Showing papers in "Age and Ageing in 2010"
TL;DR: The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia as discussed by the authors.
Abstract: The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.
8,440 citations
TL;DR: Findings suggested that predictors of NHP are mainly based on underlying cognitive and/or functional impairment, and associated lack of support and assistance in daily living, and the methodical quality of studies needs improvement.
Abstract: Objective: in the past decades, many studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of predictors of NHP in the general population of developed countries. Design: relevant articles were identified by searching the databases MEDLINE, Web of Science, Cochrane Library and PSYNDEXplus. Studies based on population-based samples with prospective study design and identification of predictors by multivariate analyses were included. Quality of studies and evidence of predictors were determined. Results: thirty-six studies were identified; one-third of the studies were of high quality. Predictors with strong evidence were increased age, low self-rated health status, functional and cognitive impairment, dementia, prior NHP and a high number of prescriptions. Predictors with inconsistent results were male gender, low education status, low income, stroke, hypertension, incontinence, depression and prior hospital use. Conclusions: findings suggested that predictors of NHP are mainly based on underlying cognitive and/or functional impairment, and associated lack of support and assistance in daily living. However, the methodical quality of studies needs improvement. More theoretical embedding of risk models of NHP would help to establish more clarity in complex relationships in using nursing homes.
753 citations
TL;DR: A comprehensive validation of the 16-item and 7-item Falls Efficacy Scale International (FES-I) by investigating the overall structure and measurement properties, convergent and predictive validity and responsiveness to change is performed.
Abstract: Objective: this study aimed to perform a comprehensive validation of the 16-item and 7-item Falls Efficacy Scale International (FES-I) by investigating the overall structure and measurement properties, convergent and predictive validity and responsiveness to change. Method: five hundred community-dwelling older people (70-90 years) were assessed on the FES-I in conjunction with demographic, physiological and neuropsychological measures at baseline and at 12 months. Falls were monitored monthly and fear of falling every 3 months. Results: the overall structure and measurement properties of both FES-I scales, as evaluated with item response theory, were good. Discriminative ability on physiological and neuropsychological measures indicated excellent validity, both at baseline (n = 500, convergent validity) and at 1-year follow-up (n = 463, predictive validity). The longitudinal follow-up suggested that FES-I scores increased over time regardless of any fall event, with a trend for a stronger increase in FES-I scores when a person suffered multiple falls in a 3-month period. Additionally, using receiver-operating characteristic (ROC) curves, cut-points were defined to differentiate between lower and higher levels of concern. Conclusions: the current study builds on the previously established psychometric properties of the FES-I. Both scales have acceptable structures, good validity and reliability and can be recommended for research and clinical purposes. Future studies should explore the FES-I's responsiveness to change during intervention studies and confirm suggested cut-points in other settings, larger samples and across different cultures. Language: en
613 citations
TL;DR: Poor handgrip strength predicts accelerated dependency in ADL and cognitive decline in oldest old, and could be a useful instrument in geriatric practice to identify those oldest old patients at risk for this accelerated decline.
Abstract: Objective: this study aimed to assess if handgrip strength predicts changes in functional, psychological and social health among oldest old. Design: the Leiden 85-plus Study is a prospective population-based follow-up study. Subjects: five-hundred fifty-five, all aged 85 years at baseline, participated in the study. Methods: handgrip strength was measured with a handgrip strength dynamometer. Functional, psychological and social health were assessed annually. Baseline data on chronic diseases were obtained from the treating physician, pharmacist, electrocardiogram and blood sample analysis. Results: at age 85, lower handgrip strength was correlated with poorer scores in functional, psychological and social health domains (all, P 0.30). Conclusion: poor handgrip strength predicts accelerated dependency in ADL and cognitive decline in oldest old. Measuring handgrip strength could be a useful instrument in geriatric practice to identify those oldest old patients at risk for this accelerated decline.
508 citations
TL;DR: Higher age and multimorbidity is found to be related to an increased risk of dying within the first year after fracture; acute complications might be one of the explanations.
Abstract: Introduction: osteoporosis is a common disease, and the incidence of osteoporotic fractures is expected to rise with the growing elderly population. Immediately following, and probably several years after a hip fracture, patients, both men and women, have a higher risk of dying compared to the general population regardless of age. The aim of this study was to assess excess mortality following hip fracture and, if possible, identify reasons for the difference between mortality for the two genders. Methods: this is a nationwide register-based cohort study presenting data from the National Hospital Discharge Register on mortality, comorbidity and medication for all Danish patients (more than 41,000 persons) experiencing a hip fracture between 1 January 1999 and 31 December 2002. Follow-up period was until 31 December 2005. Results: we found a substantially higher mortality among male hip fracture patients than female hip fracture patients despite men being 4 years younger at the time of fracture. Both male and female hip fracture patients were found to have an excess mortality rate compared to the general population. The cumulative mortality at 12 months among hip fracture patients compared to the general population was 37.1% (9.9%) in men and 26.4% (9.3%) in women. In the first year, the risk of death significantly increased for women with increasing age (hazard ratio, HR: 1.06, 95% confidence interval, CI: 1.06–1.07), the number of comedications (HR 1.04, 95% CI 1.03–1.05) and the presence of specific Charlson index components and medications described below. For men, age (HR 1.07, 95% CI 1.07–1.08), number of comedications (HR 1.06, 95% CI 1.04– 1.07) and presence of different specific Charlson index components and medications increased the risk. Long-term survival analyses revealed that excess mortality for men compared with women remained strongly significant (HR 1.70, 95% CI 1.65– 1.75, P < 0.001), even when controlled for age, fracture site, the number of medications, exposure to drug classes A, C, D, G, J, M, N, P, S and for chronic comorbidities. Conclusion: excess mortality among male patients cannot be explained by controlling for known comorbidity and medications. Besides gender, we found higher age and multimorbidity to be related to an increased risk of dying within the first year after fracture; acute complications might be one of the explanations. This study emphasises the need for particular rigorous postoperative diagnostic evaluation and treatment of comorbid conditions in the male hip fracture patient.
