Minerva . . . and other storiesBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1835 (Published 03 May 2018) Cite this as: BMJ 2018;361:k1835
Dietary supplements containing live bacteria are widely advertised as improving health and wellbeing. Nonetheless, a systematic review finds little to suggest that elderly people derive any benefit from them, at least as far as infectious illness is concerned (Age Ageing doi:10.1093/ageing/afy006). In 15 trials involving nearly 6000 people, mean age 75 years, there were no statistically significant differences in the occurrence or duration of infections between those taking probiotics and those taking placebo.
White matter hyperintensities
Small areas of hyperintensity in the white matter are common on T2 weighted brain magnetic resonance imaging, especially in older people. Although their pathogenesis isn’t fully understood, several studies have shown that they’re associated with high levels of vascular risk factors and an increased risk of stroke. A seven year longitudinal study of adults from New York, mean age 65 years at baseline, now shows that those with a higher volume of white matter hyperintensity experience a steeper decline in functional status as measured by the Barthel index of activities of daily living (PLoS Med doi:10.1371/journal.pmed.1002529).
Pulmonary function tests
Vast numbers of pulmonary function tests are performed every day so it’s good to know that the associated risks are extremely low. An audit of 20 years’ worth of data from a single hospital reports that adverse events occurred less often than one in a thousand tests (Thorax doi:10.1136/thoraxjnl-2017-210246). And even among these, only a tenth were severe enough to require hospital admission. Syncope was the commonest adverse event, followed by breathing difficulties such as hyperventilation.
Treating hypertension in elderly people
General practitioners are unwilling to make changes in their elderly patients’ antihypertensive medication according to a qualitative study from the Netherlands (BMJ Open doi:10.1136/bmjopen-2017-020871). When interviewed, they gave a number of reasons, including lack of clarity in guidelines, doubts about the benefit of intensive treatment, fear of precipitating a stroke, and reluctance to upset an established routine. Minerva feels entirely sympathetic to their conservative approach. After all, it’s much easier to make asymptomatic patients feel worse than to make them feel better.
Pyoderma gangrenosum is a rare neutrophilic dermatosis characterised by painful ulcer formation, usually on the legs, and often at the site of a minor injury. A large series of cases collected from hospitals in North America finds that the condition affects white women more frequently than other population groups (JAMA doi:10.1001/jamadermatol.2017.5978). About two thirds of these patients with pyoderma gangrenosum had comorbidities. In people under 65, inflammatory bowel disease was the commonest associated condition. In older people, rheumatoid arthritis, ankylosing spondylitis, and neoplasia were more frequent.
The postman knocks
In a blog in the London Review of Books, a postman longs to do something more useful than deliver junk mail. He envies his colleagues on the Channel Island of Jersey where, for the price of a special delivery letter, they will knock on the door, have a brief chat, and make sure the occupant is all right. He thinks that Jersey’s Call and Check scheme could be adapted for other communities and points out that posties are well placed to keep a benevolent eye on elderly people who are isolated or immobile (https://www.lrb.co.uk/blog/2018/04/23/roy-mayall/call-and-check; https://www.gov.je/News/2014/pages/CallCheckExtended.aspx).