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Background: Unhealthy dietary habits are an important risk factor for cardiovascular disease (CVD) and adopting a healthy diet is a central recommendation in CVD prevention. This study assessed the dietary habits of patients with established CVD, their compliance to dietary guidelines, and the relationship between guideline-compliance and recurrent cardiovascular event risk. Methods: 2656 patients with established CVD from the Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease (UCC-SMART) prospective cohort study, were included between 1996 and 2022. Data on dietary intake was retrospectively collected for all participants in December 2022 using a 160-item food frequency questionnaire. Compliance with dietary guidelines was quantified using an amended version of the Dutch Healthy Diet 2015 (DHD-15) index (range: 0–135). Cox proportional hazard models were used to quantify the relationship with cardiovascular events (stroke and myocardial infarction). Results: Among 2656 CVD patients (77% male, mean age 59 ± 9 years), median energy intake was 1922 [IQR: 1536–2351] kcal/day. The median DHD-15 index was 81.7 [IQR 71.2–92.0], with high compliance scores for recommendations on legumes and fish, and low scores for recommendations on whole grains, red meat, processed meat, and dairy. A higher DHD-15 score was associated with lower stroke risk (HR 0.78, 95% CI 0.66–0.92 per 10-point increase) but not with myocardial infarction. Conclusion: Compliance with dietary guidelines was suboptimal in patients with established CVD. High compliance was associated with a clinically significant reduction in stroke risk in patients with established CVD, emphasizing the importance of dietary counseling. [ABSTRACT FROM AUTHOR]

Background and purpose: Risk factors for stroke differ between women and men in general populations. However, little is known about sex differences in secondary prevention. We investigated if sex interacted with modifiable risk factors for stroke in a large arterial disease cohort. Methods: Within the prospective UCC-SMART study, 13,898 patients (35% women) with atherosclerotic disease or high-risk factor profile were followed up to 23 years for stroke incidence or recurrence. Hypertension, smoking, diabetes, overweight, dyslipidemia, high alcohol use, and physical inactivity were studied as risk factors. Association between these factors and ischemic and hemorrhagic stroke incidence or recurrence was studied in women and men using Cox proportional hazard models and Poisson regression models. Women-to-men relative hazard ratios (RHR) and rate differences (RD) were estimated for each risk factor. Left-truncated age was used as timescale. Results: The age-adjusted stroke incidence rate was lower in women than men (3.9 vs 4.4 per 1000 person-years), as was the age-adjusted stroke recurrence rate (10.0 vs 11.7). Hypertension and smoking were associated with stroke risk in both sexes. HDL cholesterol was associated with lower stroke incidence in women but not in men (RHR 0.49; CI 0.27–0.88; and RD 1.39; CI − 1.31 to 4.10). Overweight was associated with a lower stroke recurrence in women but not in men (RHR 0.42; CI 0.23–0.80; and RD 9.05; CI 2.78–15.32). Conclusions: In high-risk population, sex modifies the association of HDL cholesterol on stroke incidence, and the association of overweight on stroke recurrence. Our findings highlight the importance of sex-specific secondary prevention. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To evaluate the health-related quality of life (HR-QoL) trajectory during the first year after cancer treatment in patients with resectable primary colon cancer. Findings: On average, HR-QoL recovered to baseline level one year after start of treatment. However, 1 out of 7 patients, particularly older patients who received adjuvant chemotherapy, were at risk of non-resilience or a late decline in HR-QoL. Message: Our findings provide insight in risks for a permanent loss of HR-QoL which may support patients and physicians in the treatment decision-making process to optimize tailored cancer care. Purpose: This study aims to evaluate quality of life trajectory during the first year after surgical treatment in patients with resectable primary colon cancer. Methods: Patients with resectable primary colon cancer diagnosed between 2013 and 2019 who received surgical treatment and adjuvant chemotherapy if indicated were selected from the Prospective Dutch ColoRectal Cancer cohort study (PLCRC). Health-related quality of life (HR-QoL) was assessed using EORTC-QLQ-C30 questionnaire before surgery, and three and twelve months after surgery. HR-QoL scores varied between 0 and 100 and outcomes were compared according to age (< 70 years, ≥ 70 years), comorbidity (yes, no) and treatment type (adjuvant chemotherapy, surgical treatment only). The extent of resilience, defined as a recovery of HR-QoL to baseline level after a clinically relevant decline in HR-QoL at months, was calculated twelve months post-surgery. Results: For all 458 patients, the mean age was 66.4 years (SD 9.5), 40% were aged 70 years and older and 68% were men. Baseline level of HR-QoL summary score was relatively high with a mean of 87.9 (SD 11.5), and did not significantly differ between older and younger patients. The strongest decline of HR-QoL compared to baseline was observed at three months with a gradual recovery over time. Fourteen percent of all patients were non-resilient or showed a late decline at twelve months post-surgery. Compared to younger patients, older patients who received adjuvant chemotherapy were less resilient (respectively, 53 and 32%, p = 0.07) and at risk of a late decline in HR-QoL 1 year post-surgery (respectively, 3% versus 16%, p = 0.02). Comorbidity status had no significant impact on the HR-QoL trajectory. Conclusion: Colon cancer treatment was associated with a decline in HR-QoL three months post-surgery, but most patients return to baseline level within twelve months. Still, particularly older patients who received adjuvant chemotherapy were less resilient and at risk of a late decline in HR-QoL. These data could help in patients counselling regarding colon cancer treatment. [ABSTRACT FROM AUTHOR]

