Mortality In Elderly Subjects Research Articles

#2705 Hypertension as a risk factor for mortality and the development of chronic kidney disease after an episode of acute kidney injury in the elderly

Abstract Background and Aims Acute kidney injury (AKI) is a real public health problem due to its severity and its consequences in the short, medium and long term. Hypertension is a very common disease in our country. The association between hypertension and acute and chronic renal failure is not well studied in our country, and given the lack of data, we proposed to carry out this study and even more so the elderly, who are fragile subjects with multiple illnesses. Method We undergone a retrospective study which was carried out in the nephrology department of Fattouma Bourguiba hospital in Monastir. We included patients aged > 65 years, who had an AKI with full recovery who had been hospitalized between January 2002 and December 2015. Our study aimed to assess the impact of hypertension on mortality and the development of chronic kidney disease (CKD) after an episode of AKI. Results Our population was made up of 67 men and 60 women, 30.1% had multiple comorbidities. Pre renal Aki represented the predominant mechanism of AKI which was retained in our study with a rate of 40% and dehydration as the main aetiology in 70 patients. In the short term, 15 patients had progressed to CKD. The mean overall survival in our study was 159 months with a high risk of mortality in elderly (patients aged >65 years), who had multiple comorbidities, hypertensive, diabetics, with vascular disease, Charlson Comorbidity index >5, who presented with hyperkalaemia >5.5 and pre renal mechanism of the AKI episode. In the medium term and the long term, 4 and 2 patients developed CKD respectively. Hypertension was a factor in poor prognosis and mortality in elderly subjects after an episode of acute kidney injury (p=0.005). Conclusion Hypertension is a real public health problem impacting the short, medium and long term prognosis of patients who have had an episode of AKI with full recovery.

Higher neutrophil to lymphocyte ratio is associated with renal dysfunction and cardiac adverse remodeling in elderly with metabolic syndrome.

BackgroundPrevious studies have shown that metabolic syndrome (MetS) is associated with increased systemic inflammation and cardiac mortality in elderly subjects. However, information on the association of inflammation markers with cardiac adverse remodeling is limited in the elderly with MetS. Therefore, we investigated whether the inflammatory marker neutrophil/lymphocyte ratio (NLR) is associated with the cardiac adverse remodeling in Chinese elderly with MetS.MethodsA total of 1,087 hospitalized Chinese elderly (aged ≥ 65 years) with MetS were collected retrospectively. The cross-sectional data of echocardiography and clinical parameters were compared among quartile NLR groups.ResultsIn the elderly with MetS, higher quartile NLR (≥3.83) was found to be associated with male gender, older age, lower estimated glomerular filtration rate (eGFR), and cardiac left ventricular (LV) dilatation (all p <0.05).ConclusionHigher NLR is associated with male gender, older age, renal dysfunction, and cardiac adverse remodeling in Chinese elderly with MetS.

Screen-detected atrial fibrillation predicts mortality in elderly subjects.

AimsCurrent guidelines recommend opportunistic screening for atrial fibrillation (AF) but the prognosis of individuals is unclear. The aim of this investigation is to determine prevalence and 1-year outcome of individuals with screen-detected AF.Methods and resultsWe performed a prospective, pharmacy-based single time point AF screening study in 7107 elderly citizens (≥65 years) using a hand-held, single-lead electrocardiogram (ECG) device. Prevalence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Mean age of participants was 74 ± 5.9 years, with 58% (N = 4130) of female sex. Automated heart rhythm analyses identified AF in 432 (6.1%) participants, with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalized for CV causes. Total mortality was 2.3% in participants with a screen-detected AF and 0.8% in subjects with a normal ECG [hazard ratio (HR) 2.94; 95% confidence interval (CI) 1.49–5.78; P = 0.002]; hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI 1.52–2.84; P < 0.001). Compared with subjects without a history of AF at baseline and a normal ECG, participants with newly diagnosed or known AF had a significantly higher mortality risk with HRs of 2.64 (95% CI 1.05–6.66; P = 0.04) and 2.68 (95% CI 1.44–4.97; P = 0.002), respectively. After multivariable adjustment, screen-detected AF remained a significant predictor of death or hospitalization for CV causes.ConclusionPharmacy-based, automated AF screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next year.

