Factors predicting mortality in a total population sample of the elderly.

Between 1977 and 1979 an age stratified sample of people 65 years and over living in the community and in institutions in Gisborne, New Zealand was assessed medically and socially. This sample was followed and reviewed in 1982. At follow up 308 subjects were seen, 227 had died, and 24 had left the area. Factors predicting mortality were assessed. Using a log rank test, factors predicting mortality included age, impaired mental function, functional disability, urinary incontinence, prescribed drugs, pulse pressure, erythrocyte sedimentation rate (ESR), systolic pressure, cardiovascular drugs, and falls. However, a number of these factors increased in prevalence with age. Using a Cox's regression analysis for factors predicting mortality after controlling for age, the following were found to be significant predictors: impaired mental function; functional disability; urinary incontinence; prescribed drugs, ESR and falls. A proportional hazards general linear model showed that the major predictors of mortality in old age were markers of established disease.

Incontinence in the elderly: prevalence and prognosis.

In a randomly selected sample of 559 subjects 65 years and over living in the community and in institutions the prevalence of urinary incontinence was found to be 11.6%. In those 80 years and over the prevalence rose to 21.7%. Those with dementia were more likely to be incontinent than those with normal mental function. In the majority of those over 80 who were incontinent, the incontinence was associated with either confusion or a combination of factors. The estimated population prevalence of faecal incontinence for those 65 years and over was 3.1%. Urinary incontinence was associated with an increased risk of death. In a review of subjects after three years 73.5% of the incontinent group had died while only 34.9% of those originally continent had died. Because incontinent elderly people are commonly frail, with a number of conditions contributing to the disorder, the extent of investigation of the disorder needs to be carefully assessed for each patient.

Drugs taken by a population based sample of subjects 65 years and over in New Zealand.

Drug taking by a population based sample of 559 subjects aged 65 years and over was investigated. The median number of drugs prescribed for those 65-79 years was 1.5 drugs per subject and for those 80 years and over was 2.1 drugs per subject. In those 80 years and over, over 30% were taking diuretics, over 20% were taking digoxin and over 30% were taking psychotropic drugs. Analysis of those taking six or more drugs showed that the number of drugs prescribed could be reduced by avoiding duplication of drugs with similar action, avoiding unnecessary drugs and avoiding drugs of no proven value. The majority of subjects knew the purpose of their medications, were able to read the prescription instructions and complied with these instructions. Sharing and hoarding of tablets were uncommon.

Dementia in old age and the need for services.

A randomly selected sample of subjects aged 65 years and over was investigated to determine the prevalence of dementia. The sample, which was stratified by age, consisted of 559 subjects living in the community and institutions. It was estimated that 7.7% of those aged 65 years and over suffered from dementia. The disorder affected both sexes equally. There was a marked increase in the prevalence with age so that in those 80 years and over the prevalence rate of dementia was found to be 19%. Those suffering from dementia were significantly more likely to be receiving institutional care than those with normal intellectual function. Those with dementia used significantly more domiciliary services than did those with normal mental function and were more likely to require additional services not already provided. There was a particular need for district nursing supervision, day care and relief admissions. The high prevalence rate of dementia in the elderly, and the high use those suffering from the disorder make of both domiciliary and institutional services, should be appreciated in the planning of services for the elderly.