Archives of Gerontology and Geriatrics - Articles in Press

Trajectories of depression and their relationship with health status and social service use - Corrected Proof

2010-09-02

Abstract: This longitudinal study was conducted between 1994 and 2004 in a cohort of Southern Taiwan community-living elderly residents. The study aims to explore the trajectories of depression and how these patterns differed between respondents who survived and those who died during data collection phases; this study also investigated how health status change and health/social service use predicted the different trajectories of depression. Eight hundred and ten participants had completed all six waves of the survey or were followed-up at each wave until death in the prospective study in Kaohsiung City. Depressive symptoms were evaluated by the Short Psychiatric Evaluation Schedule (SPES). Changes in levels of depression during the ageing process were identified. Different trajectories clearly reflected heterogeneity within depression and the association with mortality. The study highlighted that diabetes, gastrointestinal problems, heart disease and disability, whether at baseline or as new occurrences, were predictors of health decline. High uses of health/social services were also predictive of increased depression. These findings identified depression as a highly dynamic process, characterized by different trajectories of depression between states of no, mild and severe depression. Greater awareness of these various trajectories should potentially improve the prevention and/or management strategies of depression.

Reactions to caregiving in frailty research - Corrected Proof

Christina Aggar, Susan Ronaldson, Ian Cameron — 2010-09-01

Abstract: Frailty is a syndrome characterized by decreased functional ability and associated with institutionalization. Many community-living frail older people rely upon the support of a family member or friend. However, there is a paucity of research exploring the reactions to caring for older people empirically identified as frail. The objective of this study was to describe carers of community-living older people identified as frail, using accepted criteria, identify care characteristics and ascertain relationships that contribute to reactions to caregiving. A cross-section of carers of community-living frail people (≥70 years) completed a postal questionnaire; the Caregiver Reaction Assessment (CRA) evaluated reactions to caregiving. Ninety-three carers completed the questionnaire (68% response rate). Correlation and multivariate analysis of variance tests (MANOVA) demonstrated statistically significant relationships between several care characteristics and reactions to caregiving. Carers who provide more than 20h of care per week and report a low self-perceived health status are susceptible to significant health and financial problems and disruption to their daily schedule. Two strategies for improving reactions to caring for persons with frailty are proposed: financial support that assists carers to improve their health status and the provision of regular formal assistance, rather than intermittent respite care.

Impact of nutritional status on long-term functional outcomes of post-acute stroke patients in Taiwan - Corrected Proof

2010-09-01

Abstract: Nutritional status is important in stroke care, but little is known regarding to the prognostic role of nutritional status on long-term functional outcomes among stroke survivors. The main purpose of this study was to evaluate to the prognostic role of nutritional status on long-term functional outcomes among stroke survivors. Data of acute stroke registry in Kaohsiung Veterans General Hospital were retrieved for analysis. Overall, 483 patients (mean age=70.7±10.3 years) with first-ever stroke were found. Among them, 95 patients (19.7%) were malnourished at admission, 310 (mean age=70.4±10.1 years, 63.5% males) survived for 6 months, and 244 (78.7%) had good functional outcomes. Subjects with poor functional outcomes were older (74.7±8.9 vs. 69.0±10.1 years, p<0.001), more likely to be malnourished (56.2% vs. 26.6%, p<0.001), to develop pneumonia upon admission (23.3% vs. 12.7%, p=0.027), had a longer hospital stay (23.5±13.9 vs. 12.5±8.2 days, p<0.001), had a higher National Institutes of Health Stroke Scale (NIHSS) score (12.9±9.3 vs. 4.9±4.3, p<0.001), poorer stroke recovery (NIHSS improvement: 6.9% vs. 27.4%, p=0.005), and poorer functional improvement (Barthel index=BI improvement in the first month: 31.4% vs. 138%, p<0.001). Older age (odds ratio=OR)=1.07, 95% confidence interval (CI=1.03–1.11, p<0.001), baseline NIHSS score (OR=1.23, 95%CI=1.15–1.31, p<0.001) and malnutrition at acute stroke (OR=2.57, 95%CI: 1.29–5.13, p<0.001) were all independent risk factors for poorer functional outcomes. In conclusion, as a potentially modifiable factor, more attentions should be paid to malnutrition to promote quality of stroke care since the acute stage.

Pain, physical performance and balance in the elderly at hospital - Corrected Proof

Hülya Yücel, Hülya Kayıhan — 2010-09-01

Abstract: This study was aimed to determine the pain, physical performance and balance conditions of the elderly hospitalized in university hospital geriatric wards. The reasons for hospitalization and co-morbid diseases were recorded. Severity of pain was assessed on a visual analogue scale. Activity independence ability was tested by physical performance test (PPT). Tinetti balance and gait evaluation scale (GES) were used to assess balance. Fifty patients (54%) had reported any kind of pain. Mean score for PPT was 13.32±6.56 and for Tinetti test was 9.76±3.8. The correlation between pain, physical performance and balance for 93 patients, 65 years and above was analyzed and not found statistically significant. We believe that pain can affect physical performance and balance. Therefore, it should be carefully evaluated in every elderly patient. Further studies are necessary to investigate the relationship between pain, physical performance and balance of elderly hospitalized patients.

White matter hyperintensities (WMH) are associated with intracranial atherosclerosis rather than extracranial atherosclerosis - Corrected Proof

2010-08-30

Abstract: There is increasing evidence for an association between WMH and large-artery atherosclerosis. We evaluated 268 patients with acute ischemic stroke to assess the relationship between intracranial (IC) atherosclerosis and WMH. The patients were classified into three groups according to the location of the stenosis; IC, extracranial (EC), and non-stenosis (NS) group. WMH were rated using the semiquantitative method of Scheltens and coworkers. The IC group had significantly more WMH score in comparison with the other groups after controlling age. The linear regression analysis showed that age was the factor most strongly associated with the total score of WMH; and the location of stenosis was positively related to WMH, especially in deep white matter. Our data show that IC stenosis is associated with WMH, indicating that IC stenosis, rather than EC stenosis, is likely to cause white matter lesions. These findings raise the possibility that occlusion of penetrating arteries, embolism to border-zone areas and a hemodynamic mechanism associated with IC stenosis leads to the formation of white matter lesions.

Revision of the ADA-classification of diabetes mellitus type 2 (DMT2): The importance of maturity onset diabetes (MOD), and senile diabetes (DS) - Corrected Proof

Marco Vacante, Michele Malaguarnera, Massimo Motta — 2010-08-27

Abstract: The changing social and economic conditions and the increase of the life span induced a progressive increase of the general prevalence of DMT2, particularly in the elderly population of the highly evoluted countries. Up to now 18 genetic loci have been identified, each of them consisting of several single nucleotide polymorphisms (SNPs). The evidence that the DMT2 is regulated by a high number of genes, demonstrate the pathogenetic complexity of this disease. The onset of diabetes mellitus (DM) in medium age is a consequence of the breakdown of the glycemic homeostasis in correlation with the genetic factors, such as the variants of the TCF7L2, obesity, etc., and the environmental factors, such as the life-style, the evolution of chronic-degenerative diseases, etc. In case of DM that onsets in old age we have to add the deterioration of the anti-aging defense mechanisms, characterized by the antagonistic action of the genes of longevity and aging. One can observe several clinical and therapeutic differences; therefore, the authors of this review propose the reinsertion of three forms into the DMT2 correlated with the age of onset and with the actual age of the subjects: the maturity onset diabetes (MOD), the maturity onset diabetes in elderly (MODE), and the senile diabetes (DS).

Characteristics of home care supporting clinics providing home care for frail elderly persons living alone in Japan - Corrected Proof

Akiko Akiyama, Hiroo Hanabusa, Hiroshi Mikami — 2010-08-23

Abstract: To explore the characteristics of home care supporting clinics providing home care for frail elderly persons living alone (EPLA), a self-administered questionnaire was mailed to 998 home care supporting clinics in the 23 wards of Tokyo, Japan between July and August 2009. Clinics providing home care for the frail EPLA significantly collaborated with 4 or more home visit nursing stations (42.5%) and 4 or more care managers (58.7%) and had sufficient medical care equipment, such as an oxygen inhaler, ventilator, and intravenous hyperalimentation. Sixty-one percent of the clinics which provided care for the 18 patients who died at home collaborated with 4 or more care managers. Our findings suggest that the factors enabling home care for frail EPLA are as follows: (1) collaboration with care managers, (2) collaboration with home visit nursing stations, (3) sufficient medical care equipment.

