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Background: There is wide variation among physicians in the level of knowledge regarding vaccines and vaccination. We sought to compare the level of vaccine knowledge between qualified specialists and postgraduate residents., Methods: A questionnaire designed ad hoc by a consensus group was circulated to the Directors of 51 geriatrics internship programs in Italy. It investigated demographics, information sources, knowledge about influenza, pneumonococcal and herpes zoster vaccines and target groups. The proportion of correct responders was compared between residents and qualified specialists, and between best (top quartile) and worst (bottom quartile) performers., Results: A total of 459 questionnaires were analyzed; 245 (53%) were females; 253 (55%) were qualified specialists, 206 (45%) were residents. Mean age was 40.3 (SD: 12.8) years, almost 60% worked in acute care wards. On average, 33% of patients asked for information about vaccination. Residents answered significantly better on 7 out of 18 questions, and numerically albeit non-statistically higher correct response rates on a further 8 questions. There were significantly more men among the poor performers (p < 0.001), and significantly more residents among the best performers (p < 0.001). Overall, the rates of correct answers were low, with >50% of correct responses achieved on only 5 out of 18 questions (27.8%); for 2 questions, <20% responded correctly., Conclusions: Postgraduate residents in training have an overall better level of knowledge of vaccines, vaccination indications and practices than qualified specialists. This study provides avenues to develop targeted interventions to ensure health care providers are up to date and providing accurate information to patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Frailty is highly prevalent in older persons and associated with negative health-related events and costs. Despite successful clinical trials, translation of evidence into implementation of dedicated programs has been scarce. This is probably due to funding limitations and lack of generalizability of rigid schemes adopted in controlled studies. We propose a guidance to implement complex interventions against frailty in the community, and describe the design and early findings of the +AGIL Barcelona program., Methods: A guidance "decalogue" resulted from an experts' panel prioritization of recommendations by international independent bodies. On this basis, we reorganized existing primary care, geriatrics and community-based resources to implement our program, which includes a screening, a multi-component intervention modulated on the comprehensive geriatric assessment and integrated follow-up plus continuity through community-based resources. The pre-post impact of the program on physical function, as well as on clinical endpoints, person-center outcomes and costs will be assessed., Results: Integrated care, multi-component, person-centered strategies to empower the final users in a flexible and adaptable way should be promoted after raising awareness and potentially convey long term investments. In 22 months, 185 participants (mean age ± SD = 81.6 ± 5.7 years, 72% women) joined the program. Although independent in the activities of daily living, participants showed clear indicators of frailty (Short Physical Performance Battery = 7.1 ± 2.5; gait speed = 0.69 ± 0.2 m/s)., Conclusions: +AGIL Barcelona may represent a unique model to manage frailty in older community-dwellers, translating evidence into pragmatic clinical practice. Further research will clarify the effects of this intervention., (Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

The survival of HIV-infected persons has been increasing over the last years, thanks to the implementation of more effective pharmacological and non-pharmacological interventions. Nevertheless, HIV-infected persons are often "biologically" older than their "chronological" age due to multiple clinical, social, and behavioral conditions of risk. The detection in this population of specific biological features and syndromic conditions typical of advanced age has made the HIV infection an interesting research model of accelerated and accentuated aging. Given such commonalities, it is possible that "biologically aged" HIV-positive persons might benefit from models of adapted and integrated care developed over the years by geriatricians for the management of their frail and complex patients. In this article, possible strategies to face the increasingly prevalent geriatric syndromes in HIV-infected persons are discussed. In particular, it is explained the importance of shifting from the traditional disease-oriented approach into models of care facilitating a multidisciplinary management of frailty.

The identification of frail older persons is a public health priority. Frailty is defined as an extreme vulnerability of the organism to endogenous and exogenous stressors, a syndrome that exposes the individual at higher risk of negative health-related outcomes as well as a transition phase between successful aging and disability. The theoretical concept of frailty is largely agreed, its practical translation still presents some limitations due to the existence of multiple tools and operational definition. In this brief review, we would like to clarify the frailty concept regarding scientific literature.

