The Relationship between Frailty, Obesity and Social Deprivation in Non-Institutionalized Elderly People.

BACKGROUND: With the increasing prevalence of obesity and the risk of increased dependency among the elderly, it becomes important to characterize the link between obesity and frailty. The relationship between obesity and social deprivation would be bidirectional, with each influencing the other. OBJECTIVES: Main objective was to study the relationship between frailty as defined by Fried and obesity (Body Mass Index (BMI) and abdominal obesity). Secondary objective was to assess the relationship between frailty and social deprivation. MATERIALS AND METHODS: This was a cross-sectional study, with data collected between January 2014 and December 2015 using a senior periodic health prevention examination form used in the 4 sites of the health examination center, in Rhone, among non-institutionalized seniors (≥ 65 years). Frailty was defined according to Fried's criteria. Obesity was defined by a BMI ≥ 30 kg / m2 and a waist circumference > 88 cm for women and >102 cm for men. We studied the association between obesity according to BMI ≥ 30kg / m2 on the one hand and abdominal obesity on the other hand with frailty according to Fried. The analyzes were adjusted for gender, age, education level, not being in a relationship and social deprivation quantified by the assessment score of deprivation and health inequalities (EPICES score). RESULTS: 1593 senior health prevention examination forms were studied. According to BMI, senior women were almost twice as likely to be frail when obese (RR = 1.92, 95% CI [1.06 - 3.45], p = 0.018). The results were similar for abdominal obesity in women aged 65-74 years (RR = 2.12, 95% CI [1.03-4.35], p = 0.029). There was no relationship in men for both types of obesity. Seniors who were socially deprived were 2.7 times more likely to be frail than non-deprived seniors (adjusted RR = 2.76, 95% CI [1.808 - 4.203], p <0.001). CONCLUSIONS: Obesity (BMI ≥ 30kg / m2 and high waist circumference) was associated with increased frailty among older, non-institutionalized women who came for a periodic health prevention examination. Screening and prevention of obesity in the elderly appears to be a major public health issue, and remains a priority target for action.

Aportación de la Fisioterapia al tratamiento del dolor pélvico crónico en endometriosis / Contribution of physiotherapy to the treatment of chronic pelvic pain in endometriosis

INTRODUCCIÓN: En 2010, el European Working Group on Sarcopenia in Older People (EWGSOP) publicó una definición de consenso para la sarcopenia. También desarrolló un algoritmo basado en la medición del rendimiento físico para la determinación de casos de sarcopenia. Se han publicado diversos estudios que determinan la prevalencia de sarcopenia con este algoritmo, pero hasta donde sabemos, no hay estudios publicados que comparen la prevalencia utilizando 3 métodos diferentes para la determinación del rendimiento físico. El objetivo de este estudio fue determinar la prevalencia de sarcopenia utilizando el algoritmo propuesto por el EWGSOP en 2010 y comparar los resultados utilizando 3 métodos diferentes para el rendimiento físico. MÉTODOS: Se trata de un estudio transversal de 97 personas de edad avanzada. Se obtuvieron medidas de masa muscular, fuerza muscular y rendimiento físico. Para diagnosticar la sarcopenia se utilizaron los puntos de corte y el algoritmo propuesto por el EWGSOP. El análisis de concordancia entre variables cualitativas utilizó el coeficiente kappa de Cohen. RESULTADOS: El coeficiente kappa encontrado comparando los resultados de los 3 métodos empleados para el rendimiento físico (Velocidad de la marcha; Timed Up & Go, Short Physical Performance Battery) indica que no existe concordancia entre ellos. El coeficiente kappa encontrado al comparar la prevalencia de la sarcopenia utilizando 3 métodos diferentes para el rendimiento físico indica que hay una concordancia casi perfecta (kappa ≥ 0,96). Al comparar los resultados del algoritmo propuesto por el EWGSOP en 2010 con un algoritmo simplificado donde no se tiene en cuenta el rendimiento físico, encontramos una concordancia casi perfecta (kappa ≥ 0,96). CONCLUSIONES: La igualdad obtenida para la prevalencia de la sarcopenia independientemente del rendimiento físico cuestiona la necesidad de tener que medir este parámetro para el diagnóstico de sarcopenia. Sería suficiente utilizar un algoritmo simplificado para obtener los mismos resultados en el diagnóstico de la sarcopenia. Los hallazgos encontrados son coherentes con la propuesta hecha por el EWGSOP2 en 2018

