Intentos de suicidio y suicidios consumados por los ancianos de una residencia / Parasuicide and suicide among elderly residents of a long-term-care facility

OBJETIVO: Recoger y analizar de forma longitudinal retrospectiva todos los intentos de suicidio y los suicidios consumados entre los ancianos de una residencia. MÉTODOS: Se estudiaron los historiales clínicos de los 938 ancianos que ingresaron en el centro entre diciembre de 1984 y marzo de 2001. Se analizaron la frecuencia, los aspectos médicos y psiquiátricos y las circunstancias en las que se producen los suicidios y los intentos de suicidio en dicha población. RESULTADOS: La edad media de los residentes al final del estudio era de 80,9 años, y su estancia media de 1.716 días. Durante el período de estudio fallecieron 445 ancianos (47,4 por ciento). De ellos, 9 (5 varones y 4 mujeres) fallecieron por suicidio, lo que representa un 2 por ciento del total de fallecimientos y una tasa de 204,2 suicidios por 100.000 personas/año. Todos los suicidas tenían un diagnóstico psiquiátrico previo. El método elegido por la mayoría fue el de precipitación, y 4 de ellos habían efectuado intentos previos. En un caso se encontraron notas dirigidas al juez. Se detectaron intentos de suicidio no consumados en otros 5 residentes, de los que 4 padecían afecciones físicas incapacitantes. Uno de los residentes efectuó cuatro intentos, sin llegar a consumar el suicidio. CONCLUSIONES: El suicidio es causa relativamente frecuente de fallecimiento en residencias, alcanzando un alto grado de eficacia, sobre todo en aquellos residentes con diagnóstico psiquiátrico previo. La relación entre intentos y consumación de suicidios se encuentra cercana a 1:1. La prevención de los casos de suicidio debería ser considerada entre las labores del personal sanitario en estos centros (AU)

Prevalence and determinants of diabetes mellitus and glucose intolerance in a Canarian Caucasian population - comparison of the 1997 ADA and the 1985 WHO criteria. The Guía Study.

AIMS: To estimate the prevalence of diabetes mellitus, impaired fasting glucose and impaired glucose tolerance in a Canarian population according to the 1997 ADA and the 1985 WHO criteria; and to study the cardiovascular risk factors associated with these categories. METHODS: A total of 691 subjects over 30 years old were chosen in a random sampling of the population (stratified by age and sex). An oral glucose tolerance test was performed (excluding known diabetic patients) and lipids were determined in the fasting state. Anthropometric and blood pressure measurements were performed, and history of smoking habits and medications was recorded. RESULTS: The prevalence of diabetes was 15.9% (1997 ADA) and 18.7% (1985 WHO); the prevalence of impaired fasting glucose and impaired glucose tolerance was 8.8 and 17.1%, respectively. The age-adjusted prevalence of diabetes (Segi's standard world population) for the population aged 30-64 years was 12.4% (1985 WHO). The risk factors significantly associated with diabetes (1997 ADA and 1985 WHO) were age, body mass index; waist-to-hip ratio, systolic and mean blood pressure, triglycerides, total cholesterol and low HDL-cholesterol. Age, body mass index and systolic blood pressure were associated with impaired fasting glucose and impaired glucose tolerance; triglycerides were also associated with impaired fasting glucose. CONCLUSIONS: The prevalence of diabetes mellitus and glucose intolerance in Guía is one of the highest among studied Caucasian populations. The new 1997 ADA criteria estimate a lower prevalence of diabetes. Impaired fasting glucose also had a lower prevalence than impaired glucose intolerance and the overlap of these categories was modest.

Incidence of anemia in older people: an epidemiologic study in a well defined population.

OBJECTIVE: To assess the incidence and clinical spectrum of anemia among older people. DESIGN: Inception cohort assembled and followed by medical records linkage until death or last clinical contact through January 1994. SETTING: Population-based study in Olmsted County, Minnesota. PARTICIPANTS: All 618 Olmsted County men and women aged 65 years or more with anemia by World Health Organization criteria that was first recognized in 1986. MEASUREMENTS: Age- and sex-adjusted incidence rates, corrected for prevalent anemia, and survival estimates using the Kaplan-Meier method, with calculation of standardized mortality ratios for specific causes of death. RESULTS: The corrected annual incidence of anemia rose with age, and rates were higher in men (90.3 per 1000; 95% CI, 79.2-101.4) than women (69.1 per 1000; 95% CI, 62.3-75.8). In 465 cases (75%), anemia was detected in conjunction with a hospitalization, but admission was due to anemia in only 57 instances. Half of the cases were caused by blood loss, two-thirds of these as a result of surgery. The cause of anemia was uncertain in 102 cases (16%). One-third of the patients were transfused with a median of 3 units each. Overall survival was worse than expected but was better among those with anemia caused by blood loss. Mortality attributable to malignancy, mental disorders, circulatory and respiratory diseases, ill-defined conditions, and injuries was significantly increased among these older patients with anemia. CONCLUSIONS: The incidence of anemia among older people is 4 to 6 times greater than that suspected clinically, rises with age, and is higher in men than in women. The apparent cause in half the cases is blood loss. Even mild anemia is associated with reduced survival, especially during the first year, but this could relate to underlying comorbid conditions.

