Association of low serum 25-hydroxyvitamin D levels and high arterial blood pressure in the elderly.

BACKGROUND: Vitamin D and calcium metabolism are involved in vascular smooth muscle cell proliferation, endothelial function and blood pressure (BP) regulation. Their physiopathology has been a matter of intensive clinical investigation with variable and sometimes contradictory results. Vitamin D insufficiency is highly prevalent in the general population, particularly among the elderly. We evaluated the association between serum 25(OH)-D levels and arterial BP in this population. METHODS: An epidemiological cross-sectional study was designed to analyse the prevalence of hypovitaminosis D ('D'AVIS' study) in our reference area. The study was performed on a representative random sample of the population over 64 years of age obtained from five primary health care areas. A medical record, arterial BP and biological analysis: serum 25(OH)-D, iPTH, creatinine, urea, calcium, albumin were obtained. RESULTS: A total of 237 subjects (53% women), aged between 64 and 93 (mean 71.7 +/- 5.3), were evaluated. The mean serum 25(OH)-D levels were 17.21 +/- 7.57 ng/ml (interval 5-54; 86% had <25 ng/ml). The mean BP was 138.8 +/- 14/80 +/- 7.4 mmHg, and 46% were on antihypertensive treatment. A significant negative association was observed between serum 25(OH)-D levels and systolic (r = -0.153, P = 0.018) and diastolic BP (r = -0.152, P = 0.019). This association persisted after controlling for possible confounders in the multivariate analyses. CONCLUSIONS: Low serum 25(OH)-D levels were inversely and independently associated with BP. Supplemental measures to prevent hypovitaminosis D in this population would be important, not only to protect the skeletal system but also for the possible beneficial effects on the cardiovascular system and the BP regulation.

[Hypovitaminosis D associated to low sun exposure in the population over 64 years old]. / Hipovitaminosis D asociada a exposición solar insuficiente en la población mayor de 64 años.

BACKGROUND AND OBJECTIVE: To identify the factors related to hypovitaminosis D in the population over 64 years of age without known risk factors of hypovitaminosis D. SUBJECTS AND METHOD: It was a cross-sectional population study in individuals over 64 year-old attending basic healthcare areas in our hospital's area of reference. A survey was conducted to assess various items (functional capacity, exposure to sun, walks, eating habits). Blood samples taken from each participant were analyzed. RESULTS: A total of 239 individuals -mean age (standard deviation): 72 (5.4) years- were evaluated. 95% of the participants scored > 90 on the Barthel index. Mean serum 25-hydroxyvitamin D3 -25(OH)D3- concentration was 17 (7.5) ng/ml and intact parathormone was 60 (26 pg/ml). The prevalence of hypovitaminosis D was 87%, including 70.3% with insufficiency (25(OH)D3 between 11 and 25 ng/ml) and 16.7% with deficiency (25(OH)D3 < or = 10 ng/ml). The intake of vitamin D and calcium were below recommended levels. The principal source of vitamin D was oily fish. Participants with deficiency scored lower on the Barthel index, had a higher mean age, lived in flats, had less exposure to sun, and used to walk less in sun-hours. Higher levels of alkaline phosphatase and intact parathormone were found in participants with deficiency. The variables independently and significantly associated with vitamin D deficiency were a Barthel score < or = 90, scant exposure to sun and living in a flat. CONCLUSIONS: There is a high prevalence of hypovitaminosis D in the population aged over 64 years in our area, which is associated with lower functional capacity, scant exposure to sun and living in flats.

Hipovitaminosis D asociada a exposición solar insuficiente en la población mayor de 64 años / Hypovitaminosis D associated to low sun exposure in the population over 64 years old

