A comparison of the prevalence of Fear of Falling between older patients with Lewy body dementia, Alzheimer's Disease, and without dementia

Background: The development of cognitive impairment and Fear of Falling (FoF) are strongly linked, but prevalence of FoF is not known in patients with different types of dementia. This study aims to evaluate and compare the prevalence and severity of FoF in patients' with dementia with Lewy bodies (DLB), Alzheimer disease (AD), and non-dementia. Methods: 46 participants with DLB, 86 participants with AD and participants without dementia (controls), underwent Comprehensive Geriatric Assessment (CGA). The Falls Efficacy Scale–International (FES-I) was used to determine and classify FoF. An overall score on the FES-I of 16–19, 20–27 and ≥28, was accepted as low, moderate, and high concern about FoF, respectively. Results: Prevalence of high FoF was 86.9% in DLB, 36.0% in AD and 37.4% in controls. All CGA parameters were worse in the DLB and AD group than non-dementia group (p 0.05). The significant relationship between DLB and FoF was maintained when adjusted for age, CGA parameters, and orthostatic hypotension (OR: 2.55, CI: 1.03–6.25, p = 0.041 comparison to AD; OR: 4.79, CI: 2.10–10.92, p < 0.001 comparison to non-dementia). Conclusion: Eight out of ten elderly patients with DLB have high FoF, which is much higher than those with AD and without dementia. Therefore, clinicians should be aware of FoF and its related consequences in the management of DLB in older adults

A comparison of the prevalence of orthostatic hypotension between older patients with Alzheimer's Disease, Lewy body dementia, and without dementia

Orthostatic hypotension (OH) is reported to be more prevalent particularly in patients with Dementia with Lewy bodies (DLB) because of the autonomic dysfunction, but prevalence of OH is not known in patients with Alzheimer Disease (AD). The aim of the present study was to determine whether OH can be used to distinguish DLB from AD. 38 patients with DLB, 88 patients with AD and 521 patients without dementia, underwent Comprehensive Geriatric Assessment. OH were evaluated for the 1st (OH1) and 3rd (OH3) minutes, taking the data in supine position as the basis, by Head-Up-Tilt Test. Prevalence of OH1 was 43.2% in AD, 44.7% in DLB and 17.9% in patients without dementia, and OH3 was 44.3% in AD, 47.4% in DLB and 17.9% in non-dementia group. The frequency of OH1 and OH3 was higher in the AD and DLB groups than in the patients without dementia (p0.05). The percentage of asymptomatic patients with OH was 87.2% and 89.6% during 1st and 3rd minutes, respectively, and this percentage was similar in three groups (p>0.05, for each). There was no significant difference between the two dementia groups in terms of comorbidities, drugs and laboratory values (p>0.05). OH is more prevalent in patients with AD than controls and similar levels are observed in those with DLB. The prevalence of OH equally is greater with DLB or AD disease progression. Clinicians should be aware of OH and its related consequences in the management of the AD in older adults

Physical activity and exercise for the prevention and management of mild cognitive impairment and dementia: a collaborative international guideline

Cognition; Dementia; ExerciseCognició; Demència; ExerciciCognición; Demencia; EjercicioBackground Physical activity and exercise have been suggested as effective interventions for the prevention and management of mild cognitive impairment (MCI) and dementia, but there are no international guidelines. Objectives To create a set of evidence- and expert consensus-based prevention and management recommendations regarding physical activity (any bodily movement produced by skeletal muscles that results in energy expenditure) and exercise (a subset of physical activity that is planned, structured, repetitive), applicable to a range of individuals from healthy older adults to those with MCI/dementia. Methods Guideline content was developed with input from several scientific and lay representatives’ societies. A systematic search across multidisciplinary databases was carried out until October 2021. Recommendations for prevention and management were developed according to the GRADE and complemented by consensus statements from the expert panels. Recommendations Physical activity may be considered for the primary prevention of dementia. In people with MCI there is continued uncertainty about the role of physical activity in slowing the conversion to dementia. Mind–body interventions have the greatest supporting evidence. In people with moderate dementia, exercise may be used for maintaining disability and cognition. All these recommendations were based on a very low/low certainty of evidence. Conclusions Although the scientific evidence on the beneficial role of physical activity and exercise in preserving cognitive functions in subjects with normal cognition, MCI or dementia is inconclusive, this panel, composed of scientific societies and other stakeholders, recommends their implementation based on their beneficial effects on almost all facets of health.Open access funding provided by Università degli Studi di Palermo within the CRUI-CARE Agreement

