Clinical associations of lymphopenia in elderly persons admitted to acute medical and psychiatric wards.

Lymphopenia is a common finding in old people admitted to medical and psychiatric wards. We describe a pilot study of the clinical associations, and prognostic significance of lymphopenia in elderly persons admitted to acute medical and psychiatric wards. Consecutive patients admitted to acute medical and psychiatric wards were prospectively selected according to initial peripheral lymphocyte count (PLC) into lymphopenic (PLC < 1.0 X 10(9)/litre, n = 41), and non-lymphopenic (PLC > 1.5 x 10(9)/litre, n = 23). Results of routine haematological and biochemical investigations were recorded, as well as drug history and medical diagnoses. Anthropometric measurements, assessment of functional ability (Barthel ADL Index), and cognitive function (Mini-Mental State Examination) were then performed by investigators blind to lymphocyte status. Patients were contacted between 3 and 6 months following recruitment into the study. Lymphopenia was associated with functional ability as measured by a lower Barthel score (p = 0.004), and cognitive impairment as measured by the Mini-Mental State Examination (p = 0.02). No association was found with medical diagnostic groupings, drugs known to cause lymphopenia, nutritional status, or survival. Lymphopenia may be a significant marker of vulnerability, and a larger study is required to elucidate the veracity and mechanisms of lymphopenia-associated debility.

Longitudinal weight changes over four years and associated health factors in 629 men and women aged over 65.

OBJECTIVES: (1) To assess changes in body weight longitudinally over 4 years in a representative group of men and women aged over 65 years, living in their own homes. (2) To assess whether initial weight (or weight in proportion to skeletal size) was associated with health 4 years later. (3) To assess whether any changes found in body weight were associated with changes in physical or mental health. (4) To compare the cross-sectional age-related changes in weight found in the initial survey with the longitudinal changes found over 4 years. DESIGN: A large randomised age-stratified survey using a structured questionnaire and measurements of body weight and demispan (for skeletal size), with a 4-year follow-up. SETTING: The survey was conducted in the respondents' own homes. SUBJECTS: 958 subjects age over 65 years, who were recruited from the Nottingham general practitioners' lists, took part in the initial survey; 629 of these subjects completed the second survey 4 years later. RESULTS: (1) The mean 4-year change in body weight was a small but significant loss; in women (n = 385) it was 1.56kg (P <0.001, 95% CI 1.02-2.10) and in men (n = 244) 0.85kg (P = 0.010, 95% CI 0.21-1.49). (2) Initial weight did not predict mortality, new morbidity nor health 4 years later. (3) There were no robust associations between weight change ans either absolute measures of physical health or changes in these measures. (4) The longitudinal change in weight was similar to that predicted by the cross-sectional data. CONCLUSIONS: (1) Ageing, in old age, is associated with loss of body weight, but with a large intra-individual variation. (2) Neither initial body weight nor the change, was associated with mortality or morbidity over 4 years in a large representative sample of old people living in their own homes in a food-rich country.

Habitus and hip fracture revisited: skeletal size, strength and cognition rather than thinness?

In a prospective study, 50 consecutive women with fractured hips were compared for body mass, skeletal size, handgrip strength and the 12-point information/orientation CAPE score with 50 age-matched women who had never broke their hips. Women were excluded from both groups if they lived in institutions or were severely disoriented. Although weight and skeletal size were significantly lower in the patients than in the controls, weights when corrected for skeletal size were not significantly different. Handgrip was significantly lower in the cases than in the controls. Both handgrip strength and CAPE score were significant correlates of hip fracture in multiple regression analysis. After exclusion of heavily dependent patients, hip fracture may be associated with reduced muscle strength rather than reduced body mass or fat.

Normal values for weight, skeletal size and body mass indices in 890 men and women aged over 65 years.

Measurements of body weight and skeletal size have been made, as part of a demographically representative survey, in 532 women and 358 men aged over 65 years living in their own homes. Body weight was assessed using calibrated portable scales. Skeletal size was measured as half body span (demispan) using a steel tape stretched from the sternal notch to the finger roots. Age had a weak but significant negative association with both body weight and demispan. After controlling for demispan, age still accounted for a significant decline in weight (in kg per decade) of 2.5 in men and 3.5 in women. Weight, demispan and indices of weight-for-skeletal-size have been presented as percentiles for men and women separately.

Protein turnover in malnourished elderly subjects: the effects of refeeding.

A primed constant-rate infusion of L-(l-14C)-leucine was used to assess protein flux, synthesis, and breakdown in a group of malnourished elderly subjects (n = 9) and a group of age-matched healthy elderly control subjects (n = 9). No significant differences between the two groups were observed in measures of protein metabolism. Four out of six malnourished subjects, restudied after a period of dietary replenishment, showed non-significant increases in protein synthesis and breakdown. Plasma insulin concentrations were significantly suppressed (p less than 0.05) and plasma growth hormone and cortisol concentrations significantly elevated (p less than 0.05) in the malnourished subjects before and after refeeding compared with the healthy elderly controls.

The effects of old age and immobility on protein turnover in human subjects with some observations on the possible role of hormones.

Protein turnover (PT), synthesis (PS) and breakdown (PB) were studied using L-(1-14C)-leucine and primed continuous infusion of 14C-HCO3 over a 6-h study period in three groups: group 1 (n = 9) fit old; group 2 (n = 6) fit young; and group 3 (n = 13) immobile old. Plasma cortisol, growth hormone (GH) and insulin levels were measured during the studies. There were significant reductions in PT (p less than 0.02), PB (p less than 0.02) and PS (p less than 0.01) in fit old compared to fit young subjects. Comparison between fit old versus immobile old subjects revealed that the immobile group (Group 3) had higher PT (p less than 0.05), PB (p less than 0.05) and PS (p less than 0.01) rates. The rates of protein turnover and components in group 3 were similar to those in group 2. There was greater variance in protein balance in the immobile subjects. Significantly higher plasma cortisols were found in the immobile than in the healthy old subjects. The immobile group had higher GH levels in response to feeding but there was no difference in insulin response to feeding. These higher plasma cortisol and GH levels may be partly responsible for the changes in PT found in immobile elderly patients.

Is primary biliary cirrhosis a different disease in the elderly?

We examined the presenting features, clinical course and prognosis in relation to age in 121 patients with primary biliary cirrhosis (PBC) for a mean follow-up of 4.6 years. 35 patients (29%) were over age 65 years at presentation/detection. There was a higher proportion of patients asymptomatic of liver disease in the older (over 65 years old) than younger (under 65 years old) group. The clinical features of PBC were less marked in the older patients both in number of symptoms (p less than 0.05) and in progression of serum bilirubin, a marker of prognosis (p less than 0.001). There was no difference in liver-related mortality between old and young patients during the follow-up period. Overall mortality in patients with PBC presenting over age 65 was no different from age- and sex-matched controls.