Aging Clinical and Experimental Research

K⩋ziora-Kornatowska, Kornelia; Kornatowski, Tomasz; Bartosz, Grzegorz; Pawluk, Hanna; Czuczejko, Jolanta; K⩋ziora, Józef; Szadujkis-Szadurski, Leszek

doi: 10.1007/BF03324634pmid: 16608130

Background and aims: One of the factors playing a role in both the aging process and the etiopathogenesis of primary hypertension is oxidative stress. The purpose of this work was to estimate the production of nitric oxide (NO), oxidase activity of ceruloplasmin (Cp) and level of malondialdehyde (MDA), the end-product of lipid peroxidation in the blood of elderly patients with primary hypertension. The influence of treatment with the angiotensin-con-verting enzyme inhibitor perindopril (P) on the above parameters was also ascertained. Methods: The study was carried out on 37 patients (69–91 yrs) with primary hypertension, treated with perindopril for 6 weeks, and normotensive subjects who constituted the two control groups: 25 (65–96 yrs — K1)and 23 (22–41 yrs — K2). Cp oxidase activity in serum, MDA level expressed as the concentration of substances reacting to thiobarbituric acid in red blood cells, and production of NO (concentration of nitrite/nitrate in plasma) by the Griess reaction were all determined. Results: In the group of patients with hypertension, Cp activity was significantly higher than that in the control groups (K1 and K2). MDA concentrations in the erythrocytes of patients with hypertension were significantly higher than in the control groups and hypertensive patients had a lower NO (nitrite/nitrate) levels in plasma when compared with controls. In patients with hypertension, after only 7 days of therapy a substantial decrease in Cp oxidative activity was found, although the lowest value was observed after 6 weeks of therapy. Nevertheless, significantly lower MDA was observed after 6 weeks of therapy, corresponding to the values obtained in controls (K1 and K2). After 6 weeks of perindopril therapy, NO (nitrite/nitrate) was statistically higher in comparison with the values obtained before therapy. Conclusions: Results confirm intensification of oxidative stress and disorders in the production of NO in elderly patients with primary hypertension, and indicate the beneficial antioxidant effect of P.

Gatts, Strawberry; Woollacott, Marjorie

doi: 10.1007/BF03324635pmid: 16608131

Background and aims: Though previous research has shown that Tai Chi reduces falls risk in older adults, no studies have examined underlying neural mechanisms responsible for balance improvement. We aimed to determine the efficacy of Tai Chi training in improving neuromuscular response characteristics underlying balance control in balance-impaired older adults. Methods: Twenty-two balance-impaired older adults were randomly divided into Tai Chi (TC) or control groups. Nineteen subjects (age 68–92, BERG 44 or less) completed the study. TC training included repetitive exercises using TC motor and biomechanical strategies, techniques, and postural elements. Control training included axial mobility exercises, balance/awareness education and stress reduction. Groups trained 1.5 hours/day, 5 days/week for 3 weeks. After post-testing the control group received TC training. Subjects walked across a force plate triggered to move forward 15 cm at 40 cm/sec at heel strike. Tibialis anterior (TA) and medial gastrocnemius (GA) responses during balance recovery were measured with electromyograms (EMGs). Four clinical measures of balance were also recorded. Results: TC subjects, but not controls, significantly reduced both TA response time from 148.92±45.11 ms to 98.67±17.22 ms (p≤0.004) and occurrence of co-contraction of antagonist muscles (p≤0.003) of the perturbed leg. Clinical balance measures also significantly improved after TC. Conclusions: TC enhanced neuromuscular responses controlling the ankle pint of the perturbed leg. Fast, accurate neuromuscular activation is crucial for efficacious response to slips or trips.

Weiss, Avraham; Beloosesky, Yichayaou; Grinblat, Joseph; Grossman, Ehud

doi: 10.1007/BF03324636pmid: 16608132

Background and aims: Orthostatic hypotension (OH) is a common finding among older patients. It has been shown that blood pressure (BP) is lower in summer than in winter. The aim of this study was to examine whether OH varies between seasons in the elderly population. Methods: Five hundred and two inpatients (241 males, 261 females) of mean age 81.6 years were included in the study; 253 were studied in summer and 166 in winter. Orthostatic tests were performed 3 times daily, 30 minutes after meals. Orthostatic hypotension was defined as a decrease of at least 20 mmHg in systolic BP and/or 10 mmHg in diastolic BP upon assuming an upright posture at least twice during the day. Results: OH was documented in 107 patients (34.8%). Initial BP did not differ between seasons (147.6±24.6/72.6±14.5 mmHg in summer, 146.7±23.4/71.5±13.4 mmHg in winter). However, the orthostatic drop in BP in the morning was greater in summer (−8A/−2.8 mmHg vs −4.3/+0.2 mmHg in winter; p<0.05). OH was also more prevalent in summer than in winter (37.9 vs 27.1%; p=0.02). After adjustment for all confounders, the risk of experiencing OH in summer was 64% higher than in winter [adjusted odds ratio (OR) 1.64 [95% Confidence Interval (CI) 1.03–2.61]. Conclusions: The prevalence of OH is higher in summer than winter. Thus, more attention should be paid to the diagnosis of OH in summer.