Rehabilitation outcomes of older Chinese patients with different cognitive function in a geriatric day hospital - Corrected Proof

James Ka Hay Luk, Charles Fei Chan, Felix Hon Wai Chan, Leung Wing Chu — 2010-08-23

Abstract: The relationship between cognitive function and geriatric day hospital (GDH) rehabilitation has not been explored. This study investigated this association in 547 older Chinese patients attended GDH. Cognitive status was assessed by Cantonese version of mini-mental state examination (C-MMSE). Functional independence measure (FIM) upon GDH admission and discharge were measured, with FIM gain=FIM discharge−FIM admission while FIM efficiency=FIM gain/by number of GDH visits. FIM discharge ≥90 was defined as satisfactory outcome of rehabilitation. Positive correlation was observed between C-MMSE admission and FIM discharge (p<0.001). There were significant differences in the FIM admission and FIM discharge among the three C-MMSE groups, with lower discharge scores in low C-MMSE groups (p<0.001). The FIM gain and FIM efficiency during GDH rehabilitation were not different among different C-MMSE groups. C-MMSE admission (p=0.03) and FIM admission (p<0.001) were both positive independent predictors for a satisfactory rehabilitation outcomes (FIM discharge ≥90). Cognitive function was not associated with FIM gain and efficiency. This suggested that selected patients with impaired cognition could still benefit from GDH rehabilitation.

Population-based reference values of handgrip strength and functional tests of muscle strength and balance in men aged 70–80 years - Corrected Proof

Eva L. Ribom, Dan Mellström, Östen Ljunggren, Magnus K. Karlsson — 2010-08-13

Abstract: With aging, the incidence of falls and fractures increases. There has during the last decades been secular changes in demographics so that the proportion of elderly increases in society. Hence, there is an increasing need for clinicians to be able to make a solid appraisal of the elderly patient's functional capacity, as to identify individuals with an increased risk to fall. If high risk individuals could be targeted fall preventive strategies might be implemented in specific risk cohorts. This would require reference values for muscle strength tests and functional tests, in order to defined high risk individuals performing inferior. From the MrOS Sweden cohort, 999 subjects aged 70–80 years were evaluated. Muscle strength and functional performance was tested by timed-stands test, 6-m and 20-cm narrow walk tests and Jamar handgrip strength test. Normative data is presented. With increasing age, there was a 10–18% successively decline in performance throughout the entire age span. This study provides reference values for handgrip strength and functional muscle tests in 70–80 years old men. The decline in the test values with increasing age, infer the use of age-specific normative data when using these tests both in clinical and research settings.

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

E.H. Mizrahi, A. Waitzman, M. Arad, T. Blumstein, A. Adunksy — 2010-08-13

Abstract: The purpose of this study was to investigate how bladder management, rather than urinary incontinence, may affect the functional outcome of ischemic stroke patients. We studied 919 consecutive patients admitted for ischemic stroke rehabilitation. Level of bladder management was determined by Functional Independence Measurement (FIM TM) sub-scale scores relevant to bladder control. FIM scores less than 5 points was determined as low-bladder management score (Low-BMS) while FIM scores greater than 5 was determined as high-bladder management score (High-BMS). Data were analyzed by t-test, Pearson correlation, and chi-square test as well as by multiple linear regression analysis. There were 594 low-bladder score patients (Low-BMS) and 325 high-bladder score patients (High-BMS), at admission. Compared with High-BMS, Low-BMS patients were slightly older (p=0.002), had longer rehabilitation stays (p<0.001) and lower mini-mental state examination (MMSE) scores (p<0.001). Total FIM at admission and discharge were lower in Low-BMS, yet their total FIM gain upon discharge was higher, compared with High-BMS (19.5±16.46 vs. 17.59±12.55, p=0.07). Multiple linear regression analyses showed that total FIM at discharge was inversely associated with Low-BMS at admission (beta=−0.407; p<0.001) and age (beta=−0.127; p<0.001). A high MMSE score (beta=0.334; p<0.001) emerged as predicting higher total FIM scores upon discharge. Low-BMS was independently predictive for total FIM gain at discharge (beta=0.166; p<0.001). The findings suggest that Low-BMS should be held as adversely affecting the rehabilitation outcomes of elderly stroke patients. However, Low-BMS patients do obtain significant gains and should not be deprived of rehabilitation.

Comparison of epicardial adipose tissue (EAT) thickness and anthropometric measurements in metabolic syndrome (MS) cases above and under the age of 65 - Corrected Proof

2010-08-12

Abstract: EAT is a new index of cardiac and visceral obesity. Waist circumference (WC) measurement is not fully reliable in the determination of visceral adipose tissue (VAT), especially in elderly individuals. Studies on the reflection of the intra-abdominal fat mass by the EAT mass surrounding the heart were performed. Our purpose in this study was to determine the relation between the MS criteria and EAT in MS cases and especially to compare anthropometric measures between non-geriatric patients under the age of 65, and geriatric ones over the age of 65 years. The study was performed during the years 2008 and 2009 on 120 cases; 66.7% of them were under the age of 65 and 33.3% of the cases were 65-year old or older. All of the patients were diagnosed as MS by the International Diabetes Federation (IDF) criteria. They were randomized as per the application order and included to the study. Each subject underwent transthoracic two-dimensional (2D) guided M-mode echocardiogram. We measured epicardial fat thickness on the 1/3 section close to the ventricle basis adjacent to the free wall of right ventricle from both the parasternal long axis (LA) and parasternal short axis (SA) views. Multiple regression analysis showed that WC, systolic blood pressure (SBP) and age were the strongest independent variables correlated with EAT (p<0.001). We also determined a significant correlation between low-density lipoprotein-cholesterol (LDL-C) and EAT (p<0.05). Our data show that EAT-measurement by echocardiography is an efficient method in determination of visceral adiposity and shall be taken into consideration especially when advanced age groups are in question.

Fatigue and disability in elderly patients with chronic obstructive pulmonary disease (COPD) - Corrected Proof

Mukadder Mollaoglu, Tülay Kars Fertelli, Fatma Özkan Tuncay — 2010-08-12

Abstract: The purpose of this study was to describe the prevalence and severity of fatigue and to investigate relationships between fatigue, and disability in elderly COPD patients. This descriptive and analytical study was conducted on 98 patients. Three instruments were used: Personal information form (PIF), visual analog scale for fatigue (VAS-F) and brief disability questionnaire (BDQ). The statistical analyses were used in order to evaluate the data: Student's t-test, Kruskall–Wallis test, Pearson correlation coefficient calculation and logistic regression analysis. All of patients in the sample experienced fatigue. The level of fatigue and disability experienced by the patients with COPD was high, their energy level was low. It was determined that as COPD patients’ fatigue increases their disability also increases, that there are relationships between fatigue and marital status and that there are relationships between disability and gender. Furthermore, in this study significant differences were found in COPD patients’ VAS-F and BDQ scores for some symptoms of COPD, such as dyspnea, fatigue, cough and sputum. The results of the study indicated that high levels of fatigue are experienced which impacts on patients’ functional condition and needs to be professionally assessed managed.

