Geriatric Rehabilitation Unit

Firenze, Italy

Geriatric Rehabilitation Unit

Firenze, Italy
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Laudisio A.,Biomedical University of Rome | Bandinelli S.,Geriatric Rehabilitation Unit | Gemma A.,UOS Accesso e Presa in Carico Assistenziale | Ferrucci L.,U.S. National Institute on Aging | Incalzi R.A.,Biomedical University of Rome
Clinical Nutrition | Year: 2014

Background & aims: Metabolic syndrome (MetS) is associated with incident disability in middle-aged subjects. We evaluated the association of MetS with functional ability in an older population. Methods: We enrolled 1155 participants aged 65+, derived from the InCHIANTI study, and followed for 3 years. MetS was diagnosed according to the National Cholesterol Education Program's ATP-III criteria. Functional ability was estimated using the Katz's activities of daily living (ADLs), and the Lawton and Brody for the instrumental activities of daily living (IADLs) scales. The association between disability and MetS at baseline and after follow-up was assessed by logistic regression. Results: At baseline, MetS was associated with reduced probability of ADLs disability among participants aged 74+ (OR=33, 95% CI=14-77; p=010), but not in younger (5.08, 95% CI=88-29.24; p=069). Also, MetS was associated with reduced probability of incident ADLs disability (OR=61, 95% CI .41-91; p=016), but neither with prevalent, nor incident IADLs disability. Conclusions: In older persons, MetS is associated with reduced probability of prevalent and incident ADLs disability. Whether older persons with MetS should receive treatment and whether the current diagnostic criteria for MetS apply to older individuals need further investigation. © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Laudisio A.,Biomedical University of Rome | Bandinelli S.,Geriatric Rehabilitation Unit | Gemma A.,UOS Accesso e Presa in Carico | Ferrucci L.,U.S. National Institute on Aging | Antonelli Incalzi R.,Biomedical University of Rome
Journal of the American Geriatrics Society | Year: 2013

Objectives To assess the association between metabolic syndrome (MetS) and hemoglobin levels in older adults. Design The Invecchiare in Chianti (InCHIANTI) Study, a cohort study with a 6-year follow-up. Setting Tuscany, Italy. Participants Adults aged 65 and older (N = 1,036). Measurements MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The adjusted association between baseline hemoglobin and MetS was assessed using multivariable linear regression with hemoglobin as a continuous variable and using logistic regression with median hemoglobin level as the reference. Logistic regression was also performed with any incident decline in hemoglobin levels as the dependent variable. Results MetS was diagnosed in 263 (25%) participants. At baseline, MetS was associated with higher hemoglobin levels (B = 0.18, 95% confidence interval (CI) = 0.03-0.33, P =.02) and with hemoglobin levels above the median value (odds ratio (OR) = 1.65, 95% CI = 1.17-2.32, P =.004) after adjusting. After 6 years, MetS was associated with lower adjusted probability of lower hemoglobin levels (OR = 0.34, 95% CI = 0.15-0.79, P =.012) but only in the oldest tertile of participants. Conclusion MetS is associated with higher hemoglobin levels in older subjects and with lower probability of hemoglobin loss over 6 years in those in the oldest age group. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Napoli N.,Biomedical University of Rome | Napoli N.,Washington University in St. Louis | Pedone C.,Biomedical University of Rome | Pozzilli P.,Biomedical University of Rome | And 4 more authors.
Bone | Year: 2011

