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PURPOSE: Men have generally demonstrated higher pressure pain thresholds (PPT) than women. However, the possible impact of aging on the gender differences in pain perception has not been fully evaluated. In this study, we aimed to investigate the gender differences in PPT over the life course, in young, middle-aged and older adults. METHODS: This cross-sectional study involved 355 pain-free healthy individuals aged 19-95 years, divided into < 45, 45-64 and ≥ 65 years age groups. PPT were measured using Fisher's algometer. Data on anthropometry, formal education and occupation were collected for each participant, and a multidimensional geriatric assessment was performed in older individuals. RESULTS: Lower PPT values were observed in old vs young adults (21.8 ± 8.7 N/cm2 vs 59.5 ± 31.6, p < 0.0001) and in women vs men (16.3 ± 6.1 vs 42.8 ± 19.6 N/cm2, p = 0.0003). A significant interaction emerged between age and sex in influencing PPT (pinteraction = 0.03). Although women had lower mean PPT values than men in all age groups, such gender difference diminished with aging, from 42.8 ± 19.6 vs 59.5 ± 31.6 N/cm2 (p = 0.001) to 16.3 ± 6.1 vs 21.8 ± 8.7 vs N/cm2 (p = 0.003) in younger and older women vs men, respectively. CONCLUSIONS: Female gender and older age are associated with lower PPT, but such gender difference seems to decrease with aging.

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OBJECTIVES: To investigate frailty state transitions in a cohort of older Italian adults to identify factors exacerbating or improving frailty conditions. DESIGN: Population-based longitudinal study with mean follow-up of 4.4 years. SETTING: Community. PARTICIPANTS: Individuals enrolled in the Progetto Veneto Anziani (Pro.V.A.) (N = 2,925; n = 1,179 male, n = 1,746 female; mean age 74.4 ± 7.3). MEASUREMENTS: Frailty was identified at baseline and follow-up based on the presence of at least three Fried criteria; prefrailty was defined as the presence of one or two Fried criteria. Anthropometric, socioeconomic, and clinical characteristics were assessed at baseline in a personal interview and clinical examination using validated scales and medical history. RESULTS: During the study period, 1,114 (38.1%) subjects retained their baseline frailty status, 1,066 (36.4%) had a transition in frailty status, and the remainder of the sample died. Older age, female sex, obesity, cardiovascular disease, osteoarthritis, smoking, loss of vision, low levels of self-sufficiency and physical performance, cognitive impairment, hypovitaminosis D, hyperuricemia, and polypharmacy were associated with increasing frailty and greater mortality. Conversely, overweight, low to moderate drinking, high educational level, and living alone were associated with decreasing frailty. CONCLUSIONS: Frailty was confirmed as a dynamic syndrome, with socioeconomic and clinical factors that could be targets of preventive actions influencing transitions to better or worse frailty status.

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BACKGROUND: An adequate vitamin intake is essential for a good nutritional status, especially in older women, who are more sensitive to nutritional deficiencies. The American, European and Italian Recommended Dietary Allowances (RDAs) derive mainly from studies on adults, and it is not clear whether they also apply to elderly people. Comparing the RDAs with the actual vitamin intake of a group of healthy older women could help to clarify the real needs of elderly people. OBJECTIVE: Our aim was to compare the American, European, and Italian RDAs with the actual vitamin intake of a group of healthy older women. DESIGN: This was a cross-sectional study. PARTICIPANTS: The study included 286 healthy women aged older than 65 years. MAIN OUTCOME MEASURES: For each micronutrient, the 50th percentile of the distribution of its intake was considered as the average requirement, and the corresponding calculated RDA for our sample was the average requirement×1.2, as recommended by the US Food and Nutrition Board. This calculated RDA was then compared with the American, European, and Italian RDAs. STATISTICAL ANALYSES PERFORMED: Student's t test or the Mann-Whitney test (after checking the normal distribution of the micronutrient) for continuous variables; the χ(2) test for categorical variables. RESULTS: The calculated RDA were 2,230 µg retinol equivalents for vitamin A, 2.8 µg for vitamin B-12, 0.9 mg for thiamin, 1.4 mg for riboflavin, 3.6 mg for pantothenic acid, 1.4 mg for vitamin B-6, 320 µg for folic acid, and 115 mg for vitamin C. CONCLUSIONS: Our findings suggest that the current RDAs are adequate for older women's intake of riboflavin, vitamin B-6, and folic acid, but should be raised for vitamin B-12 and for vitamin C.

