Archives of Gerontology and Geriatrics - Articles in Press

Frailty and its prediction of disability and health care utilization: The added value of interviews and physical measures following a self-report questionnaire - Corrected Proof

Robbert J.J. Gobbens, Marcel A.L.M. van Assen — 2012-05-17

Abstract: Aims: To establish whether the prediction of the adverse outcomes disability and six indicators of health care utilization one and two years later by the three frailty domains (physical, psychological, social) of the Tilburg Frailty Indicator (TFI) is improved by adding interview and physical measures of frailty.Materials and methods: A representative sample of 245 Dutch community-dwelling persons aged 75 years and older (response rate 53%) participated in 2008, one year later in 2009 (n=179, 73%) and again two years later in 2010 (n=141, 58%). Frailty was assessed with the TFI, an easy to administer self-report measure. Disability was measured using the Groningen Activity Restriction Scale (GARS). Indicators of health care utilization were: visit to a general practitioner (gp), contacts with health care professionals (hcps), hospital admission, receiving personal care, receiving nursing care, and receiving informal care.Results: After controlling for background characteristics, the TFI predicted disability and the indicators of health care utilization. Interviews and physical measures of frailty improved the prediction of disability. The Hospital Anxiety and Depression Scale (HADS-A) improved the prediction of contacts with hcps, but the interview and physical measures of frailty did not improve the predictions of the other indicators of health care utilization.Conclusions: Assessment by the self-report TFI is sufficient for predicting six indicators of health care utilization, but for predicting disability the use of both the TFI and the Timed Up & Go (TUG) test is recommended. It is advisable assessing all three frailty domains when examining frailty and its prediction of adverse outcomes.

The body image construct among Western seniors: A systematic review of the literature - Corrected Proof

Mathieu Roy, Hélène Payette — 2012-05-11

Abstract: Despite numerous body image researches focusing on children, adolescents, young and middle-aged adults, there is a dearth regarding the body image of Western seniors. In this paper, we reviewed this literature using a systematic three-step extraction procedure plus a quality evaluation assessment for each retained article. The results showed that, while body dissatisfaction (BD) and body image distortion (BID) exist at older ages, the importance given to body image as it relates to physical appearance is lower in comparison with younger samples. Associations between body image and physical/mental health were also shown. Various tensions regarding the aging body (appearance vs. health, inside vs. outside, natural vs. unnatural) as well as a double standard of aging were also reported among older women. We conclude that the body image experience of Western seniors has both specificities and similarities with the one of younger populations. We also conclude that some methodological aspects of the literature on body image among older adults need to be addressed in order to move forward with this field of research.

Postural balance and physical activity in daily life (PADL) in physically independent older adults with different levels of aerobic exercise capacity - Corrected Proof

2012-05-11

Abstract: Balance impairs with aging and may cause mobility limitations and functional decline. We aimed to evaluate postural balance and PADL in physically independent older adults with different levels of exercise capacity. One hundred fifty seven physically independent individuals, aged 60 years or older were evaluated. Postural balance assessment was performed during one-legged stance test using a force-platform and maximum exercise capacity with the incremental shuttle walking test (ISWT). PADL was assessed subjectively by the modified Baecke questionnaire and objectively using a pedometer. Based on the performance achieved in the ISWT, according to the percentage of the predicted value, the older adults were separated into 3 groups: low performance group (LP group, ISWT<80% predicted, n=32, 19 women), normal performance group (NP group, 80≤ISWT≤100% predicted, n=30, 22 women) and high performance group (HP group, ISWT>100% predicted, n=95, 67 women). The HP group showed better postural balance when compared to LP groups (p<0.001) and also higher levels of PADL measured with pedometer (p<0.001). There was a modest correlation (r=0.45) between exercise capacity and PADL in the LP group and a weak correlation between exercise capacity and balance (r=−28) in the HP group. Physically independent older adults with more preserved exercise capacity have better postural balance and higher levels of PADL in comparison to those older adults who show a poorer condition in terms of exercise capacity.

Evaluation of constipation in older adults: Radioopaque markers (ROMs) versus wireless motility capsule (WMC) - Corrected Proof

S.S.C. Rao, E. Coss-Adame, J. Valestin, K. Mysore — 2012-05-09

Abstract: There is scarce information regarding assessment of constipation in older subjects. We examined regional and whole-gut transit time (WGTT) with wireless motility capsule (WMC) and compared this with radioopaque markers (ROM) transit. 39 constipated and 11 healthy older subjects (≥65 years) ingested a ROM capsule and WMC, wore a data receiver and kept stool diaries for 5 days. WMC recordings were analyzed for colonic transit time (CTT), WGTT and gastric emptying time (GET). Radiographs obtained on day 5 assessed ROM transit. Results for each device were compared. The CTT (p=<0.0001), WGTT (p=<0.001) and GET (p=<0.04) as measured by WMC were all slower in constipated subjects compared to healthy subjects. ROM colonic transit was also slower (p=<0.007) in constipated compared to healthy subjects. The diagnostic utility for identifying subjects with constipation as assessed by receiver operating characteristics were similar; 0.85 (WMC) versus 0.73 (ROM). Device agreement for slow colonic transit was 88% with good correlation between WMC and ROM (CTT r=0.718, p=0.0001, WGTT r=0.693, p=0.0001). Slow transit constipation was identified in 28% with ROM and 32% with WMC. No adverse events were recorded. WMC is a safe and useful device that provides objective diagnosis of delayed colonic and whole gut transit in older constipated adults. It is a radiation-free, physiologic and ambulatory technique that provides additional diagnostic information than ROM.

