Muscle mass and grip strength in relation to carotid intima-media thickness and plaque score in patients with type 2 diabetes

Background and aimsIn this study, we examined the relationships of appendicular skeletal muscle mass (ASM) and grip strength (GS) with carotid intima-media thickness (CIMT) and plaque score (PS) in patients with type 2 diabetes.Methods and resultsA total of 1185 patients were recruited. High CIMT and high PS were defined as ≥ 75 percentile of maximal CIMT of each sex and PS ≥ 3. Patients in the lowest ASM/body mass index (BMI) or GS/BMI tertile were older and had lower HDL cholesterol, and eGFR, but higher BMI, waist circumference (WC), HOMA-IR, and C-reactive protein than those in the highest tertile. Meanwhile, individuals in the lowest ASM or GS tertile group had lower BMI and WC than those in the highest one. CIMT and PS and the prevalence of high CIMT, carotid plaques, and high PS gradually increased with decreasing tertiles of ASM, ASM/BMI, GS, and GS/BMI (p < 0.001). After adjusting for age and sex, odds ratios (ORs) and 95% confidence intervals (CIs) for high CIMT and high PS were 0.98 (0.68–1.42), 1.64 (1.14–2.36), 2.000 (1.33–3.01), and 1.77 (1.22–2.58) and 1.63 (1.16–2.30), 1.78 (1.28–2.54), 1.91 (1.33–2.75), and 1.61 (1.13–2.28) in the lowest tertile of ASM, ASM/BMI, GS, and GS/BMI, respectively. After further adjusting for potential confounders, ORs and 95% CI for high CIMT and high PS remained significant in the lowest tertile group.ConclusionsLow ASM and low GS may be independent risk factors for high CIMT and high PS in patients with type 2 diabetes.     

Prediction of falls in rehabilitation and acute care geriatric setting

PurposeTo examine the feasibility to develop an efficient and applicable geriatric hospital-specific fall risk-prediction tool.Patients and methodsThis is a prospective cohort study in five rehabilitation units and one acute care geriatric unit at a geriatric hospital. In total, 1013 patients aged over 65 years were admitted during a 6-month period. Fourteen patient characteristics found in previous studies to be risk factors for falls were tested for predictive validity. The characteristics included: age, gender, history of falls, dementia, delirium, use of psychoactive drugs, using a wheelchair, acute illness, state of post joint arthroplasty, Parkinson's disease, stroke, heart disease, vision disturbance, and hospitalization for deconditioning. Each of the characteristics was assessed individually for their predictive power based on logistic regression models.ResultsDementia (p < 0.001) and delirium (p = 0.005) predicted falls in patients hospitalized for rehabilitation. In the multivariate model, only dementia was a significant predictor in these patients, (p = 0.014), while delirium only approached significance. Being hospitalized for rehabilitation after arthroplasty was a negative predictive factor of falls (p = 0.022). Among acute care patients, only being operated on in the past for joint arthroplasty (p = 0.035) predicted falls in the multivariate model, while using a wheelchair was a negative predictive factor (p = 0.023).ConclusionThe current study reveals a poor predictive value for falls for most patient characteristics (except delirium and dementia) in elderly hospitalized patients, illustrating the incertitude of developing and using predictive falls tools based on such characteristics in hospitalized elderly patients.     

Urban-rural differences in physical performance and health status among older Japanese community-dwelling women

Background/PurposeAssessment of physical performance allows the identification of health and functional independence among older adults. Several factors, such as environmental conditions, influence the results; therefore our objective was to compare the physical performance and the health status between older Japanese women living in urban and rural communities.MethodsThe Japanese women were aged ≥65 years, and recruited in urban (n = 41, age = 73.8 ± 3.92 years) and rural (n = 54, age = 73.8 ± 4.15 years) locations through the local press. Physical performance was assessed by the Timed Up and Go (TUG), one leg stand (OLS), repeated chair stands (CS) and handgrip strength (HGS) tests. Health status was investigated using socio-demographic characteristics; anthropometric measures and body composition; physical activity, a pedometer, Life-Space Assessment (LSA); Geriatric Depression Scale; incidence of falls, fear of falling; and medical information. Variables were compared by χ² test, Independent-Samples t test and Mann Whitney U-test.ResultsRural individuals presented a better performance in the HGS test (p = 0.01) than urban individuals, who had a better performance in the CS test (p < 0.001). No statistical differences were found in the TUG or OLS tests. Rural women also had a higher body mass index (p = 0.04), waist circumference (p < 0.01), and body fat percentage (p = 0.014) than urban women, who showed higher scores in LSA (p < 0.001). Concerning medical information, more rural women complained of low back pain (p = 0.01) and gastrointestinal problems (p = 0.02).ConclusionOur findings showed that the physical performance and health status varied according to the place. Rural individuals had worse results in the CS test, but a better performance in the HGS test than urban individuals. We emphasize that health interventions should address the specific demand of each location.     

