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R S Tilvis

Publications and source records attributed to R S Tilvis.

At least 37 records · Page 2Linked to original sources
PubMed1998

Determinants and significance of declining blood pressure in old age. A prospective birth cohort study.

AIMS: To investigate the changes in blood pressure and their causes in an elderly population. METHODS: Orthostatic blood pressure measurements were performed in randomly in four birth cohorts (years 65-, 75-, 80- and 85, n=773) at 5-year intervals. RESULTS: Both systolic and diastolic blood pressures decreased in both genders and all age groups. The falls in blood pressure related closely to initial blood pressure values and to the thickness of the left ventricular posterior wall of the heart. The changes in supine (r=0.118, P=0.007) and standing systolic blood pressure (r=0.123, P=0.005), as well as supine (r=0.148, P<0.001) and standing diastolic blood pressure (r=0.186, P<0.001) correlated with changes in body weight. Changes in supine diastolic blood pressure also related to changes in serum cholesterol (r=0.207, P=0.002) and triglycerides (r=0.160, P=0.016). Changes in supine and standing systolic and standing diastolic blood pressures also related to changes in dehydroepiandrosterone sulphate (r=0.161, P<0.05; r=0.205, P<0.01; r=0.140, P<0.05, respectively). Changes in blood pressure also correlated with self-estimated poor health after 5 years (r for supine systolic blood pressure= -0.133, P<0.001, for standing systolic blood pressure= -0.135, P<0.001, for supine diastolic blood pressure= -0.111, P<0.002). PATIENTS: who were institutionalized during the follow-up or who had severely impaired performance capacity after 5 years, displayed the most marked decline in blood pressure. Declining systolic blood pressure was also related to impaired survival prognosis. According to the logistic regression analyses the baseline blood pressure, antihypertensive drugs and changes in dehydroepiandrosterone sulphate and cholesterol explained over 30% of the changes in blood pressure. In the logistic models, declining blood pressure was associated with baseline blood pressure, antihypertensive treatment, poor health after 5 years, and decreasing cholesterol and triglycerides. CONCLUSION: Decline in blood pressure in old age is associated with deteriorating health and is only partly explained by the use of antihypertensive drugs.

Aged↗
PubMed1998

How accurate is the terminal prognosis in the minimum data set?

OBJECTIVES: To determine the sensitivity and specificity of terminal prognosis in institutional long-term care (LTC) DESIGN: The Minimum Data Set (MDS 1.0). Data in regard to deaths were collected 6 and 12 months after the assessment. SETTING: A geriatric hospital responsible for all hospital-based LTC services in one health district (population 71,000) in Helsinki, Finland. PARTICIPANTS: All LTC patients (N = 656; 81% female; mean age = 83 years) in treatment during a 1-week period. RESULTS: One-fourth (n = 164) of the 656 LTC patients had a terminal prognosis. Of these patients, 70.7% survived 6 months, and 58.5% were still alive after 1 year. Consequently, terminal prognosis was associated with a four-fold risk of 6-month mortality. The sensitivity of the terminal prognosis diagnosis was only 29%, whereas the specificity was 89%. The positive predictive accuracy was 47%, but the negative predictive accuracy was 79%. CONCLUSIONS: Terminal prognosis was clearly overdiagnosed. More information is needed about short-term mortality in terminal prognosis patients and whether this diagnosis affects survival rates.

Aged↗
PubMed1998

Apolipoprotein E phenotypes, dementia and mortality in a prospective population sample.

OBJECTIVE: To study the relationships between apoE phenotypes, dementia, and mortality. SETTING: A population-based study in Helsinki, Finland (the Helsinki Ageing Study). DESIGN: A prospective birth cohort study with 5-year follow-up. PARTICIPANTS: A total of 550 subjects of three birth cohorts of 75 (n = 182), 80 (n = 185), and 85 (n = 183) years of age. MEASUREMENTS: ApoE phenotype was determined from baseline blood samples. The cognitive function of the subjects was tested at baseline and at a 5-year follow-up using the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR). Diagnosis and type of dementia were determined by a neurologist. The cohorts were followed for 5 years, and causes of death were determined. Cox proportional hazards model was used for survival analyses. Analyses were performed comparing the apoE e4 allele and others. RESULTS: At baseline, the apoE e4 allele was found in 148 of 550 subjects (27%), in 24% of nondemented persons, in 51% of patients with probable or uncertain Alzheimer's disease (AD), and in 34% patients with vascular dementia. The CDR score was worse among subjects with an e4 allele compared with others at baseline (P < .001) and after a 5-year follow-up (P = .007). The crude mortality rates of subjects with and without an e4 allele were 48% (n = 71) and 37% (n = 148), respectively. After controlling for age and gender, the hazard ratio of an e4 allele was 1.61 (95% CI, 1.21-2.14) for all-cause mortality, deaths caused by dementia 2.20 (95% CI, 1.03-4.72), and presence of AD 3.24 (95% CI, 1.67-6.25). CONCLUSIONS: In a population aged 75 to 85 years, the presence of an apoE e4 allele is associated with impaired cognitive function, clinical dementia, AD, and excess 5-year mortality resulting from dementia and all causes.

