Age and Ageing (1973), 2, 14

NORMAL VALUES FOR SIXTEEN BLOOD

CONSTITUENTS IN THE ELDERLY
R. G. S. LEASK, G. R. ANDREWS AND F. I. CAIRD
Department of Biochemistry, Stobhill Hospital, Glasgow and Department of
Geriatric Medicine, University of Glasgow

Summary
Sixteen common biochemical estimations have been performed on nearly 500 people randomly
selected from those over 65 living at home. The mean values and ranges found for serum sodium,
potassium, chloride, bicarbonate, magnesium, bilirubin, inorganic phosphate, total protein, albumin,
and globulin, were identical, and those of urea, creatinine, cholesterol, uric acid, calcium, and alka-
line phosphatase were higher than those considered normal in younger people. Sex differences
were demonstrable for serum urea, creatinine, bilirubin, phosphate, cholesterol, calcium, and
alkaline phosphatase; in the Ia3t four instances these seemed likely to be of clinical importance.

Biochemical disorders are common in the elderly, and often remediable, but assessment
of their significance may be hampered by lack of precise knowledge of normal values in
old age. Both age and sex are known to affect the normal levels of many important and
commonly measured blood constituents (Roberts, 1967; Flynn, 1969; Reed, Cannon,
Winkelman, Bhasin, Henry & Pileggi, 1972), but as the subjects in these studies have
usually been blood donors, and thus rarely if ever elderly, any effects of age over 65 years
must be determined, if at all, by projection. Attempts to derive normal values for the
elderly from data from hospital patients (Pryce, Haslam & Wootton, 1969) are less
likely to provide convincing results than comparable data from less sick people, such as
the elderly at home.
The present study, which is part of a detailed clinical, laboratory, nutritional, and
social survey of old people living at home, sets out to provide information on the normal
range of values in old age of sixteen commonly determined blood constituents.

M A T E R I A L AND M E T H O D S
Two random samples were drawn from the names of people aged 65 and over living at home. The
first (Andrews, Cowan & Anderson, 1971) was from the whole elderly population of the town of
Kilsyth, and the second from six general practices in northern Glasgow. Each sample was stratified
by age so as to increase the proportion of subjects over the age of 75 from approximately one in
three to about one in two. About 25 per cent of those who were approached refused to participate.
Subjects acutely ill at the time they were approached were excluded. The Kilsyth survey con-
tinued until 201, and the Glasgow survey until 300 subjects had taken part.
A full clinical history, including details of drugs currently being taken, was obtained, and a
physical examination carried out. Blood was taken by venepuncture, a tourniquet being used if
necessary, at approximately 11 ajn. in the case of the majority of the Kilsyth subjects, and at
1.30 p.m. in the case of the Glasgow subjects.
 Normal Values for Sixteen Blood Constituents in the Elderly 15

The analytical methods used are shown in Table I. The results from the Kilsyth and Glasgow
subjects were essentially the same, and have been combined for the purposes of analysis. Cumula-
tive frequency distributions for each constituent were plotted on probability paper to determine
their nature. The distributions found are shown in Table I, together with those given by others
(Wootton & King, 1953; Roberts, 1967). Subjects currently taking benzothiadiazines or other
diuretics were excluded from the calculation for several constituents (see Table I).
Table I. Analytical methods used, and type of frequency distribution found

