Elderly Institutionalized Subjects Research Articles

Frequency of Systemic Diseases and Oral Lesions Among the Institutionalized Elderly Subjects in the Northeast of Iran.

With ageing, the number of systemic diseases and the consumption of drugs increase. Moreover, some oral lesions, especially denture-related lesions, are commonly observed. The purpose of this study was to determine the frequency of systemic diseases and oral lesions in the elderly in the Mashhad Geriatric Institutes. Institutionalized elderly people, who could cooperate for oral examination, enrolled in this descriptive cross-sectional study. The frequency of oral lesions and their systemic diseases were recorded in the self-made checklist. For statistical analysis, Student's t-test and Chi-square test were utilized. The significance level was considered to be 0.05. During the study, 224 elderly subjects with a mean age of 75.63 ± 11.22 years were evaluated. The mean duration of residency in the elderly nursing centres was 1.87 ± 1.37 years. Hypertension, Alzheimer's disease and diabetes were the most common systemic diseases, and about 47% of the patients had two or multiple concurrent diseases. Among participants, 97.1% had at least one oral lesion. The most common oral lesions were fissured tongue (75%), sublingual varicosity (68.3%) and hairy or coated tongue (38.4%), respectively, which are classified as normal variations of oral mucosa. The most common pathological lesions were denture stomatitis, frictional keratosis and lichenoid reactions. Regarding to the high frequency of oral lesions among ageing people, regular examination of the oral mucosa for early detection of oral lesions and appropriate treatments is recommended.

Depression and quality of life in Tunisian institutionalized elderly subjects

IntroductionDepression in the elderly is common and closely interrelated with the deterioration of the quality of life, especially in the institutionalized elderly.ObjectivesIn this work, we propose to determine the prevalence of depression in the elderly in institution, to assess their quality of life and to evaluate the correlations between depression and the quality of life.MethodsOur study concerned 30 elderly subjects institutionalized at the retirement home(Sousse, Tunisia). Three validated Arabic version scales were used: The 30-item GDS (Geriatric Depression Scale), the MMSE (Mini Mental State Examination) and the SF36 (assessing the quality of life).ResultsThe mean age of our population was 75±7.3 years, the sex ratio was 1.73. The prevalence of depression was 37%. The elderly had a cognitive impairment in 16.7%. The mean global SF36 score were 11.2, attesting an altered quality of life in all our subjects: the mental component (9.43) were more altered than the physical one (13.03). No correlation between depression and quality of life was found. Depression was significantly correlated with the presence of a medical history (p=0.05). Depression had a negative and statistically significant correlation with the physical score of SF36 (r=-0.41, p=0.02) and tended towards significance for the “general health” dimension of SF36 (r=-0.32, p=0.08).ConclusionsOur study shows a high frequency of depression in the institutionalized elderly as well as a deterioration in their quality of life. Depression is strongly linked to deterioration in physical condition.Our results underline the influence of somatic diseases as a major risk factor for depression in the elderly.DisclosureNo significant relationships.

Correlation between clinical tests for gait and stability using biomechanical variables in the gait of institutionalized elderly subjects

Abstract Study aim: This study aims to identify biomechanical gait variables explaining clinical test results in institutionalized elderly people. Material and methods: Twenty-nine elderly (82.0 ± 6.3 years) residents in a nursing home were assessed. They were able to walk 10 meters without walking aids. First, the spontaneous gait was assessed using inertial measurement units in a 10-meter long corridor. Fifteen biomechanical gait variables were analyzed. Then, three clinical tests usually used in elderly subjects were applied: the Timed Up and Go (TUG) test, the Tinetti Scale and the Sit to Stand (STS) test. A correlation matrix using Pearson’s correlation coefficient between clinical and biomechanical variables was performed, obtaining a total of 45 potential correlations. A stepwise multiple linear regression analysis was then performed to determine the influence of each variable. Results: TUG, Tinetti and STS were significantly correlated with similar biomechanical variables, including temporal, temporo-spatial and kinematic variables. Adults over 80 years old and women showed stronger correlations. Single support and ankle angle at takeoff were the two most important variables in stepwise regression analysis. Conclusions: In institutionalized elderly subjects, clinical variables for gait and postural stability are correlated with the biomechanical gait variables, especially in women and adults aged over 80 years.