430 citations
TL;DR: In this paper, a prospective cohort study was conducted to assess the prevalence and the prognostic significance of oropharyngeal dysphagia among elderly patients with pneumonia, which is a common condition among the elderly but not systematically explored.
Abstract: Background: oropharyngeal dysphagia is a common condition among the elderly but not systematically explored. Objective: to assess the prevalence and the prognostic significance of oropharyngeal dysphagia among elderly patients with pneumonia. Design: a prospective cohort study. Setting: an acute geriatric unit in a general hospital. Subjects: a total of 134 elderly patients (>70 years) consecutively admitted with pneumonia. Methods: clinical bedside assessment of oropharyngeal dysphagia and aspiration with the water swallow test were performed. Demographic and clinical data, Barthel Index, Mini Nutritional Assessment, Charlson Comorbidity Index, Fine's Pneumonia Severity Index and mortality at 30 days and 1 year after admission were registered. Results: of the 134 patients, 53% were over 84 years and 55% presented clinical signs of oropharyngeal dysphagia; the mean Barthel score was 61 points indicating a frail population. Patients with dysphagia were older, showed lower functional status, higher prevalence of malnutrition and comorbidities and higher Fine's pneumonia severity scores. They had a higher mortality at 30 days (22.9% vs. 8.3%, P = 0.033) and at 1 year of follow-up (55.4% vs. 26.7%, P = 0.001). Conclusions: oropharyngeal dysphagia is a highly prevalent clinical finding in elderly patients with pneumonia and is an indicator of disease severity in older patients with pneumonia.
391 citations
TL;DR: PD may reflect a failure of the normal cellular compensatory mechanisms in vulnerable brain regions, and this vulnerability is increased by ageing, one of the best examples of an age-related disease.
Abstract: Age is the largest risk factor for the development and progression of Parkinson's disease (PD). Ageing affects many cellular processes that predispose to neurodegeneration, and age-related changes in cellular function predispose to the pathogenesis of PD. The accumulation of age-related somatic damage combined with a failure of compensatory mechanisms may lead to an acceleration of PD with age. The formation of Lewy bodies may represent a marker for protective mechanisms against age-related dysfunction and degeneration of the nervous system. Mild parkinsonian signs may be present in older people, which are associated with reduced function. These may be due to age-related decline in dopaminergic activity, incidental Lewy body disease, degenerative pathologies (early PD and Alzheimer's disease) or vascular pathology. Ageing may affect the clinical presentation of PD with altered drug side effects, increased risk of developing dementia and an increased likelihood of admission to a nursing home. Progression of PD, including the development of dementia, and hallucinations is related to the age of the patient rather than the age of disease onset. PD may reflect a failure of the normal cellular compensatory mechanisms in vulnerable brain regions, and this vulnerability is increased by ageing. PD is one of the best examples of an age-related disease.
346 citations
TL;DR: The OEP significantly reduces the risk of death and falling in older community-dwelling adults and levels of compliance with the OEP in older adults.
Abstract: BACKGROUND: the 'Otago exercise programme' (OEP) is a strength and balance retraining programme designed to prevent falls in older people living in the community. The aim of this review was to evaluate the effect of the OEP on the risk of death and fall rates and to explore levels of compliance with the OEP in older adults. METHODS: a systematic review with meta-analysis. Clinical trials where the OEP was the primary intervention and participants were community-dwelling older adults (65+) were included. Outcomes of interest included risk of death, number of falls, number of injurious falls and compliance to the exercise programme. RESULTS: seven trials, involving 1503 participants were included. The mean age of participants was 81.6 (+/-3.9) years. The OEP significantly reduced the risk of death over 12 months [risk ratio = 0.45, 95% confidence interval (CI) = 0.25-0.80], and significantly reduced fall rates (incidence rate ratio = 0.68, 95% CI = 0.56-0.79). There was no significant difference in the risk of a serious or moderate injury occurring as the result of a fall (risk ratio = 1.05, 95% CI = 0.91-1.22). Of the 747 participants who remained in the studies at 12 months, 274 (36.7%) were still exercising three or more times per week. CONCLUSION: the OEP significantly reduces the risk of death and falling in older community-dwelling adults. Language: en
263 citations
TL;DR: Age is linearly associated with greater intra-individual gait variability for most gait measures, except for step time variability in women, and gait speed may mediate the association between age and temporal variability measures.
