Most recent papers:

• Relationship between chronic kidney disease without diabetes mellitus and components of frailty in community‐dwelling Japanese older adults.
  Sungchul Lee, Sangyoon Lee, Seongryu Bae, Kazuhiro Harada, Songee Jung, Masakazu Imaoka, Hyuma Makizako, Takehiko Doi, Hiroyuki Shimada.
  Geriatrics and Gerontology International. October 20, 2017
  Aim To evaluate the relationship between kidney function without diabetes and components of the frailty phenotype in community‐dwelling Japanese older adults. Methods Participants were 8343 residents who completed baseline assessments, classified into four categories according to eGFR. Frailty status was defined using five criteria: (i) slow gait speed; (ii) muscle weakness; (iii) low physical activity; (iv) exhaustion; and (v) unintentional weight loss. Results After multivariate adjustment, participants with the lowest kidney function were at higher risk of frailty (OR 1.57, 95% CI 1.02–3.50) than those with normal kidney function. In addition, after adjustment for multiple confounders, estimated glomerular filtration rate <30 was associated with a greater risk of the individual frailty components of weight loss (OR 2.14, 95% CI 1.11–4.12), low physical activity (OR 1.35, 95% CI, 1.01–2.54) and slowness (OR 1.82, 95% CI 1.36–3.77) compared with estimated glomerular filtration rate ≥60. Conclusions Lower kidney function was associated with a higher risk of weight loss, low physical activity and slowness among community‐dwelling Japanese older adults.

  October 20, 2017   doi: 10.1111/ggi.13180   open full text
• Relationship between physical activity levels and depressive symptoms in community‐dwelling older Japanese adults.
  Songee Jung, Sangyoon Lee, Sungchul Lee, Seongryu Bae, Masakazu Imaoka, Kazuhiro Harada, Hiroyuki Shimada.
  Geriatrics and Gerontology International. October 20, 2017
  Aim The aim of the present study was to investigate the relationship between physical activity (PA) and depressive symptoms in community‐dwelling older Japanese adults. Methods A cross‐sectional study design was used to obtain data from 3191 community‐dwelling older Japanese adults aged 70–95 years. Depressive symptoms were assessed using self‐reported scores on the Geriatric Depression Scale‐15. PA was objectively measured using an accelerometer worn for a maximum of 40 days, and average daily durations of light‐intensity PA (LPA), moderate‐to‐vigorous intensity PA (MVPA) and step count were calculated. PA was compared between participants with and without depressive symptoms by carrying out analysis of covariance and multivariable logistic regression analysis adjusted for all covariates by using propensity scores. Results Depressive symptoms were present in 598 participants (19.6%). A comparison of propensity‐score adjusted PA showed that step count (5059.6 ± 53.7 vs 5003.0 ± 112.1 count/day; P = 0.652) and moderate‐to‐vigorous intensity PA duration (23.0 ± 0.4 vs 23.8 ± 0.7 min/day; P = 0.358) were not significantly different between participants with and without depressive symptoms, respectively. However, participants without depressive symptoms had a significantly higher LPA duration than those with depressive symptoms (39.4 ± 0.3 vs 37.3 ± 0.7 min/day, respectively; P < 0.01). Conclusions The present results suggest that individuals with lower LPA have a higher risk of depressive symptoms. These findings imply that PA recommendations, especially for older adults, should emphasize LPA, which appears to be especially effective at preventing depressive symptoms.

  October 20, 2017   doi: 10.1111/ggi.13195   open full text
• Cross‐cultural adaptation and validation of the Comprehensive Frailty Assessment Instrument in Chinese community‐dwelling older adults.
  Xiaoxia Qiao, Cuili Wang, Xiaoyu Tian, Lijuan Dong, Na Liu, Yaru Jin, Huaxin Si.
  Geriatrics and Gerontology International. October 20, 2017
  Aim To cross‐culturally adapt and validate the Comprehensive Frailty Assessment Instrument (CFAI) among Chinese community‐dwelling older adults. Methods The Chinese CFAI was developed through forward–backward translations. An urban sample of 1235 community‐dwelling older adults received face‐to‐face interviews to examine the validity (construct validity and criterion validity) and reliability (internal consistency and test–retest reliability). Results The Chinese CFAI achieved semantic and idiomatic equivalence, and showed acceptable reliability and an expected factor structure, except for the social support domain. The exploratory factor analysis extracted five factors explaining 53.8% of the total variance of frailty. The confirmatory factor analysis showed that the data fit well to the second‐order factor theoretical model, with a root mean square error of approximation of 0.05, Tucker‐Lewis Index of 0.93 and Comparative Fit Index of 0.95. The receiver operating characteristic analysis presented an acceptable criterion validity using the Rockwood Frailty Index as an external criterion (area under the curve 0.80), with balanced sensitivity (65.31%) and specificity (81.19%) at the optimal 39‐point frailty cut‐off of the CFAI. Conclusions The Chinese CFAI has good validity and reliability as a practical frailty measure in Chinese community‐dwelling older adults.

  October 20, 2017   doi: 10.1111/ggi.13183   open full text
• Effect of one‐time brief additional counseling on periodic health examination for 40‐ and 66‐year‐olds: 2‐Year follow up of 101 260 participants.
  Ki Young Son, Dong Wook Shin, Hyung‐Kook Yang, Jae Moon Yun, So Hyun Chun, Jong‐Koo Lee, Be Long Cho.
  Geriatrics and Gerontology International. October 18, 2017
  Aim The aim of the present study was to evaluate whether the effect of one‐time brief additional counseling in periodic health examinations (PHE) through the National Screening Program for the Translational Ages in Korea is sustained after 2 years. Methods We collected data from National Screening Program for the Translational Ages participants in 2007 and 2008. To evaluate behavior change after 2 years, we collected the participants’ health behavior data 2 years later (2009 and 2010). We defined the basic group as participants who only received PHE, and the additional group as received PHE and counseling. We carried out propensity score matching to ensure that additional counseling was the only different variable affecting health behavior between the two groups. Results After propensity score matching, 50 630 remaining matched participants were matched for each group. Of these participants, 26.5% (26 855/101 260) were aged 66 years, and 60.9% (61 653/101 260) were men. The additional group showed a significant increase in odds of smoking cessation among the 66‐year‐olds (adjusted OR 1.173, 95% CI 1.003–1.372). This effect was significant, especially when the participants did not have hypertension or hypercholesterolemia (adjusted OR 1.193, 95% CI 1.000–1.423 for hypertension and adjusted OR 1.188, 95% CI 1.009–1.398 for hypercholesterolemia). However, there was no significant association for alcohol drinking and regular exercise. Conclusions The effect of one‐time brief counseling added to a PHE in cigarette smoking was observed only among the 66‐year‐olds. However, the effect was so small that it is doubtful to be clinically relevant. Repeated counseling is required to sustain the effect of the initial motivation of counseling. Geriatr Gerontol Int 2017; ••: ••–••

  October 18, 2017   doi: 10.1111/ggi.13175   open full text
• Effects of an exercise model based on functional circuits in an older population with different levels of social participation.
  Walter Sepúlveda Loyola, Carlos Augusto Camillo, Carolina Valenzuela Torres, Vanessa Suziane Probst.
  Geriatrics and Gerontology International. October 15, 2017
  Aim To investigate whether being part of a community organization interfered with older adults’ overall functionality. The magnitude of responses to a community exercise program based on functional circuits in socially active and socially non‐active older adults was also investigated. Methods A total of 200 older adults aged ≥60 years from Requinoa, Chile, participated in the study. Participants were separated into two groups according to the level of social participation: socially active (SA) and socially non‐active (SNA). During an evaluation, data regarding the presence of comorbidities (Charlson Comorbidity Index), disability level (Modified Health Assessment Questionnaire), dynamic balance (Timed Up and Go test), muscle force (handgrip dynamometry) and sociodemographic conditions were collected. Participants followed an exercise program consisting of a functional exercise circuit including balance, resistance and aerobic exercises, twice a week, for 12 weeks. Results Both the Charlson Comorbidity Index and disability were higher in SNA compared with SA participants on inclusion. Both groups improved disability (Δ–0.25 patients [−0.5 – −0.0625 patients] for SNA and (Δ–0.125 patients [−0.5–0 patients] for SA) and balance (Δ–2 s [−3–0 s] for SNA and (Δ–1 s [−3–0 s] for SA) after training (P < 0.05 for all). Changes from baseline were statistically higher in the SNA group. Handgrip force improved only in participants in the SNA group (Δ1.7 kg [0.6–2.8 kg], P = 0.0001). No differences, however, were observed between the magnitude of improvements of handgrip between groups. Conclusions Although socially non‐active older adults had more comorbidity and disability than their socially active counterparts, they showed a higher response to a community exercise program. Geriatr Gerontol Int 2017; ••: ••–••.

  October 15, 2017   doi: 10.1111/ggi.13167   open full text
• Dentition status and frailty in community‐dwelling older adults: A 5‐year prospective cohort study.
  Masanori Iwasaki, Akihiro Yoshihara, Misuzu Sato, Kumiko Minagawa, Mieko Shimada, Mamoru Nishimuta, Toshihiro Ansai, Yutaka Yoshitake, Hideo Miyazaki.
  Geriatrics and Gerontology International. September 24, 2017
  Aim To examine the longitudinal association between dentition status and incidence of frailty in older adults. Methods The present prospective cohort study included community‐dwelling Japanese adults aged 75 years at baseline (n = 322). Dental examinations, biochemical blood examinations, physical performance and anthropometric measurements, and structured questionnaires were carried out at baseline. The presence of ≥20 teeth with nine or more occluding pairs of teeth was defined as functional dentition. Annual follow‐up examinations, including physical performance, anthropometric measurements and structured questionnaires, were carried out over a 5‐year period to determine the incidence of frailty, defined as three or more of the following five components derived from the Cardiovascular Health Study: weight loss, weakness, slowness, poor energy and low physical activity level. Adjusted hazard ratios of frailty incidence according to dentition status were calculated from Cox proportional hazards regression analyses. Results At baseline, 118 participants (36.6%) were defined as having functional dentition. During the follow up, 48 participants (14.9%) developed frailty. The adjusted hazard ratio for frailty in participants with functional dentition was 0.50 (95% confidence interval 0.25–0.98) compared with participants without functional dentition, after adjusting for sex, income, education, smoking status, body mass index, serum biomarkers and comorbidities. Conclusions Functional dentition was significantly associated with a lower risk of frailty defined by the Cardiovascular Health Study frailty index in older Japanese adults. These results suggest that maintaining healthy and functional dentition into later life is important for frailty prevention. Geriatr Gerontol Int 2017; ••: ••–••.

  September 24, 2017   doi: 10.1111/ggi.13170   open full text
• Cognitive impairment has no impact on hospital‐associated dysphagia in aspiration pneumonia patients.
  Keisuke Maeda, Hidetaka Wakabayashi, Hiroshi Shamoto, Junji Akagi.
  Geriatrics and Gerontology International. September 21, 2017
  Aim Hospital‐associated dysphagia, characterized by deconditioning of swallowing as a result of hospitalization, is sometimes observed in patients with aspiration pneumonia (AP). Cognitive impairment is known as a negative factor in dysphagia rehabilitation. The present study aimed to examine the association between cognitive impairment and hospital‐associated dysphagia in patients with AP receiving dysphagia rehabilitation. Methods A retrospective observational study was carried out in an acute geriatric hospital. A total of 249 AP patients receiving multidisciplinary individualized dysphagia rehabilitation were included. Patients were divided into four groups according to their Mini‐Mental State Examination scores. The Functional Oral Intake Scale (FOIS) was used to assess swallowing ability, and hospital‐associated dysphagia was defined as a FOIS decline of ≥1 or ≥2 levels. Body mass index and Barthel Index were obtained to assess nutritional status and activities of daily living. Results The mean age was 85.6 ± 7.3 years, and 47% were men. Frequencies of hospital‐associated dysphagia observed in lowest to highest Mini‐Mental State Examination groups were 43.0%, 36.2%, 47.4% and 27.3% (P = 0.133), and 13.9%, 20.7%, 17.5% and 5.5% (P = 0.117) based on FOIS decline ≥1 or ≥2 levels, respectively. Multivariable regression model showed that the Mini‐Mental State Examination score was not an independent determinant of FOIS at discharge (beta = 0.063, P = 0.378) after adjusting for age, sex, body mass index, Barthel Index, pneumonia severity, speech‐language pathologist intervention, comorbidities, length of hospital stay and premorbid FOIS. Conclusions The severity of cognitive impairment has no impact on hospital‐associated dysphagia in AP patients receiving dysphagia rehabilitation. A future interventional study will be expected to further validate our findings. Geriatr Gerontol Int 2017; ••: ••–••.

  September 21, 2017   doi: 10.1111/ggi.13164   open full text
• Effectiveness of a new tool for self‐evaluation of adherence to antimuscarinic drug treatment in older patients of both sexes with urge incontinence.
  Kirill Kosilov, Sergay Loparev, Irina Kuzina, Liliya Kosilova, Marina Ivanovskaya, Alexandra Prokofyeva.
  Geriatrics and Gerontology International. September 17, 2017
  Aim The present study was a comparison of the validity of the Medication Adherence Self‐Report Inventory (MASRI) questionnaire with other methods of assessing adherence to antimuscarinic drugs treatment in older patients with urge incontinence. Methods The experiment involved 733 men and women aged >65 years who had noted no less than one urge incontinence episode per day. At the beginning of the experiment, and after 4, 8 and 12 weeks, their adherence to treatment was monitored using the MASRI. Results The construct validity of the tool was confirmed by data on the correlation of the percentage of non‐adherent patients according to the MASRI and the percentage of patients having a belief barrier on the Brief Medication Questionnaire screen (r = 0.89, P ≤ 0.01; r = 0.91, P ≤ 0.01; and r = 0.91, P ≤ 0.05 at the 4th, 8th and 12th week of the follow up). The hypothesis of competitive validity was supported by comparing the percentage of non‐adherent patients according to the MASRI and the number of missed doses on the Brief Medication Questionnaire screen (r = 0.94, P ≤ 0.01; r = 0.85, P ≤ 0.05; and r = 0.7, P ≤ 0.05), and according to a visual count of pills. The area under the curve at the 4th, 8th, and 12th week was 0.95 ± 0.04, 0.92 ± 0.03 and 0.94 ± 0.04, respectively. Conclusion The MASRI questionnaire has high validity, and is effective for evaluating adherence to treatment among older patients with urge incontinence taking antimuscarinic drugs. Using the MASRI would imply lower costs and greater availability of diagnostics, and it is the tool of choice in clinical practice. Geriatr Gerontol Int 2017; ••: ••–••.

  September 17, 2017   doi: 10.1111/ggi.13150   open full text
• Clinicopathological characteristics of distant metastases of adenocarcinoma, squamous cell carcinoma and urothelial carcinoma: An autopsy study of older Japanese patients.
  Yoko Matsuda, Atsuko Seki, Keisuke Nonaka, Mototsune Kakizaki, Tan Wang, Junko Aida, Naoshi Ishikawa, Yuta Nakano, Daita Kaneda, Tadayuki Takata, Junko Takahashi‐Fujigasaki, Shigeo Murayama, Kaiyo Takubo, Toshiyuki Ishiwata, Motoji Sawabe, Tomio Arai.
  Geriatrics and Gerontology International. September 15, 2017
  Aim We aimed to clarify the characteristics of malignancies in older adults focusing on distant metastasis in the whole body. Methods We retrospectively evaluated 7710 cases of autopsies (4011 men, 3699 women, median age of 80 years), and analyzed the characteristics of metastasis of adenocarcinoma, squamous cell carcinoma and urothelial carcinoma in each organ. Results The total number of cases with adenocarcinoma, squamous cell carcinoma or urothelial carcinoma was 2856, and most of them were adenocarcinomas. Among them, 1604 had metastatic lesions, and patients with metastasis were younger than those without metastasis. The major primary organs of adenocarcinoma were the stomach, colon, lung, prostate, gallbladder and pancreas, whereas those for squamous cell carcinoma were the lung, esophagus and uterus. Urothelial carcinoma cases were found in the urinary bladder, kidney and ureter. Metastatic adenocarcinomas mainly originated from the stomach, colon, lung, pancreas and gallbladder. Metastatic squamous cell carcinomas were from the lung, esophagus and uterus, whereas the kidney, bladder and ureter were the primary origins of metastatic urothelial carcinomas. Squamous cell carcinoma showed the highest incidence of metastasis, suggestive of it being of an aggressive phenotype. Furthermore, metastatic ability and the preferred metastatic sites varied among primary organs. Conclusions We revealed an accurate incidence and the characteristics of metastatic cancer in a large‐scale autopsy study of older Japanese patients from one institution. Identifying these features might prompt screening for malignancies, and consequently improve quality of life for older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  September 15, 2017   doi: 10.1111/ggi.13165   open full text
• “Yubi‐wakka” (finger‐ring) test: A practical self‐screening method for sarcopenia, and a predictor of disability and mortality among Japanese community‐dwelling older adults.
  Tomoki Tanaka, Kyo Takahashi, Masahiro Akishita, Tetsuo Tsuji, Katsuya Iijima.
  Geriatrics and Gerontology International. September 12, 2017
  Aim We developed a simple self‐screening method, the “Yubi‐wakka (finger‐ring)” test to assess sarcopenia swiftly. This prospective cohort study aimed to examine the validity of this test as a practical method among community‐dwelling older adults for identifying sarcopenia, and for predicting disability and mortality. Methods We followed 1904 older adults, and analyzed associations between this “Yubi‐wakka” test result at baseline in 2012 and sarcopenia at baseline, new‐onset sarcopenia followed until 2014, and new‐certification for the long‐term care insurance and mortality followed until 2016. The “Yubi‐wakka” test checks whether the maximum non‐dominant calf circumference is bigger than the individual's own finger‐ring circumference, which is formed by the thumb and forefinger of both hands. We divided participants into three groups, “bigger,” “just fits” and “smaller” based on a comparison between the calf and finger‐ring circumference. Results Of 1904 participants (mean age 72.8 ± 5.4 years), 53% were grouped as “bigger,” 33% were in “just fits” and 14% were in “smaller.” Relative to “bigger,” the test results statistically associated with sarcopenia (“just fits” OR 2.4, 95% CI 1.4–4.1 and “smaller” OR 6.6, 95% CI 3.5–13), by multivariate analyses. The test results also increased the risk of new‐onset sarcopenia (“just fits” HR 2.1, 95% CI 1.2–3.8 and “smaller” HR 3.4, 95% CI 1.8–6.4). Furthermore, the “smaller” had 2.0‐ and 3.2‐fold increased risks for needing long‐term care insurance services and mortality, respectively. Conclusions The “Yubi‐wakka” test is an extremely practical method to identify older adults at risk of sarcopenia, disability and mortality. This test might contribute to increased primary prevention for sarcopenia by serving as an early wake‐up call for older adults against becoming sarcopenic. Geriatr Gerontol Int 2017; ••: ••–••.

  September 12, 2017   doi: 10.1111/ggi.13163   open full text
• Prevalence and factors associated with mild cognitive impairment among Chinese older adults with depression.
  Ning Li, Gong Chen, Ping Zeng, Jing Pang, Huan Gong, Yiwen Han, Yan Zhang, Enyi Zhang, Tiemei Zhang, Xiaoying Zheng.
  Geriatrics and Gerontology International. September 07, 2017
  Aim Depression and mild cognitive impairment (MCI) are common among older adults. Most of the existing studies were carried out in developed countries, and evidence from developing countries are lacking. In the present study, using a national sample, we aimed to describe the prevalence of MCI and its associated factors among Chinese older adults with depression. Method The present study uses data from a national survey of the 2011 Comprehensive Assessment of Elderly Health, which involved 8113 older adults from eight provinces or municipalities directly under the Central Government of six regions in China. The Geriatric Depression Scale was used to assess depression, and the Mini‐Mental State Examination was used as the measurement of cognitive function. Results The results showed that the prevalence of geriatric depression was 15.9%, and 36.4% of those with depression had MCI. Geriatric depression was found to be significantly associated with MCI after controlling for demographics. Among participants with geriatric depression, female sex, older age, rural or suburban residence, poor physical health status, education level of illiterate or elementary school, having no daily physical activity, and living in Central China or West China were associated with an increased risk of MCI. Conclusions The present study showed a high prevalence rate of MCI among Chinese older adults with depression. Early screening and treatment for MCI are necessary among people with geriatric depression. Further research and health services innovations are required to address the high prevalence of MCI in this population. Geriatr Gerontol Int 2017; ••: ••–••.

  September 07, 2017   doi: 10.1111/ggi.13171   open full text
• Health checkup behavior and individual health beliefs in older adults.
  Mika Okura, Mihoko Ogita, Miki Yamamoto, Toshimi Nakai, Tomoko Numata, Hidenori Arai.
  Geriatrics and Gerontology International. September 07, 2017
  Aim Despite Japan being a developed nation, half of its older population does not attend regular health checkups. The aim of the present study was to examine the individual health beliefs and personal recommendations that strongly influence health checkup attendance among community‐dwelling older adults. Methods In 2013, questionnaires were sent to 5401 community‐dwelling older adults who were not receiving long‐term institutionalized care. The response rate was 94.3%. We analyzed response data from 4984 older adults using multiple imputation to manage missing data. Participation in health checkups was defined as having undergone at least one checkup in the past 3 years, and non‐participation as having attended no checkups in this period. Results The participants’ mean age was 75.8 years, and 57.9% were women. The adjusted odds ratio of health checkup participation ranged from 1.35 (95% confidence interval [CI] 1.13–1.61) to 1.62 (95% CI 1.34–1.95) for positive individual health beliefs about health checkups, and was 2.21 (95% CI: 1.51–3.24) and 1.28 (95% CI: 1.17–2.08) for recommendations to participate from family and neighbors, respectively. All odds ratios were adjusted for age, sex, driving by oneself to daily shopping or clinic, paid work, method of response, internal medical therapy, polypharmacy, serious disease, periodic blood test, frailty and neighborly relationships. Conclusions The present findings suggest that both individual and community approaches might be effective in promoting participation in health checkups among community‐dwelling older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  September 07, 2017   doi: 10.1111/ggi.13169   open full text
• Validity of maximum isometric tongue pressure as a screening test for physical frailty: Cross‐sectional study of Japanese community‐dwelling older adults.
  Hirotomo Yamanashi, Yuji Shimizu, Miho Higashi, Jun Koyamatsu, Shimpei Sato, Mako Nagayoshi, Koichiro Kadota, Shinya Kawashiri, Mami Tamai, Noboru Takamura, Takahiro Maeda.
  Geriatrics and Gerontology International. September 04, 2017
  Aim Maximum isometric tongue pressure (MIP) seems to have a diagnostic value for oral phase dysphagia. The present study aimed to examine the association between MIP and frailty, and to assess the screening validity of MIP for physical frailty. Methods We carried out a cross‐sectional study, and enrolled participants aged ≥60 years from Japanese national medical check‐ups in 2015 and 2016. The Fried frailty phenotype model was used. We analyzed odds ratios (OR) and 95% confidence intervals (CI) of physical frailty using one standard deviation increments of tongue pressure. Receiver operating characteristic curves were obtained to predict physical frailty using MIP values. Results Out of 1603 participants, 968 were categorized as non‐frail, 605 as pre‐frail and 30 as frail. In logistic regression analysis, one standard deviation increment of MIP significantly differentiated frail and pre‐frail: the OR for frail with one standard deviation increment in MIP was 0.37 (95% CI 0.26–0.54, P < 0.001), and the OR for pre‐frail was 0.63 (95% CI 0.57–0.70, P < 0.001). The area under the receiver operating characteristic curve for predicting frailty with MIP score was as high as 0.776 (95% CI 0.689–0.862). A point of MIP 35 kPa had a sensitivity of 90.0%, specificity of 40.4%, a positive likelihood ratio of 1.5 and a negative likelihood ratio of 0.2 for predicting frailty. Conclusions MIP performance is independently associated with frailty. MIP also can be used as a simple screening tool for frailty. Geriatr Gerontol Int 2017; ••: ••–••.

  September 04, 2017   doi: 10.1111/ggi.13166   open full text
• Use of sodium–glucose cotransporter 2 inhibitors in older patients with type 2 diabetes mellitus.
  Takahiro Kambara, Rei Shibata, Hiroyuki Osanai, Yoshihito Nakashima, Hiroshi Asano, Kazuyoshi Sakai, Toyoaki Murohara, Masayoshi Ajioka.
  Geriatrics and Gerontology International. September 01, 2017
  Aim Sodium–glucose cotransporter 2 (SGLT2) inhibitors are antidiabetic agents that act on the proximal renal tubules to lower blood glucose levels by inhibiting glucose reabsorption and promoting urinary glucose excretion. The present study assessed the long‐term use of SGLT2 inhibitors in older patients with diabetes. Methods A total of 117 older patients with type 2 diabetes who were given SGLT2 inhibitors were enrolled from April 2014 to March 2016. Results The mean age of the patients was 73.7 ± 10.0 years. During the follow‐up period (mean 289.3 days), there was no event associated with oral administration of SGLT2 inhibitors. These drugs significantly lowered fasting blood glucose and glycosylated hemoglobin levels at 6 months, and did not affect the creatinine level, blood urea nitrogen/creatinine ratio or estimated glomerular filtration rate during treatment. Although the treatment significantly increased hemoglobin and hematocrit levels, it did not affect the ultrasonographically determined diameter of the inferior vena cava, and no signs of intravascular collapse were observed. Changes in brain natriuretic peptide levels during the follow‐up period were assessed in 78 patients with a brain natriuretic peptide level exceeding the normal upper limit before treatment with SGLT2 inhibitors. The brain natriuretic peptide levels significantly decreased after 6 months of treatment. Conclusions In older Japanese patients with diabetes, treatment with SGLT2 inhibitors for 6 months exerted a favorable hypoglycemic effect, while no sign of dehydration was observed. Geriatr Gerontol Int 2017; ••: ••–••.

  September 01, 2017   doi: 10.1111/ggi.13149   open full text
• Trend of cardiovascular risk factors in the older Iranian population: 2002–2014.
  Ali Eslami, Mojtaba Lotfaliany, Samaneh Akbarpour, Fereidoun Azizi, Farzad Hadaegh.
  Geriatrics and Gerontology International. August 31, 2017
  Aim Current study aimed to investigate the sex‐stratified secular trend of cardiovascular disease risk factors among an older population in Iran during a median follow‐up period of 8.76 years. Methods A total of 1490 participants (733 women) aged ≥60 years were evaluated in four study phases of 2002–2005, 2005–2008, 2008–2011 and 2011–2014. The trends of cardiovascular disease risk factors for each sex were estimated using generalized estimating equations. Results The age‐adjusted prevalence of diabetes, hypertension, central obesity, and chronic kidney disease at the baseline was 24%, 43%, 55%, and 32% in men and 31%, 57%, 60% and 53% in women, respectively, and had noticeable upward trend during the study period to reach 35%, 56%, 61% and 51% in men, and 42%, 71%, 74% and 67% in women, respectively. However, lipid profile parameters showed favorable trends. Despite the increasing trend in drug consumption, approximately 27% of women with diabetes and 37% of men with diabetes did not use antidiabetic medication, respectively; the results were 23% and 35% for hypertensive women and men, respectively. Among men, there was a decreasing trend towards low physical activity, from 40% at baseline to 26% at the most recent follow up. The prevalence of smoking remained steady throughout follow up. Conclusions Despite the benefits of lipid lowering, the status of other risk factor profiles are often suboptimal in both sexes. There remains much room for improvement in risk factors management, particularly for hypertension, smoking and adiposity status, and a need for an intervention. Geriatr Gerontol Int 2017; ••: ••–••.

  August 31, 2017   doi: 10.1111/ggi.13154   open full text
• Association between potentially inappropriate medications and anxiety in Japanese older patients.
  Shoichi Masumoto, Mikiya Sato, Takami Maeno, Yumiko Ichinohe, Tetsuhiro Maeno.
  Geriatrics and Gerontology International. August 31, 2017
  Aim The use of potentially inappropriate medications (PIMs) for older patients is a major public health problem. However, there is little information regarding PIMs in Japanese primary care settings, and the association between psychological problems and PIMs is unknown. The present study was carried out to explore the prevalence of PIMs among older patients in a primary care setting in Tokyo, and to assess the association between PIMs and depression and anxiety. Methods A cross‐sectional study in a Japanese outpatient clinic providing primary care was carried out. Data were collected from January 2016 to March 2016. A total of 740 patients aged ≥65 years with chronic diseases were enrolled. Information regarding sociodemographic status, comorbidities, and prescription and psychological status was collected using a questionnaire that patients were required to complete, and by reviewing the patients’ medical records. Results The Screening Tool of Older Person's Prescriptions criteria version 2 revealed PIM prescription for 32.3% of patients. Benzodiazepines, hypnotic Z‐drugs and proton pump inhibitors accounted for a majority of PIMs. After adjusting for age, sex, comorbidities, estimated glomerular filtration rate and the number of medications, anxiety was identified as a predictor for PIMs. Conclusions PIMs among older patients are common in Japanese primary care settings, and prescription of benzodiazepines or hypnotic Z‐drugs and proton pump inhibitors was frequent as PIMs. PIMs might be associated with anxiety; therefore, their association should be focused on and addressed to reduce PIMs. Geriatr Gerontol Int 2017; ••: ••–••.

  August 31, 2017   doi: 10.1111/ggi.13128   open full text
• Factors associated with cognitive function that cause a decline in the level of activities of daily living in Alzheimer's disease.
  Masaki Kamiya, Aiko Osawa, Izumi Kondo, Takashi Sakurai.
  Geriatrics and Gerontology International. August 31, 2017
  Aim The principal aim of the present study was to clarify what type of cognitive decline results in a decrease in the ability to carry out activities of daily living (ADL) in patients with Alzheimer's disease (AD). Methods The participants comprised 1384 outpatients with mild AD. We used the Mini‐Mental State Examination (MMSE) and Barthel Index (BI) as indicators of basic ADL, and the Lawton Index (LI) as an indicator of instrumental ADL (IADL). We then analyzed the relationships between MMSE and BI, as well as between MMSE and LI. We also carried out a logistic regression analysis with BI and LI subitems as dependent variables, and MMSE subitems as independent variables. Results For almost all BI and LI subitems, significantly high odds ratios (OR) were noted in MMSE “Copy the design shown” (e.g. dressing OR 3.66, toilet use OR 3.60 and transfers OR 2.80) and “Write a sentence” (e.g. ability to use telephone OR 5.24, laundry OR 2.60, grooming OR 2.50; P < 0.05). Conclusions Visuospatial cognition had an important effect on the decrease in basic ADL and IADL. Furthermore, the subitems with minimal effect on the decrease of basic ADL and IADL differed. Therefore, it appears that specific activities have little effect on the maintenance of ADL and IADL, and that determining residual cognitive function and utilizing this as a means of compensating for decreased ADL is a useful strategy. Geriatr Gerontol Int 2017; ••: ••–••.

  August 31, 2017   doi: 10.1111/ggi.13135   open full text
• Clinical characteristics of stroke occurring in the toilet: Are older adults more vulnerable?
  Joji Inamasu, Kazuhiro Tomiyasu, Satoru Miyatake, Keita Mayanagi, Masami Yoshii, Masashi Nakatsukasa.
  Geriatrics and Gerontology International. August 31, 2017
  Aim While autonomic imbalance during defecation/micturition can cause hemodynamic instability, stroke occurring in the toilet has rarely been investigated. The objective of the present study was to clarify the frequency and clinical characteristics of toilet‐related stroke. Methods Clinical data prospectively acquired between January 2011 and December 2015 on 1939 patients with acute stroke (1224 cerebral infarctions [CI], 505 intracerebral hemorrhages [ICH] and 210 subarachnoid hemorrhages [SAH]) were reviewed to identify patients with a toilet‐related stroke. For each stroke type, the ratios of stroke occurring during defecation/micturition to those occurring during other activities were calculated. Subsequently, how patients with toilet‐related stroke were brought to medical attention was investigated. Whether older patients (aged >65 years) had an elevated ratio of toilet‐related stroke was investigated in each stroke type. Results A total of 108 patients (41 CI, 37 ICH and 30 subarachnoid hemorrhages) sustained a stroke in the toilet. The ratio of toilet‐related stroke was highest in subarachnoid hemorrhages (14.3%), followed by ICH (7.3%). Circadian differences existed among the three stroke types: toilet‐related CI were more likely to occur in the night‐time than ICH. Patients with toilet‐related CI were significantly more likely to sustain cardioembolic stroke. In all three stroke types, <40% of patients could call for help by themselves. Older patients showed a significantly higher proportion of toilet‐related stroke in CI, but not in hemorrhagic strokes. Conclusions The toilet is a closed space where stroke occurs disproportionately frequently. Effort to reduce the incidence of toilet‐related strokes is warranted, as early patient detection is not always feasible. Geriatr Gerontol Int 2017; ••: ••–••.

  August 31, 2017   doi: 10.1111/ggi.13168   open full text
• Nutritional supplementation for activities of daily living and functional ability of older people in residential facilities: A systematic review.
  Marika Tsuboi, Ryo Momosaki, Mahdis Vakili, Masahiro Abo.
  Geriatrics and Gerontology International. August 31, 2017
  Aim To review the best available evidence on nutritional supplementation for activities of daily living and functional ability of older people in residential facilities. Methods Electronic searches were carried out using CENTRAL, MEDLINE and EMBASE databases for the years 2006–2016. Randomized controlled trials and cluster‐randomized controlled trials that examined the effects of nutrition interventions aimed at improving the energy or protein intake alone or both in combination were included. Two authors independently reviewed all potential studies for inclusion against the eligibility criteria. We reviewed studies for outcome relevance and methodological rigor. Any disagreement was resolved by discussion. Results A total of eight studies were included, containing four randomized controlled trials and four cluster‐randomized controlled trials involving 698 participants. There was significant improvement in handgrip strength (mean difference 1.65 kg, 95% confidence interval 0.09–3.22 kg, P = 0.04), but no difference in activities of daily living (mean difference 2.06, 95% confidence interval −18.28–22.40, P = 0.84), balance (mean difference −1.10, 95% confidence interval −3.04–0.84, P = 0.27), gait velocity (mean difference 0.00, 95% confidence interval −0.03–0.03, P = 1.00) and death (RR 1.90, 95% confidence interval 0.61–5.99, P = 0.27). Conclusions Nutritional intervention with older people in residential facilities was effective in improving handgrip strength, but did not significantly improve scores for activities of daily living, balance, gait velocity or preventing death. Further studies with larger sample sizes and of high quality are required to investigate appropriate intervention methods and specific target participants. Geriatr Gerontol Int 2017; ••: ••–••.

  August 31, 2017   doi: 10.1111/ggi.13160   open full text
• Development and psychometric properties of the Basic Amputee Mobility Score for use in patients with a major lower extremity amputation.
  Morten Tange Kristensen, Anni Østergaard Nielsen, Ulla Madsen Topp, Jakob Holmehave‐Brandt, Charlotte Falkenberg Petterson, Peter Gebuhr.
  Geriatrics and Gerontology International. August 31, 2017
  Aim To develop and examine the psychometric properties, including responsiveness and interrater reliability, of a new outcome measure for the evaluation of basic mobility activities after a major lower extremity amputation – The Basic Amputee Mobility Score (BAMS). Methods The four following essential activities were chosen through consensus meetings with experienced amputee physiotherapists: (i) supine in bed to sitting on the edge of the bed; (ii) bed to wheelchair transfer; (iii) indoor wheelchair mobility; and (iv) get up from a wheelchair to standing on the non‐amputated leg. Each activity is scored from 0 to 2 (0 = not able to; 1 = able to with assistance/guiding; and 2 = independent), and cumulated to a 1‐day BAMS score of 0–8. Validity and responsiveness were established in 106 consecutive in‐hospital patients with a major dysvascular lower extremity amputation, while reliability and agreement were examined in an additional sample of 30 patients. Results The 30‐day mortality risk was reduced by 88% (HR = 0.12, 95% CI 0.02–0.68) for those out of bed (BAMS ≥2 points) at the first physiotherapy assessment, while BAMS scores improved between the first and the discharge assessment, with a standardized response mean of 1.3. Reliability assessments resulted in a weighted Kappa value of 0.98, a standard error of measurement of 0.32 and a minimal detectable change of 0.89 points. No systematic between‐rater bias was seen (P = 0.3). Conclusions The BAMS was feasible in all patients, and showed a large responsiveness, excellent interrater reliability and with a change of 1 point indicating a real change in performances. Geriatr Gerontol Int 2017; ••: ••–••.

  August 31, 2017   doi: 10.1111/ggi.13156   open full text
• Ethnicity predicts falls among community‐dwelling older adults in Singapore.
  Tuo‐Yu Chen, Pey June Tan, Angelique Chan.
  Geriatrics and Gerontology International. August 30, 2017
  Aim The present study examined whether ethnicity independently predicted future falls among community‐dwelling older Singaporeans, and whether ethnicity moderated the relationships between falls risk factors at baseline and falls at follow up. Methods Data from a longitudinal survey of older Singaporeans were used. Baseline assessment included handgrip strength, global cognitive function, mobility difficulties, health and psychosocial status. One‐year retrospective falls information at follow up was the primary outcome. Results Final analysis included 1975 participants (mean age 73.6 ± 6.2 years, 53% women). Indians, followed by Malays, had a higher risk of falling compared with Chinese at follow up. This association remained after controlling for falls risk factors. Self‐reported pain and poor global cognitive function imposed a substantial increment in the risk of falling among Malays compared with Chinese, but not Indians. Conclusion Ethnicity was a significant predictor of future falls among older Singaporeans. Falls screening and intervention should take ethnicity into account to reach and support the appropriate target population. Geriatr Gerontol Int 2017; ••: ••–••.

  August 30, 2017   doi: 10.1111/ggi.13143   open full text
• Predictive factors of rehospitalization for worsening heart failure and cardiac death within 1 year in octogenarians hospitalized for heart failure.
  Tomoyuki Hamada, Toru Kubo, Naohito Yamasaki, Hiroaki Kitaoka.
  Geriatrics and Gerontology International. August 30, 2017
  Aim To investigate the predictive factors of cardiac events including rehospitalization for worsening heart failure (HF) and cardiac death within 1 year after hospital discharge in octogenarians hospitalized for HF. Methods We retrospectively analyzed in detail clinical data for patients aged >80 years who were admitted to Kochi University, Kochi, Japan, for acute decompensated HF in order to identify predictive factors for cardiac events within 1 year. Results A total of 67 patients (mean age of 85 ± 4 years, 39 men) were included, and 28 patients (41.8%) had cardiac events. The patients with cardiac events were significantly older, had a lower prescription rate of beta‐blockers at discharge and had a lower rate of arrhythmia as an exacerbating factor of HF than patients without cardiac events. When nutritional status was assessed by the controlling nutritional status (CONUT) score, patients in the cardiac events group had significant malnutrition (CONUT ≥5). In addition, Kaplan–Meier analysis showed that patients with CONUT ≥5 had a higher incidence of cardiac events than did those with a CONUT <5 (log–rank, P < 0.038). In logistic analysis, the independent determinants of the cardiac events within 1 year were malnutrition at moderate or severe levels by the CONUT score and no beta‐blocker medication. Conclusions In very elderly patients hospitalized for HF, malnutrition and no beta‐blocker medication were predictors of rehospitalization for worsening HF or cardiac death within 1 year. These factors could be meaningful targets for improving the management of octogenarians with HF. Geriatr Gerontol Int 2017; ••: ••–••.

  August 30, 2017   doi: 10.1111/ggi.13148   open full text
• Genetic and environmental influences on cardiovascular risk factors and cognitive function: A Chinese twin aging study.
  Chunsheng Xu, Xiaocao Tian, Jianping Sun, Yili Wu, Dongfeng Zhang, Zengchang Pang, Shuxia Li, Inge Petersen, Jonas Mengel‐From, Lene Christiansen, Kaare Christensen, Qihua Tan.
  Geriatrics and Gerontology International. August 30, 2017
  Aim To explore the genetic and environmental influences on cardiovascular risk factors (CVRF) and cognitive function in the world's largest and rapidly aging Chinese population. Methods Cognitive function and CVRF, including body mass index, systolic blood pressure, diastolic blood pressure, pulse pressure, glucose, total cholesterol, triglyceride, high‐density lipoprotein cholesterol (HDLC) and low‐density lipoprotein cholesterol were measured in 379 complete twin pairs. Univariate and bivariate twin models were fitted to estimate the genetic and environmental components in the variance and covariance of CVRF and cognition. Results Mild‐to‐high heritability was estimated for CVRF and cognition (0.27–0.74). Unique environmental factors showed low‐to‐moderate contributions (0.23–0.56). Only HDLC presented significant common environmental contribution (0.50). Bivariate analysis showed significantly negative genetic correlations (rG) between cognition and systolic blood pressure (rG = −0.56), diastolic blood pressure (rG = −0.42), pulse pressure (rG = −0.45), and positive genetic correlations between cognition and total cholesterol (rG = 0.33), triglyceride (rG = 0.23) and HDLC (rG = 0.41). HDLC and cognition presented a unique environmental correlation (rE = −0.13), but in the opposite direction. Conclusions Cognitive function was genetically related to systolic blood pressure, diastolic blood pressure, pulse pressure, total cholesterol, triglyceride and HDLC with a negative or positive direction. Cognition and HDLC might share part of a similar unique environmental factor. Geriatr Gerontol Int 2017; ••: ••–••.

  August 30, 2017   doi: 10.1111/ggi.13161   open full text
• Location of white matter changes and response to donepezil in patients with Alzheimer's disease: A retrospective and observational study.
  Meng‐Ni Wu, Yi‐Hui Kao, Ping‐Song Chou, Tzu‐Chao Lin, Lin‐Li Kao, Yuan‐Han Yang.
  Geriatrics and Gerontology International. August 29, 2017
  Aim The response to donepezil in patients with Alzheimer's disease varies, and it is important to identify the potential responder before therapy. Cerebral white matter changes (WMC) are frequently observed in older patients, and the effect of WMC on therapeutic response remains controversial. The present study aimed to investigate the relationships between the location of WMC, severe WMC and the response to donepezil. Methods Among 418 patients with Alzheimer's disease receiving donepezil, 196 patients were eligible for analysis. Five brain areas on each side were analyzed using computed tomography scans and the Age‐Related White Matter Changes Rating Scale before therapy. The Cognitive Abilities Screening Instrument was used annually. Patients were defined as responders if their baseline Cognitive Abilities Screening Instrument score minus their follow‐up Cognitive Abilities Screening Instrument score was ≤0. Results There was no significant difference in demographic data between responder and non‐responder groups. Patients in the responder group had significantly less involvement of WMC in the frontal area (P = 0.0213) and nearly a trend for less involvement of WMC in the basal ganglia (P = 0.1103). After adjustment for age, sex, education, polymorphism of apolipoprotein E, hypertension and diabetes, WMC in the frontal area (OR 0.446, P = 0.0139) and basal ganglia (OR 0.243, P = 0.0380) were significantly associated with a reduced therapeutic response. Conclusions Patients with WMC in the frontal area and basal ganglia had significant decreases in their therapeutic response to donepezil. The location of WMC, independent of their severity, might be associated with the therapeutic response in patient with Alzheimer's disease. Geriatr Gerontol Int 2017; ••: ••–••.

  August 29, 2017   doi: 10.1111/ggi.13153   open full text
• Indications, appropriateness and drug interactions of proton pump inhibitors prescribed at hospital discharge in older medical patients.
  Riccardo Fagiano, Yolanda Falcone, Gianfranco Fonte, Clara Cena, Enrico Brunetti, Mario Bo.
  Geriatrics and Gerontology International. August 28, 2017
  There is no abstract available for this paper.

  August 28, 2017   doi: 10.1111/ggi.13043   open full text
• Analysis of autonomic modulation of heart rate in patients with Parkinson's disease and elderly individuals submitted to game therapy training.
  Rodrigo Santiago Barbosa Rocha, Larissa Salgado De Oliveira Rocha, Elza Sara Maués Pena, Laiz Cristinna Ponce Caldas, Marlene Aparecida Moreno.
  Geriatrics and Gerontology International. August 23, 2017
  Aim Elderly patients and individuals with Parkinson's disease have a reduction in autonomic heart rate modulation, which may influence the survival of these patients, and rehabilitation can minimize this event. We tested the hypothesis that rehabilitation protocol with game console would influence the cardiac autonomic modulation of patients with Parkinson's Disease. Methods Eight‐seven volunteers were divided into two groups, control (n = 45) and Parkinson's (n = 42), they completed the study 40 volunteers in the control group (CG) and 31 patients in the Parkinson group (PG), and subjected to 24 sessions of game therapy physiotherapy, thrice a week. Analysis of autonomic HR modulation was conducted before and after the rehabilitation program using a Polar RS800CX HR sensor. For the analysis of heart rate variability the data were transferred to the Kubios HRV 2.2 program. Statistical analysis was performed in the Biostat 5.2 program, the comparison of the data by ANOVA followed by Tukey test, and the general characteristics by the chi‐square test. The critical value for rejecting the null hypothesis was set at P < 0.05. Results HR variability in patients with PD exhibited higher influence on the sympathetic nervous system before protocol implementation and, following the protocol, patients did not attain the normality values of the control group, exhibiting a discreet improvement and maintenance of autonomic modulation of HR values. Conclusion Subjects with PD exhibit less autonomic modulation of HR and the rehabilitation protocol with game therapy improved autonomic modulation of HR. Geriatr Gerontol Int 2017; ••: ••–••.

  August 23, 2017   doi: 10.1111/ggi.13130   open full text
• Serum sodium level within the normal range is associated with maximum voluntary tongue pressure against the palate among community‐dwelling older Japanese men.
  Yuji Shimizu, Shimpei Sato, Jun Koyamatsu, Hirotomo Yamanashi, Miho Higashi, Mako Nagayoshi, Koichiro Kadota, Shin‐Ya Kawashiri, Noboru Takamura, Takahiro Maeda.
  Geriatrics and Gerontology International. August 23, 2017
  Aim Recent geriatric studies have focused on maximum voluntary tongue pressure against the palate (MTP) as a diagnostic value for dysphagia, as dysphagia causes aspiration pneumonia. Dysphagia can also cause water intake difficulties, resulting in hypernatremia by indicating the presence of hyperosmotic dehydration. However, no studies have reported on a possible association between reduced MTP and serum sodium levels. Methods To evaluate hyperosmotic dehydration within the normal range as an indicator of reduced MTP, we carried out a cross‐sectional study of 655 older Japanese community‐dwelling men (age ≥60 years) who undertook a general health check‐up from 2015 to 2016. As a high concentration of glucose influences serum osmolarity, which might act as a strong confounding factor on this association, the additional analysis was limited to individuals without diabetes. Reduced MTP is defined as a tongue pressure at or under the 20th percentile of the study population (≤24.0 kPa). Results Independent of classical cardiovascular risk factors, the adjusted odds ratio of reduced MTP for a 1‐standard deviation increment of serum sodium (2.21 mEq/L) was 1.29 (95% confidence interval 1.10–1.52). When the analysis was limited to individuals without diabetes, the association became slightly stronger, with an adjusted corresponding value of 1.59 (95% confidence interval 1.21–2.10). Conclusions Serum sodium level within the normal range is independently associated with reduced MTP in older Japanese men. This finding suggests that measuring the MTP is clinically relevant for estimating the pathophysiological values (such as dysphagia risks and aspiration pneumonia risks) in daily clinical practice. Geriatr Gerontol Int 2017; ••: ••–••.

  August 23, 2017   doi: 10.1111/ggi.13152   open full text
• Factors associated with polypharmacy in elderly home‐care patients.
  Hitoshi Komiya, Hiroyuki Umegaki, Atsushi Asai, Shigeru Kanda, Keiko Maeda, Takuya Shimojima, Hideki Nomura, Masafumi Kuzuya.
  Geriatrics and Gerontology International. August 08, 2017
  Aim Polypharmacy, which is often observed in elderly patients, has been associated with several unfavorable outcomes, including an increased risk of potentially inappropriate medications, medication non‐adherence, drug duplication, drug–drug interactions, higher healthcare costs and adverse drug reactions. A significant association between polypharmacy and adverse outcomes among older people living in the community has also been confirmed. A reduction in the number of medications should thus be pursued for many older individuals. Nevertheless, the factors associated with polypharmacy in elderly home‐care patients have not been reported. Here, we investigated those factors in elderly home‐care patients in Japan. Methods We used the data of the participants in the Observational Study of Nagoya Elderly with Home Medical investigation. Polypharmacy was defined as the current use of six or more different medications. We carried out univariate and multivariate logistic regression analyses to assess the associations between polypharmacy and each of several factors. Results A total of 153 home‐care patients were registered. The mean number of medications used per patient was 5.9, and 51.5% of the patients belonged to the polypharmacy group. The multivariate model showed that the patients’ scores on the Charlson Comorbidity Index and the Mini‐Nutrition Assessment Short Form were inversely associated with polypharmacy, and potentially inappropriate medication was most strongly associated with polypharmacy (odds ratio 4.992). Conclusions The present findings showed that polypharmacy was quite common among the elderly home‐care patients, and they suggest that home‐care physicians should prescribe fewer medications in accord with the deterioration of home‐care patients’ general condition. Geriatr Gerontol Int 2017; ••: ••–••.

  August 08, 2017   doi: 10.1111/ggi.13132   open full text
• Association of physical activity with a systolic blood pressure difference between arms in older people.
  Koichi Sato, Tomonori Sugiura, Nobuyuki Ohte, Yasuaki Dohi.
  Geriatrics and Gerontology International. August 08, 2017
  Aim A increase in interarm systolic blood pressure difference (IASBPD) is believed to lead to increased risk of cardiovascular disease and to be a predictor of future cardiovascular events. The purpose of the present study was to test the hypothesis that an increased IASBPD is associated with reduced physical activity in older people. Methods Older people who used a geriatric health services facility (n = 147, mean age 83.3 years) were enrolled. The prevalence of IASBPD in individuals with different levels of physical activity and factors that have a crucial effect on IASBPD were investigated. The study participants were divided into three groups according to their physical activity; ambulant persons (group A), wheelchair users (group B) and bedridden persons (group C). Blood pressure around the both brachiums was simultaneously measured using two automated devices. An IASBPD of ≥10 mmHg was considered to be significant IASBPD. Results The median IASBPD was 4.5 mmHg in the present study participants, and 28 participants (19.0%) had an IASBPD ≥10 mmHg. The IASBPD in group C was greater than that in group A or B. Multivariate linear regression analysis showed that physical activity was the independent predictor of IASBPD after adjustment for possible factors. Furthermore, a logistic regression analysis with the end‐point of significant IASBPD showed that physical activity is an independent predictor of significant IASBPD. Conclusions Physical activity simply assessed by moving ability can predict IASBPD in older individuals. In older people, reduced physical activity might indicate the progression of silent or clinical atherosclerosis and an increased risk of cardiovascular disease. Geriatr Gerontol Int 2017; ••: ••–••.

  August 08, 2017   doi: 10.1111/ggi.13147   open full text
• Markers of nutritional status and mortality in older adults: The role of anemia and hypoalbuminemia.
  Ligiana Pires Corona, Yeda Aparecida Oliveira Duarte, Maria Lúcia Lebrão.
  Geriatrics and Gerontology International. August 06, 2017
  Aim The aim of the present study was to analyze the impact of anemia and hypoalbuminemia on mortality in a 5‐year period. Methods This was longitudinal population‐based observational survey part of the Saúde, Bem‐Estar e Envelhecimento study (Health, Well‐being and Aging), carried out with 1256 older adults from the third wave of the cohort, followed for 5 years, when they were contacted for the fourth wave, in Sao Paulo, Brazil. Anemia was defined when hemoglobin was <12 g/dL for women and <13 g/dL for men, and hypoalbuminemia when serum albumin was <3.5 g/dL. Survival functions were estimated according to nutritional status in four groups: (i) without nutritional alteration; (ii) anemia only; (iii) hypoalbuminemia only; and (iv) anemia and hypoalbuminemia. Hazard ratios were calculated, following the Cox proportional hazards model, controlling for baseline covariates. All analyses considered sample weights, and were carried out using the Stata 12. Results After the 5‐year period, 12.3% of the participants died, and 8.2% were lost to follow up. Those who died had lower hemoglobin and albumin concentrations (13.4 g/dL and 3.7 g/dL) compared with survivors (14.3d/dL and 3.9 g/dL; P < 0.001). The crude death rate was 27.6/1000 person‐years for participants in group i, 124.3 in group ii, 116.0 in group iii and 222.8 in group iv (P < 0.001). In the final Cox models, group 2 and 3 had a similar effect (hazard ratio 2.23, P = 0.020; 2.53, P = 0.005; respectively) and group 4 had a higher risk (hazard ratio 3.36; P = 0.004). Conclusions Anemia and hypoalbuminemia are important markers for death in older adults, and have an additive effect on mortality. Because they are common and cost‐effective biomarkers, their use should be encouraged in geriatric evaluation for all health professionals and in population settings, such as primary care. Geriatr Gerontol Int 2017; ••: ••–••.

  August 06, 2017   doi: 10.1111/ggi.13137   open full text
• Relating factors to severe injury from outdoor falls in older people.
  Hey Youn Jung, Sun Hyu Kim, Sang Cheal Lee, Sunpyo Kim, Gyu Chong Cho, Min Joung Kim, Ji Sook Lee, Chul Han.
  Geriatrics and Gerontology International. August 04, 2017
  Aim The aim of the present study was to evaluate the clinical characteristics, including floor characteristics and factors, related to severe injury from outdoor falls in older adults. Methods Patients were divided into two groups based on injury severity: the severe group and non‐severe group. The clinical and general characteristics were compared between the two groups, and factors associated with severe injury were investigated. Results Approximately 5% (364/7635) of older people involved in outdoor falls were classified into severe injury. The proportion of men and the rate of alcohol ingestion were higher in the severe group compared with that in the non‐severe group. Falling from stairs was a more frequent mechanism of fall in the severe group compared with that in the non‐severe group. Non‐slippery floor condition had a higher proportion in the severe group than that in the non‐severe group. Head and neck were the predominantly injured regions in both groups. Discharge was the most common result of emergency department treatment in the non‐severe group, whereas admission to intensive care unit was the main result in the severe group. Multivariate logistic analysis showed that male sex and falls from stairs rather than slipping down on the same level were associated with severe injury. Conclusions Floor characteristics did not influence injury severity; however, the risk of severe injury from outdoor falls in older adults was high in men and those who fell from stairs. Geriatr Gerontol Int 2017; ••: ••–••.

  August 04, 2017   doi: 10.1111/ggi.13144   open full text
• Interdependence of physical inactivity, loss of muscle mass and low dietary intake: Extrapulmonary manifestations in older chronic obstructive pulmonary disease patients.
  Kazuya Yoshimura, Susumu Sato, Shigeo Muro, Minoru Yamada, Koichi Hasegawa, Hirofumi Kiyokawa, Michiaki Mishima, Tomoki Aoyama.
  Geriatrics and Gerontology International. August 04, 2017
  Aim Extrapulmonary manifestations, such as reductions in skeletal muscle and physical inactivity, are important clinical features of patients with chronic obstructive pulmonary disease (COPD), and might depend on the severity of COPD. As it is still unclear whether the relationship between muscle loss and physical inactivity is dominated by a disease‐specific relationship or caused by patient factors, including physiological aging, we aimed to investigate the pulmonary or extrapulmonary factors associated with physical inactivity among older COPD patients. Methods A total of 38 older male COPD patients (aged ≥65 years) were enrolled, and were evaluated cross‐sectionally. Skeletal muscle mass was measured using bioelectrical impedance, and physical activity and energy intake were recorded for 2 weeks using a pedometer and diary. Results Daily step counts were successfully evaluated in 28 participants (mean forced expiratory volume in 1 s [%predicted; %FEV1]; 49.5%), and ranged widely. The mean step counts was 5166 steps/day, and found to have a significant relationship with dyspnea (r = −0.46), diffusing capacity (r = 0.47), %FEV1 (r = 0.44), skeletal muscle index (r = 0.59) and total dietary intake (r = 0.47), but not with age (P = 0.14). A stepwise multivariate analysis showed that the skeletal muscle index (β = 0.50) and total dietary intake (β = 0.35) were significant determinants of the daily step count (R2 = 0.46, p < 0.01). Conclusions Although various pulmonary factors are associated with daily physical activity, skeletal muscle mass and dietary intake are more closely correlated with physical activity in COPD patients. Because physical inactivity might be the strongest predictor of prognosis, the present results suggest that a comprehensive treatment strategy must be considered for older COPD patients to improve their extrapulmonary manifestations and pulmonary dysfunction. Geriatr Gerontol Int 2017; ••: ••–••.

  August 04, 2017   doi: 10.1111/ggi.13146   open full text
• Association of subclinical carotid atherosclerosis with immediate memory and other cognitive functions.
  Lumine Matsumoto, Kazushi Suzuki, Yoshiko Mizuno, Yumiko Ohike, Atsuko Ozeki, Satoshi Ono, Mikio Takanashi, Daigo Sawaki, Toru Suzuki, Tsutomu Yamazaki, Shoji Tsuji, Atsushi Iwata.
  Geriatrics and Gerontology International. August 04, 2017
  Aim To clarify whether carotid atherosclerosis and its risk factors are associated with cognitive decline. Methods We evaluated 206 individuals who visited our center for health screening. We carried out physical examinations, blood tests, intima‐media thickness (IMT) measurement by carotid ultrasonography, brain magnetic resonance imaging scanning and cognitive function assessments. A total of 30 individuals, who had significant cerebrovascular lesions detected in magnetic resonance imaging scans, were excluded. To detect early cognitive decline, we defined “cognitive impairment (CI)” when a patient satisfied at least one of three criteria. These were Mini‐Mental State Examination score <24, clock‐drawing test score <4 coexisting with forgetfulness and Wechsler Memory Scale‐revised delayed recall score below the normal range for the duration of education (>16 years of education: ≥9, 10–15 years: ≥5, 0–9 years: ≥3). Results Among 176 individuals, 27 were placed in the CI group. IMT was significantly higher in the CI group as compared with the non‐CI group (mean ± SD: 2.0 ± 1.0 vs 1.7 ± 0.7, P = 0018 by Student's t‐test). Other atherosclerotic risk factors, such as blood pressure, low‐density lipoprotein cholesterol, and hemoglobin A1c, were not significantly different between the two groups. In multivariate analysis, maximum IMT was associated with impaired immediate recall score on Wechsler Memory Scale‐revised, independent of the presence of deep white matter hyperintensities on the magnetic resonance imaging scan. Conclusions Subclinical carotid atherosclerosis, defined as thickened IMT, could be a marker for early stages of CI, especially for immediate memory recall. The impairment is presumably caused by inducing cerebral microvascular dysfunction in the frontal lobe. Geriatr Gerontol Int 2017; ••: ••–••.

  August 04, 2017   doi: 10.1111/ggi.13142   open full text
• Preoperative medication use and its association with postoperative length of hospital stay in surgical oncology patients receiving comprehensive geriatric assessment.
  Young Mi Jeong, Kyung Eun Lee, Eun Sook Lee, Kwang Ill Kim, Jee Eun Chung, Byung Koo Lee, Hye Sun Gwak.
  Geriatrics and Gerontology International. August 04, 2017
  Aim The present study aimed to investigate whether preoperative medication use is associated with postoperative length of hospital stay in older adults undergoing cancer surgery. Methods Patients aged ≥65 years who were scheduled for cancer surgery and presented for preoperative comprehensive geriatric assessment were included in the present study. Cognitive function evaluation and preoperative medication review were carried out, as well as baseline characteristics of participants collected from electronic medical records. The primary efficacy variable was the postoperative length of stay (LOS) in hospital. Results A total of 475 cancer patients were included for the analysis. Baseline characteristics of participants including older age, lower body mass index (BMI) and male sex were associated with longer postoperative stay. Among the clinical variables, cancer type, number of medications, potentially inappropriate medication (PIM) and delirium‐inducing medication were found as statistically significant factors for postoperative LOS. In multivariate analysis, variables independently associated with postoperative LOS were cancer type, PIM use, BMI, and the number of medications after controlling for age, BMI, sex, cancer type, the number of medications, PIM, and delirium‐inducing medication. In subgroup analysis of gastrointestinal cancer, multiple linear regression analysis showed that PIM use and BMI were significantly associated with LOS after adjustment for age, sex, and number of medication. Conclusions The present study supports the impact of medication use on postoperative LOS in geriatric oncology patients. The results add a further aspect to medication optimization in older patients undergoing cancer surgery. Geriatr Gerontol Int 2017; ••: ••–••.

  August 04, 2017   doi: 10.1111/ggi.13127   open full text
• Depression among older people in Sri Lanka: With special reference to ethnicity.
  Amartuvshin Khaltar, Neelawala GW Priyadarshani, Nisansala Y. Delpitiya, Chandrika Jayasinghe, Ananda Jayasinghe, Asuna Arai, Hiko Tamashiro.
  Geriatrics and Gerontology International. August 04, 2017
  Aim To ascertain if the factors associated with depression differ among ethnic groups in community‐dwelling older people in Kandy District, Sri Lanka. Methods A cross‐sectional survey was carried out of people aged ≥60 years living in a single divisional secretariat of Kandy District. The participants were asked about ethnicity (Sinhalese, Tamil and Muslim), sociodemographic characteristics and depression status by face‐to‐face interviews with a structured questionnaire. Depression was measured by the 15‐item Geriatric Depression Scale, and the total score of ≥6 was considered as depression. The χ2‐test and multivariate logistic regression with two‐way interaction terms between sociodemographic characteristics and ethnicity were carried out. Results Participants (n = 778) consisted of 56.6% Sinhalese, 22.1% Tamils and 21.3% Muslims. Of the participants, the prevalence of depression was 31.8% (27.3% in Sinhalese, 42.1% in Tamils and 32.9% in Muslims). Multivariate analyses showed that there were no significant interactions between sociodemographic characteristics and ethnicity. However, low economic status, low perceived social support and more than two self‐reported diseases were significantly associated with depression in all ethnic groups. Conclusions Some factors were found to be significantly associated with depression, but did not differ among ethnic groups. The findings would help practitioners to identify older people with a high risk of depression, and to intervene in its development or exacerbation. Geriatr Gerontol Int 2017; ••: ••–••.

  August 04, 2017   doi: 10.1111/ggi.13090   open full text
• Association of care recipients’ care‐need level with family caregiver participation in health check‐ups in Japan.
  Takehiro Sugiyama, Nanako Tamiya, Taeko Watanabe, Tomoko Wakui, Taiga Shibayama, Yoko Moriyama, Yui Yamaoka, Haruko Noguchi.
  Geriatrics and Gerontology International. August 04, 2017
  Aim The public mandatory long‐term care insurance system in Japan has supposedly mitigated the care burden for family caregivers of older adults, whereas family caregivers still play a considerable role in providing care. The effect of informal caregiving on the caregiver's health has been of great interest. We investigated the relationship between the amplitude of informal caregiving and caregiver participation in health check‐ups in Japan. Methods The present study was a cross‐sectional analysis of nationally representative data in Japan (2010 Comprehensive Survey of Living Conditions). We investigated the relationship between care recipients’ care‐need level and in‐home caregiver participation in health check‐ups during the last year of the survey for caregivers. Results A total of 3354 caregiver/recipient pairs were included in the study. Crude proportions of caregivers completing a health check‐up by care‐need level were 68.4% (support required 1 and 2), 63.5% (care required 1–3) and 60.3% (care required 4 and 5). Higher care‐need level was negatively associated with caregiver participation in health check‐ups (support required 1 and 2as reference, care required 1–3: odds ratio 0.82, 95% confidence interval 0.75–0.90), care required 4 and 5: odds ratio 0.76, 95% confidence interval 0.74–0.79) after adjustment for possible confounders. Inclusion of the caregiver time devoted to care per day and caregiver self‐rating of health as independent variables did not change the result. Conclusions These results suggest that facilitating health check‐up participation for family caregivers of care recipients with higher care‐need levels might be an effective intervention for decreasing the gap in health behavior possibly caused by informal caregiving. Geriatr Gerontol Int 2017; ••: ••–••.

  August 04, 2017   doi: 10.1111/ggi.13131   open full text
• Antiglycation and anti‐oxidant efficiency of carnosine in the plasma and liver of aged rats.
  İlknur Bingül, Zülbiye Yılmaz, A. Fatih Aydın, Jale Çoban, Semra Doğru‐Abbasoğlu, Müjdat Uysal.
  Geriatrics and Gerontology International. August 04, 2017
  Aim Increases in oxidative stress and advanced glycation end‐products (AGE) formation play an important role in the pathogenesis of aging. Carnosine (CAR; β‐alanyl‐L‐histidine) has anti‐oxidant and antiglycating properties. We investigated the effect of CAR supplementation on AGE levels, and protein and lipid oxidation products in the serum and liver tissue in aged rats. Methods Young (3 months‐of‐age) and aged (20 months‐of‐age) rats were injected with CAR (250 mg/kg/daily; i.p.; 5 days per week) for 2 months. At the end of this period, AGE, protein carbonyl, advanced oxidized protein products, and malondialdehyde levels were determined in the serum and liver tissue. Furthermore, reactive oxygen species formation and ferric reducing anti‐oxidant power values were measured. Results AGE, malondialdehyde, protein carbonyl and advanced oxidized protein products levels, and reactive oxygen species formation were higher in the serum and liver tissue of aged rats compared with young rats. CAR treatment was observed to significantly decrease AGE, malondialdehyde, protein carbonyl and advanced oxidized protein products levels, and reactive oxygen species formation in the serum and liver of aged rats. Conclusions These results clearly show that CAR might be useful for decreasing glycoxidant stress in aged rats. Geriatr Gerontol Int 2017; ••: ••–••.

  August 04, 2017   doi: 10.1111/ggi.13126   open full text
• Relationship between cortisol reactivity to psychosocial stress and declarative memory decline during aging: Impact of age and sex.
  Aline Talita Santos, Dayse Maria D. Leyendecker, Ana Lucia Siqueira Costa, Juliana Nery Souza‐Talarico.
  Geriatrics and Gerontology International. August 04, 2017
  Aim To analyze the relationship between memory performance and the neuroendocrine and cardiovascular response to acute psychosocial stress in healthy older people, and the sex and age impact in this relationship. Methods We randomly selected 100 literate older adults, without cognitive or functional impairment. The neuroendocrine stress response was evaluated by measuring the concentration of salivary cortisol, whereas cardiovascular reactions were determined based on blood pressure and heart rate measures taken before, during and after participant exposure to an acute psychosocial stressor ( the Trier social stress test [TSST]). Memory performance was evaluated by applying the word pairs test before and after the TSST. Results A significant reduction in the word pair test scores was observed after the TSST, and a negative correlation between cortisol concentration and immediate and delayed recall of the word pair. Cortisol concentration associated with age, sex and education explained memory performance variability before and after the TSST. Conclusions The results showed that the influence of acute stress on memory performance during aging might vary according to age and sex, highlighting potential differences in the vulnerability of older individuals to the neurotoxic effects of stress exposure on memory and consequently on the development of cognitive disorders. Geriatr Gerontol Int 2017; ••: ••–••.

  August 04, 2017   doi: 10.1111/ggi.13139   open full text
• Prevalence and determinants of frailty and associated comorbidities among older Gurkha welfare pensioners in Nepal.
  Sirjana Devkota, Bruce Anderson, Roy L. Soiza, Phyo K. Myint.
  Geriatrics and Gerontology International. August 02, 2017
  Aim Population aging is increasing in low‐income countries. Despite this, there is distinct lack of knowledge about the prevalence of comorbidities and determinants of frailty among older people in these countries. Methods We examined data from “Health and Social Care Needs Assessment Survey of the Gurkha Welfare Pensioners” carried out in 2014. Participants were aged ≥60 years from the Gorakha, Lamjung and Tanahu districts of Nepal. Face‐to‐face interviews were carried out using validated questionnaires. Demographic data, socioeconomic status, and self‐reported symptoms and illnesses were collected. Frailty was assessed using the Canadian Study of Health and Aging scale. Univariable and multivariable regression models were constructed to identify the determinants of frailty defined as Canadian Study of Health and Aging scale ≥4. Results A total of 253 participants (32.0% men) were included in the present study. Most (82.2%) participants were from the Janajati ethnic background. Men who were ex‐servicemen had higher educational attainment than women, most of whom (95.3%) were widows of ex‐servicemen (P < 0.01). A total of 48.5% of women lived with their sons, whereas 43% of the male participants lived with their wives. Women reported a higher prevalence of mental health issues, such as anxiety and insomnia, compared with men. The prevalence of frailty was 46.2% (46.3% in men and 46.1% in women). In this population, frailty was significantly associated with older age, smoking, living with son, breathing problems, unspecified pain and fatigue, poor dental health, and history of falls and fracture (P < 0.001 for all) after controlling for potential confounders. Conclusions The present study highlights the growing nature of the comorbidity burden, and frailty and its determinants in a low‐income setting. Concerted efforts should be made with regard to how best to tackle this globally. Geriatr Gerontol Int 2017; ••: ••–••.

  August 02, 2017   doi: 10.1111/ggi.13113   open full text
• Distance to screening site and older adults’ participation in cognitive impairment screening.
  Kazuhiro Harada, Sangyoon Lee, Hiroyuki Shimada, Sungchul Lee, Seongryu Bae, Yuya Anan, Kenji Harada, Takao Suzuki.
  Geriatrics and Gerontology International. August 01, 2017
  Aim To develop intervention strategies that promote screening for cognitive impairment, it is essential to identify the modifiable predictors for participation in screening. The present study aimed to examine whether a shorter distance to the screening site predicted participation in screening for cognitive impairment, and whether interactive effects of the distance and psychological factors on the participation would be observed among community‐dwelling older adults. Methods The study used a prospective design. After a baseline questionnaire survey, participation in screening for cognitive impairment was followed for 6 months (n = 9616). The distance to the screening site was measured by road distance from each residential address and categorized into four groups (<1 km, 1–1.99 km, 2–2.99 km, ≥3 km). The questionnaire measured psychological factors (behavioral intention and perceived benefits of screening), driving status and demographic factors. Results A logistic regression analysis showed that compared with the <1 km group, the 2–2.99 km (adjusted odds ratio 0.62, P = 0.040) and ≥3 km (adjusted odds ratio 0.54, P = 0.015) groups did not participate in screening after adjusting for psychological and demographic factors, and driving status. The interaction of the distances and psychological factors on participation were not significant. Conclusions The distance to the screening site predicted participation in cognitive impairment screening among older adults regardless of their psychological status. This finding shows that improving access to screening sites would be effective for promoting screening for cognitive impairments among both low and highly motivated older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  August 01, 2017   doi: 10.1111/ggi.13133   open full text
• Effectiveness of home‐based exercise in older patients with advanced chronic obstructive pulmonary disease: A 3‐year cohort study.
  Ritsuko Wakabayashi, Yuji Kusunoki, Kumiko Hattori, Takashi Motegi, Ryuko Furutate, Aki Itoh, Rupert CM Jones, Michael E Hyland, Kozui Kida.
  Geriatrics and Gerontology International. August 01, 2017
  Aim To determine whether home‐based exercise can improve clinical outcomes in older patients with advanced chronic obstructive pulmonary disease using long‐term oxygen therapy. Methods Information was provided to improve chronic obstructive pulmonary disease self‐management before the onset of the present prospective 3‐year cohort study. Patients selected either home‐based exercise using a lower‐limb cycle machine (ergo‐bicycle; group E), or usual exercise (group U). To assess self‐management, the Lung Information Needs Questionnaire was evaluated every 6 months. Clinical outcomes included the 6‐min walk test, pulmonary function tests, the body mass index, airflow obstruction, dyspnea and exercise index, St. George's respiratory questionnaire, and the number of exacerbations and hospitalizations. Results A total of 136 patients (group E = 72; group U = 64), with a mean age of 74.2 years were enrolled. Total Lung Information Needs Questionnaire scores improved over 3 years for group E (P = 0.003). The distance of the 6‐min walk test was well maintained in group E, but significantly decreased in group U (P < 0.001). The percentage of forced expiratory volume in 1 s at baseline was lower in group E (P = 0.016), but was maintained over 3 years, whereas a significant reduction was seen in group U (P = 0.001). The body mass index, airflow obstruction, dyspnea and exercise index significantly worsened in both groups over 3 years (group E: P = 0.011; group U: P < 0.001), whereas a significant decrease in the number of exacerbations was noted in group E (P = 0.009). Conclusions Patients who undertook home‐based exercise using an ergo‐bicycle were able to maintain clinical outcomes including 6‐min walk test distance and percentage of forced expiratory volume in 1 s predicted, and recorded fewer exacerbations over 3 years. Geriatr Gerontol Int 2017; ••: ••–••.

  August 01, 2017   doi: 10.1111/ggi.13134   open full text
• Prognostic value of physical function tests and muscle mass in elderly hospitalized patients. A prospective observational study.
  Rubén Hernández‐Luis, Esther Martín‐Ponce, María Monereo‐Muñoz, Geraldine Quintero‐Platt, Silvia Odeh‐Santana, Emilio González‐Reimers, Francisco Santolaria.
  Geriatrics and Gerontology International. August 01, 2017
  Aim To determine the prognostic value for mortality of physical function tests, muscle mass loss, disability and frailty in elderly hospitalized patients. Methods We prospectively included 298 hospitalized patients aged >60 years (152 men and 146 women). We assessed comorbidity using the Charlson Comorbidity Index; nutrition by body mass index, midarm muscle area and subjective nutritional score; physical muscle function by handgrip strength, gait speed, standing balance and stand up test; disability using the Barthel test and activities of daily living; frailty by the clinical frailty scale and Fried frailty index; and cognitive impairment by the Pfeiffer test. We assessed 100‐day and long‐term mortality. Results We found a high prevalence of malnutrition, comorbidity, cognitive impairment, physical function impairment, disability and frailty. Mortality at 100 days was 15.1%, with a long‐term median survival of 989 days. Mortality was significantly related to age, comorbidity, nutritional status, physical function, disability and frailty. Serum vitamin D3 levels were not related to mortality. Independent prognostic value for long‐term mortality was shown by: (i) incapacity to carry out any of the walking, stand up and standing balance tests; (ii) male sex; (iii) aged >80 years; (iv) impaired handgrip strength or gait speed; (v) Charlson Comorbidity Index ≥1; and (6) impaired muscle mass of subjective nutritional score. Conclusions In elderly hospitalized patients, there is an important role of muscle regarding prognosis, mainly related to physical function, but also and independently regarding muscle mass. Geriatr Gerontol Int 2017; ••: ••–••.

  August 01, 2017   doi: 10.1111/ggi.13138   open full text
• Family relations, sense of coherence, happiness and perceived health in retired Taiwanese: Analysis of a conceptual model.
  Hui‐Hsun Chiang, Tony Szu‐Hsien Lee.
  Geriatrics and Gerontology International. July 28, 2017
  Aim A growing awareness of the rapidly increasing aged population in the world has led to growing attention to mental health in late life. Happiness has been emphasized as an important indicator of physical health and is predicted by a sense of coherence. However, the mechanism of influence of family relations on sense of coherence, happiness and perceived health is unknown. The present study aimed to analyze a conceptual model of the relationships among family relations, sense of coherence, happiness and perceived health in retired persons. Methods A total of 142 retired participants were recruited from social service centers in Taipei, Taiwan. A structured questionnaire measuring the relationships among family relations, sense of coherence, happiness and perceived health was filled in by each respondent. Data were analyzed using structural equation modeling. Results The results showed that family relations is positively correlated with happiness, sense of coherence and perceived health. The results also showed that good family relations and a sense of coherence predict greater happiness. The results from structure equation modeling showed that the relationship between family relations and perceived health is completely mediated by happiness and a sense of coherence, but only the indirect effect of happiness is significant. The results also showed that family relations is partially mediated by the sense of coherence to happiness. Conclusions In caring for retired older people, medical professionals need to increase their family relations and sense of coherence simultaneously, and then promote happiness in their interventions. Geriatr Gerontol Int 2017; ••: ••–••.

  July 28, 2017   doi: 10.1111/ggi.13141   open full text
• Investigation of pain and life satisfaction in older adults.
  Senay Karadag Arli, Ayse Berivan Bakan, Ela Varol, Gulpinar Aslan.
  Geriatrics and Gerontology International. July 28, 2017
  Aim The present study aimed to investigate pain and life satisfaction in older adults. Methods This study, which is descriptive in nature, utilized the relational screening model. It was carried out between September 2016 and March 2017, with 387 people aged ≥65 years who were registered in Family Health Centers in Ağrı, a city located in eastern Turkey. Results The participants’ mean Geriatric Pain Measure score was 53.23 ± 29.40, indicating moderate pain. The mean Life Satisfaction Scale score was 8.50 ± 5.34, indicating moderate life satisfaction level. The study also found a statistically significant, negative relationship between life satisfaction and geriatric pain. Conclusions An increase in the elderly population brings various health problems. The results of the present study showed that the rate of chronic diseases is very high in older adults. Therefore, pain is one of the most frequently encountered health problems, and it has negative effects on life satisfaction. In conclusion, is it considered that older adults’ life satisfaction could increase if their pain is identified and reduced effectively. Geriatr Gerontol Int 2017; ••: ••–••.

  July 28, 2017   doi: 10.1111/ggi.13125   open full text
• Determinants of influenza vaccination in older adults: A nationwide community‐based study in Taiwan.
  Chang‐Hua Chen, Ming‐Shiang Wu, Wen‐Yu Hsu, Yu‐Min Chen, Chih‐Cheng Hsu, Chao A. Hsiung, I‐Chien Wu.
  Geriatrics and Gerontology International. July 28, 2017
  Aims Influenza vaccination (InVa) is an effective measure for preventing influenza infection, which is a major cause of morbidity and mortality in older adults. However, the determinants of InVa remain unclear. Methods The present study included 4756 adults aged 55 years and older who completed the baseline examination of the Healthy Aging Longitudinal Study in Taiwan. During the examination, each participant received assessments of InVa status. Comprehensive assessments of sociodemographic (age, sex, education level, marital status, living alone and occupation) and health‐related factors (chronic diseases, smoking status, alcohol intake, physical activities, cognitive status and physical performance) were also carried out. The InVa rate was defined as the number of participants who reported receiving free InVa divided by the total number of candidates for free InVa. Multinomial logistic regression analysis was applied to investigate the sociodemographic and health‐related determinants of InVa status. Results The coverage rate of InVa was 44.8% (2130/4756). Older age (adjusted odds ratio [OR; >75 years vs <65 years] 7.72, 95% CI 6.26–9.52), multiple chronic diseases (OR [≥2 vs 0)] 1.31, 95% CI 1.10–1.65) and physical activity (OR [yes vs no] 1.43, 95% CI 1.23–1.64) were positively associated with receiving InVa. A current smoking status (OR 0.67, 95% CI 0.55–0.82) was negatively associated with receiving InVa. Conclusions Older adults who received InVa differed from non‐receivers in multiple sociodemographic and health‐related characteristics. These findings support continual efforts to improve the InVa coverage rate in vulnerable populations. Geriatr Gerontol Int 2017; ••: ••–••.

  July 28, 2017   doi: 10.1111/ggi.13088   open full text
• Predicted factors for older Taiwanese to be healthy octogenarians: Results of an 18‐year national cohort study.
  Wei‐Chung Hsu, Alan C. Tsai, Yu‐Chia Chen, Jiun‐Yi Wang.
  Geriatrics and Gerontology International. July 26, 2017
  Aim To identify factors that predict the 62–69 years old Taiwanese to be healthy octogenarians. Methods We analyzed the 1989 (baseline), and 2003 and 2007 (end‐point) datasets of the Taiwan Longitudinal Survey on Aging, a national cohort study. A total of 1977 participants aged 62–69 years at baseline were tracked for 14–18 years. The outcome measure was “being healthy octogenarians”, defined as participants who were aged ≥80 years, free from activities of daily living dependency, depressive symptoms or cognitive impairment, and able to provide social support. A logistic regression model was used to identify the predictors. Results The results showed that higher educational level, conjugal living, absence of smoking or betel quid chewing, moderate alcohol drinking, routine physical activity, more leisure activities, no hypertension, no diabetes, sleeping well and satisfied with economic condition were the positive predictors for becoming a healthy octogenarian. Conclusions Using a multidimensional criterion, the present study identified a list of factors in predicting older Taiwanese becoming healthy octogenarians. The findings highlight the need to identify potential factors for various populations. Many of the predictors are modifiable factors. The present results would be valuable for planning effective health promotion strategies to achieve healthy aging for older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  July 26, 2017   doi: 10.1111/ggi.13112   open full text
• Examining trust in health professionals among family caregivers of nursing home residents with advanced dementia.
  Jannie A. Boogaard, Perla Werner, Anna Zisberg, Jenny T. Steen.
  Geriatrics and Gerontology International. July 20, 2017
  Aim In a context of increasing emphasis on shared decision‐making and palliative care in dementia, research on family caregivers’ trust in health professionals in advanced dementia is surprisingly scant. The aim of the present study was to assess trust in nursing home health professionals of family caregivers of nursing home residents with advanced dementia, and possible correlates, such as family caregivers’ satisfaction, involvement in care, care burden and patients’ symptom burden. Methods A cross‐sectional study was carried out using structured questionnaires administered through the telephone. Generalized estimating equation analyses with adjustment for nursing home clustering were applied to assess the most important associations with family caregivers’ trust. Results A total of 214 family caregivers of persons with dementia residing in 25 nursing homes participated in the study. The majority of the participants (67%) were women and adult children (75%). The majority of the family caregivers trusted physicians, nurses and nurses’ aides at a moderate‐to‐high level. Approximately half to one‐third reported moderate‐to‐low levels of trust. Higher levels of trust were associated with more positive care outcomes, such as higher family satisfaction with care and more positive evaluations of physician–family communication. Conclusions The present study showed the importance of family caregivers trusting nursing home health professionals for their experiences as caregivers. Although causation cannot be established, increased family caregivers’ trust in nursing home health professionals by improving communication and exchange of information might provide a good basis for providing optimal palliative care in advanced dementia. Geriatr Gerontol Int 2017; ••: ••–••.

  July 20, 2017   doi: 10.1111/ggi.13107   open full text
• Furosemide use and acute risk of hip fracture in older people: A nationwide case–control study in Taiwan.
  Shih‐Wei Lai, Kao‐Chi Cheng, Cheng‐Li Lin, Kuan‐Fu Liao.
  Geriatrics and Gerontology International. July 14, 2017
  Aim Little is known about the acute effects of furosemide use on the risk of hip fracture. The aim of the present study was to evaluate the association between furosemide use and acute risk of hip fracture in older people in Taiwan. Methods We carried out a retrospective nationwide case–control study using the database of the Taiwan National Health Insurance Program. A total of 4523 older adults aged ≥65 years with newly diagnosed hip fracture from 2000 to 2013 were identified as the cases. Additionally, 4523 older adults aged ≥65 years without hip fracture were randomly selected as the controls. The cases and the controls were matched by sex, age, comorbidities, and index year and month of hip fracture diagnosis. Furosemide use was defined as “current,” “recent” or “past” if the furosemide prescription was filled <3 months, 3–6 months or ≥6 months before the date of hip fracture diagnosis, respectively. The unconditional logistic regression model was used to calculate the odds ratio and 95% confidence interval (CI) for the relative risk of hip fracture associated with furosemide use. Results After adjustment for potential covariables, the adjusted odds ratios of hip fracture were 1.30 for participants with current use of furosemide (95% CI 1.14–1.48), 1.23 for participants with recent use of furosemide (95% CI 0.98–1.53) and 1.08 for participants with past use of furosemide (95% CI 0.90–1.30), compared with non‐users. Conclusions Current use of furosemide is associated with a 30% increased odds of hip fracture in older people in Taiwan. Geriatr Gerontol Int 2017; ••: ••–••.

  July 14, 2017   doi: 10.1111/ggi.13087   open full text
• Peroral endoscopic myotomy is safe and effective in achalasia patients aged older than 60 years compared with younger patients.
  Xiaowei Tang, Yutang Ren, Qiaoping Gao, Silin Huang, Jieqiong Zhou, Xiaofeng Zhang, Jianfeng Yang, Zhengjie Wei, Zhenyu Chen, Bo Jiang, Wei Gong.
  Geriatrics and Gerontology International. July 14, 2017
  Aim Peroral endoscopic myotomy (POEM) has been proven to be effective for treating achalasia, but there are limited data on POEM in elderly patients. We therefore aimed to assess the role of POEM for achalasia in patients aged ≥60 years. Methods All consecutive patients that underwent POEM between December 2011 and November 2015 at a single center were retrospectively reviewed. Patients aged ≥60 years were assigned to group A, whereas patients aged <60 years were assigned to group B. Demographic data, clinical data and treatment outcomes were compared between the two groups. Results During the study period, 113 patients (18 in group A, and 95 in group B) were enrolled. The mean age of patients in group A was 63 ± 3.9 years (range 60–74 years; 55.6% women), and that for patients in group B was 37.7 ± 11.6 years (range 18–59 years; 42.2% women). The procedural time in group A was similar to group B (66.3 ± 33.3 vs 59.8 ± 24.2 min, P = 0.332). There were also no significant differences in the incidence of intraoperative complications (P = 1.000) and gastroesophageal reflux rate (P = 0.906) between the two groups. During the mean follow‐up period of 25.2 months, treatment success (Eckardt score ≤3) was achieved in 92.9% of patients in group A, and 89.9% in group B (P = 1.000). Conclusions As well as in younger patients, POEM can be safely carried out in elderly patients, providing significant symptom relief. POEM might be recommended as the first therapeutic approach to elderly achalasia patients. Geriatr Gerontol Int 2017; ••: ••–••.

  July 14, 2017   doi: 10.1111/ggi.13083   open full text
• Prediction of geriatric rehabilitation outcomes: Comparison between three cognitive screening tools.
  Noemi Heyman, Tatyana Tsirulnicov, Merav Ben Natan.
  Geriatrics and Gerontology International. July 14, 2017
  Aim Comparison between the predictions of functional rehabilitation outcomes at a department of geriatric rehabilitation using three cognitive screening tools – Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Methods This study is a prospective study. The study participants were 212 patients aged 65 and older admitted to rehabilitation departments at a geriatric facility in central Israel, from April 2016 to October 2016. The cognitive functioning of each patient was assessed using the MMSE, MoCA, and IQCODE. Upon discharge, rehabilitation outcomes were examined using the Functional Independence Measure (FIM), cognitive FIM, delta FIM (Δ FIM), and ADL. Results Cognitive impairment was found to interfere with the rehabilitation process. The MMSE was the best predictor of functional rehabilitation outcomes at discharge, compared to the IQCODE, while the MoCA did not predict these measures. In addition, when distinguishing between patients by ethnicity (Jewish versus Arab), the MMSE and the IQCODE predicted FIM upon discharge among Jewish patients, while only the IQCODE predicted FIM upon discharge among Arab patients. Conclusions The research findings show that cognitive assessment upon admission for rehabilitation – MMSE among Jewish patients and IQCODE among Arab patients – can help predict functional rehabilitation outcomes and make the appropriate adaptations in the rehabilitation program. Geriatr Gerontol Int 2017; ••: ••–••.

  July 14, 2017   doi: 10.1111/ggi.13117   open full text
• Effects of different rehabilitation models on erythrocyte deformability and nitrite plus nitrate as end‐products of nitric oxide levels in elderly women.
  Katarzyna Filar‐Mierzwa, Barbara Wójcik, Anna Marchewka, Zbigniew Dąbrowski, Jerzy Superata, Zdzisław Wiśniowski.
  Geriatrics and Gerontology International. July 04, 2017
  Aim The aim of the present study was to analyze the effects of two rehabilitation protocols, dance movement therapy exercises (DMT) and general rehabilitation exercises (GRE), on erythrocyte deformability and plasma levels of nitrite plus nitrate as end products of nitric oxide (NOx) in elderly women. Methods The study included 39 women aged 61–82 years, subjected to either GRE (n = 20) or DMT (n = 19). Women were subjected to 5‐months programs of GRE and DMT, with each session lasting no longer than 45–50 min, and the intensity of exercising corresponding to no more than 40–60% of heart rate reserve. Plasma levels of NOx were determined spectrophotometrically before and at the end of the intervention. Results A significant increase in the total nitrate/nitrite concentration from 1.341 μmol/L to 1.590 μmol/L (7.3%) was observed in women subjected to the DMT rehabilitation program. Furthermore, an increase in erythrocyte deformability was observed in this group at shear stress 0.30. No significant difference was found between the pre‐ and post‐rehabilitation NOx levels of women participating in the GRE program. Conclusions Participation in DMT rehabilitation program might be reflected by an increase in plasma NOx levels and an improvement of erythrocyte deformability at lesser shear stress, and thus could potentially result in better vascular function. DMT should be offered to older adults, especially to persons who do not find conventional forms of rehabilitation as attractive, as they might refrain from physical activity and suffer from a faster decline in nitric oxide production. Geriatr Gerontol Int 2017; ••: ••–••.

  July 04, 2017   doi: 10.1111/ggi.13109   open full text
• Activity behavior, nutritional status and perceived health in older Brazilian adults: Does the number of chronic diseases matter?
  Emerson Sebastião, Patricia Andrea Espinoza Galvez, Priscila Missaki Nakamura, Camila Bosquiero Papini, Eduardo Kokubun, Sebastião Gobbi.
  Geriatrics and Gerontology International. July 04, 2017
  Aim The present study examined activity behavior, nutritional status and perceived health in relation to the number of chronic diseases (ChrD) in a representative sample of Brazilians aged ≥60 years. Methods A cross‐sectional, population‐based study was carried out in a midsize Brazilian city to evaluate different health risk factors. Using a stratified random sampling procedure to select a representative sample of adults, this study interviewed 1572 individuals face‐to‐face. Our analytical sample focused on those aged ≥60 years (n = 355). Statistical procedures were carried out using spss software, with the significance level set as P < 0.05. Results Older adults diagnosed with ≥2 ChrD were significantly less active during leisure time physical activity (P = 0.03), presented with significant higher body mass index values (P < 0.001) and were approximately fivefold (1.69–17.93) more likely to perceive their health as poor compared with those with zero ChrD. The group with ≥2 ChrD reported a similar amount of sitting time compared with older adults with zero or one ChrD (P > 0.05). Conclusions Having multiple ChrD has a negative impact on older adults’ leisure time physical activity, body mass index and the perception of health. The findings of the present study underscore the need for more infusive approaches tackling ChrD in Brazil focusing on healthy lifestyle behaviors, such as physical activity. Geriatr Gerontol Int 2017; ••: ••–••.

  July 04, 2017   doi: 10.1111/ggi.13078   open full text
• Five‐year survival after surgery in nonagenarian patients.
  Roberto Fariña‐Castro, Cristina Roque‐Castellano, Joaquín Marchena‐Gómez, Aurelio Rodríguez‐Pérez.
  Geriatrics and Gerontology International. July 04, 2017
  Aim In countries with longer life expectancies, the nonagenarian population is increasing. Therefore, there is greater demand for healthcare, including surgical procedures. The aim of the present study was to determine the outcomes of surgery carried out on nonagenarians in terms of long‐term survival after the procedure. Methods We carried out a cross‐longitudinal study on a cohort of 159 nonagenarian patients, who underwent a non‐cardiac, non‐traumatic surgical procedure in our institution between January 1999 and December 2011. The following variables were recorded: sociodemographic characteristics, American Society of Anesthesiologists score, Charlson Comorbidity Index, surgical site, postoperative complications, operative mortality and long‐term survival. The output variable was long‐term survival. Results Of the 159 patients,99 women (62%) and 60 men (38%), with a mean age of 91.8 years (SD ± 2.0 years), 44 cases were operations for malignant disorders (28%), 117 cases (74%) under emergency conditions and 42 cases (26%) were elective treatments. The operative mortality was 29%, 4.8% for elective surgery and 37.6% for emergency surgery (P < 0.001). The postoperative complication rate, including death, was 60%. The probability of survival at 1, 3, and 5 years was 59.6%, 35.8% and 24.1%, respectively. In multivariate analysis, American Society of Anesthesiologists score (HR 2.07, 95% CI 1.58–2.72), emergency surgery (HR 1.64, 95% CI 1.05–2.57) and postoperative medical complications (HR 2.58, 95% CI 1.73–3.85) were independently related to 5‐year survival. Conclusions These findings support the perioperative safety of elective general surgery in nonagenarian patients. In selected nonagenarian patients with no cognitive impairment, surgery must not be denied. These data might be useful for surgical decision‐making or informed consent for nonagerians. Geriatr Gerontol Int 2017; ••: ••–••.

  July 04, 2017   doi: 10.1111/ggi.13081   open full text
• Comparison of the Mini‐Mental State Examination and Montreal Cognitive Assessment executive subtests in detecting post‐stroke cognitive impairment.
  Chen Fu, Xianglan Jin, Baoxin Chen, Feiran Xue, Huanmin Niu, Rongjuan Guo, Zhigang Chen, Hong Zheng, Le Wang, Yunling Zhang.
  Geriatrics and Gerontology International. July 04, 2017
  Aim The Montreal Cognitive Assessment (MoCA) has been shown to be more sensitive in detecting executive dysfunction than the Mini‐Mental State Examination (MMSE). However, it is still not known whether all the MoCA executive subtests contribute to the superior sensitivity. Thus, the present study aimed to determine how much executive abnormality was detected by the MMSE and MoCA executive subtests in a population‐based cohort of Chinese post‐stroke patients. Methods The MMSE and MoCA were collected from post‐stroke patients (within 15 days to 1 month after stroke, including ischemic stroke and hemorrhagic stroke) in 14 hospitals of northern and southern China (including 10 top‐graded hospitals and 4 community hospitals) between June 2011 and September 2013. The proportions of patients with incorrect MoCA executive subtests and the proportions of patients with incorrect MMSE executive subtests were compared. Results A total of 1222 patients (703 men and 519 women, aged 62.06 ± 10.68 and 62.76 ± 9.86 years, respectively) were recruited. The MoCA detected more patients with executive dysfunction than the MMSE (OR 15.399, 95% CI 12.631–18.773; P < 0.001). The likelihood of incorrect MMSE executive tasks increased across decreasing scores of MoCA executive tasks (P < 0.001 for trend). Compared with the MMSE three‐step command test (15.5%), the MoCA trail‐making (57.8%), abstraction (48.0%) and abstraction (measurement tool; 45.7%) detected more patients with executive dysfunction (P < 0.001), whereas the MoCA digit span forwards (4.3%) and backwards (11.6%) detected fewer patients (P < 0.001 and P = 0.005, respectively). Conclusions The MoCA executive tasks are more sensitive in detecting executive dysfunction compared with the MMSE executive tasks. Geriatr Gerontol Int 2017; ••: ••–••.

  July 04, 2017   doi: 10.1111/ggi.13069   open full text
• Differences in the frequency of Alzheimer's disease‐associated genomic variations in populations of different races.
  Poyin Huang, Sun‐Wung Hsieh, Ya‐Hsuan Chang, Ai‐Ling Hour, Hsuan‐Yu Chen, Ching‐Kuan Liu.
  Geriatrics and Gerontology International. July 04, 2017
  Aim The general genetic background is important when studying major common diseases, such as Alzheimer's disease (AD). Determining the underlying genetic factors in populations of different races might allow for the tailored management of such diseases. The aim of the present study was to identify potential single‐nucleotide polymorphisms (SNP) and genes associated with racial differences. Methods We identified AD‐associated SNP with different carrier frequencies among races through the National Human Genome Research Institute and 1000 Genome Project databases. We generated heatmaps and carried out principle component analysis and pathway analysis. A total of 99 AD‐associated SNP from genome‐wide association studies were found to have different frequencies among races. Principle component analysis showed that specific SNP had higher or lower frequencies in specific races, and that similar races were clustered together. Results Pathway analysis showed that a total of 15 pathways involving intracellular endocytosis, inflammation, immune response and lipid metabolism were significant, and that apolipoprotein E was involved in the most significant pathways. A literature review showed that 16 genes were involved in the pathogenesis of AD, and that the identified SNP could be used to cluster different races, suggesting that these SNP represented different genomic backgrounds of races. Conclusions As disease‐associated genes might have several functional variants across different populations, these genes could be candidates for further studies, such as target gene sequencing or functional follow up of putative loci regarding racial differences. Geriatr Gerontol Int 2017; ••: ••–••.

  July 04, 2017   doi: 10.1111/ggi.13059   open full text
• Association between frailty and carotid intima media thickness and inflammatory marker in an elderly population.
  Chun‐Chin Chang, Chien‐Yi Hsu, Po‐Hsun Huang, Li‐Kuo Liu, Liang‐Kung Chen, Jaw‐Wen Chen, Shing‐Jong Lin.
  Geriatrics and Gerontology International. July 04, 2017
  Aim Frailty is a highly prevalent geriatric syndrome, characterized by increased vulnerability to subsequent morbidity and mortality. The association between frailty and preclinical atherosclerosis remains uncertain. The aim of the present study was to clarify the relationship between frailty, preclinical atherosclerosis and inflammatory markers in older adults. Methods We enrolled 1798 inhabitants of I‐Lan County of Taiwan (855 men, 47.5%; mean age 64 ± 9 years, range 50–92 years). Assessment of frailty was based on the Cardiovascular Health Study criteria. Common carotid artery intima‐media thickness (CIMT) was determined using carotid Doppler ultrasonography. Results Overall, 955 participants (53.1%) were non‐frail, 724 (40.2%) were pre‐frail and 119 (6.7%) were frail. Frail and pre‐frail participants had significantly increased CIMT, high‐sensitivity C‐reactive protein, glycated hemoglobin and urine albumin‐to‐creatinine ratio, but had lower insulin‐like growth factor‐1 level and decreased femoral neck bone mineral density (BMD). By multivariate analysis, age (OR 2.53, 95% CI 1.92–3.33), C‐reactive protein (OR 1.19, 95% CI 1.00–1.42), CIMT (OR 1.27, 95% CI 1.04–1.55) and femoral neck BMD (OR 0.49, 95% CI 0.38–0.65) were independently associated with frailty. Conclusions The present study showed the epidemiology of frailty, and the strong connection to aging, increased CIMT, enhanced inflammation and decreased femoral neck BMD. These results suggested that preclinical atherosclerosis, inflammation and femoral neck BMD were potentially modifiable risk factors for frailty. Geriatr Gerontol Int 2017; ••: ••–••.

  July 04, 2017   doi: 10.1111/ggi.13099   open full text
• Association between mental health and meal patterns among elderly Koreans.
  Yeunhee Kwak, Yoonjung Kim.
  Geriatrics and Gerontology International. July 04, 2017
  Aim The present cross‐sectional study analyzed the differences in mental health among community‐dwelling elderly Koreans based on type of meal skipping and family meal frequency. Methods We carried out a secondary data analysis using data from 4742 older adults aged ≥65 years from the Korea National Health and Nutrition Examination Survey V (2010–2012), a nationally representative sample. Results In the final model, after adjusting for covariates, we found differences in stress, depression and suicidal ideation based on the type of meal skipping. Specifically, breakfast skippers showed a greater odds ratio for depression and suicidal ideation than breakfast eaters; dinner skippers showed a greater odds ratio for suicidal ideation than dinner eaters. We also found differences in stress, depression and suicidal ideation per family meal frequency. Conclusions It is necessary to consider the type of meal skipping and family meal frequency while providing limited social resources to improve the mental health of older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  July 04, 2017   doi: 10.1111/ggi.13106   open full text
• Effects of two different glutamine‐containing enteral supplements on stool frequency and density in elderly patients recovering from acute critical illness.
  Nobutoshi Fushimi, Munenori Yamada, Hiroki Hachiya, Shun Ito, Takashi Shibuya, Noritsugu Ohashi, Akihiro Mori.
  Geriatrics and Gerontology International. July 04, 2017
  Aim Glutamine has various beneficial functions in the gastrointestinal tract. The present study was designed to investigate the effect of two different glutamine supplements on bowel movement at the start of enteral feeding in elderly inpatients. Methods This was a double‐blind, prospective, randomized comparison study. A total of 25 patients aged >75 years recovering from a critical illness in a non‐intensive care unit and scheduled for tube feeding were recruited. Of them, 22 consenting patients were randomly assigned to two groups: glutamine‐fiber‐oligosaccharide treatment group (n = 11) and glutamine F treatment group (n = 11). They were given glutamine three times daily at a dosage of 9 g/day. Enteral nutrition was given at the same dosage to both groups for the duration of the study. The end‐points were stool frequency, Bristol Scale Form Score, bowel function index (Bristol Scale Form Score × stool frequency), the percentage of patients with stool frequency over three per day and those with a BSFS of 6 or 7 in each group. Results There were no significant differences between the two groups in terms of patient characteristics before the study. All the end‐points in the glutamine F group were significantly lower than those in the glutamine‐fiber‐oligosaccharide group. Conclusions Compared with glutamine‐fiber‐oligosaccharide, glutamine F administration resulted in stool hardening and reduced stool frequency in elderly inpatients recovering from acute critical illness in non‐intensive care units. The effects might be caused by the different additive components of glutamine supplements. Geriatr Gerontol Int 2017; ••: ••–••.

  July 04, 2017   doi: 10.1111/ggi.13121   open full text
• Analysis of falls that caused serious events in hospitalized patients.
  Kazuyoshi Kobayashi, Shiro Imagama, Kei Ando, Yuko Inagaki, Yusuke Suzuki, Yoshihiro Nishida, Yoshimasa Nagao, Naoki Ishiguro.
  Geriatrics and Gerontology International. June 28, 2017
  Aim Falls are common adverse events for hospitalized elderly patients that can cause fracture, which decreases activities of daily living, and other injuries that can be fatal. The purpose of the present study was to investigate serious events due to fall, and to consider measures for fall prevention. Methods Incidents of fall were obtained from a database of 163 558 inpatients at Nagoya University Hospital, Nagoya, Aichi, Japan, from April 2012 to March 2016. The risk of fall was evaluated using a fall assessment score sheet at admission and during hospitalization, based on which patients were divided into risk grades 1, 2 and 3. A fall that led to fracture or a life‐threatening injury was defined as a serious event. Results Fall occurred in 3099 patients for 4 years (1.89%). Most patients that fell (45%) were in the highest (grade 3) risk category. Serious events associated with fall occurred in 36 of the 3099 patients (1.2%), and the overall incidence of serious events was 0.22%. These events included fracture in 24 patients, intracranial injury in 10 patients and others in two patients. Finally, one patient died. Serious events occurred significantly more frequently after falls in patients wearing slippers compared with other footwear (P < 0.01). The incidences of serious events and fall were significantly higher in patients with a higher risk of fall (P < 0.05). Conclusions The present results support the validity of our risk assessment scale for fall, but it should be recognized that fall can also occur in a patient with a low predicted risk of fall. Geriatr Gerontol Int 2017; ••: ••–••.

  June 28, 2017   doi: 10.1111/ggi.13085   open full text
• Neighborhood perception and self‐rated health among Mexican American older adults.
  Samuel Stroope, Isaiah F.A. Cohen, Joshua C. Tom, Aaron B. Franzen, Matthew A. Valasik, Kyriakos S. Markides.
  Geriatrics and Gerontology International. June 28, 2017
  Aim The aim of the present study was to assess the relationship between neighborhood perception and poor self‐rated health among older Mexican Americans, adjusting for important background characteristics, such as neighborhood ethnic composition and other health conditions. Methods Drawing on the 2004–2005 Hispanic Established Populations for the Epidemiologic Study of the Elderly data (n = 1780), the present study used logistic regression to examine the effects of neighborhood perception on poor self‐rated health of older Mexican Americans. Results The results show that participants with a greater positive perception of their neighborhood were less likely to report poor self‐rated health, controlling for both socioeconomic status and health status covariates. Conclusions The findings suggest that positive neighborhood perception serves as an important protective factor in overall health. Geriatr Gerontol Int 2017; ••: ••–••.

  June 28, 2017   doi: 10.1111/ggi.13089   open full text
• Influence of cervical, thoracic and lumbar spines, and shoulder girdle range of motion on swallowing function of dependent older adults.
  Munetsugu Tashiro, Yasutoshi Honda, Mai Ohkubo, Tetsuya Sugiyama, Ryo Ishida.
  Geriatrics and Gerontology International. June 28, 2017
  Aim The present study examined the cervical, thoracic and lumbar spines, and shoulder girdle range of motion (ROM) of dependent older adults to clarify the influence of these variables on swallowing function, in order to evaluate the efficiency of ROM training to maintain older adults’ swallowing function. Methods A total of 37 (mean age 86.8 ± 6.2 years; 11 men; 26 women) dependent older adults were included in the study. The level of swallowing function was assessed using the Functional Oral Intake Scale. The following ROM were measured three times to calculate the mean: the cervical spine (flexion, extension, rotation and lateral bending); thoracic and lumbar spines (flexion, extension, rotation and lateral bending); and shoulder girdle (flexion, extension, elevation and depression). In order to compare ROM, the participants showing Functional Oral Intake Scale scores of 7 were classified as dysphagia (−), and those showing scores <7 were included in the dysphagia (+) subgroups. Results The dysphagia (+) group showed significantly limited cervical spine (flexion, extension and lateral bending), thoracic and lumbar spines (flexion, extension, rotation and lateral bending), and shoulder girdle (flexion, elevation, and depression) ROM. Conclusions Although strict relationships were not clarified, the results of the present study suggested the influence of some joint ROM on swallowing function. This suggests the feasibility of preventing dysphagia among dependent older adults by maintaining and enhancing the elasticity and extensibility of their muscles through cervical, thoracic and lumbar spines, and shoulder girdle ROM training. Geriatr Gerontol Int 2017; ••: ••–••.

  June 28, 2017   doi: 10.1111/ggi.13097   open full text
• Fear of falling and gait parameters in older adults with and without fall history.
  Keitaro Makino, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Takao Suzuki, Hiroyuki Shimada.
  Geriatrics and Gerontology International. June 28, 2017
  Aim Fear of falling (FOF) is associated with spatial and temporal gait parameters in older adults. FOF is prevalent among older adults, both those with and without fall history. It is still unclear whether the relationships between FOF and gait parameters are affected by fall history. The aim of the present study was to compare gait parameters by the presence of FOF and fall history. Methods A total of 3575 older adults (mean age 71.7 years, 49.7% female) met the inclusion criteria for the present study. We assessed the presence of fall history and FOF by face‐to‐face interview, and gait parameters (gait speed, stride length, step rate, double support time and variation of stride length) at a comfortable speed using a computerized electronic walkway. Results Prevalences of fall history and FOF were as follows: non‐fallers without FOF 52.6% (n = 1881); fallers without FOF 6.3% (n = 227); non‐fallers with FOF 34.4% (n = 1229); and fallers with FOF 6.7% (n = 238). Analysis of covariance showed significant differences among the four groups in all gait variables even after adjusting for age, sex and number of medications used. It should be noted that non‐fallers with FOF showed significantly slower gait speed, shorter stride length and longer double support time than did non‐fallers without FOF (P < 0.001). Conclusions The present results suggest that spatial and temporal gait parameters are influenced by FOF, even in the absence of fall history. The assessment of FOF might be helpful for better understanding of age‐related changes in gait control. Geriatr Gerontol Int 2017; ••: ••–••.

  June 28, 2017   doi: 10.1111/ggi.13102   open full text
• Obesity and the prevalence of nocturia in Japanese elderly patients with type 2 diabetes mellitus: The Dogo study.
  Shinya Furukawa, Takenori Sakai, Tetsuji Niiya, Hiroaki Miyaoka, Teruki Miyake, Shin Yamamoto, Koutatsu Maruyama, Keiko Tanaka, Teruhisa Ueda, Hidenori Senba, Masamoto Torisu, Hisaka Minami, Takeshi Tanigawa, Bunzo Matsuura, Yoichi Hiasa, Yoshihiro Miyake.
  Geriatrics and Gerontology International. June 28, 2017
  Aim Nocturia is common among patients with type 2 diabetes mellitus, but limited evidence regarding the association between body mass index (BMI) and nocturia exists among such patients. The aim of the present study, therefore, was to evaluate the association between BMI and nocturia among Japanese patients with type 2 diabetes mellitus. Methods Study participants were 809 Japanese patients with type 2 diabetes mellitus. Study participants were considered to have nocturia if they answered “two or more” to the question: “How many times do you typically wake up to urinate from sleeping at night until waking in the morning?” We used the following two outcomes: (i) moderate nocturia was defined as ≥2 voids per night; and (ii) severe nocturia was defined as ≥3 voids per night. Participants were categorized into four groups according to their BMI: (i) BMI <18.5; (ii) 18.5 ≤ BMI < 25; (iii) 25 ≤ BMI < 30; and (iv) BMI ≥30. Multiple logistical regression analysis for nocturia in relation to BMI was used, with the category of 18.5 ≤ BMI < 25 as the reference. Results Obesity (BMI ≥30) was independently positively associated with severe nocturia among elderly patients (age ≥65 years) with type 2 diabetes mellitus, but not among young and middle‐aged patients: the adjusted OR was 2.96 (95% CI 1.10–7.83). BMI was not associated with moderate nocturia in all patients. Conclusions In Japanese elderly patients with type 2 diabetes mellitus, obesity was independently positively associated with severe nocturia. Geriatr Gerontol Int 2017; ••: ••–••.

  June 28, 2017   doi: 10.1111/ggi.13103   open full text
• Sleep complaints are associated with frailty in Mexican older adults in a rural setting.
  Karla Moreno‐Tamayo, Betty Manrique‐Espinoza, Oscar Rosas‐Carrasco, Alejandro Pérez‐Moreno, Aarón Salinas‐Rodríguez.
  Geriatrics and Gerontology International. June 28, 2017
  Aim The aim of the present study was to examine the association between sleep complaints and frailty status in a cohort of older adults from rural Mexico, and determine if this association varies according to sex. Methods A cross‐sectional study was carried out on a total of 591 community‐dwelling adults aged ≥70 years in rural settings of Mexico. Sleep complaints were based on self‐reported sleep problems. Frailty status was assessed according to the Fried et al. proposal, as well as general health measurements taken from participants. Multivariate logistic regression was used to analyze the association between sleep complaints and frailty. Results Frail participants accounted for 10.7% of the study sample. After adjusting for potential confounders, sleep complaints were associated with increased odds of frailty in women (OR 3.24, 95% CI 1.34–7.84), but not in men (OR 0.76, 95% CI 0.23–2.51). Conclusions In this cohort of rural Mexican older adults, sleep complaints were associated with frailty in older women. Because sleep quality is potentially remediable, future frailty prevention interventions should take sleep complaints into account. Geriatr Gerontol Int 2017; ••: ••–••.

  June 28, 2017   doi: 10.1111/ggi.13111   open full text
• Poor adherence to chronic obstructive pulmonary disease medications in primary care: Role of age, disease burden and polypharmacy.
  Davide L. Vetrano, Elisa Bianchini, Graziano Onder, Iacopo Cricelli, Claudio Cricelli, Roberto Bernabei, Germano Bettoncelli, Francesco Lapi.
  Geriatrics and Gerontology International. June 28, 2017
  Aim The aim of the present study was to assess the occurrence and determinants of poor adherence to pharmacological treatment in a cohort of primary care patients with chronic obstructive pulmonary disease (COPD), paying special attention to the role of age, comorbidity and polypharmacy. Methods We identified a cohort of COPD patients using the primary care Italian Health Search – IMS Longitudinal Patient Database. We assessed 1‐year adherence to COPD maintenance pharmacotherapy (encompassing inhaled corticosteroids, long‐acting beta agonists and long‐acting anticholinergics). Poor adherence was defined as <80% of proportion of days covered by pharmacological treatment over a 1‐year period. Results Of 22 505 patients (mean age 67.3 ± 13.2; 41.3% women) entering the study, 17 486 (77.7%) were poorly adherent. According to multivariate analysis, poor adherence is less likely in older adults (OR 0.51, 95% CI 0.40–0.66), in non‐smokers (OR 0.77, 95% CI 0.69–0.86) and in those with a history of alcohol abuse (OR 0.74, 95% CI 0.58–0.94). Higher comorbidity (OR 1.43, 95% CI 1.13–1.80) was positively associated with poor adherence. Polypharmacy was associated with poor adherence only in patients aged ≥65 years (OR 1.34, 95% CI 1.13–1.59). Finally, COPD severity was associated with a reduced likelihood of poor adherence (OR 0.20, 95% CI 0.07–0.61 for stage IV). Conclusions The present findings show that poor medication adherence is common in patients with COPD receiving long‐term treatment. The interaction between age and polypharmacy, and the role of comorbidity suggest a pivotal role of biological age as a steering determinant of poor adherence. Geriatr Gerontol Int 2017; ••: ••–••.

  June 28, 2017   doi: 10.1111/ggi.13115   open full text
• Differences in body composition and physical function related to pure sarcopenia and sarcopenic obesity: A study of community‐dwelling older adults in Japan.
  Takeshi Kera, Hisashi Kawai, Hirohiko Hirano, Motonaga Kojima, Yoshinori Fujiwara, Kazushige Ihara, Shuichi Obuchi.
  Geriatrics and Gerontology International. June 28, 2017
  Aim We compared skeletal muscle mass and physical function between older adults with sarcopenia and those with sarcopenic obesity. Methods Body composition and physical and cognitive function were measured for 1283 community‐dwelling older adults. Participants responded to questionnaires about pain and exercise. The pure sarcopenia group (PS) included individuals with sarcopenia only. The sarcopenic obesity group (SO) included individuals with both sarcopenia and obesity. Groups were compared after adjusting for sex, age and height through propensity score matching. Results The PS and SO included 129 and 105 individuals, respectively. Comorbidities were more frequent in the SO (P < 0.001). The SO had higher upper limb muscle mass (P < 0.001), and had lower ratios of lower limb muscle mass to upper limb muscle mass (P < 0.001) and of lower limb muscle mass to weight (P < 0.001). The SO also had poorer grip power (P = 0.007), gait times (usual pace, P = 0.001; maximum speed, P = 0.001), Timed Up and Go test (P < 0.001), and time standing on one foot (P = 0.005) than the PS. The SO had a higher frequency of gonalgia (P = 0.013). After adjusting for covariates, comorbidities, upper limb muscle mass, lower limb muscle mass to upper limb muscle mass ratio, lower limb muscle mass to weight ratio, gait time, Timed Up and Go test, time standing on one foot, and gonalgia differed significantly between the PS and SO. Conclusions Sarcopenic obesity decreases the ratio of lower limb muscle mass to weight by increasing weight. It affects physical function in older Japanese adults with low weight. Decreased relative lower limb muscle mass is an important function‐limiting factor in sarcopenic obesity. Geriatr Gerontol Int 2017; ••: ••–••.

  June 28, 2017   doi: 10.1111/ggi.13119   open full text
• Pilot study of the Mini Nutritional Assessment on predicting outcomes in older adults with type 2 diabetes.
  Gong‐Xiang Liu, Yan Chen, Ying‐Xue Yang, Kun Yang, Jin Liang, Shuang Wang, Hua‐Tian Gan.
  Geriatrics and Gerontology International. June 28, 2017
  Aim To date, few studies have focused on the nutritional status of elderly hospitalized patients with diabetes. Our aims were to explore the prevalence of malnutrition among elderly diabetes patients admitted to the hospital, and to explore the relationships between malnutrition and geriatric syndromes, diabetic complications, and clinical outcomes. Methods A prospective, observational study including diabetes patients aged ≥65 years was carried out in a central hospital in Western China. Nutritional status was assessed using the Mini Nutritional Assessment incorporated into a comprehensive geriatric assessment. Follow up was carried out for ≤2.8 years. Results Of 302 participants, the prevalence of malnutrition, risk of malnutrition, and normal nutrition was 18.5%, 33.1% and 48.3%, respectively. In multivariate analysis, incontinence (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.08–9.36), diabetic microvascular complications (OR 2.22, 95% CI 1.06–4.61) and activities of daily living (ADL) dependence (OR 11.6, 95% CI 5.10–26.5) were independently associated with malnutrition. Malnourished patients had longer hospital stays (P = 0.003) and higher mortality rates (P < 0.001) than patients either at risk of malnutrition or with a normal nutritional status. Multivariate analysis also showed that malnutrition was independently associated with an increased risk of death (OR 2.86, 95% CI 1.30–6.28). Conclusions The present study showed a high prevalence of malnutrition among elderly diabetes patients hospitalized for geriatric care. Considering the negative impact of malnutrition on hospital stay and mortality, adequate nutritional care should be emphasized for each elderly patient with diabetes, regardless of body mass index. Geriatr Gerontol Int 2017; ••: ••–••.

  June 28, 2017   doi: 10.1111/ggi.13110   open full text
• Positive and negative associations of individual social capital factors with health among community‐dwelling older people.
  Mai Kabayama, Chie Watanabe, Hirochika Ryuno, Kei Kamide.
  Geriatrics and Gerontology International. June 23, 2017
  Aim Previous literature has found positive correlations between social capital and health in older adults, fewer studies have investigated the subdimension's effects of social capital on health. We aimed to determine the individual social capital subfactors in community‐dwelling older adults in Japan, and to analyze the associations of these factors with physical and mental health. Method We sent a self‐administered questionnaire assessing their perception of social group activity as the individual social capital, and mental and physical health (measured by the Medical Outcomes Study Short Form‐36) to 4320 randomly selected older people. Results There were 1836 valid responses. We clarified that people who participated in any social activity group were in significantly better physical and mental health compared with the people who did not. By the factor analysis of the perception for the social group activity, we identified three components of the individual social capital aspect that we termed harmonious, hierarchic and diversity. Using multiple linear regression, we found the hierarchic aspect was significantly negatively associated with mental health, whereas the harmonious aspect was significantly positively associated with mental and physical health, and diversity was significantly positively associated with mental health. Conclusion As the previous research literature on social capital has mainly emphasized its positive health consequences, the present findings provide a novel demonstration that some aspects of individual social capital can have negative associations with health outcomes in community‐dwelling older people. For the practical application of promoting a healthier society, it is important to consider both the positive and negative sides of social capital. Geriatr Gerontol Int 2017; ••: ••–••.

  June 23, 2017   doi: 10.1111/ggi.13094   open full text
• Impact of frailty and residual subsyndromal delirium on 1‐year functional recovery: A prospective cohort study.
  Justin Chew, Wee Shiong Lim, Mei Sian Chong, Yew Yoong Ding, Laura Tay.
  Geriatrics and Gerontology International. June 22, 2017
  Aim To investigate the association between frailty and incomplete delirium recovery at discharge (residual subsyndromal delirium [RSSD]), and to examine the mediating role of RSSD in the relationship between frailty and functional recovery at 12 months post‐delirium. Methods This was a prospective observational study of 234 individuals aged ≥65 years admitted to a specialized delirium unit. A 20‐item frailty index was derived using items from a comprehensive geriatric assessment. Individuals with frailty index ≥0.25 were defined as being frail. Diagnosis of delirium was in accordance with the Confusion Assessment Method. RSSD was defined by the Delirium Rating Scale‐Revised‐98 severity score of ≥13. We measured functional status (modified Barthel Index) on admission and 12 months post‐delirium. We carried out mediation analysis to elucidate the role of baseline frailty and RSSD on 12‐month functional recovery. Results A total of 167 (71%) older adults were available for analysis of 12‐month functional status. Frailty was an independent predictor for RSSD (OR 4.1, 95% CI 2.1–8.2, P < 0.001) and functional recovery at 12 months post‐delirium (β = −13.4, 95% CI –24.9 to –1.8, P = 0.02). RSSD significantly mediated the effect of baseline frailty status on functional recovery at 12 months (coefficient = −0.1, 95% CI –0.2 to –0.02, P = 0.02), with 45% of the total effect mediated by RSSD. Conclusions Frailty as a risk factor for poor functional recovery in the year post‐delirium might be attributable in part to its impact on incomplete delirium recovery at discharge (RSSD). Our findings support screening and interventions for frailty at admission, and extended rehabilitation for frail individuals with RSSD. Geriatr Gerontol Int 2017; ••: ••–••.

  June 22, 2017   doi: 10.1111/ggi.13108   open full text
• Longitudinal changes in peripheral oxidative markers in patients with Alzheimer's disease, with or without cardiovascular disease.
  Hirokuni Hatanaka, Daisuke Hirose, Kentaro Hirao, Soichiro Shimizu, Hidekazu Kanetaka, Haruo Hanyu.
  Geriatrics and Gerontology International. June 21, 2017
  There is no abstract available for this paper.

  June 21, 2017   doi: 10.1111/ggi.12989   open full text
• Effectiveness and safety of inpatient respite care for caregivers of disabled patients in an acute care hospital.
  Junpei Komagamine.
  Geriatrics and Gerontology International. June 21, 2017
  There is no abstract available for this paper.

  June 21, 2017   doi: 10.1111/ggi.12981   open full text
• Female GADD34 mice develop age‐related inflammation and hepatocellular carcinoma.
  Naomi Nishio, Tadao Hasegawa, Ichiro Tatsuno, Masanori Isaka, Ken‐ichi Isobe.
  Geriatrics and Gerontology International. June 21, 2017
  Aim To analyze the impact of sex on GADD34 function, we studied the aging of female GADD34‐deficient mice and compared them with male GADD34‐deficient mice. Methods We used GADD34‐deficient mice on a C57BL/6 background. These mice were fed a normal diet throughout their life. Alternatively, they were fed a high‐fat diet at 3 months‐of‐age. Liver tissues taken from mice were analyzed by hematoxylin–eosin staining and immunohistochemical methods. Fresh liver cells were analyzed by flow cytometry. Results We found that female GADD34‐deficient mice did not develop obesity or fatty livers. However, female GADD34‐deficient mice had infiltrations of myeloid cells in the liver, followed by liver atrophy. Many female GADD34‐deficient mice developed hepatocellular carcinoma, whereas female wild‐type (WT) mice did not show hepatocellular carcinoma during aging. Female GADD34‐deficient mice and female WT mice developed the same percentages of lymphoma. Although a high‐fat diet induced a higher level of steatosis in young male GADD34‐deficient mice compared with WT mice, a high‐fat diet induced the same level of steatosis in young female GADD34‐deficient mice compared with WT mice. However, GADD34‐deficient female young mice had a higher level of infiltration of myeloid cells and myofibroblasts than WT mice. Conclusions In contrast to male GADD34‐deficient mice, female GADD34‐deficient mice did not show obesity as they aged. However, similar to the males, they developed inflammation followed by hepatocellular carcinoma. Geriatr Gerontol Int 2017; ••: ••–••.

  June 21, 2017   doi: 10.1111/ggi.13080   open full text
• Potential drug–drug interactions in older adults: A population‐based study.
  Thalyta Renata Araújo Santos, Erika Aparecida Silveira, Lílian Varanda Pereira, Mércia Pandolfo Provin, Dione Marçal Lima, Rita Goreti Amaral.
  Geriatrics and Gerontology International. June 21, 2017
  Aim To evaluate the potential drug–drug interactions (PDDI) between drugs used by older adults, any associated factors and recommended clinical management. Methods A cross‐sectional, population‐based study was carried out through a home survey of 934 older adults (from December 2009 to April 2010). A questionnaire was applied, and the participants were asked to show all the drugs used and their respective prescriptions, thus providing data to identify polypharmacy, self‐medication and PDDI. PDDI, their consequences, severity and clinical management were identified using Micromedex. Results Overall, 2846 drugs and 665 PDDI were identified, 71.0% of which were moderate and 22.4% serious. The prevalence of PDDI was 36.9%. Drugs with a narrow therapeutic index were involved in 17.0% of the PDDI. The variables female sex (PR = 1.11, 95% CI 1.02–1.20), age ≥80 years (PR = 1.15, 95% CI 1.03–1.28), no polypharmacy (PR = 0.72, 95% CI 0.67–0.78) and no hospitalization in the past year (PR = 0.90, 95% CI 0.82–0.97) remained associated with the presence of three or more PDDI in the final multivariate analysis model. Conclusions Most PDDI were related to routinely used drugs (enalapril, hydrochlorothiazide, calcium, captopril, levothyroxine and simvastatin), and more than one‐third of the older adults were exposed to PDDI with the possible risk of serious health consequences. Drugs with a narrow therapeutic index were involved in several PDDI, with increased risk of toxicity. The clinical management procedures most recommended are dose adjustment and dosing changes, control of the drugs’ serum levels, and monitoring of the clinical conditions. Geriatr Gerontol Int 2017; ••: ••–••.

  June 21, 2017   doi: 10.1111/ggi.13070   open full text
• Effects of a community disability prevention program for frail older adults at 48‐month follow up.
  Hyuma Makizako, Hiroyuki Shimada, Takehiko Doi, Kota Tsutumimoto, Daisuke Yoshida, Takao Suzuki.
  Geriatrics and Gerontology International. June 18, 2017
  Aim The present prospective study was carried out to determine whether participation in community‐based intervention studies exerted a positive impact on disability prevention in older adults with physical frailty. Methods A total of 514 community‐dwelling older adults (aged ≥65 years) with physical frailty who had undergone baseline assessment and participated in community‐based intervention studies (participants) or did not (non‐participants) were included in the present study. Non‐participants were selected through propensity score matching, to balance potential covariates at baseline. Disability incidence was followed up at 48 months as a main outcome. Demographic data (age, sex and medical history), global cognitive function, grip strength, walking speed, and blood test results including serum albumin and brain‐derived neurotrophic factor at baseline were included as covariates. Results Disability incidence rates differed significantly between participants (11.3%) and non‐participants (19.8%) of community‐based intervention studies during the 48‐month follow‐up period (P = 0.007). Participation in community‐based intervention studies (hazard ratio 0.55, 95% confidence interval 0.35–0.88) was significantly associated with the incidence of disability in older adults with physical frailty. Conclusions Participation in community‐based intervention studies could reduce the incidence of disability in older adults with physical frailty. Thus, strategies designed to increase the number of participants in community‐based intervention programs should be considered in community‐based approaches for the prevention of disability in older adults with physical frailty. Geriatr Gerontol Int 2017; ••: ••–••.

  June 18, 2017   doi: 10.1111/ggi.13072   open full text
• Deciding about nursing home care in dementia: A conjoint analysis of how older people balance competing goals.
  Alison Fahey, Dearbhail Ní Chaoimh, Grainne R. Mulkerrin, Eamon C. Mulkerrin, Shaun T. O'Keeffe.
  Geriatrics and Gerontology International. June 18, 2017
  Aim “Don't put me in a home” is a common preference of older people, but so too is “I don't want to be a burden on my family.” These and other goals often conflict with each other when people have worsening dementia and the issue of possible nursing home admission arises. Methods Community‐dwelling older hospital patients were asked to imagine that they lived alone, had dementia and were experiencing increasing practical difficulties, and were presented with 11 possible “outcome packages.” Conjoint analysis was used to investigate how participants ranked possible outcomes and traded‐off between these factors: place of residence (home or nursing home), burden on their family, risk of harm and duration of life. Results Of 122 potential participants, 102 inpatients aged 65–80 years completed the study. Of these participants, 46 (46%) patients give the greatest weight to reducing the burden on their family, 39 (39%) to remaining at home, 11 (11%) to minimizing the risk of harm and five (5%) to maximizing the length of life. There were no significant clinical or demographic differences between these groups. There was a strong negative correlation (Spearman's rho −0.59, P < 0.0001) between importance scores for place of residence and for burden on family. Conclusions There are important differences in how individual older people would balance the competing priorities of reducing the burden on their family and remaining at home in the event of developing dementia. Geriatr Gerontol Int 2017; ••: ••–••.

