Masticatory coefficient and physical functioning in older frail patients admitted for a Comprehensive Gerontological Assessment.

BACKGROUND: Physical functioning may be limited in older, frail patients with missing teeth without prosthetic correction. This cross-sectional study examined the relationship between physical performance and the geriatric masticatory coefficient (GMC) in patients who underwent both a comprehensive gerontological assessment (CGA) to improve poly-pathology management and an intra-oral exam. METHODS: All patients were evaluated based on the following: (corrected) GMC, number of posterior occluding pairs (POPs), short physical performance battery (SPPB) or timed up and go (TUG) test, and mini-nutritional assessment (MNA). RESULTS: Of the 256 patients (mean age 83.76[SD 6.16], 148F), 75 (29.30%) were malnourished. The corrected GMC was lower in malnourished patients. When adjusted for age, gender, and MNA, the corrected GMC correlated with the TUG time (r=-0.198, p=0.005) and SPPB score (r=0.282, p=0.009). Correlations between GMC and POPs were determined for the SPPB (r=0.269, p=0.013; r=0.319, p=0.004, respectively) but not for the TUG (r=-0.108, p=0.128; r=-0.136, p=0.072). CONCLUSION: The correlation between physical performance and decreased masticatory capacity was not fully explained by malnutrition in mildly to severely frail and multi-morbid patients; posture may also be impaired by missing teeth. The study of dental care effects on physical performance will provide further insights.

Near Visual Impairment Incidence in Relation to Diabetes in Older People: The Three-Cities Study.

OBJECTIVES: To characterize the relationship between diabetes mellitus (DM) and future risk of near vision impairment (VI) in a community-dwelling population of older people. DESIGN: Seven-year population-based longitudinal study. SETTING: Three-Cities Study, a French prospective study designed to assess the risk of cognitive and functional decline attributable to vascular factors. PARTICIPANTS: Community-dwelling individuals aged 65 and older (N = 8,412). MEASUREMENTS: DM was determined at baseline according to self-reported DM, antidiabetic treatment, and fasting blood glucose. Near visual acuity was measured at baseline and 2, 4, and 7 years later. Near VI was defined as a Snellen score greater than 20/30. RESULTS: DM was associated with a higher risk of near VI in an adjusted model (hazard ratio (HR) = 1.24, 95% confidence interval (CI) = 1.02-1.52, P = .03). Because of an interaction between Body Mass Index (BMI) and diagnosed DM, the longitudinal analyses were stratified according to BMI category. DM was associated with greater risk of near VI only in underweight (BMI <21.0 kg/m2 , HR = 2.89, 95% CI = 1.18-7.03) and normal-weight (BMI 21.0-24.9 kg/m2 , HR = 1.60, 95% CI = 1.10-2.32), but not overweight (P = .69) and obese (P = .09) subjects. CONCLUSION: DM is a risk factor for near VI in older people, particularly in those with a low or normal BMI. This risk profile should be taken into account in older adults to support their independence.

Accuracy of repeated measurements of late-night salivary cortisol to screen for early-stage recurrence of Cushing's disease following pituitary surgery.

OBJECTIVE: The performance of late-night salivary cortisol (LNSC) to accurately screen for postoperative recurrence of Cushing's disease (CD) at an early stage is unknown. The aim of this study was to compare the accuracy of multiple sampling strategies to suggest the optimal number of LNSC samples needed for diagnosing post-surgical recurrences of CD at an early stage. DESIGN: Retrospective analysis in a single centre. PATIENTS AND MEASUREMENTS: Thirty-six patients in surgical remission of CD had successive measurements of LNSC, defined as 'sequences', using a locally modified RIA assay as part of long-term follow-up (69·2 ± 10·6 months). Patients underwent an extensive biochemical evaluation within 3 months before or after a sequence of saliva sampling and were classified as being in remission or in early-stage recurrence. The accuracy of three diagnostic strategies combining two, three or four LNSC results from a sequence was estimated using areas under the ROC curves (AUC), sensitivity, specificity and predictive values. RESULTS: Forty-four sequences of LNSC measurements were available. Fifty-two percent of sequences were performed during early-stage recurrence. The intrasequence variability of LNSC was higher during recurrence than during remission (medians of SDs: 2·1 vs 0·5 nm; P < 0·0001). AUCs from ROC curves ranged from 0·93 to 0·96 depending on the strategy. For 90% sensitivities, the best specificities (92·9% and 90·9%) were achieved by strategies taking into account three or four measurements summarized either by their mean or their maximum value. CONCLUSIONS: Increase in LNSC concentration is an early abnormality during post-surgical recurrence of CD. However, due to a major within-patient variability of LNSC from 1 day to another, a screening strategy using three or four samples collected on successive days may be recommended to detect early-stage recurrence of CD with a high accuracy.