Muscle Quality Is Associated with History of Falls in Octogenarians.

OBJECTIVES: The aim of this study was to compare muscle quality (MQ) between octogenarians classified as non-fallers, fallers and recurrent fallers and identify confounding intrinsic and extrensic factors that impact likelihood for falls. DESIGN: This observational, descriptive, cross-sectional study included older adults (N=220) aged 80 years or older. MEASUREMENTS: The Short Physical Performance Battery (SPPB) was used to evaluate physical function and MQ was calculated using the ratio of grip strength to arm muscle mass (in kilograms) quantified by DXA. Variables related to sociodemographic, clinical, cognitive function, and falls were evaluated using a questionnaire and symptoms of depression were evaluated by the Geriatric Depression Scale (GDS). A Kruskal-Wallis H test was used to verify differences between groups. Binomial logistic regression was performed to determine the impact of age, depression, polypharmacy, balance, MQ, and sex on participants having more than four falls in their history. RESULTS: Increasing MQ was associated with reduced likelihood of more than four falls in their history. Non-fallers were statistically younger (p = 0.012) and took more medications (p = 0.023) than recurrent fallers. Recurrent fallers had lower MQ when compared with fallers (p = 0.007) and non-fallers (p = 0.001) and had a lower GDS score when compared with fallers (p = 0.022). Finally, fallers presented lower scores for balance when compared to non-fallers (p = 0.013). CONCLUSION: A higher MQ is associated with a reduction in the likelihood falls in octogenarians. Therefore, it may be advantageous for clinicians to evaluate MQ when the screening of the risk of falls in older adults.

Age, Period, and Cohort Effects on Activities of Daily Living, Physical Performance, and Cognitive Functioning Impairment Among the Oldest-Old in China.

BACKGROUND: The aim of this study was to examine the trends in impairment regarding activities of daily living (ADL), physical performance, and cognitive function among the oldest-old (those aged 80 and older) in China between 1998 and 2014. METHODS: We used data on 34,297 oldest-old individuals from the seven waves of the Chinese Longitudinal Healthy Longevity Study. We estimated age, period, and cohort effects on the prevalence of self-reported ADL impairment, tested physical performance and cognitive function impairment using the age-period-cohort model. RESULTS: Regarding age, the prevalence of ADL, physical performance, and cognitive function impairment were highest in the centenarians, but they did not increase with age in this population. Among the literate subgroup, the prevalence of cognitive impairment increased more rapidly with age than that in the illiterate subgroup. Regarding period, the prevalence of self-reported and tested physical impairment slowly increased between 1998 and 2014, but cognitive impairment remained stable. Regarding cohort, ADL impairment continuously decreased. However, physical and cognitive impairment remained stable after a brief decline in the early birth cohorts. CONCLUSIONS: The results suggest that the age effect is still the most obvious effect regarding several types of functional impairment. The likelihood of a younger person experiencing functional impairment may not change significantly, but ADL is likely to be amenable to improvement resulting from improved medical and social care. Therefore, increased care for the oldest-old may considerably improve their quality of life, particularly regarding their basic ADL.

Neurologic examination in the elderly.

Clinical evaluation of neurologic disorders in the elderly requires seeking a thorough history and performing an age-appropriate neurologic examination with special attention to changes that occur with normal aging. The history should be obtained from the patient as well as collateral sources close to the patient to ensure accuracy and should include contextual elements such as medical history, social, economic, and psychological background, as well as an assessment of current functional state beyond activities of daily living. The safety of the patient, including the presence of physical, psychological, and financial threats, should be addressed during the interview. The neurological examination in older adults may need to be modified to circumvent disabilities such as hearing and visual impairment. Some elements of the neurological examination are expected to be affected by the process of aging, including pupillary reactivity, presbyopia, difficulty with ocular pursuit and up-gaze, reduced or absent distal reflexes, slower motor speed, and reduced ability to tandem walk, among others. In addition to a screening neurological assessment, evaluation of older adults with a particular complaint may require additional interview queries and examination manoeuvres. Common symptoms in the elderly include cognitive difficulties, balance and gait disorders, tremors, and neuropathy. A specialized approach to patients with cognitive difficulties must include assessment of each cognitive domain, including attention, executive function, learning and memory, perceptual-motor function, and social cognition. Balance and gait are essential parts of the neurological examination, and in patients with a history of falls or mobility issues, should become a central part of the evaluation. In patient with tremors, careful observation of the tremor quality (amplitude, frequency, and alleviating/exacerbating factors such as rest, movement, and posture) can aid diagnosis. Evaluation of neuropathy includes determining modality (numbness, tingling, pain, and weakness) and the distribution of symptoms in order to localize the site of nerve injury, which can be supplemented with nerve conduction studies/electromyography, to guide further diagnostic workup and treatment. A combination of detailed history and examination often will suggest a likely underlying neurodegenerative disorder and guide further diagnostic workup to establish a specific diagnosis.