Perception of worsening health predicts mortality in older men: The Health in Men Study (HIMS) - Corrected Proof

2012-05-09

Abstract: The main purpose of this study was to determine the most robust predictor of mortality among global self-rated health (SRH), time-comparative SRH or a combination of both measures. We also sought to determine factors associated with global SRH and time-comparative SRH measures. A prospective cohort study of 5583 community-dwelling older men aged 70 years or over living in Perth, Western Australia, was used. Older age, depressive symptoms, low social support, sensory impairment, presence of pain, and high Charlson score index were associated with both SRH measures. Global and time-comparative SRH were independent predictors of all-cause mortality (adjusted hazard ratio, HR=1.24 vs. 1.41 respectively); and the risk of death was almost doubled in those with both negative global SRH and perception of worsening health over the preceding 12 months (adjusted HR 1.98, 95%CI 1.58–2.47). In this group, the rate of death was especially high during the initial four years of follow up. We concluded that the two measures of SRH are likely to reflect the same domains of health, and the simultaneous use of both measures is the best predictor of short to medium term mortality.

Effects of a program to prevent social isolation on loneliness, depression, and subjective well-being of older adults: A randomized trial among older migrants in Japan - Corrected Proof

Tami Saito, Ichiro Kai, Ayako Takizawa — 2012-05-07

Abstract: Social isolation among the elderly is a concern in developed countries. Using a randomized trial, this study examined the effect of a social isolation prevention program on loneliness, depression, and subjective well-being of the elderly in Japan. Among the elderly people who relocated to suburban Tokyo, 63 who responded to a pre-test were randomized and assessed 1 and 6 months after the program. Four sessions of a group-based program were designed to prevent social isolation by improving community knowledge and networking with other participants and community “gatekeepers.” The Life Satisfaction Index A (LSI-A), Geriatric Depression Scale (GDS), Ando-Osada-Kodama (AOK) loneliness scale, social support, and other variables were used as outcomes of this study. A linear mixed model was used to compare 20 of the 21 people in the intervention group to 40 of the 42 in the control group, and showed that the intervention program had a significant positive effect on LSI-A, social support, and familiarity with services scores and a significant negative effect on AOK over the study period. The program had no significant effect on depression. The findings of this study suggest that programs aimed at preventing social isolation are effective when they utilize existing community resources, are tailor-made based on the specific needs of the individual, and target people who can share similar experiences.

Age-associated gait patterns and the role of lower extremity strength – Results from the Baltimore Longitudinal Study of Aging - Corrected Proof

Seung-uk Ko, Sari Stenholm, E. Jeffrey Metter, Luigi Ferrucci — 2012-05-07

Abstract: The aim of the present study was to examine differences in gait characteristics across the adult lifespan and to test the hypothesis that such differences are attributable at least in part to the decline in muscle strength. The data presented here are from 190 participants of the Baltimore Longitudinal Study of Aging (BLSA) aged from 32 to 93years. Based on two age thresholds that best capture the effect of age on walking speed, participants were divided into three age groups: middle-age (32–57years; N=27), old-age (58–78years; N=125), and oldest-age (79–93years; N=38). Participants were asked to walk at their preferred and maximum speeds while recorded with 3D gait analysis system. In addition, maximum isokinetic knee extensor strength was assessed. While walking at preferred speed, range of motion (ROM) and mechanical work expenditure (MWE) of the ankle were lower within middle-age (p<0.001, p=0.047, respectively), while hip ROM and MWE were lower (p=0.006) and higher (p<0.001), respectively within oldest-age with older age. Deterioration in ankle function during customary walking initiates already at middle-age. Differences in the maximum walking speed and ankle ROM between middle-age and old-age were explained by knee strength.

Waist circumference (WC), body mass index (BMI), and disability among older adults in Latin American and the Caribbean (LAC) - Corrected Proof

Sanggon Nam, Yong-Fang Kuo, Kyriakos S. Markides, Soham Al Snih — 2012-05-07

Abstract: Purpose: To examine the association between WC and BMI on disability among older adults from LAC.Methods: Cross-sectional, multicenter city study of 5786 subjects aged 65 years and older from the Health, Well-Being and Aging in Latin America and the Caribbean (SABE) study (1999–2000). Sociodemographic variables, smoking status, medical conditions, BMI, WC, and activities of daily living (ADL) were obtained.Results: Prevalence of high WC (HWC) (>88cm) in women ranged from 48.5% (Havana) to 72.7% (Mexico City), while among men (>102cm) it ranged from 12.5% (Bridgetown) to 32.5% (Santiago). The associations between WC and ADL disability were “J” shaped, with higher risks of ADL disability observed above 110cm for women in Bridgetown, Santiago, Havana, and Montevideo. The association in Sao Paulo is plateau with higher risk above 100cm, and the association in Mexico City is closer to linear. Among men the associations were “U” (Bridgetown, Sao Paulo, and Havana), “J” shaped (Montevideo), plateau (Santiago), and closer to linear in Mexico City. When WC and BMI were analyzed together, we found that participants from Sao Paulo, Santiago, Havana, and Montevideo in the overweight or obese category with HWC were significantly more likely to report ADL disability after adjusting for all covariates.Conclusion: The findings of this study suggest that both general and abdominal adiposity are associated with disability and support the use of WC in addition to BMI to assess risk of disability in older adults.

