-
[show abstract]
[hide abstract]
ABSTRACT: Background and aims: sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the impact of sarcopenia on the risk of all-cause death in a population of frail older persons living in community.Methods: we analysed data from the Aging and Longevity Study, a prospective cohort study that collected data on all subjects aged 80 years and older residing in the Sirente geographic area (n = 364). The present analysis was conducted among those subjects who were between 80 and 85 years of age at the time of the baseline assessment (n = 197). The main outcome measure was all-cause mortality over 7-year follow-up. According to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, the diagnosis of sarcopenia required the documentation of low muscle mass and the documentation of either low muscle strength or low physical performance. Cox proportional regression models were used to estimate crude and adjusted hazard ratios and 95% confidence intervals of death by the presence of sarcopenia.Results: using the EWGSOP-suggested criteria, 43 subjects with sarcopenia (21.8%) were identified. During the 7-year follow-up, 29 (67.4%) participants died among subjects with sarcopenia compared with 63 subjects (41.2%) without sarcopenia (P < 0.001). After adjusting for potential confounders including age, gender, education, activities of daily living (ADL) impairment, body mass index, hypertension, congestive heart failure, chronic obstructive pulmonary disease, number of diseases, TNF-α, participants with sarcopenia had a higher risk of death for all causes compared with non-sarcopenic subjects (HR: 2.32, 95% CI: 1.01-5.43).Conclusions: our results obtained from a representative sample of very old and frail subjects show that sarcopenia is associated with mortality, independently of age and other clinical and functional variables.
Age and Ageing 01/2013; · 3.09 Impact Factor
-
Revista Española de Geriatría y Gerontología 07/2012; 47(4):141-2.
-
[show abstract]
[hide abstract]
ABSTRACT: Inappropriate prescriptions are common in older people admitted to nursing homes. Commonly used instruments to detect potential inappropriate prescriptions have limitations that have precluded wide use, and new instruments are needed.
The goal of this study was to determine the value of the Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right, ie appropriate, indicated Treatment (STOPP-START) criteria and the Australian criteria to detect potentially inappropriate drug prescriptions in older people on admission to nursing home care.
Cross-sectional study of 100 consecutive patients (mean age 84.7 ± 7.5 years, 80% women) admitted to 6 assisted living nursing homes, with systematic review of prescriptions used at the time of nursing home admission using the STOPP-START and the Australian criteria looking for potentially inappropriate drug treatments.
Using the STOPP criteria, 79% of the subjects showed at least one potentially inappropriate prescription. Omissions of potentially appropriate drugs were found by the START criteria in 74% of them. The Australian criteria detected at least one potential problem in 95% of the sample. The number of subjects with 2 or more problems detected was highest using the Australian criteria (72%). The most frequent potentially inappropriately used drugs detected were proton-pump inhibitors, benzodiazepines, antipsychotic drugs, and anticholinergic drugs; many cases of duplicate medications and drug interactions were also detected. Underuse of statins and aspirin in patients with high cardiovascular risk, and of calcium and vitamin D in osteoporosis was also frequent.
A high number of potentially inappropriate drug prescriptions can be detected at the time of admission to nursing home care by the use of systematic instruments. Both STOPP-START criteria and the Australian criteria performed well in this setting. The impact of this detection on health outcomes and costs should be assessed before they can be widely recommended.
Journal of the American Medical Directors Association 01/2012; 13(1):83.e9-15. · 4.64 Impact Factor
-
Journal of the American Geriatrics Society 08/2011; 59(8):1566-7. · 3.74 Impact Factor
-
Alfonso J Cruz-Jentoft,
Federico Cuesta Triana,
Mari Carmen Gómez-Cabrera,
Alfonso López-Soto,
Ferran Masanés,
Pilar Matía Martín,
José Antonio Serra Rexach,
Domingo Ruiz Hidalgo,
Antoni Salvà,
José Viña,
Francesc Formiga
[show abstract]
[hide abstract]
ABSTRACT: Sarcopenia is a common and prominent geriatric syndrome, of major interest for daily clinical practice of professionals working with older people. The number of affected individuals and its relation with disability, frailty, many chronic diseases, lifestyle and adverse outcomes are extremely relevant for geriatric care. Moreover, biological changes that lead to the loss of muscle mass and strength are intrinsically related to the mechanisms of aging. It is not therefore surprising that research in this field is growing exponentially in recent years, and sarcopenia has been placed in recent years in the forefront of research in geriatric medicine and gerontology. The Spanish Society of Geriatrics and Gerontology has recently created an Observatory of Sarcopenia, which aims to promote educational and research activities in this field. The first activity of the Observatory has been to offer the Spanish speaking scientific community a review of the current status of sarcopenia, that may allow unifying concepts and fostering interest in this promising field of geriatrics.
Revista Española de Geriatría y Gerontología 01/2011; 46(2):100-10.
