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This study aimed at investigating whether depression symptoms are associated with prevalent and incident physical frailty in Chinese older population. We analyzed data of 1168 older Chinese adults aged 70 and above in the aging arm of the Rugao Longevity and Aging Study (RuLAS). Depressive symptoms (Geriatric Depression Scale ≥ 6) were assessed by the Geriatric Depression Scale. Frailty was defined using Fried phenotype criteria at baseline and 3-year survey. At baseline, 8.9% of the participants had depression symptoms. The prevalence of pre-frailty and frailty were 34.5% and 5.9%, respectively. The percentages of depressive symptoms increase from robust (5.3%) to pre-frail (11.2%), and then to frail (31.9%) groups. After adjustments of multiple covariates, depressive symptoms were associated with both prevalent pre-frailty (OR = 1.75, 95% CI 1.08–2.84) and prevalent frailty (OR = 5.64, 95% CI 2.85–11.14) at baseline. At 3-year survey, 9.3% participants reported the development of frailty. After multiple adjustments, depressive symptoms were associated with a 2.79-fold (95% CI 1.09–7.10) increased risk of 3-year incident frailty. Depressive symptoms are associated with prevalent and incident frailty in Chinese older population. Together with the observations of the European populations, depressive symptoms may be a candidate risk factor of frailty.

Established measures of well-being rarely examine active lifestyle or religious behaviors. Though these could be assessed using individual measures, in older populations, the availability of a brief composite instrument with adequate psychometric properties would be desirable. Two studies were conducted to assess the psychometric properties (i.e., item adequacy, factorial structure, reliability and validity) of a new tool that was developed to self-rate personal satisfaction among Italian elders, the SODdisfazione dell’Anziano (SODA) Questionnaire. 135 young adults (mean age = 29.5 years, SD = 7.4) took part in Study 1, whereas Study 2 was carried out with 474 cognitively healthy 60–98-year-old people, that were asked to complete a battery of well-known well-being measures including the SODA one. Study 1 showed that the SODA questionnaire is a reliable and valid self-report tool defined by three factors, assessing satisfaction about physical and cognitive health, religious well-being, and satisfaction about time spent for leisure activities, respectively. Study 2 replicated the outcomes of Study 1, highlighting the factor structure of the SODA inventory. Moreover, a series of stepwise linear regression analyses pointed out what factors (i.e., education, physical health, social desirability, participation to outdoor leisure activities, gender, and age) predicted the variance relative to the SODA indexes. Current findings show the solid psychometric properties of SODA. SODA represents a brief, but reliable and valid, instrument for the assessment of satisfaction (focused on the state level) in late adult span.

To provide a comprehensive analysis of the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for renal cell carcinoma (RCC) in older patients. The RESURGE project is a multi-institutional dataset including 24 institutions worldwide collecting data of patients older than 75 years old who underwent RN or PN. Among three already published studies, RN patients were older (p

Background Studying physical activity (PA) trends in older populations and potential interventions for increasing PA is important, as PA is a factor in many age-related health outcomes such as chronic disease, premature mortality, physical function and injuries from falls. Objective measures of PA provide valuable information regarding the functional impact that ageing and chronic disease states may have on a patient’s life. Aims The purpose of this study was to test the validity of the AX3 PA monitor in an older population and to investigate whether the AX3 is a valid measure of distinct types or levels of activity in older people with a spectrum of mobility. Methods Validity of the AX3 PA monitor was tested using the RT3 as a means of cross-validating the AX3. Study participants wore both the AX3 and the RT3 accelerometers, positioned on their non-dominant side, whilst completing a series of standardised everyday activities. Results Although overall correlation was high (r > 0.8) between the RT3 and lower-limb-mounted AX3 counts, the correlation between the two devices was much stronger for walking activity than for any of the non-walking activities. Discussion Activity counts at all lower limb positions for the AX3 and RT3 were highly correlated. Correlation between wrist-mounted AX3 counts and lower limb AX3 counts was only moderate, and worsened when walking aids were in use. Conclusions The results of this study indicate that the AX3 monitor is a valid tool, which might be used to objectively measure walking activity in older functionally impaired adults, a welcome finding for this under-researched area.

