Biomedical subjects

S Landahl

Publications and source records attributed to S Landahl.

At least 55 records · Page 3Linked to original sources

PubMed1988

Pharmacokinetics and blood pressure effects of felodipine in elderly hypertensive patients. A comparison with young healthy subjects.

The pharmacokinetics and antihypertensive effects of felodipine, a new dihydropyridine calcium channel blocker, were studied in elderly hypertensive patients, 67 to 79 years of age and in young healthy subjects, 20 to 34 years of age following oral administration of 5 mg twice daily to steady-state. A single intravenous dose of 3H-felodipine (0.04mg) was given together with the oral dose on the study day. Cmax (17 nmol/L), Cmin (5 nmol/L) and AUC (82 nmol/L.h) were 3 times higher in the elderly than in the young subjects. Systemic availability was about 15% in both groups. Plasma clearance (CL) was reduced from 56.1 L/h in the young to 25.4 L/h in the elderly. There was no effect of age on the volume of distribution at steady-state (Vss). Reduced hepatic blood flow and enzyme activity or increased gut wall metabolism are possible reasons for the altered pharmacokinetics in the elderly. Blood pressure was reduced in the elderly from 190/99 to 177/91 mm Hg 12 hours after 5mg felodipine during twice daily dosage. The effect on blood pressure correlated with plasma concentrations of felodipine.

Adult↗

PubMed1988

Home care and intermittent care--a realistic alternative to nursing-home care?

An inventory was made among 210 elderly nursing-home patients to investigate the feasibility of exchanging their permanent stay in the nursing home for another form of care and whether they wanted to. The main alternative was intermittent nursing-home care. The patients were assessed as to physical and mental health and social conditions. The majority (62.7%) were considered too ill for other than nursing-home care. In some patients (24.8%) there were social factors, the main one being that they no longer had a home of their own. However, 26 patients (12.4%) were recommended for intermittent care, but only three were interested. From these results it was concluded that if intermittent home care is to represent a realistic alternative it should be offered to the patients before they move into a nursing home.

Aged↗

PubMed1988

Screening for thyroid disease in the elderly. Serum concentrations of thyrotropin and 3,5,3'-triiodothyronine in a representative population of 79-year-old women and men.

Thyroid function in individuals from a representative population of 79-year-olds was evaluated clinically and from measurements of serum thyrotropin (TSH) and 3,5,3'-triiodothyronine (T3). High TSH concentrations (greater than or equal to 10 mU/l) were found in 16 of 320 women (5%) and 2 of 204 men (1%). Signs and symptoms which traditionally are regarded as related to hypothyroidism were as common in subjects with high TSH concentration as in the remaining population and occurred in 10-50% of the subjects. In the 16 women with high TSH, free thyroxine (free T4) concentrations were low in 10, whereas only one subject had low thyroxine (T4) and T3 concentrations, indicating that free T4 is a more sensitive parameter for thyroid hypofunction in the elderly. Based on the T3 assay, there was no evidence for hyperthyroidism in this population. The results indicate that high TSH concentrations are common in elderly women, less common in men. The results show that classical symptoms of thyroid dysfunction are quite common in 79-year-olds, but do not correlate with biochemical indicators of thyroid dysfunction, indicating that defining "clinically euthyroid" in an elderly may be almost impossible.

Aged↗

PubMed1988

Intermittent care for old patients--when should it be offered?

An inventory was made among 229 elderly individuals in out- and in-patient care, community care and social welfare. The aim was to investigate the patients' possibilities and interest for intermittent nursing home care in order to avoid or postpone permanent institutional care. The patients were assessed as to physical and mental health and social conditions. Intermittent care was thought to be appropriate for 81 of these patients (35%). After an interview of the patients and cohabiting relatives, 21 patients (9%), mainly out-patients, took a positive interest in this form of care. The in-patients were mostly too ill, and patients in community care found intermittent care interesting but were not prepared for this form of rehabilitation and preferred to wait despite risk of acute deterioration. The most suitable and interested patients and relatives were found among those in day hospital and those on the waiting list for geriatric care.

