Association of muscle strength with functional status of elderly people

We have studied the association of muscle strength (quadriceps, biceps, handgrip), measured by a portable chair technique, with functional status (Barthel Index, manual dexterity, Mental Test Score, history of falls, fracture, prescribed drugs), in a sample of 92 elderly subjects attending a Local Authority Day Centre and Day Hospital. Anthropometric measurements and hand-grip strength were also measured in 30 young controls. Muscle area, mass and strength were significantly greater in young controls. Elderly men had significantly greater muscle area, mass and strength than elderly women. Muscle strength correlated with several measures of functional status. Using stepwise multiple regression, an independent association of muscle strength with manual dexterity, Barthel Index and receipt of domiciliary services is demonstrated.     

社区居住的老年糖尿病患者的营养状态评估

目的本研究拟探索社区居住的老年糖尿病患者的营养状况,并与非糖尿病老年人进行比较。方法纳入2013年至2014年在北京香河园社区居住的老年人820名为研究对象,依据是否患糖尿病分为2组:糖尿病组(n=170)和非糖尿病组(n=650)。该研究由接受过问卷调查培训并通过考核的研究助理在社区卫生服务中心或入户对老年人进行面对面访视。应用老年医学疾病累积评分量表(CIRS-G)进行慢病评分。应用微营养评估简表(MNA-SF)进行营养评估。依据体质量指数(BMI)不同,将糖尿病组患者分为5个亚组,与MNA-SF的营养评估结果进行χ~2分析。采用SPSS 20.0软件进行数据处理。结果 820名研究对象年龄65～97(75.4±6.7)岁,患病数(4.7±3.3)种,其中727名(88.7%)老年人可生活自理,其余可半自理。糖尿病组的CIRS-G评分显著高于非糖尿病组[(6.38±3.67)vs(4.28±3.09)分,P0.001]。糖尿病组和非糖尿病组营养不良(5.9%vs 6.3%)和营养不良风险(48.2%vs 45.8%)的发生率差异均无统计学意义(P0.05)。糖尿病组超重(38.2%vs 34.5%)和肥胖(19.4%vs 13.8%)的发生率均显著高于非糖尿病组(P0.05)。各糖尿病亚组患者营养状态与BMI水平差异无统计学意义(χ~2=10.394,P=0.238)。结论社区糖尿病老年人的营养不良发生率与非糖尿病的老年人无明显不同,约半数糖尿病老年人存在营养不良风险。糖尿病患者营养状态与BMI水平无明显相关性。     

内分泌科门诊糖尿病患者吸烟现况调查

目的 了解糖尿病患者的吸烟和戒烟状况以及对于吸烟与疾病关系的认知情况,分析目前仍在吸烟患者戒烟失败的原因,为指导戒烟治疗提供依据.方法 由呼吸科专科医师根据事先设计的调查问卷,对2010年7月至2010年9月我院内分泌科门诊就诊的糖尿病患者进行问卷调查.结果 共调查患者270例,男性67.8％,平均年龄(64.3±10.8)岁.吸烟者41.1％,被动吸烟者29.3％,其中目前吸烟者19.6％,曾经吸烟者21.5％.19.3％伴发其他疾病.目前吸烟者中,71.7％知晓所患疾病与吸烟相关,43.4％曾尝试戒烟.所有吸烟患者接受过医师戒烟劝告的为78.4％,戒烟成功患者中77.6％经医师劝导戒烟.目前吸烟患者接受过医师戒烟劝告的为79.2％,其中59.5％认为医师的劝告和建议对其戒烟有帮助.结论 糖尿病患者目前吸烟率仍较高.研究结果提示需要加强对糖尿病患者戒烟的宣教,医师劝导戒烟的方式和内容还需改善.     

Association of sarcopenia with depressive symptoms and functional status among ambulatory community-dwelling elderly

ObjectiveSarcopenia, functional disability, and depression are common problems in the elderly. Sarcopenia is associated with physical disability, functional impairment, depression, cardiometabolic diseases, and even mortality. This study aims to determine the association of sarcopenia with depression and functional status among ambulatory community-dwelling elderly aged 65 years and older.Materials and methodThe sample of this cross-sectional study consisted of 28,323 people, aged 65 years and older, living in Bornova, Izmir. Multi-stage sample selection was performed to reach 1007 individuals. However, 966 elderly people could be reached, and 861 elderly people who can walk were included in the study. The data were collected by the interviewers at home through face-to-face interview.ResultsThe mean age was 72.2 ± 5.8 (65–100) years. The prevalence of functional disability, depressive symptoms, and sarcopenia were 21.7%, 25.2%, and 4.6%, respectively. In multivariate analysis depression was associated with sarcopenia, being illiterate and divorced, perception of the economic situation as poor/moderate, increased number of chronic diseases, and having at least one physical disability. IADL associated functional disability with sarcopenia, being illiterate/literate and female, increased age and number of medications, and the BMI.ConclusionSarcopenia in ambulatory community-dwelling elderly is significantly associated with depressive symptoms and functional disability. Elderly people at high risk of sarcopenia should be screened for functional disability and depression. Appropriate interventions should also be implemented.     

