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M S O'Mahony

Publications and source records attributed to M S O'Mahony.

At least 19 recordsLinked to original sources
PubMed2005

Where older people die: a retrospective population-based study.

BACKGROUND: Palliative medicine services have invested in the community to support people dying at home. To develop end-of-life care for older people, we need to know where they die. AIM: To examine trends in age and location of death over the last 20 years. DESIGN: Retrospective death certificate review. METHOD: All Wales death certificates from 1981 to 2001 were examined. Place of death and age were noted. RESULTS: Total deaths decreased from 35,015 in 1981 to 32,966 in 2001, and mortality decreased from 12.45 per 1000 population in 1981 to 11.33 in 2001. Deaths in the community decreased from 37.6% (n = 13,155) to 22.1% (n = 7293) (p < 0.001); deaths increased in hospital from 56.7% (n = 19,871) to 61.7% (n = 20,334) (p < 0.001) and in care homes from 5.7% (n = 1989) to 16.2% (n = 5339) (p < 0.001). Between 1981 and 2001, deaths in those aged 65-74 years dropped from 9752 to 6361, but increased in the over-85s from 5661 to 9779. Deaths amongst 75-84-year-olds remained stable at around 11,000. The biggest rise in hospital and care-home deaths was in those over 85: hospital deaths increased from 2928 in 1981, to 5438 in 2001; care-home deaths increased from 941 to 3141. DISCUSSION: The last 20 years have seen a significant shift in location of death from the community to hospitals and care homes. Those aged over 85 years account for the biggest rise in hospital and care-home deaths. End-of-life needs for older people need to be addressed in hospital and care homes, not just in the community.

Age Distribution↗
PubMed2004

Adverse drug reactions in elderly patients.

Many studies from around the world show a correlation between increasing age and adverse drug reaction (ADR) rate, at least for some medical conditions. More than 80% of ADRs causing admission or occurring in hospital are type A (dose-related) in nature, and thus predictable from the known pharmacology of the drug and therefore potentially avoidable. Frail elderly patients appear to be particularly at risk of ADRs and this group is also likely to be receiving several medicines. The toxicity of some drug combinations may sometimes be synergistic and be greater than the sum of the risks of toxicity of either agent used alone. In order to recognize and to prevent ADRs (including drug interactions), good communication is crucial, and prescribers should develop an effective therapeutic partnership with the patient and with fellow health professionals. Undergraduate and postgraduate education in evidence-based therapeutics is also vitally important. The use of computer-based decision support systems (CDSS) and electronic prescribing should be encouraged, and when problems do occur, health professionals need to be aware of their professional responsibility to report suspected adverse drug events (ADEs) and ADRs. "Rational" or "obligatory" polypharmacy is becoming a legitimate practice as increasing numbers of individuals live longer and the range of available therapeutic options for many medical conditions increases. The clear risk of ADRs in this situation should be considered in the context that dose-related failure of existing therapy to manage the condition adequately may be one of the most important reasons for admission of the elderly to hospital. Thus, age itself should not be used as a reason for withholding adequate doses of effective therapies.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Drug metabolism and ageing.

Important changes in drug metabolism occur with ageing. Age-associated reductions in function of some but not all cytochrome P450 enzymes (CYPs) have been described. Induction and inhibition of CYPs needs to be revisited in light of recent advances. The function and pharmacology of transporters have not yet been examined for an age-related effect. Finally, the concept of frailty is being underpinned by studies documenting a decline in drug metabolism and changes in disposition in frail older people compared with either healthy elderly or the young.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2001

The effect of community-acquired pneumonia on plasma esterases in older people.

