Selenium and impaired physical function in US and Spanish older adults.

BACKGROUND: Selenium (Se) is a trace element with a narrow safety margin. OBJECTIVES: To evaluate the cross-sectional and longitudinal dose-response association between Se exposure and measures of impaired physical function and disability in older adults. DESIGN: NHANES 2011-2014 cross-sectional (US, n = 1733, age ≥60 years) and Seniors-ENRICA-2 2017-2019 cross-sectional and longitudinal (Spain, n = 2548 and 1741, respectively, age ≥65 years) data were analyzed. Whole blood and serum Se levels were measured using inductively coupled plasma-mass spectrometry. Lower-extremity performance was assessed with the Short Physical Performance Battery, and muscle weakness with a dynamometer. Incident mobility and agility limitations, and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including physical activity. Results across studies were pooled using random-effects meta-analysis. RESULTS: Meta-analyzed odds ratios (95% confidence interval) per log2 increase in whole blood Se were 0.54 (0.32; 0.76) for weakness, 0.59 (0.34; 0.83) for impaired lower-extremity performance, 0.48 (0.31; 0.68) for mobility limitations, 0.71 (0.45; 0.97) for agility limitations, and 0.34 (0.12; 0.56) for disability in at least one IADL. Analyses for serum Se in NHANES showed similar results. Findings suggest the inverse association with grip strength is progressive below 140 µg/L (p-value for non-linear trend in the Seniors-ENRICA-2 study = 0.13), and above 140 µg/L (p-value for non-linear trend in NHANES = 0.11). In the Seniors-ENRICA-2 cohort, with a 2.2 year follow-up period, a doubling in baseline Se levels were associated with a lower incidence of weakness [odds ratio (95% confidence interval): 0.45 (0.22; 0.91)], impaired lower-extremity performance [0.63 (0.32; 1.23)], mobility [0.43 (0.21; 0.91)] and agility [0.38 (0.18; 0.78)] limitations. DISCUSSION: In US and Spanish older adults, Se concentrations were inversely associated with physical function limitations. Further studies are needed to elucidate underlying mechanisms.

Baseline and 1-year follow-up differences between hip-fracture patients admitted from nursing homes and the community. A cohort study on 509 consecutive patients (FONDA Cohort) / Diferencias iniciales y a 1 año de seguimiento entre los pacientes con fractura de cadera de residencia de ancianos y de comunidad. Estudio de una cohorte de 509 pacientes (Cohorte FONDA)

Objective: To determine the clinical and functional differences at hospital admission and at 1 year after a hip fracture (HF) in nursing homes (NH) and community-dwelling (CD) patients. Methods: All patients with HF admitted to the orthogeriatric unit at a university hospital between January 2013 and February 2014 were prospectively included. Clinical and functional variables, and mortality were recorded during the hospital admission. The patients were contacted by telephone at 1 year to determine their vital condition and functional status. Results: A total of 509 patients were included, 116 (22.8%) of whom came from NH. Compared with the CD patients, the NH patients had higher surgical risk (ASA ≥3: 83.6% vs. 66.4%, P<.001), poorer theoretical vital prognosis (Nottingham Profile ≥5: 98.3% vs. 56.6%, P<.001), higher rate of previous functional status (median Barthel index: 55 [IQR, 36-80] vs. 90 [IQR, 75-100], P<.001), poorer mental status (Pfeiffer's SPMSQ>2: 74.1% vs. 40.2%, P<.001), and a higher rate of sarcopenia (24.3% vs. 15.2%, P<.05). There were no differences in in-hospital or at 1-year mortality. At 1 year, NH patients recovered their previous walking capacity at a lower rate (38.5% vs. 56.2%, P<.001). Conclusions: Among the patients with HF treated in an orthogeriatric unit, NH patients had higher, surgical risk, functional and mental impairment, and a higher rate of sarcopenia than CD patients. At 1 year of follow-up, NH patients did not have higher mortality, but they recovered their previous capacity for walking less frequently

