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01/2013 journal articles

COMPARISON OF SKELETAL MUSCLE MASS TO FAT-FREE MASS RATIO BETWEEN JAPANESE-BRAZILIANS AND JAPANESE

T. Abe, Y. Kawakami, M. Bass, M. Kondo, T. Fukunaga

J Aging Res Clin Practice 2013;2(1):3-6

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Background: It is unclear whether there are differences in absolute and relative skeletal muscle mass (SMM) between Japanese-Brazilians living in Brazil and Japanese living in Japan. Objective: To compare the SMM to fat-free mass (FFM) ratio as well as body composition. Design, setting, and participants: Eighty-four Japanese living in Tokyo and 85 Brazilians and 28 Japanese-Brazilians living in Sao Paulo were recruited for this cross-sectional study. Measurements: Muscle thickness (MTH) and subcutaneous fat thickness (FTH) were measured by B-mode ultrasound at nine anatomical sites on the anterior and posterior aspects of the body. Percentage body fat was estimated from FTH, and FFM was calculated. Total SMM was estimated using an ultrasound-derived prediction equation from MTH. Results: Body mass index were similar among the ethnic groups in men and women, while percent body fat was lower in Japanese than in Brazilians and Japanese-Brazilians. In men, absolute FFM and SMM were lower in Japanese-Brazilians than their Japanese and Brazilian counterparts. In women, there was no significant difference in absolute FFM among ethnic groups, but absolute SMM was lower in Brazilians and Japanese-Brazilians than in Japanese. As a result, the SMM:FFM ratio was lower in Brazilians and Japanese-Brazilians than in Japanese in men and women. Conclusion: SMM:FFM ratio was lower in both Brazilians and Japanese-Brazilians compared to Japanese, which may be associated with environmental factors.

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THE DISCREPANCY OF FAT-FREE MASS MEASURED BY DUAL ENERGY X-RAY ABSORPTIOMETRY AND AIR-DISPLACEMENT PLETHYSMOGRAPHY VARIES WITH AGE AND ADIPOSITY – IS IT RELATED TO FAT INFILTRATION?

T.W. Auyeung, J.S.W. Lee, T. Kwok, M. Li, S. Hui, J. Woo

J Aging Res Clin Practice 2013;2(1):7-10

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Background: The discrepancy of fat-free mass (FFM) measured by dual energy x-ray absorptiometry (DXA) and air-displacement plethysmography (ADP) could be attributed to the erroneous inclusion of inter-muscular adipose tissue (IMAT) which increases with age and adiposity, as part of FFM measured by DXA. We, therefore, attempted to examine whether this disagreement was related to age and adiposity. Methods: One hundred and seventy two participants aged 20 to 76 years, were examined by ADP and DXA to measure their body density (BD) and FFM respectively. FFM was also derived from BD using the 2-compartment model where: (FM+FFM)/BD = FM/FM density + FFM/FFM density. The FFM and FM density was assumed to be 1.1000 and 0.9007 respectively. The difference between DXA-measured and ADP-derived FFM was calculated and the association between this difference with age, gender, body mass index (BMI), Waist-hip ratio (WHR) was examined by multiple linear regression. Results: The DXA-measured FFM was 2.2 kg (2.3 %FFM) higher than the ADP-derived FFM. In multivariate analysis, higher BMI, higher WHR and older age was significantly associated with greater difference between DXA-measured and ADP-derived FFM. Conclusion: DXA-measured FFM was higher than that derived by the 2-compartment model using ADP BD measurement. This variation was significantly associated with older age, general and central adiposity. Comparison of DXA-measured muscle mass across a wide range of age and adiposity should take this into consideration. Fat infiltration into skeletal muscles in older and more obese adults may contribute to the unexplained discrepancy between the two methods.

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IMPACT OF WEIGHT LOSS AND AEROBIC EXERCISE ON NUTRITION AND BONE MINERAL DENSITY IN AFRICAN AMERICAN AND CAUCASIAN POSTMENOPAUSAL WOMEN

M.C. Serra, J.B. Blumenthal, A.S. Ryan

J Aging Res Clin Practice 2013;2(1):11-16

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Background: Weight loss is often recommended for obese women to reduce fat mass and the risk of developing chronic diseases, but may result in a reduction of bone mineral density (BMD). African Americans have greater BMD than Caucasians, but differences in the decrease in BMD between these races following weight reduction with and without exercise are unknown. Objectives: The purpose of this study was to investigate the hypothesis that Caucasian women would lose greater amounts of BMD than African American women after undergoing weight loss, but that the addition of aerobic exercise would attenuate the loss in both races. Design: Longitudinal. Participants: African American (n=34) and Caucasian (n=63), overweight and obese postmenopausal (age 45-80 years). Intervention: Six months of weight loss (250-350 kcal/days deficit) alone (WL) or in combination with aerobic exercise consisting of 3 days/week treadmill training at >85% of heart rate reserve for 45 min (AEX+WL). Measurements: Femoral neck, total femur, and lumbar BMD, VO2max, urinary calcium, and dietary intake. Results: African American women had a greater body weight, BMI, and BMD all sites and lower dietary protein and calcium intakes than Caucasian women (all P<0.05). Weight decreased 7.5% in both groups and VO2max increased only after AEX+WL (intervention effect, P<0.001). Both races lost ~1% of their femoral neck and total femur BMD following the interventions (P’s<0.01). There were no race by intervention interactions. There was a trend for the women undergoing WL to lose greater femoral neck BMD than those in AEX+WL (P=0.07). There were no associations between changes in BMD and changes in VO2max, urinary calcium, or dietary intake. Conclusions: Our data indicate that despite beginning the interventions with greater BMD than Caucasian postmenopausal women, African Americans were not spared from losses of femoral neck and total femur BMD following six months of weight loss, but that addition of aerobic exercise to weight loss tends to attenuate the decreases in femoral neck BMD in both races.

