Major depression in the elderly: a population study in Helsinki

The aim of the study was to estimate the prevalence of major depression and to evaluate associated features in random age cohorts of 75, 80, and 85 years (N = 651). A clinical examination was made by experienced health center physicians, and major depression was diagnosed according to DSM-III criteria. The prevalence increased with age and was 1% to 4% in the age groups of 75 and 80 years, but 13% at the age of 85 years. No sex difference was found. The frequency of major depression was fourfold among institutionalized patients (16%) as compared to those living at home (4%). Major depression was strongly associated with objective health, intellectual functioning, and functional capacity. Depression was most common in subjects suffering from poor vision, urinary incontinence, or Parkinson's disease (odd ratios 4.2 to 4.9). Depression was also correlated with musculoskeletal disorders, coronary heart disease, and cerebrovascular diseases (odd ratios 2.5 to 3.4). The survey suggests that major depression is quite rare in healthy elderly people but common in disabled institutionalized patients.     

Fecal incontinence in Wisconsin nursing homes: prevalence and associations

INTRODUCTION: This report determines the characteristics and health histories that are associated with fecal incontinence in a nursing home population. METHODS: A cross-sectional survey is reported comprised of data from the Health Care Finance Administration's Minimum Data Set submitted by Wisconsin skilled nursing facilities to the Wisconsin Center for Health Statistics' Annual Nursing Home Survey in 1992 and 1993. Demographic characteristics, functional status, and disease history were correlated with the dependent variable, fecal incontinence. RESULTS: In both 1992 and 1993, significant positive associations with fecal incontinence included the following, in order of adjusted odds ratios: urinary incontinence, tube feeding, any loss of activities of daily living, diarrhea, truncal restraints, pressure ulcers, dementia, impaired vision, fecal impaction, constipation, male gender, age, and increasing body mass index. Significant inverse associations were noted for heart disease and depression in one of the years and arthritis in both years. In both years, diabetes was not associated with fecal incontinence. CONCLUSION: Urinary incontinence frequently coexists with fecal incontinence. The treatment of fecal incontinence may depend more on awareness of these significant associations, such as tube feeding, impaction, diarrhea, and loss of activities of daily living, which might exacerbate fecal incontinence, than on the condition of the anal sphincter.     

Urogenital symptoms and their resulting discomfort in non-institutionalized 50-to-75-year-old Dutch women

OBJECTIVE: To determine the prevalence of urogenital symptoms in non-institutionalized Dutch women, aged 50 to 75 years, and the degree of discomfort. DESIGN: Cross-sectional study. SETTING: Nationwide investigation. METHOD: A questionnaire was sent to 2157 non-institutionalized Dutch women aged 50 to 75 years. The survey sample was representative of the female population aged 50 to 75 years with respect to age, marital status, level of education and menopausal age. RESULTS: The usable response was 81.6% (n = 1761). The overall prevalence of vaginal dryness, soreness and dyspareunia was 27%. The prevalence of micturition symptoms, urinary incontinence and recurrent urinary tract infections was 36%. The prevalence estimates for vaginal dryness and urinary incontinence showed a linear decrease with increasing age. Almost half of the symptomatic women reported moderate to severe discomfort. One-third of those affected received medical care. Previous hysterectomy had no effect on the reported prevalence estimates. Hysterectomized women reported moderate to severe complaints more often than non-hysterectomized ones. CONCLUSION: The prevalence of urogenital symptoms in non-institutionalized Dutch women aged 50 to 75 years, was high: 47%. Of these women, 40% to 60% experienced discomfort, but only one-third had sought medical advice. These urogenital problems will probably increase in the coming decades.     

Specific features of nosocomial infections in the elderly at a general hospital center. 5 surveys of annual prevalence

