| 1. |
- Bentham, James, et al.
(författare)
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A century of trends in adult human height
- 2016
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Ingår i: eLIFE. - 2050-084X. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.522.7) and 16.5 cm (13.319.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.
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| 2. |
- Bentham, James, et al.
(författare)
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A century of trends in adult human height
- 2016
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Ingår i: eLIFE. - : eLife Sciences Publications Ltd. - 2050-084X. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3– 19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8– 144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.
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| 3. |
- Balducci, Marco, et al.
(författare)
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SARS-CoV-2 vaccination and risk of infectious diseases in hospitalized older patients
- 2024
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Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657. ; 15:2, s. 509-517
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Vaccinations, for example flu vaccine, may be a cause of cross-reactive immunostimulation that prevents a larger spectrum of infections. However, whether SARS-CoV-2 vaccinations may also determine this effect is unclear. This study aims, first, to assess the incidence of infections at hospital admission and during the hospitalization in older inpatients vaccinated and unvaccinated against SARS-CoV-2; second, to compare length of hospital stay and in-hospital mortality between vaccinated and unvaccinated individuals.Methods This retrospective study included 754 older inpatients admitted to the Geriatrics and Orthogeriatrics Units of the University Hospital of Ferrara (Italy) between March 2021 and November 2021. Sociodemographic and health-related data, and the diagnosis of infections at hospital admission and during hospitalization were collected from medical records.Results The sample’s mean age was 87.2 years, 59.2% were females, and 75.5% were vaccinated against SARS-CoV-2. Vaccinated individuals had 36% lower odds of intra-hospital infections (OR = 0.64, 95%CI 0.44–0.94) and 39% lower in-hospital death (HR = 0.61, 95%CI 0.39–0.95), also after adjusting for potential confounders, while no significant results emerged about infections at hospital admission. Considering the hospitalization’s endpoints, SARS-CoV-2 vaccination was associated with a lower probability of being transferred to long-term care or other hospital departments than returning home (OR = 0.63, 95%CI 0.40–0.99).Conclusions In older inpatients, SARS-CoV-2 vaccination seems to be associated with a lower likelihood of intra-hospital infectious diseases not caused by SARS-CoV-2 and all-cause in-hospital mortality. The vaccination coverage in the older population could limit not only the onset and severity of COVID-19 but also the occurrence of other infectious diseases.
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| 4. |
- Boccardi, Virginia, et al.
(författare)
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Consensus paper on the executive summary of the international conference on Mediterranean diet and health : a lifelong approach an Italian initiative supported by the Mediterranean Diet Foundation and the Menarini Foundation
- 2018
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Ingår i: Nutrition. - : Elsevier BV. - 0899-9007 .- 1873-1244. ; 51-52, s. 38-45
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Tidskriftsartikel (refereegranskat)abstract
- The Mediterranean Diet Foundation, in collaboration with the International Menarini Foundation, organized the International Conference on Mediterranean Diet and Health: A Lifelong Approach. The Conference was held in Ostuni (Puglia, Italy) from March 30 to April 1, 2017. The event received the endorsement of the American Federation for Aging Research, the Research Consortium Luigi Amaducci, the European Nutrition for Health Alliance, the European Union Geriatric Medicine Society, the Clinical Section of the International Association of Gerontology and Geriatrics European Region, the National Research Council Research Project on Aging, the Italian Society of Gerontology and Geriatrics, and the Italian Society of Clinical Nutrition and Metabolism.During the conference, results were presented from major studies on dietary interventions aiming to assess the efficacy of the Mediterranean diet in the prevention of chronic diseases and the potential underlying mechanisms. Twenty-six international speakers, in seven different sessions, discussed the biological basis, clinical impact, health policy, and behavioral implications of the Mediterranean diet, and its use in potential interventions for health promotion.
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| 5. |
- Bruyere, Olivier, et al.
(författare)
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How clinical practitioners assess frailty in their daily practice : an international survey
- 2017
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Ingår i: Aging Clinical and Experimental Research. - : SPRINGER. - 1594-0667 .- 1720-8319. ; 29:5, s. 905-912
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Various operational definitions have been proposed to assess the frailty condition among older individuals. Our objective was to assess how practitioners measure the geriatric syndrome of frailty in their daily routine.Methods: An online survey was sent to national geriatric societies affiliated to the European Union Geriatric Medicine Society (EUGMS) and to members of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).Results: A total of 388 clinicians from 44 countries answered to the survey. Most of them were medical doctors (93%), and their primary field of practice was geriatrics (83%). Two hundred and five clinicians (52.8%) always assessed frailty in their daily practice, 38.1% reported to "sometimes" measure it, and 9.1% never assess it. A substantial proportion of clinicians (64.9%) diagnose frailty using more than one instrument. The most widely used tool was the gait speed test, adopted by 43.8% of the clinicians, followed by clinical frailty scale (34.3%), the SPPB test (30.2%), the frailty phenotype (26.8%) and the frailty index (16.8%).Conclusion: A variety of tools is used to assess frailty of older patients in clinical practice highlighting the need for standardisation and guidelines.
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| 6. |
- Cruz-Jentoft, Alfonso J., et al.
(författare)
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Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons : results and final recommendations from the MPI_AGE European Project
- 2020
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Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 32:5, s. 861-868
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Tidskriftsartikel (refereegranskat)abstract
- MPI_AGE is a European Union co-funded research project aimed to use the Multidimensional Prognostic Index (MPI), a validated Comprehensive Geriatric Assessment (CGA)-based prognostic tool, to develop predictive rules that guide clinical and management decisions in older people in different European countries. A series of international studies performed in different settings have shown that the MPI is useful to predict mortality and risk of hospitalization in community-dwelling older subjects at population level. Furthermore, studies performed in older people who underwent a CGA before admission to a nursing home or receiving homecare services showed that the MPI successfully identified groups of persons who could benefit, in terms of reduced mortality, of specific therapies such as statins in diabetes mellitus and coronary artery disease, anticoagulants in atrial fibrillation and antidementia drugs in cognitive decline. A prospective trial carried out in nine hospitals in Europe and Australia demonstrated that the MPI was able to predict not only in-hospital and long-term mortality, but also institutionalization, re-hospitalization and receiving homecare services during the one-year follow-up after hospital discharge. The project also explored the association between MPI and mortality in hospitalized older patients in need of complex procedures such as transcatheter aortic valve implantation or enteral tube feeding. Evidence from these studies has prompted the MPI_AGE Investigators to formulate recommendations for healthcare providers, policy makers and the general population which may help to improve the cost-effectiveness of appropriate health care interventions for older patients.
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| 7. |
- Curreri, Chiara, et al.
