Multimodal home care intervention for dependent older people “Live better at home”: Protocol of a randomized clinical trial

BackgroundThe intensity of the home care interventions for dependent older people offered in Spain may not be sufficient to help keep older people living at home, being the institutionalization in a nursing home (NH) an unavoidable consequence.ObjectiveTo evaluate the effect of intensification in home care interventions on users with grade II or III dependency, as well as training for their informal caregivers in order to delay or avoid their institutionalization in a NH.MethodsA randomized clinical trial with two parallel arms and blinded assessment will be conducted at the community level in two municipalities in Catalonia (Spain). The study will include those older people (aged 65 and over) living in the community, with degree II or III of dependency, users of the public home care unwilling to be institutionalized and with a main informal caregiver in charge, who will also participate in the study. The assessments will be performed monthly up to 15 months, when the intervention will be finished. The main outcome will be the time until the willingness for admission to a NH. Secondary variables will be composed of sociodemographic, health, psychosocial, resource use, and follow-up variables. A multivariate Cox regression model will be carried out to estimate the effectiveness of the intervention.DiscussionA multimodal home care intervention could improve the health and psychosocial status of dependent people and their informal caregivers and facilitate their permanence at home.Trial registrationNCT05567965     

Dolor en el anciano: calidad de vida,funcionalidad y factores asociados. Estudio SABE,Bogotá, Colombia

ObjectiveTo determine the impact of pain on the quality of life in older adults and its association with functionality.Materials and methodsData was taken from SABE Bogota study. A cross-sectional study was carried out during 2012, interviewing 2,000 individuals of 60 years and older, as a probabilistic cluster and representative sample. The variable ‘presence of pain’ to was used to identify associations with sociodemographic factors, self-rated health, comorbidities, functional status, cognitive status, and quality of life. The latter was estimated using a visual analogue scale of the EuroQOL tool (EQ-VAS).ResultsThe majority of older adults were women (63.4%); the mean age was 71.17 years (SD = 8.05), with a higher frequency of individuals in the age group between 60 and 69 years (48%). When comparing groups with pain vs. no pain, significantly lower scores were found in the group with pain (P < .001) in both the functionality and quality of life EQ-VAS scales. The strongest associations with pain were: joint diseases (OR: 3.08 [2.24-4.23]), severe depression (OR: 2.80 [1.63-4.79]) and functional impairment of the Basic Activities of Daily Living (BADL) (OR: 2.45 [1.31-4.58]).ConclusionsPain negatively impacts the functional independence and the perception of the quality of life in older adults, predisposing them to adverse outcomes.     

La desesperanza como predictora de la soledad en adultos mayores

Background and objectiveHopelessness is characterized by a set of negative cognitive schemas about the future, conceptualized on the basis of three dimensions: affective, motivational and cognitive. This construct is linked to loneliness, the incidence of which in older adults is increasingly high. The aim of this research is to test whether hopelessness factors predict levels of loneliness in older adults.Material and methods138 non-institutionalized persons from Valencia city between 65-90 years old participated, with a mean age of 73.67 (SD = 4.8), and 59.4% were women. The Beck Hopelessness Scale (BHS) and University of California Los Angeles Loneliness Scale (UCLA) were administered to assess participants.ResultsThe motivational and cognitive factors acted as statistically significant predictors of loneliness, while the affective factor was not presented as a significant factor. The final model obtained an R² adj = .442, F(3, 87) = 23.97, p < .001.ConclusionsLoneliness is a phenomenon of great concern in the field of gerontology due to its high incidence and impact. The results indicate that hopelessness, specifically loss of motivation and negative expectations about the future, are critical issues for the development of feelings of loneliness in older adults. Thus, it is relevant to pay attention to these variables in order to apply loneliness prevention programs.     

Asociación entre la longitud de los telómeros y deterioro cognitivo en adultos mayores

IntroductionCognitive impairment is a transition stage between normal aging and dementia, the prevalence of last one increases with age; the damage of the functions and physical integrity, places the older adult in a greater susceptibility to get sick. Telomere length is a hallmark of aging to characterize this phenotype, as well as a biomarker that reflects the underlying state of the cell. In this work, the relative length of telomeres in older adults with cognitive impairment was correlated.Material and methodsObservational-analytical study, in samples of adult patients older than 65 years with and without cognitive impairment, in whom the relative length of telomeres was measured.ResultsNinety samples of older adults were included in the study and in the association analysis according to multivariate logistic models, cognitive impairment showed almost five times more risk for telomere shortening in relation to the presence of the diagnosis of cognitive impairment (Odds ratio 4.88, p = 0.027).ConclusionsWhen correlating the relative length of telomeres in older adults diagnosed with cognitive impairment, this association was confirmed for shorter.     