Purpose: We set out to determine study objectives of clinical trials which included older patients with the four most common malignancies, to assess the extent to which the inclusion of patient-related outcomes (PROs) has changed over the last fifteen years. Method: A search of the National Institutes of Health clinical trial registry was performed to identify currently recruiting or completed phase II or III clinical trials started between 2005 and 2020, which addressed chemotherapy or immunotherapy in patients aged > 65 years with the four most common solid malignancies. Trial characteristics and study objectives were extracted from the registry website. Results: Compared to disease- and treatment-related outcomes, PROs were the least measured outcomes. Of the 1,663 trials, PROs were addressed in only 21% of all trials, in which quality of life as primary objective was found in less than 1% of all trials. Compared to all trials, trials exclusively for older patients addressed more often PROs (respectively, 30% vs 21%, p < 0.001). Over the last fifteen years, there was an incremental trend in the reporting of PROs from 17 to 24% of all trials (p = 0.007). Conclusion: Despite a slight incremental trend over the past 15 years, PROs appear to be underrepresented in clinical trials which include patients with a solid malignancy. In order to provide physicians and older patients with cancer realistic information about the impact of chemo- or immunotherapy on quality of life or functioning, researchers should strongly consider including PROs in their future clinical trials. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To evaluate the prognostic value of a shortened screening instrument based on the Dutch national Safety Management System [Veiligheidsmanagementsysteem (VMS)] guidelines for older emergency department patients. Findings: A high VMS-score is associated with elevated risks of hospitalization and 90-day mortality. A prediction model for 90-day mortality, which incorporated the VMS-score, showed promising results. Message: The shortened VMS-based screening tool can be a helpful instrument to identify frail older emergency department patients. Purpose: It is important to identify which older patients attending the emergency department are at risk of adverse outcomes to introduce preventive interventions. This study aimed to assess the prognostic value of a shortened screening instrument based on the Dutch national Safety Management System [Veiligheidsmanagementsysteem (VMS)] guidelines for adverse outcomes in older emergency department patients. Methods: A cohort study was performed including patients aged 70 years or older who visited the emergency department. Adverse outcomes included hospital admission, return emergency department visits within 30 days, and 90-day mortality. The prognostic value of the VMS-score was assessed for these adverse events and, in addition, a prediction model was developed for 90-day mortality. Results: A high VMS-score was independently associated with an increased risk of hospital admission [OR 2.26 (95% CI 1.32–3.86)] and 90-day mortality [HR 2.48 (95% CI 1.31–4.71)]. The individual VMS-questions regarding history of delirium and help in activities of daily living were associated with these outcomes as well. A prediction model for 90-day mortality was developed and showed satisfactory calibration and good discrimination [AUC 0.80 (95% CI 0.72–0.87)]. A cut-off point that selected 30% of patients at the highest risk yielded a sensitivity of 67.4%, a specificity of 75.3%, a positive predictive value of 28.5%, and a negative predictive value of 94.1%. Conclusion: The shortened VMS-based screening instrument showed to be of good prognostic value for hospitalization and 90-day mortality. The prediction model for mortality showed promising results and will be further validated and optimized. [ABSTRACT FROM AUTHOR]

Patients with chronic kidney disease (CKD) are more likely to experience falls and fractures due to renal osteodystrophy and the high prevalence of risk factors for falls. However, it is not well established how great the risk is for falls and fractures for the different stages of CKD compared to the general population. The objective of this systematic review and meta-analysis was to assess whether, and in which degree, CKD was associated with falls and fractures in adults. A systematic search in PubMed, Embase, CINAHL, and The Cochrane Library was performed on 7 September 2018. All retrospective, cross-sectional, and longitudinal studies of adults (18 years of older) that studied the association between CKD, fractures, and falls were included. Additional studies were identified by cross-referencing. A total of 39 publications were included, of which two publications assessed three types of outcome and four publications assessed two types of outcome. Ten studies focused on accidental falling; seventeen studies focused on hip, femur, and pelvis fractures; seven studies focused on vertebral fractures; and thirteen studies focused on any type of fracture without further specification. Generally, the risk of fractures increased when kidney function worsened, with the highest risks in the patients with stage 5 CKD or dialysis. This effect was most pronounced for hip fractures and any type of fractures. Furthermore, results on the association between CKD and accidental falling were contradictory. Compared to the general population, fractures are highly prevalent in patients with CKD. Besides more awareness of timely fracture risk assessment, there also should be more focus on fall prevention. [ABSTRACT FROM AUTHOR]