Distribution found
Wootton
& King Roberts This
Constituent Method (1953) (1959) Study
Sodiunrf Technicon* AutoAnalyzer* Methodology N-21b/I N N N
Potassiumf Technicon AutoAnalyzer Methodology N-21b/I L N N
Chloridef Technicon AutoAnalyzer Methodology N-21b/I N N N
Bicarbonatef Technicon AutoAnalyzer Methodology N—21b/I N — N
Calcium Technicon AutoAnalyzer Methodology N-3b N N N
Phosphate Young (1966) N N N
Magnesium Orange & Rhein (1951) — N N
Uric Acidf Crowley (1964) N N N
Total Protein Technicon AutoAnalyzer Methodology N-14b N N N
Albumin Northam & Widdowson (1967) N N N
Globulin Difference between Total Protein and Albumin NS N N
Ureaf Technicon AutoAnalyzer Methodology N—lc L L L
Creatininef Technicon AutoAnalyzer Mediodology N - l l b L L L
Bilirubin Technicon AutoAnalyzer Methodology N—12a L L L
Alkaline
phosphatase Axelsson, Ekman & Knutsson (1965) L L L
Cholesterol Annan & Isherwood (1969) L L
N = normal; L = lognormal; NS = negative skew; — = not done.
• Technicon and AutoAnalyzer are registered trade marks of Technicon Instruments Company
Ltd., Hamilton Close, Houndsmills, Basingstoke, Hants.
f Subjects taking thiazides or other diuretics excluded from analysis for these constituents.

RESULTS

These results are shown in Tables II to VII, as means and standard deviations in the
case of contituents with a normal distribution, and as logarithmic means and 95 per cent
ranges in the case of those with a lognormal distribution. The subjects are divided by
sex, and by age under or over 75.
There was no trend with age nor any sex difference in the concentrations of sodium,
potassium, chloride or bicarbonate (Table II). The mean values (± S.D.) are 140-8 ±
2-8, 4-4 ± 0 4 , 102-4 ±2-9 and 25-1 ±2-8 mmol/litre respectively.
Mean values for serum calcium concentration, both uncorrected and corrected for
serum protein concentration (Dent, 1962) fell with age, being approximately 0-2 mg/100
ml lower in both sexes in those over 75 than in those under that age. They were higher,
by 0-16-0-19 mg/100 ml, in women than in men. The serum calcium concentration was
over 10-5 mg/100 ml in 17 women (5-7 per cent) and 5 men (2-9 per cent). The corre-
sponding figures for corrected serum calcium concentration were 15 (5-0 per cent) and 4
 Table II. Electrolytes (mean ± S.D.; distributions normal)

Sex M F M F M+F

Age 65-74 75 + 65-74 75 + 65 + 65 + 65 +

No. 95 68 149 133 163 278 441

Na+ (mmol/litre) 140-5±3-l 140-8±2-5 141-0±26 1409±30 1406±2-9 140-9±2-8 14O-8±2-8

K+ (mmol/litre) 4-5±0-4 4-5±0-3 4'4±0-4 4-3±0-4 4-5±0-3 4-4±0-4 4-4±0-4
Cl~ (mmol/litre) 1021 ± 3 0 102-7±2-8 102-4±2-9 102-5±3-0 102-6±3-0 102-4±2-9 102-4±2-9
HCO 3 (mmol/litre)

No.
25 • 3 ± 2 • 8

98
25-7±2-6

74
25-3±3O

159
24-8±2-5
142
25-2±2-7
172
251 ±2-8

301
25 1 ±2-8
I
Ca++ (mg/100 ml) 9-64±0-45 9-44±0'37 9-80±0-50 9-63±0-56
9
Corr
Ca++ (mg/100 ml) 9'56±0-48 9-42±0-40 9-74±0-51 9-56±0-58
PO4 (mg P/100 ml) 2-98±0-52 2-99±0-47 3-41±0-57 3-35±O-63 3O6±0-49 3-39±0-60

Corr. Ca++ = serum calcium corrected for total protein concentration.