INTRODUCTION: Pneumonia is a major cause of morbidity and mortality in older people. The poor outcome of older pneumonia patients despite treatment is still not understood. OBJECTIVE: The aim of this study was to examine the effect of community-acquired pneumonia on enzymes of drug metabolism in older people. METHODS: Fifteen patients (median age 67 years) with a clinical and radiological diagnosis of community-acquired pneumonia and 14 healthy volunteers matched for age and gender (median age 75 years) were recruited. Plasma activities of benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase and aspirin esterase were determined spectrophotometrically at three time points in pneumonia patients--within 24 h of admission to hospital, 2 days later and 10 days later. Monocyte aryl hydrocarbon hydroxylase (AHH) activity was determined spectrofluorimetrically at the same time points. Enzyme activities were measured at one time point in healthy controls. RESULTS: Mean plasma benzoylcholinesterase activity was significantly lower in pneumonia patients on admission to hospital (mean +/- SEM 848 +/- 100) and after 10 days of treatment (mean +/- SEM 925 +/- 114) than in healthy controls (mean +/- SEM 1333 +/- 84, P < 0.05). Similarly, plasma acetylcholinesterase activity was significantly lower in pneumonia patients on admission (P = 0.007) and after 10 days of treatment (P = 0.01) than in controls. Butyrylcholinesterase activity was lower in pneumonia patients on admission (P = 0.029) than in healthy controls, but improved slightly after treatment so there was no longer a significant difference at 10 days compared with controls (P = 0.077). In contrast there were no significant differences in plasma aspirin esterase activity or induced monocyte AHH activity between pneumonia patients and healthy controls. The activities of benzoylcholinesterase (r = -0.536, P = 0.04), butyrylcholinesterase (r = -0.638, P = 0.01), acetylcholinesterase (r = -0.583, P = 0.022) and aspirin esterase (r = -0.624, P = 0.013) correlated inversely with the British Thoracic Society pneumonia poor prognostic index. CONCLUSION: The activities of several esterases are reduced in older pneumonia patients. Other enzymes including aspirin esterase and induced monocyte AHH activity are unaltered in pneumonia. There was a significant inverse relationship between the activities of all esterases studied and the British Thoracic Society pneumonia poor prognostic index.

Acetylcholinesterase↗
PubMed2001

Relationship between age and plasma esterases.

INTRODUCTION: the older population is the most medicated. Despite high drug usage, older people are generally excluded from the research underpinning new drug development. This means that drugs are prescribed to older people with very little understanding of how they are likely to metabolize them. More research is needed to investigate the possible effects of ageing on the biotransformation of drugs. We therefore undertook a cross-sectional study examining the effect of age on the activities of benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase and aspirin esterase. METHODS: we measured the activities of benzoylcholinesterase and butyrylcholinesterase in 70 healthy volunteers aged 18-85 years. We measured the activities of acetylcholinesterase and aspirin esterase in 43 healthy volunteers aged 18-85 years. We determined plasma activities of benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase and aspirin esterase spectrophotometrically. RESULTS: we found no correlation between the activities of any of the enzymes measured and advancing age. CONCLUSION: age per se is not associated with reductions in the activities of esterase enzymes.

Acetylcholinesterase↗
PubMed2001

Dyspnoea and quality of life in older people at home.

OBJECTIVES: To determine the prevalence of dyspnoea in older people at home, measure its impact on function and quality of life, and identify associated cardio-respiratory diseases. DESIGN: Cross-sectional population-based study. METHODS: We sent a modified Medical Research Council (MRC) dyspnoea questionnaire to identify breathlessness in 1404 randomly selected subjects from general practitioner lists of 5002 subjects aged 70 years and over living at home. We visited a further random sample of 500 of these subjects at home and at a study centre. SETTING: Community-based study in South Wales. MAIN OUTCOME MEASURES: Prevalence of dyspnoea (MRC grades 3-5) and its effect on psychological and functional status, and quality of life as measured by Hospital Anxiety and Depression, Nottingham Extended Activities of Daily Living and SF-36 questionnaires. RESULTS: The prevalence of dyspnoea as defined was 32.3% (95% confidence intervals: 30.3, 34.3). Breathless subjects had poorer functional status than non-breathless subjects. They also had poorer physical and mental health and were more likely to be anxious and depressed. The prevalence of left ventricular systolic dysfunction, reversible airways disease and obesity were all higher in those with dyspnoea. CONCLUSIONS: Dyspnoea is common in older people. Given its profound adverse effect on people's lives, dyspnoea is an important public health issue.

Aged↗
PubMed2001

Giardia in older people.

CASE REPORTS: We report two cases of giardiasis in elderly women. Neither patient had been abroad recently and neither had diarrhoea at the time of diagnosis. In the first case, an extensive gastrointestinal cancer work-up was carried out before the diagnosis was made. CONCLUSION: It is important to consider possible infective causes in older patients who have anaemia and weight loss.

Aged↗
PubMed2001

Age and gender bias in statin trials.

Cardiovascular disease is strongly age-related, and is the leading cause of death in older people. Several well-publicized trials have recently reported that statin drugs (HMG CoA reductase inhibitors) are effective in lowering cholesterol and in reducing the risk of myocardial infarction and stroke. In order to determine whether the results of these trials are relevant to our ageing population, we examined the representation of older people and women in randomized controlled trials of statin drugs. A systematic search of the medical literature from 1990 to 1999 was done to identify randomized placebo-controlled trials of statin drugs which evaluated clinical end-points-myocardial infarction, stroke or death. We identified 19 trials: 15 secondary prevention and four primary prevention. The mean age, age range and gender of the participants in these trials were determined. In the secondary prevention trials, the total number of patients randomized was 31683, with a combined mean age of 58.1 years. No trial enrolled people beyond the age of 75 years, and only 23% of the trial population was female. The four primary prevention trials randomized a combined total of 14 557 subjects with a mean age of 56.9 years. Only 10% of study participants were female. Statin drug trials have suffered from age and gender bias, having been mainly conducted in middle-aged male populations. The extrapolation of evidence from these trials to older people and women needs further evaluation.

