Tomasz Kostka

Predictors of quality of life in older people living at home and in institutions

Background and aims: Health-related quality of life (QOL) is considered to be the key goal for health promotion in older people. The aim of this study was to describe the correlates of QOL in home-dwelling and institutionalized elderly. Methods: One hundred and fifty-two elderly residents of long-term care homes and 160 community-dwelling elderly participated in the study. Assessment included demographic and social variables, health status, nutritional state, physical and cognitive function. Physical activity (PA) was assessed by two PA questionnaires: the Seven Day Recall PA Questionnaire and the Stanford Usual Activity Questionnaire. QOL was assessed with the Euroqol 5D questionnaire. Results: Depression was the most powerful predictor of QOL in both community-dwelling and institutionalized elderly. Complaints associated with the musculoskeletal system in community-dwelling elders and manifestations of atherosclerosis and cardiovascular diseases in institutionalized elders were the most important concomitant diseases. Regular participation in PA, preventing obesity and maintaining an adequate level of physical and cognitive function, contributed more to overall QOL in community-dwellers than in older and frailer institutionalized elderly adults. Conclusions: The relative contribution of functional and medical comorbidities, as well as health-promoting behaviors to QOL, may be different in community-dwelling and institutionalized elders. Physical and cognitive function deficits, overweight/obesity, and lack of regular PA are among primary predictors of decreased QOL in home-dwelling elders. In institutionalized subjects, these functional/behavioral data seem to be of lesser importance, the role of concomitant diseases becoming dominant.

Leg extensor power and dehydroepiandrosterone sulfate, insulin-like growth factor-I and testosterone in healthy active elderly people

Abstract We examined the association between quadriceps muscle function and serum levels of dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor I (IGF-I) and testosterone in a group of healthy elderly people. Fifty-three independent, community-dwelling elderly subjects (26 men and 27 women) aged from 66 to 84 years volunteered to participate in the study. Physical activity (PA) was evaluated by a questionnaire. Quadriceps maximal muscle power (W˙max) and optimal shortening velocity (vopt) were measured on a friction-loaded non-isokinetic cycle ergometer. The W˙max is expressed in relation to body mass (W˙max/kg, W · kg−1), and in relation to the mass of the two quadriceps muscles (W˙max/Quadr, W · kgQuadr−1). In women, when adjusted for age, anthropometric measurements and PA indices, IGF-I correlated significantly with W˙max/kg (partial correlation: r=0.59; P=0.001), W˙max/Quadr (r=0.58; P=0.002) and vopt (r=0.53; P=0.004), whereas DHEAS was correlated significantly with W˙max/kg (r=0.54; P=0.003) and W˙max/Quadr (r=0.58; P=0.002). No such correlation was found in men. These findings indicate that in healthy elderly women lower values for quadriceps muscle W˙max and vopt are related, independently of age, anthropometric measurements and PA indices, to lower circulating levels of DHEAS and IGF-I.

Simple method for determining human serum 2,2-diphenyl-1-picryl-hydrazyl (DPPH) radical scavenging activity : possible application in clinical studies on dietary antioxidants

Abstract Background: 2,2-Diphenyl-1-picryl-hydrazyl (DPPH) radical decomposition in alcohol solution is widely used, characterizing plant antioxidants that can rise in serum after fruit and vegetable intake. However, this test failed reproducible results with serum due to protein precipitation. We describe the application of serum deproteinization with acetonitrile relating to the DPPH test. Methods: Assay sensitivity, linearity, repeatability and storage effect were determined in serum samples deproteinized with an equal volume of acetonitrile. Associations between the DPPH test and the ferric reducing ability of serum (FRAP) method, measuring total antioxidant potential, were evaluated in sera from 78 healthy non-smoking men. The effect of a single ingestion of 1 L of cloudy apple juice on the serum DPPH radical scavenging activity in healthy volunteers was also investigated. Results: Assay linearity was within 5–25 μL (r=0.99, p<0.01). With 25 μL-deproteinized serum, coefficient of variation was 4.2% and detection limit was 0.5% of the initial amount of decomposed DPPH radical over 30 min incubation. There was no sera activity decrease over 14 days storage at –20°C. Mean values of DPPH radical scavenging activity and FRAP obtained in human serum were 11.2±3.3% and 382.0±88.1 μmol/L, respectively. A positive significant linear correlation was observed between these two methods (r=0.42, p<0.01). Serum supplementation with 50 μmol/L of catechin, gallic acid, ascorbic acid or uric acid enhanced DPPH test results. One brisk serving of 1 L of apple juice caused a significant increment of serum DPPH radical scavenging activity (1.9±1.9%, p<0.01) in 12 healthy subjects 1 h after juice ingestion. Conclusions: Applicability of the DPPH test to deproteinized serum with acetonitrile revealed numerous advantages, validating its practicability, simplicity and cost effectiveness as a tool in the estimation of antioxidant status in humans. Clin Chem Lab Med 2008;46:342–9.

Mechanisms of the anorexia of aging-a review.

