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Résumé Introduction Le suicide concerne toutes les tranches d’âges et les sujets âgés sont parmi les plus touchés en termes de mortalité. Dépister et évaluer le risque suicidaire des personnes âgées est indispensable en termes de prévention et de prise en charge. L’objectif de ce travail est de réaliser une synthèse bibliographique des outils d’évaluation du risque suicidaire chez les sujets âgés à partir de la littérature. Méthodologie Nous avons réalisé une revue de la littérature en utilisant comme moteur de recherche « Pub Med », « EMC », « PsychINFO » et « Google Schoolar ». Les mots clés que nous avons employés sont : suicide, psychogeriatrics, elders age, status rating scale, attempted suicide. Résultats Nous avons retenu au total trois échelles pour évaluer le risque suicidaire chez les patients âgés. L’échelle d’idéation suicidaire gériatrique (GSIS), la plus récemment élaborée, est une échelle spécifique, d’utilisation facile et de passation rapide. Les deux autres échelles, l’échelle d’idéation suicidaire (BSS) et l’échelle de désespoir de Beck (BHS), ont aussi montré leur efficacité et leur fiabilité chez les patients âgés. Discussion À partir des caractéristiques cliniques et psychométriques de ces outils, nous discutons de leur intérêt pour les cliniciens, en premier lieu les médecins traitants, consultés par la plupart des sujets âgés durant le mois précédant leur geste suicidaire. Conclusion Les sujets âgés sont plus exposés au risque suicidaire ; le geste est souvent réalisé avec une forte intentionnalité. Les échelles d’évaluation du risque suicidaire peuvent aider le praticien à réaliser une meilleure prévention ou prise en charge des patients âgés concernés. Introduction Suicide affects all age groups and the elderly are among the most affected in terms of mortality. Screening and assessing the suicidal risk of elderly people are essential in terms of prevention and care. The purpose of this work is to carry out a bibliographical synthesis of the evaluation tools of the suicidal risk in the elderly subjects from literature. Methodology We conducted a literature review using Pub Med, EMC, PsychINFO and Google Scholar as search engines. The keywords we used are: suicide, psychogeriatrics, elders age, status rating scale, suicide attempt. Results We have retained in total three scales to assess suicidal risk in elderly patients. The most recently developed Geriatric Suicide Ideation Scale (GSIS) is specific, easy-to-use and rapid scale. The two other scales, the Beck Hopelessness Scale (BHS) and the Beck Scale for suicide Ideation (BSS), also showed their effectiveness and reliability in older patients. Discussion Based on the clinical and psychometric characteristics of these tools, we discuss their interest for clinicians, first the attending physicians, consulted by most of the elderly subjects during the month preceding their suicidal act. Conclusion Elderly subjects are more exposed to suicidal risk; the gesture is often performed with a strong intentionality. Scales of suicidal risk assessment can help the practitioner achieve better prevention or care of the elderly patients concerned. [ABSTRACT FROM AUTHOR]

Dynamic modeling of the human body is an important tool to investigate the fundamentals of the biomechanics of human movement. To model the human body in terms of a multi-body system, it is necessary to know the anthropometric parameters of the body segments. For young healthy subjects, several data sets exist that are widely used in the research community, e.g. the tables provided by de Leva. None such comprehensive anthropometric parameter sets exist for elderly people. It is, however, well known that body proportions change significantly during aging, e.g. due to degenerative effects in the spine, such that parameters for young people cannot be used for realistically simulating the dynamics of elderly people. In this study, regression equations are derived from the inertial parameters, center of mass positions, and body segment lengths provided by de Leva to be adjustable to the changes in proportion of the body parts of male and female humans due to aging. Additional adjustments are made to the reference points of the parameters for the upper body segments as they are chosen in a more practicable way in the context of creating a multi-body model in a chain structure with the pelvis representing the most proximal segment. [ABSTRACT FROM AUTHOR]

