Archives of Gerontology and Geriatrics

IFC: Editorial Board

2010-03-01

Effects of serum 25-hydroxyvitamin D3 levels on physical fitness in community-dwelling frail women

2009-03-27

Abstract: The aim of this study was to evaluate the effects of a combination of serum 25-hydroxyvitamin D3 (25(OH)D3) levels and exercise on physical fitness in community-dwelling frail elderly in Japan. A longitudinal survey was conducted in a town (latitude 36° north). Eighty women aged 65 years and over attended a 3-month exercise class. A face-to-face interview was conducted based on a questionnaire. The serum levels of 25(OH)D3, intact parathyroid hormone (iPTH), were measured. Nine physical fitness tests were performed at baseline and at the end of a 3-month follow-up period. Among 80 subjects, 56.3% experienced falls, and 71.3% experienced stumbling more than once during the past year. The prevalence of 25(OH)D3<50nmol/l or 25(OH)D3<75nmol/l was 27.5% and 88.8%, respectively. Significantly greater improvements in alternate step, functional reach (FR), “timed up & go” (TUG), and 5-m walk, and superior functional capacity for the subjects with 25(OH)D3 levels greater than 67.5nmol/l (highest quartile) was observed at the end of the class. In contrast, the subjects with 25(OH)D3 levels <47.5nmol/l (lowest quartile) did not improve their physical fitness. A serum 25(OH)D3 level of greater than 47.5nmol/l may therefore be necessary to maintain walking ability and balance. Greater than 67.5nmol/l appears to be preferable for lower extremity strength in Japanese frail elderly women.

Clinical correlates of cerebral white matter hyperintensities in cognitively normal older adults

2009-04-08

Abstract: Many research studies have demonstrated asymptomatic white matter hyperintensities (WMHs) in older adults, which are postulated to be ischemic in origin. We hypothesized that certain clinical predictors, measured in a population of healthy older adults, would have a positive relationship with WMH scoring on magnetic resonance imaging (MRI). As part of a longitudinal study of cognitive aging we have performed MRI on healthy older adults. In a group of 46 volunteers (25 females; median age 73, range 63–84 years), we have calculated of the Hachinski score and Framingham Stroke Risk Profile (FSRP). Volunteers also provided self-reported health information using the Cornell Medical Index (CMI). These were compared against the total Age Related White Matter Changes (ARWMC) score. The mean total ARWMC score was 7.4±5.27 (±S.D.) and only 3 (6.5%) individuals had no evidence of WMH. Regression analysis of individual variables identified self-report of cardiovascular disease from the CMI, section C as the only significant predictor of ARWMC. A multivariate linear regression model also identified FSRP at 1 year as a second independently significant predictor. The multivariate model accounted for 19% of the variance in total ARWMC score. The only 6.5% of individuals who had no WMH is in keeping with previous studies. The important finding was the positive relationship with self-reported cardiovascular disease, which is a possible biomarker of sub-clinical cerebrovascular disease (CVD).

Prevalence and factors associated with urinary tract infections (UTIs) in very old women

Irene Eriksson, Yngve Gustafson, Lisbeth Fagerström, Birgitta Olofsson — 2009-04-06

Abstract: The aim of this study was to describe the prevalence of urinary tract infection (UTI) and associated factors among very old women. In a cross-sectional, population-based study in Sweden and Finland, 532 women were asked to participate and 395 (74.2%) were possible to evaluate for UTI. Data were collected from structured interviews and assessments made during home visits, from medical charts, caregivers and relatives. UTI diagnosis documented in medical records during the preceding 1 and 5 years was registered. About one-third (117/395, 29.6%) were diagnosed as having suffered from at least one UTI in the preceding year and 60% in the preceding 5 years. In a multivariate logistic regression model, UTI in the preceding year, was associated with vertebral fractures (odds ratio (OR)=3.2; 95% confidence interval (95% CI)=1.4–7.1), incontinence (OR=2.8; 95% CI=1.8–4.5), inflammatory rheumatic disease (OR=2.8; 95% CI=1.4–5.7) and multi-infarct dementia (OR=2.4; 95% CI=1.3–4.5). UTI is a major public health problem in very old women and were independently associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia which might indicate that UTI is not a harmless disease.

