Geriatric Unit

Firenze, Italy

Geriatric Unit

Firenze, Italy
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Patel K.,U.S. National Institute on Aging | Faulkner K.,University of Pittsburgh | Inzitari M.,Autonomous University of Barcelona | Chandler J.,Merck And Co. | And 9 more authors.
JAMA - Journal of the American Medical Association | Year: 2011

Context: Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates. Objective: To evaluate the relationship between gait speed and survival. Design, Setting, and Participants: Pooled analysis of 9 cohort studies (collected between 1986 and 2000), using individual data from 34 485 community-dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean (SD) age of 73.5 (5.9) years; 59.6%, women; and 79.8%, white; and had a mean (SD) gait speed of 0.92 (0.27) m/s. Main Outcome Measures: Survival rates and life expectancy. Results: There were 17 528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI],79.6%-88.8%)and 10-year survival ratewas59.7%(95%CI,46.5%-70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87-0.90; P<.001). Survival increased across the full range of gait speeds, with significant increments per 0.1 m/s. At age 75, predicted 10-year survival across the range of gait speeds ranged from 19% to 87% in menand from35% to 91% in women. Predicted survival based on age, sex, and gait speed was as accurate as predicted based on age, sex, use of mobility aids, and self-reported function or as age, sex, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization. Conclusion: In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults. ©2011 American Medical Association. All rights reserved.


Solfrizzi V.,University of Bari | Panza F.,Geriatric Unit | Frisardi V.,University of Bari | Seripa D.,Geriatric Unit | And 3 more authors.
Expert Review of Neurotherapeutics | Year: 2011

Preventing or postponing the onset of Alzheimer's disease (AD) and delaying or slowing its progression would lead to a consequent improvement of health status and quality of life in older age. Elevated saturated fatty acids could have negative effects on age-related cognitive decline and mild cognitive impairment (MCI). Furthermore, at present, epidemiological evidence suggests a possible association between fish consumption, monounsaturated fatty acids and polyunsaturated fatty acids (PUFA; in particular, n-3 PUFA) and a reduced risk of cognitive decline and dementia. Poorer cognitive function and an increased risk of vascular dementia (VaD) were found to be associated with a lower consumption of milk or dairy products. However, the consumption of whole-fat dairy products may be associated with cognitive decline in the elderly. Light-to-moderate alcohol use may be associated with a reduced risk of incident dementia and AD, while for VaD, cognitive decline and predementia syndromes, the current evidence is only suggestive of a protective effect. The limited epidemiological evidence available on fruit and vegetable consumption and cognition generally supports a protective role of these macronutrients against cognitive decline, dementia and AD. Only recently, higher adherence to a Mediterranean-type diet was associated with decreased cognitive decline, although the Mediterranean diet (MeDi) combines several foods, micro- and macro-nutrients already separately proposed as potential protective factors against dementia and predementia syndromes. In fact, recent prospective studies provided evidence that higher adherence to a Mediterranean-type diet could be associated with slower cognitive decline, reduced risk of progression from MCI to AD, reduced risk of AD and a decreased all-cause mortality in AD patients. These findings suggested that adherence to the MeDi may affect not only the risk of AD, but also of predementia syndromes and their progression to overt dementia. Based on the current evidence concerning these factors, no definitive dietary recommendations are possible. However, following dietary advice for lowering the risk of cardiovascular and metabolic disorders, high levels of consumption of fats from fish, vegetable oils, nonstarchy vegetables, low glycemic index fruits and a diet low in foods with added sugars and with moderate wine intake should be encouraged. Hopefully this will open new opportunities for the prevention and management of dementia and AD. © 2011 Expert Reviews Ltd.