Background: Changes arising from the aging process, particularly changes in body composition, contribute to the functional decline of the elderly. Objective: To compare the body composition and muscle strength, mobility and quality in active elderly women according to the distance walked during the 6-minute walk test (6MWT). Method: The study included 77 active elderly women aged 65 to 80 years, who were divided into tertiles (A, B and C) according to the distance covered in the 6MWT. We performed anthropometric and clinical evaluations. Body composition was determined by dual energy X-ray absorptiometry (DXA). Handgrip strength (HGS) was measured with a portable dynamometer (Saehan), and knee extension strength (KES) was measured with the one repetition maximum test (1-RM). Functional mobility was assessed by the Timed Up and Go (TUG) test, and body balance was assessed by the Berg Balance Scale (BBS). Muscle quality was defined by the ratio between muscle strength (kgf) and muscle mass (kg). Results: The group that walked the shortest distance in the 6MWT had a higher BMI (A=30.8±7.0, B=27.2±4.2 and C=25.9±3.5 kg/m2), greater amount of fat mass (A=31.3±10.7, B=25.9±6.7 and C=23.81±6.46 kg) lower HGS (A=21.8±5.1, B=22.1±3.5 and C=25.5±5.1 kgf), lower knee extension strength (A=30.6±10.9, B=40.4±12.5 and C=47.2±10.1 kgf), lower arm muscle quality (A=10.1±3.7, B=11.6±2 and C=12.7±2.2 kg) and lower leg muscle quality (A=1.78±1, B=2.84±0.98 and C=3.31±0.77 kg). There was no significant difference between muscle mass (p=0.25) and lean mass (p=0.26). Conclusion: Body fat has a negative influence on functional performance, even among active elderly women. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: We evaluated the incidence of myocardial infarction (MI) in a population of Southern Italy and the relationship of dietary macronutrients with incident MI. Methods and results: The ONCONUT cohort included 5632 subjects followed-up, over 50 years, recruited in 1992. At baseline, they completed a validated semi-quantitative food frequency questionnaire and gave details of their medical history. After 5years they were traced by their family physician, who found 108 incident MI. Ninety-seven of them and 194 controls, sampled from the noncases at baseline and paired for diabetes to the cases, entered this nested case-control study. MI rate per 1000 person-years was 9.6 in males and 3.7 in females. In non-diabetics, saturated fat were associated with MI directly (odds ratio (OR): tertile 2 vs. 1 = 2.32, tertile 3 vs. 1 = 2.82; chi-square for trend, p = 0.03) and polyunsaturated fats inversely (OR: tertile 2 vs. 1 = 0.80, tertile 3 vs. 1 = 0.37; chi-square for trend, p = 0.05), while in diabetics, starchy carbohydrates (OR: tertile 2 vs. 1 = 1.51, tertile 3 vs. 1 = 6.73; chi-square for trend, p = 0.01) and glycaemic index (OR: tertile 2 vs. 1 = 2.74, tertile 3 vs. 1 = 5.34; chi-square for trend, p = 0.01) were associated directly with MI. Conclusions: MI incidence in this population was lower than that found in northern countries. In non-diabetics, saturated fats were associated directly and polyunsaturated fat inversely with MI; in diabetics, starchy carbohydrates and high-glycaemic-index foods were associated directly with MI. [Copyright &y& Elsevier]

Abstract: Background: Fixed-dose combined isosorbide dinitrate/hydralazine (FDC I/H) significantly improved outcomes in patients with advanced heart failure (HF) receiving background neurohormonal therapy in the African-American Heart Failure Trial (A-HeFT). In this analysis, we investigated treatment effects by age <65 or ≥65 years. Methods and Results: Time-to-event curves were produced by the Kaplan-Meier method. Hazard ratios were calculated with the Cox proportional hazards model. Baseline characteristics showed that patients ≥65 years old had less hypertensive and more ischemic HF, better quality of life (QoL) scores, higher plasma B-type natriuretic peptide and creatinine levels, and received less background neurohormonal therapy. Kaplan-Meier curves showed that FDC I/H improved mortality and event-free survival in elderly patients. The hazard ratios for mortality, first heart failure hospitalization, and event-free survival (both unadjusted and adjusted for baseline differences), were similar quantitatively and in direction of effect in both age groups. Conclusions: In A-HeFT, FDC I/H improved outcomes in HF patients aged <65 or ≥65 years, despite significant baseline differences between these age groups. Patients aged ≥65 years, a group at greater mortality risk, had the greatest survival benefit from FDC I/H. [Copyright &y& Elsevier]

