N. Ferrara

Frailty predicts long-term mortality in elderly subjects with chronic heart failure.

Background  The elderly are characterized by a high prevalence of chronic heart failure (CHF) and frailty, which is a complex interaction of physical, psychological and social impairment. This study aimed to examine the predictive role of frailty on long‐term mortality in elderly subjects with CHF.

Alterations in β-adrenoceptor mechanisms in the aging heart. Relationship with heart failure

In chronic heart failure substantial and characteristic changes occur in the function of the adrenergic nervous system. Studies in isolated left ventricular muscle and in single cardiomyocytes from experimental models of aging and, recently, from humans show an age-related reduced contractile response to β-adrenoceptor stimulation. “β-adrenoceptor desensitization” is thought to be a general and common mechanism to explain the age- and heart failure-related decrease in β-adrenoceptor response. The aim of this review is to compare alterations in β-adrenoceptor mechanisms in physiological cardiovascular aging and chronic heart failure. From an analysis of the overall data on the role of aging in β-adrenoceptor regulation in human and animal hearts, it is possible to conclude that the reduced response to β-agonists is common to all species and all cardiac tissues. Moreover, the age-related changes are limited to β-adrenoceptor-G-protein (s)-adenylyl cyclase system abnormalities, while the type and level of abnormalities change with species and tissues. The modifications shown in the aging heart are not very different from some observed in heart failure. In particular, both in aged and failing hearts we may see that the decrease in β-adrenoceptor responsiveness is related to changes in G-protein function.

Moderate alcohol consumption predicts long-term mortality in elderly subjects with chronic heart failure

ObjectiveModerate alcohol consumption is related to a reduction of mortality. However, this phenomenon is not well established in the elderly, especially in the presence of chronic heart failure (CHF). The aim of the study was to verify the effect of moderate alcohol consumption on 12-year mortality in elderly community-dwelling with and without CHF.Settingscommunity-dwelling from 5 regions of Italy.ParticipantsA cohort of 1332 subjects aged 65 and older.MeasurementMortality after 12-year follow-up in elderly subjects (≥65 years old) with and without CHF was studied. Moderate alcohol consumption was considered ≤250 ml/day (drinkers).ResultsIn the absence of CHF (n=947), mortality was 42.2% in drinkers vs. 53.7% in non-drinker elderly subjects (p=0.021). In contrast, in the presence of CHF (n=117), mortality was 86.5% in drinkers vs. 69.7% in non-drinker elderly subjects (p=0.004). Accordingly, Cox regression analysis shows that a moderate alcohol consumption is protective of mortality in the absence (HR=0.79; CI 95% 0.66–0.95; p<0.01) but it is predictive of mortality in the presence of CHF (HR=1.29; CI 95% 1.05–1.97; p<0.05).ConclusionsOur data demonstrates that moderate alcohol consumption is associated with an increased long-term mortality risk in the elderly in the presence of CHF.

Effects of a 6-days-a-week low protein diet regimen on depressive symptoms in young-old type 2 diabetic patients

OBJECTIVES Late-life depression is one of the main health problems among elderly diabetic subjects. In addition, depression is a common psychopathological condition among renal failure patients and most of these patients follow a low protein diet regimen (LPD). However, the effects of LPD on depressive symptoms are unclear. DESIGN In the present study, the effects of LPD regimen on depressive symptoms in elderly type 2 diabetic subjects with renal failure were investigated. PARTICIPANTS Fifty-two young-old type 2 diabetic patients with renal failure were enrolled in the study. All participants after normal protein diet regimen providing 1.2g/kg per d were instructed to consume either a LPD providing 0.8 g/kg per d, 7 d a wk (LPD 7/7), or a LPD providing 0.8 g/kg per d 6 d a wk (LPD 6/7) randomly. RESULTS Mean 15-item Geriatric Depression Scale (GDS-15) (2.0±0.6) and Beck Depression Inventory (BDI) (4.1±1.0), during normal protein diet regimen, significantly increased to (6.7±1.6) and (12.2±1.4), respectively, after LPD 7/7 (P<0.05 versus normal protein diet). However, after LPD 6/7, mean GDS-15 and BDI significantly decreased to (4.4±1.5) and (6.7±1.6), respectively (P<0.05 versus LPD 7/7). CONCLUSION LPD 6/7 regimen significantly decreased depressive symptoms in young-old type 2 diabetic patients.