Ferrer A.,Primary Healthcare Center El Pla I | Padros G.,LHospitalet Cornella | Formiga F.,Geriatric Unit | Formiga F.,Lhospitalet Of Llobregat | And 4 more authors.
Journal of the American Geriatrics Society | Year: 2012

Objectives To describe the prevalence of diabetes mellitus (DM) in community-dwelling 85-year-olds and to study the factors associated. Design Cross-sectional. Setting Community-based survey study of seven primary healthcare centers. Participants Three hundred twenty-eight people born in 1924 and registered with primary healthcare centers. Measurements Information on sociodemographic variables, Barthel Index (BI), Spanish version of the Mini-Mental State Examination (MEC), Mini Nutritional Assessment (MNA), Braden scale for risk of pressure ulcers, Charlson Comorbidity Index, chronic diseases, social risk, quality of life, chronic drug prescriptions, and blood tests was recorded. Participants were defined as having DM according to self-report, physician diagnosis, antidiabetic prescriptions, or plasma glucose concentration 7 mmol/L or more. A comparative analysis was performed between participants with and without DM. Results The prevalence of DM in 328 octogenarians studied was 25.9%. Logistic regression showed an association between DM and BI (odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.00-1.05, P =.007), Braden risk score (OR = 0.87, 95% CI = 0.79-0.97, P =.01), thyroid disease (OR = 0.23, 95% CI = 0.06-0.92, P =.04), chronic drug prescriptions (OR = 1.28, 95% CI = 1.15-1.42, P <.001), white-cell count (OR = 1.34, 95% CI = 1.15-1.56, P <.001), low-density lipoprotein cholesterol (LDL-C; OR = 0.63, 95% CI = 0.43-0.92, P =.02) and folic acid level (OR = 1.04, 95% CI = 1.01-1.07, P =.005). Conclusion There is a high prevalence of DM at 85 years old. The presence of DM was positively associated with disability, drug prescription, white blood cell count, and folic acid level, whereas there was an inverse relationship between DM and Braden scale score, thyroid disease, and LDL-C. The effect of morbidities on DM may require a multidisciplinary approach to manage its complexity. © 2012, The American Geriatrics Society.


Abou-Raya A.,Rheumatology Unit | Abou-Raya S.,Geriatric Unit | Khadrawi T.,Alexandria University | Helmii M.,Medical Research Institute
Journal of Rheumatology | Year: 2014

Objective. To investigate the efficacy of 6 weeks of daily low-dose oral prednisolone in improving pain, mobility, and systemic low-grade inflammation in the short term and whether the effect would be sustained at 12 weeks in older adults with moderate to severe knee osteoarthritis (OA). Methods.A total of 125 patients with primary knee OA were randomized 1:1; 63 received 7.5 mg/day of prednisolone and 62 received placebo for 6 weeks. Outcome measures included pain reduction and improvement in function scores and systemic inflammation markers. Pain was assessed using the visual analog pain scale (0-100 mm). Secondary outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index scores, patient global assessment (PGA) of the severity of knee OA, and 6-min walk distance (6MWD). Serum levels of interleukin 1 (IL-1), IL-6, tumor necrosis factor (TNF)-α, and high-sensitivity C-reactive protein (hsCRP) were measured. Results. There was a clinically relevant reduction in the intervention group compared to the placebo group for knee pain, physical function, PGA, and 6MWD at 6 weeks. The mean difference between treatment arms (95% CI) was 10.9 (4.8-18.0), p < 0.001; 9.5 (3.7-15.4), p < 0.05; 15.7 (5.3-26.1), p < 0.001; and 86.9 (29.8-144.1), p < 0.05, respectively. Further, there was a clinically relevant reduction in the serum levels of IL-1, IL-6, TNF-α, and hsCRP at 6 weeks in the intervention group when compared to the placebo group. These differences remained significant at 12 weeks. The Outcome Measures in Rheumatology Clinical Trials- Osteoarthritis Research Society International responder rate was 65% in the intervention group and 34% in the placebo group (p < 0.05). Conclusion. Low-dose oral prednisolone had both a short-term and a longer sustained effect resulting in less knee pain, better physical function, and attenuation of systemic inflammation in older patients with knee OA (Clinical Trials.gov identifier NCT01619163). The Journal of Rheumatology Copyright © 2014. All rights reserved.


