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Background & Aims: Lean body mass loss has been indicated as a reliable marker of frailty and poor physical performance among older individuals. We evaluated the relationship between calf circumference and frailty, physical performance, muscle strength, and functional status in persons aged 80 years or older., Methods: Data are from the baseline evaluation of the Aging and Longevity Study in the Sirente geographic area (ilSIRENTE Study) (n = 357). The calf circumference was measured at the point of greatest circumference. Frailty was categorized according to the present of slow gait speed, weakness, weight loss, energy expenditure and exhaustion. Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4-m walking speed test, the balance test and the chair stand test. Analyses of covariance were performed to evaluate the relationship between different calf circumference and physical function., Results: After adjustment for potential confounders, which included age, gender, education, body mass index, sensory impairments, cerebrovascular diseases, albumin, reactive C protein, interleukine-6, and cholesterol, physical performance (SPPB score: 7.27 versus 6.18, p = 0.02) and muscle strength (Hand Grip: 32 kg versus 28 kg, p = 0.03) measures significantly improved as calf circumference increased. The frailty index score was significantly lower among subjects with higher calf circumference (1.66 versus 2.17, p = 0.01)., Conclusions: The present study suggests that among community-dwelling older people, calf circumference may be positively related to lower frailty index and higher functional performance. As such, calf circumference is a valuable tool for guiding public health policy and clinical decisions., (Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background and Aims: sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the impact of sarcopenia on the risk of all-cause death in a population of frail older persons living in community., Methods: we analysed data from the Aging and Longevity Study, a prospective cohort study that collected data on all subjects aged 80 years and older residing in the Sirente geographic area (n = 364). The present analysis was conducted among those subjects who were between 80 and 85 years of age at the time of the baseline assessment (n = 197). The main outcome measure was all-cause mortality over 7-year follow-up. According to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, the diagnosis of sarcopenia required the documentation of low muscle mass and the documentation of either low muscle strength or low physical performance. Cox proportional regression models were used to estimate crude and adjusted hazard ratios and 95% confidence intervals of death by the presence of sarcopenia., Results: using the EWGSOP-suggested criteria, 43 subjects with sarcopenia (21.8%) were identified. During the 7-year follow-up, 29 (67.4%) participants died among subjects with sarcopenia compared with 63 subjects (41.2%) without sarcopenia (P < 0.001). After adjusting for potential confounders including age, gender, education, activities of daily living (ADL) impairment, body mass index, hypertension, congestive heart failure, chronic obstructive pulmonary disease, number of diseases, TNF-α, participants with sarcopenia had a higher risk of death for all causes compared with non-sarcopenic subjects (HR: 2.32, 95% CI: 1.01-5.43)., Conclusions: our results obtained from a representative sample of very old and frail subjects show that sarcopenia is associated with mortality, independently of age and other clinical and functional variables.

Unlabelled: To investigate whether interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) protein levels predict all-cause mortality in older persons living in the community., Design: Prospective cohort study., Setting: Data were from the Aging and Longevity Study in the Sirente Geographic Area, a prospective cohort study., Participants: Individuals aged 80 and older living in an Italian mountain community (N = 362)., Measurements: Participants were classified according to the median value of the three inflammation markers (IL-6, 2.08 pg/mL; TNF-α, 1.43 pg/mL; CRP, 3.08 mg/L). A composite summary score of inflammation was also created. The main outcome was risk of death after 4 years of follow-up., Results: One hundred fifty deaths occurred during 4 years of follow-up. In the unadjusted model, high levels of each of the three markers were associated with greater mortality. After adjusting for potential confounders, high levels of IL-6 (hazard ratio (HR) = 2.18, 95% confidence interval (CI) = 1.29-3.69) and CRP (HR = 2.58, 95% CI = 1.52-4.40) were associated with a significantly greater risk of death, whereas the association between TNF-α protein levels and mortality was no longer significant (HR = 1.26, 95% CI = 0.74-2.15). The composite summary score of inflammation was strongly associated with mortality, with the highest risk estimated for individuals with all three inflammatory markers above the median., Conclusion: Low levels of inflammatory markers are associated with better survival in older adults, independent of age and other clinical and functional variables., (© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.)

