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Objective: To explore the trends of vitamin intake over a 10-year follow-up in a group of successfully aging elderly people. Design: Longitudinal study. Setting: City of Padua, Italy. Participants: 78 (34M/44F) free-living and still well-functioning survivors among the Italian participants in the SENECA multicenter project, aged 70-75 y at the baseline. Measurements: Data were collected by means of a modified validated dietary history, both at baseline and then 10 y later. The dietary intake of vitamins B1, B2, A and C were considered, calculating the percentages of individuals with an intake below the lowest European Recommended Dietary Intake (RDI). Results: Mean energy and macronutrient intake were consistent with dietary guidelines at both time points. There was no decline in total energy intake after a decade. At baseline, the intake of all vitamins exceeded the Lowest European RDI, with the exception of vitamin B1, for which 44% of the men and 60% of the women were already deficient. After a decade, the prevalence of vitamin B2 and vitamin A deficiencies rose to 50% of the sample. Vitamin C deficiencies rose in a decade from 3% to 6% in men and from 2.3% to 4.5% in women and it was the least prevalent. Conclusion: Despite an adequate nutritional/functional status and a total energy intake that could be expected to cover the recommendations for micronutrients too, a considerable proportion of our successfully aging elderly were already deficient in, or at high risk of becoming deficient in several essential vitamins. Multivitamin supplementation may be necessary, even in healthy individuals, to ensure an adequate micronutrient intake in the elderly. [ABSTRACT FROM AUTHOR]

To explore the trends of food preferences and nutrient intake over a 10-year follow-up in a group of successfully aging elderly. Longitudinal study. City of Padua, Italy. Randomly stratified sample of 97 men and 94 women born between 1913 and 1918. The study involved a dietary assessment conducted in 1988/89 and repeated in 1999. Data were collected by means of a modified validated dietary history. Nutrient and energy intake remained fairly stable over a decade, despite changes in eating habits, with a higher intake of sweets and a lower consumption of soft drinks in both genders. All individuals significantly increased their daily intake of water. Despite changes in eating habits, no significant decline in total energy and macronutrient intake was recorded in a decade in our elderly. The increased daily consumption of water and decreased use of soft drinks would suggest that these people were still receptive to nutritional advice even in very old age, while the increase in their sweet-eating might be because aging itself increases a person’s sweet tooth, and this could be regarded as an age-related effect on dietary habits. [ABSTRACT FROM AUTHOR]

Purpose: An optimal active-can lead configuration during implantable cardioverter defibrillator (ICD) placement is important to obtain an adequate defibrillation safety margin. The purpose of this multicenter study was to evaluate the rate of the first shock success at defibrillation testing according to the type of lead implant (single vs. dual coil) and shock polarity (cathodal and anodal) in a large series of consecutive patients who received transvenous ICDs., Methods: This was a multicenter study enrolling 469 consecutive patients. Single- versus dual-coil leads and cathodal versus anodal polarity were evaluated at defibrillation testing. In all cases, the value of the energy for the first shock was set to 20 J less than the maximum energy deliverable from the device., Results: A total of 469 patients underwent defibrillation testing: 158 (34 %) had dual-coil and 311 (66 %) had single-coil lead systems configuration, 254 (54 %) received anodal shock and 215 (46 %) received cathodal shock. In 35 (7.4 %) patients, the shock was unsuccessful. No significant differences in the outcome of defibrillation testing using single- versus dual-coil lead were observed but the multivariate analysis showed an increased risk of shock failure using cathodal shock polarity (OR 2.37, 95 % CI 1.12-5.03)., Conclusions: Both single- and dual-coil transvenous ICD lead systems were associated with high rates of successful ICD implantation, and we found no significant differences in ventricular arrhythmias interruption between the two ICD lead systems configuration. Instead, anodal defibrillation was more likely to be successful than cathodal defibrillation.

