Update in Geriatric Medicine

Update in Geriatric Medicine

David B. Reuben, MD*

From the University of California, Los Angeles, Center for Health Sciences and David Geffen School of Medicine, Los Angeles, California.

2007 Series: Update Sessions from Internal Medicine 2007

In 2006, the evidence base in geriatric medicine added new therapies and approaches to improve the health and health care of older persons. The field was also advanced by findings from carefully conducted studies indicating that some commonly used treatments are ineffective and should be discarded. A summary of changes that clinicians can implement on the basis of this research is provided in the Table.

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Table. Changes to Clinical Practice Emerging from Articles Important to Geriatricians in 2006

Endocrinology

Roberts LM, Pattison H, Roalfe A, et al. Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction? Ann Intern Med. 2006;145:573-81. [PMID: 17043339]

Question: Is subclinical thyroid dysfunction in elderly persons associated with depression and cognitive dysfunction?

Study Design: Cross-sectional study.

Patients: 5865 patients 65 years of age or older (mean age, 73.6 years [SD, 5.6]; 50.9% female) who were not receiving treatment for a thyroid disorder. Patients were classified as overtly hyperthyroid (n = 15), subclinically hyperthyroid (n = 127), euthyroid (n = 5524), subclinically hypothyroid (n = 168), overtly hypothyroid (n = 23), or unknown (n = 11; excluded from analyses).

Setting: 20 primary care practices in central England.

Outcomes: Cognition, depression, and anxiety assessed by using validated tests.

Sponsor: Healthcare Foundation, Primary Care Research and Clinical Trials Unit, Midlands GP Research Consortium.

Results: There were no clinically or statistically significant differences in measures of cognition, depression, or anxiety between patients with subclinical thyroid dysfunction (hypothyroidism or hyperthyroidism) and those who were euthyroid.

Conclusion: Subclinical thyroid dysfunction is not associated with cognitive dysfunction or mood disorders.

Commentary: Subclinical thyroid dysfunction is common in older people, and some organizations recommend screening for it, especially in older women. As a result, subclinical hypothyroidism and hyperthyroidism have been increasingly recognized, and many patients are treated for their laboratory abnormalities. The case for treatment is weakened considerably by this study. In addition, data suggest that some older individuals with higher thyroid-stimulating hormone levels and lower free thyroxine levels actually have a …

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