RÉSUMÉ
Background and Objectives: It is well established that patients with cognitive impairment are at a higher risk of falls. However, the impact of coexisting neuropsychiatric symptoms on the overall risk of falls in hospitalized geriatric individuals with and without dementia has not been extensively studied. This cross-sectional study will assess the association between neuropsychiatric symptoms and fall risk in geriatric individuals analyzed by sex. Materials and Methods: A total of 234 patients, both with and without dementia, admitted to the geriatric ward at Leszek Giec Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, Poland, between January 2019 and January 2020 were included in this study. The Neuropsychiatric Inventory-Questionnaire was used to assess the presence of neuropsychiatric symptoms. Increased fall risk was defined by Berg scores of ≤40. Results: The mean age of the study group was 80.7 ± 6.6, and women accounted for 62.8% of the study population. Apathy was the most common neuropsychiatric symptom, affecting 58.1% of patients, and it was the most common symptom among people with dementia, affecting 67.80% of patients. The receiver operating characteristics curve analysis revealed that a high fall risk was significantly associated with the total number of neuropsychiatric symptoms (≥4) and the total intensity of these symptoms (≥6). For women, high fall risk was associated with three or more neuropsychiatric symptoms and a total neuropsychiatric symptom intensity score of at least 6. For men, the association of high fall risk with the total number of NPS was not significant; a total NPS intensity score of 10 or more was associated with high fall risk. Multivariate logistic regression analysis identified associations with fall risk for hallucinations. Conclusions: Our results suggest that the presence of neuropsychiatric symptoms, particularly hallucinations is associated with an increased risk of falls in geriatric inpatients. In addition, the cumulative total of NPS and their cumulative intensity are both independently associated with an increased risk of falls. These results suggest that fall prevention strategies should include the management of neuropsychiatric symptoms in hospitalized geriatric individuals.
Sujet(s)
Dysfonctionnement cognitif , Démence , Mâle , Humains , Femelle , Sujet âgé , Patients hospitalisés , Études transversales , Dysfonctionnement cognitif/épidémiologie , Dysfonctionnement cognitif/étiologie , Dysfonctionnement cognitif/psychologie , Chutes accidentelles/prévention et contrôle , Démence/épidémiologie , Démence/étiologie , Démence/psychologie , Hallucinations , Facteurs de risqueRÉSUMÉ
INTRODUCTION: There are limited data on prevalence of dementia in centenarians and near-centenarians (C/NC), its determinants, and whether the risk of dementia continues to rise beyond 100. METHODS: Participant-level data were obtained from 18 community-based studies (N = 4427) in 11 countries that included individuals ≥95 years. A harmonization protocol was applied to cognitive and functional impairments, and a meta-analysis was performed. RESULTS: The mean age was 98.3 years (SD = 2.67); 79% were women. After adjusting for age, sex, and education, dementia prevalence was 53.2% in women and 45.5% in men, with risk continuing to increase with age. Education (OR 0.95;0.92-0.98) was protective, as was hypertension (odds ratio [OR] 0.51;0.35-0.74) in five studies. Dementia was not associated with diabetes, vision and hearing impairments, smoking, and body mass index (BMI). DISCUSSION: Among the exceptional old, dementia prevalence remains higher in the older participants. Education was protective against dementia, but other factors for dementia-free survival in C/NC remain to be understood.
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Centenaires , Cognition , Mâle , Sujet âgé de 80 ans ou plus , Humains , Femelle , Indice de masse corporelle , Niveau d'instructionRÉSUMÉ
Background: Societal aging - as a global demographic phenomenon - shows no indication of abating. As a result, the problem of age-associated disability and related long-term care is emerging as a major public health challenge. It is important that methods for identifying older adults at risk of adverse outcomes are implemented early. Methods: The study group consisted of 145 individuals, 44.1% women, who were randomized from community-dwelling 60-74-year-old adults. A comprehensive geriatric assessment was supplemented with Fried frailty phenotype evaluation and blood tests (including adhesion molecules, matrix metalloproteinases and neurotrophic factors). A follow-up by phone call was made for at least 3 years after the initial examination. Composite endpoint (CE) included falls, hospitalization, institutionalization and death. Results: Mean study group age was 66.5 ± 4.1 years () and mean number of diseases was 3.7 ± 2.2. Functional status of the subjects was good, as indicated by high Barthel Index scores of 99.1 ± 2.4, MMSE scores of 29.0 ±1.5 and no frailty case. During a three-year follow-up, 71 participants (49.0%) experienced any CE-events. The Wilcoxon-Gehan test indicates that a higher probability of three-year CE completion was associated with an age >65 years (P = 0.006), coronary artery disease (CAD) (P = 0.008), 6-Minute Walk Test <432 m (P = 0.034), serum glucose >120 mg/dL (P = 0.047), serum cortisol >10 µg/dL (P = 0.011), leptin ≥15 ng/mL (P = 0.018), P-selectin ≥23 ng/mL (P = 0.006) and GDNF ≥20 pg/mL (P = 0.004). CAD (OR = 3.64, 95% CI = 1.53-8.69, P = 0.004), educational status (OR = 0.87, 95% CI = 0.77-0.98, P = 0.022) and P-selectin levels (OR = 1.07, 95% CI = 1.02-1.13, P = 0.013) were independent measures predicting three-year CE occurrence in multivariate logistic regression analysis adjusted for clinical and functional measures, and blood tests. Conclusion: Coronary artery disease, poorer lower educational status and higher P-selectin levels were predictive of adverse outcomes in the community-dwelling healthy-aging early-old adults during three-year follow-up.
