The study sample for this study comprised 318 subjects (219 women and 99 men), aged 68.6 ± 0.8 years. All subjects underwent clinical assessment, nocturnal polygraphy, and cognitive and mood disorders evaluation. RLS was assessed with the standard validated criteria and severity was evaluated by the use of International Restless Legs Syndrome Study Group (IRLS) questionnaire.

RLS was present in 24.2% of the sample, prevalence being greater in women (29.7%) than in men (12.1%). The mean IRLS score was 16.6 ± 4.8, 67% of cases having mild to moderate range. Participants with RLS reported greater hypnotic (p < .001) and antidepressant medication intake (p < .001) and had higher anxiety (p < .001) and depression (p < .001) scores. Participants with RLS had lower cognitive performances at Stroop and Verbal fluency tests than participants without RLS (p < .05 and p = .002, respectively). These associations remained significant after multivariate adjustment for medication, depression, and subjective sleep.

Presence of undiagnosed RLS is higher in healthy elderly participants without previously diagnosed sleep disorders, affecting women more often than men. The presence of RLS increased the risk of anxiety and mood disorders and predispose to preclinical cognitive decline independently of anxiety, mood disorders, duration and quality of sleep, and medication.

Using nationally representative data on adults aged 50–64 years from the 1999–2006 National Health and Nutrition Examination Surveys, we examined weight change for two periods of adulthood: prime age (age 25–10 years ago) and midlife (the last 10 years). Weight changes in each period were categorized as stable (gain <10 kg) or gain (gain ≥10 kg) to create weight history comparison groups: stable-stable, gain-stable (prime age gain), stable-gain (midlife gain), and gain-gain (continuous gain). Persons who lost weight were excluded. Logistic regression predicted odds of metabolic syndrome and its subcomponents based on weight history, adjusting for current BMI and covariates.

Participants in the gain-stable group had 89% elevated odds of metabolic syndrome (odds ratio = 1.89, 95% CI: 1.19–3.01) relative to the stable-stable group, even after adjustment for current BMI. All weight gain groups had increased odds of low HDL and high triglycerides relative to participants with continuously stable weights. No significant associations were found between weight history and hypertension or high glucose.

Weight history confers information about metabolic risk factors above and beyond attained weight status. In particular, adult weight gain is related to risk of low HDL and high triglycerides. Weight history may contribute to our understanding of why some obese older persons are metabolically healthy but others are not.

Basal and postprandial levels of active and total ghrelin were measured in 15 younger (mean age 35.4 years) and 19 older (80.7 years) participants following a carbohydrate-rich test meal.

Our results showed that older participants felt postprandially less hungry and more full. Although basal levels were not significantly different, active and total ghrelin levels declined postprandially only in the younger study participants. Highly significant differences between the two age groups were shown for the changes of the area under the curve for active ghrelin (p = .024).

Our study demonstrates for the first time that differences in hunger and satiety sensations in relation to age are paralleled by a substantially different response of acylated and total ghrelin, that is, the absence of a postprandial decline in ghrelin levels.

This cross-sectional study included 2,039 men and women aged 55 years and older from the 1999–2002 National Health and Nutrition Examination Survey. Fat mass was measured by dual-energy x-ray absorptiometry and leg strength by dynamometer. Based on fat mass and leg strength tertiles, four independent groups were identified: non-dynapenic and non-obese, obese alone, dynapenic alone, and dynapenic-obese. An objective physical function measure was obtained from a 20-foot walking speed test, whereas subjective physical function measures were obtained from five self-reported questions.

Within both sexes, the dynapenic-obese group had a slower walking speed than the non-dynapenic and non-obese and obese-alone groups (p ≤ .01) but not the dynapenic-alone group. Similarly, with the exception of the dynapenic-alone group in men, the global subjective score was lower in the dynapenic-obese group than in the non-dynapenic and non-obese and obese-alone groups (p ≤ .01). By comparison to the dynapenic-obese group, the adjusted odds ratios (95% confidence interval) for walking disability were 0.21 (0.12–0.35) in the non-dynapenic and non-obese, 0.34 (0.20–0.56) in the obese-alone, and 0.54 (0.33–0.89) in the dynapenic-obese groups. The corresponding odds ratios for a disability based on the global subjective score were 0.20 (0.09–0.42), 0.60 (0.30–1.21), and 0.41 (0.19–0.87).