Gender differences in incidence and determinants of disability in activities of daily living among elderly individuals: SABE study - Corrected Proof

2012-04-30

Abstract: Determining the groups that are most susceptible to developing disability is essential to establishing effective prevention and rehabilitation strategies. The aim of the present study was to determine gender differences in the incidence of disability regarding activities of daily living (ADL) and determinants among elderly residents of Sao Paulo, Brazil. In 2000, 1634 elderly with no difficulties regarding ADL (modified Katz Index) were selected. These activities were reassessed in 2006 and disability was the outcome for the analysis of determinants. The following characteristics were analyzed at baseline: socio-demographic, behavioral, health status, medications, falls, hospitalizations, depressive symptoms, cognition, handgrip, mobility and balance. The incidence density was 42.4/1000 women/year and 17.5/1000 men/year. After adjusting for socioeconomic status and health conditions, women with chronic diseases and social vulnerability continued to have a greater incidence of disability. The following were determinants of the incidence of disability: age and depressive symptoms in both genders; stroke and slowness on the sit-and-stand test among men; and osteoarthritis and sedentary lifestyle among women. Better cognitive performance and handgrip strength were protective factors among men and women, respectively. Adverse clinical and social conditions determine differences between genders regarding the incidence of disability. Decreased mobility and balance and health conditions that affect the central nervous system or lead to impaired cognition disable men more, whereas a sedentary lifestyle, reduction in muscle strength and conditions that affect the osteoarticular system disable women more.

Participation bias in postal surveys among older adults: The role played by self-reported health, physical functional decline and frailty - Corrected Proof

Philipe de Souto Barreto — 2012-04-25

Abstract: Postal survey is a simple and efficient way to collect information in large study samples. The purpose of this study was to find out differences between older adults who responded to a postal survey on health outcomes and those who did not, and to examine the importance of frailty, physical functional decline and poor self-reported health in determining non-response. We mailed out a questionnaire on general health twice at a year's interval to 1000 individuals ≥60 years, and members of the medical insurance scheme of the French national education system. At Year1, 535 persons responded to the questionnaire (65% women, 70.9±8.4 years). A year later (Year2), we obtained 384 responses (63.3% women, 70.5±7.8 years). Compared to respondents, non-respondents at Year2 were more frequently categorized as frail, reported more often to be in bad health, and had more physical functional declines. Frailty, physical functional decline and poor self-reported health increased the likelihood of not responding to Year2 questionnaire, with poor self-reported health weakening the association of physical functional decline and non-response. Respondents of this postal survey are fitter and healthier than non-respondents. This participation bias precludes the generalization of postal surveys results.

The efficacy of counseling and progressive resistance home-exercises on adherence, health-related quality of life and function after discharge from a geriatric day-hospital - Corrected Proof

Therese Brovold, Dawn A. Skelton, Astrid Bergland — 2012-04-16

Abstract: Loss of function and low exercise adherence is common among older people after hospitalization. The aim of this randomized-controlled trial was to evaluate the effects of a combined counseling- and exercise program on changes in health-related quality of life (HRQL) and physical function in patients attending a day hospital and continuing exercise at home. The exercise program consisted of counseling, balance- and progressive resistance training and support from the physical therapist at Geriatric Day-Hospital (GDH) and home for the Intervention-group. The Control-group received counseling, balance-training and support from the physical therapist. The sample was recruited from a GDH in Norway. 108 participants were randomized into the Intervention group (IT) (n=53) or the Control group (CT) (n=55). After 3 months 77 participants were tested. The intention to treat analysis showed that the program had significant benefits in terms of Health Related Quality of Life, measured by SF-36, on the domains vitality and bodily pain, in favor of the IT-group who performed the combined resistance exercises and balance program. All participants increased their scores on physical function, measured by Berg Balance Scale, Timed Up and Go, 5 times Sit-to-Stand, 6Min Walk Test and Activities Balance Confidence Scale, no group differences. Both groups were adherent to the home exercise program The results show that it is possible to facilitate older people to increase their HRQL, physical function and level of physical activity through counseling, exercise and support from physical therapists.

Quadriceps muscle tone, elasticity and stiffness in older males: Reliability and symmetry using the MyotonPRO - Corrected Proof

Lucy Aird, Dinesh Samuel, Maria Stokes — 2012-04-16

Abstract: Background: The MyotonPRO (Myoton Ltd; London) is a new portable device for measuring muscle mechanical properties (e.g. tone) and its reliability has yet to be established. Little is known about between-limb symmetry of mechanical properties in healthy older people, despite symmetry often being used as a measure of unilateral abnormalities in clinical assessment. Since quadriceps is important for mobility, it was selected for the present study.Aims: To investigate: (i) between-day intra-rater reliability of a novice user of MyotonPRO; (ii) between-side symmetry of mechanical properties of quadriceps in older males.Methods: Twenty healthy, community dwelling, right-lower-limb-dominant males (mean age 71.7, range 65–82 years) were studied. With the participant in relaxed supine lying, the MyotonPRO applied two consecutive sets of 10 taps to induce muscle oscillations of rectus femoris, from which measurements of decrement (elasticity), frequency (tone), and stiffness were obtained. Tests were performed on two occasions at the same time and day of the week, one week apart.Results: Repeated measurements had very high within-day (intraclass correlation coefficient, ICC 3,1>0.90) and high between-day (ICC 3,2>0.70; mean of two measurement sets) reliability. There was no statistically significant difference between muscle mechanical properties of the dominant and non-dominant muscles (<2.5% difference; p>0.05), thereby indicating symmetry.Conclusions: High intra-rater reliability was established for MyotonPRO measurements of quadriceps in healthy older males, which were symmetrical between sides. These findings indicate that larger studies are warranted to establish normal reference ranges of data with which to compare patients with muscle abnormalities.