Abstract: The aim of the study was to explore the relation between saliva level of 3-methoxy-4-hydroxy-phenylglycol (MHPG) and a later cognitive decline in non-demented elderly subjects. We have reported that sMHPG in 214 elderly subjects living in the community (age 74.5±5.9years) was associated with scores on the Mini-Mental State Examination (MMSE) and the Frontal Assessment Battery (FAB) in 2004 to 2006 (Time A). The same cohort underwent these cognitive tests again from 2007 to 2009 (Time B). The cognitive function of the 147 of 214 subjects could be reassessed by the same cognitive tests. The score on the FAB, but not the MMSE, was significantly reduced at Time B (14.6±2.6) compared with that of Time A (15.2±1.9). There was a significant negative correlation between the baseline sMHPG and the changes in the FAB score subtracted from Time B to Time A or the scores on the FAB at Time B in men, but not at Time A. These correlations were not found in women. These data indicate that high sMHPG might be associated with subsequent cognitive decline assessed by the FAB in non-demented elderly men living in the community. [Copyright &y& Elsevier]

Abstract: Background and Aim: Depression is emerging as an independent risk factor for CV events, though mechanisms underlying this association are unknown. We investigated the relation between depression and LV hypertrophy (LVH) and LV structure in a group of elderly subjects. Methods and Results: Three hundred seventy patients (mean age 79 ± 6 years) were enrolled. CV risk factors were assessed. Depression was defined as a score ≥6 on the 15-item Geriatric Depression Scale. On the basis of the presence of LVH and of LV relative wall thickness (RWT) 4 echocardiographic patterns of LV adaptation were defined: concentric LVH (LVH with increased RWT); eccentric LVH (LVH with normal RWT); concentric LV remodeling (no LVH with increased RWT); normal LV (no LVH with normal RWT). Prevalence of hypertension was approximately 86% and 24.7% had diabetes (n.s. depressed vs not depressed subjects). BP was comparable in these two groups (134.7 ± 1.4 vs 135.3 ± 1.8 mmHg, 77.1 ± 0.8 vs 76.3 ± 1.0 mmHg for SBP and DBP respectively). Depressed subjects (n = 165) showed a significantly higher occurrence of concentric LVH than not depressed, after adjustment for age, sex, and hypertension. Depression was associated with a 2.1 fold higher risk of showing a LV concentric, either remodeling or LVH, pattern after adjustment for age, sex, and traditional CV risk factors. Conclusions: Depression is accompanied by a higher occurrence of concentric LVH in elderly subjects, independently of BP levels. [Copyright &y& Elsevier]

Summary: SPH is a subjective and objective assessment of personal health. It is important in evaluation of health status in the elderly as it has capacity to predict mortality, functional declining, and health-care demands. A lot of research has been published about SPH in the elderly, but little is known about SPH in the very old, especially in comparison with the “younger-old” (YO) population. The study has aimed to investigate SPH in 240 elderly patients and compare the data between the “oldest-old” (OO) (aged>90 years; n=52) and the YO (aged 60–74 years; n=188) subjects. Results have shown that the OO group of patients had better SPH than their YO counterparts. Our findings implicate that very old persons belong to a special sub-group of elderly, the “successfully aged”, probably due to their genetic stability, distinctive lifestyle, or both. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this study was to evaluate the inflammatory cell subset proportions in the upper gingival connective tissue, including mature dendritic cells (DC) in elderly and younger patients with generalized chronic periodontitis in order to further understand the effect of aging on gingival inflammatory phenomenon. Methods: Gingival tissue specimens presenting chronic periodontitis from 8 elderly patients aged >75 (test group, group T) and from 8 younger patients aged 50–60 (considered as controls, group C) were analysed by immunohistochemistry using monoclonal antibodies against CD45RB, CD4, CD8, CD19, CD68, DC-SIGN, DC-LAMP molecules. The number of each immunolabelled cells subset was counted using image analysis. Results: The difference in the number of CD45RB+leucocytes in the upper gingival connective tissue between groups was not significant permitting to use it as reference. As compared to group C, the lymphocyte subsets/CD45RB+leucocytes ratios tended to decrease in group T but the decrease was significant only for CD4+T lymphocytes/CD45RB+cells ratio (p <0.03). On the opposite, the ratios of antigen-presenting cells DC-SIGN+cells/CD45RB+cells and DC-LAMP+cells/CD45RB+cells were significantly increased (p <0.03 and <0.0001, respectively) in group T. Moreover, in group T the DC-LAMP+cells/DC-SIGN+cells ratio was significantly increased (p <0.05) showing an increased number of matured dendritic cells. Conclusion: During chronic periodontitis in elderly patients, our results show a decrease in the ratio of gingival CD4+lymphocyte subset associated with an increase in the ratios of antigen-presenting cells subsets and more particularly maturated DC-LAMP+dendritic cells. [Copyright &y& Elsevier]