Asociación entre albuminuria y mortalidad en adultos mayores con pie diabético en el servicio de clínica de día en el Centro Médico Naval (2010-2015)

Objetivo: determinar la relación entre albuminuria y mortalidad en adultos mayores con pie diabético atendidos en la Clínica de Día del Servicio de Geriatría del Centro Médico Naval del Perú “Cirujano Mayor Santiago Távara” en el periodo 2010-2015. Materiales y Métodos: estudio cuantitativo, observacional, analítico, cohorte retrospectiva. Se incluyeron datos de 89 pacientes adultos mayores, que cumplieron los criterios de selección. Se realizó un análisis descriptivo incluyendo las principales variables como fallecimiento durante el estudio, comorbilidades y variables sociodemográficas. Posteriormente, se hizo un análisis bivariado en base a supervivencia al final del estudio donde se analizaron todas las covariables en base a la variable principal del estudio (mortalidad). Resultados: la edad promedio fue de 79,3 ± 7,2 años con predominancia del sexo masculino (58,4%), encontramos que 52 participantes (58,4%) tenían antecedentes de albuminuria y que el 7,9% de la población falleció durante el estudio, de los cuales el 100% presentaba albuminuria. Finalmente, al igual que en el caso de albuminuria, todos los pacientes con antecedente de amputación por pie diabético fallecieron durante el seguimiento. Conclusión: se encontró relación significativa entre la presencia de albuminuria y mortalidad en los adultos mayores con pie diabético incluidos en el estudio.

P6543Screen-detected atrial fibrillation in a one-minute single-lead ECG predicts mortality in elderly subjects

Abstract Background Atrial fibrillation (AF) is the most common arrhythmia associated with increased morbidity and mortality. Current guidelines recommend opportunistic screening for AF but the prognostic impact of screen-detected AF is unclear. Methods We performed a 4-week, prospective, pharmacy-based AF screening study in 7107 elderly citizens (≥65 years) using a hand-held, automated, one-minute single-lead ECG (SL-ECG) recording device. Prevalence and incidence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Results Automated SL-ECG analyses revealed heartbeat irregularities suspicious of AF in 432 (6.1%) participants with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalised for CV causes. Total mortality was 2.3% in participants with a SL-ECG suspicious of AF and 0.8% in subjects with a normal SL-ECG (HR 2.93; 95% CI: 1.49, 5.77; P=0.002, Figure 1A); hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI: 1.52, 2.84; P&lt;0.001, Figure 1B). Compared with subjects without a history of AF at baseline and a normal SL-ECG, participants with newly diagnosed AF or known AF had a significantly higher mortality risk with HRs of 2.63 (95% CI: 1.04, 6.63; p=0.04) and 2.68 (95% CI: 1.45, 4.98; p=0.002), respectively. After multivariable adjustment, a SL-ECG recording suspicious of AF remained a significant predictor of death or hospitalization for CV causes. Figure 1 Conclusions Pharmacy-based, automated, one-minute SL-ECG screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next one year. Acknowledgement/Funding Unrestricted research grant by Pfizer/BMS. Matthias Zink received a DGK electrophysiology grant (funded by St. Jude Medical).

Mortality in Critically Ill Elderly Individuals Receiving Mechanical Ventilation.

