J K H Lim | Search PubMed

PubMed2003

Thyroid dysfunction in elderly patients.

INTRODUCTION: The aim of this study was to determine the prevalence of thyroid dysfunction in an elderly in-patient population in a restructured hospital. METHODS: This was a prospective observational study performed on consecutive patients admitted into a geriatric ward in a restructured hospital in Singapore over a period of 3 months. Thyroid function tests (free thyroxine and thyroid stimulating hormone) were performed on all patients during routine blood screening. For those with abnormal thyroid function tests, further investigations including thyroid autoantibodies and anterior pituitary hormone measurements were performed where indicated. Demographic data, the presence of sepsis, hypoalbuminaemia and patients' functional status as well as other thyroid-related data were captured. RESULTS: A total of 184 patients were screened and 62 (33.7%) patients were found to have abnormal thyroid function tests. The mean age was 83.8 years (SD 6.2). Twenty (32.3%) were males and 42 (67.7%) were females. Thirty-three (53.2%) patients had sepsis on admission, 29 (46.8%) were functionally dependent and 22 (35.5%) had hypoalbuminaemia. The prevalence of thyroid disorders were as follows: 1 (0.5%), 4 (2.2%), 9 (4.9%), 15 (8.2%) and 33 (17.9%) patients had hyperthyroidism, subclinical hypothyroidism, primary hypothyroidism, secondary hypothyroidism and sick euthyroid syndrome, respectively. Cross-tabulating sick euthyroid syndrome against functional dependence, hypoalbuminaemia and sepsis did not reveal any significant association (Fisher's exact test, P = 0.44, P = 0.42 and P = 0.61, respectively). CONCLUSION: There was a high prevalence of thyroid dysfunction in the elderly in-patient population. We would advocate a lower threshold for screening elderly in-patients for thyroid dysfunction.

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PubMed2002

Stroke prevention in elderly patients with atrial fibrillation.

BACKGROUND: The prevalence of atrial fibrillation increases with age. Atrial fibrillation has been shown to be a significant risk factor for stroke in the elderly. Anticoagulation is effective in preventing stroke in geriatric patients with atrial fibrillation, yet many elderly patients with atrial fibrillation are not anticoagulated. OBJECTIVES: This study aims to determine the prevalence of atrial fibrillation in an inpatient population of a geriatric unit and explores the usage of anticoagulants in those patients diagnosed with atrial fibrillation. METHODS: Consecutive admissions to a geriatric unit were screened with an electrocardiogram to establish a diagnosis of atrial fibrillation. Those with atrial fibrillation were evaluated for risk factors for stroke and for contraindications for anticoagulation. Documentation of reasons for withholding anticoagulation was also examined. RESULTS: Five hundred and six consecutive inpatient admissions were screened. Fifty-six patients had atrial fibrillation (11.1%). Forty of these were known cases of atrial fibrillation whereas sixteen were newly diagnosed. There were 22 (39.3%) males and 34 (60.7%) females. The mean age was 83.3 years (S.D. 6.8). The four most common risk concomitant factors for stroke were age above 75 years (54, 96.4%), hypertension (41, 73.2%), congestive cardiac failure (28, 50%), and a history of strokes (20, 35.7%). Fifty-five (98.2%) patients had at least two other concomitant risk factors for stroke. On discharge, only nine (16.1%) out of 56 patients were anticoagulated. Anticoagulation was withheld because of contraindications in 44 (78.6%) patients and because of patients' objection to anticoagulation in 3 (5.3%) patients. The two most common reasons for withholding anticoagulation were the risk of recurrent falls (18, 38.3%) and peptic ulcer disease (15, 31.9%). CONCLUSIONS: The prevalence rate of atrial fibrillation in elderly inpatients was found to be 11.1%. Most of the elderly with atrial fibrillation had multiple concomitant risk factors for stroke and would benefit from anticoagulant therapy. However, in the majority, anticoagulation was withheld because of contraindications (78.6%) and patients' objection to anticoagulation (5.3%).

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