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Volume 64, Issue 8 (8-2006)
Background: Community-acquired pneumonia could be a life-threatening condition especially in elderly patients. The factors influencing the outcome in elderly patients are thought to be different from those in young adults. We compared the clinical and paraclinical profiles in elderly and nonelderly patients with community-acquired pneumonias.
Methods: In this cross-sectional study, seventy nine patients who were hospitalized with community acquired pneumonia over a period of one year were included. Patients' medical records were reviewed and data related to comorbid conditions, signs and symptoms, laboratory and radiographic findings were gathered using a checklist.
Results: The clinical features, laboratory parameters and complications from pneumonia were almost similar in 41 elderly (group I, age ≥65years) and 38 young (group II, age<65years) subjects. Delirium was seen more in elderly group (p=0.05). The average body temperature and pulse rate were significantly higher in nonelderly group. Sixty one percent of elderly patients and 21% of young patients have Po2 less than 60 (p=0.02). Smoking (29.1%), neurological disturbances (19%), congestive heart failure (15.2%), chronic obstructive pulmonary disease and diabetes mellitus (13.9%) were associated comorbidities in both groups. In non elderly group, immune compromise and IV drug use were more common as underlying comorbid conditions. Two of three mortalities were due to elder patients.
Conclusion: Community acquired pneumonia could have more serious clinical and abnormal laboratory features in the elderly than younger patients. Mortality rate may be higher in older patients. Comorbid conditions are frequently seen in both elderly and nonelderly patients with community acquired pneumonia, but IV drug use and immune compromise are more frequent in nonelderly patients.
Volume 64, Issue 9 (9-2006)
Background: Multiple drug use is frequently considered to be hazardous for the elderly because of their greater vulnerability to the complications. The purpose of this study was to determine the prevalence of polypharmacy in Tehran and to assess the relative demographic characteristics of patients.
Methods: In a cross-sectional study 400 persons aging 55 years and older were interviewed in order to determine the presence of polypharmacy (daily intake of three or more drugs). The cases were randomly selected and asked to answer a questionnaire through interview at home. The questionnaire contained questions about all taking drugs, pattern of using each drug and also patients' personal, social and medical history. Chi-square and fisher exact tests and determination of odds ratios were used in order to data analysis.
Results: Medium number of drugs used was 3.4 ± 1.9 in studied cases and %39.6 of cases were exposed to polypharmacy. The prevalence of physician prescribed drug usage was observed to be increased by increasing number of total used drugs in each case (P<0.002). The most commonly used drugs were A.S.A, Atenolol and propranolol and these drugs were prescribed by physician in over than %90 of cases. There was a positive correlations between polypharmacy with referring to multiple physicians (OR=1.96, CI 95%, 1.28-2.98) (P<0.002) and adverse drug reactions (OR=2.44, CI 95%, 1.47-4.05) (P<0.001). Polypharmacy was more prevalent in the age group of 65-75 years (P<0.04) and lower levels of education (P<0.004) and less prevalent in the group with moderate income (P<0.001).
Conclusion: Polypharmacy is common among adults aging 55 years and more in Tehran and is affected by age, education level and economic status.
Volume 65, Issue 3 (6-2007)
Background: The effects of population aging are becoming apparent throughout the world. Diseases, such as cardio-vascular disease (CVD) and diabetes, are among the most important factors affecting morbidity and mortality, especially in the elderly. These diseases not only result in huge economic costs for treatment and care, but also results in hardship and time lost for relatives of the afflicted individuals. The association between nutritional status and disease is well known. In the present study, the effects of both under-nutrition and over-nutrition on the prevalence of disease are monitored in an urban Iranian elderly population. Thus far, no similar study has been performed in the Iran.
Methods: This cross-sectional study was conducted in Isfahan, Iran, during late 2003 on 1694 elderly people (731 males, 963 females), aged 60 years and older. Subjects were randomly chosen from all urban elderly people during a door-to-door and weight and height survey. They were selected using a cluster sampling method, each containing 30 clusters. From each cluster, 58 elderly were selected at random. Using each subjects body mass index (BMI), the nutritional status was categorized as overweight (BMI greater than 25), underweight (BMI less than 19) and normal (having a BMI equal to or more than 19 and equal to or less than 25). Any illnesses known to each subject were also recorded.
Results: Results showed that 4.7% of the subjects were underweight and 61.2% overweight. Women were more likely to be overweight and long periods of watching television increased the risk of overweight in all subjects. Being overweight was associated with diabetes and coronary vascular diseases, and lean people were less likely to suffer from such diseases.
Conclusion: This study indicates a high prevalence of overweight among the Iranian elderly population, indicating the need for improvement in nutritional status in order to reduce the prevalence of diabetes and CVD.
Volume 70, Issue 2 (5-2012)
Background: The basal levels of androgens in women decline gradually with age. These changes may reduce muscle strength and bone density leading to fatigue and psychological problems. Thus, the aim of this study was to compare the effects of resistance and endurance exercises on androgens, cortisol and lactate concentrations in elderly women.
Methods: In this study, 10 elderly women with a mean age of 54.3±3.74 years and a BMI of 24.88±2.07 kg/m2 completed an endurance exercise session (ES), a resistance exercise session (RS), and a control session (CS) in a randomized, cross-balanced design. The RS consisted of three sets of 10 repetitions of eight exercises with 80% 1RM (one repetition maximum) over of 45 minutes and the ES consisted of cycling at 60%-70% of maximum oxygen consumption for 45 minutes. During the CS, subjects performed no exercise. Before and immediately after exercises, and after 15 minutes of recovery, and also during CS blood samples were obtained an analyzed for serum testosterone, dehydroepiandrosterone sulfate, cortisol and lactate.