Self-reported problems before and after prosthodontic treatments according to newly created Turkish version of oral health impact profile - Corrected Proof

Ilgi Baran, Rana Nalcaci — 2010-08-12

Abstract: The aim of the study was to assess patients’ socio-demographic factors with their removable prosthesis in general, as well as to assess their problems with the functional limitation, physical pain, psychological discomfort, physical disability, social disability, and handicap investigate impaired oral health-related quality of life (OHRQoL) in patient treated with removable dentures before treatment and at 1 and 12 months after treatment. The first part of the questionnaire was comprised of 20 questions. It was designed in four different sections as: (i) general socio-demographic factors, (ii) general health, (iii) experience and use of dental and denture care, and (iv) anamnestic sign and symptoms of temporomandibular disorders (TMD). A statistical analysis system (SAS) was used for data management and analysis. Patient-reported problems were studied using the item list contained in the Turkish version of the oral health impact profile (OHIP) in a convenience sample of 136 prosthodontic patients before (m0), 1 month after (m1), and 12 months (m2) after treatment were then examined by using two-way ANOVA with repeated measurement. Differences in OHRQoL were present when item-specific prevalence was stratified by time of total scores; gender, residential area, working status, self-reported general health, smoking status, denture type, importance of the convenient dental care, trauma story, self-reported TMD/pain, and self-reported TMD/difficulty opening mouth wide. At baseline, the most prevalent frequently reported problems “difficulties chewing” (49.3%), “digestion worse” (40.4%), “take longer to complete a meal” (36%), “food catching” (30.9%), and “dentures not fitting” (29.4%), and m2 the most prevalent frequently reported problems were “avoid going out” (25%), “difficulties chewing” (17.6), “sore jaw” (15.5%), and “take longer to complete a meal” (14%). The study confirmed that denture status is by far the strongest predictor of impaired OHRQoL compared to socio-demographic factors. Subjects with strong or moderate values had significantly fewer oral health-related problems (OHIP-extent) of time of total scores. The number of problems decreased substantially after prosthodontic treatment. The profile of pretreatment and post-treatment problems differed substantially, but in general, only a few problems remained after adaptation to new dentures.

Clinical manifestations of elderly patients with digitalis intoxication in the emergency department - Corrected Proof

2010-08-12

Abstract: This study aimed to determine the clinical characteristics of elderly patients diagnosed with digitalis intoxication, on the Emergency Department, University Hospital Complex, A Coruña, Spain. During the study period (January–September 2008) cases were included in which digitalis intoxication was confirmed by plasma digoxin levels. We collected data on age, gender, base-line diseases, therapeutic indications for digoxin, functional classification, ejection fraction, plasma digoxin levels, creatinine clearance, ions, gasometry, electrocardiogram, concomitant medication, symptomatology and treatment. The results were: mean age 82.0±6.6 years, predominantly female subjects (83.7%). The most prevalent pathologies were cardiac valvulopathy (81.0%), hypertension (68.3%) and ischemic cardiopathy (46.3%), 95.1% had a background of cardiac insufficiency, and 52.6% were in functional grade III. The mean digoxin level was 2.7±0.69ng/ml, 23.1% of the patients had a creatinine clearance of less than 60ml/min/1.73m2 and 2.6% had a severely reduced glomerular filtration rate (GFR) (clearance<30ml/min/1.73m2). A negative correlation was found between digoxin levels and clearance (r=−0.22; p=0.18) and between the levels and cardiac frequency (r=−0.35; p=0.026). Of the patients, 47.5% presented bradycardia and 87.8% arrhythmias, most frequently auricular fibrillation. The most frequent symptoms were nausea (54.8%), fatigue (42.9%), vomiting (33.3%) and anorexia (28.6%). We conclude that clinical digestive symptoms in elderly women who are taking digitalis, with bradycardia and impaired renal functioning, should lead us to suspect digitalis intoxication.

Motor cortex hyperexcitability in subcortical ischemic vascular dementia - Corrected Proof

2010-08-12

Abstract: To study whether in subcortical ischemic vascular dementia (SIVD) the changes of motor cortex excitability are due to the dementing process or to the cerebrovascular lesions, we examined 20 SIVD patients, 20 patients with subcortical ischemic disease without dementia (SIDWD) and 20 control subjects who underwent transcranial magnetic stimulation (TMS). Motor threshold (MT), amplitudes of motor evoked potentials (MEPs) and silent period (SP) were considered. MT in SIVD patients (32.7±2.6%) was significantly lower (p<0.001) than in SIDWD patients (47.9±3.4%) and in controls (49.1±4.2%). MEP amplitude was larger in SIVD patients (6.8±1.7mV) than in the other groups (5.7±1.9mV and 5.2±1.8mV, p<0.02). Motor cortex excitability is enhanced in SIVD. Our data, taken together with previous results in Alzheimer disease (AD), indicate that motor cortex hyperexcitability is a common finding in different dementing illnesses.

Outcome of first-ever acute ischemic stroke in the elderly - Corrected Proof

Isabel Soares, Pedro Abecasis, José M. Ferro — 2010-08-05

Abstract: Our purpose was to evaluate the outcome of patients aged 70 years or older with a first-ever acute ischemic stroke and to identify the factors which determine poor outcome. Data from 115 patients, non-disabled prior to stroke, consecutively admitted to a medical department of a teaching hospital over a 30-month period, were prospectively collected at stroke onset and 6-month follow-up. Clinical and brain imaging findings and functional status were recorded. Predictors of unfavorable outcome at 6 months, defined as a modified Rankin Scale score >2, were analyzed by multiple logistic regression. The mean age of this cohort was 78.6 years (SD, 5.7) and 66.1% were women, 73.9% had hypertension, 25.2% diabetes, 36.0% atrial fibrillation (AF), 33.9% heart failure (HF), 15.8% previous transient ischemic attack (TIA), 47.8% a Charlson comorbidity index (CCI) score >1 and 52.2% a baseline National Institute of Health stroke scale (NIHSS) score ≥6. At 6 months, 54 patients (47%) had unfavorable outcome and the independent predictors of poor outcome were the initial systolic blood pressure and the NIHSS score on admission. In conclusion, near 50% of these old patients were dependent or dead 6 months after stroke onset and the main predictor of poor outcome was the neurological severity of stroke.

The relationship between functional capacity (FC) and cardiac autonomic nervous dysfunction to surgery stress in senile patients - Corrected Proof

2010-08-04

Abstract: The aim of the study presented here is to compare the pre- and post-operative cardiac autonomic nervous function of senile patients with different functional capacities (FC). Ninety-two senile patients scheduled for elective non-cardiac surgery were selected, whose FC was evaluated in terms of Duke activity status index (DASI). According to FC, the patients were classified into three groups: Group 1 (poor FC); Group 2 (moderate FC) and Group 3 (excellent FC). Heart rate variability (HRV) was monitored during the night before, on the 1st and the 2nd day after operation respectively. The results demonstrated some indices of pre-operative HRV of patients with poor or moderate FC were significantly lower than those with excellent FC. After surgery, total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) of all patients were significantly decreased. The LF/HF of patients with a poor or moderate FC showed a significant difference compared to patients with excellent FC. In conclusion, we emphasize that surgery induced a cardiac autonomic nervous dysfunction in senile patients not only with low FC but also with high FC; the disturbance of pre- and post-operative cardiac autonomic nervous activity is associated with a diminished FC (<7METs=metabolic equivalents) in senile patients.

Prognostic impact of pre-operative albumin on short-term mortality and complications in patients with hip fracture - Corrected Proof

2010-08-04

Abstract: Low serum albumin may have prognostic value for morbidity and mortality in patients with hip fracture. The primary aim of the study was to evaluate the independent association between low serum albumin (<35g/l) at hospital admission and short-term (in-hospital) mortality and post-operative complications of patients with hip fracture. We reviewed a prospective population-based cohort of 583 hip fracture patients who had pre-operative albumin values measured at hospital admission in one of the 3 tertiary hospitals in Northern Alberta, Canada. Patients with a primary diagnosis of hip fracture and 65 years or older were included. The primary outcomes were in-hospital mortality and any pre-specified post-operative complication. Mean serum albumin level was 33.8±4.5g/l (±S.D.), and overall 55% (n=318) of patients had a low albumin. The in-hospital mortality was 8% (n=46) and rate of any non-fatal post-operative complication rate was 31/100. Mortality was 11% (n=35) among those with low albumin levels and 4% (n=11) for those with normal values (unadjusted odds ratio (OR) 2.86, 95% CI=1.42–5.74). After multivariate adjustment, the association between low serum albumin and mortality remained large and statistically significant (adjusted OR=2.44, 95% confidence interval (CI)=1.17–5.12). Low albumin levels were also significantly associated with post-operative medical complications (adjusted OR=1.96, 95% CI=1.36–2.83). We conclude that routine measurement of serum albumin provides valuable prognostic information for treating this frail population.

