Dry eye and dry mouth in the elderly - A population-based assessment

Background: Symptoms of dry eye and dry mouth are common in the elderly and are often debilitating. Previous research on small populations has been in consistent regarding the contribution to sicca symptoms of autoimmune marke rs, medication use, and other factors. The objective of this study was to d etermine the population prevalence of symptoms of dry eye and dry mouth and to evaluate possible risk factors. Methods: This is a population-based study of 2481 individuals, aged 65 to 8 4 years, residing in Salisbury, Md, and identified by the Health Care Finan cing Medicare database. The main outcome measures included information on s icca symptoms, medical history, medication use, and joint examination resul ts collected in a standardized manner. Autoimmune status was assessed in 12 00 individuals by measuring antinuclear antibody, rheumatoid factor, and au toantibodies to the soluble nuclear antigens Ro/SS-A and La/SS-B by double immunodiffusion. Results: Approximately 27% of the population reported dry eye or dry mouth symptoms to be present often or all the time and 4.4% reported both. The pr evalence of dry mouth (but not dry eye) symptoms increased with age, female sex, and white race. No association of sicca symptoms was found with rheum atoid arthritis, smoking, alcohol consumption, reproductive hormonal status , or the presence of autoantibodies. A strong, dose-response relationship w as observed between sicca symptoms and the use of certain medication classe s. The proportion of the population prevalence of sicca symptoms attributab le to the use of drying medications was estimated at 62% for dry eye and dr y mouth and 38% for dry eye or dry mouth symptoms. Conclusions: Sicca symptoms are common in the elderly, and medication side effects appear to be a major underlying factor. Our results do not indicate an association between autoimmune status and sicca symptoms and do not sup port immunologic testing in persons with sicca symptoms in the absence of o ther important systemic features.