Maria Chiara Corti

Epidemiology of osteoarthritis: prevalence, risk factors and functional impact.

Osteoarthritis (OA), the most common form of arthritis, is a major contributor to functional impairment and reduced independence in older adults. OA of the hip and knee are two of the most important causes of pain and physical disability in community-dwelling adults. Symptomatic hand OA is a common disease among the elderly, and impairs hand function, this impairment being largely mediated by pain. Like other chronic diseases, the etiology of OA is multifactorial, and several local and systemic risk factors have been identified. Differences in the prevalence of OA may be attributable to both genetic and life-style factors. Disease definition may be based upon clinical or radiographic criteria, although case definition should rely on radiographic features for epidemiological studies. This review focuses on the functional impact of the disease, describes geographic differences in prevalence rates, discusses disease definition criteria, and summarizes the most common risk factors, including age, associated with the risk of OA.

Cognitive functions are not affected by dietary fatty acids in elderly subjects in the Pro.V.A. study population

Background and aims: Environmental, lifestyle, and dietary factors, including the type of dietary fatty acids consumed, may influence the onset of dementia. The aim of the present study was therefore to examine whether type of dietary fats consumed is associated with cognitive performance. Methods: Using gaschromatography, plasma phospholipid fatty acid composition was determined in a sample of subjects (age ≥ 65 years) randomly selected from the general Pro.V.A. study population. Plasma phospholipid fatty acid composition is a reliable marker of the type of fats present in the diet. The subjects’ cognitive capacity was tested using the Mini-Mental State Examination (MMSE). Results: At multiple regression analysis, the MMSE score variance was correlated with age and education level in 30% of cases, whereas the other variables considered (including type of fatty acids consumed) had an almost negligible effect. Conclusions: In free-living elderly subjects, moderate to severe cognitive impairment is not associated with dietary fatty acids.

A Comparison of Objective Physical Performance Tests and Future Mortality in the Elderly People

BackgroundnPhysical performance is an important predictor of mortality, but little is known on the comparative prognostic utility of different objective physical performance tests in community-dwelling older adults. We compared the prognostic usefulness of several objective physical performance tests on mortality, adjusting our analyses for potential confounders.nnnMethodsnAmong 3,099 older community-dwelling participants included in the Progetto Veneto Anziani study, 2,096 were followed for a mean of 4.4 years. Physical performance tests measured were Short Physical Performance Battery (SPPB), 4-meter gait speed, chair stands time, leg extension and flexion, handgrip strength, and 6-Minute Walking Test (6MWT), treated as continuous variables and categorized in gender-specific quartiles. The main outcome was mortality assessed with death certificates.nnnResultsnParticipants who died during the follow-up (n = 327) scored significantly worse in all physical performance tests measured at baseline than those who survived (n = 1,769). Using a Harrells C-index, the highest C-index was observed for 6MWT in men (C-index = 0.735; 95% confidence interval [CI]: 0.701-0.770, p < .0001) and SPPB in women (C-index = 0.781; 95% CI: 0.740-0.822, p = .0009). However, in both genders, only SPPB, 4-meter walking speed, and 6MWT are significant predictors of mortality. Analyses using sex-specific quartiles substantially confirmed these findings.nnnConclusionsnSlow gait speed, 6MWT, and SPPB are significant predictors for mortality in community-dwelling older men and women. Physicians should consider using these tests to identify elderly individuals who are at higher risk of death to improve clinical decision making.

Frailty Is Associated with an Increased Risk of Incident Type 2 Diabetes in the Elderly

OBJECTIVEnTo investigate whether frailty is associated with an increased risk of incident type 2 diabetes mellitus (T2DM) in a prospective cohort of community-dwelling older people.nnnDESIGNnLongitudinal study, mean follow-up of 4.4xa0years.nnnSETTINGnProgetto Veneto Anziani (Pro.V.A.) study that involved older community-dwellers.nnnPARTICIPANTSn1754 men and women older than 65xa0years without T2DM at baseline.nnnMEASUREMENTSnFrailty status was defined according to Fried criteria and categorized as frailty (≥3 criteria), prefrailty (1-2 criteria), or no frailty (0 criterion). Incident T2DM was defined as fasting plasma glucose (FPG) ≥7.0xa0mmol/L, or glycosylated hemoglobin ≥6.5%, the use of glucose-lowering drugs, or FPG ≥11.1xa0mmol/L on a 2-hour oral glucose tolerance test during the follow-up. All T2DM diagnoses were confirmed by endocrinologists.nnnRESULTSnAt baseline, frail participants (nxa0=xa0174) were significantly (a) more obese and had higher waist circumference, (b) experienced a higher rate of cardiovascular disease (including hypertension), and (c) presented with higher, but not pathologic, values of glycosylated hemoglobin and FPG than prefrail (nxa0=xa0830) and nonfrail participants (nxa0=xa0750). Over a 4.4-year follow-up, 265 individuals developed T2DM. In a logistic regression analysis, adjusted for potential baseline confounders, frailty [odds ratio (OR)xa0=xa01.87, 95% confidence interval (CI)xa0=xa01.31-2.13, Pxa0<xa0.0001] and prefrailty (ORxa0=xa01.60, 95% CIxa0=xa01.27-2.00, Pxa0<xa0.0001) were associated with a significantly higher incidence of T2DM than in nonfrail individuals.nnnCONCLUSIONnAmong community-dwelling older people, frailty and prefrailty were significant and independent predictors of T2DM, which is a major and potentially preventable risk factor for multiple comorbidities.