Dynapenic-obesity was associated with a poorer physical function than obesity alone and in most cases with dynapenia alone.

Six hundred seventy-seven participants (289 males and 388 females) between 16 and 104 years of age, categorized as long lived (LL; >85 years old) or controls (C; <85 years old), were genotyped for Gly1057Asp-IRS2 locus variability (rs1805097). All participants, contacted at home or in their institution or selected from Italian geriatric and internal medicine or geriatric rehabilitation structures, underwent to a clinical, biochemical, and functional characterization, with particular attention to the insulin and IGF-1 signaling. Insulin resistance (Homeostasis Model Assessment [HOMA]-IR), insulin sensitivity (HOMA IS), and ß-cell function (HOMA-B cell) were calculated by the HOMA2 calculator v2.2 (www.dtu.ox.ac.uk/homa).

In the whole population, homozygous IRS2^Asp/Asp participants were more represented among LL versus C participants (16.7% vs 12.0%; p = .04). The association between IRS2 gene polymorphism with longevity (being LL) was independent of anthropometric and metabolic covariates (odds ratio: 2.07, 95% confidence interval [CI] = 1.38–3.12; p = .001). Categorizing participants into percentiles by age, IRS2Asp/Asp participants were more likely to reach extreme old age (≥90 percentile, 96–104 years; odds ratio: 2.03, 95% CI = 1.39–2.99; p = .0003).

These results support the hypothesis that the IRS2 branch of the insulin and IGF signaling is associated with human longevity. Further studies will be necessary for replicating our finding in an independent larger population group with sufficient power before the association between IRS2 gene polymorphism and longevity can be regarded as proven. Furthermore, studies of genetic and/or environmental background interactions may be useful after basic replication is complete.

A literature review of recent contributions gathered from a variety of disciplines seeks a more sturdy and consistent heuristic from which derivative work may proceed.

Publications from basic and clinical sciences as well as related nonmedical fields reveal a new conceptual framework for the understanding of human aging, which suggests a broader framework of contributing agencies and their policy implications.

Aging is not a disease and therefore demands a different lens for analysis. This article provides a deeper focus and insists on the inclusion of a heightened sense of the participation of time. Incorporation of the imperatives applied by the Second Law of Thermodynamics is the foundation of the new definitions.

Seven relevant community-based studies of older adults with RDW measurement and mortality ascertainment were identified. Cox proportional hazards regression and meta-analysis on individual participant data were performed.

Median RDW values varied across studies from 13.2% to 14.6%. During 68,822 person-years of follow-up of 11,827 older adults with RDW measured, there was a graded increased risk of death associated with higher RDW values (p < .001). For every 1% increment in RDW, total mortality risk increased by 14% (adjusted hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.11–1.17). In addition, RDW was strongly associated with deaths from CVD (adjusted HR: 1.15; 95% CI: 1.12–1.25), cancer (adjusted HR: 1.13; 95% CI: 1.07–1.20), and other causes (adjusted HR: 1.13; 95% CI: 1.07–1.18). Furthermore, the RDW–mortality association occurred in all major demographic, disease, and nutritional risk factor subgroups examined. Among the subset of 1,603 older adults without major age-associated diseases, RDW remained strongly associated with total mortality (adjusted HR: 1.32; 95% CI: 1.21–1.44).

RDW is a routinely reported test that is a powerful predictor of mortality in community-dwelling older adults with and without age-associated diseases. The biologic mechanisms underlying this association merit investigation.

In 20 healthy elderly men undergoing elective vertebral surgery, IMAT within erector spinae was evaluated by magnetic resonance imaging and body composition by dual-energy x-ray absorptiometry. Fasting glucose, insulin, high-sensitive C-reactive protein (hs-CRP), leptin, adiponectin, and interleukin 6 (IL-6) were measured, and insulin resistance was estimated by homeostasis model assessment (HOMA) index. In subcutaneous adipose tissue (SAT) biopsies near the erector spinae, quantification of gene expression was performed.