Aged↗
PubMed1998

Why is the pain relief of dying patients often unsuccessful? The relatives' perspectives.

In order to determine relatives' opinions of the pain relief of dying patients a postal questionnaire was sent to close relatives (n = 371) of aged patients (mean age 80.1 years) who had died one to two years earlier. In the relatives' opinions, 57% of the patients (n = 211) had suffered from moderate to severe pain and in 22% (n = 46) of these the pain relief was unsuccessful. Inadequate pain relief was associated with a feeling of helplessness in the patients (odds ratio 2.6), insufficient self-determination of analgesic use (9.4), unsatisfactory care of daily needs such as nutrition (8.3), and insufficient care of concomitant symptoms such as dry mouth (6.2). The pain relief was also evaluated as having been unsuccessful when the relatives received limited information about the forthcoming death (5.7), when it was difficult to discuss with the clinical staff (5.7), and when the relatives were not supported by, for example, comforting and heartening (7.9) or encouraging to participate in the care (7.2). In the multivariate analysis, the self-determination of the patients about their pain medication (5.7), difficulties of the relatives to discuss issues with the nursing staff (3.7) and poor atmosphere of the treatment environment (2.8) emerged as the most significant associates of unsuccessful pain relief. The results show that dissatisfaction with the pain management is associated with low appreciation of the treatment of other discomforts and complaints. Successful pain management therefore requires a holistic approach to the wider spectrum of problems in dying patients.

Aged↗
PubMed1997

Does fasting plasma insulin increase by age in the general elderly population?

The aim of this study was to examine the association of fasting plasma insulin with age. Insulin levels are influenced by obesity, physical inactivity, and medications, e.g., thiazide diuretics and beta adrenergic blockers. Further, comorbidity and pre-terminal conditions may confound the age-association of insulin. 1197 random subjects from four birth cohorts of the general aged population in southern Finland were examined, and followed for five years. Insulin levels at baseline tended to increase in men to the age of 75 years (mean 15.1 mU/L, SE 2.18), and in women to the age of 80 years (mean 15.9 mU/L, SE 1.14). The same association was seen among survivors in a five-year follow-up. These associations remained significant after controlling for obesity, physical inactivity and hyperinsulinogenic medications.

Aged↗
PubMed1997

Impacts of components of the metabolic syndrome on health status and survival in an aged population.

The clinical significances of different components of the multiple metabolic syndrome were studied in a five-year follow-up study of random persons (n = 1,199) of four birth cohorts at ages 65, 75, 80, and 85 years. The subjects were examined clinically and their serum lipids, blood glucose, plasma insulin, blood pressure, and health score were determined. The health score was measured using a visual analogue scale. All subjects were followed for 5 years. Health score, diastolic blood pressure and body mass index declined over age, but serum triglycerides, and blood glucose were similar, whilst serum high density lipoprotein (HDL)-cholesterol increased. Among women fasting plasma insulin was lowest in the age group of 65 years. The associations of components of the multiple metabolic syndrome varied by age. In the age groups of 65 and 75 years high body mass index, plasma insulin, glucose, triglycerides and low HDL-cholesterol were associated with impaired health. In the age group of 85 years high blood pressure, total cholesterol, and HDL-cholesterol were associated with good health. The baseline health score was consistently lower in the decedents than survivors of all age groups, but components of the metabolic syndrome were generally not associated with impaired survival.

Aged↗
PubMed1997

Blood pressure and mortality in an older population. A 5-year follow-up of the Helsinki Ageing Study.