Relationship between depression and loneliness in elderly and examination of influential factors - Corrected Proof

Rukuye Aylaz, Ümmühan Aktürk, Behice Erci, Hatice Öztürk, Hakime Aslan — 2012-04-10

Abstract: This study was planned and conducted for the purpose of examining the relationship between depression and loneliness in elderly people and the influencing factors. The study was a descriptive and correlational study and its population consisted of 17,080 older individuals aged sixty and over who were registered at six Family Healthcare Centers (FHCs) located in the provisional center of Malatya. The sample of the study comprised of 913 elderly people who were chosen from the elderly people registered at the FHCs first by cluster sampling and then by simple random sampling from the clusters in proportion to the population. The data was collected between April and June 2011 using a questionnaire developed by the investigators in line with the literature, the Geriatric Depression Scale (GDS) and the UCLA Loneliness Scale (ULS). They had a mean score of 13.83±7.4 from the GDS and 40.50±12.1 from the ULS. A positive correlation was found between Geriatric Depression and loneliness (r=0.608, p<0.001). It was observed that there was a significant correlation between loneliness and depression in the elderly people living in a community, presence of social security and higher income, on the other hand, led to lower mean scores. In view of these results, it can be advised that a minimum income should be secured for elderly people whether they have social security or not, their families and the society should be trained not to leave elderly people alone.

The effect of ballroom dance on balance and functional autonomy among the isolated elderly - Corrected Proof

2012-04-09

Abstract: The aim of the present study was to analyze the influence of a ballroom dancing program on the functional autonomy and physical balance of institutionalized elderly individuals. The study enrolled 75 sedentary elderly subjects from long-term institutions who were randomly divided into a ballroom dance program group (EG; n=39) and a control group (CG; n=36). The protocol of the Latin American Group for Maturity (GDLAM) was used to evaluate functional autonomy. Physical balance was analyzed using a stabilometer and posture meter platforms. The level of significance in statistical tests was set at p<0.05. Regarding the physical balance evaluation, only the members of the EG achieved a significant reduction in weight (Δ=−0.98kg) following the experiment, both in the intragroup (p=0.002) and in the intergroup analysis (p=0.012). In the evaluation of functional autonomy, only the EG showed a significant reduction in the execution time of all the tests and in the GDLAM index: GI (Δ=−6.99), both in the intragroup (p<0.001) and in the intergroup analysis (p=0.011). Thus, it can be inferred that sedentary elderly individuals who are residents of long-term institutions can improve their functional autonomy and balance with a ballroom dance program.

Non-pharmacological prevention of major depression among community-dwelling older adults: A systematic review of the efficacy of psychotherapy interventions - Corrected Proof

2012-04-09

Abstract: Depression is a major public health burden among the aging population. While older adults prefer non-pharmacological treatment, few options for psychotherapy are available in primary care settings, which is where older adults tend to receive mental health services. Indicated prevention is a cost-effective, public health approach to prevent major depressive disorder among people with depressive symptoms who do not yet meet standard criteria for major depression. We critically reviewed randomized controlled trials (RCTs) that assessed the efficacy of psychotherapy among community-dwelling older adults with subthreshold depression (depressive symptoms that do not meet standard criteria for major depression). We examined the intervention types, results, internal validity, and external validity of five studies. We used the United States Preventive Services Task Force (USPSTF) guidelines to rate the quality of the studies and to provide recommendations. Results suggest that psychotherapy is a safe and cost-effective method to reduce the public health burden of depression among older adults with subthreshold depression.

Significance and association of serum uric acid (UA) levels with components of metabolic syndrome (MS) in the elderly - Corrected Proof

Wen-Ko Chiou, Ding-Hau Huang, Ming-Hsu Wang, Yun-Ju Lee, Jen-Der Lin — 2012-04-09

Abstract: Information concerning the association of serum UA levels and the development of MS in the Chinese aging population is limited. The aims of this study were to investigate age-related metabolic disorders and analyze the relationship between serum UA levels and the components of MS in the elderly. This cross-sectional observational study was performed in subjects from the Department of Health Examination, including 1182 subjects aged ≧65 years; among these subjects, 528 were women (mean age, 70.7±4.8 years) and 654 were men (mean age, 71.4±5.3 years). All the subjects underwent three-dimensional (3-D) whole-body scanning for accurate anthropometric measurements. Data analyses were performed using SPSS software. Results: MS, hyperuricemia, hypertension, and diabetes mellitus (DM) were present in 53.9%, 40.6%, 33.1%, and 30.1% of the subjects, respectively. Univariate statistical analysis showed that age, blood pressure, blood sugar levels, high-density lipoprotein levels, triglyceride levels, WBC count, and related anthropometric indices differed significantly in subjects categorized according to serum UA levels. In conclusion, our study showed that a high percentage of elderly subjects had hyperuricemia. The results showed an association between serum UA levels and cardiovascular risk factors, and this finding warrants concern with regard to the aging population.

