Plasma selenium is positively related to performance in neurological tasks assessing coordination and motor speed.

Parkinson's disease (PD) is a degenerative process affecting the striato nigral system (SN). Its etiology, although obscure, may involve oxidative damage. Selenium, an antioxidant, was shown to protect the SN in animal models. In the current study, we investigate the association between plasma selenium concentrations and the presence of "soft" neurological signs related to the SN. Plasma selenium concentration was assessed in participants of age ≥65 years in the InCHIANTI study, a population-based cohort study in Tuscany, Italy. PD was defined based on standard criteria. "Soft" neurological signs were ascertained by physical examination. A total of 1,012 participants were included. No association was found between the presence of PD and plasma selenium. There was, however, a strong association between plasma selenium and timed performance-based assessments. Lower levels of selenium were significantly associated withdecreased performance in neurological tests of coordination among older adults. Prospective studies are needed to further investigate the effects of selenium on SN dysfunction.

Nutritional risk and health care use before and after an acute hospitalization among the elderly.

OBJECTIVE: Our objective was to assess the nutritional status and health care use of community-dwelling elderly before hospitalization and determine risk factors for longer hospitalizations during 3 mo of follow-up. METHODS: During a 1-y period, we recruited patients 65 y and older admitted to an internal medicine ward at Soroka Medical Center (Beer-Sheva, Israel). Data were obtained regarding health and nutritional status and demographic and social characteristics. We assessed the utilization of health care services during a follow-up period of 3 mo. RESULTS: Seventy-nine of 204 patients (38.7%) were at nutritional risk. Patients at nutritional risk were older (P < 0.001) and less educated (P = 0.03) than the well-nourished group. Nutritional risk was associated with more diagnosed diseases, days of hospital stay, and physician visits before admission. Participants hospitalized for more than 6 d were significantly less educated, with lower cognitive, functional, Mini Nutritional Assessment, and Nutritional Risk Index scores and a significantly higher depressive symptoms score. Functional status and sum of nutritional problems were significant predictors of length of hospitalization in the following 3 mo. CONCLUSION: Nutritional risk is a source of concern for health care providers and services, because it significantly increases risk of hospital admission and length of stay. It is important to increase the awareness of primary care providers to the impact of nutrition on health care use and provide appropriate tools to screen and treat nutritional problems.

Nutritional status in relation to balance and falls in the elderly: a preliminary look at serum folate.

BACKGROUND/AIM: In elderly persons, fall-related injury is a serious public health problem. We investigated the impact of essential nutritional elements on falls in the elderly. METHODS: Clinical function, balance, gait and disability tests and health and nutritional status assessments were performed. All subjects were interviewed regarding the occurrence of falls in the last year. Blood tests for serum vitamin D, folate and B(12) were conducted among a randomly selected subsample of 54 participants in the same month. RESULTS: One hundred 65- to 91-year-old volunteers participated in the study, and 29 of them fell at least once during the past year. The depression score was higher (indicating more depressive symptoms) among fallers compared with non-fallers (4.0 +/- 3.2 vs. 2.5 +/- 2.3, respectively). The overall function score (indicating better function) was marginally higher in non-fallers. Subsequent comparisons between fallers and non-fallers were adjusted for overall function and depression scores. Serum folate was significantly lower in fallers (9.5 +/- 7.1 vs. 16.2 +/- 6.7 ng/ml, p = 0.02). Dietary intake was equal in both groups. Correlation analyses indicate a significant association between vitamin D and the functional measurements: timed get up and go (negative), Berg balance test, overall functional score, lower extremity score and limitation score (positive correlation coefficients). Serum folate was highly and negatively associated with the number of falls and with prescribed medications and was the only protective factor against falls in a multivariate analysis. CONCLUSIONS: Vitamin D was related to most functional and balance measurements. Serum folate was protective against falls. For every 1 ng/ml increase in serum folate the occurrence of falls decreased by 19%.

Diet and eating habits in high and low socioeconomic groups.

OBJECTIVE: We measured the difference of dietary intake and eating habits across socioeconomic statuses (SESs) in Israel. METHODS: Participants were randomly recruited from three high SES municipalities and three low SES municipalities in the Negev. Participants were interviewed at home with 24-h food questionnaires that included additional questions regarding health and eating habits. Nutrient and energy intakes were compared between groups, as were major contributors to the energy and food groups. RESULTS: One hundred sixteen participants from the high SES group and 206 from the low SES entered the study. Those in the low SES group were older, heavier, less educated, and less physically active. Dietary intake among the participants in the low SES group was significantly lower in protein, monounsaturated fat, and most vitamins and minerals (thiamine, riboflavin, niacin, vitamin C, calcium, magnesium, and iron). Conversely, vitamin E intake was higher in the low SES group. In the low SES group, the main contributors to energy intake were breads, oils, and sugars. Oils, fats, and citrus fruits were consumed more among subjects in the low SES group, whereas dairy products, grains, and legumes were consumed less by subjects in the high SES group. CONCLUSION: In a detailed survey conducted in two distinct populations, we found poorer diet quality in the low SES group. The root causes for such divergence need further study. As smoking declines in the modern world, nutrition will become the key risk factor in many diseases. Further research and educational and legislative initiatives are needed to curtail this risk.