Effect of bright light therapy on sleep and mood in elderly institutionalized subjects with mild to moderate cognitive impairment

Effect of bright light therapy on sleep and mood in elderly institutionalized subjects with mild to moderate cognitive impairment

A 21-winter seasons retrospective study of antibody response after influenza vaccination in elderly (60–85 years old) and very elderly (>85 years old) institutionalized subjects

ABSTRACTInfluenza vaccination is considered the best mean for preventing the higher rates of mortality associated with influenza virus infection in the elderly as compared with younger people. Since the number of very elderly subjects, aged >85 years, is rapidly increasing, and some authors reported increments in influenza-associated mortality with age, the aim of this study was to increase the limited information available on the immunogenicity of the influenza vaccines in this age group. This was a retrospective study which analyzed the antibody response induced by commercially available trivalent inactivated influenza vaccines in 1491 elderly subjects (60–85 years old) and 1139 very elderly subjects (>85 years old) during 21 winter seasons included between 1993–1994 and 2014–2015. The antibody response of the two age groups was, in most instances, acceptable according to the Committee for Medical Products for Human Use and comparable. In accordance with previous data obtained in the elderly, the use of MF59-adjuvanted or intradermal administered vaccines (enhanced vaccines) was found to be preferable as compared with conventional formulations (split or subunit vaccines). Vaccines containing new strains induced higher antibody response as compared with vaccines with the same antigenic composition of the previous years. These results suggest that the current recommendation for use of enhanced influenza vaccines for the elderly is appropriate, but that efforts to improve the effectiveness of the present prophylactic measures against influenza are needed, especially in the years with vaccines with the same antigenic composition of the previous winter season.

P376: In 2014, there is still a substantial number of older nursing home residents without vitamin D supplementation

Introduction: Vitamin D inadequacy is common in the elderly population, especially among institutionalized people. Because an optimal vitamin D status has been linked with lower healthrelated adverse effects, the use of vitamin D supplementation has been recommended in older and frail population. The objective of this study was to assess the number of nursing home residents supplemented with vitamin D. Methods: This is a cross-sectional study performed early 2014 in 4 nursing homes from Belgium. Vitamin D supplementations consumed were collected from medical records. Results: A total of 156 elderly institutionalized subjects (mean age: 84.8±8.4 years, 76.6% of women) were included in this study. Seventy-eight (i.e. 50%) were supplemented with vitamin D at a median dose of 880 IU/day (P25-P75: 833 IU/day-3571 IU/day). Interestingly, only 5 (6.41%) of them received a mean daily dose below 800IU and 47 (60.3%) a mean daily dose between 800 and 1000 IU. Those supplemented with vitamin D had, compared to non-supplemented subjects, a significantly lower body mass index (25.1±4.7 kg/m vs. 27.1±4.94 kg/m, p = 0.01), a higher number of drugs consumed (10.57±3.72 vs. 9.10±4.30 p=0.02), and a lower physical function, assessed by the “short physical performance battery” (4.52±2.90 points vs. 5.60±3.13 points, p = 0.03) and the “timed up and go” test (32.9±30.5 seconds vs. 23.4±12.7 seconds, p = 0.01). Conclusion: Compared to what has been previously observed in Belgium a few years ago, it seems that the number of nursing home subjects supplemented with vitamin D increases although it is not optimal yet.