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EFFECTIVENESS OF ACETYLCHOLINESTERASE INHIBITORS AND MEMANTINE IN THE TREATMENT OF ALZHEIMER’S DISEASE: A SYSTEMATIC REVIEW AND COMPARATIVE ANALYSIS

R. Modha, G. Pietri, B. Schauble, M. Gaudig

J Aging Res Clin Practice 2013;2(1):17-31

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Introduction: Many randomized throughout placebo-controlled trials have investigated the use of acetylcholinesterase inhibitors (AChEIs) and memantine in Alzheimer’s disease (AD). However, few trials comparing different drugs have been conducted, meaning their relative effectiveness is not well-established. Methods: A systematic review of randomized controlled trials was conducted to identify the evidence base for donepezil, galantamine, rivastigmine, and memantine when used within European licensing limits. Literature databases (start to March 2010) and conference proceedings (2007 - 2010) were screened. Mixed treatment comparisons (MTC), were used to evaluate the comparative efficacy and safety. Results: Fifty-eight studies were identified; 48 were placebo comparisons, indicating the limited comparative evidence. Direct meta-analysis demonstrated that AChEIs are associated with significant advantage over placebo in cognitive outcomes at 3 months and 6 months (p<0.05); the pooled results of two studies did not indicate a significant advantage for memantine over placebo. An advantage for galantamine and donepezil over placebo in behavior at 6 months (NPI scale) was observed. MTC analysis identified no significant difference between AChEIs for cognition at 3 and 6 months, nor for behavior. A small increase in frequency of any adverse event was observed for AChEIs (approximate relative risk of 1.1) but not for memantine. Oral rivastigmine was associated with a higher risk of all and specific adverse events than other treatments. Conclusions: The benefits of AChEIs but not memantine on cognition in AD were established. No clear difference in cognition or behavior is apparent between AChEIs.

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PHARMACOLOGICAL, BIOCHEMICAL AND TOXICOLOGICAL EVALUATION OF POTASH ALUM AS ANTI-OBESITY AGENT

Z. Ahmed, I. Kazmi, M. Afzal, M. Pravez, R. Singh, S. Saleem, R. Kaur, F. Anwar

J Aging Res Clin Practice 2013;2(1):32-34

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The objective of present study was to evaluate the role of Potash Alum as an anti obesity agent in Wistar rats fed on high fat diet (HFD). Animals were fed on HFD (58% fat) with or without Potash Alum for 24 weeks. Results revealed that oral intake of Potash Alum exhibited significant reduction in body weight, food intake, serum triglycerides (TG), total cholesterol (TC), high density lipoproteins (HDL), alkaline phosphatase (ALP), serum glutamic oxaloacetic transaminase (SGOT), Serum glutamic pyruvic transaminase (SGPT) whereas simultaneously increased the dry weight of feces, total lipids in feces, in kidneys and liver compared to HFD fed control. Furthermore, a particularly new observation i.e., the enlargement of teeth along with gummosis was noticed with the treatment.

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RELATIONSHIP BETWEEN BODY COMPOSITION AND BONE MASS IN ELDERLY EGYPTIAN WITH PRIMARY OSTEOPOROSIS

A.K. Mortagy, S.A. Hamza, S.M.S. El Said, M.Z. Abdelwadoud, A.H. Mohammed, M.S.S. Elaraby

J Aging Res Clin Practice 2013;2(1):35-38

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Objectives: To detect the relationship between body composition and primary osteoporosis in elderly Egyptian. Method: A case control study performed among 100 elderly participants divided into two groups; a case group comprised 50 elderly patients with osteoporosis and 50 elderly as control group. Each participant was subjected to clinical examination, evaluation of bone mineral density (BMD) and body composition, laboratory investigations to exclude secondary osteoporosis. Results: Body Mass Index (BMI) was significantly more among the control group (P< 0.5). Total fat mass (TFM), fat percentage (FP) was significantly more among the control group. On the other hand lean percentage was significantly higher among cases (P<0.05). Significant correlations between; TFM with BMD in L2-4, and BMD of neck femur and BMD in L2-4(P<0.05) were found. Highly significant correlation between serum albumin and calcium and femur T score. Conclusion: BMD is highly correlated with weight and BMI and elements of body composition including total fat mass and fat percentage. There is positive correlation between serum calcium and albumin level with BMD.

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MALNUTRITION IN A SAMPLE OF COMMUNITY-DWELLING OLDER PENNSYLVANIANS

R.A. DiMaria-Ghalili, Y.L. Michael, A.L. Rosso

J Aging Res Clin Practice 2013;2(1):39-45

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Objectives: Determine the prevalence of malnutrition in community-dwelling older adults with an adapted MNA and analyze the association of nutritional status with use of community-based programs. Design: Random digit dial telephone survey. Participants: Probability sample of community-dwelling adults aged 60 years and older living in Southeastern Pennsylvania (n= 3,209 adults). Measurements: Standardized questionnaires were administered by trained interviewers. Scores for each MNA item were derived from survey items (food intake, mobility, psychological stress and hospitalization, depression, height and weight). Results: Thirty-eight percent of older adults were well nourished (n = 1,168), 56.3% (n=1,740) were at-risk, and 5.9% (n = 183) were malnourished. Malnourished older adults were more likely to live alone, reside in the city, receive food stamps, have no usual source of health care, and report fair and poor self-rated health (p < .05). Malnourished older adults were more likely to use transportation services (Odds Ratio (OR) = 2.19 [95% Confidence Interval (CI): 1.47, 3.25]) and housing services (OR = 2.83 [95% CI: 1.80, 4.46]). Conclusion: This is the first study to use the MNA in a probability sample of older adults in the U.S. Our results have important health and policy implications related to providing services to malnourished older adults. In our sample, malnourished older adults were less likely to have a usual source of health care, but were more likely to use transportation and housing services. Agencies providing community-based services could incorporate nutrition screening programs to help identify the most vulnerable older adults.

