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Objectives: In the absence of a simple validated instrument to screen for cognitive impairment among illiterate Lebanese older adults, the aims of this study were to validate an Arabic version of the Test of Nine Images (A-TNI93) adapted by the Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'Univesité Saint Joseph (GTD-USJ) for illiterate older Lebanese and to establish normative data. Method: A national population-based sample of 332 community-dwelling illiterate Lebanese aged 55 years and older was administered the A-TNI93 (GTD-USJ) scoring free and overall recall. The sample is part of a larger national sample (1342 participants) used to validate an Arabic version of the Mini-Mental State Examination already reported. Reproducibility, sensitivity, specificity, and area under the curve of the A-TNI93 (GTD-USJ) scoring to detect cognitive impairment according to Clinical Dementia Rating (CDR) as the gold standard were measured. Normative data were established among 188 cognitively normal participants. Results: A threshold score of six on free recall (FR) provided a sensitivity of 66.7% and a specificity of 90.5%. The area under the curve was 0.93. By taking either scores, that is, a FR ≤ 6 or a total recall ≤ 8, the A-TNI93 (GTD-USJ) slightly improved dementia case detection with a sensitivity of 70.8% and a specificity of 88%. Normative data illustrate the distribution of cognitive performance among illiterate older adults. Conclusions: Compared to the CDR requiring physician's competence, the A-TNI93 (GTD-USJ) is a valid Arabic adaptation to screen for cognitive impairment among illiterate Lebanese older adults. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether and at what dose vitamin D supplementation affects insulin resistance (IR). Objective: We sought to investigate whether vitamin D at doses higher than currently recommended decreases indexes of IR in an ambulatory population of overweight elderly subjects. Design: This double-blind, randomized, controlled multicenter trial enrolled 257 elderly overweight individuals aged ≥65 y with baseline 25-hydroxyvitamin D [25(OH)D] concentrations between 10 and 30 ng/mL. All subjects received 1000 mg calcium citrate/d, with vitamin D administered weekly at an equivalent dose of 600 or 3750 IU/d. The homeostasis model assessment (HOMA) of IR index at 1 y was the primary outcome. We also assessed the McAuley index. Results: In total, 222 subjects (55% women) with a mean ± SD age and body mass index (BMI; in kg/m²) of 71 ± 4 y and 30 ± 4, respectively, completed the study. Subjects' baseline characteristics, including IR indexes, were similar across groups: 69% had prediabetes, 54% had hypertension (47% were taking antihypertensive medications), and 60% had hyperlipidemia, nearly half of whom were receiving lipidlowering drugs. At 1 y, mean ± SD serum 25(OH)D increased from 20 ± 7 to 26 ± 7 ng/mL in the low-dose arm (P < 0.0001) and from 21 ± 8 to 36 ± 10 ng/mL in the high-dose arm (P < 0.001). Median HOMA-IR indexes did not change compared with baseline concentrations and were similar in the high- [2.2 (IQR: 1.5, 2.9)] and low-dose [2.3 (IQR: 1.6, 3.3] treatment groups. Adjusted analyses showed that HOMA-IR was predicted by the baseline HOMA index and BMI but not by vitamin D dose, baseline serum 25(OH)D, or change in 25(OH)D. Conclusion: Vitamin D3 at 3750 IU/d did not improve HOMA-IR compared with the Institute of Medicine Recommended Dietary Allowance of 600 IU/d in elderly overweight individuals. This trial was registered at clinicaltrials.gov as NCT01315366. [ABSTRACT FROM AUTHOR]

Background: Medical conditions and depen- dency levels of the elderly in the Lebanese long-term care institutions have not been described. This may undermine care commissioning and development to institutionalized elderly. Data to inform policy and practice are needed., Objective: To identify clinical diagnoses and dependency levels among elderly residents in long-term care institutions in Lebanon., Methods: Cross-sectional survey of long-term care institutions throughout Lebanon as identified by the Mihistry of Social Affairs., Results: Thirty-one out of 42 long- term care institutions have been included in this survey. Among them, 1371 elderly subjects were included in the analysis; 75.6% were over the age of 75, and female repre- sented 67%. Medical morbidities and associated disabilities have driven admission in 70.5% of residents; 45.6% of resi- dents reported dernentia, stroke or other neurodegenerativb disease. Overall, 60% of residents required locomotor assis- tance., Conclusions: Elderly residents in long-term carb institutions are predominantly females, with mental and/or locomotor disabilities resulting fror neurological and ar- thritic conditions. Targeting healthcare for such health condi- tions remains a challenge for the institutions.

