Personal dignity in people with early-stage dementia: A longitudinal study.

BACKGROUND: A psychosocial problem faced by people with early-stage dementia (PwESD) is the perception of threats to personal dignity. Insights into its dynamics are important for understanding how it changes as dementia advances and to develop suitable interventions. However, longitudinal studies on this change in PwESD are lacking. AIMS: To determine how perceptions of dignity and selected clinical and social factors change over 1 year in home-dwelling PwESD and the predictors associated with changes in perceptions of dignity over 1 year. RESEARCH DESIGN AND METHODS: A longitudinal study was conducted. The sample included 258 home-dwelling Czech PwESD. Data were collected using the Patient Dignity Inventory (PDI-CZ), Mini-Mental State Examination, Bristol Activities of Daily Living Scale, Geriatric Depression Scale and items related to social involvement. Questionnaires were completed by the PwESD at baseline and after 1 year. ETHICAL CONSIDERATIONS: The study was approved by the ethics committee and informed consent was provided by the participants. RESULTS: People with Early-Stage Dementia rated the threat to dignity as mild and the ratings did not change significantly after 1 year. Cognitive function, self-sufficiency, vision, and hearing worsened, and more PwESD lived with others rather than with a partner after 1 year. Worsened depression was the only predictor of change in perceived personal dignity after 1 year, both overall and in each of the PDI-CZ domains. Predictors of self-sufficiency and pain affected only some PDI-CZ domains. CONCLUSIONS: Perceptions of threat to dignity were mild in PwESD after 1 year, although worsened clinical factors represented a potential threat to dignity. Our findings lead us to hypothesise that perceived threats to personal dignity are not directly influenced by health condition, but rather by the social context.

Psychometric Validation of the Czech Version of the Quality of Life - Alzheimer's Disease Scale in Patients with Early-Stage Dementia.

BACKGROUND/AIMS: The aim of this study was to perform a psychometric validation of the Czech version of the Quality of Life - Alzheimer's Disease scale (QoL-AD) for patients with early-stage dementia. METHODS: The sample included 212 patient-proxy pairs. For convergent validity, the Czech version of the Bristol Activities of Daily Living Scale (BADLS-CZ), the Short Physical Performance Battery (SPPB), and the Geriatric Depression Scale (GDS) were used. RESULTS: The reliability of the QoL-AD for patients and caregivers was good (Cronbach's α = 0.85, ICC = 0.25-0.54). A positive correlation existed between the QoL-AD and the SPPB, and negative correlations existed between the QoL-AD and the BADLS-CZ as well as between the QoL-AD and the GDS. Factor analysis resulted in a three-factor solution (physical and mental health, family life, and social security). CONCLUSION: The Czech version of the QoL-AD has good psychometric properties in compliance with international recommendations.

Statin therapy in elderly patients.

Cardiovascular events occur most frequently in patients at higher age groups. The elderly suffer not only more advanced and complex changes of cardiovascular system but, also, other chronic conditions. Moreover, compared to middle-age, different therapeutic response is often observed due to changes of pharmaco-kinetics and -dynamics; these patients use other medications, which may trigger drug interactions. The situation is further complicated by non-adherence related to frequent cognitive impairment. On one hand the elderly enjoy the greatest absolute benefit from adequate cardiovascular treatment while on the other they might be more susceptible to adverse reactions. In spite of the fact statins represent preventative medications, they must be indicated cautiously taken into consideration comorbidities, frailty and disability occurring in advanced age. Frail and disabled patients have greater risk of statin adverse effects, however, even these patients have lower mortality rates while being on statins. In seniors with life expectancy exceeding 5 years statins, when indicated, bring unambiguously proven benefit and should be considered high-priority medications. Key words: atherosclerosis - cardiovascular disease - dyslipidemia - elderly - frailty - management - statins.

The impact of combinations of non-steroidal anti-inflammatory drugs and anti-hypertensive agents on blood pressure.

