The hyperforin derivative IDN5706 occludes spatial memory impairments and neuropathological changes in a double transgenic Alzheimer's mouse model.

The use of natural compounds is an interesting stratagem in the search of drugs with therapeutic potential for the treatment of Alzheimer's disease (AD). We report here the effect of the hyperforin derivative (IDN5706, tetrahydrohyperforin), a semi-synthetic derivative of the St. John's Wort, on the brain neuropathology, learning and memory in a double transgenic (APPswe, PS-1dE9) mouse model of AD. Results indicate that, IDN5706 alleviates memory decline induced by amyloid-beta (Abeta) deposits as indicated by the Morris water maze paradigm. Moreover, the analysis of Abeta deposits by immunodetection and thioflavin-S staining of brain sections, only reveals a decrease in the frequency of the larger-size Abeta deposits, suggesting that IDN5706 affected the turnover of amyloid plaques. Immunohistochemical analysis, using GFAP and n-Tyrosine indicated that the hyperforin derivative prevents the inflammatory astrocytic reaction and the oxidative damage triggered by high Abeta deposit levels. We conclude that the hyperforin derivative, IDN5706, has therapeutic potential for prevention and treatment of AD.

Caídas en adultos mayores institucionalizados: descripción y evaluación geriátrica / Falls in institutionalized elderly subjects. Features and geriatric assessment

BACKGROUND: Falls are an important cause of disability and mortality among elderly subjects. AIM: To study the features and incidence of falls in institutionalized elderly subjects. PATIENTS AND METHODS: Prospective recording of all falls, occurring in a period of eight months, to 453 subjects older than 60 years, living a home for the elderly. Evaluation of functional status of subjects suffering falls, using the Spanish Red Cross score. One hundred and two subjects living in the same place, but not suffering falls, were considered as controls. RESULTS: One hundred and three subjects, aged 80 +/- 6 years (24 per cent of the sample) suffered falls. Most falls were during the day and while walking. Seventy percent of subjects suffering falls did not have a history of previous falls. Nine percent of those falling, suffered a fracture. Compared to controls, falling subjects had a more deteriorated functional and mental status and consumed more benzodiazepines and neuroleptics. CONCLUSIONS: There is an association between functional status and psychotropic medication consumption and the incidence of falls in institutionalized elderly subjects.

Falta de reconocimiento de osteoporosis y omisión de tratamiento en adultos mayores con fractura de cadera en Chile / Missed diagnosis of osteoporosis and failure to treat adults with hip fracture in Chile

BACKGROUND: Hip fractures are the most severe complication of osteoporosis, yet patients who suffer hip fracture rarely receive adequate treatment. AIM: To assess diagnosis and treatment of osteoporosis in patients with hip fracture. PATIENTS AND METHODS: A retrospective study in 203 patients admitted for hip fracture surgery at two medical institutions in Santiago, Chile. Clinical data from 101 patients from the Hospital Clínico Pontificia Universidad Católica de Chile (a university tertiary care hospital, HCPUC) and 102 patients from Hospital de Urgencia de la Asistencia Pública (a public emergency hospital, HUAP) were reviewed. We also evaluated incidence of new fractures, further treatment of osteoporosis and functionality, by means of a telephonic survey of 48 per cent of patients (n = 99) 12.3 +/- 5.3 months after hip fracture in HCPUC and 16.5 +/- 3.0 months for HUAP. RESULTS: A previous diagnosis of osteoporosis was present in 2.9 per cent and 1 per cent of cases, and treatment prior to fracture in 3.9 per cent and 0 per cent of cases from HCPUC and HUAP, respectively. None of the patients in HUAP were diagnosed with osteoporosis during hospital stay or given treatment for this condition at discharge, in comparison to 0.9 per cent (n = 1) and 2 per cent (n = 2), respectively, in HCPUC. Seven and six percent of cases presented prior hip fractures. Telephonic follow up of patients revealed that 75.6 per cent persisted without treatment for osteoporosis. At follow up, 2.9 per cent and 3 per cent of patients in HCPUC and HUAP had presented new hip fractures. At the time of survey 30.9 per cent and 34 per cent of patients, respectively, were considered invalid. CONCLUSIONS: Missed diagnosis and failure to treat osteoporosis occurred in over 90 per cent of patients admitted for hip fracture, regardless of the different complexities in the hospitals of admission. The data suggest that lack of medical action on these issues may play a role in failure to prevent new hip fractures.

[Characteristics of falls among free living elders]. / Características de las caídas en el adulto mayor que vive en la comunidad.

