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Background: In randomized clinical trials, compared to Internal Medicine, admission to Geriatrics improved clinical outcomes of frail older patients accessing the Emergency Department (ED). Whether this advantage is maintained also in the "real world" is uncertain. We compared long-term survival of patients admitted to Geriatrics or Internal Medicine wards after stratification for background risk and across a variety of discharge diagnoses., Method: Data were derived from the "Silver Code National Project," an observational study of 180,079 unselected 75+ years old persons, admitted via the ED to Internal Medicine (n = 169,717, 94.2%) or Geriatrics (n = 10,362) wards in Italy. The Dynamic Silver Code (DSC), based on administrative data, was applied to balance for background risk between participants admitted to Geriatrics or Internal Medicine., Results: One-year mortality was 33.7%, lower in participants discharged from Geriatrics (32.1%) than from Internal Medicine (33.8%; p < .001), and increased progressively across four DSC risk classes (p < .001). Admission to Geriatrics was associated with survival advantage in DSC class II to IV participants, with HR (95% CI) of 0.88 (0.83-0.94), 0.86 (0.80-0.92), and 0.92 (0.86-0.97), respectively. Cerebrovascular diseases, cognitive disorders, and heart failure were the discharge diagnoses with the widest survival benefit from admission to Geriatrics, which was mostly observed in DSC class III., Conclusions: Admission to Geriatrics may provide long-term survival benefit in subjects who, based on the DSC, may be considered at an intermediate risk. Specific clinical conditions should be considered in the ED to improve selection of patients to be targeted for Geriatrics admission., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To assess the association of the anticholinergic medication burden with hospitalization and mortality in nursing home elderly patients and to investigate the role of coronary artery disease (CAD)., Design: Longitudinal (5-year) retrospective observational study., Setting: Nursing homes in Italy., Participants: A total of 3761 nursing home older residents., Measurements: A comprehensive clinical and functional assessment was carried out through the interRAI long-term care facility instrument. The anticholinergic burden was assessed through the anticholinergic cognitive burden (ACB) scale. Occurrence of hospitalization/all-cause mortality was the primary composite outcome. First hospitalization and all-cause mortality were the secondary outcomes of the study. Hazard ratios (HRs) and subdistribution HRs were obtained through Cox and competing risk (death as competing event for hospitalization) models., Results: Within the sample (mean age 83 ± 7 years; 72% females) the incidence rate of the primary outcome was 10/100 person-year. After adjusting for potential confounders and compared with participants with an ACB of 0, those with an ACB of 1 [HR 1.46; 95% confidence interval (CI) 1.12-1.90] and ABC of 2+ (HR 1.41; 95% CI 1.11-1.79) presented an increased risk of developing the primary outcome. After stratification, the risk for the primary outcome increased along with the anticholinergic burden, only for participants affected by CAD (HR 1.53; 95% CI 0.94-2.50 and HR 1.71; 95% CI 1.09-2.68 for the ACB of 1 and ACB of 2+ groups). An ACB score of 2+ was marginally associated with first hospitalization, considering death as a competing risk, only for those with CAD (subdistribution HR 3.47; 95% CI 0.99-12.3)., Conclusions: Anticholinergic medication burden is associated to hospitalization and all-cause mortality in institutionalized older adults. CAD increases such risk. The effectiveness and safety profile of complex drug regimens should be reconsidered in this population., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the relationship between midarm muscle circumference (MAMC) and physical performance, muscle strength, functional status and survival in persons aged 80 years or older., Methods: Data are from the baseline evaluation of the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study) (n = 357). MAMC was calculated taking into account the mid upper arm circumference and the triceps skinfold thickness of the right arm. Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4-m walking speed test, the balance test and the chair stand test. Analyses of covariance were performed to evaluate the relationship between different MAMC levels and physical function. Cox proportional regression models were used to estimate crude and adjusted hazard ratios and 95% confidence intervals of death by MAMC levels., Results: After adjustment for potential confounders - which included age, gender, living alone, sensory impairments (hearing and vision), body mass index, albumin and cholesterol - physical performance and function (which were measured using the 4-m walking speed test, the Short Physical Performance Battery score, the hand grip strength), improved significantly as MAMC increased. Compared with those in the low MAMC tertile, subjects in the high MAMC tertile had a lower risk of death (adjusted hazard ratio (HR) 0.45; 95% Confidence Interval (CI) 0.23-0.87)., Conclusions: The present study suggests that among community-dwelling old-old subjects muscle mass may be positively related to functional performance and survival., (Copyright 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Elevated systemic levels of myeloperoxidase (MPO) have been associated with unfavourable clinical outcomes. In the present study, we evaluate the impact of MPO, a pro-oxidant enzyme that catalyzes the initiation of lipid peroxidation and affects nitric oxide levels, on the risk of all-cause mortality in a large population of frail octogenarians and nonagenarians living in community., Methods: We analyzed data from the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study), a prospective cohort study that collected data on all individuals aged 80 years and older living in a mountain community (n = 363). The main outcome measure was the risk of death after 4 years of follow-up. Participants were divided into three groups based on MPO tertiles: lower tertile < or = 61.5 microg/L (n = 120), intermediate tertile 61.6-140.6 microg/L (n = 120), and higher tertile > or = 140.7 microg/L (n = 123)., Results: A total of 150 deaths occurred during 4-years follow-up. The mean MPO level was 170.8 + or - 177.5 microg/L among those who died compared with 135.4 + or - 142.4 microg/L among survivors (p = .03). Individuals in the highest MPO tertile had higher risk of mortality (40% [60/123]) compared with those in the lower tertile (26% [39/120]). After adjusting for potential confounders, compared with participants in the lower tertile, those in the higher tertile had a hazard ratio for mortality of 1.97 (95% confidence interval: 1.02-3.80)., Conclusion: Our results obtained from a representative sample of very old and frail elderly individuals expand the knowledge that low levels of MPO are associated with better survival.