Objective: In this study, we evaluate the impact of disability and multimorbidity on the risk of all-cause death in a population of frail older persons living in community., Study Design and Setting: We analyzed data from the Aging and Longevity Study in the Sirente geographic area, a prospective cohort study that collected data on all subjects aged 80 years and older (n=364). The main outcome measure was all-cause mortality over 4-year follow-up., Results: A total of 150 deaths occurred. Sixty-seven subjects (44.6%) died in the nondisabled group compared with 83 subjects (55.3%) in the disabled group (P<0.01). Thirty-nine subjects (31.7%) died among subjects without multimorbidity compared with 111 subjects (46.0%) with two or more diseases (P<0.01). When examining the combined effect of multimorbidity and disability, the effect of disability on the risk of death was higher than that of multimorbidity. After adjusting for potential confounders, relative to those without disability and multimorbidity, disabled subjects showed an increased risk of death when multimorbidity was associated (hazard ratio [HR]=3.91; 95% confidence interval [CI]=1.53-10.00) and in absence of multimorbidity (HR=2.36; 95% CI=0.63-8.83)., Conclusion: Our results show that disability exerts an important influence on mortality, independently of age and other clinical and functional variables., (Copyright 2010 Elsevier Inc. All rights reserved.)

Background: High-density lipoprotein (HDL) cholesterol has been hypothesized to be a reliable marker of frailty and poor prognosis among the oldest elderly., Objective: In the present study, we evaluate the impact of HDL cholesterol on the risk of all-cause mortality in a large population of frail octogenarians and nonagenarians living in a community., Methods: We analyzed data from the Aging and Longevity Study in the Sirente geographic area (ilSIRENTE Study), a prospective cohort study that collected data on all subjects aged 80 year and older living in a mountain community (n = 359). The main outcome measure was the relative hazard ratio of death after 2 years of follow-up for different levels of HDL cholesterol., Results: A total of 86 deaths (30 men and 56 women) occurred during 2 years of follow-up. Among men the mean HDL cholesterol level was 36.7 +/- 7.6 mg/dl among those who died as compared with 43.4 +/- 10.3 mg/dl among survivors (p = 0.001). Similarly, among women, the mean HDL cholesterol level was 42.2 +/- 11.5 mg/dl among those who died as compared with 49.3 +/- 14.9 mg/dl among survivors (p = 0.001). Adjusting for potential confounders, including markers of frailty, LDL cholesterol, and triglycerides, somewhat reduced the strength of the association between HDL cholesterol levels and mortality, but it remained statistically significant., Conclusions: Our results obtained from a representative sample of very old and frail elderly subjects expand the knowledge that high levels of HDL cholesterol are associated with better survival. These findings support the hypothesis of a strong implication of the lipoprotein metabolism in the process of living an extremely long life., ((c) 2007 S. Karger AG, Basel.)

