The authors examined the effects of cognitive function, as assessed by the Mini-Mental State Examination, and drug use on the incidence of hip fracture in a community-based Swedish population of 1,608 subjects who were aged > or = 75 years on October 1, 1987, and who had not had a hip fracture. During the 7,123.8 person-year follow-up, 134 first hip fractures were identified. The Cox proportional hazards model was used to estimate the relative risk of developing hip fracture, taking into account several potential confounders. Compared with those without cognitive impairment, subjects with mild impairment (Mini-Mental State Examination scores 18-23) had a relative risk of 2.04 (95% confidence interval (CI) 1.29-3.24), and subjects with moderate-severe impairment (Mini-Mental State Examination score < 18) had a relative risk of 2.09 (95% CI 1.17-3.72). Subjects using opioid analgesics (97% took propoxyphene) had a relative risk of 2.01 (95% CI 1.19-3.40). Taking potassium supplements (99% took potassium chloride) was related to a reduced risk of hip fracture (relative risk = 0.55, 95% CI 0.31-0.98), while diuretics did not have an independent impact. In summary, the results show that cognitive impairment and use of propoxyphene are associated with increased risk of hip fracture. The observed protection of potassium chloride merits further attention. The limitation of the study was that the assessment of drug use was made only at baseline.

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CV drugs are used commonly in older people. We suggest that the symptoms correlating with cardiac glycoside use may be signs of unrecognized toxicity, and this may relate to our finding that drug use is often not tailored to renal function as measured by creatinine clearance.

Ethanol concentrations were assayed in urine samples obtained from 10 newly presenting diabetic patients (aged 50-69 years) with glycosuria and symptoms suggesting genito-urinary candidiasis. No alcohol was detected initially with diabetic urine samples, but when stored at room temperature 8 out of 10 samples showed increasing levels of ethanol from day 3 to day 20. Peak levels were more than 10,000 mg/l in three samples and more than 1500 mg/l in six samples. Studies were also performed using normal urine and urine to which was added glucose and/or Candida. Samples were kept at either room temperature or 4 degrees C for up to 21 days and ethanol assays performed at regular intervals. Studies with non-diabetic urine showed a maximum ethanol level of 500 mg/l after 11 days only in samples containing both glucose and Candida and kept at room temperature.

Urine was collected over 24 h from 40 patients with advanced malignant disease who had received a known four‐hourly oral dose of either diamorphine or morphine in an elixir or of diamorphine by injection for at least 3 days. Samples were assayed for total urinary morphine (free and conjugated) by gas‐liquid chromatography. The percentage of the administered dose recovered as morphine was: diamorphine hydrochloride by injection: 70% (s.d. 25) diamorphine hydrochloride by mouth: 77% (s.d. 27) morphine sulphate by mouth: 56% (s.d. 21) It is suggested that diamorphine hydrochloride is completely absorbed by the ***gastro‐intestinal tract but that morphine sulphate is only some two‐thirds absorbed.

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In a cross-sectional study, we have investigated the prevalence of self-reported symptoms and their association with medicinal drug use in elderly people. Data from the Kungsholmen Project were used, a population-based study of elderly people aged 75 years and over in Stockholm, Sweden. The study sample comprised 1800 persons. Information on the occurrence of 22 different symptoms and the actual drug use was obtained at interviews with the participants. The relation of symptoms to age, gender and housing, and their association with drug use was analysed using logistic regression. The most commonly reported symptoms were pain and tiredness. In general, symptoms were more common in women and at higher ages. Many of the associations between symptoms and drug use reflected established treatments. However, some were suggestive of inappropriate treatment or dosage; for example, the association between tiredness and the use of anxiolytics and hypnotics-sedatives.

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