Relationship between admission albumin levels and rehabilitation outcomes in older patients - Corrected Proof

James Ka Hay Luk, Patrick Ka Chun Chiu, Sidney Tam, Leung Wing Chu — 2010-08-03

Abstract: The relationship between serum albumin level and rehabilitation outcome in older patients has not been fully explored. This study investigated this association in older Chinese patients. We studied 1604 patients in two geriatric convalescence hospitals. Admission albumin levels (g/l) were measured and segregated into three groups: <30g/l; 30 to <35g/l; ≥35g/l. Absolute functional and motor gain were determined by Barthel index (BI) and elderly mobility scale (EMS) and expressed as BI efficacy and EMS efficacy. BI and EMS efficiency were deduced by the efficacy divided by the length of hospital stay (LOS). Satisfactory motor and functional outcomes were defined as discharge EMS≥15 and BI≥75. Significant improvement in EMS and BI scores across all 3 albumin groups on discharge was observed, with lower scores in low albumin groups. The EMS and BI efficacy were the same in 3 albumin groups. However, EMS and BI efficiency were higher in the high albumin groups. Admission albumin was not independent predictors for satisfactory motor and functional outcomes. For satisfactory motor outcome (EMS≥15), female gender (p=0.0004), age (p=0.0009) and urinary incontinence (p=0.0076) were negative predictors while living at home (p=0.0028), admission EMS (p<0.001) and BI score (p=0.0004) were positive predictors. For satisfactory functional outcome (BI≥75), age (p=0.015) and urinary incontinence (p<0.001) were negative predictors while female gender (p=0.0024), LOS (p=0.033), C-MMSE (p<0.001), admission EMS (p=0.003) and BI (p<0.001) were positive predictors. Admission albumin levels were related to functional and motor efficiency, but not with absolute functional and motor gain. Albumin was not an independent predictor for satisfactory motor and functional outcome.

How to assess frailty and the need for care? Report from the Study of Health and Drugs in the Elderly (SHADES) in community dwellings in Sweden - Corrected Proof

2010-08-02

Abstract: Knowledge about the need for care of elderly individuals in community dwellings and the factors affecting their needs and support is limited. The aim of this study was to characterize the frailty of a population of elderly individuals living in community dwellings in Sweden in relation to co-morbidity, use of drugs, and risk of severe conditions such as malnutrition, pressure ulcers, and falls. In 2008, 315 elderly individuals living in community dwellings were interviewed and examined as part of the SHADES-study. The elderly demonstrated co-morbidity (a mean of three diseases) and polypharmacy (an average of seven drugs). More than half the sample was at risk for malnutrition, one third was at risk for developing pressure ulcers, and nearly all (93%) had an increased risk of falling and a great majority had cognitive problems. Age, pulse pressure, body mass index, and specific items from the modified Norton scale (MNS), the Downton fall risk index (DFRI), and the mini nutritional assessment (MNA-SF) were related to different outcomes, defining the need for care and frailty. Based on the results of this study, we suggest a single set of items useful for understanding the need for care and to improve individual based care in community dwellings.

Quetiapine augmentation of antidepressant treatment in elderly patients suffering from depressive symptoms: A retrospective chart review - Corrected Proof

Shelly Tadger, Diana Paleacu, Yoram Barak — 2010-08-02

Abstract: Depression in elderly patients is often characterized by poor responses to standard antidepressants. Several reports have suggested that quetiapine also may have antidepressant properties. The present study aimed to evaluate the efficacy of quetiapine augmentation in depressed elderly patients previously unresponsive to a full course of treatment. Medical charts of elderly depressed inpatients treated at a tertiary care psychiatric center during a 3-year period were reviewed. Clinical and demographic data were extracted from computerized records and analyzed. The primary outcome measure was the change on the clinical global impressions scale for improvement (CGI-I). Twenty depressed elderly inpatients received quetiapine augmentation during the study period. Prior to augmentation all had been treated with antidepressants. Baseline mean severity of depression was 6.40; severity after augmentation was significantly reduced to 3.25; the change in CGI-I was 2.10 (p<0.03). Mean quetiapine dose was 70mg; mean duration of augmentation was 3.9 weeks. Five patients complained of somnolence. One patient discontinued psycho-tropics and switched to electroconvulsive therapy (ECT) due to life-threatening suicidal tendencies. We tentatively conclude that quetiapine augmentation for elderly depressed patients unresponsive to standard antidepressant treatment may be a safe and efficacious option. Further prospective studies need be carried out to support our observation.

Impairments in mobility and balance in relation to frailty - Corrected Proof

Daniel H.J. Davis, Michael R.H. Rockwood, Arnold B. Mitnitski, Kenneth Rockwood — 2010-08-02

Abstract: We set out to describe the relationship between impaired balance, mobility and frailty, and relate these to risk of death. We examined a subsample of 1295 community-dwelling non-demented adults from the second wave of the Canadian Study of Health and Aging (CSHA), a prospective population-based cohort study. Frailty index (FI) scores were constructed from a standardized comprehensive geriatric assessment (FI-CGA). History of mobility impairments and falls were assessed. Timed-up-and-go (TUG) and functional reach (FR) performance were measured. The CSHA clinical frailty scale (CFS) was judged by a physician. Adverse outcomes were determined at CSHA-3, conducted 5 years later. The FI-CGA varied in association with impaired mobility and balance. A history of mobility problems was demonstrable at FI-CGA scores >0.12. This level of frailty also represented the most marked deterioration in performance measures (TUG and FR). FI-CGA scores best predicted mortality (HR 1.04±0.02), proving to be a dominating factor in multivariate regression models that included mobility and balance markers. Only at the upper range of FI-CGA reported (>0.45) did all participants demonstrate mobility impairment. Impaired balance and mobility contribute to frailty, but neither is sufficient to define a participant as frail.

The relationship between the body mass index (BMI) and foot posture in elderly people - Corrected Proof

Thaís Rabiatti Aurichio, José Rubens Rebelatto, Alessandra Paiva de Castro — 2010-08-02

Abstract: We wanted to evaluate the postural characteristics of the feet of older people and their relationship with the BMI. We evaluated 227 older women and 172 older men with respect to the BMI, the arch index (AI) and the foot posture index (FPI). The obese women presented mean values for the AI significantly greater than those of the normal and overweight women. The means for some of the criteria of the FPI were significantly higher in the obese men. There was a positive correlation between the BMI and the AI and some of the FPI criteria. The conclusion was that obese women presented flatter feet while obese men presented more pronated feet, indicating a relationship between high BMI values and postural characteristics of the feet of subjects studied.

Reliability of 4-m and 6-m walking speed tests in elderly people with cognitive impairment - Corrected Proof

2010-08-02

Abstract: The purpose of this study was to evaluate the interrater and test–retest reliability of 4-m and 6-m walking speed tests in elderly people with cognitive impairment. 50 subjects aged 65 and over with cognitive impairment were selected from an adult day-care centre and a nursing home. To examine interrater reliability, 21 people were evaluated independently by two researchers who administered the 4-m and 6-m walking tests in each evaluation. For test–retest reliability, two observers administered the tests to the same 29 subjects, with a time interval of one week. Intraclass correlation coefficients (ICCs) were calculated to examine interrater and test–retest reliability. The ICCs for interrater reliability reached values of 0.96 and 0.88 for the 4-m and 6-m walking tests, respectively. In the test–retest study, the time interval was 7.4±1.17 days. The ICCs were 0.91 for the 4-m test and 0.86 for the 6-m test. The results support the use of walking tests in elderly people with cognitive impairment.