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Maladie des artères coronaires , Fragilité , Vieillissement en bonne santé , Sujet âgé , Niveau d'instruction , Femelle , Personne âgée fragile , Fragilité/épidémiologie , Évaluation gériatrique/méthodes , Humains , Vie autonome , Mâle , Sélectine P , Répartition aléatoireRÉSUMÉ
Background and Objectives: Anticholinergic drug use in the pharmacotherapy of elderly persons is common despite the increased risk of side effects. We examined the prevalence of anticholinergic drug use and total anticholinergic drug burden among patients admitted to an acute care geriatric ward in Poland. Materials and Methods: Cross-sectional study of 329 subjects hospitalized at the geriatric ward. Patient condition was assessed with a comprehensive geriatric assessment. The Anticholinergic Cognitive Burden (ACB) scale was used to estimate the total anticholinergic load. Results: Mean patient age was 79.61 ± 6.82 years. 40.73% of them were burdened with at least one anticholinergic drug. The clinically significant anticholinergic burden was observed in 13.98% of subjects. Patients with dementia, risk of falls, and severe disability had significantly higher total ACB scores compared to other groups. The receiver operating characteristics (ROC) curve revealed that the total ACB score ≥ 1 was significantly associated with dementia and the risk of falls. Total ACB score ≥ 2 was significantly associated with severe disability. Conclusions: Patients admitted to an acute care geriatric ward had an anticholinergic cognitive burden score comparable to other patient populations. We found associations at both low and elevated levels of anticholinergic burden with dementia and risk of falls. At elevated anticholinergic burden levels, we found associations with severe disability. Despite recommendations against the use of anticholinergics in older adults these medications are still commonly prescribed. Further study is necessary to define the characteristics of anticholinergic medication most closely associated with negative outcomes in elderly populations.
Sujet(s)
Antagonistes cholinergiques , Démence , Sujet âgé , Sujet âgé de 80 ans ou plus , Antagonistes cholinergiques/effets indésirables , Études transversales , Hôpitaux , Humains , Patients hospitalisésRÉSUMÉ
BACKGROUND: Simple, easy-to-perform, safe and cost-effective methods for the prediction of adverse outcomes in older adults are essential for the identification of patients who are most likely to benefit from early preventive interventions. METHODS: The study included 160 community-dwelling individuals aged 60-74 years, with 44.4% women. A comprehensive geriatric assessment was performed in all participants. Bioimpedance body composition analysis included 149 subjects. Among other tests, functional assessment included the Barthel Index of Activities of Daily Living (Barthel Index), Mini-Mental State Examination (MMSE), Timed Up and Go (TUG) and Fried frailty phenotype. Follow-up by telephone was made after at least 365 days. The composite endpoint (CE) included fall, hospitalization, institutionalization and death. RESULTS: Cohort characteristics: age 66.8±4.2 years (mean±SD), 3.81±2.23 diseases, 4.29±3.60 medications or supplements, and good functional status (MMSE 29.0±1.5, Barthel Index 98.1±8.2, prevalence of Fried frailty phenotype 2.5%). During one-year follow-up, 34 subjects (21.3%; 95% confidence interval [CI] =14.9-27.6%) experienced CE: hospitalizations (13.8%; 95% CI=8.41-19.1), falls (9.38%; 95% CI=4.86-13.9), death (0.63%; 95% CI=0-1.85) and no institutionalization. A higher probability of CE was associated with age ≥70 years (P=0.018), taking any medication or supplements (P=0.007), usual pace gait speed ≤0.8 m/s (P=0.028) and TUG >9 s (P<0.002). TUG was the only independent measure predicting one-year CE occurrence (OR=1.22, 95% CI=1.07-1.40, P=0.003) in multivariate logistic regression. However, its predictive power was poor; the area under the receiver operating characteristic curve was 0.659 (95% CI 0.551-0.766, P=0.004) and Youden's J statistic for a TUG cut-off of 9.0 s was 0.261 (sensitivity 0.618 and specificity 0.643). CONCLUSION: The TUG test was superior to frailty phenotype measures in predicting one-year incidence of a CE consisting of fall, hospitalization, institutionalization and death in a cohort of healthy-aging community-dwelling early-old adults, although its value as a stand-alone test was limited.
