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Background Cardiac arrhythmias are common conditions in older people. Unfortunately, there is limited literature on associations between cardiac arrhythmias and physical performance or disability. We therefore aimed to prospectively investigate associations between cardiac arrhythmias and changes in disability and physical performance during 8 years of follow-up, using data from the Italian Longitudinal Study on Aging (ILSA). Methods Cardiac arrhythmias diagnosis was posed through a screening phase, confirmed by a physician. The onset of disability in activities of daily living (ADL) and the changes in several physical performance tests during follow-up were considered as outcomes. Fully-adjusted and propensity-score Cox Proportional Hazard models and mixed models were used for exploring associations between cardiac arrhythmia and the outcomes of interest. Results The prevalence of cardiac arrhythmia at baseline was 23.3%. People reporting cardiac arrhythmia at the baseline were significantly older, more frequently male, smokers and reported a higher presence of all medical conditions investigated (hypertension, heart failure, angina, myocardial infarction, diabetes, stroke), but no difference in dementia, Parkinsonism, cognitive or mood disorder. Cardiac arrhythmia at baseline was significantly associated with the incidence of disability in ADL (HR = 1.23; 95%: CI: 1.01-1.50; P = 0.0478 in propensity score analyses; HR = 1.28; 95% CI: 1.01-1.61; P = 0.0401 in fully adjusted models). Cardiac arrhythmia at baseline was also associated with a significant worsening in balance test (P = 0.0436). Conclusions The presence of cardiac arrhythmia at baseline was associated with a significant higher risk of disability and of worsening in some physical performance tests, particularly those relating to balance. Screening and frequently assessing physical performance in older people affected by cardiac arrhythmia can be important to prevent a loss of physical performance, with further, potential, complications of medical management. © 2020 JGC All rights reserved

OBJECTIVE: To identify the determinants of mobility among people aged 50+ from Finland, Spain and Poland. STUDY DESIGN: Observational cross-sectional population study. MAIN OUTCOME MEASURES: A mobility score was based on responses to items referring to body movements, walking, moving around and using transportation. Determinants of mobility were entered in hierarchical regression models in the following order: sociodemographic characteristics, health habits, chronic conditions, description of general state of health, vision and hearing, social networks, built environment. RESULTS: Complete data were available for 3902 participants (mean age 65.1, SD 9.8). The final model explained 64.7% of the variation in mobility. The most relevant predictors were: pain, age and living in Finland, presence of arthritis, stroke and diabetes, high-risk waist circumference, physical inactivity, and perceiving the neighborhood environment as more exploitable. CONCLUSIONS: Our results provide public health indications that could support concrete actions to address the modifiable determinants of mobility. These include the identification and treatment of pain-related problems, increasing the level of physical activity and the improvement of neighborhood features in terms of presence of general utility places or means of transportation. These factors can be modified with short- to medium-term interventions and such a change could improve the mobility of ageing population, with evident benefits for health.

Background:Gender differences for incidence of dementia among elderly people have been usually investigated considering gender as a predictor and not as a stratification variable.Methods:Analyses were based on data collected by the Italian Longitudinal Study on Aging (ILSA), which enrolled 5,632 participants aged 65–84 years between 1992 and 2000. During a median follow-up of 7.8 years, there were 194 cases of incident dementia in the participants with complete data. Cox proportional hazard models for competing risks, stratified by sex, were defined to determine risk factors in relation to developing dementia.Results:The incidence rate of dementia increased from 5.57/1,000 person-years at 65–69 years of age to 30.06/1,000 person-years at 80–84 years. Cox proportional hazard models for competing risks of incidence of dementia and death revealed that, among men, significant risk factors were heart failure, Parkinson's disease, family history of dementia, mild depressive symptomatology and age, while triglycerides were associated with a lower risk of developing dementia. Significant risk factors in women were age, both mild and severe depressive symptomatology, glycemia ≥109 mg/dL, and a BMI < 24.1 kg/m2. Even as little as three years of schooling was found to be a significant protective factor against the incidence of dementia only for women.Conclusions:Our results suggest that there is an effect modification by gender in our study population in relation to the association between low education level, lipid profile, BMI, and glycemia and dementia.