Association of cognitive dysfunction with hippocampal atrophy in elderly Japanese people with type 2 diabetes

This study aimed to examine the associations of cognitive function with hippocampal and whole brain atrophies, age, education, and diabetes-related parameters in patients with type 2 diabetes.Sixty-one patients over 65 years of age with type 2 diabetes and 53 age- and sex-matched non-diabetic controls were enrolled. Hippocampal and whole brain atrophies were assessed by quantifying hippocampal and brain volumes by brain magnetic resonance imaging. Cognitive function was evaluated by Mini-Mental State Examination (MMSE) and the Revised Hasegawa Dementia Scale (HDS-R).Compared with the non-diabetic group, patients with type 2 diabetes showed significant increases in hippocampal and whole brain atrophies. The MMSE and HDS-R scores in type 2 diabetic patients showed significant negative correlations with age and significant positive correlations with years of education. These scores were also significantly negatively correlated with hippocampal atrophy, but not whole brain atrophy. Hippocampal atrophy in diabetic patients did not, however, correlate with age, years of education, or diabetes-related parameters.We showed hippocampal and whole brain atrophies to be more frequent in elderly patients with type 2 diabetes than in non-diabetic controls. Their cognitive functions were significantly and negatively associated with hippocampal atrophy.     

Glycemic control in elderly people with diabetes

Hyperglycemia is only one of several metabolic derangements that are prevalent in diabetes mellitus. Of these, hyperlipidemia, obesity, and co-existent hypertension may make more important contributions to complications than persistently elevated blood sugars. The role of hyperglycemia in the genesis of diabetic complications is uncertain and there is little evidence from prospective randomized controlled studies to support rigorous hypoglycemic treatment. Adverse consequences of pharmacologic therapy can be severe, including death, and are most frequent in the elderly. The group of elderly diabetic ambulatory patients is markedly heterogeneous and individualization of therapy is required. Obese persons require dietary therapy, and additional dietary manipulations are needed for patients with the complications of hyperlipidemia, hypertension, and nephropathy. Pharmacologic hypoglycemic therapy may be required to control symptoms, but its use in asymptomatic diabetic persons is for the most part unwarranted.     

Metabolic syndrome: The association of obesity and unhealthy lifestyle among Malaysian elderly people

The aim of this study is to investigate the prevalence of metabolic syndrome (MetS) and its predictors among Malaysian elderly. A total of 343 elderly aged ≥60 years residing low cost flats in an urban area in the central of Malaysia were invited to participate in health screening in community centers. Subjects were interviewed to obtain socio demography, health status and behavior data. Anthropometric measurements were also measured. A total of 30 ml fasting blood was taken to determine fasting serum lipid, glucose level and oxidative stress. MetS was classified according to The International Diabetes Federation (IDF) criteria. The prevalence of MetS was 43.4%. More women (48.1%) were affected than men (36.3%) (p < 0.05). Being obese or overweight was the strongest predictor for MetS in men and women (p < 0.05, both gender). High carbohydrate intake increased risk of MetS in men by 2.8 folds. In women, higher fat free mass index, physical inactivity and good appetite increased risk of MetS by 3.9, 2.1 and 2.3 folds respectively. MetS affected almost half of Malaysian elderly being investigated, especially women, and is associated with obesity and unhealthy lifestyle. It is essential to develop preventive and intervention strategies to curb undesirable consequences associated with MetS.     