The influence of arthritis on the anthropometric parameters of the feet of older women

2009-04-06

Abstract: Age-related and arthritis-related foot modifications have been described in literature, but there is a lack of references that allow shoes to be designed on the basis of specific anthropometric measurements of older women. The aim of this study was to identify the anthropometric characteristics of the feet of elderly women with and without arthritis. This is an observational transversal study. The right and left feet of 227 older women aged between 60 and 90 years (69.6±6.8 years) were evaluated, of whom 45 reported a diagnosis of arthritis (non-osteoarthritis). The anthropometric evaluation of the feet comprised the variables of width, perimeter, height, foot length, first and fifth metatarsophalangeal angles, the arch-index and the foot posture index (FPI). The data were analyzed using the analysis of probability to compare the groups (arthritic and non-arthritic women). The differences between the means were significant in the case of the FPI and some of its criteria, such as the calcaneal frontal plane position, the bulge in the region of the talo-navicular joint and the forefoot alignment. The width of the right foot was also significantly greater in the women with arthritis. These results are preliminary findings that may help direct larger studies of foot characteristics among older adults with arthritis.

How often and how far do frail elderly people need to go outdoors to maintain functional capacity?

2009-04-08

Abstract: The purpose of this study was to investigate the relationship between the frequency of going outdoors into the life-space and functional impairment in community-living frail elderly people. Participants were 1872 community-dwelling elderly people (65–100 years). The participants were asked activities of daily living (ADL) status and how far they traveled and how often they traveled to that area in the 4 weeks before the assessment. We selected two demographic variables, five physiological variables, 11 primary diseases or geriatric syndromes, and four psychosocial variables as possible confounding factors of ADL limitations and correlates of going outdoors. After adjusting for the confounders, multiple logistic regression showed that limitations in basic ADL and instrumental ADL were most strongly associated with going outside the home less than once a week and with going into the neighborhood less than once a week, respectively. Low self-efficacy for going outdoors related most strongly to restrictions in these outdoor activities. These results suggest that going outdoors into the neighborhood at least once a week is beneficial for maintaining physical function in frail elderly people.

Cognitive decline and dementia in elderly medical inpatients remain underestimated and underdiagnosed in a recently established university general hospital in Greece

2009-04-09

Abstract: The aim of this study was to report the prevalence of cognitive decline as well as its recognition rates in elderly inpatients in a general hospital in Greece. Two hundred randomly selected patients, 65 years old and over, hospitalized in surgery and internal medicine departments, were assessed for cognitive decline in a period of 12 months by means of structured clinical interview for DSM-IV axis-I disorders, clinical version (SCID-IV), mini-mental state examination (MMSE) and the clock drawing test (CDT). During the next 12 months the liaison calls were evaluated and the two periods were compared. During the first screening period, when psychiatric assessment was performed, 61 patients (30.5%) were diagnosed to present cognitive decline. During the second period, there were only 20 liaison calls from the same departments for patients over 65 years of age, from which 15 patients were found to present cognitive decline. Comparison between the two periods showed significant underestimation of cognitive decline. In the general hospital the cognitive decline of elderly inpatients remains still under-recognized.

Undertreatment of depressive symptomatology in the elderly living in long stay institutions (LSIs) and in the community in Brazil

2009-04-09

Abstract: The aim of the present study was to assess the presence of depressive symptomatology among elderly residents in long stay institution (LSI) and in the community of Recife, Brazil. In total, 81 LSI elderly patients (mean age of 75.55±9.18 years) and 132 elderly (mean age of 73.14±8.27 years) individuals from the community were evaluated. Depressive symptomatology was assessed by the geriatric depression scale (GDS-15), cognitive status by the mini mental state examination (MMSE) and capacity to perform the activities of daily living (ADL) by the Katz Index. Comorbidities and the use of medication were recorded. The LSI elderly exhibited more depressive symptoms (p<0.001) and more dependency (p<0.001). We observed no differences in MMSE (p=0.058). The elderly in the community displayed more comorbidities and the LSI elderly consumed more medication (p<0.001 and <0.001, respectively). According to multivariate analysis (logistic regression), being male, having no spouse and having a low schooling level are risk factors for depressive symptoms. In conclusion, most elderly with depressive symptoms received no medication for depression.