Abstract: BACKGROUND: gait variability may be an important predictor of falls risk, but its characteristics are poorly understood. OBJECTIVE: to examine the relationship between age and gait variability in a population-based sample of older people. DESIGN: cross-sectional study. METHODS: in people aged 60-86 years (n = 412), temporal and spatial gait variability measures were recorded with a GAITRite walkway. Regression analysis was used to model the relationship between age and gait variability adjusting for height, weight and self-reported chronic disease. Further adjustment was made for gait speed to examine its influence on the associations. RESULTS: older age was associated with greater variability (P < 0.05) in all gait measures. All relationships were linear, except that between age and step time variability, which was curvilinear in women. Adjusting for gait speed changed the magnitude of the age coefficient by 62-86% for temporal variability measures, 25% for step length variability and 5-12% for step width variability. CONCLUSION: age is linearly associated with greater intra-individual gait variability for most gait measures, except for step time variability in women. Gait speed may mediate the association between age and temporal variability measures. Further study is needed to understand the factors responsible for the greater gait variability with ageing.
248 citations
TL;DR: Both poor self-rated health status and the presence of chronic disease are risk factors for depression among the elderly, despite the methodological limitations of this meta-analysis.
Abstract: Objective: the goal of this study was to determine the relationship between health status, including self-rated health status and chronic disease, and risk for depression among the elderly. Method: MEDLINE, EMBASE and The Cochrane Library Database were used to identify potential studies. The studies were classified into cross-sectional and longitudinal subsets. For each study, the numbers of the total participants, cases (for cross-sectional study) or incident cases (for longitudinal study) of depression in each health status group were extracted and entered into Review Manager 4.2. The quantitative meta-analysis of cross-sectional studies and that of longitudinal studies were performed, respectively. For prevalence and incidence rates of depression, odds risk and relative risk (RR) were calculated, respectively. Results: the quantitative meta-analysis showed that, compared with the elderly without chronic disease, those with chronic disease had higher risk for depression (RR: 1.53, 95% confidence intervals (CI): 1.20–1.97). Compared with the elderly with good self-rated health, those with poor self-rated health had higher risk for depression (RR: 2.40, 95% CI: 1.94–2.97). Conclusions: despite the methodological limitations of this meta-analysis, both poor self-rated health status and the presence of chronic disease are risk factors for depression among the elderly. In the elderly, poor self-reported health status appears to be more strongly associated with depression than the presence of chronic disease.
227 citations
TL;DR: In this paper, the authors examined the prevalence and correlates of frailty in the UK among community-dwelling young-old (64-74 years) men and women who participated in the Hertfordshire Cohort Study, UK.
Abstract: Background: frailty, a multi-dimensional geriatric syndrome, confers a high risk for falls, disability, hospitalisation and mortality. The prevalence and correlates of frailty in the UK are unknown. Methods: frailty, defined by Fried, was examined among community-dwelling young-old (64–74 years) men (n = 320) and women (n = 318) who participated in the Hertfordshire Cohort Study, UK. Results: the prevalence of frailty was 8.5% among women and 4.1% among men (P = 0.02). Among men, older age (P = 0.009), younger age of leaving education (P = 0.05), not owning/mortgaging one's home (odds ratio [OR] for frailty 3.45 [95% confidence interval {CI} 1.01–11.81], P = 0.05, in comparison with owner/mortgage occupiers) and reduced car availability (OR for frailty 3.57 per unit decrease in number of cars available [95% CI 1.32, 10.0], P = 0.01) were associated with increased odds of frailty. Among women, not owning/mortgaging one's home (P = 0.02) was associated with frailty. With the exception of car availability among men (P = 0.03), all associations were non-significant (P > 0.05) after adjustment for co-morbidity. Conclusions: frailty is not uncommon even among community-dwelling young-old men and women in the UK. There are social inequalities in frailty which appear to be mediated by co-morbidity.
TL;DR: Levels of knowledge about recognising and preventing stroke were poor and most participants stated they would contact the EMS at the onset of stroke symptoms.
Abstract: Background: the recognition of stroke symptoms by the public and activation of the emergency medical services (EMS) are the most important factors in instigating pre-hospital stroke care. Studies have suggested that poor recognition of the warning signs of stroke is the main cause of delay in accessing the EMS. Methods: an integrative review of published studies about stroke knowledge and awareness was performed by searching online bibliographic databases, using keywords, from 1966 to 2008. Studies were included in the review if they focussed on risk factors, signs and symptoms, action and information. Each study was reviewed by two researchers (SJ and MJ). Results: we identified 169 studies of which 39 were included in the review. The ability to name one risk factor for stroke varied between studies, ranging from 18% to 94% when asked open-ended questions and from 42% to 97% when asked closed questions. The ability to name one symptom ranged from 25% to 72% when asked open-ended questions and from 95% to 100% when asked closed questions. When asked what action people would take if they thought they were having a stroke, between 53% and 98% replied that they would call the EMS. People generally obtained information about stroke from family and friends. Older members of the population, ethnic minority groups and those with lower levels of education had consistently poor levels of stroke knowledge. Conclusions: generally, levels of knowledge about recognising and preventing stroke were poor. Nevertheless, most participants stated they would contact the EMS at the onset of stroke symptoms.
TL;DR: A meta-analysis of clinical practice and service development dementia syndromes in nursing home patients and the prevalence and burden by severity in subjects aged 75 years or over within the PAQUID cohort found that the latter had a higher prevalence of dementia than the former.