Risk of Alzheimer's disease among elderly patients with anemia: population-based investigations in Olmsted County, Minnesota.

PURPOSE: To evaluate the association, if any, between Alzheimer's disease (AD) and anemia among the elderly. METHODS: Both case-control and cohort methodologies were used to evaluate this association. The case-control study included all incident cases of AD whose onset occurred during 1980-1984 in Rochester, MN (n = 302). An age- and gender-matched control was selected from among Rochester residents seen for care at Mayo Clinic during the year of onset of the case. All community medical records for cases and controls were reviewed to identify women with hemoglobin levels of < 12 g/dL and men with hemoglobin levels of < 13 g/dL during the year of onset and the prior year for cases and during the index year and year prior for controls. Logistic regression was used to estimate odds ratios (OR). The retrospective cohort study used the 618 residents of Olmsted County, MN, who were > or = 65 years of age and whose anemia, as defined above, was newly recognized in 1986. Standardized incidence ratios (SIR) for AD were estimated by use of the person-years of follow-up in the cohort and the incidence rates of AD for this community. RESULTS: In the case-control study, an almost twofold increase in occurrence of AD was associated with anemia (OR, 1.88; 95% CI, 1.17-3.03). For men and women, respectively, the ORs were 1.81 (95% CI, 0.75-4.39) and 1.96 (95% CI, 1.11-3.47). The cohort study showed no overall increase in risk of AD (SIR, 0.98; 95% CI, 0.67-1.37). For men, the SIR was a comparable 1.49 (95% CI, 0.79-2.56), whereas for women the SIR was only 0.79 (95% CI, 0.49-1.23). CONCLUSIONS: Although anemia may be a risk factor for AD in the elderly, the mechanism by which anemia contributes to the pathogenesis of AD or to the unmasking of AD symptoms is unknown.

Trends in the incidence of polycythemia vera among Olmsted County, Minnesota residents, 1935-1989.

To investigate the suggestion that the incidence of polycythemia vera has increased in recent decades, we ascertained secular trends in the incidence of polycythemia vera in Olmsted County, Minnesota, over the 55-year period, 1935-1989. The inpatient and outpatient medical records of all potential cases of polycythemia vera in Olmsted County residents were reviewed and the diagnostic criteria of the Polycythemia Vera Study Group were applied. We found no indication of an increase in the age- and sex-adjusted incidence of polycythemia vera, which averaged 1.9 per 100,000 person-years (95% C.I., 1.4-2.5) over the study period. Incidence rates increased with age, and age-adjusted incidence rates were greater for men (2.8 per 100,000 person-years; 95% C.I., 1.8-3.9) than for women (1.3 per 100,000 person-years; 95% C.I., 0.7-1.9), with the highest incidence rate (23.5 per 100,000 person-years) among men aged 70-79 years. Survival was reduced in this inception cohort of 50 cases, compared to that expected for individuals of like age and sex (P < 0.0001); median survival following diagnosis was 7.2 years.

Prevalence of anemia in medical practice: community versus referral patients.

OBJECTIVE: To compare the prevalence of anemia among community and referral patients. DESIGN: A Mayo Clinic laboratory database was searched for hemoglobin determinations between Jan. 1, 1985, and Dec. 31, 1989, in residents and nonresidents of Olmsted County, Minnesota, who were 20 years of age or older (a more restricted period within this interval was used for those 70 years of age or older). MATERIAL AND METHODS: Using the World Health Organization criteria for anemia, we estimated the prevalence of anemia as of July 1, 1987, among Olmsted County residents 20 years of age or older (community patients) and compared this finding with the prevalence among non-Olmsted County patients of the same age registered at the Mayo Clinic during the same year (referral patients). RESULTS: The crude prevalence of anemia among Olmsted County men was less than that among male referral patients, but this difference was decreased by adjusting for the older mean age of referral patients (6.6% versus 7.0%; P = 0.01). Even after age-adjustment, the prevalence of anemia was greater among community women than among female referral patients (12.4% versus 8.2%; P < 0.001). Before age 55 years, the prevalence of anemia was lower among men than among women, but after that age, anemia became more frequent in men, reaching a 44.4% prevalence among community men 85 years of age or older. The overall prevalence rate was sensitive to the criteria used to define a low hemoglobin level, however. CONCLUSION: Clinicians should be aware of the high prevalence of anemia, especially among elderly community patients. This precaution should help minimize the overlooked diagnosis of anemia and the failure to identify and treat its underlying cause.