Functional status of elderly people with hearing loss

The objective is to determine the prevalence of hearing loss in people over 65 years of age, to describe the functional status of people with hearing loss and to identify the need for hearing aid use. In a cross-sectional study, a random sample of 1387 people aged 65 years and over was selected. The primary study variables were: hearing level by audiometric assessment, self-perceived hearing loss, screening for hypoacusia using the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) and physical, cognitive and emotional functional status. Using the HHIE-S it was determined that 11.3% of the subjects had severe hearing handicap. According to the Ventry/Weinstein criteria 43.6% had hearing handicap. When asked about the use of hearing aids, 4.5% of the study subjects said they used them, although 41.9% had hearing loss of 35 dB or more in their better ear. The variables associated with the need for a hearing aid were age >75 years (odds ratio=OR=3.2), ADL dependence (OR=2.7), cognitive impairment (OR=2.0), multiple health problems (OR=1.8), male sex (OR=1.6) and single/widowed (OR=1.5). In conclusion, there is a high prevalence of hearing loss associated with other functional limitations. Of those people who would benefit from a hearing aid (more than a third of people over 65 years old), 89.3% do not own one. The screening of hearing loss needs to be improved.     

Current status of diabetes management in elderly Koreans with diabetes

Knowledge about the current status of diabetes management is indispensable for the improvement of diabetes management. We performed a survey to investigate the current trend of diabetes management in elderly Koreans, at eight hospitals located throughout the country. A total of 539 patients with type 2 diabetes older than 65 years (men=224, women=315) were recruited. Their mean age was 71.5+/-4.9 years and BMI 24.3+/-3.4 (men=23.6+/-2.8, women=24.9+/-3.7)kg/m(2), and 38.2% of the patients were obese (BMI> or =25 kg/m(2), men=29.5%, women=44.4%). The mean duration of the diabetes was 13.1+/-9.2 years. Although 37.3% of the patients had A1C below 7.0%, 33.8% of the patients had A1C more than 8.0%. Three hundred and sixty three patients (67.4%) were treated with oral hypoglycemic agents and 175 patients (32.5%) were treated with insulin or combination with oral agents. The glycemic control was better in patients treated with oral agents (oral agent group=7.7+/-4.6%, insulin group=8.5+/-1.9%). Although mean SBP and DBP were 131.4+/-16.7 and 75.9+/-10.4 mmHg, respectively, 67.4% of the patients had hypertension and 38.2% of the patients with hypertension did not reach the goal (<130/80 mmHg). Of 539 elderly patients, 253 patients (47.4%) had dyslipidemia (LDL-C> or =4.1 mmol/l and/or triglyceride> or =2.5 mmol/l and/or HDL-C<1.1 mmol/l) and 72.7% of the patients with dyslipidemia took the lipid lowering agents. However, 47.4% of them did not achieve the goal (LDL-C<2.6 mmol/l and/or triglyceride<1.7 mmol/l and/or HDL-C>1.1 mmol/l). Twenty-eight patients (5.5%) had been admitted to the hospital because of severe hypoglycemia. Half of the patients (57%) had microvascular complications (retinopathy, neuropathy or overt proteinuria), and 28% of the patients had macro-vascular complications (CVD, stroke or peripheral vascular disease). As elderly diabetic patients are usually polymorbid, diabetes mellitus in old age is needed a more comprehensive approach to not only the treatment of hyperglycemia but also of hypertension, dyslipidemia and other associated diseases.     

Residual cardiovascular risk among people with diabetes

Type 2 diabetes (T2D) is a growing health concern across both developed and developing countries. Cardiovascular disease (CVD) remains the major cause of increased mortality in this patient population. In recent years, effective low density lipoprotein lowering treatments and other risk reduction strategies have substantially reduced the risk of atherosclerotic CVD, yet patients with T2D continue to remain at increased risk for atherosclerotic CVD. Here, we will briefly review various proposed underlying mechanisms for this residual risk with a more in-depth focus on the potential role of triglyceride-rich lipoproteins in residual risk and potential avenues to target this pharmacologically.     

Disability and quality of life in elderly people with diabetes

To implement preventive policies of disability in older diabetic people, the role of diabetes in the disablement process should be investigated. Diabetes mellitus is consistently associated with a higher prevalence of disability at all states, as well as with a progression in disability states and may be considered as a brake on recovery. This association is partially explained by existing complications, associated conditions (obesity, depression, arterial hypertension) treatment burden, and other social characteristics (lower income, lower educational level). Finally, in the disablement process, the role of altered muscle metabolism due to diabetes, aging, nutrition and sedentary lifestyle may represent a major target for interventions to improve functions and potentially activities in elderly people.     

Nutrient intake in relation to central and overall obesity status among elderly people living in the Mediterranean islands: The MEDIS study

Background and Aim

The aim of the present work was to evaluate the relationship between energy-generating nutrients and the presence of central and overall obesity after correcting for socio-demographic, lifestyle and clinical characteristics, among healthy elders.