-
Alfonso J Cruz-Jentoft,
Jean Pierre Baeyens,
Jürgen M Bauer,
Yves Boirie,
Tommy Cederholm,
Francesco Landi,
Finbarr C Martin,
Jean-Pierre Michel,
Yves Rolland,
Stéphane M Schneider,
Eva Topinková,
Maurits Vandewoude,
Mauro Zamboni
[show abstract]
[hide abstract]
ABSTRACT: The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.
Age and Ageing 04/2010; 39(4):412-23. · 3.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Discrimination in research of new drugs for older people is frequent. We examined research protocols submitted to a research ethics committee, to ascertain whether they stipulated unjustified upper age limits, and whether these age limits are changing in time.
Systematic review of protocols of studies submitted to the Research Ethics Committee of a public university hospital, in four different years, looking for unjustified upper age limits. Studies that dealt with topics or conditions that automatically excluded older people were not examined.
In the first three cohorts of protocols of intervention studies (1994, 1999, 2004), 36% to 40% stipulated an upper age limit. In 2007, only 19% of the protocols showed an unjustified limit. Non-intervention trials rarely had upper age limits. Age limits were arbitrarily chosen (65, 70, 75 or 80 years were chosen as cut-off points in most cases). Five to 6% of the protocols specifically concerned older persons, with no change in time.
Unjustified age limits are frequent in the protocols of intervention studies, although the numbers have been falling recently. Ethics research committees are in a strong position to influence research practice and to reduce unethical age discrimination.
Aging clinical and experimental research 04/2010; 22(2):175-8. · 1.55 Impact Factor
-
Journal of the American Medical Directors Association 03/2010; 11(3):153-6. · 4.64 Impact Factor
-
International Journal of Geriatric Psychiatry 12/2009; 25(1):1-2. · 2.42 Impact Factor
-
Alfonso J Cruz-Jentoft,
Alain Franco,
Pascal Sommer,
Jean Pierre Baeyens,
Ewa Jankowska,
Adriana Maggi,
Piotr Ponikowski,
Andrzej Rys,
Kataryna Szczerbinska,
Jean-Pierre Michel,
Andrzej Milewicz
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND. In September 2008, under the French Presidency of the European Union and with the support of the Polish Minister of Health, a European Summit on Age-Related Disease was organised inWroclaw (Poland). At this meeting, European politicians, gerontologists and geriatricians gathered to discuss a common approach to future challenges related to age-related disease. Politicians and decision-makers from the European Union and Ministers of Health and their deputies from many European countries raised the problems and difficulties to be tackled in a growing population with a high burden of disease, and asked scientists to write a consensus document with recommendations for future actions and decisions. Scientists and clinicians worked in parallel in three different groups, on health promotion and preventive actions, basic research in age-related disease, and clinical aspects of disease in older people. Beforehand, the format of the paper with recommendations was discussed, and it was finally agreed that, for a better understanding by decision- makers, it would be divided in two different columns: one with facts that were considered settled and agreed by most experts (under the heading We know), and a second with recommendations related to each fact (We recommend). No limit on the number of topics to be discussed was settled. After careful and detailed discussion in each group, which in most cases included the exact wording of each statement, chairpersons presented the results in a plenary session, and new input from all participants was received, until each of the statements and recommendations were accepted by a large majority. Areas with no consensus were excluded from the document. Immediately after the Summit, the chairpersons sent the document both to the main authors and to a list of experts (see footnote) who had made presentations at the summit and agreed to review and critically comment on the final document, which is presented below. As regards the scientific aspects of the planning of the Summit, several organisations, under the leadership of the EUGMS, were asked both to review the program and to suggest names of speakers and participants. After the Summit, the Boards of these organizations (European Union Geriatric Medicine Society (EUGMS), International Association of Gerontology and Geriatrics-European Region (IAGGER), European Association of Geriatric Psychiatry (EAGP), International Society of Gerontechnology (ISG) and International Society for the Study of the Aging Male (ISSAM) agreed to consider the document as an official paper, and help with its dissemination. The name Silver Paper was used, recalling the grey or silvery hair of our older citizens, as an easy reference. It has been sent officially to several bodies of the European Union and to Health Ministers of most European countries; and will be published in other languages in local journals. Its declared intention is to foster changes in policies which may, in the future, reduce the burden of disease in old age.
Aging clinical and experimental research 12/2009; 21(6):376-85. · 1.55 Impact Factor
-
Medicina Clínica 10/2009; 135(11):529; author reply 530-1. · 1.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP/START criteria could become a useful screening tool to improve prescription in older people.
Revista Española de Geriatría y Gerontología 07/2009; 44(5):273-9.
-
European Journal of Ageing 02/2009; 6(1):51-57. · 1.27 Impact Factor
-
Alistair Burns,
Roberto Bernabei,
Roger Bullock, Alfonso J Cruz Jentoft,
Lutz Frölich,
Christoph Hock,
Minna Raivio,
Eric Triau,
Maurits Vandewoude,
Anders Wimo,
Elizabeth Came,
Bart Van Baelen,
Gerry L Hammond,
Joop C van Oene,
Susanne Schwalen
[show abstract]
[hide abstract]
ABSTRACT: The efficacy of galantamine has been shown in patients with mild, moderate, and advanced moderate Alzheimer's disease (AD). Here we report its efficacy in patients with severe AD.