Developing a quick and practical screen to improve the identification of poor hydration in geriatric and rehabilitative care

Angela Vivanti, Keren Harvey, Susan Ash — 2009-04-27

Abstract: Dehydration has been associated with increased morbidity and mortality. Dehydration risk increases with advancing age, and will progressively become an issue as the aging population increases. Worldwide, those aged 60 years and over are the fastest growing segment of the population. The study aimed to develop a clinically practical means to identify dehydration amongst older people in the clinical care setting. Older people aged 60 years or over admitted to the Geriatric and Rehabilitation Unit (GARU) of two tertiary teaching hospitals were eligible for participation in the study. Ninety potential screening questions and 38 clinical parameters were initially tested on a single sample (n=33) with the most promising 11 parameters selected to undergo further testing in an independent group (n=86). Of the almost 130 variables explored, tongue dryness was most strongly associated with poor hydration status, demonstrating 64% sensitivity and 62% specificity within the study participants. The result was not confounded by age, gender or body mass index. With minimal training, inter-rater repeatability was over 90%. This study identified tongue dryness as a potentially practical tool to identify dehydration risk amongst older people in the clinical care setting. Further studies to validate the potential screen in larger and varied populations of older people are required.

Clinical pathways: Adherence issues in complex older female patients with heart failure (HF)

Anna Byszewski, Nahid Azad, Frank J. Molnar, Stephanie Amos — 2009-04-30

Abstract: HF is a leading health care concern, often under-recognized and under-treated in older women. Management of this complex condition frequently requires a multidisciplinary approach and a clinical pathway can be used to deliver coordinated care. This report is based on the intervention/treatment arm (n=45) of a randomized controlled trial in older women who participated in a multidisciplinary clinic. We describe the development of a clinical pathway for HF and the variance reporting including factors affecting adherence with the pathway. Variances are patient or staff actions that did not meet the expected outcomes. Of the 45 intervention arm female patients, 5 were able to fully complete the program, meaning that all of the intended 12 visits were completed successfully. Thirteen women missed more than three clinic visits, and the rest attended most visits. Variance tracking identified that visits were interrupted most often by patient-related health issues, such as fatigue and pain, which may not be surprising given the expected multiple co-morbidities in this population. Transportation problems were identified as a barrier to attendance. Our study demonstrates that a clinical pathway can be implemented in an older, female population with HF. This report identifies some of the challenges and provides future recommendations for prospective pathway development.

The memory alteration test (M@T) discriminates between subjective memory complaints, mild cognitive impairment and Alzheimer's disease

L. Rami, B. Bosch, R. Sanchez-Valle, J.L. Molinuevo — 2009-04-17

Abstract: This work aimed at establishing the memory alteration test (M@T), which is a memory screening test, capable for discriminating between subjects with subjective memory complaints (SMC) (without objective memory impairment) and patients with amnestic mild cognitive impairment (A-MCI) and with mild Alzheimer's disease (AD). The discriminative validity was assessed in a sample of 37 subjects with SMC, 50 patients with A-MCI according to the Petersen-criteria, and 66 patients with mild AD (global deterioration scale: 4 stage) according to the NINCDS-ADRDA criteria. M@T mean scores were significantly different among groups: 39.7±5.1 (±S.D.) in the SMC group, 31.5±3.9 in the A-MCI group, and 21.8±4.9 in mild AD. A cut-off score of 37 points had a sensitivity of 96% and a specificity of 70% to differentiate A-MCI from SMC (ABC=0.88). A cut-off score of 33 points had a sensitivity of 100% and a specificity of 86% to differentiate mild AD from SMC sample (AUC=0.99). We conclude that the M@T provides efficient and valid discrimination between SMC subjects and A-MCI, and between SMC subjects and mild AD.