Aged↗

PubMed1988

Haematological abnormalities and reference intervals in the elderly. A cross-sectional comparative study of three urban Swedish population samples aged 70, 75 and 81 years.

We compared three representative population samples aged 70 (n = 312), 75 (n = 486) and 81 (n = 404) years. Anaemia defined either as blood haemoglobin concentration below the corresponding health-related lower reference limits or according to WHO was, in the total study groups, more common at age 81. Anaemia of unknown cause was rare, but somewhat more common at age 81. Mean blood haemoglobin concentrations in subsamples without definable disorders were significantly lower at age 81 than at ages 70 and 75, whereas the lower health-related reference limits did not differ significantly. White blood cell counts tended to be lower and iron deficiency was somewhat more common at age 81. No significant differences were found in platelet counts or in the prevalence of low plasma cobalamin concentrations. These results indicate a fall in blood haemoglobin with advancing age. The arbitrary WHO criteria for anaemia are clinically applicable at age 70-81.

Age Factors↗

PubMed1987

Postural disturbances in a 75-year-old population: I. Prevalence and functional consequences.

In a representative population of 425 women and 333 men aged 75 years a survey of postural disturbances showed a prevalence of 40% among women and 30% among men. The most common forms were a feeling of unsteadiness when rising from lying to standing and when walking. Postural disturbances had been present for more than 6 months in 85%. One third of the probands had daily or constant troubles and about one tenth of the subjects had these problems occasionally. Associated symptoms were unusual. About one fifth of the probands had fallen as a result of dizziness. Those with postural disturbances were also more handicapped and had a greater need for walking-aids, transport for the disabled, and home social services.

Aged↗

PubMed1987

Blood pressure and mortality in old age. Eleven years' follow-up of a 70-year-old population.

The association between blood pressure levels and mortality up to 11 years has been studied in two representative samples of men and women (1951 people in total) from the longitudinal population study 'seventy-year-old people in Göteborg, Sweden'. We found a significant association between systolic blood pressure (SBP) and mean arterial pressures (MAP) and mortality after 6 years when data from both sexes were pooled. After 11 years, the mortality in the 10% of subjects who had the highest blood pressures at the age of 70 (greater than or equal to 190/105 for men and greater than or equal to 200/105 for women) was 30% higher among the men and 50-60% higher among the women than in the 75% of subjects with the lowest blood pressures. There was no difference between SBP and diastolic blood pressure (DBP) in this respect. A significant association between blood pressure and mortality remained when background factors such as treatment for hypertension, heart failure, coronary heart disease (CHD), diabetes, cholesterol, body mass index (BMI) and smoking habits were kept constant.

Aged↗

PubMed1987

Drug treatment in 70-82-year-old persons. A longitudinal study.

The drug consumption has been studied in two 70-year-old cohorts within the frames of the longitudinal population study "70-year-old people in Göteborg, Sweden". The first cohort has been followed for 12 years and the second, which was born 5 years later, for 5 years. In the first cohort the proportion of men and women on drug treatment increased from 61 and 77% at age 70 to 90 and 97% at age 82. The average number of drugs among those on treatment increased from 3.1 (men) and 3.4 (women) to 3.9 and 5.4, respectively. The most common drugs at age 70 were anxiolytics (20 and 29%), diuretics (15 and 29%), analgesics (12 and 20%), and digitalis (13 and 14%) and at 82 years of age analgesics (39 and 56%), anxiolytics (27 and 49%), diuretics (26 and 42%), and laxatives (19 and 28%). The second examined cohort used more drugs mainly at age 75 than the first cohort. The longitudinal follow-up of the first cohort indicated an overmortality mainly among men on drug treatment at ages 70 and 75. The patients' knowledge of the indications for the treatment was often weak and at age 82, 25% of the patients were unaware of the indications for one or more of the drugs.

Aged↗

PubMed1986

Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years. Report from a double-blind international multicenter study.

