Archives of Gerontology and Geriatrics

Editorial Board

2010-09-01

Factors affecting mortality of frail hip-fractured elderly patients

Avital Hershkovitz, Irena Polatov, Yechayaou Beloosesky, Shai Brill — 2009-10-12

Abstract: Hip fracture in the elderly may lead to increased morbidity and mortality. We assessed factors affecting mortality of frail elderly hip-fractured patients during the first 2 years after discharge from a post-acute rehabilitation program. Included were 376 patients admitted from 1/2006 to 9/2007. Kaplan–Meier curves were used for survival analysis. During the 2 years after discharge 68 patients (20.8%) died. Sex, fracture type, operation versus conservative treatment, time to surgical intervention, presence of depression, impaired neurological function or comorbidity burden were not found to be significant predictors of mortality. Comparisons of survival curves showed significantly higher mortality in patients with admission albumin level of <3.5g/dl compared to patients with levels of ≥3.5g/dl (p=0.017); demented versus cognitively intact patients (p<0.001); patients with admission FIM score of <40 versus those with scores of 40–79 and ≥80 (p=0.012); very old patients (>84) compared with old (75–84) and young-old patients (<75) (p=0.003). Multivariate analysis showed that only dementia and age were independent predictors of mortality in the studied group. Multidisciplinary teams should be aware of treatable variables affecting these patients’ survival and should endeavor to improve their functional and nutritional level. Moreover, expectation coordination should be carried out with very old and cognitively impaired patients.

Relationship between age and serum thyrotropin among asymptomatic older people in Taiwan

Chia-Chang Huang, Yu-Chun Chen, Liang-Kung Chen, Shinn-Jang Hwang, Hong-Da Lin — 2009-10-12

Abstract: Hypothyroidism is a common disorder in older people, and may be asymptomatic and hard to be diagnosed. The main purpose of this study was to evaluate the distribution of serum thyrotropin (thyroxin-stimulating hormone, TSH) among asymptomatic older people in Taiwan, and to evaluate the relationship between age and serum TSH. In 2007, all subjects participating in the annual elderly health examinations at Taipei Veterans General Hospital were invited for study and were enrolled when they were fully consented. In total, 1716 asymptomatic elderly people (mean age: 73.2±4.4 years, 56.3% males) participated in this study after careful exclusion of 38 subjects with past history of thyroid disorders. All participants were divided into two groups: (1) younger old (age 65–79) and (2) older old (age over 80) for further analysis. The mean serum levels of TSH were similar between younger old and older old groups (2.43±5.36μIU/ml for younger old and 2.36±3.51μIU/ml for older old, p=0.444). The overall prevalence of suspected hypothyroidism was 9.2% among asymptomatic older people in Taiwan, which was significantly lower than in Caucasians. The prevalence of suspected hypothyroidism may reach 25.9% if the TSH cutoff was lowered to 2.5μIU/ml. Further study is needed to determine the normal reference range of serum TSH in older people.

Cognitive impairment in old people living in the community

Constança Paúl, Oscar Ribeiro, Pedro Santos — 2009-10-12

Abstract: Cognitive impairment has a high prevalence in the elderly, especially in the oldest old, and it is a major concern for autonomous old people living in the community and their families. Any possible intervention will benefit from early detection of cognitive decline related signs. The Portuguese version of the mini-mental state examination (MMSE) was used to assess cognitive impairment in a sample of 1266 old community-dwellers in Portugal, mean age 70.3±8.7 years. A standard questionnaire was also used including measures on social network, psychological distress, functionality, perceived health status, and socio-demographic variables. We recorded education levels and illiteracy by using different cut points to select people with and without cognitive impairment and results showed a 9.6% prevalence of positive cases. In general, cognitive impairment is higher in women, older people, widows(ers), and people with negative self-perception of health and with difficulties in basic and in instrumental activities of daily living (ADL and IADL). Cognitive impairment was found to be predicted by gender, age and psychological distress, explaining 18% of variance. Findings are discussed considering available literature and possible interventions for community residents.