Correlates of gait speed in a sample of physically active elderly

ObjectivesGait speed (GS) is an important predictor of disability, falls, institutionalization and death among elderly people. Our aim was to assess which factors are associated with higher GS in a sample of physically active elderly.Subjects and methodsA cross-sectional study was performed in a sample of 43 self-sufficient and active elderly (12 men and 31 women) aged 65–82 years. Anthropometric features (weight and height), mobility (Tinetti test), physical and mental health (Short Form 12 - SF12 questionnaire), physical activity (Physical Activity Scale for Elderly - PASE questionnaire), strength and power of lower limbs (Myotest Pro accelerometer) and GS were measured. A multivariable linear regression model was built in order to identify which variables were associated with higher GS.ResultsThe final multivariable linear regression model included gender, fall in the previous year, hypertension, age, BMI and Mental Health score. Furthermore, it explained nearly 2/3 of the variability in GS (R² = 0.64). Male sex, hypertension and a higher Mental Health score were associated with higher GS, whereas fall in the previous year and higher values of both age and BMI were associated with lower GS. A further model which included an interaction between sex and BMI (R² = 0.68) revealed that the negative association between GS and BMI was found among women but not among men.ConclusionsIn addition to the well-known associations between GS and demographic and anthropometric characteristics, we reported a positive association between mental health and GS among generally healthy and physically active community-dwelling elderly.     

Low serum creatinine to cystatin C ratio is independently associated with sarcopenia and high carotid plaque score in patients with type 2 diabetes

Background and aimsLow serum creatinine (Cr) to cystatin C (cysC) ratio has been suggested to be associated with low muscle mass and strength and poor prognosis in various chronic disease. We investigated the associations of CCR with sarcopenia and carotid plaque score (PS) in patients with type 2 diabetes mellitus.Methods and resultsA total of 1577 patients with type 2 diabetes were enrolled. High PS was defined as PS ≥ 3. Sarcopenia was assessed by the measurement of appendicular skeletal muscle mass (ASM) and grip strength (GS). Compared to the highest CCR group, the lowest tertile group was older; had higher C-reactive protein levels, CIMT, and PS, but lower cysC-based estimated glomerular filtration rate (cysC-eGFR), ASM/BMI, and GS. Positive correlations between CCR and ASM/BMI (r = 0.239 in men and 0.303 in women, p < 0.001) and GS (r = 0.282 in men and 0.270 in women, p < 0.001) were observed in both genders. Odds ratios and 95% confidence intervals for high PS after adjusting for age and sex were 1.22 (0.92–1.61, p = 0.18) in the middle and 1.74 (1.31–2.30, p < 0.001) in the lowest tertiles, respectively, with those of the lowest tertile remaining significant after further adjusting for multiple confounders.ConclusionsLow CCR was independently associated with sarcopenia and high PS in patients with type 2 diabetes mellitus, especially after adjusting for ASM/BMI and GS.     

Incidence of falls and fear of falling in Japanese patients with rheumatoid arthritis

The objective of this study is to determine the incidence of falls and fear of falling by gender and age in Japanese patients with rheumatoid arthritis (RA). Among the Japanese patients who participated in a single-institute-based prospective observational cohort study of patients with RA, namely the Institute of Rheumatology Rheumatoid Arthritis, 765 men (median age 63 years) and 4,231 women (median age 60 years) with RA responded to questions related to falls. Eight percent of men and 11% of women reported one or more falls during the previous 6 months. At least one fall and multiple falls were significantly more frequent in men (p < 0.05) and in women (p < 0.001) with RA over age 65 and age 75 years, respectively, although there was no significant linear increase in risk with age. Sixteen percent of men and 22% of women reported fear of falling. More men over age 65 tended to report fear of falling than those under age 65 (p < 0.001), although the incidence of women with fear of falling increased with advancing age. Japanese patients with RA over age 65 and age 75 appeared to have a high risk of at least one fall and multiple falls, respectively.     