P377: Diabetes in the elderly: nutritional implications

Introduction: Vitamin D inadequacy is common in the elderly population, especially among institutionalized people. Because an optimal vitamin D status has been linked with lower healthrelated adverse effects, the use of vitamin D supplementation has been recommended in older and frail population. The objective of this study was to assess the number of nursing home residents supplemented with vitamin D. Methods: This is a cross-sectional study performed early 2014 in 4 nursing homes from Belgium. Vitamin D supplementations consumed were collected from medical records. Results: A total of 156 elderly institutionalized subjects (mean age: 84.8±8.4 years, 76.6% of women) were included in this study. Seventy-eight (i.e. 50%) were supplemented with vitamin D at a median dose of 880 IU/day (P25-P75: 833 IU/day-3571 IU/day). Interestingly, only 5 (6.41%) of them received a mean daily dose below 800IU and 47 (60.3%) a mean daily dose between 800 and 1000 IU. Those supplemented with vitamin D had, compared to non-supplemented subjects, a significantly lower body mass index (25.1±4.7 kg/m vs. 27.1±4.94 kg/m, p = 0.01), a higher number of drugs consumed (10.57±3.72 vs. 9.10±4.30 p=0.02), and a lower physical function, assessed by the “short physical performance battery” (4.52±2.90 points vs. 5.60±3.13 points, p = 0.03) and the “timed up and go” test (32.9±30.5 seconds vs. 23.4±12.7 seconds, p = 0.01). Conclusion: Compared to what has been previously observed in Belgium a few years ago, it seems that the number of nursing home subjects supplemented with vitamin D increases although it is not optimal yet.

Comparative Study of Immunogenicity of Split, Intradermal and MF59-adjuvanted Influenza Vaccines in Elderly Institutionalized Subjects

The reduced immunogenicity and effectiveness of influenza vaccines in subjects presenting high risk of influenza-related complications, hospitalization and death, led the innovative drive to search for new strategies to implement the immune response elicited by influenza vaccines including addition of adjuvants, and use of alternative routes of antigen delivery.In this study we evaluated and compared the immune antibody response induced in 252 elderly volunteers living in nursing homes after immunization with three different 2012-2013 seasonal trivalent inactivated influenza vaccines: a conventional split vaccine (n=26), and two potentiated vaccines (a subunit vaccine adjuvanted with MF59 (n=137) or a split vaccine administered intradermally (n=89)), specially licensed for elderly people. Haemagglutination inhibiting (HI) antibody titers were assessed in blood samples collected before and one month after vaccination.The results were evaluated as increase in HI titers found comparing pre- and post-vaccination sera and according to the Committee for Medicinal Products for Human Use (CHMP) criteria for approval of influenza vaccines in the elderly. Significant antibody increases and fulfillment of all the three CHMP requirements were observed against A/H3N2 and B antigens following immunization with the two potentiated vaccines. After immunization with conventional vaccine responses were lower against A/H3N2 and equivalent against the B antigen. The two potentiated vaccines induced significant antibody increases against A/H1N1 antigen, however, only one of the CHMP criteria was reached. The HI antibody increases after conventional vaccine were significant only for the geometric mean titer and none of the CHMP criteria was fulfilled. The antibody responses induced by the two potentiated vaccines against the three vaccine antigens wereequivalent although post-vaccination titers against the B antigen tended to be higher in subjects vaccinated with intradermal vaccine than in individuals receiving MF59-adjuvanted vaccine.In conclusion the use of MF59 adjuvant and intradermal vaccination appear to be appropriate strategies to address the challenge of declining immune response in the elderly after influenza vaccination.

Bright light exposure improves the sleep–wake rhythm in institutionalized elder

Aging causes deep disturbances in the circadian rhythms of sleep–wake and activity–rest, with reduced activity, increased sleep fragility and phase advances. These changes have been attributed to degenerative changes in the circadian clock (suprachiasmatic nucleus) and to poor light exposure, the most important external synchronizer. This report aims at assessing the effectiveness of bright light therapy to improve the rest activity and temperature rhythms of elderly institutionalized subjects. Activity, wrist temperature and environmental light exposure were continuously monitored in 9 female institutionalized elder (mean age 76) during three weeks using Hobo sensors for light exposure and activity. IButtons (Maxim®) were used to record wrist temperature (Cronobiotech, R&D). The reference level was established during the first week. During the second week, subjects underwent 50 min of bright light therapy (10.000 lux) every day. The third week served to assess the permanence of the consequences of the bright light administered during the second week. Exposure to bright light produced significant changes in wrist temperature and activity parameters. In both cases, the amplitude of the rhythm was increased. A significant phase delay was recorded and the robustness and stability of the rhythm were increased. These results show that the normal phase advance observed in old subjects may be reverted after bright light exposure. In addition, the increased amplitude of the activity rest rhythm suggests that the sleep–wake rhythm also was improved. Bright light is an efficient therapeutic procedure to improve the quality of life in elderly subjects.

