Good news and bad news: depressive symptoms decline and undertreatment increases with age in home care and institutional settings.

OBJECTIVES: Examination of prevalence of depressive symptoms among older persons in home care (HC) and complex continuing care (CCC) hospitals/units, factors associated with depressive symptoms in those settings, and rate of antidepressant use among older persons with depressive symptoms. DESIGN: Observational study using data from interRAI assessments used in normal clinical practice. Logistic regression models were used to identify factors associated with depressive symptoms in the frail elderly and treatment approaches were described. SETTINGS: Fourteen HC agencies and 134 CCC hospitals/units in Ontario, Canada. PARTICIPANTS: Older persons (N = 191,9871) aged 65 years and older, including 114,497 persons from HC and 77,490 persons from CCC. MEASUREMENT: Data were collected using Resident Assessment Instrument 2.0 (RAI 2.0) (1996-2004) in CCC and Resident Assessment Instrument for Home Care (RAI-HC) (2003-2004) in HC. RESULTS: Prevalence of depressive symptoms among older HC enrollees was lower (12.0%) than in CCC (23.6%). It decreased significantly with age in HC (to about 6% in those older than 95 years) but there were not substantial age differences in CCC. Common factors associated with depressive symptoms in both types of care were cognitive impairment, instability of health, daily pain, disability in activities of daily living; however, advanced age lost its protective effect in CCC. Less than half of the persons in HC and CCC with depressive symptoms were treated with antidepressants and their use decreased with age. CONCLUSIONS: Undertreatment of depressive symptoms among older persons remains a serious problem. Learning more about factors associated with depressive symptoms among the oldest old might improve detection and treatment of depression.

Polish Centenarians Programme. Multidisciplinary studies of successful ageing: aims, methods, and preliminary results.

Studies of centenarians as a model of successful ageing may help identify various environmental, social, psychological, and genetic factors supporting longevity. The scientific aims of the programme were to assess health status and environmental determinants of ageing of Polish centenarians, and to collect biological material for studying selected aspects of longevity, including genetic factors. The social aim of the project was to bring public attention to ageing of the population, as well as living conditions of elderly individuals. The intention of the authors of this paper is to present aims, scope, methods and preliminary results of the Polish Centenarians Programme, as well as to provide potential new partners for studying various aspects of longevity and ageing with the information about available materials collected during the programme. In this study, 346 subjects aged 100+ were visited, biological material was collected from 285 subjects, and 153 lymphocyte cell lines were immortalized.

[Comprehensive geriatric assessment in hospitalized patients aged 80 years and more]. / Kompleksowa ocena geriatryczna pacjentów hospitalizowanych po 80 roku zycia.

Comprehensive geriatric assessment during hospitalization, taking into account the specificity of geriatric patients could be used both in acute and long-term care. We analyzed 63 patients aged at least 80 years, born on odd days and hospitalized at the Department of Internal Medicine and Geriatrics, University Hospital, Kraków. We examined patients using Geriatric Assessment Chart which consisted of Barthel Index (used to determinate motor activity), MMSE, GDS (Geriatric Depression Scale), abbreviated Tinetti Test, Waterlow Index (used to determine the risk of pressure sore development), delirium risk factors scale, and social evaluation. The data were analyzed according to sex, marital status, level of mood, and residence status (free living or institutionalized). The mean age of 47 women and 16 men was 85.0 +/- 4.34 years. Dementia was been found in 60% of examined patients. Depression (usually mild) was encountered in 55.4%. Motor activity was moderately to severely impaired in the entire group, with high level of risk of falls and development of pressure sores. Thirteen per cent of the patients have been admitted with already developed ulcers. The results suggest the need for the comprehensive geriatric assessment both in hospitalized patients and in post-hospital phase of care.

[Hematologic parameters in Polish centenarians]. / Charakterystyka parametrów hematologicznych krwinek czerwonych u Polskich 100-latków.

We undertook this study to characterize the haematological indices in centenarian subjects who should be an excellent group to study the mechanisms of physiological aging. This study is a part of the Polish Centenarians Program co-ordinated by the International Institute of Molecular and Cell Biology in Warsaw. We examined 89 subjects aged 100 to 111 (14 males and 75 females). Mean values of all haematological parameters were within the normal range in females. In males, haemoglobin level (Hb), red blood cell count (RBC) and hematocrit (Hct) were slightly lower than WHO references (12.7 +/- 1.3 g/dl, 4.10 +/- 0.48 M/ml and 38.4 +/- 3.8%, respectively). However, anaemia was more frequent in females than in males (57.1% vs 29.1%, p < 0.05). In females with anaemia there was a tendency to decrease its severity with age. In the oldest group (aged 105-111 years) Hb and Hct had a tendency for lower values vs the youngest group (100-101 years) (10.1 +/- 1.8 g/dl vs 11.6 +/- 0.1 g/dl, p = 0.067 and 30.9 +/- 5.0% vs 35.0 +/- 0.3%, p = 0.067). Additionally, in the youngest group there were three females with severe anaemia (Hb < 9.0 g/dl) whereas in the oldest group all females with anaemia had Hb above 11.0 g/dl. In males the analysis was not undertaken because of small group of studied subjects. In conclusion, anaemia seems to be a relatively common problem in studied centenarians. Severe anaemia seems to be an eliminating factor in centenarian women.

Electrocardiogram in centenarians.

