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03/2013 journal articles

VITAMIN D DEFICIENCY/INSUFFICIENCY AND OBESITY AND METABOLIC DISORDERS IN COMMUNITY-LIVING CHILEAN ELDERLY PEOPLE

B. Angel, H. Sanchez, L. Lera, X. Cea, C. Albala

J Aging Res Clin Practice 2013;2(3):251-256

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Background: Objective: To examine obesity and metabolic disorders associated with vitamin D (VitD) deficiency/insufficiency in community-living Chilean older people. Methods: Cross sectional study in 1186 community dwelling subjects 60-98 years old (807 women) residing in Santiago Chile. Plasma levels of 25-hydroxyvitamin D (25(OH)D) were determined by radioimmunoassay. Glucose, insulin and US-CRP, were measured in a fasting blood sample. Blood pressure and complete anthropometry were evaluated. Diabetes was defined as ≥ 126 mg/dl or use of anti-diabetic agents, fasting glucose intolerance (FGI) was defined as glucose ≥100 mg/dL and insulin resistance as HOMA-IR ≥ 2.6. VitD deficiency was defined as a serum 25(OH)D concentration <50 nmol/L and VitD insufficiency as 50-74 nmol/L. The relationship between VitD and metabolic disorders was studied using multivariable logistic regression models. Results: Mean serum 25(OH)D was 63.2 nmol/L ± 33.1 (men 66.0 ± 33.0; women 62.0 ± 33.2, p=0.48) the lowest in people ≥70 years (55.8 ± 26.6). VitD levels were under 75nmol/L in 67.0% of men and 73.0% of women (p=0.020). The prevalence of VitD deficiency was 36.5% in men and more prevalent in women 40.8% (p=0.045). Obesity was present in 37.6% of women and 26.3% of men p<0.001. Significant negative crude association between VitD across BMI categories was found in the total sample (p<0.001). Crude association of VitD <50nmol/L with obesity (p=0.002), waist circumference (p=0.011), Insulin resistance (p<0.001), Metabolic syndrome (p=0.004), HTA (p<0.001) and Age ≥ 70 years (p<0.001) was observed. After adjustment by age, sex, waist circumference and season, VitD <50nmol/L was associated with increased risk of insulin resistance, OR 3.12 (95%CI 1.66 – 5.86), p<0.001. Conclusion: High prevalence of VitD deficiency/insufficiency was observed in the Chilean older people. VitD deficiency is associated with insulin resistance. In the future, randomized controlled trials are needed to establish a cause-effect relationship between VitD deficiency, obesity and its metabolic consequences.

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THE CONSUMPTION OF RED PUPUNHA (BACTRIS GASIPAES KUNTH) INCREASES HDL CHOLESTEROL AND REDUCES WEIGHT GAIN OF LACTATING AND POST-LACTATING WISTAR RATS

R. Piccolotto Carvalho, J.R. Gonzaga Lemos, R. Souza de Aquino Sales, M. Gassen Martins, C.H. Nascimento, M. Bayona, J.L. Marcon, J. Barros Monteiro

J Aging Res Clin Practice 2013;2(3):257-260

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Introduction: The lactating and post-lactating periods are marked by large metabolic change. Production of milk is 60% lipid dependent. We reported in a recent scientific meeting that Red pupunha palm tree fruit increases HDL cholesterol in lactating rats. This study evaluated if consumption of Red Pupunha by adult female rats has a beneficial impact on the lipid metabolism of lacting and post-lacting adult rats. Objective: Evaluate if consumption of red pupunha has a beneficial effect in the lipid metabolism of lacting and post-lacting adult Wistar rats. Research Methods: Four groups including two for control; (1) control adult lactating rats, (2) control adults post-lactating rats; and two experimental groups; (3) pupunha adults lactating rats and (4) pupunha adult post-lactating rats were evaluated and compared regarding: weight gain, food consumption, plasma total protein, glucose, total lipid, triglycerides, total cholesterol and HDL-cholesterol levels. The mean difference and its 95% confidence intervals were used for group comparisons. Group comparisons were evaluated by using analysis of variance (one-way ANOVA). The statistical significance of the pairwise differences among groups was assessed by using the two-sided Tukey test. Results: There were no important differences in food consumption, plasma glucose, total lipids and triglycerides among groups. The red pupunha lactating group gain less weight showing lower body mass index (BMI) than controls (p < 0.05). Total cholesterol was lower in red pupunha lactating than in controls but not in the red pupunha post-lactating group as compared to controls. Triglycerides were lower in the post-lactating red pupunha group as compared to the control group (p = 0.039) but not for the lactating groups. Red pupunha lactating and post-lactating groups had higher HDL-cholesterol than their corresponding control groups (p ≤ 0.01). Conclusion: Original findings include the beneficial effect of red pupunha in post-lactating rats increasing the HDL-cholesterol and lowering the BMI. Red pupunha was confirmed to increase HDL-cholesterol in lactating rats. These results suggest that red pupunha is a healthy fruit to be consumed during lactating and post-lactating periods as it is related to better lipid profile and less body weight gain.