Milaneschi Y.,U.S. National Institute on Aging | Shardell M.,University of Maryland Baltimore County | Maria Corsi A.,Tuscany Health Regional Agency | Vazzana R.,University of Chieti Pescara | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Context: Hypovitaminosis D and depressive symptoms are common conditions in older adults. Objective: We examined the relationship between 25-hydroxyvitamin D [25(OH)D] and depressive symptoms over a 6-yr follow-up in a sample of older adults. Design and Setting: This research is part of a population-based cohort study (InCHIANTI Study) in Tuscany, Italy. Participants: A total of 531 women and 423 men aged 65 yr and older participated. Main Outcome Measure: Serum 25(OH)D was measured at baseline. Depressive symptoms were assessed at baseline and at 3- and 6-yr follow-ups using the Center for Epidemiological Studies-Depression Scale (CES-D). Depressed mood was defined as CES-D of 16 or higher. Analyses were stratified by sex and adjusted for relevant biomarkers and variables related to sociodemographics, somatic health, and functional status. Results: Women with 25(OH)D less than 50 nmol/liter compared with those with higher levels experienced increases in CES-D scores of 2.1 (P = 0.02) and 2.2 (P = 0.04) points higher at, respectively, 3- and 6-yr follow-up. Women with low vitamin D (Vit-D) had also significantly higher risk of developing depressive mood over the follow-up (hazard ratio = 2.0; 95% confidence interval = 1.2-3.2; P = 0.005). In parallel models, men with 25(OH)D less than 50 nmol/liter compared with those with higher levels experienced increases in CES-D scores of 1.9 (P = 0.01) and 1.1 (P = 0.20) points higher at 3- and 6-yr follow-up.Menwith low Vit-Dtended to have higher risk of developing depressed mood (hazard ratio = 1.6; 95% confidence interval = 0.9 -2.8; P = 0.1). Conclusion: Our findings suggest that hypovitaminosis D is a risk factor for the development of depressive symptoms in older persons. The strength of the prospective association is higher in women than in men. Understanding the potential causal pathway between Vit- D deficiency and depression requires further research. Copyright © 2010 by The Endocrine Society.


Stenholm S.,University of Turku | Stenholm S.,Finnish National Institute for Health and Welfare | Guralnik J.M.,University of Maryland, Baltimore | Bandinelli S.,Geriatric Unit | Ferrucci L.,U.S. National Institute on Aging
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2014

Background. Lower extremity physical performance measured at one point in time is a powerful predictor of future disability. Whether information on previous lower extremity performance adds independent information to disability prediction compared to a single measure alone is unknown. Methods. Data are from community-dwelling men and women aged greater than or equal to 65 years enrolled in the Invecchiare in Chianti study who were free of mobility and activities of daily living (ADL) disability at baseline and at 3-year follow-up (n = 891). Walking speed and Short Physical Performance Battery were examined at baseline and at the 3-year follow-up (zero-time). Logistic regression analysis was used to examine the associations between physical performance measures and incident mobility and ADL disability detected at the 6-year and 9-year follow-up. Results. Walking speed and Short Physical Performance Battery score assessed at the zero-time strongly predicted development of mobility and ADL disability during the subsequent 6 years independent of walking speed/Short Physical Performance Battery score 3 years prior. Conclusions. Current lower extremity performance is a strong risk factor for subsequent mobility and ADL disability and is independent of performance 3 years prior, which has negligible independent prognostic value. © 2013 Published by Oxford University Press.


Stenholm S.,Finnish National Institute for Health and Welfare | Kronholm E.,Finnish National Institute for Health and Welfare | Bandinelli S.,Geriatric Unit | Guralnik J.M.,U.S. National Institute on Aging | Ferrucci L.,U.S. National Institute on Aging
Sleep | Year: 2011

Study Objectives: To characterize elderly persons into sleep/rest groups based on their self-reported habitual total sleeping time (TST) and habitual time in bed (TIB) and to examine the prospective association between sleep/rest behavior on physical function decline. Design: Population-based InCHIANTI study with 6 years follow-up (Tuscany, Italy). Setting: Community. Participants: Men and women aged ≥ 65 years (n = 751). Measurements and Results: At baseline, participants were categorized into 5 sleep/rest behavior groups according to their self-reported TST and TIB, computed from bedtime and wake-up time. Physical function was assessed at baseline and at 3- and 6-year follow-ups as walking speed, the Short Physical Performance Battery (SPPB), and self-reported mobility disability (ability to walk 400 m or climb one flight of stairs). Both long (≥ 9 h) TST and long TIB predicted accelerated decline in objectively measured physical performance and greater incidence in subjectively assessed mobility disability, but short (≤ 6 h) TST did not. After combining TST and TIB, long sleepers (TST and TIB ≥ 9 h) experienced the greatest decline in physical performance and had the highest risk for incident mobility disability in comparison to mid-range sleepers with 7-8 h TST and TIB. Subjective short sleepers reporting short (≤ 6 h) TST but long (≥ 9 h) TIB showed a greater decline in SPPB score and had a higher risk of incident mobility disability than true short sleepers with short (≤ 6 h) TST and TIB ≤ 8 hours. Conclusions: Extended time in bed as well as long total sleeping time is associated with greater physical function decline than mid-range or short sleep. TIB offers important additive information to the self-reported sleep duration when evaluating the consequences of sleep duration on health and functional status.