IMAT showed a significant association with body mass index and total and regional body fat, even after adjustment for age. Insulin, HOMA, and leptin were significantly correlated with IMAT, whereas hs-CRP presented an association of borderline significance. IL-6 expression in SAT was significantly associated with IMAT; IL-6 messenger RNA (mRNA) was negatively associated with adiponectin and peroxisome proliferator–activated receptor gamma expression. In multivariate regression analysis, 68% of IMAT variance was explained by fat mass and age, independent of waist circumference, leptin, HOMA, and IL-6 mRNA.

IMAT was primarily related to age and total body adiposity; subclinical inflammation in fat significantly contributes to IMAT.

Twenty young (mean age = 21 years) and 20 older (M = 78 years) women were instructed to slowly lower their body weight, similar to the descent phase of a push-up, from body lean angles ranging from 15° to 90°. Measures were acquired of peak upper extremity energy absorption, arm deflection, and hand contact force.

On average, older women were able to absorb 45% less energy in the dominant arm than young women (1.7 ± 0.5% vs 3.1 ± 0.4% of their body weight x body height; p < .001). These results suggest that, even when both arms participate equally, the average energy content of a forward fall exceeds by 5-fold the average energy that our older participants could absorb and exceeds by 2.7-fold the average energy that young participants could absorb.

During a descent movement that simulates fall arrest, the energy-absorbing capacity of the upper extremities in older women is nearly half that of young women. Absorbing the full energy of a fall in the upper extremities is a challenging task even for healthy young women. Strengthening of upper extremity muscles should enhance this ability and presumably reduce the risk for injury to the hip and head during a fall.

We conducted a cross-sectional study to determine the prevalence of PIM use among 689 patients with MCI. We used the 2003 Beers Criteria for cognitive impairment to identify PIMs. We then determined if certain patients were more likely to use PIMs.

There were 143 (20.8%) patients with MCI taking a PIM: 108 (15.7%) patients were taking one PIM and 35 (5.1%) patients were taking two or more PIMs. The most common PIMs were anticholinergics (35.7%) and benzodiazepines (31.5%). Patients were more likely to be taking PIMs if they were women and were taking a greater number of medications and less likely if they had a history of myocardial infarction.

Patients with MCI are frequently taking PIMs that may negatively affect cognition. Future research is needed to assess whether cognitive impairment symptoms are improved if PIM use is reduced.

Longitudinal associations between change in depression (Patient Health Questionnaire-9 [PHQ-9]) and weight (self-reported and chart abstracted) were examined in 2,600 patients with type 2 diabetes (mean age 62, SD = 11.6) who were surveyed by telephone in 2001–2002 and 5 years later as part of the Pathways study. Mixed effects regression analyses compared a) patients with persistently low depression symptoms with those whose depression worsened (increased at least 5 points on PHQ-9) over 5 years and b) patients with persistently high depression symptoms with those who improved (decreased at least 5 points on PHQ-9) over 5 years.

Those who worsened in comparison to those with persistently low depression symptoms did not differ in their pattern of weight change (z = 1.54, p = .12). Both groups weighed approximately 92 kg at baseline and lost approximately 2 kg. A significantly different pattern of change over time was observed for those with persistently high depression symptoms in comparison to those whose depression improved (z = 1.98, p = .04). Although the groups had almost identical weight at baseline (approximately 100 kg), at the 5-year assessment, those with persistently high depression symptoms had about half the weight loss (M = –1.71, SD = 9.08) in comparison to those whose depression improved (M = –3.62, SD = 19.93).

In persons with diabetes who have clinically significant levels of depressive symptoms, improvement in depression is accompanied by significantly greater, clinically significant weight loss.

Data are from 2,984 women and men aged 70–79 years participating in the Health, Aging, and Body Composition Study without mobility limitation at baseline. Obesity was defined as body mass index greater than or equal to 30 kg/m² and the MetS as meeting greater than or equal to 3 of the ATP III criteria. Mobility limitation was defined as any difficulty walking one-quarter mile or climbing 10 steps during two consecutive semiannual assessments for more than 6.5 years.

