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Increased rates of anxiety and depression have been reported for older adults during the COVID-19 pandemic. However, little is known regarding the onset of mental health morbidity during the acute phase of the disease and the role of age as potential independent risk factor for psychiatric symptoms. The cross-sectional association between older age and psychiatric symptoms has been estimated in a sample of 130 patients hospitalized for COVID-19 during the first and second wave of the pandemic. Compared to younger patients, those who were 70 years of age or older resulted at a higher risk of psychiatric symptoms measured on the Brief Psychiatric Symptoms Rating Scale (BPRS) (adjusted (adj.) odds ratio (OR) 2.36, 95% confidence interval (CI) 1.05–5.30) and delirium (adj. OR 5.24, 95% CI 1.63–16.8)). No association was found between older age and depressive symptoms or anxiety. Age was associated with psychiatric symptoms independently of gender, marital status, history of psychiatric illness, severity of disease and cardiovascular morbidity. Older adults appear at high risk of developing psychiatric symptoms related to COVID-19 disease during hospital stay. Multidisciplinary preventive and therapeutic interventions should be implemented to reduce the risk of psychiatric morbidity and related adverse health care outcomes among older hospital inpatients with COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Dementia is common in nursing homes (NH) residents. Defining dementia comorbidities is instrumental to identify groups of persons with dementia that differ in terms of health trajectories and resources consumption. We performed a cross‐sectional study to identify comorbidity patterns and their associated clinical, behavioral, and functional phenotypes in institutionalized older adults with dementia. Methods: We analyzed data on 2563 Italian NH residents with dementia, collected between January 2014 and December 2018 using the multidimensional assessment instrument interRAI Long‐Term Care Facility (LTCF). A standard principal component procedure was used to identify comorbidity patterns. Linear regression analyses were used to ascertain correlates of expression of the different patterns. Results: Among NH residents with dementia, we identified three different comorbidity patterns: (1) heart diseases, (2) cardiovascular and respiratory diseases and sensory impairments, and (3) psychiatric diseases. Older age significantly related to increased expression of the first two patterns, while younger patients displayed increased expression of the third one. Recent hospital admissions were associated with increased expression of the heart diseases pattern (β = 0.028; 95% confidence interval [CI] 0.003 to 0.05). Depressive symptoms and delirium episodes increased the expression of the psychiatric diseases pattern (β = 0.130, 95% CI 0.10 to 0.17, and β 0.130, CI 0.10 to 0.17, respectively), while showed a lower expression of the heart diseases pattern. Discussion: We identified different comorbidity patterns within NH residents with dementia that differ in term of clinical and functional profiles. The prompt recognition of health needs associated to a comorbidity pattern may help improve long‐term prognosis and quality of life of these individuals. Highlights: Defining dementia comorbidities patterns in institutionalized older adults is key.Institutionalized older adults with dementia express different care needs.Comorbidity patterns are instrumental to identify different patients' phenotypes.Phenotypes vary in terms of health trajectories and demand different care plans.Prompt recognition of phenotypes in nursing homes can positively impact on outcomes. [ABSTRACT FROM AUTHOR]

Background: Frailty is increasingly reported among older adults with cardiovascular diseases and it has been demonstrated to increase negative health outcomes and mortality. To date, no systematic review of the evidence is available regarding the association between frailty and ischemic heart disease (IHD). We performed a systematic review of literature and a meta-analysis to assess the association between frailty and IHD.Methods: We selected all the studies that provided information on the association between frailty and IHD, regardless of the study setting, study design, or definition of IHD and frailty. PubMed, Web of Science and Embase were searched for relevant papers. Studies that adopted the Fried definition for frailty were included in the meta-analyses. For each measure of interest (proportions and estimates of associations), a meta-analysis was performed if at least three studies used the same definition of frailty. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting.Results: Thirty-seven studies were included. Of these, 22 adopted the Fried criteria to define frailty and provided estimates of prevalence and therefore they were included in meta-analyses. The pooled prevalence of IHD in frail individuals was 17% (95% Confidence Interval [95%CI] 11-23%) and the pooled prevalence of frailty in individuals with IHD was 19% (95% CI 15-24%). The prevalence of frailty among IHD patients ranged from 4 to 61%. Insufficient data were found to assess longitudinal association between frailty and IHD.Conclusions: Frailty is quite common in older persons with IHD. The identification of frailty among older adults with IHD should be considered relevant to provide individualized strategies of cardiovascular prevention and care. Further research should specifically explore the association between frailty and IHD and investigate the potential common biological ground. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

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]