Background: Sarcopenia, the age-related loss of muscle mass, may not be an isolated process but is associated with an increase in fat mass. The aim of this study was to estimate the mortality risk of sarcopenia in the presence or absence of obesity., Methods: Data are from 934 participants aged 65 years or older, enrolled in the "Invecchiare in Chianti" study, and followed for 6 years. At baseline, a peripheral quantitative computerized tomography (pQCT) scan was performed on all participants to evaluate the muscle density, and the muscular and fat cross-sectional areas of the calf. Walking speed was measured on a 7-m track. Cox proportional hazard models were performed to estimate the association of pQCT measures (per 1 standard deviation increase) with mortality., Results: Unadjusted analyses showed significant associations of muscle density (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.69-0.88), muscle area (HR 0.75, 95% CI 0.66-0.86), and fat area (HR 0.82, 95% CI 0.73-0.92) with mortality. After adjustment for potential confounders, no body composition parameter was significantly associated with mortality. Walking speed (used as a reference measure to verify whether the negative results were due to peculiarities of the study sample) confirmed its well-established association with mortality risk (HR 0.73, 95% CI 0.60-0.88). These results did not change after the analyses were stratified according to sarcopenia and body mass index groups, and restricted to participants with frailty or a high inflammatory profile., Conclusions: Calf skeletal muscle and fat mass are not significant risk factors for mortality in community-dwelling older adults. Walking speed confirmed to be a powerful predictor of health-related events.

Background: Physical function measures have been shown to predict negative health-related events in older persons, including mortality. These markers of functioning may interact with the self-rated health (SRH) in the prediction of events. Aim of the present study is to compare the predictive value for mortality of measures of physical function and SRH status, and test their possible interactions., Methods: Data are from 335 older persons aged >or= 80 years (mean age 85.6 years) enrolled in the "Invecchiamento e Longevità nel Sirente" (ilSIRENTE) study. The predictive values for mortality of 4-meter walk test, Short Physical Performance Battery (SPPB), hand grip strength, Activities of Daily Living (ADL) scale, Instrumental ADL (IADL) scale, and a SRH scale were compared using proportional hazard models. Kaplan-Meier survival curves for mortality and Receiver Operating Characteristic (ROC) curve analyses were also computed to estimate the predictive value of the independent variables of interest for mortality (alone and in combination)., Results: During the 24-month follow-up (mean 1.8 years), 71 (21.2%) events occurred in the study sample. All the tested variables were able to significantly predict mortality. No significant interaction was reported between physical function measures and SRH. The SPPB score was the strongest predictor of overall mortality after adjustment for potential confounders (per SD increase; HR 0.64; 95%CI 0.48-0.86). A similar predictive value was showed by the SRH (per SD increase; HR 0.76; 95%CI 0.59-0.97). The chair stand test was the SPPB subtask showing the highest prognostic value., Conclusion: All the tested measures are able to predict mortality with different extents, but strongest results were obtained from the SPPB and the SRH. The chair stand test may be as useful as the complete SPPB in estimating the mortality risk.

Objectives: To assess the association between chewing problems and risk of mortality in an older population receiving home care in Europe., Design: Retrospective cohort study., Setting: Eleven European countries., Participants: Two thousand seven hundred fifty-five older adults (mean age+/-standard deviation 82.2+/-7.2) in home care., Measurements: Data were collected using the Minimum Data Set for Home Care. Study personnel recorded chewing problems (inability to chew food easily and without pain or difficulties, regardless of cause) that presented in the last 3 days before baseline assessment. Data on mortality were collected over a 1-year period., Results: Three hundred ninety-five participants (14.3%) presented with chewing problems. One-year mortality differed significantly according to presence of chewing problems; 303 of 2,361 (12.8%) without chewing problems (crude incident rate per person-year (p-y)=0.15) and 80 of 394 (20.3%) participants with chewing problems (crude incident rate per p-y=0.24) died during follow-up. After adjusting for potential confounders, the risk of death was significantly higher for participants with chewing problems (adjusted hazard ratio (HR)=1.45, 95% confidence intervals (CI)=1.05-1.99). This association remained after exclusion of participants with cognitive impairment (adjusted HR=1.50, 95% CI=1.03-2.20) and those with unintended weight loss (adjusted HR=1.62, 95% CI=1.12-2.34)., Conclusion: In older adults in home care in Europe, chewing problems are associated with greater risk of mortality.