INTRODUCTION: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a definition for sarcopenia. They also developed an algorithm based on the measurement of physical performance to determine cases of sarcopenia. Several studies have already been published that determine the prevalence of sarcopenia with this algorithm, but as far as we know, there are no published studies comparing the prevalence using 3 different methods for determining physical performance. The objective of our study was to determine the prevalence of sarcopenia in a group of elderly people using the algorithm proposed by the EWGSOP in 2010, and to compare the results using 3 different methods for determining physical performance. METHODS: A cross-sectional study was conducted with 97 elderly people. Measurements were obtained of muscle mass, muscle strength, and physical performance. To diagnose sarcopenia, the cut-off points and the diagnostic algorithm proposed by the EWGSOP were used. Cohen's Kappa coefficient was used for the analysis of the agreement between qualitative variables. RESULTS: The kappa coefficient, found by comparing the results for the 3 methods used to determine physical performance (Gait speed; Timed Up & Go test, Short Physical Performance Battery), suggests that there is no concordance between them. When comparing the prevalence of sarcopenia using 3 different methods for the determination of physical performance, the kappa coefficient found suggests that there is an almost perfect agreement (kappa ≥ 0.96). An almost perfect agreement (kappa ≥ 0.96) was found when comparing the results of the algorithm proposed by the EWGSOP in 2010 with a simplified algorithm where physical performance for the diagnosis of sarcopenia is not taken into account. CONCLUSIONS: The equality in the results obtained for prevalence showed that the measurement of physical performance is not a necessary parameter for the diagnosis of sarcopenia. To obtain the same results in the diagnosis of sarcopenia, it is enough to use a simplified algorithm. The findings found are consistent with the proposal made by the EWGSOP in 2018

Comparación de la prevalencia de sarcopenia en personas de edad avanzada según el algoritmo propuesto por el EWGSOP en 2010 para la identificación de casos de sarcopenia utilizando tres métodos diferentes para la determinación del rendimiento físico / Comparison of the prevalence of sarcopenia in elderly people according to the algorithm proposed by the EWGSOP in 2010 for sarcopenia case-finding using three different methods for determining physical performance

INTRODUCCIÓN: En 2010, el European Working Group on Sarcopenia in Older People (EWGSOP) publicó una definición de consenso para la sarcopenia. También desarrolló un algoritmo basado en la medición del rendimiento físico para la determinación de casos de sarcopenia. Se han publicado diversos estudios que determinan la prevalencia de sarcopenia con este algoritmo, pero hasta donde sabemos, no hay estudios publicados que comparen la prevalencia utilizando 3 métodos diferentes para la determinación del rendimiento físico. El objetivo de este estudio fue determinar la prevalencia de sarcopenia utilizando el algoritmo propuesto por el EWGSOP en 2010 y comparar los resultados utilizando 3 métodos diferentes para el rendimiento físico. MÉTODOS: Se trata de un estudio transversal de 97 personas de edad avanzada. Se obtuvieron medidas de masa muscular, fuerza muscular y rendimiento físico. Para diagnosticar la sarcopenia se utilizaron los puntos de corte y el algoritmo propuesto por el EWGSOP. El análisis de concordancia entre variables cualitativas utilizó el coeficiente kappa de Cohen. RESULTADOS: El coeficiente kappa encontrado comparando los resultados de los 3 métodos empleados para el rendimiento físico (Velocidad de la marcha; Timed Up & Go, Short Physical Performance Battery) indica que no existe concordancia entre ellos. El coeficiente kappa encontrado al comparar la prevalencia de la sarcopenia utilizando 3 métodos diferentes para el rendimiento físico indica que hay una concordancia casi perfecta (kappa ≥ 0,96). Al comparar los resultados del algoritmo propuesto por el EWGSOP en 2010 con un algoritmo simplificado donde no se tiene en cuenta el rendimiento físico, encontramos una concordancia casi perfecta (kappa ≥ 0,96). CONCLUSIONES: La igualdad obtenida para la prevalencia de la sarcopenia independientemente del rendimiento físico cuestiona la necesidad de tener que medir este parámetro para el diagnóstico de sarcopenia. Sería suficiente utilizar un algoritmo simplificado para obtener los mismos resultados en el diagnóstico de la sarcopenia. Los hallazgos encontrados son coherentes con la propuesta hecha por el EWGSOP2 en 2018