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PURPOSE: Although high serum uric acid (SUA) levels are associated with negative outcomes in older people, recent studies reported that hyperuricemia could help protect against the onset of bone fractures. We consequently examined whether baseline SUA levels were associated with risk of incident osteoporotic fractures in a representative group of elderly people with no fractures or other bone-modifying conditions or drugs at the baseline. METHODS: Among 3099 people aged ≥ 65 years initially involved in the PRO.V.A. study, 1586 participants with no prior diagnosis of osteoporotic fractures, and no conditions or medication affecting bone metabolism at the baseline were followed up for 4.4 ± 1.2 years. Baseline SUA levels were classified in gender-specific quintiles. Incident osteoporotic fractures were considered as any new fractures occurring at the usual sites of osteoporotic fractures. RESULTS: At the baseline, participants with higher SUA levels had significantly less osteoporosis and lower serum beta cross-laps levels, but higher serum parathormone concentrations irrespective of gender. Over a 4.4-year follow-up, 185 subjects were diagnosed with a new osteoporotic fracture, giving rise to an incidence of 25 events per 1,000 person-years. Cox's regression analysis, adjusted for potential baseline and follow-up confounders, revealed no relationship between high SUA levels and incident fractures during the follow-up in the sample as a whole (p for trend=0.46) or by gender (p for trend=0.14 in males and 0.64 in females). CONCLUSIONS: Baseline SUA concentrations were not associated with the onset of new osteoporotic fractures over a 4.4-year follow-up in our sample of community-dwelling older men and women.

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BACKGROUND: Frailty is an important risk factor for cardiovascular disease (CVD), but the impact of early, potentially reversible stages of frailty on CVD risk is unknown. OBJECTIVES: This study sought to ascertain whether pre-frailty can predict the onset of CVD in a cohort of community-dwelling, not disabled, elderly people. METHODS: A sample of 1,567 participants age 65 to 96 years without frailty or disability at baseline was followed for 4.4 years. Pre-frailty was defined as the presence of 1 or 2 modified Fried criteria (unintentional weight loss, low physical activity level, weakness, exhaustion, and slow gait speed), and incident CVD as onset of coronary artery diseases, heart failure, stroke, peripheral artery disease, or CVD-related mortality. RESULTS: During follow-up, 551 participants developed CVD. Compared with participants who did not become frail, those with 1 modified Fried criterion (p = 0.03) and those with 2 criteria (p = 0.001) had a significantly higher risk of CVD, even after adjusting for several potential confounders (traditional risk factors for CVD, inflammatory markers, and hemoglobin A1c levels). Low energy expenditure (p = 0.03), exhaustion (p = 0.01), and slow gait speed (p = 0.03) were significantly associated with the onset of CVD, whereas unintentional weight loss and weakness were not. CONCLUSIONS: Our findings suggest that pre-frailty, which is potentially reversible, is independently associated with a higher risk of older adults developing CVD. Among the physical domains of pre-frailty, low gait speed seems to be the best predictor of future CVD.