Table III. Plasma proteins (mean ± S.D.: distributions normal)

Sex M F M F M+F
Age 65-74 75 + 65-74I 75 + 65 + 65 + 65 +
No. 98 77 158 150 175 308 483

Total protein (g/100 ml) 7 •13±0- 49 7 •07 ±0 •59 7 •13±0 •47 7 •06±0 •48 7 •10±0 •53 7 •09±0 •48 7 •10±0- 50
Albumin (g/100 ml) 4 •04±0- 41 4 •07±0 •67 4 •16±0 •42 4 •15±0 •39 4 •04±0 •41 4 •15±0 •40 4 •11 ±0-41
Globulin (g/100 ml) 3 •16±0- 56 3 •05±0 •56 2 •96±0- 44 2 •99±0 •52 3 •10±0 •56 2 •99±0 •48 3 •05±0- 53
 Normal Values for Sixteen Blood Constituents in the Elderly 17

(2-3 per cent). Serum calcium concentrations of 11-0 mg/100 ml or more were found in
8 women and 1 man. Mean values for serum inorganic phosphate concentration were
unaffected by age, but were higher in women (3-39 + 0-60 mg P/100 ml) than in men
(3-06±049mgP/100ml).
Mean values for total plasma proteins fell slightly with age, being 0-06-0-07 g/100 ml
lower in those over than in those under 75 (Table III). There was no sex difference in
total plasma protein concentration, but the mean serum albumin concentration was
0-11 g/100 ml higher in women, and the mean serum globulin concentration higher, by
the same amount, in men.
The logarithmic means of serum urea and creatinine concentrations were higher in
men than women, and rose with age in both sexes (Table IV). Upper 95 per cent limits
for serum urea concentration were approximately 60 mg/100 ml, and for serum creatinine,
1-9 mg/100 ml.
Serum bilirubin concentrations showed no trend with age, but the logarithmic mean
was 0 1 mg/100 ml higher in men than women (Table IV). The upper 95 per cent limit

Table IV. Serum urea, creatinine, bilirubin and alkaline phosphatase (log mean±S.D.; mean
and 95 per cent range; distributions lognormal)

Sex M F M F

Age 65-74 75 + 65-74 75 + 65 + 65 +

Urea (mg/\00 ml)
No. 95 69 149 134 — —
Log mean 1-5845 1-6301 1-5424 1-5625 — —
±S.D. + 0-0959 + 0-0985 ±0-1027 . ±01102 — —
Mean 38-4 42-7 34-9 36-5 — —
95% range 25-60 27-67 22-60 22-61 — —
Creatinine
(mg/100 ml)
No. 86 61 140 118 — —
Log mean 0-0384 0 0774 T-9615 00181
±S.D. ±01090 ±0-0934 ±01646 ±0-0897 — —
Mean 1-09 1-20 0-91 104 — —
95% range 0-66-1-81 0-78-1-84 0-43-1-95 0-44-1-58 — —
Bilirubin
(mg/100 ml)
No. 95 73 146 137 168 283
Log mean T-8264 T-8283 1-7469 T-7464 T-8244 1-7472
±S.D. ±0-1767 ±0-1498 ±01618 ±0-1477 ±01689 ±0-1551
Mean 0-67 0-67 0-56 0-56 0-67 0-56
95% range 0-30-1-51 0-34-1-34 0-26-118 0-28-1 10 0-31-1-46 0-27-1-14
Alkaline
phosphatase
(K-A units)
No. 94 78 164 143 172 307
Log mean 0-9992 1-0242 10396 10950 10119 1-0659
±S.D. ±0-1549 + 0-1247 ±0-1454 ±0 1680 + 01461 ±0-1584
Mean 100 10-6 110 12-5 10-3 11 -6
95% range 5-20 6-20 6-21 6-27 5-20 6-24
18 R. G. S. Leask, G. R. Andrews and F. I. Caird

was 1-5 mg/100 ml in men and 1-1 mg/100 ml in women. Fifteen men (9 per cent) and
12 women (4 per cent) had serum bilirubin concentrations of 1-1 mg/100 ml or more.
Serum alkaline phosphatase concentrations were higher in women than men (Table
IV), and the 95 per cent range was up to 20 K-A units in men and 24 units in women.
Serum cholesterol levels averaged 45 mg/100 ml higher in women than in men and
showed a slight tendency to fall with age (Table V). The 95 per cent limits are wide,
from 160 to 345 mg/100 ml in men, and 180 to 435 mg/100 ml in women; 43 per cent of
women and 8 per cent of men had values of 300 mg/100 ml or more.