Age-related changes in the thickness of the deep and superficial abdominal muscles in women - Corrected Proof

Megumi Ota, Tome Ikezoe, Koji Kaneoka, Noriaki Ichihashi — 2012-04-09

Abstract: The study investigated age-related changes in the thickness of the deep and superficial abdominal muscles of 103 healthy women who could walk independently The participants were classified into five age groups: young (n=26; 20–24 years), young adult (n=26; 25–44 years), middle-aged (n=16; 45–64 years), young-old (n=16; 65–74 years), and old-old (n=19; 75–85 years). The muscle thicknesses of the right rectus abdominis, external oblique, internal oblique, and transversus abdominis were measured using ultrasound imaging. The rectus abdominis was significantly thicker in the young group compared with the young adult, middle-aged, young-old, and old-old groups (p<0.05). The external oblique and internal oblique muscles were significantly thicker in the young group compared with the middle-aged, young-old, and old-old groups (p<0.05). However, there were no significant differences in the thickness of the transversus abdominis between groups. The results suggest that age-related muscle atrophy occurs from an early age in superficial abdominal muscles, such as rectus abdominis, and that age-related atrophy is less in deep abdominal muscles such as the transversus abdominis.

Opportunities for improved trauma care of the elderly – A single center analysis of 2090 severely injured patients - Corrected Proof

2012-04-05

Abstract: Purpose: Western trauma centers are increasingly confronted with elderly trauma patients in parallel to an increase of the elderly population. The purpose of this study was to identify shortcomings and opportunities for improvement in the treatment of elderly trauma patients.Materials and methods: Retrospective analysis of a prospectively collected single-center trauma database. Patients were grouped according to age and analyzed using univariate and multivariate analysis.Results: 158 patients (7.6%) were older than 75years, and 604 patients (28.9%) were between 50 and 75years. Although comparable with respect to injury severity (injury severity score (ISS) 29–33) and age-adjusted Acute Physiologic and Chronic Health Evaluation (APACHE) score, there was a significant increase in mortality beyond the age of 50 (>75years: 63.9%), with age being an independent predictor of mortality. Despite a similar rate and severity of head injuries (affecting 71% of all patients), mortality of head injuries was highest in patients >75years (70.2%), accounting for the increased mortality in this group. Patients >75years old were less likely to undergo craniotomy, and withdrawal of medical support occurred five times more frequently. Surviving patients ≥50years required shorter ICU care than patients below 50years (7.8 vs. 12.4days).Conclusions: With increasing life expectancy and sustained independence, elderly trauma patients have become a regular occurrence in trauma services. Despite comparable injury severity and physiologic status upon admission, these patients suffer from disproportionately high mortality rates. Closed head injuries account for the majority of fatalities, regardless of the extent of therapeutic measures applied.

Disability and co-morbidity in relation to frailty: How much do they overlap? - Corrected Proof

Olga Theou, Michael R.H. Rockwood, Arnold Mitnitski, Kenneth Rockwood — 2012-03-29

Abstract: The purpose of this study was to examine the association of disability and co-morbidity with frailty in older adults. 2305 participants aged 65+ from the second wave of the Canadian Study of Health and Aging (CSHA), a prospective population-based cohort study, comprised the study sample. Following a standard procedure, two different frailty index (FI) measures were constructed from 37 deficits by dividing the recorded deficits by the total number of measures. One version excluded disability and co-morbidity items, the other included them. Time to death was measured for up to five years. Frailty was defined using either the frailty phenotype or a cut-point applied to each FI. Of people defined as frail using the frailty phenotype, 15/416 (3.6%) experienced neither disability nor co-morbidity. Using 0.25 as the cut-point score for the FI (without disability/co-morbidity) resulted in 101/1176 (8.6%) frail participants that had neither disability nor co-morbidity. Activities of daily living (ADL) limitations and co-morbidities occurred more often among people with the highest levels of frailty. The first ADLs to become impaired with increasing frailty were bathing, managing medication, and cooking with more than 25% of older adults with a FI score (without disability/co-morbidity) >0.22 experiencing dependency on them. The hazard ratio (HR) per 0.1 increase in FI score was 1.25 (95% CI: 1.20–1.30) when disability and co-morbidity were included in the index and 1.21 (1.16–1.25) when they were not included. In conclusion, disability and co-morbidity greatly overlap with other deficits that might be used to define frailty and add to their ability to predict mortality.

Social support and mobility limitation as modifiable predictors of improvement in depressive symptoms in the elderly: Results of a national longitudinal study - Corrected Proof

2012-03-29

Abstract: Few national longitudinal studies have investigated the predictors of a better depression outcome in geriatric depression. This study examined the predictors of improvement in case-level depressive symptoms in the elderly. In this prospective cohort and population-based study in Taiwan, 206 non-demented and case-level depressed subjects aged 65 and older were interviewed at baseline in 2003 and follow-up in 2007. The independent variables included demographics, chronic medical diseases, and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms, assessed using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CESD-10) assessed at follow-up. Multivariate analyses were used to identify the predictors of improvement in depression. The independent predictors of improvement in depression over a 4-year follow-up period are more social support and fewer mobility limitations at baseline. With regards to practical health-related behaviors, the 2 items of social support most associated with improvement in depression were willingness of significant others to talk with you and satisfaction with dependence upon significant others; the 2 items of mobility limitations most associated with non-improvement of depression were difficulty in carrying things and squatting. These findings suggested that health-related behaviors were important to the depression outcome in the elderly; moreover, interventions to improve depression should include practical health-related behaviors aimed at these modifiable risk factors.