The terms multimorbidity and frailty are increasingly used in the medical literature to measure the risk profile of an older individual in order to support clinical decisions and design ad hoc interventions. The construct of multimorbidity was initially developed and used in nongeriatric settings. It generates a monodimensional nosological risk profile, grounding its roots in the somewhat inadequate framework of disease. On the other hand, frailty is a geriatric concept that implies a more exhaustive and comprehensive assessment of the individual and his/her environment, facilitating the implementation of multidimensional and tailored interventions. This article aims to promote among geriatricians the use of terms that may better enhance their background and provide more value to their unrivaled expertise in caring for biologically aged persons., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Despite dedicated efforts to identify interventions to delay aging, most promising interventions yielding dramatic life-span extension in animal models of aging are often ineffective when translated to clinical trials. This may be due to differences in primary outcomes between species and difficulties in determining the optimal clinical trial paradigms for translation. Measures of physical function, including brief standardized testing batteries, are currently being proposed as biomarkers of aging in humans, are predictive of adverse health events, disability, and mortality, and are commonly used as functional outcomes for clinical trials. Motor outcomes are now being incorporated into preclinical testing, a positive step toward enhancing our ability to translate aging interventions to clinical trials. To further these efforts, we begin a discussion of physical function and disability assessment across species, with special emphasis on mice, rats, monkeys, and man. By understanding how physical function is assessed in humans, we can tailor measurements in animals to better model those outcomes to establish effective, standardized translational functional assessments with aging., (© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The sustainability of healthcare systems worldwide is threatened by the absolute and relative increase in the number of older persons. The traditional models of care (largely based on a disease-centered approach) are inadequate for a clinical world dominated by older individuals with multiple (chronic) comorbidities and mutually interacting syndromes. There is the need to shift the center of the medical intervention from the disease to the biological age of the individual. Thus, multiple medical specialties have started looking with some interest at concepts of geriatric medicine in order to better face the increased complexity (due to age-related conditions) of their average patient. In this scenario, special interest has been given to frailty, a condition characterized by the reduction of the individual's homeostatic reserves and increased vulnerability to stressors. Frailty may indeed represent the fulcrum to lever for reshaping the healthcare systems in order to make them more responsive to new clinical needs. However, the dissemination of the frailty concept across medical specialties requires a parallel and careful consideration around the currently undervalued role of geriatricians in our daily practice., (Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Prevent increased number of dependent elderly has become a new priority for European public health. To achieve this, it is necessary to identify the frail older persons at risk of becoming dependent. Detecting frailty also allows to better understand an old patient's physiological reserves before making a therapeutic decision. To date, research tries to realize simple frailty screening tools allowing the clinician to better target - care provided to old adults during their first consultation. Furthermore, frailty is a reversible syndrome, so a global geriatric evaluation will allow the implementation of an individual program of early multi-domain care. The Multidomain intervention to prevent disability project in elders (MINDED), a randomized trial to prevent disability in elders, aims, in its second phase, to test the feasibility and to verify logistical, methodological and organizational aspects of the multi-domain intervention of the pilot study. In this paper, we shall describe the difficulties encountered and the solutions found during this feasibility phase.

The integration of frailty measures in clinical practice is crucial for the development of interventions against disabling conditions in older persons. The frailty phenotype (proposed and validated by Fried and colleagues in the Cardiovascular Health Study) and the Frailty Index (proposed and validated by Rockwood and colleagues in the Canadian Study of Health and Aging) represent the most known operational definitions of frailty in older persons. Unfortunately, they are often wrongly considered as alternatives and/or substitutables. These two instruments are indeed very different and should rather be considered as complementary. In the present paper, we discuss about the designs and rationals of the two instruments, proposing the correct ways for having them implemented in the clinical setting.