Metabolic syndrome and cardiovascular disease in the elderly: the Progetto Veneto Anziani (Pro.V.A.) Study

Background and aims: The prevalence of the metabolic syndrome increases with age, although only few data are available about its prevalence in the general elderly population. This study describes the prevalence of the metabolic syndrome in an elderly population, and its association with cardiovascular diseases. Methods: The Progetto Veneto Anziani (Pro.V.A.) is an observational study of 3099 subjects aged 65 and older, randomly selected from the general population of Northern Italy. Cardiovascular diseases and metabolic syndrome according to Adult Treatment Panel III were evaluated in 2910 subjects. Results: The metabolic syndrome was present in 25.6% of men and 48.1% of women. Its prevalence was mainly due to high blood pressure (93%) in both sexes, and to abdominal obesity in 73% of women. The prevalence of cardiovascular diseases was significantly higher among subjects with metabolic syndrome. Together with age and former smoking habits, the metabolic syndrome was significantly associated with cardiovascular diseases. High blood pressure and low HDL were independently associated with cardiovascular diseases in men, and with high fasting plasma glucose and waist circumference in women. Conclusions: The metabolic syndrome is frequent, and significantly but not independently associated with prevalent cardiovascular diseases in the elderly. In old people, rather than the metabolic syndrome per se, some of its components are independently associated with cardiovascular diseases.

Changes in Frailty Status and Risk of Depression: Results From the Progetto Veneto Anziani Longitudinal Study

OBJECTIVEnTo evaluate whether prefrailty was associated with the risk of developing depression and if longitudinal changes in frailty status corresponded to changes in incident depression during follow up.nnnMETHODSnA population-based, prospective cohort study was conducted for 4.4 years in two separate geographic areas near the city of Padua in the Veneto Region of Northern Italy. In 891 nondepressed, nonfrail, community-dwelling Italian subjects agedu2009≥u200965 (46.6% men) belonging to the Progetto Veneto Anziani study, depression was defined according to the Geriatric Depression Scale and was confirmed by geriatricians skilled in psychogeriatric medicine. Prefrailty was defined by the presence of one or two criteria among the Fried criteria.nnnRESULTSnThe incidence rate of depression was 13.3% among subjects improving their frailty status at follow-up (Nu2009=u200915), 15.0% in those who remained stable (Nu2009=u200979), and 26.7% among worsening participants (Nu2009=u200967) (pu2009=u20090.001). Prefrailty at baseline did not predict the onset of depression (HR: 0.82; 95% CI: 0.55-1.21; Wald χ2u2009=u20090.73; dfu2009=u20091; pu2009=u20090.43), but a deterioration during follow-up in at least one additional frailty criteria was associated with a significantly higher risk (HR: 1.95; 95% CI: 1.32-2.89; Wald χ2u2009=u20095.78; dfu2009=u20092; pu2009=u20090.01). Improvement in frailty status was not associated with the risk of incident depression (HR: 0.71; 95% CI: 0.35-1.42; Wald χ2u2009=u20090.47; dfu2009=u20092; pu2009=u20090.28).nnnCONCLUSIONnOur data did not offer evidence that prefrailty per se predisposes to the onset of depression, but worsening in frailty status is associated with an almost twofold increased risk of incident depression, irrespective from the initial level of impairment.

The fatty acid composition of plasma phospholipids and the insulin sensitivity in elderly diabetic patients. The Pro.V.A. study

