Reference Standard for the Measurement of Loss of Autonomy and Functional Capacities in Long-Term Care Facilities.

The vast majority of people living in long-term care facilities (LTCFs) are octogenarians (i.e., in Québec, 57.4% of the residents are age 85 or older, 26.2% are between age 75 and 84, 10.7% are between age 65 and 74, and 5.7% are below age 65 (1)), who are affected by a great loss of physical or cognitive autonomy due to illnesses and are unable to maintain their independence, safety and mobility at home. For the majority of them, their last living environment will be a LTCF. Moreover, the annual turnover in LTCFs is one-third of all residents (2) while the average length of stay is 823 days (1). Therefore the main challenges for caregivers in LTCFs are the maintenance of functional capacities and preventing patients from becoming bedridden and isolated. Measuring the level of autonomy and functional capacities is therefore a key element in the care of institutionalized people. Several validated tools are available to quantify the degree of dependence and the functional capacities of older people living in long-term care facilities. This narrative review aims to present the characteristics of the specific population living in long-term care facilities and describe the most widely used and validated tools to measure their level of autonomy and functional capacities.

Potential Efficacy of Pragmatic Exercise Program (SPRINT) during Hospitalization in Older Adults on Health Care and Physical Performance: A Pilot Study.

OBJECTIVES: Immobilization contribute to iatrogenic decline in hospitalized older adult. Implementing physical activity (PA) seems to be one of the best and easy solution. However, PA interventions are poorly integrated into usual care and those available are either non-specific, need supervision or requested human/material resources. Thus, we aimed to assess the effect of a pragmatic, unsupervised, and specific PA program (SPRINT) on health care practice and functional capacities in hospitalized older patients. DESIGN: Single arm interventional pragmatic pilot study. SETTING: Geriatric Assessment Unit (GAU). PARTICIPANTS: Of the 39 patients (> 65 years) hospitalized in a GAU and eligible, 19 agreed to participate (AP) and 20 declined (N-AP). INTERVENTION: One of the 4 PA programs, developed by our team, was allocated according to mobility profile. Individual functional capacities (i.e. balance, walking speed, functional mobility profile (PFMP)), active time (METS> 1.5: min), length of hospitalization (LOS), discharge orientation were assessed at admission and discharge of GAU. RESULTS: Baseline characteristics of the 2 groups were comparable. At discharge, the AP group improved more on walking speed (0.57 ± 0.21 vs. 0.64 ± 0.19; p = 0.013), Berg balance scale (41.8 ± 13.7 vs. 45.1 ± 9.7; p = 0.017) and PFMP (54.0 ± 7.1 vs 55.1 ± 5.5; p = 0.042) than the N-AP group. The LOS was significantly shorter in AP group compared to the N-AP group (5 vs. 36 days; p = 0.026) and more subjects in the AP group were oriented at home without health or social services (89.5 vs. 60%; p=0.065). CONCLUSION: SPRINT appears effective to counteract iatrogenic decline and decreased the LOS. Moreover, this simple pragmatic PA tool seems to improve the life trajectory and healthcare practice in aging population. Further researches are needed to confirm these promising pragmatic results.

[The Confusion Assessment Method: Transcultural adaptation of a French version]. / Adaptation transculturelle francophone de la Confusion Assessment Method.

INTRODUCTION: The Confusion Assessment Method (CAM) is a validated key tool in clinical practice and research programs to diagnose delirium and assess its severity. There is no validated French version of the CAM training manual and coding guide (Inouye SK). The aim of this study was to establish a consensual French version of the CAM and its manual. METHODS: Cross-cultural adaptation to achieve equivalence between the original version and a French adapted version of the CAM manual. RESULTS: A rigorous process was conducted including control of cultural adequacy of the tool's components, double forward and back translations, reconciliation, expert committee review (including bilingual translators with different nationalities, a linguist, highly qualified clinicians, methodologists) and pretesting. A consensual French version of the CAM was achieved. CONCLUSION: Implementation of the CAM French version in daily clinical practice will enable optimal diagnosis of delirium diagnosis and enhance communication between health professionals in French speaking countries. Validity and psychometric properties are being tested in a French multicenter cohort, opening up new perspectives for improved quality of care and research programs in French speaking countries.