Between December, 2003, and March, 2007, patients aged 84 (SD 6) years with severe AD (mini-mental state examination [MMSE] score 5-12 points), in a nursing home setting were randomly assigned to receive galantamine (n=207), titrated initially to 24 mg/day, or placebo (n=200). Co-primary efficacy measures for cognitive function and ability to undertake normal daily activities were the severe impairment battery (SIB) and the seven-item minimum data set-activities of daily living (MDS-ADL), respectively. Adverse events, vital signs, laboratory parameters, and electrocardiograms were monitored. This trial is registered with ClinicalTrials.gov, number NCT00216593.
168 of 207 (81%) patients in the galantamine group and 161 of 200 (81%) in the placebo group completed the study. Mean SIB scores increased (improved) by 1.9 (95% CI -0.1 to 3.9) points with galantamine and decreased (worsened) by 3.0 (-5.6 to -0.5) points with placebo (between-group least squares mean difference 4.36, 1.3 to 7.5; p=0.006). Mean MDS-ADL self-performance score worsened by 1.2 (0.6 to 1.8) points and 1.6 (0.8 to 2.3) points, respectively (between-group least squares mean difference -0.41, -1.3 to 0.5; p=0.383). Nominally significant between-group differences in favour of galantamine occurred for the SIB domains of memory (p=0.006), praxis (p=0.010), and visuospatial ability (p=0.002), and for the MDS-ADL subitem locomotion on unit (p=0.021). 183 of 207 patients (88%) who received galantamine and 177 of 200 (89%) who received placebo had adverse events, which were mostly mild to moderate. Eight patients (4%) in the galantamine group and 21 patients (11%) in the placebo group died. ECG abnormalities were similar between the two groups.
Galantamine can be started and used safely in elderly patients with severe AD. Galantamine improved cognitive function but failed to significantly improve the co-primary parameter of overall activities of daily living.
The Lancet Neurology 12/2008; 8(1):39-47. · 23.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: By 2050, the European population of 720 million will include 187 million (one quarter) octogenarians. Although living longer is a true privilege, care for the graying population suffering from chronic and disabling diseases will raise enormous challenges to healthcare systems and geriatric education. Are European countries ready to cope with these challenges? An extensive 2006 survey of geriatric education in thirty-one of 33 European countries testifies that geriatrics is a recognized medical specialty in 16 countries and a subspecialty in nine of them. Six European countries have an established chair of geriatric medicine in each of their medical schools. Undergraduate teaching activities are organized in 25 of the surveyed countries and postgraduate teaching in 22 countries under the leadership of geriatricians (n=16) or general internists (n=6). A comparison with data collected in the 1990s shows important progresses: the number of established chairs increased by 45%, the undergraduate and postgraduate teaching activities increased respectively by 23% and 19%. However, these changes are very heterogeneously organized from country to country and within each country. In most European countries, there remains a huge need for reinforcing and harmonizing geriatric teaching activities to prepare the next generation of medical doctors to address the projected increase in chronic and disabled older patients. Several different innovative strategies are proposed.
Journal of the American Geriatrics Society 09/2008; 56(8):1536-42. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The physiopathology of delirium has still not been characterized in depth, although this entity can be defined as a functional brain disorder provoked by one or multiple organic causes that display a common clinical syndrome. Certain specific brain regions that are involved in delirium have been identified, such as the prefrontal cortex, the thalamus and the basal ganglia, especially in the nondominant hemisphere. Functional changes occur in a large number of neurotransmitters: the most frequent and best characterized are a reduction of cholinergic function and an increase in dopaminergic and gabaergic function, although alterations in almost all neurotransmitter systems (serotoninergic, noradrenergic, glutaminergic, histaminergic) have been found. Inflammation also seems to play an important role, at least in some types of delirium. Delirium in the elderly typically has a multifactorial etiology, with several simultaneous or sequential causes. Numerous risk factors have been described, both predisposing individuals to delirium and triggering this syndrome. Knowledge of these factors and their interactions is of great clinical importance and consequently etiologic diagnosis should be based on a multifactorial model.
Revista Española de Geriatría y Gerontología 02/2008; 43 Suppl 3:4-12.
-
Revista Española de Geriatría y Gerontología 44(4):171-2.
-
[show abstract]
[hide abstract]
ABSTRACT: The current article is a statement of the meeting with international and multidisciplinary participation, held in Wrocław, Poland on September 11-13, 2008. The meeting was devoted to working out a position focusing on the challenge for individuals, health care systems, biological, psychosocial, epidemiological, medical, and public health sciences in the ageing populations of the twenty-first century. The statement is presented as an overview, in tabular format, of the current European situation regarding basic biological research on ageing, health promotion and preventive action, clinical care for older people, and recommendations for future actions.
Endokrynologia Polska 60(5):408-14. · 1.24 Impact Factor
-
Revista Española de Geriatría y Gerontología 46(3):170.
