Seven female patients (mean age 86 years) with proven biochemical primary hypothyroidism were enrolled in a single-blind randomized crossover study, of standard daily versus twice-weekly thyroxine therapy, with each phase of one month's duration. The median daily dose of thyroxine was 100 micrograms (range 75-100 micrograms). Serum levels of thyroid hormones and thyrotrophin were very similar during twice-weekly thyroxine therapy to those during daily therapy and there were no statistically significant differences between trough and peak serum total triiodothyronine, free thyroxine, or thyrotrophin levels or systolic time intervals during twice-weekly thyroxine. Administration of thyroxine twice-weekly to elderly patients with primary hypothyroidism gives effective biochemical thyroid hormone replacement, with no evidence from the systolic time intervals of tissue thyrotoxicosis at expected peak thyroid hormone concentrations. Supervised twice-weekly thyroxine should be considered in patients with primary hypothyroidism who comply poorly with daily dosing.

Patients with non-rheumatic atrial fibrillation have a fivefold increased risk of stroke. Warfarin reduces this risk by approximately two thirds, but evidence for benefit from aspirin is less compelling. We assessed whether our current practice reflects the message of the trials. In a retrospective case record study we reviewed notes of 131 patients with atrial fibrillation (AF), mean age 79 (range 53-95) years, admitted to a medical unit (72) or geriatric assessment unit (59). Thirty-two patients had paroxysmal AF. Of 115 patients with nonrheumatic AF, 36 (31%) had one or more recorded contraindication to anti-coagulation. Although 79 patients (69%) had no recorded contraindication to warfarin, only 2 took warfarin and 15 aspirin prior to admission. Ten patients commenced warfarin and 8 aspirin before discharge. Thirty-nine patients (53%) without contraindication, were discharged without antithrombotic therapy. Despite evidence to support anticoagulating patients with non-rheumatic AF, this rarely occurs.

The haemodynamic response to postural stress (60 degrees foot-down tilt) was measured by impedance cardiography in six elderly cardiovascular-normal patients and 39 with symptomatic postural hypotension (systolic blood pressure drop greater than or equal to 20 mmHg or more). In the normal elderly the mean increase in heart rate, fall in blood pressure and cardiac output, and rise in peripheral resistance was less than that described in younger subjects. The changes were at their maximum in 1 min, and there was little further change over the next 5 min. In those with postural hypotension, orthostatic reduction (or failure to rise) of the peripheral resistance was the mechanism in 83% of cases, whatever the cause, and the time course of the haemodynamic changes was the same in the majority as in the normals. Serial tests in patients whose postural hypotension was controlled (by cessation of causal drugs, often multiple, by fludrocortisone, or by dihydroergotamine) showed return to normal.

Over a five-year period (1974-78), 2947 patients were admitted to the Coronary Care Unit, Victoria Infirmary, Glasgow, and it was confirmed that 1474 of these patients had had a myocardial infarction. Over 70% were of state pensionable age, that is women over the age of 60 years and men over 65 years. No difference was found in the incidence of successful resuscitation from primary ventricular fibrillation following acute myocardial infarction between the under-60-year-old and over-70-year-old age groups. Further, this study did not show any rise in mortality, with age, following acute myocardial infarction.

The cardiac output has been determined by radionuclide angiocardiography and by impedance cardiography in 93 elderly patients. The agreement between the two methods was excellent in patients in sinus rhythm, without regurgitant valvular lesions, and without severe airways obstruction or right bundle branch block. In atrial fibrillation the lack of correlation may be due to differences in heart rate during the two measurements, in regurgitant valvular lesions to the fact that impedance cardiography measures stroke output, whether forward or backward, in airways obstruction to high values for the basal thoracic impedance, and in right bundle branch block perhaps to the abnormal impedance wave-form often present.