Anorexia and Eating Patterns in the Elderly

ObjectivesTo evaluate the change in eating habits occurring in community- dwelling and institutionalized elderly subjects with senile anorexia.DesignCross- sectional, observational.SettingCommunity, nursing homes and rehabilitation or acute care facilities in four Italian regions.Participants A random sample of 526 subjects, aged 65 years and older (217 free living individuals, 213 residents in nursing homes, and 93 patients in rehabilitation and acute wards).MeasurementsAll subjects underwent a multidimensional geriatric evaluation of: nutritional status, anthropometric parameters, health and cognitive status, depression, taste, chewing and swallowing function, and some hormones related to appetite. Diet variety was assessed, considering the frequency of consumption of different food groups (milk and dairy products; meat, fish, and eggs; cereals and derivatives; fruit and vegetables).ResultsIn anorexic elderly subjects the global food intake was reduced, and the eating pattern was characterized by the reduced consumption of certain food groups (“meat, eggs and fish” and “fruit and vegetables”) whereas the frequency of consumption of milk and cereals remained almost unchanged. Nutritional parameters were significantly better in normal eating subjects and correlated with diet variety.ConclusionBecause of the high prevalence of senile anorexia in the geriatric population and its impact on the nutritional status, further research should be prompted to establish an intervention. protocol allowing the early diagnosis of anorexia of aging, aimed at identifying its causes and at optimizing treatment of anorexic patients.

Nutritional Care in a Nursing Home in Italy

IntroductionMalnutrition is a clinical condition due to the imbalance among needs, intake and use of nutrients, leading to the increase of morbidity and mortality, and to the impairment of quality of life. Even in industrialized countries undernutrition is becoming an alarming phenomenon, especially involving elderly institutionalized subjects.A multicentric study called PIMAI (Project Iatrogenic MAlnutrition in Italy), was carried out in Italy over 2005. The aims of this study were to determine the prevalence of malnutrition in hospitals and in nursing care homes (NH), to assess the level of nutritional attention and to measure the perceived quality in food and nutritional care.This paper represents a preliminary analysis of data collected in a NH included in the PIMAI project.Materials and methodsA total of 100 subjects (29 males and 71 females, aged 80.2±10 years), were recruited from January to June 2005 at the Clinical Rehabilitation Institute “Villa delle Querce” in Nemi (Rome), among patients in the NH facility. All the participants underwent a multidimensional geriatric evaluation (considering nutritional, clinical, functional and cognitive parameters), and a survey on “perceived quality” of nutritional care.Results and discussionAccording to nutritional status defined by the Mini Nutritional Assessment®, data analysis showed a high prevalence of malnutrition (36%) especially related to advanced age, chewing, cognitive and functional impairments. Patients seemed to consider nutrition to be important for their health; on the other hand, they were not thoroughly satisfied with the quality of food. Particularly, it was observed scarce attention to nutritional status from medical and nursing staff.ConclusionsOur study confirms the need to pay greater attention to nutritional status in elderly institutionalized subjects. Medical and nursing teams need to be aware of the importance to perform an evaluation of nutritional status in these subset of subjects.

Bone is more susceptible to vitamin K deficiency than liver in the institutionalized elderly.

