Archives of Gerontology and Geriatrics - Articles in Press

VNCOP-B plus rituximab therapy in elderly patients with aggressive B-cell non-Hodgkin lymphoma: A multicenter experience - Corrected Proof

2009-11-19

Abstract: CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) plus rituximab is a standard chemotherapy used to treat patients with aggressive B-cell non-Hodgkin lymphoma (B-NHL). However, among elderly patients, this regimen has not been completely satisfactory in its efficacy and safety. We report our clinical experience in 8 collaborative institutions to determine if the VNCOP-B (etoposide, mitoxantrone, cyclophosphamide, vincristine, prednisolone, and bleomycin) combination therapy plus rituximab was effective and safe to treat elderly patients with aggressive B-NHL. Between September 2004 and December 2007, 23 previously untreated patients, median age 73 years, 50.0% classified as high-intermediate/high-risk on the standard International Prognostic Index (IPI) entered this trial. Complete remission rate was 90.5%, with a 100% overall response rate (RR) at the end of induction therapy; overall survival (OS) rate at 3 years was 76.4% (median follow-up 744 days), with an 82.6% 3-year progression-free survival (PFS) rate (median follow-up 744 days). The most common grade 3/4 toxicities were hematologic, including neutropenia in 75.0% of the patients despite prophylactic administration of granulocyte colony-stimulating factor (G-CSF), febrile neutropenia in 30.0%, respectively. There was no treatment-related mortality (TRM). Rituximab not only combined with chemotherapy but also given sequentially improved survival. R-VNCOP-B could be another option for elderly patients who are not considered to tolerate in receiving R-CHOP.

Association between C-reactive protein (CRP) level and physical performance in community-dwelling elderly in Japan - Corrected Proof

Yuko Yoshida, Hajime Iwasa, Shu Kumagai, Hideyo Yoshida, Takao Suzuki — 2009-11-18

Abstract: Inflammatory cytokines may contribute to lower physical function in elderly. The purpose of this study was to clarify the relation between circulating level of C-reactive protein (CRP) and physical performance among the community-dwelling elderly in Japan. Participants were 803 (329 men and 474 women) aged 65 years and over. Four physical performances were assessed using hand-grip strength, length of time standing on one leg, and walking speed (usual and maximal). Low physical performance was defined as the lowest 25% of study sample in each sex. Multiple logistic regression analysis showed that CRP was negatively associated with physical performance in hand-grip strength (odds ratio=OR=1.86, 95% confidence interval=95% CI=1.32–3.05, OR=2.92, 95% CI=1.53–5.58, for the middle and highest, respectively), time of one leg standing (OR=1.96, 95% CI=1.28–3.00, OR=2.16, 95% CI=1.19–3.92, for the middle and highest, respectively) and maximal walking speed (OR=2.46, 95% CI=1.23–4.93, for the highest) when adjusted for the confounding factors. The results showed the negatively associated between CRP level and physical performance when adjusted for the confounding factors. CRP level may be a useful indicator for detecting the lower physical performance in elderly.

Measuring balance, lower extremity strength and gait in the elderly: Construct validation of an instrument - Corrected Proof

2009-11-18

Abstract: The purpose of the study was to determine the degree to which scores of a modified version of the ‘Timed Get Up and Go’ test (TGUG) were associated with other measures of functional performance. Thirty-seven community-dwelling older women (72.3±5.5 years) volunteered to participate. Subjects were assessed when performing the modified TGUG test. Correlations between the performance-oriented mobility assessment (POMA), single-leg balance, five chair rises, fast and normal gait speed, knee extension and flexion strength, and the modified TGUG were conducted. Total time to perform the modified TGUG test was significantly correlated with normal and fast gait speed (p<0.05). The Pearson correlation coefficients were −0.841 and −0.748, respectively. The time needed to perform several tasks of the modified TGUG test significantly correlated with five chair rises, and with right knee extensor strength (p<0.05). Points obtained in the assessment questionnaire correlated significantly to points obtained in the POMA scale (p<0.05). The Pearson correlation coefficient was 0.795. Based on the strength of the correlations obtained between components of the modified TGUG and the comparison tests, concurrent, criterion validity of the modified TGUG has been established.

Comfort for the dying: five year retrospective and one year prospective studies of end of life experiences - Corrected Proof

Peter Fenwick, Hilary Lovelace, Sue Brayne — 2009-11-16

Abstract: Many cultures have reported end-of-life experiences (ELEs) as part of the dying process. However, few studies have examined the mental states of the dying in the weeks and days before death. Following an ELE pilot study with a palliative care team, 38 nurses, doctors and end-of-life carers from two hospices and a nursing home took part in a 5-year retrospective followed by a 1-year prospective ELE study. Interviewees’ reports (first-hand and second-hand accounts from relatives, patients and residents) suggested that ELEs are not uncommon. ELEs included deathbed phenomena (DBP) such as visions, coincidences and the desire to reconcile with estranged family members. These experiences seemed to comfort both the dying and the bereaved. Interviewees described other phenomena such as clocks stopping synchronistically at the time of death, shapes leaving the body, light surrounding the body and strange animal behavior. Interviewees confirmed that ELEs differed from drug-induced hallucinations and occurred in clear consciousness. Most expressed concern about a lack of specialist ELE training and education and recommended that ELE modules be included in their training courses. ELEs provided comfort and hope for the dying and consolation for the bereaved. Further research is required to find the true prevalence and range of ELE phenomena.

Peeking through the cracks: An assessment of the prevalence, clinical characteristics and health-related quality of life (HRQoL) of people with polypathology in a hospital setting - Corrected Proof

2009-11-16

Abstract: Little is known about the prevalence of the recently defined polypathology notion in hospital populations. Patients admitted to medical wards were assessed using established criteria of polypathology. Prevalence of polypathology, interobserver reliability, clinical features, nutritional status, and HRQoL were assessed using clinical data and interview, mini-nutritional assessment (MNA), and the 12-item short-form health survey (SF-12) scales. Of a total of 812 patients studied, 196 (24%) met polypathology criteria (65% men, of mean age 71.3±11.6 years, mean defining chronic diseases 2.4±0.046, and other comorbidities 2.6±0.094). Interobserver reliability for the detection of cases was good (κ=0.628). Their mean Charlson index/prescribed drugs were 3.3/6, respectively. Severe dyspnea, delirium, or active neoplasia were present in 44, 15, and 11%. A bad nutritional status/risk of malnutrition was evident in 10.3/52.6%, and correlated with the number of previous hospitalizations (p=0.041), and the presence of active neoplasia (p=0.037). Mean physical/mental summaries of HRQoL were 33.9±10, and 42±13, and correlated with a better nutritional status (p=0.011, and p=0.001, respectively). Polypathology affects one quarter of inpatients in a hospital setting, and can be easily and reliably identified. The diversity and complexity of patient needs underscore the need for continuity of care between community and hospital, crossing sub-speciality lines and institutional boundaries.

Home care from the perspective of older clients and their professional carers - Corrected Proof

Sini Eloranta, Seija Arve, Hannu Isoaho, Pirkko Routasalo — 2009-11-13

Abstract: The aim of this cross-sectional study was to explore and compare the views of older home care Cs and their professional carers in relation to the care given. The data were collected with a postal questionnaire distributed to 200 Cs (≥65 years) and 570 Ps (Ps), with a total response rate of 63%. The differences in responses between Cs and Ps were analyzed using cross-tabulations, the Pearson χ2-test and Fisher's exact test. The Cs’ and the staff's perceptions of Cs’ own resources were very similar. The collaboration between the Cs and the staff was experienced as being confidential. However, their views differed when separate issues of the collaborative relationship were queried. The staff saw the coordination of care in a positive light. The results showed that information transfer between staff, Cs and close relatives still needs to be developed. The evaluation of home care interventions was also quite weak.

