Withdrawal from long-term use of zopiclone, zolpidem and temazepam may improve perceived sleep and quality of life in older adults with primary insomnia.

Long-term use of benzodiazepines or benzodiazepine receptor agonists is widespread, although guidelines recommend short-term use. Only few controlled studies have characterized the effect of discontinuation of their chronic use on sleep and quality of life. We studied perceived sleep and quality of life in 92 older (age 55-91 years) outpatients with primary insomnia before and after withdrawal from long-term use of zopiclone, zolpidem or temazepam (BZDA). BZDA was withdrawn during 1 month, during which the participants received psychosocial support and blindly melatonin or placebo. A questionnaire was used to study perceived sleep and quality of life before withdrawal, and 1 month and 6 months later. 89 participants completed the 6-month follow-up. As melatonin did not improve withdrawal, all participants were pooled and then separated based solely on the withdrawal results at 6 months (34 Withdrawers. 55 Nonwithdrawers) for this secondary analysis. At 6 months, the Withdrawers had significantly (P < 0.05) shorter sleep-onset latency and less difficulty in initiating sleep than at baseline and when compared to Nonwithdrawers. Compared to baseline, both Withdrawers and Nonwithdrawers had at 6 months significantly (P < 0.05) less fatigue during the morning and daytime. Stress was alleviated more in Withdrawers than in Nonwithdrawers (P < 0.05). Satisfaction with life and expected health 1 year later improved (P < 0.05) in Withdrawers. In conclusion, sleep disturbances, daytime fatigue and impaired quality of life may resolve within 6 months of BZDA withdrawal. These results encourage withdrawal from chronic use of benzodiazepine-type hypnotics, particularly in older subjects.

Long-term persistence of withdrawal of temazepam, zopiclone, and zolpidem in older adults: a 3-year follow-up study.

BACKGROUND: Studies on persistence of benzodiazepine agonist (BZDA) withdrawal in older outpatients are few, and few studies on long-term persistence over years have yet been published. To describe the persistence of temazepam, zolpidem, and zopiclone (BZDA) withdrawal among older outpatients at 3 years from the beginning of withdrawal, as well as any changes in use of other medications. METHODS: 92 outpatients (≥55 years) with primary insomnia, long-term BZDA use as hypnotics (mean duration of BZDA use 9.9 ± 6.2 years), and willingness to withdraw from BZDAs each received either melatonin or a placebo nightly for one month. During this period, BZDAs were meant to be gradually withdrawn. Sleep hygiene counselling and psychosocial support were provided. Three years later, use of BZDAs and other medications was determined by interview and confirmed from medical records. RESULTS: Of the original 92 outpatients, 83 (90%) participated in the 3-year survey (mean follow-up 3.3 ± 0.2 years). The number of BZDA-free participants decreased from 34 (37%) at 6 months to 26 (28%; intention-to-treat) at 3 years, that of irregular BZDA users decreased from 44 (48%) at 6 months to 27 (29%) at 3 years, while that of regular users increased from 11 (12%) at 6 months to 30 (33%) at 3 years (P = 0.001). Those who were regular BZDA users at 3 years had at baseline (before withdrawal) higher BMI (P = 0.001) than did other participants. At 3 years, the total number of medications remained unchanged for non-users (P = 0.432), but increased for the irregular (P = 0.011) and regular users (P = 0.026) compared to baseline. At 3 years, compared to baseline, use of antidepressants, dopamine agonists, melatonin, and NSAIDs/paracetamol was significantly more common in the whole cohort, but their use did not differ between the BZDA-user subgroups. Randomization to melatonin or placebo during BZDA withdrawal was unrelated to BZDA-withdrawal result. CONCLUSIONS: At 3 years after withdrawal, the number of BZDA-free participants had decreased, but still one-third of the subjects remained BZDA-free, and one-third had reduced their use. Successful BZDA withdrawal did not lead to any increase in total number of medications; use of symptomatic medications in the whole cohort, however, did increase.

High sensitive C-reactive protein (hsCRP), cardiovascular events and mortality in the aged: a prospective 9-year follow-up study.

