LOW CIRCULATING LEVELS OF INSULIN-LIKE GROWTH-FACTORS AND TESTOSTERONE IN CHRONICALLY INSTITUTIONALIZED ELDERLY MEN

Objective: To determine the prevalences of and the associations between hyposomatomedinemia and hypogonadism in healthy young men, healthy old men, and chronically institutionalized old men. Design: Survey with serial blood tests. Setting: Veterans Affairs nursing home and young and old men living in the community. Subjects: Three groups were studied: healthy young men (20-29 years old, n = 32), healthy old men (59-98 years old, n = 30), and chronically institutionalized old men (59-95 years old, n = 112). Measurements: Plasma insulin-like growth factor-I (IGF-I), total testosterone (TT), free testosterone (FT), and plasma insulin-like growth factor-II (IGF-II) were measured. In subjects with low testosterone level, serum luteinizing hormone (LH) was also determined. In a subset of chronically institutionalized old men with low IGF-I, the serum growth hormone (GH) level was analyzed during the first 4 hours of sleep. Results: A low IGF-I level (defined as a value below the lower 2.5 percentile of the comparison group) occurred in 85% of the healthy old men when compared with healthy young men (P < 0.001), in 90% of the chronically institutionalized old men when compared with healthy young men (P < 0.001), and in 26% of the chronically institutionalized old men when compared with healthy old men (P < 0.001),. In chronically institutionalized old men with low IGF-I compared with healthy young men, nocturnal peaks of serum GH were <2 ng/mL in most cases. Low TT (defined as a value below the lower 2.5 percentile of the comparison group occurred in 86% of the healthy old. men when compared with healthy young men (P < 0.001), in 88% of the Chronically institutionalized old men when compared with healthy young men (P < 0.001), and in 28% of the chronically institutionalized old men when compared with healthy old men (P < 0.001). The results of FT were similar. In 80% of the institutionalized old men with low TT and FT, the serum LH level was low (<20 mU/mL). In 53% of the institutionalized old men, the IGF-II level was below the lower 2.5 percentile of the healthy old men (P < 0.001). In both healthy and institutionalized old men, IGF-I and IGF-II levels were significantly correlated to each other (r = 0.6), but neither was significantly correlated to TT or FT. In the institutionalized old men, IGF-I was inversely correlated with age and with a diagnosis of dementia; TT and FT were inversely correlated with age and with the degree of dependency in ADL's. Conclusions: Compared with healthy young men, most healthy old men have low serum IGF-I, TT, and FT levels. The geriatric hyposomatomedinemia and hypogonadism are more severe in institutionalized old men. In the latter group, both endocrine deficiencies are usually of central origin, but their occurrences are not significantly associated. Healthy old men usually have a low level of IGF-I compared with healthy young men, but a similar level of IGF-II; institutionalized old men are usually low in both values.