In Japan, γ-carboxylation of blood coagulation factors is the basis for determining adequate intake (AI) for vitamin K in Dietary Reference Intakes (DRIs) issued in 2010. Recently, vitamin K is also known to be essential for preventing fracture. In this study, relative susceptibility of liver and bone to vitamin K deficiency was studied. Thirty-seven elderly institutionalized subjects were evaluated for vitamin K status by measuring serum PIVKA (protein induced by vitamin K absence) -II and ucOC (undercarboxylated osteocalcin) levels, as sensitive markers for hepatic and skeletal vitamin K deficiency, respectively. Serum PIVKA-II and ucOC levels, with their cut-off values in the parentheses, were 20.2±8.9 mAUmL (28 mAU/mL) and 4.7±3.0 ng/mL (4.5 ng/mL), respectively. Median vitamin K intake was approximately 200 μg/day, which is more than 3 times higher than the current Japanese AI. Vitamin K intake was significantly correlated with serum PIVKA-II and ucOC/OC levels, but not with serum ucOC level. Although serum ucOC level is generally a good indicator for vitamin K status, multiple regression analysis revealed that elevated bone turnover marker significantly contributed to serum ucOC level. All subjects had vitamin K intake exceeding AI for vitamin K. Nevertheless, serum PIVKA-II and ucOC concentrations exceeded the cut-off value in 14% and 43% of subjects, respectively. The present findings suggest that vitamin K intake greater than the current AI is required for the skeletal health in the institutionalized elderly.

Impact of low cost strength training of dorsi‐ and plantar flexors on balance and functional mobility in institutionalized elderly people

To evaluate the effects of a low cost strength training program of the dorsi- and ankle plantar flexors on muscle strength, balance and functional mobility, in elderly institutionalized subjects; and to determine the association between strength gain and balance and/or functional mobility gain. Forty-eight volunteers were recruited and equally divided into two groups: intervention (aged 78.44 +/- 3.84 years) and control (aged 79.78 +/- 3.90 years). Both groups were tested at baseline and outcome for ankle dorsi- and plantar flexors muscle strength, balance and functional mobility. The intervention group participated in a 6-week program, three-sessions-per-week, of resisted ankle dorsi- and plantar flexion exercises using elastic bands. In the intervention group, maximal isometric dorsi- (from 8.4 +/- 0.45 to 12.6 +/- 0.95 kg; P <or= 0.001) and plantar flexors strength (from 13.0 +/- 0.85 to 17.5 +/- 0.93 kg; P <or= 0.001), balance (from 14.6 +/- 0.54 to 22.3 +/- 1.81 cm; P <or= 0.001) and functional mobility (from 18.4 +/- 0.51 to 11.0 +/- 0.66 s; P <or= 0.001) increased significantly after the 6-week strength training program. In the control group, no significant differences were detected. In the intervention group, a significant correlation between plantar flexor strength gain and balance gain was found (r = 0.826; P = 0.01). The proposed low cost strength training of dorsi- and plantar flexors improved strength, balance and functional mobility in institutionalized elderly people; moreover, the improvement in plantar flexor strength was associated with the improvement in balance.

Efectividad del uso combinado de varias escalas para medir el riesgo de caídas en ancianos

Objective To attempt to establish a relationship among combined actions of several assessment scales of risk of falls related to previous reports of involuntary falls by elderly institutionalized subjects in a day care service during the last year. Patients and methods Evaluations of day care center users were carried out with the Tinetti test, Timed up and Go, Functional Reach test and JH Dowton fall risk scale. In addition to age, the Barthel index of functional capacity and existence or not of falls during the last year was recorded. Results 38 people (25 women and 13 men) were studied. Mean age was 81.5 (SD: 5.4) and the Barthel index 84.1(17.2). Individual tests showed a similar proportion of falls among users at risk (approx. 55 %) and a greater difference among users without risks. In an isolated way, the greatest predictive effectiveness on falls followed the next sequence: Tinetti, JH Dowton, Timed Up and Go and Functional Reach. Nevertheless, when the four trials are combined, it can be observed that 63.6% of the elderly have had 3 or 4 positive trials have suffered at least one fall during the last year, while this percentage is reduced to 25 % among those with 2 or less positives on the risk assessment scales. Conclusions The combined use of the four assessment scales used in this study shows better sensitivity to the risk of fall than evaluation with individual use of the above-mentioned tests.