  June 18, 2017   doi: 10.1111/ggi.13096   open full text
• Factors associated with the difficulty in hospital acceptance among elderly emergency patients: A population‐based study in Osaka City, Japan.
  Tasuku Matsuyama, Tetsuhisa Kitamura, Yusuke Katayama, Kosuke Kiyohara, Sumito Hayashida, Takashi Kawamura, Taku Iwami, Bon Ohta.
  Geriatrics and Gerontology International. June 18, 2017
  Aim We aimed to investigate prehospital factors associated with difficulty in hospital acceptance among elderly emergency patients. Methods We reviewed ambulance records in Osaka City from January 2013 through December 2014, and enrolled all elderly emergency patients aged ≥65 years who were transported by on‐scene emergency medical service personnel to a hospital that the personnel had selected. The definition of difficulty in hospital acceptance was to the requirement for ≥4 phone calls to hospitals by emergency medical service personnel before receiving a decision from the destination hospitals. Prehospital factors associated with difficulty in hospital acceptance were examined through logistic regression analysis. Results During the study period, 72 105 elderly patients were included, and 13 332 patients (18.5%) experienced difficulty in hospital acceptance. In the simple linear regression model, hospital selection time increased significantly with an increasing number of phone calls (R2 = 0.774). In the multivariable analysis, older age (P for trend <0.001), calls from a healthcare facility (adjusted odds ratio [AOR] 1.23, 95% confidence interval [CI] 1.15–1.32), night‐time (AOR 2.17, 95% CI 2.08–2.26) and weekend/holidays (AOR 1.43, 95% CI 1.38–1.49) were significantly associated with difficulty in hospital acceptance. A positive association was observed between gastrointestinal emergency‐related symptoms and difficulty in hospital acceptance among elderly patients with symptoms of internal disease (AOR 1.71, 95% CI 1.53–1.91). Conclusions In Japan, which has a rapidly aging population, a comprehensive strategy for elderly emergency patients, especially for advanced age groups or nursing home residents, is required. Geriatr Gerontol Int 2017; ••: ••–••.

  June 18, 2017   doi: 10.1111/ggi.13098   open full text
• Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice.
  Marissa H.G. Gerards, Christopher McCrum, Avril Mansfield, Kenneth Meijer.
  Geriatrics and Gerontology International. June 16, 2017
  Falls are a leading cause of injury, hospitalization and even death among older adults. Although various strength and balance exercise interventions have shown moderate reductions in falls incidence among healthy older adults, no significant falls incidence improvements have been consistently seen in frail older adults or in patient groups with an increased falls risk (e.g. people with Parkinson's disease and stroke). This might be due to a lack of task specificity of previous exercise interventions to the recovery actions required to prevent a fall. Perturbation‐based balance training (PBT) is an emerging task‐specific intervention that aims to improve reactive balance control after destabilizing perturbations in a safe and controlled environment. Although early studies were carried out predominantly in research laboratory settings, work in clinical settings with various patient groups has been proliferating. A systematic search of recent PBT studies showed a significant reduction of falls incidence among healthy older adults and certain patient groups (e.g. people with Parkinson's disease and stroke), with clinically relevant reductions in frail older adults. The most practical methods in clinical settings might be treadmill‐based systems and therapist‐applied perturbations, and PBT that incorporates multiple perturbation types and directions might be of most benefit. Although more controlled studies with long‐term follow‐up periods are required to better elucidate the effects of PBT on falls incidence, PBT appears to be a feasible and effective approach to falls reduction among older adults in clinical settings. Geriatr Gerontol Int 2017; ••: ••–••.

  June 16, 2017   doi: 10.1111/ggi.13082   open full text
• Prevalence of chronic obstructive pulmonary disease in independent community‐dwelling older adults: The Fujiwara‐kyo study.
  Masanori Yoshikawa, Yoshifumi Yamamoto, Koichi Tomoda, Yukio Fujita, Motoo Yamauchi, Takao Osa, Hiroki Uyama, Nozomi Okamoto, Norio Kurumatani, Hiroshi Kimura.
  Geriatrics and Gerontology International. June 16, 2017
  Aim As the Japanese population ages, the number of older patients with chronic obstructive pulmonary disease (COPD) is expected to increase, but the prevalence of COPD in patients aged ≥80 years remains unclear. The purpose of the present study was to determine the prevalence of COPD in independent community‐dwelling older adults aged ≥80 years. Methods We investigated the prevalence of COPD in 2862 independent community‐dwelling older adults (1504 men, 1358 women, mean age 77.7 ± 7.0 years) who underwent spirometry in the Fujiwara‐kyo study, a study of successful aging in older adults. Those participants with airflow limitation (forced expiratory volume in 1 s/forced vital capacity <0.7) who indicated on a self‐administered questionnaire that they had a history of smoking and did not have bronchial asthma were considered to have COPD. Results The prevalence of COPD was 16.9% among all participants and 37.4% among smokers. The prevalence among individuals aged ≥80 years (19.7%) was significantly higher than that among those aged <80 years (16.0%; P < 0.05). When forced expiratory volume in 1 s/forced vital capacity lower limit of normal was used as the criterion for airflow limitation, the prevalence fell to 11.0%. Patients with mild‐to‐moderate airflow limitation (stage I/stage II) accounted for the great majority (91.2%) of COPD patients aged ≥80 years. Conclusions A high prevalence of mild‐to‐moderate COPD was observed even in the independent community‐dwelling older adults aged ≥80 years. However, the benefits of the spirometric screening and treatment for these patients needs to be determined. Geriatr Gerontol Int 2017; ••: ••–••.

  June 16, 2017   doi: 10.1111/ggi.13091   open full text
• Comparison of healthcare utilization and life‐sustaining interventions between elderly patients with dementia and those with cancer near the end of life: A nationwide, population‐based study in Taiwan.
  Yu‐Han Chen, Chung‐Han Ho, Chien‐Cheng Huang, Ya‐Wen Hsu, Yueh‐Chun Chen, Ping‐Jen Chen, Guan‐Ting Chen, Jhi‐Joung Wang.
  Geriatrics and Gerontology International. June 16, 2017
  Aim Little is known about the pattern of healthcare services for end‐of‐life patients with dementia (PwD) in East Asia. We compared this pattern between PwD and cancer patients in their last year of life in Taiwan. Methods Taiwan's National Health Insurance Research Database was applied for this case–control analysis. The records of patients who had dementia and died between 2002 and 2011 were reviewed. The control group was decedents with cancer. The utilization of hospitalization, emergency department visits and life‐sustaining interventions during the last year of life between the two groups were compared. Results Of the 2724 patients enrolled, 908 had dementia and 1816 had cancer. PwD were more likely to have a higher frequency of admission to hospital and intensive care unit, and longer stays compared with cancer patients. PwD had a higher risk of enteral tube insertion and feeding, endotracheal intubation and tracheostomy, mechanical ventilation, hemodialysis and cardiopulmonary resuscitation (OR 4.36, 95% CI 3.51–5.41), which was the highest among the selected procedures. Conclusions PwD in their last year of life in Taiwan underwent aggressive interventions significantly more frequently than did their counterparts in Western countries. Providing comfort‐centered care for better quality of life for end‐of‐life PwD is a priority of Taiwan's national health policy. Geriatr Gerontol Int 2017; ••: ••–••.

  June 16, 2017   doi: 10.1111/ggi.13084   open full text
• Validity of the National Center for Geriatrics and Gerontology‐Functional Assessment Tool and Mini‐Mental State Examination for detecting the incidence of dementia in older Japanese adults.
  Hiroyuki Shimada, Hyuma Makizako, Hyuntae Park, Takehiko Doi, Sangyoon Lee.
  Geriatrics and Gerontology International. June 16, 2017
  Aim Numerous neuropsychological tests are implemented in the clinical setting. However, a readily available cognitive test is required to detect the risk of dementia in the community setting. Methods A total of 4151 persons aged ≥65 years participated in the present prospective cohort study. We assessed cognitive performance using the Mini‐Mental State Examination and the National Center for Geriatrics and Gerontology‐Functional Assessment Tool. The National Center for Geriatrics and Gerontology‐Functional Assessment Tool includes tests of story and word list memory, attention and executive function, processing speed, and visuospatial skill to screen for cognitive impairment. All measurements were transformed to Z‐scores to compare among the cognitive tests. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 36 months. Results After an average of 43 months, 180 (4.3%) participants were diagnosed with dementia. Survival analyses showed that the probability of dementia was significantly associated with all cognitive tests, except for visuospatial skill. The processing speed test showed the highest hazard ratios for the incidence of dementia (Z‐score: hazard ratio 0.61, 95% confidence interval 0.50–0.75, P < 0.01). In subgroup analysis, there were no significant relationships between cognitive tests and the incidence of dementia in participants without global cognitive impairment. Conclusions We conclude that the National Center for Geriatrics and Gerontology‐Functional Assessment Tool, as well as the Mini‐Mental State Examination, play an important role in detecting the risk of dementia in the community setting. Further analysis is required to identify the risk of dementia in older people without global cognitive impairment. Geriatr Gerontol Int 2017; ••: ••–••.

  June 16, 2017   doi: 10.1111/ggi.13079   open full text
• Urinary tract infection in patients with hip fracture: An underestimated event?
  Christopher Bliemel, Benjamin Buecking, Juliana Hack, Rene Aigner, Daphne‐Asimenia Eschbach, Steffen Ruchholtz, Ludwig Oberkircher.
  Geriatrics and Gerontology International. June 16, 2017
  Aim Urinary tract infections (UTI) represent a common perioperative complication among elderly patients with hip fracture. To determine the impact of UTI on the perioperative course of elderly patients with hip fractures, a prospective study was carried out. Methods A total of 402 surgically‐treated geriatric hip fracture patients were consecutively enrolled at a level 1 trauma center. On admission, all patients received an indwelling urinary catheter. Clinically symptomatic patients were screened more closely for UTI. Patients diagnosed with UTI were compared with asymptomatic patients. Outcomes in both patient groups were measured using in‐hospital mortality, overall length of hospital stay, wound infection, functional results and mobility at discharge. Multivariate regression analysis was carried out to control for influencing factors. Results A total of 97 patients (24%) sustained a UTI during in‐hospital treatment. UTI were independently associated with inferior functional outcomes as assessed by the Barthel Index (β = −0.091; P = 0.031), Timed Up and Go test (β = 0.364; P = 0.001) and Tinetti test (β = −0.169; P = 0.001) at discharge. Additionally, length of hospital stay was significantly longer for patients with a UTI diagnosis (β = 0.123; P = 0.029) after controlling for all other variables. No differences were observed in the rate of wound infection (odds ratio 1.185; P = 0.898) or in‐hospital mortality (P < 0.997). Conclusions Patients with UTI seem to be at risk of inferior functional outcomes. In addition to an early detection of symptomatic UTI and a targeted antibiotic therapy, perioperative care should focus on preserving functional ability to protect these patients from further loss of independence and prolonged clinical courses. Geriatr Gerontol Int 2017; ••: ••–••.

  June 16, 2017   doi: 10.1111/ggi.13077   open full text
• Impact of family characteristics by marital status of cohabitating adult children on depression among Korean older adults.
  Juyeong Kim, Young Choi, Jae Woo Choi, Jin Young Nam, Eun‐Cheol Park.
  Geriatrics and Gerontology International. June 15, 2017
  Aim To identify the association between different living arrangements of intergenerational household composition and depression in older adults. Methods Data from the Korea Longitudinal Study of Aging, the first to fourth waves, were used. Using the first wave as baseline, our analysis included 5046 participants aged ≥60 years with at least one living child. Depression was measured using the 10‐item Center for Epidemiological Studies Depression scale. Factors investigated included living arrangements according to household composition and the marital status of a cohabiting adult child. A generalized estimating equation with the logit link for binary outcomes was used to examine the association between living arrangements and depression. Results Compared with the older adults living with a married child and grandchildren, those living alone, those living with an unmarried child, and those living with an unmarried child and grandchildren were more likely to have depression (OR 1.41, 95% CI 1.13–1.75; OR 1.40, 95% CI 1.18–1.66; OR 1.60, 95% CI 1.27–2.01). In particular, women were more likely to have depression than men in the association between living arrangements and depression. Conclusions Efforts should be made to provide social services for older adults living alone and those living with an unmarried child in a two‐/three‐generation family, in particular, for those who are female. Geriatr Gerontol Int 2017; ••: ••–••.

  June 15, 2017   doi: 10.1111/ggi.13066   open full text
• Mini‐Nutritional Assessment Short‐Form as a useful method of predicting poor 1‐year outcome in elderly patients undergoing orthopedic surgery.
  Che‐Sheng Chu, Chih‐Kuang Liang, Ming‐Yueh Chou, Ti Lu, Yu‐Te Lin, Chin‐Liang Chu.
  Geriatrics and Gerontology International. June 05, 2017
  Aim The present study aimed to determine whether the Mini‐Nutritional Assessment Short‐Form (MNA‐SF) can predict the 1‐year outcome of orthopedic fracture surgery in elderly patients. Methods This 1‐year prospective study assessed nutrition using the MNA‐SF at baseline, and postoperatively at 6 and 12 months. Repeated measures analysis of covariance was used to examine functional change over time for two MNA‐SF categories. Multivariable logistic regression analysis with forward stepwise modeling was carried out to identify risk factors of functional decline, emergency department visit, hospital readmission and mortality at follow up. Results There were 312 participants, 11 of whom died (3.53%) during 1‐year follow up. The mean age was 74.04 ± 7.65 years. A total of 88.1% and 11.9% of the participants were well nourished (MNA‐SF 12–14 points) or at risk of undernutrition (0–11 points), respectively. For MNA‐SF as a continuous variable, lower MNA‐SF scores were associated with a significantly higher risk of emergency department visit at 6‐month follow up, and mortality at 12‐month follow up (emergency room visit, adjusted odds ratio 0.78, 95% CI 0.63–0.96, P < 0.05; mortality, adjusted odds ratio 0.73, 95% CI 0.57–0.94, P < 0.05). No association was found between functional decline and hospital readmission, and MNA‐SF scores. For MNA‐SF categories, functional decline was more profound in patients at risk of undernutrition than in well‐nourished patients, especially 6–12 months postoperatively. Conclusions The MNA‐SF could be an effective and non‐invasive preoperative screening tool to predict functional decline, emergency department visit and mortality during the year after surgery. Geriatr Gerontol Int 2017; ••: ••–••.

  June 05, 2017   doi: 10.1111/ggi.13075   open full text
• Possible mechanism underlying the association between higher hemoglobin level and hypertension in older Japanese men.
  Yuji Shimizu, Shimpei Sato, Jun Koyamatsu, Hirotomo Yamanashi, Mako Nagayoshi, Koichiro Kadota, Shin‐Ya Kawashiri, Takahiro Maeda.
  Geriatrics and Gerontology International. June 05, 2017
  Aim Hemoglobin is reported to be positively associated with hypertension. However, the underlying mechanism of this association is unknown. Recently, bone marrow‐derived CD34‐positive cells have been reported to play an important role in endothelial repair in conjunction with platelets. As the association between hypertension and endothelial dysfunction is bidirectional, the influence of endothelial repair also might strongly influence the association between hemoglobin and hypertension. Methods To clarify the clinical importance of the hematological parameter on endothelial maintenance in older men, we carried out a cross‐sectional study of 222 Japanese men aged 60–69 years undergoing a general health checkup. Results For participants with a lower platelet count (≤21.0/μL), hemoglobin was significantly positively associated with hypertension, but not for participants with a higher platelet count (>21.0/μL). The classical cardiovascular risk factor adjusted odds ratio of hypertension for 1‐standard deviation increment of hemoglobin (1.0 g/dL) was 2.09 (95% CI: 1.26, 3.48) for participants with a lower platelet count, and 1.07 (95% CI: 0.68, 1.67) for participants with a higher platelet count. We also found that although there was no significant correlation between hemoglobin and circulating CD34‐positive cells for participants with a lower platelet count (β = −0.06, P = 0.603), a significant positive correlation was seen for participants with a higher platelet count (β = 0.29, P = 0.004). Conclusions The positive association between hemoglobin and hypertension was limited to participants with a lower platelet count as a result of insufficient endothelial repair. These results represent an efficient tool for clarifying the mechanism of endothelial maintenance that correlates with hypertension. Geriatr Gerontol Int 2017; ••: ••–••.

  June 05, 2017   doi: 10.1111/ggi.13068   open full text
• Novel tool for deprescribing in chronic patients with multimorbidity: List of Evidence‐Based Deprescribing for Chronic Patients criteria.
  Aitana Rodríguez‐Pérez, Eva Rocío Alfaro‐Lara, Sandra Albiñana‐Perez, María Dolores Nieto‐Martín, Jesús Díez‐Manglano, Concepción Pérez‐Guerrero, Bernardo Santos‐Ramos.
  Geriatrics and Gerontology International. May 21, 2017
  Aim To create a tool to identify drugs and clinical situations that offers an opportunity of deprescribing in patients with multimorbidity. Methods A literature review completed with electronic brainstorming, and subsequently, a panel of experts using the Delphi methodology were applied. The experts assessed the criteria identified in the literature and brainstorming as possible situations for deprescribing. They were also asked to assess the influence of life prognosis in each criterion. A tool was composed of the most appropriate criteria according to the strength of their evidence, usefulness in patients with multimorbidity and applicability in clinical practice. Results Out of a total of 100, 27 criteria were selected to be included in the final list. It was named the LESS‐CHRON criteria (List of Evidence‐baSed depreScribing for CHRONic patients), and was organized by the anatomical group of the Anatomical, Therapeutic, Chemical (ATC) classification system of the drug to be deprescribed. Each criterion contains: drug indication for which it is prescribed, clinical situation that offers an opportunity to deprescribe, clinical variable to be monitored and the minimum time to follow up the patient after deprescribing. Conclusions The “LESS‐CHRON criteria” are the result of a comprehensive and standardized methodology to identify clinical situations for deprescribing drugs in chronic patients with multimorbidity. Geriatr Gerontol Int 2017; ••: ••‐••.

  May 21, 2017   doi: 10.1111/ggi.13062   open full text
• Clinical features of extremely elderly patients with heart failure.
  Tetsuro Yokokawa, Akiomi Yoshihisa, Yuki Kanno, Takamasa Sato, Satoshi Suzuki, Tomofumi Misaka, Masayoshi Oikawa, Atsushi Kobayashi, Takayoshi Yamaki, Hiroyuki Kunii, Kazuhiko Nakazato, Hitoshi Suzuki, Shu‐Ichi Saitoh, Yasuchika Takeishi.
  Geriatrics and Gerontology International. May 21, 2017
  Aim To investigate the clinical features of heart failure in extremely elderly patients. Methods We analyzed 1163 consecutive hospitalized heart failure patients. The patients were divided into an extremely elderly group (≥85 years‐of‐age, n = 88) and a non‐extremely elderly group (<85 years‐of‐age, n = 1075). Results The extremely elderly group had higher rates of hypertension, chronic kidney disease, anemia, higher systolic blood pressure and lower body mass index, and lower use of β‐blockers and anticoagulants compared with the non‐extremely elderly group. During the mean follow‐up period of 1038 days, the extremely elderly group had higher mortality compared with the non‐extremely elderly group (P < 0.001). In multivariate analysis, in the non‐extremely elderly group, age (HR 1.027, P < 0.001), body mass index (HR 0.919, P < 0.001), New York Heart Association III or IV (HR 3.626, P < 0.001), preserved ejection fraction (HR 0.553, P < 0.001), anemia (HR 1.941, P < 0.001), β‐blockers (HR 0.695, P = 0.028) and renin–angiotensin system inhibitors (HR 0.603, P = 0.001) were independent predictors for all‐cause death. In contrast, atrial fibrillation (HR 2.042, P = 0.015) and renin–angiotensin system inhibitors (HR 0.470, P = 0.014) were independent predictors for all‐cause death in the extremely elderly group, suggesting that the prognostic factors were different between the two groups. Conclusions We should be careful of atrial fibrillation and renin–angiotensin system inhibitors in managing extremely elderly patients with heart failure. Geriatr Gerontol Int 2017; ••: ••–••.

  May 21, 2017   doi: 10.1111/ggi.13060   open full text
• Association between the frequency and autonomy of social participation and self‐rated health.
  Kimiko Tomioka, Norio Kurumatani, Hiroshi Hosoi.
  Geriatrics and Gerontology International. May 18, 2017
  Aim Although numerous studies have reported that social participation (SP) has favorable effects on older people's health, no studies have focused on the autonomy of SP. We investigated the cross‐sectional relationship between the type, frequency, and autonomy of SP and self‐rated health (SRH). Methods A postal survey was mailed to 19 354 citizens born between 1945 and 1949 in a city in Nara prefecture (response rate: 65.9%). A total of 12 157 respondents (5114 men and 7043 women) with independent basic activities of daily living made up the analytical participants. Six types of SP were measured: volunteer groups, sports groups, hobby groups, senior citizens’ clubs, neighborhood community associations and cultural groups. Using multiple logistic regressions, we calculated the odds ratio for poor SRH, with non‐participation as the reference. Covariates included age, family size, body mass index, comorbidities, smoking, drinking, walking, depression and cognitive function. Results Adjusted odds ratios for poor SRH decreased with more frequent SP or with more voluntary SP among both sexes, but this dose–response relationship was stronger in women than in men. After mutual adjustment for the frequency and autonomy of SP, voluntary SP had stronger effects on SRH than frequent SP, especially in sports and hobby groups among men, and in volunteer and hobby groups among women. For cultural groups, women with frequent and voluntary SP had positive effects on SRH, but frequent and obligatory SP had negative effects on men. Conclusions The present results imply that encouraging voluntarily chosen SP rather than frequent SP might be a key point for successful aging. Geriatr Gerontol Int 2017; ••: ••–••.

  May 18, 2017   doi: 10.1111/ggi.13074   open full text
• Prevalence of muscle weakness based on different diagnostic criteria in community‐dwelling older adults: A comparison of grip strength dynamometers.
  Miji Kim, Shoji Shinkai.
  Geriatrics and Gerontology International. May 18, 2017
  Aim The present study compared the performance of the Jamar and Smedley dynamometers for the measurement of grip strength, and the two dynamometers were used to determine the prevalence rate of weakness in a large, community‐dwelling, older adult population, based on different diagnostic criteria. Methods A total of 467 community‐dwelling older adults aged 69–89 years were recruited into the study. Grip strength was measured with two dynamometers; the Jamar hydraulic hand dynamometer was used as the reference device. To assess agreement between grip strength measurements by the two dynamometers, linear regression and Bland–Altman analyses were carried out. Results In a comparison of the dynamometers, high coefficients of determination (R2) were obtained for grip strength (R2 = 0.80, standard error of the estimate 2.68 kg in male participants, and R2 = 0.75, standard error of the estimate = 1.95 kg in female participants). There was systematic bias with underestimation of grip strength (bias 3.09 kg, 95% confidence interval 2.77 to 3.41 for men; bias 2.60 kg, 95% confidence interval 2.31 to 2.89 for women) by the Smedley dynamometer. In both sexes, no proportional bias was noted between the two dynamometers for measurement of grip strength (r = 0.030, P = 0.611 for male participants; r = −0.033, P = 0.653 for female participants). The prevalence of weakness ranged from 1.8 to 19.9% in male participants, and 0.5 to 27.4% in female participants. Conclusions The present study shows that despite the excellent correlation between the two dynamometers, there is a statistically significant difference in grip strength measurements. The Smedley dynamometer showed a higher prevalence of weakness than did the Jamar dynamometer. Geriatr Gerontol Int 2017; ••: ••–••

  May 18, 2017   doi: 10.1111/ggi.13027   open full text
• Sarcopenia is a risk factor for falling in independently living Japanese older adults: A 2‐year prospective cohort study of the GAINA study.
  Hiromi Matsumoto, Chika Tanimura, Shinji Tanishima, Mari Osaki, Hisashi Noma, Hiroshi Hagino.
  Geriatrics and Gerontology International. May 18, 2017
  Aim The purpose of the present study was to investigate whether sarcopenia was associated with future falls in the general Japanese older population. Methods This study was a 2‐year prospective observational study. Participants were recruited from individuals who had an annual town‐sponsored medical check‐up and had not received nursing care. The inclusion criteria for participants in our study were: (i) agreement to participate; (ii) living independently; and (iii) the ability to walk to where the survey was carried out and to provide self‐reported data. A total of 223 residents (82 men, 141 women) participated in the baseline assessment in the study. Demographic information, previous fall history, locomotive syndrome, body function and structural measurements and pain at the knee and/or lumber spine were assessed. The Asian Working Group for Sarcopenia algorithm was used to classify the presence of sarcopenia, and assess the history of falling when the participant received their annual medical check‐up. Results A total of 162 participants had an annual follow‐up assessment, 50 of whom (30.8%) fell at least once during the 2‐year observational period after baseline assessment. Previous falling history, prevalence of locomotive syndrome, sarcopenia and pain were significantly higher in participants who had fallen compared with participants who had not. Multiple logistic regression analysis showed the prevalence of sarcopenia was a significant predictor of falling. Conclusion The key finding of the present study suggests that sarcopenia is a risk factor for falling in older adults who are living independently even after adjustment for previous falls and confounding factors. Geriatr Gerontol Int 2017; ••: ••–••.

  May 18, 2017   doi: 10.1111/ggi.13047   open full text
• Sex differences in metabolic risk indicator of dementia in an elderly urban Korean population: A community‐based cross‐sectional study.
  Yeon‐Ha Kim, Nam Hoon Kim, Moon‐Hee Jung, Hee‐Jin Kim.
  Geriatrics and Gerontology International. May 16, 2017
  Aim The aim of the present study was to evaluate the age‐specific prevalence of dementia, and develop a metabolic risk indicator for dementia according to sex. Methods This cross‐sectional study was carried out from September 2007 through December 2012 with 19 935 elderly participants in metropolitan Seoul, Korea. Multiphase assessments were used to measure metabolic risk factors and confirm dementia according to sex. Specifically, multivariate logistic regression analyses were used to identify how elderly men and women differed in regard to metabolic risk indicators of dementia. Results The adjusted prevalence rates of dementia in elderly Seoul residents were estimated at 4.9%, 6.1% and 5.6% in men, women and the overall population, respectively. Stroke conferred an odds ratio of 5.14 (95% CI 3.91–6.77) and 2.55 (95% CI 2.01–3.25) in men and women, respectively. Additionally, within the female population, diabetes mellitus conferred an odds ratio of 1.29 (95% CI 1.09–1.53), whereas alcohol consumption conferred an odds ratio of 0.77 (95% CI 0.61–0.97). Conclusions Stroke played a primary role as a metabolic risk indicator of dementia in elderly men, while diabetes mellitus and alcohol abstinence were important metabolic risk factors in elderly women. Taken together, the data show that when designing preventative measures against dementia based on metabolic risk, sex needs to be taken into account. Geriatr Gerontol Int 2017; ••: ••–••.

  May 16, 2017   doi: 10.1111/ggi.13049   open full text
• Chronic kidney disease: A likely underestimated component of multimorbidity in older patients with chronic obstructive pulmonary disease.
  Andrea Corsonello, Filippo Aucella, Claudio Pedone, Raffaele Antonelli‐Incalzi.
  Geriatrics and Gerontology International. May 16, 2017
  The coexistence of chronic kidney disease and chronic obstructive pulmonary disease, two age‐related conditions, has important clinical and prognostic implications. Respiratory failure is associated with important changes in glomerular and tubulointerstitial function. In contrast, renal failure can affect lung function, mainly by adding a restrictive component or causing complications, such as uremic pulmonary edema and pleural effusion. The effect of age on renal and pulmonary function adds to the complexity of the interplay between the kidney and the lung in these patients. Chronic kidney disease also represents an important risk factor for adverse drug reactions in older chronic obstructive pulmonary disease patients in which multimorbidity and polypharmacy are highly prevalent. Finally, an additive effect of chronic kidney disease and chronic obstructive pulmonary disease might also contribute to the pathophysiology of sarcopenia. Nevertheless, several gaps in our knowledge of the lung–kidney interplay still exist, thus suggesting further basic and clinical research on this topic. Geriatr Gerontol Int 2017; ••: ••–••.

  May 16, 2017   doi: 10.1111/ggi.13054   open full text
• Effect of sex on the association of isokinetic quadriceps strength with hypertension among older Americans.
  Kristen D. Dodd, Priscilla R. Wessly, Richard F. Gillum.
  Geriatrics and Gerontology International. May 15, 2017
  There is no abstract available for this paper.

  May 15, 2017   doi: 10.1111/ggi.12961   open full text
• Femoral osteoporosis is more common than lumbar osteoporosis in patients with Werner syndrome.
  Seijiro Mori, Heying Zhou, Masaya Yamaga, Minoru Takemoto, Koutaro Yokote.
  Geriatrics and Gerontology International. May 15, 2017
  There is no abstract available for this paper.

  May 15, 2017   doi: 10.1111/ggi.12960   open full text
• Reduced brain‐derived neurotrophic factor is associated with cognitive dysfunction in patients with chronic heart failure.
  Hideaki Suzuki, Yasuharu Matsumoto, Hideki Ota, Koichiro Sugimura, Jun Takahashi, Kenta Ito, Satoshi Miyata, Hiroyuki Arai, Yasuyuki Taki, Katsutoshi Furukawa, Yoshihiro Fukumoto, Hiroaki Shimokawa.
  Geriatrics and Gerontology International. May 15, 2017
  There is no abstract available for this paper.

  May 15, 2017   doi: 10.1111/ggi.12959   open full text
• Personality traits and behavioral disturbances in dementia: A new risk factor?
  Fiammetta Monacelli, Matteo Prefumo, Luisa Ientile, Alessio Nencioni, Gianluca Serafini, Alessio Signori, Patrizio Odetti.
  Geriatrics and Gerontology International. May 15, 2017
  There is no abstract available for this paper.

  May 15, 2017   doi: 10.1111/ggi.12954   open full text
• Do sociodemographic, behavioral or health status variables affect longitudinal anthropometric changes in older adults? Population‐based cohort study in Southern Brazil.
  Vanessa Fernanda Goes, Elisabeth Wazlawik, Eleonora d’Orsi, Albert Navarro, David Alejandro González‐Chica.
  Geriatrics and Gerontology International. May 10, 2017
  Aim To assess the influence of sociodemographic, behavioral and health status variables on longitudinal changes in height, weight, and waist circumference in older adults. Methods This is a population‐based cohort study in Southern Brazil (EpiFloripa Study) investigating 1702 individuals aged 70.6 ± 8.0 years (62.5% women). Height, weight and waist circumference were measured in 2009/10 and 2013/14 (n = 1197). Linear mixed regression models were used to estimate age‐related changes in anthropometric measurements according to the explanatory variables. Results Unmarried individuals, with higher education level or household income, with excessive alcohol consumption, former smokers and positives for some chronic disease were heavier than their counterparts. Similar associations were observed for waist circumference in terms of marital status, smoking and the presence of chronic diseases. Height was higher among the wealthiest, in former smokers and those physically active. Only in men were a lower education level and being unmarried associated with higher weight loss after the age of 75 years, but not with waist circumference reduction. Conclusions Despite their association with current height, weight and waist circumference, neither behavioral variables nor the presence of chronic diseases influenced the anthropometric changes. Less educated and unmarried men lose weight at a higher rate, showing a higher risk of sarcopenia. Geriatr Gerontol Int 2017; ••: ••–••.

  May 10, 2017   doi: 10.1111/ggi.13024   open full text
• Frailty in older adults with amnestic mild cognitive impairment as a result of Alzheimer's disease: A comparison of two models of frailty characterization.
  Natália O.C. Cezar, Rafael Izbicki, Diego Cardoso, Jouce G. Almeida, Leandro Valiengo, Marina V.Z. Camargo, Orestes V. Forlenza, Monica S. Yassuda, Ivan Aprahamian.
  Geriatrics and Gerontology International. May 10, 2017
  Aim To verify the prevalence and presence of frailty markers, and their relationship to cognitive function among older adults with amnestic mild cognitive impairment (aMCI). Methods This was an observational study with transversal analyses. Older adults with aMCI as a result of Alzheimer's disease (n = 40) were compared with healthy controls (n = 26) at the Psychogeriatric Outpatient Unit, Institute and Department of Psychiatry, Faculty of Medicine of the University of São Paulo. All participants were submitted to a broad clinical and neuropsychological evaluation. Frailty was evaluated according to the Cardiovascular Health Study (CHS) phenotype and the Edmonton Frail Scale (EFS). MCI was diagnosed by a multidisciplinary consensus according to the Petersen criteria and cerebrospinal fluid analysis for Alzheimer's disease biomarkers. Results The prevalence of frailty was significantly higher in the aMCI compared with the control group when it was assessed with the EFS (P = 0.047), but not with the CHS (P = 0.255). The prevalence of frailty varied on the criteria used (EFS 7.5%; CHS 30%). The fatigue variable in the CHS (P = 0.036), and the mood (P = 0.019) and functional independence (P = 0.042) variables from the EFS were significantly different between the groups. Visuospatial function (OR 2.405, P = 0.042) was associated with the CHS criteria. Conclusion The identification of frailty features in aMCI appears to depend on the protocol used for evaluation. Visuospatial function showed a higher risk for frailty with the CHS. Geriatr Gerontol Int ••; ••: ••–••

  May 10, 2017   doi: 10.1111/ggi.13028   open full text
• Physician‐initiated first‐in‐human clinical study using a novel angiogenic peptide, AG30/5C, for patients with severe limb ulcers.
  Hironori Nakagami, Toshifumi Yamaoka, Misa Hayashi, Atsushi Tanemura, Yasushi Takeya, Hitomi Kurinami, Ken Sugimoto, Ayumi Nakamura, Kazunori Tomono, Katsuto Tamai, Ichiro Katayama, Hiromi Rakugi, Yasufumi Kaneda.
  Geriatrics and Gerontology International. May 10, 2017
  Aim In patients with diabetes or ischemia, angiogenesis and infection control are required for chronic leg ulcers, which substantially impair patients’ quality of life. We developed a novel functional peptide, named AG30/5C, with angiogenic and anti‐microbial properties. Treatment with AG30/5C significantly accelerated the wound healing of full‐thickness defects in mice. To evaluate the safety of AG30/5C in the treatment of leg ulcers, a physician‐initiated clinical study was carried out. Methods The first‐in‐human trial was designed as an open‐label treatment with AG30/5C (0.1 mg/mL) given twice per day for 11 days, and with a follow‐up period of 17 days. The inclusion criteria for severe skin ulcers were: (i) diabetes or critical limb ischemia; (ii) resistance to standard therapy for 1 month; and (iii) detection of methicillin‐resistant Staphylococcus aureus in the skin ulcer. Results Four patients were enrolled in this study, and two patients met these criteria. For the evaluation of safety, three adverse effects were reported as possibly related to AG30/5C treatment; however, these adverse effects were not severe and resolved during or after treatment. Thus, there were no safety concerns. In both patients, the size of the ulcer decreased after treatment (44.62% and 10.23% decrease), and further decreased after the follow‐up period (73.85% and 10.23% decrease). The former patient was diagnosed as Werner syndrome and the skin ulcer was resistant to standard therapy; however, it was sensitive to AG30/5C treatment. Conclusions Topical treatment with AG30/5C for severe leg ulcers was safe, well tolerated and effective. Geriatr Gerontol Int 2017; ••: ••–••.

  May 10, 2017   doi: 10.1111/ggi.13051   open full text
• Comparison of personality traits and successful aging in older Taiwanese.
  Chia‐Yi Chiao, Chiu‐Yueh Hsiao.
  Geriatrics and Gerontology International. May 10, 2017
  Aim The present study aimed to compare the difference of personality traits and successful aging among older Taiwanese adults. The proportions of successful agers who meet the criteria for successful aging was also be proposed. Methods A comparative descriptive study design was applied. To measure the definition of successful aging, three concepts proposed by Rowe and Kahn with five indicators were included. Demographic data were compared by the χ2‐test and Fisher's exact test across the subgroups defined by social economic status, marital status, and health habits. The comparison of personality traits and successful aging was applied by logistic regression. Results The results of the present study showed that the personality traits of conscientiousness, openness and emotional stability were found to be related to the dimensions of successful aging. In addition, except for the personality trait of openness, the personality traits of conscientiousness, extraversion, emotional stability and agreeableness were significantly different in the successful aging versus the non‐successful aging group. Conclusions The present study found the differences between personality traits and successful aging. Our study also provided essential information with regard to the differences of successful aging for older people. Geriatr Gerontol Int 2017; ••: •–••.

  May 10, 2017   doi: 10.1111/ggi.13019   open full text
• Association between body composition parameters and risk of mild cognitive impairment in older Japanese adults.
  Seongryu Bae, Hiroyuki Shimada, Hyuntae Park, Sangyoon Lee, Hyuma Makizako, Takehiko Doi, Daisuke Yoshida, Kota Tsutsumimoto, Yuya Anan, Takao Suzuki.
  Geriatrics and Gerontology International. May 09, 2017
  Aim The aim of the present study was to investigate the association between various body composition parameters and the risk of mild cognitive impairment (MCI) in older Japanese adults, as well as potential sex‐related differences in the risk of MCI. Methods Participants underwent cognitive tests, and were divided into 840 participants with MCI (mean age 71.9 ± 5.5 years) and 1740 without MCI (mean age 71.3 ± 5.2 years). Body composition parameters were measured using a bioelectrical impedance analyzer. Multiple logistic regression analysis was then carried out to examine the associations between body composition parameters and risk of MCI. Results After adjusting for confounding factors, those in the lowest quartile for fat‐free mass had a higher risk of MCI than those in the highest quartile (men: odds ratio [OR] 1.96, 95% confidence interval CI 1.24–3.10; women: OR 1.49, 95% CI 1.01–2.19). Loss of muscle mass in the upper (OR 2.17, 95% CI 1.40–3.37) and lower (OR 1.99, 95% CI 1.25–3.15) limbs was associated with a higher MCI risk in men. However, only loss of muscle mass in the lower limbs was associated with a higher MCI risk (OR 1.61, 95% CI 1.06–2.44) in women. No associations were found between obesity measures and MCI. Conclusions We found that loss of fat‐free mass was associated with MCI in older adults, regardless of sex. We also found that appendicular muscle mass was more closely associated with MCI in men than in women. These results suggest that the association between appendicular muscle mass and MCI might have different underlying mechanisms based on sex. Geriatr Gerontol Int 2017; ••: ••–••.

  May 09, 2017   doi: 10.1111/ggi.13018   open full text
• Impact of long‐hours family caregiving on non‐fatal coronary heart disease risk in middle‐aged people: Results from a longitudinal nationwide survey in Japan.
  Atsushi Miyawaki, Jun Tomio, Yasuki Kobayashi, Hideto Takahashi, Haruko Noguchi, Nanako Tamiya.
  Geriatrics and Gerontology International. May 02, 2017
  Aim The effects of family caregiving, especially long‐hours caregiving, on coronary heart disease (CHD) are debatable. We examined the impact of family caregiving on incident non‐fatal CHD. Methods We used data from the Longitudinal Survey of Middle‐Aged and Elderly Persons from 2005 to 2010, a nationwide panel survey for Japanese people aged 50–59 years in 2005 (baseline). After we excluded non‐respondents and people with missing key variables at baseline, 25 121 individuals without CHD, stroke or cancer were followed up for a mean of 4.6 years. The exposure was assessed at baseline by three indicators: (i) family caregiving; (ii) hours spent caregiving; and (iii) kinship type of care recipient. The non‐fatal CHD incidence was identified according to questionnaire responses from 2006 to 2010. Results Cox's proportional hazards analysis did not show a statistically significant association between family caregiving and incident non‐fatal CHD (hazard ratio [HR] 1.13, 95% confidence interval [CI] 0.92–1.40). Caregivers who spent 20–69 h per week on care showed a statistically significant increased risk for non‐fatal CHD (HR 1.78, 95% CI 1.23–2.58) compared with non‐caregivers; whereas this increased risk was statistically significant only among women (HR 1.98, 95% CI 1.27–3.08), but not among men (HR 1.35, 95% CI 0.67–2.71). Kinship type of care recipient did not make a significant difference to the effects of family caregiving on incident non‐fatal CHD. Conclusions Long‐hours family caregiving could be an independent risk factor for incident non‐fatal CHD among middle‐aged women in Japan. Geriatr Gerontol Int 2017; ••: ••–••.

  May 02, 2017   doi: 10.1111/ggi.13061   open full text
• Effects of a simple home‐based exercise program on fall prevention in older adults: A 12‐month primary care setting, randomized controlled trial.
  Chitima Boongird, Prasit Keesukphan, Soontraporn Phiphadthakusolkul, Sasivimol Rattanasiri, Ammarin Thakkinstian.
  Geriatrics and Gerontology International. April 24, 2017
  Aim To investigate the effects of a simple home‐based exercise program on falls, physical functioning, fear of falling and quality of life in a primary care setting. Methods Participants (n = 439), aged ≥65 years with mild‐to‐moderate balance dysfunction were randomly assigned to an exercise (n = 219) or control (n = 220) group. The program consisted of five combined exercises, which progressed in difficulty, and a walking plan. Controls received fall prevention education. Physical functioning and other outcomes were measured at 3‐ and 6‐month follow‐up visits. Falls were monitored with fall diaries and phone interviews at 3, 6, 9, and 12 months respectively. Results The 12 months of the home‐based exercise program showed the incidence of falls was 0.30 falls per person year in the exercise group, compared with 0.40 in the control group. The estimated incidence rate ratio was 0.75 (95% CI 0.55–1.04), which was not statistically significant. The fear of falling (measured by the Thai fall efficacy scale) was significantly lower in the exercise than control group (24.7 vs 27.0, P = 0.003). Also, the trend of program adherence increased in the exercise group. (29.6% to 56.8%). Conclusions This simple home‐based exercise program showed a reduction in fear of falling and a positive trend towards exercise adherence. Further studies should focus on factors associated with exercise adherence, the benefits of increased home visits and should follow participants longer in order to evaluate the effects of the program. Geriatr Gerontol Int 2017; ••: ••–••.

  April 24, 2017   doi: 10.1111/ggi.13052   open full text
• Effects of age and viscosity on food transport and breathing–swallowing coordination during eating of two‐phase food in nursing home residents.
  Tsuyoshi Yamada, Koichiro Matsuo, Masayuki Izawa, Shizuru Yamada, Yuji Masuda, Tadashi Ogasawara.
  Geriatrics and Gerontology International. April 20, 2017
  Aim When eating food that contains both liquid and solid phases, the liquid component frequently enters the hypopharynx before swallowing and can increase the risk of aspiration. Thus, we examined whether the initial viscosity of mixed consistency food could alter pre‐swallow food transport and breathing–swallowing coordination in older adults. Methods Fiberoptic endoscopy was recorded while 18 healthy young adults and 19 older adults ate 5 g of steamed rice combined with 3 mL of blue‐dye water. Liquid viscosity was set at three levels by the addition of a thickening agent (0 wt%, thin; 2 wt%, thicker; 4 wt%, higher‐viscosity, respectively). We measured the timing of swallow initiation and its corresponding respiratory phase for each participant. Results For thin mixed consistency food, whereas the timing of swallow initiation was comparable between young and older participants, swallowing was initiated during inspiration significantly more often in older participants (31.6 %) than in young participants (5.6 %). In contrast, the timing of swallow initiation was delayed in older participants for thicker and higher‐viscosity foods, although swallowing was commonly initiated during expiration in both groups. Conclusions In older adults, we observed that swallow initiation function was preserved for thin mixed consistency samples, but breathing–swallowing coupling was diminished. For higher‐viscosity foods, swallow initiation was delayed in this group, but breathing–swallowing coordination was not disturbed, probably as a result of the slow bolus flow into the hypopharynx. Thus, it appears the initial viscosity of mixed consistency food profoundly affects food transport before swallowing as well as breathing–swallowing coordination in nursing home residents. Geriatr Gerontol Int 2017; ••: ••–••.

  April 20, 2017   doi: 10.1111/ggi.13056   open full text
• Predictors of the health‐related quality of life of Chinese people with major neurocognitive disorders and their caregivers: The roles of self‐esteem and caregiver's burden.
  Daniel Kim‐wan Young, Petrus Yat‐nam Ng, Timothy Kwok.
  Geriatrics and Gerontology International. April 20, 2017
  Aim The present research study aimed to identify and compare the clinical and non‐clinical factors that predict the self‐reported and proxy‐reported health‐related quality of life (HRQoL) of people with major neurocognitive disorder (PwND) who are living at home in a Chinese society. Methods A total of 57 Chinese PwND‐family caregiver dyads that were using the services of local senior centers were recruited through a cross‐sectional survey with convenience sampling. Each PwND and caregiver rated the PwND's HRQoL independently by using the Quality of Life‐Alzheimer's disease measure. Additional measures included the Rosenberg Self‐Esteem Scale (RSES), Index for Managing Memory Loss, Geriatric Depression Scale, Cornell Scale for Depression in Dementia and Zarit Burden Inventory. Results The results of hierarchical multiple linear regression analyses showed that the PwND's self‐rated HRQoL and caregiver‐rated HRQoL were found to be predicted by different clinical and non‐clinical variables. In particular, the self‐esteem of PwND had the highest predictive power for the self‐rated HRQoL, whereas the caregiver burden is the only significant predictor for the caregiver‐rated HRQoL. Conclusions In the present study, the self‐esteem of PwND and the caregiver's burden were found to be important factors predicting self‐rated HRQoL and caregiver‐rated HRQoL respectively, which is probably because of the influence of traditional Chinese cultural values. Thus, it is important for non‐pharmacological interventions to address these special needs to promote HRQoL for this population. Geriatr Gerontol Int 2017; ••: ••–••.

  April 20, 2017   doi: 10.1111/ggi.13065   open full text
• Effect of water bath temperature on physiological parameters and subjective sensation in older people.
  Junji Ono, Nobuko Hashiguchi, Hiroyuki Sawatari, Tomoko Ohkusa, Mami Miyazono, Su‐young Son, Chie Magota, Yutaka Tochihara, Akiko Chishaki.
  Geriatrics and Gerontology International. April 19, 2017
  Aim In Japan, the incidence of water bathing‐related cardiopulmonary accidents among older people is high in winter. The purpose of the present study was to investigate alterations in physiological characteristics and subjective thermal sensations of older people when bathing in a cool environment. Methods We assessed the skin temperature, rectal temperature, blood pressure, pulse rate, body fluid loss (sweat and urine), and subjective thermal responses of 11 older healthy male and 10 young male volunteers throughout 42°C and 39°C bathing in a room at 20°C with 50% humidity. Results At 42°C bathing, the rectal temperature during bathing and in the post‐bathing period were significantly lower in the older men than in the young men, and skin temperature during the post‐bathing period decreased gradually in the older men. Systolic blood pressure and pulse rate immediately increased just after entering 42°C water and decreased during bathing in the older men. With the activities of dressing, systolic blood pressure increased followed by a decrease during the post‐bathing period. Thus, double product (pulse rate × systolic blood pressure) increased during the bathing period. Although there was no significant difference in body fluid loss between the older and younger men in 42°C water, the older men produced significantly less sweat. The older men also reported feeling less warm after 42°C bathing, and feeling less cold during the post‐bathing period after 39°C bathing. Conclusions These results suggest that hot water bathing during cold seasons might induce more serious physiological changes in older people. Geriatr Gerontol Int 2017; ••: ••–••.

  April 19, 2017   doi: 10.1111/ggi.13053   open full text
• Impact of hospitalization in an acute geriatric unit on polypharmacy and potentially inappropriate prescriptions: A retrospective study.
  Marta Gutiérrez‐Valencia, Mikel Izquierdo, Vincenzo Malafarina, Javier Alonso‐Renedo, Belén González‐Glaría, Beatriz Larrayoz‐Sola, María Pilar Monforte‐Gasque, Pello Latasa‐Zamalloa, Nicolás Martínez‐Velilla.
  Geriatrics and Gerontology International. April 19, 2017
  Aim Polypharmacy is a highly prevalent geriatric syndrome, and hospitalizations can worsen it. The aim of the present study was to analyze the influence of hospitalization on polypharmacy and indicators of quality of prescribing, and their possible association with health outcomes. Methods A retrospective study of 200 patients discharged from an acute geriatric unit was carried out. Indicators of quality of prescription were registered at admission and discharge: polypharmacy defined as ≥5 medications, hyperpolypharmacy (≥10), potentially inappropriate prescribing by Beers and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, potentially prescribing omissions by Screening Tool to Alert doctors to the Right Treatment (START) criteria, drug interactions and anticholinergic burden measured with the Anticholinergic Risk Scale. Mortality, emergency room visits and hospital admissions occurring during 6 months after discharge were also registered. Results The total number of drugs increased at discharge (9.1 vs 10.1, P < 0.001), without increasing chronic medications (8.5 vs 8.3, P = 0.699). No significant variations were observed in the prevalence of polypharmacy (86.5% vs 82.2%), potentially inappropriate prescribing (68.5% vs 71.5%), potential prescribing omissions (58% vs 58%) or drug interactions (82.5% vs 83.5%). Patients with anticholinergic drugs tended to increase, not reaching statistical significance (39.5% vs 44.5%; P = 0.064). Polypharmacy was associated with emergency room visits (OR 2.62, 95% CI 1.07–6.40; P = 0.034), and hyperpolypharmacy with hospitalizations (OR 2.49, 95% CI 1.25–4.93; P = 0.009). Conclusions After hospitalization in an acute geriatric unit, the prevalence of polypharmacy, potentially inappropriate prescribing, potential prescribing omissions, interactions or anticholinergic drugs is still very high. Polypharmacy is a risk factor for hospitalization and emergency room visits. Measuring indicators of quality of prescription might be useful to design interventions to optimize pharmacotherapy and improve health outcomes in elderly acute patients. Geriatr Gerontol Int 2017; ••: ••–••.

  April 19, 2017   doi: 10.1111/ggi.13073   open full text
• Clinical frailty is independently associated with non‐prescription of anticoagulants in older patients with atrial fibrillation.
  Isuru Induruwa, Nicholas R. Evans, Ayesha Aziz, Snigdha Reddy, Kayvan Khadjooi, Roman Romero‐Ortuno.
  Geriatrics and Gerontology International. April 18, 2017
  Aim Anticoagulants are underused in older patients with atrial fibrillation (AF). Scoring systems, such as CHA2DS2‐VASc and HAS‐BLED, are recommended to guide clinicians in anticoagulation decisions, but patients’ frailty might be an underrecognized factor. We investigated the association between the Clinical Frailty Scale (CFS) and community anticoagulant prescribing habits in patients aged ≥75 years with AF admitted acutely to hospital. Methods Data were gathered retrospectively over 3 months on individuals admitted under a medical team to a tertiary teaching hospital in the UK. Demographics, AF history, CHA2DS2−VASc, HAS‐BLED and CFS were collected. Bivariable analysis compared anticoagulated and non‐anticoagulated groups. Each component of the CHA2DS2‐VASc and HAS‐BLED scores, as well as frailty, age and sex, were entered in a multivariable analysis. Results A total of 419 patients with known AF were included. Of these, 215 were not anticoagulated (51.3%) on admission. Non‐anticoagulated individuals were older (median age 87 years, [interquartile range (IQR) 7] vs 83 years [IQR 6], P < 0.001), more likely to be frail (81.4% vs 52.5%, P < 0.001) and had lower CHA2DS2‐VASc scores (median 4, [IQR 2] vs 5 [IQR 2], P = 0.01). In the multivariable analysis, frailty had the strongest effect against anticoagulant prescription (OR 0.77, 95% CI 0.70–0.85, P < 0.001) compared with other significant risk factors, such as age (OR 0.98, 95% CI 0.97–0.98, P < 0.001) and bleeding risk (OR 0.85, 95% CI 0.74–0.97, P = 0.02). Conclusions Frailty is associated with non‐prescription of anticoagulants, independently of CHA2DS2‐VASc and HAS‐BLED. It could be an important unmeasured factor in anticoagulation decisions. The utility of explicit frailty measurements in anticoagulation decisions and patient outcomes requires further research. Geriatr Gerontol Int 2017; ••: ••–••.

  April 18, 2017   doi: 10.1111/ggi.13058   open full text
• Physical activities impact sense of coherence among community‐dwelling older adults.
  Takafumi Monma, Fumi Takeda, Tomohiro Okura.
  Geriatrics and Gerontology International. April 18, 2017
  Aim The objective of the present study was to investigate bidirectional longitudinal relationships between sense of coherence (SOC) and physical activities (PA) among community‐dwelling older adults. Methods Self‐administered questionnaires were sent to 508 community‐dwelling adults aged 65–85 years who expressed their intention to participate in our surveys including cognitive function tests and physical performance tests. Of these, 427 people responded to the baseline survey, and 223 of them participated in the follow‐up survey 1 year later. Finally, the number of eligible respondents who had no missing values in all data was 179 (valid response rate: 35.2%). We used the 13‐item five‐point version of the Sense of Coherence Scale to assess SOC variables, and the Physical Activity Scale for the Elderly to assess PA variables. A structural equation modeling method was used to analyze bidirectional longitudinal relationships between SOC and PA. Cross‐lagged effects and synchronous effects models were applied to analyze these relationships. Demographic variables (age, sex, education, living arrangements, medical histories, employment status), cognitive function and physical performance were used as control variables. Results Leisure‐time PA had a cross‐lagged effect (β = 0.117, P < 0.05) and a synchronous effect (β = 0.217, P < 0.001) on SOC. In contrast, no significant effect of SOC on any type of PA was observed in either the cross‐lagged effects model or the synchronous effects model. Conclusions Leisure‐time PA might contribute to enhancing SOC in community‐dwelling older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  April 18, 2017   doi: 10.1111/ggi.13063   open full text
• Identifying frailty in primary care: A systematic review.
  Linda Lee, Tejal Patel, Loretta M. Hillier, Niraj Maulkhan, Karen Slonim, Andrew Costa.
  Geriatrics and Gerontology International. April 12, 2017
  Aim Identification of frailty in the primary care setting could be improved with the availability of easily identifiable markers of frailty. The purpose of this article was to systematically review markers for frailty or risk tools that have been validated in the ambulatory care setting. Methods Medline, PubMed, CIHAHL and Embase databases were searched up to March 2016 for studies on frailty markers in community‐dwelling individuals 65 years or older. Studies were included for review if they were carried out in primary care or outpatient settings, used a validated definition of frailty, compared two or more markers, and used randomized controlled trial, quasi‐experimental or prospective cohort designs. Results Of the 3405 titles screened, 12 were retained for review. All of the studies were prospective cohort designs. Studies most frequently assessed biological markers, such as immune, inflammation, endocrine biomarkers and metabolic syndrome markers. Not one specific marker was repeatedly identified as a definitive marker for frailty. Conclusions There is a lack of psychometrically sound and clinically useful frailty markers. There is a need for further research to identify highly sensitive, specific and accurate markers that are feasible to use in the context of busy primary care practice. Geriatr Gerontol Int 2017; ••: ••–••.

  April 12, 2017   doi: 10.1111/ggi.12955   open full text
• Prevalence and risk factors of depression in the empty nest elderly from the Sichuan Longmenshan fault earthquake.
  Jiuping Xu, Yang Sun, Ziqi Wang.
  Geriatrics and Gerontology International. April 12, 2017
  Aim There have been few recent studies that have systematically investigated the risk factors for psychological illnesses caused by earthquakes in the empty nest elderly. The aim of this study was to determine the prevalence and risk factors for depression in this special group in the hardest hit areas of the 2008 Sichuan Longmenshan fault Earthquake. Methods A cross‐sectional study was conducted in 10 severely damaged counties from Oct 2015 to Jan 2016 on 1,783 empty nesters, all of whom completed the Geriatric Depression Scale and the Social Support Rating Scale. Socio‐demographic information was also collected in a cross‐sectional survey. Results It was found that 83.1 % of empty nesters had depression overall, with 94.5 % in females, 95.8 % in the single elderly (widowed or divorced) and 97.7 % in those who had suffered bereavement because of the earthquake. The logistic regression analysis showed that being female, of single status, having poor subjective support, poor support availability and suffering from bereavement were the main risk factors for depression. Conclusions Of the earthquake affected empty nest elderly, depression was highest in females and the bereaved. Further poor subjective support was found to be strong indicator of depression in this special group. To minimize depression in the vulnerable elderly, measures should be taken to assist empty nesters in the earthquake‐stricken areas make full use of social support. Geriatr Gerontol Int 2017; ••: ••–••.

  April 12, 2017   doi: 10.1111/ggi.13050   open full text
• Efficacy of rhythmic exercise and walking exercise in older adults' exercise participation rates and physical function outcomes.
  Yang Sun Park, Kyung Koh, Ji Seung Yang, Jae Kun Shim.
  Geriatrics and Gerontology International. April 12, 2017
  Aim The purpose of the present study was to evaluate the efficacy of two different exercise types, rhythmic exercise designed from local music and dance (RE) and walking exercise (WE), in terms of exercise participation and physical function changes in older adults over a period of 12 weeks. Methods Exercise participation was assessed through the attendance rate and retention rate, and physical function was evaluated through the Short Physical Performance Battery, static balance test and gait test. Results The RE group showed significantly higher attendance and retention rates; greater improvement in Short Physical Performance Battery scores; and greater improvement in static balance, as compared with the WE. No differences were found between the RE and WE groups in gait parameters. Conclusions The results suggest that RE was more effective than WE in retaining exercise participation and improving physical function in older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  April 12, 2017   doi: 10.1111/ggi.13046   open full text
• Effects of regular water‐ and land‐based exercise on physical function after 5 years: A long‐term study on the well‐being of older Japanese adults.
  Tomoya Tsujimoto, Tatsunori Ikemoto, Makoto Kurisuno, Machiko Akao, Hirofumi Miyagawa, Msayuki Inoue, Young‐Chang P. Arai, Takahiro Ushida, Masataka Deie.
  Geriatrics and Gerontology International. April 12, 2017
  Aim To investigate the effects of 5 years of physical exercise on functional parameters among older Japanese adults who carried out water‐ or land‐based exercise. Methods We retrospectively investigated data from 5707 medical examinations and enrolled 77 older adults into the study. Eligible participants had to be aged ≥60 years, and engaged in water‐based exercise (n = 38) or a combination of water‐ and land‐based exercise (n = 39) for at least 80% of their total exercise time for over 5 years at our fitness center. In statistical analysis, a two‐way repeated‐measures analysis of variance was carried out to examine the effects over time and by exercise type, and the changes in each parameter over 5 years were also compared between the two groups. Results We found significant main effects and an interaction between time and exercise type for gait speed, with an early decline in the combined exercise group, as well as significant main effects of time, showing a functional decline in grip strength, one‐leg standing time and step/height ratio in both exercise types at the 5‐year follow up. The 5‐year changes in each parameter did not differ between the two groups despite the frequency of exercise, even though we found a negative correlation between changes in one‐leg standing time and total amount of water‐based exercise. Conclusion Contrary to expectations, these results suggest that regular engagement in water‐based exercise, even combined with land‐based exercise, might have poor long‐term benefits for maintaining physical performance in older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  April 12, 2017   doi: 10.1111/ggi.13045   open full text
• Foreign bodies in the external auditory canal: Influence of age on incidence and outcomes in a Japanese population.
  Yoshio Nakao, Tohru Tanigawa, Kenta Murotani, Jun‐ichi Yamashita.
  Geriatrics and Gerontology International. April 12, 2017
  Aim Otolaryngologists occasionally observe foreign bodies (FB) in the external auditory canal (EAC), although relatively few studies have focused on the role of age in this condition. Methods We retrospectively compared the incidences, outcomes and complications of FB in the EAC in different age groups. Results The patients at our center included 24 children (19%), 46 adults (37%) and 56 older adults (44%). Compared with adults, older adults were significantly more likely to have FB (peak age 75–79 years), be women (18/46 vs 34/56, P = 0.0461) and be unaware of their FB (18/46 vs 34/56, P = 0.0461). We observed that all EAC FB were more common during the summer, and biotic FB were not observed during the winter. Complications were more common in cases of biotic FB, compared with abiotic FB (5/27 vs 6/99, P = 0.0421). Conclusion Our findings show that older adults are particularly susceptible to FB, are frequently unaware of their FB and can develop complications. These characteristics should be considered before treating FB in the EAC. Geriatr Gerontol Int 2017; ••: ••–••.

  April 12, 2017   doi: 10.1111/ggi.13048   open full text
• To recognize fall related psychological concern should not lead to neglect other psychomotor consequences of falls.
  Frédéric Bloch.
  Geriatrics and Gerontology International. April 12, 2017
  There is no abstract available for this paper.

  April 12, 2017   doi: 10.1111/ggi.12926   open full text
• Frailty, functional decline and mortality in hospitalized older adults.
  Juan J. Baztán, María De la Puente, Alberto Socorro.
  Geriatrics and Gerontology International. April 12, 2017
  There is no abstract available for this paper.

  April 12, 2017   doi: 10.1111/ggi.12925   open full text
• Establishment of a new medical school in the Tohoku region after the Great East Japan Earthquake.
  Katsutoshi Furukawa, Takahiro Ohara, Isabelle Miyazawa, Kazuhiro Sumitomo, Hideaki Hitomi.
  Geriatrics and Gerontology International. April 12, 2017
  There is no abstract available for this paper.

  April 12, 2017   doi: 10.1111/ggi.12905   open full text
• Effects of a multifactorial intervention comprising resistance exercise, nutritional and psychosocial programs on frailty and functional health in community‐dwelling older adults: A randomized, controlled, cross‐over trial.
  Satoshi Seino, Mariko Nishi, Hiroshi Murayama, Miki Narita, Yuri Yokoyama, Yu Nofuji, Yu Taniguchi, Hidenori Amano, Akihiko Kitamura, Shoji Shinkai.
  Geriatrics and Gerontology International. April 10, 2017
  Aim To examine the effects of a multifactorial intervention on frailty and functional health among community‐dwelling older adults, a 6‐month randomized, controlled, cross‐over trial was carried out within the Hatoyama Cohort Study. Methods A total of 77 pre‐frail or frail older adults (mean age 74.6 years) were randomly allocated to an immediate intervention group (IIG; n = 38) or delayed intervention group (DIG; n = 39). The IIG participated in a twice‐weekly multifactorial intervention comprising resistance exercise, nutritional education and psychosocial programs. No intervention was given to the DIG during the initial 3‐month period, and both groups were crossed over for the latter 3‐month period. Pre‐frailty and frailty were determined by using the Check‐List 15, which was validated against Fried's frailty criteria. Effects of the intervention on primary (Check‐List 15 score and frailty status) and secondary outcomes (physical and psychosocial functions, and nutritional intake) were examined for both 3‐month periods. Results As compared with the DIG, the IIG had significant reductions in Check‐List 15 score (−0.36 points; 95% CI −0.74 to −0.03), frailty prevalence (−23.5%, 95% CI −40.4 to −6.7), Timed Up and Go test (−0.25 s, 95% CI −0.47 to −0.08), and Geriatric Depression Score (−0.92 points, 95% CI −1.44 to −0.39), and improvements in the Dietary Variety Score (0.65 points, 95% CI 0.05–1.25), and protein (1.9% E, 95% CI 1.1–2.7) and micronutrient intakes at 3 months, all of which, excluding protein and micronutrient intakes, persisted at 6 months. The DIG showed similar intervention effects in the latter 3‐month period. Conclusions This 3‐month multifactorial intervention reduced frailty and improved functional health. These intervention effects persisted for at least 3 months post‐intervention. Geriatr Gerontol Int 2017; ••: ••–••.

  April 10, 2017   doi: 10.1111/ggi.13016   open full text
• Similarities and differences between older and young adult patients with celiac disease.
  Çağdaş Kalkan, Fatih Karakaya, Irfan Soykan.
  Geriatrics and Gerontology International. April 10, 2017
  Aim Celiac disease is an autoimmune enteropathy with variable clinical symptoms. Elderly patients can have different manifestations from those of young patients. The aims of the present study were to investigate whether any differences or similarities exist between older and young patients with celiac disease with a special emphasis on concurrent autoimmune diseases. Methods Celiac disease patients were stratified as older and younger patients. These two groups were then compared by means of clinical symptoms, laboratory parameters and concurrent autoimmune diseases. Factors associated with the presence of an autoimmune disease were identified by univariate and multivariate analysis. Results There were 66 older patients (mean age 67.7 ± 3.2 years, 50 women), and 277 younger patients (mean age 35.9 ± 11.7 years, 207 women). Of the 66 older patients, eight patients had gastrointestinal symptoms and 58 patients had extradigestive symptoms. In the younger group, the number of patients referred due to gastrointestinal symptoms was higher (8 [12.2%] vs 200 (72.2%), P < 0.001) compared with the older group. Whereas 10 (15.1%) older patients showed polyautoimmunity, 55 (19.8%) younger patients had polyautoimmunity. Multiple autoimmune syndrome was more common in older patients compared with young patients (31 [47%] vs 12 [4%], P < 0.001, respectively). Conclusions The presentation of celiac disease clinically, histologically and by means of laboratory parameters is different in older and young patients. Polyautoimmunity and multiple autoimmune syndrome are more common in older patients compared with younger patients. A biopsy score of Marsh score type, antinuclear antibody positivity, high serum anti‐tissue transglutaminase immunoglobulin A level and low hemoglobin level were risk factors for having an autoimmune disease. Geriatr Gerontol Int 2017; ••: ••–••.

  April 10, 2017   doi: 10.1111/ggi.13020   open full text
• Circulating irisin levels as a predictive biomarker for sarcopenia: A cross‐sectional community‐based study.
  Jae Seung Chang, Tae Ho Kim, Tuyet Thi Nguyen, Kyu‐Sang Park, Nahyun Kim, In Deok Kong.
  Geriatrics and Gerontology International. April 10, 2017
  Aim Myokines are peptides released by the skeletal muscle, and have gained popularity as potential biomarkers for sarcopenia. Irisin is a recently identified myokine, but its role in pathological sarcopenia remains unclear. We investigated the validity and accuracy of circulating irisin levels as a potential biomarker for sarcopenia. Methods We evaluated the anthropometrics, body composition, sarcopenia‐related parameters and serum irisin levels of 715 community‐dwelling Koreans. Sarcopenia was determined on the basis of the clinical diagnostic criteria of muscle atrophy and weakness, which were proposed by the Asian Working Group for Sarcopenia. Results Circulating irisin levels were correlated with appendicular lean mass/height2 (rmen = 0.275; rwomen = 0.321) and handgrip strength (rmen = 0.219; rwomen = 0.312) in both sexes (all P < 0.01). Furthermore, the mean circulating irisin levels were lower in the sarcopenia group than in the normal group (all P < 0.05). In the logistic regression models, the association between serum irisin concentration and incident sarcopenia persisted even after adjusting for potential confounders, such as sex, age and fat indices (odds ratio 0.20, 95% CI 0.07–0.60; P for trend <0.01). The predictive values of serum irisin for sarcopenia were <1.0 μg/mL in men and <1.16 μg/mL in women, with the area under the receiver operating characteristic curves of 0.87 (95% CI 0.77–0.99) and 0.68 (95% CI 0.55–0.81), respectively (all P < 0.01). Conclusions A low level of circulating irisin is a sensitive marker for muscle weakness and atrophy. Irisin is a potential biomarker for muscle dysfunction that could help predict the onset of sarcopenia and provide new avenues for monitoring age‐related muscle changes. Geriatr Gerontol Int 2017; ••: ••–••.

  April 10, 2017   doi: 10.1111/ggi.13030   open full text
• Clinical medication review tool for polypharmacy: Mapping approach for pharmacotherapeutic classifications.
  Fumihiro Mizokami, Tomohiro Mizuno, Tomoyo Mori, Tadashi Nagamatsu, Hideharu Endo, Tomoyuki Hirashita, Takanobu Ichino, Masahiro Akishita, Katsunori Furuta.
  Geriatrics and Gerontology International. March 30, 2017
  Aim Polypharmacy is an extremely important problem, because it increases the risk of adverse drug reactions. The aim of the current study was to create a clinical medication review tool to detect inappropriate medication use, and assess this new method with elderly Japanese patients. Methods The new method involves optimizing prescription drugs from indications, based on the chronic disease‐anatomical therapeutic class code list. The present study investigated the prevalence of potentially inappropriate medications in 5667 Japanese patients aged ≥65 years with polypharmacy (≥5 drugs) in comparison with the Beers criteria 2012. Results We propose a new method called the Mapping Approach for Pharmacotherapeutic Classifications: (i) identify the chronic disease‐anatomical therapeutic class code assigned to the prescription drugs; (ii) identify the chronic disease‐anatomical therapeutic class code corresponding to the patient's chronic disease; (iii) compare the prescription drug and patient's chronic disease chronic disease‐anatomical therapeutic class codes; and (iv) identify the appropriateness of medication use based on the comparison (appropriate use is defined as matching codes). The mean number of potentially inappropriate medications detected was significantly different between the mapping approach and Beers criteria 2012 (3.1 ± 2.6 vs 0.6 ± 0.8 drugs, respectively; P < 0.001). Conclusions The Mapping Approach for Pharmacotherapeutic Classifications is highly dependent on the chronic condition. Pharmacists should confirm the chronic condition with the treating physician before reducing a patient's medications. We hope this process will further influence prescribing patterns, and decrease the inappropriate use of medications and associated adverse drug reactions in older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  March 30, 2017   doi: 10.1111/ggi.13014   open full text
• Outcomes of laparoscopic sleeve gastrectomy in elderly obese Japanese patients.
  Aiko Hayashi, Yukari Maeda, Minoru Takemoto, Hirotake Tokuyama, Hisashi Koide, Aya Kitahara, Hideki Hayashi, Takumi Kitamoto, Masaya Yamaga, Kazuki Kobayashi, Koutaro Yokote.
  Geriatrics and Gerontology International. March 30, 2017
  Aim Laparoscopic sleeve gastrectomy (LSG) has proven to be the most effective strategy for the treatment of morbid obesity, however its efficacy and safety in an aging population has not yet been confirmed. In this study, we evaluated the effectiveness and safety of LSG in elderly obese Japanese patients. Methods Three obese individuals aged >60 years and 11 obese individuals aged <60 years who underwent LSG were enrolled. Pre‐ and postoperative changes after at least 12 months were examined, including bodyweight, body mass index, total weight loss, excess weight loss, bone mineral density and bone‐related markers. Results There were no significant differences between patients aged <60 years and >60 years in terms of percent total weight loss (24.4 ± 11 vs 23 ± 4.4%, respectively) and percent excess weight loss (49.1 ± 23.4 vs 47.6 ± 10 %, respectively). Dual‐energy X‐ray absorptiometry was carried out before and 12 months after LSG. There were no significant differences in bone mineral density changes at the lumbar spine and femoral neck between the two groups (0.01 ± 0.06 vs 0.02 ± 0.03 g/cm2, −0.03 ± 0.06 vs −0.08 ± 0.02 g/cm2, respectively). There were no peri‐ and postoperative complications. All three patients aged >60 years had reduced bone mineral density in the femoral neck after LSG; one was diagnosed with osteoporosis. Conclusions Although the present results suggest that LSG could be of considerable benefit to elderly obese Japanese patients, long‐term careful observation after bariatric surgery is especially important in elderly patients to prevent future osteoporosis. Geriatr Gerontol Int 2017; ••: ••–••.

  March 30, 2017   doi: 10.1111/ggi.13022   open full text
• Korean version of the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight questionnaire versus the Modified Kihon Checklist for Frailty Screening in Community‐Dwelling Older Adults: The Aging Study of PyeongChang Rural Area.
  Il‐Young Jang, Hee‐Won Jung, Chang Ki Lee, Kwang Ho Jang, Eun‐Il Cho, Ju Jin Jung, Euna Park, Juyoung Kim, Young Soo Lee, Eunju Lee, Dae Hyun Kim.
  Geriatrics and Gerontology International. March 30, 2017
  Aim To compare the five‐item Korean version of the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (K‐FRAIL) questionnaire versus the 28‐item Kihon + 3 index (the 25‐item original Kihon checklist plus multimorbidity, sensory impairment, and Timed Up and Go test) in identifying prefrail or frail older adults. Methods We carried out a cross‐sectional analysis of 212 community‐dwelling older adults (mean age 76 years; 41% male) in PyeongChang County, Korea. We compared the C statistic, sensitivity and specificity of the K‐FRAIL questionnaire (range 0–5; cut‐point ≥1) versus the Kihon + 3 index (range 0–31; cut‐point ≥4) and the original Kihon checklist (range 0–25; cut‐point ≥4) in identifying prefrail or frail individuals according to the Cardiovascular Health Study criteria. Results According to the Cardiovascular Health Study criteria, 150 individuals (70.8%) were prefrail or frail. The C statistic of the K‐FRAIL questionnaire in identifying prefrail or frail individuals was lower than that of the Kihon + 3 index (0.77 vs 0.85; P = 0.022) or that of the original Kihon checklist (0.77 vs 0.84; P = 0.046). However, at the a priori cut‐points, the K‐FRAIL questionnaire had sensitivity (0.79 vs 0.85; P = 0.095) and specificity (0.69 vs 0.69; P = 1.000) that were not significantly different from those of the Kihon + 3 index. However, the K‐FRAIL questionnaire was more sensitive (0.79 vs 0.69; P = 0.016), but less specific (0.69 vs 0.86, p = 0.018) than the original Kihon checklist. Conclusions For frailty screening in community‐dwelling older adults, the simple K‐FRAIL questionnaire might not be inferior to the current standard of the Kihon + 3 index, and it might be more sensitive and less specific than the original Kihon checklist. Geriatr Gerontol Int 2017; ••: ••–••.

  March 30, 2017   doi: 10.1111/ggi.13017   open full text
• Metabolic mediators of the impact of general and central adiposity measures on cardiovascular disease and mortality risks in older adults: Tehran Lipid and Glucose Study.
  Sara Kazempour‐Ardebili, Azra Ramezankhani, Ali Eslami, Samaneh Akbarpour, Fereidoun Azizi, Farzad Hadaegh.
  Geriatrics and Gerontology International. March 28, 2017
  Aims To investigate the relationship between body mass index, waist circumference, waist‐to‐hip ratio and waist‐to‐height ratio, as well as the mediating factors through which they might exert their risk for cardiovascular disease/coronary heart disease and mortality events in the older Iranian population during a median follow up of 9.5 years. Methods The study population included participants, aged ≥65 years, free of cardiovascular disease at baseline. The confounder‐adjusted hazard ratio was calculated for a 1‐SD change in each anthropometric measure with and without adjustment for hypercholesterolemia, diabetes and hypertension. Results During the study follow up, 193 participants developed their first cardiovascular disease event and 183 deaths occurred. No association was found between cardiovascular disease/coronary heart disease and body mass index, even in the confounder‐adjusted models. Central adiposity measures showed a significant risk for cardiovascular disease events in the confounder‐adjusted model ranging from hazard ratio 1.16 (95% confidence interval 1.02–1.33) for waist‐to‐hip ratio to 1.21 (95% confidence interval 1.03–1.42) for waist‐to‐height ratio. Adjustment for hypertension alone or in combination with other metabolic mediators attenuated the hazard ratio to null. Although hypercholesterolemia did not show any mediating effect of central adiposity measures for cardiovascular disease/coronary heart disease, hypertension was the most powerful mediator, accounting for 30–45% of the excess risk. Conclusions Central rather than general adiposity showed a significant role in determining cardiovascular disease/coronary heart disease risk. The harmful effect of central adiposity was completely attributable to mediators, especially hypertension. Clinical interventions for control of mediators focusing on hypertension should be emphasized. Geriatr Gerontol Int 2017; ••: ••–••.

  March 28, 2017   doi: 10.1111/ggi.13015   open full text
• Risk assessment and falls prevention in the older adult: Asian experience with the Falls Risk for Older People in the Community tool.
  Si Min Lee, Germaine Loo, Welras Long, Jing Zhan Lock, Ser Yee Soh, Santhosh Kumar Seetharaman, Reshma Aziz Merchant.
  Geriatrics and Gerontology International. March 27, 2017
  There is no abstract available for this paper.

  March 27, 2017   doi: 10.1111/ggi.12889   open full text
• Spanish translation of the Kihon Checklist (frailty index).
  Ana Maseda, Laura Lorenzo‐López, Rocío López‐López, Hidenori Arai, José C. Millán‐Calenti.
  Geriatrics and Gerontology International. March 27, 2017
  There is no abstract available for this paper.

  March 27, 2017   doi: 10.1111/ggi.12892   open full text
• Association of blood pressure and cognitive decline in older adults with diabetes mellitus during a 9‐year observational study.
  Hiroyuki Umegaki, Takahiko Kawamura, Toshitaka Umemura, Naoko Kawano.
  Geriatrics and Gerontology International. March 27, 2017
  There is no abstract available for this paper.

  March 27, 2017   doi: 10.1111/ggi.12886   open full text
• Sleep apnea and lateral balance instability in older adults.
  Masashi Kanezaki, Teruhiro Ogawa.
  Geriatrics and Gerontology International. March 27, 2017
  There is no abstract available for this paper.

  March 27, 2017   doi: 10.1111/ggi.12885   open full text
• Cross‐sectional study of equol producer status and cognitive impairment in older adults.
  Michiya Igase, Keiji Igase, Yasuharu Tabara, Yasumasa Ohyagi, Katsuhiko Kohara.
  Geriatrics and Gerontology International. March 27, 2017
  Aim It is well known that consumption of isoflavones reduces the risk of cardiovascular disease. However, the effectiveness of isoflavones in preventing dementia is controversial. A number of intervention studies have produced conflicting results. One possible reason is that the ability to produce equol, a metabolite of a soy isoflavone, differs greatly in individuals. In addition to existing data, we sought to confirm whether an apparent beneficial effect in cognitive function is observed after soy consumption in equol producers compared with non‐producers. Methods The present study was a cross‐sectional, observational study of 152 (male/female = 61/91, mean age 69.2 ± 9.2 years) individuals. Participants were divided into two groups according to equol production status, which was determined using urine samples collected after a soy challenge test. Cognitive function was assessed using two computer‐based questionnaires (touch panel‐type dementia assessment scale [TDAS] and mild cognitive impairment [MCI] screen). Results Overall, 60 (40%) of 152 participants were equol producers. Both TDAS and prevalence of MCI were significantly higher in the equol producer group than in the non‐producer group. In univariate analyses, TDAS significantly correlated with age, serum creatinine, estimated glomerular filtration rate and low‐density lipoprotein cholesterol. In multiple regression analysis using TDAS as a dependent variable, equol producer (β = 0.236, P = 0.005) was selected as an independent variable. In addition, multiple logistic regression analysis to assess the presence of MCI showed that being an equol producer was an independent risk factor for MCI (odds ratio 3.961). Conclusions Compared with equol non‐producers, equol producers showed an apparent beneficial effect in cognitive function after soy intake. Geriatr Gerontol Int 2017; ••: ••–••.

  March 27, 2017   doi: 10.1111/ggi.13029   open full text
• Major electrocardiographic abnormality predicts support/care‐need certification and/or death in community‐dwelling older adults with no history of cardiovascular disease.
  Tazuo Okuno, Keisuke Watanabe, Kumie Nakajima, Osamu Iritani, Hiroshi Yano, Takuro Morita, Taroh Himeno, Yuta Igarashi, Masashi Okuro, Shigeto Morimoto.
  Geriatrics and Gerontology International. March 27, 2017
  Aim Not only cardiovascular disease (CVD) itself, but also subclinical major electrocardiographic (ECG) abnormalities are related to frailty in older adults. We investigated whether major ECG abnormality was associated with first support/care‐need certification in Long‐Term Care Insurance or death in community‐dwelling older adults. Methods We analyzed 1078 community‐dwelling older adults with no history of certification aged 65–94 years. Relationships between baseline major ECG abnormality and risk of first certification or death were estimated using the Cox proportional hazards model. Results During 5 years, 135 first certifications and 53 deaths occurred. Among participants with no prior history of CVD (n = 875), those with major ECG abnormality (n = 282) showed significantly higher adjusted hazard ratios (HR) for certification (HR 2.42, 95% CI 1.58–3.69, P < 0.001) and for death (HR 2.44, 95% CI 1.27–4.69, P = 0.008) compared with control participants without major ECG abnormality (n = 593). The impact of major ECG abnormality on certification in this group was more evident in older adults with age ≥75 years, female sex or hyperuricemia. Participants with either arrhythmia or ST/T abnormality on ECG examination tended to have higher HR for certification as a result of dementia. In participants with a prior history of CVD (n = 203), the impact of major ECG abnormality (n = 126) on certification was not significant. Conclusions These observations show that subclinical major ECG abnormality predicts higher risk for later support/care‐need certification in community‐dwelling older adults with no prior history of CVD. Geriatr Gerontol Int 2017; ••: ••–••.

  March 27, 2017   doi: 10.1111/ggi.13002   open full text
• Relationships among sense of coherence, oral health status, nutritional status and care need level of older adults according to path analysis.
  Nanae Dewake, Tomoko Hamasaki, Rie Sakai, Shima Yamada, Yuko Nima, Miki Tomoe, Satoko Kakuta, Masanori Iwasaki, Inho Soh, Yoshihiro Shimazaki, Toshihiro Ansai.
  Geriatrics and Gerontology International. March 27, 2017
  Aim Sense of coherence (SOC) is a measurement of ability of an individual to cope with psychological stress and remain in good health. The aim of the present study was to examine the relationships among SOC score, oral health status, nutritional status and care need level of older adults using path analysis. Methods We enrolled 53 older adults (17 men and 36 women) who were attending a day care service (mean age 80.4 ± 6.5 years). SOC was assessed using a 13‐item, seven‐scale instrument. Oral health status (number of present teeth, denture use) and nutritional status (assessed with Mini‐Nutritional Assessment Short‐Form) were also evaluated. Path analysis was used to examine the relationship of SOC with other related factors, including care need level. Results The mean SOC score was 57.0 ± 13.9. Mini‐Nutritional Assessment Short‐Form results showed that one participant (1.8%) was malnourished, 26 (49.1%) were at risk of malnutrition and 26 (49.1%) had normal nutritional status. Participants with high SOC scores showed a strong positive attitude, had a relatively large number of teeth, were in good nutritional condition and showed low care need levels. Conclusions The present results showed that maintaining a high SOC level and good oral health help to reduce care need levels in older adults, and also prevent a worsening of their nutritional condition. Geriatr Gerontol Int 2017; ••:••–••.

  March 27, 2017   doi: 10.1111/ggi.13025   open full text
• Mini‐Mental State Examination score trajectories and incident disabling dementia among community‐dwelling older Japanese adults.
  Yu Taniguchi, Akihiko Kitamura, Hiroshi Murayama, Hidenori Amano, Tomohiro Shinozaki, Isao Yokota, Satoshi Seino, Yu Nofuji, Mariko Nishi, Yuri Yokoyama, Yutaka Matsuyama, Yoshinori Fujiwara, Shoji Shinkai.
  Geriatrics and Gerontology International. March 14, 2017
  Aim The present prospective study used repeated measures analysis to identify potential Mini‐Mental State Examination (MMSE) score trajectories and determine whether MMSE trajectory was associated with incident disabling dementia among community‐dwelling older Japanese adults. Methods A total of 1724 non‐demented adults (mean age 71.4 years [SD 5.7]; 56.7% women) aged 65–90 years participated in annual geriatric health assessments during the period from June 2002 through July 2014. The total number of observations was 6755, and the average number of follow‐up assessments was 3.9. A review of municipal databases in the Japanese public long‐term care insurance system showed that 205 (11.9%) participants developed disabling dementia through December 2014. Results We identified three distinct MMSE score trajectory patterns (high, middle and low) in adults aged 65–90 years. After adjusting for important confounders, participants with middle (42.8%) and low (5.1%) MMSE trajectories had hazard ratios of 2.46 (95% confidence interval 1.64–3.68) and 10.73 (95% confidence interval 4.91–23.45), respectively, for incident disabling dementia, as compared with those in the high (52.1%) trajectory group. Conclusions Approximately half of the participants were classified as having a high MMSE trajectory, whereas 43% and 5% had middle and low MMSE trajectories, respectively, in this population. Individuals with middle and low MMSE trajectories had a higher risk for incident disabling dementia, which suggests that a high‐risk approach to dementia prevention should target people with mild and more rapid cognitive decline. Geriatr Gerontol Int 2017; ••: ••–••.

  March 14, 2017   doi: 10.1111/ggi.12996   open full text
• Training with a balance exercise assist robot is more effective than conventional training for frail older adults.
  Kenichi Ozaki, Izumi Kondo, Satoshi Hirano, Hitoshi Kagaya, Eiichi Saitoh, Aiko Osawa, Yoichi Fujinori.
  Geriatrics and Gerontology International. March 10, 2017
  Aim To examine the efficacy of postural strategy training using a balance exercise assist robot (BEAR) as compared with conventional balance training for frail older adults. Methods The present study was designed as a cross‐over trial without a washout term. A total of 27 community‐dwelling frail or prefrail elderly residents (7 men, 20 women; age range 65–85 years) were selected from a volunteer sample. Two exercises were prepared for interventions: robotic exercise moving the center of gravity by the balance exercise assist robot system; and conventional balance training combining muscle‐strengthening exercise, postural strategy training and applied motion exercise. Each exercise was carried out twice a week for 6 weeks. Participants were allocated randomly to either the robotic exercise first group or the conventional balance exercise first group. Main outcome measures: preferred and maximal gait speeds, tandem gait speeds, timed up‐and‐go test, functional reach test, functional base of support, center of pressure, and muscle strength of the lower extremities were assessed before and after completion of each exercise program. Results Robotic exercise achieved significant improvements for tandem gait speed (P = 0.012), functional reach test (P = 0.002), timed up‐and‐go test (P = 0.023) and muscle strength of the lower extremities (P = 0.001–0.030) compared with conventional exercise. Conclusions In frail or prefrail older adults, robotic exercise was more effective for improving dynamic balance and lower extremity muscle strength than conventional exercise. These findings suggest that postural strategy training with the balance exercise assist robot is effective to improve the gait instability and muscle weakness often seen in frail older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  March 10, 2017   doi: 10.1111/ggi.13009   open full text
• Effect of caregiving relationship and formal long‐term care service use on caregiver well‐being.
  Kirsten Eom, Michael J. Penkunas, Angelique W.M. Chan.
  Geriatrics and Gerontology International. March 09, 2017
  Aim Despite efforts to revise the traditional long‐term care (LTC) model, informal caregivers continue to provide a substantial amount of support to older adults as front‐line care providers. The present study aimed to understand the effect of informal caregiving on caregivers’ well‐being in Singapore with respect to different types of patient–caregiver relationships. Second, this study examined the association between formal LTC service use and caregivers’ well‐being. Methods Two waves of data for 781 dyads of patients with LTC needs and their caregivers from a longitudinal study were analyzed. Multilevel regression models were used to examine the association between caregivers’ well‐being (self‐rated general health, stress level and quality of life) and LTC service use among different patient–caregiver relationships. Results Spousal caregivers reported significantly lower quality of life compared with adult children caregivers. Non‐immediate family caregivers showed better overall well‐being compared with spouse and adult children caregivers. Caregivers of patients referred to nursing homes reported higher levels of stress and poorer self‐rated general health compared with caregivers of patients referred to community‐based services. Spouse and non‐immediate family caregivers of patients who utilized nursing home or home‐based services presented poorer self‐rated general health than caregivers of the patients who did not use any formal services. Conclusions Developing a better understanding of the associations between well‐being and formal LTC service use for different types of patient–caregiver relationships is critical for policy makers and healthcare providers who aim to create holistic systems of care. Geriatr Gerontol Int 2016; ••: ••–••.

  March 09, 2017   doi: 10.1111/ggi.12958   open full text
• Time‐course of muscle growth, and its relationship with muscle strength in both young and older women.
  Jeremy P. Loenneke, Lindy M. Rossow, Christopher A. Fahs, Robert S. Thiebaud, J. Grant Mouser, Michael G. Bemben.
  Geriatrics and Gerontology International. March 09, 2017
  Aim The time‐course for changes in muscle size and strength is not well understood, particularly in women. In addition, contributions of muscle size to strength are commonly assessed utilizing a pre–post change score; however, a more appropriate within‐subject correlational analysis has never been used. Methods To determine the time‐course for thigh muscle size and strength in young (aged 18–25 years) and older (aged 50–65 years) women, and determine the relationship between size and strength after 8 weeks of training carried our three times per week. Results Anterior muscle thickness at the 50% site increased after 1 week of training, and exceeded the measurement error after 2 weeks (mean difference 0.23 cm, 95% CI 0.12–0.34 cm). Anterior muscle thickness at the 70% site increased and exceeded the measurement error after 2 weeks (mean difference 0.30 cm, 95% CI 0.15–0.45 cm). Posterior muscle thickness at the 50% site increased after 1 week of training, and exceeded the measurement error after 2 weeks (mean difference 0.24 cm, 95% CI 0.03–0.44 cm). Posterior muscle thickness at the 70% site increased after 1 week, and exceeded the measurement error after 3 weeks (mean difference 0.21 cm, 95% CI 0.07–0.35 cm). Muscle strength, assessed through one‐repetition maximum, increased by 2 weeks in most measurements, and the within‐subject variance explained by changes in muscle size ranged between 9% and 35%. Conclusions Muscle growth appeared to occur early into a training program in both young and older women. Furthermore, although a large portion remains unexplained, the variance in muscle strength explained by muscle size is greater than previous studies not utilizing within‐subject correlations. Geriatr Gerontol Int 2017; ••: ••–••.

  March 09, 2017   doi: 10.1111/ggi.13010   open full text
• Different clinical effect of four antidementia drugs for Alzheimer's disease patients depending on white matter severity.
  Yusuke Fukui, Nozomi Hishikawa, Jin Ichinose, Kota Sato, Yumiko Nakano, Ryuta Morihara, Yasuyuki Ohta, Toru Yamashita, Koji Abe.
  Geriatrics and Gerontology International. March 09, 2017
  Aim To examine the clinical effect of four antidementia drugs (donepezil, galantamine, rivastigmine and memantine) in Alzheimer's disease patients who were divided into subgroups based on their periventricular hyperintensity (PVH) severity. Methods A total of 551 Alzheimer's disease patients (201 men and 350 women) were divided into four subgroups based on their PVH severity (0–III). They received monotherapy for 12 months. We compared the clinical effects at the baseline, and at 3, 6 and 12 months after initiation. Results The baseline age became higher with PVH grades, and the Mini‐Mental State Examination and Hasegawa Dementia Scale‐Revised showed a decrease that was dependent on white matter severity. Although the PVH 0 subgroup showed stable cognitive, affective and ADL functions until 12 months in all four drug groups, the PVH I subgroup showed an improved Apathy Scale from the baseline in response to memantine at 3 and 9 months (P < 0.05), and galantamine at 9 months (P < 0.01). In the PVH II subgroup, the Mini‐Mental State Examination showed a significant improvement from the baseline in response to galantamine (P < 0.05) at 9 months and Hasegawa Dementia Scale‐Revised (P < 0.05) at 3 months. In the PVH III subgroup, cognitive and affective functions were preserved in all four drug groups until 12 months, but activities of daily living deteriorated in the riverstigmine group at 6 and 12 months (P < 0.05). Conclusions The present study shows that these four drugs showed sensitivity dependent on white matter severity that clinically affected cognitive, affective and activities of daily living functions. Geriatr Gerontol Int 2017; ••: ••–••.

  March 09, 2017   doi: 10.1111/ggi.13007   open full text
• Hospital admissions by the oldest old: Past trends in one of the most ageing countries in the world.
  Daniela Brandão, Oscar Ribeiro, Alberto Freitas, Constança Paúl.
  Geriatrics and Gerontology International. March 09, 2017
  Aim To examine discharges of octogenarians, nonagenarians and centenarians from Portuguese public hospitals, namely admission type, principal diagnoses, comorbidities and length of stay. Methods The present study used administrative data from public acute care hospitals in the Portuguese National Health Service. All discharges of persons aged ≥80 years between 2000 and 2014 were analyzed. HCUP Clinical Classifications Software was considered to aggregate principal diagnosis, and comorbidities were assessed using the Charlson Comorbidity Index computed using International Classification of Diseases 9th Revision Clinical Modification codes. Results A total of 2 494 924 discharges of persons aged 80 years or older were registered. Most (73.7%) referred to inpatient episodes, of which 73% were unplanned and medical (non‐surgical). Pneumonia (12.2%), acute cerebrovascular disease (7.1%) and non‐hypertensive cardiac heart failure (5.3%) were the most common principal diagnoses among inpatient episodes. Congestive heart failure and diabetes without chronic complications were the two most frequent comorbidities (16.6%), and discharge diagnoses with higher median length of stay were tuberculosis, burns, and infective arthritis and osteomyelitis. Conclusions The number of hospitalizations of the oldest old has suffered a significant increase in the past few years, reinforcing the need for healthcare services being prepared to the specificities of the oldest old population. Geriatr Gerontol Int 2017; ••: ••–••.

  March 09, 2017   doi: 10.1111/ggi.13006   open full text
• Changes in health behaviors and the trajectory of body mass index among older Japanese: A 19‐year longitudinal study.
  Hiroshi Murayama, Jersey Liang, Benjamin A Shaw, Anda Botoseneanu, Erika Kobayashi, Taro Fukaya, Shoji Shinkai.
  Geriatrics and Gerontology International. March 09, 2017
  Aim Although the modification of lifestyle factors might facilitate weight control, the effects of health behaviors on the trajectory of bodyweight among older adults have been understudied. We examined the effect of changes in smoking, alcohol use and physical activity on the long‐term trajectory of body mass index (BMI) among older Japanese adults. Methods Data came from a national sample of 4869 Japanese adults aged 60 years and older at baseline, with up to seven repeated observations over a period of 19 years (1987–2006). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in BMI trajectory. Results The average BMI among older Japanese adults was 22.3 at baseline, and decreased with an accelerating rate over time. Smoking was significantly associated with lower BMI over time, whereas smoking cessation was associated with higher BMI. Drinking and physical activity were not associated with BMI. We found significant interactions between age and smoking status, and between sex and physical activity, on BMI trajectory: the association between smoking and lower BMI was stronger in younger participants compared with older participants. The association between physical activity and higher BMI was more pronounced among men compared with women. Conclusion The present findings yield important new information regarding the complex dynamics underlying the linkage between lifestyles factors and BMI trajectory among older Japanese, and suggest that there might be cross‐cultural differences in these linkages. Geriatr Gerontol Int 2017; ••: ••–••.

  March 09, 2017   doi: 10.1111/ggi.13008   open full text
• Sarcopenia based on the Asian Working Group for Sarcopenia criteria and all‐cause mortality risk in older Japanese adults.
  Atsumu Yuki, Fujiko Ando, Rei Otsuka, Hiroshi Shimokata.
  Geriatrics and Gerontology International. March 05, 2017
  Aim The association between sarcopenia diagnosed according to the criteria of the Asian Working Group for Sarcopenia and increased mortality risk is currently unknown. The present study assessed the longitudinal relationship between sarcopenia and mortality risk in an elderly Japanese population. Methods Participants were 720 community‐dwelling Japanese individuals aged 65–79 years at baseline (November 1997 to April 2000). The participants were followed from baseline to 31 December 2014 (mean duration 11.0 years). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria, using extremity muscle mass assessed by dual‐energy X‐ray absorptiometry, grip strength and gait speed. A population dynamics survey was used to obtain information on deaths. The relationship between sarcopenia and mortality was assessed using Kaplan–Meier survival curves and Cox proportional hazards regression. The Cox proportional hazards model was used to control for potential confounders, including age at baseline, body mass index, total caloric intake, alcohol intake, current smoking habits, leisure‐time physical activity and the number of current diseases. Results The fully adjusted hazard ratio for all‐cause mortality among men in the sarcopenia group was 1.95 (95% confidence interval 1.04–3.67) compared with that in the normal group. No significant association between sarcopenia and all‐cause mortality was observed among women. Conclusion The complications of sarcopenia, including low muscle mass, low grip strength and low gait speed, appear to be significant risks for mortality in older Japanese men. Geriatr Gerontol Int 2016; ••: ••–••.

  March 05, 2017   doi: 10.1111/ggi.12946   open full text
• Relationship between cytokine levels in the cerebrospinal fluid and 11C‐Pittsburgh compound B retention in patients with mild cognitive impairment.
  Yoshitake Abe, Noriyuki Kimura, Ryuichi Takahashi, Megumi Gotou, Ken Mizukami, Hirotatsu Uchida, Etsuro Matsubara.
  Geriatrics and Gerontology International. March 05, 2017
  Aim In the present study, we examined the relationship between cytokine levels in the cerebrospinal fluid (CSF) and 11C‐Pittsburgh compound B (PiB) retention in patients with mild cognitive impairment. Methods A total of 33 participants (12 men and 21 women; mean age 76.5 years) with mild cognitive impairment underwent neuropsychological assessments, PiB positron emission tomography and analysis of cytokine levels in the CSF. The CSF levels of 48 cytokines and growth factors were measured using multiplex immunoassays. PiB retention was assessed based on a standardized uptake value ratio. Mild cognitive impairment participants were classified as PiB‐positive and PiB‐negative, with a cut‐off level of 1.4. We compared the CSF cytokine levels and Alzheimer's disease biomarkers, including β‐amyloid 1–42, total tau and tau phosphorylated at threonine 181, between the two subgroups, and evaluated the correlation between PiB retention or CSF Alzheimer's disease biomarkers and CSF cytokine levels. Results Cytokine levels in the CSF did not differ between the two subgroups. Macrophage inflammatory protein‐1β levels in the CSF significantly correlated with PiB retention only in the PiB‐positive subgroup, whereas stem cell growth factor‐β levels significantly correlated with PiB retention in the PiB‐negative subgroup. Furthermore, stem cell growth factor‐β levels significantly correlated with total tau and tau phosphorylated at threonine 181 levels in only the PiB‐negative subgroup. Conclusion The present findings suggest that macrophage inflammatory protein‐1β and stem cell growth factor‐β are associated with chronic inflammatory processes accompanied by amyloid deposition or AD pathophysiology. Geriatr Gerontol Int 2017; ••: ••–••.

  March 05, 2017   doi: 10.1111/ggi.12991   open full text
• Bibliometric analysis of journals in the field of geriatrics and gerontology.
  Hui Min Ang, Yu Heng Kwan.
  Geriatrics and Gerontology International. February 27, 2017
  There is no abstract available for this paper.

  February 27, 2017   doi: 10.1111/ggi.12880   open full text
• Prevalence of inadequately justified medications transferred during outpatient handoffs of elderly patients.
  Junpei Komagamine, Kazuhiko Hagane.
  Geriatrics and Gerontology International. February 27, 2017
  There is no abstract available for this paper.

  February 27, 2017   doi: 10.1111/ggi.12877   open full text
• Odor eliminator for changing geriatric diapers of bedridden patients.
  Masahiki Fujii, Makoto Satoh, Hidetada Sasaki.
  Geriatrics and Gerontology International. February 27, 2017
  There is no abstract available for this paper.

  February 27, 2017   doi: 10.1111/ggi.12856   open full text
• Assessment of grip strength in older people needs standardization by age and sex.
  Naoto Kamide, Yoshitaka Shiba, Haruhiko Sato.
  Geriatrics and Gerontology International. February 27, 2017
  There is no abstract available for this paper.

  February 27, 2017   doi: 10.1111/ggi.12813   open full text
• Benefits of the Japanese version of the advance care planning facilitators education program.
  Hisayuki Miura, Yoshiyuki Kizawa, Seiji Bito, Shigeru Onozawa, Tetsuo Shimizu, Norio Higuchi, Sanae Takanashi, Naomi Kubokawa, Mitsunori Nishikawa, Atsushi Harada, Kenji Toba.
  Geriatrics and Gerontology International. February 27, 2017
  There is no abstract available for this paper.

  February 27, 2017   doi: 10.1111/ggi.12814   open full text
• Social participation among older adults not engaged in full‐ or part‐time work is associated with more physical activity and less sedentary time.
  Hiroyuki Kikuchi, Shigeru Inoue, Noritoshi Fukushima, Tomoko Takamiya, Yuko Odagiri, Yumiko Ohya, Shiho Amagasa, Koichiro Oka, Neville Owen.
  Geriatrics and Gerontology International. February 23, 2017
  Aim Social participation provides health benefits for older adults. However, there is the need to identify whether higher social participation is associated with older adults being more physically active and less sedentary (sitting time). We examined the associations of social participation with physical activity, and sedentary time, in a population‐based sample of older Japanese adults. Methods A population‐based, cross‐sectional mail survey carried out in 2010 was used to collect data on social participation, physical activity, sedentary time and sociodemographic characteristics. Data were examined from 1146 community‐dwelling, unemployed older adults (mean age 70.1 years, 43% men). Multivariate logistic regression analyses were used to calculate odds ratios (OR) for associations of social participation with physical activity and total sedentary time; and, for associations with passive and mentally‐active sedentary (sitting) time. Results For both men and women, those with higher social participation were more physically active (OR 2.10, 95% CI 1.44–3.06 among men; OR 1.93, 95% CI 1.39–2.68 among women). Total sedentary time had significant associations among men (OR 0.62, 95% CI 0.42–0.90), but not among women (OR 0.80, 95% CI 0.58–1.11). Social participation was associated with less passive sedentary time (OR 0.55, 95% CI 0.38–0.81 for men; OR 0.72, 95% CI 0.51–0.99 for women). Conclusions Promoting social participation among older adults could contribute to increasing physical activity and reducing sedentary time, with potential benefits for chronic disease. Further research is required to elucidate the deleterious and beneficial roles of passive and mentally‐active sedentary time for older adults. Geriatr Gerontol Int 2017; ••: ••–••.

  February 23, 2017   doi: 10.1111/ggi.12995   open full text
• Comparison of four criteria for potentially inappropriate medications in Brazilian community‐dwelling older adults.
  Priscila Horta Novaes, Danielle Teles Cruz, Alessandra Lamas Granero Lucchetti, Isabel Cristina Gonçalves Leite, Giancarlo Lucchetti.
  Geriatrics and Gerontology International. February 22, 2017
  Aim To compare four potentially inappropriate medication (PIM) criteria from different regions of the world in terms of their characteristics, concordance, sensitivity, specificity and predictive values in a community‐dwelling sample. Methods A cross‐sectional, observational, epidemiological study was carried out by a door‐to‐door survey in a Brazilian city. The following PIM criteria were applied: Beers‐2015, Screening Tool of Older People's Potentially Inappropriate Prescriptions (STOPP)‐2015, The European Union (EU)(7)‐PIM list and Taiwan criteria. The associations of criteria with the presence or absence of falls, hospitalizations and cognitive impairment were determined, and their sensitivity, specificity, positive predictive value, negative predictive value and concordance among the criteria were assessed. Results A total of 368 (92%) older adults were in continuous use of at least one drug. A high prevalence of PIM by Beers (50.0 %), STOPP (46.2%), EU(7)‐PIM (59.5%) and Taiwan 31.3%) criteria was found. There was a high concordance among the PIM criteria (66.3–81.8%), and a moderate‐to‐high intraclass correlation between criteria (0.607–0.851). In general, the Taiwan criterion had lower levels of sensitivity (25.7–34.0%) and higher levels of specificity (67.8–70.3%), The EU(7)‐PIM criteria had higher levels of sensitivity (60–75.3%) and lower levels of specificity (41.1–46.9%), whereas the Beers and STOPP had a more balanced sensitivity/specificity ratio (sensitivity: STOPP 50.7–55.3% and Beers 53.0–56.9 %; specificity: STOPP 56–56.6% and Beers 51.6–53.8%). Conclusions The present study found moderate‐to‐high levels of concordance among the four PIM criteria assessed, pointing to a consensus in this field. However, each criterion showed particular characteristics: the EU(7)‐PIM criterion had higher sensitivity, the Taiwan criterion higher specificity, and the Beers and STOPP a more balanced profile. These results highlight that each criterion has its own characteristics, and should be used according to health providers’ objectives. Geriatr Gerontol Int 2017; ••: ••–••.

  February 22, 2017   doi: 10.1111/ggi.12944   open full text
• The clinical relevance of orthostatic hypotension in elderly patients.
  Laura Hartog, Nanne Kleefstra, Rene Luigies, Sophia Rooij, Henk Bilo, Kornelis Hateren.
  Geriatrics and Gerontology International. February 22, 2017
  Aim Orthostatic hypotension (OH) is highly prevalent in old age. The impact of OH on orthostatic complaints and falling is questionable. We wondered if the consensus definition of OH plays an essential role in the accuracy and direction of the prediction of these endpoints. We aimed to explore the relation between different definitions of OH, including relative decrease of blood pressure, and orthostatic complaints and falling. Methods A cross‐sectional study was performed with 1415 participants aged ≥65 years visiting a mobile fall‐prevention team. The CAREFALL Triage Instrument and data on blood pressure, orthostatic complaints and previous fall incidents were collected. Multivariate binary logistic regression analyses were performed to assess the association of different definitions of OH and orthostatic complaints or falling. Ten different definitions of OH based on different relative declines of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were defined. Results The 2011 consensus definition of OH was not related to orthostatic complaints (Odds Ratio (OR) 1.07 (95 % Confidence Interval (CI) 0.68–1.69)) or previous fall incidents (OR 1.08 (95%CI 0.83–1.41)). A ≥ 25 % SBP decrease was significantly related to orthostatic complaints (OR 2.81 (95%CI 1.31–6.05)) and a ≥ 25 % DBP decrease was related to previous fall incidents (OR 2.56 (95%CI 1.08–6.09)). Conclusions With the exception of a decrease of ≥25 % SBP or DBP, the clinical relevance of incidental OH blood pressure measurements seems very limited with respect to orthostatic complaints or fall incidents in elderly patients. Using relative decreases may be more appropriate in clinical practice. Geriatr Gerontol Int 2016; ••: ••–••.

  February 22, 2017   doi: 10.1111/ggi.12983   open full text
• Renal function affects hippocampal volume and cognition: The role of vascular burden and amyloid deposition.
  Hoyoung An, Booyeol Choi, Sang Joon Son, Eun Young Cho, Seon‐Ok Kim, Sooyun Cho, Duk‐Hee Kang, Chul Lee, Seong Yoon Kim,.
  Geriatrics and Gerontology International. February 22, 2017
  Aim We determined if differences in renal function, even within normal levels, influenced hippocampal volume (HCV) and cognition. Methods Cognitively normal (CN) and mild cognitive impairment (MCI) subjects with eGFR ≥ 60 ml/min/1.73m2 were selected from the ADNI database (N = 1,269) and divided into three groups (eGFR 60–75, 75–90 and ≥90). Associations between eGFR, HCV and cognition scores were examined using regression methods, and random‐coefficient models. The relationship between various factors, such as vascular burden and brain amyloid deposition, were investigated using path analysis. Results Higher eGFR was associated with larger HCVs and better cognition in all subjects at baseline. In MCI subjects, hippocampal atrophy in the eGFR ≥ 90 group progressed at just half the rate of the eGFR 75–90 group (P = .006), and was also somewhat slower than the eGFR 60–75 group (P = .08). A comprehensive path model linking eGFR, HCV and cognition, and integrating vascular burden and amyloid deposition, is proposed. Conclusions Higher renal function was associated with slower hippocampal atrophy and cognitive decline even within normal levels of renal function. This relationship was mediated mainly through cardiovascular risk burden and amyloid deposition. Further studies examining neuroinflammation are needed. Geriatr Gerontol Int 2017; ••: ••– ••.

  February 22, 2017   doi: 10.1111/ggi.12985   open full text
• Potentially inappropriate medications in Chinese older adults: The beers criteria compared with the screening tool of older persons’ prescriptions criteria.
  Hong Li, Shiyun Pu, Qinhui Liu, Xin Huang, Jiangying Kuang, Lei Chen, Jing Shen, Shihai Cheng, Tong Wu, Rui Li, Yanping Li, Li Mo, Wei Jiang, Yi Song, Jinhan He.
  Geriatrics and Gerontology International. February 22, 2017
  Aim The present study aimed to assess the prevalence of potentially inappropriate medications (PIM) use in West China Hospital residents aged ≥65 years, using two sets of criteria – the Beers and Screening Tool of Older Persons’ Prescriptions (STOPP) criteria – and to compare the Beers and STOPP criteria, and to determine the better criteria for assessing PIM of older adults in China. Methods This was a retrospective cross‐sectional study, and all patients were aged ≥65 years and admitted through the Information Center of West China Hospital from October 2010 to April 2013. The Beers and STOPP criteria were used to identify PIM. A multivariate logistic regression study was used to identify the predictors of PIM use. Results In the 6337 patients included, the mean age was 81.30 years (SD 6.75), 4795 (75.70%) were male and 5033 (79.42%) were prescribed at least one PIM by either criterion. The Beers criteria identified PIM use in 4593 (72.48%) of patients, and 3278 (51.73%) of patients used at least one PIM according to the STOPP criteria. The most prevalent PIM according to the Beers criteria were benzodiazepines (34.40%); according to the STOPP criteria, it was calcium channel blockers with chronic constipation (18.52%). Increasing age, sex (female), the number of diagnostic diseases and the number of prescribed medications predicted PIM use by both criteria. Conclusion The present study showed a high frequency of PIM in China. The Beers criteria had a higher detection rate and were more sensitive for assessing PIM of older adults in China. Geriatr Gerontol Int 2017; ••: ••–••.

  February 22, 2017   doi: 10.1111/ggi.12999   open full text
• Development of a candy‐sucking test for evaluating oral function in elderly patients with dementia: A pilot study.
  Takahiro Mori, Mineka Yoshikawa, Mariko Maruyama, Aya Hiraoka, Masahiro Nakamori, Mitsuyoshi Yoshida, Kazuhiro Tsuga.
  Geriatrics and Gerontology International. February 22, 2017
  Aim To maintain oral intake in elderly patients with dementia, it is important to evaluate their oral function. However, these patients often have difficulties following instructions during oral function tests, especially with the progression of dementia. The task of sucking a lollipop candy is simple for elderly patients with mild or severe dementia. The present study aimed to develop a new oral function test – the “candy sucking test” (CST) – for elderly patients with dementia. Methods We recruited 23 female elderly patients with dementia (mean age 89.0 ± 6.7 years). First, we determined the number of participants who were able to carry out this new oral function test, compared with other existing tests. Then, swallowing function was evaluated using videofluoroscopy for those who could carry out the CST. Results More participants were able to perform carry out CST than other function tests (P < 0.05). A significant correlation was observed between the CST value, evaluated as the difference in candy weight, and oral transit time (ρ = −0.62, P < 0.01). Conclusions The CST could be useful as a new method for evaluating the oral function of elderly patients with dementia. Geriatr Gerontol Int 2017; ••: ••–••.

  February 22, 2017   doi: 10.1111/ggi.13003   open full text
• Physical and social determinants of dietary variety among older adults living alone in Japan.
  Yoshiharu Fukuda, Midori Ishikawa, Tetsuji Yokoyama, Tatsumi Hayashi, Tomoki Nakaya, Yukari Takemi, Kaoru Kusama, Nobuo Yoshiike, Miho Nozue, Kaori Yoshiba, Nobuko Murayama.
  Geriatrics and Gerontology International. February 22, 2017
  Aim Food security and sufficient nutrient intake are critical to longevity and active aging. The present study aimed to elucidate physical and social factors related to dietary variety among single‐living older adults in Japanese communities. Methods The cross‐sectional survey with a self‐administrated questionnaire was carried out for all older adults living alone aged 65 years and older in three cities of Japan during 2014. Dietary variety score (DVS) was determined by counting the number of 10 food groups consumed at least once in 2 days using a food frequency questionnaire. Using the data of 704 men and 1366 women, the sex‐specific association of low DVS (<4) with age, region, frailty, annual income, social support, distance to the nearest supermarket and car ownership was analyzed. Results The prevalence of low DVS was 40.9% for men and 18.4% for women. Frailty and low social support were associated with low DVS. A gradient association with income was found for women, whereas men showed a threshold: <1.5 million yen per year was associated with low DVS. The distance to the nearest supermarket was not significantly associated with DVS. Conclusions The findings of the present study imply that as well as frailty, poor social support and economic disadvantage are associated with a decline in dietary variety. In particular, frail men with income <1.5 million yen per year had a high risk of decreased dietary variety. Formal and informal support to secure food accessibility for physically and socially vulnerable older adults should be encouraged. Geriatr Gerontol Int 2017; ••: ••–••.

  February 22, 2017   doi: 10.1111/ggi.13004   open full text
• Analysis of team types based on collaborative relationships among doctors, home‐visiting nurses and care managers for effective support of patients in end‐of‐life home care.
  Junko Fujita, Sakiko Fukui, Sumie Ikezaki, Chizuru Otoguro, Mayuko Tsujimura.
  Geriatrics and Gerontology International. February 21, 2017
  Aim To define the team types consisting of doctors, home‐visiting nurses and care managers for end‐of‐life care by measuring the collaboration relationship, and to identify the factors related to the team types. Methods A questionnaire survey of 43 teams including doctors, home‐visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one‐way analysis and multiple comparison analysis. Results Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home‐visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face‐to‐face cooperation with other members and home‐visiting nurses' collaborative practice. Conclusions It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; ••: ••–••.

  February 21, 2017   doi: 10.1111/ggi.12998   open full text
• Chronic condition as a mediator between metabolic syndrome and cognition among community‐dwelling older adults: The moderating role of sex.
  Hui Foh Foong, Tengku Aizan Hamid, Rahimah Ibrahim, Sharifah Azizah Haron, Suzana Shahar.
  Geriatrics and Gerontology International. February 11, 2017
  Aim Metabolic syndrome and chronic conditions are significant predictors of cognition; however, few studies have examined how they work together in predicting cognition in old age. Therefore, the present study examines whether a chronic condition mediates the association between metabolic syndrome and cognition. In addition, it discusses the moderating role of sex in the relationships between metabolic syndrome, chronic conditions and cognition. Methods Secondary analysis was carried out of data from the Malaysian national survey that involved 2322 community residents aged 60 years or older in Peninsular Malaysia. Cognition was measured by the digit symbol substitution test. Metabolic syndrome was assessed by five biomarkers: triglyceride, fasting blood sugar, systolic blood pressure, cholesterol ratio and body mass index. Chronic conditions were assessed by self‐reported medical history. The structural equation modeling technique was used to analyze the mediation and moderation tests. Results The number of chronic conditions partially mediated the association between metabolic syndrome and cognition. Men and women did not differ in the relationship between metabolic syndrome and cognition; however, the number of chronic conditions was found to be negatively associated with cognition in older women, but not in men. Conclusions Metabolic syndrome might increase the likelihood of older adults to suffer from more chronic conditions; these responses might reduce their cognition. To prevent cognitive decline in old age, specific intervention to minimize the number of chronic conditions by reducing their vascular risk factors is warranted, especially among older women. Geriatr Gerontol Int 2017; ••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.12993   open full text
• Where to go if not the hospital? Reviewing geriatric bed utilization in an acute care hospital in Singapore.
  Ke Zhou, Arpana R. Vidyarthi, Chek Hooi Wong, David Matchar.
  Geriatrics and Gerontology International. February 11, 2017
  Aim Singapore is one of the fastest‐aging countries in the world, and the demand for acute hospital care for older adults is expected to triple in the next 25 years. Hence, it is crucial to understand the opportunities in reducing potentially avoidable bed days (PABD), which are days spent in acute hospitals delivering only non‐acute services. We aimed to access the prevalence, causes and consequences of PABD among geriatric patients. Methods We examined all hospitalizations from 1 August through 31 December 2013 in the geriatric wards of an acute hospital in Singapore. PABD were identified using a modified Appropriateness Evaluation Protocol. Non‐acute services were classified as subacute care, rehabilitative care, long‐term care or social care. Hospitalization patterns were determined based on the presence or absence of non‐acute services, and multinomial logistic regression was used to determine predictors of different patterns. Results Of the 273 bed days used by 254 patients, 49% were potentially avoidable. The most common non‐acute services provided were rehabilitative care (19%), subacute care (12%) and long‐term care (8%). New acute issues arose after the admission conditions subsided in 2.4% of hospitalizations, 61% of which were nosocomial infections. Being socially at risk as assessed on admission predicted the development of new acute issues (sensitivity = 62%; specificity = 88%). Conclusions In the present study, almost half of the bed days were potentially avoidable. New acute issues can arise after PABD, which are dangerous to these frail older adults. Proactive discharge planning and increasing access to intermediate and long‐term care services are required to reduce PABD. Geriatr Gerontol Int 2017; ••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.12936   open full text
• Impact of poor sleep quality and physical inactivity on cognitive function in community‐dwelling older adults.
  Sho Nakakubo, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Sangyoon Lee, Sungchul Lee, Ryo Hotta, Seongryu Bae, Takao Suzuki, Hiroyuki Shimada.
  Geriatrics and Gerontology International. February 11, 2017
  Aim The purpose of the present study was to examine whether the combination of subjective sleep quality and physical activity is associated with cognitive performance among community‐dwelling older adults. Methods Cross‐sectional data on 5381 older adults who participated in part of the National Center for Geriatrics and Gerontology – Study of Geriatric Syndromes were analyzed. We assessed general cognitive impairment using the Mini‐Mental State Examination, and also assessed story memory, attention, executive function and processing speed using the National Center for Geriatrics and Gerontology Functional Assessment Tool. Physical activity was assessed using two questionnaires, and participants were categorized as active or inactive. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and participants were categorized as having poor (PS) or good sleep quality (GS). Results Participants in the inactive + PS group had worse performances than those in the active + GS group in all cognitive measures (Mini‐Mental State Examination: P = 0.008, story memory: P = 0.007, other cognitive measures: P < 0.001), and also had worse performances than those in the inactive + GS and active + PS groups in the trail‐making test, part B, and the symbol digit substitution test (P < 0.001, respectively). Additionally, participants in the inactive + GS group had worse performances than in the active + GS in the trail‐making test, part B, and the symbol digit substitution test (P = 0.002 and P = 0.001, respectively). Conclusions Inactivity and poor sleep quality were associated with poor cognitive performance among community‐dwelling older adults. The combination of poor sleep quality and physical inactivity also worsened cognitive performance. Geriatr Gerontol Int 2017; ••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.12973   open full text
• Prevalence of anemia and iron deficiency in older Portuguese adults: An EMPIRE substudy.
  António Robalo Nunes, Cândida Fonseca, Filipa Marques, Aurora Belo, Dialina Brilhante, José Cortez.
  Geriatrics and Gerontology International. February 11, 2017
  Aim The present study aimed to characterize the prevalence of anemia and iron deficiency in older Portuguese adults, and to compare it with the prevalence in younger individuals. Methods A population‐based, cross‐sectional study (EMPIRE study) enrolling a representative sample of 6267 adults aged <65 years and 1617 adults aged ≥65 years was carried out. Hemoglobin, ferritin, creatinine and C‐reactive protein levels were measured by Point‐of‐Care tests. Results Anemia was more prevalent (P < 0.001) in participants aged ≥80 years (31.4%) compared with participants aged <65 years (19.6%) and 65–79 years (17.3%). At a 30‐ng/mL ferritin cut‐off, iron deficiency was more prevalent in participants aged ≥80 years (42.8%) compared with participants aged <65 years (31.5%) and 65–79 years (30.2%). Alternative ferritin cut‐offs showed overall similar patterns. Anemia and iron deficiency were significantly more prevalent in older individuals who self‐reported heart failure, coronary heart disease and gastritis. Anemia was more prevalent in participants aged <65 years in the north of Portugal and participants aged ≥65 years in central Portugal, following the prevalence of iron deficiency in the regions. In all regions, anemia was more prevalent in participants aged ≥80 years (reaching 39.0% in Lisbon and Tagus Valley, and 51.0% in the south). Conclusions Anemia and iron deficiency are highly prevalent in older Portuguese adults, particularly among those aged ≥80 years. Better diagnosis, prevention and treatment strategies should be implemented taking into account the outstanding role of iron deficiency in older Portuguese adults, the differences between regions and the intrinsic characteristics of this population. Geriatr Gerontol Int 2017; ••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.12966   open full text
• Relationship between functional independence measure and geriatric nutritional risk index in pneumonia patients in long‐term nursing care facilities.
  Yuji Mitani, Yutaro Oki, Yukari Fujimoto, Takumi Yamaguchi, Kentaro Iwata, Yu Watanabe, Kazuki Takahashi, Kanji Yamada, Akira Ishikawa.
  Geriatrics and Gerontology International. February 11, 2017
  Aim The prevention of pneumonia is an urgent issue among Japanese older adults. However, little has been reported on the relationship between a Functional Independence Measure (FIM) and the Geriatric Nutrition Risk Index (GNRI) for the prevention of pneumonia in patients in long‐term care facilities in Japan. We aimed to clarify the relevance of FIM and GNRI for inpatients with and without pneumonia. Methods We identified 233 patients who were hospitalized in our long‐term nursing hospital from April 2012 to September 2013. We compared differences in FIM among GNRI classes for four groups: (i) pneumonia/high GNRI; (ii) pneumonia/low GNRI; (iii) no pneumonia/high GNRI; and (iv) no pneumonia/low GNRI. To assess the pneumonia predictors, we used a logistic regression for long‐term nursing patients. Receiver operating characteristic analysis showed cut‐off values and the area under the curve. Results A total of 88 (37.8%) of 233 inpatients had pneumonia. FIM of the pneumonia/low GNRI groups was significantly lower than that of the no pneumonia/high and low GNRI groups. Logistic regression showed that FIM (P < 0.001; OR −1.035, 95% CI −1.019–1.051) and GNRI (P = 0.017; OR −1.038, 95% CI −1.007–1.070) were predictors of pneumonia. The cut‐off values for FIM and GNRI were 26.6 (P < 0.001, the area under the curve 0.70) and 80.5 (P < 0.001, the area under the curve 0.65), respectively. Conclusion Low activity and malnutrition might lead to the development of pneumonia. FIM and GNRI are useful predictor tools that could help to prevent pneumonia in Japanese patients in long‐term care facilities. Geriatr Gerontol Int 2016; ••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.12942   open full text
• Glycemic control and disability‐free survival in hypoglycemic agent‐treated community‐dwelling older patients with type 2 diabetes mellitus.
  Takuro Morita, Tazuo Okuno, Taroh Himeno, Keisuke Watanabe, Kumie Nakajima, Yumi Koizumi, Hiroshi Yano, Osamu Iritani, Masashi Okuro, Shigeto Morimoto.
  Geriatrics and Gerontology International. February 11, 2017
  Aim Although lower glycated hemoglobin (HbA1c) has been believed to be an important marker of improvement of glycemic control in order to maintain better quality of life for patients with diabetes mellitus, a too low HbA1c might be harmful in older adults. We investigated whether this was the case with respect to risk of support/care‐need certification in community‐dwelling older patients with type 2 diabetes mellitus. Methods We analyzed 184 diabetes patients aged 65–94 years receiving glucose‐lowering medication/insulin. The end‐points were first support/care‐need certification and/or death. The relationships between four classes of HbA1c and risk of support/care‐need certification and/or death were determined using the Cox proportional hazards regression model. Results During 5 years, 42 first support/care‐need certifications and 13 deaths occurred. The association of HbA1c with risk of support/care‐need certification after adjustment for age, sex and confounding variables was J‐shaped, with the nadir at an HbA1c level of 6.5 to <7.0%, and with an increased risk of support/care‐need certification (HR 3.45, 95% CI 1.02–11.6, P = 0.046) at an HbA1c level of <6.0% compared with the nadir. When compared with patients with HbA1c ≥6.0%, those with HbA1c <6.0% showed a higher risk of support/care‐need certification as a result of dementia (HR 12.5, 95% CI 3.00–52.2, P = 0.001), but not as a result of arthralgia/fracture, stroke or other disorders. Conclusions These observations show that a too low HbA1c might be associated with a later risk of incident disability as a result of dementia in community‐dwelling older diabetes patients. Geriatr Gerontol Int 2017; •••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.12975   open full text
• Factors associated with perceived unmet dental care needs of older adults.
  Songi Chae, Yunhwan Lee, Jinhee Kim, Ki Hong Chun, Jeong Keun Lee.
  Geriatrics and Gerontology International. February 11, 2017
  Aim Although older adults have high dental care needs as a result of prevalent oral health problems, they have high unmet needs. The purpose of the present study was to examine factors associated with unmet dental care needs among older adults living in the community. Methods This study analyzed 1419 adults aged 65 years and older who participated in both the health interview survey and oral examination of the Fifth Korea National Health and Nutrition Examination Survey carried out in 2010. Predisposing (age, sex, education, marital status), enabling (place of residence, work status, income, health insurance) and need (self‐rated oral health, difficulty chewing, toothache, number of teeth, dental caries, periodontal disease) factors associated with self‐perceived unmet dental care needs were analyzed through multiple logistic regression analysis. Results Unmet dental care needs accounted for 27.9% in older adults. Age, income, difficulty chewing and the presence of permanent tooth caries were significantly associated with unmet dental care needs, adjusting for covariates. Compared with those aged 75 years and older, the 65–69 years age group showed 1.86‐fold higher odds of unmet dental care needs. Lower household income was associated with a higher likelihood of not receiving dental care when required. Unmet dental care needs were significantly higher among those with chewing difficulty (OR 2.14, 95% CI 1.55, 2.95) and permanent tooth caries (OR 1.86, 95% CI 1.28–2.70). Conclusions Unmet dental care needs are prevalent in older people who are socioeconomically disadvantaged and vulnerable in oral health. Geriatr Gerontol Int 2017; ••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.12997   open full text
• Association between sarcopenia and nutritional status and physical activity among community‐dwelling Chinese adults aged 60 years and older.
  Shan Hai, Li Cao, Hui Wang, Jianghua Zhou, Ping Liu, Ying Yang, Qiukui Hao, Birong Dong.
  Geriatrics and Gerontology International. February 11, 2017
  Aim The aim of the present study was to examine the association between sarcopenia and nutritional status and physical activity among community‐dwelling Chinese people aged 60 years and older. Methods This study was carried out on 836 community‐dwelling Chinese individuals aged ≥60 years to evaluate sarcopenia using the Asian Working Group for Sarcopenia criteria. Sociodemographic characteristics and lifestyle habits were collected using a general questionnaire. Nutritional status was assessed using the Mini Nutritional Assessment and biochemical parameters, whereas physical activity was assessed using the long form of the International Physical Activity Questionnaire. In addition, univariate and multivariate analysis was used to analyze the association between sarcopenia with nutritional status and physical activity. Results The total prevalence rate of sarcopenia was 10.5%, 47 (11.3%) men and 41 (9.7%) women who were classified as sarcopenia. The prevalence of sarcopenia was significantly lower among the participants of normal nutrition status. Compared with the participants with sarcopenia, those without sarcopenia had higher levels of prealbumin (P < 0.05) and hemoglobin (P < 0.05) for both sexes. In the multivariate model, after adjustment for all covariates, the Mini Nutritional Assessment score (adjusted OR 0.769, 95% CI 0.689–0.859, P < 0.05) was statistically significantly associated with sarcopenia, but the relationship between physical activity and sarcopenia was not significant. Conclusions The prevalence of sarcopenia in the Chinese community‐dwelling population aged 60 years and older was high. There was a significant association between sarcopenia and nutritional status, but not with physical activity, based on a questionnaire. Further studies should evaluate whether maintaining a good nutritional status might be effective in lowering the risk of sarcopenia. Geriatr Gerontol Int 2017; ••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.13001   open full text
• The neural substrate of gait and executive function relationship in elderly women: A PET study.
  Ryota Sakurai, Kenji Ishii, Masashi Yasunaga, Rumi Takeuchi, Yoh Murayama, Naoko Sakuma, Muneyuki Sakata, Keiichi Oda, Kenji Ishibashi, Kiichi Ishiwata, Yoshinori Fujiwara, Manuel Montero‐Odasso.
  Geriatrics and Gerontology International. February 11, 2017
  Aim Understanding the relationship between age‐related gait impairment, such as slow gait, and executive functioning in seniors may help identify individuals at higher risk of mobility decline, falls, and progression to dementia at earlier stages. We aim to identify brain regions concomitantly associated with poor gait and executive functioning in a cohort of well‐functioning elderly women. Methods In total, 149 well‐functioning women aged 70.1 ± 6.2 years underwent FDG‐PET to evaluate regional cerebral metabolic rates of glucose normalized in reference to cerebellar glucose metabolic value (normalized‐rCMRglc) in 16 brain areas. We assessed gait speed, step length and cadence under usual and fast conditions. Executive function was assessed using Trail‐Making‐Tests (TMT) A and B. Results Adjusted multiple regression analyses for potential covariates showed that TMT‐B and ΔTMT (TMT B‐A) were associated with gait speed and cadence at fast condition. Lower normalized‐rCMRglc in the posterior cingulate and primary sensorimotor cortices were associated with longer TMT‐B and ΔTMT times (i.e., lower executive function) as well as with slower gait speed and lower cadence at fast condition. Slower gait speed and lower cadence at fast condition were also associated with lower normalized‐rCMRglc in the occipital and parietal cortices. There were no other significant associations. Conclusions In healthy elderly women without impending disability or cognitive impairment, reduced glucose metabolism in the posterior cingulate and primary sensorimotor cortices were associated with both lower gait performance and executive functioning. Our results suggest that gait control and executive functions might share the same neural substrate. Geriatr Gerontol Int 2017; ••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.12982   open full text
• Correlates of subjective transportation deficiency among older adults attending outpatient clinics in a tertiary care hospital in Mexico City.
  Ana Patricia Navarrete‐Reyes, Carlos Tonatiuh Medina‐Rimoldi, José Alberto Avila‐Funes.
  Geriatrics and Gerontology International. February 11, 2017
  Aim Older adults frequently report problems of transportation. Little is known about the correlates of transportation deficiency in Latin America. Therefore, the aim of the present study was to determine the correlates of subjective transportation deficiency (STD) among community‐dwelling older adults attending a tertiary care hospital in Mexico City. Methods Cross‐sectional study of 228 participants aged ≥70 years being followed in any of the outpatient clinics of a tertiary care hospital in Mexico City. Data were obtained through a structured questionnaire. Univariate and multivariate logistic regression analyses were carried out in order to identify the correlates of STD. Results The mean age of the participants was 79.8 years (SD 6.4) and 67.1% were women. STD was present in 46% of participants. The multivariate logistic regression model showed that female sex, illiteracy, mobility disability and the use of an assistive walking device had an independent and statistically significant association with STD. Conclusions Female sex, illiteracy, mobility disability and the use of an assistive walking device were independent correlates of STD in the present study. Identifying the frequency and correlates of transportation deficiency in vulnerable populations will allow for the identification and implementation of useful public policies, as well as for the optimization of prevention and treatment strategies in an attempt to preserve mobility and autonomy, especially in low‐ and middle‐income countries where previous work on transportation deficiency is lacking. Geriatr Gerontol Int 2016; ••: ••–••.