Oral care help to maintain nutritional status in frail older people

Yasunori Sumi, Nobuyoshi Ozawa, Hiroko Miura, Yukihiro Michiwaki, Osami Umemura — 2009-11-05

Abstract: The purpose of this study was to evaluate the effect of continuous oral care on the nutritional status of older people who require care using a 1-year randomized, controlled study. Fifty-three residents of a nursing home in Japan participated in this study. Subjects were randomly divided into two groups, an oral care intervention group and control group. The subjects in the oral care intervention group received professional oral care from a dentist three times a week over the course of 1 year. Body weight, body mass index (BMI), serum albumin, and high-density lipoprotein cholesterol (HDL-C) were measured as objective indicators of nutritional status at baseline and after 1 year, and compared between the groups. In the oral care group, no significant decline was seen in all indicators from the start to the end of the intervention, but in the control group there was a statistically significant decline in all indicators at the end of the year. These results suggest that the intervention of oral care alone can serve to maintain the nutritional status of older people who require care. Implementation of continuous oral care is an important task from the viewpoint of maintaining nutritional status in older people.

Acute medical management of the non-ST-segment elevation acute coronary syndromes (NSTE-ACS) in older patients

Andrew Docherty — 2009-10-12

Abstract: Older patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) represent many clinical challenges. For example diagnosis can be difficult, and comorbidities are common. Furthermore, NSTE-ACS is particularly common in older patients (>60% of acute myocardial infarctions occurring in patients aged 65 years or older) and the mortality associated with NSTE-ACS is particularly high. Despite these many concerns, evidence from clinical trials based on this group of patients is limited. Future prospective clinical trials should therefore more accurately reflect the NSTE-ACS patient population by including more elderly patients and including efficacy endpoints that are relevant for these patients. Furthermore, the lack of clear clinical evidence in this population means that the current treatment guidelines do not fully address the needs of elderly patients. Several recent clinical trials have highlighted some of the main considerations we should make when treating elderly patients with NSTE-ACS. Different therapy options in the pharmacological management of NSTE-ACS in this age group are also discussed.

Adult age differences in the Color Stroop Test: A comparison between an Item-by-item and a Blocked version

C. Ludwig, E. Borella, M. Tettamanti, A. de Ribaupierre — 2009-10-21

Abstract: The Color Stroop Test is consensually considered as a task to assess the efficiency of inhibitory mechanisms. If the Stroop interference effect is largely undisputed, it is also acknowledged that the size of this effect varies as a function of various task manipulations, such as the task format. The aim of the present study was to compare the size of adult age-related differences in inhibition as assessed by two different versions of the Color Stroop Test: a standard Blocked paper-and-pencil version and a computerized Item-by-item one. Results showed pronounced age-related differences in the interference effect in the Blocked version, but not in the Item-by-item one. These findings are discussed in terms of the characteristics of the tasks. The choice of the appropriate version with respect to clinical aims is also addressed.

Cigarette smoking and cognitive impairment: A 10-year cohort study in Taiwan

2009-10-16

Abstract: The relationship between cigarette smoking and cognitive impairment is not a simple one. Some studies have demonstrated that cigarette smoking is a risk factor for cognitive impairment in the elderly, whereas other studies have shown cigarette smoking to be protective against dementia. This study aims to explore the relationship between cigarette smoking and cognitive impairment in elderly persons without dementia, during a 10-year period. Data were derived from a population-based cohort study of 1436 elderly Taiwanese. Cognitive function was measured by the SPMSQ both in 1993 and in 2003. A total of 1436 participants free of cognitive impairment at baseline (SPMSQ≥6 in 1993) were included in these analyses. Subsequently, participants were divided into three groups: never, past, and current smokers. The effect of cigarette smoking on cognitive function was assessed using logistic regression. In the logistic regression model adjusted for age, education, hypertension, diabetes, heart disease, and stroke at baseline, persons who had quit smoking (Odds ratio=OR=0.31; 95% CI=0.18–0.53; p<0.001) and those who continued to smoke (OR=0.37; 95% CI=0.20–0.70; p<0.001) were about one-third as likely to develop cognitive impairment as were those who never smoked. However, no dose–response relationship was observed between pack-years and cognitive impairment. Past and current smokers were less likely to develop cognitive impairment during a 10-year follow-up than were those who had never smoked. The present study suggests that smoking may be protective for cognitive function.

