Benedetta Bartali

Executive Function Correlates with Walking Speed in Older Persons: The InCHIANTI Study

Objectives: To study the association between performance on psychological tests of executive function and performance on lower extremity tasks with different attentional demands in a large sample of nondemented, older adults.

High-Frequency Vibration Training Increases Muscle Power in Postmenopausal Women

OBJECTIVE To test whether training on a high-frequency (28Hz) vibrating platform improves muscle power and bone characteristics in postmenopausal women. DESIGN Randomized controlled trial with 6-month follow-up. SETTING Outpatient clinic in a general hospital in Italy. PARTICIPANTS Twenty-nine postmenopausal women (intervention group, n=14; matched controls, n=15). INTERVENTION Participants stood on a ground-based oscillating platform for three 2-minute sessions for a total of 6 minutes per training session, twice weekly for 6 months. The controls did not receive any training. Both groups were evaluated at baseline and after 6 months. MAIN OUTCOME MEASURES Muscle power, calculated from ground reaction forces produced by landing after jumping as high as possible on a forceplate, cortical bone density, and biomarkers of bone turnover. RESULTS Over 6 months, muscle power improved by about 5% in women who received the intervention, and it remained unchanged in controls (P=.004). Muscle force remained stable in both the intervention and control groups. No significant changes were observed in bone characteristics. CONCLUSION Reflex muscular contractions induced by vibration training improve muscle power in postmenopausal women.

The frailty syndrome: a critical issue in geriatric oncology

Evidence exists that the geriatric intervention guided by Comprehensive Geriatric Assessment (CGA) has positive effects on a number of important health outcomes in frail older patients. Although a number of observational studies, editorials, special articles and clinical reports, suggest that CGA should be used to guide the assessment and clinical decision-making in older cancer patients, there is limited support to this view in the literature. Older patients that are diagnosed with cancer are usually healthier and less problematic than persons of the same age who are randomly sampled from the general population. In these persons, the cancer dominates the clinical picture and, therefore, instruments especially tuned for the frail elderly may provide little information. The concept of the frailty syndrome, characterized by high susceptibility, low functional reserve and unstable homeostasis, has recently received a lot of attention by the geriatric community. A CGA approach, which also evaluates elements of the frailty syndrome, may be of great interest for those oncologists who want to identify older patients likely to develop severe toxicity and severe side effects in response to aggressive treatment. Improvements in the definition of the frailty syndrome may profit from the clinical experience of oncologists.

Epidemiology of back pain in a representative cohort of italian persons 65 years of age and older : The InCHIANTI study

Study Design. Clinico-epidemiologic study in the Chianti area (Tuscany, Italy). Objectives. To describe prevalence and correlates of back pain in a representative sample of the population. Summary of Background Data. Back pain is common in old age and is related to functional limitations, but back pain characteristics and correlates in older adults, which may be targeted by specific interventions, are still underinvestigated. Methods. A total of 1,299 persons aged 65 or older were selected from the city registry of Greve in Chianti and Bagno a Ripoli; 1,008 (565 women; 443 men) were included in this analysis. Back pain in the past 12 months was ascertained using a questionnaire. Potential correlates of back pain were identified in age- and sex-adjusted regression analyses, and their independent association with back pain was tested in a multivariate model. Results. The prevalence of frequent back pain was 31.5%. Back pain was reported less often by men and the very old, was primarily located in the dorsolumbar and lumbar spine, was moderate in intensity and mainly elicited by carrying, lifting, and pushing heavy objects. Among participants who reported frequent back pain, 76.3% had no back pain-related impairments; 7.4% of the overall study population had back pain-related functional limitation. Back pain participants were significantly more likely to report difficulty in heavy household chores, carrying a shopping bag, cutting toenails, and using public transportation. Limited trunk extension, depression, low levels of prior-year physical activity, and hip, knee, and foot pain were independent correlates of back pain. Conclusions. Frequent back pain is highly prevalent in the older population and is often associated with conditions that are potentially reversible.

Serum micronutrient concentrations and decline in physical function among older persons.

CONTEXT Maintaining independence of older persons is a public health priority, and identifying the factors that contribute to decline in physical function is needed to prevent or postpone the disablement process. The potential deleterious effect of poor nutrition on decline in physical function in older persons is unclear. OBJECTIVE To determine whether a low serum concentration of micronutrients is associated with subsequent decline in physical function among older men and women living in the community. DESIGN, SETTING, AND PARTICIPANTS Longitudinal study of 698 community-living persons 65 years or older who were randomly selected from a population registry in Tuscany, Italy. Participants completed the baseline examination from November 1, 1998, through May 28, 2000, and the 3-year follow-up assessments from November 1, 2001, through March 30, 2003. MAIN OUTCOME MEASURE Decline in physical function was defined as a loss of at least 1 point in the Short Physical Performance Battery during the 3-year follow-up. Odds ratios (ORs) were calculated for the lowest quartile of each nutrient using the other 3 quartiles combined as the reference group. Two additional and complementary analytical approaches were used to confirm the validity of the results. RESULTS The mean decline in the Short Physical Performance Battery score was 1.1 point. In a logistic regression analysis that was adjusted for potential confounders, only a low concentration of vitamin E (<1.1 microg/mL [<24.9 micromol/L]) was significantly associated with subsequent decline in physical function (OR, 1.62; 95% confidence interval, 1.11-2.36; P = .01 for association of lowest alpha-tocopherol quartile with at least a 1-point decline in physical function). In a general linear model, the concentration of vitamin E at baseline, when analyzed as a continuous measure, was significantly associated with the Short Physical Performance Battery score at follow-up after adjustment for potential confounders and Short Physical Performance Battery score at baseline (beta = .023; P = .01). In a classification and regression tree analysis, age older than 81 years and vitamin E (in participants aged 70-80 years) were identified as the strongest determinants of decline in physical function (physical decline in 84% and 60%, respectively; misclassification error rate, 0.33). CONCLUSIONS These results provide empirical evidence that a low serum concentration of vitamin E is associated with subsequent decline in physical function among community-living older adults. Clinical trials may be warranted to determine whether an optimal concentration of vitamin E reduces functional decline and the onset of disability in older persons.