Background: The authors describe the prevalence of moderate-intensity physical activity in a population of older persons living in the community. In addition, they explore the relationship between physical activity and mortality., Methods: In this longitudinal observational study, the authors analyzed data from patients admitted to home care programs collected as part of the Italian Silver Network Home Care project. Twelve home health agencies participated in the project, which evaluated the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 2757 patients were enrolled in the current study. The primary outcome measures were the prevalence of 2 or more hours per week of physical activity and survival., Results: Fewer than 20% of patients had regular physical activity. During a median follow-up period of 10 months from the initial MDS-HC assessment, 442 (16%) patients died. After adjusting for sex, physical and cognitive disability, and all potential risk factors for death, active patients were less likely to die compared with those with no or very low-intensity physical activity (relative risk ratio [RR], 0.51; 95% confidence interval [CI], 0.35-0.73). This inverse relationship was also significant in patients aged 80 years and older (RR 0.55; 95% CI, 0.32-0.95)., Conclusions: Physical activity is associated with a significantly lower risk of all-cause mortality. The current findings support the possibility that moderate-intensity physical activity has an independent effect on survival even among frail and old persons., (Copyright 2004 The Gerontological Society of America)

Background: In randomized clinical trials, compared to Internal Medicine, admission to Geriatrics improved clinical outcomes of frail older patients accessing the Emergency Department (ED). Whether this advantage is maintained also in the "real world" is uncertain. We compared long-term survival of patients admitted to Geriatrics or Internal Medicine wards after stratification for background risk and across a variety of discharge diagnoses.Method: Data were derived from the "Silver Code National Project," an observational study of 180,079 unselected 75+ years old persons, admitted via the ED to Internal Medicine (n = 169,717, 94.2%) or Geriatrics (n = 10,362) wards in Italy. The Dynamic Silver Code (DSC), based on administrative data, was applied to balance for background risk between participants admitted to Geriatrics or Internal Medicine.Results: One-year mortality was 33.7%, lower in participants discharged from Geriatrics (32.1%) than from Internal Medicine (33.8%; p < .001), and increased progressively across four DSC risk classes (p < .001). Admission to Geriatrics was associated with survival advantage in DSC class II to IV participants, with HR (95% CI) of 0.88 (0.83-0.94), 0.86 (0.80-0.92), and 0.92 (0.86-0.97), respectively. Cerebrovascular diseases, cognitive disorders, and heart failure were the discharge diagnoses with the widest survival benefit from admission to Geriatrics, which was mostly observed in DSC class III.Conclusions: Admission to Geriatrics may provide long-term survival benefit in subjects who, based on the DSC, may be considered at an intermediate risk. Specific clinical conditions should be considered in the ED to improve selection of patients to be targeted for Geriatrics admission. [ABSTRACT FROM AUTHOR]

Background: Concurrent vision and hearing impairment, known as dual sensory impairment (DSI), is associated with increased mortality. We aimed to examine individual and joint associations of DSI and involvement in activities with mortality in a large European nursing home study.Methods: In total, 2,851 nursing home residents in 59 facilities in eight countries were followed for 1 year in the Services and Health for Elderly in Long TERm Care study. Vision and hearing impairment and average time of involvement in activities were assessed by trained research staff using the interRAI Long Term Care Facilities. Association between DSI and 1-year all-cause mortality was examined using Cox proportional hazards models adjusted for age, sex, facility, diagnoses of coronary heart disease and diabetes mellitus, self-rated health, end-stage disease, and functional and cognitive status. The modifying effect of involvement in activities on the association was investigated by the additive hazard model.Results: DSI, defined as moderate to severe impairment in both senses, was independently associated with a 35% increased risk of 1-year mortality compared with non-DSI. Residents with DSI who were involved in activities did not have higher mortality, while residents with DSI who were not involved in activities had 51% higher mortality than non-DSI residents who were involved in activities, equivalent to approximately 209 additional deaths per 1,000 person-years (p = .012) due to the interaction between DSI and no involvement in activities.Conclusions: DSI is associated with increased mortality at nursing homes when combined with no involvement in activities. [ABSTRACT FROM AUTHOR]