Does the Spanish version of the SWLS measure the same in Spain and Peru?

AimSatisfaction with life is a measure of protection in older adults. There lies the importance of providing quality instruments. The aim of the study was to evaluate the invariance of the life satisfaction scale (SWLS) in two samples of older adults in Spain and Peru.MethodThe participants were 857 older adults in Spain (mean age = 68.23 years, SD = 5.93) and 336 older adults in Peru (average age = 72.42, SD = 7.07). All multi-group confirmatory factor analyzes were estimated in Mplus 8.0.ResultsThe results indicate the presence of a strict invariance of the one-dimensional structure of the SWLS in samples of older adults in Spain and Peru, which allows for meaningful comparisons of latent means and covariances. Comparison of latent means showed small differences in the construct between the cultural groups.ConclusionsThe SWLS is a valid instrument for intercultural comparisons between Spanish and Peruvian population. The measurement invariance assessment contributes to a better understanding of life satisfaction in populations from different cultural contexts.     

Factors associated with self-rated health status of older people with multimorbidity in Colombia: A cross-sectional study

Background and objectiveIn Colombia, older adults (60 years and older) are expected to represent 15.5% of the overall population by 2025. Consequently, the demand for social and healthcare services will increase, especially because of the numerous medical conditions associated with aging. The purpose of the present study was to determine the patient's self-rated health status of older adults with multimorbidity and its determining factors based on gender in an insurance company of the Colombian health system.MethodologyA cross-sectional study was performed to analyze the sociodemographic and clinical characteristics of 438 patients older than 75 years as well as their self-rated health status (EQ-5D-3L questionnaire) during the first geriatric consultation of a comprehensive healthcare program. A multivariate linear regression analysis was performed to identify factors determining their self-rated health status.ResultsWomen had a worse self-rated health status than men [mean (standard deviation) EQ-5D index score: 0.77 (0.20) vs. 0.65 (0.18); p < 0.001]. In all sample, factors independently associated with self-rated health status were self-perception of weakness and dependency. In men, additional factors related to EQ-5D index were low levels of physical activity, recurrent falls, fecal incontinence, and auditory and visual disorders. In women, other health-determining factors were decrease in walking speed, and a medical history of depression/anxiety.ConclusionsFactors associated with the self-rated health status of older adults who were part of a comprehensive healthcare program in Colombia varied according to gender. This study will help in approaching health interventions in healthcare programs for older adults in a differentiated manner.     

Tasa de filtración glomerular estimada y mortalidad posterior al alta en una unidad geriátrica de agudos

ObjectiveTo determine the relationship between estimated glomerular filtration rate (eGFR) and mortality in a retrospective cohort of older adults admitted to an acute care for the elderly (ACE) unit.Materials and methodsThe study included 1,678 patients aged 60 years and over admitted to an AEC, in Cali, Colombia, from 2012 to 2015, and followed- up until 2016. The primary outcome was mortality. Renal function (eGFR) was estimated using Modification of Diet in Renal Disease Study (MDRD-4) equation. The renal function was grouped according to the eGFR (ml/min/1.73 m²) as follows: slightly decreased (≥ 60), moderately decreased (30-59), and severely decreased (< 30). Bivariate survival and multivariate Cox regression analyses were performed.ResultsIn the univariate analysis, patients with severely decreased eGFR had higher mortality than those with a higher eGFR (P = .046). In the group with severely decreased eGFR, survival was lower in the functionally dependent group (Barthel index [IB] < 60) than in the independent group (IB ≥ 60) (log rank test; P = .001). In the multivariate analysis, there was a significant increase in the risk of death in the elderly with severely decreased eGFR (< 30) compared with slightly decreased eGFR (≥ 60) (hazard ratio [HR], 1.44; 95% confidence interval [CI]; 1.02-2.05, P = .039). There was also a significant increase in the risk of death in the dependent elderly compared to the independent ones [HR 1.72; 95% CI; 1.26-2.34, P = .000], those who had the high morbidity (≥ 4) with low albumin (< 3.2 g/dL) compared with those with low morbidity (0-3) and high albumin (≥ 3.2) [HR 1.77; 95% CI; 1.18-2.65, P = .005], and in those with a high (16-102 mg/dL) C-reactive protein (CRP) compared with those with low CRP (0-15) [HR 1.42; 95% CI; 1.01-2.01, P = .043].ConclusionsThe risk of mortality after hospital admission to an AEC unit is greater in patients with eGFR < 30. Poor functional status performance, high comorbidity, low plasma albumin, and increased inflammation markers are additional prognostic factors to be taken into account. The improvement in the functional status could improve the survival after hospitalisation.     