The combined status of physical performance and depressive symptoms is strongly associated with a history of falling in community-dwelling elderly: Cross-sectional findings from the Obu Study of Health Promotion for the Elderly (OSHPE)

The purpose of this study was to examine whether the combined factors of physical performance, depressive symptoms and cognitive status are significantly associated with a history of falling in community-dwelling elderly. We performed a cross-sectional community-based survey, the OSHPE, from August 2011 to February 2012. In total, 5104 community-dwelling older adults aged 65 years and older (mean age 72.0) participated in the OSHPE. Participants underwent a grip strength (GS) test, chair stand test (CST), Timed Up & Go (TUG) test, Geriatric Depression Scale (GDS), and Mini-Mental State Examination (MMSE). Of the 4481 participants who met our requirements, 645 (14.4%) participants reported falling at least once in the past year. In a signal detection analysis (SDA), we found that the combination of GDS (≥6 points) and TUG (≥10.6 s) had the highest fall rate (36.4%), and the combination of GDS (<6 points) and CST (<11.1 s) had the lowest fall rate (11.7%). The highest fall rate group had a significantly higher odds ratio (OR) compared with the lowest fall rate group after adjusting for other potentially confounding variables [OR 3.12 (95% confidence interval (CI) 2.08–4.68) p < 0.001]. The combination of depressive symptoms, TUG, and CST performance was strongly associated with a history of falling in community-dwelling elderly.     

Waist circumference,visceral abdominal fat thickness and three components of metabolic syndrome

ObjectiveThe relationships between the waist circumference (WC), visceral adipose tissue (VAT) thickness and three components of metabolic syndrome (MetS) were explored to verify which of the obesity indices might be superior.MethodsA cross-sectional study was conducted of 1256 subjects (840 males and 416 females) aged 26–89 years, who were individuals undergoing intensive health checkup. The three components of MetS examined were high blood pressure, glucose intolerance and dyslipidemia. Receiver-operating characteristic (ROC) curve analysis and multiple logistic regression analysis were used for the analyses.ResultsThe mean values of the WC and VAT thickness were significantly higher in the subject group positive for each of the metabolic syndrome components than in the subject group that was negative for all the components (p < 0.001). ROC curve analysis showed that the WC showed an advantage over the VAT thickness only for predicting high blood pressure in men. Logistic regression analysis revealed increase of the odds ratios of the WC for glucose intolerance (p < 0.001), high blood pressure (p < 0.001) and dyslipidemia (p < 0.01) in men. In contrast, the odds ratio of the VAT thickness was significantly increased only for dyslipidemia (p < 0.01) in men. In women, the odds ratios of the WC for glucose intolerance (p < 0.01) and dyslipidemia (p < 0.001) were significantly increased, and odds ratio of the VAT thickness for high blood pressure (p < 0.01) was significantly increased.ConclusionThis survey presented an advantage of WC over VAT thickness as an obesity index for identifying all the three components of metabolic syndrome, although sex differences in the study outcomes were found.     

Prevalence and Associated Factors of Frailty Among Elderly People in Taiwan

BackgroundFrailty has begun to attract attention in recent years because it is associated with adverse health outcomes. The purpose of this study was to estimate the prevalence of frailty in elderly people in Taiwan and to examine the associated factors.MethodsData were extracted from a representative subsample of “The Coming of an Aging Society: An Integrative Study on Social Planning in Taiwan in 2025” that comprised 495 older adults. Multinomial logistic regression analyses were conducted to examine the relationships between frailty status and individual factors, health conditions, environmental factors, and activities.ResultsAmong all the participants, 45.9% were classified as “nonfrail”, 45.9% exhibited “prefrailty”, and 8.3% were “frail”. After controlling for the dependent variables, the factors significantly influencing prefrailty were age [odds ratio (OR) = 1.07, p < 0.001], diabetes (OR = 2.18, p < 0.01), depressive syndrome (OR = 3.66, p < 0.001), and the number of activities in which the participants were involved (OR = 1.24, p < 0.05). The factors significantly influencing frailty were age (OR = 1.14, p < 0.001), non-Fukien ethnicity (OR = 3.01, p < 0.05), depressive syndrome (OR = 6.89, p < 0.001), diabetes (OR = 2.69, p < 0.05), and the number of activities in which the participants were involved (OR = 2.39, p < 0.001).ConclusionTo prevent a decline in the functions of elderly people, the results of this study should be referenced when developing intervention strategies in which preventive actions are implemented to aid elderly people with particular risk factors such as diabetes, depression, and infrequent participation in social activities.     