  February 11, 2017   doi: 10.1111/ggi.12987   open full text
• Comparative economic evaluation of home‐based and hospital‐based palliative care for terminal cancer patients.
  Koki Kato, Haruhisa Fukuda.
  Geriatrics and Gerontology International. February 08, 2017
  Aim To quantify the difference between adjusted costs for home‐based palliative care and hospital‐based palliative care in terminally ill cancer patients. Methods We carried out a case–control study of home‐care patients (cases) who had died at home between January 2009 and December 2013, and hospital‐care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. Results The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18–36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12–10.51), non‐use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53–46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11–29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97–34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59–1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093–7991, P = 0.015) in treatment costs. Conclusions Despite similar treatment durations between the groups, treatment costs were substantially lower in the home‐care group. These findings might inform the policymaking process for improving the home‐care support system. Geriatr Gerontol Int 2017; ••: ••–••.

  February 08, 2017   doi: 10.1111/ggi.12977   open full text
• Impact of continuous in‐home rehabilitation on quality of life and activities of daily living in elderly clients over 1 year.
  Miyuki Imanishi, Hisao Tomohisa, Kazuo Higaki.
  Geriatrics and Gerontology International. February 08, 2017
  Aim To verify the effect of in‐home rehabilitation on quality of life and activities of daily living in elderly clients. Methods In this non‐randomized controlled intervention trial, elderly participants were separated into a rehabilitation or a non‐rehabilitation group (n = 100 each). The non‐rehabilitation group received basic in‐home nursing care, including assistance with cooking, cleaning, toileting, meals and medication. The rehabilitation group received a physical treatment program provided by a licensed professional once a week and basic nursing care in the home. For each group, quality of life and activities of daily living were assessed approximately every 3 months over a 1‐year period. Quality of life was evaluated using the Philadelphia Geriatric Center Morale Scale, and activities of daily living were evaluated based on the Functional Independence Measure. Results The rehabilitation group showed statistically significant improvements in both quality of life and activities of daily living. In contrast, the non‐rehabilitation group, although showing slight improvement in quality of life at 9 months, showed almost no effects at the other time‐points and no significant changes in activities of daily living over the course of the study. Conclusions The results of the present study suggest that long‐term continuous in‐home rehabilitation might improve quality of life and activities of daily living in elderly clients. Geriatr Gerontol Int 2017; ••: ••–••.

  February 08, 2017   doi: 10.1111/ggi.12978   open full text
• Association between nighttime sleep duration, sleep timing and falls among middle‐aged and older Chinese population: A cross‐sectional analysis from the Dongfeng–Tongji cohort study, China.
  Yi Wang, Wending Li, Lijun Shen, Lulu Song, Hui Li, Bingqing Liu, Jing Yuan, Youjie Wang.
  Geriatrics and Gerontology International. February 08, 2017
  Aim To examine the association between nighttime sleep duration, sleep timing, and their interactive effect on falls among middle‐aged and older Chinese adults. Methods The study sample of 35,465 (mean age 64.5 years) subjects were from the Dongfeng–Tongji cohort. All subjects completed baseline questionnaires and medical examinations. Participants were classified into five groups based on nighttime sleep duration: <7 h, 7– ≤ 8 h, 8– ≤ 9 h, 9– ≤ 10 h, ≥10 h, and three groups based on sleep timing: <21:00, 21:00– ≤ 23:00, ≥23:00. Logistic regression models estimated the odds ratios (ORs) of nighttime sleep duration/timing with single/recurrent falls. Results The one year rate of falls was 15.2 % among the subjects. After adjusting for potential confounders, participants with longer sleep duration (≥10 h) had 1.48 times (95 % confidence interval [CI], 1.11–1.97) higher odds of recurrent falls, compared with those sleeping 7– ≤ 8 h. Earlier (<21:00) and later (≥23:00) sleep timing were associated with recurrent falls (earlier: OR 1.90, 95 % CI 1.33–2.73; later: OR 1.33, 95 % CI 1.14–1.56) compared with a normal sleep schedule (sleep during 21:00– ≤ 23:00). The combined effect showed that longer sleep duration and earlier sleep timing were associated with a greater occurrence of falls (OR 1.66, 95 % CI 1.22–2.26). Conclusions Long nighttime sleep duration was associated with a higher occurrence of recurrent falls but not with a single fall. Long sleep duration with early timing greatly increased both single and recurrent falls. Geriatr Gerontol Int 2017; ••: ••–••.

  February 08, 2017   doi: 10.1111/ggi.12984   open full text
• Femoral muscle mass relates to physical frailty components in community‐dwelling older people.
  Tetsuya Takahashi, Masamitsu Sugie, Marina Nara, Teruyuki Koyama, Shuichi P Obuchi, Kazumasa Harada, Syunei Kyo, Hideki Ito.
  Geriatrics and Gerontology International. January 26, 2017
  Aim To examine the relationship between lower limb muscle (femoral muscle, calf muscle) mass and exercise capacity, and frailty components in community‐dwelling older people. Methods Participants included 121 community‐dwelling individuals. There were 42 men and 79 women, and the mean age was 77.7 years (range 56–97 years). Appendicular skeletal muscle mass was determined using dual‐energy X‐ray absorptiometry, and the skeletal muscle index was calculated using the following formula: appendicular skeletal muscle / body height. Femoral muscle mass and calf muscle mass were determined, respectively, by dividing the femoral bone and tibial bone at the knee joint space. A symptom‐limited cardiopulmonary exercise testing was carried out and peak oxygen uptake was measured. Functional exercise performance was evaluated using the handgrip strength measurement, comfortable walking speed, and the Timed Up and Go test. All patients gave written, informed consent before data collection. Results Peak oxygen uptake correlated positively with the skeletal muscle index (r = 0.491). Only femoral muscle mass that was corrected with the whole body muscle mass was positively correlated with peak oxygen uptake (r = 0.473), handgrip strength (r = 0.382), comfortable walking speed (r = 0.427), and the Timed Up and Go test (r = 0.379). Calf muscle mass that was corrected with the whole‐body muscle mass showed no correlation with exercise capacity and frailty components. A similar tendency was observed in both men and women. Conclusions Femoral muscle mass influenced exercise capacity and physical frail components compared with calf muscle mass. These results suggest the importance of the femoral muscle in physical frailty. Geriatr Gerontol Int 2017; ••: ••–••.

  January 26, 2017   doi: 10.1111/ggi.12945   open full text
• Characteristics of care management agencies affect expenditure on home help and day care services: A population‐based cross‐sectional study in Japan.
  Mei Feng, Ayumi Igarashi, Maiko Noguchi‐Watanabe, Satoru Yoshie, Katsuya Iijima, Noriko Yamamoto‐Mitani.
  Geriatrics and Gerontology International. January 26, 2017
  Aim The financial interests of care management agencies can affect how care managers assist clients' use of long‐term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Methods Population‐based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1–5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Results Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Conclusions Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; ••: ••–••.

  January 26, 2017   doi: 10.1111/ggi.12969   open full text
• Effects of life review interventions on psychosocial outcomes among older adults: A systematic review and meta‐analysis.
  Xiuyan Lan, Huimin Xiao, Ying Chen.
  Geriatrics and Gerontology International. January 26, 2017
  Aim The present study aimed to evaluate the effects of life review interventions on psychosocial outcomes among older adults. Methods We searched PubMed, Ovid, CINHAL, Cochrane library, PsycINFO, Springer Link, Oxford Journals Collection, FRMS, CBM, VIP, CNKI, and Wanfang to identify randomized controlled trials and controlled clinical trials that evaluate the effects of life review among older adults. The quality of studies included was evaluated and the relevant information was extracted. Then, a meta‐analysis was carried out with RevMan software. Results We identified 15 studies that met the inclusion criteria, and 11 studies were allowed for meta‐analysis. The combined results of the meta‐analysis showed that life review significantly reduced depression (standardized mean difference 0.57, 95% CI 0.73 to –0.42) and hopelessness (mean difference [MD] 4.01, 95% CI 6.13 to –1.89). There was a significant improvement in well‐being (standardized mean difference 0.54, 95% CI 0.01–1.06) and specific memory (MD 1.05, 95% CI 0.07–2.03). However, other study findings did not support its effect in life satisfaction (MD 2.15, 95% CI 0.69– 5.00), self‐esteem (MD 0.21, 95% CI 2.09–2.50), the quality of life (standardized mean difference 0.15, 95% CI 0.96–0.66), extended memory (MD 0.03, 95% CI 0.61–0.55), categorical memory (MD 0.48, 95% CI 1.08– 0.12) and no recall (MD 0.30, 95% CI 1.12– 0.52). Conclusions Life review is a worthwhile intervention for reducing depression and hopelessness, and improving quality of life, well‐being and specific memory in older adults. More well‐designed trials with a large sample and long‐term follow up are necessary to confirm the effects of life review on other psychosocial outcomes. Geriatr Gerontol Int 2017; ••: ••–••.

  January 26, 2017   doi: 10.1111/ggi.12947   open full text
• Cross‐cultural adaptation and psychometric study of the Turkish version of the Rapid Assessment of Physical Activity.
  Fatma Kübra Çekok, Turhan Kahraman, Muhammet Kalkışım, Arzu Genç, Pembe Keskinoğlu.
  Geriatrics and Gerontology International. January 26, 2017
  Aim The Rapid Assessment of Physical Activity (RAPA) is a valid tool for use in clinical practice to provide an easily administered and interpreted means of assessing levels of physical activity among adults older than 50 years. However, there are some concerns about its reliability. The aim was to linguistically and culturally adapt the RAPA into Turkish, and assess its validity and reliability. Methods This methodological and cross‐sectional study included 110 participants (68 women) from the community and a nursing home. The RAPA was translated and culturally adapted into Turkish using established double‐back translation methods. The participants completed the RAPA twice with a 1‐week interval to examine test–retest reliability. The International Physical Activity Questionnaire‐Short Form and Physical Activity Scale for the Elderly were used to examine the validity. Results The mean age of the participants was 70.5 years (SD 10.5 years). The weighted kappa coefficients exceed 0.81 for each of the nine items, the aerobic score and strength and flexibility score, showing that the test–retest reliability was very good. There were positive moderate correlations between the RAPA, International Physical Activity Questionnaire‐Short Form and Physical Activity Scale for the Elderly (P < 0.01). Additionally, the RAPA was negatively correlated with the International Physical Activity Questionnaire‐Short Form sitting time as prehypothesized (P < 0.01). The convergent and discriminate validity of the RAPA were acceptable. Conclusions The present study has shown that the Turkish version of the RAPA was an easy‐to‐use, valid and reliable measure of physical activity among adults aged older than 50 years. This study has also provided considerable evidence about the test–retest reliability of the RAPA, which was not investigated in the original validation study. Geriatr Gerontol Int 2017; ••: ••–••.

  January 26, 2017   doi: 10.1111/ggi.12970   open full text
• Creative approach for successful aging: A pilot study of an intergenerational health promotion program.
  Yen‐Chun Lin, Yu‐Tzu Dai, Lian‐Hua Huang, Suh‐Chin Wang, Guey‐Shiun Huang.
  Geriatrics and Gerontology International. January 26, 2017
  Aim To develop and evaluate the effectiveness of an intergenerational health promotion program. Methods This was an action research project. A total of 34 participants attended the 12‐week program and completed the pre‐test and post‐test. There were 16 middle‐aged and nine older adults recruited from a district of Taipei, and nine young adults recruited from the principal investigator's university. The “Attitudes toward Aging Scale” and the “Spiritual Health Scale” were two assessment instruments used in the study. Results The results showed that there were significant improvements in the Attitudes toward Aging Scale for the young adult group (aged 18–29 years) and in the Spiritual Health Scale for the older adult group (aged 65–80 years). The evaluation showed that participants were satisfied with the program. Conclusions The results of the present study provide future directions for successful aging and intergenerational learning. Geriatr Gerontol Int 2017; ••: ••–••.

  January 26, 2017   doi: 10.1111/ggi.12963   open full text
• Diabetes‐related dementia is associated with dynapenia, but not with sarcopenia.
  Daisuke Hirose, Haruo Hanyu, Raita Fukasawa, Nayuta Namioka, Hirokuni Hatanaka, Tomohiko Sato.
  Geriatrics and Gerontology International. January 23, 2017
  There is no abstract available for this paper.

  January 23, 2017   doi: 10.1111/ggi.12791   open full text
• Characteristics of injuries of older adults in Korea by use of the National Emergency Department of Information System and injury surveillance system.
  Changhyun Kang, Sungmin Myoung, Soon‐Young Moon.
  Geriatrics and Gerontology International. January 23, 2017
  There is no abstract available for this paper.

  January 23, 2017   doi: 10.1111/ggi.12750   open full text
• Association of loneliness and healthcare utilization among older adults in Singapore.
  Ka Keat Lim, Angelique Chan.
  Geriatrics and Gerontology International. January 06, 2017
  Aim To assess the association between loneliness and physician visits among community‐dwelling older adults in Singapore. Methods We obtained data from two consecutive waves (2009 and 2011) of a nationally representative longitudinal survey of community‐dwelling Singaporeans aged 60 years and older. Out of 3103 responses, we excluded proxy interviews (n = 365; 11.8 %), resulting in a final analysis cohort of 2738 respondents. Using the frequency of physician visits in the past 30 days as the dependent variable, we carried out negative binomial hurdle regression controlling for predisposing characteristics, enabling factors, needs, social capital and change in loneliness status between the two waves of the survey. Results Approximately 23% of respondents suffered from chronic loneliness; a further 19% developed loneliness, whereas 33% recovered from loneliness by wave 2. Chronic (OR 0.76 ± 0.11) and recently‐developed loneliness (OR 0.70 ± 0.10) were significantly associated with lower odds of physician visits, compared with being never lonely. Meanwhile, those who recovered from loneliness had the same odds of physician visits, but were associated with lower number of visits (−0.71 ± 0.27) if they did utilize their physicians. Conclusions The present study found a significant association between loneliness and lower odds of physician visits regardless of whether the loneliness was recently developed or chronic. In addition, respondents who had loneliness in the past also had a significantly lower number of visits to physicians compared with those who were never lonely. Further studies on the underlying behavior and the health consequences are warranted. Geriatr Gerontol Int 2017; ••: ••‐••.

  January 06, 2017   doi: 10.1111/ggi.12962   open full text
• Alcohol and tobacco consumption concordance and its correlates in older couples in Latin America.
  Mayra Pires Alves Machado, Davi Camara Opaleye, Tiago Veiga Pereira, Ivan Padilla, Ana Regina Noto, Martin Prince, Cleusa Pinheiro Ferri.
  Geriatrics and Gerontology International. January 06, 2017
  Aim As little is known about alcohol and tobacco consumption concordance between older spouses in low‐ and middle‐income countries, the present study aimed to estimate this in older couples from five Latin American countries. Methods This study is a secondary analysis of data collected between 2003 and 2007 by the 10/66 Dementia Research Group, from 1451 couples aged over 65 years from Cuba, the Dominican Republic, Peru, Mexico and Puerto Rico. Kappa statistic was used to assess the agreement of the behavior beyond chance, and logistic regression models with meta‐analyses were used to estimate the factors associated with concordance. Results The mean age of the total sample was 74.8 years (SD 6.6). The results showed high levels of agreement rates in relation to drinking and smoking (75.9% and 85% of couples, respectively, did not drink or smoke), which were beyond the agreement expected by chance. Increased age was associated with concordance on both being non‐drinkers (OR 1.03, 95% CI 1.01–1.05) and non‐smokers (OR 1.05, 95% CI 1.02–1.07); and having a larger social network was associated with less likelihood of the couple being non‐drinkers (OR 0.93, 95% CI 0.88–0.98). Attending religious meetings was associated with increased likelihood of the couple being non‐smokers (OR 1.19, 95% CI 1.01–1.41). Socioeconomic circumstances were not associated with couples’ concordance. Conclusions Older Latin American couples have high levels of concordance in drinking and smoking habits, which increases with age, and were not associated with socioeconomic circumstances, but were with social network. This knowledge can assist the development of policies and interventions to promote health among this growing population. Geriatr Gerontol Int 2017; ••: ••–••.

  January 06, 2017   doi: 10.1111/ggi.12974   open full text
• Mediating effect of decline in social activities on urinary incontinence and negative mood: Do sex and marital differences exist?
  Xue Bai, Doris Yin Ping Leung, Claudia Kam Yuk Lai, Alice Ming Lin Chong, Iris Chi.
  Geriatrics and Gerontology International. January 06, 2017
  Aim We tested the mediating effect of decline in social participation on urinary incontinence (UI) and negative mood in older adults by sex and marital status. Methods We carried out secondary analysis of data collected from 5301 Chinese adults aged 60 years or older in Hong Kong who had completed an initial screening instrument for subsidized long‐term care services in 2010. Path analysis within structural equation modeling was carried out. Results Satisfactory model fit was obtained: male–married group (n = 1949, standardized root means squared residual [SRMR] = 0.034, robust root mean square error of approximation [R‐RMSEA] = 0.045, robust comparative fit index [R‐CFI] = 0.965), male–other group (n = 519, SRMR = 0.023, R‐RMSEA = 0.011, R‐CFI = 0.988), female–married group (n = 948, SRMR = 0.018, R‐RMSEA = 0.002, R‐CFI = 1.000) and female–other group (n = 2251, SRMR = 0.023, R‐RMSEA = 0.048, R‐CFI = 0.970). In the male–married subsample, UI had both a significant direct effect (β = 0.046) and significant indirect effect on mood through decline in social participation (β = 0.021); for the female–other subsample, UI (β = 0.058) and decline in social participation (β = 0.335) had significant direct effects on negative mood. Decline in social participation had a significant direct effect on negative mood in the male–other subsample (β = 0.306) and the female–married subsample (β = 0.325). Conclusions Decline in social participation mediated the relationship between UI and negative mood in married older men, but not male–other group or women. It is important to recognize these sex and marital status differences, and expand social participation opportunities for UI patients. Geriatr Gerontol Int 2017; ••: ••–••.

  January 06, 2017   doi: 10.1111/ggi.12976   open full text
• Self‐reported quality of sleep is associated with physical strength among community‐dwelling young‐old adults.
  Katarzyna B. Malinowska, Tome Ikezoe, Noriaki Ichihashi, Hidenori Arai, Kimihiko Murase, Kazuo Chin, Takahisa Kawaguchi, Yasuharu Tabara, Takeo Nakayama, Fumihiko Matsuda, Tadao Tsuboyama.
  Geriatrics and Gerontology International. January 06, 2017
  Aim The present study examined the association between self‐reported quality of sleep (QOS) and physical function in community‐dwelling young‐old adults. Methods This cross‐sectional study included 737 community‐dwelling older adults aged 60 years and older (498 women, 239 men); age 68.3 ± 5.2 years (range 60–79 years). Participants completed a self‐administered questionnaire, which included the Pittsburgh Sleep Quality Index, as well as information regarding sociodemographic characteristics, physical activity, smoking and alcohol consumption. The χ2‐test was used to compare categorical variables stratified by QOS, and the unpaired t‐test was used for continuous variables for men and women separately. Furthermore, logistic regression analyses were carried out to verify the association between QOS and physical function measures. Results The unpaired t‐test showed a significant difference ((P < 0.05) in the Timed Up and Go test and physical strength outcomes, which included: handgrip, quadriceps setting, knee extension and hip flexion strength between the good QOS and poor QOS groups among the men. However, the t‐test results for physical function outcomes did not show a significant difference among the women. In the logistic regression model, after adjusting for age, sex and potential confounding factors, handgrip strength remained significantly associated with QOS (OR 0.96, 95% CI 0.92–1.00). Conclusion QOS was associated with physical function in young‐old adults; those with good QOS were especially more likely to possess stronger grip strengths; however, further research is required to identify the temporal relationship. Geriatr Gerontol Int 2017; ••: ••–••.

  January 06, 2017   doi: 10.1111/ggi.12965   open full text
• Therapeutic effects of drug switching between acetylcholinesterase inhibitors in patients with Alzheimer's disease.
  Yasuyuki Ohta, Mohamed Darwish, Nozomi Hishikawa, Toru Yamashita, Kota Sato, Mami Takemoto, Koji Abe.
  Geriatrics and Gerontology International. January 06, 2017
  Aim To evaluate the therapeutic effects of switching from one acetylcholinesterase inhibitor (ChEI), donepezil, galantamine or rivastigmine, to another in Alzheimer's disease patients. Methods We retrospectively enrolled 171 Alzheimer's disease patients, whose ChEI medication was changed. The patients were evaluated on three major aspects of dementia – cognitive, affective and activities of daily living (ADL) measures – at 6 months (M) before the drug switch, at the time of drug switch (baseline), and at 3 M and 6 M after the drug switch. Results The doses of the three ChEI were significantly lower at 6 M after the switch compared with the pre‐switch doses. Improvements in apathy were found at 3 M when switching from donepezil to galantamine, but not to rivastigmine, but this switch had adverse effects on ADL. Improvements in cognitive scores at 3 M were also found when switching from galantamine to rivastigmine, but not to donepezil. However, both of these changes improved Abe's Behavioral and Psychological Symptoms of Dementia scores (ABS), except ADL. Switching from rivastigmine to donepezil worsened ABS at 6 M, but preserved cognitive and ADL scores. Conclusions The present study suggests that despite a relatively lower dose of ChEI after the switch, switching from donepezil or rivastigmine preserved cognitive functions for at least 6 M. Switching from galantamine to rivastigmine improved Mini‐Mental State Examination and ABS at 3 M, but did not improve ADL scores. Geriatr Gerontol Int 2017; ••: ••–••.

  January 06, 2017   doi: 10.1111/ggi.12971   open full text
• Effects of 6 months of aerobic and resistance exercise training on carotid artery intima media thickness in overweight and obese older women.
  Jinkee Park, Hyuntea Park.
  Geriatrics and Gerontology International. January 06, 2017
  Aim We studied the effects of exercise on carotid intima‐media thickness, luminal diameter, and flow velocity in overweight and obese older women, and the associations between carotid parameters changes and other variables. Methods A total of 41 overweight and obese older women (aged 65–77 years, fat mass percent ≥ 32%), who were divided into a control group (n = 20) and a supervised combined exercise group (n = 21). The 24‐week combined exercise program (aerobic and resistance exercise) consisted of sessions 40–80 min in length 5 days per week under the supervision of an exercise specialist. Body composition, blood pressure, physical function and carotid variables were assessed. The differences in all variables, and the relative changes between baseline and 24 weeks’ follow up were evaluated. Results Carotid intima‐media thickness, systolic carotid luminal diameter, peak systolic flow velocity and end diastolic flow velocity showed a significant group × time interaction. No interaction was observed for diastolic luminal diameter. In the exercise group, the change of carotid intima‐media thickness was significantly associated with systolic blood pressure, maximal walking speed, 1‐mile walking time and maximal oxygen uptake. Also, the change of peak systolic flow velocity was significantly associated with skeletal muscle mass, diastolic blood pressure and maximum walking speed. Conclusions Combined exercise can effectively improve carotid intima‐media thickness in overweight and obese older women. In addition, exercise training increases the systolic carotid luminal diameter and flow velocity in older women. Therefore, regular combined exercise might help prevent atherosclerotic disease by improving the carotid artery. Geriatr Gerontol Int 2017; ••: ••–••.

  January 06, 2017   doi: 10.1111/ggi.12972   open full text
• Factors associated with unexpected admissions and mortality among low‐functioning older patients receiving home medical care.
  Hiroyuki Umegaki, Atushi Asai, Shigeru Kanda, Keiko Maeda, Takuya Shimojima, Hideki Nomura, Masafumi Kuzuya.
  Geriatrics and Gerontology International. January 06, 2017
  Aim The need for and availability of home medical care for elderly patients with limitations in terms of access to medical facilities has been increasing. We investigated the association between low function, malnutrition, dementia and multicomorbidity with patient prognosis, focusing on unexpected hospital admissions and mortality in elderly non‐cancer patients receiving home care. Methods The study included 124 Japanese patients receiving home medical care in the form of regular visits from doctors and nurses for physical and/or mental disability. Results Of the patients studied, 36.2% experienced hospital admission. Student's t‐test showed that admitted patients had significantly higher Charlson Comorbidity Index scores. Meanwhile, 19.6% of patients died during the course of the study. Student's t‐test showed that older patients had a higher risk of mortality, and significantly lower activities of daily living and Mini‐Nutritional Assessment Short‐Form scores. Cox hazard analysis showed that multicomorbidity was a risk for unexpected hospital admission, and malnutrition was a risk for mortality in frail older adults receiving home medical care. Conclusions We found that multicomorbidity was a risk for unexpected hospital admission, and malnutrition was a risk for mortality in frail older adults receiving home medical care. Geriatr Gerontol Int 2017; ••: ••–••

  January 06, 2017   doi: 10.1111/ggi.12943   open full text
• Effects of rapid aging and lower participation rate among younger adults on the short‐term trend of physical activity in the National Health and Nutrition Survey, Japan.
  Nobuo Nishi, Takeshi Yoshizawa, Nagako Okuda.
  Geriatrics and Gerontology International. January 06, 2017
  Aim The National Health and Nutrition Survey, Japan, has annually monitored two indicators of physical activity in adults. They are contrasting in the association with age; the prevalence of exercise habit is lower and step counts are higher among younger participants. The present study aimed to examine the effects of rapid aging of the Japanese population and the lower participation rate among younger adults on the short‐term trend of two indicators of physical activity using tabulated data. Methods The prevalence of exercise habit and step counts by age groups (≥20 years) from 2003 to 2010 were estimated using tabulated data from the National Health and Nutrition Survey by calculating sex‐specific means weighted by age‐specific Japanese population data for each year (population‐weighted estimates) and for a fixed year (2005; age‐standardized estimates). Linear regression analyses were used to test the statistical significance of their trends. Results Statistically significant increasing trends in the prevalence of exercise habit were observed for the crude means (P = 0.029), the population‐weighted estimates (P = 0.007) and the age‐standardized estimates (P = 0.016) only in men. Statistically significant decreasing trends in the step counts were observed for the crude means (P = 0.006 in men and P = 0.033 in women) and the population‐weighted estimates (P = 0.008 in men and P = 0.049 in women) both in men and women, but for the age‐standardized estimates (P = 0.039) only in men. Conclusions The effects of rapid aging of the Japanese population and the lower participation rate among younger adults on the short‐term trend are not small, and age‐standardization is necessary to observe even the short‐term trend of physical activity data. Geriatr Gerontol Int 2017; ••: ••–••.

  January 06, 2017   doi: 10.1111/ggi.12956   open full text
• End‐of‐life care for people dying with dementia in general practice in Belgium, Italy and Spain: A cross‐sectional, retrospective study.
  Yolanda W .H. Penders, Gwenda Albers, Luc Deliens, Guido Miccinesi, Tomás Vega Alonso, Maite Miralles, Sarah Moreels, Lieve Van den Block,.
  Geriatrics and Gerontology International. January 06, 2017
  Aim To describe and compare end‐of‐life care for people with mild or severe dementia in general practice in Belgium, Italy and Spain, in terms of place of care, place of death, treatment aims, use of specialized palliative care and communication with general practitioners (GPs). Methods Cross‐sectional retrospective survey was carried out of nationwide networks of GPs in Belgium, Italy and Spain, including patients who died aged 65 years or older in 2009–2011 and were judged by the GP to have had dementia (n = 1623). Results GPs reported a higher proportion of older people with severe dementia in Belgium (55%) than in Spain (46 %) and Italy (45 %), and a higher proportion of patients living in care homes (57% vs 18% and 13%, respectively). A palliative treatment aim was common in the last 3 months of life in all three countries. Specialized palliative care services were provided in 14% (Italy, severe dementia) to 38% (Belgium, severe dementia) of cases. Communication between GP and patient about illness‐related topics occurred in between 50% (Italy) and 72% (Belgium) of cases of mild dementia, and 10% (Italy) to 32% (Belgium) of cases of severe dementia. Patient preferences for end‐of‐life care were known in a minority of cases. Few people (13–15 %) were transferred between care settings in the last week of life. Conclusions Although overall treatment aims at the end of life are often aligned with a palliative care approach and transfer rates are low, there is room for improvement in end‐of‐life care for people with dementia in all countries studied, especially regarding early patient–GP communication. Geriatr Gerontol Int 2017; ••: ••–••.

  January 06, 2017   doi: 10.1111/ggi.12948   open full text
• Fear of falling and mortality among community‐dwelling older adults in the Shih‐Pai study in Taiwan: A longitudinal follow‐up study.
  Hsiao‐Ting Chang, Hsi‐Chung Chen, Pesus Chou.
  Geriatrics and Gerontology International. January 06, 2017
  Aim Little is known about the association between fear of falling (FOF) and the risk of mortality. The aim of the present study was to investigate the association between FOF and mortality among community‐dwelling older adults. Methods A total of 3814 older adults aged 65 years and older living in the Shih‐Pai area in Taiwan participated in this 7‐year follow‐up longitudinal study. A structured questionnaire was used to record participants’ FOF, history of falling, demographic characteristics, medical conditions, history of insomnia, depression symptoms and subjective health from 1999 to 2002. Follow‐up all‐cause mortality data were obtained from the National Death Registry of the Department of Health to identify the occurrence of deaths from the initial interview through to 31 December 2008. Results At the baseline assessment, the mean age of the participants was 73.8 ± 5.8 years, 56.4% were men and 53.4% had FOF. Cox regression showed that participants with FOF had an increased risk of mortality (aHR 1.16, 95% CI 1.02–1.33) after adjusting for sex, history of falling, age, body mass index, marital status, education level, smoking status, alcohol use, living status, chronic condition, depression and subjective health. Furthermore, FOF was a significant risk factor for male participants (aHR 1.17, 95% CI 1.00–1.38), but had a marginal risk for female participants (aHR 1.24, 95% CI 0.95–1.60) after adjusting for other risk factors, as in the full model except for sex. Conclusions The findings of the present study suggest that FOF is a significant risk factor of mortality, especially in older male adults. Further research on the mechanism and effects of fear of falling on mortality is necessary. Geriatr Gerontol Int 2017; ••: ••–••.

  January 06, 2017   doi: 10.1111/ggi.12968   open full text
• Depression in older adults: Do close family members recognize it?
  Sachiko Yamazaki, Hiromi Imuta, Seiji Yasumura.
  Geriatrics and Gerontology International. December 28, 2016
  There is no abstract available for this paper.

  December 28, 2016   doi: 10.1111/ggi.12744   open full text
• Characteristics of physical prefrailty among Japanese healthy older adults.
  Eiji Matsushita, Kiwako Okada, Yui Ito, Shosuke Satake, Nariaki Shiraishi, Takahisa Hirose, Masafumi Kuzuya.
  Geriatrics and Gerontology International. December 09, 2016
  Aim The purpose of the present study was to clarify the characteristics of frailty at an early stage (prefrailty) in a healthy elderly Japanese population. Methods The participants were 620 healthy older adults (age range 60–89 years) who were current students or graduates of a community college for older adults in Japan. All participants were evaluated using the Kihon Checklist, a tool developed to screen for frailty in Japan. The participants were categorized by the Fried criteria (lost weight, handgrip strength, walking speed, exhaustion, physical activity) into either a prefrailty (1–2 criteria) or a non‐frailty (0 criterion) group. Results In the logistic regression model for the prevalence of prefrailty, significant and independent determinants were chronic constipation (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.15–3.90, P = 0.016), occurrence of incontinence (OR 2.0, 95% CI 1.39–2.82, P < 0.001), unable to climb stairs (OR 3.0, 95% CI 1.26–7.02, P = 0.013), dry mouth (OR 1.5, 95% CI 1.04–2.22, P = 0.029), a lack of fulfillment (OR 3.2, 95% CI 1.26–7.93, P = 0.015), found easy tasks difficult (OR 2.8, 95% CI 1.30–5.85, P = 0.008) and felt helpless (OR 2.1, 95% CI 1.02–4.39, P = 0.044). Conclusions These results suggest that the appearance of autonomic failure, oral malfunction and some psychological factors in relation to depressed mood, but not anthropometric measurements, are characteristic of prefrailty. Geriatr Gerontol Int 2016; ••: ••–••.

  December 09, 2016   doi: 10.1111/ggi.12935   open full text
• Effect of galantamine on attention in patients with Alzheimer's disease combined with cerebrovascular disease.
  Jeong Jin Park, Seong Hye Choi, SangYun Kim, Ae Young Lee, So Young Moon, Jun Hong Lee, Jae Cheol Kwon, Kyung Won Park, Bon D. Ku, Hyun Jeong Han, Eun‐Joo Kim, Yong S. Shim.
  Geriatrics and Gerontology International. December 09, 2016
  Aim Patients with Alzheimer's disease (AD) and cerebrovascular disease (CVD) show greater attentional deficits compared with AD patients without CVD. The aim of the present study was to investigate the effect of galantamine on attention in AD patients with CVD. Methods In this open trial, 1512 patients with AD and CVD were recruited from 71 nationwide hospitals. The patients were given galantamine for 16 weeks. The primary outcome measure was the score on the Attention Questionnaire Scale (AQS), which measures the patients’ attention in their daily lives. The secondary outcome measures were the scores on the Korean Mini‐Mental State Examination, the Clinical Dementia Rating scale and the Global Deterioration Scale. Efficacy measures were calculated both at baseline and at the end of the treatment (week 16). Results The responders rate on the AQS (change of the AQS from baseline >0) was 60.6% in AD patients with CVD. At the end of the treatment, both the AQS (15.0 ± 5.7 vs 16.3 ± 5.8, P < 0.001) and the Korean Mini‐Mental State Examination scores (17.8 ± 4.8 vs 18.1 ± 5.1, P < 0.001) showed a significant improvement relative to the baseline performance. The Clinical Dementia Rating (1.25 ± 0.59 vs 1.22 ± 0.63 P = 0.025) and Global Deterioration Scale (3.82 ± 0.94 vs 3.76 ± 0.96, P = 0.002) scores also showed a significant decrease at the end of the treatment. Conclusions Galantamine is effective in improving attention in the daily lives of AD patients with CVD. Geriatr Gerontol Int 2016; ••: ••–••.

  December 09, 2016   doi: 10.1111/ggi.12934   open full text
• Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents.
  Dagmar Dräger, Andrea Budnick, Ronny Kuhnert, Sonja Kalinowski, Franziska Könner, Reinhold Kreutz.
  Geriatrics and Gerontology International. December 09, 2016
  Aim Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. Methods In a cluster‐randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. Results The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6‐month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. Conclusions Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long‐term implementation appears necessary. Geriatr Gerontol Int 2016; ••: ••–••.

  December 09, 2016   doi: 10.1111/ggi.12924   open full text
• Interrelationship between Mini‐Mental State Examination scores and biochemical parameters in patients with mild cognitive impairment and Alzheimer's disease.
  Ramasamy Vasantharekha, Hannah P. Priyanka, Thangavel Swarnalingam, Avathvadi Venkatesan Srinivasan, Srinivasan ThyagaRajan.
  Geriatrics and Gerontology International. December 06, 2016
  Aim The aim of the present study was to provide first‐hand information about the prevalence of mild cognitive impairment (MCI) and Alzheimer's disease (AD) in Tamil Nadu, a southern state in India, and examine if there exists a relationship between cognitive functions and biochemical parameters in these patients. Methods Surveys were collected from adults, older men and women (n = 3126) from different regions of Tamil Nadu, which were followed up after 12 months for 1337 participants. Mini‐Mental State Examination (MMSE) scores, lipid profile, and liver function tests were carried out in the elderly, MCI and AD patients. Based on the MMSE scores, the elderly population was classified into old control (28.97 ± 1.49; n = 1868), MCI (19.58 ± 1.17; n = 734) and AD (7.18 ± 1.38; n = 304) groups. Peripheral blood samples were collected after overnight fast from both male and female volunteers (n = 40 per group) who were categorized as young adult control, old control, MCI and AD. Results AD patients showed lower MMSE scores compared with the young adults, old and MCI groups, and MMSE further decreased at follow‐up examination a year later. In the serum of AD patients, high‐density lipoprotein, alkaline phosphatase activity and bilirubin levels were lower, whereas low‐density lipoprotein, total cholesterol and triglycerides levels were higher. MMSE was positively correlated with high‐density lipoprotein, and negatively correlated with other lipid parameters in AD. Conclusions Hypercholesterolemia is a risk factor for AD that might result in neurotoxicity and cognitive impairment. Dysfunction of lipoprotein and heme metabolism might also provide additional targets for AD diagnosis. Geriatr Gerontol Int 2016; ••: ••–••.

  December 06, 2016   doi: 10.1111/ggi.12957   open full text
• Agreement between Chronic Kidney Disease Epidemiological Collaboration and Berlin Initiative Study equations for estimating glomerular filtration rate in older people: The Invecchiare in Chianti (Aging in Chianti Region) study.
  Andrea Corsonello, Claudio Pedone, Stefania Bandinelli, Luigi Ferrucci, Raffaele Antonelli Incalzi.
  Geriatrics and Gerontology International. December 05, 2016
  Aim The aim was to investigate to what extent chronic kidney disease (CKD) can be staged interchangeably by Chronic Kidney Disease Epidemiological Collaboration (CKD‐EPI) and by Berlin Initiative Study (BIS) equations, and to verify whether cystatin C can improve concordance between formulas. Methods Our series consisted of 828 community‐dwelling individuals aged 65 years or older enrolled in the Invecchiare in Chianti Study (“Aging in the Chianti Region”). Estimated glomerular filtration rate was calculated using the creatinine‐based CKD‐EPI, creatinine/cystatin C‐based CKD‐EPI, creatinine‐based BIS and creatinine/cystatin C‐based BIS equations. Agreement and sources of discrepancy between equations in identifying people with different degrees of kidney dysfunction was investigated by κ statistic and Bland–Altman plots. Results Overall, CKD‐EPI values were higher than that obtained with BIS equations, especially for eGFR = 30–60 mL/min/1.73 m2. A total of 191 out of 828 participants were classified in stage 2 by the creatinine‐based CKD‐EPI and in stage 3a by the creatinine‐based BIS equation, whereas 123 participants were classified in stage 2 by creatinine/cystatin C‐based CKD‐EPI and in stage 3a by the creatinine/cystatin C‐based BIS equation. A total of 27 participants were classified in stage 3a by creatinine‐based CKD‐EPI and in stage 3b by creatinine‐based BIS equation, whereas 18 were classified as stage 3a by creatinine/cystatin C‐based CKD‐EPI and stage 3b by the creatinine/cystatin C‐based BIS equation. Conclusions Despite a fair overall concordance, the CKD‐EPI and BIS equations cannot be considered interchangeable to assess estimated glomerular filtration rate in older people, and using creatinine/cystatin C‐based rather than creatinine‐based equations only marginally improves the concordance between CKD‐EPI and BIS. Disagreement between equations might significantly impact the applications of stage‐specific measures for managing CKD among older people. Geriatr Gerontol Int 2016; ••: ••–••.

  December 05, 2016   doi: 10.1111/ggi.12932   open full text
• Fear of falling and physical function in older adults with cataract: Exploring the role of vision as a moderator.
  Anna Palagyi, Jonathon Q Ng, Kris Rogers, Lynn Meuleners, Peter McCluskey, Andrew White, Nigel Morlet, Lisa Keay.
  Geriatrics and Gerontology International. December 04, 2016
  Aim To examine fear of falling and associated factors in a cohort of older adults with cataract, and investigate the interplay of vision and physical function with respect to fear of falling. Methods We analyzed baseline data from a longitudinal study of adults aged ≥65 years referred for cataract surgery. Fear of falling was assessed by the Short Falls Efficacy Scale‐International. Physical function was determined by the Short Physical Performance Battery. Participants underwent assessment of visual acuity, contrast sensitivity, visual disability, quality of life, depressive symptoms, exercise frequency, comorbidity and falls history. Factors associated with fear of falling were assessed using linear regression. Planned stepwise regression investigated vision as a potential moderator of the relationship between physical function and fear of falling. Results Among 322 participants, 32.9 % (n = 106) showed high fear of falling. Poorer physical function, more comorbidities and greater visual disability were independently associated with a higher fear of falling (all P < 0.001). Visual disability moderated the relationship between physical function and fear of falling (β = −0.10, P = 0.04). The impact of physical function on fear of falling was strongest in participants with higher (+1 standard deviation above the mean) visual disability (b = −0.21, P < 0.001). Conclusions Fear of falling in older adults with cataract is greatest in those with poorer physical function and higher levels of visual disability. Perceived visual ability has a moderating role in the relationship between physical function and fear of falling; physical function alone might not adequately predict falls concern. Geriatr Gerontol Int 2016; ••: ••–••.

  December 04, 2016   doi: 10.1111/ggi.12930   open full text
• Memory performance on the story recall test and prediction of cognitive dysfunction progression in mild cognitive impairment and Alzheimer's dementia.
  Jong‐Hwan Park, Hyuntae Park, Sang Wuk Sohn, Sungjae Kim, Kyung Won Park.
  Geriatrics and Gerontology International. December 01, 2016
  Aim To determine the factors that influence diagnosis and differentiation of patients with mild cognitive impairment (MCI) and Alzheimer's dementia (AD) by comparing memory test results at baseline with those at 1–2‐year follow up. Methods We consecutively recruited 23 healthy participants, 44 MCI patients and 27 patients with very mild AD according to the National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorder Association criteria for probable Alzheimer's disease and Petersen's clinical diagnostic criteria. We carried out detailed neuropsychological tests, including the Story Recall Test (SRT) and the Seoul Verbal Learning Test, for all participants. We defined study participants as the “progression group” as follows: (i) participants who showed conversion to dementia from the MCI state; and (ii) those with dementia who showed more than a three‐point decrement in their Mini‐Mental State Examination scores with accompanying functional decline from baseline status, which were ascertained by physician's clinical judgment. Results The SRT delayed recall scores were significantly lower in the patients with mild AD than in those with MCI and after progression. Lower (relative risk 1.1, 95% confidence interval 0.1–1.6) and higher SRT delayed recall scores (relative risk 2.1, confidence interval 1.0–2.8), and two‐test combined immediate and delayed recall scores (relative risk 2.0, confidence interval 0.9–2.3; and relative risk 2.8, confidence interval 1.1–4.2, respectively) were independent predictors of progression in a stepwise multiple adjusted Cox proportional hazards model, with age, sex, depression and educational level forced into the model. Conclusions The present study suggests that the SRT delayed recall score independently predicts progression to dementia in patients with MCI. Geriatr Gerontol Int 2016; ••: ••–••.

  December 01, 2016   doi: 10.1111/ggi.12940   open full text
• Dysphagia is associated with functional decline during acute‐care hospitalization of older patients.
  Haruyo Matsuo, Yoshihiro Yoshimura, Naoki Ishizaki, Tsuyoshi Ueno.
  Geriatrics and Gerontology International. December 01, 2016
  Aim Physical function is considered to be associated with dysphagia: however, there is little data regarding the association between dysphagia and functional decline during hospitalization among older patients. The aim of the present study was to investigate the prevalence of dysphagia, and the association between dysphagia and functional status during hospitalization in older acute‐care patients. Methods A total of 103 older patients without present or prior history of diseases that could directly impair swallowing and cause dysphagia (45 men and 58 women; mean age 80.5 years) hospitalized in acute‐care wards were included in the present study. Dysphagia or difficulty swallowing was assessed by using the 10‐item Eating Assessment Tool. Functional and nutritional status, such as Barthel Index (BI), Mini‐Nutritional Assessment short form, body mass index, calf circumference, handgrip strength and dysphagia, were analyzed to evaluate their relationships. Results Dysphagia, as assessed using the 10‐item Eating Assessment Tool, was noted in 26.2% of the participants. Multivariate analysis showed that dysphagia, handgrip strength and BI on admission were independently associated with poor BI gain during hospitalization after adjustment for age, sex, causative disease for admission, premorbid ADL, length of hospital stay, Mini‐Nutritional Assessment short form, handgrip strength and BI. Conclusions Dysphagia, as assessed by the 10‐item Eating Assessment Tool, was common in older patients. In addition, dysphagia was independently associated with poorer functional recovery during acute‐care hospitalization of older patients. Geriatr Gerontol Int 2016; ••: ••–••.

  December 01, 2016   doi: 10.1111/ggi.12941   open full text
• Predictors of rehospitalization among older adults: Results of the CRIME Study.
  Federica Sganga, Francesco Landi, Stefano Volpato, Antonio Cherubini, Carmelinda Ruggiero, Andrea Corsonello, Paolo Fabbietti, Fabrizia Lattanzio, Ester Manes Gravina, Roberto Bernabei, Graziano Onder.
  Geriatrics and Gerontology International. November 21, 2016
  Aim To assess the predictors of readmission among older adults hospitalized in acute care wards. Methods A prospective cohort study was carried out among 921 hospitalized older adults participating in the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) project. The primary outcome of the study was rehospitalization within 1 year after discharge from acute care hospitals. We assessed the participants with a questionnaire including 350 items about demographic, social and clinical characteristics. We analyzed all factors at discharge that could be considered predictors of readmission. Results The mean age of the participants was 81.2 years (SD 7.4 years), and 509 were women (55.3%). Overall, 280 of 921 patients (30.4%) were rehospitalized during the 1‐year follow up of the study. Patients with a Mini‐Mental State Examination score equal to or higher than 24 had a higher probability of rehospitalization, as compared with those who performed lower than 24 (OR 1.76, 95% CI 1.04–2.83). In addition, heart failure (OR 1.77, 95% CI 1.14–2.24), the number of falls during 1‐year follow up (OR 1.15, 95% CI 1.05–1.28) and the number of drugs during first hospitalization (OR 1.15, 95% CI 1.01–1.07) were significantly associated with rehospitalization, whereas no significant association was shown for age, sex and walking speed for minimum size (OR 1.15, 95% CI 0.99–2.00). Conclusions Predictors of readmission in older people are an intact cognitive status; the presence of a geriatric condition, such as heart failure and falls; and a high number of drugs during first hospitalization. Further studies are required to assess the impact of home care for avoiding readmission in patients with an intact cognitive status, and supporting and treating patients with dementia. Geriatr Gerontol Int 2016; ••: ••–••.

  November 21, 2016   doi: 10.1111/ggi.12938   open full text
• Association between dialysis treatment and cognitive decline: A study from the Project in Sado for Total Health (PROST), Japan.
  Yumi Watanabe, Kaori Kitamura, Kazutoshi Nakamura, Kazuhiro Sanpei, Minako Wakasugi, Akio Yokoseki, Keiko Kabasawa, Osamu Onodera, Takeshi Ikeuchi, Ryozo Kuwano, Takeshi Momotsu, Ichiei Narita, Naoto Endo.
  Geriatrics and Gerontology International. November 21, 2016
  Aim Evidence for the association between dialysis treatment and cognitive decline is limited. The present study aimed to determine whether dialysis treatment is associated with cognitive decline in adult outpatients of a general hospital in Japan. Methods This was a cross‐sectional substudy of the Project in Sado for Total Health (PROST). Total Health PROST targeted adult outpatients of a general hospital in Sado City, Niigata, Japan. Among 753 patients (mean age 68.1 ± 11.6 years) analyzed, 66 received dialysis. Cognitive state was evaluated using the Mini‐Mental State Examination, and those with a Mini‐Mental State Examination score <24 were considered “cognitively declined.” The prevalence of cognitive decline was compared by odds ratios calculated with multiple logistic regression analysis. Variables included in the analyses were dialysis, age, sex and self‐reported histories of hypertension, diabetes, stroke and ischemic heart disease. Results Of the 66 dialysis patients, 24 (36.4%) showed cognitive decline, whereas 172 (25.0%) of 687 non‐dialysis patients showed cognitive decline. The age and sex‐adjusted odds ratio for cognitive decline in dialysis patients was 2.57 (95% confidence interval 1.43–4.61), relative to non‐dialysis patients. The odds ratio remained significant (odds ratio 2.69, 95% confidence interval 1.49–4.88) even after adjusting for all covariates. Conclusion The prevalence of cognitive decline was high in dialysis patients relative to non‐dialysis patients among outpatients of a general hospital in Japan. Geriatr Gerontol Int 2016; ••: ••–••.

  November 21, 2016   doi: 10.1111/ggi.12937   open full text
• Social participation, willingness and quality of life: A population‐based study among older adults in rural areas of China.
  Qian He, Yanjie Cui, Ling Liang, Qi Zhong, Jie Li, Yuancheng Li, Xiaofeng Lv, Fen Huang.
  Geriatrics and Gerontology International. November 21, 2016
  Aim The present study aimed to reflect the current situation of social participation in rural areas of China, willingness to participate in social activities, association between health‐related quality of life and social participation, and factors related to social participation. Methods A total of 2644 rural adults aged 60 years and older were randomly selected and surveyed with a self‐rating questionnaire. We used the unified definition of social participation in our study. The Medical Outcomes Study Short‐Form Health Survey was used to measure health‐related quality of life. Results The overall engagement of social activities was 26%. Those who participated in social activities were more likely to have high scores of health‐related quality of life. Older men with a high educational level (OR 1.59, 95% CI 1.01–2.29) living alone or with a spouse (OR 1.51, 95% CI 1.08–2.12), high objective social support (OR 1.08, 95% CI 1.00–1.17) and high support utilization (OR 1.13, 95% CI 1.07–1.21) were inclined to engage in social participation. Older women with high individual income (OR 1.74, 95% CI 1.25–2.43), single marital status (OR 1.53, 95% CI 1.11–2.10), normal weight (OR 1.92, 95% CI 1.10–3.34), overweight (OR 2.28, 95% CI 1.24–4.19), living alone or with a spouse (OR 1.55, 95% CI 1.20–2.00), objective social support (OR 1.11, 95% CI 1.04–1.18) and subjective social support (OR 1.15, 95% CI 1.10–1.20) were more willing to engage in social participation. Conclusions Engagement in social activities is relatively low in rural areas, and associations of willingness and health‐related quality of life with social participation were found. Policy‐makers and government workers should make appropriate types of encouragement policies around social participation for older adults in rural areas. Geriatr Gerontol Int 2016; ••: ••–••.

  November 21, 2016   doi: 10.1111/ggi.12939   open full text
• Cognitive abilities predict death during the next 15 years in older Japanese adults.
  Yukiko Nishita, Chikako Tange, Makiko Tomida, Rei Otsuka, Fujiko Ando, Hiroshi Shimokata.
  Geriatrics and Gerontology International. November 17, 2016
  Aim The longitudinal relationship between cognitive abilities and subsequent death was investigated among community‐dwelling older Japanese adults. Methods Participants (n = 1060; age range 60–79 years) comprised the first‐wave participants of the National Institute for Longevity Sciences‐Longitudinal Study of Aging. Participants’ cognitive abilities were measured at baseline using the Japanese Wechsler Adult Intelligence Scale‐Revised Short Form, which includes the following tests: Information (general knowledge), Similarities (logical abstract thinking), Picture Completion (visual perception and long‐term visual memory) and Digit Symbol (information processing speed). By each cognitive test score, participants were classified into three groups: the high‐level group (≥ the mean + 1SD), the low–level group (≤ the mean – 1SD) and the middle‐level group. Data on death and moving during the subsequent 15 years were collected and analyzed using the multiple Cox proportional hazard model adjusted for physical and psychosocial covariates. Results During the follow‐up period, 308 participants (29.06%) had died and 93 participants (8.77%) had moved. In the Similarities test, adjusted hazard ratios (HR) of the low‐level group to the high‐level group were significant (HR 1.49, 95% CI 1.02–2.17, P = 0.038). Furthermore, in the Digit symbol test, the adjusted HR of the low‐level group to the high‐level group was significant (HR 1.62, 95% CI 1.03–2.58, P = 0.038). Significant adjusted HR were not observed for the Information or Picture Completion tests. Conclusions It is suggested that a lower level of logical abstract thinking and slower information processing speed are associated with shorter survival among older Japanese adults. Geriatr Gerontol Int 2016; ••: ••–••.

  November 17, 2016   doi: 10.1111/ggi.12952   open full text
• N‐terminal pro‐brain natriuretic peptide is a useful marker to identify latent heart failure patients in older adults in a rural outpatient clinic.
  Kosuke Hamagawa, Toru Kubo, Kotaro Nishimura, Yuichi Baba, Takayoshi Hirota, Naohito Yamasaki, Hiroaki Kitaoka.
  Geriatrics and Gerontology International. November 17, 2016
  Aim Although measurement of natriuretic peptides including N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) has been recommended for identifying heart failure (HF) patients, the prevalence of elderly patients with latent HF who are attending an outpatient clinic is unknown. Methods We measured NT‐proBNP levels in 393 patients (aged 75 ± 9 years) in a rural outpatient clinic. Patients with a diagnosis of heart disease were excluded. The patients were divided into two groups by the values of NT‐proBNP: high NT‐proBNP group (>400 pg/mL) and low NT‐proBNP group (≤400 pg/mL) according to Japanese guidelines. Patients with a high NT‐proBNP value underwent echocardiography including tissue Doppler examination. Results A total of 43 (11%) patients had high NT‐proBNP values. Those patients were older, and larger percentages of those patients were male, had atrial fibrillation, history of stroke and dementia. Echocardiography was carried out in 39 of the 43 patients with high NT‐proBNP values, and there were four patients with left ventricular systolic dysfunction, two with hypertrophic cardiomyopathy and one with aortic regurgitation. In the remaining 32 patients, 27 patients had diastolic HF in accordance with Japanese guidelines. A diagnosis of HF according to the guidelines was finally made in 34 (87 %) of the 39 patients. Conclusions A large number of elderly patients without a diagnosis of HF who were attending an outpatient clinic showed high levels of NT‐proBNP, and measurement of NT‐proBNP is useful to identify patients with latent HF. Geriatr Gerontol Int 2016; ••: ••–••.

  November 17, 2016   doi: 10.1111/ggi.12951   open full text
• Frailty and sarcopenia in subjects with Alzheimer's disease with or without cerebrovascular disease.
  Daisuke Hirose, Haruo Hanyu, Raita Fukasawa, Hirokuni Hatanaka, Nayuta Namioka, Hirofumi Sakurai.
  Geriatrics and Gerontology International. November 14, 2016
  There is no abstract available for this paper.

  November 14, 2016   doi: 10.1111/ggi.12709   open full text
• Neuropsychological differences in Alzheimer's disease patients with or without type 2 diabetes mellitus.
  Madoka Yanagawa, Hiroyuki Umegaki, Taeko Makino, Hirotaka Nakashima, Masafumi Kuzuya.
  Geriatrics and Gerontology International. November 14, 2016
  There is no abstract available for this paper.

  November 14, 2016   doi: 10.1111/ggi.12703   open full text
• Angiotensin‐converting enzyme insertion/deletion polymorphism and the longitudinal progression of Alzheimer's disease.
  Ping‐Song Chou, Meng‐Ni Wu, Mei‐Chuan Chou, I Chien, Yuan‐Han Yang.
  Geriatrics and Gerontology International. November 10, 2016
  Aim The angiotensin‐converting enzyme gene (ACE) insertion (I)/deletion (D) polymorphism is considered a biologically plausible gene for Alzheimer's disease (AD) in cross‐sectional studies. The present study aimed to investigate the longitudinal effect of ACE I/D polymorphism on AD progression. Methods This 3‐year observational study investigated the longitudinal effect of ACE I/D polymorphism on AD progression. Clinically diagnosed AD patients with a clinical dementia rating (CDR) of 0.5 or 1 were enrolled in the study. The Mini‐Mental State Examination (MMSE), Cognitive Assessment Screening Instrument (CASI) and the CDR scale were carried out for all patients on the date of the initial interview and 36 ± 6 months after the initial evaluation. Results A total of 177 patients with sporadic AD were enrolled in this study. Among all patients, those with the I/I genotype showed a higher risk of CDR deterioration (I/I versus I/D + D/D: adjusted OR 2.103, 95% CI 1.113–3.972; adjusted P = 0.022). Among 74 AD patients without hypertension, those with the I/I genotype showed significantly greater differences in the MMSE, CASI and the CDR‐sum of box scores, and a higher risk of CDR deterioration (I/I versus I/D + D/D: adjusted OR 3.255, 95% CI 1.099–9.639; adjusted P = 0.033) after adjustment for possible confounders during the 3‐year follow up. Conclusions Patients with AD who were homozygous for the I allele presented with a more rapid AD deterioration than did those who had other ACE genotypes, particularly those patients without hypertension. Geriatr Gerontol Int 2016; ••: ••–••.

  November 10, 2016   doi: 10.1111/ggi.12929   open full text
• Does being assisted by care workers affect antipsychotics prescription among older people discharged from hospital?
  Mirko Di Rosa, Paolo Fabbietti, Andrea Corsonello, Sergio Fusco, Federica Sganga, Stefano Volpato, Carmelinda Ruggiero, Graziano Onder, Fabrizia Lattanzio.
  Geriatrics and Gerontology International. November 10, 2016
  Aim Several factors can affect antipsychotic prescriptions, among which, caregivers. However, whether being assisted by a care worker might increase the rate of antipsychotic prescriptions at discharge from acute care hospital has not been previously investigated. We aimed to investigate whether being assisted by a care worker is associated with increased use of antipsychotics among older patients discharged from acute care hospitals. Methods The present series consisted of 928 patients not taking antipsychotics at admission in seven acute care wards of geriatric medicine in Italy (mean age 80.8 ± 7.2 years, 54.9% women). The outcome of the study was defined as receiving an antipsychotic prescription at discharge. Patients were grouped according to their living conditions as follows: (i) living alone; (ii) living only with care worker; (iii) living with care worker and family members; and (iv) living only with family members. The association between study variables and antipsychotic prescription at discharge was investigated by logistic regression analysis. Results After adjusting for potential confounders, being assisted by care workers was significantly associated with the outcome (OR 2.64, 95% CI 1.21–5.75). Diagnosis of dementia (OR 2.73, 95% CI 1.65–4.51), instrumental activities of daily living limitations (OR 1.12, 95% CI 1.05–1.21) and delirium during stay (OR 3.87, 95% CI 2.01–7.47) also qualified as independent correlates of antipsychotic prescription at discharge. Conclusions Being assisted by care workers could increase the likelihood of receiving antipsychotics at discharge from acute care hospitals. Geriatr Gerontol Int 2016; ••: ••–••.

  November 10, 2016   doi: 10.1111/ggi.12931   open full text
• Cholinesterase inhibitors and dramatic emotional therapy for dementia patients.
  Yuhsaku Maeda, Eriko Kaneda, Suguru Hasegawa, Shingo Yoshida, Masahiko Fujii, Hidetada Sasaki.
  Geriatrics and Gerontology International. October 19, 2016
  There is no abstract available for this paper.

  October 19, 2016   doi: 10.1111/ggi.12693   open full text
• Bullous pemphigoid and percutaneous endoscopic gastrostomy.
  Tsukasa Nozu, Toshikatsu Okumura.
  Geriatrics and Gerontology International. October 19, 2016
  There is no abstract available for this paper.

  October 19, 2016   doi: 10.1111/ggi.12690   open full text
• Total anticholinergic burden and survival within a cohort of elderly Mexican Americans.
  G Blair Sarbacker, David V Espino, Robert C Wood, Sandra L Oakes, Dheeraj Anand, Kyriakos A Markides.
  Geriatrics and Gerontology International. October 10, 2016
  Aim Studies examining the association between mortality and anticholinergic burden in the geriatric population are conflicting and are absent in the Mexican American population. The present study aimed to determine whether higher anticholinergic burden increases mortality in a cohort representative of community‐based older Mexican Americans in the USA. Methods This retrospective cohort database study used the Hispanic Established Populations for the Epidemiologic Study of the Elderly cohort. The primary outcome, mortality, was assessed beginning at the second interview in 1995 until the fifth interview in 2005. Medications were classified for anticholinergic burden according to the modified‐Anticholinergic Drug Scale and were summed across all reported medications creating a measure of total anticholinergic burden. Anticholinergic burden was tested for association with mortality using survival analysis. Results The 1497 older adults reporting medication usage were included. Survival analysis showed a statistically significant (P < 0.05) relationship between anticholinergic burden and increased mortality. Conclusions Anticholinergic burden is associated with increased mortality in Southwestern Mexican American older adults who report taking prescription or non prescription medications. These findings suggest that anticholinergic burden might be a risk factor for mortality in this selected population, with additional studies required to further define the risk. Geriatr Gerontol Int 2016; ••: ••–••.

  October 10, 2016   doi: 10.1111/ggi.12907   open full text
• Association between the older adults’ social relationships and functional status in Japan.
  Kumi Watanabe, Emiko Tanaka, Taeko Watanabe, Wencan Chen, Bailiang Wu, Sumio Ito, Rika Okumura, Tokie Anme.
  Geriatrics and Gerontology International. October 10, 2016
  Aim Previous studies have shown that social relationships positively contribute to the functioning of older adults. However, the particular aspects of social relationships that are most predictive remain unknown. Consequently, the current study aimed to clarify what elements of social relationships impacted the maintenance of functioning among older adults. Methods The present study used baseline data collected in 2011, and follow‐up surveys were carried out 3 years later. Participants included individuals aged 65 years or older who lived in a suburban community in Japan. A total of 434 participants met inclusion criteria for the study and were included in analysis. The Index of Social Interaction measure consists of five subscales (independence, social curiosity, interaction, participation and feeling of safety), and was used to assess the multiple elements of social relationships. Results After controlling for age, sex, disease status and mobility in 2011, the results showed that the social curiosity subscale was significantly associated with functional status after 3 years (OR 1.29, 95% CI 1.02–1.63). Other Index of Social Interaction subscales were non‐significant. Conclusions The current study suggests that interaction with environment and multifaceted social relationships have the strongest impact on functional ability for older adults in Japan. Geriatr Gerontol Int 2016; ••: ••–••.

  October 10, 2016   doi: 10.1111/ggi.12909   open full text
• Depressive symptoms modify age effects on hippocampal subfields in older adults.
  Sarah M Szymkowicz, Molly E McLaren, Andrew O'Shea, Adam J Woods, Stephen D Anton, Vonetta M Dotson.
  Geriatrics and Gerontology International. October 02, 2016
  Aim Major depression is associated with hippocampal volume changes, especially in late‐life depression. These changes usually consist of volume reductions, but depression‐related increases in hippocampal volume have also been reported. Subfield analysis has identified structural changes primarily in the cornu ammonis (CA) 1, CA2–3 and subiculum of the hippocampus in individuals with major depression; however, it is unclear whether lower levels of depressive symptoms are also associated volume reduction, or if depressive symptoms interact with age to impact hippocampal subfields. The current study addressed these questions. Methods A total of 43 community‐dwelling older adults completed the Center for Epidemiologic Studies Depression Scale and underwent magnetic resonance imaging. Hippocampal subfield segmentation was carried out using an automated procedure, and left and right volumes from CA1, CA2‐3, and the subiculum served as outcome measures. Multiple hierarchical regressions were carried out with age, Center for Epidemiologic Studies Depression Scale scores and their interaction as the independent variables, and sex and total intracranial volume as covariates. Results Higher Center for Epidemiologic Studies Depression Scale scores were associated with less age‐related volumetric decreases in the right subiculum and right CA1. Conclusions Age‐related atrophy in the hippocampus might be counteracted by depressive symptom‐related enlargement of CA1 and the subiculum. More research is required to better understand the functional significance of this relationship. Geriatr Gerontol Int 2016; ••: ••–••.

  October 02, 2016   doi: 10.1111/ggi.12901   open full text
• Mobility, balance and frailty in community‐dwelling older adults: What is the best 1‐year predictor of falls?
  Anna Mulasso, Mattia Roppolo, Robbert J Gobbens, Emanuela Rabaglietti.
  Geriatrics and Gerontology International. September 29, 2016
  Aim The present study aimed, first, to compare the ability to predict falls over 12 months for three measures – mobility, balance and frailty. Second, among the three domains of frailty – physical, psychological and social – we investigated what is the strongest predictor of falls. Methods A total of 192 community‐dwelling older adults (age 73.0 ± 6.2 years; 62% women) were involved in this longitudinal study. The Timed Up and Go (TUG) test, One Leg Standing (OLS) test and the Tilburg Frailty Indicator (TFI) were respectively used to measure mobility, balance and frailty. The TFI is a questionnaire based on a multidimensional conceptualization of frailty consisting of 15 items in three domains (physical, psychological and social). Falls were self‐reported during the 12‐month follow up. Logistic regression models, adjusted for interesting variables, were carried out to predict the risk of falls. Results History of falls and chronic conditions were the indicators more strongly related with falls over 12 months. The TFI resulted as a stronger predictor of falls when compared with the TUG and OLS tests. The explained variance of the three models was 31.2%, 22.4% and 22.2%, respectively. The TFI was significantly associated with falls (P < 0.001), whereas the TUG and the OLS were not (P > 0.05). Among the three frailty domains, physical (P < 0.001) and psychological (P = 0.041) domains were significant predictors of falls. Conclusions The findings showed that the TFI might be an effective tool for predicting falls at 12 months in aged populations, probably because it is able to capture the multifactorial facets that can lead to falls. Geriatr Gerontol Int 2016; ••: ••–••.

  September 29, 2016   doi: 10.1111/ggi.12893   open full text
• Long sleep duration, independent of frailty and chronic Inflammation, was associated with higher mortality: A national population‐based study.
  Wei‐Ju Lee, Li‐Ning Peng, Chih‐Kuang Liang, Shu‐Ti Chiou, Liang‐Kung Chen.
  Geriatrics and Gerontology International. September 29, 2016
  Aim There is a complex interrelationship between long sleep duration, frailty, chronic inflammation and mortality among the community‐dwelling middle‐aged and elderly population, which remains unclear and deserves to be investigated. The current study intended to explore these associations by using a prospective population‐based cohort study. Methods A total of 937 community‐dwelling middle‐aged and elderly people were enrolled. Sleep patterns of the study participants were categorized as short (<6 h), average or long (≥8 h). Sleep disturbance was defined by daytime dysfunction defined by the Pittsburg Sleep Quality Index. Frailty was defined as three or more phenotypes of Fried's Frailty. Results During an average of 4.7 years follow up, 72 (7.7%) study participants died. The adjusted hazard ratio (HR) for death of long sleepers was 2.42 (95% confidence interval [CI] 1.38–4.27), HR of long sleepers plus frailty was 2.37 (95% CI 1.35–4.19) and HR of long sleepers plus log interleukin‐6 was 2.11 (95% CI 1.19–3.76). Adjusted HR of daytime dysfunction was 1.79 (95% CI 1.09–2.94). The association between daytime dysfunction and mortality became statistical insignificant after further adjustment for frailty. Conclusions Long sleep duration, independent of frailty and interleukin‐6, was associated with 5‐year mortality in older adults. The relationship between daytime dysfunction and death diminished after adjusting for frailty. Geriatr Gerontol Int 2016; ••: ••–••.

  September 29, 2016   doi: 10.1111/ggi.12899   open full text
• Influence of cerebral white matter hyperintensities on cognitive impairment in elderly medical patients.
  Koichi Shibata, Yoshiko Nishimura, Kuniaki Otsuka, Hiroshi Sakura.
  Geriatrics and Gerontology International. September 29, 2016
  Aim We investigated the characteristics of elderly medical patients with white matter hyperintensities on magnetic resonance imaging. Methods A total of 213 patients (123 men and 90 women; mean age 74.8 years) reported their history of hypertension, diabetes, dyslipidemia, previous stroke, coronary heart disease and chronic kidney disease (CKD). All patients completed the Mini‐Mental State Examination and Geriatric Depression Scale. White matter hyperintensities were evaluated for the periventricular region, basal ganglia (BGH), deep white matter and infratentorial region, and brain atrophy was calculated as bicaudate ratios. Results Patients with cognitive impairment (Mini‐Mental State Examination score < 24) were significantly older (P = 0.001), had periventricular region hyperintensities (P = 0.029) and BGH (P = 0.0015), and showed atrophy (P < 0.0001). Logistic regression showed that cognitive impairment was predicted by stroke (OR 2.5, 95% CI 0.033–0.894, P = 0.036) and atrophy (OR 8.43, 95% CI 5.71–37.0, P = 0.0109). Multiple regressions showed that BGH was associated with CKD (β = 0.213; P = 0.003), and infratentorial region was associated with stroke (β = 0.157; P =0.035) and CKD (β = 0.172; P = 0.016). Periventricular region was associated with age (β = 0.2; P = 0.011) and Geriatric Depression Scale (β = 0.151; P = 0.037), and deep white matter hyperintensities with age (β = 0.189; P = 0.016). Conclusions Although cognitive impairment in elderly medical patients is associated with stroke and brain atrophy, white matter hyperintensities, especially BGH and infratentorial region, are associated with cognitive decline in relation to CKD. Geriatr Gerontol Int 2016; ••: ••–••.

  September 29, 2016   doi: 10.1111/ggi.12900   open full text
• Relationship between chronic kidney disease with diabetes or hypertension and frailty in community‐dwelling Japanese older adults.
  Sungchul Lee, Sangyoon Lee, Kazuhiro Harada, Seongryu Bae, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Hyuntae Park, Takao Suzuki, Hiroyuki Shimada.
  Geriatrics and Gerontology International. September 27, 2016
  Aim The aim of the present study was to evaluate the relationship between kidney function with concomitant diabetes or hypertension and frailty in community‐dwelling Japanese older adults. Methods The participants were 9606 residents (community‐dwelling Japanese older adults) who completed baseline assessments. The estimated glomerular filtration rate (mL/min/1.73 m2) was determined according to the serum creatinine level, and participants were classified into four mutually exclusive categories: ≥60.0 (normal range), 45.0–59.9, 30.0–44.9 and <30.0 mL/min/1.73 m2. Frailty status was defined using five criteria as described by Fried: slow gait speed, muscle weakness, low physical activity, exhaustion and unintentional weight loss. Participants who met three, four or five criteria satisfied the definition of having frailty. Multivariate logistic regression was used to examine the relationships between estimated glomerular filtration rate and frailty. Results After multivariate adjustment, participants with lower kidney function (estimated glomerular filtration rate <30.0 mL/min/1.73 m2) were more frail (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.01−3.59). In addition, individuals with a history of diabetes (OR 2.76, 95% CI 1.21−8.24) or hypertension (OR 2.53, 95% CI 1.45−5.12) showed a significantly increased risk of frailty in the lower kidney function group, regardless of multivariate controls. Furthermore, the analyses showed an even greater increase in the risk of frailty in patients with a history of both diabetes and hypertension (OR 3.67, 95% CI 1.13−14.1) Conclusions A lower level of kidney function was associated with a higher risk of frailty in community‐dwelling Japanese older adults. Geriatr Gerontol Int 2016; ••: ••–••.

  September 27, 2016   doi: 10.1111/ggi.12910   open full text
• Social activities are associated with cognitive decline in older Koreans.
  DaeHyun Kim, Hidenori Arai, SungHi Kim.
  Geriatrics and Gerontology International. September 26, 2016
  Aim Social activity seems to be important for the prevention of cognitive impairment and frailty. The objective of the present study was to investigate whether social activities are associated with the development of cognitive impairment in Korean older people. Methods We analyzed data from the Korean National Longitudinal Study on Aging. A total of 2495 Korean community‐dwelling older adults (1163 men and 1332 women) aged between 65 and 79 years at the first wave of the Korean National Longitudinal Study on Aging were used for analysis. Cognitive function was assessed by the Mini‐Mental State Examination in 2006 and 2012. Multiple logistic regression analysis was carried out by adjusting covariates, such as age, sex, education, employment, Center for Epidemiological Studies‐Depression and instrumental activities of daily living scores, and weight loss. Results Among the participants, 951 participants (38.1%) showed cognitive decline. Compared with those who participated in a large number of group social activities, multivariate‐adjusted odds ratios of cognitive decline in those who participated in a moderate and small number of group activities were 1.18 (95% CI 0.93–1.48) and 1.80 (95% CI 1.16–1.90), respectively. Among six types of group social activities, two types (social club/café and alumni) showed a significant correlation with less cognitive decline; adjusted odds ratios of the group with a small number of activities were 1.31 (95% CI 1.09–1.56) and 1.46 (95% CI 1.10–1.93), respectively, compared with the group with a large number of activities. Personal social activities and the other four types of activities (religious, political, leisure and volunteer) did not affect the outcome. Conclusions Two social group activities (social club/café and alumni) were significantly associated with less cognitive decline in older Koreans. Geriatr Gerontol Int 2017; 17: 1191–1196.

  September 26, 2016   doi: 10.1111/ggi.12861   open full text
• Risk factors for short‐ and long‐term mortality in very old patients with Clostridium difficile infection: A retrospective study.
  Yaara Leibovici‐Weissman, Alaa Atamna, Agata Schlesinger, Noa Eliakim‐Raz, Jihad Bishara, Dafna Yahav.
  Geriatrics and Gerontology International. September 20, 2016
  Aim Most cases of Clostridium difficile infections (CDI) occur in patients aged 65 years and older. Older age is associated with increased mortality. Risk factors for mortality in patients aged 80 years and older are not well recognized. Methods We analyzed retrospective data including 184 patients aged 80 years and older hospitalized with CDI during 2009–2014. We aimed to delineate risk factors for short‐ and long‐term mortality. Results The 30‐day mortality was 33.2%; 1‐year mortality was 64.7%. Median survival was 110 days (interquartile range 24–655 days). All four patients who underwent colectomy died. Risk factors for 30‐day mortality in multivariate analysis were diabetes mellitus, low albumin and therapy other than metronidazole monotherapy, the latter probably reflecting higher severity of disease rather than a true predictor of mortality. Risk factors for long‐term mortality analyzed in Cox regression were albumin ≤2.5 g/dL (HR 0.58, 95% CI 0.395–0.850), presentation with sepsis (HR 0.597, 95% CI 0.408–0.873), a non‐independent activities of daily living baseline status (HR 0.460, 95% CI 0.236–‐0.897) and Charlson score (HR 0.867, 95% CI 0.801–0.938). None of the traditional severity indices for CDI (such as leukocytosis or creatinine increase) proved to be predictors of mortality over the age of 80 years. Conclusions The prognosis of old patients with CDI is dismal. Considering the high mortality, efforts to prevent CDI should be first priority in patients aged 80 years and older. Assessment of albumin levels should be part of the evaluation at presentation and considered when choosing treatment, rather than standard severity indexes for CDI. Geriatr Gerontol Int 2016; ••: ••–••.

  September 20, 2016   doi: 10.1111/ggi.12866   open full text
• Indications, complications and outcomes of elderly patients undergoing retrievable inferior vena cava filter placement.
  Amihai Rottenstreich, Geffen Kleinstern, Allan I. Bloom, Alexander Klimov, Yosef Kalish.
  Geriatrics and Gerontology International. September 20, 2016
  Aim The utilization of inferior vena cava filter placement for pulmonary embolism prevention in elderly patients has not been well characterized. The present study aimed to review indications, complications and follow‐up data of elderly patients undergoing inferior vena cava filter placement. Methods A retrospective review was carried out of consecutive admitted patients who underwent inferior vena cava filter insertion at a large university hospital with a level I trauma center. Results Overall, 455 retrievable filters were inserted between 2009 and 2014. A total of 133 patients (29.2%) were aged ≥70 years. Elderly patients were less likely to have their filter retrieved compared with non‐elderly patients (5.3% vs 21.4%, P < 0.001). Filter‐related complications occurred in 13% of non‐elderly patients and 14.3% of elderly patients (P = 0.72), most of them occurring in the first 3 months after filter placement. Survival among elderly patients with no evidence of active malignancy was similar to the non‐elderly patients with a 1‐year survival rate of 76.3% versus 82% in non‐elderly patients (P = 0.22), and a 2‐year survival rate of 73.1% versus 78.6% in non‐elderly patients (P = 0.27). Although decreased, survival rates among elderly patients with active cancer were still substantial, with a 1‐year survival rate of 45% and 2‐year survival rate of 40%. Conclusions Elderly patients had significantly lower rates of filter retrieval with similar complication rate. Survival rates among elderly patients were substantial, and in elderly patients with no active cancer were even comparable with non‐elderly patients. When feasible, filter retrieval should be attempted in all elderly patients in order to prevent filter‐related complications. Geriatr Gerontol Int 2016; ••: ••–••.

  September 20, 2016   doi: 10.1111/ggi.12906   open full text
• Palliative care needs and symptoms of nursing home residents with and without dementia: A cross‐sectional study.
  Kirsten Hermans, Joachim Cohen, Nele Spruytte, Chantal Van Audenhove, Anja Declercq.
  Geriatrics and Gerontology International. September 16, 2016
  Aim The aims of the present study were: (i) to describe palliative care needs and symptoms of older adults anticipated to be in the last year of their life in Flemish nursing homes (Belgium); and (ii) to evaluate whether these needs differ between residents with and without dementia. Methods A cross‐sectional study was carried out in 2014. Nurses and nursing assistants in 15 Flemish nursing homes (Belgium) completed the Palliative care Outcome Scale for 109 residents with palliative care needs. Results Pain, as well as other physical symptoms, was present in more than half of the nursing home residents according to caregivers. The most prominent needs occurred on psychosocial and spiritual domains, such as patient anxiety, support, finding life worth living and self‐worth. Caregivers reported that residents with dementia experienced fewer physical symptoms apart from pain than did residents without dementia (coeffficient –0.73, 95% CI –1.18–0.84; P = 0.001. Furthermore, residents with dementia received higher scores on the items “support” (coefficient 0.75; 95% CI 0.15–1.34, P = 0.015), “life worthwhile” (coeffficient 0.58; 95% CI 0.090–1.07, P = 0.020) and “self‐worth” (coefficient 0.58, 95% CI 0.13–1.03, P = 0.012). Conclusions According to caregivers, residents with dementia experienced fewer other physical symptoms (e.g. nausea) than residents without dementia. This, however, might be a result of an underdetection of other symptoms in nursing home residents with dementia. Furthermore, most challenges in nursing homes lie within the spiritual and psychosocial domains of palliative care, particularly in people with dementia. These aspects should be integrated in the professional education of caregivers. Assessment tools might be of help to improve the identification of needs and symptoms. Geriatr Gerontol Int 2016; ••: ••–••.

  September 16, 2016   doi: 10.1111/ggi.12903   open full text
• Objectively‐measured outdoor time and physical and psychological function among older adults.
  Kazuhiro Harada, Sangyoon Lee, Sungchul Lee, Seongryu Bae, Kenji Harada, Takao Suzuki, Hiroyuki Shimada.
  Geriatrics and Gerontology International. September 16, 2016
  Aim Objective measurements of outdoor time are essential to establishing evidence about the health benefits of going outdoors among older adults. To better understanding the health benefits of going outdoors, clarification of potential mediators to connect going outdoors with health benefits is necessary. The present study aimed to investigate associations of objectively‐measured outdoor time with older adults’ physical and psychological function, and examine the mediating role of physical activity on these associations. Methods Baseline data from a randomized control trial of physical activity among older adults with global cognitive impairment was used. Data from 192 participants were analyzed. Measures included steps‐per‐day, objectively‐measured outdoor time per day using global positioning systems, physical function (cardiorespiratory fitness, lower‐extremity strength), psychological function (depression, well‐being) and basic factors. Results Path analysis showed that outdoor time was significantly associated with steps‐per‐day (path coefficient = 0.23) and depression (path coefficient = –0.16). Outdoor time was not directly associated with cardiorespiratory fitness, lower‐extremity strength and well‐being. However, steps‐per‐day was associated with cardiorespiratory fitness (path coefficient = 0.18), lower‐extremity strength (path coefficient = –0.22) and well‐being (path coefficient = 0.14). Conclusions We found that objectively‐measured outdoor time was indirectly associated with physical function, and both directly and indirectly with psychological function through physical activity among older adults. This finding indicates that going outdoors influences older adults’ health outcomes, and is mainly mediated by physical activity. Geriatr Gerontol Int 2016; ••: ••–••.

  September 16, 2016   doi: 10.1111/ggi.12895   open full text
• Association of cognition with functional trajectories in patients admitted to geriatric wards: A retrospective observational study.
  Peter Hartley, Kerry Alexander, Jennifer Adamson, Carol Cunningham, Georgina Embleton, Roman Romero‐Ortuno.
  Geriatrics and Gerontology International. September 16, 2016
  Aim Impaired cognition is common among older patients admitted to acute hospitals, but its association with functional trajectories has not been well studied. Methods A retrospective observational study was carried out in an English tertiary university hospital. We analyzed all first episodes of county residents aged ≥75 years admitted to the Department of Medicine for the Elderly wards between December 2014 and May 2015. A history of dementia or a cognitive concern in the absence of a known diagnosis of dementia were recorded on admission. A cognitive concern included possible undiagnosed dementia or delirium. Function was retrospectively measured with the modified Rankin Scale at preadmission baseline, admission and discharge. Results There were 663 first hospital episodes over the period, of which 590 patients survived. Among the latter, 244 had no cognitive impairment, 134 a diagnosis of dementia, 66 a cognitive concern in the absence of a known dementia and 146 had missing cognitive data. When frailty, acuity, age and comorbidity were controlled for, people with known dementia had a similar functional recovery compared with those with no cognitive impairment. People with a cognitive concern, but no known dementia, had lesser functional recovery and greater disability at discharge than those with no cognitive impairment (mean discharge modified Rankin Scale 3.4 compared with 3.1, P = 0.011). Conclusions Dementia per se might not be a marker of poor rehabilitation potential. Older people with acute cognitive concerns might be more vulnerable to poor functional recovery. Our cognitive variables are not gold standard, and further research is required to clarify this relationship. Geriatr Gerontol Int 2016; ••: ••–••

  September 16, 2016   doi: 10.1111/ggi.12884   open full text
• Improving physical fitness and health status perception in community‐dwelling older adults through a structured program for physical activity promotion in the city of Naples, Italy: A randomized controlled trial.
  Francesca Gallè, Valeria Di Onofrio, Vincenzo Romano Spica, Roberto Mastronuzzi, Pio Russo Krauss, Patrizia Belfiore, Pasqualina Buono, Giorgio Liguori.
  Geriatrics and Gerontology International. September 15, 2016
  Aim To evaluate the efficacy and feasibility of a physical activity promotion intervention in community‐dwelling older adults based on a free program of exercise adapted for older adults aged ≥60 years managed by trainees from the Movement Sciences degree course. Methods A total of 160 adults aged 60–82 years were randomly allocated into the intervention and control group. The exercise program consisted of 1‐h sessions carried out twice a week for a year. Control participants received recommendations about an active lifestyle from their physicians. Senior Fitness Tests and the 12‐item Short Form Health Survey were used to assess six functional fitness domains of participants and perception of their health status, respectively. Body mass index was also evaluated. Results A total of 62 participants completed the exercise path. At the end of the intervention, they showed a significant body mass index decrease (from 27.9 ± 1.6 to 25.1 ± 1.8 kg/m2, P < 0.01), and a significant improvement in functional domains, mainly aerobic fitness (+33.9%, P < 0.01) and agility (+24.2%, P < 0.01), and in good health status perception (+38.7%, P < 0.05). Similar variations were not observed in the control group (P > 0.05). A high acceptance of the intervention was registered among participants (>88.7%); staff competence and gratuitousness were the most appreciated features (>85.5%). Conclusions The structured program represented a useful opportunity to promote physical activity among participants, and it was effective in improving their physical fitness and health status perception. Similar interventions are required to sensitize the whole older population, and experts in Movement Sciences might represent a key figure in this context. Geriatr Gerontol Int 2016; ••: ••–••.

  September 15, 2016   doi: 10.1111/ggi.12879   open full text
• Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community.
  Hirotoshi Niikawa, Tsuyoshi Okamura, Kae Ito, Chiaki Ura, Fumiko Miyamae, Naoko Sakuma, Mutsuo Ijuin, Hiroki Inagaki, Mika Sugiyama, Shuichi Awata.
  Geriatrics and Gerontology International. September 15, 2016
  Aim Polypharmacy is a serious medical problem among older adults. Polypharmacy can cause adverse drug reactions and is associated with frailty. Several drugs, particularly psychotropic medications, can cause cognitive impairment. Recent research also suggests that polypharmacy can cause cognitive impairment. We investigated the prevalence of polypharmacy, and examined the association between polypharmacy and cognitive impairment in a large sample of community‐dwelling older adults in Japan. Methods A questionnaire covering sociodemographic variables was sent to all residents aged ≥65 years in an urban residential district of Tokyo, Japan (n = 7682). Next, 3000 individuals were randomly selected as study participants. A trained nurse and researcher interviewed participants in their own homes to obtain information about cognitive status, prescribed medications, and current medical history. Cognitive status was assessed using the Mini‐Mental State Examination. Polypharmacy was defined as treatment with six or more prescribed medications. Results Of the 1270 respondents who completed an interview, 1152 were included in the analysis of medications. The prevalence of polypharmacy was 28.0% (n = 323). When the older adults in the medications analysis were stratified by Mini‐Mental State Examination scores, polypharmacy was present in 48.3% of those scoring <24, and 25.7% of those scoring ≥24 (χ2 = 26.76, P < 0.001). After controlling for potential confounding factors (including psychotropic medications), a multivariate logistic regression analysis showed an association between polypharmacy and cognitive impairment (odds ratio 1.83, 95% confidence interval 1.10–3.02; P = 0.019). Conclusions Polypharmacy was associated with cognitive impairment among urban community‐dwelling older adults. Geriatr Gerontol Int 2017; 17: 1286–1293.

  September 15, 2016   doi: 10.1111/ggi.12862   open full text
• Comparability of two representative devices for bioelectrical impedance data acquisition.
  Minoru Yamada, Yosuke Yamada, Hidenori Arai.
  Geriatrics and Gerontology International. September 05, 2016
  There is no abstract available for this paper.

  September 05, 2016   doi: 10.1111/ggi.12647   open full text
• Factors related to the decision‐making for moving the older adults into long‐term care facilities in Taiwan.
  Yen‐Ping Hsieh, Ying‐Chia Huang, Shou‐Jen Lan, Ching‐Sung Ho.
  Geriatrics and Gerontology International. August 31, 2016
  Aim To investigate the relationships between demographic characteristics of the elderly, type of long‐term care (LTC) facilities, and the reasons for moving into LTC facilities. Methods Research participants included people aged over 65 years, living in LTC facilities. A total of 1280 questionnaires were distributed to 111 LTC facilities in Taiwan; 480 questionnaires were retrieved, and 232 were included in the valid sample. The study used a non‐linear canonical correlation analysis, which assesses the relationships among similar sets of categorical variables. Results The results showed that the older adults in quadrant I were characterized by being involved in the decision‐making regarding the choice of LTC facilities and received economic support from their children. The older adults in quadrant II mainly lived in LTC facilities to receive medical care, whereas those in quadrant III typically included individuals with low income, who did not choose to live in LTC facilities. Furthermore, those in quadrant IV had positive cognitions associated with LTC facilities. Conclusions We believe that the results of the present study will facilitate policy‐making in the field of LTC, provide reference to the practitioners and the older adults, and identify the types of decisions older adults make when moving into LTC facilities, thus assisting older adults to improve their strategies regarding staying in LTC facilities. Geriatr Gerontol Int 2017; 17: 1319–1327.

  August 31, 2016   doi: 10.1111/ggi.12860   open full text
• Factors associated with ageist attitudes among college students.
  Matthew Lee Smith, Caroline D Bergeron, Clay Cowart, SangNam Ahn, Samuel D Towne, Marcia G Ory, Mindy A Menn, JD Chaney.
  Geriatrics and Gerontology International. August 31, 2016
  Aim Ageist views have the potential to deleteriously impact large populations of older adults in the USA and worldwide. The high levels of ageism among young adults might originate from their limited interactions with older adults (individuals aged 65 years and older). The present study examined the factors associated with ageist attitudes among college students. Methods Data were analyzed from 641 college students using an internet‐delivered questionnaire. Participants were asked to rate their level of agreement with 17 ageist statements about older adults. A general least squares regression analysis was carried out to identify the associations of participants’ sex, race/ethnicity and interactions with older adults on self‐identified ageist attitudes. Results Approximately 37% of participating college students interacted with older adults one or more times per week, 38.3% had resided with an older adult in their lifetime and 78.2% had volunteered/worked with an older adult. Participants who were female (P = 0.035), African American (P = 0.033), those with more frequent interaction with older adults (P = 0.001) and those with experience living with an older adult (P = 0.028) reported significantly lower negative ageist attitudes. Conclusions Findings suggest that increased exposure to and interactions with older adults can reduce ageist views among college students. Practical recommendations are provided to increase students’ opportunities for interactions with and exposure to older adults. Geriatr Gerontol Int 2016; ••: ••–••.

  August 31, 2016   doi: 10.1111/ggi.12894   open full text
• Near falls predict substantial falls in older adults: A prospective cohort study.
  Koutatsu Nagai, Minoru Yamada, Miyuki Komatsu, Akira Tamaki, Mizuki Kanai, Toshiaki Miyamoto, Rui Tsukagoshi, Tadao Tsuboyama.
  Geriatrics and Gerontology International. August 31, 2016
  Aim Little is known about the relationship between near falls and substantial falls in older adults. Clarifying this relationship would be helpful to assess fall risk in greater detail. The purpose of the present study was to clarify whether near falls predict future falls. Methods This was designed to be a prospective cohort study. Participants were recruited from a community apartment for older adults. After a baseline physical assessment, participants were asked to record the incidence of near falls in a diary for 3 months. After the survey period, participants were followed for 6 months by telephone contact every 2 months. Cox proportional hazards regression models were used to analyze the association between near falls and falls. Results A total of 60 participants were included in the analysis. During the initial 3 months, 23 participants (38%) experienced near falls. Eight participants (13%) experienced substantial falls during the following 6 months. Cox proportional hazards regression models adjusted for age, body mass index, sex and physical frailty showed that experience of near falls (hazards regression 6.0, 95% confidence intervals 1.1–31.7; P < 0.05) was significantly associated with incidence of future falls. Conclusions Experience of near falls among older adults is an independent predictor of substantial falls irrespective of the physical frailty status. Clinicians might need to focus on near falls to appropriately assess the fall risk in older adults. Geriatr Gerontol Int 2016; ••: ••–••.

  August 31, 2016   doi: 10.1111/ggi.12898   open full text
• Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults.
  Janhavi Ajit Vaingankar, Siow Ann Chong, Edimansyah Abdin, Louisa Picco, Boon Yiang Chua, Saleha Shafie, Hui Lin Ong, Sherilyn Chang, Esmond Seow, Derrick Heng, Peak Chiang Chiam, Mythily Subramaniam.
  Geriatrics and Gerontology International. August 31, 2016
  Aim The present study examined the prevalence of frailty and its association with sociodemographic, clinical and social characteristics, and service utilization in a representative general population sample of Singaporean older adults. Methods A single‐phase, cross‐sectional survey was carried out in a nationally representative sample of 2102 Singapore residents aged 60 years and older. Five frailty parameters (weakness, slowness, exhaustion, low physical activity and/or unintentional weight loss) were measured to assess Fried's frailty phenotype to identify frail (meeting 3/5 criteria), prefrail (meeting 1 or 2 criteria) and non‐frail (absence of all 5) older adults. On testing independent associations, multiple backward stepwise logistic regression analyses were carried out to identify the strongest correlates of frail states. Results The prevalence of frailty among the older adult population was found to be 5.7%. Sociodemographic, clinical and social characteristics differed significantly at an independent level by frailty status. A higher proportion of frail older adults had care needs (54.5%) compared to pre‐frail (13.5%) and non‐frail (2.2%), and poor social networks (58.8% vs prefrail [36.6%] and non‐frail [28.6%]). Frail older adults also had significantly higher service utilization. Significant correlates of frail state were older age, poor social networks, having any care need, and a history of dementia, diabetes, cancer, respiratory problems or paralysis. Conclusions Frailty is common among older adults in Singapore, and it correlates with many components at the person, health and societal levels, thus highlighting the importance of individual‐ and population‐level frailty detection and interventions in this population. Geriatr Gerontol Int 2016; ••: ••–••

  August 31, 2016   doi: 10.1111/ggi.12891   open full text
• Health‐related quality of life of older Asian patients with multimorbidity in primary care in a developed nation.
  Joanne Hui Min Quah, Pei Wang, Roderica Rui Ge Ng, Nan Luo, Ngiap Chuan Tan.
  Geriatrics and Gerontology International. August 31, 2016
  Aim Older adults are susceptible to two or more chronic ailments or multimorbidity. The present study aimed to establish the relationship between multimorbidity and health‐related quality of life (HRQoL) amongst Asian elderly patients in primary care in a developed nation. It also assessed how functional disability and chronic musculoskeletal pain are associated with HRQoL. Methods A cross‐sectional study was carried out in a Singapore public primary care clinic. An interviewer‐administered questionnaire was used to collect data on chronic disease profile, HRQoL (using the European Quality of Life 5 Dimension), basic activities of daily living, instrumental activities of daily living, musculoskeletal pain and sociodemographic characteristics. The association of multimorbidity, functional disability and chronic musculoskeletal pain with HRQoL was assessed using multivariate linear regression analysis. Results A total of 498 outpatients aged 65 years and older with multimorbidity were enrolled. Their mean age was 73.9 years, and approximately 75% had between two and four chronic conditions. The most commonly reported chronic conditions were hypertension (86.1%), hyperlipidemia (80.7%), diabetes (40.2%) and arthritis (33.3%). The European Quality of Life 5 Dimension index score decreased significantly when the number of comorbidities was more than five. Chronic hip and knee pain, one or more “dependent” activities of daily living dimensions and two or more “dependent” IADL dimensions were independently associated with worse HRQoL. Conclusions Multimorbidity is associated with poorer HRQoL amongst older adults in Singapore. Review of chronic musculoskeletal pain and functional disabilities should be integrated into the comprehensive assessment of older adults in an enhanced model of primary care to improve the HRQoL of these older patients. Geriatr Gerontol Int 2016; ••: ••–••.

  August 31, 2016   doi: 10.1111/ggi.12881   open full text
• Optimal frequency/time combination of whole‐body vibration training for improving muscle size and strength of people with age‐related muscle loss (sarcopenia): A randomized controlled trial.
  Ning Wei, Marco YC Pang, Shamay SM Ng, Gabriel YF Ng.
  Geriatrics and Gerontology International. August 31, 2016
  Aim To determine the optimal combination of frequency and exposure time of a whole‐body vibration (WBV) training program for improving muscle performance of older people with age‐related muscle loss. Methods A total of 80 community‐dwelling older adults with age‐related muscle loss were randomly divided into four equal groups, namely, low‐frequency long duration (20 Hz × 720 s), medium‐frequency medium duration (40 Hz × 360 s), high‐frequency short duration (60 Hz × 240 s) and control (no training) for 12‐week WBV training and 12‐week follow up. Assessments were carried out at baseline, mid‐intervention, post‐intervention, mid‐follow up, follow up for the cross‐sectional area of the vastus medialis, isometric knee extension strength at 90°, and isokinetic knee extension at 60°/s and 180°/s. Results There was a significant time × group interaction effect in isokinetic knee extension at 180°/s. Significant time effects were found in all muscle strength outcome variables. Group differences in percentage change from baseline were significant between medium‐frequency medium duration and control on isokinetic knee extension at 180°/s and 60°/s. No changes were found in the cross‐sectional area of the vastus medialis. Conclusions With the total number of vibrations controlled, the combination of 40 Hz and 360 s of WBV exercise had the best outcome among all other combinations tested. The improvements in knee extension performance can be maintained for 12 weeks after cessation of WBV training. Geriatr Gerontol Int 2016; ••: ••–••.

  August 31, 2016   doi: 10.1111/ggi.12878   open full text
• Comprehensive effects of galantamine and cilostazol combination therapy on patients with Alzheimer's disease with asymptomatic lacunar infarction.
  Nozomi Hishikawa, Yusuke Fukui, Kota Sato, Yasuyuki Ohta, Toru Yamashita, Koji Abe.
  Geriatrics and Gerontology International. August 31, 2016
  Aim The coexistence of Alzheimer's disease (AD) and cerebrovascular disease pathology increases age‐dependently. We comprehensively analyzed the clinical effects of galantamine or cilostazol monotherapy to the add‐on combination therapy on three major factors of dementia, such as cognitive, affective and activities of daily living functions in AD patients with asymptomatic lacunar infarction. Methods We divided 101 AD patients with asymptomatic lacunar infarction into two subgroups: group A (n = 61, first treated with galantamine and then cilostazol added) and group B (n = 40, first treated with cilostazol and galantamine added). We compared the clinical effects before and after combination therapy of galantamine and cilostazol (i.e. 3 months [M] before (–3 M), baseline (0 M), 3 and 6 M after the add‐on combination). Results Galantamine monotherapy increased cognitive Hasegawa dementia score‐revised scores, which were further improved with add‐on cilostazol. Cilostazol monotherapy also increased the cognitive tests, which were further improved with add‐on galantamine. Add‐on cilostazol significantly improved Geriatric Depression Scale and Abe's behavioral and psychological symptoms of dementia scores after galantamine monotherapy. Cilostazol monotherapy also significantly improved Geriatric Depression Scale scores, with further improvements in Geriatric Depression Scale, apathy scores and Abe's behavioral and psychological symptoms of dementia scores by add‐on galantamine. Activities of daily living scores continuously improved with galantamine monotherapy and add‐on cilostazol. Conclusions The present study provides a clinical possibility that galantamine or cilostazol monotherapy and the combination therapy maintained or even improved cognitive, affective, and activities of daily living functions in AD with asymptomatic lacunar infarction. Geriatr Gerontol Int 2016; ••: ••–••.

  August 31, 2016   doi: 10.1111/ggi.12870   open full text
• Relationship between fear of falling and functional status in nursing home residents aged older than 65 years.
  Mirjana Kocic, Zorica Stojanovic, Milica Lazovic, Dejan Nikolic, Vesna Zivkovic, Marina Milenkovic, Konstansa Lazarevic.
  Geriatrics and Gerontology International. August 31, 2016
  Aim The present study investigated the relationship between fear of falling and functional status, and sociodemographic and health‐related factors in nursing home residents aged older than 65 years. Methods The cross‐sectional study involved 100 participants who were residents of a nursing home and aged older than 65 years. Fear of falling was assessed using the Falls Efficacy Scale. Functional status was assessed by four performance‐based measures. Balance was assessed by the Berg Balance Scale, mobility by the Timed Up and Go test, lower limbs muscle strength by the Chair Rising Test and participants’ functional ability by the motor Functional Independence Measure. Results There was a significant negative correlation between the Falls Efficacy Scale and Berg Balance Scale (P < 0.001), and motor Functional Independence Measure (P < 0.001) scores; and a positive correlation with the Timed Up and Go test (P < 0.001) and Chair Rising Test (P < 0.001) values. Falls Efficacy Scale score increase is associated with age, being a widower/widow and the number of falls in the previous year. Higher fear of falling is associated with an increase in the number of falls in the previous year and with a decrease in Berg Balance Scale score. Conclusions The study found a significant associations between Falls Efficacy Scale score and all of the examined parameters of functional status, the number of falls in the previous year, age and marital status of widower/widow. The major finding was that poor balance and an increase in the number of falls in the previous year are independent factors significantly associated with the fear of falling. Geriatr Gerontol Int 2016; ••: ••–••.

  August 31, 2016   doi: 10.1111/ggi.12897   open full text
• Propensity for Japanese‐American older adults’ use of medical alert services in Hawaii.
  Yuka Yamazaki, Valerie Yontz, Cullen Hayashida.
  Geriatrics and Gerontology International. August 26, 2016
  Aim Hawaii is a fast‐aging, multi‐ethnic state. At present, ethnic Japanese represent the largest segment of the elderly population (aged ≥65 years). Studies in Western countries have identified an association between ethnicity and the use of homecare services. The present study sought to substantiate this association in relation to the use of a personal emergency response system service by older ethnic Japanese adults in Hawaii. Methods Questionnaires were mailed to 585 elderly subscribers of a company providing personal emergency response system services in Hawaii in 2014. The questionnaire inquired about the subscriber's ethnicity, functional disability, number of medications taken and falls experienced. Additional information on the sex, age and service payer was obtained for each of the responding subscribers from the corporate database. The χ2‐test and t‐test were carried out to assess the associations between factors. Results A total of 244 questionnaires were analyzed (41.7% response rate; mean age of respondents 86.1 + 7.8 years). Compared with non‐Japanese older adults, ethnic Japanese older adults had a higher propensity to use the personal emergency response system services, were older, used fewer prescribed medications and were more likely to have these services paid for by family members or to pay themselves. Conclusions Japanese culture might influence the use of personal emergency response system services. Ethnic Japanese older adults might want to receive homecare services focusing on preventing minor accidents from becoming medical crises because of their high level of concern for health, their independence and the availability of family support. Healthcare planners should consider such factors in the provision of care in Hawaii.

  August 26, 2016   doi: 10.1111/ggi.12871   open full text
• Height is an indicator of vascular maintenance capacity in older men.
  Yuji Shimizu, Shimpei Sato, Jun Koyamatsu, Hirotomo Yamanashi, Mako Nagayoshi, Koichiro Kadota, Takahiro Maeda.
  Geriatrics and Gerontology International. August 26, 2016
  Aim Bone‐derived circulating CD34‐positive cells are reported to play an important role in vascular maintenance. Additionally, height might influence age‐related hematopoietic bone marrow decline, as it positively correlates with total bone marrow volume. As hypertension should mask the beneficial effects of circulating CD34‐positive cells, hypertension status should account for this correlation. The present study aimed to clarify the clinical importance of height on vascular maintenance in older Japanese men. Methods We carried out a cross‐sectional study of 343 older men aged 65–69 years who underwent a general health checkup from 2013 to 2015. Results Independent of known cardiovascular risk factors, height was found to be slightly, but significantly, positively correlated with the log number of circulating CD34‐positive cells in systolic, but not non‐systolic, hypertensive men. Multilinear regression analysis showed a parameter estimate (B) and standardized parameter estimate (β) of 3.23 × 10–2, 0.28 (P = 0.003) for systolic hypertensive men and –0.49 × 10–2, –0.04 (P = 0.495) for non‐systolic hypertensive men. Conclusions Height positively correlates with circulating CD34‐positive cells in systolic, but not non‐systolic, hypertensive men. As the beneficial effects of circulating CD34‐positive cells on endothelial repair might be masked by hypertension where the production of CD34‐positive cells is stimulated by hypertension‐induced vascular damage, among individuals with systolic hypertension, circulating CD34‐positive cells should indicate the limits of endothelial repair. Therefore, height might indicate the capacity for adequate vascular maintenance in older men.

  August 26, 2016   doi: 10.1111/ggi.12876   open full text
• Frailty syndrome in patients with heart rhythm disorders.
  Agnieszka Mlynarska, Rafal Mlynarski, Krzysztof S Golba.
  Geriatrics and Gerontology International. August 25, 2016
  Aim To assess the prevalence of frailty syndrome in patients with heart rhythm disorders that qualified for pacemaker implantation. Methods The study included 171 patients (83 women, aged 73.9 ± 6.7 years) who qualified for pacemaker implantation as a result of sinus node dysfunction (81 patients) or atrio‐ventricular blocks (AVB; 90 patients). A total of 60 patients (25 women, aged 72.40 ± 7.09 years) without heart rhythm disorders were included in the control group. Frailty syndrome was diagnosed using the Canadian Study of Health and Aging Clinical Frailty Scale test. Results Frailty syndrome was diagnosed in 25.15% of the patients, and pre‐frailty in 36.84% of the patients. Frailty syndrome was diagnosed in 10% of the control group, and the average value of frailty was 3.35 ± 0.92. Frailty occurred significantly more often among patients with AVB (33.34%) compared with patients who were diagnosed with sinus node dysfunction (16.05%); P = 0.0081. The average score of frailty for sinus node dysfunction was 3.71 ± 0.89, and for AVB it was 4.14 ± 0.93; P = 0.0152. In the case of AVB, the women had a statistically more intense level of frailty of 4.54 ± 0.90 as compared with the men 3.87 ± 0.85; P = 0.0294. In the multiple logistic analysis, the presence of any arrhythmia was strongly associated with frailty syndrome (OR 2.1286, 95% CI 1.4594 – 3.1049; P = 0.0001). Conclusions Frailty syndrome was diagnosed in one‐quarter of patients with cardiac arrhythmias, whereas a further 40% were at a higher risk of frailty syndrome, and its occurrence was significantly higher if compared with the control group. Frailty occurred significantly more often among patients with atrio‐ventricular blocks, especially in women. The results of the present research showed that there is a statistical association between frailty and arrhythmias. Geriatr Gerontol Int 2017; 17: 1313–1318.

  August 25, 2016   doi: 10.1111/ggi.12868   open full text
• Differences in the effect of exercise interventions between prefrail older adults and older adults without frailty: A pilot study.
  Eiko Takano, Toshio Teranishi, Toyoaki Watanabe, Kensuke Ohno, Shiko Kitaji, Shunji Sawa, Yoshikiyo Kanada, Kenji Toba, Izumi Kondo.
  Geriatrics and Gerontology International. August 21, 2016
  Aim We aimed to clarify whether there are differences in the effect of exercise interventions between prefrail older adults and older adults without frailty. Methods The participants were community‐dwelling older adults (mean age 75.1 ± 5.1 years). The participants were instructed to use a training method at home to prevent frailty. The effects of the intervention were evaluated at 4 months. Outcome measures were the Timed Up and Go test, grip strength, one leg balance, knee extension strength and the fall risk index. The present study used the criteria for frailty status of the National Center for Geriatrics and Gerontology in Japan. The studied sample included prefrail participants (n = 17) and robust participants (n = 24). We compared the value of outcome measures before and after the intervention in each group using two‐way repeated measures analysis of variance. Results There were significant differences for the group effect for one leg balance (P < 0.01), and there were significant differences for the time effect for Timed Up and Go, one leg balance and knee extension strength (P < 0.01). In these outcomes, there were no significant interactions between frailty status and intervention. Four prefrail participants (mean age 78.0 ± 3.8 years) returned to the robust status after the intervention. No participants became frail. Conclusions These results suggest that we can expect similar interventional effects for prefrail older adults and robust older adults. It is important that a frail status be prevented in prefrail older adults by using an exercise intervention. Further studies are required to determine the different effects of exercise intervention on prefrail status compared with frailty status in community‐dwelling older adults. Geriatr Gerontol Int 2017; 17: 1265–1269.

  August 21, 2016   doi: 10.1111/ggi.12853   open full text
• Preliminary evidence that rivastigmine‐induced inhibition of serum butyrylcholinesterase activity improves behavioral symptoms in Japanese patients with Alzheimer's disease.
  Nobuyasu Bando, Yu Nakamura.
  Geriatrics and Gerontology International. August 21, 2016
  Aim To investigate whether the inhibitory rate of serum butyrylcholinesterase (BuChE) activity in Japanese patients with Alzheimer's disease is correlated with cognitive function, behavioral symptoms and caregiver burden. Methods A total of 61 patients with mild to moderately severe Alzheimer's disease who were not undergoing cholinesterase enzyme inhibitor/memantine combinatorial treatment received a rivastigmine (18 mg) patch for 24 weeks. The rate of inhibition of BuChE was correlated with scores obtained on cognitive (Mini‐Mental State Examination), behavioral (the Japanese version of the modified Crichton Geriatric Behavioral Rating Scale [CGBRS] and Vitality Index [VI]) and burden (the Japanese version of Zarit Burden Inventory [ZBI]) scales; and the Clinical Global Impression of Change scale. Results The serum BuChE activity showed a significant decrease after 24 weeks compared with baseline (P < 0.001). Overall, significant effects were found in the Mini‐Mental State Examination score, VI score and modified CGBRS score. We then divided patient groups into a high inhibitory rate (≥40%) group and a low inhibitory rate (<40%) group; there were significant improvements in the Mini‐Mental State Examination score, VI score and modified CGBRS score in both groups. However, favorable results were seen in cooperation, restlessness and leisure on modified CGBRS subscales in the high inhibitory rate group (P < 0.001, P = 0.007, P < 0.001, respectively), and rehabilitation and other activities on VI subscales in the high inhibitory rate group (P = 0.005) compared with those in the low inhibitory rate group. Conclusions Demonstrable significant improvements in behavioral symptoms, such as low cooperation, restlessness or low activities in patients with Alzheimer's disease, were achieved on inhibition of BuChE at a rate of 40% or more. Geriatr Gerontol Int 2017; 17: 1306–1312.

  August 21, 2016   doi: 10.1111/ggi.12865   open full text
• Tall stature in coronary heart disease patients is associated with decreased risk of frailty in late life.
  Miriam Lutski, David Tanne, Uri Goldbourt.
  Geriatrics and Gerontology International. August 19, 2016
  Aim We investigated the possible inverse association between tall stature and subsequent late‐life frailty. Methods A subset of surviving men with coronary heart disease (n = 1232; mean age at baseline 57.0 ± 6.0 years), who previously participated in the Bezafibrate Infarction Prevention clinical trial (1990–1997) were reassessed during 2004–2008 (T1; n = 558) and 2011–2013 (T2; n = 351) at the mean ages of 72.6 ± 6.4 years and 77.2 ± 6.4 years, respectively. Frailty status was measured at T2 according to the physical phenotype developed by Fried, and was categorized into non‐frail, prefrail and frail. We estimated the odds ratios of increasing frailty by tertiles of height at baseline. Results Among 351 patients, 117 (33.3%) were classified as non‐frail, 134 (38.2%) as prefrail and 100 (28.5%) as frail. Frailty was found among 21% of participants at the highest tertile, 33% at the middle tertile and 46% at the lowest tertile for height (P for trend = 0.002). Adjusting for age, weight, place of birth, education, blood pressure, New York Heart Association classification functional class and comorbidity score, the estimated OR for increasing frailty for participants in the highest tertile was 0.32 (95% CI 0.17–0.59) and for those at the middle tertile 0.46 (95% CI 0.27–0.79), as compared with the lowest tertile. An increment of 1 SD of height was associated with a 38% (95% CI 18–53%) decrease in frailty odds. Conclusion Among men with coronary heart disease, tall stature was associated with lower adjusted odds of late‐life frailty. Geriatr Gerontol Int 2017; 17: 1270–1277.

  August 19, 2016   doi: 10.1111/ggi.12855   open full text
• Development of an oral health‐related self‐efficacy scale for use with older adults.
  Yuki Ohara, Naomi Yoshida, Hisashi Kawai, Shuichi Obuchi, Hideyo Yoshida, Shiro Mataki, Hirohiko Hirano, Yutaka Watanabe.
  Geriatrics and Gerontology International. August 17, 2016
  Aim Self‐efficacy is considered to be an important factor influencing behavior change; however, there are no existing tools to measure self‐efficacy in the context of oral health among older adults. The purpose of the present study was to develop the Geriatric Self‐Efficacy Scale for Oral Health (GSEOH) for use with older adults, and to evaluate its reliability and validity. Methods The self‐administered questionnaire was completed by 646 Japanese older people. The draft version of the scale consisted of 35 items that were generated to measure the three dimensions of personal beliefs in tooth brushing, observing own oral health status and oral function. We carried out a principal components factor analysis with promax rotation, and investigated the scale's internal consistency and construct validity. Results The final version of the scale consisted of three dimensions measured with 20 items. Cronbach's alpha of the GSEOH total scale was 0.924. There were significant differences (P < 0.05) in total scores on the GSEOH for the change process of oral health behavior, and in relation to self‐rated oral health. Conclusions We developed the GSEOH, with three factors and 20 items, and confirmed its reliability and validity. More studies are necessary to investigate the cross‐cultural validity and reliability with larger samples from other countries.

  August 17, 2016   doi: 10.1111/ggi.12873   open full text
• Impact of consumer‐directed care on quality of life in the community aged care sector.
  Norma Bulamu, Billingsley Kaambwa, Liz Gill, Ian Cameron, Sue McKechnie, Jeff Fiebig, Robin Grady, Julie Ratcliffe.
  Geriatrics and Gerontology International. August 17, 2016
  Aim All consumer‐directed care (CDC) models aim to transfer “choice” and “control” over the allocated funds from the aged care provider to service recipients. This study presents an empirical assessment of the relationships between quality of life for older adults aged ≥65 years receiving community aged care services in Australia under CDC compared with those receiving traditional provider‐directed care (PDC). Methods Self‐reported quality of life (health status and capabilities) were measured for older adults receiving community aged care services (n = 139) using the EuroQoL five dimensions five‐level version and the older people‐specific capability index (ICECAP‐O) instruments. The relationship between quality of life, mode of service delivery, and other sociodemographic characteristics were examined using descriptive statistical and multivariate regression analyses. Results The quality of life of individuals receiving CDC and PDC was similar (ICECAP‐O: CDC mean 0.74 [SD 0.17], PDC mean 0.78 [SD 0.17]. EuroQoL five dimensions five‐level version: CDC mean 0.46 [SD 0.33], PDC mean 0.49 [SD0.27]). In general, individuals in receipt of CDC reported higher levels of capability in the control and independence dimension for the ICECAP‐O relative to those receiving PDC. Multivariate regression analysis showed that living alone was associated with higher quality of life (P = 0.01) and higher levels of capability (P = 0.02). Conclusions Although no discernible differences in overall quality of life were found, higher levels of self‐reported control and independence for those in receipt of CDC suggest that the main policy objectives of transferring “choice” and “control” away from the aged care provider and to the individual are being met.

  August 17, 2016   doi: 10.1111/ggi.12872   open full text
• Economic and living statuses of community‐dwelling older adults and the related factors.
  Meng‐Chin Chen, Kuei‐Min Chen.
  Geriatrics and Gerontology International. August 17, 2016
  Aim The health and well‐being of older adults are closely related to their economic and living statuses. Socioeconomic inequality has a substantial impact on the healthcare received by these older adults. The present study aimed to understand the current economic and living statuses of community older adults, and examine the relationships among their demographics, economic status and living status. Methods This study used a cross‐sectional correlational design. Stratified random sampling was applied to recruit 384 community‐dwelling older adults. A face‐to‐face structured questionnaire was used to collect data. Results The economic and living statuses of older adults were significantly correlated with age, sex, and educational level. Young‐old adults were more likely than the oldest‐old adults to possess economic power in their households (OR 2.80, P < 0.001). Men were less likely than women to be financially supported by others (OR 0.28, P = 0.001). Participants with a high school education or above were less likely than uneducated participants to be financially supported by others (OR 0.11, P < 0.001); the probability of participants with an elementary school education living alone was 2.65‐fold that of uneducated participants (OR 2.65, P = 0.028). Conclusions We suggest that in addition to placing its concern over age, the government should focus on older women and uneducated older adults to further refine the current social welfare policies. Geriatr Gerontol Int 2016; ••: ••–••.

  August 17, 2016   doi: 10.1111/ggi.12875   open full text
• Increasing incidence of elderly‐onset autoimmune hepatitis.
  Kazuhiko Morii, Yuh Nagano, Takeharu Yamamoto, Shinichiro Nakamura, Hiroaki Okushin.
  Geriatrics and Gerontology International. August 17, 2016
  Aim Autoimmune hepatitis (AIH) commonly shows bimodal distribution of onset age: at young adulthood and at 50–60 years‐of‐age. However, in recent times, the incidence of elderly‐onset AIH seems to be increasing. This study aimed to investigate whether the incidence of elderly‐onset AIH is increasing, and whether these patients show any clinical features different from those observed in younger patients. Methods Data about patients with newly diagnosed AIH visiting the Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo, Japan, were retrospectively collected for the period ranging from January 2010 to May 2016. A total of 71 patients (56 women and 15 men, age 18–88 years) were included in this study. Patients were divided into two cohorts: elderly (≥70 years; n = 28) and adult cohort (15–69 years; n = 43). Demographic and clinical characteristics, biochemical and serological markers, radiological and histological findings, and therapeutic courses were evaluated. Results The median age of the patients was 65 years, the most frequent range being the 70s (37%), followed by the 60s (25%). The elderly cohort had significantly higher levels of serum immunoglobulin G and antinuclear antibody, lesser hepatitis activity scores, and lesser chance of developing other autoimmune diseases. They tended to have higher C‐reactive protein levels and lower serum alanine aminotransferase levels. All patients achieved clinical remission after treatment. Conclusions This study clearly showed an increase in the incidence of elderly‐onset AIH. These patients had some unique characteristics, showing that the development of elderly‐onset AIH is influenced by age‐associated immune dysfunction called immunosenescence.

  August 17, 2016   doi: 10.1111/ggi.12874   open full text
• Prevalence of potentially inappropriate prescribing among older adults: A comparison of the Beers 2012 and Screening Tool of Older Person's Prescriptions criteria version 2.
  Gulistan Bahat, Ilker Bay, Asli Tufan, Fatih Tufan, Cihan Kilic, Mehmet Akif Karan.
  Geriatrics and Gerontology International. August 10, 2016
  Aim To date, there is no study comparing the Beers 2012 and Screening Tool of Older Person's Prescriptions (STOPP) version 2 criteria, nor reporting a comparison of the prevalence of potentially inappropriate Prescribing (PIM) with STOPP version 2. We aimed to evaluate the prescriptions of patients admitted to a geriatric outpatient clinic with these tools, and to document the factors related to PIM use. Methods Older patients (aged ≥65 years) admitted to the outpatient clinic of a university hospital were retrospectively evaluated for PIM with Beers 2012 and STOPP version 2 criteria. Age; sex; chronic disease and number of drugs; and functional, depression and nutritional statuses were studied with regression analysis as possible factors related to PIM. Results The study included 667 participants (63.1% women, mean age 77.6 ± 6.3 years). The mean number of drugs was 6.1 ± 3.4. PIM prevalence detected by STOPP version 2 was higher than that of the Beers 2012 criteria (39.1% vs 33.3%, respectively; P < 0.001; Z = –3.5) with moderate agreement in between (kappa = 0.44). Antipsychotics, over‐the‐counter vitamin/supplements, aspirin, selective‐serotonin‐reuptake‐inhibitors and anticholinergics were the leading drug classes for PIM. The extent of polypharmacy (P < 0.001, OR 1.29, 95% CI 1.20–1.38) was the most important variable related to PIM, along with the multiple comorbidities (P = 0.005, OR 1.16, 95% CI 1.05–1.30). Higher level of functionality was inversely associated with PIM (P = 0.009, OR 0.90, 95% CI 0.83–0.97). Conclusions Inappropriate prescription prevalence of ~40% by STOPP version 2 was similar to the global worldwide prevalence – yet at the upper end. STOPP version 2 was more successful than Beers 2012 to detect PIM. Patients with multiple drug use, multiple comorbidities and more dependency were more likely to have PIM requiring special attention during prescription. Geriatr Gerontol Int 2017; 17: 1245–1251.

  August 10, 2016   doi: 10.1111/ggi.12850   open full text
• Adequacy of initial evaluation of fever in long‐term care facilities.
  Kosuke Yamada, Takafumi Nakagawa, Hidenori Hatto, Junichiro Miyachi, Masato Narushima, Ken Sakushima, Shingo Fukuma, Yukari Yamada, Shunichi Fukuhara.
  Geriatrics and Gerontology International. August 10, 2016
  Aim Febrile residents in long‐term care facilities (LTCF) might be inadequately evaluated by caregivers. The present study aimed to examine the factors associated with inadequacy of initial fever evaluations by caregivers at night in LTCF. Methods We carried out a cross‐sectional study among a convenience sample of caregivers employed at 11 LTCF in Japan using a vignette‐based questionnaire. The respondents were randomly assigned to one of two scenarios describing a mild or severe febrile episode in an LTCF resident at night. The respondents’ thinking patterns were classified based on influential factors in their fever evaluation. Associations between adequacy of evaluation and respondents’ characteristics were evaluated using generalized linear mixed models. Results A total of 34% of fever evaluations among caregivers were considered to be inadequate regarding the necessity for examination by a physician, due in most cases to underestimating the severity of the fever. Respondents’ thinking patterns in fever evaluation were significantly associated with the adequacy of the evaluation. Caregivers who placed particular importance on the preferences of residents and families versus other factors including the resident's febrile condition, were more likely to make an inadequate evaluation than those who did not. Conclusions Our findings here suggest that eagerness to comply with residents’ preference in fever evaluation could prompt caregivers not to call for an appropriate diagnostic procedure. Geriatr Gerontol Int 2017; 17: 1294–1299.

  August 10, 2016   doi: 10.1111/ggi.12863   open full text
• Quality of life and national pension receipt after retirement among older adults.
  Yeong Jun Ju, Kyu‐Tae Han, Hyo Jung Lee, Joo Eun Lee, Jae Woo Choi, In Seon Hyun, Eun‐Cheol Park.
  Geriatrics and Gerontology International. August 10, 2016
  Aim As the aging population (including baby boomers) retires, its members face the problem of retirement security. Social security, including the national pension, is the most important source of retirement security and thus directly affects the well‐being of retired older adults. We investigated the relationship between national pension receipt and quality of life (QoL) among Koreans aged 60 years or older. Methods We used data from the Korean Longitudinal Study of Aging obtained in 2006–2012 from 340 baseline individuals who had retired. We measured QoL using a visual analog scale. A generalized estimating equations model was used to carry out a longitudinal regression analysis on longitudinal data. Results When participants who received a national pension were used as the reference group, those participants who did not receive a national pension had a QoL of –4.40 (SE = 1.73; P = 0.0109). Additionally, individuals without a national pension and with a low household income showed the most drastic decrease in QoL (–10.42; SE = 4.53; P = 0.0214). Individuals without a national pension and with a low wealth level showed a considerable decrease in QoL compared with individuals with national pension and with a low wealth level (–8.34; SE = 4.14; P = 0.0438). Conclusions National pension receipt among retired older adults influences QoL, and the present results suggest that guaranteed income is very important to retired older adults with a low economic status. Thus, we require national pension schemes that aim to address retirement security for these individuals. Geriatr Gerontol Int 2017; 17: 1205–1213.

  August 10, 2016   doi: 10.1111/ggi.12846   open full text
• Evaluation of successful aging among older people in China: Results from China health and retirement longitudinal study.
  Huaqing Liu, Julie E Byles, Xiaoyue Xu, Min Zhang, Xuesen Wu, John J Hall.
  Geriatrics and Gerontology International. August 10, 2016
  Aim China faces a “time‐bomb” of the aging population. Successful aging has long been a goal in the field of gerontology. The present study aimed to evaluate successful aging among Chinese older adults. Methods Data on a total of 7102 people in the China Health and Retirement Study aged ≥60 years were analyzed in the present study. Successful aging is defined by the model of Rowe and Kahn including the following five indicators: “no major diseases,” “no disability,” “high cognitive functioning,” “high physical functioning” and “active engagement with life.” Using logistic regression analysis, crude and adjusted odds ratios with 95% confidence intervals were calculated to evaluate the relationship between sociodemographic parameters and successful aging. Results The prevalence of successful aging was 13.2% among Chinese older people. The percentage of older people with the five indicators, “no major diseases,” “no disability,” “high cognitive functioning,” “high physical functioning,” and “active engagement with life” was 41.7%, 92.1%, 54.2%, 70.2% and 46.0%, respectively. Multiple logistic regression showed people who had received education of high/vocational school or above had significantly greater odds of successful aging compared with those with less than primary school education (P < 0.05). The effect of education to college level or above on cognitive functioning was 2.51‐fold higher in women than men (P = 0.006). Older people from a non‐agricultural Hukou had 1.85‐fold higher odds of successful aging than those from an agricultural Hukou. Older people living in the central, northeast or western regions had lower odds of successful aging relative to those living in the east coast region (0.72, 0.72 and 0.56, respectively). Conclusions The prevalence of successful aging is low among Chinese older people, and is affected by sociodemographic factors, such as education, Hukou and regions. Geriatr Gerontol Int 2017; 17: 1183–1190.

  August 10, 2016   doi: 10.1111/ggi.12848   open full text
• Predictive ability of a simple subjective memory complaints scale for incident dementia: Evaluation of Japan's national checklist, the “Kihon Checklist”.
  Yasutake Tomata, Kemmyo Sugiyama, Yu Kaiho, Yumi Sugawara, Atsushi Hozawa, Ichiro Tsuji.
  Geriatrics and Gerontology International. August 10, 2016
  Aim Subjective memory complaints scales are expected to be useful for the prediction of future cognitive decline. In Japan, the “Kihon Checklist‐Cognitive Function” (KCL‐CF), which consists of three items, is used for primary screening of high‐risk older adults. However, the predictive validity of the KCL‐CF remains unknown. The aim of the present cohort study was to examine whether the KCL‐CF can predict the incidence of dementia. Methods Information on the KCL‐CF score (0–3 points) was collected from community‐dwelling older adults (≥65 years) through a questionnaire. Data on incident dementia were retrieved from the Long‐term Care Insurance database. The Cox model and receiver operating characteristic curve analysis were used. Results Among 13 974 participants, the 5.7‐year rate of incident dementia was 8.8%. All KCL‐CF items significantly predicted the risk of incident dementia even after adjustment for age and sex (P‐trend < 0.0001). A higher KCL‐CF score was associated with a higher risk of dementia; the age‐ and sex‐adjusted hazard ratios (95% confidence interval) were 1.00 (reference) for a KCL‐CF score of 0 points, 1.89 (1.65–2.15) for 1 point, 3.01 (2.59–3.50) for 2 points, and 6.20 (4.87–7.90) for 3 points (P‐trend < 0.0001). A cut‐off score of ≥1 points had a specificity of 65.1% and a sensitivity of 60.2%, and the area under the receiver operating characteristic curve was 0.65 (95% confidence interval 0.63–0.66). Conclusions The KCL‐CF was able to predict incident dementia. However, because a false‐negativity rate of approximately 40% would be expected, the KCL‐CF score alone might not be sufficient for screening of dementia incidence. Geriatr Gerontol Int 2017; 17: 1300–1305.

