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Causes for vitamin K antagonist discontinuation in elderly patients with atrial fibrillation
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9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
pre-disability phase amenable to preventive integrated actions in order to delay/avoid healthcare burdening disabling conditions. Structured programmes of physical activity have demonstrated efficacy in delaying or reverting some components of physical frailty, promoting the maintenance of mobility and function in community-dwelling older persons. Methods.– I2-FRESCO is an integrated initiative across six European countries aimed at identifying older persons at risk of mobility disability and negative health-related events. Subjects will be selected if they have a SPPB score < 10. After an initial screening by their general practitioner/or devoted healthcare services they will be enrolled in a one-year multifactorial structured intervention based on health literacy, coached physical activity and nutritional counselling. The cost effectiveness impact of interventions will be evaluated. Key elements are: the collaboration of general practitioners with local geriatric centres of reference, use of shared screening protocols, Information Communication Technologies as enabling infrastructure for clinical data capture in real-life conditions, physical activity and nutritional interventions, and the empowerment of the older person for self-monitoring and improving his/her lifestyle and function. The I2-FRESCO project aims at combining and upscaling seminal experiences in the screening of frailty, the comprehensive geriatric assessment, and home-based tele-monitoring techniques. I2-FRESCO is collaboratively elaborated in the frame of the Active & Healthy Ageing European Innovation Partnership launched in March 2012 by the European Commission. http://dx.doi.org/10.1016/j.eurger.2013.07.137 P074
Prognostic value of different sarcopenic obesity definitions for worsening disability in elderly men and women A.P. Rossi , V. Mastrandrea , P. Bertassello , G. Mazzali , L. Bissoli , M. Zanardo , S. Confente , F. Fantin , M. Zamboni Geriatric Division, Department of Medicine, University of Medicine, Verona, Italy Introduction.– The research on combined effect of muscle impairment and obesity in the elderly is hampered by the lack of a widely agreed operational definition of sarcopenic obesity (SO). The aim of the study was to introduce alternative definitions of SO and to prospectively evaluate with a 5.5-year follow-up, the prognostic value of these definitions on worsening disability and decline in walking speed in a sample of old men and women. Methods.– In 97 women and 62 men aged 71.5 ± 2.2 years, body fat and appendicular fat free mass, 6 minutes walking test (6MWT), leg isometric strength, BMI, waist and reported disabilities were evaluated at baseline, 2-years and 5.5-years of follow-up. The study population was categorized in dynapenic/visceral obese (D/VO), non dynapenic/visceral obese (ND/VO), dynapenic/non visceral obese (D/NVO), non dynapenic/non visceral obese (ND/NVO,referent category) and in dynapenic/obese (D/O), non dynapenic/obese (ND/O), dynapenic/non obese (D/NO), non dynapenic/non obese (ND/NO,referent category). Results.– In a binary logistic regression considering the current definition of SO, the risk of worsening disability was 1.35 (95%IC:0.69–2.65) for non sarcopenic obese. The risk of worsening disability considering alternative definitions, was 3.72 (95%CI:1.90–7.30) for the D/VO and 1.42 (95%IC:0.72–2.79) for the ND/VO group. At baseline D/VO and D/O subjects walked lower distance at the 6MWT. Repeated measure analysis showed that ND/VO subjects presented greater decline in 6MWT performance compared to other groups.
