Archives of Gerontology and Geriatrics - Articles in Press

Inflammatory biomarkers as predictors of hospitalization and death in community-dwelling older adults - Corrected Proof

2012-02-06

Abstract: Individuals with multimorbidity may be at increased risk of hospitalization and death. Comorbidity indexes do not capture severity of illness or healthcare utilization; however, inflammation biomarkers that are not disease-specific may predict hospitalization and death in older adults. We sought to predict hospitalization and mortality of older adults using inflammation biomarkers. From a prospective, observational study, 370 community-dwelling adults 65 years or older from central Alabama participated in an in-home assessment and provided fasting blood samples for inflammation biomarker testing in 2004. We calculated an inflammation summary score (range 0–4), one point each for low albumin, high C-reactive protein, low cholesterol, and high interleukin-6. Utilizing Cox proportional hazards models, inflammation summary scores were used to predicted time to hospitalization and death during a 4-year follow up period. The mean age was 73.7 (±5.9 yrs), and 53 (14%) participants had summary scores of 3 or 4. The rates of dying were significantly increased for participants with inflammation summary scores of 2, 3, or 4 (hazard ratio (HR) 2.22, 2.78, and 7.55, respectively; p<0.05). An inflammation summary score of 4 significantly predicted hospitalization (HR 5.92, p<0.05). Community-dwelling older adults with biomarkers positive for inflammation had increased rates of being hospitalized or dying during the follow up period. Assessment of the individual contribution of particular inflammation biomarkers in the prediction of health outcomes in older populations and the development of validated summary scores to predict morbidity and mortality are needed.

Corrigendum to “Independence of elderly patients with arterial hypertension in fulfilling their needs, in the aspect of functional assessment and quality of life (QoL)” [Arch. Gerontol. Geriatr. 52 (2011) e204–e209] - Corrected Proof

2012-02-02

The authors regret that Agnieszka Kotkiewicz was omitted from the authorship list, which should therefore read: Marta Muszalika,*, Ate Dijkstrab, Kornelia Kędziora-Kornatowskaa, Halina Zielińska-Więczkowskac, Tomasz Kornatowskid, Agnieszka Kotkiewicze

Tooth loss and edentulism in the Turkish elderly - Corrected Proof

Bahar Güçiz Doğan, Saadet Gökalp — 2012-01-31

Abstract: The aim of this study was to evaluate partial and complete tooth loss and some related demographic factors, and oral health behaviors among Turkish elderly. According to recent censuses, elderly population of Turkey is rapidly growing. There is no nationwide information related to edentulism and natural teeth retention among 65–74 year-old people in Turkey. In this nationwide representative cross-sectional study, 1545 subjects aged 65–74 years were evaluated using the proportional stratified cluster sampling method. The data were collected via a structured, pre-tested face to face administered questionnaire and an oral examination. Chi-square test and binary logistic regression analyses were used to determine the significance of explanatory variables. 48.0% of elderly were edentate. The mean DMF-T was 25.8±8.5. These values were higher in women (p=0.016), older age (p<0.001) and rural individuals (p<0.001). Only 12.4% of the subjects had functional dentition. Age, visiting dentist, and health security were associated with edentulism. Female sex (OR=1.37), 70–74 age group (OR=2.08) and illiteracy (OR=3.25) were the independent factors of not having functional dentition. A reduction in edentulism in elderly may be achieved by the implementation of community programs promoting oral health for the prevention and treatment.

Effects of dual-task switch exercise on gait and gait initiation performance in older adults: Preliminary results of a randomized controlled trial - Corrected Proof

2012-01-30

Abstract: Few studies have reported the effect of exercise intervention for improving postural control deficit in older adults at high risk of falling. We have developed a “Dual-task Switch Exercise (DSE)” program that focuses on gait initiation performance under the dual-task condition. The purpose of this study was to evaluate whether gait initiation performance could be improved by a specific exercise intervention. Eighteen participants were randomly assigned to either DSE or control groups. The DSE group received focused training to improve the ability to initiate movements quickly under the dual-task condition. The control group received steady-state walking training. After 30-min of seated training sessions, participants received 5-min individualized training sessions once a week for 24 weeks. In the pre- and post-training period, performance of the steady-state gait (10-m walking time) and gait initiation (reaction time, backward center of pressure (COP) displacement) were measured under the single- and dual-task conditions. The results of a randomized clinical trial showed that both groups showed improvement of steady-state walking time under the dual-task condition (main effect of time; p=0.018). However, DSE was more effective in improving both the reaction time and backward COP displacement during gait initiation under the dual-task condition than control (interaction effect of time×group; reaction time, p=0.015; COP displacement, p=0.011). There were no significant differences in steady-state gait and gait initiation performance under the single-task condition between pre- and post-training in both groups. Only the specific exercise intervention improved gait initiation performance under the dual-task condition.

Transcranial sonography (TCS) in Parkinson's disease (PD) and essential tremor (ET) in relation with putative premotor symptoms of PD - Corrected Proof

2012-01-25

Abstract: Background: Hyperechogenicity of substantia nigra (SN+) is a common finding in transcranial ultrasound studies of parkinsonian patients. However, this feature is also found in 13–16% of ET patients. The possible links between ET and PD are of special interest, particularly with the familial aggregated data supporting this association. However, few studies have been conducted regarding the factors associated with the emergence of PD in the ET population. In this study, we investigated the possible association between SN+ and putative premotor symptoms of PD in patients with ET. Methods: A total of 47 patients with PD and 64 patients with ET were enrolled in the study. All patients underwent TCS and completed a structured interview for putative premotor symptoms of PD. Results: As expected, there were significant differences observed in the frequency and size of SN+, and the prevalence of the putative premotor symptoms of PD. More interestingly, in the ET group a significant association between SN+ and each premotor symptom was observed and a trend was also found that ET cases with more putative premotor symptoms of PD had a greater size of SN+. In contrast, in the PD group, SN+ was not influenced by the cumulative effect of premotor symptoms. Conclusion: The results of this study suggest that SN+ in patients with ET is influenced by the putative premotor symptoms of PD.

The prevalence and detection of chronic kidney disease (CKD)-related metabolic complications as a function of estimated glomerular filtration rate in the oldest old - Corrected Proof

2012-01-20

Abstract: Background: The prevalence of CKD rises with age. The prevalence of CKD-related metabolic complications in the oldest old in relation to different GFR estimations is largely unknown. eGFR-based thresholds for the detection of these complications remain uncertain.Methods: A cross-sectional analysis embedded within the BELFRAIL study, a population-based prospective cohort study of the oldest old in Belgium, was performed. The prevalence of anemia, elevated serum parathyroid hormone (PTH), high serum phosphorus and low uncorrected serum calcium was analyzed in relation to GFR estimated by three serum creatinine-based equations and one cystatin C-based equation.Results: 567 patients aged 80 and over were included (63% women). The prevalence of anemia, elevated PTH and high phosphorus showed an inverse relationship with eGFR. This relationship remained after logistic regression analysis adjusting for demographics and co-morbidity. No such relationship between low calcium and eGFR was found. Using an eGFR of 60ml/min/1.73m2 modification of diet in renal disease equation (MDRD) as screening threshold for metabolic complications would result in a high incidence of missed complications: 29%, 28% and 40% for anemia, elevated PTH and high phosphorus, respectively.Conclusion: The presence of anemia, an elevated PTH or an elevated serum phosphorus level increased with lower eGFR but even among patients with an eGFR >60ml/min/1.73m2, these complications are common. Thus this eGFR cut-off appears inadequate for patients aged 80 and over. How the oldest old may be screened appropriately for these CKD-related complications requires further investigation.

Corrigendum to “Breast cancer in elderly women” [Arch. Gerontol. Geriatr. 39 (2004) 291–299] - Corrected Proof

Nebojsa Djordjevic, Aleksandar Karanikolic, Miomir Pesic — 2012-01-18

The authors apologize for reproducing several sections of text from two articles published in the Journal of the National Cancer Institute and The American Journal of Surgery. They also acknowledge that these articles should have been cited. The authors apologize to the authors and publishers of these articles for their error in reproducing text without any attribution.