INTRODUCTION: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a definition for sarcopenia. They also developed an algorithm based on the measurement of physical performance to determine cases of sarcopenia. Several studies have already been published that determine the prevalence of sarcopenia with this algorithm, but as far as we know, there are no published studies comparing the prevalence using 3 different methods for determining physical performance. The objective of our study was to determine the prevalence of sarcopenia in a group of elderly people using the algorithm proposed by the EWGSOP in 2010, and to compare the results using 3 different methods for determining physical performance. METHODS: A cross-sectional study was conducted with 97 elderly people. Measurements were obtained of muscle mass, muscle strength, and physical performance. To diagnose sarcopenia, the cut-off points and the diagnostic algorithm proposed by the EWGSOP were used. Cohen's Kappa coefficient was used for the analysis of the agreement between qualitative variables. RESULTS: The kappa coefficient, found by comparing the results for the 3 methods used to determine physical performance (Gait speed; Timed Up & Go test, Short Physical Performance Battery), suggests that there is no concordance between them. When comparing the prevalence of sarcopenia using 3 different methods for the determination of physical performance, the kappa coefficient found suggests that there is an almost perfect agreement (kappa ≥ 0.96). An almost perfect agreement (kappa ≥ 0.96) was found when comparing the results of the algorithm proposed by the EWGSOP in 2010 with a simplified algorithm where physical performance for the diagnosis of sarcopenia is not taken into account. CONCLUSIONS: The equality in the results obtained for prevalence showed that the measurement of physical performance is not a necessary parameter for the diagnosis of sarcopenia. To obtain the same results in the diagnosis of sarcopenia, it is enough to use a simplified algorithm. The findings found are consistent with the proposal made by the EWGSOP in 2018

Associations between Plasmatic Polyunsaturated Fatty Acids Concentrations and Cognitive Status and Decline in Neurocognitive Disorders.

OBJECTIVE: To examine the association of plasmatic and erythrocyte concentrations polyunsaturated fatty acids (PUFA) with both cognitive status and decline. DESIGN: Longitudinal observational cohort study. SETTING: Memory Clinic of Lyon Sud university hospital. PARTICIPANTS: 140 patients, aged 60 and older, were referred to the memory clinic, and successively included in the cohort, between March 2010 and February 2014. MEASUREMENTS: Concentration of ω-3 PUFA (eicosapentaenoic: EPA and docosahexaenoic: DHA) and ω-6 PUFA (arachidonic: AA), were measured at baseline in plasma and in the erythrocytes membrane. Cognitive status was assessed using the mini mental state examination (MMSE), at baseline and every six months during follow-up. The median follow-up period was of 11,5 months. RESULTS: Compared to participants with minor neurocognitive disorders (MMSE≥24), participants with major neurocognitive disorders (NCD) had lower plasmatic concentrations of EPA and DHA (p<0.05) at baseline. Erythrocyte AA and DHA concentrations were significantly lower in patients with cognitive decline (defined as a ≥2 points loss of MMSE per year), while no difference in plasmatic concentrations was observed. CONCLUSIONS: Our study suggests that ω-3 PUFA plasma concentrations (mainly EPA and DHA) could be associated with cognitive status in older people. Moreover, in this exploratory study, lower erythrocyte PUFA concentrations (AA and DHA) were associated with accelerated decline and could be proposed as a surrogate marker for prediction of cognitive decline.

Comparison between investigations of induced stepping postural responses and voluntary steps to better detect community-dwelling elderly fallers.

In this paper, we review a physiological task that is predominant in preventing humans from falling, but that simultaneously also challenges balance: taking a step. In particular, two variants of this task are presented and compared: the voluntary step versus a step induced by an external and unpredictable perturbation. We show that, while these contribute different information, it is interesting to compare these. Indeed, they both are relevant in a global balance assessment and should be included within this, at the same level as tests usually dispensed in the clinical environment such as posturography. We choose to focus on the community-dwelling elderly population, to discuss means of early detection of risk of falls, in order to prescribe an appropriate prevention. An overview of posture-movement coordination and balance recovery strategies is also provided. Finally, a working hypothesis is suggested on how "compensatory protective" steps are controlled and how their evaluation could bring additional information to the global balance assessment of risk of fall.