Incidence of perioperative myocardial infarction and of 2-year mortality in 577 elderly patients undergoing noncardiac vascular surgery treated with and without statins

2009-10-12

Abstract: Of 577 patients, mean age 74 years, undergoing noncardiac vascular surgery, 300 (52%) had carotid endarterectomy, 179 (31%) had lower extremity revascularization, and 98 (17%) had abdominal aortic aneurysm repair. Of the 577 patients, 302 (52%) were treated with statins. Perioperative myocardial infarction (MI) occurred in 18 of 302 patients (6%) treated with statins and in 38 of 275 patients (14%) not treated with statins (p=0.001). Two-year mortality occurred in 18 of 302 patients (6%) treated with statins and in 43 of 275 patients (16%) not treated with statins (p=0.0002). Perioperative MI or mortality occurred in 34 of 302 patients (11%) treated with statins and in 74 of 275 patients (27%) not treated with statins (p<0.0001). Stepwise Cox regression analysis showed that significant independent prognostic factors for perioperative MI or death were use of statins (risk ratio=RR=0.43, p<0.0001), use of beta blockers (RR=0.55, p=0.002), carotid endarterectomy (RR=0.60, p=0.009), and diabetes (RR=1.5, p=0.045). In conclusion, patients undergoing noncardiac vascular surgery treated with statins had a 57% less chance of having perioperative MI or death at 2-year follow-up after controlling for other variables.

Mobility disability in midlife: A longitudinal study of the role of anticipated instrumental support and social class

C.J. Nilsson, K. Avlund, R. Lund — 2009-10-12

Abstract: On the basis of the evidence of a protective effect of social support on the functional ability of older people and social inequalities in mobility the present study aims to (1) study if onset of mobility disability in a middle-aged cohort is associated with social class and (2) study if anticipation of instrumental support has a protective effect on mobility at 6-year follow-up, and whether this effect is modified by social class. Data on 3549 40- and 50-year-old men and women were obtained from The Danish Longitudinal Study on Work, Unemployment and Health in 2000 and 2006. Ten percent of the study participants experienced onset of mobility disability at follow-up. Significantly more individuals in the lower social classes experienced onset of mobility disability and never anticipated instrumental support, compared to the higher social classes. In this middle-aged population the anticipation of instrumental support had no significant effect on mobility disability at 6-year follow-up. Social class did not modify the association between anticipated instrumental support and mobility, but was the most important confounder. Further research on the effect of social support on mobility in midlife is needed in order to identify individuals at risk of disability at an early stage.

Dementia care costs and the patient's quality of life (QoL) in Taiwan: Home versus institutional care services

Yu-Chun Kuo, Chung-Fu Lan, Liang-Kung Chen, Virginia M. Lan — 2009-12-30

Abstract: Organizing optimal care for demented older people is a complex health care issue. Controversies of service models for demented patients should be balanced between cost of care, placement, and quality of life (QoL). The main purpose of this study was to explore the optimal model of dementia care in Taiwan by evaluating the care cost, patients’ QoL and healthcare settings. Overall, 140 pairs of demented patients and their primary informal caregivers were enrolled (89 community-living and 51 institute-living). Compared to institute-living subjects, community-living subjects were significantly better in cognition, physical function and QoL. The annual direct cost of institutional care was significantly higher than community care (464,193 New Taiwanese Dollar (NTD) vs. 144,047 (NTD), p<0.001), but indirect cost was significantly higher in home care (287,904 NTD vs. 35,665 NTD, p<0.001). The care cost of home care subjects with low physical dependence was significantly lower than institutional care subjects, but the care cost of home care subjects with high physical dependence was significantly higher than institutional care subjects. Physical dependence was the significant determinant of QoL for demented patients in this study. In conclusion, demented patients with low physical dependence may be cared in the communities with support and those who had high physical dependence may be cared in the institutes in terms of the balance of QoL and the care cost.