Sujet(s)
Vieillissement en bonne santé , Vie autonome , Équilibre postural/physiologie , Vitesse de marche , Chutes accidentelles/prévention et contrôle , Activités de la vie quotidienne , Sujet âgé , Sujet âgé de 80 ans ou plus , Études de cohortes , Femelle , Fragilité/épidémiologie , Évaluation gériatrique/méthodes , Humains , Mâle , Techniques de physiothérapie , Prévalence , Études ergonomiquesRÉSUMÉ
BACKGROUND: Demographic aging results in increased incidence of old-age disability. Frailty is a major factor contributing to old-age disability. The aim of this study was to investigate the prevalence of the frailty phenotype as defined by Fried et al and to estimate the need for associated preventative interventions in early-old community-dwelling inhabitants of the southern industrial region of Poland, as well as to investigate the defining components of the frailty phenotype. METHODS: The study group consisted of 160 individuals with an average age of 66.8 ± 4.2 years ( ± SD), 71 (44.4%) of study participants were women. The cohort was randomized out of over 843 thousand community-dwelling Upper Silesian inhabitants aged 60-74 years, who agreed to participate in this project. A comprehensive geriatric assessment (CGA), frailty phenotype test (as described by Fried et al) blood tests and bioimpedance body structure analysis was completed for study participants. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale (IADL), Mini-Mental State Examination (MMSE), the Timed Up and Go (TUG) test, Tinetti Performance-Oriented Mobility Assessment (POMA), and Geriatric Depression Scale - Short Form (GDS-SF). RESULTS: Prefrailty was diagnosed in 24.4% of the subjects (95% Confidence Interval (CI) = 17.7-31.0%; 31% in women and 19.1% in men, P=0.082) and frailty in 2.5% subjects (95% CI 0.1-4.9%; more frequently in women: 4.2% versus 1.1% in men, P=0.046). Having one or more positive frailty criteria was positively associated with depression (odds ratio (OR)=2.85, 95% CI=1.08-7.54, P=0.035) and negatively associated with MMSE score (OR=0.72, 95% CI=0.56-0.93, P=0.012) and fat-free mass (OR=0.96, 95% CI=0.92-0.99, P=0.016) in multivariate logistic regression analysis adjusted for age, sex, disease prevalence, number of medications, functional tests (Barthel Index, IADL, MMSE, GDS-SF), BMI, bioimpedance body composition score, and blood tests. CONCLUSION: At least 25% of the early-old community-dwelling population would benefit from a frailty prevention program. The frailty phenotype reflects both physical and mental health in this population.
Sujet(s)
Cognition , Fragilité , Évaluation gériatrique , Vie autonome , Activités de la vie quotidienne , Sujet âgé , Évaluation de l'invalidité , Femelle , Fragilité/diagnostic , Fragilité/épidémiologie , Fragilité/physiopathologie , Fragilité/psychologie , Évaluation gériatrique/méthodes , Évaluation gériatrique/statistiques et données numériques , Disparités de l'état de santé , Humains , Vie autonome/psychologie , Vie autonome/statistiques et données numériques , Mâle , Santé mentale , Adulte d'âge moyen , Pologne/épidémiologie , PrévalenceRÉSUMÉ
BACKGROUND: Resistin (RES) concentration increases in end-stage renal disease patients. However, there have been no studies defining the role of physical activity in RES concentrations in hemodialyzed (HD) patients. This study was aimed to determine metabolic and inflammatory effects, including RES, of 4-week supervised rehabilitation program in HD patients, with or without metabolic syndrome (MS). METHODS: The study was completed by 28 patients aged 56.9±13.3 years ( x ¯ ± SD ) who were HD for 50.6±73.4 months, and 30 controls aged 61.5±8.3 years with normal renal function. Both the groups were divided into two subgroups with respect to MS. Individualized supervised rehabilitation program based on physiotherapy, including exercises, was provided to each subject for 4 weeks. Baseline and post-intervention complete blood count, glycated hemoglobin (HbA1c) and levels of serum RES, leptin, adiponectin, cystatin C, erythropoietin, high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α), interleukin-6, transforming growth factor- ß1, plasminogen activator inhibitor-1 homocysteine, insulin, albumin, parathyroid hormone (PTH), and phosphorus were measured. RESULTS: Compared to controls, HD patients showed higher baseline leucocytes count and higher serum concentrations of RES, leptin, cystatin C, hs-CRP, TNF-α, homocysteine, phosphorus, PTH while hemoglobin, glucose, and albumin concentrations. A positive correlation between serum albumin and RES concentrations was observed in HD patients. Post-intervention RES increase was observed in HD patients without MS (post-intervention 34.22±8.89 vs baseline 30.16±11.04 ng/mL; P=0.046) while no change was observed in patients with MS and in the control group. CONCLUSION: MS modifies a RES response to the rehabilitation program in HD patients.