Key conclusions.– subjects presenting low muscle strength and visceral obesity showed higher risk of worsening disability and lower distance walked at baseline. Visceral obese subjects showed greater decline in distance walked at the 6MWT. http://dx.doi.org/10.1016/j.eurger.2013.07.138 P075
Multimodal analgesia and rehabilitation in elderly patients with total knee replacement: A pilot study on functional recovery and tolerability A. Baricich , M. Invernizzi , P. Castelli , S.M. Rondini , P. Milani , C. Cisari Physical Medicine and Rehabilitation Unit, A.O.U. Maggiore della Carità–Health Sciences Department, Piemonte Orientale University, Novara, Italy Introduction.– Analgesic strategies during rehabilitation have to be integrated into clinical practice in patients undergoing total knee replacement (TKR) to improve functional recovery. Aim.– To assess whether multi-modal pain treatment (preoperative steroids administration, COX-2 inhibitors and controlled-release opioids) is able to provide better functional recovery following unilateral TKR and well tolerated in elderly patients. Patients and methods.– Patients scheduled for unilateral TKR for osteoarthritis, age ≥ 70 years, were eligible. Patients of the study group (n = 17) started on the day before surgery with OxycodoneNaloxone (ON) 20 mg–10 mg every 12 hours; in addition, they received a single dose of MetilPrednisolone 125 mg i.v. just before performing anaesthesia. After surgery, this group continued with ON 20 mg–10 mg every 12 hours and Etoricoxib 90 mg daily for 2 days, then they received only ON 10-5 mg every 12 hours for 10 days. The placebo group (n = 16) received acetaminophen-codeine 500-30 mg (three doses/day maximum) for 15 days. Both groups participated in a standard rehabilitation program. Results.– Significant and early improvement in pain control was observed in patients who received multimodal treatment on day 4, both at rest and during activity (P < 0.05). Moreover, these patients showed a significantly greater gain in ROM of the knee at days 4 and 15 (P < 0.05). No side effects that led to the discontinuation of the care were recorded. Conclusions.– A multimodal analgesia protocol in TKR, if associated to rehabilitation treatment leads to improved pain control and more rapid functional results and is well tolerated in elderly patients. http://dx.doi.org/10.1016/j.eurger.2013.07.139 P076
Causes for vitamin K antagonist discontinuation in elderly patients with atrial fibrillation G. Bertozzo , S. Granziera , F. Petruzzellis , L. Marigo , K. Rossi , T. Infante , S. Pletti , G. Nante , E. Manzato Department of Medicine, Division of Geriatrics, University of Padua Medical School, Padua, Italy Introduction.– Guidelines recommend Vitamin K antagonist (VKA) in the elderly with atrial fibrillation (AF), but in clinical practice undertreatment is well documented. Age ≥ 80 is a risk factor both for withholding VKA at AF onset and for treatment discontinuation. In adults main factors related to suspension are: male gender, low stroke risk, poor cognitive function, while in literature poor data are available about the elderly. Our study aimed to analyse the discon-
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
tinuation rate of very elderly patients on VKA for AF, the associated causes and following treatment. Methods.– This is a prospective study on ≥ 80 years outpatients with non valvular AF starting VKA at the Anticoagulation Clinic in Padua (Italy). Follow-up longed from 2007 to 2012. Data derive from 2 electronic cross-checked databases and telephonic interviews. Results.– Among 798 patients, 18.4% (147) discontinued VKA (mean follow-up 1.5 ± 1.6 years). Main causes were frailty (47%), haemorrhages (19.7%), sinus rhythm restoration (17%). 84.9% of suspensions were decided by a specialist; 13.7% by general practitioner. After suspension, 33.6% started heparin, 30.7% antiplatelet therapy, 29.3% received no therapy. Discontinuation was significantly related to rate of haemorrhages (P < 0.00) and lower time spent in therapeutic range (TTR) (P = 0.01). No association was found with age, sex, ischemic events and CHADS2 score. Key conclusions.– Discontinuation rate was comparable between our cohort of very elderly and the general population. Elderly suspension mostly depended on frailty, haemorrhages and sinus rhythm restoration. Risk factors for discontinuation were low TTR and major bleedings. http://dx.doi.org/10.1016/j.eurger.2013.07.140 P077
Cytochrome P450 (Cyp) gene polymorphisms and response to escitalopram treatment in elderly patients with late-onset depression D. Seripa a , G.H. Paroni a , G. D’Onofrio a , A. Pilotto b , S. Bazzano c , C. Gravina a , M. Urbano a , A.P. Gallo d , L. Di Mauro d , A. Padovani b , A. Pilotto a,c a Gerontology and Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy b Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy c Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padova, Italy d Laboratory of Clinical Chemistry, Department of Clinical Pathology, IRCCS Casa Sollievo della Sofferenza, Foggia, Italy Introduction.– Escitalopram is the selective serotonin reuptake inhibitor most commonly used for the symptomatic treatment of major depressive disorders. Escitalopram is inactivated by the polymorphic cytochrome P450 (CYP) 3A4 and 2D6 enzymes. Aim of this study is to investigate the relationships between CYP2D6 and CYP3A4 gene polymorphisms and the responder/non-responder phenotype to escitalopram treatment in patients with late-onset depression (LOD) attending a geriatric ward. Methods.– Eighty-five patients with a clinical diagnosis of lateonset MDD according to DMS-IV-TR criteria were consecutively recruited at the geriatric unit of the IRCCS “Casa Sollievo della Sofferenza”. The responder phenotype was defined as an observed reduction ≥ 50% on the HAM-D 21 score at six-months followup. The high-throughput analysis of five variants in the CYP3A4 gene and fifteen variants in the CYP2D6 gene was made by means of the Infinity analyzer (Autogenomics, Inc. Vista, CA, USA) using CYP3A4 and CYP2D6I assays according to manufacturer instructions. Genetic analyses were made in blinded fashion. Results.– At follow-up 24 patients showed a responder phenotype whereas 61 patients showed a non-responder phenotype. No variants in the CYP3A4 genes were observed in both responder and non-responder patients. Conversely, several CYP2D6 variants were identified. No differences were observed in the distribution of CYP2D6 variants associated with a reduced enzyme activity (45.83% vs 52.46%; P = 0.328) as well as those associated with a increased enzyme activity (11.48% vs 0%; P = 0.079). These variants, however, were present only in NR patients.