Background & Aims: To establish reference values for limb composition, fat-free mass (FFM) and fat mass (FM) in Italian adults for gender-specific age brackets 20-80 years old and to assess age-related regional changes in body composition., Methods: A multicenter, retrospective study was conducted on 1571 healthy subjects, 1240 women and 331 men. Regional FFM and FM were measured by dual-energy X-ray absorptiometry. FM was expressed as % of limb weight., Results: FFM in men diminished with age in both arms and legs, with reference ranges (25th -75th percentile) of 3.8-4.6 kg and 10.4-12.2 kg, respectively for 20-29 year-olds, and 3.1-3.9 kg and 8.2-10.4 kg for 70-79 year-olds. Women's arm FFM remained stable with aging (reference values 1.7-2.2 kg), decreasing in their legs (6.2-7.2 kg for 20-29 year-olds, 5.5-6.5 kg for 70-79 year-olds). Limb FM% increased with age in both genders: the reference values were 9-15% (arms) and 12-21% (legs) for 20-29 year-old men, and 19-26% and 19-29%, respectively, for 70-79 year-olds; for women's arms, they were 25-36% for 20-29 year-olds and 36-48% for 70-79 year-olds, while their leg FM remained the same with aging, i.e. 32-40%., Conclusions: These data complete the published reference values for whole body composition, enabling physiological or pathological changes in limb composition to be identified in Caucasian populations living in the Mediterranean area., (Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: To present sociodemographic and health status harmonized variables constructed to evaluate cross-national differences in term of Disability Free Life Expectancy (DFLE) across different surveys., Method: The study comprises national surveys conducted in Bulgaria, Italy, and Latin America and the Caribbean. A homogeneous group of health determinants for the older population was created and the DFLE indicator based on Sullivan's method was developed considering the harmonized common variables on disability., Results: For all countries, DFLE values decline as age increases for both sexes, with a pronounced decline among women. Regardless the native country, women always present higher Life Expectancy than men at each age; however, they live a higher percentage of these years with disability., Discussion: Further research should be carried out with standardized instruments that allow a more direct comparison, along with measurements of the potential differences across countries, which could explain differences in disability prevalence and DFLE.

Aim: The DALY measure represents a new tool for improving the capacity of local health unit to assess population health needs and priorities. Our study aimed to increase the validity of the Disability Adjusted Life Years (DALY), by incorporating local estimates of the disease incidence and applying population-specific disability weights., Methods: This is a prospective cohort study enrolling subjects aged 45+ years, first-time admitted to the hospital with principal diagnosis of 490-492, 496 ICD IX-CM codes and followed for one year to evaluate the vital status. A subset was administered the Saint George Respiratory Questionnaire to estimate the distribution of the chronic obstructive pulmonary disease (COPD)-related disability., Results: Estimates of total DALY (per 1000) for COPD varied between 2.1 to 3.4 years among men and between 1.0 to 2.3 years among women; percentages of years of life lost due to a premature mortality were between 60 and 70%., Conclusion: The DALY represents a new tool for improving the capacity to assess population health needs and priorities. Policy makers owning such a further element of evaluation may be better oriented in allocating resources for COPD among the different health care chapters: prevention, emergency, chronicity and rehabilitation.