Self-perception of uselessness and mortality among older adults in China

BackgroundNegative self-perceptions of aging among older adults have been associated with higher mortality in developed countries. However, it is unclear whether an association exists in developing countries where living to older age is more selective.Design and methodsUsing five waves of data (2000, 2002, 2005, 2008, and 2011) from a national survey of adults aged 65 and older in China (n = 30,948), this study investigates how self-perceived feelings of uselessness are associated with subsequent mortality. Analyses were stratified by sex and age group (65–79, 80–89, 90–99, and 100+), and adjusted for a wide range of covariates.ResultsCompared with women who never reported perceived uselessness, results from adjusted models shows that women who always reported perceived uselessness had 42% (p < 0.001), 31% (p < 0.001), and 24% (p < 0.001) higher risks of mortality in each of the three oldest age groups, respectively. These associations were only slightly attenuated when covariates were adjusted, but non-significant once baseline health was further controlled for. For men, compared with those who never reported perceived uselessness, the adjusted models for those who always reported perceived uselessness had 62% (p < 0.001), 62% (p < 0.001), 69% (p < 0.001), and 25% (p < 0.1) higher risks of mortality in each of the four sequential age groups, respectively. The association was only slightly diminished—and many remained statistically significant—with further adjustments for psychological disposition and baseline health.ConclusionsSelf-perceived uselessness is associated with higher mortality risks in older adults in China. The association is stronger in men than in women and persists at very old ages.     

Daytime activity and sleep are associated with motor function in older intensive care unit survivors

BackgroundHospitalized older intensive care unit (ICU) survivors are often inactive and experience sleep disturbances.ObjectiveWe explored associations between post-ICU activity, sleep/rest, and motor function among hospitalized older ICU survivors.MethodsWe enrolled 30 older ICU survivors, ages 65 and older, within 24–48 h of ICU discharge. Actigraphy measured post-ICU activity and sleep/rest. Selected measures from the National Institutes of Health Toolbox Motor Battery assessed grip strength and dexterity. Multivariate regression examined associations between post-ICU activity, sleep/rest, and motor function, adjusting for covariates.ResultsLower daytime activity (β = 0.258, p = .035) and greater daytime sleep/rest (β = −0.295, p = .022) were associated with worse grip strength. Lower daytime activity (β = −0.376, p = .037) and greater daytime sleep/rest (β = 0.409, p = .026) were associated with worse dexterity.ConclusionPost-ICU inactivity and prolonged rest periods are associated with worse motor function in hospitalized older ICU survivors.     

The comparison of resistance and balance exercise on balance and falls efficacy in older females

ObjectivesThe purpose of this study is to compare the effectiveness of resistance and balance exercise in reducing the risk of falls for females 65-years-old or older.DesignThe study was a single blind, controlled trial, conducted over a period of 12-weeks with pre- and post-exercise assessment.Patients and methodsNinety-five participants were randomly assigned to one of three groups: resistance-training group, balance training group, control group. Resistance training group were trained to increase strength of upper, lower. Balance training group were trained to improve balance, coordination and proprioception. Outcome measurement consisted of balance ability, muscle strength, proprioception and fall efficacy.ResultsThe resistance and balance exercise group showed a statistically significant improvement in balance ability compared to the control group (P < 0.01). The resistance exercise group showed significant improvement in muscle strength compared to the balance exercise group (P < 0.01). The balance exercise group showed significant improvement in proprioception compared to the resistance exercise group (P < 0.01). Both resistance and balance exercise showed a significant improvement in fall efficacy than the control group (P < 0.01).ConclusionsWe conclude that the resistance and balance exercise have significant effects on balance ability and falls efficacy in older females.     