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Conclusion.– If confirmed, our preliminary results suggested that the analysis of CYP2D6 gene may be useful in identify patients with LOD with different responses to escitalopram treatment. http://dx.doi.org/10.1016/j.eurger.2013.07.141 P078
Association between sarcopenia, in-hospital and 1-year mortality in older adults admitted to acute care wards: Results from the crime study D.L. Vetrano a,b,c,d , F. Landi a,b,c,d , S. Volpato a,b,c,d , A. Cherubini a,b,c,d , A. Corsonello a,b,c,d , F. Lattanzio a,b,c,d , R. Bernabei a,b,c,d , G. Onder a,b,c,d a Department of Geriatrics, Orthopaedics and Neurosciences, Catholic University of Sacred Heart, Rome, Italy b Department of Medical Sciences, University of Ferrara, Ferrara, Italy c Geriatrics, Research Hospital of Ancona, IRCCS – Italian National Research Centre on Aging (INRCA), Ancona, Italy d Unit of Geriatric Pharmaco-epidemiology, IRCCS – Italian National Research Centre on Aging, Cosenza, Italy Introduction.– Sarcopenia is a common condition in older and frail populations and it was associated with adverse health outcomes as falls, disability and mortality. However the impact of sarcopenia on mortality in hospitalized older adults has rarely been evaluated. Aim of the present study was to investigate the association between sarcopenia and mortality during hospital stay and during 1 year follow up (FU) in older individuals admitted to acute care wards. Methods.– We evaluated 770 in-hospital patients aged ≥ 65 years old, participating to the CRIME project. Muscle mass was quantified with the Bioelectrical Impedance Analysis (BIA). The diagnosis of sarcopenia was based on the algorithm proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). After discharge participants were followed for 1 year. Results.– Within the 770 participants (mean age 81 ± 7 years, 56% women) sarcopenia was present in 214 (28%) of them; 22 participants died during hospital stay and 113 during FU. Participants with sarcopenia had a significantly higher in-hospital (6% vs 2%; P = 0.007) and 1-year mortality (26% vs 14%; P < 0.001) as compared with participants without sarcopenia. After adjusting for potential confounders, sarcopenia resulted significantly associated with inhospital (HR 3.47; 95% C.I. 1.41–8.52) and 1-year mortality (HR 1.80; 95% C.I. 1.30–2.68). Conclusions.– Sarcopenia is a prevalent condition among older adults admitted to acute care wards and results a risk factor for both in-hospital and 1-year mortality. http://dx.doi.org/10.1016/j.eurger.2013.07.142 P079
Vitamin D predicts independent walking recovery after hip fracture surgery E. Savino a , A. Ferrari c , M.L. Davoli c , E. Martini b , A. Nardelli e , F. Lauretani e , G. Zuliani a , A. Zurlo d , M.L. Lunardelli b , S. Volpato a a Department of Medical Sciences, University of Ferrara, Ferrara, Italy b Orthogeriatric Unit, University Hospital Policlinico S. Orsola Malpighi, Bologna, Italy c Geriatric Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy d Orthogeriatric Unit, S. Anna Hospital, Ferrara, Italy e Geriatric Unit, University Hospital of Parma, Parma, Italy Introduction.– In older people, hip fracture often leads to disability and mortality. Vitamin-D deficiency affects muscle strength and lower-extremity function. We evaluated the association of baseline
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