Orthostatic hypotension (OH) and mortality in relation to age, blood pressure and frailty - Corrected Proof

Michael R.H. Rockwood, Susan E. Howlett, Kenneth Rockwood — 2012-01-12

Abstract: Systolic hypertension and OH, as with many other deficits, accumulate with age. This deficit accumulation results in frailty: enhanced vulnerability to adverse outcomes. This study evaluated OH in relation to age, frailty, systolic hypertension, and mortality. In the population-based Canadian Study of Health and Aging second clinical examination, complete data were available on 1347 people, mean age=83.3 (SD=6.4)years. A frailty index (FI) was calculated from a 52-item Comprehensive Geriatric Assessment (CGA), yielding an FI-CGA from 0 (no deficits) to 1.0 (52 deficits). The mean change in blood pressure from lying to standing was 7.3±15.6mmHg (range +94 to −60). In total, 239 people (17.7%) had OH (change >20mmHg systolic or >10mmHg diastolic). Mean systolic blood pressure was higher (155.8±23.3mmHg) in people with OH than in those without (141.4±23mmHg), as was the FI-CGA (0.18 vs. 0.16). OH increased with frailty and systolic hypertension, but not age. Unadjusted, OH was associated with an increased risk of death (relative risk=1.21, 95% confidence interval 1.19–1.23). Adjusted for frailty, this result was not significant. OH may be a marker of the system dysregulation seen in frailty, but as a state variable is a less powerful marker of vulnerability than is the FI-CGA.

Yearly transitions of disability profiles in older people living at home - Corrected Proof

2012-01-06

Abstract: Purpose: Planning home services for older people requires extensive knowledge about the progression of disabilities. Disability-based case-mix classifications identify meaningful groups of older people; yet transitions between profiles are mostly unknown.Methods: Disability was assessed annually over four years with the Functional Autonomy Measurement System (SMAF) in 1410 older people at risk of functional decline aged 75 and over and living at home. The SMAF generates a case-mix classification of 14 Iso-SMAF profiles with progressive mean disability levels. Transitions made by older people were analyzed using a continuous-time, multi-state Markov model to estimate the probabilities of annual transitions into and out of each profile as well as the mean sojourn time in each profile.Results: The probability of staying in a profile tended to decrease as profile severity increased. For profiles 5 and above, recovery to mild profiles 1, 2 and 3 was low, while annual probabilities of death and institutionalization were high (>0.10). The lower disability profiles (1 and 2) evidenced a mean profile sojourn time of over two years, contrary to sojourn times of 18 months or less with the other profiles.Conclusions: The probabilities are identifiable, indicating that a disability-based classification can characterize progression in older people. Since the required resources and costs are known for each profile, these probabilities are very helpful in planning home services for elderly populations.

Determinants of cognitive performance among community dwelling older adults in an impoverished sub-district of São Paulo in Brazil - Corrected Proof

2012-01-05

Abstract: Determinants of cognitive performance in old age have received limited attention in Latin America. We investigated the association of socio-demographic and health-related variables with cognitive performance in a sample of older adults with limited educational experience living in a poor sub-district of the city of São Paulo. This was a cross-sectional population-based study which included a sample of 384 seniors 65 years and older. Cognition was assessed by the Mini-Mental State Examination (MMSE) and the Brief Cognitive Screening Battery (BCSB) (episodic memory test with 10 pictures, verbal fluency (VF), Clock Drawing Test (CDT)). Results indicated that age, sex, schooling, depressive symptoms, and systolic blood pressure (SBP) level had a significant impact on the cognitive performance of the sample. Therefore, pharmacological and psychosocial interventions with a focus on improving mood and controlling hypertension may have beneficial effects on cognition among seniors with similar socio-demographic characteristics.

Mini-Nutritional-Assessment (MNA) without Body Mass Index (BMI) predicts functional disability in elderly Taiwanese - Corrected Proof

Li-Chin Lee, Alan Chung-hong Tsai — 2012-01-05

Abstract: Nutritional status and functional ability are mutually dependent especially in the elderly. This study examined the functional status-predictive ability of the MNA in a cross-sectional study. We analyzed the dataset of the “Survey of Health and Living Status of the Elderly in Taiwan” (SHLSET). Subjects were 2948≥65 year-old persons who were rated with the long-form (LF) and short-form (SF) MNA with or without BMI for the risk of malnutrition, and with the Activities of Daily Living (ADL) and the Instrument Activities of Daily Living (IADL) for functional status. The ADL and IADL scores were calculated according to rated nutritional status. Receiver Operating Characteristic (ROC) curves were generated for ADL and IADL status predicted by the MNA. Logistic regression was performed to evaluate the association of rated MNA scores with ADL or IADL status. Results showed that both SF and LF of MNA-T1 and T2 were able to predict ADL and IADL disabilities. Those who were rated malnourished or at risk of malnutrition had drastically higher risk of ADL or IADL dependency compared to those who were rated normal. The SF versions performed well in rating nutritional status and predicting ADL and IADL status. Overall, MNA-T2-SF performed at least equally well as MNA-T1-SF in rating functional decline. These results suggest the MNA is able to predict functional decline of the elderly. MNA-T2, especially the SF, a version without BMI should be particularly useful in clinical, long-term care and community settings.

Obesity and use of compensatory strategies to perform common daily activities in pre-clinically disabled older adults - Corrected Proof

Kelly M. Naugle, Torrance J. Higgins, Todd M. Manini — 2012-01-03

Abstract: Objectives: To examine the association between the use of compensatory strategies to successfully complete common daily activities—an indicator of pre-clinical disability—and body mass in pre-clinically disabled older adults.Design: Cross-sectional observational study.Participants: Two hundred and fifty-nine pre-clinically disabled older adults defined as having changed the frequency or manner of performing daily tasks without reporting any difficulty.Measurements: The use of compensatory strategies were objectively evaluated using the Modification (MOD) scale—a reliable and valid scale for assessing the manner in which common daily activities were completed. Height and weight were measured to classify participants into the following body mass index (BMI) categories: (1) normal: 18.5–24.9kg/m2, (2) overweight: 25.0–29.9kg/m2, (3) obese class I: 30.0–34.9kg/m2, and (4) obese class II: 35.0–39.9kg/m2.Results: Compared to other BMI categories, individuals with class II obesity demonstrated a significantly higher probability of using ≥1 compensatory strategies when rising from a chair (30cm height), kneel to stand, stair ascent, stair descent, and supine to stand tasks. When summarized over all tasks, individuals with class II obesity were 18 times more likely to use extensive compensatory strategies (≥6 on MOD scale) compared to normal weight older adults. Similar trends at a lesser magnitude were found in obese and overweight compared to normal weight older adults.Conclusion: Obesity is associated with extensive use of compensatory strategies when performing common daily tasks prior to the onset of perceived difficulty, thus placing them at higher risk of disability compared to their peers with lower body mass.

Perceptual and motor inhibitory abilities in normal aging and Alzheimer disease (AD): A preliminary study - Corrected Proof

David Stawarczyk, Julien Grandjean, Eric Salmon, Fabienne Collette — 2012-01-03

Abstract: Deficits in inhibitory abilities are frequently observed in normal aging and AD. However, few studies have explored the generality of these deficits in a single group of participants. A battery of tasks assessing perceptual and motor inhibitory functioning was administered to young and older healthy participants (Study 1), as well as to mild Alzheimer patients (Study 2). Results did not agree with a selective impairment of motor or perceptual inhibition in either AD or normal aging but rather suggest that a decrease in cognitive resources available in working memory could explain inhibitory performance both in normal aging and AD.

A comparison of physical activity (PA) assessment tools across levels of frailty - Corrected Proof

Olga Theou, Jennifer M. Jakobi, Anthony A. Vandervoort, Gareth R. Jones — 2012-01-03

Abstract: Purpose: Determine which PA assessment tools are most closely related to frailty and whether PA is different across levels of frailty.Methods: Fifty community-dwelling Greek older women (63–90years) participated in this study. PA was measured objectively over 10h using an accelerometer, a heart rate (HR) monitor, a portable electromyography (EMG) unit, and a global positioning system (GPS) and subjectively using the short version of the Minnesota Leisure Time Activity Questionnaire (MLTAQ). Participants were divided into three tertiles based on level of frailty as calculated from a Frailty Index (FI): low FI group (<0.17 FI); intermediate FI group (0.17–0.38 FI); and high FI group (>0.38 FI).Results: Accelerometer step counts had the strongest correlation with frailty and were different across levels of frailty. The percentage of time engaged in PA was 31±15% when PA was determined using an accelerometer. Forty-five percent of the variability in the FI was explained by a combination of PA assessment tools including; accelerometer, EMG, GPS, and MLTAQ. The individual contribution of EMG determined activity from the biceps brachii (BB) to the FI prediction was 16%. Accelerometer contributed an additional 10% and time engaged in PA, as assessed with the MLTAQ, added an additional 6% to the prediction of FI score.Conclusions: PA assessment tools, when used in combination, provide important information about the PA accumulation of older women across levels of frailty.