  August 10, 2016   doi: 10.1111/ggi.12864   open full text
• Relationships between intramuscular fat, muscle strength and gait independence in older women: A cross‐sectional study.
  Naoki Akazawa, Naomi Okawa, Kimiyuki Tamura, Hideki Moriyama.
  Geriatrics and Gerontology International. August 10, 2016
  Aim The objectives of the present study were to examine the relationships between intramuscular fat, muscle strength and gait independence, as well as to clarify the intramuscular fat characteristics of dependent older women. Methods A total of 25 older women who were unable to walk with or without assistance (dependent group), 22 frail older women (frail group) and 22 healthy older women (healthy group) participated in the present study. The frail participants could walk independently, but showed three or more of the following characteristics: slowness, weakness, weight loss, exhaustion and low physical activity. Outcome measures were quadriceps intramuscular fat determined by ultrasound echo intensity, and quadriceps muscle strength of the dependent, frail and healthy groups. In addition, the degree of gait independence (functional independence measures gait score) was assessed in the dependent and frail groups. Results Echo intensity in the dependent group was significantly negatively correlated with muscle strength and the functional independence measure gait score (correlation coefficients −0.635 and −0.344, respectively). Furthermore, echo intensity in the dependent group was significantly higher than in the healthy group. There was no significant difference in echo intensity between the dependent and frail groups. Conclusions The present results suggest negative relationships between intramuscular fat and muscle strength, and intramuscular fat and degree of gait independence in dependent older women. In addition, dependent older women have more intramuscular fat than healthy older women. Geriatr Gerontol Int 2016; ••: ••–••.

  August 10, 2016   doi: 10.1111/ggi.12869   open full text
• Establishment of an appropriate fall prevention program: A community‐based study.
  Yohei Otaka, Mitsuo Morita, Toshio Mimura, Mitsuyoshi Uzawa, Meigen Liu.
  Geriatrics and Gerontology International. August 05, 2016
  Aim To identify an appropriate community‐based fall prevention program Methods We introduced two programs to 24 senior centers, “community salons,” in a Japanese city, and carried out a prospective controlled trial between 2004 and 2005. Eight salons (185 participants aged 72.0 ± 7.1 years) received a single‐visit program consisting of one multidisciplinary team visit that included fall risk assessment with feedback and a fall prevention lecture. A total of 16 salons (418 participants aged 73.6 ± 7.4 years) received a year‐round comprehensive program, with visits carried out every 3 months. We compared the fall rates for 1 year between the two programs. Based on the results, we implemented a modified program until 2014 and examined the long‐term consequences. Results In the prospective controlled trial, fall rates did not differ significantly between programs (P = 0.449). Instead, fall rates for both programs decreased significantly by 0.89 (95% CI 0.84–0.94) times each month. Therefore, we implemented a modified version of the single‐visit program. By March 2014, the programs had been delivered to 1863 individuals, and the total number of attendees was 6622. The average attendance frequency per participant was 0.62 times per year. The majority (85.3%) of salons requested the program every year. Overall, the risk of falling (fall rates in the preceding year) decreased significantly as the number of program attendances increased (incident rate ratio = 0.89, 95% CI 0.85–0.92) irrespective of initial program types. Conclusions The programs including fall risk assessment with feedback and a fall prevention lecture reduced falls when embedded into the community, and they were accepted well over the course of 10 years. Geriatr Gerontol Int 2016; ••: ••–••.

  August 05, 2016   doi: 10.1111/ggi.12831   open full text
• Medication use and adherence among multi‐ethnic community‐dwelling older adults in Malaysia.
  Chin Fen Neoh, Chiau Ming Long, Siong Meng Lim, Kalavathy Ramasamy, Suzana Shahar, Abu Bakar Abdul Majeed.
  Geriatrics and Gerontology International. August 04, 2016
  Aim The present study assessed adherence, barriers, belief and awareness towards the use of medications among multi‐ethnic community‐dwelling older adults in Malaysia. Medication accessibility, expenditure and perceptions towards medicine labeling among older adults were also evaluated. Methods A cross‐sectional study was carried out in the central region of Malaysia from January to August 2015. The older adults enrolled in an ongoing prospective community‐based geriatric cohort study and prescribed with medicines were interviewed using a 50‐item validated questionnaire. Results Of the 79 older adults interviewed, 39.2% had ≥4 prescribed medications. Most obtained their medications free‐of‐charge from government hospitals (66, 83.5%). Nearly half (35, 44.3%) had trouble reading labels for medicines that they had received. Chinese older adults (P = 0.001) and those with lower monthly household income (P < 0.001) expressed difficulty in reading medication labels. Most (59, 75.0%) were unable to differentiate between generic and brand names of the medications, and 49.4% of the older adults did not know that all medicines had to be registered with the Ministry of Health, Malaysia. Most older adults had positive beliefs about the necessity of their medications, and 50.6% (n = 40) reported high medication adherence. The medication adherence score was negatively correlated with the concerns score (r = –0.5, P < 0.001). Conclusions The findings from the present study provide a unique insight into the diversity of medication use among multiethnic community‐dwelling older adults. Although high adherence to medications and positive beliefs about the necessity of medications were reported by the older adults, their knowledge about medications remained insufficient and they had difficulty in reading medication labels. Geriatr Gerontol Int 2017; 17: 1214–1220.

  August 04, 2016   doi: 10.1111/ggi.12849   open full text
• Inappropriate behaviors and hypersexuality in individuals with dementia: An overview of a neglected issue.
  Michele Torrisi, Alberto Cacciola, Angela Marra, Rosaria De Luca, Placido Bramanti, Rocco Salvatore Calabrò.
  Geriatrics and Gerontology International. August 04, 2016
  Behavioral and psychological symptoms of dementia are very common in patients affected by dementia, and are associated with high rates of institutionalization. Behavioral and psychological symptoms of dementia consist of aggressive behavior, delusions, hallucinations, depression, apathy, wandering, stereotyped and inappropriate sexual behavior. Interestingly, the latter has been reported to be relatively uncommon, but causing immense distress to patients and their caregivers. The genesis of inappropriate behavior is considered a combination of neurological, psychological and social factors. Although assessment is mainly carried out by clinical observation and interviews with caregivers, the most appropriate management of behavioral and psychological symptoms of dementia, including hypersexuality, is a combination of pharmacological and non‐pharmacological interventions, according to specific symptoms, degree of cognitive dysfunction and subtype of dementia. The present narrative review will mainly focus on aggressiveness, disinhibition, aberrant motor, and sexually inappropriate behavior diagnostic work‐up and treatment, in an attempt to provide both the patients and their caregivers with useful information to better manage these symptoms and improve their quality of life. Space is particularly dedicated to inappropriate sexual behavior, which is still considered a neglected issue. Geriatr Gerontol Int 2017; 17: 865–874.

  August 04, 2016   doi: 10.1111/ggi.12854   open full text
• Is there an obesity paradox in the Japanese elderly population? A community‐based cohort study of 13 280 men and women.
  Kenji Yamazaki, Etsuji Suzuki, Takashi Yorifuji, Toshihide Tsuda, Toshiki Ohta, Kazuko Ishikawa‐Takata, Hiroyuki Doi.
  Geriatrics and Gerontology International. August 04, 2016
  Aim Despite increased interest in an obesity paradox (i.e. a survival advantage of being obese), evidence remains sparse in Japanese populations. We aimed to verify this phenomenon among community‐dwelling older adults in Japan. Methods Older adults aged 65–84 years randomly chosen from all 74 municipalities in Shizuoka Prefecture completed questionnaires including body mass index information. Participants were followed from 1999 to 2009. Following World Health Organization guidelines, participants were classified using an appropriate body mass index for Asian populations as follows: <18.5 kg/m2 (underweight), 18.5–23.0 kg/m2 (normal weight), 23.0–27.5 kg/m2 (overweight) and ≥27.5 kg/m2 (obesity). We estimated hazard ratios and their 95% confidence intervals for all‐cause mortality, controlling for sex, age, smoking status, alcohol consumption, physical activity, hypertension and diabetes mellitus. Results Compared with normal‐weight participants, overweight/obese participants tended to have lower hazard ratios; the multivariate hazard ratios (95% confidence interval) were 0.86 (0.62–1.19) for obesity, 0.83 (0.73–0.94) for overweight and 1.60 (1.40–1.82) for underweight. In subgroup analyses by sex and age, the hazard ratios tended to be lower among obese men, albeit not significantly; hazard ratios (95% confidence interval) were 0.56 (0.25–1.27) in men aged 65–74 years, and 0.78 (0.41–1.45) in men aged 75–84 years. Conclusions The present study provides evidence of a conservative obesity paradox among older Japanese people, using the appropriate body mass index cut‐off points for Asian populations. In particular, obese older men tend to have a lower risk of all‐cause mortality. Geriatr Gerontol Int 2017; 17: 1257–1264.

  August 04, 2016   doi: 10.1111/ggi.12851   open full text
• Geriatric problems correlated with cognitive decline using a screening test named “Dr. SUPERMAN” for comprehensive geriatric assessment in elderly inpatients.
  Nayuta Namioka, Hirofumi Sakurai, Hideyuki Terayama, Toshihiko Iwamoto, Teruaki Fujihira, Hiromi Tsugehara, Akihiko Tsuchida, Haruo Hanyu.
  Geriatrics and Gerontology International. August 04, 2016
  Aim We have recently developed and validated a screening test for comprehensive geriatric assessment (CGA). We investigated the prevalence of geriatric problems in elderly inpatients using CGA, and determined the relationship between geriatric problems and cognitive decline. Methods We enrolled consecutive elderly inpatients aged >65 years who were admitted to all of the hospital departments at Tokyo Medical University Hospital, Tokyo, Japan, between July and December 2013. We investigated the prevalence of specific geriatric problems or situations in elderly inpatients using a screening test for CGA named “Dr. SUPERMAN.” We examined 3969 elderly inpatients (2211 men and 1758 women; mean age 75.5 ± 6.7 years) using CGA. Inpatients were divided into three groups by age, namely, 65–74 years, 75–84 years and ≥85 years. Inpatients were divided into the two groups of “internal medicine” and “other departments.” Results Geriatric problems were more frequently found in patients who were aged ≥85 years and admitted to “internal medicine” departments. Furthermore, multiple regression analysis found cognitive decline significantly correlated with ADL decline, age, poor medication adherence, upper and lower extremity function disorder, visual/auditory disorder, and urinary disorder. In particular, cognitive decline strongly correlated with a decline in activities of daily living. Conclusions CGA should be considered for the treatment of elderly inpatients, particularly those with cognitive decline and admitted to “internal medicine” departments. Geriatr Gerontol Int 2017; 17: 1252–1256.

  August 04, 2016   doi: 10.1111/ggi.12859   open full text
• Vitamin D and the characteristics associated with risk for knee pain among Korean older adults: Findings from a nationally representative survey.
  Ari Lee, Jong‐Eun Lee.
  Geriatrics and Gerontology International. July 27, 2016
  Aim To explore vitamin D and the risk factors associated with knee pain in a representative population of Korean older adults Methods Data were analyzed from the Korean National Health and Nutrition Examination Survey (2010–2013). A total of 3874 participants (1728 men, 2146 women) aged 65 years and older who had a measured serum 25‐hydroxyvitamin D level were evaluated. Multivariate logistic regression was used to investigate the relationship between serum vitamin D and knee pain severity Results Sex, age, obesity, education, knee radiographic osteoarthritis, hip pain and back pain were associated with having knee pain. Also, the level of serum 25‐hydroxyvitamin D was not significantly associated with knee pain severity. After controlling for confounding factors, the level of serum 25‐hydroxyvitamin D was not significantly associated with knee pain, and severity levels of mild, moderate and severe. Conclusions The results show that the serum vitamin D did not have a significant effect on knee pain in older adults in Korea. Geriatr Gerontol Int 2017; 17: 1278–1285.

  July 27, 2016   doi: 10.1111/ggi.12857   open full text
• Systematic review of the Kihon Checklist: Is it a reliable assessment of frailty?
  Priscila Yukari Sewo Sampaio, Ricardo Aurélio Carvalho Sampaio, Minoru Yamada, Hidenori Arai.
  Geriatrics and Gerontology International. July 22, 2016
  Aim To investigate whether the Kihon Checklist (KCL) can predict frailty and disability. Methods The studies analyzed for the present review were retrieved by searching electronic databases and other sources using the keywords “Kihon Checklist” and “Basic Checklist.” The articles were restricted to those written in English and published in health sciences journals from the year 2006 until the end of April 2015. To be included in the full analysis, the study had to be primary research and use the KCL as a dependent or independent variable. Results A total of 62 articles were identified in the initial search, and after screening, 13 articles were included in this review. The KCL was found to be closely correlated with validated assessments of frailty phenotypes. The complete version of the KCL and specific domains have been used as research outcomes to verify frailty in cross‐sectional and longitudinal studies. KCL domains were applied to evaluate different outcomes, such as depressive mood, functional disability and instrumental activities of daily living limitations. Conclusions The KCL is a reliable tool for predicting general frailty and frailty aspects in older adults. The KCL was shown to be adequate for cross‐cultural studies and to be suitable for addressing frailty demands among elderly in multiple cohorts. The KCL is a short questionnaire, which makes its administration by health promoters easy; thus, it has been used to evaluate the effectiveness of frailty interventions. We strongly recommend use of the KCL in community and clinical practice to assess frailty status. Geriatr Gerontol Int 2016; 16: 893‐902.

  July 22, 2016   doi: 10.1111/ggi.12833   open full text
• Association of metabolic syndrome and 25‐hydroxyvitamin D with cognitive impairment among elderly Koreans.
  Eun Young Lee, Su Jin Lee, Kyoung Min Kim, Young Mi Yun, Bo Mi Song, Jong Eun Kim, Hyeon Chang Kim, Yumie Rhee, Yoosik Youm, Chang Oh Kim.
  Geriatrics and Gerontology International. July 22, 2016
  Aim Metabolic syndrome and vitamin D deficiency are prevalent in older adults, and are considered risk factors for cognitive impairment. We investigated the combined effects of MetS and serum 25‐hydroxyvitamin D (25[OH]D) levels on cognitive function in older adults. Methods We studied 2940 participants aged ≥65 years from the Korean Urban Rural Elderly cohort study. Metabolic syndrome was defined according to the updated Adult Treatment Panel III criteria. Serum 25(OH)D levels were categorized into four groups: <25, 25–49, 50–74 and ≥75 nmol/L. Cognitive function was assessed using the Mini‐Mental State Examination. Results Participants with cognitive impairment had higher metabolic syndrome prevalence and lower serum 25(OH)D levels than those without cognitive impairment. In univariate analysis, both metabolic syndrome and low 25(OH)D levels were associated with cognitive impairment. These associations remained unchanged after adjusting for potential confounders including age, sex, season and education. In addition, participants with metabolic syndrome and low 25(OH)D had significantly increased odds for cognitive impairment (odds ratio 3.06, 95% CI 1.61–5.80) when compared with those with no metabolic syndrome and high 25(OH)D. Conclusions Metabolic syndrome was associated with cognitive impairment, and this risk was synergistically increased when metabolic syndrome was combined with low 25(OH)D. A focus on individuals with metabolic syndrome and low 25(OH)D might be helpful to identify older adults who are at risk of cognitive impairment. Geriatr Gerontol Int 2016; ••: ••–••.

  July 22, 2016   doi: 10.1111/ggi.12826   open full text
• Differences between older and young patients with autoimmune gastritis.
  Çağdaş Kalkan, Irfan Soykan.
  Geriatrics and Gerontology International. July 22, 2016
  Aim Elderly patients with autoimmune gastritis might have different symptoms than those of young patients. The aim of the present study was to compare presented symptoms and laboratory parameters associated with autoimmune gastritis in both old and young age groups. Methods A total of 355 patients with autoimmune gastritis were stratified into two groups: 65 years or older (n = 119, mean age 69.47 ± 5.027 years), and under 65 years (n = 236, mean age 45.79 ± 10.51 years). These two groups were then evaluated and compared by means of clinical symptoms, concurrent autoimmune diseases, serum gastrin, vitamin B12 and chromogranin A levels, and the presence of enterochromograffin‐like cell hyperplasia. Results Among 119 older patients, 35 had dyspeptic symptoms, and 84 patients were referred for vitamin B12 and/or iron deficiency. In the younger group (n = 236), there were more patients who had dyspeptic symptoms (36 vs 200, P < 0.001). Serum gastrin (726.68 ± 266.183 vs 214.36 ± 104.62 pg/mL, P < 0.001) and chromogranin A (301.26 ± 172.95 vs 106.59 ± 67.66 ng/mL, P < 0.001) levels were significantly higher, and the presence of enterochromograffin‐like cell hyperplasia was more frequent (113 vs 31, P < 0.001) in older patients than younger patients. Polyautoimmunity (66.3% vs 24.5%) and multiple autoimmune syndrome (17.6% vs 5.5%) were more common in older patients (P < 0.001). Conclusions There are differences in the clinical characteristics and the laboratory parameters between patients with autoimmune gastritis that are older and younger than 65 years‐of‐age. Elderly patients with autoimmune gastritis were investigated more commonly for vitamin B12 and/or iron deficiency. Polyautoimmunity and multiple autoimmune syndrome were more common, and serum gastrin and chromogranin A levels were significantly higher in older patients. Geriatr Gerontol Int 2016; ••: ••–••.

  July 22, 2016   doi: 10.1111/ggi.12832   open full text
• Sarcopenia and mortality in older people living in a nursing home in Turkey.
  Ahmet Yalcin, Sevgi Aras, Volkan Atmis, Ozlem Karaarslan Cengiz, Esat Cinar, Teslime Atli, Murat Varli.
  Geriatrics and Gerontology International. July 20, 2016
  Aim The aim of the present study was to evaluate the relationship between mortality and sarcopenia defined by the criteria of the European Working Group on Sarcopenia in Older People in older nursing home residents in Turkey. Methods This was an observational prospective study. Nursing home residents who were aged older than 65 years and living in the Seyranbagları Nursing Home and Rehabilitation Center (Ankara, Turkey) were recruited for the study. The main outcome measure was the relationship between sarcopenia and mortality. Diagnosis of sarcopenia was carried out according to the European Working Group on Sarcopenia in Older People criteria. Bioelectrical impedance analysis was used for skeletal muscle mass measurement. Muscle strength and muscle performance were evaluated by handgrip testing and gait speed, respectively. Mortality was assessed at the end of 2 years. The Kaplan–Meier method and Cox regression analysis were used to evaluate the relationship between sarcopenia and all‐cause mortality. Results The prevalence of sarcopenia and severe sarcopenia were 29% and 25.4%, respectively. A total of 44% (18) of sarcopenic participants died, whereas 15% (15) of participants without sarcopenia died after 2 years of follow up (P < 0.001). After adjusting for confounding factors, sarcopenia was associated with all‐cause mortality among older nursing home residents in Turkey (HR 2.38, 95% CI 1.04–5.46; P = 0.039). However, sarcopenia was not significantly related with mortality after adjustment of MNA score (HR 2.04, 95% CI 0.85–4.9; P = 0.1). Conclusions Sarcopenia independently increases all‐cause mortality in older nursing home residents in Turkey. Nutritional status plays a role in sarcopenia‐related mortality. Geriatr Gerontol Int 2016; ••: ••–••.

  July 20, 2016   doi: 10.1111/ggi.12840   open full text
• Prognostic value of acute delirium recovery in older adults.
  Carlos Jorge‐Ripper, María‐Remedios Alemán, Rosa Ros, Selena Aguilera, Emilio González‐Reimers, Elisa Espelosín, Francisco Santolaria.
  Geriatrics and Gerontology International. July 19, 2016
  Aim To analyze the prognostic impact of short‐term changes in the intensity of delirium in association or not with sepsis. We also aimed to analyze if s100B, a serum protein derived from astrocytes related to cerebral damage, could be a marker of delirium or sepsis. Methods We included 47 patients with acute delirium and sepsis, 36 with delirium and no evidence of infection, and 36 patients with sepsis without delirium. The diagnosis of delirium was established by the Confusion Assessment Method. To evaluate delirium, we recorded the following characteristics on the first and third day after admission: level of consciousness, orientation, attention, hallucinations, psychomotor activity, language and disorganized thinking. Results In 53 patients, delirium improved during hospitalization with 3.8% of mortality, whereas in the 30 patients in which delirium did not improve or worsened, 50% died during hospitalization. The improvement on the third day of consciousness, orientation, attention and disorganized thinking was related to a better long‐term survival. s100B and inflammatory markers tumor necrosis factor‐α, interleukin‐6, interleukin‐10 and interferon‐γ were increased in patients with sepsis and confusion when compared with control participants; furthermore, s100B, interleukin‐6 and interferon‐γ were increased in septic patients without confusion, but also in delirious patients without sepsis. Conclusions The main factor related to mortality was the recovery from delirium during hospitalization. We found increased s100B serum levels in patients with delirium, but also in septic patients without delirium. This increase was not related to mortality. Geriatr Gerontol Int 2017; 17: 1161–1167.

  July 19, 2016   doi: 10.1111/ggi.12842   open full text
• Low intakes of carotene, vitamin B2, pantothenate and calcium predict cognitive decline among elderly patients with diabetes mellitus: The Japanese Elderly Diabetes Intervention Trial.
  Atsushi Araki, Yukio Yoshimura, Takashi Sakurai, Hiroyuki Umegaki, Chiemi Kamada, Satoshi Iimuro, Yasuo Ohashi, Hideki Ito,.
  Geriatrics and Gerontology International. July 18, 2016
  Aim The present study aimed to examine whether nutrient intakes predicted cognitive decline among elderly patients with diabetes mellitus. Methods This study evaluated data from a 6‐year prospective follow up of 237 elderly patients (aged ≥65 years) with diabetes mellitus, and the associations of baseline nutrient intakes with cognitive decline. Cognitive decline was defined as a ≥2‐point decrease in the Mini‐Mental State Examination (MMSE) score. Intakes of food and nutrients were assessed using a validated food frequency questionnaire, and were compared between patients with cognitive decline and intact cognition. Analysis of covariance and logistic regression analysis were used to compare the changes in the MMSE score during the follow up among intake tertile groups for each nutrient. Results Compared with men with intact cognition, the men with cognitive decline had lower baseline intakes of calcium, vitamin A, vitamin B2, pantothenate, soluble fiber, green vegetables and milk. However, no significant associations between cognitive decline and nutrient intakes were observed among women. After adjusting for age, body mass index, glycated hemoglobin levels, history of severe hypoglycemia, previous stroke and baseline MMSE score, we found that cognitive decline was significantly associated with low intakes of carotene, vitamin B2, pantothenate, calcium and green vegetables. Multiple logistic regression analysis showed that intakes of nutrients and green vegetables predicted cognitive decline after adjusting for age, body mass index, glycated hemoglobin levels, baseline MMSE score, and incident stroke during the follow up. Conclusions These findings suggest that sufficient intakes of carotene, vitamin B2, pantothenate, calcium and vegetables could help prevent cognitive decline among elderly men with diabetes mellitus. Geriatr Gerontol Int 2017; 17: 1168–1175.

  July 18, 2016   doi: 10.1111/ggi.12843   open full text
• Psychological predictors of participation in screening for cognitive impairment among community‐dwelling older adults.
  Kazuhiro Harada, Sangyoon Lee, Hiroyuki Shimada, Sungchul Lee, Seongryu Bae, Yuya Anan, Kenji Harada, Takao Suzuki.
  Geriatrics and Gerontology International. July 18, 2016
  Aim Detecting cognitive impairment in the earlier stages is important for preventing or delaying dementia. To develop intervention strategies that promote screening for cognitive impairment, it is essential to identify the modifiable predictors for participation in screening. The present study examined whether participation in screening for cognitive impairment was predicted by the constructs of the health belief model, dementia worry and behavioral intentions to undergo screening among older adults. Methods The study used a prospective design. After a baseline questionnaire survey, participation in screening for cognitive impairment was followed for 6 months (n = 10 023). Participation in the screening, constructs of the health belief model (perceived susceptibility to dementia, perceived severity of dementia, perceived benefits of screening, perceived barriers to screening), dementia worry, behavioral intentions and demographic factors were measured. Results A path analysis showed that the behavioral intention to undergo screening (path coefficient = 0.29) directly predicted participation in screening for cognitive impairment, whereas other psychological and demographic factors did not directly predict participation. The behavioral intention was explained by the perceived benefits of screening (path coefficient = 0.51), perceived barriers to screening (path coefficient = −0.19) and perceived susceptibility to dementia (path coefficient = 0.16). Conclusions Participation in screening for cognitive impairment was positively predicted by higher behavioral intention to undergo screening. In turn, this behavioral intention was mainly predicted by the perceived benefits of screening among older adults. These findings suggest that emphasizing the perceived benefits and encouraging behavioral intentions might promote participation in screening for cognitive impairment. Geriatr Gerontol Int 2017; 17: 1197–1204.

  July 18, 2016   doi: 10.1111/ggi.12841   open full text
• Association between circulating fibroblast growth factor‐23 and age‐related cardiovascular–renal parameters in a healthy Chinese population.
  Nan Wang, Xiaojuan Bai, Bo Jin, Wen Han, Xuefeng Sun, Xiangmei Chen.
  Geriatrics and Gerontology International. July 18, 2016
  Aim Previous studies showed that circulating fibroblast growth factor‐23 (FGF23) is a new biomarker linked to cardiovascular and kidney diseases. Here, we explored the association between serum FGF23 and aging‐related cardiovascular–renal parameters in a healthy Chinese population. Methods A total of 314 healthy participants aged 36–87 years were enrolled. Cardiovascular structure and function were assessed by the left ventricular ejection fraction, the ratio of early diastolic peak flow velocity to late diastolic peak flow velocity at the mitral leaflet tips, carotid intima‐media thickness, the diameter of the bilateral common carotid artery, blood systolic peak and end diastolic velocities, which were measured by M‐mode ultrasonography. Glomerular filtration rate was evaluated using the Chronic Kidney Disease Epidemiology Collaboration equation and Chronic Kidney Disease Epidemiology Collaboration equation for Asians. Serum FGF23, 1, 25‐dihydroxy vitamin D3 and parathyroid hormone were measured by enzyme‐linked immunosorbent assay. Results For all participants, intima‐media thickness/diameter of the bilateral common carotid artery gradually decreased with the progression from low to high FGF23 concentration (P < 0.05). After adjusting for all possible confounders, FGF23 remained significantly associated with intima‐media thickness/diameter of the bilateral common carotid artery (P = 0.016). In women, serum FGF23 was significantly associated with serum creatinine, cystatin C and estimated glomerular filtration rate in the Spearman correlation analysis. FGF23 remained significantly associated with serum creatinine (P = 0.046) and estimated glomerular filtration rate (P = 0.034) after full adjustment. However, no such relationship was apparent in men. Conclusions Serum FGF23 was correlated with aging‐related cardiovascular–renal parameters even in healthy people. Measurement of serum FGF23 can provide valuable information to predict cardiovascular–renal function in healthy people, especially in older female adults. Geriatr Gerontol Int 2017; 17: 1221–1231.

  July 18, 2016   doi: 10.1111/ggi.12844   open full text
• Effect of a dual task on quantitative Timed Up and Go performance in community‐dwelling older adults: A preliminary study.
  Erin Smith, Lorcan Walsh, Julie Doyle, Barry Greene, Catherine Blake.
  Geriatrics and Gerontology International. July 18, 2016
  Aim The Timed Up and Go test (TUG) is used as a measure of functional ability in older adults; however, the method of measurement does not allow us to determine which aspects of the test deficits occur in. The aim of the present study was to examine the ability of the quantitative TUG (QTUG) to measure performance during the TUG test under three different conditions – single task, motor task and cognitive dual task – and to compare performance between fallers and non‐fallers in high‐functioning community‐dwelling older adults. Methods A total of 37 community‐dwelling older adults, 16 with a self‐reported falls history in the previous year, were recruited. Participants underwent a falls risk assessment with a physiotherapist including the QTUG under three conditions (single task, motor task, cognitive dual‐task). A total of 10 clinical parameters were chosen for analysis using mancova and a series of ancova, with age, sex and body mass index included as covariates. Results The mancova analysis showed a significant difference across the three task conditions (Wilk's Lambda F20,186 = 3.37, P < 0.001. No overall significant difference between faller and non‐faller groups (Wilk's Lambda F10,96 = 1.469, P = 0.163) or significant interaction between task and faller status (Wilk's Lambda F20,192 = 1.131, P = 0.321) was found. ancova results for each of the parameters showed overall differences between single, motor and cognitive tasks for all of the variables, except time in double support. When faller and non‐faller differences were explored, cadence and stride velocity was greater, and stride time longer in those with a prior history of falls. Conclusions In community‐dwelling older adults, these preliminary results show that a cognitive dual‐task significantly (P < 0.025) affects QTUG performance in almost all parameters, with a significant (P < 0.025) reduction in time‐to‐stand observed with a motor task. Although no statistical difference was found between fallers and non‐fallers for many of the parameters, cadence, stride time and stride velocity were statistically different (P < 0.05). A larger sample size and more assessment points might lead to more definitive findings. These results highlight the need for further research to examine QTUG performance under dual‐task conditions between fallers and non‐fallers in this population, and to look at the ability of dual‐task QTUG assessment to measure change longitudinally and the effectiveness of therapeutic interventions. Geriatr Gerontol Int 2017; 17: 1176–1182.

  July 18, 2016   doi: 10.1111/ggi.12845   open full text
• Clinical frailty and functional trajectories in hospitalized older adults: A retrospective observational study.
  Peter Hartley, Jennifer Adamson, Carol Cunningham, Georgina Embleton, Roman Romero‐Ortuno.
  Geriatrics and Gerontology International. July 18, 2016
  Aim Frailty predicts inpatient mortality and length of stay, but its link to functional trajectories is under‐researched. Addenbrooke's Hospital, Cambridge, UK, collects the Clinical Frailty Scale (CFS) within 72 h of admission for those aged ≥75 years. We studied whether the CFS links to functional trajectories in hospitalized older adults. Methods This was a retrospective observational study in an English university hospital. We analyzed all first episodes of county residents aged ≥75 years admitted to the Department of Medicine for the Elderly wards between December 2014 and May 2015. Data were extracted from the hospital's information systems. Patients were classified as non‐frail (CFS 1–4), moderately frail (CFS 5–6) and severely frail (CFS 7–8). Function was retrospectively measured with the modified Rankin Scale (mRS) at preadmission, admission and discharge. Results Of 539 eligible patients, 46 died during admission (mortality rates: 2% in CFS 1–4, 5% in CFS 5–6, 19% in CFS 7–8). Among the 493 survivors, 121 were non‐frail, 235 moderately and 137 severely frail. The mean mRS of the non‐frail was 1.8 (95% CI 1.7–2.0) at baseline, 3.3 (95% CI 3.1–3.5) on admission and 2.2 (95% CI 2.0–2.3) on discharge (mean length of stay 9 days). The moderately frail had a mean mRS of 2.9 (95% CI 2.8–3.0) at baseline, 4.0 (95% CI 3.8–4.1) on admission and 3.2 (95% CI 3.1–3.3) on discharge (mean length of stay 15 days). The severely frail had mean mRS of 3.5 (95% CI 3.3–3.6) at baseline, 4.3 (95% CI 4.1–4.4) on admission and 3.7 (95% CI 3.6–3.9) on discharge, respectively (mean length of stay 17 days). Conclusions In older inpatients, frailty might be linked to lower and slower functional recovery. Prospective work is required to confirm these trajectories and understand how to influence them. Geriatr Gerontol Int 2016; ••: ••–••.

  July 18, 2016   doi: 10.1111/ggi.12827   open full text
• Parameters affecting inhalation therapy adherence in elderly patients with chronic obstructive lung disease and asthma.
  Onur Turan, Pakize Ayse Turan, Arzu Mirici.
  Geriatrics and Gerontology International. July 18, 2016
  Aim One of the most significant problems in the treatment of elderly patients is incorrect use of inhaler devices. The purpose of the present study was to assess the parameters affecting treatment adherence among elderly patients. Methods Spirometry, the Mini‐Mental State Examination for cognitive impairment and the Morisky Medication Adherence Scale‐4 were carried out in 121 (88 chronic obstructive lung disease patients according to the Global Initiative for Chronic Obstructive Lung Disease, 33 asthma patients according to The Global Initiative for Asthma (GINA) criteria) participants aged over 65 years. Results The patients with cognitive impairment, low socioeconomic status, a high number of admissions to an emergency service in past year and the presence of dyspnea or sputum had significantly lower inhalation device use scores (P = 0.017, 0.03, 0.025, 0.03 and 0.02). The patients with high Mini‐Mental State Examination scores and forced expiratory volume in 1 s (as liter and percentage) were found to be more successful in using inhaler devices (P = 0.005, 0.007 and 0.022). There was a negative correlation between number of hospitalizations and inhalation device score (P = 0.021).The participants without education/training by a doctor about the inhaler device had a significantly poorer treatment adherence (P < 0.001). Conclusions Older chronic obstructive lung disease and asthmatic patients have more difficulty with the correct use of inhaler devices. Cognitive impairment might be an important parameter that can affect inhalation device technique. Socioeconomic status, smoking, pulmonary symptoms and admissions to hospital were also thought to have effects on the adherence to inhalation therapy. The type of chronic respiratory disease (chronic obstructive lung disease/asthma) is not a major factor influencing therapy adherence. Assessment of cognitive functions, choosing suitable inhalation devices and educational programs for inhaler use could improve the success of inhaler technique in elderly patients. Geriatr Gerontol Int 2017; 17: 999–1005.

  July 18, 2016   doi: 10.1111/ggi.12823   open full text
• Antihypertensive medicines utilization: A decade‐long nationwide study of octogenarians, nonagenarians and centenarians.
  Sujita W Narayan, Prasad S Nishtala.
  Geriatrics and Gerontology International. July 18, 2016
  Aim Gaining an insight into the utilization of antihypertensive medicines against a background of evolving hypertension treatment guidelines that might not be relevant to the oldest old is important. The aim of the present study was to characterize the overall trends in the utilization of antihypertensive medicines in the oldest old by therapeutic class and chemical type, stratified by age and sex over a decade. Methods Antihypertensive medicines utilization was examined using the therapeutic and chemical groups based on the World Health Organization Collaborating Center for Drug Statistics Mythology's Anatomical Therapeutic Chemical classification system for all individuals aged ≥80 years. Regression and repeated cross‐sectional analyses was carried out, and defined daily dose was used to describe the utilization per thousand older people per day. Results Utilization of antihypertensive medicines increased over the decade from 187.28 in 2005 to 205.01 defined daily dose per thousand older people per day in 2014, and shifted from mainly diuretics to angiotensin‐converting enzyme inhibitors. Interestingly, with the exception of diuretics, utilization of all medicines decreased gradually with increasing age. Single products use increased by 1.48‐fold in 2014 compared with 2005, and for fixed‐dose combinations the increase was 1.41‐fold for the same period. Conclusions The increased utilization of angiotensin‐converting enzyme inhibitors is consistent with recommendations from cardiovascular guidelines formulated from large randomized control trials that often exclude the oldest old. Interestingly, the utilization of beta‐blockers decreased and diuretics increased in centenarians. The utilization of calcium channel blockers and angiotensin‐converting enzyme inhibitors across the study period increased in all age categories. Geriatr Gerontol Int 2016; ••: ••–••.

  July 18, 2016   doi: 10.1111/ggi.12838   open full text
• Disease burden morbidity assessment by self‐report: Psychometric properties in older adults in Spain.
  Irene GM Wijers, Alba Ayala, Carmen Rodriguez‐Blazquez, Angel Rodriguez‐Laso, Vicente Rodriguez‐Rodriguez, Maria João Forjaz.
  Geriatrics and Gerontology International. July 18, 2016
  Aim To carry out an analysis of the psychometric properties of the Disease Burden Morbidity Assessment (DBMA) according to the assumptions of the Classical Test Theory. Methods A sample of 707 community‐dwelling adults aged 65 years and older, living in Spain, completed the DBMA. Psychometric properties of the scale (feasibility, acceptability, scaling assumptions, reliability and construct validity) were analyzed. Results The mean DBMA score was 6.8. Feasibility and acceptability were satisfactory, except for large floor effects (>50%), as well as a skewed distribution (1.8). Item‐total corrected correlation ranged 0.10–0.49, item homogeneity index was 0.09 and Cronbach's alpha was 0.72. Disease burden correlated strongly with physical functioning (r = –0.56) and perceived health (r = –0.56), and moderately with depression (r = 0.41) and the Personal Wellbeing Index (r = –0.41). Exploratory factor analysis extracted five factors, explaining 44% of the variance. Conclusions The DBMA is an acceptable and valid instrument for measuring disease burden in older adults. Future studies should include Rasch analysis to further assess dimensionality and explore other measurement properties. Geriatr Gerontol 2016; ••: ••–••

  July 18, 2016   doi: 10.1111/ggi.12835   open full text
• Association between gait abnormality and malnutrition in a community‐dwelling elderly population.
  Shogo Misu, Tsuyoshi Asai, Takehiko Doi, Ryuichi Sawa, Yuya Ueda, Takashi Saito, Ryo Nakamura, Shunsuke Murata, Taiki Sugimoto, Minoru Yamada, Rei Ono.
  Geriatrics and Gerontology International. July 18, 2016
  Aim Malnutrition is common in older adults, and contributes to the risk of falls and functional impairment. Gait performance also contributes to falls and functional impairment; however, the association between malnutrition and gait performance remains unclear. The purpose of the present study was to investigate the association between malnutrition risk and gait performance. Methods The study participants included 204 community‐dwelling older adults with a mean age of 73.4 ± 4.3 years. Nutritional status was evaluated using the short version of the Mini‐Nutritional Assessment. A score of 11 points was used as the cut‐off, and the participants were categorized into two groups: ≤11, malnutrition‐risk group; and ≥12, well‐nourished group. Gait performance was assessed by gait speed and walking smoothness. Walking smoothness was quantified by harmonic ratios (HR), which were derived from vertical (VT), mediolateral (ML) and anteroposterior trunk accelerations, recorded during over‐ground walking. Skeletal muscle mass index, handgrip strength and physical functions were also measured. Results HR in the ML direction was significantly lower in the malnutrition‐risk group than the well‐nourished group (P = 0.002); however, no differences between the two groups were observed in gait speed or HR in the VT and anteroposterior directions. The relationship between malnutrition and HR in the ML direction was independent of skeletal muscle mass index, handgrip strength, physical function, gait speed, and other confounders (P < 0.05). Conclusions In community‐dwelling older adults, malnutrition is related to decreased walking smoothness in the ML direction, suggesting that nutritional status affects lateral trunk control during walking. Geriatr Gerontol Int 2017; 17: 1155–1160.

  July 18, 2016   doi: 10.1111/ggi.12839   open full text
• Age‐specific risk factors for incident disability in activities of daily living among middle‐aged and elderly community‐dwelling Japanese women during an 8–9‐year follow up: The Hizen‐Oshima study.
  Takuhiro Okabe, Yasuyo Abe, Yoshihito Tomita, Satoshi Mizukami, Mitsuo Kanagae, Kazuhiko Arima, Takayuki Nishimura, Ritsu Tsujimoto, Natsumi Tanaka, Hisashi Goto, Itsuko Horiguchi, Kiyoshi Aoyagi.
  Geriatrics and Gerontology International. July 12, 2016
  Aim The purposes of the present study were to investigate risk factors for incident disability in activities of daily living (ADL) among middle‐aged and older women, and to determine whether there are differences in risk factors according to age groups. Methods The participants were 264 Japanese women aged 40 years and older. A self‐administered questionnaire was used to survey participants about difficulty in carrying out selected basic and instrumental ADL at baseline and at follow up. ADL disability was defined as difficulty carrying out three or more ADL. Information on knee joint or back pain and comorbidities (heart disease, lung disease, stroke or diabetes mellitus) was obtained using a self‐administered questionnaire at baseline. Physical performance measurements (grip strength, chair stand time, rapid walking speed and functional reach) were also carried out at baseline. Results The prevalence of incident ADL disability was 44 (27.5%) in women aged 40–64 years, and 57 (54.8%) in women aged ≥65 years (P < 0.001). Multiple logistic regression analysis showed that decreased grip strength and having pain were significantly associated with a higher risk for incident ADL disability among women aged 40–64 years. For women aged ≥65 years, decreased rapid walking speed, having a comorbidity and having pain were associated with incident ADL disability. Conclusions The present study showed that a different set of risk factors was associated with incident ADL disability among women aged 40–64 years and women aged ≥65 years. Age‐specific screening and intervention strategies are necessary for effective prevention of incident ADL disability. Geriatr Gerontol Int 2016; ••: ••–••.

  July 12, 2016   doi: 10.1111/ggi.12834   open full text
• Effect of elastic band‐based high‐speed power training on cognitive function, physical performance and muscle strength in older women with mild cognitive impairment.
  Dong Hyun Yoon, Dongheon Kang, Hee‐jae Kim, Jin‐Soo Kim, Han Sol Song, Wook Song.
  Geriatrics and Gerontology International. July 10, 2016
  Aim The effectiveness of resistance training in improving cognitive function in older adults is well demonstrated. In particular, unconventional high‐speed resistance training can improve muscle power development. In the present study, the effectiveness of 12 weeks of elastic band‐based high‐speed power training (HSPT) was examined. Methods Participants were randomly assigned into a HSPT group (n = 14, age 75.0 ± 0.9 years), a low‐speed strength training (LSST) group (n = 9, age 76.0 ± 1.3 years) and a control group (CON; n = 7, age 78.0 ± 1.0 years). A 1‐h exercise program was provided twice a week for 12 weeks for the HSPT and LSST groups, and balance and tone exercises were carried out by the CON group. Results Significant increases in levels of cognitive function, physical function, and muscle strength were observed in both the HSPT and LSST groups. In cognitive function, significant improvements in the Mini‐Mental State Examination and Montreal Cognitive Assessment were seen in both the HSPT and LSST groups compared with the CON group. In physical functions, Short Physical Performance Battery scores were increased significantly in the HSPT and LSST groups compared with the CON group. In the 12 weeks of elastic band‐based training, the HSPT group showed greater improvements in older women with mild cognitive impairment than the LSST group, although both regimens were effective in improving cognitive function, physical function and muscle strength. Conclusions We conclude that elastic band‐based HSPT, as compared with LSST, is more efficient in helping older women with mild cognitive impairment to improve cognitive function, physical performance and muscle strength. Geriatr Gerontol Int 2017; 17: 765–772.

  July 10, 2016   doi: 10.1111/ggi.12784   open full text
• Insomnia and depression impair oral health‐related quality of life in the old‐old.
  Satoshi Noguchi, Michiko Makino, Satoru Haresaku, Kaoru Shimada, Toru Naito.
  Geriatrics and Gerontology International. July 07, 2016
  Aim A previous study reported that the oral health‐related quality of life (OHRQoL) of Japanese individuals dropped sharply as they reached old‐old age. The aim of present study was to explore the risk factors of OHRQoL by investigating the association of OHRQoL with oral indices, lifestyle and psychological distress. Methods A questionnaire survey was carried out to assess the OHRQoL, oral indices, lifestyle, and psychological distress of patients who were of ≥75 years of age and who regularly visited a dental clinic for maintenance. OHRQoL and psychological distress were assessed using the General Oral Health Assessment Index (GOHAI) and the General Health Questionnaire, respectively. The relationships between the GOHAI score and related factors were examined by non‐parametric bivariate and logistic regression analyses using a GOHAI cut‐off score of 45.0. Results A total of 187 old‐old patients with a mean age of 77.9 ± 3.0 years participated in the present study. The average GOHAI score was 50.8 ± 8.0. In the bivariate analyses, the average sleeping hours, use of sleep medication, Short Form 8‐Item Health Survey (SF‐8), General Health Questionnaire score, and the number of teeth present were significantly correlated with the GOHAI score. A logistic regression analysis showed that the number of teeth present, General Health Questionnaire and the use of sleep medication were associated with the GOHAI score. Conclusions The present study found that the OHRQoL was strongly associated with insomnia and depression. It is therefore suggested that oral healthcare professionals take general background information, such as the presence of insomnia and depression, into consideration to improve OHRQoL when they treat old‐old patients. Geriatr Gerontol Int 2017; 17: 893–897.

  July 07, 2016   doi: 10.1111/ggi.12816   open full text
• Factors associated with end‐of‐life by home‐visit nursing‐care providers in Japan.
  Miharu Nakanishi, Junko Niimura, Atsushi Nishida.
  Geriatrics and Gerontology International. July 07, 2016
  Aim Home‐visit nursing‐care services in Japan are expected to provide home hospice services for older patients with non‐cancer diseases. The aim of the present study was to examine factors that contribute to the provision of end‐of‐life care by home‐visit nursing‐care providers in Japan. Methods The present retrospective study was carried out using nationally representative cross‐sectional data from the 2007, 2010, and 2013 Survey of Institutions and Establishments for Long‐Term Care. A total of 138 008 randomly sampled home‐visit nursing‐care service users were included in this analysis. End‐of‐life care (study outcome) was defined as the provision of nursing‐care within the last month of life. Results Of the 138 008 patients at home, 2280 (1.7%) received home‐based nursing care within the last month of life, and end‐of‐life care was offered primarily to cancer patients (n = 1651; 72.4%). After accounting for patient characteristics, patients were more likely to receive end‐of‐life care when they used home‐visit nursing‐care providers that had a greater number of nursing staff or were located in a region with fewer hospital beds. Conclusions Among home‐visit nursing‐care providers, the nursing staff ratio and the availability of hospital beds were related to the provision of end‐of‐life care. Home‐visit nursing‐care providers should establish specialist hospice care teams with enhanced staffing ratios to allow for the adequate provision of home‐based end‐of‐life care. A community‐based network between home‐visit nursing‐care providers and hospitals should also be established to attain an integrated end‐of‐life care system for elderly populations in regions with more hospital beds. Geriatr Gerontol Int 2017; 17: 991–998.

  July 07, 2016   doi: 10.1111/ggi.12822   open full text
• Fear of falling, but not gait impairment, predicts subjective memory complaints in cognitively intact older adults.
  Ryota Sakurai, Hiroyuki Suzuki, Susumu Ogawa, Hisashi Kawai, Hideyo Yoshida, Hirohiko Hirano, Kazushige Ihara, Shuichi Obuchi, Yoshinori Fujiwara.
  Geriatrics and Gerontology International. July 07, 2016
  Aim Understanding the risk factors for developing subjective memory complaints (SMC) could help with early screening and treatment for cognitive impairment. The aim of the present study was to explore the risk factors for developing SMC, by focusing on gait‐related variables. Methods A total of 406 community‐dwelling older adults aged 65–85 years without impending cognitive impairment participated in baseline and 1‐year follow‐up evaluations. A comprehensive evaluation was carried out, and included gait speed and fear of falling (FoF) assessments, and the Montreal Cognitive Assessment test. Logistic regression analyses were carried out to independently evaluate the risk factors at baseline and follow‐up evaluations. Results At baseline, 45.1% of older adults had SMC. The presence of SMC at baseline was associated with being female, subjective hearing loss and FoF. Of 223 participants who did not report SMC at baseline, 48 had newly developed SMC at follow up (21.5%). The significant predictors for developing SMC were being female and FoF, but not gait speed, and were independent of depression symptoms. The Montreal Cognitive Assessment total score at baseline was a marginally significant predictor for developing SMC at follow up (P = 0.06), but a lower score in the language domain was a significant predictor in further analysis. Conclusions FoF was a significant risk for future development of SMC, suggesting that FoF might reflect the risk of cognitive impairment at an earlier stage, or that FoF and SMC could share the same basis of anxiety for daily activities. The mechanisms and consequence of this longitudinal relationship require further study. Geriatr Gerontol Int 2016; ••: ••–••.

  July 07, 2016   doi: 10.1111/ggi.12829   open full text
• Impact of dementia on behavioral independence and disturbance.
  Naoyuki Nakayama, Makoto Suzuki, Arisa Endo, Yusuke Nitanda, Nao Tanabe, Aki Watanabe, Michinari Fukuda, Teruaki Endo.
  Geriatrics and Gerontology International. July 05, 2016
  Aim Decreasing behavioral independence levels and increasing frequencies of behavioral disturbances are the most problematic aspects for people with dementia. However, the relative effects of dementia on these factors are unknown. We investigated variability in behavioral independence and disturbance profiles of patients with dementia. Methods This was a cross‐sectional correlation study in which 70 inpatients with dementia from convalescent wards in a hospital were enrolled. We assessed cognitive impairments with the Mini‐Mental State Examination, evaluated behavioral independence levels with the Functional Independence Measure and assessed frequency of behavioral disturbances with the Dementia Behavior Disturbance Scale. Results Coefficient determination was 0.395 (P < 0.0001) between the Mini‐Mental State Examination and Functional Independence Measure scores, 0.261 (P < 0.0001) between the Mini‐Mental State Examination and Dementia Behavior Disturbance Scale scores, and 0.355 (P < 0.0001) between the Functional Independence Measure and Dementia Behavior Disturbance Scale scores. The most easily accomplished behavioral independence was eating, and the hardest was transfer to tub/shower. The behavioral disturbance with the highest frequency was urinary incontinence, and the lowest was emptying drawers or closets. Conclusions Moderate correlations were found between severity of dementia and behavioral independence levels and frequencies of behavioral disturbances. There were both easier and harder to accomplish behaviors, and both higher and lower frequencies of behavioral disturbances. Geriatr Gerontol Int 2017; 17: 605–613.

  July 05, 2016   doi: 10.1111/ggi.12767   open full text
• Social support, coping strategies and their correlations with older adults’ relocation adjustments after natural disaster.
  Shiau‐Fang Chao.
  Geriatrics and Gerontology International. July 05, 2016
  Aim The present study examines the associations among social support, coping strategies and relocation adjustment outcomes, including community cohesion, residential satisfaction and depressive symptoms, for older persons in Taiwan displaced by Typhoon Morakot. Methods This study enrolled 372 adults aged 60 years or older who were relocated to permanent houses after Typhoon Morakot destroyed their homes on 8 August 2009. A path analysis simultaneously examined the hypothesized links among social support, coping strategies and relocation adjustment outcomes. Results The relationships between coping strategies and relocation outcomes varied. Problem‐focused and support‐seeking coping were positively related to perceived community cohesion, whereas emotion‐focused coping was associated with a high number of depressive symptoms. Social support was positively related to residential satisfaction. Additionally, social support was also indirectly related to increased community cohesion and residential satisfaction through its positive relationship with support‐seeking and problem‐focused coping. Conclusions More interventions should be implemented to enhance support within informal networks and a sense of belonging to the new resident community, thereby promoting more active coping strategies, enhancing the effectiveness of coping efforts and maximizing positive adjustment outcomes. Geriatr Gerontol Int 2017; 17: 1006–1014.

  July 05, 2016   doi: 10.1111/ggi.12807   open full text
• Trend of centenarian deaths in Hong Kong between 2001 and 2010.
  Ruby Yu, Wilson Tam, Jean Woo.
  Geriatrics and Gerontology International. July 05, 2016
  Aim To examine the trends in the leading causes of deaths in centenarians in Hong Kong. Methods Descriptive analyses of vital statistics data on mortality in Hong Kong from 2001 to 2010 were carried out. Results The number of centenarians’ deaths increased by 136% in 10 years, from less than 28 men and 166 women in 2001 to 80 men and 378 women in 2010. During the study period, the top leading cause of death was pneumonia, accounting for 33.8% of all deaths. In contrast, the other leading causes accounted for much smaller percentages; for example, the second and third leading causes were chronic ischemic heart disease and unspecified dementia, and account for 4.3% and 4.2% of the total, respectively. This cause‐of‐death pattern has remained fairly stable between 2001 and 2010. A total of 985 (30.8%) deaths occurred in January to March. The correlation between the average monthly temperature and the number of deaths was –0.720 (P < 0.01). Conclusions The number of deaths continues to increase in Hong Kong. These trends have major implications for healthcare in an aging population. Geriatr Gerontol Int 2017; 17: 931–936.

  July 05, 2016   doi: 10.1111/ggi.12812   open full text
• Association between comprehensive health literacy and frailty level in community‐dwelling older adults: A cross‐sectional study in Japan.
  Hidehiko Shirooka, Shu Nishiguchi, Naoto Fukutani, Daiki Adachi, Yuto Tashiro, Takayuki Hotta, Saori Morino, Yuma Nozaki, Hinako Hirata, Moe Yamaguchi, Tomoki Aoyama.
  Geriatrics and Gerontology International. July 05, 2016
  Aim The present study explored the association between comprehensive health literacy and frailty level in community‐dwelling older adults in Japan. Methods This was a cross‐sectional study. We enrolled 517 community‐dwelling older adults (mean age 73.2 ± 6.3 years; 410 women). We divided the cohort into two groups, non‐frail and any‐frail, based on Fried Frailty Index scores. We assessed comprehensive health literacy using a 14‐item health literacy scale, and classified the participants as having high or low health literacy. We carried out multivariate logistic regression analysis in which the dependent variable was the presence of non‐frailty and the independent variable was the presence of high health literacy. The analysis was adjusted for age, sex, body mass index, educational history and cognitive function. Results There were 132 (25.5%) and 385 (74.5%) participants in the non‐frail and any‐frail groups, respectively. The analysis showed that high health literacy was independently associated with the non‐frail group (odds ratio 1.64, 95% confidence interval 1.03–2.61). Conclusions The results showed that high health literacy was associated with non‐frailty. This result implies that comprehensive health literacy might play a salient role in maintaining good health status in community‐dwelling older adults in Japan. Geriatr Gerontol Int 2017; 17: 804‐809.

  July 05, 2016   doi: 10.1111/ggi.12793   open full text
• Dietary diversity decreases the risk of cognitive decline among Japanese older adults.
  Rei Otsuka, Yukiko Nishita, Chikako Tange, Makiko Tomida, Yuki Kato, Mariko Nakamoto, Tomoko Imai, Fujiko Ando, Hiroshi Shimokata.
  Geriatrics and Gerontology International. July 05, 2016
  Aim To clarify the effectiveness of dietary diversity, calculated by dietary records, on cognitive decline. Methods Data were derived from the National Institute for Longevity Sciences – Longitudinal Study of Aging. Participants comprised 298 men and 272 women aged 60–81 years at baseline (second wave) who participated in the follow‐up study (third to seventh wave) at least once. Cognitive function was assessed with the Mini‐Mental State Examination in all study waves. Dietary diversity was determined using the Quantitative Index for Dietary Diversity based on a 3‐day dietary record in the second wave. Cumulative data among participants with a Mini‐Mental State Examination score >27 in the second wave were analyzed using a generalized estimating equation. Multivariate adjusted odds ratios and 95% confidence intervals for Mini‐Mental State Examination scores ≤27 in each study wave according to a 1 standard deviation (increase), or quartiles of the Quantitative Index for Dietary Diversity at baseline, were adjusted for sex, age, follow‐up time, baseline Mini‐Mental State Examination score, education, body mass index, annual household income, current smoking status, energy intake and disease history. Results Multivariate adjusted odds ratio for a decline in Mini‐Mental State Examination score was 0.79 (95% CI 0.70–0.89; P < 0.001) with a 1 SD increase in dietary diversity score, or 1.00 (reference), 0.99 (95% CI 0.70–1.43), 0.68 (95% CI 0.46–0.99) and 0.56 (95% CI 0.38–0.83) according to the lowest through highest quartiles of dietary diversity score, respectively (trend P = 0.001). Conclusions Daily intake of various kinds of food might be a protective factor against cognitive decline in community‐dwelling Japanese older adults. Geriatr Gerontol Int 2017; 17: 937–944.

  July 05, 2016   doi: 10.1111/ggi.12817   open full text
• Catheter replacement structure in home medical care settings and regional characteristics in Tokyo and three adjoining prefectures.
  Takuma Kimura, Satoru Yoshie, Rumiko Tsuchiya, Shohei Kawagoe, Satoshi Hirahara, Katsuya Iijima, Toru Akahoshi, Tetsuo Tsuji.
  Geriatrics and Gerontology International. June 21, 2016
  Aim The present study investigated the association between the structure of catheter replacement services in home medical care settings and regional characteristics. Methods An anonymous self‐administered questionnaire was carried out from August to September 2013. Participants were physicians from 5338 clinics that provided medical care services at home, and nurses from 1619 home‐visit nursing stations in Tokyo and three adjoining prefectures. The questionnaire covered catheter replacement (gastrostomy tubes, nasogastric tubes, tracheal cannulas) during home medical care, and the professions of those who replaced urethral catheters for male and female patients. Regions were divided into two groups (higher‐ and lower‐density regions) based on the number of clinics, number of home‐visit nursing stations and the ratio of the population aged ≥65 years. The rates of respondents that reported catheter replacement was usually executed, and those who reported catheters were replaced by “physicians in principle” were compared between the groups. Results Responses were received from 842 clinics (16.3%) and 499 home‐visit nursing stations (31.4%). In the higher‐density regions, the rate of physicians who reported urethral catheters for male patients were replaced by “physicians in principle” was significantly higher than in the lower‐density regions (P < 0.001). In the lower‐density regions, the rate of nurses who reported urethral catheters for male patients were replaced by “nurses in principle” was significantly higher compared with the higher‐density regions (P < 0.016). Conclusions In home medical care settings, urethral catheters for male patients are replaced by nurses in regions where physician resources are limited. Geriatr Gerontol Int 2017; 17: 628–636.

  June 21, 2016   doi: 10.1111/ggi.12769   open full text
• Prevalence and prognostic influence of bacterial pyuria in elderly patients with pneumonia: A retrospective study.
  Hiroaki Oka, Kosaku Komiya, Minoru Ohama, Yoshiyuki Kawano, Masahiro Uchida, Hajime Miyajima, Tomohiko Iwashita, Eiji Okabe, Tadao Kawamura, Kazuhiro Yasuda, Taisuke Matsumoto, Jun‐ichi Kadota.
  Geriatrics and Gerontology International. June 15, 2016
  Aim The number of elderly patients with pneumonia is significantly increasing as the populations in many countries age. Although elderly patients with pneumonia are at risk of developing urinary tract infections, no studies have examined the prevalence or the prognostic impact of this complication. The aim of the present study was to investigate the prevalence of comorbid bacterial pyuria and the impact on the prognosis of elderly patients with pneumonia. Methods We retrospectively evaluated 132 patients aged >65 years who were hospitalized for pneumonia and who underwent a urinary sediment test on admission. The background characteristics, laboratory results and treatment regimens were documented, and the risk factors for the complication of bacterial pyuria and its association with 90‐day mortality in pneumonia patients were elucidated. Results A total of 37 (28%) of 132 patients were complicated by bacterial pyuria. The patients with bacterial pyuria were more often women, showed a poorer performance status, were more frequently fed by percutaneous endoscopic gastrostomy, and more frequently used diapers and/or a bladder catheter. Regarding first‐line drugs, 82.6% of the patients received beta‐lactamase inhibitors and extended‐spectrum penicillins. The use of a bladder catheter and a poor performance status were associated with bacterial pyuria. A multivariate analysis showed that a poor performance status was the only factor associated with 90‐day mortality. Conclusions Bacterial pyuria did not affect the prognosis of patients who were treated with penicillin‐based regimens. Thus, broad‐spectrum antibiotics are not necessarily required for elderly patients with pneumonia complicated by urinary tract infection. Geriatr Gerontol Int 2016; ••: ••–••.

  June 15, 2016   doi: 10.1111/ggi.12830   open full text
• Evaluation of prognostic indices in elderly hospitalized patients.
  Fiammetta Monacelli, Manuela Tafuro, Luigi Molfetta, Marina Sartini, Alessio Nencioni, Michele Cea, Roberta Borghi, Fabrizio Montecucco, Patrizio Odetti.
  Geriatrics and Gerontology International. June 15, 2016
  Aim Prognosis informs the physician's decision‐making process, especially for frail older adults. So far, any non‐disease‐specific index has proven full evidence for routine use in clinical practice. Here, we aimed at assessing, prospectively, the calibration and discriminating accuracy of validated prognostic indices in a cohort of elderly hospitalized patients. Methods This was a prospective observational study that enrolled elderly patients (n = 100). The patients' assessment included clinical variables, as well as the following five prognostic indices of mortality: (i) Levine index (2007); (ii) Walter index (2001); (iii) CARING (C, primary diagnosis of cancer; A, ≥ 2 admissions to the hospital for a chronic illness within the last year; R, resident in a nursing home; I, intensive care unit admission with multiorgan failure, NG, noncancer hospice guidelines [meeting ≥ 2 of the National Hospice and Palliative Care Organization's guidelines]) criteria of Fischer (2006–2011); (iv) Silver Code of Di Bari (2010); and (v) Burden of Illness Score for Elderly Persons of Inouye (2003). Results Patients' clinical characteristics: 70% women (age 86.20 ± 0.69 years), 30% men (age 85.40 ± 1.07 years), Comorbidity Illness rating scale (CIRS) 4.3 ± 0.61 and Barthel Index 28 ± 0.54. Walter and Burden of Illness Score for Elderly Persons scores showed similar prediction rates when compared with the expected validated values (ancova: F = 14.00, P < 0.008). Burden of Illness Score for Elderly Persons was the most calibrated and accurate index (receiver operating characteristic curve 0.72; P < 0.02). Conclusions None of the assessed prognostic indices, in a “real world” scenario, afforded the optimal predictive accuracy (receiver operating characteristic curve 0.90); all these indices are still far from a robust answer to the prognosis in older age, reflecting a poor ability to encompass the spectrum of frailty. Effort should be made to tailor the prognostication in geriatrics, moving from a disease‐centered model to a precision model, tailored to the frail phenotype. Geriatr Gerontol Int 2017; 17: 1015–1021.

  June 15, 2016   doi: 10.1111/ggi.12801   open full text
• Multifaceted changes and mortality in older people: A longitudinal study in Taiwan.
  Huei‐Jia Tzeng, Miaw‐Chwen Lee.
  Geriatrics and Gerontology International. June 15, 2016
  Aim Human life expectancy has increased steadily over the past two centuries. In the context of aging, resilience appears to be central to improving quality of life and preserving independence in later years. The present study investigated multifaceted changes and their association with mortality in older people in Taiwan. Methods The present study used older participants aged 60 years or older from the first and second waves (1989 and 1993) of the longitudinal Survey of Health and Living Status of the Elderly in Taiwan. Multifaceted changes comprised chronic conditions, self‐rated health, activities of daily living, depression, life satisfaction, social engagement and religious activity. “Positive change” was defined as stable or improving indicator scores from 1989 to 1993. Logistic regressions and Cox proportional hazard models were used to examine associations of positive changes with sociodemographic characteristics and with mortality. Results The percentages of positive changes in indicators of respondents ranged from 47% for activities of daily living to 78% for religious activity. The probability of positive changes for chronic conditions, life satisfaction, social engagement, and religious activity were lower in men, singles, less educated and the oldest respondents than in their counterparts. Lower mortality rates were observed in respondents with positive changes of self‐rated health (HR = 0.72), activities of daily living (HR = 0.67), life satisfaction (HR = 0.85) and religious activity (HR = 0.79). Conclusions Various changes were valid predictors of mortality in old age. None of the multifaceted aspects of change should be overlooked when designing policies for aging well and active aging in later life. Geriatr Gerontol Int 2017; 17: 959–966.

  June 15, 2016   doi: 10.1111/ggi.12819   open full text
• Depressive symptoms in spouse caregivers of dementia patients: A longitudinal study in South Korea.
  Woorim Kim, Tae‐Hoon Lee, Jaeyong Shin, Eun‐Cheol Park.
  Geriatrics and Gerontology International. June 15, 2016
  Aim To investigate the association between spouse cognitive status and depressive symptoms in cohabiting spouses, and to further analyze how participation in social network‐enhancing activities interplays in the objected relationship. Methods Data from the Korean Longitudinal Study of Aging, 2006–2012, were used. A total of 2782 male and 2515 female married participants currently cohabiting with their partners were included in the baseline. The association between spouse cognitive status and depressive symptoms, measured using the Center for Epidemiological Studies Depression scale, was investigated through the generalized estimating equation model. Results When setting the participants living with spouses of normal cognitive function as reference, participants living with spouses having mild dementia (male β 0.7349, P ≤ 0.0001; female β 0.8042, P ≤ 0.0001), and moderate and severe dementia (male β 1.1504, P ≤ 0.0001; female β 1.2462, P ≤ 0.0006) showed higher depression scores in a dose–response relationship. Additionally, male and female subjects participating in social network facilitating activities had lower increases in depression scores than their non‐participating counterparts. Conclusions Spouse cognitive impairment is associated with increasing depression scores in cohabiting caregivers. Individuals not participating in social network‐facilitating activities are more vulnerable to the negative mental health effects of spouse cognitive impairment. Hence, considering the increasing importance of late life depression and cognitive decline in aging societies, it is important to note the protective effects of social network and support in addressing the mental health of spouse caregivers. Geriatr Gerontol Int 2017; 17: 973–983.

  June 15, 2016   doi: 10.1111/ggi.12820   open full text
• Pressure pain threshold is higher in hypertensive compared with normotensive older adults: A case–control study.
  Marcelo Nascimento Rebelatto, Francisco Alburquerque‐Sendín, João Flavio Guimarães, Tania Fatima Salvini.
  Geriatrics and Gerontology International. June 15, 2016
  Aim To establish whether there are differences in pain sensitivity between hypertensive and normotensive older adults. Methods A cross‐sectional case control study was carried out. A total of 72 older adults, 36 normotensive and 36 hypertensive, participated in the study. The pressure pain threshold (PPT) was assessed on seven points bilaterally in both groups by means of pressure algometry. Two‐factor analysis of variance (anova) – group and sex – was carried out, and the magnitude of the differences was calculated using Cohen's index. Results The PPT values were higher in the group of hypertensive older adults compared with the normotensive older adults; that difference was significant (P < 0.05) for the following points: right and left trochanters, left trapezium, left L3/L4 and left anterior tibialis muscle, with both trochanter and left L3/L4 PPT showing moderate magnitude of the differences. The correlations shown among the PPT were stronger in the group of hypertensive older adults. Thus, hypoalgesia was more generalized among the hypertensive older adults compared with the normotensive older adults. Sex did not influence that difference, although the magnitude of the difference was greater among men compared with women. Conclusions Hypoalgesia, as assessed by means of PPT, showed a relationship with arterial hypertension in older adults. The influence of sex on hypoalgesia shown by hypertensive individuals is controversial. Geriatr Gerontol Int 2017; 17: 967–972.

  June 15, 2016   doi: 10.1111/ggi.12824   open full text
• Correlations between geriatric nutritional risk index and peripheral artery disease in elderly coronary artery disease patients.
  Toshiki Kawamiya, Susumu Suzuki, Hideki Ishii, Kenshi Hirayama, Kazuhiro Harada, Yohei Shibata, Yosuke Tatami, Shingo Harata, Kazuhiro Kawashima, Ayako Kunimura, Yohei Takayama, Yusaku Shimbo, Naohiro Osugi, Dai Yamamoto, Tomoyuki Ota, Chikao Kono, Toyoaki Murohara.
  Geriatrics and Gerontology International. June 15, 2016
  Aim Malnutrition is associated with the development of atherosclerosis and an increased risk of cardiovascular mortality in elderly patients. The present study aimed to investigate the association between the Geriatric Nutritional Risk Index (GNRI), a simple nutritional assessment tool, and the prevalence of peripheral artery disease (PAD) in elderly coronary artery disease patients. Methods We evaluated 228 elderly coronary artery disease patients (mean age 74.0 ± 5.7 years). Ankle‐brachial index (ABI) measurements were routinely carried out to investigate the prevalence of lower extremity PAD. Patients showing ABI <0.9 were defined as having PAD. Results Based on our findings, 20.6% of the study patients had PAD. The median GNRI values were significantly lower in patients with PAD than those in patients without PAD (93.8 vs 100.0, P < 0.001). Even after multivariate adjustment, GNRI values were independently associated with PAD (odds ratio 0.94; 95% confidence interval 0.89–0.99; P = 0.024). Furthermore, patients with low GNRI and high C‐reactive protein levels had a 5.5‐fold higher risk of having PAD than those with high GNRI and low C‐reactive protein levels. Conclusions GNRI values showed a strong relationship with PAD in elderly coronary artery disease patients. These data reinforce the utility of GNRI as a screening tool in clinical practice. Geriatr Gerontol Int 2016; ••: ••‐••.

  June 15, 2016   doi: 10.1111/ggi.12828   open full text
• Oxidative stress and inflammation are associated with physical frailty in patients with Alzheimer's disease.
  Nayuta Namioka, Haruo Hanyu, Daisuke Hirose, Hirokuni Hatanaka, Tomohiko Sato, Soichiro Shimizu.
  Geriatrics and Gerontology International. June 14, 2016
  Aims Dementia is closely connected with frailty, and these two conditions are common in older adults. However, the biological mechanism that causes frailty in patients with Alzheimer's disease (AD) is not fully understood. We determined whether oxidative stress and inflammatory mechanisms could be associated with physical frailty in patients with AD. Methods We studied 140 elderly outpatients with mild‐to‐moderate AD. Frailty status was determined according to the presence of the following five measurable characteristics: weight loss, exhaustion, low physical activity, slowness and weakness. We measured oxidative stress markers, including plasma levels of diacron reactive oxygen metabolite and biological anti‐oxidant potential, endogenous plasma anti‐oxidants, such as albumin, bilirubin and uric acid, and urinary 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG) and 8‐epiPGF2α (8‐isoprostane), and inflammatory markers, including interleukin‐6 and tumor necrosis factor‐α. Results Among patients, 44 (31%) were non‐frail, 62 (44%) were prefrail and 34 (24%) were frail. Frail and prefrail patients were older, more likely to be women and had more comorbid medical conditions than non‐frail patients. Frail or prefrail patients showed significantly higher diacron reactive oxygen metabolite and lower biological anti‐oxidant potential levels, a significant decrease in bilirubin, a significant increase in urinary 8‐OHdG and 8‐isoprostane levels, and a significantly higher interleukin‐6 level, in contrast to non‐frail patients. Conclusions Physical frailty is common in old and female AD patients with comorbid medical diseases. The present results strongly suggest that oxidative stress and inflammation are involved in the pathophysiology of frailty status in individuals with AD. Geriatr Gerontol Int 2017; 17: 913–918.

  June 14, 2016   doi: 10.1111/ggi.12804   open full text
• Association between sedentary time and kidney function in community‐dwelling elderly Japanese people.
  Sungchul Lee, Hiroyuki Shimada, Sangyoon Lee, Hyuma Makizako, Takehiko Doi, Kazuhiro Harada, Seongryu Bae, Kenji Harada, Ryo Hotta, Kota Tsutsumimoto, Daisuke Yoshida, Sho Nakakubo, Yuya Anan, Hyuntae Park, Takao Suzuki.
  Geriatrics and Gerontology International. June 14, 2016
  Aim The aim of the present study was to evaluate the relationship between sedentary time and declines in kidney function among community‐dwelling older adults. Methods Participants comprised 10 242 community‐dwelling older adults who were participating in the National Center for Geriatrics and Gerontology – Study of Geriatric Syndromes. Sedentary time was determined by asking participants to record the total amount of hours usually spent sitting each day, with values divided into quartiles of 0 to <4 h (reference), 4 to <6 h, 6 to <8 h and ≥8 h of sitting time per day. The estimated glomerular filtration rate was determined according to creatinine levels, and participants were classified into two categories: ≥60.0 or <60 mL/min/1.73 m2. Results After multivariate adjustment, the highest quartiles of sedentary time showed a higher rate of kidney function decline than those in the lowest quartile (odds ratio 1.42, 95% CI 1.02–1.37). In addition, participants with a history of cancer (odds ratio 1.18, 95% CI 1.01–1.39) or hypertension (odds ratio 1.38; 95% CI 1.07–1.60) had significantly increased risks of kidney function decline in the highest sedentary time group, regardless of multivariate control. Furthermore, analyses showed an increased risk of kidney function decline for a history of both cancer and hypertension (odds ratio 2.02, 95% CI 1.08–3.80). Conclusions A higher level of sedentary time was associated with kidney function decline among community‐dwelling older adults. Geriatr Gerontol Int 2017; 17: 730–736.

  June 14, 2016   doi: 10.1111/ggi.12779   open full text
• Screening for postoperative delirium in patients with acute hip fracture: Assessment of predictive factors.
  Asli Koskderelioglu, Ozlem Onder, Melike Gucuyener, Taskin Altay, Cemil Kayali, Muhtesem Gedizlioglu.
  Geriatrics and Gerontology International. June 10, 2016
  Aim The aim of the present study was to estimate the incidence and risk factors of delirium during the early postoperative period after hip fracture surgery. Furthermore, we investigated the accuracy of the Confusion Assessment Method for the Intensive Care Unit (CAM‐ICU) for detection and assessment of delirium in orthopedic patients. Methods We consecutively recruited patients aged 65 years or older undergoing hip fracture surgery. The presence of delirium was determined daily by two of the authors according to the CAM‐ICU criteria. A further evaluation was made with the reference standard Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria for delirium. Their cognitive function was evaluated with the Mini‐Mental State Examination, and possible depressive mood with the Beck Depression Inventory. Baseline characteristics, as well as the American Society of Anesthesiologists classification and clinical outcomes, were analyzed for a correlation with accompanying delirium. Results Among 109 patients, 20 (18.3%) were diagnosed with delirium. The concurrent validity of CAM‐ICU was good (kappa = 0.84). Specificity was 98.9%, and sensitivity was 80%. Multivariate regression analysis showed that Mini‐Mental State Examination (P = 0.001; odds ratio 0.75, 95% confidence interval 0.65–0.86) and Beck Depression Inventory scores (P = 0.001; odds ratio 1.13, 95% confidence interval 1.05–1.22) correlated with the occurrence of delirium. Conclusıons The present results show that CAM‐ICU is highly sensitive and specific to identify delirium in hip fracture patients in the postoperative period. Among all of the risk factors, cognitive impairment and depressive mood were strongly associated with postoperative delirium. We suggest that a preoperative assessment of cognition and depression might be useful for identifying patients with a higher risk of postoperative delirium. Geriatr Gerontol Int 2017; 17: 919–924.

  June 10, 2016   doi: 10.1111/ggi.12806   open full text
• Geriatric risk in the surgical management of infectious spondylitis.
  Jae Hong Ha, Se Ho Kim, Sang‐Min Park, Choon‐Ki Lee, Bong‐Soon Chang, Hyoungmin Kim.
  Geriatrics and Gerontology International. June 10, 2016
  Aim The purpose of the present study was to evaluate and compare clinical outcomes in patients aged >65 years and <65 years who have undergone surgery for infectious spondylitis, and to identify any prognostic factors. Methods We reviewed 60 consecutive patients treated surgically for infectious spondylitis. We reviewed patients’ medical records especially focusing on comorbidities, preoperative serum albumin levels, postoperative complications and control of infection on follow up. Statistical analysis was carried out to determine whether these various factors affected clinical outcomes. Results Postoperative complication rates (P = 0.764) and infection control rates (P = 0.275) were not significantly different between the two groups. Univariate analysis did not show a correlation between age and clinical outcome, whereas body mass index (BMI; P = 0.04), Charlson Comorbidity Index (CCI; P = 0.017), American Society of Anesthesiologists (ASA) grade (P = 0.006) and serum albumin (P = 0.003) were associated with overall postoperative complications. BMI (P = 0.002) and CCI (P = 0.000) were also associated with postoperative fatalities. The χ2‐test for trend also showed that CCI (P = 0.018), ASA grade (P = 0.007) and low serum albumin (<3.5 mg/dL; P = 0.004) were associated with postoperative complications. Logistic regression analysis showed that ASA grade (P = 0.034) and BMI (P = 0.044) were related to overall postoperative complications. Receiver operating characteristic curve analysis using ASA grade and BMI to predict major postoperative complications and fatality showed an area under the curve value of 0.793 (P = 0.001) and 0.942 (p=0.002), respectively. Conclusions BMI, ASA grade, CCI scores and serum albumin levels, rather than age, might be useful in predicting clinical outcome in surgery for infectious spondylitis in elderly patients. Geriatr Gerontol Int 2017; 17: 984–990.

  June 10, 2016   doi: 10.1111/ggi.12821   open full text
• Patterns of long‐term care services use in a suburban municipality of Japan: a population‐based study.
  Ayumi Igarashi, Noriko Yamamoto‐Mitani, Satoru Yoshie, Katsuya Iijima.
  Geriatrics and Gerontology International. June 08, 2016
  Aim Increasing service use under the long‐term care insurance (LTCI) system in Japan requires a comprehensive understanding of how the services are actually used. This study aimed to identify patterns of LTCI service use and to examine the characteristics of the patterns. Methods We analyzed data from a population of 4,339 older adults living in the community who were certified as “Needing Care” and were using at least one LTCI service in a suburban municipality of Japan. We identified six patterns of service use using cluster analysis based on the amount of fees for LTCI services and compared characteristics among the clusters. Results The clusters were: 1) light use of care services (n = 1,852); 2) day care‐centered (n = 1,071); 3) day care with rehabilitation‐centered (n = 616); 4) home help‐centered (n = 365); 5) short‐stay respite service‐centered (n = 246); and 6) compound uses of visiting services (n = 189). “Home help‐centered” and “short‐stay respite service‐centered” clusters used a large number of fees, whereas “compound uses of visiting services” clusters did not despite their severe conditions. The “day care‐centered (with rehabilitation)” classification included few people who needed medical procedures, likely due to the lack of medical facilities in those agencies. Conclusions The results show the impact of social and medical factors on LTCI service use, suggesting possible difficulties in the socialization of care. The clusters could be used as typical service use patterns, providing a framework for further studies, such as those evaluating the services’ effects. Geriatr Gerontol Int 2017; 17: 753‐759.

  June 08, 2016   doi: 10.1111/ggi.12781   open full text
• Angiotensin‐converting enzyme insertion/deletion polymorphism is associated with cerebral white matter changes in Alzheimer's disease.
  Ping‐Song Chou, Shyh‐Jong Wu, Yi‐Hui Kao, Mei‐Chuan Chou, Shu‐Yu Tai, Yuan‐Han Yang.
  Geriatrics and Gerontology International. June 07, 2016
  Aim The presence of cerebral white matter changes (WMC) has been reported as an important predictor of the rapidity of cognitive decline in Alzheimer's disease (AD). The association between the angiotensin‐converting enzyme (ACE) insertion/deletion (I/D) polymorphism and WMC in AD is yet to be elucidated. The present study aimed to examine the association between the ACE I/D polymorphism and WMC among AD patients in Taiwan. Methods A total of 403 patients clinically diagnosed with AD were recruited in a cross‐sectional study carried out in an area hospital in Kaohsiung, Taiwan. The ACE I/D polymorphism was genotyped, and cerebral white matter rating was carried out using the visual rating scale for age‐related white matter changes. Results The I allele was associated with a significantly lower total age‐related white matter changes scale score compared with the D allele (4.83 vs 5.93, P = 0.013). The total age‐related white matter changes scale score was significantly lower for the I/I genotype than for the I/D (4.37 vs 5.87, P = 0.009) and I/D + D/D genotypes (4.37 vs 5.91, P = 0.006), with no differences observed between the I/I + I/D and the D/D genotypes (5.08 vs 6.09, P = 0.373), after adjustment for age and hypertension. A stratified analysis by sex demonstrated that the I/I genotype was associated with significant lower WMC than other genotypes in women, but not in men. Conclusions The present study supports the hypothesis that the ACE I/D polymorphism is associated with the severity of WMC in patients with AD. Patients with AD who are homozygous for the I allele might be less likely to develop WMC, especially women. Geriatr Gerontol Int 2017; 17: 945–950.

  June 07, 2016   doi: 10.1111/ggi.12815   open full text
• Cognitive impairment is independently associated with definitive and possible sarcopenia in hospitalized older adults: The prevalence and impact of comorbidities.
  Keisuke Maeda, Junji Akagi.
  Geriatrics and Gerontology International. June 07, 2016
  Aim Older adults often present with several comorbidities, including sarcopenia. However, the prevalence of sarcopenia and its associations with other comorbidities in hospitalized older adults are unknown. The present study aimed to determine the prevalence of sarcopenia, and its associations with other comorbidities in hospitalized older adults. Methods The present cross‐sectional study included 619 patients admitted to a geriatric hospital. The prevalence of comorbidities in the presence and absence of sarcopenia, nutritional status (according to body mass index and the Mini‐Nutritional Assessment‐Short Form), and activities of daily living (according to the Barthel Index) were assessed. Sarcopenia was defined as skeletal muscle loss evaluated by both bioelectrical impedance and handgrip strength analyses. Results Of the 619 participants (mean age 83.0 ± 8.2 years), 417 (67.4%) and 87 (14.1%) had definitive and possible sarcopenia, respectively. The prevalence rates of cognitive impairment and stroke were significantly higher in patients with definitive sarcopenia and those with possible sarcopenia than in those without sarcopenia (cognitive impairment 54.4%, 70.1% and 20.9%, respectively, P < 0.001; stroke 31.2%, 48.3% and 19.1%, respectively, P < 0.001). Multivariate logistic regression analysis showed that cognitive impairment was independently associated with sarcopenia after adjusting for age, sex, the Mini‐Nutritional Assessment‐Short Form score, Barthel Index and primary disease (adjusted odds ratio 1.98, 95% confidence interval 1.06–3.71; P = 0.032). Conclusions Sarcopenia might be highly prevalent among hospitalized older adults. Furthermore, cognitive impairment might be an independent explanatory variable of sarcopenia. Therefore, further studies on sarcopenia in patients with cognitive impairment are warranted.

  June 07, 2016   doi: 10.1111/ggi.12825   open full text
• Systematic review of traditional Chinese medicine for geriatrics.
  Shin Takayama, Koh Iwasaki.
  Geriatrics and Gerontology International. June 07, 2016
  The Japan Geriatrics Society revised its criteria for the medical treatment and safety of the elderly in 2015. The Japan Geriatrics Society guidelines contain a chapter for traditional Chinese medicine (TCM; traditional medicines in East Asian countries, such as China, Japan, Korea, Taiwan, Vietnam and Singapore), because it is widely used for elderly patients and is sometimes covered by national medical insurance in Japan. The updated guidelines should be improved based on a comprehensive, systematic review and evidence grading. TCM is rapidly expanding in the literature, and is under intensive investigation in clinical trials. The objective of the present trial was to review TCM systematically and reflect the results to update the TCM chapter of the Japan Geriatrics Society guidelines. Here, we introduce the results of the systemic review of TCM for geriatrics. Geriatr Gerontol Int 2017; 17: 679–688.

  June 07, 2016   doi: 10.1111/ggi.12803   open full text
• Diabetes mellitus, hypertension and frailty: A population‐based, cross‐sectional study of Mexican older adults.
  Roberto Carlos Castrejón‐Pérez, Luis Miguel Gutiérrez‐Robledo, Matteo Cesari, Mario Ulises Pérez‐Zepeda.
  Geriatrics and Gerontology International. June 02, 2016
  Aim Chronic diseases are frequent in older adults, particularly hypertension and diabetes. The relationship between frailty and these two conditions is still unclear. The aim of the present analyses was to explore the association between frailty with diabetes and hypertension in Mexican older adults. Methods Analyses of the Mexican Health and Nutrition Survey, a cross‐sectional survey, are presented. Data on diabetes and hypertension were acquired along with associated conditions (time since diagnosis, pharmacological treatment, among others). A 36‐item frailty index was constructed and rescaled to z‐values (individual scores minus population mean divided by one standard deviation). Multiple linear regression models were carried out, adjusted for age and sex. Results From 7164 older adults, 54.8% were women, and their mean age was 70.6 years with a mean frailty index score of 0.175. The prevalence of diabetes was of 22.2%, and 37.3% for hypertension. An independent association between diabetes, hypertension or both conditions (coefficients 0.28, 0.4 and 0.63, respectively, P < 0.001) with frailty was found. Having any diabetic complication was significantly associated with frailty with a coefficient of 0.55 (95% CI 0.45–0.65, P < 0.001) in the adjusted model. The number of years since diagnosis was also associated with frailty for both conditions. Conclusions Diabetes and hypertension are associated with frailty. In addition, an incremental association was found when both conditions were present or with worse associated features (any complication, more time since diagnosis). Frailty should be of particular concern in populations with a high prevalence of these conditions. Geriatr Gerontol Int 2017; 17: 925–930.

  June 02, 2016   doi: 10.1111/ggi.12805   open full text
• Clinical characteristics of atrial fibrillation‐related cardioembolic stroke in patients aged 80 years or older.
  Koji Tanaka, Takeshi Yamada, Takako Torii, Shoji Matsumoto, Takeo Yoshimura, Kei‐ichiro Takase, Yoshifumi Wakata, Naoki Nakashima, Jun‐ichi Kira, Hiroyuki Murai.
  Geriatrics and Gerontology International. June 02, 2016
  Aim Atrial fibrillation (AF)‐related cardioembolic stroke is a serious problem in the aging society. The present study examined the clinical characteristics and outcomes of AF‐related cardioembolic stroke in patients aged ≥80 years. Methods Between September 2011 and April 2014, consecutive patients with ischemic stroke and AF were retrospectively extracted from the multicenter database. Clinical characteristics were compared between patients aged ≥80 years and <80 years. Multivariate cox proportional hazard models were used to estimate hazard ratios and 95% confidential intervals on 90‐day mortality for age of ≥80 years. Results A total of 253 patients aged ≥80 years (87 men, 86.4 ± 5.0 years) and 196 patients aged <80 years (134 men, 70.4 ± 7.1 years) were included. Patients aged ≥80 years were more frequently female, and more likely to have higher premorbid modified Rankin Scale score (mRS), lower body mass index, previous history of stroke, prior antiplatelet therapy, congestive heart failure, and persistent AF. Patients aged ≥80 years had higher initial National Institutes of Health Stroke Scale score and were more likely to have occlusion of the cervicocephalic arteries, but less likely to receive thrombolysis. Patients aged ≥80 years had a higher mRS and mortality after 3 months. Age of ≥80 years was a significant predictor of 90‐day mortality after adjustment for sex (hazard ratio 2.20, 95% confidential interval 1.25–4.09), but was no longer significant after further adjustment for other clinical characteristics and stroke severity. Conclusions In AF‐related cardioembolic stroke, patients aged ≥80 years had different clinical characteristics and poorer outcome compared with patients aged <80 years. Geriatr Gerontol Int 2017; 17: 708–713.

  June 02, 2016   doi: 10.1111/ggi.12773   open full text
• Application of qualitative response models in a relevance study of older adults' health depreciation and medical care demand.
  Shuo‐Chun Weng, Yu‐Chi Chen, Ching‐Yu Chen, Yuan‐Yang Cheng, Yih‐Jing Tang, Shu‐Hui Yang, Jwu‐Rong Lin,.
  Geriatrics and Gerontology International. June 01, 2016
  Aim The effect of health depreciation in older people on medical care demand is not well understood. We tried to assess the medical care demand with length of hospitalization and their impact on profits as a result of health depreciation. Methods All participants who underwent comprehensive geriatric assessment were from a prospective cohort study at a tertiary hospital. A total of 1191 cases between September 2008 to October 2012 were investigated. Three sets of qualitative response models were constructed to estimate the impact of older adults' health depreciation on multidisciplinary geriatric care services. Furthermore, we analyzed the factors affecting the composite end‐point of rehospitalization within 14 days, re‐admission to the emergency department within 3 days and patient death. Results Greater health depreciation in elderly patients was positively correlated with greater medical care demand. Three major components were defined as health depreciation: elderly adaptation function, geriatric syndromes and multiple chronic diseases. On admission, the better the basic living functions, the shorter the length of hospitalization (coefficient = −0.35, P < 0.001 in Poisson regression; coefficient = −0.33, P < 0.001 in order choice profit model; coefficient = −0.29, P < 0.001 in binary choice profit model). The major determinants for poor outcome were male sex, middle old age and length of hospitalization. However, factors that correlated with relatively good outcome were functional improvement after medical care services and level of disease education. Conclusions An optimal allocation system for selection of cases into multidisciplinary geriatric care is required because of limited resources. Outcomes will improve with health promotion and preventive care services. Geriatr Gerontol Int 2017; 17: 645–652.

  June 01, 2016   doi: 10.1111/ggi.12751   open full text
• Factors associated with the severity of obstructive sleep apnea in older adults.
  Kazuhiro Hongyo, Norihisa Ito, Koichi Yamamoto, Yukiko Yasunobe, Masao Takeda, Ryosuke Oguro, Yoichi Takami, Yasushi Takeya, Ken Sugimoto, Hiromi Rakugi.
  Geriatrics and Gerontology International. June 01, 2016
  Aim Epidemiological studies have shown that severe obstructive sleep apnea (OSA) is associated with higher mortality when compared with mild to moderate OSA. Because aging is a well‐known risk factor for OSA, we aimed to elucidate the underlying factors associated with the severity of OSA in elderly patients. Methods Patients who underwent polysomnography were divided into the non‐elderly group (aged <65 years; n = 44) and the elderly group (aged ≥65 years; n = 46). The severity of OSA was determined by the apnea hypopnea index (AHI), and each group was subdivided into two groups: mild to moderate OSA (5 < AHI < 30) and severe OSA (AHI ≥30) . In the elderly group, geriatric assessments to evaluate physical and neuropsychiatric function were carried out. Results All patients had OSA as diagnosed by an AHI >5. Whereas body mass index was positively correlated with AHI in both groups, age was correlated with AHI only in the elderly group. Body mass index and age were higher in severe OSA than mild to moderate OSA in the elderly group. Unexpectedly, no significant difference was observed in physical strength, cognitive function, apathy scale, depression scale or activities of daily living between mild to moderate OSA and severe OSA in the elderly group. Binary logistic regression analysis showed that male sex, body mass index and aging were independent risk factors of severe OSA in the elderly group. Conclusions Our findings suggest that aging increases the severity of OSA in elderly patients, even if they are physically active and neuropsychiatrically unimpaired. Geriatr Gerontol Int 2017; 17: 614–621.

  June 01, 2016   doi: 10.1111/ggi.12768   open full text
• Association between polypharmacy and multiple uses of medical facilities in nursing home residents.
  Taro Kojima, Kiyoshi Shimada, Atsuko Terada, Koji Nishizawa, Kouki Matsumoto, Yasuko Yoshimatsu, Masahiro Akishita.
  Geriatrics and Gerontology International. June 01, 2016
  There is no abstract available for this paper.

  June 01, 2016   doi: 10.1111/ggi.12591   open full text
• Age‐dependent increase in serum levels of indoxyl sulphate and p‐cresol sulphate is not related to their precursors: Tryptophan and tyrosine.
  Aleksandra Wyczalkowska‐Tomasik, Bozena Czarkowska‐Paczek, Joanna Giebultowicz, Piotr Wroczynski, Leszek Paczek.
  Geriatrics and Gerontology International. May 31, 2016
  Aim Retention of indoxyl sulphate and p‐cresol sulphate is associated with many diseases. The aim of the present study was to examine serum levels of indoxyl sulphate and p‐cresol sulphate, the dynamics of their changes according to age, and their precursors. Methods The study included 180 healthy individuals aged 20–90 years (n = 180), divided into subgroups by decade (n = 30 in each subgroup) and into subgroups of ≥65 years (n = 42) or <65 years (n = 138). Serum indoxyl sulphate and p‐cresol sulphate, tryptophan, and tyrosine were measured using high‐performance liquid chromatography–mass spectrometry. Results The 70–90 years age group had higher indoxyl sulphate than the 50–59 years age group (P = 0.033). The 70–90 years age group had higher p‐cresol sulphate than the 20–29 years (P < 0.001), 30–39 years (P < 0.001), 40–49 years (P = 0.007) and 50–59 years (P = 0.001) age groups; the 60–69 years age group had higher p‐cresol sulphate than the 20–29 years (P = 0.043) and 30–39 years (P = 0.011) age groups. Indoxyl sulphate and p‐cresol sulphate serum levels were higher in those aged ≥65 years. Indoxyl sulphate and p‐cresol sulphate serum levels correlated positively with age, but not with tryptophan and tyrosine, respectively. Conclusions Healthy aging is associated with indoxyl sulphate and p‐cresol sulphate serum level increases, which are not linked to tryptophan and tyrosine serum levels. Geriatr Gerontol Int 2017; 17: 1022–1026.

  May 31, 2016   doi: 10.1111/ggi.12811   open full text
• What factors influence healthy aging? A person‐centered approach among older adults in Taiwan.
  Li‐Fan Liu, Pei‐Fang Su.
  Geriatrics and Gerontology International. May 31, 2016
  Aim The present study aimed to identify the health profiles of older adults by using latent class analysis to investigate health heterogeneity and to determine what factors predicted healthy aging among an oldest‐old sample cohort that was followed up for 14 years in Taiwan. Methods Data were drawn from five waves (carried out in 1993, 1996, 1999, 2003 and 2007) of the Taiwan Longitudinal Study on Aging to examine the changes in health heterogeneity in a nationally representative oldest‐old cohort of Taiwanese. Overall, data from a total of 11 145 observations of 3155 older adults were considered. The influential factors predicting health changes were analyzed by using a generalized estimating equation. Results The results showed that four health profiles were identified among the aging population observed in the Taiwan Longitudinal Study on Aging. With increasing age, the combined effects of the physical functioning, cognitive and emotional health, and comorbidities of older adults significantly impact their health changes. Apart from health deteriorating with age and sex disparities, educational and economic status, health behaviors, and social participation at the individual level were found to be the robust factors in predicting healthy aging. Conclusions In considering what factors impact healthy aging, we suggest that a person‐centered approach would be useful and critical for policy makers to understand the compositions of health profiles and the influencing factors in view of a life‐course perspective. Based on the factors identified as influencing healthy aging at the individual level, it is imperative from a policy‐making perspective to maximize opportunities for healthy aging. Geriatr Gerontol Int 2017; 17: 697–707.

  May 31, 2016   doi: 10.1111/ggi.12774   open full text
• Self‐reported health status as a predictor of functional decline in a community‐dwelling elderly population: Nationwide longitudinal survey in Korea.
  Sang Hyuck Kim, Belong Cho, Chang Won Won, Young Ho Hong, Ki Young Son.
  Geriatrics and Gerontology International. May 31, 2016
  Aim As the elderly population is increasing, the prediction and prevention of functional decline in older adults are of great concern. The present study aimed to evaluate whether poor self‐reported health status (SRHS) could predict functional decline after 2 years in the elderly population. Methods Data from the Korean Longitudinal Study of Aging panel, a national representative sample of aging Koreans, were used. Participants of the investigation were the elderly population aged 65 years or more without disability in carrying out activities of daily living (ADL) at baseline. The survey asked respondents about their subjective health status. Setting the respondents who stated their health status as “very good” or “good” as the reference group, multivariable logistic regression analysis was carried out to compare functional decline according to the baseline SRHS. Results A total of 2824 participants were included in the analysis. Among them, 138 (4.9 %) reported functional decline of at least one of the seven ADL components after 2 years. In multivariable logistic regression analysis, SRHS was significantly associated with subsequent functional decline in respondents who chose “Bad” (odds ratio 3.32, 95% confidence interval 1.71–6.44) or “Very bad” (OR 4.75, 95% CI 2.12–10.66). Furthermore, poorer SRHS was significantly associated with subsequent impairment in each ADL component. Also, SRHS predicted overall subsequent impairment in the instrumental ADL. Conclusions SRHS predicted functional decline after 2 years in older adults without baseline disabilities. SRHS can be a good predictor of future functional decline in the elderly population. Geriatr Gerontol Int 2017; 17: 885–892.

  May 31, 2016   doi: 10.1111/ggi.12797   open full text
• Chronic kidney disease‐related physical frailty and cognitive impairment: a systemic review.
  Zhiyuan Shen, Qingwei Ruan, Zhuowei Yu, Zhongquan Sun.
  Geriatrics and Gerontology International. May 31, 2016
  Aim The objective of this review was to assess chronic kidney disease‐related frailty and cognitive impairment, as well as their probable causes, mechanisms and the interventions. Methods Studies from 1990 to 2015 were reviewed to evaluate the relationship between chronic kidney disease and physical frailty and cognitive impairment. Of the 1694 studies from the initial search, longitudinal studies (n = 22) with the keywords “Cognitive and CKD” and longitudinal or cross‐sectional studies (n = 5) with the keywords “Frailty and CKD” were included in final analysis. Results By pooling current research, we show clear evidence for a relationship between chronic kidney disease and frailty and cognitive impairment in major studies. Vascular disease is likely an important mediator, particularly for cognitive impairment. However, non‐vascular factors also play an important role. Many of the other mechanisms that contribute to impaired cognitive function and increased frailty in CKD remain to be elucidated. In limited studies, medication therapy did not obtain the ideal effect. There are limited data on treatment strategies, but addressing the vascular disease risk factors earlier in life might decrease the subsequent burden of frailty and cognitive impairment in this population. Multidimensional interventions, which address both microvascular health and other factors, may have substantial benefits for both the cognitive impairments and physical frailty in this vulnerable population. Conclusions Chronic kidney disease is a potential cause of frailty and cognitive impairment. Vascular and non‐vascular factors are the possible causes. The mechanism of chronic kidney disease‐induced physical frailty and cognitive impairment suggests that multidimensional interventions may be effective therapeutic strategies in the early stage of chronic kidney disease. Geriatr Gerontol Int 2017; 17: 529–544.

  May 31, 2016   doi: 10.1111/ggi.12758   open full text
• Wide range of body composition measures are associated with cognitive function in community‐dwelling older adults.
  Huiloo Won, Zahara Abdul Manaf, Arimi Fitri Mat Ludin, Suzana Shahar.
  Geriatrics and Gerontology International. May 27, 2016
  Aim Studies of the association between body composition, both body fat and body muscle, and cognitive function are rarely reported. The aim of the present study was to determine the association between a wide range of body composition measures with cognitive function in older adults. Methods A total of 2322 Malaysian older adults aged 60 years and older were recruited using multistage random sampling in a population‐based cross‐sectional study. Out of 2322 older adults recruited, 2309 (48% men) completed assessments on cognitive function and body composition. Cognitive functions were assessed using the Malay version of the Mini‐Mental State Examination, the Bahasa Malaysia version of Montreal Cognitive Assessment, Digit Span Test, Digit Symbol Test and Rey Auditory Verbal Learning Test. Body composition included body mass index, mid‐upper arm circumference, waist circumference, calf circumference, waist‐to‐hip ratio, percentage body fat and skeletal muscle mass. Results The association between body composition and cognitive functions was analyzed using multiple linear regression. After adjustment for age, education years, hypertension, hypercholesterolemia, diabetes mellitus, depression, smoking status and alcohol consumption, we found that calf circumference appeared as a significant predictor for all cognitive tests among both men and women (P < 0.05), except for the Rey Auditory Verbal Learning Test. Waist‐to‐hip ratio was detected as a significant predictor for all cognitive tests among women (P < 0.05), but was only a significant predictor for the Bahasa Malaysia version of Montreal Cognitive Assessment among men (P < 0.05). Conclusions These results suggest that there is a need to maintain muscle mass and lower adipose tissue among older adults for optimal cognitive function. Geriatr Gerontol Int 2017; 17: 554–560.

  May 27, 2016   doi: 10.1111/ggi.12753   open full text
• The association of change in medication regimen and use of inappropriate medication based on beers criteria with adverse outcomes in Japanese long‐term care facilities.
  Shinya Ishii, Taro Kojima, Kazuhiko Ezawa, Kentaro Higashi, Yukihiko Ikebata, Yozo Takehisa, Masahiro Akishita.
  Geriatrics and Gerontology International. May 26, 2016
  Aim To describe medication use including potentially inappropriate medication (PIM) and examine the association between adverse outcomes and patient factors including PIM use in Japanese elderly patients in long‐term care facilities. Methods This was a retrospective cohort study of 470 patients in 53 Geriatric Health Service Facilities and 44 Sanatorium Type Medical Care Facilities for the Elderly Requiring Long Term Care. Standardized forms were used to collect information including oral and parenteral medication use on admission, and 1 month and 3 months after admission. PIMs were determined by the 2003 or 2012 Beers criteria. Adverse outcomes were any medical events leading to emergency department transfer, hospitalization to acute care hospitals or death. Results A total of 2,227 oral medications and 197 parenteral medications were prescribed for 470 patients on admission. PIM exposure based on the 2003 and 2012 Beers criteria was observed in 11.9% and 37.5%, respectively. Adverse outcomes within 3 months after admission were observed in 8.9% of the entire cohort, and were associated with age, sex, facility type and number of parenteral medications on admission. Adverse outcomes between one and three months after admission were associated with age, sex, number of parenteral medications at one month, and a change in the number of oral and parenteral medications within one month after admission. PIM exposure was not associated with adverse outcomes in any models. Conclusions Use of PIM was prevalent in long‐term care facilities. Our findings support the importance of comprehensive assessment of medication regimens including parenteral medication. Geriatr Gerontol Int 2017; 17: 591–597.

  May 26, 2016   doi: 10.1111/ggi.12761   open full text
• Combination of body mass‐based resistance training and high‐intensity walking can improve both muscle size and V˙O2 peak in untrained older women.
  Hayao Ozaki, Tomoharu Kitada, Takashi Nakagata, Hisashi Naito.
  Geriatrics and Gerontology International. May 23, 2016
  Aim Here, we aimed to compare the effect of a combination of body mass‐based resistance exercise and moderate‐intensity (55% peak oxygen uptake [ V˙O2peak]) walking or high‐intensity (75% V˙O2peak) walking on muscle size and V˙O2 peak in untrained older women. Methods A total of 12 untrained older women (mean age 60 ± 2 years) were randomly assigned to either a moderate‐intensity aerobic training group (n = 6) or high‐intensity aerobic training group (n = 6). Both groups carried out body‐mass based (lower body) resistance exercises (2 sets of 10 repetitions) on 3 days/week for 8 weeks. Between these exercises, the participants in the moderate‐intensity aerobic training group walked at a previously determined speed equivalent to 55% V˙O2peak, whereas those in the high‐intensity aerobic training group walked at a speed equivalent to 75% V˙O2peak. Results Muscle thickness of the anterior aspect of the thigh and maximal isokinetic knee extension strength significantly increased in both groups (P < 0.01); these relative changes were negatively correlated with the absolute muscle thickness of the anterior aspect of the thigh value and the relative value of maximal knee strength to body mass at pre‐intervention, respectively. A significant group × time interaction was noted for V˙O2peak (P < 0.05), which increased only in the high‐intensity aerobic training group. Conclusions Body mass‐based resistance training significantly induced muscle hypertrophy in untrained older women. In particular, lower muscle thickness before intervention was associated with greater training‐induced growth. Furthermore, V˙O2peak can be increased by combined circuit training involving low‐load resistance exercise and walking, particularly when a relatively high intensity of walking is maintained. Geriatr Gerontol Int 2017; 17: 779–784.

  May 23, 2016   doi: 10.1111/ggi.12786   open full text
• Peripheral cytokines, C‐X‐C motif ligand10 and interleukin‐13, are associated with Malaysian Alzheimer's disease.
  Dayana Sazereen Mohd Hasni, Siong Meng Lim, Ai Vyrn Chin, Maw Pin Tan, Philip Jun Hua Poi, Shahrul Bahyah Kamaruzzaman, Abu Bakar Abdul Majeed, Kalavathy Ramasamy.
  Geriatrics and Gerontology International. May 23, 2016
  Aim Cytokines released from chronically‐activated microglia could result in neuroinflammation. An accurate profile of the relationship between cytokines and Alzheimer's disease (AD) pathogenesis, as well as the patterns of these inflammatory mediators in AD patients could lead to the identification of peripheral markers for the disease. The present study was undertaken to identify pro‐ and anti‐inflammatory cytokines associated with AD in the Malaysian population. Methods Further to informed consent from 39 healthy subjects and 39 probable AD patients, 8.5 mL of peripheral blood was collected and serum was extracted. The differential levels of 12 serum cytokines extracted from peripheral blood samples were measured using Procarta Multiplex Cytokine and enzyme‐linked immunoassay kits. Concentrations of cytokines were measured at 615 nm using a fluorometer. Results Except for tumor necrosis factor‐α, all classical pro‐inflammatory cytokines (interleukin [IL]‐1β, IL‐6, IL‐12 and interferon‐γ) were found to be significantly upregulated (P < 0.001) in AD patients. Three of the five non‐classical pro‐inflammatory cytokines (C‐X‐C motif ligand 10 [CXCL‐10], monocyte chemoattractant protein‐1 and macrophage inflammatory protein‐1α) showed similar patterns. Both classical IL‐10 and non‐classical IL‐13 anti‐inflammatory cytokines were significantly downregulated (P < 0.001) in AD patients when compared with non‐AD controls. Receiver operating characteristic curve analyses for both CXCL‐10 (IP‐10) and IL‐13 showed a high level of diagnostic accuracy (area under curve = 1 [95% confidence interval]). Both CXCL‐10 and IL‐13 also showed sensitivity of 100% and specificity of 100% for diagnosis of AD (cut‐off values >53.65 ρg/mL and <9.315 ρg/mL, respectively). Conclusions Both the non‐classical pro‐inflammatory CXCL‐10 and anti‐inflammatory IL‐13 cytokines showed promising potential as blood‐based cytokine biomarkers for AD. This is the first study of non‐classical cytokine profiles of Malaysian AD patients. Geriatr Gerontol Int 2017; 17: 839–846.

  May 23, 2016   doi: 10.1111/ggi.12783   open full text
• Cumulative number of hospital bed days among older adults in the last year of life: A retrospective cohort study.
  Tatsuro Ishizaki, Masaya Shimmei, Haruhisa Fukuda, Eun‐Hwan Oh, Chiho Shimada, Tomoko Wakui, Hiroko Mori, Ryutaro Takahashi.
  Geriatrics and Gerontology International. May 23, 2016
  Aim To determine whether age, proximity to death and long‐term care insurance certification are related to receiving hospital inpatient care; the number of hospital bed days (HBD) among older Japanese adults in the last year of life; and to estimate the total number of HBD. Methods Using health insurance claims and death certificate data, the present retrospective cohort study examined the HBD of city residents aged ≥65 years who died between September 2006 and October 2009 in Soma City, Japan. Using a two‐part model, factors associated with receiving hospital inpatient care and the total number of HBD in each quarter in the last year of life were examined. Results The total number of HBD in the last year of life varied widely; 13% had no admission, and 27% stayed ≥90 days. Younger age, approaching death and having long‐term care insurance certification were significantly associated with being more likely to receive hospital inpatient care during each quarterly period in the last year of life. In contrast, having long‐term care insurance certification and the last 3‐month period before death, compared with the first 3‐month period, were significantly associated with a fewer number of HBD. Conclusions The present study showed that older age was associated with being less likely to receive hospital inpatient care. The findings regarding the risk of inpatient care and total number of HBD in the last year of life help to understand resource use among older dying adults, and to develop evidence‐based healthcare policies within aging societies. Geriatr Gerontol Int 2017; 17: 737–743.

  May 23, 2016   doi: 10.1111/ggi.12777   open full text
• Non‐invasive mechanical ventilation in elderly patients: A narrative review.
  Ines Maria Grazia Piroddi, Cornelius Barlascini, Antonio Esquinas, Fulvio Braido, Paolo Banfi, Antonello Nicolini.
  Geriatrics and Gerontology International. May 23, 2016
  The treatment of acute respiratory failure with non‐invasive ventilation (NIV) as a first‐line therapy is increasingly common in intensive care units. The reduced invasiveness of NIV leads to better outcomes than endotracheal intubation in carefully selected groups of patients. Furthermore, the use of NIV as a palliative treatment for respiratory failure and dyspnea has become increasingly common. NIV also has an impact on the use of “do not intubate” orders. In the present narrative review, we explore the use and outcome of NIV in elderly patients. To accomplish this, we reviewed the most recent available medical literature. Geriatr Gerontol Int 2017; 17: 689–696.

  May 23, 2016   doi: 10.1111/ggi.12810   open full text
• Cholinergic enhancement increases regional cerebral blood flow to the posterior cingulate cortex in mild Alzheimer's disease.
  Tomomichi Iizuka, Masashi Kameyama.
  Geriatrics and Gerontology International. May 23, 2016
  Aim The brain region that shows reductions in regional cerebral blood flow (rCBF) earliest is the posterior cingulate cortex (PCC), which is thought to have a relationship with cognitive function. We made a hypothesis that the PCC hypoperfusion is a result of cholinergic dysfunction and can be restored by cholinergic enhancement. This present longitudinal study aimed to detect the restoration of PCC rCBF in response to donepezil, an acetylcholine esterase inhibitor. Methods We evaluated rCBF changes in the PCC, precuneus and anterior cingulate cortex using perfusion single‐photon emission computed tomography (SPECT), statistical analysis and region of interest analysis, prospectively. We allocated 36 patients with mild AD to either the responder or non‐responder groups based on changes in Mini‐Mental State Examination scores. The patients were followed up for 18 months. Results The PCC rCBF significantly increased in responders after 6 months of donepezil therapy. Statistical maps at baseline showed a typical decreased pattern of mild AD and obvious rCBF restoration in the bilateral PCC at 6 months in responders. Changes in Mini‐Mental State Examination scores and the AD assessment scale cognitive scores significantly correlated with rCBF changes in the PCC of responders. Conclusions Cholinergic enhancement restored PCC rCBF under the three conditions of mild AD, responders and short follow‐up interval, and that increase correlated with improved cognitive function. These findings support our hypothesis that PCC rCBF reflects cholinergic function in AD patients. Geriatr Gerontol Int 2017; 17: 951–958.

  May 23, 2016   doi: 10.1111/ggi.12818   open full text
• Association of low back and knee pain with falls in Japanese community‐dwelling older adults: A 3‐year prospective cohort study.
  Jun Kitayuguchi, Masamitsu Kamada, Shigeru Inoue, Hiroharu Kamioka, Takafumi Abe, Shimpei Okada, Yoshiteru Mutoh.
  Geriatrics and Gerontology International. May 20, 2016
  Aim To examine whether the chronicity and intensity of low back pain (LBP) or knee pain (KP) was associated with the occurrence of falls among a community‐dwelling older population. Methods This was a community‐based 3‐year prospective cohort study. In 2009, baseline questionnaires were mailed to 3080 randomly selected residents aged 60–79 years; 2534 residents (82.3%) responded to the baseline survey, and 1‐ and 3‐year follow‐up surveys were subsequently mailed to them. The data for 1890 respondents who had no falls in the past year at baseline were analyzed. Associations between pain status (chronicity, intensity and persistence) and the occurrence of falls were analyzed by multivariable‐adjusted logistic regression. Results A total of 197 (13.6%) participants had at least one fall during 12 months at 3‐year follow up; of those, 68 (4.8%) had multiple falls, and 65 (4.5%) resulted in an injury. Chronicity and intensity of LBP were associated with injurious falls (P for trend = 0.033 and P for linearity = 0.041, respectively), and KP was associated with at least one fall (P for trend = 0.021 and P for linearity = 0.040, respectively). In addition, participants who had chronic pain persistently at both baseline and 1‐year follow up had a higher risk of falls (LBP for injurious falls; adjusted odd ratio 2.46, 95% confidence interval 1.08–5.63, KP for at least one fall; adjusted odd ratio 2.39, 95% confidence interval 1.29–4.44), compared with those who had no pain at both time‐points. Conclusions LBP and KP chronicity, intensity and persistence of chronic pain were associated with a greater risk of falls in older adults. Geriatr Gerontol Int 2017; 17: 875–884.

  May 20, 2016   doi: 10.1111/ggi.12799   open full text
• Too little sleep and too much sleep among older adults: Associations with self‐reported sleep medication use, sleep quality and healthcare utilization.
  Namkee G Choi, Diana M DiNitto, C Nathan Marti, Bryan Y Choi.
  Geriatrics and Gerontology International. May 16, 2016
  Aim The present study examined relationships among older adults' sleep duration (1–5 h and ≥10 h vs 6–9 h), sleep medication use, sleep quality and healthcare use. Methods The 2013 USA National Health Interview Survey provided data on a sample of 7196 community‐dwelling individuals aged ≥65 years. Bivariate analyses and multivariate regression analyses were used to examine study questions. Results Of the sample, 85% slept 6–9 h on average, 8% slept 1–5 h and 7% slept ≥10 h. One‐sixth of optimal sleepers, one‐quarter of short sleepers and one‐fifth of long sleepers used sleep medications at least once in the preceding week. Medication intake of one to two times, as opposed to non‐use, was associated with a greater risk of short than optimal sleep (RRR 1.60, 95% CI 1.03–2.48). Short sleep was positively, but long sleep was negatively associated with trouble falling asleep and staying asleep. Any medication use was positively associated with trouble falling asleep and staying asleep. Short sleep was associated with greater odds of emergency department visits (OR 1.36, 95% CI 1.06–1.77), whereas long sleep was associated with greater odds of an overnight hospital stay (OR 1.48, 95% CI 1.04–2.11) and home care use (OR 2.46, 95% CI 1.37–4.41). Medication intake one to two times was associated with greater odds of emergency department visits (OR 1.48, 95% CI 1.11–1.98). Conclusions Sleep medication use does not appear to promote sleep health. Both short and long sleep durations are associated with a higher likelihood of healthcare use. Clinicians need to examine older adults' sleep health and medication use, and their effects on healthcare use. Geriatr Gerontol Int 2017; 17: 545–553.

  May 16, 2016   doi: 10.1111/ggi.12749   open full text
• Comparative study of disability‐free life expectancy across six low‐ and middle‐income countries.
  Witness Chirinda, He Chen.
  Geriatrics and Gerontology International. May 16, 2016
  Aim There is a knowledge gap about the disability‐free life expectancy (DFLE) in low‐ and middle‐income countries. The present study aimed to compute and compare DFLE in six such countries, and examine sex differences in DFLE in each country. Methods Based on data from the World Health Organization Study on Global Aging and Adult Health wave 1 survey, we used the Sullivan method to estimate DFLE among persons aged years 50 years and older. Disability was divided into moderate disability and severe disability during the calculation. Results Of the six countries, China had the highest DFLE and lowest expected average lifetime with disability. India had the lowest DFLE and highest life years with moderate and severe disability. In each country, women live longer than men, but with more disabilities in both absolute and proportional terms. The huge sex difference in Russia requires special attention. In addition, most of the life expectancy lived with disability was spent with severe disability, rather than moderate disability. Conclusions The study has shed some light on the disparities across the six countries with regard to DFLE at old ages. The low percentage of DFLE in life expectancy in some countries, such as India, calls for effective policies on healthy aging. The “sex disability‐survival paradox” in DFLE is supported by our results. To differentiate the severity of disability should be routine in calculating DFLE. Geriatr Gerontol Int 2017; 17: 637–644.

  May 16, 2016   doi: 10.1111/ggi.12748   open full text
• Evaluation of a dysphagia screening system based on the Mann Assessment of Swallowing Ability for use in dependent older adults.
  Mariko Ohira, Ryo Ishida, Yoshinobu Maki, Mai Ohkubo, Tetsuya Sugiyama, Takaharu Sakayori, Toru Sato.
  Geriatrics and Gerontology International. May 16, 2016
  Aim Dysphagia is common in dependent older adults. Thus, a method of evaluating eating and swallowing functions that can be used to diagnose and manage dysphagia in a simple and robust manner is required. In 2002, the Mann Assessment of Swallowing Ability (MASA) was introduced to identify dysphagia in acute‐stage stroke patients. As the MASA enables easy screening, it might also be applicable to dependent older adults if appropriate MASA cut‐off values and the most useful assessment items could be determined. In the present study, we attempted to determine suitable MASA cut‐off values, and the most useful assessment items for predicting aspiration and pharyngeal retention in dependent older adults. Methods Using the MASA, we evaluated the eating and swallowing functions of 50 dependent older adults with dysphagia. All of the patients also underwent videoendoscopic‐based swallowing evaluations to detect aspiration and pharyngeal retention. The participants' characteristics and the utility of each assessment item were compared between various groups. Using the patients' videoendoscopic findings as a reference, receiver operating characteristic curve analysis was carried out to determine appropriate cut‐off values for predicting aspiration and pharyngeal retention in dependent older adults. Results The optimal MASA cut‐off values for predicting aspiration and pharyngeal retention were 122 points and 151 points, respectively. A total of 17 of the 24 clinical items assessed by the MASA were found to be associated with aspiration in dependent older adults. Conclusions The MASA is a useful screening tool for evaluating eating and swallowing functions in dependent older adults. Geriatr Gerontol Int 2017; 17: 561‐567.

  May 16, 2016   doi: 10.1111/ggi.12755   open full text
• Association between body composition and hip fractures in older women with physical frailty.
  Oleg Zaslavsky, Wenjun Li, Scott Going, Mridul Datta, Linda Snetselaar, Shira Zelber‐Sagi.
  Geriatrics and Gerontology International. May 10, 2016
  Aim We sought to determine the extent to which higher lean and fat mass as measured by dual X‐ray absorptiometry in older adults with frailty are related to total hip bone mass density (BMD) index and the rate of hip fractures. Methods The data are from the Women's Health Initiative Observational Study. We identified 872 participants aged ≥65 years with body composition measures and positive frailty. Frailty was determined using modified Fried's criteria. Linear and Cox regressions were used to model study outcomes. Results During the follow‐up period, 5.6% patients (n = 49) had sustained a hip fracture. Body composition indexes were associated with total hip BMD (P < 0.001 for all). In models adjusted for age, ethnicity, smoking, history of fractures, recurrent falls, number of frailty criteria and corresponding lean mass, the hazard ratio for hip fracture per 1 kg/m2 increase in fat mass was 0.73 (95% confidence interval 0.60–0.88) for appendicular compartment, 0.76 (95% confidence interval 0.65–0.89) for trunk and 0.84 (95% confidence interval 0.77–0.93) for whole‐body fat mass. The hazard ratio for hip fracture per 1 kg/m2 increase in appendicular lean mass was 0.63 (95% confidence interval 0.46–0.88). However, after final adjustment for total hip BMD, the only index that remained statistically significant was whole‐body fat mass (P for trend = 0.04). Conclusions We showed that in frail older women, higher fat and lean mass was associated with reduced hip‐fracture rates. Higher whole‐body adiposity, however, was also associated with lower hip‐fracture rate independent of total hip BMD. The present results confirm the importance of weight maintenance in frail populations. Geriatr Gerontol Int 2017; 17: 898–904.

  May 10, 2016   doi: 10.1111/ggi.12798   open full text
• Physicians’ opinions regarding the criteria for resuming oral intake after aspiration pneumonia: A questionnaire survey and cluster analysis of hospitals across Japan.
  Tsuneaki Kenzaka, Ayako Kumabe, Koki Kosami, Yasufumi Matsuoka, Kensuke Minami, Daisuke Ninomiya, Ayako Noda, Masanobu Okayama.
  Geriatrics and Gerontology International. May 10, 2016
  Aim To investigate the items that are considered by physicians when making decisions regarding the resumption of oral intake among patients with aspiration pneumonia who have undergone short‐term fasting. Methods We surveyed 2490 Japanese hospitals that had internal medicine and respiratory medicine departments. We mailed questionnaires that contained 24 items related to oral intake resumption after aspiration pneumonia to the head of the department at each hospital. Cronbach statistics, principal component analysis and cluster analysis were used to analyze the results. Results We received responses from 350 hospitals; 89.7% of the respondents answered that they “Strongly agree” that “level of consciousness” is a useful criterion for resuming oral intake. Furthermore, 66%, 66%, 63.4%, 58.5% and 51% of the respondents answered that they “strongly agree” regarding the use of SpO2, the discretion of the attending physician, body temperature, swallowing function test results, mental state and respiratory rate, respectively. In the cluster analysis, level of consciousness, body temperature, SpO2, respiratory rate, mental state and the discretion of the attending physician belonged to the first cluster. The second cluster consisted of the patient's request, the family's request, the opinions of the medical staff and non‐physician healthcare providers, and performance status. Conclusions Physicians consider several criteria during decision‐making regarding oral intake resumption, which can be assigned to two clusters. Future studies are required to develop generalizable and objective criteria. Geriatr Gerontol Int 2017; 17: 810–818.

  May 10, 2016   doi: 10.1111/ggi.12792   open full text
• Poor oral status is associated with rehabilitation outcome in older people.
  Ai Shiraishi, Yoshihiro Yoshimura, Hidetaka Wakabayashi, Yuri Tsuji.
  Geriatrics and Gerontology International. May 06, 2016
  Aim Poor oral status is associated with increased physical dependency and cognitive decline. Malnutrition, a potential result of poor oral status, is associated with poorer rehabilitation outcome and physical function. However, the association between oral status and rehabilitation outcome is not fully understood. The present study investigated the association of poor oral status with rehabilitation outcome in older patients. Methods A retrospective cohort study was carried out of 108 consecutive patients (mean age 80.5 ± 6.8 years; 50.9% men) who were admitted to convalescent rehabilitation wards. The Revised Oral Assessment Guide was used to evaluate oral status. Rehabilitation outcome was evaluated by the Functional Independence Measure (FIM) on discharge. Multivariate analyses were applied to examine the associations between poor oral status and motor‐FIM on discharge. Results According to the Revised Oral Assessment Guide score, 14.8% of participants had normal oral status, 52.8% had slight to moderate oral problems and 32.4% had severe oral problems. The median scores of motor‐FIM on admission and on discharge were 52 (interquartile range 25–70) and 75 (interquartile range 51–89), respectively. Multivariate analysis showed that the Revised Oral Assessment Guide score and the motor‐/cognitive‐FIM scores on admission were significant independent factors for motor‐FIM on discharge, after adjusted for sex, age, length of stay, nutritional status, handgrip and causative diseases (P < 0.001). Conclusions Poor oral status is associated with rehabilitation outcome in older people. Geriatr Gerontol Int 2017; 17: 598–604.

  May 06, 2016   doi: 10.1111/ggi.12763   open full text
• Effects of lactoferrin and lactoperoxidase‐containing food on the oral hygiene status of older individuals: A randomized, double blinded, placebo‐controlled clinical trial.
  Yu Morita, Kentaro Ishikawa, Manabu Nakano, Hiroyuki Wakabayashi, Koji Yamauchi, Fumiaki Abe, Takafumi Ooka, Shouji Hironaka.
  Geriatrics and Gerontology International. May 06, 2016
  Aim Lactoferrin and lactoperoxidase have antimicrobial effects against oral pathogens. This randomized, double‐blinded, placebo‐controlled parallel group study tested the efficacy of a lactoferrin and lactoperoxidase‐containing tablet (LF + LPO tablet) in improving the oral hygiene status of older individuals. Methods A total of 46 participants (31 nursing home residents and 15 healthy older individuals) were randomly assigned to receive either lactoferrin and lactoperoxidase‐containing tablets or placebo tablets, and were asked to suck on a tablet after every meal for 8 weeks. Oral and bacteriological assessments were carried out at baseline, 4 weeks and 8 weeks. Results A total of 47 participants (test group n = 20; mean age 80.4 ± 6.4 years; placebo group n = 17; mean age 85.9 ± 6.7 years) were included in the efficacy analysis. In the test group, the total number of bacteria in the tongue coating was significantly reduced at 4 and 8 weeks compared with that at baseline, and the number of Porphyromonas gingivalis and Fusobacterium nucleatum was significantly reduced at 8 weeks. The total number of bacteria and the number of P. gingivalis in the supragingival plaque were significantly reduced at 8 weeks. Furthermore, there was a significant difference in the change in the number of P. gingivalis in supragingival plaque at 8 weeks between the two groups. Conclusions Lactoferrin and lactoperoxidase‐containing tablet ingestion showed antibacterial effects on periodontal bacteria present in the tongue coating and supragingival plaque, indicating that long‐term ingestion could improve the oral hygiene of older individuals. Geriatr Gerontol Int 2017; 17: 714–721.

  May 06, 2016   doi: 10.1111/ggi.12776   open full text
• Risk factors and consequences of decreased kidney function in nursing home residents: A longitudinal study.
  Beata Borgström Bolmsjö, Sigvard Mölstad, Martin Gallagher, John Chalmers, Carl Johan Östgren, Patrik Midlöv.
  Geriatrics and Gerontology International. May 06, 2016
  Aim The aim of the present study was to study the renal function and the relationship of deterioration in renal function with major outcomes in elderly nursing home residents. A second aim was to compare the internationally recommended formulae for estimated glomerular filtration rate (eGFR) consisting of both creatinine and cystatin C in a nursing home population. Methods A total of 429 patients from 11 nursing homes were included during 2008–2011. GFR was estimated, from formulae based on both creatinine and cystatin C, at baseline and after 1 and 2 years. The patients were divided into groups based on chronic kidney disease level, and comparisons were made for mortality, morbidity, the use of medications and between the different formulae for eGFR. Results Survival was lower in the groups with lower renal function. Over 60% of the residents had impaired renal function. Those with impaired renal function were older, had a higher number of medications and a higher prevalence of heart failure. Higher number of medications was associated with a greater risk of rapid decline in renal function with an odds ratio of 1.2 (95% confidence interval 1.06–1.36, P = 0.003). The compared eGFR formulae based on both cystatin C and creatinine were in excellent concordance with each other. Conclusions Decreased renal function was associated with increased mortality. A majority of nursing home residents had declining renal function, which should be considered when prescribing medications. The more medications, the higher the risk for rapidly declining renal function. Geriatr Gerontol Int 2017; 17: 791–797.

  May 06, 2016   doi: 10.1111/ggi.12789   open full text
• Factors associated with health‐related decision‐making in older adults from Southern Brazil.
  Patricia Morsch, Andrea Ribeiro Mirandola, Iride Cristofoli Caberlon, Ângelo José Gonçalves Bós.
  Geriatrics and Gerontology International. May 06, 2016
  Aim To analyze older adults’ health‐related decision‐making profile. Methods Secondary analysis of a population‐based study with 6945 older‐adults (aged ≥60 years) in Southern Brazil. Multiple logistic regressions were calculated to describe the odds of deciding alone or asking for advice, compared with the chance of letting someone else decide about health‐related issues. Associated variables were age, sex, marital status, education level, number of chronic morbidities, having children and quality of life. Results The odds of asking for advice instead of letting others decide were significantly higher in the younger group and those with better levels of quality of life, independent of other variables. The chance of asking for advice was lower for unmarried (62%), widowed (76%) and those with children (50%). The chance of men deciding for themselves about their health instead of letting others decide was 47% higher compared with women (P = 0.0002), but 45% lower in the older group (P < 0.0001). Participants who where unmarried and childless, and individuals with better levels of quality of life were more likely to decide alone instead of letting others decide (P < 0.05). Conclusions Decision‐making is fundamental for older adults’ good quality of life. Aging makes older adults more vulnerable to dependence; however, it does not necessarily mean that they lose or decrease their ability to make decisions regarding their own health and desires. Geriatr Gerontol Int 2017; 17: 798‐803.

  May 06, 2016   doi: 10.1111/ggi.12788   open full text
• Negative impact of oral health conditions on oral health related quality of life of community dwelling elders in Mexico city, a population based study.
  Roberto Carlos Castrejón‐Pérez, S. Aída Borges‐Yáñez, Ma. Esther Irigoyen‐Camacho, Luis Pablo Cruz‐Hervert.
  Geriatrics and Gerontology International. May 06, 2016
  Aim Oral health in old persons is frequently poor; non‐functional prostheses are common and negatively affect quality of life. The objective of this study was to estimate the impact of oral health problems on oral health related quality of life in a sample of home dwelling Mexican elders. Methods Household survey in 655 persons 70 years old and over residing in one county in Mexico City. Variables Oral Health Related Quality of Life (Short version of the Oral Health Impact Profile validated in Mexico‐OHIP‐14‐sp), self‐perception of general and oral health, xerostomia, utilization of dental services, utilization and functionality of removable dental prostheses, dental and periodontal conditions, age, gender, marital status, schooling, depression, cognitive impairment and independence in activities of daily living (ADL). A negative binomial regression model was fitted. Results Mean age was 79.2 ± 7.1 years; 54.2% were women. Mean OHIP‐14‐Sp score was 6.8 ± 8.7, median was 4. The final model showed that men (RR = 1.30); persons with xerostomia (RR = 1.41); no utilization of removable prostheses (RR = 1.55); utilization of non‐functional removable prostheses (RR = 1.69); fair self‐perception of general health (RR = 1.34); equal (RR = 1.43) or worse (RR = 2.32) self‐perception of oral health compared with persons of the same age; and being dependent for at least one ADL (RR = 1.71) increased the probability of higher scores of the OHIP‐14‐sp. Age, schooling, depression, cognitive impairment and periodontal conditions showed no association. Conclusions Oral rehabilitation can improve quality of life, health education and health promotion for the elder and their caregivers may reduce the risk of dental problems. Geriatr Gerontol Int 2017; 17: 744–752.