pre-disability phase amenable to preventive integrated actions in order to delay/avoid healthcare burdening disabling conditions. Structured programmes of physical activity have demonstrated efficacy in delaying or reverting some components of physical frailty, promoting the maintenance of mobility and function in community-dwelling older persons. Methods.– I2-FRESCO is an integrated initiative across six European countries aimed at identifying older persons at risk of mobility disability and negative health-related events. Subjects will be selected if they have a SPPB score < 10. After an initial screening by their general practitioner/or devoted healthcare services they will be enrolled in a one-year multifactorial structured intervention based on health literacy, coached physical activity and nutritional counselling. The cost effectiveness impact of interventions will be evaluated. Key elements are: the collaboration of general practitioners with local geriatric centres of reference, use of shared screening protocols, Information Communication Technologies as enabling infrastructure for clinical data capture in real-life conditions, physical activity and nutritional interventions, and the empowerment of the older person for self-monitoring and improving his/her lifestyle and function. The I2-FRESCO project aims at combining and upscaling seminal experiences in the screening of frailty, the comprehensive geriatric assessment, and home-based tele-monitoring techniques. I2-FRESCO is collaboratively elaborated in the frame of the Active & Healthy Ageing European Innovation Partnership launched in March 2012 by the European Commission. http://dx.doi.org/10.1016/j.eurger.2013.07.137 P074
Prognostic value of different sarcopenic obesity definitions for worsening disability in elderly men and women A.P. Rossi , V. Mastrandrea , P. Bertassello , G. Mazzali , L. Bissoli , M. Zanardo , S. Confente , F. Fantin , M. Zamboni Geriatric Division, Department of Medicine, University of Medicine, Verona, Italy Introduction.– The research on combined effect of muscle impairment and obesity in the elderly is hampered by the lack of a widely agreed operational definition of sarcopenic obesity (SO). The aim of the study was to introduce alternative definitions of SO and to prospectively evaluate with a 5.5-year follow-up, the prognostic value of these definitions on worsening disability and decline in walking speed in a sample of old men and women. Methods.– In 97 women and 62 men aged 71.5 ± 2.2 years, body fat and appendicular fat free mass, 6 minutes walking test (6MWT), leg isometric strength, BMI, waist and reported disabilities were evaluated at baseline, 2-years and 5.5-years of follow-up. The study population was categorized in dynapenic/visceral obese (D/VO), non dynapenic/visceral obese (ND/VO), dynapenic/non visceral obese (D/NVO), non dynapenic/non visceral obese (ND/NVO,referent category) and in dynapenic/obese (D/O), non dynapenic/obese (ND/O), dynapenic/non obese (D/NO), non dynapenic/non obese (ND/NO,referent category). Results.– In a binary logistic regression considering the current definition of SO, the risk of worsening disability was 1.35 (95%IC:0.69–2.65) for non sarcopenic obese. The risk of worsening disability considering alternative definitions, was 3.72 (95%CI:1.90–7.30) for the D/VO and 1.42 (95%IC:0.72–2.79) for the ND/VO group. At baseline D/VO and D/O subjects walked lower distance at the 6MWT. Repeated measure analysis showed that ND/VO subjects presented greater decline in 6MWT performance compared to other groups.