The aim of this work was to establish the factors that determine the onset of constipation in acutely hospitalized older patients with a view to contributing towards an evidence-based identification of which patients warrant early, specific preventive measures. To evade the problem posed by the definition of constipation, we have considered parameters that are part of the daily routine in the hospital ward, such as the prescription of laxatives, also paying attention to how the co-operative older person subjectively interpret this condition. One thirds of the 192 hospitalized older patients needed a laxative at least once every 3 days. Multivariate analysis identified the use of laxatives at home as the only risk factor for objective constipation while in hospital (odds ratio (OR)=3.0). A significant risk of being dissatisfied with their bowel emptying emerged among patients who were bedridden for more than 2 weeks (OR=6.0), and in those who experienced cerebrovascular events (OR=3.1). The use of laxatives at home and awareness that satisfaction with bowel movements drops in patients obliged to stay in bed for lengthy periods of time and in those who have suffered cerebrovascular damage, should provide the grounds for a screening program to establish rational guidelines on bowel movement therapy., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Acetylcholinesterase inhibitors (AChEIs) have been used to improve cognitive status and disability in patients with mild to moderate Alzheimer's disease (AD). However, while the efficacy of AChEIs (i.e. how they act in randomized controlled trials) in this setting is widely accepted, their effectiveness (i.e. how they behave in the real world) remains controversial. To compare the effects of three AChEIs, donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon), in an Italian national, prospective, observational study representative of the 'real world' clinical practice of AChEI treatment for AD. 938 patients with mild to moderate AD collected within the framework of the Italian National Cronos Project (CP), involving several UVAs (AD Evaluation Units) spread over the entire national territory, who were receiving donepezil, galantamine or rivastigmine were followed for 36 weeks by measuring: (i) function, as determined by the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales; (ii) cognition, as measured by the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) [primary outcome measures]; and (iii) behaviour, as measured on the Neuropsychiatric Inventory (NPI) and Clinical Dementia Rating (CDR) scale. Moreover, all patients were genotyped for apolipoprotein E (apoE) genetic variants. No statistically significant improvement in the primary outcome measures (MMSE and ADAS-Cog) was observed with drug therapy at 36 weeks, at which point all groups had lost, on average, 1 point on the MMSE and gained 2-3 points on the ADAS-Cog scale compared with baseline. On the secondary outcome measures at week 36, all treatment groups showed a significant worsening on the ADL and IADL scales compared with baseline, while on the NPI scale there were no significant differences from baseline except for the galantamine-treated group which worsened significantly. Moreover, patients receiving galantamine worsened significantly compared with the donepezil-treated group on the IADL scale. ApoE epsilon4 allele did not influence the effect of drug therapy. Over a 36-week follow-up period, no significant difference in the effects of donepezil, galantamine and rivastigmine on a variety of functional and cognitive parameters was observed in a large number of apoE-genotyped patients with mild to moderate AD recruited within the framework of a national project representative of the scenario usually encountered in actual clinical practice in Italy. The limitations (possibility of administration of lower drug doses than are used in clinical trials, relatively short follow-up period and the lack of randomization) and strengths (large number of patients, concomitant observation of the three drugs and the number of parameters assessed, including apoE genotype) of the present study are acknowledged. Our type of naturalistic study should complement clinical trials because 'real world' practice operates in the face of the numerous variables (e.g. health status and co-morbidities) associated with a complex disease such as AD in elderly people.

The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status, but only few studies have investigated the relationship among its components in terms of factorial structure. We have considered data from the Italian Longitudinal Study on Aging (ILSA), carried out in Italy in 1992 on a sample of 5,632 subjects aged 65-84 years, and followed up in 1996. The aim of our study was to investigate static factorial structure in three groups of elderly (subjects with a diagnosis of dementia at baseline; subjects free of dementia at baseline, but incident cases at follow-up; subjects who never developed dementia during the 4-year follow-up). Considering our results, we could hypothesize that MMSE static structure reflects the cognitive profile of elderly, and is thus influenced by subjects' potential to develop dementia., (Copyright 2006 S. Karger AG, Basel.)

Purpose: To assess the effect of education on Disability Free Life Expectancy among older Italians, using a hierarchical model as indicator of disability, with estimates based on the multistate life table method and IMaCh software., Methods: Data were obtained from the Italian Longitudinal Study on Aging which considered a random sample of 5632 individuals., Results: Total life expectancy ranged from 16.5 years for men aged 65 years to 6 years for men aged 80. The age range for women was 19.6 and 8.4 years, respectively. For both sexes, increasing age was associated with a lower probability of recovery from a mild state of disability, with a greater probability of worsening for all individuals presenting an independent state at baseline, and with a greater probability of dying except for women from a mild state of disability. A medium/high educational level was associated with a greater probability of recovery only in men with a mild state of disability at baseline, and with a lower probability of worsening in both sexes, except for men with a mild state of disability at baseline., Discussion: The positive effects of high education are well established in most research work and, being a modifiable factor, strategies focused on increasing level of education and, hence strengthening access to information and use of health services would produce significant benefits.

