Journal of the Association of Physicians of India
JAPI
Editor : Dr. Siddharth N. Shah
February 2018 • VOL. 66
Abstracts : Free Papers – Platform Presentation (APICON-2018) - Geriatrics
A Prospective Study of Thyroid Function Test in Geriatric Population and its Clinical Correlation
Introduction: Thyroid gland functioning is very important for human body. After diabetes, thyroid dysfunction is a common endocrine disorder, especially in the elderly, with a 2 to 5% prevalence of clinically significant disease reported in geriatric institutions. Hence there is a need for early diagnosis and studying various factors responsible for thyroid dysfunction in elderly to improve quality of life.
Material: This study was intended to study the thyroid functions in geriatric age group and their clinical correlation. A sample size of 75 patients aged above 60 years with clinical suspicion of thyroid disorder coming for check-up in medicine and geriatric OPD were selected. Further they were subjected to a detailed clinical examination and thyroid function testing (T3, T4 and TSH) by biochemical means. Those who were found to have altered thyroid functions were subjected for thyroid protein antibody (TPO) testing.
Observation: Total of 75 patients aged above 60 years were included in study. Thyroid function test was altered in 22 patients (29%), out of which overt hypothyroidism was seen in 11 (14.6%), subclinical hypothyroidism in 5(6.6%), hyperthyroidism in 4(5.3%), and subclinical hyperthyroidism in 2 (2.6%). In this study 52 patients were female and 23 were male. It was observed that females (21.3%) had higher incidence of thyroid dysfunctions as compared to males (8%). TPO antibodies were positive in all hypothyroidism cases suggestive of autoimmune cause as age advances. Lipid profile was seen altered in thyroid disorders.
Conclusion: Thyroid disorder is common among elderly females as compared to male. Hypothyroidism is more common compared to hyperthyroidism. Thyroid dysfunction is associated with altered lipid profile. Thyroid disordered should be ruled out in all symptomatic elderly patients.
A Study of Magnitude of Zinc Deficiency and its Effects on the Clinical Manifestation Among Elderly
Introduction: Zinc is an essential trace element and constituent of many metalloenzymes required for normal body metabolism.It plays an important role in the transcription factors,maintaining normal immune mechanism,fighting oxidative stress,co-factor of many enzymes.
Zinc is found in sufficient amounts in animal based diet.But for those people who depend on plant based diet like grains, legumes contain very little amount of zinc which is not sufficient for the body.
Elderly are at a greater risk of Zinc deficiency than the general population. And elderly consume less amount of food and also they have decreased level of absorption.So the amount of Zinc they consume is not enough for healthy aging process.
Zinc deficiency leads to scaly rash around mouth,hands and groin and many conditions like diarrhoea,loss of appetite,infections,hair loss and poor wound healing.
There were not much studies published in India regarding zinc deficiency in elderly.
Objectives of the Study:
a. Assess the magnitude of zinc deficiency among elderly patients.
b. To assess the relationship between zinc status and inflammatory marker(ESR) among elderly.
Materials and Method: Patients admitted into/followed up on OPD basis department of General Medicine, J.S.S. Hospital, Mysore.
Method of Collection of Data: 75 patients admitted into/followed up on OPD basis in Department of General Medicine who fulfill the inclusion criteria and Mini Nutritional Assessment scale are taken and Serum zinc,albumin,Cholesterol and ESR are estimated.
Inclusion Criteria
Elderly of Both Gender
>65 Years
Exclusion Criteria:
<65 Years
Elderly not able to comprehend
Elderly who are terminally ill
Who are already on Zinc supplementation
Not giving willingness for the investigations.
Elderly who are at risk of Zinc toxicity like gastric irritation,abdominalpain,anaemia,dizziness,nausea and vomiting
Results: In the present study conducted,we have collected 75 patients greater than 65 years till date in a span of 10 months. 37 were males and 39 were females. All the 75patients were taken after assessment on KATZ scale,Mini nutritional assessment scale and GDS score.Baseline level of zinc was taken as 10micromole/L.
Out of 75 patients,46 patients(61.33%) were found to be deficient in zinc.In these zinc deficient patients the other parameters were calculated.
40 (86.95%) out off 46 patients were suffering from depression according to GDS scoring.
Clinical manifestations like oral ulcers, diarrhea, hairloss, loss of appetite, poor vision was high among zinc deficient elderly.
19(41.33%) patients were found to be deficient in serum albumin.ESR was increased in 44(95.65%) patients indicating some underlying infection or inflammation.
Zinc and High density lipoprotein were found to have a positive correlation. 26(56.52%) out of 46 zinc deficient were also found to be low in HDL.Zinc was having negative correlation with LDL and triglycerides. LDL was high in 22(47.82%) of zinc deficient patients. 20(43.47%) patients with zinc deficiency were having high triglyceride levels.
Conclusion: There is a significant correlation between zinc deficiency and severe illness in elderly as zinc is an important co-enzyme in normal metabolism of many enzymes in the body for proper functioning of human and healthy aging process.Zinc deficiency also has a role in affecting the lipid profile of the patients.Deficiency of zinc has led to rise in inflammatory markers which correlates with underlying infection.