Introduction: Ghrelin is a stomach secreted hormone, believed to play an important role in energy balance and in food intake. Experimental studies have shown a positive effect of ghrelin on bone metabolism, but both in vivo and clinical findings have been contradictory. We aimed to investigate the effect of ghrelin on volumetric BMD in a large cohort of elderly subjects. Methods: We have studied 401 women (mean age 75.1. years, range 65-94) and 306 men (mean age 73.9. years, range 65-94) from the InChianti study, which included measurements of BMD using quantitative CT of the tibia and of body composition using bio impedancemetry. Serum ghrelin was measured using ELISA. We excluded participants with diabetes, hyperthyroidism, using hormone replacement or glucocorticoid therapy. We evaluated the correlation of ghrelin with total, trabecular, and cortical BMD using Pearson's coefficient, and linear regression models to estimate the association between ghrelin and BMD controlling for potential confounders. Results: In women, after correction for potential confounders, ghrelin was associated with trabecular BMD (β= 7.08, P < 0.02), but not with total or cortical BMD. In men, adjusted multivariable models showed a nearly significant association between serum ghrelin and trabecular BMD (β= 4.99, P = 0.069) and no association with either cortical or total BMD. Conclusions: Serum ghrelin is positively correlated with trabecular BMD in a cohort of elderly healthy Italian women. The fact that trabecular is more metabolically active than cortical bone and the larger number of females might explain this selective association. © 2011 Elsevier Inc.

Ferrucci L.,U.S. National Institute on Aging | Semba R.D.,Johns Hopkins University | Guralnik J.M.,Demography and Biometry Laboratory | Ershler W.B.,U.S. National Institute on Aging | And 9 more authors.
Blood | Year: 2010

In patients with overt inflammatory diseases, up-regulated hepcidin impairs iron absorption and macrophage release, causing anemia. Whether the mild proinflammatory state of aging is associated with increased hepcidin is unknown. We characterized the relationships between urinary hepcidin, iron status, anemia, and inflammation in 582 patients 65 years or older participating in the InCHIANTI (Invecchiare in Chianti, "Aging in the Chianti Area") study, a population-based study of aging in Tuscany, Italy. Compared with nonanemic persons, urinary hepcidin (nanograms/milligram of urinary creatinine) was significantly lower in iron deficiency and inflammation anemia compared with no anemia or other anemia types. Urinary hepcidin was positively correlated with log(ferritin) and negatively correlated with the soluble transferrin receptor/log(ferritin) ratio but not correlated with markers of inflammation: interleukin-6 (IL-6), IL-1β, tumor necrosis factor-α, and C-reactive protein (CRP). Lower iron was significantly correlated with higher IL-6 and CRP. Adjusting for confounders, IL-6 and CRP remained significantly associated with serum iron, with no evidence that such a relationship was accounted for by variability in urinary hepcidin. In conclusion, elevated proinflammatory markers were associated with anemia and low iron status, but not with higher urinary hepcidin. Future studies should test whether hepcidin production becomes up-regulated only in situations of overt inflammation. © 2010 by The American Society of Hematology.

Deshpande N.,Queen's University | Metter E.J.,U.S. National Institute on Aging | Guralnik J.,University of Maryland, Baltimore | Bandinelli S.,Geriatric Rehabilitation Unit | Ferrucci L.,U.S. National Institute on Aging
Archives of Physical Medicine and Rehabilitation | Year: 2013

Objective: To identify a standard physical performance test, which can predict 3-year incident mobility disability independent of demographics. Design: Longitudinal cohort study. Setting: Population-based middle-aged and older adult cohort assessment performed at a local geriatric clinical center. Participants: Community-living middle-aged and older persons (age, 50-85y) without baseline mobility disability (N=622). Interventions: Not applicable. Main Outcome Measures: Mobility disability was ascertained at baseline and at 3-year follow-up using an established self-report method: self-reported inability to walk a quarter mile without resting or inability to walk up a flight of stairs unsupported. Physical performance tests included self-selected usual gait speed, time required to complete 5 times sit-to-stand (5TSTS), and 400-m brisk walking. Demographic variables age, sex, height, and weight were recorded. Results: Overall, 13.5% participants reported 3-year incident mobility disability. Usual gait speed <1.2m/s, requiring >13.6 seconds to complete 5TSTS, and completing 400m at <1.19m/s walking speed were highly predictive of future mobility disability independent of demographics. Conclusions: Inability to complete 5TSTS in <13.7 seconds can be a clinically convenient guideline for monitoring and for further assessment of middle-aged and older persons, in order to prevent or delay future mobility disability.