Incidence of mobility limitation was 55% in women and 44% in men. In women, adjusted risk of developing mobility limitation was progressively greater in nonobese participants with the MetS (hazard ratio [HR] = 1.49, 95% confidence interval [CI] = 1.24–1.80), obese participants without the MetS (HR = 1.95, 95% CI = 1.51–2.53), and obese participants with the MetS (HR = 2.16, 95% CI = 1.78–2.63) relative to the nonobese without the MetS. In men, the corresponding adjusted HRs (95% CI) were 1.07 (0.87–1.32), 1.64 (1.19–2.25), and 1.41 (1.12–1.78). Elevated inflammatory markers partly explained the association between obesity, the MetS, and mobility limitation, particularly in nonobese and obese participants with the MetS.

Obesity itself, independent of its metabolic consequences, is a risk factor for mobility limitation among obese older adults. In addition, having the MetS increases the risk of functional decline in older nonobese women but not in men.

Observational study of 547 disabled women aged 65 years and older (Women’s Health and Aging Study I) including 131 frail who participated in a test of EC. EC (seated step test), cardiac function (chronotropic index), pulmonary function (forced vital capacity, FVC), musculoskeletal function (quadriceps strength, QS), and frailty status were measured and interactive effects were modeled using linear regression and differentiation.

Each physiological system had a direct relationship with EC, which was lower in frail compared with nonfrail. The relationship between FVC and EC was positive and increased with increasing QS in nonfrail subjects. The effect of QS on EC was positive and increased with increasing FVC regardless of frailty. In subjects with low QS, frailty status was associated with lower EC and this effect became stronger with increasing FVC.

Findings suggest but do not show that frailty status modifies the effects of physiological function in several systems on EC. Approaches to understanding emergent properties such as vulnerability to illness and death and clinical efforts to prevent and treat frailty should evaluate and possibly intervene on several physiological systems to be maximally effective.

Ambulatory activity data were collected continuously from 157 community-dwelling older adults for 2 weeks. Participants were separated post hoc into groups based on the mean number of steps per day: highly active (steps ≥ 10,000), moderately active (5,000 ≤ steps < 10,000 steps), and inactive (steps <5,000 steps). Detrended fluctuation analysis (DFA), entropy rate (ER), and approximate entropy (ApEn) were used to examine the complexity of daily time series composed of 1-minute step count values. Coefficient of variation was used to examine time series variability. Between-group differences for each parameter were evaluated using analysis of variance.

All groups displayed patterns of fluctuating step count values containing complex temporal structure. DFA, ER, and ApEn parameter values increased monotonically and significantly with increasing activity level (p < .001). The variability of step count fluctuations did not differ among groups.

Highly active participants had more complex patterns of ambulatory activity than less active participants. The results supported the idea that, in addition to the volume of activity produced by an individual, patterns of ambulatory activity contain unique information that shows promise for offering insights into walking behavior associated with healthy aging.

Multiple measures of vision and cognition were collected at the baseline examination of a population of 1,425 drivers aged 67–87 years in greater Salisbury, Maryland. Each driver had real-time data collected on 5 days of driving performance at baseline and again at 1 year. Failure to stop at a red traffic light was the primary outcome.

Overall, 3.8% of older drivers failed to stop at red traffic lights, with 15% of those who ran the light having failed 10% or more of the traffic lights they encountered. A narrowing of the attentional visual field (AVF; the extent of peripheral vision in which objects are detected while attention is also centrally fixated) was associated with failure to stop at traffic lights at baseline and predictive 1 year later (incidence rate ratio = 1.09 per degree lost, 95% confidence interval = 1.01–1.16). Persons with smaller vertical AVF were more likely to fail to stop. No demographic or vision variable was related to failure to stop.

Failure to stop at red lights was a relatively uncommon event in older drivers and associated with reduced ability to pay attention to visual events in the vertical field of vision.

Stratified sampling of two socioeconomically diverse strata of St Louis, Missouri, occurred in 2000–2001. Inclusion criteria were self-reported black or African American race, born 1936–1950 inclusive, and Mini-Mental State Examination score of 16 or greater. In-home evaluations of handgrip strength, lean body mass percentage (LBM%), physical performance, upper and lower body functional limitations (UBFLs and LBFLs), and basic and instrumental activities of daily living (BADLs and IADLs) were collected. Of the 998 participants, 368 had blood sampled at baseline. Serum was stored and assayed in 2006.