Objective: The criteria for inappropriate drug use developed by Beers have been widely used in drug utilization reviews to assess the quality of prescribing, but there is still inconclusive evidence that these criteria can impact on patient outcomes. The aim of the present study was to evaluate the relationship between the use of inappropriate drugs and measures of physical performance, muscle strength and functional status in an elderly population (80+ years)., Methods: Data are from the baseline evaluation of 364 subjects enrolled in the ilSIRENTE study, a prospective cohort study performed in a mountain community living in the Sirente geographic area (L'Aquila, Abruzzo) in Central Italy. Physical performance was assessed using the physical performance battery score (SPPB), which is based on three timed tests: 4-m walking speed, balance and chair stand tests. Muscle strength was measured by hand grip strength. Inappropriate drug use was defined by the 2003 Beers criteria. Analyses of covariance were performed to evaluate the relationship of inappropriate drugs with physical function., Results: In the unadjusted model, all of the physical performance, muscle strength and functional measures showed significant associations with inappropriate drug use. Following adjustment for potential confounders, which included age, gender, physical activity level, cognitive performance scale, comorbidity, lung diseases and diabetes, these associations were still statistically significant for the physical performance battery score [non-users inappropriate drugs: 7.0; standard error (SE): 0.1; users inappropriate drugs: 6.1; SE: 0.2; p = 0.007] The 4-m walking speed, physical performance battery score and Total Activities of Daily Living (ADL) scale score showed worsening results among subjects using two inappropriate medications compared with subjects using one inappropriate drug or none at all., Conclusions: The use of inappropriate medication (as defined by Beers 2003 criteria) was found to be common among the elderly Italian study cohort living in the community. Our results suggest that among old-old subjects the use of inappropriate drugs is associated with impaired physical performance.

Background: Anemia status is a typical feature of the "frailty syndrome" of elderly subjects. Increasing evidences suggest that low hemoglobin concentration is common in elderly subjects and adversely affects morbidity and mortality., Objective: In the present study, we evaluate the impact of hemoglobin concentration on the risk of all-cause mortality in a large population of frail and old subjects living in a nursing home., Methods: There were 372 residents admitted to the teaching nursing home of Catholic University of Rome aged 65 years and older from January 2002 to November 2004 who were enrolled. For the present study we selected all the subjects with a full MDS-NH assessment within 14 days after admission. The main outcome measure was the relative hazard ratio of death after 2 years of follow-up for different levels of hemoglobin concentration., Results: Based on the WHO criteria for anemia, 235 participants were anemic at enrollment (63.1% of the cohort). A total of 130 deaths (44 men and 86 women) occurred during 2-years of follow-up. Death rates for those with and without anemia based on the WHO criteria were 38% and 28%, respectively (P = .03). The age- and sex-adjusted hazard ratio for mortality was 1.56 (95% CI, 1.07-2.28) for persons with anemia. Compared with the lower tertile, the age- and sex-adjusted hazard ratios of mortality for hemoglobin in the second and third tertiles were 0.40 (95% CI, 0.26-0.61), and 0.39 (95% CI, 0.24-0.58), respectively. Adjusting for potential confounders, including markers of frailty, cognitive impairment, creatinine levels, cancer, stroke, body mass index, and pressure ulcer, somewhat reduced the strength of the association between hemoglobin level and mortality, but it remained statistically significant., Conclusion: Our results obtained from a representative sample of very old and frail elderly subjects living in a nursing home expand the knowledge that high levels of hemoglobin are associated with better survival. Anemia should be actively sought, appropriate diagnostic strategies should be implemented to search for potentially correctable causes, and aggressive interventions may be warranted to reduce mortality and improve functional status.

Objectives: To explore the relationship between a case management approach and the risk of institutionalization in a large European population of frail, old people in home care., Design: Retrospective cohort study., Setting: Eleven European countries., Participants: Three thousand two hundred ninety-two older adults receiving home care (mean age 82.3+/-7.3)., Measurements: Data on nursing home admission were collected every 6 months for 1 year., Results: One thousand one hundred eighty-four (36%) persons received a home care program based on case management, and 2,108 (64%) received a traditional care approach (no case manager). During the 1-year follow-up, 81 of 1,184 clients (6.8%) in the case management group and 274 of 2,108 (13%) in the traditional care group were admitted to a nursing home (P<.001). After adjusting for potential confounders, the risk of nursing home admission was significantly lower for participants in the case management group than for those in a traditional care model (adjusted odds ratio=0.56, 95% confidence interval=0.43-0.63)., Conclusion: Home care services based on a case management approach reduce risk of institutionalization and likely lower costs.