In a randomized double-blind study (N = 562), a traditional treatment schedule, starting antihypertensive treatment in elderly hypertensive patients (60 to 75 years old) with 25 mg of hydrochlorothiazide once daily and doubling the dose if a satisfactory response was not achieved, was compared with antihypertensive treatment of 100 mg of metoprolol once daily, adding 12.5 mg of hydrochlorothiazide for patients whose response was not satisfactorialy achieved with metoprolol alone. Systolic and diastolic blood pressure was significantly reduced with both regimens. The frequency rates of responders (diastolic blood pressure, less than or equal to 95 mm Hg) in the metoprolol group and the hydrochlorothiazide group were 50% and 47% after four weeks and 65% and 61% after eight weeks, respectively. There were no significant differences in total symptom score or single symptoms between the regimens, but significantly more patients had hypokalemia and hyperuricemia with the hydrochlorothiazide regimen. Thus, we conclude that beginning antihypertensive treatment with 100 mg of metoprolol once daily and adding a small dose of hydrochlorothiazide (12.5 mg) in patients whose response is not satisfactory with metoprolol alone appears to be effective and safe in elderly hypertensive patients.

Aged↗

PubMed1986

Age-related changes in blood pressure.

This report is based on three different representative population samples of a total of 1304 men (50-79 years old) and 1246 women (38-79 years old) observed for up to 12 years. Subjects' consumption of antihypertensive drugs and blood pressure levels in subjects with and without such treatment are presented. The prevalence of treatment with antihypertensive drugs (including beta-blockers and diuretics for other indications) increased from 2% at age 50 years to 37% at 79 years of age among the men and from 1% at 38 years to 61% at 79 years of age among the women. The mean systolic/diastolic blood pressure in untreated subjects increased from 138/91 mm Hg at age 50 years to 159/91 mm Hg at age 70 years in the men and from 123/79 mm Hg at age 38 years to 168/93 mm Hg at age 70 years in the women. At age 79 years the mean systolic/diastolic blood pressure was 155/83 mm Hg in the men and 161/85 mm Hg in the women. In a longitudinal follow-up of reexamined subjects, there was an increase in systolic blood pressure levels up to age 75 years and a reduction in diastolic blood pressure after age 75 years in both sexes.

Adult↗

PubMed1986

Renal function in an elderly population. A study of S-creatinine, 51Cr-EDTA clearance, endogenous creatinine clearance and maximal tubular water reabsorption.

There has been reported a decline in renal function with age, a decline that seems to accelerate after the age of 50. A systemically chosen sample of 70- and 75-year-old probands from the study '70-year-olds in Göteborg' have previously been examined with respect to GFR. The present study is a longitudinal follow-up of GFR in the previously examined 75-year-old probands at age 79. Renal tubular water absorption was also determined. In order to make a longitudinal comparison, S-creatinine was determined in a subsample of 166 probands, who had attended the study at 70, 75 and 79 years of age, by using frozen sera from these three examinations. S-creatinine increased slightly but statistically significant in both sexes between 70 years and 79 years of age. The reference values for EDTA clearance at age 79 calculated as M +/- 2 SD were 46-94 ml/min X 1.73 m2 BSA without any difference between the sexes. There was no change in GFR between 75 years and 79 years of age. We did not find any correlation between EDTA clearance and creatinine clearance. The tubular water reabsorption for probands without disorders was 843 +/- 92.6 (range 709-982). The results suggest that the renal filtration rate at age 79 is still good and that the ageing of the tubular function is not as pronounced as that of the GFR.

Age Factors↗

PubMed1986

Cyanocobalamin absorption in the elderly: results for healthy subjects and for subjects with low serum cobalamin concentration.

We examined the intestinal absorption of cyano[57Co]cobalamin from a non-protein-bound test dose given to 38 subjects from a population of elderly. The subjects were 76 years old and were apparently free from conditions known to affect cyanocobalamin absorption. Their gastric mucosal function was normal, as judged from determinations of serum gastrin and pepsinogen I. The urinary excretion of radioactivity during the first 24 h was 24(SD 7)%, range 8.6 to 45.2%, corresponding to a health-associated reference interval of 10 to 38%. The results indicate that cyanocobalamin absorption does not decline during normal aging. Duplicate studies were performed in another 20 subjects (70-81 years old) from the same population study; these subjects had a serum cobalamin concentration less than 130 pmol/L. The imprecision (CV) was 23%.

