Pre-Frailty and Risk of Cardiovascular Disease in Elderly Men and Women The Pro.V.A. Study

Background Frailty is an important risk factor for cardiovascular disease (CVD), but the impact of early, potentially reversible stages of frailty on CVD risk is unknown. Objectives This study sought to ascertain whether pre-frailty can predict the onset of CVD in a cohort of community-dwelling, not disabled, elderly people. Methods A sample of 1,567 participants age 65 to 96 years without frailty or disability at baseline was followed for 4.4 years. Pre-frailty was defined as the presence of 1 or 2 modified Fried criteria (unintentional weight loss, low physical activity level, weakness, exhaustion, and slow gait speed), and incident CVD as onset of coronary artery diseases, heart failure,…

Body mass index as a predictor of all-cause mortality in nursing home residents during a 5-year follow-up.

Background: Body mass index (BMI) is considered a short-term mortality predictor, but a consensus has not been reached on its role and that of other nutritional parameters in predicting long-term mortality in nursing home residents. Objectives: To correlate BMI, Mini Nutritional Assessment scores, and serum albumin levels with the 5-year mortality rate in institutionalized elderly subjects. Methods: A total of 181 nursing home residents aged ≥70 years were included in a 5-year longitudinal study. Data were collected on all participants' nutritional, health, cognitive, and functional status by means of a comprehensive geriatric assessment. Data on the participants' vital status were obtained…

Acute decompensated heart failure: Decision pathways for older people

Introduction: Acute decompensated heart failure (ADHF) is a common condition in older people, but little research has been conducted on the appropriate decision pathways for this population. The aim of this review was to explore ADHF management in older people, paying particular attention to the comprehensive geriatric assessment (CGA). Material and methods: A search was run in the PubMed literature database, combining the term "acute heart failure" with "management", "geriatric" "multidisciplinary", "co-management", "co-care", "approach", and "comprehensive geriatric assessment", from the databases inception to 1st January 2015. A manual check was also conducted on the reference lists in t…

Vitamin D deficiency predicts cognitive decline in older men and women: The Pro.V.A. Study

Objective: To test the hypothesis that hypovitaminosis D is associated with a higher risk of cognitive decline over a 4.4-year follow-up in a large sample of older adults. Methods: This research was part of the Progetto Veneto Anziani (Pro.V.A.), an Italian populationbased cohort study of 1,927 elderly subjects. Serum 25-hydroxyvitamin D (25OHD) levels were measured at the baseline. Global cognitive function was measured with the Mini-Mental State Examination (MMSE); scores lower than 24 were indicative of cognitive dysfunction, and a decline of 3 or more points on the MMSE over the follow-up was considered as clinically significant. Analyses were adjusted for relevant confounders, includin…

RISK OF CARDIOVASCULAR DISEASE MORBIDITY AND MORTALITY IN FRAIL AND PRE-FRAIL OLDER ADULTS:RESULTS FROM A META-ANALYSIS AND EXPLORATORY META-REGRESSION ANALYSIS

Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs)+/- 95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total …

Effect of acetyl-l-carnitine in the treatment of diabetic peripheral neuropathy : A systematic review and meta-analysis

Background/aim: Deficiency of acetyl-L-carnitine (ALC) and L-carnitine (LC) appears to play a role in peripheral diabetic neuropathy, although the evidence in humans is still limited. We conducted a systematic review and meta-analysis investigating the effect of ALC on pain and electromyographic parameters in people with diabetic neuropathy. Methods: A literature search in major databases, without language restriction, was undertaken. Eligible studies were randomized controlled trials (RCTs) or pre-and post-test studies. The effect of ALC supplementation on pain perception and electromyographic parameters in patients with diabetic neuropathy was compared vs. a control group (RCTs). The effe…

Extranodal Extension of Nodal Metastases Is a Poor Prognostic Indicator in Gastric Cancer: a Systematic Review and Meta-analysis.

Introduction: The extranodal extension (ENE) of nodal metastases (the extension of neoplastic cells through the nodal capsule into the perinodal soft tissue) is a histological feature that has been considered a prognostic factor in several cancers, but the role in gastric cancer was not yet investigated. We aimed to investigate the prognostic role of ENE in patients affected by gastric cancer through a systematic review and meta-analysis. Material and Methods: Two independent authors searched major databases until 09/30/2015 to identify studies providing data on gastric cancer patients’ prognostic parameters and comparing patients with ENE (ENE+) vs intra-nodal extension (ENE−). The data we…

A Comparison of Objective Physical Performance Tests and Future Mortality in the Elderly People.

Background: Physical performance is an important predictor of mortality, but little is known on the comparative prognostic utility of different objective physical performance tests in community-dwelling older adults. We compared the prognostic usefulness of several objective physical performance tests on mortality, adjusting our analyses for potential confounders. Methods: Among 3,099 older community-dwelling participants included in the Progetto Veneto Anziani study, 2,096 were followed for a mean of 4.4 years. Physical performance tests measured were Short Physical Performance Battery (SPPB), 4-meter gait speed, chair stands time, leg extension and flexion, handgrip strength, and 6-Minute…

Role of comprehensive geriatric assessment in the management of osteoporotic hip fracture in the elderly: an overview

Purpose: To highlight the advantages of comprehensive geriatric assessment (CGA) over usual care in the management of elderly patients with fragility hip fractures in terms of reducing the related mortality and disability. Method: An overview of publications on the topic was conducted using the MEDLINE and EMBASE databases. Results: Several models of geriatric and orthopedic comanagement have been developed in recent years, all characterized by a variable degree of integration, and they have been shown to reduce complications, disability and mortality in elderly hip-fracture patients. Preoperatively, CGA should identify the comorbidities that need to be treated in view of surgery, so as to …

Geriatric Insights on Elderly Women and Heart Disease

Purpose of Review: The prevalence of heart diseases is growing in recent years and will further rise because of the increased longevity of elderly population, mainly reported for the female gender. Recent Findings: Several studies have demonstrated the presence of a large sex-specific variability on physiopathology, presentation, and overall prognosis of cardiovascular diseases (CVD). Women, in particular, tend to present heart diseases generally later than men, have a higher number of comorbidities, and report worse outcomes. Moreover, atypical symptomatology of heart diseases in older women constitutes a potential source of delay in the identification of such pathologies, influencing the …

Serum Thyroid-Stimulating Hormone Levels and Frailty in the Elderly: The Progetto Veneto Anziani Study