Nowadays NSAIDs are the most frequently used groups of drugs, especially because of their availability. Their consumption is high among older people, who are much more sensitive to the side effects, and who are often also taking other drugs which can interact with them. Moreover, the majority of the older population is suffering from hypertension. This could well explain the commonly encountered experience of drug interaction between NSAIDs and antihypertensive drugs, which is very common in clinical practice. The severity of this drug interaction is classified as class C, with a recommendation to monitor therapy. However, even a minor long-term increase in blood pressure can significantly increase the risk of cardiovascular mortality, while mortality rates can possibly be reduced by sufficiently effective treatment of hypertension. Therefore, in clinical practice, this type of interaction should not be overlooked as a major cause of failure of hypertension treatment in older patients, as well in many cases in general. The present article focusses on the mechanism and the degree of influence on the blood pressure of particular types of antihypertensive agents used in combination with NSAID. Not all groups of antihypertensive drugs are affected to the same degree; some are more affected, and others, such as calcium channel blockers, are not affected at all. Similarly, not every NSAID increases blood pressure. Many studies, some of which are analyzed in this article, present evidence of the degree of the influence NSAIDs have on blood pressure.

Biogerontology in the Czech Republic.

Authors provide results of their review of research in the field of biogerontology. Despite the fact that the term "biogerontology" is not commonly used in Czech scientific practice, there have been many research efforts in this field. Up to present, the Czech research teams have focused on the theoretical and biological models of ageing, its immunological aspects, the risk factors of unsuccessfull human ageing, and also metabolic and nutritional factors. Many research teams are dealing with the mechanisms of the neurodegeneration. The authors conclude that better coordination and systematic funding of research in gerontology is needed because of the actual demographic challenges.

Effect of the Exercise Dance for Seniors (EXDASE) program on lower-body functioning among institutionalized older adults.

OBJECTIVE: The authors conducted a randomized control trial to examine the effect of the Exercise Dance for Seniors (EXDASE) program on lower-body functioning among older individuals from residential care facilities in the Czech Republic. METHOD: Participants were randomly assigned into an experimental or control group. The experimental group completed a 3-month EXDASE program. Lower-body functioning was assessed using four performance-based measures. A 2 (group) x 2 (test) general linear model for repeated measures was used to explore whether differences in performance could be attributed to the intervention. RESULTS: The authors found Group x Test interactions for the chair stand test, F(1, 50) = 14.37, p < .001, the 2-minute step test, F(1, 50) = 7.33, p = .009, the chair sit-and-reach test, F(1, 50) = 5.28, p = .026, and the timed up-and-go test, F (1, 44) = 6.59, p = .014, indicating that the experimental group outperformed the control group from pretest to posttest. DISCUSSION: A relatively simple dance-based exercise can support lower-body functioning in previously sedentary, frail older adults.

A changed view of serum prealbumin in the elderly: prealbumin values influenced by concomitant inflammation.

AIMS: We are currently witnessing changes in views on the evaluation of serum proteins. A decrease may signal not only malnutrition. It may also be an indicator of simultaneously occurring inflammatory disease. Prealbumin, due to its short half-life, is a suitable indicator of changes in protein-energy balance, but its levels show, as with other serum proteins, a decrease in the case of inflammation too. The present study aimed to determine the prealbumin values of hospitalized geriatric patients and how they are affected by inflammatory disease. METHODS: In 101 patients aged over 80 years, the relationships were compared between prealbumin and C-reactive protein in the whole group and then in the subgroups with normal and increased C-reactive protein. RESULTS: In 67.33 % of hospitalized geriatric patients prealbumin was below the limit of the norm. A statistically highly significant dependence (p < 0.001) was demonstrated between a decrease in prealbumin and an increase in C-reactive protein in the whole group. In the subgroup with normal C-reactive protein, no statistically significant decrease in prealbumin was demonstrated, whereas in the subgroup with increased C-reactive protein a significant decrease in prealbumin (p < 0.001 for the whole group, p < 0.01 men, p < 0.05 women) was found. CONCLUSIONS: The study demonstrated subnormal mean initial values of prealbumin and a highly statistically significant negative correlation between a decrease in prealbumin and an increase in C-reactive protein in the whole group. We confirm that in inflammation there is a statistically significant decrease in serum concentration of prealbumin.