Association between C-reactive protein (CRP) level and physical performance in community-dwelling elderly in Japan

Yuko Yoshida, Hajime Iwasa, Shu Kumagai, Hideyo Yoshida, Takao Suzuki — 2009-11-18

Abstract: Inflammatory cytokines may contribute to lower physical function in elderly. The purpose of this study was to clarify the relation between circulating level of C-reactive protein (CRP) and physical performance among the community-dwelling elderly in Japan. Participants were 803 (329 men and 474 women) aged 65 years and over. Four physical performances were assessed using hand-grip strength, length of time standing on one leg, and walking speed (usual and maximal). Low physical performance was defined as the lowest 25% of study sample in each sex. Multiple logistic regression analysis showed that CRP was negatively associated with physical performance in hand-grip strength (odds ratio=OR=1.86, 95% confidence interval=95% CI=1.32–3.05, OR=2.92, 95% CI=1.53–5.58, for the middle and highest, respectively), time of one leg standing (OR=1.96, 95% CI=1.28–3.00, OR=2.16, 95% CI=1.19–3.92, for the middle and highest, respectively) and maximal walking speed (OR=2.46, 95% CI=1.23–4.93, for the highest) when adjusted for the confounding factors. The results showed the negatively associated between CRP level and physical performance when adjusted for the confounding factors. CRP level may be a useful indicator for detecting the lower physical performance in elderly.

The efficacy of home-based muscle training for the elderly osteoporotic women: The effects of daily muscle training on quality of life (QoL)

2009-11-09

Abstract: There is little evidence that home-based muscle training through exercise improves the muscle strength and QoL of elderly osteoporotic women. The efficacy of home-based daily exercise on muscle strength of the upper and lower extremities and QoL were examined in elderly osteoporotic women by means of a case-controlled study that was designed and conducted between 2005 and 2006. Sixty-three osteoporotic women over 60 years of age were randomly assigned to 12 months of muscle exercise or to no intervention. The outcomes were changes in muscle strength and quality of life (QoL). Ultimately, sixty-two participants completed the 12 months program. Before the start of home-exercise training, the lumbar spine bone mineral density (BMD) and femoral neck BMD values in the intervention group were significantly lower than those in the control group (p<0.05). Grip strength and maximum walking speed increased significantly in the intervention group (p<0.05). In terms of QoL, physical functioning was improved by home-based exercise in the intervention group (p=0.05), while there were no improvements in any of the categories of Short-Form 36 in the control group. Our results suggest that home-based training is effective for elderly osteoporotic women in improving not only muscle strength in upper and lower extremities but also physical functioning in QoL.

Comfort for the dying: five year retrospective and one year prospective studies of end of life experiences

Peter Fenwick, Hilary Lovelace, Sue Brayne — 2009-11-16

Abstract: Many cultures have reported end-of-life experiences (ELEs) as part of the dying process. However, few studies have examined the mental states of the dying in the weeks and days before death. Following an ELE pilot study with a palliative care team, 38 nurses, doctors and end-of-life carers from two hospices and a nursing home took part in a 5-year retrospective followed by a 1-year prospective ELE study. Interviewees’ reports (first-hand and second-hand accounts from relatives, patients and residents) suggested that ELEs are not uncommon. ELEs included deathbed phenomena (DBP) such as visions, coincidences and the desire to reconcile with estranged family members. These experiences seemed to comfort both the dying and the bereaved. Interviewees described other phenomena such as clocks stopping synchronistically at the time of death, shapes leaving the body, light surrounding the body and strange animal behavior. Interviewees confirmed that ELEs differed from drug-induced hallucinations and occurred in clear consciousness. Most expressed concern about a lack of specialist ELE training and education and recommended that ELE modules be included in their training courses. ELEs provided comfort and hope for the dying and consolation for the bereaved. Further research is required to find the true prevalence and range of ELE phenomena.

Home care from the perspective of older clients and their professional carers

Sini Eloranta, Seija Arve, Hannu Isoaho, Pirkko Routasalo — 2009-11-13

Abstract: The aim of this cross-sectional study was to explore and compare the views of older home care Cs and their professional carers in relation to the care given. The data were collected with a postal questionnaire distributed to 200 Cs (≥65 years) and 570 Ps (Ps), with a total response rate of 63%. The differences in responses between Cs and Ps were analyzed using cross-tabulations, the Pearson χ2-test and Fisher's exact test. The Cs’ and the staff's perceptions of Cs’ own resources were very similar. The collaboration between the Cs and the staff was experienced as being confidential. However, their views differed when separate issues of the collaborative relationship were queried. The staff saw the coordination of care in a positive light. The results showed that information transfer between staff, Cs and close relatives still needs to be developed. The evaluation of home care interventions was also quite weak.