Background: 1.5–8% of older adults live in nursing homes (NHs), presenting a high prevalence of frailty and polypharmacy. Aims: To investigate the association of frailty with polypharmacy and drug prescription patterns in a sample of European Nursing Home (NH) residents. Methods: Cross-sectional study based on the data from the Services and Health for Elderly in Long TERm care (SHELTER) study. 4121 NH residents in Europe and Israel. Residents' clinical, cognitive, social, and physical status were evaluated with the InterRAI LTCF tool, which allows comprehensive, standardized evaluation of persons living in NH. Polypharmacy and hyperpolypharmacy were defined as the concurrent use of ≥ 5 and ≥ 10 medications. Frailty was defined according to the FRAIL-NH scale. Results: Of 4121 participants, 46.6% were frail (mean age 84.6 ± 9.2 years; 76.4% female). Polypharmacy and hyperpolypharmacy were associated with a lower likelihood of frailty (Odds Ratio = 0.72; 95% CI = 0.59–0.87 and OR = 0.75; 95% CI = 0.60–0.94, respectively). Patterns of drug prescriptions were different between frail and non-frail residents. Symptomatic drugs (laxatives, paracetamol, and opioids) were more frequently prescribed among frail residents, while preventive drugs (bisphosphonates, vitamin D, and acetylsalicylic acid) were more frequently prescribed among non-frail residents. Conclusions: Frailty is associated with less polypharmacy and with higher prevalence of symptomatic drugs use among NH residents. Further studies are needed to define appropriateness of drug prescription in frail individuals. [ABSTRACT FROM AUTHOR]

Objective: There is increasing evidence that anorexia of aging can cause physical and mental impairment. The aim of the present study was to evaluate the relationship between anorexia and sarcopenia in elderly persons aged 80 years or older. Methods: Data are from the baseline evaluation of 354 subjects enrolled in the ilSIRENTE study. The ilSIRENTE study is a prospective cohort study performed in the mountain community living in the Sirente geographic area (L'Aquila, Abruzzo) in Central Italy. We defined anorexia as the presence of loss of appetite and/or lower food intake. According to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, diagnosis of sarcopenia required the documentation of low muscle mass plus the documentation of either low muscle strength or low physical performance. The relationship between anorexia and sarcopenia was estimated by deriving odds ratios from the multiple logistic regression models considering sarcopenia as the dependent variable. Results: Nearly 21 % of the study sample showed symptoms of anorexia. Using the EWGSOP-suggested algorithm, 103 subjects (29.1 %) with sarcopenia were identified. Thirty-four (46.6 %) participants were affected by sarcopenia among subjects with anorexia compared to 69 subjects [24.6 %] without anorexia ( p < 0.001). After adjusting for potential confounders including age, gender, functional and cognitive impairment, physical activity, urinary incontinence, comorbidity, congestive heart failure, COPD, depression, anti-cholinergic drugs, and TNF-α plasmatic levels, participants with anorexia had a higher risk of sarcopenia compared with non-anorexic subjects (HR 1.88, 95 % CI 1.01-3.51). Conclusions: Anorexia is common among community-dwelling older subjects in Italy. Our results suggest that among old-old subjects, anorexia is independently associated with sarcopenia. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the relationship between sarcopenia and 2-year risk of falls in a population of persons aged 80 years or older. Methods: Data are from the baseline and follow-up evaluations of the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study) (n =260). According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia was diagnosed in presence of low muscle mass (mid-arm muscle circumference) plus either low muscle strength (hand grip) or low physical performance (4-m walking speed). The primary outcome measure was the incident falls during the follow-up period of 2 years. The relationship between sarcopenia and incident falls was estimated by deriving hazard ratios (HRs) from multiple logistic regression models considering the dependent variable of interest at least one fall during the follow-up period. Results: Sixty-six participants (25.4%) were identified as affected by sarcopenia. Eighteen out of 66 (27.3%) participants with sarcopenia and 19 out of 194 (9.8%) without sarcopenia reported incident falls during the two-year follow-up of the study (p <0.001). After adjusting for age, gender, cognitive impairment, ADL impairment, sensory impairments, BMI, depression, physical activity, cholesterol, stroke, diabetes, number of medications, and C-reactive protein, participants with sarcopenia had a higher risk of incident falls compared with non sarcopenic subjects (adjusted hazard ratio [HR], 3.23; 95% confidence interval [CI], 1.25–8.29). Conclusions: The present study suggests that sarcopenia – assessed using the EWGSOP algorithm – is highly prevalent among elderly persons without gender differences (25%). Sarcopenic participants were over three times more likely to fall during a follow-up period of 2 years relative to non sarcopenic individuals, regardless of age, gender and other confounding factors. [Copyright &y& Elsevier]

