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Background: Falls in older adults significantly impact overall health and healthcare costs. Intrinsic capacity (IC) reflects functional reserve and is an indicator of healthy aging. Aims: To explore the association between IC and recent falls (≤ 90 days) in community-dwelling octogenarians from the Aging and Longevity in the Sirente geographic area (IlSIRENTE) study. Methods: The Minimum Data Set for Home Care (MDS−HC) and supplementary questionnaires and tests were used to assess the five IC domains: locomotion, cognition, vitality, psychology, and sensory. Scores in each domain were rescaled using the percent of maximum possible score method and averaged to obtain an overall IC score (range 0−100). Results: The study included 319 participants (mean age 85.5 ± 4.8 years, 67.1% women). Mean IC score was 80.5 ± 14.2. The optimal IC score cut-off for predicting the two-year risk of incident loss of at least one activity of daily living (ADL) was determined and validated in a subset of 240 individuals without ADL disability at baseline (mean age 84.7 ± 4.4 years, 67.1% women). Participants were then stratified into low (< 77.6) and high (≥ 77.6) IC categories. Those with high IC (63.9%) were younger, more often males, and had lower prevalence of recent falls, disability, multimorbidity, and polypharmacy. Logistic regression models including IC as a continuous variable revealed a significant association between higher IC and lower odds of falls. This association was significant in the unadjusted (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94–0.98, p < 0.001), age- and sex-adjusted (OR 0.96, 95% CI 0.94–0.98, p < 0.001), and fully adjusted models (OR 0.96, 95% CI 0.93–0.99, p = 0.003). When considering IC as a categorical variable, unadjusted logistic regression showed a strong association between high IC and lower odds of falls (OR 0.31, 95% CI 0.16–0.60, p < 0.001). This association remained significant in both the age- and sex-adjusted (OR 0.30, 95% CI 0.15–0.59, p < 0.001) and fully adjusted models (OR 0.33, 95% CI 0.16–0.82, p = 0.007). The locomotion domain was independently associated with falls in the unadjusted (OR 0.98, 95% CI 0.97–0.99, p < 0.001), age- and sex-adjusted (OR 0.97, 95% CI 0.96–0.99, p < 0.001), and fully adjusted model (OR 0.98, 95% CI 0.96–0.99, p < 0.001). Discussion: This is the first study using an MDS−HC-derived instrument to assess IC. Individuals with higher IC were less likely to report recent falls, with locomotion being an independently associated domain. Conclusions: Lower IC is linked to increased odds of falls. Interventions to maintain and improve IC, especially the locomotion domain, may reduce fall risk in community-dwelling octogenarians. [ABSTRACT FROM AUTHOR]

The article presents a research paper on the link between physical performance and long-term survival in a cohort of community-dwelling older people from the "Aging and Longevity in the Sirente Geographic Area" study. Topics discussed include the methods used in the study, the definition of long-term survival, and the implications of the study for assessing mortality risk in octogenarians.

Regular engagement in physical activity (PA) or physical exercise (PE) is effective at improving physical performance and body composition in older adults. Less is known about the benefits that may be obtained through combining PA with PE and whether the effects of activity habits differ between men and women. This study cross-sectionally investigated the association of PA and/or PE with physical performance and anthropometric measures in a large and relatively unselected sample of older adults enrolled in the Longevity Check-up (Lookup) 7+ project. Participants were individuals 65 years and older living in the community who were recruited in unconventional settings across Italy. Adherence to PA or PE was operationalized as involvement in light walking or various types of exercise, respectively, at least twice weekly for a minimum of 30 min per session throughout the last 12 months. Physical performance measures included handgrip strength and five-time sit-to-stand (5STS) tests. Lower-limb muscle power and appendicular skeletal muscle mass (ASM) were estimated through validated equations. We analyzed data of 4119 participants, of whom 2222 (53.4%) were women. The mean age was 72.8 ± 5.8 years in men and 72.1 ± 5.4 years in women. Regular engagement in PA + PE was reported by 139 (7.3%) men and 100 (4.5%) women. Results indicated that regular walking activity and/or PE were significantly associated with better physical performance and greater ASM with sex-specific patterns. Associations were also influenced by the type of activity, physical performance assessment tool, and anthropometric parameters. Men engaged in PA + PE performed better on the 5STS test and had greater handgrip strength, ASM, and relative and specific muscle power than those practicing either PA or PE. In women, the combination of PA and PE was associated with greater handgrip strength. The findings of this study indicate that older adults regularly practicing PA + PE had better physical performance than those who only engaged in either modality. In men, the combination of PA and PE was also associated with greater ASM. [ABSTRACT FROM AUTHOR]