The efficacy of home-based muscle training for the elderly osteoporotic women: The effects of daily muscle training on quality of life (QoL) - Corrected Proof

2009-11-09

Abstract: There is little evidence that home-based muscle training through exercise improves the muscle strength and QoL of elderly osteoporotic women. The efficacy of home-based daily exercise on muscle strength of the upper and lower extremities and QoL were examined in elderly osteoporotic women by means of a case-controlled study that was designed and conducted between 2005 and 2006. Sixty-three osteoporotic women over 60 years of age were randomly assigned to 12 months of muscle exercise or to no intervention. The outcomes were changes in muscle strength and quality of life (QoL). Ultimately, sixty-two participants completed the 12 months program. Before the start of home-exercise training, the lumbar spine bone mineral density (BMD) and femoral neck BMD values in the intervention group were significantly lower than those in the control group (p<0.05). Grip strength and maximum walking speed increased significantly in the intervention group (p<0.05). In terms of QoL, physical functioning was improved by home-based exercise in the intervention group (p=0.05), while there were no improvements in any of the categories of Short-Form 36 in the control group. Our results suggest that home-based training is effective for elderly osteoporotic women in improving not only muscle strength in upper and lower extremities but also physical functioning in QoL.

Oral care help to maintain nutritional status in frail older people - Corrected Proof

Yasunori Sumi, Nobuyoshi Ozawa, Hiroko Miura, Yukihiro Michiwaki, Osami Umemura — 2009-11-05

Abstract: The purpose of this study was to evaluate the effect of continuous oral care on the nutritional status of older people who require care using a 1-year randomized, controlled study. Fifty-three residents of a nursing home in Japan participated in this study. Subjects were randomly divided into two groups, an oral care intervention group and control group. The subjects in the oral care intervention group received professional oral care from a dentist three times a week over the course of 1 year. Body weight, body mass index (BMI), serum albumin, and high-density lipoprotein cholesterol (HDL-C) were measured as objective indicators of nutritional status at baseline and after 1 year, and compared between the groups. In the oral care group, no significant decline was seen in all indicators from the start to the end of the intervention, but in the control group there was a statistically significant decline in all indicators at the end of the year. These results suggest that the intervention of oral care alone can serve to maintain the nutritional status of older people who require care. Implementation of continuous oral care is an important task from the viewpoint of maintaining nutritional status in older people.

Needs of caregivers of the patients with dementia - Corrected Proof

2009-10-23

Abstract: This study was conducted to isolate the needs families express both for medical and psychological care, and for educational and social support in 112 caregivers of patients affected by moderate to severe dementia (mini mental state examination=MMSE score: 9±7) consecutively recruited at our Memory Clinic, to develop approaches as individualized as possible. The medical needs caregivers express are mainly relative to a better knowledge of the disease (78%) and the exact diagnosis (65%); the education-related needs are mainly relative to the acquisition of communicational skills (83%) and the optimal handling of cognitive (77%) and behavioral disorders (81%); the psychological ones mainly concern the area of assistance induced emotional stress management (37%) and the elaboration of feelings such as anxiety, rage and guilt (49%). Variance analysis shows a correlation between emotional caregivers’ needs and the subjective and objective burdens they carry. Despite the attention to the role families play in caring for patients with a diagnoses of moderate to severe dementia, caregivers still express low levels of illness-consciousness and high levels of psychological discomfort. A lot more ought to be done in order to provide better information about the disease, about appropriate cognitive and behavioral disorder management skills, and about viable psychological support.

Adult age differences in the Color Stroop Test: A comparison between an Item-by-item and a Blocked version - Corrected Proof

C. Ludwig, E. Borella, M. Tettamanti, A. de Ribaupierre — 2009-10-21

Abstract: The Color Stroop Test is consensually considered as a task to assess the efficiency of inhibitory mechanisms. If the Stroop interference effect is largely undisputed, it is also acknowledged that the size of this effect varies as a function of various task manipulations, such as the task format. The aim of the present study was to compare the size of adult age-related differences in inhibition as assessed by two different versions of the Color Stroop Test: a standard Blocked paper-and-pencil version and a computerized Item-by-item one. Results showed pronounced age-related differences in the interference effect in the Blocked version, but not in the Item-by-item one. These findings are discussed in terms of the characteristics of the tasks. The choice of the appropriate version with respect to clinical aims is also addressed.

Cigarette smoking and cognitive impairment: A 10-year cohort study in Taiwan - Corrected Proof

2009-10-16

Abstract: The relationship between cigarette smoking and cognitive impairment is not a simple one. Some studies have demonstrated that cigarette smoking is a risk factor for cognitive impairment in the elderly, whereas other studies have shown cigarette smoking to be protective against dementia. This study aims to explore the relationship between cigarette smoking and cognitive impairment in elderly persons without dementia, during a 10-year period. Data were derived from a population-based cohort study of 1436 elderly Taiwanese. Cognitive function was measured by the SPMSQ both in 1993 and in 2003. A total of 1436 participants free of cognitive impairment at baseline (SPMSQ≥6 in 1993) were included in these analyses. Subsequently, participants were divided into three groups: never, past, and current smokers. The effect of cigarette smoking on cognitive function was assessed using logistic regression. In the logistic regression model adjusted for age, education, hypertension, diabetes, heart disease, and stroke at baseline, persons who had quit smoking (Odds ratio=OR=0.31; 95% CI=0.18–0.53; p<0.001) and those who continued to smoke (OR=0.37; 95% CI=0.20–0.70; p<0.001) were about one-third as likely to develop cognitive impairment as were those who never smoked. However, no dose–response relationship was observed between pack-years and cognitive impairment. Past and current smokers were less likely to develop cognitive impairment during a 10-year follow-up than were those who had never smoked. The present study suggests that smoking may be protective for cognitive function.

Factors triggering the oral mucosal lesions by complete dentures - Corrected Proof

2009-10-12

Abstract: Oral mucosal lesions may represent acute or chronic reactions to factors related with dentures. The aim of this study was to determine the frequency of the oral lesions related to gender, age, the length of time of denture usage, the balance of denture and cleaning methods and frequency. The 106 patients who have old complete dentures came to the Dental Faculty of Marmara University, Istanbul (Turkey) to have new complete dentures were asked to participate in the investigation. The subjects (51 men and 55 women) were 37–80 years of age with a mean age of 60.28±10.52 years. All main factors were estimated in subgroups: cleaning methods and frequency were divided into 3 subgroups respectively as toothbrush and toothpaste/soap, denture cleansing tablets and sodium carbonate, and 3 times a day, everyday, every 3 day and once a week. The data obtained was evaluated by One-way ANOVA, Mann–Whitney U-test, Kruskal–Wallis-test, Student t-test and χ2-test. The level of statistical significance was set at p<0.05. The patients displayed statistically significant differences in the topics of the length of time of denture usage and the balance of denture in terms of retention. The complete denture wearers should be educated in the importance of periodic examination due to the changing of supporting tissues for detection early mucosal lesions to maintain their oral and dentures hygiene in optimum level.

Cognitive decline is associated with nutritional risk in subjects with small head circumference (HC) - Corrected Proof

2009-10-12

Abstract: Nutrition has been found to be associated with cognitive impairment, but it has not been established whether these associations are present solely in later life or whether they are present in younger age as well. HC is a good indicator of brain development and the most sensitive anthropometric indicator of prolonged malnutrition during early life. This study examined the interaction between early HC and later (nutrition screening initiative) nutritional factors on the risk of cognitive decline in the elderly. The longitudinal factorial design had the mini-mental state examination (MMSE) score as the dependent variable, with HC as one factor and nutritional risk as another. We studied a sample of 495 not cognitively impaired Korean participants with 2 years follow-up data. After multivariable adjustment, interactive effect between HC and nutritional risk was significantly associated with cognitive decline (F=2.449, p=0.045). Simple main effect analysis showed that compared with highest HC, lowest HC was associated with a cognitive decline. Nutritional risk was associated with cognitive function decline only in individuals with small HC. Therefore, the prevention for cognitive impairment and dementia should involve nutritional strategies throughout life.

