Aging Clinical and Experimental Research

Lymphopenia is a common finding in elderly patients and its relevance is unknown. To evaluate the clinical prognostic value of lymphopenia on the admission of elderly hospitalized patients. From 2012 to 2013, all consecutive patients >75 hospitalized because of medical conditions were prospectively included in the study. Sociodemographic, clinical and laboratory data were collected. Lymphopenia was considered by a plasmatic lymphocyte count of <1100 × 109/l. Hospital length of stay, in-hospital mortality and mortality after a 1-year follow-up were assessed. The total sample consisted of 180 patients, 90 of whom were females (50 %). Mean age was 83.8 years (SD 5.4). Lymphopenia was present in 45 patients (25 %) upon admission. When compared, those patients with lymphopenia showed a longer hospital stay (19.9 vs. 15.7 days; p 0.002) and higher in-hospital mortality (26.7 vs 7.7 %; p 0.001). The odds ratio for in-hospital mortality in patients with lymphopenia was 3.9 (p 0.03) and the hazard ratio for 1-year mortality 1.9 (p 0.038). Both groups of elderly patients, with and without lymphopenia on admission, showed no differences related to sociodemographic, clinical, or other laboratory data. The study showed no difference in rate of infections between the groups. A quarter of our elderly hospitalized patients had lymphopenia on admission. Furthermore, lymphopenia seemed to constitute as a predictor for bad outcome in terms of a longer hospital stay, in-hospital mortality and 1-year mortality after discharge.

Epidemiological studies have shown that circulating sex hormone-binding globulin (SHBG) levels are lower in metabolic syndrome (MetS) patients than in non-MetS individuals. In this study, we investigated the relationship of polymorphisms in the SHBG gene with the serum SHBG levels and MetS in Han Chinese. We performed a cross-sectional study of 316 subjects who were recruited from a health checkup population at Zhongshan Hospital, Fudan University. Anthropometric measurements, blood pressure, fasting plasma glucose, lipid levels, total testosterone, and SHBG levels were obtained in addition to the seven SHBG single-nucleotide polymorphisms (SNPs). The variant allele (AG or AA) carriers in rs6259, compared to the wild-type allele carriers (GG), have a lower risk for MetS [OR 0.56, 95 % confidence interval (CI) 0.33–0.96] and higher serum SHBG and TT levels (P = 0.016, 0.004). CT or TT allele carriers in rs3760213, compared to CC allele carriers, also have a lower risk for MetS (OR 0.59, 95 % CI 0.34–1.00) and significantly higher SHBG and TT levels (P = 0.029, 0.009). Carriers having both of the variant alleles had the lowest risk of MetS (OR 0.51, 95 % CI 0.275–0.950) and the highest SHBG levels. The risk of MetS rose with the decrease in serum SHBG levels for rs6259 and rs376021 carriers. rs6259 and rs3760213 SNPs are associated with the risk of MetS and lower serum SHBG level in Chinese Han males.

Community Occupational Therapy in Dementia in Italy (COTID−IT) is a feasible and effective treatment that aims improving the quality of life and well−being of people with dementia and caregivers. The implementation of the program in the national context has not been studied yet. The objective of this study is to identify barriers and facilitators in the Italian implementation of the program. We designed a quantitative cross-sectional survey. A questionnaire was developed to collect descriptive data regarding the respondents, the perceived barriers and facilitators regarding the application of COTiD and possible actions to promote the implementation process. The questionnaire was sent to all 90 Italian OTs trained in the use of COTiD−IT from 2013 to 2020. 50 people responded (61%). Barriers to the implementation of the COTID−IT included lack of knowledge about Occupational Therapy and the COTID−IT program by other health professionals. In addition, the scarcity of economic funds invested in home rehabilitation is experienced as another significant barrier. Facilitators were found to be the presence of an interprofessional team interested in the COTID−IT program and occupational therapy and the fact that COTID−IT is supported by scientific evidence. The creation of national and regional inter professional education and support groups, the availability of online resources are seen as opportunities to better implement the COTID−IT program. Implementation of psychosocial interventions is complex. OTs in Italy should be increasingly included within health policies and care programs of people with dementia to promote the use of COTID−IT. Further studies are needed to detail the policy and methodological actions that OTs should take in the future to disseminate and consolidate this intervention.

Long-term glucocorticoid (GC) therapy is frequently indicated to treat autoimmune and chronic inflammatory diseases in daily clinical practice. Two of the most devastating untoward effects are bone loss and fractures. Doses as low as 2.5 mg of prednisone for more than 3 months can impair bone integrity. Population at risk is defined based on the dose and duration of GC therapy and should be stratified according to FRAX (Fracture Risk Assessment Tool), major osteoporotic fracture, prior fractures, and bone mineral density values (BMD). General measures include to prescribe the lowest dose of GC to control the underlying disease for the shortest possible time, maintain adequate vitamin D levels and calcium intake, maintain mobility, and prescribe a bone acting agent in patients at high risk of fracture. These agents include oral and intravenous bisphosphonates, denosumab, and teriparatide.