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BACKGROUND: An extensive, albeit contrasting literature has suggested a possible role for orthostatic hypotension as a risk factor for cardiovascular (CVD) and non-CVD mortality, while no data are available for orthostatic hypertension. We investigated whether orthostatic changes in blood pressure (BP) were associated with any increased risk of all-cause, CVD or non-CVD mortality in a group of elderly people. METHODS: Two thousand seven hundred and eighty six community-dwelling older participants were followed for 4.4 years. Participants were grouped according to whether they had a drop ≤20 mm Hg in systolic, or ≤10 mm Hg in diastolic BP (orthostatic hypotension), an increase in mean orthostatic systolic BP ≥20 (orthostatic hypertension), or normal changes within 3 minutes of orthostatism. RESULTS: During follow-up, 640 subjects died, 208 of them for CVD-related reasons. Adjusted Cox's regression analysis revealed that, compared with normal changes, orthostatic hypertension was associated with higher all-cause (HR = 1.23; 95% CI: 1.02-1.39) and CVD-related mortality (HR = 1.41; 95% CI: 1.08-1.74), while orthostatic hypotension was only associated with a higher non-CVD mortality (HR = 1.19; 95% CI: 1.01-1.60). Orthostatic hypertension emerged as a predictor of all-cause mortality for: participants over 75 years old; participants with a BMI below 25 kg/m2; participants with no CVD or disabilities; and those taking less than three medications. Orthostatic hypertension also predicted CVD-related mortality in individuals with no hypertension, heart failure, coronary artery disease, or atrial fibrillation. CONCLUSIONS: Orthostatic hypertension and hypotension both seem to be relevant risk factors for mortality in the elderly, orthostatic hypertension correlating with all-cause and CVD-related mortality and orthostatic hypotension with non-CVD mortality.

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AIM: This study was conducted to examine whether low serum levels of 25-hydroxyvitamin D (25OHD)are associated with a higher risk of incident peripheral artery disease (PAD) in a representative group of elderly people. METHODS: We followed 1568 community-dwelling elderly participants without PAD at the baseline (among a sample of 2097 initially eligible) over a mean of 4.4 years as part of the Progetto Veneto Anziani (Pro.V.A.) study. The baseline serum 25OHD levels were categorized as ＜24, 25-49, 50-74, ＞75 nmol/L, and incident PAD was defined as an ankle-brachial index below 0.9. RESULTS: At the baseline, there were no differences in known risk factors for PAD (BMI, waist circumference, diabetes, cardiovascular diseases, smoking habits, total cholesterol) or in the ankle-brachial index (ABI) between the groups with different serum 25OHD levels (＜24, 25-49, 50-74, ＞75 nmol/L). During a 4.4-year follow-up, 371 subjects developed PAD. The group with serum 25OHD levels ＞75 nmol/L was set as the reference group, and an adjusted Cox's regression analysis showed no association between low vitamin D levels and incident PAD during the follow-up: the hazard ratio ranged from 0.76 (95%CI: 0.41-1.42) for participants with serum 25OHD levels below 25 nmol/L to 1.32 (95%CI: 0.72-2.39) for those with serum 25OHD levels between 50-74 nmol/L (p for trend=0.08). These results did not change when participants were stratified by several risk factors for PAD. CONCLUSIONS: Baseline hypovitaminosis D did not predict the onset of PAD over a 4.4-year follow-up in elderly people.