OBJECTIVE: The clinical utility of application of hsCRP categorization and the association of hsCRP with vascular disease (VD) events are less studied among the aged. This study investigated whether an elevated hsCRP has an additive effect on conventional vascular risk factors in predicting cardiovascular morbidity and all-cause mortality among the aged. METHODS AND RESULTS: a prospective population-based study with a 9-year follow-up among persons aged ≥64 and without VD and C-reactive protein (CRP)<10mg/L at baseline (n=771). Adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) for VDs and all-cause mortality predicted by hsCRP level were estimated. During the follow-up, there were 151 major VD events, and 217 subjects died. After the adjustment for age and gender or risk factors related to VD events or a metabolic syndrome (MetS), hsCRP was not related to incident VD events (HR 1.14, 95% CI 0.96-1.35, p=.127 or 1.11, 0.94-1.32, p=.212, respectively). hsCRP predicted all-cause mortality after the adjustment for age and gender (1.18, 1.03-1.36, p=.020) and multiple factors (1.16, 1.00-1.33, p=.046) but not beyond conventional risk factors. High risk participants (hsCRP 3.0-9.9mg/L) had higher age and gender adjusted (1.50, 1.07-2.10, p=.018) and tended to have higher risk factor adjusted all-cause mortality (1.41, 1.00-2.00, p=.052) compared with low risk participants (hsCRP<1mg/L). CONCLUSIONS: hsCRP may not be useful in prediction of cardiovascular events.

Sex hormones and the risk of type 2 diabetes mellitus: A 9-year follow up among elderly men in Finland.

AIM: To analyze whether sex hormone levels predict the incidence of type2 diabetes among elderly Finnish men. METHODS: This was a prospective population-based study, with a 9-year follow up period. The study population in the municipality of Lieto, Finland, consisted of elderly (age ≥64 years) men free of type 2 diabetes at baseline in 1998-1999 (n = 430). Body mass index and cardiovascular disease-adjusted hazard ratios and their 95% confidence intervals for type 2 diabetes predicted by testosterone, free testosterone, sex hormone-binding globulin, luteinizing hormone, and testosterone/luteinizing hormone were estimated. RESULTS: A total of 30 new cases of type 2 diabetes developed during the follow-up period. After adjustment, only higher levels of testosterone (hazard ratio for one-unit increase 0.93, 95% confidence interval 0.87-0.99, P = 0.020) and free testosterone (hazard ratio for 10-unit increase 0.96, 95% confidence interval 0.91-1.00, P = 0.044) were associated with a lower risk of incident type 2 diabetes during the follow up. These associations (0.94, 95% confidence interval 0.87-1.00, P = 0.050 and 0.95, 95% confidence interval 0.90-1.00, P = 0.035, respectively) persisted even after additional adjustment of sex hormone-binding globulin. CONCLUSION: Higher levels of testosterone and free testosterone independently predicted a reduced risk of type 2 diabetes in the elderly men.

Handgrip strength and balance in older adults following withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotics.

BACKGROUND: Benzodiazepines and related drugs affect physical functioning negatively and increase fall and fracture risk. As impaired muscle strength and balance are risk factors for falls, we examined the effects of hypnotic withdrawal on handgrip strength and balance in older adult outpatients during and after long-term use of temazepam, zopiclone and zolpidem (here collectively referred to as "benzodiazepines"). METHODS: Eighty-nine chronic users (59 women, 30 men) of temazepam, zopiclone or zolpidem aged ≥55 years participated in a benzodiazepine withdrawal study. Individual physician-directed withdrawal was performed gradually over a one-month period and participants were followed up to six months. Handgrip strength was assessed using a handheld dynamometer, and balance using the Short Berg's Balance Scale during the period of benzodiazepine use (baseline), and at 1, 2, 3 weeks, and 1, 2 and 6 months after initiating withdrawal. Withdrawal outcome and persistence were determined by plasma benzodiazepine-determinations at baseline and at four weeks ("short-term withdrawers", n = 69; "short-term non-withdrawers", n = 20), and by interviews at six months ("long-term withdrawers", n = 34; "long-term non-withdrawers", n = 55). Also most of the non-withdrawers markedly reduced their benzodiazepine use. RESULTS: Within three weeks after initiating withdrawal, handgrip strength improved significantly (P ≤ 0.005) compared to baseline values. Among women, long-term withdrawers improved their handgrip strength both when compared to their baseline values (P = 0.001) or to non-withdrawers (P =0.004). In men, improvement of handgrip strength from baseline was not significantly better in withdrawers than in non-withdrawers. However, men did improve their handgrip strength values compared to baseline (P = 0.002). Compared to balance test results at baseline, withdrawers improved starting from the first week after withdrawal initiation. There was, however, only a borderline difference (P = 0.054) in balance improvement between the long-term withdrawers and long-term non-withdrawers. Of note, the non-withdrawers tended to improve their handgrip strength and balance compared to baseline values, in parallel with their reduced benzodiazepine use. CONCLUSIONS: Withdrawal from long-term use of benzodiazepines can rapidly improve muscle strength and balance. Our results encourage discontinuing benzodiazepine hypnotics, particularly in older women who are at a high risk of falling and sustaining fractures. TRIAL REGISTRATION: EU Clinical Trials Register: EudraCT2008000679530. Registered 31 October 2008.