The systematic adoption of "second-generation" comprehensive geriatric assessment instruments, initiated with the Minimum Data Set (MDS) implementation in U.S. nursing homes, and continued with the uptake of related MDS instruments internationally, has contributed to the creation of large patient-level data sets. In the present special article, we illustrate the potential of analyses using the MDS data to: (a) identify novel prognostic factors; (b) explore outcomes of interventions in relatively unselected clinical populations; (c) monitor quality of care; and (d) conduct comparisons of case mix, outcomes, and quality of care. To illustrate these applications, we use a sample of elderly patients admitted to home care in 11 European Home Health Agencies that participated in the AgeD in HOme Care (AD-HOC) project, sponsored by the European Union. The participants were assessed by trained staff using the MDS for Home Care, 2.0 version. We argue that the harmonization by InterRAI of the MDS forms for different health settings, referred to as "the third generation of assessment," has produced the first scientific, standardized methodology in the approach to effective geriatric care. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the association between chewing problems and risk of mortality in an older population receiving home care in Europe. DESIGN: Retrospective cohort study. SETTING: Eleven European countries. PARTICIPANTS: Two thousand seven hundred fifty-five older adults (mean age±standard deviation 82.2±7.2) in home care. MEASUREMENTS: Data were collected using the Minimum Data Set for Home Care. Study personnel recorded chewing problems (inability to chew food easily and without pain or difficulties, regardless of cause) that presented in the last 3 days before baseline assessment. Data on mortality were collected over a 1-year period. RESULTS: Three hundred ninety-five participants (14.3%) presented with chewing problems. One-year mortality differed significantly according to presence of chewing problems; 303 of 2,361 (12.8%) without chewing problems (crude incident rate per person-year (p-y)=0.15) and 80 of 394 (20.3%) participants with chewing problems (crude incident rate per p-y=0.24) died during follow-up. After adjusting for potential confounders, the risk of death was significantly higher for participants with chewing problems (adjusted hazard ratio (HR)=1.45, 95% confidence intervals (CI)=1.05–1.99). This association remained after exclusion of participants with cognitive impairment (adjusted HR=1.50, 95% CI=1.03–2.20) and those with unintended weight loss (adjusted HR=1.62, 95% CI=1.12–2.34). CONCLUSION: In older adults in home care in Europe, chewing problems are associated with greater risk of mortality. [ABSTRACT FROM AUTHOR]

Several studies in vitro or in rodent models have suggested a potential relationship between angiotensin-converting enzyme (ACE) inhibition and the insulin-like growth factor 1 (IGF-1) axis. However, this relationship has only rarely been investigated in humans. The aim of the present cross-sectional study was to assess the association of ACE inhibitors with free IGF-1 and IGFBP-3 in the blood of older hypertensive adults. Data are from the baseline evaluation of the ilSIRENTE study, which enrolled 364 subjects aged 80 or older. For the present study we selected a subpopulation of 264 hypertensive participants without congestive heart failure. Free IGF-1 and IGFBP-3 in the blood were measured by a radioimmunoassay method. Analyses of covariance were performed to evaluate the differences in free IGF-1 and IGFBP-3 levels according to the use of ACE inhibitors. The mean age of participants was 85.7 years (SD: 4.9), 170 (64%) were women and 123 (47%) were using an ACE inhibitor. Following adjustment for potential confounders, the concentration of free IGF-1 was slightly, but not significantly higher among ACE inhibitor users than among non-users (0.74 vs. 0.65 ng/mL; p = 0.20). In contrast, ACE inhibitor users had a significantly higher IGFBP-3 serum levels than non-users (4821 vs. 4330 ng/mL; p = 0.005). In addition, the concentration of IGFBP-3 was significantly higher among ACE inhibitors users than among non-users of antihypertensive drugs ( p = 0.02) and users of other antihypertensive drugs ( p = 0.01). Among hypertensive older adults, ACE inhibitors use is associated with higher IGFBP-3 levels. [ABSTRACT FROM AUTHOR]

Background. The association between total serum cholesterol and health outcomes among older adults is controversial. The objective of the present study was to determine within a cohort of acutely hospitalized disabled elderly patients whether total cholesterol predicts recovery from disability in basic activities of daily living (ADL). Methods. Patients (3150) 65 years old or older admitted to 81 acute care units in Italy and presenting with ADL disability at hospital admission were included in this study. ADL disability was defined as need of assistance or total dependence in one or more ADLs (eating. dressing, personal hygiene, transferring, and toilet use). Recovery was defined as no disability at hospital discharge in any of the five ADLs considered. Results. Mean age of study participants was 80.5 ± 7.2 years, and 1305 (41. 1%) were men. The rate of recovery from ADL disability was 14.5% for participants with total cholesterol <200 mg/dL (n = 306/2108), 20.2% far those with total cholesterol between 200 and 239 mg/dL (n = 144/713), and 23.1% for those with total cholesterol ≥240 mg/dL (n = 76/329). After adjustment far potential confounders, relative to that of patients with cholesterol <200 mg/dL, risk ratios for recovery were 1.31 for participants with cholesterol between 200 and 239 mg/dL (95% confidence interval [CI], 1.07-1.627 and 1.36 (95% CI, 1.04-1.79) for those with cholesterol ≥240 mg/dL. After exclusion of 769 patients with total cholesterol <145 mg/dL, the risk ratios (compared with those for participants with cholesterol <200 mg/dL) for recovery were 1.33 (95% CI, 1.07-1.66) for participants with cholesterol between 200 and 239 mg/dL and 1.41 (95% CI, 1.06-1.88) for patients with cholesterol ≥240 mg/dL. Conclusions. Among hospitalized disabled older adults, elevated levels of cholesterol are associated with increased rate of recovery from ADL disability. [ABSTRACT FROM AUTHOR]