Frailty and nutrition: searching for evidence.

Frailty is a geriatric syndrome that predicts disability, morbidity and mortality in the elderly. Poor nutritional status is one of the main risk factors for frailty. Macronutrients and micronutrients deficiencies are associated with frailty. Recent studies suggest that improving nutritional status for macronutrients and micronutrients may reduce the risk of frailty. Specific diets such as the Mediterranean diet rich in anti-oxidants, is currently investigated in the prevention of frailty. The aim of this paper is to summarize the current body of knowledge on the relations between nutrition and frailty, and provide recommendations for future nutritional research on the field of frailty.

A global cloud map of the nearest known brown dwarf.

Brown dwarfs--substellar bodies more massive than planets but not massive enough to initiate the sustained hydrogen fusion that powers self-luminous stars--are born hot and slowly cool as they age. As they cool below about 2,300 kelvin, liquid or crystalline particles composed of calcium aluminates, silicates and iron condense into atmospheric 'dust', which disappears at still cooler temperatures (around 1,300 kelvin). Models to explain this dust dispersal include both an abrupt sinking of the entire cloud deck into the deep, unobservable atmosphere and breakup of the cloud into scattered patches (as seen on Jupiter and Saturn). However, hitherto observations of brown dwarfs have been limited to globally integrated measurements, which can reveal surface inhomogeneities but cannot unambiguously resolve surface features. Here we report a two-dimensional map of a brown dwarf's surface that allows identification of large-scale bright and dark features, indicative of patchy clouds. Monitoring suggests that the characteristic timescale for the evolution of global weather patterns is approximately one day.

MAPT STUDY: A MULTIDOMAIN APPROACH FOR PREVENTING ALZHEIMER'S DISEASE: DESIGN AND BASELINE DATA.

OBJECTIVE: The Multidomain Alzheimer Preventive Trial (MAPT study) was designed to assess the efficacy of isolated supplementation with omega-3 fatty acid, an isolated multidomain intervention (consisting of nutritional counseling, physical exercise, cognitive stimulation) or a combination of the two interventions on the change of cognitive functions in frail subjects aged 70 years and older for a period of 3 years. Ancillary neuroimaging studies were additionally implemented to evaluate the impact of interventions on cerebral metabolism (FDG PET scans) and atrophy rate (MRIs), as well as brain amyloïd deposit (AV45 PET scans). DESIGN PATIENTS: 1680 subjects (mean age: 75.3 years; female: 64.8 %), enrolled by 13 memory clinics, were randomized into one of the following four groups: omega-3 supplementation alone, multidomain intervention alone, omega-3 plus multidomain intervention, or placebo. Participants underwent cognitive, functional and biological assessments at M6, M12, M24 and M36 visits. The primary endpoint is a change of memory function at 3 years, as assessed by the Free and Cued Selective Reminding test. All participants will be followed for 2 additional years after the 3-years intervention (MAPT PLUS extension study). INTERVENTIONS: 1/Omega-3 supplementation: two soft capsules daily as a single dose, containing a total of 400 mg docosahexaenoic acid (DHA), i.e., 800 mg docosahexaenoic acid per day, for 3 years. 2/ Multidomain intervention: collective training sessions conducted in small groups (6-8 participants) in twelve 120-minute sessions over the first 2 months (two sessions a week for the first month, and one session a week the second month) then a 60-minute session per month in the following three areas: nutrition, physical activity, and cognition until the end of the 3 years. In addition to the collective sessions, individualized preventive outpatient visits exploring possible risk factors for cognitive decline are performed at baseline, M12 and M24. BASELINE POPULATION: For cognition, the mean MMSE at baseline was 28.1 (± 1.6). About 58% and 42% of participants had a CDR score equal to 0 and 0.5, respectively. Regarding mobility status, 200 (11.9%) had a 4-m gait speed lower or equal to 0.8 m/s. According to the Fried criteria, 673 (42.1%) participants were considered pre frail, and 51 (3.2%) frail. The red blood cell DHA content was 26.1 ± 8.1 µg/g. Five hundred and three participants underwent baseline MRI. AV45 PET scans were performed in 271 individuals and preliminary results showed that 38.0% had a cortical SUVR > 1.17, which gave an indication of significant brain amyloïd deposit. DISCUSSION: The MAPT trial is presently the first largest and longest multidomain preventive trial relevant to cognitive decline in older adults with subjective memory complaints. The multidomain intervention designed for the MAPT trial is likely to be easily implemented within the general population.

