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Urinary tract infections (UTIs) are common in the elderly, and cover a range of conditions from asymptomatic bacteriuria to urosepsis. Risk factors for developing symptomatic UTIs include immunosenescence, exposure to nosocomial pathogens, multiple comorbidities, and a history of UTIs. European guidelines on urological infections recommend antimicrobial treatment only for symptomatic UTIs. Non-antimicrobial options to treat and prevent UTIs include among others cranberry products, OM-89 Escherichia coli bacterial lysate vaccine, and estrogen therapy in postmenopausal women, although evidence for their efficacy is weak. Another non-antimicrobial option to control and prevent UTIs is a medical device (Utipro Plus®) containing xyloglucan, gelatin, propolis, and extracts of Hibiscus sabdariffa. The device acts in the intestine as a mechanical barrier to protect against invasion by uropathogenic E. coli strains. A randomized controlled trial of Utipro Plus® in patients with uncomplicated UTIs provided good-quality evidence of its efficacy compared with placebo. In an observational study of Utipro Plus® in patients with recurrent UTIs, more than 80% women reported a return to their pre-UTI clinical status and about 30% transitioned from symptomatic UTIs to asymptomatic bacteriuria. New treatment strategies that offer a safe and effective non-antimicrobial means of managing UTIs could have an important role in the elderly.

Introduction Poor balance ability in older adults result in multiple complications. Poor balance ability has not been studied among older adults living at high altitudes. In this study, we analysed factors associated with poor balance ability by using the Functional Reach (FR) among older adults living in nine high-altitude communities. Material and methods Analytical cross-sectional study, carried out in inhabitants aged 60 or over from nine high-altitude Andean communities of Peru during 2013–2016. FR was divided according to the cut-off point of 8 inches (20.32 cm) and two groups were generated: poor balance ability (FR less or equal than 20.32 cm) and good balance ability (greater than 20.32 cm). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor balance ability. Prevalence ratio (PR) with 95% confidence intervals (95CI%) are presented. Results A total of 365 older adults were studied. The average age was 73.0 ± 6.9 years (range: 60–91 years), and 180 (49.3%) participants had poor balance ability. In the adjusted Poisson regression analysis, the factors associated with poor balance ability were: alcohol consumption (PR = 1.35; 95%CI: 1.05–1.73), exhaustion (PR = 2.22; 95%CI: 1.49–3.31), gait speed (PR = 0.67; 95%CI: 0.50–0.90), having had at least one fall in the last year (PR = 2.03; 95%CI: 1.19–3.46), having at least one comorbidity (PR = 1.60; 95%CI: 1.10–2.35) and having two or more comorbidities (PR = 1.61; 95%CI: 1.07–2.42) compared to none. Conclusions Approximately a half of the older adults from these high-altitude communities had poor balance ability. Interventions need to be designed to target these balance issues and prevent adverse events from concurring to these individuals.

The application of a stochastic mechanical noise has been shown to improve plantar touch sensitivity in patients with diabetic neuropathy and balance control. The present work aimed to test the feasibility of a specially designed vibrating device on gait and posture in older patients with type 2 diabetes with special interest on potential side effect (sensation of needles or tingling, dizziness or falls) before further investigations. For this, gait and balance tests were performed in 29 older out and in-patients (mean age 84 years, Barthel index ≥ 60/100) immediately before and after a 19 min plantar vibrating sequence, as well as 15 min after. These tests included posturographic measurements under eyes closed and static conditions and clinical gait tests (Short Physical Performance Battery and Timed-Up and Go tests). The results showed that no side effect was measured immediately, 15 min and up to 30 days after the vibration sequence. Besides, postural and clinical gait tests showed global positive effects at immediate and 15 min follow-up. Further investigation are now necessary to determine whether a daily stimulation sequence for a given time would lead to long-term positive effects on daily living (NCT01654341; https://clinicaltrials.gov/ct2/show/NCT01654341).

Dozens of scales and questionnaires have been used in the detection of frailty; however, a generalized method for its screening and diagnosis is still lacking in clinical settings. FRAILTOOLS´ main objective is to evaluate the usefulness of frailty scales in the detection of frailty in different clinical and social settings, and its integration in management algorithms for the frail older patient. FRAILTOOLS is an observational, longitudinal and prospective study with a follow-up of 6, 12 and 18 months. People older than 75 years old will be recruited from three separate clinical settings (acute geriatric wards, geriatric outpatient clinics and primary care) and one social setting (nursing homes). Exclusion criteria include Mini-mental State Examination

Frailty is a condition characterized by a high vulnerability to low-power stressors affecting around 10% of people older than 65 years.