Vitamin B12 Deficiency Induced by the Use of Gastric Acid Inhibitors: Calcium Supplements as a Potential Effect Modifier.

OBJECTIVE: Use of gastric acid inhibitors has emerged as a risk factor of vitamin B12 deficiency, especially in older adults. Calcium supplements could be an effect modifier of this relationship by its role in the absorption process of vitamin B12. The aim of this study is to examine whether the use of calcium supplements could be an effect modifier of the association between gastric acid inhibitors and vitamin B12 deficiency. DESIGN: Cross-sectional study based on medical chart reviews. SETTING: Geriatric Assessment Unit (GAU) of a university-affiliated hospital. PARTICIPANTS: The study included 172 patients discharged from the GAU between 2008 and 2012. MEASUREMENTS: Cases of vitamin B12 deficiency were identified as those who had received a diagnosis of vitamin B12 deficiency, and/or were receiving a treatment for vitamin B12 deficiency. Use of gastric acid inhibitors and calcium supplements at admission was determined from the pharmacist report. Associations between medications and vitamin B12 status were investigated using logistic regression models. RESULTS: Seventy-one patients (41%) had vitamin B12 deficiency. At admission, 42% were taking gastric acid inhibitors and 45% calcium supplements. After adjustment for covariates, analyses revealed that vitamin B12 deficiency was more likely among users of gastric acid inhibitors who did not concomitantly received calcium supplements [OR=3.12; P=0.01]. Conversely, no significant association was observed in patients using both, gastric acid inhibitors and calcium supplements [OR=1.30; P=0.59]. CONCLUSIONS: The present study provides the very first evidence that the use of calcium supplements could be an effect modifier of the association between gastric acid inhibitors and vitamin B12 deficiency. Failure to consider calcium supplements as an effect modifier could have led to biased risk estimates in previous published studies.

A comprehensive profile of the sociodemographic, psychosocial and health characteristics of Ontario home care clients with dementia.

INTRODUCTION: This study provides a comprehensive summary of the sociodemographic, psychosocial and health characteristics of a large population-based cohort of Ontario home care clients (aged 50 years and over) with dementia and examines the variation in these characteristics in those with co-existing neurological conditions. METHODS: Clients were assessed with the Resident Assessment Instrument-Home Care (RAI-HC) between January 2003 and December 2010. Descriptive analyses examined the distribution of these characteristics among clients with dementia relative to several comparison groups, as well as clients with other recorded neurological conditions. RESULTS: Approximately 22% of clients (n=104 802) had a diagnosis of dementia (average age 83 years, 64% female) and about one in four within this group had a co-existing neurological condition (most commonly stroke or Parkinson disease). About 43% of those with dementia did not live with their primary caregiver. Relative to several comparison groups, clients with dementia showed considerably higher levels of cognitive and functional impairment, aggression, anxiety, wandering, hallucinations/delusions, caregiver distress and a greater risk for institutionalization. Conversely, they showed a lower prevalence of several chronic conditions and lower levels of recent health service use. Depressive symptoms were relatively common in the dementia and other neurological groups. CONCLUSION: Clients with co-existing neurological conditions exhibited unique clinical profiles illustrating the need for tailored and flexible home care services and enhanced caregiver assistance programs.