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OBJECTIVE: Dehydroepiandrosterone sulfate (DHEAS) appears to have a protective effect against depression, but contrasting findings are available. Therefore, we investigated whether high serum DHEAS levels were associated with any protective effect on incident depression and incident severe depression in a representative group of elderly men and women. METHODS: In a population-based cohort longitudinal study in the general community, 789 older participants without depression and cognitive impairment at the baseline were included, among 3,099 screened subjects. Serum DHEAS levels were determined based on blood samples; incident depression and severe depression were diagnosed by means of the Geriatric Depression Scale (GDS) and confirmed by geriatricians skilled in psychogeriatric medicine. RESULTS: No baseline differences were found in GDS across age- and gender-specific tertiles of serum DHEAS. Over 4.4 years of follow-up, 137 new cases of depression were recorded. Of them, 35 among men and 64 in women were cases of incident severe depression. Cox's regression analysis, adjusted for potential confounders, revealed that higher DHEAS levels were associated with reduced risk of incident depression irrespective of gender (HR: 0.30; 95% CI: 0.09-0.96; Wald χ(2) = 4.09; df = 1; p = 0.04; women: HR: 0.31; 95% CI: 0.14-0.69; Wald χ(2) = 8.37; df = 1; p = 0.004) and of severe incident depression only in men (HR: 0.25; 95% CI: 0.06-0.99; Wald χ(2) = 4.05; df = 1; p = 0.04). CONCLUSION: Higher serum DHEAS levels were found to be significantly protective for the onset of depression irrespective of gender, whereas only in men was this association found also for incident severe depression.

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BACKGROUND: Magnesium deficiency is associated with poor physical performance, but no trials are available on how magnesium supplementation affects elderly people's physical performance. OBJECTIVE: The aim of our study was to investigate whether 12 wk of oral magnesium supplementation can improve physical performance in healthy elderly women. DESIGN: In a parallel-group, randomized controlled trial, 139 healthy women (mean ± SD age: 71.5 ± 5.2 y) attending a mild fitness program were randomly allocated to a treatment group (300 mg Mg/d; n = 62) or a control group (no placebo or intervention; n = 77) by using a computer-generated randomization sequence, and researchers were blinded to their grouping. After assessment at baseline and again after 12 wk, the primary outcome was a change in the Short Physical Performance Battery (SPPB); secondary outcomes were changes in peak torque isometric and isokinetic strength of the lower limbs and handgrip strength. RESULTS: A total of 124 participants allocated to the treatment (n = 53) or control (n = 71) group were considered in the final analysis. At baseline, the SPPB scores did not differ between the 2 groups. After 12 wk, the treated group had a significantly better total SPPB score (Δ = 0.41 ± 0.24 points; P = 0.03), chair stand times (Δ = -1.31 ± 0.33 s; P < 0.0001), and 4-m walking speeds (Δ = 0.14 ± 0.03 m/s; P = 0.006) than did the control group. These findings were more evident in participants with a magnesium dietary intake lower than the Recommended Dietary Allowance. No significant differences emerged for the secondary outcomes investigated, and no serious adverse effects were reported. CONCLUSIONS: Daily magnesium oxide supplementation for 12 wk seems to improve physical performance in healthy elderly women. These findings suggest a role for magnesium supplementation in preventing or delaying the age-related decline in physical performance.

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CONTEXT: Increasing research has shown that low levels of serum 25-hydroxyvitamin (25OHD) predict the onset of diabetes, but no research is available on this issue in elderly people. OBJECTIVE: Our objective was to examine whether low serum levels of 25OHD are associated with a higher risk of incident type 2 diabetes over a lengthy follow-up in a representative group of elderly people. DESIGN AND SETTING: This was a population-based cohort study as part of the Progetto Veneto Anziani (Pro.V.A.) Study over a follow-up of 4.4 years in the general community. PARTICIPANTS: PARTICIPANTS included 2227 participants (1728 with follow-up visits and 499 died during the follow-up) over 65 years of age without diabetes at baseline, of 2352 initially included. MAIN OUTCOME MEASURE: The main outcome measure was incident diabetes. RESULTS: There were no baseline differences in known factors for the onset of diabetes (body mass index, waist circumference, total cholesterol, renal function, and hemoglobin A1c levels) between the groups with different serum 25OHD levels (≤ 25, 25-50, 50-75, and ≥ 75 nmol/L). Over a 4.4-year follow-up, 291 individuals developed diabetes, with an incidence of 28 events per 1000 person-years. No significant difference in the incidence of diabetes emerged between the baseline 25OHD groups. Cox's regression analysis, adjusted for potential confounders, revealed no relationship between low vitamin D levels and incident diabetes during the follow-up (hazard ratio [HR] = 1.05, 95% confidence interval [CI] = 0.76-1.45, P = .77; HR = 1.44, 95% CI = 0.95-1.98, P = .12; and HR = 1.37, 95% CI = 0.87-2.16, P = .17 for those with 25OHD ≤25, 25-50, and 50-75 nmol/L, respectively). CONCLUSION: Baseline serum concentrations of 25OHD were not associated with the incidence of diabetes in community-dwelling elderly people over a follow-up of 4.4 years.