Backgroundfalls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present.Objectivesto create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries.Methodsa steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting.Recommendationsall older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations.Conclusionsthe core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Background After an acute infection, older persons may benefit from geriatric rehabilitation (GR). Objectives This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. Design Multicentre prospective cohort study. Setting 59 GR facilities in 10 European countries. Participants Post-COVID-19 patients admitted to GR between October 2020 and October 2021. Methods Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. Results 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0–7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P  < 0.001) points per month and stabilised around 17.0 (quadratic slope: −0.26, SE 0.02, P  < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P  < 0.001) and stabilised around 0.8 (quadratic slope: −0.014, SE 0.001, P  < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. Conclusions Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR. [ABSTRACT FROM AUTHOR]

Abstract Background Physical function measures have been shown to predict negative health-related events in older persons, including mortality. These markers of functioning may interact with the self-rated health (SRH) in the prediction of events. Aim of the present study is to compare the predictive value for mortality of measures of physical function and SRH status, and test their possible interactions. Methods Data are from 335 older persons aged ≥ 80 years (mean age 85.6 years) enrolled in the "Invecchiamento e Longevità nel Sirente" (ilSIRENTE) study. The predictive values for mortality of 4-meter walk test, Short Physical Performance Battery (SPPB), hand grip strength, Activities of Daily Living (ADL) scale, Instrumental ADL (IADL) scale, and a SRH scale were compared using proportional hazard models. Kaplan-Meier survival curves for mortality and Receiver Operating Characteristic (ROC) curve analyses were also computed to estimate the predictive value of the independent variables of interest for mortality (alone and in combination). Results During the 24-month follow-up (mean 1.8 years), 71 (21.2%) events occurred in the study sample. All the tested variables were able to significantly predict mortality. No significant interaction was reported between physical function measures and SRH. The SPPB score was the strongest predictor of overall mortality after adjustment for potential confounders (per SD increase; HR 0.64; 95%CI 0.48–0.86). A similar predictive value was showed by the SRH (per SD increase; HR 0.76; 95%CI 0.59–0.97). The chair stand test was the SPPB subtask showing the highest prognostic value. Conclusion All the tested measures are able to predict mortality with different extents, but strongest results were obtained from the SPPB and the SRH. The chair stand test may be as useful as the complete SPPB in estimating the mortality risk.

BACKGROUND/OBJECTIVES Examining handgrip strength (HGS) asymmetry and weakness together may extend the predictive capacity of HGS for capturing possible health problems such as cognitive impairment. The purpose of this study was to determine the associations of HGS asymmetry and weakness on lower cognitive functioning in a national sample of aging Americans. DESIGN Longitudinal panel. SETTING Participant residences. PARTICIPANTS The analytic sample included 17,163 Americans aged 65.0 years (standard deviation = 10.1 years) who participated in the 2006 to 2016 waves of the Health and Retirement Study (HRS). MEASUREMENTS A handgrip dynamometer was used to measure HGS; weakness was defined as HGS below 26 kg (men) or below 16 kg (women). Persons with HGS above 10% stronger on either hand were considered as having any HGS asymmetry. Those with HGS that was more than 10% stronger on their dominant or nondominant hand were considered as having dominant or nondominant HGS asymmetry, respectively. The Telephone Interview of Cognitive Status determined lower cognitive functioning (≤11 for ages 50‐64 years; ≤10 for ages ≥65 years). Covariate‐adjusted linear mixed‐effects models analyzed the associations of each HGS asymmetry and weakness group on lower cognitive functioning. RESULTS: Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had greater odds for lower cognitive functioning: 1.15 (95% confidence interval [CI] = 1.03‐1.27) for any HGS asymmetry alone, 1.64 (95% CI = 1.21‐2.23) for weakness alone, and 1.95 (95% CI = 1.51‐2.53) for any HGS asymmetry and weakness. Each HGS asymmetry dominance and weakness group also had greater odds for lower cognitive functioning: 1.12 (95% CI = 1.01‐1.25) for asymmetric dominant HGS alone, 1.27 (95% CI = 1.05‐1.53) for asymmetric nondominant HGS alone, 1.64 (95% CI = 1.21‐2.23) for weakness alone, 1.89 (95% CI = 1.39‐2.57) for weakness and asymmetric dominant HGS, and 2.10 (95% CI = 1.37‐3.20) for weakness and asymmetric nondominant HGS. Conclusion: The presence of both HGS asymmetry and weakness may predict accelerated declines in cognitive functioning. [ABSTRACT FROM AUTHOR]