The clinical implications and importance of anemia in older women

Objectives: The objective of this study was to investigate associations between anemia with geriatric syndromes and comprehensive geriatric assessment (CGA) parameters in older women. Methods: 886 older outpatient women were included . Anemia was defined as a hemoglobin concentration below 12 g/dL. patients were divided into two groups as anemic and non-anemic. The relationships between anemia and CGA parameters/geriatric syndromes were determined. Results: The mean age of the participants was 76.00 ± 8.91. The prevalence of patients with anemia was 15.35%. There was a significant difference between anemic and non-anemic groups in terms of age, Charlson Comorbidity Index, body mass index, the number of drugs used, and the presence of chronic renal failure (p < 0.05). After adjustment for these covariates, anemia was associated with Timed Up and Go test (OR: 1.10, 95% CI: 1.02–1.18), muscle strength (OR: 0.99, 95% CI: 0.83–0.99), dynapenia (OR: 1.92, 95% CI: 1.06–3.47), Mini Nutritional Assessment scores (OR: 0.88, 95% CI: 0.83–0.94), poor nutritional status (OR: 1.97, 95% CI: 1.10–3.48), Fried scores (OR: 1.42, 95% CI: 1.24–1.68), frailty (OR: 2.58, 95% CI: 1.42–4.69), falls (OR: 1.78, 95% CI: 1.10–2.92) and polypharmacy (OR: 2.31, 95% CI: 1.38–3.86). Conclusion: In the present study anemia was associated with frailty, polypharmacy, poor nutritional status, falls, and decreased muscle strength. Therefore, anemia may be a sign of poor health status in older women. When anemia is detected in an older woman, CGA should be strongly considered if not routinely performed

What is the optimal body mass index range for older adults?

Background- Obesity is pathophysiologically complex in older adults compared to that in young and middle-aged adults. The aim of the present study was to determine the appropriate body mass index (BMI) range based on geriatric evaluation parameters in which complications can be minimized in older adults. Methods- A total of 1,051 older adult patients who underwent comprehensive geriatric assessment were included. The patients’ demographic characteristics, comorbid diseases, number of drugs, BMI, basic and instrumental activities of daily living (BADL and IADL), Tinetti balance and walking scale, Mini Nutritional Assessment, Geriatric Depression Scale-15, Mini-Mental State Examination, Time Up and Go test, and handgrip strength measurement were extracted from patient records. Results- Of the patients who took part, 73% were female, and the mean age was 77.22±7.10 years. The most negative results were observed in those with a BMI 35 kg/m2. Receiver operating characteristic (ROC) analysis of the optimum BMI cutoff levels to detect the desirable values of geriatric assessment parameters was found to be 31–32 and 27–28 kg/m2 for female and male, respectively. Conclusion- Older adults with BMI 35 kg/m2 were at a higher risk of a decrease in functional capacity, and experienced gait and balance problems, fall risk, decrease in muscle strength, and malnutrition. Data from this study suggest that the optimum range of BMI levels for older adults is 31–32 and 27–28 kg/m2 for female and male, respectively

The relationship between chronic diseases and number of sexual partners: an exploratory analysis

Background: We investigated sex-specific associations between lifetime number of sexual partners and several health outcomes in a large sample of older adults in England. Methods: We used cross-sectional data from 2,537 men and 3,185 women aged ≥50 years participating in the English Longitudinal Study of Ageing. Participants reported the number of sexual partners they had had in their lifetime. Outcomes were self-rated health and self-reported limiting long-standing illness, cancer, coronary heart disease (CHD), and stroke. We used logistic regression to analyse associations between lifetime number of sexual partners and health outcomes, adjusted for relevant sociodemographic and health-related covariates. Results: Having had 10 or more lifetime sexual partners was associated with higher odds of reporting a diagnosis of cancer than having had 0-1 sexual partners in men (OR=1.69, 95% CI 1.01-2.83) and women (OR=1.91, 95% CI 1.04-3.51), respectively. Women who had 10 or more lifetime sexual partners also had higher odds of reporting a limiting long-standing illness (OR=1.64, 95% CI 1.15 2.35). No other statistically significant associations were observed. Conclusions: A higher lifetime number of sexual partners is associated with increased odds of reported cancer. Longitudinal research is required to establish causality. Understanding the predictive value of lifetime number of sexual partner as a behavioural risk factor may improve clinical assessment of cancer risk in older adults

Associations between sexual activity and weight status: Findings from the English Longitudinal Study of Ageing.