Fundamento y objetivo: Identificar los factores relacionados con la hipovitaminosis D en la población ambulatoria mayor de 64 años sin factores de riesgo conocidos de hipovitaminosis D. Sujetos y método: Se ha realizado un estudio transversal de ámbito poblacional en personas mayores de 64 años procedentes de las áreas básicas de salud del área de referencia del hospital. Se realizó una encuesta con varios ítems (capacidad funcional, exposición solar, paseos, alimentación) y se determinaron parámetros analíticos. Resultados: Se evaluó a 239 personas, cuya edad media (desviación estándar) era de 72 (5,4) años. El 95% presentaba un índice de Barthel mayor de 90. La concentración sérica media de 25-hidroxicolecalciferol ­25(OH)D3­ fue de 17 (7,5) ng/ml y la de paratirina intacta, de 60 (26) pg/ml. La prevalencia de hipovitaminosis D fue del 87%. El 70,3% presentó insuficiencia ­25(OH)D3 entre 11 y 25 ng/ml­ y el 16,7% deficiencia ­25(OH)D3 # 10 ng/ml­. La ingesta de vitamina D y calcio fue inferior a lo recomendado. La principal fuente de vitamina D fue el pescado azul. Las personas con deficiencia tenían un menor índice de Barthel, edad media superior, vivían en pisos, tenían una ingesta menor de calcio, menor exposición solar y menor hábito de pasear al sol. Los valores más elevados de fosfatasa alcalina y paratirina intacta se hallaron en las personas con deficiencia. Las variables asociadas independiente y significativamente con la situación de deficiencia fueron el índice de Barthel igual o menor de 90, no tomar el sol y vivir en un piso. Conclusiones: Se evidencia una elevada prevalencia de hipovitaminosis D durante los meses de invierno, que se asocia a un menor grado de autonomía funcional, a un escaso hábito de exposición solar y a vivir en un piso, en los mayores de 64 años residentes en nuestra comunidad

Background and objective: To identify the factors related to hypovitaminosis D in the population over 64 years of age without known risk factors of hypovitaminosis D. Subjects and method: It was a cross-sectional population study in individuals over 64 year-old attending basic healthcare areas in our hospital's area of reference. A survey was conducted to assess various items (functional capacity, exposure to sun, walks, eating habits). Blood samples taken from each participant were analyzed. Results: A total of 239 individuals ­mean age (standard deviation): 72 (5.4) years­ were evaluated. 95% of the participants scored > 90 on the Barthel index. Mean serum 25-hydroxyvitamin D3 ­25(OH)D3­ concentration was 17 (7.5) ng/ml and intact parathormone was 60 (26 pg/ml). The prevalence of hypovitaminosis D was 87%, including 70.3% with insufficiency (25(OH)D3 between 11 and 25 ng/ml) and 16.7% with deficiency (25(OH)D3 # 10 ng/ml). The intake of vitamin D and calcium were below recommended levels. The principal source of vitamin D was oily fish. Participants with deficiency scored lower on the Barthel index, had a higher mean age, lived in flats, had less exposure to sun, and used to walk less in sun-hours. Higher levels of alkaline phosphatase and intact parathormone were found in participants with deficiency. The variables independently and significantly associated with vitamin D deficiency were a Barthel score # 90, scant exposure to sun and living in a flat. Conclusions: There is a high prevalence of hypovitaminosis D in the population aged over 64 years in our area, which is associated with lower functional capacity, scant exposure to sun and living in flats

[Evaluation assessment of the cut-off point of vitamin D in the population older than 64 years old]. / Valoración del umbral óptimo de vitamina D en la población mayor de 64 años.

BACKGROUND AND OBJECTIVE: Serum 25(OH)D(3) is the best indicator of vitamin D status, although some controversy remains regarding "normal" and "abnormal" values. The objective was to identify the 25(OH)D(3) serum concentration threshold which allows to know the 25(OH)D(3) serum levels correlated to PTH(i) increase and to describe the prevalence of hypovitaminosis D. PATIENTS AND METHOD: Cross-sectional population study in subjects over 64 years of age residing in the basic healthcare areas in our hospital's area of reference. RESULTS: A total of 239 persons -mean age (standard deviation) 72 (5.4) years- were evaluated. Mean serum concentrations of 25(OH)D(3) and PTH(i) were 17 (7.5) ng/ml and 60.5 (26.1) pg/ml, respectively. 32% of the subjects showed an increase in the serum concentration of PTH(i) > 65 pg/ml. 96% of the cases with an increase in PTH(i) had serum concentrations of 25(OH)D(3) < or = 25.5 ng/ml. In 70% of the subjects, the serum concentration levels of 25(OH)D(3) ranged between 11 and 25 ng/ml and in 17% the levels of 25(OH)D(3) were lower than 10 ng/ml. CONCLUSIONS: The normal ranges for our population could correspond to levels of 25(OH)D3 > or = 25 ng/ml, with a 95% of sensibility to detect secondary hyperparathyroidism.