Little is known about the effects of detraining in older adults, particularly those who regularly exercise. To determine the consequences of 3 months of cessation of a habitual supervised exercise on functional fitness and quality of life in aged adults and to explore the associations among those parameters. Thirty-eight women and 11 men (mean age 75.5 ± 5.7 years) took part in a physical exercise program for 9 months, followed by a 3-month detraining period. Participants completed physical function tests and questionnaires regarding the quality of life and leisure-time physical activity at the end of the exercise program (baseline) and 3 months later (detraining). After the detraining period, performance in the 8 Foot Up and Go test (p

Cardiac rehabilitation (CR) seeks to simultaneously improve several outcome parameters related to patient risk factors, exercise capacity and subjective health. A single score, the multiple outcome criterion (MOC), comprised of alterations in 13 outcome variables was used to measure the overall success of CR in an older population. As this success depends on the older patient's characteristics at the time of admission to CR, we attempted to determine the most important influences.The impact of baseline characteristics on the success of CR, measured by MOC, was analysed using a mixed model for 1,220 older patients (70.9 ± 7.0 years, 78.3 % men) who enrolled in 12 CR clinics. A multitude of potentially influential baseline patient characteristics was considered including sociodemographic variables, comorbidity, duration of hospital stay, exercise capacity, cardiovascular risk factors, emotional status, and laboratory and echocardiographic data.Overall, CR was successful, as indicated by the mean value of the MOC (0.6 ± 0.45; min -1.0, max 2.0; positive values denoting improvement, negative ones deterioration). Examples of association with negative MOC values included smoking (MOC -0.15, p0.001), female gender (MOC -0.07, p = 0.049), and a longer hospital stay (MOC -0.03, p = 0.03). An example of association with positive MOC value was depression score (MOC 0.06, p = 0.003). Further associations included maximal exercise capacity, blood pressure, heart rate and the rehabilitation centre attended.Our results emphasize the necessity to take into consideration baseline characteristics when evaluating the success of CR and setting treatment targets for older patients.

The current healthcare systems are built around the traditional paradigm of patients suffering from a single acute illness. They are, therefore, largely unprepared to face the increasing demands for health services arising from the expansion of an older population with specific medical needs related to multiple chronic disorders. As a consequence, the medical conditions of a large and growing segment of the older European population are not efficiently managed by the available healthcare services. In the context of an aging population, policy makers such as the European Commission and European Institutions, such as the European Medicines Agency (EMA), devote time and resources to study and accompany the need of the aging population. The EMA recognizes the importance of making sure that the needs of the Elderly are considered during development, approval, and use of new medicines, and, therefore, engages with healthcare professional organisations. The Sarcopenia and Physical Frailty in Older People: Multicomponent Intervention Strategies (SPRINTT) is the obvious result of these strategies. The present article describes the SPRINTT workpackage activities aimed at engaging the scientific discussion on the physical frailty and sarcopenia with the EMA as one of its interlocutor, acknowledging the need to collaborate on this topic to foster a productive dialogue.

Loss of power has been demonstrated to have severe functional consequences to perform physical daily living tasks in old age. This study aimed to assess how moment and velocity were affected for each joint of the lower limbs during squat jumping for older men in comparison with young adults. Twenty-one healthy older men (74.5 ± 4.6 years) and 22 young men (21.8 ± 2.8 years) performed maximal squat jumps. Inverse dynamics procedure was used to compute the net joint power, moment and velocity produced at the hip, knee and ankle joints. Vertical jump height of the elderly was 64 % lower than the young adults. The maximal power of the body mass center (P max bmc ) was 57 % lower in the older population. For the instant at P max bmc , the vertical ground reaction force and the vertical velocity of the body mass center were 26 % and 35 % less in the older adults than in the young adults, respectively (p

There is a relationship between high levels of inflammatory markers and low adhesion to the practice of physical activity in the older population. The objective of the present study was to compare the effect of two types of exercise programs, i.e., aerobic training and aerobic plus resistance training on the plasma levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) of elderly hypertensive subjects. Hypertensive older volunteers in use of antihypertensive drugs were randomized to three groups: aerobic group (AG), resistance and aerobic group (RAG) and control group (CG). Training lasted 10 weeks, with sessions held three times a week. Blood samples were collected before training and 24 h after completion of the 30 sessions for the determination of serum IL-6 and TNF-α levels. Body mass index was obtained before and after 10 weeks. After intervention, BMI values were lower in AG and RAG compared to CG (p < 0.001), IL-6 was reduced in AG compared to CG (p = 0.04), and TNF-α levels were lower only in RAG compared to CG (p = 0.01). Concluding, both types of training were effective in reducing BMI values in hypertensive older subjects. Aerobic exercise produced the reduction of plasma IL-6 levels. However, the combination of aerobic and resistance exercise, which would be more indicated for the prevention of loss of functionality with aging, showed lower TNF-α mediator after training than control group and a greater fall of TNF-α levels associated to higher BMI reduction.