Dose-dependent effect of rehabilitation in functional recovery of older patients in the post-acute care unit - Corrected Proof

2011-12-30

Abstract: Post-acute care (PAC) is of great importance to promote functional recovery of older patients, which should be provided by the interdisciplinary team. In PAC services, rehabilitative therapy plays a key role, but the optimal intensity for rehabilitative therapy remained unclear. Between July 2007 and December 2010, all patients with functional decline after acute illness hospitalization admitted to the PAC unit of a community hospital in Taiwan were enrolled. Usual rehabilitation program, 40-min per day and five days a week, was provided to all patients before April 2009. After April 2009, the rehabilitative therapy was increased to 80min per day. Functional improvement was measured by comprehensive geriatric assessment (CGA) at admission and 4 weeks after admissions to the PAC unit. Overall, 458 patients (mean age: 83.4±5.5 years, all males) completed PAC services. Compared of all dimensions in CGA, increased dosage of rehabilitative therapy showed significantly better improvement in daily living activities (Barthel index (BI): 28.8±18.4 vs. 20.0±14.6, p<0.001), depressive mood (geriatric depression score short form (GDS): −0.5±1.0 vs. −0.1±0.5, p<0.001), and pain reduction (numerical rating scale (NRS): −2.0±2.2 vs. −0.9±2.1, p=0.01); but not in cognitive function (mini-mental status examination (MMSE): 2.9±3.3 vs. 3.3.±5.2, p=0.305), and nutritional status (body mass index (BMI): 0.3±0.9 vs. 0.3±2.5, p=0.9). In conclusion, intensive rehabilitative therapy significantly promote physical and psychological function with pain reduction, which deserves further investigations to evaluate whether there is a ceiling effect of rehabilitative therapy in PAC services.

A long-term follow-up of 221 hip fracture patients in southeastern Finland: Analysis of survival and prior or subsequent fractures - Corrected Proof

2011-12-30

Abstract: To analyze the type and effect of prior and subsequent fractures in a hip fracture cohort. Materials and methods: Hip fracture patients (n=221) were followed for a mean of 8 years and all prior and subsequent fractures were studied. Incidence of the first fracture and subsequent fractures according to sex, age group, and time between the first and the index hip fracture were measured. The absolute fracture risk was measured in the study subjects and in the age groups <75 years and ≥75 years. Patients’ survival was analyzed with the life-table method. Results: One third of the hip fracture patients had sustained previous fractures. In men, these were mostly ankle or hip fractures, and in women, wrist fractures. Of the subjects, 24% suffered a subsequent fracture, which in both sexes was usually a second hip fracture. At the end of the 8-year follow-up, 74% of the patients had died. The observed absolute fracture risk was 7% at one year and 24% at 5 years. In women, excess mortality was lowest during the first 4.8 years after the index hip fracture among patients with one fracture. However, it was highest among women with two fractures. In men, excess mortality was lowest among those with two fractures and highest among those with ≥3 fractures. There were no differences between the genders in sustaining subsequent fractures. Conclusions: The fracture risk subsequent to hip fracture was similar in both genders. Patients with prior hip fractures had the worst survival rate.

The effects of group reminiscence therapy on depression, self-esteem, and affect balance of Chinese community-dwelling elderly - Corrected Proof

Wenjuan Zhou, Guoping He, Jing Gao, Qun Yuan, Hui Feng, Clarence K. Zhang — 2011-12-30

Abstract: Objectives: To study the effects of group reminiscence therapy on depressive symptoms, self-esteem, and affect balance among community dwelling elderly.Methods: Eight communities were randomly selected from 372 eligible communities in Changsha city. They were randomly divided into four experimental groups and four control group. Geriatric Depression Scale (GDS) was used to screen entire 478 older adults living in these 8 communities. One hundred and sixty five of them had a GDS score between 11 and 25; among them, 125 participated in the study finally. The elderly group who were in the control group received health education, while the intervention group received both health education and group reminiscence therapy for 6 weeks. Both groups were assessed with the GDS, Self-Esteem Scale (SES), and Affect Balance Scale (ABS) before and after the 6-week-intervention. The results were analyzed using a mixed effect model with fixed effect of the intervention and random effect of the community, incorporating the structured randomness at the community level.Results: After 6 weeks’ therapy, the GDS scores in the intervention group decreased significantly compared to those in the control group (p<0.001). Scores on the positive affect subscale and affect balance in the intervention group increased significantly higher than control group, and scores on the negative affect subscale decreased significantly lower than control group (p<0.01). After the intervention, there were no statistically significant differences in self-esteem scores between intervention and control groups.Conclusions: Group reminiscence therapy was effective in reducing symptoms of depression, improving affect balance, and promoting mental health of community-dwelling elderly.

The relationship between apolipoprotein (apo) E polymorphism and lipid changes: An 8-year cohort study in Beijing elderly persons - Corrected Proof

2011-12-29

Abstract: This study aimed to investigate the influence of apoE genetic polymorphism on serum lipid changes in a community-based elderly population in China in an 8-year period, in which 746 individual, aged 65.29±6.85 years (mean±standard deviation (SD)) were enrolled and serum lipid parameters were checked at baseline. After 8 years, serum lipids as well as apoE genotypes were measured. The frequencies of apoE allele were 9.4%, 81.7%, and 8.9% for ɛ2, ɛ3 and ɛ4, respectively. After the population was divided into 3 groups by different apoE allele carriers, the apoE allele carriers for ɛ2, ɛ3 and ɛ4 were 121 (16.2%), 513 (68.8%) and 112 (15.0%), respectively. Levels of total cholesterol (TC) and low density lipoprotein (LDL) in ɛ2 carriers were lower comparing with that of ɛ3 allele carriers at baseline. 8 years later, TC and high density lipoprotein (HDL) elevated and LDL decreased with aging in this population (p<0.01). The changes of TC levels were smaller in ɛ2 allele carriers as compared to that of ɛ3 allele carriers. The difference was still statistically significant after controlling for age, sex, smoking status, drinking habit, body mass index (BMI) and baseline TC level. The same trend of changes was noted for LDL between ɛ2 and ɛ3 allele carriers. However, no significant differences were noted between ɛ4 and ɛ3 allele carriers on lipid changes. This community-based study shows that ɛ2 allele is helpful on lipid changes. The effect of ɛ4 allele on lipid change is not strong in this elderly population. Genetic and environmental factors maybe co-operate on lipid metabolism in elderly persons.

Is a composite score of physical performance measures more useful than usual gait speed alone in assessing functional status? - Corrected Proof

2011-12-26

Abstract: Overall physical performance can be represented by a composite score that is derived from upper and lower extremity performance measures. We aimed to identify whether composite scores of performance measures, particularly the lower extremity performance (LEP) score, upper extremity performance (UEP) score, and an overall score, are more accurate than usual gait speed (UGS) for assessing a wide range of functional status. We conducted a cross-sectional analysis on data from 701 community-dwelling older women (mean age 74.3 years). Trained testers measured UGS and the seven tests included in the composite scores. Using self-reported questionnaires, we assessed multiphasic functional status: physical function, higher-level functional capacity, mobility limitation, activities of daily living (ADLs), and falls. We compared the areas under the receiver operating characteristic curves (AUCs) of UGS with LEP, UEP, and overall scores for each status. We found no significant differences between the AUCs of UGS and LEP score for each status. The UEP score had significantly smaller AUCs for low physical function (0.73) and mobility limitation (0.78) than UGS alone (0.81 and 0.85, respectively), and the differences were substantial. Although the overall score had significantly greater AUCs for low higher-level functional capacity (0.83) and ADLs disability (0.83) than UGS alone (0.78 and 0.80, respectively), the differences were only 3–5%. The UGS should not be regarded solely as a measure of lower extremity function; this single test may represent overall physical performance. The UGS alone, which can be measured quickly and easily, suffice for assessing a wide range of functional status in older women.