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BACKGROUND: Frailty has emerged as a key medical syndrome predictive of comorbidity, disability, institutionalization and death. As a component of the five frailty phenotype diagnostic criteria, patient grip strength deserves attention as a simple and objective measure of the frailty syndrome. The aim of this study was to assess conditions that influence grip strength in geriatric inpatients. PATIENTS AND METHODS: The study group consisted of 80 patients aged 78.6±7.0 years [Formula: see text], with 68.8% women, admitted to the Department of Geriatrics. A comprehensive geriatric assessment was complemented with assessment for the frailty phenotype as described by Fried et al for all patients in the study group. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale and Mini-Mental State Examination. RESULTS: Three or more frailty criteria were positive in 32 patients (40%), while 56 subjects (70%) fulfilled the frailty criterion of weakness (grip strength test). Multivariate linear regression analysis revealed that two independent measures showed positive association with grip strength - Mini-Mental State Examination score (ß=0.239; P=0.001) and statin use (ß=0.213; P=0.002) - and four independent measures were negatively associated with grip strength - female sex (ß=-0.671; P<0.001), C-reactive protein (ß=-0.253; P<0.001), prior myocardial infarction (ß=-0.190; P=0.006) and use of an antidepressant (ß=-0.163; P=0.018). Low physical activity was identified as the only independent qualitative frailty component associated with 2-year mortality in multivariate logistic regression analysis after adjustment for age and sex (odds ratio =6.000; 95% CI =1.357-26.536; P=0.018). CONCLUSION: Cognitive function, somatic comorbidity and medical treatment affect grip strength as a measure of physical frailty in geriatric inpatients. Grip strength was not predictive of 2-year mortality in this group.
Sujet(s)
Personne âgée fragile , Fragilité/diagnostic , Évaluation gériatrique/méthodes , Force de la main , Sujet âgé , Sujet âgé de 80 ans ou plus , Protéine C-réactive , Cognition , Comorbidité , Exercice physique , Femelle , Fragilité/épidémiologie , Humains , Patients hospitalisés , Mâle , Tests de l'état mental et de la démence , Infarctus du myocarde/épidémiologie , Odds ratio , Répartition par sexeRÉSUMÉ
BACKGROUND: Prevention strategies for pressure ulcer formation remain critical in patients with an advanced illness. We analyzed factors associated with the development of pressure ulcers in patients hospitalized in a palliative care ward setting. PATIENTS AND METHODS: This study was a retrospective analysis of 329 consecutive patients with a mean age (± standard deviation) of 70.4±11.8 years (range: 30-96 years, median 70.0 years; 55.3% women), who were admitted to the Palliative Care Department between July 2012 and May 2014. RESULTS: Patients were hospitalized for mean of 24.8±31.4 days (1-310 days, median 14 days). A total of 256 patients (77.8%) died in the ward and 73 patients (22.2%) were discharged. Two hundred and six patients (62.6%) did not develop pressure ulcers during their stay in the ward, 84 patients (25.5%) were admitted with pressure ulcers, and 39 patients (11.9%) developed pressure ulcers in the ward. Four factors assessed at admission appear to predict the development of pressure ulcers in the multivariate logistic regression model: Waterlow score (odds ratio [OR] =1.140, 95% confidence interval [CI] =1.057-1.229, P=0.001), transfer from other hospital wards (OR =2.938, 95% CI =1.339-6.448, P=0.007), hemoglobin level (OR =0.814, 95% CI =0.693-0.956, P=0.012), and systolic blood pressure (OR =0.976, 95% CI =0.955-0.997, P=0.023). Five other factors assessed during hospitalization appear to be associated with pressure ulcer development: mean evening body temperature (OR =3.830, 95% CI =1.729-8.486, P=0.001), mean Waterlow score (OR =1.194, 95% CI =1.092-1.306, P<0.001), the lowest recorded sodium concentration (OR =0.880, 95% CI =0.814-0.951, P=0.001), mean systolic blood pressure (OR =0.956, 95% CI =0.929-0.984, P=0.003), and the lowest recorded hemoglobin level (OR =0.803, 95% CI =0.672-0.960, P=0.016). CONCLUSION: Hyponatremia and low blood pressure may contribute to the formation of pressure ulcers in patients with an advanced illness.
Sujet(s)
Hyponatrémie/épidémiologie , Hypotension artérielle/épidémiologie , Soins palliatifs/statistiques et données numériques , Escarre/épidémiologie , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Incidence , Modèles logistiques , Mâle , Adulte d'âge moyen , Odds ratio , Études rétrospectives , Facteurs de risqueRÉSUMÉ
BACKGROUND: Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. OBJECTIVE: Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. METHODS: Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( [Formula: see text] ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. RESULTS: About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years (P<0.001), body mass index (BMI) <23.5 (P=0.007), Mini-Mental State Examination <20 (P=0.004), Barthel Index <65 (P=0.002), hemoglobin <7.69 mmol/L (P=0.017), serum protein <70 g/L (P=0.008), albumin <32 g/L (P=0.001), and calcium level <2.27 mmol/L. Four independent factors associated with fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76-19.49; P<0.001), history of falls (OR =2.55; 95% CI =1.05-6.19; P=0.039), age (OR =1.14; 95% CI =1.05-1.23; P=0.001), and BMI (OR =0.91; 95% CI =0.83-0.99; P=0.034). CONCLUSION: Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls.