Previous studies that evaluated mortality in elderly subjects who received mechanical ventilation had conflicting results. The aim of this systematic review was to evaluate the effects of age on mortality. A number of medical literature databases and the references listed (from 1974 to May 2015) were searched for studies that compared 2 different age groups. The primary outcome was mortality in subjects ages ≥ 65 y. The severity scores, ICU and hospital lengths of stay, and the presence of ventilator-associated pneumonia were secondary outcomes. Finally, mortality in the subjects with ARDS and of cutoff ages 70 and 80 y was assessed by subgroup analysis. Evidence quality was assessed by the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria score. Of the 5,182 articles identified, 21 were included. Subjects ages ≥ 65 y had higher mortalities (odds ratio [OR] 1.80, 95% CI 1.56-2.08; I2 = 71%). APACHE (Acute Physiology and Chronic Health Evaluation) II revealed intergroup differences (mean difference 3.07, 95% CI 2.52-3.61; I2 = 0%), whereas neither the ICU nor hospital length of stay (mean difference 1.27, 95% CI -0.82 to 3.36, I2 = 82%, and mean difference 1.29, 95% CI -0.71 to 3.29, I2 = 0%, respectively) nor the groups in the 2 studies that assessed ventilator-associated pneumonia exhibited any difference. Subgroup analysis revealed a higher mortality in the older subjects, in the subjects with ARDS (OR 1.76, 95% CI 1.30-2.36; I2 = 0%) and in the subjects ages 70 and 80 y (OR 1.78, 95% CI 1.51-2.10, I2 = 71%; and OR 1.96, 95% CI 1.81-2.13, I2 = 0%, respectively). The quality of associated evidence was low or very low. Although low-quality evidence was available, we conclude that age is associated with a greater mortality in critical subjects who were receiving mechanical ventilation.

Utility of predictive tools for risk stratification of elderly individuals with all-cause acute respiratory infection.

A number of scoring tools have been developed to predict illness severity and patient outcome for proven pneumonia, however, less is known about the utility of clinical prediction scores for all-cause acute respiratory infection (ARI), especially in elderly subjects who are at increased risk of poor outcomes. We retrospectively analyzed risk factors and outcomes of individuals ≥ 60years of age presenting to the emergency department with a clinical diagnosis of ARI. Of 276 individuals in the study, 40 had proven viral infection and 52 proven bacterial infection, but 184 patients with clinically adjudicated ARI (67%) remained without a proven microbial etiology despite extensive clinical (and expanded research) workup. Patients who were older, had multiple comorbidities, or who had proven bacterial infection were more likely to require hospital and ICU admission. We identified a novel model based on 11 demographic and clinical variables that were significant risk factors for ICU admission or mortality in elderly subjects with all-cause ARI. As comparators, a modified PORT score was found to correlate more closely with all-cause ARI severity than a modified CURB-65 score (r, 0.54, 0.39). Interestingly, modified Jackson symptom scores were found to inversely correlate with severity (r, - 0.34) but show potential for differentiating viral and bacterial etiologies. Modified PORT, CURB-65, Jackson symptom scores, and a novel ARI scoring tool presented herein all offer predictive ability for all-cause ARI in elderly subjects. Such broadly applicable scoring metrics have the potential to assist in treatment and triage decisions at the point of care.

Body Mass Index and Mortality in Elderly Subjects from the Moli-Sani Study: A Possible Mediation by Low-Grade Inflammation?

ABSTRACTThe association between obesity and mortality in the elderly remains controversial. To test the association between BMI and mortality, with the hypothesis of a mediation by low-grade inflammation (LGI), a prospective study design (median follow-up 7.8 years) was used on a sample of 4,970 elderly subjects (age ≥ 65 years) from the Moli-sani Study cohort. The association between BMI categories and overall or cause-specific mortality (hazard ratio, HR) was calculated by multivariable Cox regression. Dose-response relationship was tested using restricted cubic splines. Interaction between BMI and LGI, assessed through high-sensitivity C-reactive protein (hs-CRP) and INFLA-score, was also tested. In comparison with normal-weight, overweight was significantly associated with a 20% (adjusted HR = 0.80; 95%CI 0.67–0.95) reduced risk of total mortality, while severe obesity (BMI > 40) with an increased risk (HR = 1.81; 95%CI 1.13–2.93). Cubic spline curves showed a U-shaped relationship between BMI and total mortality (p value for nonlinear relationship = 0.001). Similar results were found for cardio-cerebrovascular and other causes mortality. Hs-CRP and INFLA-score were associated with an increased risk of total mortality in adjusted analyses. Mediation analysis did not show any effect of LGI on the association between BMI and mortality. However, after stratification for LGI under or below the population median, greater LGI increased the risk of mortality in obese elderly more than expected (p for interaction = 0.04). A U-shaped association between BMI and mortality was observed in Italian elderly subjects. While the association was independent of LGI levels, there was a significant interaction between BMI and LGI in increasing mortality risk in obese elderly individuals.

