M. Di Bari

Epidemiological profile of symptomatic osteoarthritis in older adults: a population based study in Dicomano, Italy

Objectives: To assess the prevalence of hand, hip, and knee osteoarthritis (OA) in an older Italian community dwelling population and its association with disability. Method: A cross sectional survey of the whole community aged 65 years and over, was carried out in Dicomano, a small rural town in Tuscany, Italy. Subjects were screened by geriatricians for major chronic conditions, including hip, knee, and hand OA, using diagnostic algorithms based on the American College of Rheumatology (ACR) clinical criteria. A rheumatologist examined subjects who screened positive. Disability was assessed by a World Health Organisation questionnaire. Results: 697 of 864 eligible subjects (81% of the eligible population) were screened. OA of the knee, hand, or hip was identified by clinical ACR criteria respectively in 159, 139, and 81 subjects, and was confirmed by the rheumatologist in 158/182 (87%), 75/101 (74%), and 63.2% of cases. The estimated prevalence was 29.8%, 14.9%, and 7.7%, respectively. Only hip OA was significantly associated with disability in basic activities of daily living. Conclusions: About one third of community dwelling older people are affected by symptomatic peripheral OA. Hip OA was strongly associated with disability.

Is suboptimal prescribing a risk factor for poor health outcomes in community-dwelling elders? The ICARe Dicomano study.

Mostly because of comorbidity and drugs consumption, older persons are often exposed to an increased risk of sub‐optimal prescribing (SP). At present, few studies investigated the association between SP and long‐term health outcomes. We examined the relation between SP and the risk of mortality and hospitalization in Italian older community‐dwellers.

Features of excessive alcohol drinking in older adults distinctively captured by behavioral and biological screening instruments. An epidemiological study.

The entire > or =65-year-old population living in a small Italian town, where alcohol use is almost ubiquitous, was assessed with a frequency-quantity questionnaire for alcohol intake and with two screening instruments for alcohol problems, the CAGE questionnaire and the MCV-gammaGT test. Aim of the study was to assess whether these instruments identify different subsets of subjects with alcohol problems. Of the 649 participants, 19.1% were at-risk drinkers (average intake > 40 g/day in men and > 20 g/day in women). Both the screening instruments were positive in only a minority of participants. Of the 377 drinkers, 53 gave > or =1 affirmative response to the CAGE questionnaire, whereas 24 had a positive MCV-gammaGT test. The concordance between positive CAGE questionnaire and MCV-gammaGT test was limited to seven subjects (kappa = 0.10), and these tests identified subjects who differed for several health and psychosocial characteristics. Participants aged > or =75 years drank less, but had similar prevalence of CAGE and MCV-gammaGT positive markers as compared to younger participants. In conclusion, excessive drinking is common in the elderly. Screening tests based on behavioral and biological markers identify two different sets of subjects with possible alcohol problems. This might indicate the opportunity to use these instruments in conjunction.

Angiotensin-converting enzyme inhibition and novel cardiovascular risk biomarkers: results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study.

Background Beneficial effects of angiotensin converting enzyme (ACE) inhibitors seem to be mediated by mechanisms that are partly independent of blood pressure lowering. The present study evaluates effects of an ACE-inhibitor (i.e. fosinopril) intervention on novel cardiovascular risk factors.BACKGROUND Beneficial effects of angiotensin-converting enzyme (ACE) inhibitors seem to be mediated by mechanisms that are partly independent of blood pressure lowering. The present study evaluates effects of an ACE inhibitor (ie, fosinopril) intervention on novel cardiovascular risk factors. METHODS Data are from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study, a double-blind, crossover, randomized, placebo-controlled trial enrolling subjects > or =55 years old with high cardiovascular disease risk profile. Biomarkers of hemostasis (ie, plasminogen activator inhibitor 1, D-dimer), inflammation (ie, C-reactive protein, interleukin-6), and endothelial function (ie, endothelin 1, vascular cell adhesion molecule 1) were measured at the baseline, at the midterm, and at end of follow-up (after 1 year) clinic visits. Paired t test analyses (after Sidaks adjustment, P < .009) were performed to compare biomarkers modifications after fosinopril/placebo interventions. RESULTS Mean age of the sample (n = 290, women 43.4%) was 66.0 years old. No significant differences were reported for C-reactive protein, interleukin 6, plasminogen activator inhibitor 1, vascular cell adhesion molecule 1, and endothelin 1 levels in the comparisons between fosinopril and placebo interventions. D-dimer was the only biomarker showing a significant difference between fosinopril intervention (median 0.32 microg/mL, interquartile range 0.22-0.52 microg/mL) and placebo (median 0.29 microg/mL, interquartile range 0.20-0.47 microg/mL, P = .007) when analyses were restricted to participants with higher compliance to treatment and receiving the maximum ACE inhibitor dosage. CONCLUSIONS Angiotensin-converting enzyme inhibition does not significantly modify major biomarkers of inflammation, hemostasis, and endothelial function. Further studies should confirm the possible effect of ACE inhibitors on the fibrinolysis pathway.