Many, even healthy, older people fail to adequately regulate food intake and experience loss of weight. Aging-associated changes in the regulation of appetite and the lack of hunger have been termed as the anorexia of aging. The etiology of the anorexia of aging is multi-factorial and includes a combination of physiological changes associated with aging (decline in smell and taste, reduced central and peripheral drive to eat, delayed gastric emptying), pathological conditions (depression, dementia, somatic diseases, medications and iatrogenic interventions, oral-health status), and social factors (poverty, loneliness). However, exact mechanisms of the anorexia of aging remain to be elucidated. Many neurobiological mechanisms may be secondary to age-related changes in body composition and not associated with anorexia per se. Therefore, further studies on pathophysiological mechanisms of the anorexia of aging should employ accurate measurement of body fat and lean mass. The anorexia of aging is associated with protein-energy malnutrition, sarcopenia, frailty, functional deterioration, morbidity, and mortality. Since this symptom can lead to dramatic consequences, early identification and effective interventions are needed. One of the most important goals in the geriatric care is to optimize nutritional status of the elderly.

Peak anaerobic power in elderly men

Abstract The relationship of maximal anaerobic power (Pmax) of the quadriceps muscle and corresponding optimal shortening velocity (vopt) with age, habitual physical activity (PA) and maximal oxygen consumption (V˙O2max) were assessed in 37 healthy older [71.1 (SD 3.8) years] men and compared to those of 16 young [22.7 (SD 3.4) years] men. The PA was evaluated using a questionnaire. The Pmax and vopt were measured on a friction loaded non-isokinetic cycle ergometer. The Pmax was expressed relative to body mass –Pmax · kg−1, and relative to the mass of the two quadriceps muscles –Pmax· kgquad−1. The decline of Pmax· kg−1 from youth to advanced age (8.3% per decade) was greater than the decrease in quadriceps muscle mass (3.8% per decade), in Pmax· kgquad−1 (5.9% per decade) and in vopt (4.3% per decade). In the older men, a negative relationship of Pmax· kg−1 (r = −0.33) and Pmax· kgquad−1 (r = −0.44) with age was found. Ergometer measurements were not correlated with PA activity indices or V˙O2max, while V˙O2max was positively associated with PA. In a multiple stepwise regression analysis age was the only variable that contributed significantly to Pmax· kg−1 and Pmax· kgquad−1 variances. Our findings indicated that in these healthy elderly men, unlike the fall in V˙O2max, habitual PA did not attenuate the decline in Pmax of the quadriceps muscle with age. This finding was different from a previously described relationship in older women and would suggest sex differences in determining Pmax in healthy older subjects.

Anabolic and catabolic hormonal responses to experimental two-set low-volume resistance exercise in sedentary and active elderly people

Background and aims: The influence of acute low-volume resistance exercise on serum growth hormone (GH), insulin-like growth factor I (IGF-I), dehydroepiandrosterone sulphate (DHEAS), total testosterone (TT) and cortisol was ascertained in elderly subjects. Methods: Forty-seven independent, community-dwelling volunteers aged >65 years were recruited: 23 (11 men, 12 women) were sedentary individuals, and 24 (12 men, 12 women) had been regularly involved in physical activity for several years. The protocol consisted of two sets of leg extensions: one graded by loading to reach maximal power; the other consisted of 10 consecutive leg extensions using a load corresponding to maximal power. Results: IGF-I levels increased immediately after exercise, returning almost completely to pre-exercise values by the 15-minute post-exercise time point. The changes in all four study groups were similar. Not any of the groups presented systematic exercise-induced changes in circulating GH, DHEAS and TT levels. With respect to pre-exercise cortisol levels, significant decreases were observed both at the immediate and at the 15-minute post-exercise time points. These changes were independent of gender and physical activity level. Conclusions: Our data indicate that low-volume resistance exercise may decrease cortisol levels and increase serum anabolic/catabolic hormone ratios. In view of the experimental character of our resistance training protocol and the lack of control-day data, these results should be corroborated by long-term low-volume resistance training programs.

Relationship of physical activity and fitness to lipid and lipoprotein (a) in elderly subjects.

PURPOSE To determine, both by a cross-sectional and longitudinal study design, the relationship of maximal oxygen consumption (VO2max) and physical activity (PA) to blood lipids and lipoprotein(a) [Lp(a)] in a population of healthy and weight-stable elderly volunteers aged 66-84 yr. METHODS In a cross-sectional study in 52 subjects (23 men and 29 women), all independent variables (age, anthropometric, VO2max, and PA indices) were used in a multiple stepwise regression analysis to select variables influencing lipid and lipoprotein parameters. In a prospective nonintervention study, 38 subjects (17 men and 21 women) were reexamined after 6 months. RESULTS In a cross-sectional study, sports activity index contributed significantly to total cholesterol (TC), low density lipoprotein (LDL) cholesterol (LDL-C), TC/high density lipoprotein (HDL) cholesterol (HDL-C) ratio, and LDL-C/HDL-C ratio variance in men, whereas VO2max accounted for 23% variance of apolipoprotein A-I in women. In a prospective study, there was no indication that any measured variable was correlated with absolute or relative changes in PA indices in the total group or when analyzed by gender. CONCLUSIONS These data confirm that favorable relationship between PA/fitness and blood lipid profile is visible in elderly people but spontaneous changes in habitual PA are not a sufficient stimulus to alter serum lipid and lipoprotein levels in this population. Furthermore, there is no direct association between Lp(a) levels and PA, fitness, or body composition in the elderly men and women.