Peeking through the cracks: An assessment of the prevalence, clinical characteristics and health-related quality of life (HRQoL) of people with polypathology in a hospital setting

2009-11-16

Abstract: Little is known about the prevalence of the recently defined polypathology notion in hospital populations. Patients admitted to medical wards were assessed using established criteria of polypathology. Prevalence of polypathology, interobserver reliability, clinical features, nutritional status, and HRQoL were assessed using clinical data and interview, mini-nutritional assessment (MNA), and the 12-item short-form health survey (SF-12) scales. Of a total of 812 patients studied, 196 (24%) met polypathology criteria (65% men, of mean age 71.3±11.6 years, mean defining chronic diseases 2.4±0.046, and other comorbidities 2.6±0.094). Interobserver reliability for the detection of cases was good (κ=0.628). Their mean Charlson index/prescribed drugs were 3.3/6, respectively. Severe dyspnea, delirium, or active neoplasia were present in 44, 15, and 11%. A bad nutritional status/risk of malnutrition was evident in 10.3/52.6%, and correlated with the number of previous hospitalizations (p=0.041), and the presence of active neoplasia (p=0.037). Mean physical/mental summaries of HRQoL were 33.9±10, and 42±13, and correlated with a better nutritional status (p=0.011, and p=0.001, respectively). Polypathology affects one quarter of inpatients in a hospital setting, and can be easily and reliably identified. The diversity and complexity of patient needs underscore the need for continuity of care between community and hospital, crossing sub-speciality lines and institutional boundaries.

Mobility performance tests for discriminating high risk of frailty in community-dwelling older women

2009-11-26

Abstract: We aimed to compare and identify high and low risk of frailty in community-dwelling older women by using five mobility performance tests. The participants were 166 older women at high risk and 171 age-matched controls at low risk of frailty according to the long-term care insurance (LTCI) system (age: 65–90 years). The mobility performance tests included 5-chair sit-to-stand (STS), alternate step, timed up-and-go (TUG), timed rapid gait (TRG), and usual gait speed (UGS). Data analysis showed that high-risk individuals (81.9%) were more likely to be pre-frail than low-risk individuals (55.0%) by Fried's frailty phenotype. The four mobility performance tests, except the 5-chair STS, had the largest areas under the curve (AUC) for discriminating older women at high and low risk (AUC>0.80, p<0.001). The optimal cutpoint (6s) for the TRG test had the highest sensitivity (78%) and specificity (83%) in identifying high risk of frailty. Our results suggest that walking ability tests are clinically useful in screening older individuals at high risk of frailty. In particular, the TRG test is more likely than other tests to discriminate older women at high risk of frailty based on the LTCI system.

Measuring balance, lower extremity strength and gait in the elderly: Construct validation of an instrument

2009-11-18

Abstract: The purpose of the study was to determine the degree to which scores of a modified version of the ‘Timed Get Up and Go’ test (TGUG) were associated with other measures of functional performance. Thirty-seven community-dwelling older women (72.3±5.5 years) volunteered to participate. Subjects were assessed when performing the modified TGUG test. Correlations between the performance-oriented mobility assessment (POMA), single-leg balance, five chair rises, fast and normal gait speed, knee extension and flexion strength, and the modified TGUG were conducted. Total time to perform the modified TGUG test was significantly correlated with normal and fast gait speed (p<0.05). The Pearson correlation coefficients were −0.841 and −0.748, respectively. The time needed to perform several tasks of the modified TGUG test significantly correlated with five chair rises, and with right knee extensor strength (p<0.05). Points obtained in the assessment questionnaire correlated significantly to points obtained in the POMA scale (p<0.05). The Pearson correlation coefficient was 0.795. Based on the strength of the correlations obtained between components of the modified TGUG and the comparison tests, concurrent, criterion validity of the modified TGUG has been established.