Comprehensive geriatric assessment of older patients and associated factors of admission to Emergency Departments in pre-covid 19 Era – A Portuguese study

ObjectivesIdentifying frequent users’ (≥3 admissions/year) associated factors in an emergency department (ED), using a comprehensive geriatric assessment (CGA), describing the characteristics of patients over 65 years of age.MethodsA cross-sectional study was performed between August 2017 and June 2018 in an ED in Lisbon, Portugal. CGA was applied and completed with clinical records. Clinical, functional, mental and social scores were created based in Portuguese Society of Internal Medicine, and a statistical model was developed.ResultsCGA was applied to 426 patients over 64 years old in an ED. The mean age was 79.3, 84.7% had multimorbidity. 51.2%, 75.6%, and 40% had dependence on basic, instrumental, and walking activities, respectively. 52% had depressive symptoms, 65.7% had cognitive impairment, 63% were undernourished/at risk for malnutrition. 33.1% were socially at risk. Polypharmacy was present with a use on average of 6.5 drugs daily. Social, clinical, functional, and mental scores were unfavourable in 48.6%, 79.6%, 54.9% and 83.1% of the population, respectively. There were 2.7 hospital admissions/year and 39.9% were frequent ED users (≥3/year). The logistic regression model was weak, but showed that patients with polypharmacy, elevated Charlson Comorbidity index and an impairment nutritional status presented higher risk of being frequent users.ConclusionsThis study showed that 97.1% of patients had needs that would justify an interventional care plan. This intervention should be extended to primary care and nursing homes. While not providing a robust model, our study has indicated nutritional problems, polypharmacy, and an elevated Charlson index as the features with more weight in frequent users’ admissions.     

Delirium prevalence in a Colombian hospital,association with geriatric syndromes and complications during hospitalization

BackgroundThe aim of this paper is to describe the prevalence of Delirium and the factors associated with its presentation and complications identified in a geriatric unit in Colombia.Material and methodsThis is a retrospective observational study that included all patients admitted consecutively for two years in a geriatric unit of a hospital in Bogotá, Colombia. We assessed delirium prevalence with the Confusion Assessment Method (CAM). The independent variables were age, sex, functional impairment (Barthel < 90), malnutrition (MNA < 12), pressure ulcers at admission, state of the social support network, number of comorbidities, polypharmacy (5 or more drugs), complications such as ICU requirement, hospital stay, in-hospital functional impairment and mortality were also evaluated. As an exclusion criterion: not having CAM registered in the medical record, all the patients had this information.ResultsWe studied 1599 subjects with a mean age of 86 years (IQR 9). Delirium prevalence was 51.03%. Delirium was associated with a higher rate of: pressure ulcers on admission [OR 3.76 (CI 2.60–5.43 p < 0.001)], functional impairment [OR 2.38 (CI 1.79–3.16 p < 0.001)], malnutrition [OR 2.06 (CI 1.56–2.73 p < 0.001)], and infection [OR 1.46 (CI 1.17–1.82 p < 0.001)]. Moreover delirium has a higher association with mortality [OR 2.80 (1.03–7.54 p = 0.042)], in-hospital functional decline [OR 1.82 (1.41–2.36 p < 0.001)], and longer hospital stay [OR 1.04 (1.04–1.09 p = 0.006)]; independently of age, sex, pressure ulcers on admission, functional impairment, malnutrition, dementia, infection and limited social network.ConclusionOur study suggests that infectious diseases and geriatric syndromes such as, functional dependence, pressure ulcers, malnutrition or major cognitive impairment are independently associated with the presence of delirium on admission. Additionally, the presence of delirium is independently associated during hospitalization with complications, longer hospital stay, functional impairment and mortality.     

