Journal of the American Geriatrics Society

Volume 56, Issue 7 p. 1259-1264

The Health Consequences of Peripheral Neurological Deficits in an Elderly Cohort: An Oklahoma Physicians Resource/Research Network Study

James W. Mold MD, MPH,

James W. Mold MD, MPH

From the ^* University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

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Frank Lawler MD, MSPH,

Frank Lawler MD, MSPH

From the ^* University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

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Michelle Roberts BA,

Michelle Roberts BA

From the ^* University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

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James W. Mold MD, MPH,

James W. Mold MD, MPH

From the ^* University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

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Frank Lawler MD, MSPH,

Frank Lawler MD, MSPH

From the ^* University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

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Michelle Roberts BA,

Michelle Roberts BA

From the ^* University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

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First published: 07 August 2008

https://doi.org/10.1111/j.1532-5415.2008.01736.x

Citations: 10

Address correspondence to James W. Mold, MD, MPH, University of Oklahoma Health Sciences Center, 900 NE 10th Street, Oklahoma City, OK 73104. E-mail: [email protected]

Presented as an abstract at the North American Primary Care Research Group 33rd Annual Meeting, October 16, 2005, Quebec City, Quebec, Canada.

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Abstract

OBJECTIVES: To determine whether the belief that loss of deep tendon reflexes and vibratory sensation in the ankles in older patients is of no great consequence is valid.

DESIGN: Four-year longitudinal cohort study.

SETTING: Primary care practice–based research network.

PARTICIPANTS: Six hundred four noninstitutionalized individuals aged 65 and older with no self-reported medical conditions known to cause peripheral neuropathy (PN), recruited from the practices of 23 primary care physicians in central Oklahoma.

MEASUREMENTS: Annual standardized peripheral neurological examination performed by two research nurses plus a questionnaire that included self-reported measures of health, health-related quality of life (HRQoL Quality of Well-Being—Self Administered (QWB-SA) and Health Utilities Index-3 (HUI-3), physical functioning—(Medical Outcomes Study 36-item Short Form Survey (SF-36)), falls, and use of healthcare services. Deaths were determined from participant contacts, primary care physicians, and the Social Security death index.

RESULTS: One hundred sixty of 604 participants had symmetrical peripheral neurological deficits (SPNDs). After controlling for age, sex, race, education, income, body mass index, HRQoL, physical functioning, self-rated health, cognitive test score, and a variety of medical conditions, SPNDs were associated with earlier hospitalization (P=.03); greater mortality (P<.001); and declines in HRQoL (QWB-SA, P<.001), self-rated health (P=.02) physical functioning (SF-36, P=.005), and bodily pain (SF-36, P=.001).

CONCLUSION: SPNDs of undetermined cause, found in older patients on physical examination, appear to be associated with greater morbidity and mortality.

REFERENCES

1 Mold JW, Vesely SK, Keyl BA et al. The prevalence, predictors, and consequences of peripheral sensory neuropathy in older patients. J Am Board Fam Pract 2004; 17: 309–318.
10.3122/jabfm.17.5.309
PubMedWeb of Science®Google Scholar
2 Jordan B, Cummings JL. Mental status and neurologic examination in the elderly. In: WR Hazzard, JP Blass, WH Ettinger et al., eds. Principles of Geriatric Medicine and Gerontology. New York: McGraw-Hill, 1999, pp 1215–1216.

Google Scholar
3 Mold JW, Fryer GE, Roberts AM. When do older patients change primary care physicians? J Am Board Fam Pract 2004; 17: 453–460.
10.3122/jabfm.17.6.453
PubMedWeb of Science®Google Scholar
4 Mold JW, Roberts M, Aboshady HM. Prevalence and predictors of night sweats, day sweats, and hot flashes in older primary care patients: An OKPRN study. Ann Fam Med 2004; 2: 391–397.

Web of Science®Google Scholar
5 Cho DY, Mold JW, Roberts M. Further investigation of the negative association between hypertension and peripheral neuropathy in the elderly: An Oklahoma physicians resource/research network (OKPRN) study. J Am Board Fam Med 2006; 19: 240–250.

Web of Science®Google Scholar
6 Cooperating Clinics Committee of the American Rheumatism Association. A seven day variability study of 499 patients with peripheral rheumatoid arthritis. Arthritis Rheum 1965; 8: 302–334.
10.1002/art.1780080214
PubMedGoogle Scholar
7 Raiche M, Hebert R, Prince F et al. Screening older adults at risk of falling with the Tinetti balance scale. Lancet 2000; 356: 1001–1002.
10.1016/S0140-6736(00)02695-7
CASPubMedWeb of Science®Google Scholar
8 Chen H, Cohen P. Using individual growth model to analyze the change in quality of life from adolescence to adulthood. Health Qual Life Outcomes 2006; 4: 10.
10.1186/1477-7525-4-10
PubMedWeb of Science®Google Scholar
9 Fairclough DL. Design and Analysis of Quality of Life Studies in Clinical Trials. Boca Raton: Chapman & Hall/CRC, 2002, pp 41–68.