Summary: Anxiety has been shown to be associated with cardiovascular disease. Atherosclerosis is responsible for the vast majority of cardiovascular events. Recent evidence is accumulating to show that insulin resistance (IR) plays a central role in determining the clinical manifestations of established atherosclerotic lesions. The current preliminary study aimed to investigate the associations between trait anxiety, IR, and atherosclerotic progression in healthy elderly subjects with normal fasting glucose and without metabolic syndrome. Thirty-five healthy elderly subjects (19 males and 16 females, mean age 64.5±4.7 years) were enrolled in this study. Trait anxiety was measured using a questionnaire corresponding to the trait anxiety scale taken from the State and Trait Anxiety Inventory. The homeostasis model assessment (HOMA-R) and plasma leptin-to-adiponectin ratio (L/A ratio), which are convenient IR indexes calculated from fasting blood sampling, were examined. As measurements of atherosclerotic progression, we performed two ultrasound methods, namely brachial artery flow-mediated dilation (FMD), an endothelial function assessment quantitatively reflecting the endothelium-dependent vasodilation responses following hyperemia, and measurement of carotid intima-media thickness (IMT). The severity of trait anxiety was positively associated with HOMA-R and L/A ratio, and negatively associated with the percent change of brachial artery FMD (%FMD). HOMA-R and L/A ratio were positively associated with carotid IMT, and L/A ratio was negatively associated with %FMD. These data showed the associations between trait anxiety, IR indexes and endothelial dysfunction or atherosclerotic progression. This pilot study, with a cross-sectional design, supports the promising role of IR for clarifying the pathophysiological mechanism by which anxiety contributes to an increasing risk of atherosclerosis. [Copyright &y& Elsevier]

Abstract: Studies aimed at collecting reference parameters for haematochemical analysis in the elderly are scarce and for the oldest old subjects even more rare. In order to establish the reference values for the most common laboratory text in long living individuals, we measured haematochemical parameters in >100 years old subjects and in aged subjects as control. Six hundred and two centenarians accepted to be enrolled in the study. A case history containing the complete anamnesis, clinical examinations, evaluation of the clinical cognitive and functional tests, was prepared for each centenarian. Blood samples from 120>100 years old subjects free of chronic or acute Illness (i.e. Alzheimer’s disease, metabolic diseases, cardiovascular disease, stroke, neoplastic and infectious diseases) were analysed. A population of 381 healthy old subjects (age range 65–85 years old), recruited in the same geographic areas and with the same clinical characteristic of the health centenarians, was utilized as control. Significant differences were observed for blood glucose, ALT, cholesterol and platelet levels, reduced in centenarians respect to the old subjects, whereas blood urea nitrogen levels were found significantly increased in centenarians. In conclusion, reference values of the healthy adults can generally been utilized also for the healthy oldest old group, with the notable exception of the above mentioned laboratory parameters that appear to be modified in long living subjects. [Copyright &y& Elsevier]

Abstract: Adiponectin is an adipocyte-specific secretory protein that circulates in serum as three oligomeric complexes known as the high, medium and low molecular weight form (HMW, MMW and LMW). HMW adiponectin has been suggested to be a better predictor of metabolic variables, and it was recently reported that the ratio of HMW to total adiponectin or to LMW, not the absolute amount of plasma adiponectin, might be crucial in determining insulin sensitivity. Insulin resistance (IR) is considered to be a primary component of vascular risk factors. Although the association of depression with atherosclerotic vascular diseases has been well documented, the contribution of IR to the evolution and progression of depression-associated vascular morbidity and mortality remains unknown. The current preliminary study showed that the ratio of HMW to total adiponectin or to LMW, not the absolute amount of plasma adiponectin, was negatively associated with depression severity in healthy elderly subjects without metabolic syndrome. This pilot study supports a promising role of adiponectin multimer distribution for clarifying the pathophysiological mechanism by which depression is associated with increased risk for IR, leading to cardiovascular disease, metabolic syndrome or type 2 diabetes. [Copyright &y& Elsevier]

