Dehydroepiandrosterone sulfate and fall risk in older people: Sex differences in the Pro.V.A. longitudinal study.

BACKGROUND: The effect of dehydroepiandrosterone sulfate (DHEA-S) on fall risk in older age is still unclear, as is the effect of sex on any relationship between the two. Our aim was to evaluate the association between DHEA-S and the risk of falls and risk of recurrent falls in community-dwelling older men and women. METHODS: We included 1949 (781 M, 1168 F) older adults enrolled in the Progetto Veneto Anziani study. Baseline serum DHEA-S levels were analyzed by immunoassay. The number of falls reported in the year preceding the 4.4-year follow-up assessment was collected. The association between DHEA-S and falls was analyzed by multinomial logistic regression, adjusting for potential confounders and considering death as alternative outcome. RESULTS: After the follow-up, 548 (36.8%) individuals reported at least one fall in the previous year, and 214 (14.4%) reported ≥2 falls (recurrent falls). Each 1-standard deviation (SD) increase in log-transformed DHEA-S level reduced the odds of experiencing at least one fall by 9% (95%CI:0.88-0.95), and the risk of recurrent falls by 16% (95%CI:0.79-0.89). The highest DHEA-S tertile was 27% (95%CI:0.65-0.83) less likely to experience recurrent falls than the lowest tertile. The analyses, stratified by sex, suggested a strong association between DHEA-S and the fall risk for women (OR = 0.91; 95%CI:0.87-0.95 for at least one fall; OR = 0.83, 95%CI:0.78-0.89 for recurrent falls per each 1-SD increase in log-transformed DHEA-S); non-significant results were observed among men. CONCLUSIONS: Higher levels of DHEA-S are associated with a lower risk of falls and recurrent falls in older people, especially women.

Prognostic value of cardiac troponin I assay in hospitalized elderly patients.

BACKGROUND: Cardiac troponin I (cTnI) has been poorly studied in elderly inpatients. AIM: This study wanted to assess factors influencing the increase in cTnI and its prognostic value in hospitalized elderly patients. METHODS: 354 elderly (mean age of 84.8 ± 6.9 years) patients consecutively admitted in the Geriatrics Division in Padua were tested for cTnI levels assay during the hospital stay. Number of subsequent patient deaths at 6 months and 2 years were registered. RESULTS: Of the 354 patients, 27 (7.6%) died in hospital; their levels were not significantly higher or more frequently positive on cTnI than those of the remainder of the sample. 71 (20.01%) patients died within 6 months of being discharged, and in-hospital positive cTnI levels emerged as a mortality risk factor in this group [unadjusted HR 1.13 (1.04-1.23); p = 0.004]. At 2 years, a total of 174 patients (49.2%) had died, but in-hospital pathological cTnI levels were not a mortality risk factor in this group. DISCUSSION: It should be noted that cTnI level was a risk factor for mortality at 6 months but no longer at 2 years after an elderly patient's hospitalization. This finding may relate to patients' limited physiological reserves or be driven by the fact that the elderly tend to receive fewer evidence-based treatments, and to be managed more conservatively than younger patients. CONCLUSIONS: In the multidimensional analysis of older patients, troponin I can be used to stratify patients and assess mortality risk at 6 months, but not at 2 years.

Difficulties with Fine Motor Skills and Cognitive Impairment in an Elderly Population: The Progetto Veneto Anziani.

OBJECTIVES: To investigate dysfunction in fine motor skills in a cohort of older Italian adults, identifying their prevalence and usefulness as indicators and predictors of cognitive impairment. DESIGN: Population-based longitudinal study with mean follow-up of 4.4 years. SETTING: Community. PARTICIPANTS: Older men and women enrolled in the Progetto Veneto Anziani (Pro.V.A.) (N = 2,361); 1,243 subjects who were cognitively intact at baseline were selected for longitudinal analyses. MEASUREMENTS: Fine motor skills were assessed by measuring the time needed to successfully complete two functional tasks: putting on a shirt and a manual dexterity task. Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score less than 24. RESULTS: On simple correlation, baseline MMSE score was significantly associated with the manual dexterity task (correlation coefficient (r) = -0.25, P < .001) and time needed to put on a shirt (r = -0.29, P < .001). Over the study period, changes in time needed to perform the fine motor tasks were significantly associated with changes in MMSE (putting on a shirt: ß = 0.083, P = .003; manual dexterity task: ß = 0.098, P < .001). Logistic regression analyses confirmed that worse results on tasks were associated with cognitive impairment at baseline (odds ratio (OR) = 2.47, 95% confidence interval (CI) = 1.74-3.50, for the fourth quartile of time needed to put on a shirt; OR = 1.98, 95% CI = 1.42-2.76, for the fourth manual dexterity task quartile) and greater risk of cognitive impairment developing during follow-up (OR = 4.38, 95% CI = 2.46-7.80, for the fourth quartile of time needed to put on a shirt; OR = 2.20, 95% CI = 1.30-3.72, for the fourth manual dexterity task quartile). CONCLUSIONS: Difficulties with fine motor skills are common in older adults, and assessing them may help to identify early signs of dementia, subjects at high risk to develop cognitive decline, and individuals who can be referred to specialists.

Semmes-Weinstein Monofilament Examination for Predicting Physical Performance and the Risk of Falls in Older People: Results of the Pro.V.A. Longitudinal Study.

OBJECTIVE: To investigate whether the Semmes-Weinstein monofilament examination (SWME) was associated with, and could predict, measures of physical performance and the risk of fall in older people. DESIGN: Prospective study. SETTING: Community. PARTICIPANTS: Older participants (N=2826) enrolled in the Progetto Veneto Anziani (Pro.V.A.) study and a subsample of persons (n=1885) who did not report falls at baseline for longitudinal analyses. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Falls reported in the year preceding the assessment and Short Physical Performance Battery (SPPB) were recorded at baseline and again after 4.4 years. RESULTS: At baseline, 830 participants (29.4%) had experienced falls in the previous year, with a higher prevalence of falls in those positive at SWME than in those negative at SWME (35.8% vs 28.0%; P=.001). Using logistic regression, participants positive at SWME had a (significant) 66% higher risk of presenting worse SPPB score (95% confidence interval, 1.51-1.83) and between 25% and 32% higher risks of having experienced ≥1 fall or recurrent falls than did those negative at SWME. The incidence of falls at follow-up was higher in the positive SWME group than in the negative SWME group (42.2% vs 30.7%; P=.001), and multinomial logistic regression showed that the former had a 13% higher risk of decline in SPPB scores (95% confidence interval, 1.03-1.25), particularly for gait and balance; 48% higher risk of having had 1 fall; and 77% higher risk of recurrent falls. At both baseline and follow-up, the larger the extension of neuropathy (negative SWME vs unilateral impairment in positive SWME vs bilateral impairment in positive SWME), the greater its negative effect on falls and physical performance. CONCLUSIONS: SMWE was associated with, and could predict, lower extremity physical performance and falls in older people.