Community-dwelling Elderly Individuals Research Articles

Determinants for Quantitative Sensory Testing and the Association with Chronic Musculoskeletal Pain in the General Elderly Population

Chronic musculoskeletal pain is accompanied by central sensitization, which can be determined with quantitative sensory testing (QST). In this study, we aim to investigate whether central sensitization, as measured by thermal QST, is detectable in community-dwelling elderly individuals suffering from self-reported chronic pain and identify determinants influencing thermal QST measurement analyses and interpretation. In 3,936 participants of the Rotterdam Study, cold and warmth sensitivity and heat pain thresholds were determined using the thermo-sensory analyzer TSA II (Medoc Advanced Medical Systems, Durham, NC, U.S.A.). Using Cox regression, associations were studied with chronic pain and potential determinants (body mass index [BMI], reaction speed, systolic and diastolic blood pressure, skin color, skin temperature, seasonal influence, depression, anxiety, atopic eczema, age at menarche, years since menopause, hormone replacement therapy (HRT) use during menopause, and reproductive lifespan). In addition to the effect of age and gender on thermal sensitivity, darker skin color and the presence of atopic eczema were associated with higher sensitivity for heat pain. Cold sensitivity and warmth sensitivity thresholds were both influenced by BMI, reaction speed, skin temperature, season, depression, dark skin color, years since menopause, and reproductive lifespan. The presence of chronic pain was associated with 0.2 degrees lower heat pain threshold in all participants, and 0.3 degrees lower in individuals with chronic pain in more than 2 sites. Higher sensitivity for heat pain, one feature of central sensitization, is present in community-dwelling elderly with chronic pain. Additional determinants should be considered when analyzing and interpreting QST measurements.

Physiological Levels of Melatonin Relate to Cognitive Function and Depressive Symptoms: The HEIJO-KYO Cohort.

In contrast with randomized controlled trials, observational studies have suggested that physiological levels of melatonin are reduced in patients with dementia or depression, but the relationship has not been evaluated in large populations. The objective was to determine the relationships between physiological levels of melatonin and cognitive function and depressive symptoms. A cohort of 1105 community-dwelling elderly individuals was enrolled in this cross-sectional study (mean age, 71.8 ± 7.1 y). Urinary 6-sulfatoxymelatonin excretion (UME) and Mini-Mental State Examination (MMSE; n = 935) and Geriatric Depression Scale (GDS; n = 1097) scores were measured as indices of physiological melatonin levels, cognitive function, and depressive symptoms, respectively. With increases in UME quartiles, the prevalence of cognitive impairment (MMSE score ≤ 26) and depressed mood (GDS score ≥ 6) significantly decreased (P for trend = .003 and .012, respectively). In multivariate logistic regression models, after adjusting for confounders such as age, gender, socioeconomic status, physical activity, and sleep/wake cycles, higher UME levels were significantly associated with lower odds ratios (ORs) for cognitive impairment and depressed mood (ORs: Q1 = 1.00; Q2 = 0.88 and 0.76; Q3 = 0.66 and 0.85; Q4 = 0.67 and 0.53; P for trend = .023 and .033, respectively). In addition, the highest UME group showed a significantly lower OR for depressed mood than the lowest UME group (Q4 vs Q1: OR, 0.53; 95% confidence interval, 0.32-0.89; P = .033). UME levels above the median value were significantly associated with a lower OR for cognitive impairment, even after further adjustment for depressive symptoms (OR = 0.74; 95% confidence interval, 0.55-0.99; P = .043). Significant associations of higher physiological melatonin levels with lower prevalence of cognitive impairment and depressed mood were revealed in a large general elderly population. The association between physiological melatonin levels and cognitive function was independent of depressive symptoms.

Hip Protectors: Are They Worth it?