Relationship between oral stereognostic ability and dietary intake in older Japanese adults with complete dentures.

PURPOSE: Oral stereognostic ability (OSA) is a useful indicator of oral perception to recognize food characteristics during mastication. Previous studies have shown associations between dietary intake and oral health status, such as taste perception. However, the effect of oral sensory ability on dietary intake is unclear. The purpose of this study was to investigate the association between oral sensory ability and dietary intake in older Japanese complete denture wearers. METHODS: This cross-sectional study included 164 participants aged 69-71 or 79-81years old, wearing both maxillary and mandibular complete dentures. OSA test was used to evaluate oral tactile perception. Diet during the preceding month was assessed using a self-administered diet history questionnaire. Multivariable linear regression analysis was conducted to assess the association between OSA score and food and nutrient intake after adjusting for age, sex, socioeconomic factors, and occlusal force. RESULTS: The bivariate analysis showed that OSA score was significantly and positively correlated with intake of green and yellow vegetables and negatively correlated with intake of cereals among examined foods. OSA score was also positively correlated with intake of vitamins A, B2, and C and α-tocopherol (as a substitute for vitamin E) among examined nutrients. After adjusting for age, sex, socioeconomic factors, and occlusal force, OSA score remained significantly associated with intake of green and yellow vegetables and α-tocopherol. CONCLUSIONS: OSA was significantly associated with intake of green and yellow vegetables in older complete denture wearers.

Estilo de vida associado a níveis séricos de HDL colesterol em longevos: Estudo AMPAL / Estilo de vida asociado a niveles séricos de HDL colesterol en longevos: Estudio AMPAL / Lifestyle associated to serum levels of HDL cholesterol in oldest-old people: the AMPAL Study

O artigo buscou identificar os determinantes significativamente relacionados a níveis séricos de HDL colesterol em longevos (≥ 85 anos) de um município do Sul do Brasil. O aumento da frequência semanal no consumo de refrigerante, em um dia, resultou na diminuição de 2mg/dL no HDL colesterol. Ser homem, ter circunferência da cintura aumentada, possuir níveis séricos elevados de triglicerídeos e consumir frequentemente refrigerante, independentemente do tipo, foram fatores inversamente associados a níveis de HDL colesterol.

This article intended to identify significantly determinants related to HDL cholesterol serum levels in oldest-old (≥ 85 years) in a South city of Brazil. It could be expected the declining of 2mg/dL HDL cholesterol value by each one day of increasing on the weekly frequency refrigerant consumption. The HDL cholesterol levels were inversely associated with being man, to have higher waist circumference, serum triglyceride levels and frequency refrigerant consumption, regardless the kind of it.

El articulo deseo identificar determinantes significativamente relacionados con los niveles séricos de colesterol HDL en la longevidad (≥ 85 años) de un municipio del sur de Brasil. El aumento de la frecuencia semanal en el consumo de refrigerante en un día, resultaba en la disminución de 2mg/dL HDL. Ser hombre, tener circunferencia de la cintura aumentada, poseer niveles séricos elevados de triglicéridos y consumir frecuentemente refrigerante, independientemente del tipo, fueron factores inversamente asociados a niveles de HDL.

Serum Cardiac Troponin T Levels in Asymptomatic Elderly Nursing Home Residents.

BACKGROUND: The definition of myocardial infarction relies on elevated troponin levels. However, elevated levels of high sensitive cardiac troponin (hs-cTnT) assays have been reported in elderly patients without acute myocardial infarction. We sought to determine whether elevated hs-cTnT levels have a prognostic value in stable elderly subjects without any acute illness. METHODS: The study cohort included residents of a nursing home who were asymptomatic without any acute medical problem. Serum hs-cTnT levels were measured, and participants were divided into high and low hs-cTnT groups. We measured hs-cTnT levels of young healthy volunteers as well and compared them with hs-cTnT levels of those nursing home residents. RESULTS: Fifty-seven nursing home residents and 14 young volunteers were included in the study. The average age of nursing home residents was 83 ± 14 years, compared with 37 ± 3 years of the volunteers. Levels of hs-cTnT were significantly higher in the elderly compared with the volunteers (0.02 ± 0.016 ng/mL vs 0.005 ± 0.0003 ng/mL; P < .001); accordingly, we chose a cutoff of 0.02 ng/mL hs-cTnT and divided the 57 patients into 2 subgroups for further evaluation. After adjustment for age, gender, and glomerular filtration rate, the hs-cTnT was still an independent predictor of 1-year mortality (relative risk 2.04 [95% conficence interval, 2.009-29.45], P = .003). CONCLUSIONS: Mild elevations of hs-cTnT levels are common in elderly patients, and hs-cTnT level is an independent marker of mortality risk in this population. For patients older than 70 years, a different hs-cTnT cutoff is required (eg, higher than 0.014 ng/mL).

Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study.

BACKGROUND: The oldest-old (those aged ≥80 years) are the most rapidly growing age group globally, and are most in need of health care and assistance. We aimed to assess changes in mortality, disability in activities of daily living, and physical and cognitive functioning among oldest-old individuals between 1998 and 2008. METHODS: We used data from the Chinese Longitudinal Healthy Longevity Study. Three pairs of cohorts aged 80-89 years, 90-99 years, and 100-105 years (in total, 19 528 oldest-old participants) were examined; the two cohorts in each pair were born 10 years apart, with the same age at the time of the assessment in the 1998 and 2008 surveys. Four health outcomes were investigated: annual death rate, Activities of Daily Living (ADL), physical performance in three tests and cognitive function measured by Mini-Mental State Examination (MMSE). We used different tests and multivariate regression analyses to examine the cohort differences. FINDINGS: Controlling for various confounding factors, we noted that annual mortality among oldest-old individuals was substantially reduced between 0·2% and 1·3% in 1998-2008 compared with individuals of the same age born 10 years previously, and that disability according to activities of daily living had significantly reduced annually between 0·8% and 2·8%. However, cognitive impairment in the later cohorts increased annually between 0·7% and 2·2% and objective physical performance capacity (standing up from a chair, picking up a book from the floor, and turning around 360°) decreased anually between 0·4% and 3·8%. We also noted that female mortality was substantially lower than male mortality among the oldest-old, but that women's functional capacities in activities of daily living, cognition, and physical performance were worse than their male counterparts. INTERPRETATION: Advances in medications, lifestyle, and socioeconomics might compress activities of daily living disability, that is, benefits of success, but lifespan extension might expand disability of physical and cognitive functioning as more frail, elderly individuals survive with health problems, that is, costs of success. FUNDING: National Natural Science Foundation of China, National Institute on Aging/National Institutes of Health, United Nations Funds for Population Activities.

Centenarian athletes: Examples of ultimate human performance?

BACKGROUND: some centenarians are engaged in regular physical activity and sometimes in sporting events. OBJECTIVE: we aimed to identify world records of centenarian athletes in several sports and determine which represented the best performance when compared to all-age world records, all disciplines taken together. METHODS: all of the best performances achieved by centenarians were identified and compared in three disciplines: athletics, swimming and cycling. The performances were considered as an average of the respective speeds, except for jumping and throwing events for which the maximum distances performed were considered. Within each discipline, the decline in performance of centenarian athletes was expressed as a percentage of the world record for that discipline. In total, 60 performances of centenarian athletes were found. These performances belong to 19 individuals: 10 in athletics, 8 in swimming and 1 in cycling. RESULTS: the centenarian world record performed by Robert Marchand in one hour track cycling appears to be the best performance (-50.6% compared with the all-age world record in this discipline) achieved by a centenarian. CONCLUSIONS: although the physiological characteristics of Robert Marchand are certainly exceptional, his remarkable performance could also be due to the lower age-related decline for cycling performances compared with running and swimming. Our observations offer new perspectives on how the human body can resist the deleterious effects of ageing.

Odontoid fractures in the octogenarian: a systematic review and meta-analysis.