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NUTRITIONAL ASSESSMENT OF GERIATRIC OUTPATIENTS USING MNA AND MUST SCREENING TOOLS

I.M. Heemels, A. Janse, J.H.M. de Vries, C.P.G.M. de Groot

J Aging Res Clin Practice 2013;2(1):46-50

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Rationale: For optimal treatment of malnutrition, hospital outpatients need to be screened early. MUST is a recommended screening tool, but MNA or MNA-SF might be more effective in predicting outcome for geriatric outpatients. Objective: To compare MNA and MNA-SF with MUST in screening for malnutrition in geriatric outpatients. Design: A cross-sectional, comparative study was performed during 8 consecutive weeks. Setting: During their visit to the outpatient clinic of Hospital ‘Gelderse Vallei’ (ZGV) patients were screened. Participants: Exclusion criteria (age <65 y, truth disclosure) reduced sample size from 224 to 152. Measurements: After performing CGA, based on MNA-SF, MNA and MUST questions, risk of malnutrition was assessed. Results: MNA-SF indicated 53.9% (n=82) of patients as ‘possibly malnourished’, of whom MNA classified 57.3% as ‘at risk’ and 4.9% as ‘malnourished’. MUST classified 12.5% (n=19) and 2% (n=3) of patients respectively as ‘medium risk’ and ‘high risk’. MNA-SF and MUST classified 40.8% (n=62) and MNA and MUST 46.3% (n=38) patients differently (McNemar test, p<0.0001). There was fair agreement between both MNA-SF and MUST and between MNA and MUST (kappa=0.23 and k=0.22, respectively). Significant differences (p<0.0001) in classification were determined by the items ‘mobility’, ‘declined food intake >3days’, ‘psychological stress’, ‘weight loss’, in the MNA and ‘weight loss’ in the MUST. Conclusion: MNA classified more geriatric outpatients as malnourished than MUST, and may therefore prevent missing patients at risk. MNA may be more suitable in this population because it includes more geriatric oriented risk factors that point out the issues needing attention for treatment of malnutrition.

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CALF CIRCUMFERENCE AND BODY MASS INDEX ARE MORE USEFUL PREDICTORS OF HOSPITALIZATION THAN THE MINI NUTRITIONAL ASSESSMENT IN INSTITUTIONALIZED JAPANESE ELDERLY

C. Momoki, F. Hayashi, R. Tanaka, S. Miyata, Y. Hayashi, A. Otuka, M. Nakahira, K. Yamagishi, S. Hirata, S. Ohfuji, W. Fukushima, Y. Hirota, D. Habu

J Aging Res Clin Practice 2013;2(1):51-56

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Objective: The objective of this study was to determine independent nutritional assessment factors affecting hospitalization due to deteriorating symptoms and to examine nutritional assessment when these factors were substituted for MNA in institutionalized elderly Japanese people. Methods: Eighty subjects (21 men and 59 women, 81.4±9.2 years) were enrolled. Multivariate logistic regression analysis was used to determine independent factors influencing hospitalization during a follow-up period of approximately 1 year. Associations between nutritional assessment using these factors, MNA and anthropometric variables, and dietary intakes were assessed. Results: Twenty-two subjects were hospitalized during the 1-year follow-up period. Body mass index (BMI) < 22kg/m2 (OR=5.68, 95%CI 1.31-24.7), calf circumference (CC) < 29cm (OR=5.75, 95%CI 1.64-20.2), arm muscle area (AMA) ≤ 36cm2 (OR=4.39, 95%CI 1.25-15.4), and arm muscle circumference (AMC) ≤ 21cm (OR=3.00, 95%CI 0.87-10.4) were associated with hospitalization in multivariate analysis. MNA was not associated with hospitalization (malnutrition group OR = 3.69; 95% CI 0.48–28.6). In CC and BMI groups, all anthropometric variables were significantly different such as MNA groups . In BMI groups, anthropometric variables without activities of daily living (ADL) were different. Cumulative hospitalization was only significantly different in 2 CC groups. Conclusion: These results show that CC and BMI are more useful predictors of hospitalization than MNA and are useful as independent nutritional assessment variables in this study.

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THE CHANGE IN MINI-NUTRITIONAL ASSESSMENT (MNA) SCORES ON ADMISSION AND DISCHARGE FROM AN ASIAN COMMUNITY HOSPITAL

C.P. Phua, S.Y. Tan, E.T. Boen, S.M. Yu, T.Z. Ho

J Aging Res Clin Practice 2013;2(1):57-60

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There is a high prevalence of malnutrition in local nursing homes and hospitals.1,2 As such it is important to develop a systemic and practical approach to identify this group at patients during their stay in community hospitals to improve their clinical outcome. Aims: Our objectives are to find out the prevalence of malnutrition in elderly (age > 65) patients on admission and on discharge from a community hospital and develop a quality indicator to assess patients’ change in nutritional status. Methods: The mini-nutritional assessment administered for geriatric patients (age ≥65 years old) admitted to a community hospital over a 3 month period on admission and before discharge. Demographics data, Charlson Score, Modified Barthel Index score (on admission and before discharge), mode of feeding and length of stay are also obtained. The newly proposed nutritional improvement score, the Inpatient Nutritional Improvement Score is calculated by the following formula: (Mini-nutritional assessment score on discharge minus score on admission) / Mini-nutritional assessment score on admission. Results: 33.8% of the patients were malnourished on admission using the mini-nutritional assessment. The mean Inpatient Nutritional Improvement Score was 0.19. The factors correlated with a higher score are presence of nasogastric tube on admission, oral supplements and a longer length of stay. Age, initial Barthel, Charlson score, race, gender (Chinese) and number of dietitian reviews were not significantly related with the Inpatient Nutritional Improvement Score. Conclusion: There is a high prevalence of malnutrition in the community hospital. The proposed Inpatient Nutritional Improvement Score is simple to calculate and is useful to track the nutritional improvement of patients in a community hospital.

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THE MINI NUTRITIONAL ASSESSMENT AS AN INDICATOR OF FRAILTY IN OLDER FINNISH PEOPLE

I. Nykänen, T.H Rissanen, S. Hartikainen

J Aging Res Clin Practice 2013;2(1):61-64

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Objective: To evaluate how well the Mini Nutritional Assessment (MNA) screening test is able to identify frailty in community-dwelling older people. Design: Cross-sectional study. Setting: Population-based. Participants: 584 persons aged 75 and older (mean 81.2 SD 4.6), 70% female. Measurements: Nutritional status was assessed using the MNA and frailty was defined according to the modified Fried´s frailty criteria (FCC). Results: According to the mini-nutritional assessment classification, 65% (n=380), 34% (n=199), and 1% (n=5) of the participants were assessed as well-nourished, at risk of malnutrition, and malnourished, respectively. Using the FFC, 38% (n=219) were not-frail, 47% (n=276) were pre-frail and 15% (n=89) were frail. Of all 199 participants identified as being the risk of malnutrition by MNA, 15% (n=30) were not-frail, 52% (n=104) were pre-frail and 33% (n=65) were frail, by FFC. Furthermore 50% (n=189) were not-frail, 45% (n=170) were pre-frail and 5% (n=21) were frail among well-nourished participants. The sensitivity of the MNA in identifying frailty was 0.50, specificity 0.86, positive predictive value 0.85, negative predictive value 0.52 and the Youden Index 0.36. Conclusion: Mini Nutritional Assessment screening test is not sufficiently sensitive for screening frailty status in older population. Frailty is a comprehensive syndrome and may require a more extensive screening tool including all components of frailty.