Impact of geriatric risk factors on pegylated liposomal doxorubicin tolerance and efficacy in elderly metastatic breast cancer patients: final results of the DOGMES multicentre GINECO trial.

BACKGROUND: Metastatic breast cancer chemotherapy in the elderly is considered effective in carefully selected patients, but there is little data regarding its effect in vulnerable patients. METHODS: We evaluated tumour response (primary endpoint), feasibility and outcomes after six courses of an adapted dose of pegylated liposomal doxorubicin (PLD) (40 mg/m(2) every 28 days) as first-line chemotherapy for hormone-resistant MBC. RESULTS: Of 60 patients >70 years (median 77 years), 15% had performance status ≥2 and 73% had visceral metastases. Geriatric assessment included: ≥2 comorbidities, 42%; ≥1 deficiency in Activities of Daily Living (ADL), 10% and Instrumental ADL (IADL), 82%; living in residential homes, 12%; albumin <35 g/L, 17%; body mass index (BMI) <21, 20%; depression, 17%; and lymphocytes ≤1 × 10(3)/mm(3), 27%. Complete response, partial response and stable disease were observed in 5%, 15% and 60%, respectively, but only 48% completed six cycles. Treatment discontinuations were mostly due to disease progression (18%) and non-haematological (NH) toxicities (22%). Eight patients died during treatment (three possibly related to PLD), and 15 had unplanned hospital admissions. Exploratory analyses to identify geriatric covariates associated with treatment outcomes revealed severe haematological toxicities significantly correlated with lymphocytes ≤1 × 10(3)/mm(3). NH toxicities correlated with age ≥80 years and living in residential homes. Progression-free survival (median 6.1 months) decreased with age, deficiency in IADL, cardiac dysfunction and living in residential homes. Overall survival (median 15.7 months) also decreased with living in residential homes. CONCLUSION: Despite manageable haematological toxicities and expected response rates, PLD feasibility was poor in unselected elderly patients.

Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes.

BACKGROUND: The prevalence of vitamin D insufficiency is very high in the nursing home (NH) population. Paradoxically, vitamin D insufficiency is rarely treated despite of strong clinical evidence and recommendations for supplementation. This review aims at reporting the current knowledge of vitamin D supplementation in NH and proposing recommendations adapted to the specificities of this institutional setting. DESIGN: Current literature on vitamin D supplementation for NH residents was narratively presented and discussed by the French Group of Geriatrics and Nutrition. RESULT: Vitamin D supplementation is a safe and well-tolerated treatment. Most residents in NH have vitamin D insufficiency, and would benefit from vitamin D supplement. However, only few residents are actually treated. Current specific and personalized protocols for vitamin D supplementation may not be practical for use in NH settings (e.g., assessment of serum vitamin D concentrations before and after supplementation). Therefore, our group proposes a model of intervention based on the systematic supplementation of vitamin D (1,000 IU/day) since the patient's admission to the NH and throughout his/her stay without the need of a preliminary evaluation of the baseline levels. Calcium should be prescribed only in case of poor dietary calcium intake. CONCLUSION: A population-based rather than individual-based approach may probably improve the management of vitamin D insufficiency in the older population living in NH, without increasing the risks of adverse health problems. The clinical relevance and cost effectiveness of this proposal should be assessed under NH real-world conditions to establish its feasibility.

Intramyocellular lipid variations in active older men: relationship with aerobic fitness.

