Archives of Gerontology and Geriatrics

Editorial Board

2012-01-01

Publisher's note

2011-09-19

Archives of Gerontology and Geriatrics was founded in 1982 under the Editorship of Professor S.A Memeo and Professor. I. Zs.-Nagy with Elsevier 30 years ago. It was recognised back then that human aging is a complex phenomenon and the launch of Archives of Gerontology and Geriatrics offered authors and readers an interdisciplinary, integrative journal for all of those involved in aging research.

Editorial

John M. Starr — 2011-10-20

It is with great pleasure and excitement that I take over the Editorship of Archives of Gerontology and Geriatrics from Professor Zs.-Nagy its founding Editor and who, heroically, has been at the helm for nearly thirty years, a truly gargantuan effort. The last thirty years have seen momentous changes in the fields of gerontology and geriatrics; in particular, the emergence of high quality research from countries where population aging is happening on a massive scale. In this issue there are papers from countries long represented in this area, Canada, Finland, France, Israel, Italy, Japan, Poland, Spain, Sweden and the United States, but also studies from newer research groups in Antigua and Barbuda, Brazil, China, Greece, Korea, Malaysia, Slovenia, Taiwan, and Turkey. This total of nineteen different countries demonstrates how aging research has become a global enterprise, and how the global research community engaged in this enterprise is represented in Archives of Geriatrics and Gerontology. A second massive shift has been away from traditional print forms for publication toward electronic media. Indeed, Archives of Geriatrics and Gerontology is largely accessed electronically and over the last year the journal has reflected this change by moving to an exclusively electronic submission system.

Frailty and survival of older Chinese adults in urban and rural areas: Results from the Beijing Longitudinal Study of Aging

2011-05-30

Abstract: Differences in frailty between rural and urban older adults have been demonstrated in developed countries. It is not understood how the apparently greater differences in living conditions between different types of regions in China may affect health and outcomes of older Chinese adults. Here, a frailty index (FI) based on the accumulation of health deficits was used to investigate health and survival differences in older Chinese men and women. We studied rural (n=1121) and urban (n=2136) older adults (55–97 years old) in the Beijing Longitudinal Study of Aging (BLSA), of whom 48.9% (rural) and 35.4% (urban) died over 8 years of follow-up. The FI was generated from 35 self-reported health deficits. The mean FI increased exponentially with age (r2=0.87) and was higher in women than in men. The death rate increased significantly with increases in the FI, but women showed a lower death rate than did men. The mean FI in urban older adults (0.12±0.10) was lower than that in their rural counterparts (0.14±0.12, p<0.001). Urban dwellers showed better survival compared with their counterparts in the rural areas. Adjusted by age, sex, and education level, the hazard ratio for death for each increment of the FI was 1.28 for urban people and 1.27 for rural people. Chinese urban dwellers showed better health and survival than rural dwelling older adults. The FI readily summarized health and mortality differences among different geographic regions, reflecting the impact of the environment, socioeconomics, and medical services on deficit accumulation and on survival.

Association between inflammatory-related disease burden and frailty: Results from the Women's Health and Aging Studies (WHAS) I and II

Sandy S. Chang, Carlos O. Weiss, Qian-Li Xue, Linda P. Fried — 2011-07-15

Abstract: Frailty is associated with a pro-inflammatory state, which has been characterized by elevated levels of systemic inflammatory biomarkers, but has not been related to the number of co-existing chronic diseases associated with inflammation. We sought to determine the extent to which a higher number of inflammatory-related diseases is associated with frailty and to identify the most common disease patterns associated with being frail in older adults. We performed binomial regression analyses to assess whether a higher count of inflammatory-related diseases increases the probability of frailty using data from the WHAS I and II, companion cohorts composed of 70–79-year-old community-dwelling older women in Baltimore, Maryland (n=620). An increase of one inflammatory-related disease was associated log-linearly with frailty (Prevalence Ratio (PR)=2.28, 95% Confidence Interval (CI)=1.81–2.87). After adjusting for age, race, education, and smoking status, the probability of frailty remained significant (PR=1.97, 95%CI=1.52–2.55). In the frail population, chronic kidney disease (CKD) and depressive symptoms (Prevalence=22.9%, 95%CI=14.2–34.8%); CVD and depressive symptoms (21.7%, 95%CI=13.2–33.5%); CKD and anemia (18.7%, 95%CI=11.1–29.7%); cardiovascular disease (CVD), CKD, and pulmonary disease (10.7%, 95%CI=5.2–21.0%); CKD, anemia, and depressive symptoms (8.7%, 95%CI=3.9–18.2%); and CVD, anemia, pulmonary disease, and depressive symptoms (5.0%, 95%CI=1.6–14.4%) were among the most frequent disease combinations. Their prevalence percentages were significantly higher in the frail versus non-frail women. A higher inflammatory-related disease count, perhaps reflecting a greater pro-inflammatory burden, increases the likelihood of frailty. Shared mechanisms among specific disease combinations may further contribute to this risk.

A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort

2011-02-22

Abstract: This study aimed to compare the predictive accuracy for several frailty-related adverse health outcomes of a cumulative index derived from the Italian population-based elderly cohort of the Conselice Study of Brain Aging (CSBA), which takes into account multiple different domains (demographic, clinical, functional, and nutritional parameters), with that of an index derived from the Study of Osteoporotic Fractures (SOF), modified for application to the CSBA database and henceforth called mSOF, which is exclusively focused on muscular fitness. Data are for 1007 CSBA participants aged ≥65 years. Investigated adverse outcomes included 4- and 7-year risk of death and 4-year risk of fractures, falls, disability, hospitalization, and nursing home placement. Accuracy for prediction of these outcomes was investigated using area under the curve (AUC) statistics. CSBA index performed better than mSOF index for prediction of mortality (p<0.001), hospitalization (p=0.002), and nursing home placement (p=0.049). For all outcomes excluding falls, frailty defined by CSBA index had a slightly lower specificity but a much higher sensitivity than frailty defined by mSOF Index. In conclusion, in this elderly cohort, the multidimensional CSBA index is a better predictor of frailty-related adverse health outcomes than the unidimensional mSOF index.

Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons

2011-03-03

Abstract: The aim was to determine the validity and usefulness of hand-held dynamometry for measuring muscle strength in independent community-dwelling older persons. Cross-sectional study was performed in 281 subjects aged over 65, mean age of 74.3 years. The strength of six muscle groups was measured in three consecutive attempts using JAMAR hand-held dynamometers. Individual values, maximums and means, intra- and inter-individual variability, test–retest reliability and concurrent validity with functional tests are described. The main results were: strength increased with each attempt for all muscle groups, suggesting technique learning, except for pinch and grip, suggesting muscle fatigability. Relative intra- and inter-individual variability was higher in women; it was lower for the pinch and grip strength. Test–retest reliability was very good and concurrent validity with functional tests was good. We conclude that hand-held dynamometry is valid and useful for determining functionality. It is recommended to perform three attempts for all strength measurements, except for pinch and grip, in which one is sufficient.

Physical fitness and 6.5-year mortality in an 85-year-old community-dwelling population

2011-05-18

Abstract: Although poor physical fitness is known to be associated with increased mortality in adult and elderly populations, this association is not conclusive in very elderly. The purpose of the present study was to evaluate the association for a very old community-dwelling population. The participants (90 males, 117 females) were 85-year-old individuals residing in Fukuoka, Japan. Baseline examinations including muscle strength of the handgrip and leg extension, one-leg standing, leg stepping rate, and walking were performed in 2003 and these subjects were followed for 6.5 years. During the follow-up period, 81 individuals (49 males and 32 females) died. Handgrip strength and leg extension strength at age 85 were stronger in surviving men than in non-survivors. Total mortality adjusted for both gender and serum level of total cholesterol fell 5–6% with a 1-kg increase in the handgrip strength of a single hand or both hands. Total mortality also decreased 2% with a 1kg increase in the leg extension strength of both legs. With adjustment for gender and total cholesterol, mortality fell by 57% in participants of the walking test and fell by 45% in participants of the stepping-rate test compared to mortality in nonparticipants. No association was found between mortality and participation in the handgrip strength test, leg extension strength test, or one-leg standing time test. In conclusion, not only poor muscle strength in handgrip or leg extension, but also nonparticipation in walking test or leg-stepping test were independent predictors of total mortality in a very elderly population.