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ESTIMATING NUTRITIONAL STATUS IN A SMALL COHORT OF ELDERLY CARE HOME RESIDENTS USING MUST, MNA AND BIOELECTRICAL IMPEDANCE PHASE ANGLE AND VECTOR ANALYSIS

A. Slee

J Aging Res Clin Practice 2013;2(1):65-70

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Objectives: This study aimed to perform a non-invasive nutritional assessment in a group of elderly care home residents over a two-month period to estimate nutritional status using the malnutrition universal screening tool (MUST), the mini-nutritional assessment (MNA)-short form (-SF) and full version (-FULL), and bioelectrical impedance assessment (BIA). Design: An observational study performed over a 2 month period. Setting: A residential nursing care home in Lincolnshire, United Kingdom. Participants: 14 elderly Caucasian participants with presence of significant comorbidity were recruited (8 females and 6 males), mean age 85.6 ±6.2 (77-96). Measurements: Anthropometric measurements (height, weight, mid-upper arm and calf circumferences), calculation of body mass index (BMI), MUST and MNA scoring, and BIA at 50 kHz were completed at weeks 0, 4 and 8. BIA phase angle (PA) and BIA vector analysis (BIVA) at 50 kHz was investigated. Results: Group BMI indicated that the residents were a mixed group of body sizes and on average generally well nourished (e.g. week 0: 26.4kg/m2±6.5 (18.3-35.9). The MUST tool categorised residents predominantly within the low risk/normal range (62-67%); whereas MNA-SF placed the majority within medium/at risk category (57-77%); and MNA-FULL within medium/at risk (64-92%). PA (group at 0: 4.1±1.2 (2.2-6.7)) and BIVA indicated group data was similar to reference data for comorbid elderly populations with a lower nutritional and functional status. Conclusion: Study results indicate a potential data trend whereby there may be a mismatch in the assessment of nutritional status using MUST compared to the MNA. BIA PA and BIVA data supported the MNA results and were found to be consistent with reference population groups. Further studies in larger cohort groups will be necessary to confirm or refute this finding.

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LESS HEALTHY ELDERLY EATING LESS FOOD ARE IDENTIFIED BY A MODIFIED MNA TOOL

D. Nitzan Kaluski, F. Stern, J. Kachal, R. Goldsmith, T. Shimony, R. Dichtiar, L. Keinan-Boker

J Aging Res Clin Practice 2013;2(1):71-77

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Background: The MABAT ZAHAV survey is part of several National Health and Nutrition surveys conducted in Israel over the past decade in different population groups. Objectives: To ascertain whether a modified form of the Mini Nutritional Assessment (MNA) tool identifies community-dwelling elderly Jews at risk of malnutrition by evaluating their food groups and nutrient intakes. Design: A Cross-sectional study. Participants and setting: A total of 1,499 free-living Jewish elderly sampled from two major Health Insurance Funds in Israel were interviewed at their homes. This study analyses were restricted to 1,016 and 1,067 elderly with modified full MNA and modified MNA-SF, respectively. Measurements: Nutritional status was assessed using a modified full MNA and a modified short form MNA (MNA-SF). To evaluate food intake, a 24-hour dietary recall was carried out. Results: Based on the modified full MNA score, about 64% of the elderly had normal nutritional status, 34% were at risk of malnutrition and 2% were malnourished. The corresponding proportions based on the modified MNA-SF score were 66%, 28% and 6%, respectively. According to the modified full MNA, elderly 'at risk of malnutrition' compared to those with 'normal nutritional status', consumed significantly less portions of some food groups. Their energy, macronutrient and selected micronutrient intakes were also significantly lower. According to the MNA-SF, the only significant differences were found for energy, macronutrients and selected micronutrients, with a lower consumption in the elderly at risk of malnutrition. With the modified full MNA being utilized as a gold-standard, the modified MNA-SF sensitivity (for 'risk of malnutrition' vs. 'normal nutritional status') was 85% and its specificity, 96%. Conclusions: The modified full MNA accurately captures elderly at risk of malnutrition, and its scores are highly correlated to those of the modified MNA-SF. Thus MNA-SF can be used by the community health care services to screen for malnutrition risk.

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ADDITIVE EFFECT OF TAI CHI DURING DIETARY WEIGHT LOSS ON PHYSICAL FUNCTION AND BODY COMPOSITION IN OBESE OLDER WOMEN

L.A. Katkowski, M.C. Benson, S. Magnanti, I.E. Lofgren, F. Xu, M.J. Delmonico

J Aging Res Clin Practice 2013;2(1):78-85

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Background: While exercise during dietary weight loss has been shown to improve physical function and body composition, Tai Chi during weight loss has not been studied in obese older women. Objective: To investigate the effects of Tai Chi during dietary weight loss on measures of body composition and physical function. Design: Randomized controlled trial. Setting: Laboratory setting at a university. Participants: Twenty seven obese older women randomized to a weight loss only group (WL, n=13, aged 62.7±6.0 years) or a Tai Chi plus weight loss group (TCWL, n=14; aged 60.4±5.9 years). Intervention: Both groups participated in behaviorally-based, 16-week, dietary program (modified Dietary Approaches to Stop Hypertension) for weight loss. In addition, the TCWL group completed three sessions per week of a modified 24 form Yang style Tai Chi. Measurements: Body fat mass and the 400 meter walk. Results: Both groups significantly lost body mass (TCWL, -2.2±0.9 kg; WL, -3.7±0.9 kg; p<0.05) with no between-group differences. Body fat mass change did not differ between the groups (p=0.727). There was a borderline attenuation of fat-free mass (FFM) between the TCWL group and the WL group (p=0.056). A tendency for significance was observed between the TCWL and WL groups for leg strength (p=0.062), grip strength (p=0.070), timed up and go test (p=0.069), and FFM (p=0.056). Conclusion: Tai Chi during dietary weight loss does not appear to have a significant additive effect on global measures of physical function and most measures of body composition but may help increase muscle strength.

