The Health Consequences of Peripheral Neurological Deficits in an Elderly Cohort: an Oklahoma Physicians Resource/Research Network Study

Objectives: To determine whether the belief that loss of deep tendon reflexes and vibratory sensation in the ankles in older patients is of no great consequence is valid.

Design: Four-year longitudinal cohort study.

Setting: Primary care practice-based research network.

Participants: Six hundred four noninstitutionalized individuals aged 65 and older with no self-reported medical conditions known to cause peripheral neuropathy (PN), recruited from the practices of 23 primary care physicians in central Oklahoma.

Measurements: Annual standardized peripheral neurological examination performed by two research nurses plus a questionnaire that included self-reported measures of health, health-related quality of life (HRQoL Quality of Well-Being--Self Administered (QWB-SA) and Health Utilities Index-3 (HUI-3), physical functioning--(Medical Outcomes Study 36-item Short Form Survey (SF-36)), falls, and use of healthcare services. Deaths were determined from participant contacts, primary care physicians, and the Social Security death index.

Results: One hundred sixty of 604 participants had symmetrical peripheral neurological deficits (SPNDs). After controlling for age, sex, race, education, income, body mass index, HRQoL, physical functioning, self-rated health, cognitive test score, and a variety of medical conditions, SPNDs were associated with earlier hospitalization (P=.03); greater mortality (P<.001); and declines in HRQoL (QWB-SA, P<.001), self-rated health (P=.02) physical functioning (SF-36, P=.005), and bodily pain (SF-36, P=.001).

Conclusion: SPNDs of undetermined cause, found in older patients on physical examination, appear to be associated with greater morbidity and mortality.