Aged↗

PubMed1984

Pharmacokinetics of metoprolol in healthy, elderly, non-smoking individuals after a single dose and two weeks of treatment.

The effect of long-term treatment on the absorption and disposition of metoprolol has been evaluated in 8 healthy, non-smoking, elderly individuals (mean age 74.5 years) and in a control group of 8 healthy, young individuals. Two trace doses of [3H]metoprolol were given i.v., first concomitantly with a single oral 50 mg dose of cold metoprolol, and second, with the morning dose after 2 weeks of treatment with 50 mg b.d. In the elderly, the mean AUC increased by about 45% (p less than 0.05) over the treatment period, while in the control group the mean AUC was 18% greater (p less than 0.05) on Day 14 than on Day 1. In the elderly, changes both in pre-systemic elimination and in total body clearance accounted for the elevation of the AUC, whereas reduced first-pass effect appeared to be the major cause of the increased steady-state plasma level in the control group. With the exception of the volume term, V beta, the pharmacokinetic parameters were not significantly different between the elderly and the young individuals. For this reason, almost identical steady-state plasma levels were attained in the two groups. The results suggest that age-related physiological changes may have some minor effects on the pharmacokinetics of metoprolol, and also that the changes do not lead to significantly altered plasma concentrations compared to those in young individuals.

Administration, Oral↗

PubMed1984

Heart volume and the prevalence of certain common cardiovascular disorders at 70 and 75 years of age.

Heart volume and the prevalence of coronary heart disease, certain ECG-registered abnormalities, hypertension and congestive heart failure were studied in a representative sample of 70-year-olds, who were re-examined at the age of 75. Although previous and the present observations indicate that the heart volume increases with age earlier in adult life in apparently healthy individuals, no further volume change was observed between age 70 and 75. A significant correlation between heart volume and symptoms indicating congestive heart failure was only observed at volumes above 550-600 ml m-2 BSA in males and 500-550 ml m-2 BSA in females. 38% of the men and 26% of the women were without signs of heart disease or treatment for such disease at both 70 and 75 years of age. These figures are, however, obviously too low since a considerable overdiagnosis and overtreatment, mainly of hypertension in females and congestive heart failure exist in the sample. Anginal pain occurred in about 10% of males and females at both ages while ECG-abnormalities suggesting myocardial ischaemia increased in prevalence between age 70 and 75. The prevalence of congestive heart failure was 11% and 8% respectively in males and females of age 70, and had increased in both sexes by about 50% at age 75.

Aged↗

PubMed1984

Salivary flow, saliva, pH and buffering capacity in 70-year-old men and women. Correlation to dental health, dryness in the mouth, disease and drug treatment.

A representative systematic selection of 30% of all 70-year-olds (1148 persons) in Göteborg were invited to a population study. The participation rate was 85%. Sixteen per cent of the men and 25% of the women reported dryness in the mouth (sex. diff. P less than 0.01). There was a significant correlation between the number of drugs consumed by the subjects and subjective dryness (in both sexes P less than 0.001). Intake of drugs from the groups of anticholionergics, antihistamines, sedatives, hypnotics or phenothiazines respectively seemed to have the highest predicative value for dryness in the mouth (men P less than 0.05 and women P less than 0.01). There was also a positive correlation between subjective dryness and number of definable diseases in both sexes (P less than 0.01). In a consecutive sample (fifty-eight men and fifty-three women) a study of salivary flow, direct pH and buffer effect were performed. The mean value of unstimulated salivary secretion was in men 0.25 and in women 0.18 ml/min. Corresponding figures for stimulated secretion was 1.65 and 1.04 ml/min (sex. diff. P less than 0.01). A significantly lower unstimulated secretion was noted in women with subjective dryness (P less than 0.01). A negative significant correlation were found between dental invalidity, according to Eichner's classification, and stimulated secretion when drug treatment had been considered (men P less than 0.05 and women P less than 0.01). Only weak relations were noted between salivary secretions and drug treatment. Only intake of drugs with diuretic effect were negatively correlated to stimulated secretion (P less than 0.01). Diseases of the circulatory system were correlated to subjective dryness (P less than 0.01).