Background: Frailty is a major health issue which impacts the life of older people, posing a significant challenge to the health system. One of the key emerging areas is the development of frailty interventions to halt or reverse the progression of the condition. In many countries, economic evidence is required to inform public funding decisions for such interventions, and cost-effectiveness models are needed to estimate long-term costs and effects. Such models should capture current clinical understanding of frailty, its progression and its health consequences. The objective of this paper is to present a conceptual model of frailty that can be used to inform the development of a cost-effectiveness model to evaluate frailty interventions. Methods: After critical analysis of the clinical and economic literature, a Delphi study consisting of experts from the disciplines of clinical medicine and epidemiology was undertaken to inform the key components of the conceptual model. We also identified relevant databases that can be used to populate and validate the model. Results: A list of significant health states/events for which frailty is a strong independent risk factor was identified (e.g., hip fracture, hospital admission, delirium, death). We also identified a list of important patient attributes that may influence disease progression (e.g., age, gender, previous hospital admissions, depression). A number of large-scale relevant databases were also identified to populate and validate the cost-effectiveness model. Face validity of model structure was confirmed by experts. Discussion and conclusions: The proposed conceptual model is being used as a basis for developing a new cost-effectiveness model to estimate lifetime costs and outcomes associated with a range of frailty interventions. Using an appropriate model structure, which more accurately reflects the natural history of frailty, will improve model transparency and accuracy. This will ultimately lead to better informed public funding decisions around interventions to manage frailty. [ABSTRACT FROM AUTHOR]

The established relationship between the single disease and its treatment (composed by potentially multiple drugs) is unique and bidirectional: the treatment is taken because of the disease, and the disease is improved by the treatment. The onset of adverse reactions is often managed following the same vertical approach leading to the prescribing cascade Furthermore, as sketched in Figure 2, the presence of multiple diseases, each theoretically requiring specific treatment, subtly and exponentially increases the number of disease-disease, disease-drug, and drug-drug interactions. The multiplication of the disease-drug, disease-disease, and drug-drug interactions exponentially increases the clinical complexity. Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug-drug interactions in robust versus frail hospitalised falls patients: a prospective cohort study. [Extracted from the article]

Multimorbidity is a common and burdensome condition that may affect quality of life, increase medical needs, and make people live more years of life with disability. Negative outcomes related to multimorbidity occur beyond what we would expect from the summed effect of single conditions, as chronic diseases interact with each other, mutually enhancing their negative effects, and eventually leading to new clinical phenotypes. Moreover, multimorbidity mirrors an accelerated global susceptibility and a loss of resilience, which are both hallmarks of aging. Due to the complexity of its assessment and definition, and the lack of clear evidence steering its management, multimorbidity represents one of the main current challenges for clinicians, researchers, and policymakers. The authors of this article recently reflected on these issues during two twin international symposia at the 2016 European Union Geriatric Medicine Society (EUGMS) meeting in Lisbon, Portugal, and the 2016 Gerontological Society of America (GSA) meeting in New Orleans, USA. The present work summarizes the most relevant aspects related to multimorbidity, with the ultimate goal to identify knowledge gaps and suggest future directions to approach this condition. [ABSTRACT FROM AUTHOR]

Aims: To describe the associations of frailty with diabetes mellitus and related conditions in older adults.Methods: We conducted a cross-sectional analysis of a representative sample of older adults (n = 5379). We generated a 35-item frailty index (FI) and obtained information on diabetes and related conditions (peripheral neuropathy, lower limb amputation, diabetic coma, number of physician visits due to diabetes-related conditions, all-cause hospitalizations in the past year, years since diabetes diagnosis, and type of treatment). Logistic and Poisson regression models were used to determine the associations between frailty and diabetes and its complications.Results: The mean age was 70.3 years (± 7.8); 54.7% were women. Those with an FI ≤ 0.082 composed the reference group. Multivariate analysis showed an OR of 2.32 (95% CI 1.93-2.73, p < 0.001) for the association between diabetes and frailty. People who were hospitalized for any cause during the previous year, those receiving both insulin and an oral compound to manage diabetes, and those with peripheral neuropathy showed ORs of 2.32 (95% CI 1.69-3.18, p < 0.001), 5.6 (95% CI 1.58-19.8, p = 0.008), and 2.02 (95% CI 1.42-2.86, p < 0.001), respectively, for being in the most frail group.Conclusions: People with diabetes have higher frailty scores. Furthermore, older adults with diabetes and higher burden of frailty have more diabetes-related complications. [ABSTRACT FROM AUTHOR]

