Purpose: to identify cross-sectional correlates of disability and risk factors for the development activities of daily living (ADL) and instrumental ADL (IADL) disability in community-dwelling older adults.

Methods: the study population consisted of 897 subjects aged 65–102 years from the InCHIANTI study, a population-based cohort in Tuscany (Italy). Factors potentially associated with high risk of disability were measured at baseline (1998–2000), and disability in ADLs and IADLs were assessed both at baseline and at the 3-year follow-up (2001–03).

Results: the baseline prevalence of ADL disability and IADL disability were, respectively, 5.5% (49/897) and 22.2% (199/897). Of 848 participants free of ADL disability at baseline, 72 developed ADL disability and 25 of the 49 who were already disabled had a worsening in ADL disability over a 3-year follow-up. Of 698 participants without IADL disability at baseline, 100 developed IADL disability and 104 of the 199 who already had IADL disability had a worsening disability in IADL over 3 years. In a fully adjusted model, high level of physical activity compared to sedentary state was significantly associated with lower incidence rates of both ADL and IADL disability at the 3-year follow-up visit (odds ratio (OR): 0.30; 95% confidence intervals (CI) 0.12–0.76 for ADL disability and OR: 0.18; 95% CI 0.09–0.36 for IADL disability). After adjusting for multiple confounders, higher energy intake (OR for difference in 100 kcal/day: 1.09; 95% CI 1.02–1.15) and hypertension (OR: 1.91; 95% CI 1.06–3.43) were significant risk factors for incident or worsening ADL disability.

Conclusions: higher level of physical activity and lower energy intake may be protective against the development in ADL and IADL disability in older persons.

Methods: a cross-sectional study was conducted in southern Brazil. A sample of 1,069 urban women, age 60+, was assessed for UI (in-person interview), adiposity (body mass index [BMI] and waist circumference [WC]) and fitness. Logistic regression models were developed to assess the association between UI and the independent variables—adiposity (BMI and WC) and fitness indicators. All models were adjusted for age, socioecomomic level, diabetes and hypertension.

Results: BMI and functional tests were not significantly associated with UI. WC was an independent and significant predictor. Relative to women in the lowest quartile of WC, odds ratios for UI were 1.98 for WC of 79–86 cm, 2.07 for WC of 86–94 cm and 2.24 for WC >94 cm (P = 0.03).

Conclusion: central adiposity, as indicated by large WC, increases the risk of UI. Intra-abdominal pressure and its effect on urethral structures may be responsible for this increased risk. Older women should be counselled on the risk of central obesity for UI.

Objective: to compare the usual walking speed of our participants against that required by the TMG.

Design: cross-sectional observational study.

Setting: comprehensive geriatric assessment outpatient clinic.

Subjects: 355 community-dwelling older subjects aged ≥60 assessed between August 2007 and September 2008 (mean age 72.7, SD 7.2).

Methods: linear regression analysis between age and observed walking speed, followed by comparison of predicted walking speeds at four different ages (i.e. 60, 70, 80 and 89) against minimum walking speeds required to cross standard Irish roads when regulated by the pelican system.

Results: age and walking speed had a strong inverse correlation F (1, 353) = 108.48, P < 0.001, R² = 0.235. The regression predicted a walking speed of 1.30 m/s (95% confidence interval 1.24–1.35) at the age of 60, 1.10 (1.07–1.13) at 70, 0.91 (0.87–0.94) at 80 and 0.73 (0.66–0.80) at 89. Against these predicted walking speeds, standard crossing times appeared insufficient for very old people.

Conclusions: as currently defined in the TMG, maximum pedestrian crossing times at pelican crossings may represent a hazard for very old people. This should be addressed within the Irish authorities’ plan to improve safety and equality for older people.

Objective: to evaluate the prevalence of NTIS, its impact on patients’ survival and the possible pathogenic role of systemic inflammation.

Design: observational cross-sectional analysis.

Participants and setting: three hundred and one acutely ill older patients (156 women; median age 81 years, range 65–101) consecutively admitted to a primary care unit.

Methods: serum FT₃, FT₄ and thyrotropin levels as well as acute inflammation indexes were evaluated.

Results: the NTIS prevalence (specifically low T3 syndrome) was 31.9%. A significant association was found between NTIS and acute renal failure (P = 0.006), New York Heart Association classification (NYHA) IV heart failure (P = 0.003) and metastasised cancer disease (P = 0.0002). Serum FT₃ values correlated inversely with serum C-reactive protein (P < 0.0001), lactate dehydrogenase (P = 0.0004), fibrinogen (P = 0.03) and erythrocyte sedimentation rate (P < 0.0001) values, and progressively decreased with increasing tertiles of age (P = 0.0004). The mortality rate was significantly higher (P = 0.0002) among patients with low T3 syndrome, which emerged as the sole predictive factor of death (odds ratio 4.3; 95% confidence interval 1.7–10.5).

Conclusions: low T3 syndrome is very common in the hospitalised older population, emerging as the most sensitive independent predictor of short-term survival. Serum FT₃ determination should be included in the assessment of short-term prognosis of acutely ill older patients.

Method: MEDLINE, EMBASE and The Cochrane Library Database were used to identify potential studies. The studies were classified into cross-sectional and longitudinal subsets. For each study, the numbers of the total participants, cases (for cross-sectional study) or incident cases (for longitudinal study) of depression in each health status group were extracted and entered into Review Manager 4.2. The quantitative meta-analysis of cross-sectional studies and that of longitudinal studies were performed, respectively. For prevalence and incidence rates of depression, odds risk and relative risk (RR) were calculated, respectively.