Five-year survival of patients after out-of-hospital cardiac arrest depending on age - Corrected Proof

Miloslav Pleskot, Radka Hazukova, Hana Stritecka, Eva Cermakova — 2010-08-02

Abstract: Patient's age belongs to the independent prognostic factors of patients after out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the influence of age on 5-year survival in professionally cardio-pulmonary resuscitated patients with “primary cardiac” etiology OHCA. In this analysis of prospective multi-centric study, from April 1, 2002 until August 31, 2004, a total of 560 patients were included (aged 16–97 years) from the East Bohemian region, for whom a professional cardio-pulmonary resuscitation for OHCA was attempted. In the age subgroup <70 years there were 307 patients and in the age subgroup ≥70 years there were 253 patients. Of the subgroup <70 years, 29 patients (10%) survived to year 5 (58% from the 50 patients surviving to day 30), and in the subgroup ≥70 years, we had 4 patients surviving to year 5 (2%) (29% from the 14 patients surviving to day 30), respectively (Fisher‘s exact test; comparison in the all resuscitated patients: p<0.001, in the population surviving to day 30: p=0.071). In conclusion, there was a trend towards a worse outcome in 5-year survival following OHCA in the patients aged ≥70 years. Nevertheless, these data support that prognosis OHCA of elders is not associated with universal dismal outcome.

Prevalence of geriatric conditions: A hospital-wide survey of 455 geriatric inpatients in a tertiary medical center - Corrected Proof

Cheryl Chia-Hui Chen, Chung-Jen Yen, Yu-Tzu Dai, Charlotte Wang, Guan-Hua Huang — 2010-07-20

Abstract: The aim of this study was to investigate the prevalence of common geriatric conditions in a tertiary medical center. We conducted a cross-sectional, hospital-wide survey of 455 inpatients, aged 65 and older, from 24 medical and surgical units of a 2200-bed urban academic medical center in Taiwan. Patients were screened in face-to-face interviews for 15 geriatric conditions. The prevalence of geriatric conditions was determined and compared by medical versus surgical services. Our sample of participants had a mean age of 75.3±6.1 years (±S.D.), range=65–92. The prevalence of geriatric conditions ranged from 5% (pressure ulcers) to 57% (polypharmacy; taking>5 prescriptions). The majority was visually impaired (74%) and complained of sleep disturbance during their hospital stay (58%). Prevalence rates of certain geriatric conditions differed significantly between medical and surgical units, suggesting that care should address not only common conditions but also those with higher rates on different units. Furthermore, high rates of geriatric conditions indicate strong needs for care that does not fit into traditional disease models of medicine. Care should be better targeted to address different risks for geriatric conditions of medical versus surgical geriatric inpatients in acute care settings.

A quick dementia screening tool for primary care physicians - Corrected Proof

Chin-Ying Chen, Kai-Kuen Leung, Ching-Yu Chen — 2010-07-20

Abstract: The accuracy and consuming-time of screening methods are important factors in the early diagnosis of dementia. In this study, we aimed to know whether the eight-item test (including three-item recall, attention and calculation, subtracted from the mini-mental state examination (MMSE), clock drawing test (CDT), and instrumental activities of daily living (IADL) impairment or any combination of the above tests can be used as a quick and effective dementia screening tool. A total of 188 seniors aged over 60 years were enrolled at a geriatric clinic. The result revealed that a cutoff score of 6/7 in an eight-item scale had a sensitivity of 94.9% and a specificity of 59.1% in the detection of dementia. In terms of sensitivity and specificity, the eight-item scale performed better than a score of two in three-item recall (51.3%/87.3%), a score of one in three-item recall (83.3%/53.6%), CDT (39.0%/96.9%), mini-cognitive assessment instrument (Mini-Cog) test (53.7%/95.5%), a score of less than three in attention/calculation test (74.7%/77.3%), impairment of transportation or medication in IADL (67.2%/90.6%), and any impairment in IADL (77.2%/67.9%). In subgroup analysis, a cutoff score of 5/6 were adjusted for the low-education group. We conclude that an eight-item test is a sufficient and simple tool for the screening of early dementia in primary-care clinics focused on older people care.

Changes in body weight and physical performance after receiving dietary advice in patients with chronic obstructive pulmonary disease (COPD): 1-year follow-up - Corrected Proof

Nighat Farooqi, Lisbeth Nordström, Rune Lundgren, Thomas Sandström, Lena Håglin — 2010-07-09

Abstract: Nutritional studies in patients with chronic obstructive pulmonary disease (COPD) are often based on oral nutritional supplementation and are of short duration. Our aim was to study the changes in body weight and physical performance in COPD patients after receiving the dietary advice for 1 year. Thirty-six patients with COPD as a primary diagnosis (mean age: 68.5±7.8 years), referred to a pulmonary rehabilitation program were studied. Each patient received dietary advice individually. Body weight had increased significantly by 1.3kg (p=0.02) and walking distance by 83.2m (p=0.007) after 1 year. There was an increase in mean handgrip strength after 1 year (1.6kg, p=0.07). The mean intake of energy and protein expressed as percent of energy and protein requirement had increased after 1 year (15%, p<0.001, and 5.6%, p=0.09, respectively). Handgrip strength correlated significantly with energy (r=0.53, p=0.002), fat (r=0.50, p=0.02) and protein intake (r=0.41, p=0.002) after 1 year. In conclusion, positive effects on body weight, handgrip strength and walking distance in patients with COPD were seen after receiving dietary advice with a 1-year follow-up.

Frailty and disability in the elderly: A diagnostic dilemma - Corrected Proof

A. Polidoro, T. Dornbusch, A. Vestri, S. Di Bona, C. Alessandri — 2010-07-08

Abstract: Decreased reserves in multiple organ systems identify frailty syndrome in the elderly. However, its clinical diagnostic approach may be hard, particularly in patients with chronic diseases. The purpose of the study was to delineate the role of disability in the frailty syndrome in a group of hospitalized elderly people. A total of 150 consecutive patients (62 males/88 females), aged between 64 and 97 years and 1–2 days before hospital discharge, were submitted to several geriatric scales designed to assess disability and/or morbidity. All the geriatric scales used showed an elevated percentage of abnormal values both in females and in males. Nevertheless, the activities of daily living (ADL), instrumental activities of daily living (IADL), Tinetti balance index (TBI), Barthel index (BI) scores showed significantly better values in men than in women (p=0.007, =0.02, =0.02 and =0.01, respectively). This preliminary cross-sectional study, underlines the fact that all geriatric tests employed have shown pathological scores, but those of the ADL, IADL, TBI and BI scores exploring disability were significantly better in males than in females. The mismatch between functional and morbidity tests seems to support the hypothesis that a disability state may be independent from morbidity.

Self-administrated test based on the Marigliano-Cacciafesta Polypathological Scale (MCPS), as a screening tool for early identification of frailty in the elderly: A cohort study - Corrected Proof

2010-07-05

Abstract: The aim of our study was to screen people of advanced age for “frailty”, and illnesses, in order to prevent future disabilities through interventions made globally and individually to these patients. Applying the items such as those of the Marigliano-Cacciafesta Polypathological Scale (MCPS), we utilized a completely multi-dimensional evaluation. We have elaborated a series of simple and comprehensive questions enabling all participants to answer independently and easily. The results of the testing were successful. Within their limits, all the participants considered the test as a valuable instrument to assess their weaknesses. The test was especially efficient when it came to identifying problem areas in the psycho-physical state and frailty of elderly patients, as well as some loss of their own autonomy. These studies successfully tested a cohort of elderly people with similar symptoms.

Implication of serotonin-transporter (5-HTT) gene polymorphism in subjective memory complaints and mild cognitive impairment (MCI) - Corrected Proof

2010-07-05

Abstract: Serotonin-transporter-linked polymorphism (5-HTTLPR) is involved in neuropsychiatric diseases and recently the S-isoform has been correlated with a higher risk of developing emotion-induced retrograde amnesia. In order to better clarify the possible role of the 5-HTT S/L polymorphism and its effects on cognitive ability, especially on memory skills, we report here the distributions of the 5-HTT genetic variant and the Apolipoprotein E (ApoE) ɛ-4 allele and their association with neuropsychological measures in older adults reporting problems with everyday memory. Moreover, we verified the presence of a possible association between the S-allele with depression and the personal trait of neuroticism. Our results indicate an association between the 5-HTTLPR S-allele and the risk of developing MCI. No association was found in the other three groups. We found a positive dose-dependent association between the S-allele and the Rey–Osterrieth complex figure test (recall) score. Finally, our data did not find an association between the same allele and depression or neuroticism. This data, in our opinion shows a slight, non-established influence of 5-HTTLPR on memory skills exhibited in challenging memory tests but no influence on other extra-mnesic cognitive abilities.