Comparison of frailty between users and nonusers of a day care center using the Kihon Checklist in Brazil

Background/purposeDay care centers are rapidly expanding in Brazil to meet the needs of the increasing older population. However, health profiles of their clients remain unclear. Therefore, this study aimed to investigate and compare the health conditions of users and nonusers of a day care center using a new frailty index, the Kihon Checklist.MethodsThis was a cross-sectional observational study. We recruited 59 users (mean age 81.1 ± 6.69 years) and 173 nonusers (mean age 69.9 ± 7.39 years). The nonusers were recruited at a recreational club and municipal health units, and the users were recruited at a day care center for the elderly in Brazil. Measurements consisted of questionnaires regarding sociodemographic and health-related characteristics and the Kihon Checklist.ResultsCompared with the nonusers, users had a higher prevalence of frailty (p < 0.001) and impairment of all specific domains (instrumental activities of daily living impairment, p < 0.001; physical inactivity, p < 0.001; seclusion, p < 0.001; cognitive deficit, p < 0.001; and depression, p < 0.001). The users were also more likely to be frail [odds ratio (OR), 14.226; 95% confidence interval (CI), 5.423–37.320; p < 0.001], dependence in instrumental activities of daily living (OR, 78.845; 95% CI, 19.569–317.674; p < 0.001), physically inactive (OR, 3.509; 95% CI, 1.467–8.394; p = 0.005), cognitively impaired (OR, 5.887; 95% CI, 2.360–14.686; p < 0.001), and depressed (OR, 5.175; 95% CI, 2.322–11.531; p < 0.001) than the nonusers.ConclusionThe users of the day care center were frailer than nonusers, especially with regard to independence in instrumental activities of daily living, physical strength, cognitive function, and mood. Health care workers should use the Kihon Checklist to verify frequently the condition of elderly patients to prevent worsening of frailty.     

The Physiological Profile Assessment: Clinical validity of the postural sway measure and comparison of impairments by age

BackgroundThe Physiological Profile Assessment (PPA) assesses falls risk in older adults by measuring impairments most associated with multiple falls. To date, no study has investigated the change in PPA impairment profile with age.ObjectiveTo describe impairment profiles, by age and ability to complete the postural sway measure, of older adults fallers.ParticipantsWe note that 885 older adults referred to multidisciplinary falls clinics located within two inner London boroughs (UK).MethodsAnonymised data was extracted from the PPA falls risk database. For comparisons, data was grouped by gender, age, and ability to complete the postural Sway test.ResultsThere were significant differences between all age groups in PPA falls risk, edge contrast sensitivity, quadriceps strength (Quad), postural sway and reported falls within the previous year (P < 0.01). The oldest age group (90+) had the highest PPA falls risk (P < 0.01), yet reported significantly less falls than the youngest age group (60 to 69; P < 0.05). There was significant variability in test results, with younger age groups displaying greater variability across PPA measures, and older age groups displaying more consistency (P < 0.05); 15.1% (n = 134) of patients that were able to perform the postural sway measure received a higher risk score for this test than those unable to complete the task.ConclusionsGreater variability in younger age groups indicates that specific impairments may provide the cause of falls, whereas widespread global reduction in function and frailty may provide the cause for falls in the older age groups. The postural sway scoring does not reflect ability to perform the test.     

Body composition and frailty profiles in Brazilian older people: Frailty in Brazilian Older People Study-FIBRA-BR

ObjectiveTo determine the association between body composition and frailty in older Brazilian subjects.Material and methodsThis is a Cross-sectional study called FIBRA-BR and developed in community Brazilian aged ≥65 (n = 5638). Frailty was assessed according to Fried et al. definition and body composition was determined by BMI, waist circumference and waist-hip ratio.ResultsThe lowest prevalence of frailty was observed in subjects with BMI between 25.0 and 29.9 kg/m². Subjects with a BMI <18.5 and those with elevated WC presented a higher risk of frailty compared to eutrophic subjects (odds ratio (OR) = 3.10; 95% CI: 2.06–4.67) and (OR = 1.15; 95% CI: 1.03–1.27), respectively. Being overweight was protective for pre-frailty (OR = 0.48; 95% CI: 0.4–0.58) and frailty (OR = 0.77; 95% CI: 0.67–0.9). Obese older people presented a higher risk of pre-frailty only (OR = 1.29; 95% CI: 1.09–1.51). Older people with high WC showed a greater proportion of frailty regardless of the BMI range.ConclusionUndernutrition is associated with pre-frailty and frailty in Brazilian elderly subjects, whereas obesity is associated only with pre-frailty. Overweight seems to have a protective effect against the syndrome. The excess of abdominal fat is associated with both profiles independent of the BMI.     

