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Objectives: To investigate the association between adherence to the Mediterranean Diet (Med-Diet), cardiometabolic disorders and polypharmacy.Design: Cross-sectional study.Setting: Geriatrics outpatient clinic, Policlinico Umberto I, Sapienza University of Rome.Participants: 508 patients (219 male, 289 female) aged 50 to 89 who were evaluated for cardiovascular and metabolic disorders.Methods and Measurements: Patients underwent a comprehensive medical assessment including medical history and the use of medications. Adherence to Med-Diet was assessed using the validated Med-Diet 14-item questionnaire; for the analysis, patients were divided in high (≥8) and medium-low (<8) adherence. Polypharmacy was defined as taking ≥5 medications.Results: 476 patients completed the study. Mean age was 70.4 years; 58% female. Median Med-Diet score was 8 (6-9). Patients with medium-low adherence had higher body mass index (p=0.029) and higher prevalence of arterial hypertension (p<0.001), previous coronary (p=0.002) and cerebrovascular events (p=0.011), diabetes, (p<0.001) and dyslipidemia (p=0.001) compared to those at high adherence. Med-Diet score decreased with the number of cardiometabolic disorders (p<0.001). The prevalence of polypharmacy was 39%. Consumption of olive oil (p=0.005), vegetables, (p<0.001), wine (p=0.017), legumes (p=0.028), fish (p=0.046) and nuts (p=0.045) were all inversely associated with the overall number of medications. In a multivariable regression model, medium-low adherence to Med-Diet was independently associated to polypharmacy (O.R.:1.859; 95% CI 1.142 to 3.025; p=0.013), after adjusting for possible confounding factors.Conclusion: Med-Diet was inversely associated with cardiometabolic disorders and with polypharmacy, suggesting that improved Med-Diet adherence might potentially delay the onset of age-related health deterioration and reduce the need of multiple medications. [ABSTRACT FROM AUTHOR]

Objectives: the possible therapeutic role of vitamin D in different kind of diseases explains the growing interest in this vitamin due to its pleiotropic effects. This short report shows preliminary results of prevalence of hypovitaminosis D in a group of patients and proposes a oral supplement therapy effective in correcting hypovitaminosis in a short time, without side effects. Methods: 243 patients (aged 26-93; 67 males) were enrolled at this study. We evaluated plasma levels of 25-hydroxyvitamin D [25(OH)D] with the following cut-off values: < 10ng/ml or <0-25 nmol/L (deficient), 10-30 ng/ml or 25-75nmol/L 30-50 (insufficient) and > 30 ng/ml or > 50 nmol/L (normal). The first 73 patients with hypovitaminosis D received at baseline 25,000 IU (Cholecalciferol) per os twice a month (Tp.A). The next patients (Tp.B) at baseline received a loading dose of 50,000 IU once a week for 8 weeks, followed by a maintenance dose of 25,000 IU twice a month. Results: hypovitaminosis D is a widespread condition (i.e. 82.3%) not only in elderly (75.6% of 75 patients aged <65 yrs and 86.5% of 168 subjects aged >65 yrs). Preliminary results at 6 months show that Tp.B is more effective in correcting hypovitaminosis D (baseline 14.4 ± 5.3 ng/ml; 24 wk 43.3 ± 14.7 ng/ml; p<0.0001). Conclusion: hypovitaminosis D is an important public health problem. We believe it is important to quickly achieve normal Vit. D plasma values in order to produce pleiotropic effects. [ABSTRACT FROM AUTHOR]

