News and reviews

Age and Ageing, Nov, 1998 by Diogenes

Restless legs

One of the most difficult symptoms to control in old age is restless legs. A particularly good review suggests that this may be due to vascular impairment or a minor neuropathy (Eur J Endovasc Surg 1997; 14: 430-2). Characteristics are that that the problem only occurs at rest, is worse at night, forces movements of the lower limbs and causes discomfort deep within the legs. Patients may benefit from massage and movement, and a wide range of drugs has been used. None is particularly effective and all should be avoided if there is a high risk of toxicity.

Bromocriptine, asbestos and pleural fibrosis

Drugs used in Parkinson's disease cause many side effects. Among the more unusual is that of bromocriptine in causing pleural fibrosis in patients previously exposed to asbestos (Eur Resp J 1997; 10: 2711-5). Eleven cases from Sweden and four from Australia were reviewed recently. When the drug was stopped, patients felt better, were less breathless and lost a previously persistent cough. The mechanism behind the side effect has not been defined yet.

Old people with broken hearts

There is considerable interest in the effects of physical illness on the quality of life in old age. A report on changes of mood associated with angina pectoris or myocardial infarction in men and women over 65 (Family Practice 1997; 14: 436-45) found a 29% prevalence of depression of men with coronary heart disease (CHD) compared with 20% in controls. In women, depression was no more common in those with CHD than in controls. Is CHD is the cause or effect of depression?

Are peanuts bad for you?

One of the more common malignancies in old age is carcinoma of the rectum. A disturbing revelation is that the daily administration of 100g of peanuts to volunteers produced a 41% increase in rectal mucosal proliferation in 36 volunteers who had been identified as having increased mucosal TF antigen (Gastroenterology 1998; 114-9). Gastronomically speaking, we shall soon have to chose between a short and merry life or a long and boring one.

Do speech therapists help patients with stroke-induced aphasia?

564 speech therapists in Scotland competed a questionnaire on their involvement in aphasia associated with stroke (Health Bul 1998; 56: 518-25). 50% spent more than 6 h per week on this, but less than half thought their work was effective. They also had concerns about the effectiveness of their training in aphasia and reported under-referral of cases by doctors, an excessive workload and problems in providing patients with transport and access. Research is urgently required into measuring the efficacy of treatment and planning and developing an effective service.

Does stenting improve outcome in transluminal coronary angioplasty (TCA)?

TCA has the advantage over other forms of coronary artery disease as it is less traumatic. A disadvantage is the high rate of restenosis. In a recent controlled trial, the effectiveness of TCA with arterial stenting against TCA alone was evaluated (Heart 1998; 79: 18-23). At 6 months, 7% of patients with stenting (compared with 29% of controls) had restenosed arteries. These encouraging results, if validated elsewhere, should increase the proportion of old people considered suitable for coronary artery surgery.

Morbidity and mortality from biliary surgery in old age

The high incidence of gallbladder disease combines with multiple pathology to make surgery of the biliary tract and important cause of morbidity and mortality in old age. Recently, a retrospective review of biliary surgery in 76 patients over 80 revealed that 14 developed wound infections, 13 urinary tract infections and 10 respiratory infections (Hepatogastroenterology 1997; 44: 1565-8); 11.8% died, usually from respiratory complications. Variables increasing morbidity were being male, the presence of cardiovascular disease and the presence of jaundice. Jaundice was the only factor associated with an increase in mortality. These retrospective data on open abdominal surgery should provide a useful baseline for future studies of the safety of laparoscopic surgery.

Can we predict life span?

At one time the only way of predicting life span was to talk to an elderly Greek lady wielding a pair of shears. A more scientific approach is to relate the life span of an individual to those of his or her parents (Hum Biol 1997; 69: 873-8). When data were collected from the South Australian Register of Births, Deaths and Marriages, the correlation between child and parents was only 0.1, but, by using statistical techniques to account for environment and heredity, a heriditability factor for longevity of 0.46 was achieved. The authors are optimistic that with further study they will be able to achieve even more accurate results. Once this is achieved, however, we are left with the question of whether we really want to know our life span.

Do older women want hormone replacement therapy (HRT)?

Although HRT reduces the rate of bone loss, there has been less information on the proportion of women who would welcome treatment. A questionnaire given to women attending a gynaecology clinic revealed that 91% had heard of HRT, and that awareness was greater in the 50-59-year age group (Int J Clin Pract 1998; 52: 7-14); 78% considered that they knew insufficient about the topic. Most women did not appreciate the effect of HRT on preventing cardiovascular disease but were unduly anxious about the risk of breast cancer. Many women are interested in HRT but would benefit from information and counselling before treatment.