Platelet activation is caused not by aging but by atherosclerosis

Hitoshi Kurabayashi, Kazuo Kubota, Akiko Hishinuma, Mitsuru Majima — 2009-11-23

Abstract: Platelet activation increases with age, although it is still controversial whether it derives from aging per se or from atherosclerosis concomitant with aging. The purpose of this study is to clarify the association between platelet activation and aging or atherosclerosis. We studied the ultrastructure of platelets in the elderly subjects with or without atherosclerosis and healthy young subjects. The platelet shape changes were evaluated by transmission electron microscopy and the contents of peroxidase and fibrinogen were assessed using a scoring system based on cytochemical staining and immunogold marking methods. No significant differences in platelet shape changes and the contents of peroxidase and fibrinogen in platelet were observed between healthy young and nonatherosclerotic elderly subjects, although the frequency of pseudopods increased and the content of peroxidase decreased in atherosclerotic elderly patients. It is suggested that platelet activation is not derived from aging but from atherosclerosis, although it is difficult to separate aging from coexisting atherosclerosis.

VNCOP-B plus rituximab therapy in elderly patients with aggressive B-cell non-Hodgkin lymphoma: A multicenter experience

2009-11-19

Abstract: CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) plus rituximab is a standard chemotherapy used to treat patients with aggressive B-cell non-Hodgkin lymphoma (B-NHL). However, among elderly patients, this regimen has not been completely satisfactory in its efficacy and safety. We report our clinical experience in 8 collaborative institutions to determine if the VNCOP-B (etoposide, mitoxantrone, cyclophosphamide, vincristine, prednisolone, and bleomycin) combination therapy plus rituximab was effective and safe to treat elderly patients with aggressive B-NHL. Between September 2004 and December 2007, 23 previously untreated patients, median age 73 years, 50.0% classified as high-intermediate/high-risk on the standard International Prognostic Index (IPI) entered this trial. Complete remission rate was 90.5%, with a 100% overall response rate (RR) at the end of induction therapy; overall survival (OS) rate at 3 years was 76.4% (median follow-up 744 days), with an 82.6% 3-year progression-free survival (PFS) rate (median follow-up 744 days). The most common grade 3/4 toxicities were hematologic, including neutropenia in 75.0% of the patients despite prophylactic administration of granulocyte colony-stimulating factor (G-CSF), febrile neutropenia in 30.0%, respectively. There was no treatment-related mortality (TRM). Rituximab not only combined with chemotherapy but also given sequentially improved survival. R-VNCOP-B could be another option for elderly patients who are not considered to tolerate in receiving R-CHOP.

Electrocardiographic and other clinical correlates of walking ability in older women

2009-11-26

Abstract: The purpose of this study was to examine how resting electrocardiographic (ECG) and other clinical variables, which can be included in a routine clinical examination, predict walking ability in older women. Three hundred and twenty women (63–75 years) without overt cardiac diseases and apparent mobility limitations were studied. Measurements performed were clinical examination (standard 12-lead resting ECG, assessment of physical activity level, presence of chronic diseases, use of beta-blockers, body mass index (BMI), ability to squat, resting blood pressure) and six-minute walking test. Participants walked 533±75m in the six-minute walking test. The best electrocardiographic predictors of long walking distance were high TV5 and TII, but their explanation rates were small (4.5% and 3.8%, respectively). In hypertensive participants (systolic blood pressure=SBP≥160mmHg), the respective values were 9.3% and 5.8%. The best predictors of long walking distance were ability to squat without limitations and low BMI (15.5% and 13.6%, respectively). Altogether the studied variables explained 36% of the variation in walking distance. The data gathered in clinical examination give useful information for the assessment of walking ability in relatively healthy older women. Resting ECG does not give clinically significant additional information for the assessment in subjects without overt cardiac disease.