Wilhelmson, Katarina; Lundin, Eva; Andersson, Christina; Sundh, Valter; Waern, Margda

doi: 10.1007/BF03324637pmid: 16608133

Background and aims: Self-reported data and/or medical records are often used to assess the prevalence of illness and impairment in epidemiological studies. However, these two data sources do not always provide the same information. The aim was to compare data from interviews and medical records regarding illness, symptoms and impairment in the elderly, and to analyze the agreement between a consensus from both data sources and data from interviews and medical records, respectively. Methods: We interviewed 130 persons (age range 67–99) regarding socio-demographic background data and physical and mental health. Medical records were reviewed. Illness burden was rated according to the Cumulative Illness Rating Scale for Geriatrics, and was rated in three ways based on: 1) interview data; 2) medical records; 3) information from both interviews and medical records considered to be consensus. Agreement was measured by the Kappa coefficient and the Svensson Paired Rank Measurement. A permutation test tested whether the ratings from interviews and medical records had the same agreement when compared with consensus. Results: Statistically significant differences in agreement were found between interview versus consensus and medical records versus consensus for the vascular system (medical records best), eyes/ears/ nose/throat/larynx and musculoskeletal/integument (interview best). Medical records gave better information concerning specific diseases and diagnoses, whereas interview data provided a better measure of illness, functional impairment and health in a broader sense. Conclusions: Both medical records and interviews yield good information of elderly people’s health status, but they focus on different aspects of health.

Eskelinen, Seija; Isoaho, Raimo; Kivelä, Sirkka-Liisa; Irjala, Kerttu

doi: 10.1007/BF03324638pmid: 16608134

Background and aims: Clinical guidelines are produced in order to achieve an acceptable standard of care, especially for patients with common diseases in primary care. The treatment of primary hypothyroidism serves as an example of the content of clinical guidelines and actual practice. The aim of this study was to compare the follow-up of primary hypothyroidism by thyroid function tests, serum TSH and serum-free T4, in older patients managed in primary care, with recommendations in treatment guidelines and textbooks. Methods: Participation rate 82% (n=1260), mean age 74 years, (range 64–100 yrs). Patients with primary hypothyroidism were identified by means of cross-sectional survey (Lieto Study 1998–1999) and 4-year retrospective collection of laboratory database medical records (1994–1998), performed in autumn 2003. Results: In most stable (=treated for more than 14 months) thyroxine users, both serum TSH (mean 1.4 measurements/year) and serum-free T4 (mean 0.8 measurements/year) values were measured over the 4-year period of thyroxine treatment. 66.4% of serum TSH and 85.3% of serum-free T4 values were within normal range. 41.7% of serum-free T4 determinations had been performed without indication (=with TSH in normal range). Conclusions: Compared with the recommended testing frequency given in various guidelines, a considerable number of extra measurements, especially serum-free T4, were performed. However, some key issues in the recommendations were difficult to interpret, and the age or other main characteristics of the patient were not taken into consideration adequately.

Bäckmand, Heli; Kaprio, Jaakko; Kujala, Urho; Sarna, Seppo; Fogelholm, Mikael

doi: 10.1007/BF03324639pmid: 16608135

Background and aims: Physical exercise plays an important role in the prevention and reduction of disabilities in elderly people. The aim of this study was to determine the role of physical activity in the physical and psychological functioning of daily living in a cohort of former elite male athletes representing different sports, and controls of middle and old age. Methods: Subjects were 664 former elite male athletes (mean age 64.4 years) and 500 controls (62.0 years) in middle and old age. Subjects were mailed “Physical activity and health survey” questionnaires in 1985 and 1995. The primary outcomes — the physical and psychological functioning of daily living — were assessed in 1995 using items from the Mini-Finland Health Survey. Logistic regression was used for longitudinal as well as cross-sectional analyses to estimate odds ratios (OR) for poor physical and psychological functioning of daily living in relation to recreational physical activity adjusted for age, sport group, life-style, BMI, mood, chronic diseases, personality characteristics, life-events and socio-economic status. Results: In the longitudinal analysis, low levels of physical activity (lowest MET quintile vs highest quintile) in 1985 (OR 4.91, 95% confidence interval (CI) 2.02–11.9), older age (≥70 yrs vs under 60 yrs OR 9.93, 95% CI 4.90–20.2), depression (OR 2.03, 95% CI 1.01–4.09) and anxiety in 1995 (OR 2.67, 95% CI 1.34–5.32) increased the risk of poor physical functioning of daily living in 1995, whereas an increase in a physical activity between 1985–1995 (OR 0.89, 95% CI 0.83–0.95) protected against poor physical functioning of daily living. A history of participating in specific types of sports, especially among certain power sports (weight-lifting and track & field throwers) (OR 0.19, 95% CI 0.06–0.60) and team sports (OR 0.34, 95% CI 0.15–0.81) did reveal a significant protective effect against poor psychological functioning of daily living in the longitudinal analysis. Conclusions: This study suggests that an increase in physical exercise supports physical daily functionality. A specific history of sports participation promotes psychological well-being at an older age.

Timonen, Leena; Rantanen, Taina; Mäkinen, Erkki; Timonen, Tero; Törmäkangas, Timo; Sulkava, Raimo

doi: 10.1007/BF03324640pmid: 16608136

Background and aims: An acute illness may place older frail people at increased risk of losing independence in functional abilities. Physical exercise may reduce the risk by improving muscle strength and balance. However, the effects of physical training on functional abilities have not been studied among frail, very old people recovering from an acute illness. The aim of this study was to determine the effects of a group-based exercise program on their ability to carry out self-care (ADL) and instrumental activities (IADL) relevant to daily life after discharge from hospital. Methods: This randomized controlled trial examined 68 community-dwelling women aged 75 years or older (mean age 83.0, SD 3.9) who were hospitalized due to an acute illness, and were mobility-impaired at admission. Participants were recruited from the geriatric ward of a primary-care health-center hospital, and were randomized into group-based strength training (n=34) and control (n=34) groups. The 10-week group-based intervention included strength training and functional exercises. The control group received instructions for a home exercise training program, including functional exercises but no further encouragement to exercise. The level of independence in ADL and IADL was evaluated, using a 13-item scale with stepwise grading from fully independent to fully dependent. Measurements took place immediately before and after the intervention, and three and nine months later. Results: The intervention did not have any significant main effect (p=0.407), nor was there any significant interaction between follow-up time and intervention (p=0.854). Conclusions: The multi-component outpatient strength training program did not improve autonomy in expert-evaluated ADL/IADL functions.

Monaco, Marco; Vallero, Fulvia; Monaco, Roberto; Mautino, Fulvio; Cavanna, Alberto

doi: 10.1007/BF03324641pmid: 16608137

Background and aims: Low body mass index (BMI) is associated with high risk of osteoporosis and fractures, but its impact on functional recovery after fractures is unknown. Our aim was to investigate the association between BMI and both functional recovery and period of rehabilitation in hip-fractured women. Methods: 510 out of 580 Caucasian women with hip fracture, admitted consecutively to a rehabilitation hospital, were investigated in this retrospective study. Functional recovery was assessed using the Barthel index score. Results: In the 510 women, BMI was 22.8±4.1 kg/m2 (mean±SD). After adjustment for age, femur bone mineral density, and the Barthel index assessed on admission to rehabilitation, a significant negative association was found between BMI and both the Barthel index score after rehabilitation and changes in it resulting from rehabilitation (p≤0.001). After adjustment for age and the Barthel index assessed on admission to rehabilitation, a significant positive association was found between BMI and period of rehabilitation (p≤0.001). The results were similar when BMI was evaluated either as individual values or after categorization according to World Health Organization criteria. Conclusions: In a sample of hip-fractured women, BMI was negatively associated with Barthel index scores and positively associated with period of rehabilitation. BMI may affect function after hip fracture, apart from hip fracture risk: subjects with higher BMI and low hip fracture risk may have poorer functional recovery in case of hip fracture, despite prolonged rehabilitation. Conversely, subjects with lower BMI and high hip fracture risk may have better functional recovery in case of hip fracture.

Zanocchi, Mauro; Maero, Barbara; Martinelli, Elisa; Cerrato, Flavio; Corsinovi, Laura; Gonella, Mafalda; Ponte, Elisabetta; Luppino, Angela; Margolicci, Angela; Molaschi, Mario

doi: 10.1007/BF03324642pmid: 16608138

Wouters-Wesseling, Wendeline; Slump, Erika; Kleijer, Chantai; Groot, Lisette; Staveren, Wija

doi: 10.1007/BF03324643pmid: 16608139

Background and aims: Many elderly people with Alzheimer’s disease experience weight loss. Illness and inadequate regain after a period of illness are considered as contributory causes of progressive weight loss in psychogeriatric patients. We studied whether early use of a liquid nutrition supplement immediately after onset of acute illness from infection can prevent weight loss in elderly psychogeriatric nursing home residents. Methods: Randomised controlled trial of 5 weeks after the onset of illness. Thirty-four psychogeriatric nursing home residents (aged ±65 yrs) completed the study period. A liquid nutrition supplement (200 ml) once daily immediately after diagnosis of infection or standard treatment (enriched food after referral to a dietician) were provided. Body weight, mid-upper arm circumference, calf circumference, triceps skin fold thickness, dietary energy intake, and need for care were measured. Results: Weight change during the study period was significantly different between the standard (−0.4 kg) and supplement (+0.8 kg) groups (p=0.040). No significant differences were observed in changes of midupper arm circumference, triceps skin fold thickness, calf circumference or energy intake between groups. Conclusions: Early provision of a liquid nutrition supplement immediately after onset of acute illness from infection leads to weight gain in elderly psychogeriatric nursing home residents.