Hip fractures are one of the most serious conditions in frail elderly subjects, greatly increasing morbidity and mortality, and decreasing healthy life years. Since their first introduction on the market, hip protectors have been revealed to be a potential preventive measure for hip fractures, in addition to other well-known recognized medical interventions and rehabilitation procedures. However, randomized controlled trials have given contradictory results regarding their efficacy. Moreover, little data are available on the cost effectiveness of hip protectors. Adherence is a major problem in assessing the effectiveness of hip protectors in preventing fractures. Indeed, there is a lack of general consensus on a standard definition and quantitative objective estimation of adherence to hip protectors, along with still scarce evidence on specific interventions on how to ameliorate it. From what is known so far, it seems reasonable to advise the use of hip protectors in aged care facilities, since recent pooled analyses have suggested their efficacy in this setting. The introduction of sensors combined with hip protectors will probably address this issue, both for monitoring and optimizing compliance, especially in elderly people. In the meantime, new, well-designed studies following specific guidelines are strongly encouraged and needed. In particular, studies in community-dwelling elderly individuals at high risk of first or further fragility fractures are required. The optimization of the tested devices in a preclinical setting according to international standard biomechanical testing is necessary.

Frail Elders in an Urban District Setting in Malaysia: Multidimensional Frailty and Its Correlates.

In the past decade, the population in Malaysia has been rapidly ageing. This poses new challenges and issues that threaten the ability of the elderly to independently age in place. A multistage cross-sectional study on 789 community-dwelling elderly individuals aged 60 years and above was conducted in an urban district in Malaysia to assess the geriatric syndrome of frailty. Using a multidimensional frailty index, we detected 67.7% prefrail and 5.7% frail elders. Cognitive status was a significant correlate for frailty status among the respondents as well as those who perceived their health status as very poor or quite poor; but self-rated health was no longer significant when controlled for sociodemographic variables. Lower-body weakness and history of falls were associated with increasing frailty levels, and this association persisted in the multivariate model. This study offers support that physical disability, falls, and cognition are important determinants for frailty. This initial work on frailty among urban elders in Malaysia provides important correlations and identifies potential risk factors that can form the basis of information for targeted preventive measures for this vulnerable group in their prefrail state.

Mental health: New horizons in nutrition research and dietetic practice

Mental health: New horizons in nutrition research and dietetic practice

Fall risk factors and sex differences among community-dwelling elderly individuals in Japan. A Kameoka study

Although factors associated with falls might differ between men and women, no large-scale studies were conducted to examine the sex difference of risk factors for falls in Japanese elderly. The purpose of this study was to examine fall risk factors and sex differences among community-dwelling elderly individuals using a complete survey of the geriatric population in Kameoka city. A self-administered questionnaire survey was conducted with 18,231 community-dwelling elderly individuals aged 65 years or over in Kameoka city, Kyoto Prefecture, between July and August 2011, excluding people who were publicly certified with a long-term care need of grade 3 or higher. The questionnaire was individually distributed and collected via mail. Out of 12,159 responders (recovery rate of 72.2%), we analyzed the data of 12,054 elderly individuals who were not certified as having long-term care needs. The questionnaire was composed of basic attributes, a simple screening test for fall risk, the Kihon Check List with 25 items, and the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence with 13 items. These items were grouped into nine factors: motor function, malnutrition, oral function, houseboundness, forgetfulness, depression, Instrumental Activity of Daily Living (IADL), intellectual activities, and social role. Of all the respondents, 20.8% experienced falls within the last year, and 26.6% were classified as having high fall risk. Fall risk increased with age in both sexes, and risk in all age groups was higher for women than for men. All factors were significantly associated with fall risk in both sexes. After controlling for these factors, a significant relationship was found between fall risk and motor function, malnutrition, oral function, forgetfulness, depression, and IADL in men and motor function, oral function, forgetfulness, depression, and IADL in women. The deterioration of motor function was associated with three-times-higher risk than non-deterioration of motor function. In addition, significant interaction was found in sex×malnutrition, oral function, IADL, and intellectual activities; malnutrition and low oral function were stronger factors in men than in women; and IADL and intellectual activities were stronger factors in women than in men. One in five community-dwelling independent elderly individuals experienced falls in the last year, and one in four had high fall risk. We found a significant relationship between fall risk and the nine factors, particularly deterioration of motor function in both sexes. Sex difference was observed for fall risk factors; therefore, a sex-specific support policy for fall prevention is necessary.