Cardiovascular Risk Factors and Total Serum Antioxidant Capacity in Healthy Men and in Men with Coronary Heart Disease

Whether the incidence of coronary heart disease (CHD) is related to a decrease in total antioxidant capacity (TAC) has not yet been completely clarified. We assessed TAC of blood serum in a group of 163 men with CHD aged 34.8–77.0 years and in 163 age-matched peers without CHD. Two spectrophotometric methods were applied to assess TAC: ferric reducing ability of serum (TAC-FRAS) and 2.2-diphenyl-1-picryl-hydrazyl (TAC-DPPH) tests. In the CHD group, multivariate analysis revealed that uric acid (UA), triglycerides, and systolic blood pressure contributed independently to the TAC-FRAS variance. TAC-DPPH was favorably predicted by UA concentration, but negatively so by current smoking and glucose levels. In men without CHD, UA was the only independent determinant of both TAC-FRAS and TAC-DPPH. Presence of CHD was not an independent predictor of TAC—observed between-group differences (higher TAC in CHD patients) disappeared after adjustment for other confounders. We conclude that UA is the main determinant of TAC of blood serum in men. TAC is not directly influenced by age or CHD but is related to several indices of overweight/obesity and laboratory measures of metabolic syndrome, especially in patients with CHD.

Long-Term Effect of Different Physical Activity Levels on Subclinical Atherosclerosis in Middle-Aged Men: A 25-Year Prospective Study

Background The purpose of the study was to investigate the influence of lifetime physical activity (PA) on selected indices of atherosclerosis in longitudinal observation of middle-aged men. Methods The subject of the study was a cohort of 101 men (mean age 59,7±9,0 years), free of cardiovascular symptoms and treatment, participating in follow-up examinations in the years 1985/90-2011/12. Self-report PA was assessed by interviewer-administered Seven-Day PA Recall and Historical PA questionnaire. Subclinical atherosclerosis was measured by assessing the coronary artery calcification (CAC) according to Agatstons method using multi-slice computed tomography; the carotid intima-media thickness (IMT) using high-resolution B-mode ultrasound; and the reactive hyperemia index (RHI) using peripheral arterial tonometry (EndoPAT2000). The participants were initially divided into three groups according to tertiles of exercise-related energy expenditure (EE) in kcal/week at baseline, i.e. <2050 (low-to-moderate; n = 33), 2050–3840 (high; n = 34), >3840 (very high; n = 34). Results The low-to-moderate, high and very high PA groups were comparable in terms of age and atherosclerosis risk factors at baseline. No linear relationship was found between PA and CAC, IMT and RHI. Men who maintained low-to-moderate (n = 26), high (n = 21) and very high (n = 15) PA level had the mean CAC of 286.1±361.9, 10.7±28.9, and 106.1±278.3 (p<0.001 for low-to moderate vs high; p<0.05 for low-to-moderate vs very high); the mean IMT of 0.751±0.19 mm, 0,641±0.26 mm, and 0.750±0.60 mm (p>0.05); and the mean RHI of 1.69±0.4, 2.00±0.4, and 2.13±0.5 (p for trend = 0.050), respectively. No cases of CAC>400, IMT ≥0.9 and RHI<1.67 were noted only among men with maintained high PA level. At final examination men with high and very high PA had more favorable cardiometabolic profile than men with lower PA. Conclusions Maintaining regular high PA level through young and middle adulthood may protect against atherosclerosis as measured by CAC, IMT and RHI.

Influence of chronic cardiovascular disease and hospitalisation due to this disease on quality of life of community-dwelling elderly

The aim of this study was to describe the impact of chronic cardiovascular disease (CVD) and hospitalisation due to this disease on quality-of-life (QOL) in community-dwelling elderly. The study was carried out in the three age- and gender-matched groups of older subjects: 100 elderly without CVD, 100 elderly with CVD and 100 patients actually hospitalised for the cardiologic reasons. The assessment included demographic and social variables, health status, nutritional state, physical activity (PA), physical and cognitive function. QOL was assessed with the Euroqol 5D questionnaire. Presence of CVD per se detracted from QOL only moderately, increasing the subjective perception of pain/discomfort. Hospitalisation was connected with the reduction of the majority of QOL dimensions and the decrease of rating on visual analogue scale (VAS). When taking into account all confounders the presence of CVD did not significantly contribute to overall QOL, while hospitalisation decreased the usual activity dimension of QOL and VAS, but interestingly, improved the perception of well-being in relation to anxiety/depression. Variables that most powerfully detracted from QOL were lower functional status, higher number of medications used, poor nutritional state, low habitual PA and above all, depression. These findings suggest that physical and cognitive function as well as regular PA may affect QOL more in community-dwelling elderly than the presence of CVD or even need of hospitalisation.