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USE OF VITAMIN D SUPPLEMENTS AND ITS ASSOCIATIONS AMONG OLDER SERVICE HOUSING RESIDENTS

S. Muurinen, H. Soini, M. Suominen, T. Vikstedt, H. Kautiainen, K. Pitkälä

J Aging Res Clin Practice 2013;2(1):86-90

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Background: Vitamin D supplements are recommended for elderly persons. However the frequency of use has been low and the dose insufficient. Objectives: 1) To study the frequency of use of vitamin D supplements in 65+ residents of service houses; 2) to explore the dose of vitamin D among users; and 3) to clarify the factors associated with the use of supplements. Design, setting and participants: This cross-sectional study aimed to include all the service housing residents (N=2 214) in 69 service houses in Helsinki and Espoo in 2007. Residents in temporary respite care were excluded (5%). Of permanent residents, 70% (N=1475) were assessed. Measurements: Trained nurses in each service house performed a personal interview and assessment including the Mini Nutritional Assessment to assess the residents' nutritional, functional and health status, use of medications and use of vitamin D supplements. Medical records were used to confirm demographic and medical data. Results: Of the residents, 60.1% were users of vitamin D supplements. The proportion of users having a therapeutic dose (≥20 µg/day) was 23.9 %. In random effects logit model male gender (OR 0.34, 95% CI 0.24-0.48) and prior hip fracture (OR 2.64, 95% CI 1.71-4.07) were independently associated with the use of vitamin D supplements. Conclusions: The use of vitamin D was less than optimal among 65+ service housing residents. However, when comparing with our previous assessment of nursing home population 2003, the proportion of the users has doubled.

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EFFECTS OF NUTRITIONAL INTERVENTION ON IMMUNE MARKERS IN MALNOURISHED ELDERLY

F. Neelemaat, M.A.E. van Bokhorst-de van der Schueren, H.J. Bontkes, J.C. Seidell, S. Hougee, A. Thijs

J Aging Res Clin Practice 2013;2(1):91-98

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Introduction: Both malnutrition and advanced age are known to negatively impact the immune system. The aim of this exploratory randomized controlled trial was to study the effects of a composite nutritional intervention on immune markers, endocrine markers and a selection of micronutrients in malnourished ill elderly patients. Patients and methods: Malnourished elderly patients (> 60 yrs) newly admitted to the departments of general internal medicine of a university medical center were randomised to receive either usual care plus a multi-component nutritional intervention (energy and protein enriched diet, comprising oral nutritional support, calcium-vitamin D supplement, telephone counselling by a dietitian) for three months post-discharge or usual care alone. Immune markers (interleukins, complement, C-reactive protein, albumin, TNF-α), endocrine markers (growth factors) and micronutrients (iron, ferritin, vitamin A, E and D), were measured at baseline and three months following hospital discharge. Results: In the parent study 210 patients were included, 105 in each group. This study is a subanalysis of 89 patients (46 patients in the intervention group and 43 in the control group) of whom both baseline and final measurement of immune markers, endocrine markers and micronutrients were available. This selection of patients appeared to be in a better health status compared to the total group. At baseline, most of the analysed immune markers, endocrine markers and micronutrients showed values within the normal range, with no statistically significant differences between intervention group and control group. Most immune markers, endocrine markers and micronutrients tended to improved over time, without statistically significant differences between groups, except for vitamin D (p=0.008), confirming the supplementation of vitamin D in the intervention group. Conclusion: A three months nutritional intervention in malnourished ill elderly patients had no measurable additional influence on measured immune markers, endocrine markers and selected micronutrients. The improved outcomes were presumably caused by patients’ improved health status during time.

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THE “PRINT”-STUDY - A 36 WEEK - PROTEIN-ENERGY-INTERVENTION FOR IMPROVING THE NUTRITIONAL STATUS OF GERIATRIC PATIENTS

B. Sturtzel, G. Ohrenberger, I. Elmadfa

J Aging Res Clin Practice 2013;2(1):99-103

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Background: Little is known about the protein needs of diseased elderly. Geriatric patients often eat less and are therefore not adequately nourished. Objective: The PRINT (PRotein INTervention)-Study evaluated, in a 36 weeks intervention, if it is possible to increase the protein-energy-intake of institutionalized geriatric patients through protein-energy-optimized meals and if these arrangements could help to improve the nutritional status. Design: A controlled parallel intervention trial. It compares the protein-energy- intake of geriatric patients from protein-energy-optimized meals (intervention group) with common meals (control croup) served from the catering- service-system of a geriatric hospital. Setting: Geriatric hospital in Vienna. Participants: Included: Patients with oral food intake. Excluded: Patients with enteral or parenteral nutrition or taking supplements. 144 geriatric patients with a mean age of 84.9 (± 9.3) years gave their consent to take part in the study.16.6% were men and 83.4% were woman. 82 patients with a mean age of 84.2 (±9.5) years completed the intervention-protocol. Intervention: The intervention was realized with two arrangements. Arrangement 1 (week 1 to 36): Protein optimization of the daily served soups, purees or desserts by adding additional eggs, whipping cream or soured cream (≈ 4g protein/person/d). Arrangement 2 (week 23 to 36): Protein optimization through an additionally daily served cup of milk (200ml) (≈ 8g protein/person/d). With both arrangements together, according the calculation-plan, a mean protein optimization of ≈12g protein/d was reached. Measurements: Protein-energy- intakes were assessed by means of 3-day-weighing records at week 1, week 20 and week 36 of intervention-time. Albumin, serum total protein and bodyweight were taken from the medical report at week 1, week 20 and week 36 of intervention-time. The non-parametric Friedman test for repeated measurements was used to establish the differences within the groups (sig. p<0.05). Results: In the intervention group protein/energy intake increased significantly (p<0.001/p<0.001), serum total protein concentrations increased significantly (p=<0.01) and bodyweight was kept constant (p= 0.993). In the control group protein/energy intake (p<0.001/p<0.001) and bodyweight (p< 0.05) decreased significantly. During intervention- time 12% of the intervention and 20% of the control participants died. Discussion: For geriatric patients a low-dose, long-term protein-energy-addition to the daily meals provision of the catering-system-service could help to improve their protein-energy-intake and nutritional status