(författare)
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The influence of occupation type and complexity on cognitive performance in older adults
- 2022
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Ingår i: Psychiatry Research. - : Elsevier BV. - 0925-4927 .- 1872-7506. ; 326
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Tidskriftsartikel (refereegranskat)abstract
- Sociodemographic factors, such as education and occupation, may influence the individual's cognitive reserve. We explored the extent to which the type and complexity of previous work activities influence cognitive performance (evaluated with Mini-Mental State Examination, MMSE, and the Animal Naming Test, ANT) in 799 older people with or without brain damage. The presence of cortical/subcortical ischemic brain lesions and right/left hippocampal atrophy was derived from magnetic resonance imaging. We found that individuals who had done intellectual work had better MMSE and ANT scores than their counterparts in the presence of brain lesions or hippocampal atrophy. Among the manual workers there were significant differences between the MMSE scores of individuals with and without brain damage (mean MMSE difference (2.09 [SD: 0.68], p=0.01), but not among the intellectuals (0.19 [SD: 0.29], p=0.36) nor the service providers (1.67 [SD: 0.55], p=0.21). Occupations involving more complex dealings with people were associated with better MMSE scores in the presence of brain lesions [β=-0.41, 95%CI: -0.72,-0.09] and hippocampal atrophy [β=-0.29, 95%CI:-0.58,-0.001]. These results indicate that in more cognitively stimulating work with greater social interaction may help older individuals preserve cognitive functions, even in the presence of brain damage.
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| 8. |
- Danaei, Goodarz, et al.
(författare)
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Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331288 participants
- 2015
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Ingår i: The Lancet Diabetes & Endocrinology. - 2213-8595 .- 2213-8587. ; 3:8, s. 624-637
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Tidskriftsartikel (refereegranskat)abstract
- Background Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA(1c). We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA(1c) (HbA(1c) >= 6 . 5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG >= 7 . 0 mmol/L or 2hOGTT >= 11 . 1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings Population prevalence of diabetes based on FPG- or-2hOGTT was correlated with prevalence based on FPG alone (r= 0 . 98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA(1c) was lower than prevalence based on FPG in 42 . 8% of age-sex-survey groups and higher in another 41 . 6%; in the other 15 . 6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA(1c)-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA(1c) 6 . 5% or more had a pooled sensitivity of 52 . 8% (95% CI 51 . 3-54 . 3%) and a pooled specificity of 99 . 74% (99 . 71-99 . 78%) compared with FPG 7 . 0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30 . 5% (28 . 7-32 . 3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA(1c) versus FPG. Interpretation Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA(1c)-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.
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| 9. |
- DeAngelis, Nicola, et al.
(författare)
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2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy
- 2021
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Ingår i: World Journal of Emergency Surgery. - : BMC. - 1749-7922. ; 16:1
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Forskningsöversikt (refereegranskat)abstract
- Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
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| 10. |
- Demurtas, Jacopo, et al.
(författare)
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Physical Activity and Exercise in Mild Cognitive Impairment and Dementia : An Umbrella Review of Intervention and Observational Studies
- 2020
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 21:10, s. 1415-1422
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Forskningsöversikt (refereegranskat)abstract
- Objectives: The aim of this umbrella review was to determine the effect of physical activity/exercise on improving cognitive and noncognitive outcomes in people with MCI (mild cognitive impairment) and dementia.Design: Umbrella review of systematic reviews (SR), with or without meta-analyses (MAs), of randomized controlled trials (RCTs) and observational studies.Settings and Participants: People with MCI or dementia, confirmed through validated assessment measures. Any form of physical activity/exercise was included. As controls, we included participants not following any prespecified physical activity/exercise intervention or following the same standard protocol with the intervention group.Methods: The protocol was registered in PROSPERO (CDR 164197). Major databases were searched until December 31, 2019. The certainty of evidence of statistically significant outcomes was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. SRs' findings, without a formal MA, were reported descriptively.Results: Among 1160 articles initially evaluated, 27 SRs (all of RCTs, 9 without MA) for a total of 28,205 participants with MCI/dementia were included. In patients with MCI, mind-body intervention (standardized mean difference [SMD] = 0.36; 95% confidence intervals [CI] 0.20-0.52; low certainty) and mixed physical activity interventions (SMD = 0.30; 95% CI 0.11-0.49; moderate certainty) had a small effect on global cognition, whereas resistance training (SMD = 0.80; 95% CI 0.29-1.31; very low certainty) had a large effect on global cognition. In people affected by dementia, physical activity/exercise was effective in improving global cognition in Alzheimer disease (SMD = 1.10; 95% CI 0.65-1.64; very low certainty) and in all types of dementia (SMD = 0.48; 95% CI 0.22-0.74; low certainty). Finally, physical activity/exercise improved noncognitive outcomes in people with dementia including falls, and neuropsychiatric symptoms.Conclusions and Implications: Supported by very low-to-moderate certainty of evidence, physical activity/exercise has a positive effect on several cognitive and noncognitive outcomes in people with MCI and dementia, but RCTs, with low risk of bias/confounding, are still needed to confirm these relationships.
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| 11. |
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| 12. |
- Kamte, Stephane L. Ngahang, et al.
(författare)
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Identification of highly effective antitrypanosomal compounds in essential oils from the Apiaceae family
- 2018
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Ingår i: Ecotoxicology and Environmental Safety. - : Elsevier. - 0147-6513 .- 1090-2414. ; 156, s. 154-165
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Tidskriftsartikel (refereegranskat)abstract
- The Apiaceae family encompasses aromatic plants of economic importance employed in foodstuffs, beverages, perfumery, pharmaceuticals and cosmetics. Apiaceae are rich sources of essential oils because of the wealth of secretory structures (ducts and vittae) they are endowed with. The Apiaceae essential oils are available on an industrial level because of the wide cultivation and disposability of the bulky material from which they are extracted as well as their relatively cheap price. In the fight against protozoal infections, essential oils may represent new therapeutic options. In the present work, we focused on a panel of nine Apiaceae species (Siler montamon, Sison amomum, Echinophora spinosa, Kundmannia sicula, Crithmum maritimum, Helosciadium nodiforum, Pimpinella anisum, Heracleum sphondylium and Trachyspermum cunmi) and their essential oils as a model for the identification of trypanocidal compounds to be used as alternative/integrative therapies in the treatment of Human African trypanosomiasis (HAT) and as starting material for drug design. The evaluation of inhibitory effects of the Apiaceae essential oils against Trypanosoma brucei showed that some of them (E. spinosa, S. amomum, C. maritimwn and H. nodifloruin) were active, with EC50 in the range 2.7-10.7 mu g/mL. Most of these oils were selective against T. brucei, except the one from C. maritimum that was highly selective against the BALB/3T3 mammalian cells. Testing nine characteristic individual components (a-pinene, sabinene, alpha-phellandrene, p-cymene, limonene, beta-ocimene, gamma-terpinene, terpinolene, and myristicin) of these oils, we showed that some of them had much higher selectivity than the oils themselves. Terpinolene was particularly active with an EC50 value of 0.035 mu g/rnL (0.26 mu M) and a selectivity index (SI) of 180. Four other compounds with EC50 in the range 1.0-6.0 mu g/mL (7.4-44 mu M) had also good SI: a-pinene (> 100), beta-ocimene (> 91), limonene (> 18) and sabinene ( > 17). In conclusion, these results highlight that the essential oils from the Apiaceae family are a reservoir of substances to be used as leading compounds for the development of natural drugs for the treatment of HAT.