High or low thyroid-stimulating hormone (TSH) levels seem to be associated with several negative outcomes in the elderly, but the literature about TSH and frailty is still limited. In this article, we investigated whether TSH is associated with prevalent and incident frailty in a cohort of older community-dwelling subjects. Among 3099 initially screened in the Progetto Veneto Anziani Study, 2571 men and women aged ≥65 years (for cross-sectional analyses) and 1732 (longitudinal, mean follow-up period of 4.4 years) were divided into sex-specific quintiles according to baseline serum TSH concentrations within normal range (0.3 and 4.2 mUI/L). Frailty was defined as the presence of three among …

Extranodal extension in N1-adenocarcinoma of the pancreas and papilla of Vater: A systematic review and meta-analysis of its prognostic significance

The aim of the study was to investigate the prognostic role of extranodal extension (ENE) of lymph node metastasis in adenocarcinoma of the pancreas (PDAC) and papilla [cancer of the papilla of Vater (CPV)]. A PubMed and SCOPUS search from database inception until 5 January 2015 without language restrictions was conducted. Eligible were prospective studies reporting data on prognostic parameters in individuals with PDAC and/or CPV, comparing participants with the presence of ENE (ENE +) with those with intranodal extension (ENE). Data were summarized using risk ratios for number of deaths/recurrences and hazard ratios for time-dependent risk related to ENE+, adjusted for potential confounde…

Serum uric acid and incident osteoporotic fractures in old people: The PRO.V.A study

Purpose: Although high serum uric acid (SUA) levels are associated with negative outcomes in older people, recent studies reported that hyperuricemia could help protect against the onset of bone fractures. We consequently examined whether baseline SUA levels were associated with risk of incident osteoporotic fractures in a representative group of elderly people with no fractures or other bone-modifying conditions or drugs at the baseline. Methods: Among 3099 people aged ≥ 65. years initially involved in the PRO.V.A. study, 1586 participants with no prior diagnosis of osteoporotic fractures, and no conditions or medication affecting bone metabolism at the baseline were followed up for 4.4. ±…

Inflammatory cytokines and anorexia nervosa: A meta-analysis of cross-sectional and longitudinal studies

Objective: Although inflammation is increasingly implicated in psychiatric disorders, less is known about its role in anorexia nervosa (AN), an illness with low body mass index (BMI). Methods: We performed a systematic PubMed literature search until 12/31/2013 and meta-analyzed cross-sectional and longitudinal studies comparing circulating pro- and anti-inflammatory cytokines between patients with anorexia nervosa (AN) and healthy controls (HCs) (1) before and (2) after weight gain, and (3) within AN patients before and after weight gain. Standardized mean differences (SMDs). ±. 95% confidence intervals (CIs) for results from ≥2 studies were calculated. Results: Of 999 initial hits, 22 stud…

Inflammation and sarcopenia: A systematic review and meta-analysis

Inflammatory cytokines have been shown to prompt muscle wasting, ultimately stimulating protein catabolism and suppressing muscle synthesis. However, the possible association between inflammatory parameters and sarcopenia is poorly understood. We therefore aimed to summarize the current evidence about this topic with a meta-analysis of studies reporting serum inflammatory parameters in patients with sarcopenia vs. people without sarcopenia (controls). An electronic PubMed and Scopus search through to 09/01/2016 and meta-analysis of cross-sectional studies comparing serum levels of inflammatory cytokines between patients with sarcopenia and controls was made, calculating random-effects stand…

Serum Dehydroepiandrosterone Sulfate and Risk for Type 2 Diabetes in Older Men and Women: The Pro.V.A Study

Objective: A large body of clinical data suggests the importance of endogenous sex hormones in the pathogenesis of diabetes, but very little is known about the possible relationship between dehydroepiandrosterone sulfate (DHEAS) and diabetes, particularly in the elderly. We aimed, therefore, to examine whether high serum levels of DHEAS have any protective effects on the incidence of type 2 diabetes and to elucidate the possible role of gender in a cohort of older subjects. Methods: We followed 1258 community-dwelling subjects aged ≥65 years without type 2 diabetes who belonged to the Progetto Veneto Anziani (Pro.V.A.) for 4.4±1.2 years. DHEAS were measured at baseline and categorized into …

Chronic gout in the elderly

Gout is the most common cause of inflammatory arthritis in men over 40 years old; it is a debilitating disease and, if untreated, can result in a chronic progressive disease, including tophaceous gout. In the elderly it represents a special issue, with notable clinical and therapeutic differences from the classical form with a systemic involvement. The burden of the disease increases particularly in the very old people, in whom arthritis, impaired gait and eyesight problems may enhance the related disability. Chronic gout moreover could aggravate heart and kidney disease and increase overall mortality and organ-related damage. Early diagnosis and appropriate treatment are important goals fo…

Frailty Is Associated with an Increased Risk of Incident Type 2 Diabetes in the Elderly

Objective To investigate whether frailty is associated with an increased risk of incident type 2 diabetes mellitus (T2DM) in a prospective cohort of community-dwelling older people. Design Longitudinal study, mean follow-up of 4.4 years. Setting Progetto Veneto Anziani (Pro.V.A.) study that involved older community-dwellers. Participants 1754 men and women older than 65 years without T2DM at baseline. Measurements Frailty status was defined according to Fried criteria and categorized as frailty (≥3 criteria), prefrailty (1-2 criteria), or no frailty (0 criterion). Incident T2DM was defined as fasting plasma glucose (FPG) ≥7.0 mmol/L, or glycosylated hemoglobin ≥6.5%, the use of glucose-lowe…

Factors influencing serum 25-hydroxivitamin D levels and other bone metabolism parameters in healthy older women

Objective: Older women have frequently low serum 25-hydroxivitamin D (25[OH]D) concentrations, high parathormone (PTH) levels and low bone mineral density (BMD) values. Endogenous synthesis, dietary habits, sunlight exposure and fat-mass-mediated storage may influence 25(OH)D levels and bone metabolism, but the relevance of these factors in the elderly has yet to be fully elucidated. We aimed to investigate the influence of dietary vitamin D intake and fat mass on serum 25(OH)D levels and bone metabolism in older women. Design: Cross-sectional. Setting: Community. Participants: 218 fit older women attending a biweekly mild fitness program. Measurements: Dietary habits was investigated throu…

Measurement of lean body mass using bioelectrical impedance analysis: a consideration of the pros and cons

The assessment of body composition has important applications in the evaluation of nutritional status and estimating potential health risks. Bioelectrical impedance analysis (BIA) is a valid method for the assessment of body composition. BIA is an alternative to more invasive and expensive methods like dual-energy X-ray absorptiometry, computerized tomography, and magnetic resonance imaging. Bioelectrical impedance analysis is an easy-to-use and low-cost method for the estimation of fat-free mass (FFM) in physiological and pathological conditions. The reliability of BIA measurements is influenced by various factors related to the instrument itself, including electrodes, operator, subject, a…