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BACKGROUND: Optimal vitamin D status is important for overall health and well-being, particularly in the elderly. Although vitamin D synthesis in the skin declines with age, exposure to sunlight still seems to help older-aged adults to achieve adequate serum 25-hydroxyvitamin D (25OHD) levels. Elderly people would therefore benefit from outdoor leisure activities, but the effects of different types of pastime on serum 25OHD levels have yet to be thoroughly investigated. AIMS: To assess the association of different pastimes with 25OHD deficiency in elderly subjects. METHODS: A sample of 2,349 community-dwelling elderly individuals (1,389 females and 960 males) enrolled in the Progetto Veneto Anziani was analyzed. Brisk walking, cycling, gardening and fishing were classed as outdoor activities, and dancing and gym workouts as indoor pastimes. Any activities undertaken for at least 1 hour/week during the previous month were considered as being practiced regularly. Logistic regression models were used to estimate the association between different pastimes and 25OHD deficiency. RESULTS: Serum 25OHD levels were significantly higher in individuals who engaged in outdoor pastimes (+25% in women, +27.7% in men) compared to those who did not. In particular, subjects regularly practicing gardening or cycling had higher serum 25OHD levels than those who did not, whereas 25OHD levels differed little between subjects who did or did not undertake indoor activities. Among the outdoor pastimes considered, logistic regression analysis confirmed a lower likelihood of vitamin D deficiency (25OHD<50 nmol/L) for cyclists (OR 0.51, 95% CI 0.37-0.69 in women; OR 0.50, 95% CI 0.29-0.87 in men) and gardeners (OR 0.62, 95% CI 0.47-0.83 in women; OR 0.46, 95% CI 0.26-0.80), but not for brisk walkers. CONCLUSIONS: Regular cycling and gardening reduce the likelihood of inadequate vitamin D status in Caucasian elderly people, irrespective of their age, BMI and comorbidities, and of the season of the year.

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It is known that weakness in the lower limbs is associated with recurrent falls in old people. Among the tests routinely used to assess lower extremity strength, the Short Physical Performance Battery (SPPB) is one of those used most often, but its relationship with recurrent falls is poorly investigated. We aimed to determine if SPPB scores are related to recurrent falling in a sample of 2710 older-aged people, and to ascertain which test in the SPPB is most strongly associated with a higher rate of falls. In this cross-sectional study, we demonstrated that participants scoring 0-6 in the SPPB were more likely to be recurrent fallers than those scoring 10-12 (odds ratio [OR]=3.46, 95% confidence interval [CI] 2.04-5.88 in women; OR=3.82, 95% CI 1.77- 8.52, in men). SPPB scores of 7-9 were only associated with women being more likely to be recurrent fallers (OR=2.03, 95% CI 1.28-3.22). When the SPPB items were analyzed separately, even a lower score in gait speed for women was significantly associated with the presence of recurrent falls (OR=2.11; 95% CI 1.04-4.30), whereas in men only a significant increase in the time taken to complete the five timed chair stands test was associated with a higher rate of falls (OR=2.75; 95% CI 1.21-6.23). In conclusion, our study demonstrated that SPPB scores ≤6 are associated with a higher fall rate in old people of both genders; in females, even an SPPB score between 7 and 9 identifies subjects at a higher likelihood of being recurrent fallers. Among the single items of the SPPB, the most strongly associated with falls were gait speed in women and the five timed chair stands test in men.