  May 06, 2016   doi: 10.1111/ggi.12780   open full text
• Sex differences in attachment to spouses among older Japanese couples.
  Katsunori Yokoyama, Kazutoyo Shirakawa, Tomohiro Hirao, Morihito Nakatsu, Takeshi Yoda, Hiromi Suzuki, Yugo Okabe, Gotaro Shirakami.
  Geriatrics and Gerontology International. May 06, 2016
  Aim Attachment among older adults can partially explain sex differences in bereavement outcomes, but there is currently little evidence regarding this. The aim was to quantify sex differences in the proportion of spouses as attachment figures among older couples. Methods We carried out a secondary analysis of cross‐sectional questionnaire survey data. The dataset included information about 5137 respondents aged 65 years or older in Kanonji and Mitoyo, two rural cities in Kagawa prefecture, Japan; those who were never married or were widowed or divorced were excluded. The questionnaire asked participants whom they most want to be close by when they die (this person was defined as an “attachment figure”), and compared the proportion of older people of each sex who named their spouse. We used multiple logistic regression analyses to examine the independent association of sex with the proportion of spouses as attachment figures. Results Of the 2513 male respondents, 1494 (59.5%) answered “spouse.” Of the 2624 female respondents, 904 (34.5%) answered “spouse.” Multiple logistic regression analyses adjusted for age, live‐in children, annual income, participation in community activities, presence of a long‐term primary care doctor, anxiety about death and preferences for place of death showed that men had a higher probability of attachment to spouses than women (odds ratio 2.83, 95% confidence interval 2.43–3.31). Conclusions Spouses are more likely to be attachment figures for men than for women. The present study supports the theory that sex differences in attachment might partially explain the differences in the bereavement effect between sexes among older people. Geriatr Gerontol Int 2017; 17: 834‐838.

  May 06, 2016   doi: 10.1111/ggi.12790   open full text
• Clinical features of incidental mild cognitive impairment and dementia in a population‐based study.
  Nozomi Hishikawa, Yusuke Fukui, Kota Sato, Toru Yamashita, Yasuyuki Ohta, Koji Abe.
  Geriatrics and Gerontology International. May 06, 2016
  Aim The number of people with dementia is rapidly increasing as populations around the world age. It is important to grasp the characteristic features of mild cognitive impairment (MCI) for early detection and prevention of dementia. Methods We examined 408 individuals recruited from a health checkup for metabolic syndrome, which comprised three groups: normal (n = 325), MCI (n = 55) and apparent cognitive decline (ACD; n = 28). We compared cognitive/affective functions and exercise/hobby habits with assessments of vascular risk factors and results from computerized touch‐panel tests. Results Among the 408 individuals, 93.1% showed normal scores on the Mini‐Mental State Examination, and 6.9% had ACD. Among the normal Mini‐Mental State Examination participants, 14.5% had MCI (13.5% of all participants). The three groups of participants showed significant differences in age, education, systolic blood pressure, glycosylated hemoglobin and high‐density lipoprotein cholesterol level. Even within the normal range, those in the MCI group showed significantly lower cognitive function than those in the normal group. Scores on the Geriatric Depression Scale were greater in the MCI group, and “day–night reversal” was worse in the ACD group. Scores on touch‐panel screening tests were significantly worse in the MCI and ACD groups than in the normal group. Participants showed better cognitive and affective function if they exercised regularly or had hobbies. Conclusions Incidental MCI and ACD had prevalences of 13.5% and 6.9%, respectively, in the population‐based study. Participants with these conditions showed cognitive/affective decline and impairment on computerized touch‐panel tests in relation to vascular risk factors and exercise/hobbies. Geriatr Gerontol Int 2017; 17: 722–729.

  May 06, 2016   doi: 10.1111/ggi.12778   open full text
• Relationship between skeletal muscle mass and swallowing function in patients with Alzheimer's disease.
  Daisuke Takagi, Hirohiko Hirano, Yutaka Watanabe, Ayako Edahiro, Yuki Ohara, Hideyo Yoshida, Hunkyung Kim, Kohji Murakami, Shouji Hironaka.
  Geriatrics and Gerontology International. May 06, 2016
  Aim The present study verified the hypothesis that decreased skeletal muscle in older adults with Alzheimer's disease is related to Alzheimer's disease progression and decreased oral or swallowing function. Methods We investigated 232 patients with Alzheimer's disease (31 men, 201 women, average age 85.4 ± 5.9 years) in two regions in Japan. The patients provided basic information (sex and age), and were assessed for skeletal muscle index, dementia severity (clinical dementia rating), activities of daily living, nutritional status, oral status and swallowing function. Results Stratification by clinical dementia rating was as follows: clinical dementia rating 0.5:21 patients (9.0%), clinical dementia rating 1:85 patients (36.6%), clinical dementia rating 2:88 patients (37.9%) and clinical dementia rating 3:38 patients (16.3%). Alzheimer's disease severity was significantly related to skeletal muscle index. Logistic regression analysis showed that clinical dementia rating 3 (odds ratio 11.68, 95% confidence interval 4.52–30.20), body mass index < 18.5 (odds ratio 3.18, 95% confidence interval 1.27–8.00), calf circumference <30.5 cm (odds ratio 9.33, 95% confidence interval 2.01–43.27) and poor swallowing function (odds ratio 4.93, 95% confidence interval 1.10–22.04) had a significant effect on decreased skeletal muscle index. Conclusions Therefore, decreased skeletal muscle mass in patients with Alzheimer's disease requires strategies to manage swallowing dysfunction. Geriatr Gerontol Int 2016; 17: 402–409.

  May 06, 2016   doi: 10.1111/ggi.12728   open full text
• Neuroimaging for diagnosing dementia with Lewy bodies: What is the best neuroimaging technique in discriminating dementia with Lewy bodies from Alzheimer's disease?
  Soichiro Shimizu, Hidekazu Kanetaka, Kentaro Hirao, Raita Fukasawa, Nayuta Namioka, Hirokuni Hatanaka, Daisuke Hirose, Takahiko Umahara, Hirofumi Sakurai, Haruo Hanyu.
  Geriatrics and Gerontology International. May 03, 2016
  Aim We compared the diagnostic value of four neuroimaging techniques, namely, 123I‐2β‐Carbomethoxy‐3β‐(4‐iodophenyl)‐N‐(3‐fluoropropyl) nortropane (123I‐FP‐CIT) dopamine transporter single‐photon emission computed tomography (DAT‐SPECT), magnetic resonance imaging, perfusion SPECT and 123I‐metaiodobenzyl‐guanidine myocardial scintigraphy in differentiating dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). Methods A total of 32 patients with probable AD and 32 patients with probable DLB were enrolled in the present study. For the comparison study, we used the specific binding ratio for DAT‐SPECT, the heart‐to‐mediastinum ratio in the delay phase for 123I‐metaiodobenzyl‐guanidine myocardial scintigraphy, z‐scores in the medial occipital lobe for perfusion SPECT and z‐scores of hippocampal atrophy using a voxel‐based specific regional analysis system for AD for magnetic resonance imaging. Results DAT‐SPECT enabled more accurate differentiation of DLB from AD than other methods. 123I‐metaiodobenzyl‐guanidine myocardial scintigraphy enabled more accurate differentiation of DLB from AD than magnetic resonance imaging and perfusion SPECT. Conclusions In agreement with the recent consensus clinical diagnostic criteria for DLB, we confirmed that the diagnostic accuracy of DAT‐SPECT imaging is significantly higher than other neuroimaging techniques. Geriatr Gerontol Int 2017; 17: 819‐824.

  May 03, 2016   doi: 10.1111/ggi.12794   open full text
• Effects of an integrated health education and elastic band resistance training program on physical function and muscle strength in community‐dwelling elderly women: Healthy Aging and Happy Aging II study.
  Seung‐Lyul Oh, Hee‐jae Kim, Shinae Woo, Be‐Long Cho, Misoon Song, Yeon‐Hwan Park, Jae‐Young Lim, Wook Song.
  Geriatrics and Gerontology International. May 03, 2016
  Aim In the present study, we determined the effect of an integrated health education and elastic band resistance training program on body composition, physical function, muscle strength and quality in community‐dwelling elderly women. Methods We recruited participants with eligibility inclusion criteria, and randomly assigned them to either the control group (n = 19) or the intervention group (n = 19). The integrated intervention program comprised of health education and individual counseling, and elastic band training for 18 weeks (8 weeks of supervised training and 10 weeks of self‐directed training). We assessed body composition, muscle strength and quality, and physical function at pre‐, after 8 weeks (mid‐) and 18 weeks (post‐training). Results After the intervention, there were no significant changes in skeletal muscle index, fat free mass, total lean mass and total fat mass for both the control group and intervention group. However, the interaction effect was significantly different in SPPB score (P < 0.05), isokinetic strength (60 deg/s, P < 0.001; 120 deg/s; P < 0.05) and muscle quality (P < 0.05) after 18 weeks of intervention relative to the baseline of the control and intervention groups. The supervised elastic band training of 8 weeks did not improve short physical performance battery score and isokinetic strength, whereas there was a significant increase of those outcomes (10.6% improvement, 9.8~23.5% improvement) after 10 weeks of following self‐directed exercise compared with the baseline. Conclusions These results show the effectiveness of following self‐directed resistance training with health education after supervised training cessation in improvement of short physical performance battery and leg muscle strength. This intervention program might be an effective method to promote muscle strength and quality, and to prevent frailty in elderly women. Geriatr Gerontol Int 2017; 17: 825‐833.

  May 03, 2016   doi: 10.1111/ggi.12795   open full text
• Indoor and outdoor falls among older adult trauma patients: A comparison of patient characteristics, associated factors and outcomes.
  Tracy Chippendale, Patricia A Gentile, Melissa K James, Gloria Melnic.
  Geriatrics and Gerontology International. May 03, 2016
  Aim The aim of the present study was to examine significant differences in patient characteristics, associated factors and outcomes for indoor versus outdoor falls among trauma patients. Methods A retrospective cross‐sectional study using data from the trauma registry and electronic medical records at a level 1 trauma center in the USA was carried out. People aged 55 years or older, for whom fall location could be identified (n = 712), were included in the study. Demographic information, functional status before admission, comorbid conditions, activation level, Injury Severity Score, discharge disposition and injury type were included in the comparative analyses. Associated factors for falls and fractures in each location were also examined using logistic regression. Results Significant differences were found in patient characteristics between indoor and outdoor fallers. Significant differences in outcomes were found related to discharge disposition and injury type. Open wounds were more common among outdoor fallers (26.5%) as compared with indoor fallers (16.3%, P = 0.002). Although disorders of joints with difficulty walking were associated with fractures among both indoor (OR 7.20, CI 2.19–23.66) and outdoor fallers (OR 5.65, CI 1.27–25.06), sex was only associated with fractures among those who fell indoors (OR 1.69 CI 1.12–2.56). Conclusions Significant differences exist in characteristics of indoor and outdoor fallers, and for discharge disposition and injury type for each fall location among patients admitted for trauma care. Factors associated with fractures differ between indoor and outdoor fallers. Results can help to inform targeted primary and secondary prevention initiatives. Geriatr Gerontol Int 2017; 17: 905–912.

  May 03, 2016   doi: 10.1111/ggi.12800   open full text
• Reference intervals of β‐C‐terminal telopeptide of type I collagen, procollagen type I N‐terminal propeptide and osteocalcin for very elderly Chinese men.
  Zhangxuan Shou, Xue Jin, Pingda Bian, Xiuyang Li, Jinping Chen.
  Geriatrics and Gerontology International. May 02, 2016
  Aim The present study was intended to establish the reference intervals of β‐C‐terminal telopeptide of type I collagen, procollagen type I N‐terminal propeptide and osteocalcin for very elderly (aged 80 years or more) Chinese men. Methods A total of 1316 very elderly Chinese men were recruited into the study, and subjected to a survey of clinical characteristics, measurements of bone mineral density and assays of bone turnover markers. The relationships between underlying diseases and bone turnover markers were investigated, and the reference intervals of β‐C‐terminal telopeptide of type I collagen, procollagen type I N‐terminal propeptide and osteocalcin for very elderly Chinese men were established through defining the central 95% range of all observations. Results We found that type 2 diabetes mellitus, chronic obstructive pulmonary disease and abnormal bone mass were associated with serum bone turnover markers (P < 0.01), and thereby identified 208 men without type 2 diabetes mellitus, chronic obstructive pulmonary disease and/or abnormal bone mass as healthy participants from 1316 very elderly Chinese men. The reference intervals for very elderly Chinese men were 0.13–0.63 ng/mL for β‐C‐terminal telopeptide of type I collagen, 18–94 ng/mL for procollagen type I N‐terminal propeptide and 9–28 ng/mL for osteocalcin, respectively. The three turnover markers were moderately correlated to each other (P < 0.001), and all negatively associated with the bone mineral density of three sites (P < 0.05). Conclusions We have established the reference intervals of β‐C‐terminal telopeptide of type I collagen, procollagen type I N‐terminal propeptide and osteocalcin for very elderly Chinese men. Geriatr Gerontol Int 2017; 17: 773–778.

  May 02, 2016   doi: 10.1111/ggi.12785   open full text
• Examining the differences in the stigma of dementia and diabetes among Chinese Americans.
  Benjamin KP Woo, Pratik Mehta.
  Geriatrics and Gerontology International. May 02, 2016
  Aim One of the major barriers in making a diagnosis and managing dementia in the Chinese American population is the stigma surrounding the disease. The goal of the present study was to examine differences in the stigma and perceptions of dementia and diabetes among Chinese Americans. Methods A total of 449 Chinese Americans answered one survey with two self‐administered, true/false questionnaires assessing stigma and perceptions toward dementia and diabetes. Higher total scores were associated with increased stigma and negative perceptions. The results of the two questionnaires were compared to assess for any differences in attitudes. Results For the dementia questionnaire, the mean score was 5.58 (95% CI 5.37–5.79) with a standard deviation of 2.31. For the diabetes questionnaire, the mean score was 2.01 (95% CI 1.85‐2.18) with a standard deviation of 1.76. Statistical analysis showed that Chinese Americans were more likely to hold stigmatized views toward dementia than diabetes (t = 33.9, d.f. = 448, P < 0.01). Conclusions The higher average score in the dementia questionnaire shows that there are greater stigma and negative perceptions of dementia in comparison with diabetes among Chinese Americans. Considering that stigma delays access to healthcare for dementia‐related symptoms, efforts should be taken to minimize negative attitudes associated with dementia. Geriatr Gerontol Int 2017; 17: 760–764.

  May 02, 2016   doi: 10.1111/ggi.12782   open full text
• Reduction in the numbers of drugs administered to elderly in‐patients with polypharmacy by a multidisciplinary review of medication using electronic medical records.
  Yuichi Hayashi, Ayumi Godai, Megumi Yamada, Nobuaki Yoshikura, Naoko Harada, Akihiro Koumura, Akio Kimura, Shinji Okayasu, Yasuko Matsuno, Yasutomi Kinosada, Yoshinori Itoh, Takashi Inuzuka.
  Geriatrics and Gerontology International. May 02, 2016
  Aim Polypharmacy is a major problem for elderly patients in developed countries. We investigated whether a multidisciplinary medication review using electronic medical records could reduce the number of drugs administered to elderly patients receiving polypharmacy. Methods The present study included 432 elderly patients (188 women, 244 men; 267 patients aged 65–74 years and 165 patients aged ≥75 years) who were admitted to and discharged from the Department of Neurology and Geriatrics, Gifu University Hospital, between 2004 and 2011; those who died at the hospital were excluded. The names, categories, and numbers of orally administered drugs at admission and discharge were examined retrospectively using electronic medical records. The histories of continuous oral immunotherapy use at the hospital, falls during the 2 years before hospital admission and the presence of fall risk factors were also evaluated. P‐values <0.05 were considered statistically significant. Results On average 1.14 ± 3.07 fewer types of drugs were given to patients at discharge than at admission in patients receiving polypharmacy (P < 0.001). However, the number of drugs given to patients undergoing continuous oral immunotherapy increased by 1.67 ± 3.47 (P < 0.001). The number of drugs was reduced in 33.1% of fallers, and 36.3% of non‐fallers. In both fallers and non‐fallers, there was a reduction in drug categories associated with falls. Conclusions Multidisciplinary medication review using electronic medical records could significantly reduce the numbers of drugs taken by elderly inpatients receiving polypharmacy, including drugs associated with falls, in both fallers and non‐fallers Geriatr Gerontol Int 2017; 17: 653–658.

  May 02, 2016   doi: 10.1111/ggi.12764   open full text
• Association between posterior teeth occlusion and functional dependence among older adults in nursing homes in Japan.
  Kenji Takeuchi, Maya Izumi, Michiko Furuta, Toru Takeshita, Yukie Shibata, Shinya Kageyama, Seijun Ganaha, Yoshihisa Yamashita.
  Geriatrics and Gerontology International. April 27, 2016
  Aim To examine whether posterior teeth occlusion is associated with functional dependence regardless of the number of natural teeth among Japanese nursing home residents. Methods The present cross‐sectional study included 234 residents aged >60 years from eight nursing homes in Aso City, Japan. Functional dependence in basic activities of daily living was measured using the Barthel Index, and the primary outcome was independence for essential personal care (Barthel Index ≥ 60 points). Posterior teeth occlusion was assessed by a dentist using the total number of functional tooth units, depending on the number and location of the remaining natural and artificial teeth on implant‐supported, fixed, and removable prostheses. Logistic regression models were used to assess univariate and multivariate associations between the total number of functional tooth units and independence for essential personal care. Models were sequentially adjusted for the number of natural teeth, demographic characteristics, socioeconomic status, health behaviors and comorbidities. Results Independence for essential personal care was found in 14.1% of participants. Greater total numbers of functional tooth units were significantly associated with greater odds of independence for essential personal care (odds ratio 1.12; 95% confidence interval 1.01–1.24). The association remained significant after adjustment for the number of natural teeth and other possible confounders (odds ratio 1.14, 95% confidence interval 1.01–1.29). Conclusions Posterior teeth occlusion was independently associated with functional dependence among nursing home older residents in Japan. The maintenance and restoration of posterior teeth occlusion might be preventive factors against late‐life functional decline. Geriatr Gerontol Int 2017; 17: 622–627.

  April 27, 2016   doi: 10.1111/ggi.12762   open full text
• Relationship between advanced glycation end‐product accumulation and low skeletal muscle mass in Japanese men and women.
  Michitaka Kato, Akira Kubo, Yosuke Sugioka, Rie Mitsui, Nobuki Fukuhara, Fumi Nihei, Yoshihiko Takeda.
  Geriatrics and Gerontology International. April 27, 2016
  Aim The present study aimed to investigate the relationship between advanced glycation end‐product accumulation and skeletal muscle mass among middle‐aged and older Japanese men and women. Methods A total of 132 participants enrolled in this cross‐sectional study. Skin autofluorescence was assessed as a measure of advanced glycation‐end products. Appendicular skeletal muscle mass was measured using dual‐energy X‐ray absorptiometry, and skeletal muscle index was calculated by dividing appendicular skeletal muscle mass by height squared. Participants were divided into two groups (low skeletal muscle index and normal skeletal muscle index) using the Asian Working Group for Sarcopenia's skeletal muscle index criteria for diagnosing sarcopenia. Multivariate logistic regression analysis and the area under the receiver operating characteristic curve were used to determine significant factors associated with low skeletal muscle index. Results Participants consisted of 70 men (mean age 57 ± 10 years) and 62 women (mean age 60 ± 11 years). There were 31 and 101 participants in the low and normal skeletal muscle index groups, respectively. Skin autofluorescence was significantly higher in the low skeletal muscle index group compared with the normal skeletal muscle index group (P < 0.01). Skin autofluorescence was a significant independent factor associated with low skeletal muscle index based on multivariate logistic regression analysis (odds ratio 15.7, 95% confidence interval 1.85–133.01; P = 0.012). The cut‐off for skin autofluorescence was 2.45 arbitrary units, with a sensitivity of 0.75 and specificity of 0.91. Conclusions Skin autofluorescence was an independent factor associated with low skeletal muscle index among middle‐aged and older Japanese men and women. Geriatr Gerontol Int 2017; 17: 785–790.

  April 27, 2016   doi: 10.1111/ggi.12787   open full text
• Effects on agitation with rivastigmine patch monotherapy and combination therapy with memantine in mild to moderate Alzheimer's disease: a multicenter 24‐week prospective randomized open‐label study (the Korean EXelon Patch and combination with mEmantine Comparative Trial study)*.
  Soo J Yoon, Seong H Choi, Hae R Na, Kyung‐Won Park, Eun‐Joo Kim, Hyun J Han, Jae‐Hong Lee, Young S Shim, Duk L Na.
  Geriatrics and Gerontology International. April 25, 2016
  Aim Memantine is known to be effective in the treatment of the behavioral symptoms of dementia, especially agitation in moderate to severe Alzheimer's disease (AD). However, memantine and rivastigmine patch combination therapy has not been well studied in determining treatment effectiveness with mild to moderate AD patients. Methods This was a multicenter, 24‐week, prospective, randomized, open‐label study design. A total 147 AD patients with Mini‐Mental State Examination scores from 10 to 20 were randomly assigned to rivastigmine patch monotherapy and combination therapy with memantine groups. Agitation symptoms, using the Korean Version of the Cohen Mansfield Agitation Inventory were evaluated at baseline and at study end. Suppression and emergence of agitation symptoms were also evaluated. We carried out factor analyses to evaluate the interrelationship of agitation symptoms and to investigate treatment response in these symptoms. Results Factor analyses showed two symptom clusters: factor A – aggressive agitated behaviors – versus factor B – non‐aggressive agitated behaviors. The rivastigmine patch monotherapy group showed significantly decreased factor B scores and had a tendency of decreased Korean Version of the Cohen Mansfield Agitation Inventory total scores and factor A scores. Conversely, the combination therapy group showed significantly increased Korean Version of the Cohen Mansfield Agitation Inventory total scores and factor B scores. Neither monotherapy nor combination therapy reduced the emergence of new agitation symptoms. Conclusions In this trial of mild to moderate AD patients, the rivastigmine patch monotherapy group experienced a reduction of non‐aggressive agitated behaviors. However, combination therapy with memantine did not show any benefit on the agitation associated with mild to moderate AD. Geriatr Gerontol Int 2017; 17: 494–499.

  April 25, 2016   doi: 10.1111/ggi.12754   open full text
• Risk factors for disability progression among Japanese long‐term care service users: A 3‐year prospective cohort study.
  Kuniyasu Kamiya, Takuji Adachi, Kenji Sasou, Tadashi Suzuki, Sumio Yamada.
  Geriatrics and Gerontology International. April 21, 2016
  Aim To examine the predictive ability of memory deterioration and grip strength for disability progression among those who utilized the home‐help service. Methods We prospectively followed a cohort of community‐dwelling older people who were aged 65 years or older, certified support level 1–2 or care level 1–2 and home‐help service users provided by Consumers' Cooperatives in Aichi and Kanagawa prefecture. Memory capability, grip strength, chronic conditions and other indices were surveyed at baseline. Disability progression was defined as being certified care level 3 or higher, or institutionalization during 3‐year follow up. Results We assessed 417 older adults, of which 386 were included (7.4% excluded). In multivariate Cox regression analyses, a higher eligibility level and memory deterioration were independently associated with a higher hazard ratio. When chronic conditions were entered in the model, cancer and low grip strength were additionally associated. Conclusions The findings of the present study show that memory deterioration is a risk factor for disability progression. Also, grip strength might be a risk factor with consideration of chronic conditions. The cause–effect relationship of those factors and disability progression would be a future challenging issue. Geriatr Gerontol Int 2017; 17: 568–574.

  April 21, 2016   doi: 10.1111/ggi.12756   open full text
• Predictors of in‐hospital mortality in octogenarian patients who underwent primary percutaneous coronary intervention after ST segment elevated myocardial infarction.
  Gokturk Ipek, Ozge Kurmus, Cemal Koseoglu, Tolga Onuk, Baris Gungor, Ozgur Kirbas, Mehmet B Karatas, Muhammed Keskin, Edibe Betul Borklu, Mert Ilker Hayiroglu, Ozan Tanik, Ahmet Oz, Osman Bolca.
  Geriatrics and Gerontology International. April 18, 2016
  Aim Octogenarian patients have higher mortality and morbidity rates after acute coronary syndromes. Risk factors for in‐hospital mortality in the primary percutaneous coronary intervention (PCI) era were underrepresented in previous studies. In the present study, we aimed to assess the risk factors of in‐hospital mortality after primary PCI in this population. Methods We analyzed 2353 patients who underwent primary PCI after ST segment elevated myocardial infarction (STEMI). Patients were divided into two groups according to aged: ≥80 years (octogenarian) and <80 years (control). Risk factors for in‐hospital mortality were analyzed in the whole group and octogenarian patients. Results We found that octogenarians have 10.6‐fold higher mortality risk after STEMI. After a univariate and multivariate analysis, acute stent thrombosis was the most explicit risk factor for in‐hospital mortality in the octogenarian group (OR 21.13, 95% CI 2.11–102.76, P < 0.001). Additionally, anterior myocardial infarction (OR 4.90, 95% CI 1.90–22.10, P = 0.04), ventricular arrhythmias (OR 15.64, 95% CI 2.81–87.12, P = 0.002), multivessel disease (OR 6.5, 95% CI 1.11–38.85, P = 0.04), ejection fraction <30% (OR 1.24, 95% CI 0.26–6.00, P = 0.04) and KILLIP score ≥2 (OR 1.20, 95% CI 0.20– 7.41, P = 0.01) were also significantly associated with mortality. Conclusions Acute stent thrombosis, anterior MI, heart failure, low ejection fraction, ventricular arrhythmias and multivessel disease are the independent risk factors for in‐hospital mortality among octogenarian patients after primary PCI. Geriatr Gerontol Int 2017; 17: 584–590.

  April 18, 2016   doi: 10.1111/ggi.12759   open full text
• Comparison of three scoring systems for risk stratification in elderly patients wıth acute upper gastrointestinal bleeding.
  Çağdaş Kalkan, Irfan Soykan, Fatih Karakaya, Ali Tüzün, Zeynep Bıyıklı Gençtürk.
  Geriatrics and Gerontology International. April 14, 2016
  Aim Acute gastrointestinal bleeding is a potentially life‐threatening condition that requires rapid assessment and dynamic management. Several scoring systems are used to predict mortality and rebleeding in such cases. The aim of the present study was to compare three scoring systems for predicting short‐term mortality, rebleeding, duration of hospitalization and the need for blood transfusion in elderly patients with upper gastrointestinal bleeding. Methods The present study included 335 elderly patients with upper gastrointestinal bleeding. Pre‐ and post‐endoscopic Rockall, Glasgow–Blatchford and AIMS65 scores were calculated. The ability of these scores to predict rebleeding, mortality, duration of hospitalization and the need for blood transfusion was determined. Results Pre‐ (4.5) and post‐endoscopic (7.5) Rockall scores were superior to the Glasgow–Blatchford (12.5) score for predicting mortality (P = 0.006 and P = 0.015). Likewise, pre‐ (4.5) and post‐endoscopic Rockall scores were superior to the respective Glasgow–Blatchford scores for predicting rebleeding (P = 0.013 and P = 0.03). There was an association between duration of hospitalization and mortality; as the duration of hospitalization increased the mortality rate increased. In all, 94% of patients hospitalized for a mean of 5 days were alive versus 56.1% of those hospitalized for 20 days, and 20.2% of those hospitalized for 40 days. Conclusions In elderly patients with upper gastrointestinal bleeding, the Rockall score is clinically more useful for predicting mortality and rebleeding than the Glasgow–Blatchford and AIMS65 scores; however, for predicting duration of hospitalization and the need for blood transfusion, the Glasgow–Blatchford score is superior to the Rockall and AIMS65 scores. Geriatr Gerontol Int 2017; 17: 575–583.

  April 14, 2016   doi: 10.1111/ggi.12757   open full text
• Advanced dementia: opinions of physicians and nurses about antibiotic therapy, artificial hydration and nutrition in patients with different life expectancies.
  Valentina Pengo, Anna Zurlo, Alberto Voci, Elisabetta Valentini, Francesca De Zaiacomo, Massimo Catarini, Mario Iasevoli, Stefania Maggi, Renzo Pegoraro, Enzo Manzato, Valter Giantin.
  Geriatrics and Gerontology International. March 23, 2016
  Aim: The aim of the present study was to investigate the proportion of physicians and nurses who agree with the administration of antibiotic therapy (AT), artificial hydration (AH), and artificial nutrition (AN) in patients with advanced dementia and different life expectancies. Furthermore, we aimed at analyzing the correlates of the opinion according to which medical treatments should no longer be given to advanced dementia patients once their life expectancy falls. Methods: End‐of‐life decisions and opinions were measured with a questionnaire that was sent to geriatric units, hospices and nursing homes in three different regions of Italy. Multivariate logistic regressions were carried out to ascertain the correlates of the agreement with the administration of AH, AT or AN. Results: When the patient's life expectancy was 1–6 months, 83% of respondents agreed with AH, 79% with AT and 71% with AN. When the life expectancy was less than 1 month, a large proportion of respondents still agreed with AH and AT (73% and 61%), whereas less than one in two respondents (48%) agreed with AN. Conclusions: The findings of the present study showed that AN creates more ethical dilemmas in the clinical management of end of life than other treatments, such as AH or AT. Opinions on whether or not these practices are appropriate at the end of life were related with feelings, thoughts and ethical issues that played a different part for physicians and nurses. Geriatr Gerontol Int 2017; 17: 487–493.

  March 23, 2016   doi: 10.1111/ggi.12746   open full text
• Differences in caregiver daily impression by sex, education and career length.
  Ryusuke Ae, Takao Kojo, Kazuhiko Kotani, Masanobu Okayama, Masanari Kuwabara, Nobuko Makino, Yasuko Aoyama, Takashi Sano, Yosikazu Nakamura.
  Geriatrics and Gerontology International. March 23, 2016
  Aim We previously proposed the concept of caregiver daily impression (CDI) as a practical tool for emergency triage. We herein assessed how CDI varies by sex, education and career length by determining CDI scores as quantitative outcome measures. Methods We carried out a cross‐sectional study using a self‐reported questionnaire among caregivers in 20 long‐term care facilities in Hyogo, Japan. A total of 10 CDI variables measured participants' previous experience of emergency transfers using a scale from 0–10. The resulting total was defined as the CDI score. We hypothetically considered that higher scores indicated greater caregiver focus. The CDI scores were compared by sex, education and career length using analysis of covariance. Results A total of 601 personal caregivers were evaluated (mean age 36.7 years; 36% men). The mean career length was 6.9 years, with the following groupings: 1–4 years (38%), 5–9 years (37%) and >10 years (24%). After adjustment for sex and education, the CDI scores for the variable, “poor eye contact,” significantly differed between caregivers with ≥10 and <5 years of experience (scores of 5.0 ± 3.1 and 4.0 ± 2.7, respectively). The CDI scores for variables related to eyes tended to increase with experience, whereas other CDI scores decreased. Male caregivers focused on residents' eyes significantly more than did female caregivers. Conclusions We found that the CDI variable, “poor eye contact,” is influenced by career length. Caregivers with more experience attach more importance to their impression of residents' eyes than do those with less experience. Sex‐related differences in CDI might also exist. Geriatr Gerontol Int 2016; 17: 410–415.

  March 23, 2016   doi: 10.1111/ggi.12729   open full text
• Health and happiness among community‐dwelling older adults in Domkhar valley, Ladakh, India.
  Ryota Sakamoto, Kiyohito Okumiya, Tsering Norboo, Norboo Tsering, Taizo Wada, Michiko Fujisawa, Hissei Imai, Mitsuhiro Nose, Yasuko Ishimoto, Yumi Kimura, Eriko Fukutomi, Wenling Chen, Kozo Matsubayashi.
  Geriatrics and Gerontology International. March 23, 2016
  Aim The aim of the present study was to show the status of objective geriatric functions and subjective quality of life in Ladakh, India, compared with Japanese controls. Methods We analyzed data of 117 people aged 60 years or older in Domkhar, and age‐ and sex‐specific Japanese controls. Variables measured included blood pressure, hemoglobin, timed up & go test, basic activities of daily living, Geriatric Depression Scale and the Visual Analog Scale for subjective quality of life. Results People in Domkhar were more likely to have difficulties in basic activities of daily living compared with Japanese controls. However, they were significantly more likely to maintain social roles. The Visual Analog Scale scores in subjective friendship, economic satisfaction and happiness were higher in Domkhar compared with Japanese controls. Living alone (OR 9.92, 95% CI 2.13–46.26), high Geriatric Depression Scale score (6 or more; OR 8.45, 95% CI 1.65–43.35) and timed up & go test (17 s or more; OR 21.00, 95% CI 1.69–260.87) were significantly associated with a low score of subjective happiness (less than 50). Residence in Domkhar (OR 0.17, 95% CI 0.04–0.77) was a significant factor for low prevalence of a low score of subjective happiness by multivariate logistic regression analysis. Conclusions Subjective quality of life among older adults in Domkhar was higher than Japanese controls despite a higher rate of difficulty in basic activities of daily living. We have to consider prevention, treatment, and care of not only diseases and disabilities, but also loneliness for the older adults. Geriatr Gerontol Int 2017; 17: 480–486.

  March 23, 2016   doi: 10.1111/ggi.12745   open full text
• Determinants of the nutritional status of older adults in urban Lebanon.
  Rosy Mitri, Christa Boulos, Salim M Adib.
  Geriatrics and Gerontology International. February 05, 2016
  Aim To assess the nutritional status, and its association with sociodemographic factors, health and functional status of community‐dwelling older adults living in the Greater Beirut area. Methods This was a cross‐sectional study involving 905 randomly selected community dwelling older adults aged ≥65 years living in Greater Beirut (Beirut and surrounding suburbs). Participants completed a standardized questionnaire on sociodemographic factors, health characteristics, and functional and nutritional status, based on the Mini Nutritional Assessment. Results Among the older adults who participated in the study, 2.8% (95% CI 0.01–0.03) were malnourished, and 45.5% (95% CI 0.42–0.48) were at risk of malnutrition. Sociodemographic variables were not associated with the nutritional status. Variables significantly associated with poorer nutritional status were: poor perception of general health (OR 1.58, 95%CI 1.28–1.97), more chronic diseases (OR 2.05, 95% CI1.26–3.33), poor perception of oral health (OR 1.36, 95% CI 1.14–1.61), depressive disorders (OR 1.76, 95% CI 1.30–2.40), higher body mass index (OR 1.98, 95% CI1.67–2.34) and disability (OR 5.80, 95% CI 1.96–17.11). Conclusions The present study showed an unacceptable risk of malnutrition among Lebanese older adults, independent of age, sex and socioeconomic status. The presence of comorbidities, treated or not, affecting general and oral health emerged as major determinants of poor nutrition. Geriatr Gerontol Int 2017; 17: 424–432.

  February 05, 2016   doi: 10.1111/ggi.12732   open full text
• Effects of the Staff Training for Assisted Living Residences protocol for caregivers of older adults with dementia: A pilot study in the Brazilian population.
  Larissa Silva Serelli, Ramon Castro Reis, Jerson Laks, Analuiza Camozzato Pádua, Cássio MC Bottino, Paulo Caramelli.
  Geriatrics and Gerontology International. February 05, 2016
  Aim To investigate the effects of the Staff Training for Assisted Living Residences administered to formal caregivers of older adults with behavioral and psychological symptoms of dementia in the institutional environment. Methods The project was developed in two long‐term care institutions in Belo Horizonte, Brazil, with 25 formal caregivers and 46 older adults with dementia. The training was carried out over 6 weeks. Evaluations were carried out with the caregivers and the elderly residents, using specific instruments to evaluate different domains (demographic data, etiological diagnoses of dementia, severity of dementia, global cognition, functional performance, quality of life, behavior, burden of caregiver, depression and anxiety). The total time for data collection was 6 months. Results A significant improvement in behavioral and psychological symptoms of dementia, as assessed by the Neuropsychiatric Inventory, was observed (P < 0.008), with no changes in the other indexes. No significant changes were observed in parameters related to caregivers. Conclusions The Staff Training for Assisted Living Residences protocol was effective in reducing neuropsychiatric symptoms in dementia patients, and might be a feasible and positive strategy to train formal caregivers in long‐term care institutions in Brazil. Geriatr Gerontol Int 2017; 17: 449–455.

  February 05, 2016   doi: 10.1111/ggi.12742   open full text
• Healthcare‐associated pneumonia with positive respiratory methicillin‐resistant Staphylococcus aureus culture: Predictors of the true pathogenicity.
  Yasunori Enomoto, Koshi Yokomura, Hirotsugu Hasegawa, Yuichi Ozawa, Takashi Matsui, Takafumi Suda.
  Geriatrics and Gerontology International. February 05, 2016
  Aim Although methicillin‐resistant Staphylococcus aureus (MRSA) is commonly isolated from respiratory specimens in healthcare‐associated pneumonia (HCAP), it is difficult to determine the causative pathogen because of the possibilities of contamination/colonization. The present study aimed to identify clinical predictors of the true pathogenicity of MRSA in HCAP. Methods Patients with HCAP with positive MRSA cultures in the sputum or endotracheal aspirates who were admitted to Seirei Mikatahara General Hospital, Hamamatsu, Japan, from 2009 to 2014 were enrolled. According to the administered drugs and the treatment outcomes, patients with true MRSA pneumonia (MP) and those with contamination/colonization of MRSA (false MP) were identified. Baseline characteristics were compared between groups, and clinical predictors of true MP were evaluated by logistic regression analyses. Results A total of 93 patients (mean age 78.7 ± 12.6 years) were identified and classified into the true MP (n = 16) or false MP (n = 77) groups. Although baseline characteristics were broadly similar between groups, the true MP group had significantly more patients with PaO2 ≤ 60 Torr/pulse oximetry saturation ≤90% and those with MRSA single cultivation. Both variables were significant predictors of true MP in multivariate analysis (odds ratio of PaO2 ≤ 60 Torr/pulse oximetry saturation ≤90%: 5.64, 95% confidence interval 1.17–27.32; odds ratio of MRSA single cultivation: 4.76, 95% confidence interval 1.22–18.60). Conclusions Poor oxygenation and MRSA single cultivation imply the true pathogenicity of MRSA in HCAP with positive respiratory MRSA cultures. The present results might be helpful for the proper use of anti‐MRSA drugs in this population. Geriatr Gerontol Int 2017; 17: 456–462.

  February 05, 2016   doi: 10.1111/ggi.12739   open full text
• Clinical features and prognosis of elderly patients with hepatocellular carcinoma not indicated for surgical resection.
  Akiyoshi Kinoshita, Kazuhiko Koike, Hirokazu Nishino.
  Geriatrics and Gerontology International. February 05, 2016
  Hepatocellular carcinoma (HCC) is a major health problem worldwide. The average life expectancy during the 20th century has increased in many parts of the world, and therefore the opportunities to examine elderly HCC patients have significantly increased worldwide. Many elderly patients develop HCC with intermediate to advanced stages of disease at the initial diagnosis, and have more comorbidities and compromised liver regeneration compared with younger patients. These circumstances show that elderly patients with HCC are poorer candidates for surgical resection or transplantation. The aim of the present review was to focus on the clinical features and prognosis of elderly HCC patients not indicated for surgical resection including multimodal treatment. Although the chronological age of 60 or 65 years as the definition of an elderly person is accepted in most countries, many studies in our review article define elderly as those aged 75 years or older. Geriatr Gerontol Int 2017; 17: 189–201.

  February 05, 2016   doi: 10.1111/ggi.12747   open full text
• Reduction of diuretics and analysis of water and muscle volumes to prevent falls and fall‐related fractures in older adults.
  Kosuke Okada, Masahiro Okada, Nanao Kamada, Yumiko Yamaguchi, Masayuki Kakehashi, Hidemi Sasaki, Shigeko Katoh, Katsuya Morita.
  Geriatrics and Gerontology International. February 03, 2016
  Aim In an attempt to decrease the incidence of falls and fall‐related fractures at a special geriatric nursing home, we endeavored to reduce diuretic doses, and examined the relationship between the effectiveness of this approach with the body compositions and activities of daily living of the study cohort. Methods We enrolled 93 participants living in the community, 60 residents of an intermediate geriatric nursing home and 50 residents of the 100‐bed Kandayama Yasuragien special geriatric nursing home. We recorded body composition using a multifrequency bioelectrical impedance analyzer. Daily loop diuretic and other diuretic regimens of those in the special geriatric nursing home were reduced or replaced with “NY‐mode” diuretic therapy, namely, spironolactone 12.5 mg orally once on alternate days. Results The incidence of falls fell from 53 in 2011 to 29 in 2012, and there were no fall‐related proximal femoral fractures for 3 years after the introduction of NY‐mode diuretic therapy. We also found statistically significant differences in muscle and intracellular water volumes in our elderly participants: those with higher care requirements or lower levels of independence had lower muscle or water volumes. Conclusions We found that reducing or replacing daily diuretics with NY‐mode therapy appeared to reduce the incidence of falls and fall‐related proximal femoral fracture, likely by preserving intracellular and extracellular body water volumes. Low‐dose spironolactone (12.5 mg on alternate days) appears to be an effective means of treating elderly individuals with chronic heart failure or other edematous states, while preventing falls and fall‐related fractures. Geriatr Gerontol Int 2017; 17: 262–269.

  February 03, 2016   doi: 10.1111/ggi.12719   open full text
• What affects the subjective sleep quality of hospitalized elderly patients?
  Mi Jeong Park, Kon Hee Kim.
  Geriatrics and Gerontology International. February 03, 2016
  Aim The present study aimed to identify the factors affecting the subjective sleep quality in elderly inpatients. Methods The participants were 290 older adults admitted in three general hospitals. Data were collected using a structured questionnaire consisting of scales for general characteristics, sleep quality, activities of daily living, instrumental activities of daily living and depression. Collected data were analyzed by descriptive statistics, t‐test, one‐way anova, Scheffé post‐hoc, Pearson's correlation coefficient and stepwise multiple regression. Results There were statistically significant differences in sleep quality according to age, education level, marital status, monthly income and number of cohabitants. The most powerful predictor of sleep quality was depression (P < 0.01, R2 = 0.30). Five variables, depression, perceived health status, diagnosis, number of cohabitants and duration of hospitalization; explained 43.0% of the total variance in sleep quality. Conclusions Elderly inpatients suffered from low sleep quality, and depression affected their sleep. We should develop and apply hospital‐tailored sleep interventions considering older adults' depression, and then hospitalized older adults' sleep could improve. Furthermore, it is useful to identify other sleep‐related factors. Geriatr Gerontol Int 2017; 17: 471–479.

  February 03, 2016   doi: 10.1111/ggi.12743   open full text
• Prevalence of depression and related social and physical factors amongst the Iranian elderly population in 2012.
  Parisa Taheri Tanjanai, Mahdi Moradinazar, Farid Najafi.
  Geriatrics and Gerontology International. January 28, 2016
  Aim Depression is the most common psychiatric disorder and the second most common cause of disability among older adults. The objective of the present study was to investigate the prevalence of depression and related social and physical factors in the Iranian elderly population in 2012. Methods In this cross‐sectional study, 1350 Iranian older adults aged older than 60 years were selected considering the gender proportion of the population of five out of 31 provinces of Iran. To define depression, the short form (15‐item) of the Geriatric Depression Scale was administered. To analyze the data, logistic regression was carried out using stata software (version 12.0). Results From 1350 participants, 642 (47.5%) were men and the rest were women. The mean ± SD age of the sample was 69 ± 7 years. The prevalence of depression was 36.7% (42.5% in women and 30.2% in men). At the bivariate level, sex, educational level, marital status, satisfaction with income, occupation, relationship with the financial provider, leisure time, activities of daily living, and frequency of meeting with friends and relatives were factors determining the odds of depression. However, after multivariate control, marital status and educational level were removed from the final model. In contrast, smoking, which was insignificant at the bivariate level, became significant at the multivariate level. Conclusions Depression has a high prevalence among the Iranian elderly population. Therefore, it is important that this vulnerable group is provided with access to supportive environments that involve active participation in occupational and social activities, which in turn help reduce the chance of suffering from depression. Geriatr Gerontol Int 2017; 17: 126–131.

  January 28, 2016   doi: 10.1111/ggi.12680   open full text
• Health status, geriatric syndromes and prescription of oral anticoagulant therapy in elderly medical inpatients with atrial fibrillation.
  Mario Bo, Irene Sciarrillo, Guido Maggiani, Yolanda Falcone, Marina Iacovino, Enrica Grisoglio, Gianfranco Fonte, Simon Grosjean, Fiorenzo Gaita.
  Geriatrics and Gerontology International. January 28, 2016
  Aim The aim of the present study was to investigate the prevalence of geriatric syndromes among older medical inpatients with atrial fibrillation, and their association with use of vitamin K antagonists. Methods A retrospective study of patients aged ≥65 years discharged with a diagnosis of atrial fibrillation from the Acute Geriatric Ward was carried out. Stroke and bleeding risk were evaluated according to the CHA2DS2‐VASC and HAS‐BLED scores. Comorbidity, cognitive status, functional autonomy and contraindications to vitamin K antagonists were also considered. Results Atrial fibrillation was documented in 1078 of 3650 patients (29.5%, mean age 83.4 ± 6.6 years, 60.3% women). Contraindications to vitamin K antagonists were documented in 24.9% of patients. Prescription of vitamin K antagonists at discharge was 37.8% and 47.9%, in the overall sample and in those without contraindications, respectively. In the overall sample, prescription of vitamin K antagonists was associated with younger age, permanent/persistent atrial fibrillation, home discharge, less comorbidity, higher hemoglobin levels, better functional independence, known atrial fibrillation at admission and lower HAS‐BLED score. Among patients without contraindications to vitamin K antagonists, their use at discharge was independently associated with younger age, permanent/persistent atrial fibrillation, home discharge, higher hemoglobin levels and CHA2DS2‐VASC score, better functional autonomy, and greater number of drugs. Conclusions We showed a high prevalence of atrial fibrillation among older medical inpatients, who have a poor health status and a high prevalence of geriatric syndromes. Vitamin K antagonists were prescribed in less than half of the patients; underuse was mainly accounted for by a high prevalence of comorbidities/contraindications, poor health status and limited functional autonomy. Geriatr Gerontol Int 2017; 17: 416–423.

  January 28, 2016   doi: 10.1111/ggi.12730   open full text
• Cerebrospinal fluid inflammatory markers in amnestic mild cognitive impairment.
  Liara Rizzi, Matheus Roriz‐Cruz.
  Geriatrics and Gerontology International. January 28, 2016
  Aims Inflammatory processes might play a significant role at the pathophysiology of Alzheimer's disease (AD). Neuroinflammation is characterized by activation of microglia and the release of inflammatory cytokines, such as interleukin (IL)‐1β, IL‐6 and tumor necrosis factor‐α. Although, it is unknown what the real contribution of these inflammatory markers in the development of AD is. The purpose of the present study was to assess the possible relationship between inflammatory markers in the cerebrospinal fluid (CSF) of amnestic mild cognitive impairment patients (aMCI), aged 60 years or older, and compare with aged healthy controls. Methods We examined concentrations of IL‐1β, IL‐6 and tumor necrosis factor‐α in the CSF of aMCI patients and controls by enzyme immunoassay. aMCI diagnoses were based on anamnesis and Petersen criteria, corroborated by the Clinical Dementia Rating. Cognitive function was assessed by neuropsychological tests. Results CSF levels of IL‐1β (13.735 vs 22.932 pg/mL; P < 0.001) and tumor necrosis factor‐α (1.913 vs 2.627 pg/mL; P = 0.002), but not IL‐6 (4.178 vs 5.689 pg/mL; P = 0.106), were significantly reduced in the aMCI samples as compared with controls. Individuals with IL‐1β < 17 pg/mL were at a 7.2 (CI 1.5–36; P: 0.016) increased odds of aMCI. There was a positive correlation between IL‐1β levels and the Consortium to Establish a Registry for Alzheimer's Disease word list score (rs = 0.299; P = 0.046). Linear regression analysis showed that IL‐1β levels might explain 13.7% (β = 24.545; P = 0.012) of the variance on this Consortium to Establish a Registry for Alzheimer's Disease subscore. Conclusion The present results show a pattern of cytokines expression in the CSF of aMCI patients that might be relevant to the pathogeny of prodromal AD. Geriatr Gerontol Int 2017; 17: 239–245.

  January 28, 2016   doi: 10.1111/ggi.12704   open full text
• Relationship between restraint use, engagement in social activity, and decline in cognitive status among residents newly admitted to long‐term care facilities.
  Shannon Freeman, Lina Spirgiene, Melinda Martin‐Khan, John P Hirdes.
  Geriatrics and Gerontology International. January 28, 2016
  Aim Declining cognitive function can negatively affect residents' quality of life (QOL) in long‐term care facilities (LTCFs). The present study examined the role of physical restraint use, use of antipsychotic medications, and engagement in social activities to affect change in cognitive status and drive cognitive decline among residents newly admitted to a LTCF. Methods Secondary data analysis used interRAI Minimum Data Set 2.0 data gathered at admission and first follow‐up assessment (n = 111,052). The interRAI Minimum Data Set 2.0 collects comprehensive information as part of regular clinical care, and is mandated for all LTCF in Ontario, Canada. Bivariate and logistic regression analyses investigated the roles of physical restraint use, antipsychotic medication use and social engagement affecting cognition, and were stratified based on the presence/absence of diagnosis of dementia. Results At follow up, 16.1% of residents (n = 16 414) showed decline in cognition. Residents with one or more physical restraints (chair, trunk and limb) were at increased risk for cognitive decline evidenced among residents with and without a diagnosis of dementia. Antipsychotic medication use did not emerge as a strong predictor of cognitive decline. Social engagement was protective against cognitive decline, and more pronounced for residents without a diagnosis of dementia. Conclusion Physical restraint use should be avoided, or used as a last resort. LTCFs should prioritize resident engagement in social activities in either formal activities or ad hoc, as soon as possible on entry to the LTCFs. Prioritizing social networks and greater participation in activities might decrease the risk for cognitive decline, thereby improving or maintaining resident quality of life. Geriatr Gerontol Int 2017; 17: 246–255.

  January 28, 2016   doi: 10.1111/ggi.12707   open full text
• Predicting emerging care‐need with simple functional indicators: Findings from a national cohort study in Taiwan.
  Wei‐Chung Hsu, Li‐Ching Chen, Jiun‐Yi Wang.
  Geriatrics and Gerontology International. January 28, 2016
  Aim To evaluate the predictive abilities of single items and their combinations in the instrumental activities of daily living and Nagi scales to predict emerging care‐need of older adults. Methods We analyzed the 1999 (baseline) and 2003 (end‐point) datasets of the Taiwan Longitudinal Study on Aging. After excluding the proxy respondents, incomplete data or those who had care‐need at baseline, 2521 of the 2890 participants (aged ≥65 years at baseline) were included in data analysis. Care‐need was defined as a person receiving formal or informal care, or having any activities of daily living dependency. The predictive abilities of the items in instrumental activities of daily living or Nagi scale, singly or in combination to predict emerging care‐need during the subsequent 4 years were evaluated by the improvement in values of Nagelkerke R2, Akaike information criterion and Bayesian information criterion in logistic regression models. Results The single item “doing heavy housework” showed the best predictive abilities among all others. When combined this item with “walking 200 m,” the two‐item indicator significantly improved the predictive abilities. However, no three‐item combined indicator improved the predictive abilities. Conclusions The two‐item indicator that combines “doing heavy housework” and “walking 200 m” from the instrumental activities of daily living and Nagi scales showed superior ability to predict emerging care‐need of older Taiwanese. The indicator could serve as the foundation for developing a scale to predict emerging care‐need of older adults. Geriatr Gerontol Int 2017; 17: 375–381.

  January 28, 2016   doi: 10.1111/ggi.12716   open full text
• Predictive factors of mortality and deterioration in performance of activities of daily living after hip fracture surgery in Kagoshima, Japan.
  Yasuhiro Ishidou, Chihaya Koriyama, Hironori Kakoi, Takao Setoguchi, Satoshi Nagano, Masataka Hirotsu, Takuya Yamamoto, Masahiro Yokouchi, Setsuro Komiya.
  Geriatrics and Gerontology International. January 28, 2016
  Aim Given that different hospitals achieve different outcomes, optimal evaluation of treatment outcomes in the local community requires evaluation of many institutions in that area. We carried out a prospective multicenter cohort study in Kagoshima Prefecture to identify factors that contribute to deterioration in activities of daily living performance and patient mortality 1 year after surgical treatment of hip fractures. Methods We prospectively enrolled 387 patients who underwent surgery for hip fractures in 33 registered facilities within a 6‐month period from February to July 2007. Logistic regression analysis was carried out to identify factors that contribute to deterioration in activities of daily living performance and death within 1 year after surgery. Results An increased risk of Barthel Index (BI) deterioration was associated with increased age (P for trend = 0.003), worse pre‐injury BI (P for trend = 0.021), trochanteric fractures (OR 2.07, 95% CI 1.31–3.27), worse BI at discharge (P for trend < 0.001) and postoperatively developed cognitive impairment (OR 6.34, 95% CI 2.15–18.7). The OR for BI deterioration in patients with newly‐diagnosed disease after discharge was approximately 9.16 (95% CI 4.03–20.8). No factors except age and sex were statistically significant as the preoperative indicators of mortality risk. Only BI at discharge was a significant determinant of mortality risk (P for trend = 0.013) after adjusting for the effects of age and sex. Conclusions Patients with poor activities of daily living performance at the time of hospital discharge were likely to show poor functional recovery and a high 1‐year postoperative mortality. Geriatr Gerontol Int 2017; 17: 391–401.

  January 28, 2016   doi: 10.1111/ggi.12718   open full text
• The consumption of two or more fall risk‐increasing drugs rather than polypharmacy is associated with falls.
  Anam Zia, Shahrul B Kamaruzzaman, Maw P Tan.
  Geriatrics and Gerontology International. January 28, 2016
  Aim The presemt study aimed to determine the association between the risk of recurrent and injurious falls with polypharmacy, fall risk‐increasing drugs (FRID) and FRID count among community‐dwelling older adults. Methods Participants (n = 202) were aged ≥65 years with two or more falls or one injurious fall in the past year, whereas controls (n = 156) included volunteers aged ≥65 years with no falls in the past year. A detailed medication history was obtained alongside demographic data. Polypharmacy was defined as “regular use of five or more prescription drugs.” FRID were identified as cardiovascular agents, central nervous system drugs, analgesics and endocrine drugs; multiple FRID were defined as two or more FRID. Multiple logistic regression analyses were used to adjust for confounders. Results The use of non‐steroidal anti‐inflammatory drugs was independently associated with an increased risk of falls. Univariate analyses showed both polypharmacy (OR 2.23, 95% CI 1.39–3.56; P = 0.001) and the use of two or more FRID (OR 2.9, 95% CI 1.9–4.5; P = 0.0001) were significantly more likely amongst fallers. After adjustment for age, sex and comorbidities, blood pressure, and physical performance scores, polypharmacy was no longer associated with falls (OR 1.6, 95% CI 0.9–2.9; P = 0.102), whereas the consumption of two or more FRID remained a significant predictor for falls (OR 2.8, 95% CI 1.4–5.3; P = 0.001). Conclusions Among high risk fallers, the use of two or more FRID was an independent risk factor for falls instead of polypharmacy. Our findings will inform clinical practice in terms of medication reviews among older adults at higher risk of falls. Future intervention studies will seek to confirm whether avoidance or withdrawal of multiple FRID reduces the risk of future falls. Geriatr Gerontol Int 2017; 17: 463–470.

  January 28, 2016   doi: 10.1111/ggi.12741   open full text
• Beneficial effects of dietary docosahexaenoic acid intervention on cognitive function and mental health of the oldest elderly in Japanese care facilities and nursing homes.
  Michio Hashimoto, Setsushi Kato, Yoko Tanabe, Masanori Katakura, Abdullah Al Mamun, Miho Ohno, Shahdat Hossain, Keiichi Onoda, Shuhei Yamaguchi, Osamu Shido.
  Geriatrics and Gerontology International. January 28, 2016
  Aim We examined the effects of the administration of docosahexaenoic acid (DHA)‐enriched meals on cognitive function in the oldest elderly with cognitive impairment, such as dementia, living in nursing homes, and on the improvement in caregiver burden at aging agencies. Methods Participants in elderly care facilities and nursing homes (n = 75; 88.5 ± 0.6 years) were randomized in active and placebo groups. The active group had family‐style meals containing an additional 1720 mg of docosahexaenoic acid per day for 12 months. At baseline, and after 6 and 12 months of intervention, cognitive function was assessed using Hasegawa's Dementia Scale‐Revised and the Mini‐Mental State Examination; mental health condition was assessed with the Apathy scale and the Zung Self‐Rating Depression Scale; caregiver burden was evaluated using Zarit Burden Interview scores; and participants’ serum biochemical factors were measured. Results The participants were suggested to have dementia. After 12 months, the mean change in Mini‐Mental State Examination subitem “Registration” score from baseline to month 12 showed a tendency to be greater in the active group than that in the placebo group. Mean changes in the Apathy scale from baseline to month 12 were less, and the changes in the Zung Self‐Rating Depression Scale and the total Zarit Burden Interview scores showed a tendency to be lower in the active group than in the placebo group, respectively. Conclusion These results suggest that docosahexaenoic acid‐enriched meals protect against age‐related cognitive decline, and also improve apathy and caregiver burden for the oldest‐elderly Japanese with cognitive impairment, such as dementia. Geriatr Gerontol Int 2017; 17: 330–337.

  January 28, 2016   doi: 10.1111/ggi.12691   open full text
• Sex differences in depressive effects of experiencing spousal bereavement.
  Hyo Jung Lee, Sang Gyu Lee, Sung‐Youn Chun, Eun‐Cheol Park.
  Geriatrics and Gerontology International. January 22, 2016
  Aim Spousal death is a significant event that becomes a turning point in an individual's life. Widowed persons experience new circumstances, which might induce depression. However, the effects of spousal death on depression can differ by sex and culture. Thus, the present study examined the association between depressive levels and experience of spousal death in Korean adults aged older than 45 years. Methods The data were from the Korean Longitudinal Study of Aging from 2010 to 2012. The analysis used frequency analysis to compare the distribution of demographic variables between men and women, and anova to compare 10‐item short‐form Center for Epidemiological Studies Depression Scale scores as the dependent variable among comparison groups. We also carried out linear mixed model analysis on the association between the 10‐item short‐form Center for Epidemiological Studies Depression Scale and experience of spousal death. Results Among 5481 respondents, 2735 were men and 2741 were women. The number of men and women who experienced spousal death were 43 (1.6%) and 181 (6.6%), respectively. Men had lower depressive levels than women when they had been married (men 2.99, women 3.64). Both men and women experiencing spousal death had significantly higher 10‐item short‐form Center for Epidemiological Studies Depression Scale scores than married men and women (men β = 0.911, P = 0.003; women β = 0.512, P = 0.001; ref: no experience of spousal death). Conclusions There was a significant association between experience of spousal death and depressive level for both men and women. We suggest that policy practitioners promote community programs that provide bereaved adults with easy access to meaningful social participation and support the minimum cost of living of the widowed. Geriatr Gerontol Int 2017; 17: 322–329.

  January 22, 2016   doi: 10.1111/ggi.12712   open full text
• Effects of aging and sarcopenia on tongue pressure and jaw‐opening force.
  Nami Machida, Haruka Tohara, Koji Hara, Ayano Kumakura, Yoko Wakasugi, Ayako Nakane, Shunsuke Minakuchi.
  Geriatrics and Gerontology International. January 22, 2016
  Aim Aging and sarcopenia reduce not only body strength, but also the strength of swallowing muscles. We examined how aging and sarcopenia affect tongue pressure and jaw‐opening force. Methods A total of 97 older adults (97 men, mean age 78.5 ± 6.6 years; 100 women, mean age 77.8 ± 6.2 years) were enrolled. Classification of sarcopenia was based on the Criteria of Asian Working Group for Sarcopenia. To investigate which variable between aging and sarcopenia was a significant independent variable on tongue pressure and jaw‐opening force, multivariate linear regression analysis was carried out. Results The mean tongue pressure was 26.3 ± 7.8 kPa in men and 24.6 ± 7.2 kPa in women. The mean jaw‐opening force was 6.3 ± 1.6 kg in men and 5.2 ± 1.3 kg in women. Tongue pressure in men, aging and sarcopenia were significant independent variables, whereas only sarcopenia was a significant independent variable in women. Jaw‐opening force in men and sarcopenia were significant independent variables, whereas neither aging nor sarcopenia were significant independent variables in women. Conclusions We found different characteristics in the effects of aging and sarcopenia based on site and sex. We suggested that aging decreased tongue pressure more than jaw‐opening force, and affected men more than women. Sarcopenia affected tongue pressure and jaw‐opening force, with the exception of jaw‐opening force in women. Considering these characteristics is useful to predict the decline of swallowing function, and provide appropriate interventions preventing dysphagia. Geriatr Gerontol Int 2017; 17: 295–301.

  January 22, 2016   doi: 10.1111/ggi.12715   open full text
• Ultra‐short version of the oral health impact profile in elderly Chileans.
  Soraya León, Gloria Correa‐Beltrán, Renato J De Marchi, Rodrigo A Giacaman.
  Geriatrics and Gerontology International. January 22, 2016
  Aim The aim of the present study was to develop and validate an ultra‐short Spanish version of the Oral Health Impact Profile (OHIP) in an elderly Chilean population. Methods The OHIP‐49Sp was applied to 490 older adults, and the seven questions with the higher impact on oral health‐related quality of life were selected through linear regression. These items were applied to 85 older adults to test internal consistency (Cronbach's alpha). A discriminative validity analysis was carried out along with the assessment of sociodemographic and clinical variables. Data were analyzed using the Mann–Whitney U‐test, Student's t‐test and one‐way anova tests with a 95% confidence level. Results High internal consistency values were obtained for the OHIP‐7Sp instrument (0.93). There was an association between the OHIP‐7Sp scores and the presence of caries, need for complex periodontal treatment, prosthetic needs, and age younger than 70 years. Conclusion The OHIP‐7Sp proved to be a consistent and valid tool to assess oral health‐related quality of life in Chilean older adults, and can be incorporated in epidemiological studies that include several other targets. Geriatr Gerontol Int 2017; 17: 277–285.

  January 22, 2016   doi: 10.1111/ggi.12710   open full text
• Multicentered epidemiological study of factors associated with total bacterial count in the saliva of older people requiring nursing care.
  Takashi Tohara, Takeshi Kikutani, Fumiyo Tamura, Mitsuyoshi Yoshida, Takuo Kuboki.
  Geriatrics and Gerontology International. January 22, 2016
  Aim To clarify whether the number of present teeth, independent of other well‐known factors, was associated with the total bacterial count in the saliva of older people requiring care at nursing homes in a multicentered epidemiological survey. Method The participants were 618 older people (mean age 86.8 ± 6.9 years; 122 men, 496 women) residing in 14 nursing homes across Japan. The dependent variable was the participant's salivary bacterial count, and the independent variables were basic demographic data, oral conditions and activity of daily living (measured by Barthel Index). Statistical analysis was first carried out by Student's t‐test, Pearson's correlation coefficient analysis and Spearman's rank correlation coefficient analysis. Independent variables found to have a significant relationship to their salivary bacterial count by the univariate analyses were further examined by stepwise multivariate analysis. Results The independent variables shown by univariate analysis to have a significant positive relationship with higher salivary bacterial count were presence of food residue (P = 0.001), absence of mouth dryness (P = 0.001), need of oral care assistance (P = 0.001), inability to keep the mouth opened (P = 0.009), inability to gargle (P = 0.002), denture use (P = 0.004), higher number of present teeth (P = 0.006) and lower Barthel Index (P = 0.001). Subsequent multivariate analysis identified presence of food residue (P = 0.031), higher number of present teeth (P = 0.043) and lower Barthel Index (P = 0.001) as independent associated factors for higher salivary bacterial count. Conclusions The present study found that presence of food residue, higher number of present teeth and decreased activity of daily living were significantly related to higher bacterial count in the saliva of older people requiring care. Geriatr Gerontol Int 2017; 17: 219–225.

  January 22, 2016   doi: 10.1111/ggi.12695   open full text
• Association between tooth loss and medical costs related to stroke in healthy older adults aged over 75 years in Japan.
  Masanori Iwasaki, Misuzu Sato, Akihiro Yoshihara, Toshihiro Ansai, Hideo Miyazaki.
  Geriatrics and Gerontology International. January 22, 2016
  Aim Growing evidence suggests that tooth loss is associated with increased risk of stroke. In the current study, we investigated cumulative medical costs related to stroke using data from the Advanced Elderly Medical Service System. We hypothesized that tooth loss was associated with an increase in medical costs related to stroke among older Japanese adults. Methods A total of 273 Japanese adults aged 80 years were enrolled in the current study. Baseline medical and dental examinations were carried out in June 2008. Medical care use and costs were monitored by linkage with National Health Insurance claim files from baseline to the end of February 2011. Medical costs related to stroke per month were calculated and examined for any association with the baseline number of remaining teeth using a linear regression model with robust standard errors. Results A total of 19 individuals were admitted to hospital for stroke during the follow‐up period. A significant negative association was found between the number of teeth and medical costs related to stroke per month. The regression coefficients of the number of teeth in relation to medical costs related to stroke was −248 (95% CI −438 to −58, P = 0.011) in the crude model and −226 (95% CI −413 to −38, P = 0.018) after adjusting for other confounders. Conclusion Within the limitations of the present study, the reported findings suggest an independent relationship of tooth loss with increase in medical cost related to stroke among older Japanese adults. Further studies are necessary to substantiate these findings. Geriatr Gerontol Int 2017; 17: 202–210.

  January 22, 2016   doi: 10.1111/ggi.12687   open full text
• Relationship between built environment attributes and physical function in Japanese community‐dwelling older adults.
  Yuki Soma, Kenji Tsunoda, Naruki Kitano, Takashi Jindo, Taishi Tsuji, Mahshid Saghazadeh, Tomohiro Okura.
  Geriatrics and Gerontology International. January 22, 2016
  Aim To explore the relationships between the built environment and older adults’ physical function. Methods The present cross‐sectional study carried out in 2010–2012 used data drawn from 509 community‐dwelling older adults aged 65–86 years living in Kasama City, a Japanese rural region. We evaluated physical function with the following performance tests: grip strength, sit‐to‐stand, timed up & go and walking speed. Using geographic information systems, we measured population density and the number of destinations related to daily life, community centers, medical facilities and recreational facilities within participants’ neighborhoods. Results After adjusting for potential confounders, we found lower population density was related to poor performance of sit‐to‐stand and walking speed in both sexes, and grip strength in women (trend P < 0.05). A lower number of daily life‐related destinations was related to poor performance of sit‐to‐stand and walking speed in men, and grip strength and sit‐to‐stand in women. Similarly, the number of community centers was related to walking speed in both sexes. The number of medical and recreational facilities was also related to some physical performance in both sexes. A lower land use mix score, calculated by principal component analysis, was related to lower performance of sit‐to‐stand and walking speed in men, and grip strength and sit‐to‐stand in women. Conclusion The present study suggests that, although there are some sex differences, low population density, land use mix, and fewer daily life‐related destinations, community centers, medical facilities and recreational facilities are negative determinants of physical function. Geriatr Gerontol Int 2017; 17: 382–390.

  January 22, 2016   doi: 10.1111/ggi.12717   open full text
• Association between body mass index and outcome in Japanese ischemic stroke patients.
  Shinya Kawase, Hisanori Kowa, Yutaka Suto, Hiroki Fukuda, Masayoshi Kusumi, Hiroyuki Nakayasu, Kenji Nakashima.
  Geriatrics and Gerontology International. January 22, 2016
  Aim An association between body mass index (BMI) and stroke outcome have been reported, but the results are controversial. The aim of the present study was to evaluate whether BMI is associated with ischemic stroke outcome. Methods Consecutive Japanese acute ischemic stroke patients were analyzed. BMI was categorized as underweight (BMI <18.5 kg/m2), normal weight (18.5–24.9 kg/m2) and obese (≥25 kg/m2). BMI and short‐term and long‐term outcomes were examined. Short‐term outcomes were evaluated using the modified Rankin scale score at hospitalization and discharge; modified Rankin scale ≥3 was defined as a poor outcome. Long‐term outcomes were evaluated by all‐cause mortality. The recurrence rate was also evaluated in each BMI group. Values of P < 0.05 were considered significant. Results A total of 1206 acute ischemic stroke patients (760 men; mean age 72.5 years) were analyzed in the present study. There were 111 underweight cases (9.2%), 785 normal weight cases (65.1%) and 310 obese cases (25.7%). The underweight group had a significantly higher rate of poor short and long‐term outcomes than the normal weight group. The outcomes of the obese group were not significantly different from those of the normal weight group. Recurrence was not significantly different among the groups. Conclusions Lower BMI might be a predictor of poorer short‐term and long‐term stroke outcomes. Geriatr Gerontol Int 2017; 17: 369–374.

  January 22, 2016   doi: 10.1111/ggi.12713   open full text
• Effects of a change in social activity on quality of life among middle‐aged and elderly Koreans: Analysis of the Korean longitudinal study of aging (2006–2012).
  Young Choi, Kwang‐Sig Lee, Jaeyong Shin, Jeoung A Kwon, Eun‐Cheol Park.
  Geriatrics and Gerontology International. January 22, 2016
  Aim The aim of the present study was to examine a relationship between altered social activity and quality of life in later life. Methods Data came from the Korean Longitudinal Study of Aging (2006–2012), which consisted of 7096 participants aged 45 years or older. Change in social activity was classified into four categories; that is, “consistent non‐participation,” “participation to no participation,” “no participation to participation” and “consistent participation.” Social activity was divided into various elements, and the same analysis was carried out for each element. The linear mixed model was used to investigate the association between changes in social activity and quality of life among middle‐aged and elderly Koreans. Results Those with changes from “participation to no participation” (b 2.253, P < 0.0001), “no participation to participation” (b 3.348, P < 0.0001) and “consistent participation” (b 6.624, P < 0.0001) were more likely to be satisfied with their lives than those with “consistent non‐participation” (P < 0.0001 for trend). In addition, the impact of the positive relationship between consistent participation in social activity and quality of life varied across different elements of social activity. The positive association was particularly strong for religious activities, friendship organization, leisure/culture clubs, family/school reunion and voluntary work (b 1.451, P < 0.0004; b 5.049, P < 0.0001; b 4.903, P < 0.0001; b 4.757, P < 0.0001; b 4.562, P < 0.0001; respectively, for consistent participation vs consistent non‐participation). Conclusion Consistent participation in religious activities, friendship organizations, leisure/culture clubs, family/school reunion ,and volunteer work improves quality of life among middle aged and older Koreans. Geriatr Gerontol Int 2017; 17: 132–141.

  January 22, 2016   doi: 10.1111/ggi.12685   open full text
• Prevalence of sarcopenia in older Brazilians: A systematic review and meta‐analysis.
  Juliano Bergamaschine Mata Diz, Amanda Aparecida Oliveira Leopoldino, Bruno de Souza Moreira, Nicholas Henschke, Rosangela Correa Dias, Leani Souza Máximo Pereira, Vinicius Cunha Oliveira.
  Geriatrics and Gerontology International. January 22, 2016
  Aim Sarcopenia is the age‐related loss of muscle mass and function that evolves into disability, loss of independence and death. In Brazil the number of older people is rapidly growing, resulting in an increased prevalence of chronic conditions associated with old age. As prevalence estimates provide essential information to policymakers when developing healthcare strategies, this systematic review and meta‐analysis aimed to estimate the prevalence of sarcopenia in older Brazilians. Methods Electronic database searches and hand‐searching in relevant journals and reference lists were carried out without language restriction. Studies that reported the prevalence of sarcopenia in Brazilians aged 60 years or older were considered for inclusion. Sarcopenia was defined as low muscle mass, low muscle function or low muscle mass and function. Meta‐analysis was carried out using a random‐effects model. Results A total of 31 studies were included pooling 9416 participants. The overall prevalence of sarcopenia in older Brazilians was 17.0% (95% CI 13.0–22.0). Sensitivity analysis showed rates of 20.0% (95% CI 11.0–32.0) in women and 12.0% (95% CI 9.0–16.0) in men. Prevalence was 16.0% (95% CI 12.0–23.0) based on low muscle mass and function; and 17.0% (95% CI 9.0–31.0) based only on low muscle mass. The difference between these two criteria was not significant (P = 0.96). Conclusions Sarcopenia is an emerging public health issue in Brazil. Attention should be paid to changes in prevalence rates over the next years because of the increase in the older population. Geriatr Gerontol Int 2017; 17: 5–16.

  January 22, 2016   doi: 10.1111/ggi.12720   open full text
• Synergistic or independent impacts of low frequency of going outside the home and social isolation on functional decline: A 4‐year prospective study of urban Japanese older adults.
  Yoshinori Fujiwara, Mariko Nishi, Taro Fukaya, Masami Hasebe, Kumiko Nonaka, Takashi Koike, Hiroyuki Suzuki, Yoh Murayama, Masashige Saito, Erika Kobayashi.
  Geriatrics and Gerontology International. January 22, 2016
  Aim Decreased frequency of going outside the home and being socially isolated are regarded as predictors of poor health. The object of the present study was to clarify whether these factors have synergistic or independent impacts on future functional decline. Methods We examined a prospective cohort of 2427 community‐dwelling persons, aged ≥65 years, who responded to the baseline mail survey in Wako City, in 2008. Participants were asked about the frequency of going outside the home, social isolation status (having contact less than once a week with anyone outside household), functional capacity (Tokyo Metropolitan Institute of Gerontology‐Index of Competence), age, sex, annual income, self‐rated health, depressive mood and mobility. Results Of 1575 persons (72.1%) who completely responded to the follow‐up survey (T2) in 2012, we defined the groups as follows: group 1, not isolated and going outside the home every day (n = 897); group 2, not isolated and going outside the home less than every day (n = 311); group 3, isolated and going outside the home every day (n = 224); and group 4, isolated and going outside the home less than every day (n = 143). Multiple logistic regression analyses showed that the variables identifying group 3 for men and group 2 for women with reference to group 1 were predictors of subsequent functional decline even after adjustment for confounders (odds ratios 2.01, 1.63; 95% CI 1.20–3.38, 1.03–2.56, respectively). Conclusion Social isolation regardless of going outside the home every day for men and going outside the home less than every day regardless of being not socially isolated for women might predict functional decline. Geriatr Gerontol Int 2017; 17: 500–508.

  January 22, 2016   doi: 10.1111/ggi.12731   open full text
• A concordance of self‐reported and performance‐based assessments of mobility as a mortality predictor for older Mexican Americans.
  Sanggon Nam, Soham Al Snih, Kyriakos S Markides.
  Geriatrics and Gerontology International. January 22, 2016
  Aim To assess the efficacy in mortality prediction of a concordance of performance‐based (timed 10‐foot walk; performance‐oriented mobility assessment [POMA]) and self‐rated (reported ability to walk across a small room with no help from people or devices; activities of daily living [ADL]) assessments of mobility for Mexican Americans aged 75 years and older. Methods A longitudinal study of 2069 participants aged 75 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly wave 5 (June 2004 to January 2006) and wave 6 (February 2007 to February 2008) was carried out. Sociodemographic variables, performance‐based (timed 10‐foot walk) and self‐rated assessments (reported ability to walk across a small room without the help of any people or devices) of mobility, and mortality data were obtained. Results The ADL/POMA concordance assessment showed a prevalence of the “positively concordant” group (completed the walk and reported being able to walk, ADL and POMA both positive), followed by the “pessimist,” “optimist,” and “negatively concordant” groups at 80.09%, 10.50%, 3.78% and 5.63%, respectively. Logistic regression analyses showed that “negatively concordant” was a critical mortality predictor (OR 4.80; 95% CI 2.59–8.90) followed by “pessimist” (OR 1.94; 95% CI 1.12–3.36) as compared with the reference group, “positively concordant.” Conclusion The ADL/POMA concordance is an effective predictor of mortality for older Mexican Americans in the Hispanic Established Population for the Epidemiological Study of the Elderly. Geriatr Gerontol Int 2017; 17: 433–439.

  January 22, 2016   doi: 10.1111/ggi.12734   open full text
• Development and validation of a new quality of life scale for patients receiving home‐based medical care: The Observational Study of Nagoya Elderly with Home Medical Care.
  Hiroko Kamitani, Hiroyuki Umegaki, Kazushi Okamoto, Shigeru Kanda, Atsushi Asai, Keiko Maeda, Hideki Nomura, Takuya Shimojima, Yusuke Suzuki, Hiroko Ohshima, Masafumi Kuzuya.
  Geriatrics and Gerontology International. January 22, 2016
  Aim To develop and validate a scale that assesses quality of life in patients receiving home‐based medical care. Methods A new quality of life scale was developed and evaluated in four phases: (i) item generation; (ii) first field study with a 14‐item questionnaire; (iii) preliminary validation study, to reduce the number of items to four; and (iv) second field study comprising 40 patients, to evaluate the validity of the final version. Participants were requested to answer both the final version of the scale and the Short Form‐8, to enable identification of any relationship between the two. Results Items were generated after discussions with doctors and care managers, and 14 items were selected for the draft version. In the preliminary validation study, 10 items were deleted, based on the results of statistical analysis of the data from the first field study. A psychometric analysis showed that the final four‐item questionnaire had internal consistency (Cronbach's α = 0.7), and a significant association with the Short Form‐8. Conclusions We created the first quality of life scale for patients receiving home‐based medical care. The scale's internal consistency was confirmed, as well as its external validity. This scale can be used independently of factors such as a patient's age, sex, level of independence in the presence of dementia or disability, swallowing function, hearing ability and communication ability, and can be used with ease in routine clinical practice. Geriatr Gerontol Int 2017; 17: 440–448.

  January 22, 2016   doi: 10.1111/ggi.12735   open full text
• Effectiveness of a multidisciplinary home‐based medication review program in reducing healthcare utilization among older adult Singaporeans.
  Kheng Yong Ong, Mcvin Hua Heng Cheen, Joanne Swee Gek Chng, Li Li Chen, Sock Mui Ng, Seng Han Lim, Paik Shia Lim, Wei Terk Chang.
  Geriatrics and Gerontology International. January 21, 2016
  Aim The study aimed to: (i) evaluate the effectiveness of a multidisciplinary home‐based medication review (HBMR) program in reducing hospital admissions and emergency department (ED) visits, cost of hospital admissions and length of stay (LOS); and (ii) determine the prevalence of drug‐related problems (DRP) in elderly Singaporeans. Methods A retrospective observational study was carried out at an academic medical center in Singapore. Patients referred between 1 March 2011 and 31 December 2012 were included. Frequency of hospital admissions and ED visits, cost of hospital admissions, and LOS 6 months before and after HBMR, number of DRP, their categories, and their outcomes (i.e. resolved/ unresolved) were recorded. Results The analysis included 107 patients with a mean (SD) age of 75.6 years (7.6 years). HBMR resulted in a 41% reduction in risk for hospital admissions (Incidence rate ratio 0.59, 95% CI 0.47–0.73, P < 0.001). The same magnitude of reduction was observed for ED visits. The mean (SD) cost of hospital admissions reduced from $16 957.77 ($16 118.35) before HBMR to $7488.76 ($12 773.40) after (P < 0.001). Among 62 patients with hospital admissions before and after HBMR, the mean (SD) LOS decreased from 26.5 days (22.4 days) to 17.6 days (17.8 days; P = 0.010). The team identified 525 DRP from 1353 medications reviewed. Of these, 34 (6.7%) and 174 (34.1%) were resolved with and without physician involvement, respectively. The most common DRP identified were failure to receive drug (n = 163, 31.0%) and untreated indication (n = 140, 26.7%). Conclusions The multidisciplinary HBMR program was associated with reduced ED visits, hospital admissions, LOS and costs in older adult Singaporeans with multiple DRP. Geriatr Gerontol Int 2017; 17: 302–307.

  January 21, 2016   doi: 10.1111/ggi.12706   open full text
• Social isolation and risk for malnutrition among older people.
  Christa Boulos, Pascale Salameh, Pascale Barberger‐Gateau.
  Geriatrics and Gerontology International. January 21, 2016
  Aim Social isolation and loneliness are emerging issues among the geriatric population. The relationships between both, and their impact on health and nutritional status in older people are complex. The purpose of the present study was to evaluate the association between three components of social isolation: social network, feeling of loneliness, commensality and nutritional status. Methods A total of 1200 randomly selected elderly individuals aged ≥65 years and living in rural areas of Lebanon participated in the present study. Data were collected during a face‐to‐face interview including nutritional status (Mini‐Nutritional Assessment), measures of social isolation (Lubben Social Network Scale), subjective loneliness (Jong‐Gierveld Loneliness Scale), sociodemographic conditions, and health and functional status. Results Both social isolation and loneliness were independently associated with a higher risk of malnutrition (OR 1.58, P = 0.011; OR 1.15, P = 0.020, respectively). However no association was found between the frequency of sharing meals and the risk of malnutrition. Conclusions The present study showed that social isolation and subjective loneliness are two independent risk factors for malnutrition among older people. Geriatr Gerontol Int 2017; 17: 286–294.

  January 21, 2016   doi: 10.1111/ggi.12711   open full text
• Neuroimaging signatures of frailty: A population‐based study in community‐dwelling older adults (the Atahualpa Project).
  Oscar H Del Brutto, Robertino M Mera, Kristen Cagino, Kathryn D Fanning, Marleni F Milla‐Martinez, Johnathan L Nieves, Mauricio Zambrano, Mark J Sedler.
  Geriatrics and Gerontology International. January 21, 2016
  Aims Frailty is a geriatric state of physical vulnerability that might be associated with cognitive decline in the absence of a concurrent neurodegenerative disorder. This assumes that neuroimaging studies are normal, but such examinations have rarely been considered for a frailty work‐up. The present study identifies neuroimaging signatures in older adults interviewed with the Edmonton Frail Scale (EFS). Methods Community‐dwellers aged ≥60 years enrolled in the Atahualpa Project were invited to undergo brain magnetic resonance imaging. Using generalized regression models, we evaluated the association between frailty and diffuse cortical and subcortical brain damage, after adjusting for relevant confounders. Multivariate models estimated the interaction of age in the association between frailty and these neuroimaging signatures. Results Out of 298 participants (mean age 70 ± 8 years, 57% women), 151 (51%) had moderate‐to‐severe cortical atrophy and 74 (25%) had moderate‐to‐severe white matter hyperintensities of presumed vascular origin. Mean EFS scores were 5 ± 3 points, with 140 (47%) individuals classified as robust, 65 (22%) as pre‐frail and 93 (31%) as frail. Multivariate models showed a significant association between cortical atrophy with the continuous (P = 0.002) and the categorized (P = 0.008) EFS score. The relationship between white matter hyperintensities and the EFS was marginal. According to interaction models, prefrail or frail individuals aged ≥67 years presented more prominent neuroimaging signatures of diffuse cortical or subcortical damage than their robust counterparts. Conclusions Neuroimaging signatures of frailty are mainly related to age. This reinforces the importance of early frailty detection to reduce its catastrophic consequences. Geriatr Gerontol Int 2017; 17: 270–276.

  January 21, 2016   doi: 10.1111/ggi.12708   open full text
• What is the reasonable option for elderly patients with incidental pancreatic cystic neoplasms? Follow‐up observation versus surgical resection.
  Hyo Jung Kim, Jae Seon Kim, Jae Min Lee, Moon Kyung Joo, Beom Jae Lee, Ji Hoon Kim, Jong Eun Yeon, Jong‐Jae Park, Hong Sik Lee, Kwan Soo Byun, Chang Duck Kim, Young‐Tae Bak.
  Geriatrics and Gerontology International. January 21, 2016
  Aims Pancreatic cystic neoplasms (PCN) with malignant potential are thought to be less aggressive than ordinary ductal adenocarcinoma, even in the setting of malignant transformation. Therefore, deciding whether or not to carry out surgery is very difficult, especially in elderly and asymptomatic patients, because of the high risk of perioperative morbidities. The aim of the present study was to examine clinical outcomes of PCN patients aged 65 years or older. Methods This retrospective analysis included patients with incidentally detected PCN with follow‐up durations >1 year. Patients diagnosed with obvious simple cysts, pseudocysts or pancreatic cancer and patients with a history of pancreatic disease were excluded from the study. Results The present study included 201 patients (older group 104 patients ≥65 years; younger group 97 patients <65 years). Surgical resections were carried out for 27 patients in the older group and 41 patients in the younger group. There were 133 patients who were followed up without surgery (mean follow‐up duration 41 months). Postoperative morbidity occurred in 22.2% of the patients in the older group and 21.9% of the patients in the younger group. Malignancy occurred in one patient in the older group and in two patients in the younger group. The PCN diameter increased in 20 patients during follow up: 16.9% of the older group and 12.5% of the younger group. Conclusions The malignancy rate was very low in incidental PCN patients irrespective of age. Follow‐up observation without surgery appears to be a safe option in older patients with morbidity. Geriatr Gerontol Int 2017; 17: 256–261.

  January 21, 2016   doi: 10.1111/ggi.12705   open full text
• Cognitive impairment is associated with the absence of fear of falling in community‐dwelling frail older adults.
  Hidehiko Shirooka, Shu Nishiguchi, Naoto Fukutani, Yuto Tashiro, Yuma Nozaki, Hinako Hirata, Moe Yamaguchi, Seishiro Tasaka, Tomofumi Matsushita, Keisuke Matsubara, Tomoki Aoyama.
  Geriatrics and Gerontology International. January 21, 2016
  Aim The purpose of the present study was to explore the association between cognitive function and fear of falling in frail/non‐frail older adults in a community setting. Methods We recruited 483 community‐dwelling older adults aged 65 years and older (mean age 73.3 ± 5.1 years, 68.3% women). Fear of falling was assessed using a yes/no question, “Are you afraid of falling?” Cognitive function was measured using the Mini‐Mental State Examination. The five subscores of the examination were also recorded. We used the frailty criteria developed by the Cardiovascular Health Study, and divided the participants into non‐frail and frail groups according to the number of affected domains. The statistical analyses were carried out separately for these two groups. Results A multiple logistic regression analysis showed that, in frail older adults, cognitive impairment was significantly associated with the absence of fear of falling (OR 0.04, 95% CI 0.00–0.50, P = 0.012). In addition, a stepwise multivariate logistic regression analysis showed that the score on the attention and calculation subsection of the Mini‐Mental State Examination was positively associated with the presence of fear of falling in frail older adults (OR 1.83, 95% CI 1.08–3.12, P = 0.026). In contrast, cognitive impairment was not associated with fear of falling in non‐frail older adults. Conclusions The results suggest that cognitive impairment, especially that in executive function, is associated with the absence of fear of falling in community‐dwelling frail older adults. Geriatr Gerontol Int 2017; 17: 232–238.

  January 21, 2016   doi: 10.1111/ggi.12702   open full text
• Classification of frailty using the Kihon checklist: A cluster analysis of older adults in urban areas.
  Takeshi Kera, Hisashi Kawai, Hideyo Yoshida, Hirohiko Hirano, Motonaga Kojima, Yoshinori Fujiwara, Kazushige Ihara, Shuichi Obuchi.
  Geriatrics and Gerontology International. January 21, 2016
  Aim Frailty is an important predictor of the need for long‐term care and hospitalization. Our aim was to categorize frailty in community‐dwelling older adults. Methods The present study was carried out in 2011–2013, and consisted of 1380 individuals over 65 years of age. Participants completed the Kihon checklist, which is widely used to assess frailty in Japan, and their physical, cognitive and social function was evaluated. Non‐hierarchical cluster analysis was used to statistically categorize frailty. The optimum number of clusters was determined as the point at which the external reference values (instrumental activity of daily living score, grip power, 10‐m walk time, body mass index, portable fall risk index, occlusal force and Mini‐Mental State Examination score) differed. Results According to the Kihon checklist, 369 (26.7%) of the 1380 study participants were considered frail. When the cluster number was increased from two to six, the scores in each subdomain of the Kihon checklist significantly differed. The estimated minimum number of clusters was five, and each of the five cluster groups had distinct characteristics. The numbers of participants in cluster groups 1–5 were 105, 78, 62, 71 and 53, respectively. Conclusions We identified five types of frailty in community‐dwelling older adults in Japan: “experience of falling,” “pre‐frailty,” “oral frailty,” “housebound” and “severe frailty.” Geriatr Gerontol Int 2017; 17: 69–77.

  January 21, 2016   doi: 10.1111/ggi.12676   open full text
• Relationships between sarcopenia and household status and locomotive syndrome in a community‐dwelling elderly women in Japan.
  Chika Momoki, Daiki Habu, Juri Ogura, Arisa Tada, Ai Hasei, Kotone Sakurai, Hatsumi Watanabe.
  Geriatrics and Gerontology International. January 21, 2016
  Aim The aim of the present study was to identify factors associated with sarcopenia in community‐dwelling elderly women in Japan. Methods A total of 186 women aged over 65 years attending preventive care classes were enrolled in the study. Muscle mass was assessed using bioelectrical impedance analysis. Sarcopenia was defined as low muscle mass and low muscle strength in accord with the consensus report of the Asian Working Group for Sarcopenia. Data regarding household status (living alone, with a spouse, or with children and/or grandchildren), calf circumference and the presence of locomotive syndrome were obtained, as well as dietary variety score, Tokyo Metropolitan Institute of Gerontology Index of Competence and Mini‐Nutritional Assessment short form, and 10‐item Eating Assessment Tool scores. Results Sarcopenia was identified in 21.0% of participants. Participants with sarcopenia were older, had a lower body mass index and calf circumference, and were more likely to have locomotive syndrome, and living with children and/or grandchildren. In multivariate analysis, age, body mass index <18.5 and locomotive syndrome were significantly associated with sarcopenia, as were associated living alone (OR 1.69, 95% CI 0.45–6.41), and living with children and/or grandchildren (OR 2.46, 95% CI 0.71–8.54) and dietary variety score ≥9 (OR 4.98, 95% CI 0.97–25.56). Conclusions Age, body mass index, dietary variety score, locomotive syndrome and household status were associated with sarcopenia. Early interventions are required for older adults identified as having a higher risk of sarcopenia to prevent its adverse health consequences. Geriatr Gerontol Int 2017; 17: 54–60.

  January 21, 2016   doi: 10.1111/ggi.12674   open full text
• Neuroprotective effects of pretreatment of ginsenoside Rb1 on severe cerebral ischemia‐induced injuries in aged mice: Involvement of anti‐oxidant signaling.
  Xiao Dong, Lei Zheng, Shujing Lu, Yanbei Yang.
  Geriatrics and Gerontology International. December 29, 2015
  Aim Ginsenosides, a class of ginseng compounds of herbal medicine, have been shown to have therapeutic potential for the neuroprotection of brain damage after cerebral ischemia because of their activities including anti‐oxidant and anti‐inflammation. In the elderly population, aging‐induced oxidative stress has been implicated in exacerbating brain injury, which might also be ameliorated by anti‐oxidants, such as ginsenosides. However, this hypothesis has yet to be explored. Methods Here we present in vivo studies highlighting a protective function of ginsenoside Rb1, a natural steroid glycoside derivative purified from saponin of Panax ginseng, in neurological injury during aging. Results Compared with young mice, the recovery of brain damage after middle cerebral artery occlusion is significantly impaired in aged mice, whereas the long‐term pretreatment with ginsenoside Rb1 through oral administration can greatly prevent the injury in a dose‐dependent manner. In addition, we further explored the involvement of oxidative stress and extracellular signal‐regulated kinase activation in aged mice stimulated by cerebral ischemia, both of which were found to be blocked by ginsenoside Rb1. Conclusions These observations suggest that ginsenoside Rb1 could represent promising applications as anti‐oxidants for the anti‐aging treatment of neurological disorders, such as stroke, in elderly patients. Geriatr Gerontol Int 2017; 17: 338–345.

  December 29, 2015   doi: 10.1111/ggi.12699   open full text
• Age‐related differences in dual task performance: A cross‐sectional study on women.
  Paolo R Brustio, Daniele Magistro, Emanuela Rabaglietti, Monica E Liubicich.
  Geriatrics and Gerontology International. December 29, 2015
  Aim Simultaneous performances of motor and attention‐demanding tasks are common in activities of everyday life. The present cross‐sectional study examined the changes and age‐related differences on mobility performance with an additional cognitive or motor task, and evaluated the relative dual‐task cost (DTC) on the motor performance in young, middle‐aged and older women. Methods A total of 30 young (mean age 25.12 ± 3.00 years), 30 middle‐aged (mean age 47.82 ± 5.06 years) and 30 older women (mean age 72.74 ± 5.95 years) were recruited. Participants carried out: (i) single task: Timed Up & Go Test; (ii) cognitive dual‐task: Timed Up & Go Test while counting backwards by three; (iii) manual dual‐task: Timed Up & Go Test while carrying a glass of water. A repeated measures anova with between‐factor as age groups and within‐factor as tasks was carried out to assess the effect of aging on the performance of mobility tasks. DTC was calculated as ([performance in single‐task − performance in dual‐task] / performance in single task) × 100%. One‐way ancova were carried out to compare the DTC among the three age groups. Results A significant interaction between age groups and task (F4,172 = 6.716, P < 0.001, partial η2 = 0.135) was observed. Specifically, older women showed a worse mobility performance under dual‐task condition compared with young and middle‐aged groups. Furthermore, DTC differences in cognitive task were observed in older women compared with younger and middle‐aged women (F2,86 = 7.649, P < 0.001, partial η2 = 0.151), but not in manual task. Conclusion Dual‐task conditions might affect mobility performance differently across the lifespan, and could be particularly challenging in older women. Geriatr Gerontol Int 2017; 17: 315–321.

  December 29, 2015   doi: 10.1111/ggi.12700   open full text
• Videoendoscopic evaluation of food bolus preparation: A comparison between normal adult dentates and older adult dentates.
  Kohei Matsuno, Kanji Nohara, Hikari Fukatsu, Nobukazu Tanaka, Nami Fujii, Yasuhiro Sasao, Takayoshi Sakai.
  Geriatrics and Gerontology International. December 29, 2015
  Aim Food bolus preparation plays an important role in swallowing food. The ability to carry out oral functions varies with age, and the same might be true of the ability to prepare food boluses. Previously developed methods for assessing food bolus preparation were not able to evaluate swallowed boluses; that is, the boluses were spat out before they were swallowed. The aim of the present study was to evaluate food bolus preparation in older adults using videoendoscopy, and to compare the food bolus preparation abilities of older adults and younger healthy adults. Methods The participants were 30 older adults and 30 younger healthy adults. None of the participants showed any symptoms of dysphagia or eating difficulties. In each examination, an endoscope was inserted into the nasal passage, and the participant was instructed to eat cooked rice. The grinding, mixing and aggregation of each bolus was graded from 0 to 2, with higher numbers indicating more marked grinding, mixing and aggregation. We simultaneously investigated the number of chewing cycles. Results The older adults showed higher grinding scores and lower mixing scores than the younger healthy adults. However, neither of these differences was significant. In contrast, the older adults showed significantly lower aggregation scores and carried out a significantly greater number of chewing cycles than the younger healthy adults. Conclusions Using videoendoscopy, we found that older adults showed lower aggregation scores and carried out a greater number of chewing cycles than younger healthy adults. These results suggest that older adults are less able to prepare food boluses than younger healthy adults. Geriatr Gerontol Int 2017; 17: 226–231.

  December 29, 2015   doi: 10.1111/ggi.12697   open full text
• Randomized double‐blind placebo‐controlled multicenter trial of Yokukansan for neuropsychiatric symptoms in Alzheimer's disease.
  Katsutoshi Furukawa, Naoki Tomita, Daisuke Uematsu, Kazunori Okahara, Hiroyuki Shimada, Masaki Ikeda, Toshifumi Matsui, Koichi Kozaki, Masahiko Fujii, Tatsuji Ogawa, Hiroyuki Umegaki, Katsuya Urakami, Hiroshi Nomura, Naoto Kobayashi, Aki Nakanishi, Yukihiro Washimi, Hisashi Yonezawa, Satoshi Takahashi, Masaharu Kubota, Yosuke Wakutani, Daisuke Ito, Takahiro Sasaki, Etsuro Matsubara, Kaori Une, Aiko Ishiki, Yukie Yahagi, Mikio Shoji, Hiroyasu Sato, Yasuo Terayama, Masafumi Kuzuya, Nobuo Araki, Manabu Kodama, Takuhiro Yamaguchi, Hiroyuki Arai.
  Geriatrics and Gerontology International. December 29, 2015
  Aim Yokukansan (YKS), a traditional herbal medicine, has been used to treat behavioral and psychological symptoms of dementia (BPSD). The present study is the first double‐blind, randomized, placebo‐controlled trial to determine the efficacy and safety of YKS for the treatment of BPSD in Alzheimer's disease (AD). Methods A total of 22 sites consisting of clinics, hospitals and nursing homes participated. A total of 145 patients with AD were randomized. Active YKS (7.5 g/day) and placebo were supplied to 75 and 70 participants, respectively. The primary outcome measure was the 4‐week change in total score of the Neuropsychiatric Inventory Brief Questionnaire Form (NPI‐Q), an instrument that evaluates BPSD. Secondary outcome measures included 12‐week changes in NPI‐Q scores, changes in NPI‐Q subcategory scores and total scores of the Mini‐Mental‐State Examination. Results Four‐week changes in NPI‐Q total scores did not differ significantly between the treatment and placebo groups. There were also no significant differences between groups in 12‐week changes in total NPI‐Q scores, NPI‐Q subcategory scores or total Mini‐Mental‐State Examination scores. However, a subgroup with fewer than 20 points on the Mini‐Mental‐State Examination at baseline showed a greater decrease in “agitation/aggression” score in the YKS group than in the placebo group (P = 0.007). No serious adverse effects were observed during the study. Conclusions Our data did not reach statistical significance regarding the efficacy of YKS against BPSD; however, YKS improves some symptoms including “agitation/aggression” and “hallucinations” with low frequencies of adverse events. Geriatr Gerontol Int 2017; 17: 211–218

  December 29, 2015   doi: 10.1111/ggi.12696   open full text
• Effect of oral cleaning using mouthwash and a mouth moisturizing gel on bacterial number and moisture level of the tongue surface of older adults requiring nursing care.
  Kenichiro Kobayashi, Masahiro Ryu, Sachi Izumi, Takayuki Ueda, Kaoru Sakurai.
  Geriatrics and Gerontology International. December 29, 2015
  Aim To evaluate the effect of oral cleaning using a mouthwash and a mouth moisturizing gel on the number of bacteria and moisture level of the tongue surface of older adults requiring nursing care. Methods The 60 participants were randomly divided into groups according to their use of oral cleaning procedures as follows: group 1, mouthwash and a moisturizing gel (M + m); group 2, mouthwash (M); group 3, water and a moisturizing gel (W + m); and group 4, water (W). The number of anaerobic bacteria, tongue coating index and moisture level of the tongue surface were measured at baseline, and after 1 and 2 weeks after cleaning commenced to compare the effectiveness of oral cleaning among the groups. Results There was no significant difference in baseline measurements among the groups. The numbers of anaerobic bacteria decreased for all groups, and there were significant differences in the rates of decrease after 2 weeks between the M + m and W + m groups, M + m and W groups, and M and W groups. The tongue coating index decreased for all groups. There was no significant difference in the rate of decrease among the groups after 1 week, and there was a significant difference after 2 weeks between the M + m and W groups. The moisture levels of all groups increased, and there were significant differences after 2 weeks between the M + m and M groups, the M + m and W groups, and the W + m and W groups. Conclusion The most effective cleaning technique was the combination of a mouthwash and a moisturizing gel. Geriatr Gerontol Int 2017; 17: 116–121.

  December 29, 2015   doi: 10.1111/ggi.12684   open full text
• Qualitative muscle mass index as a predictor of skeletal muscle function deficit in Asian older adults.
  Jae Seung Chang, Tae Ho Kim, Hanul Kim, Eun Hee Choi, Nahyun Kim, In Deok Kong.
  Geriatrics and Gerontology International. December 29, 2015
  Aim The present cross‐sectional study was carried out among community‐dwelling Koreans to determine the validity of various muscle mass indices and to propose more clinically relevant diagnostic criteria. Methods This study measured the anthropometrics, body composition and physical capability of 415 older Koreans. Skeletal muscle indices were calculated by dividing appendicular lean mass by height or weight. Apart from this, we adjusted appendicular lean mass for body mass index, body surface area or waist‐to‐height ratio, which we then named the qualitative muscle mass index. Skeletal muscle function deficit was defined as a combination of weakness and slowness. Results Qualitative muscle indices were closely associated with physical capabilities. Receiver operating characteristic and logistic analyses showed that qualitative muscle indices had significantly greater discriminatory powers regarding low muscle function than did the height‐adjusted index in both men and women, and even showed higher discriminatory potentials than the weight‐adjusted index in men (all P < 0.05). The cut‐off values of qualitative muscle indices of body mass index‐, body surface area‐, and waist‐to‐height ratio‐adjusted indices for identifying functional deficits were 0.760, 11.40 and 34.18 for men, and 0.530, 8.91 and 23.07 for women, respectively. Conclusions The present study suggests that qualitative muscle indices are more accurate in predicting low muscle function than are height‐ and weight‐adjusted indices, because they consider anthropometric characteristics as part of the definition. The results might provide new avenues for conceptualizations of sarcopenia accompanied by obesity, and can be used as ethnic‐specific reference values of muscle mass indices based on functional outcome in an elderly Korean/Asian population. Geriatr Gerontol Int 2017; 17: 99–107.

  December 29, 2015   doi: 10.1111/ggi.12681   open full text
• Impact of multidimensional poverty on the self‐efficacy of older people: Results from an Australian longitudinal study.
  Emily J Callander, Deborah J Schofield.
  Geriatrics and Gerontology International. December 23, 2015
  Aims Self‐efficacy has numerous benefits for active and healthy aging, including giving the people the ability to make positive changes to their living standards and lifestyles. The present study aims to determine whether falling into multidimensional poverty lowers self‐efficacy. Methods Longitudinal analysis of waves 7–11 (2007–2011) of the nationally representative Household, Income and Labor Dynamics in Australia survey using linear regression models. The analysis focused on the Australian population aged 65 years and older. The Freedom Poverty Measure was used to identify those in multidimensional poverty. Results Those who fell into multidimensional poverty for 3 or 4 years between 2007 and 2011 had their self‐efficacy scores decline by an average of 27 points (SD 21.2). Those who fell into poverty had significantly lower self‐efficacy scores in 2011 – up to 57% lower (−66.6%, −45.7% P < 0.0001) after being in multidimensional poverty for 3 or 4 years between 2007 and 2011 than those who were never in poverty. Conclusions Falling into multidimensional poverty lowers the self‐efficacy scores of older people. In order to improve the chances of older people making long‐term changes to improve their living standards, feelings of self‐efficacy should first be assessed and improved. Geriatr Gerontol Int 2017; 17: 308–314.

  December 23, 2015   doi: 10.1111/ggi.12689   open full text
• Family history and its relationship with dementia stigma beliefs among Chinese Americans.
  Benjamin KP Woo.
  Geriatrics and Gerontology International. December 23, 2015
  Aim It is known that Chinese Americans associate dementia with stigma and “loss of face.” However, further research is required to provide a more complete picture of the extent and nature of stigma in Chinese Americans with family histories of dementia (FHD). The present study examined whether FHD are associated with quantitative measures of stigma in Chinese Americans. Methods A total of 300 Chinese Americans in two health seminars answered a 15‐item, true/false questionnaire to assess their beliefs toward dementia. Two groups were dichotomized and compared based on FHD. Results Both groups subscribed to moderately stigmatizing views about dementia. Our findings showed that the group with FHD was more likely to disclose having relatives with dementia. However, this group was also more likely to perceive patients with dementia to be incapable of feeling other people's worries or concerns at once. Conclusions Strategies to decrease stigma toward dementia are required. Cultural interventions must also extend into the Chinese American general public to reduce stigma of dementia. Geriatr Gerontol Int 2017; 17: 122–125.

  December 23, 2015   doi: 10.1111/ggi.12686   open full text
• Aging well: Processing speed inhibition and working memory related to balance and aerobic endurance.
  Laura Zettel‐Watson, Meagan Suen, Lara Wehbe, Dana N Rutledge, Barbara J Cherry.
  Geriatrics and Gerontology International. December 23, 2015
  Aim The present study explored whether certain physical performance measures could be linked to specific cognitive domains in healthy older adults. Method A total of 50 adults (mean age 69.5 years, SD 8.1) were evaluated on physical performance using measures of balance (Fullerton Advanced Balance Scale), functional mobility (8‐ft up‐and‐go), lower body strength (30‐s chair stand), gait (30‐ft walk velocity) and aerobic endurance (6‐min walk). Cognitive measures included Stroop Color–Word Test, Digit Span Backward, Trail Making Tests, Everyday Problems Test, Digit Symbol Substitution and a Brown–Peterson test. Principal component analyses reduced cognition to domains of processing speed, inhibition and working memory. Results Hierarchical regression analyses were carried out with age and each physical measure as potential predictors of the three cognitive domains. The balance scale and 6‐min walk were specifically associated with processing speed, inhibition and working memory. Conclusions Better dynamic balance and aerobic endurance predicted enhanced processing speed, inhibition and working memory in older adults, with these last two domains considered components of executive function. Geriatr Gerontol Int 2017; 17: 108–115.

  December 23, 2015   doi: 10.1111/ggi.12682   open full text
• Yoga and compassion meditation program improve quality of life and self‐compassion in family caregivers of Alzheimer's disease patients: A randomized controlled trial.
  Marcelo AD Danucalov, Elisa H Kozasa, Rui F Afonso, José CF Galduroz, José R Leite.
  Geriatrics and Gerontology International. December 21, 2015
  Aim To investigate the effects of the practice of yoga in combination with compassion meditation on the quality of life, attention, vitality and self‐compassion of family caregivers of patients with Alzheimer's disease. Methods A total of 46 volunteers were randomly allocated to two groups, the yoga and compassion meditation program group (n = 25), and the control group (CG) that received no treatment (n = 21). The program lasted 8 weeks, and comprised three yoga and meditation practices per week, with each session lasting 1 h and 15 min. Quality of life, attention, vitality, and self‐compassion scores were measured pre‐ and postintervention. Results The yoga and compassion meditation program group showed statistically significant improvements (P < 0.05) on quality of life, attention, vitality and self‐compassion scores as compared with the control group, which showed no statistical significant differences at the postintervention time‐point. Conclusions The findings of the present study suggest that an 8‐week yoga and compassion meditation program can improve the quality of life, vitality, attention, and self‐compassion of family caregivers of Alzheimer's disease patients. Geriatr Gerontol Int 2017; 17: 85–91.

  December 21, 2015   doi: 10.1111/ggi.12675   open full text
• Predictors of chewing ability among community‐residing older adults in Korea.
  Kyongok Park, Gwi‐Ryung Son Hong.
  Geriatrics and Gerontology International. December 21, 2015
  Aims Decreased chewing ability in older adults can lead to poor nutritional and physical conditions, and eventually death. The present study examined the relationships between chewing ability and related characteristics (e.g. health promotion habits, health status and functional status), and identified predictors of chewing ability in community‐residing older adults. Methods Among the total of 11 542 participants in the 2011 National Survey on Older Adults in Korea, data from 10 543 participants were used for analysis. Chewing ability was evaluated using a self‐report of chewing ability. Exercise ability was assessed by objective exercise ability and perceived exercise ability in both the upper and lower extremities. Depression and cognitive functions were measured using the Geriatric Depression Scale‐Short Form and the Mini‐Mental State Examination, respectively. Results A total of 56.9% of participants had poor chewing abilities. After adjusting for age and sex, logistic regression analysis showed that depression (OR 1.76, 95% CI 1.60–1.92), cognitive impairment (OR 1.28, 95% CI 1.17–1.40), objective exercise ability (OR 1.24, 95% CI 1.11–1.41), regular exercise habits (OR 1.23, 95% CI 1.13–1.34), medical check‐up history (OR 1.17, 95% CI 1.05–1.32), number of chronic diseases (OR 1.12, 95% CI 1.09–1.15) and perceived exercise ability in the lower extremities (OR 1.08, 95% CI 1.05–1.10) were significant predictors of chewing ability. Conclusion Chewing ability in older adults should be improved in consideration of mental and general health condition. Geriatr Gerontol Int 2017; 17: 78–84.

  December 21, 2015   doi: 10.1111/ggi.12677   open full text
• Effects of gum chewing exercises on saliva secretion and occlusal force in community‐dwelling elderly individuals: A pilot study.
  Kazuharu Nakagawa, Koichiro Matsuo, Daisuke Takagi, Yu Morita, Takafumi Ooka, Shouji Hironaka, Yoshiharu Mukai.
  Geriatrics and Gerontology International. December 21, 2015
  Aim Elderly individuals face the risk of reductions in saliva secretion and occlusal force caused by systemic diseases or medications that can eventually result in malnutrition and systemic complications. We tested the hypothesis that regular gum chewing exercises (GCE) would enhance saliva secretion and occlusal force in an elderly population. Methods A total of 12 community‐dwelling elderly individuals (3 men and 9 women) participated in this study after providing informed consent. Participants carried out GCE regimens using a soft gum (GCE‐S) or hard gum (GCE‐H) for 2 weeks each, with a 2‐week rest period between trials. Mucosal moisture on the tongue surface, resting saliva, and occlusal force were measured before and after each test gum, and changes in parameters at relevant time‐points were statistically analyzed. Differences in each measurement item were assessed using the Friedman test for before and after the GCE. We used the Holm's correction for multiple comparisons if the Friedman test results were significant. The critical value for rejecting the null hypothesis was set at P < 0.05. Results Resting saliva secretion significantly increased after GCE‐S, returned to baseline levels during the rest period and significantly increased again after GCE‐H. Mucosal moisture and occlusal force followed a similar trend, with a significant rise after GCE‐H. Conclusions The results of the present study suggest that GCE can increase resting saliva secretion and occlusal force in elderly individuals. Further investigations are required on the appropriate use of soft and hard gums to address oral frailty in elderly individuals. Geriatr Gerontol Int 2017; 17: 48–53.

  December 21, 2015   doi: 10.1111/ggi.12670   open full text
• Design of the Mobility and Independent Living in Elders Study: An older adult cohort in rural India.
  Tushar Singh, Pawan K Sharma, Guru Rajesh Jammy, Jane A Cauley, Clareann H Bunker, PS Reddy, Anne B Newman.
  Geriatrics and Gerontology International. December 21, 2015
  Aim The Mobility and Independent Living in Elders Study (MILES) was established in 2012 to estimate the prevalence, incidence, and risk factors for disability and age‐related disease in rural older Indians. Here we describe the main goals of MILES, the essential elements of its design and examinations, and the initial findings from the baseline visit. Methods A random sample of 562 men and women aged ≥60 years was enrolled from the Medchal region in Telangana State. Baseline examination consisted of two separate clinical visits, and included measurements of blood pressure, anthropometry, physical function, peripheral artery disease, cognitive function, bone and muscle quality, knee osteoarthritis, carotid intima‐media thickness, and blood biomarkers. A comprehensive interview was carried out for demographics, disability and disease history. Annual follow‐up visits are ongoing to collect information on incident disability and disease. Results The median age of participants was 66 years (range 60–92 years); median body mass index 21.7 kg/m2, median gait speed 0.67 m/s and 55% self‐reported their health status as fair or poor. Conclusions These findings suggest a more frail population in the MILES cohort compared with older adults in USA cohorts. MILES will provide estimates of burden of disease, and disability and risk factors in older adults. Findings will be used to identify potential interventions to prevent disability in this rural Indian population. Geriatr Gerontol Int 2017; 17: 31–40.

  December 21, 2015   doi: 10.1111/ggi.12668   open full text
• Relationship between cardiac autonomic function and cognitive function in Alzheimer's disease.
  Zen Nonogaki, Hiroyuki Umegaki, Taeko Makino, Yusuke Suzuki, Masafumi Kuzuya.
  Geriatrics and Gerontology International. December 08, 2015
  Aim Alzheimer's disease (AD) affects many central nervous structures and neurotransmitter systems. These changes affect not only cognitive function, but also cardiac autonomic function. However, the functional relationship between cardiac autonomic function and cognition in AD has not yet been investigated. The objective of the present study was to evaluate the association between cardiac autonomic function measured by heart rate variability and cognitive function in AD. Methods A total of 78 AD patients were recruited for this study. Cardiac autonomic function was evaluated using heart rate variability analysis. Multiple linear regression analysis was used to model the association between heart rate variability and cognitive function (global cognitive function, memory, executive function and processing speed), after adjustment for covariates. Results Global cognitive function was negatively associated with sympathetic modulation (low‐to‐high frequency power ratio). Memory performance was positively associated with parasympathetic modulation (high frequency power) and negatively associated with sympathetic modulation (low‐to‐high frequency power ratio). These associations were independent of age, sex, educational years, diabetes, hypertension and cholinesterase inhibitor use. Conclusions Cognitive function, especially in the areas of memory, is associated with cardiac autonomic function in AD. Specifically, lower cognitive performance was found to be associated with significantly higher cardiac sympathetic and lower parasympathetic function in AD. Geriatr Gerontol Int 2017; 17: 92–98.

  December 08, 2015   doi: 10.1111/ggi.12679   open full text
• Effectiveness of pacemaker tele‐monitoring on quality of life, functional capacity, event detection and workload: The PONIENTE trial.
  Antonio Lopez‐Villegas, Daniel Catalan‐Matamoros, Emilio Robles‐Musso, Salvador Peiro.
  Geriatrics and Gerontology International. December 04, 2015
  Aims The purpose of the present study was to assess the effectiveness of the remote monitoring (RM) of older adults with pacemakers on health‐related quality of life, functional capacity, feasibility, reliability and safety. Methods The PONIENTE study is a controlled, non‐randomized, non‐blinded clinical trial, with data collection carried out during the pre‐implant stage and after 12 months. Between October of 2012 and November of 2013, 82 patients were assigned to either a remote monitoring group (n = 30) or a conventional hospital monitoring (HM) group (n = 52). The EuroQol‐5D (EQ‐5D) and the Duke Activity Status Index were used to measure health‐related quality of life and functional capacity, respectively. Baseline characteristics and number of hospital visits were also analyzed. Results The baseline characteristics of the two study groups were similar for both the EQ‐5D (RM 0.74, HM 0.67; P = 0.404) and the Duke Activity Status Index (RM 21.42, HM 19.95; P = 0.272). At the 12‐month follow up, the EQ‐5D utility score was improved for both groups (RM 0.91, HM 0.81; P = 0.154), unlike the EQ‐5D Visual Analog Scale (P = 0.043). The Duke Activity Status Index score was similar to the baseline score. The number of in‐hospital visits was 27% lower (3 vs 4; P < 0.001) in the remote group as compared with the hospital group. Conclusions The PONIENTE trial suggests that the remote monitoring of pacemakers in older adults is an equivalent option to hospital monitoring, in terms of health‐related quality of life and functional capacity. Furthermore, it allows for the early detection of clinical and pacemaker‐related adverse events, and significantly reduces the number of in‐hospital visits. Geriatr Gerontol Int 2016; 16: 1188–1195.

  December 04, 2015   doi: 10.1111/ggi.12612   open full text
• Radiographic evaluation of nursing‐ and healthcare‐associated pneumonia.
  Takahiro Haga, Mizuki Fukuoka, Mizuo Morita, Kohei Cho, Koichiro Tatsumi.
  Geriatrics and Gerontology International. December 04, 2015
  Aim Radiographic testing has an important role in the diagnosis and evaluation of pneumonia. The aim of the present study was to evaluate the usefulness of computed tomography (CT), in comparison with chest roentography (CR), in the diagnosis and evaluation of nursing‐ and healthcare‐associated pneumonia (NHCAP) . Methods The utility of CT in the diagnosis of NHCAP was compared with that of CR in a prospective study of patients who visited the emergency room in Nissan Tamagawa Hospital, Tokyo, Japan, with clinical symptoms that were indicative of NHCAP. We also evaluated whether particular CT findings were risk factors for NHCAP‐associated mortality. Results A total of 162 patients with suspected NHCAP were included in the study. The 162 patients included 147 (90.6%) patients who were diagnosed with NHCAP based on the detection of pneumonic infiltration on CT. In contrast, CR was not capable of recognizing pneumonic infiltration in 15 of the 147 (10.2%) patients. A multivariable analysis which was carried out to determine the risk factors for NHCAP‐associated mortality, showed that oxygen desaturation had the greatest odds ratio, followed by a blood urea nitrogen level of ≥21 mg/dL and the detection of bilateral pneumonic infiltration by CT. Conclusions We herein show that CT is superior to CR for the diagnosis and evaluation of NHCAP. The present study will provide a foundation for further studies to clarify whether the use of CT in the diagnosis and evaluation of NHCAP can improve the clinical outcome of patients with NHCAP. Geriatr Gerontol Int 2017; 17: 41–47.

  December 04, 2015   doi: 10.1111/ggi.12669   open full text
• Relationships between the duration of illness and the current status of diabetes in elderly patients with type 2 diabetes mellitus.
  Hiroyuki Ito, Takashi Omoto, Mariko Abe, Suzuko Matsumoto, Masahiro Shinozaki, Shinya Nishio, Shinichi Antoku, Mizuo Mifune, Michiko Togane.
  Geriatrics and Gerontology International. December 04, 2015
  Aims The aim of the present study was to clarify the relationships between the duration of diabetes and the current statuses of diabetes in elderly (aged ≥65 years) patients with type 2 diabetes. Methods Clinical characteristics were cross‐sectionally examined in 1436 patients (684 elderly and 752 non‐elderly) with type 2 diabetes. Results As the duration of diabetes increased, the patients' age, frequency of receiving insulin therapy and glycated hemoglobin value increased in both the elderly and non‐elderly groups, whereas the urinary C‐peptide immunoreactivity and glomerular filtration rate decreased. The duration of diabetes (years) was significantly associated with the prevalence of diabetic retinopathy (OR 1.05, 95% CI 1.03–1.07, P < 0.01), nephropathy (OR 1.03, 95% CI 1.01–1.05, P < 0.01) and neuropathy (OR 1.08, 95% CI 1.05–1.12, P < 0.01), but not with cerebrovascular disease (OR 1.01, 95% CI 0.99–1.03, P = 0.38), coronary heart disease (OR 1.02, 95% CI 1.00–1.04, P = 0.09) or peripheral artery disease (OR 1.02, 95%CI 0.99–1.05, P = 0.12) in the elderly patients after adjusting for the traditional risk factors of diabetic angiopathies. In contrast, the duration of diabetes showed a significant association with the prevalence of both diabetic micro‐ and macroangiopathies in the non‐elderly patients. Conclusions It should be noted that atherosclerotic diseases are present in the clinical setting for the management of elderly diabetic patients independent of the duration of diabetes. Geriatr Gerontol Int 2017; 17: 24–30.

  December 04, 2015   doi: 10.1111/ggi.12654   open full text
• Factors associated with the effect of pulmonary rehabilitation on physical activity in patients with chronic obstructive pulmonary disease.
  Kenro Kanao, Masashi Shiraishi, Yuji Higashimoto, Kazushige Maeda, Ryuji Sugiya, Satoshi Okajima, Yasutaka Chiba, Toshiyuki Yamagata, Katsuhiko Terada, Kanji Fukuda, Yuji Tohda.
  Geriatrics and Gerontology International. December 04, 2015
  Aim Although the effects of pulmonary rehabilitation (PR) have been well defined for chronic obstructive pulmonary disease (COPD), it remains controversial whether PR improves physical activity (PA). The purpose of the present study was to identify factors associated with the effect of PR on PA. Methods This was a prospective study of 29 patients with COPD. They underwent pulmonary rehabilitation twice weekly for 12 weeks, and were assessed using the hospital anxiety and depression score, 6‐min walk distance (6MWD), and the St. George Respiratory Questionnaire (SGRQ) before and after they underwent PR. The PA of patients was measured by a three‐axis accelerometer. Physical activity level (PAL) was calculated by dividing each patient's total energy expenditure by basal metabolic rate. Correlations between changes in PAL after PR and 6MWD, St. George Respiratory Questionnaire, and hospital anxiety and depression score scores, and clinical parameters, including forced expiratory volume in 1 s were determined. Results 6MWD was significantly increased, but PAL was unchanged after PR. PAL was positively correlated with 6MWD, but not with percent predicted forced expiratory volume in 1 s nor St. George Respiratory Questionnaire scores before PR. The increase in PAL was negatively correlated with changes in hospital anxiety and depression score anxiety and depression scores, but was not correlated with the change in 6MWD. Conclusions A PR program for COPD patients improved results of the 6MWD, but not PAL. Increased PAL was associated with improvements in anxiety and depression, but not with increased exercise capacity. Treating the depression and anxiety of patients with COPD might not only reduce emotional distress, but also improve their PAL. Geriatr Gerontol Int 2017; 17: 17–23.

  December 04, 2015   doi: 10.1111/ggi.12656   open full text
• Prevalence and correlates of abuse screening items among community‐dwelling Hong Kong Chinese older adults.
  Doris YP Leung, Shirley KL Lo, Angela YM Leung, Vivian WQ Lou, Alice ML Chong, Joseph SK Kwan, Wallace CH Chan, Iris Chi.
  Geriatrics and Gerontology International. December 02, 2015
  Aim The present study aims to describe the prevalence of potential elder abuse, and to examine correlates of abuse screening items among Chinese community‐dwelling older adults. Methods We analyzed the data of 3435 older persons aged ≥60 years who had first applied for the long‐term care services in Hong Kong and completed the screening tool (Minimum Data Set–Home Care) in 2006. For each of the five abuse screening items (“fearful of a family member/caregiver,” “unexplained injuries/broken bones/burns,” “physically restrained,” “unusually poor hygiene” and “neglected/abused/mistreated”), we examined its relationship with four types of factors: older person, perpetrator, relationship and environment. Results The rates of individual abuse screening items ranged from 3.9% for physically restrained to 0.03% for unexplained injures/broken bones/burns. Physically restrained was positively associated with activities of daily living impairments, instrumental activities of daily living impairments, perceived poor health, physically abusive behavior and caregiver mental health. Unusually poor hygiene was positively associated with socially inappropriate behavior and actively resisted care. “Fearful of a family member/caregiver” was positively associated with perceived poor health, conflicting relationship and mental health, and negatively with care activities. Neglected/abused/mistreated was positively associated with age and informal care, and negatively with care activities. Conclusions We identified a number of associated factors of different abuse screening items among older adults. Our findings could inform healthcare practitioners in identifying those older persons who might be at higher risk of abuse, and provide a knowledge base on which to develop effective preventive measures in the Chinese population. Geriatr Gerontol Int 2017; 17: 150–160.

  December 02, 2015   doi: 10.1111/ggi.12655   open full text
• Speech perception enhancement in elderly hearing aid users using an auditory training program for mobile devices.
  Jyaehyoung Yu, Hanjae Jeon, Changgeun Song, Woojae Han.
  Geriatrics and Gerontology International. December 02, 2015
  Aims The goal of the present study was to develop an auditory training program using a mobile device and to test its efficacy by applying it to older adults suffering from moderate‐to‐severe sensorineural hearing loss. Methods Among the 20 elderly hearing‐impaired listeners who participated, 10 were randomly assigned to a training group (TG) and 10 were assigned to a non‐training group (NTG) as a control. As a baseline, all participants were measured by vowel, consonant and sentence tests. In the experiment, the TG had been trained for 4 weeks using a mobile program, which had four levels and consisted of 10 Korean nonsense syllables, with each level completed in 1 week. In contrast, traditional auditory training had been provided for the NTG during the same period. To evaluate whether a training effect was achieved, the two groups also carried out the same tests as the baseline after completing the experiment. Results The results showed that performance on the consonant and sentence tests in the TG was significantly increased compared with that of the NTG. Also, improved scores of speech perception were retained at 2 weeks after the training was completed. However, vowel scores were not changed after the 4‐week training in both the TG and the NTG. Conclusions This result pattern suggests that a moderate amount of auditory training using the mobile device with cost‐effective and minimal supervision is useful when it is used to improve the speech understanding of older adults with hearing loss. Geriatr Gerontol Int 2017; 17: 61–68.

  December 02, 2015   doi: 10.1111/ggi.12678   open full text
• Lower body function as a predictor of mortality over 13 years of follow up: Findings from Hispanic Established Population for the Epidemiological Study of the Elderly.
  Sanggon Nam, Soham Al Snih, Kyriakos Markides.
  Geriatrics and Gerontology International. December 02, 2015
  Aim The objective of this research was to investigate the effect of lower body function on mortality over 13 years of follow‐up study. Methods Data from the Hispanic Established Population for the Epidemiological Study of the Elderly were used, and the Cox proportional hazard model of mortality on age sex, education, body mass index, Center for Epidemiological Studies Depression Scale, Mini‐Mental State Examination, any activities of daily living, walk score and short physical performance battery was applied. Results Results showed lower body function to be a strong predictor of mortality over 13 years, as indicated by walk and short physical performance battery scores, as well as any activities of daily living, depression and cognitive function. Furthermore, overweight or obese participants tended to live significantly longer over the long term. Conclusions Lower body function significantly impacts mortality at 2, 7 and 13 years of follow‐up study, but this association decreases in magnitude over time. Geriatr Gerontol Int 2016; 16: 1324–1331.

  December 02, 2015   doi: 10.1111/ggi.12650   open full text
• Long‐term care planning and preferences among Japanese American baby boomers: Comparison with non‐Japanese Americans.
  Michiko Iwasaki, Mark E Pierson, Devon Madison, Susan M McCurry.
  Geriatrics and Gerontology International. November 04, 2015
  Aims Nikkei (Japanese American) communities are known to be forerunners for building culturally sensitive long‐term care (LTC) services and programs. Existing literature highlights evolving cultural shifts among Nikkei communities as well as the baby boomers from the previous aging cohort. The present study's primary purpose was to examine Japanese American (JA) boomers' perceptions about their LTC planning compared with their non‐JA counterparts. JA's residential and care preferences were also examined. Methods The study applied survey methodology with a total of 499 “boomers” (age 51–71 years) in the state of Washington. Data obtained from JA (n = 264) were compared with the data from non‐JA Washingtonians (non‐JA, n = 235). Data from an additional subset of questions asking JA's preferences for retirement/LTC facilities were also analyzed. Results The findings showed similarities and differences between the two groups. No group differences were found with regard to caregiving experiences, exposure to LTC, expectation of requiring future LTC or physical proximity to their adult children. JA boomers, however, showed more knowledge about LTC‐related facts, stronger preference to avoid becoming dependent on their families and a higher rate of LTC insurance purchases. JA boomers ranked higher preferences on culturally universal elements (e.g. transportation services, Internet access) for their retirement and LTC facilities over Japanese cultural‐specific elements. JA boomers also preferred to reside with a mixture of racial/ethnic residents. Conclusions The present study suggests that the LTC industry including JA communities should accommodate boomers' retirement plans and preferences with a multicultural selection of services and settings. Geriatr Gerontol Int 2016; 16: 1074–1084.