TITRE: Profil complet des caractéristiques sociodémographiques, psychosociales et sanitaires des clients des soins à domicile atteints de démence en Ontario. INTRODUCTION: Cette étude fournit une synthèse des caractéristiques sociodémographiques, psychosociales et sanitaires d'une vaste cohorte représentative des clients des soins à domicile en Ontario (âgés de 50 ans ou plus) atteints de démence et elle examine les variations de ces caractéristiques chez les clients atteints de maladies neurologiques concomitantes. MÉTHODOLOGIE: Les clients ont été évalués à l'aide de l'Instrument d'évaluation des résidents ­ Soins à domicile (RAI-HC) entre janvier 2003 et décembre 2010. Les analyses descriptives fournissent la répartition de ces caractéristiques en comparant les clients atteints de démence et ceux de plusieurs autres groupes ainsi que ceux atteints d'autres maladies neurologiques documentées. RÉSULTATS: Environ 22 % des clients (n = 104 802) avaient reçu un diagnostic de démence (âge moyen de 83 ans, 64 % de femmes) et un sur quatre parmi eux était atteint d'une maladie neurologique concomitante (AVC ou maladie de Parkinson la plupart du temps). Environ 43 % des clients atteints de démence n'habitaient pas avec leur principal aidant. Par rapport aux clients des groupes de comparaison, les clients atteints de démence présentaient des taux considérablement plus élevés de déficit cognitif et fonctionnel, d'agressivité, d'anxiété, d'errance et d'hallucinations ou de délire, avaient plus souvent un aidant en détresse et couraient un plus grand risque de placement en établissement. Par contre, ils étaient moins souvent atteints de diverses maladies chroniques et étaient moins nombreux à avoir eu recours à des services de santé récemment. Les symptômes de dépression étaient relativement fréquents chez les clients atteints de démence et chez ceux atteints d'une autre maladie neurologique. CONCLUSION: Les clients atteints de maladies neurologiques concomitantes présentaient des profils cliniques bien particuliers illustrant la nécessité de personnaliser et d'assouplir les services de soins à domicile et d'améliorer les programmes de soutien pour les aidants.

Challenges in managing the diet of older adults with early-stage Alzheimer dementia: a caregiver perspective.

UNLABELLED: Caregivers (CG) of older adults suffering from Alzheimer disease (AD) are confronted by many challenges when caring for their family member; these include dietary management. OBJECTIVES: To identify difficulties in dietary management encountered by CG taking part in the Nutrition Intervention Study (NIS), and to gather their opinions on the intervention. DESIGN, SETTING AND PARTICIPANTS: Thirty-three CG of individuals with AD from the NIS intervention group were contacted. Individual interviews were conducted and analyzed using qualitative data analysis, and themes around challenges related to dietary practices experienced by CG were identified. RESULTS: Twenty-four CG were interviewed; 58% were aged 70 and older and 58% were the patient's spouse. Three major thematic categories emerged: 1. Dietary challenges and coping strategies used by CG; 2. CGs' opinion about the NIS; 3. CG interest in participating in a nutrition education support service. Changes in food habits and increasing dependency on the CG were the major themes related to dietary challenges. CONCLUSION: A better understanding of the CG's experience is essential for the development of nutrition interventions adapted to the needs of older adults with AD and their CG.

Relationship between home hazards and falling among community-dwelling seniors using home-care services.

BACKGROUND: Evidence linking home hazards to falls has not been well established. The evidence-based approach to fall-risk assessment in longitudinal studies becomes difficult because of exposures that change during follow-up. We conducted a cohort study to determine the prevalence of hazards and to resolve whether they are linked to the risk of falls among 959 seniors receiving home-care services. METHODS: A home hazards assessment was completed at entry and every six months thereafter using a standardized form. The adjusted (for a number of confounding factors) relationship between home hazards and falls was estimated using a survival model taking into account updated time-varying exposures and multiple events. Falls leading to a medical consultation were examined as a secondary outcome, hypothesized as a measure of severity. FINDINGS: Home environmental hazards were found in 91% of homes, with a mean of 3.3 risks per individual. The bathroom was the most common place for hazards. The presence of hazards was significantly associated with all falls and fall-related medical consultations, and showed relatively constant effects from one fall to another. IMPLICATIONS: The current study is innovative in its approach and useful in its contribution to the understanding of the interaction between home environmental hazards and falls. Our results indicate that inattention to changes in exposure masks the statistical association between home hazards and falls. Each environmental hazard identified in the home increases the risk of falling by about 19%. These findings support the positive findings of trials that demonstrate the effectiveness of this home hazard reduction program, particularly for at-risk people.

