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Little is known of the factors that transform fear of falling (FOF) from a normal adaptive to a maladaptive response that could alter its impact on fall risk. Focusing on judgment capacity, we investigated whether it is associated with FOF and FOF-related activity restriction (AR), and whether it modifies the influence of FOF on fall risk. Data came from 2625 community-dwelling older adults enrolled in the Progetto Veneto Anziani. Baseline FOF and AR were assessed through personal interviews, and judgment capacity-high, moderate, or poor-through situational tests. At follow-up after 4.4 years, self-reported falls during the previous year were recorded. The associations between judgment and FOF/AR, and between FOF and the risk of at least one fall or recurrent falls (two or more falls), stratified by judgment capacity, were evaluated using multinomial logistic regressions. Compared with high-judgment participants, lower judgment participants were 20% more likely to report FOF; moderate judgment participants were 54% more likely and poor judgment participants twice as likely to report AR. After adjusting for potential confounders, including physical activity and physical performance, FOF increased the reporting of at least one fall only in the poor judgment group. The association between FOF and recurrent falls was stronger in individuals with poor (odds ratio [OR] = 3.66, 95% confidence interval [CI]: 2.10-6.36) than with moderate (OR = 2.81, 95% CI: 2.22-3.55) or high (OR = 1.65, 95% CI: 1.48-1.83) judgment. Poor judgment capacity increases the probability of FOF and AR in older adults, and may exacerbate the effect of FOF in increasing fall risk.

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 five Fried's criteria. At baseline, taking those in the third quintile of serum TSH as reference (Q3) and adjusting for potential confounders, participants in the highest (Q5) quintile had an increased odds ratio (OR) of having frailty (OR = 1.55; 95% confidence interval [CI]: 1.03-2.33 for men; OR = 1.97; 95% CI: 1.59-2.45 for women). Men in Q1 had significant higher odds of having muscle weakness and exhaustion, while those in Q5 had muscle weakness and slow gait speed. Women in Q1 had significantly higher odds of having all the Fried's criteria (except for exhaustion), while those in Q5 reported a significantly higher presence of muscle weakness and slow gait speed. At follow-up, men in Q5 had an increased risk of frailty (OR = 1.37; 95% CI: 1.02-1.91) similar to women in Q1 (OR = 1.47; 95% CI: 1.21-1.78). In conclusion, men with higher and women with lower serum TSH levels are at increased risk of frailty.

Hyperuricemia (HU) is growing worldwide and associates with several medical conditions in the elderly. However, data about older people and possible gender differences are sparse. The aim of this study was to compare HU prevalence rates and association with relevant medical disorders in elderly subjects of both sexes. Pro.V.A. is a survey of 3099 individuals aged 65+, focusing on chronic diseases and disability. Uric acid (UA) levels were dichotomized using 6.0 mg/dL (females) and 7.0 mg/dL (males), and multivariate logistic regression models were used to estimate odds ratios (ORs) between HU and single comorbidity. HU prevalence was 21.5% in females and 15.8% in males. HU was associated with most anthropometric and laboratory variables in women, but not in men. After adjustment for age, body mass index, and renal function, HU was independently associated with the presence of cardiovascular diseases in both sexes. In women, HU was associated with hand osteoarthritis (OR = 1.52; 95%CI: 1.12-2.08) and edentulism (OR = 1.31; 95%CI: 1.01-1.71), while resulted protective for osteoporosis (OR = 0.69; 95%CI: 0.53-0.91). In men, HU was significantly related with knee osteoarthritis (OR = 1.72; 95%CI: 1.06-2.79) and chronic obstructive pulmonary disease (OR = 1.60; 95%CI: 1.04-2.45). The presence of ≥4 comorbidities was a stronger determinant of HU in men (OR = 2.54; 95%CI: 1.21-5.37) than in women (ns). Patterns of age-dependent UA increase are markedly different in men and women. HU prevalence is substantial and its association with other diseases is gender specific, connoting a peculiar clinical profile.

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 geriatricians skilled in psychogeriatric medicine. No differences in baseline MMSE scores across Hb tertiles emerged in either gender. After the 4.4 years of follow-up, we identified 403 new cases of cognitive impairment (147 men and 256 women). Cox's regression analysis showed that participants with the lowest baseline Hb concentrations carried a significant 37% higher risk (95% confidence interval [CI]: 1.08-1.75; p = 0.01) of being diagnosed with cognitive impairment during the follow-up. Considering the gender separately, the risk of cognitive impairment only increased significantly, by 60%, for men in the lowest Hb tertile (95% CI: 1.06-2.41; p = 0.02), but not for women (hazard ratio = 1.32; 95% CI: 0.97-1.79; p = 0.08). In conclusion, low Hb concentrations may predict the onset of cognitive impairment in the elderly, apparently with a stronger association in men than in women.

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 algorithm investigating disease history, medical documentation, symptoms, and physical examination of the joints. On logistic regression analysis, taking those in the highest 25OHD quartile for reference, those in the lowest quartile had significantly higher odds of OA involving the hands (odds ratio [OR] = 1.26, 95% confidence interval [CI] 1.15-1.38 in the sample as whole; 1.36, 95% CI 1.15-1.60 in men and 1.22, 95% CI 1.09-1.37 in women), and pain (OR = 1.18, 95% CI 1.06-1.32 in the sample as whole; 1.52, 95% CI 1.21-1.90 in men and 1.15, 95% CI 1.03-1.29 in women). Similar results were found for the hip. For the knee, low 25OHD levels were associated with the presence of OA in the sample as a whole, and in women, and with the presence of pain in the sample as a whole. In conclusion, low 25OHD levels are associated with the presence of OA and with OA-related pain, particularly when the hand and hip are involved.

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% confidence interval [CI] 2.04-5.88 in women; OR=3.82, 95% CI 1.77- 8.52, in men). SPPB scores of 7-9 were only associated with women being more likely to be recurrent fallers (OR=2.03, 95% CI 1.28-3.22). When the SPPB items were analyzed separately, even a lower score in gait speed for women was significantly associated with the presence of recurrent falls (OR=2.11; 95% CI 1.04-4.30), whereas in men only a significant increase in the time taken to complete the five timed chair stands test was associated with a higher rate of falls (OR=2.75; 95% CI 1.21-6.23). In conclusion, our study demonstrated that SPPB scores ≤6 are associated with a higher fall rate in old people of both genders; in females, even an SPPB score between 7 and 9 identifies subjects at a higher likelihood of being recurrent fallers. Among the single items of the SPPB, the most strongly associated with falls were gait speed in women and the five timed chair stands test in men.