Aim: To assess the association between socio-demographic characteristics and community attitudes towards mentally ill people., Method: We assessed a sample of 280 subjects, stratified for sex and age, which has identified using the electoral registers of Brescia. A letter was sent to everyone in order to introduce the future potential study participant to the topics of the public attitudes towards mental illness and it included an invitation to take part in the study. After, 280 subjects were contacted by telephone. Finally, 174 persons, who expressed their willingness to collaborate, were visited by a team of four trained interviewers. The instruments used were: a semi-structured interview; the Community Attitudes to the Mentally Ill (CAMI) inventory, which is composed by 40 statements, concerning the degree of acceptance of mental health services and mentally ill patients in the community; and the Fear and Behavioural Intentions (FABI) inventory, which is composed by 10 items, concerning fears and behavioural intentions towards mentally ill people. 106 subjects refused to participate., Results: Factor analysis of the CAMI revealed three components Physical distance and fear, Social isolation and Social responsibility and tolerance. Factor 1 is associated with: people >61 years old; people being divorced/widowed/living separated; people who haven't participated in social or volunteer activities. Factor 2 is associated with: people > 41 years old; people being schooled at a level that's higher than elementary level; unemployed people. Factor 3 doesn't present any associations., Conclusions: The results of this study outline the need to: a) promote interventions focused to improve the general attitude towards people with mental illness; b) to favour specific actions in order to prevent or eliminate prejudices in subgroups of the population.

It is widely acknowledged that there is a strong need to identify which modifiable risk factors predict healthy aging to use this information as the scientific basis for systematic interventions. Data from a 4-year longitudinal study on aging among 5632 older Italians were used. The definition of vitality was based on both cognitive and physical status, and the envisaged transitions were: positive or nonpositive stable, positive or negative transition, lost, and deceased. Predictors associated with different vitality trajectories were investigated by multinomial logistic analysis with a six-level outcome. Age and educational level were predictors of being "positive stable," whereas the other factors behaved differently according to comparison group. For example, being overweight is a common predictor except when compared to the deceased group, as is depressive symptomatology except when compared to the "positive transition" group. Interventions are warranted to reduce social inequalities, promote adequate body weight, and prevent and treat depressive symptoms.

Purpose: To estimate Disability-Free Life Expectancy (DFLE) among a cohort of 3005 Italians aged 65-84 and evaluate geographical differences., Method: Sullivan method was used to estimate DFLE based on the Performance Test (PPTs), Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs); furthermore, a hierarchical scale of disability was defined to evaluate the pattern of DFLE and geographical differences., Results: Men aged 65-69 will live 67% of their remaining life free of PPTs disability, 77% free of IADLs and 83% free of ADLs disability. Women aged 65-69 will live 44, 63 and 76%, respectively. In the hierarchical structure, mild DFLE for subjects aged 65-69, was of 12.8 years for both sexes; moderate DFLE was of 13.4 and 14.2 years and severe DFLE was of 13.5 and 15.3 years, for men and women, respectively. People living in Central Italy are those with the highest number of years lived free of mild disability; people living in Northern Italy are instead those expected to live more years free of moderate and severe disability., Conclusions: The hierarchical approach showed that women tend to live more years with some level of disability than men, although the moderate and severe disability occur almost simultaneously among men.

Background: Studies on the association between depressive symptomatology (DS) and cardiovascular events and mortality in elderly persons have yielded contradictory findings. To address this issue, the authors assessed DS and an extensive array of sociodemographic, behavioral, and biological variables in the largest population-based sample of older Italians ever studied and analyzed their association with coronary heart disease (CHD) morbidity and total number of deaths., Methods: This prospective, community-based cohort study included a sample of 5632 Italians, 65 years and older, who were recruited from the demographic registries of eight municipalities in Italy. Depressive symptomatology was assessed using the Geriatric Depression Scale, and a score > or =10 was used to indicate the presence of DS. All traditional cardiovascular disease risk factors were assessed at baseline, through questionnaires, blood tests, and physical examinations. The outcomes were CHD fatal and nonfatal events and total number of deaths. The association of the predictive variables with the outcomes was assessed using different Cox models., Results: Baseline DS was associated with a higher incidence of fatal and nonfatal CHD events (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.06-2.60) and with cardiovascular mortality in men (HR, 2.49; 95% CI, 1.60-3.87) and with total mortality in men (HR, 2.02; 95% CI, 1.58-2.58) and women (HR, 1.43; 95% CI, 1.04-1.95) at the 4-year follow-up assessment. This association was observed after adjusting for a vast array of potential confounding variables, including major chronic conditions., Conclusions: Depressive symptomatology confers an increased risk for CHD in men and for total mortality in men and women but is not explained by health behaviors, social isolation, or biological or clinical determinants.