The evolution of nutritional status of geriatric patients without cachexia is associated with food intake in sub-acute care.

OBJECTIVES: To determine if changes in patients' nutritional status during hospitalization are related to daily energy and protein intakes when cachectic/inflammatory conditions are controlled for. DESIGN: Prospective study. SUBJECTS: A total of 32 non-cachectic patients (21 women; 65-92 y). METHODS: Nutritional status was evaluated at admission and discharge using the Protein-Energy Malnutrition Index which includes BMI, %IBW, TS, MAC, albumin, hemoglobin and lymphocyte count. Food intake was assessed 3 meals/day every other day for an average of 46.2 +/- 14.6 meals/participant. RESULTS: In all, 47% of the study sample was malnourished at admission. Nutritional status improved in 73% of patients who had been identified as malnourished and in 30 % of non-malnourished patients at admission. Total energy intake correlated with improvements in BMI, %IBW and total lymphocyte count (all p < 0.04). Improvement in PEMI score for the whole group was associated with functional status (p < 0.05). Controlling for this variable, energy (kj/kg body weight) and protein (g/kg body weight) intakes correlated positively with improvements in BMI, %IBW and MAC (Energy: partial r = 0.644, 0.624, 0.466 respectively; Protein: partial r = 0.582, 0.554, 0.433 respectively; all p < 0.05). CONCLUSIONS: Results from this study offer strong evidence that when cachectic/inflammatory conditions are controlled for, standard nutrition care is compatible with the maintenance or improvement of nutritional status during the hospital stay.

Dietary intervention in older adults with early-stage Alzheimer dementia: early lessons learned.

In older adults, an adequate diet depends on their ability to procure and prepare food and eat independently or the availability of dietary assistance when needed. Inadequate food intake or increased nutritional requirements lead to poor nutritional status, which is considered a key determinant of morbidity, increased risk of infection, and mortality in elderly individuals. Weight loss among seniors also heralds increased morbidity and mortality. Dietary behaviour disorders affecting food consumption, nutrition status and maintenance of body weight are common in older adults, and have a substantial impact on nutritional status and quality of life among older adults with Alzheimer Dementia (AD). The Nutrition Intervention Study (NIS) is ongoing. It employs a quasi-experimental pre-post intervention design in physically-well, community-dwelling early stage AD patients aged 70 y or older. To date, 34 intervention group patients and 25 control group participants have been recruited with their primary caregivers (CG) from 6 hospital-based memory and geriatric clinics in Montreal. The NIS uses clinical dietetics principles to develop and offer tailored dietary strategies to patients and their CG. This paper reports on the application of dietary intervention strategies in two intervention group participants; one was deemed successful while the other was considered unsuccessful. The report documents challenges encountered in assessing and counselling this clientele, and seeks to explain the outcome of intervention in these patients.

Risk factors for falling among community-dwelling seniors using home-care services: an extended hazards model with time-dependent covariates and multiple events.

The identification of risk factors for falls in longitudinal studies becomes difficult because of exposures that change during the follow-up and also because individual subjects may experience an event more than once. These issues have been neglected and improper statistical techniques have been used. The typical approaches have been to report the proportion of fallers or the time to first fall. Both avoid the underlying assumption of independence between events and discard pertinent data. We review the existing methods and propose a Cox hazards extension. We exemplify it in the study of potential risk factors associated with all falls in 959 seniors. Finally, we compare the results of the proposed Wei, Lin, & Weissfeld (WLW) method with those of several other techniques. Stable exposure variables measured at baseline and updated time-varying exposures include socio-demographic characteristics, BMI, nutritional risk, alcohol consumption, home hazards, gait and balance, and medications. Results demonstrate that the usual methods of analyzing risk factors for falling are inappropriate, as they produce considerable biases relative to the WLW model using time-dependent covariates. Results also show that modeling for first events may be inefficient, given that the risk of occurrence varies between falls.

Nutritional implications of patient-provider interactions in hospital settings: evidence from a within-subject assessment of mealtime exchanges and food intake in elderly patients.