Table V. Serum cholesterol (mg/100 ml) (log mean±S.D.; mean and 95 per cent range: distri-
butions lognormal)
Sex M F M F

Age 65-74 75 + 65-74 75 + 65 + 65 +

No. 89 75 147 131 164 278

Log mean 2-3847 2-3567 2-4531 2-4432 2-3719 2-4485

±S.D. ±0-0834 ±0-0794 ±0-0970 ±0-0932 ±0-0828 ±00954
Mean 243 227 284 277 236 281
95% range 165-356 158-328 182^44 181^*26 161-345 181^36

Serum uric acid concentrations were higher in men than women by about 0-5 mg/
100 ml, and rose slightly with age in both sexes (Table VI).
Serum magnesium was determined in 41 subjects, chosen consecutively and at random
from the main sample. The mean value was 1-99 mg/100 ml, with 95 per cent limits of
1-5 to 2-5 mg/100 ml (Table VII).

Table VI. Serum uric acid (mg/100 ml) (mean±S.D.; distribution normal)

Sex M F M F

Age •65-74 75 + 65-74 75 + 65 + 65 +

No. 85 63 137 119 148 256

Mean
±S.D. 5-41 ±1-20 5 •53±1-14 4-79±l-21 5 •07 ±1-63 5-46±l-18 4-92±l-43

Table VII. Serum magnesium (mg/100 ml) (mean±S.D.; distribution normal)

Sex M F M+F
No. 15 26 41

Mean ±s .D. 2 -03±0- 17 1 •96±0- 29 1 •99±0-25

 Normal Values for Sixteen Blood Constituents in the Elderly 19

DISCUSSION

Assessment of the significance of the findings in a study such as this necessitates dis-
cussion of the problems of sampling and of technical and statistical methodology. There
can be no doubt that a sample of old people living at home is more likely to approximate
to the admittedly somewhat hypothetical concept of 'normal old age* than one drawn
from elderly hospital patients. In the present study the acutely ill were excluded, and
though abnormalities were detectable on clinical examination or simple investigation in
every subject, it seems unlikely that (with one exception) any one abnormality would be
frequent enough to bias the results of more than one blood constituent investigated.
The exception is the taking of oral diuretics, which might be expected to affect the results
in at least the cases of serum sodium, potassium, chloride, bicarbonate, urea, creatinine,
and uric acid. Subjects taking diuretics were therefore excluded from the analysis of the
results for these constituents. Little bias is likely to have been introduced by the relatively
high rate of refusal to participate, since Akhtar (1972) found that the physical health (on
superficial examination) of the Kilsyth subjects who refused to take part was good. In a
similar survey, with a similar refusal rate, Milne, Maule & Williamson (1971) reported
similar conclusions.
The principal technical problems encountered derive from the fact that the blood
samples were not taken in the fasting state, and from the need to use a tourniquet to
obtain adequate blood samples (of 50 ml) from a number of subjects. Food may lower
serum inorganic phosphate concentration (Annino & Relman, 1959). Venous stasis,
particularly if accompanied by forearm exercise, is known to affect levels of sodium,
potassium, chloride, calcium, protein, and cholesterol (Broome & Holt, 1964), but the
mean values of these constituents found in this study are close to those found both when
venous stasis was excluded (Flynn, 1969) and when it was employed (Roberts, 1967).
A tourniquet is often needed in clinical practice, and its effects, except perhaps in the
case of serum calcium, are relatively small and customarily disregarded.
Dispute and difficulty surrounds the proper statistical presentation of biochemical
results (Roberts, 1967; Reed, Henry & Mason, 1971), but it would seem as a minimum
essential to determine the type of frequency distribution for each constituent. Table I
shows that this study is in excellent general agreement on this point with previous
findings (Wootton & King, 1953; Roberts, 1967). The findings for those constituents
whose frequency distribution is normal have been presented in the conventional way, as
the mean and standard deviation, from which the 95 per cent range can be easily
determined. Constituents whose distribution is lognormal are shown as the logarithmic
mean and the upper and lower limits of the 95 per cent range, because it is usually this
range with which the clinician is concerned.
The mean values and standard deviations found in the present study for many blood
constituents (e.g. serum sodium, potassium, chloride, bicarbonate, magnesium) show no
variation with age or sex, and are very close to those found by others in middle age
(Wootton & King, 1953; Roberts, 1967; Flynn, 1969) and those quoted in textbooks
(Cantarow & Trumper, 1963). Chen & Millard (1972) found 55 per cent of serum
sodium concentrations in old people at home to be below 137 mequiv/litre. Subjects
taking oral diuretics were not excluded, but the explanation of this high frequency of
hyponatraemia is obscure. It may be concluded both that age per se has no major effect
 20 . R. G. S. Leask, G. R. Andrews and F. I. Cahd