Abstract: Background and Aims: Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. At present, no data are available on sarcopenia in the nursing home population. The aim of the current study was to explore the relationship between sarcopenia and all-cause mortality in a population of elderly persons aged 70 years and older living in a nursing home in Italy. Methods: This study was conducted among all subjects (n = 122) aged 70 years and older who lived in the teaching nursing home of Catholic University of Rome between August 1, 2010, and September 30, 2010. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia was diagnosed in presence of low muscle mass plus either low muscle strength or low physical performance. The primary outcome measure was survival after 6 months. Results: Forty residents (32.8%) were indentified as affected by sarcopenia. This condition was more common in men (68%) than in women (21%). During the follow-up period, 26 (21.3%) patients died. After adjusting for age, gender, cerebrovascular diseases, osteoarthritis, chronic obstructive pulmonary disease, activity of daily living impairment, and body mass index, residents with sarcopenia were more likely to die compared with those without sarcopenia (adjusted hazard ratio 2.34; 95% confidence interval 1.04–5.24). Conclusions: The present study suggests that among subjects living in a nursing home, sarcopenia is highly prevalent and is associated with a significantly increased risk of all-cause death. The current findings support the possibility that sarcopenia has an independent effect on survival among nursing home residents. [Copyright &y& Elsevier]

Background and aims. Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. At present, there are no data on sarcopenia in nursing home population. We evaluated the prevalence of sarcopenia and its association with functional and clinical status in a population of elderly persons aged 70 years and older living in nursing homes. Methods. This study was conducted selecting all the participants (n = 122) living in the teaching nursing homes of Catholic University of Rome who were aged 70 years and older from August 1, 2010, to September 30, 2010. The European Working Group on Sarcopenia in Older People (EWGSOP) criteria were adopted. Accordingly, diagnosis of sarcopenia required the documentation of low muscle mass plus the documentation of either low muscle strength or low physical performance. Results. Forty residents (32.8%) were identified as affected by sarcopenia. The multivariate logistic regression analysis showed a high increase in risk of sarcopenia for male residents (odds ratio [OR] 13.39; 95% confidence interval [CI] 3.51–50.63) and for residents affected by cerebrovascular disease (OR 5.16; 95% CI 1.03–25.87) or osteoarthritis (OR 7.24; 95% CI 2.02–25.95). Residents who had a body mass index higher than 21 kg/m2 had a lower risk to be sarcopenic (OR 0.76; 95% CI 0.64–0.90) relative to those with body mass index less than 21 kg/m2. Similarly, sarcopenia was less likely to be present among participants involved in leisure physical activity for 1 hour or more per day (OR 0.40; 95% CI 0.12–0.98). Conclusions. The present study suggests that among participants living in nursing homes, sarcopenia is highly prevalent and it is more represented among male residents (68%) than among female residents (21%). Our findings support the hypothesis that muscle mass is strongly associated with nutritional status and physical activity in nursing homes, too. [ABSTRACT FROM PUBLISHER]