BACKGROUND: Falls by older adults are a frequent problem among ambulatory patients in primary care. AIM: To describe the prevalence and features of falls among elders consulting to an ambulatory Geriatric Clinic. PATIENTS AND METHODS: Persons aged 60 years or more were surveyed about the number of falls in the preceding six months, the characteristics and consequences of each falls. Biopsychosocial characteristics were recorded and the Tinetti gait and balance test was performed in all patients reporting falls. RESULTS: In 104 (18.2%) of 571 clinical consultations, one or more falls were reported. Among patients who fell and provided complete data (n = 95), 64% reported one fall and 36% reported two or more, totaling 156 falls to analyze. The mean age of the patients with falls was 71.8 +/- 6.8 years. The functional and cognitive status was normal in 73 and 71.6% of cases respectively and 38% carried out periodical physical activity. Fifty seven percent of falls occurred outside of home, and an extrinsic factor was a precipitating cause in 55% of the falls. A post-fall syndrome appeared in 21% of cases and 2.6% resulted in fractures. Falling two or more times versus one time during the last six months was statistically associated with an age over 75, an absence of periodic physical activity, functional impairments, three or more chronic diseases, neurological diseases and with living alone, among other variables. CONCLUSIONS: Falls among elders occur mainly outside of home, in subjects older than 75 years old, functionally dependent and with an important involvement of extrinsic factors. Physical activity, as well as the control of environmental risks, could be protective factors against recurrent falls.

[Differences in plasma antioxidants according to socioeconomic level in Chilean women]. / Diferencias en antioxidantes plasmáticos según nivel socioeconómico en mujeres chilenas.

BACKGROUND: Free radical-mediated oxidative damage is a known initial event in atherogenesis. Cardiovascular disease is frequent in the Chilean population showing differences in the prevalence of risk factors of the disease according to socioeconomic level (SEL). AIM: To determine levels of antioxidants and lipid peroxides in Chilean women from different SEL. PATIENTS AND METHODS: Blood samples were taken from 81 women for measurements of plasma ascorbic acid, beta-carotene, alpha-tocopherol, licopene, ubiquinol, glutathione, total plasma antioxidant capacity, and lipid peroxides (TBARS). RESULTS: Individuals in the lower SEL showed reduced levels of plasma beta-carotene, ascorbic acid, alpha-tocopherol, and ubiquinol compared to women in the higher SEL. There were no differences between groups in the plasma levels of glutathione, total antioxidant capacity, or TBARS. CONCLUSIONS: The results could be explained in part by the higher consumption of fruits and vegetables in women from the upper SEL.

[Depression in the aged: preliminary evaluation of the effectiveness, as an screening instrument, of the 5-item version of the Geriatric Depression Scale]. / Depresión en el adulto mayor: evaluación preliminar de la efectividad, como instrumento de tamizaje, de la versión de 5 ítems de la Escala de Depresión Geriátrica.

INTRODUCTION: The best approach to improve under-recognition of depression is routine screening, ideally using an instrument that is highly effective and easy to administer. OBJECTIVE: To test the effectiveness of the 5-item version of the Geriatric Depression Scale (5-GDS) for depression screening in a community-dwelling Chilean elderly population. PARTICIPANTS AND METHODS: 110 subjects were evaluated at the geriatric outpatient clinic of a university teaching hospital. Patients answered a questionnaire that included the Geriatric Depression Scale (GDS), and demographic information. Using the 15-item GDS score as reference standard to classify subjects as depressed, test characteristics of the 5-GDS were evaluated. RESULTS: Subjects had a mean 15-item GDS score of 5.4; 47% classified as depressed. Depressed and not depressed subjects were similar with regard to demographics, educational level and comorbid conditions. The mean score was 1.9 for the 5-item GDS. Pearson correlation for 15-item and 5-item GDS scores was 0.92, p < 0.001. Using 15-item GDS score as reference standard, the 5-item GDS had a sensitivity of 0.88, specificity 0.90, positive predictive value 0.88 and negative predictive value 0.90. CONCLUSIONS: The 5-item GDS seems to be a promising screening tool for depression. If revalidated against clinical evaluation, it might be the preferred screening tool for depression in the Chilean community-dwelling elderly.

[Application of RUG-T18 classification system to elderly patients admitted to a university hospital]. / Resultados al aplicar el sistema de clasificación de pacientes "RUG-T18" en ancianos ingresados a un hospital universitario.

