A study of the effects of tamoxifen in the frail elderly: Difficulties encountered in nursing home research

Objective: This study was conducted in order to determine whether the effects of tamoxifen in elderly, frail nursing home residents are similar to those that have been previously reported for younger postmenopausal women. Design: a chart review study. Setting: The Jewish Home and Hospital for Aged (JHHA), a subacute long-term care facility. Participants: One hundred fifty-eight women who had been at the JHHA at any time since 1986. One hundred ten had a history of breast cancer 43 of these had been treated with tamoxifen while at the JHHA (Group 1), and 66 had not (Group II). The remaining 49 women had no history of breast cancer (Group III). Measurements: Data were collected from the time of admission to the JHHA through August, 1994 on: chemistry profiles, bone fractures apparently not a consequence of metastasis, gynecological parameters, and thromboemboli. Results: The lack of pre-admission clinical information presented problems regarding research design and the interpretation of our findings. Nevertheless, compared to women who had not been treated with tamoxifen, treated women had a significantly elevated incidence of vaginal discharge (P = 0.01) and a lower prevalence of elevated total cholesterol (P = 0.04). Although not statistically significant, they also had decreased levels of low density lipoprotein cholesterol and an increased incidence of thromboemboli and bone fractures. Conclusions: While some of the effects of tamoxifen in elderly, frail women are similar to those observed in younger, postmenopausal women, others may be different. Our results suggest a need for further innovative studies that focus on the consequences of tamoxifen treatment in the elderly, frail population.