The incidence and the mortality of cancer increase with age. This article explores the possibility of decreasing cancerrelated mortality in the aged with secondary prevention of cancer deaths that entails early diagnosis of cancer through the screening of asymptomatic older individuals. We establish that screening of asymptomatic individuals should be based on physiologic rather than chronologic age that may be estimated from a comprehensive geriatric assessment and possibly with the utilization of biologic markers of aging. It is reasonable to offer some form of screening for lung and colorectal cancer to individuals with a life expectancy of at least five years and screening for breast and prostate cancer to women and men respectively with a life expectancy of at least ten years. The ideal number of screening sessions and the ideal interval between screening sessions is unestablished. The aging of the population, the diversity of the older population, the development of new and more sensitive screening interventions, the discovery of new biologic markers of cancer and age represent the main challenges in studying the value of cancer screening in the aged. Probably the most reliable information may be obtained from rapid-learning databases in which information related to each person's physiologic age is included. Worldwide, the incidence and prevalence of cancer increase with age [1]. In the meantime the risk of cancer-related mortality increases with age at diagnosis [2-4]. As the world population is aging, cancer in the older person is an ever more common problem, and the reduction of cancer deaths in older individuals represents the most urgent goal of cancer control. In this article we explore secondary cancer prevention as representing a strategy to reduce the risk of mortality in the aged.This hypothesis is based on four considerations: i. Several studies showed that the practice of screening asymptomatic individuals for cancer becomes less common with the aging of the population [5]. ii. The average life expectancy of the Western population is rapidly increasing1. Consequently the benefits of early detection of cancer that emerges several years after diagnosis may be present even for those undergoing screening at an advanced age. iii. New forms of cancer treatment, including minimally invasive surgery [6], stereotactic radio surgery [7], and targeted systemic therapy [8], are associated with decreased risk of complications. They may be safely utilized in individuals with limited tolerance of stress who might be hurt by more aggressive treatments. It is now possible to personalize cancer screening according to individual life expectancy and tolerance of stress, as the estimate of a person's physiologic age is becoming more precise [1,9]. After reviewing the principles and the effectiveness of cancer screening and early detection, this article will explore the benefits and risks of secondary cancer prevention in older individuals. In particular we will review the current evidence and the limitations of previous clinical trials. At the end we will propose a conceptual framework to guide the screening of older individuals for cancer, and we will propose a research agenda.

Background: Metabolic syndrome (MetS) remains a controversial entity. Specific clusters of MetS components - rather than MetS per se - are associated with accelerated arterial ageing and with cardiovascular (CV) events. To investigate whether the distribution of clusters of MetS components differed cross-culturally, we studied 34,821 subjects from 12 cohorts from 10 European countries and one cohort from the USA in the MARE (Metabolic syndrome and Arteries REsearch) Consortium. Methods: In accordance with the ATP III criteria, MetS was defined as an alteration three or more of the following five components: elevated glucose (G), fasting glucose >= 110 mg/dl; low HDL cholesterol, = 150 mg/dl; elevated blood pressure (B), >= 130/ >= 85 mmHg; abdominal obesity (W), waist circumference >102 cm for men or >88 cm for women. Results: MetS had a 24.3% prevalence (8468 subjects: 23.9% in men vs. 24.6% in women, p < 0.001) with an age-associated increase in its prevalence in all the cohorts. The age-adjusted prevalence of the clusters of MetS components previously associated with greater arterial and CV burden differed across countries (p < 0.0001) and in men and women (p < 0.0001). In details, the cluster TBW was observed in 12% of the subjects with MetS, but was far more common in the cohorts from the UK (32.3%), Sardinia in Italy (19.6%), and Germany (18.5%) and less prevalent in the cohorts from Sweden (1.2%), Spain (2.6%), and the USA (2.5%). The cluster GBW accounted for 12.7% of subjects with MetS with higher occurrence in Southern Europe (Italy, Spain, and Portugal: 31.4, 18.4, and 17.1% respectively) and in Belgium (20.4%), than in Northern Europe (Germany, Sweden, and Lithuania: 7.6, 9.4, and 9.6% respectively). Conclusions: The analysis of the distribution of MetS suggested that what follows under the common definition of MetS is not a unique entity rather a constellation of cluster of MetS components, likely selectively risky for CV disease, whose occurrence differs across countries. (Less)