[Anemia--prevalence and etiology among acutely admitted geriatric patients]. / Anaemi--praevalens og aetiologi hos patienter indlagt på en geriatrisk afdeling.

INTRODUCTION: The purpose of this study was to determine the prevalence of anemia among acutely admitted geriatric patients, and among these patients to ascertain how often anemia is listed as a diagnosis, the distribution of these diagnoses and to compare the diagnostic approach to anemia with that suggested in the literature. MATERIALS AND METHODS: Age, sex and hemoglobin concentrations (hgb) were registered for patients referred to the acute geriatric ward of Odense University Hospital between 6/1/04 and 8/31/04. The prevalence of anemia was determined on the basis of the local laboratory's sex-specific lower reference limits for hgb. Diagnoses of discharge, laboratory data and, if performed, results of bone marrow and endoscopic investigations were also registered for anemic patients. RESULTS: 110 of 289 patients (38%) were anemic. The prevalence was significantly higher among men (61%, 95% confidence interval 51-71%) than among women (27%, 95% confidence interval 21-34%). 30 of the anemic patients (27%) had anemia listed as a diagnosis, including 14 with the diagnosis anemia without specification. A minority of anemic patients had measurements of serum ferritin (37%), serum iron (10%), plasma cobalamin (35%) and erythrocyte folate (35%), and a blood smear was likewise performed on a minority of anemic patients (26%). CONCLUSION: Anemia often remains undiagnosed or ignored. Clinicians should be aware of the high prevalence of anemia among geriatric patients and should appreciate the importance of a correct diagnostic approach to anemia in the elderly.

[Incidence of delirium in a geriatric ward of a university hospital]. / Incidencen af delirium på en geriatrisk universitetshospitalsafdeling.

INTRODUCTION: The aim of this study was to determine the prevalence of delirium based on the CAM scale in a geriatric ward in a university hospital. This paper describes the numbers of predisposing and precipitating factors are compared with the development of delirium. Finally, we present a discussion about treatment and prophylaxis. MATERIALS AND METHODS: Over a period of eight weeks, all newly admitted patients were interviewed and scored with CAM. The numbers of predisposing and precipitating factors were registered. Finally, the treatment was focused upon. RESULTS: 270 patients were admitted, 222 patients were interviewed and 48 patients were excluded. The prevalence of delirium was 7%. We were unable to find a correlation between risk factors or precipitating factors and delirium for this population. CONCLUSION: The prevalence of 7% is a satisfying result. There is a discrepancy between diagnosing delirium with CAM and the doctors' routine. All patients must be considered as high-risk patients. Treatment has not been completely standardised.

Hyponatraemia in very old nonhospitalised people: association with drug use.

OBJECTIVE: Hyponatraemia is one of the major problems in geriatric inpatients. However, in nonhospitalised elderly, the preponderance of hyponatraemia and the importance of the effect of drug intake on serum sodium concentrations are little known. This study investigated the prevalence of hyponatraemia in very old nonhospitalised people, controlling for factors that may induce hyponatraemia (especially drug use). METHODS: Data on serum sodium concentration, health and drug use were retrieved for 185 persons aged 92 to 93 years (the 1905 cohort) and 147 persons aged 100 years (the centenarian cohort) participating in two major population-based studies of elderly people in Denmark. Data were analysed by comparing median serum sodium concentrations between users and nonusers of various drugs after controlling for the influence of age, sex, cancer, heart failure, hypothyroidism, renal failure and smoking. Furthermore, the preponderance of drug use in the patients with clinically relevant hyponatraemia was compared with that in persons with normal serum sodium concentrations. RESULTS: Median serum sodium concentration was 140 mmol/L for the centenarians and 141 mmol/L for the 1905 cohort. In total, 19 persons had hyponatraemia (serum sodium concentration < or =134 mmol/L). There was no association between median serum sodium concentration and any of the above-mentioned diseases, or sex or smoking. Of the drugs generally known to cause hyponatraemia, only omeprazole and oral antidiabetic agents were associated with significantly lower median serum sodium concentrations (difference 3 mmol/L). Use of thiazide diuretics was significantly more common than expected in persons with hyponatraemia compared with persons with a normal serum sodium concentration (7 of 19 vs 46 of 270 individuals). Furthermore, the results suggested that digoxin and lactulose might be associated with a lowered median serum sodium concentration. CONCLUSION: This study demonstrates that severe hyponatraemia was rarely seen in a population-based sample of very old persons and that drugs have only a limited influence on serum sodium concentration. The only drug class associated with clinically relevant hyponatraemia was thiazide diuretics, which were used by significantly more persons with hyponatraemia. Furthermore, this study suggests that digoxin and lactulose use is associated with lower serum sodium concentrations in the elderly.