Abstract: Negative psychological characteristics have been recognized as independent risk factors of cardiovascular disease (CVD). The purpose of this study was to evaluate the influence of depression and anxiety on cardiac autonomic function and endothelial function in healthy elderly subjects. Forty-six healthy elderly volunteers (mean age 60.8 years) were enrolled in this study. Cardiac autonomic function was assessed by spectral analysis of heart rate variability (HRV) with the head-up tilt test. Brachial artery endothelium-dependent flow-mediated dilation (FMD) was measured using high-resolution ultrasound. A significant positive correlation was observed between the State and Trait Anxiety Inventory (STAI)-trait score as a parameter of anxiety and HRV sympathetic modulation in the supine position (baseline), and a significant negative correlation between this score and the head-up-induced HRV sympathetic response from the baseline. The STAI-trait score also showed a significant negative correlation with the percent change of FMD (%FMD). Analysis using structural equation modeling showed that higher trait anxiety reduced %FMD via abnormalities of sympathetic activity. On the other hand, psychometric parameters of depression were not associated with any HRV component or %FMD. These results suggest that there are specific interactions among higher trait anxiety, abnormalities of sympathetic activity, and endothelial dysfunction. This finding may be useful in clarifying the pathophysiological mechanism by which anxiety is associated with increased risks for atherosclerosis and CVD. [Copyright &y& Elsevier]

Abstract: We examined whether social role and self-rated health in an older population were predictors for 6-year total mortality among a non-disabled community-dwelling older population in Saku City, Nagano Prefecture, Japan, surveyed in 1992 and 1998. A total of 8090 men and women aged 65–99 years who reported no disability in performing activities of daily living (ADL) at the time of the survey in 1992 and provided information on their survival status at follow-up 6 years later were analyzed in this study. One dependent variable was survival status in 1998 and independent variables were various factors potentially associated with total mortality, which were obtained from a questionnaire survey at the baseline. During the 6-year interval, having poor self-rated health and poor social roles were identified as significant predictors for total mortality among both men and women. This study revealed that social role and self-rated health are independent predictors for 6-year total mortality for non-disabled Japanese aged 65 years or older. [Copyright &y& Elsevier]

Abstract: Purpose. – Neuropsychology provides essential information to all participants (physicians, psychologists, occupational therapists) involved in the treatment of the elderly. When treating depressed elderly patients, a comprehensive neuropsychological examination is required for diagnosis, prognosis and to control the effectiveness of antidepressant treatment. Key message and recent facts. – Depression in elderly people is frequent and difficult to diagnose. Some forms of depression usher in or are associated with a neurodegenerative disease. In the case of diagnosis, the neuropsychological examination should furnish useful information to guide the clinician. The qualitative analysis of results (strategies used and type of errors) and the weakening of cognitive processes efficiency provides supplementary information and increases the reliability of the diagnosis. It also gives information about the long term evolution of cognitive deficits. It should reveal the presence of characteristics which help to distinguish patients who are developing dementia (predictive power of certain tests). Finally, it enables the clinician to evaluate the outcome of antidepressant treatment, to adjust the prescription according to the performance and to adapt an holistic treatment. Perspective and projects. – A neuropsychological examination may provide new perspectives, such as the possibility of predicting the outcome of dementia which are accompanied by affective disorders, such as Alzheimer''s disease, vascular dementia and frontotemporal dementia. Neuropsychology may thus improve the treatment of these patients by providing information to a better understanding of their deficits and their impact on daily living abilities. [Copyright &y& Elsevier]

Abstract: Summary. – The aim of this study was to determine the effects of a programme of stair-climbing combined with electrostimulation onto posturokinetic capacities in healthy elderly. Methods. – Three groups of elderly women performed a programme: stair-climbing (ME), electrostimulation (ES), two activities simultaneously (ME + ES). The dynamic balance improved for the three groups, but the contribution of visual information in the control of oscillation amplitude was less in the ME group than in the ES and ME + ES groups. Conclusion. – In the case of superimposed technique, the electrical stimulation interferes in neurophysiologic afference integration in relationship to voluntary movement. The ME group was probably more efficient than the ES and SC + ES groups at changing balancing tactics. [Copyright &y& Elsevier]