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ROLE OF CHOLESTEROL IN THE AGING BRAIN

S. Dudani

J Aging Res Clin Practice 2013;2(3):261-263

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Cholesterol is an essential component of cell membranes and is critical for cell survival and performance.The Central nervous system (CNS) contains nearly 23% of total body cholesterol even though it represents only 2.2 % of total body weight. Cholesterol is required by the brain for active axonal growth, synapse formation and remodelling. Changes in the level of cholesterol are seen to occur in the brain in aging and in neurodegenerative diseases including Alzheimer’s disease (AD). In this article, we review the role of cholesterol in normal brain function as well examine the changes associated with hypercholesterolemia and aging. Understanding the causes and consequences of these changes would help to design strategies to delay cognitive decline associated with aging and neurodegenerative diseases.In view of the increased longevity seen, this would go a long way to help reduce the morbidity associated with these conditions in the increasing geriatric population.

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ASSOCIATION BETWEEN DIABETES AND COGNITION IN OLDER ADULTS WITHOUT DEMENTIA

E. Helmes, T. Østbye, R.E. Steenhuis

J Aging Res Clin Practice 2013;2(3):264-270

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Objectives: Data from the Canadian Study of Health and Aging (CSHA) evaluated cognition and depression in a sample of older adults with diabetes and compared them with those without diabetes. Design: Neuropsychological test scores from a comprehensive clinical assessment were contrasted for the two groups and test scores from CSHA-1 in 1991 used to predict test scores five years later from CSHA-2 with diabetes and depression as additional predictors. Results: There were no differences at CSHA-1 between those with diabetes and those without after adjusting for covariates of age, education, and gender. Older adults with diabetes at CSHA-2 scored lower on a measure of short-term memory, with age, education and CSHA-1 test scores as significant covariates in hierarchical regression analyses. Diabetes and depression were both associated with a measure of verbal short term memory. Conclusions: In this relatively healthy community sample, diabetes appears to have modest influences upon cognition, with verbal short-term memory being the most sensitive to the effects of diabetes.

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VITAMIN D AND CARDIOVASCULAR DISEASES

H. Matejovska Kubesova, P. Weber, K.Bielakova, E. Fernandova, J. Matejovsky, V. Polcarova, H. Meluzinova

J Aging Res Clin Practice 2013;2(3):271-275

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A lot of attention is paid to vitamin D in the last few years due to its broader spectrum of influence in human organs. Nuclear vitamin D receptors (VDR) are proved to be a main mechanism of action. More and more evidence of the negative influence of vitamin D deficiency on cardiovascular system appears together with low vitamin D serum levels in the current population, mostly due to life style with little exposure of unprotected skin to sun light. The course of ischemic heart disease can be worsened by low serum level of vitamin D because of higher risk of myocardial infarction a cardiac failure with more frequent hospitalisations. Higher risk of arrythmias during vitamin D deficiency is explained by higher production of parathormone and its binding to receptors stimulating phospholipase C followed by increased activity of catecholamines, angiotensin II and endothelin in ischaemic myocardium. There is no evidence of any association of vitamin D and cholesterol levels, on the other hand normal level of vitamin D helps to keep the triglyceride serum concentration in normal range. Hypertension is influenced negatively by low level of vitamin D due to stimulation of renin-angiotensin-aldosteron system, parathormon secretion and lower antiiflammatory and vasculoprotective effect. The course of cardiovascular diseases can be positively modulated by keeping vitamin D level within normal range. The adequate exposure of unprotected skin to sun is recommended as natural suplement and effective source of vitamin D.