Melatonin for sedative withdrawal in older patients with primary insomnia: a randomized double-blind placebo-controlled trial.

AIM: We compared the efficacy of melatonin and placebo as adjuvants in the withdrawal of patients from long term temazepam, zopiclone or zolpidem (here 'BZD') use. METHODS: A double-blind, placebo-controlled, randomized trial was conducted in a primary health care outpatient clinic. Ninety-two men or women (≥55 years) with primary insomnia and chronic BZD use received controlled release melatonin 2 mg (CRM) (n = 46) or placebo (n = 46) during the 1 month withdrawal from BZDs. Psychosocial support was provided. Follow-up continued for up to 6 months. Successful BZD withdrawal by the end of 1 month was confirmed by BZD plasma determinations, while reduction in BZD use and abstinence continuing for 6 months were noted. RESULTS: There were two drop-outs on CRM and one on placebo. After a 1 month withdrawal, 31 participants (67%; 95% CI 54, 81) on CRM and 39 (85%; 74, 95) on placebo had withdrawn completely (intention-to-treat analysis between groups, P = 0.051; per protocol P = 0.043). Reduction in BZD use was similar or even more rare in the CRM than in the placebo group (P = 0.052 per protocol). After 6 months, 14 participants in the CRM group and 20 in the placebo group remained non-users of BZD (NS between groups). BZD doses were higher in the CRM than in the placebo group at the end of the 6 month follow-up (P = 0.025). Withdrawal symptoms did not differ between the groups. CONCLUSIONS: Gradual dose reduction of BZDs combined with CRM or placebo, and psychosocial support produced high short term and moderate long term BZD abstinence. CRM showed no withdrawal benefit compared with placebo.

Effect of withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotic agents on cognition in older adults.

PURPOSE: The aim of this study was to assess the effect of withdrawal from the long-term use of temazepam, zopiclone or zolpidem as hypnotics drugs (here referred to as BZD) on cognitive performance. METHODS: Ninety-two adults (age ≥55 years) with primary insomnia and who were long-term daily users of BZD volunteered to participate in a 1-month medically supported withdrawal attempt from BZD use, with a subsequent 5-month follow-up. Withdrawal was based on plasma BZD measurements at baseline, at 1 month and during subsequent regular clinical appointments. Attention and psychomotor performance were measured using the CogniSpeed® at baseline and at 1, 2 and 6 months. Reaction times were determined in the Simple Reaction Time (SRT), Two-Choice Reaction Time (2-CRT) and Vigilance tests, and errors were measured by the 2-CRT and Vigilance tests. The cognition data of the withdrawal group were also compared with a cohort of BZD non-users. RESULTS: Eighty-nine (97 %) participants (59 women, 30 men) were followed-up for a maximum of 6 months. During the follow-up period, changes in reaction times and errors did not differ between short-term withdrawers (no residual BZD at 1 month; N = 69), non-withdrawers (residual BZD at 1 month; N = 20) or long-term withdrawers (N = 34). Compared to the reaction times of the BZD-free cohort, those of BZD users were slower at baseline. The reaction times of BZD withdrawers based on the results of the SRT or 2-CRT tests during follow-up did not reach those of the BZD-free cohort, but there was no difference between these groups in the Vigilance test. CONCLUSIONS: Long-term use of BDZ as hypnotic drugs by older adults is related to prolonged impairment of attentional and psychomotor cognitive functioning that persists for at least 6 months after withdrawal.

Midlife sleep characteristics associated with late life cognitive function.

STUDY OBJECTIVES: Previous studies with limited follow-up times have suggested that sleep-related traits are associated with an increased risk of incident dementia or cognitive decline. We investigated the association between midlife sleep characteristics and late life cognitive function. DESIGN: A follow-up study with a median follow-up time of 22.5 (range 15.8-25.7) years assessing the association between midlife sleep characteristics and later cognitive function. SETTING: Questionnaire data from 1981 were used in the assessment of sleep characteristics, use of hypnotics, and covariates at baseline. Between 1999 and 2007, participants were assigned a linear cognitive score with a maximum score of 51 based on a telephone interview (mean score 38.3, SD 6.1). Linear regression analyses were controlled for age, sex, education, ApoE genotype, and follow-up time. PARTICIPANTS: 2,336 members of the Finnish Twin cohort who were at least 65 years of age. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Baseline short (< 7 h/day) and long (> 8 h/day) sleepers had lower cognitive scores than participants sleeping 7-8 h/ day (ß = -0.84, P = 0.014 and ß = -1.66, P < 0.001, respectively). As compared to good sleep quality, poor or rather poor sleep quality was associated with a lower cognitive score (ß = -1.00, P = 0.011). Also, the use of hypnotics ≥ 60 days per year was associated with poorer cognitive function (ß = -1.92, P = 0.002). CONCLUSIONS: This is the first study indicating that midlife sleep length, sleep quality, and use of hypnotics are associated with late life cognitive function. Further confirmation is needed, but sleep-related characteristics may emerge as new risk factors for cognitive impairment.

Does high sensitive CRP improve cardiovascular risk prediction in metabolic syndrome among the aged?

OBJECTIVES: To analyze whether an elevated level of high hsCRP has an additive effect on metabolic syndrome (MetS) in predicting future cardiovascular events (CVEs) as well as on all-cause mortality among the aged subjects. DESIGN: A prospective, population-based study with a 9-year follow-up. The study population consisted of persons aged 64 and above in 1998-99 without vascular disease and CRP less than 10 mg/l at baseline (n = 733). Adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) for CVEs and all-cause mortality predicted by baseline MetS (defined by both International Diabetes Federation (IDF) and World Health Organization (WHO)) and hsCRP-level were estimated. RESULTS: During the 9-year follow-up, a total of 142 CVEs and 206 deaths occurred. After multivariable adjustment, no significant interactions were found between hsCRP and MetS in CVEs (IDF: p = 0.828; WHO: p = 0.572) or in all-cause mortality (IDF: p = 0.113; WHO: p = 0.374). HsCRP was not associated with the occurrence of CVEs (IDF: HR = 1.10, 95% CI = 0.92-1.32, p = 0.281; WHO: HR = 1.10, 95% CI = 0.93-1.32, p = 0.247) or with all-cause mortality (IDF: HR = 1.12, 95% CI = 0.97-1.29, p = 0.134; WHO: HR = 1.11, 95% CI = 0.96-1.28, p = 0.146). CONCLUSIONS: It seems that hsCRP does not give any extra value in evaluation of CVE risk or all-cause mortality of older subjects with MetS.

Midlife cardiovascular risk factors and late cognitive impairment.

Cardiovascular risk factors increase the risk of dementia in later life. The aims of the current study were to assess the effect of multiple midlife cardiovascular risk factors on the risk of cognitive impairment in later life, and to assess the validity of the previously suggested CAIDE Study risk score predicting dementia risk 20 years later. A total of 2,165 Finnish twins were followed and at the end of the follow-up their cognitive status was assessed with a validated telephone interview. The assessment of the risk factors at baseline was based on a self-report questionnaire. Relative risk ratios (RR) were calculated and receiver operating characteristic analyses performed. Midlife obesity (RR 2.42, 95 % CI 1.47-3.98), hypertension (RR 1.38, 95 % CI 1.01-1.88) and low leisure time physical activity (RR 2.52, 95 % CI 1.10-5.76) increased the risk of cognitive impairment after a mean follow-up of 22.6 ± 2.3 years. Hypercholesterolemia did not significantly increase the risk (RR 1.52, 95 % CI 0.92-2.51). Overweight individuals who gained more than 10 % weight between 1981 and 1990 had an increased risk of cognitive impairment (RR 4.27, 95 % CI 1.62-11.2). The CAIDE Study risk score combining various individual risk factors had an area-under-curve of 0.74 (95 % CI 0.69-0.79, n = 591), and there was a strong association between an increasing risk score and the risk of cognitive impairment. The results indicate that multiple midlife cardiovascular risk factors increase the risk of cognitive impairment in later life. Also, a risk score including easily measurable midlife factors predicts an individual's cognitive impairment risk well.