Disability, and not diabetes, is a strong predictor of mortality in oldest old patients hospitalized with pneumonia

BackgroundPneumonia causes more deaths than any other infectious disease, especially in older patients with multiple chronic diseases. Recent studies identified a low functional status as prognostic factor for mortality in elderly patients with pneumonia while contrasting data are available about the role of diabetes. The aim of this study was to evaluate the in-hospital, 3-month and 1-year mortality in elderly subjects affected by pneumonia enrolled in the RePoSi register. MethodsWe retrospectively analyzed the data collected on hospitalized elderly patients in the frame of the REPOSI project. We analyzed the socio-demographic, laboratory and clinical characteristics of subjects with pneumonia. Multivariate logistic analysis was used to explore the relationship between variables and mortality. ResultsAmong 4714 patients 284 had pneumonia. 52.8% were males and the mean age was 80 years old. 19.8% of these patients had a Barthel Index ≤40 (p ˂ 0.0001), as well as 43.2% had a short blessed test ≥10 (p ˂ 0.0117). In these subjects a significant CIRS for the evaluation of severity and comorbidity indexes (p ˂ 0.0001) were present. Although a higher fasting glucose level was identified in people with pneumonia, in the multivariate logistic analysis diabetes was not independently associated with in-hospital, 3-month and 1-year mortality, whereas patients with lower Barthel Index had a higher mortality risk (odds ratio being 9.45, 6.84, 19.55 in hospital, at 3 and 12 months). ConclusionElderly hospitalized patients affected by pneumonia with a clinically significant disability had a higher mortality risk while diabetes does not represent an important determinant of short and long-term outcome.

Is functional mobility an independent mortality risk factor in subjects with dementia?

ObjectiveTo investigate whether functional mobility is a predictor of 12-month mortality in elderly subjects with dementia. Study designProspective multicentre study performed in nine French university hospitals. Patients aged 75 years or more and hospitalised in medical wards via the emergency department were eligible. Those with a diagnosis of dementia were considered in the analyses. Main outcome measuresPatients’ characteristics obtained through comprehensive geriatric assessment performed during the first week of hospitalisation. Functional mobility was assessed using the timed “Up & Go” test. The main outcome was time to death within the 12 months of follow-up. Bivariable relationships between each risk factor and mortality were assessed using a Cox regression model with one explanatory variable. For multivariable analysis, the Cox regression model was used in a stepwise method after examining potential confounders and interactions. ResultsIn all, 589 patients had a diagnosis of dementia, and were considered in the present analyses. Their mean age was 86±6years and most (69%) were female. The prevalence of functional mobility disorders was 86%. After 12 months, 232 (39%) had died. After adjustment for potential confounders, functional mobility was associated with a significantly higher risk of 12-month mortality (HR=1.66; 95% CI=1.02–2.71; p=0.04). ConclusionsImpaired functional mobility as assessed by the timed Up & Go test identifies subjects with dementia at risk of unfavourable outcome.

Chronic obstructive pulmonary disease and long-term mortality in elderly subjects with chronic heart failure.

Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are associated with high rates of mortality in elderly subjects. Concurrent CHF and COPD frequently occur, especially in with advancing age. This study examines long-term mortality in community-dwelling elderly subjects affected by CHF alone, COPD alone, and coexistent CHF and COPD. The study evaluated 12-years mortality in 1288 subjects stratified for the presence or absence of CHF or COPD alone, and for coexistence of CHF and COPD. Mortality, at 12year follow-up, was 46.7% overall, 68.6% in the presence of CHF alone (p < 0.001), 56.9% in the presence of COPD alone (p < 0.01); mortality was 86.2% where CHF and COPD coexisted (p < 0.001) and was significantly higher than in CHF or COPD alone (p < 0.05). Multivariate analysis indicates that CHF (Hazard risk = 1.67, 95% confidence interval 1.15-3.27, p < 0.031) and COPD (Hazard risk = 1.27, 95% confidence interval = 1.08-1.85, p < 0.042) were predictive of long-term mortality. When CHF and COPD simultaneously occurred, the risk dramatically increased up to 3.73 (95% confidence interval = 1.19-6.93, p < 0.001). Long-term follow-up showed higher mortality among elderly subjects affected by CHF or COPD. Simultaneous presence of CHF and COPD significantly increased the risk of death. Therefore, the presence of COPD in CHF patients should be considered a relevant factor in predicting high risk of mortality.

The Effect of Age on Characteristics and Mortality of Intracerebral Hemorrhage in the Oldest-Old

Background: Incidence of acute intracerebral hemorrhage (ICH) increases with age, but there is a lack of information about ICH characteristics in the oldest-old (age ≥85 years). In particular, there is a need for information about hematoma volume, which is included in most clinical scales for prediction of mortality in ICH patients. Many of these scales also assume that, independent of ICH characteristics, the oldest-old have a higher mortality than younger elderly patients (age 65-74 years). However, supporting evidence from cohort studies is limited. We investigated ICH characteristics of oldest-old subjects compared to young (<65 years), young-old (65-74 years) and old-old (75-84 years) subjects. We also investigated whether age is an independent mortality predictor in elderly (age ≥65 years) subjects with acute ICH. Methods: We retrospectively collected clinical and neuroimaging data of 383 subjects (age 34-104 years) with acute supratentorial primary ICH who were admitted to an Italian Stroke Unit (SU) between October 2007 and December 2014. Measured ICH characteristics included hematoma location, volume and intraventricular extension of hemorrhage on admission CT scan; admission Glasgow Coma Scale ≤8 and hematoma expansion (HE) measured on follow-up CT-scans obtained after 24 h. General linear models and logistic models were used to investigate the association of age with ICH characteristics. These models were adjusted for pre-admission characteristics, hematoma location and time from symptom onset to admission CT scan. Limited to elderly subjects, Cox models were used to investigate the association of age with in-SU and 1-year mortality: the model for in-SU mortality adjusted for pre-admission and ICH admission characteristics and the model for 1-year mortality additionally adjusted for functional status and disposition at SU discharge. Results: Independent of pre-admission characteristics, hematoma location and time from symptom onset to admission CT-scan, oldest-old subjects had the highest admission hematoma volume (p < 0.01). Age was unrelated to all other ICH characteristics including HE. In elderly patients, multivariable adjusted risk of in-SU and 1-year mortality did not vary across age categories. Conclusions: Oldest-old subjects with acute supratentorial ICH have higher admission hematoma volume than young and young-old subjects but do not differ for other ICH characteristics. When taking into account confounding from ICH characteristics, risk of in-SU and 1-year mortality in elderly subjects with acute supratentorial ICH does not differ across age categories. Our findings question use of age as an independent criterion for stratification of mortality risk in elderly subjects with acute ICH.

All-cause mortality risk in elderly individuals with disabilities: a retrospective observational study.