The MALVA (MAntova LongeVA) study aims at investigating the socio-demographic, clinical and genetic characteristics of all subjects over 98 years of age residing in the province of Mantova (Northern Italy). In this paper we present the study protocol and the main demographic results. Absolute number, prevalence ratio and female/male ratio of the subjects aged 98+ and of the centenarians in the Mantova province (370,645 inhabitants at 31st December 1997) were checked at the baseline of the study (31st March 1998) as well as in the two years preceding and following the study. A total of 117 subjects aged 98+ (including 39 centenarians) were traced at 31st March 1998; the prevalence ratio was 31.6 per 100000 (12.1 for centenarians), and the female/male ratio was 6.3 (6.5 for centenarians). The distribution of the oldest old according to places of birth and residence was non-homogeneous across the provincial territory. Seventy-seven subjects (66% of the identified subjects) were enrolled in the study and administered a protocol including an interview about socio-economic conditions, lifetime habits and pathological and pharmacological case histories, as well as medical examination, performance-based tests and blood sample collection. Data on the socio-demographic characteristics and the health status of very old people in the province of Mantova are discussed and compared to findings from previous studies on Italian centenarians.

Dementia is known to be associated with excess mortality. Physical disability, as a marker of dementia severity, is often considered the last step on the way from disease to death. The objective of this study was to investigate the direct effect of dementia on mortality in a population-based study, carried out in Italy, with a sample of 5,632 individuals aged 65-84 years. At 4-year follow-up, 998 participants had died. The independent predictors of death were: age (75-84 years; HR 2.63, CI = 2.11-3.27), male sex (HR 1.45, CI = 1.22-1.74), coronary heart disease (HR 1.61, CI = 1.34-1.94), moderate and severe instrumental activities of daily living disability (HR 1.98, CI = 1.30-3.03 and HR 3.26, CI = 2.09-5.09, respectively), diabetes in subjects with a survival time greater than 23 months (HR 0.68, CI = 0.43-1.08) and dementia (HR 2.07, CI = 1.62-2.66). These data provide evidence that dementia per se, independently from physical disability, is a strong predictor of death in the elderly., (Copyright 2003 S. Karger AG, Basel)

Background: Urinary incontinence (UI) is a common problem in elderly people, due mainly to functional impairments and concurrent medical diseases. Few studies, however, have assessed the prevalence of UI in noninstitutionalized individuals. The objectives of the present work were to estimate the prevalence of UI in a community-based population of elderly Italians and to determine the associated physical, social, and psychological factors., Methods: A random sample of noninstitutionalized men (n = 867) and women (n = 1531), aged 65 years and older, from the Veneto region of northeastern Italy, were interviewed at home, using an extensive multidisciplinary questionnaire, to assess their quality of life and social, biological, and psychological correlates., Results: The prevalence rate of UI was of 11.2% among men and of 21.6% among women. Among those reporting the condition, approximately 53% of women and 59% of men reported experiencing incontinence daily or weekly. Association of UI was found for participants older than 70 years in both men (odds ratio [OR] 2.49, 95% confidence interval [CI] 1.45-4.28) and women (OR 1.49, 95% CI 1.11-2.02). Three of the medical conditions investigated were associated with increases in the odds in women, namely chronic obstructive pulmonary disease (OR 1.53, 95% CI 1.11-2.12), Parkinsonism (OR 2.27, 95% CI 1.14-4.54), and hip fracture (OR 1.38,95% CI 1.02-1.88), whereas chronic diarrhea was the only condition associated with UI in men (OR 6.92, 95% CI 2.22-21.5). Participants with a physical disability were two times more likely to report incontinence, and the odds were increased by 50% in women who had sleep disturbances., Conclusions: Incontinence is highly prevalent in the Italian elderly population, and several common chronic conditions are significantly associated with it. Moreover, very few people with incontinence seek health care or are aware of potential treatments.