Aim To investigate if older adults using multiple drugs have an increased risk of rehospitalization and mortality after hospital discharge. Methods This was a prospective cohort study carried out in acute care hospitals. The primary outcomes of the study were rehospitalization and mortality within 1 year after discharge from acute care hospitals. The study population was categorized in two groups according to the number of drugs prescribed at hospital discharge: no polypharmacy (<8 drugs) and polypharmacy (≥8 drugs). Results The mean age of 480 participants was 78.6 ± 6.8 years ,and half of them (n = 238; 49.6%) were using multiple drugs (≥8 drugs). Overall, 65 out of 242 participants (26.9%) in the no polypharmacy group and 92/238 (39.1%) in the polypharmacy group were rehospitalized ( P = 0.004), and 15 out of 242 (6.2%) in the no polypharmacy and 23 out of 238 (9.7%) in the polypharmacy group died during the 1 year follow up ( P = 0.16). After adjusting for potential confounders, participants in the polypharmacy group had an increased risk of 1-year rehospitalization as compared with those in the no polypharmacy group ( RR = 1.81, 95% CI = 1.18-2.75). No significant association was observed between mortality and polypharmacy. Conclusions Older persons using multiple drugs are at increased risk of rehospitalization. Further studies are required to assess the impact of programs aimed at reducing polypharmacy on health outcomes. Geriatr Gerontol Int 2015; 15: 141-146. [ABSTRACT FROM AUTHOR]

Background and aims: sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the impact of sarcopenia on the risk of all-cause death in a population of frail older persons living in community.Methods: we analysed data from the Aging and Longevity Study, a prospective cohort study that collected data on all subjects aged 80 years and older residing in the Sirente geographic area (n = 364). The present analysis was conducted among those subjects who were between 80 and 85 years of age at the time of the baseline assessment (n = 197). The main outcome measure was all-cause mortality over 7-year follow-up. According to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, the diagnosis of sarcopenia required the documentation of low muscle mass and the documentation of either low muscle strength or low physical performance. Cox proportional regression models were used to estimate crude and adjusted hazard ratios and 95% confidence intervals of death by the presence of sarcopenia.Results: using the EWGSOP-suggested criteria, 43 subjects with sarcopenia (21.8%) were identified. During the 7-year follow-up, 29 (67.4%) participants died among subjects with sarcopenia compared with 63 subjects (41.2%) without sarcopenia (P < 0.001). After adjusting for potential confounders including age, gender, education, activities of daily living (ADL) impairment, body mass index, hypertension, congestive heart failure, chronic obstructive pulmonary disease, number of diseases, TNF-α, participants with sarcopenia had a higher risk of death for all causes compared with non-sarcopenic subjects (HR: 2.32, 95% CI: 1.01–5.43).Conclusions: our results obtained from a representative sample of very old and frail subjects show that sarcopenia is associated with mortality, independently of age and other clinical and functional variables. [ABSTRACT FROM PUBLISHER]

Objectives: Subjects with depression might request more healthcare services. The aim of this study was to evaluate the association of depressive symptoms with hospitalization and mortality rates in a general unselected older population. Methods: We assessed the association of the 30-items Geriatric Depression Scale (GDS) score with one-year hospitalization and mortality in all 344 subjects aged 75+ living in Tuscania (Italy). This population had been enrolled in a national study of the genetic determinants of health status. Analyses were conducted using continuous, as well as categorical GDS score levels. Results: After adjusting for potential confounders, depressive symptoms were associated in Cox regression modelling with hospitalization (relative risk, RR = 1.05; 95% confidence interval, CI = 1.01-1.09; p = 0.016), but not with mortality (RR = 1.06; 95% CI = 0.96-1.16; p = 0.246). Increasing GDS score levels were associated with increasing risk of hospitalization (p for trend = 0.033). Up to 39% of hospitalizations might be attributed to depression. Conclusion: Depressive symptoms are not associated with increased mortality rates in general older populations. However, depressive symptoms represent a potentially reversible determinant of increased hospitalization rates in these subjects, independent of the presence and severity of other medical conditions. [ABSTRACT FROM AUTHOR]

The article discusses the meta-analysis that was conducted to study the effect of atypical antipsychotics in the mortality among patients with dementia in nursing homes. A retrospective cohort study was done to compare the risk of death in relation to atypical and traditional antipsychotics in a large population of nursing home patients. Findings show that conventional antipsychotics are linked with higher risk of all-cause mortality than atypical agents.