Relación del factor de crecimiento de fibroblastos 21 con indicadores de masa y función muscular en personas mayores con sobrepeso u obesidad. Estudio exploratorio

BackgroundAge-related decreases in muscle mass and function are associated with the development of metabolic impairments, particularly in the context of obesity. Fibroblast growth factor 21 (FGF-21) has been suggested as a common mediator of both processes. No known studies have examined the association between FGF-21 and muscle mass and function in overweight or obese older adults. With this in mind, this study aimed to investigate the association between plasma levels of FGF-21 and muscle mass and function outcomes in overweight or obese older adults.Materials and methodsExploratory study, which included 39 adults of 60-70 years old with body mass indexes > 25 kg/m². As study outcomes, measurements were made of appendicular muscle mass (AMM), grip strength, 5 times sit-to-stand test (5xSTT), as well as plasma levels of FGF-21, fasting glucose, and insulin. The homeostatic model assessment index (HOMA-IR) was also calculated to determine the presence of insulin resistance.ResultsSignificant relationships were found between plasma levels of FGF-21 vs 5xSTT (rho = 0.49; P < .05). Moreover, FGF-21 levels were significantly higher in those with insulin resistance (P < .05), as well as with having lower levels of AMM (P < .05).ConclusionThere is a relationship between the plasma levels of FGF-21 and muscle function outcomes in overweight or obese older adults. Future studies should investigate the potential causalities between these relationships.     

Determinantes sociales,clínicos y psicosociales asociados a hipertensión arterial no controlada en adultos mayores. Encuesta SABE Colombia 2016

ObjectiveTo evaluate sociodemographic, clinical and psychosocial characteristics that are associated with uncontrolled arterial hypertension (HANC) in older adults in Colombia.MethodsSecondary analysis of data from the National Survey of Health, Welfare and Aging (SABE Colombia 2016), in which men and women aged 60 years or older in the country who were not institutionalized were interviewed. The dependent variable was uncontrolled hypertension (HANC) (≥140/90 mm Hg). The SABE survey surveyed 23694 older adults; 11264 had a diagnosis of arterial hypertension (HTA) and were taking antihypertensive medication. On the other hand, 5106 older adults, randomly selected, had their blood pressure taken. Participants previously diagnosed with HTA under medical management with antihypertensives and who had had their blood pressure taken at the same time were included, resulting in a sample of 2656 participants. Sociodemographic, clinical and psychosocial characteristics were evaluated. Univariate, bivariate, and multivariate analyzes with logistic regression were performed.ResultsOne thousand one hundred eighty-eight (44.7%) participants presented HANC. A higher prevalence of HANC was observed in adults older than 74 years (OR 1.31; 95% CI 1.09-1.57) and lower prevalence in residents of urban areas (OR 0.55; 95% CI 0.42–0.71).ConclusionsAge over 74 years and living in a rural area were identified as variables associated with inadequate blood pressure control in non-institutionalized older adults in Colombia.     

Mujeres mayores de 65 años que realizan ejercicio físico supervisado: diferencias en la capacidad física,la actividad física y la calidad de vida en función de su velocidad de la marcha

IntroductionWalking speed (WS) is an easy, quick and inexpensive measure that could be used to discern between older people with greater and lesser function and thus individualize physical exercise programs.ObjectivesTo analyze the differences in physical capacity, physical activity, and quality of life in people over 65 years of age who attended a physical exercise program according to their WS and age.Methods55 women (mean age: 76.67 ± 6.66 years) were divided into groups based on their WS (low WS: ≤ 1.59 m/s and high WS: > 1.59 m/s) and age (older-younger: ≤ 76 years and older-older: > 76 years). The following parameters were compared: 10 Meters Walk Test (10MWT), Arm Curl Test, Handgrip, Chair Stand Test, 8 Foot Up and Go Test (8FUG), 6 Minute Walk Test (6MWT), and the Minnesota and The Short Form-36 Health Survey (SF-36) questionnaires.ResultsThe level of physical activity was higher than 3000 METs/week in all groups. The high WS group had better results in the Arm Curl Test, 10MWT, 8FUG and 6MWT and in the Physical Role and Vitality dimensions of the SF-36 (P < .05). The older-older group had lower weight, BMI and Handgrip (P < .01).ConclusionsThe best results in physical capacity and quality of life are in those women with higher WS, suggesting that WS could be useful to individualize physical exercise programs.     

