Age and Ageing Advance Access originally published online on June 4, 2007
Age and Ageing 2007 36(4):364-365; doi:10.1093/ageing/afm066
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News and Reviews
Syncope in people aged 45 years and overA condition guaranteed to cause chaos and alarm at church services and other public meetings is syncope. A survey from America showed an overall prevalence of syncope of 19% in a random population of individuals over the age of 45 years (Am J Med 2006; 119: 1088), but no increase in prevalence with advancing age.
Age-related macular degeneration (AMD) and hip fractures
It seems inevitable that individuals with poor eyesight are more likely to fall. The cause of visual importance may be important, however. A comparison of exudative age-related macular degeneration (AMD) with atrophic AMD indicated that the former did not effect the frequency of hip fractures, but there was a higher incidence in those with the latter (Am J Ophthalm 2006; 142: 1081–83). There is no obvious explanation for the difference. It may be that the two conditions have different effects on visual acuity or visual fields, but there are no data on this.
Transcranial magnetometric stimulation (TMS) and electroconvulsive therapy (ECT) in severe depression
In current practice electroconvulsive therapy (ECT) is the main physical form of intervention in depression. More recently tests have been conducted on repetitive transcranial magnetometric stimulation (TMS). In a recent trial, the two methods were applied at random over 15 days to patients with severe depression (Am J Psych 2007; 64:73–71). At the end of the course patients on ECT had a lower Hamilton Rating Scale. Fifty nine percent of them made a recovery whereas this only was achieved in 17% of those given TMS. No doubt, further studies will consolidate or refute these results.
Folic acid deficiency and deafness
Popular magazines and television adverts would have us believe that vitamin therapy is a panacea for all ills. The spotlight has recently been targeted on folic acid deficiency and deafness where positive results have been achieved by using the vitamin in a double blind trial (Ann Int Med 2007; 146: 1–9). Elderly men and women in the treatment group with normal folic acid levels received 800 µg daily doses of the vitamin for 3 years. At the end of the 3 years there had been a slower decline in hearing in the treatment group.
Defining the need for radiography in women with sore backs
Vertebral fractures are a cause of morbidity and mortality in elderly patients and it would be useful to devise a reliable clinical technique for diagnosing the cause of this. A group in Europe has attempted this by using a questionnaire and examination protocol (Ann Rheum Dis 2007; 60: 81–85). Diagnostic criteria were age, severity of pain, height loss, history of previous vertebral fractures, dorsal location of pain and the sudden onset of pain. Subjects with a score of more than seven had a 43% probability of having a fracture. Given the potential hazards of missing a fracture a stronger correlation would be required before abandoning a routine X-ray.
Osteoporosis in rheumatoid arthritis
A particularly severe complication of rheumatoid arthritis and its treatment is osteoporosis. It would appear that insufficient attention has been given to this problem (Arth Rheum 2007; 551: 873–77). This was found in 193 patients on glucocorticoids, 48% of whom had been on oral glucocorticoids. The principal observation was that, of those on 5 mg of prednisolone or more per day for more than 3 months, only 64% were on treatment for osteoporosis. Only 35% of those on a smaller dose were on treatment for osteoporosis. Factors influencing treatment for osteoporosis were being female, the dose of glucocorticoid and a previous osteoporotic fracture. The conclusion about prevention of osteoporosis by clinicians is that they did well but could do better.
It is well documented that, even in Manchester, warm weather is associated with an increased mortality. In France, things have been taken a stage further when it has been suggested high ozone levels are yet another problem in warm weather (Arch Environ Occup Health 1005; 60: 205–12). Data from a heat wave lasting 2 weeks indicated that in twelve French cities peak temperatures were associated with peak ozone levels. The high ozone levels correlated with a high mortality. There also was an interaction between temperate and ozone levels and mortality. If such is the case, why do we feel so miserable in dull, wet and cold weather with long winter nights?
Cataract surgery in the future
In Australia, 9,000 patients had cataract surgery in 2003 (Arch Ophth 2006; 124: 1750–53). The increase in numbers was greatest in those with visual acuity of less than 6/12, these increased from 2,300 in 1950 to 7,210 in 2005. It is clear that demographic factors and a changed threshold for visual acuity as an indication for surgery will further increase the large number of patients receiving this treatment.
Minimal access hip arthroplasty
New uses for minimal access surgery continue apace. A more recent application relates to total hip arthroplasty. The results of pilot work in the United Kingdom have recently been reviewed (Ann Roy Coll Surg 2007; 89: 34–40). This established that only 23% of surgeons regularly performing arthoplasties perform minimal access surgery, and that 63% of those who do, perform more than 20 such surgeries per year. Further experience will establish whether benefits will outweigh side effects and whether this will become another area of expanding new technologies and cost.
Encouraging progress has been made in devising new techniques for the treatment of prostatic cancer. One of these is brachytherapy in which needles with I125 are inserted into various parts of the prostate. The treatment was applied to 300 patients with carcinoma in which there were low, medium and high rates of spread (BJU 2006; 98: 1210–15). The median period of follow-up was 45 months. The actuarial survival rate was 93%. There was no difference for those in different risk groups, or in those receiving or not receiving androgen deprivation therapy. The average prostate specific androgen level was 0.3 mg/ml at 3 years for all risk groups.
Herpes zoster: cardiac disease
Herpes zoster causes much pain and debility in old people. Two case reports remind us that it can also cause cardiac disease (Cardiology 2007; 107: 1–7). One concerns a 72-year-old in which the infection presented as a pleuro-pericarditis. The other was a 64-year-old man who presented with complete heart block. It seems that there the cases were due to foci of infection within the autonomic nervous system which became reactivated.
Age and life expectancy in medullary thyroid cancer (MTC)
In most diseases, age has an adverse effect on prognosis. This may not be true of medullary thyroid cancer (MTC) (Clin End 2006; 65: 729–36). There was a recent review of patients with the condition aged 3 to 83 years. The 10-year survival was 75%, with 63% clinically well and 20% in biochemical remission. Multivariate analysis established that only the stage of the disease, or its extrathryoid extension had an adverse effect on outcome. Neither age nor persistent biochemical abnormalities had any effect on this. Indeed, patients without recurrence after treatment had a life expectancy similar to that of the general population.
Notes
Contributions to this column should be sent to Professor W. J. MacLennan
Email: Profmaclennan{at}aol.com
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