A força de preensão manual é boa preditora do desempenho funcional de idosos frágeis: um estudo correlacional múltiplo

A força de preensão manual (FPM) associa-se com a funcionalidade de idosos, mas há dúvidas sobre o valor dessa relação em todas as situações. O estudo observou a correlação entre FPM de idosos residentes em instituições de cuidados permanentes (asilos) e o desempenho funcional (DF) em tarefas específicas e inespecíficas para as mãos. Participaram 12 homens (70±6 anos; 64±9 kg; 160±10 cm) e sete mulheres (77±11 anos; 49±10 kg; 147±10 cm). A FPM foi medida com dinamômetro hidráulico. As tarefas motoras propostas foram: caminhar 10 m na velocidade máxima (C10), timed up &amp; go test (TUGT), colocar e retirar chave de fechadura (TCCF) e tirar e recolocar lâmpada em um bocal (TCLB). O teste de Wilcoxon revelou que os homens apresentaram melhores desempenhos que as mulheres em todos as medidas, exceto IMC, TCCF e TCLB (p&lt;0,05). Os coeficientes de Spearman revelaram que três testes apresentaram correlações significativas com a FPM: TRLB (r = -0,54; p = 0,018); TUGT (r = -0,67; p = 0,002) e C10 (r = -0,69; p = 0,001). A correlação múltipla entre a FPM e o conjunto dos testes revelou-se igualmente significativa (R-múltiplo = 0,66; p&lt;0,04). Conclui-se que a FPM pode ser uma boa preditora do desempenho em tarefas motoras em idosos frágeis, investindo-se de potencial para apreciação da funcionalidade como um todo, enquanto variável de exposição epidemiológica.

Relationship between Dental Occlusion and Falls among the Elderly with Dementia

Purpose: Multifactorial interventions to prevent falls are relatively less effective in the elderly with dementia. We hypothesize that the primitive posture reflex associated with dental occlusion may play an important role in preventing falls in elderly persons with dementia. To demonstrate this, we compared the incidence of falls in individuals with and without dental occlusion.Methods: This study was conducted at a special geriatric hospital for patients with severe dementia in Hiroshima, Japan. One hundred and forty-six ambulatory institutionalized elderly subjects (42 male and 104 female; mean age, 82.2 y) were divided into three groups on the basis of oral examinations: Group A, premolar and molar occlusion was maintained by natural dentition; Group B, occlusion was maintained by partial or full denture(s); and Group C, occlusion was not maintained by either natural or prosthetic teeth. Each subject was classified into either the "High Falls" (history of two or more falls during the previous one year) or "Low Falls" (history of one or no fall during the previous one year) category. In addition, a small pilot study was conducted to investigate the prevalence of falls in edentulous individuals within one year following denture delivery.Results: During the 1-year investigation period, 41 of the 146 subjects had recurrent falls and the dental occlusion status was found to be significantly different between the "High Falls" group and the "Low Falls" group (P<0.0001). In the "High Falls" group, 10 subjects had dentures; of these, three patients were excluded because of a comatose condition or death from old age, and the remaining 7 patients experienced fewer falls during the one-year follow-up.Conclusion: These findings suggest that dental occlusion with either natural or prosthetic teeth may play an important role in maintaining the postural reflex and preventing falls in the elderly with dementia.

Low-Dose Vitamin D Prevents Muscular Atrophy and Reduces Falls and Hip Fractures in Women after Stroke: A Randomized Controlled Trial

Vitamin D supplementation is suggested to reduce the risk of falls among ambulatory or institutionalized elderly subjects. The present study was undertaken to address the reduced risk of falls and hip fractures in patients with long-standing stroke by vitamin D supplementation.Ninety-six elderly women with poststroke hemiplegia were followed for two years. Patients were randomly assigned to one of the two groups, and 48 patients received 1,000 IU ergocalciferol daily, and the remaining 48 received placebo. The number of falls per person and incidence of hip fractures were compared between the two groups. Strength and tissue ATPase of skeletal muscles on the nonparetic side were assessed before and after the study.At baseline, serum 25-hydroxyvitamin D levels were in the deficient range (<10 ng/ml) in all patients; and vitamin D treatment enhanced serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels. Vitamin D treatment accounted for a 59% reduction in falls (95% CI, 28-81%; p = 0.003). There were increases in the relative number and size of type II muscle fibers and improved muscle strength in the vitamin D-treated group. Hip fractures occurred in 4 of 48 placebo group and 0 in 48 vitamin D2 group during the 2-year study period (log-rank, p = 0.049).Vitamin D may increase muscle strength by improving atrophy of type II muscle fibers, which may lead to decreased falls and hip fractures.