Efectos del estado cognitivo sobre las alteraciones del equilibrio y la marcha en ancianos institucionalizados

BackgroundAgeing has been linked to a high prevalence of cognitive impairment, which, in turn, has been related to balance disturbances and gait disorders. The aim of this study was to identify whether there are differences between subjects with and without cognitive impairment regarding the quality of gait and balance.Material and methodsAn observational study was conducted on institutionalised people older than 65 years (n = 82). Gait and balance was evaluated after the assessment of cognitive impairment using the Mini-Mental State Examination (MMSE). Single and dual tests were used including, the 6-minute walking, stride length, and gait speed. Timed Up and Go tests were also used to evaluate balance.ResultsThe participants were divided into three groups: 28 subjects in the group without cognitive impairment (MMSE ≥ 27), 29 subjects with mild (27 < MMSE ≤ 21) and 26 subjects with moderate cognitive impairment (MMSE < 21). Gait assessment showed significant between-groups differences in all the variables (P < .05). The variables assessing balance also showed significantly worse values in those groups with cognitive impairment.ConclusionThe severity of cognitive impairment is related to impaired balance and gait, thus the clinical monitoring of these variables in population at risk is needed.     

Comparison of Radioiodine Utilization in Adolescent and Young Adult and Older Thyroid Cancer Patients

ObjectiveDifferentiated thyroid cancer (DTC) is 1 of the most common cancers in adolescents and young adults (AYA, ages 15-39). Although most AYAs with DTC are considered low risk compared to older patients, there are no specific postoperative radioiodine (RAI) treatment recommendations despite the potential adverse effects specific to this age group, namely secondary malignancies and fertility difficulties. This study compares factors influencing RAI utilization in AYA and older patients.MethodsA total of 5,687 primary DTC patients were identified from the SEER (Surveillance, Epidemiology, and End Results) database between January 1, 2004 and January 31, 2009. The 2009 American Thyroid Association (ATA) guidelines were used to classify patients as low (LR) or intermediate/high risk (IHR) based on tumor characteristics. Multivariate logistic regression analysis was performed.ResultsOverall, 56.9% of AYA (n = 1,963) patients received postoperative RAI compared to 52.2% of older (n = 3,724) patients (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.09-1.35, P = .001). For AYA patients, having a total thyroidectomy (TTx) (OR: 3.53, 95% CI: 2.7-4.61, P < .001) predicted RAI in a multivariate model whereas LR status (OR: 0.52, 95% CI: 0.43-0.63, P < .001) and northeast residence (OR: 0.39, 95% CI: 0.29-0.52, P < .001) decreased the probability. All 3 factors similarly affected older patients in addition to an increased likelihood after lymph node (LN) dissection. Additionally, after selecting for TTx (n = 1,077), no factor influenced the use of RAI for AYA patients, whereas LR (OR: 0.30, 95% CI: 0.21-0.43, P < .001) and northeast residence (OR: 0.39, 95% CI: 0.19-0.79, P = .008) were associated with decreased RAI use in older patients.ConclusionDespite their excellent prognosis, AYA thyroid cancer patients are more likely to receive postoperative RAI compared to older patients. Increased awareness of the unique survivorship implications for AYA patients will be an important aspect to address going forward. (Endocr Pract. 2014;20:405-411)     

Does emotional dysregulation mediate the relationship between disability and depressive symptoms in older people?

BackgroundEmotion dysregulation has been consistently linked to psychopathology, and the relationship between disability and depressive symptomatology in old age is well-known.ObjectiveTo examine the mediational role of emotional dysregulation in the relationship between perceived disability and depressive symptomatology in older adults.MethodsTwo hundred eighty-three participants, aged 60–96 years (M ± SD = 74.22 ± 8.69; 62.9% women; 29.0% with long-term care support [LTC-S] and 71.0% community residents without LTC-S), were assessed with the Geriatric Depression Scale-8 (GDS-8), the World Health Organization Disability Assessment Schedule-2 (WHODAS-2), and the Difficulties in Emotion Regulation Scale-16 (DERS-16).ResultsA mediation model was established, which revealed: (1) a moderate association between WHODAS-2 and GDS-8 (β = 0.20; p < .001); (2) DERS-16 partially and weakly mediated the relationship between WHODAS-2 and GDS-8 (β = 0.003; p < .01). The model explained 31.9% of the variance of depressive symptoms. An inconsistent mediation model was obtained in the LTC-S group.ConclusionsGlobally, our findings indicate that disability has an indirect relationship with depressive symptomatology through emotional dysregulation (except for those in the LTC-S). Accordingly, we present suggestions for the treatment of depressive symptoms and for the inclusion of other emotion regulation variables in the study of the disability-depressive symptom link in future studies with older people in the LTC-S.     