Background: With the anticipated increase in the number of elderly people in Lebanon, it is important to develop services tailored to their specific needs. The Identification of Seniors At Risk (ISAR) tool identifies, in emergency setting, frail elderly people at risk of adverse outcomes, who are more likely to benefit from a geriatric approach., Objectives: i) Assess the geriatric profile according to ISAR score ii) correlate the score to outcomes two months after Emergency Department (ED) visit., Methods: A two-month prospective study: at the ED of Hôtel-Dieu de France Hospital, we interviewed 273 people aged 70 years and older (or their caregiver) using the ISAR tool. Telephone follow-up was done two months later., Results: The prevalence of subjects with ISAR score ≥ 2 and thus likely to benefit from the establishment of a geriatric service is 70.7% (95% CI: 64.9-76.0). Elderly patients admitted to ED with ISAR score ≥ 2 are more likely to be hospitalized (51.6%) than subjects of the same age and sex with ISAR score < 2 (36.9%) (p = 0.034). After two months of follow-up, the risk of hospital readmission and the risk of death was significantly associated with the ISAR score (p = 0.0005) CONCLUSION: The percentage of elderly people likely to benefit from specialized geriatric care network upon admission to the ED of a university hospital is significantly high [70.7% (95% Cl: 64.9-76 .0)].

Aim of the Study: The aim of this study was to compare geometric indices of hip bone strength in overweight and control elderly men., Methods & Results: This study included 16 overweight (Body mass index (BMI) > 25 kg/m2) elderly men (aged 65-84 years) and 38 age-matched controls (BMI < 25 kg/m2). Body composition and bone mineral density (BMD) were assessed by dual-energy X-ray absorptiometry (DXA). To evaluate hip bone geometry, DXA scans were analyzed at the femoral neck, the intertrochanteric region, and the femoral shaft by the Hip Structure Analysis (HSA) program. Cross sectional area (CSA), an index of axial compression strength, section modulus (Z), an index of bending strength, cross sectional moment of inertia (CSMI), an index of structural rigidity, cortical thickness (CT) and buckling ratio (BR) were measured from bone mass profiles. Lean mass, body weight, fat mass and BMI were higher in overweight men compared to controls (p < 0.001). CSA and Z were higher in overweight subjects compared to controls (p < 0.05) at the three regions (femoral neck, intertrochanteric and femoral shaft). After adjustment for age, CSA and Z of the intertrochanteric region and the femoral shaft remained significantly higher in overweight men compared to controls (p < 0.05). After adjustment for either body weight, BMI or lean mass, there were no differences between the two groups (overweight and controls) regarding the HSA variables (CSA, CSMI, Z, CT and BR) of the three regions., Conclusion: This study suggests that overweight elderly men have greater indices of bone axial and bending strength in comparison to controls at the intertrochanteric and the femoral shaft.

Aim of the Study: The aim of this study was to compare bone mineral content (BMC), bone mineral density (BMD) and bone mineral apparent density (BMAD) in obese, overweight and normal weight adolescent boys., Methods & Results: This study included 23 obese, 19 overweight and 25 normal weight adolescents (aged 14-20 years) boys. The three groups (obese, overweight and normal weight) were matched for age and maturation index. Body composition, BMC and BMD were assessed by dual-energy X-ray absorptiometry (DXA). The expressions whole body (WB) BMC/height and WB BMD/height were used to adjust for WB bone size. BMAD was calculated for the WB. WB BMC, WB BMC/height, total hip (TH) BMD, femoral neck (FN) BMD and ultra distal (UD) radius BMD) were higher in obese and overweight boys in comparison to normal weight boys (p < 0.05). WB BMAD was lower in obese boys in comparison to overweight and normal weight boys (p < 0.05). After adjustment for either weight or lean mass, obese boys displayed lower WB BMC, WB BMC/height and WB BMD values in comparison to overweight and normal weight boys (p < 0.05)., Conclusion: This study suggests that WB BMC, WB BMC/height and WB BMD do not adapt to the increased body weight in obese adolescent boys.