OBJECTIVE: To examine the nutritional implications of the interactions taking place between patients and care providers during mealtimes in hospital settings. Specifically, we tested research propositions that the amount and nature of interpersonal behaviours exchanged between patients and providers impact patients' food intake. These propositions were derived from prior evidence of social influences on eating behaviour and a well-established framework that identifies two fundamental modalities of human interaction: striving for mastery and power (agency) and efforts to promote union with others (communion). DESIGN: In a within-subject naturalistic study, participants were observed on multiple meals (n=1477, 46.2 meals/participant on average), during which participants' and providers' agency- and communion-related behaviours and patients' protein and energy intake were recorded. Meal-level frequency and complementarity of patients' and providers' behaviours were computed to test research propositions. SETTING: Dining room of a geriatric rehabilitation unit. SUBJECTS: Thirty-two elderly patients (21 females, mean age:78.8, 95% CI: 76.4, 81.1). RESULTS: Meal-level frequency of patient-provider exchanges (P=0.016) and patients' agency-related behaviours (P=0.029), as well as mutual reciprocation of patients' and providers' communion-related behaviours (P=0.015) on a given meal were positively linked to protein intake. Higher energy intake was found during meals where patients expressed more agency-related behaviours (P=0.029). CONCLUSION: Results present evidence that the amount and nature of patient-provider interpersonal exchanges on a given meal influence the nutritional quality of food intake in hospitalized elderly. They provide insights into how to improve the design and delivery of routine care to this malnutrition-prone population. SPONSORSHIP: This study was supported by the Canadian Institutes of Health Research (Operating grant to Laurette Dubé, Doctoral Fellowship to Catherine Paquet) the Fonds de la Recherche en santé du Québec and by the Danone Institute (Doctoral fellowship to Danielle St-Arnaud McKenzie).

[Cholinesterase inhibitor therapy in long term care settings]. / Les anticholinestérasiques en soins de longue durée: analyse des pratiques actuelles à partir d'une étude observationnelle francoquébécoise.

PURPOSE: Cholinesterase Inhibitors (ChEIs) have proven efficacy in outpatients with mild to moderate Alzheimer's Disease (AD). The benefits of maintaining this treatment once patients are institutionalised remain controversial. The aim of this study was to present current therapeutic strategies regarding ChEIs use in long-term care settings (LTC). METHODS: A multicentric, retrospective, observational study was conducted on currently available ChEIs (donezepil, rivastigmine, galantamine) prescribed in LTC. Data were obtained from medical records. Judgement was based on three criteria: ChEIs indication, follow-up, and justification for maintenance of treatment. RESULTS: Among the 1,373 patients evaluated, 6% (N=81) were receiving ChEIs. They represented various stages of the disease, with cognitive and functional decline ranging from severe (18%) to very mild (10%). Among patients receiving ChEIs, 29% met neither the indication for which these drugs were approved, nor professional guidelines. Patient evaluation at entry was of high quality, with 90% of records including cognitive, functional and behavioural evaluation. Follow-up evaluations were weaker, with at least one assessment domain missing in 40% of the medical records. ChEIs treatment was maintained, although almost half of patients experienced a worsening of their clinical state. CONCLUSION: This study shows that follow-up of institutionalised patients receiving ChEIs could be improved. While treatment maintenance seems to be the rule, it should be questioned on ethical, efficacy, and economic grounds. The rationale for use and discontinuation of these therapeutic strategies in institutional settings requires urgent review.

Normal optic nerve head topography in the early stages of dementia of the Alzheimer type.

In view of the existing controversy as to whether or not the optic nerve head (ONH) is altered in Alzheimer disease, we used modern imaging technology to evaluate the ONH structure in individuals with dementia of the Alzheimer type (DAT). Real-time topographical images of the ONH were obtained with a Heidelberg retina tomograph from individuals in the early stages of DAT and age-matched controls. The various ONH parameters examined in this study did not differ significantly between DAT and age-matched subjects. These results suggest that the deficits in visual function that are known to occur in DAT are not related to ONH structural anomalies, at least in the earlier stages of the disease.