Hypovitaminosis D and fat mass in healthy older people

Prospective studies have suggested that hypovitaminosis D can predict the onset of obesity, but they relied mainly on body mass index, which could be scarcely reliable in older people. We investigated whether baseline hypovitaminosis D could predict higher fat mass (FM) levels using dual-energy X-ray absorptiometry in a sample of 116 fit and healthy older subjects. Although no significant differences in FM estimates emerged between subjects with and without hypovitaminosis D at the baseline, abdominal FM was found significantly higher in the former group (with hypovitaminosis D at the baseline) than in the latter after 3 years of follow-up. Adjusted logistic regression analysis confirmed th…

Serum 25-Hydroxyvitamin D and Orthostatic Hypotension in Old People

Interest in the association between serum 25-hydroxyvitamin D (25OHD) and blood pressure has increased because recent research showed a close relationship between them, but there is still little information on the possible association between 25OHD and orthostatic hypotension. The aim of this study was to explore the relationship of 25OHD levels with any presence of orthostatic hypotension in a large group of older people. This study was part of the Progetto Veneto Anziani (Pro.V.A.), an Italian population–based cohort study involving people aged >65 years. In this cross-sectional work, we considered 2640 (1081 men and 1559 women) with a mean age of 73.8±6.8 years. Orthostatic hypotensi…

Frailty and incident depression in community-dwelling older people: results from the ELSA study

Objective: Frailty and pre-frailty are two common conditions in the older people, but whether these conditions could predict depression is still limited to a few longitudinal studies. In this paper, we aimed to investigate whether frailty and pre-frailty are associated with an increased risk of depression in a prospective cohort of community-dwelling older people. Methods: Four thousand seventy-seven community-dwelling men and women over 60 years without depression at baseline were included from the English Longitudinal Study of Ageing. Frailty status was defined according to modified Fried's criteria (weakness, weight loss, slow gait speed, low physical activity and exhaustion) and categor…

Prevalence of sarcopenia and associated factors in the healthy older adults of the Peruvian Andes

Aim To assess the prevalence of sarcopenia and associated factors in a population of older people living in a rural area of the Peruvian Andes. Materials and methods The study concerned 222 people aged ≥65 years. Sarcopenia was diagnosed on the basis of skeletal muscle mass, measured using bioimpedance analysis, and gait speed, measured with the 4-m walking test, as recommended by the International Working Group on sarcopenia. Self-reported physical activity, the Short Physical Performance Battery, and the Six-Minute Walking Test also contributed information on participants’ physical performance status. Disabilities were investigated by assessing participants’ self-reported difficulties in …

Serum 25-hydroxyvitamin d and the onset of late-life depressive mood in older men and women: the Pro.V.A. study.

Depression is a debilitating chronic condition, and its diagnosis and treatment in elderly people are often challenging. Because depressive mood seems to follow a seasonal pattern, peaking in summer and winter (1), it has recently been suggested that, through its action on the hypothalamus (which is involved in mood regulation), vitamin D might account for the link between seasonal changes in photoperiod and seasonal mood swings (2). Acting as a neurosteroid hormone, vitamin D may regulate human and animal neurotransmission, neuroprotection, and neuroimmunomodulation (3), and nuclear vitamin D receptors have been located in the human cortex and hippocampus (4). Although an association betwe…

A case of naturally evolving gout in an elderly man

Gout is a common disorder in adults that can lead to severe organ decline, disability and impaired quality of life due to the formation of periarticular tophi. We report a case of massive tophaceous gout in a 78-year-old man with a 16-year-long history of untreated disease. The patient gradually became disabled, his renal function deteriorated, and he finally died of sepsis. Our case demonstrates that chronic gout not only affects the joints, but is also associated with organ function decline and can, even nowadays, lead to death. © 2011 Elsevier Ireland Ltd.

Serum dehydroepiandrosterone sulfate and osteoarthritis in older people: the Pro.V.A. study.

Although osteoarthritis (OA) and low levels of dehydroepiandrosterone sulfate (DHEAS) are common in the elderly, no studies on human beings are available concerning the possible relationship between them. We aimed to examine the relationship between DHEAS levels and any presence of OA in a cohort of community-dwelling older subjects. This study was part of the Progetto Veneto Anziani (Pro.V.A.), an Italian population-based cohort study on people over 65 years old. In this cross-sectional work, we considered 2050 individuals with a mean age of 74.2 ± 7.1 years (818 M and 1232 F), and with a complete set of information on OA and DHEAS levels. OA was defined using a standardized algorithm inve…

Inflammation and frailty in the elderly: A systematic review and meta-analysis

The pathogenesis of frailty and the role of inflammation is poorly understood. We examined the evidence considering the relationship between inflammation and frailty through a systematic review and meta-analysis. A systematic literature search of papers providing data on inflammatory biomarkers and frailty was carried out in major electronic databases from inception until May 2016. From 1856 initial hits, 35 studies (32 cross-sectional studies n = 3232 frail, n = 11,483 pre-frail and n = 8522 robust, and 563 pre-frail + robust; 3 longitudinal studies n = 3402 participants without frailty at baseline) were meta-analyzed. Cross-sectional studies reported that compared to 6757 robust participa…

Is pain sensitivity altered in people with Alzheimer's disease? A systematic review and meta-analysis of experimental pain research

Background Clinical studies suggest people with Alzheimer's disease (AD) have altered pain sensitivity. Experimental pain research is equivocal. Objective Conduct a meta-analysis to investigate if people with AD have altered pain sensitivity compared to healthy controls (HCs). Methods Three authors searched electronic databases from inception till November 2015 for experimental pain studies in AD vs. HCs. Outcome measures were pain threshold, tolerance, pain ratings, heart rate response to noxious stimuli and the Facial Action Coding System (FACS). Random effect meta-analysis calculating Hedges' g ± 95% confidence intervals (CI) was conducted. Results Thirteen studies were identified, inclu…

Vitamin D deficiency and leisure time activities in the elderly: are all pastimes the same?