Use of the elderly risk assessment (ERA) index to predict 2-year mortality and nursing home placement among community dwelling older adults

2011-03-14

Abstract: The objective was to determine the relationship between a high score on the ERA index and 2-year mortality and nursing home placement. As of January 1, 2005, 12,650 community-dwelling patients over 60 years of age were impaneled with a primary care practice at the Mayo Clinic in Rochester, MN. This was a retrospective cohort study utilizing an administrative risk score, the ERA score. Primary outcomes were 2-year mortality and 2-year nursing home placement. The predictor variable was ERA score. Relative risk estimates were used to describe the association between the ERA index and mortality and nursing home placement. The relative risk of 2-year mortality was 51.4 (95% confidence interval=CI=28.0–94.4) in patients in the highest risk group compared to the lowest group. The relative risk of nursing home placement was 113.2 (95% CI=76.1–168.4). Patients with high ERA scores are at high risk for 2-year mortality and 2-year nursing home placement. These findings suggest that the utilization of an electronic risk score can help identify patients at risk for death or nursing home placement. Clinically, the identification of high risk individuals may be useful for utilization of clinical case management.

Serum albumin (SA) levels and 10-year mortality in a community-dwelling 70-year-old population

Yutaka Takata, Toshihiro Ansai, Akihiro Yoshihara, Hideo Miyazaki — 2011-04-04

Abstract: Although an association between SA concentrations and mortality in the patients is well known, this association is not conclusive in elderly community-dwelling populations. We therefore attempted to determine whether this association could be extended to a Japanese 70-year-old community-dwelling population. Seventy-year-old subjects residing in Niigata City, Japan participated. Baseline examinations including a determination of SA concentrations were performed in June 1998 in 600 participants, and they were followed for 10 years. During the 10-year follow up, 80 subjects died. Albumin levels were divided into four groups (highest>45g/l, higher 43–44g/l, lower 41–42g/l, lowest <40g/l). The survival rate using Kaplan–Meier methods was longer in the highest and higher albumin groups than in the lowest and lower groups. No differences were found between the four groups in the mortalities from cancer, cardiovascular disease (CVD) or pneumonia. Individuals with the lowest albumin levels had 2.7 or 2.9 times higher total mortality, whether adjusted with confounding factors or not, using Cox regression analysis. The mortality hazard ratio (HR) found in the lowest group was compared to the highest group. In an elderly 70-year-old Japanese community-dwelling population, lower SA concentrations were an independent predictor of total mortality, but not mortality due to cancer, CVD, or pneumonia.

Assessment of dietary intake and nutritional status (MNA) in Polish free-living elderly people from rural environments

Joanna Wyka, Jadwiga Biernat, Jolanta Mikołajczak, Ewa Piotrowska — 2011-03-03

Abstract: The proportion of elderly people in the global population is rapidly increasing. Their nutritional status indicates many deficiencies that are risky to health. The aim of this paper was to assess the nutrition and nutritional status in elderly individuals above 60 years old living in their family houses in rural areas. Dietary intake and nutritional status were measured in 174 elderly women and 64 men living in the rural areas of Oleśnica (near Wrocław, SW Poland). Energy intake, consumption of nutrients, selected anthropometric and biochemical indicators, were measured in two groups: one at risk of malnutrition and one with adequate nutrition. Using the mini nutritional assessment (MNA) questionnaire, 238 persons over 60 years of age were qualified according to their nutritional status. Anthropometric and biochemical parameters were measured. The group of women at risk of malnutrition (n=30) showed a statistically significantly lower energy intake in their diet (1127kcal) compared to women with adequate nutrition (1351kcal). The entire group of examined individuals showed a too low consumption of fiber, calcium, vitamins C and D, and folates. Most of the examined women had a too high body mass index (BMI) (on average 28.8), waist circumference was 96.3cm, and the triceps skinfold (TSF) was 25.2mm thick. Women at a risk of malnutrition had statistically significantly lower lipid parameters than those with adequate nutrition (respectively: TC 191.1 vs. 219.1m/dl, p<0.001, LDL-cholesterol 107.1 vs. 125.1m/dl, p<0.008, TG 129 vs. 143mg/dl). Men with a risk of malnutrition had a statistically significantly lower BMI (26.0 vs. 28.7, p<0.04), and also lower waist and arm perimeters compared to men with correct nutrition. According to the Charlson comorbidity index (CCI), 8.2% of person with adequate nutrition had poor prognostic indicator for overall survival. All the examined individuals showed many significant nutritional deficiencies. The group with nutritional risk had more pronounced nutritional deficiencies. Despite a too low energy value of foods among individuals with correct nutrition, their anthropometric parameters paradoxically showed the presence of excessive fatty tissue. The most frequent diseases existed in examined group were coronary artery disease and congestive heart failure.

Predictors of participation in physical activity for community-dwelling elderly Italians

Cinzia Giuli, Roberta Papa, Eugenio Mocchegiani, Fiorella Marcellini — 2011-04-01

Abstract: This paper analyses variables associated with community-dwelling older people's engagement in physical activity (PA). Data were examined using the results from the European ZINCAGE study on 306 community-dwelling Italians aged 65years and over. The lifestyle questionnaire was used to evaluate the data. Levels of regular/non-regular PA were based on ≥1h of weekly exercise. Logistic regression analysis was used to analyze the predictors of PA. Participants reported the time they had spent per week engaging in PA over the last year. Overall, 56.2% of them engaged in regular physical exercise. PA levels decreased in subjects with probable cognitive decline, depression and high perceived stress levels (p<0.001). Lower age, a lower body mass index (BMI), better health status, absence of depression, being married, were all associated with regular PA. The importance of monitoring PA in the elderly emerged, in particular in those having some certain social-demographic characteristics.

Homebound older persons: Prevalence, characteristics, and longitudinal predictors

Jiska Cohen-Mansfield, Dov Shmotkin, Haim Hazan — 2011-03-21

Abstract: The current study examines the prevalence and correlates of homebound status aiming to elucidate the predictors and implications of being homebound. Analyzed sample was drawn from two representative cohorts of older persons in Israel, including 1191 participants (mean age=83.10±5.3 years) of the first wave of the Cross-Sectional and Longitudinal Aging Study (CALAS) and 418 participants (mean age=83.13±5.2 years) of the Israeli Multidisciplinary Aging Study (IMAS). Cross-sectional and longitudinal analyses were conducted. Homebound prevalence rates of 17.7–19.5% were found. Homebound participants tended to be older, female, have obese or underweight body mass index (BMI), poorer health, lower functional status, less income, higher depressed affect, were significantly lonelier (in CALAS), and more likely to have stairs and no elevators, than their counterparts. Predictors of becoming homebound include low functional IADL status, having stairs and no elevator (in both cohorts), old age, female gender, and being obese or underweight (in CALAS). The study shows that homebound status is a prevalent problem in old-old Israelis. Economic and socio-demographic resources, environment, and function play a role in determining the older person's homebound status. Implications for preventing homebound status and mitigating its impact with regards to the Israeli context are discussed.

