Enrico Benvenuti

Measuring muscular strength of the lower limbs by hand-held dynamometer: A standard protocol

The aim of this study is to describe the reliability of measuring maximal strength of eight muscle groups of the lower limb by a handheld dynamometer, according to a standard assessment protocol. The study population consisted of 26 patients (14 males and 12 females; age range 60–90 years) admitted to a geriatric hospital. Multiple assessments of muscle strength by two different examiners were compared to estimate test-retest and inter-rater reliability. The range of strength evaluated across the eight muscle groups was 2.1–29.8 Kg/force. Overall, short-term (same day) and long-term (one week apart) test-retest and inter-rater reliability were very high, with 60% of the intraclass correlation coefficient values above 0.8, and the majority above 0.7. No significant differences in strength were found comparing the left and the right side of each muscle group. Differences between values collected in the same subject by two different examiners, and by the same examiner at different points in time were similar, not influenced by the average strength of the muscle group, and significantly larger for long-term than for short-term comparisons. By using a standardized measurement protocol, reliable measurements of muscle strength can be obtained by a hand-held dynamometer in frail older persons.

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.

Is the Telephone Interview for Cognitive Status a valid alternative in persons who cannot be evaluated by the Mini Mental State Examination

The Mini Mental State Examination (MMSE), a widely used tool for first-line assessment of cognitive function, cannot be fully administered to persons with severe visual or upper extremity impairments. This cross-sectional study, which was performed in a sample of patients admitted to the outpatient clinic of the INRCA Geriatric Department “I Fraticini” (Firenze, Italy) and their relatives, evaluated whether the Telephone Interview for Cognitive Status (TICS), a test originally created for telephone screening of cognitive impairment, is a valid alternative for assessment of cognition in persons who cannot provide valid responses to all the MMSE items. Fifteen subjects in each of seven MMSE strata (9–11, 12–14, 15–17, 18–20, 21–23, 24–26, 27–30) were consecutively selected. Inclusion criteria were: age ≥60 years; Italian as the main language; education ≥3 years; medical stability; and ability to complete the MMSE. At admission, participants were examined for dementia by an expert clinician according to the DSM IV criteria. Italian versions of the TICS and the MMSE were administered face-to-face by two trained interviewers. The TICS was readministered face-to-face one week later by the same interviewer that had previously administered the test. The TICS showed good test-retest reproducibility. Assessments taken one week apart differed on average by 0.52±1.9 points (p<0.01), indicating a systematic improvement. The TICS explained 96% of the variance in the MMSE, and this association was independent of age, gender and education. More than 90% of the cases “screening positive” (i.e., scoring below a certain cut-off) by the TICS, were also identified as “screening positive” when comparable MMSE cut-off scores were used. Using comparable cut-off scores, the sensitivity and specificity of TICS and MMSE in detecting a standard clinical diagnosis of dementia largely overlapped. In persons who cannot be evaluated with the MMSE in its full form, the face-to-face administration of the TICS is a reliable and valid alternative.

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.

Extradural motor cortex stimulation as a method to treat advanced Parkinson’s disease: new perspectives in geriatric medicine

Motor fluctuations not controlled by pharmacological therapy are often encountered in long-term Parkinson’s disease (PD). Neurosurgery treatment represented by deep brain stimulation (DBS) was considered a valid alternative to pharmacological treatment. Unfortunately this method is most effective in patients under age of 70. Recently it has been suggested that extradural motor cortex stimulation (EMCS) could be a valid cost-effective alternative to DBS to control motor symptoms in patients affected by Parkinson’s disease. The relevant non-invasive surgical technique makes this treatment particularly indicated in geriatric patients. Brain atrophy, cognitive impairment, psychiatric symptoms are not an absolute contraindication to the treatment. We submitted to EMCS an outpatient afferent to our geriatric department, a woman 68 yrs old. The patient showed an improvement of 35% as measured by the Unified Parkinson Disease Rating Scale (UPDRS) scale after the surgery. If our findings will be confirmed in larger series, a new dimension will be added to the treatment of PD.

Preventive health care for older women: life-style recommendations and new directions.

One of the key paradoxes in gerontology is that, despite a higher longevity, aging women experience worse health and longer disability than men. However, there is growing evidence that changes in life-style, medical interventions and systematic screening for certain diseases may substantially reduce the excess risk of major chronic conditions and disability in aging women, and therefore improve the quality of their late life. The potentials and public health implications of prevention in older women have been recently emphasized, not only by the scientific literature, but also by the media. More and more women are turning to their primary care physicians or other health professionals to seek counselling and help on how to reduce the burden of chronic disease and disability in old age by quitting smoking, eating a healthy diet, increasing physical activity, and coping with stress. Hormone replacement therapy also has a central role in this action of prevention. To maximize compliance, women should be provided a few guidelines that are easy to understand, and can be followed without interfering too much with their daily life activities. This article reviews the current literature on prevention in older women to select preventive strategies that are based on robust scientific evidence. This list of guidelines should be considered as a starting point for all those who are in charge of caring for middle-aged and older women.

Understanding the physiological and functional consequences of menopause: The PROSALMEN study

Background and aims: Women live longer and are more often affected by disability and poor health than men. The mechanism underlying this sex-related “mortality-morbidity” paradox is still unclear but it has been suggested that the physiological and functional changes occurring during the menopausal transition play an important role. The aim of PROSALMEN (PROgetto SALute MENopausa: Health in Menopause Project) is to study in great detail how these changes affect the integrity and function of the physiologic subsystems that are relevant to the maintenance of an active and healthy life-style during the aging process. Methods: PROSALMEN is a cross-sectional comparison of age-matched pre- and post-menopausal women. Thirty post-m enopausal women, aged 48–58 years, were enrolled in the study together with 30 age-matched pre-menopausal controls. A number of clinical, biological and functional parameters were collected assessing the integrity and level of function of the physiological subsystems that are important for mobility. Furthermore, we collected information on risk factors, medical conditions and symptoms that frequently develop or become clinically evident after menopause, including the most important elements of the classical post-m enopausal syndrome. Conclusions: This rich dataset will be used to start dissecting the causal pathway leading from menopause to damages in the musculoskeletal system and, in turn, to reduced physical function. The final goal is to understand how and to what extent changes in health behavior and pharmacological treatments in addition to hormone replacement therapy (HRT) may counteract these processes.