Key conclusions.– subjects presenting low muscle strength and visceral obesity showed higher risk of worsening disability and lower distance walked at baseline. Visceral obese subjects showed greater decline in distance walked at the 6MWT. http://dx.doi.org/10.1016/j.eurger.2013.07.138 P075
Multimodal analgesia and rehabilitation in elderly patients with total knee replacement: A pilot study on functional recovery and tolerability A. Baricich , M. Invernizzi , P. Castelli , S.M. Rondini , P. Milani , C. Cisari Physical Medicine and Rehabilitation Unit, A.O.U. Maggiore della Carità–Health Sciences Department, Piemonte Orientale University, Novara, Italy Introduction.– Analgesic strategies during rehabilitation have to be integrated into clinical practice in patients undergoing total knee replacement (TKR) to improve functional recovery. Aim.– To assess whether multi-modal pain treatment (preoperative steroids administration, COX-2 inhibitors and controlled-release opioids) is able to provide better functional recovery following unilateral TKR and well tolerated in elderly patients. Patients and methods.– Patients scheduled for unilateral TKR for osteoarthritis, age ≥ 70 years, were eligible. Patients of the study group (n = 17) started on the day before surgery with OxycodoneNaloxone (ON) 20 mg–10 mg every 12 hours; in addition, they received a single dose of MetilPrednisolone 125 mg i.v. just before performing anaesthesia. After surgery, this group continued with ON 20 mg–10 mg every 12 hours and Etoricoxib 90 mg daily for 2 days, then they received only ON 10-5 mg every 12 hours for 10 days. The placebo group (n = 16) received acetaminophen-codeine 500-30 mg (three doses/day maximum) for 15 days. Both groups participated in a standard rehabilitation program. Results.– Significant and early improvement in pain control was observed in patients who received multimodal treatment on day 4, both at rest and during activity (P < 0.05). Moreover, these patients showed a significantly greater gain in ROM of the knee at days 4 and 15 (P < 0.05). No side effects that led to the discontinuation of the care were recorded. Conclusions.– A multimodal analgesia protocol in TKR, if associated to rehabilitation treatment leads to improved pain control and more rapid functional results and is well tolerated in elderly patients. http://dx.doi.org/10.1016/j.eurger.2013.07.139 P076
Causes for vitamin K antagonist discontinuation in elderly patients with atrial fibrillation G. Bertozzo , S. Granziera , F. Petruzzellis , L. Marigo , K. Rossi , T. Infante , S. Pletti , G. Nante , E. Manzato Department of Medicine, Division of Geriatrics, University of Padua Medical School, Padua, Italy Introduction.– Guidelines recommend Vitamin K antagonist (VKA) in the elderly with atrial fibrillation (AF), but in clinical practice undertreatment is well documented. Age ≥ 80 is a risk factor both for withholding VKA at AF onset and for treatment discontinuation. In adults main factors related to suspension are: male gender, low stroke risk, poor cognitive function, while in literature poor data are available about the elderly. Our study aimed to analyse the discon-
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
tinuation rate of very elderly patients on VKA for AF, the associated causes and following treatment. Methods.– This is a prospective study on ≥ 80 years outpatients with non valvular AF starting VKA at the Anticoagulation Clinic in Padua (Italy). Follow-up longed from 2007 to 2012. Data derive from 2 electronic cross-checked databases and telephonic interviews. Results.– Among 798 patients, 18.4% (147) discontinued VKA (mean follow-up 1.5 ± 1.6 years). Main causes were frailty (47%), haemorrhages (19.7%), sinus rhythm restoration (17%). 84.9% of suspensions were decided by a specialist; 13.7% by general practitioner. After suspension, 33.6% started heparin, 30.7% antiplatelet therapy, 29.3% received no therapy. Discontinuation was significantly related to rate of haemorrhages (P < 0.00) and lower time spent in therapeutic range (TTR) (P = 0.01). No association was found with age, sex, ischemic events and CHADS2 score. Key conclusions.– Discontinuation rate was comparable between our cohort of very elderly and the general population. Elderly suspension mostly depended on frailty, haemorrhages and sinus rhythm restoration. Risk factors for discontinuation were low TTR and major bleedings. http://dx.doi.org/10.1016/j.eurger.2013.07.140 P077
Cytochrome P450 (Cyp) gene polymorphisms and response to escitalopram treatment in elderly patients with late-onset depression D. Seripa a , G.H. Paroni a , G. D’Onofrio a , A. Pilotto b , S. Bazzano c , C. Gravina a , M. Urbano a , A.P. Gallo d , L. Di Mauro d , A. Padovani b , A. Pilotto a,c a Gerontology and Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy b Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy c Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padova, Italy d Laboratory of Clinical Chemistry, Department of Clinical Pathology, IRCCS Casa Sollievo della Sofferenza, Foggia, Italy Introduction.– Escitalopram is the selective serotonin reuptake inhibitor most commonly used for the symptomatic treatment of major depressive disorders. Escitalopram is inactivated by the polymorphic cytochrome P450 (CYP) 3A4 and 2D6 enzymes. Aim of this study is to investigate the relationships between CYP2D6 and CYP3A4 gene polymorphisms and the responder/non-responder phenotype to escitalopram treatment in patients with late-onset depression (LOD) attending a geriatric ward. Methods.– Eighty-five patients with a clinical diagnosis of lateonset MDD according to DMS-IV-TR criteria were consecutively recruited at the geriatric unit of the IRCCS “Casa Sollievo della Sofferenza”. The responder phenotype was defined as an observed reduction ≥ 50% on the HAM-D 21 score at six-months followup. The high-throughput analysis of five variants in the CYP3A4 gene and fifteen variants in the CYP2D6 gene was made by means of the Infinity analyzer (Autogenomics, Inc. Vista, CA, USA) using CYP3A4 and CYP2D6I assays according to manufacturer instructions. Genetic analyses were made in blinded fashion. Results.– At follow-up 24 patients showed a responder phenotype whereas 61 patients showed a non-responder phenotype. No variants in the CYP3A4 genes were observed in both responder and non-responder patients. Conversely, several CYP2D6 variants were identified. No differences were observed in the distribution of CYP2D6 variants associated with a reduced enzyme activity (45.83% vs 52.46%; P = 0.328) as well as those associated with a increased enzyme activity (11.48% vs 0%; P = 0.079). These variants, however, were present only in NR patients.