Effects of an adapted leisure education program as a means of support for caregivers of people with dementia - Corrected Proof

Hélène Carbonneau, Chantal D. Caron, Johanne Desrosiers — 2010-07-05

Abstract: The loss of autonomy associated with dementia affects the people with dementia themselves as well as their caregivers who are often left feeling powerless and incompetent in their caregiving role. Most of the programs developed to support caregivers focus on burden and do not consider the positive aspects of caregiving. Leisure represents a way to enhance the presence of positive aspects in the caring experience. Moreover, leisure might contribute to the maintenance of satisfactory relationships between the caregivers and the person with dementia. An adapted leisure education program was developed as a means of support to caregiver involvement. This study (n=49) aims to evaluate the impact of this program on caregivers’ well-being, self-efficacy towards adapted leisure, and quality of the relationship with the care receiver. Mixed methods were used. Pretest–posttest with a follow-up design made up the quantitative part. In addition, open-end interviews (n=10) were conducted. The quantitative results showed few impacts of the program on caregivers. However, the qualitative analysis revealed that the intervention had positive impacts for the caregivers, care receivers and other family members. This study introduces caregiver support in a new, positive perspective by focusing on the positive aspects of caregiving rather than the burden.

Gender differences in hand grip power in the elderly - Corrected Proof

Shinichi Demura, Hiroki Aoki, Hiroki Sugiura — 2010-07-02

Abstract: This study aimed to clarify the difference in hand grip power in elderly males and females. The subjects were 15 elderly males (mean age 65.6±2.5 years, mean height 165.7±6.0cm, mean mass 63.9±5.5kg) and 15 elderly females (mean age 65.0±2.6 years, mean height 155.2±5.3cm, mean mass 56.5±7.3kg). Peak velocity was measured by the dominant hand with loads of 30, 40 and 50% of maximum voluntary contraction (MVC). The MVC was significantly greater in males than in females. The peak velocity and the required time to reach peak velocity in all loads showed insignificant differences between both groups. Hand grip power was significantly greater in males than in females in all loads. In conclusion, elderly males have superior hand grip power compared to elderly females and this gender difference depends largely on MVC. The decrease in muscle contraction velocity in those main muscle groups related to hand grip movement accompanied by age may be greater in males than in females.

Determinants of quality of life (QoL) in elderly stroke patients: A short-term follow-up study - Corrected Proof

Rezzan Gunaydin, Altinay Goksel Karatepe, Taciser Kaya, Ozgur Ulutas — 2010-07-02

Abstract: The aim of this study was to determine the quality of life (QoL) at the third month after stroke and to identify the factors related with and determinants of QoL in geriatric stroke patients. Eighty of 122 patients who were assessed within the first week after stroke were reevaluated at the third month. Patients were divided into two groups as those of ≥65 years old (geriatric group) and those of <65 years old (non-geriatric group). The stroke severity, functional status, and ambulation level were assessed by the Canadian neurological scale (CNS), the functional independence measure (FIM), and the functional ambulation classification scale (FACS) within the first week of stroke, respectively. Depression and QoL levels were also determined at the third month using the Zung self-rating depression scale (ZDS) and both the Short Form-36 (SF-36) survey and the stroke-specific quality of life (SSQoL) scale, respectively. The QoL of 80 patients according to the SF-36 were lower than those of general population. No significant difference was found in stroke severity, functional status at baseline and third month, depression and QoL between geriatric and non-geriatric patients (p>0.05). The most influenced subscale of QoL was work/productivity in geriatric patients, and the main determinant of QoL was the functional status during the assessment. Stroke patients had an impaired QoL, and geriatric patients did not demonstrate a difference in terms of QoL compared to non-geriatric patients. The fact that the main determinant of QoL was functional status has been suggested that improving of physical function may be helpful to provide a better QoL for stroke patients.

Social interactions and depressive symptoms among community dwelling older adults in Nepal: A synergic effect model - Corrected Proof

Ramraj Gautam, Tami Saito, Susan Crocker Houde, Ichiro Kai — 2010-07-02

Abstract: In Asian families, where patriarchal family systems are common, living arrangements of older adults are characterized by residing with a married son. This study examines the synergic effects of intergenerational solidarity (emotional and instrumental support exchange and anticipated support) on depression of older adults from a developing country, Nepal. Gender differences are also explored in the study. This was a cross-sectional face-to-face interview study of 489 community dwelling older adults living in an urban area of Nepal. The data were analyzed using multiple regression models with each dimension of intergenerational solidarity and conflict variables entered one-by-one with the confounding variables. The results illustrate that older women receiving lower emotional and instrumental support were significantly more likely to be depressed compared to older men receiving less support from their son. Also, women reporting lower anticipated support and higher conflict with their son were more likely to be depressed than men. Regarding synergic effects, emotional support exchange buffered against the deleterious effects of conflict with depression in older adults. The results highlight a need for further research on late life intergenerational relationships (IR) and mental health of older adults in developing countries so that it can be useful for health care practitioners.

Prevalence of high ankle–brachial index (ABI) in general population of Southern Italy, risk factor profiles and systemic cardiovascular co-morbidity: An epidemiological study - Corrected Proof

2010-06-30

Abstract: Many studies have been carried out to assess the prevalence, risk factors and co-morbidities of peripheral artery disease (PAD). By contrast, to date there is a lack of data on patients with high-ABI. This study aimed at estimating the prevalence of increased ABI (ABI>1.4) and to evaluate the involvement of traditional cardiovascular (CV) risk factors and the atherosclerotic burden (peripheral and carotid arteries) of these patients in a population of Southern Italy. We invited 9647 subjects, age ranging from 30 to 80, by letters to undergo an ABI measurement. Consequently, in patients with ABI>1.4, an ultrasound evaluation of the peripheral and carotid arteries was performed. An ABI>1.4 was found in 260 of 3412 subjects (7.6%). Statistically significant differences were reported in age, diabetes and hypertension, body mass index (BMI) and waist circumference (WC). No differences in sex distribution, dyslipidemia and smoke prevalence were observed. Moreover, 67.9% of ABI>1.4 patients showed a peripheral intima–media thickness (IMT)>0.9mm; at linear regression it was correlated with ABI values; 25% of patients showed peripheral plaques. A carotid IMT>0.9mm was reported in 78.6% of high-ABI patients and 32.1% were affected by atherosclerotic plaques. The observed increased-ABI prevalence of 7.6% was higher than previously reported. This was more prevalent in an older population with diabetes, hypertension and obesity. Moreover, these patients are characterized by an extended atherosclerotic involvement. Further studies are needed to clarify this evidence, a longitudinal observation of this clinical outcome, as we are performing, could provide a number of interesting elements.

Risk factors of all-cause in-hospital mortality among Korean elderly bacteremic urinary tract infection (UTI) patients - Corrected Proof

2010-06-25

Abstract: Urinary tract infection (UTI) is the most frequent cause of bacteremia/sepsis in elderly people and increasing antimicrobial resistance in uropathogens has been observed. To describe the characteristics of bacteremic UTI in elderly patients and to identify the independent risk factors of all-cause in-hospital mortality, a retrospective cohort study of bacteremic UTI patients of age over 65 was performed at a single 2000-bed tertiary hospital. Bacteremic UTI was defined as the isolation of the same organism from both urine and blood within 48h. Eighty-six elderly bacteremic UTI patients were enrolled. Community-acquired infection was the case for most patients (79.1%), and Escherichia coli accounted for 88.6% (70/79) among Gram-negative organisms. Non-E. coli Gram-negative organisms were more frequent in hospital-acquired cases and male patients while chronic urinary catheter insertion was related with Gram-positive urosepsis. The antibiotic susceptibility among Gram-negative organisms was not different depending on the source of bacteremic UTI, while non-E. coli Gram-negative organisms were less frequently susceptible for cefotaxime, cefoperazone/sulbactam, and aztreonam. All-cause in-hospital mortality was 11.6%, and functional dependency (adjusted hazard ratio=HR=10.9, 95% confidence interval=95%CI=2.2–54.6) and low serum albumin (adjusted HR=27.0, 95%CI=2.0–361.2) were independently related with increased all-cause in-hospital mortality.