Loneliness in elderly individuals, level of dependence in activities of daily living (ADL) and influential factors

Rabia Hacihasanoğlu, Arzu Yildirim, Papatya Karakurt — 2011-04-25

Abstract: This study has been carried out to investigate the level of loneliness, determine the level of dependence in the ADL and influential factors in the elderly people. This descriptive, cross-sectional study was conducted in 5 Family Healthcare Centers (FHC) located in central Erzincan, Turkey between March and June 2010. The data of the research was collected using a questionnaire that determined the descriptive and UCLA Loneliness Scale (UCLA-LS). Mean score of the UCLA-LS was determined as 51.59±4.44. It was determined that 2% of the elderly ADL were completely dependent, 14.5% were semi-dependent. Factors such as being old, a widow/divorced, having a lower level of education and/or income, living alone, having a chronic disease, poor self-perceived health, lack of visits by relatives or acquaintances, dissatisfaction with the place of living, and being fully dependent while performing daily activities were determined as factors which increased the level of loneliness. Furthermore, factors such as being old, a female, a widow/divorced, living together with a daughter/son, having a chronic disease and poor self-perceived health were found to be influential in dependency. Elderly people who are alone and dependent in fulfilling their ADL should be monitored more closely.

Contextual effect of neighborhood environment on homebound elderly in a Japanese community

Hiroshi Murayama, Satoru Yoshie, Ikuko Sugawara, Tomoko Wakui, Reiko Arami — 2011-05-10

Abstract: Homebound status is associated with poorer health and disability; however, the impact of community factors on the decision to remain homebound is unclear. We applied multilevel analyses to examine the association between neighborhood environment and homebound status among Japanese community-dwelling elderly. A cross-sectional survey was conducted in February 2009 using a mailed questionnaire. A total of 4123 participants aged 20years and over living in 72 small districts of Kashiwa, Japan, were randomly selected for the survey. Of the 1735 returned questionnaires, the 588 that were completed by individuals aged 65years and over were used for analysis. Frequency of going outdoors was assessed and respondents going outdoors once a week or less were defined as homebound. Neighborhood environment was assessed using three subscales of the Neighborhood Environment Walkability Scale (NEWS-A) (land use mix-access, aesthetics and crime safety). Multilevel logistic regression analysis indicated that the lower score of land use mix-access at the district level was associated with the elderly being homebound after adjustment for individual demographic data, physical, psychological and social factors and district prevalence of population aged 65years or more. This finding could contribute to devising a successful community-based strategy for homebound prevention of community-dwelling elderly individuals.

Changes of psychical and physical conditions in the elderly after a four-year follow-up

S.M. Zuccaro, R. Steindler, S. Scena, M. Costarella — 2011-05-25

Abstract: The elderly show a loss of both the intellectual functions and of motion ability. This happens also without particular pathologies; possible tests to highlight this loss are the Mini Mental State Examination (MMSE), and the Functional Reach (FR)-test. During 2004–2005 winter 50 healthy subjects were analyzed; the subjects were divided into three age-groups: from 55 to 64 years; from 65 to 74 years; over 75 years of age. The test results showed a significant decline of MMSE and FR from the first group to the other two groups, a same behavior of male and female subjects, a greater decline of physical characteristics compared to psychic characteristics. During 2008–2009 winter several subjects (34 of 50) were again analyzed, and a more accurate facility was used to measure the FR. The aim of the new test has been the exam of the cognitive conditions and of the physical performances after the 4 year follow-up. The results of the new tests confirm the previous results, both with regard to the decline of the psychophysical characteristics from the first age-group to the others but the decrease is not as significant as the previous, and with regard to the greater physical decline. What is surprising is that the decline of both the psychic and the physical characteristics concerns only the first age-group, not the other two. Maybe healthy subjects, without particular pathologies reach a stabilization of the above-mentioned characteristics; some hypothesis is given to explain what happens.

Which body mass index (BMI) is better in the elderly for functional status?

2011-05-31

Abstract: BMI is commonly used indicator of malnutrition and 18.5–24.9kg/m2 is generally regarded optimal. However, there is an ongoing debate on ideal range for elderly. BMI cut-off values vary also between ethnic groups. We aimed to investigate relationships between BMI, functional status and malnutrition in elderly living in a nursing home in Turkey. BMIs of 254 residents were calculated. Chronic diseases and currently used drugs were noted. Functional status was evaluated with Katz-activities-of-daily-living (ADL) and Lawton-instrumental-activities-of-daily-living (IADL). Nutritional assessment was performed by Mini-Nutritional-Assessment (MNA) test. Mean age was 75.2±8.2 years. Subjects were classified into 4 groups as BMI <18.5, 18.5–24.9, 25–29.9, and ≥30.0kg/m2. ADL scores and IADL scores were higher in higher BMI groups. There were no differences in terms of age-number of chronic diseases. Even in BMI ≥35kg/m2 residents, ADL was significantly higher than 25–34.9kg/m2 residents. BMI was significantly correlated with ADL and IADL scores. In Groups 3 and 4, there were 22.2% and 9.1% residents without normal nutrition, respectively. Better functional status was associated with higher BMI values even in BMIs ≥30kg/m2. In elderly, relative high rates of undernutrition may be present in BMIs regarded as overweight or obese.

Use of knee height for the estimation of stature in elderly Turkish people and their relationship with cardiometabolic risk factors

Berrin Karadag, Ali Osman Ozturk, Nur Sener, Yuksel Altuntas — 2010-12-24

Abstract: The determination of the approximately truest value in height measurement is important in many fields, but it is difficult to perform true measurements, especially in the elderly individuals. We planned to investigate the following items in geriatric Turkish population: to calculate the decrease in height with advancing age by using the standing height measurement and estimated height derived from the knee height; to evaluate the significance of difference between the two measurement methods in the calculation of body mass index (BMI) and waist/height ratio (WHtR); to determine the cut-off value of WHtR according to estimated height in elderly individuals. We studied 551 cases aged between 19 and 97 years. Knee height was measured using a sliding caliper in a sitting position. Linear regression analysis was carried out to derive predictive equations for the estimation of stature with adults (≤50 years of age) according to the gender. This equation was then used to estimate height among elderly subjects. Of the cases, 60.3% were <60 years (mean: 48.75±7.50); 39.7% of the cases were >60 years (mean: 69.51±7.12). Estimated BMI (EBMI) measurements in the females and males >60 years were in average 1.23kg/m2 and 0.92kg/m2 higher than their real BMIs, respectively. EBMI measurements in the females <60 years were 0.32kg/m2 higher than their real BMIs (p<0.01). There is a statistically significant difference between WHtR in the females of both age groups, and in the males >60 years, as compared to our estimated WHtR (EWHtR) measurements (p<0.01). The cut-off point of WHtR was 0.61 and 0.58 in the female and male cases of >60 years in our study, respectively. WHtR seemed to be a better anthropometric index that could predict most cardiometabolic risk factors in our study. EWHtR emerged to be a better cardiometabolic risk index especially in the elderly group.

Nursing students’ attitudes toward ageism in Turkey

Yasemin Yildirim Usta, Yurdanur Demir, Melike Yönder, Aynur Yildiz — 2011-02-28

Abstract: This research involved a descriptive study with the goal of examining the attitudes of 145 Turkish nursing students studying toward ageism and the factors affecting ageism views. A Student Description Form and the Ageism Attitude Scale (AAS) were the data collection instruments used in this study. Statistical evaluation of the data included percentage, median and Kruskal Wallis Test and Mann–Whitney U-test. The average age of student participants was 20.10±3.52; further 37.9% of these students were 1st year nursing students, 25.5% of were 2nd year, 11.7% were 3rd year, and 24.8% were 4th year students. Of the students in this study 63.4% had completed coursework in elderly health as part of undergraduate study. Average scores on the AAS students were 84.01±7.61 points. Most female students who completed classes related to elderly health, either lived with or planned to live with at least one elderly parent after starting a family or already experienced having an elderly relative in their home. These students tended to have positive attitudes toward aging.