Present state of evaluating malnutrition in the elderly - analysing indicators.

OBJECTIVES: Malnutrition in old age is a significant problem. The study presents a survey of the basic methods used in the diagnosis of malnutrition in the elderly such as nutritional anamnesis, anthropometrical, laboratory a functional examinations and indicating specific differences as compared with a younger population. METHODS: We conducted a search of Czech and foreign literature (using PubMed, Medline) focused on diagnostic methods and examinations of nutritional markers especially by geriatric patients published from 1994 to 2006. RESULTS AND CONCLUSIONS: The examinations we presented are simple, non-invasive methods, which can we use especially for out-patient monitoring of geriatric patients to recognize nutrition disorders. Timely diagnosis of malnutrition in the elderly can prevent patients from worsing self-sufficiency and quality of life of the seniors, increasing the risk of institutionalisation, prolonging hospitalisations due to increased rates of complications and increasing the treatment costs and mortality of geriatric patients.

Fluorimetric determination of the levels of urinary neopterin and serum thiobarbituric acid reactive substances in the nonagenarians.

Twelve self-sustaining nonagenarians, 10 women and two men, aged 94+/-3 years, and eight institutionalised nonagenarians, eight women, aged 91+/-1 year as well as 11 control subjects, seven women and four men, aged 84+/-5 years entered the study. Urinary neopterin, an indicator of systemic immune activation, and serum thiobarbituric acid reactive substances (TBARS), a marker of lipoperoxidation, were determined initially, and collection of the blood and urine samples was repeated at 3-month interval. Neopterin was measured in the urine specimens by reversed-phase high performance liquid chromatography. A C(18) reversed-phase column 3.3x150 mm, 5 mum-diameter packing Separon SGX was used. Potassium phosphate buffer (15 mmol l(-1), pH 6.4) at flow rate of 0.8 ml min(-1) was used as mobile phase. After centrifugation (5 min, 1300xg) and diluting 100 mul of urine specimens with 1.0 ml of mobile phase containing 2 g of disodium-EDTA per litre, a 20 mul sample was injected on a column. Neopterin was identified by its native fluorescence (353 nm excitation, 438 nm emission). Creatinine was determined by Jaffé kinetic reaction after dilution of sample 1:50 (v/v). The concentration of neopterin in urine was expressed as neopterin/creatinine ratio (mumol mol(-1) creatinine). TBARS were determined spectrofluorometrically using LS-5 spectrofluorimeter (excitation wavelength 528 nm, emission wavelength 558 nm) after extraction with n-butanol treatment with thiobarbituric acid. The significance of differences between nonagenarians and control group was examined by ANOVA-Kruskal-Wallis tests, using statistical software NCSS 6.0.21 (Kaysville, UT, 1996). The decision on significance was based on P=0.05. Urinary neopterin was significantly higher in institutionalised compared to self-sustaining subjects and controls (625+/-565 vs. 203+/-63 mumol mol(-1) creatinine, and 198+/-128 mumol mol(-1) creatinine, respectively, P=0.006). The serum TBARS were higher in both groups of nonagenarians (3.23+/-1.16 mumol l(-1) and 2.69+/-0.39 vs. 2.12+/-0.83 mumol l(-1) for the self-sustaining, institutionalised and controls, respectively, P=0.023). We conclude that the fluorimetric determinations of urinary neopterin and serum TBARS can be useful for the monitoring health status in the elderly patients.