Background Optimal vitamin D status is important for overall health and well-being, particularly in the elderly. Although vitamin D synthesis in the skin declines with age, exposure to sunlight still seems to help older-aged adults to achieve adequate serum 25-hydroxyvitamin D (25OHD) levels. Elderly people would therefore benefit from outdoor leisure activities, but the effects of different types of pastime on serum 25OHD levels have yet to be thoroughly investigated. Aims To assess the association of different pastimes with 25OHD deficiency in elderly subjects. Methods A sample of 2,349 community-dwelling elderly individuals (1,389 females and 960 males) enrolled in the Progetto Veneto An…

Orthostatic changes in blood pressure and mortality in the elderly: The Pro.V.A study

BACKGROUND An extensive, albeit contrasting literature has suggested a possible role for orthostatic hypotension as a risk factor for cardiovascular (CVD) and non-CVD mortality, while no data are available for orthostatic hypertension. We investigated whether orthostatic changes in blood pressure (BP) were associated with any increased risk of all-cause, CVD or non-CVD mortality in a group of elderly people. METHODS Two thousand seven hundred and eighty six community-dwelling older participants were followed for 4.4 years. Participants were grouped according to whether they had a drop ≤20mm Hg in systolic, or ≤10mm Hg in diastolic BP (orthostatic hypotension), an increase in mean orthostati…

Effects of high-intensity circuit training, low-intensity circuit training and endurance training on blood pressure and lipoproteins in middle-aged overweight men.

Background The aim of this study was to determine the physiological effects of an high-intensity circuit training (HICT) on several cardiovascular disease risk factors in healthy, overweight middle-aged subjects, and to compare the effects of HICT to traditional endurance training (ET) and low-intensity circuit training (LICT). Methods Fifty-eight participants (ages 61±3.3 yrs, BMI 29.8±0.9) were randomly assigned to one of the three exercise treatment groups: HICT, LICT and ET. The three groups exercised three times per week, 50 min per session for 12 weeks. Baseline and after intervention anthropometric characteristics: body weight (BW), fat mass (FM); blood pressure: diastolic (DBP) and …

Results of an Observational Cohort Study of Hyperuricemia as a Predictor of Poor Physical Performance in the Elderly

Objective: Hyperuricemia is frequent in older people and associated with several medical conditions. The relationship between hyperuricemia and physical performance is limited. We aimed to investigate the association between hyperuricemia and physical performance over a 4.4-year followup in the elderly. Methods: A total of 1,904 community-dwelling older participants were followed for a mean of 4.4 years. Hyperuricemia at baseline was defined using serum uric acid concentrations ≥6 and ≥7 mg/dl for women and men, respectively. Objective physical performance tests measured included the Short Physical Performance Battery (SPPB), 4-meter gait speed, chair-stands time, leg extension and flexion,…

Prognostic implications of extranodal extension in node-positive squamous cell carcinoma of the vulva: A systematic review and meta-analysis

Squamous cell carcinoma (SCC) of the vulva is the fourth most common gynecological cancer, usually staged with the TNM or FIGO systems. Since 2009, FIGO staging has taken the extranodal extension (ENE) of lymph node metastases into account. ENE is defined as the spread of a lymph node metastasis into surrounding soft tissue. Although the TNM and FIGO systems acknowledge the importance of ENE in SCC, no comprehensive studies have analyzed the prognostic impact of this parameter. We therefore queried the PubMed and SCOPUS databases from their inception up until 04/01/2015, adopting no language restrictions: all prospective studies reporting on prognostic parameters in patients with vulvar SCC…

Low Hemoglobin Levels and the Onset of Cognitive Impairment in Older People: The PRO.V.A. Study

Low hemoglobin (Hb) levels are attracting interest as a risk factor for cognitive impairment, but with contrasting evidence emerging from the current literature. The aim of our work was to investigate the relationship between baseline serum Hb levels and the incidence of cognitive impairment in older people over a follow-up of 4.4 years. Our study considered a sample of 1227 elderly subjects cognitively intact at baseline, enrolled under the Progetto Veneto Anziani (Pro.V.A.) among 3099 screened subjects. For all participants, we measured serum Hb levels on blood samples; incident cognitive impairment was defined as a Mini Mental State Examination (MMSE) score <24 and confirmed by geriat…

Hypovitaminosis D predicts the onset of orthostatic hypotension in older adults

A number of small cross sectional studies have demonstrated that hypovitaminosis D (represented by low 25 hydroxyvitamin D (25OHD) levels) is associated with orthostatic hypotension (OH). We investigated if hypovitaminosis D is associated with the onset of OH in older adults over a follow-up of 4.4 years. 25OHD was categorized using sex-specific quartiles; OH was defined as a drop of ≤20 mm Hg in systolic or ≤10 mm Hg in diastolic blood pressure <3 minutes of standing. Among 1308 elderly without OH at baseline, using an adjusted logistic regression analysis and taking those with higher baseline serum 25OHD as reference, there was a significant increase in the onset of OH in those with lo…

Nutritional predictors of cognitive impairment severity in demented elderly patients: The key role of BMI

Introduction: The body mass index (BMI) is commonly used to assess nutritional status and the Mini Mental State Examination (MMSE) is a validated tool for assessing cognitive status in elderly people. Nutritional and cognitive aspects are closely related in dementia. Objectives: To establish whether BMI predicts cognitive decline in demented patients and whether an "alarm" BMI cut-off exists for declining MMSE scores. Subjects and methods: 82 elderly demented patients underwent clinical, bio-chemical and functional assessment. Design: Transversal study. Results: The mean BMI was 26.08±4.48 kg/m 2 and the mean MMSE 18.68±5.38. Patients with BMI>25 kg/m2 had significantly lower MMSE scores…

Vitamin K antagonists' use and fracture risk: results from a systematic review and meta‐analysis

Background: Although vitamin K antagonists (VKAs) lower serum values of bone deposition markers, the link with osteoporosis and fractures remains controversial. Objectives: To assess whether the use of VKAs is associated with an increased prevalence and/or incidence of osteoporosis, fractures, or lower bone mineral density (BMD) values. Methods: We conducted a systematic PubMed and EMBASE literature search until August 31, 2014, and a meta-analysis of cross-sectional and longitudinal studies investigating fractures and BMD, comparing patients treated with VKAs and healthy controls (HCs) or with patients with medical illness (medical controls, MCs). Standardized mean differences ± 95% and co…

Weight loss is associated with improvements in cognitive function among overweight and obese people: A systematic review and meta-analysis

Whilst obesity is associated with a higher risk of cognitive impairment, the influence of weight loss on cognitive function in obese/overweight people is equivocal. We conducted a meta-analysis of randomized controlled trials (RCTs) and longitudinal studies evaluating the influence of voluntary weight loss on cognitive function in obese/overweight individuals. Articles were acquired from a systematic search of major databases from inception till 01/2016. A random effect meta-analysis of weight loss interventions (diet, physical activity, bariatric surgery) on different cognitive domains (memory, attention, executive functions, language and motor speed) was conducted. Twenty studies (13 long…

Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly: The Progetto Veneto Anziani Study.