Evaluation of the learning outcomes of a year-long postgraduate training course in community geriatrics for primary care doctors - Corrected Proof

2010-06-23

Abstract: There are increasing expectations on primary care doctors to shoulder a bigger share of care for patients with common geriatric problems in the community. This study aims to examine the outcomes of a postgraduate training course in geriatrics for primary care doctors. A questionnaire developed by the research team was sent to the course graduates (years 2001–2007). Ninety-eight replies were received with a response rate of 52.4% (98/187). Difference in the ratings by the respondents before and after taking the course was analyzed using the nonparametric Wilcoxon signed rank test. Most respondents felt more rewarding and had participated more in geriatric care, and the majority had improvement in their communication skills with elderly patients after taking the course. Moreover, the graduates are more confident in diagnosing and managing common geriatric problems, and deciding to which specialty to refer the elderly patients. Of the referrals, there was a significant increase to private geriatricians and a significant reduction to other specialists. The average number of elderly patients seen per day had also increased. However, little change was observed about making nursing home visits, the frequency of which remained low. Many graduates expressed difficulties in conducting nursing home visits.

Caregivers’ estimation of patients’ quality of life (QoL) in Alzheimer's disease (AD): An approach using the ADRQL - Corrected Proof

2010-06-23

Abstract: The purpose of this study was to describe the QoL of patients with AD (PAD) as perceived by family caregivers, and to analyze the correlates of such QoL. This study covered 92 PAD enrolled in a cognitive-motor stimulation study. The severity of cognitive impairment ranged from mild cognitive impairment to severe dementia. QoL was measured using the AD-related quality of life (ADRQL) scale. Social and clinical variables (for both PAD and caregiver) as well as other variables relating to cognition, activities of daily living (ADL), behavior, mood and caregiver burden were recorded. Spearman correlation coefficients and multivariate linear regression analysis were used to analyze the correlates of ADRQL (global score and subscores). Behavior and basic ADL were the best predictors of global QoL (coefficient of determination R2=0.57, p<0.0005). Cognition contributed marginally to global QoL (R2=0.03, p<0.05). The following variables were specifically associated with ADRQL subscores: household income (lower response to surroundings, R2=0.11), instrumental ADL (less awareness of self, R2=0.09), mood (better feelings and mood, R2=0.04), caregiver caring for another dependent person (higher social interaction, R2=0.04), and caregiver burden (worse feelings and mood, R2=0.03). In conclusion, the main determinants of QoL in PAD are functional capacities and behavior. Other medical, psychological and social variables could also be contributing to specific aspects of QoL on an individual basis.

Social relations in older adults: Secular trends and longitudinal changes over a 16-year follow-up - Corrected Proof

2010-06-18

Abstract: Drawing on population studies in Finland, we investigated secular trends and longitudinal changes in social relations. The cohort comparison data comprised on 974 persons aged 65–69 years from three cohorts born between 1919 and 1939 and interviewed in 1988, 1996 and 2004. Longitudinal analyses were conducted for 635 persons aged 65–74 years over a 16-year follow-up at three measurement points. Social relations were studied on the basis of frequency seeing one's offspring, perceptions of the sufficiency of these contacts, and by asking whom the participants considered as their closest person and how often and in how many tasks they helped someone. The cohort comparisons showed that the frequency of seeing one's offspring had decreased in the most recent cohort and that the number of contacts was considered more inadequate. Longitudinal analyses showed that although the proportion of children as the closest persons increased, meetings with them became fewer. Helping others was more common in the last cohort, but in the longitudinal analyses it decreased with age. Finnish people at retirement help others more than before, but they do not meet their offspring as often as they would like. Measures are needed for action to promote intergenerational exchange in older adults on both individual and societal level.

Aerobic resistance, functional autonomy and quality of life (QoL) of elderly women impacted by a recreation and walking program - Corrected Proof

2010-06-16

Abstract: The present study had as a goal to analyze the impact of a physical activity program (recreation and walking) over the aerobic resistance, the functional autonomy and the quality of life of elderly women. To this experimental study the elderly women (65±6.40 years old) were randomly separated in experimental group (EG, n=31) and a control group (CG, n=28). A 6-min-walking test (aerobic resistance); a protocol of autonomy evaluation of the Latin-American Group for Maturity Development (functional autonomy), and the WHO QoL-old tests were utilized. The intervention happened with classes of recreation and walking practice, three times a week, for 1h, during 4 months. The results found revealed significant improvement for the EG at the aerobic resistance (Δ%=29.06%, p=0.0001), functional autonomy (Δ%=−27.15%, p=0.0001) and QoL (Δ%=15.47%, p=0.0001). It was concluded that the systematic physical exercise interferes in a positive way at the autonomy, aerobic resistance and QoL of the elderly women.

Receptors and aging: Structural selectivity of the rhamnose-receptor on fibroblasts as shown by Ca2+-mobilization and gene-expression profiles - Corrected Proof

2010-06-14

Abstract: Qualitative and quantitative modifications of receptors were shown to play a key role in cell and tissue aging. We recently described the properties of a rhamnose-recognizing receptor on fibroblasts involved in the mediation of age-dependent functions of these cells. Using Ca2+-mobilization and DNA-microarrays we could show in the presence of rhamnose-rich oligo- and polysaccharides (RROPs) Ca2+-mobilization and changes in gene regulation. Here, we compared the effects of several RROPs, differing in their carbohydrate sequence and molecular weights, in normal human dermal fibroblasts (NHDFs). It appeared that different structural features were required for maximal effects on Ca2+-mobilization and gene-expression profiles. Maximal effect on Ca2+ influx and intracellular free calcium regulation was exhibited by RROP-1, a 50kDa average molecular weight polysaccharide, and RROP-3, a 5kDa average molecular weight oligosaccharide with a different carbohydrate sequence. Maximal effect on gene-expression profiles was obtained with RROP-3. These results suggest the possibility of several different transmission pathways from the rhamnose-receptor to intracellular targets, differentially affecting these two intracellular functions, with potential consequences on aging. Although of only relative specificity, this receptor site exhibits a high affinity for rhamnose, absent from vertebrate glycoconjugates. The rhamnose-receptor might well represent an evolutionary conserved conformation of a prokaryote lectin.

Factors related to disability: Evidence from the “Treviso Longeva (TRELONG) Study” - Corrected Proof

2010-06-10

Abstract: Prolongation of life is an important public health goal as long as there is an emphasis on the quality of life (QoL) and independent living. Diminishing abilities to ambulate and participate in activities of daily living point to a serious decline in functional health, increasing the risk of institutionalization and death. In our work we found a pattern of factors associated with disability, especially cognitive impairment, as well as stroke, physical activity and performance, reading, and the nutritional biomarkers, blood albumin and high-density lipoprotein cholesterol (HDL-C). The attention to this cluster of markers, suggesting multidimensional prevention, may have unexpected good effects against disability.

Explaining the ineffectiveness of a Tai Chi fall prevention training for community-living older people: A process evaluation alongside a randomized clinical trial (RCT) - Corrected Proof

2010-06-08

Abstract: The results of a randomized clinical trial (RCT) on the effects of a Tai Chi fall prevention in community-living older people with a high risk of falling in the Netherlands showed no beneficial effects on falls and secondary outcomes (e.g., balance, fear of falling). The aim of this study is to provide insight in process-related factors that may have influenced the effectiveness of the intervention. The intervention consisted of Tai Chi Chuan (TCC) training for 1h twice a week for 13 weeks. We used self-administered questionnaires and registration forms to collect data from participants and instructors. We analyzed quantitative data by means of descriptive statistics and categorized qualitative data based on the content of the answers given. Of the participants, that started the program 89 (79%) completed the intervention, but a minority of 47% attended 80% of more of the lessons. All participants and instructors were positive about the program and most participants reported benefits from the intervention. Suggestions for improvements mainly relate to adjustments of training aspects. The main process-related factors that may be have influenced the lack of beneficial effects on falls and secondary outcomes are the relatively high withdrawal and the low adherence rates.