Nonverbal communication of caregivers in Slovenian nursing homes

Marija Zaletel, Asja Nina Kovacev, Ruza Pandel Mikus, Lijana Zaletel Kragelj — 2011-03-09

Abstract: This study aimed at determining the characteristics of nonverbal communication (NVC) of caregivers in Slovene nursing homes. The cross-sectional study was performed on 267 randomly selected caregivers from 27 randomly selected nursing homes. Facial expressions/head movements, hand gestures/trunk movements, and modes of speaking/paralinguistic signals were observed. The caregivers manifested altogether 11,324 NVC expressions. Those definitely reflecting positive attitude prevailed and accounted for 59.3% of all expressions, whereas those definitely reflecting negative attitude were very rare and accounted for 9.1% of all expressions, at a ratio of 6.5:1 (p<0.001). Differences were statistically highly significant between genders (men manifested negative attitude expressions significantly more frequently, 11.8%) and professions (social helpers manifested positive attitude expressions significantly less frequently, 56.4%; other professionals manifested negative attitude expressions significantly less frequently, 5.4%) (p<0.001). The results were similar within groups of NVC expressions. Although our study showed that caregivers in Slovene nursing homes use positive attitude expressions much more frequently than negative there is a reason for concern due to a general decline in positive values and beliefs in Slovene society. Promoting positive attitude NVC among new generations of caregivers in nursing homes need to become one of the most important contents of their life-long learning and training.

Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly

Miharu Nakanishi, Hisato Imai — 2011-01-12

Abstract: The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor–employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice.

Protective effects of social networks on disability among older adults in Spain

Miguel-Ángel Escobar-Bravo, Dolores Puga-González, Monserrat Martín-Baranera — 2011-02-28

Abstract: The loss of autonomy at advanced ages is not only associated with ageing, but also with the characteristics of the physical and social environment. Recent investigations have shown that social networks, social engagement and participation act like predictors of disability among the elderly. The aim of this study is to determine whether social networks are related to the development and progression of disability in the early years of old age. The source of data is the first wave of the survey “Processes of Vulnerability among Spanish Elderly”, carried out in 2005 to a sample of 1244 individuals. The population object of study is the cohort aged 70–74years in metropolitan areas (Madrid and Barcelona) and not institutionalized. Disability is measured by the development of basic activities of daily life (ADL), and instrumental activities of daily life (IADL). The structural aspects of the social relationships are measured through the diversity of social networks and participation. We used the social network index (SNI). For each point over the SNI, the risk of developing any type of disability decreased by 49% (HR=0.51, 95%CI=0.31–0.82). The SNI was a decisive factor in all forecasting models constructed with some hazard ratios (HR) that ranged from 0.29 (95%CI=0.14–0.59) in the first model to 0.43 (95%CI 0.20–0.90) in the full model. The results of the present study showed a strong association between an active social life, emotional support provided by friends and confidents and disability. These findings suggest a protective effect of social networks on disability. Also, these results indicate that some family and emotional ties have a significant effect on both the prevalence and the incidence of disability.

Self-rated health (SRH) and socioeconomic position (SEP) among urban home-dwelling older adults

Tommi Sulander, Pertti Pohjolainen, Elina Karvinen — 2011-03-10

Abstract: The main purpose of this study was to examine the association of education and adequacy of income with self-rated health (SRH) among home-dwelling older people aged 75 and over living in the urban area. A cross-sectional survey from 2008 was used to study 1395 older adults aged 75 and over living in one of the central areas of the city center of Helsinki, the capital of Finland. Associations of SRH with, education and adequacy of income were tested using ordinal regression model. Those with a lower level of education had higher level of poor health. Self-assessed adequacy of income had also a strong association with SRH. For the oldest respondents this association was even stronger than the association between education and SRH. Subjective evaluation of financial situation should be used as a key indicator of socioeconomic position (SEP) in studies examining inequalities in health especially among older adults.

Designing robots for the elderly: Appearance issue and beyond

Ya-Huei Wu, Christine Fassert, Anne-Sophie Rigaud — 2011-02-24

Abstract: This paper provides the results of three focus groups organized in the framework of the ROBADOM project, aiming at designing a service type assistive robot for the elderly with mild cognitive impairment living at home. The main objective of these focus groups was to give some recommendations to engineers in charge of the design of the robot's appearance. Results showed that although many humanoid robots were criticized by most participants, some small creative humanoid robots were appreciated. However, beyond the issue of the robot appearance, many ethical and social issues were raised. These focus groups offered an opportunity for participants to discuss the very idea of an assistive robot and to challenge some implicit preconceptions of the roboticists. Finally, we discuss how assistive robots could be designed considering the social context of the elderly and how to implicate the elderly as future end-users in the design process.

Depressive symptomatology as a risk factor for increased health service utilization among elderly patients in primary care

Yan Press, Howard Tandeter, Pnina Romem, Ruth Hazzan, Miri Farkash — 2011-03-07

Abstract: Depression may play an important role in determining frequent physician visits in the older population. Our aim is to examine the relationships between socio-demographic variables, co-morbidity, memory complaints, functional status, depressive symptomatology, and health care utilization among community dwelling older patients. The study was conducted in urban primary health care clinics in Beer-Sheva, Israel. Two groups were identified: low care utilizers (LCU), with ≤6 visits to family physicians (FP)/year and high care utilizers (HCU) with ≥16 visits to FP/year. Data were collected during a structured face-to-face individual interview. The study population included 180 patients, of them 86 (47.7%) were LCU and 94 (52.2%) were HCU. In all clinical measurements the HCU group indicators were statistically significant worse off than the LCU group: average depressive symptoms (5.6 vs. 2.5, p<0.01), memory complaints (57.5% vs. 23.3%, p<0.01), Barthel Index (BI) (89.9 vs. 96.0, p<0.001), OARS (10.8 vs. 12.5, p<0.01), and co-morbidity: total cumulative score (TCS) of Charlson comorbidity index (CCI) (2.2 vs. 1.3, p<0.01). Our study raises the possibility that at least one of the reasons for over-utilization of health services by older residents in the community is depressive symptomatology.

Anxiety, depression and quality of life (QoL) in patients with chronic dizziness

2011-05-12

Abstract: Mood disorders and the severity of dizziness often interact with each other. However, the impact of age on anxiety and depression in dizzy patients has rarely been explored. The purpose of this study was to evaluate the correlation between the Dizziness Handicap Inventory (DHI) and the Hospital Anxiety and Depression Scale (HADS) in a group of patients with dizziness. The statistical relationships between age and each scale were studied. This cross-sectional study revealed a high correlation between DHI subgroups and HADS subscales. We found statistical correlation between neither age and HADS subscales nor age and DHI subgroups. In addition, Short-Form 36 Health Survey Questionnaires (SF-36) showed a high correlation with the dizziness handicap severity. The present study revealed that age does not influence mood disorders and the severity of dizziness in dizzy patients.

Late onset suicide: Distinction between “young-old” vs. “old-old” suicide victims. How different populations are they?

2011-03-14

Abstract: Elderly suicide rates are the highest of any age group. Greece is among the countries with the highest proportion of elderly people in the European Union (EU). Elderly suicide victims seem to possess different characteristics. Aim of our study was to elucidate the different characteristics of elderly suicide victims. Data was collected from a two-year psychological autopsy study, conducted at the Athens’ Department of Forensic Medicine, the largest in Greece. Elderly suicide victims represented 35% of total suicides. The majority (69.5%) were males. Only 12.4% had previous psychiatric hospitalization but more than half (65.2%) had psychiatric history (81% of them had history of depression). As expected, there was a high incidence of physical illness (81.6%). The majority (82%) of the elderly suicide victims made a suicide attempt for the first time and it was unfortunately successful. When the elderly suicide victims were divided in two categories (“young-old” and “old-old”) the differences between the two groups were: elderly over 75 years had more physical problems and more frequently positive psychiatric history without ever been hospitalized for psychiatric problems. Late life suicides seem to encapsulate population groups with different characteristics. Their differences can be a useful guide aiming to formulate specific suicide prevention strategies. This is of great importance, given the very high frequency of completed suicides in this age group.