Objective: Criteria for inappropriate drug use developed by Beers have been widely used in drug utilization reviews as the basis for educational materials and to assess the quality of prescribing. However, there is inconclusive evidence that these criteria can impact on patient outcomes. The objective of this study was to evaluate the impact of inappropriate drug use on all-cause mortality, adverse drug reactions (ADRs) and length of stay among in-hospital patients. Methods: We performed a retrospective, cohort study on 5,152 patients aged 65 years or older admitted to 81 hospitals in Italy between 1997 and 1998. Inappropriate drug use was defined by 2003 Beers criteria. Outcomes of the study were: (a) in-hospital mortality; (b) incidence of ADR occurring during hospital stay; (c) length of hospital stay 13 days or more. Results: The mean age of 5,152 participants was 78.8 years (standard deviation = 8.4 years), and 2,463 (47.8%) were men. During hospital stay, 1,475 (28.6% of the study sample) patients received one or more inappropriate drugs. After adjusting for potential confounders, use of inappropriate drugs was not associated significantly with either mortality [odds ratio (OR) 1.05; 95% confidence intervals (CI): 0.75-1.48], ADR (OR 1.20; 95% CI: 0.89-1.61) or length of stay 13 days or more (OR 1.09; 95% CI: 0.95-1.25). Conclusions: This study did not show any significant effect of inappropriate drug use defined by Beers 2003 criteria on health outcomes among hospitalized older adults. Further studies conducted in different settings, using additional health outcomes and alternate measures of inappropriate drug use, are needed. [ABSTRACT FROM AUTHOR]

Background: Late-life depression is common among older adults living in nursing homes (NHs). Over the last 30 years there has been an increase in the rates of prescription of antidepressant medications across all ages, with the largest rise reported in older adults. This study aimed to describe the pattern of antidepressant medication use among NH residents from 7 European countries and Israel and to examine patient and facilities characteristics that may account for it.Methods: We conducted a cross-sectional analysis of data from the SHELTER study, an observational longitudinal cohort study that collected comprehensive resident data using the interRAI Long-Term Care Facility instrument in 7 European Countries and Israel. Descriptive statistics were used to examine sample characteristics. Potential correlates of antidepressant medication use were identified using multiple logistic regression modeling.Results: Among 4023 residents entering the study, 32% had depressive symptoms and nearly half of these individuals used antidepressants. Antidepressant medication use varied by country, with a prevalence in the overall sample of 35.6% (n = 1431). Among antidepressant users, 59.9% were receiving selective serotonin reuptake inhibitors (SSRI). The strongest correlates of antidepressant use included reported diagnosis of anxiety, depression, bipolar disorder, pain, falls and high level of social engagement. Age over 85 years, living in facilities located in rural areas and a diagnosis of schizophrenia reduced the likelihood of being prescribed with an antidepressant.Conclusions: A large proportion of residents in European long-term care facilities receive antidepressant medications. The decision to prescribe antidepressants to NH residents seems to be influenced by both patient and facility characteristics. Future longitudinal studies should evaluate the efficacy and safety of antidepressant use in NHs thus providing evidence for recommendations for clinical practice. [ABSTRACT FROM AUTHOR]

Mild cognitive impairment (MCI), also termed mild neurocognitive disorder, includes a heterogeneous group of conditions characterized by declines in one or more cognitive domains greater than that expected during "normal" aging but not severe enough to impair functional abilities. MCI has been associated with an increased risk of developing dementia and even considered an early stage of it. Therefore, noninvasively accessible biomarkers of MCI are highly sought after for early identification of the condition. Systemic inflammation, metabolic perturbations, and declining physical performance have been described in people with MCI. However, whether biological and functional parameters differ across MCI neuropsychological subtypes is presently debated. Likewise, the predictive value of existing biomarkers toward MCI conversion into dementia is unclear. The "develOpment of metabolic and functional markers of Dementia IN Older people" (ODINO) study was conceived as a multi-dimensional investigation in which multi-marker discovery will be coupled with innovative statistical approaches to characterize patterns of systemic inflammation, metabolic perturbations, and physical performance in older adults with MCI. The ultimate aim of ODINO is to identify potential biomarkers specific for MCI subtypes and predictive of MCI conversion into Alzheimer's disease or other forms of dementia over a three-year follow-up. Here, we describe the rationale, design, and methods of ODINO. [ABSTRACT FROM AUTHOR]

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]

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. [Copyright &y& Elsevier]