Abstract: 1. Murphy J, O'Keeffe ST. Frequency and appropriateness of antipsychotic medication use in older people in long-term care. Ir J Med Sci 2008; 177: 35–7. 2. Magsi H, Malloy T. Underrecognition of cognitive impairment in assisted living facilities. JAGS 2005; 53: 295–8. 3. Magaziner J, German P, Zimmerman S et al. The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: diagnosis by expert panel. Gerontologist 2000; 40: 663–72. 4. Sørensen L, Foldspang A, Gulmann NC et al. Assessment of dementia in nursing home residents by nurses and assistants: criteria validity and determinants. Int J Geriatr Psychiatry 2001; 16: 615–21. 5. Lopez Mongil R, Lopez Trigo JA. Prevalencia de deterioro cognitivo y demencia en residencias españolas: estudio Resydem. Inf Psiquiátr 2007; 2: 188–93. 6. Helmer C, Peres K, Letenneur L et al. Dementia in subjects aged 75 years or over within the PAQUID cohort: prevalence and burden by severity. Dement Geriatr Cogn Disord 2006; 22: 87–94. 7. Engedal K, Haugen PK. The prevalence of dementia in a sample of elderly norwegians. Int J Geriatr Psychiatry 1993; 8: 565–70. 8. Köhler L, Weyerer S, Schäufele M. Proxy screening tools improve the recognition of dementia in old-age homes: results of a validation study. Age Ageing 2007; 36: 549–54. 9. Matthews EF, Dening T. Prevalence of dementia in institutional care. Lancet 2002; 360: 225–6. 10. MacDonald AJD, Carpenter GI. The recognition of dementia in ‘non-EMI’ nursing home residents in South East England. Int J Geriatr Psychiatry 2003; 18: 105–8. 11. Knapp M, Comas-Herrera A, Somani A et al. Dementia: international comparisons. Summary report for the National Audit Office. Personal Social Services Research Unit, London School of Economics and Political Science and the Institute of Psychiatry, King’s College London, 2007. 12. Anderson M, Gottfries CG. Clinical practice and service development dementia syndromes in nursing home patients. Int Psychogeriatr 1992; 4: 241–52. 13. Falconer, O'Neil S. Profiling disability within nursing homes: a census-based approach. Age Ageing 2007; 36: 209–13. 14. Folstein MF, Folstein SE, McHugh PR et al. Mini-Mental State Examination. User's Guide. Odessa, Florida: Psychological Assessment Resources, Inc., 2001. 15. Nasreddine ZS, Phillips NA, Bédirian V et al. The Montreal Cognitive Assessment, MOCA: a brief screening tool for Mild Cognitive Impairment. J Am Geriatr Soc 2005; 53: 695–9.
TL;DR: In this paper, the prevalence of orthostatic hypotension (OH) and associations with medication use in community-dwelling older women were determined using data from the British Women's Heart and Health Study.
Abstract: Objective: to determine the prevalence of orthostatic hypotension (OH) and associations with medication use in communitydwelling older women. Design: cross-sectional analysis using data from the British Women’s Heart and Health Study. Setting: general practices in 23 towns in the UK. Participants: 3,775 women aged 60–80 years from 1999 to 2001. Main outcome measure: orthostatic hypotension—drop of ≥20mmHg in systolic and/or a drop of ≥10mmHg in diastolic blood pressure on standing. Results: prevalence of OH was 28% (95% confidence interval [CI] 26.6, 29.4), which increased with age and hypertension. Regardless of treatment status or diagnosed hypertension, raised blood pressure was strongly associated with OH (P < 0.001). OH was strongly associated with number of antihypertensives taken (none vs three or more: odds ratio [OR] 2.24, 95% CI 1.47–3.40, P < 0.001); the association was slightly attenuated after allowing for age and co-morbidities (OR 1.99; 95% CI 1.30, 3.05; P = 0.003). Women with multiple co-morbidities had markedly increased odds of OH independent of age, number and type of medications taken (none vs four or more diagnoses: OR 2.28, 95% CI 1.58–3.30, P = 0.005). Conclusion: uncontrolled hypertension, use of three or more antihypertensives and multiple co-morbidities are predictors of OH in older women. Detection or monitoring of OH in these groups may prevent women from suffering its adverse consequences.
TL;DR: In the Concord Health and Ageing in Men study, a population-based study conducted in Sydney, Australia, a cross-sectional relationship between frailty and use of specific health and community services was investigated in 1,674 community-dwelling men aged 70 or older as discussed by the authors.
Abstract: Background: frailty is a concept used to describe older people at high risk of adverse outcomes, including falls, functional decline, hospital or nursing home admission and death. The associations between frailty and use of specific health and community services have not been investigated. Methods:thecross-sectionalrelationshipbetweenfrailtyanduseofseveralhealthandcommunityservicesinthelast12months was investigated in 1,674 community-dwelling men aged 70 or older in the Concord Health and Ageing in Men study, a population-based study conducted in Sydney, Australia. Frailty was assessed using a modified version of the Cardiovascular Health Study criteria. Results: overall, 158 (9.4%) subjects were frail, 679 (40.6%) were intermediate (pre-frail) and 837 (50.0%) were robust. Frailty was associated with use of health and community services in the last 12 months, including consulting a doctor, visiting or being visited by a nurse or a physiotherapist, using help with meals or household duties and spending at least one night in a hospital or nursing home. Frail men without disability in activities of daily living were twice more likely to have seen a doctor in the previous 2 weeks than robust men (adjusted odds ratio 2.04, 95% confidence interval 1.21–3.44), independent of age, comorbidity and socio-economic status. Conclusion: frailty is strongly associated with use of health and community services in community-dwelling older men. The high level of use of medical services suggests that doctors and nurses could play a key role in implementation of preventive interventions.