Hicks G.E.,University of Delaware | Hicks G.E.,University of Maryland Baltimore County | Shardell M.,University of Maryland Baltimore County | Alley D.E.,University of Maryland Baltimore County | And 7 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2012

Background. Theoretical definitions of sarcopenia traditionally emphasize age-related loss of muscle strength; however, most analyses of the association between strength and mobility examine strength at a single time point. This study sought to identify sex-specific cutpoints for muscle strength and power (at one time point) and 3-year changes in strength and power that would maximize prediction of 3-year mobility decline. Methods. Longitudinal analysis of 934 adults aged ≥65 years enrolled in the Invecchiare in Chianti study was conducted. Grip strength, knee extension strength, and lower extremity power were measured at baseline and 3 years postenrollment. Mobility function (gait speed and self-reported mobility disability) was measured at 3 and 6 years postenrollment. Classification and regression tree analysis was used to predict mobility decline from Years 3 to 6. Results. Men with knee extension strength <19.2 kg and grip strength <39.0 kg had clinically meaningful declines in gait speed of. 24 m/s. Furthermore, men with power <105 W were nearly nine times more likely to develop incident mobility disability (likelihood ratio = 8.68; 95% confidence interval = 3.91, 19.44). Among women, knee extension strength <18.0 kg was associated with a minimal gait speed decline of 0.06 m/s, and women with leg power <64 W were three times more likely to develop incident mobility disability (likelihood ratio = 3.01; 95% confidence interval = 1.79, 5.08). Three-year changes in strength and power did not predict mobility decline in either sex. Conclusions. Findings suggest that strength and power measured at one time point are more predictive of mobility decline than 3-year changes and that low strength and power are particularly powerful risk factors in men. © 2011 The Author.

Volpato S.,University of Ferrara | Bianchi L.,University of Ferrara | Cherubini A.,IRCCS INRCA | Cherubini A.,University of Perugia | And 8 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2014

Background.Muscle impairment is a common condition in older people and a powerful risk factor for disability and mortality. The aim of this study was to apply the European Working Group on Sarcopenia in Older People criteria to estimate the prevalence and investigate the clinical correlates of sarcopenia, in a sample of Italian community-dwelling older people.Methods.Cross-sectional analysis of 730 participants (74% aged 65 years and older) enrolled in the InCHIANTI study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria using bioimpedance analysis for muscle mass assessment. Logistic regression analysis was used to identify the factors independently associated with sarcopenia.Results.Sarcopenia defined by the European Working Group on Sarcopenia in Older People criteria increased steeply with age (p <. 001), with 31.6% of women and 17.4% of men aged 80 years or older being affected by this condition. Higher education (odds ratio: 0.85; 95% CI: 0.74-0.98), lower insulin-like growth factor I (lowest vs highest tertile, odds ratio: 3.89; 95% CI: 1.03-14.1), and low bioavailable testosterone (odds ratio: 2.67; 95% CI: 1.31-5.44) were independently associated with the likelihood of being sarcopenic. Nutritional intake, physical activity, and level of comorbidity were not associated with sarcopenia.Conclusions.Sarcopenia identified by the European Working Group on Sarcopenia in Older People criteria is a relatively common condition in Italian octogenarians, and its prevalence increases with aging. Correlates of sarcopenia identified in this study might suggest new approaches for prevention and treatment of sarcopenia. © The Author 2013.