Importance of end-of-life support to minimize caregiver's regret during bereavement of the elderly for better subsequent adaptation to bereavement

Akiko Akiyama, Kumiko Numata, Hiroshi Mikami — 2009-04-20

Abstract: This study examined whether the quality of end-of-life home medical care affected caregiver's psychological recovery from bereavement. We analyzed survey responses from an anonymous self-administered questionnaire from 147 bereaved family members (caregivers). Questionnaire content included information on the quality of end-of-life home medical care, feelings during bereavement and present feelings. Results showed that caregiver regret during bereavement was significantly associated with present feelings about loss regardless of the length of time after death of a loved one. Aspects of end-of-life support that were statistically significant at minimizing regret during bereavement were: (1) fulfilled home medical care service system, (2) peaceful death of the patient, and (3) providing direct care by the caregiver. These findings suggest that end-of-life support to minimize caregiver regret during bereavement was crucial for better subsequent adaptation to bereavement.

Breast cancer in the elderly

Ioannis E. Petrakis, Stefanos Paraskakis — 2009-05-04

Abstract: Breast cancer is the most commonly diagnosed cancer in women and most breast cancers are not attributable to risk factors other than female gender and increased age. However, despite its increasing prevalence in the geriatric population, prospective clinical trials for older cancer patients do not exist and most data come from retrospective studies or subanalyses from general population studies. As a result physician's, patient's and family members’ fear predominates and elderly patients do not receive the appropriate treatment when compared with younger ones. Treatment is offered according to biological age alone and life expectancy, comorbidity and functional status are not considered when deciding treatment strategy. Surgery is often denied to patients older than 70 years of age, radiotherapy and chemotherapy are omitted due to the fear of toxicity and hormonal therapy, even though it represents a great tool as adjuvant therapy, it is associated with significant morbidity when chosen as primary treatment. Palliation of symptoms remains the main goal for metastatic disease but for the rest of the patients improving disease-free survival in the early stages should guide therapy no matter chronological age.

Safety and feasibility of radiotherapy treatment in elderly non-small-cell lung cancer (NSCLC) patients

2009-05-04

Abstract: The purpose of this study was to evaluate the feasibility and activity of radiotherapy (RT) treatment in elderly patients with locally advanced lung cancer. From January 2002 to December 2007, 51 consecutive patients (43 men and 8 women) aged ≥65 received RT for locally advanced lung cancer, 22 with radical intent and 16 in adjuvant setting. Thirty-six patients received chemotherapy. Variables considered were age, co-morbidities, evaluated according to the adult co-morbidity evaluation index (ACE-27), surgery vs. no surgery, radiation dose and chemotherapy. The median age was 74.7 years (range 65–91). Of the patients, 15.7% had no co-morbidity, 41.2% mild, 25.5% moderate, and 17.6% had severe co-morbidities. Sixteen subjects (31.4%) underwent surgery. All patients completed the planned radiation schedule, while chemotherapy was reduced in 16 patients. At a median follow-up of 22 months, the 2- and 3-year overall survival rates were 46.5% and 35.4%, respectively. Patients with no or mild co-morbidities (p<0.0001) and a good performance status (p<0.0001) had a better survival. The actuarial progression-free survival at 2 and 3 years was 41.4% and 38.2%, respectively. Acute lung toxicity rates were different between patients with different ACE-27 indexes, whereas late toxicity was not influenced. In conclusion, in elderly patients, the compliance with RT is good and the rate of toxicity is acceptable. Patients with no or mild co-morbidities have a significantly better survival. The increasing severity of co-morbidities may sufficiently shorten the remaining life expectancy, cancel the gains obtained by RT and increase the acute lung toxicity. Further prospective trials are needed to confirm these results.

The effect of functional balance training in frail nursing home residents

Darja Rugelj — 2009-04-27

Abstract: The purpose of this study was to design and evaluate the specifically targeted functional balance training for a group of frail nursing home residents. Fifty residents of two nursing homes were assigned to an exercise and control group. Thirty-three participants (age 75.7±6.7 years) in the balance training group finished 12 weeks of training protocol that consisted of 14 activities that challenged different balance subsystems. The results showed that the participants in the training group reached higher score on Berg Balance Scale (BBS) (p<0.001), were able to stand longer on a compliant surface with eyes opened and closed (p<0.01 and p<0.02, respectively), and were faster at both, the four square and ten meter walk tests (p<0.001), whereas there were no changes for the control group during the same time period. Anyhow, functional improvement of balance did not reflect in the parameters of postural sway. In conclusion our results suggest that the specifically targeted functional balance training is effective as far as functional activities are concerned while this kind of training does not reflect as a change in the steadiness of the center of pressure (CoP).