Contexte : Les sujets très âgés (80 ans et plus) et les sujets âgés polypathologiques sont victimes d’une iatrogénie fréquente et grave, alors qu’ils restent quasiment exclus de la recherche clinique. Méthodes : Nous avons recueilli par questionnaire l’opinion des gériatres sur la nécessité et la faisabilité d’essais thérapeutiques contrôlés randomisés (ETCR) dans cette population. Résultats : Parmi les gériatres interrogés, 48,3 % avaient déjà participé à un ETCR mais 96,8 % les jugent scientifiquement indispensables. Parmi les gériatres n’ayant jamais participé à un ETCR, 36 % étaient dans ce cas, faute de proposition. Les principales difficultés ressenties par les gériatres pour développer les ETCR sont méthodologiques (hétérogénéité des patients incompatible avec des critères d’inclusion trop stricts) et liées au consentement du patient. Pour 38,2 % des gériatres, l’absence d’obligation réglementaire pour l’industrie pharmaceutique est un frein important au développement de ces ETCR. Conclusions : Le développement des ETCR chez les sujets très âgés dépend donc avant tout d’un choix politique avec adoption d’une réglementation adaptée. Mots clés : sujet âgé, essais thérapeutiques, gériatres Abstract Background: Very elderly subjects (aged ≥80 years) and polypathological elderly subjects experience frequent and serious adverse drug effects. They are nevertheless still excluded from clinical research. Methods: We questioned geriatricians through a questionnaire about the usefulness and feasibility of randomised controlled trials (RCTs) in this population. Results: Forty-eight percent of geriatricians questioned did participate in RCTs, but 96.8% considered that RCTs including very elderly subjects were scientifically necessary. Among geriatricians who never participated in RCTs, 36% were never contacted regarding participation in such clinical research. The most important difficulties in developing RCTs in very elderly subjects were methodological difficulties (narrow eligibility criteria incompatible with patient heterogeneity) and those associated with patient consent. For 38.2% of the geriatricians, the fact that pharmaceutical companies are under no obligation to promote RCTs in very elderly subjects represents a major obstacle in the development of such RCTs. Conclusions: The development of RCTs involving very elderly subjects depends first on a political choice, together with an adapted regulatory framework. Keywords: elderly subjects, clinical trials, geriatricians Texte reçu le 14 mars 2004 ; accepté le 29 juin 2004 [ABSTRACT FROM AUTHOR]

Le vieillissement est un facteur important de surconsommation médicamenteuse : les personnes âgées de plus de 65 ans représentent environ 15 % de la population alors qu’elles consomment près d’un tiers des prescriptions. Cette surconsommation génère un certain nombre de dangers potentiels (pathologie iatrogène, mauvaise observance, interactions médicamenteuses..) et s’avère économiquement coûteuse. La consommation moyenne des médicaments se situe aux alentours de cinq dans la plupart des études, qu’il s’agisse de patients ambulatoires ou hospitalisés. Les classes médicamenteuses les plus prescrites sont les médicaments à visée cardiovasculaire et les psychotropes. Les antalgiques et les anti-inflammatoires non stéroïdiens (AINS) sont également très prescrits. Ce sont aussi les classes qui provoquent le plus d’effets indésirables (EI) chez les personnes âgées. Les raisons de cette surconsommation sont multiples. Certaines tiennent au patient (polypathologie, régression des différentes fonctions de l’organisme, mauvaise observance, mésusage..), d’autres tiennent au prescripteur, à l’entourage, familial mais aussi soignant, à l’évolution des médicaments et des connaissances. Les études qui ont comparé les prescriptions à des référentiels ont montré qu’un certain nombre sont inappropriées : au moins une prescription est inadéquate chez 21,3 % des patients institutionnalisés et chez 40 % des patients en maison de convalescence dans une méta-analyse, 12,5 % dans une autre étude chez des patients vivant à domicile. La gravité potentielle de cette surconsommation chez les personnes âgées nécessite, plus encore que chez l’adulte, une analyse précise de la situation et une prescription raisonnée, et raisonnable, régulièrement réévaluée. Mots clés : personne âgée, surconsommation médicamenteuse, polypathologie, modifications pharmacologiques, observance, prescription inappropriée Abstract Aging is a major factor in the over-consumption of drugs: although individuals aged >65 years account for approximately 15% of the population, almost one-third of all prescriptions are made out for this age group. This over-consumption is responsible for a number of potential hazards, such as iatrogenic pathology, poor compliance and drug interactions; it is also an economic burden. Most studies report an average of five drugs prescribed per individual, regardless of outpatient or inpatient status. Cardiovascular and psychotropic drugs are the most widely prescribed classes. Analgesic and nonsteroidal anti-inflammatory drugs are also very common. These are also the classes responsible for the highest number of adverse events in the elderly. There are numerous reasons for this over-consumption; in some cases, it is attributable to the patient himself (multiple diseases, deterioration of bodily functions, poor compliance, misuse, etc.), while in others, the prescribing physician, family or professional caregivers are at fault. The development of new drugs and the information made available regarding them can also be implicated. Studies comparing actual prescriptions with reference indications have shown that some are inappropriate: one meta-analysis showed that for 21.3% of patients in institutions and 40% of patients in convalescent homes, at least one prescription was inadequate; and in another analysis, the same applied to 12.5% of patients living at home. The potential seriousness of this over-consumption by elderly patients, even more so than in adults, calls for a detailed analysis of the situation and rational, regularly reviewed, realistic prescribing. Keywords: elderly subjects, drug over-consumption, multiple diseases, pharmacological changes, compliance, inappropriate prescription [ABSTRACT FROM AUTHOR]