Chiles N.S.,University of Maryland, Baltimore | Phillips C.L.,U.S. National Institute on Aging | Volpato S.,University of Ferrara | Bandinelli S.,Geriatric Rehabilitation Unit | And 3 more authors.
Journal of Diabetes and its Complications | Year: 2014

Objective Diabetes among older adults causes many complications, including decreased lower-extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine the following: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes-physical function relationship. Research Design and Methods This study included 983 participants, age 65 years and older from the InCHIANTI study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0 to 12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cutpoints of PNF tests were used to create a neuropathy score from 0 to 5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. Results and Conclusion One hundred twenty-six (12.8%) participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (β = - 0.99; p < 0.01), decreased walking speed (β = - 0.1 m/s; p < 0.01), decreased nerve conduction velocity (β = - 1.7 m/s; p < 0.01), and increased neuropathy (β = 0.25; p < 0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF. © 2014 Elsevier Inc.

Volpato S.,University of Ferrara | Ferrucci L.,U.S. National Institute on Aging | Secchiero P.,University of Ferrara | Corallini F.,University of Ferrara | And 5 more authors.
Atherosclerosis | Year: 2011

Objective: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) exhibits biological activity on vascular cells in vitro. Rapid variation of circulating TRAIL levels occurs during acute coronary ischemia, suggesting that biological pathways involving TRAIL may be activated during ischemic heart disease. However, whether differential levels of soluble TRAIL in normal individuals are associated with adverse health outcomes has not been investigated. We tested the hypothesis that TRAIL levels predict mortality in a population based sample of community dwelling men and women. Methods: Plasma TRAIL level was measured by ELISA at baseline in 1282 adults (mean age 68 years) enrolled in the InCHIANTI study. Vital status was ascertained over the six-year follow-up. Results: In multivariable Cox regression analysis adjusted for potential confounders including prevalent cardiovascular diseases (CVD), ankle-brachial index, electrocardiogram abnormalities, and inflammatory markers, baseline TRAIL levels were inversely related to all-cause mortality (p= 0.008). In stratified analyses, the prognostic effect of TRAIL level was strong and highly significant in participants with prevalent CVD (N= 321), (lowest versus highest quartile: HR 3.1; 95% CI 1.5-6.5) while it was negligible in those free of CVD (p value for the interaction term between CVD status and TRAIL levels = 0.038). Similar findings were obtained when CVD mortality was considered as the outcome of interest. Conclusions: In older patients with CVD, low levels of TRAIL were associated with increased risk of death over a period of 6 years. Lower concentration of circulating TRAIL may be related to the clinical evolution of older adults with CVD. © 2010 Elsevier Ireland Ltd.

Bari M.D.,University of Florence | Balzi D.,Epidemiology Unit | Roberts A.T.,University of Florence | Barchielli A.,Epidemiology Unit | And 6 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2010

BackgroundPrognostic stratification of older patients with complex medical problems among those who access the emergency department (ED) may improve the effectiveness of geriatric interventions. Whether such targeting can be performed through simple administrative data is unknown.MethodsWe examined the discharge records for 10,913 patients aged 75 years or older admitted during 2005 to the ED of all public hospitals in Florence, Italy. Using information on demographics, drug treatment, previous hospital admissions, and discharge diagnoses, we developed a 1-year mortality prognostic index. The predictive validity of this index was tested in a subsample of patients independent of the subsample used for its original development. Finally, we tested whether patients stratified by the prognostic index had different mortality when admitted to a geriatrics compared with an internal medicine ward.ResultsIn the validation subsample, patients with scores of 4-6, 7-10, and 11+ compared with those with scores less than 4 had hazard ratios (95% confidence interval) for 1-year mortality of, respectively, 1.5 (1.3-1.7), 2.2 (1.3-1.7), and 3.0 (2.6-3.4). Patients in the worse prognostic stratum experienced 33% higher mortality when admitted to an internal medicine compared with a geriatrics ward, although mortality was not significantly affected by the type of ward of admission in all other risk strata.ConclusionsSimple administrative data provide prognostic information on long-term mortality in older patients hospitalized via ED. Patients with worse prognostic index scores appear to benefit from admission in a geriatrics compared with an internal medicine ward.

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