ObjectivesDisability is considered an important issue that affects the elderly population. This study aimed to explore the relationship between disability and all-cause mortality in US elderly individuals.DesignRetrospective and longitudinal designs.SettingData from the National Health and Nutrition Examination Survey (NHANES 1999–2002) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.ParticipantsA total of 1834 participants in the age range 60–84 years from NHANES 1999–2002.Main outcome measuresWe acquired five major domains of disability (activities of daily living (ADL), general physical activities (GPA), instrumental ADL (IADL), lower extremity mobility (LEM) and leisure and social activities (LSA)) through self-reporting. We applied an extended-model approach with Cox (proportional hazards) regression analysis to investigate the relationship between different features of disability and all-cause mortality risk in the study population.ResultsDuring a mean follow-up of 5.7 years, 77 deaths occurred. An increased risk of all-cause mortality was identified in elderly individuals with disability after adjustment for potential confounders (HR 2.23; 95% CI 1.29 to 3.85; p=0.004). Participants with more than one domain of disability were associated with a higher risk of mortality (ptrend=0.047). Adjusted HRs and 95% CIs for each domain of disability were 2.53 (1.49 to 4.31), 1.99 (0.93 to 4.29), 1.74 (0.72 to 4.16), 1.57 (0.76 to 3.27) and 1.52 (0.93 to 2.48) for LEM, LSA, ADL, IADL and GPA, respectively.ConclusionsThe results of this study support an increased association between disability and all-cause mortality in the elderly in the USA. Disability in LEM may be a good predictor of high risk of all-cause mortality in elderly subjects.

From inflammaging to healthy aging by dietary lifestyle choices: is epigenetics the key to personalized nutrition?

The progressively older population in developed countries is reflected in an increase in the number of people suffering from age-related chronic inflammatory diseases such as metabolic syndrome, diabetes, heart and lung diseases, cancer, osteoporosis, arthritis, and dementia. The heterogeneity in biological aging, chronological age, and aging-associated disorders in humans have been ascribed to different genetic and environmental factors (i.e., diet, pollution, stress) that are closely linked to socioeconomic factors. The common denominator of these factors is the inflammatory response. Chronic low-grade systemic inflammation during physiological aging and immunosenescence are intertwined in the pathogenesis of premature aging also defined as ‘inflammaging.’ The latter has been associated with frailty, morbidity, and mortality in elderly subjects. However, it is unknown to what extent inflammaging or longevity is controlled by epigenetic events in early life. Today, human diet is believed to have a major influence on both the development and prevention of age-related diseases. Most plant-derived dietary phytochemicals and macro- and micronutrients modulate oxidative stress and inflammatory signaling and regulate metabolic pathways and bioenergetics that can be translated into stable epigenetic patterns of gene expression. Therefore, diet interventions designed for healthy aging have become a hot topic in nutritional epigenomic research. Increasing evidence has revealed that complex interactions between food components and histone modifications, DNA methylation, non-coding RNA expression, and chromatin remodeling factors influence the inflammaging phenotype and as such may protect or predispose an individual to many age-related diseases. Remarkably, humans present a broad range of responses to similar dietary challenges due to both genetic and epigenetic modulations of the expression of target proteins and key genes involved in the metabolism and distribution of the dietary constituents. Here, we will summarize the epigenetic actions of dietary components, including phytochemicals, and macro- and micronutrients as well as metabolites, that can attenuate inflammaging. We will discuss the challenges facing personalized nutrition to translate highly variable interindividual epigenetic diet responses to potential individual health benefits/risks related to aging disease.

Dietary total antioxidant capacity and mortality in the PREDIMED study.

The aim of the present study was to assess the association between the dietary total antioxidant capacity, the dietary intake of different antioxidants and mortality in a Mediterranean population at high cardiovascular disease risk. A total of 7,447 subjects from the PREDIMED study (multicenter, parallel group, randomized controlled clinical trial), were analyzed treating data as an observational cohort. Different antioxidant vitamin intake and total dietary antioxidant capacity were calculated from a validated 137-item food frequency questionnaire at baseline and updated yearly. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were fitted to assess the relationship between dietary total antioxidant capacity and mortality. Dietary total antioxidant capacity was estimated using ferric-reducing antioxidant power assays. A total of 319 deaths were recorded after a median follow-up of 4.3 years. Subjects belonging to the upper quintile of antioxidant capacity were younger, ex-smokers, with high educational level, and more active and had higher alcohol intake. Multivariable-adjusted models revealed no statistically significant difference between total dietary antioxidant capacity and mortality (Q5 vs. Q1 ref HR 0.85; 95% CI 0.60-1.20) neither for the intake of all the vitamins studied. No statistically significant association was found between antioxidant capacity and total mortality in elderly subjects at high cardiovascular risk.