  November 04, 2015   doi: 10.1111/ggi.12601   open full text
• Comparison of the prevalence of sarcopenia using skeletal muscle mass index and calf circumference applying the European consensus definition in elderly Mexican women.
  Maria Consuelo Velazquez‐Alva, Maria Esther Irigoyen Camacho, Irina Lazarevich, Jaime Delgadillo Velazquez, Patricia Acosta Dominguez, Marco A Zepeda Zepeda.
  Geriatrics and Gerontology International. November 04, 2015
  Aim To compare the prevalence of sarcopenia using two indicators: skeletal muscle mass index (SMI) and calf circumference (CC) used in the algorithm proposed by the European Working Group on Sarcopenia in Mexican elderly women. Methods This was a cross‐sectional study. Lean body mass was determined by dual‐energy X‐ray absorptiometry. To define sarcopenia, the SMI was obtained using a cut‐off value of 5.5 kg/m2, and the CC cut‐off was 31 cm. For gait speed and handgrip strength, the cut‐off values were 0.8 m/s and 20 kg, respectively. Results A total of 137 women (mean age 73.8 ± 6.7 years) participated in the study. The prevalence of sarcopenia was 14.6% using SMI and 11.0% using CC (P = 0.009). Body mass index was associated with a lower probability of sarcopenia applying SMI or CC (OR 0.75, P = 0.002 for SMI and OR 0.71, P = 0.004 for CC). Sarcopenia evaluated either with dual‐energy X‐ray absorptiometry or CC was not associated with physical performance, such as five times chair stand test, timed up and go test and short physical performance battery. Additionally, SMI was not associated with physical performance, five times chair stand test (P = 0.775) and timed up‐and‐go test (P = 0.341). Conclusions The prevalence of sarcopenia in active elderly women was low. A higher prevalence of sarcopenia was detected using SMI compared with CC. It is important to identify the best methods to assess skeletal muscle mass to obtain a reliable diagnosis of sarcopenia. Geriatr Gerontol Int 2017; 17: 161–170.

  November 04, 2015   doi: 10.1111/ggi.12652   open full text
• Comparison of quality of sleep, depression, and life satisfaction between older adults in nursing homes and long‐term care hospitals in Korea.
  Kon Hee Kim, Eun Hee Hwang.
  Geriatrics and Gerontology International. November 04, 2015
  Aim The purpose of the present study was to identify the sleep quality, depression, and life satisfaction between nursing home and long‐term care hospital residents. Methods Data was collected through a structured questionnaire survey of 61 nursing home residents and 74 long‐term care hospital residents. Descriptive statistics, t‐test, χ2‐test, anova, Pearson's correlation were used to analyze the data. Results The residents living in a nursing home showed higher subjective health status and sleep quality than long‐term care hospital residents. Depression did not show a significant difference between them. However, there was a significant difference in depression score by subjective health status. Sleep quality and depression showed a significant negative correlation for both residents. In terms of depression and life satisfaction, nursing home residents showed a significant negative correlation, and long‐term care hospital residents showed a significant positive correlation. Conclusions These results show that environmental management is essential to enhance sleep quality, thus depression and subjective health status will be improved. Geriatr Gerontol Int 2017; 17: 142–149.

  November 04, 2015   doi: 10.1111/ggi.12651   open full text
• Effects of spousal illness on self‐rated health in older couples: Role of sex and proximity to adult children.
  Tami Saito, Tomoko Wakui, Ichiro Kai.
  Geriatrics and Gerontology International. November 04, 2015
  Aims The present study examined the impact of serious spousal illness or hospitalization on community‐dwelling older adults' self‐rated health (SRH), and explored the moderating effects of sex and residential proximity to adult children using a prospective and representative survey design. Methods The sample was obtained from a 2‐year longitudinal survey of non‐institutionalized men and women aged 65 years and older carried out in the Fukui Prefecture, Japan (n = 1573). The effect of serious spousal illness or hospitalization on SRH during the survey period was examined after controlling for baseline SRH, sex, age, socioeconomic status, chronic illness and other baseline covariates. Results Overall, 15.7% of respondents had experienced a serious spousal illness or hospitalization within the previous year. After controlling for covariates, spousal illness had a significant negative effect on SRH at follow‐up (P = 0.031). More serious effects of spousal illness were found in older adults whose children lived farther than 30 min away than in couples who lived with their children (P = 0.009). However, there was no significant interaction effect between sex and spousal illness. Conclusions Serious spousal illness could cause deterioration in the health of older spouses, particularly for older parents whose children live a distance away. Geriatr Gerontol Int 2016; 16: 1332–1338.

  November 04, 2015   doi: 10.1111/ggi.12646   open full text
• Characteristics of colonoscopic findings in the very elderly.
  Yasuo Tanaka, Tomio Arai, Satoko Uegaki, Mina Sasaki, Nobuo Kanazawa, Takashi Inamatsu.
  Geriatrics and Gerontology International. November 04, 2015
  Aim To determine the incidence and endoscopic types of colorectal lesions diagnosed with colonoscopy in elderly patients. Methods Consecutive Japanese patients who underwent colonic endoscopy between 1994 and 2007 (n = 5145; 2245 men and 2900 women, age 20–101 years) were examined retrospectively. Correlations between age, sex and number of lesions were analyzed. Results The incidence of advanced tumors was significantly correlated with increasing age in men (P = 0.02), and tumors were detected mainly in the sigmoid colon and rectum in both sexes. Right‐sided colon cancer was significantly more common in women compared with men (P < 0.001). Polyps were detected throughout the colon, and their incidence was correlated significantly with increasing age in women (P = 0.01). Diverticula were frequently detected in the ascending and sigmoid colon in both sexes. Left‐sided diverticula were significantly more common in women compared with men (P < 0.001). Lateral spreading tumors were detected mainly in the cecum in both sexes. Though the number of cases with angioectasia was small, angioectasia was slightly more common in the cecum and the ascending colon in women. Conclusions In the present study, the incidence of advanced tumors correlated with increasing age in men, and right‐sided cases were significantly more common in women than in men. The incidence of polyps correlated with increasing age in women. Left‐sided diverticula were significantly more common in women than in men. Geriatr Gerontol Int 2016; 16: 1319–1323.

  November 04, 2015   doi: 10.1111/ggi.12648   open full text
• Peripheral oxidative stress markers in diabetes‐related dementia.
  Hirokuni Hatanaka, Haruo Hanyu, Raita Fukasawa, Tomohiko Sato, Soichiro Shimizu, Hirofumi Sakurai.
  Geriatrics and Gerontology International. November 04, 2015
  Aims We previously found that there was a dementia subgroup with characteristics predominantly associated with diabetes mellitus (DM)‐related metabolic abnormalities, referred to as “diabetes‐related dementia (DrD).” We determined the possible role of oxidative stress in the pathophysiology of DrD. Methods In a 2013 study, we classified 175 patients with clinically diagnosed Alzheimer's disease (AD) and DM into four subgroups based on brain imaging. Among them, we measured endogenous plasma anti‐oxidants, such as albumin, unconjugated bilirubin and uric acid, and urinary 8‐hydroxy‐2′‐deoxyguanosine and 8‐isoprostane in 58 patients of an AD group showing decreased regional cerebral blood flow of the parietotemporal lobe on single‐photon emission computed tomography (AD+DM group), and in 35 patients of a DrD group showing neither decreased regional cerebral blood flow of the parietotemporal lobe nor cerebrovascular disease on magnetic resonance imaging, which is strongly associated with DM‐related factors. A total of 31 patients with AD and without DM (AD−DM group) were enrolled as a control group. Results The DrD group showed a significant decrease in plasma levels of anti‐oxidants, and a significant increase in urinary 8‐hydroxy‐2′‐deoxyguanosine and 8‐isoprostane levels in contrast to the AD−DM and AD+DM groups. Cognitive performance was negatively correlated with urinary 8‐hydroxy‐2′‐deoxyguanosine and 8‐isoprostane levels in the DrD group. Conclusions These results strongly suggest that a decrease in anti‐oxidant levels and an increase in oxidative damage might be involved in the pathophysiology and cognitive decline associated with DrD. Geriatr Gerontol Int 2016; 16: 1312–1318.

  November 04, 2015   doi: 10.1111/ggi.12645   open full text
• Instructions influence response to the Chinese version of the Movement‐Specific Reinvestment Scale in community‐dwelling older adults.
  Thomson WL Wong, Bruce Abernethy, Rich SW Masters.
  Geriatrics and Gerontology International. November 04, 2015
  Aim To examine whether differences emerged when the Chinese version of the Movement‐Specific Reinvestment Scale (MSRS‐C) was administered to community‐dwelling older adults with instructions to respond in the context of “general” movements, walking, using chopsticks or dressing. Furthermore, the difference between the six‐point Likert scale and four‐point Likert scale response formats of the MSRS‐C was investigated. Methods The study was implemented in the community of Hong Kong with 52 older adults (mean age 77.4 years). Telephone interviews were carried out on two occasions for each participant. Participants provided a verbal response to each of 10 questions from the MSRS‐C with different response formats (i.e., six‐point or four‐point Likert Scales) and different instructions in the response context (i.e. general, walking, using chopsticks, dressing). The sequence of response format and context was randomized for each participant. Results Older fallers scored significantly higher on the MSRS‐C (general) with six‐point or four‐point response formats than non‐fallers. The MSRS‐C (general) and MSRS‐C (walking) were not statistically different, and showed good discriminative power for previous older fall status (older fallers or older non‐fallers). However, MSRS‐C (chopsticks) and MSRS‐C (dressing) failed to differentiate older fallers from older non‐fallers. Conclusion Both the MSRS‐C (general) and MSRS‐C (walking) with a six‐point or a four‐point response format showed good discrimination of older fallers from non‐fallers. Older adults might respond to the MSRS‐C with respect to the most challenging movements (e.g. fall‐related movements) in their daily living. Geriatr Gerontol Int 2016; 16: 1305–1311.

  November 04, 2015   doi: 10.1111/ggi.12644   open full text
• Kinship moderates the association between a demented individual's behavioral disturbance and a caregiver's burden: Findings from a national survey in Taiwan.
  Linen Nymphas Lin, Shwu‐Chong Wu.
  Geriatrics and Gerontology International. November 04, 2015
  Aim The present study aimed to assess the moderating role of kinship between the behavioral disturbance of care recipients (CRs) with dementia and the caregivers' (CGs') burden in Taiwan. Methods The data of 965 CG‐CR dyads on the behavioral disturbance of CR with dementia, CG burden, CG kinship to CR and other relevant variables were obtained from the Assessment of the National Long‐Term Care Need in Taiwan (ANLTCNT). To test the moderating effect of CG‐CR kinship on the association between behavioral disturbance of CR and CG burden, a series of hierarchical multiple linear regression models were used after controlling for potential factors associated with CG burden. Results Different kinships had significant differences in terms of burden, except for relational burden. The interaction terms (of CRs' behavioral disturbance by kinship) were not significant on burden of time and emotional burden. On relational burden, the impact of CRs' behavioral disturbance on CG burden was significantly higher for a wife than for a daughter‐in‐law or a son. The impact of CRs' behavioral disturbance on financial burden was lower for a wife than for a daughter‐in‐law. In terms of the total burden, the impact of CRs' behavioral disturbance was higher for a daughter than for a son. Conclusion These findings highlight the importance of CG kinship to CR moderating the association between the CRs' level of behavioral disturbance and the CGs' relational, financial, and total burden, when refining kinship‐oriented interventions for community services to CRs with dementia and their CGs. Geriatr Gerontol Int 2016; 16: 1272–1280.

  November 04, 2015   doi: 10.1111/ggi.12634   open full text
• Interdisciplinary intervention reduced the risk of being persistently depressive among older patients with hip fracture.
  Ming‐Yueh Tseng, Yea‐Ing L Shyu, Jersey Liang, Wen‐Che Tsai.
  Geriatrics and Gerontology International. October 23, 2015
  Aim To assess the effects of an interdisciplinary intervention on the trajectories of depressive symptoms among older patients during 2 years after hip fracture surgery. Methods A secondary analysis of data from a randomized controlled trial that contrasted usual care with an interdisciplinary program. Whereas usual care (n = 77) entailed only in‐hospital rehabilitation and occasional discharge planning, the interdisciplinary program (n = 76) consisted of geriatric consultation, in‐hospital rehabilitation, discharge planning and rehabilitation at home for 3 months after hospitalization. Depressive symptoms were assessed by using the Chinese version of the Geriatric Depression Scale short‐form, before discharge, and 1, 3, 6, 12, 18 and 24 months after discharge. Covariates included demographic attributes, pre‐fracture performance of activities of daily living (Chinese Barthel Index) and cognitive functioning (Mini‐Mental State Examination). Results Changes in depressive symptoms can be characterized by three trajectory groups, including a non‐depressive group (n = 58, 37.8%), a marginally depressive group (n = 46, 30.7%) and a persistently depressive group (n = 49, 31.5%). Relative to those who received usual care, participants in the interdisciplinary program had a significantly lower risk of being in the persistently depressive group (odds ratio 0.23, P < 0.05). In addition, women and those physically and cognitively more impaired were more likely to be in the marginally and persistently depressive groups. Conclusions Our interdisciplinary intervention reduced older persons' likelihood of having persistent depressive symptoms after hip fracture surgery. Geriatr Gerontol Int 2016; 16: 1145–1152.

  October 23, 2015   doi: 10.1111/ggi.12617   open full text
• Age and sex differences in the taste sensitivity of young adult, young‐old and old‐old Japanese.
  Masaki Yoshinaka, Kazunori Ikebe, Masahiro Uota, Taiji Ogawa, Tadashi Okada, Chisato Inomata, Hajime Takeshita, Yusuke Mihara, Yasuyuki Gondo, Yukie Masui, Kei Kamide, Yasumichi Arai, Ryutaro Takahashi, Yoshinobu Maeda.
  Geriatrics and Gerontology International. October 23, 2015
  Aim The present study examined sex and age differences in taste sensitivity among young adult, young‐old and old‐old Japanese. Methods Participants were divided into three groups comprising 477 men and 519 women in the young‐old group (aged 69–71 years), 449 men and 500 women in the old‐old group (aged 79–81 years), and 35 men and 35 women in the young adult group (aged 24–32 years). Recognition thresholds for the four basic tastes were measured using the 1‐mL whole mouth gustatory test, in which taste solutions of the four basic tastes were tested in five concentrations. Results Young adults showed significantly lower recognition thresholds than the young‐old group, and the young‐old group showed significantly lower recognition thresholds than the old‐old group. Among the young‐old and old‐old groups, women showed significantly lower recognition thresholds than males for sour, salty and bitter tastes, but there was no sex difference in the sweet taste threshold between the two groups. Conclusions The present study confirmed that there are age and sex differences in taste sensitivity for the four basic tastes among young adult, young‐old, and old‐old Japanese, and that the sensitivity of sweet taste is more robust than the other tastes. Geriatr Gerontol Int 2016; 16: 1281–1288.

  October 23, 2015   doi: 10.1111/ggi.12638   open full text
• Impact of potentially inappropriate medication and continuity of care in a sample of Taiwan elderly patients with diabetes mellitus who have also experienced heart failure.
  Yung‐Rung Lai, Yi‐Sun Yang, Min‐Ling Tsai, Ying‐Li Lu, Edy Kornelius, Chien‐Ning Huang, Jeng‐Yuan Chiou.
  Geriatrics and Gerontology International. October 23, 2015
  Aims Continuity of care (COC) and potentially inappropriate medication (PIM) can affect the elderly healthcare outcome. We evaluated the COC and PIM effects in older diabetes mellitus (DM) patients with heart failure (HF). Methods The Longitudinal Health Insurance Database of 2005 was multiple‐year claim data collected from 2005 to 2010 in Taiwan. There were both 823 DM and non‐DM subjects aged 65 years and older in this observational study. The COC index and 2012 Beers criteria were applied to evaluate the COC and HF‐PIM in older DM patients with heart failure. The dependent variables were either hospital admissions or emergency department visits. Generalized estimating equation was used to adjust all covariates. Results During 2005–2010, the rate of HF‐PIM in the elderly DM group was 86.1%, the mean COC index was 0.28 ± 0.19, the admission rate was 31.9% and the emergency department rate was 38.8 %. Lower COC index was associated with HF‐PIM and HF‐PIM duration in older DM patients with HF. Lower COC index was associated with hospitalizations (OR 0.07, 95% CI 0.05–0.11) and ED visits (OR 0.10, 95% CI 0.07–0.13), but HF‐PIM was not significant. The duration of HF‐PIM was related with poor health outcomes over 90 and 180 days for hospitalization and emergency department visit, respectively. Conclusion Among elderly DM patients with HF, COC had positive effects on healthcare outcomes. Improving COC and reducing PIM duration for elderly DM patients with HF seems warranted. Geriatr Gerontol Int 2016; 16: 1117–1126.

  October 23, 2015   doi: 10.1111/ggi.12606   open full text
• Systematic review of the barriers affecting medication adherence in older adults.
  Angela Frances Yap, Thiru Thirumoorthy, Yu Heng Kwan.
  Geriatrics and Gerontology International. October 20, 2015
  Medication adherence is a crucial part in the management of chronic diseases. As older adults form a greater proportion of the population with chronic diseases and multiple morbidities, understanding medication adherence in older adults becomes important. In the present article, we aimed to systematically review the literature for the factors associated with medication adherence in the geriatric population. We carried out a literature search using electronic databases and related keywords. 17 391 articles were reviewed in total. 65 articles were found to be relevant to our objective. A total of 80 factors of five different categories were found to be associated with medication adherence in older adults. The factors, the types of studies and the number of studies that agreed or disagreed were presented. A flower model for medication adherence was also presented to allow clinicians to better understand the complex nature of medication adherence in this population. The 80 factors reviewed were categorized into five main categories; namely, patient factors, medication factors, physician factors, system‐based factors and other factors as factors affecting poor medication adherence in older adults. Clinicians need to be mindful of the complex nature of factors affecting medication adherence in this population to optimize therapeutic outcomes. Clinicians have to be more skillful to discover and to optimize the medication adherence factors in geriatric patients. The flower model is presented as a framework for clinicians to better understand the various factors affecting medication adherence in older adults. Geriatr Gerontol Int 2016; 16: 1093–1101.

  October 20, 2015   doi: 10.1111/ggi.12616   open full text
• Construct validity of posture as a measure of physical function in elderly individuals: Use of a digitalized inclinometer to assess trunk inclination.
  Yoshikazu Suzuki, Hisashi Kawai, Motonaga Kojima, Yoshitaka Shiba, Hideyo Yoshida, Hirohiko Hirano, Yoshinori Fujiwara, Kazushige Ihara, Shuichi Obuchi.
  Geriatrics and Gerontology International. October 13, 2015
  Aim The first aim of the present study was to determine the construct validity of evaluating posture as a measure of physical function in elderly individuals. The second aim was to determine reference values for sternum inclination in elderly individuals when measured using a digitalized inclinometer. Methods We included 834 community‐dwelling elderly individuals (350 men and 484 women) in this study. We used a digital inclinometer for measuring sternum inclination angle. We evaluated physical functions, including muscle strength, static balance, gait ability and the functional mobility of our study participants. To assess the construct validity of sternum inclination in elderly people, Pearson's correlation coefficient between sternum inclination and participant characteristics was calculated. To determine a reference value of sternum inclination by age, P for trend was calculated. Results In men, the sternum inclination angle and sternum inclination index were significantly associated with all anthropometric measures, except static balance. In women, the sternum inclination index was significantly associated with all measures, whereas the sternum inclination angle was associated with all measures except for balance and the Timed Up and Go test. Trend of sternum inclination index by age was significant. Conclusions Our results show that the sternum inclination as a measure of physical function in elderly men and women has construct validity. We determined reference values for sternum inclination of which trend by age was considered. Geriatr Gerontol Int 2016; 16: 1068–1073.

  October 13, 2015   doi: 10.1111/ggi.12600   open full text
• Dimensions of stereotypical attitudes among older adults: Analysis of two countries.
  Edward Helmes, Nancy A Pachana.
  Geriatrics and Gerontology International. October 13, 2015
  Aim Much research on attitudes towards older adults has used younger adults as participants and identified a range of negative attitudes towards older persons. Comparatively little literature has explored the attitudes of older adults themselves towards their own age cohort. Methods The present study explicitly compared attitudes towards other older adults from samples of 195 older adults in Australia and 172 older Canadians. Attitudinal measures included the Aging Attitudes Questionnaire (assesses older adults' attitudes toward other older adults), Fraboni Scale of Ageism (assesses younger adults' attitudes toward older adults) and the Reactions to Aging Questionnaire (assesses attitudes toward one's own aging), as well as a scale measuring knowledge of aging, the Facts on Aging Quiz, adapted for Australia and Canada. Responses on the three attitudinal measures were subjected to principal components analysis. Results Two components emerged in both samples, one defined by the Reactions to Aging Questionnaire and Aging Attitudes Questionnaire scales and the second by the Fraboni Scale of Ageism scales. Regression analyses to ascertain prediction of scores on the Facts on Aging Quiz, adapted for Australia and Facts on Aging Quiz, adapted for Canada showed that only the Aging Attitudes Questionnaire scale for Physical Changes predicted scores on the Facts on Aging Quiz, adapted for Australia and no attitudes predicted Facts on Aging Quiz, adapted for Canada scores. Conclusions It appears that older adults distinguish between their own aging and aging in others. Knowledge of aging appears to be predicted only by attitudes toward physical changes. Given increasing proportions of older adults in the population, as well as increasing access to aging information available to older cohorts, continued research on how older adults view themselves and the aging process is important, and will almost certainly continue to evolve over time. Geriatr Gerontol Int 2016; 16: 1226–1230.

  October 13, 2015   doi: 10.1111/ggi.12613   open full text
• Autobiographical memory for the differential diagnosis of cognitive pathology in aging.
  Juan C Meléndez, Rita Redondo, Marta Torres, Teresa Mayordomo, Alicia Sales.
  Geriatrics and Gerontology International. October 13, 2015
  Aim The present study distinguishes three memory stages across the lifespan, and aims to compare episodic and semantic autobiographical memory in healthy older adults, with amnesic mild cognitive impairment, and with Alzheimer's disease. This information can offer evidence about the way semantic and episodic autobiographical memory work, and how the disease affects them. Methods The sample was composed of 56 people, all aged over 60 years; 15 with amnestic mild cognitive impairment, 12 with Alzheimer's disease and 29 healthy older people. Participants were evaluated with the Autobiographical Memory Interview. Results A mixed anova showed significant main effects of memory and time‐period, and significant interactions of memory × group, time‐period × group and memory × time × group. Discussion Assessment of autobiographical memory provides information to differentiate amnestic mild cognitive impairment patients from Alzheimer's disease patients. Although the decline in episodic memory starts with the onset of the disease, semantic memory is maintained until moderate stages of dementia. Geriatr Gerontol Int 2016; 16:1220–1225.

  October 13, 2015   doi: 10.1111/ggi.12611   open full text
• Relationship among health‐related quality of life, depression and awareness of home care services in elderly patients.
  Ülkü Polat, Burcu Bayrak Kahraman, İlknur Kaynak, Ümit Görgülü.
  Geriatrics and Gerontology International. October 13, 2015
  Aims The present descriptive study was carried out to determine the relationship between health‐related quality of life, depression and awareness of home care services among elderly patients. Methods Patients aged 65 years or older staying at the surgery and internal medicine clinics were included in the study. The “Patient Introduction Form,” “Short Form‐36 Quality of Life Questionnaire” and “Geriatric Depression Scale” were utilized in the collection of data. Results In the present study, it was determined that only approximately half of elderly patients (54.9%) knew the concept of home care, most of them had not previously received home care and requested home care related to medical care. The mean scores were lower in some areas of the quality of life questionnaire in some factors that could influence home care awareness. These factors were determined as: female sex, history of falling, chronic illness, functionally, moderately or severely dependent, no previous receipt of home care and wishing to receive home care. Conclusions The home care requirement of elderly patients can be influenced by many physiological, psychological and social factors that can affect their quality of life. Thus, it is of utmost importance that medical professionals evaluate the quality of life of elderly individuals and its influencing factors. Geriatr Gerontol Int 2016; 16: 1211–1219.

  October 13, 2015   doi: 10.1111/ggi.12618   open full text
• Interview‐ and questionnaire‐based surveys on elderly patients' wishes about artificial nutrition and hydration during end‐of‐life care.
  Yasuhiro Yamaguchi, Hiromi Mori, Masaki Ishii, Sohshi Okamoto, Kiyoshi Yamaguchi, Setsu Iijima, Sumito Ogawa, Yasuyoshi Ouchi, Masahiro Akishita.
  Geriatrics and Gerontology International. October 13, 2015
  Aim To promote advance directives, it is crucial to understand how many older persons have wishes related to end‐of‐life care. Additionally, it is important to understand how cognitive function or mood affect these wishes. Methods For the interview‐based survey, 99 inpatients aged 75 years or older were enrolled after excluding patients with a Mini‐Mental State Examination score of 20 or less. For the questionnaire‐based survey, 99 outpatients aged 75 years or older without dementia were enrolled. Both surveys comprised the same items on older patients' wishes related to artificial nutrition and hydration (ANH) during end‐of‐life care. Results Of the total enrolled patients, 76.8% participated in the interviews. Of these, 50.0% were against ANH during their end‐of‐life care, including the patients who were definitely against ANH (26.3%). In contrast, just 5.3% wished to receive ANH. In the questionnaire survey, 65.6% of the respondents were against ANH, and 4.9% wished to receive ANH. Aging and Mini‐Mental State Examination scores of less than 24 were significantly associated with a higher tendency to decline from participating in the interview. However, the distribution of the interview answers was not associated with age, Mini‐Mental State Examination or Geriatric Depression Scale scores. Of the interviewed patients, 84.2% agreed to their responses being preserved in their medical records. Conclusions Although the majority of the elderly patients were against ANH during end‐of‐life care, many patients did not have definite wishes in Japan. The percentage of those who were against ANH was not associated with cognitive function or depressive state. Geriatr Gerontol Int 2016; 16: 1204–1210.

  October 13, 2015   doi: 10.1111/ggi.12615   open full text
• Perceived poor health is positively associated with physical limitations and chronic diseases in Brazilian nonagenarians and centenarians.
  Emerson Sebastião.
  Geriatrics and Gerontology International. October 13, 2015
  Aim The oldest old are in most need of help. The present study examined the association between perceived health, physical functioning and diagnosed chronic disease in a sample of Brazilian nonagenarians and centenarians. Methods The 2008 Brazilian Household Survey dataset was used. The 2008 Brazilian Household Survey interviewed 292 553 individuals aged 14 years and older from the 26 Brazilian states plus the Federal District, selected in a multistage procedure. Our analytical sample focused on those aged 90 years and older. This yielded a final sample of 819 individuals. Logistic regression was used to examine the association between self‐reported health and health conditions. Results Nearly 7% (n = 56) of the total sample were centenarians. High rates of physical limitations and chronic disease were reported by the participants. Participants reporting their health as poor were, on average, twofold more likely to report limitations in activities of daily living, and 1.7‐fold more likely to report a chronic disease. Conclusions Perceived poor health was positively associated with physical limitations and chronic disease in Brazilian oldest‐old. These findings highlight the need for feasible interventions aiming to improve health and quality of life in this population, especially because this is the fastest growing age group worldwide. Geriatr Gerontol Int 2016; 16: 1196–1203.

  October 13, 2015   doi: 10.1111/ggi.12614   open full text
• Effect of early rehabilitation on activities of daily living in patients with aspiration pneumonia.
  Maiko Yagi, Hideo Yasunaga, Hiroki Matsui, Kiyohide Fushimi, Masashi Fujimoto, Teruyuki Koyama, Junko Fujitani.
  Geriatrics and Gerontology International. October 13, 2015
  Aim To assess the effect of early rehabilitation on improving activities of daily living (ADL) in elderly patients with aspiration pneumonia. Methods Using the Japanese Diagnosis Procedure Combination inpatient database, we retrospectively analyzed consecutive patients with aspiration pneumonia at admission who received early rehabilitation (n = 48 201) or did not receive any rehabilitation (n = 64 357) from July 2010 to March 2013. Early rehabilitation was defined as any type of physical rehabilitation initiated within 7 days after admission. The proportions of improved ADL scores from admission to discharge were compared between the early rehabilitation group and the non‐rehabilitation group using a multivariable logistic regression analysis and instrumental variable analysis. Results The proportion of improved ADL scores was higher in the early rehabilitation group than in the non‐rehabilitation group (25.4% vs 33.9%; P < 0.001). The multivariable logistic regression analysis showed that the early rehabilitation group exhibited significant improvement in ADL (odds ratio 1.57; 95% confidence interval 1.50–1.64; P < 0.001). The instrumental variable analysis showed that early rehabilitation was associated with increased proportion of improved ADL (risk difference 8.2%; 95% confidence interval 6.9–9.5%; P < 0.001). Conclusions The present results suggest that early rehabilitation might improve ADL during hospitalization in patients with aspiration pneumonia. Geriatr Gerontol Int 2016; 16: 1181–1187.

  October 13, 2015   doi: 10.1111/ggi.12610   open full text
• Adherence to prescribed medications for chronic illnesses among older adults in a rural community, Karnataka, India.
  Shailendra Kumar B Hegde, Farah Naaz Fathima, Twinkle Agrawal, Dominic Misquith.
  Geriatrics and Gerontology International. October 13, 2015
  Aim To assess adherence to prescribed medications for chronic illnesses and to identify factors associated with it among rural older adults. Methods A cross‐sectional study was carried out from September to November 2011 in three subcenters in Lakkur PHC, Kolar District, India. All older adults were listed, and those suffering from chronic non‐communicable diseases were included in the study. A structured interview schedule comprising of 48 items was used to measure adherence, and to identify factors associated with adherence in the domains of socioeconomic status, therapy, health systems, patient behavior and physical factors. Results Of the 184 older adults included in the study, 63.6% were fully adherent to their medication. Non‐adherence to medication showed a statistically significant relationship with the absence of a medical store within their village, non‐availability of drugs at the nearest medical store, inability to understand the doctor's language, failure to explain the consequences of not taking medicines by the healthcare provider, self‐alteration of medicine dosage, fear that medicines will lead to the development of dependence to medicines and difficulty in swallowing. Those who led busy lives, those who had been prescribed three or more types of medicines prescribed per day, those who required special skills to take medicines (injections, inhalers), those who had made adjustments to their usual lifestyle to take medicines and those who had knowledge that medicines need to be taken lifelong were more likely to be adherent to their medications. Four factors, namely, the doctor explaining the consequences of not taking medicines, altering the dosage of the medicines by the patients themselves, the number of medicines prescribed per day and having the knowledge that medicines need to be taken lifelong, were critical determinants of adherence to medications. Geriatr Gerontol Int 2016; 16: 1339–1345.

  October 13, 2015   doi: 10.1111/ggi.12637   open full text
• Age‐related changes in prefrontal oxygenation during memory encoding and retrieval.
  Kazuki Uemura, Takehiko Doi, Hiroyuki Shimada, Hyuma Makizako, Hyuntae Park, Takao Suzuki.
  Geriatrics and Gerontology International. October 13, 2015
  Aim Memory dysfunction is a major component of age‐related cognitive decline, and is a marker of cognitive impairment. Emerging evidence suggests that the prefrontal cortex is required for maintenance of memory functions. The purpose of the present study was to elucidate age‐related changes in prefrontal oxygenation during memory encoding and retrieval using near‐infrared spectroscopy. Methods We examined 21 young (mean age 24.3 years), 52 young‐old (mean age 69.7 years) and 50 old‐old (mean age 79.5 years) participants. The concentration of oxyhemoglobin, which is a reliable biomarker of changes in regional cerebral blood flow, in the right and left prefrontal cortex was measured during encoding and delayed retrieval of a list of 10 target words. The average number of correct answers in the retrieval task was used as a measure of task performance. Results During encoding, oxyhemoglobin was significantly and bilaterally lower in young‐old and old‐old participants compared with young participants. Meanwhile, during retrieval, only old‐old participants showed significantly decreased oxyhemoglobin compared with young and young‐old participants. The old‐old participants showed fewer correct answers in the retrieval period than the young and young‐old participants. Conclusions Old‐old participants showed reduced prefrontal oxygenation during both encoding and retrieval, and decreased memory performance compared with younger participants. It is necessary for the clinical application of near‐infrared spectroscopy to consider the effects of demographic variables on cerebral oxygenation. Geriatr Gerontol Int 2016; 16: 1296–1304.

  October 13, 2015   doi: 10.1111/ggi.12642   open full text
• Dietary patterns and depressive symptoms in a Taiwanese population aged 53 years and over: Results from the Taiwan Longitudinal Study of Aging.
  Hsin‐Jen Tsai.
  Geriatrics and Gerontology International. October 13, 2015
  Aim The present study aimed to examine the associations between dietary patterns and depressive symptoms in a Taiwanese population aged 53 years and over, and evaluate the longitudinal impacts of dietary patterns on depressive symptoms. Methods Data were from the Taiwan Longitudinal Study of Aging. Result Depressive symptoms were identified in 23% of adults aged ≥53 years. Multivariate logistic regression analysis showed that a Western dietary pattern, which was characterized by frequent consumption of meat/poultry and eggs, with infrequent consumption of fish, beans/legumes, vegetables and fruit, was cross‐sectionally associated with a high risk of depressive symptoms (P < 0.05). A traditional dietary pattern, which was characterized by frequent consumption of meat/poultry and eggs with infrequent consumption of fish, increased by 60% the risk of depressive symptoms during the subsequent 8 years (P < 0.05). A healthy dietary pattern, which was characterized by frequent consumption of fish, vegetables and fruits, was not significantly associated with subsequent depressive symptoms. Conclusions Dietary patterns correlate with depressive symptoms in a Taiwanese population aged 53 years and over. The Western and traditional dietary patterns, characterized by frequent consumption of meat/poultry and eggs, and infrequent consumption of fish, increased the risk of current and subsequent depressive symptoms. Geriatr Gerontol Int 2016; 16: 1289–1295.

  October 13, 2015   doi: 10.1111/ggi.12641   open full text
• Cardiac reoperations in octogenarians: Do they really benefit?
  Heinz Deschka, Matthias Machner, Henryk Welp, Angelo Maria Dell'Aquila, Stefan Erler, Gerhard Wimmer‐Greinecker.
  Geriatrics and Gerontology International. October 13, 2015
  Aim According to the demographic development of our society, the numbers of octogenarians referred to cardiac surgery are continuously growing. Although the benefit of first‐time cardiac procedures for these patients is well documented, the fate of octogenarians after redo‐procedures, with special regard to long‐term survival, functional status and quality of life, is poorly investigated. Methods We retrospectively identified 84 consecutive patients aged ≥80 years, who underwent a cardiac reoperation at the department for Cardiothoracic Surgery in the Heart & Vessel Center Bad Bevensen between January 2007 and 2013. Demographic profiles as well as operative data were analyzed, and the patients were prospectively followed. Patient's functional status and quality of life were assessed with the Barthel Index, New York Heart Association class and the short form‐12 questionnaire. Results The mean age of the study group (61 men, 23 women) was 81.9 ± 1.9 years. Most redo‐procedures were carried out after primary coronary artery bypass grafting (65%), primary aortic valve replacement (21%) and primary mitral valve replacement (6%). The most frequent actual surgical procedures were combined coronary artery bypass grafting and aortic valve replacement (26%), isolated coronary artery bypass grafting (19%), and isolated aortic valve replacement (19%). The mean length of hospital stay was 17 ± 15 days. In‐hospital mortality counted for 32.1%. During follow up (29 ± 20 months) a further 19.0% of the patients died. The Barthel Index of the survivors was 89 ± 17 and their mean New York Heart Association class was 2 ± 1. A total of 93% of the patients were living at home. Summary scores of physical and mental health of the short form‐12 questionnaire equalled those of an age‐ and sex‐matched normative population. Conclusions Despite high perioperative mortality, results document a sustainable recovery of the survivors offering the prospect of a highly independent and satisfying life. Therefore, advanced age alone should not be a contraindication for redo cardiac interventions. Geriatr Gerontol Int 2016; 16: 1138–1144.

  October 13, 2015   doi: 10.1111/ggi.12609   open full text
• Functional Independence and Difficulty Scale: Instrument development and validity evaluation.
  Takashi Saito, Kazuhiro P Izawa, Yutaka Omori, Shuichiro Watanabe.
  Geriatrics and Gerontology International. October 13, 2015
  Aims To validate the Functional Independence and Difficulty Scale, a new instrument that assesses both independence and difficulty in carrying out basic activities of daily living. Methods First, we developed an item list for our construct through a literature review. Second, an expert panel evaluated the item list using the modified Delphi method. Third, to evaluate psychometric properties, a random sample of 593 community‐dwelling older adults aged ≥ 65 years from Shiki City, Japan, was surveyed by mail. Results We developed an instrument comprising 14 items: getting up from bed, standing up from a chair, standing up from the floor, dressing, putting on pants, eating, cleaning after toileting, washing, brushing teeth, opening a PET bottle, cutting toenails, walking inside, walking outside and going up or down four to six steps. Function scores for basic activities of daily living ranged from 14–42, with higher scores representing better function. Internal consistency was acceptable (Cronbach's alpha = 0.92). Spearman's partial correlation coefficients controlled for sex and age between the new assessment tool, and the Katz Index and Tokyo Metropolitan Institute of Gerontology Index of Competence were 0.81 (P < 0.01) and 0.63 (P < 0.01), respectively. Conclusions This new tool for assessment of the basic activities of daily living showed good internal consistency and validity. This assessment tool might be applicable in research and clinical practice to evaluate the basic activities of daily living of community‐dwelling elderly Japanese people. Geriatr Gerontol Int 2016; 16: 1127–1137.

  October 13, 2015   doi: 10.1111/ggi.12605   open full text
• Different glucose tolerance status and incident cardiovascular disease and all‐cause mortality among elderly Iranians.
  Mohammadhassan Mirbolouk, Mohammad Ali Hajebrahimi, Samaneh Akbarpour, Maryam Tohidi, Fereidoun Azizi, Farzad Hadaegh.
  Geriatrics and Gerontology International. October 13, 2015
  Aims To determine the effect of different glucose categories on incident cardiovascular disease (CVD) and all‐cause mortality in a population‐based cohort. Methods A total of 834 individuals aged 65 years and older without a history of CVD at baseline were stratified according to 2‐h post‐load glucose fasting glucose test into six categories including: (i) normal fasting glucose/normal glucose tolerance; (ii) prediabetes, (iii) isolated fasting hyperglycemia (IFH); (iv) isolated post‐challenge hyperglycemia (IPH); (v) IPH and IFH; and (vi) known diabetes mellitus. The prognostic significance of these groups on CVD and total mortality were examined by Cox proportional hazard ratios in a multivariate adjusted model. Results Over 9 years of follow up, 186 incidents of CVD and 218 deaths occurred (72 CVD mortality).Of the population, 45.2%, 30.7%, 1.2%, 6.1% 4.7%, and 11.9% were normal fasting glucose/normal glucose tolerance, prediabetes IFH, IPH, IFH and IPH, and known diabetes mellitus, respectively. Multivariate adjusted hazard ratios for CVD were 1.13 (95% CI 0.78–1.64), 1.03 (95% CI 0.25–4.22), 1.17 (95% CI 0.65–2.11), 2.52 (95% CI 1.43–4.42) and 2.39 (95% CI 1.55–3.69), and for CVD mortality were 0.59 (95% CI 0.27–1.30), 2.02 (95% CI 0.27–15.15), 1.26 (95% CI 0.51–3.16), 3.57 (95% CI 1.64–7.75), and 4.70 (95% CI 2.54–8.69) for prediabetes, IFH, IPH, IFH and IPH, and known diabetes mellitus phenotypes, respectively. Corresponding hazard ratios for all‐cause mortality in multivariate model adjusted for prevalent CVD were 1.07 (95% CI 0.73–1.57), 0.59 (95% CI 0.08–4.30), 0.92 (95% CI 0.5–1.70), 2.31 (95% CI 1.33–4.01) and 3.88 (95% CI 2.70–5.55), respectively. Conclusion Among the elderly population with newly diagnosed diabetes, only the combined IFH and IPH phenotype, but not IFH or IPH alone, was a significant predictor of CVD and mortality events. Prediabetes was not associated with any risk. Geriatr Gerontol Int 2016; 16: 1263–1271.

  October 13, 2015   doi: 10.1111/ggi.12633   open full text
• Injury and medical expenditure in emergency department visits of older veterans.
  Fu‐Ting Wang, Yuhsuan Chang, Wu‐Chien Chien, Hung‐Hui Li.
  Geriatrics and Gerontology International. October 13, 2015
  Aim The purpose of the present study was to investigate the injury types and medical utilization profiles of veterans in emergency department visits by using big data from the National Health Insurance program in Taiwan. Method We used the outpatient prescriptions and treatment records between 1997 and 2010 of veterans aged ≥65 years in the National Health Insurance Research Database. The International Classification of Diseases, Ninth Revision, Clinical Modification codes 800–999 (i.e. injuries) were selected, and the emergency medical treatment and the medical institutions' basic profile were recorded. Results A total of 287 113 veterans were selected for this study. The average age was 77.4 years, and most participants were men (71.2%). The total medical expenses were US$46.0 million (an average of US$160.00 per person). Contusions/abrasions, open wounds, and fractures comprised 29.2%, 26.6% and 16.3% of the injuries, respectively. In addition, contusions/abrasions, open wounds, and fractures comprised 23.8%, 21.5% and 19.8%, respectively, of the total medical expenses. The highest charges for a single injury episode were for spinal cord and nerve injuries (an average of US$349.00 per person). Regarding sex differences, women mainly experienced fractures and contusions/abrasions, whereas men experienced open wounds. Conclusions The injury rate of veterans was reported higher than the non‐veterans. Preventive methods are proposed to decrease the occurrences of injury, number of emergency visits and medical expenses. Geriatr Gerontol Int 2016; 16: 1254–1262.

  October 13, 2015   doi: 10.1111/ggi.12620   open full text
• Favorable outcomes in octogenarians treated with bioresorbable polymer drug‐eluting stent.
  Ivan Ilic, Ivan Stankovic, Bojan Ilisic, Milivoje Cerovic, Aleksandar Aleksic, Ivica Nikolajevic, Srdjan Kafedzic, Carlos Cuellas Ramon, Maxim Sokolov, Mohamed El Setecha, Biljana Putnikovic, Aleksandar N Neskovic.
  Geriatrics and Gerontology International. October 13, 2015
  Aim As a result of a higher prevalence of comorbidities, elderly adults are often underrepresented in clinical trials, and more often experience complications during percutaneous coronary intervention. Our aim was to evaluate clinical outcomes of patients older than 80 years, compared with their younger counterparts, when bioresorbable polymer biolimus A9 drug‐eluting stent is used for their treatment. Methods The prospective, observational e‐Nobori registry was created to validate the safety and efficacy of bioresorbable polymer drug‐eluting stent in unselected patients. The primary end‐point of the study was freedom from target lesion failure defined as a composite of cardiac death, target vessel‐related myocardial infarction and clinically‐driven target lesion revascularization at 1 year. Results There were 781 (7.8%) octogenarians, they were less frequently male (62% vs 77%; P < 0.0001) and more often presented as acute coronary syndrome (44% vs 39%; P = 0.0182). The index percutaneous coronary intervention success was lower in the elderly patients (98% vs 99%; P = 0.0398). One‐year follow up was completed for 97% of the elderly patients and 99% of the younger patients. The difference in target lesion failure (3.33% vs 2.83%; log–rank P = 0.0114) was mainly driven by increased mortality in octogenarians (3.73% vs 1.47%; P < 0.0001). Elderly patients had more bleeding and vascular complications (2.67% vs 1.05%; P = 0.0001). Conclusions Despite advanced age, multiple comorbidities and complexity of treated lesions, clinical outcomes are favorable in octogenarians treated by bioresorbable polymer biolimus A9 drug‐eluting stent. Geriatr Gerontol Int 2016; 16: 1246–1253.

  October 13, 2015   doi: 10.1111/ggi.12619   open full text
• Evaluating attention in delirium: A comparison of bedside tests of attention.
  Dimitrios Adamis, David Meagher, Orla Murray, Donagh O'Neill, Edmond O'Mahony, Owen Mulligan, Geraldine McCarthy.
  Geriatrics and Gerontology International. September 29, 2015
  Aim Impaired attention is a core diagnostic feature for delirium. The present study examined the discriminating properties for patients with delirium versus those with dementia and/or no neurocognitive disorder of four objective tests of attention: digit span, vigilance “A” test, serial 7s subtraction and months of the year backwards together with global clinical subjective rating of attention. Methods This as a prospective study of older patients admitted consecutively in a general hospital. Participants were assessed using the Confusion Assessment Method, Delirium Rating Scale–98 Revised and Montreal Cognitive Assessment scales, and months of the year backwards. Pre‐existing dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Results The sample consisted of 200 participants (mean age 81.1 ± 6.5 years; 50% women; pre‐existing cognitive impairment in 126 [63%]). A total of 34 (17%) were identified with delirium (Confusion Assessment Method +). The five approaches to assessing attention had statistically significant correlations (P < 0.05). Discriminant analysis showed that clinical subjective rating of attention in conjunction with the months of the year backwards had the best discriminatory ability to identify Confusion Assessment Method‐defined delirium, and to discriminate patients with delirium from those with dementia and/or normal cognition. Both of these approaches had high sensitivity, but modest specificity. Conclusion Objective tests are useful for prediction of non‐delirium, but lack specificity for a delirium diagnosis. Global attentional deficits were more indicative of delirium than deficits of specific domains of attention. Geriatr Gerontol Int 2016; 16: 1028–1035.

  September 29, 2015   doi: 10.1111/ggi.12592   open full text
• Influence of cerebral white matter lesions on the activities of daily living of older patients with mild stroke.
  Yutaka Yamashita, Ikuo Wada, Mitsuya Horiba, Kento Sahashi.
  Geriatrics and Gerontology International. September 24, 2015
  Aim Neurological symptom severity is a prognostic factor for post‐stroke activities of daily living (ADL). Recently, it has been reported that white matter lesions indicate poor functional prognosis in patients with stroke. The present study investigated the influence of white matter lesions on the ADL of older patients with stroke who have mild neurological symptoms. Method We investigated ADL at discharge in 44 patients with stroke (men, n = 27; women, n = 17; mean age 78 years [range 71–85 years]) aged ≥65 years with National Institutes of Health Stroke Scale scores of ≤5 (cerebral infarction, n = 37; cerebral hemorrhage, n = 7). We used single correlation analysis and multiple regression analysis to investigate factors that correlated with ADL at discharge. ADL at discharge was also evaluated on the basis of white matter lesion severity (Fazekas classification, grades 0–3). Results Single correlation analysis showed that age (r = −0.36, P = 0.016), male sex (r = 0.362, P = 0.016), neurological symptom severity (r = −0.361, P = 0.016), ADL on starting rehabilitation (r = 0.685, P < 0.001) and white matter lesion severity (r = −0.361, P = 0.016) significantly correlated with ADL at discharge. Multiple regression analysis showed that ADL on starting rehabilitation (β = 0.519, t = 4.723, P < 0.001) and white matter lesion severity (β = −0.309, t = −3.057, P < 0.01) were statistically significant prognostic factors for ADL at discharge. ADL at discharge score was significantly lower in the group with high white matter lesion severity (Fazekas, grade 2) than in the other two groups (Fazekas, grade 0, P < 0.01; Fazekas, grade 1, P < 0.05). Conclusion Severe white matter lesions are a prognostic factor for poor ADL at discharge in older patients with stroke who have mild neurological symptoms. Geriatr Gerontol Int 2016; 16: 942–947.

  September 24, 2015   doi: 10.1111/ggi.12580   open full text
• Calcifications in the carotid siphon correlate with silent cerebral small vessel disease in community‐dwelling older adults: A population‐based study in rural Ecuador.
  Oscar H Del Brutto, Robertino M Mera, Jennifer Gillman, Jung‐eun Ha, Mauricio Zambrano.
  Geriatrics and Gerontology International. September 03, 2015
  Aim Using a population‐based, cross‐sectional design, we aimed to assess whether the presence of calcifications in the carotid siphon (as seen on computed tomography) is associated with silent markers of cerebral small vessel disease (on magnetic resonance imaging) in apparently healthy older adults living in Atahualpa, a rural Ecuadorian village. Methods Stroke‐free Atahualpa residents aged ≥60 years identified during a door‐to‐door survey underwent head computed tomography for assessment of carotid siphon calcifications, and brain magnetic resonance imaging for identification of white matter hyperintensities and silent lacunar infarcts. We evaluated the association between calcifications and markers of small vessel disease using logistic regression models adjusted for demographics and cardiovascular risk factors. Results The mean age of the 236 participants was 71 ± 8 years, and 139 (59%) were women. Computed tomography readings showed high calcium content in the carotid siphon in 64 individuals (27%), and magnetic resonance imaging showed moderate‐to‐severe white matter hyperintensities in 51 (30%) and lacunar infarcts in 28 (12%). In the univariate analysis, individuals with high calcium content were older and were more likely to have high fasting glucose levels than those with low calcium content. After adjusting for confounding variables, we found an independent association between high calcium content in the carotid siphon and moderate‐to‐severe white matter hyperintensities (OR 2.3, 95% CI 1.1–4.9, P = 0.035) as well as lacunar infarcts (OR 3.1, 95% CI 1.3–7.6, P = 0.013). Conclusions The present study shows a direct relationship between calcium content in the carotid siphon and silent small vessel disease in an indigenous Latin American population. Geriatr Gerontol Int 2016; 16: 1063–1067.

  September 03, 2015   doi: 10.1111/ggi.12599   open full text
• Prevalence of elder self‐neglect in a Chicago Chinese population: The role of cognitive physical and mental health.
  XinQi Dong, Melissa Simon.
  Geriatrics and Gerontology International. September 03, 2015
  Aim The present study examined the cognitive, physical and psychological characteristics associated with elder self‐neglect in a USA Chinese older population. Methods The Population Study of Chinese Elderly in Chicago is a population‐based epidemiological study of Chinese older adults in the greater Chicago area. In total, 3159 Chinese older adults aged 60 years and older were interviewed from 2011 to 2013. Personal and home environment was rated on hoarding, personal hygiene, house in need of repair, unsanitary conditions and inadequate utility. Results The prevalence of elder self‐neglect of all severities was higher among older adults who were with worsening health status, lower cognitive function, lower physical function and more depressive symptoms. Poorer health status (mild self‐neglect OR 1.20, 95% CI 1.06–1.35; moderate/severe self‐neglect: OR 1.52, 95% CI 1.30–1.77), lower physical function (activities of daily living moderate/severe self‐neglect OR 1.09, 95% CI 1.05–1.13; instrumental activities of daily living mild OR 1.04, 95% CI 1.03–1.06; instrumental activities of dailiy living moderate/severe OR 1.06, 95% CI 1.04–1.07), lower cognitive function (mild self‐neglect OR 1.05, 95% CI 1.03–1.07; moderate/severe self‐neglect OR 1.07, 95% CI 1.04–1.09) and more depressive symptoms (mild self‐neglect OR 1.05, 95% CI 1.02–1.07; moderate/severe self‐neglect OR 1.08, 95% CI 1.06–1.11) were significantly associated with increased risk for elder self‐neglect of all severities. Conclusion Older adults with lower levels of cognitive, physical, and psychological health were more likely to report elder self‐neglect and its phenotypes. Future research is required to examine risk/protective factors associated with elder self‐neglect. Geriatr Gerontol Int 2016; 16: 1051–1062.

  September 03, 2015   doi: 10.1111/ggi.12598   open full text
• Impact of the combination of cognitive and balance training on gait, fear and risk of falling and quality of life in seniors with mild cognitive impairment.
  Magdaléna Hagovská, Zuzana Olekszyová.
  Geriatrics and Gerontology International. September 03, 2015
  Aim To investigate the effect of specific cognitive training with CogniPlus and balance training, affecting cognitive functioning, gait speed, risk and fear of falling, and quality of life in an elderly cohort with mild cognitive impairment. Methods The research sample was composed of 80 older adults with a mild cognitive deficit (mean age 67.07 years) divided into the experimental group (n = 40) and control group (n = 40). This was a randomized, controlled trial. The experimental group carried out selected exercises from the CogniPlus program combined with balance training. Patients participated in 20 sessions twice per week in an outpatient clinic. Both groups completed 30 min of balance training daily for 10 weeks. Cognitive functions were evaluated by the Mini‐Mental State Examination. The fear of falling was assessed by Falls Efficacy Scale‐I. The static and dynamic aspects of balance were assessed by the Tinetti test and functional stretching. Gait speed was assessed by four forms of the Timed Up & Go test. Quality of life was investigated according to Spitzer. Results The two groups showed significant differences recorded after training in the Mini‐Mental State Examination, Up and Go test with dual tasking, balance by Tinetti test and the quality of life in favor of the experimental group (P < 0.03–0.0001). There were no significant differences found between the groups in the assessment of fear of falling and other monitored parameters. Conclusions The combination of selected exercises from the CogniPlus program with balance training contributed to achieving better results than balance training alone for elderly people with mild cognitive impairment. Geriatr Gerontol Int 2016; 16: 1043–1050.

  September 03, 2015   doi: 10.1111/ggi.12593   open full text
• Prevalence of sarcopenia in acute hip fracture patients and its influence on short‐term clinical outcome.
  Juan I González‐Montalvo, Teresa Alarcón, Pilar Gotor, Rocío Queipo, Rocío Velasco, Rubén Hoyos, Armando Pardo, Angel Otero.
  Geriatrics and Gerontology International. September 03, 2015
  Aim Current international criteria provide standardized procedures to diagnose sarcopenia in older people. However, to date few data exist on patients with acute disease. The present study was carried out to determine the frequency of sarcopenia in acute hip fracture patients, and its association with their baseline characteristics and prognosis during hospitalization. Methods Data were collected from 509 consecutive patients hospitalized for hip fracture. The European Working Group on Sarcopenia in Older People Criteria for sarcopenia were applied in the first 72 h. Muscle mass was measured by electrical bioimpedance and grip strength by hydraulic dynamometer. Clinical, functional and cognitive characteristics were assessed at baseline and hospital discharge, and their association with the presence of sarcopenia was studied. Results A total of 479 patients (94%) met the inclusion criteria. The mean age was 85.3 (SD 6.8 years). The frequency of sarcopenia was 17.1% (12.4% in men, 18.3% in women). Sarcopenia was associated with residence in nursing homes (30.5% vs 19.6%, P = 0.030), older age (86.8, SD 6.2 vs 85.1, SD 6.9 years, P = 0.038), and lower body mass index (23.1, SD 3.6 vs 25.6, SD 4.23, P < 0.001). In the multivariate analysis, only low body mass index was predictive of sarcopenia (OR 0.85, 95% CI 0.80–0.91). Sarcopenia was associated with worse functional prognosis at discharge in the crude analysis (OR 1.88, 95% CI 1.15–3.07), but not in the multivariate analysis (OR 1.68, 95% CI 0.99–2.84). Conclusions Sarcopenia was detected in almost one of five acute hip fracture patients and was associated with lower body mass index, but an association with worse prognosis at discharge could not be confirmed. Geriatr Gerontol Int 2016; 16: 1021‐1027.

  September 03, 2015   doi: 10.1111/ggi.12590   open full text
• Algorithm of medication review in frail older people: Focus on minimizing the use of high‐risk medications.
  Arjun Poudel, Anna Ballokova, Ruth E Hubbard, Leonard C Gray, Charles A Mitchell, Lisa M Nissen, Ian A Scott.
  Geriatrics and Gerontology International. September 03, 2015
  Aim Frail older people typically suffer several chronic diseases, receive multiple medications and are more likely to be institutionalized in residential aged care facilities. In such patients, optimizing prescribing and avoiding use of high‐risk medications might prevent adverse events. The present study aimed to develop a pragmatic, easily applied algorithm for medication review to help clinicians identify and discontinue potentially inappropriate high‐risk medications. Methods The literature was searched for robust evidence of the association of adverse effects related to potentially inappropriate medications in older patients to identify high‐risk medications. Prior research into the cessation of potentially inappropriate medications in older patients in different settings was synthesized into a four‐step algorithm for incorporation into clinical assessment protocols for patients, particularly those in residential aged care facilities. Results The algorithm comprises several steps leading to individualized prescribing recommendations: (i) identify a high‐risk medication; (ii) ascertain the current indications for the medication and assess their validity; (iii) assess if the drug is providing ongoing symptomatic benefit; and (iv) consider withdrawing, altering or continuing medications. Decision support resources were developed to complement the algorithm in ensuring a systematic and patient‐centered approach to medication discontinuation. These include a comprehensive list of high‐risk medications and the reasons for inappropriateness, lists of alternative treatments, and suggested medication withdrawal protocols. Conclusions The algorithm captures a range of different clinical scenarios in relation to potentially inappropriate medications, and offers an evidence‐based approach to identifying and, if appropriate, discontinuing such medications. Studies are required to evaluate algorithm effects on prescribing decisions and patient outcomes. Geriatr Gerontol Int 2016; 16: 1002–1013.

  September 03, 2015   doi: 10.1111/ggi.12589   open full text
• Factors associated with older adults' need for oral hygiene management by dental professionals.
  Shiho Morishita, Yutaka Watanabe, Yuki Ohara, Ayako Edahiro, Emiko Sato, Takeo Suga, Hirohiko Hirano.
  Geriatrics and Gerontology International. September 03, 2015
  Aim The aim of the present study was to assess the need for oral hygiene management by dental professionals among older adults requiring long‐term care, and to collect basic data for building a dental treatment framework on a regional level. Although healthcare providers are aware of the importance of oral care for older adults requiring long‐term care, reports claim that the provision of oral care is insufficient, and a framework is being built for the provision of oral hygiene management by dental professionals. Methods A survey on lifestyle and oral health was carried out on 372 older adults requiring long‐term care in one town in Japan. Binomial logistic regression analysis was carried out to assess factors affecting the need for oral hygiene management. Results A total of 66.1% of participants required oral hygiene management. The Barthel Index, Clinical Dementia Rating, oral hygiene status and other factors differed significantly with the presence or absence of oral hygiene management need. In addition to variables related to oral hygiene status (dental plaque and tongue coating), factors that significantly affected oral hygiene management need included the Clinical Dementia Rating (odds ratio 2.63, 95% confidence interval 1.08–6.41). Conclusions The results of the present study suggest that the need for oral hygiene management by dental professionals increases as dementia advances. However, current systems that provide regional dental care are structured based on the level of care need and the degree of independence. A dementia perspective needs to be added to these systems. Geriatr Gerontol Int 2016; 16: 956–962.

  September 03, 2015   doi: 10.1111/ggi.12585   open full text
• Pre‐stroke dementia does not affect the post‐acute care functional outcome of old patients with ischemic stroke.
  Eliyahu‐Hayim Mizrahi, Marina Arad, Abraham Adunsky.
  Geriatrics and Gerontology International. September 03, 2015
  Aim The purpose of the present study was to evaluate whether a diagnosis of dementia before stroke onset (pre‐stroke dementia [PSD]) affects the short‐term functional outcome of elderly ischemic stroke patients. Methods This was a retrospective case–control study comprising of consecutive elderly ischemic stroke patients. Functional outcome was assessed by the Functional Independence Measure scale (FIM) at admission and discharge. Data was analyzed by t‐test, χ2‐test, multiple linear regression analysis and logistic regression. Results There were 919 patients with acute ischemic stroke, out of whom 11.5% were diagnosed with PSD on index day. Compared with non‐PSD patients, those with pre‐stroke dementia had a shorter length of stay (P < 0.001), higher rate of female patients (P < 0.001) and lower Mini‐Mental State Examination scores (P < 0.001). Both total and motor FIM scores at admission and discharge, and their respective FIM gain scores at discharge were higher in non‐PSD compared with PSD patients (P < 0.001). In logistic regression analysis to identify factors predicting successful outcome (defined as total FIM at discharge ≥80), PSD remained as significantly associated with increased risk for adverse outcome on discharge (OR 2.449, CI 1.207–4.970, P = 0.013). Conclusions The present findings suggest that a diagnosis of pre‐stroke dementia is associated with lower FIM scores at admission and discharge in patients with ischemic stroke. Yet, daily motor FIM gains were similar in PSD and non‐PSD patients, suggesting that these patients should not be deprived of a post‐acute rehabilitation, based on a diagnosis of dementia before stroke onset. Geriatr Gerontol Int 2016; 16: 928–933.

  September 03, 2015   doi: 10.1111/ggi.12574   open full text
• Social participation and self‐rated health among older male veterans and non‐veterans.
  Namkee G Choi, Diana M DiNitto, C Nathan Marti.
  Geriatrics and Gerontology International. September 03, 2015
  Aim To examine self‐rated health (SRH) and its association with social participation, along with physical and mental health indicators, among USA male veterans and non‐veterans aged ≥65 years. Methods The two waves of the National Health and Aging Trend Study provided data (n = 2845 at wave 1; n = 2235 at wave 2). Multilevel mixed effects generalized linear models were fit to test the hypotheses. Results Despite their older age, veterans did not differ from non‐veterans in their physical, mental and cognitive health, and they had better SRH. However, black and Hispanic veterans had lower SRH than non‐Hispanic white veterans. Formal group activities and outings for enjoyment were positively associated with better SRH for veterans, non‐veterans and all veteran cohorts. Conclusions Aging veterans, especially black and Hispanic veterans, require programs and services that will help increase their social connectedness. Geriatr Gerontol Int 2016; 16: 920–927.

  September 03, 2015   doi: 10.1111/ggi.12577   open full text
• Inflammatory hypothesis as a link between Alzheimer's disease and diabetes mellitus.
  Melda Bozluolcay, Gülnur Andican, Sinem Fırtına, Gökhan Erkol, Dildar Konukoglu.
  Geriatrics and Gerontology International. September 03, 2015
  Aims The aim of the present study was to evaluate whether there was an inflammation‐mediated link between Alzheimer's disease (AD) and type 2 diabetes mellitus (DM) status. Methods An age‐matched control group and patient groups designated as AD without treatment (AD); AD under cholinesterase inhibitors (AD‐CEI); DM without treatment (DM); DM under oral antidiabetic agents (DM‐OAD); AD under treatment, who had newly diagnosed DM (AD‐CEI+DM); and DM under treatment, who had newly diagnosed probable AD (DM‐OAD+AD) were studied. Serum inflammation status was evaluated by the determination of serum C‐reactive protein (CRP), tumor necrosis factor‐alpha, interleukin (IL)‐1β and IL‐6 levels. CRP levels were determined by an immunonephelometric method. The others were assayed by enzyme‐linked immunosorbent assay methods. Results IL‐1β levels were found to be significantly lower in the DM group than in the control group (P < 0.01). The AD group had significantly higher serum IL‐1β levels than the DM group (P < 0.01). IL‐6 levels were significantly higher in the AD and DM groups than in controls (P < 0.01 and P < 0.01). Serum tumor necrosis factor‐alpha and CRP levels in the AD (P < 0.05 and P < 0.001, respectively) and DM groups (P < 0.05 and P < 0.001, respectively) were significantly higher when compared with the controls. The presence of AD or DM or therapies of the diseases did not significantly change in serum tumor necrosis factor‐alpha levels. The AD‐CEI + DM and DM‐OAD+AD groups had significantly higher CRP levels than the AD‐CEI group (P < 0.05) and DM‐OAD groups (P < 0.001), respectively. Serum CRP levels showed a positive correlation with Mini‐Mental State Examination scores (r = 0.339, P < 0.01). Conclusion Our findings support the presence of a low‐grade systemic inflammation link between AD and DM. Geriatr Gerontol Int 2016; 16: 1161–1166.

  September 03, 2015   doi: 10.1111/ggi.12602   open full text
• Enhancing homework adherence of Chinese older adults: A case study using Instrumental Reminiscence Intervention.
  Vivian Wei Qun Lou, Judith Wing Nam Au, Jacky Chak Pui Choy.
  Geriatrics and Gerontology International. September 03, 2015
  Aim The present study aimed to examine effective clinical strategies that facilitate homework adherence among Chinese older adults who participated in group therapy using Instrumental Reminiscence Intervention (IRI) to reduce depressive symptoms. Methods Examination was based on IRI for 15 groups of older adults, with four to eight participants in each group. Homework assignment was included as a core component of the intervention in each session, except the first session. Particular emphasis was put on both homework design and assignment strategies. Results Two effective strategies were developed. The first was the development of a tactic card as a tool for homework content and assignment. The second strategy was interventionist training. Clinical examples are used to illustrate how these strategies can enhance homework adherence in a Chinese context. Conclusions The two clinical strategies were found to be effective in enhancing homework adherence among Chinese older participants in a group therapy setting. These strategies are recommended for use in group clinical settings for Chinese participants. Geriatr Gerontol Int 2016; 16: 1153–1160.

  September 03, 2015   doi: 10.1111/ggi.12595   open full text
• Prognostic value of preoperative N‐terminal pro‐brain natriuretic peptide in non‐cardiac surgery of elderly patients with normal left ventricular systolic function.
  In Jai Kim, Jae Youn Moon, Eun‐Jung Ko, Yeong‐Min Lim, Sang Hoon Kim, Woo‐In Yang, Jung‐Hoon Sung, Sang‐Wook Lim, Dong‐Hun Cha.
  Geriatrics and Gerontology International. September 03, 2015
  Aim We investigated the prognostic value of preoperative N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in non‐cardiac surgery in elderly patients who showed normal left ventricular function on preoperative echocardiography. Methods We analyzed 1459 patients aged older than 70 years who had consulted a cardiologist for the evaluation of cardiovascular risk for non‐cardiac surgery. Of the 721 patients who simultaneously underwent echocardiography and NT‐proBNP assessments, 506 who showed normal left ventricular systolic function were included. The predictive power of NT‐proBNP for the risk of major adverse cardiac and cerebrovascular events (MACCE) was evaluated. Results MACCE occurred in 40 (7.9%) of the 506 patients, and the median value of NT‐proBNP was higher in patients with complications than in those without (MACCE group: 1700.5 pg/mL vs non MACCE group: 206.35 pg/mL; P < 0.001). The area under the receiver operating characteristic curve was 0.804 (P < 0.001), with an optimal cut‐off of 425.3 pg/mL. Multivariate analysis showed that increased NT‐proBNP (>425.3 pg/mL; odds ratio 6.381; P < 0.001) was the only independent risk factor for the prediction of MACCE. Conclusions In elderly patients who showed normal left ventricular systolic function on echocardiography, measurement of preoperative NT‐proBNP concentration might be a useful test for predicting the occurrence of MACCE after non‐cardiac surgery. Geriatr Gerontol Int 2016; 16: 1109–1116.

  September 03, 2015   doi: 10.1111/ggi.12597   open full text
• Spatial and temporal gait characteristics in pre‐frail community‐dwelling older adults.
  Renato Campos Freire Junior, Jaqueline Mello Porto, Natália Camargo Rodrigues, Roberta de Matos Brunelli, Luis Felipe Pinto Braga, Daniela Cristina Carvalho Abreu.
  Geriatrics and Gerontology International. September 03, 2015
  Aim A number of studies have explored possible relationships, behavior, and meanings of spatial and temporal gait variables in frail and pre‐frail older adults, particularly the gait speed variable. However, it is necessary to know the relationship of other spatial and temporal gait variables of pre‐frail older adults. Thus, the objective of the present study was to evaluate and compare gait standards between pre‐frail and non‐frail older people. Methods A total of 69 older adults aged 60 year and older, divided into two groups, non‐frail (n = 42) and pre‐frail (n = 27), were evaluated. Gait parameters were analyzed using the GAITRite® Platinum 26′ Portable Walkway System. Results Pre‐frail older people had smaller step lengths (P = 0.041), larger base of support (P = 0.040), lower speed (P = 0.019), lower single support percentage (P = 0.033) and higher double support percentage (P = 0.036), compared with non‐frail older people. A history of falls was correlated to lower gait speed and step length in pre‐frail older adults. Conclusions Identifying pre‐frail older people could have significant clinical consequences, as frailty is a dynamic process, and such individuals can therefore progress into a state of frailty or revert to a non‐frail state. Therefore, the identification of gait variables in pre‐frail older people can be an important tool to recognize gait deficits and to initiate the appropriate treatment. Geriatr Gerontol Int 2016; 16: 1102–1108.

  September 03, 2015   doi: 10.1111/ggi.12594   open full text
• Differences of oral health conditions between adults and older adults: A census in a Southern Brazilian city.
  Noeli Boscato, Helena S Schuch, Claudia E Grasel, Marilia L Goettems.
  Geriatrics and Gerontology International. August 27, 2015
  Aim To assess differences in the oral diseases/conditions between adults and older adults. Methods A cross‐sectional study was carried out with all adults and older adults in Luzerna, South Brazil (n = 569). Clinical data included use of and need for dental prostheses; number of decayed, missing and filled teeth; and temporomandibular disorder. Differences between adults and older adults were evaluated using χ2‐tests. Associations between independent variables and the use of and need for dental prostheses were determined using Poisson regression analyses (P < 0.05). Results Increased number of decayed, missing and filled teeth, use of and need for dental prostheses, higher use of complete dentures, and fewer temporomandibular disorder signs and symptoms were observed in older adults. After adjustments, lower social class (P = 0.001) and unmarried status (P = 0.05) were associated with greater need for prosthetic rehabilitation. Women (P = 0.02), older individuals (P < 0.001) and those of lower socioeconomic status (P = 0.001) had a higher risk of using prostheses. Conclusion A significant difference of oral conditions between adults and older adults was observed. The frequency of use of and need for dental prostheses was higher for older adults, although they had reported lower frequency of temporomandibular disorder. Women, married and individuals of higher socioeconomic status showed better oral health conditions. Geriatr Gerontol Int 2016; 16: 1014–1020.

  August 27, 2015   doi: 10.1111/ggi.12588   open full text
• Comprehensive Geriatric Assessment is a useful predictive tool for postoperative delirium after gastrointestinal surgery in old‐old adults.
  Yoshihiro Maekawa, Ken Sugimoto, Makoto Yamasaki, Yasushi Takeya, Koichi Yamamoto, Mitsuru Ohishi, Toshio Ogihara, Ayumi Shintani, Yuichiro Doki, Masaki Mori, Hiromi Rakugi.
  Geriatrics and Gerontology International. August 26, 2015
  Aim To determine whether carrying out the Comprehensive Geriatric Assessment before operations would be useful for predicting complications, particularly postoperative delirium (POD), in old‐old patients. Methods A total of 517 patients aged 75 years and older, who underwent radical surgery for gastrointestinal cancer at Osaka University Hospital, were recruited for this observational study. The Comprehensive Geriatric Assessment components and assessment of performance status were carried out before surgery, and a record of postoperative complications including POD was made prospectively until discharge from hospital. The following morphological and clinical measurements were also obtained from the medical records: age, sex, disease type, previous history, comorbid lifestyle‐related diseases, POD, postoperative complications, operative method, duration of operation, hemorrhage volume, blood transfusion volume, method of anesthesia, body mass index and blood tests. Results POD appeared in 24.0% of the 517 patients who underwent surgery. Barthel Index, Mini‐Mental State Examination, instrumental activities of daily living and Geriatric Depression Scale results were associated with the incidence of POD, and the Barthel Index, Mini‐Mental State Examination and Instrumental Activities of Daily Living results were extracted as independent factors associated with the development of POD after adjusting for traditional risk factors for postoperative complications and performance status. Conclusions The Comprehensive Geriatric Assessment before gastrointestinal surgery can be a useful tool for predicting the development of POD in old‐old patients. Geriatr Gerontol Int 2016; 16: 1036–1042.

  August 26, 2015   doi: 10.1111/ggi.12587   open full text
• Young adults' experiences of their parents caring for a relative with dementia.
  Pik Yi Hou, Claudia Kam Yuk Lai, Ching Sum Chung, Amy Kin Kwan Sham, Ching Lai Yeung.
  Geriatrics and Gerontology International. August 26, 2015
  Aim The aim of the present study was to explore the experiences and perceptions young adults had of family members who are caring for a relative with dementia. Methods An exploratory qualitative study with semi‐structured interviews was carried out and data were collected from 24 young adults recruited through purposive sampling. The participants had to have a close relative who was caring for an elderly family member with dementia. A content analysis approach was used for the verbatim transcription. Results The findings showed that caring for a relative with dementia was perceived as a time‐consuming, exhausting and long‐term task. The participants experienced stress and strain, although they were not the primary caregivers. Despite their negative perceptions of the task, they were willing to take on the responsibility of becoming a primary caregiver in the future. However, they intended to seek assistance in meeting their caregiving roles and responsibilities. Seeing how their close relative cared for a dependent older adult led them to reflect on what they would become in the future. Interestingly, although the participants expected their future offspring to take care of them when they became old, they did not want to be a burden to their children. Conclusion Young adults are the caregivers of tomorrow. Knowing their perspective on caregiving is important if health professionals are to help them evolve into a caregiving role. It has implications for realizing the goal of aging in place. Geriatr Gerontol Int 2016; 16: 873–879.

  August 26, 2015   doi: 10.1111/ggi.12559   open full text
• Frequency, nature and outcomes of hospital admissions in centenarians in an area of North‐East England.
  Catherine L Dotchin, William K Gray, Elizabeth Gaskin, Samantha Hartley, Richard W Walker.
  Geriatrics and Gerontology International. August 26, 2015
  Aims There are few data on the use of hospital services by centenarians living in the UK. In the present study, we recorded the frequency, nature and outcomes of hospital admissions in centenarians in an area of North‐East England. Methods Data regarding hospital attendance in centenarians in Northumberland and North Tyneside, covered by one National Health Service Trust, were collected. For the years 2010–2013, demographics, frequency of admission and length of hospital stay data were collected. Medical notes for those admitted in 2011 were reviewed, and data extracted relating to diagnosis, medications and past medical history. Results Across the 4 years of the study, there were 349 hospital attendances of centenarians. A total of 264 of these attendances resulted in admission with an overnight stay. In 2011, there were 107 attendances, 75 of which (in 54 unique patents) resulted in admission and an overnight stay. The unique patients admitted represented 41.5% of the centenarians living in the catchment area. The most common primary reason for admission in centenarians was respiratory tract infection, though falls were a primary or secondary reason for admission in 41.3% of centenarians. There were 11 in‐hospital deaths in 2011, and a further seven deaths within 30 days of discharge. The median number of medications taken on admission and discharge was six. Conclusions Almost half of the centenarians living in the catchment area were admitted to hospital during 2011. Over 25% of admissions either died in hospital or within 30 days of discharge. Geriatr Gerontol Int 2016; 16: 969–975.

  August 26, 2015   doi: 10.1111/ggi.12586   open full text
• Impact of board‐certificated physiatrists on rehabilitation outcomes in elderly patients after hip fracture: An observational study using the Japan Rehabilitation Database.
  Ryo Momosaki, Wataru Kakuda, Naoki Yamada, Masahiro Abo.
  Geriatrics and Gerontology International. August 26, 2015
  Aim To clarify the impact on rehabilitation outcomes of board‐certificated physiatrists (BCP) as the physicians with primary responsibility for elderly patients in convalescent rehabilitation wards after hip fracture. Methods The present retrospective observational study used 2005–2013 data from the Japan Rehabilitation Database. We identified in‐hospital patients with hip fracture admitted to rehabilitation wards. After applying exclusion criteria, 824 patients were eligible. The primary outcome was functional independence measure instrument efficiency. Results BCP were responsible for the care of 46% of patients with hip fracture. Patients who were managed by a BCP had significantly higher mean functional independence measure efficiency than patients who were not, both before and after adjustment by inverse propensity‐score weighting (0.37 vs 0.26; P = 0.04 and 0.39 vs 0.26; P < 0.01, respectively). Additionally, the mean length of stay was significantly shorter in patients who were managed by BCP than in those who were not, both before and after inverse propensity‐score weighting (65 vs 71 days, P = 0.04 and 64 vs 69 days, P < 0.01, respectively). Conclusions Our data suggest that the participation of BCP is associated with good rehabilitation outcomes in patients with hip fracture at convalescent rehabilitation wards. Geriatr Gerontol Int 2016; 16: 963–968.

  August 26, 2015   doi: 10.1111/ggi.12582   open full text
• Effect of health Baduanjin Qigong for mild to moderate Parkinson's disease.
  Chun‐Mei Xiao, Yong‐Chang Zhuang.
  Geriatrics and Gerontology International. August 26, 2015
  Aim The present study investigated the effectiveness of Baduanjin Qigong on symptoms related to gait, functional mobility and sleep in Parkinson disease (PD) patients. Methods A total of 100 patients (age 67.53 ± 8.56 years, range 55–80 years) with mild to moderate PD were randomly assigned to two groups. Participants in the Baduanjin Qigong group (BQG) received a Baduanjin Qigong program, consisting of four 45‐min sessions each week and daily walking 30 min for 6 months. Participants in the control group were carried out daily walking for 30 min. Pre‐ and post‐intervention testing was carried out to assess sleep quality, fatigue, functional mobility and gait performance in these participants. Results After the 6‐month Baduanjin Qigong intervention, the BQG showed sleep quality improvements in the Unified Parkinson's Disease Rating Scale score (P = 0.049), Parkinson's Disease Sleep Scale‐2 (PDSS‐2) total score (P = 0.039), Motor Symptoms at Night (PDSS‐2) score (P = 0.039), PD Symptoms at Night (PDSS‐2) score (P = 0.029), Disturbed Sleep (PDSS‐2) score (P = 0.037). The BQG showing functional mobility capacity greater improvements in the Berg Balance Scale (P = 0.041) and 6‐minute walk test (P = 0.042), and greater decrease in the Timed Up & Go (s; P = 0.046). The BQG showing gait function increased in the gait speed (m/s; P = 0.011). However, this was not the case for the control group, which remained at the same level as pretest performance. Conclusions BQG improved the gait performance, functional mobility and sleep quality in older adults with PD at the 6‐month follow up. It is as an alternative home exercise program for older adults in rehabilitation for PD. Geriatr Gerontol Int 2016; 16: 911–919.

  August 26, 2015   doi: 10.1111/ggi.12571   open full text
• Psychometric integrity of the Chinese Happiness Inventory among retired older people in Taiwan.
  Hui‐Hsun Chiang, Lin Lin, Tony Szu‐Hsien Lee.
  Geriatrics and Gerontology International. August 14, 2015
  Aim Happiness is an important indicator of mental and physical health. It has been emphasized as one kind of well‐being, and its definition varies from culture to culture. The main objective of the present study was to examine the psychometric integrity and dimensions of the Chinese Happiness Inventory (CHI) in relation to scores on Ryff's Psychological Well‐Being Scale among retired older people in Taiwan. Methods A cross‐sectional study was carried out at social service centers in Taipei, Taiwan. Retired adults gave informed consent from September to November 2010, and completed a package of structured questionnaires measuring happiness and psychological well‐being. Internal consistency, the factor structure of the CHI and criterion validity were assessed. Results Results from an exploratory factor analysis showed a three‐factor solution for the CHI. These factors were named Positive Affect, Life Satisfaction and Interpersonal Relationships. Internal consistency coefficients were 0.95 (Positive Affect), 0.91 (Life Satisfaction), 0.85 (Interpersonal Relationships) and 0.97 (total scale). The results of a canonical correlation analysis showed the presence of a strong relationship between CHI and Ryff's Psychological Well‐Being Scale (r = 0.69), and that two canonical variates could be derived from the relationship between them. Conclusions The results show that the CHI is a three‐dimensional scale with high reliability and validity. The construct of happiness emphasizes relationships in relation to others and environment rather than autonomy in this sample. Although the components of happiness might be similar for Positive Affect and Life Satisfaction, their weights for Interpersonal Relationships should be considered when measuring happiness in different cultures. Geriatr Gerontol Int 2016; 16: 865–872.

  August 14, 2015   doi: 10.1111/ggi.12568   open full text
• Association between periodontitis and medical expenditure in older adults: A 33‐month follow‐up study.
  Misuzu Sato, Masanori Iwasaki, Akihiro Yoshihara, Hideo Miyazaki.
  Geriatrics and Gerontology International. August 14, 2015
  Aim Along with rapid aging, medical expenditure for older adults has been increasing in Japan. Research has shown that periodontitis is a useful predictor for excess medical expenditure; however, limited information is available on the elderly population after adequately considering confounding factors. The aim of the present study was to evaluate the association between periodontitis and long‐term medical expenditure in elderly Japanese. Methods Baseline health and periodontal examinations were carried out in June 2008. Japanese adults (n = 245) aged 80 years were classified into quartiles based on periodontal inflamed surface area (PISA), which quantifies the degree of periodontal inflammation. Medical care use and costs were monitored by assessment of the National Health Insurance claim files from the baseline survey through the end of February 2011. Multivariable analysis of the differences in medical expenditure among PISA quartiles was carried out using linear regression with robust standard errors. Results The participants in the fourth (with the largest PISA) and third quartiles had significantly higher inpatient medical expenditure compared with those of the first quartile (P < 0.01 and = 0.04, respectively). Participants in the fourth quartile had significantly higher total medical expenditure (P < 0.01) compared with the first quartile. A trend was observed of higher inpatient and total medical expenditure with increasing PISA. Conclusions A significant association was found between periodontitis and future increase in medical expenditure, suggesting that periodontitis might be a modifiable factor for the reduction of excess medical expenditure among elderly Japanese. Geriatr Gerontol Int 2016; 16: 856–864.

  August 14, 2015   doi: 10.1111/ggi.12569   open full text
• Is preoperative state anxiety a risk factor for postoperative delirium among elderly hip fracture patients?
  Bastiaan Van Grootven, Elke Detroyer, Els Devriendt, An Sermon, Mieke Deschodt, Johan Flamaing, Christophe Dubois, Koen Milisen.
  Geriatrics and Gerontology International. August 14, 2015
  Aim To determine if preoperative state anxiety is a risk factor for postoperative delirium in older hip fracture patients. Methods A secondary data analysis comprising data from a prospective non‐randomized trial including 86 patients with a hip fracture aged 65 years and older was carried out. State anxiety was measured preoperatively using the State‐Trait Anxiety Inventory. Delirium and its severity was measured pre‐ and postoperatively (day 1, 3, 5, 8) by trained research nurses using the Confusion Assessment Method and Delirium Index. Results A total of 24 patients (27.9%) developed delirium postoperatively. Preoperative state anxiety (State‐Trait Anxiety Inventory) was not associated with postoperative delirium (rb = 0.135, P = 0.353), duration of postoperative delirium (rho = 0.038, P = 0.861) or severity of postoperative delirium (rho = 0.153, P = 0.160). Independent predictors of postoperative delirium were lower MMSE scores (OR 0.75, 95% CI 0.60–0.95, P = 0.015), osteosynthesis surgery (OR 3.66, 95% CI 1.02–13.15, P = 0,047) and lowest intraoperative diastolic blood pressure (OR 0.92, 95% CI 0.85–0.99, P = 0.031). Conclusion No relationship between state anxiety and postoperative delirium was found, but significant methodological hurdles were observed and discussed providing important groundwork for further research in this area. Further research should focus on reliable measurement of state anxiety in cognitively impaired older populations. Geriatr Gerontol Int 2016; 16: 948–955.

  August 14, 2015   doi: 10.1111/ggi.12581   open full text
• Daytime sleepiness is independently associated with falls in older adults with dementia.
  Pin‐Yuan Chen, Hsiao‐Ting Chiu, Hsiao‐Yean Chiu.
  Geriatrics and Gerontology International. August 05, 2015
  Aim To examine whether elderly people with dementia have a higher prevalence of falls and sleep disturbances than those without dementia, and to determine the subjective sleep characteristics associated with falls in older adults with dementia. Methods This was a cross‐sectional, population‐based study derived from the data in the 2009 Taiwan National Health Interview Survey. A total of 123 older adults with dementia (aged 65 years or older), and 246 older adults without dementia who were randomly selected from the database were included. The occurrence of falls and subjective sleep characteristics (e.g. sleep hours, insomnia symptoms, daytime sleepiness, difficulty in breathing during sleep and daytime naps) were evaluated using the responses to the survey questions. Results The prevalence of falls in older adults with dementia were approximately twofold higher than that for those without dementia (27.6% vs 15.3%, P = 0.006). Older adults with dementia had longer sleep hours, and increased daytime sleepiness, daytime naps and difficulty in breathing during sleep (all P < 0.05) than those without dementia. Among older adults with dementia, daytime sleepiness was the only sleep characteristic that was significantly correlated to an increased risk of falls (adjusted odds ratio 5.56, 95% confidence interval 1.95–15.91) despite controlling for possible risk factors. Conclusions Older adults with dementia had a higher prevalence of falls and sleep disturbances than that observed for those without dementia. Daytime sleepiness was an independent risk factor of falls in elderly people, with dementia after accounting for a range of covariates. Geriatr Gerontol Int 2016; 16: 850–855.

  August 05, 2015   doi: 10.1111/ggi.12567   open full text
• Outcome of intravenous recombinant tissue plasminogen activator for acute ischemic stroke in patients aged over 80 years.
  Gioia Mione, Xavier Ducrocq, Nathalie Thilly, Jean‐Christophe Lacour, Hervé Vespignani, Sébastien Richard.
  Geriatrics and Gerontology International. August 05, 2015
  Aim Practitioners are faced with a substantial challenge when considering recombinant tissue plasminogen activator (rt‐PA) therapy for older patients with ischemic stroke. Patients aged over 80 years suffer from the most severe cerebral infarcts. The benefit of rt‐PA treatment compared with single standard care only in stroke units remains to be clearly assessed. Methods We collected data from 321 patients aged over 80 years admitted for acute cerebral infarction to the stroke unit of Nancy University Hospital in France between 1 January 2009 and 31 December 2012. Patients were stratified into two groups: treated or not with rt‐PA. Baseline characteristics and outcome were collected and compared between both groups. Good outcome at 3 months was defined as modified Rankin Scale score ≤2. Results The 55 patients treated with rt‐PA had a higher National Institute of Health Stroke Scale score on admission than those without (15 vs 5; P < 0.001). They were more likely to have intracranial haemorrhage (20 vs 5%; P < 0.001) without an increased mortality rate (28 vs 27%; P = 0.95). Multivariate analysis showed a more favorable outcome (odds ratio 7, 95% confidence interval 3–16.5; P < 0.001). Slightly higher percentages of patients with modified Rankin Scale ≤2 were found after intention‐to‐treat analysis (49 vs 45%) and after exclusion of patients with baseline modified Rankin Scale >2 (57 vs 54 %), but without reaching significance (P > 0.05). Conclusions Rt‐PA therapy would appear to improve prognosis in the elderly with ischemic stroke. This suggests that age alone should no longer be a barrier to rt‐PA therapy. Geriatr Gerontol Int 2016; 16: 843–849.

  August 05, 2015   doi: 10.1111/ggi.12565   open full text
• Relationship between white matter lesions and regional cerebral blood flow changes during longitudinal follow up in Alzheimer's disease.
  Takuya Hanaoka, Noriyuki Kimura, Yasuhiro Aso, Makoto Takemaru, Yuki Kimura, Masato Ishibashi, Etsuro Matsubara.
  Geriatrics and Gerontology International. August 05, 2015
  Aim The aim of the present study was to evaluate the relationship between baseline white matter lesions (WML) and changes in regional cerebral blood flow during longitudinal follow up of patients with Alzheimer's disease (AD). Methods A total of 38 patients with AD were included in the study (16 men, 22 women; mean age 77.8 years). All patients were evaluated using the Mini‐Mental State Examination and brain perfusion single‐photon emission computed tomography at baseline with an approximately 2‐year follow up. The patients were divided into two subgroups according to the presence of WML on magnetic resonance imaging. Single‐photon emission computed tomography data were analyzed using a voxel‐by‐voxel group analysis with Statistical Parametric Mapping 8 and region of interest analysis using FineSRT. Changes in Mini‐Mental State Examination scores and regional cerebral blood flow were analyzed using the Wilcoxon signed‐rank test. Results Mean Mini‐Mental State Examination scores in AD patients with WML significantly decreased from 19.4 ± 4.8 to 15.5 ± 6.5 (P = 0.003). Statistical Parametric Mapping 8 and FineSRT analysis showed more severe and widespread regional cerebral blood flow reduction, mainly in the frontal and mesial temporal regions in AD patients with WML compared with those without WML. Conclusion Baseline WML could predict a rapid progression of cognitive and brain functional impairment during longitudinal follow up in AD. Geriatr Gerontol Int 2016; 16: 836–842.

  August 05, 2015   doi: 10.1111/ggi.12563   open full text
• Differences in lifestyle, physical performance and quality of life between frail and robust Brazilian community‐dwelling elderly women.
  Priscila Yukari Sewo Sampaio, Ricardo Aurélio Carvalho Sampaio, Hélio José Coelho Júnior, Luis Felipe M Teixeira, Vitor D Tessutti, Marco Carlos Uchida, Hidenori Arai.
  Geriatrics and Gerontology International. August 05, 2015
  Aim To investigate the lifestyles, physical performance and quality of life (QOL) of frail and robust Brazilian community‐dwelling older women, and to identify risk factors for frailty. Methods Frailty was assessed using the Kihon Checklist. Lifestyles were assessed using a questionnaire. Physical performance was assessed by measuring walking speeds, performance on the one‐leg stand test and the five‐times chair stand test and handgrip strength. QOL was assessed using the Short Form‐8 questionnaire. Participants were divided into frail and robust groups based on their total Kihon Checklist scores. Results A total of 109 participants (age 70.8 ± 6.87 years) were included in this study (robust n = 85, frail n = 24). Differences in living structures (P < 0.001), financial satisfaction (P = 0.004) and the frequencies with which participants leave the house (P < 0.001) were found between groups. The frail group had more fallers (P = 0.047), and lower engagement in physical activity (P = 0.044), lower body mass indices (P = 0.043) and poorer nutritional status (P = 0.002), whereas robust older people showed better physical performance (walking speed P < 0.001, one‐leg stand P = 0.021, handgrip strength P = 0.002) and higher QOL scores (general health P = 0.005, role‐physical P = 0.013, bodily pain P = 0.002, vitality P = 0.001, social functioning P = 0.001, role‐emotional P = 0.008). Multivariate regression analysis identified a slow usual walking speed and bodily pain as risk factors for frailty. Conclusions Frail participants had higher indices for being housebound, and having financial dissatisfaction, a sedentary lifestyle, falls, and malnutrition. Furthermore, they showed poorer physical performance and QOL. An early, well‐focused approach is crucial, especially for older adults who walk slowly and have bodily pain to preserve health and QOL. Geriatr Gerontol Int 2016; 16: 829–835.

  August 05, 2015   doi: 10.1111/ggi.12562   open full text
• Factors predicting perioperative delirium and acute exacerbation of behavioral and psychological symptoms of dementia based on admission data in elderly patients with proximal femoral fracture: A retrospective study.
  Tomohiro Tanaka.
  Geriatrics and Gerontology International. August 05, 2015
  Aim To examine factors predicting the onset of perioperative delirium and acute exacerbation of behavioral and psychological symptoms of dementia (BPSD), based on patient background, operative background and laboratory data obtained on admission, in elderly patients with proximal femoral fracture. Methods The participants were 152 patients (aged >70 years) who underwent surgery between 1 November 2012 and 31 March 2014. The participants were classified into group B (with onset of perioperative delirium or acute exacerbation of BPSD, n = 52), or group N, (without onset, n = 100), and risk factors were retrospectively examined. Onset was judged based on the presence or absence of common items; that is, “hallucination and delusion,” “disturbing speech,” “excitatory behavior” and “altered sleep‐wake cycle.” The participants were observed for 1 week after admission. Results The incidence of perioperative delirium or acute exacerbation of BPSD was 34.2% in total. In univariate analysis, the incidence was significantly higher (P < 0.005) in group B for the age, history of dementia and serum albumin level items. In multivariate analysis, history of dementia, serum albumin level and peripheral lymphocyte count (odds ratio 3.55, 0.17, 1.00, respectively) were identified as independent predictive factors. In the subanalysis, the incidence was 91.3% in the group with a history of dementia, serum albumin level <3.7 g/dL and peripheral lymphocyte count < 1200/μL. Conclusions History of dementia, a low serum albumin level and low peripheral lymphocyte count were found to be useful factors for predicting the onset of perioperative delirium and acute exacerbation of BPSD. Geriatr Gerontol Int 2016; 16: 821–828.

  August 05, 2015   doi: 10.1111/ggi.12560   open full text
• Consumption profile and factors associated with the ingestion of beer and distilled beverages among elderly Brazilians: Gender differences.
  João Gabriel Silva Souza, Kimberly Marie Jones, Adelia Dayane Guimarães Fonseca, Andréa Maria Eleutério Barros Lima Martins.
  Geriatrics and Gerontology International. August 05, 2015
  Aim To estimate the prevalence of the consumption of beer and distilled beverages and associated factors among Brazilian older adults residing in a highly populated city in Brazil, highlighting the factors associated with frequent consumption and differences in consumption between men and women. Methods It was a cross‐sectional, analytic study carried out by means of probability samples of conglomerates of older adults (aged 65–74 years). Descriptive analysis, univariate analysis and estimates of multivariate models through logistic regression (OR, 95% CI) were realized. Results 500 of the 736 evaluated seniors were included in the present analysis. 128 (27.3%), 103 (21.3%) and 167 (34.9%) of the seniors indicate past or current use of beer, distilled beverages and frequent use of alcohol, respectively. The consumption of beer was associated with use of tobacco between women; and with marital status and schooling between men. The consumption of distilled beverages was associated with schooling and use of tobacco between women; and age and use of tobacco in men. Daily or weekly use was associated with schooling and use of tobacco between women; age and the use of tobacco between men. Conclusion In the elderly population studied, a noteworthy prevalence of the consumption of beer and distilled beverages was identified, and this use was associated with personal and behavioral determinants. Similar associations related to frequent (daily or weekly) consumption were also identified. Significant differences in the profile of consumption were identified between men and women, with more abusive use among men. Geriatr Gerontol Int 2016; 16: 810–820.

  August 05, 2015   doi: 10.1111/ggi.12556   open full text
• Mortality in Brazilian community‐dwelling older adults: 7 years of follow up in primary care.
  Talita Cristina Barbosa Rezende Ferreira, Arlete Maria Valente Coimbra, Glaucia Regina Falsarella, Lilian Tereza Lavras Costallat, Ibsen Bellini Coimbra.
  Geriatrics and Gerontology International. August 05, 2015
  Aim To describe the main causes and factors associated with mortality in community‐dwelling older adults in a county where the public health system covers most of the population. Methods We analyzed data from an existing cross‐sectional study of 2209 participants (age ≥60 years) in a city in southeast Brazil where 92% of the population is served by a public system of primary care. Over a period of 7 years, 386 participants died and were included in the sample. We assessed the impacts that dependence on others for basic activities of daily living and instrumental activities of daily living, Geriatric Depression Scale scores, and health history have on mortality. Results The participants' mean age was 75.2 years (SD 8.2); 51.7% of the participants were women, and 51.3% had depressive symptoms. The main causes of death were circulatory diseases (40.3%), cancer (19.8%) and respiratory diseases (13.5%). Multivariate analysis showed that, taken together, the use of more than four medications per day, smoking, lower income, older age and dependence on others for a greater number of instrumental activities of daily living predicted death in this population. Conclusions Understanding the factors that are associated with mortality can facilitate understanding, and aid in developing policies regarding primary care for the elderly. Geriatr Gerontol Int 2016; 16: 804–809.

  August 05, 2015   doi: 10.1111/ggi.12561   open full text
• Early symptoms of Alzheimer's disease in Japan and Taiwan.
  Yuan‐Han Yang, Chia‐Ling Hsu, Mei‐Chuan Chou, Mari Kasai, Kenichi Meguro, Ching‐Kuan Liu.
  Geriatrics and Gerontology International. August 05, 2015
  Aim The effects of Alzheimer's disease (AD) are making a major impact on the socioeconomic status of older adults in society. The recognition of early symptoms and clinical presentation are crucial issues to foster early diagnosis and treatment in order to have better therapeutic outcomes. Methods We recruited clinically diagnosed AD patients at the very mild stage in the Clinical Dementia Rating scale 0.5 and mild stage Clinical Dementia Rating scale 1.0 in Taiwan and Japan. Psychometrics including the Ascertain Dementia 8 (AD8) questionnaire were administered to collect and compare the differences of the clinical presentation of the participants from the two countries. Results A total of 1189 participants, 641 from Taiwan and 548 from Japan, were recruited in the present study. In the very mild dementia group with Clinical Dementia Rating scale 0.5, apart from AD8‐2: reduced interest in hobbies/activities (P = 0.056) and AD8‐4: trouble learning how to use a tool, appliance or gadget (P = 0.224), other AD8 subitems were significantly different between the two countries. Japanese participants had a higher reported frequency of AD8‐5: forgetting the correct month or year (82.7%) than that (57.9%) in Taiwanese (P < 0.001). Taiwanese participants had a higher reported frequency in AD8‐1: problems with judgment (20.3%), AD8‐3: repeats questions, stories or statements (67.5%), AD8‐6: difficulty handling complicated financial affairs (32.5%); AD8‐7: difficulty remembering appointments (53.8%); and AD8‐8: consistent problems with thinking and/or memory (89.3%) than those in Japanese participants. Conclusion Early symptoms of AD in both countries are different. The frequently reported early symptoms are important for primary physicians and the general population so that they can recognize the disease in the early stage so as to have a better therapeutic outcome. Such efforts would increase the awareness of dementia in the general population. Geriatr Gerontol Int 2016; 16: 797–803.

  August 05, 2015   doi: 10.1111/ggi.12557   open full text
• Influence of comorbidities on the efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.
  Yuji Higashimoto, Toshiyuki Yamagata, Kazushige Maeda, Noritsugu Honda, Akiko Sano, Osamu Nishiyama, Hiroyuki Sano, Takashi Iwanaga, Yasutaka Chiba, Kanji Fukuda, Yuji Tohda.
  Geriatrics and Gerontology International. August 05, 2015
  Aim To evaluate the influence of comorbidities and aging on pulmonary rehabilitation (PR) efficacy in patients with chronic obstructive pulmonary disease (COPD). Methods This was a retrospective cohort study of patients with COPD attending an outpatient PR program. Comorbidity information was collected with the Charlson Index, BODE index and COPD‐specific comorbidity test, and also included other common conditions not included in these indexes. The efficacy of PR was defined as a 54‐m increase in 6‐min walk distance or a four‐point decrease in St. George's Respiratory Questionnaire score. Patients were divided into two age groups according to the median age of 72 years. Results A total of 21 of 52 patients (40%) showed a clinically significant benefit by the 6‐min walk distance, and 29 patients (55.8%) by the St. George's Respiratory Questionnaire score. PR efficacy was not different between the elderly group and the younger group by either parameter. A total of 98% of the patients had at least one chronic comorbidity. Hypertension was the most frequently reported comorbidity (28.5%). Higher body mass index, Hospital Anxiety and Depression Scale anxiety score and St. George's Respiratory Questionnaire total score were associated with a good response to PR by the 6‐min walk distance. None of the individual comorbidities or indexes were correlated with the efficacy of PR. Multiple logistic regression analysis showed that body mass index was independently associated with the response to PR. Conclusions PR is equally effective in elderly and younger patients with COPD, with efficacy influenced by body mass index and anxiety. Geriatr Gerontol Int 2016; 16: 934–941.

  August 05, 2015   doi: 10.1111/ggi.12575   open full text
• Sarcopenia prevalence and factors associated with sarcopenia in older people living in a nursing home in Ankara Turkey.
  Ahmet Yalcin, Sevgi Aras, Volkan Atmis, Ozlem Karaarslan Cengiz, Murat Varli, Esat Cinar, Teslime Atli.
  Geriatrics and Gerontology International. August 05, 2015
  Aim Sarcopenia is prevalent in older people, and is related to survival and disability. There are no data on sarcopenia evaluated according to European Working Group on Sarcopenia in Older People criteria for nursing home residents in Turkey. We aimed to evaluate the prevalence of sarcopenia according to European Working Group on Sarcopenia in Older People criteria and associated factors with sarcopenia among nursing home residents in Turkey. Methods The study cohort consisted of individuals aged over 65 years and living in the Seyranbağları Nursing Home and Rehabilitation Center in Ankara, Turkey. Besides demographic and medical data, Mini‐Mental State Examination, activities of daily living, Mini‐Nutritional Assessment, body mass index, calf circumference, gait speed and handgrip strength were also investigated. Muscle mass was evaluated by bioelectrical impedance analysis. Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People criteria. Results A total of 141 older individuals were evaluated. Sarcopenia was found in 29% (n = 41) of the participants. Participants with sarcopenia were older and had low scores for activities of daily living, low body mass index, greater cognitive dysfunction, high malnutrition risk and low calf circumference. Body mass index and calf circumference were found to be associated with sarcopenia in multivariate logistic regression analysis. Conclusions Almost one‐third of older nursing home residents were diagnosed with sarcopenia according to European Working Group on Sarcopenia in Older People criteria in this study in Turkey. Calf circumference and body mass index were associated with increased risk of sarcopenia among nursing home residents. This is the first study evaluating sarcopenia using European Working Group on Sarcopenia in Older People criteria in Turkey. Geriatr Gerontol Int 2016; 16: 903–910.

  August 05, 2015   doi: 10.1111/ggi.12570   open full text
• Effect of thrombus aspiration on postprocedural outcomes in elderly patients with acute ST‐elevation myocardial ınfarction.
  Ender Emre, Ertan Ural, Göksel Kahraman, Ulas Bildirici, Teoman Kilic, Serdar Bozyel, Raşik Onuk, Tayyar Akbulut, Dilek Ural.
  Geriatrics and Gerontology International. August 05, 2015
  Aim The effects of thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) for ST‐elevation myocardial infarction (STEMI) have been evaluated in several studies. The aim of the present study was to evaluate postprocedural outcomes in elderly STEMI patients who have a tendency for vasoconstruction and decreased coronary flow reserve. Methods A total of 124 patients (aged ≥65 years) with STEMI who underwent primary PCI (71.2% men, 29.8% women, mean age 74 ± 7 years) were enrolled in the study. Patients were divided into two groups according to intervention with and without TA. Acute angiographic, electrocardiographic and echocardiographic results were compared between the two groups. Results TA was carried out in 42 patients (33.8%). Baseline clinical characteristics and predischarge echocardiographic features did not differ between TA(+) and TA(–) patients (ejection fraction 37.26 ± 8.91 vs 38.53 ± 11.18, P = 0.558, wall motion index 1.69 ± 0.38 vs 1.76 ± 0.37, P = 0.316, septal E′ 0.058 ± 0.022 vs 0.053 ± 0.015, P = 0.267, E/E′ 11.82 ± 4.30 vs 13.12 ± 5.09, P = 0.370). Acute angiographic and electrocardiographic results did not differ between the two groups, but were slightly better in the thrombectomy group than those without TA corrected TIMI frame count (31.63 ± 16.33 vs 34.97 ± 15.81, P = 0.197, TIMI‐3 88.1% vs 79.3%, P = 0.223, ST segment resolution 81.3% vs 70.3%, P = 0.250). Conclusions Thrombectomy during primary PCI has no effect on postprocedural outcomes in an elderly group with STEMI. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  August 05, 2015   doi: 10.1111/ggi.12545   open full text
• Prevalence and outcomes of comorbid illnesses in elderly patients with respiratory diseases.
  Ayse Bahadir, Mediha Gonenc Ortakoylu, Sinem Iliaz, Zehra Dilek Kanmaz, Belma Akbaba Bagci, Raim Iliaz, Emel Caglar.
  Geriatrics and Gerontology International. July 14, 2015
  Aim The aim of the present study was to determine the prevalence of comorbidities in very elderly patients hospitalized as a result of acute respiratory diseases and to analyze sex‐specific differences, and to examine the effects of these comorbidities on their treatment outcomes. Methods A total of 3316 patients were admitted to our pulmonary inpatient clinic between 2009 and 2011, and 243 of them (aged over 80 years) with acute respiratory disease were included in our study. Data were retrospectively collected, and included demographic features, comorbidities, laboratory findings, length of hospital stay and in‐hospital mortality. Results In total of 243, 144 patients (59.3%) were men and 99 patients (40.7%) were women. The mean age was 84 ± 3 years. The prevalence of comorbidity was 75.7% (n = 184). The most common comorbid disease in patients with chronic obstructive pulmonary disease was congestive heart failure (32.9%), and it was chronic obstructive pulmonary disease (49.4%) in patients with pneumonia. The rate of having one comorbidity was 58.2% (n = 107) and 35.3% (n = 65) had two. Approximately half (52.6%) of the in‐hospital deaths occurred within the first 48 hours of hospitalization. The number of comorbidities was higher in the deceased patients compared with the living patients (P = 0.01). Conclusions The present study showed that the majority of our patients had at least one comorbidity. The first 48 hours of hospitalization was very important, especially for the patients with comorbidities, to determine the need for intensive care unit and prognosis. The coexistence of comorbidities can increase the risk of mortality in the elderly. Geriatr Gerontol Int 2016; 16: 791–796.

  July 14, 2015   doi: 10.1111/ggi.12549   open full text
• Validation of a questionnaire for orthostatic hypotension for routine clinical use.
  James Frith, Julia L Newton.
  Geriatrics and Gerontology International. July 14, 2015
  Aim To validate a new patient‐reported outcome measure for routine clinical use. Methods A total of 50 older individuals with orthostatic hypotension who attended a falls and syncope clinic completed three questionnaires, the recently developed Orthostatic Hypotension Questionnaire, the existing Orthostatic Grading Scale and the quality of life measure EQ‐5D‐5L. Validity of the Orthostatic Hypotension Questionnaire was tested against the aforementioned questionnaires for symptoms and for quality of life. Comorbidity was quantified using the Charlson Comorbidity Index. Results The cohort of 50 individuals had a median age of 67 years (interquartile range 26–89 years) with a median Charlson Comorbidity Index of 3 (interquartile range 2–5). The total Orthostatic Hypotension Questionnaire Symptom Assessment score correlated strongly with the Orthostatic Grading Scale (0.616, P < 0.001) and the Orthostatic Hypotension Questionnaire Daily Activity Scale correlated strongly with daily activity on the EQ‐5D‐5L (0.61, P < 0.001). Using the Orthostatic Grading Scale, individuals' symptoms were categorized as mild, moderate or severe, the Orthostatic Hypotension Questionnaire scores were significantly different between these groups (P < 0.001). Internal consistency was high (Cronbach's apha 0.882), and ceiling or floor effects did not limit the total scores. Conclusion The Orthostatic Hypotension Questionnaire is a valid patient report tool to quantify the symptom burden of people with orthostatic hypotension. Because the symptoms associated with orthostatic hypotension are frequently non‐specific, it will be a clinically useful tool to measure and quantify symptom load in people with orthostatic hypotension. Geriatr Gerontol Int 2016; 16: 785–790.

  July 14, 2015   doi: 10.1111/ggi.12553   open full text
• Neuroanatomical correlates of error types on the Clock Drawing Test in Alzheimer's disease patients.
  Hirotaka Nakashima, Hiroyuki Umegaki, Taeko Makino, Katsuhiko Kato, Shinji Abe, Yusuke Suzuki, Masahumi Kuzuya.
  Geriatrics and Gerontology International. July 14, 2015
  Aim We sought to identify the relationship between regional cerebral blood flow (rCBF) and error types on the Clock Drawing Test (CDT) in patients with Alzheimer's disease (AD). Method The CDT was administered to 142 patients with AD. We used the Mendez scoring method. Their rCBF values were measured by single‐photon emission computed tomography. The correlation between the CDT total score and rCBF was examined on a voxel‐by‐voxel basis. After we excluded 37 patients whose drawings were inappropriate for assessing the CDT error types, we examined the relationships between each error type on the CDT and rCBF. Results Total score on the CDT was positively correlated with rCBF in the left posterior middle temporal lobe. We also found relationships between the error “non‐existence of number 2, or not pointing toward number 2” and the left frontal lobe; the error “uneven number spacing” and the bilateral frontal lobe; “deviation of the clock center” and the left frontal lobe; “missing numbers” and the right parietal lobe; “uneven number distance from edge” and the right parietal and the temporal lobes; “same length hands” and the bilateral temporal lobe; and “unclosed circle” and the left temporal lobe. Conclusions Each error type on the CDT appears to relate to a different brain region. These findings will be useful in the understanding of CDT performances and the underlying neuropsychological pathology. Geriatr Gerontol Int 2016; 16: 777–784.

  July 14, 2015   doi: 10.1111/ggi.12550   open full text
• Utility of video consultation to improve the outcomes of home enteral nutrition in a population of frail older patients.
  Paolo Orlandoni, Nikolina Jukic Peladic, Liana Spazzafumo, Claudia Venturini, Claudia Cola, Debora Sparvoli, Natascia Giorgini, Redenta Basile, Donata Fagnani.
  Geriatrics and Gerontology International. July 14, 2015
  Aim To determine whether the outcomes of home enteral nutrition for frail older patients can be improved by video consultation between home visiting staff and a hospital physician, specialized in clinical nutrition, during monthly home visits. Methods A randomized prospective study out of patients aged older than 65 years receiving home enteral nutrition from the Department of Clinical Nutrition of an Italian geriatric hospital in 2013 was carried. A total of 100 patients were randomly assigned to receive video consultation in addition to regular monthly home visits, 88 patients only had regular monthly home visits. Therapy outcomes – incidence rates of complications, outpatient hospital visits and hospitalizations – were compared between two groups. A logistic regression analysis was carried out to evaluate the usefulness of the video consultation to improve therapy outcomes. Results Incidence rates for metabolic and gastrointestinal complications were significantly lower for patients who received a video consultation, respectively: 0.032/year “video consultation” versus 0.055/year “no video consultation” (P = 0.0001) and 0.006/year “video consultation” versus 0.028/year “no video consultation” (P < 0.0001). No differences were found for incidence rates of mechanical complications, outpatient hospital visits and hospitalizations. Logistic regression showed that the video consultation was significantly correlated with a reduction of metabolic complications (OR 2.63, 95% CI 1.00–6.91; P = 0.049 after adjustment for duration of home enteral nutrition and diabetes mellitus 2). Conclusion The present study provides evidence that a video consultation between home visiting staff and hospital physicians specialized in clinical nutrition during monthly home visits is associated with a reduction of metabolic complications in a population of frail older patients. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  July 14, 2015   doi: 10.1111/ggi.12551   open full text
• Type of surgery is associated with pain and walking difficulties among older people with previous hip fracture.
  Anu Salpakoski, Mauri Kallinen, Ilkka Kiviranta, Markku Alen, Erja Portegijs, Esa Jämsen, Jari Ylinen, Taina Rantanen, Sarianna Sipilä.
  Geriatrics and Gerontology International. July 14, 2015
  Aim The aim was to assess the level of lower body pain among people with previous femoral neck fracture, and whether the type of surgery was associated with pain and physical function a mean of 2 years after surgery. Methods The study included 115 community‐dwelling older adults aged 60 years and older with previous femoral neck fracture, and 31 reference subjects without previous lower limb injuries. A total of 30 patients had internal fixation surgery, 70 had hemiarthroplasty and 15 had total hip replacement. All patients had surgery in the same hospital and received typical inpatient rehabilitation. From 1.6 months to 7.5 years after the fracture, the patients underwent examination including clinical evaluation, measurements of pain in the lower body (visual analog scale), physical function (maximal walking speed, Timed Up & Go, Berg Balance Scale) and self‐reported walking difficulties. Results Hip fracture patients reported more pain (81 ± 88 mm) compared with the reference group (25 ± 39 mm, P = 0.004). Patients with internal fixation reported significantly more pain than the other study groups. Significantly more patients with internal fixation (53%) reported walking difficulties compared with patients who had hemiarthroplasty (29%, P = 0.028) or total hip replacement (13%, P = 0.018). No significant difference was observed in performance‐based physical function between the fracture groups, but participants in the reference group had better physical function than any of the fracture groups. Conclusions Hip fracture patients treated with internal fixation experienced more pain and walking difficulties than the hemiarthroplasty and total hip replacement groups. Different types of surgical fixation might require different rehabilitation and pain management strategies after hip fracture. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  July 14, 2015   doi: 10.1111/ggi.12552   open full text
• Social risk factors for falls among rural Nigerian community‐dwelling older adults.
  Fatai Adesina Maruf, Chidile Muonwe, Marufat Odetunde.
  Geriatrics and Gerontology International. July 14, 2015
  Aim Reports on social risk factors for falls are scarce. This study explored the associations of selected sociodemographic and health variables with falls among rural Nigerian community‐dwelling older adults. Methods The present cross‐sectional study involved 131 community‐dwelling older adults (84 women and 47 men) recruited at an outreach center. Demographic (age, sex and marital status), social (frequency of visiting relations and friends, and number of consistent informal carers) and health (number of comorbid conditions) variables were recorded. Results Having fewer than two informal carers (0.26, 95% CI 0.10–0.68) was independently associated with reduced risk for falls. Visiting relations and friends less than twice per week was independently associated with greater risks for falls (3.85, 95% CI 1.42–10.46) and recurrent falls (4.86, 95% CI 1.25–18.85). Conclusions The number of informal carers and frequency of social visits are risk factors for falls in older adults, and need to be taken into consideration in any strategy for fall prevention in older adults. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  July 14, 2015   doi: 10.1111/ggi.12548   open full text
• Course of functional status in elderly patients after coronary artery bypass surgery: 6‐month follow up.
  Márcio Niemeyer‐Guimarães, Maysa Seabra Cendoroglo, Clineu Mello Almada‐Filho.
  Geriatrics and Gerontology International. July 14, 2015
  Aim To determine longitudinal changes in functional status using three functional assessment scales in elderly patients undergoing coronary artery bypass grafting. Methods This was a prospective observational cohort study of 73 patients aged ≥60 years undergoing elective coronary artery bypass grafting. Patients were assessed for functional status before admission, at hospital discharge, and at 1 and 6 months after discharge using the Functional Independence Measure, Katz Activities of Daily Living scale, and Lawton Instrumental Activities of Daily Living scale. Data were stratified by age (≥70 years and <70 years) and complications (with and without) for analysis. Results In patients aged ≥70 years (n = 38), Functional Independence Measure scores ranged from 121.30 ± 6.42 (pre‐admission) to 112.10 ± 17.10 (1 month) and 117.80 ± 13.50 (6 months), Katz scores from 5.88 ± 0.32 (pre‐admission) to 5.45 ± 1.04 (1 month) and 5.83 ± 0.65 (6 months), and Lawton scores from 25.40 ± 3.30 (pre‐admission) to 20.05 ± 4.93 (1 month) and 24.50 ± 4.10 (6 months; P < 0.001 for all). No significant changes were found in scale scores over time between groups with (n = 34) and without (n = 39) complications. When groups aged ≥70 years (n = 38) and <70 (n = 35) were compared, Functional Independence Measure scores showed a difference toward recovery over time in older patients (discharge – pre‐admission, P = 0.010; 1 month – pre‐admission, P = 0.0004; and 6 months – pre‐admission, P = 0.079). Conclusions The Functional Independence Measure was able to detect significant functional loss over a 6‐month period in elderly patients undergoing coronary artery bypass grafting, suggesting that this scale is a promising tool for the assessment of functional recovery over time after cardiac surgery, especially in patients aged older than 70 years. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  July 14, 2015   doi: 10.1111/ggi.12547   open full text
• Evaluating family function in caring for a geriatric group: Family APGAR applied for older adults by home care nurses.
  Mei‐Wen Wang, Yi‐Yu Huang.
  Geriatrics and Gerontology International. July 14, 2015
  Aim Family function is an essential factor affecting older adults' health. However, there has been no appropriate method to assess the family function of most older adults with fragility or poor health status. The present study aimed to explore the differences and relevance of family function estimated by home care nurses and the older adults, and to determine if nurses could represent older adults to provide the estimation. Methods Study participants were 50 older adults who were aged older 65 years and were taken care of at home by well‐trained nurses. The present study used the Family APGAR as the questionnaire. We compared the results evaluated by the older adults and their home care nurses. The results included the level of dysfunction and the total scores of the questionnaire. The paired t‐test and McNemar–Bowker test were used for the analysis. Results Family function could be leveled as “good,” “moderate dysfunction” and “severe dysfunction” according to the scores. The family function levels estimated by nurses showed no significant differences to the patients' condition (P = 0.123 > 0.05). Comparing the total scores of the older adults with those of their own home care nurses, the results showed a moderate to nearly high correlation (R = 0.689/P < 0.001). Caring time might be the factor affecting the result. Conclusions The present study provides a way of helping physicians to ascertain older adults' family problems much earlier and to improve the their health status by enhancing family support. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  July 14, 2015   doi: 10.1111/ggi.12544   open full text
• Validity of the Kihon Checklist for assessing frailty status.
  Shosuke Satake, Kazuyoshi Senda, Young‐Jae Hong, Hisayuki Miura, Hidetoshi Endo, Takashi Sakurai, Izumi Kondo, Kenji Toba.
  Geriatrics and Gerontology International. July 14, 2015
  Aim The Kihon Checklist is extensively used in Japan to identify elderly persons who are at risk of requiring support/care. We aimed to determine whether or not the Kihon Checklist can estimate frailty status defined by the Cardiovascular Health Study criteria. Methods This cross‐sectional study evaluated the Kihon Checklist and activities of daily living based on self‐records maintained with the assistance of nurses in a convenience sample of 164 elderly outpatients who lived without care or support. Body composition was measured using dual energy X‐ray absorptiometry. Physical functions, nutritional status, cognitive function and depressive mood were assessed using standardized evaluations. Frailty status was evaluated using the Cardiovascular Health Study frailty criteria. Results The total Kihon Checklist score closely correlated with validated assessments of physical functions, nutritional state, cognitive function, depressive mood and the number of frailty phenotypes defined by the Cardiovascular Health Study criteria (ρ = 0.655, P < 0.001). The area under the receiver operating characteristics curves for the evaluation of frailty status was 0.81 for prefrailty and 0.92 for frailty. The sensitivity and the specificity were 70.3% and 78.3% for prefrailty, and 89.5% and 80.7% for frailty at total Kihon Checklist scores of 3/4 and 7/8, respectively. Conclusion The Kihon Checklist is a useful tool for frailty screening. Analyzing the results of this self‐reporting questionnaire, together with other more high‐tech screening modalities, will cost‐effectively improve the quality of life for many elderly individuals in a timely manner. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  July 14, 2015   doi: 10.1111/ggi.12543   open full text
• Global cognitive performance and frailty in non‐demented community‐dwelling older adults: Findings from the Sasaguri Genkimon Study.
  Sanmei Chen, Takanori Honda, Kenji Narazaki, Tao Chen, Yu Nofuji, Shuzo Kumagai.
  Geriatrics and Gerontology International. June 16, 2015
  Aim To investigate the associations of global cognitive performance with frailty and pre‐frailty in non‐demented community‐dwelling older adults. Method A cross‐sectional study was carried out using data from the baseline survey of the Sasaguri Genkimon Study in 2011. The study sample consisted of 1565 older adults with complete data and no evidence of dementia. Global cognitive performance was evaluated using the Montreal Cognitive Assessment (MoCA) and the Mini‐Mental State Examination (MMSE). Frailty state was defined using the Cardiovascular Health Study criteria, based on five components: unintentional weight loss, low grip strength, exhaustion, low gait speed and low physical activity. Results Total MoCA and MMSE scores, and their domain‐specific scores decreased across the non‐frail, pre‐frail and frail groups. Poorer total MoCA and MMSE scores, as well as their domain‐specific scores, were associated with the greater likelihood of being frail, but not with pre‐frailty after full adjustment. The strength of the association with frailty was greater for total MoCA score than for total MMSE score. Domain‐specific scores for visuospatial abilities and attention domains in both of the MoCA and MMSE were consistently associated with the likelihood of pre‐frailty and frailty, even after being mutually adjusted for all domains. Conclusions The MoCA performance is more strongly associated with the odds of frailty than the MMSE performance in the relatively functional and non‐demented older adult population. The present findings could contribute to further exploration of possible common pathways that can be targeted in the prevention and management for both of these two conditions. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  June 16, 2015   doi: 10.1111/ggi.12546   open full text
• Prevention of cognitive and physical decline by enjoyable walking‐habituation program based on brain‐activating rehabilitation.
  Tatsuhiko Murai, Tomoharu Yamaguchi, Yohko Maki, Mikie Isahai, Ayumi Kaiho Sato, Tetsuya Yamagami, Chiaki Ura, Fumiko Miyamae, Ryutaro Takahashi, Haruyasu Yamaguchi.
  Geriatrics and Gerontology International. June 16, 2015
  Aim Evaluating effects of an enjoyable walking‐habituation program. Methods We carried out a 12‐week intervention, consisting of an enjoyable walking‐habituation program based on five principles of brain‐activating rehabilitation: pleasant atmosphere, interactive communication, social roles, praising each other and errorless support. The program, once a week for 90 min, was carried out in small groups. Participants were 71 community‐dwelling people (72.2 ± 4.3) without dementia. Cognitive function was evaluated in five cognitive domains: memory, executive function, word fluency, visuospatial abilities and sustained attention. Additionally, quality of life, depressive state, functional capacity, range of activities, social network and subjective memory complaints were assessed using questionnaires. Motor function was also evaluated. Measurement was carried out before the observation period, after observation and after intervention. Results A total of 63 participants were included in the analysis. Daily steps, executive function, subjective memory complaints, functional capacity and 5‐m maximum walking time significantly improved during the intervention period (after observation to after intervention) compared with the observation period (before the observation period to after observation). No significant differences were seen in other evaluations. At 6 months after the intervention, 52 of 63 participants (82.5%) continued to walk once a week or more, and all of them were confident about continuing to walk in the future. Furthermore, all participants were satisfied with our walking‐habituation program and all replied that they felt delighted. Conclusion The intervention program, based on the five principles of brain‐activating rehabilitation, resulted in improvement of some cognitive and physical functions, as well as a high walking‐habituation rate at 6 months' follow up. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  June 16, 2015   doi: 10.1111/ggi.12541   open full text
• Living arrangements, social networks and onset or progression of pain among older adults in Singapore.
  Ying‐Ying Leung, Suat Lay Teo, Ming Boon Chua, Prassanna Raman, Chang Liu, Angelique Chan.
  Geriatrics and Gerontology International. June 16, 2015
  Aims We aimed to evaluate the relationship between living arrangements, and strength of social network with onset and progression of chronic pain over 2 years in elderly Singaporeans. Methods We used data from the Social Isolation Health and Lifestyles Survey, a nationally representative survey of community‐dwelling older Singaporeans aged >60 years (n = 4990) in 2009 and follow up in 2011. We used binomial logistic regression models to examine factors associated with self‐reported onset and progression of chronic pain over time. Results A total of 3103 participants (53.8% women) completed both surveys (weighted response rate 63.7%). The mean age (SD) was 69.4 (0.5) years. The prevalence of mild and moderate‐extreme chronic pain at baseline were 27.7% and 12.8%. A total of 20.1% and 3.9% of the participants reported having chronic pain onset and progression over 2 years, respectively. In the binomial regression models, lower education level, living alone and poorer self‐rated health were predictors for onset of chronic pain in women. Weak social networks and disability were associated with progression of chronic pain in women. Conclusions Chronic pain is common in Singaporean older adults. Living alone and weak social network were sociopsychological factors associated with the onset or progression of chronic pain. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  June 16, 2015   doi: 10.1111/ggi.12539   open full text
• Giant cell arteritis (Horton's disease) in very elderly patients aged 80 years and older: A study of 25 cases.
  Géraldine Muller, Hervé Devilliers, Jean‐François Besancenot, Patrick Manckoundia.
  Geriatrics and Gerontology International. June 16, 2015
  Aim Analysis of the characteristics of very elderly patients with giant cell arteritis (GCA). Methods Patients aged 80 years and older diagnosed with GCA in our department between 1 January 2002 and 31 July 2008 were retrospectively included. For each patient, we recorded general characteristics, reason(s) for hospitalization, specialty of the physician or department that referred the patient to us, medical history, treatment at admission, GCA clinical features, time to diagnosis of GCA, biological screening and GCA treatment. Results We analyzed 25 clinical records, 18 women and seven men with a mean age of 83.9 years. General weakness, visual loss and inflammatory syndrome were the principal reasons for hospitalization. Patients were mainly referred by general practitioners or ophthalmological departments. At diagnosis, headache and musculoskeletal disorders were the most frequent signs (52% each), before general weakness and visual disorders. Time to diagnosis was 2.2 months. Inflammatory syndrome was very frequent (92%). Biopsy of the temporal artery confirmed GCA in 16 cases. Corticosteroid therapy (CST) mean dose was 0.9 mg/kg/day. Because of the positive evolution, CST was stopped in nine patients after 22.7 ± 15 months. A total of 22 patients received a preventive osteoporosis treatment. After 3 months of CST, clinical signs and IS vanished in 22 patients. CST complications, mainly infection, appeared in 17 patients. Conclusion Clinical and biological features of GCA in the very elderly patients of the present study were comparable with those described in the literature in younger patients. However, it must be pointed out that our patients were not compared with a younger population in this study. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  June 16, 2015   doi: 10.1111/ggi.12536   open full text
• Factors related to low serum vitamin B12 levels in elderly patients with non‐atrophic gastritis in contrast to patients with normal vitamin B12 levels.
  Çağdaş Kalkan, Fatih Karakaya, Ali Tüzün, Zeynep Bıyıklı Gençtürk, Irfan Soykan.
  Geriatrics and Gerontology International. June 04, 2015
  Aim Vitamin B12 deficiency is frequent in older patients, and the main reason is pernicious anemia. However, vitamin B12 deficiency can occur in patients who do not have atrophic gastritis. The aim of the present study was to investigate factors affecting serum vitamin B12 levels in older patients with non‐atrophic gastritis. Methods A total of 1256 out of 1607 patients aged over 60 years who had undergone upper gastrointestinal endoscopy for various reasons, and who had serum vitamin B12 value and were diagnosed as having “non‐atrophic gastritis” were analyzed by means of factors affecting low serum vitamin B12 levels. Results Non‐atrophic gastritis patients were divided into two groups: patients with normal serum vitamin B12 (group I, n = 759) and patients with low serum vitamin B12 (group II, n = 497). The median serum vitamin B12 was 339 pg/mL (range 201–987 pg/mL) in group I and 180 pg/mL (range 50–200 pg/mL) in group II. Helicobacter pylori (n = 154 vs 325, P < 0.001), neutrophil activity (n = 176 vs 367, P < 0.001), intestinal metaplasia (n = 35 vs 14, P < 0.001) and inflammation (n = 230 vs 386, P < 0.001) were present significantly more often in group II compared with group I. A total of 785 patients were both negative for Helicobacter pylori and atrophy. Of these 785 patients, neutrophil activity (n = 56, [32.6%] vs 25, [4.4%], P < 0.001) and inflammation (n = 69, [40.1%] vs 82, [13.4%], P < 0.001) scores were present significantly more often in group II compared with group I. Conclusions Helicobacter pylori was present significantly more often in older patients whose serum vitamin B12 levels were ≤200 pg/mL, and Helicobacter pylori density was inversely correlated with serum B12 level. Upper gastrointestinal endoscopic examination should be suggested for elderly patients with serum vitamin B12 level ≤200 pg/mL. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  June 04, 2015   doi: 10.1111/ggi.12537   open full text
• Age and sex differences of risk factors of activity limitations in Japanese older adults.
  Takafumi Monma, Fumi Takeda, Haruko Noguchi, Nanako Tamiya.
  Geriatrics and Gerontology International. June 04, 2015
  Aim The objective of the present study was to verify how socioeconomic and physical/mental health status would be associated with activity limitations by age and sex among older adults, using nationally representative cross‐sectional data in Japan. Methods The present study focused on 8373 older adults aged 65 years or older extracted from the Comprehensive Survey of Living Conditions conducted in 2007 by the Japanese Ministry of Health, Labor and Welfare. Univariate and multiple logistic regression analyses and population‐attributable risk were applied to validate the relationships of socioeconomic and physical/mental health status with activity limitations among the total population, and by age groups (young‐old or old‐old) and sex. Results Mental health showed the highest odds ratio and population‐attributable risk in the total population. In addition, low back pain was associated with activity limitations regardless of age and sex. Other musculoskeletal diseases, such as arthropathy and osteoporosis, were related to activity limitations for women, regardless of age, whereas cardiovascular diseases, including angina pectoris/myocardial infarction and cerebral stroke, were associated with activity limitations for men in any age group. There were no statistically significant correlations between socioeconomic status and activity limitations in any groups. Conclusion Mental health was the most important factor of activity limitations in Japanese older adults. Furthermore, low back pain regardless of age and sex, other musculoskeletal diseases only for women and cardiovascular diseases mainly for men could also be significant risk factors to activity limitations. Therefore, preventive approaches of activity limitations considering sex differences are important for older adults in Japan. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  June 04, 2015   doi: 10.1111/ggi.12533   open full text
• Associations between healthy lifestyles and health outcomes among older Koreans.
  Jiyoung Lyu, Seungah H Lee, Hae‐Young Kim.
  Geriatrics and Gerontology International. June 04, 2015
  Aim Healthy lifestyles have been found to be positively associated with physical and mental health outcomes in later life. Although multiple health behaviors have the potential to enhance health among older adults, little is known about a multiple behavior approach. Therefore, the purpose of the present study was to examine the relationship between multiple healthy lifestyles and health outcomes among Korean older adults. Methods The study sample consisted of 3844 Korean older adults aged 65 years and older from a cross‐section sample being followed in the nationally representative dataset, the 2012 Korean Longitudinal Study of Ageing. Healthy lifestyles included non‐smoking, normal drinking, physical activity and normal weight. Adjusting for covariates (age, sex, marital status, education, household income and having chronic condition), a multivariate logistic regression was carried out to examine self‐rated health, disability, cognitive impairment and depression as four individual health outcomes. Results Compared with respondents with no healthy lifestyle factors, respondents with at least one healthy lifestyle factor had better self‐rated health, respondents with at least two healthy lifestyle factors had reduced risk of disability, and respondents with at least three healthy lifestyle factors had reduced risk of cognitive impairment. Interestingly, having just two or three healthy lifestyle factor was associated with reduced risk of depression. Conclusions These results suggest that older Koreans with more healthy lifestyles are healthier than those with less healthy lifestyles. Also, the association between multiple healthy lifestyle factors and health outcomes is different by specific health outcome, showing different mechanisms between multiple healthy lifestyle factors and each health outcome. Geriatr Gerontol Int 2015; ●●: ●●–●●.