AIMS: Intramyocellular lipid (IMCL) variations in older men are poorly explored. In young adults, IMCL can be influenced by both diet and exercise interventions; this flexibility is related to aerobic fitness. We evaluated in active older adults the influence of maximal aerobic capacity on short-term diet and exercise-induced variations in IMCL stores. METHODS: Intramyocellular lipids were measured by (1) H magnetic resonance spectroscopy ((1) H-MRS) after a 3-day fat depletion-replenishment diet (IMCL(FDR) ) and immediately after a 2-h exercise at 50% VO(2) max (IMCL(FDR) (_) (EX) ). To further explore diet influence, the protocol was repeated after a high-fat diet (HF), with both pre- and post-exercise measurements (IMCL(HF) and IMCL(HF) (_) (EX) ). RESULTS: In active older men (69.8 ± 5.2 years), IMCL(FDR) was lowered by exercise (IMCL(FDR) = 3.45 ± 1.52 vs. IMCL(FDR) (_) (EX) = 2.74 ± 1.15 mmol kg(-1) wet weight, P < 0.05), and exercise-induced variations were correlated to the initial store (P < 0.05, r = -0.72). IMCL(FDR) was linked with aerobic fitness (P < 0.05, r = 0.76), when adjusted by fat mass. IMCL(HF) was lower than IMCL(FDR) (P < 0.05), decreased after exercise (P < 0.05) and varied also as a function of initial store (P < 0.05, r = -0.89), but without link with aerobic fitness. Finally, diet-induced IMCL store variations were positively linked to aerobic fitness (P < 0.05, r = 0.89). CONCLUSION: Variations of the IMCL stores in physically active older adults appear related to aerobic fitness, with similarly fast adaptation to short-term interventions combining diet and exercise as young active adults.

Recruitment strategies for preventive trials. The MAPT study (MultiDomain Alzheimer Preventive Trial).

1680 participants were randomized over the recruitment period in MAPT study. A total of 1290 participants were recruited in the 7 University Hospital centers, and 390 participants in the 6 memory clinics around Toulouse Gerontopole / Alzheimer Disease research clinical center. The first randomization was on May 30, 2008, and the targeted number of randomized participants was reached on February 24, 2011; 2595 subjects were finally screened, of which 1680 fulfilled the eligibility criteria which represents 64.8%. Approximately, one quarter of screened people refused to participate after the detailed presentation of the study and 4.3% were still interested in participating but missed for unknown reasons the baseline visit even after repeated contacts. Of the 1810 subjects who signed the consent for participating to the study at the baseline visit, 130 (7.1%) were excluded because one of the eligibility criteria was not satisfied. Interestingly, the higher percentage of randomizations compared to screened participants is the personal contact source; almost 85 % of screened participants entered in the study. In an equivalent way, Medias and conferences are efficient recruiting sources to enrol volunteers in the study. Unexpectedly, only about 60% of screened participants from the hospital and GP sources were randomized and 33.2% from health care services. Almost a quarter of the randomized participants come from the hospital outpatients clinics and approximately 20% from public conferences. A total of 1128 contacts yielded to 556 screened volunteers and 345 randomized participants in the coordinating center of Toulouse. Thus, 30 % of contacts were recruited.

Efficacy of a home-based intervention programme on the physical activity level and functional ability of older people using domestic services: a randomised study.

OBJECTIVE: Our main objective was to assess whether a home-based program supervised by home helpers (HH) during their normal working hours can prevent excessive sedentariness (mainly maximum walking time and distance) and preserve functional status in elderly people at risk for frailty or disability and using domestic services. DESIGN: A four-month, open label, randomised trial with two groups called "prevention" and "control". SETTING: In the homes of study participants. PARTICIPANTS: The participants were all over 78 years old, lived independently at home, and received the visits of HHs at least once a week. INTERVENTION: The intervention combined a self-administered exercise program, with 10 g amino-acid supplementation under the supervision of HHs. MEASUREMENTS: Main outcome measures included physical activity (the PASE questionnaire), functional tests, nutritional and autonomy scores, and compliance (50% or more was considered satisfactory). Non-parametric methods were used for comparisons between the two groups. A linear regression model was fitted to assess the effect of the intervention on the relative variation of outcomes, adjusted for unbalanced baseline co-variables. RESULTS: One hundred and two persons (prevention n=53, control n=49) with a median age of 85 years were included. Their median Activities of Daily Living and Instrumental Activities of Daily Living (IADL) scores were 6 and 7 respectively. Twenty-three (44%) were good compliers for both interventions. The maximum walking time remained stable while decreasing by 25% in the control group (p=0.0015); and fewer participants had a worsened IADL score in the prevention group (p=0.05). The baseline IADL Score was significantly associated with good compliance to the prevention program (p=0.0011). In good compliers, maximum walking distance and maximum walking time increased by 29.15% (0.0 to 66.7) and 33.3% (-20.0 to 50.0) respectively. CONCLUSION: This study confirms the feasibility of a prevention program supervised by HHs, and some benefit from the intervention and identifies predictors for better compliance. It will help in the design of prevention trials for elderly people at risk for frailty.