Volpato S.,University of Ferrara | Bianchi L.,University of Ferrara | Lauretani F.,University of Parma | Lauretani F.,Tuscany Regional Health Agency | And 4 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - Older people with type 2 diabetes are at high risk of mobility disability. We investigated the association of diabetes with lower-limb musclemass andmuscle quality to verify whether diabetes-related muscle impairments mediate the association between diabetes and low walking speed. RESEARCH DESIGN AND METHODS - We performed a cross-sectional analysis of 835 participants (65 years old and older) enrolled in the InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) population-based study. Total,muscular, and fat cross-sectional areas of the calf and relative muscle density were measured using peripheral quantitative computerized tomography. Indicators of muscle performance included knee-extension torque, ankle plantar flexion and dorsiflexion strength, lower-extremity muscle power, and ankle muscle quality (ratio of ankle strength to the muscle area [kilograms per centimeters squared]). Gait performance was assessed by 4- and 400-m walking speed. Diabetes was ascertained by standard American Diabetes Association criteria. RESULTS - Prevalence of diabetes was 11.4%. After adjustment for age and sex, participants with diabetes had lower muscle density, knee and ankle strength, and muscle power and worse muscle quality (all P < 0.05). Diabetic participants were also slower on both 4-m (β: -0.115 ± 0.024 m/s, P < 0.001) and 400-m (β:-0.053 ± 0.023 m/s, P < 0.05) walking tests. In multivariable linear regression models, lower-limb muscle characteristics accounted for 24.3 and 15.1% of walking speed difference comparing diabetic and nondiabetic subjects in the 4- and 400-m walks, respectively. CONCLUSIONS - In older persons, diabetes is associated with reduced muscle strength and worse muscle quality. These impairments are important contributors of walking limitations related to diabetes. © 2012 by the American Diabetes Association.


Yu B.,U.S. National Institute on Aging | Zhou C.,University of Washington | Bandinelli S.,Geriatric unit
Statistics in Medicine | Year: 2011

Receiver operating characteristic (ROC) curves are commonly used to summarize the classification accuracy of diagnostic tests. It is not uncommon in medical practice that multiple diagnostic tests are routinely performed or multiple disease markers are available for the same individuals. When the true disease status is verified by a gold standard (GS) test, a variety of methods have been proposed to combine such potential correlated tests to increase the accuracy of disease diagnosis. In this article, we propose a method of combining multiple diagnostic tests in the absence of a GS. We assume that the test values and their classification accuracies are dependent on covariates. Simulation studies are performed to examine the performance of the combination method. The proposed method is applied to data from a population-based aging study to compare the accuracy of three screening tests for kidney function and to estimate the prevalence of moderate kidney impairment. © 2011 John Wiley & Sons, Ltd.


Kaiser M.J.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bandinelli S.,Geriatric Unit | Lunenfeld B.,Bar - Ilan University
Acta Biomedica | Year: 2010

Frailty and malnutrition are both highly prevalent in the older population and have therefore become principle topics in geriatric research. Frailty is of multifactorial origin and is regarded as a fundamental risk factor for deteriorating health status and disability in older people. It is estimated that prevalence rates for frailty and pre-frailty reach as high as 27% and 51%, respectively. The role of nutritional deficiency in the development of frailty was suggested long ago, however research conducted in this area is relatively recent. The critical role of micronutrients in this context suggests the need to improve the quality of food eaten by older people - not just the quantity. This review summarizes the recent literature on the nutritional pathways to frailty with particular focus on the effect of energy, protein and micronutrients. (www.actabiomedica.it). © Mattioli 1885.

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