Background: High-density lipoprotein (HDL) cholesterol has been hypothesized to be a reliable marker of frailty and poor prognosis among the oldest elderly. Objective: In the present study, we evaluate the impact of HDL cholesterol on the risk of all-cause mortality in a large population of frail octogenarians and nonagenarians living in a community. Methods: We analyzed data from the Aging and Longevity Study in the Sirente geographic area (ilSIRENTE Study), a prospective cohort study that collected data on all subjects aged 80 year and older living in a mountain community (n = 359). The main outcome measure was the relative hazard ratio of death after 2 years of follow-up for different levels of HDL cholesterol. Results: A total of 86 deaths (30 men and 56 women) occurred during 2 years of follow-up. Among men the mean HDL cholesterol level was 36.7 ± 7.6 mg/dl among those who died as compared with 43.4 ± 10.3 mg/dl among survivors (p = 0.001). Similarly, among women, the mean HDL cholesterol level was 42.2 ± 11.5 mg/dl among those who died as compared with 49.3 ± 14.9 mg/dl among survivors (p = 0.001). Adjusting for potential confounders, including markers of frailty, LDL cholesterol, and triglycerides, somewhat reduced the strength of the association between HDL cholesterol levels and mortality, but it remained statistically significant. Conclusions: Our results obtained from a representative sample of very old and frail elderly subjects expand the knowledge that high levels of HDL cholesterol are associated with better survival. These findings support the hypothesis of a strong implication of the lipoprotein metabolism in the process of living an extremely long life. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Several studies have raised concerns over a possible reduction in the beneficial effects of ACE inhibitors on mortality in people also taking aspirin (acetylsalicylic acid). Objective: We performed this study to determine whether there is a reduction in the beneficial effects of ACE inhibitors on mortality in elderly people with heart failure also taking aspirin. Participants: 822 patients discharged from hospital wards with a diagnosis of heart failure participated in the GIFA (Italian Group of Pharmacoepidemiology in the Elderly) study. Measurements: We analysed the characteristics of the participants according to the type of therapy prescribed (no ACE inhibitor/no aspirin, ACE inhibitor/no aspirin, no ACE inhibitor/aspirin and ACE inhibitor/aspirin). We calculated the hazard ratios (HRs) for dying associated with each of these treatments, and calculated the synergy index to identify any negative interaction between ACE inhibitor and aspirin. Results: The mean age of study participants was 79 ± 7.3 (SD) years. Of the 629 (76.5%) patients discharged on ACE inhibitor and/or aspirin therapy, 31.0% were taking both drugs. Compared with no therapy with ACE inhibitor or aspirin, the HR for death was 0.65 (95% CI 0.31, 1.36) for aspirin users, 0.45 (95% CI 0.27, 0.74) for ACE inhibitor users and 0.37 (95% CI 0.19, 0.70) for ACE inhibitor/aspirin users. The synergy index was 0.98 (95% CI 0.34, 2.80), suggesting no interaction between the drugs. Conclusions: Our data do not support the existence of a negative interaction between ACE inhibitors and aspirin in elderly patients with heart failure. [ABSTRACT FROM AUTHOR]

Aim Urinary incontinence is one of the most common, disruptive and often disabling conditions affecting frail older people living in community. The aims of present study were to describe the prevalence of bladder catheter in a population of older women living in community and to examine the relationship between urinary catheter and mortality. Methods This was an observational cohort study. We analyzed data from the Italian Silver Network Home Care project that collected data on patients admitted to Home Care programs. A total of twelve Home Health Agencies participated in such project evaluating the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 1,004 women were enrolled in the present study. The main outcome measures were prevalence of bladder catheter and 1-year survival according to catheterization. Results The prevalence of incontinent patients with bladder catheter was 38.1%. Incontinent patients with indwelling bladder catheter did not show significant difference for age and comorbidity while they showed a significant higher level of physical and functional impairment, as expressed by higher score in activities of daily living (ADL) scale (6.5 ± 1.3 vs. 5.5 ± 2.2, P < 0.001) and higher prevalence of sensory impairment, pressure ulcers (44% vs. 12%, P < 0.001), and urinary tract infections (21% vs. 10%, P < 0.001). After adjusting for age and for all the variables significantly different between catheterized and not-catheterized subjects at baseline, subjects with indwelling bladder catheter were more likely to die compared to those without catheter (RR, 1.44; 95% CI 1.01-2.07). Conclusions Catheterization has an important prognostic implication for frail old women living in the community, independent of age and other clinical and functional variables. A failure in decreasing the unnecessary bladder catheter use and the duration of catheterization among frail incontinent women should be considered an indicator of poor quality of care. © 2004 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Background: There is a lack of information on the effects of angiotensin-converting enzyme (ACE) inhibitors in very old people with heart failure (HF). The objective of this study is to estimate the prevalence of prescriptions of ACE inhibitors in elderly people with HF discharged from acute care hospitals, and to evaluate the effect of these drugs on 1-year mortality rates.Methods: We used data from the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA). In 1998, we undertook a 1-year longitudinal study on elderly people (aged 65+ years) discharged with a diagnosis of HF. We compared the demographic and clinical characteristics associated with a prescription at discharge of ACE inhibitors, and used a Cox proportional hazard regression model to calculate the relative hazard of dying associated with the use of ACE inhibitors.Results: We enrolled 818 patients in the study with a mean age of 79 years (range: 65-101 years). One fourth of the participants were aged 85 years or older. ACE inhibitors were prescribed to 550 patients (67.2%) at discharge. Older age and physical disability were negatively correlated with the use of ACE inhibitors. People using ACE inhibitors had a 40% reduction of mortality (HR [hazard ratio]: 0.60; 95% CI [confidence intervals]: 0.42-0.88). The reduction in mortality was much stronger among disabled people (HR: 0.35; 95% CI: 0.19-0.64).Conclusion: ACE inhibitors are still underprescribed among elderly people with HF discharged from acute care hospitals. Even in this frail, elderly population, we found a beneficial effect of ACE inhibitors. There is room to further improve the quality of care for elderly people with HF. [ABSTRACT FROM AUTHOR]

