title: Impact of thyroid status and age on comprehensive geriatric assessment.
abstract: This study aimed to evaluate the prevalence of thyroid dysfunction in elderly subjects attending an outpatient clinic at a tertiary hospital and to assess whether subclinical hypothyroidism (SCH) or aging affected activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive status, or depressive symptoms. This crosssectional study included 411 patients recruited in the outpatient geriatric setting. 48 subjects reported levothyroxine use and were evaluated separately. After excluding subjects with diseases or drugs which could influence thyroid status, the 284 subjects remaining were classified as having euthyroidism (n = 235, 82.8 %), subclinical hypothyroidism (n = 43, 15.1 %), subclinical hyperthyroidism (n = 4, 1.4 %), or overt hyperthyroidism (n = 2, 0.7 %). ADLs and IADLs were assessed using the Katz Index (ranging from 0 [independence] to 6 [dependence in all activities]) and Health Assessment Questionnaire (ranging from 0 to 3 [severely disabled]), respectively. Cognition was assessed using the mini mental state depressive symptoms that were assessed using the Geriatric depression scale or cornell scale for depression in dementia. SCH did not reduce performance in ADLs or IADLs in elderly subjects as a whole, but was an independent protective factor against dependence in ADLs (OR = 0.196 [0.045-0.853]; p = 0.003) and IADLs (OR = 0.060 [0.010-0.361]; p = 0.002) in subjects aged ≥85 years. Very old subjects with SCH showed better performance in ADLs than did those with euthyroidism (Katz Index: 0.9 ± 1.6 [median: 0.5] vs. 1.7 ± 1.7 [1.0], p = 0.024; HAQ: 1.2 ± 0.8 [0.9] vs. 1.8 ± 1.0 [1.9], p = 0.015). This putative protective effect of SCH was not found in subjects aged <85 years. The number of falls, number of medications used, depressive symptoms, and cognitive impairment did not differ among thyroid status groups, regardless of age. In conclusion, SCH does not have impact functional performance in the elderly population as a whole, but was associated with better functional status in subjects aged ≥85 years.
authors.affiliation: Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373. Edifício do Centro de Ciências da Saúde, Bloco K, Cidade Universitária, Rio de Janeiro, RJ, 21.941-902, Brazil, medsilva@gmail.com.
authors.forename: Silvana Oliveira
authors.initials: SO
authors.lastname: E Silva
authors.forename: I Thien
authors.initials: IT
authors.lastname: Chan
authors.forename: Maryna A
authors.initials: MA
authors.lastname: Lobo Santos
authors.forename: Marcela
authors.initials: M
authors.lastname: Cohen
authors.forename: Mayra
authors.initials: M
authors.lastname: de La Roque P Araujo
authors.forename: Julia
authors.initials: J
authors.lastname: da Silva Almeida
authors.forename: Andressa
authors.initials: A
authors.lastname: Simões
authors.forename: Helder Renato B
authors.initials: HR
authors.lastname: Givigi
authors.forename: Mario
authors.initials: M
authors.lastname: Vaisman
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Paixão
authors.forename: Patricia
authors.initials: P
authors.lastname: de Fatima Dos S Teixeira
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D020249:Hormone Replacement Therapy; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000502:physiology*; D013974:Thyroxine / Q000627:therapeutic use
chemical_list: D013974:Thyroxine