Factors affecting mortality of frail hip-fractured elderly patients - Corrected Proof

Avital Hershkovitz, Irena Polatov, Yechayaou Beloosesky, Shai Brill — 2009-10-12

Abstract: Hip fracture in the elderly may lead to increased morbidity and mortality. We assessed factors affecting mortality of frail elderly hip-fractured patients during the first 2 years after discharge from a post-acute rehabilitation program. Included were 376 patients admitted from 1/2006 to 9/2007. Kaplan–Meier curves were used for survival analysis. During the 2 years after discharge 68 patients (20.8%) died. Sex, fracture type, operation versus conservative treatment, time to surgical intervention, presence of depression, impaired neurological function or comorbidity burden were not found to be significant predictors of mortality. Comparisons of survival curves showed significantly higher mortality in patients with admission albumin level of <3.5g/dl compared to patients with levels of ≥3.5g/dl (p=0.017); demented versus cognitively intact patients (p<0.001); patients with admission FIM score of <40 versus those with scores of 40–79 and ≥80 (p=0.012); very old patients (>84) compared with old (75–84) and young-old patients (<75) (p=0.003). Multivariate analysis showed that only dementia and age were independent predictors of mortality in the studied group. Multidisciplinary teams should be aware of treatable variables affecting these patients’ survival and should endeavor to improve their functional and nutritional level. Moreover, expectation coordination should be carried out with very old and cognitively impaired patients.

Relationship between age and serum thyrotropin among asymptomatic older people in Taiwan - Corrected Proof

Chia-Chang Huang, Yu-Chun Chen, Liang-Kung Chen, Shinn-Jang Hwang, Hong-Da Lin — 2009-10-12

Abstract: Hypothyroidism is a common disorder in older people, and may be asymptomatic and hard to be diagnosed. The main purpose of this study was to evaluate the distribution of serum thyrotropin (thyroxin-stimulating hormone, TSH) among asymptomatic older people in Taiwan, and to evaluate the relationship between age and serum TSH. In 2007, all subjects participating in the annual elderly health examinations at Taipei Veterans General Hospital were invited for study and were enrolled when they were fully consented. In total, 1716 asymptomatic elderly people (mean age: 73.2±4.4 years, 56.3% males) participated in this study after careful exclusion of 38 subjects with past history of thyroid disorders. All participants were divided into two groups: (1) younger old (age 65–79) and (2) older old (age over 80) for further analysis. The mean serum levels of TSH were similar between younger old and older old groups (2.43±5.36μIU/ml for younger old and 2.36±3.51μIU/ml for older old, p=0.444). The overall prevalence of suspected hypothyroidism was 9.2% among asymptomatic older people in Taiwan, which was significantly lower than in Caucasians. The prevalence of suspected hypothyroidism may reach 25.9% if the TSH cutoff was lowered to 2.5μIU/ml. Further study is needed to determine the normal reference range of serum TSH in older people.

Cognitive impairment in old people living in the community - Corrected Proof

Constança Paúl, Oscar Ribeiro, Pedro Santos — 2009-10-12

Abstract: Cognitive impairment has a high prevalence in the elderly, especially in the oldest old, and it is a major concern for autonomous old people living in the community and their families. Any possible intervention will benefit from early detection of cognitive decline related signs. The Portuguese version of the mini-mental state examination (MMSE) was used to assess cognitive impairment in a sample of 1266 old community-dwellers in Portugal, mean age 70.3±8.7 years. A standard questionnaire was also used including measures on social network, psychological distress, functionality, perceived health status, and socio-demographic variables. We recorded education levels and illiteracy by using different cut points to select people with and without cognitive impairment and results showed a 9.6% prevalence of positive cases. In general, cognitive impairment is higher in women, older people, widows(ers), and people with negative self-perception of health and with difficulties in basic and in instrumental activities of daily living (ADL and IADL). Cognitive impairment was found to be predicted by gender, age and psychological distress, explaining 18% of variance. Findings are discussed considering available literature and possible interventions for community residents.

Acute medical management of the non-ST-segment elevation acute coronary syndromes (NSTE-ACS) in older patients - Corrected Proof

Andrew Docherty — 2009-10-12

Abstract: Older patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) represent many clinical challenges. For example diagnosis can be difficult, and comorbidities are common. Furthermore, NSTE-ACS is particularly common in older patients (>60% of acute myocardial infarctions occurring in patients aged 65 years or older) and the mortality associated with NSTE-ACS is particularly high. Despite these many concerns, evidence from clinical trials based on this group of patients is limited. Future prospective clinical trials should therefore more accurately reflect the NSTE-ACS patient population by including more elderly patients and including efficacy endpoints that are relevant for these patients. Furthermore, the lack of clear clinical evidence in this population means that the current treatment guidelines do not fully address the needs of elderly patients. Several recent clinical trials have highlighted some of the main considerations we should make when treating elderly patients with NSTE-ACS. Different therapy options in the pharmacological management of NSTE-ACS in this age group are also discussed.

Incidence of perioperative myocardial infarction and of 2-year mortality in 577 elderly patients undergoing noncardiac vascular surgery treated with and without statins - Corrected Proof

2009-10-12

Abstract: Of 577 patients, mean age 74 years, undergoing noncardiac vascular surgery, 300 (52%) had carotid endarterectomy, 179 (31%) had lower extremity revascularization, and 98 (17%) had abdominal aortic aneurysm repair. Of the 577 patients, 302 (52%) were treated with statins. Perioperative myocardial infarction (MI) occurred in 18 of 302 patients (6%) treated with statins and in 38 of 275 patients (14%) not treated with statins (p=0.001). Two-year mortality occurred in 18 of 302 patients (6%) treated with statins and in 43 of 275 patients (16%) not treated with statins (p=0.0002). Perioperative MI or mortality occurred in 34 of 302 patients (11%) treated with statins and in 74 of 275 patients (27%) not treated with statins (p<0.0001). Stepwise Cox regression analysis showed that significant independent prognostic factors for perioperative MI or death were use of statins (risk ratio=RR=0.43, p<0.0001), use of beta blockers (RR=0.55, p=0.002), carotid endarterectomy (RR=0.60, p=0.009), and diabetes (RR=1.5, p=0.045). In conclusion, patients undergoing noncardiac vascular surgery treated with statins had a 57% less chance of having perioperative MI or death at 2-year follow-up after controlling for other variables.

Mobility disability in midlife: A longitudinal study of the role of anticipated instrumental support and social class - Corrected Proof

C.J. Nilsson, K. Avlund, R. Lund — 2009-10-12

Abstract: On the basis of the evidence of a protective effect of social support on the functional ability of older people and social inequalities in mobility the present study aims to (1) study if onset of mobility disability in a middle-aged cohort is associated with social class and (2) study if anticipation of instrumental support has a protective effect on mobility at 6-year follow-up, and whether this effect is modified by social class. Data on 3549 40- and 50-year-old men and women were obtained from The Danish Longitudinal Study on Work, Unemployment and Health in 2000 and 2006. Ten percent of the study participants experienced onset of mobility disability at follow-up. Significantly more individuals in the lower social classes experienced onset of mobility disability and never anticipated instrumental support, compared to the higher social classes. In this middle-aged population the anticipation of instrumental support had no significant effect on mobility disability at 6-year follow-up. Social class did not modify the association between anticipated instrumental support and mobility, but was the most important confounder. Further research on the effect of social support on mobility in midlife is needed in order to identify individuals at risk of disability at an early stage.

The impact of hip fracture (HF) on the functional status (FS) of older persons in Rio de Janeiro, Brazil: Results of a prospective cohort study - Corrected Proof

Silvia R.M. Pereira, Martine T.E. Puts, Margareth C. Portela, Mario A. Sayeg — 2009-09-28

Abstract: There is no prospective study investigating the impact of hip fracture (HF) on functional status (FS) in Brazil. The objective of this study was to investigate the impact of a HF on the FS of older persons 1 year after the fracture and the factors associated with decline in FS 1 year after the fracture. Two hundred and forty-six patients who were admitted to one of four hospitals after HF participated. The sample for this study consisted of 160 patients who were still alive and had information on functional limitations after 1 year. The Brazil Old Age Schedule (BOAS) was used to assess FS before and 1 year after HF. Logistic regression analyses were used to identify predictors of decline 1 year after fracture. Of the patients, 46.3% did not achieve their prior FS. Older age, being underweight, total length of stay and the use of psychotics/sedatives and anxiolitics were associated in multivariate analyses with decline in FS. Working before the fracture was protective of decline in FS. We conclude that HF severely compromised the FS of older persons in Rio de Janeiro, Brazil.

Factors of high impacts on the life of caregivers of disabled elderly - Corrected Proof

2009-09-22

Abstract: Elderly caregivers suffer physical and psychological consequences of the act of caring. The objective of this study was to characterize primary caregivers of elderly people in the community and identify the higher impacts of this activity on their life. We interviewed 127 caregivers about sociodemographic characteristics, presence of anxiety/depression (self-reporting questionnaire=SRQ), burden of care (caregiver burden scale=CBS); while their dependents were evaluated using sociodemographic questionnaires, health history, activities of daily living (ADL) scale and geriatric depression scale (GDS-15). The caregivers’ mean age was 55.1±13.3 years; among them most were women and daughters with up to 4 years of education. The mean time as responsible for the elderly was 86.5±96.3 months; 56% divided the caring responsibility and 28.2% had another occupation; 32.3% presented psychoemotional illness. There was a positive correlation between the CBS and the caregiver factors: psychoemotional disorders, time as responsible for the elderly and education level; as well as between the CBS and the elderly: number of activities with dependence, presence of depression and incontinences. The correlation between the elderly's personal income and number of visits received was negative. The identification of high impacts on the caregivers’ life would facilitate the professional approach.

Chromogranin A (CgA) serum level as a marker of progression in hepatocellular carcinoma (HCC) of elderly patients - Corrected Proof

2009-09-22

Abstract: The observation of neuroendocrine (NE) activity during clinical course of hepatocellular carcinoma (HCC), suggested the use of NE serum markers to detect it. Thus we have evaluated the usefulness of serum measurements of CgA in monitoring disease activity of HCC. We investigated the role of serum concentrations of CgA, α-fetoprotein (AFP) and des-γ-carboxyl-prothrombin (DCP) in 55 patients with HCC, 27 patients with cirrhosis, 22 patients with chronic hepatitis and a control group of 20 volunteers and the relationship between the pre-treatment serum CgA and clinical stages of the disease. CgA was significantly higher in the patients affected by HCC as compared with those affected by either hepatitis or cirrhosis (p<0.001). We also observed significant differences, comparing CgA serum levels in the tumor classes T1–T4: T1 vs. T2 (p<0.001), T1 vs. T3 (p<0.001), T1 vs. T4 (p<0.001), T2 vs. T3 (p<0.001), T2 vs. T4 (p<0.001) and T3 vs. T4 (p<0.001). CgA levels were significantly higher in poorly differentiated HCC vs. well differentiated (p<0.05) and medium differentiated ones (p<0.001). Also the comparison between Child-Pugh degree A and C showed a significant difference in CgA levels (p<0.001). Thereby, patients with higher CgA level had poor survival and showed poor prognosis, compared to those with lower CgA level, i.e., the CgA is useful in monitoring progression of disease and may assist as a prognostic indicator.

Erratum to “Alpha-lipoic acid as a new treatment option for Alzheimer type dementia” [Arch. Gerontol. Geriatr. 32 (2001) 275–282] - Corrected Proof

Klaus Hager, Andres Marahrens, Marlene Kenklies, Peter Riederer, Gerald Münch — 2009-09-18

The publisher regrets that the title of the above paper contained an incorrect spelling of the word Alzheimer. The correct title should be: Alpha-lipoic acid as a new treatment option for Alzheimer type dementia.

Profiles of functioning as predictors of mortality in old age: The advantage of a configurative approach - Corrected Proof

2009-09-14

Abstract: This study proposes the concept of functioning profile, by which one's status is summarized across essential functioning domains, and validates its efficiency in predicting mortality. The study analyzed data of two cohorts of community-dwelling Israelis aged 75 and over, nationally sampled in 1989 (N=1200) and 1999 (N=421), respectively. Eight groups with differential profiles reflected higher versus lower levels of functioning in three domains: physical (activities of daily living), cognitive (Orientation–Memory–Concentration test=OMC) and affective (depressive symptoms). The analyses predicted mortality within 4 years, adjusting for sociodemographic and health variables. Relative to the optimal profile, most functioning profiles represented groups having elevated mortality risks of considerable consistency across cohorts. Physical functioning was the most predictive component in the profiles, but its combinations with cognitive and affective functioning produced unique contributions to mortality prediction. The study suggests that the functioning profile, representing a person-centered configurative approach (i.e., one that considers the person's combined standing on key factors), is a useful concept for delineating risk groups in late life and evaluating risk factors in predicting mortality.

Association between serum copper, zinc and hospital admissions among care home residents - Corrected Proof

2009-09-09

Abstract: Nutritional status is important in various health care settings, long-term care is no exception. The relationship between protein-energy malnutrition and clinical outcomes in care homes has been reported. However, little is known about the roles of trace elements in clinical outcomes of care home residents. In 2002, 75 severely disabled care home residents (mean age: 77.7±8.2 years, 64.3% males) were enrolled for study. The status of protein-energy malnutrition at enrollment was as follows: 47.9% underweight (body mass index, BMI<20kg/m2), 15.5% hypoalbuminemia (serum albumin <3.5mg/dl), and 29.6% hypocholesterolemia (serum total cholesterol <160mg/dl), respectively. During the 6-month follow-up, anthropometric measurements (i.e., BMI and mid-arm circumferences) remained similar, but the biochemical markers of nutritional status (i.e., albumin, total cholesterol) were significantly deteriorated, and both serum zinc and copper were significantly increased. Compared with subjects without hospitalizations during the follow-up period, subjects ever hospitalized had significantly lower mean serum levels of albumin (3.6±0.3mg/dl vs. 3.9±0.3mg/dl, p=0.002), zinc (74.3±12.1 vs. 89.6±20.5μg/dl, p=0.020), and higher serum levels of copper (110.6±14.1 vs. 95.2±21.1μg/dl, p=0.023) at baseline screening. Adjusted for age, sex, and protein-energy malnutrition, baseline serum copper (odds ratio=OR=1.08, 95% CI=1.02–1.15, p=0.015) and zinc (OR=0.92, 95% CI=0.84–1.00, p=0.053) were significant independent predictive factor for hospital admissions. In conclusion, adjusted for age, sex, and protein-energy malnutrition, serum levels of copper and zinc both were independent predictive factors for hospitalizations among care home residents. Further interventional study is needed to clarify the prognostic roles of serum copper and zinc among care home residents.

Hydrotherapy after total knee arthroplasty. A follow-up study - Corrected Proof

S. Giaquinto, E. Ciotola, V. Dall’Armi, F. Margutti — 2009-09-07

Abstract: The study evaluated the subjective functional outcome following total knee arthroplasty (TKA) in participants who underwent hydrotherapy (HT) six months after discharge from a rehabilitation unit. A total of 70 subjects, 12 of which were lost at follow-up, were randomly assigned to either a conventional gym treatment (N=30) or HT (N=28). A prospective design was performed. Participants were interviewed with Western-Ontario McMasters Universities Osteoarthritis Index (WOMAC™) at admission, at discharge and six months later. Kruskal–Wallis and Wilcoxon tests were applied for statistical analysis. Both groups improved. The WOMAC™ subscales, namely pain, stiffness and function, were all positively affected. Statistical analysis indicates that scores on all subscales were significantly lower for the HT group. The benefits gained by the time of discharge were still found after six months. HT is recommended after TKA in a geriatric population.

Hierarchical linear and logistic modeling of outcomes of antihypertensive treatment in elderly patients: Findings from the PREVIEW study - Corrected Proof

2009-08-28

Abstract: Achieving guideline-recommended blood pressure targets is difficult in older adults with hypertension. We completed a subgroup analysis of patients 65 years of age or older enrolled in PREVIEW, a prospective, multicenter, pharmacoepidemiological study of the determinants and outcomes of second-line antihypertensive treatment with valsartan in Belgium. Multilevel modeling was used to identify physician- and patient-level determinants of blood pressure values and practice guideline-derived definitions of blood pressure control. Data on 1560 patients and 504 physicians were used in this analysis. Blood pressure control rates for patients age 65 and over were lower for systolic (34.2% vs. 38.6%) and combined systolic/diastolic blood pressure (31.2% vs. 34.4%) compared to the entire PREVIEW sample. Twenty-seven percent of the variability in systolic, and 32% in diastolic pressure after 90 days of treatment were attributable to such variables as physicians’ knowledge and adherence to evidence-based guidelines, practice patterns, and experience; with the remaining variance attributable to various demographic, behavioral, and clinical patient-related factors. Several independent predictors of uncontrolled blood pressure after 90 days of treatment were identified, largely confirming factors identified as determinants of blood pressure values. Recommendations for managing hypertension in the elderly are made in view of these findings.

Effect of physical exercise and age on knee joint position sense - Corrected Proof

Fernando Ribeiro, José Oliveira — 2009-08-28

Abstract: This study aimed to test the hypotheses that knee position sense declines with age and that regular exercise can attenuate that decline. This cross-sectional study encompassed 69 older and 60 young adults divided in four groups (exercised-old, N=31; non-exercised-old, N=38; exercised-young, N=35; non-exercised-young, N=25) according to chronological age and exercise practice in the past year. Knee position sense was measured by open kinetic chain technique and active positioning and is reported as the absolute and relative angular error. Knee angles were determined by computer analysis of videotape images using the Ariel Performance Analysis System. Compared to their non-exercised counterparts, exercised-young and -old showed lower absolute and relative angular errors. The absolute (1.62±0.71°) and relative errors (0.02±1.65°) for exercised-young were lower than all other groups (p<0.001). The absolute and relative errors of exercised-old (4.27±2.49° and 5.51±3.42°) were similar to non-exercised-young (4.74±2.67° and 4.18±3.40°). The non-exercised-old exhibited higher absolute (9.35±4.34°) and relative errors (9.73±5.15°) than all other groups (p<0.001). The present data indicates that age has deleterious effects on knee position sense although regular exercise can attenuate that age-related decline.

Aging change of mandibular condyle in female F344/N rat - Corrected Proof

2009-08-17

Abstract: To ascertain whether laboratory rats represent an adequate animal model for aging oral cavity research, this study focused on the morphology of the mandibular condyle. Aging changes of cartilaginous conformation and shape of the mandibular condyles were analyzed in female F344/N rats. In the condylar cartilage, articular, proliferative cell and hypertrophic cell layers were observed in 1-month-old (M) rat, whereas flattened cell layer was notable at 2M. A mature cell layer was observed in the condylar cartilage of rats at 7.7M and over. Deranged cartilaginous layers and thinning articular layer were observed in 30.9M rat. The sagittal length of the condyle decreased, whereas the frontal one increased with aging and/or age. There were three phases in the transition patterns of the size of the condyle, which seemed to correspond to the respective growing, aging and senescence phases in the rat. The results suggested that degenerative change of condylar cartilage in rat was similar to that in human, whereas change of the shape of the condyle was different between rat and human, caused by a different pattern of mastication.

The clinical and rehabilitative complexity in dementia with Lewy bodies (DLB): Experience on a random sample of elderly patients dwelling in an RSA (“Residenza Sanitaria Assistita”) of Catania - Corrected Proof

2009-08-10

Abstract: This study was aimed at evaluating the occurrence of DLB in a population sample recovered in assisted sanitary residence (RSA=from the Italian name of “Residenza Sanitaria Assistita”) in the Province of Catania. We considered 126 patients from a randomized population recovered in RSA of Viagrande (Catania) in the period from 1st March, 2005 and 31st March, 2007. Those who proved to be demented according to the DSM-III diagnostic protocols, and having a mini mental state examination (MMSE)-score <24 were divided in 2 groups: Group A, all the demented people without the DLB; and Group B, the DLB patients, according to the diagnostic criteria of McKeith. All patients underwent at admission, after 1 month, and at emission the following psychometric and functional tests: MMSE, geriatric depression scale (GDS) [], Barthel index (BI), activities of daily living (ADL) and instrumental ADL (IADL). Particular attention was dedicated to the presence of delirium during the last 15 days before the admission and during the recovery, the mortality and the prevalence of other complaints. The observed data confirm the prevalence of fragility of DLB patients in 20% of them, a fluctuation of the cognitive capacities, a better recovery of the affectivity, a reduced functional autonomy and autosufficiency. In addition, the DLB patients display a major presence of prevalent delirium, compared to the total population of demented patients, while in this last population only incidental delirium episodes occurred during the recovery period (31.6% vs. 16.6%; p<0.001). In the DLB population decubital lesions occurred more frequently, and were of more severe staging, compared to the controls (45% vs. 27%; p<0.001). Also, the mortality of the DLB patients was higher (about 30% vs. 17% in 12 months). These data confirm the particularity and higher complexity of the DLB patients recovered in the RSA.

Decreased dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) concentrations in plasma of Alzheimer's disease (AD) patients - Corrected Proof

Sarah Aldred, Patrizia Mecocci — 2009-08-10

Abstract: DHEA is secreted by the adrenal cortex and is also a neurosteroid. Its sulfate (DHEAS) is the most abundant steroid in circulation. The levels of both are seen to decline in concentration with age. Evidence is available for altered levels of DHEA and DHEAS in AD but is limited to relatively few studies assessing small cohorts. This study assessed plasma DHEA and DHEAS levels in AD sufferers (n=72) and compared them to age-matched controls (n=72). Plasma DHEA concentrations were significantly lower in AD patients compared to control (4.24±0.4ng/ml for AD; 3.38±0.3ng/ml for control, p=0.027, Mann–Whitney 1-tailed) and DHEA levels were significantly correlated to DHEAS levels in both control and AD conditions (Spearman's rho correlation coefficient=0.635 in controls and 0.467 in AD, p≤0.01). This study highlighted a measurable difference in DHEA and DHEAS concentrations in plasma from a large cohort of patients suffering from AD when compared to age-matched controls.

Prevalence of hypomagnesemia (HM) in a geriatric long-term care (LTC) setting - Corrected Proof

Zeev Arinzon, Alexander Peisakh, Samuel Schrire, Yitshal Neor Berner — 2009-08-10

Abstract: Electrolyte abnormalities are frequently observed in elderly long-term care (LTC) patients. Magnesium is a trace mineral, but is the second most abundant intracellular cation and the fourth most abundant cation in the body. This was a cross-sectional study to assess the prevalence of hypomagnesemia (HM) in non-selected elderly LTC patients. A total of 159 patients aged 65 years and older were included in the study. The attributes and variables related to the patients’ hospital course were used to compare the two groups. We used univariate and multivariate analyses to correlate magnesium levels with demographic, clinical factors and laboratory data. HM was found in 36% of the patients, of whom 35% presented with moderate HM (0.8–0.9μequiv./l) and 18% with severe HM (≤0.7μequiv./l). Patients with HM had a higher number of comorbid diseases per patient (p=0.038), low body mass index (BMI) (p=0.044) and more of them presented with laboratory markers of malnutrition, such as low total cholesterol (TC) and serum albumin (SA) levels. Coexistence with other electrolyte abnormalities was higher among patients with HM than without (p=0.006), predominantly hypocalcemia and hypokalemia (p=0.023 and 0.032, respectively). Using regression analysis, independent variables significantly associated with serum magnesium levels were serum albumin, calcium, potassium, urea levels, chronic renal failure (CRF), chronic heart failure (CHF), diabetes mellitus (DM) and diuretic drugs (R2=0.877). Both early (up to 30 days) and late rate of death were higher in patients with HM. The incidence of HM in LTC elderly patients is high and multifactorial. Understanding the causes of HM, correction of magnesium level, and definitive and effective treatment of the cause leading to HM is important to improve patient prognosis.

Analysis of postural control in elderly subjects suffering from Psychomotor Disadaptation Syndrome (PDS) - Corrected Proof

2009-08-10

Abstract: PDS is a geriatric affliction, described in 1999, characterized by postural impairments, including backward disequilibrium, freezing, a deterioration in the ability to anticipate postural adjustments, anxiety and fear of falling, inducing loss of autonomy. This study compared 10 subjects suffering from PDS, aged 87.3±4.9 years, with 10 control subjects, aged 85.4±7.9 years concerning postural control (body sway amplitude). In all participants, postural control was assessed using the SwayStar™ system in natural (spontaneous) and standardized stances, eyes open and eyes closed over a period of 40s. It was found that: (1) with eyes open, subjects with PDS showed greater body sway amplitude than did controls whatever the position (natural or standardized) and the plane (sagittal or frontal) considered (F1,16=6.05; p=0.026), (2) with eyes closed, subjects with PDS showed greater body sway amplitude than did controls in the natural stance whatever the plane (F1,18=7.65; p=0.013). In conclusion, PDS has a negative effect on postural control. This data must be taken into account during the rehabilitation of patients with this syndrome.

The influence of age on blood pressure evaluation of hypertensive subjects - Corrected Proof

2009-08-10

Abstract: The aim of this study was to determine whether age influences the concordance between different methods of blood pressure (BP) measurement and ambulatory BP monitoring (ABPM) in hypertensive subjects. We studied two groups: I, individuals younger than 50 years (n=57), and II, individuals aged 60 years or older (n=55). They were submitted to the performance of one ABPM, office BP measurements, home BP monitoring (HBPM), and BP measurements at a public health center (PHCBP). Student's t-test, Fisher's test and Lin coefficient were calculated. For Group II, systolic and diastolic pressures measured by HBPM were higher than by day ABPM (p<0.01). The concordance between day ABPM and the other methods was lower for Group II than for Group I. There was a good concordance between systolic day ABPM and office BP, and between systolic ABPM and PHCBP only for Group I (Lin coefficient=0.71 and 0.73). Group II reported better sleep quality after ABPM (p<0.05). Considering 24-h ABPM, 52.6% of Group I and 29% of Group II were controlled (p<0.01). Concluding, there was worse concordance between different methods of BP measurements and day ABPM in the older group, which had lower hypertension control rate and better tolerance of ABPM.

Blood homocysteine and risk of depression in the elderly - Corrected Proof

2009-07-31

Abstract: We studied whether increased blood homocysteine is a predictor for incident depression in a population-based cohort aged ≥65. A total of 240 men and 217 women were identified at baseline and were assessed 4 years later for depression (Geriatric Depression Scale, GDS ≥10 or use of antidepressants). Risk of incident depression was estimated for the highest gender-specific tertile of baseline plasma homocysteine compared to the other tertiles combined in a reference group. As deficiencies of B12 and folate are the main determinant of increased blood homocysteine in old age, serum concentrations of these vitamins were also measured. In women only, the highest homocysteine tertile was associated with incident depression. However, women with combined serum B12/folate deficiency had the highest blood homocysteine but also a lower depression risk than vitamin-replete women. In conclusion, the data only moderately support the hypothesis that blood homocysteine is a predictor of depression.

Predisposing chronic diseases and hypophosphatemia in patients with influenza - Corrected Proof

Lena M. Håglin, Lars Åke Burman, Mats Nilsson — 2009-07-29

Abstract: Almost half of the hospitalized influenza patients have a chronic disease, which increases the risk for secondary bacterial infections and for adults >65 years influenza is related to high mortality risk. The impact of diabetes mellitus (DM), asthma bronchiale, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) on the risk of having a low serum phosphatemia (S-P) in addition to influenza is important to investigate as this increases both morbidity and mortality and can be prevented. Hypophosphatemia could be the explanation for reduced chemo-taxis and phagocytosis, which in addition to respiratory function may increase the risk of pneumonia and sepsis. Data for this study was collected from the medical journals retrospectively for 100 patients admitted to the Department of Infectious Diseases during the study period, 1992–94, with the clinical diagnosis influenza out of which seventy-two cases were used in the calculation. Forty-seven percent of the hospitalized influenza patients had a 2.7-fold risk of suffering from DM than of any other chronic disease and an almost significantly doubled risk of having a low S-P level with a chronic disease. The prevalence of hypophosphatemia (S-P<0.70mmol/l) was high; 13.0% of the women and 15.0% of the men; 34.0% of all patients had S-P<0.82mmol/l. Men, in contrast to women, showed clinical signs of a secondary bacterial infection more frequently (12/41 and 6/35, respectively). Our study gives indications for an involvement of low S-P with chronic disease.

Glioblastoma in elderly patients: Safety and efficacy of adjuvant radiotherapy with concomitant temozolomide - Corrected Proof

2009-07-23

Abstract: The aim of this study was to evaluate the impact of radiotherapy plus concomitant and adjuvant temozolomide (TMZ), in terms of feasibility and activity, in elderly patients with glioblastoma. From January 2002 to December 2007, 42 consecutive patients with glioblastoma (27 men and 15 women) aged 65 years or more (median age 71.3 years), received radiotherapy plus concomitant and adjuvant TMZ. Nineteen patients (45.2%) had a Karnofsky index ≥80. Thirty-six patients (85.8%) underwent complete or subtotal resection, while 6 patients (14.2%) were only biopsied. All patients received adjuvant radiotherapy within 4 weeks from surgery. Twenty-two patients (54.8%) underwent adjuvant TMZ. Early discontinuation of concomitant TMZ program due to toxicity was observed in 8 patients. Considered variables were: age, Karnofsky index, surgery versus no surgery, radiation dose, and chemotherapy. At a median follow-up of 10.2 months, the 6- and 12-month overall survival rates were 81.9% and 27.8%, respectively. There was a significantly better survival for patients with a performance status according to Karnofsky >80 (p<0.0001). Actuarial progression-free survival at 6- and 12-month was 46.4% and 9.8%, respectively. Globally, the treatment was well tolerated with no treatment-related toxicity in 69% of patients. In conclusion, in elderly patients, the adjuvant chemo-radiotherapy was well tolerated with an acceptable rate of toxicity, and patients with a good performance status had a significantly better survival. However, further prospective trials are needed to confirm these results.

Abnormal thyroid stimulating hormone (TSH) in psychiatric long-term care patients - Corrected Proof

Samia Sabeen, Caroline Chou, Suzanne Holroyd — 2009-07-21

Abstract: The objective of the study was to find the prevalence of thyroid dysfunction in long-term care patients referred to psychiatry. We reviewed 868 charts of long-term care residents referred for psychiatric consultation to the university-based psychiatry outreach service. Data obtained were demographics, psychiatric and thyroid diagnoses, and TSH data. Of 868 patients, 10.8% had elevated TSH, 8% in those with a prior diagnosis of hypothyroidism. TSH was low in 0.07%. Elevated TSH was associated with female gender (p<0.001) and a trend with psychosis (p=0.056). No association was found with depression or behavioral disturbance in this study.

Nutritional and hydration status in elderly subjects: Clinical rating versus bioimpedance analysis - Corrected Proof

A. Rösler, F. Lehmann, T. Krause, R. Wirth, W. von Renteln-Kruse — 2009-07-21

Abstract: Malnutrition and dehydration are common in elderly. A simple, reliable instrument to assess nutritional and hydration status would be very helpful. Bioelectrical impedance analysis (BIA) has been promising in this context, but data of elderly persons and geriatric in-hospital patients are rare. Therefore, we first compared BIA measurements (resistance, reactance, phase angle and a resulting vectorgraph) with a clinical assessment in 31 community-dwelling women and 30 female nursing-home residents. The results of the BIA measurement correlated well to weight, hand grip strength, and calf circumference. We then compared BIA measurements with clinical judgement of hydration status in 103 acute geriatric hospital in-patients. Concordance between the results of clinical judgement and BIA measurements was only 43.7%. In assessing geriatric in-patients, there is little concordance between the clinical and the bioelectrical evaluation of the hydration status.

The short version of the Activities-specific Balance Confidence (ABC) scale: Its validity, reliability, and relationship to balance impairment and falls in older adults - Corrected Proof

Stacey Schepens, Allon Goldberg, Melissa Wallace — 2009-07-17

Abstract: A shortened version of the ABC 16-item scale (ABC-16), the ABC-6, has been proposed as an alternative balance confidence measure. We investigated whether the ABC-6 is a valid and reliable measure of balance confidence and examined its relationship to balance impairment and falls in older adults. Thirty-five community-dwelling older adults completed the ABC-16, including the 6 questions of the ABC-6. They also completed the following clinical balance tests: unipedal stance time (UST), functional reach (FR), Timed Up and Go (TUG), and maximum step length (MSL). Participants reported 12-month falls history. Balance confidence on the ABC-6 was significantly lower than on the ABC-16, however scores were highly correlated. Fallers reported lower balance confidence than non-fallers as measured by the ABC-6 scale, but confidence did not differ between the groups with the ABC-16. The ABC-6 significantly correlated with all balance tests assessed and number of falls. The ABC-16 significantly correlated with all balance tests assessed, but not with number of falls. Test–retest reliability for the ABC-16 and ABC-6 was good to excellent. The ABC-6 is a valid and reliable measure of balance confidence in community-dwelling older adults, and shows stronger relationships to falls than does the ABC-16. The ABC-6 may be a more useful balance confidence assessment tool than the ABC-16.

Assessing glomerular filtration rate (GFR) in elderly Chinese patients with chronic kidney disease (CKD): A comparison of various predictive equations - Corrected Proof

2009-07-17

Abstract: The aim of this study was to evaluate the applicability of formulas based on serum creatinine (SC) levels in elderly Chinese patients with CKD. A total of 103 elderly CKD patients were investigated. The GFR was estimated with Cockcroft–Gault-equation, MDRD1-equation, abbreviated MDRD-equation, Jelliffe-1973-equation, Mawer-equation, Hull-equation, Jelliffe-1971-equation, SC-reciprocal-equation, Gate-equation and Bjornsson-equation. The accuracy of estimated GFR (eGFR) values was compared with the 99mTc-DTPA-GFR (standardized GFR=sGFR) in elderly CKD patients. Bland–Altman analysis demonstrated that Hull-equation, Cockcroft–Gault-equation and Bjornsson-equation were better than the other ones. However, the agreement limits of all the equations exceeded the prior acceptable tolerances defined as 60ml/min/(1.73m2). Linear regressions showed that the slopes of Jelliffe-1973-equation, Cockcroft–Gault-equation and Bjornsson-equation were closer to the identical line. The median of difference of MDRD1-equation, abbreviated MDRD-equation and Gate-equation were smaller. Accuracy of Jelliffe-1973-equation, Cockcroft–Gault-equation and Hull-equation were better than those of the other equations. But 30% accuracy of all the equations were less than 70%. When compared the bias as well as accuracy of eGFR with sGFR values in different stages of CKD, GFR estimated by MDRD1-equation, Hull-equation, Cockcroft–Gault-equation and Jelliffe-1973-equation showed good results. These results suggested that when SC was checked with enzymatic method, GFR-estimation equations may show great bias in elderly Chinese CKD patients. Further improved formulas are needed to evaluate renal function in elderly Chinese patients with CKD.

Older age and type of surgery predict the early inflammatory response to hip trauma mediated by interleukin-6 (IL-6) - Corrected Proof

2009-07-17

Abstract: Hip trauma and surgery are associated with systemic inflammatory reaction. However, little evidence exists about the role of IL-6. In order to assess the inflammatory response, we evaluated white blood cell (WBC) count, C-reactive protein (CRP) and IL-6 dynamics in sequential pre- and postsurgical samples collected from 125 elderly patients (mean age 78±9 years) undergoing osteosynthesis (OS) for extracapsular hip fractures (n=69), hemiarthroplasty (HA) or urgent total hip arthroplasty for intracapsular fractures (UA) (n=35), and elective total hip arthroplasty for osteoarthrosis (OA) (n=21). Both preoperative CRP and IL-6 levels were higher in patients with intracapsular fractures. IL-6 levels reached peak values immediately after the surgery, while CRP peak levels were reached 48h after the surgery. The overall inflammatory reaction was more intense in HA patients compared to the other subgroups. Independent of each other, older age and the hip fracture type affected the IL-6 response, while the CRP response depended only on the type of surgery. The abrupt increase in IL-6 immediately after the procedure suggests its involvement in the early stages of the postoperative inflammatory reaction after hip surgery. This reaction is particularly pronounced in elderly patients receiving HA.

Gender differences in age-related increase of asleep blood pressure - Corrected Proof

Santiago Perez-Lloret, Jorge E. Toblli, Daniel P. Cardinali, José Milei — 2009-07-16

Abstract: The present study was conducted to characterize gender differences in age-related variation of nocturnal elevation of blood pressure (NEBP), as well as of diurnal and nocturnal systolic (SBP) and diastolic blood pressure (DBP). Untreated subjects (N=1689) underwent 24h ambulatory blood pressure monitoring. Frequency of NEBP was similar in elderly men and women, but it was lower in women below 30 years of age as compared to men of similar age (0% vs. 20% respectively, p<0.01). In men, the frequency of NEBP increased by 4.2±0.7% per decade, whereas women showed a significantly higher progression rate (7.3±1.0%, p<0.04). Diurnal and nocturnal SBP increased with age by 15% and 25% in females (p<0.001) and by 3% and 8% in males (p<0.02). Gender difference was significant (p<0.001). Diurnal and nocturnal DBP were lower in females of all age groups (p<0.001). The results indicate a significantly lower prevalence of NEBP among young women in comparison to young men that was not detected when aged men and women were compared, suggesting a higher progression rate of NEBP with advancing age in women.

Validation of the Chinese-Canadian study of health and aging clinical frailty scale (CSHA-CFS) telephone version - Corrected Proof

Ding-Cheng (Derrick) Chan, Hsiao-Hui Tsou, Chin-Ying Chen, Ching-Yu Chen — 2009-07-16

Abstract: This was a cross-sectional validation study of the Chinese-Canadian study of health and aging clinical frailty scale telephone version (CSHA-CFS TV). The study pool consisted of 67 patients of outpatient clinics at a tertiary medical center in Taipei, Taiwan. They were enrolled in the program comprehensive geriatric assessment and the frailty study of elderly patients (CGAFSEP). The Chinese-Canadian study of health and aging clinical frailty scale physician version (CSHA-CFS PV) is a 7-point scale assigned after comprehensive geriatric assessments. Higher score indicates frailer status. The Chinese-Canadian study of health and aging clinical frailty scale (CSHA-CFS) telephone version (TV) included 17 questions adapted from the physician version. Two trained research assistants conducted the telephone interviews. Administration time was <3min. Standard reliability and validity measures were applied. Three-fifths of the subjects were older than 75 years, and half of them were females. Inter-rater reliability was achieved with weighted kappa of 0.684, (p=0.002) between first 20 ratings from 2 interviewers. Criterion validity was achieved with weighted kappa of 0.689 (p<0.0001) and Kendal's tau of 0.612 (p<0.0001) between the TV and the PV scores. Divergent validity was demonstrated with significant correlation but only fair agreements comparing both TV and PV scores with the cardiovascular health survey (CHS) phenotypic definition of frailty. One could conclude that the CSHA-CFS TV appears to be a quick, reliable, and valid frailty screening instrument for community-dwelling elderly.

Obstacle-negotiating gait and related physical measurement indicators for the community-dwelling elderly in Japan - Corrected Proof

2009-07-13

Abstract: The aim of this study is to assess obstacle-negotiating gait (ONG) and explore its related physical factors. Subjects comprised 571 community-dwelling persons (195 men and 376 women) age ≥65 years and without cognitive impairment. ONG, timed up and go (TUG), and stair-climbing were measured and their relations were assessed. Walking ability (usual walking speed=UWS and daily walking steps=DWS), balance deficiency, and musculoskeletal function (handgrip strength and bone health) were examined objectively to explore ONG related physical factors. Logistic regression and general linear model analysis were performed with adjustment for age and body mass index (BMI). Time of ONG was 7.72s in men and 8.93s in women. Logistic regression analysis showed that the fast tertiles of ONG corresponding to the fast levels of TUG and stair-climbing had the highest odds ratio values. General linear model analysis showed that ONG was significantly associated with UWS and balance deficiency (no) in men, and with UWS, handgrip strength, DWS and balance deficiency (no) in women. Overall, ONG was considerably associated with falls screening tools and its determinants were also the main causes of falls. Training in ONG could be an attractive strategy for the prevention of falls among the elderly.

Physical and social functional abilities seem to be maintained by a multifaceted randomized controlled nutritional intervention among old (>65 years) Danish nursing home residents - Corrected Proof

Anne Marie Beck, Karin Damkjær, Liv W. Sørbye — 2009-07-13

Abstract: The purpose was to test the hypothesis that a multifaceted 11 weeks randomized controlled intervention would have a significant influence of functional abilities in old nursing home residents. Participants were 121 old (>65 years) residents in seven Danish nursing homes. The intervention consisted of nutrition (chocolate, homemade oral supplements), group exercise (moderate intensity) and oral care. Measurements taken were weight, body mass index (BMI), energy and protein intake, and functional abilities (activities of daily living=ADL, cognitive performance, and social engagement). The results showed that the nutrition and exercise were well accepted. After 11 weeks the change in % weight (1.3 vs. −0.6%, p=0.005), % BMI (0.4 vs. −0.2%, p=0.003), energy intake (0.7 vs. −0.3MJ/day, p=0.084) and protein intake (5 vs. −2g/day, p=0.012) was higher in the intervention group than in the control group. Also, after 11 weeks, social and physical function had decreased in the control group but was unchanged in the intervention group. The difference between groups was significant in relation to social engagement (p=0.009). After the end of the intervention both groups had lost weight and physical function. Cognitive performance did not change, at any time. In conclusion, it seems possible to maintain social (and physical) functional abilities in old nursing home residents by means of a multifaceted intervention.

A rare familiar case of hereditary bisalbuminemia and diabetic predisposition: A possible predictive link? - Corrected Proof

A. Bellomo, M. Mancinella, G. Troisi, V. Marigliano — 2009-07-06

Abstract: We present a case report of hereditary bisalbuminemia in an Italian family with three affected members. Bisalbuminemia represents a genetic variant of the albumin, it will then be permanent, or acquired and then be transient. It is characterized by the presence of two albumin bands in electrophoresis: the first band with the same mobility of the normal albumin, the second band with a fast variable or a slow variable. The double band of albumin was detected fortuitously on a routine analytical study of an adult woman who was referred to our laboratory with an increase of fasting glucose value, this originated the study of the rest of the members of the family. Finally, it is like the genetic peculiarity of this family core show a possible predictive link between bisalbuminemia on one hand and the predisposition to type II diabetes mellitus on the other hand. As a result of such high probability we are eager to continue further search at our medicine predictive centre.

Multicomponent exercise program improves blood lipid profile and antioxidant capacity in older women - Corrected Proof

2009-07-06

Abstract: This study intended to determine the effect of multicomponent exercise on blood lipid profile and on antioxidant capacity in older women. Forty women aged 60–80 years participated in a supervised multicomponent exercise program. Plasma contents of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein A-1 (Apo A-1) and apolipoprotein B (Apo B-100), total antioxidant status (TAS) and the enzymatic activities of glutathione reductase (GR) and glutathione peroxidase (GPx) were evaluated before and after 8-month training. The multicomponent exercise program induced a significant decrease in TG, TC/HDL-C and Apo B/Apo A-1 and a significant increase in HDL-C and Apo A-1 (p<0.05). There was a significant increase in plasma TAS as well as GR and GPx enzyme activities. The present data show that an 8-month supervised moderate-intensity multicomponent exercise program resulted in beneficial improvements of blood lipid profile that were accompanied by positive modulation of antioxidant capacity.

Lack of association between antisperm antibodies and language dysfunction in Alzheimer's disease - Corrected Proof

Changsu Han, Nan Hie Kim, Do Young Kwon, Woo-Keun Seo, Moon Ho Park — 2009-07-02

Abstract: Alzheimer's disease (AD) is the single most common cause of primary dementia. Language-based frontotemporal dementia, another type of primary dementia, is known as primary progressive aphasia (PPA). Although the cardinal feature of AD is a progressive loss of memory, many patients with AD also present with language impairment. Moreover AD and PPA have partially shared pathophysiology. Recently, it was suggested that a history of vasectomy might be a risk factor for PPA, by immune responses to sperm or antisperm antibody (ASA), which has long been known to have antigenic property. As ASAs could develop naturally in both men and women, we studied the relation between the presence of ASAs and cognitive function in AD. A total of 86 elderly were selected (46 patient with AD, 20 with mild cognitive impairment, and 20 without cognitive dysfunction) and were assessed for the presence of ASAs with neuropsychological evaluation. However, there were no significant differences in the distribution of ASAs according to cognitive status or language function status. Thus, the current study does not support the association between the immune responses and language dysfunction in AD.

Patient clock drawing and accuracy of self-report compared with chart review for colorectal cancer (CRC) screening - Corrected Proof

Jeanette M. Daly, Barcey T. Levy, Mrinalini Joshi, Yinghui Xu, Gerald J. Jogerst — 2009-07-02

Abstract: The purpose of this study was to test the accuracy of patient colorectal cancer (CRC) screening self-report and CRC screening documented in their medical record for those who are cognitively impaired and those who are not based on the clock drawing task. A cross-sectional study where patient survey and medical record information were linked was conducted in 16 primary care offices. Of the 960 patients mailed questionnaires, there were 493 respondents who completed the questionnaire and clock drawing, had a chart review, and had no help in drawing the clock or completing the questionnaire. Chart review was conducted for CRC screening in physician offices. Clock drawings were scored 0–7 according to the Watson method. Accuracy of ever being screened for CRC or being up-to-date for CRC screening was determined by comparing self-report with medical records and calculating sensitivity, specificity, positive and negative predictive values, false positive rate, and false negative rate. Seventy-five clocks were abnormal, scoring 4 or more. Agreement between self-reported colonoscopy and medical record review was higher in subjects with normal clock drawings than those with abnormal clock drawings. When examining predictors of agreement/disagreement for colonoscopy screening, abnormal clock drawing was the single predictor for higher disagreement.