upon the blood levels of these constituents, and also that 'abnormal' levels are not
commonly encountered in relatively healthy old people.
The sex difference in serum bilirubin concentrations has been noted by others
(O'Hagan, Hamilton, Le Breton & Shaw, 1957; Reed et al., 1972), but is not large
enough to have clinical significance. It does not appear to be due to any difference in the
prevalence of frank liver disease, since any other evidence of liver disease was very rare
in the population studied. The upper limits found for bilirubin concentration are above
those commonly given (0-9-10 mg/100 ml). Some of the subjects with levels of
1-1 mg/100 ml and more may have been examples of constitutional hyperbilirubin-
aemia (Gilbert's syndrome).
Serum calcium levels have been shown to fall with age, but to be higher in post-
menopausal women than in men of the same age (Young & Nordin, 1967; Flynn, 1969;
Reed et al., 1972). They rise after oophorectomy and fall with the administration of
oestrogens (Young, Jasani, Smith & Nordin, 1968; Riggs, Jowsey, Kelly, Jones &
Maher, 1969). These phenomena have been attributed to the withdrawal of oestrogenic
influences on the skeleton at the menopause and the development of a state of relative
hyperparathyroidism (Hossain, Smith & Nordin, 1970). The fact that serum inorganic
phosphate levels are higher in older women than in men (Greenberg, Winters and
Graham, I960; Reed et al, 1972) (Table II) is difficult to reconcile with this hypothesis,
but whatever the mechanism and significance of the sex difference in serum calcium
concentrations, in the present study a substantial proportion of women (5-7 per cent)
were found to have levels above the commonly accepted upper normal limits of 10-5
mg/100 ml. This proportion is little affected by correction for serum protein concentra-
tion. Some of these high values may perhaps be due to venous stasis and some to blood
samples being taken in the non-fasting state. Certainly it is difficult to believe that the
population prevalence of hyperparathyroidism or any other cause of hypercalcaemia can
be as great as 5 per cent. None of the subjects with high serum calcium concentrations
was investigated in further detail, but none had any symptoms or radiological or other
biochemical evidence of hyperparathyroidism. The"true upper limit for normal serum
calcium concentration in women over 60 may in fact be as high as 11-4 mg/100 ml
(Reed et al., 1972).
Age-related changes in serum alkaline phosphatase levels are well described (Clark,
Beck & Shock, 1959; Hobson & Jordan, 1959). The increase with age is sometimes
attributed to an increasing prevalence of occult Paget's disease of bone, but this is
unlikely to explain the sex difference, which has also been previously demonstrated
(Hobson & Jordan, 1959; Roberts, 1967), since the serum alkaline phosphatase level is
higher in women at all ages, while Paget's disease is generally considered commoner in
men. It is possible that the high values in old age, and especially in old women, are
due to a considerable prevalence of unrecognized osteomalacia due to dietary Vitamin
D deficiency (Exton-Smith, Hodkinson & Stanton, 1966; Chen & Millard, 1972). There
may be some correlation in elderly, women between high serum alkaline phosphatase
levels and subnormal Vitamin D intake (McLennan, Caird & Macleod, 1972). However,
values up to 20 K-A units per 100 ml can probably be accepted as normal in elderly
women (Reed et al., 1972).
Sex differences and an age-related increase in serum urea and creatinine are well
described in middle age (Campbell, Greene, Keyser, Waters, Weddell & Withey, 1968;
 Normal Values for Sixteen Blood Constituents in the Elderly 21