Background: Lifestyle habits have a key role in cardiometabolic health. The effects of combined aerobic training (AT) and high protein intake (HPI) on cardiometabolic parameters in older adults are not well established. Aims: To investigate the association of AT and HPI with blood pressure (BP), blood glucose, and total blood cholesterol levels in a sample of Italian older adults enrolled in the Longevity Check-up 7 + (Lookup 7 +) study. Methods: Lookup 7 + is an ongoing project started in June 2015 and conducted in unconventional settings (e.g., exhibitions, malls, health promotion campaigns) across Italy with the aim of fostering adoption of healthy lifestyles in the general population. For the present investigation, analyses were conducted in participants 65 + years and with body mass index values ≥ 18.5 kg/m2 (n = 3219). Systolic (SBP) and diastolic BP (DBP), blood glucose, and total blood cholesterol were measured. Protein intake was estimated using a 12-item food frequency questionnaire. HPI was operationalized as a daily protein intake ≥ 0.8 g/kg of body weight. AT was operationalized as the practice of running and/or swimming for 60 + minutes at least twice weekly during the previous year. Results: The mean age of the 3219 participants was 72.7 ± 5.7 years, and 55.2% were women. Adherence to AT combined with a HPI was negatively and independently associated with SPB (β: − 4.976; 95% confidence interval: − 9.8 to − 0.08). No other significant associations were observed. Discussion and conclusions: Our results indicate that AT combined with HPI was negatively associated with SBP in a large and relatively unselected sample of Italian older adults living in the community. These findings need confirmation by ad hoc designed studies. [ABSTRACT FROM AUTHOR]

Background : Nutritional status is a critical factor throughout COVID-19 disease course. Malnutrition is associated with poor outcomes in hospitalized COVID-19 patients. Aim : To assess the prevalence of malnutrition and identify its associated factors in COVID-19 survivors. Methods: Study cohort included 1230 COVID-19 survivors aged 18–86 attending a post-COVID-19 outpatient service. Data on clinical parameters, anthropometry, acute COVID-19 symptoms, lifestyle habits were collected through a comprehensive medical assessment. Malnutrition was assessed according to Global Leadership Initiative on Malnutrition (GLIM) criteria. Results : Prevalence of malnutrition was 22% at 4–5 months after acute disease. Participants who were not hospitalized during acute COVID-19 showed a higher frequency of malnutrition compared to those who needed hospitalization (26% versus 19%, p < 0.01). Malnutrition was found in 25% COVID-19 survivors over 65 years of age compared to 21% younger participants (p < 0.01). After multivariable adjustment, the likelihood of being malnourished increased progressively and independently with advancing age (Odds ratio [OR] 1.02; 95% CI 1.01–1.03) and in male participants (OR 5.56; 95% CI 3.53–8.74). Malnutrition was associated with loss of appetite (OR 2.50; 95% CI 1.73–3.62), and dysgeusia (OR 4.05; 95% CI 2.30–7.21) during acute COVID-19. Discussion : In the present investigation we showed that malnutrition was highly prevalent in a large cohort of COVID-19 survivors at 4–5 months from acute illness. Conclusions : Our findings highlight the need to implement comprehensive nutritional assessment and therapy as an integral part of care for COVID-19 patients. [ABSTRACT FROM AUTHOR]

