LonelyLonely Elder SyndromeElder Syndrome

Sayed Sileem, MScSayed Sileem, MScCardiologistCardiologist

Kafr Saad central hospitalKafr Saad central hospital20142014

One of the most important causes ofOne of the most important causes of research failure in EGYPT is hate and research failure in EGYPT is hate and

ivoryivory..

If you want to live in light side, Hide If you want to live in light side, Hide your candle of windyour candle of wind

Live inside the box but think outside Live inside the box but think outside itit

You must leave a beneficial trace for You must leave a beneficial trace for the human being, as you are not an the human being, as you are not an

animalanimal

The person who has information has The person who has information has the powerthe power

You may hate something carryYou may hate something carry welfare welfare for youfor you..

I noticed some of elder people sleep deeply I noticed some of elder people sleep deeply once they were admitted to ICUonce they were admitted to ICU..

They were presented by dyspnoeaThey were presented by dyspnoea..By history , they were lonely eldersBy history , they were lonely elders....And this was the starting questionAnd this was the starting question..

IN ELDER PEOPLE, IS THEREIN ELDER PEOPLE, IS THERE A A LINK BETWEEN DYSPNEA AND LINK BETWEEN DYSPNEA AND

LONELINESS ESPECIALLY WHEN LONELINESS ESPECIALLY WHEN A NEIGHBOR OR A COLLEAGUE A NEIGHBOR OR A COLLEAGUE

DIESDIES??

HypothesisHypothesis::

IntroductionIntroduction::Dyspnea, like pain, is a multidimensional Dyspnea, like pain, is a multidimensional

experience with multiple layers of meaning: experience with multiple layers of meaning: physiological, emotional, cognitive, physiological, emotional, cognitive,

behavioral dimensions. It is more prevalent behavioral dimensions. It is more prevalent in aging persons. One of the most common in aging persons. One of the most common symptoms experienced by patients with all symptoms experienced by patients with all types of advanced lung disease. Dyspnea is types of advanced lung disease. Dyspnea is more common, and often more severe in more common, and often more severe in the last few weeks before death.the last few weeks before death. (WHO, (WHO,

20052005(.(.

Despite dyspnea is a highly Despite dyspnea is a highly prevalent symptom in older adults prevalent symptom in older adults and increases with age regardless and increases with age regardless of the type of illness or community of the type of illness or community

in which they live in which they live (Bednash & (Bednash & Ferrell, 2001(,Ferrell, 2001(,

Research indicates dyspnea is Research indicates dyspnea is

inadequately assessed at the end inadequately assessed at the end of life of life (Sykes, 1997(Sykes, 1997(.(.

In brief, these are the causes of dyspnea in elder people: In brief, these are the causes of dyspnea in elder people: Debility with aging adult like Anemia, atelectasis, pulmonary Debility with aging adult like Anemia, atelectasis, pulmonary

embolism, pneumonia, emphysema, cachexia-anorexia embolism, pneumonia, emphysema, cachexia-anorexia syndrome, or weakness (asthenia), concurrent disease with syndrome, or weakness (asthenia), concurrent disease with

increased age like COPD, asthma, CHF, acidosis, angina, cancer increased age like COPD, asthma, CHF, acidosis, angina, cancer complications like pleural effusions, complications of treatment complications like pleural effusions, complications of treatment

of primary disease, psychological disorders: anxiety, of primary disease, psychological disorders: anxiety, depression, panic disorders.depression, panic disorders. (Dickerson, Benedetti, Davis et al., 2001)

(Adapted from Morrison & Meier, 2003).

Stress, anxiety, depression, delirium, dementia, certain drugs, Stress, anxiety, depression, delirium, dementia, certain drugs, alcohol, and medical problems such as arthritis, nerve problems, alcohol, and medical problems such as arthritis, nerve problems,

breathing difficulty, heartburn, and frequent urination at night can breathing difficulty, heartburn, and frequent urination at night can cause sleep problems. Sleep Problems lower quality of life and can cause sleep problems. Sleep Problems lower quality of life and can contribute to falls, injuries and other health problems contribute to falls, injuries and other health problems (Olde Rikkert et

al., 2008).

Shortness of breath was associated with older age, poor perceived Shortness of breath was associated with older age, poor perceived health, more anxiety and depressive symptoms, impaired daily health, more anxiety and depressive symptoms, impaired daily

functioning, and lower happinessfunctioning, and lower happiness. (Bèr Huijnena, et al.2005).