Physical fitness levels among independent non-institutionalized Spanish elderly: The elderly EXERNET multi-center study - Corrected Proof

2012-03-19

Abstract: Background: Physical fitness is gaining in importance in all population groups, including elderly, but data are still scarce. The aim of this study was to report gender and age specific physical fitness levels in non-institutionalized Spanish elderly. Methods: A representative sample of 3136 elderly (≥65y), 724 men and 2412 women, from 6 Regions of Spain: Madrid, Aragón, Castilla y León, Castilla-La Mancha, Extremadura and Canarias were assessed in the elderly EXERNET multi-center study between 2008 and 2009. The authors assessed static balance, muscular strength, flexibility, agility, walking speed and cardiorespiratory fitness using eight different fitness tests: one leg balance, chair stand, arm curl, chair sit-and-reach, back scratch, 8-foot up-and-go, 30-m walk, and 6min walk tests. Results: The authors derived gender and age-specific normative values for physical fitness in the non-institutionalized Spanish elderly. The figures showed greater physical fitness in the elderly men than in women, except for the flexibility test, and a trend toward decreased physical fitness in both genders as their age increased. Conclusions: The normative values hereby provided will enable evaluation and correct interpretation of independent non-institutionalized Spanish elderly fitness status.

Physical activity and physical functioning in Swedish and Iranian 75-year-olds – A comparison - Corrected Proof

2012-03-19

Abstract: Background and purpose: The pattern of population aging is highly complex and contextually based. Cross-national comparisons are helpful to explore related factors. Two cross-sectional studies designed to compare physical activity level, physical functioning and certain health related factors in 75-year-old women and men in Sweden and Iran. Materials and methods: Cohorts of 637 Swedish and 851 Iranian 75-year-olds were investigated with the same methods regarding physical activity level, physical functioning and health related factors. Results: There were differences in physical activity level (p<0.001), self-reported physical functioning (p<0.001) objective physical functioning (p<0.001), health status (p<0.001) and most socio-demographic aspects between the two countries. Here the Swedish cohort had the advantage. There was no difference between the countries regarding prevalence of vertigo or falls. The only variables where the Iranian cohort had advantage over the Swedes were grip strength and smoking habits. There were larger gender differences in walking habits, self-selected walking speed, timed chair stand, and one-leg stance in Iran, and in grip strength in Sweden, all to the disadvantage of women. Conclusions: Iranian 75-years-olds had a lower physical activity level, a worse lower extremity physical function but a better grip strength, a worse physical health status, but smoked less than their Swedish counterparts. Despite this, there were no differences regarding vertigo or falls. In most aspects, the magnitude of gender differences was about the same and in disadvantage of women, although there were larger differences in Iran in some lower extremity functions.

Stochastic resonance whole-body vibration training for chair rising performance on untrained elderly: A pilot study - Corrected Proof

Slavko Rogan, Roger Hilfiker, Stefan Schmid, Lorenz Radlinger — 2012-03-19

Abstract: The present randomized controlled pilot study was conducted to determine the feasibility of the study protocol and the effects of four-week-long sessions involving stochastic resonance whole-body vibration (SR-WBV) training on chair rising in elderly individuals. Twenty elderly participants were divided into a SR-WBV group or a sham group. Peak force, rate of force development, rising time, time to stabilization and total time during chair rising performance were investigated. Intraclass correlation coefficients, Mann–Whitney U-tests and Wilcoxon signed-ranked tests were used. Low volume SR-WBV over 12 training sessions might provide a safe treatment method.

Activity level of hospital medical inpatients: An observational study - Corrected Proof

Suzanne S. Kuys, Urszula E. Dolecka, Amanda Guard — 2012-03-14

Abstract: Objectives: To determine the activity level of people admitted for an acute hospital medical admission and to describe the location of and people present at the activity.Design: Prospective observational behavioral mapping study.Participants: 102 patients admitted to general medical wards.Intervention: Participants were observed 1min every 10min during a working day from 8.30am to 4.30pm.Outcome measures: Highest level of activity was recorded; location, activity and person/s attending the participant.Results: Data from 76 participants were analyzed; mean age 67 (SD 19) years, 38 (50%) male. Participants were observed for 450min. They spent 394 (88%) min in their rooms, 18 (4%) min in the bathroom and 27 (6%) min off the ward. Of the time in their rooms, participants spent a median 315 (IQR 205–398) min lying in bed, 10 (IQR 0–38) min sitting on or out of bed and 1 (IQR 0–20) min standing or walking. Participants spent a median 115 (IQR 70–158) min doing nothing, 80 (IQR 43–160) min resting or sleeping and 75 (IQR 40–168) min talking, reading or watching television. Participants were alone 280 (IQR 230–340) min and with one person 90 (IQR 50–130) min. Participants were with staff a median 120 (IQR 73–180) min; nurses 35 (IQR 20–60) min, medical staff 10 (IQR 0–18) min and allied health staff 10 (IQR 0–20) min.Conclusion: People admitted to general medical wards are inactive during hospital stay; spending the majority of the working day in their rooms, in bed and alone.

Psychological effects of Tai Chi Chuan - Corrected Proof

P.J. Jimenez, A. Melendez, U. Albers — 2012-03-05

Abstract: This article reviews the scientific studies which have been carried out at the international level on the psychological benefits that Tai Chi Chuan (TCC) brings to those who practice it. It analyzes the framework in which the research was performed, the real benefits that this activity achieves and their causes. The present article brings a new analytical perspective to the reviews carried out to date in regard to classifying and analyzing the psychological variables involved in the practice of TCC and offers a homogeneous framework within which to develop research in this field based on the model proposed by .