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COMPARISON OF LABORATORY- AND FIELD-BASED ESTIMATES OF MUSCLE QUALITY FOR PREDICTING PHYSICAL FUNCTION IN OLDER WOMEN

C.R. Straight, A.O. Brady, M.D. Schmidt, E.M. Evans

J Aging Res Clin Practice 2013;2(3):276-279

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Background: Muscle quality is related to physical function in older adults, however no study has investigated the utility of a field-based estimate for use in clinical settings. Objectives: This study investigated laboratory- and field-based measurements of muscle quality for predicting physical function in community-dwelling older women. Design: Cross-sectional. Setting: University research laboratory. Participants: Community-dwelling older women (n = 97, 73.9 ± 5.6 y). Measurements: Leg extension power using the Nottingham power rig, handgrip strength, body composition via dual-energy X-ray absorptiometry, and physical function (6-minute walk, 8-foot up-and-go, 30-second chair stand). Laboratory-based muscle quality (MQ-LAB) was defined as leg power (watts) normalized for lower-body mineral-free lean mass (kg) and field-based muscle quality (MQ-FIELD) was measured as handgrip strength normalized for body mass index. Results: MQ-LAB (r range = 0.42 to -0.63, all p < 0.01) and MQ-FIELD (r range = 0.37 to -0.50, all p < 0.01) had similar associations with measures of physical function. Using linear regression analysis, the percent improvement in physical function that could be expected from a 10% increase in muscle quality was similar for laboratory- and field-based estimates (2.7-4.4% vs. 2.6-3.8%, respectively). Conclusions: A field-based estimate of muscle quality provides a similar prediction of physical function to a laboratory-based approach in community-dwelling older women, and may be feasible for use in a clinical setting by practitioners.

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INFLUENCE OF BARTHEL INDEX ON PLASMATIC LEVELS OF 25 HYDROXYVITAMIN D IN ELDERLY PATIENTS

A. Supervía, M.T. Martínez-Izquierdo, R. Güerri, M.I. Sarbu, A. Solano, D. Marzo, J. Ares, A. Díez-Pérez, L. Mellibovsky

J Aging Res Clin Practice 2013;2(3):280-283

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Objectives: To evaluate the prevalence of vitamin D deficiency in the elderly and its relationship with the functional capacity. Design: Observational study. Setting: Emergency Department of a tertiary hospital. Participants: Consecutive non-selected patient’s aged 65 or more. Methods: The patients were divided in two groups: moderate to severe disability (BI 0–75), and mild to no impairment (BI 76–100). Comparisons of vitamin D metabolites and parathormone between groups were made. Measurements: Barthel index, vitamin D metabolites and intact parathormone. Results: Fifty-nine patients were included. Mean age: 77.25 (8.5) years. Fourteen patients (23.7%) had a BI ≤ of 75. The patients with BI ≤ 75 had lower levels of 25 hydroxyvitamin D and 1,25 dihydroxyvitamin D compared with the BI > 75 group [(8.93 (3.4) vs 16.56 (12.5) ng/ml; p = 0.015), and (24.39 (12.8) vs 39.65 (21.1) pg/ml; p = 0.009], and higher levels of intact parathormone (113.29 (75.8) vs (64.59 (37.2) pg/ml; p = 0.020). Levels of 25 hydroxyvitamin D < 10 ng/ml was found in 71.4% of patients with BI ≤ 75 and in 44.4% with IB > 75. The only factor that predicted values of 25 hydroxyvitamin D below to 10 was a BI ≤ 75 (OR: 4.58; IC 95%: 1.124-18.689; p = 0.034). Conclusions: The prevalence of hypovitaminosis D in elderly is elevated. Patients with IB < 75 have lower levels of 25 hydroxyvitamin D. A BI below 75 predicts values of vitamin D less than 10ng/ml.