OBJECTIVE: Hypertension is an established risk factor of cardiovascular diseases, and in clinical studies its treatment has reduced cardiovascular complications in subjects up to 80 years of age. In the older age groups, prognostic data on blood pressure is sparse. We evaluated the prognostic significance of different blood pressure levels and the history of elevated blood pressure in an older population. DESIGN: In the Helsinki Ageing Study random individuals 75, 80, and 85 years of age (n = 521) were evaluated at baseline using postal questionnaires, structured interviews, clinical examinations, laboratory investigations, and blood pressure measurements (supine, seated, standing). Date of death during a 5-year follow-up was verified using computerized registers, and thus the follow-up was 100% complete. The data were analysed using life-table analyses and Cox proportional hazards models. RESULTS: At 5 years, 240 subjects (40%) had died, 50% of them of cardiovascular disease. In crude analyses, an inverse relationship between both systolic and diastolic blood pressure and mortality was observed in all groups combined (P < 0.01), and separately in the 80 and 85-year-old groups. However, a J-shaped link between diastolic blood pressure and mortality was found in the 75-year-old group. After controlling for age, gender and the presence of clinically significant diseases (in 72% of subjects) baseline blood pressure was associated with favourable 5-year survival. The risk ratios of systolic (per 10 mmHg) and diastolic blood pressure (per 5 mmHg) were 0.90 (95% CI 0.85-0.96) and 0.92 (95% CI 0.86-0.99), respectively. Neither isolated systolic hypertension nor a history of hypertension treatment were associated with 5-year survival. CONCLUSION: At the population level, among subjects aged 75 years and over, favourable 5-year survival is indicated by a high, but not a low, blood pressure.

Age Distribution↗
PubMed1997

Elevated fasting plasma insulin in a general aged population: an innocent companion of cardiovascular diseases.

OBJECTIVE: Although high insulin levels have been linked to cardiovascular disease, the role of insulin as an independent risk factor has been questioned. Our objective was to examine the association of fasting plasma insulin with cardiovascular disease as well as to investigate the prognostic value of insulin with respect to survival. DESIGN: A 5-year follow-up of random samples from four birth cohorts age 65 (n = 660), 75 (n = 194), 80 (n = 179), and 85 (n = 162) years at baseline. SETTING: Two urban communities in southern Finland. MEASUREMENTS: Clinical and laboratory investigation at base line with collection of date and cause of death information during follow-up. RESULTS: Subjects with cardiovascular disease generally had higher levels of fasting plasma insulin than did subjects without cardiovascular disease (13.9 mU/L vs 11.2 mU/L, P < .001). Heart failure and hypertension were associated with significant 30 to 80% elevations of insulin levels in all but the oldest group. In the 65-year-old group, all vascular diseases were associated with significantly elevated insulin. The associations were generally not explained by body mass index or by use of diuretics or beta-blockers. During the follow-up insulin was generally not associated with an impaired survival. On the contrary, in subjects with manifest cardiovascular disease, high insulin was associated with a rather favorable 5-year survival prognosis. Exclusion of subjects who died during the first 500 days of follow-up did not change these associations. CONCLUSION: Albeit fasting plasma insulin appeared to be secondarily associated with cardiovascular disease in this general aged population, it was related to a fair or favorable survival prognosis.

Activities of Daily Living↗
PubMed1996

High plasma insulin is associated with lower LDL cholesterol in elderly individuals.

To investigate possible relationships between plasma low density lipoprotein (LDL) cholesterol and fasting plasma insulin in the elderly, cross-sectional random samples of age cohorts (65, 75, 80 and 85 years, n = 1188, M/F 38/62 percent) were studied in the neighbouring cities of Helsinki and Vantaa, Finland. Plasma total and high density lipoprotein (HDL) cholesterol, plasma triglycerides, blood glucose and plasma insulin were measured after an overnight fast. LDL cholesterol was calculated using the Friedewald equation. Statistical analyses were performed separately in subjects with non-insulin-dependent diabetes mellitus (NIDDM, n = 219) and non-diabetic subjects (n = 969). Comparison of lipid levels by insulin quartile (I < 7.4 IU/1, II 7.4-10.0, III 10.1-15.0, IV > 15.0) showed that total and LDL cholesterol decreased in the highest insulin quartile (P = 0.003). This trend prevailed after adjustments for age, gender, body mass index, blood glucose and serum triglycerides, and it was significant also in normotriglyceridemic (serum triglycerides <2.3 mmol/l) subjects. Furthermore, the association between high insulin and lower cholesterol was seen in normoglycemic (fasting blood glucose <6.7 mmol/l) and diabetic subjects. Lower LDL cholesterol in elderly subjects with higher fasting insulin may reflect poor health or a 'harvesting' effect, but the results may also be due to effects of insulin on LDL catabolism and/or cholesterol absorption.