The present study was conducted to test the association between adherence to specific exercise modalities and sarcopenia severity in Italian older adults. Data were collected as part of the ongoing Longevity Check-Up 7+ (Lookup 7+) project. Lookup 7+ began in June 2015 and has since been conducted in unconventional settings (e.g., exhibitions, malls, social events) throughout Italy. In the present study, we used data on adults 65 years and older. Sarcopenia was identified according to the simultaneous presence of dynapenia and low appendicular muscle mass. Muscle strength was measured by isometric handgrip and sit-to-stand (STS) testing. Sarcopenia was categorized as severe if participants reported difficulty or inability to walk 400 m. Engagement in running and/or swimming (RS) or strength training with or without stretching (SS) was used to define exercise modalities. Analyses were conducted in 3289 participants (mean age: 72.7 ± 5.7 years; 1814 women). The results of the binary regression showed negative associations between RS and the presence of STS-based sarcopenia in women, and between RS and STS-based severe sarcopenia in men. Collectively, these findings indicate that RS is negatively associated with the presence of sarcopenia in large sample of relatively unselected Italian older adults. [ABSTRACT FROM AUTHOR]

The present study was conducted to test the association between protein intake and blood pressure, glucose levels, and blood cholesterol in a large sample of Italian older adults. Longevity Check-up 7+ (Lookup 7+) is an ongoing project that started in June 2015. The project is conducted in unconventional settings (e.g., exhibitions, malls, health promotion campaigns) across Italy with the aim of fostering adoption of healthy lifestyles in the general population. For the present study, participants were eligible if they were 65+ years and provided written informed consent. Systolic (SBP) and diastolic blood pressure (DBP), and blood glucose and cholesterol levels were assessed. Protein intake was estimated using a 12-item food frequency questionnaire. Three-thousand four-hundred and four older adults were included in the study. The results of the linear regression showed an inverse association between protein intake (as a continuous variable) and DBP, and a positive correlation with blood cholesterol levels. The findings of the present study indicate that a high intake of protein was negatively associated with DBP and positively associated with total blood cholesterol levels in a large cohort of Italian older adults, after adjustment for numerous covariates. [ABSTRACT FROM AUTHOR]

Background: Low muscle strength is a powerful predictor of negative health‐related events and a key component of sarcopenia. The lack of normative values for muscle strength across ages hampers the practical appraisal of this parameter. The aim of the present study was to produce normative values for upper and lower extremity muscle strength across a wide spectrum of ages, in a large sample of community‐dwellers recruited in the Longevity check‐up (Lookup) 7+ project. Methods: Lookup 7+ is an ongoing project that started in June 2015 and conducted in unconventional settings (i.e. exhibitions, malls, and health promotion campaigns) across Italy with the aim of fostering the adoption of healthy lifestyles in the general population. Candidate participants are eligible for enrolment if they are 18+ years and provide written informed consent. Upper and lower extremity muscle strength is assessed by handgrip strength and five‐repetition chair‐stand [5 × sit‐to‐stand (STS)] tests, respectively. Cross‐sectional centile and normative values for handgrip strength and 5 × STS tests from age 18 to 80+ years were generated for the two genders. Smoothed normative curves for the two tests were constructed for men and women using the lambda‐mu‐sigma method. Results: From 1 June 2015 to 30 May 2019, 11 448 participants were enrolled. The mean age of participants was 55.6 years (standard deviation: 11.5 years; range: 18–98 years), and 6382 (56%) were women. Normative values for handgrip strength and the 5 × STS test, both absolute and normalized by body mass index, were obtained for men and women, stratified by age groups. Values of upper and lower extremity muscle strength across ages identified three periods in life: an increase to peak in young age and early adulthood (18–24 years), preservation through midlife (25–44 years), and a decline from midlife onwards (45+ years). Conclusions: Our study established age‐specific and gender‐specific percentile reference values for handgrip strength and the 5 × STS test. The normative curves generated can be used to interpret the assessment of muscle strength in everyday practice for the early detection of individuals with or at risk of sarcopenia. [ABSTRACT FROM AUTHOR]