BACKGROUND: Electrocardiographic abnormalities in the very elderly have not yet been fully assessed. AIM: To evaluate ECG recordings obtained from centenarians. METHODS: ECG tracings recorded at place of residence of 35 subjects aged 100-112 years (mean 101.7 years) were examined using the Minnesota code. RESULTS: Entirely normal ECG recordings were found in 5.7% of centenarians. The most frequently encountered abnormalities included leftward QRS axis deviation (45.7%), abnormal T wave morphology (42.9%), ST segment depression (34.3%), extrasystolic beats (28.6%), left anterior haemiblock (25.7%) and first degree atrio-ventricular block (17.1%). Other, less frequently present abnormalities, included Q wave or QS complex, atrial fibrillation, right or left bundle branch block, left ventricular hypertrophy or low QRS voltage. CONCLUSIONS: In the majority of centenarians ECG shows numerous but usually benign abnormalities. Only very few centenarians have entirely normal ECG.

Pain among the oldest old in community and institutional settings.

The relationship between pain and increasing age was investigated using data from two different care settings collected on a province-wide basis in Ontario. Home care clients (HC) and complex continuing care patients (CCC) are assessed using the Resident Assessment Instrument-Home Care and Resident Assessment Instrument 2.0 instruments, respectively, as part of normal clinical practice. For this study, the sample was restricted to those aged 65 years and older and totaled 193,158 individuals. Centenarians (those 100 years of age or older) made up 0.41% (n=788) of the sample. Pain was assessed according to a previously validated pain scale embedded in both assessments that uses items on frequency and intensity. Based on 5-year age groups beginning at 65, the mean reported pain score was lower with each increment in age for men and women. Multiple logistic regression models were constructed and the odds ratios for pain in both HC and CCC groups decreased consistently in higher age groups after adjusting for disease diagnoses, cognition, functional status and health indicators. A model that included categories of analgesic medications coded based on the WHO pain ladder showed the relationship persisted after controlling for analgesia. In clinical settings, the oldest old appear to have lower levels of pain compared with the young old after adjusting for a variety of potential confounding variables.

The prevalence of cardiovascular risk factors among centenarians is low: risk factors in centenarians.

BACKGROUND: The presence of major cardiovascular risk factors was investigated in a group of centenarians. METHODS: The following risk factors: sex, smoking, overweight, diabetes, hypertension and hypercholesterolemia were analysed in 93 centenarians and compared with data obtained from 90 individuals age 40-60 years. RESULTS: Smoking, overweight and hypercholesterolemia were found statistically more often in a younger population, whereas hypertension was diagnosed more frequently in centenarians. No or one risk factor were found in 55.4% of centenarians and in 14.2% of younger subjects. CONCLUSIONS: Centenarians are characterized by a much better cardiovascular risk profile than middle-aged individuals. This indicates that longevity is related to low cardiovascular risk.

Arterial stiffness is increased in hypertensive centenarians.

BACKGROUND: The aim of our study was to assess the relationship between blood pressure and arterial stiffness in Polish centenarians. MATERIALS AND METHODS: We examined 59 centenarians with the mean age of 101.3 years. Peripheral blood pressure was estimated upon mean value of three measurements and arterial stiffness by pulse wave analysis (PWA). Pressure waveforms were recorded from the radial artery and the waveform data were then processed by SphygmoCor to produce the estimated aortic pressure waveform. All subjects were divided into the three subgroups: normotensives (< 140/ 90 mmHg), systolic hypertensives (ISH, SBP > or = 140 and DBP < 90 mmHg) and systolo-diastolic hypertensives (> or = 140/90 or treated). RESULTS: The mean values of peripheral BP for the entire group were: 149.5/76.8 mmHg for SBPP/DBPP and 136.1/ 77.8 mmHg for central SBPC/DBPC, respectively. The mean value of pulse pressures were: 72.7/58.4 mmHg for peripheral (PPP)/central (PPc). Arterial stiffness indices calculated from PWA were: 96.6%, 33.2% and 32.2% for peripheral (AIxP), central (AIxC) and central normalized for heart rate (AIxC75) augmentation indexes, respectively. The PPc was the lowest in the normotensive group (40.1 mmHg) when compared both with the ISH group (71.1 mmHg) and the systolo-diastolic group (58.1 mmHg). The lowest arterial stiffness indices (AIxp, AIxC75) calculated from PWA were found in the normotensive group: 85.4% and 28.5%, comparing with 96.1% and 33.7% in the ISH group and 104.8% and 32.9% for the systolo-diastolic group. CONCLUSIONS: In centenarians, similarly to younger subjects, those with hypertension present with arterial stiffness.

[Morphology of neutrophils in centarians]. / Morfologia granulocytów obojetnochlonnych krwi u osób stuletnich.

Recently, centenarians are involved in many research programs as they are believed to represent so-called successful aging. The aim of the study was to characterize morphological alterations observed in neutrophils from their peripheral blood. The study involved 40 centenarians (group B--34 females and 6 males) as well as 40 young healthy subjects aged 20-30 years (group K--35 females and 5 males). The study is a part of the Polish Centanarians Program coordinated by the International Institute of Molecular and Cell Biology in Warsaw. In this study, the morphometry of neutrophils from blood smear was performed in all studied subjects. Additionally, in centenarians, the relationship between observed alteration and serum level of vitamin B12 and folic acid was analyzed. Both the mean size of granulocytes and the mean value of neutrophil lobe counts were higher in group B vs group K (15.5 +/- 0.6 mm and 13.9 +/- 0.7 mm; p<0.0001 and 4.01 +/- 0.7 and 3.2 +/- 0.2; p<0.0001). Chromatin chips and toxic granules in cytoplasm were observed more often in centenarians as well (39/40 vs 20/40--p<0.0001 and 40/40 vs. 23/40--p<0.0001; respectively). In centenarians, there was no relationship between the presence of morphological alterations in granulocytes and the serum level of vitamin B12 and folic acid. In conclusion, morphological alterations were very common in studied centenarians. Detailed analysis of biochemical parameters and clinical status is necessary to answer the question about their pathomechanism.