Specific features of nosocomial infections in patients aged 70 years or older admitted to a short-term care medical department in a 400-bed general hospital were studied to assist in designing nosocomial infection control programs for this population. Data from five annual prevalence surveys were evaluated retrospectively. The 517 patients aged 70 years or older were compared to the 1093 patients younger than 70 years. The older patients were more likely to have risk factors for nosocomial infections including severe disease (36.2% vs 19.1%; P < 10(-6)), referral from another department (24.6% vs 17.5%; P < 0.01), a long hospital stay duration (8.5 days vs 3.5 days), mechanical ventilation (4.3% vs 1.6%; P < 0.01), an indwelling urinary catheter (12.0% vs 4.0%; P < 10(-7)), and a long median duration of urinary catheterization (6 days vs 2 days). The prevalence of nosocomial infections was increased nearly two-fold in the older patients (10.3% vs 5.6%; P < 0.01), although the difference was statistically significant only for urinary tract infections (5.4% vs 1.4%; P < 10(-5)), particularly in patients without urinary catheters. After exclusion of all patients with urinary tract infections, the prevalence of nosocomial infections was similar in the older and younger patients (4.3% vs 3.7%) despite a persistently higher frequency of risk factors for nosocomial infection in the older group. These results indicate that urinary tract infection should be the main target of programs aimed at minimizing nosocomial infection in elderly patients admitted to short-term care facilities. Faultless technique is essential during urinary catheter insertion. High-quality nursing care contributes substantially to the prevention of urinary tract infection in noncatheterized patients with urinary incontinence or neurologic disorders.     

Urinary and fecal incontinence in geriatric facilities in the Czech Republic

BACKGROUND: Incontinence represents one of the common problems in long-term care geriatric facilities and nursing homes. However, in the Czech Republic data on prevalence, severity and incontinence-associated factors for nursing home residents are not available. The aim of the study was to report the prevalence of urinary (UI) and bowel incontinence (BI) in different geriatric facilities and to identify factors positively associated with incontinence. METHODS AND RESULTS: In a sample of 1162 residents of 18 long-term care facilities UI has been found in 684 residents (63.3%). Health and social care facilities did not differ significantly (60.7 vs 65.6%). Of the incontinent 294 residents (27.2%) suffered from permanent/daily incontinence, 390 (36.1%) from occasional transitory UI. Prevalence of BI reached 54.4%, as well as double incontinence (45.9%). Cognitive impairment, self-care ADL and/or mobility dependency and bed rest are factors significantly associated with UI (for all P < 0.001). However, age, gender and urinary tract infection did not reach the statistical significance (P = 0.280-0.069). Risk adjustment/stratification for UI revealed the prevalence of 33.0% in the low risk group. In the high risk group (high ADL dependency and severe cognitive impairment) the prevalence came up to 96.0%. CONCLUSIONS: Our study presents the first results focused on incontinence problem in long-term care geriatric institutions in the Czech Republic. High prevalence of this condition makes incontinence an important medical, nursing and economical yet neglected problem.     

Sexual dysfunction in men with lower urinary tract symptoms

The conventional view that sexual function is not adversely affected by lower urinary tract symptoms (LUTS), assumed to be caused by enlargement secondary to benign prostatic hyperplasia (BPH), was investigated in this study of 423 men aged 40 years and over in a community population in the UK and 1271 urology clinic attenders aged 45 years and over in 12 countries, using the ICSmale and ICSsex questionnaires. Sexual dysfunction was found to be common: in the community, age standardized prevalences of reduced rigidity of erections were 53%, reduced ejaculation 47%, and pain on ejaculation 5%; in clinic men, age standardized prevalences of reduced rigidity of erections were 60%, reduced ejaculation 62%, and pain on ejaculation 17%. Sex lives were reported to be spoiled by LUTS in 8% of community men and 46% in the clinic. There were negative trends for age in the extent to which clinic men were bothered by these symptoms, although older men were still very concerned. Significantly raised odds ratios of sexual dysfunction were found in those with LUTS, especially storage symptoms associated with incontinence. Urinary flow rates were not associated with sexual symptoms. Sexual dysfunction is, therefore, strongly associated with LUTS, is a matter of concern to the men affected, and should be taken into account when managing patients with LUTS.     