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BACKGROUND: Body mass index (BMI) is considered a short-term mortality predictor, but a consensus has not been reached on its role and that of other nutritional parameters in predicting long-term mortality in nursing home residents. OBJECTIVES: To correlate BMI, Mini Nutritional Assessment scores, and serum albumin levels with the 5-year mortality rate in institutionalized elderly subjects. METHODS: A total of 181 nursing home residents aged ≥ 70 years were included in a 5-year longitudinal study. Data were collected on all participants' nutritional, health, cognitive, and functional status by means of a comprehensive geriatric assessment. Data on the participants' vital status were obtained 5 years after beginning the study, and a survival analysis was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models. RESULTS: The 5-year mortality rate was 63%. The deceased subjects (n = 115) had a lower BMI (24.7 ± 4.6 vs 26.6 ± 5.0 kg/m(2); P = .03) and Mini Nutritional Assessment score (18.6 ± 3.7 vs 20.1 ± 3.6; P = .02) than those still alive. Serum albumin levels did not differ between the two groups. Among the three indicators of nutritional status considered in this study, only BMI ≥ 30 kg/m(2) was significantly associated with a lower mortality risk at 5 years (hazard ratio = 0.432; 95% CI 0.20-0.70; P = .04), the risk for death being greater the lower the BMI class (log-rank test: P < .001). CONCLUSIONS: Our findings suggest that BMI is the best of the three parameters considered as a nutritional predictor of nursing home residents' mortality in the longer term, and indicate that a lower mortality risk coincides with a higher BMI.

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BACKGROUND: Aging is generally accompanied by changes in body composition, muscle mass and strength, leading to a decline in motor and functional performance. Physical activity and eating habits could be involved in modulating this paraphysiological deterioration. Aim of our study was to investigate changes in body composition, diet and physical performance in healthy, elderly females over a 3-year follow-up. METHODS: 92 healthy elderly females (70.9±4.0 years) attending a twice-weekly mild fitness program were eligible for the study. They were assessed at baseline and again after 3 years in terms of clinical history, diet, body composition by DEXA, resting energy expenditure, handgrip strength, knee extensor isometric/isotonic strength, and functional performance measured using the Short Physical Performance Battery (SPPB). RESULTS: After 3 years, women had a significant decline in muscle strength (∆ isotonic: -1.4±4.3 kg, ∆ isokinetic: -2.0±6.3 kg, ∆ handgrip: -3.2±5.0 kg; p<0.001) and physical performance (∆ walking time: 0.71±0.9 s, ∆ walking speed: -0.25±0.35 m/s; p<0.001), while their weight and body composition parameters did not change, except for a small decrease in appendicular skeletal muscle mass (-0.4±1.4 kg). There was a significant drop in calorie (∆:-345.7±533.1 kcal/d; p<0.001) and protein intake (∆:-0.14±0.23 g/d; p<0.001), while resting energy expenditure remained stable. ∆ calorie intake correlated with the variation in 4-meter walking time (r: 0.34; p<0.01). CONCLUSIONS: With advancing age, physical performance declines even in healthy, fit females despite a spare of weight and body composition. This decline in physical activity could lead to a lower calorie intake, which would explain why there is no variation in body weight.