Kaufman, Grant & Moorhouse, 1969, Waters, Elwood, Asscher & Abemethy, 1970)
and have also been shown in old age (Milne & Williamson, 1972). The sex difference is
too small to be of practical importance, but the upper 95 per cent limit, shown in Table
IV, of approximately 60 mg/100 ml for serum urea concentration is in agreement with
the findings of Milne & Williamson (1972), and also with clinical experience, that in
old age values between the customary upper limit of normal of 40 mg/100 ml and 60
mg/100 ml do not signify renal failure. The increase with age in blood levels of these
two substances which are both very largely excreted by glomerular filtration undoubtedly
reflects the well-described fall with age in glomerular filtration rate (Shock, 1968), or
more precisely, the fact that this fall exceeds any age-related fall in output of urea or
creatinine.
A sex difference and age-related rise in serum uric acid concentration is well estab-
lished (Dodge & Mikkelsen, 1970; Reed et al., 1972). In the present study, exclusion of
subjects taking oral diuretics proved important in this connection, since the serum uric
acid level was over 8 mg/100 ml in 11 of29 such subjects, and over lOmg/lOOmlin 5. No
subjects were encountered in whom a diagnosis of gout was justified. This study suggests
that in the elderly the upper limit of normal using the method of Crowley (1964) should
be taken as approximately 7-7 mg/100 ml in both sexes.
The mean values for total plasma protein shown in Table III are little different from
those found by others in middle age (Wootton & King, 1953; Roberts, 1967), and do not
support the view that there is a substantial decline with age in plasma protein levels
(Pryce et al., 1969; Reed et al., 1972). The sex differences found, of higher serum
albumin levels in women and of globulin in men, are not large, but do not appear to have
been noted previously, and are difficult to explain.
The serum cholesterol level in any population is undoubtedly affected both by age
and sex, and by other factors probably mainly nutritional in origin (Keys, 1957). It is
well established that serum cholesterol levels show an increase with age in both sexes and
an additional increase in women after the menopause, so that levels are higher in men
than women under the age of 50 and higher in women over that age (Adlersberg,
Schaefer, Steinberg & Wang, 1956; Reed et al., 1972). The findings in the present
investigation support this view, though they show a slight fall with age over 75 in both
sexes, such as might result from a cohort effect due to the earlier death of people with
higher cholesterol levels. The absolute values found in the present study are high, with
over 40 per cent of women and 8 per cent of men having a serum cholesterol concentration
over 300 mg/100 ml, but are very similar to those found by others (Hobson, Jordan &
Roseman, 1953; Reed et al., 1972). There is no evidence that the high values in women
reflect the existence of a large pool of subjects with undiagnosed hypothyroidism
(Thomson, Andrews, Caird & Wilson, 1972).
In summary, the present study shows that the blood levels of many commonly deter-
mined constituents are identical in the elderly to those well known in youth and middle
age. Abnormal values of these constituents must therefore be considered abnormal
regardless of age. In other instances, such as serum urea, creatinine, uric acid and
cholesterol, values in healthy old people may differ substantially from those in middle
age. Values within the ranges demonstrated should therefore not give rise to concern in
old people, nor should they result in unnecessary, inconvenient, and possibly even
hazardous investigations. Sex differences can be shown in old age for the blood levels of
22 R. G. S. Leask, G. R. Andrews and F. I. Caird

many substances, but are only rarely of a magnitude sufficient to make them of clinical
significance.