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BARRIERS TO LOSING WEIGHT FOR OVERWEIGHT AND OBESE OLDER ADULTS

B.L. Callen

J Aging Res Clin Practice 2013;2(3):285-288

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Background: Obesity is growing rapidly among older adults. Objective: To understand the barriers older adults face when trying to lose weight. from their own perspective. Design: Focus group. Setting: A senior center in a southeastern urban area. Participants: Eleven overweight or obese older adults. Results: Ten barriers to weight loss were cited. They were: 1) emotional eating, 2) living alone, 3) eating out of habit 4) reduced exercise 5) health issues such as pain, 6) cost of fresh fruits and vegetables, 7) time required for scratch cooking, 8) addiction to junk food, 9) time needed to count calories and 10) sustaining motivation. Conclusions: Interventions are needed to assist overweight and obese older adults who want to lose weight for health promotion and disease prevention...

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“EXERCISING FREQUENTLY AND EATING PROPERLY HAS HELPED IMMENSELY”: BENEFITS OF AN ONLINE CHRONIC DISEASE SELF-MANAGEMENT WORKSHOP FOR LOW-INCOME HOMEBOUND OLDER ADULTS

S. An, N.G. Choi

J Aging Res Clin Practice 2013;2(3):289-294

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Background: Low-income homebound older adults need chronic disease self-management knowledge and skills to cope with their multiple medical conditions. Objectives: This study explored low-income homebound older adults’ experience, described in their own words, of online chronic disease self-management workshop. Design and setting: Twenty recipients (aged 62+ years) of a home-delivered meals (HDM) program in a central Texas city participated in a feasibility study. Measures: Sources of data were the deidentified bulletin board posts written by each participant and transcripts from two focus groups with the participants, conducted 5-8 weeks after completion of the BCBH workshop. Results: Two most important mechanisms of change that the participants adopted were exercise and healthy eating. They have also increased their knowledge of chronic disease and benefited from interactions with other participants. Conclusion: This study underscores the importance of reaching these older adults to help them get into such a program.

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MID UPPER ARM CIRCUMFERENCE AS A PREDICTOR OF MALNUTRITION IN OLDER ADULTS AND ITS RELATION TO MALNUTRITION SCREENING AND ASSESSMENT TOOLS

M. Mascarenhas de Menezes Costenla, C.A. da Cunha Santos, J. Celso Dias Correia da Fonseca

J Aging Res Clin Practice 2013;2(3):295-299

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ASSESSMENT OF NUTRITIONAL STATUS OF ELDERLY POPULATIONS IN RURAL MINIA, EGYPT

E.M. Mahfouz, E.S. Mohammed, T.A. Abd El-Rhman

J Aging Res Clin Practice 2013;2(3):300-302

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Aim: This study was conducted to identify the magnitude of undernutrition and to determine the associated risk factors among elderly populations in rural Minia, Egypt. Subjects and methods: A cross sectional study was conducted on 350 elderly chosen by systematic random sample in the period from December 2011 till May 2012. An interview administered questionnaire about demographic characteristics of elderly subjects and Mini Nutritional Assessment (MNA) were carried out. Results: Based on MNA score, 38.3% of participated elderly have malnutrition or are at risk of malnutrition. Elderly females were significantly more likely to be affected by malnutrition than males (9.8% vs 6.6%). Nearly 38% of persons ≥ 80 years were malnourished vs 5.8% of persons in age group 60-69 years (p˂0.001). Malnutrition was higher among elderly persons who had chronic and acute disease. Conclusion: This study revealed that the percentage of malnutrition and malnutrition risk in this elderly group were 8.6% and 29.7% respectively, with higher percentages in females. These results highlight the need to screen and monitor elderly people and to involve families in the proper nutritional care of elderly.

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CLINICAL AND FUNCTIONAL CHARACTERISTICS OF NONAGENARIANS HOSPITALIZED IN A GERIATRIC UNIT: A DESCRIPTIVE STUDY

J. Petermans, S. Mathieu, S. Allepaerts, S. Gillain, J. Pincemail, A. Samalea Suarez, L. Seidel, J.O. Defraigne, D. Gillain