Time to surgery and rehabilitation resources affect outcomes in orthogeriatric units - Corrected Proof

2011-12-19

Abstract: Objective: To compare the pathways of care and clinical results for patients admitted for hip fracture (HF) in 3 orthogeriatric co-managed care centers in order to estimate the effect of system factors on mortality and functional outcome. Design: Prospective inception multicenter cohort study. Setting: Three tertiary Hospitals. Participants: 806 patients consecutively admitted with HF. Measurements: 1-Year mortality, the loss of 1 or more functional abilities in activities of daily living (ADLs), and the recovery/maintenance of independent ambulation at 6 months from the fracture. Results: On the whole sample, 71.1% of patients survived 1 year from the fracture. In one hospital the risk of 1-year mortality was significantly higher even after adjusting for age, sex, comorbidity, prefracture functional status and cognitive impairment (odd ratio (OR) 1.56, 95% confidence interval (CI) 1.15–2.18, p=0.01). This was principally explained by a longer time to surgery (5.2 days±3.2 vs 2.7±2.3 and 2.7±2.2, p<0.001). The three hospitals also differed in the rate of subjects losing the ability in ADLs after 6 months from the fracture (54.2%, 61%, 43.5%, p=0.016), while no statistical differences were found in the recovery of independent ambulation. On the basis of multivariate models, a lower access to post-acute rehabilitation could account for lower outcome in functional status. Conclusions: This study suggests that system factors such as time to surgery and rehabilitation resources can affect functional recovery and 1-year mortality in orthogeriatric units and they could explain different outcomes when comparing care models.

Outcome and quality of life of elderly critically ill patients: An Italian prospective observational study - Corrected Proof

2011-12-19

Abstract: The demand of critical care admissions to intensive care unit (ICU) is projected to rise in the next decade. The aim of this study was to evaluate short and long-term mortality and quality of life (QoL) of elderly patients (80 years and older) admitted to two ICUs for medical conditions, abdominal surgery (planned and unplanned) and orthopedic surgery for hip fractures, over a 6-year period. Three months and one year after ICU discharge, patients or family members were contacted by telephone to obtain follow-up information using the EuroQoL questionnaire. The data were compared with an age-matched of the Italian population. Two hundred eighty-eight patients were included in the study. ICU mortality of medical (14.8%) and unplanned surgical patients (26.4%) was higher than that of planned surgical (5.0%) and orthopedic patients (2.5%), as was hospital mortality (27.7% vs. 50.0% vs. 5.0% vs. 14.3%). Three months and 12 months mortality rates after ICU discharge were 40.7% and 61.1% in medical patients, 70.5% and 76.4% in unplanned surgical patients, 20.0% and 30.0% in planned surgical patients, 36.2% and 46.2% in orthopedic patients. QoL measures revealed that, one year after ICU discharge, medical and orthopedic patients had significantly more severe problems vis-à-vis mobility, self-care and activity than abdominal surgical patients and control population. Type of admission was the independent risk factor associated with ICU and long-term mortality, whereas age 90 year and older was associated with long-term mortality. Orthopedic surgery for hip fractures seems to influence QoL similar to medical diseases.

Intracranial deep white matter lesions (DWLs) are associated with chronic kidney disease (CKD) and cognitive impairment: A 5-year follow-up magnetic resonance imaging (MRI) study - Corrected Proof

2011-12-16

Abstract: Stroke incidence and cognitive decline are related to progression of arteriosclerosis in intracranial DWLs. However, the relationships between DWLs and factors associated with their progression, including CKD, have not been fully elucidated using longitudinal MRI. Of 291 individuals (184 males, 107 females; age 66.9±6.1 years) who had voluntarily participated in a hospital-based health check-up and underwent repeated brain MRI scans in 2003 and 2008, 273 were evaluated in this study. The DWL group included those having DWL without progression, and the DWL progression (DWLP) group included those having an increase in grade number according to the Fazekas classification. Unimpaired age-matched subjects with no brain MRI abnormalities constituted Group C. The Mini-Mental State Examination (MMSE) and verbal fluency tasks were used for objective cognitive evaluations according to the MR evaluation schedule in 2008. Associations between DWLs and vascular risk factors were examined. DWLP occurred in 9.2% of subjects. Compared to Group C subjects, DWL and DWLP group subjects had high odds ratios (ORs) for hypertension (HT) (2.23 and 2.92, respectively) and CKD (1.40 and 2.41, respectively). After adjustment for potential confounders, the ORs of CKD for DWLs remained significant (1.13 and 1.43, p<0.05). DWLs and DWLP were associated with low cognitive scale scores and increased CKD. In conclusion, CKD was associated with DWLs and DWLP as an independent risk factor and a lower level of cognitive function 5 years after CKD was identified. Successful CKD therapy may be expected to prevent DWLP.

Using detrended fluctuation analysis (DFA) to analyze whether vibratory insoles enhance balance stability for elderly fallers - Corrected Proof

Chien-Chih Wang, Wen-Hung Yang — 2011-12-14

Abstract: Falls are a common and devastating problem among elderly people. In a previous study, vibratory insoles were developed to improve postural stability for elderly fallers. To verify the effects of vibratory insoles, a two-stage experiment was conducted to collect center of pressure (COP) signals from 26 elderly fallers and 16 healthy young subjects while standing still. The DFA is used to analyze the behavior of different time-series data obtained from the trajectory of COP. Postural stability was compared by the DFA scaling exponent between a control condition (before using vibratory insoles) and a vibration condition (after using vibratory insoles). For elderly fallers, DFA scaling exponents 95% confidence interval were [1.434, 1.547] and [1.329, 1.451] under control and vibration conditions in the anteroposterior (AP) direction, respectively. The experimental results revealed that temporary stimuli of appropriate amplitude produced by vibration insoles enhanced postural stability in elderly fallers and was more obvious in the AP direction.

Salivary cortisol and frailty syndrome in elderly residents of long-stay institutions: A cross-sectional study - Corrected Proof

2011-12-12

Abstract: Analyze the relationship between frailty and cortisol in elderly residents of long-stay institutions. A cross-sectional study was conducted in the city of João Pessoa-PB-Brazil, on a sample of residents of long-stay institutions. Data were collected on frailty phenotype (weight loss, fatigue, slowness, weakness and low physical activity) and salivary cortisol (first measurement between 6 and 7a.m.; second measurement between 11 and 12a.m.; third measurement between 4 and 5p.m.). Statistical analysis applied Pearson's correlation test, Chi-square test, ANOVA and linear regression. The sample was composed of 69 elderly subjects, 37.7% men and 62.3% women, with a mean age of 77.5 (±7.8) years. The percentage of frail elderly was 45.8%. Frail aged subjects achieved higher cortisol values on the third measurement (p=0.04) and frailty load was significantly associated to the first measurement (r=0.25, p=0.04). Simple linear regression analysis showed a rate of determination (R2=0.05) between frailty load and the first cortisol measurement. Greater cortisol values in the morning and before bed among frail aged individuals suggest a positive correlation may exist between cortisol levels and frailty in elderly residents of long-stay institutions.

The effect of intra-articular hyaluronic acid treatment on gait velocity in older knee osteoarthritis patients: A randomized, controlled study - Corrected Proof

2011-12-12

Abstract: Purpose: To determine the effect of intra-articular hyaluronic acid (HA) on gait velocity, pain, and function, in older knee osteoarthritis (OA) patients. Materials and methods: Thirty knee OA patients (Kellgren–Lawrence II–III) [72.44 (±6.11) years old] were randomized, using the ‘RANDBETWEEN’ function in Microsoft Excel, to receive three weekly injections of HA (2ml of 20mg/ml HA), or placebo (P) (1.2ml of 0.001mg/ml HA), with fifteen participants per group. Patients and assessors were blind to treatment. Self-selected and fast gait velocities were measured with the GAITRite® system. Knee pain, stiffness, and physical function were measured with the Western Ontario McMaster Osteoarthritis OA index (WOMAC OA index). Data from 1 week, 3 and 6 months post-treatment were analyzed using repeated measures ANOVA. Results: The HA group significantly improved self-selected and fast gait velocity, while the P group only significantly improved self-selected gait velocity. Mean improvements in self-selected gait velocity [Mean (SD); 95% CI] [1.25 (52.4)cm/s; −18.38; 20.88] and fast gait velocity [7.16 (71.75)cm/s; −19.72; 34.04] were not significantly different between groups. Improvements in WOMAC pain scores were significantly greater in the HA group than the P group [−2.47 (6.39); −4.86; −0.08], while improvements in stiffness [−0.87 (2.42); −1.77; 0.04] and physical function [−7.23 (19.77); −14.63; 0.16] scores were not. Conclusions: The overall effect of HA on gait velocity in older knee OA patients was not significant compared to placebo. The preliminary results of improved fast gait velocity following HA treatment should be investigated further, along with the incidence of falls, in a larger sample of older knee OA patients.ClinicalTrials.gov ID: NCT00778076.