Aged↗
PubMed1996

Postural hypotension and dizziness in a general aged population: a four-year follow-up of the Helsinki Aging Study.

OBJECTIVE: To evaluate the frequency, risk factors, and prognostic significances of postural hypotension (PH) and dizziness on postural testing (DPT). DESIGN: A prospective cohort study. SETTING: General community, The Helsinki (Finland) Aging Study. SUBJECTS: Persons of three age cohorts (75, 80, and 85 years, n = 569) were chosen randomly and followed for 4 years. MEASURES: Postal questionnaires, structured interview, extensive clinical and laboratory examinations, blood pressure (BP) changes in a postural test using different definitions for PH, history of dizziness, dizziness on testing postural blood pressure reactions (DPT), and date of death during a 4-year follow-up. RESULTS: The frequency of a fall in systolic blood pressure greater than 20 mm Hg or a fall in diastolic pressure greater than 10 mm Hg (PH-I) was 30.3%. Both criteria occurred simultaneously (PH-II) in 7.5%, and if dizziness on postural testing (DPT) was an additional symptom (PH-III), the prevalence was 2.6%. The overall prevalence of DPT was 19.7%. PH-I, PH-II, and DPT were also frequent among the healthy aged (26.6%, 6.6%, and 17.3%, respectively). The postural change in BP correlated inversely with the initial supine BP levels (systolic r = -.149, P < .001 and diastolic r = -.218, P < .001), but in persons with isolated systolic hypertension PH was rather less frequent (21.9% and 2.3%). DPT was more common in the subjects with heart failure (26.3%, P < .05), impaired exercise tolerance (NYHA III-IV) (33.7%, P < .05), and PH-II (37.2%, P < .05) compared with the healthy controls (17.3%). The 1-year mortality was higher in subjects with than without DPT (7.1% vs 4.8%, P < .05), but the difference was not significant after controlling for age and gender. PH-I, PH-II, and PH-III were not significantly related to 4-year mortality. CONCLUSIONS: In this study of older people in Helsinki, Finland, asymptomatic hypotensive postural BP reactions and DPT were found frequently among healthy older people, and they tended to be increased in people with some diseases. Neither PH nor DPT were of prognostic significance for mortality in this population.

Aged↗
PubMed1994

Aging and genetic variation of plasma apolipoproteins. Relative loss of the apolipoprotein E4 phenotype in centenarians.

We determined the common polymorphism of apolipoprotein E (E2, E3, and E4), apolipoprotein B Xba I polymorphism, and apolipoprotein C-III Sst I polymorphism in almost all Finnish centenarians alive in 1991 (n = 179/185). Plasma lipid and lipoprotein levels in different apolipoprotein genotypes were also measured. In comparison with younger Finnish populations studied previously, the frequency of the apolipoprotein E epsilon 2 allele was almost twice as high (7.0% versus 4.1%; P < .05) and that of the epsilon 4 allele only approximately one third as high (8.4% versus 22.7%; P < .001) in the centenarians. Plasma cholesterol and high-density lipoprotein cholesterol levels tended to be lowest in the group with the epsilon 2 allele (4.33 mmol/L and 1.41 mmol/L, respectively), intermediate in those with the epsilon 3 allele (4.57 mmol/L and 1.48 mmol/L, respectively), and highest in those with the epsilon 4 allele (4.82 mmol/L and 1.60 mmol/L, respectively). The frequencies of the apolipoprotein B X1 and X2 alleles (Xba I restriction site absent or present, respectively) among the centenarians and among the young Finns were not significantly different, whereas the apolipoprotein C-III S2 allele (Sst I restriction site present) occurred more often in the centenarians (frequency, 12.9%) than in the youngest reference population (frequency, 8.8%; P < .05). Centenarians with the apolipoprotein B X2X2 genotype and apolipoprotein E4 phenotype had a higher mean plasma cholesterol level than those with the X1X1 genotype and E2 phenotype (5.24 versus 3.43 mmol/L; P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Survival prognosis in geriatric patients admitted to permanent institutional care.