TL;DR: Using the Modified Rankin Scale to assess the utility of natriuretic peptide testing for long-term risk assessment following acute ischemic stroke and how well it predicts death and cardiac events in patients with heart failure is recommended.
Abstract: 439–44. 14. Sharma JC, Ananda K, Ross I, Hill R, Vassallo M. N-terminal proBrain natriuretic peptide levels predict short-term poststroke survival. J Stroke Cerebrovasc Dis 2006; 15: 121–7. 15. Etgen T, Baum H, Sander K, Sander D. Cardiac troponins and N-terminal pro-brain natriuretic peptide in acute ischemic stroke do not relate to clinical prognosis. Stroke 2005; 36: 270–5. 16. Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the Modified Rankin Scale. A systematic review. Stroke. Published online ahead of print 13 August 2009. 17. Anand IS, Fisher LD, Chiang YT et al. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003; 107: 1278–83. 18. Cowie MR, Mendez GF. BNP and congestive cardiac failure. Prog Cardiovasc Dis 2002; 44: 293–321. 19. Jensen JK, Atar D, Kristensen SR, Mickley H, Januzzi JL Jr. Usefulness of natriuretic peptide testing for long-term risk assessment following acute ischemic stroke. Am J Cardiol 2009; 104: 287–91. 20. Nogami M, Shiga J, Takatsu A, Endo N, Ishiyama I. Immunohistochemistry of atrial natriuretic peptide in brain infarction. Histochem J 2001; 33: 87–90. 21. Sviri GE, Shik V, Raz B, Soustiel JF. Role of brain natriuretic peptide in cerebral vasospasm. Acta Neurochir (Wien) 2003; 145: 851–60. 22. Doust JA, Pietrzak E, Dobson A, Glasziou P. How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review. BMJ 2005; 330: 625.
TL;DR: There is a lack of high-quality evidence to support the efficacy of weight loss programmes in older people, and modest weight reductions were observed.
Abstract: Purpose: the prevalence of obesity is rapidly increasing in older adults. Information is required about what interventions are effective in reducing obesity and influencing health outcomes in this age group. Design: systematic review and meta-analysis. Data sources: thirteen databases were searched, earliest date 1966 to December 2008, including Medline, CINAHL, PsycINFO, the Cochrane database and EMBASE. Study selection: we included studies with participants’ mean age ≥60 years and mean body mass index ≥30 kg/m 2 , with outcomes at a minimum of 1 year. Data were independently extracted by two reviewers and differences resolved by consensus. Data extraction: nine eligible trials were included. Study interventions targeted diet, physical activity and mixed approaches. Populations included patients with coronary artery disease, diabetes mellitus and osteoarthritis. Results: meta-analysis (seven studies) demonstrated a modest but significant weight loss of 3.0 kg [95% confidence interval (CI) 5.1–0.9] at 1 year. Total cholesterol (four studies) did not show a significant change: −0.36 mmol/l (95% CI −0.75 to 0.04). There was no significant change in high-density lipoprotein, low-density lipoprotein or triglycerides. In one study, recurrence of hypertension or cardiovascular events was significantly reduced (hazard ratio 0.65, 95% CI 0.50–0.85). Six-minute walk test did not significantly change in one study. Health-related quality of life significantly improved in one study but did not improve in a second study. Conclusions: although modest weight reductions were observed, there is a lack of high-quality evidence to support the efficacy of weight loss programmes in older people.
TL;DR: Higher level of physical activity and lower energy intake may be protective against the development in ADL and IADL disability in older persons.
Abstract: Background: the identification of modifiable risk factors for preventing disability in older individuals is essential for planning preventive strategies. Purpose: to identify cross-sectional correlates of disability and risk factors for the development activities of daily living (ADL) and instrumental ADL (IADL) disability in community-dwelling older adults. Methods: the study population consisted of 897 subjects aged 65–102 years from the InCHIANTI study, a population-based cohort in Tuscany (Italy). Factors potentially associated with high risk of disability were measured at baseline (1998–2000), and disability in ADLs and IADLs were assessed both at baseline and at the 3-year follow-up (2001–03). Results: the baseline prevalence of ADL disability and IADL disability were, respectively, 5.5% (49/897) and 22.2% (199/ 897). Of 848 participants free of ADL disability at baseline, 72 developed ADL disability and 25 of the 49 who were already disabled had a worsening in ADL disability over a 3-year follow-up. Of 698 participants without IADL disability at baseline, 100 developed IADL disability and 104 of the 199 who already had IADL disability had a worsening disability in IADL over 3 years. In a fully adjusted model, high level of physical activity compared to sedentary state was significantly associated with lower incidence rates of both ADL and IADL disability at the 3-year follow-up visit (odds ratio (OR): 0.30; 95% confidence intervals (CI) 0.12–0.76 for ADL disability and OR: 0.18; 95% CI 0.09–0.36 for IADL disability). After adjusting for multiple confounders, higher energy intake (OR for difference in 100kcal/day: 1.09; 95% CI 1.02–1.15) and hypertension (OR: 1.91; 95% CI 1.06–3.43) were significant risk factors for incident or worsening ADL disability. Conclusions: higher level of physical activity and lower energy intake may be protective against the development in ADL and IADL disability in older persons.
