergency unit may be underestimated because staff fail to ask the right questions. Review of patients at an accident and emergency unit revealed that only 37% with a history of falls had been identified (J Pub Health 2005; 27: 33–5). Measures will need to be taken to ensure a more effective means of collecting this vital information.
Dietary supplements, old age and muscle power
Many old people are badly nourished but would dietary measures improve their health? A randomised trial was conducted on patients aged 75 years or over with a body mass index 
27 g/m2 and a triceps skinfold thickness under the 10th centile of normal (Gerontology 2005; 51: 179–85). Sixty-six subjects were given oral supplements containing 5,040 kJ and 47 g of protein per day and the control group was given a standard diet. A substantial drop-out rate meant that only 41 of the treatment group and 70 of the controls completed the study. The only measure in which there was a substantial change was a triceps skinfold thickness of 13.9% in the treatment group and 7.2% in the controls. The message is that even if elderly patients with nutritional problems are identified it is extremely difficult to treat them.
Do elderly women fall over more often than elderly men?
Review of an emergency department in the USA established that there was an incidence of falls of 29.5% in men over 65 years compared with 70.5% in women (Inj Prev 2005; 11: 115–9). Women were also 2.2 times more likely to have fractures and 1.5 times more likely to be admitted for hospital care. Much more work is required to establish why there should be such dramatic differences between the sexes.
Drinking water and Alzheimer’s disease
The debate as to whether aluminium in the water causes dementia has been running for as long as Agatha Christie’s play, The Mousetrap. A recent contribution from France relates to 1,462 individuals aged 75 years or over who were kept under review for up to 7 years (Am J Nutr 2005; 81: 897–902). All were questioned about their intake of tap water or mineral water. Those estimated as having a lower intake of silica were more likely to develop dementia. It was proposed that silica worked by preventing the absorption of aluminium. If nothing else, the controversy should keep University Research Selectivity indices up for the foreseeable future.
South Asians growing old in Britain: what are their expectations?
In the past, we have all too often got things wrong by planning for old people without finding out what they themselves want. There may be a further crisis ahead in that we know little about the aspirations of old people who have come from abroad over the last 50 years. A start on this was made by interviewing a group of Gujaratis and Bengalis living in their own homes (Katbamna, Nuffield Community Care Studies Unit, University of Leicester, 2004). Those who were most disadvantaged felt marginalised from their own society and were extremely pessimistic. All participants had expectations of support from the family and the State, but many had doubts as to the ability of their families to meet such obligations. There were mixed views on there being payment for the care of old people. The general message seems to be that, as in many groups, it will no longer be realistic for us to expect that old people will receive care from within their extended family.
Osteoporotic fractures of the tibial plateau
A series of three cases provides a reminder that the sudden onset of knee pain may be the result of a fractured tibial plateau in a patient with osteoporosis (Am J Orthop 2005; 34: 186–9). This is often misdiagnosed as osteoarthritis but can be identified by taking an X-ray of the joint, which should show a horizontal line of sclerosis below the plateau. This takes some time to develop so it is best to time a second X-ray about a week after the onset of symptoms. Failure to identify the lesion may result in too aggressive a programme of rehabilitation with complete avulsion of the tibial plateau.
It is well recognised even in sunny Manchester that hot weather can be bad for elderly people. The situation is much worse in countries where it really gets hot in summer. An example is North Carolina, where there is a strong relationship between mortality and both the average summer temperature and the number of days over 32°C. Non-occupational deaths were more common in older people, particularly those with mental and physical disorders. Healthy young men were not exempt, however, and there was a high mortality amongst farm workers involved in heavy manual labour. This was particularly common in Afro-Americans, but this may have been a result of more of them being involved in manual work.
Diogenes
Contributions to this column should be sent to
Professor W. J. MacLennan,
26 Caiystane Avenue,
Edinburgh EH10 6SG, UK
Email: Profmaclennan{at}aol.com
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