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Mortality related to heart rate (HR) increase in the elderly has not yet been well established. To ascertain the relationships among cognitive impairment (CI), mortality, and HR increase, the authors prospectively studied a random sample of elderly subjects stratified according to presence or absence of CI. Elderly subjects randomly selected in 1991 (n = 1332) were followed up for 12 years. Mortality was established in 98.1% of the subjects. When HR was stratified in quartiles (69, 70-75, 76-80, and80 bpm), mortality was linearly associated with increased HR in all (from 47.7 to 57.0; r2 = .43, p = .019) and in subjects without (from 41.7 to 51.1%; r2 = .50, p = .043) but not in those with CI (from 57.5 to 66.1; r2 = .20, p = .363). Cox regression analysis, adjusted for several variables, shows that HR doesn't predict mortality in all subjects (RR 0.69; 95% CI = 0.27-1.73) or in those with CI (RR 0.91; 95% CI = 0.81-1.02). In contrast, HR predicts mortality in subjects without CI (RR 1.10; 95% CI = 1.00-1.22). Hence, HR increase is a predictor of mortality in elderly subjects without CI. However, when considering all elderly subjects and those with CI, HR increase seems to have no effect on mortality. Thus, CI should be considered when focusing on HR increase as risk factor for mortality in the elderly.

Background The elderly are characterized by a high prevalence of chronic heart failure (CHF) and frailty, which is a complex interaction of physical, psychological and social impairment. This study aimed to examine the predictive role of frailty on long-term mortality in elderly subjects with CHF. Materials and methods The study assessed long-term mortality after 12-year follow up in 120 subjects with CHF and 1139 subjects without CHF, selected in 1992, from a random sample of the elderly population in the Campania region of Italy. Frailty was assessed according to a ‘Frailty Staging System’. Results Subjects with CHF were prevalently female (60%) and older than 75 years (mean 75·9 ± 6·7); subjects without CHF were prevalently female (56·4%) and younger than 75 years (mean 74·0 ± 6·3). In subjects with and without CHF stratified into classes of frailty there was a statistically significant increase in age, comorbidity, disability and low social support, and a decrease in MMSE score. Moreover, death progressively increased more with frailty in subjects (70·0% to 94·4%, P

Background and aims: We investigated the prevalence of visual impairment (VI), its determinants and its association with Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Gross Mobility (GM) and 6- year mortality in elderly subjects. A cross-sectional survey in a large population randomly selected in 1992 with a 6-year mortality evaluation in Campania, a region in southern Italy. Methods: A random sample of 1332 elderly subjects aged 65 to 95 years (mean age 74.2±6.4), selected from the electoral rolls, was interviewed by trained physicians. Self-reported visual function, socio-demographic and clinical characteristics were recorded. Disability was assessed by measuring ability in ADL, IADL and GM. Results: VI was found to affect 34% of this population, with an age-related increase of mild and severe VI. VI affects ADL, IADL and GM disability. Age, diabetes and low educational level, but not comorbidity or hypertension, proved to be predictors of VI. Mortality increased with severity of VI in 38.1% of subjects with severe functional impairment (p

Background The aging heart is characterized by structural changes, which are implicated in the development of left ventricular diastolic dysfunction. However, important changes in systolic function may also occur. Left ventricular end-systolic elastance (Ees) is a major determinant of cardiac systolic function and ventricular—arterial interaction. Aim To evaluate left-ventricular Ees in elderly subjects compared with adult control subjects. Methods We studied dilated (DA, n=14) and hypertensive (HA, n=21) cardiomyopathy patients, and both adult control (A, n=25; age 55.6±6.6 years) and elderly (E, n=25; age 76.3±7.1 years) subjects without clinical–instrumental evidence of cardiovascular disease. M-mode, two-dimensional, and pulsed Doppler echocardiogram were performed. Doppler-derived indices of diastolic function were assessed and Ees was calculated by a modified single-beat method. Results Ees was reduced in dilated cardiomyopathy (1.32±0.10 mm Hg/ml) and increased in hypertensive cardiomyopathy (3.12±0.33 mm Hg/ml) patients compared to age-matched control subjects (1.96±0.26 mm Hg/ml; p