We describe the prevalence of cognitive impairment in a population of community-living older people, its association with functional decline, and degree of comorbidity. In addition, we examined the relationship between different levels of cognitive impairment and mortality. We conducted an observational study of 1787 patients aged 65 years and above with any degree of cognitive impairment. Patient data were collected with the Minimum Data Set for Home Care. More than 50% of patients had some level of cognitive impairment, which correlates with the degree of physical frailty. On the contrary, patients with cognitive impairment appear to have fewer comorbid conditions and are less likely to receive medications than patients with normal cognitive status. In particular, hypertension, congestive heart failure, chronic obstructive pulmonary disease, cancer, diabetes mellitus, and osteoporosis are found more frequently among patients with normal mental status compared with those showing some level of cognitive defects. Yet, more severe cognitive impairment is associated with a higher mortality rate. Demented patients are characterized by a high prevalence of functional disability and by increased mortality. This increased morbidity and mortality rate is associated with a lower prevalence of comorbid clinical conditions and drug use, relative to patients with normal cognitive performance. The present findings support the possibility that severe cognitive impairment has an independent effect on survival. (J Geriatr Psychiatry Neurol 2001; 14:21-27). [ABSTRACT FROM AUTHOR]

Background. Sarcopenia is a common condition in older and frail populations, and it has been associated with adverse health outcomes. However, impact of sarcopenia on mortality in hospitalized older adults has rarely been evaluated. Aim of the present study was to investigate the association between sarcopenia and mortality during hospital stay and at 1 year after discharge in older individuals admitted to acute care wards. Methods. This is a multicentre observational study involving 770 in-hospital patients. Muscle mass was quantified with the bioelectrical impedance analysis. The diagnosis of sarcopenia was based on the algorithm proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). After discharge, participants were followed for 1 year. Mortality was assessed during hospital stay and during 1-year follow-up. Results. Within the 770 participants (mean age: 81 ± 7 years, 56% women), sarcopenia was present in 214 (28%) of them, 22 participants died during hospital stay, and 113 in the year after discharge. Participants with sarcopenia had a significantly higher in-hospital (6% vs 2%; p = .007) and 1-year mortality (26% vs 14%; p < .001) as compared with participants without sarcopenia. After adjusting for potential confounders, sarcopenia resulted significantly associated with in-hospital (hazard ratio: 3.45; 95% CI: 1.35–8.86) and 1-year mortality (hazard ratio: 1.59; 95% CI: 1.10–2.41). Conclusions. Sarcopenia is a prevalent condition among older adults admitted to acute care wards and it is associated with increased short- and long-term mortality in hospitalized older adults. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: The principal aims of the present study were to explore the prevalence of anorexia and the factors correlated to anorexia in a large population of older people living in nursing home. Secondary, we evaluated the impact of anorexia on 1-year survival. Methods: Data are from baseline evaluation of 1904 participants enrolled in the Un Link Informatico sui Servizi Sanitari Esistenti per l’Anziano study, a project evaluating the quality of care for older persons living in an Italian nursing home. All participants underwent a standardized comprehensive evaluation using the Italian version of the inter Resident Assessment Instrument Minimum Data Set (version 2.0) for Nursing Home. We defined anorexia as the presence of lower food intake. The relationship between covariates and anorexia was estimated by deriving ORs and relative 95% CIs from multiple logistic regression models including anorexia as the dependent variable of interest. Hazard ratios and 95% CIs for mortality by anorexia were calculated. Results: More than 12% (240 participants) of the study sample suffered from anorexia, as defined by the presence of decreased food intake or the presence of poor appetite. Participants with functional impairment, dementia, behavior problems, chewing problems, renal failure, constipation, and depression, those treated with proton pump inhibitors and opioids had a nearly 2-fold increased risk of anorexia compared with participants not affected by these syndromes. Furthermore, participants with anorexia had a higher risk of death for all causes compared with nonanorexic participants (hazard ratio 2.26, 95% CI: 2.14–2.38). Conclusions: The major finding is that potentially reversible causes, such as depression, pharmacologic therapies, and chewing problems, were strongly and independently associated with anorexia among frail older people living in nursing home. Furthermore, anorexia was associated with higher rate of mortality, independently of age and other clinical and functional variables. [Copyright &y& Elsevier]