Absolute risks were LBFLs of 2 or more, 46%; UBFLs of 1 or more, 23.5%; BADLs of 2 or more, 20.6%; and IADLs of 2 or more, 22.5%. Independent of age, sex, and underlying comorbid conditions, higher CRP and sTNFR were associated with poorer physical performance (β = –1.462, p < .001 and β = –0.618, p = .003), UBFLs (odds ratio [OR] 2.26, 95% confidence interval [CI] 1.1–4.64 and OR 1.39, 95% CI 0.96–2.02), LBFLs (OR 2.30, 95% CI 1.19–4.45 and OR 1.91, 95% CI 1.26–2.91), BADLs (OR 2.79, 95% CI 1.03–5.96 and OR 1.66, 95% CI 1.11–2.46), and IADLs (OR 2.13, 95% CI 1.03–4.41 and OR 1.43, 95% CI 0.99–2.08). Higher CRP (β = –3.251, p <.001), sIL-6R (β = –6.152, p = .013), and lower adiponectin (β = 2.947, p = .052) were associated with lower LBM%.

Higher CRP and sTNFR are independently associated with disability and physical dysfunction. Higher sIL-6R, CRP, and lower adiponectin associate with lower LBM%.

Sixty-six elective abdominal surgery patients aged 24–91 years were assessed before and at the second and fourth day after surgical intervention. Outcome parameters were grip strength, muscle endurance, fatigue subscale of the Profile of Mood State and visual analog scale for pain, and the circulating inflammatory mediators C-reactive protein, interleukin (IL)-6, and tumor necrosis factor-alpha (TNF-).

All parameters worsened postoperatively (p < .01) and remained significantly (p < .05) worse until the fourth day postsurgery, except for TNF- (no significant change). Older age was related to higher surgery-induced IL-6 levels at the second (p < .05) and fourth postoperative (p < .01) day and to worse self-perceived fatigue and muscle endurance (both p < .05) at the fourth postoperative day. Higher pain levels at the second day following surgery was related to more self-perceived fatigue (p < .05). Worsening muscle endurance following surgery was significantly related to higher IL-6 release following surgery (p < .01) and self-perceived fatigue (p < .05) at the fourth day following the intervention. Age and surgery-induced increase in circulating IL-6 at Day 4 postsurgery was highest in patients showing both worsened muscle endurance and self-perceived fatigue (p < .05).

Surgery-induced inflammation is related to reduced muscle endurance and the sensation of fatigue. Elderly patients suffer from a higher impact of surgery on muscle endurance.

Study participants were from the annual Health Examination for the Elderly Program in the National Taiwan University Hospital (135 women and 121 men, mean age 72.2 years). Self-reported sleep duration was grouped into three categories: less than 5, 5–7.9, and 8 or more hours. Short sleep duration was defined as sleep duration less than 5 hours. Falling during the previous 12 months was ascertained by self-report questionnaire. The association of sleep duration with falling was examined by using multiple logistic regression. We approximated risk ratio (RR) of falls from the adjusted odds ratio (OR) after correction of falls incidence in the previous year.

Sleep duration was inversely associated with falling among women. After adjusting for multiple confounding factors including use of antihypertensives and psychotropic medications, the OR of falls for each hour decrease in sleep duration was 1.95 (95% confidence interval [CI] 1.24–3.06). Moreover, women with sleep deprivation had a greater odds of falls within the last year than those with longer sleep durations. The estimated RR of falls comparing women with short sleep duration (sleep <5 hours) with those without was 2.98 (95% CI 1.32–4.62). We did not find an association among men.

Sleep deprivation is independently associated with falls in women but not in men. Short sleep duration may be an indicator to identify women at risk for falling.

In the Women’s Health Initiative Memory Study (WHIMS) clinical trial, we examined associations at baseline and over a 6-year follow-up period between the Modified Mini-Mental State (3MS) Examination and three physical performance measures (PPMs): gait speed (meters/second), chair stands (number of stands in 15 seconds), and grip strength (kilograms). Using mixed models, we examined the baseline 3MS as predictor of change in PPM, change in the 3MS as predictor of change in PPM, and baseline PPM as predictors of 3MS change.