Age-related changes in the flash electroretinogram and oscillatory potentials in individuals age 75 and older.

OBJECTIVES: To evaluate whether the inner plexiform layer of the retina is altered during senescence by examining the oscillatory potentials (OPs) of the flash electroretinogram (fERG) in individuals age 75 and older. DESIGN: Cross-sectional, observational study. SETTING: A university-based center. PARTICIPANTS: Fifty-six healthy volunteers (age 20-88 years). MEASUREMENTS: fERGs and OPs were first evaluated in scotopic conditions, following pupillary dilation and dark adaptation, in young (20-32 years; n = 30) and older (75-88 years; n = 26) individuals. Electrical signals were recorded with a Dawson-Trick-Litzkow type (DTL) fiber electrode in response to blue and white flashes. Red flashes were subsequently delivered to the test eye for photopic fERG and OP recordings following a period of light adaptation. RESULTS: The amplitude of the a- and b-waves in response to blue and white flashes was significantly decreased in older people and their implicit time was increased. The latency of the a- and b-waves under photopic conditions was also prolonged with senescence, but only the amplitude of the b-wave was reduced. The amplitude of most OPs recorded under both scotopic and photopic conditions decreased with age, whereas their implicit times were prolonged. CONCLUSIONS: Our results confirm previous findings regarding the age dependency of the fERG a- and b-waves. Furthermore, we provide novel information concerning the detrimental effects of age on the OPs, indicating that the neuronal elements within the inner plexiform layer of the retina are compromised with senescence.

Changes in the retinocortical evoked potentials in subjects 75 years of age and older.

OBJECTIVE: Current trends are showing a rapid increase in the elderly population, particularly the subgroup that is 75 years of age or more. Considering the fact that several ocular diseases are more prevalent among the elderly, it is increasingly important to investigate normal visual function in this subgroup of our population. The objective of this study was to determine the effects of advanced aging on visual retinocortical function by evaluating the electrophysiological responses of the most rapidly increasing segment of the geriatric population. METHODS: Fifty-eight healthy subjects between the ages of 20--32 years (n=30) and 75--88 years (n=28) participated in this study. We recorded their pattern electroretinograms (ERGs) and cortical visual evoked potentials (VEPs) under stimulus conditions biased toward the preferential response of the magnocellular and parvocellular subdivisions of the visual system. RESULTS: Elderly subjects showed reduced ERG amplitudes relative to young participants. The amplitude of the VEPs also decreased with age, while their latency increased. The effect of senescence was most apparent under stimulus conditions combining the magnocellular and parvocellular pathway contributions and less pronounced when the stimulus conditions were biased to favor the response of either system. CONCLUSIONS: Our results demonstrate that visual retinal and cortical function deteriorates with old age. Our data further indicate that senescence has widespread effects on the visual system, altering the functioning of both the magnocellular and parvocellular visual pathways.

Anthropometric changes over 5 years in elderly Canadians by age, gender, and cognitive status.

BACKGROUND: Numerous changes in body composition occur with aging. This study reports on secondary analyses of data from a subsample of institutionalized and free-living elderly Canadians taking part in both phases of the Canadian Study of Health and Aging (CSHA-1 and CHSA-2; n = 10,263) to document and examine correlates of the evolution of anthropometric characteristics over a 5-year period. METHODS: In CSHA-1, community-dwelling (n = 1464) and institutionalized (n = 963) participants' height and weight were measured in clinics. Surviving participants were remeasured in CSHA-2; valid data were available for 487 community-dwelling respondents (66.9% of those seen in clinics in CSHA-2) and 140 institutionalized participants (46.9% of those reassessed). Body mass index (BMI = weight [kg]/height [m(2)]) was calculated. Paired t tests were used to test changes over the interval, and repeated-measures multivariate analysis of variance was used to examine the extent of differences within and across categories. RESULTS: The average weight loss between study phases in community-dwelling and institutionalized participants was approximately 2 kg (p <.001). In institutions, this was statistically significant in most stratification categories, as was the case in community-dwelling participants (by gender, age, dementia screening score, and cognitive diagnosis). Among those who were cognitively intact, the greatest weight losses occurred in participants under 90 years old and in those aged 70 to 79 years with a diagnosis of dementia (p <.01). Stature decreased more in institutionalized (2 cm) than in community-dwelling participants (1.4 cm). In institutions, this was significant among the oldest men (p <.005), while in the community there were no differences in the extent of height lost in all stratification categories. The average BMI was largely stable. CONCLUSIONS: Body weight and stature declined with aging among elderly Canadian CSHA participants, particularly in the very old and those with dementia. Such longitudinal anthropometric data are needed along with information on dietary intakes, and medical, cognitive, and functional measures to plan interventions geared to maximizing nutritional and overall health in the elderly population, whatever their cognitive status.