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| 13. |
- Marseglia, Anna, et al.
(författare)
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Cognitive functioning among patients with diabetic foot
- 2014
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Ingår i: Journal of diabetes and its complications. - : Elsevier BV. - 1056-8727 .- 1873-460X. ; 28:6, s. 863-868
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Using diabetic foot (OF) as an indicator of severe diabetes, we aimed to investigate the cognitive profile of OF patients and the relations between cognitive functioning and both diabetes complications and comorbidities. Methods: Dementia-free patients with DF aged 30-90 (n = 153) were assessed through medical records and a cognitive battery. Information on diabetes complications and comorbidities was collected via interview; glycated hemoglobin (HbA1c) was tested. Data were analyzed using robust logistic or quantile regression adjusted for potential confounders. Results: The mean Mini-Mental Examination (MMSE) score of patients was 24.6 (SD = 3.6), and 40% had global cognitive dysfunction (MMSE <= 24). Among elderly patients (aged >= 65), MMSE impairment was related to amputation (OR 3.59, 95% CI 1.07-12.11). Episodic memory impairment was associated with foot amputation (OR 4.13, 95% CI 1.11-1528) and microvascular complications (OR 9.68, 95% CI 1.67-56.06). Further, elderly patients with HbA1c <7% had increased odds of psychomotor slowness (OR 7.75, 95% CI 1.55-38.73) and abstract reasoning impairment (OR 4.49, 95% CI: 1.15-17.46). However, such significant associations were not shown in adult patients aged <65. Conclusion: Amputation, microvascular diseases and glycemic control were associated with impaired global cognitive function and its domains among patients aged >= 65.
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| 14. |
- Pilotto, Alberto, et al.
(författare)
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Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease
- 2016
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Ingår i: American Journal of Cardiology. - : Elsevier BV. - 0002-9149 .- 1879-1913. ; 118:11, s. 1624-1630
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Tidskriftsartikel (refereegranskat)abstract
- Clinical decision-making for statin treatment in older patients with coronary artery disease (CAD) is under debate, particularly in community-dwelling frail patients at high risk of death. In this retrospective observational study on 2,597 community-dwelling patients aged >= 65 years with a previous hospitalization for CAD, we estimated mortality risk assessed with the Multidimensional Prognostic Index (MPI), based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA), used to determine accessibility to homecare services/nursing home admission in 2005 to 2013 in the Padua Health District, Veneto, Italy. Participants were categorized as having mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) baseline mortality risk, and propensity score-adjusted hazard ratios (HRs) of 3-year mortality rate were calculated according to statin treatment in these subgroups. Greater MPI-SVaMA scores were associated with lower rates of statin treatment and higher 3-year mortality rate (MPI-SVaMA-1 = 23.4%; MPI-SVaMA-2 = 39.1%; MPI-SVaMA-3 = 76.2%). After adjusting for propensity score quintiles, statin treatment was associated with lower 3-year mortality risk irrespective of MPI-SVaMA group (HRs [95% confidence intervals] 0.45 [0.37 to 0.55], 0.44 [0.36 to 0.53], and 0.28 [0.21 to 0.39] in MPI-SVaMA-1,-2, and-3 groups, respectively [interaction test p = 0.202]). Subgroup analyses showed that statin treatment was also beneficial irrespective of age (HRs [95% confidence intervals] 0.38 [0.27 to 0.53], 0.45 [0.38 to 0.54], and 0.44 [0.37 to 0.54] in 65 to 74, 75 to 84, and Z85 year age groups, respectively [interaction test p = 0.597]). In conclusion, in community-dwelling frail older patients with CAD, statin treatment was significantly associated with reduced 3-year mortality rate irrespective of age and multidimensional impairment, although the frailest patients were less likely to be treated with statins.
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| 15. |
- Siviero, Paola, et al.
(författare)
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Quality of life outcomes in patients undergoing knee replacement surgery : longitudinal findings from the QPro-Gin study
- 2020
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many patients report postoperative pain, limited improvement in physical function and poor quality of life (QOL) after knee replacement surgery. Our study uses baseline predictors of change to investigate the QOL of patients with knee osteoarthritis 3-months after knee replacement surgery.Methods: A prospective observational study was designed to evaluate patients (n = 132) scheduled for uni-compartmental or total knee replacement surgery who were assessed at baseline (preoperatively) and 3-months after. Physical and mental endpoints based on the component scores of the SF-12 and on the Western Ontario and McMaster Universities Arthritis (WOMAC) index were used to investigate patients' QOL. Generalised estimating equation methodology was used to assess patients' baseline characteristics (age, sex, education, body mass index (BMI), comorbidity, depressive symptoms, cognitive impairment, smoking/alcohol and type of surgery), the study endpoints and their changes over a 3-month post-surgery period. Stratified analyses by rehabilitation status after discharge were performed.Results: Longitudinal data analysis showed that the baseline factors associated with improvement in general QOL at the 3-month post-surgery assessment were higher BMI, a high comorbidity, total (as opposed to unicompartmental) knee replacement and low education level. Data analysis of the patients who underwent rehabilitation after discharge revealed that the current smokers' physical QOL worsened over time. The general QOL was unchanged over time in the presence of depressive symptomatology.Conclusions: These findings underline the importance of using comprehensive assessment methods to identify factors affecting functionality and QOL, and developing interventions to improve the health/wellbeing of patients after knee replacement.
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| 16. |
- Siviero, Paola, et al.