What factors affect life satisfaction (LS) among the oldest-old?

Åsa Enkvist, Henrik Ekström, Sölve Elmståhl — 2011-05-10

Abstract: Few studies have examined the association between LS in the oldest-old and not only health-related, but also psychological and socio-economical factors. The aim of this study was to examine LS in relation to functional capacity, locus of control (LoC) health status and other factors previously known to influence LS in the oldest-old. The study population consisted of 681 individuals aged 78–98 years, drawn from the longitudinal population study “Good Aging in Skåne” (GÅS), part of a national survey (SNAC) who fulfilled a questionnaire. In a regression model was shown that the number of symptoms, marital status, LoC, especially internal and powerful others, depressive mood and age significantly could predict life satisfaction three years later. Specific diagnoses like stroke, dementia and cardiac disease were not related to LS. Independence in physical functioning was related to unchanged LS, stratified for age and gender during a 3-year follow-up. The clinical implications of this study are that attention should be paid to recognizing and treating factors that affect LS and are reachable for medical intervention. Relieving symptoms and paying attention to personality factors that modify LS seem to be key-factors in the care of elderly.

Life satisfaction (LS) and symptoms among the oldest-old: Results from the longitudinal population study called Good Aging in Skåne (GÅS)

Åsa Enkvist, Henrik Ekström, Sölve Elmståhl — 2011-06-01

Abstract: Studies on the prevalence of symptoms in the general population and its’ relation to LS in the oldest-old are to our knowledge non-existent. The aim of this study was to describe the frequency and experienced severity of elderly subjects’ reported symptoms and how symptoms are related to LS. The study population consisted of 681 individuals aged 78–93 years, drawn from the longitudinal population study, GÅS, part of a national survey (SNAC). Scores on the life satisfaction index were related to scores on a modified version of the Göteborg Quality of Life (GQoL) instrument, covering 32 common symptoms. Musculo-skeletal symptoms like pain were reported by 74%, 80% had depressive symptoms and 68% general fatigue. Less than 6% of men and women reported no metabolic symptoms or symptoms related to the head. In a multiple regression model it was shown that four groups of symptoms could significantly predict LS 3 years later: depression, tension, GI-symptoms and musculo-skeletal symptoms. The clinical implication of this study is that careful attention should be paid to the elderly patients’ complaints concerning symptoms in the above areas since this has the potential to significantly increase the patients’ satisfaction with life.

Perception and negative effect of loneliness in a Chicago Chinese population of older adults

XinQi Dong, E-Shien Chang, Esther Wong, Melissa Simon — 2011-05-30

Abstract: This qualitative study aims to investigate the cultural understandings of loneliness, identify the contexts of loneliness, and to examine its effect on the health and well-being of U.S. Chinese older adults. Despite loneliness is one of the main indicators of well-being, little attention has been paid to understanding loneliness among immigrant older adults. This study utilizes both survey questionnaires and semi-structured focus group methods to investigate the feelings of loneliness among U.S. Chinese older adults. Based on interviews with 78 community-dwelling Chinese older adults in Chicago Chinatown, this community-based participatory research study (CBPR) shows loneliness is common among U.S. Chinese older adults. It was frequently identified through emotional isolation and social isolation. Social, psychological and physical health factors could contribute to the experience of loneliness. In addition, the health of older adults with loneliness may be associated with worsening overall health, elder mistreatment, health behavior changes and increased healthcare utilizations. This study has implications for healthcare professionals, social services agencies and policy makers. Our findings point to the needs for healthcare professionals to be more alert of the association of loneliness and adverse health outcomes. Communities and social services agencies should collectively take a lead in reducing social isolation, improving intergenerational relationships, and increasing social networks and companionship for this group of vulnerable older adults.

Withdrawal of psychotropic drugs decreases the risk of falls requiring treatment

M. Salonoja, M. Salminen, T. Vahlberg, P. Aarnio, S.-L. Kivelä — 2011-03-21

Abstract: This non-randomized, controlled trial assessed the effects of ceasing fall-risk-increasing drugs (FRIDs) (psychotropics or opiates or potent anticholinergics) on the risk of falls requiring medical treatment as a sub-analysis of a randomized, controlled multifactorial fall prevention. The population in this 12-month study consisted of 528 community-dwelling subjects aged 65years or older with a history of at least one fall. The subjects were divided retrospectively into three groups according to the use of any FRID, any psychotropic drug, and benzodiazepine or related drug (BZD/BZDRD). The subjects in the intervention group (IG) ceasing the drug use were compared with the subjects in IG and the control group (CG) not ceasing the use of the corresponding type of drugs during the intervention period. Falls were recorded from medical records. For the year after the 12-month intervention the relative risk ratio (with 95% confidence intervals=CI) for controls in CG compared with the withdrawal group in IG was 8.26 (1.07–63.73) among the users of psychotropics and 8.11 (1.03–63.60) among the users of BZDs/BZDRDs. Withdrawal of psychotropics, especially BZDs/BZDRDs may have played an important role by lowering the risk of falls requiring medical treatment during the year after the 12-month multifactorial intervention.

Drug-related problems (DRPs) identified from geriatric medication safety review clinics

2011-02-25

Abstract: Drug-related problems (DRPs) were identified from baseline data of 193 Medication Safety Review Clinic (MSRC) patients. MSRCs enroll older adults (≥65 years) with either (1) prescriptions of ≥8 chronic medications (drugs prescribed for ≥28 days) or (2) a visit to ≥3 different physicians at the two participating hospitals in Taipei, Taiwan from August to October 2007. The Pharmaceutical Care Network Europe (PCNE) Classification Version 5.01 was used to report DRPs. Mean age was 76.2±6.2 years and 53% of participants were male. Participants had, on average, 9.0±2.6 chronic conditions and took 8.9±3.1 chronic medications and 1.7±1.8 dietary supplements. Eighty-seven percent had at least one DRP. Being older, having orthostatic hypotension and taking more chronic medications were associated with higher likelihood of having at least one DRP. For the 1713 medications and 331 diet supplements reviewed, 427 DRPs were found, 490 causes (1.1±0.4 per problem) identified and 1067 interventions proposed (2.5±0.6 per problem). The most common DRP category was “drug not taken/administered” (35%), and the most common offending drug category was cardiovascular agents (33%). Prevalence of DRPs was high among geriatric outpatients prescribed multiple medications. Careful medication review is needed in routine clinical practice to improve prescription quality.

Non-pharmacological interventions on cognitive functions in older people with mild cognitive impairment (MCI)

2011-03-14

Abstract: Mild cognitive impairment (MCI) can be a stage of pre-dementia. There is no consensus about pharmacological treatment for this population, so it is important to structure non-pharmacological interventions for increasing their cognitive reserve. We intended to analyze the effects of non-pharmacological interventions in the cognitive functions in older people with MC, in form of a systemic review. Data sources were the Web of Science, Biological Abstracts, Medline, Pub Med, EBSCHost, Scirus and Google Scholar. All studies were longitudinal trials, with MCI sample, aged>60 years, community-dwelling, and having cognitive functions as dependent variable. Seven studies, from 91 previously selected ones, were identified according to the inclusion criteria. Six studies used cognitive intervention, improving memory and one study used physical activity as intervention, improving executive functions. The results show evidence that physical activity and cognitive exercise may improve memory and executive functions in older people with MCI. But yet, more controlled studies are needed to establish a protocol of recommendations regarding the systemization of exercise, necessary to produce benefits in the cognitive functioning in older people with MCI.