Valoración del umbral óptimo de vitamina D en la población mayor de 64 años / Evaluation assessment of the cut-off point of vitamin D in the population older than 64 years old

Fundamento y objetivo: El mejor indicador del estado de la vitamina D es la determinación en suero del 25-hidroxicolecalciferol [25(OH)D3], aunque cuáles son los valores normales es objeto de controversia. El objetivo del estudio ha sido conocer el umbral de 25(OH)D3 a partir del cual se produce la mayoría de los incrementos de los valores de parathormona intacta (PTHi) y describir la prevalencia de hipovitaminosis D en la población estudiada. Pacientes y método: Se ha realizado un estudio transversal de ámbito poblacional en personas mayores de 64 años procedentes de las áreas básicas de salud del área de referencia de un hospital. Resultados: Se evaluó a 239 personas, con una edad media (desviación estándar) de 72 (5,4) años. Los valores medios de 25(OH)D3 y de PTHi fueron 17 (7,5) ng/ml y 60,5 (26,1) pg/ml, respectivamente. El 32% presentó valores de PTHi superiores a 65 pg/ml. El 96% de los casos con PTHi elevada tenía valores de 25(OH)D3 iguales o inferiores a 25,5 ng/ml. El 70% de los participantes presentó valores de 25(OH)D3 entre 11 y 25 ng/ml y el 17%, valores inferiores a 10 ng/ml. Conclusiones: El umbral de normalidad para nuestra población podría corresponder a valores de 25(OH)D3 iguales o superiores a 25 ng/ml, con una sensibilidad del 95% para detectar hiperparatiroidismo secundario

Background and objective: Serum 25(OH)D3 is the best indicator of vitamin D status, although some controversy remains regarding «normal» and «abnormal» values. The objective was to identify the 25(OH)D3 serum concentration treshold which allows to know the 25(OH)D3 serum levels correlated to PTHi increase and to describe the prevalence of hypovitaminosis D. Patients and method: Cross-sectional population study in subjects over 64 years of age residing in the basic healthcare areas in our hospital's area of reference. Results: A total of 239 persons ­mean age (standard deviation) 72 (5.4) years­ were evaluated. Mean serum concentrations of 25(OH)D3 and PTHi were 17 (7.5) ng/ml and 60.5 (26.1) pg/ml, respectively. 32% of the subjects showed an increase in the serum concentration of PTHi > 65 pg/ml. 96% of the cases with an increase in PTHi had serum concentrations of 25(OH)D3 ¾ 25.5 ng/ml. In 70% of the subjects, the serum concentration levels of 25(OH)D3 ranged between 11 and 25 ng/ml and in 17% the levels of 25(OH)D3 were lower than 10 ng/ml. Conclusions: The normal ranges for our population could correspond to levels of 25(OH)D3 >= 25 ng/ml, with a 95% of sensibility to detect secondary hyperparathyroidism

[Evolution of the use of antibiotics in a hospital long-term care center in Catalonia]. / Evolución del uso de antibióticos en un centro sociosanitario de ámbito hospitalario en Cataluña.

INTRODUCTION: Advanced age, together with immune system changes, malnutrition, chronic disease, and the institutional environment, all contribute to a higher risk of acquiring infection in the elderly. Antibiotics are widely used in geriatric centers, but often their use is not optimal. MATERIAL AND METHODS: Study carried out during the period 1992-1999 in Centro Sociosanitario Albada (Sabadell, Spain). Data were taken from the Pharmacy Department's unidose registry. We determined the most frequently used antibiotics, the hospital units with highest consumption, the variation in these factors over time, and related costs. RESULTS: A progressive increase in overall antibiotic consumption was observed during the first 5 years of the study with subsequent stabilization. The units showing highest consumption were the Moderate and Highly-Dependent Chronic Unit, the Palliative Care Unit and the Convalescence and Rehabilitation Unit, with significant increases in the Palliative Care Unit in the last two years of the study. Amoxicillin-clavulanate, ciprofloxacin and norfloxacin were the most extensively used antibiotics. Cost increases were seen in the last three years despite the stabilization of antibiotic use. CONCLUSION: We observed a change in the consumption and profile of the antimicrobial agents used in our setting, probably related to changes in the population, increases in parenteral treatment and changes in the criteria for treatment of terminal patients. The establishment of controls for antibiotic use in long-term care centers would lead to improvements in the quality of the care provided.