(författare)
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The prevalence of frailty and its associated factors in an Italian institutionalized older population : findings from the cross-sectional Alvise Cornaro Center Study
- 2022
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Ingår i: Aging Clinical and Experimental Research. - : Springer. - 1594-0667 .- 1720-8319. ; :34, s. 1103-1112
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Tidskriftsartikel (refereegranskat)abstract
- Background: While it is well established that frail older people have a higher risk of negative health outcomes, the prevalence of frailty and its associated factors in Italian older institutionalized population has never been investigated.Aims: The aims of this study were to assess the prevalence of frailty and to identify its associated factors in an Italian residential care home population.Methods: An observational cross-sectional study was designed to evaluate older people aged 70 or over of an Italian residential care home. A multidimensional assessment examining functional, geriatric, ophthalmic, and audiological domains was carried out to identify factors associated with frailty. Physical frailty was evaluated using Fried's criteria.Results: Data analysis uncovered a 51.1% prevalence of pre-frailty and a 40.4% prevalence of frailty in the 94 eligible participants (64 females) whose data were complete. The multivariable analysis showed that a low education level (OR = 5.12, 95% CI 1.22-21.49), a low physical quality of life score (OR = 13.25, 95% CI 3.51-50.08), a low mental quality of life score (OR = 9.22, 95% CI 2.38-35.69), visual impairment (OR = 7.65, 95% CI 1.77-33.14), and hearing impairment (OR = 4.62, 95% CI 1.03-20.66) were independently associated with frailty.Conclusions: Frailty was found to be highly prevalent in the residential care home studied. Since frailty is a reversible condition, identifying the modifiable factors associated to it should be viewed as an important step in planning and implementing targeted, early prevention strategies.
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| 17. |
- Sut, Stefania, et al.
(författare)
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Identification of tagitinin C from Tithonia diversifolia as antitrypanosomal compound using bioactivity-guided fractionation
- 2018
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Ingår i: Fitoterapia (Milano). - : Elsevier. - 0367-326X .- 1873-6971. ; 124, s. 145-151
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Tidskriftsartikel (refereegranskat)abstract
- Tithonia diversifolia (Asteraceae), is used as traditional medicine in tropical countries for the treatment of various diseases, including malaria. Although numerous studies have assessed the antimalarial properties, nothing is known about the effect of T. diversifolia extracts on trypanosomiasis. In this study extracts of T. diversifolia aerial parts were evaluated for their bioactivity against Trypanosoma brucei. The activity was studied against bloodstream forms of T. brucei (TC221), as well as against mammalian cells (BALB/3T3 mouse fibroblasts), as a counter-screen for toxicity. Both methanolic and aqueous extracts showed significant effects with IC50 values of 1.1 and 2.2 mu g/mL against T. brucei (TC221) and 5.2 and 3.7 mu g/mL against BALB/3T3 cells, respectively. A bioassay-guided fractionation on the methanolic extract yielded in identification of active fractions (F8 and F9) with IC50 values of 0.41 and 0.43 mu g/mL, respectively, against T. brucei (TC221) and 1.4 and 1.5 mu g/mL, respectively, against BALB/3T3 cells,. The phytochemical composition of the extracts and the purified fractions were investigated using HPLC-ESI-MS/MS and 1D and 2D NMR spectra showing the presence of sesquiterpene lactones that in turn were subjected to the isolation procedure. Tagitinin A and C were rather active but the latter presented a very strong inhibition on T. brucei (TC221) with an IC50 value of 0.0042 mu g/mL. This activity was 4.5 times better than that of the reference drug suramin. The results of this study shed light on the antitrypanosomal effects of T. diversifolia extracts and highlighted tagitinin C as one of the possible responsible for this effect. Further structure activity relationships studies on tagitinins are needed to consider this sesquiterpenes as lead compounds for the development of new antitrypanosomal drugs.
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| 18. |
- Trevisan, Caterina, et al.
(författare)
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Cross-Sectional and Longitudinal Associations between Peak Expiratory Flow and Frailty in Older Adults
- 2019
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Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 8:11
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Tidskriftsartikel (refereegranskat)abstract
- Peak expiratory flow (PEF) has been linked to several health-related outcomes in older people, but its association with frailty is still unclear. This study investigates the association between PEF and prevalent and incident frailty in older adults. Data come from 2559 community-dwelling participants (age >= 60 years) of the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Baseline PEF was expressed as standardized residual (SR) percentiles. Frailty was assessed at baseline and over six years, according to the Fried criteria. Associations between PEF and frailty were estimated cross-sectionally through logistic regressions, and longitudinally by multinomial logistic regression, considering death as alternative outcome. Obstructive respiratory diseases and smoking habits were treated as potential effect modifiers. Our cross-sectional results showed that the 10th-49th and <10th PEF SR percentile categories were associated with three- and five-fold higher likelihood of being frail than the 80th-100th category. Similar estimates were confirmed longitudinally, i.e., adjusted OR = 3.11 (95% CI: 1.61-6.01) for PEF SR percentiles < 10th, compared with 80th-100th percentiles. Associations were enounced in participants without physical deficits, and tended to be stronger among those with baseline obstructive respiratory diseases, and, longitudinally, also among former/current smokers. These findings suggest that PEF is a marker of general robustness in older adults, and its reduction exceeding that expected by age is associated with frailty development.
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| 19. |
- Trevisan, Caterina, et al.
(författare)
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Falls may trigger body weight decline in nursing home residents
- 2021
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Ingår i: Nutrition (Burbank, Los Angeles County, Calif.). - : Elsevier BV. - 0899-9007 .- 1873-1244. ; 90
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The effect of falls on changes in body weight is still unknown. This study investigated the extent to which falls can modify the course of body weight in nursing home residents, and aimed to identify the factors that might modulate this effect.Methods: The sample included 132 residents aged ≥60 y who had experienced at least one fall after nursing home admission. Body weight was measured monthly in the 6 mo after the fall in the entire sample, and also in the 6 mo prefall in a subsample (n = 111). Sociodemographic and health data were obtained from medical records. Linear mixed models were used to estimate the average monthly changes in body weight after the fall in the total sample, and as a function of the sociodemographic and medical factors.Results: Falls modified the course of body weight in the total sample (β = −0.28, 95% confidence interval, −0.44 to −0.12, for the change in slope before and after fall) in all age classes and especially in individuals with severe cognitive impairment who received less-frequent informal visits (β = −0.55, 95% confidence interval, −0.87 to −0.22). Individuals aged ≥90 y and those with severe cognitive impairment had a steeper monthly weight decline in the 6 mo postfall, of 0.23 and 0.35 kg greater, respectively, than their younger and cognitively healthier counterparts.Conclusions: Falls may trigger a body weight loss in nursing home residents, especially in the oldest old people and those with severe cognitive impairment who receive little support from informal caregivers. These findings highlight the importance of monitoring nutritional status of people who live in institutions after falls.
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| 20. |
- Trevisan, Caterina, et al.