Age Factors↗
PubMed1999

Plasma esterases in cystic fibrosis: the impact of a respiratory exacerbation and its treatment.

OBJECTIVES: To determine the effect of an exacerbation of respiratory symptoms in cystic fibrosis (CF) on the activities of plasma benzoylcholinesterase and butyrylcholinesterase. METHODS: Twenty-nine patients with CF in a respiratory exacerbation and 27 healthy volunteers matched for age and sex were recruited. Blood was obtained from the patients when commencing antibiotic treatment and 14 days later on completion of treatment. One blood sample was taken from the healthy volunteers. The activities of benzoylcholinesterase and butyrylcholinesterase were determined by spectrophotometric assay. The circulating inflammatory markers, C-reactive protein and neutrophil elastase-alpha1antiproteinase complex were also measured. RESULTS: Benzoylcholinesterase activity was significantly (P = 0.001) lower in patients at the start of a respiratory exacerbation, compared with healthy controls [mean (SD): 917 (274) versus 1191(298) nmol x ml(-1) x min(-1)]. Benzoylcholinesterase activity increased significantly in patients to 1013 (237) nmol x ml(-1) x min(-1), following a course of antibiotic treatment (P = 0.006). Butyrylcholinesterase activity was also lower (P = 0.001) in patients at the start of a respiratory exacerbation, compared with healthy controls [5.54 (1.64) versus 7.01 (1.79) micromol x ml(-1) x min(-1)], and increased significantly in the patients to 6.31 (1.58) micromol x ml(-1) x min(-1) following treatment (P = 0.006). CONCLUSION: We demonstrated significant suppression of plasma esterase activities during an exacerbation of respiratory symptoms in CF, which was only partially reversed after antibiotic treatment. Further studies are needed to examine other pathways of drug metabolism in this group of chronically infected patients.

Adult↗
PubMed1997

Reliability of parathyroid hormone measurements in the period immediately following hip fracture.

AIM: As it is unclear whether parathyroid hormone (PTH) measurements performed immediately after hip fracture are reliable indicators of pre-fracture metabolic status, we set out to define how PTH levels are affected by hip fracture and its surgical repair. METHOD: In two longitudinal projects, we studied 12 patients presenting with hip fracture and eight patients undergoing elective hip replacement. PTH, calcium and 25-hydroxyvitamin D (25OHD) levels were measured on admission, 2 days and 1 week later and after recovery at least 2 months after initial admission. FINDINGS: In the subjects presenting with hip fracture, PTH levels during inpatient care were no different from those subsequently measured during the recovery period. In subjects undergoing elective hip surgery, PTH levels did not change following surgery and again remained unchanged into the recovery period. CONCLUSIONS: Measurements of PTH performed during inpatient care of those with hip fracture appear sufficiently reliable for use in assessment of metabolic status.

Aged↗
PubMed1997

Frailty and ageing.

Explore the source record for details and available documents.

Activities of Daily Living↗
PubMed1994

Age, environmental factors and drug metabolism.

Both ageing and the environment have a significant impact on xenobiotic metabolism. Furthermore, there is some evidence from in vivo studies that the elderly respond to environmental changes to a lesser degree than younger individuals. This article reviews the available evidence and concentrates on possible underlying mechanisms.

Aging↗
PubMed1992

Serum ferritin in newly diagnosed and poorly controlled diabetes mellitus.

Serum ferritin was measured in 50 patients at diagnosis of diabetes mellitus (DM) and in 20 patients with established DM and poor metabolic control. Twenty-two patients had hyperferritinemia at diagnosis. Four patients had a recognised cause for their hyperferritinemia. In the remaining 18 patients ferritin levels decreased from a mean of 506 +/- 3.6 (SE) ug/l at diagnosis to 254 +/- 29.2 ug/l seven months later (p < 0.001). Metabolic control improved significantly over the same time. All 20 patients with established DM and poor metabolic control had normal ferritin levels. When compared with the newly diagnosed hyperferritinemic patients no difference was found in levels of glycosylated haemoglobin, but ferritin values differed significantly between the two groups (p < 0.001). These results indicate that transient hyperferritinemia is a feature of newly diagnosed DM but not of established DM with poor control. If used to screen diabetic patients for haemochromatosis, serum ferritin should be measured in established DM rather than at diagnosis.

Adolescent↗