We studied a cohort of 1408 older subjects to explore whether postural changes in blood pressure (BP; defined as orthostatic hypo- or hypertension) can predict the onset of cognitive deterioration. Orthostatic hypotension was defined as a drop of 20 mm Hg in systolic or 10 mm Hg in diastolic BP and orthostatic hypertension as a rise of 20 mm Hg in systolic BP. Orthostatic BP values were grouped into quintiles for secondary analyses. Two cognitive assessments were considered: (1) cognitive impairment, that is, Mini-Mental State Examination scores ≤24/30, and (2) cognitive decline (CD), that is, a 3-point decrease in Mini-Mental State Examination score from the baseline to the follow-up. At t…

What physical performance measures predict incident cognitive decline among intact older adults? A 4.4 year follow up study

Reductions in physical performance, cognitive impairment (CI) and decline (CD), are common in older age, but few prospective cohort studies have considered the relationship between these domains. In this study we investigated whether reduced physical performance and low handgrip/lower limbs strength, could predict a higher incidence of CI/CD during a 4-year follow-up among a cohort of elderly individuals. From 3099 older community-dwelling individuals initially enrolled in the Progetto Veneto Anziani (PRO.V.A.) study, 1249 participants without CI at the baseline were included (mean age 72.2 years, 59.5% females). Physical performance measures included the Short Physical Performance Battery …

Hyperuricemia protects against low bone mineral density, osteoporosis and fractures: a systematic review and meta-analysis

Background: Serum uric acid (SUA) accounts for about 50% of extracellular antioxidant activity, suggesting that hyperuricemia may have a protective role in diseases characterized by high levels of oxidative stress, such as osteoporosis. We aimed to meta-analyse data regarding bone mineral density (BMD), osteoporosis and fractures in people with higher SUA vs. lower SUA concentrations. Materials and methods: Two investigators conducted a literature search using PubMed and Scopus, without language restrictions. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were used for BMD; risk ratios (RRs) and adjusted odds ratios (ORs) for cross-sectional data. Most possible adju…

Low Hemoglobin Levels and Risk of Developing Depression in the Elderly: Results From the Prospective PRO.V.A. Study.

OBJECTIVE Low hemoglobin negatively affects health in the elderly, but research about the association with risk for depression is limited. We investigated the association between baseline hemoglobin concentrations and incident depression in a cohort of nondepressed elderly individuals. METHODS As part of the Northern Italian Progetto Veneto Anziani (PRO.V.A.) study, randomly drawn, community-dwelling subjects aged ≥ 65 years underwent prospective clinical and laboratory assessments between October 1995 and December 2002. The association between baseline hemoglobin and depression was assessed with adjusted Cox regression analyses. Baseline serum hemoglobin concentrations were further categor…

Changes in Frailty Status and Risk of Depression: Results From the Progetto Veneto Anziani Longitudinal Study.

Objective To evaluate whether prefrailty was associated with the risk of developing depression and if longitudinal changes in frailty status corresponded to changes in incident depression during follow up. Methods A population-based, prospective cohort study was conducted for 4.4 years in two separate geographic areas near the city of Padua in the Veneto Region of Northern Italy. In 891 nondepressed, nonfrail, community-dwelling Italian subjects aged ≥ 65 (46.6% men) belonging to the Progetto Veneto Anziani study, depression was defined according to the Geriatric Depression Scale and was confirmed by geriatricians skilled in psychogeriatric medicine. Prefrailty was defined by the presence o…

Monoclonal gammopathy of undetermined significance and bone health outcomes: a systematic review and exploratory meta-analysis.

Monoclonal gammopathy of undetermined significance (MGUS) is a common condition in the elderly. A number of studies have investigated the relationship between MGUS and bone health outcomes including bone mineral density (BMD), osteoporosis and fractures, but no meta-analysis exists. We conducted a systematic review and exploratory meta-analysis comparing bone health outcomes in patients with MGUS. Two independent authors searched PubMed and Scopus from inception until 19 October 2016. A meta-analysis of cross-sectional and longitudinal studies investigating fractures and BMD was conducted. Standardised mean differences (SMD) ± 95% confidence intervals (CIs) were calculated for BMD, and risk…

Effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise program: A randomized controlled trial

Background: Magnesium deficiency is associated with poor physical performance, but no trials are available on how magnesium supplementation affects elderly people’s physical performance. Objective: The aim of our study was to investigate whether 12 wk of oral magnesium supplementation can improve physical performance in healthy elderly women. Design: In a parallel-group, randomized controlled trial, 139 healthy women (mean 6 SD age: 71.5 6 5.2 y) attending a mild fitness program were randomly allocated to a treatment group (300 mg Mg/d; n = 62) or a control group (no placebo or intervention; n = 77) by using a computer-generated randomization sequence, and researchers were blinded to their …

Tophaceous gout in the elderly: A clinical case review

Gout is the most common cause of arthritis in the elderly. Its incidence among older people has risen worldwide due to an increase in risk factors such as renal diseases, metabolic syndrome, and a diet rich in purines. In older age, tophaceous gout may affect different joints from its classical presentation, due to other concomitant musculoskeletal diseases, but specific data on its epidemiology and clinical aspects in the elderly are limited to a few case reports. The present review focuses on the distinctive aspects of tophaceous gout in the elderly, revisiting all our clinical cases seen from 1990 to December 2011. Our findings indicate that: tophaceous gout can affect several joints in …

Serum 25-Hydroxyvitamin D and Osteoarthritis in Older People: The Progetto Veneto Anziani Study.

Recent work has shown that low 25-hydroxyvitamin D (25OHD) levels are associated with the presence of osteoarthritis (OA), but these studies focused on radiographical changes of OA, investigated only one joint, and did not consider the association with OA-related pain. In this study, we aimed to examine the relationship between 25OHD levels and any presence of OA and pain in a cohort of older people. This study was part of the Progetto Veneto Anziani (Pro.V.A), a population-based cohort study in older people. In this cross-sectional work, we considered 2756 subjects (1102 males and 1654 females) with a mean age of 74.2 ± 7.1 years. OA and OA-related pain were defined using a standardized al…

Nutritional status, physical performance and disability in the elderly of the Peruvian Andes

Background: Although nutritional status plays an important part in the physical performance and disability of older people, this relationship has been little studied in developing countries. Aims: A study on the effects of nutritional status on the physical performance and functional status of elderly people living in rural areas of the Peruvian Andes. Methods: The study concerned 222 people aged ≥65 years living in a rural area of the Peruvian Andes. The Mini-Nutritional Assessment (MNA) was used to classify participants as malnourished (MNA <= 17), at risk of malnutrition (MNA 18-23), or well-nourished (MNA>= 24). The short physical performance battery (SPPB) and six-minute walking …