Transition Patterns of Frailty Syndrome in Comunity-Dwelling Elderly Individuals: A Longitudinal Study.

Little information is available about transitional patterns related to frailty syndrome in elderly individuals living in the community. To assess transitional patterns and determine which frailty phenotype variables are more involved in this process. Longitudinal study. Community-dwelling elderly individuals in Belo Horizonte, Minas Gerais, Brazil. Two hundred individuals over 65 years old. The frailty phenotype was assessed at two different times, with a mean interval of 13 months. Comparison of the frequency distributions between the baseline and second assessment was conducted through Pearson's chi-squared test, and a binary logistic regression was conducted to assess the most important items in this transition. Sixty-eight percent of the elderly were women, with an average age of 73.7 (± 6.1) years. The pre-frail group transitioned the most between evaluations. Eighty-five individuals transitioned among frailty levels: 46 showed improvement while 39 worsened. Individuals who did scored low on the handgrip strength test in the first evaluation were more likely to have their frailty level worsen. Among individuals who showed improvements, those who were positive for weight loss and poor physical activity level in the first evaluation were less likely to improve. In this study, a greater number of individuals showed improved frailty levels over 13 months than worsened levels. Poor handgrip strength, weight loss, and poor physical activity are the most influential variables in frailty transitioning, leading to worsening levels of frailty or difficulty in making improvements.

Japanese elderly persons walk faster than non-Asian elderly persons: a meta-regression analysis.

[Purpose] The purpose of this study was to clarify ethnic differences in walking speed by comparing walking speed in both Japanese and non-Asian elderly individuals and to investigate the necessity of consideration of ethnic differences in walking speed. [Subjects and Methods] Articles that reported comfortable walking speeds for community-dwelling elderly individuals were identified from electronic databases. Articles that involved community-dwelling individuals who were 60 years old or older and well functioning were included in the study. Articles that involved Asians were excluded. Weighted means for 5-m walking times were calculated as walking speeds from the Japanese and non-Asian sample data. The effects of age, gender, and ethnicity on 5-m walking times were then investigated using meta-regression analysis. [Results] Twenty studies (34 groups) were included for Japanese, and 16 studies (28 groups) were included for non-Asians. The weighted mean 5-m walking time was estimated to be 4.15 sec (95% confidence interval [CI]: 3.87–4.44) for Japanese and 4.24 sec (95% CI: 4.09–4.40) for non-Asians. Furthermore, using meta-regression analysis adjusted for age and gender, the 5-m walking time was 0.40 sec faster (95% CI: 0.03–0.77) for Japanese than for non-Asian elderly individuals. [Conclusion] Walking speed appeared faster for Japanese community-dwelling elderly individuals than for non-Asian elderly individuals.

Cognitive Impairment, Depression, and Cooccurrence of Both among the Elderly in Panama: Differential Associations with Multimorbidity and Functional Limitations.

Cognitive impairment and depression are common mental health problems among the elderly, although few studies have examined their cooccurrence in older adults in Latin America. The purpose of this study was to examine cognitive impairment, depression, and cooccurrence of the two conditions and associated factors in a sample of older adults in Panama. This study included 304 community-dwelling elderly (≥65 years) individuals. Participants underwent a clinical interview and assessments of cognitive function by the Minimental State Examination and depressive symptoms by the Geriatric Depression Scale. Limitations in basic (BADL) and instrumental (IADL) activities in daily living and the presence of chronic illnesses were recorded. Multinomial regression analysis revealed that cooccurrence of cognitive impairment and depressive symptoms was explained by increasing age (OR: 3.2, 95% CI: 1.20, 8.30), low education (OR: 3.3, 95% CI: 1.33, 8.38), having four or more chronic conditions (OR: 11.5, 95% CI: 2.84, 46.63), and BADL limitations (OR: 5.0, 95% CI: 1.26, 19.68). Less education and limitations in BADL and IADL increased the odds of cognitive impairment alone, while less education and three or more chronic conditions increased the odds of depression alone. These findings underscore the relevance of assessing cognitive impairment in the elderly as part of a long-term approach to managing depression and vice versa.