Gender and the functional outcome of elderly ischemic stroke patients - Corrected Proof

E.H. Mizrahi, A. Waitzman, M. Arad, A. Adunsky — 2011-12-09

Abstract: The purpose of this study was to investigate the effect of gender on the functional outcome after ischemic stroke. In a retrospective chart review we studied 919 survivors of ischemic stroke admitted for rehabilitation at a geriatric rehabilitation ward of a university affiliated hospital. Functional outcome of female and male patients was assessed by Functional Independence Measurement (FIM™) at admission and discharge. Data were analyzed by t test, Chi-square test and Linear Regression. A total number of 919 patients were admitted of whom 56% were males. A higher proportion of male patients reported ischemic heart disease (p<0.001), hypercholesterolemia (p=0.035), Parkinson‘s disease (p=0.044), and previous stroke (p<0.001). Males had also higher Mini-Mental State Examination (MMSE) scores (p<0.001). Total FIM at admission (62.54±25.98 and 66.00±25.49; p=0.043), and total FIM at discharge (80.39±30.35 and 85.59±29.08; p=0.008), motor FIM at admission (40.04±18.89 and 42.51±18.47; p=0.047) and motor FIM at discharge (56.41±23.04 and 60.44±21.84; p=0.007) were higher among male patients. However, a trend for a borderline statistical difference was observed for FIM gains upon discharge between men and women. A multiple linear regression analysis showed that total FIM at discharge was neither associated with male nor female gender (β=−0.009; p=0.69). The findings suggest that the functional outcome of male survivors presenting for rehabilitation after acute ischemic stroke is slightly better. After adjusting for possible covariates, gender did not emerge as an independent predictor for higher FIM at discharge, suggesting that gender should not be held as adversely affecting rehabilitation of such patients.

Morbidity in aged Finns: A systematic review - Corrected Proof

Marika Salminen, Ismo Räihä, Jarna Heinonen, Sirkka-Liisa Kivelä — 2011-12-07

Abstract: Aim: The aim was to carry out a systematic review of original studies about morbidity in the aged in Finland. Methods: Publications with data on morbidity in the aged (≥65 years) in peer-reviewed scientific journals in Finnish and English were systematically searched for in literature databases, websites of National Institute of Health and Welfare (NIHW), National Public Health Institute (NPHI), and Stakes and reference lists of retrieved articles. Publications from 1990 onwards were included. Results: The search produced 39 publications about morbidity in the aged in Finland fulfilling the inclusion criteria. The most common disease categories in the aged were cardiovascular diseases (CVDs), musculoskeletal disorders (MSDs), hypertension, orthostatic hypotension (OH), insomnia, diabetes, articular diseases, diseases causing cognitive decline, and depression. The prevalence of many of these diseases increased with age. Conclusions: The morbidity increases with aging, and even the oldest-old are not exceptionally healthy. Because of the increasing number of aged people, the absolute use of health and social services by this population sector will most probably increase in Finland and other developed countries.

Social inequality in dynamic balance performance in an early old age Spanish population: The role of health and lifestyle associated factors - Corrected Proof

2011-12-06

Abstract: This study investigates the association between socioeconomic status (SES) and dynamic balance performance and whether lifestyle factors explained any possible associations. A total of 448 nondisabled individuals, age-range 54–75years and enrolled in the Active Aging Longitudinal Study of Spain in 2006, constituted the study population. Baseline data of this cross-sectional study were obtained by personal interviews and objective measures of balance performance. The present study shows an educational gradient in poor dynamic balance, where individuals with no formal education had higher risk of poor balance, also after adjustment for age, gender, obesity and physical activity. In addition, obesity and sedentary physical activity were related to poor dynamic balance. The findings suggest an independent effect of both SES and behavioral factors on poor balance performance in the older Spanish population.

Selective upregulation of p66-Shc gene expression in the liver and brain of aged rats - Corrected Proof

Kiyoaki Sone, Mari Mori, Nozomu Mori — 2011-11-30

Abstract: The phosphotyrosine signaling followed by various receptor activations conforms a unique signaling platform during metazoan evolution, and is crucial for animal development, maturation, and aging. Shc is the most versatile bipartite phosphotyrosine signal adaptor harboring phosphotrosine-biding (PTB) and Src-homology2 (SH2) domains. Among the Shc adaptor family members, p66-Shc is of potential interest in aging studies, since its deletion in mice resulted in a longer lifespan and/or higher quality of life in later stages of life. However, a few studies have examined the gene expression profiles of p66-Shc in aging tissues. Here, we quantified the expression levels of transcripts of Shc-related isoforms in the liver and brain of young adult, middle-aged, and aged rats, and found that p66-Shc gene expression is specifically up-regulated in the aged liver and brain. In the aged liver tissue, p66-Shc expression was also evident at the protein level, and accumulated in the soluble fraction of the aged tissue. These results indicate that p66-Shc is not only related to animal longevity but also affected during aging, and thus the repression of p66-Shc could become a potential target for an anti-aging strategy.

The association between physical disability and eye care utilization among elderly population in Taiwan: A nationwide cohort study - Corrected Proof

2011-11-28

Abstract: Medical utilization by elderly population is influenced by a number of factors, and physical disabilities may play an important role. Despite the fact that extensive studies have been carried evaluating medical utilization by older individuals, little is known regarding the impact of physical disabilities on eye care utilization. Using datasets from the Taiwan National Health Interview Survey and National Health Insurance (NHI) system, a sample of 1726 elderly people was obtained for analysis. Older persons with worse Activity of Daily Living (ADL) disabilities were less likely to have eye care (odds ratio (OR): 0.39, 95% confidence interval (CI): 0.25–0.62), but elderly who had Instrumental Activity of Daily Living (IADL) disabilities alone were not associated with lower odds (OR=0.86, 95% CI=0.61–1.20). In addition to the above, female individuals (OR=1.91, 95% CI=1.44–2.53), those with poorer vision (OR=1.89, 95% CI=1.36–2.62), those having eye discomfort (OR=1.66, 95% CI=1.26–2.18 and OR=2.14, 95% CI=1. 32–3.46 respectively for mild and more than moderate eye discomfort), and those with severe eye disease (OR=1.96, 95% CI=1.23–3.10) were more likely to undergo eye care. In conclusion, physical disability is a strong risk factor for lack of eye care utilization among older Taiwanese. The barriers associated with low eye care utilization among individuals with ADL disabilities should be explored in order to facilitate effective policy implementation among those elderly with disabilities so that they are able to receive appropriate eye care.

Brugada syndrome (BS) and syncope: A complex therapeutic issue - Corrected Proof

2011-11-24

Abstract: A 66 year-old man was brought to the emergency room (ER) for syncope and sphincter incontinence; syncope duration was about 15min. Similar short duration episodes had been referred by his relatives during the last months, following small traumas; no seizures had been registered. Patient told he was affected with BS, having already been diagnosed 5 years before, after performing an electrocardiogram (ECG) highly suggestive for it. He had performed an electrophysiologic study, which had not shown any sustained ventricular arrhythmias after scheduled stimulation. This finding together to the lack of symptoms had suggested a conservative treatment, notwithstanding that familiar history documented his father's sudden death. Patient was also affected with hypertension and gastroesophageal reflux disease. Clinical examination did not suggest any significant findings. Laboratory tests, supra aortic Doppler ultrasound, electroencephalogram (EEG) and brain CT were normal. ECG showed sinus rhythm with a heart frequency of 82bpm, QRS axis was normal, as well as atrioventricular conduction. ST coved-type elevation with right bundle branch block pattern and repolarization abnormalities were found. Holter ECG and Doppler echocardiography were also performed. The onset of syncope in presence of BS suggested the evaluation of this case report together with electrophysiolgists and neurologists. Therefore, an implantable cardioverter defibrillator (ICD) was implanted through left subclavian vein. He was discharged eight days after hospitalization, diagnosis was “Syncope in patient affected with BS, hypertension”. Arrhythmogenic risk stratification is necessary; the indication for implanting this device is obvious in symptomatic patients, whereas it is controversial in patients presenting only ECG patterns of BS. In conclusion, the above mentioned case report rises remarkable diagnostic and therapeutic issues. The finding of BS in a patient with syncope indicates the opportunity of implanting a defibrillator and only clinical experience and common opinions may help doctors in taking the most appropriated, often difficult, decisions.