Measurement of coronaphobia in older adults: Validation of the Spanish version of the Coronavirus Anxiety Scale

Background and objectiveThe Coronavirus Anxiety Scale (CAS) is an instrument that measures the severity of anxiety due to COVID-19 or coronaphobia. In the context of the COVID-19 pandemic, older adults are the most vulnerable age group; therefore, the aim of the study was to evaluate the psychometric properties of the CAS in this group.Materials and method274 Peruvian older adults participated (M_age = 67.86; SD = 6.34, 64.6% women). In addition to the CAS, the 2-item Patient Health Questionnaire (PHQ-2), and 2-item Generalized Anxiety Disorder Scale (GAD-2) were applied. Confirmatory Factor Analysis (CFA) was used to assess the factor structure of the CAS and Item Response Theory was used to analyze item characteristics. A sequence of hierarchical variance models was used to evaluate the measurement invariance of the CAS according to age. To assess reliability, Cronbach's alpha coefficient (α) and the omega coefficient (ω) were used. The correlations between the CAS score and the scores of the PHQ-2 and GAD-2 scales were calculated with Pearson's correlation coefficient (r).ResultsThe results of the CFA indicated that the unidimensional model of the CAS fitted the data adequately and showed very good reliability (α and ω ≥ .83). Likewise, all items provided high information and adequate discrimination, which allowed for better detection of average and high levels of coronaphobia in the older adult population. However, the CAS did not show evidence of being strictly invariant between older adults aged 60–65 years and 66–86 years. The CAS showed significant correlations with anxiety (r = .72; [95%CI: .66, .87] p < .01) and depression (r = .53; [95%CI: .43, .76] p < .01).ConclusionThe CAS in Spanish shows evidence of validity based on internal structure, convergent and divergent validity, as well as an adequate reliability estimate to assess coronaphobia in older adults. The CAS can be used to detect average and high levels of coronaphobia in the older adult population.     

Electromyographic patterns of lower limb muscles during apprehensive gait in younger and older female adults

ObjectiveInvestigate the influence of apprehensive gait on activation and cocontraction of lower limb muscles of younger and older female adults.MethodsData of 17 younger (21.47 ± 2.06 yr) and 18 older women (65.33 ± 3.14 yr) were considered for this study. Participants walked on the treadmill at two different conditions: normal gait and apprehensive gait. The surface electromyographic signals (EMG) were recorded during both conditions on: rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), tibialis anterior (TA), gastrocnemius lateralis (GL), and soleus (SO).ResultsApprehensive gait promoted greater activation of thigh muscles than normal gait (F = 5.34 and p = 0.007, for significant main effect of condition; RF, p = 0.002; VM, p < 0.001; VL, p = 0.003; and BF, p = 0.001). Older adults had greater cocontraction of knee and ankle stabilizer muscles than younger women (F = 4.05 and p = 0.019, for significant main effect of groups; VM/BF, p = 0.010; TA/GL, p = 0.007; and TA/SO, p = 0.002).ConclusionApprehensive gait promoted greater activation of thigh muscles and older adults had greater cocontraction of knee and ankle stabilizer muscles. Thus, apprehensive gait may leads to increased percentage of neuromuscular capacity, which is associated with greater cocontraction and contribute to the onset of fatigue and increased risk of falling in older people.     

Interaction between GSTM1 genotype and IL-6 on mortality in older adults: results from the ilSIRENTE study

Background and aimsThe inflammatory process is related to oxidative stress and inflammation was proven to be a strong determinant of the aging process and to ultimately lead to death. The aim of the present study was to assess if, in a population of older adults, the effect of antioxidant genes GSTM1 and GSTT1 genotypes on mortality may differ depending on levels of inflammation.MethodsData are from 353 older persons aged ?80 years enrolled in the ilSIRENTE study. Study population was divided into two groups computed based on the median value of serum IL-6 (low IL-6, n = 177 and high IL-6, n = 176). All participants were followed up for 48 months.ResultsMean age of study participants was 85.8 years (Standard Deviation 4.8), 235 (66.6%) were women. Overall 48/177 participant (27.1%) in the low IL-6 group died during the study period, compared with 97/176 (55.1%) in the high IL-6 group (p < 0.001). After adjusting for potential confounders, GSTM1 wildtype had no effect on mortality in the low IL-6 group (RR = 1.07; 95% CI 0.46–2.47), but it was associated with a significant lower mortality rate in the high IL-6 level (RR = 0.33; 95% CI 0.15–0.69). Testing the interaction between IL-6 and GSTM1 genotype, we found a significant result (p = 0.02). No significant effect of GSTT1 genotype on mortality was shown in participants with low and high IL-6 level.ConclusionGSTM1 wildtype is associated with reduced mortality among older adults with high levels of inflammation, but not among those with low levels of inflammation.