O4.07: Low SBP levels under combination anti-hypertensive therapy are associated with increased mortality in elderly subjects living in nursing homes. The PARTAGE study

O4.07: Low SBP levels under combination anti-hypertensive therapy are associated with increased mortality in elderly subjects living in nursing homes. The PARTAGE study

Long-term mortality in frail elderly subjects with osteoarthritis

Elderly subjects are characterized by a high prevalence of OA and clinical frailty. This study aimed to examine the predictive role of clinical frailty on long-term mortality in elderly subjects with and without OA. Mortality was evaluated after a 12-year follow-up in 698 subjects with and 590 subjects without OA recruited in 1992. Clinical frailty was assessed according to the Frailty Staging System and stratified in tertiles. After a 12-year follow-up, mortality was 42.2% in subjects without and 55.8% in subjects with OA (P = 0.256). With increasing frailty, mortality increased by 30.5% (P for trend < 0.001) in subjects without and by 45.6% in subjects with OA (P for trend < 0.001). Multivariate analysis showed that frailty [hazard ratio (HR) = 1.49 for each unit of increase, 95% CI 1.32, 1.94, P < 0.001) but not OA (HR = 1.28, 95% CI 0.987, 1.39, P = 0.412) was predictive of long-term mortality. Moreover, when Cox regression analysis was performed, frailty enhanced the risk of long-term mortality for each unit of increase by 32% (HR = 1.32, 95% CI 1.06, 1.65, P = 0.03) in the absence of OA and by 98% in the presence (HR = 1.98, 95% CI 1.63, 2.95, P < 0.01) of OA. Clinical frailty significantly predicts mortality in subjects without OA and even more in those with OA. Thus clinical frailty may be considered a new prognostic factor to identify subjects with OA at high risk of mortality.

The usefulness of anthropometric measures

Based on EWGSOP guidelines, muscle mass should be evaluated using the DEXA or bioelectrical impedance analysis (BIA) [1]. In our study, it was not possible to assess all participants using DEXA or BIA. Therefore, muscle mass was estimated using the measurement of the mid-arm muscle circumference (MAMC) [2]. Indeed, anthropometric measures are generally considered poor markers of muscle mass, and their role in the assessment of sarcopenia is debatable [3]. For example, Faisy et al. [4] suggested that BIA might be superior to MAMC in predicting malnutrition and negative outcomes among patients with chronic obstructive pulmonary disease and acute respiratory failure. However, as previously demonstrated, MAMC provides a simple measure of body composition. Moreover, muscle mass as assessed by MAMC was shown to be independently associated with mortality in elderly subjects [5, 6]. MAMC estimates performed by expert personnel have shown excellent reliability [7]. Mid-arm muscle circumference estimation could be a practical and useful tool for the assessment of nutritional status and sarcopenia in older adults. In fact, it is simple, quick, inexpensive, noninvasive, and easy to use, valuable especially in those settings where DEXA and BIA are not available (i.e., nursing homes and long-term care settings). It is essential to recognize the relevance of the clinical assessment of sarcopenia and to reach a large and consolidated consensus on the recommended tools to measure body composition when DEXA and BIA are not accessible. Anthropometric measures (MAMC and/or calf circumference) could represent a simple and reliable instrument for the clinical assessment of nutritional status and sarcopenia.

Comment on: Singer et al. Adiponectin and All-Cause Mortality in Elderly People With Type 2 Diabetes. Diabetes Care 2012;35:1858–1863

The article in Diabetes Care by Singer et al. (1) elegantly showed that higher adiponectin was independently associated with increased all-cause mortality in elderly subjects with type 2 diabetes mellitus (T2DM). This was in contrary to the authors’ hypothesis that higher adiponectin level would be associated with lower all-cause mortality given the anti-inflammation, antiatherogenic, and insulin-sensitizing properties of adiponectin. The authors alluded to the important association between elevated adiponectin and chronic kidney disease, which could have contributed to increased mortality. However, they conceded that …

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

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