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THE EFFECT OF ISOFLAVONES SUPPLEMENTATION ON SEX STEROIDS, LIPIDS AND INFLAMMATION MARKERS IN ELDERLY MEN

A. Garrido, M. Pia De La Maza, Y. Muñoz, L. Valladares

J Aging Res Clin Practice 2013;2(1):104-109

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Background/Objective: To analyze the biological impact of soy isoflavones intake over specific cardiovascular risk factors, we investigated whether an oral supplement influenced serum levels of lipoprotein, steroids sex hormones and some inflammatory markers in elderly men. Subject/Methods: Thirty healthy men, aged 65-80 years, were invited to take part in this randomized control study, to receive either 100 mg/day of isoflavones supplement (n=15) or identical placebo capsules (n=15). Blood samples obtained at baseline and after 24 weeks were analyzed for total isoflavones, lipoprotein, triglycerides, fibrinogen, adiponectin, leptin, insulin, estradiol, testosterone, DHEA, DHEAS, sex hormone-binding globulin, plasminogen activator inhibitor-1 (PAI-1), P-selectin, high sensitive C-reactive protein (hsCRP) and platelet thromboxane A2 receptor density. Body weight and blood pressure were also registered at baseline and at the end of the treatment. Changes in variables within and between groups were analyzed through ANOVA for repeated measures. Results: The levels of PAI, hsCRP and p-selectin were decreased significantly (p<0.05) after the treatment period only in the intervention group. All the other studied parameters did not change significantly in either group. Conclusion: During this 24–weeks intervention, soy isoflavone intake modified serum levels of PAI-1, hsCRP and P-selectin in elderly men. Further studies with diverse markers of inflammation are necessary to clarify the specific effect of isoflavones on immune response.

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COMORBIDITY MEASURES AND MORTALITY IN INSTITUTIONALISED ELDERLY

H.Y. Neo, M. Chan, T.L. Tan

J Aging Res Clin Practice 2013;2(1):110-116

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Background: Objectives: The utility of comorbidity indices for the assessment of frail institutionalised elderly have not been fully explored. Such information may prove useful for individualized advanced care planning and healthcare resource allocation.We aimed to compare the predictive properties of four indices (CIRS-G total score, CIRS index, Charlson Score and Charlson age-adjusted) in the setting of a multi-racial Asian long term care facility. Design and Setting: We conducted a cross-sectional study with prospective collection of mortality data for 158 patients (mean age 76.6±12.3 years) at a nursing home in Singapore. Measurements: A multi-disciplinary team evaluated baseline demographics, disease number, medication burden, Mini Nutritional Assessment (MNA) score and modified Barthel Index (MBI). Correlations with baseline measures, univariate and multivariate regression analyses were performed to determine the impact of comorbidity indices on 2-year mortality. Results: Baseline correlations were significant but modest between the 4 indices and medication burden, MBI and MNA (Pearson's R range: 0.23-0.31, all p<0.05).Two year all-cause mortality was 25.8% (n=41). Upon univariate analyses, mortality was significantly associated with MBI (OR 0.99, P=0.016), MNA (OR 0.87, P=0.006), number of diseases (OR 1.21; P=0.048), CIRS-G total score (OR 1.14; P=0.010) and age-adjusted Charlson Score (OR 1.25; P=0.032). After accounting for age, gender, race, MBI and MNA, only CIRS-G total score significantly predicts mortality in the multivariate analysis (OR 1.14; P=0.02). Conclusion: Beyond its association with baseline demographics, nutritional and functional measures, the CIRS-G total score remained a significant predictor of mortality compared to indices derived from the Charlson Score. Inclusion of said comorbidity variable will be useful when interpreting mortality data of institutionalized elderly and planning of residential care resource allocation.

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PREVALENCE AND PREDICTORS OF GERIATRIC SYNDROMES IN AN OUTPATIENT CLINIC AT A TERTIARY CARE HOSPITAL OF INDIA

P.C. Das, P. Chatterjee, P. Kumar, G. Kumar, A.B. Dey

J Aging Res Clin Practice 2013;2(1):117-120

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Background: The precise prevalence of "Geriatric syndromes" among older patients in India is uncertain both in community or hospital setting. We examine the prevalence of geriatric syndromes in a dedicated outpatient clinic of a tertiary care hospital and to correlate their association with commonly encountered co-morbidities. Methods: OPD records of 343 older patients of the Geriatric Clinic of All India Institute of Medical Sciences, New Delhi, India, between August 2010 and January 2011 were reviewed. Data on prevalence of geriatric syndromes and the co morbidities were collected and the significance of their association was analyzed with appropriate statistical methods. Results: The mean age of presentation was 70.19(±5.6) years. The top five commonly associated comorbidities were hypertension (39.4%), diabetes (21.6%), cataract (12.5%), COPD (10.5%) and osteoarthritis (OA) (8.2%). Comprehensive geriatric assessment of these patients showed the prevalence of geriatric syndromes were depression 28(8.2%), cognitive impairment5 (1.5%), falls 26(7.6%), incontinence 15(4.4%) and functional dependency 37(10.9%). In our study CAD and osteoarthritis were strongly associated with cognitive impairment ( p=0.000) and falls (p=0.004) respectively. Old CVA was found to be significantly associated with depression (p=0.010) and falls ( p=0.007). Conclusions: Prevalence of Geriatric syndrome in outpatient settings was high. Under- recognition of these syndromes with routine medical assessments was common. Co- morbidities are very often independently associated with these geriatric syndromes. Therefore, routine screening by comprehensive geriatric assessment can prevent future disability.

