Demography: Key Indicators

• Population– “Baby boomers” (1946‐64) will dramatically change the aging demographics

– In 2000, 35 million persons 65+ lived in the US. By 2030, this will double to 70 million

– The 85+ age group is growing faster than any other age group

– Women make up 58% of those 65+, but 70% of those 85+

– In 1998, 41% of older women lived alone, compared to  17% of older men

General Principles of Aging: Old Foks Are Different

• Atypical presentation of acute illness• Multiple concurrent problems• Non‐specific symptoms• Hidden illness• Under‐reporting• Multiple “losses” condensed into a short time span• Expected physiologic aging changes

Atypical Presentation of Acute Illness

• Only 40% of elderly fit the classic one symptom = one disease model– Acute myocardial infarction without chest pain– Acute hyperthyroidism without tachycardia, weight loss, etc.

– Acute infection without rising WBC count or typical fever

– Fatigue as chief presenting complaint of CHF

Main issues

• Does aging in itself affect laboratory tests and therefore warrant different reference values for the elderly population?

• If so, which reference values directly relate to aging and which are secondary to other factors?– Subclinical disorders, polypharmacy, alcohol and other addicting 

drugs, malnutrition, relative immobility, obesity, chronic diseases, decrease in number of patients

• Do we need a specific screening battery of laboratory testin different elderly patients groups?

Hematology

Hemoglobin

‐ The final study population consisted of 462 patients admitted to the ED (i.e., cases; 262 renal colics, 62 pneumonia, 51 acute pancreatitis, 46 AMI and 41 major trauma) and 429 healthy blood donors (i.e., controls).

‐ The median hemoglobin value in all patients (137 g/L; IQR, 126–148 g/L) was significantly lower than in healthy controls (151 g/L; IQR, 141–157 g/L; p14.0%), was remarkably higher in patient cases than in controls (anemia: 23 versus 4%, p

Hemoglobin

Hemoglobin

Hemoglobin

RDW

Nevertheless, reliable data emerged from several epidemiologicalinvestigations disclosed a new and otherwise unpredictable scenario inthe clinical usefulness of this measure, supporting the hypothesis thatRDW might be a useful parameter for gathering meaningful clinicalinformation, either diagnostic or prognostic, on a variety ofcardiovascular and thrombotic disorders.

RDW

The pooled estimates were 0.820 (95% CI 0.786–0.851) for sensitivity, 0.461 (95% CI 0.443–0.479) for specificity, 0.932 (95% CI 0.918–0.944) for NPV and 0.222 (95% CI 0.205–0.241) for PPV and 0.652 (95% CI 0.596–0.707) for AUC. The DOR was 3.9 (95% CI 2.3–6.5).

The MPV exhibited an area under the curve of 0.74 (95% CI, 0.58 to 0.89; P

MPV

APTT

APTT

A highly significant correlation was observed betweenage and D-dimer values in the entire cohort of patients(r=0.08; p=0.010), as well as in those with (n=200;r=0.23; p=0.001) or without (n=1447; r=0.079; p=0.005)a final diagnosis of VTE.

Our data support the hypothesis that D-dimer testinglacks specificity for diagnosing VTE, especially inelderly patients admitted to the ED, and in those withsignificant co-morbidities.

D‐dimer

D‐dimer

Biochemistry

GFR

GFR

GFR

Blood Lipids

37%!!!

Blood gases

Prevalence of hyponatremia in femur neck fractures. A one-year survey.

Gianfranco Cervellin, Michele Mitaritonno, Mario Pedrazzoni, Alessandra Picanza, Giuseppe Lippi

Submitted

115

120

125

130

135

140

145

150

155

Controls Patients

 Sodium (m

mol/L)

p

Prevalence of hyponatremia and hypovitaminosis D in ambulatory adults.

Gianfranco Cervellin et al.Submitted

r = 0.11; p

Physiology Pathology

Physiological or pathological decline in the elderly?

At age 4 success is . . . not piddling in your pants.At age 12 success is . . . having friends.At age 17 success is . . . having a drivers licence.At age 35 success is . . . having money.At age 50 success is . . . having money.At age 70 success is . . . having a drivers licence.At age 75 success is . . . having friends.

At age 80 success is . . . not piddling in your pants.

Physiological or pathological decline in the elderly?

Conclusions in the elderly

• Laboratory values not always fall into our traditional,normal ranges

• Extreme values of a test result are more predictive of disease than minimally abnormal results

• Total number of drugs, number of diagnosis and total disability scores are significantly correlated with the number of test results outside the reference intervals

• Interpret any test result in the context of their individual illness