Objetivo: Determinar las diferencias clínicas y funcionales, basales y al año de la fractura, en los pacientes hospitalizados por fractura de cadera (FC) que provienen de residencia de ancianos (RA) y de la comunidad. Métodos: Se incluyeron de forma prospectiva todos los pacientes ingresados con el diagnóstico de FC en la unidad de ortogeriatría de un hospital universitario entre enero de 2013 y febrero de 2014. Se recogieron variables clínicas, funcionales, cognitivas y la evolución durante la hospitalización. Se contactó telefónicamente al año para conocer su estado vital y funcional. Resultados: Se incluyeron 509 pacientes, de los que 116 (22,8%) provenían de RA. Comparados con las personas que provenían de comunidad, éstos tenían un mayor riesgo quirúrgico (ASA≥3: 83,6% vs. 66,4%, p<0,001), peor pronóstico vital teórico (Perfil de Nottingham≥5: 98,3% vs. 56,6%, p<0,001), peor estado funcional basal (Índice Barthel medio: 55 [RIC, 36-80] vs. 90 [RIC, 75-100], p<0,001), peor estado mental (Test de Pfeiffer>2: 74,1% vs. 40,2%, p<0,001) y tasas más altas de sarcopenia (24,3% vs. 15,2%, p<0,05). No hubo diferencias en la mortalidad durante la hospitalización ni al año. Al año los pacientes de RA recuperaron su capacidad de ambulación previa con menos frecuencia (38,5% vs. 56,2%, p<0,001). Conclusiones: Los pacientes ingresados por FC provenientes de RA presentan mayor riesgo quirúrgico, mayor deterioro funcional y mental y mayor tasa de sarcopenia que los pacientes de la comunidad. No presentan mayor mortalidad durante el ingreso ni al año de la FC, pero recuperan su capacidad de deambulación previa con menos frecuencia

Baseline and 1-year follow-up differences between hip-fracture patients admitted from nursing homes and the community. A cohort study on 509 consecutive patients (FONDA Cohort).

OBJECTIVE: To determine the clinical and functional differences at hospital admission and at 1 year after a hip fracture (HF) in nursing homes (NH) and community-dwelling (CD) patients. METHODS: All patients with HF admitted to the orthogeriatric unit at a university hospital between January 2013 and February 2014 were prospectively included. Clinical and functional variables, and mortality were recorded during the hospital admission. The patients were contacted by telephone at 1 year to determine their vital condition and functional status. RESULTS: A total of 509 patients were included, 116 (22.8%) of whom came from NH. Compared with the CD patients, the NH patients had higher surgical risk (ASA ≥3: 83.6% vs. 66.4%, P<.001), poorer theoretical vital prognosis (Nottingham Profile ≥5: 98.3% vs. 56.6%, P<.001), higher rate of previous functional status (median Barthel index: 55 [IQR, 36-80] vs. 90 [IQR, 75-100], P<.001), poorer mental status (Pfeiffer's SPMSQ>2: 74.1% vs. 40.2%, P<.001), and a higher rate of sarcopenia (24.3% vs. 15.2%, P<.05). There were no differences in in-hospital or at 1-year mortality. At 1 year, NH patients recovered their previous walking capacity at a lower rate (38.5% vs. 56.2%, P<.001). CONCLUSIONS: Among the patients with HF treated in an orthogeriatric unit, NH patients had higher, surgical risk, functional and mental impairment, and a higher rate of sarcopenia than CD patients. At 1 year of follow-up, NH patients did not have higher mortality, but they recovered their previous capacity for walking less frequently.

Evaluación de la adherencia al tratamiento con calcio y vitamina D en ancianos de una zona básica de salud / Evaluation of adherence to treatment with calcium and vitamin D in the elderly in a basic health area