Background: While respiratory muscle strength is recognized to decline with aging process, the relationship between sarcopenia and pulmonary function remains to be studied. The present study was undertaken to provide a better insight into the comprehension of the relationship between pulmonary function and muscle function (strength and physical performance) using an unselected sample of subjects assessed during the Longevity Check‐up 7+ project. Methods: Look‐up 7+ is an ongoing cross‐sectional survey started in June 2015 and conducted in unconventional settings (i.e. exhibitions, malls, and health promotion campaigns) across Italy. Candidate participants are eligible for enrolment if they are at least 18 years of age and provide written informed consent. Muscle strength was assessed by handgrip strength test, and physical performance was evaluated by chair stand test. Spirometer analysis was performed using the AirSmart system, and the largest forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) values were collected. Results: The mean age of 925 subjects participating in the Longevity check‐7+ surveys and receiving the spirometer evaluation was 55.6 years (range from 18 to 98 years), and 501 (54%) were women. Overall, both in male and female participants, FVC, FEV1 and PEF positively correlated with handgrip strength and chair stand tests. The receiver operator characteristic curve analysis revealed that the areas under the curves for FVC, FEV1, and PEF were 0.79, 0.80 and 0.80, respectively. Conclusions: The results clearly show that pulmonary function was positively associated with handgrip strength and chair stand tests. Based on this observation, muscle strength, physical performance, and pulmonary function should be recommended as the method of choice for the early detection of individuals at risk of probable sarcopenia and at the same time to better characterized the severity of sarcopenia status. [ABSTRACT FROM AUTHOR]

Background Primordial prevention is essential for promoting cardiovascular health and longevity through the so-called seven cardiovascular health metrics (CHMs) (i.e. smoking, body mass index, diet, physical activity, blood pressure, blood glucose and total cholesterol). Measures of muscle mass and function are recognized as powerful predictors of health-related events and survival. Therefore, the present study was undertaken to assess the prevalence and distribution of the seven CHMs and measures of muscle mass and function in an unselected cohort of community-dwellers. Methods The Longevity check-up 7+ (Lookup 7+) project is an ongoing cross-sectional survey conducted in unconventional settings (e.g. exhibitions, malls and health promotion campaigns) across Italy. CHMs are assessed through a brief questionnaire and by measurement of standing height, body weight, blood glucose, blood cholesterol and blood pressure. Muscle mass is estimated from calf circumference, whereas muscle strength and function are measured via handgrip strength and chair-stand testing, respectively. Results Analyses were conducted in 6323 community-living adults (mean age: 54 ± 15 years, 57% women) recruited between 1 June 2015 and 30 June 2017. Participants presented on average 4.3 ± 1.3 ideal CHMs, which decreased with age. Only 19.5% of participants met >5 ideal metrics, while 8.3% met <3. All seven ideal metrics were met by 4.7% of enrollees. Muscle mass, strength and function declined progressively with age, starting at 45–50 years. Conclusion Our population showed suboptimal CHMs scores, with very low prevalence of all ideal metrics. The number of ideal metrics decreased progressively with age and so did muscle mass and function. [ABSTRACT FROM AUTHOR]

Background: Beers criteria and screening tool of older person's prescriptions (STOPP) criteria are widely used to assess potentially inappropriate drug use (PIDU).Objective: the aims of the present study are (i) to assess the prevalence of PIDU based on 2012 Beers criteria and STOPP criteria and (ii) to determine the impact of PIDU, as defined by these criteria, on health outcomes among older in-hospital patients.Design: prospective observational study.Setting and subjects: a total of 871 in-hospital patients participating to the CRIteria to Assess Appropriate Medication Use among Elderly Complex Patients project.Methods: outcome measures were (i) adverse drug reactions (ADR); (ii) decline in functional status; (iii) combined outcome (ADR or declined in functional status).Results: the prevalence of PIDU was 58.4% applying Beers criteria, 50.4% applying STOPP criteria and 75.0% combining both sets of criteria. PIDU defined based on STOPP criteria was significantly associated with ADR [odds ratio (OR) 2.36; 95% confidence interval (CI) 1.10–5.06], and decline in physical function (OR: 2.00; 95% CI: 1.10–3.64), while, despite a positive trend, no significant association was observed for Beers criteria or the combination of both criteria. The combined outcome was significantly associated with PIDU defined based on Beers (OR: 1.74; 95% CI: 1.06–2.85), STOPP criteria (OR: 2.14; 95% CI: 1.32–3.47) or both (OR 2.02; 95% CI: 1.06–3.84).Conclusions: PIDU is common in hospitalised older adults and the combination of Beers and STOPP criteria might lead to the identification of a larger number of cases of PIDU than the application of a single set of criteria. STOPP criteria significantly predict all in-hospital outcomes considered, while Beers criteria were significantly associated with the combined outcome only. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment is a common finding in end-stage renal disease patients on chronic hemodialysis, but data on the associated factors are still scanty. Aims: The present study evaluated the association between cognitive function and left ventricular systolic function in hemodialysis patients. Methods: We enrolled 72 patients admitted to the Hemodialysis Unit of the Catholic University, Rome. Cognitive performance was evaluated using the Mini Mental State Examination (MMSE); a cutoff of 24 was used to diagnose cognitive impairment. Left ventricular ejection fraction (LVEF) was assessed by echocardiography. Multivariable linear and logistic regressions were adopted to assess the adjusted association between cognitive performance and LVEF. Also, linear discriminant analysis was performed to ascertain the cutoff level of LVEF which best predicted cognitive impairment. Results: Cognitive impairment was found in 37 (51 %) patients. According to linear regression, MMSE was independently associated with LVEF ( B = 0.06; 95 % CI = 0.01-0.12; P = 0.040). Logistic regression confirmed the inverse association between LVEF and cognitive impairment (OR = 0.87; 95 % CI = 0.78-0.98; P = 0.022). In linear discriminant analysis, the LVEF cutoff level that best predicted cognitive impairment was ≤51 %. Conclusion: Cognitive impairment is a common finding in hemodialysis patients. Even mildly depressed LVEF is independently associated with cognitive impairment. This association and its potential therapeutic implications should be assessed in dedicated studies. [ABSTRACT FROM AUTHOR]