Disability related to COPD tool (DIRECT): towards an assessment of COPD-related disability in routine practice.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a worldwide public health concern. It is also a major source of disability that is often overlooked, depriving patients of effective treatments. This study describes the development and validation of a questionnaire specifically assessing COPD-related disability. METHODS: The DIsability RElated to COPD Tool (DIRECT) was developed according to reference methods, including literature review, patient and clinician interviews and test in a pilot study. A 12-item questionnaire was included for finalization and validation in an observational cross-sectional study conducted by 60 French pulmonologists, who recruited 275 COPD patients of stage II, III and IV according to the GOLD classification. Rasch modeling was conducted and psychometric properties were assessed (internal consistency reliability; concurrent and clinical validity). RESULTS: The DIRECT score was built from the 10 items retained in the Rasch model. Their internal consistency reliability was excellent (Cronbach's alpha = 0.95). The score was highly correlated with the Saint George's Respiratory Questionnaire Activity score (r = 0.83) and the London Handicap Scale (r = -0.70), a generic disability measure. It was highly statistically significantly associated to four clinical parameters (P < 0.001): GOLD classification, BODE index, FEV1 and 6-minute walk distance. CONCLUSION: DIRECT is a promising tool that could help enhance the management of COPD patients by integrating an evaluation of the COPD-related disability into daily practice.

Effects of branched amino acids supplementation in malnourished elderly with catabolic status.

BACKGROUND: Among various nutrients branched amino acids (BCAAS) have been shown to be the most responsible for the stimulation of protein synthesis in various situations including catabolic states. OBJECTIVES: We evaluated the effect of a small amount of proteins enriched with BCAAs (0.4 g/kg/day and 0.2 g/kg/day BCAAs) on body weight and composition; nitrogen balance, energy intake and inflammation after 2 weeks of supplementation in acute elderly with catabolic status. DESIGN: Two weeks randomized controlled trial. SETTING: Geriatric department of teaching hospital. SUBJECTS: Thirty patients with malnutrition and inflammatory process (MNA < 24, albumin < 30 g/l and CRP > or = 20 mg/l) who agreed to participate in the study were consecutively included. METHODS: Body composition was determined by labelled water dilution method; resting energy expenditure (REE) was determined by indirect calorimetry; energy intake was calculated for a 3 days period at D1 and D12. Nutritional and inflammatory proteins and cytokines (IL-6 and TNF) were measured at day 1 and 14. RESULTS: No difference was observed at day 14 between supplemented (S) and control (C) group for weight (S: 58.0 +/- 11.8 kg and C: 60.0 +/- 15.9 kg); fat free mass (S: 40.7 +/- 8.3 kg and C: 40 +/- 8.2 kg); nitrogen balance (S: 1.34 +/- 2.21 g/day and C: 0.59 +/- 4.47 g/day); and energy intake (S: 20 +/- 3.6 kcal/day and C: 20.5 +/- 8.6 kcal/day). Energy intake was at similar level than REE and clearly less than energy requirement in C and S. A significant decrease was observed for orosomucoid and Prognostic Inflammatory and Nutritional Index (PINI) in S. CONCLUSION: Our results do not confirm improvement of nutritional status with enriched BCAAs supplementation as suggested in the literature. Persistence of inflammatory condition may be an explanation despite an improvement of inflammatory status was observed in the supplemented group. Those results show clearly that energy requirements are not covered in acute hospitalized elderly people. The fact that not only energy intake but also REE are decreased brings a new insight on catabolic situations.

A giant planet imaged in the disk of the young star beta Pictoris.

Here, we show that the approximately 10-million-year-old beta Pictoris system hosts a massive giant planet, beta Pictoris b, located 8 to 15 astronomical units from the star. This result confirms that gas giant planets form rapidly within disks and validates the use of disk structures as fingerprints of embedded planets. Among the few planets already imaged, beta Pictoris b is the closest to its parent star. Its short period could allow for recording of the full orbit within 17 years.

Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force.