Among 1,793 women (mean age = 70.3 years, 89% white, and mean 3MS score = 95.1), PPM were weakly correlated with 3MS—gait speed: r = .06, p = .02; chair stands: r = .09, p < .001; and grip strength: r = .10, p < .001. Baseline 3MS score was associated with subsequent PPM decline after adjustment for demographics, comorbid conditions, medications, and lifestyle factors. For every SD (4.2 points) higher 3MS score, 0.04 SD (0.04 m/s) less gait speed and 0.05 SD (0.29 kg) less grip strength decline is expected over 6 years (p ≤ .01 both). Changes in 3MS and PPM were associated, particularly with chair stands and grip strength (p < .003 both). Baseline PPMs were not associated with subsequent 3MS change.

Baseline global cognitive function and change in global cognitive function were associated with physical performance change, but baseline physical performance was not associated with cognitive change in this cohort. These analyses support the hypothesis that cognitive decline on average precedes or co-occurs with physical performance decline.

Our sample included 40 adults with knee or hip osteoarthritis (OA) and 20 healthy controls. Fatigue was measured by ecological momentary assessment several times a day along with continuous measurement of physical activity using a wrist-worn accelerometer. Fatigability was measured as the fatigue increase after a period of high activity.

Compared with controls, participants with OA were approximately four times more likely to have an increase in fatigue after a high activity interval (37.0% vs 9.8%). Among people with OA, average fatigue and fatigability were not highly related (r = .13). Fatigue was most strongly associated with reported physical function, pain, and vitality, whereas fatigability was most strongly associated with body mass index, OA severity, and knee strength.

Although fatigue among people with OA was more associated with subjective reports of physical function and symptoms, pairing fatigue reports with physical activity tapped objective factors that may be related to the biomechanical demands of daily life activities. Thus, fatigability measurement may help discern how symptoms relate to daily life function and help to refine treatment approaches in OA.

We recruited 2000 men and 2000 women aged 65 years or older. Baseline BMI, waist–hip ratio (WHR), body fat index (BFI = total body fat/height square), relative truncal fat (RTF = trunk fat/total body fat), and body muscle mass index (BMMI = total body muscle mass/height square) were measured. Mortality was ascertained by death registry after 63.3 (median) months.

Two hundred and forty-two men and 78 women died. In men, mortality hazard ratio (HR) decreased consistently by 0.85 (p < .005), 0.86 (p < .005), and 0.86 (p < .005) per every quintile increase in BMI, BFI, and BMMI, respectively. A J-shaped relationship was observed in central adiposity (RTF and WHR) quintiles; the minimum values were at the 3rd WHR quintile (0.92–0.94) and 4th RTF quintile (mean WHR, 0.94). When RTF was tested with BFI, both high and low central adiposity were unfavorable while general adiposity became marginally insignificant (p = 0.062). When BFI and BMMI were tested together, increasing adiposity rather than muscle mass favored survival (BFI quintile, HR 0.97, p .015; BMMI quintile, HR 1.00, p .997).

Older men were resistive to hazards of overweight and adiposity; and mild-grade overweight, obesity, and even central obesity might be protective. This may bear significant implication on the recommended cutoff values for BMI and WHR in the older population.

To develop and validate a diagnostic tool for evaluating upper gastrointestinal symptoms in older patients.

A cohort of 206 older patients who underwent a upper gastrointestinal endoscopy (development cohort) was used for developing a 15-item upper gastrointestinal symptom questionnaire for the elderly population (UGISQUE), including five symptom clusters: (a) abdominal pain syndrome, (b) reflux syndrome, (c) indigestion syndrome, (d) bleeding, and (e) nonspecific symptoms. The questionnaire was then validated in a cohort of 326 older patients selected from those who underwent an upper gastrointestinal endoscopy in 15 gastroenterological centers in Italy (validation cohort).

The endoscopic diagnoses in the development and validation cohorts were esophagitis (E) 15.5% and 29.4%, erosive gastritis (EG) 24.8% and 24.8%, peptic ulcer (PU) 26.2% and 14.7%, and without organic lesions (WOL) 31.0% and 33.5%, respectively. In both the cohorts, patients with upper gastrointestinal disorders showed significantly more symptoms than WOL patients. The predictive value of UGISQUE for any pathological condition (E, EG, or PU) was good, with areas under the receiver-operating characteristic curve of .80, 95% confidence interval (CI) 0.743–0.864, and of .78, 95% CI 0.73–0.83, in the development and validation cohorts, respectively. The accuracy of UGISQUE was significantly higher than that for the individual clusters of symptoms in predicting the presence of E (p = .004), PU (p < .0001), or any pathological condition (p < .0001).