Geriatrician input into nursing homes reduces emergency hospital admissions - Corrected Proof

2011-11-23

Abstract: Nursing home residents are often very dependent, very frail and have complex care needs. Effective partnerships between primary and secondary care will be of benefit to these residents. We looked at 1954 admission episodes to our Trust from April 2006 to March 2009 inclusive. 3 nursing homes had the highest number of multiple admissions (≥4). Four strategies to reduce hospital admissions were used at these nursing homes for 3 months. An alert was also sent to the geriatrician if one of the residents was admitted so that their discharge from hospital could be expedited. The project was then extended for another 4 months with 6 nursing homes. The results showed that geriatrician input into nursing homes had a significant impact on admissions from nursing homes (χ2(2)=6.261, p<0.05). The second part of the project also showed significant impact on admissions (χ2(2)=12.552, p<0.05). Furthermore, in both parts of the project the length of stay in hospital for the residents was reduced. Geriatricians working together with co-ordinated multidisciplinary teams are well placed to manage the care needs of frail, elderly care home residents.

Pain and quality of life (QoL) in elderly: The Turkish experience - Corrected Proof

2011-11-21

Abstract: Purpose: The aims of this study were to evaluate the effects of demographic and clinical determinants on pain and to investigate the possible risk factors that disrupt QoL.Materials and methods: The design of this research was a prospective study performed in tertiary care hospital-based physical medicine and rehabilitation departments. A comprehensive geriatric pain assessment (Geriatric Pain Scale, GPS) and health-related quality of life (HR-QOL) assessment (Nottingham Health Profile, NHP) were performed.Results: Of the 275 patients, 76% were female and 59.6% were older than 70 years of age. Two hundred seventy four patients (99.7%) had various levels of pain. The mean age of the patent group was 72.77±5.7 (min: 65, max: 96) years. The overall GPS was 60.41±22 (min: 0, max: 99.9), and the total NHP score was 49.01±22.4 (min: 0, max: 100). Correlation analyses showed that for the total GPS score, female gender, lower education, and economic status were significant determinants of higher levels of pain. The multiple linear regression analysis showed that the NHP, GPS, Self-Reported Disability Index (SRDI), and Geriatric Depression Scale (GDS) were significant determinants of poorer HR-QOL.Conclusions: There was a high prevalence of pain and being female, having low income, having low social support, having a higher rate of disability with related multiple comorbidities, and depression as related factors of HR-QOL. Strengthening these negative predictors of HR-QOL might enhance the efficiency of pain therapies in this population.

Assessment of vulnerable older adults’ physical function according to the Japanese Long-Term Care Insurance (LTCI) system and Fried's criteria for frailty syndrome - Corrected Proof

2011-11-18

Abstract: This study aimed to evaluate the physical frailty status of vulnerable older adults as classified in the Japanese LTCI system and to compare this with Fried's definition. A total of 444 older adults were classified based on the LTCI system as independent, vulnerable, or dependent, and 400 of these participants also fit Fried's criteria for not frail, pre-frail or frail. We evaluated their physical function with a 12 item physical function test. We derived a physical function score (PFS) from these 12 items and a principal component analysis was used to make comparisons. The receiver operating characteristic (ROC) curve analysis was performed to identify the sensitivity and specificity of the PFS cut-off points to distinguish the dependent category from the other categories. We found significant differences and a hierarchical order for the PFSs among the three groups of the LTCI system (the independent, 0.41±0.54; the vulnerable, −0.40±0.76; and the dependent, −1.49±0.73) and of Fried's definition (not frail, 0.50±0.51; pre frail, −0.11±0.63; and frail, −1.25±0.98). The optimal cut-off value (OCV) was −0.593. This study showed that the range of physical function of people considered frail category (pre-frail, vulnerable, and frail) is wide and overlapping. That is, the physical function of vulnerable older adults is worse than the pre-frail, but better than the frail. To better recognize older adults in need of greater support, the vulnerable should also receive assessment of their frailty status according to Fried's definition.

Comparison of a combination of upper extremity performance measures and usual gait speed alone for discriminating upper extremity functional limitation and disability in older women - Corrected Proof

2011-11-18

Abstract: Although usual gait speed (UGS) is considered an indicator of overall well-being, it is unclear whether upper extremity performance (UEP) measures provide a similar, additive contribution to functional status. We aimed to identify whether combining UEP measures can more accurately discriminate upper extremity functional limitation (UE limitation) and disability compared to UGS. We conducted a cross-sectional analysis on data from 322 community-dwelling older women, aged 65–96 years. Trained testers assessed UGS, and hand-grip strength (GRIP), functional reach (FR), back scratch, manipulating pegs (PEG), and moving beans with chopsticks as UEP measures. We assessed three functional statuses: UE limitation, activities of daily living (ADLs) and instrumental ADLs (IADLs) disabilities using self-reported questionnaires. Areas under the receiver operating characteristic curves (AUCs) were used to compare the discriminating power of UGS, with the individual and combined UEP measures for each status. Among UEP measures, only GRIP (AUC=0.68 for UE limitation, 0.81 for IADLs disability, and 0.84 for ADLs disability) could accurately discriminate each status as well as UGS (AUC=0.65, 0.83, and 0.91, respectively). Furthermore, UGS alone could discriminate UE limitation almost as well as the combination of GRIP, PEG, and FR (AUC=0.70). Combining other UEP measures did not help discriminate further. There were few advantages to combining UEP measures, and UGS or GRIP alone may suffice for assessing UE limitation and disability. However, the UGS should be the test of first choice, certainly more than GRIP, in routine assessment of functional limitation and disability, including UE limitation.

The validity of an assessment of maximum angular velocity of knee extension (KE) using a gyroscope - Corrected Proof

2011-11-18

Abstract: Although it is more important to assess the muscular power of the lower extremities than the strength, no simplified method for doing so has been found. The aim of this study was to assess the validity of the assessment of the angular velocity of KE using a gyroscope. Participants included 105 community-dwelling older people (55 women, 50 men, age±standard deviation (SD) 75±5.3). Pearson correlation coefficients and Spearman rank-correlation coefficients were used to examine the relationships between the angular velocity of KE and functional performance measurements, a self-efficacy scale and health-related quality of life (HRQOL). The data from the gyroscope were significantly correlated with some physical functions such as muscle strength (r=0.304, p<0.01), and walking velocity (r=0.543, p<0.001). In addition, the joint angular velocity was significantly correlated with self-efficacy (r=0.219–0.329, p<0.01–0.05) and HRQOL (r=0.207–0.359, p<0.01–0.05). The absolute value of the correlation coefficient of angular velocity tended to be greater than that of the muscle strength for mobility functions such as walking velocity and the timed-up-and-go (TUG) test. In conclusion, it was found that the assessment of the angular velocity of the knee joint using a gyroscope could be a feasible and meaningful measurement in the geriatrics field.

The effect of anemia and white matter hyperintensities (WMH) on cognitive impairment in patients with amnestic mild cognitive impairment (MCI) - Corrected Proof

2011-11-17

Abstract: Anemia and subcortical ischemic change might be associated with increased risks for cognitive impairment among the elderly. This study examined the associations among anemia, WMH and cognitive function in patients with amnestic MCI. We recruited 278 subjects with amnestic MCI from the Clinical Research Center for Dementia of South Korea (CREDOS), a hospital-based cohort study. A standardized neuropsychological battery, containing tests of language, visuospatial function, verbal memory and executive function, was used for all patients. Anemia was defined as a hemoglobin concentration below 12g/dl for women and below 13g/dl for men. The severity of WMH was also examined using brain magnetic resonance imaging (MRI). After multivariable adjustments, anemia and WMH were associated with poorer performance on cognitive function tests (anemia: Stroop test, F=4.17, p=0.042; WMH: Stroop test, F=6.45, p=0.002; Rey-complex figure test-copy, F=4.08, p=0.018). Moreover, a significant interaction between anemia and the severity of WMH was observed in performance on the Go/no go test (F=4.50, p=0.012) and the Stroop test (F=3.36, p=0.037). In post hoc analysis, anemic patients with severe WMH had significantly worse scores on measure of executive function (Go/no go test, p=0.011; Stroop test, p=0.001). Anemia and WMH had interactive effects on executive function impairment among the elderly with amnestic MCI.