ACKGROUND: Preclinical cognitive changes may predict an increased risk of dementia, allowing selection of subgroups as possible targets for preventive or therapeutic interventions. OBJECTIVE: To evaluate the predictive effect of daily functioning and motor performance (MP) on the progression to dementia in normal cognition, cognitive impairment, no dementia (CIND), and mild cognitive impairment (MCI). METHODS: The Italian Longitudinal Study on Aging is a large population-based survey on age-related diseases of the cardiovascular and nervous systems. After the baseline assessment, to detect prevalent cases of cognitive impairment and dementia, participants were re-examined at 4-year and 8-year follow-ups. Functional independence was evaluated using the Index of Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL) Scale. A six-test battery was used to assess MP. RESULTS: Overall, 2,386 individuals were included, for a total of 16,545 person-years. Eight-year incidence of dementia (per 1,000 person-years) was 12.69 in total sample, 9.86 in subjects with normal cognition at baseline, 22.99 in CIND, and 21.43 in MCI. Progression to dementia was significantly higher with increasing baseline ADL and IADL impairment, and with a worse MP. In Cox regression analyses controlled for demographics and major age-related conditions, increased IADL impairment was the stronger predictor of progression to dementia (p

The associations between prevalence, incidence and recovery from activities of daily living (ADL) disability and social ties among community-dwelling persons over 65 in Finland, The Netherlands and Spain are examined. Data were harmonized in the CLESA study. The baseline sample was composed of 3,648 subjects between 65 and 85 years old, living in Finland, The Netherlands and Spain. Disability in four activities of daily living was determined at baseline and at follow-up. Social participation, number of family ties and presence of friends were added to obtain a social ties index. Logistic regressions were fitted to the prevalence, incidence and recovery data to estimate the associations between disability and social ties, adjusting for education, co-morbidity and self-rated health. The modifying effects of country, age and sex were tested in all models. For every country, the social ties index, having friends and social participation were negatively associated with ADL disability prevalence. ADL incidence was negatively related to the number of family ties, with a stronger relationship in Spain than in The Netherlands or Finland. ADL recovery was associated with the social ties index. No age or gender differences in these associations were found. Social ties appear to generate a beneficial effect on the maintenance and restoration of ADL function. While social ties play an important role in maintaining and restoring function in all three countries, family ties appear to generate a stronger effect on protection from disability incidence than does social participation, and the strength of this effect varies by culture.

Unintentional injuries are one of the main contributors to mortality and disability in elderly populations in low- and middle-income countries. The aim of this study was to examine the annual road traffic and other bodily (not including falls) injury prevalence and associated risk factors among older adults across six lower and upper middle-income countries. A cross- sectional survey involving face-to-face household interviews were conducted in China (n=13,177), Ghana (n=4305), India (n=6560), Mexico (n=2318), the Russian Federation (n=3938) and South Africa (n=3840), resulting in population-based cohorts of persons aged 50+ years. Measures included questions on injury, self-rated visual difficulties, alcohol use, depression treatment, sleeping problems, self-reported health status, and vision assessment using LogMAR (logarithm of Minimum Angle of Resolution) eye charts. It comprises rows of letters and is used to measure visual acuity. Results indicate that the overall annual non-fatal road traffic injury prevalence was 2.0% and for other bodily injury 2.1% (not including falls) across the six countries. The multivariate logistic regression analysis found that residing in a rural area, taking medications or other treatment for depression in the past 12 months and having a sleeping problem were associated with road traffic injury, while younger age, residing in a rural area, hazardous or harmful alcohol use and having a sleeping problem were associated with other bodily injury. Visual impairment was not associated with prevalence of road traffic injuries. This study provides the burden of non-fatal road traffic injury and other bodily injury and their associated risk factors across the six countries’ studies. The findings of this study improves the understanding of non-fatal road traffic injury and other bodily injury upon which policy makers, programme developers and researchers in public health can design strategic interventions to reduce these preventable injuries as well as improve safety associated with unintentional injuries.Keywords: injury, traffic, ageing, China, Ghana, India, Mexico, Russian Federation, South Africa.

BackgroundDepression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.MethodAs part of a prospective, population-based study on a random sample of 5632 subjects aged 65–84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.ResultsSeverity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15–1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32–0.95; men MHR 0.59, 95% CI 0.37–0.93). Neither sociodemographic nor medical confounders significantly modified these associations.ConclusionsConsistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

Background/Objectives: Although there is plenty of evidence of the association between metabolic syndrome (MS) and cardiovascular disease, the relationship between alcohol consumption and MS is still questioned. The few publications with respect to the elderly seem to indicate that alcohol consumption is unassociated with MS. The aim of this study was to assess the association between alcohol consumption and the prevalence and incidence of MS, as well as its components in a large sample of Italian elderly people. Subjects/Methods: This is a multicenter study on a population-based sample of Italian people aged 65–84 years. The Italian Longitudinal Study on Aging (ILSA) included a prevalence phase in 1992 and an incidence phase from 1995 to 1996. The median length of follow-up was 3.5 years. In the present study, the analysis included 1321 men grouped into five alcohol consumption classes: abstainers, and those consuming p12, 13–24, 25–47 or X48 g of alcohol in a day. Among the 1122 women considered, the last two of the above five categories were pooled together (424 g/day). MS was defined according to ATP III criteria. All statistical analyses were stratified by gender. Results: Adjusted odds ratios showed that categorized alcohol consumption was not significantly associated with the prevalence and incidence of MS when compared with abstainers in either gender. For the MS incidence survey, three of five components (systolic pressure, glycemia and waist circumference) proved to be significantly and harmfully affected by alcohol consumption in males, whereas no such significant association emerged in females. Conclusions: These results suggest that alcohol can modify an individual’s metabolic condition and that, even among the elderly, men might be more sensitive to the effects of alcohol than women.