Google Scholar
10 Singer JD. Using SAS PROC MIXED to fit multilevel models, hierarchical models, and individual growth models. J Educ Behav Stats 1998; 24: 323–355.
10.3102/10769986023004323
Google Scholar
11 Koski K, Luukinen H, Laippala P et al. Risk factors for major injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study. Gerontology 1998; 44: 232–238.
10.1159/000022017
CASPubMedWeb of Science®Google Scholar
12 Luukinen H, Koski K, Laippala P et al. Predictors for recurrent falls among the home-dwelling elderly. Scand J Prim Health Care 1995; 13: 294–299.
10.3109/02813439508996778
CASPubMedWeb of Science®Google Scholar
13 Sorock GS, Labiner DM. Peripheral neuromuscular dysfunction and falls in a elderly cohort. Am J Epidemiol 1992; 136: 584–591.

CASPubMedWeb of Science®Google Scholar
14 Richardson JK, Hurvitz EA. Peripheral neuropathy: A true risk factor for falls. J Gerontol A Biol Sci Med Sci 1995; 50A: M211–M215.

Google Scholar
15 Richardson JS, Ching C, Hurvitz EA. The relationship between electromyographically documented peripheral neuropathy and falls. J Am Geriatr Soc 1992; 40: 1008–1012.
10.1111/j.1532-5415.1992.tb04477.x
CASPubMedWeb of Science®Google Scholar
16 Koopman RJ, Mainous AG, Liszka HA et al. Evidence of nephropathy and peripheral neuropathy in US adults with undiagnosed diabetes. Ann Fam Med 2006; 4: 427–432.
10.1370/afm.577
PubMedWeb of Science®Google Scholar
17 Davies M, Brophy S, Williams R et al. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care 2006; 29: 1518–1522.
10.2337/dc05-2228
PubMedWeb of Science®Google Scholar
18 Vileikyte L, Leventhal H, Gonzalez JS et al. Diabetic peripheral neuropathy and depressive symptoms. Diabetes Care 2005; 28: 2378–2383.
10.2337/diacare.28.10.2378
PubMedWeb of Science®Google Scholar
19 Padua L, Schenone A, Aprile I et al. Quality of life and disability assessment in neuropathy: A multicentre study. J Peripher Nerv Syst 2005; 10: 3–10.

PubMedWeb of Science®Google Scholar
20 Tolle T, Xiao Z, Sadosky AB. Painful diabetic neuropathy: A cross-sectional survey of health state impairment and treatment patterns. J Diabetes Complicat 2006; 20: 26–33.

Web of Science®Google Scholar
21 Dorfman LJ, Bosley TM. Age-related changes in peripheral and central nerve conduction in man. Neurology 1979; 29: 38–44.
10.1212/WNL.29.1.38
CASPubMedWeb of Science®Google Scholar
22 Bouche P, Cattelin F, Saint-Jean O et al. Clinical and electrophysiological study of the peripheral nervous system in the elderly. J Neurol 1993; 240: 263–268.
10.1007/BF00838158
CASPubMedWeb of Science®Google Scholar
23 Jacobs JM, Love S. Qualitative and quantitative morphology of human sural nerve at different ages. Brain 1985; 108: 897–924.
10.1093/brain/108.4.897
PubMedWeb of Science®Google Scholar
24 Vrancken AAF, Franssen H, Wokke JH et al. Chronic idiopathic axonal polyneuropathy and successful aging of the peripheral nervous system in elderly people. Arch Neurol 2002; 59: 533–540.
10.1001/archneur.59.4.533
PubMedWeb of Science®Google Scholar
25 Richardson JK. The clinical identification of peripheral neuropathy among older persons. Arch Phys Med Rehabil 2002; 83: 1553–1558.
10.1053/apmr.2002.35656
PubMedWeb of Science®Google Scholar
26 Hughes RAC, Umapathi T, Gray IA et al. A controlled investigation of the cause of chronic idiopathic axonal polyneuropathy. Brain 2004; 127: 1723–1730.
10.1093/brain/awh192
CASPubMedWeb of Science®Google Scholar
27 Meyer-Rosberg K, Burckhardt CS, Huizar K et al. A comparison of the SF-36 and Nottingham Health Profile in patients with chronic neuropathic pain. Eur J Pain 2001; 5: 391–403.
10.1053/eujp.2001.0260
CASPubMedWeb of Science®Google Scholar
28 Novella SP, Inzucchi SE, Goldstein JM. The frequency of undiagnosed diabetes and impaired glucose tolerance in patients with idiopathic sensory neuropathy. Muscle Nerve 2001; 24: 1229–1231.
10.1002/mus.1137
CASPubMedWeb of Science®Google Scholar

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Volume56, Issue7

July 2008

Pages 1259-1264

The Health Consequences of Peripheral Neurological Deficits in an Elderly Cohort: An Oklahoma Physicians Resource/Research Network Study

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The Health Consequences of Peripheral Neurological Deficits in an Elderly Cohort: An Oklahoma Physicians Resource/Research Network Study

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