Sujet(s)
Chutes accidentelles/prévention et contrôle , Activités de la vie quotidienne , Vieillissement , Indice de masse corporelle , Délire avec confusion/psychologie , Évaluation gériatrique/méthodes , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Hospitalisation , Humains , Modèles logistiques , Mâle , Analyse multifactorielle , Pologne , Études prospectives , Facteurs de risqueRÉSUMÉ
BACKGROUND: Management of geriatric patients would be simplified if a universally accepted definition of frailty for clinical use was defined. Among definitions of frailty, Fried frailty phenotype criteria constitute a common reference frame for many geriatric studies. However, this reference frame has been tested primarily in elderly patients presenting with relatively good health status. OBJECTIVE: The aim of this article was to assess the usefulness and limitations of Fried frailty phenotype criteria in geriatric inpatients, characterized by comorbidity and functional impairments, and to estimate the frailty phenotype prevalence in this group. PATIENTS AND METHODS: Five hundred consecutive patients of the university hospital subacute geriatric ward, aged 79.0±8.4 years (67% women and 33% men), participated in this cross-sectional study. Comprehensive geriatric assessment and Fried frailty phenotype component evaluation were performed in all patients. RESULTS: Multimorbidity (6.0±2.8 diseases) characterized our study group, with a wide range of clinical conditions and functional states (Barthel Index of Activities of Daily Living 72.2±28.2 and Mini-Mental State Examination 23.6±7.1 scores). All five Fried frailty components were assessed in 65% of patients (95% confidence interval [CI] =60.8-69.2) (diagnostic group). One or more components were not feasible to be assessed in 35% of the remaining patients (nondiagnostic group) because of lack of past patient's body mass control and/or cognitive or physical impairment. Patients from the nondiagnostic group, as compared to patients from the diagnostic group, presented with more advanced age, higher prevalence of dementia, lower prevalence of hypertension, lower systolic and diastolic blood pressure, body mass index, Mini-Mental State Examination and Barthel Index of Activities of Daily Living. Despite diagnostic limitations, we found ≥3 positive criteria (thus, frailty diagnosis) in 54.2% of the study group (95% CI =49.8-58.6), with prevalence from 31.7% in sexagenarians to 67.6% in nonagenarians. CONCLUSION: Fried frailty phenotype criteria seem useful for geriatric inpatient assessment, despite diagnostic limitations. High prevalence of frailty among geriatric inpatients suggests that evaluation for frailty should be considered a part of the comprehensive geriatric assessment.
Sujet(s)
Comorbidité , Personne âgée fragile , Évaluation gériatrique/méthodes , Gériatrie/statistiques et données numériques , Patients hospitalisés , Activités de la vie quotidienne , Sujet âgé , Sujet âgé de 80 ans ou plus , Études transversales , Femelle , Humains , Mâle , Phénotype , PologneRÉSUMÉ
We examined the electrocardiographic (ECG) findings of centenarians and associated them with >360-day survival. Physical and functional assessment, resting electrocardiogram and laboratory tests were performed on 86 study participants 101.9 ± 1.2 years old (mean ± SD) (70 women, 16 men) and followed for at least 360 days. Centenarian ECGs were assessed for left ventricular hypertrophy (LVH) according to the Romhilt-Estes score, Sokolow-Lyon criteria and Cornell voltage criteria which were positive for 12.8, 6.98, and 10.5 % of participants, respectively. Fifty-two study participants (60 %) survived ≥360 days. Multivariate logistic regression analysis revealed a negative relationship between 360-day survival and the following: R II <0.45 mV adjusted for CRP (odds ratio (OR) = 0.108, 95 % confidence interval (CI) = 0.034-0.341, P < .001), R aVF < 0.35 mV adjusted for CRP (OR = 0.151, 95 % CI = 0.039-0.584, P < .006), Sokolow-Lyon voltage <1.45 mV adjusted for CRP (OR = 0.178, 95 % CI = 0.064-0.492, P = .001), QRS ≥90 ms adjusted for CRP (OR = 0.375, 95 % CI = 0.144-0.975, P = .044), and Romhilt-Estes score ≥5 points adjusted for sex and Barthel Index (OR = 0.459, 95 % CI = 0.212-0.993, P = .048) in single variable ECG models. QRS voltage correlated positively with systolic and pulse pressure, serum vitamin B12 level, sodium, calcium, phosphorous, TIMP-1, and eGFR. QRS voltage correlated negatively with BMI, WHR, serum leptin, IL-6, TNF-α, and PAI-1 levels. QRS complex duration correlated positively with CRP; QTc correlated positively with TNF-α. Results suggest that Romhilt-Estes LVH criteria scores ≥5 points, low ECG QRS voltages (Sokolow-Lyon voltage <1.45 mV), and QRS complexes ≥90 ms are predictive of centenarian 360-day mortality.