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PURPOSE: The aim of this paper is to investigate whether bioelectrical impedance vector analysis (BIVA) can be a suitable technique for the assessment of sarcopenia. We also investigate the potential use of specific BIVA as an indicator of sarcopenic obesity. SUBJECTS AND METHODS: The sample comprised 207 free-living elderly individuals of both sexes, aged 65 to 93 years. Anthropometric and bioelectrical measurements were taken according to standard criteria. The "classic" and "specific" BIVA procedures, which respectively correct bioelectrical values for body height and body geometry, were used. Dual energy X-ray absorptiometry (DXA) was used as the reference method for identifying sarcopenic and obese sarcopenic individuals. Bioelectrical and DXA values were compared using Student's t-test and Hotelling's T(2) test, as well as Pearson's correlation coefficient. RESULTS: According to classic BIVA, sarcopenic individuals of both sexes showed higher values of resistance/height (R/H; p < 0.01) and impedance/height (Z/H; p < 0.01), and a lower phase angle (p < 0.01). Similarly, specific BIVA showed significant differences between sarcopenic and nonsarcopenic individuals (men: T(2) = 15.7, p < 0.01; women: T(2) = 10.7, p < 0.01), with the sarcopenic groups showing a lower specific reactance and phase angle. Phase angle was positively correlated with the skeletal muscle mass index (men: r = 0.52, p < 0.01; women: r = 0.31, p < 0.01). Specific BIVA also recognized bioelectrical differences between sarcopenic and sarcopenic obese men (T(2) = 13.4, p < 0.01), mainly due to the higher values of specific R in sarcopenic obese individuals. CONCLUSION: BIVA detected muscle-mass variations in sarcopenic individuals, and specific BIVA was able to discriminate sarcopenic individuals from sarcopenic obese individuals. These procedures are promising tools for screening for presarcopenia, sarcopenia, and sarcopenic obesity in routine practice.

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AIMS: The aim of this study was to assess, in a natural setting, the development of cognitive, behavioral and functional performance of elderly dementia patients treated with cholinesterase inhibitors (ChEIs) during a 21-month follow-up. Another aim was to compare patterns of clinical changes in relation to patients' level of cognitive impairment at the beginning of therapy. METHOD: Of the 1987 elderly demented patients seen at our unit, 143 met the inclusion/ exclusion criteria, were followed for at least 21 months, and were thus included in the study. At baseline and each control point (up to 21 months), patients were scored for Mini Mental State Examination (MMSE), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). RESULTS: After 21 months' treatment with ChEIs, patients showed a significant reduction in MMSE, ADL and IADL values. The MMSE score decreased by 1.7 points/year (95% CI -2.1; -1.3), irrespective of initial cognitive level, and was lower than that expected in non-treated patients (-3/-4 points/year). CONCLUSION: ChEI therapy is effective in slowing the progression of dementia, even in the long term, irrespective of baseline cognitive level.

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AIMS: 1) to evaluate the prevalence of diabetes mellitus (DM) in a geriatric ward; 2) to assess the efficacy and safety of insulin analogs in elderly inpatients over 65 years of age. METHODS: We analysed the medical records of 1851 elderly inpatients admitted to our geriatric clinic from March 2009 to September 2011, to identify patients with DM. The efficacy and safety of insulin analogs were measured in patients with a hospital stay of at least 9 days, by assessing the means of all glycemic sticks (4-7 sticks/day), number of hyperglycemic events (>250 mg/dL) and number of hypoglycemic events (<70 mg/dL) daily. RESULTS: DM prevalence was 25% (463/1851). Diabetic patients' mean age was 82.9 ± 7.5 years. DM mortality during hospital stay was 10.8% vs 6.7% for non-diabetics (p<0.05). 206/463 diabetic inpatients were treated with insulin, and 85.9% of them received analogs (Rapid and Longer-Acting). Decreases in mean daily glycemia values (from 218.8 ± 81.6 mg/dL to 170.9 ± 42.9 mg/dL, p<0.001) and in number of hyperglycemic events (from 118 to 47) (p<0.012) were noted in 128 insulin analog-treated patients over the 9-day hospitalization. Only 35 hypoglycemic events were found out of 4745 sticks (0.7%). CONCLUSIONS: 1) DM prevalence and mortality in our very old inpatients are high and similar to data reported in the literature. 2) Insulin therapy with analogs is effective (achieves good glycemic control) and safe (low rate of hypoglycemia) even in these frail, very old inpatients.