Relationship among Subjective Satisfaction with Verbal Communication, Dental Status, and Health-Related Quality of Life in Japanese Community-Residing Elderly Individuals

Aim: We aimed to explore factors related to improving health-related quality of life (HRQOL) among Japanese community-residing elderly individuals. Using a questionnaire, we investigated subjective satisfaction with verbal communication, dental status, and HRQOL in community-residing elderly people. Methods: Subjects were 454 independent elderly individuals, with a mean age of 76.1 ± 6.8 years, living in Japan. The Japanese version of the SF-8 Health Survey was used to evaluate HRQOL. Subjective satisfaction with verbal communication was investigated using a five-point scale. Multiple regression analysis was conducted to identify determinants affecting HRQOL. Covariance structure analysis was conducted to investigate any mutual association between age, presence of natural teeth, satisfaction with verbal communication, and HRQOL. Results: The HRQOL scores of subjects who answered that they were “very satisfied” or “satisfied” with verbal communication were significantly higher than those of subjects in the groups of “neither satisfied nor unsatisfied”, the “unsatisfied”, and the “very unsatisfied” in physical component summary (PCS) scores or mental component summary (MCS) scores of SF-8 (P < 0.001). In multiple regression analysis, age, gender, and satisfaction with verbal communication were independent predictors of PCS scores. Furthermore, age and subjective satisfaction with verbal communication were also independent predictors of MCS scores. There was a significant positive correlation between subjective satisfaction with verbal communication and PCS (r = 0.307, P < 0.001) or MCS (r = 0.435, P < 0.001) in covariance structure analysis. Conclusions: Satisfaction with verbal communication is significantly related to HRQOL among Japanese community-dwelling elderly individuals.

Reproducibility and validity of the 50-meter walking test in community-dwelling elderly.

[Purpose] This study aimed to investigate the reproducibility and validity of the 50-m walking test. [Subjects] Reproducibility was investigated in 19 community-dwelling elderly women (mean age, 76.3 years), and validity was investigated in 31 community-dwelling elderly individuals (12 men and 19 women; mean age, 75.7 years). [Methods] The time taken to walk 50 m, the time taken to walk each 10-m section (laps 1–5), the time taken to walk 10 m, and grip strength were measured. In addition, the functional reach test (FRT), one-leg standing test, and timed up and go (TUG) test were performed. [Results] In a reproducibility analysis, the interclass correlation coefficient (1,1) was 0.97. In a Bland-Altman analysis, no systematic error was found. The measured values from the 50-m walking test included a measurement error of 1.5 s, and the acceptable margin of error was confirmed to be 3.1 s. In a validity analysis, the 50-m walking test score was significantly correlated with the 10-m walking and TUG test scores. [Conclusion] Our results suggest that the 50-m walking test score may be a useful index of the walking ability of community-dwelling elderly.

The effect of a “surveillance nurse” telephone support intervention in a home care program

This study is an evaluation of a unique “surveillance nurse” telephone support intervention for community-dwelling elderly individuals in a home care program. A combined propensity-based covariate-matching procedure was used to pair each individual who received the intervention (“treatment” condition, nT = 930) to a similar individual who did not receive the intervention (“control” condition, nC1 = 930) from among a large pool of potential control individuals (nC0 = 4656). The intervention consisted of regularly scheduled telephone calls from a surveillance nurse to proactively assess the individual's well-being, care plan status, use of and need for services (home support, adult day program, physiotherapy, etc.) and home environment (e.g., informal caregiver support). Treatment and control conditions were compared with respect to four service utilization outcomes: (1) rate of survival in the community before institutionalization in an assisted living or nursing home facility or death, (2) rate of emergency room registrations, (3) rate of acute care hospitalizations, and (4) rate of days in hospital, during home care enrollment. Results indicated a beneficial effect of the surveillance nurse intervention on reducing rate of service utilization by increasing the duration of the home care episode.