Sujet(s)
Vieillissement , Électrocardiographie , Hypertrophie ventriculaire gauche/mortalité , Fonction ventriculaire gauche/physiologie , Sujet âgé de 80 ans ou plus , Femelle , Études de suivi , Humains , Hypertrophie ventriculaire gauche/physiopathologie , Mâle , Pologne/épidémiologie , Pronostic , Reproductibilité des résultats , Études rétrospectives , Taux de survie/tendances , Facteurs tempsRÉSUMÉ
BACKGROUND: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. OBJECTIVE: Evaluate specific factors for development of delirium in a geriatric ward setting. METHODS: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed. RESULTS: Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54-5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44-3.65; P<0.001), previous delirium incidents (OR =2.23; CI =1.47-3.38; P<0.001), previous fall incidents (OR =1.76; CI =1.17-2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11-2.53; P=0.014). CONCLUSION: Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.
Sujet(s)
Chutes accidentelles , Délire avec confusion/diagnostic , Démence/psychologie , Hospitalisation/statistiques et données numériques , Transfert de patient , Inhibiteurs de la pompe à protons/effets indésirables , Sujet âgé , Sujet âgé de 80 ans ou plus , Études transversales , Femelle , Évaluation gériatrique , Hôpitaux universitaires , Humains , Unités de soins intensifs , Estimation de Kaplan-Meier , Modèles logistiques , Mâle , Adulte d'âge moyen , Analyse multifactorielle , Mesure de la douleur , Pologne , Études prospectives , Échelles d'évaluation en psychiatrie , Facteurs de risqueRÉSUMÉ
BACKGROUND: Considerable variability exists in international prevalence and incidence estimates of dementia. The accuracy of estimates of dementia in the oldest-old and the controversial question of whether dementia incidence and prevalence decline at very old age will be crucial for better understanding the dynamics between survival to extreme old age and the occurrence and risk for various types of dementia and comorbidities. International Centenarian Consortium - Dementia (ICC-Dementia) seeks to harmonise centenarian and near-centenarian studies internationally to describe the cognitive and functional profiles of exceptionally old individuals, and ascertain the trajectories of decline and thereby the age-standardised prevalence and incidence of dementia in this population. The primary goal of the ICC-Dementia is to establish a large and thorough heterogeneous sample that has the power to answer epidemiological questions that small, separate studies cannot. A secondary aim is to examine cohort-specific effects and differential survivorship into very old age. We hope to lay the foundation for further investigation into risk and protective factors for dementia and healthy exceptional brain ageing in centenarians across diverse ethnoracial and sociocultural groups. METHODS: Studies focusing on individuals aged ≥95 years (approximately the oldest 1 percentile for men, oldest 5th percentile for women), with a minimum sample of 80 individuals, including assessment of cognition and functional status, are invited to participate. There are currently seventeen member or potential member studies from Asia, Europe, the Americas, and Oceania. Initial attempts at harmonising key variables are in progress. DISCUSSION: General challenges facing large, international consortia like ICC-Dementia include timely and effective communication among member studies, ethical and practical issues relating to human subject studies and data sharing, and the challenges related to data harmonisation. A specific challenge for ICC-Dementia relates to the concept and definition of'abnormal' in this exceptional group of individuals who are rarely free of physical, sensory and/or cognitive impairments.
Sujet(s)
Dysfonctionnement cognitif/épidémiologie , Démence/épidémiologie , Sujet âgé de 80 ans ou plus , Encéphale/physiologie , Cognition/physiologie , Femelle , Humains , Incidence , Mâle , Prévalence , RisqueRÉSUMÉ
Centenarians represent a rapidly growing population. To better characterize this specific age group, we have performed a cross-sectional study to observe associations between functional measures and a range of biochemical markers, including inflammatory markers and their significance as predictors of 360-day survival. Medical history and physical and functional assessment (Mini-Mental State Examination (MMSE), Katz Index (activities of daily living, ADL) and Barthel Index (Barthel Index) of Activities of Daily Living, and Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)) were conducted on 86 101.9 ± 1.2-year-old (mean ± SD) subjects (70 women, 16 men). Blood tests were performed on 84 subjects of whom 43 also had extended biomarker assessment. As a reference group 30 51.8 ± 5.0-year old healthy subjects (20 women, 10 men) were recruited. The centenarians received follow-up phone calls. Fifty-two centenarians (60 %) survived ≥360 days. Longer survival was associated with higher MMSE (hazard ratio, HR = 0.934, 95 % confidence interval (CI) 0.896-0.975, P = .002), ADL (HR = 0.840, 95 % CI 0.716-0.985, P = .032), Barthel Index (HR = 0.988, 95 % CI 0.977-0.999, P = .026), and albumin level (HR .926, 95 % CI 0.870-0.986, P .016) and with lower white blood cell (WBC) (HR = 1.161, 95 % CI 1.059-1.273, P = .001), C-reactive protein (CRP) (HR = 1.032, 95 % CI 1.014-1.050, P < .001), IL-6 (HR = 1.182, 95 % CI 1.047-1.335, P = .007), and endothelin-1 (ET-1) level (HR = 3.711, 95 % CI 1.233-11.169, P = .020). Centenarians had higher 360-day survival probability with MMSE ≥13 (P < .001), ADL ≥1 (P < .001), Barthel Index ≥15 (P < .001), Lawton IADL ≥10 points (P = .009), WBC <8.3 G/L (P = .039), CRP <10 mg/L (P < .001), IL-6 <6 pg/mL (P .002), and ET-1 <1.1 pg/mL (P .007). Our results indicate that functional measures, inflammatory markers, and endothelin-1 are predictors of 360-day survival in centenarians.