The sustainability of healthcare systems is threatened by the increasing (absolute and relative) number of older persons referring to clinical services. Such global phenomenon is questioning the traditional paradigms of medicine, pushing towards the need of new criteria at the basis of clinical decision algorithms. In this context, frailty has been advocated as a geriatric condition potentially capable of overcoming the weakness of chronological age in the identification of individuals requiring adapted care due to their increased vulnerability to stressors. Interestingly, frailty poses itself beyond the concept of nosological conditions due to the difficulties at correctly framing traditional diseases in the complex and heterogeneous scenario of elders. Thus, frailty may play a key role in public health policies for promoting integrated care towards biologically aged individuals, currently presenting multiple unmet clinical needs. At the same time, the term frailty has also been frequently used in the literature for framing a physical condition of risk for (mainly functional) negative endpoints. The combination of such physical impairment with an organ-specific phenotype (e.g., the age-related skeletal muscle decline or sarcopenia) may determine the assumptions for the development of a clinical condition to be used as potential target for ad hoc interventions against physical disability. In the present article, we present the background of frailty and sarcopenia, and discuss their potentialities for reshaping current clinical and research practice in order to promote holistic approach to older patients, solicit personalization of care, and develop new targets for innovative interventions. [ABSTRACT FROM AUTHOR]

Background: Manual measurement of 4-meter gait speed by a stopwatch is the gold standard test for functional assessment in older adults. However, the accuracy of this technique may be biased by several factors, including intra- and inter-operator variability. Instrumental techniques of measurement using accelerometers may have a higher accuracy. Studies addressing the concordance between these two techniques are missing. The aim of the present community-based observational study was to compare manual and instrumental measurements of 4-meter gait speed in older individuals and to assess their relationship with other indicators of physical performance. Methods: One-hundred seventy-two (69 men, 103 women) non-disabled community-dwellers aged ≥65 years were enrolled. They underwent a comprehensive geriatric assessment including physical function by Short Physical Performance Battery (SPPB), hand grip strength, and 6-minute walking test (6MWT). Timed usual walking speed on a 4-meter course was assessed by using both a stopwatch (4-meter manual measurement, 4-MM) and a tri-axial accelerometer (4-meter automatic measurement, 4-MA). Correlations between these performance measures were evaluated separately in men and women by partial correlation coefficients. Results: In both genders, 4-MA was associated with 4-MM (men r = 0.62, p<0.001; women r = 0.73, p<0.001), handgrip strength (men r = 0.40, p = 0.005; women r = 0.29, p = 0.001) and 6MWT (men r = 0.50, p = 0.0004; women r = 0.22, p = 0.048). 4-MM was associated with handgrip strength and 6MWT in both men and women. Considering gait speed <0.6 m/s as diagnostic of dismobility syndrome, the two methods of assessment disagreed, with a different categorization of subjects, in 19% of men and 23% of women. The use of accelerometer resulted in 29 (13 M, 16 F) additional diagnoses of dismobility, compared with the 4-MM. Conclusions: In an older population, the concordance of gait speeds manually or instrumentally assessed is not optimal. The results suggest that manual measures might lead to misclassification of a substantial number of subjects. However, longitudinal studies using standardized and validated procedures aimed at the comparison of different techniques are needed before recommending the use of accelerometers in comprehensive geriatric assessment. [ABSTRACT FROM AUTHOR]