This document is a Joint Position Statement by Gruppo Italiano di OrtoGeriatria (GIOG) supported by Societa Italiana di Gerontologia e Geriatria (SIGG), and Associazione Italiana Psicogeriatria (AIP) on management of hip fracture older patients. Orthogeriatric care is at present the best model of care to improve results in older patients after hip fracture. The implementation of orthogeriatric model of care, based on the collaboration between orthopaedic surgeons and geriatricians, must take into account the local availability of resources and facilities and should be integrated into the local context. At the same time the programme must be based on the best available evidences and planned following accepted quality standards that ensure the efficacy of the intervention. The position paper focused on eight quality standards for the management of hip fracture older patients in orthogeriatric model of care. The GIOG promotes the development of a clinic database with the aim of obtaining a qualitative improvement in the management of hip fracture.

Research has shown increased prevalence rates over time in several health indicators in the older population. These increases have not been accompanied by corresponding increases in ADL and IADL disability. As disability and other health indicators follow different trends, the associations between them may change. And, as both health and disability also appear to follow different trends for men and women, we can expect gender differences in the associations. We examined gender differences in how objective tests of function, as well as self-reported health and function indicators, were associated with ADL/IADL in 1992 and 2002.Data came from the Swedish Panel Study of Living Conditions among the Oldest Old (SWEOLD), a nationally representative interview survey of persons aged 77+.Compared with men, women had significantly higher prevalence rates for most health indicators in both survey years, but there were no significant gender differences in ADL/IADL limitations. Prevalence rates increased significantly between 1992 and 2002 for all health indicators, but not for ADL/IADL. Most of the associations between ADL/IADL and other health indicators were stronger for men than for women. The overall pattern found was that associations have become weaker for women over time; for men, the picture was mixed.The changing associations between ADL/IADL and other health indicators may reflect complex interplay between changes in several social and environmental factors, some of which may be modifiable. ADL/IADL appear to reflect different dimensions of health and different kinds of needs for men and women.

Background and aims: The prevalence of knee and hip symptoms varies from study to study, or is unknown. The goals of this study were to determine the prevalence of these symptoms, of diagnosed osteoarthritis and the use of prostheses, by age and gender, in a sample of the general older population. Methods: We mailed a questionnaire to 11,002 people aged 60 to 90 years who were selected by stratified random sampling. The questionnaire included questions on pain, functional limitations, diagnosed osteoarthritis, previous operations on either or both joints, and sociodemographic data. Descriptive statistics were performed. Results: From 10,150 people who fulfilled the selection criteria, 74.6% answered the questionnaire. Up to 49.2% of the subjects reported pain in either knee or hip or both, with pain in the knee reported more frequently (38.3%) than the hip (23.8%). Functional limitations were present in 51.6% of respondents, with 42.5% having limitations in the knees and 27.7% in the hips. The symptoms increased with age and were more prevalent in women. About 6.6% of respondents reported that they had already had prosthesis implant (hip 3.9%; knee 2.6%). The presence of a hip prosthesis was slightly lower in women than in men and more women had a knee prosthesis. Physicians had already diagnosed osteoarthritis in 38.5% of the sample, 19.4% of the hip and 31% of the knee. Conclusions: The prevalence of pain symptoms is relatively high among older people, more often in the knee and, in both pints, more often in women, but the rate of prosthetic surgeries was low, which means that additional studies are necessary to gain insight into the healthcare needs of the population.