TL;DR: The clinical benefit and cost effectiveness of ED care, and alternate programs to reduce ED transfer, cannot be confidently compared from published work, and further research is required to accurately describe these and to determine their comparative worth.
Abstract: Background emergency care for older people living in residential aged care facilities (RACF) is a complex area of health policy. The epidemiology of patient transfer between RACF and hospital emergency departments (ED), clinical outcomes and costs associated with transfer and efficacy of programs aiming to reduce transfer are not well known. Design systematic review based on a comprehensive literature search in three electronic databases and published article reference lists. Results the incidence of transfer from RACF to ED is >30 transfers/100 RACF beds/year in most studies. The casemix from RACF is varied and reflects that of the broad elderly population, with some risk difference. At least 40% of transfers are not admitted to hospital. There is insufficient data to fully address our other questions; however, hospitalisations from RACF can be reduced through advanced care planning, use of management guidelines for acute illnesses and improved primary care. Conclusions residents of RACF have a high annual risk of transfer to ED. The clinical benefit and cost effectiveness of ED care, and alternate programs to reduce ED transfer, cannot be confidently compared from published work. Further research is required to accurately describe these and to determine their comparative worth.
TL;DR: Exercise programmes aimed at improving gait speed and ML joint power from hip and ankle may help reverse age-associated changes in gait pattern among older adults.
Abstract: Objective: the present study investigated the effects of walking under different challenges and kinematics and kinetics generated during these activities and how these vary with age. We hypothesised that age-associated changes in gait speed and kinetics are more pronounced during fast-speed walking and post-activity walking, compared with usual-speed walking. Methods: investigated walking under three conditions: (i) usual speed, (ii) fast speed and (iii) post-activity in 183 Baltimore Longitudinal Study of Aging participants (mean 73 ± 9 years) who could walk unassisted. Results: across all tasks, gait speed decreased with older age and this decline rate was exacerbated in the fast-speed walking task, compared with usual-speed walking (P< 0.001). Medial–lateral (ML) hip-generative mechanical work expenditure declined with age and the rate of decline was steeper for walking at fast speed and post-activity during hip extension (P= 0.032 and 0.027, respectively), compared with usual-speed walking. Conclusions: these findings indicate that older adults experience exacerbated declines in gait speed and ML control of the hip, which is explicitly evident during challenging walking. Exercise programmes aimed at improving gait speed and ML joint power from hip and ankle may help reverse age-associated changes in gait pattern among older adults.
TL;DR: There is not sufficient data to recommend anything regarding initiation or continuation of lipid-lowering treatment for the population aged 80+, with known CVD, and it is even possible that statins may increase all-cause mortality in this group of elderly individuals without CVD.
Abstract: People aged 80 or older are the fastest growing population in high-income countries. One of the most common causes of death among the elderly is the cardiovascular disease (CVD). Lipid-lowering treatment is common, e.g. one-third of 75–84year-old Swedes are treated with statins [3]. The assumption that hypercholesterolaemia is a risk factor at the highest ages seems to be based on extrapolation from younger adults. A review of observational studies shows a trend where all-cause mortality was highest when total cholesterol (TC) was lowest (‘a reverse J-shaped’ association between TC and all-cause mortality). Low TC (<5.5 mmol/l) is associated with the highest mortality rate in 80+-year olds. No clear optimal level of TC was identified. A review of the few randomised controlled trials including 80+-year olds did not provide evidence of an effect of lipid-lowering treatment on total mortality in 80+-year-old people. There is not sufficient data to recommend anything regarding initiation or continuation of lipid-lowering treatment for the population aged 80+, with known CVD, and it is even possible that statins may increase all-cause mortality in this group of elderly individuals without CVD.
TL;DR: Investigation of the population impact on functional disability of chronic conditions individually and in combination found foot problems, arthritis, cognitive impairment, heart problems and vision were the major determinants of disability.
Abstract: Objectives to investigate the population impact on functional disability of chronic conditions individually and in combination. Methods data from 9,008 community-dwelling individuals aged 65 and older from the Canadian Study of Health and Aging (CSHA) were used to estimate the population attributable risk (PAR) for chronic conditions after adjusting for confounding variables. Functional disability was measured using activity of daily living (ADL) and instrumental activity of daily living (IADL). Results five chronic conditions (foot problems, arthritis, cognitive impairment, heart problems and vision) made the largest contribution to ADL- and IADL-related functional disabilities. There was variation in magnitude and ranking of population attributable risk (PAR) by age, sex and definition of disability. All chronic conditions taken simultaneously accounted for about 66% of the ADL-related disability and almost 50% of the IADL-related disability. Conclusions in community-dwelling older adults, foot problems, arthritis, cognitive impairment, heart problems and vision were the major determinants of disability. Attempts to reduce disability burden in older Canadians should target these chronic conditions; however, preventive interventions will be most efficient if they recognize the differences in the drivers of PAR by sex, age group and type of functional disability being targeted.