OBJECTIVE: To investigate the association between weight status and sexual activity in middle-aged and older adults. METHODS: Cross-sectional analysis on Wave 6 (2012/13) of the English Longitudinal Study of Ageing. Data were from 2,200 men and 2,737 women aged ≥50 years (mean 68.2 years). The explanatory variable was weight status, defined as normal-weight (BMI: ≤24.9), overweight (BMI: 25.0-29.9) or obese (BMI: ≥30) based on objective measurements of height and weight. Outcome variables were any self-reported sexual activity in the last year (yes/no) and, if yes, frequency of sexual intercourse in the last month. Covariates included a range of sociodemographic, lifestyle, and health-related variables. Associations were analysed using binary (past-year sexual activity) and ordinal (frequency of past-month sexual intercourse) logistic regression models. RESULTS: The majority (73.3%) of men and half (50.0%) of women reported any sexual activity in the last year. The odds of reporting any sexual activity in the last year did not differ significantly by weight status in either men or women. However, among those who were sexually active, men with overweight (OR = 1.45, 95% CI 1.15-1.81, p = 0.002) or obesity (OR = 1.38, 95% CI 1.07-1.77, p = 0.015), and women with overweight (OR = 1.34, 95% CI 1.05-1.71, p = 0.017) reported significantly more frequent sexual intercourse in the last month compared with those who had a BMI in the normal-weight range, after adjustment for covariates. CONCLUSION: Older adults with overweight or obesity who are sexually active engage in more frequent sexual activity than those who are normal weight

Mini nutritional assessment scale-short form can be useful for frailty screening in older adults

Aim: Mini Nutritional Assessment-Short Form (MNA-SF) is used to assess nutritional status in older adults, but it is not known whether it can define frailty. It was aimed to investigate that the MNA-SF can identify frailty status defined by Fried criteria. Methods: 1003 outpatients aged 65 or older were included the study. All patients were performed comprehensive geriatric assessment. Frailty status was evaluated by Fried criteria: unintentional weight loss, exhaustion, low levels of activity, weakness and slowness. 1 point is assigned for each criterion: 0 points, not frail; 1-2 points, prefrail; ≥3 points, frail. If the total score of MNA-SF was 11, it was accepted that there was malnutrition, risk of malnutrition, and no malnutrition, respectively. Results: Of the 1003 outpatients, of whom the mean age was 74.2 ± 8.5 years, 313 participants (31.2%) were considered frail and 382 (38.1%) pre-frail. Among frail patients and pre-frail patients, 49.2 and 25.1% were at risk of malnutrition and 22.0% and 1.6% were malnourished, respectively. MNA-SF with a cut-off point of 11.0 had a sensitivity of 71.2% and a specificity of 92.8% to detect frail participants, and with a cut-off point of 13 had a sensitivity of 45.7% and a specificity of 78.3% to detect pre-frailty. The area under the curve of MNA-SF was 0.906 and 0.687 for the estimation of frailty and pre-frailty, respectively. Conclusion: MNA-SF can be useful for frailty screening in older adults

Sexual Activity is Associated with Greater Enjoyment of Life in Older Adults

Background: Relationships between sexual activity, problems and concerns and wellbeing among older adults have not been fully explored. Aim: To investigate associations between sexual activity, problems and concerns and experienced wellbeing in a representative sample of older adults. Methods: Cross-sectional analyses from the English Longitudinal Study of Ageing. Sexual behavior, problems and concerns were assessed by self-completion questionnaire. Covariates included age, partnership status, socio-economic status, smoking status, alcohol intake, limiting long-standing illness, and depressive symptoms. Data were analyzed using one-way independent analyses of variance. Main Outcome: Enjoyment of life was assessed with the pleasure subscale from CASP-19, a validated measure of quality of life specific to older age. Results: Data were available on sexual activity and enjoyment of life for a total of 3,045 men and 3,834 women (mean=64.4 in men, 65.3 in women). Men and women who reported any sexual activity in the past year had significantly higher mean enjoyment of life scores than those who were not sexually active (men=9.75 vs. 9.44, p<0.001, women=9.86 vs. 9.67, p=0.003). Among sexually active men, frequent (≥2 times a month) sexual intercourse (p<0.001) and frequent kissing, petting or fondling (p<0.001) were associated with greater enjoyment of life. Among sexually active women, frequent kissing, petting or fondling was also associated with greater enjoyment of life (p<0.001) but there was no significant association with frequent intercourse (p=0.101). Concerns about one’s sex life and problems with sexual function were strongly associated with lower levels of enjoyment of life in men, and to a lesser extent in women. Conclusion: This is among the first studies to show that wellbeing is higher among older adults when they are sexually active. Preferences regarding the expression of sexual activity differed between the sexes. Further longitudinal research is required in order to confirm a causal association between sexual activity and wellbeing