Axonal degeneration affects muscle density in older men and women

Using data from InCHIANTI, a prospective population-based survey of older persons, we examined the relationship of peroneal nerve conduction velocity (NCV, a measure of nerve myelination) and compound muscle action potential (CMAP, a measure of axonal degeneration) with calf muscle mass and density, two complementary measures of sarcopenia. NCV and CMAP were assessed by surface electroneurography of the right peroneal nerve conducted in 1162 participants, 515 men and 647 women, age 21-96 years, free of major neurological diseases. Cross-sectional muscle area and calf muscle density were measured using peripheral quantitative computerized tomography (pQCT). Both nerve and muscle parameters declined with age although in most cases the decline was not linear. In both sexes, CMAP, but not NCV, was independently and significantly associated with calf muscle density. These findings suggest that intrinsic changes in the muscle tissue are partially caused by a reduction in the number of motor axons.

Vitamin E levels, cognitive impairment and dementia in older persons : the InCHIANTI study

There is conflicting evidence that antioxidants contribute to maintaining cognitive function in elderly subjects. We investigated whether vitamin E plasma levels are related to the presence of dementia and cognitive impairment in a population-based cohort study conducted in Italy. A total of 1033 participants aged at least 65 years received clinical and neuropsychological examinations, donated blood for vitamin E analysis and had their diets assessed. Participants with plasma vitamin E levels in the bottom tertile had a significantly higher probability of being demented (OR 2.6, 95% CI 1.0-7.1) and also of suffering from cognitive impairment (OR 2.2, 95% CI 1.2-4.2) compared to those in the highest vitamin E tertile after adjustment for age, gender, education, lipid levels, energy intake, vitamin E intake, and smoking. This study supports the notion that higher vitamin E plasma levels might provide significant protection against cognitive impairment and dementia in elderly subjects.

Protein Intake and Muscle Strength in Older Persons: Does Inflammation Matter?

To examine whether protein intake is associated with change in muscle strength in older persons. Because systemic inflammation has been associated with protein catabolism, the study also evaluated whether a synergistic effect exists between protein intake and inflammatory markers on change in muscle strength.

A randomized, controlled trial of disability prevention in frail older patients screened in primary care: the FRASI Study. Design and baseline evaluation

Background and aims: We describe the enrollment and intervention phases of FRASI (FRAilty, Screening and Intervention), a randomized controlled trial aimed at preventing ADL disability in frail older persons screened in primary care. Methods: Patients, 70–85 years old, non-disabled and non-cognitively impaired, were screened for frailty (score ≤9 on the Short Physical Performance Battery, SPPB) during primary care visits. Of 447 eligible persons, 410 came to the study clinic and 251 were randomized into treatment (n=126) and control groups (n=125). The active group received an intensive medical intervention, and sixteen 90-minute supervised exercise sessions over 8 weeks. The primary outcome was time to ADL disability onset or death in the 12-month period after study enrollment. Results: The two study arms were similar for demographics, cognitive function, physical function and health status. Compared with a population-based sample selected according to FRASI inclusion criteria except SPPB score, FRASI participants had significantly worse health and functional status. Restricting the comparison to persons with SPPB ≤9, all differences disappeared. The 99 participants (78.6% of 126) who completed the intervention participated in a mean of 15.3±1.6 exercise sessions. Conclusions: Screening in primary care for non-disabled, older persons with SPPB ≤9 yields individuals with substantial morbidity, impairments and functional limitations that can be successfully involved in an intensive medical and exercise intervention. Whether such an intervention effectively prevents new disability remains to be confirmed.

Changes in anthropometric measures in men and women across the life-span: findings from the InCHIANTI study.

Summary¶¶Objectives: To describe the age distribution of anthropometric parameters in a population-based sample of older persons.¶Methods: Cross-sectional survey of a population-based sample of persons over a wide age-range living in the Chianti area, Italy, between 1998 to 2000. Total cohort: 1 453 men and women, of whom 424 younger than 65 and 1 029 aged 65 years or older. Participation rate: 69.4 % in < 65 yrs and 91.6 % in ≤ 65 yrs. Analytical cohort: anthropometric measures were available for 1 266 subjects.¶Results: Height and weight declined with increasing age in both sexes. In men, Body mass index (BMI) increased with age up to age 45—54 and then it declined. In women, it reached its maximum at age 65—74 and remained higher than in men in each corresponding age group above 65 years of age. Waist-to-hip ratio (WHR) progressively increased in men up to age 55—64 and then slightly declined. In women WHR steadily increased over the entire age range.¶Conclusions: Height and weight decline with age, regardless to differences in body size attributable to secular trend. In both sexes, important fat redistribution occurs between 45 and 54 years and in older women the increase in WHR mostly reflects a reduction of fat deposits in the hips. This information may be relevant for a correct interpretation of changes in WHR in older persons. However, these findings were obtained in a cross-sectional study and should be verified in a longitudinal perspective.