Prevalence of dyslipidemia in the elderly in rural areas of Thailand.

Dyslipidemia is highly prevalent in the urban areas of Thailand but information in the rural area, particularly in the elderly, is limited. The objective of this study was to determine the prevalence of dyslipidemia in the elderly who live in the rural areas of Thailand. Random sampling of the volunteers aged > or = 60 years in 3 districts of Samut Songkhram and Ratchaburi provinces was done. After 12-hour fast, the blood sampling was drawn for the analysis of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol. Eighty men and 123 women, aged 60-87 years old, were included in the study. Mean serum lipid levels of cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were 261.74+/-47.58, 180.35+/-45.06, 43.72+/-12.06, and 188.38+/-103.84 mg/dl respectively. Women had significantly higher body mass index, cholesterol and LDL cholesterol levels than men. Seventy percent of them had cholesterol > or = 240 mg/dl and LDL cholesterol > or = 160 mg/dl. Twenty-five percent had HDL cholesterol < or = 35 mg/dl. However, LDL/HDL cholesterol ratio > 5 which indicated high risk for coronary heart disease were found in only 34%. In conclusion, prevalence of dyslipidemia was very high in Thai rural elderly. Further surveillance in this population is essential in verifying the impact of dyslipidemia as a risk of cardiovascular disease in Thai elderly people.

Hypertension in the elderly: a community study.

Hypertension in the elderly features differently from its younger counterpart in terms of diagnosis, associated condition, atypical manifestation, management and complication. Epidemiological study in this increasing age group in the community is, therefore, needed. 334 elderly subjects living in various parts of Bangkok were randomly recruited by appointment at 7 geriatric day centers situated in local health offices of Bangkok Metropolitan Authority. Each subject received blood tests before being interviewed and measured by digital sphygmomanometer. Blood pressure and heart rate changes were recorded during lying, sitting and standing. The prevalence of hypertension was 36.5 per cent, 33.2 per cent were already aware of its existence while 3.3 per cent were newly detected by the survey. Isolated systolic hypertension, a unique subtype found in the elderly, was 4.5 per cent of all or 37.5 per cent among the hypertensive group. The associated medical conditions among the case group were diabetes mellitus 22.9 per cent, hyperlipidemia 13.9 per cent, hyperuricemia 33.3 per cent and heart disease 18.0 per cent. As far as postural hypotension is concerned, 14.8 per cent of case group whereas 11.3 per cent of the control group were affected. On the other hand, the symptom of postural dizziness was found to be 31.1 per cent and 55.2 per cent in the case and control group respectively. Following the statistical logistic regression analysis, the independent associated factors in the hypertension group were: history of hyperlipidemia, increased serum uric acid and poor heart rate response after standing. These findings, as parts of the multiple pathology and potential complications prevalent among this group, should be of concern by any physician looking after the elderly.

The epidemiologic study of geriatric patients at siriraj geriatric clinic.

A retrospective study was designed to explore the epidemiology of geriatric patients at Siriraj Geriatric Clinic organised by the department of Preventive and Social Medicine, both in terms of social and medical aspects. A total of 854 patients were recruited with a male to female ratio of 1 : 1.6 and an average age of 67.1 + 6.1 years in 1985 and two years more in 1995 ranging from 60-90 years. The majority of the patients were married (62.1%), achieved secondary school (47.5%) and depended on pensions (46.4%). The average number of family member actually living in the same house was 4.0 + 2.7. The number of those who smoked cigarettes, drank alcohol and consumed tonic food were 29.1 percent, 41.7 percent and 48.7 percent respectively, while multivitamins were taken most in the tonic food category (31.7%). Regarding the prevalence of clinical complaints, arthralgia was the most common problem (58.3%) followed by amnesia (51.5%). Those who lived in a single family tended to be economically poorer than those who lived as an extended family, and they tended to work outdoors during the pre-retirement period. Being unable to take the bus was the most common disability among instrumental activity of daily living (IADL) while the elderly aged 71 years or more were found more among those who failed to perform each aspect of instrumental activity of daily living, especially in self-drug administration with the highest odds ratio of 19.5 (95% confidence interval 2.4-884.9). As far as systemic complaints were concerned, the elderly aged 71 years or more were found to suffer more significantly from hearing loss and urinary system symptoms with an odds ratio of 2.4 (95% confidence interval 1.5-3.7) and 2.1 (95% confidence interval 1.0-4.4) sequentially. When considering the impact of clinical complaints to the IADL, those of visual abnormality, hearing loss, urinary symptoms, amnesia and insomnia were found more frequently in those patients with impaired IADL that was statistically significant. The elderly with three chronic diseases or more or who were regularly taking three types of drugs or more would be disabled in terms of IADL, with odds ratios of 1.8 (95% confidence interval 1.1-2.9) and (95% confidence interval 1.8-6.4) respectively.