Abstract: Background and Aims: Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. At present, no data are available on sarcopenia in the nursing home population. The aim of the current study was to explore the relationship between sarcopenia and all-cause mortality in a population of elderly persons aged 70 years and older living in a nursing home in Italy. Methods: This study was conducted among all subjects (n = 122) aged 70 years and older who lived in the teaching nursing home of Catholic University of Rome between August 1, 2010, and September 30, 2010. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia was diagnosed in presence of low muscle mass plus either low muscle strength or low physical performance. The primary outcome measure was survival after 6 months. Results: Forty residents (32.8%) were indentified as affected by sarcopenia. This condition was more common in men (68%) than in women (21%). During the follow-up period, 26 (21.3%) patients died. After adjusting for age, gender, cerebrovascular diseases, osteoarthritis, chronic obstructive pulmonary disease, activity of daily living impairment, and body mass index, residents with sarcopenia were more likely to die compared with those without sarcopenia (adjusted hazard ratio 2.34; 95% confidence interval 1.04–5.24). Conclusions: The present study suggests that among subjects living in a nursing home, sarcopenia is highly prevalent and is associated with a significantly increased risk of all-cause death. The current findings support the possibility that sarcopenia has an independent effect on survival among nursing home residents. [Copyright &y& Elsevier]

Objective: In this study, we evaluate the impact of disability and multimorbidity on the risk of all-cause death in a population of frail older persons living in community. Study Design and Setting: We analyzed data from the Aging and Longevity Study in the Sirente geographic area, a prospective cohort study that collected data on all subjects aged 80 years and older (n =364). The main outcome measure was all-cause mortality over 4-year follow-up. Results: A total of 150 deaths occurred. Sixty-seven subjects (44.6%) died in the nondisabled group compared with 83 subjects (55.3%) in the disabled group (P <0.01). Thirty-nine subjects (31.7%) died among subjects without multimorbidity compared with 111 subjects (46.0%) with two or more diseases (P <0.01). When examining the combined effect of multimorbidity and disability, the effect of disability on the risk of death was higher than that of multimorbidity. After adjusting for potential confounders, relative to those without disability and multimorbidity, disabled subjects showed an increased risk of death when multimorbidity was associated (hazard ratio [HR]=3.91; 95% confidence interval [CI]=1.53–10.00) and in absence of multimorbidity (HR=2.36; 95% CI=0.63–8.83). Conclusion: Our results show that disability exerts an important influence on mortality, independently of age and other clinical and functional variables. [Copyright &y& Elsevier]

Abstract: Objective: Maintaining or increasing physical activity in late-middle age has been shown to be associated with a reduction in mortality. The aim of the present study was to explore the relationship between regular walking and the risk of all-cause death in a large population of frail and very old people living in community. Methods: We analyzed data from the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE study), a prospective cohort study that collected data on all subjects aged 80 year and older living in a mountain community. Baseline assessments of participants started in December 2003 and were completed in September 2004. All subjects were followed-up for 24 months. To the purpose of this study we selected all subjects without impairment in the activities of daily living (n =248). The main outcome measure was the relative hazard ratio of death over two years of follow-up for different levels of walking activity. Results: During a mean follow-up time of 24 months from baseline assessment, 30 subjects (12%) died. There was an uneven distribution of the risk. After adjusting for age, gender and other possible risk factors of death (functional and cognitive disability, congestive heart failure, hypertension, osteoarthritis, depression, number of medications, body mass index, cholesterol and reactive C protein) subjects walking 1 h or more per day were less likely to die compared to participants walking less than 1 h per day (RR, 0.36; 95% CI 0.12–0.98). Conclusions: Our results obtained from a representative sample of very old and frail elderly subjects expand the knowledge that high levels of walking activity are associated with better survival. [Copyright &y& Elsevier]

Background: Anemia status is a typical feature of the “frailty syndrome” of elderly subjects. Increasing evidences suggest that low hemoglobin concentration is common in elderly subjects and adversely affects morbidity and mortality. Objective: In the present study, we evaluate the impact of hemoglobin concentration on the risk of all-cause mortality in a large population of frail and old subjects living in a nursing home. Methods: There were 372 residents admitted to the teaching nursing home of Catholic University of Rome aged 65 years and older from January 2002 to November 2004 who were enrolled. For the present study we selected all the subjects with a full MDS-NH assessment within 14 days after admission. The main outcome measure was the relative hazard ratio of death after 2 years of follow-up for different levels of hemoglobin concentration. Results: Based on the WHO criteria for anemia, 235 participants were anemic at enrollment (63.1% of the cohort). A total of 130 deaths (44 men and 86 women) occurred during 2-years of follow-up. Death rates for those with and without anemia based on the WHO criteria were 38% and 28%, respectively (P = .03). The age- and sex-adjusted hazard ratio for mortality was 1.56 (95% CI, 1.07–2.28) for persons with anemia. Compared with the lower tertile, the age- and sex-adjusted hazard ratios of mortality for hemoglobin in the second and third tertiles were 0.40 (95% CI, 0.26–0.61), and 0.39 (95% CI, 0.24–0.58), respectively. Adjusting for potential confounders, including markers of frailty, cognitive impairment, creatinine levels, cancer, stroke, body mass index, and pressure ulcer, somewhat reduced the strength of the association between hemoglobin level and mortality, but it remained statistically significant. Conclusion: Our results obtained from a representative sample of very old and frail elderly subjects living in a nursing home expand the knowledge that high levels of hemoglobin are associated with better survival. Anemia should be actively sought, appropriate diagnostic strategies should be implemented to search for potentially correctable causes, and aggressive interventions may be warranted to reduce mortality and improve functional status. [Copyright &y& Elsevier]