Falls and their consequences constitute serious health problems in the older population. The aim was to study predisposing factors for falls among older people in geriatric care settings, focusing on drugs.This population-based study, with a cross-sectional design, analysed all geriatric care settings, comprising 68 residential care facilities, 31 nursing homes, 66 group dwellings for people with dementia, seven rehabilitation/short-stay units, two somatic geriatric and two psychogeriatric clinics, in the county of Västerbotten; 3604 residents with a mean age of 83.3+/-7.0 (65-103) years (68% women) were included. The residents were assessed by means of the Multi-Dimensional Dementia Assessment Scale (MDDAS) that measures, for example, mobility, paresis, vision, hearing, functions of activities of daily living (ADL), and behavioural and psychiatric symptoms. Drug consumption and falls during the previous week were recorded.Three hundred and one residents (8.4%) had sustained a fall at least once during the preceding week. Multivariate analyses showed that a history of falls, the ability to get up from a chair, the need for a helper when walking, pain, cognitive impairment, and use of neuroleptics or antidepressants were all associated with being a faller. Among the antidepressants, selective serotonin reuptake inhibitors (SSRIs) but not serotonin and noradrenalin reuptake inhibitors (SNRIs) were associated with falls. Cholinesterase inhibitors were not associated with falls.Like functional and cognitive impairment, treatments with antidepressants and neuroleptics are predisposing factors for falls in older people in residential care. However, there seem to be differences between subgroups among these drugs and, from the perspective of fall prevention, SNRIs rather than SSRIs should perhaps be preferred in the treatment of depression in older people.

Background and aims: Hip and knee replacements have become increasingly common in the older population but the prevalence of these procedures and the potential impact on functioning towards the end of life have not been previously described. The aim of this study was to estimate the rates and distribution of hip and knee joint replacements and hip implants (surgical pins, screws, rods, plates, etc.) in people aged 65 and over who died in the US in 1993, and to measure mobility outcomes during their last year of life. Methods: Data were drawn from the 1993 National Mortality Followback Survey; 7684 deaths in people aged 65 years or over were included. From these data full informant interviews were available for 6586 (86%). Three hundred and forty-four decedents had hip joint replacements, 357 had hip implants, and 102 had knee joint replacements. Replicate methods were used to obtain weighted estimates for all decedents in the 1993 US base population. Results: Of female and male decedents, 15.5% (95% CI: 14.3–16.7) and 6.1% (95% CI: 3.9–8.2), respectively, had received the studied devices. About 80% of these had been implanted more than a year before death. There were large differences in the risks of receiving a hip joint replacement or a hip implant depending on gender, education and race. About 60% of recipients either had no difficulty in getting around their own homes during the last year of life or had difficulty lasting less than 6 months. Conclusions: Implanted hip and knee devices were common in older people who died in the US in 1993. Large sociodemographic differences in those who received vs those who did not were present at the end of life. While difficulty in walking is the main indication for joint replacements, a majority of those receiving replacements experienced less than 6 months of mobility difficulties in their own homes during the last year of their lives.

Latin America, with a population of 31 million people over 60 years of age that will triple in the next 33 years to 93.3 million, will be characterized as a region of rapid aging. For example, Brazil will increase its older population from 13 .9 million by the year 2000 to 31.6 million by the year 2025, and Mexico from 6.6 million to 17.5 million in the same period. Those countries with the greatest elderly population densities will contain ove r half of the persons in this age group in all of Latin America. Whereas the growth rate of the older population in developed countries is slowing, in developing countries it is increasingvery rapidly so that by the year 2000, 62% and by the year 2025, 72% of the world's elderly people will be in developing countries. Latin America alone, however, contains only 6% of the total world-wide elderly population, and will reach 8% by 2025. Nonetheless, the aging of this region will accelerate rapidly. The transition will occur within the next 35 years, unlike the experience of developed nations which took 1000 years to reach the same age structure. This means that Latin America will not have much time to prepare for this phenomenon. It is not difficult to explain the demographic forces behind this age transition. The death rate began to drop at the beginning of the century from rates of approximately 40 per 1000 to the currently much lower figures , such as those of Mexico (6.2) and Chile (6.4). These death rates declined primarily because of the reduction in infant mortality, with the most rapid decline following the Second World War. The refore , these countries together with Colombia , in which the death rate decreased the most, also have the highest birthrates (26 , 23, 26 per thousand). The resulting demographic explosion of young people, especially in the 1950s, will later create an equal demographic explosion of older people early in the next century.