Magnesium Status in Alzheimer's Disease: A Systematic Review

The interest in poor magnesium (Mg) status as risk factor for Alzheimer's disease (AD) is increasing due to its antioxidant and neuroprotective properties. A systematic PubMed literature search of studies investigating Mg status was undertaken comparing AD to healthy controls (HCs) or patients with medical illness (medical controls [MCs]). Standardized mean differences (SMDs) ± 95% confidence intervals (CIs) were calculated for all outcomes. Of 192 potentially eligible studies, 13 were included (559 patients with AD, 381 HCs, and 126 MCs). Compared to HCs, patients with AD had significantly lower Mg in cerebrospinal fluid (2 studies; SMD = -0.35; P =.02) and in hair (2 studies; SMD = -0.75;…

Validation of bioelectrical impedance analysis for estimating limb lean mass in free-living Caucasian elderly people

Background & aims Aging is characterized by a loss of limb lean mass (LLM) that can lead to physical disability and death. Regional bioelectrical impedance analysis (BIA) may be a reliable method for estimating LLM, but no prediction equations are available for elderly Caucasian subjects. The aim of this study was to develop and validate a BIA-based equation for predicting LLM in healthy elderly Caucasians, taking dual X-ray absorptiometry (DXA) as the reference method. Methods Using a cross-sectional design, 244 free-living healthy Caucasian subjects (117 men, 179 women) over 60 years of age were enrolled. LLM was measured with DXA (LLMDXA), and the resistance (Rz) and reactance (Xc) o…

Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients: A systematic review and an exploratory meta-analysis

Invasive breast cancer is the most common malignancy in women. Its most common site of metastasis is represented by the lymph nodes of axilla, and the sentinel lymph node (SLN) is the first station of nodal metastasis. Axillary SLN biopsy accurately predicts axillary lymph node status and has been accepted as standard of care for nodal staging in breast cancer. To date, the morphologic aspects of SLN metastasis have not been considered by the oncologic staging system. Extranodal extension (ENE) of nodal metastasis, defined as extension of neoplastic cells through the nodal capsule into the peri-nodal adipose tissue, has recently emerged as an important prognostic factor in several types of …

Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: A systematic review and meta-analysis

We conducted a systematic review and meta-analysis investigating the influence of acetylcholinesterase inhibitors (AChEIs) therapy on nutritional status and weight across observational and interventional studies. Two authors searched major electronic databases from inception until 10/14/2015 for longitudinal, open-label and randomised double-blind placebo controlled (randomised controlled trials (RCTs)) studies of AChEIs in patients with dementia reporting nutritional status outcome data. Out of 3551 initial hits, 25 studies (12 open-label trials, 9 RCTs and 4 longitudinal studies) including 10 792 patients with dementia were meta-analysed. In longitudinal studies (median follow-up 6 months…

Association Between Short Physical Performance Battery and Falls in Older People: The Progetto Veneto Anziani Study.

It is known that weakness in the lower limbs is associated with recurrent falls in old people. Among the tests routinely used to assess lower extremity strength, the Short Physical Performance Battery (SPPB) is one of those used most often, but its relationship with recurrent falls is poorly investigated. We aimed to determine if SPPB scores are related to recurrent falling in a sample of 2710 older-aged people, and to ascertain which test in the SPPB is most strongly associated with a higher rate of falls. In this cross-sectional study, we demonstrated that participants scoring 0-6 in the SPPB were more likely to be recurrent fallers than those scoring 10-12 (odds ratio [OR]=3.46, 95% conf…

Low vitamin D levels increase the risk of type 2 diabetes in older adults: A systematic review and meta-analysis

Low serum levels of 25 hydroxyvitamin D (25OHD) (hypovitaminosis D) is common in older adults and associated with several negative outcomes. The association between hypovitaminosis D and diabetes in older adults is equivocal, however. We conducted a meta-analysis investigating if hypovitaminosis D is associated with diabetes in prospective studies among older participants. Two investigators systematically searched major electronic databases, from inception until 10/07/2016. The cumulative incidence of diabetes among groups was estimated according to baseline serum 25OHD levels. Random effect models were used to assess the association between hypovitaminosis D and diabetes at follow-up. From…

Taste loss in the elderly: Possible implications for dietary habits.

Aging may coincide with a declining gustatory function that can affect dietary intake and ultimately have negative health consequences. Taste loss is caused by physiological changes and worsened by events often associated with aging, such as polypharmacy and chronic disease. The most pronounced increase in elderly people's detection threshold has been observed for sour and bitter tastes, but their perception of salty, sweet, and umami tastes also seems to decline with age. It has often been suggested that elderly people who lose their sense of taste may eat less food or choose stronger flavors, but the literature has revealed a more complicated picture: taste loss does not appear to make el…

Marital status and frailty in older people: Gender differences in the Progetto Veneto Anziani longitudinal study

Objectives: Marital status has been associated with disability and mortality, but its potential role as a factor influencing frailty has yet to be thoroughly investigated. The analysis of gender-related differences in the relationship between marital status and frailty is another interesting matter that remains to be fully elucidated. The aim of our study was to examine the association between marital status and the incidence of frailty in a cohort of older men and women over a 4.4-year follow-up. Materials and Methods: A sample of 1887 subjects older than 65 years, enrolled under the Progetto Veneto Anziani (Pro.V.A.) and with no evidence of frailty at baseline, were grouped by marital sta…

Anorexia and Eating Patterns in the Elderly

Objectives To evaluate the change in eating habits occurring in community- dwelling and institutionalized elderly subjects with senile anorexia. Design Cross- sectional, observational. Setting Community, nursing homes and rehabilitation or acute care facilities in four Italian regions. Participants A random sample of 526 subjects, aged 65 years and older (217 free living individuals, 213 residents in nursing homes, and 93 patients in rehabilitation and acute wards). Measurements All subjects underwent a multidimensional geriatric evaluation of: nutritional status, anthropometric parameters, health and cognitive status, depression, taste, chewing and swallowing function, and some hormones re…

Factors Influencing Transitions Between Frailty States in Elderly Adults: The Progetto Veneto Anziani Longitudinal Study.