UGISQUE is an accurate diagnostic tool for evaluating symptoms in elderly patients with upper gastrointestinal disorders.

We examined the discharge records for 10,913 patients aged 75 years or older admitted during 2005 to the ED of all public hospitals in Florence, Italy. Using information on demographics, drug treatment, previous hospital admissions, and discharge diagnoses, we developed a 1-year mortality prognostic index. The predictive validity of this index was tested in a subsample of patients independent of the subsample used for its original development. Finally, we tested whether patients stratified by the prognostic index had different mortality when admitted to a geriatrics compared with an internal medicine ward.

In the validation subsample, patients with scores of 4–6, 7–10, and 11+ compared with those with scores less than 4 had hazard ratios (95% confidence interval) for 1-year mortality of, respectively, 1.5 (1.3–1.7), 2.2 (1.3–1.7), and 3.0 (2.6–3.4). Patients in the worse prognostic stratum experienced 33% higher mortality when admitted to an internal medicine compared with a geriatrics ward, although mortality was not significantly affected by the type of ward of admission in all other risk strata.

Simple administrative data provide prognostic information on long-term mortality in older patients hospitalized via ED. Patients with worse prognostic index scores appear to benefit from admission in a geriatrics compared with an internal medicine ward.

Longitudinal cohort study using prospectively collected data on weight, physical function, and health status in four U.S. Communities in the Cardiovascular Health Study. Included were 3,278 participants (2,013 women and 541 African Americans), aged 65 or older at enrollment, who had at least five weight measurements. Weight was measured at annual clinic visits between 1992 and 1999, and summary measures of mean weight, coefficient of variation, average annual weight change, and episodes of loss and gain (cycling) were calculated. Participants were followed from 1999 to 2006 for activities of daily living (ADL) difficulty, incident mobility limitations, and mortality.

Higher mean weight, weight variability, and weight cycling increased the risk of new onset of ADL difficulties and mobility limitations. After adjustment for risk factors, the hazard ratio (95% confidence interval) for weight cycling for incident ADL impairment was 1.28 (1.12, 1.47), similar to that for several comorbidities in our model, including cancer and diabetes. Lower weight, weight loss, higher variability, and weight cycling were all risk factors for mortality, after adjustment for demographic risk factors, height, self-report health status, and comorbidities.

Variations in weight are important indicators of future physical limitations and mortality in the elderly and may reflect difficulties in maintaining homeostasis throughout older ages. Monitoring the weight of an older person for fluctuations or episodes of both loss and gain is an important aspect of geriatric care.

We compared the body composition change in 147 older weight changers (54% women, 38% black) with the gender- and race-matched weight-stable individuals over the weight-cycling period. A weight cycle was defined as weight loss of 3% or more with regain of within ±3% of baseline weight for a period of 2 years.

Both men and women showed significantly lower total body mass after the weight loss and regain. Proportionally, more lean mass was lost during the weight-loss period than was gained during the weight-regain period, especially in men. After weight regain, men showed only a slightly lower lean mass than the stable group, and this was not statistically significant, although the failure to fully regain total weight explained most of the deficit in lean mass after the weight cycle.

These data suggest that weight loss even with regain may contribute to a net loss of lean mass in older men but warrant further studies.

Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample. The participants completed baseline surveys in 1963 or 1973 (mean age 41.6 years, range 25–63 years). The surveys included questions about height, weight, diseases, and lifestyle factors. Beginning in 1986, the same individuals were assessed on neuropsychological tests every 3 years (except in 1995) until 2002. During the study period, 781 individuals who were 50 years and older (60% women) had at least one complete neuropsychological assessment. A composite score of general cognitive ability was derived from the cognitive test battery for each measurement occasion.

Latent growth curve models adjusted for twinness showed that persons with higher midlife BMI scores had significantly lower general cognitive ability and significantly steeper longitudinal decline than their thinner counterparts. The association did not change substantially when persons who developed dementia during the study period were excluded from the analysis.

Higher midlife BMI scores precede lower general cognitive ability and steeper cognitive decline in both men and women. The association does not seem to be mediated by an increased risk for dementia.