Aged↗

PubMed1983

Pharmacokinetics of metoprolol and its metabolite alpha-OH-metoprolol in healthy, non-smoking, elderly individuals.

The absorption and disposition of metoprolol have been evaluated in 10 healthy, non-smoking, elderly individuals (mean age 73.1 years) by simultaneous determination of [3H]-metoprolol and unlabelled metoprolol. The labelled drug was given as an intravenous tracer dose, immediately followed by oral metoprolol 25 mg. The experiment was preceded by administration of metoprolol 25 mg b.i.d. for 3 days. The volume of distribution, elimination half-life and total body clearance were almost the same as previously observed in healthy, young subjects. The mean systemic availability was about 39% in the elderly, which is lower than the mean of 55% observed in a control group of young volunteers who received 50 mg b.i.d. In the elderly, the mean plasma concentration of alpha-OH-metoprolol was about twice as high as that of the parent drug, whereas the opposite was true of the control group. The results indicate that age-related physiological changes have a negligible effect on the pharmacokinetics of metoprolol.

Adult↗

PubMed1983

Functional studies in 79-year-olds. I. Performance in hygiene activities.

In the longitudinal population study "70-year-old people in Göteborg" (H 70) at the second follow-up in 1980-81, 112 women and 93 men were examined concerning their hygiene abilities such as visiting the toilet and taking a bath. These elderly people were interviewed about their locomotor function, needs of technical aids and personal assistance available at home. An examination of their functional ability was performed in accordance with a standardized test in two bathrooms, one with a bathtub and the other one with a shower area. Recordings of heart rate and subjectively perceived exertion were made during the test. Almost all were able to stand in front of the washbasin when washing themselves. Climbing in, sitting down and getting out of the bathtub required relatively high levels of effort, and almost one in five had difficulties. Only a few subjects needed personal assistance for getting out of the bathtub. There were large intraindividual variations of heart rate and perceived exertion in the various tasks. More than three of four took advantage of the handrails next to the bathtub during the test compared to one third of the subjects having handrails at home. Two thirds of the subjects had at least one technical aid in the bathroom, the most common technical aid in the bathroom was a "non-slip" mat in the bathtub. The importance of designing products and adapting the environment corresponding to the functional capacity of the elderly is emphasized.

Activities of Daily Living↗

PubMed1982

Penbutolol (Hoe 893d) in primary hypertension. Blood pressure effects, tolerance and plasma concentrations.

Penbutolol (Hoe 893d), a long-acting non-selective beta-adrenoceptor blocking agent, was given once daily to 23 patients with primary hypertension, WHO Stages I-II. The dose (50-100mg) needed to achieve the therapeutic goal, i.e. supine diastolic BP less than 95 mm Hg, was titrated individually. On a daily dose of penbutolol 83 +/- 19 mg (mean +/- SD) blood pressure (BP, mean +/- SD) fell from 180 +/- 21/112 +/- 8 mmHg on placebo to 154 +/- 25/94 +/- 14 mmHg. 18 patients who reached the therapeutic goal (responders) continued in a double blind, cross-over study versus placebo, during which the supine BP fell on average 20/10 mmHg on the same dose of penbutolol, and 2/1 mmHg on placebo. Plasma concentrations (mean +/- SD) of free 0.10 +/- 0.07 microgram/ml) and total (2.02 +/- 1.39 microgram/ml) penbutolol did not differ between responders and nonresponders, and were not correlated with the fall in BP. Side effects were mild and mostly well tolerated. One patient developed dermatitis and another an elevation of liver enzymes.

Adult↗