Low predictability of anthropometric indicators of obesity in metabolic syndrome (MS) risks among elderly women - Corrected Proof

Fu-Ling Chu, Chung-Huei Hsu, Chii Jeng — 2012-03-05

Abstract: While diagnostic criteria for MS may vary depending on ethnicity, obesity remains a key risk factor in its development. In Taiwan, the incidence of obesity and MS among women has been increasing; however cut-off values for defining obesity for the diagnosis of MS among different groups of women have not been clearly established. The goal of this research was to examine the suitability of various anthropometric indicators of obesity in predicting the presence of MS criteria and to determine appropriate cut-off values of these indicators for women of different age and menstrual status. The sample was derived from the 2002 “Taiwan Three High Prevalence Survey” database. Women were divided into three groups based on age and menstrual status. Receiver-operating characteristic (ROC) curves was applied to the anthropometric indicators of obesity including, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), to ascertain its value in predicting MS. 2848 cases were included. It was found that most MS component values were worse with age and following menopause. Obesity indicators showed poor predictability for MS risks in post-menopausal women over 65 years, but good predictability in women under 65 years; our study revealed the following as ideal cut-off values for non-menopausal female: WHtR<0.49, WC<78cm, WHR<0.79, BMI<24kg/m2; for menopausal women, WHtR<0.54, WC<83cm, WHR<0.84, BMI<24.4kg/m2. It was concluded that obesity alone is not a reliable predictor of MS risks in women over the age of 65, and cut-off values for obesity indicators need to be further reduced in non-menopausal women.

Paid caregiver motivation, work conditions, and falls among senior clients - Corrected Proof

Lee A. Lindquist, Karen Tam, Elisha Friesema, Gary J. Martin — 2012-02-23

Abstract: The purpose of this study was to determine the motivation of paid non-familial caregivers of seniors, understand more about their work conditions, and identify any links to negative outcomes among their senior clients. Ninety-eight paid caregivers (eighty-five female and thirteen male), recruited from multiple sites (i.e. senior centers, shopping malls, local parks, lobbies of senior apartments, caregiver agency meetings) completed face-to-face questionnaires and semi-structured interviews. We found that 60.7% of participants chose to become a caregiver because they enjoyed being with seniors while 31.7% were unable to obtain other work, and 8.2% stated it was a prerequisite to a different health related occupation. Caregivers stated that the most challenging conditions of their work were physical lifting (24.5%), behavioral and psychological symptoms of dementia (24.5%), senior depression/mood changes (18.4%), attachment with impending death (8.2%), missing injuries to client (5.1%), lack of sleep (4.1%), and lack of connection with outside world (3.1%). Caregivers who reported that the best part of their job was the salary, flexible hours, and ease of work were significantly more likely to have clients who fell and fractured a bone than those who enjoyed being with seniors (job characteristics, 62.5% vs. senior enjoyment, 25.6%; p<0.004). We concluded that in pursuing their occupation, paid caregivers are motivated commonly by their love of seniors and also by their lack of other job opportunities. Paid caregivers frequently face challenging work conditions. When seeking a caregiver for a senior, motivation of the caregiver should be considered when hiring.

Social isolation risk factors in older hospitalized individuals - Corrected Proof

2012-02-20

Abstract: Background: Elderly people are particularly vulnerable to the effects of social reduction, so there is an urgent need to identify the risks associated with social isolation. The aim of this paper was to analyze associations between psychological, socio-demographic, functional aspects on the risk of social isolation, mortality and re-hospitalization in older persons.Methods: This is a longitudinal study on 580 hospitalized elderly sample aged ≥70yrs recruited from 2005 to 2007 in the Geriatrics Operative Unit of INRCA in Fermo, Italy. The comprehensive geriatric assessment (CGA) was used. Outcome measures included 36-month mortality and re-hospitalization.Results: In all patients, approximately 20% (n=112) of the subjects were socially isolated. Women perceived their social support significantly worse than men (77.7 vs. 22.3%; p<0.001). A multiple logistic regression analysis (goodness of fit χ2=102.86, p<0.001) with risk of social isolation as the dependent variable, showed that women were at a greater risk than men for social isolation (OR=1.99, 95% CI=1.13–3.50). Furthermore, patients with a higher number of family components (OR=0.72, 95% CI=0.59–0.88) and good parameters of quality of life (PCS-12: OR=0.94, 95% CI=0.91–0.98; MCS-12: OR=0.94, 95% CI=0.92–0.97) were less likely to be socially isolated. Cox regression models adjusted for gender, quality of life and number of family components, showed that the social isolation did not predict mortality (HR=1.44, 95% CI=0.84–2.46, p=0.19), but was associated with higher re-hospitalization rates (HR=1.28, 95% CI=1.02–1.59, p=0.03).Conclusions: Our findings highlight several aspects related to the risk of social isolation and re-hospitalization in a specific group of older persons.