Objectives: Sarcopenia is known as a geriatric syndrome associated with increased disability and decreased survival in elderly patients. In oncological patients, pretreatment low skeletal muscle mass (SMM), sometimes referred to as sarcopenia, is an emerging negative prognostic factor. Commonly, only SMM is assessed in cancer patients. Sarcopenia is defined as the combination of low SMM and low muscle function (MF). We investigated the relation between SMM, MF, sarcopenia (SMM and MF combined), and overall survival (OS) in a group of elderly patients with head-and-neck squamous cell carcinoma (HNSCC). Patients and methods: A retrospective study in elderly HNSCC patients treated between 2015 and 2018 was performed. The prognostic value of SMM and MF seperately, and sarcopenia was investigated. Results: Eighty-five patients were included of whom 48.2% had sarcopenia. The median OS was significantly worse for patients treated with curative intent with sarcopenia (12.07 months; IQR 3.64–21.82) compared to patients without sarcopenia (13.60 months; IQR 5.98-27.00) (HR 2.80; 95% CI 1.14–6.88; p = 0.03). SMM and MF seperately were not significant predictors of OS. Conclusion: Sarcopenia is associated with impaired OS in elderly HNSCC patients. Sarcopenia, defined as the combination of low SMM and low MF, appears to be a better predictor of OS than low SMM or low MF separately. [ABSTRACT FROM AUTHOR]

Falls are under-recognized as adverse drug events.Healthcare professionals are reluctant to withdraw fall-risk-increasing medications.The EuGMS Task and Finish group on fall-risk-increasing drugs (FRIDs) proposes in this paper its recommendations on dissemination of knowledge about, management of, and future research on FRIDs. Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper. [ABSTRACT FROM AUTHOR]

Background: Although the incidences of osteoporosis and atherosclerosis increase with age, there is growing evidence that the coincidental occurrence of both diseases may be independent of age. In general, studies in men are scarce and results are inconsistent.Objective: to investigate the relationship between atherosclerosis and bone mineral density, and the influence of insulin sensitivity and low grade inflammation on this relationship in 332 men without CVD.Methods: Aortic Pulse wave velocity (PWV), augmentation index (AIX) and measurements of carotid intima media thickness (CIMT) were assessed. BMD measurements were performed with dual-X-ray absorptiometry (DEXA), subcutaneous fat by ultrasonography. Serum concentrations of lipids, hsCRP, glucose and insulin were measured. Insulin sensitivity was calculated by use of the quantitative insulin sensitivity (QUICKI). We used multivariate linear regression models to examine the association of hsCRP, insulin sensitivity, PWV, Aix, CIMT with BMD.Results: A higher CIMT was significantly associated with higher BMD after multivariate adjustment (β 99.7; p=0.02). Further adjustment for weight attenuated the estimates towards non-significant. No association was found between PWV or AIX and BMD. Lower insulin sensitivity was associated with higher BMD (β -645.1; p<0.01). After adjustment for weight this association was no longer significant. A similar effect was seen for the association between hsCRP and BMD.Conclusion: In this population of healthy, non-obese, men without a history of cardiovascular disease the positively association between cardiovascular parameters and BMD was mainly explained by weight, suggesting that in this population weight plays a protective role in the development of osteoporosis [ABSTRACT FROM AUTHOR]

Older, more vulnerable individuals are increasingly often described in the literature as being frail. Because frailty is often perceived as being undesirable and associated with high health risks, it is important to establish how we can predict, recognize, and treat frailty. Frailty is predisposed by advancing age in combination with physiological deterioration, especially a loss of muscle mass and bone density. Although the symptoms of frailty are diverse, the most common symptoms are a deterioration of activities of daily living (ADL), mobility, nutritional status, cognition, and endurance. The consequences of frailty are institutionalization, morbidity, and mortality. The main determinants of frailty are limitations in ADL, weight loss, diminished mobility or patterns of activity, lowered serum cholesterol level, and sensitivity to change. There is no gold standard for the measurement of frailty, and often studies use a combination of instruments. Although a couple of multidimensional instruments have been developed to measure frailty in its totality, the reliability and validity of these instruments have yet to be established. Successful interventions against frailty include increasing muscle strength through training and individualized recommendations made on the basis of an extensive geriatric assessment. [ABSTRACT FROM AUTHOR]

Serum testosterone levels decline significantly with aging and this has been associated with reduced sexual function. We have conducted a double-blind, randomized, placebo-controlled trial to investigate the effect of testosterone supplementation on sexual function in 237 elderly men with a testosterone level <13.7 nmol l−1. Participants were randomly assigned to receive oral testosterone undecanoate or a placebo for 6 months. A total of 207 men completed the study. After treatment, there were no differences in scores on sexual function between the groups. Subanalysis showed that although a baseline testosterone level in the lowest tertile was associated with significantly lower scores for sexual fantasies, desire of sexual contact and frequency of sexual contact, supplementation of testosterone did not result in improvement on any of these items in this group. In conclusion, the findings do not support the view that testosterone undecanoate supplementation for 6 months to elderly men with low-normal testosterone concentrations favorably affects sexual function.International Journal of Impotence Research (2009) 21, 129–138; doi:10.1038/ijir.2009.5; published online 19 February 2009 [ABSTRACT FROM AUTHOR]