Introducción y objetivo. El déficit de vitamina D en los ancianos es elevado. Complementar con suplementos de calcio y vitamina D es una práctica habitual en individuos con riesgo de caídas y/o fracturas que, sin embargo, obtiene un bajo grado de cumplimiento. El objetivo es determinar la adherencia al calcio y vitamina D en ancianos con hipovitaminosis D en una zona urbana de Madrid. Pacientes y métodos. Estudio de intervención en 438 individuos ≥ 65 años con hipovitaminosis D procedentes de la «Cohorte Peñagrande». Se les pautó calcio y vitamina D y se valoró la adherencia a los 3 y 12 meses mediante el test de Morisky-Green y el recuento de recetas prescritas. Resultados. Se analizaron 413 de los 438 individuos con hipovitaminosis D (18 casos no se trataron por contraindicaciones y 7 se perdieron). A los 3 y 12 meses el 63,9 y el 47,2%, respectivamente, fueron adherentes. El 19,3% de los no adherentes a los 3 meses fueron buenos cumplidores al año tras una intervención educativa breve. La comorbilidad se asoció con menor adherencia al año (46,3% versus 35,2%, p = 0,027). La principal causa de no adherencia al calcio fue la intolerancia digestiva, y a la vitamina D, los olvidos. Se observó concordancia entre valorar la adherencia con el test de Morisky y recuento de recetas prescritas (índice Kappa = 69,8%). Conclusiones. La falta de adherencia a tratamientos crónicos con calcio y vitamina D es un problema relevante en ancianos. Es importante evaluar la adherencia y aplicar estrategias de educación sanitaria en la práctica clínica (AU)

Background and objective. The vitamin D deficiency is high in the elderly population. Calcium and vitamin D supplements is a frequently used measure in individuals at risk for falls and/or fractures. However, this practice has achieved a low level of compliance. The aim is to assess the adherence to treatment with calcium and vitamin D in elders with hypovitaminosis D in an urban area of Madrid. Patients and methods. Intervention study performed on 438 individuals ≥ 65 years from the ‘Peñagrande Cohort’ with hypovitaminosis D that were treated with calcium and vitamin D. Adherence at 3 and 12 months was assessed using the Morisky-Green and counting of prescriptions written. Results. A total of 413 of the 438 individuals with hypovitaminosis D were analysed (18 patients were not treated because of contraindications, and 7 were considered lost). At 3 and 12 months, 63.9% and 47.2%, respectively, were adherents. After a brief educational intervention, 19.3% of individuals without adherence at 3 months became good compliers when measured at one year. Comorbidity was associated with lower rates of adherence to treatment after one year (46.3% versus 35.2%, P = .027). The main cause of non-adherence to calcium was digestive intolerance, and due to oversights for vitamin D. Concordance between adherence assessed by the Morisky test and counting of prescriptions written was high (Kappa index = 69.8%). Conclusions. Non-adherence to chronic treatment with calcium and vitamin D is a relevant problem in elderly. It is important to assess adherence and implement health education strategies in clinical practice (AU)

[Evaluation of adherence to treatment with calcium and vitamin D in the elderly in a basic health area]. / Evaluación de la adherencia al tratamiento con calcio y vitaminaD en ancianos de una zona básica de salud.

BACKGROUND AND OBJECTIVE: The vitamin D deficiency is high in the elderly population. Calcium and vitamin D supplements is a frequently used measure in individuals at risk for falls and/or fractures. However, this practice has achieved a low level of compliance. The aim is to assess the adherence to treatment with calcium and vitamin D in elders with hypovitaminosis D in an urban area of Madrid. PATIENTS AND METHODS: Intervention study performed on 438 individuals ≥65years from the 'Peñagrande Cohort' with hypovitaminosis D that were treated with calcium and vitamin D. Adherence at 3 and 12 months was assessed using the Morisky-Green and counting of prescriptions written. RESULTS: A total of 413 of the 438 individuals with hypovitaminosis D were analysed (18 patients were not treated because of contraindications, and 7 were considered lost). At 3 and 12 months, 63.9% and 47.2%, respectively, were adherents. After a brief educational intervention, 19.3% of individuals without adherence at 3 months became good compliers when measured at one year. Comorbidity was associated with lower rates of adherence to treatment after one year (46.3% versus 35.2%, P=.027). The main cause of non-adherence to calcium was digestive intolerance, and due to oversights for vitamin D. Concordance between adherence assessed by the Morisky test and counting of prescriptions written was high (Kappa index=69.8%). CONCLUSIONS: Non-adherence to chronic treatment with calcium and vitamin D is a relevant problem in elderly. It is important to assess adherence and implement health education strategies in clinical practice.