[Low-weight and weight loss as predictors of morbidity and mortality in old age].

BACKGROUND: Elderly individuals who experience weight loss are at increased risk of premature death and disability. These data contradict findings among younger populations, showing direct relationship between Body Mass Index (BMI) and chronic diseases. METHODS: In the following manuscript we reviewed papers published in medical as well as in nutritional journals in the area of weight change, morbidity and mortality in old age, since 1990. RESULTS: Recent data indicates that among the elderly, unintentional weight loss of 5% of baseline weight during a period of 1 year marks the beginning of nutritional deterioration. As for BMI, in most studies that were reviewed for this manuscript, BMI of over 25 was protective. In a large study that was conducted in Hong Kong with 2032 participants aged 70 and older, low baseline weight was associated with mortality and was an independent predictor for the development of new diseases. In another large multicentered cohort study in the USA, 4714 participants were followed. Mortality rates among weight losers were twice as high as mortality rates among the rest of the group. CONCLUSIONS: Low-weight and weight loss are independent predictors for mortality among the elderly population. There is a need to develop and implement screening methods for weight loss in all the medical settings that deal with elderly people. Additionally, there is a need for developing and assessing models for intervention among elderly people who are at nutritional risk.

[Drug related taste disturbances: emphasis on the elderly].

BACKGROUND: Taste disturbances are common among the elderly due to physiologic changes, diseases, and medications. As many as 11% of elderly persons using multiple drugs report taste aberrations. The main danger of taste decline and disturbance in the old is food-anhedonia, causing loss of body weight via decreased calorie and nutrient intake. GOALS: To overview drug related taste disturbances emphasizing the elderly. METHODS: Review of Hebrew and English medical literature. RESULTS: Taste-disturbances can be divided into hypogeusia [diminished sense of taste], ageusia [absence of taste], and the 2 types of dysgeusia [taste distortion]: aliageusia [food related] and phantogeusia [taste illusions]. The mechanisms by which drugs impair taste are numerous, and may be related to drug chemical structure. The treatment of taste disturbances is empiric and has limited success. Treatments include: shifting drugs within the same class, zinc replacement (proven to enhance taste sensation for sweet, bitter and salty flavors), palliative measures (use of mints, sugarless chewing-gums, and bicarbonate mouthwashes), niacin and vitamin A ameliorate hypo and dysgeusia. CONCLUSIONS: Disturbed taste sensation is common among the elderly, and should be considered whenever unexplained nutritional decline is present. Scrupulous drug screening is mandatory, and other intervention modalities can be beneficial.

High prevalences of vitamin B12 and folic acid deficiency in elderly subjects in Israel.

The prevalences of vitamin B12 and folic acid deficiency in the general Israeli population of elders has not been assessed. We measured plasma cobalamin and folic acid concentrations in 418 subjects from four institutions for the aged, 749 subjects attending 19 geriatric day centres and 104 healthy controls. Methylmalonic acid (MMA) and/or homocysteine concentrations were determined in subjects who had a cobalamin concentration <221 pmol/l or folic acid concentration <11 nmol/l respectively. The prevalences of vitamin B12 deficiency (cobalamin <147 pmol/l and MMA > or =0.24 micromol/l), and folic acid deficiency (folic acid <11 nmol/l and homocysteine of >15 micromol/l) in subjects from day centres were 12.6% and 16.4% respectively, and in subjects from institutions 1.2% and 2.2% respectively (P < 0.001). Multiple logistic regression analysis indicated that the relative risk of living at home versus institutions for the aged was highly significant, with odds ratios (OR) of 6.8 [95% confidence interval (CI) 2.6-18.0] for vitamin B12 deficiency and 6.6 (95% CI 2.9-13.1) for folic acid deficiency. Analysis of data for day centre patients showed that folic acid deficiency was a significant risk factor of vitamin B12 deficiency (adjusted OR 3.68, 95% CI 2.27-5.98), and vitamin B12 deficiency was a significant risk of folic acid deficiency (adjusted OR 3.69, 95% CI 2.27-6.01). These data suggest that malnutrition is a major cause of the highly prevalent deficiencies of vitamin B12 and/or folic acid in elderly Israeli subjects dwelling at home.