One of noncardiac-nonpulmonary types of dyspnea is functional One of noncardiac-nonpulmonary types of dyspnea is functional (anxiety). (anxiety). (Walter C. Morgan, et al. 1998)

The The most common causesmost common causes of of dyspnea in the elderly include: (HF, dyspnea in the elderly include: (HF,

COPD, and BA).COPD, and BA).

Other causes include: Other causes include: (parenchymal lung disease, (parenchymal lung disease,

pulmonary vascular diseases, upper pulmonary vascular diseases, upper airway obstruction and pneumonia).airway obstruction and pneumonia).

((Yernault JCYernault JC.et al. 2010).et al. 2010)

I found no author had mentioned the link between this I found no author had mentioned the link between this dyspnoea and living alone with fear of death. During the dyspnoea and living alone with fear of death. During the

period from 2001 to 2010, I noticed that a valuable period from 2001 to 2010, I noticed that a valuable number of older people came to my clinic , ICU or the ER number of older people came to my clinic , ICU or the ER

with dyspnea but investigations revealed no relevant with dyspnea but investigations revealed no relevant organic disease, I tried to help some of those people, by organic disease, I tried to help some of those people, by

studying their social life, I found an incredible link studying their social life, I found an incredible link between dyspnea and living alone especially when a between dyspnea and living alone especially when a

neighbor or a colleague dies. So, I decided to start this neighbor or a colleague dies. So, I decided to start this study.study.

I created a master table to register every patient ≥ I created a master table to register every patient ≥ 60 60 years presented to my clinic or ER with dyspnoea. years presented to my clinic or ER with dyspnoea.

I divided these patients into 3 subgroups: (1) from 60 to < 70 I divided these patients into 3 subgroups: (1) from 60 to < 70 (2) from 70 to < 80 (3) ≥ 80 years old.(2) from 70 to < 80 (3) ≥ 80 years old.

I started by 60 years old as this is the age of retirement when I started by 60 years old as this is the age of retirement when the sense of loneliness is maximally felt. the sense of loneliness is maximally felt.

I also divided them into two groups: females and males.I also divided them into two groups: females and males.

Then divided them into two groups: highly educated and less Then divided them into two groups: highly educated and less educated patients. educated patients.

Then divided them according to marital status in to 3 Then divided them according to marital status in to 3 subgroups: (1) married (2) widow (3) single, whether divorced subgroups: (1) married (2) widow (3) single, whether divorced

or never marriedor never married..

Methods:Methods:

To exclude organic causes of dyspnoea, To exclude organic causes of dyspnoea, these patients these patients underwent clinical examination, laboratory investigations, and underwent clinical examination, laboratory investigations, and

radiologic manoeuvres as follows: radiologic manoeuvres as follows:

CBC to exclude Anemia,CBC to exclude Anemia,Pulse oximetry to determine the hemoglobin oxygen saturation, Pulse oximetry to determine the hemoglobin oxygen saturation,

ABG to exclude altered pH, ABG to exclude altered pH, BNP and /or echocardiogram to exclude heart failure,BNP and /or echocardiogram to exclude heart failure,

Cardiac enzymes and ECG to exclude acute ischemia and Cardiac enzymes and ECG to exclude acute ischemia and myocardial infarction,myocardial infarction,

Chest-X-ray and pulmonary functions to exclude pulmonary Chest-X-ray and pulmonary functions to exclude pulmonary disease.disease.

Hence, these patients were divided into two groups according Hence, these patients were divided into two groups according to chronic chest diseases (present or absent), chronic heart to chronic chest diseases (present or absent), chronic heart

diseases (present or absent), and chronic diseases other than diseases (present or absent), and chronic diseases other than pulmonary and cardiac (present or absentpulmonary and cardiac (present or absent).).

Then, I divided these patients according to frequency Then, I divided these patients according to frequency ofof seeking medical advice due to dyspnoea into two seeking medical advice due to dyspnoea into two subgroups: (1) frequent “>1 attach every 2 months” subgroups: (1) frequent “>1 attach every 2 months”

(2) infrequent “≤ 1 attack every 2 months”. (2) infrequent “≤ 1 attack every 2 months”.

Then, I divided them according to the circumstances Then, I divided them according to the circumstances and location of living into two subgroups: (1) lives and location of living into two subgroups: (1) lives

alone (2) lives with others especially at night. alone (2) lives with others especially at night.

Then,Then, how could we treat this dyspnoea? I divided how could we treat this dyspnoea? I divided these patients into two subgroups according to the these patients into two subgroups according to the answer of this question: (1) medical care including answer of this question: (1) medical care including

drugs and manoeuvres (2) social care and sedativesdrugs and manoeuvres (2) social care and sedatives..