Validity of a screening tool for detecting subtle cognitive impairment in the middle-aged and elderly.

The present study tested 121 middle-aged and elderly community-dwelling individuals on the computer-based Subtle Cognitive Impairment Test (SCIT) and compared their performance with that on several neuropsychological tests. The SCIT had excellent internal consistency, as demonstrated by a high split-half reliability measure (0.88–0.93). Performance on the SCIT was unaffected by the confounding factors of sex, education level, and mood state. Many participants demonstrated impaired performance on one or more of the neuropsychological tests (Controlled Oral Word Association Task, Rey Auditory and Verbal Learning Task, Grooved Pegboard [GP], Complex Figures). Performance on SCIT subtests correlated significantly with performance on many of the neuropsychological subtests, and the best and worst performing quartiles on the SCIT subtest discriminated between good and poor performers on other subtests, collectively indicating concurrent validity of the SCIT. Principal components analysis indicated that SCIT performance does not cluster with performance on most of the other cognitive tests, and instead is associated with decision-making efficacy, and processing speed and efficiency. Thus, the SCIT is responsive to the processes that underpin multiple cognitive domains, rather than being specific for a single domain. Since the SCIT is quick and easy to administer, and is well tolerated by the elderly, it may have utility as a screening tool for detecting cognitive impairment in middle-aged and elderly populations.

Abstract 12358: Abnormal Left Ventricular Midwall Fractional Shortening and Elevated Circulating Biomarkers Predict High Mortality in Elderly Individuals in the General Population

Background: Individuals in the general population with a minimal elevation of cardiac biomarkers and left ventricular hypertrophy are at high cardiovascular risk and may be candidate for early strategies of prevention and treatment. We investigated the combination of several circulating biomarkers with abnormal midwall fractional shortening (MFS), an early echocardiographic indicator of preclinical systolic dysfunction, with adverse outcomes. Methods: Circulating levels of N-terminal probrain natriuretic peptide (NT-proBNP), high sensitivity cardiac troponin T (hs-cTnT), and intercellular adhesion molecule-1 (ICAM-1) were measured in 550 elderly community-dwelling individuals (65-84 years) from the PREDICTOR study. Participants were referred to cardiology centers for clinical examination and Doppler echocardiography with centrally-measured MFS. Causes of death or hospitalization were available after a median follow-up of 46 [39-54] months from record-linkage of administrative data. Results: Individuals with LV midwall dysfunction (MFS&lt;15%, n= 204 (38%)) had higher levels of NT-proBNP (148 [57-311] ng/L), hs-cTnT (7.3 [3.9-11.6] ng/L)and ICAM-1 (211 [177-261] ng/mL) than those with normal function (82 [42-171] and 5.0 [3.0-8.3] ng/L, 193 [165-230], respectively, p&lt;0.001). The cumulative incidence of total mortality (n=36) among individuals with abnormal MFS and elevated NT-proBNP (&gt;75th age- and sex-specific percentile) was 14% vs. 2% (abnormal MFS, low NT-proBNP), 6% (normal MFS, high NT-proBNP) and 1% (normal MFS, low NT-proBNP). Corresponding values for hs-cTnT (&gt; 3ng/L) were 14, 0, 5 and 3% (p&lt;0.0001) and 15, 5, 7 and 2% for ICAM-1 above median concentration (all p&lt;0.0001). After adjustment for sex, age, eGFR and hypertension, subjects with abnormal MFS and an elevated biomarker had a higher risk of total mortality compared to those with normal MFS and low biomarker: HR = 11.4 [1.5-87.7] (p=0.02) for NT-proBNP and 7.4 [2.1-25.6] (p=0.002) for ICAM-1, but not for hs-cTnT. Similar trends were seen for GDF-15. Conclusions: Elevation of circulating biomarkers combined with early alterations in LV systolic function with MFS identifies a subgroup of individuals in the general population aged 65 or more at higher risk for mortality.