Study of Risk Factors of Mild Cognitive Impairment in Elderly Patients with Type 2 Diabetes
Introduction: An association between T2DM and cognitive impairment has been reported but data is limited.We investigated the cross-sectional association between various physical and biochemical parameters and mild cognitive impairment (MCI) in elderly type 2 diabetic patients.
Objective: To identify risk factors of mild cognitive impairment among elderly patients with type 2 diabetes mellites.
Materials and Methods: 200 type 2 diabetic patients (sample size as given by statistician) aged 60 years and above were enrolled in the study. Mild cognitive impairment (MCI) is detected among them using Montreal Cognitive Assessment (MoCA) score. Detailed history is taken and examination is done. BMI, Waist to hip ratio and BP are recorded & Hba1c and lipid profile are measured for all the subjects.
Observations: Patients are aged between Observations: Patients are aged between 60 - 72 years with mean age of 68 years. 116 (58%) patients have MCI(MoCA <26) and 84 (42%) do not have MCI (MoCA >26). compared with the patients without MCI, patients with MCI had longer duration of diabetes, associated hypertension, higher levels of non HDL, total cholesterol, total triglyceride levels and lower HDL levels. There is no significant difference in duration of hypertension, BP values, BMI and Hba1c and levels between both groups. MoCA scores were negatively correlated with the history of hypertension (r = - 0.23, p= 0.002), duration of diabetes (r=0.17,p=0.044) and non HDL cholesterol (r= - 0.78 p = 0.001). Multiple regression analysis showed that history of hypertension (beta= - 0.27 p=0.002) and non HDL (beta = - 0.3 p= 0.001)were significantly independent determinants of MoCA score.
Conclusion : These findings can be used in the management of cognitive impairment in diabetic patients. The study suggest that control of blood pressure and lifestyle changes can reduce risk of MCI development in diabetic patients.
Myocardial Injury in Critically Ill Elderly Patients with Non-Cardiac Diagnosis at Admission
Introduction: Critically ill elderly patients are at high risk for myocardial ischemia because of older age, increased intrinsic and extrinsicsympathetic stimulation, hypoxia, vasopressor use, and coagulation disorders. In clinical practice, the diagnosis of myocardial injury in ICU patients is complicated by frequent absence of clinical symptoms and presence of confounding co morbidities. So Myocardial infarction (MI) in the critically ill patients is a diagnostic challenge and is associated with adverse outcome for the patient. The presence of elevated troponin T levels, in addition to ECG changes, may help to make a decision to rule in or out myocardial injury. So the aim of this study is to study the clinical profile of patients developing myocardial injury assessed by raised cardiac troponin T, ECG findings in critically ill elderly patients admitted to ICU for non-cardiac diagnosis.
Materials and Methods: The study subjects are minimum of 128 patients calculated using N-MASTER software with confidence interval of 95% and absolute precision of 6%, admitted to medical ICU in RAMAIAH HOSPITAL during the study period of July 2016 to August 2017.
Observation: 130 elderly patients admitted to ICU with multiple comorbidities were studied. The study revealed that they are at risk of myocardial injury based on the results that 35 out of 130 (26.9%) patients developed acute myocardial injury. 13(37.1%) out of 35 patients who had myocardial injury had fatal outcome (p<0.001). 60 patients developed new symptoms during the ICU stay, most common being dyspnoea (46.7%). The most common diagnosis of patients who developed myocardial injury was pneumonia (42%). The prevalence of diabetes mellitus,hypertension, past history of IHD, past history of CVA and COPD reached statistical significance (p<0.001) between the two groups of patients who developed myocardial injury and who did not develop myocardial injury.
In patients with multiple comorbidities, the presence of following trigger factors increases the risk of mortality. These trigger factors are 1) hypotension with use of vasopressor agents(p=0.04), 2) anemia (p=0.001) 3) hypoxia (p=0.001) 4) hypoglycemia or hyperglycemia(p=0.001), and 5) poorly supplemented hypothyroidism.
Conclusion: The common comorbidities we found in the study are Diabetes Mellitus, Hypertension, Obstructive airway disease, Hypothyroidism and IHD in various combinations. The parameters related to these comorbidities are poorly controlled in patients who had myocardial injury. Of significance was the finding of trigger factors which appeared to have contributed significantly to the occurrence of myocardial injury. Hence the factors mentioned below could very well be precipitants in an acutelysick elderly. 1.Hypoxemia, 2.Hypotension, 3.Hypoglycemia, 4.Hyperglycemia, 5.Anemia, 6.Poorly supplemented hypothyroidism. The above trigger factors fortunately are easily treatable and preventable factors. Hence all elderly patients with or without multiple comorbidities who are hospitalized with acute form of stressors must be aggressively evaluated for precipitants and adequately treated. The same guidelines can be extrapolated to elderly patients followed up as outpatient. Elderly patients on outpatient follow up required to be examined and assessed for theabove trigger factors to prevent the additional risk.
Key words: Elderly, Critically Ill, Non-Cardiac Diagnosis, Myocardial Injury, Atypical Presentation, Trigger Factors.