BACKGROUND: Among case mix classifications, the best for hospitalized elders is the Resource Utilization Groups (RUG) system, which allows a better location of patients, resource administration and the design of health care strategies for elderly people. AIM: To report the results of RUG-T18 classification of elderly patients admitted to an university hospital. PATIENTS AND METHODS: RUG-T18 classification was applied to 210 patients aged 75.2 +/- 7.2 years old, 108 male, admitted to the Clinical Hospital of the Catholic University of Chile. RESULTS: The clinical classification of assessed patients was rehabilitation in 50.9% of cases, special care in 10.5%, clinically complex in 37.1% and reduced physical functions in 0.5%. None had behavioral alterations. There were no differences between subjects older or younger than 75 years old. Daily life activities showed that help was required for sphincter control in 46% of patients, for feeding in 44% and for mobilization in 64% (28% of patients required help from two or more people). Geriatric assessment showed that, since 1993, the proportion of elders with greater functional derangement increased from 18 to 28%, and the proportion of those with mental disturbances from 4 to 12%, specially among those over 75 years old. CONCLUSIONS: Most elders admitted to the hospital are classified in the superior categories of the RUG-T18 system and have severe mental and functional limitations. These patients require a multidisciplinary approach with a great emphasis in rehabilitation.

[Ambulatory geriatric assessment of 2116 in poor elderly]. / Valoración geriátrica ambulatoria de 2116 adultos mayores pobres.

BACKGROUND: Geriatric assessment quantifies medical, functional, mental and social capabilities and alterations of elders and is the first step to initiate specific intervention programs. AIM: To report the initial geriatric assessment of a program aimed to help poor elders living in Metropolitan Santiago. SUBJECTS AND METHODS: Two thousand one hundred sixteen free living subjects aged 65 to 99 years old (711 males) were subjected to an assessment using a simple geriatric score validated abroad and used previously in Chile. The resulting score ranges from 0 (better) to 5 (worst). RESULTS: Eighty eight percent of elders did not have problems in the functional evaluation. Subjects over 75 years old needed occasional support for the daily activities with higher frequency than younger subjects (12 and 5.4% respectively, p < 0.001) and had a higher frequency of major functional limitations (7.8 and 3.2% respectively, p < 0.001). Mental assessment was considered normal in 89.4% of subjects. Those over 75 years old had a higher frequency of memory disturbances (11.4 and 6.5% respectively) and cognitive alterations (4.6 and 1.8% respectively). Indefinite social support could be received by 84% of subjects, but 7.4% did not have access to this resource. CONCLUSIONS: Geriatric assessment of poor elders gives useful information to identify those subjects that require community help.

[Functional risk assessment of poor Chilean elders using an instrument validated in Canada]. / Medición del riesgo funcional en adultos mayores pobres, con un instrumento validado en Canadá.

BACKGROUND: Information about medical and social situation of elders is limited in Chile. AIM: To assess the functional risk of Chilean elders using an instrument validated in Canada. SUBJECTS AND METHODS: As part of a project aimed to help poor elders, 2,116 subjects living in Santiago, aged 65 to 99 years old (1,334 female, and 625 older than 75 years old), were interviewed. RESULTS: Thirty percent of these elders were using more than three medications and 13% lived alone. Visual problems were detected in 75%, memory problems were found in 62%, 63% felt depressed, 46% had hearing problems, 42% suffered a fall during the last year, 35% had a health problem that forced them to stay at home, 32% did not count with help in a case of need, 33% referred some type of nutritional problem, 26% needed help for daily living activities and 25% considered to have a worst health than counterparts of the same age. Among subjects older than 75 years old, the frequency of memory problems, auditory impairment, number of falls, health problems that precluded leaving the house, limitation for daily activities and the use of walking aids, was significantly higher. Although men and women had similar ages, men were in worst functional conditions, and had required more admissions to hospitals. There was a higher proportion of women living alone. Females also had a higher frequency of depression, memory disturbances, falls and use of more than three medications. CONCLUSIONS: Women elders tend to be in better functional conditions than men and people older than 75 years old have a higher functional risk. The applied instrument allowed a better focalization of our geriatric program.

[Comparative study of institutionalized and non-institutionalized nonagenarians]. / Estudio comparativo de nonagenarios que viven en sus propios hogares versus los institucionalizados.