The influence of neck pain on sensorimotor function in the elderly - Corrected Proof

Sureeporn Uthaikhup, Gwendolen Jull, Somporn Sungkarat, Julia Treleaven — 2012-02-20

Abstract: Greater disturbances in sensorimotor control have been demonstrated in younger to middle aged groups. However, it is unknown whether or not the impairments documented in these populations can be extrapolated to elders with neck pain. The aim of this study was to investigate the influence of neck pain on sensorimotor function in elders. Twenty elders with neck pain (12 women and 8 men) and 20 healthy elder controls (14 women and 6 men) aged 65 years and over were recruited from the general community. Tests for sensorimotor function included; cervical joint position sense (JPS); computerised rod-and-frame test (RFT); smooth pursuit neck torsion test (SPNT); standing balance (under conditions of eyes open, eyes closed on firm and soft surfaces in comfortable stance); step test and ten-meter walk test with and without head movement. Elders with neck pain had greater deficits in the majority of sensorimotor function tests after controlling for effects of age and comorbidities. Significant differences were found in the SPNT (p<0.01), error in the RFT (frame angled at 10° and 15° anticlockwise) (p<0.05), standing balance (amplitude of sway) – eyes open on a firm surface in the medio-lateral (ML) direction (p=0.03), and total number of steps on the step test, both left and right sides (p<0.01). Elders with neck pain have greater sensorimotor disturbances than elders without neck pain, supporting a contribution of altered afferent information originating from the cervical spine to such disturbances. The findings may inform falls prevention and management programs.

Effects of exercise programs on balance in older women with age-related visual problems: A pilot study - Corrected Proof

2012-02-13

Abstract: Aim: This study aimed to compare the effects of two exercise programs on balance and risk of falls in older women with age-related visual dysfunction. Methods: Participants living in a residential home were randomly allocated to Group I (n=21) receiving a progressive, tailored multimodal exercise program in addition to the standard osteoporosis exercise program or Group II (n=20) receiving the standard osteoporosis exercise program alone. At baseline, and after the 6-month exercise program outcomes were measured. Results: After the exercise program there was significant between-group difference in favor of the Group I in Timed Up and Go (TUG) test (p=0.001), but not in Berg Balance score (p=0.130), and Barthel Activity Index (p=0.662). In Group I the risk of falls reduced by 46%, but this result was not significant (RR=0.54, 95% CI 0.294–1.007). The mean length of event-free time was significantly longer in the Group I than in Group II (18.5weeks, 95% CI 15.4–21.7 vs. 14.8weeks, 95% CI 11.1–18.4; p=0.049). Conclusion: If the current osteoporosis guideline is applied for older adults with low vision, it would be worthwhile putting more emphasis on the inclusion of patient-tailored strength and balance exercises to improve balance and potentially reduce the risk of falls.

Studies on health in elderly observation centers (abbreviated from Italian: COSA): A multidimensional evaluation (MDE) of an elderly population frequenting a diurnal center in Catania - Corrected Proof

2012-02-10

Abstract: The worldwide progressive aging of the population forces us to reconsider the strategies of evaluation the effects of the geriatric “tsunami” on the health politics. The present study on the COSA (abbreviated from the Italian name: “Centro Osservazione Salute Anziani”) has the aim to investigate the effects of a new form called Specialistic Geriatric Assistance on the already existing geriatric services in our territory, like UVG (Unità Valutazione Geriatrica), ADI (Assistenza Domiciliare Integrata), MMG (Medici di Medicina Generale). The present preliminary studies were carried out a group of elderly people frequenting the elderly day center “Villa Angela” located in Catania. We enrolled 42 subjects, 29 females and 13 males, in the age-range of 65–89 years (mean=73.6 years). An evaluation protocol was used for the participants, having two parts. The first part was a general one performing an accurate anamnestic examination, while the second part evaluated the cognitive and affective spheres, and the levels of autonomy and autosufficiency. The data obtained show that that the elderly population of the daily center “Villa Angela” in Catania is affected by numerous pathologies and comorbidities, which all increase the total risk of disabilities. The subjects use a high number of medicines (sometimes more than 10), which is not always justified by the pathologies found in them. Considering the functional profiles of the patients, the sanitary services offered to them are appropriate, because almost all of the elderly people were autonomous and autosufficient, having still adequate physical performances. The higher cognitive performance seemed to be reduced in more than 50% of the patients, showing almost always a slight or moderate deterioration. The depressive state measured by the GDS seemed to reach the deflection of joy of life 54.8%, while the established depression was detected in 12%. These results emphasize the importance of the functional psychogeriatric screening, which is able to reveal an early diagnosis of depression in the geriatric ages. For this, and many other motifs, we believe that these preliminary examinations suggest to organize at least one COSA available to our elderly people.

Prevalence of cardiovascular pathologies in elderly population living in an industrialized area, compared to a control population residing in a rural area - Corrected Proof

2012-02-10

Abstract: The development of cardiovascular pathologies is potentially connected to the surrounding environment, partly due to purely environmental factors, like exposition to pollutions, or anthropological ones, like the type of manual or stressing working activities. The relevant literature has already widely discussed the correlation between the acute and chronic exposition to atmospheric pollutants of different types and the pathogenetic events, such as the atherogenesis, thrombosis, and hypertension, The present study intends to verify this idea on a larger population exposed to different geographical conditions, comparing an agricultural village (Pachino-Siracusa) with an industrialized area (Augusta-Siracusa), both having identical sanitary services of basic importance. On the basis of the specific rates of hospitalizations, we compared the prevalence of cardiovasular pathologies in the resident populations. These studies confirmed the negative influence of the risk factors deriving from the environmental pollutions even on the cardiovascular aging, displaying an increased rate of hospitalization for angina pectoris, myocardial infarction and cardiac arrhytmias in the industrialized population.

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.

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.

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.

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.

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.

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 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.

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.

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.