ACKNOWLEDGEMENTS

Our thanks are due to the general practitioners in Kilsyth and northern Glasgow for
permission to study their patients, to our colleagues in the surveys, in particular Drs
A. J. Akhtar, A. J. J. Gilmore and W. J. McLennan, Miss A. C. Crombie, S.R.N., and
Miss J. MacDougall, S.R.N.; to Dr J. W. Chambers and the staff of the Biochemistry
Department, Stobhill Hospital, for the estimations; and to the subjects for their willing
co-operation. The study was supported by a grant from the Nuffield Provincial Hospitals
Trust.

REFERENCES

ADLERSBERC, D., SCHAEFER, L. E., STEINBERG, A. G. & WANG, C. I. (1956). Age, sex, serum
lipids in coronary atherosclerosis. Jf. Am. med. Ass. 162, 619.
AKHTAR, A. J. (1972). Refusal to participate in a survey of the elderly. Geront. Clin. In the press.
ANDREWS, G. R., COWAN, N. R. & ANDERSON, W. F. (1971). The practice of geriatric medicine
in the community. In: Problems and Progress in Medical Care. Essays on Current Research,
5th Series, ed. McLachlan, G. p. 58. Oxford: University Press.
ANNAN, W. & ISHERWOOD, D. M. (1969). An automated method for the direct determination of
total serum cholesterol. J. med. Lab. Tech. 26, 202.
ANNINO, J. S. & RELMAN, A. S. (1959). The effect of eating on some of the clinically important
chemical constituents of the blood. Am. J. clin. Path. 31, 155.
AXELSSON, H., EKMAN, B. & KNUTSSON, D. (1965). In: Automation in Analytical Chemistry, ed.
Skegjjs, L. T., p. 603. Technicon Symposia.
BROOME, T. P. & HOLT, J. M. (1964). Venous stasis and forearm exercise during venepuncture as
sources of error in plasma electrolyte determinations. Can. med. Ass. J. 90, 1105.
CAMPBELL, H., GREENE, W. J. W., KEYSER, J. W., WATERS, W. E., WEDDELL, J. M. & WITHEY, J. L.
(1968). Pilot survey of haemoglobin and plasma urea concentration in a random sample of
adults in Wales 1965-1966. Br.J. prev. soc. Med. 22, 41.
CANTAHOW, A. & TRUMPER, M. (1963). Clinical Biochemistry. 6th edn. Philadelphia and London:
Saunders.
CHEN, F. W. K. & MILLARD, P. H. (1972). The effect of ageing on certain biochemical values.
Modern Geriatrics, 2, 92.
CLARK, L. C , BECK, E. I. & SHOCK, N. W. (1959). Serum alkaline phosphatase in middle and old
age. J. Geront. 6, 7.
CROWLEY, L. V. (1964). Determination of uric acid: an automated analysis based on a carbonate
method. Clin. Chem. 10, 838.
DENT, C. E. (1962). Some problems of hyperparathyroidism. Br. med. J. 2, 1419.
DODGE, H. J. & MIKKELSEN, W. M. (1970). Observations on the distribution of serum uric acid
levels in participants of the Tecumseh, Michigan, Community Health studies. J. Chron. Dis.
23, 161.
FJCTON-SMTTH, HODKINSON, H. M. & STANTON, B. R. (1966). Nutrition and metabolic bone
disease in old age. Lancet, ii, 999.
FLYNN, F. V. (1969). Effect of age and sex on the normal range. Ann. clin. Biochem. 6, 1.
GREENBERG, B. G., WrNTERS, R. W. & GRAHAM, J. B. (1960). The normal range of plasma phos-
phorus and its utility as a discriminant in the diagnosis of congenital hypophosphataemia. J.
din. Endocr. Metab. 20, 364.
 Normal Values for Sixteen Blood Constituents in the Elderly 23