Determinants of prolonged intensive care unit stay after cardiac surgery in the elderly

Objectives: In the last decade, there has been a rapid increase in the number of elderly patients referred for cardiac surgery. Recent studies have identified risk factors for prolonged intensive care unit (ICU) stay in cardiac surgery patients. The aims of this study was to evaluate pre-operative risk factors for ICU stay longer than 3 days in a cardiac surgery elderly population, and whether prolonged ICU stay may influence disability, functional recovery and length of rehabilitation. Methods: Two hundred and fifty elderly (≧65 years) cardiac surgery patients were consecutively evaluated at enter in cardiac rehabilitation after ICU dismissal from January 2008 to July 2009. Univariate and multivariate analyses for risk factors were performed for ICU stay longer than 3 days. Thereafter, 6-minute walking test (6MWT), Barthel Index (BI), BI percent recovery and length of stay (LOS) in rehabilitation were evaluated. Results: Mean age was 72.9±4.8 yrs, 170 (68%) patients underwent cardiac surgery for coronary artery by-pass grafting (CABG), 56 (22.4%) for valve replacement and 24 (9.6%) for both CABG and valve replacement. Mean ICU stay was 1.9±1.5 days and 72 patients (28.8%) spent more than 3 days in ICU. Age, New York Heart Association class ≧3, Cumulative Illness Rating Scale (CIRS) score, prevalence of stroke and renal failure were significantly higher in patients with than in those without ICU stay ≧3 days. Off-pump CABG, Physical Activity Scale for the Elderly (PASE), BI and 6MWT were significantly lower in patients with than in those without ICU stay ≧3 days. Multivariate analysis shows that female sex, a NYHA class ≧3, CIRS and PASE score are predictors of ICU stay ≧3 days independently of age, off-pump CABG, stroke and renal failure. Multiple linear regression shows that ICU stay ≧3 days is negatively associated with 6MWT, BI at entry and BI percent recovery, whereas it is positively associated with a longer rehabilitation LOS. Conclusions: Pre-operative comprehensive assessment in the elderly could help to identify predictors of long ICU stay after cardiac surgery. This approach could help to better define the elderly cardiac surgery patients and their needs throughout the cardiac rehabilitation program in order to maximize functional capacity recovery, reducing disability and rehabilitation LOS.

Masked depression in an octogenarian: case report.

weight measures would be better used as continuous variables than BMI categories to classify overweight or obesity status in middle-aged and older U.S. adults because of the identified patterns of reporting errors. The effects of age and sex on concordance should be taken into consideration when interpreting overweight or obesity status and related clinical outcomes. Practitioners and researchers should collect direct measures of height and weight to obtain more-accurate measures for individuals, as well as to correctly estimate obesity prevalence in clinical and public health practice. Collecting measured height and weight is especially important in longitudinal studies to correctly capture changes in these measures. Methods to adjust existing self-reported height and weight data maybe needed to correctly reflect longitudinal trend in obesity in U.S. middle-aged and older adults.

Corrigendum to “Tandem action of exercise training and food restriction completely preserves ischemic preconditioning in the aging heart” [Experimental Gerontology 40/1–2 (2005) 43–50]

Cattedra di Geriatria, Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Universita degli Studi di Napoli ‘Federico II’, Naples, Italy Cattedra di Medicina Interna, Dipartimento di Scienze Animali, Vegetali ed Ambientali, Universita del Molise, Campobasso, Italy Istituto Scientifico di Campoli/Telese, Fondazione Salvatore Maugeri, IRCCS, Benevento, Italy Department of Clinical Pathology and Laboratory Medicine, II University of Naples, Naples, Italy Department of Medicine, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA