Importance Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting. Objective To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population. Data Sources PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions. Study Selection Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270 000 deaths. Data Extraction Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking). Results Random-effects summary all-cause mortality HRs for overweight (BMI of 25- Conclusions and Relevance Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.

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Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis

The epidemiology of falls and syncope.

https://escholarship.org/content/qt3254d7bt/qt3254d7bt.pdf?t=pzvrnh

Sarcopenia With Limited Mobility: An International Consensus

Walking speed (WS) is a valid, reliable, and sensitive measure appropriate for assessing and monitoring functional status and overall health in a wide range of populations. These capabilities have led to its designation as the "sixth vital sign". By synthesizing the available evidence on WS, this scholarly review article provides clinicians with a reference tool regarding this robust measure. Recommendations on testing procedures for assessing WS, including optimal distance, inclusion of acceleration and deceleration phases, instructions, and instrumentation are given. After assessing an individual's WS, clinicians need to know what this value represents. Therefore, WS cut-off values and the corresponding predicted outcomes, as well as minimal detectable change values for specific populations and settings are provided.

https://digitalcommons.sacredheart.edu/cgi/viewcontent.cgi?article=1172&context=pthms_fac

Walking Speed: The Functional Vital Sign

Outcome instruments to measure frailty: A systematic review

This paper describes a method for ranking pathological causes according to both mortality and disability. This method consists of measuring the theoretical gain which could be obtained on life expectancy free of disability by eliminating deaths and disabilities resulting from the considered cause. An application to United States mortality and disability data is then given as an illustration. Using the proposed method, chronic conditions of the locomotor system appear as the second in order of importance, after cardiovascular diseases. Respiratory diseases, which have consequences for both mortality and disability, rank third among health problems whereas malignant neoplasms rank fourth because of their relatively small effect in terms of disability. The application of this method by planning agencies, could contribute to better allocation of resources among various intervention programmes or various research programmes which health administrations may decide to support.

Potential Gains in Life Expectancy Free of Disability: A Tool for Health Planning

https://www.hal.inserm.fr/inserm-00108731/document

Hierarchical components of physical frailty predicted incidence of dependency in a cohort of elderly women.

Risk of syncope in the elderly and consumption of drugs: A case-control study☆

Purpose

To describe the trends of potentially inappropriate medication (PIM) use in older adults from 1995 to 2004 in the East of France, by using the 1997 Beers criteria and its French update, and to assess risk factors for this PIM use.



Methods

We carried out a repeated cross-sectional study using data collected among people aged ≥65 years, examined in the Center for Preventive Medicine. Studied variables were socio-demographic, clinical data, medication consumption and the self-health status. Joinpoint regression analysis was used to estimate the temporal changes in PIM rate.



Results

30 683 participants were included. 51.2% were women. The mean age was 70.1 ± 4.3 years [65–99]. The annual overall rate of PIM use decreased significantly during the study period. These rates range from 14.9% in 1995 to 9.0% in 2004 according the Beers criteria (−3.4% per year) and from 33.5% in 1995 to 19.3% in 2004 according to the French update criteria (−3.6% per year). The annual rate of medication users increased during the same period (+0.75% per year). The risk of PIM consumption increased with age, number of drugs and frequency of the visits to the physician (OR = 1.26 [1.18–1.35]). This risk was also higher among women (OR = 1.29 [1.18–1.40]), elderly living alone (OR = 1.09 [1.02–1.17]) and with those with low education level (OR = 1.19 [1.02–1.38]).



Conclusion

This study shows a decrease in PIM consumption. Despite an increase of drug use in the elderly, an improving of the quality of this consumption remains possible. Copyright © 2009 John Wiley & Sons, Ltd.

Trends of the potentially inappropriate medication consumption over 10 years in older adults in the East of France.

Purpose

Activity limitations, which induce loss of autonomy in the elderly, are a major public health problem. We investigated the associations between objectively determined visual impairments and activity limitations and assessed the visual acuity thresholds associated with these restrictions.



Methods

The study sample consisted of 1887 people aged 63 years and over from a population-based cohort. Moderate to severe visual impairment was defined as presenting visual acuity lower than 20/70, according to the World Health Organization (WHO) definition. In addition, we studied mild visual impairment, defined as visual acuity [20/70–20/40]. Multivariate logistic regressions were used to estimate the associations between vision and instrumental activities of daily living (IADL) limitations. Using receiver-operating characteristic (ROC) curves, we identified visual acuity thresholds that maximized the Youden index ([sensitivity + specificity]−1) for predicting IADL limitations.



Results

After adjustment for potential confounders, moderate to severe visual impairment and mild visual impairment were strongly associated with IADL limitations (odds ratio [OR] = 3.49; 95% confidence interval [CI] = 1.93, 6.32 and OR = 1.77; 95% CI = 1.07, 2.91, respectively). Visual acuity was a strong predictor of IADL limitations, with an area under the ROC curve of 0.72 (95% CI = 0.68, 0.76). The best discrimination between subjects with or without IADL limitations (global, physical and cognitive) was obtained for visual acuities around 20/40–20/50.



Conclusion

This study confirms major increased risk for IADL limitations in subjects with moderate to severe visual impairment. In addition, it suggests that milder visual impairments (in particular below 20/40) may also be related to an increased risk for IADL limitations and should be considered for early medical intervention, before the decline of the subject autonomy.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/aos.12335

Alain Colvez

Papers

Potential Gains in Life Expectancy Free of Disability: A Tool for Health Planning

Hierarchical components of physical frailty predicted incidence of dependency in a cohort of elderly women.

Risk of syncope in the elderly and consumption of drugs: A case-control study☆

Trends of the potentially inappropriate medication consumption over 10 years in older adults in the East of France.

Visual acuity thresholds associated with activity limitations in the elderly. The Pathologies Oculaires Liées à l'Age study.