Sujet(s)
Activités de la vie quotidienne , Vieillissement , Marqueurs biologiques/sang , Cognition/physiologie , Endothéline-1/sang , Évaluation gériatrique/méthodes , Sujet âgé , Sujet âgé de 80 ans ou plus , Protéine C-réactive/métabolisme , Études transversales , Femelle , Humains , Mâle , Adulte d'âge moyen , Tests neuropsychologiques , Pologne/épidémiologie , Taux de survie/tendancesRÉSUMÉ
The number of centenarians is projected to rise rapidly. However, knowledge of evidence-based health care in this group is still poor. Hypertension is the most common condition that leads to multiple organ complications, disability, and premature death. No guidelines for the management of high blood pressure (BP) in centenarians are available. We have performed a cross-sectional study to characterize clinical and functional state of Polish centenarians, with a special focus on BP. The study comprised 86 consecutive 100.9 ± 1.2 years old (mean ± SD) subjects (70 women and 16 men). The assessment included structured interview, physical examination, geriatric functional assessment, resting electrocardiography, and blood and urine sampling. The subjects were followed-up on the phone. Subjects who survived 180 days (83 %) as compared to non-survivors had higher systolic BP (SBP), diastolic BP (DPB), mean arterial pressure (MAP), pulse pressure (PP), higher mini-mental state examination, Barthel Index of Activities of Daily Living and Lawton Instrumental Activities of Daily Living Scale scores, higher serum albumin and calcium levels, and total iron-binding capacity, while lower serum creatinine, cystatin C, folate, and C-reactive protein levels. SBP ≥140 mm Hg, DBP ≥90 mm Hg, MAP ≥100 mm Hg, and PP ≥40 mm Hg were associated with higher 180-day survival probability. Results suggest that mildly elevated blood pressure is a marker for better health status in Polish centenarians.
Sujet(s)
Pression sanguine/physiologie , État de santé , Longévité/physiologie , Activités de la vie quotidienne , Facteurs âges , Sujet âgé de 80 ans ou plus , Marqueurs biologiques/métabolisme , Cognition/physiologie , Études transversales , Femelle , Évaluation gériatrique , Humains , Mâle , PologneRÉSUMÉ
The enforced sedentary lifestyle and muscle paresis below the level of injury are associated with adipose tissue accumulation in the trunk. The value of anthropometric indicators of obesity in patients with spinal cord injuries has also been called into question. We hypothesized that the Body Mass Index recommended by the WHO to diagnose obesity in general population has too low sensitivity in case of wheelchair rugby players. The study group comprised 14 wheelchair rugby players, aged 32.6 ± 5.1 years, who had sustained CSCI (paralysis of lower limbs and upper extremities). The research tool was the Tanita Viscan visceral and trunk fat analyzer AB140 using the abdominal bioelectrical impedance analysis (BIA) to estimate the visceral fat level (Vfat) and trunk fat percentage (Tfat). The AB140 analyzer also allowed the measurement of body composition of those individuals who could not assume an upright position. Our analyses revealed high and very high correlation coefficients between Vfat and WC (r=0.9), WHtR (r=0.7) and Tfat (r=0.9) whereas the correlation between Vfat and the BMI was weak, especially in the subgroup with Vfat < 13.5% (r=0.2). The subgroup with Vfat>13.5 exhibited a moderate-level relationship between the BMI and visceral fat increase. It was concluded that the BMI had a low sensitivity for predicting obesity risk in wheelchair rugby players after CSCI. The sensitivity of WC measurement was higher and thus, it may be stated that it constitutes an objective tool for predicting obesity risk in post-CSCI wheelchair rugby players.
RÉSUMÉ
Large clinical trials and experimental studies have indicated that not all of the beneficial properties of angiotensin-converting enzyme inhibitors (ACE-Is) can be attributed to the lowering of blood pressure. The aim of this study was to assess doctors' opinions about the importance of the cardioprotective effects of ACE-Is beyond lowering blood pressure. The study participants (685 physicians) filled in a questionnaire testing doctors' knowledge of all of the therapeutic effects of ACE-Is not directly associated with lowering blood pressure and their clinical importance. In addition, each doctor filled in 20 questionnaires for subsequent patients treated with any ACE-I. Fifty-nine percent of the investigated physicians were aware of most of the therapeutic effects of ACE-Is. The most important therapeutic effects for the respondents were the following: reduction of peripheral resistance, inhibition of left ventricle hypertrophy, inhibition of vascular remodeling and atherosclerotic plaque stabilization. The most commonly prescribed ACE-Is were perindopril, lisinopril and chinalapril for inhibition of left ventricular hypertrophy and perindopril, ramipril and chinalapril for inhibition of arterial wall remodeling. The ACE-Is that were used to reduce peripheral vessel resistance included perindopril, lisinopril and trandolapril. Drugs used to stabilize the plaque included perindopril, lisinopril and cilazapril. The therapeutic effects of ACE-Is beyond lowering blood pressure were considered to be valid and important in daily clinical practice for the prevention of cardiovascular diseases and diabetic complications. The attribution of the effects of a particular ACE-I was not always in accordance with evidence-based medicine. The obtained treatment outcomes were attributed to the entire group of ACE-Is.
