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

Facteurs prédictifs de la mortalité dans les trois ans chez les personnes âgées

Prévalence et facteurs associés à la fragilité chez les personnes âgées autonomes vivant à domicile

La preconisation d‘un diagnostic precoce de la maladie d‘Alzheimer (MA) est largement justifiee pour que les personnes atteintes et leur entourage puissent beneficier d‘une prise en charge professionnelle. En revanche, le depistage des cas n‘ayant pas entraine des consequences dans la vie quotidienne ne s‘impose pas compte tenu des difficultes a distinguer les formes debutantes de maladie d‘Alzheimer de la diminution de certaines performances intellectuelles observee avec l‘âge. Mais il existe, a l‘echelle de la population, un risque de glissement entre diagnostic precoce et depistage de perturbations intellectuelles toujours plus benignes. Ce risque est majore par la peur des personnes « normales » qui percoivent la MA comme « un fleau des temps modernes », la tendance a medicaliser de plus en plus largement la population et la pression de l‘industrie du medicament. Les seuils de depistage, de diagnostic et de prise en charge therapeutique sont au centre du debat. Le deplacement d‘un seuil vers une plus grande sensibilite, dans la perspective de n‘oublier aucun cas, est mecaniquement paye d‘une baisse de la specificite, qui conduit a augmenter la proportion des faux positifs. Il faut donc mesurer le prejudice de qualifier abusivement des personnes normales de malades atteints de maladie d‘Alzheimer. En l‘etat de la situation, il ne serait pas sage de renoncer a ce que le diagnostic soit valide par des centres de reference et laisse a la seule appreciation des praticiens des soins de premiere ligne.

Qu‘est‐ce que la démence ?

Étude des facteurs de risque de chute chez la personne âgée vivant a domicilerole des medicaments

It is justified to develop early diagnosis for Alzheimer disease and related disorders in order to offer professional support to patients and informal caregivers. On the other hand, the usefulness of screening cases, which have no repercussion on daily life, is not proven considering the difficulty to discriminate early stages from age-related intellectual performance decline. Taking into account a general population point of view, we assume that there is a risk to evolve from early diagnosis to screening. This trend is increased by the fear of the general population, which sees Alzheimer disease as a new plague, the movement towards medicalization in the general population, and the pressure of the pharmaceutical industry. The definition of thresholds for screening, diagnosis and therapy is a central issue. Improving the sensitivity of a test by lowering the threshold leads to a reduction of specificity and a rise of the false positive rate. It is necessary to evaluate the negative impact of labelling normal persons as Alzheimer disease's patients. In the present situation, it would not be sensible to leave the responsibility of the diagnosis to primary care professionals and to give up the validation process performed by the expert or reference centres.

Alain Colvez

Papers

Facteurs prédictifs de la mortalité dans les trois ans chez les personnes âgées

Prévalence et facteurs associés à la fragilité chez les personnes âgées autonomes vivant à domicile

Qu‘est‐ce que la démence ?

Étude des facteurs de risque de chute chez la personne âgée vivant a domicilerole des medicaments

[What is dementia? 8. Alzheimer's disease early diagnosis: a public health point of view].