Aim: Primordial prevention is essential for reaching cardiovascular (CV) health. This is defined by seven health metrics identified by the American Heart Association. Aim of the present study was to assess prevalence and distribution of these seven CV health metrics within an unselected population. Methods: All the 1110 consecutive individuals (mean age 56 ± 13 years; 56% women) who agreed to be screened within the context of a national campaign of CV prevention were included. The following findings have been considered as ideal: never/former smoker, regular participation in physical activity, body mass index lower than 25.0, healthy diet, cholesterol lower than 200 mg/dl, diabetes absence and a blood pressure lower than 120/80 mmHg. Results: Participants presented, on average, 4.1 ± 1.2 ideal CV health metrics, with a decreasing number across age-groups. Only 10.4% covered more than five ideal CV health metrics and 8.3% covered less than three ideal health metrics. Only 1.9% of the study population met all the seven ideal metrics. In particular, only 34% (379 subjects) in our population presented an ideal level of cholesterol. The higher prevalence was observed in younger subjects (45%) and the lower (28%) in people older than 62 years (P < 0.001). Conclusion: Prevalence of the seven CV health metrics was low in our population and just 1 in 10 met more than five ideal CV health metrics. Social initiatives and awareness policies from governments are mandatory to promote CV health. Further studies should address the impact of such CV metrics on several outcomes in European countries. [ABSTRACT FROM AUTHOR]

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

Objectives Declining muscle mass and function are hallmarks of the aging process. The preservation of muscle trophism may protect against various negative health outcomes. Age- and sex-specific curves of muscle mass, strength, and function, using data from a large sample of community-dwelling people, are necessary. Material and methods Two surveys (Longevity Check-up and Very Important Protein [VIP]), conducted during EXPO 2015 in Milan, consisted of a population assessment aimed at evaluating the prevalence of specific health metrics in subjects outside of a research setting (n = 3206), with a special focus on muscle mass, strength, and function. Muscle mass was estimated by using mid-arm muscle circumference (MAMC) and calf circumference of the dominant side. Muscle strength and function were assessed through handgrip strength testing and repeated chair stand test, respectively. Results The mean age of 3206 participants in the Longevity Check-up and VIP surveys was 51.9 years (SD 15.6, range 18–98 years), and 1694 (52.8%) were women. Cross-sectional inspection suggests that both calf circumference and MAMC decline nonlinearly with age and the rate of decline varies by gender. These measures are stable until 50 years and then begin to decrease slightly with age, with the effect being more evident in men than in women. The main effect of the age category was observed in muscle strength and physical performance parameters. Muscle strength declined significantly after 45 years of age, both in men and women ( P < .001). The muscle quality of the upper extremities, defined as handgrip strength divided by MAMC, declined significantly with aging, as well ( P < .001). The time to complete the chair stand test was similar from 18 years to 40 to 44 years, and then a linear decline in performing the test across age groups was observed, with an increased time of more than 3 seconds, both in men and women ( P < .001). Conclusions Muscle mass and strength curves may be used to extract reference values for subsequent use in research as well as in the clinical setting. In particular, the analyses of trajectories of muscle parameters may help identify cutoffs for the estimation of risk of adverse events. [ABSTRACT FROM AUTHOR]