Evolución del uso de antibióticos en un centro sociosanitario de ámbito hospitalario en Cataluña / Evolution of the use of antibiotics in a hospital long-term care center in Catalonia

INTRODUCCIÓN. La edad avanzada junto con las modificaciones en el sistema immunitario, la malnutrición, la coexistencia de enfermedades crónicas y la propia institucionalización comportan un riesgo de adquisición de infecciones y el consiguiente uso de antibióticos, que no siempre es adecuado. MATERIAL Y MÉTODOS. Estudio realizado desde 1992 hasta 1999 en el Centro Sociosanitario Albada (CSSA). Se analizan los antibióticos más utilizados, las unidades de mayor consumo, su variación en el tiempo y los costes por consumo, a partir del registro de unidosis de que dispone el servicio de farmacia de nuestro hospital. RESULTADOS. Se observó un aumento progresivo en el consumo global de antibióticos durante los primeros 5 años de estudio, con una tendencia posterior a la estabilización. Las unidades de mayor consumo fueron la Unidad de Crónicos de Media y Alta Dependencia, la Unidad de Cuidados Paliativos y la Unidad de Convalecencia y Rehabilitación, con un incremento relevante en el consumo en la Unidad de Cuidados Paliativos en los últimos 2 años del estudio. Los antibióticos más utilizados fueron amoxicilina-ácido clavulánico, ciprofloxacino y norfloxacino. Se ha observado un incremento de los costes en los últimos 3 años, a pesar de la estabilización en la prescripción de antibióticos. CONCLUSIÓN. Se aprecia un cambio en el consumo y el perfil de antibióticos utilizados, probablemente relacionado con cambios en la población, aumento del tratamiento parenteral y cambio de criterio en el tratamiento de pacientes terminales. Establecer un control del uso de antibióticos en centros sociosanitarios permitiría mejorar la calidad asistencial (AU)

Prevalencia de hipovitaminosis D en una población anciana institucionalizada. Valoración del tratamiento sustitutivo / Prevalence of hypovitaminosis D in elderly institutionalized residents: influence of a sustitutive treatment

FUNDAMENTO: La osteoporosis senil es una enfermedad grave y prevalente, uno de cuyos mecanismos causantes más importantes parece ser el déficit de vitamina D. La hipovitaminosis D es probablemente frecuente entre la población anciana, en especial en la institucionalizada. El objetivo de este trabajo fue determinar la prevalencia de hipovitaminosis D en una población anciana institucionalizada. SUJETOS Y MÉTODO: Estudio transversal en el que se incluyó de forma aleatoria 100 ancianos institucionalizados. Se valoró la prevalencia de hipovitaminosis D, así como las posibles repercusiones sobre el metabolismo fosfocálcico y la presencia de hiperparatiroidismo secundario. Se recogieron además el grado de exposición solar y la presencia de comorbilidad. Estudio longitudinal (6 meses) en el que se incluyeron los individuos con hipovitaminosis D y se valoró la eficacia de dos pautas terapéuticas distintas con calcidiol (16.000 UI a la semana o 16.000 UI cada tres semanas).RESULTADOS: El 87 por ciento de los individuos presentaron hipovitaminosis D. El 21,8 por ciento de ellos presentaron además un hiperparatiroidismo secundario. La población estudiada tuvo también un bajo grado de exposición solar y una alta prevalencia de comorbilidad. Las dos dosis de calcidiol consiguen normalizar las concentraciones de 25-OHD3 y compensar el hiperparatiroidismo secundario, si bien con la administración semanal se consiguieron concentraciones sanguíneas más elevadas. CONCLUSIONES: En la población anciana institucionalizada y con elevada comorbilidad, la prevalencia de hipovitaminosis D es muy alta. El aporte de calcio y calcidiol consigue normalizar la 25-OHD3, mejorar la absorción de calcio y compensar el hiperparatiroidismo secundario. En la población geriátrica institucionalizada debería considerarse la necesidad de la suplementación con calcio y vitamina D (AU)