Background: Most studies report that people with higher education enjoy better health and longer life. Although it is well known that most risk factors are more common among individuals with a lower level of education, the underlying mechanism of this association is not fully understood. The objective of this study was to assess the association between education, disability, and mortality., Methods: We analyzed data on 1,817 men and 1,643 women, aged 65-84 years, to assess the association of educational level with physical disability and mortality adjusting for age, sex, smoking habit, occupation, and major chronic conditions., Results: The association between educational level and disability was characterized by a dose-response effect, with the relative odds significantly decreased by about 30%, 60%, and 79% in those with 4 or 5, 6 to 8, and more than 8 years of education, compared to those with 3 or less years of education. Death rates were lower among persons with 4 or more years of education compared to those with less education. However, after adjusting for disability status, education was no longer associated with mortality (RR=0.97, CI=0.65-1.43)., Conclusions: The strong association of low education with disability found in this study may explain the inverse association with mortality reported in previous studies. Disability, indeed, seems to be the mediator between education and mortality and might be due to the higher severity level of diseases, leading to death, in the lower educated group.

Objectives: To investigate the prevalence rate of hearing impairment, assessed by both the Sanders' questionnaire and the speech audiometry test, and its association with health-related factors in the older population of the Veneto region of Italy., Design: A cross-sectional survey., Setting: A community-based population., Participants: 2398 noninstitutionalized individuals aged 65 years and older residing in the Veneto region of Italy., Measurements: Prevalence rates of hearing impairment and odds ratios for its association with potential risk factors., Main Results: The prevalence of self-reported hearing impairment at home was 8.1% in men and 7.4% in women, and in a social environment it was 11.1% and 9.3%, respectively. Women were less likely to report hearing difficulties in both environments, and increased risks were found for depression, age, and poor self-rated health. Participants with diabetes or cognitive impairment had increased odds only at home, in contrast to people with a low education level, who had increased odds only in a social environment. The prevalence assessed by speech audiometry was 19% in both sexes. Increased age, diabetes, and poor self-rated health were associated with impaired speech intelligibility, cognitive impairment was associated with 4-fold increased odds among past users of alcohol, and men with a low education level were about three times as likely as others to have hearing impairment., Conclusions: Speech audiometry testing detected a higher prevalence of hearing impairment than use of a self-reported questionnaire and was associated with poor self-rated health, history of diabetes, and cognitive impairment among past users of alcohol and among men with low levels of education. The association between hearing deficit and depressive symptomatology was confirmed only with self-reported hearing impairment.

Objectives: To determine the prevalence rates of self-reported sleep complaints and their association with health-related factors., Design: A cross-sectional study., Setting: People living in the community., Participants: A total of 2398 noninstitutionalized individuals, aged 65 years and older, residing in the Veneto region, northeast Italy., Measurements: Odds ratios for the association of sleep complaints with potential risk factors., Results: The prevalence of insomnia was 36% in men and 54% in women, with increased risks for women (odds ratio (OR) = 1.69, 95% CI: 1.3-2.1), depression (OR = 1.93, 95% CI, 1.5-2.5), and regular users of sleep medications (OR = 5.58, 95% CI, 4.3-7.3). About 26% of men and 21% of women reported no sleep complaints. Night awakening, reported by about two-thirds of the participants, was the most common sleep disturbance. Women and regular users of sleep medications had significantly increased odds for insomnia and for not feeling rested upon awakening in the morning. Depressive symptomatology was more strongly associated with insomnia and night awakening than with awakening not rested, whereas physical disability was more strongly associated with awakening not rested than with the other two sleep disturbances., Conclusion: Our findings show that sleep complaints, highly common among older Italians, are associated with a wide range of medical conditions and with the use of sleep medications. Further longitudinal studies are needed to investigate the causes and the negative health consequences of sleep disturbances to improve both the diagnosis and treatment.