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

Background: Wide consensus exists on the notion that low muscle mass is a predictor of negative health-related events, such as disability, morbidity, and mortality. Indeed, the European Working Group on Sarcopenia in Older People 2 had identified muscle mass as the key component to confirm the diagnosis of sarcopenia. However, the lack of normative values for muscle mass across ages hampers the practical assessment of this important parameter. The aim of the present study was to produce cross-sectional centile and normative values for calf circumference (a surrogate estimation of muscle mass) across a wide spectrum of ages using a large and unselected sample of community-dwellers enrolled in the Longevity Check-up 7+ (Lookup 7+) project., Methods: This is a cross-sectional study using the data of Lookup 7+ project, an ongoing study started in June 2015 and conducted in unconventional settings (i.e., exhibitions, malls, and health promotion campaigns). Candidate participants were considered eligible for enrolment if they were at least 45 years of age and provided written informed consent. Calf circumference was measured using an inextensible but flexible plastic tape in a sitting position with the knee and ankle at a right angle and the feet resting on the floor. Normative values for calf circumference from ages 45 to 80 + years were generated., Results: A total of 11 814 participants were enrolled from 1 June 2015 to 30 September 2022. The mean age of participants included in the analyses was 61.8 years (standard deviation; 10.2 years; range: 45-98 years), and 6686 (57%) were women. Normative values for calf circumference were obtained for men and women, stratified by age groups. Accordingly, a calf circumference tape, with colour bands that demarcate the centiles range into which the patient falls, was created and validated., Conclusions: Our study established age- and gender-specific centile reference values for calf circumference. The calf circumference tape can be used to easily interpret the assessment in every-day practice for the early detection of individuals with or at risk of sarcopenia and malnutrition., (© 2023 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.)