Cognitive impairment is an age-related condition as the rate of cognitive decline rapidly increases with aging. The aim of this study was to screen the risk of cognitive decline in people over 60 years from 16 different Italian cities, by comparing the results of a self-administered questionnaire with the MMSE. We analyzed data from 203 persons aged 60 years and over, who voluntarily accepted to participate during the "Second Prevention Day for AD". A self-administered questionnaire, developed by clinicians of our Department of Aging, was distributed to all participants, in order to easily screen the risk of cognitive impairment. Then, all subjects underwent cognitive assessment by MMSE. We esteemed the risk of cognitive impairment of all participants basing on MMSE scores (no risk, mild and moderate risk) and we compared this assessment with the results obtained by the self-administered questionnaire. The comparison between the risk of cognitive impairment revealed by our questionnaire and the risk esteemed by MMSE resulted in a discrepancy in 43.96% of cases in no risk class. In mild risk group there was a discrepancy of results in 70.53% of subjects. In moderate risk class there was a discrepancy of results in 38.46% of individuals. Our questionnaire resulted to be accurate for the evaluation of patients with moderate risk of cognitive impairment. It showed a lower accuracy for the mild risk class, often overestimating the risk of cognitive decline., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Everybody is subject to a physical clock, determining the calendar age, and also to a biological clock, the speed of which depends on the interaction between the genetic reserves and the environment. Stress is taken into account more and more as one of the main factors responsible for the acceleration of the biological clock and the dishomogeneity of the aging process. Despite the fact that centenarians are prone to chronic stress due to a progressive loss of self-sufficiency, more than a half of our centenarians were not depressed and had a low trait-anxiety: they showed an emotional tendency to react with a low anxiety-intensity to stressful conditions. Their good physical conditions may be explained by a positive character-disposition and by strong adaptability to the adversities of the life. Personality traits can be reduced to five basic phenomena, the so-called Big Five: extroversion, agreeableness, conscientiousness, openness to experience and emotional stability. In our sample 65.4% were classified as extroverted, 50% as open minded and 34.5% showed good emotional stability. In the centenarians aging of all apparatuses was slowed down by a healthy lifestyle and also by good adaptability that allowed for a positive and effective response to stress throughout their whole lives.

Atrial fibrillation (AF), which is a very common disease among the elderly, is already well known as a risk factor for arterial thromboembolism and stroke. The attention of medical research is now focused on establishing a possible role of AF in the development of cognitive impairment in order to include this arrhythmia among risk factors for dementia. The aim of this work was to investigate the relationship between AF and various types of dementia, such as vascular dementia (VaD), Alzheimer's disease (AD) and mixed dementia (MD). The study consisted of 71 VaD, AD or MD patients, 31 males and 40 females. The sample has been divided in 2 groups according to the sex, and these two groups have been analyzed separately. In females, a statistically significant association was found between mini mental state examination (MMSE) and clinical dementia rating (CDR) scores and AF occurrence (r=-0.32; p<0.05; r=0.33; p<0.05). On the contrary, no significant linear correlation was found between AF and a lower activities if daily living (ADL) and instrumental activities if daily living (IADL) scores. In males, AF/MMSE, AF/CDR, AF/ADL and AF/IADL variables have not been found to be linearly related to each other. Unexpectedly, AF turned to be associated to AD more often than to VAD, becoming a possible risk factor for this neurodegenerative disease. Our results are supported by many studies in literature attributing a basic role of brain hypoperfusion in sporadic AD patho-genesis. More and more scientific data suggest that the already well known risk factors for AD could be considered just the top of an iceberg, providing powerful arguments for impaired cerebral perfusion as the primary trigger in the development of this disease. Moreover, the mildly favorable treatment response in patients with AD to therapy that improves cerebral blood flow is a consistent finding; the same cannot be said of antiamyloid treatments. This opens new possibilities to find an effective way to treat this dramatic pathology.

The 20th century will be remembered for its technological and scientific discoveries and for the exceptional changes in the demographic structure brought about by these and the improved economic and social conditions; in fact, the reduction in the birth rate and a fall in the death rate have caused an increase in the population of the elderly. Today the elderly population represents about 20% of the total and is much more heterogeneous than in the past, with several classes of the elderly: the young elderly from 64 to 74; the old elderly from 75 to 84, the very old from 85 to 100 and the oldest old who are living around a century. The aging of the population has brought out several problems of the elderly, among the "frailty", the effects of which increase as the years pass and which regards about one half of the very old. Frailty is a reduction of the body's ability to maintaine global homeostasis and is caused by a reduction of the functional reserves of all the organs and apparatus which occurs with aging. Screening the frail elderly with a careful multidimensional assessment is important to prevent health problems and to promote good health and it is a good parameter in evaluating the management of the geriatric assistance network and thus health and social costs.