INTRODUCTION: The use of a simple, safe, and easy to perform assessment tool, like gait speed, to evaluate vulnerability to adverse outcomes in community-dwelling older people is appealing, but its predictive capacity is still questioned. The present manuscript summarises the conclusions of an expert panel in the domain of physical performance measures and frailty in older people, who reviewed and discussed the existing literature in a 2-day meeting held in Toulouse, France on March 12-13, 2009. The aim of the IANA Task Force was to state if, in the light of actual scientific evidence, gait speed assessed at usual pace had the capacity to identify community-dwelling older people at risk of adverse outcomes, and if gait speed could be used as a single-item tool instead of more comprehensive but more time-consuming assessment instruments. METHODS: A systematic review of literature was performed prior to the meeting (Medline search and additional pearling of reference lists and key-articles supplied by Task Force members). Manuscripts were retained for the present revision only when a high level of evidence was present following 4 pre-selected criteria: a) gait speed, at usual pace, had to be specifically assessed as a single-item tool, b) gait speed should be measured over a short distance, c) at baseline, participants had to be autonomous, community-dwelling older people, and d) the evaluation of onset of adverse outcomes (i.e. disability, cognitive impairment, institutionalisation, falls, and/or mortality) had to be assessed longitudinally over time. Based on the prior criteria, a final selection of 27 articles was used for the present manuscript. RESULTS: Gait speed at usual pace was found to be a consistent risk factor for disability, cognitive impairment, institutionalisation, falls, and/or mortality. In predicting these adverse outcomes over time, gait speed was at least as sensible as composite tools. CONCLUSIONS: Although more specific surveys needs to be performed, there is sufficient evidence to state that gait speed identifies autonomous community-dwelling older people at risk of adverse outcomes and can be used as a single-item assessment tool. The assessment at usual pace over 4 meters was the most often used method in literature and might represent a quick, safe, inexpensive and highly reliable instrument to be implemented.

Is there an association between serum 25-hydroxyvitamin D concentration and muscle strength among older women? Results from baseline assessment of the EPIDOS study.

OBJECTIVE: To examine whether low serum 25-hydroxyvitamin D (25OHD) concentration were associated with low muscle strength while taking into account the effects of potential confounders among a cohort of community-dwelling women aged 75 years and older. DESIGN: Cross-sectional study corresponding to the baseline assessment of the EPIDOS study. SETTING: Five French cities including Amiens, Lyon, Montpellier, Paris and Toulouse. PARTICIPANTS: Randomized sample of 440 women included in the EPIDOS study. MEASUREMENT: Maximal isometric voluntary contraction strength of the lower limb and hand with computerized dynamometers, serum 25OHD and parathyroid hormone concentration. Age at baseline evaluation, number of chronic diseases, body mass index (BMI), use of calcium drug, practice of a regular physical activity, serum calcium concentration and clearance of creatinine were used as covariables. Subjects were separated into 3 groups based on serum 25 OHD levels with the following cut-off values: < 15 ng/ml, 15-30 ng/ml and > 30 ng/ml. RESULTS: More than 90% of women had a serum 25OHD insufficiency (i.e. < 30 ng/ml) and 40.2% had a related secondary hyperparathyroidism. The mean value of muscle strength was not different among the 3 groups of women (174.9 +/- 53.2 for serum 25OHD < 15 ng/ml versus 175.9 +/- 52.6 for serum 25OHD 15-30 ng/ml versus 173.4 +/- 53.1 for serum 25OHD > 30 ng/ml with P=0.946 for quadriceps, and 56.1 +/- 13.2 for serum 25OHD < 15 ng/ml versus 57.1 +/- 13.5 for serum 25OHD 15-30 ng/ml versus 61.1 +/- 12.7 for serum 25OHD > 30 ng/ml with P= 0.064 for handgrip). There was no significant association between serum 25OHD concentration and quadriceps strength (crude beta = 0.03 with P = 0.891 and adjusted beta = -0.04 with P = 0.837). Univariate linear regression showed a significant association between serum 25OHD concentration and handgrip strength (crude beta = 0.16 with P = 0.049) but not while using an adjusted model (adjusted beta = 0.13 with P = 0.106). CONCLUSIONS: The findings of this study do not support the hypothesis of a relationship between low serum 25OHD concentration and low muscle strength. Further research is needed to corroborate and explain this finding.