The influence of clinical and laboratory findings on the two-year survival prognosis was investigated in 558 geriatric patients admitted to permanent institutional care. The patients surviving for two years (52%) were somewhat younger (79 vs 82 years, p less than 0.01), and on admission had significantly higher diastolic blood pressure (p less than 0.001), serum thyroxin (p less than 0.05), serum albumin (p less than 0.01) and blood haemoglobin (p less than 0.05), but lower treatment score (p less than 0.001), serum creatinine (p less than 0.001), and fasting plasma glucose (p less than 0.05). Decreased survival prognosis was also found in patients with abnormal serum sodium, chloride, and potassium (p less than 0.05 or less). However, an excess mortality of patients with abnormal laboratory data occurred within the first month after admission. Stepwise logistic regression analysis disclosed that the three-month survival prognosis was significantly impaired by low blood pressure (less than 110/70 mmHg), high treatment score (greater than 22), elevated serum creatinine (greater than 150 mumol/L), use of digitalis and atrial fibrillation. Poor two-year survival was further associated with the use of diuretics, and diabetes mellitus. The risk for death was lowest in patients with elevated blood pressure (greater than 160/95 mmHg). These data verify the significance of the clinically common diseases and indicators of homeostasis in the assessment of geriatric hospital patients, and demonstrate the nature of "terminal decline" in geriatric practice.

Aged↗
PubMed1992

Serum ionized calcium and the prevalence of primary hyperparathyroidism in age cohorts of 75, 80 and 85 years.

In the elderly, primary hyperparathyroidism (HPT) is often disguised as 'senility' which can, however, be alleviated or cured by parathyroid surgery. The prevalence of HPT in the non-selected 75- to 85-year-old subjects (n = 610) randomly sampled from census records was estimated by measurements of serum ionized calcium and intact parathyrin levels. The prevalence of cases that require clinical attention seems to be around 3% in women and less than 1% in men. Furthermore, this study indicates that, on average, the serum ionized calcium concentration remains stable even in the elderly.

Aged↗
PubMed1992

Calcemic status of geriatric patients: a longitudinal study.

Serum ionized (CaI), total (CaT) and albumin-'corrected' total (CaA) calcium concentrations were measured in 108 geriatric long-term inpatients on admission and again 37 months (mean) later. Mean CaI, especially when pH adjusted, remained extremely stable, indicating well-preserved homeostatic calcemic control even in the terminal years in the elderly. Further, the results indicate that in addition to their previously shown invalidity in interindividual comparisons, CaT and CaA are inferior to CaI and can also be misleading in the detection of slight longitudinal changes in the 'true' calcemic status of an individual geriatric patient.

Aged↗
PubMed1990

Serum plant sterols and cholesterol precursors reflect cholesterol absorption and synthesis in volunteers of a randomly selected male population.

To investigate the regulation of serum levels of cholesterol precursor sterols and plant sterols, these noncholesterol sterols, fatty acids, and various parameters of cholesterol metabolism were analyzed in 63 volunteers from a randomly selected Finnish male population sample of 100 subjects, aged 50 years, who had normal dietary habits. Serum levels of cholesterol precursors, desmosterol and lathosterol (in terms of micrograms/mg cholesterol), were negatively related to both the fractional and absolute absorption of dietary cholesterol and serum high density lipoprotein (HDL) cholesterol, and positively related to overall cholesterol synthesis and serum very low density lipoprotein (VLDL) cholesterol. Serum levels of the plant sterols, campesterol and sitosterol, exhibited positive correlations with the polyunsaturated/saturated fatty acid ratio of dietary fat, the linoleic acid contents of plasma and dietary lipids, the amount of dietary plant sterols (as indicated by fecal output), fractional and absolute absorption of dietary cholesterol, and HDL cholesterol, but were inversely related to the overall cholesterol synthesis and VLDL cholesterol. Stepwise multiple regression analysis revealed that the serum level of campesterol was associated with fractional cholesterol absorption, dietary plant sterols, and biliary cholesterol secretion, and that of sitosterol with dietary plant sterols, cholesterol synthesis, fractional cholesterol absorption, and biliary cholesterol secretion. Thus, the serum non-cholesterol sterols are significant indicators of cholesterol absorption and synthesis even under basal conditions and, since gas liquid chromatographic determination of these sterols is quite simple, their measurement may be valuable for monitoring cholesterol metabolism in large-scale epidemiologic studies.

Absorption↗