Effect of melatonin-rich night-time milk on sleep and activity in elderly institutionalized subjects

Melatonin production decreases with advancing age, leading to insomnia and changes in circadian rhythmicity. Administration of melatonin in variable doses resulting in supraphysiological or physiological night-time blood levels of melatonin has been shown to improve sleep quality in the elderly. To study the effect of low doses of melatonin, which do not affect daytime blood melatonin concentrations, night-time milk containing 10–40 ng/l melatonin was used as a drink with meals. The effect of about 0.5 l night-time milk daily on sleep quality and circadian activity was studied in elderly institutionalized subjects in two long-term double-blind, placebo-controlled, crossover studies. Night-time milk was given for 8 weeks and normal day-time milk for 8 weeks with a 1-week washout period in between. In the first study, which was performed during spring with sleep quality evaluated subjectively by specially trained nurses, 70 demented patients showed only a seasonal effect on their sleep quality. In the second study performed around the winter solstice, 81 fairly healthy subjects living in rest-homes were divided into three groups, two for the crossover study as in the first investigation with a third group consuming only normal daytime milk as a control group to evaluate the effect of season. Caregivers graded the sleep quality and activity that was monitored separately for the morning before noon and for the evening after noon. In the second study, the effect of season was recognizable in the scores for sleep quality, which increased in all groups after the winter solstice. However, there were no changes in activity in the control group or in the group that consumed night-time milk during the first period of the crossover study, whereas both morning and evening activity increased significantly in the group that consumed night-time milk during the later period. Even ultra-low doses of melatonin may benefit the elderly by increasing their daytime activity.

Prevalencia de hipovitaminosis D en una población anciana institucionalizada. Valoración del tratamiento sustitutivo

Osteoporosis in the elderly is a common and severe disease, vitamin D deficiency being an important causative factor. Hypovitaminosis D is frequent in old people, particularly those living in nursing homes. We performed a cross-sectional study of 100 randomly recruited elderly institutionalized subjects. The prevalence of hypovitaminosis D and its possible repercussion on the phosphocalcium metabolism were assessed. The degree of sun exposure and the existence of co-morbidity were also recorded. Individuals with hypovitaminosis D were included in a longitudinal study (6 months' duration) aimed at assess the efficacy of treatment with calcium and two different therapeutic regimens with calcidiol (16,000 IU/week or 16,000 IU every 3 weeks). 87% of individuals had hypovitaminosis D; 21.8% of them had secondary hyperparathyroidism. The study population had a low degree of sun exposure and a high level of co-morbidity. The two doses of calcidiol led to a normalization of 25-OHD3 levels, increased calciuria and compensated secondary hyperparathyroidism, yet higher 25-OHD3 levels were achieved with the weekly therapeutic scheme. Hypovitaminosis D prevalence appears to be very high In the elderly institutionalized population. Calcium and calcidiol supplementation normalized 25-OHD3, improved calcium absorption and compensated secondary hyperparathyroidism. Calcium and vitamin D supplementation should be employed routinely in the elderly institutionalized population.

ASYMPTOMATIC BACTERIURIA IN THE ELDERLY

Asymptomatic bacteriuria is frequent in elderly, populations. The major contributing factors are selected physiologic aging changes and comorbid illnesses, which occur with increased frequency in these populations. There is little short-term or long-term adverse outcomes attributable to this high prevalence and incidence of asymptomatic bacteriuria and no evidence for an impact on survival. A number of important questions relating to this problem have yet to be resolved. First, further studies in the noninstitutionalized population are needed to characterize the incidence of asymptomatic infection and its relationship to symptomatic infection. In the institutionalized population, studies to refine the clinical diagnosis of symptomatic urinary infection occurring in a population with such a high prevalence of asymptomatic bacteriuria are needed. In addition, further assessment of the impact of the reservoir of asymptomatic bacteriuria in elderly institutionalized subjects as a contributor to the problem of antimicrobial resistance in the institutionalized population should be a priority.