Summary: Background & aims: Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the relationship between midarm muscle circumference (MAMC) and physical performance, muscle strength, functional status and survival in persons aged 80 years or older. Methods: Data are from the baseline evaluation of the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study) (n = 357). MAMC was calculated taking into account the mid upper arm circumference and the triceps skinfold thickness of the right arm. Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4-m walking speed test, the balance test and the chair stand test. Analyses of covariance were performed to evaluate the relationship between different MAMC levels and physical function. Cox proportional regression models were used to estimate crude and adjusted hazard ratios and 95% confidence intervals of death by MAMC levels. Results: After adjustment for potential confounders – which included age, gender, living alone, sensory impairments (hearing and vision), body mass index, albumin and cholesterol – physical performance and function (which were measured using the 4-m walking speed test, the Short Physical Performance Battery score, the hand grip strength), improved significantly as MAMC increased. Compared with those in the low MAMC tertile, subjects in the high MAMC tertile had a lower risk of death (adjusted hazard ratio (HR) 0.45; 95% Confidence Interval (CI) 0.23–0.87). Conclusions: The present study suggests that among community-dwelling old–old subjects muscle mass may be positively related to functional performance and survival. [ABSTRACT FROM AUTHOR]

• One in six residents of nursing homes use strong anticholinergic medications. • There was a 20-fold variation in prevalence across the 12 countries. • Antipsychotics and antidepressants were the most common strong anticholinergics. There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty. Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0–2 (non-frail), 3–6 (frail) and 7–14 (most-frail). Data were analyzed using descriptive statistics. Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %). One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm. [ABSTRACT FROM AUTHOR]

Objective: Increasing evidence suggests that anorexia of aging can cause physical and mental impairment. The aim of the present study was to evaluate the relationship between anorexia of aging and measures of physical performance, muscle strength, and functional status in older persons aged 80 years or older. Methods: Data are from baseline evaluation of 364 subjects enrolled in the ilSIRENTE study. The ilSIRENTE study is a prospective cohort study performed in the mountain community living in the Sirente geographic area (L''Aquila, Abruzzo) in central Italy. Physical performance was assessed using the physical performance battery score (SPPB), which is based on 3 timed tests: 4-meter walking speed, balance, and chair stand tests. Muscle strength was measured by hand grip strength. We defined anorexia as the presence of loss of appetite and/or lower food intake. Analyses of covariance were performed to evaluate the relationship of anorexia with physical function. Results: In the unadjusted model, all the physical performance, muscle strength, and functional measures showed significant associations with the presence of anorexia. After adjustment for potential confounders (age, gender, BMI, number of diseases, depression, congestive heart failure, lung diseases) these associations were weaker but still statistically significant (physical performance battery score: subjects without anorexia 6.8, SE 0.2, subjects with anorexia 5.8, SE 0.4, P = .03; 4-meter walking speed: subjects without anorexia 0.5 m/s, SE 0.1, subjects with anorexia 0.3 m/s, SE 0.1, P = 5.001 hand grip strength: subjects without anorexia 30.8 kg, SE 0.7, subjects with anorexia 27.9 kg, SE 1.5, P = .03). Furthermore, relative to participants without anorexia, those subjects with anorexia showed a significantly higher risk of developing disability after 2 years of follow-up (hazard ratio 2.25; 95% confidence intervals 1.15–4.39). Conclusions: Anorexia is common among community older subjects in Italy. Our results suggest that among old-old subjects, the presence of anorexia is associated with impaired physical performance and with a significant increased risk of incident disability, irrespective of potential confounders. [Copyright &y& Elsevier]