Objectives: To investigate frailty state transitions in a cohort of older Italian adults to identify factors exacerbating or improving frailty conditions. Design: Population-based longitudinal study with mean follow-up of 4.4 years. Setting: Community. Participants: Individuals enrolled in the Progetto Veneto Anziani (Pro.V.A.) (N = 2,925; n = 1,179 male, n = 1,746 female; mean age 74.4 ± 7.3). Measurements: Frailty was identified at baseline and follow-up based on the presence of at least three Fried criteria; prefrailty was defined as the presence of one or two Fried criteria. Anthropometric, socioeconomic, and clinical characteristics were assessed at baseline in a personal interview and…

Prognostic role and implications of mutation status of tumor suppressor gene ARID1A in cancer: A systematic review and meta-analysis

Loss of the tumor suppressor gene AT-rich interactive domain-containing protein 1A (ARID1A) has been demonstrated in several cancers, but its prognostic role is unknown. We aimed to investigate the risk associated with loss of ARID1A (ARID1A-) for all-cause mortality, cancer-specific mortality and recurrence of disease in subjects with cancer. PubMed and SCOPUS search from database inception until 01/31/2015 without language restriction was conducted, contacting authors for unpublished data. Eligible were prospective studies reporting data on prognostic parameters in subjects with cancer, comparing participants with presence of ARID1A (ARID1A+) vs. ARID1A-, assessed either via immunohistoch…

Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living Caucasian older adults

Background & aims: Aging is characterized by a loss of appendicular skeletal muscle mass (ASMM) leading to physical disability and death. Bioelectrical impedance analysis (BIA) is reliable in estimating ASMM but no prediction equations are available for elderly Caucasian subjects. The aim of the study was to develop and validate an equation derived from bioelectrical impedance analysis (BIA) to predict appendicular skeletal muscle mass (ASMM) in healthy Caucasian elderly subjects, taking dual X-ray absorptiometry (DXA) as the reference method, and comparing the reliability of the new equation with another BIA-based model developed by Kyle etal. (Kyle UG, Genton L, Hans D, Pichard C, 200…

A rare case of sepsis due to Corynebacterium macginleyi from central venous catheter in an elderly woman

Corynebacterium macginleyi is a gram positive rod that causes especially ocular infections: since now only six elderly cases of extraocular infection are described. A 76 years old bedridden woman with a central venous catheter was hospitalized for 10 days of persistent fever. She was treated before with vancomicin and then with imipenem. The clinical conditions improved and the patient was discharged after two weeks of hospitalization. Among recognised risk factors for this infection the advanced age, indwelling devices and immunosuppression seem the most important. On the other hand, the antibiotics of choice are glycopeptides while the association of another antibiotic is recommended in o…

A new diagnosis of left main coronary artery atresia in a very old woman

Serum Dehydroepiandrosterone Sulfate and Incident Depression in the Elderly: The Pro.V.A. Study

Objective: Dehydroepiandrosterone sulfate (DHEAS) appears to have a protective effect against depression, but contrasting findings are available. Therefore, we investigated whether high serum DHEAS levels were associated with any protective effect on incident depression and incident severe depression in a representative group of elderly men and women. Methods: In a population-based cohort longitudinal study in the general community, 789 older participants without depression and cognitive impairment at the baseline were included, among 3,099 screened subjects. Serum DHEAS levels were determined based on blood samples; incident depression and severe depression were diagnosed by means of the G…

Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up.

Background/Objectives:The objective of this study was to ascertain the effect of weight loss over the course of 1 year on 5-year mortality in old nursing home (NH) residents in different classes of body mass index (BMI).Subjects/Methods:A longitudinal study was conducted on 161 NH residents aged ≥70 years at the Istituto di Riposo per Anziani, Padova, Italy. Data were collected using a comprehensive geriatric assessment at baseline and at a 1-year follow-up visit. Mortality was recorded over a 5-year follow-up. We divided our sample into four groups using as cutoffs a BMI of 25 and a weight gain or loss of 5% at 1 year (BMI ≥25 and weight stable/gain, BMI ≥25 and weight loss, BMI<25 and …

Effect of Oral Beta-Hydroxy-Beta-Methylbutyrate (HMB) Supplementation on Physical Performance in Healthy Old Women Over 65 Years: An Open Label Randomized Controlled Trial

Although older people are particularly liable to sarcopenia, limited research is available on beta-hydroxy-beta-methylbutyrate (HMB) supplementation in this population, particularly in healthy subjects. In this parallel-group, randomized, controlled, open-label trial, we aimed to evaluate whether an oral supplement containing 1.5 g of calcium HMB for 8 weeks could improve physical performance and muscle strength parameters in a group of community-dwelling healthy older women. Eighty healthy women attending a twice-weekly mild fitness program were divided into two equal groups of 40, and 32 of the treated women and 33 control completed the study. We considered a change in the Short Physical …

Hypovitaminosis D and orthostatic hypotension: A systematic review and meta-analysis

Objectives: Orthostatic hypotension is a common condition among older adults and is associated with a range of deleterious outcomes. Recently, interest has developed in hypovitaminosis D (defined as low 25 hydroxiyVitamin D levels) as a potential risk factor for orthostatic hypotension. We conducted a systematic review and meta-analysis examining the association of orthostatic hypotension between study participants with and without hypovitaminosis D, including the adjustment of potential confounders (age, sex, BMI, renal function, comorbidities, seasonality, use of antihypertensive medications, and supplementation with cholecalciferol). Methods: A systematic literature search of major elect…

Effects of 6 Weeks of Traditional Resistance Training or High Intensity Interval Resistance Training on Body Composition, Aerobic Power and Strength in Healthy Young Subjects: A Randomized Parallel Trial

Consistent practice of physical activity has well known positive effects on general health

Preventive effect of risedronate on bone loss and frailty fractures in elderly women treated with anastrozole for early breast cancer.

The aim of this study was to assess the effect of adjuvant anastrozole, alone or associated with risedronate, on BMD and bone fracture risk in women more than 70 years old with hormone receptor-positive early breast cancer (EBC). In a group of 51 elderly women (aged 76.4 ± 5.0 years) considered for adjuvant aromatase inhibitors for EBC, 24 patients with T-scores ≥ -2 and no prevalent fractures received anastrozole 1 mg/day (group A), and 27 patients with T-scores < -2, or with T-scores ≥ -2 and prevalent fractures (group B), received anastrozole (1 mg/day) plus risedronate (35 mg/week). Both groups received supplementation with 1 g calcium carbonate and 800 IU vitamin D per day. Differen…

Osteoarthritis and mortality: a prospective cohort study and systematic review with meta-analysis

Objectives: Osteoarthritis (OA) is a leading cause of disability, but the relationship with premature mortality remains uncertain. We aimed to investigate the relationship between OA and mortality from any cause and from cardiovascular disease (CVD).\ud \ud Methods: Electronic literature databases searches were conducted to identify prospective studies comparing mortality in a sample of people with and without OA. Risk of all-cause and CVD mortality were summarized using adjusted hazard ratios (HRs) for joint specific (hand, hip, and knee) and joint non-specific OA. New data from the Progetto Veneto Anziani (PRO.V.A.) study were also included. Results: From the PRO.V.A. study (N 1⁄4 2927), …

Are the Recommended Dietary Allowances for Vitamins Appropriate for Elderly People?