HOBSON, W. & JORDAN, A. (1959). A study of serum alkaline phosphatase levels in old people
living at home. J. Geront. 14, 292.
HOBSON, W., JORDAN, A. & ROSEMAN, C. (1953). Serum cholesterol levels in elderly people living
at home. Lancet, ii, 961.
HOSSAIN, M., SMITH, D. A. & NORDIN, B. E. C. (1970). Parathyroid activity and post-menopausal
osteoporosis. Lancet, i, 809.
KAUFMAN, B. J., GRANT, D. R. & MOORHOUSE, J. A. (1969). An analysis of blood urea nitrogen
and haemoglobin values in a population screened for diabetes mellitus. Can. med. Ass. J. 100,
744.
KEYS, A. (1957). Diet and the epidemiology of coronary heart disease. J. am. med. Ass. 164, 1912.
MCLENNAN, W. J. F CAIRD, F. I. & MACLEOD, C. (1972). Diet and bone rarefaction in old age.
Age and Ageing, 1, 131.
MILNE, J. S., MAULE, M. M. & WILLIAMSON, J. (1971). Method of sampling in a study of older
people with a comparison of respondents and non-respondents. Br. J. prev. soc. Med. 25, 37.
MILNE, J. S. & WILLIAMSON, J. (1972). Plasma urea concentration in older people. Geront. Clin.
14, 32.
NORTHAM, B. E. & WIDDOWSON, G. M. (1967). A.C.B. Technical Bulletin No. 11.
O'HAGAN, J. E.( HAMILTON, T., LE BRETON, E. G. & SHAW, A. E. (1957). Human serum bilirubin.
Clin. Chem. 3, 609.
ORANGE, M. & RHEIN, H. C. (1951). Micro-estimation of magnesium in body fluids. J. biol. Chem.
189, 379.
PRYCE, J. D., HASLAM, R. M. & WOOTTON, I. D. P. (1969). Extraction of normal values from a
mixed hospital population. Ann. din. Biochem. 6, 6.
REED, A. H., CANNON, D. C , WINKELMAN, J. W., BHASIN, Y. P., HENRY, P. J. & PILECGI, V. J.
(1972). Estimation of normal ranges from a controlled sample survey. Sex- and age-related
influences on the SMA 12/60 screening group of tests. Clin. Chem. 18, 57.
REED, A. H., HENRY, R. J. & MASON, W. B. (1971). Influence of statistical method used on the
resulting estimate of the normal range. Clin. Chem. 17, 275.
RIGGS, B. L., JOWSEY, J., KELLY, P. J., JONES, J. D. & MAHER, F. T. (1969). Effects of sex hor-
mones on bone in primary osteoporosis. J. clin. Invest. 48, 1065.
ROBERTS, L. B. (1967). The normal ranges, with statistical analysis, for seventeen blood constitu-
ents. Clin. Mm. acta 16, 69.
SHOCK, N. W. (1968). Physiology of ageing. In: Surgery of the Aged and Debilitated Patient, ed.
Powers, J. H., p. 10. Philadelphia and London: Saunders.
THOMSON, J. A., ANDREWS, G. R., CAIRD, F. I. & WILSON, R. (1972). Serum protein-bound and
plasma inorganic iodine in the elderly at home. Age and Ageing, 1, 158.
WATERS, W. E., ELWOOD, P. C , ASSCHER, A. W. & ABERNETHY, M. (1970). Clinical significance
of dyauria in women. Br. med. J. 2, 754.
WOOTTON, I. D. P. & KING, E. J. (1953). Normal values for blood constituents: inter-hospital
differences. Lancet, i, 470.
YOUNG, D. S. (1966). Improved method for the automatic determination of serum inorganic
phosphate. J. din. Path. 19, 397.
YOUNG, M. M., JASANI, C , SMITH, D. A. & NORDIN, B. E. C. (1968). Some effects of ethinyl
oestradiol on calcium and phosphate metabolism in osteoporosis. Clin. Sci. 34, 411.
YOUNG, M. M. & NORDIN, B. E. C. (1967). Effects of natural and artificial menopause on plasma
and urinary calcium and phosphate. Lancet, ii, 118.

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F. I. Caird, University Department of Geriatric Medicine, Southern General Hospital, Glasgow
G51 47T.