Methods and Results

During 2005-2007, 553 elderly men and 637 elderly women (mean age 74 ± 7 years) from eight Mediterranean islands in Greece and Cyprus, were enrolled. The retrieved information included demographic, bio-clinical and dietary characteristics. MedDietScore assessed adherence to the Mediterranean dietary pattern.The prevalence of obesity was 27% in males and 39% in females (p < 0.001), while 73% of males and 87% of females had central obesity. The prevalence of diabetes, hypercholesterolemia and hypertension was higher in the obese than in the non-obese participants (p < 0.01). After adjusting for various confounders, a 1% increase in carbohydrate consumption was associated with a 12% (95% CI 0.78-0.99) lower likelihood of having central obesity, while a 1% increase in carbohydrate and protein consumption was associated with a 14% (95% CI 0.78-0.95) and 16% (95% CI 0.72-0.97) lower likelihood of being obese, respectively. Vegetable protein was found to be associated with a 15% (95% CI 0.77-0.93) lower likelihood of being obese while, only low glycemic index carbohydrates seem to be associated with a 6% (95% CI 0.90-0.98) lower likelihood of having central obesity.

Conclusions

The presented findings suggest that a diet high in carbohydrates and vegetable protein is associated with a lower likelihood of being obese and may help elderly people to preserve normal weight.     

Angina among elderly people and its relationship with disability

A postal questionnaire was sent to 2705 people aged 60 and over requesting information about anginal symptoms, their degree of disability and dependency and the use they made of community services. Those with angina showed marked degrees of disability and dependency and used some services to a considerable extent. Postal questionnaires are a satisfactory screening device for identifying individuals at risk and can assist practitioners in organizing their workload for patients with disabling conditions.     

北京市大屯地区青年人群吸烟与被动吸烟现状调查

目的:了解地区青年人群吸烟与被动吸烟情况。方法:本研究采用按人口规模大小成比例的概率抽样方法,对大屯地区常住居民18~44岁,1 172名进行问卷调查。结果:被调查者中吸烟率为12.9%,男性(26.5%)高于女性(2.4%),59.5%的吸烟者第一支烟是18~24岁。男性、35~44岁组、离异或丧偶、高中/中专文化程度吸烟率较高(P0.05)。吸烟者中高血压患病率、饮酒、嗜盐习惯咸、超重均高于不吸烟者(P0.05)。本地区被动吸烟率为24.3%,35~44岁年龄段被动吸烟率最高(28.1%,P0.05),与性别、文化程度无关。被动吸烟的地点主要为工作场所和餐厅。目前,本地区青年人群的戒烟率较低,仅为9.0%。结论:大屯地区青年人群吸烟率相对较低,但男性、35~44岁组和文化程度低的人群吸烟率较高,应针对这类人群加强戒烟宣教和干预,并从青少年开始进行健康宣教,从而减少慢性病危险因素的发生。另外,被动吸烟地点主要是公共场所,因此,在公共场所实施严格的控烟制度,必然会减少其带来的危害。     

Association between serum uric acid and cardiovascular risk factors among elderly people in Taiwan

In order to understand the distribution of serum uric acid and the relationship between serum uric acid and the cardiovascular risk factor among elderly people, a cross-sectional study was conducted in Chung-Shing-Shin-Tseun community in Taiwan in May 1998. All individuals aged 65 and over were collected. A total of 1123 persons, out of 1774 registered residents, were contacted by face-to-face interview. The response rate was 63.3%. However, only 586 respondents had blood tests and completed questionnaires. Analysis in this study was based on these 586 subjects. The mean uric acid values were 7.4 +/- 1.8 mg/dl in men and 6.3 +/- 1.6 mg/dl in women, respectively (p < 0.001). Multivariate linear regression showed that serum uric acid was significantly correlated with sex and body mass index. Simple correlation showed that serum uric acid was significantly correlated with diastolic pressure, total cholesterol, triglyceride and creatinine. Age, systolic pressure and fasting glucose were not related to serum uric acid. In our conclusion, the uric acid values are high among elderly people. The serum uric acid levels are significantly associated with the cardiovascular risk factors among elderly people.     

Specifying cigarette smoking and quitting among people with serious mental illness

People with serious mental illnesses (SMI) have a high prevalence of cigarette smoking. Details of their smoking and quitting behaviors are needed to create effective interventions. This study aims to describe the smoking and quitting histories, current behaviors, and motivations of an outpatient sample of smokers with SMI. A structured interview and Breathalyzer assessment were administered to 120 smokers from four diverse mental health settings. Participants' smoking and quitting self-report data are presented in combination with demographic and clinical variables; the results provide implications for smoking cessation, amelioration, and prevention interventions and for future research.