(författare)
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Frailty and the risk of infection-related hospitalizations in older age : Differences by sex
- 2023
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Ingår i: Maturitas. - : Elsevier BV. - 0378-5122 .- 1873-4111. ; 168, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the extent to which frailty is associated with infection-related hospitalizations in older men and women, and to explore whether, among women, previous exposure to endogenous estrogens in terms of age at menopause and number of pregnancies modify such a relationship.Study design: The sample comprised 2784 participants in the Progetto Veneto Anziani aged ≥65 years. At baseline and after 4.4 years, frailty was identified according to the presence of three or more of the following: weakness, exhaustion, weight loss, low physical activity, and low walking speed. A passive follow-up on infection-related hospitalizations and mortality was performed for 10 years of observation through linkage with regional registers.Main outcome measures: The association between frailty and infection-related hospitalizations was assessed through mixed-effects Cox regressions.Results: Frailty was significantly associated with a 78 % higher risk of infection-related hospitalization, with stronger results in men (hazard ratio = 2.32, 95 % confidence interval 1.63–3.30) than in women (hazard ratio = 1.54, 95 % confidence interval 1.18–2.02). Focusing on women, we found a possible modifying effect for the number of pregnancies but not menopausal age. Women who had experienced one or no pregnancy demonstrated a higher hazard of infection-related hospitalization as a function of frailty (hazard ratio = 3.00, 95 % confidence interval 1.58–5.71) than women who had experienced two or more pregnancies (hazard ratio = 1.68, 95 % confidence interval 1.18–2.39).Conclusion: Frailty in older age increases the risk of infection-related hospitalizations, especially in men. The “immunologic advantage” of the female sex in younger age seems to persist also after menopause as a function of the number of pregnancies a woman has experienced.
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| 21. |
- Trevisan, Caterina, et al.
(författare)
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Gender Differences in the Relationship Between Marital Status and the Development of Frailty : A Swedish Longitudinal Population-Based Study
- 2020
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Ingår i: Journal of Women's Health. - : Mary Ann Liebert Inc. - 1540-9996 .- 1931-843X. ; 29:7
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Tidskriftsartikel (refereegranskat)abstract
- Background: The gender-specific role of marital status for the development of frailty has not been clarified. This study evaluates the gender differences in the association between marital status and frailty development, and the possible modifying effect by age cohort in such a relationship. Methods: The sample included 2179 community-dwelling older adults involved in the Swedish National Study on Aging and Care in Kungsholmen, followed up for 6 years. Participants stable in marital status over time were categorized as partnered, widowed, single, and divorced. Changes were classified as losing one's partner and gaining a partner. Frailty was defined as the presence of three or more criteria among: weight loss, low physical activity, slow walking speed, weakness, and exhaustion. The association between marital status and frailty, with death as an alternative outcome and controlling for confounders, was estimated with multinomial logistic regressions. Results: Men who remained single (odds ratio [OR] = 2.50, 95% confidence interval [95% CI] 1.05 - 5.98) and those who lost their partner (OR = 2.59, 95% CI 1.16 - 5.77) had higher odds of frailty than those with a partner. The OR differed between younger (60-80 years) and older (>= 81 years) women (p-(interaction) = 0.04). The youngest women who remained divorced had a higher risk of frailty (OR = 2.75, 95% CI 1.24 - 6.08) than those who still had a partner. Conversely, older women who lost their partner had 80% (95% CI 0.05-0.86) lower odds of frailty than those with a partner. Conclusions: Marital status can influence frailty development differently for women and men. This gender-specific influence may vary by age cohort, perhaps in response to sociocultural factors.
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| 22. |
- Trevisan, Caterina, et al.
(författare)
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Hospital length of stay and 30-day readmissions in older people : their association in a 20-year cohort study in Italy
- 2023
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Background There are conflicting data on whether hospital length of stay (LOS) reduction affects readmission rates in older adults. We explored 20-year trends of hospital LOS and 30-day rehospitalizations in a cohort of Italian older people, and investigated their association.Methods Participants in the Pro.V.A. project (n = 3099) were followed-up from 1996 to 2018. LOS and 30-day rehospitalizations, i.e. new hospitalizations within 30 days from a previous discharge, were obtained from personal interviews and regional registers. Rehospitalizations in the 6 months before death were also assessed. Linear regressions evaluated the associations between LOS and the frequency of 30-day rehospitalizations, adjusting for the mean age of the cohort within each year.Results Over 20 years, 2320 (74.9%) participants were hospitalized. Mean LOS gradually decreased from 17.3 days in 1996 to 11.3 days in 2018, while 30-day rehospitalization rates increased from 6.6% in 1996 to 13.6% in 2018. LOS was inversely associated with 30-day rehospitalizations frequency over time (β = -2.33, p = 0.01), similarly in men and women. A total of 1506 individuals was hospitalized within 6 months before death. The frequency of 30-day readmissions at the end of life increased from 1.4% in 1997 to 8.3% in 2017 and was associated with mean LOS (β = -1.17, p = 0.03).Conclusions The gradual LOS reduction observed in the latter decades is associated with higher 30-day readmission rates in older patients in Italy. This suggests that a careful pre-discharge assessment is warranted in older people, and that community healthcare services should be improved to reduce the risk of readmission.
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| 23. |
- Trevisan, Caterina, et al.
(författare)
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Impact of Social Network on the Risk and Consequences of Injurious Falls in Older Adults
- 2019
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 67:9, s. 1851-1858
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES A smaller social network is associated with worse health-related outcomes in older people. We examined the impact of social connections and social support on the risk of injurious fall and on fall-related functional decline and mortality. DESIGN Prospective study with 6-year follow-up. SETTING Community. PARTICIPANTS A total of 2630 participants (aged >= 60 years) from the Swedish National Study on Aging and Care in Kungsholmen. MEASUREMENTS Social connections (social network size and contact frequency) and social support (social resource perception and satisfaction) were assessed through validated questionnaires. Data on injurious falls (falls requiring inpatient or outpatient care) and mortality came from official registers. We defined injurious falls as severe if they caused fracture and/or intracranial injury and as multiple if two or more occurred during the 6-year follow-up. Functional decline was defined as the loss of ability to perform one or more activities of daily living during the follow-up. RESULTS During the follow-up, 322 participants experienced injurious falls. After adjusting for potential confounders, the hazard ratio of injurious falls was 1.7 (95% confidence interval [CI] = 1.1-2.4) for people with poor social connections and 1.5 (95% CI = 1.1-2.1) for people with moderate social connections (reference: rich social connections). Social support was not associated with fall risk. The odds of functional decline among those with severe/multiple falls and (1) poor social connections (odds ratio [OR] = 5.2 [95% CI = 2.1-12.9]) or (2) poor social support (OR = 4.5 [95% CI = 1.7-12.0]) was up to twice as high as among those with severe/multiple falls and (3) rich social connections (OR = 2.5 [95% CI = .9-6.6]) or (4) rich social support (OR = 2.7 [95% CI = 1.2-6.3]). Similar but more attenuated results emerged for mortality. CONCLUSIONS Social network may influence fall risk and fall-related functional decline and mortality. J Am Geriatr Soc 67:1851-1858, 2019
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| 24. |
- Trevisan, Caterina, et al.