TL;DR: The study suggests that men who live alone can possibly alleviate their risk of disability onset by being socially active and by having access to satisfactory social relations, although women do not seem to benefit as much from cohabitation.
Abstract: Purpose to investigate if the increased risk of disability onset among older people who live alone could possibly be moderated by either high social participation or by being satisfied with the social relations. Design and methods logistic regression models were tested using two waves in a study population of 2,697 non-disabled older men and women from The Danish Longitudinal Study on Preventive Home Visits. Results living alone and low social participation were significant risk factors for later male disability onset. Not being satisfied with the social relations was significantly associated with onset of disability for both genders. Among men who lived alone low social participation was a significant predictor of disability onset [odds ratio, OR = 2.30 (1.00-5.29)]; for cohabiting men social participation was not associated with disability onset, [adjusted OR = 0.91 (0.49-1.71)]. Similar results were present concerning satisfaction with the social relations among men. There was no significant interaction for women. Conclusions the study suggests that men who live alone can possibly alleviate their risk of disability onset by being socially active and by having access to satisfactory social relations. Women do not seem to benefit as much from cohabitation as men, although women who live alone and who are not satisfied with their social relations also constitute a significant risk category.
TL;DR: A variety of infectious agents were identified as the cause of outbreaks in the elderly and HCWs in LTCFs and attack rates and case fatality rates are useful indicators for setting priorities for education and prevention of the outbreaks.
Abstract: Background: infectious outbreaks in long-term care facilities (LTCFs) tend to have a significant impact on infection rates and mortality rates of the residents. Objectives: this review aimed to update the information on pathogens identified in such outbreaks and to try to explore indicators that reflect the impact of outbreaks among residents and health care workers (HCWs). Methods: MEDLINE (1966―2008) was used to identify outbreaks using the following thesaurus terms: 'Cross-Infection', 'Disease Outbreaks', 'Urinary-Tract Infections' and 'Blood-Borne Pathogens'. Elderly care facilities were identified with the following thesaurus terms: 'Long-Term Care', 'Assisted-Living Facilities', 'Homes for the Aged' and 'Nursing Homes'. Age category was limited using 'Aged'. Results: thirty-seven pathogens were associated with 206 outbreaks. The largest number of reported outbreaks by a single pathogen involved the influenza virus, followed by noroviruses. Among residents, the highest median attack rate for respiratory infection outbreaks was caused by Chlamydia pneumoniae (46%), followed by respiratory syncytial virus (40%). In gastrointestinal tract infection outbreaks, high median attack rates were caused by Clostridium perfringens (48%) and noroviruses (45%). Outbreaks with high median case fatality rates were caused by Group A Streptococci (50%) and Streptococcus pneumoniae (44%). High median attack rates for HCWs were caused by C. pneumoniae (41%), noroviruses (42%) and scabies (36%). Conclusion: a variety of infectious agents were identified as the cause of outbreaks in the elderly and HCWs in LTCFs. Attack rates and case fatality rates are useful indicators for setting priorities for education and prevention of the outbreaks.
TL;DR: IP and PO were highly prevalent raising the need of a greater health literacy concerning geriatric conditions in non-geriatrician practitioners who care elderly as well as in the community, in hospital and institutional settings for improving quality and safety in prescribing medication.
Abstract: OBJECTIVE: the study aimed to determine the prevalence of and risk factors for inappropriate prescribing (IP) and prescribing omission (PO) in elderly with mental co-morbidities. PARTICIPANTS: One hundred fifty consecutive inpatients with mental co-morbidities hospitalised for acute medical illness (mean age 80 +/- 9, 70% of women) were considered for the study. MEASUREMENTS: IP and PO were prospectively identified according to STOPP/START criteria at hospital admission. RESULTS: over 95% were taking ≥ 1 medication (median = 7) which amounted to 1,137 prescriptions. The prevalence of IP was 77% and PO was 65%. The most frequent encountered IP concerned drugs adversely affecting fallers (25%) and antiaggregants therapy without atherosclerosis (14%). PO concerned antidepressants with moderate/severe depression (20%) and calcium-vitamin D supplementation (18%). Independent predictors for IP were increased number of concomitant drugs (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-1.89), being cognitively impaired (OR 1.83, 95% CI 1.55-2.24), and having fallen in the preceding 3 months (OR 2.03, 95% CI 1.52-2.61) or hospitalised in the preceding year (OR 1.09, 95% CI 1.02-1.23). Concerning PO, psychiatric disorder (OR 1.64, 95% CI 1.42-2.01) and increase level of co-morbidities (OR 1.79, 95% CI 1.48-1.99) were identified. Living in an institutional setting was a predictive maker for both IP (OR 1.45, 95% CI 1.27-1.74) and PO (OR 1.67, 95% CI 1.32-1.91). CONCLUSION: IP and PO were highly prevalent raising the need of a greater health literacy concerning geriatric conditions in non-geriatrician practitioners who care elderly as well as in the community, in hospital and institutional settings for improving quality and safety in prescribing medication.
TL;DR: Over one in six patients are currently prescribed antipsychotic drugs known to be of little benefit and causing significant harm, with other psychotropics equally commonly used.
