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Diagnosing and managing thyroid disease in the nursing home.

Abstract

Thyroid disorders occur at any age, but hypothyroidism is more common in older than in younger adults. In fact, the prevalence of thyroid disorders increases with age, and it is higher in old-old frail residents in nursing homes. Since thyroid diseases in older age, both overt reduced and increased function, may manifest as disorders of other organs, physicians need a high index of suspicion to detect thyroid dysfunction in an older person with multiple comorbidities and chronic polypharmacy. This is particularly true for residents of long-term facilities, where multiple chronic diseases may make it less attractive to direct attention to thyroid function. Subclinical hyperthyroidism and hypothyroidism, more frequently seen in older populations, have been linked to increased total and cardiovascular mortality. Since chronic diseases are more prevalent in old age, nonthyroidal illness is also seen frequently in this age group. Although, there is still debate on the decision to treat or not to treat subclinical thyroid disorders, current recommendations state the necessity of considering treatment on an individual basis according to symptomatology and to the possible benefit that the older person may obtain with treatment, discouraging extended screening and treatment in the community population of subjects older than 65. However, in the long-term setting, the possibility of thyroid dysfunction can be more often investigated, and the consideration of treatment and follow-up is needed to improve quality of life of affected older people.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Geriatric Unit, Institute of Internal Medicine and Geriatrics, University of Palermo, Italy. mabar@unipa.it

    , ,

    Source

    MeSH

    Aged, 80 and over
    Aging
    Female
    Homes for the Aged
    Humans
    Long-Term Care
    Male
    Nursing Homes
    Prevalence
    Thyroid Diseases

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    18187108

    Citation

    * When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diagnosing and managing thyroid disease in the nursing home. AU - Dominguez,Ligia J, AU - Bevilacqua,Maurizio, AU - Dibella,Giovanna, AU - Barbagallo,Mario, PY - 2007/07/20/received PY - 2008/1/12/pubmed PY - 2008/1/30/medline PY - 2008/1/12/entrez SP - 9 EP - 17 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 9 IS - 1 N2 - Thyroid disorders occur at any age, but hypothyroidism is more common in older than in younger adults. In fact, the prevalence of thyroid disorders increases with age, and it is higher in old-old frail residents in nursing homes. Since thyroid diseases in older age, both overt reduced and increased function, may manifest as disorders of other organs, physicians need a high index of suspicion to detect thyroid dysfunction in an older person with multiple comorbidities and chronic polypharmacy. This is particularly true for residents of long-term facilities, where multiple chronic diseases may make it less attractive to direct attention to thyroid function. Subclinical hyperthyroidism and hypothyroidism, more frequently seen in older populations, have been linked to increased total and cardiovascular mortality. Since chronic diseases are more prevalent in old age, nonthyroidal illness is also seen frequently in this age group. Although, there is still debate on the decision to treat or not to treat subclinical thyroid disorders, current recommendations state the necessity of considering treatment on an individual basis according to symptomatology and to the possible benefit that the older person may obtain with treatment, discouraging extended screening and treatment in the community population of subjects older than 65. However, in the long-term setting, the possibility of thyroid dysfunction can be more often investigated, and the consideration of treatment and follow-up is needed to improve quality of life of affected older people. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/18187108/full_citation/Diagnosing_and_managing_thyroid_disease_in_the_nursing_home_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(07)00350-7 DB - PRIME DP - Unbound Medicine ER -