Annals of Long Term Care

Reviewed, prepared, and submitted by Thomas T. Yoshikawa, MD, Editor-in-Chief, Journal of the American Geriatrics Society

Title:
Body Mass Index and Survival in Men and Women Aged 70 to 75

Authors:
Flicker, Leon; McCaul Kieran A; Hankey, Graeme J; et al

Summary:
Although the common medical “wisdom” is that being overweight is associated with shortened survival and life expectancy, primarily related to associated higher incidence of diabetes mellitus and cardiovascular complications, there have been numerous publications during the past 5 years suggesting that being overweight in older people age 70 and beyond is not a risk factor for all-cause mortality. In this paper from Australia, 4677 men and 4563 women aged 70 to 75 were recruited for a longitudinal study of health and followed for up to 10 years. Their body mass index (BMI) was measured and the relative risk of all-cause mortality, as well as mortality due to cardiovascular disease, cancer, and chronic respiratory disease were evaluated. Mortality risk was the lowest for overweight individuals, being 13% less than normal weight persons; the risk of death was similar for obese and normal-weight persons. These outcomes were found for all-cause mortality, as well as deaths due to cardiovascular disease, cancer, and chronic respiratory disease. In addition, the association of overweight and lower mortality was found in both healthy and non-healthy individuals.

Comment:
This and other reports demonstrating reduced mortality with increased body weight (but not obese state) in elderly persons underscores the need for clinicians to be cautious in recommending weight reduction in older adults (beyond 70 years) who are reasonably healthy and have no significant diseases that might be aggravated or worsened by being overweight. If aging (and frailty) is defined in large part as a progressive loss of physiological reserves, then we need to determine if body fat provides a source of reserve capacity. The mechanism(s) of being overweight and reduced mortality has yet to be elucidated.

The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or Journal of the American Geriatrics Society.

Title:
Efficacy and Safety of a Once-Yearly Intravenous Zoledronic Acid 5 mg for Fracture Prevention in Elderly Postmenopausal Women with Osteoporosis Aged 75 and Older

Authors:
Boonen, Steven; Black, Dennis M; Colon-Emeric, Cathleen S; et al

Summary:
Vertebral and hip fractures secondary to osteoporosis is common in older women. Although oral bisphosphonates have been shown to be effective in improving bone integrity and reducing fractures, there remains a very large number of patients with osteoporosis who either are not prescribed the drug by their providers or do not adhere to a prescribed therapeutic regimen. In this article, post hoc analysis from two large prospective, randomized, multicenter, double-blind, placebo-controlled trials involved 7765 postmenopausal women with documented femoral neck osteoporosis with or without existing vertebral fracture(s). Participants received once-yearly 15-minute intravenous infusion of zoledronic acid or placebo (on day 0, at 12 months, and at 24 months) and monitored over a 3-year period. All participants also received calcium and vitamin D. At 3 years, the incidence of any clinical, clinical vertebral, and nonvertebral fracture were significantly lower in the zoledronic acid group compared with the placebo group. The incidence of hip fracture was lower in the zoledronic acid group but did not reach statistical significance. Post-dose adverse events were higher in the zoledronic acid group but the rate of serious adverse events and deaths were not significantly different between both groups.

Comment:
This study suggests that once-yearly infusion of zoledronic acid was effective and reasonably safe in treating osteoporosis and reducing associated fractures in older women aged 75 years and older.

The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or Journal of the American Geriatrics Society.

______________________________________________________________________________

Title:
Chronic Kidney Disease and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study

Authors:
Yaffe, Kristine; Ackerson, Lynn; Tamura, Manjula Kurella; et al

Summary:
Aging is associated with kidney dysfunction. Because cognitive impairment is also associated with advancing age, this study examined whether older adults with chronic kidney disease had cognitive impairment and the spectrum of cognitive domains that are affected. As part of the Chronic Renal Insufficiency Cohort Study, 855 adults aged 55 and older with chronic kidney disease were evaluated with six (6) cognitive tests. The mean age of the study group was approximately 65 years. Participants in the study with lower estimated glomerular filtration rate (eGFR; using Modification of Diet in Renal Disease equation) had lower cognitive scores for most cognitive domains. When participants with advanced renal failure (eGFR< 30 mL/min/1.73 m2) were compared to those participants with mild to moderate kidney disease (eGFR of 45-59 mL/min/1.73 m2), the former group were more likely to have impairments in global cognition, naming, attention, executive function and delayed memory than the latter group.

Comment:
These findings indicate that older patients with chronic kidney disease, especially with advanced disease, should be screened for cognitive impairment(s).

The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or Journal of the American Geriatrics Society.