Aims: To assess the role of type 2 diabetes as a risk factor for cognitive decline among elderly people. Methods: Analyses were carried out on data from the Italian Longitudinal Study on Aging, a study on 5,632 subjects aged 65–84 years, with baseline in 1992 and follow-ups in 1996 and 2000. Results: At baseline, diabetic women had significantly worse scores on all cognitive tests compared to nondiabetic women, but did not show worsening over time, whereas men with diabetes did not show worse scores on cognitive tests at baseline compared to nondiabetic males; however, diabetes in men was associated with a risk of cognitive decline over time, particularly in attention. Higher levels of HbA 1c were associated with poorer performance on memory tests at follow-up in both sexes. Conclusion: The impact of diabetes on cognitive status might differ in older men and women, probably because of a survival effect, with a higher mortality at a younger age among diabetic men. The metabolic and cardiovascular abnormalities associated with diabetes might be responsible for the cognitive decline, at different rates and ages, in men and women. The routine assessment of diabetes complications in the elderly should include cognitive evaluation in both sexes.

Objectives: Depressive symptoms (DS) are very frequent in elderly individuals and are associated with negative outcomes. This study was undertaken to evaluate whether DS predict physical disability in this population. Methods: A prospective, community-based cohort study, this work included 5,632 individuals aged 65–84 years, who were recruited from the demographic registries of eight Italian municipalities in 1992. The complete data of 3,256 subjects were collected and analyzed. DS were assessed using the Geriatric Depression Scale with a score 10/30 indicating DS. All traditional risk factors for disability established by questionnaires and physical examinations were assessed at baseline. The outcomes were self-reported disability on the activities of daily living (ADL) test and the performance-based physical function assessment (Physical Performance Tests, PPT). The contribution of the predictive variables to the outcomes evaluated after a mean follow-up of 3.5 0.4 years was assessed using hierarchical logistic nested models. Results: Baseline DS was associated with higher rates of ADL disability (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.12–2.66) and PPT disability (OR 1.83, 95% CI 1.17–2.85) in men and with ADL disability (OR 1.81, 95% CI 1.28 –2.55) in women. The independent predictors of PPT disability in women were arthritis (OR 2.13, 95% CI 1.28 –3.53) and age (OR 1.09; 95% CI 1.03–1.15). Conclusions: This study provides evidence that older persons who report DS are at higher risk of subsequent physical decline. In women, arthritis is a more powerful predictor of preclinical disability, as measured by PPT.

This study aims at investigating the socio-demographic characteristics and health conditions of very elderly people in the Mantova province (North Italy). By March 31st 1998 a total of 117 subjects aged 98+ (including 39 centenarians) were resident in the Mantova province. 84 subjects (72% of the population aged 98+) agreed to participate in the study. The survey was carried out in the shortest time possible in order to minimize bias due to the high mortality rate among very elderly people. 77 surviving subjects were administered a protocol including an interview about socio-economic conditions, lifetime habits, as well as medical examination, evaluation of physical and cognitive function, evaluation of state of depression and performance-based tests. Data on the health status, quality of life and social network of very long-lived people in the Mantova province are discussed and compared with findings from studies on Italian centenarians. Among the very elderly people in the Mantova province a high prevalence of functional and cognitive impairment was found. However, the degree of perceived well-being was good and no symptoms of depressions were observed. Despite the poor health status of the long-lived, the burden of care falls mainly on the families, and the presence of living children is a protective factor against institutionalization.

To study the accuracy of A-mode ultrasonography (A-MU) in detecting secretion in maxillary and frontal sinuses in critically ill, intubated patients undergoing mechanical ventilation. Open study in mechanically ventilated, comatose patients. Medical-surgical intensive care unit in the General Hospital of Rovigo. 50 consecutive, mechanically ventilated, critically ill patients. All patients were in a coma and needed cerebral computed tomography (CT) for a diagnosis. The A-MU technique gave 100 images of maxillary and frontal sinuses. The images were read blindly and classified into five categories: definitely normal, definitely abnormal, probably normal, questionable, and probably abnormal. CT findings were considered to be the “gold standard”. The specificity of echo images varied from 72 to 98% and the sensitivity from 63 to 86% for maxillary sinuses. For frontal sinuses, the specificity varied from 96 to 99% and the sensitivity from 14 to 57%. The area under the receiver-operating characteristic curve was found to be 0.89 and 0.76 for maxillary and frontal sinuses, respectively. The A-MU technique is an accurate tool for detecting secretion in the maxillary sinuses in intubated patients. More investigations are necessary in order to evaluate its usefulness in the frontal sinuses.