(författare)
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Judgment Capacity, Fear of Falling, and the Risk of Falls in Community-Dwelling Older Adults : The Progetto Veneto Anziani Longitudinal Study
- 2020
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Ingår i: Rejuvenation Research. - : Mary Ann Liebert Inc. - 1549-1684 .- 1557-8577. ; 23:3, s. 237-244
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Tidskriftsartikel (refereegranskat)abstract
- Little is known of the factors that transform fear of falling (FOF) from a normal adaptive to a maladaptive response that could alter its impact on fall risk. Focusing on judgment capacity, we investigated whether it is associated with FOF and FOF-related activity restriction (AR), and whether it modifies the influence of FOF on fall risk. Data came from 2625 community-dwelling older adults enrolled in the Progetto Veneto Anziani. Baseline FOF and AR were assessed through personal interviews, and judgment capacity-high, moderate, or poor-through situational tests. At follow-up after 4.4 years, self-reported falls during the previous year were recorded. The associations between judgment and FOF/AR, and between FOF and the risk of at least one fall or recurrent falls (two or more falls), stratified by judgment capacity, were evaluated using multinomial logistic regressions. Compared with high-judgment participants, lower judgment participants were 20% more likely to report FOF; moderate judgment participants were 54% more likely and poor judgment participants twice as likely to report AR. After adjusting for potential confounders, including physical activity and physical performance, FOF increased the reporting of at least one fall only in the poor judgment group. The association between FOF and recurrent falls was stronger in individuals with poor (odds ratio [OR] = 3.66, 95% confidence interval [CI]: 2.10-6.36) than with moderate (OR = 2.81, 95% CI: 2.22-3.55) or high (OR = 1.65, 95% CI: 1.48-1.83) judgment. Poor judgment capacity increases the probability of FOF and AR in older adults, and may exacerbate the effect of FOF in increasing fall risk.
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| 25. |
- Trevisan, Caterina, et al.
(författare)
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Nutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults : A Systematic Review and Meta-Analysis
- 2019
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 20:5, s. 569-582
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Forskningsöversikt (refereegranskat)abstract
- Objectives: To evaluate the association between nutritional status, defined on the basis of a multidimensional evaluation, and body mass index (BMI) with the risk of falls and recurrent falls in communitydwelling older people.Design: Systematic literature review and meta-analysis.Setting and Participants: Community-dwelling older adults.Measures: A systematic literature review was conducted on prospective studies identified through electronic and hand searches until October 2017. A random effects meta-analysis was used to evaluate the relative risk (RR) of experiencing falls and recurrent falls (>= 2 falls within at least 6 months) on the basis of nutritional status, defined by multidimensional scores. A random effects dose-response metaanalysis was used to evaluate the association between BMI and the risk of falls and recurrent falls.Results: People who were malnourished or those at risk for malnutrition had a pooled 45% higher risk of experiencing at least 1 fall than were those well-nourished (9510 subjects). Increased falls risk was observed in subjects malnourished versus well-nourished [RR 1.64, 95% confidence interval (CI) 1.182.28; 3 studies, 8379 subjects], whereas no substantial results were observed for risk of recurrent falls. A U-shaped association was detected between BMI and the risk for falls (P <. 001), with the nadir between 24.5 and 30 (144,934 subjects). Taking a BMI of 23.5 as reference, the pooled RR of falling ranged between 1.09 (95% CI 1.04-1.15) for a BMI of 17, to 1.07 (95% CI 0.92-1.24) for a BMI of 37.5. No associations were observed between BMI and recurrent falls (120,185 subjects).Conclusions/Implications: The results of our work suggest therefore that nutritional status and BMI should be evaluated when assessing the risk for falls in older age.
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| 26. |
- Trevisan, Caterina, et al.
(författare)
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Peak Expiratory Flow and the Risk of Injurious Falls in Older Adults : The Role of Physical and Cognitive Deficits
- 2020
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 21:9, s. 1288-1294
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Previous studies showed that peak expiratory flow (PEF) is associated with health-related outcomes in advanced age, but the extent to which it may be related to falls risk remains unclear. We aimed to detect the association between PEF and injurious falls in older adults and to explore the role of cognitive and physical deficits in this association.Design: Prospective study with a 6-year follow-up.Setting and Participants: The study involves 2234 community-dwelling older adults with no history of pulmonary disease.Methods: For each study participant, we assessed the PEF at baseline, expressed as standardized residual (SR) percentile and derived from the normalization of residuals between the measured and predicted PEF values (based on individual age, sex, and body height); incident injurious falls over 6 years, from Hospital Discharge Diagnosis; and physical and cognitive functioning at the baseline and at 3- and 6-year followups by evaluating walking speed, balance, chair stand, and Mini-Mental State Examination, respectively.Results: Over the follow-up, 232 individuals experienced injurious falls. Cox models indicated 7% higher risk of falls per each 10th reduction in PEF SR-percentile. The risk of injurious falls increased by more than twice for those who had PEF SR-percentile <10th as for values of 80th-100th (hazard ratio = 2.31, 95% confidence interval: 1.41-3.76). Physical deficits mediated 63% of the total effect of PEF on falls risk.Conclusions and Implications: Our findings suggest that low PEF is associated with higher risk of injurious falls in older adults, and most of this association is explained by balance or muscular strength deficits.
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| 27. |
- Trevisan, Caterina, et al.
(författare)
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Peak expiratory flow, walking speed and survival in older adults : An 18-year longitudinal population-based study
- 2020
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Ingår i: Experimental Gerontology. - : Elsevier BV. - 0531-5565 .- 1873-6815. ; 135
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Tidskriftsartikel (refereegranskat)abstract
- Background: Peak expiratory flow (PEF) and walking speed (WS) have been proposed as indicators of robustness and are independent predictors of health-related outcomes. We aimed to investigate how the co-occurrence of respiratory and physical impairments changes as a function of age, and to quantify the association of the combination of low PEF and slow WS on survival in older people.Methods: This prospective study analyzes data from 2656 community-dwelling participants (age >= 60 years) from the SNAC-K study. At baseline, we assessed: (1) sociodemographic, lifestyle and medical data; (2) respiratory function, estimated through PEF and expressed as standardized residual (SR) percentile; and (3) WS at usual pace, categorized as no (> 1.2 m/s), mild (0.8-1.2 m/s) and moderate-to-severe (< 0.8 m/s) walking impairment. Participants' vital status over an 18-year follow-up was derived from registers. The association of different combinations of PEF and WS on median survival time was estimated through Laplace regression adjusted for potential confounders.Results: Respiratory and walking impairments co-occurred more frequently with increasing age. Among individuals with PEF SR-percentiles < 10th, the percentage of moderate-to-severe walking impairment was 12.1% in sexagenarians, 35.7% in septuagenarians, and 75-80% in the oldest old. The greatest reduction in median survival time (- 5.4 [95%CI: -6.4; -4.4] years, p < 0.001) was observed among people with combined respiratory and moderate-to-severe walking impairments, compared with those with no dysfunctions, who had a median survival time of 17.4 (95%CI: 17.0; 17.8) years.Conclusions: Impaired PEF and WS co-occur more frequently with advancing age, and their co-occurrence is associated with shorter survival.
