Clinical Question: How common are peripheral sensory deficits in elderly patients?

Setting: Outpatient (primary care)

Study Design: Descriptive

Synopsis: Investigators enrolled patients 65 years or older from the practices of family physicians in the Oklahoma Physicians Resource/Research Network. Patients who agreed to participate completed a questionnaire about demographic information, health habits, medical conditions, symptoms, recent falls, functional status, and health-related quality of life. At the enrollment visit, one of two research nurses trained by a neurologist performed the peripheral neurologic examination. The assessment included the presence or absence of deep tendon reflexes at the ankles, position sense at the great toes, vibratory sense at the medial malleoli, fine-touch sensation in the soles of the feet, balance examination, and a timed distance walk. Peripheral neuropathy was defined as the presence of one or more complete bilateral deficits.

The 799 consenting subjects who met inclusion criteria were more likely than nonparticipants to be men, younger, better educated, in better health, and white. The mean age of participants was 73.4 years (range = 64 to 94 years). More than one fourth (27.5 percent) gave a history of at least one disease known to cause peripheral neuropathy. The prevalence of at least one bilateral sensory deficit increased from 26 percent for 65- to 74-year-old patients to 54 percent for those 85 years and older. The most common bilateral deficit was the absence of ankle reflexes (86 percent of those with deficits), followed by insensitivity to touch (31 percent), vibration (15 percent), and position (7 percent). Factors associated with sensory deficits included increasing age, incomes of less than $15,000, a history of military service, higher body mass index, diabetes mellitus, vitamin B₁₂ deficiency, rheumatoid arthritis, and the absence of hypertension. Patients with one or more deficits frequently reported numbness of extremities (28 percent), pain or discomfort (48 percent), restless legs (31 percent), trouble walking (44 percent), and trouble with balance (35 percent).

Bottom Line: Peripheral sensory deficits are common in the elderly, present in 26 percent of patients 65 to 74 years of age and increasing to 54 percent for those 85 years and older. Frequently, there is no obvious associated medical cause. Because patients enrolled in this study were clearly younger and healthier than those declining to participate, the true prevalence of peripheral neuropathy in this population may be even higher. (Level of Evidence: 3b)