The clinical features and the laboratory aspects of the amiodarone-induced hypothyroidism (AIH) in the elderly as well as the effects of amiodarone treatment in aged AIH people have not yet been well clarified. In the present paper, we evaluated 18 subjects of both sexes (7 females, 11 males), aged 65–83 years, affected by AIH, recruited in Central Tuscany, Italy. The patients were divided in two subsets on the basis of thyroid stimulating hormone (TSH) values: mild (TSH<20 mU/l; Group A, n=11) and severe (TSH>20 mU/l; Group B, n=7) hypothyroid patients. On the basis of clinical features, hypothyroidism was diagnosed only in two patients (out of Group B). Concerning the hormonal pattern, we found that free tetraiodothyronine (fT4) levels were significantly lower than the normal range only in Group B subjects; TSH and thyroglobulin were higher than normal in both groups; free triiodothyronine (fT3) were always in the normal range. Thyroid autoantibodies were found positive only in one patient out of Group A and in two patients out of Group B. In 5/18 patients T4 substitutive therapy was rapidly assigned, because of severe degree of hypothyroidism. In the remaining 13/18 patients, we evaluated the clinical behavior of AIH. After additional cardiac evaluation, amiodarone was withdrawn in 5/13 patients: during follow-up period (4–10 months) four patients became quickly euthyroid while one worsened. In 8/13 patients, amiodarone treatment had to be carried on; during follow-up (2–48 months), four patients remained mildly hypothyroid, while other four patients became severely hypothyroid. In conclusion, in amiodarone treated elderly people, diagnosis of hypothyroidism is reliable only on the basis of high values of TSH; clinical features and fT3 serum levels never enable diagnosis. [Copyright &y& Elsevier]

Background: Elevated plasma total homocysteine (tHcy) concentrations are common in the elderly and have been suggested to be a risk factor for dementia. Objective: In an elderly population, we examined the relation between plasma tHcy and scores on the Mini-Mental State Examination (MMSE), a commonly used screening measure of cognitive impairment in general practice. Design: Fasting plasma tHcy concentrations were measured in 650 healthy, cognitively normal Italian community dwellers aged ? 65 y (x ± SD: 72.8 ± 6.0 y). Socioeconomic status; serum folate, vitamin B-12, and creatinine; other potential dietary and lifestyle determinants of tHcy; and conventional vascular disease risk factors were also assessed. Results: Subjects with MMSE scores of 26-28 had higher plasma tHcy concentrations (12.7 μmol/L; range: 12.2-13.2 μmol/L) than did those with scores > 28 (11.9 μmol/L; 11.4-12.3 μmol/L; P < 0.01). Subjects with scores of 24-25 had higher plasma tHcy concentrations (14.5 μmol/L; 13.5-15.6 μmol/L) than did subjects with scores of 26-28 (P < 0.01) or > 28 (P < 0.001). The risk of hyperhomocysteinemia (plasma tHcy > 15 μmol/L) was higher in subjects with scores of 24-25 (odds ratio: 3.81; 95% CI: 1.9, 7.5) or 26-28 (odds ratio: 1.96; 95% CI: 1.3, 3.0) than in those with scores > 28. The results did not change after adjustment for conventional vascular risk factors and for age, medical, dietary, and lifestyle determinants of plasma tHcy. Conclusion: Elevated plasma tHcy has an independent, graded association with concurrent cognitive impairment as measured with the MMSE in healthy elderly community dwellers. [ABSTRACT FROM AUTHOR]