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BACKGROUND AND AIMS: Congestive heart failure (CHF) is characterized by high levels of B-type natriuretic peptide (BNP), expanded total body water (TBW) and extracellular water (ECW). Bioelectrical impedance analysis (BIA) has demonstrated high diagnostic accuracy in CHF but no information is available for older patients. We hypothesized that, in the follow-up of patients with CHF, body fluid changes estimated by BIA are related to BNP variations rather than with body weight. The aim of this study was to evaluate the relationship between variations in body fluid compartments, body weight and BNP in hospitalized elderly patients with decompensated CHF. METHODS: 49 elderly patients admitted to the Geriatric Department for decompensated CHF were included in the study. On admission and at discharge, all patients underwent clinical and functional assessment and BNP dosage. TBW and ECW were also determined by the BIA method. RESULTS: At discharge, all patients showed reductions in TBW (ΔTBW -2.9 ± 3.0 liters), ECW (ΔECW 1.9 ± 2.1 liters) and BNP levels (ΔBNP -219.6 ± 458.1 pg/mL). Variations in TBW and ECW were correlated with BNP changes (r=0.65 and 0.62, respectively) rather than with body weight variations and BNP changes (r=0.51). CONCLUSIONS: The stronger relationship between fluid variations determined by BIA and BNP changes may make BIA a useful method in the follow-up of decompensated CHF elderly patients.

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Aging-related physical changes do not necessarily lead to a decline in sexual functioning: good physical and mental health, a positive attitude toward sex in later life, and access to a healthy partner are associated with continued sexual activity, and regular sexual expression is associated with good physical and mental health. However, it is usually assumed that older adults do not have sexual desires, and elderly people often find it difficult to discuss this topic with their doctor. There are many potential barriers concerning sexuality in older age: the lack of a healthy sexual partner, depression, the monotony of a repetitive sexual relationship, a spouse's physical unattractiveness, hormone variability, and illness and/or iatrogenic factors. Adaptive coping strategies can considerably mitigate the impact of such factors, however, and one way of contributing to breaking down barriers and taboos is undoubtedly to ensure that physicians are willing to discuss their patients' sexual history. The aim of this review was to explore the barriers and taboos to sexual expression in seniors, to propose strategies to foster this aspect of their lives, and to help physicians investigate the sexual history of their elderly patients.

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Elderly subjects with advanced dementia are exposed, like all aging individuals, to a wide range of chronic degenerative and progressive medical conditions which can cause pain and discomfort, both physical and psychological. Pain is defined as an unpleasant subjective experience, generally assessed with verbal self-reporting methods. The inability to report pain verbally - a common occurrence in advanced stages of dementia - is widely recognized as the main confounding factor in identifying these patients' pain. As several previous studies on pain assessment in cognitively impaired elderly subjects systematically eliminated non-communicative demented patients, it is hard to estimate the prevalence of their pain. The lack of pain assessment methods which do not rely on self-reporting contributes to under-estimation of the prevalence of pain, particularly among institutionalized patients, the majority of whom suffer from some degree of dementia. Assessing chronic pain in these frail elderly patients requires careful monitoring of any changes in their behavior which may be due to a new source of discomfort, rather than an aggravation of their cognitive impairment. Although some currently available tools for pain assessment in non-verbal older adults seem promising, no single tool has yet been sufficiently validated as reliable for widespread adoption in clinical practice. Prior research has documented a significantly lower prescription of analgesic medications in demented patients than in cognitively intact peers: as untreated or under-treated pain can have adverse physical and psychological consequences, there is an urgent need for appropriate pain assessment methods in elderly patients with advanced dementia, since too many of them continue to suffer needlessly. The purpose of this review is to discuss the main tools developed in the last decade for pain assessment in non-communicative older individuals, highlighting the strengths and weaknesses of each, and providing a guide for their use in clinical practice, particularly in geriatric settings.

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