Background: An adequate vitamin intake is essential for a good nutritional status, especially in older women, who are more sensitive to nutritional deficiencies. The American, European and Italian Recommended Dietary Allowances (RDAs) derive mainly from studies on adults, and it is not clear whether they also apply to elderly people. Comparing the RDAs with the actual vitamin intake of a group of healthy older women could help to clarify the real needs of elderly people. Objective: Our aim was to compare the American, European, and Italian RDAs with the actual vitamin intake of a group of healthy older women. Design: This was a cross-sectional study. Participants: The study included 286 hea…

Extranodal extension of lymph node metastasis is a marker of poor prognosis in oesophageal cancer: A systematic review with meta-analysis

The extranodal extension (ENE) of nodal metastasis is the extension of neoplastic cells through the nodal capsule into the perinodal adipose tissue. This histological feature has recently been indicated as an important prognostic factor in different types of malignancies; in this manuscript, we aim at defining its role in the prognosis of oesophageal cancer with the tool of meta-analysis. Two independent authors searched SCOPUS and PubMed until 31 August 2015 without language restrictions. The studies with available data about prognostic parameters in subjects with oesophageal cancer, comparing patients with the presence of ENE (ENE+) versus only intranodal extension (ENE-), were considered…

Serum 25-hydroxyvitamin D and the incidence of peripheral artery disease in the elderly: The Pro.V.A study

Aim: This study was conducted to examine whether low serum levels of 25-hydroxyvitamin D (250HD) are associated with a higher risk of incident peripheral artery disease (PAD) in a representative group of elderly people. Methods: We followed 1568 community-dwelling elderly participants without PAD at the baseline among a sample of 2097 initially eligible over a mean of 4.4 years as part of the Progetto Veneto Anziani (Pro.V.A.) study. The baseline serum 250HD levels were categorized as <24, 25-49, 50-74, >75 nmol/L, and incident PAD was defined as an ankle-brachial index below 0.9. Results: At the baseline, there were no differences in known risk factors for PAD (BMI), waist circumfere…

Nutritional and global indexes of progression in dementia: a 12-month prospective study.

Background: To assess the influence of body mass index (BMI) on the progression of dementia. Methods: Sixty elderly outpatients with untreated dementia followed for 12 months. All patients underwent clinical, cognitive, functional, and nutritional assessment at the baseline and after 12 months. Patients were divided into 2 groups by baseline BMI (< or ≥25 kg/m2). Results: Participants with a baseline BMI ≥25 kg/m2 had significantly higher Mini-Mental State Examination (MMSE) scores (21 ± 5.1 vs 15.9 ± 5.5; P < .001), while clinical dementia rating (CDR) and multidimensional prognostic index (MPI) scores were similar in the 2 groups. After 12 months, the MMSE score decreased significan…

Imaging of sarcopenia.

Sarcopenia is currently considered a geriatric syndrome increasing in older people. The consequences of sarcopenia – in terms of impaired mobility, limited self-sufficiency and disability – have been amply demonstrated, increasing the need to develop methods to identify muscle mass loss as early as possible. Although sarcopenia involves a reduction in both muscle mass and function, loss of muscle mass remains the essential criterion for diagnosing this condition in daily practice. Computed tomography and magnetic resonance imaging represent the gold standard for studying body composition, and can identify quantitative and qualitative changes in muscle mass. These techniques are costly, time…

Serum 25-Hydroxyvitamin D and Incidence of Diabetes in Elderly People: The PRO.V.A. Study

Context: Increasing research has shown that low levels of serum 25-hydroxyvitamin (25OHD) predict the onset of diabetes, but no research is available on this issue in elderly people. Objective: Our objective was to examine whether low serum levels of 25OHD are associated with a higher risk of incident type 2 diabetes over a lengthy follow-up in a representative group of elderly people. Design and Setting: This was a population-based cohort study as part of the Progetto Veneto Anziani (Pro.V.A.) Study over a follow-up of 4.4 years in the general community. Participants: Participants included 2227 participants (1728 with follow-up visits and 499 died during the follow-up) over 65 years of ag…

Senile anorexia in acute-ward and rehabilitations settings.

The most common pathological change in eating behaviour among older persons is anorexia, which accounts for a large percent of undernutrition in older adults. The main research aims are to determine, in a sample of acute and rehabilitation elderly subjects, the prevalence of anorexia of aging and the causes most impacting on senile anorexia.Methods: four different Units cooperated to this research study. Patients were recruited from geriatric acute and rehabilitation wards in Italy. Each Research Unit, for the estimation of the prevalence of anorexia in elderly subjects evaluated all the patients aged over 65 recruited from April 2006 to June 2007. Nutritional status, depression, social, fu…

A case of hypocalcemia

Hypocalcemia is a common disorder in the elderly, affecting 10% of the elderly population as a whole, 18% of those in hospital and 36% of those in long-term care [1, 2]. Many conditions can lead to hypocalcemia in adults young and old, e.g. primary hypoparathyroidism, chronic renal failure, gastrointestinal diseases (such as celiac disease or Crohn’s disease), drugs (particularly diuretics, bisphosphonates and antiepileptics), acute pancreatitis and thyroid surgery. Rare causes of hypocalcemia include isolated vitamin 1.25(OH)D3 deficiency or vitamin 1.25(OH)D3 resistance. Another, often neglected cause of hypocalcemia relating to functional parathyroid deficiency is hypomagnesemia. Magnesi…

Pain increases the risk of developing frailty in older adults with osteoarthritis

OBJECTIVE.: While osteoarthritis (OA)-related pain increases the risk of physical inactivity, disability, and falls, less is known about whether pain increases the risk of frailty. We investigated if people with OA reporting pain are more likely to develop frailty than people with OA without pain. DESIGN.: Population-based prospective cohort study with a follow-up of 4.4 years. SETTING.: Community. SUBJECTS.: The subjects were 1,775 older men and women with osteoarthritis, enrolled in the Progetto Veneto Anziani. METHODS.: Pain was ascertained according to medical records, symptoms/signs, and use of analgesics. Participants were considered frail if they met three out of five criteria of Fri…