A self-administered questionnaire to screen the risk of dementia: A pilot study and the results of a comparison with the mini-mental state examination (MMSE) - Corrected Proof

2011-11-16

Abstract: Cognitive impairment is an age-related condition as the rate of cognitive decline rapidly increases with aging. The aim of this study was to screen the risk of cognitive decline in people over 60years from 16 different Italian cities, by comparing the results of a self-administered questionnaire with the MMSE. We analyzed data from 203 persons aged 60years and over, who voluntarily accepted to participate during the “Second Prevention Day for AD”. A self-administered questionnaire, developed by clinicians of our Department of Aging, was distributed to all participants, in order to easily screen the risk of cognitive impairment. Then, all subjects underwent cognitive assessment by MMSE. We esteemed the risk of cognitive impairment of all participants basing on MMSE scores (no risk, mild and moderate risk) and we compared this assessment with the results obtained by the self-administered questionnaire. The comparison between the risk of cognitive impairment revealed by our questionnaire and the risk esteemed by MMSE resulted in a discrepancy in 43.96% of cases in no risk class. In mild risk group there was a discrepancy of results in 70.53% of subjects. In moderate risk class there was a discrepancy of results in 38.46% of individuals. Our questionnaire resulted to be accurate for the evaluation of patients with moderate risk of cognitive impairment. It showed a lower accuracy for the mild risk class, often overestimating the risk of cognitive decline.

Topography of cortical thinning areas associated with hippocampal atrophy (HA) in patients with Alzheimer's disease (AD) - Corrected Proof

2011-11-16

Abstract: Prior studies have shown that patients with AD have decreased functional or structural connectivity between the hippocampus and other brain areas. To the best of our knowledge, however, there have been no studies investigating the topography of cortical thinning areas and correlations with HA using surface based morphometry of three-dimensional (3D) T1-weighted magnetic resonance (MR) images. Cortical thickness was measured using SBM, and hippocampal volume was measured using an automated method, in 219 patients with AD and 54 subjects with no cognitive impairment (NCI). A partial correlation model was used in analysis of cortical thinning related to HA. Cortical thinning areas related to HA were found mostly within areas associated with polysynaptic or direct pathways of the hippocampus, a finding consistent with the disconnection hypothesis. Therefore, the cortical atrophy related to HA in patients with AD may represent disrupted cortical brain networks in connection with HA. However, since the topography of HA-related cortical thinning in groups with Clinical Dementia Ratings (CDR) of 0.5 and 1 corresponded to the stages I–II and III–IV of Braak and Braak staging, respectively, we could not exclude the possibility of the “concomitant hypothesis,” i.e. that these areas are affected concomitantly with the hippocampus.

The effect of aging and dental status on the frequency of eating out - Corrected Proof

Anastassia Kossioni, Olga Bellou — 2011-11-16

Abstract: Although many studies have investigated the effect of impaired dentition on eating habits and social expression, very few studies have evaluated the effect of age and dental status on the frequency of eating out, which was the purpose of the present study. A sample of 161 community-dwelling adults aged between 20 and 94 years of age was interviewed and then clinically examined to record dental and denture status. The bivariate analyses revealed that those who were eating out less often were more likely older, widowed, pensioners, with elementary or less than elementary education, suffering from hypertension, overweight or obese, with bad self-rated health, complaining for xerostomia, with difficulties chewing hard food and with fewer natural teeth. Multiple logistic regression analysis identified as significant predictors for less frequently eating out older age and low educational level. These results suggest that in the particular cultural environment the dental status is not an independent predictor of the frequency of eating out, but other biological and social factors play a more significant role.

Mean platelet volume (MPV) is associated with leukoaraiosis in the apparently healthy elderly - Corrected Proof

2011-11-14

Abstract: Leukoaraiosis refers to diffuse white matter abnormalities on MR brain scans, which have been suggested to be associated with cerebral microangiopathy and geriatric syndromes such as cognitive impairment, depressive mood and gait disturbance. MPV is a simple indicator of platelet size and has been known to be a marker of platelet activity. MPV is now considered a link between inflammation and thrombosis in multiple cardiovascular and cerebrovascular disorders including hypertension, peripheral artery disease, and stroke. This cross-sectional study aims to evaluate the association between MPV and leukoaraiosis for 223 healthy elderly subjects (142 men, 81 women; mean age 66.0±5.2 years) in a health examination program including brain magnetic resonance imaging (MRI) scans. The overall prevalence rate of leukoaraiosis was 15.3%. The mean MPV was significantly higher in the leukoaraiosis group than control group: 8.4±0.8 and 8.1±1.0, respectively (p=0.036). A higher value of MPV was independently associated with an increased risk of leukoaraiosis. In the multivariate logistic analysis, the odds ratio (OR) (95% confidence interval (CI)) for leukoaraiosis was 1.61 (1.02–2.53) with 1fL of MPV increment after adjusting for confounding variables. In conclusion, MPV was found to be independently and positively associated with leukoaraiosis. This finding indicates that MPV values may be a useful additional measure in assessing the risk of leukoaraiosis in the clinical setting.

Factors affecting trajectory patterns of self-rated health (SRH) in an older population—A community-based longitudinal study - Corrected Proof

Hui-Lan Lee, Hui-Chuan Huang, Ming-Der Lee, Jeen Hsiu Chen, Kuan-Chia Lin — 2011-11-09

Abstract: Self-rated health (SRH) is considered a relevant and important predictor for major health outcomes in the older population. SRH status may interact with certain factors and change over a person's lifetime. In this study, we sought to characterize profiles of older people over time by constructing prototypical trajectories of the variable of interest, namely SRH. The underlying assumption was that the collection of observed individual trajectories could be efficiently summarized by a smaller set of latent clusters of those trajectories. Data was obtained from the Longitudinal Survey of Health and Living Status of the Elderly in Taiwan, which was conducted between 1989 and 2003 and included five separate waves of survey. A total of 3937 subjects aged 60 or older (2251 males and 1686 females) comprised the major analytic cohort. Latent Class Growth Analysis (LCGA) was used to identify developmental classes of trajectory patterns in SRH. The results showed that during a 14-year period, SRH developed five major longitudinal trajectories. Less than one-third of the older population was able to maintain their formerly good or moderate health status; when change occurred, decline was more likely than improvement. In addition, LCGA indicated that many demographic characteristics, as well as physical and psychological propensities, were associated with poor SRH in the older population. Specifically, these factors played a role in involving baseline SRH level and its trend toward deterioration in later life. Health care professionals must understand the various longitudinal patterns and factors affecting SRH trajectories if they are to develop programs aimed at maintaining the older population's health and well-being.

A supportive home visit program for older adults implemented by non-professionals: Feasibility and effects on physical performance and quality of life at one year – A pilot study - Corrected Proof

Kristiina Niemelä, Raija Leinonen, Pia Laukkanen — 2011-11-07

Abstract: Knowledge of supportive home rehabilitative procedures is needed to improve the independent home training and psychosocial wellbeing of older people. The primary focus of this study was to assess the feasibility of a home visit program involving the use of non-professional home rehabilitation assistants (HRAs) support among elderly. The secondary objective was to investigate the effects to physical performance and health-related quality of life (HRQL) of older people. A controlled intervention study was implemented at two war veterans’ rehabilitation centers in Finland. The study included 22 long-term unemployed people aged 26–58 years, who were educated in HRA tasks and 417 community-dwelling persons aged 65–99 years, who participated in 10–28 days of inpatient rehabilitation. The intervention group (IG) received 10–14-month physiotherapist-supervised HRA home visit program. The control group (CG) received no home visit intervention. Additional information was collected to assess the feasibility of the intervention. Structured interviews were carried out. Physical performance was evaluated through several validated tests, pain with the Visual Analog Scale (VAS), and HRQL with the Leipad questionnaire. The HRAs adopted their supporting role through the social activation of the rehabilitees and continued to study to become practical nurses. At 10–14 months, HRQL among women (p=0.029) and chair rising among men (p=0.028) improved in the IG but declined in the CG. The supportive home visit program was feasible and improved the HRQL in women and chair rising in men. This model could motivate long-term unemployed people to educate themselves.

Factorial validity and invariance of the Life Satisfaction Index in older people across groups and time: Addressing the heterogeneity of age, functional ability, and depression - Corrected Proof

Cecilia Fagerström, Magnus Lindwall, Anne Ingeborg Berg, Mikael Rennemark — 2011-11-07

Abstract: In the last decades, extensive research efforts have been directed at exploring life satisfaction in old age, and the Life Satisfaction Index A (LSIA) scale, developed by Neugarten et al. in the 1960s, is one of the most commonly used instruments. However, studies have focused on predicting and comparing changes in people's life satisfaction without testing if the LSIA instrument is equally valid for different subgroups of people. The present study investigated the underlying dimensions of the LSIA in a Swedish population (n=1402) of people 60–96 years of age. The study also examined factorial invariance across age, gender, functional ability and depression during a six-year period. The results showed that while a five-factor solution of the LSIA did not exhibit an acceptable fit to the data, a three-factor solution did show a close fit. The two three-factor models that demonstrated the best fit showed invariance across gender and across time, but noninvariance across groups with different levels of reduced functional ability, depressive symptoms and age. These findings suggest that the psychometric properties of life satisfaction instruments like the LSIA need to be taken into consideration before drawing conclusions about life satisfaction when comparing older people of different ages and with different depression and function levels.