Subthreshold depression in older subjects: An unmet therapeutic need

Major depression, defined according to DSM IV TR criteria, is less common in older subjects, while other types of depression are two to three times more prevalent. This heterogeneous group of disturbances has received different names: depression not otherwise specified, minor depression, subthreshold or subsyndromal depression. Moreover, each condition has been defined using heterogeneous criteria by different authors. The term of subthreshold depression will be adopted in this position statement. Subthreshold depression has been associated with the same negative consequences of major depression, including reduced well being and quality of life, worsening health status, greater disability, increased morbidity and mortality. Nevertheless, there is a dearth of clinical trials in this area, and therefore older patients with subthreshold depression are either not treated or they are treated with the same non pharmacological and pharmacological therapies used for major depression, despite the lack of supporting scientific evidence. There is an urgent need to reach a consensus concerning the diagnostic criteria for subthreshold depression as well as to perform clinical trials to identify effective and safe therapies in this too long neglected patient group.

Age-related changes in the pharmacodynamics of intravenous glyceryl trinitrate

Comparable hemodynamic effects were obtained administering a much lower intravenous dose of glyceryl trinitrate (GTN) in elderly than in younger patients. The pharmacodynamics and kinetics of GTN were thus assessed in 2 groups of patients with acute my-ocardial infarction (group A: ≤ 65 years, 6 patients; group B: ≥ 75 years, 6 patients). The arterial and venous dose-concentration relationship and the associated hemodynamic changes at end-point (EP: 10% reduction in mean systemic arterial pressure) were similar in the 2 groups. However, in older subjects EP was reached at a lower GTN infusion rate (0.11 ± 0.04 vs 0.33 ± 0.11 μg·kg−1·min−1, mean ± S.D.; p < 0.001), and with lower arterial and venous drug concentrations (arterial [GTN]: 1.2 ± 0.1 vs 4.6 ± 1.2 ng·ml−1; p < 0.01; venous [GTN]: 0.09 ± 0.05 vs 0.35 ± 0.15 ng·ml−1; p < 0.05), whereas overall GTN kinetics appeared to be substantially independent of age. Thus, the enhanced efficacy of GTN in advanced age seems to stem mainly from pharmacodynamic changes, which may be the consequence of dampened baroreceptor reflexes, as suggested by a lower heart rate increase per unitary fall in systolic arterial pressure observed in group B (0.12 ± 0.07 vs 0.41 ± 0.29 b·min−1·mmHg−1; p < 0.05). (Aging 2: 59–64, 1990)

AB0797 Gait abnormalities in rheumatic patients with temporomandibular joint involvement.

Background The relationship between temporomandibular joint disorders (TMD) and alterations of posture and gait has been widely discussed in several investigations, reaching different and sometimes opposite conclusions Objectives To investigate whether TMD in early rheumatoid and psoriatic arthritis could influence gait pattern, assessed by computerized gait analysis with dual task (DT) paradigm. Methods Two groups of subjects were examined: a group of 30 patients with TMD in early rheumatoid or psoriatic arthritis without signs of involvement of other joints and a control group of 30 healthy subjects. Both temporomandibular joints were examined by ultrasound imaging in every subject. Gait analysis with a photogrammetric system during treadmill walking was performed. In DT procedure, treadmill walking was associated with a cognitive task. The coordination patterns thigh-leg, leg-foot and thigh-foot were analyzed. Results Sonographic findings showed joint effusion and alterations of condylar profile in all patients. Spatio-temporal parameters, during treadmill walking, did not show significant differences between controls and patients in single and dual task. Patients showed an asymmetric behavior of the coordination pattern leg-foot in DT procedure, during swing and stance phase of walking. In healthy subjects no significant difference of the coordination pattern leg-foot was observed. Conclusions DT procedure assessed the relationship between TMD and changes of the coordination pattern leg-foot during walking. DT shows that patients with TMD involvement develop an inadequate walking performance. These data focus the attention on the presence of postural abnormalities and gait alterations in patients with TMD, suggesting its evaluation in arthritides to obtain a timely correction of the gait modifications. Disclosure of Interest None Declared

Intensive Care of Acute Ischemic Cardiopathy in Old Patients

Ventricular power failure is presently the main therapeutic problem during acute myocardial infarction (AMI), since it accounts for more than 50 per cent of deaths in any age,1 (see Table 1). Direct measurements of cardiac hemodynamics through the use of right heart balloon flow-directed catheters have proved to be of invaluable help in optimizing the clinical management of patients with AMI, as they allow for selection of the most appropriate therapy, based on individual pathophysiological data.2,3 In this lecture, we will describe the immediate effects of the drugs which are most commonly used in the correction of the hemodynamic disorders complicating AMI, and we will examine their efficacy in young (age <65 years) and elderly (age ≥65 years) patients.