Analysis of emergency department visits by elderly patients in an urban public hospital in Turkey

Background/PurposeElderly patients have higher rates of emergency department visits worldwide. Emergency department utilization by older elderly is much more than younger elderly due to their disease complexity, comorbidities, and severity. This study aimed to determine the sociodemographic and clinical characteristics of elderly patients admitted to the emergency department of a hospital and to compare attendance data regarding older age groups.MethodsAll older people admitted to the emergency department in 2011 were evaluated retrospectively. Patients aged 65–74 years were defined as younger elderly and those aged ≥75 years as older elderly. The prevalence of emergency admission, demographic information, reason for visit, time of admission, diagnosis of disease, and disposition of the two age groups were compared. The Chi-square test was used to analyze data.ResultsThe mean age of the elderly patients was 74.7 ± 6.8 years; 56.7% of them were female. Elderly patients accounted for 11.9% of all emergency department visits. The mean number of emergency department visits per year was 1.15 for older elderly patients and 0.75 for younger elderly patients (p < 0.001). The season in which emergency visits are most frequent was winter, and the most frequent presentation times were evening and night shifts (18:00–23:59 hours). The most common emergency department diagnosis among older and younger elderly patients was related to circulatory disease (26.3% and 21.2%, respectively; p < 0.001). Nearly 90% of the elderly were discharged from the emergency department. Older elderly patients were more likely to be admitted to the hospital than younger elderly patients (14.3% vs. 4.7%).ConclusionThe annual rates of admission to the emergency departments and hospitals were significantly higher in the older elderly population than in the younger elderly population. The most common diagnoses among elderly patients were disorders of the circulatory system.     

Effects of cardiac rehabilitation on physical function and exercise capacity in elderly cardiovascular patients with frailty

BackgroundThe effects of cardiac rehabilitation (CR) on long-term prognosis of cardiovascular disease (CVD) are well known. However, the effect of CR on frail CVD patients has not been fully addressed.MethodsThis study consisted of 89 CVD patients with their age ≥65 years old (68 males, 75 ± 6 years), who participated in the outpatient CR program for 3 months. All the patients underwent cardiopulmonary exercise testing and the physical frailty was assessed using the Japanese Version of the Cardiovascular Health Study Standard before and after CR. Based on the assessment of frailty before CR, the patients were divided into the following two groups: frailty group (n = 23) and non-frailty group (n = 66: robust in 10 and pre-frail in 56 patients).ResultsIn the frailty group, 20 patients (87%) improved from frail status after CR, and usual walking speed, maximal grip strength, and lower extremity strength were significantly improved (1.06±0.20 vs. 1.20±0.18 m/sec, p<0.001; 21.7 ± 5.5 vs. 23.6 ± 6.3 kg, p<0.01; 0.37±0.09 vs. 0.43±0.11 kgf/kg, p = 0.001, respectively), but peak VO₂ did not change after CR (15.9 ± 3.1 vs. 16.2 ± 3.8 ml/min/kg, NS). In the non-frailty group, all these parameters were significantly improved after CR (1.24±0.19 vs. 1.29±0.23 m/sec, p<0.05, 28.7 ± 7.0 vs. 30.2 ± 7.3 kg, p<0.001, 0.50±0.18 vs. 0.54±0.13 kgf/kg, p<0.05, 17.7 ± 4.7 vs 18.5 ± 4.2 ml/min/kg, p<0.01, respectively).ConclusionShort-term CR could obtain the improvement of the physical function, providing the prerequisite step for possibly following improvement of exercise capacity in elderly CVD patients with frailty. It may be inferred that longer duration of CR would be needed to obtain the improvement of exercise capacity in these patients, being the future consideration to be determined.     