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| 28. |
- Trevisan, Caterina, et al.
(författare)
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Polypharmacy and Antibody Response to SARS-CoV-2 Vaccination in Residents of Long-Term Care Facilities : The GeroCovid Vax Study
- 2023
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Ingår i: Drugs & Aging. - 1170-229X .- 1179-1969. ; 40:12, s. 1133-1141
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objective Polypharmacy is common in older adults, particularly among those living in long-term care facilities. This condition represents a marker of clinical complexity and might directly affect the immunological response. However, there are limited data on the association of polypharmacy with vaccine immunogenicity. This study evaluated the immune response to anti-SARS-CoV-2 vaccines in older residents of long-term care facilities as a function of the number of medications used.Methods In 478 long-term care facility residents participating in the GeroCovid Vax study, we assessed SARS-CoV-2 trimeric S IgG levels through chemiluminescent assays before the vaccination and after 2, 6, and 12 months. A booster dose was administered between 6- and 12-month assessments. Sociodemographic information and data on chronic diseases and medications were derived from medical records. Based on the number of daily medications, residents were classified into the no polypharmacy (zero to four medications), polypharmacy (five to nine medications), and hyperpolypharmacy (ten or more medications) groups.Results In the sample (mean age 82.1 years, 69.2% female), 200 (41.8%) residents were taking five or fewer medications/day (no polypharmacy), 229 (47.9%) had polypharmacy, and 49 (10.3%) had hyperpolypharmacy. Using linear mixed models adjusted for potential confounders, we found that hyperpolypharmacy was associated with a steeper antibody decline after 6 months from the first vaccine dose administration (β = − 0.29, 95% confidence interval − 0.54, − 0.03, p = 0.03) than no polypharmacy, while no significant differences were observed at 12 months.Conclusions The humoral immune response to SARS-CoV-2 vaccination of older residents showed only slight changes as a function of the number of medications taken. Although it seemed less durable among older residents with hyperpolypharmacy, the booster dose administration equalized such a difference.
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| 29. |
- Trevisan, Caterina, et al.
(författare)
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The Association Between Injurious Falls and Older Adults' Cognitive Function : The Role of Depressive Mood and Physical Performance
- 2021
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Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1079-5006 .- 1758-535X. ; 76:9, s. e163-e170
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Tidskriftsartikel (refereegranskat)abstract
- Background: The impact of falls on cognitive function is unclear. We explored whether injurious falls are associated with cognitive decline in older adults, and evaluated the role of changes in psychological and physical health as mediators of such association.Methods: This prospective study involved 2267 community-dwelling participants in the Swedish National study on Aging and Care in Kungsholmen (≥60 years). Data on injurious falls (ie, falls requiring medical attention) during each 3-year time interval of follow-up were obtained from national registers. Assessment of cognitive function (Mini-Mental State Examination), depressive mood (Montgomery-Åsberg Depression Rating Scale), and physical performance (walking speed) were carried out every 3 or 6 years over a 12-year follow-up. The association between falls and cognition was estimated through linear mixed-effects models, and the mediating role of changes in depressive mood and physical performance was tested using mediation analysis.Results: After adjusting for potential confounders, individuals who experienced injurious falls had a greater annual decline in Mini-Mental State Examination in the subsequent time interval (β = −1.49, 95% CI: −1.84; −1.13), than those who did not. The association increased with the occurrence of ≥2 falls (β = −2.13, 95% CI: −2.70; −1.56). Worsening of walking speed and depressive mood explained around 26% and 8%, respectively, of the association between falls and cognitive decline.Conclusions: Injurious falls are associated with greater cognitive decline, and this association is partly mediated by worsening of physical performance and, in a lesser extent, of depressive mood. These findings suggest that physical deficits and low mood are potential therapeutic targets for mitigating the association between falls and cognitive decline.
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| 30. |
- Trevisan, Caterina, et al.
(författare)
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The impact of falls on the need for hospital care in older people : results from the Pro.V.A. study
- 2023
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Ingår i: Cehui dili xinxi. - 2499-6564. ; 71:2, s. 68-76
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims. Falls have been associated with adverse health-related outcomes in older people, but their effects on the need for hospital admissions is unclear. We investigated the association between falls and all-cause hospitalizations in older people. Methods. A sample of 2,123 community-dwelling adults aged >= 65 underwent multidimensional assessment at baseline and after 4.4 years. Self-reported falls in the year before baseline and in the year before the 4.4-year assessment were categorized as none, one, or >= 2 (recurrent falls). The hospitalizations number over 7 years after baseline was obtained from medical records. The association between falls and hospitalizations number was investigated using multivariable generalized mixed models with a Poisson distribution. Possible modifying effects of sociodemographic and medical factors on the studied association was investigated through interaction analysis. Results. Compared with no falls, the annual hospitalizations number for people who reported recurrent falls increased by 1.38 (95% CI: 1.05-1.81) in the short-term (over one year) and by 1.20 (95% CI: 1.031.39) in the long term (over 3.5 years). That increase was more marked in the first two years after the fall, then tended to lessen over time. No significant modifying effects on the association between falls and hospitalizations number were found. Conclusions. Recurrent falls may result in a greater need for hospital-based care, both in the short term, and, although to a lesser extent, in the long term. Since older people account for more than one in three inpatients, identifying modifiable factors for hospitalization, e.g. falls, is essential from clinical and public health perspectives.
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| 31. |
- Trevisan, Caterina, et al.
(författare)
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Trajectories of cognitive and physical performance after accidental falls in nursing home residents : A prospective study
- 2022
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Ingår i: Geriatric Nursing. - : Elsevier BV. - 0197-4572 .- 1528-3984. ; 47, s. 100-106
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Tidskriftsartikel (refereegranskat)abstract
- This prospective study evaluated cognitive and physical trajectories of nursing home (NH) residents after fall occurrence and their predictors. In 167 residents aged ≥60, we considered the closest pre-fall assessment and up to the first three post-fall assessments of cognitive and physical functions performed through Mini-Mental State Examination (MMSE) and Tinetti tests. Mixture models identified three post-fall cognitive and physical trajectories: stability, slow decline, and rapid decline. At logistic regression, older age, fewer informal visits, and falls within one month from institutionalization increased the probability of experiencing a decline in MMSE and Tinetti scores. Worse pre-fall cognitive function increased the likelihood of cognitive and physical decline, while worse pre-fall Tinetti score negatively impacted only physical decline.In conclusion, the impact of falls on the cognitive and physical health of NH residents may be modulated by their pre-fall cognitive function and some modifiable factors, such as social interactions and physical function.