Background: The “frailty syndrome” (a geriatric multidimensional condition characterized by decreased reserve and diminished resistance to stressors) represents a promising target of preventive interventions against disability in elders. Available screening tools for the identification of frailty in the absence of disability present major limitations. In particular, they have to be administered by a trained assessor, require special equipment, and/or do not discriminate between frail and disabled individuals. Aim of this study is to verify the agreement of a novel self-reported questionnaire (the “Frail Non-Disabled” [FiND] instrument) designed for detecting non-mobility disabled frail older persons with results from reference tools. Methodology/Principal Findings: Data are from 45 community-dwelling individuals aged ≥60 years. Participants were asked to complete the FiND questionnaire separately exploring the frailty and disability domains. Then, a blinded assessor objectively measured the frailty status (using the phenotype proposed by Fried and colleagues) and mobility disability (using the 400-meter walk test). Cohen's kappa coefficients were calculated to determine the agreement between the FiND questionnaire with the reference instruments. Mean age of participants (women 62.2%) was 72.5 (standard deviation 8.2) years. Seven (15.6%) participants presented mobility disability as being unable to complete the 400-meter walk test. According to the frailty phenotype criteria, 25 (55.6%) participants were pre-frail or frail, and 13 (28.9%) were robust. Overall, a substantial agreement of the instrument with the reference tools (kappa = 0.748, quadratic weighted kappa = 0.836, both p values<0.001) was reported with only 7 (15.6%) participants incorrectly categorized. The agreement between results of the FiND disability domain and the 400-meter walk test was excellent (kappa = 0.920, p<0.001). Conclusions/Significance: The FiND questionnaire presents a very good capacity to correctly identify frail older persons without mobility disability living in the community. This screening tool may represent an opportunity for diffusing awareness about frailty and disability and supporting specific preventive campaigns. [ABSTRACT FROM AUTHOR]

The article presents a case of a 95-year-old female who was presented to a geriatric unit due to mild chest pain and minimal haematemesis that occurred while eating. An oesophagogastroduodenoscopy showed oesophageal bleeding ulceration and large hiatal para-oesophageal hernia. She was diagnosed with esophageal perforation and was treated with broad-spectrum antibiotic therapy (amoxicillin-clavulanate) and proton pump inhibitors.

Background. Screening tools for the identification of vulnerable older patients with cancer are needed. Aim of this study is to measure the prognostic value of multiple screening tools for the assessment of mortality risk in oncogeriatrics. Methods. The prognostic value of the following assessment tools was tested in 200 older women with gynecological cancer (mean age = 73.5 years) for 1-year mortality: Short Physical Performance Battery, usual gait speed, handgrip strength, Eastern Cooperative Oncology Group Performance Status scale, Karnofsky Performance Status scale, Vulnerable Elders Scale-13, activities of daily living, and instrumental activities of daily living. Cox proportional hazard models were performed to estimate the associations of the performance measures with mortality. Areas under receiver operating characteristic curves were also estimated. Results. Twenty-three participants (11.5%) died during the follow-up. The Short Physical Performance Battery, usual gait speed, and instrumental activities of daily living were the only parameters significantly associated with mortality, even after adjustment for confounders. No statistically significant results were reported for other functional measures. Similar results were obtained when testing the predictive values of the performance measures at the receiver operating characteristic analyses. Conclusions. The Short Physical Performance Battery and especially the usual gait speed may represent promising tools for measuring the mortality risk of older cancer patients, thus potentially supporting clinical decisions. Further studies are needed to confirm and extend the present findings. [ABSTRACT FROM PUBLISHER]

It has been hypothesized that cellular damage caused by oxidative stress is associated with late-life depression but epidemiological evidence is limited. In the present study we evaluated the association between urinary 8-iso-prostaglandin F2α (8-iso-PGF2α), a biomarker of lipid peroxidation, and depressed mood in a large sample of community-dwelling older adults. Participants were selected from the Health, Aging and Body Composition study, a community-based longitudinal study of older persons (aged 70–79 years). The present analyses was based on a subsample of 1027 men and 948 women free of mobility disability. Urinary concentration of 8-iso-PGF2α was measured by radioimmunoassay methods and adjusted for urinary creatinine. Depressed mood was defined as a score greater than 5 on the 15-item Geriatric Depression Scale and/or use of antidepressant medications. Depressed mood was present in 3.0% of men and 5.5% of women. Depressed men presented higher urinary concentrations of 8-iso-PGF2α than non-depressed men even after adjustment for multiple sociodemographic, lifestyle and health factors (p = 0.03, Cohen’s d = 0.30). This association was not present in women (depressed status-by-sex interaction p = 0.04). Our study showed that oxidative damage may be linked to depression in older men from a large sample of the general population. Further studies are needed to explore whether the modulation of oxidative stress may break down the link between late-life depression and its deleterious health consequences. [ABSTRACT FROM AUTHOR]