Abstract: Few studies have assessed the impact of pain on physical function among old-old subjects. The aim of the present observational study was to evaluate the association between presence of daily pain and incident disability in elderly subjects aged 80 years or older living in the community. We used data from the “Invecchiamento e Longevità nel Sirente” (ilSIRENTE) project, a two-year longitudinal study enrolling subjects aged 80 years or older. Daily pain was defined as any type of pain or discomfort in any part of the body manifested every day over the seven days preceding the baseline assessment. Disability in performing activities of daily living (ADLs) was defined as the need of assistance in one or more of the following ADLs: eating, dressing, transferring, mobility in bed, personal hygiene, and toileting. The mean age of 204 subjects participating to this study was 84.3 years (standard deviation [SD]: 3.8), and 135 (SD: 66.1%) were women. Of the total sample, 103 subjects (50.4%) presented with daily pain. After a two-year follow-up, 25 of 103 (24.2%) participants with daily pain and 14 of 101 (13.9%) without daily pain developed disability. After adjusting for potential confounders, presence of daily pain was associated with an increased risk of disability, but this association did not reach statistical significance (hazard ratio [HR]: 1.87; 95% confidence interval [CI]: 0.92–4.26). The risk of disability increased with pain severity. Compared with subjects without daily pain, the risk of incident disability was higher for participants with mild pain (HR: 1.35; 95% CI: 0.65–3.28) and significantly higher for those with moderate to severe pain (HR: 6.94; 95% CI: 2.00–23.01). In conclusion, among very old subjects living in the community, moderate to severe daily pain is associated with a significant increased risk of disability, irrespective of potential confounders. [Copyright &y& Elsevier]

Abstract: Objective: The principal aims of the present study were to explore the prevalence of anorexia and the factors correlated to anorexia in a large population of older people living in nursing home. Secondary, we evaluated the impact of anorexia on 1-year survival. Methods: Data are from baseline evaluation of 1904 participants enrolled in the Un Link Informatico sui Servizi Sanitari Esistenti per l’Anziano study, a project evaluating the quality of care for older persons living in an Italian nursing home. All participants underwent a standardized comprehensive evaluation using the Italian version of the inter Resident Assessment Instrument Minimum Data Set (version 2.0) for Nursing Home. We defined anorexia as the presence of lower food intake. The relationship between covariates and anorexia was estimated by deriving ORs and relative 95% CIs from multiple logistic regression models including anorexia as the dependent variable of interest. Hazard ratios and 95% CIs for mortality by anorexia were calculated. Results: More than 12% (240 participants) of the study sample suffered from anorexia, as defined by the presence of decreased food intake or the presence of poor appetite. Participants with functional impairment, dementia, behavior problems, chewing problems, renal failure, constipation, and depression, those treated with proton pump inhibitors and opioids had a nearly 2-fold increased risk of anorexia compared with participants not affected by these syndromes. Furthermore, participants with anorexia had a higher risk of death for all causes compared with nonanorexic participants (hazard ratio 2.26, 95% CI: 2.14–2.38). Conclusions: The major finding is that potentially reversible causes, such as depression, pharmacologic therapies, and chewing problems, were strongly and independently associated with anorexia among frail older people living in nursing home. Furthermore, anorexia was associated with higher rate of mortality, independently of age and other clinical and functional variables. [Copyright &y& Elsevier]

Abstract: Objective: Maintaining or increasing physical activity in late-middle age has been shown to be associated with a reduction in mortality. The aim of the present study was to explore the relationship between regular walking and the risk of all-cause death in a large population of frail and very old people living in community. Methods: We analyzed data from the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE study), a prospective cohort study that collected data on all subjects aged 80 year and older living in a mountain community. Baseline assessments of participants started in December 2003 and were completed in September 2004. All subjects were followed-up for 24 months. To the purpose of this study we selected all subjects without impairment in the activities of daily living (n =248). The main outcome measure was the relative hazard ratio of death over two years of follow-up for different levels of walking activity. Results: During a mean follow-up time of 24 months from baseline assessment, 30 subjects (12%) died. There was an uneven distribution of the risk. After adjusting for age, gender and other possible risk factors of death (functional and cognitive disability, congestive heart failure, hypertension, osteoarthritis, depression, number of medications, body mass index, cholesterol and reactive C protein) subjects walking 1 h or more per day were less likely to die compared to participants walking less than 1 h per day (RR, 0.36; 95% CI 0.12–0.98). Conclusions: Our results obtained from a representative sample of very old and frail elderly subjects expand the knowledge that high levels of walking activity are associated with better survival. [Copyright &y& Elsevier]