Forgiveness, Ego-Integrity, and Depressive Symptoms in Community-Dwelling and Residential Elderly Adults.

This study aimed first, to investigate the relation between forgivingness and depressive symptoms in elderly individuals and second, to explore whether the developmental task of integrity/despair is a possible underlying process in this relation. Both aims were studied in a sample of community-dwelling elderly individuals as well as in a sample of residential elderly individuals. Community-dwelling elderly individuals (n = 280, M = 75.98 years) and residential elderly individuals (n = 205, M = 83.20 years) in Belgium filled out questionnaires on forgivingness, depressive symptoms, and the developmental task of integrity/despair. Structural equation modeling was used to test the mediational role of integrity/despair in the relation between forgivingness and depression in both samples. Furthermore, multigroup analyses tested the convergence of the mediational models in the community-dwelling elderly individuals and the residential elderly individuals. Forgivingness and depression were negatively associated in both residential elderly individuals and community-dwelling elderly individuals. The developmental task of finding integrity and avoiding despair showed to be a significant mediator in this relationship. Framed within a life-span perspective, we showed that the developmental task of finding a balance between integrity and despair is an important intrapersonal mechanism through which forgivingness is related with depressed feelings for residential as well as community-dwelling elderly individuals.

Continuous participation in a day-care prevention service improves the mobility of the community-dwelling elderly

This study aimed to examine the effect of continuous participation in a day-care fall prevention service on the mobility of the community-dwelling elderly. Peak and mean transfer velocities of the center of gravity (PV and MV, respectively) as well as 10-m maximum walking speed (MWS) were calculated for 57 elderly who participated continuously in a day-care fall prevention service, held 24 times every year for 3 years, between 2010 and 2012 [continuous group (CON), age: 76.0 ± 6.1 years], and 157 elderly who participated in it for only the first year within the same period [dropout group (DO), age: 76.6 ± 6.1 years]. No significant difference was found between PV, MV, and MWS in the first year for the CON and DO (t &gt; 1.27, p &lt; 0.05). The, PV and MV of the CON increased significantly within a year (F = 28.1 and 30.5, p &lt; 0.05 in both). Moreover, PV, MV, and MWS of the CON in the third year were significantly higher than those in the DO (t &gt; 2.55, p &lt; 0.05). Our results suggest that continuous participation in a day-care fall prevention service contributes to an improvement in the mobility of community-dwelling elderly individuals. Keywords: Continuity, Nursing Care Prevention Service, Mobility.

Effects of Short-Term Training of Community-Dwelling Elderly with Modular Interactive Tiles.

Objective: The objective of this study is to test for the increased mobility, agility, balancing, and general fitness of community-dwelling elderly individuals as a result of short-term training involving playing with modular interactive tiles (Entertainment Robotics, Odense, Denmark) at two community activity centers for the elderly. Three different tests from the Senior Fitness Test were used in order to test a variety of health parameters of the community-dwelling elderly, including those parameters related to fall prevention. Materials and Methods: Eighteen community-dwelling elderly individuals (63-95 years of age; mean, 83.2 years of age) were assessed in one intervention group without the use of a control group. The intervention group performed nine group sessions (1-1.5 hours each) of playful training with the modular interactive tiles over a 12-week period in two community activity centers for the elderly. Data were collected using pre-tests and post-tests of the 6-Minute Walk Test (6MWT), the 8-foot Timed Up & Go Test (TUG), and the Chair-Stand Test (CS). Data were analyzed for statistically significant differences and increases of means. Results: The 6MWT, TUG, and CS measurements showed statistically significant differences and increases of means between the pre-tests and post-tests with the 6MWT (P<0.001) (means difference, 22.4 percent), TUG (P<0.001) (means difference, 15 percent), and CS (P<0.002) (means difference, 14 percent). Fifty-six percent of the elderly progressed from one health risk level to a better level, according to the three tests. Conclusions: Statistically significant increases in scores were found across all tests, suggesting an improvement of many different health parameters for the elderly. Well-established research has shown the relationship between such test scores and fall incidents, balancing, mobility, agility, etc. This significant improvement in the health status of the elderly is obtained in as few as nine training sessions over a 12-week period of "playing" exergames with the modular interactive tiles.