Health status, social networks and support systems of so called old old in a population-based comparative study of residents ages 69-74 and 75-80

To analyze the different features of health status, social support and networks of elderly people by age groups, a survey was performed of the social environment and health related issues among residents aged 69-74 and 75-80, the so called old-old, in Takasu, a small farming town in Hokkaido. The results were as follows: 1. The percentage of elderly having some of the symptoms related to dementia, lower scores of ADL, and poorer conditions of eye sight or hearing were significantly higher among the elderly aged 75-80 compared to those aged 69-74. The prevalence of diseases, such as senile cataracts in both sexes, and heart diseases in men were also higher among those aged 75 and over. 2. Although there were no differences in the mean number of hospital admissions or in the percentage of those having been sick in bed for more than 1 week during the previous one year, both the mean number of out-patient visits and percentage having a family physician were significantly higher in the elderly over 75 than under. Deterioration of IADL were prominent in the item on being able to go far away by themselves. 3. Almost 70% of the elderly participated in community-based social activities in Takasu. There were only small differences in social support and network among the different categories of family structure of the elderly. However women over 75 had statistically significantly lower number of the social supports compared to the younger age groups. A significantly smaller percentage of people was able to obtain the emotional or care support from their spouse for in elderly over 75 than for elderly under 75. 4. The results of this study suggest the need to provide more social support and networks for the old-old over 75 years old who tend to have more diseases and to be in poorer health condition, both physically or mentally than younger old.     

Urinary incontinence among patients admitted to a geriatric department. Prevalence and therapeutic needs

Urinary incontinence is a common condition in elderly people. It is well established that urinary incontinence in most cases can be significantly improved or cured by simple investigations and treatments. During a three month period 227 newly admitted geriatric patients were examined with the purpose of investigating 1) the prevalence of urinary incontinence; 2) the history of seeking medical treatment; 3) the present motivation for treatment; 4) the inconvenience the patients experienced from their incontinence. Fifty-seven percent of the women and 46% of the men suffered from urinary incontinence (mean age 81.8 years). Thirty-eight percent of the patients with present or previous incontinence had sought medical treatment. In 28% of these cases the treatment had been successful. The main reason for patients not seeking treatment was lack of expectation of treatment opportunities. Forty-four percent of the incontinent patients requested treatment in our geriatric department. Patients reported increasing inconvenience in line with increasing severity of the incontinence problem. Despite good treatment opportunities urinary incontinence in the elderly is still underdiagnosed and poorly treated.     

Management of neurogenic fecal incontinence in myelodysplastic children by a modified continent appendiceal stoma and antegrade colonic enema

OBJECTIVES: Antegrade colonic enemas for neurogenic fecal incontinence via reverse reimplanted appendices (Mitrofanoff principle) have been primarily reported by Malone and coworkers in 1990. We used a modification of the described surgical technique and treated the first 10 patients with neurogenic fecal incontinence due to spina bifida. The surgical procedure and the results are reported. METHODS: Since November 1991, we have used a surgical procedure similar to the appendiceal continence mechanism in urinary diversion to establish a continent colonic cutaneous stoma for antegrade enemas in 10 myelodysplastic patients (4 females, 6 males; median age 13.2 years [range 6 to 26]) with severe neurogenic fecal incontinence. The average follow-up is now 26.4 months (range 12.5 to 50). All patients had neurogenic bladder dysfunction successfully managed by clean intermittent catheterization, anticholinergic drugs, or artificial sphincter implantation. The surgical technique for fecal incontinence included the partial orthotopic submucosal imbedding of the appendix into a cecal tenia and the fixation of the ileocecal region at the inner side of the abdominal wall after creation of an appendicocutaneous catheterizable stoma. RESULTS: All patients reached fecal continence for at least 38 hours (median 45.3) by using antegrade colonic enemas with 1.5% saline solution (n = 9) or GoLYTELY solution (n = 1), 0.5 to 1.5 L every 2 to 3 days. All other therapies (diet, oral medication, rectal purgative, or enema) to reach fecal continence had previously failed. There were only two complications seen at the follow-up. One boy with an artificial urinary sphincter presented with infection of the sphincter system, which led to explantation. Another boy presented 15 months after creation of the colonic appendiceal stoma with saline intoxication possibly due to a homemade saline solution. CONCLUSIONS: We conclude that the antegrade colonic enema via an orthotopic continent appendiceal stoma is a safe and highly effective treatment modality for fecal incontinence in patients with neurogenic bowel dysfunction if nonsurgical management has failed.     