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PARATHYROID HORMONE, VITAMIN D, AND COGNITIVE DECLINE IN OLDER PEOPLE WITH A HISTORY OF VASCULAR DISEASES

M.P. Björkman, K.H. Pitkala, T.E. Strandberg, R.S. Tilvis

J Aging Res Clin Practice 2013;2(1):121-125

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Introduction: Cross-sectional and prospective follow-up studies have suggested serum 25-hydroxyvitamin D (25-OHD) to associate with cognitive decline. However, other regulators of calcium homeostasis, such as parathyroid hormone (PTH), may confound this association. In this prospective three-year follow-up study the predictive value of both 25-OHD and PTH for cognitive decline were investigated. Methods: Older community-dwelling people (N=400, age=80±5 years) with a history of vascular diseases were included. In addition to thorough clinical examination cognition was assessed by Consortium to Establish a Registry for Alzheimer Disease neuropsychological assessment battery total score (CERAD) at baseline and after three-year follow-up. Baseline serum 25-OHD, PTH, total calcium, creatinine and apolipoprotein E4 genotype were determined. Results: The mean baseline MMSE score was 26±3 and that of total CERAD score 69±12. A weak inverse association was observed between baseline PTH levels and CERAD total scores (r= -0.120, p=0.023). The highest baseline PTH quartile (≥83.1 ng/l) compared with lower quartiles was associated with 2.4-fold risk (95%CIs=1.05-5.35) for at least 10-point decline in CERAD total score within three years. The risk remained significant after controlling for age, gender, education, apolipoprotein E4, baseline CERAD score, body mass index, creatinine, total calcium, and 25-hydrovitamin D. No significant associations were found between baseline 25-OHD and cognition in cross-sectional or longitudinal analyses. Conclusion: High baseline levels of PTH are associated independently of baseline vitamin D status with clinically significant cognitive decline in older community-dwelling people with a history of vascular diseases. Further studies are warranted to address the role of PTH and its regulators in the etiology of cognitive impairment.

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TOOTH LOSS, PERIODONTAL DISEASE, AND MINERAL CONTENT OF CALCIUM AND MAGNESIUM IN THE DIET OR URINE IN THE ELDERLY

A. Yoshihara, R. Watanabe, M. Nishimuta, H. Miyazaki

J Aging Res Clin Practice 2013;2(1):126-130

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Objective: The purpose of this study was to assess whether tooth loss or periodontal disease is related to the intake of selected nutrients or to the amount of key nutrients found in urine. Methods: We evaluated the number of present teeth and the mean clinical attachment level (CAL) in 57 people aged 74 years. All food intakes were measured by a precise weighing method for 3 consecutive days. Furthermore, selected components of partition urine excretion were measured. Multiple linear regression analysis was performed to assess the relationship between the number of remaining teeth or mean CAL and dietary and urinary Ca/Mg molar ratio. Results: Mean clinical attachment level was significantly associated with urinary Ca/Mg molar ratios by standardized coefficients after adjusting for gender smoking habits and the number of remaining teeth. The standardized coefficients were 0.33 (p=0.031). In addition, the number of remaining teeth was significantly associated with both urinary and dietary Ca/Mg molar ratios by standardized coefficients after adjusting for gender and smoking habits. The standardized coefficients were -0.38 (p=0.006) and -0.31 (p=0.020), respectively. Conclusions: This study suggests that dietary and urinary Ca/Mg molar ratios are significantly associated with tooth loss. In addition, there is a significant relationship between urinary Ca/Mg molar ratio and periodontal disease, which is the main reason for tooth loss.

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ANALYSIS OF THE LIPID PROFILE OF ELDERLY PEOPLE: A POPULATION-BASED STUDY

E.J. Muller Uliano, M. Constante Dutra, T. Martins, D.F. Grassi de Paula Machado, R.A. Vieira e Silva, D.J. Trevisol, F. Schuelter Trevisol

J Aging Res Clin Practice 2013;2(1):131-136

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Objectives: To examine the lipid profile of elderly people living in Tubarão, state of Santa Catarina, and the prevalence of dyslipidemia among them. Methods: Cross-sectional study. We studied 822 elderly people living in Tubarão, state of Santa Catarina, Brazil, between September 2010 and May 2011. Consenting participants were interviewed about their socio-demographic characteristics, lifestyle, clinical and family history of cardiovascular events. We determined the lipid profile and anthropometric measurements (weight and height). Results: Dyslipidemia was found in 152 (48.1%) men and 310 (55.9%) women. Isolated hypertriglyceridemia was the most commonly found form of fat. The mean serum total cholesterol level in the study was 204.5±42.4 mg/dL. Dyslipidemia was significantly more common in women than in men, especially among white, obese men living alone. However, only obesity was an independent risk factor for dyslipidemia. Conclusion: A high prevalence rate of dyslipidemia was found in the surveyed population, which implies a major risk factor for coronary artery disease.

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ALARMING VITAMIN D DEFICIENCY IN OLDER PSYCHIATRIC INPATIENTS

R.M. Marijnissen, W.J. Derks, A.B. Gaasbeek, S.C. Stalpers-Konijnenburg, R.C. Oude Voshaar

J Aging Res Clin Practice 2013;2(1):137-141

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Objectives: To explore vitamin D levels in older persons admitted to a psychiatric ward, acknowledging its potential relationship with a variety of psychiatric disorders and high prevalence rates of inadequate vitamin D levels in later life. Design: Consecutive case-series. Setting: Old age psychiatry ward of a secondary mental health centre in the Netherlands. Participants: 159 patients aged 52 to 94 admitted at the old age psychiatry ward. Measurements: Serum vitamin D3 (25(OH)D) levels were determined by taking a fasting blood sample within two days of admission and classified in five categories, i.e. severe deficient (< 10 nmol/l), deficient (10-24 nmol/l), insufficient (25-49 nmol/l), hypovitaminosis (50-74) and adequate (≥75 nmol/l) serum levels. Psychiatric diagnosis was made according to DSM-IV-TR criteria and classified in five overarching categories, i.e. depressive disorders, bipolar disorder, cognitive disorder no delirium, psychotic disorders and other psychiatric disorders. Results: Only 4/159 (2.5%) patients had adequate vitamin D levels. In 35 (22.0%) patients we found hypovitaminosis, vitamin D insufficiency in 69 patients (43.4%) and deficiency in 51 patients (32.0%) of which 15 patients (9.4%) had a severe deficiency. Although the prevalence of insufficiency and deficiency did no differ across diagnostic groups, patients with psychotic disorders had lower levels of vitamin D compared to the other diagnostic groups. Conclusion: The high prevalence of inadequate vitamin D levels argues for screening of vitamin D levels in older persons admitted to a psychiatric ward enabling an optimal vitamin D supplementation. The wide range of inadequate levels supports vitamin D assessment to determine the appropriate supplementation dosage regime.