Background and aims: The prevalence of diabetes is increasing worldwide indicating that life-style habits are important determinants for this disease. The aim of this study was to examine the effects of dietary fats on insulin sensitivity in diabetic patients. Methods: In a randomly selected sample of population aged 65 and older, plasma phospholipid fatty acid composition was determined by gaschromatography. The plasma phospholipid fatty acid composition is a reliable marker of the type of fats present in the diet. Insulin resistance was estimated with the Homeostasis Model Assessment (HOMA). Results: Body weight, height, body mass index (BMI), waist circumference, serum cholesterol as well as fasting insulin, and the HOMA index were lower in the older groups. With increasing age, there was an increase in the monounsaturated fatty acid content and a decrease in the polyunsaturated and n-6 polyunsaturated fatty acids. In the linear regression analysis, saturated fatty acids were significantly related to waist circumference, fasting glucose, fasting insulin, and HOMA. Significant relations were also observed between HOMA and BMI, triglycerides, waist circumference, and age. Triglycerides and HDL cholesterol were strongly interrelated as well as BMI and waist circumference. In the multiple regression analysis including age, BMI, waist circumference, triglycerides, HDL cholesterol, and saturated fatty acids, the HOMA index was predicted significantly only by age, BMI, and triglycerides. This model explained 28% of the HOMA variance. Conclusions: In elderly diabetic patients insulin sensitivity is modulated by age, BMI, and triglycerides, but the type of dietary fats is not independently associated with insulin sensitivity.

A case-mix classification system for explaining healthcare costs using administrative data in Italy

BACKGROUNDnThe Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy).nnnMETHODSnAll residents in the Veneto Region were included in the study. The ACG system was applied to classify the regional population based on the following information sources for the year 2015: Hospital Discharges, Emergency Room visits, Chronic disease registry for copayment exemptions, ambulatory visits, medications, the Home care database, and drug prescriptions. Simple linear regressions were used to contrast an age-gender model to models incorporating more comprehensive risk measures aimed at predicting health care costs.nnnRESULTSnA simple age-gender model explained only 8% of the variance of 2015 total costs. Adding diagnoses-related variables provided a 23% increase, while pharmacy based variables provided an additional 17% increase in explained variance. The adjusted R-squared of the comprehensive model was 6 times that of the simple age-gender model.nnnCONCLUSIONSnACG System provides substantial improvement in predicting health care costs when compared to simple age-gender adjustments. Aging itself is not the main determinant of the increase of health care costs, which is better explained by the accumulation of chronic conditions and the resulting multimorbidity.

Effectiveness and safety of oral anticoagulation with non-vitamin K antagonists compared to well-managed vitamin K antagonists in naïve patients with non-valvular atrial fibrillation: Propensity score matched cohort study

BACKGROUNDnThe global real-life impact of non-vitamin K antagonist oral anticoagulants (NOACs) introduction in the healthcare system in a setting of well-managed vitamin K antagonist (VKA) therapy has not been specifically addressed.nnnMETHODSnWe did a population-based retrospective cohort study in naïve patients initiating oral anticoagulants for stroke prevention in atrial fibrillation in a region with a well-managed VKA therapy. NOAC and VKA cohorts were identified using Anatomical Therapeutic Chemical (ATC) codes, while excluding other indications for anticoagulation therapy using ICD-9CM codes. Propensity score was conducted using two different approaches: stratification and 1:1 matching. Event-rates were assessed using both an intention to treat (ITT) and as treated analyses.nnnRESULTSnOf the 137,800 selected patients, 40,411 (6923 treated with NOACs and 33,488 with VKAs) were identified (June 2013-December 2015). Overall ischaemic stroke and major bleeding risk did not significantly differ between the groups both in the ITT and as treated analyses. Noteworthy, intracranial bleeding risk was lower with NOACs (stratified model HR=0.69; 95%CI 0.48-0.99; 1:1 matched model HR=0.73; 95%CI 0.47-1.13) reaching statistical significance in the as treated analysis in both stratified and 1:1 matched models (HR=0.51; 95%CI 0.32-0.80 and HR=0.52; 95%CI 0.30-0.90, respectively).nnnCONCLUSIONnDespite well-managed anticoagulation with VKAs, NOACs introduction has a positive global impact in the public healthcare system in terms of effectiveness and safety especially by lowering intracranial bleeding.

Excess mortality in 2015: a time series and cause-of-death analysis in Northern Italy

AimsTo investigate the excess mortality registered in the Veneto Region (Northern Italy) in 2015.MethodsA Seasonal Autoregressive Integrated Moving Average Model was applied to predict overall mortality expected in 2014–2015 based on that observed in 2000–2013. The annual percent change in age-standardized rates (APC) was estimated for specific causes of death in 2007–2015.ResultsCompared to 2014, the number of deaths and the overall age-standardized mortality increased in 2015 by 7.8 and 4.5%, respectively. When accounting for time trends, the observed mortality was lower than expected in 2014 (−4.5%) and slightly higher in 2015 (+1.1%). In 2015, mortality increased especially for causes with an already rising trend: neurologic/psychiatric (APCu2009=u20091.2; 95% Confidence Interval 0.3–2.0%) and infectious diseases (APCu2009=u20095.9; 3.6–8.2%).ConclusionsShort-term changes and long-term trends in mortality must be interpreted within the frame of a rapid growth in the population of elderly subjects affected by multiple comorbidities.