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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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 2013; ●●: ●●–●●.

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.

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.

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 2013; ●●: ●●–●●.

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.

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.

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 2013; ●●: ●●–●●.

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.

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%.

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 2013; ●●: ●●–●●.

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.

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).

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 2013; ●●: ●●–●●.

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.

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.

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 2013; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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 2013; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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 2013; ●●: ●●–●●.

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.

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).

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 2013; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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).

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.

There was a significant improvement or stability of motor abilities in the PG; while these abilities decreased in the NPG. Geriatr Gerontol Int 2013; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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).

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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 (HbA_1c) <7.0%, blood pressure, body mass index, waist circumference and lipid profiles.

The proportion of older adults who achieved target HbA_1c (<7.0%) was 41.7%. A greater proportion of older adults aged ≥80 years significantly achieved the targets of HbA_1c <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 HbA_1c <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.

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 HbA_1c (<7.0%) and triglycerides (<1.7 mmol/L) than older adults aged 60–69 years. Geriatr Gerontol Int 2013; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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).

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.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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).

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.

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; ●●: ●●–●●.

Between-groups cross-sectional chart audits of 55 nursing home residents with dementia who died from cancer were carried out.

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.

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; ●●: ●●–●●.

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).

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

Safety and usefulness of EBUS-TBNA in older people were comparable with those in younger people. Geriatr Gerontol Int 2013; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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)

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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).

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

Illuminance and the physical and mental health of 24 elderly people living, with some assistance, in their homes in a prefecture in the Hokuriku region were studied over 3 days. Illuminance was quantified in accordance with the rotation of the earth, with day and night defined according to times of sunrise/sunset. Daytime mean illuminance and mean time exposed to seven levels of illuminance between 50 and 1000 lx during the day were calculated. Physical and mental health were assessed through interviews using the Instrumental Activities of Daily Living Scale, the Short-Form 36-Item Health Survey version 2, the Philadelphia Geriatric Center Morale Scale and the Geriatric Depression Scale-Short Form. Analysis of the correlation between illuminance and scores on mental and physical health was carried out.

The mean score for daytime illuminance was 687 lx. The mean time for daytime exposure to light above 400 lx was 59 min. A significant positive correlation was found between daytime mean illuminance, time exposed to light over 400 lx and life satisfaction. A significant negative correlation was found between time exposed to light over 400 lx and depression scores.

Findings uncovered for the first time the actual illumination experienced by frail elderly individuals living at home in Japan. The quantification of illuminance is important, because research has shown a relationship between mental health and illuminance exposure. Geriatr Gerontol Int 2012; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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”.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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; ●●: ●●–●●.

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.

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.

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 2012; ●●: ●●–●●.

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).

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.

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 2012; ●●: ●●–●●.

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.

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.

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 2012; ●●: ●●–●●.

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.

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.

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 2012; ●●: ●●–●●.

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.

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).

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 2012; ●●: ●●–●●.

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.

Compared with owned home, short-term rental home predicted a higher likelihood of incident of falls and activity limitation due to fear of falling.

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; ●●: ●●–●●.

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.

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).

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; ●●: ●●–●●.

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.

Participants who practised basic physical exercises improved in agility and aerobic endurance, and SSE improved balance tests.

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; ●●: ●●–●●.

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.

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).

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

Past physical function trajectories relate to later long-term care utilization. Geriatr Gerontol Int 2012; ●●: ●●–●●.

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.

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.

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 2012; ●●: ●●–●●.

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.

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).

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 2012; ●●: ●●–●●.

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.

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.

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 2012; ●●: ●●–●●.

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.

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

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 2012; ●●: ●●–●●.

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.

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%).

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 2012; ●●: ●●–●●.

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.

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.

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 2012; ••: ••–••.

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.

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).

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.