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| 32. |
- Veronese, Nicola, et al.
(författare)
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Interventions to prevent and treat delirium: An umbrella review of randomized controlled trials
- 2024
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Ingår i: Ageing Research Reviews. - : ELSEVIER IRELAND LTD. - 1568-1637 .- 1872-9649. ; 97
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Forskningsöversikt (refereegranskat)abstract
- Delirium is a common condition across different settings and populations. The interventions for preventing and managing this condition are still poorly known. The aim of this umbrella review is to synthesize and grade all preventative and therapeutic interventions for delirium. We searched five databases from database inception up to March 15th, 2023 and we included meta -analyses of randomized controlled trials (RCTs) to decrease the risk of/the severity of delirium. From 1959 records after deduplication, we included 59 systematic reviews with meta -analyses, providing 110 meta -analytic estimates across populations, interventions, outcomes, settings, and age groups (485 unique RCTs, 172,045 participants). In surgery setting, for preventing delirium, high GRADE evidence supported dexmedetomidine (RR =0.53; 95%CI: 0.46 -0.67, k =13, N =3988) and comprehensive geriatric assessment (OR =0.46; 95%CI =0.32 -0.67, k =3, N =496) in older adults, dexmedetomidine in adults (RR =0.33, 95%CI =0.24 -0.45, k =7, N =1974), A2-adrenergic agonists after induction of anesthesia (OR = 0.28, 95%CI = 0.19 -0.40, k =10, N =669) in children. High certainty evidence did not support melatonergic agents in older adults for delirium prevention. Moderate certainty supported the effect of dexmedetomidine in adults and children (k =4), various non -pharmacological interventions in adults and older people (k =4), second -generation antipsychotics in adults and mixed age groups (k =3), EEG -guided anesthesia in adults (k =2), mixed pharmacological interventions (k =1), five other specific pharmacological interventions in children (k =1 each). In conclusion, our work indicates that effective treatments to prevent delirium differ across populations, settings, and age groups. Results inform future guidelines to prevent or treat delirium, accounting for safety and costs of interventions. More research is needed in non -surgical settings.
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| 33. |
- Vetrano, Davide L., et al.
(författare)
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Fostering healthy aging : The interdependency of infections, immunity and frailty
- 2021
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Ingår i: Ageing Research Reviews. - : Elsevier BV. - 1568-1637 .- 1872-9649. ; 69
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Forskningsöversikt (refereegranskat)abstract
- Untangling the interdependency of infections, immunity and frailty may help to clarify their roles in the maintenance of health in aging individuals, and the recent COVID-19 pandemic has further highlighted such priority. In this scoping review we aimed to systematically collect the evidence on 1) the impact of common infections such as influenza, pneumonia and varicella zoster on frailty development, and 2) the role played by frailty in the response to immunization of older adults. Findings are discussed under a unifying framework to identify knowledge gaps and outline their clinical and public health implications to foster a healthier aging. Twenty-nine studies (113,863 participants) selected to answer the first question provided a moderately strong evidence of an association between infections and physical as well as cognitive decline – two essential dimensions of frailty. Thirteen studies (34,520 participants) investigating the second aim, showed that frailty was associated with an impaired immune response in older ages, likely due to immunosenescence. However, the paucity of studies, the absence of tools to predict vaccine efficacy, and the lack of studies investigating the efficacy of newer vaccines in presence of frailty, strongly limit the formulation of more personalized immunization strategies for older adults. The current evidence suggests that infections and frailty repeatedly cross each other pathophysiological paths and accelerate the aging process in a vicious circle. Such evidence opens to several considerations. First, the prevention of both conditions pass through a life course approach, which includes several individual and societal aspects. Second, the maintenance of a well-functioning immune system may be accomplished by preventing frailty, and vice versa. Third, increasing the adherence to immunization may delay the onset of frailty and maintain the immune system homeostasis, beyond preventing infections.
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| 34. |
- Virgilio, Enrico, et al.
(författare)
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Diabetes Affects Antibody Response to SARS-CoV-2 Vaccination in Older Residents of Long-term Care Facilities : Data From the GeroCovid Vax Study
- 2022
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 45:12, s. 2935-2942
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVEType 2 diabetes may affect the humoral immune response after vaccination, but data concerning coronavirus disease 19 (COVID-19) vaccines are scarce. We evaluated the impact of diabetes on antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in older residents of long-term care facilities (LTCFs) and tested for differences according to antidiabetic treatment.RESEARCH DESIGN AND METHODSFor this analysis, 555 older residents of LTCFs participating in the GeroCovid Vax study were included. SARS-CoV-2 trimeric S immunoglobulin G (anti-S IgG) concentrations using chemiluminescent assays were tested before the first dose and after 2 and 6 months. The impact of diabetes on anti-S IgG levels was evaluated using linear mixed models, which included the interaction between time and presence of diabetes. A second model also considered diabetes treatment: no insulin therapy (including dietary only or use of oral antidiabetic agents) and insulin therapy (alone or in combination with oral antidiabetic agents).RESULTSThe mean age of the sample was 82.1 years, 68.1% were women, and 25.2% had diabetes. In linear mixed models, presence of diabetes was associated with lower anti-S IgG levels at 2 (β = −0.20; 95% CI −0.34, −0.06) and 6 months (β = −0.22; 95% CI −0.37, −0.07) after the first vaccine dose. Compared with those without diabetes, residents with diabetes not using insulin had lower IgG levels at 2- and 6-month assessments (β = −0.24; 95% CI −0.43, −0.05 and β = −0.30; 95% CI −0.50, −0.10, respectively), whereas no differences were observed for those using insulin.CONCLUSIONSOlder residents of LTCFs with diabetes tended to have weaker antibody response to COVID-19 vaccination. Insulin treatment might buffer this effect and establish humoral immunity similar to that in individuals without diabetes.
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- Zhou, Bin, et al.
(författare)
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Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants
- 2016
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Ingår i: The Lancet. - : Elsevier B.V.. - 0140-6736 .- 1474-547X. ; 387:10027, s. 1513-1530
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Tidskriftsartikel (refereegranskat)abstract
- Background: One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are aff ecting the number of adults with diabetes.Methods: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.Findings: We used data from 751 studies including 4372000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-17.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target.Interpretation: Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults aff ected, has increased faster in low-income and middle-income countries than in high-income countries.
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