Diminished secretion of growth hormone is responsible in part for the decrease of lean body mass, the expansion of adipose-tissue mass, and the thinning of the skin that occur in old age.

This study aims to learn whether the annual clinical and laboratory screening of nursing home residents provides significant information about their chance of dying during the following year. In August 1984, a comprehensive clinical data base was compiled for 176 male residents of this VA nursing home. During the next 14 months, 12 men were discharged to other locations and were dropped from the study; among the remaining 166, who comprised the study group of this report, 24 died. The most common immediate causes of death were infections (67%) and cardiac disorders (25%). Twenty of the deaths occurred after transfer to the acute hospital services. Among the 67 items in the clinical data base (including absence or presence of 17 diagnoses and 16 drugs), eight were significantly correlated with death rate. Age and functional impairment were directly related, and inversely related were the following: body weight as percent of ideal, triceps skin fold, hematocrit, hemoglobin, serum albumin, and serum cholesterol. Multivariate analysis showed cholesterol and hematocrit to be the most informative of the eight mortality predictors and to correlate with death independently of age and functional level. Subgroups defined on the basis of combinations of mortality-related attributes differed many fold in their death rates. For example, men with cholesterol less than or equal to 156 mg/dl and hematocrit less than or equal to 41% died at a rate 42 times the rate of men with values above both thresholds. For each mortality-related attribute, death rate varied with the level of the attribute. This relationship extended into the generally accepted "normal ranges" for cholesterol, hematocrit, hemoglobin, and albumin.

Serum cholesterol was measured in 129 men (average age 70.6; range 41-96) of a Veterans Administration Nursing Home, and was correlated with other items in an extensive clinical data base. Serum cholesterol was less than 150 mg/dl in 13% of the subjects, and was less than 160 mg/dl in 18%. Cholesterol greater than 280 mg/dl occurred in 8%. Serum cholesterol varied directly (p less than 0.02) with: body weight, serum albumin, serum total protein, serum sodium, ability to walk, and ability to feed oneself; and indirectly (p less than 0.02) with death rate, degree of functional dependence, and serum SGOT and LDH. Nursing home men with cholesterol less than 150 mg/dl had a death rate of 63% during the 14 months after the cholesterol analysis, compared to a death rate of 9% in men with cholesterol greater than 150 mg/dl (p less than 0.05). Death rate during the year after the analysis was 52% if cholesterol was below 160 mg/dl, compared to 7% if it was above this threshold (p less than 0.05).

Serum albumin was measured in 126 men (average age 70.6; range 40 to 96) of a Veterans Administration Nursing Home, and was correlated with other items in an extensive clinical data base, including death or survival during the year after the analysis. The reason for institutionalization was chronic neurologic disease or other disabling physical condition in 63 men (group A), and psychiatric disorder in 63 men (group B). In group A, the proportions of men with albumin less than 3.5, 3.5-4.0, and greater than 4.0 g/dl were 6%, 37%, and 57%, respectively. In this group, the serum albumin level was significantly (p less than 0.05) correlated with death rate, hemoglobin, hematocrit, serum cholesterol, and serum lactic dehydrogenase. The death rate in group A during the year after the albumin analysis was 25%. For the patients with albumin level less than 3.5, 3.5-4.0, and greater than 4.0 g/dl, the death rates were 50%, 43%, and 11% respectively (p less than 0.01 for comparison of the former two groups with the latter). The subgroup with albumin 3.5-4.0 g/dl represented only 37% of the men in group A, but accounted for 63% of the group's deaths. In group B, serum albumin level was not significantly correlated with any other clinical variable. Death rate during the year after the albumin analysis was only 2% in group B, and did not correlate with the albumin level. These data indicate that, in nonpsychiatric Nursing Home men, the desirable level for the serum albumin concentration is higher than 3.5 g/dl.