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DISCREPANCY AND ASSOCIATION BETWEEN PERCEIVED SLEEP STATE AND OBJECTIVE SLEEP MEASURES IN OLDER ADULTS WITH SLEEP COMPLAINTS

W.C. Liao, S.Y. Tsai, C.P. Kuo, L. Wang, C. Lo, H. Ting, M.J. Chiu

J Aging Res Clin Practice 2013;2(1):142-147

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Objective: We investigated sleep state and the perception of sleep state in a group of community dwelling elders with sleep disturbance. Discrepancy between perceived and measured sleep and its relation to sleep quality and sleep structure were examined. Design: A cross-section correlation study. Setting: Sleep laboratory in a medical center. Participants: Thirty-two healthy older adults (mean age 63.0 years, 19 women and 13 men) with sleep disturbance (Pittsburgh Sleep Quality Index score ≥ 5). Measurements: Participants were scheduled to sleep three consecutive nights to receive overnight polysomnography (PSG) and completed the Morning Questionnaire the next morning. Results: PSG showed 379.5 minutes of total sleep time (TST) with nocturnal awakenings of 48 minutes, and a sleep efficiency of 85.7%. Participants perceived 344.4 minutes of TST with awakenings of 29.6 minutes and a sleep efficiency of 80.4%. Significant differences (t=2.07-2.85, p< .05) existed between perceived and measured sleep. About one-third (31.3%) markedly underestimated (> 60 min) their TST. Discrepancy between the perceived and measured TST was negatively correlated with the duration of stage 1 sleep and sleep quality, which indicated that participants with poor sleep quality and longer stage 1 sleep perceived a shorter than actual TST. Conclusions: Older adults with sleep complaints have poor objective sleep. Both sleep structure and cognitive components affect the perception of sleep state.

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OLDER FALLERS WITH SELF-REPORTED DIZZINESS HAVE HIGH LEVELS OF ANXIETY AND DEPRESSION AND ADOPT A STIFFENING STRATEGY WHEN EXPOSED TO OPTOKINETIC STIMULI

J. McLoughlin, C. Barr, D.L. Sturnieks, S.R. Lord, M. Crotty

J Aging Res Clin Practice 2013;2(1):148-151

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Background: Objective: Many people with dizziness can develop visual dependence, an over-reliance on vision for spatial orientation. Specific visual environments including optokinetic visual stimuli can elicit feelings of disequilibrium and is known to result in increases in postural instability in patients with anxiety and vestibular dysfunction. Our study aims to investigate dizziness and postural sway in various visual conditions in a group of older people referred to a falls clinic. Design: We investigated postural sway in six visual conditions in a group of older people referred to a falls clinic with and without self-reported dizziness. Setting: South Australian Movement Analysis Centre, Repatriation General Hospital, South Australia. Participants: 100 adults (41 male) with a mean age of 82 years (range 66-94 years) participated. Measurements: We collected data on self-reported dizziness, space and motion discomfort, anxiety, depression and fear of falls. Postural sway, measured by Centre of Pressure (CoP) path length, was assessed with eyes open, eyes closed and when exposed to two linear and two rotating types of optokinetic stimuli (OKS). Results: 36 participants (36%) reported suffering dizziness. These participants had significantly higher levels of anxiety and depression, and demonstrated significantly shorter CoP path lengths for all six balance conditions compared to those without dizziness (p<0.05). The “forward” OKS, however, induced relatively greater sway in the dizzy participants. Conclusions: These findings suggest that dizziness is common in older fallers and that it contributes to a stiffening strategy to maintain standing balance. Vestibular rehabilitation using OKS for older fallers with dizziness warrants investigation in further research studies.

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TIMED UP-AND-GO TEST: A POTENTIAL INDICATOR FOR SUCCESSFUL AGING OF OLDER MEN IN TAIWAN

L.-K. Liu, L.-Y. Chen, L.-N. Peng, C.-L. Liu, M.-H. Lin, L.-K. Chen

J Aging Res Clin Practice 2013;2(1):152-156

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Background: The Timed Up and Go (TUG) test has been associated with balance, falls, physical performance and health outcomes. The aim of this study was to explore the relationship of TUG, sarcopenia, and functional assessments among the oldest old Chinese men in Taiwan. Methods: A cross-sectional study was conducted in 2011 by recruiting residents of the Taoyuan Veteran Home in Taiwan to evaluate the relationship between demographic profiles, physical function (Barthel Index, Instrumental Activities of Daily Living), mental function (Mini-Mental State Examination, Geriatric Depression Scale), body composition (fat-free mass), physical performance (handgrip strength), and results of TUG. Results: Overall, 301 subjects (mean age: 85.8±5.3 years, all males), 147 (48.8%) of whom were sarcopenic, were enrolled for study. The study subjects were basically physically and mentally fit. Sarcopenia and results of TUG were significantly associated with older age, smaller body size, poorer physical function, poorer cognitive function and more depressive symptoms. The best cutoff of TUG determined by the receiver operating characteristic curve was 12.5 seconds (sensitivity: 0.72, specificity: 0.63). Multivariate logistic regression showed that older age (OR: 1.06, 95% C.I.: 1.005-1.124, P=0.033), poorer Barthel Index (OR: 1.04, 95% C.I.: 1.002-1.082, P=0.041), poorer Mini-Mental State Examination score (OR: 1.09, 95% C.I.: 1.009-1.187, P=0.030), fat free mass/height2 (OR: 1.33, 95% C.I.: 1.153-1.522, P<0.001), and abnormal TUG (OR: 2.01, 95% C.I.: 1.106-3.636, P=0.022) were all independent risk associative factors for sarcopenia, but not depressive symptoms (OR: 1.12, 95% C.I.: 0.947-1.333, P=0.181). Conclusions: TUG was significantly associated with poorer physical function, mental function and mood status, as well as sarcopenia, which may play an important role in community-based screening programs for successful agers and sarcopenia among oldest old people.

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