Antecedents of Death in the Men of a Veterans Administration Nursing Home

Rudman, Daniel; Mattson, Dale E.; Nagraj, Hoskote S.; Caindec, Norma; Rudman, Inge W.; Jackson, Daniel L.

doi:10.1111/j.1532-5415.1987.tb01394.x

Cited by 89 publications

(40 citation statements)

References 36 publications

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“…Poor nutritional status in stroke patients who may be depen dent on others for their meals could perhaps explain this observation. Low cholesterol con centration has also been shown to predict mortality in nursing-home residents [13]. It is interesting that even at 20 months, the Glas gow Coma Score is still included as a predic tor of mortality, representing the extent of neuronal damage as a result of the index stroke.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Long-Term Survival and Disability among Three-Month Stroke Survivors

Woo

Kay²,

Yuen³

et al. 1992

Neuroepidemiology

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216 survivors of acute stroke were studied 3 months postictus to determine predictors of long-term survival and disability 20 months after the initial stroke. Factors predicting mortality were, in order of importance, old age, a history of ischaemic heart disease, low mental-test score, low serum cholesterol concentration, low Glasgow Coma Score on admission, and the presence of left ventricular hypertrophy. 73% of subjects were correctly classified by discriminant function analysis using these variables. Factors predicting poor functional outcome (Barthel Index 15) were a low Barthel Index at 3 months, old age, low mental-test score at 3 months and a low Glasgow Coma Score on admission. 70% of subjects were correctly classified into 3 functional-outcome groups using these variables. Stroke subtype and size, position, and the territory of the lesion on brain CT did not influence long-term outcome. We conclude that factors affecting long-term survival and disability are different from those affecting outcome immediately after stroke.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Long-Term Survival and Disability among Three-Month Stroke Survivors

Woo

Kay²,

Yuen³

et al. 1992

Neuroepidemiology

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“…In contrast, one study [18] of an aged institutionalized human population revealed that patients with serum levels of cholesterol !150 mg/dl exhibited a mortality rate of 63% when compared to 9% in patients with cholesterol levels 1150 mg/ dl. Another study from the same group [19] by multivariate analysis of a geriatric population, showed that men with serum cholesterol levels of ^156 mg/dl and hematocrit of ^41%, died at a rate 42 times to those of men with values above both thresholds.…”

Section: Lipidsmentioning

confidence: 99%

Aging Liver

Anantharaju¹,

Feller²,

Chedid³

2002

Gerontology

165

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Aging is characterized by a progressive decline of cellular functions. The aging liver appears to preserve its function relatively well. Aging is associated in human liver with morphological changes such as decrease in size attributable to decreased hepatic blood flow. Ultrastructural analysis of the human liver has revealed that the integrity of mitochondria and enzymatic activity remain mostly unchanged with aging. Reactive oxygen species (ROS) are involved in the aging process and result mainly from nonenzymatic processes in the liver. Endogenous free radicals are generated within mitochondria and suspected to cause severe injury to mitochondrial DNA. This damaged DNA accumulates with aging. In addition, polyunsaturated fatty acids, highly sensitive to ROS, decrease in liver mitochondria from human centenarians, a feature acquired during evolution as a protective mechanism to favor longevity. Diet is considered the main environmental factor having effect on lifespan. It has a major impact on aging liver, the central metabolic organ of the body. The ubiquitin proteolytic pathway in the liver serves to destroy many proteins, among them p21 which is encoded by abundant mRNA in senescent cells, can inhibit cell proliferation and favors DNA repair. Drug therapy in the elderly may be complicated by several factors such as decline in body weight, renal function, liver mass and hepatic blood flow, making adverse drug reactions more frequent. Hepatic drug metabolism is mainly mediated by the cytochrome P₄₅₀system and drug interactions in the elderly are likely related to the progressive decline of this system after the fifth decade of life and another decrease in individuals aged >70. Antihypertensive therapy in the elderly depends upon either hepatic or renal function and should be adjusted accordingly. Finally, telomerases are the biological clocks of replicative lifespan. Shortening of telomeric ends of chromosomes correlates with aging and decline in the replicative potential of the cell: replicative senescence. Telomere DNA of human somatic cells shortens during each cell division thus leading to a finite proliferation. Transfection of the telomerase reverse transcriptase gene results in elongation of telomeres and extension of lifespan. This also applies to humans. Replicative senescence in human cells evolved as a mechanism to protect them from continuous divisions leading to multiple mutations. Longer-lived species such as humans had to develop replicative senescence to ensure that they would have the increased protection that their longevity necessitates.

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“…Among the 67 items evaluated, only 8 were related to the risk of death and included bodyweight (as percent of ideal), hematocrit, hemoglobin, serum albumin, and cholesterol level. In a multivariate analysis, the most predictive factors were cholesterol and hematocrit [34]. The decrease of cholesterol level was also found as a potent marker of mortality in an 18-month follow-up study, including 370 nursing home residents [35].…”

Section: Changes In Cholesterol Levels With Agementioning

confidence: 95%

Prevention of cardiovascular events in elderly hypercholesterolemic patients

Bruckert

1999

Curr Atheroscler Rep

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The management of hyperlipidemia in the elderly patient is a major problem, given the frequency of dyslipidemias and cardiovascular disorders in this age group. Therapy must take current uncertainties into account and, in the absence of therapeutic studies carried out in the elderly, is typically based upon a case-by-case approach. Raised cholesterol levels remain a significant risk factor for coronary heart disease (CHD) in the elderly. Although the relative risk of CHD tends to diminish with increasing age, this reduction is accompanied by an increase in absolute risk (ie, the number of events) as the frequency of the illness increases markedly with age. The results of major outcome studies with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), when analyzed according to patient age, indicate that the benefits of these agents are not merely confined to younger individuals. However, the elderly form a unique patient population--the proportion of women is greater and the profile of cardiovascular illnesses is characterized, among others, by a greater incidence of cerebrovascular accidents. Problems relating to poor tolerability and comorbidity (which may give rise to drug-drug interactions) also occur more frequently in this age group. Moreover, the potential widespread treatment of hyperlipidemia in the elderly has profound economic implications. Under these circumstances, the clinical practice recommendations depend upon a reasonable extrapolation of epidemiologic and therapeutic data obtained from middle-aged men. At present, treatment is therefore aimed at patients with the most severe forms of hyperlipidemia, generally in the secondary prevention setting, taking into account the patient's life expectancy. The results of ongoing studies will determine the benefits of lipid-lowering therapy for primary prevention of CHD in the elderly.

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Antecedents of Death in the Men of a Veterans Administration Nursing Home

Cited by 89 publications

References 36 publications

Factors Influencing Long-Term Survival and Disability among Three-Month Stroke Survivors

Factors Influencing Long-Term Survival and Disability among Three-Month Stroke Survivors

Aging Liver

Prevention of cardiovascular events in elderly hypercholesterolemic patients

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