Drug-using behaviors of the elderly living in nursing homes and community-dwellings in Manisa, Turkey - Corrected Proof

Saliha Altıparmak, Osman Altıparmak — 2011-10-31

Abstract: Aim: The study aimed to investigate drug-taking behaviors of the elderly living in a nursing home or community dwelling and to determine the factors affecting their behaviors.Materials and methods: This cross-sectional study was conducted on the elderly living at homes (n=106) or in nursing homes (n=220) in the city center of Manisa located in the Aegean region of Turkey. The study data were collected between February 2011 and May 2011. For data collection, three survey forms were used: the socio-demographic questionnaire, the standardized mini mental test and the questionnaire which enquires drug-using behavior. The data were evaluated with SPSS for 15.00 Windows statistical package program. Data descriptive statistics were evaluated with the chi-square test, Student's t-test and logistic regression analysis.Results: The mean age of the whole group was 73.4±6.3 (65–94). In the study group, the mean numbers of chronic diseases and medications used were 1.2±0.9 (0–5) and 2.6±1.8 (0–10), respectively. According to the survey results, those living in nursing homes, males and those with education higher than primary school education displayed better drug-taking behaviors than those living at home, females and those with less than primary school education, respectively.Conclusion: The appropriate use of medicine is a major problem in old age. Living at home or in a nursing home, gender and education are important factors affecting the correct use of medicine in old age.

Outcome predictors affecting the efficacy of clonazepam therapy for the management of burning mouth syndrome (BMS) - Corrected Proof

Ji-Young Ko, Moon-Jong Kim, Sang-Goo Lee, Hong-Seop Kho — 2011-10-31

Abstract: BMS is a common condition characterized by chronic oral mucosal pain condition and primarily affects elderly women. Although clonazepam therapy has been widely used due to its efficacy, it is not always effective because of the complexity of BMS pathogenesis. In this study, we have investigated outcome predictors of clonazepam therapy in patients with BMS. One hundred patients with BMS (7 men and 93 women, mean age 58.5±10.8 years) were instructed to take 0.5mg of clonazepam once or twice daily for 4 weeks. The patients were sub-grouped according to psychological status, salivary flow rate, presence of psychiatric medications, symptom area and duration, symptom severity, presence of oral parafunctions, and accompanying oral complaints. The changes in symptoms were analyzed and compared between the sub-groups. Subjects with T-scores ≤50 for each psychological symptom dimension, a greater degree of initial symptoms (visual analog scale (VAS)≥5), and accompanying oral complaints, such as xerostomia and taste disturbance, displayed greater decreases in symptoms compared with their counterparts. In conclusion, psychological status, initial symptom severity, and the presence of xerostomia and/or taste disturbance can serve as outcome predictors of clonazepam therapy for patients with BMS.

Adjuvant radiotherapy on older and oldest breast cancer patients after conservative surgery: A retrospective analysis - Corrected Proof

2011-10-31

Abstract: Purpose of this study was to evaluate the impact of adjuvant radiotherapy, in terms of feasibility and activity, in women aged ≥75 years with early (stage) breast cancer. From January 2000 to December 2007, 131 consecutive patients aged 75 years or older received adjuvant radiotherapy after breast conserving surgery. Eighty-two patients received radiotherapy in combination with 5 years of hormone therapy with tamoxifen or aromatase inhibitor. Thirty out of 131 received chemotherapy. Variables considered were age, stage, co-morbidity, performance status, radiation dose (boost), hormone therapy and chemotherapy. The mean age was 78.3 years (range 75–88 years). A total of 19.1% of the patients had no co-morbidity, 57.38% mild, 19.8% moderate, and 3.8% had severe co-morbidities. All patients but one completed the planned radiation schedule. At a median follow-up of 56 months, the 5-year overall survival rate was 78.8%. There was a better survival for patients with no or mild co-morbidities (p<0.0001). The disease-free survival at 5 years was 89.6%. No difference in acute and late toxicity rates was found between patients with different ACE-27 (Adult Comorbidity Evaluation-27) indexes and for different age. We conclude that compliance with adjuvant radiotherapy is good and rate of toxicity is acceptable in elderly patients. Patients with no or mild co-morbidities have a significantly better survival. Increasing severity of co-morbidity may sufficiently shorten remaining life expectancy to cancel gains with adjuvant radiotherapy. Further prospective trials are needed to confirm these results.

Mortality in patients with hip fracture aged over 90 years: A report from a progressively aging island - Corrected Proof

Masaru Kadowaki, Michihaya Kono, Kaoru Nishiguchi, Hiroyuki Kakimaru, Yuji Uchio — 2011-10-31

Abstract: Introduction: In our aging society, hip fractures are common in elderly patients, especially those aged above 90 years. Improving mortality rates after this injury is an important part of medical management for the elderly. This study assessed mortality rates after hip fracture in patients aged ≥90 years and examined factors that contribute to mortality.Method: Between April 2003 and March 2009, 186 patients aged ≥65 years were studied. Of these, 50 patients were aged ≥90 years. Walking ability before injury and at discharge, preoperative physical status, number of comorbidities, postoperative survival, sex, fracture type, and patients’ residential status were investigated.Results: One-year mortality was higher in patients aged ≥90 years (24%) than in younger patients (10%) (p=0.01). Moreover, older patients were less likely to retain walking ability at discharge, and poor postoperative ambulatory levels were associated with increased mortality. Preoperative physical status according to the grading system of the American Society of Anesthesiologists (ASA) did not differ between the two age groups. Poor ASA grade was associated with mortality in the entire population, but this association was not significant in the older group. Although older patients had a higher number of trochanteric fractures, fracture type and mortality did not significantly correlate with age.Conclusion: Acceptable outcomes of hip fracture surgery can be achieved in very old patients. In addition, postoperative ambulatory level may be a predictor of mortality.

Age-specific incidence ratios of colorectal cancer (CRC) in Turkey: CRC in older people is increasing - Corrected Proof

Faruk Tas, Serkan Keskin — 2011-10-24

Abstract: Life expectancy has greatly increased in the last century. In the last decades, cancer in the older people has become an increasingly common problem owing to the prolonged life-expectancy of the general population and to the improved management of common cancers. The aim of this study was to demonstrate the age-specific incidence ratios in patients with CRC. Data were collected from hospital-based registries from 1988 to 2007. A total of 4209 patients were assessed. The median age at diagnosis was 58 years. When compared to Surveillance Epidemiology and End Results (SEER) data, these values were found to be 13 years younger than American patients. Trends consist of the median ages of patients were increased during years (p<0.001). Along the years, especially in the last years, the ratios of cancer patients of older than 70 years were significantly increased among the cancer patient populations. CRC in older person has become an increasingly common problem in the last years.

Determinants of changes in self-rated health among Finnish war veterans: Results from the Veteran Project 1992 and 2004 surveys - Corrected Proof

2011-10-24

Abstract: Self-rated health is a strong predictor of mortality, morbidity, future functional capacity and the quality of life. Measures of self-rated health have been collected fairly regularly since the 1980s, but few of them focus on self-rated health among the elderly war veterans. The aim of this study was to examine changes in self-rated health among Finnish war veterans from 1992 to 2004 and to analyze the independent determinants associated with changes in veterans’ self-rated health. The study population was 4999 veterans living in Finland, who participated in data collection of both the Veteran Project 1992 and 2004. Logistic regression models were used to identify independent predictors for changes in self-rated health. Analyses were conducted separately for men with and without disability and for women. During the follow-up, self-rated health improved or remained unchanged among 88.8% of the men without disability, 90.5% of the men with disability and 87.9% of the women. Determinants for declined self-rated health were a new cardiovascular disease (CVD) among all veteran groups, increased walking difficulties among men without disability and women, a new neurological disease and institutionalization among men without disability, and a new musculoskeletal disease among men with disability. In conclusion, the majority of veterans rated their health improved or unchanged during the follow-up. The importance of mobility impairments and cardiovascular, musculoskeletal and neurological diseases as the predictors of declined self-rated health were confirmed.