Objective: Low muscle mass is one of the mediators of numerous complications accompanying malnutrition status and sarcopenia and at the same time may have a greater effect on survival than other clinical characteristics. In this study, we evaluated the impact of low appendicular skeletal muscle (ASM) on all-cause mortality risk over 10 years in older community-dwellers., Design: Prospective cohort study., Setting: Population-based study., Participants: All persons aged 80+ years living in the community of the Sirente geographic area (L'Aquila, Italy) (n = 364). Participants were categorised in low or normal ASM based on the COONUT equation that considered calf circumference, age and gender., Primary Outcome: All-cause mortality over 10 years according to the low ASM estimated by calf circumference., Results: Low estimated ASM was identified in 128 participants (37 %). A total of 245 deaths were recorded over 10 years: 110 among participants with low ASM (85.3 %) and 135 among persons with normal ASM (65.1 %; p < 0.001). Participants with low ASM had a higher risk of death than those with normal ASM (HR: 3.38; 95 % CI: 1.93-5.93). This association remained statistically significant after adjusting for a number of potential confounders, such as age, gender, ADL impairment, cognitive impairment, BMI, and plasma CRP and IL6 levels (HR: 1.84; 95 % CI: 1.03-3.28)., Conclusions: Our findings show that low estimated ASM by calf circumference is predictive of 10 years mortality in older community-dwellers. The derived equation used in the present study to estimate ASM, based on calf circumference, may be particularly relevant in clinical practice. Hence, in older persons with low ASM, interventions targeting muscle mass may be effective at preventing or postponing negative health outcomes., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The ongoing "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT)" randomized controlled trial (RCT) is testing the efficacy of a multicomponent intervention in the prevention of mobility disability in older adults with physical frailty & sarcopenia (PF&S). Here, we describe the procedures followed for PF&S case finding and screening of candidate participants for the SPRINTT RCT. We also illustrate the main demographic and clinical characteristics of eligible screenees., Methods: The identification of PF&S was based on the co-occurrence of three defining elements: (1) reduced physical performance (defined as a score on the Short Physical Performance Battery between 3 and 9); (2) low muscle mass according to the criteria released by the Foundation for the National Institutes of Health; and (3) absence of mobility disability (defined as ability to complete the 400-m walk test in 15 min). SPRINTT was advertised through a variety of means. Site-specific case finding strategies were developed to accommodate the variability across centers in catchment area characteristics and access to the target population. A quick "participant profiling" questionnaire was devised to facilitate PF&S case finding., Results: During approximately 22 months, 12,358 prescreening interviews were completed in 17 SPRINTT sites resulting in 6710 clinic screening visits. Eventually, 1566 candidates were found to be eligible for participating in the SPRINTT RCT. Eligible screenees showed substantial physical function impairment and comorbidity burden. In most centers, project advertisement through mass media was the most rewarding case finding strategy., Conclusion: PF&S case finding in the community is a challenging, but feasible task. Although largely autonomous in daily life activities, older adults with PF&S suffer from significant functional impairment and comorbidity. This subset of the older population is therefore at high risk for disability and other negative health-related events. Key strategies to consider for successfully intercepting at-risk older adults should focus on mass communication methods., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of the present study was to investigate the prevalence of abnormal cholesterol levels and to explore awareness of cholesterol values in an unselected sample of community-living adults., Design: Cross-sectional survey., Setting: Exhibitions, malls and health promotion campaigns across Italy., Participants: 3535 community dwellers aged 18-98 years were enrolled between September 2016 and June 2017. Analyses were conducted in 3040 participants, after excluding 495 enrolees on cholesterol-lowering medications., Main Outcome Measures: Total blood cholesterol levels and awareness of cholesterol values., Results: Abnormal blood cholesterol values were found in 1961 (64.5%) of participants with no differences between genders (p=0.06). Among those who believed they had normal cholesterol levels, only 48% had values below 200 mg/dL. More than 40% had cholesterol values between 200 and 240 mg/dL, and around 10% had values >240 mg/dL. More than one-third of participants had not measured cholesterol in the last year. Among them, only 36% had normal cholesterol levels., Conclusions: Abnormal blood cholesterol is highly prevalent in our sample of Italian community dwellers, with less than half of participants being aware of their cholesterol levels., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Muscle mass and strength ineluctably decline with advancing age. Yet, the impact of ethnicity on the pattern of changes and their magnitude is unclear. The aims of the present study were to analyze age- and gender-specific changes in measures of muscle mass and strength among community-living persons and to identify differences between Caucasian and Asian participants., Methods: The Italian survey ("Longevity Check-up"), conducted during Milan EXPO 2015, consisted of a population assessment aimed at evaluating the prevalence of specific health metrics in persons outside of a conventional research setting (n=1924), with a special focus on muscle mass and strength. The Taiwanese survey used the first-wave sampling from the I-Lan Longitudinal Aging Study (ILAS) collected from August 2011 to August 2013 (n=1839). ILAS was designed to explore the interrelationship between sarcopenia and frailty in community-dwelling older people in Taiwan. In both studies, muscle mass was estimated by measuring the calf circumference (CC), whereas muscle strength was assessed by handgrip strength testing., Results: The mean age of the 1924 Italian participants was 62.5years (standard deviation 8.3, range from 50 to 98years), of whom 1031 (53.6%) were women. Similarly, the mean age of the Taiwanese sample was 63.9years (standard deviation 9.3, range from 50 to 92years), with 966 (52.5%) women. CC declined with age in both genders and was significantly greater among Italian participants compared with Taiwanese people in all age groups. A similar effect of age was observed for muscle strength. As for CC, muscle strength was significantly greater among Italian persons relative to Taiwanese participants., Conclusion: Muscle mass and strength declined with age in both ethnic groups. Caucasians showed greater muscle mass and performed better than their Asian counterparts. However, the age at which declines began to appear and the rate of decline during aging were comparable between the two populations., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Prescribing pharmacological treatment for hospitalized older patients represents a challenge for physicians. In particular, hospitalized older adults present with acute and chronic diseases, which may require multiple treatments and increase their susceptibility to adverse drug reactions. Patterns of drugs use have rarely been investigated in these patients., Objective: To describe patterns of drugs use among hospitalized older adults participating in the CRiteria to assess Appropriate Medication use among Elderly complex patients (CRIME) project., Methods: We performed a cross-sectional multicentre study based on data from the CRIME project, a study performed in geriatric and internal medicine acute care wards of 7 Italian hospitals. The only two exclusion criteria were: age < 65 years old and unwillingness to participate in the study. Participants were assessed at hospital admission and followed until discharge., Results: Mean (Standard Deviation) age of 1123 participants was 81.5 (7.4) years, with 629 (56%) being women and 572 participants (51%) were admitted from Emergency Room. Mean length of stay was 11.2 (6.7) days. Mean number of drugs used greatly varied before (6.2, SD 3.2), during (10.6, SD 5.6) and after (7.1, SD 3.1) hospitalization. No difference in the number of drugs used during hospital stay was observed across age groups. During hospital stay, drugs for acid related disorders (77.9%) and antithrombotic agents (76.8%) were the most commonly used drugs, followed by drugs acting on the renin-angiotensin system (58.0%) and diuretics (57.1%). Very common was the use of psycholeptics (34.3%) and psychoanaleptics (22.4%)., Conclusion: Use of multiple drug treatments is common in hospitalized older adults and hospitalization is associated with a substantial increment in the number of drugs used, with no differences across age groups.