BACKGROUND: The 1992 census showed that 10,470 people over 90 years old lived in Santiago and we do not have information about their general medical status. AIM: To evaluate and compare quality of life and functional status of free living and institutionalized nonagenarians in Santiago. SUBJECTS AND METHODS: During 24 months, 241 people of 90 years or older were interviewed. One hundred twenty seven (96 female) lived in their own homes and 114 (108 female) lived in institutions. The geriatric evaluation scale, validated in previous studies, was used as the assessment instrument. RESULTS: Mean age of subjects was 94 years old (range 90 to 106). Eight percent of subjects were bedridden. No differences in general condition, fecal or urinary continence, nutritional status, blood pressure, cognition, sight and hearing acuity, were observed between free living and institutionalized subjects. Free living elders had a significantly higher number of brothers or offspring and 90% were happy with the place where they lived. CONCLUSIONS: Most nonagenarians in Santiago are in good general medical conditions. Probably, the decision to become institutionalized depends more on lack of family support than on worse medical, functional or mental conditions.

[The situation of the elderly in Chile]. / La situación del adulto mayor en Chile.

Chile is experiencing a demographic transition and the causes of death and diseases of elders are similar to those of developed countries. However, these facts do not reflect the real problems that elderly people must face in this country, since they frequently suffer of not well diagnosed or assessed chronic diseases or functional limitations, that render them dependent or prostrated. If Chile wants to improve the physical and mental well being of elders, a global policy towards them must be developed and the financing of health services must be assured. In March 1996, a National Policy for Elderly People, aiming to improve the quality of life of these individuals, was approved by the government. We must successfully prevent and retard functional impairment and divulge the integral geriatric focus, encouraging global assessment, preventing disabilities and protecting functional independence. We must develop specialized Geriatric services in general hospitals, day care centers and rehabilitation units. We must teach the general principles of geriatric practise to health teams. Chile has a few trained specialists in geriatric medicine that must train other professionals. Thus, Medical Schools should expand research and post graduate training programs in geriatrics.

[Pilot experience with the use of an ambulatory geriatric assessment instrument]. / Experiencia piloto en el uso de una ficha de evaluación geriátrica ambulatoria.

BACKGROUND: Ten percent of the Chilean population is over 60 years old and general practitioners need an instrument to assess the degree of disability and multiple ailments of elders. AIM: To develop and use an instrument to assess elders consulting in primary care outpatient clinics. PATIENTS AND METHODS: An instrument to be used by general practitioners, aimed to assess bio-psico-social risk of elders was devised by the Geriatrics Program at the Faculty of Medicine of the Catholic University of Chile. The instrument was used in 100 elders (82 female) aged 71 +/- 8 years old consulting in a primary care outpatient clinic. RESULTS: The instrument took less than 5 minutes to be used. The most frequent risk factors found were living alone in 62% of subjects, falls in the last year in 47%, memory disturbances in 62%, overweight in 76%, visual impairment in 76%, urinary incontinence in 26% and depression in 76%. Thirty percent had difficulties to climb stairs and 4% had no support in case of severe disability. CONCLUSIONS: The applied instrument is fast to apply, easily understood by patients and detects problems associated with old age, that will help to plan primary care health programs.

[Geriatric evaluation of elderly patients at a university hospital]. / Evaluación geriátrica de adultos mayores en un hospital universitario.

The aim of this work was to evaluate general aspects, medical diagnoses, degree of disability, mental status and social support of hospitalized elders using a Geriatric Assessment Scale, devised at the Catholic University. Ninety eight hospitalized subjects (58 female, aged 60 to 74 years old) were surveyed before discharge. Results showed that 34% had serious handicaps in their daily living and required third party help, 14% had a moderate cognitive impairment and that 12% lacked social or family support. We conclude that the scale is useful, easy to use and allows to obtain a thorough diagnosis of hospitalized elders.

Attitudes of hospital doctors in Wales to use of intravenous fluids and antibiotics in the terminally ill.

Decisions concerning the use of intravenous fluids and antibiotics in terminally ill patients are regularly made by hospital doctors, but there is little record of staff attitudes and current practice in Britain. A questionnaire was therefore distributed to 833 Welsh hospital doctors, citing the case of a hypothetical terminally ill patient and asking questions about medical management. Of the 448 (54%) doctors who replied, 346 (77%) had managed a similar patient recently. Intravenous fluids would be administered by 238 (53%), with 206 of these (87%) resiting the cannula as required and 62 (26%) resorting to a central venous line if there was no alternative. With increasing age and seniority doctors become conservative in their approach. Nearly all claimed that 'ensuring the patient's comfort' was the reason for their decision. Only 72 (16%) would use antibiotics if the patient became pyrexial. The results suggest that British doctors are divided in their approach to the medical management of terminally ill patients and there is a need for greater discussion and training so that all the issues involved are fully appreciated.