Impaired access to semantic memory for the cognition of geographic space in Alzheimer's disease

2009-05-08

Abstract: This study explores the possibility to capitalize from a widely used semantic fluency test, in order to investigate aspects of topographical space representation, still poorly studied in neurodegenerative diseases. Twenty-six patients with mild Alzheimer's disease (AD) and 13 healthy control (CTR) subjects underwent neuropsychological assessment at baseline (T0) and about 2 years later (T1). The cities named during category verbal fluency test (“names of cities”) were marked on a map, and the polygon perimeter obtained by joining the external points was computed. Mini-mental state examination (MMSE) score, number of cities named and perimeter length were compared between T0 and T1, both within-group and between groups. MMSE score and number of cities significantly differed between AD and CTR both at T0 and at T1; perimeter length differed significantly only at T1. Between T0 and T1, all the three parameters significantly decreased in AD, while they were substantially unchanged in CTR. Besides a reduction of semantic verbal fluency, there seems to be a ‘restriction’ of mental geographic space representation already in mild AD. These findings should be confirmed and exploited by further ad hoc investigations.

The associations of gender, depression and elder mistreatment in a community-dwelling Chinese population: The modifying effect of social support

XinQi Dong, Todd Beck, Melissa A. Simon — 2009-04-27

Abstract: The aims of this study are to: (1) examine the gender differences in the association of depression and elder mistreatment (EM) in a community-dwelling Chinese population; and (2) examine the potential differential modifying effect of greater social support on these associations. We conducted a cross-sectional study of 141 women and 270 men aged 60 years or greater who presented to an urban medical center. EM was assessed using the modified Vulnerability to Abuse Screening Scale (VASS) and depression was assessed using the Geriatric Depression Scale (GDS) and overall social support was measured using the Social Support Index (SSI). After adjusting for potential confounders, depression was associated with 447% increased risk for EM among men (odds ratio, OR=4.47; 95% confidence intervals (CI)=1.52–13.13) and 854% increased risk for EM among women (OR=8.54; 95% CI=2.85–25.57). After examining the effect of greater social support on depression (social support×depression), depression was no longer associated with increased risk for EM in men (parameter estimate=PE=0.62±0.82 (±S.E.M.)=0.82, p=0.454). However, among women, depression remained as a significant risk factor for EM (PE=1.49±0.68, p=0.029). Depression is significant risk factor for EM for both men and women. However, effect of greater overall social support may have higher protective effect in men than in women.

Prevalence and patterns of comorbid cognitive impairment in low vision rehabilitation for macular disease

2009-05-08

Abstract: The prevalence of comorbid cognitive impairment among older adults referred to low vision rehabilitation (LVR) for macular disease is unknown. We performed cognitive testing on 101 adults aged 65 years or older with macular disease who were referred to The Duke LVR Clinic between September 2007 and March 2008. Scores on the telephone interview for cognitive status-modified (TICS-m) ranged from 7 to 44, with 18.8% of scores below an established cutoff for cognitive impairment (≤27) and an additional 27.7% of scores considered marginal (28–30). On letter fluency, 46% of participants scored at least 1× standard deviation (SD) below the mean for their age, gender, race, and education level, and 18% of participants scored at least 2× below their demographic mean. On logical memory, 26% of participants scored at least 1× below the mean for their age group and race and 6% scored at least 2× below their demographic mean. High prevalence of cognitive impairment, with particular difficulty in verbal fluency and verbal memory, may compromise the success of LVR interventions among macular disease patients. Additional work is needed to develop strategies to maximize function in older adults with this common comorbidity.