Metabolic syndrome defined by modified International Diabetes Federation criteria and type 2 diabetes mellitus risk: a 9-year follow-up among the aged in Finland.

The aim was to analyse the relationship between metabolic syndrome and type 2 diabetes mellitus risk among the aged. This was a prospective population-based study, with a 9-year follow-up. All subjects of the municipality of Lieto in Finland aged ≥64 in 1998-1999 with no type 2 diabetes mellitus at baseline (n=1117) were included. Hazard ratios for incident type 2 diabetes mellitus predicted by metabolic syndrome (defined by modified International Diabetes Federation criteria) were estimated. During the 9-year follow-up, a total of 69 participants (6.2%) developed type 2 diabetes mellitus. After multivariable adjustment (age, gender, smoking, frequency of exercise, cardiovascular disease and low-density lipoprotein-cholesterol), type 2 diabetes mellitus (hazard ratio, 95% confidence interval) (3.15, 1.89-5.25, p < 0.001) was more common in subjects with metabolic syndrome compared to subjects without it. Evaluating metabolic syndrome components individually, impaired fasting glucose (5.09, 2.64-9.82, p < 0.001) and obesity (1.71, 1.05-2.97, p = 0.034) predicted a higher incidence of type 2 diabetes mellitus. Our findings suggest that metabolic syndrome predicts onset of type 2 diabetes mellitus even in late life. Impaired fasting glucose and obesity should be targets for primary prevention of diabetes among the aged with metabolic syndrome.

Self-neglect of the elderly. An overview.

Self-neglect is characterized by the inability to perform essential self-care tasks threatening a person's health and safety. The exact prevalence of self-neglect in a community-based aged population is not known. Cognitive impairment is the most important predisposing factor of self-neglect. There are also a number of other predisposing factors such as psychiatric diseases, pre-morbid personality, alcohol abuse, poor physical ability, lack of social support and a low socioeconomic situation. Self-neglect has a number of serious consequences. It is an independent risk factor for early mortality among the aged. It commonly causes malnutrition, frailty and the deterioration of physical ability, therefore, increasing the risk of falls and fractures. Untreated medical conditions result in emergency visits and acute hospitalization. The neglect of housekeeping and financial affairs seriously affects the domestic environment. Diagnosis and treatment of self-neglect should be based on the medical and psychosocial assessment of a patient. Patients require multidisciplinary support at home or in hospital, and sometimes long-term care is inevitable. There is no sufficient scientific evidence to support the benefits of early intervention in self-neglect. Controlled studies are needed, especially to show whether early diagnosis followed by increased social support and tailored health care services have an effect on the outcome.

CNS medications as predictors of precipitous cognitive decline in the cognitively disabled aged: a longitudinal population-based study.

BACKGROUND/AIMS: Psychotropics and antiepileptics (AE) are medications commonly used among the aged with cognitive decline or dementia, although they may precipitate further cognitive decline. Our aim was to analyze the relationships between the use of (i) psychotropics (i.e. benzodiazepines or related drugs, BZD, antipsychotics, AP, or antidepressants, AD), opioids (Op), anticholinergics (ACh) or AEs or the concomitant use of two of these drugs, and (ii) the risk of precipitous cognitive decline in an older (≥65 years) cognitively disabled population. METHODS: A longitudinal population-based study of general aged community-dwelling patients was executed in two phases (1990-1991 and 1998-1999) in Lieto, Finland. Fifty-two individuals cognitively disabled (MMSE score 0-23) at the 1990-1991 baseline form this study's sample. Cognitive abilities were assessed in each phase with the Mini-Mental State Examination (MMSE) and medication utilization data were collected in both phases. The mean follow-up time was 7.6 years. Multivariate models were used to analyze the change in MMSE total score between medication users and non-users. RESULTS: BZD or any psychotropic use was associated with greater cognitive decline in elders aged ≥75 years compared to non-users (change in MMSE sum score: -8.6 ± 7.0 vs. -3.3 ± 5.6 and -5.9 ± 7.0 vs. -2.7 ± 6.4, respectively). A greater decline was also associated specifically with the concomitant use of BZD and AP (-16 vs. -1.4 ± 7.8); as were BZD and any drug with CNS effects (-9.6 ± 9.9 vs. -1.3 ± 7.2) compared to non-users. The concomitant use of BZD and AD (-10.7 ± 4.7 vs. -3.2 ± 5.6) or ACh (-15.0 ± 8.5 vs. -3.3 ± 5.6) or any drug with CNS effects (-13.3 ± 6.5 vs. -3.3 ± 5.6) was associated with cognitive decline in patients ≥75 years compared to non-users of any drug with CNS effects. CONCLUSION: The use of a BZD or any psychotropic medication may be an independent risk factor for cognitive decline in the cognitively disabled aged, and patients co-prescribed psychotropic medications had greater cognitive decline. Studies with larger sample sizes and studies on possible pathophysiologic mechanisms are needed.