Do self-referent metacognition and residential context predict depressive symptoms across late-life span? A developmental study in an Italian sample

Objectives: There is controversial evidence concerning the variables favoring depression in community-dwelling elderly individuals. This study mainly investigates the impact of lifestyle, residential environment, cognitive efficiency and social desirability in predicting self-assessed depressive signs in late adult span.Method: One hundred forty-nine elders were recruited in Northern Italy and Sardinia – an Italian island characterized by the longevity of people living in the inner areas. Participants were presented a battery of questionnaires assessing cognitive efficiency and self-referent measures of depression, metacognition and social desirability.Results: A hierarchical regression analysis showed that residential environment was the most effective predictor of depressive symptoms, along with gardening and spending time for hobbies. In contrast, social desirability and metacognitive scores played a minor role in predicting mental health. An analysis of variance showed that Sardinian elders showed fewer signs of depression than age-matched elders residing in Northern Italy.Conclusion: The Sardinian residential environment is a strong predictor of preserved mental health in late adulthood. In contrast, self-rated metacognitive efficiency and social desirability play a very marginal role in predicting depression among the elderly.

Dietary acid load, kidney function, osteoporosis, and risk of fractures in elderly men and women.

Because kidney dysfunction reduces the ability to excrete dietary acid excess, we hypothesized that underlying kidney function may have confounded the mixed studies linking dietary acid load with the risk of osteoporosis and fractures in the community. In a relatively large survey of elderly men and women, we report that dietary acid load did neither associate with DEXA-estimated bone mineral density nor with fracture risk. Underlying kidney function did not modify these null findings. Our results do not support the dietary acid-base hypothesis of bone loss. Impaired renal function reduces the ability to excrete dietary acid excess. We here investigate the association between dietary acid load and bone mineral density (BMD), osteoporosis, and fracture risk by renal function status. An observational study was conducted in 861 community-dwelling 70-year-old men and women (49% men) with complete dietary data from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS). The exposure was dietary acid load as estimated from 7-day food records by the net endogenous acid production (NEAP) and potential renal acid load (PRAL) algorithms. Renal function assessed by cystatin C estimated glomerular filtration rate was reduced in 21% of the individuals. Study outcomes were BMD and osteoporosis state (assessed by DEXA) and time to fracture (median follow-up of 9.2 years). In cross-section, dietary acid load had no significant associations with BMD or with the diagnosis of osteoporosis. During follow-up, 131 fractures were validated. Neither NEAP (adjusted hazard ratios (HR) (95% confidence interval (CI)), 1.01 (0.85-1.21), per 1 SD increment) nor PRAL (adjusted HR (95% CI), 1.07 (0.88-1.30), per 1 SD increment) associated with fracture risk. Further multivariate adjustment for kidney function or stratification by the presence of kidney disease did not modify these null associations. The hypothesis that dietary acid load associates with reduced BMD or increased fracture risk was not supported by this study in community-dwelling elderly individuals. Renal function did not influence on this null finding.

P106: Investigation of predictors of decreased skeletal muscle mass in community-dwelling elderly individuals

P106: Investigation of predictors of decreased skeletal muscle mass in community-dwelling elderly individuals