The influence of a cognitive stimulation program on the quality of life perception among the elderly

2011-04-04

Abstract: There is an undeniable concern among the elderly about the mental changes they experience as they grow older. In general, the elderly tend to regard mental deterioration as a pathological condition, however these changes should be considered inherent in the aging process and in the last few years cognitive stimulation programs have been developed in order to address these concerns among the elderly. The purpose of this study is to analyze the influence of a cognitive training program on 53 subjects with age-related memory loss. The results of cognitive performance have been compared with a control group consisting of 51 subjects with no cognitive training. Moreover, this research analyses the relationship between cognitive changes and the variation in the perceived quality of life of the elderly people in both groups. The results show significant changes in the test group, demonstrating improved cognitive performance and quality of life perception.

Prevalence of gender disparities and predictors affecting the occurrence of mild cognitive impairment (MCI)

2011-05-06

Abstract: The aims were to investigate the prevalence of mild cognitive impairment (MCI) within gender disparities in Malaysian older adults, and to determine the predictors of MCI according to gender disparities. A community-based sample of urban, multiethnic dwelling elderly aged 60 years of age and above from Cheras, Kuala Lumpur was recruited. Prevalence of all-type MCI, amnestic-type MCI (am-MCI) and non-amnestic-type MCI (nam-MCI) was assessed using comprehensive neuropsychological batteries. The association between demography, socioeconomic status, lifestyle practices, and nutritional status and health risk factors with MCI were examined. Predictors of MCI occurrence between gender disparities were determined. The prevalence of all-type MCI, am-MCI and nam-MCI was 21.1%, 15.4% and 5.7%, respectively. Binary logistic regression indicated that hypercholesterolemia is the significant predictor for MCI in men after adjustment for age, ethnicity and total years of education. While, in women, MCI was best predicted by married status, without exercise practice, overweight and obesity. These results suggest that approximately one-fifth of the studied elderly people had MCI. Predictors for MCI are totally different between men and women. It is critical to identify those at higher risk for MCI in order to implement preventative measures to delay or reverse this abnormal condition.

Neurochemical alterations of the entorhinal cortex in amnestic mild cognitive impairment (aMCI): A three-year follow-up study

2011-05-18

Abstract: The neurochemical alterations in the entorhinal cortex have not yet been measured, even though the entorhinal cortex is the earliest involved brain region in aMCI. In this study, we investigated whether brain regions including the entorhinal cortex would show early involvement of neurochemical abnormalities in aMCI, and whether magnetic resonance spectroscopy (MRS) abnormalities might be a predictive marker of conversion of aMCI to Alzheimer's disease (AD). MRS was performed on 13 aMCI patients and 11 patients with no cognitive impairment (NCI). Localizing voxels were placed within the entorhinal cortex, hippocampus, posterior cingulate gyrus, and occipital white matter in the dominant hemisphere. N-acetyl aspartate/creatinine (NAA/Cr) ratios in the entorhinal cortex were significantly lower in aMCI patients than in NCI subjects. After a three-year follow-up, seven aMCI patients converted to AD and six remained stable. Baseline NAA/Cr ratios of entorhinal cortex were decreased in converters, compared to NCI. Our study suggested the entorhinal cortex is the earliest site that is subject to neurochemical alteration in aMCI patients, and baseline MRS metabolite ratios in the entorhinal cortex can be a marker for predicting conversion of aMCI to AD.

Cognitive impairment as predictor of functional dependence in an elderly sample

2011-03-14

Abstract: This retrospective study determines the role of cognitive decline as a predictor of functional dependence. In a representative 600 community-dwellers aged 65 or older, we examined using a logistic regression model, the association between cognitive status (taking into account age and educational level) and dependence on basic and instrumental activities of daily living (ADL and IADL, resp.), controlling for socio-demographic variables and health conditions. The Mini-Mental State Examination (MMSE) scores were compared in participants with functional disability to perform basic and instrumental activities. Cognitive status influenced functional dependence on activities of daily living, basic (OR=4.1, 95%CI=2.7–6.1) and instrumental (OR=5.7, 95%CI=3.5–9.3), independently of gender, age, educational level and health conditions. Besides, cognitive impairment was associated with the dependence on certain basic (e.g., bathing, toileting) and instrumental (e.g., using the telephone, taking medications, and handling finances) activities. This was a gradual relationship, the highest cognitive decline implied the highest loss of ability at carrying out activities, with a larger impact on basic activities. These findings suggest that cognitive decline can be a predictor for functional dependence, independently of other variables, and turn into a very useful tool indicating the need for support.

Patterns and correlates of depression in hospitalized older adults

2011-05-13

Abstract: Depression is often associated with illness or injury requiring acute hospitalization, particularly in older adults. We sought to determine patterns of change in depressive symptoms in older adults from hospitalization to 3months post discharge and to examine factors associated with depressive symptoms 3months after discharge. The study included 197 patients aged 65 years or older hospitalized with an acute medical illness. Sociodemographic and clinical measures, including depressive symptoms using the Center for Epidemiologic Study—Depression (CES-D) scale, were collected during the inpatient stay and at 3months post discharge. Mean age was 75.3±7.5 (±S.D.) years, 59% of the participants were female, 61% unmarried, and 72% had a high school education or more. High depressive symptoms (i.e., CES-D≥16) were reported in 37% at admission. Of the 8% depressed at follow-up, 81% were also depressed at admission; 19% were new cases of depression. Depressive symptoms 3months post-hospitalization were significantly associated with follow-up daily living skills (p=0.001) and social support (p<0.0001). Patients with persistent depressive symptoms make up the majority of post-hospitalization depression cases. Post-hospitalization social support and daily living skills appear to be important in the management of follow-up depressive symptoms.

The relationship between pulse pressure and leukoaraiosis in the elderly

Seung-Hee Kim, Jae-Yong Shim, Hye-Ree Lee, Ha-Young Na, Yong-Jae Lee — 2011-04-14

Abstract: Leukaraiosis and a higher level of pulse pressure are well-recognized as associated with cardiovascular disease, vascular angiopathy, and geriatric syndrome. A cross-sectional study was conducted to examine the relation between pulse pressure and leukoaraiosis based on brain magnetic resonance imaging (MRI) scans in the apparently healthy elderly (147 men aged 60–84 years and 89 women aged 60–82 years). The odds ratios (OR) and 95% confidence interval (CI) for leukoaraiosis were calculated using multivariate logistic regression analyses according to each quartile of pulse pressure. The percentage of leukoaraiosis gradually increased in accordance with pulse pressure quartiles: 5.1%, 8.6%, 16.1%, and 26.2% for men, and 4.5%, 8.7%, 13.0%, and 23.8% for women. In comparison with subjects in the lowest quartile, the OR (95%CI) for leukoaraiosis in the highest quartile was 6.80 (1.20–38.45) in men after adjusting for age, body mass index, fasting plasma glucose, HDL-cholesterol, triglyceride (TG), smoking status, and current drinking. However, the relationship was not evident in women after adjusting for the same co-variables. In conclusion, pulse pressure was found to be independently associated with leukoaraiosis regardless of classical cardiovascular risk factors in elderly men.

Aerobic conditioning, blood pressure (BP) and body mass index (BMI) of older participants of the Brazilian Family Health Program (FHP) after 16 weeks of guided physical activity

2011-03-10

Abstract: Because physical exercise is an efficient means to improve maximum consumption of oxygen (VO2max) and reduce body fat, the objective of this work was to evaluate the effect of 4 months of a guided physical activity program on BMI, BP and estimated VO2max of older participants of the FHP. The sample was composed of 70 older participants who were divided into two groups: the experimental group (EG) (26 women and 9 men) and the control group (CG) (20 women and 15 men). The program of physical activity included walking, hydrogymnastics, weight-training exercises and stretching exercises. The intensity of the aerobics exercises was set such that participants would achieve 55–65% of the estimated maximum heart rate, with the corresponding effort to be subjectively rated by the participant as 12–13 points on a 6–20 point scale. After 4 months of guided physical activity, there was a significant 19.26% improvement in the VO2max in the EG (p≤0.001), and the diastolic pressure in the EG was significantly lower than that in the CG (p≤0.001). In conclusion, the 16-week program of physical activity significantly improved the cardiorespiratory capacity of older individuals.