In this study, we aimed to determine influenza, pneumococcal, and herpes zoster (HZ) vaccination status, among patients aged 65 or above, and to determine their level of knowledge about these vaccines and the factors affecting the vaccination rates. This was a cross-sectional descriptive study conducted through face-to-face interviews with patients who were admitted to Gemerek State Hospital Family Medicine Clinics. The questionnaire prepared by the researchers following the literature review was applied by researchers. The study included a total of 326 participants with a mean age of 71.59 ± 6.96 (min: 65, max: 96). Influenza, pneumococcal, and HZ vaccination rates were 21.8% (n = 71), 4.3% (n = 14), and 1.8% (n = 6), respectively. The odds ratio (OR) in the patients for whom influenza vaccination was recommended was calculated to be 15.25 compared to those for whom influenza vaccination was not recommended (95% CI 8.73–26.64, p < 0.001), OR in the patients for whom pneumococcal vaccination was recommended was calculated to be 257.5 compared to those for whom pneumococcal vaccination was not recommended (95% CI 50.75–1306.44, p < 0.001), and OR in the patients for whom HZ vaccination was recommended was calculated to be 126.0 compared to those for whom HZ vaccination was not recommended (95% CI 18.59–853.92, p < 0.001). The main findings of the present study are that the vaccination rate for all three vaccines is low, vaccination recommendation by a physician significantly increases vaccination rates, and the vaccination rate of patients, who have been informed by the physician about the vaccine, is higher.

The aim of this study was to compare the efficacy of four analgesia techniques on postoperative pain after per-trochanteric femur fracture. A retrospective cohort study was conducted on 131 consecutive patients older than 75 years enrolled in an 18-month period and who underwent per-trochanteric fracture repair under spinal analgesia. Patients received postoperative analgesia from: G1 (n = 36), intravenous analgesia on demand only; G2 (n = 28) administration of acetaminophen at fixed hours; G3 (n = 50) continuous morphine infusion; G4 (n = 17), preoperative echo-graphic guided femoral nerve block. Continuous opioid infusion failed to prevent the onset of pain at the end of the effects of subarachnoid anesthesia (rescue dose of analgesic in 48 % of patients in G3 vs. 22 % in G2 in the first day; p < 0.05). The greater effectiveness was achieved by preventing the onset of pain with drugs administered at time intervals (rescue dose of analgesic in 48 % of patients in G3, 58 % in G1 and 48 % in G4 vs. 22 % in G2 in the first day and rescue dose of analgesic in 32 % of patients in G3, 67 % in G1 and 76 % in G4 vs. 18 % in G2 in the second day; p < 0.05). Our study does not confirm the effectiveness of a single shot femoral nerve block on postoperative pain in per-trochanteric femur fracture (PAIN VAS score > 3 at t1 in 23 % of patients in G1 and 19 % in G4 vs. 10 % in G2 and G3; p < 0.05).

Aging might affect the effectiveness of the sole supplementation of calcium and vitamin D in post-menopausal women, due to the development of vitamin D resistance in the gut, which limits calcium absorption. Thus, we wanted to test the efficacy of a mixture of calcium (500 mg), 25-hydroxyvitamin D [25(OH)D; 300 IU], inulin (3 g) and soy isoflavones (40 mg), to improve calcium absorption in this type of population. It is a retrospective study on otherwise healthy post-menopausal women. The following parameters were evaluated at baseline and after 3 months of supplementation: daily calciuria as an indirect marker of calcium absorption, serum 25(OH)D, parathormone, insulin-like growth factor 1 (IGF1) as a marker of bone anabolism, collagen telopeptide and osteocalcin as markers of bone resorption and bone turnover, respectively. Twenty-eight women (median age 67 years) were included in the analysis. The supplementation markedly increased daily calciuria (+60 %; p = 0.00009), while reducing parathormone levels (−18 %; p = 0.02) and leaving 25(OH)D unaltered. An increase in IGF1 (+16 %; p = 0.01) and a reduction in collagen telopeptide (−17 %; p = 0.04) were observed, too, as well as a modest trend towards osteocalcin reduction, although not significant. These results suggest that the considered mixture improved intestinal calcium absorption and bone metabolism in post-menopausal women. Since the amount of supplemented calcium was relatively low and 25(OH)D levels were unchanged, the observed effects are likely due to the combined contributions of inulin and soy isoflavones.

Alterations in bone and muscle parameters related to advanced aging and physical inactivity have never been investigated in oldest-old women. To investigate the impact of physical inactivity on bone mineral density (BMD) and body composition at the systemic and regional levels in oldest-old (> 75 years old) women. We hypothesized that, further to aging, alterations in bone and body composition parameters are exacerbated in the locomotor limbs that have experienced physical inactivity. Whole-body and regional (lower limbs and trunk) BMD and fat-free soft tissue mass (FFSTM) were measured by means of dual-energy X-ray absorptiometry in 11 oldest-old wheelchair-bound women (OIW), 11 oldest-old mobile women (OMW), and 11 young healthy women (YW), all matched for weight (± 10 kg), height (± 10 cm). Whole-body BMD was reduced by 15% from YW to OMW and 10% from OMW to OIW. Whole-body FFSTM was also reduced from YW to OIW (− 13%). Lower limb BMD was progressively reduced among YW, OMW and OIW (− 23%). Similarly, lower limb FFSTM was reduced among YW (12,816 ± 1797 g), OMW (11,999 ± 1512 g) and OIW (10,037 ± 1489 g). Trunk BMD was progressively reduced among YW, OMW and OIW (− 19%), while FFSTM was similar among the three groups ~ 19801 g. The results of the present study suggest that the alterations in bone and body composition parameters are exacerbated in the physical inactive oldest-old. These negative effects of physical inactivity are not confined to the locomotor limbs, and a systemic decline of bone and muscle parameters are likely associated with the physical inactivity.