Age-related topographical changes in the normal human optic nerve head measured by scanning laser tomography.

PURPOSE: This study was designed to investigate the effects of advanced aging on the optic nerve head (ONH) structure and retinal nerve fiber layer (RNFL) thickness in the eldest segment of our population. METHODS: Twenty-seven healthy elderly subjects between 75 and 88 years of age (average, 80.1 +/- 0.83 years) and 30 healthy younger subjects between 20 and 32 years of age (average, 23.1 +/- 0.50 years) were recruited for a cross-sectional comparison between ONH morphology and RNFL thickness as measured by scanning laser tomography. The ONH disc, cup, and rim areas; cup-to-disc ratio; and the mean thickness of the RNFL were quantified. RESULTS: The cup and disc areas as well as the cup-to-disc area ratio increased with age, whereas the RNFL thickness decreased during the course of normal senescence. CONCLUSIONS: Any diagnoses of ocular pathology in the elderly must differentiate the effects of normal aging on the ONH topography and RNFL thickness. To that effect, the present study provides a clinical profile of ocular structures that extend into the oldest geriatric age group.

Weight change, nutritional risk and its determinants among cognitively intact and demented elderly Canadians.

Nutritional risk and its predictors were assessed by evaluating longitudinal changes in body weight using data collected from elderly community-dwelling and institutionalized Canadians who participated in both phases of the Canadian Study of Health and Aging, CSHA (n = 10,263). Change in body weight (% initial weight) was examined over a 5-year interval in 584 community and 237 institutionalized participants, and its predictors tested in multiple and logistic regression analyses. Average weight at CSHA-2 was 97% of initial weight at CSHA-1. Values were lower in those over 90 years and the demented. Increasing frailty in a 7-point scale (beta = -1.23, p = 0.04) predicted weight loss in institutional participants, as did difficulty in eating unaided (beta = 4.24, p < 0.001) and reported loss of interest in life (beta = 2.22, p < 0.001) among community subjects. Some 16% in institutions and 9% in the community were at moderate/severe nutritional risk, disproportionately represented by the oldest subjects and the demented. These analyses support the importance of assessing dietary intakes, anthropometrics, well-being and environmental predictors of aging in the elderly.

An evaluation of the retinal nerve fiber layer thickness by scanning laser polarimetry in individuals with dementia of the Alzheimer type.

PURPOSE: To determine, using scanning laser polarimetry, whether or not the retinal nerve fiber layer (RNFL) is altered in dementia of the Alzheimer type (DAT). METHODS: Thirty individuals with mild to moderate DAT and 30 healthy age-matched controls participated in the study. Fundus images were acquired with a Nerve Fiber Analyzer. RNFL thickness measurements were obtained under an ellipse located 1.75 disc diameter from the optic nerve head (ONH) center. RESULTS: No differences in RNFL thickness were observed between DAT and healthy subjects. The regional distribution of RNFL thickness was similar between the two test groups, with the RNFL being thickest in the superior and inferior retinal segments relative to the nasal and temporal regions. CONCLUSIONS: Our data indicate that the RNFL is not altered in DAT, at least in the earlier stages of the disease.