This fulfilled master tableThis fulfilled master table in in MicrosoftMicrosoft excel 2010 program is excel 2010 program is

transferred to SPSS-16.0 for transferred to SPSS-16.0 for Windows program to analyse Windows program to analyse

these datathese data..

•Mixed dyspnea (psychic and organic).Mixed dyspnea (psychic and organic).

Locality of the studied patients as they were from Damietta Locality of the studied patients as they were from Damietta

governorate, Egypt.governorate, Egypt.

I am one of the limitations of the study as I registered I am one of the limitations of the study as I registered patients who came to me for medical advice, while those patients who came to me for medical advice, while those

who went to other physicians are not included.who went to other physicians are not included.

I studied the patients who asked medical advice in my I studied the patients who asked medical advice in my clinic and in Kafr Saad central hospital ER only while clinic and in Kafr Saad central hospital ER only while

those patients who went to other clinics or hospitals or those patients who went to other clinics or hospitals or those treated by home visits were not included in this those treated by home visits were not included in this

study.study.

Majority of the study times were during my country Majority of the study times were during my country revolution, where the emotional elements were dominantrevolution, where the emotional elements were dominant..

Limitations

This study included 683 cases, This study included 683 cases, 308 females and 375 males. I 308 females and 375 males. I

used descriptive statistical used descriptive statistical analysis crosstabs and Chi-analysis crosstabs and Chi-

square methods to detect the square methods to detect the significance of the analysis significance of the analysis

results. The result is significant results. The result is significant when its p-value is when its p-value is ≤ 0.05≤ 0.05..

Results:

To answer the main question (In elder people, is there a link between dyspnea

and loneliness?), the most important aspect of the research became the

relationship between living alone and dyspnea treated with social care or

sedation. It was as follows:

In this table 1; those patients who live alone in this old age need a social care

more than medical care (P=0.000).

When I analyzed the When I analyzed the data according to living data according to living circumstances, i.e. this circumstances, i.e. this

elder lives alone or lives elder lives alone or lives with others:with others:

  Lives Lives

alonealone

Not Not

alonealoneP valueP value

EducationEducationHigh educatedHigh educated 8383 111111

0.0000.000

Less educatedLess educated 362362 127127

GenderGenderFemaleFemale 211211 9797

0.0950.095

MaleMale 234234 141141

AgeAge

60s60s 9696 129129

0.0000.00070s70s 161161 8989

≤≤8080 188188 2020

Relieved byRelieved byMedical careMedical care 4343 223223

0.0000.000

Social careSocial care 402402 1515

FrequencyFrequencyFrequentFrequent 364364 8080

0.0000.000

InfrequentInfrequent 8181 158158

Chronic chest Chronic chest

diseasesdiseases

PresentPresent 33 6565

0.0000.000

AbsentAbsent 442442 173173

Chronic heart Chronic heart

diseasesdiseases

PresentPresent 398398 147147

0.0000.000

AbsentAbsent 4747 6464

Other chronic Other chronic

diseasesdiseases

PresentPresent 233233 2929

0.0000.000

AbsentAbsent 212212 209209

This table 2; shows the cross relations of living circumstances with all other items.

There was a significant link between dyspnea (whether organic or

psychological) in elder people and living alone. Both females and males were

affected with no significant difference, this means “we are dealing with an

important social view for human life”.

When I analyzed the patient’s data according to the successful way of treatment, whether treated with social care and sedation or treated with medications other

than sedatives and/or maneuvers:

Discussion:

Patients who live alone in this old age need a social care more than medical care (P=0.000). They are afraid of

death especially at night when they may die and others are far away and no one can save them. So, they seek attention through involuntary dyspnea to keep their

relatives around them. They sleep in crowded and open places where people are found enormously. Once they are

admitted to ICU, they sleep deeply. This is the cause of nomenclature “lonely elder syndrome”.

This syndrome affects elder people especially if they have chronic cardiac

diseases, if they were less educated, and its attacks occur frequently. It occurs in both

females and males without significant difference. Its incidence increases with

time.

Application:Application:

Every patient aged more than 60 years comes to ER with dyspnea with/without suffocation must undergo previous

investigations to exclude organic causes of dyspnea, if there is no organic cause, it is ‘Lonely Elder Syndrome”,

treat it properly.

One of the most important causes ofOne of the most important causes of research failure in EGYPT is hate and research failure in EGYPT is hate and

ivoryivory..

If you want to live in light side, Hide If you want to live in light side, Hide your candle of windyour candle of wind

Live inside the box but think outside Live inside the box but think outside itit

You must leave a beneficial trace for You must leave a beneficial trace for the human being, as you are not an the human being, as you are not an

animalanimal

The person who has information has The person who has information has the powerthe power