Results: the quantitative meta-analysis showed that, compared with the elderly without chronic disease, those with chronic disease had higher risk for depression (RR: 1.53, 95% confidence intervals (CI): 1.20–1.97). Compared with the elderly with good self-rated health, those with poor self-rated health had higher risk for depression (RR: 2.40, 95% CI: 1.94–2.97).

Conclusions: despite the methodological limitations of this meta-analysis, both poor self-rated health status and the presence of chronic disease are risk factors for depression among the elderly. In the elderly, poor self-reported health status appears to be more strongly associated with depression than the presence of chronic disease.

Methods: an integrative review of published studies about stroke knowledge and awareness was performed by searching online bibliographic databases, using keywords, from 1966 to 2008. Studies were included in the review if they focussed on risk factors, signs and symptoms, action and information. Each study was reviewed by two researchers (SJ and MJ).

Results: we identified 169 studies of which 39 were included in the review. The ability to name one risk factor for stroke varied between studies, ranging from 18% to 94% when asked open-ended questions and from 42% to 97% when asked closed questions. The ability to name one symptom ranged from 25% to 72% when asked open-ended questions and from 95% to 100% when asked closed questions. When asked what action people would take if they thought they were having a stroke, between 53% and 98% replied that they would call the EMS. People generally obtained information about stroke from family and friends. Older members of the population, ethnic minority groups and those with lower levels of education had consistently poor levels of stroke knowledge.

Conclusions: generally, levels of knowledge about recognising and preventing stroke were poor. Nevertheless, most participants stated they would contact the EMS at the onset of stroke symptoms.

Design: cross-sectional analysis using data from the British Women’s Heart and Health Study.

Setting: general practices in 23 towns in the UK.

Participants: 3,775 women aged 60–80 years from 1999 to 2001.

Main outcome measure: orthostatic hypotension—drop of ≥20 mmHg in systolic and/or a drop of ≥10 mmHg in diastolic blood pressure on standing.

Results: prevalence of OH was 28% (95% confidence interval [CI] 26.6, 29.4), which increased with age and hypertension. Regardless of treatment status or diagnosed hypertension, raised blood pressure was strongly associated with OH (P < 0.001). OH was strongly associated with number of antihypertensives taken (none vs three or more: odds ratio [OR] 2.24, 95% CI 1.47–3.40, P < 0.001); the association was slightly attenuated after allowing for age and co-morbidities (OR 1.99; 95% CI 1.30, 3.05; P = 0.003). Women with multiple co-morbidities had markedly increased odds of OH independent of age, number and type of medications taken (none vs four or more diagnoses: OR 2.28, 95% CI 1.58–3.30, P = 0.005).

Conclusion: uncontrolled hypertension, use of three or more antihypertensives and multiple co-morbidities are predictors of OH in older women. Detection or monitoring of OH in these groups may prevent women from suffering its adverse consequences.

Objective: the aim of the study is to investigate the possible interaction of HDL-C on inflammation and physical function.

Design: cross-sectional study.

Setting: town of Tuscania (Italy).

Subjects: all the 329 community-dwelling older persons aged ≥75 years (mean age 79.8 ± 5.2 years, women 56.2%).

Methods: HDL-C, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. Activities of daily living (ADL), instrumental ADL (IADL) and 4-m walking speed were assessed. Linear regression models were performed.

Results: given the multiple significant interactions, models were stratified according to HDL-C concentrations. In participants with normal HDL-C concentrations, only IL-6 showed a significant association with IADL (β = –0.439, SE = 0.176, P = 0.01). In participants with low HDL-C concentrations, all three inflammatory biomarkers were significantly associated with 4-m walking speed and IADL. IL-6 was also significantly associated with ADL (β = –0.755, SE = 0.259, P = 0.006), whereas borderline significances were reported for CRP and ESR.

Conclusions: the association between inflammation and physical function is particularly enhanced in elders with low HDL-C concentrations. Though HDL-C may merely act as a wellbeing index, HDL-C concentrations should be considered in studies evaluating inflammation and physical function.

Objective: to assess the prevalence and the prognostic significance of oropharyngeal dysphagia among elderly patients with pneumonia.

Design: a prospective cohort study.

Setting: an acute geriatric unit in a general hospital.

Subjects: a total of 134 elderly patients (>70 years) consecutively admitted with pneumonia.

Methods: clinical bedside assessment of oropharyngeal dysphagia and aspiration with the water swallow test were performed. Demographic and clinical data, Barthel Index, Mini Nutritional Assessment, Charlson Comorbidity Index, Fine's Pneumonia Severity Index and mortality at 30 days and 1 year after admission were registered.

Results: of the 134 patients, 53% were over 84 years and 55% presented clinical signs of oropharyngeal dysphagia; the mean Barthel score was 61 points indicating a frail population. Patients with dysphagia were older, showed lower functional status, higher prevalence of malnutrition and comorbidities and higher Fine's pneumonia severity scores. They had a higher mortality at 30 days (22.9% vs. 8.3%, P = 0.033) and at 1 year of follow-up (55.4% vs. 26.7%, P = 0.001).

Conclusions: oropharyngeal dysphagia is a highly prevalent clinical finding in elderly patients with pneumonia and is an indicator of disease severity in older patients with pneumonia.