Urinary incontinence in rural older women: prevalence, incidence and remission

OBJECTIVES: To determine the prevalence, incidence, and remission rates of urinary incontinence in a large group of older women over a 6-year time span and to assess factors associated with incontinence incidence and remission. DESIGN: Longitudinal cohort study. SETTING: Two rural counties in Iowa. PARTICIPANTS: 2025 women aged 65 years or older residing in rural Iowa, enrolled in the Iowa 65+ Rural Health Study of EPESE (Establishment of Populations for Epidemiologic Studies of the Elderly) were interviewed in person annually for 6 years; specific responses to queries about urinary incontinence were given at baseline, 3-, and 6-year intervals. MEASUREMENTS: Conditional multivariate logistic regression analysis was done to assess the relationship between incontinence symptoms and various factors previously found to be related to incontinence. RESULTS: The baseline prevalence of urge incontinence was 36.3%, and of stress incontinence it was 40.3%. For urge incontinence, the 3-year incidence and remission rates between the third and sixth years were 28.5% and 22.1%, respectively. For stress incontinence, the 3-year incidence and remission rates between years 3 and 6 were 28.6% and 25.1%, respectively. Seventy-six percent and 84% of women who reported no urge or stress incontinence, respectively, at the baseline interview were continent at both follow-up interviews. The only significant factors related to changes in incontinence status were age, which was associated with an increased incidence of urge incontinence (OR 1.11, P = .017, 95% CI 1.019-1.203), and improvement in activities of daily living, which was associated with a increased remission of urge incontinence (OR 0.50, P = .015, 95% CI 0.28-0.9) CONCLUSION: In some older women, urinary incontinence is a dynamic state, with women moving back and forth along a continuum between continence and incontinence. These results are tempered by limitations of the study, which include its questionnaire design and lack of ability to detect potential treatment effect.     

Prevalence of central autonomic neuropathy in elderly dialysis patients

BACKGROUND: Autonomic neuropathy is frequently present in dialysis patients. In addition, deterioration of autonomic function occurs with ageing. This study examines the true prevalence of autonomic neuropathy in elderly dialysis patients and questions whether the combination of age and uraemia further increases the chance of dysautonomia being present. METHODS: We compared the results of five different tests (30:15 ratio; Valsalva ratio; heart rate response to deep breathing and the blood pressure responses to sustained hand grip and standing) of parasympathetic and combined parasympathetic and sympathetic dysfunction in older haemodialysis patients (mean age 70.2 years), younger haemodialysis patients (mean age 48.1 years) and two groups of subjects with normal renal function (mean age 73.0 years and 42.5 years respectively). RESULTS: Parasympathetic dysfunction was most prevalent in older patients on dialysis (65.9% (95% confidence intervals 51.4-80.4%), compared with 33.3% (95% confidence intervals 19.0-47.5% in younger dialysis patients), and 11.8 and 0% in the old and young control groups respectively). Combined parasympathetic and sympathetic dysfunction was seen in 41.5% (95% confidence intervals 26.5-56.5%) and 11.9% (95% confidence intervals 2.1-56.5%) of the old and young dialysis patients respectively but not in any of the control subjects. No interaction was seen between age and subject type. CONCLUSIONS: We conclude that although older dialysis patients have severe impairment of cardiovascular autonomic innervation, the prevalence of dysfunction is not higher than would be expected in an ageing population with uraemia.     

Effects of 60 Hz electromagnetic fields on early growth in three plant species and a replication of previous results

OBJECTIVE: To examine the relation between obstetric factors and the prevalence of urinary incontinence three months after delivery. DESIGN: 2134 postal questionnaires sent between August 1989 and June 1991. SETTING: Teaching hospital in Dunedin, New Zealand. SUBJECTS: All women three months postpartum who were resident in the Dunedin area. MAIN OUTCOME MEASURE: Prevalence of urinary incontinence. RESULTS: 1505 questionnaires were returned (70.5% response rate). At three months postpartum 34.3% of women admitted to some degree of urinary incontinence with 3.3% having daily or more frequent leakage. There was a significant reduction in the prevalence of incontinence for women having a caesarean section, in particular in primiparous women with a history of no previous incontinence (prevalence of incontinence following a vaginal delivery 24.5%, following a caesarean section 5.2% P = 0.002). There was little difference between elective caesarean sections and those carried out in the first and second stages of labour. The odds ratios for women having a caesarean section were 0.4 (95% confidence interval (CI) 0.2.-0.7) (all women and all primiparae) and 0.2 (95% CI 0.0-0.6) (primipara with no previous incontinence) in comparison with those having a normal vaginal delivery. The prevalence of incontinence was also significantly lower in women having had two caesarean sections (23.3%; P = 0.05) but similar in those women having three or more caesarean sections (38.9%) in comparison with those women who delivered vaginally (37.7%). Other significant independent odds rations were found for daily antenatal pelvic floor exercises (PFE) (0.6, 95% CI 0.4-0.9), parity > or = 5 (2.2, 95% CI 1.0-4.9) and pre-pregnancy body mass index (1.07, 95% CI 1.04-1.10). CONCLUSIONS: Adverse risk factors for urinary incontinence at three months postpartum are vaginal delivery, obesity and multiparity (> or = 5). Caesarean section and daily antenatal PFE appear to be protective, although not completely so.     

A case of recessive X-linked ichthyosis: scale-specific abnormalities of lipid composition may explain the pathogenesis of the skin manifestation

Even though fecal incontinence is a leading cause of nursing home placement, risk factors contributing to its development have not been established. Identification of such factors may lead to prevention of incontinence and reduce the need for nursing home placement. A total of 388 residents of five nursing homes were included. Data regarding mental status, bowel habits, obstetrics history, and the presence, frequency, and severity of fecal incontinence were collected for each participant. Of the 388 nursing home residents, 46% were incontinent of feces. Incontinence was 1.5 times more common in males and in those younger than 65 years of age. In both univariate and multivariate analyses, diarrhea, dementia, restricted mobility, and male gender were independently associated with incontinence. In contrast to previous studies, constipation was not associated with fecal incontinence. If elimination of these risk factors leads to prevention of incontinence in even a few people, some elderly patients may not require institutionalization, which will result in improvement in their quality of life, not to mention a reduction in public health expenditures.     

Epidemiology of diabetes mellitus in the elderly in northern Greece: a population study

This population based study was undertaken to ascertain the overall prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the elderly using the WHO criteria. The role of obesity in the development of DM or IGT has been investigated for both sexes per decade of age. Furthermore the potential for DM to increase with age, as has been suggested before, has been evaluated using the IGT as a proportion of total glucose intolerance (IGT/TGI) for the same parts of the tested sample. From the 647 persons registered as elderly people in a small town in northern Greece (total population 5875 people), 66 persons did not participate in this survey. Fifty-six subjects (9.7%) had previously diagnosed DM. The remainder were tested using fasting blood glucose measurements or an oral glucose tolerance test (OGTT). The prevalence of previously undiagnosed DM according to fasting blood glucose values or after 2 h of 75 g load values was 10.1% and 9.3%, respectively. Thus the overall prevalence of DM was 29.1% and of IGT was 15.1%. These data support an increased frequency of DM (65% previously undiagnosed) and IGT in the elderly, whereas this population's susceptibility seems to decline in the older groups for both sexes. Obesity remains a risk factor for DM and IGT particularly among the younger groups although its role has been found to decline with age.     

Prevalence of benign prostatic hyperplasia in Spanish men 40 years old or older

PURPOSE: We estimate the prevalence of benign prostatic hyperplasia (BPH) according to symptoms as well as prostate obstruction determined by uroflowmetry and prostate size. MATERIALS AND METHODS: A cross-sectional study was performed at the autonomous community of Andalusia in 1,106 men 40 years old or older. The International Prostate Symptom Score (I-PSS) questionnaire was used to establish symptoms, abdominal and transrectal ultrasonography was done to measure prostate size and uroflowmetry was performed to measure urinary flow obstruction. RESULTS: The prevalence of moderate or severe symptoms was 24.94% and it increased with age. Of the 1,106 subjects 4.19% had severe prostatism, while 12.45% had poor quality of life (I-PSS greater than 3). Average prostate size was greater than 30 gm. in men 60 years old or older. Maximum urine flow was less than 10 and 15 ml. per second in 25.97 and 55.67% of the men, respectively. The prevalence of BPH, defined as I-PSS greater than 7, maximum flow less than 15 ml. per second and prostate size greater than 30 gm., was 11.77% (range 0.75 to 30 at ages 40 to 49 and greater than 70 years, respectively). CONCLUSIONS: The prevalence of BPH increases with age. Moderate prostatism is perceived as resulting in poor quality of life by young subjects and good quality of life by some older subjects. In some men there were symptoms and obstruction but no prostate enlargement. This percentage persists with age after 50 years, when the prevalence of BPH starts to increase.     

Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study

OBJECTIVE: To study the prevalence and causes of blindness and visual impairment in various age categories of a large population-based study. METHODS: For the study, 6775 subjects aged 55 years or older underwent an extensive ophthalmologic screening examination, including measurements of visual acuity and the visual field and fundus photography. The causes of blindness or visual impairment were determined using all screening information and medical records. RESULTS: The prevalence of blindness, according to World Health Organization criteria, ranged from 0.1% in subjects aged 55 to 64 years to 3.9% in subjects aged 85 years or older; the prevalence of visual impairment ranged from 0.1% to 11.8%. For persons younger than 75 years, myopic degeneration and optic neuropathy were the most important causes of impaired vision. For persons aged 75 years or older, age-related macular degeneration was the major cause of the increased prevalence of blindness, whereas age-related cataract predominantly caused the increased prevalence of visual impairment. CONCLUSIONS: The hierarchy of causes of blindness and visual impairment is highly determined by age. As yet, little can be done to reduce the exponential increase of blindness; however, adequate implementation of surgery to treat cataract could reduce visual impairment by one third. Underuse of ophthalmologic care is a prominent cause of the high frequency of untreated cataracts among the elderly.     

Urinary incontinence and psychological distress among older adults.

We examined the relationship between urinary incontinence and psychological distress in a sample of community-dwelling older adults. The data are from a probability sample of Washtenaw County, Michigan residents ages 60 years and older, who were interviewed in 1983 and 1984. A total of 747 women and 431 men were included in the analyses. Experiencing urinary incontinence, particularly in a severe form, was weakly related to depression, negative affect, and low life satisfaction. These relationships are partly explained by the fact that incontinent respondents are less healthy than are continent respondents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation and management of urinary incontinence in older patients

The training of health care providers in the diagnosis and management of urinary incontinence is inadequate, and evaluation and management skills are less than optimal. Urinary incontinence volume measurement is difficult to perform accurately in elderly long-term-care inpatients. After incontinence has been noted, the physician needs to select the appropriate studies to determine the cause and choose the correct treatment. Otherwise, treatable causes such as outlet obstruction or fecal impaction may be missed. Subsequent management includes scheduled visits to the toilet, treatment of impaired mobility, use of easily identified and accessible toilet facilities, reevaluation of the need for restraints and side rails, and, if appropriate, the use of drugs to treat the incontinence. Many elderly incontinent patients who are treated in the outpatient setting can be cured or substantially improved.     

Urinary incontinence in women in a geriatric ward

101 elderly female patients participated in a multidisciplinary programme for the diagnosis and management of urinary incontinence. Their median age was 81 years. 83 patients had been incontinent for more than 12 months. In only 23 patients was incontinence recognised as a problem prior to admission, and 69 patients claimed that they had never received any treatment for their disability. Urge and mixed incontinence were found to be the most prevalent forms, based on symptoms and simple measurements. After assessment, one to six measures were implemented for each patient in order to counteract internal and external causes of incontinence. The patients were reviewed after 6-8 weeks. 60 patients claimed there was an improvement, including 20 who described themselves as "much improved", and seven who had become continent. It is suggested that a hospital stay may provide a suitable opportunity to undertake primary assessment and treatment of incontinence in elderly women.     

Health problems in rural elderly at Varanasi, Uttar Pradesh

Present study comprised of 1070 elderly patients coming to P.H.C. Bhopauli, Varanasi during January 1991-December 1992. Males were 578 and females were 492. Male predominance was present in younger elderly whereas female predominance was seen among those over 75 years of age. Socio-economic status-wise 265 cases belonged to upper, 394 middle and 411 to lower income group. Arthritis (615) was the commonest disease in elderly followed by hypertension (510), visual problems (400), ischaemic heart disease (IHD) (350), hearing impairement (300), diabetes mellitus (DM) (280), protozoal and worm infestations (240), chronic bronchitis, asthma, emphysema (238), tuberculosis (220), peptic ulcer syndrome (210), varicose vein (200), haemorrhoids (180), urinary problems (154). Two hundred and forty seven cases had 2 diseases followed by 3 diseases (239), 4 diseases (165), 5 diseases (127) and more than 5 diseases (81). Multiple diseases were more frequent among those above 75 years of age. Atypical presentations and complications of different diseases were more frequent among older elderly.