Causes of Death in People with Dementia from 2002 to 2015: A Nationwide Study

Background: Dementia is associated with increased mortality. However, it is not clear whether causes of death in people with dementia have changed over time. Objective: To investigate if causes of death changed over time in people with dementia compared to the general elderly population. Methods: We included longitudinal data from nationwide registries on all Danish residents aged≥65 years to 110 years who died between 2002 to 2015. We assessed the annual frequency of dementia-related deaths (defined as a dementia diagnosis registered as a cause of death) and of underlying causes of death in people registered with dementia compared to the general elderly population. Results: From 2002 to 2015, 621,826 people died, of whom 103,785 were diagnosed with dementia. During this period, the percentage of dementia-related deaths increased from 10.1%to 15.2%in women, and from 6.3%to 9.5%in men in the general elderly population. From 2002 to 2015, dementia became the leading, registered underlying cause of death in people with diagnosed dementia. Simultaneously, a marked decline in cardiovascular and cerebrovascular deaths was observed in people with and without dementia. Conclusion: This is the first study to investigate if the causes of death change over time in people with diagnosed dementia compared with the general elderly population. The increase in the registration of dementia as an underlying cause of death could reflect increasing awareness of dementia as a fatal condition.

EQ-5D-5L reference values for the German general elderly population

Background Reference values are a helpful tool to facilitate comparisons of sampled values against a specified reference population. The aim is to describe the health profile and to provide visual analogue scale (EQ VAS) and utility reference values for the EQ-5D-5L from a normative sample of the general elderly population (65+) in Germany. Methods We analysed a sub-set of data from the German EQ-5D-5L valuation study using self-reported information based on EQ-5D-5L. We examined the share of respondents in each severity level per dimension as well as means, standard deviations (SD) and 95% confidence intervals for the index and EQ VAS values stratified by age groups and gender. Age was categorised in four groups (65–69, 70–74, 75–79 and > 79 years) to facilitate a more detailed examination of age-related health-related quality of life (HRQoL). Results The average index and EQ VAS scores were 0.84 (SD 0.22) and 73.2 (SD 18.5), respectively. In total, 21.4% reported no problems in all dimensions. With higher age, health problems were reported more frequently, which, in turn, lead to monotonically decreasing index and EQ VAS values. Overall, men reported fewer problems than women and this difference was largest beyond the age of 80. Conclusion HRQoL in the oldest old appears to be less stable and differs from the young elderly. However, the conventional age categorisation of earlier population norms studies seems to mask these differences. Hence, the more detailed provision of EQ-5D-5L reference values for the elderly population seems helpful for future German studies.

Review: Stimulant Augmentation with Antidepressant in Elderly Patients with Major Depressive Disorder

According to the Centers for Disease Control and Prevention (CDC), depression affects about 1%-5% of the general elderly population, 13.5% in elderly who require home healthcare, and 11.5% in older hospital patients” CDC, 2017. Depression in the elderly is accompanied by functional weakening and early death due to suicide and other causes, Symptoms may include sadness; lack of interest, power, and ability to concentrate; insomnia and decreased appetite; and co-disease. Elderly patients have a lower response to antidepressant medications than adult patients.

Reference Values for Bone Mineral Density and Bone Turnover Markers in the General Elderly Population: A Japanese Cohort Survey Randomly Sampled From A Basic Resident Registry

The aim of this study was to provide definitive reference values for bone mineral density (BMD) and bone turnover markers in the general elderly population. Registered citizens of 50 to 89 years old were targeted for this survey. After random sampling from the resident registry of Obuse town, we established eight groups based on age (50s, 60s, 70s, and 80s) and gender. A total of 411 people were enrolled. We used a dual-energy x-ray absorptiometry device to measure and evaluate BMD. The bone formation marker bone alkaline phosphatase (BAP) was measured as a bone turnover marker. Bone resorption markers, including pentosidine, urinary total deoxypyridinoline, urinary type I collagen N-telopeptide, tartrate-resistant acid phosphatase 5b (TRACP-5b), 25-hydroxyvitamin D, and whole PTH were also measured as bone turnover markers.Sixty-three people (15.3%) were diagnosed as OP. In women, BMD decreased with age. On the other hand, there was no characteristic change with age in men. As for bone markers, 25(OH)D, whole parathyroid hormone, and BAP showed no characteristics associated with gender and aging. In terms of the association between low BMD and bone markers, there was a significant association between low BMD and TRACP-5b in females.In conclusions, BMD decreased with age in women. However, there was no decline with age in men. All bone metabolism markers showed no significant characteristics associated with age or gender, except for a significant association between low BMD and TRACP-5b in females. TRACP-5b was a potentially useful marker for the detection of low BMD.

Validation of Short Form of Preferences for Routines Scale: Norms in Older Adults

High level of preferences for routines is an indicator of psychological vulnerability in older adults. However, the psychometric properties of the Preferences for Routines Scale (PRS) initially validated in a small selected sample of older adults revealed a low Cronbach’s α (.50) in the general elderly population. The present study aims to improve the PRS using the data from the “AMI” and “PAQUID” population-based studies. Among 718 older persons, the most discriminative items are identified using item response theory methodology. A short form of the PRS (PRS-S) included five of the ten items of the original scale and showed improved internal consistency and test–retest reliability. The factors associated with the PRS-S are similar to those found in previous studies. Norms are provided according to gender and educational level. The reduction of the number of items tends to facilitate its administration and promote its use in both clinical and epidemiologic research contexts.