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Conclusion.– If confirmed, our preliminary results suggested that the analysis of CYP2D6 gene may be useful in identify patients with LOD with different responses to escitalopram treatment. http://dx.doi.org/10.1016/j.eurger.2013.07.141 P078
Association between sarcopenia, in-hospital and 1-year mortality in older adults admitted to acute care wards: Results from the crime study D.L. Vetrano a,b,c,d , F. Landi a,b,c,d , S. Volpato a,b,c,d , A. Cherubini a,b,c,d , A. Corsonello a,b,c,d , F. Lattanzio a,b,c,d , R. Bernabei a,b,c,d , G. Onder a,b,c,d a Department of Geriatrics, Orthopaedics and Neurosciences, Catholic University of Sacred Heart, Rome, Italy b Department of Medical Sciences, University of Ferrara, Ferrara, Italy c Geriatrics, Research Hospital of Ancona, IRCCS – Italian National Research Centre on Aging (INRCA), Ancona, Italy d Unit of Geriatric Pharmaco-epidemiology, IRCCS – Italian National Research Centre on Aging, Cosenza, Italy Introduction.– Sarcopenia is a common condition in older and frail populations and it was associated with adverse health outcomes as falls, disability and mortality. However the impact of sarcopenia on mortality in hospitalized older adults has rarely been evaluated. Aim of the present study was to investigate the association between sarcopenia and mortality during hospital stay and during 1 year follow up (FU) in older individuals admitted to acute care wards. Methods.– We evaluated 770 in-hospital patients aged ≥ 65 years old, participating to the CRIME project. Muscle mass was quantified with the Bioelectrical Impedance Analysis (BIA). The diagnosis of sarcopenia was based on the algorithm proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). After discharge participants were followed for 1 year. Results.– Within the 770 participants (mean age 81 ± 7 years, 56% women) sarcopenia was present in 214 (28%) of them; 22 participants died during hospital stay and 113 during FU. Participants with sarcopenia had a significantly higher in-hospital (6% vs 2%; P = 0.007) and 1-year mortality (26% vs 14%; P < 0.001) as compared with participants without sarcopenia. After adjusting for potential confounders, sarcopenia resulted significantly associated with inhospital (HR 3.47; 95% C.I. 1.41–8.52) and 1-year mortality (HR 1.80; 95% C.I. 1.30–2.68). Conclusions.– Sarcopenia is a prevalent condition among older adults admitted to acute care wards and results a risk factor for both in-hospital and 1-year mortality. http://dx.doi.org/10.1016/j.eurger.2013.07.142 P079
Vitamin D predicts independent walking recovery after hip fracture surgery E. Savino a , A. Ferrari c , M.L. Davoli c , E. Martini b , A. Nardelli e , F. Lauretani e , G. Zuliani a , A. Zurlo d , M.L. Lunardelli b , S. Volpato a a Department of Medical Sciences, University of Ferrara, Ferrara, Italy b Orthogeriatric Unit, University Hospital Policlinico S. Orsola Malpighi, Bologna, Italy c Geriatric Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy d Orthogeriatric Unit, S. Anna Hospital, Ferrara, Italy e Geriatric Unit, University Hospital of Parma, Parma, Italy Introduction.– In older people, hip fracture often leads to disability and mortality. Vitamin-D deficiency affects muscle strength and lower-extremity function. We evaluated the association of baseline