INTRODUCTION: Odontoid fractures (OF) are the most frequent cervical spine fracture type in the elderly, often following low-velocity falls. The rise in life expectancies has led to an increase in octogenarians suffering OF, for which the optimal treatment remains undetermined. EVIDENCE ACQUISITION: A comprehensive search was conducted (National Library of Medicine MEDLINE, Cochrane Central Register of Controlled Trials) for all articles through 03/2016. Articles were included if the study population evaluated treatment modalities in OF patients aged ≥80-years. Outcomes assessed were mortality, complications, osseous union, and fracture stability. Pooled odds ratios (OR) and 95% confidence intervals (CI) are reported. EVIDENCE SYNTHESIS: Across 22 case series/retrospective studies, attributable mortality for surgery was 5.4% (8/149) vs. 10.1% (10/99) for nonsurgery (P=0.159). Surgery patients suffered higher complications rates (38.9%, 58/149; vs. 24.5%, 26/106); OR 1.96 ([1.13-3.40], P=0.016). Osseous union was better achieved with surgery (68.5%, 37/54; vs. 43.2%, 16/37); OR 2.86 ([1.20-6.80]; P=0.016). Fracture stability was better achieved with surgery (86.0%, 49/57; vs. 63.6%, 28/44); OR 3.50 ([1.33-9.21], P=0.009). CONCLUSIONS: In general, octogenarians undergoing surgery for OF showed higher fusion and stability rates compared to nonsurgery, which may be due in part to surgical selection criteria, surgeon preference and patient comorbidities. Higher complications were observed for surgery patients, while no differences were observed for mortality. Prospective trials are greatly needed to identify the optional treatment modality and predictors of clinical outcome in octogenarians suffering OF.

[About the HbA1c in the elderly]. / À propos du dosage de l'HbA1c chez le sujet âgé.

HbA1c product of non enzymatic glycation of HbA increases in relation with the mean blood glucose level during the former 2-3 months. HbA1c levels are correlated with the development of diabetic complications and HbA1c assessment is now the gold standard for evaluation of diabetes control. HbA1c level should not be higher than 7% to avoid these complications. However, in aged peoples, the objectives of diabetes control vary according to their health status. It must be good with HbA1c lower than 7-7.5% in healthy subjects and more relax in subjects with symptoms of frailty and risks of non perceived and self corrected hypoglycemia. Under these conditions, HbA1c values lower than 8 to 9% are advised. Nevertheless, hypoglycemia episodes may occur in patients with high HbA1c and capillary glucose follow-up is necessary for detection of such complications.

Loss of occlusal support affects the decline in activities of daily living in elderly people receiving home care.

PURPOSE: This study aimed to clarify whether the absence of occlusal support would lead to a decline in the activities of daily living (ADL) in elderly people receiving home care. METHODS: The subjects of this study were 322 elderly individual aged 65 and older who were receiving home care during a one-year observation period. The subjects were divided into two groups according to the change in the total score of the Barthel Index (BI) during the prospective cohort study period (the dependent variable): the maintained/improved activities of daily living group, in which the score was unchanged or improved, and the worsened activities of daily living group, in which the score decreased. The relationship between occlusal status (the presence or absence of occlusal support) at the baseline measurement and each BI score change was evaluated in the slightly, moderately and totally dependent ADL subgroups. RESULTS: The number of subjects in the maintained/improved and the worsened ADL groups was 152 and 170, respectively. The baseline characteristics of cognitive function and occlusal support were significantly different between the maintained/improved and the worsened ADL groups (p < 0.05). Among the ADL subgroups, significantly reduced scores in mobility and toilet use were observed only in the slightly dependent group (p < 0.05). CONCLUSIONS: Our results suggest that the loss of occlusal support may be an important factor in the decline of ADL in elderly people receiving home care, especially slightly dependent people.

Assessing Upper Extremity Motion: An Innovative Method to Identify Frailty.

OBJECTIVES: To objectively identify frailty using wireless sensors and an innovative upper extremity motion assessment routine that does not rely on gait. DESIGN: Validation study. SETTING: Southwestern tertiary academic medical center, Tucson, Arizona. PARTICIPANTS: Convenience subsample of the Arizona Frailty Cohort, a community-dwelling older adults (≥65; n = 117; 50 nonfrail, 51 prefrail, 16 frail). MEASUREMENTS: Wireless sensors were attached to the upper arm and forearm with bands, and subjects performed repetitive elbow flexion for 20 seconds on each side. Information was extracted on objective slowness, weakness, exhaustion, and flexibility measures, and associations between parameters and Fried frailty categories were determined. RESULTS: Speed of elbow flexion (slowness) was 29% less in prefrail and 59% less in frail than in nonfrail controls (P < .001), power of movement (weakness) was 61% less in prefrail and 89% less frail (P < .001), and speed variation (exhaustion) was 35% more in prefrail and 272% more in frail (P < .001). Using elbow flexion parameters in regression models, sensitivity and specificity of 100% were achieved in predicting frailty and sensitivity of 87% and specificity of 95% in predicting prefrailty compared to Fried frailty category. CONCLUSION: The suggested innovative upper extremity frailty assessment method integrates low-cost sensors, and the physical assessment is easily performed in less than 1 minute. The uniqueness of the proposed technology is its applicability in older nonambulatory individuals, such as those in emergency settings. Further improvement is warrant to make it suitable for routine clinical applications.