Results: There was a significant increase in testosterone levels following resistance and endurance exercise sessions (P<0.05). Dehydroepiandrosterone sulfate demonstrated a significant increase after resistance exercise (P<0.05). While differences in cortisol levels were not significant within groups, but they were significant (P<0.05) between groups.
Conclusion: A session of resistance exercise in elderly women can increase concentrations of androgens that are essential for their health and well-being.
Volume 71, Issue 9 (12-2013)
Background: Choosing the right drug with the least side effects and highest effectiveness for the control of seizures in the elderly is important. The aim of this study was compare the efficacy of lamotrigine and levetiracetam in the management of epilepsy in the elderly.
Methods: This study was performed as a double-blind randomized clinical trial in patients that referred to the neurologic clinic at Sina University Hospital, Tehran, Iran in 2012. The patients over sixty years old with a diagnosis of epilepsy were selected. They had one seizure in year at least and one attack in the last 6 months. First, the patients divided to two groups Group one were treated with lamotrigine, 25 mg per day and group two were treated with levetiracetam, 250 mg per day for 24 weeks. In the absence of drug complications, the dose was increased to the maximum dose listed in the treatment protocol. Second the patients were followed in number of attacks, abnormalities in laboratory data and side effects of drug in 2, 4, 8, 12 and 20 weeks. The collecting data of the study were analyzed using descriptive and analytical statistics methods.
Results: Forty nine cases, 28 males and 21 females in lamotrigine group and 46 cases in levetiracetam group, 27 males and 19 females participated in the final analysis. Mean age of patients was 72.40±5.87 (63-85). Drug side effects were observed in 57 cases, 26 cases of lamotrigine group and 31 cases of levetiracetam group. Seizure frequency showed a declining trend in both groups but in lamotrigine group more than levetiracetam group in last week (P= 0.039).
Conclusion: The findings of the study showed lamotrigine and levetiracetam were effective in management of epilepsy in the elderly. Levetiracetam has a higher seizure-free effect than lamotrigine but lamotrigine is better tolerated than levetiracetam.
Volume 76, Issue 5 (8-2018)
Methods: This cross-sectional study is part of a cohort study, "investigation of the health status of elderly in Amirkola City", which was performed on 1616 old people aged≥ 60 years, (response rate 72 %). The baseline data of this study were collected in the Center for Social Determinants of Health (SDH) Research Centre of the Babol University of Medical Sciences during March 2011 to July 2012. We considered the age, sex, physical activity, quadriceps muscle strength, daily activity, serum level of vitamin D, BMI, number of comorbidities and orthostatic hypotension as independent variables. Using the results of Berg balance test, the balance status of participants (as dependent variable) was categorized into two groups: score between 41-56 as normal (low risk of fall) and score < 41 as balance disorder (medium or high risk of fall). Then, the association of independent variables with balance status were evaluated in the logistic regression model.
Results: The mean and standard deviation of participants' age was 69.37±7.6 years, 54.7% of them were men and 7.5% of them had balance disorder. The odds ratio of medium or high falls in women to men, the number of comorbidities, having strong quadriceps to weak muscles, seniors aged 80 years and over, to 60-69, seniors with high physical activity to low physical activity, daily activities were (OR=2.1, 95%CI: 1.0-4.1), (OR=1.7, 95%CI: 1.0-2.9), (OR=0.05, 95%CI: 0.0-0.4), (OR=5.0, 95%CI: 2.3-10.6), (OR=0.3, 95%CI: 0.1-0.6), (OR=14.4, 95%CI: 3.4-60.4), respectively and statistically significant. The odds ratio of fall for vitamin D, orthostatic blood pressure and BMI variables did not show any statistically significant differences. The results of the analysis showed that the balance in all age groups in men was better than women.
Conclusion: Weak quadriceps, aging, being a woman and having comorbidities are the most important risk factors of balance disorder in the elderly.
Volume 79, Issue 9 (12-2021)
Methods: The present retrospective cohort study was performed on 444 elderly patients with Covid-19 admitted from 1 April until late October 2020 in Baharloo Hospital in Tehran, Iran. After being diagnosed using the results of RT-PCR and CT scan, patients, were divided into 3 groups: moderate, severe and very severe based on the severity of the disease. Analysis of variance was used to compare quantitative data and a chi-square test was used to examine qualitative variables in disease groups.
Results: From 444 elderly participants in the study, 73% were infected moderately, 15% severely, and 12% had a very severe form. The mean age was 72.90±8.42 and patients with a very severe form of the disease (75.68±8.28) were older. The average time from the onset of symptoms to hospitalization was 7 days. In the elderly with a very severe form of the disease, respiratory dyspnea (P=0.002) and decreased level of consciousness (P<0.0001) were higher. The average hospital stay was 7 days. In very severe form it lasted up to 11 days. ICU mortality and hospitalization were higher in patients with very severe forms of the disease. With the increasing delay in the days of hospitalization, the severity of the disease and mortality has increased.
Conclusion: The study showed that prolonging the onset of symptoms till hospitalization worsens prognosis and also exacerbates the disease and increases mortality in the elderly.
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