Identifying cognitive dysfunction using the nurses’ rapidly clinical judgment in elderly inpatients

Background/PurposeThe aim of this study was to examine the relationship between nurses’ clinical judgment on cognitive function by fall risk assessment and mini-mental state examination (MMSE) scores in elderly inpatients.MethodsWe studied 61 consecutive hospitalized patients who received both comprehensive geriatric assessment (CGA) and fall risk assessment at the Department of Geriatric Medicine in Kyoto University Hospital from January 2006 to June 2010. During the fall risk assessment at admission, primary nurses evaluated the cognitive function by four items (with or without disorientation, impaired judgment, lack of comprehension, and memory loss), while a trained clinical assistant performed CGA including MMSE. Patients were divided into three groups according to the MMSE scores. The association between the four items of judgment by nurses and MMSE scores was then studied.ResultsThe mean age was 80.1 years and 55.7% of the patients were female. The percentage of patients judged to have impaired judgment, lack of comprehension, and memory loss was higher in patients with lower MMSE scores (impaired judgment, p for trend = 0.001; lack of comprehension, p for trend = 0.043; memory loss, p for trend = 0.001). The percentage of patients judged to have at least one of the four abnormalities was also significantly higher in patients with lower MMSE scores (p for trend <0.001). However, no significant relationship was found between disorientation and the MMSE scores. Further, nurses could not detect impaired cognition by the four items in one-third of the patients with mild impairment determined by MMSE.ConclusionThese data indicate that a comprehensive evaluation using all the four items on cognitive impairment is more effective in detecting cognitive impairment in elderly than using individual items, although one-third of cognitively impaired elderly patients may miss detection despite the use of the four items. Better approaches should be developed to identify cognitively impaired elderly patients by nurses.     

Effect of physical activity at midlife on skeletal muscle mass in old age in community-dwelling older women: A cross-sectional study

Background/PurposeMeasures to prevent the development of muscle mass decline should be initiated from midlife. However, the impact of physical activity at midlife on muscle mass in old age remains uncertain. The aim of this cross-sectional study was to determine whether physical activity at midlife influences muscle mass and physical performance in old age.MethodsA total of 272 Japanese women aged 65 years and older were enrolled in the study. Information about physical activity levels at midlife and in old age were collected using a retrospective questionnaire. We calculated the skeletal muscle mass index in old age and recorded the participants' walking speed and hand grip strength in old age. We then classified the participants into four groups according to their physical activity levels at midlife and in old age and conducted multiple linear regression analysis to determine whether the physical activity levels at midlife and in old age were associated with skeletal muscle mass index and physical performance in old age.ResultsThe participants in the groups that were physically inactive at midlife had a significantly lower skeletal muscle mass index in old age than those who were physically active at midlife (p < 0.01). Participants in the groups that were physically inactive in old age also had significantly slower walking speeds at old age than those who were physically active (p < 0.01). These associations remained significant after adjustment for age and body mass index.ConclusionPhysical activity at midlife may be associated with a higher muscle mass in old age and physical activity in old age may be associated with higher walking speeds in old age.     

The effects of eyeball exercise on balance ability and falls efficacy of the elderly who have experienced a fall: A single-blind,randomized controlled trial

PurposeThe purpose of this study was to investigate the effects of eyeball exercise on balance and fall efficacy of the elderly who have experienced a fall.Material and methodsSubjects were randomly assigned to the eyeball exercise group (n = 30) or functional exercise group (n = 31). All subjects received 30 sessions for 10 weeks. To identify the effects on balance, static and dynamic balance were measured using the center of pressure (CoP) measurement equipment and Timed Up and Go Test (TUGT) respectively. Fall efficacy was evaluated using the modified efficacy scale (MFES). The outcome measurements were performed before and after the 10 weeks training period.ResultsAfter 10 weeks, static balance, dynamic balance, and fall efficacy were significantly improved in both groups. Also, there were significant differences in the outcome measures between both groups (p < 0.05).ConclusionsThese results indicate that eyeball exercise is beneficial to improve the fall efficacy as well as the balance of the elderly compared with functional exercise. Eyeball exercise would be useful to improve balance and fall efficacy of the elderly who have experienced a fall.