Appropriate prescribing and important drug interactions in older adults.

Polypharmacy, specifically the overuse and misuse of medications, is associated with adverse health events, increased disability, hospitalizations, and mortality. Mechanisms through which polypharmacy may increase adverse health outcomes include decreased adherence, increased drug side effects, higher use of potentially inappropriate medications, and more frequent drug-drug interactions. This article reviews clinical problems associated with polypharmacy and presents a framework to optimize prescribing for older adults.

Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100.

BACKGROUND: Little is known about the health and functioning of individuals who become centenarians in the years prior to reaching age 100. We examined long-term trajectories of disease, disability, and cognitive function in a sample of U.S. centenarians to determine how their aging experience differs from their nonsurviving cohort counterparts, and if there is heterogeneity in the aging experience of centenarians. METHODS: Data are from the 1993-2010 waves of the nationally representative Health and Retirement Study. Among those who had the potential to become centenarians, we identified 1,045 respondents who died before reaching age 100 and 96 who survived to their 100th birthday. Respondents, or their proxies, reported on diagnosis of six major diseases (hypertension, heart disease, lung disease, stroke, cancer, and diabetes), limitations in activities of daily living, and cognitive function. RESULTS: As they age to 100, centenarians are generally healthier than nonsurviving members of their cohort, and a number of individuals who become centenarians reach 100 with no self-reported diseases or functional impairments. About 23% of centenarians reached age 100 with no major chronic disease and approximately the same number had no disability (18%). Over half (55%) reached 100 without cognitive impairment. Disease and functioning trajectories of centenarians differ by sex, education, and marital status. CONCLUSIONS: While some centenarians have poor health and functioning upon reaching age 100, others are able to achieve exceptional longevity in relatively good health and without loss of functioning. This study underscores the importance of examining variation in the growing centenarian population.

Thoracic anesthesia in the elderly.

PURPOSE OF REVIEW: The mean age of patients presenting for thoracic surgery is rising steadily, associated with an increased demand for thoracic surgical treatments by geriatric patients. With increasing age, physiologic changes and comorbidities have to be considered. Thoracic anesthesia for elderly patients requires greater specific knowledge. RECENT FINDINGS: Respiratory mechanics change progressively during aging, and the pharmacology of different drugs is also altered with increasing age. This has implications for the preoperative, intraoperative and postoperative management of elderly patients scheduled for thoracic surgery. Special focus has to be placed on preoperative evaluation, the ventilation regime and general intraoperative management. Effective postoperative pain treatment after geriatric thoracic surgery requires careful pain assessment and drug titration. SUMMARY: Considering key points of physiology and pharmacology can help to provide best possible care for the increasing number of elderly patients in thoracic surgery. Management of geriatric patients in thoracic surgery offer opportunities for anaesthetic interventions including protective ventilation, use of different anesthetics, anaesthesia monitoring, fluid management and pain therapy.

Prognostic value of the Duke treadmill score in octogenarians undergoing myocardial perfusion imaging.

OBJECTIVES/BACKGROUND: Although Duke treadmill score (DTS) is the most widely used risk stratification method in younger patients undergoing exercise treadmill test (ETT) its specific value in the elderly is not established. METHODS: 137 patients aged ≥80 years who underwent ETT myocardial perfusion imaging (MPI) were studied. DTS and MPI (including summed stress scores, SSS) related data were registered per patient and follow up was performed to document cardiac death (CD), myocardial infarction (MI) and late (>3 months) revascularization (LR). Kaplan Meir and Cox regression survival analysis were employed to determine the prognostic value of DTS in relation to MPI data for these endpoints. RESULTS: After a median follow up duration of 6.7 years 28 deaths, 7 CDs, 4 non fatal MIs and 12 LRs were observed. Incidence rates of CD/MI were significantly different only between low and high risk SSS categories (p = 0.044). Risk groups by DTS had no significant differences in survival free of CD/MI (p = 0.743) in contrast to risk groups according to SSS (p = 0.026), while both DTS and SSS based risk groups had significantly different survival free of CD/MI or LR. SSS was a significant univariate predictor of both CD/MI (HR 1.088, p = 0.019) and CD/MI or LR (HR 1.095, p < 0.001), but DTS only of the latter endpoint (HR 0.909, p = 0.003). CONCLUSIONS: In octogenarians DTS was found to be a significant predictor of the LR related endpoint but not of the hard endpoint of CD/MI, in contrast to SSS which was a powerful predictor of both soft and hard cardiac endpoints.