Abstract: Objective: to compare psychotropic prescribing in older people with dementia and the general elderly population. Design and setting: retrospective population database study in 315 General Practices. Subjects: there were 271,365 patients aged ≥65, of which 10,058 (3.7%) recorded as having dementia. Methods: epidemiology of psychotropic prescribing in older people with and without dementia; multilevel modelling of patient and practice characteristics associated with antipsychotic prescribing. Results: people with dementia were currently prescribed an antipsychotic drug (17.7%), an antidepressant (28.7%) and a hypnotic/anxiolytic (16.7%). Compared to the general elderly population, antipsychotic prescribing was 17.4 [95% confidence interval (CI) 16.4–18.4], antidepressant prescribing 2.7 (95% CI 2.6–1.8) and hypnotic/anxiolytics 2.2 (95% 2.1–2.3) times more likely in people with dementia. Most antipsychotic prescribing in people with dementia was prolonged (>16 weeks). Patients living in more deprived areas and registered with larger and more remote practices were more likely to be prescribed prolonged antipsychotics. Conclusions: over one in six patients are currently prescribed antipsychotic drugs known to be of little benefit and causing significant harm, with other psychotropics equally commonly used. Changing this will require investment in services to support alternative management strategies for people with behavioural and psychological disturbance associated with dementia.
TL;DR: Delirium is associated with high rates of institutionalisation and an increased risk of death up to 5 years after index event and those with delirium tended to be older with more preadmission cognitive impairment, greater functional dependency and more co-morbidity and did not spend more days in hospital in the 4 years prior to index admission.
Abstract: Objective: To investigate the hypotheses that delirium affects the most vulnerable older adults and is associated with long term adverse health outcome.
Design: Prospective, cohort study.
Setting and Participants: 278 medical patients aged 75 years and over admitted acutely to a district general hospital in South Wales.
Measurements: Patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Assessments also included illness severity, preadmission cognition, co-morbidity and functional status. Patients were followed for 5 years to determine rates of institutionalization and mortality. Number of days in hospital in the 4 years prior to and 5 years after index admission were recorded.
Results: Delirium was detected in 103 patients and excluded in 175. Median time to death was 162 days [Interquartile range (IQR) 21-556] for those with delirium compared to 1444 days (25% mortality 435 days, 75% mortality >5 years) for those without (P<0.001). After adjustment for multiple confounders, delirium was associated with an increased risk of death [hazard ratio range 2.0-3.5; P ≤0.002]. Institutionalisation was higher in the first year following delirium (P=0.03). While those with delirium tended to be older with more preadmission cognitive impairment, greater functional dependency and more co-morbidity, they did not spend more days in hospital in the 4 years prior to index admission.
Conclusions: Delirium is associated with high rates of institutionalization and an increased risk of death up to five years after index event. Prior to delirium, individuals seem to compensate for their vulnerability. The impact of delirium itself, directly or indirectly, may convert vulnerability into adverse outcome.
TL;DR: Low HRQOL scores were associated with lower levels of antihypertensive medication adherence in older adults and may be an important barrier to achieving high medication adherence.
Abstract: Purpose: health-related quality of life (HRQOL) is an important psycho-social characteristic which may impact an individual’s ability to manage their chronic disease. We examined the association between HRQOL and antihypertensive medication adherence in older adults. Methods: participants were part of a cohort study of older adults enrolled in a managed care organisation and treated for hypertension (n=2,180). Physical and Mental Component Summary Scores (PCS and MCS) of HRQOL were assessed using the RAND Medical Outcomes Study 36-item tool. Adherence to antihypertensive medication was assessed with the eightitem Morisky Medication Adherence Scale. Results: the mean age of participants was 75.0 ± 5.6 years, 69.3% were white, 58.5% were women and 14.1% had low antihypertensive medication adherence. Low HRQOL scores were associated with lower levels of antihypertensive medication adherence in older adults. After adjustment for covariates, those with low PCS and MCS scores were 1.33 (95% CI 1.01, 1.74) and 2.26 (95% CI 1.74, 2.97) times more likely, respectively, to have low antihypertensive medication adherence than those with PCS and MCS scores in the top 2 tertiles. Conclusions: low HRQOL may be an important barrier to achieving high medication adherence.
TL;DR: It is not possible to estimate the frequency of drug-related problem through a review of selected articles or to evaluate the efficacy of the proposed interventions, so more research is needed in this field to reduce uncertainty and generate evidence-based recommendations for physicians.
Abstract: Drug-related problems in older people during care transitions have become a major public health problem since they threaten patient safety. The objective of our paper is to investigate the extent and frequency of drug-related problems (discontinuity, adherence, errors, interactions and adverse events) after hospital discharge and the efficacy of interventions intended to reduce them. We included 20 studies in the review. All of them underlined the high frequency and complexity of drug-related problems in older people after hospital discharge. Interventions proposed to improve care transitions led to diverse and sometimes contradictory results, but the findings suggested that combining hospital discharge measures with home follow-up strategies is of value. We conclude that it is not possible to estimate the frequency of drug-related problem through a review of selected articles or to evaluate the efficacy of the proposed interventions. More research is needed in this field to reduce uncertainty and generate evidence-based recommendations for physicians.