Introduction and Rationale: The number of older cancer patients is increasing with global aging of the population. A close interaction between oncologists and geriatricians becomes necessary to (1) better evaluate the elders’ health status, (2) determine their residual clinical/biological reserves, and (3) optimize the provided medical care. In fact, aggressive antineoplastic managements are often denied to older patients, possibly because of the common misconception suggesting older age and/or clinical complexity as absolute contraindications to advanced treatments. Methods: The primary aim of the presented project is to assess whether assigning a geriatrician to provide daily medical care to older cancer patients (aged 65 years and older) admitted to an oncology ward increases the number of patients eligible for a chemotherapeutic and/or surgical intervention. The project is articulated in 2 phases: (1) a retrospective phase based on analysis of data collected over the 2 years before the beginning of the study, and (2) a prospective 2-year intervention. Additional information about clinical conditions, biological parameters, adverse drug reactions, body composition, physical function, and 1-year health-related events will also be recorded. Outcomes: The combination of expertise from oncologists and geriatricians is likely to result in (1) an improved selection of candidates for interventions aimed at increasing disability-free life expectancy and/or overall survival, and (2) a more rational exclusion of patients at higher risk of toxicity or with poor prognosis. In this article, the development of an onco-geriatric unit aimed at the evaluation, management, and treatment of older women with gynecological cancer is also described. [Copyright &y& Elsevier]

Background The Frailty Index (FI), proposed by Rockwood and Mitniski, measures the deficits accumulation occurring with aging, and can be generated from the results of a comprehensive clinical assessment. Its construct (based on pure arithmetical assumptions) may represent a unique feature for supporting unbiased comparisons among clinical facilities/services. Objective To propose an example depicting how the FI may support health economic evaluations and provide insights for public health. Design Observational study. Setting Nine nursing homes participating in the “Incidence of pNeumonia and related ConseqUences in nursing home Residents” (INCUR) study. Subjects A sample of 345 older persons living in nursing homes. Methods A 30-item FI was generated from clinical data retrieved from medical charts. Health care expenditures that occurred over 12 months of follow-up for each participant were obtained from the Caisse Primaire d'Assurance Maladie . Descriptive analyses describing the relationships between the FI of residents with the annual health care expenditures according to nursing home are presented. Results Mean age of the study sample was 86.0 (SD 7.9) years. The median annual cost per patient was 27,717.75 (interquartile range, IQR 25,917.60–32,118.02) Euros. The median FI was 0.33 (IQR 0.27–0.43). Results are graphically presented to highlight clinical and economic differences across nursing homes, so as to identify potential discrepancies between clinical burden and consumed resources. Conclusions In this article, an example on how the FI may support health economic analyses and promote an improved allocation of healthcare resources is presented. [ABSTRACT FROM AUTHOR]

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. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Depression in older persons represents a major issue because of its relevant prevalence and the associated higher risk of adverse health-related events. The aim of this study was to evaluate the relationship of depressive symptoms with measures of physical performance, muscle strength, and functional status. Data are from baseline evaluation of the ilSIRENTE Study (n = 364). Physical performance was assessed using the Short Physical Performance Battery and the 4-meter walking test. Muscle strength was measured by hand-grip strength. Functional performance was assessed using Basic and Instrumental Activities of Daily Living. Depression was defined by analyzing the different depressive manifestations included in the Minimum Data Set for Home Care Form: verbal expression of sad and/or anxious mood and demonstrated signs of mental distress. Analyses of covariance and linear regressions were performed to evaluate the relationship between depression and physical function. Participants with depression showed significantly worse results in all of the physical function tests. Subjects with depression presented significantly lower adjusted mean results for the 4-meter walking test (0.41 m/s; SE, 0.03) and the Short Physical Performance Battery score (5.68; SE, 0.38) compared with those without depression (0.50 m/s; SE, 0.01 and 6.93; SE, 0.21; all P < .01, respectively). Participants with depressed mood also presented a higher number of impaired instrumental activities of daily living (3.69; SE, 0.25) compared with participants with less than 3 depressive symptoms (2.85; SE, 0.14; P = .005). No significant difference was reported for the hand-grip strength and the Basic Activities of Daily Living scale. In conclusion, physical performance and functional status measures are significantly and negatively influenced by the presence of depression in community-dwelling older persons aged 80 years and older. [ABSTRACT FROM AUTHOR]