Sujet(s)
Inhibiteurs de l'enzyme de conversion de l'angiotensine/usage thérapeutique , Cardiotoniques/usage thérapeutique , Connaissances, attitudes et pratiques en santé , Sujet âgé , Inhibiteurs de l'enzyme de conversion de l'angiotensine/pharmacologie , Pression sanguine/effets des médicaments et des substances chimiques , Cardiotoniques/pharmacologie , Maladies cardiovasculaires/prévention et contrôle , Complications du diabète/prévention et contrôle , Femelle , Humains , Mâle , Adulte d'âge moyen , Médecins/statistiques et données numériques , Enquêtes et questionnairesRÉSUMÉ
BACKGROUND: Physical activity is an essential component of diabetes management; however, exercise is associated with the risk for metabolic decompensation. The aim of the study was to analyze insulin response to the short-term intense exercise in middle-aged Type 2 diabetic patients treated with gliclazide. MATERIALS AND METHODS: Fourteen Type 2 diabetic patients (47.9+/-1.6 years, mean+/-S.E.M.), treated with gliclazide, and 14 healthy controls (45.1+/-1.0 years) were submitted to standard graduated submaximal (90% HR(max)) exercise treadmill testing at 2 h after standardized breakfast. Serum glucose, insulin, proinsulin, C peptide, growth hormone, insulin-like growth factor-1, and cortisol concentrations; and plasma lactate, glucagon, epinephrine, and norepinephrine concentrations were measured during the periexercise period up to the 60th min of the recovery period. RESULTS: Significant hemodynamic (heart rate, systolic, and diastolic blood pressure), metabolic (lactate concentration), and hormonal (epinephrine and norepinephrine levels) responses to the exercise were similar in patients and healthy subjects. Glucose, insulin, and proinsulin levels were higher in the diabetic group at the preexercise and at all the next analyzed time points. The insulin concentration increased during the postprandial period in both groups and decreased subsequently during the exercise only in the control group, without concurrent C peptide decline. The C peptide-to-insulin ratio increased during the exercise and decreased immediately postexercise only in the control group. CONCLUSIONS: The initial decrease of the insulin serum concentration during short-term intense exercise in normal middle-aged men is primarily related to the increased clearance of the hormone. Normal insulin response to the exercise was abolished in Type 2 diabetic patients treated with gliclazide.
Sujet(s)
Diabète de type 2 , Exercice physique/physiologie , Gliclazide/administration et posologie , Hypoglycémiants/administration et posologie , Insuline/sang , Adulte , Pression sanguine , Diabète de type 2/sang , Diabète de type 2/traitement médicamenteux , Diabète de type 2/physiopathologie , Épreuve d'effort , Jeûne/physiologie , Rythme cardiaque , Humains , Mâle , Adulte d'âge moyenRÉSUMÉ
BACKGROUND: Physical activity is crucial for treatment of diabetes. However, intensive exercise brings the risk for metabolic decompensation; therefore, predicting its effect on glycemia is of great importance. MATERIALS AND METHODS: Fourteen type 2 diabetic patients (47.9+/-1.6 years; mean+/-S.E.M.), treated with gliclazide, and 14 healthy controls (45.1+/-1.0 years) were subjected to standard graded submaximal (90% HR(max)) exercise treadmill testing for 2 h after standardized breakfast. Blood glucose, lactate, insulin, and proinsulin concentrations were measured on fasting and during the periexercise period up to 120 min after the effort. Glucagon, growth hormone, cortisol, and catecholamines were determined up to 60 min of the recovery period. RESULTS: After exercise, glycemia decreased from the preexercise value of 11.3+/-1.4 to 8.0+/-1.1 mmol/l at 120 min (P<.001) in the diabetic group, while in controls, it did not change significantly. Shift in glycemia during and after exercise in the diabetic group was dependent on preexercise glycemia, according to the quadratic polynomial regression model, whereas a simple negative correlation between these indices was found in the control group. Insulinemia tended to decrease from the midexercise maximum of 488+/-116 to 261+/-71 pmol/l at the 120th min in diabetic patients. Neither hypoglycemia nor deficit in response of counterregulatory hormones was observed. CONCLUSIONS: In the type 2 diabetic patients treated with gliclazide, short-term, intensive, submaximal exercise, performed 2 h after a meal, causes reduction of hyperglycemia during the recovery period. Preexercise glycemia was found to be a primary predictor of the shift in glycemia under the exercise, according to the polynomial regression model.