The falling risk and physical fitness in older people

Ayşe Toraman, Necmiye Ün Yıldırım — 2009-11-26

Abstract: Aims of this study was to analyze the correlation between the falling risk and their physical fitness, determining the top parameters affecting the falling risk, and preparing an evaluation procedure for the medical department working on this issue for the old people in retirement homes. This study includes 60 persons whose mean age was 73.3±6.6 years. Their demographic characteristics, cognitive function, their balance, falling risk and their physical fitness level have been evaluated. A survey has been done to determine their demographic features. The cognitive function was determined using mini-mental state examination (MMSE) test; for falling risk the Berg balance test (BBT) and balance by standing on one foot test were used, and the physical fitness was determined by senior fitness test (SFT). While the BBT correlation between chair stand, arm curl and 2-min step test are positive; but the correlation between BBT and ‘8-foot up-and-go test’ were negative. However, there was no correlation between the BBT and chair sit-and-reach test, back scratch test (p>0.05). Due to the results of logistic regression models in order to find out the variations affecting the falling risk most, it has been showed that ‘8-foot up-and-go test’ was reliable. Additionally the subjects probability performing the ‘8-foot up-and-go’ before 8.14s was OR=11 (95% confidence interval=95%CI=2.25–53.84) times more with maximum 56 points in BBT. We have shown that the falling risk increases with declining of upper and lower extremity muscle strength, aerobic endurance, agility and dynamic balance performance. Agility and dynamic balance performance were mostly relevant with falling risk. We concluded that the old persons’ falling risk and physical fitness level should be evaluated in some intervals. According to their falling risks and physical fitness level, the rehabilitation programs should be programmed to decrease their falling risk, and to increase lower and upper extremity muscle strength, aerobic endurance and especially their agility and dynamic balance performance.

Body mass index (BMI), body composition and mortality of nursing home elderly residents

2009-11-26

Abstract: The body mass index (BMI) is a key marker of nutritional status among older patients, but does not reflect changes in body composition, The aim of the present study was to investigate BMI levels and body composition in a sample of disabled nursing home residents, and to study possible interrelations between BMI, fat-free body mass (FFM), body fat mass (BFM), skeletal muscle mass (SMM) and 1-year mortality rates. FFM and SMM were assessed by 24-h urine creatinine excretion and BFM as the difference between BMI and FFM. We calculated relative risk (RR) and odds ratio (OR) of 1-year mortality, associated with different levels of BMI, FFM index (where index=value/height2), SMM index and BFM index in 82 disabled institutionalized elderly patients. One-year mortality rate was 29.3%. Adjusted relative risk of mortality of low BMI patients was 1.45 (95% CI=0.73–2.89; OR=1.73) and 0.63 (95% CI=0.33–1.60; OR=0.72) in high BMI. Risk of mortality was higher in those having low FMM index or SMM index (RR=2.42, 95% CI=0.36–16.18; OR=2.55 and RR=3.22, 95% CI=0.78–13.32; OR=3.67, respectively). It is concluded that low FFM and SMM indexes among disabled nursing home residents are far better predictors than BMI for 1-year mortality estimation.

Obesity and depressive symptoms in elderly Koreans: Evidence for the “Jolly Fat” hypothesis from the Ansan Geriatric (AGE) Study

2009-12-30

Abstract: The current study is to examine the association between obesity and depressive symptoms and to test the validity of “Jolly Fat” hypothesis in elderly Koreans. A total of 1229 elderly (60–85 years old) Koreans selected from the Ansan Geriatric Study participated in this study. Body mass index (BMI) was calculated from the measured weights and heights of subjects. Overweight and obese were defined as BMI ≥23 and ≥25, respectively. Depressive symptoms were measured using the 30-item Korean version of the Geriatric Depression Scale (K-GDS), with a cutoff point of 18. The prevalence of depressive symptoms in elderly Korean women was higher than in men (20.9% vs. 9.2%, p<0.001). Among elderly women, higher mean values of obesity indexes, such as weight, BMI, waist circumference, waist–hip ratio, and body fat mass, were found in normal subjects than in those with depressive symptoms. No such differences were found in elderly men. Obese elderly women were less likely to suffer from depressive symptoms compared to those with apparently normal weight (odds ratio (OR)=0.63, 95% CI: 0.41–0.96). This inverse association was evident after adjustment for confounders, such as age, education, personal expenses, smoking, alcohol consumption, regular exercise, self-perceived health, presence of chronic disease, and cognitive function. Our data are consistent with the “Jolly Fat” hypothesis being valid only in women, but not in men, among elderly Koreans. A causal relationship between obesity and depressive symptoms should be evaluated in future studies in elderly Korean women.