Background: Physical function measures have gained increased importance in the evaluation of older persons. The presence of comorbidity is a major and growing issue in geriatrics. Objective: To evaluate the relationship between comorbidity and physical function in community-dwelling older persons. Methods: Data are from baseline evaluation of the ilSIRENTE study (n = 364). Physical performance was assessed using the Short Physical Performance Battery (SPPB) and the 4-meter walking test. Muscle strength was measured by hand-grip strength. Functional performance was assessed using Basic and Instrumental Activities of Daily Living (ADLs and IADLs, respectively). Comorbidity was defined as ≥3 clinical conditions. Analyses of covariance and linear regressions were performed to evaluate the relationship between comorbidity and physical function. Results: The mean age of participants was 85.9 (SD = 4.9) years. About one third (37.4%) of participants reported ≥3 clinical conditions. Participants with comorbidity had significantly worse results in all the physical function tests. Participants with comorbidity had significantly lower adjusted results for the 4-meter walking test (0.444 m/s) and the SPPB score (6.131) compared to those without comorbidity (0.531 m/s and 7.221; all p = 0.001, respectively). Participants with comorbidity were more IADL-impaired (3.152) than participants without comorbidity (2.767; p = 0.04). No significant association of ADLs and hand-grip strength with comorbidity was reported. Similar strengths of association for the 4-meter walking test (per SD increase, β = –0.280; p = 0.001) and the SPPB (per SD increase, β = –0.285; p = 0.001) with comorbidity were reported. Conclusions: Physical function measures, especially walking speed and SPPB, are associated with comorbidity. Physical performance measures may improve the clinical evaluation of older persons. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: To define clinically relevant cutpoints for usual gait speed and to investigate their predictive value for health-related events in older persons. Design: Prospective cohort study. Setting: Health, Aging and Body Composition Study. Participants: Three thousand forty-seven well-functioning older persons (mean age 74.2). Measurements: Usual gait speed on a 6-m course was assessed at baseline. Participants were randomly divided into two groups to identify (Sample A; n=2,031) and then validate (Sample B; n=1,016) usual gait-speed cutpoints. Rates of persistent lower extremity limitation events (mean follow-up 4.9 years) were calculated according to gait speed in Sample A. A cutpoint (defining high- (<1 m/s) and low risk (≥1 m/s) groups) was identified based on persistent lower extremity limitation events. The predictive value of the identified cutpoints for major health-related events (persistent severe lower extremity limitation, death, and hospitalization) was evaluated in Sample B using Cox regression analyses. Results: A graded response was seen between risk groups and health-related outcomes. Participants in the high-risk group had a higher risk of persistent lower extremity limitation (rate ratio (RR)=2.20, 95% confidence interval (CI)=1.76–2.74), persistent severe lower extremity limitation (RR=2.29, 95% CI=1.63–3.20), death (RR=1.64, 95% CI=1.14–2.37), and hospitalization (RR=1.48, 95% CI=1.02–2.13) than those in the low-risk group. Conclusion: Usual gait speed of less than 1 m/s identifies persons at high risk of health-related outcomes in well-functioning older people. Provision of a clinically meaningful cutpoint for usual gait speed may facilitate its use in clinical and research settings. [ABSTRACT FROM AUTHOR]

The author discusses aspects of the frailty syndrome that was repeated solicited in literature. It states that the growing number of older was seriously threatened the healthcare sustainability. It adds that the condition of cognitive frailty occupy the fragmentation of frailty concept into components and sub-domains. It says that in clinical domain the accelerated implementation of frailty syndrome was responsible for the gaps of understanding and knowledge.