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.

Background & Aims: Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the relationship between midarm muscle circumference (MAMC) and physical performance, muscle strength, functional status and survival in persons aged 80 years or older., Methods: Data are from the baseline evaluation of the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study) (n = 357). MAMC was calculated taking into account the mid upper arm circumference and the triceps skinfold thickness of the right arm. Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4-m walking speed test, the balance test and the chair stand test. Analyses of covariance were performed to evaluate the relationship between different MAMC levels and physical function. Cox proportional regression models were used to estimate crude and adjusted hazard ratios and 95% confidence intervals of death by MAMC levels., Results: After adjustment for potential confounders - which included age, gender, living alone, sensory impairments (hearing and vision), body mass index, albumin and cholesterol - physical performance and function (which were measured using the 4-m walking speed test, the Short Physical Performance Battery score, the hand grip strength), improved significantly as MAMC increased. Compared with those in the low MAMC tertile, subjects in the high MAMC tertile had a lower risk of death (adjusted hazard ratio (HR) 0.45; 95% Confidence Interval (CI) 0.23-0.87)., Conclusions: The present study suggests that among community-dwelling old-old subjects muscle mass may be positively related to functional performance and survival., (Copyright 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: Increasing evidence suggests that anorexia of aging can cause physical and mental impairment. The aim of the present study was to evaluate the relationship between anorexia of aging and measures of physical performance, muscle strength, and functional status in older persons aged 80 years or older., Methods: Data are from baseline evaluation of 364 subjects enrolled in the ilSIRENTE study. The ilSIRENTE study is a prospective cohort study performed in the mountain community living in the Sirente geographic area (L'Aquila, Abruzzo) in central Italy. Physical performance was assessed using the physical performance battery score (SPPB), which is based on 3 timed tests: 4-meter walking speed, balance, and chair stand tests. Muscle strength was measured by hand grip strength. We defined anorexia as the presence of loss of appetite and/or lower food intake. Analyses of covariance were performed to evaluate the relationship of anorexia with physical function., Results: In the unadjusted model, all the physical performance, muscle strength, and functional measures showed significant associations with the presence of anorexia. After adjustment for potential confounders (age, gender, BMI, number of diseases, depression, congestive heart failure, lung diseases) these associations were weaker but still statistically significant (physical performance battery score: subjects without anorexia 6.8, SE 0.2, subjects with anorexia 5.8, SE 0.4, P = .03; 4-meter walking speed: subjects without anorexia 0.5 m/s, SE 0.1, subjects with anorexia 0.3 m/s, SE 0.1, P = 5.001 hand grip strength: subjects without anorexia 30.8 kg, SE 0.7, subjects with anorexia 27.9 kg, SE 1.5, P = .03). Furthermore, relative to participants without anorexia, those subjects with anorexia showed a significantly higher risk of developing disability after 2 years of follow-up (hazard ratio 2.25; 95% confidence intervals 1.15-4.39)., Conclusions: Anorexia is common among community older subjects in Italy. Our results suggest that among old-old subjects, the presence of anorexia is associated with impaired physical performance and with a significant increased risk of incident disability, irrespective of potential confounders., (Copyright (c) 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)