  June 04, 2015   doi: 10.1111/ggi.12531   open full text
• Sex hormones and the risk of type 2 diabetes mellitus: A 9‐year follow up among elderly men in Finland.
  Marika Salminen, Tero Vahlberg, Ismo Räihä, Leo Niskanen, Sirkka‐Liisa Kivelä, Kerttu Irjala.
  Geriatrics and Gerontology International. May 29, 2014
  Aim To analyze whether sex hormone levels predict the incidence of type2 diabetes among elderly Finnish men. Methods This was a prospective population‐based study, with a 9‐year follow up period. The study population in the municipality of Lieto, Finland, consisted of elderly (age ≥64 years) men free of type 2 diabetes at baseline in 1998–1999 (n = 430). Body mass index and cardiovascular disease‐adjusted hazard ratios and their 95% confidence intervals for type 2 diabetes predicted by testosterone, free testosterone, sex hormone‐binding globulin, luteinizing hormone, and testosterone/luteinizing hormone were estimated. Results A total of 30 new cases of type 2 diabetes developed during the follow‐up period. After adjustment, only higher levels of testosterone (hazard ratio for one‐unit increase 0.93, 95% confidence interval 0.87–0.99, P = 0.020) and free testosterone (hazard ratio for 10‐unit increase 0.96, 95% confidence interval 0.91–1.00, P = 0.044) were associated with a lower risk of incident type 2 diabetes during the follow up. These associations (0.94, 95% confidence interval 0.87–1.00, P = 0.050 and 0.95, 95% confidence interval 0.90–1.00, P = 0.035, respectively) persisted even after additional adjustment of sex hormone‐binding globulin. Conclusion Higher levels of testosterone and free testosterone independently predicted a reduced risk of type 2 diabetes in the elderly men. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  May 29, 2014   doi: 10.1111/ggi.12312   open full text
• Olive leaf extract decreases age‐induced oxidative stress in major organs of aged rats.
  Jale Çoban, Serdar Öztezcan, Semra Doğru‐Abbasoğlu, Ilknur Bingül, Kübra Yeşil‐Mizrak, Müjdat Uysal.
  Geriatrics and Gerontology International. May 22, 2014
  Aim Olive leaf (Olea europaea L.) extract (OLE) is a powerful anti‐oxidant rich in polyphenols. As oxidative stress plays an important role in aging, we investigated the effect of OLE on oxidative stress in the liver, heart and brain of aged rats. Methods Young (age 3 months) and aged (age 20 months) Wistar rats were used. Aged rats received OLE (500 and 1000 mg/kg/day) in drinking water for 2 months. Malondialdehyde (MDA), diene conjugate (DC), protein carbonyl (PC), glutathione (GSH), vitamin E and vitamin C levels, and superoxide dismutase (SOD), glutathione peroxidase (GSH‐Px) and glutathione transferase (GST) activities were determined. Results MDA, DC and PC levels increased in tissues of aged rats. GSH levels decreased in the liver, but not in the heart and brain. There was no change of other anti‐oxidant parameters in tissues. Hepatic SOD and GSH‐Px protein expressions also remained unchanged. OLE treatment caused decreased tissue MDA, DC and PC levels, and increased hepatic GSH levels in aged rats. Other anti‐oxidant parameters, hepatic SOD and GSH‐Px protein expressions did not alter in aged rats by OLE treatment. Conclusion The present results suggest that OLE seems to be useful for decreasing oxidative stress in examined tissues by acting as an anti‐oxidant itself without affecting the anti‐oxidant system. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  May 22, 2014   doi: 10.1111/ggi.12192   open full text
• Association of perceived stress with depressive symptoms in older Taiwanese: Results of a population‐based study.
  Alan C Tsai, Shu‐Huang Chi, Jiun‐Yi Wang.
  Geriatrics and Gerontology International. May 22, 2014
  Aims We determined the association of perceived stress with depressive symptoms in older Taiwanese. Methods We analyzed the 2007 dataset of the Taiwan Longitudinal Survey on Aging, a population‐based survey of 4534 persons aged ≥54 years. Perceived stress was based on respondents' reports of whether each of the five situations (own health, financial status, job, getting along with family members and family members' problems) “makes you feel stressed or anxious”. Participants were rated with the 10‐item Center for Epidemiologic Studies Depression scale (score 0–30; ≥10 as having depressive symptoms). Multivariate logistic regression analysis was carried out to determine the association of each perceived stress situation with depressive symptoms in persons aged 54–64 years (middle‐aged), 65–74 years (young‐old) and ≥75 years (old‐old). Results Over one‐third of respondents were stressed over their own health. The middle‐aged respondents who were stressed were 2.0–10.9‐fold as likely to have depressive symptoms, the young‐old were 3.1–8.1‐fold as likely and the old‐old were 4.3–12.6‐fold as likely compared with the non‐stressed respondents (all P < 0.001). Financial stress and its association with depressive symptoms deceased with increasing age. Nearly half of the Taiwanese older adults had concerns over family members' problems and the concern was associated with depressive symptoms in the younger age groups. Relationship strain with family members existed in <10% of older Taiwanese, but the association with depressive symptoms was strong. Job‐related stress was not associated with depressive symptoms. Conclusions Perceived stress and its association with depressive symptoms vary according to stress situations and age. The present findings should be useful for developing appropriate strategies to reduce the risk of depression in older adults. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  May 22, 2014   doi: 10.1111/ggi.12307   open full text
• Management and decision‐making process leading to coronary angiography and revascularization in octogenarians with coronary artery disease: Insights from a large single‐center registry.
  Anne‐Céline Martin, Florence Dumas, Christian Spaulding, Stéphane Manzo‐Silberman.
  Geriatrics and Gerontology International. May 22, 2014
  Aims Cardiovascular diseases remain the most common cause of death in older adults. Guidelines state that advanced age alone should not limit the use of invasive therapy. However, coronary angiograms and subsequent revascularization are often not carried out in octogenarians. The benefit/risk balance of an invasive strategy and the decision‐making process are not clearly defined. The aim of the present study was to assess the decision‐making process, and the in‐hospital and long‐term mortality based on the clinical presentation, the diagnostic approach (coronary angiogram or conservative) and the therapeutic management (revascularization or not). Methods The present study was a single‐center retrospective analysis. Results A total of 522 patients aged ≥80 years, with a diagnosis of coronary disease were included from 2003 to 2009. The mean age was 82 ± 2.6 years. A total of 195 of 522 (37%) presented with a ST segment elevation myocardial infarction (STEMI). A coronary angiogram was carried out in 316 patients (60.5%) and 71% were treated by percutaneous coronary revascularization. A total of 39.5% were considered ineligible for a coronary angiogram due to cardiological reasons or comorbidities. Excluding cardiogenic shock, overall in‐hospital mortality was 4.9%. Clinical presentation strongly influenced both in‐hospital and 6‐month mortality rates (cardiogenic shock 20% and 28.7%, stable angina 1% and 4.1%, respectively, P < 0.001). Long‐term mortality was reduced in the coronary angiography arm compared with the conservative group (14.3% vs 20.9%, P = 0.04) whether or not revascularization was carried out. Conclusion In the present study, in octogenarians, long‐term mortality was lower in the group of patients who underwent a coronary angiogram, regardless of revascularization. The selection process for coronary angiography and angioplasty was mostly influenced by the existence of age‐associated comorbidities. Risk prediction models are required to reduce age‐dependent biases. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  May 22, 2014   doi: 10.1111/ggi.12308   open full text
• Efficacy of a thermoexpandable metallic prostate stent (Memokath) in elderly patients with urethral obstruction requiring long‐term management with urethral Foley catheters.
  Ryoji Kimata, Kaoru Nemoto, Yuji Tomita, Ryo Takahashi, Tsutomu Hamasaki, Yukihiro Kondo.
  Geriatrics and Gerontology International. May 22, 2014
  Aim To investigate whether the insertion of a thermoexpandable metallic prostate stent (Memokath) facilitates the removal of Foley catheters in elderly patients ineligible for urethral obstruction surgery because of the potential complications involved in long‐term catheter management. Methods A total of 37 male patients (mean age 79.8 ± 6.2 years) ineligible for surgery under general anesthesia because of advanced age, the presence of post‐cerebrovascular disorders or anticoagulant therapy use and who subsequently had a Memokath stent inserted between June 2007 and November 2009 were enrolled in the present study. Patients with spinal injury were excluded. We compared the correlation between prostatic urethral length and total prostate volume (TPV). We also evaluated the postoperative postvoid residual (PVR) and presence of pyuria, and reviewed postoperative complications and unassisted urination ability. Results We found a positive correlation between prostatic urethral length and TPV. After the insertion of the Memokath stent, the catheters were removed from all patients who could urinate unassisted. The PVR was <50 mL in 76.4% patients, and there was a 52% improvement in pyuria after insertion of the Memokath stent. The mean postoperative follow‐up duration was 33.2 ± 16.7 months. A total of 21 patients (56.7%) were able to urinate unassisted after receiving the Memokath stent. Unassisted urination was difficult in patients with poor performance status. No serious complications were observed after insertion of the Memokath stent. Conclusions The Memokath stent was safe and useful for elderly patients with urethral obstruction and good performance status requiring long‐term management with urethral Foley catheters. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  May 22, 2014   doi: 10.1111/ggi.12309   open full text
• Efficacy of language‐appropriate cueing on micrographia in Korean patients with Parkinson's disease.
  HyangHee Kim, Ji Hye Yoon, Hyo Suk Nam.
  Geriatrics and Gerontology International. May 22, 2014
  Aim First, we objectively quantified the handwriting size of Parkinson's disease (PD) patients. Second, we investigated the efficacy of the external visual cueing on Korean handwriting in PD. Methods We recruited 57 patients diagnosed with PD and 37 community‐dwelling normal older adults. All participants were asked to write a target word on a blank sheet of paper. For investigating the external visual cueing, 24 PD patients wrote the target word in square grids. The size of each syllable of the word was measured using a public domain software program. In order to measure the area of a syllable, the upper, lower, left and right margins of the syllable were outlined with a rectangle. The area of selection in square pixels or in calibrated square units was used to spatially calibrate the image automatically. Results The PD group showed significantly smaller writing size than the normal group in all syllables of the free writing. The writing size in the square grids of the PD patients was bigger than their free writing. Conclusion The present study is noteworthy, because it is the first attempt to use a software program to objectively quantify parkinsonian handwriting size. This measuring system would help clinicians monitor handwriting size throughout the disease course. From the perspective of rehabilitation, language‐appropriate external visual cues might be useful in daily communication (i.e. handwriting) activities in Korean patients with PD. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  May 22, 2014   doi: 10.1111/ggi.12313   open full text
• Effectiveness of an oral health educational program on community‐dwelling older people with xerostomia.
  Yuki Ohara, Naomi Yoshida, Yoko Kono, Hirohiko Hirano, Hideyo Yoshida, Shiro Mataki, Kumiko Sugimoto.
  Geriatrics and Gerontology International. May 05, 2014
  Aim The purpose of the present study was to evaluate the changes in oral health and function through an oral health educational program for the independent older people with xerostomia. Methods Community‐dwelling older people with xerostomia aged over 65 years who participated in a preliminary comprehensive health survey in 2011 were recruited for the educational program. A total of 47 participants were randomly assigned into two groups, the intervention group (n = 26) and the control group (n = 21). The intervention group attended a 90‐min oral health education program every 2 weeks for 3 months. The program consisted of oral hygiene instruction, facial and tongue muscle exercise, and salivary gland massage. The control group was provided only general information about oral health. The assessments of oral function, such as oral diadochokinesis of articulation, swallowing, taste threshold and salivary flow rate, were carried out before and after 3 months with or without intervention. Results A total of 38 participants (21 of intervention group and 17 of control group) completed the study protocol. In the intervention group, resting salivation significantly improved after the program. The second and third cumulated Repetitive Saliva Swallowing Test times significantly improved in the intervention group. The threshold for bitterness significantly lowered in the intervention group, whereas the sour threshold significantly heightened in the control group after 3 months (P < 0.05). Conclusions The present study suggests that the educational program targeting oral function improvement is effective among the independent older population. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  May 05, 2014   doi: 10.1111/ggi.12301   open full text
• Effectiveness of combined exercise training to improve functional fitness in older adults: A randomized controlled trial.
  Nelson Sousa, Romeu Mendes, Catarina Abrantes, Jaime Sampaio, José Oliveira.
  Geriatrics and Gerontology International. April 30, 2014
  Aim The present randomized controlled trial evaluated the impact of different exercise training modalities on functional fitness responses in apparently healthy older men. Methods A total of 59 community‐dwelling older men were randomly assigned to an aerobic training group (ATG, n = 19), a combined aerobic and resistance training group (CTG, n = 20) or a control group (n = 20). Both exercise training programs were moderate‐to‐vigorous intensity, 3 days/week for 9 months. Six independent functional fitness tests (back scratch, chair sit‐and‐reach, 30‐s chair stand, arm curl, 8‐ft up‐and‐go, 6‐min walk) were measured on five different occasions. The data were analyzed using a mixed‐model ANOVA. Results ANOVA showed a significant main effect of group (P < 0.001) for all functional fitness tests, with significant differences between both training groups and controls. However, the ATG only improved the chair sit‐and‐reach and the 30‐s chair stand performance, whereas CTG improved in all functional fitness tests. ANOVA also identified a significant main effect of time for 8‐ft up‐and‐go (P = 0.031) in the CTG. Conclusions Only the combined exercise program was effective in improving all functional fitness components related to daily living activities. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 30, 2014   doi: 10.1111/ggi.12188   open full text
• Home death is associated with frequency of physician home medical care visits: A questionnaire survey on communications in home medical care settings.
  Takuma Kimura, Teruhiko Imanaga, Makoto Matsuzaki, Tohru Akahoshi.
  Geriatrics and Gerontology International. April 28, 2014
  Aim To investigate the factors related to communications in home medical care settings, and the association between such factors and a patient's place of death. Methods A questionnaire survey of 295 families of patients who had previously received home medical care was carried out in June and July 2011. The response rate was 83.8% (n = 227). Following the exclusion of families where the patient was still alive, or where the place of death was unknown, 143 questionnaires were available for analysis. Logistic regression was used to identify significant associations between possible factors related to communication and occurrence of home death. Results Home death was observed in 66.4% (n = 95) of the families analyzed. Home death was significantly associated with the frequency of doctor home‐visits per week (OR 2.835, 95% CI 1.436–5.597, P = 0.003). There was no statistically significant association between home death and any of the other variables included: malignant tumors as primary disease, independence in daily activity, duration of home medical care, duration of doctor's visits, experience of doctor–patient communication without family, doctor–family communication without the patient or explanation from the doctor on the phone, existence of home‐visit nursing services, existence of family's anxieties and/or questions, age of primary caregiver(s) and sex of primary caregiver(s). Conclusion The frequency of doctor home‐visits was the only factor identified that was positively associated with the occurrence of home death in home medical care settings. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 28, 2014   doi: 10.1111/ggi.12297   open full text
• Fall frequency and risk factors in patients with Parkinson's disease in Belgrade, Serbia: A cross‐sectional study.
  Tatjana Gazibara, Tatjana Pekmezovic, Darija Kisic Tepavcevic, Aleksandra Tomic, Iva Stankovic, Vladimir S Kostic, Marina Svetel.
  Geriatrics and Gerontology International. April 28, 2014
  Aim The aim of the present study was to estimate fall frequency as well as demographic and clinical factors related to falling in a cohort of Serbian patients with Parkinson's disease (PD). Method The cross‐sectional study comprised 300 consecutive patients recruited at the Neurology Clinic in Belgrade, Serbia, from August 2011 to December 2012. Data were acquired though detailed interviews, while a history of falling referred to the period of 6 months before testing. After a interview related to the circumstances of the last fall sustained by PD patients, the participants were evaluated with the Mini‐Mental State Examination, the Unified Parkinson's Disease Rating Scale, the Hoehn and Yahr scale, the Falls Efficacy Scale and the Self‐Assessment Disability Scale, New Freezing of Gait questionnaire for frequency and impact of freezing, and the Hamilton Depression and the Hamilton Anxiety Rating Scale. Results A total of 60% of individuals reported a fall in the 6‐month period before testing. Multivariate regression showed that patients with PD who had a Self‐Assessment Disability Scale score of ≥56 and Unified Parkinson's Disease Rating Scale total score of ≥69 were 2.04 and 3.32 times more likely to fall, respectively (95% CI 1.10–3.79, P = 0.023 for Self‐Assessment Disability Scale and 95% CI 1.83–6.00, P = 0.001 for Unified Parkinson's Disease Rating Scale). In contrast, a decrease of risk for falling by 57% was observed among those who practiced regular physical activity before the onset of PD (95% CI 0.23–0.80, P = 0.008). Conclusion There is a strong relationship between falling and self‐perceived disability, whereas previous physical exercise had a protective effect. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 28, 2014   doi: 10.1111/ggi.12300   open full text
• Executive dysfunction in elderly diabetic patients.
  Tomader Taha Abdel Rahman, Manal Mohsen Mohammed, Abeer atea Saad Aldeen.
  Geriatrics and Gerontology International. April 21, 2014
  Aim Diabetes mellitus is a chronic medical condition that is dependent on adherence to medical therapy and making decisions related to lifestyle changes. This decision‐making capacity is under the control of a specific domain of cognitive function known as executive function. The purpose of the present study was to evaluate the frequency rate of executive dysfunction among elderly diabetic patients and to assess its association with glycemic control. Method This was a cross‐sectional study. The study was carried out with 1200 diabetic older adults aged 60 years or older visiting the specific diabetes care outpatient clinics of Ain Shams University Hospital and Ain Shams Specialized Hospital, Cairo, Egypt. Executive function was evaluated using the animal verbal fluency test (AVF), clock drawing test (CDT) and digit span backward (DSB). Glycemic control was assessed by measuring hemoglobin A1c (HbA1c). Results The frequency rate of executive dysfunction among elderly diabetic patients is 55%. There were negative correlations between HbA1c and AVF (r = −0.570, P = 0.001), CDT (r = −0.191, P = 0.014), DSB (r = 0.282, P = 0.002) and medication adherence (r = −0.365, P = 0.001). Positive correlations were detected between HbA1c and diabetes duration (r = 0.424, P = 0.020), body mass index (r = 0.194, P = 0.012), and Geriatric Depression Scale (r = 0.380, P = 0.030). Conclusion Executive dysfunction is extremely common among elderly diabetic patients and it is significantly associated with poor glycemic control. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 21, 2014   doi: 10.1111/ggi.12288   open full text
• Different obesity phenotypes, and incident cardiovascular disease and mortality events in elderly Iranians: Tehran lipid and glucose study.
  Mohammadhassan Mirbolouk, Samaneh Asgari, Farhad Sheikholeslami, Fardin Mirbolouk, Fereidoun Azizi, Farzad Hadaegh.
  Geriatrics and Gerontology International. April 21, 2014
  Aim To determine the impact of body mass index and the presence of metabolic syndrome (MetS) on cardiovascular disease (CVD) and mortality events in an elderly Tehranian population. Methods A population‐based cohort of 1199 participants aged ≥65 years were followed for a mean of 9.74 years. Participants were stratified according to body mass index categories and MetS status. Cox regression analyses were used to estimate the hazard ratio of CVD and mortality events, given overweight participants without MetS as reference. Result During follow up, 271 CVD events and 239 deaths (106 CVD deaths) occurred. Regarding CVD, multivariate‐adjusted hazard ratios for CVD events in normal weight and obese participants without MetS were 1.21 (95% CI 0.77–1.91) and 1.46 (95% CI 0.64–3.34), respectively, and for normal weight, overweight and obese participants with MetS were 2.07 (95% CI 1.23–3.28), 1.72 (95% CI 1.13–2.62), and 1.53 (95% CI 0.95–2.45), respectively. Corresponding hazard ratios for CVD mortality were 2.08 (95% CI 0.93–4.82), 1.07 (95% CI 0.13–8.78), 3.71 (95% CI 1.55–8.85), 2.42 (95% CI 1.06–5.51) and 3.31 (95% CI 1.39–7.88), and for all‐cause mortality were 1.41 (95% CI 0.9–2.23), 1.33 (95% CI 0.51–3.47), 1.84 (95% CI 1.1–3.09), 1.46 (95% CI 0.93–2.34) and 1.5 (95% CI 0.91–2.56), respectively. In the presence of diabetes in place of MetS, all of the diabetic participants regardless of body mass index category highlighted a significant risk for CVD and mortality events. Conclusion Among the elderly population, the presence of MetS was necessary for exploring the risk of CVD events and its mortality; however, only the normal weight population with MetS had a significant risk for all‐cause mortality Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 21, 2014   doi: 10.1111/ggi.12295   open full text
• Self‐rated health and associated factors among older people living alone in Shanghai.
  Yu Chen, Alison E While, Allan Hicks.
  Geriatrics and Gerontology International. April 21, 2014
  Aim Self‐rated health is a reliable and important health measure related to older people's mortality and quality of life. Few studies regarding the self‐rated health of older people living alone have been carried out in Mainland China. The present study aimed to investigate the self‐rated health of older people living alone in Shanghai and its associated factors. Methods A stratified random cluster sample of 521 community‐dwelling older people living alone in Shanghai completed structured questionnaires through face‐to‐face interviews. The data collected included self‐rated health, physical health, depression, functional ability, physical activity, health services satisfaction, loneliness, social support and sociodemographic variables. Results More than two‐fifths of the participants (43.2%) reported good self‐rated health. Multinomial logistic regression analyses found that chronic disease, acute disease, functional ability, satisfaction with health services, depression and age were predictors of self‐rated health. Conclusions Identifying factors associated with the self‐rated health of older people living alone could inform the delivery of appropriate health and social care interventions to promote older people's health. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 21, 2014   doi: 10.1111/ggi.12298   open full text
• Mitochondrial free radical theory of aging: Who moved my premise?
  Ye Liu, Jiangang Long, Jiankang Liu.
  Geriatrics and Gerontology International. April 18, 2014
  First proposed by D Harman in the 1950s, the Mitochondrial Free Radical Theory of Aging (MFRTA) has become one of the most tested and well‐known theories in aging research. Its core statement is that aging results from the accumulation of oxidative damage, which is closely linked with the release of reactive oxygen species (ROS) from mitochondria. Although MFRTA has been well acknowledged for more than half a century, conflicting evidence is piling up in recent years querying the causal effect of ROS in aging. A critical idea thus emerges that contrary to their conventional image only as toxic agents, ROS at a non‐toxic level function as signaling molecules that induce protective defense in responses to age‐dependent damage. Furthermore, the peroxisome, another organelle in eukaryotic cells, might have a say in longevity modulation. Peroxisomes and mitochondria are two organelles closely related to each other, and their interaction has major implications for the regulation of aging. The present review particularizes the questionable sequiturs of the MFRTA, and recommends peroxisome, similarly as mitochondrion, as a possible candidate for the regulation of aging. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 18, 2014   doi: 10.1111/ggi.12296   open full text
• Initial phase performance in a 30‐s verbal fluency task as being reflective of aging effect.
  Seon Ha Lee, HyangHee Kim, JungWan Kim, Ji Hye Yoon, Soo Ryon Kim.
  Geriatrics and Gerontology International. April 15, 2014
  Aim The purpose of the present study was to investigate if performance in a 30‐s verbal semantic fluency task (i.e. animal naming) across five elderly aged groups (60–64; 65–69; 70–74; 75–79; 80–84 years) would be reflective of aging effect. Methods We analyzed differences in performance across 5‐s phases and the moment of first word production in these five age groups. Results The following results were obtained: (i) with increasing age, the total number of words produced gradually declined (P < 0.001); (ii) there were significant differences in performance among the age groups in three phases (0–5, 6–10, 16–20 s) (P < 0.05); and (iii) the first word production within the first 5‐s phase was significantly delayed in the 75–79 years and 80–84 years age groups compared with the rest of the age groups. Conclusions Performance in the initial 5‐s phase might be sensitive to cognitive degeneration in normal older adults. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 15, 2014   doi: 10.1111/ggi.12284   open full text
• Physical performance and quality of life in single and recurrent fallers: Data from the Improving Medication Prescribing to Reduce Risk of Falls study.
  Nicole DA Boyé, Francesco US Mattace‐Raso, Esther MM Van Lieshout, Klaas A Hartholt, Ed F Van Beeck, Tischa JM Van der Cammen.
  Geriatrics and Gerontology International. April 15, 2014
  Aim Although guidelines regarding falls prevention make a clear distinction between single and recurrent fallers, differences in functional status, physical performance, and quality of life in single and recurrent fallers have not been thoroughly investigated. Therefore, we investigated the differences in functional status, physical performance and health‐related quality of life (HRQoL) between single and recurrent fallers. Methods From October 2008 to October 2011, 616 community‐dwelling older adults who visited the emergency department as a result of a fall were enrolled. Physical performance was assessed with the Timed Up & Go (TUG) test, the Five Times Sit to Stand (FTSS) test, handgrip strength and the tandem stand test. Functional status was measured using the activities of daily living and instrumental activities of daily living scales. HRQoL was measured using the European Quality of Life five dimensions (EQ‐5D), and the Short Form‐12 version 2. A general linear model was used to compare the means of the scores. Results Recurrent falls in community‐dwelling older adults were associated with poorer physical performance as measured by the TUG test (P < 0.001), FTSS test (P = 0.011), handgrip strength (P < 0.001) and tandem stand (P < 0.001), and lower HRQoL scores as measured by the EQ‐5D (P = 0.006) and SF‐12 (P = 0.006 and P = 0.012). Conclusion The present findings provide further evidence that recurrent fallers have poorer physical performance and quality of life than single fallers. Recurrent falls might be a symptom of underlying disease and frailty, and reason for further assessment. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 15, 2014   doi: 10.1111/ggi.12287   open full text
• Trait of routinization and adaptation to life in continuing care communities among older adults in Israel.
  Anna Zisberg, Waheed Kaabiya, Elena O Siegel.
  Geriatrics and Gerontology International. April 15, 2014
  Aim To examine the relationship between levels of adaptation to independent living in continuing care communities and the personality trait, routinization. Methods Using a correlative design, structured face‐to‐face interviews were carried out with 120 older adults residing in independent housing units across six continuing care facilities in Israel, using the Index of Relocation Adjustment and the Variety Assessment Scale questionnaires. Results In a mixed model, one of the two routinization subscales (disliking disruption) was moderately associated with adaptation, controlling for decision to enter the facility, satisfaction with the facility, family relationship, functional status, education, family status and type of setting. Residents who expressed high levels of disliking disruption, higher functional status and less involvement in the decision to enter the facility reported poorer adaptation to their living conditions. Conclusion Our findings point out the complexity and intricacy of personal attributes as factors associated with adaptation to transitions in older age, and highlight the potential contribution of the trait of routinization to adaptation. Further research is required to identify ways to best support older adult transitions to institutional environments, considering different personality traits and environments. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 15, 2014   doi: 10.1111/ggi.12289   open full text
• Apolipoprotein E genotype and physical function among older people with mild cognitive impairment.
  Takehiko Doi, Hiroyuki Shimada, Hyuma Makizako, Kota Tsutsumimoto, Kazuki Uemura, Takao Suzuki.
  Geriatrics and Gerontology International. April 15, 2014
  Aim Mild cognitive impairment (MCI) is conceptualized as prodromal of Alzheimer's disease (AD). Declined physical function is one of the risk factors for progression to AD, whereas genetic factors, especially the apolipoprotein E ε4 allele (APOE4), also contribute to the risk of AD and affect the risk factors. However, the association between APOE4 and physical function in MCI is still unclear. To elucidate the association, we carried out the present study to compare physical function between APOE4 carriers and non‐carriers in MCI. Methods The study included 386 MCI patients (mean age 71.6 years) who were classified into APOE4 carrier and non‐carrier groups. The participants' characteristics were assessed by face‐to‐face interviews. Grip strength, five chair stand test, walking speed and 6‐min walking test were measured as physical functions. Results In univariate analysis, the APOE4 carrier group had decreased walking speed compared with the non‐carrier group (P < 0.05), but other measures of physical function were not significantly different between the groups. The linear regression model showed a significant association between walking speed and APOE4 after adjusting for covariates (P < 0.05). Conclusions The present study showed that APOE4 carrier participants with MCI had decreased walking speed compared with non‐carrier participants. Thus, APOE4 genotypes should be considered as a potential mediator when the measure of walking speed is used as a risk factor of dementia in older adults with MCI. Further studies using prospective data are required to clarify the relationship between physical function and genetic factors in MCI. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 15, 2014   doi: 10.1111/ggi.12291   open full text
• Impact of cognitive reserve on the progression of mild cognitive impairment to Alzheimer's disease in Japan.
  Akira Osone, Reiko Arai, Rina Hakamada, Kazutaka Shimoda.
  Geriatrics and Gerontology International. April 15, 2014
  Aim The present study aimed to investigate whether cognitive reserve (CR), referring here to education and premorbid intelligence (IQ), is associated with the risk for progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD). Methods A total of 51 patients with MCI and 59 patients with AD were prospectively enrolled for assessment with the Mini‐Mental State Examination, the Japanese version of the cognitive subscale of the Alzheimer's Disease Assessment Scale, the Japanese version of the Nelson Adult Reading Test (JART), magnetic resonance imaging (MRI) and single‐photon emission computed tomography (SPECT), adjusting for sex, age at diagnosis, age at onset and duration of illness. Results SPECT findings showed hypoperfusion in the posterior cingulate gyri and precunei, suggesting that the participants were in the early or mild stage of AD or MCI. Voxel‐based morphometry MRI showed no statistical differences between the two groups in gray matter loss in the entorhinal and hippocampal areas; however, multiple logistic regression analysis showed a significant difference in premorbid IQ measured with JART. Conclusion Despite the limitations of the cross‐sectional design, the findings suggest that premorbid intellectual function might explain the discrepancy in clinical status between MCI and AD patients with a similar magnitude of brain pathology and comorbid medical disorders. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 15, 2014   doi: 10.1111/ggi.12292   open full text
• Comparisons of prognostic factors between young and elderly patients with chronic heart failure.
  Takamasa Sato, Hiroyuki Yamauchi, Yuki Kanno, Satoshi Suzuki, Akiomi Yoshihisa, Takayoshi Yamaki, Koichi Sugimoto, Hiroyuki Kunii, Kazuhiko Nakazato, Hitoshi Suzuki, Shu‐ichi Saitoh, Yasuchika Takeishi.
  Geriatrics and Gerontology International. April 15, 2014
  Aim The purpose in the present study was to compare prognostic risk factors between older and younger chronic heart failure (CHF) patients. Methods We examined 598 consecutive CHF patients (476 men and 122 women, mean age 61.4 ± 14.3 years) who underwent cardiopulmonary exercise testing, echocardiography and blood examination. We divided the 598 patients into two groups: the elderly group (age ≥75 years, n = 123) and the young group (age <75, n = 475). We compared blood testing data, exercise capacity, cardiac function and prognosis between the two groups. Patients were followed up (median 782 days) to register cardiac deaths or rehospitalization as a result of worsening heart failure. Results Patients in the elderly group were associated with higher frequencies of atrial fibrillation and diuretic use than those in the young group. Patients in the elderly group had lower hemoglobin concentration, more impaired renal function, higher plasma B‐type natriuretic peptide (BNP) levels, smaller left ventricular volume, longer deceleration time of early mitral wave and lower exercise capacity than those in the young group. There were 199 cardiac events during follow‐up periods. As expected, Kaplan–Meier analysis showed that patients in the elderly group had higher cardiac event rates than those in the young group. In the young group, multivariable Cox hazard analysis showed that hemoglobin concentration, log BNP and peak VO2 were independent predictors related to cardiac events. In contrast, in the elderly group, estimated glomerular filtration rate, atrial fibrillation and peak VO2 were independent factors to predict adverse clinical outcomes. Conclusions Prognostic factors were different between the elderly and young patients in CHF. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 15, 2014   doi: 10.1111/ggi.12293   open full text
• Implications of tobacco smoking on the oral health of older adults.
  Rupali Agnihotri, Sumit Gaur.
  Geriatrics and Gerontology International. April 03, 2014
  Cigarette smoking is the foremost health risk issue affecting individuals of all age groups globally. It specifically influences the geriatric population as a result of chronic exposure to toxins. Its role in various systemic and oral diseases including cancer, premalignant lesions, periodontitis, tooth loss, dental caries and implant failures is well established. Smoking causes immuno‐inflammatory imbalances resulting in increased oxidative stress in the body. The latter hastens the immunosenescence and inflammaging process, which increases the susceptibility to infections. Thus, implementation of smoking cessation programs among older adults is imperative to prevent the development and progression of oral and systemic diseases. The present review focuses on smoking‐associated oral health problems in older adults, and the steps required for cessation of the habit. Geriatr Gerontol Int 2014; ●●: ●●–●●.

  April 03, 2014   doi: 10.1111/ggi.12285   open full text
• Green tea: A novel functional food for the oral health of older adults.
  Sumit Gaur, Rupali Agnihotri.
  Geriatrics and Gerontology International. November 21, 2013
  Functional foods are foods with positive health effects that extend beyond their nutritional value. They affect the function of the body and help in the management of specific health conditions. Green tea, a time‐honoured Chinese herb, might be regarded as a functional food because of its inherent anti‐oxidant, anti‐inflammatory, antimicrobial and antimutagenic properties. They are attributed to its reservoir of polyphenols, particularly the catechin, epigallocatechin‐3‐gallate. Owing to these beneficial actions, this traditional beverage was used in the management of chronic systemic diseases including cancer. Recently, it has been emphasized that the host immuno‐inflammatory reactions destroy the oral tissues to a greater extent than the microbial activity alone. Green tea with its wide spectrum of activities could be a healthy alternative for controlling these damaging reactions seen in oral diseases, specifically, chronic periodontitis, dental caries and oral cancer, which are a common occurrence in the elderly population. Geriatr Gerontol Int 2014; 14: 238–250.

  November 21, 2013   doi: 10.1111/ggi.12194   open full text
• Benzodiazepine discontinuation and patient outcome in a chronic geriatric medical/psychiatric unit: A retrospective chart review.
  Yuma Yokoi, Meenal Misal, Esther Oh, Michele Bellantoni, Paul B Rosenberg.
  Geriatrics and Gerontology International. November 08, 2013
  Aim A substantial number of elderly patients take benzodiazepines (BZD) regularly despite concerns about toxicity and possible dependence, and there are relatively few data to guide clinicians' decisions regarding discontinuing benzodiazepines in the elderly. Methods We carried out a retrospective chart review of 75 elderly patients admitted to a chronic medical/psychiatric unit who were taking a standing dose of benzodiazepines on admission, comparing 40 patients who discontinued benzodiazepines versus 35 who did not discontinue. Purpose We examined the association of BZD discontinuation versus continuation with clinical outcomes on discharge, and further examined clinical characteristics associated with BZD discontinuation. Results Discontinuers had shorter length of stay without evidence of worse cognitive and functional outcome except a trend toward increased incidence of agitation. Logistic regression models suggested anxiety, higher age and higher dose of antidepressants at the beginning were significantly related to successful discontinuation during admission after regression. Conclusion These data imply that BZD withdrawal during admission can be safe and feasible in many elderly frail patients, and that withdrawal might be associated with shorter duration of chronic hospitalization. Geriatr Gerontol Int 2014; 14: 388–394.

  November 08, 2013   doi: 10.1111/ggi.12113   open full text
• Validation study of Charlson Comorbidity Index in predicting mortality in Chinese older adults.
  Tuen‐Ching Chan, James Ka‐Hay Luk, Leung‐Wing Chu, Felix Hon‐Wai Chan.
  Geriatrics and Gerontology International. September 11, 2013
  Aim The Charlson Comorbidity Index (CCI) is commonly studied for predicting mortality, but there is no validation study of it in Chinese older adults. The objective of the present study was to validate the use of CCI in Chinese older adults for predicting mortality. Method We carried out a retrospective cohort study from 2004 to 2013 for patients discharged from a geriatric day hospital in Hong Kong. Comorbidity was quantified using CCI, and patients were divided into six groups according to their score of CCI: CCI‐0, CCI‐1, CCI‐2, CCI‐3, CCI‐4 and CCI ≥ 5. Other data collected included demographics, and functional, nutritional, cognitive and social assessment. The outcome measure was 1‐year mortality. Results At 1‐year follow up, 3.8% (n = 17), 5.9% (n = 37), 9.2% (n = 35), 12.9% (n = 20), 16.9% (n = 23) and 19.3% (n = 60) of CCI‐0, CCI‐1, CCI‐2, CCI‐3, CCI‐4 and CCI ≥ 5 died, respectively (P < 0.001). Multivariate analysis showed that CCI‐1, CCI‐2, CCI‐3, CCI‐4 and CCI ≥ 5 have a hazard ratio (HR) of 1.34 (confidence interval [CI] 1.04–2.12), 2.18 (CI 1.03–4.61), 3.44 (CI 1.52–7.81), 3.74 (CI 1.35–10.39) and 4.63 (CI 2.28–9.43), respectively, compared with CCI‐0. The area under the curve of the receiver operating characteristic curves of CCI in predicting 1‐year mortality for older adults was 0.68 (CI 0.64–0.72). Conclusion There is a significant dose–response relationship in the hazard ratio between CCI and 1‐year mortality in Chinese older adults, but involvements of functional, nutritional and social assessments are important for comprehensive quantification of health status in older adults. Geriatr Gerontol Int 2014; 14: 452–457.

  September 11, 2013   doi: 10.1111/ggi.12129   open full text
• Epileptic activities are common in older people with delirium.
  Gilles Naeije, Imane Bachir, Nicolas Gaspard, Benjamin Legros, Thierry Pepersack.
  Geriatrics and Gerontology International. August 04, 2013
  Aim Delirium is responsible for up to 56% of hospital admissions in the elderly. Epilepsy and delirium share most risk factors and are both associated with confusion. The aim of this work was to study whether a link between epileptic activity (EA) and delirium existed, and if this link was relevant. Methods Charts of patients aged over 65 years admitted for delirium at the emergency room in 2011 were retrospectively reviewed. Risk factors for delirium, past medical history, medications, biological and iconographic work‐up were analyzed. Those characteristics were compared in patients who had electroencephalogram (EEG) with those who had not. Clinical characteristics of patients with EA on EEG were compared with the patients without EA. Results A total of 177 charts were analyzed. The only parameters associated with the realization of an EEG were anti‐epileptic drug treatment and subdural hematoma. A total of 56% (98/177) of patients had EEG. A total of 84% of EEG were abnormal. EA were present in 15% of EEG: 12 with interictal epileptiform discharges and three with non‐convulsive status (NCSE). In multivariate analysis, only dehydration and the use of anticholinergic drugs were associated with EA. Outcome showed a trend for longer hospital stay and a higher institutionalization rate for patients with delirium who had EA. Conclusion EA occur in a significant proportion of delirium, and possibly have a role in the prognosis and pathophysiology of this disorder. Almost no anomalies can distinguish a priori patients in delirium who will have EA. EEG should be carried out in all older patients with delirium. Geriatr Gerontol Int 2013; 14: 447–451.

  August 04, 2013   doi: 10.1111/ggi.12128   open full text
• Non‐pharmacological treatment reducing not only behavioral symptoms, but also psychotic symptoms of older adults with dementia: A prospective cohort study in Taiwan.
  Rue‐Chuan Chen, Chien‐Liang Liu, Ming‐Hsien Lin, Li‐Ning Peng, Liang‐Yu Chen, Li‐Kuo Liu, Liang‐Kung Chen.
  Geriatrics and Gerontology International. August 01, 2013
  Aim The clinical effectiveness of non‐pharmacological interventions on behavioral and psychological symptoms of dementia (BPSD) among older Chinese with dementia remains unclear, and the evidence supporting the benefits of a non‐pharmacological approach on psychotic symptoms is scarce. Methods A prospective cohort study including 104 older men with dementia living in two veterans homes in Taiwan was carried out in 2011. An organized program of music therapy, orientation training, art‐cognitive activities and physical activities was carried out for the intervention group. All participants were evaluated for neuropsychiatric inventory (NPI), defined daily dose of psychotropic drug use, Barthel Index, Instrumental Activities of Daily Living, Mini‐Mental State Examination, Geriatric Depression Scale, Tinetti balance score and Tinetti gait score. Results Overall, 104 residents were enrolled and 92 of them completed the study. The intervention group had a more significant reduction than the reference group in the overall NPI score (−2.36, P = 0.046), and in the subcategories of delusion (−0.9, P = 0.018), hallucination (−0.82, P = 0.004) and agitation (−0.91, P = 0.038). Multivariate analysis showed that the non‐pharmacological intervention was associated with a favorable outcome in overall NPI score (OR 4.113, P = 0.013) and in the subcategories of hallucination (OR 14.309, P = 0.049) and agitation (OR 6.604, P = 0.037). Meanwhile, a higher baseline NPI score was also associated with a favorable outcome in overall NPI score, and in the subcategories of delusion, hallucination and agitation. Conclusion Non‐pharmacological interventions have a positive effect on behavioral and psychological symptoms of dementia, not only in outward symptoms like agitation, but also intrinsic psychotic symptoms like hallucination and delusion, and agitation in older Chinese men with dementia. Geriatr Gerontol Int 2013; 14: 440–446.

  August 01, 2013   doi: 10.1111/ggi.12126   open full text
• Self‐perceived health and quality of life by activity status in community‐dwelling older adults.
  Lara Pino, Abel E González‐Vélez, Maria‐Eugenia Prieto‐Flores, Alba Ayala, Gloria Fernandez‐Mayoralas, Fermina Rojo‐Perez, Pablo Martinez‐Martin, Maria João Forjaz.
  Geriatrics and Gerontology International. July 26, 2013
  Aim The present study aimed at analyzing whether activity status is associated with self‐perceived health status and quality of life (QoL) in community‐dwelling older adults. Methods We used a cross‐sectional design based on a semi‐structured QoL questionnaire in a representative sample of 1106 community‐dwelling adults aged 60 years and older in Spain. Logistic regression models were used to explain the association of activity status with self‐perceived health status and QoL, assessed by means of the EQ‐5D‐3L index, controlling for the influence of sociodemographic, social and support network variables, and health indicators. Results The mean age ± standard deviation was 72.1 ± 7.8 years. For the activity status, 8.5% were working people, 53.7% retirees, 30.6% homemakers and 7.2% pensioners. All homemakers and 93.6% pensioners were women. In the model to assess perceived health status, when controlling for sociodemographic, social and support network variables, we found that working people rated their health better than the retired group. In this model, pensioners rated their health status worst, whereas homemakers did not show any significant difference compared with the retired group. However, there were no differences in the model of QoL by activity status. Conclusion Activity status was associated with self‐perceived health status, but not with QoL. This study draws attention to the need of considering the activity of older adults for actions aimed at maintaining and improving their health. Geriatr Gerontol Int 2014; 14: 464–473.

  July 26, 2013   doi: 10.1111/ggi.12119   open full text
• Association of decreased sympathetic nervous activity with mortality of older adults in long‐term care.
  Koji Shibasaki, Sumito Ogawa, Shizuru Yamada, Katsuya Iijima, Masato Eto, Koichi Kozaki, Kenji Toba, Masahiro Akishita, Yasuyoshi Ouchi.
  Geriatrics and Gerontology International. July 23, 2013
  Aim To investigate the relationship between physical function, mortality and autonomic nervous activity measured by heart rate variability of elderly in long‐term care. Methods Cross‐sectional and longitudinal studies were carried out at hospitals and health service facilities for the elderly in Nagano prefecture, Japan, from July 2007 to March 2011. A total of 105 long‐term care older adults and 17 control older adults with independent physical function were included. The Functional Independence Measure (FIM) and Barthel Index were determined as indices of physical function. Twenty‐four‐hour Holter monitoring was carried out. From RR intervals in electrocardiograms, heart rate and standard deviations of all NN intervals in all 5‐min segments of the entire recording, power spectral density, low frequency, high frequency and low frequency/high frequency (LF/HF) were calculated. Results FIM score and Barthel Index were 46 ± 26 and 30 ± 31, respectively, in long‐term care elderly. FIM and Barthel index were significantly correlated with heart rate and the standard deviations of all NN intervals after adjustment for age, sex, cardiovascular risk factors and FIM. Furthermore, LF/HF was significantly decreased in long‐term care elderly compared with control elderly after adjustment for covariates. In addition, decrease in LF/HF was an independent risk factor for mortality. Conclusion Low LF/HF activity was observed in long‐term care elderly and was related to an increase of overall mortality. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  July 23, 2013   doi: 10.1111/ggi.12074   open full text
• Understanding delusion in dementia: A review.
  Gabriele Cipriani, Sabrina Danti, Marcella Vedovello, Angelo Nuti, Claudio Lucetti.
  Geriatrics and Gerontology International. July 23, 2013
  Alzheimer's disease and other dementia are associated with cognitive and functional impairment, as well as neuropsychiatric sequelae, including psychotic features. Research has largely concentrated on the study of cognitive decline, but the associated behavioral and neuropsychiatric symptoms are of equal importance in the clinical profile of the disease. Delusions are common, disabling and persistent in the course of dementia. The purpose of the present review was to examine the phenomenon of delusion in people with dementia. We searched the electronic databases for original research and review articles using the search terms “delusion, dementia, Alzheimer's disease, frontotemporal dementia, vascular dementia and Lewy body disease”. Various types of explanations have been proposed regarding the etiology of delusional belief in dementia, and cerebral correlates are considered. Pharmacological and non‐pharmacological treatments are analyzed. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  July 23, 2013   doi: 10.1111/ggi.12105   open full text
• Size variability of handwriting in healthy Korean older adults.
  Ji Hye Yoon, HyangHee Kim, JungWan Kim, Eunjeong Park, Soo Ryon Kim.
  Geriatrics and Gerontology International. July 23, 2013
  Aim The aim of the present study was to delineate how age‐related deterioration affects the handwriting of healthy elderly (HE) subjects. Methods A total of 235 HE (54 males, 181 females) aged 57–91 years participated as subjects in the study. In order to compare the area of handwriting, we divided the participants into two groups: (i) aged 57–74 years; and (ii) aged 75–91 years. The writing stimulus was a four‐syllabic word with one‐to‐one grapheme‐to‐phoneme correspondence. The size of each syllable in the target word was measured using a software program. Alignment of the word to baseline was assessed using a multiple‐choice checklist. Results As compared with handwriting by the younger group, the older group showed greater variability in the size of the written syllables within the word (P = 0.023). Conclusion The handwriting was characterized by unequal size among syllables and non‐perpendicular alignment, which could be explained by several factors. First, the variability might have resulted from irregular fine movement motor control in older adults. Second, the deterioration of visual feedback and visuomotor integration in normal aging might have affected handwriting performance. In conclusion, variability of handwriting can be sensitive in predicting the aging process. Geriatr Gerontol Int 2014; 14: 458–463.

  July 23, 2013   doi: 10.1111/ggi.12106   open full text
• Relationship between tissue hydroxyl radical and oxidatively modified macromolecule levels.
  Toru Sasaki, Sho‐Ichi Mogi, Takao Kaneko, Haruka Kojima, Shinsuke Katoh, Akira Sano, Shuji Kojima.
  Geriatrics and Gerontology International. July 23, 2013
  Aims The relationship between hydroxyl radical (·OH) and oxidatively modified macromolecule formations was examined in tissues from young and aged mice. Methods To determine the ·OH generation in tissues in vivo using the hydroxylation trapping reaction of ·OH into salicylic acid (SA), analytical conditions for dihydroxybenzoic acid (DHBA) and SA determination, and optimum dosages of SA for administration and time‐points of tissue sampling were determined. 2, 3‐DHBA levels in tissues from young mice and age‐related changes were determined with the oxidatively modified macromolecules. Results 2, 3‐DHBA, a hydroxylation compound of SA, is considered to be suitable for determination of ·OH levels in tissues. Tissue levels of 2, 3‐DHBA expressed as a molar ratio to SA, was comparable among tissues, and was in accordance with 8‐oxo‐2′‐deoxyguanosine (8‐oxodG) and carbonylated proteins. In the aging process, 2, 3‐DHBA levels in the brain and heart increased in the biphasic pattern in accordance with the 8‐oxodG and thiobarbituric acid reactive substances (TBARS) levels, whereas levels of carbonylated proteins were not changed with age. Conclusions An in vivo method for ·OH measurement using hydroxylation of SA was optimized. However, as a limitation, 2, 3‐DHBA, as well as other oxidative stress markers, could be affected by various in vivo factors. The accordance was seen among 2, 3‐DHBA, 8‐oxodG and carbonylated protein levels in tissues from young mice. The tissue levels of 2, 3‐DHBA increased in accordance with the 8‐oxodG and TBARS during the aging process. Geriatr Gerontol Int 2014; 14: 498–507.

  July 23, 2013   doi: 10.1111/ggi.12107   open full text
• Hip fracture risk factors and the discriminability of hip fracture risk vary by age: A case–control study.
  Mahesan Anpalahan, Stewart G Morrison, Stephen J Gibson.
  Geriatrics and Gerontology International. July 23, 2013
  Aims To determine the important risk factors for hip fracture and the discriminability of hip fracture risk in different age cohorts (≤80 years, >80 years). Methods Consecutive admissions of hip fracture over 24 months in those aged >60 years, and an age‐ and sex‐matched control derived from admissions under a medical unit were prospectively assessed. The risk factors and the discriminabilty of hip fracture risk by age were investigated for each sex in univariate and multivariate models. The area under the curve (AUC) statistics from the receiver operating characteristic curve analysis was used to estimate the ability of the independent risk factors to discriminate hip fracture risk. Results The important risk factors in women aged ≤80 years were lower bodyweight, previous osteoporotic fracture, hip fracture in first‐degree relatives and lower plasma 25OHD, and their discriminative effect was (AUC) 0.69. Previous osteoporotic fracture and lower plasma 25OHD were the important risk factors in men aged ≤80 years, with a discriminative effect of 0.83. In the >80‐year age cohorts, only falls was independently associated with hip fracture in both sexes, with discriminative effects of 0.60 and 0.62 in females and males, respectively. Conclusions The overall discrimination of hip fracture risk appears less adequate in those aged >80 years when compared with those aged ≤80 years. Although skeletal factors have a greater risk association with hip fracture in patients aged ≤80 years, it is falls that is important in those aged >80 years. The relative importance of risk factors also appears to vary between the sexes in those aged ≤80 years. Geriatr Gerontol Int 2014; 14: 413–419.

  July 23, 2013   doi: 10.1111/ggi.12117   open full text
• Fear of intimacy with helping professionals and its impact on elderly Chinese.
  Ying Lau, Aloysius Chow, Sally Chan, Wenru Wang.
  Geriatrics and Gerontology International. July 23, 2013
  Aim The present study aimed to investigate the attitudes of Chinese older adults toward seeking help from healthcare professionals, and its impact on their self‐care ability and medication adherence. Methods A cross‐sectional study using a questionnaire survey was carried out. A convenience sample of 301 older adults was recruited from six health centers in Macao, People's Republic of China. The Chinese versions of Fear of Intimacy with Helping Professionals (C‐FIHP), Exercise of Self‐care Agency (C‐ESCA) and Morisky 4‐Item Self‐Report Measure of Medication‐Taking Behavior (C‐MMAS) were used to measure the study variables. Results Chinese older adults who were married and had comorbidity with arthritis showed significantly negative attitudes toward seeking help form healthcare professional than those who were not married (P < 0.05) and did not have arthritis (P < 0.01). There are significant negative correlations between C‐FIHP with C‐ESCA (P < 0.01) and C‐MMAS‐4 (P < 0.01). Regression analysis identified three predicative factors of fear of intimacy with helping professionals: marital status, comorbidity with arthritis and self‐care agency, which accounted for 23.9% of variance. Conclusions The present study suggests that Chinese older adults' fear of intimacy with helping professionals impacts their perceived self‐care ability and medication adherence. The three predictive factors identified in the present study might provide useful pointers for healthcare professionals to customize an effective approach to encourage and engage older adults. This might improve the self‐care ability and medication adherence of older adults, which will result in a better quality of life and psychosocial well‐being. Geriatr Gerontol Int 2014; 14: 474–480.

  July 23, 2013   doi: 10.1111/ggi.12121   open full text
• Frailty Index in Europeans: Association with determinants of health.
  Roman Romero‐Ortuno.
  Geriatrics and Gerontology International. July 23, 2013
  Aim The Frailty Index (FI) summarizes differences in health status within individuals, and the determinants of health drive that variability. The aim of the present study was to investigate the influence of education, income, smoking, alcohol intake and parental longevity on the FI variability in subjects of the same chronological age group. Methods Analyses were based on a 40‐item FI based on the first wave of the Survey of Health, Aging and Retirement in Europe (SHARE, http://www.share‐project.org/), including 29 905 participants aged ≥50 years from 12 countries. For each sex, the sample was divided into age categories (50s, 60s, 70s, 80s and ≥90), and FI quartiles within age categories were calculated. Multivariate ordinal regressions were computed to assess the relative contribution of the health determinants on the FI quartiles in each age group. Results In women, the most significant multivariate predictors were years of education (odds ratios [OR] around 0.9), and difficulties making ends meet (OR between 1.8 and 2.1). In men, the most significant multivariate predictors were years of education (OR around 0.9), difficulties making ends meet (OR between 1.6 and 2.1), mother's age at death (OR under 1), and father's age at death (OR under 1). Conclusions Consistently with the literature, education and income explained, in both sexes, cross‐sectional variability in FI in subjects of the same chronological age group. The influence of parental longevity seemed to be greater in men, which mirrors previous studies showing that genetic factors might have a higher impact on longevity in men. Geriatr Gerontol Int 2014; 14: 420–429.

  July 23, 2013   doi: 10.1111/ggi.12122   open full text
• Dose–response meta‐analysis on coffee, tea and caffeine consumption with risk of Parkinson's disease.
  Hui Qi, Shixue Li.
  Geriatrics and Gerontology International. July 23, 2013
  Aims A dose–response meta‐analysis was carried out between Parkinson's disease (PD) risk, and coffee, tea and caffeine consumption. Methods A comprehensive search was carried out to identify eligible studies. The fixed or random effect model was used based on heterogeneity test. The dose–response relationship was assessed by restricted cubic spline. Results A total of 13 articles involving 901 764 participants for coffee, eight articles involving 344 895 participants for tea and seven articles involving 492 724 participants for caffeine were included. A non‐linear relationship was found between coffee consumption and PD risk overall, and the strength of protection reached the maximum at approximately 3 cups/day (smoking‐adjusted relative risk: 0.72, 95% confidence interval 0.65–0.81). A linear relationship was found between tea and caffeine consumption, and PD risk overall, and the smoking‐adjusted risk of PD decreased by 26% and 17% for every two cups/day and 200 mg/day increments, respectively. The association of coffee and tea consumption with PD risk was stronger for men than that for women, and the association of caffeine consumption with PD risk was stronger for ever users of hormones than that for never users of hormones among postmenopausal women. The aforementioned associations were weaker for USA relative to Europe or Asia. Conclusions A linear dose‐relationship for decreased PD risk with tea and caffeine consumption was found, whereas the strength of protection reached a maximum at approximately 3 cups/day for coffee consumption overall. Further studies are required to confirm the findings. Geriatr Gerontol Int 2014; 14: 430–439.

  July 23, 2013   doi: 10.1111/ggi.12123   open full text
• Functional decline over 2 years in older Spanish adults: Evidence from the Survey of Health, Ageing and Retirement in Europe.
  Santiago Rodríguez López, Pilar Montero, Margarita Carmenate, Mauricio Avendano.
  Geriatrics and Gerontology International. July 12, 2013
  Aim To evaluate the social, educational, health and behavioral predictors of physical functional decline in older Spanish adults. Methods A 2‐year longitudinal study based on 699 community‐dwelling Spanish adults aged over 65 years participating in the Survey of Health, Ageing and Retirement in Europe was carried out. Several predictors of a combined measure of functional disability were examined using logistic regressions. Results A decline in function was experienced by 166 individuals. Functional decline in men was associated with an increased number of chronic diseases (OR 2.25, 95% CI 1.21–4.19) and depressive symptoms (OR 5.05, 95% CI 2.42–10.54) over a 2‐year period, whereas among women it was associated with decreased numeracy score (OR 1.88, 95%CI 1.05–3.34). Conclusions Longitudinal changes in predictors are strongly associated with longitudinal changes in function between baseline and a 2‐year follow up, most clearly among men. A decrease in cognitive functioning and increased depressive symptoms are associated with a decline in physical functioning, and can serve as useful clinical predictors to prevent disability in older Spanish adults. Geriatr Gerontol Int 2014; 14: 403–412.

  July 12, 2013   doi: 10.1111/ggi.12115   open full text
• Comparison of clinical profile in elderly patients with nursing and healthcare‐associated pneumonia, and those with community‐acquired pneumonia.
  Nahoko Nakagawa, Yoko Saito, Mari Sasaki, Yasunari Tsuda, Hideaki Mochizuki, Hideki Takahashi.
  Geriatrics and Gerontology International. July 08, 2013
  Aim Nursing and healthcare‐associated pneumonia (NHCAP) is a modified category of healthcare‐associated pneumonia adjusted for the healthcare system of Japan. The clinical characteristics and risk factors for mortality have not been well characterized in elderly patients with NHCAP. Methods We retrospectively investigated 960 consecutive patients aged ≥65 years admitted for pneumonia. Baseline characteristics, severity, pathogen distribution, outcomes and risk factors for mortality were compared between patients with community‐acquired pneumonia (CAP) and those with NHCAP. The applicability of age, dehydration, respiratory failure, orientation disturbance, and low BP (A‐DROP) score, a standard severity index for CAP in Japan, was also evaluated in NHCAP. Results The study participants consisted of 373 patients (38.8%) with CAP and 587 (61.2%) with NHCAP. The patients with NHCAP were older and had poorer performance status (PS) and more comorbidities than those with CAP. The frequency of potentially drug‐resistant (PDR) pathogens and in‐hospital mortality were found in 10 (2.7%) and 17 patients (4.6%) with CAP, and 60 (10.2%) and 83 patients (14.1%) with NHCAP, respectively (P < 0.0001). The incidences of PDR pathogens and mortality were not significantly different among the criteria for NHCAP. The higher mortality was associated with PS, comorbidity with Charlson Comorbidity Index ≥3, and the coexistence of congestive heart failure, chronic kidney disease and malignancy. A‐DROP score was poor at predicting mortality in most patients with NHCAP. Conclusion The current criteria for NHCAP seem to be appropriate for differentiating patients with poor outcomes from community‐acquired pneumonia patients. It is essential to assess individual underlying conditions, such as PS and comorbidity, when caring for patients with NHCAP. Geriatr Gerontol Int 2013; 14: 362–371.

  July 08, 2013   doi: 10.1111/ggi.12110   open full text
• EQ‐5D rated by proxy in institutionalized older adults with dementia: Psychometric pros and cons.
  Alicia Diaz‐Redondo, Carmen Rodriguez‐Blazquez, Alba Ayala, Pablo Martinez‐Martin, Maria João Forjaz,.
  Geriatrics and Gerontology International. July 07, 2013
  Aim Measurement of health‐related quality of life in people with dementia is a challenge, because of their special characteristics and the difficulties that this term entails itself. The present study aimed at assessing the psychometric properties of the EQ‐5D rated by a familiar or a professional caregiver of institutionalized older adults with dementia. Methods We analyzed the EQ‐5D psychometric properties from 525 questionnaires rated by proxy, in a sample of institutionalized older adults with dementia. Results The mean EQ‐5D index score was 0.11 ± 0.38, and 51.54 ± 21.47 for the visual analog scale. The intraclass correlation coefficient was 0.72. Regarding internal consistency, Cronbach's alpha was 0.64, and the item‐total correlation ranged from 0.33 to 0.53. Exploratory factor analysis identified a functional and a subjective factor, accounting for 67.35% of the variance. Convergent validity of EQ‐5D with Quality of Life Alzheimer's Disease by proxy and Quality of Life in Late‐stage Dementia scales was satisfactory (r = 0.36–0.58). The EQ‐5D showed appropriate discriminative validity among patients grouped into several categories. Multiple linear regression models, using EQ‐index and visual analog scale as dependent variables, identified dependence level, proxy characteristics, leisure and comorbidity as determinants of quality of life. Conclusions Despite some limitations in the more subjective dimensions, the proxy‐rated EQ‐5D showed satisfactory psychometric properties in the present study, suggesting that it is a valid and alternative instrument to assess quality of life in institutionalized older people with dementia. Geriatr Gerontol Int 2014; 14: 346–353.

  July 07, 2013   doi: 10.1111/ggi.12108   open full text
• Association between site‐specific muscle loss of lower body and one‐leg standing balance in active women: The HIREGASAKI study.
  Takashi Abe, Madoka Ogawa, Jeremy P Loenneke, Robert S Thiebaud, Mark Loftin, Naotoshi Mitsukawa.
  Geriatrics and Gerontology International. July 07, 2013
  Aim To test the hypothesis that static balance is associated with site‐specific loss of muscle mass in older adults. Methods A total of 57 active women aged 52–83 years had their muscle thickness (MTH) measured by ultrasound at four sites on the anterior and posterior aspects of their upper‐ and lower‐leg. MTH ratios were calculated to assess the site‐specific muscle loss. One‐leg standing balance with eyes open and maximum isometric knee extension/flexion strength were measured. Daytime physical activity was also measured. The participants were separated into three groups based on achieved timed one‐leg balance test: less than 60 s (n = 19, G1), 60–120 s (n = 12, G2) and over 120 s (n = 26, G3). Results Age was inversely correlated to the upper‐leg (A50 : P70) MTH ratios (r = −0.389, P < 0.001), but not lower‐leg ratio (r = 0.047), thus site‐specific muscle loss was observed in the upper‐leg. Total muscle mass was similar among the groups. A50 : P70 MTH ratio and absolute and relative knee flexion strength were lower in G1 than in G3. Step counts and durations of moderate and vigorous exercise were lower in G1 and G2 than in G3. There were significant correlations between one‐leg balance and A50 : P70 MTH ratio (r = 0.271, P < 0.05) and physical activity level (r = 0.357–0.481, P < 0.01). After adjusting for step count, one‐leg balance was only correlated significantly with duration of vigorous exercise (r = 0.319, P < 0.05). Conclusion Higher physical activity could have more impact on balance regulation, as the influence of site‐specific muscle loss was weak in active women. Geriatr Gerontol Int 2014; 14: 381–387.

  July 07, 2013   doi: 10.1111/ggi.12112   open full text
• Six‐year longitudinal changes in body composition of middle‐aged and elderly Japanese: Age and sex differences in appendicular skeletal muscle mass.
  Itsuko Kitamura, Michiko Koda, Rei Otsuka, Fujiko Ando, Hiroshi Shimokata.
  Geriatrics and Gerontology International. July 01, 2013
  Aim Little is known about longitudinal changes of body composition measured by dual‐energy X‐ray absorptiometry (DXA) in middle‐aged and elderly individuals. We evaluated longitudinal changes of body composition, and age and sex differences in appendicular skeletal muscle mass. Methods Participants were 1454 community‐dwelling Japanese men and women aged 40–79 years. Body composition at baseline and 6‐year follow up was measured by DXA. Results Fat increased significantly in men of all ages, and in women aged in their 40s and 50s. Among men, arm lean tissue mass (LTM) changed by 0.9%, −0.5%, −1.4% and −3.7%, respectively, for the 40s to the 70s, and decreased significantly in the 60s and 70s. Leg LTM in men changed by −0.4%, −1.3%, −1.7% and −3.9%, respectively, and decreased significantly from the 50s to the 70s. Compared with the preceding age groups, significant differences were observed between the 60s and 70s in arm and leg LTM change in men. Among women, arm LTM changed by 0.7%, 0.2%, 1.6% and −1.5%, respectively, which was significant in the 60s and 70s. Leg LTM decreased significantly in all age groups of women by −2.0%, −2.8%, −2.4% and −3.9%, respectively. With respect to sex differences, leg LTM loss rates were significantly higher in women than men at the 40s and 50s. Conclusions Longitudinal data suggest that arm and leg LTM decreased markedly in men in their 70s, and leg LTM had already decreased in women in their 40s. Geriatr Gerontol Int 2014; 14: 354–361.

  July 01, 2013   doi: 10.1111/ggi.12109   open full text
• Profile of elderly with multiple physician visits: Advocacy for tailored comprehensive geriatric assessment use in clinics.
  Mei‐Chen Kuo, Chii Jeng, Ching‐Min Chen, Wen‐Shan Jian.
  Geriatrics and Gerontology International. July 01, 2013
  Aim The rapid growth of the elderly population has given rise to the need for better geriatric care. The present study explored the common conditions of elderly outpatients with multiple physician visits in order to develop feasible clinical indicators that can be rapidly administered for the evaluation of geriatric syndromes in outpatient settings. Methods The National Health Insurance Research Database (2008) was analyzed. Claims for elderly outpatients with more than two physician visits in the same day were retrieved. The primary diagnoses, types of prescriptions and comorbidities were cross‐examined. Results The overall prevalence rate for elderly patients with multiple physician visits ranged from 28.41% to 39.40%, and which increased steadily with age. A maximum of seven physician visits in a single day was observed. The most common multiple physician visit was two visits per day, with a prevalence rate of 30.97%. The two most common accompanying conditions were hypertension (3.79%) and type 2 diabetes mellitus (3.68%). There was a greater relative increase in the prevalence of senile dementia and chronic obstructive pulmonary disease in older age groups. The three overall leading specialties were cardiology, internal medicine, and ophthalmology; however, rehabilitation medicine was the most common female‐specific specialty. The most commonly prescribed medications were antihypertension drugs. The most prevalent comorbidity was type 2 diabetes mellitus and hypertension. Conclusion We conclude that our data represent crucial information for the design of concise assessment metrics for application to the most chronic conditions in an effort to implement better geriatric healthcare. Geriatr Gerontol Int 2014; 14: 372–380.

  July 01, 2013   doi: 10.1111/ggi.12111   open full text
• Frailty among community‐dwelling elderly Mexican people: Prevalence and association with sociodemographic characteristics, health state and the use of health services.
  Sergio Sánchez‐García, Rosalinda Sánchez‐Arenas, Carmen García‐Peña, Oscar Rosas‐Carrasco, José Alberto Ávila‐Funes, Liliana Ruiz‐Arregui, Teresa Juárez‐Cedillo.
  Geriatrics and Gerontology International. July 01, 2013
  Aim To estimate the prevalence of frailty phenotypes and their association with the sociodemographic characteristics, health state and the use of health services in the last 6 months among community‐dwelling elderly in Mexico City. Methods The present study included 1933 elderly individuals from Mexico City. We estimated the prevalence of the frailty phenotype based on Fried and Walston. Household interviews were carried out to collect information on sociodemographics (sex, age, education, marital status, live alone, paid job), health state (activities of daily living, cognitive function, depression, comorbidity, nutritional status) and the use of health services in the last 6 months. Results The estimated prevalence of frailty was 15.7%, pre‐frailty at 33.3% and non‐frailty at 51.0%. The statistically relevant associations in the pre‐frail elderly were female (OR 0.83), older age (OR 2.48), single (OR 1.03), living alone (OR 1.23), no paid work (OR 0.82), limitations in the basic activities of daily living (OR 2.11) and instrumental activities of daily living (OR 2.10), cognitive impairment (OR 1.49), depression symptoms (OR 3.82), underweight/malnourished (OR 1.89), overweight/obesity (OR 0.80), moderate comorbidity (OR 2.05), and use of health services (OR 1.04) using the non‐frail phenotype as the comparison category. Frailly is associated with female (OR 1.05), older age (OR 10.32), less educated (OR 2.51), single OR 1.39), living alone (OR 0.86), no paid work (OR 1.16), limitations in the basic activities of daily living (OR 7.66) and instrumental activities of daily living (OR 8.42), cognitive impairment (OR 3.02), depression symptoms (OR 11.23), underweight/malnourished (OR 1.49), overweight/obesity (OR 0.49), moderate comorbidity (OR 3.55), and use of health services (OR 1.99) using the non‐frail phenotype as the comparison category. Conclusions The results suggest that older age, disability, comorbidity, cognitive impairment and depression could have an influence role in frailty. Geriatr Gerontol Int 2014; 14: 395–402.

  July 01, 2013   doi: 10.1111/ggi.12114   open full text
• Relationship between structural characteristics and outcome quality indicators at health care facilities for the elderly requiring long‐term care in Japan from a nationwide survey.
  Felipe Alfonso Sandoval Garrido, Nanako Tamiya, Masayo Kashiwagi, Sumiko Miyata, Jiro Okochi, Yoko Moriyama, Yui Yamaoka, Kiyoshi Takamuku.
  Geriatrics and Gerontology International. June 18, 2013
  Aim To clarify the performance situation of selected quality indicators: falls, pressure ulcers and dehydration, at health care facilities for the elderly in Japan, and what structural characteristics are related to them. Methods The operational population consisted of 1057 institutionalized users (approximately 10 randomly selected per facility) from a survey answered by the care staff. The facilities were divided into two groups according to their prevalence of negative outcomes (falls, pressure ulcers, dehydration): the best 25% (the very good performers) and the remaining 75% (not so good performers). Logistic regression analysis was carried out to examine the relationship between the structure characteristics of the facilities and their performance regarding each quality indicator. Results After controlling for sex, years of operation and average age of the users, our results showed a beneficial significant relationship between falls and the total number of nurses per 100 users with an adjusted odds ratio (AOR) of 0.77 (95% CI 0.59–0.98); In contrast, for pressure ulcers, harmful associations between a higher number of registered nurses (AOR 1.23, 95% CI 1.01–1.05) and the availability of 24‐h nurse staffing (AOR 4.95, 95% CI 1.19–24.91) were found; regarding dehydration, we did not find any related staffing characteristics. Conclusion Nursing staff might be considered as a potentially related variable in the quality of care in health care facilities for the elderly. The present study is the first to show a relationship between structural characteristics and quality outcomes in health care facilities for the elderly. Geriatr Gerontol Int 2013; 14: 301–308.

  June 18, 2013   doi: 10.1111/ggi.12098   open full text
• Cost‐minimization analysis of a tailored oral health intervention designed for immigrant older adults.
  Rodrigo J Mariño, Jorge Fajardo, Hanny Calache, Mike Morgan.
  Geriatrics and Gerontology International. June 18, 2013
  Aim This paper presents an economic evaluation, from a societal viewpoint, comparing a community‐based oral health promotion program aimed at improving the gingival health of immigrant older adults, with one‐on‐one chairside oral hygiene instructions at a public dental clinic in Melbourne, Australia. Methods The costs associated with implementing and operating the oral health promotion program were identified and measured using 2008 prices. The intervention was based on the Oral Health Information Seminars/Sheets model, and consisted of 10 20‐min oral hygiene group seminars and four 10‐min supervised individual brushing sessions carried out by a non‐oral health professional educator. Health outcomes were measured as a reduction in gingival bleeding. Clinical data showed a 75% reduction in mean gingival bleeding scores among those who took part in the intervention. A population of 100 active, independent‐living older adults living in Melbourne, and members of Italian social clubs, was used for modeling in this analysis. Results This analysis estimated that if an oral hygiene program using the Oral Health Information Seminars/Sheets model was available to 100 older adults, the net cost from a societal perspective would be AUD$6965.20. In comparison, a standard individual oral hygiene instruction program, at public dental clinics, given equivalent levels of case complexity and assuming the same level of effectiveness, would cost AUD$40 185.00. Per participant cost of a community‐based oral health promotion program was $69.65 versus $401.85 for chairside instruction. Conclusions Findings confirm that community‐based oral health interventions are highly cost‐effective and an efficient use of society's financial resources. Geriatr Gerontol Int 2013; 14: 336–340.

  June 18, 2013   doi: 10.1111/ggi.12103   open full text
• Provision of long‐term care in relation to needs in urban and rural municipalities in Japan and Sweden.
  Mårten Lagergren, Noriko Kurube.
  Geriatrics and Gerontology International. June 10, 2013
  Aim The aim of the study was to establish whether there are differences in long‐term care (LTC) provision with regard to needs between rural and urban municipalities in Japan and Sweden, and we propose possible causes for these differences. Methods Using comparable datasets from Japan (n = 20 699) and Sweden (n = 17 576), the care systems have been compared on an individual level. The datasets each contain information from nine large urban, midsize urban and rural municipalities regarding disability levels and the LTC services provided. Results LTC users in the large urban municipalities in both countries are, on average, less disabled than users in the midsize urban and rural municipalities. In both countries, per capita costs for LTC were lower in the large urban municipalities than in the rural municipalities (10% and 14%, respectively). However, when standardized for the level of disability, the per capita costs were higher in the large urban municipalities (4% in both cases). Multivariate analysis showed that there were significant per capita cost differences between the large urban and the rural municipalities in Japan. In Sweden, there were no significant per capita cost differences between the different types of municipality when age, sex and disability differences were accounted for. Conclusion The findings seem to reflect the effect of differences in household structure, which in the large urban municipalities result in less access to informal LTC, thereby influencing the propensity to apply for formal, public LTC – especially for those with lesser needs. In Japan, where the number of extended family households is decreasing, this gives an idea of the future challenges facing LTC provision. Geriatr Gerontol Int 2014; 14: 315–327..

  June 10, 2013   doi: 10.1111/ggi.12100   open full text
• Underweight/overweight and the risk of long‐term care: Follow‐up study using data of the Japanese long‐term care insurance system.
  Akiko Honda, Naohito Tanabe, Nao Seki, Yoshiko Ogawa, Hiroshi Suzuki.
  Geriatrics and Gerontology International. June 10, 2013
  Aim Both being underweight and overweight can lead to reduced activity of daily living, which subsequently can require long‐term care. The aim of the present study was to clarify the association between underweight/overweight and the subsequent risk of long‐term care introduction. Methods We tracked the data of long‐term care insurance for 1580 men and women aged ≥65 years who had participated in the official population‐based health check‐up program in 2001 in Tsunan town and Sekikawa village, Japan. The health check‐up data and medical expenditure data for the fiscal year 2001 were used as baseline data. Participants were classified into underweight (body mass index (BMI) <18.5 kg/m2), normal range (BMI = 18.5 to <25.0 kg/m2) and overweight (BMI ≥25.0 kg/m2); the normal range was used as a reference category in Cox proportional hazards models. Results During the average 5.8 years of follow up, 156 participants were identified to start using long‐term care services. Among the young‐old elderly (65–74 years‐of‐age), underweight was significantly associated with the risk of long‐term care introduction (multivariable‐adjusted HR 4.26, 95% CI 1.69–10.72), whereas overweight was not (multivariable‐adjusted HR 1.45, 95% CI 0.69–3.06). Neither underweight nor overweight were significantly associated with long‐term care introduction among the old‐old elderly (≥75 years‐of‐age). Conclusions Underweight could be a good predictor of long‐term care introduction in the young‐old elderly. We should pay attention to underweight in the elderly, as it might be a manifestation of some physical or mental problems related to future long‐term care introduction. Geriatr Gerontol Int 2014; 14: 328–335.

  June 10, 2013   doi: 10.1111/ggi.12102   open full text
• Evaluation of an intra‐institutional diabetes disease management program for the glycemic control of elderly long‐term care diabetic patients.
  Emily Lubart, Refael Segal, Julio Wainstein, Galina Marinov, Alexandra Yarovoy, Arthur Leibovitz.
  Geriatrics and Gerontology International. June 10, 2013
  Aim Increasing numbers of nursing home elderly patients suffer from diabetes requiring individually optimized glycemic control. This is a complicated challenge because of their high comorbidity level, and heterogeneous and changing eating status varying from independent to dysphagia and enteral feeding. In order to cope with these complex needs, we developed and implemented a diabetes disease management program. The purpose of the present study was to evaluate this program. Methods We used the point prevalence approach by checking for fasting blood glucose, glycated hemoglobin and other routine biochemical tests. Eating status was evaluated by the Functional Outcome Swallowing Scale. Details about the diabetes disease management program are given in the text. Results A total of 86 (36%) of the 234 patients on the study day were diabetics. Of these, 80 were eligible for the study. Their mean fasting blood glucose was 143.1 ± 60.6 mg/dL. The mean glycated hemoglobin level was 7.23 ± 1.39%. Conclusion No case of hypoglycemia was detected on the examination day, or during the preceding 3 weeks. No significant difference was found among the different Functional Outcome Swallowing Scale categories. These results are within satisfactory range for this category of patients suggesting that our diabetes disease management program contributes to a better glycemic control. Geriatr Gerontol Int 2014; 14: 341–345.

  June 10, 2013   doi: 10.1111/ggi.12104   open full text
• Blueberry treatment attenuates D‐galactose‐induced oxidative stress and tissue damage in rat liver.
  Jale Çoban, Esra Betül‐Kalaz, Canan Küçükgergin, A Fatih Aydın, Işın Doğan‐Ekici, Semra Doğru‐Abbasoğlu, Müjdat Uysal.
  Geriatrics and Gerontology International. June 10, 2013
  Aim d‐galactose (GAL) causes aging‐related changes and oxidative stress in the organism. We investigated the effect of whole fresh blueberry (BB; Vaccinium corymbosum L.) treatment on oxidative stress in age‐related liver injury model. Methods Rats received GAL (300 mg/kg, s.c.; 5 days per week) alone or together with 5% (BB1) and 10% (BB2) BB‐containing chow for 2 months. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities, and hepatic malondialdehyde (MDA), protein carbonyl (PC) and glutathione (GSH) levels, and CuZn‐superoxide dismutase (SOD1), glutathione peroxidase (GPx1) and glutathione transferase (GST) activities together with mRNA expressions of SOD1, GPx1, MnSOD (SOD2) and phospholipid hydroperoxide glutathione peroxidase (GPx4) were determined in GAL‐treated rats. Results MDA and PC levels increased, but GSH levels, SOD1 and GPx1 activities decreased together with histopathological structural damage in the liver in GAL‐treated rats. There was no change in hepatic mRNA expressions of SOD2 and GPx1, but SOD1 and GPx4 expressions decreased. BB1 and BB2 caused significant decreases in serum ALT and AST activities together with the amelioration in histopathological findings in GAL‐treated rats. Both BB1 and BB2 reduced MDA and PC levels, and elevated GSH levels, and SOD1 and GPx1 activities. However, hepatic mRNA expressions of SOD1, SOD2, GPx1 and GPx4 remained unchanged in GAL‐treated rats. Conclusions These results show that BB restored liver pro‐oxidant status together with histopathological amelioration by acting as an anti‐oxidant (radical scavenger) itself without affecting mRNA expressions of anti‐oxidant enzymes in GAL‐treated rats. Geriatr Gerontol Int 2014; 14: 490–497.

  June 10, 2013   doi: 10.1111/ggi.12096   open full text
• High normotension is associated with higher metabolic syndrome risk in postmenopausal women.
  Chun‐Hsien Hsu, Jiunn‐Diann Lin, Chung‐Ze Wu, Shu Chuen Lau, Yen‐Lin Chen, Sai‐Hung Tang, Shu‐Man Yu, Dee Pei.
  Geriatrics and Gerontology International. June 10, 2013
  Aim Cardiovascular disease and diabetes are important causes for mortality in older people. Both hypertension and prehypertension are correlated with them. Recently, health promotion and disease prevention in postmenopausal women have become an essential issue of public health policy. The present study aimed to evaluate whether the harmful effects of blood pressure (BP) could still be found in normotensive postmenopausal women (below 120/80 mmHg). Methods A total of 4539 normotensive postmenopausal women aged 51 years or older, undergoing routine health examinations, were enrolled in the cross‐sectional analyses. To mitigate the effect of age on BP, participants within the same age were divided into tertiles according to their systolic BP (SBP). Then, participants in the low‐SBP tertile of each age stratum were pooled together to form a larger group (low‐normal SBP group [LNSBP]). Similarly, the middle‐ and high‐normal SBP were grouped accordingly (MNSBP and HNSBP). Metabolic syndrome (MetS) was considered to be a surrogate for future cardiovascular disease and diabetes. Results The study showed that HNSBP bore a higher likelihood of having abnormal MetS components, elevated low‐density lipoprotein cholesterol levels and a higher odds ratio (1.46; 95% confidence interval 1.17–1.81) for having MetS than LNSBP. In contrast, age, body mass index, fasting plasma glucose and low‐density lipoprotein cholesterol were significantly related to SBP in multiple regression analysis. Conclusions The risk of having MetS was significantly associated with higher SBP even within normotension. Primary prevention, such as lifestyle modification, and more strict control of BP should be stressed in postmenopausal women. Geriatr Gerontol Int 2014; 14: 293–300.

  June 10, 2013   doi: 10.1111/ggi.12097   open full text
• Cardiopulmonary resuscitation: Outcome and its predictors among hospitalized elderly patients in Egypt.
  Moatasem Salah Amer, Tomader Taha Abdel Rahman, Walaa Wessam Aly, Nesma Gamal Ahmad.
  Geriatrics and Gerontology International. June 10, 2013
  Aim Our aim was to study the outcome and the predictors of in‐hospital cardiopulmonary resuscitation (CPR) among elderly patients admitted to Ain Shams University Hospitals, Egypt. Methods We carried out a cross‐sectional study for all elderly patients (age ≥60 years) who underwent CPR after cardiac arrest at Ain Shams University Hospitals, Egypt, during a 1.5‐year study period. We excluded patients who were declared dead on arrival. Results We found 380 cases of elderly in‐hospital cardiac arrest that underwent CPR. Asystole was the most common arrhythmia detected at the time of arrest (85.1%), followed by ventricular tachycardia (8.7%) and ventricular fibrillation (6.2%). Return of spontaneous circulation was achieved in 32.6% of patients and 8.4% survived to discharge from hospital. Multivariate logistic regression analysis identified three independent predictors of better outcome (survival >24 h): response time ≤5 min (OR 5.1, 95% CI 1.9–13.4), location of CPR in emergency department (OR 3.2, 95% CI 1.6–6.4) and pre‐arrest morbidity (PAM) score ≤7 (OR 3.1, 95% CI 1.6–6.1). Conclusion Outcome of CPR after in‐hospital cardiac arrest in our setting was poor. The response time ≤5 min, CPR in the emergency department and PAM score ≤7 were independent predictors of good outcome. Geriatr Gerontol Int 2014; 14: 309–314.

  June 10, 2013   doi: 10.1111/ggi.12099   open full text
• Community end‐of‐life care among Chinese older adults living in nursing homes.
  Leung‐Wing Chu, Jason C So, Lai‐Chin Wong, James KH Luk, Patrick KC Chiu, Cherry SY Chan, Fiona SM Kwan, June Chau, Elsie Hui, Jean Woo, Sarah M McGhee.
  Geriatrics and Gerontology International. May 19, 2013
  Aim The aim of the present study was to investigate the preference and willingness‐to‐pay (WTP) of older Chinese adults for community end‐of‐life care in a nursing home rather than a hospital. Methods A total of 1540 older Chinese adults from 140 nursing homes were interviewed. Four hypothetical questions were asked to explore their preferences for end‐of‐life care. Using a discrete choice approach, specific questions explored acceptable trade‐offs between three attributes: availability of doctors onsite, attitude of the care staff and additional cost of care per month. Results Approximately 35% of respondents preferred end‐of‐life care in the nursing home, whereas 23% of them would consider it in a better nursing home. A good attitude of staff was the most important attribute of the care site. Respondents were willing to pay an extra cost of US$5 (HK$39) per month for more coverage of doctor's time, and US$49 (HK$379) for a better attitude of staff in the nursing home. The marginal WTP for both more coverage of doctor's time and better attitude of staff amounted to US$54 (HK$418). Respondents on government subsidy valued the cost attribute more highly, as expected, validating the hypothesis that those respondents would be less willing to pay an additional cost for end‐of‐life care. Conclusions Older Chinese adults living in nursing homes are willing to pay an additional fee for community end‐of‐life care services in nursing homes. Both the availability of the doctor and attitudes of nursing home staff are important, with the most important attribute being the staff attitudes. Geriatr Gerontol Int 2013; 14: 273–284.

  May 19, 2013   doi: 10.1111/ggi.12090   open full text
• Rate of cognitive decline in relation to sex after 60 years‐of‐age: A systematic review.
  Leandro Ferreira, Ruth Ferreira Santos‐Galduróz, Cleusa Pinheiro Ferri, José Carlos Fernandes Galduróz.
  Geriatrics and Gerontology International. May 19, 2013
  Some studies have shown differences in specific cognitive ability domains between the sexes at 60 years‐of‐age. However is important to analyze whether the rate of cognitive decline is also similar between the sexes after this age. The present study examined previously published literature to investigate whether cognitive decline is distinct between men and women after the age of 60 years. A systematic review was carried out with the PubMed, LILACS and PsycINFO databases (2001–2011) using the following search terms: aging, aged, cognitive function, mild cognitive impairment, mental health and cognition. We analyzed longitudinal research that used neuropsychological tests for evaluating cognitive function, showed results separated by sex and that excluded participants with dementia. Elderly women showed better performance in tests of episodic memory, whereas elderly men had a better visuospatial ability. Only one study detected distinct rates of cognitive decline in specific tests between the sexes. Despite differences observed in some domains, most of the studies showed that this rate is similar between the sexes until the age of 80 years. It is unclear whether sex influences the rate of cognitive decline after the age of 80 years. The present review observed that sex does not determine the rate of cognitive decline between 60 and 80 years‐of‐age. The contextual and cultural factors that involve men and women might determine a distinct decline between them, rather than sex alone. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  May 19, 2013   doi: 10.1111/ggi.12093   open full text
• Prevalence of and factors related to pain among elderly Japanese residents in long‐term healthcare facilities.
  Yakari Takai, Noriko Yamamoto‐Mitani, Ayako Ko.
  Geriatrics and Gerontology International. May 19, 2013
  Aim We aimed to examine the pain prevalence among residents who stayed at healthcare facilities for the elderly requiring long‐term care in Japan, and explore factors related to self‐reported pain. Methods This was a cross‐sectional study. All residents in nine healthcare facilities in Japan were asked to participate in the present study, with the exclusion of short‐term and temporary residents. Demographic data were collected from participating residents' medical records. The residents were evaluated using the Barthel Index, the Folstein Mini‐Mental State Examination and Self‐Rated Health measures. After/during patients underwent a body movement protocol, self‐reported pain/Abbey Pain Scale scores were obtained. The χ2‐test, t‐test and logistic regression analyses were carried out to identify factors related to pain. Results Data were obtained from 246 residents. The prevalence of pain among the residents was 47.2%. Self‐rated health status and history of fracture were significantly associated with self‐reported pain. Logistic regression analysis showed that self‐rated health status (odds ratio [OR] 0.50, 95% confidence interval (CI) 0.28–0.88), mental health diagnoses (OR 9.18, 95%CI 1.27–66.52) and respiratory diagnoses (OR 0.16; 95%CI 0.03–0.97) were associated with pain experienced by residents. Conclusions Nearly half of the residents suffered from pain on movement. The pain of these elderly residents should be managed in order to improve their health status. Geriatr Gerontol Int 2013; 14: 481–489.

  May 19, 2013   doi: 10.1111/ggi.12094   open full text
• Falls and fractures in participants and excluded non‐participants of a fall prevention exercise program for elderly women with a history of falls: 1‐year follow‐up study.
  Hunkyung Kim, Hideyo Yoshida, Takao Suzuki.
  Geriatrics and Gerontology International. May 19, 2013
  Aim To evaluate the effectiveness of a strength and balance enhancing exercise intervention as a means of preventing falls in community‐dwelling elderly Japanese women with a history of falls, while comparing functional fitness, fall and fracture rate in excluded subjects. Methods A 1‐year follow‐up trial was carried out on 105 participants over the age of 70 years, who were randomly assigned to the exercise or education group, and also on 91 women excluded based on the exclusion criteria. The exercise group attended a 60‐min exercise class twice a week for 3 months. Falls, injuries, fractures, and functional fitness assessments were measured at baseline, post‐intervention and 1‐year follow up. Results During the follow up, fall rates were 19.6% in the exercise group, 40.4% in the education group and 40.8% in excluded subjects (χ2 = 7.069, P = 0.029). Compared with the exercise group, the odds ratio (OR) for falls was greater in the education group (OR 2.78, 95% confidence interval (CI) 1.17–6.96) and excluded participants (OR 2.83, 95%CI 1.25–6.80). The OR for fractures was over fourfold greater in excluded participants (OR 4.30, 95% CI 1.02–9.70) than the exercise group. Conclusions The exercise intervention for participants with fall history effectively decreased incidences of falls and fractures. However, fall and fracture rates in excluded people were high. Further research focusing on feasible countermeasures for falls in excluded people who are at high risk of fractures is required. Geriatr Gerontol Int 2013; 14: 285–292.

  May 19, 2013   doi: 10.1111/ggi.12095   open full text
• Migraine and vascular risk factors in the elderly.
  Ronit Gilad, Mona Boaz, Ron Dabby, Vitali Finkelstein, Abraham Rapoport, Yair Lampl.
  Geriatrics and Gerontology International. May 06, 2013
  Aim The association between migraine and cerebrovascular disease is well documented in younger migraine patients, especially those with aura. Prevalence estimates of vascular risk factors among elderly migraine sufferers are lacking. The present study was designed to estimate the prevalence of vascular risk factors in the elderly population with late onset of migraine without aura. Methods The medical records of 163 patients aged 50 years and older suffering from migraine without aura were assessed for vascular risk factors, including hypertension, elevated serum lipid levels, diabetes mellitus and cardiovascular disease. Prevalence was estimated and compared with age‐ and sex‐matched vascular risk factor estimates for the general population extracted from the 2003–2004 Israeli National Health Interview Survey, and to a group of patients matched by age suffering from migraine with aura. Results Among women with migraine without aura, hypertension, hyperlipidemia and diabetes mellitus were significantly less prevalent than among women without migraine without aura. Prevalence estimates for vascular risk factors did not differ by migraine among males. The group of older patients suffering from migraine with aura showed a higher incidence of vascular risk factors in respect to the group of migraine patients without aura. Conclusions The findings of the present study might have an important clinical relevance, suggesting another pathophysiological process in respect to patients suffering from migraine with aura, and this evidence might have different therapeutic implications. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  May 06, 2013   doi: 10.1111/ggi.12061   open full text
• Intensive rehabilitation for dementia improved cognitive function and reduced behavioral disturbance in geriatric health service facilities in Japan.
  Kenji Toba, Yu Nakamura, Hidetoshi Endo, Jiro Okochi, Yukiko Tanaka, Chiyako Inaniwa, Akira Takahashi, Naoko Tsunoda, Kentaro Higashi, Motoharu Hirai, Hiroyuki Hirakawa, Shizuru Yamada, Yohko Maki, Tomoharu Yamaguchi, Haruyasu Yamaguchi.
  Geriatrics and Gerontology International. May 06, 2013
  Aim To examine the efficacy of rehabilitation for elderly individuals with dementia at intermediate facilities between hospitals and home, based on the policies for elderly individuals to promote community‐based care at home and dehospitalization. Methods Participants were older adults with dementia newly admitted to intermediate facilities. A total of 158 in the intervention group who claimed Long‐Term Care Insurance for three consecutive months, and 54 in the control group were included in the analysis. The interventions were carried out in a tailor‐made manner to meet individual needs. The personal sessions were carried out three times a week for 3 months after admission by physical, occupational or speech therapists. Outcome measures were cognitive tests (Hasegawa Dementia Scale revised [HDS‐R] and Mini‐Mental State Examination), and observational assessments of dementia severity, activities of daily living (ADL), social activities, behavioral and psychological symptoms of dementia (BPSD) using a short version of the Dementia Disturbance Scale (DBD13), depressive mood, and vitality. Results Significant improvement in the intervention group was shown in cognitive function measured by HDS‐R (interaction F[1, 196] = 5.190, P = 0.024), observational evaluation of dementia severity (F[1,198] = 9.550, P = 0.002) and BPSD (DBD13; F[1,197] = 4.506, P = 0.035). Vitality, social activities, depressive mood and ADL were significantly improved only in the intervention group, although interaction was not significant. Conclusions Significant improvement by intervention was shown in multiple domains including cognitive function and BPSD. Cognitive decline and worsening of BPSD are predictors of care burden and hospitalization, thus intensive rehabilitation for dementia was beneficial for both individuals with dementia and their caregivers. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  May 06, 2013   doi: 10.1111/ggi.12080   open full text
• Prevalence and determinants of use of potentially inappropriate medications in elderly inpatients: A prospective study in a tertiary healthcare setting.
  Krishna Undela, Dipika Bansal, Sanjay D'Cruz, Atul Sachdev, Pramil Tiwari.
  Geriatrics and Gerontology International. May 06, 2013
  Aim To determine the prevalence and predictors of potentially inappropriate medications (PIM) prescribing in elderly inpatients using the modified American Geriatrics Society (AGS) updated Beers criteria 2012 and comparing it with the Beers criteria 2003. Methods The prospective observational study was carried out between September 2011 and May 2012 at a public teaching hospital. Elderly inpatients aged ≥60 years were included. Multivariate logistic regression analysis was used to determine the predictors of PIM prescribing. Results The results were based on data of 502 patients; more than half (60%) were males and 66% were aged between 60–69 years with a mean (standard deviation [SD]) of 68 (7) years. Mean (SD) number of diagnoses and medications were three (1) and nine (4), respectively. A total of 81 (16%) patients were prescribed with at least ≥1 PIM according to modified AGS updated Beers criteria 2012, compared with 11% according to Beers criteria 2003. On multivariate regression, important predictors for PIM prescribing were found to be age ≥80 years (odds ratio [OR] 2.46, 95% confidence interval (CI) 1.27–3.12; P = 0.03), male sex (OR 1.35, 95% CI 1.06–1.84; P = 0.03), more than three diagnoses (OR 2.47, 95% CI 1.59–3.39; P = 0.04), ≥6 medications prescribed (OR 1.16, 95% CI 1.02–1.35; P = 0.03) and ≥10 days of hospital stay (OR 1.59, 95% CI 1.09–2.31; P = 0.02). Conclusions The results show that PIM prescribing is common among hospitalized elderly Indian patients. It is feasible to reduce this practice through the provision of appropriate unbiased information to healthcare professionals. Geriatr Gerontol Int 2014; 14: 251–258.

  May 06, 2013   doi: 10.1111/ggi.12081   open full text
• Effect of a multimodal exercise program on sleep disturbances and instrumental activities of daily living performance on Parkinson's and Alzheimer's disease patients.
  Carla Manuela Crispim Nascimento, Carlos Ayan, Jose Maria Cancela, Lilian Teresa Bucken Gobbi, Sebastião Gobbi, Florindo Stella.
  Geriatrics and Gerontology International. May 06, 2013
  Aim To assess the contribution of a multimodal exercise program on the sleep disturbances (SD) and on the performance of instrumental activities daily living (IADL) in patients with clinical diagnosis of Alzheimer's disease (AD) and Parkinson's disease patients (PD). Methods A total of 42 consecutive patients (23 training group, 19 control group) with PD and 35 demented patients with AD (19 trained group, 16 control group) were recruited. Participants in both training groups carried out three 1‐h sessions per week of a multimodal exercise program for 6 months. The Pfeffer Questionnaire for Instrumental Activities and the Mini‐Sleep Questionnaire were used to assess the effects of the program on IADL and SD respectively. Results Two‐way ancova showed interactions in IADL and SD. Significant improvements were observed for these variables in both intervention groups, and maintenance or worsening was observed in control groups. The analysis of effect size showed these improvements. Conclusion The present study results show that a mild to moderate intensity of multimodal physical exercises carried out on a regular basis over 6 months can contribute to reducing IADL deficits and attenuating SD. Geriatr Gerontol Int 2014; 14: 259–266.

  May 06, 2013   doi: 10.1111/ggi.12082   open full text
• Measurement structure of the caregiver burden scale: Findings from a national community survey in Taiwan.
  Linen Nymphas Lin, Shwu‐Chong Wu.
  Geriatrics and Gerontology International. May 06, 2013
  Aim There is no appropriate understanding of community family caregiver burden. The object of the present study was to evaluate the measurement structure of a caregiver burden scale from a nationally representative Taiwanese community sample. Methods Data from nationally representative subjects completing face‐to‐face interviews on caregiver burden were analyzed. A total of 9020 primary adult family caregivers were enrolled. All of the valid respondents were equally divided into three subsamples. The first sample was used to explore the factor structure of burden scale. The second sample was used to validate the factor structure. The third sample was used to verify the adequacy and stability of the factor structures developed in the former steps. Results A total of 8826 valid data were included for analysis. Exploratory and confirmatory factor analysis identified the four‐factor, 15‐item Caregiver Burden Scale (CBS‐15) in the present study. The extracted four factors were predominantly accounted for by the items measuring “burden of time,” “relational burden,” “financial burden” and “emotional burden”. All the goodness‐of‐fit indices reported for this model were acceptable. Conclusion The present study supports the usefulness of the CBS‐15 as a tool to understand the measurement structure of burden in a nationally representative Taiwanese community family caregivers sample. The CBS‐15 can be used to identify community caregiver needs. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  May 06, 2013   doi: 10.1111/ggi.12076   open full text
• Predicting clinical instability of older patients in post‐acute care units: A nationwide cohort study.
  Wei‐Ju Lee, Ming‐Yueh Chou, Li‐Ning Peng, Chih‐Kuang Liang, Li‐Kuo Liu, Chien‐Liang Liu, Liang‐Kung Chen, Yung‐Hung Wu,.
  Geriatrics and Gerontology International. May 06, 2013
  Aim Although patients admitted to post‐acute care (PAC) units are usually clinically stable, unexpected medical conditions requiring acute ward readmissions still occur and can jeopardize the clinical effectiveness of PAC services. The main purpose of the present study was to evaluate predictive factors for clinical instability of patients in PAC units to improve the quality of PAC services. Methods This was a nationwide multicenter cohort study that recruited patients from five PAC units in Taiwan between July 2007 and June 2009. All patients received the comprehensive geriatric assessment (CGA) within 72 h of PAC unit admissions. Conditions requiring acute ward re‐admissions from PAC units were defined as clinical instability. Causes of clinical instability for all patients and data of CGA were collected for analysis. Results Of 918 enrolled participants, 119 (12.9%) experienced acute ward readmissions, including 106 (89.1%) admissions related to medical conditions and 13 (10.9%) for surgical causes. Common conditions included diseases of the respiratory system (n = 32, 26.9%), genitourinary system (n = 24, 20.2%) and digestive system (n = 14, 11.8%). Surgical conditions, mainly fractures and dislocation of upper limbs, were significantly more likely to occur later (P = 0.05) in the PAC unit admissions than medical conditions. Compared with the non‐readmission group, the readmission group was leaner (mean body mass index 21.1 ± 2.8 vs 22.0 ± 3.8 kg/m2, P = 0.007), having poorer functional status (mean Barthel Index 41.0 ± 19.4 vs 45.4 ± 20.3, P = 0.02; mean IADL: 1.3 ± 1.6 vs 1.7 ± 1.8, P = 0.016), poorer cognitive function (mean Mini‐Mental State Examination: 16.8 ± 6.4 vs 18.3 ± 6.4, P = 0.022), poorer ambulation (mean Timed Up & Go test 32.7 ± 18.7 vs 26.6 ± 11.7 s, P = 0.039) and poorer nutritional status (mean Mini‐Nutrition Assessment 13.3 ± 5.7 vs 15.4 ± 5.8, P < 0.001), but similar in depression status (mean Geriatric Depression Score 3.7 ± 3.3 vs 3.4 ± 2.8, P = 0.247). In multivariate logistical regression model, lower Mini‐Mental State Examination score was the only independent predictor for clinical instability (odds ratio 3.8, 95% confidence interval 1.348–10.870, P = 0.012). Conclusion Approximately 13% of PAC patients might experience acute ward readmissions, and nearly 90% of them are caused by medical conditions. Poor cognitive function is a significant predictive factor for clinical instability in PAC, which deserves more clinical attention for all PAC patients. Geriatr Gerontol Int 2014; 14: 267–272..