Forty-four institutionalized elderly subjects with body mass indexes (BMI) of either ≥ 24 or ≤, 21 participated in a 16-wk crossover study designed to determine the effects of low-dose zinc supplementation [306 µmol (20 mg)/d] on food intake, anthropometry, and biochemical and immunological indexes. Initial serum zinc concentrations were low in both groups and increased by ~20% after zinc supplementation. Zinc supplementation allowed a partial but significant restoration of serum thymulin activity and improved nutritional status (food intake and serum albumin and transthyretin concentrations) but had no effect on anthropometrie indexes or serum apolipoproteins, except apolipoprotein CII and apolipoprotein CIII. After zinc supplementation, serum copper concentration decreased but there was no change in the ratio of low-density-lipoprotein cholesterol to high-density-lipoprotein cholesterol. Low-dose zinc supplementation allows restoration, at least partially, of nutritional and thymic status without the known disadvantages of high doses of zinc. [ABSTRACT FROM AUTHOR]

Nutritional assessment of elderly people is limited due to a lack of age-corrected standards. The objective of this study was to develop a new, more age-independent index for nutritional assessment by correcting the creatinine height index (CHI) for the age-induced changes in its variables. This might improve the differentiation between physiological reduction in muscle mass in elderly people and the changes induced by malnutrition. Seventy-four elderly and 100 young healthy volunteers were compared by anthropometnc and biochemical-assessment variables. From the high correlation between total arm length and body length (r = 0.86; P < 0.001) and the use of an alternative formula to calculate ideal body weight (IBW) from height and wrist circumference, a relatively age-independent estimate of IBW was determined. Creatinine arm index, as an adapted index of CHI, is proposed based on this age-independent IBW estimation and a specific creatinine coefficient for different age groups. [ABSTRACT FROM AUTHOR]

There are numerous reports in the literature of impaired gastrointestinal function with aging. However, most gastrointestinal functions remain relatively intact because of the large reserve capacity of the intestine, pancreas, and liver. Clinically important changes in gastrointestinal function with aging in human include decreased taste thresholds, hypochlorhydria due to atrophie gastritis, and decreased liver blood flow and size. Increased absorbability of lipids and large size molecules has been demonstrated in aging animals, but this has not been studied in humans. Nutrients with impaired gastrointestinal bioavail-ability in aging include dietary B-12, calcium carbonate, and ferric iron in atrophie gastritis; calcium, zinc, and possibly carbohydrate in a mixed meal. The implications of these changes for health maintenance and chronic disease in elderly people are in need of study. [ABSTRACT FROM AUTHOR]

Background: Recent accumulating lines of evidence reveal that leptin is associated with synaptic plasticity and neuroprotective activity in the brain. Methods: In this preliminary study with a cross-sectional design, we examined the relationship between plasma leptin level and total or regional gray matter (GM) volume in 34 elderly subjects (mean age 64.5 years) with normal fasting glucose level and without dementia and metabolic syndrome by voxel-based morphometry of magnetic resonance imaging scans. Results: Plasma leptin level showed no significant correlation with total GM volume but showed a significantly positive correlation with GM volumes in the right hippocampus, left parahippocampus, and right cerebellum with adjustments for age, gender, body mass index (BMI), and waist-to-hip ratio (W/H). Also, after adjustments for age, gender, BMI, W/H, and intracranial volume, plasma leptin level significantly positively correlated with GM volumes in the right hippocampus and bilateral cerebella but not with that in the left parahippocampus. Conclusions: The results of this pilot study would be beneficial for our understanding of the neuroprotective effects of leptin on human brain aging. [Copyright &y& Elsevier]