J Aging Res Clin Practice 2013;2(3):303-309

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Introduction: The nonagenarian population will increase in the next 30 years. Physically and cognitively, they look "more robust". We purposed to look for characteristics which make them different from elderly of lower age when hospitalized in GU. Material and methods: 61 nonagenarians (mean age: 92.4) and 60 old over 75 years (mean age: 81.9) hospitalized in GU were studied. Each of the patients underwent, in addition to the medical history and the usual clinical examination a geriatric assessment. This evaluation included Katz's and Lawton's indices which were completed based on the functional state prior to hospitalization outside any acute phenomenon, a walking test and the hand-grip test. The Montreal Cognitive Assessment was used to assess the cognitive condition. These evaluations were all performed at the end of hospitalization. The nutritional condition was also verified with the short MNA test. The water swallow test according to Di Pipo was also performed to detect any risk of aspiration. Each group was followed by a telephone call, 3, 6 and 12 months after discharge. Death, condition of living, evolution of the illness, weight, falls and rate of hospitalization were performed. The two groups were compared by the Mann-Withney non-parametric tests, for continuous variables, and chi-square for categorical variables. Results were significant at p<0.05. Results: Nonagenarians had the same ADL scores as octogenarians but their IADL scores were higher (P=0.040). They had lower power at the handgrip test (P=0.035), tended to have worse walking test (P=0.10) and took fewer medications (P=0.0017).No significant differences are observed in the other assessment. The length of hospital stay does not differ. The median for the two groups is 15 days. The death rate at the hospital is also the same. (6 nonagenarians and 4 persons under 90 years). Concerning the number of persons contacted after the discharge, there is only a significant difference at 12 months between the 2 groups (p=0.035). After 3 months 10 nonagenarians are dead against 6 for the octogenarians (p=ns), 3 months after discharge, 40.0% of the octogenarians are living at home, with help for only 14.8% of the nonagenarians (p=0.013). After 6 and 12 months there are no statistical differences in the situation of living between the 2 groups. No difference is observed between the 2 groups according the evolution of the illness of the weight and of the incidence of falls but the rate of hospitalization is particularly low in the 2 populations; from 21.6% after 3 months to 19.2% after 6 months in the octogenarians and from 14% after 3 months to 0% after 12 months in the nonagenarians (p = 0,017). Conclusion: This study shows that nonagenarians admitted to GU have albeit the same functional pattern than octogenarians but take fewer medications. Despite the fact that their walking speed is lower (< than 0.6m/sec) is associated with a risk of greater functional and/or cognitive decline their outcomes don’t differs very significantly from the younger’s even if they are more in nursing home during the 6 months after discharge. No difference in this topic is observed after one year. With 10 years older their functional profile look as well efficient as octogenarians.

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MEDICAL ILLNESSES AND RISK OF DELIRIUM IN ACUTE HOSPITALIZED ADULT-OLDER PATIENTS

G. Zuliani, F. Bonetti, C. Soavi, S. Magon, A. Passaro, B. Boari, F. Guerzoni, M. Gallerani

J Aging Res Clin Practice 2013;2(3):310-316

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Objectives: The pathogenesis of delirium in hospitalised patients is complex and multi-factorial. Although several medical conditions had been associated with delirium, the real impact of different diseases on delirium onset has not been completely clarified. In this study we provided a comparison of delirium prevalence across various diseases in a large sample of adult/older individuals > 60 years (mean age:70.5 years) admitted to acute medical wards. Design: Observational cross-sectional study. Setting: St. Anna University Hospital (Ferrara, Italy). Population: Hospital-based population; data from 74.379 consecutive discharge records of subjects ≥ 60 years were analysed. Measurements: DRGs, primary/secondary diagnosis (ICD-9-CM code), number of procedures and admissions, length of hospital stay, and possible death were evaluated. ICD-9 codes for delirium included 290.11, 290.3, 290.41, 293.0, and 293.1. Results. Overall, 1300 patients received a delirium diagnosis. Compared with controls, they were characterized by higher number of diagnoses, procedures, and comorbidity. The risk of delirium was associated with DRGs related to brain pathologies, major orthopaedic diseases/procedures, and major infections. As regards ICD-9 diagnoses, 13.7% (n.179) of delirium diagnoses could be attributable to cerebral atherosclerosis, 9.3% (n.121) to urinary tract infections, 6.5% (n.85) to Alzheimer’s disease, 5.5% to hypertension, 3.6% to diabetes, and 3.5% to atrial fibrillation (total: 42.1%). Conclusions: Our data suggest that among hospitalised elderly patients urinary infections might represent the most frequent modifiable risk factor for delirium. Clinicians need to have a high index of suspicion as regards the presence of urinary tract infections in this subjects, especially in those with cognitive impairment, since its early recognition and treatment might contribute to decrease the probability of delirium onset.

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