Prior antiplatelet drug use and short-term mortality in older patients with acute ischemic stroke (AIS)

2011-02-28

Abstract: Some studies suggest that previous treatment with antiplatelet agents (AA) might reduce ischemic stroke severity and improve outcomes in terms of clinical deficits or mortality. We evaluated the effect of the prior chronic use of AA on short-term (30 days) mortality in a sample of consecutive patients with AIS. Four hundred thirty-nine older patients (>65 years) with “major” AIS (modified Rankin scale≥3) consecutively admitted to the University ward of Internal Medicine or Geriatrics were enrolled. Stroke was classified according to Oxfordshire Community Stroke Project (OCSP). Data recorded included: (1) clinical features; (2) medical history including home therapies, and vascular risk factors; (3) routine clinical chemistry analyzes (verb)/analyses (noun). Short-term (30 days) mortality was 27.6%. One hundred fifteen subjects (26.2%) were taking AA before admission. Compared with subjects not treated, subjects taking AA were characterized by higher prevalence of recurrent stroke (35% vs. 22%). In this group, a trend toward a higher prevalence of congestive heart failure (CHF), smoking, and altered levels of consciousness (ALC) was noted. Stroke type and short-term mortality (33% vs. 26.2%; odds ratio=OR=1.25; 95% confidence interval=CI=0.75–2.10, age and gender adjusted) were not different between the two groups. Adjustment for glucose, CHF, previous stroke, smoking, and ALC did not change mortality risk (OR=0.83; 95%CI=0.40–1.72). We conclude that in older patients hospitalized for “major” AIS, prior use of AA was not associated with any benefit in terms of short-term mortality both in patients with first, as well as in those with recurrent ischemic stroke.

Hemorheological changes with strontium ranelate treatment do not seem to be related to its claimed prothrombotic effects

2010-12-17

Abstract: Strontium ranelate is claimed to be related with increased risk of thromboembolic events. No explanation of this increased incidence of thromboembolism has been identified. However, growing evidence has clearly demonstrated the involvement of blood rheology in any thrombotic process. The aim of this study was to assess hemorheological changes with strontium ranelate treatment in elderly women with osteoporosis. This study was designed in a prospective manner. Twenty-two elderly women diagnosed with osteoporosis were included. During a 2-month treatment period, participants received strontium ranelate 2g/day. Hemorheological parameters including erythrocyte deformability, erythrocyte aggregation and plasma viscosity were measured before and after 2 months therapy with strontium ranelate. The median age of the patients was 70.0 (range=65–80) years. After 60 days of treatment, there was no statistically significant change in hemorheological parameters. None of the subjects developed clinical venous thromboembolic event (VTE) during the 2-month period of strontium ranelate treatment. Our study demonstrated that in elderly women, treatment of osteoporosis with strontium ranelate did not change hemorheological parameters over 2 months of time. However, its long-term effects on hemorheologic parameters should be evaluated further with a larger sample.

Vitamin D: drug of the future. A new therapeutic approach

2011-04-04

Abstract: Besides increasing calcium absorption in the bowel and promoting the normal formation and mineralization of bone, vitamin D exerts relevant pleiotropic effects in different tissues. Serum levels of vitamin D show correlation with the risk of infections, cardiovascular diseases, cancer and autoimmune disorders. The possible therapeutic role of vitamin D in different kind of diseases: inflammatory, immunologic, infectious and neoplastic ones, explains the growing interest in this vitamin due to its pleiotropic effects, and makes it a candidate to become a potential drug in the next future.

Influence of enteric nutrition on blood urea nitrogen (BUN) in very old patients with chronic kidney disease (CKD)

Linda Shavit, Meyer Lifschitz, Ilia Galperin — 2011-04-15

Abstract: The purpose was to check the influence of enteric nutrition on BUN in very elderly patients. Clinical data on patients in whom enteral feeding was initiated after a period of poor oral intake are presented. Patients with evidence of volume depletion, signs of gastrointestinal bleeding or medicines that might increase BUN were excluded. We evaluated 5 patients (mean age 90.6±3 years) who were admitted to geriatric department. Mean plasma creatinine concentration was 1.17±0.34mg/dl, but mean estimated glomerular filtration rate (eGFR) was 41.6±17ml/min/1.73m2. Enteral nutrition was administered at a dose of mean 1580±53ml/day at mean duration of 9±4 days. Mean BUN was 52±30mg/dl at baseline, increases to 109±9.4mg/dl after initiation of feeding and decreased to 82±1.1mg/dl with reduction of dose of enteral nutrition. Our conclusion was that initiation of enteral feeding may induce a large accumulation of nitrogen waste products in elderly patients in whom serum creatinine is an unreliable indicator of kidney function. High protein intake should be considered in differential diagnosis of disproportionate high increment of BUN.

Discovering knowledge of hemodialysis (HD) quality using granularity-based rough set theory

Hung-Lieh Chou, Ssu-Hsiang Wang, Ching-Hsue Cheng — 2011-03-08

Abstract: This study collected the real HD-data from area scale hospital database with 72 attributes and 18,113 records. The study proposes a novel procedure to assess the patient's HD-quality, including five facets: (1) Delete the unrelated attributes and missing values. (2) Employ expert granularity to cut decision-attributed Kt/V (where K is the dialyzer clearance coefficient of urea nitrogen, t is the time for dialysis and V is the urea nitrogen volume of distribution in the body). (3) Use information-gain to select features, to reduce the total number of attributes to 17. (4) Utilize multiple regression to test the degree of co-linearity and select features, the dimension of dataset is reduced to 8 attributes and 2737 records. (5) Finally, the rules of HD-quality and accuracy performance are generated by granular rough set theory. In performance comparison, the decision tree (DT-C4.5), the Naïve Bayes (NB) probabilistic model and Artificial Neural Networks-Multilayer Perceptrons (ANN-MLP) are employed to compare with the proposed procedure in accuracy. The results can assist doctors to reduce the time of diagnosis and to achieve dose of fitness-based dialysis for the patients.

The sense of coherence (SOC) as an important determinant of life satisfaction, based on own research, and exemplified by the students of University of the Third Age (U3A)

2011-04-11

Abstract: The SOC is an important determinant of life satisfaction of elderly people. It determines the level of coping with various difficult situations, which accompany an old age stage. The aim of the study was to determine the connection between the SOC levels and life satisfaction among the U3A students. Another analyzed relationship was the SOC level against the background of socio-demographic factors. The study comprised 257 students of the U3A in Poland, located in the city of Bydgoszcz. The study group consisted of 237 women and 20 men, at the average age of 64.54±6.01 years. The vast majority of the study group included individuals at the secondary education level, as well as married individuals. Just over half of the group claimed to be in good health, and have no afflictions. All of the respondents were fully mobile. The study was conducted with the diagnostic poll method, using the standardized questionnaires: The Scale SOC-29, WHOQOL-Bref, and the Geriatric Depression Scale (GDS-bref version). The average value of global SOC was 128.77; the standard deviation 21.04; discrepancy 153 (minimum 50 and maximum 203). The SOC indicated significant relationship with quality of life (QoL) in the mental domain, social relationships, and environmental domain; no significant correlation in the physical domain was observed. The QOL reached about 70% of maximum result value, showing equal levels in its specific areas. A moderately decreasing (r=−0.375, p<0.01) relation η=0.376, between global SOC values and depression occurrence, as well as its non-existence was shown in the study. Individual SOC components were also negatively correlated with depression. Another observation was weak correlation between the sense of coherence and the individuals’ level of education. No statistically significant effect of age, gender and marital status on the SOC levels of U3A students was found. Higher parameters of SOC and level of education shape significantly higher effects of life satisfaction, and result in better adaptation to old age stage as a phase of multiple challenges, and increasing life difficulties.

Parkinson's disease (PD) in the elderly: An example of geriatric syndrome (GS)?

2011-04-04

Abstract: PD is an age-related neurodegenerative disorder that affects as many as 1–2% of persons aged 60 years and older. In the latest decade, the approach to PD was dramatically changed. In fact, although for many years PD has been considered only “a disease that affects walking”, with a key role of the neurotransmitter dopamine, recently the neurological approach has been substantially modified. The approach for this disease is not only a neurological issue. Given the complexity of its clinical aspects, such as depression, anxiety, dementia, sleep disorder, pneumonia dysfagia-related and malnutrition, a multidisciplinary evaluation and not just a neurological evaluation is needed. We suggest a n multidisciplinary approach for this old actor, underlying a subtle link between neurophatological stages of the disease (Braak's classification) and clinical aspects (Braak's stages 1 and 2 associated with the premotor phase; Braak's stages 3–4 associated with the motor symptoms and Braak's stages 5–6 associated with cognitive impairment). In addition, we emphasize the usefulness of geriatric evaluation for the identification of frail “in situ”, frail, and disable status for improving care and treatment in this multifaceted disease.

Hospital acquired infections (HAI) in the elderly: Comparison with the younger patients

Meltem Avci, Onur Ozgenc, Seher Ayten Coskuner, Ali Ilgın Olut — 2011-05-02

Abstract: The aim of this retrospective study is to determine the frequency, type, microbiological characteristics and outcome of HAIs in the elderly (age≥65) and to compare the data with younger patients in a Turkish Training and Research Hospital. From January 2008 to December 2009, the infection control team analyzed HAIs among 60,585 hospitalized patients (20,109 aged≥65 and 40,747 aged between 18 and 64 years) with a total number of 419,017 patient days. A total of 825 HAIs episodes were detected in 607 patients, of which 395 episodes were in 301 elderly patients. The incidence of HAIs per 1000 patient days was 2.49 in the elderly and 1.64 in the younger patients’ group (p<0.001). The most common site of infection in the elderly patients was the urinary tract, whereas in non-elderly group this was the lower respiratory tract. The incidence density of urinary tract infections, respiratory tract infections, surgical site, skin and soft tissue infections, primary bacteremia, and prosthesis infections were significantly higher in the elderly group (p<0.05). Gram-negative species were the most frequently isolated agents in both groups. There were no significant differences between the groups in the frequency of isolated pathogens or antibiotic susceptibility patterns. Overall, the fatality rate was found 16.8%. The elderly patients were more likely to have crude mortality rates (22% vs. 12%; p<0.01). The death was most often related to pneumonia, primary bacteremia or intravascular catheter infections in both groups.

The interplay of infections, function and length of stay (LOS) in newly admitted geriatric psychiatry patients

Rhonda E. Malyuk, Carol Wong, Barbara Buree, Arvind Kang, Nirmal Kang — 2011-03-07

Abstract: The purpose of this study was to determine the impact of identifying and treating infections on functional outcomes and length of stay (LOS). Our retrospective naturalistic study reviewed all new admissions to a tertiary geriatric psychiatry teaching hospital from 2003 to 2007. Over this four-year period, 390 patients were admitted and discharged with 21% (85) of patients identified as having infections on admission. Those with infections were compared to the group without to determine and compare clinical characteristics. Factors included in analysis were: age, gender, diagnoses, medical comorbidity, neuropsychiatric symptoms, functional outcomes, medications and LOS. Both groups were similar in gender, psychiatric diagnoses and severity of dementia. Those requiring antibiotics for treatment of infections on admission, were older (p=0.003), had poorer baseline function (p=0.005) and higher medical comorbidity (p<0.001). At discharge, the group with infections showed greater functional improvement (p<0.001), particularly in mobility (p=0.005) and cognition (p=0.046), and had a shorter LOS (p=0.02). We conclude that a significant number of patients in tertiary geriatric services continue to have infections on admission. Early identification and treatment of infections can result in improved function and decreased LOS.

The clinical outcome of elderly patients with acute pancreatitis is not different in spite of the different etiologies and severity

2011-02-18

Abstract: The aim of this study was to investigate the overall clinical characteristics of elderly patients with acute pancreatitis. We retrospectively evaluated 227 consecutively enrolled patients who were admitted with acute pancreatitis. The clinical features, the radiological and laboratory data and the clinical outcome were analyzed according to the age groups (≥65 years vs. <65 years). Among the 227 enrolled patients with acute pancreatitis, there were 85 elderly patients and 142 non-elderly. The mean age of the elderly patients was 72.3±5.5 years and that of the non-elderly was 44.7±11.7 (p<0.001). For the elderly patients, biliary pancreatitis was the most common cause (56.5%), but alcoholic pancreatitis was most common in the non-elderly patients (45.8%). Although the computed tomography (CT) severity index was significantly higher for the non-elderly patients (p<0.001), the acute physiology and chronic health evaluation (APACHE II) score was significantly higher for the elderly than that for the non-elderly (p<0.001). However, the duration of the hospital stay (10.3±9.6 days vs. 11.9±10.1 days, p=0.619) and mortality (3.5% vs. 0.7%, p=0.148) were not different between the age-groups. In our study, chronological age had no significant influence on the clinical outcome in spite of the different etiologies and severity of acute pancreatitis.

Mortality and functional evolution at one year after hospital admission due to heart failure (HF) in elderly patients

2011-04-11

Abstract: The aim of this observational study was to describe the characteristics (including functional measures) of the elderly patients hospitalized in the acute geriatric unit (AGU) and diagnosed with HF as well as to determine the variables associated with mortality at one year after discharge. A prospective study including patients aged 70 and over hospitalized for acute decompensated HF was performed. The baseline measures were demographics, comorbidity, clinical, functional and cognitive status. The outcome for this study was death within one year from the index hospital admission date. During the length of the study, 32.7% patients died (20.7% within the first three months). The clinical features associated with HF-related mortality in the univariate analysis were institutionalization, a higher dependence in performing basic activities or instrumental activities of daily living (IADL). Older age did not correlate with mortality, nor did left ventricular hypertrophy (LVH), the ejection fraction or the pharmacological treatment at discharge. After performing the logistic regression analysis, the only variable independently related to a higher mortality risk at one year was the preadmission dependence in performing basic activities of daily living (BADL). The results of this study highlight that preadmission functional and sociodemographic variables are the best predictors of mortality at one year, surpassing the classic prognostic factors. Performing an adequate assessment at the time of admission, which should include a functional evaluation, may help us to better classify patients and to offer them a customized therapeutic plan with better prognostic capabilities.

Free wall rupture (FWR) in patients with acute ST-elevation myocardial infarction (STEMI) receiving fibrinolytic therapy (FT): A 7-year prospective study

2011-04-25

Abstract: Previous studies have shown a paradoxical increase in early mortality in older patients (>70 years) with acute STEMI treated with fibrinolytic therapy (FT), which has been attributed to the development of free wall rupture (FWR). Our aim was to assess occurrence of FWR in STEMI patients receiving FT. In this 7-year prospective study, data from 1701 consecutive patients were obtained. We analyzed predictors of the in-hospital mortality in patients>70 years old. The independent contribution of several variables to overall mortality and FWR development was assessed using multiple logistic regression analyses. The mortality of entire cohort was 18% (306/1701). Diabetes mellitus, anterior infarction, smoking, female gender and hypercholesterolemia were independent predictors of in-hospital mortality. FT was given to 18% of all patients (304/1701) of which 13% died (39/304). FWR was 18.4-times more often in patients who received FT. Among patients younger than 70 years who received FT there was no FWR, while in patients ≥70 years of age FWR was found in almost half of the deceased (30/68; 44%). Application of FT in STEMI patients is not associated with higher mortality, but significantly increases number of FWR, especially in patients over 70 years of age.