Morbidity in aged Finns: a systematic review.

AIM: The aim was to carry out a systematic review of original studies about morbidity in the aged in Finland. METHODS: Publications with data on morbidity in the aged (≥65 years) in peer-reviewed scientific journals in Finnish and English were systematically searched for in literature databases, websites of National Institute of Health and Welfare (NIHW), National Public Health Institute (NPHI), and Stakes and reference lists of retrieved articles. Publications from 1990 onwards were included. RESULTS: The search produced 39 publications about morbidity in the aged in Finland fulfilling the inclusion criteria. The most common disease categories in the aged were cardiovascular diseases (CVDs), musculoskeletal disorders (MSDs), hypertension, orthostatic hypotension (OH), insomnia, diabetes, articular diseases, diseases causing cognitive decline, and depression. The prevalence of many of these diseases increased with age. CONCLUSIONS: The morbidity increases with aging, and even the oldest-old are not exceptionally healthy. Because of the increasing number of aged people, the absolute use of health and social services by this population sector will most probably increase in Finland and other developed countries.

Fractures as an independent predictor of functional decline in older people: a population-based study with an 8-year follow-up.

BACKGROUND: Fractures among older people are common, but there is scant evidence about the impact of fractures on functional decline in an unselected older population. OBJECTIVE: The objective of this study was to analyze the impact of lower and upper body fractures on functional performance among older adults during an 8-year follow-up. METHODS: A population-based cohort of 616 Finnish persons aged 65 and over was followed for up to 8 years, and the association between fractures and the risk of short-term (0-2 years) and long-term (up to 8 years) functional decline was analyzed. Fractures were categorized according their functional influence on mobility and activities of daily living (ADL) into lower and upper body fractures. Multivariate cumulative logistic regression model was used in the analyses. RESULTS: During the 8-year follow-up, 112 (18%) persons sustained at least one fracture. In the multivariate analyses, lower body fractures predicted both short-term and long-term decline in mobility [cumulative odds ratio (COR) 4.7, 95% confidence interval (95% CI) 1.9-11.7 and COR 2.6, 95% CI 1.1-6.2, respectively] and in ADL performance (COR 3.1, 95% CI 1.3-7.6 and COR 4.7, 95% CI 2.0-11.4, respectively). Upper body fractures predicted decline in ADL performance during the long-term follow-up (COR 2.5, 95% CI 1.3-4.8). Pre-fracture functional decline and inactivity in leisure time physical exercise were independently associated with the risk of decline in extensive activities. CONCLUSION: Fractures have an independent influence on the development of functional decline in older persons regardless of the pre-fracture health. Prevention of falls and fractures and improvement of treatment, rehabilitation and follow-up process after fractures are needed.

Use of CNS medications and cognitive decline in the aged: a longitudinal population-based study.