Urinary tract infection in the elderly: a clinical study.

Urinary tract infection is one of the most common causes of infection in the elderly living in the community as well as in institutions. While the preventive measures involve the enhancement of immunological status, perineal hygiene and avoiding unnecessary instrumentation, the clinical manifestation predicting the outcome, the main objective of the study, is also no less important after the infection takes place. Cross-sectional study was designed recruiting 107 cases from the general medical wards to compare various relevant clinical parameters in terms of the final outcome. The result showed that the aged group 75 years old or more, the catheter-related cases, prior bedbound status, confusion, anorexia with nasogastric tube feeding, respiratory failure requiring mechanical ventilation, septic shock, the presence of candida in urine, the extreme temperature either less than 37 degrees C or more than 40 degrees C and finally the mistake in interpreting the gram stain of the urine were found more common in the dead group with statistical significance. Multiple logistic regression analysis revealed anorexia with nasogastric tube feeding, prior bedbound status, the need for mechanical ventilation, septic shock and extreme body temperature response independently predicted the outcome of the elderly with urinary tract infection.

Relationships of vitamin B1, B12, folate and the cognitive ability of the Thai rural elderly.

The comparisons of the levels of vitamin B1, B12 and folate between the elderly with good and poor cognitive ability are the goals of this study. 203 subjects enrolled in 3 geriatric centers of Ratchaburi province and nearby were recruited. All the subjects were tested with structured Thai Mini Mental State Examination (TMSE) questionnaire by trained examiners. With the cut off point of 23 out of 30 in TMSE, 31 per cent were designated as poor cognitive group. Radiodilution assay was used to determine the level of serum B12 and red cell folate while the TPP effect was processed by spectrophotometry. The prevalence of vitamin B1, B12 and folate deficiency were 30.2 per cent, 3.8 per cent and 8.2 per cent consecutively. None of the studied vitamin levels was shown to be significantly different between the poor and good cognitive group suggesting no proved indication to the use of vitamin B1, B12 and folate in the healthy elderly with poor cognitive function.

Liver abscess in polycystic liver disease.

A case of an elderly female whose clinical manifestations were atypical in view of physiologic aging changes and multiple pathology commonly found in the geriatric group. The liver abscess had presented clinically and radiologically like a hepatic malignancy and pus was obtained during the process of liver biopsy. Even though anchovy-like pus suggested amebic in origin, the microscopic exam showed numerous polymorphonuclear leucocyte and the culture both from the blood and pus grew Klebsiella spp. as well as the study for E. histolytica antibody was also negative. Pyogenic liver abscess was the working diagnosis and indicated for surgical drainage. Adult polycystic liver disease was found intraoperatively and the liver pathology did reveal the presence of many amebae in the cavity of the right lobe of the liver. After the administration of ceftriaxone and metronidazole as well as the surgical drainage, the patient recovered uneventfully within sixteen days of admission.

Septicemia in the elderly.

The epidemiologic study regarding septicemia in the elderly was done in general medical wards and intensive care units of Department of Medicine, Siriraj Hospital. The average age of the 100 patients recruited was 70.6 + 8.2 years old with the prevalence of community-acquired septicemia and nosocomial septicemia being 52% and 48% respectively. Sex, the ratio of infection from gram-negative and gram-positive organisms and the mortality rate were not significantly different between those two groups of patients. Gram-negative septicemia constituted 70% of all infections i.e. 2-2.5 time of gram-positive septicemia. The most frequent causative organisms were E. coli (19%) and nonfermentative gram-negative rod (18-%) whereas Staphylococcus aureus was found in greatest number among gram-positive organisms (10%). The mortality rate of septicemia was 49% but only 28% could be discharged alive due to the fact that another 23% of the patients died from other causes such as from the complications of their own underlying diseases as only 2% had no any underlying disease. Cirrhosis was found to be the most serious underlying disease with the mortality rate of 1%. The most common identified site of infection was urinary tract infection (16%), however, intravascular catheter was responsible for nosocomial septicemia in the greatest extent. Serum albumin nonspecific prognostic in elderly patients with the average value of 3.01 + 0.78 gm% among the survivors and 2.55 + 0.97 gm% among the victims. Multiple logistic regression analysis showed that septic shock, hypothermia and consciousness were the independent risk factors of the mortality rate of septicemia in the elderly.