Objectives: To examine the influence of known cardiovascular risk factors (cholesterol, blood glucose levels, arterial pressures, heart rate, and aging) on baroreflex sensitivity., Design: An observational epidemiological study., Setting: Geriatric Division at the Policlinico Umberto Primo, University of Rome La Sapienza., Participants: Two hundred three subjects whose ages ranged from 9 to 94 years, apparently healthy and free of detectable clinical evidence of atherosclerosis., Measurements: All subjects underwent determination of baroreflex sensitivity by phenylephrine infusion (BSphe), and by a noninvasive method derived from spectral analysis of R-R interval and arterial pressure variabilities (alpha index)., Results: The population, subdivided into tertiles for each variable studied, had lower BSphe values and lower alpha indexes as a function of age, plasma low-density lipoprotein (LDL) cholesterol, and systolic blood pressure. The alpha index was significantly lower in both groups with elevated LDL cholesterol levels than in those with lower levels (II and III vs I tertile, P <.001), whereas BSphe differed significantly only in the two groups who had extreme levels of LDL (I vs III tertile, P <.001). Multiple regression analysis identified a negative association of the alpha index with age (P <.001), heart rate (P <.01), area under the glucose-response curve (P <.001), and LDL cholesterol (P <.01), but of BSphe only with age (P <.001) and heart rate (P <.01)., Conclusion: These findings indicate that some risk factors for coronary heart disease adversely influence baroreflex sensitivity.

Background: Elderly people constitute a heterogeneous group and are at an increased risk for the development of cancer. It is not clear whether comorbid conditions and functional status influence clinical decisions and the pattern of referral in elderly cancer patients. The current study investigated functional status measured by Eastern Cooperative Oncology Group performance status, comorbid conditions, and medication taken as well as social environment in three series of patients grouped according to age and diagnosis., Methods: A total of 593 patients were involved: 138 neoplastic patients age > 70 years with breast, colon, or prostate carcinoma, 177 neoplastic patients age < 70 years with the same types of pathology, and 278 elderly patients with nonneoplastic conditions. Patients with neoplastic disease were recruited from cancer centers; patients with nonneoplastic disease were recruited from either geriatric or general medicine departments. Differences in the distribution of variables were analyzed by univariate and bivariate analyses., Results: No significant differences in social environment, marital status, or education were observed. Statistical differences were noted when comparing the distribution of comorbidities, performance status, and medication taken, elderly neoplastic patients presented in poorer condition compared with younger patients but in better condition compared with elderly patients with nonneoplastic disease., Conclusions: The overall better health of older cancer patients compared with those without cancer needs to be assessed further. It is possible that cancer is more likely to be diagnosed in healthier elderly, or that primary care providers are reluctant to refer for cancer care patients in poor general health. Studies of comorbidity, function, and social resources are necessary to establish the impact of cancer on survival and quality of life of older patients and to determine the social resources necessary for adequate care.

The medical records of all women (297 cases) with breast cancer > or = 70 years of age, presenting at our Institute from January 1980 to December 1989, were reviewed. Data from 226 elderly women was compared to that from 100 stage-matched patients < 50 years of age, presenting during the same 10-year study interval. Conservative surgery was significantly more frequent in young patients (71.1%) compared to elderly women (26.1%) and radical mastectomy according to Halsted was undertaken in 34.3% of the elderly group compared to 8.9% of young patients (p < 0.001). Since 'incidental' diagnosis was significantly more frequent in the elderly group (59.9% versus 6.0%) (p < 0.001), primary care physicians may play an important role in the early diagnosis of breast cancer in the majority of elderly women.

The goal of this study was the evaluation of cardiac arrhythmias in an unselected population of elderly patients by 24-hour Holter electrocardiography. An elevated incidence of hyperkinetic (62%) and hypokinetic arrhythmias (22.7%) were detected. Following a critical review of the literature, the Authors conclude that even in hyperkinetic arrhythmias a conservative approach is advisable without indiscriminate therapeutic treatment. This review also confirmed the clinical utility of ambulatory monitoring in the detection of arrhythmias, otherwise underestimated, mainly in asymptomatic patients.