BACKGROUND: Previous studies have found associations between the use of central nervous system medication and the risk of cognitive decline in the aged. Our aim was to assess whether the use of a single central nervous system (CNS) medication and, on the other hand, the combined use of multiple CNS medications over time are related to the risk of cognitive decline in an older (≥ 65 yrs) population that is cognitively intact at baseline. METHODS: We conducted a longitudinal population-based study of cognitively intact older adults. The participants were 65 years old or older and had Mini-Mental State Examination (MMSE) sum scores of 24 points or higher. The study included a 7.6-year follow-up. The use of benzodiazepines and related drugs (BZDs), antipsychotics (APs), antidepressants (ADs), opioids (Ops), anticholinergics (AChs) and antiepileptics (AEs) was determined at baseline and after a 7.6-years of the follow-up period. Cognitive functioning was used as an outcome variable measured with MMSE at baseline and at the mean follow-up of 7.6 years. Control variables were adjusted with analyses of covariance. RESULTS: After adjusting for control variables, the use of Ops and the concomitant use of Ops and BZDs as well as the use of Ops and any CNS medication were associated with cognitive decline. The use of AChs was associated with decline in cognitive functioning only in men. CONCLUSIONS: Of all the CNS medications analyzed in this study, the use of Ops may have the greatest effect on cognitive functioning in the ageing population. Due to small sample sizes these findings cannot be generalized to the unselected ageing population. More studies are needed concerning the long-term use of CNS medications, especially their concomitant use, and their potential cognitive effects.

Self-neglect in the case of the elderly. Where are we now?

UNLABELLED: Self-neglect in an elderly person is a behavior that threatens his/her own health and safety. It is present when a person refuses to adequately feed, water, shelter, or clothe himself, refuses medication or medical care, and personal safety measures. MATERIAL AND METHOD: This is a multicentric study of self-neglect in three geriatric units from Finland, Greece and Romania The medical, social, psychological and behavioral profile analysis was based on a questionnaire; this questionnaire relied on existing studies and social, economic and medical facts in the three countries. The cognitive function, nutritional status, and the presence or absence of depression have also been assessed. RESULTS AND DISCUSSIONS: The data obtained until now support the importance of self-neglect among the elderly. The social-medical network should not only identify, diagnose, prevent, and treat the elderly affected by the phenomenon of self-neglect, but also educate the society to help them and, moreover, to prevent their marginalization.

Metabolic syndrome and vascular risk: a 9-year follow-up among the aged in Finland.

The aim was to analyze the relationship between metabolic syndrome (MetS) and vascular risk among the aged. A prospective population-based study, with a 9-year follow-up. All subjects of the municipality of Lieto in Finland aged ≥64 in 1998-99 participated (n = 1183). Hazard ratios (HRs) for fatal or non-fatal coronary (CHD), cerebrovascular (CV), or all vascular events predicted by MetS (defined by International Diabetes Federation) were estimated. During the 9-year follow-up, a total of 348 vascular events occurred, including 208 CHD and 150 CV events. After multivariable adjustment, CHD events (1.70, 1.07-2.71, P = .026) and vascular events (1.57, 1.07-2.30, P = .021) were more common in men with MetS compared to men without it. Evaluating MetS components individually, low HDL-cholesterol among women predicted a higher occurrence of CV (2.44, 1.46-4.09, P < .001) and all vascular (1.78, 1.26-2.53, P = .001) events. Elevated blood pressure among men was related to fewer CHD events (0.46, 0.25-0.83, P = .010). Our findings suggest that MetS does predict vascular events in late life among men. In older women, only low HDL-cholesterol was associated with vascular risk. Slightly or moderately elevated blood pressure values do not predict vascular events in this age group.

Myocardial infarction events and cardiovascular risk factor levels in Finnish- and Swedish-speaking populations of Finland.

BACKGROUND. The Swedish-speaking minority of Finland is unique, because it has a higher socioeconomic status (SES) and longer life expectancy than the Finnish-speaking majority. We hypothesized that this minority may have a lower attack rate of coronary events and analysed whether this could be explained by their higher SES. METHODS. The population-based myocardial infarction (MI) registers recorded 4,845 MI events in Turku during 1988-1998. Individual-level indicators of SES were obtained from Statistics Finland. The population-based FINRISK surveys recorded cardiovascular risk factors and native languages of 10,432 people in 1987, 1997, and 2002. RESULTS. The age-standardized attack rate of MI was lower among the 35-64-year-old Swedish-speaking men than among Finnish-speaking men (rate ratio 0.66; 95% confidence interval 0.47-0.85) and the difference remained significant after adjustment for SES. The Swedish-speaking inhabitants had higher age-, sex-, and SES-adjusted high-density lipoprotein cholesterol, and lower triglycerides, body mass index, and diastolic blood pressure. Conclusion. The Swedish-speaking inhabitants of Turku had lower MI morbidity and coronary mortality than the Finnish-speaking inhabitants. After controlling for SES, these differences remained significant among men, suggesting that other factors, such as differences in the risk factor profiles may also play a role.