  May 06, 2013   doi: 10.1111/ggi.12083   open full text
• Longitudinal study of the cognitive, behavioral and physical status of day care service users with dementia: Factors associated with long‐term day care use.
  Toshiyuki Ono, Akira Tamai, Daisuke Takeuchi, Yuzuru Tamai, Yuka Hasegawa.
  Geriatrics and Gerontology International. April 25, 2013
  Aim The aim of the present retrospective study was to investigate the time‐courses of the cognitive, behavioral and physical status of day care service users with dementia, and to determine the factors associated with the long‐term use of day care in order to aid the development of better interventions. Methods We analyzed the data of 162 consecutive patients who attended our day care clinic for 1 year or more between 1 April 2000 and 31 March 2010. The patients were divided into three groups according to the length of their day care attendance (the 1‐year, 3‐year and 5‐year groups). Then, we investigated the time‐courses of their cognitive, behavioral and physical status. Logistic regression analysis was used to detect the factors that affect the duration of day care service attendance in dementia patients. Results The Hasegawa Dementia Scale‐Revised (HDS‐R), Assessment Scale for Symptoms of Dementia (ASSD) and Nishimura's Activities of Daily Living (N‐ADL) scores of the three groups all significantly deteriorated during the study period except for the HDS‐R score of the 3‐year group. Higher age and a high ASSD score were associated with a short period of day care service attendance, whereas the patients' daughters‐in‐law acting as a caregiver was related to the long‐term use of day care services in model 1. Conclusions It is better to control behavioral and psychological symptoms in order to improve the utilities of day care for dementia patients. The caregiving environment of dementia patients might be associated with the length of day care attendance. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 25, 2013   doi: 10.1111/ggi.12071   open full text
• Impact of ambulatory physiotherapy on motor abilities of elderly subjects with Alzheimer's disease.
  Patrick Manckoundia, Michaël Taroux, Alexandre Kubicki, France Mourey.
  Geriatrics and Gerontology International. April 25, 2013
  Aim We investigated the impact of ambulatory physiotherapy (AP) on motor abilities in elderly subjects with Alzheimer's disease (AD). Methods Subjects with mild to moderate AD were included and divided into “physiotherapy group” (PG) and “no physiotherapy group” (NPG) according to whether or not they received AP between inclusion (T0) and the second time of assessment, between 15 and 36 months after inclusion (T1). The follow‐up duration, Mini‐Mental State Examination, Tinetti and mini motor test (MMT) scores, Timed Up & Go test (TUG), gait speed (GS), one‐leg balance (OLB), history of falls within the last 6 months (HF), ability to rise from the floor (RFF) and the use of a walking aid (UWA) were recorded at T0, and after at least 15 months of follow up (T1). Results A total of 50 subjects were included in the NPG and 20 in the PG. At baseline, these groups were not significantly different for all the parameters recorded. The anova showed a progression of cognitive disorders in the two groups between T0 and T1 (P < 0.001), which was similar in the two groups (P = 0.83). For each postural and motor quantitative test (Tinetti, MMT, TUG, GS) the anova showed a main effect of time of assessment (All P < 0.05) associated with a group × time of assessment interaction (All P < 0.05). The comparison between the two groups with regard to the evolution of qualitative parameters showed a significant difference for the OLB test only. No significant difference was found for RFF, HF and UWA. Conclusions There was a significant improvement or stability of motor abilities in the PG; while these abilities decreased in the NPG. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 25, 2013   doi: 10.1111/ggi.12075   open full text
• Poor correlation between handgrip strength and isokinetic performance of knee flexor and extensor muscles in community‐dwelling elderly women.
  Diogo Carvalho Felicio, Daniele Sirineu Pereira, Alexandra Miranda Assumpção, Fabianna Resende Jesus‐Moraleida, Barbara Zille Queiroz, Juscelio Pereira Silva, Naysa Maciel Brito Rosa, João Marcos Domingues Dias, Leani Souza Máximo Pereira.
  Geriatrics and Gerontology International. April 25, 2013
  Aim To investigate the correlation between handgrip strength and performance of knee flexor and extensor muscles determined using an isokinetic dynamometer in community‐dwelling elderly women. Methods This was a cross‐sectional study. Sample selection for the study was made by convenience, and 221 (71.07 ± 4.93 years) community‐dwelling elderly women were included. Knee flexor and extensor muscle performance was measured using an isokinetic dynamometer Biodex System 3 Pro. The isokinetic variables chosen for analysis were peak torque, peak torque/bodyweight, total work/bodyweight, total work, average power, and agonist/antagonist ratio at the angular velocities of 60°/s and 180°/s. Assessment of handgrip strength was carried out using the Jamar dynamometer. Spearman's correlation coefficient was calculated to identify intervariable correlations. Results Only knee flexor peak torque (60°/s) and average power (60°/s), and knee extensor peak torque (180°/s) and total work (180°/s) were significantly (P < 0.05), yet poorly, correlated with handgrip strength (r < 0.30). Conclusion The majority of analyses did not show any correlation between variables assessed by isokinetic dynamometer and handgrip dynamometer. Caution is required when generalizing handgrip strength as a predictor of global muscle strength in community‐dwelling elderly women. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 25, 2013   doi: 10.1111/ggi.12077   open full text
• Prevalence of depression and associated risk factors among the elderly in Middle Anatolia, Turkey.
  Didem Arslantas, Alaettin Ünsal, Demet Ozbabalık.
  Geriatrics and Gerontology International. April 15, 2013
  Aim The present cross‐sectional study was carried out to determine the prevalence of depression among the elderly, and to examine the relationship between depression and dependency in activities of daily living. Material‐Methods According to the records of the Beylikova Community Health Center, there were 251 individuals aged 65 years and older living in the town center, and 203 (80.8%) of them had been reached. The depression status was assessed by using the Geriatric Depression Scale (GDS), Katz's Activities of Daily Living (ADL) Scale, and Lawton and Brody's Instrumental Activities of Daily Living (IADL) Scale. Among the statistical analyses, the χ2‐test and Spearman's correlation analysis were used. A value of P < 0.05 was considered statistically significant. Results The prevalence of depression was found to be 45.8% (93 persons). The prevalence of depression was significantly higher in women, in those with a history of any chronic disease and in those living alone. The scores on the GDS and thus the severity of depression decreased with increasing scores on ADL and IADL scales (for each, P < 0.05). Conclusion Depression seen in nearly every second older individual implies that the problem is very common. It was concluded that primary healthcare should be integrated into community‐based care, and it would be appropriate to plan early diagnosis and treatment programs for the elderly. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 15, 2013   doi: 10.1111/ggi.12065   open full text
• Non‐capable residents: Is the experience of dependence understood in nursing homes? A qualitative study.
  Domingo Palacios‐Ceña, Cristina Gómez‐Calero, José Miguel Cachón‐Pérez, Miguel Brea‐Rivero, Daniel Gómez‐Pérez, César Fernández‐de‐las‐Peñas.
  Geriatrics and Gerontology International. April 15, 2013
  Objective  The aim of the present study was to describe how dependence was experienced by Spanish nursing home residents with functional limitations. Methods  A qualitative phenomenological approach was followed. An initial purposeful sampling of Spanish residents in for‐profit nursing homes in the southern area of Madrid was carried out. Theoretical sampling was also implemented in order to gain a more in‐depth understanding of dependence. The inclusion criteria for nursing home residents were: aged 60 years old or older, having a functional impairment (Barthel Index <90), and lack of any cognitive impairment (Mini‐Mental State Examination‐Folstein >19) and able to communicate verbally in Spanish. Data were collected using unstructured and semi‐structured interviews. The interviews were tape recorded and fully transcribed. Data collection was concluded once theoretical saturation was reached, and the data were analyzed using the Giorgi proposal. Results  A total of 30 residents (15 female and 15 male) with a mean age of 83 years were included. Two main themes that describe the significance of dependence in nursing homes emerged from the data: (i) remaining “capable”, with one subtheme named “building the difference”, where residents described their own dependence classification of “non‐capable” residents; and (ii) “sharing life”, with two subthemes named “living together with non‐capable residents” and “sharing the environment”. Being considered as “non‐capable” is labelling the resident forever. Conclusions  The dependence experience of Spanish nursing home residents might help us gain a deeper insight into their expectations about functional limitations, as well as to understand the change in the relationship between residents considered “non‐capable”, caregivers and the other residents. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 15, 2013   doi: 10.1111/ggi.12066   open full text
• Effect of pimobendan in addition to standard therapy for heart failure on prevention of readmission in elderly patients with severe chronic heart failure.
  Hiroaki Kawano, Shuji Arakawa, Osami Satoh, Yuji Matsumoto, Motonobu Hayano, Daisuke Nakatomi, Toshihiko Yamasa, Koji Maemura.
  Geriatrics and Gerontology International. April 15, 2013
  Aim We evaluated the effect of pimobendan, a positive inotropic agent, in elderly patients with frequent readmission as a result of heart failure despite conventional therapy. Methods Pimobendan was given to five male patients with severe chronic heart failure (New York Heart Association class III–IV) (age range 69–89 years; mean 78 ± 8 years; ischemic cardiomyopathy in three cases, dilated cardiomyopathy in two cases) who required repeated admission for heart failure despite conventional therapy with angiotensin inhibitors, beta‐blockers, diuretics and anti‐arrhythmic agents. After the addition of pimobendan at a dose of 1.25–3.75 mg/day, we evaluated serum levels of brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), septal e′ and left ventricular end‐diastolic diameter (LVDD) by echocardiography, as well as readmission rates for more than 2 years. Results The serum level of BNP significantly decreased after treatment with pimobendan, although its level returned to pretreatment levels after 2 years. LVEF significantly improved after the treatment, with the improvement continuing beyond the 2 years, although LVDD did not change after treatment. Septal e′ significantly improved after the treatment, although its level returned to pretreatment levels at 2 years after the treatment. Readmission rates significantly decreased for 2 years after the treatment, although one patient required cardiac resynchronization therapy for severe heart failure, and another patient required cardiac pacemaker implantation for sick sinus syndrome 2 years after adding pimobendan. Conclusions Pimobendan in conjunction with conventional therapy for heart failure decreases the readmission rate in elderly patients with severe heart failure for at least 2 years. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 15, 2013   doi: 10.1111/ggi.12067   open full text
• Control of glycemia and other cardiovascular disease risk factors in older adults with type 2 diabetes mellitus: Data from the Adult Diabetes Control and Management.
  Shariff‐Ghazali Sazlina, Ismail Mastura, Zaiton Ahmad, Ai‐Theng Cheong, Bujang‐Mohamad Adam, Haniff Jamaiyah, Ping‐Yein Lee, Syed‐Abdul‐Rahman Syed‐Alwi, Boon‐How Chew, Taher SriWahyu.
  Geriatrics and Gerontology International. April 15, 2013
  Aim The aims of the present study were to assess the control of glycemia and other cardiovascular disease risk factors, and the association between age and these controls among older adults with type 2 diabetes in Malaysia. Methods A cross‐sectional study was carried out using cases notified to the Adult Diabetes Control and Management database between 1 January and 31 December 2009. A total of 10 363 people aged over 60 years with type 2 diabetes mellitus were included in the analyses. A standard online case report form was used to record demographic data, clinical factors (diabetes duration, comorbid condition and treatment modalities), cardiovascular disease risk factors, diabetes complications and laboratory assessments. The cardiovascular disease risk factors controls assessed included glycosylated hemoglobin (HbA1c) <7.0%, blood pressure, body mass index, waist circumference and lipid profiles. Results The proportion of older adults who achieved target HbA1c (<7.0%) was 41.7%. A greater proportion of older adults aged ≥80 years significantly achieved the targets of HbA1c <7% (P < 0.001), waist circumference (P < 0.001), low‐density lipoprotein cholesterol <2.6 mmol/L (P = 0.007) and triglycerides <1.7 mmol/L (P = 0.001) when compared with the younger elderly groups. They were also associated with achieving target HbA1c <7.0% (OR = 1.90, 95% CI 1.68–2.26) and triglycerides <1.7 mmol/L (OR = 1.20, 95%CI 1.04–1.46) than those aged 60–69 years. Conclusion The control of cardiovascular disease risk factors was suboptimal in older adults with type 2 diabetes. The oldest elderly were more likely to achieve target HbA1c (<7.0%) and triglycerides (<1.7 mmol/L) than older adults aged 60–69 years. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 15, 2013   doi: 10.1111/ggi.12070   open full text
• Caregiver burden of Mexican dementia patients: The role of dysexecutive syndrome, sleep disorders, schooling and caregiver depression.
  Óscar Rosas‐Carrasco, María de Guadalupe Guerra‐Silla, Laura del Pilar Torres‐Arreola, Carmen García‐Peña, Cristopher Isaac Escamilla‐Jiménez, César González‐González.
  Geriatrics and Gerontology International. April 15, 2013
  Aims As a result of the accelerated growth of the elderly population, reconfiguration of families and member roles, and the increase of mental disorders, it is necessary to investigate the effects of this set of factors on the caregivers of patients with dementia in Mexico. Mental disorders of individuals have a negative impact on their physical and emotional quality of life, leading to greater dependence and making the caring experience a heavy burden. Several studies (none in Mexico) have used either the characteristics of the patient or caregiver to determine the burden, but few studies have included both profiles within a single study. The objective of the present study was to analyze the characteristics of the patients and caregivers associated with caregiver burden. Methods A multicenter study was carried out in six health institutions located in Mexico City, including 175 patients (and their caregivers) diagnosed with different types of dementia. We used the Spanish Caregiver Burden Screen. Descriptive analysis and logistic regressions were used to estimate the effect of the covariates on the caregiver burden. Results The results showed that patient variables have a greater impact on caregiver burden than caregiver‐associated variables. Dysexecutive syndrome, sleep disorders, schooling and caregiver depression are associated with a higher level of caregiver burden. Conclusions Caregiver burden is a complex phenomenon. The results of the present study showed the need to implement multifactorial interventions targeting the caregiver to reduce the burden, strengthen the skills for patient management to avoid depression, improve patient health, and diminish functional dependence and future hospitalization. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 15, 2013   doi: 10.1111/ggi.12072   open full text
• Atenolol use is associated with long‐term mortality in community‐dwelling older adults with hypertension.
  Gianluca Testa, Francesco Cacciatore, David Della‐Morte, Francesca Mazzella, Chiara Mastrobuoni, Gianluigi Galizia, Gaetano Gargiulo, Franco Rengo, Domenico Bonaduce, Pasquale Abete.
  Geriatrics and Gerontology International. April 15, 2013
  Aim The role of atenolol, a non‐vasodilating beta‐blocker drug, on long‐term mortality in hypertensive older adults is still unclear. The aim of the present study was to evaluate long‐term mortality in community‐dwelling hypertensive older adults taking atenolol. Methods Long‐term mortality after 12‐year follow up in isolated hypertensive older adults (n = 972) was analyzed. The patients were stratified in the presence and absence of atenolol use. Systolic, diastolic and pulse arterial pressure were measured. Results Older adults taking atenolol showed a greater mortality and higher pulse arterial pressure values than those not taking atenolol (73.9% vs 55.0%; P = 0.047 and 74.7 ± 14.1 vs 63.0 ± 14.2 mmHg, P < 0.001, respectively). Cox regression analysis showed that atenolol use (hazard risk 1.91; 95% confidence interval 1.04–4.31; P = 0.04) and pulse arterial pressure (hazard risk 1.02; 95% confidence interval 1.01–1.03; P = 0.032) were predictive of long‐term mortality. Conclusions Atenolol use was related to increased mortality in community‐dwelling hypertensive Older adults. This increase in mortality risk seems to be related to an increase of pulse arterial pressure. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 15, 2013   doi: 10.1111/ggi.12073   open full text
• Longitudinal study of regional cerebral blood flow in elderly patients with idiopathic rapid eye movement sleep behavior disorder.
  Hirofumi Sakurai, Haruo Hanyu, Yuichi Inoue, Hidekazu Kanetaka, Masaki Nakamura, Tomoyuki Miyamoto, Taeko Sasai, Toshihiko Iwamoto.
  Geriatrics and Gerontology International. April 15, 2013
  Aim Single photon emission computed tomography (SPECT) studies showed that regional cerebral blood flow (rCBF) abnormalities in idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) are similar to those seen in Parkinson's disease (PD) and dementia with Lewy bodies (DLB). The aim of the present study was to assess the longitudinal rCBF changes in patients with iRBD using repeated SPECT. Methods Nine patients with iRBD (7 men and 2 women; mean age 71.1 ± 3.2 years) underwent baseline and follow‐up SPECT studies (a mean interval of 22.8 ± 9.2 months). Results A decrease in rCBF was found in bilateral parietotemporal and occipital areas at the first and second SPECT. Compared with the first SPECT, the second SPECT showed a decreased rCBF in the medial portions of the parietooccipital lobe with a significant decrease in rCBF of the right posterior cingulate. None of the patients showed any neurological deficits, including extrapyramidal and cerebellar signs, visual hallucinations, and neuropsychological impairments during the study. Conclusion These findings suggest that longitudinal measurements of rCBF can show the presence of progressing neurodegenerative process in iRBD. Longitudinal SPECT study can be used to monitor the progression of degenerative process in patients with iRBD, even though there were no evolving neurological and neuropsychiatric impairments. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 15, 2013   doi: 10.1111/ggi.12068   open full text
• Cognitive impairment and depression in the early 60s: which is more problematic in terms of instrumental activities of daily living?
  Boyoung Park, Jae Kwan Jun, Jonghan Park.
  Geriatrics and Gerontology International. April 07, 2013
  Aim We evaluated the impact of cognitive impairment and depression on functional impairment in people aged in their early 60s. Methods This cross‐sectional study included 3034 inhabitants of a rural area of Korea aged 60–64 years. The Korean version of the Mini‐Mental State Examination (MMSE‐K), the Geriatric Depression Scale (GDS‐15), and Lawton's Instrumental Activities of Daily Living (IADL) Scale were used to assess cognitive impairment, depression and functional impairment. Results A total of 30.8% of participants reported that they were dependent for at least one of the items on the IADL scale, and the overall prevalence of cognitive impairment and depression was 17.3% and 25.9%, respectively. The results showed that cognitive impairment had a stronger relationship with IADL impairment than did depression (odds ratio [OR] = 4.91, 95% confidence interval [CI] 3.91–6.17; c‐statistics = 0.647 and OR = 2.05, 95% CI 1.67–2.50; c‐statistics = 0.622, respectively). In particular, subclinical levels of the MMSE‐K and GDS‐15 score were associated with IADL impairment in participants without cognitive impairment or depression (OR = 0.73, 95% CI 0.67–0.80, OR = 1.09, 95% CI 1.03–1.16, per 1 point score increase, respectively). Only the MMSE‐K score showed a significant association in participants with either cognitive impairment or depression, or both. Our findings also showed the independent association of IADL impairment with age, employment status, education and type of insurance. Conclusions Compared with depression, cognitive impairment was more strongly associated with IADL impairment. Subclinical level of cognitive impairment and depression were also associated with IADL impairment in mentally healthy participants. Therefore, early intervention is required to prevent further decline. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 07, 2013   doi: 10.1111/ggi.12055   open full text
• Age–gender differences in the reaction times of ankle muscles.
  Junghwa Hong, Ji‐Won Kim, Hong‐Young Chung, Hyo‐Hee Kim, Yuri Kwon, Chul‐Seung Kim, Ye‐Ji Ho, Gwang‐Moon Eom, Jae‐Hoon Jun, Byung Kyu Park.
  Geriatrics and Gerontology International. April 02, 2013
  Aim Reaction times of the hip abductor were reported to be longer in elderly women than in elderly men, and this was suggested to be related to mediolateral balance performance. The aim of the present study was to investigate the effects of age and gender on the reaction performance of ankle muscles, which have predominant roles in anterioposterior balance control. Methods A total of 40 elderly subjects and 40 young subjects (even number of men and women) carried out a series of isometric plantarflexions and dorsiflexions, as forcefully and quickly as possible, in response to auditory stimulus. Surface electromyogram at the dorsiflexor and plantarflexor were recorded, together with foot plantar force. Premotor time, motor time and total reaction time derived from the experimental data were compared between age groups and genders by two‐way anova. Results Both dorsiflexor and plantarflexor showed similar reaction performance. Premotor time increased with age with no gender difference. Motor time increased with age in women and not in men, resulting in longer motor time in elderly women than in elderly men. Total reaction time was dominated by premotor time, so that it was longer in the elderly with no gender difference. Conclusion Although age‐related elongation of motor time was greater in women, total reaction time was not different between the genders. This may be related to no gender difference in anterioposterior balance performance. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 02, 2013   doi: 10.1111/ggi.12063   open full text
• Functional aging impairs the role of feedback in motor learning.
  Yu Liu, Chunmei Cao, Jin H Yan.
  Geriatrics and Gerontology International. April 01, 2013
  Aim Optimal motor skill acquisition frequently requires augmented feedback or knowledge of results (KR). However, the effect of functional declines on the benefits of KR remains to be determined. The objective of this research was to examine how cognitive and motor deficits of older adults influence the use of KR for motor skill learning. Methods A total of 57 older adults (mean 73.1 years; SD 4.2) received both cognitive and eye–hand coordination assessments, whereas 55 young controls (mean 25.8 years; SD 3.8) took only the eye–hand coordination test. All young and older participants learned a time‐constrained arm movement through KR in three pre‐KR and post‐KR intervals. Results In the subsequent no‐KR skill retests, absolute and variable time errors were not significantly reduced for the older learners who had KR during skill practice, especially for those with cognitive and motor dysfunctions. The finding suggests that KR results in no measureable improvement for older adults with cognitive and motor functional deficiencies. More importantly, for the older adults, longer post‐KR intervals showed greater detrimental effects on feedback‐based motor learning than shorter pauses after KR delivery. Discussion The findings support the hypothesis about the effects of cognitive and motor deficits on KR in motor skill learning of older adults. The dynamics of cognitive and motor aging, external feedback and internal control mechanisms collectively explain the deterioration in the sensory‐motor learning of older adults. The theoretical implications and practical relevance of functional aging for motor skill learning are discussed. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  April 01, 2013   doi: 10.1111/ggi.12013   open full text
• Effects of hospitalist‐directed interdisciplinary medicine floor service on hospital outcomes for seniors with acute medical illness.
  Ji Won Yoo, Haesun Seol, Sun Jung Kim, Janet Miyoung Yang, Woo Sang Ryu, Too Dae Min, Jong Bum Choi, Minkyung Kwon, Sulgi Kim.
  Geriatrics and Gerontology International. March 26, 2013
  Aim To examine whether a hospitalist‐directed interdisciplinary (ITD) team in an internal medicine residency program enhances the hospital and clinical outcomes for seniors with acute medical illness. Methods Seniors admitted to a USA teaching hospital medical floor‐teaching services were allocated to the ITD (n = 379) and usual care teams (n = 383). Compared with the usual care team, the ITD team physicians carried out daily “geriatric” assessment and management, and led ITD team meetings. Results The mean probability of functional decline on hospital discharge in the ITD team (25%; 95% CI 19–30%) was significantly lower than that in the usual care team (36%; 95% CI 30–43%; OR 0.35; 95% CI 0.10–0.92; P < 0.001). The mean probability of delirium in the ITD team (26%; 95% CI 20–32%) was significantly lower than that in the usual care team (34%; 95% CI 28–41%; OR 0.48; 95% CI 0.16–0.97; P = 0.03). The mean probability of transition to an institution in the ITD team (18%; 95% CI 13–23%) was significantly lower than that in the usual care team (26%; 95% CI 19–32%; OR 0.41; 95% CI 0.14–0.95; P = 0.01). Conclusions Hospitalist‐directed ITD team care is associated with reductions of functional decline, delirium and transition to an institution for seniors with acute medical illness. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 26, 2013   doi: 10.1111/ggi.12056   open full text
• Frailty assessment in the geriatric outpatient clinic.
  Hidong Kim, Patricia A Higgins, David H Canaday, Chris J Burant, Thomas R Hornick.
  Geriatrics and Gerontology International. March 26, 2013
  Aim Frailty is a common phenomenon in geriatric patients. In the present translational research study, we assessed two frailty instruments (Fried 2001; Gill 2002), comparing the usefulness and scoring classifications for frailty screening in an academically affiliated geriatrics clinic. Methods Assessment was completed on 162 male veterans (mean age 83.7 years, 57% African American) enrolled in a geriatric clinic. The instruments' component criteria, which are well known to gerontological clinicians, were administered in a standard order and scoring was identical to original instruments. Results The five‐item Fried frailty instrument required 15–20 min to complete; the two‐item Gill frailty instrument required less than 2 min. Of the 162 participants assessed, 72 were determined to be frail by at least one of the instruments, but just 33 were frail by both instruments. Correlations between the instruments were Spearman = 0.55 (P < 0.001) and kappa = 0.25, (P < 0.001). There were no differences in frailty scores based on race, and there were equivocal results based on age, even though this was an older sample, with almost 17% ≥90 years. A total of 63% (103/162) of the sample met the criterion for weak grip strength, and decreasing grip strength correlated with increasing age (r = −0.238, P = 0.002). Conclusion Expedient identification of the frailty syndrome remains an unmet necessity for clinical practice. The different results by the Fried and Gill frailty instruments are likely due to differences in component domains and testing methods. The present results support previous findings that showed that grip strength might be an important indicator of increasing frailty. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 26, 2013   doi: 10.1111/ggi.12057   open full text
• Stroke in centenarians.
  Tom Skyhøj Olsen, Klaus Kaae Andersen.
  Geriatrics and Gerontology International. March 26, 2013
  Aim Reports on centenarians with stroke have thus far been casuistic. We present clinical characteristics and 1‐month mortality in 39 centenarians admitted to Danish hospitals with acute stroke within 2000–2010. Methods A Danish stroke registry (2000–2010) contains information about 61 935 acute stroke patients among which 39 patients were centenarians. Data included age, sex, civil and housing status, stroke severity (Scandinavian Stroke Scale [SSS], 0 worst to 58 best), computed tomography scan, cardiovascular risk factors and death within 1 month after stroke. Data in centenarians were compared with similar data in stroke patients aged 40–69 years (n = 25 023), 70–79 years (n = 16 048), 80–89 years (n = 16 274) and 90–99 years (n = 3379). Results Of the 39 centenarians, 87% were women, 82% were living alone and 64% were living in their own home before the stroke. In general, the prevalence of cardiovascular risk factors was lower in centenarians, particularly with regard to previous myocardial infarction, previous stroke and diabetes mellitus. Strokes were significantly more severe (SSS 25.4), and 1‐month mortality (38.5%) was significantly higher in centenarians when compared with other age groups. Conclusion Centenarians with stroke are from a cardiovascular standpoint healthier than their younger counterparts. Yet, strokes in centenarians are more severe and associated with very high mortality. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 26, 2013   doi: 10.1111/ggi.12058   open full text
• Potentially inappropriate medicines in a cohort of community‐dwelling older people in New Zealand.
  Prasad S Nishtala, Michael L Bagge, A John Campbell, June M Tordoff.
  Geriatrics and Gerontology International. March 26, 2013
  Aim To examine independent factors associated with potentially inappropriate medicines (PIM) among 316 community‐dwelling people aged ≥75 years living in Dunedin. Methods People aged ≥75 years living in the community in Dunedin, New Zealand, taking ≥1 prescription medicines, randomly sampled from the electoral roll, were interviewed about their medicine‐taking practices. A medication inventory comprising prescription and non‐prescription medicines was taken from each participant at the time of the interview. Participants used a median of seven prescription medicines (range 1–19) and one non‐prescription medicine (0–14). PIM were identified using the updated 2012 Beers criteria. Results PIM were identified in 42.7% (n = 135) older people. A total of 23 (7.2%) took two PIM, five (1.5%) took three PIM, four (1.2%) took four PIM and one (0.3%) took five PIM. Of the 184 total PIM identified, the top three drug classes were non‐COX‐selective non‐steroidal anti‐inflammatory drugs (24.0%), tricyclic antidepressants (16.8%) and benzodiazepines (14.6%). Polypharmacy (adjusted odds ratio [OR] 2.06, 95% confidence interval [CI] 1.03–4.12) and the use of any psychotropic drug use (OR 22.05, 95% CI 5.80–83.84) were associated with PIM exposure. In the Poisson regression model, the risk of taking a PIM significantly decreased with age (OR 0.95, CI 0.91–0.99) and increased as the number of drugs prescribed increased (OR 1.11, CI 1.08–1.15). Conclusion The prevalence of PIM is relatively high in community‐dwelling older people aged ≥75 years living in New Zealand. PIM defined by the Beers criteria might be a useful initial screening tool, before efforts to stop unsafe medication use or replace with safer alternatives are initiated. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 26, 2013   doi: 10.1111/ggi.12059   open full text
• Vitamin K: Novel molecular mechanisms of action and its roles in osteoporosis.
  Kotaro Azuma, Yasuyoshi Ouchi, Satoshi Inoue.
  Geriatrics and Gerontology International. March 26, 2013
  Vitamin K is a fat‐soluble vitamin, which is involved in blood coagulation mediated by maintaining the activity of coagulation factors in the liver. Vitamin K also has extrahepatic actions and has been shown to prevent bone fractures in clinical studies. In addition, epidemiological studies suggest that a lack of vitamin K is associated with several geriatric diseases, including osteoporosis, osteoarthritis, dementia and arteriosclerosis. It has also been shown that vitamin K contributes to the prevention and treatment of some kinds of malignancies. Recently, we discovered a novel role for vitamin K as a ligand of the nuclear receptor, steroid and xenobiotic receptor (SXR), and its murine ortholog, pregnane X receptor (PXR). In addition to its established roles as a cofactor of γ‐glutamyl carboxylase (GGCX) in mediating post‐transcriptional modifications, vitamin K has a different mode of action mediated by transcriptional regulation of SXR/PXR target genes. Analysis of bone tissue from PXR‐deficient mice showed that the bone protective effects of vitamin K are partially mediated by SXR/PXR‐dependent signaling. The discoveries of a novel mode of vitamin K action have opened up new possibilities that vitamin K might be useful for prevention or treatment of a variety of diseases that affect the geriatric population. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 26, 2013   doi: 10.1111/ggi.12060   open full text
• Rheumatoid arthritis in the elderly and its relationship with periodontitis: A review.
  Rupali Agnihotri, Sumit Gaur.
  Geriatrics and Gerontology International. March 26, 2013
  Periodontitis and rheumatoid arthritis are chronic inflammatory diseases commonly seen in the elderly. It has been proposed that the two conditions are interrelated and influence the severity of each other. Recently, the role of Porphyromonas gingivalis, a periodontopathogen, has been explained in the pathogenesis and progression of rheumatoid arthritis. It can be inferred from the present review that the two conditions share a common pathobiology, genetics and environmental risk factors. Furthermore, a thorough understanding of the aforementioned mechanisms might enable the development of conjoint treatment modalities beneficial in treating the geriatric population afflicted by both the disorders. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 26, 2013   doi: 10.1111/ggi.12062   open full text
• Physical strength is associated with Mini‐Mental State Examination scores in Spanish institutionalized elderly.
  Raquel Pedrero‐Chamizo, Ulrike Albers, José L Tobaruela, Agustín Meléndez, Manuel J Castillo, Marcela González‐Gross.
  Geriatrics and Gerontology International. March 19, 2013
  Aim The present cross‐sectional study aimed at assessing muscle strength of hands, the dominant arm and legs in Spanish institutionalized elderly people according to sex, age and cognitive status. Methods A total of 153 elderly subjects (102 females, 51 males, mean age 83.6 ± 6.8 years) living in the region of Madrid were measured for handgrip strength (kg) with a Takei TKK 5101 digital dynamometer (range 5–100 kg, precision 0.1 kg), and arm and leg endurance strength (repetitions) according to the Rikli and Jones tests. Cognitive status was determined with the Mini‐Mental State Examination (MMSE). Results The values for men and women were, respectively: 23.5 ± 7.3 kg and 11.6 ± 4.6 kg (right handgrip), 22.0 ± 7.8 kg and 10.7 ± 4.8 kg (left handgrip), 13 ± 5 and 10 ± 5 repetitions (arm strength), 8 ± 5 and 5 ± 4 repetitions (legs strength), and 21 ± 6 and 17 ± 7 (MMSE score). All parameters were significantly higher for men (P ≤ 0.01), but strength decline with age was less pronounced in women. In all MMSE groups, lower strength was associated with lower cognitive status. Conclusions Strength values were lower in older subjects in both sexes; this difference was higher in men than in women. Higher strength values were associated with better cognitive status, which was the most influencing variable, even more than sex and age. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 19, 2013   doi: 10.1111/ggi.12050   open full text
• Impact of diabetes on cognitive impairment and disability in elderly hospitalized patients with heart failure.
  Giorgio Basile, Andrea Crucitti, Maria D Cucinotta, Paolo Figliomeni, Antonio Lacquaniti, Antonino Catalano, Nancy Morabito, Michele Buemi, Antonino Lasco.
  Geriatrics and Gerontology International. March 19, 2013
  Aim Heart failure (HF) and diabetes mellitus (DM) are each associated with cognitive impairment and disability. The aim of the present study was to evaluate the impact of DM on cognitive impairment and functional status in elderly hospitalized patients affected by HF. Methods A total of 79 elderly hospitalized patients with HF were enrolled in the present study. They underwent physical and instrumental examination, and geriatric multidimensional assessment including Mini‐Mental State Examination (MMSE), Geriatric Depression Scale (GDS), activities of daily living (ADL) and instrumental activities of daily living (IADL). Differences between groups were established by t‐test, Spearman's correlation coefficient was searched to examine the relation between variables. All results were considered significant if P was <0.05. Results HF and DM coexisted in 43 patients (54.4% of cases); when they occurred together patients showed, compared with non diabetic patients, a greater clinical severity of HF (44.2% were in New York Heart Association class IV vs 16.7%, P = 0.017), a lower MMSE score (20.4 ± 3.6 vs 23 ± 3.8, P = 0.004), and a lower number of preserved functions in ADL (3 ± 1.6 vs 4 ± 1.8, P = 0.008) and in IADL (3.2 ± 1.7 vs 4.6 ± 2.3, P = 0.003). The correlation between DM and cognitive impairment, and disability was confirmed by multivariate and univariate analysis. Conclusions We confirm that DM is frequent in elderly hospitalized patients with HF, and we report that it has a negative impact on cognitive functions and functional status, worsening cognitive impairment, and disability observed in these patients. Comprehensive geriatric assessment is necessary for older adults with HF, especially when DM coexists. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 19, 2013   doi: 10.1111/ggi.12051   open full text
• Prevalence and factors associated with rheumatic diseases and chronic joint symptoms in the elderly.
  Gláucia R Falsarella, Ibsen B Coimbra, Caroline C Barcelos, Lilian TL Costallat, Olga MF Carvalho, Arlete MV Coimbra.
  Geriatrics and Gerontology International. March 19, 2013
  Aim In the elderly population, rheumatic conditions are major causes of pain that restrict participation in activities and mobility, and cause difficulties in the execution of self‐care tasks. The present study aimed to analyze the prevalence and factors associated with the self‐reported rheumatic diseases and chronic joint symptoms of the elderly. Methods This transversal epidemiological survey involved 2209 older adults (aged ≥60 years). The investigation included sociodemographic factors, anthropometrics, activities of daily living, chronic conditions, medication and quality of life. Univariate and multivariate regression analysis were used for statistical procedures, P ≤ 0.05. Results The prevalence of rheumatism was 22.7%. Multivariate analysis showed that rheumatism was correlated with the following: female sex (OR = 1.91), high income (OR = 2.34), cardiovascular disease (OR = 1.42), cataracts (OR = 1.39), glucocorticoids (OR = 5.24), other anti‐inflammatory medications (OR = 2.24) and pain (OR = 0.983). After adjusting for age and glucocorticoids, an association between cataracts and rheumatism was detected (OR = 1.32). The prevalence of symptoms was 45.6%. Multivariate regression results for symptoms included the following: female sex (OR = 1.40), body mass index ≥30.0 kg/m2 (OR = 3.31), functional capacity (OR = 0.990), general health (OR = 0.993) and pain (OR = 0.981). After adjustment for age and glucocorticoids, an association between cataracts and symptoms was detected (OR = 1.26). Conclusion There was a significant association of rheumatism and symptoms with women and high incomes. Obesity was associated with joint symptoms, which in turn were associated with an impaired quality of life. Cataracts and cardiovascular disease were associated with rheumatism. The identification of these characteristics in the elderly will contribute to a better understanding of this systemic disease and should be used to plan effective preventive measures. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 19, 2013   doi: 10.1111/ggi.12052   open full text
• Decision to transfer to an emergency department from residential aged care: A systematic review of qualitative research.
  Glenn Arendts, Susan Quine, Kirsten Howard.
  Geriatrics and Gerontology International. March 19, 2013
  Aim If developing policies to optimize quality acute care within residential aged care facilities (RACF) is a goal, understanding the factors that influence the decision to transfer a resident from RACF to hospital emergency departments is important. The aim of the present study was to review the published literature pertaining to transfer decisions. Methods We carried out a systematic review of the qualitative literature to ascertain key influences on transfer decisions amongst three key stakeholder groups – residents, their family and carers. Results From 11 papers we found two themes encompassing seven domains of influence. Transfers are influenced by an expectation or goal of improved resident clinical or quality of life outcomes – these are domains within the “resident dominant” theme. However, transfers also occur where there is no expectation of resident benefit. These domains, such as inadequate facility resourcing and care planning, are categorized within the “resident subordinate” theme. Conclusion Transfer decisions are often influenced by considerations beyond expected benefit to the individual resident. Conceptualizing influences on transfer decisions within this framework might assist clinicians and policy makers in the design and delivery of services for RACF residents. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 19, 2013   doi: 10.1111/ggi.12053   open full text
• Rationale for physicians to propose do‐not‐resuscitate orders in elderly community‐acquired pneumonia cases.
  Yohei Oshitani, Hideaki Nagai, Hirotoshi Matsui.
  Geriatrics and Gerontology International. March 19, 2013
  Aim In many countries, do‐not‐resuscitate (DNR) orders were not legislated, partly because rationale for proposal of DNR orders have not been studied in elderly pneumonia patients with cognitive and physical disorders. The aim of the present study was to elucidate the factors influencing physicians' proposal for DNR orders and their validity as prognostic predictor, by comparing elderly pneumonia cases with and without DNR orders. Methods Medical records of community‐acquired pneumonia patients aged 65 years or older were retrospectively studied (n = 641). The patients were categorized into two groups; one with DNR orders within 72 h after admission and the other without it. Results DNR was decided in 183 patients (28.5%). The DNR group, containing more elderly patients with poorer performance status, showed higher rates of malnutrition, dementia, aspiration, very severe pneumonia, respiratory failure and mortality. The choice of antimicrobials was not affected by the presence of DNR orders. Mortality rate within 30 days was higher in the DNR group than in the non‐DNR group (33.9% vs 2.8%, P < 0.001), as well as total hospital mortality (56.8% vs 4.8%, P < 0.001). Multiple logistic analysis identified factors involved in the decision‐making of DNR orders; that is, aspiration, healthcare‐associated pneumonia, respiratory failure, intensive airspace consolidation, age 75 years and older, performance status 3 and 4, and serum albumin<2.5 g/dL were positive factors for DNR orders. Conclusion The present study showed factors involved in the physicians proposal of DNR orders, demonstrating that DNR was empirically chosen based on comprehensive judgment of several prognostic predictors and it, in itself, was a good prognostic predictor. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 19, 2013   doi: 10.1111/ggi.12054   open full text
• Prescribing patterns of proton pump inhibitors in older hospitalized patients in a Scottish health board.
  Anna Amrit Jarchow‐MacDonald, Arduino A Mangoni.
  Geriatrics and Gerontology International. March 18, 2013
  Aim Proton‐pump inhibitors (PPI) are extensively prescribed worldwide. However, little information is available on PPI prescribing patterns, associated clinical and demographic factors, and potential drug–drug interactions in frail older patients. Methods Data on clinical and demographic characteristics, and full medication exposure were collected in a consecutive series of 361 older patients (age 84 ± 7 years) admitted to two acute geriatric admission units (Aberdeen, National Health Service Grampian) between 1 February 2010 and 30 June 2010. A set of predetermined criteria was used to assess appropriateness of PPI prescribing. Results PPI were prescribed in 148 patients (41.0%). Inappropriate overprescribing was observed in 127 patients (35.2% of the study population, 85.8% of patients prescribed PPI). PPI were inappropriately not prescribed in 20 patients (48.8% of patients with an indication for PPI treatment). Regression analysis showed that the total number of non‐PPI prescribed drugs (OR 1.08; 95%CI 1.01–1.15) and a higher Charlson Comorbidity Index (OR 1.08; 95%CI 1.001–1.16) were independently associated with inappropriate PPI overprescribing. Potential drug–drug interactions were found in 75 patients (22.8% of the study population), mainly in patients with PPI overprescribing. Conclusions Inappropriate PPI prescribing is common in frail older hospitalized patients, and might increase the risk of drug–drug interactions. Polypharmacy and comorbidity were independently associated with inappropriate PPI prescribing in this group. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 18, 2013   doi: 10.1111/ggi.12047   open full text
• Prevalence of lower urinary tract symptoms in middle‐aged and elderly Japanese.
  Yoko Osuga, Kikuo Okamura, Fujiko Ando, Hiroshi Shimokata.
  Geriatrics and Gerontology International. March 18, 2013
  Aims To estimate the prevalence of lower urinary tract symptoms (LUTS) in Japanese people, and the relationships to aging and sex, we carried out the present population‐based study. Methods The present study included 1198 men aged 60.7 ± 12.5 years and 1218 women aged 60.8 ± 12.7 years who participated in a study of aging carried out at the National Center for Geriatrics and Gerontology between 2006 and 2008, using linguistically validated versions of the International Prostate Symptom Score (I‐PSS) and International Consultation on Incontinence Questionnaire Short‐form (ICIQ‐SF). Results The prevalence of I‐PSS ≥8 was 25.2% in men and 11.8% in women, that of two or more a week urinary incontinence was 3.3% and 6.6%, respectively, and that of I‐PSS ≥8 and/or two or more a week urinary incontinence was 25.8% and 16.0%, respectively. The prevalence of the seven symptoms in I‐PSS increased with aging. Just 9.1% of men and 4.6% of women who reported LUTS were medicated for LUTS. Conclusions The results showed that the severity of LUTS in Japan was related to aging. The prevalence of LUTS with I‐PSS ≥8 in Japan is similar to that in other countries. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 18, 2013   doi: 10.1111/ggi.12048   open full text
• Pain and hospice care in nursing home residents with dementia and terminal cancer.
  Todd B Monroe, Michael A Carter, Karen S Feldt, Mary S Dietrich, Ronald L Cowan.
  Geriatrics and Gerontology International. March 18, 2013
  Aim One condition associated with severe end‐of‐life pain that can lead to a poor quality of death is cancer. Cancer pain in people with dementia is of particular concern because of communication problems that occur with worsening disease. The aim of the current pilot study was to examine the association between hospice enrolment, dementia severity and pain among nursing home residents who died from advanced cancer. Methods Between‐groups cross‐sectional chart audits of 55 nursing home residents with dementia who died from cancer were carried out. Results A total of 45% of residents were in hospice at the end‐of‐life. Residents in hospice were more likely to receive an opioid (80% vs 43%, P = 0.005); but less likely to show severe cognitive impairment (20% vs 50%, P = 0.050). Enrolment in hospice was associated with an increased likelihood of receiving an opioid after controlling for level of cognitive impairment (OR = 3.9, 95% CI = 1.1–14.0, P = 0.037). Lower levels of cognitive functioning were associated with a decreased likelihood of receiving an opioid after controlling for enrolment in hospice (OR = 0.3, 95% CI = 0.1–0.8, P = 0.030). Notably, 40% of nursing home residents with dementia who died from cancer did not receive any opioid during this time. Conclusions Preliminary results suggest that hospice enrolment might be influenced by the facility or region of this particular country. Hospice enrolment predicts more opioid pain treatment in residents with dementia and terminal cancer; however, no resident with very severe dementia and terminal cancer was placed in hospice care. Severely cognitively impaired nursing home residents requiring opioids are at great risk of suffering from untreated advanced cancer pain. New methods are urgently required to improve end‐of‐life palliative care for nursing home residents with terminal cancer and severe dementia. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 18, 2013   doi: 10.1111/ggi.12049   open full text
• Endobronchial ultrasound transbronchial needle aspiration in older people.
  Shotaro Okachi, Naoyuki Imai, Kazuyoshi Imaizumi, Tetsunari Hase, Yuichiro Shindo, Koji Sakamoto, Hiromichi Aso, Keiko Wakahara, Izumi Hashimoto, Satoru Ito, Naozumi Hashimoto, Mitsuo Sato, Masashi Kondo, Yoshinori Hasegawa.
  Geriatrics and Gerontology International. March 06, 2013
  Aim The usefulness and safety of endobronchial ultrasound transbronchial needle aspiration (EBUS‐TBNA) have been established recently, but no study has evaluated whether or not aging increases the risk of the procedure. In the present study, we aimed to assess the usefulness and safety of EBUS‐TBNA in older patients. Methods The medical records and database of 109 patients who received EBUS‐TBNA between 2008 and 2011 at Nagoya University Hospital, Nagoya, Japan were reviewed retrospectively. All patients underwent bronchoscopy under light sedation with midazolam. A total of 34 patients were aged 70 years or older (the older group) and 75 were aged 69 years or younger (the younger group). We analyzed patients' characteristics, changes of clinical parameters, usage doses of midazolam and lidocaine, procedure duration, geographic data of biopsied lymph nodes, diagnostic yield, and complications in both groups. Results There were more comorbidities in the older group. Four patients (11.8%) in the older group had poor performance status (2–3). Systolic blood pressure at baseline was significantly higher in the older group. There were no statistical differences between the two groups in some clinical parameters (minimum oxygen saturation [SpO2], reduction in SpO2, maximum oxygen supplementation, elevation of systolic blood pressure, increase of heart rate) during the procedure. Diagnostic performance in older patients was similar to that found in younger patients. There was no difference in the frequency of complications between both groups. Conclusion Safety and usefulness of EBUS‐TBNA in older people were comparable with those in younger people. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 06, 2013   doi: 10.1111/ggi.12043   open full text
• Association of statin use with risk of dementia: A meta‐analysis of prospective cohort studies.
  Yu Song, Hongwei Nie, Yong Xu, Ling Zhang, Yan Wu.
  Geriatrics and Gerontology International. March 06, 2013
  Statins are a class of medications that reduce cholesterol by inhibiting 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase, which were thought to have a positive impact on dementia. We carried out the present meta‐analysis to investigate whether statins might be associated with a reduction on risk of dementia. We carried out a meta‐analysis of prospective cohort studies to examine the risk of dementia associated with statins. Ovid‐Medline database, PubMed database, Springer Link database and Google Scholar in English search were carried out for relevant studies. Selected studies had to describe an original study defined by strict screening and diagnostic criteria. We included eight prospective cohort studies that reported relative risks with 95% confidence intervals for the association of statins and dementia risk. A random effects model was used to calculate the summary risk estimates. The studies eligible for analysis involved 2851 cases and 57020 participants. The summary relative risk of dementia for the use of statins was 0.62 (95% confidence interval 0.43–0.81), with evidence of heterogeneity (P = 0.001, I2 = 70.8%). Findings of the present meta‐analysis show that statin use was associated with a reduced risk of dementia. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 06, 2013   doi: 10.1111/ggi.12044   open full text
• Corticosteroids injection in rotator cuff tears in elderly patient: Pain outcome prediction.
  Bernardo Gialanella, Maurizio Bertolinelli.
  Geriatrics and Gerontology International. March 06, 2013
  Aim The aim of this prospective study was to evaluate the effect of corticosteroids intra‐articular injections on pain in patients with rotator cuff tear (RCT), and to identify predictors for pain outcomes. Methods A total of 60 patients with RCT were enrolled. All patients underwent rehabilitation; 20 patients received a single intra‐articular injection of 40 mg triamcinolone acetonide and 20 patients had a repeat injection at a 21‐day interval. Backward stepwise regression analysis was used to predict effectiveness and improvement of pain. The independent variables were age, sex, symptom duration, tear size, passive range of motion (ROM), active ROM, non‐steroidal anti‐inflammatory drugs request, pain at rest, number of triamcinolone injections and severity of osteoarthritis at admission. Results At 3 and 6 months, patients who received triamcinolone had higher effectiveness and improvement in pain during activities and pain at night than those of control group. At the 3‐month interval post‐therapy, active ROM was the only predictor for effectiveness in pain during activity, effectiveness in pain at night and improvement in pain at night. Six months after therapy, active ROM was a predictor for improvement in pain at night. Age was a predictor for effectiveness in pain at night, whereas tear size of RCT was a predictor for effectiveness and improvement in pain during activity. Conclusions Corticosteroids can relieve pain in RCT. Active ROM is the most important predictor of pain outcomes. This finding can be useful to physicians when deciding on the type of patients who might best benefit from intra‐articular injections of corticosteroids. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 06, 2013   doi: 10.1111/ggi.12046   open full text
• Association of sarcopenia with functional decline in community‐dwelling elderly subjects in Japan.
  Yoshimi Tanimoto, Misuzu Watanabe, Wei Sun, Keiji Tanimoto, Kanako Shishikura, Yumiko Sugiura, Toshiyuki Kusabiraki, Koichi Kono.
  Geriatrics and Gerontology International. March 03, 2013
  Aim The present study aimed to determine the association of sarcopenia, defined by muscle mass, muscle strength and physical performance, with functional disability from a 2‐year cohort study of community‐dwelling elderly Japanese people. Method Participants were 743 community‐dwelling elderly Japanese people aged 65 years or older. We used bioelectrical impedance analysis (BIA) to measure muscle mass, grip strength to measure muscle strength, and usual walking speed to measure physical performance in a baseline study. Functional disability was defined using an activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale at baseline and during follow‐up examinations 2 years later. Logistic regression analysis, adjusted for age and body mass index, was used to examine the association between sarcopenia and the occurrence of functional disability. Results In the present study, 7.8% of men and 10.2% of women were classified as having sarcopenia. Among sarcopenia patients in the baseline study, 36.8% of men and 18.8% of women became dependent in ADL at 2‐year follow up. From the logistic regression analysis adjusted by age and body mass index, sarcopenia was significantly associated with the occurrences of physical disability compared with normal subjects in both men and women. Conclusions Sarcopenia, defined by muscle mass, muscle strength and physical performance, was associated with functional decline over a 2‐year period in elderly Japanese. Interventions to prevent sarcopenia are very important to prevent functional decline among elderly individuals. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 03, 2013   doi: 10.1111/ggi.12037   open full text
• Age‐related skeletal muscle mass loss and physical performance in Taiwan: Implications to diagnostic strategy of sarcopenia in Asia.
  Li‐Kuo Liu, Wei‐Ju Lee, Chien‐Liang Liu, Liang‐Yu Chen, Ming‐Hsien Lin, Li‐Ning Peng, Liang‐Kung Chen.
  Geriatrics and Gerontology International. March 03, 2013
  Aim Skeletal muscle loss is a common feature of aging, and is associated with unfavorable outcomes. Although several indexes of skeletal muscle mass measurement have been developed, the most optimal index for sarcopenia diagnosis among Asian populations has remained unclear. The present study aimed to evaluate the relationship between skeletal muscle mass and physical performance among community‐dwelling people in Taiwan. Methods Data of the I‐Lan Longitudinal Aging Study (ILAS) were retrieved for study. Comparisons between demographic profiles, physical performance and skeletal muscle mass (measured by dual‐energy X‐ray absorptiometry) were carried out. Skeletal muscle mass expressed by lean body mass divided by squared height (LBM/ht2), appendicular muscle mass divided by squared height (ASM/ht2) and percent skeletal muscle index (SMI%) were compared between measurements of physical performance. Results Overall, the data of 532 participants (mean age 64.6 ± 9.5 years, male 53.0%) were retrieved for analysis. Age was associated with poorer physical performance, and decreased ASM/ht2 and LBM/ht2, but not SMI%. Skeletal muscle mass (SMI%) was less significantly related to slow walking speed than ASM/ht2 in men. In women, all three muscle indexes showed no significant association between slow walking speed. In contrast, low handgrip strength was strongly associated with decreased skeletal muscle mass (measured by ASM/ht2 and LBM/ht2, but not SMI%) in both men and women. Conclusions Skeletal muscle mass was significantly associated with handgrip strength along with aging, but the association of skeletal muscle mass and walking speed was less significant. In sarcopenia diagnosis among Asian populations, ASM/ht2 should be the most suitable index for skeletal muscle mass measurements, and physical performance should be measured universally beyond measurements of skeletal muscle mass. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 03, 2013   doi: 10.1111/ggi.12040   open full text
• Short‐term clinical outcomes in delirious older patients: A study at general medical wards in a university hospital in Thailand.
  Rungnirand Praditsuwan, Achara Sirisuwat, Jintana Assanasen, Waricha Eiamjinnasuwat, Sorapop Pakdeewongse, Duangsawang Limmathuroskul, Varalak Srinonprasert.
  Geriatrics and Gerontology International. March 03, 2013
  Aim Delirium, a common disorder in hospitalized older patients, frequently results in unfavorable consequences. Previous studies in different settings have provided conflicting results regarding clinical outcomes and mortality. We aimed to study three clinical outcomes – length of stay (LOS), in‐hospital mortality and 3‐month mortality – among delirious Thai older patients. Methods A prospective observational study was carried out in a university hospital in Thailand. All patients aged older than 70 years admitted to general medical wards were included. Delirium assessments were undertaken within the first 24 h of admission and serially until discharge. Subsequent assessments were carried out at 3 months after discharge. Delirium was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Factors associated with mortality were determined by using logistic regression models. Results LOS was significantly longer in the delirium group (10 and 8 days, P = 0.001). Furthermore, the delirium group had higher in‐hospital and 3‐month mortality (P < 0.001). Factors significantly associated with in‐hospital mortality in multivariate analysis were age more than 80 years (AOR 2.74, 95% CI 1.05–7.15), malignancy (AOR 3.11, 95% CI 1.16–8.33), severe illness (AOR 3.75, 95% CI 1.38–10.20) and delirium (AOR 7.34, 95% CI 1.51–35.69). Delirium remained a strong predictor for 3‐month mortality in multivariate analysis with AOR of 3.33 (95% CI 1.45–7.62) Conclusions Delirium was associated with prolonged hospital‐stay and was the strongest predictor for mortality among older hospitalized patients. It requires serious attention from physicians, healthcare administrators and policy makers to implement an appropriate management plan for this high‐burden issue. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 03, 2013   doi: 10.1111/ggi.12041   open full text
• Medication adherence: Is it a hidden drug‐related problem in hidden elderly?
  Vivian WY Lee, Kathy KW Pang, Ka Chun Hui, Jennifer CK Kwok, Siu Ling Leung, Doris Sau Fung Yu, Diana Tze Fan Lee.
  Geriatrics and Gerontology International. March 03, 2013
  Aim The present study aimed to identify the health needs of the hidden elderly in Hong Kong, and to investigate the impacts of pharmacist and nursing interventions on medication management and well‐being in hidden elderly. Methods Participants were recruited by social workers if they were aged 65 years or older; did not have normal social life and network; did not have family support; and were not linked to the existing network of community support. Pharmacists identified drug‐related problems. The health needs of participants were assessed by observations and interviews. Outcome measurements were scores of Morisky 8‐item Medication Adherence Scale and EuroQoL (Quality of Life) 5‐D Questionnaire. Results A total of 93 participants were recruited and 86 participants completed the study. The mean age was 81.46 ± 5.70 years, the mean number of chronic disease was 3.29 ± 1.45 and the mean number of chronic medications was 6.36 ± 2.96. The most commonly observed chronic diseases were hypertension, cardiac problems, diabetes, hyperlipidemia and arthritis. Drug non‐adherence and storage problems were found in 61.63% and 69.77% of participants. The mean total EuroQoL score increased by 1.05 (P ≤ 0.001). The mean Morisky score decreased by 0.61, signifying improvement of medication adherence (P < 0.001). Female sex (P = 0.045), polypharmacy with more than nine concurrent medications (P = 0.013), arthritis (P = 0.006) and drug storage problems (P = 0.002) were identified as factors associated with poor medication adherence. Conclusions The majority of hidden elderly suffered from multiple chronic diseases, and the prevalence of drug‐related problems was high. Pharmacist and nursing interventions improved drug‐related problems, drug compliance and quality of life in hidden elderly. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  March 03, 2013   doi: 10.1111/ggi.12042   open full text
• Decreased serum transforming growth factor‐β1 concentration with aging is associated with the severity of emphysema in chronic obstructive pulmonary disease.
  Koichiro Kamio, Takeo Ishii, Takashi Motegi, Kumiko Hattori, Yuji Kusunoki, Arata Azuma, Akihiko Gemma, Kozui Kida.
  Geriatrics and Gerontology International. February 26, 2013
  Aim Age‐associated changes of the lung might increase pathogenetic susceptibility to chronic obstructive pulmonary disease (COPD). Decrement in serum transforming growth factor (TGF)‐β1 concentration is reported in elderly people. As impaired TGF‐β1 signaling could cause emphysema‐like changes, we hypothesized that decreased TGF‐β1 with aging is correlated with emphysema. Methods Symptomatic patients with or without COPD and healthy normal subjects without COPD were recruited (COPD, n = 182; smoking controls, n = 73; normal, n = 26). We investigated the correlation between TGF‐β1 and extent of emphysema and airway wall thickness, which were defined as the percentage of low‐attenuation area (LAA%) and large airway wall area (WA%) on pulmonary high‐resolution computed tomography, respectively. The correlation of pulmonary function test parameters and TGF‐β1 was evaluated. TGF‐β1 was determined by enzyme‐linked immunosorbent assay. Results TGF‐β1 significantly decreased with age (P = 0.0009). When the correlation between age and TGF‐β1 was analyzed in each group, a significant inverse correlation was found in COPD patients and smoking controls (P = 0.0095 and 0.0132, respectively), whereas no correlation was observed in healthy older adults. Among COPD patients with severe emphysema, LAA% was inversely correlated with TGF‐β1 (n = 89, P = 0.0104), whereas WA% and pulmonary function test parameters were not. Conclusions Although no correlation was found between TGF‐β1 and the severity of COPD, TGF‐β1 significantly decreased as emphysema became more severe. Age‐related decrease of TGF‐β1 in COPD might be associated with emphysematous alterations of the lungs in elderly subjects. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  February 26, 2013   doi: 10.1111/ggi.12031   open full text
• Age and gender differences in correlations of leisure‐time, household, and work‐related physical activity with physical performance in older Japanese adults.
  Kenji Tsunoda, Yuki Soma, Naruki Kitano, Taishi Tsuji, Yasuhiro Mitsuishi, Ji‐Yeong Yoon, Tomohiro Okura.
  Geriatrics and Gerontology International. February 26, 2013
  Aim This study aimed to compare relationships of leisure‐time, household, and work‐related physical activity (PA) with physical performance by age and gender in older Japanese adults. Methods This cross‐sectional study included 525 community‐dwelling older adults (73.3 ± 5.2 years) recruited in 2009–2011 in Kasama City, rural Japan. We used the Physical Activity Scale for the Elderly to assess PA variables. Physical performance was evaluated by 11 performance tests: grip strength, single‐leg balance, functional reach, sit‐and‐reach, standing time from long sitting position, sit‐to‐stand, timed up and go, habitual walk, hand working, and simple and choice reaction times. Results After adjusting for potential confounders, leisure‐time PA in young‐old (≤74 years) men correlated significantly with eight performance tests (absolute value of Spearman's partial rank correlation coefficient: r = 0.18–0.39), whereas in old‐old (≥75 years) men it correlated with three performance tests (r = 0.20–0.23). Although leisure‐time PA correlated with six performance tests (r = 0.19–0.22) in young‐old women, there were no significant correlations between leisure‐time PA and performance tests in old‐old women. Household PA of young‐old men (r = 0.20–0.23) and old‐old women (r = 0.26–0.34) correlated with four performance tests. In old‐old men and young‐old women, no significant correlation was found between household PA and performance tests. Work‐related PA did not relate significantly to any performance tests in any groups. Conclusion This study showed that leisure‐time PA is related to physical performance, especially in young‐old men and women, and household PA is especially related in young‐old men and old‐old women. Our findings suggest that supporting strategies for maintaining physical functions would differ by gender and age. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  February 26, 2013   doi: 10.1111/ggi.12032   open full text
• Long‐term effects of aerobic training versus combined aerobic and resistance training in modifying cardiovascular disease risk factors in healthy elderly men.
  Nelson Sousa, Romeu Mendes, Catarina Abrantes, Jaime Sampaio, José Oliveira.
  Geriatrics and Gerontology International. February 26, 2013
  Aims The purpose of the present study was to compare different modes of exercise in chronic modification of cardiovascular diseases risk factors. Methods A total of 48 healthy elderly men were randomly assigned to an aerobic training group (n = 15, aged 71.7 ± 4.7 years), a combined (aerobic and resistance) training group (n = 16, aged 68.5 ± 3.5 years) and a control group (n = 17, aged 67.0 ± 5.8 years). Both training programs were of moderate‐to‐vigorous intensity, 3 days per week for 9 months. Primary outcome measures included body composition, blood pressure and lipid profile. Odds ratios (OR) between hypertension, obesity and dyslipidemia were calculated. The independence between risk factors, aggregation and group factor was tested (baseline vs post‐test). Results There was significant aggregation between hypertension and obesity (OR 2.57, 95% CI 1.24–5.33). After 32 weeks, there was a significant change in the number of hypertensive (χ2 = 8.1, P = 0.004) and dyslipidemic (χ2 = 3.9, P = 0.049) participants, and also a favorable modification in the risk factors aggregation (χ2 = 7.9, P = 0.019), but only in the combined training group. Conclusions Combined aerobic and resistance training is more effective in the chronic modification of blood pressure and lipid profile, and in the reduction of total risk factors aggregated. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  February 26, 2013   doi: 10.1111/ggi.12033   open full text
• Validation and cross‐cultural adaptation of the Falls Efficacy Scale in patients with Parkinson's disease in Serbia.
  Tatjana Gazibara, Iva Stankovic, Aleksandra Tomic, Marina Svetel, Darija Kisic Tepavcevic, Vladimir S. Kostic, Tatjana Pekmezovic.
  Geriatrics and Gerontology International. February 26, 2013
  Aim The aim of the present study was to assess the validity and reliability of the Falls Efficacy Scale (FES) in Parkinson's disease (PD) patients in Serbia. Methods A cross‐sectional study was carried out at the Clinic for Neurology, between June 2011 and June 2012. A total of 201 consecutive PD outpatients were recruited. The inclusion criteria were: ability to walk independently for at least 10 m, ability to stand for at least 90 s and a Mini‐Mental State Examination score >24. The exclusion criteria were: the presence of other major neurological, psychiatric, visual, audio‐vestibular and orthopedic disturbances. The 10‐item FES was translated according to internationally‐accepted methodology. The internal reliability of the Serbian version of the FES was evaluated using Cronbach's alpha coefficient. Reproducibility of the FES was evaluated using the Spearman–Brown coefficient. To evaluate construct validity, an exploratory factor analysis (principal component analysis, varimax rotation) was carried out. Results The internal consistency of the Serbian version of the FES was 0.98. Age, duration of disease, Hoehn and Yahr stage, Unified Parkinson's Disease Rating Scale motor score, history of falls, and the Hamilton depression and anxiety scores were significantly correlated with the total FES score. On factor analysis, all 10 items were compact in a one‐factor cluster, with an explained variance of 85%. Spearman–Brown's correlation coefficient between the total scores was 0.99. Conclusions The psychometric characteristics of the Serbian version of the FES have excellent reliability and validity as an instrument for measuring the fear of falling in PD patients. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  February 26, 2013   doi: 10.1111/ggi.12034   open full text
• Effects of an internal medicine floor interdisciplinary team on hospital and clinical outcomes of seniors with acute medical illness.
  Ji Won Yoo, Sulgi Kim, Haesun Seol, Sun Jung Kim, Janet Miyoung Yang, Woo Sang Ryu, Too Jae Min, Jong Bum Choi, Minkyung Kwon, Shunichi Nakagawa.
  Geriatrics and Gerontology International. February 26, 2013
  Aim To examine whether an internal medicine interdisciplinary floor team enhances the hospital and clinical outcomes for seniors with acute medical illness. Methods Seniors admitted to medical floor teaching services of a USA teaching hospital were recruited and allocated to the interdisciplinary (ITD; n = 236) and usual care teams (n = 248). Compared with the usual care team, the interdisciplinary team physicians carried out daily “geriatric” assessment and management, and led the interdisciplinary team meeting designed for improving interprofessional collaboration. Results After controlling for patient and physician characteristics, the mean hospital length of stay in the ITD team (6.1 days; 95% CI 5.2–7.7 days) was 0.7 days shorter than that in the usual care team (6.8 days; 95% CI 5.7–8.3 days; P = 0.008). There was no significant difference in delirium and 30‐day hospital readmission between care groups. Conclusions Notwithstanding partly positive associations, the results from the present study suggest that interdisciplinary team‐based care is, at best, associated with enhancing the clinical and hospital outcomes for seniors with acute medical illness. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  February 26, 2013   doi: 10.1111/ggi.12035   open full text
• Predictors of viral pneumonia: The need for viral testing in all patients hospitalized for nursing home‐acquired pneumonia.
  Hon Ming Ma, Kin Ping Lee, Jean Woo.
  Geriatrics and Gerontology International. February 26, 2013
  Aim Community‐acquired pneumonia (CAP) is presumed to be bacterial in origin and empirical antibiotics are almost always given on admission. However, early detection of viral infection is also very important for hospital infection control and timely use of antiviral agents. The present study aimed to compare patients with viral and bacterial pneumonia, and identify independent predictors of viral pneumonia. Methods A prospective cohort study was carried out in a tertiary teaching hospital in a 1‐year period. Older patients (aged ≥65 years) were recruited if they were admitted for CAP confirmed by chest radiographs. Results A cohort of 488 patients was analyzed. Infective causes were found in 137 (28.1%) patients. Bacterial, viral and mixed infections were detected in 86 (17.6%), 41 (8.4%) and 10 (2.0%) patients, respectively. Bacteriology was established mostly by sputum culture and virology by nasopharyngeal aspirate (NPA) viral culture. The commonest bacterial isolates were Haemophilus influenzae (31), Pseudomonas aeruginosa (15), Mycobacterium tuberculosis (14), Klebsiella spp. (9) and Streptococcus pneumoniae (6). Influenza A virus (28, 8 were pandemic 2009 A/H1N1 subtype) and respiratory syncytial virus (16) were the most frequent viral causes. Independent predictors of viral pneumonia included nursing home residence (RR 3.056, P = 0.009) and absence of leukocytosis (RR 0.425, P = 0.026). Conclusions All nursing home residents hospitalized for CAP should undergo NPA viral testing because of infection control, early antiviral treatment and discharge planning. We suggest that empirical antiviral agents might be considered for nursing home residents hospitalized for CAP if outbreaks of influenza‐like illness are reported in nursing homes. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  February 26, 2013   doi: 10.1111/ggi.12036   open full text
• Physical performance measures as a useful indicator of multiple geriatric syndromes in women aged 75 years and older.
  Satoshi Seino, Noriko Yabushita, Mi‐ji Kim, Miyuki Nemoto, Songee Jung, Yosuke Osuka, Yoshiro Okubo, Rafael Figueroa, Tomoaki Matsuo, Kiyoji Tanaka.
  Geriatrics and Gerontology International. January 20, 2013
  Aim To identify whether individual physical performance measures or a combination of measures is a better indicator of multiple geriatric syndromes (MGS) defined as the concomitant presence of more than one geriatric syndrome in an individual. Methods We carried out cross‐sectional analyses on data from 340 community‐dwelling women aged 75 years and older (mean 80.0 years). We examined the following geriatric syndromes: urinary incontinence, falls, underweight, depression and functional decline. Trained testers measured usual gait speed (UGS), hand‐grip strength and lower extremity performance (LEP) score derived from four LEP measures: tandem stance, chair stand test, alternate step and timed up‐and‐go (TUG). We categorized UGS to distinguish high‐ and low‐performing participants using the established 1.0 m/s cut‐off point. Applying the same population percentile (35.8%), we determined cut‐off points for all individual measures and the LEP score. Results The UGS, TUG and LEP score had similar discriminating powers for MGS (each with area under receiver–operator curves [AUC] of 0.80), which were more significant than the discriminating powers of other individual measures (AUC = 0.69–0.76) when considered as continuous variables. A slow UGS, especially less than 1.0 m/s, was more strongly associated with MGS (odds ratio [OR] = 7.6, 95% confidence interval [CI] = 3.6–15.9) than the same percentiles for TUG (OR = 3.9, 95% CI = 1.9–7.8) and LEP score (OR = 5.2, 95% CI = 2.5–10.6). Conclusion The UGS test alone might be sufficient in detecting MGS in women aged 75 years and older compared with a more comprehensive test battery. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  January 20, 2013   doi: 10.1111/ggi.12029   open full text
• Lung function changes in older people with metabolic syndrome and diabetes.
  Simone Scarlata, Filippo Luca Fimognari, Matteo Cesari, Renato Giua, Alessandro Franco, Patrizio Pasqualetti, Ruggero Pastorelli, Raffaele Antonelli‐Incalzi.
  Geriatrics and Gerontology International. January 14, 2013
  Aim Restrictive lung dysfunction (RLD; defined as reduced forced vital capacity [FVC] in the presence of normal forced expiratory volume in 1 s [FEV1]/FVC ratio) is highly prevalent in the elderly, and is associated with diabetes, metabolic syndrome (MetS) and abdominal obesity. The aim of this study was to assess the relative contribution of diabetes, MetS and abdominal obesity in characterizing RLD in the elderly. Methods This was cross‐sectional analysis of 192 consecutive, community‐dwelling persons (mean age 70.8 ± 8 years). The participants were grouped according to the number of MetS components (i.e. 0, 1, 2, 3 or 4) and the presence of diabetes. According to the Adult Treatment Panel‐III criteria, participants with three or four components were considered to be affected by MetS. Independent correlates of RLD and obstructive lung dysfunction (OLD; FEV1/FVC < 0.70) were assessed by logistic regression models. Results The mean age of the sample population was 70.8 years. FVC expressed as percent of the predicted value declined for an increasing number of MetS components (P < 0.0001), but diabetes did not account for further ventilatory decline. Consistently, MetS (OR 3.03, 95% CI 1.16–7.89) and abdominal obesity (OR 4.89, 95% CI 1.17–20.3), but not diabetes, were independently associated with RLD. OLD did not worsen for an increasing number of MetS components and was only related to age (OR 1.07, 95% CI 1.01–1.13) and smoking (OR 1.04, 95% CI 1.01–1.06). Conclusions MetS and abdominal obesity, two conditions of prediabetes, but not diabetes itself, are closely associated with RLD. These conditions might be implicated in the pathogenesis of the RLD, which is frequently observed in diabetic patients. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  January 14, 2013   doi: 10.1111/ggi.12026   open full text
• Trajectories of older adults' hearing difficulties: Examining the influence of health behaviors and social activity over 10 years.
  Chyrisse Heine, Colette Browning, Sean Cowlishaw, Hal Kendig.
  Geriatrics and Gerontology International. January 14, 2013
  Aim The aims of the present study were to describe the trajectories of self‐reported hearing difficulties over time, and evaluate the impacts of age, sex, lifestyle factors and social activity, in explaining individual differences in patterns of change over time. Methods As part of the Melbourne Longitudinal Studies on Healthy Aging (MELSHA) Program, the hearing status of 947 adults aged 65 years and older, across five measurement periods (over 10 years), were analyzed using Latent Growth Curve Modeling analysis. A multidimensional survey was also administered, which included questions relating to sociodemographic variables, self‐reported hearing difficulties, nutrition, smoking habits and level of social activity. Results Although there was a general increase in hearing difficulties over time, older age, poor nutrition, a lifetime of smoking and increased social activity predicted more rapid increases in hearing difficulty over time. Conclusions Findings support the importance of lifestyle factors in reducing the rate of perceived hearing difficulties in older people, and provide further evidence of the links between lifestyle and sensory loss in older people. Poor nutrition and smoking are areas that both clinicians and public health professionals should address in their work with older people. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  January 14, 2013   doi: 10.1111/ggi.12030   open full text
• Use of complementary and alternative medicine to treat constipation in the elderly.
  E. Paul Cherniack.
  Geriatrics and Gerontology International. January 07, 2013
  Many modalities of complementary and alternative medicine, such as probiotic bacteria, traditional herbal medicines, biofeedback and massage, have been used to treat constipation in older adults. Virtually all studies in the published literature have been plagued with methodological problems, such as lack of blinding. Chinese herbal medications have been the most frequent subject of studies in controlled trials, but have suffered from methodological insufficiencies, and few have been published in publications other than Chinese language journals. Several therapies, such as yogurt containing probiotic bacteria and massage, are relatively easy to use by the patient, and are likely to cause few adverse reactions. Therefore, complementary and alternative therapies might show the greatest promise for being adopted as adjunctive therapies to conventional treatment. Geriatr Gerontol Int 2013; 13: 533–538.

  January 07, 2013   doi: 10.1111/ggi.12023   open full text
• Retrospective cohort study of the incidence and risk of fever in elderly people living at home: A pragmatic aspect of home medical management in Japan.
  Kenichi Yokobayashi, Masato Matsushima, Yasuki Fujinuma, Susumu Tazuma.
  Geriatrics and Gerontology International. January 07, 2013
  Aim In Japan, many elderly patients are managed at home, and fever is a common problem. This study examined the incidence of fever events in elderly patients on home medical management, and underlying disorders from the pragmatic standpoint. This study also investigated whether the care‐need level determined at the start of home care predicts fever onset. Methods The participants were patients aged ≥65 years who received home medical management from one clinic from 1 July 2008 to 30 June 2009. End‐points were onset of fever, diagnosis at time of fever onset and outcome. The incidence of fever was determined using the Kaplan–Meier method and compared using the log–rank test. To evaluate the effect of care‐need level on fever, Cox's proportional hazards model was used to adjust for confounding variables. Results A total 105 patients were included, with 100% follow up. The median observation period was 364 days. There were 64 fever events, for a fever incidence of 2.3/1000 patient‐days (95% CI 1.8–2.9); fever occurred at least once in 42.6% of participants. Fever was significantly more likely to occur in care‐need level 5 than in ≤4, with a risk ratio of 2.4. The most common diagnosis for all fever events was pneumonia/bronchitis, followed by urinary tract infection, and skin and soft tissue infection. Nearly 80% of cases were cured at home. Conclusions Fever occurred in approximately half of the participants over 1 year, and was more likely in patients requiring the highest care level; nearly 80% of cases were cured at home. Geriatr Gerontol Int 2013; ●●: ●●–●●.

  January 07, 2013   doi: 10.1111/ggi.12024   open full text
• Optineurin and amyotrophic lateral sclerosis.
  Hirofumi Maruyama, Hideshi Kawakami.
  Geriatrics and Gerontology International. December 26, 2012
  Amyotrophic lateral sclerosis is a devastating disease, and thus it is important to identify the causative gene and resolve the mechanism of the disease. We identified optineurin as a causative gene for amyotrophic lateral sclerosis. We found three types of mutations: a homozygous deletion of exon 5, a homozygous Q398X nonsense mutation and a heterozygous E478G missense mutation within its ubiquitin‐binding domain. Optineurin negatively regulates the tumor necrosis factor‐α‐induced activation of nuclear factor kappa B. Nonsense and missense mutations abolished this function. Mutations related to amyotrophic lateral sclerosis also negated the inhibition of interferon regulatory factor‐3. The missense mutation showed a cyotoplasmic distribution different from that of the wild type. There are no specific clinical symptoms related to optineurin. However, severe brain atrophy was detected in patients with homozygous deletion. Neuropathologically, an E478G patient showed transactive response DNA‐binding protein of 43 kDa‐positive neuronal intracytoplasmic inclusions in the spinal and medullary motor neurons. Furthermore, Golgi fragmentation was identified in 73% of this patient's anterior horn cells. In addition, optineurin is colocalized with fused in sarcoma in the basophilic inclusions of amyotrophic lateral sclerosis with fused in sarcoma mutations, and in basophilic inclusion body disease. These findings strongly suggest that optineurin is involved in the pathogenesis of amyotrophic lateral sclerosis. Geriatr Gerontol Int 2013; 13: 528–532.

  December 26, 2012   doi: 10.1111/ggi.12022   open full text
• Ethical problems in geriatrics: Views of Turkish primary healthcare professionals.
  Funda Gülay Kadıoğlu, Rana Can, Sadık Nazik, Selim Kadıoğlu.
  Geriatrics and Gerontology International. December 26, 2012
  Aim Primary healthcare professionals frequently encounter ethical issues in the care of older adults. These issues might particularly appear in the context of “age discrimination”, “respect for autonomy”, “respect for privacy” and “decision‐making competency”. The aims of this study were to determine the frequency rates of various geriatric ethical problems and to evaluate the importance given to these problems in primary healthcare. Methods In order to evaluate the opinions, a questionnaire tool was formulated. The participants were asked to review the list of geriatric ethical issues, to state the frequency of encountering them and to identify the importance ratings for each issue. The sample consisted of 86 primary healthcare professionals (50 physicians and 36 nurses) aged between 24 and 50 years. Results Based on the results, the most frequently encountered ethical issues were on “decision‐making competency” and these issues respectively were “decision‐making with relatives instead of elder patients”, “not informing elders due to the lack of tolerance” and “not informing elders due to the lack of comprehending”. The most important geriatric ethical issues were “ignoring respect for privacy”, “ignoring patient's complaints” and “rejecting detailed examination or treatment because of age”. Conclusion Overall, the results show that the nurses and physicians in primary healthcare frequently encounter geriatric ethical problems related to the decision‐making process, which is a common issue for Turkey as a paternalistic society. The findings show that primary healthcare professionals are sensitive to geriatric ethical issues; however, this sensitivity does not prevent the emergence of these issues. Geriatr Gerontol Int 2012; ●●: ●●–●●.

  December 26, 2012   doi: 10.1111/ggi.12019   open full text
• Association of spinal inclination with physical performance measures among community‐dwelling Japanese women aged 40 years and older.
  Yasuyo Abe, Kiyoshi Aoyagi, Tadao Tsurumoto, Chih‐Yu Chen, Mitsuo Kanagae, Satoshi Mizukami, Zhaojia Ye, Yosuke Kusano.
  Geriatrics and Gerontology International. December 26, 2012
  Aim Spinal inclination assesses spinal posture as a whole. However, the association between spinal inclination and physical performance has not yet been fully elucidated. Therefore, this study aimed to explore the association of spinal inclination with physical performance measures. Methods The participants were 107 Japanese women aged 40–84 years. Spinal posture was assessed as inclination to a perpendicular line by using a computer‐assisted device. Increased inclination value means forward inclination of the spine. Physical performance was measured by using the following methods: 6‐m walking time, chair stand time, functional reach, Timed Up & Go Test, and grip strength. Information on participants' comorbidities, osteoporosis, knee joint pain, back pain, falls in the previous year, regular exercise and usage of non‐steroidal anti‐inflammatory drugs (NSAIDs), was also collected. Results Pearson's correlation analysis showed significant associations between spinal inclination and all of the physical performance measures. Pearson's partial correlation analysis adjusted for age showed significant associations of increased inclination with poor physical functioning in 6‐m walking time, chair stand time, functional reach, and Timed Up & Go Test, but not in grip strength. Linear regression analysis adjusted for age, grip strength, number of comorbidities, osteoporosis, knee joint pain, back pain, falls in previous year, regular activity and taking NSAIDs showed that spinal inclination was associated with poor function in 6‐m walking time, chair stand time, functional reach and Timed Up & Go Test. Conclusion Forward spinal inclination was associated with impairment in various physical performance measures. Proper prevention and treatment of underlying disorders should be prompted. Geriatr Gerontol Int 2012; ●●: ●●–●●.

  December 26, 2012   doi: 10.1111/ggi.12020   open full text
• Study on the factors determining home death of patients during home care: A historical cohort study at a home care support clinic.
  Seiji Kawagoe, Toshihide Tsuda, Hiroyuki Doi.
  Geriatrics and Gerontology International. December 26, 2012
  Aim Associations between markedly low activities of daily living (ADL) at the start of home visit care and patient home death were analyzed using data from a home care support clinic in Japan that has a low rate of home deaths. Methods The study was a historical cohort study. It involved patients who began to receive home visit care from a home visit care support clinic between 1 April 2006 and 31 March 2011. Using home death as a dependent variable and presence/absence of markedly low ADL and other parameters (cancer, the patient's desire for home death, etc.) as independent variables, the adjusted hazard ratio and 95% confidence interval (CI) were calculated using the Cox proportional hazards model. Results Markedly low ADL were associated with home death even after adjustment for factors that influence home death (adjusted hazard ratio 4.40; 95% CI 2.37–8.16). Cancer and the patient's desire for home death were statistically significant factors involved in home death. In a subgroup analysis according to the presence/absence of cancer, the association between markedly low ADL and home death was stronger in the cancer‐free group (adjusted hazard ratio 10.78; 95% CI 2.89–40.26) than in the cancer group (adjusted hazard ratio 5.58; 95% CI2.39–13.05). Conclusion Patients' desire for home death could be fulfilled if home care support clinics provide home visit services to not only terminal‐stage cancer patients, but also bedridden cancer‐free patients. We must establish systems for older adults to remain at home during the terminal period of their lives. Geriatr Gerontol Int 2012; ●●: ●●–●●.

  December 26, 2012   doi: 10.1111/ggi.12018   open full text
• Necessity of normative data on the Japanese version of the Wechsler Memory Scale‐Revised Logical Memory subtest for old‐old people.
  Naoko Kawano, Shuichi Awata, Mutsuo Ijuin, Kunihiro Iwamoto, Norio Ozaki.
  Geriatrics and Gerontology International. December 21, 2012
  Aim Episodic memory is vulnerable to deterioration in people suffering from Alzheimer's disease. Currently, the Logical Memory (LM) subtest of the Wechsler Memory Scale‐Revised (WMS‐R) is used internationally as an operational definition to identify people with mild cognitive impairment (MCI). However, the Japanese version of the LM has not been adequately normalized for old‐old people. Therefore, norms of the LM for people aged 75 years and over are required, and the effects of sex, age and education on performance were evaluated. Methods A total of 50 (27 female and 23 male) participants without a history of dementia and symptomatic stroke events recruited from the community and hospital populations were investigated using the Mini‐Mental State Examination, the LM and some interference tasks. Results The mean scores (standard deviations) of the sample were 15.5 (5.4) on LM‐I and 9.9 (6.6) on LM‐II. The distributions of the LM‐I and ‐II scores satisfied the normality assumption. The LM‐I and LM‐II scores correlated with age and the LM‐I score correlated with educational background. Conclusions For the Japanese version of the LM, the means, standard deviations and distribution features of the old‐old sample are presented. Although the normal sample was chosen to closely match the demographic profile of the Japanese population, the present sample might have had a higher educational background than the age‐matched population, especially the males. Further study is required to standardize the Japanese version of the LM subtest for each 5‐year interval for latter‐stage elderly people. Geriatr Gerontol Int 2013; 13: 726–730.

  December 21, 2012   doi: 10.1111/ggi.12007   open full text
• Evaluation of chewing ability and its relationship with activities of daily living, depression, cognitive status and food intake in the community‐dwelling elderly.
  Yumi Kimura, Hiroshi Ogawa, Akihiro Yoshihara, Takayuki Yamaga, Tomoya Takiguchi, Taizo Wada, Ryota Sakamoto, Yasuko Ishimoto, Eriko Fukutomi, Wenling Chen, Michiko Fujisawa, Kiyohito Okumiya, Kuniaki Otsuka, Hideo Miyazaki, Kozo Matsubayashi.
  Geriatrics and Gerontology International. December 21, 2012
  Aim The aim of this study was to assess chewing ability using color‐changeable chewing gum and to show the association between chewing ability and geriatric functions, as well as dietary status in the community‐dwelling elderly. Methods The study population consisted of 269 community‐dwelling elderly aged ≥75 living in Tosa, Japan. Assessment of chewing ability was carried out by a dentist using color‐changeable chewing gum. Activities of daily living (ADL), depression and subjective quality of life (QOL) were assessed by questionnaire. Cognitive status was assessed by; Mini‐Mental State Examination (MMSE), Hasegawa Dementia Scale‐Revised (HDS‐R) and Frontal Assessment Battery (FAB) during the check‐up. Food diversity was assessed using the 11‐item Food Diversity Score Kyoto (FDSK‐11). Results Number of teeth was significantly related to chewing ability (P < 0.001). The participants with low chewing ability had significantly lower ADL scores in the items of self‐maintenance (P = 0.029) and intellectual activity (P = 0.021). There was a significant association between low chewing ability and depression (P < 0.001). Lower cognitive functions were significantly related to low chewing ability; MMSE (P = 0.022), HDSR (P = 0.017) and FAB (P = 0.002). The participants with low chewing ability had lower food variety (P < 0.001), and less frequent intake of beans, vegetables, seaweed and nuts, than the participants with high chewing ability. Conclusion Low chewing ability evaluated by color‐changeable gum was associated with lower ADL, lower cognitive functioning, depression and food insufficiency in the community‐dwelling elderly. More attention should be paid to assessing chewing ability of elderly persons in community settings. Geriatr Gerontol Int 2013; 13: 718–725.

  December 21, 2012   doi: 10.1111/ggi.12006   open full text
• Trends in mortality rates in elderly ST elevation myocardial infarction patients submitted to primary percutaneous coronary intervention: A 7‐year single‐center experience.
  Chiara Lazzeri, Serafina Valente, Marco Chiostri, Paola Attanà, Claudio Picariello, Gian Franco Gensini.
  Geriatrics and Gerontology International. December 21, 2012
  Aim Limited data are available on the safety and outcome of percutaneous coronary intervention (PCI) in elderly patients with ST elevation myocardial infarction (STEMI), as elderly patients are under‐represented in randomized trials. Methods We therefore aimed at assessing the trends in mortality rates (both at short‐term and at 1‐year follow up) in an unselected cohort of 404 STEMI patients aged ≥75 years all submitted to primary PCI and consecutively admitted to our Intensive Cardiac Care Unit from 2004 to 2010. Results In the first period (2004–2006), 202 patients (202/661, 30.6%) were aged ≥75 years, whereas in the second period (2007–2010), 203 patients (203/607, 33.4%) were aged ≥75 years. In the second period, STEMI patients were older (P < 0.001), more diabetic (P < 0.001) and with a higher incidence of comorbidities (P < 0.001). A significantly lower use of intra‐aortic balloon pump was observed, together with a reduced rate of bleeding, whereas the incidence of worsening renal function significantly increased (P = 0.011). No difference was observed in the length of stay and in mortality rate (both in‐hospital and 1‐year post‐discharge) between the first and the second period. Conclusions According to our data, patients aged ≥75 years are characterized by an increasing number of comorbidities (in particular, a higher incidence of diabetes). Over a 6‐year period, despite a more advanced age, early mortality (and length of stay) remained unchanged (probably thanks to a significant reduction in bleeding events), and no difference was observed in 1‐year post‐discharge mortality in these patients. Geriatr Gerontol Int 2013; 13: 711–717.

  December 21, 2012   doi: 10.1111/ggi.12005   open full text
• High frequency of calcification in basal ganglia on brain computed tomography images in Japanese older adults.
  Megumi Yamada, Takahiko Asano, Kouichirou Okamoto, Yuichi Hayashi, Masayuki Kanematsu, Hiroaki Hoshi, Yasuhisa Akaiwa, Takayoshi Shimohata, Masatoyo Nishizawa, Takashi Inuzuka, Isao Hozumi.
  Geriatrics and Gerontology International. December 21, 2012
  Aim To investigate the frequency of calcification in the basal ganglia and the dentate nuclei in the cerebellum, and compare the difference in age and area, we examined the brain computed tomography (CT) images of all patients in two representative university hospitals in Japan. Methods We examined the brain CT images of 2526 patients in Gifu University Hospital (UH) and 2573 patients in Niigata UH. These patients were examined in these hospitals from October 2009 to September 2010. Results Punctate calcification of the basal ganglia was observed in 435 of 2526 patients (17.2%) in Gifu UH and 530 of 2573 patients (20.6%) in Niigata UH. The frequency of calcification increased with age. Patchy calcification of the basal ganglia was observed in 32 (1.3%) and 50 patients (1.9%) in Gifu UH and Niigata UH, respectively. Among patients aged over 65 years, 24 (2.1%) and 34 (3.1%) patients showed patchy calcification in Gifu UH and Niigata UH, respectively. Calcification of the cerebellar dentate nuclei was detected in just seven and four patients in Gifu UH and Niigata UH, respectively. Conclusion Compared with previous reports, the frequency of calcification of the basal ganglia in this study markedly increased. This might be because of the increased number of older adults and the increased sensitivity of CT. Geriatr Gerontol Int 2013; 13: 706–710.

  December 21, 2012   doi: 10.1111/ggi.12004   open full text
• Eating management and functional outcome of elderly patients with symptomatic ischemic stroke undergoing inpatient rehabilitation.
  Eliyahu‐Hayim Mizrahi, Marina Arad, Abraham Weiss, Arthur Leibovitz, Abraham Adunsky.
  Geriatrics and Gerontology International. December 21, 2012
  Aim The purpose of this study was to investigate whether, and to what extent, post‐stroke eating management (EM) at admission to a rehabilitation ward is associated with functional outcome. Methods This was a retrospective study comprising 716 consecutive elderly patients with first ever symptomatic ischemic stroke. Level of eating management was determined by Functional Independence Measurement (FIM) subscale scores relevant to eating management, where scores ≤5 points define low‐eating management (Low‐EM) ability and scores >5 indicate independent eating management. Data was analyzed by t‐test, χ2‐test, Pearson's correlation and by multiple linear regression analysis. Results A total of 418 and 298 Low‐EM and High‐EM patients, respectively, were eligible for final analysis. Compared with High‐EM, Low‐EM patients were slightly older (P = 0.04), had longer rehabilitation stays (P < 0.001) and lower Mini‐Mental State Examination (MMSE) scores (P < 0.001). Total FIM at admission and discharge were lower in Low‐EMS, yet there was no statistically significant difference in total FIM gain on discharge between the two groups. Multiple linear regression analyses showed that total FIM at discharge was inversely associated with Low‐EM at admission (β‐coefficient = −0.389, P < 0.001). Low‐EM scores were independently predictive for higher total FIM gain at discharge (β‐coefficient = 0.125, P = 0.005). Conclusion The findings suggest that impaired eating management on admission is associated with adverse functional outcome. However, patients presenting to rehabilitation with impaired eating management do obtain significant functional gains and should not be deprived of rehabilitation. Geriatr Gerontol Int 2013; 13: 701–705.

  December 21, 2012   doi: 10.1111/ggi.12003   open full text
• Positive affect as a predictor of lower risk of functional decline in community‐dwelling elderly in Japan.
  Mayumi Hirosaki, Yasuko Ishimoto, Yoriko Kasahara, Akiko Konno, Yumi Kimura, Eriko Fukutomi, Wenling Chen, Masahiro Nakatsuka, Michiko Fujisawa, Ryota Sakamoto, Masayuki Ishine, Kiyohito Okumiya, Kuniaki Otsuka, Taizo Wada, Kozo Matsubayashi.
  Geriatrics and Gerontology International. December 21, 2012
  Aim To investigate whether positive affect independently predicts a lower risk of functional decline among community‐dwelling older Japanese. Methods A 2‐year prospective study was carried out among 505 residents of Tosa Town aged 65 years and older without disability in carrying out basic activities of daily living (BADL) at baseline. Positive and negative affect was measured using the 15‐item Geriatric Depression Scale, which includes items that reflect positive affect, as well as items that reflect negative affect. Information on functional ability, sociodemographic factors and medical conditions was obtained using a self‐administered questionnaire. Results A total of 72 (14.3%) participants reported a decline in BADL at the 2‐year follow up. The sum‐score of the positive items was significantly associated with a lower risk of functional decline (OR 0.78, 95% CI 0.64–0.97), after controlling for potential confounding factors. Of the five positive items, three items (feeling satisfied with life OR 0.49, 95% CI 0.25–0.95; feeling happy most of the time OR 0.50, 95% CI 0.25–0.99; and feeling full of energy OR 0.46, 95% CI 0.22–0.95) were significantly associated with functional decline after adjusting for confounders. These associations were also independent of negative affect. In contrast, none of the negative items predicted functional decline after controlling for confounding factors. Conclusions Positive psychological well‐being, specifically the feeling of satisfaction with life, happiness and energy, might have a favorable effect on the maintenance of functional ability, regardless of negative affect. Geriatr Gerontol Int 2012; ●●: ●●–●●.

  December 21, 2012   doi: 10.1111/ggi.12008   open full text
• Preoperative prediction of macrophage infiltration by 3‐D tomographic ultrasound in endoarterectomized carotid plaques in elderly patients.
  Shun‐ichi Koyama, Takao Hashimoto, Takahiko Umahara, Tomotaka Akai, Daisuke Watanabe, Jiro Akimoto, Toshitaka Nagao, Toshiki Uchihara, Jo Haraoka, Toshihiko Iwamoto.
  Geriatrics and Gerontology International. December 21, 2012
  Aim Assessment of plaque characteristics is important for the optimal treatment of carotid stenosis, particularly in elderly patients. Macrophage infiltration is reported to be involved in carotid plaque instability. However, immunohistochemical assessment of the detailed localization of macrophage infiltration in carotid plaques remains limited. We attempted to elucidate this using 3‐D ultrasonography (3D‐US). We compared findings of the detailed localization of macrophage infiltration with findings from the newly developed tomographic ultrasound imaging (TUI). Methods We obtained specimens of carotid arteries from 18 patients undergoing carotid endarterectomy (CEA), and investigated the localization of macrophages and vascular smooth muscle cells. Their localization obtained from 11 patients was compared with their preoperative TUI findings. Results We classified the localization of macrophage infiltration into four types: (i) focal infiltration in the thick fibrous cap (12 cases); (ii) subendothelial zonal infiltration (2 cases); (iii) peripheral infiltration around the lipid core (8 cases); and (iv) local infiltration near the shoulder of the fibrous cap (2 cases). Among them, preoperative TUI was available in 11 CEA cases for histological comparison. We identified two sites of focal macrophage infiltration that corresponded to local echogenic lesions without an acoustic shadow on TUI. The proliferation of smooth muscle cells failed to show an apparent echogenicity. Conclusions TUI could not only evaluate the morphological features, but also showed the two types of focal macrophage infiltration relevant to plaque instability as an echogenic focus. TUI carried out by 3D‐US is an easily applicable and non‐invasive method that is considered useful for evaluating carotid plaques in elderly patients. Geriatr Gerontol Int 2012; ●●: ●●–●●.

  December 21, 2012   doi: 10.1111/ggi.12009   open full text
• Anemia in elderly patients: New insight into an old disorder.
  Emmanuel Andrès, Khalid Serraj, Laure Federici, Thomas Vogel, Georges Kaltenbach.
  Geriatrics and Gerontology International. December 17, 2012
  Anemia is an important healthcare concern among the elderly. In these patients, the anemia is often mild, with a hemoglobin level >10 g/dL. It is usually well tolerated, but might be responsible for several proteiform and/or atypical presenting complaints. In the elderly, anemia is usually of multifactorial origin, including chronic inflammation, chronic kidney disease, nutrient deficiencies and iron deficiency (approximately two‐thirds of all cases). The remaining cases are unexplained (unknown etiology). In the elderly, the classic diagnosis of anemia, which is based on the mean corpuscular volume associated with a low hemoglobin level, might not be accurate. A predefined standardized diagnostic procedure should be followed. In the common case of frail elderly patients, all investigations should be carefully considered and invasive examinations undertaken where justified (risk–benefit balance). Nevertheless, most cases of anemia require further investigation and the underlying cause should be identified and treated whenever possible. Geriatr Gerontol Int 2013; 13: 519–527.

  December 17, 2012   doi: 10.1111/ggi.12017   open full text
• Home ownership and fall‐related outcomes among older adults in South Korea.
  Young Kyung Do, Cheong‐Seok Kim.
  Geriatrics and Gerontology International. December 17, 2012
  Aim Many of the previously identified environmental risk factors for fall‐related outcomes (e.g. flooring, stairs and steps, kitchen, and bathrooms) are amenable to change, but the extent of the changes on these home‐related risk factors are conditional on home ownership of the elderly. This study aims to test whether lack of home ownership is associated with a higher risk of falls, and a higher likelihood of reporting fear of falling and activity limitations due to fear of falling among older adults in South Korea. Methods Using data from the first two waves (2006 and 2008) of the Korean Longitudinal Study of Aging, the associations between home ownership variables and three fall‐related outcomes were examined in two regression models. A logistic regression model of any falls in the past 2 years was estimated to examine whether older adults living in short‐term rental homes based on monthly rent have an increased risk of falls. A probit model accounting for sample selection was estimated to examine whether the two related outcomes, fear of falling and limiting activities due to fear of falling, are associated with home ownership status. Results Compared with owned home, short‐term rental home predicted a higher likelihood of incident of falls and activity limitation due to fear of falling. Conclusions The study findings suggest that the lack of home ownership with unstable housing tenure is an important risk factor for fall‐related outcomes among older adults in South Korea. Geriatr Gerontol Int 2012; ●●: ●●–●●.

  December 17, 2012   doi: 10.1111/ggi.12015   open full text
• Effect of square‐stepping exercise and basic exercises on functional fitness of older adults.
  Camila Vieira Ligo Teixeira, Sebastião Gobbi, Jessica Rodrigues Pereira, Deisy Terumi Ueno, Ryosuke Shigematsu, Lilian Teresa Bucken Gobbi.
  Geriatrics and Gerontology International. December 12, 2012
  Aim The aging process might reduce functional fitness, including balance, which can increase the risk of falls among older adults. Different types of intervention seem to benefit older adults, therefore the purpose of this study was to analyze the effect of a program using square‐stepping exercises (SSE) sequences only on functional fitness in older adults. Furthermore, the possible effects were compared with a basic exercise program. Methods A total of 86 community‐dwelling older adults (aged >60 years) were divided into four groups: one group practised only SSE sequences (n = 21), the second group practised basic physical exercises (n = 20), the third group practised both SSE sequences and physical exercises (n = 25); and the fourth group was the control group, which was evaluated in their functional fitness before and after the 16‐week research period. Results Participants who practised basic physical exercises improved in agility and aerobic endurance, and SSE improved balance tests. Conclusions SSE and basic exercise, practised together or alone, seem to have a good influence on the functional fitness of older adults. In addition, SSE training seems to be an effective new kind of activity for balance training. Geriatr Gerontol Int 2012; ●●: ●●–●●.

  December 12, 2012   doi: 10.1111/ggi.12011   open full text
• Evaluation of multidimensional neurocognitive function using a tablet personal computer: Test–retest reliability and validity in community‐dwelling older adults.
  Hyuma Makizako, Hiroyuki Shimada, Hyuntae Park, Takehiko Doi, Daisuke Yoshida, Kazuki Uemura, Kota Tsutsumimoto, Takao Suzuki.
  Geriatrics and Gerontology International. December 12, 2012
  Aim This study sought to confirm the test–retest reliability and validity of the National Center for Geriatrics and Gerontology functional assessment tool (NCGG‐FAT), a newly developed assessment of multidimensional neurocognitive function using a tablet personal computer (PC). Methods This study included 20 community‐dwelling older adults (9 females, aged 65–81 years). Participants were administered the NCGG‐FAT twice, separated by approximately 30 days to determine test–retest reliability. To test the validity of the measure, participants underwent established neurocognitive measurements, including memory, attention, executive function, processing speed and visuospatial function within a week from the first administration of the NCGG‐FAT. Results Test–retest reliability was in an acceptable range for each component of the NCGG‐FAT, with intraclass correlation coefficients ranging from 0.764 to 0.942. Each task in the NCGG‐FAT showed a moderate to high correlation with scores on widely‐used conventional neurocognitive tests (r = 0.496 to 0.842). Conclusion We found that the NCGG‐FAT using a tablet PC was reliable in a sample of community‐dwelling older adults. The NCGG‐FAT might be useful for cognitive screening in population‐based samples and outcomes, enabling assessment of the effects of intervention on multidimensional cognitive function among older adults. Geriatr Gerontol Int 2012; ●●: ●●–●●.

  December 12, 2012   doi: 10.1111/ggi.12014   open full text
• Trends of gender gaps in life expectancy in Japan, 1947–2010: Associations with gender mortality ratio and a social development index.
  Yan Liu, Asuna Arai, Yoshihide Obayashi, Koji Kanda, Eugene Boostrom, Romeo B. Lee, Hiko Tamashiro.
  Geriatrics and Gerontology International. December 06, 2012
  Aim This study analyzed the trend of gender gaps in life expectancy (GGLE) in Japan between 1947 and 2010, and explored the correlations of GGLE with gender mortality ratio and social development indices. Methods Using GGLE and social indices data collected from the official websites, we carried out trends analysis of GGLE by calculating segmented average growth rates for different periods. We explored the association between GGLE and all‐cause mortality; and between GGLE and Human Development Index (HDI) while controlling for time trend, by computing the generalized additive models based on the software R (version 2.15). Results Japan's GGLE increased in a fluctuating fashion. Across 53 years, the average growth rates varied widely: 0.14% (1947–1956), 1.43% (1956–1974), 1.06% (1974–2004) and −0.60% (2004–2010) (overall average 0.87%). The value of GGLE peaked to 7.00 years in 2004, and then has slowly declined (6.75 years in 2010). Age‐adjusted all‐cause gender mortality ratio had a statistically positive association with GGLE (P < 0.01), whereas HDI was found to have no such association. Conclusion The increased trend of GGLE in Japan could be partly explained by increased disease‐specific mortality ratios (male/female), especially those involving chronic bronchitis and emphysema, diseases of the liver, suicide and cancer. The recent decline of GGLE might imply that Japanese women have been catching up with the lifestyle of men, resulting in similar mortality patterns. This calls for gender‐sensitive approaches to developing policies and programs that will help sustain healthy lifestyles to combat smoking and alcohol intake, and social support to prevent suicide. Geriatr Gerontol Int 2013; 13: 792–797.

  December 06, 2012   doi: 10.1111/ggi.12001   open full text
• Factors that allow elderly individuals to stay at home with their families using the Japanese long‐term care insurance system.
  Yumiko Oyama, Nanako Tamiya, Masayo Kashiwagi, Mikiya Sato, Kazuhiro Ohwaki, Eiji Yano.
  Geriatrics and Gerontology International. December 06, 2012
  Aim This study examined the factors that allow elderly individuals to stay at home continuously by considering the roles of the family caregiver, the use of services and characteristics of the elderly individual. Methods We analyzed 432 elderly individuals living at home with family. The outcome was that participants remained at home continuously over a 24‐month period. The participants were stratified into two care‐needs levels, and then multiple logistic regression analyses were carried out to examine relationships between staying at home and the Japanese version of the Zarit Burden Interview (J‐ZBI), public Long‐term Care Insurance (LTCI) service use, family caregivers' characteristics and elderly peoples' characteristics. Results Low scores on the J‐ZBI were related to outcome in both care‐needs subgroups (low care‐needs subgroup: OR 2.11; 95% CI 1.31–3.43, high care‐needs subgroup: OR 5.03; 95% CI 1.04–31.1). Regarding LTCI services, the use of home‐visit nursing (HN) service was related to staying at home continuously in the high care‐needs group (OR 37.39; 95% CI 3.31–879.1). Conclusions Alleviation of caregiver' burden was essential for continuous stay at home of elderly people regardless of care‐needs levels. Also, the HN service was founded as the relevant LTCI service factor for staying at home continuously. The HN service use might affect the outcome when we consider the causal relationship. Therefore, the policy for the promotion of HN service use will be important to achieve the ultimate goal of LTCI, which is to allow elderly people to live in their communities for as long as possible. Geriatr Gerontol Int 2013; 13: 764–773.

  December 06, 2012   doi: 10.1111/ggi.12002   open full text
• Potential benefits of reducing medication‐related anticholinergic burden for demented older adults: A prospective cohort study.
  Yen‐Chi Yeh, Chien‐Liang Liu, Li‐Ning Peng, Ming‐Hsien Lin, Liang‐Kung Chen.
  Geriatrics and Gerontology International. December 06, 2012
  Aim Medication‐related anticholinergic burden is a quality indicator for geriatric pharmacotherapy; however, little is known regarding the benefits of reducing anticholinergic burden for demented patients Methods Demented residents in a Veteran Home were enrolled for this study and an educational program was held for primary care physicians providing services at the Veterans Home. Residents were assigned to the intervention group if the primary care team could adhere to the research protocol and the remaining residents were assigned to the reference group receiving conventional care. Anticholinergic burden was estimated by Clinician‐Rated Anticholinergic Score (CR‐ACHS). Healthcare outcomes; for example, hospitalizations, mortality, cognitive and physical function, were compared between groups. Results Overall, 53 of the 67 demented residents (mean age 83.4 ± 4.4 years) completed this study. Anticholinergic exposure was found in 38 participants (56.7%) at baseline, in which antipsychotics (n = 29, 76.3%) and antidepressants (n = 19, 50%) were the most common agents. Compared with participants in the reference group, CR‐ACHS was significantly reduced in the intervention group at 12‐week follow up (intervention group vs reference group = 0.5 ± 1.1 vs 1.1 ± 1.3, P = 0.021), whereas the mean Mini‐Mental State Examination and Barthel Index were similar between groups. In contrast, no clinical complication was observed regarding medication adjustments during the study period. Conclusions Anticholinergic burden can be successfully and safely reduced through an educational program for primary care physicians, but the benefit of reducing anticholinergic burden remained unclear within the first 12 weeks. Further investigation is required to evaluate the long‐term benefits of reducing anticholinergic burden for demented older adults. Geriatr Gerontol Int 2013; 13: 694–700.

  December 06, 2012   doi: 10.1111/ggi.12000   open full text
• Relationships between frailty, neighborhood security, social cohesion and sense of belonging among community‐dwelling older people.
  Jane M Cramm, Anna P Nieboer.
  Geriatrics and Gerontology International. November 27, 2012
  Aim The relationships between frailty and neighborhood social resources and neighborhood quality among community‐dwelling older people are poorly understood. We therefore enquired into these associations while controlling for important individual characteristics. Methods Our cross‐sectional study included 945 out of 1440 (66% response rate) community‐dwelling older people (aged ≥70 years) in Rotterdam. The sample included approximately 430 older adults per district and was proportional with respect to neighborhood and age. Potential participants were mailed questionnaires, non‐respondents were first sent a reminder, then asked by telephone and finally visited at home to complete the questionnaire. Results Age, sex, marital status and level of education varied between the frail and non‐frail. A significantly larger proportion of the frail was female (64.4% vs 48.0%; P ≤ 0.001), fewer were married (22.1% vs 48.4%; P ≤ 0.001) and the frail were, on average, older than the non‐frail (78.8 vs 76.0 years; P ≤ 0.001). A significantly larger proportion of the frail were poorly educated (25.9% vs 18.6%; P ≤ 0.01). Multilevel regression analyses showed that older age (P < 0.001) was associated with higher likelihood of frailty and marital status (P < 0.001) with lower likelihood of frailty. Feeling more secure (P < 0.001) and having a stronger sense of social cohesion and neighborhood belonging (P < 0.05) seemed to protect against frailty. Conclusion The results of this study support the importance of feeling safe, social cohesion and a sense of belonging within the neighborhood. These findings could have important implications for efforts to reduce frailty of older people within communities. Geriatr Gerontol Int 2013; 13: 759–763.

  November 27, 2012   doi: 10.1111/j.1447-0594.2012.00967.x   open full text
• Screening for dementia: Brazilian version of the Informant Questionnaire on Cognitive Decline on the Elderly and its psychometric properties.
  Maria Angélica dos Santos Sanchez, Roberto Alves Lourenço.
  Geriatrics and Gerontology International. November 27, 2012
  Aim To assess the criterion validity of the Brazilian version of the Informant Questionnaire on Cognitive Decline on the Elderly (IQCODE‐BR), and analyze the influence of educational level and age of both the elderly and the informants on the questionnaire scores. Method The study design was a cross‐sectional study with a convenience sample. Convergent validity was assessed using the Mini‐Mental State Examination, and the accuracy of the IQCODE‐BR was evaluated by receiver operating characteristic curve analysis. Multivariate logistic regression analysis was carried out to determine the influence of sociodemographic characteristics on IQCODE‐BR scores. Results A total of 169 elderly individuals participated in the study, of which 35.5% were diagnosed with dementia. There was no statistically significant association between the IQCODE‐BR scores, and the age and educational level of both the elderly and the informants. The cut‐off point for greater accuracy was 3.52, with sensitivity of 83.3% and specificity of 80.7%. The area under the receiver operating characteristic curve was 0.83 (95% CI 0.766–0.893). There was a negative and moderate correlation between IQCODE‐BR and the Mini‐Mental State Examination scores (P < 0.01). Conclusion This study suggests that the IQCODE‐BR is a valid tool for screening of dementia and that IQCODE‐BR scores do not seem to be influenced by age, educational level and other factors associated with the informants. However, further studies are required to evaluate informant characteristics, such as anxiety states, depression and burden level. Geriatr Gerontol Int 2013; 13: 687–693.

  November 27, 2012   doi: 10.1111/j.1447-0594.2012.00966.x   open full text
• Effects of physical function trajectories on later long‐term care utilization among the Taiwanese elderly.
  Hui‐Chuan Hsu.
  Geriatrics and Gerontology International. November 22, 2012
  Aim The aim of this study was to examine the effects of trajectories of physical function on later long‐term care utilization based on longitudinal panel data of older adults. Methods A representative longitudinal sample of older adults during the years 1993 to 2007 was used (n = 1232). Trajectories of physical function from 1993 to 2007 were identified by group‐based trajectory analysis, and then the relationships of the past trajectories with the use of nursing homes and care assistants, and the amount of utilization used in 2007 were examined. Results Four groups of physical function difficulties trajectories were identified: none (38.8%), little (34.1%), late increasing (16.1%) and early increasing (11.0%). The early‐ and late‐increasing difficulty groups were more likely to use and used more nursing homes and care assistants. In particular, a long‐term disability is closely related to a larger probability of using nursing homes than using care assistants at home. The utilization of care assistants seems a priority choice at the early‐increasing stage of disability. When the disability worsens and lasts a long time, a nursing home is then the next choice. Conclusion Past physical function trajectories relate to later long‐term care utilization. Geriatr Gerontol Int 2013; 13: 751–758.

  November 22, 2012   doi: 10.1111/j.1447-0594.2012.00964.x   open full text
• “How was your health 3 years ago?” Predicting mortality in older adults using a retrospective change measure of self‐rated health.
  Henrike Galenkamp, Dorly JH Deeg, Arjan W. Braam, Martijn Huisman.
  Geriatrics and Gerontology International. November 22, 2012
  Aim Studies have shown better predictive value of self‐rated health (SRH) for mortality when prospective change in SRH is considered. However, retrospective change is more feasible and might have better sensitivity to objective health changes. This study compares the predictive value for mortality of retrospectively measured change in SRH (based on a “then‐test”) with current SRH and prospectively measured change in SRH. Methods Data from two waves of the Longitudinal Aging Study Amsterdam (2001–2003 and 2005–2006 [T0], n = 1894) were used. Retrospective change was defined as the difference between SRH at T0 (“current SRH”) and SRH measured with a then‐test at T0, asking for a renewed judgement of one's health at the previous wave. Prospective change was defined as change in SRH between the two waves. We applied Cox proportional hazards analysis to predict 5‐year mortality. Results Having poorer current SRH significantly predicted mortality (HR poor vs very good SRH = 4.42). Declined SRH was associated with higher mortality risk, but only when measured prospectively (one point decline vs no change HR = 1.33; two points decline HR = 1.95). After adjusting for current SRH, neither change measure predicted mortality. Results were similar in subgroups that did and did not experience incident diseases or limitations between the two waves. Conclusions Neither retrospective, nor prospective changes in SRH improved the prediction of mortality in older adults over current SRH. These results imply that using a standard single indicator for self‐rated health in research or clinical practice might suffice to identify those with a high risk of future negative health outcomes. Geriatr Gerontol Int 2013; 13: 678–686.

  November 22, 2012   doi: 10.1111/j.1447-0594.2012.00963.x   open full text
• Association of serum uric acid level with muscle strength and cognitive function among Chinese aged 50–74 years.
  Yili Wu, Dongfeng Zhang, Zengchang Pang, Wenjie Jiang, Shaojie Wang, Qihua Tan.
  Geriatrics and Gerontology International. November 22, 2012
  Aim Previous studies have shown that uric acid (UA) has strong anti‐oxidant properties, and that high circulating levels of UA are prospectively associated with improved muscle function and cognitive performances in elderly Caucasians. We carried out a replication study in elderly Chinese using cross‐sectional design. Methods Data from 2006 individuals aged 50–74 years who participated in a population‐based cross‐sectional survey in Qingdao, China, were analyzed. Hand grip strength was measured in kilograms by using an electronic dynamometer. The sit‐to‐stand (STS) test time was used to represent lower limb strength. The Mini‐Mental State Examination (MMSE) was used to estimate the participants' cognitive function. Lifestyle, comorbidities and laboratory measures were considered as potential confounders. Multiple linear regression models and binary logistic regression were fitted to find the association of UA with strength measures and cognitive performances. Results Participants were grouped according to UA tertiles (<257.75 mmol/L, ≥257.75 and ≤359.00 mmol/L, >359.00 mmol/L). Hand grip strength significantly increased across UA tertiles (26.4 ± 8.5 kg; 30.1 ± 10.5 kg; 35.0 ± 11.4 kg; P < 0.001), and prevalence of cognitive disorder declined across UA tertiles (7.9%, 4.9%, 3.1%; P = 0.012). After adjusting for potential confounders, high UA level remained significantly associated with high grip strength (P = 0.023) and decreased risk of cognitive disorder with an OR of 1.002 (95% CI 1.000–1.004; P = 0.022). However, UA level was not significantly associated with STS time (P = 0.780). Conclusions Our findings suggested that notwithstanding the associated increased risk of cardiovascular disease, UA might play a protective role in aging‐associated decline in muscle strength and cognitive function. Geriatr Gerontol Int 2013; 13: 672–677.

  November 22, 2012   doi: 10.1111/j.1447-0594.2012.00962.x   open full text
• Risk factors for acquiring extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in geriatric patients with multiple comorbidities in respiratory care wards.
  Hsiu‐Chen Lin, Li‐An Lai, Jui‐Yu Wu, Yih‐Ming Su, Su‐Ping Chang, Yu‐Mei Hsueh.
  Geriatrics and Gerontology International. November 22, 2012
  Aim Extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae is associated with a high mortality rate and increased medical care costs. Elderly patients might receive mechanical ventilation with respiratory treatment for the long term in respiratory care wards (RCW). This retrospective case–control study sought to determine the risk factors for geriatric patients who acquire a urinary tract infection with ESBL‐producing Escherichia coli or Klebsiella pneumoniae in this type of hospital. Methods Two RCW participated in this study from September 2006 to March 2007. Patients suspected of having a UTI were enrolled in this study. Urine samples were collected for culture. The medical records and demographic data of patients, including days of hospitalization, comorbidities and duration of invasive instruments, were recorded. UTI was diagnosed by physicians. ESBL‐producing isolates were detected using the phenotypic confirmatory tests according to the Clinical and Laboratory Standard Institute standards. Results There were 109 patients having 240 sets of clinical data and laboratory specimens. The prevalence of ESBL‐producing isolates of E. coli. and K. pneumoniae were 39.5% and 69.7%, respectively. Patients with multiple underlying comorbidities (OR = 2.88, P < 0.05) or receiving more than two antimicrobial agents (OR = 3.71, P < 0.05) were at an increased risk for acquiring the ESBL‐producing microorganisms after adjustment for sex, age and days of hospitalization. Conclusions Geriatric patients with recent exposure to two or more antibiotics and two or more numbers of comorbidities were at risk for ESBL‐producing organism infection. Our results suggest that infection control procedures in RCW should be concerned with reducing antimicrobial prescriptions and patient comorbidities. Geriatr Gerontol Int 2013; 13: 663–671.

  November 22, 2012   doi: 10.1111/j.1447-0594.2012.00961.x   open full text
• Importance of cognitive assessment as part of the “Kihon Checklist” developed by the Japanese Ministry of Health, Labor and Welfare for prediction of frailty at a 2‐year follow up.
  Eriko Fukutomi, Kiyohito Okumiya, Taizo Wada, Ryota Sakamoto, Yasuko Ishimoto, Yumi Kimura, Yoriko Kasahara, Wen‐Ling Chen, Hissei Imai, Michiko Fujisawa, Kuniaki Otuka, Kozo Matsubayashi.
  Geriatrics and Gerontology International. November 22, 2012
  Aim To investigate which category in the “Kihon Checklist” developed by the Japanese Ministry of Health, Labor and Welfare can predict functional decline for community‐dwelling elderly people at a 2‐year follow up. Method We compared comprehensive geriatric assessment (CGA) between “specified elderly individuals” at high risk of requiring long‐term care insurance (LTCI) and “uncertified elderly people” (neither certified under LTCI nor “specified”), and also compared CGA between the risk group and non‐risk group, in subcategories of the “Kihon Checklist”, such as physical strength, nutrition/oral function, overall low score on questions 1–20, houseboundness, cognitive function, and depression risk. The study population consisted of 527 elderly participants aged 75 years and older in a cross‐sectional study, and 382 in a longitudinal study. CGA was assessed for basic and higher functional activities of daily living (ADL), depressive symptoms, and quality of life (QOL). The Student's t‐test was used in the cross‐sectional study and ANOVA with repeated measures was used in the longitudinal analysis. Results In the cross‐sectional study, the risk group had lower functions in all CGA items than the non‐risk group in all subcategories of the “Kihon Checklist.” In the longitudinal study, Tokyo Metropolitan Institute of Gerontology Index of Competence scores and its three subscales declined in the risk group both in physical and cognitive subcategories compared with the non‐risk group, whereas only one or two subscales of Tokyo Metropolitan Institute of Gerontology Index of Competence declined in “specified” and the other two subcategories of the Kihon Checklist Conclusion In both cross‐sectional and longitudinal studies, the assessment of physical strength and cognitive function was more useful to detect frail elderly. Geriatr Gerontol Int 2013; 13: 654–662.

  November 22, 2012   doi: 10.1111/j.1447-0594.2012.00959.x   open full text
• Validation of the Insomnia in the Elderly Scale for the detection of insomnia in older adults.
  Beatriz Navarro, Jesús López‐Torres, Fernando Andrés, José Miguel Latorre, María Jesús Montes, Ignacio Párraga.
  Geriatrics and Gerontology International. November 22, 2012
  Aim The main objective of this study was the validation of a brief support instrument for the diagnosis of insomnia in older adults. Methods An observational study was carried out for the evaluation of the Insomnia in the Elderly Scale using the psychiatric interview as the gold standard. Data was collected in a primary care setting in the city of Albacete, Spain. Participants were 926 non‐institutionalized older adults aged ≥65 years. Results Sleep characteristics, and the health and sociodemographic status of the participants were assessed. The Insomnia in the Elderly Scale is divided into two subscales for the evaluation of the Diagnostic and Statistical Manual of Mental Disorders, Fouth Edition criteria A and B for insomnia. The area under the receiver operating characteristic curve for subscale A was 0.868. The cut‐off point to detect the presence of diagnostic criterion A for insomnia was a score of ≥3 (sensitivity: 86.4%; specificity: 69.5%). The area under the receiver operating characteristic curve for subscale B was 0.832. The cut‐off point to detect the presence of diagnostic criterion B was a score of ≥2 (sensitivity: 86.3%; specificity: 66.4%). Conclusions The Insomnia in the Elderly Scale has appropriate psychometric properties. This scale compensates for the lack of validated instruments for use in the population aged 65 years or older. The fact that it is divided into two subscales to separately evaluate the insomnia criteria enables us to detect the presence of each of them. Finally, it has been validated in participants aged 65 years and older, which is the target population for this scale. Geriatr Gerontol Int 2013; 13: 646–653.

  November 22, 2012   doi: 10.1111/j.1447-0594.2012.00958.x   open full text
• Effects of a comprehensive intervention program, including hot bathing, on overweight adults: A randomized controlled trial.
  Ryota Sakurai, Yoshinori Fujiwara, Kyoko Saito, Taro Fukaya, Mi‐Ji Kim, Masashi Yasunaga, Hunkyung Kim, Kishiko Ogawa, Chiaki Tanaka, Nobuyo Tsunoda, Etsuko Muraki, Katsuhiko Suzuki, Shoji Shinkai, Shuichiro Watanabe.
  Geriatrics and Gerontology International. October 24, 2012
  Aim The objective of this study was to evaluate the effects of a comprehensive overweight intervention program, which utilizes hot bathing, on overweight, community‐dwelling middle‐aged and older adults in a randomized controlled trial. Methods The program was carried out in a hot bath facility and included 66 community‐dwelling middle‐aged and older Japanese adults (mean age 61.6 years, SD 7.5, 77.3% were women). The participants were randomly assigned to an exercise, diet and hot bathing intervention group (group A), exercise and diet intervention group (group B), a hot‐bathing intervention group (group C) and a control group (group D). The participants in groups A and B participated in a comprehensive intervention program (including exercise and diet classes) twice a week for 3 months, and groups A and C had hot bathing. Results After 3 months, the participants in group A showed a reduction in weight, abdominal circumference, body mass index and body fat percentage compared with the other intervention groups. And the lower extremity function (i.e. walking speed) had greater improvement in the participants in groups A and B compared with groups C and D. In group C, in which only hot bathing was the intervention, there were no significant improvements in measurement items. Conclusions Our study provides preliminary evidence that a comprehensive intervention program, including hot bathing, is useful for community residents with a tendency toward overweight. Geriatr Gerontol Int 2013; 13: 638–645.

  October 24, 2012   doi: 10.1111/j.1447-0594.2012.00955.x   open full text
• Activities of daily living independence in Iranian blind war survivors: A cross sectional study, 2008.
  Reza Amini, Robab Sahaf, Alireza Kaldi, Hamid Haghani, Keyvan Davatgaran, Mehdi Masoumi, Reza Hayatbakhsh, Mehdi Rassafiani.
  Geriatrics and Gerontology International. October 16, 2012
  Aim Assessment of activities of daily living (ADL) can be helpful for designing individualized rehabilitation programs for disabled individuals. Measuring and comparing the basic ADL (BADL) and instrumental ADL (IADL) independence between middle aged and senior Iranian blind war survivors (IBWS) was the aim of this study. Methods This cross‐sectional study assessed BADL and IADL of 312 blind war survivors, using the Barthel Index and the Lawton–Bordy scale. Data collection was carried out in a recreational event for the blind war survivors in Mashhad, Iran, 2008. Results The majority of the participants were male (99%), and more than 80% had multiple injuries. None of them were independent in all BADL and IADL. Older groups were more dependent in IADL such as telephone use, drug management, financial management, and BADL such as walking on uneven surfaces, bed/chair transfer and using stairs. The functional status and activities’ level differences between those aged younger than 50 years and those aged older than 50 years were significant (P < 0.05). Discussion In the present study, all the IBWS were dependent in at least one ADL. Multiple physical injuries could be one of the main reasons for the dependency in this group. IBWS aged older than 50 years were considerably more dependent in their BADL and IADL than the younger group. It appears that starting the fifth decade of age in IBWS might cause some considerable decrease in their function. Training and individualized rehabilitation programs are warranted. Geriatr Gerontol Int 2013; 13: 741–750.

  October 16, 2012   doi: 10.1111/j.1447-0594.2012.00954.x   open full text
• Immediate effects of physical therapy on gait disturbance and frontal assessment battery in Parkinson's disease.
  Makoto Sohmiya, Naoki Wada, Masayuki Tazawa, Koichi Okamoto, Kenji Shirakura.
  Geriatrics and Gerontology International. October 05, 2012
  Aim:  To examine whether the Frontal Assessment Battery is associated with the immediate effects of physical therapy on gait disturbance in patients with Parkinson's disease. Methods:  A total of 18 patients with idiopathic Parkinson's disease (Hoehn and Yahr stage range 3–4) who were able to ambulate independently and who were not demented were included. Patients were divided into two groups on the basis of Frontal Assessment Battery scores: the high score group (score ≥13, n = 11) and the low score group (score ≤12, n = 7). A 3‐D motion analysis system was used to acquire gait parameter data before and after a 30‐min physical therapy program. Stride length, step length, cadence, walking velocity, single support time and double support time were measured. The range of motion of the hip, knee and ankle joint, and maximal trunk displacement on the horizontal plane were measured. Results:  In the high‐score group, significant improvement was observed in walking velocity, stride length and step length, and in the range of motion of the hip and knee joint. Maximal trunk displacement decreased significantly. In contrast, no significant improvement was observed in the low‐score group. Multivariate logistic regression analysis showed that Frontal Assessment Battery scores were a predictor of improvement in the range of motion of bilateral hip and knee joints, and maximal trunk displacement. Conclusions:  We showed that the subtests of motor learning of the Frontal Assessment Battery might be associated with the immediate effects of physical therapy on gait disturbance in Parkinson's disease. Geriatr Gerontol Int 2013; 13: 630–637.

  October 05, 2012   doi: 10.1111/j.1447-0594.2012.00953.x   open full text
• Minor effects of green tea catechin supplementation on cardiovascular risk markers in active older people: A randomized controlled trial.
  Ryo Miyazaki, Kazuhiko Kotani, Makoto Ayabe, Kokoro Tsuzaki, Junko Shimada, Naoki Sakane, Hideto Takase, Hiroshi Ichikawa, Yoshikazu Yonei, Kojiro Ishii.
  Geriatrics and Gerontology International. October 05, 2012
  Aim:  Although previous studies have shown that consumption of green tea catechins (GTC) and walking might prevent development of cardiovascular disease (CVD), the effects of GTC supplementation on CVD risk in active older people are unknown. Methods:  A total of 52 older adults (male/female 20/32, mean age 69.1 ± 5.9 years) participating in a pedometer‐based walking program were randomly assigned to a GTC group with an intake of 630.9 mg GTC daily (n = 26) or a control group (n = 26) for 14 weeks. Cardiovascular risk markers were measured before and after this trial. Results:  In the GTC group, values of the following markers were significantly reduced (P < 0.05) from the beginning to the end of the trial: waist circumference (from 84.2 ± 8.4 to 82.2 ± 8.5 cm), hip circumference (from 95.1 ± 6.9 to 92.2 ± 6.3 cm), total cholesterol (from 233.0 ± 46.3 to 218.8 ± 42.3 mg/dL), low‐density lipoprotein cholesterol (from 130.4 ± 36.2 to 119.1 ± 33.4 mg/dL) and low‐density lipoprotein cholesterol to high‐density lipoprotein cholesterol ratio (from 2.0 ± 1.7 to 1.7 ± 0.5); only hip circumference (from 95.6 ± 8.1 to 94.1 ± 7.6 cm) was significantly reduced (P < 0.05) in the control group. No significant between‐group differences were found for any parameter measured. Conclusions:  Although GTC might reduce cholesterol levels, the present randomized control trial suggests that GTC supplementation in active older participants did not significantly affect cardiovascular risk markers. Future studies should identify more effective combinations of GTC supplementation and physical activity. Geriatr Gerontol Int 2013; 13: 622–629.

  October 05, 2012   doi: 10.1111/j.1447-0594.2012.00952.x   open full text
• Prescribing of potentially inappropriate medications among the elderly population in an ambulatory care setting in a Saudi military hospital: Trend and cost.
  Hussain A Al‐Omar, Mohammed S Al‐Sultan, Hisham S Abu‐Auda.
  Geriatrics and Gerontology International. October 05, 2012
  Aim:  To explore the prevalence of potentially inappropriate medication (PIM) use in the elderly, to identify the trends and the patterns of prescribing such medication, and to calculate the associated direct medication cost of such practice in a Saudi hospital. Methods:  This was a retrospective cross‐sectional study of patients who were aged 65 years or older on at least one PIM. The source of our data was outpatient pharmacy prescription records at Riyadh Military Hospital (RMH) for 2002, 2003 and 2004. Beers' explicit criteria for PIM was used to identify these medications. Results:  A total of 20 521 PIM were identified. The prevalence of PIM for 2002, 2003 and 2004 was 2.5%, 2.3% and 2.1%, respectively. A total of 43.6% of the patients had filled a prescription of one PIM, 18% filled two PIM and 38.4% filled three or more PIM. Digoxin accounted for 23.7% of these PIM. The most commonly prescribed medications were cardiovascular medications at 26.7%. The total direct cost that was associated with inappropriate prescribing was 518 314 Saudi Riyals (US$138 217) during the study period. Conclusion:  PIM prescribing in RMH was less compared with what was published in the literature in other countries. It was unclear whether these results reflect the level of elderly healthcare services provided to RMH patients or because of underreporting. Drug utilization review programs, medical education, recruiting physicians and clinical pharmacists who are specialized in geriatrics, finding safer medications or integration of computer software to detect such medications during prescriptions entry can improve the medical services provided to the elderly. Geriatr Gerontol Int 2013; 13: 616–621.

  October 05, 2012   doi: 10.1111/j.1447-0594.2012.00951.x   open full text
• High parathyroid hormone, but not low vitamin D concentrations, expose elderly inpatients to hypertension.
  Leyla Mateus‐Hamdan, Olivier Beauchet, Béatrice Bouvard, Erick Legrand, Bruno Fantino, Cédric Annweiler.
  Geriatrics and Gerontology International. September 19, 2012
  Aim:  Serum parathyroid hormone (PTH) and 25‐hydroxyvitamin D (25OHD) concentrations might contribute to blood pressure (BP) levels. Mixed results in previous literature could be due to the failure to consider both these hormones concurrently, despite their long‐known relationship. Our objective was to examine the association of serum intact PTH and 25OHD concentrations with BP levels amongst older inpatients, while accounting for each other. Methods:  The participants were 284 Caucasian older inpatients with no suspicion of primary hyperparathyroidism (mean age 85.87 ± 5.90 years; 65.8% female) admitted to the geriatric acute care unit of Angers University Hospital, France. They were divided into two groups according to the existence of hypertension (i.e. systolic blood pressure [SBP] >140 mmHg, or diastolic blood pressure [DBP] >90 mmHg). Age, sex, numbers of chronic diseases and of drugs taken daily, use of antihypertensive or corticosteroid drugs and of calcium supplements/vitamin D, thyroid‐stimulating hormone and albumin concentrations, creatinine clearance, and season tested were used as covariables. Results:  Hypertensive participants (n = 106) had higher intact PTH concentrations than normotensive patients (P = 0.044). There was a positive linear association of BP with intact PTH concentrations (adjusted β = 0.08, P = 0.015 for SBP; adjusted β = 0.05, P = 0.044 for DBP), but not with vitamin D. Serum intact PTH concentration, unlike 25OHD, was associated with hypertension (adjusted OR 1.01, P = 0.038). Conclusions:  Irrespective of 25OHD, PTH was associated with hypertension by increasing both SBP and DBP. Geriatr Gerontol 2013; 13: 783–791.

  September 19, 2012   doi: 10.1111/j.1447-0594.2012.00945.x   open full text
• Morbidity and mortality among newly hospitalized patients with community‐acquired pneumococcal bacteremia: A retrospective cohort study in three teaching hospitals in Japan.
  Hiromichi Suzuki, Yasuharu Tokuda, Daisuke Shichi, Hiroichi Ishikawa, Tetsuhiro Maeno, Hidenori Nakamura.
  Geriatrics and Gerontology International. September 19, 2012
  Aim:  Although the mortality rate of pneumococcal bacteremia has been intensively studied, few studies have examined how it influences patient morbidity. This study aimed to fill this research gap by clarifying the impact of pneumococcal bacteremia on mortality and morbidity. Methods:  We carried out a retrospective cohort study of adult patients hospitalized with community‐acquired pneumococcal bacteremia in three teaching hospitals in Japan from January 2003 to December 2010. Morbidity was defined as a worsening Katz Index score compared with that before infection onset, new impairment of oral intake or new requirement for oxygen assistance at discharge. Results:  Of 135 patients identified (mean age 70 years; 38% female), 116 (86%) were able to carry out activities of daily living independently before the onset of the infection. Pneumonia was found to be the most common infective source (69%), followed by meningitis (10%) and septic arthritis or vertebral osteomyelitis (8.1%). The 14‐day, 30‐day, and inpatient mortality rates were found to be 15%, 20% and 25%, respectively. The morbidity at discharge was 26 out of 101 (26%) among all survivors and 18 out of 42 (43%) among survivors who were aged ≥75 years. Multivariate analysis showed that an age of ≥75 years is an independent predictor of morbidity (adjusted odds ratio 16.3, 95% CI 2.0–135.9). Conclusions:  Our study showed that a high proportion of inpatient morbidity and mortality occurs in adult patients with pneumococcal bacteremia, especially among those aged ≥75 years. Geriatr Gerontol Int 2013; 13: 607–615..

  September 19, 2012   doi: 10.1111/j.1447-0594.2012.00949.x   open full text
• Cross‐sectional and longitudinal associations of functional and health status with institutional care use: Results from the Survey of Health and Living Status of the Elderly in Taiwan.
  Hsin‐Jen Tsai.
  Geriatrics and Gerontology International. September 19, 2012
  Aim:  This study evaluated the cross‐sectional and longitudinal associations of functional and health status with institutional care, and examined determinants of institutional care use over time. Methods:  Data of this study were obtained from the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET), which was launched in 1989 and involved a nationally representative sample of nearly‐old and old Taiwanese. The baseline data in this present study were collected in 1999, and followed in 2003 and 2007. Results:  Participants with institutional care use had a higher activities of daily living (ADL) score, more self‐reported diseases and poorer self‐reported health status than participants without institutional care use (all P < 0.05). Cross‐sectional analysis showed that a higher ADL score, having heart diseases and having a stroke were positively associated with institutional care use (P < 0.05); whereas the number of self‐reported diseases and poor self‐reported health status were not associated with institutional care use. Longitudinal analysis showed that increased ADL scores and the number of self‐reported diseases over 4‐ and 8 years were associated with an increased likelihood of subsequent institutional care use (all P < 0.05). Worsening health status over 4 years was associated with an increased likelihood of subsequent institutional care use, but this association did not exist over 8 years. Conclusions:  Only ADL and ADL deterioration over time are cross‐sectionally and longitudinally associated with increased institutional care use. Declining functional status is a major determinant of institutional care use for Taiwanese aged over 53 years. Geriatr Gerontol Int 2013; 13: 597–606.

  September 19, 2012   doi: 10.1111/j.1447-0594.2012.00944.x   open full text
• Prevalence of anemia in Chinese nursing home older adults: Implication of age and renal impairment.
  Tuen Ching Chan, Desmond Yat Hin Yap, Yat Fung Shea, James Ka Hay Luk, Felix Hon Wai Chan, Leung Wing Chu.
  Geriatrics and Gerontology International. September 19, 2012
  Aim:  There is little data regarding the prevalence and associated comorbidities of anemia in Chinese nursing home older adults. The objective of this study was to investigate the prevalence and associated comorbidities of anemia in Chinese nursing home older adults. Methods:  We carried out a retrospective cross‐sectional study in nine nursing homes in Hong Kong. The hemoglobin (Hb) level, mean corpuscular volume (MCV), serum creatinine and comorbidities data of residents were examined. Older adults were regarded as anemic according to the World Health Organization criteria (Hb <13g/dL for men and <12g/dL for women). The glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease Study (MDRD [Chinese‐adjusted]) equation. Patients with chronic renal impairment were defined as having eGFR <60 mL/min/1.73 m2. Results:  A total of 812 residents were included (mean age 86.0 ± 7.6 years). The mean hemoglobin was 12.0 ± 1.8g/dL in men and 11.4 ± 1.6g/dL in women. The mean eGFR was 75.1 ± 31.7 mL/min/1.73 m2. A total of 67.0% of residents had anemia (70.5% in men and 65.2% in women). Anemic older adults were older and had a higher prevalence of renal impairment than non‐anemic older adults (P < 0.001). There was no significant difference between the two groups regarding the prevalence of other comorbidities. When stratified into different age groups, there were significant correlations between anemia and renal impairment in all subgroups (age ≤80 years, P < 0.05; age 81–90 years, P < 0.01; age >90 years, P < 0.05). The same correlation was found between normocytic anemia and renal impairment. Conversely, when stratified according to eGFR (≥60 mL/min/1.73 m2vs <60 mL/min/1.73 m2), we did not observe a significant correlation between anemia and age group. Conclusion:  In conclusion, anemia is prevalent in Chinese nursing home residents and is strongly associated with renal impairment. Further studies of early identification and management of anemia with renal impairment are recommended in this population. Geriatr Gerontol Int 2013; 13: 591–596.

  September 19, 2012   doi: 10.1111/j.1447-0594.2012.00942.x   open full text
• Physicians' attitudes toward the definition of “death from age‐related physical debility” in deceased elderly with aspiration pneumonia.
  Kosaku Komiya, Hiroshi Ishii, Hisako Kushima, Shintaro Sato, Hiroki Kimura, Takaaki Yasuda, Eiji Okabe, Issei Tokimatsu, Hidehiko Yamamoto, Jun‐ichi Kadota.
  Geriatrics and Gerontology International. September 19, 2012
  Aim:  Deaths from aspiration pneumonia in elderly patients are occasionally considered to be “death from age‐related physical debility”, because most aspiration pneumonias are a result of aging and lead to death without any definitive therapy. The aim of the present study was to assess physicians' attitudes toward the diagnosis of and actual description of “death from age‐related physical debility” on death certificates for deceased patients with aspiration pneumonia. Methods:  This study surveyed 62 Japanese physicians including 36 pulmonologists and 26 other physicians who treat patients with pneumonia. Their attitudes regarding consideration and actually recorded “death from age‐related physical debility” for deceased patients with aspiration pneumonia were assessed by using anonymous questionnaires, which included the decision‐making process and the necessity of detailed diagnostic criteria. Results:  A total of 32 (52%) respondents had considered deceased patients with aspiration pneumonia to be “death from age‐related physical debility”, and 10 (16%) have actually stated this on the death certificate. Advanced age, bedridden status, inability of oral intake and disturbance of consciousness including dementia were major factors in their decision‐making. A total of 34 (55%) of the respondent physicians wanted detailed criteria to be established. Conclusions:  Physicians' attitudes toward the definition of “death from age‐related physical debility” vary a great deal depending on the respondent. The description in death certificates therefore might inaccurately reflect the results of current mortality statistics in Japan. Geriatr Gerontol Int 2013; 13: 586–590.

  September 19, 2012   doi: 10.1111/j.1447-0594.2012.00941.x   open full text
• Computed tomography findings of aspiration pneumonia in 53 patients.
  Kosaku Komiya, Hiroshi Ishii, Kenji Umeki, Tadao Kawamura, Fumito Okada, Eiji Okabe, Junji Murakami, Yukio Kato, Bunroku Matsumoto, Shinji Teramoto, Takeshi Johkoh, Jun‐ichi Kadota.
  Geriatrics and Gerontology International. September 19, 2012
  Aim:  No large case series has so far shown the chest computed tomography (CT) features in patients with aspiration pneumonia, despite the fact that aspiration pneumonia is the most common pulmonary disease in the elderly and is regarded as gravity‐dependent pneumonia. The aim of the present study was to elucidate the CT features based on the patients' status in patients with dysphagia‐associated aspiration pneumonia. Methods:  A total of 53 patients, who were hospitalized because of pneumonia and subsequently confirmed to have dysphagia by videofluorography, were entered into this study. The CT findings were independently evaluated by two radiologists who were unaware of the patients' clinical information. The relationships between the patients' status and the CT patterns of pneumonia or their distributions were analyzed. Results:  There were eight patients (15%) with lobar pneumonia, 36 patients (68%) with bronchopneumonia and nine patients (17%) with bronchiolitis. Posterior lung predominance was seen in 49 patients (92%). In the craniocaudal observation, lower lung predominance was found in 25 patients (47%) and diffuse distribution was seen in 28 patients (53%). A decreased performance status was significantly associated with a diffuse distribution (P = 0.039). Conclusions:  Aspiration pneumonia more frequently presented as a bronchopneumonia pattern followed by a bronchiolitis pattern on CT. Their distributions were characterized by gravity dependence, and anterior‐ or upper lung‐limited pneumonia might not be due to dysphagia‐associated pneumonia. Geriatr Gerontol Int 2013; 13: 580–585.

  September 19, 2012   doi: 10.1111/j.1447-0594.2012.00940.x   open full text
• Telomerase activity and telomere length distribution in vascular endothelial cells in a short‐term culture under the presence of hydrogen peroxide.
  Toyoki Maeda, Jing‐Zhi Guan, Masamichi Koyanagi, Naoki Makino.
  Geriatrics and Gerontology International. September 18, 2012
  Aim:  The aim of this study was to assess the biological effects of oxidative stress on human vascular endothelial cells. Methods:  The telomeric changes and the alterations of the expression of telomere‐associated proteins in human umbilical venous endothelial cells (HUVEC) cultured in the presence of hydrogen peroxide (H2O2) were analyzed. Results:  During the culture, the cell growth rate decreased, whereas the telomerase activity of the surviving cells increased. As the H2O2 level increased, long telomeres decreased proportionally, thus resulting in a telomere length distribution that was rich in short telomeres. These observations suggested that H2O2‐affected endothelial cells bear telomeric features similar to those of aged cells. In contrast, the expression of telomere‐associated proteins, TRF1 and TRF2, showed different changes. TRF1 increased in relation to H2O2 concentration, whereas TRF2 showed no significant change. The surviving cells exposed to H2O2 showed a H2O2‐dose dependent increase in telomerase activity, whereas the telomere protein and RNA components were only elevated in low concentrations of H2O2. Conclusions:  The increase in telomerase activity and TRF1 protein expression of vascular endothelial cell might show an aspect of cellular protective reaction against oxygen stress. Geriatr Gerontol Int 2013; 13: 774–782.

  September 18, 2012   doi: 10.1111/j.1447-0594.2012.00936.x   open full text
• Association between hospital volume and outcomes of elderly and non‐elderly patients with acute biliary diseases: A national administrative database analysis.
  Atsuhiko Murata, Shinya Matsuda, Kazuaki Kuwabara, Yukako Ichimiya, Yasufumi Matsuda, Tatsuhiko Kubo, Yoshihisa Fujino, Kenji Fujimori, Hiromasa Horiguchi.
  Geriatrics and Gerontology International. September 18, 2012
  Aim:  This study aimed to investigate the relationship between hospital volume and clinical outcomes of elderly and non‐elderly patients with acute biliary diseases using data from a national administrative database. Methods:  Overall, 26 720 elderly and 33 774 non‐elderly patients with acute biliary diseases were referred to 820 hospitals in Japan. Hospital volume was categorized into three groups based on the case numbers during the study period: low‐volume, medium‐volume and high‐volume. We compared the risk‐adjusted length of stay (LOS) and in‐hospital mortality in relation to hospital volume. These analyses were stratified according to the presence of invasive treatments for acute biliary diseases. Results:  Multiple linear regression analyses showed that increased hospital volume was significantly associated with shorter LOS in both elderly and non‐elderly patients with and without invasive treatments. Increased hospital volume was significantly associated with decreased relative risk of in‐hospital mortality in elderly patients. The odds ratio for high‐volume hospitals was 0.672 in elderly patients without invasive treatments (95% confidence interval [CI] 0.533–0.847, P = 0.001) and 0.715 in those with invasive treatments (95% C, 0.566–0.904, P = 0.005). However, no significant differences for in‐hospital mortality were seen in non‐elderly patients with and without invasive treatments. Conclusion:  This study has highlighted that higher volume hospitals significantly reduced LOS and in‐hospital mortality for elderly patients with acute biliary diseases, but not non‐elderly patients. The current results are of value for elderly healthcare policy decision‐making, and highlight the need for further studies into the quality of care for elderly patients. Geriatr Gerontol Int 2013; 13: 731–740.

  September 18, 2012   doi: 10.1111/j.1447-0594.2012.00938.x   open full text
• Multidimensional health‐transition patterns among a middle‐aged and older population.
  Wen‐Chiung Chang, Feng‐Ping Lu, Tzuo‐Yun Lan, Shwu‐Chong Wu.
  Geriatrics and Gerontology International. September 18, 2012
  Aim:  Previous studies on health transition have focused on single‐dimension outcomes and minimally evaluated heterogeneity. This study aimed to explore heterogeneous and multidimensional health‐transition patterns on comorbidity, frailty and disability while examining the factors predicting different patterns of health transition. Methods:  This study drew on data from a nationwide and longitudinally‐followed sample of 5131 Taiwanese aged 50 years and older who were interviewed in 1996, 1999, 2003 and 2007. Latent class analysis (LCA) and multinomial logistic regression were applied to identify health‐transition patterns and their predictors. Results:  We identified six health‐transition classes by applying LCA, including “persistently healthy”, “well‐managed comorbidity”, “originally comorbid and gradually deteriorating to disability”, “deteriorating gradually and died in late stage of the follow‐up period”, “deteriorating and died in middle stage of the follow‐up period”, and “originally comorbid and died in early stage of the follow‐up period”. Using the “well‐managed comorbidity” class as the reference group, men had higher probabilities of being in the categories of dying in the follow‐up period, but a lower risk of deteriorating to disability. Younger baseline age, higher education, having social engagement and non‐smoking were predictors of “persistently healthy” and were associated with a lower risk of deteriorating to disability and death. Having a spouse and health examinations were associated with a lower risk of death, and also a lower probability of “persistently healthy”. Conclusions:  Heterogeneous and multidimensional health‐transition patterns exist in middle‐aged and older populations. Several factors might have an effect on health‐transition patterns. Geriatr Gerontol Int 2013; 13: 571–579.

  September 18, 2012   doi: 10.1111/j.1447-0594.2012.00937.x   open full text
• Association of geriatric conditions and cardiovascular diseases with disability in older adults with diabetes: Findings from a nationally representative survey.
  Chia‐Lin Li, Yi‐Chen Chiu, Hsing‐Yi Chang, Kuang‐Hung Hsu, Yuh‐Bin Bai, Hui‐Hsuan Wang.
  Geriatrics and Gerontology International. September 18, 2012
  Aim:  To examine how diabetes in combination with cardiovascular diseases (hypertension, heart disease and stroke) and geriatric conditions (cognitive impairment and depressive symptoms) affects the odds of disability in older adults. Methods:  We analyzed data from a nationally representative sample of people aged 65 years and over (n = 2727) participating in the 2005 National Health Interview Survey in Taiwan. A total of 473 participants had a history of self‐reported physician diagnosed diabetes. Disability was defined as reporting limitations in one or more tasks of activities of daily living (ADL), instrumental activities of daily living (IADL) or general physical activities (GPA). The Mini‐Mental State Examination was used to assess cognitive function. The Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. Results:  After adjustment for other factors, cardiovascular diseases and geriatric conditions independently contributed to the excess odds of disability among participants with diabetes. Participants who had diabetes combined with cardiovascular diseases and geriatric conditions had odds ratios for ADL, IADL and GPA disability of 18.02 (95% CI 5.13–63.34), 7.95 (95% CI 4.07–15.50) and 5.89 (95% CI 3.19–10.90), respectively. Conclusion:  Our results highlight the high prevalence of co‐occurrence of cardiovascular diseases with geriatric conditions in people with diabetes. Furthermore, the combined presence of these diseases and conditions is strongly associated with an excess odds of disability. These findings highlight the critical importance of preventing cardiovascular disease morbidity, and improving depressed mood and cognitive function in order to reduce disability risk in older adults with diabetes. Geriatr Gerontol Int 2013; 13: 563–570.

  September 18, 2012   doi: 10.1111/j.1447-0594.2012.00935.x   open full text
• Occlusal support including that from artificial teeth as an indicator for health promotion among community‐dwelling elderly in Japan.
  Motoshi Kimura, Misuzu Watanabe, Yoshimi Tanimoto, Toshiyuki Kusabiraki, Maki Komiyama, Itsushi Hayashida, Koichi Kono.
  Geriatrics and Gerontology International. September 18, 2012
  Aim:  The Eichner index (EI) is used to evaluate occlusal support. However, this index is based on existing natural tooth contact. This study aimed to establish whether a modified EI that included artificial teeth reflected individual oral condition of elderly people, and to clarify the relationship between this index and: (i) mental condition; (ii) physical condition; and (iii) physical function. Methods:  We recruited 286 people (145 men, 141 women) aged 65–79 years. They were divided into three groups by modified EI, and then underwent assessment of oral condition. After establishing that the index was clearly related to oral condition, we investigated psychological factors (satisfaction with life, self‐rated health and anxiety regarding falling), indicators of walking and balance (Timed Up & Go test [TUG] and one‐leg standing balance), physical condition (higher‐level functional capacity [HLFC]: instrumental activities of daily living [IADL], intellectual activity and social role; continuous walking over 15 min; and frequency of outings), and health history in the previous year (history of hospital admissions and falls). Results:  Modified EI was a good indicator of occlusal condition. The index was significantly correlated in men with satisfaction with life, TUG test, one‐leg standing balance, overall HLFC and HLFC‐IADL, and in women with TUG test, one‐leg standing balance and HLFC‐Intellectual activity. Conclusion:  The evaluation of occlusal support including that from artificial teeth is beneficial in the elderly as an indicator of health and oral function, in particular firm bite. Geriatr Gerontol Int 2013; 13: 539–546.

  September 18, 2012   doi: 10.1111/j.1447-0594.2012.00931.x   open full text
• Rate of progression of Alzheimer's disease in younger versus older patients: A longitudinal single photon emission computed tomography study.
  Minoru Sakai, Haruo Hanyu, Kazumasa Kume, Tomohiko Sato, Kentaro Hirao, Hidekazu Kanetaka, Shine Abe, Kiyoshi Kanaya, Hirofumi Sakurai, Toshihiko Iwamoto.
  Geriatrics and Gerontology International. September 10, 2012
  Aim:  Although several researchers have examined the effect of age on disease progression in patients with Alzheimer's disease (AD), the results are controversial. We investigated the effect of age on the rate of progression of cognitive impairment and on regional cerebral blood flow (rCBF) deficits using longitudinal single photon emission computed tomography (SPECT) studies. Methods:  We divided 75 patients with AD who were followed up for 24–90 months into the younger AD group (n = 32, age at initial examination ≤75 years) and the older AD group (n = 43, age at initial examination >75 years). We assessed changes in Mini‐Mental State Examination (MMSE) scores and rCBF between initial and final examinations. Results:  The change in the annual MMSE score was greater in the younger AD group than in the older AD group. The mean annual MMSE score changes correlated significantly with age at the initial examination. The initial and follow‐up SPECT studies showed more severe and extensive rCBF deficits in the younger AD group than in the older AD group. Conclusion:  Our longitudinal SPECT study showed that the rate of progression of cognitive impairment and the rCBF deficits were higher in younger patients with AD than in older patients with AD. Therefore, age is an important factor to consider, not only in the diagnosis, but also in the treatment and prognosis of patients with AD. Geriatr Gerontol Int 2013; 13: 555–562.

  September 10, 2012   doi: 10.1111/j.1447-0594.2012.00934.x   open full text
• Intensified rehabilitation therapy and transitions to skilled nursing facilities in community‐living seniors with acute medical illnesses.
  Ji Won Yoo, Sulgi Kim, Jai Hyun Choi, Woo Sang Ryu.
  Geriatrics and Gerontology International. September 10, 2012
  Aim:  To examine whether rehabilitation therapy type would be associated with transitions to skilled nursing facilities (SNF) in community‐living seniors with acute medical illnesses. Methods:  Using administrative and clinical data, multivariate regression analysis examined the relationship between the extent of rehabilitation therapy and transitions to SNF in all participants, as well as participants by physical function at admission. Results:  In all participants (n = 929), the intensified rehabilitation therapy was associated with a lower probability of transitions to SNF (14% vs 21%; odds ratio [OR] 0.59; 95% confidence intervals [CI] 0.22–0.96; P = 0.02). In participants with mild physical limitations (n = 270), less frequent transitions to SNF occurred when patients received intensified rehabilitation therapy [16% vs 23%; OR 0.46; 95% CI 0.17–0.94; P = 0.01]. In participants with moderate to severe physical limitations (n = 265), the decreased frequency of transitions to SNF associated with rehabilitation therapy became more pronounced (18% vs 28%; OR 0.34; 95% CI 0.07–0.89; P = 0.004). By contrast, in participants without physical limitation (n = 394), the number of transitions to SNF did not change significantly when they received intensified rehabilitation therapy (P = 0.53). Conclusions:  We found a significant relationship between intensified rehabilitation therapy and the decrease of transitions to SNF in community‐living seniors with acute medical illness. The magnitude of this relationship increased in participants with more physical limitations, but not in participants without physical limitations at admission. Geriatr Gerontol Int 2013; 13: 547–554.

  September 10, 2012   doi: 10.1111/j.1447-0594.2012.00932.x   open full text