Systemic lupus erythematosus (SLE) in the elderly is uncommon and rarely reported with disease onset at age 65 and older. The aim of this study is to retrospectively analyze the influence of age at disease onset on the clinical features and prognosis of SLE. From 1988 to 1998, we encountered 21 lupus patients with disease onset at age 65 and older (all are included in group A). For comparison, 21 lupus patients with disease onset between 50-64 years of age (group B) and 152 lupus patients with disease onset before 50 years of age (group C) were obtained by a simple random sampling method from the hospital registry. Clinical features as included in the 1982 ARA revised criteria for classification of SLE and survival rate were analyzed and compared among these three groups. Group A had a smaller female to male ratio, longer duration from disease onset to diagnosis, less malar rash, more discoid lupus, and shorter survival rate that group C. There was no statistically significant difference in clinical features and survival between groups A and B, as well as between female and male patients of these two groups. The main cause of death in group A was septic shock. In conclusion, the clinical features and prognosis of SLE were influenced by the age at disease onset. However, clinical features and prognosis of SLE were similar in both late-onset lupus groups.

BackgroundFalls are very common among the older people. Nearly one-third older people living in a community fall each year. However, few studies have examined factors associated with falls in a community-dwelling population of older Taiwanese adults.ObjectivesTo identify the associated factors for falls during the previous 12 months among the community-dwelling Taiwanese older people receiving annual geriatric health examinations.ParticipantsPeople aged sixty-five years or older, living in the community, assessed by annual geriatric health examinationsMethods1377 community-dwellers aged ≥65 years who received annual geriatric health examinations at one hospital in northern Taiwan between March and November of 2008. They were asked about their history of falls during the year prior to their most recent health examination.ResultsThe average age of the 1377 participants was 74.9±6.8 years, 48.9% of which were women. Three-hundred and thirteen of the participants (22.7%) had at least one fall during the previous year. Multivariate analysis showed that odds ratio for the risk of falling was 1.94 (95% CI 1.36-2.76) when the female gender group is compared with the male gender group. The adjusted odds ratios of age and waist circumference were 1.03 (95% CI 1.00–1.06) and 1.03 (95% CI 1.01–1.05) respectively. The adjusted odds ratios of visual acuity, Karnofsky scale, and serum albumin level were 0.34 (95% CI 0.15–0.76), 0.94 (95% CI 0.89–0.98), and 0.37 (95% CI 0.18–0.76) respectively. Larger waist circumference, older age, female gender, poorer visual acuity, lower score on the Karnofsky Performance Scale, and lower serum albumin level were the independent associated factors for falls.ConclusionIn addition to other associated factors, waist circumference should be included as a novel risk factor for falls.

The metabolic syndrome is an independent risk factor for falls in community-dwelling older adults and should be addressed with regard to prevention of falls.

preexisting defects in cholesterol metabolism. 8 Although statins have anti-inflammatory properties, lipophilic statins are proinflammatory in human monocytes in vitro and in leukocytes in mice in vivo. 9 It has been hypothesized that the cognitive effects of statins are greater with lipophilic statins. Of the available agents, simvastatin, atorvastatin, and lovastatin are lipophilic, and pravastatin and fluvastatin are hydrophilic. 10 In the current study, 88% of the subjects were taking lipophilic statins.These results should be evaluated in light of limitations of a small retrospective study. A major limitation of the study is that follow-up MMSE scores were not available in the comparison group in whom statins were not discontinued. It was also not possible to exclude a practice effect as accounting for some of the improvement. In addition, comorbid medical conditions were not accounted for systematically. Because the intent was to test the cognitive effects of statins in patients with preexisting memory problems, any implications apply only to that group. Although statins are beneficial in vascular disease, their effects on cognition have yet to be established, and a subset of people may experience cognitive side effects.Future studies need to delineate cognitive effects of statins based on subject characteristics, disease markers, stage of dementia, and individual properties of the statins. A prospective study of statin withdrawal and re-challenge may be useful in overcoming some of the methodological limitations in this report and help in identifying whether the observation here merits further consideration.