Participation after a stroke: Changes over time as a function of cognitive deficits - Corrected Proof

2010-06-07

Abstract: Participation refers to the engagement of a person in daily activities and social roles. The goal of this study was to compare changes in older adults’ participation over time following a stroke as a function of the presence of deficits in memory, visual perception, executive functions, visual attention or language. A total of 197 persons with stroke were assessed 3 weeks, 3 months and 6 months after discharge from an acute care hospital, rehabilitation unit or geriatric day hospital. The Assessment of Life Habits (ALH) was used to measure participation. Neuropsychological measures were used to assess the presence of a cognitive deficit in the domains of memory, visual perception, executive functions (inhibition), visual attention and language. Overall, results indicate that participation after a stroke improves over time after hospital discharge in spite of cognitive deficits. Changes in participation over time differed between unimpaired and impaired participants only for language and executive deficits in three domains: interpersonal relationships, community life and responsibilities. These results indicate that when returning to the community after a stroke, positive changes in participation over time are possible even with cognitive deficits.

Can impairment in memory, language and executive functions predict neuropsychiatric symptoms in Alzheimer's disease (AD)? Findings from a cross-sectional study - Corrected Proof

2010-06-07

Abstract: The authors performed a cross-sectional study to examine the relationship between specific cognitive domains and behavioral and psychological symptoms in dementia (BPSD) in 125 patients with probable AD. Cognitive deficits were evaluated with the mini mental state examination (MMSE), trail-making test (TMT), Rey auditory verbal learning test (RAVLT), and semantic fluency test (SFT) and phonemic fluency test (PhFT), whereas the neuropsychiatric inventory (NPI) was used to rate BPSD. Patients’ performance in cognitive tests significantly correlated with total NPI scores (p<0.0001). After controlling for demographic and clinical characteristics, cognitive impairments in memory, executive function, and language (RAVLT, TMT, PhFT, SFT) importantly estimated total NPI scores (p<0.001, multivariate regression models). These findings suggest that the evaluation of cognitive domains may have a predictive value for the occurrence of BPSD.

Inability of waist-to-height ratio to predict new onset diabetes mellitus among older adults in Taiwan: A five-year observational cohort study - Corrected Proof

Ren-Jieh Kuo, Yung-Hung Wu, Liang-Kung Chen — 2010-06-07

Abstract: Abdominal obesity plays a significant role in cardiometabolic health. Due to the difficulties to quantify abdominal obesity, a number of proxy indicators have been developed, including waist circumference (WC), waist-to-hip (WTH) ratio, and waist-to-height (WHtR) ratio. The main purpose of this study was to evaluate the ability of WHtR predicting new onset diabetes mellitus (NOD) among older adults in rural Taiwan. In 2000, 372 subjects (mean age=61.8±11.3 years, 57.8% females) living in the Tou-Cheng Township of I-Lan County participated in the study and 250 of them (6 deceased, mean age of survivors=67.1±10.7 years, 58.9% females) were successfully followed in 2005. The mean BMI of the primary cohort was 25.0±3.6kg/m2; the proportion of obesity and overweight was 47.8% and 21.0%, respectively. The mean WHtR was 0.57±0.07, and the prevalence of high WHtR (>0.5) was 83.9%. The prevalence of diabetes mellitus (DM) and impaired fasting glucose (IFG) was 18.5% and 19.6%, respectively. Comparisons between subjects with high WHtR (>0.5) and low WHtR (<0.5) showed significant cardiovascular risk factor clustering in high WHtR group, but serum cholesterol and high-density lipoprotein cholesterol similar in both groups. In 2005, the prevalence of DM and IFG among 244 survivors was 24.9% and 24.1%, respectively. Overall, the cumulative incidence of NOD during the 5-year follow-up was 8.2% (20/244), which was 8.7% (18/206) in high WHtR group and 5.3% (2/38) in low WHtR group (p=0.489). Adjusted for age and sex, IFG was the only independent risk factor for NOD in this study (odds ratio=OR=9.21, 95% confidence interval=CI=2.70–31.46), but not the high WHtR. In conclusion, high WHtR is a common phenomenon (83.9%) of community-living older adults in rural Taiwan and it did not predict significantly NOD in 5-year follow-up. Further investigations are needed to evaluate the predictability of WHtR in NOD among older adults and to compare the effectiveness of WHtR with other conventional risk factors.

Muscle strength, muscle balance, physical function and plasma interleukin-6 (IL-6) levels in elderly women with knee osteoarthritis (OA) - Corrected Proof

2010-06-07

Abstract: An increased circulating level of inflammatory cytokines has been associated with sarcopenia, functional disability, chronic diseases, and mortality in the elderly. Osteoarthritis (OA) is a disease common to this population, the seriousness of articular degeneration has been associated to the increase in some cytokines, IL-6 among them. The aim of the present study was to correlate IL-6 plasma levels with muscle strength, endurance, muscle balance hamstring/quadriceps (H/Q) and physical function in 80 elderly women (71.2±5.3) with knee OA. IL-6 was measured using enzyme-linked immunosorbent assay (ELISA). Quadriceps and hamstring muscle strength, endurance and hamstring-quadriceps muscle balance were assessed using a Biodex system 3 pro® isokinetic dynamometer. Physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Spearman's correlation coefficient was used to explore the relationship between the outcomes at the significance level of α=0.05. IL-6 was inversely correlated to the endurance of the hamstring muscles (r=−0.232; p=0.03) and muscle balance (H/Q) on the lower right side at 180°/s (r=−0.254; p=0.023). No significant correlation between IL-6, muscle strength and physical function was found. Our results show that elevated levels of IL-6 may possibly contribute to the reduction of the endurance of hamstring muscles and H/Q muscle balance in the elderly studied.

Health expectancies in the older Thai population - Corrected Proof

2010-06-07

Abstract: This study aims to investigate health expectancies in five domains: cognitive health, psychological health, physical health, functional ability and self-perceived global health (SPGH) in the older Thai population. There are few studies reporting health expectancies in multidimensional health domains, most of which reported only one health dimension. The dataset used was from the Bangkok Longitudinal Study by Siriraj Hospital for the Older Men and Women (BLOSSOM), which is a community cohort study in Bangkok, Thailand. This analysis is based on the cross-sectional data in the year 2005–2006 and includes 5936 participants aged 50 years and over from community settings within six suburban areas in Bangkok. The study found that women had a longer total life expectancy (LE), but had shorter cognitive impairment-free (CIFLE), physical illness-free (PHILE) and disability-free (DIFLE) LEs, than men. However, there was no difference between the life expectancies for living with good SPGH in men and in women. Differences in health expectations might explain this finding. Health promotion and disease prevention should be initiated at a younger age and should target all health domains.

A learning curve of total knee arthroplasty (TKA) based on surgical volume analysis - Corrected Proof

Ching-Hsue Cheng, Yu-Tien Cheng, Jr-Shian Chen — 2010-06-07

Abstract: The purpose of this study is to discover valuable medical facts by utilizing the Taiwan National Health Insurance (NHI) database, which contains 32,200 records of TKA surgeries. Three main objectives of this paper include the following: (a) building learning curves of TKA from the target database; (b) characterizing how the TKA volume correlates with infection rate and mortality; (c) examining the differences of infection rate and mortality between the medical center (Group I) and the non-medical center (Group II). The TKA samples are classified into two groups according to their institution type (medical center and non-medical center). The Z-test is used to test whether there are differences in the infection rate and mortality between the two observed groups. This study also adopts linear/nonlinear regression to investigate the relationship between TKA volume and the infection rate (mortality). This study has three main findings: (a) it confirms a correlation between the TKA surgical volumes and certain outcomes, (b) surgeons and hospitals with higher TKA volumes exhibit better operation quality, lower postoperative complication rate, and (c) there are significant differences in infection and mortality rate between Group I and Group II.