The impact of chronic diseases on the health and well-being of South Africans in early and later old age

Margaret S. Westaway — 2009-04-27

Abstract: This paper examines the impact of chronic disease status on health and well-being of South Africans in early and later old age. A structured questionnaire, comprising demographic characteristics, self-reported chronic disease status, an 18-item health problems scale and the health and well-being sub-scales from the SF-12 was used to collect data from 400 black, 101 Indian, 107 white and 102 colored residents of Greater Pretoria, South Africa. One hundred and ninety (27%) reported no chronic disease, 181 (25%) had hypertension alone, 179 (25%) had hypertension combined with one or more other chronic diseases and 160 (23%) had other chronic diseases without hypertension. There were no significant differences on health and well-being by race, language, gender or marital status. However, there were significant race, age group and gender effects on chronic disease status. Controlling for these factors, the no chronic disease group had significantly better health and well-being than the other three groups; the group with hypertension alone also had better health and well-being than the chronic disease groups with and without hypertension. It was concluded that chronic diseases combined with and without hypertension were more detrimental to health and well-being than no chronic disease or hypertension alone.

The short-term effect of acetylcholinesterase inhibitor on the regional cerebral blood flow of Alzheimer's disease

Hyun Cho, Jee-Hyun Kwon, Hyun-Jin Seo, Jae-Seung Kim — 2009-04-27

Abstract: This study is to investigate changes in regional cerebral blood flow (rCBF) of Alzheimer's disease (AD) in short-term treatment with acetylcholinesterase inhibitor (ChEI). rCBF was measured by single photon emission computed tomography (SPECT). CBF measurements were performed in 13 AD patients before treatment and 4 months later, while the control group with syncope or headache consisted of 17 patients. The clinical diagnosis of AD was based on the NINCDS-ADRDA criteria. Significant increases in rCBF were noted in the left angular, the right superior frontal gyrus, the right occipital, the left temporal lobe and the left orbital gyrus at the end of short-term therapy. Reduction in the rCBF before treatment is more profound in the left superior temporal, the right precentral and the both inferior frontal gyri compared with the control group. It achieved increase of rCBF after ChEI treatment. Also it overall increased in global cognitive functions including Korean Version Mini Mental State Examination (K-MMSE) and Clinical Dementia Rating (CDR). Treatment with ChEI for 4 months could increase rCBF and improve cognitive function of patients with AD.

Tests for the evaluation of depression in the elderly: A systematic review

2009-05-05

Abstract: The incidence of depression in the elderly has risen in recent years, with 30% of people over the age of 65 now reported to suffer from mood disorders. There are a number of possible causes for this increase; moreover, as the symptoms of depression in the elderly are often difficult to identify and interpret, a diagnosis of depression in the elderly may be difficult to make, particularly when other concomitant pathologies mask the signs and symptoms of this disease. There is thus a need to standardize the various self-rating and hetero-evaluation scales used to differentiate between normal and depressed subjects. These tools are designed to investigate and evaluate the various components of depression in depth. They are essential for the diagnosis and therapy in patients who suffer from mood disorders, though it should be borne in mind that these tests need to be preceded and confirmed by a thorough psychiatric examination.

Evaluating outcomes of Taiwan's first gerontology certification program

2009-05-14

Abstract: The elderly population will approach 20% within the next 20 years. This enhances the need for skilled and experienced health care providers. There is a critical need to strengthen gerontology curricula to prepare health-related professionals for a graying population. The purpose of this article is to investigate student satisfaction with the first National Project for Excellence in Gerontological Care Education (NPEGCE) in Taiwan. A cross-sectional design was used. A sample of 151 medical, nursing, and physical therapy students, who had enrolled in the NPEGCE and had taken at least one core course, completed a satisfaction questionnaire. To ensure content validity, a multidisciplinary, institutional committee of gerontology and geriatric faculty designed the content. Overall satisfaction scores varied between satisfied (4-points) and very satisfied (5-points). Medical students gave higher ratings than others. Two factors (Curriculum and Teaching) were extracted. A strong correlation was found between the subscales and overall satisfaction scores. Internal scale consistency reliability scores ranged from 0.92 to 0.96. Overall, this study demonstrates a moderate level of satisfaction with the NPEGCE. However, these results are from a single institution; they are not generalizable. This is also the first student satisfaction report from Taiwan. There are no similar programs or evaluation results to compare them with. Since the NPEGCE was well received by students and seemed to encourage a more nurturing attitude towards the elderly; it can be regarded as a catalyst for better elderly care in the future.