: PurposeAlthough total cholesterol levels among middle-aged persons correlate with long-term mortality from all causes, this association remains controversial in older persons. We explored whether total cholesterol levels were independently associated with in-hospital mortality among elderly patients.: MethodsWe analyzed data from a large collaborative observational study, the Italian Group of Pharmacoepidemiology in the Elderly (GIFA), which collected data on hospitalized patients. A total of 6984 patients aged 65 years or older who had been admitted to 81 participating medical centers during four survey periods (from 1993 to 1998) were enrolled. Patients were divided into four groups based on total cholesterol levels at hospital admission: <160 mg/dL (n = 2115), 160 to 199 mg/dL (n = 2210), 200 to 239 mg/dL (n = 1719), and ≥240 mg/dL (n = 940).: ResultsPatients (mean [± SD] age, 78 ± 7 years) were hospitalized for an average of 15 ± 10 days. The mean total cholesterol level was 186 ± 49 mg/dL. A total of 202 patients died during hospitalization. Mortality was inversely related to cholesterol levels (<160 mg/dL: 5.2% [110/2115]; 160–199 mg/dL: 2.2% [49/2210]; 200–239 mg/dL: 1.6% [27/1719]; and ≥240 mg/dL: 1.7% [16/940]; P for linear trend <0.001). After adjustment for potential confounders (demographic characteristics, smoking, alcohol use, indicators of nutritional status, markers of frailty, and comorbid conditions), low cholesterol levels continued to be associated with in-hospital mortality. Compared with patients who had cholesterol levels <160 mg/dL, the odds ratios for in-hospital mortality were 0.49 (95% confidence interval [CI]: 0.34 to 0.70) for participants with cholesterol levels of 160 to 199 mg/dL, 0.41 (95% CI: 0.26 to 0.65) for those with cholesterol levels of 200 to 239 mg/dL, and 0.56 (95% CI: 0.32 to 0.98) for those with cholesterol levels ≥240 mg/dL. These estimates were similar after further adjustment for inflammatory markers and after excluding patients with liver disease.: ConclusionAmong older hospitalized adults, low serum cholesterol levels appear to be an independent predictor of short-term mortality. [Copyright &y& Elsevier]

Abstract: Introduction: Older adults with advanced cognitive impairment have a limited life expectancy and the use of multiple drugs is of questionable benefit in this population. The aim of the present study was to assess if, in a sample of nursing home (NH) residents with advanced cognitive impairment, the effect of polypharmacy on mortality differs depending on estimated life expectancy. Methods: Data were from the Services and Health for Elderly in Long TERm care (SHELTER) project, a study collecting information on residents admitted to 57 NHs in 8 European countries. Polypharmacy was defined as the concomitant use of 10 or more drugs. Limited life expectancy was estimated based on an Advanced Dementia Prognostic Tool (ADEPT) score of 13.5 or more. A Cognitive Performance Scale score of 5 or more was used to define advanced cognitive impairment. Participants were followed for 1 year. Results: Mean age of 822 residents with advanced cognitive impairment entering the study was 84.6 (SD 8.0) years, and 630 (86.6%) were women. Overall, 123 participants (15.0%) had an ADEPT score of 13.5 or more (indicating limited life expectancy) and 114 (13.9%) were on polypharmacy. Relative to residents with ADEPT score less than 13.5, those with ADEPT score of 13.5 or higher had a lower use of benzodiazepines, antidementia drugs, and statins but a higher use of beta-blockers, digoxin, and antibiotics. Polypharmacy was associated with increased mortality among residents with ADEPT score of 13.5 or more (adjusted hazard ratio [HR] 2.19, 95% confidence interval [CI]: 1.15–4.17), but not among those with ADEPT score less than 13.5 (adjusted HR 1.10, 95% CI: 0.71–1.71). Discussion: Polypharmacy is associated with increased mortality in NH residents with advanced cognitive impairment at the end of life. Conclusion: These findings underline the need to assess life expectancy in older adults to improve the prescribing process and to simplify drug regimens. [Copyright &y& Elsevier]