Gait change in the elderly may be a strategy to maintain postural stability while walking. However, gait laterality is accompanied by back pain or an increased risk of a fall. This study aimed to examine group-related differences and gait laterality in elderly females with mild or severe unilateral knee pain. Seventy-five elderly females (66&#x2013;87 years old) were included, which comprised the following groups: 47 with mild unilateral knee pain and 28 with severe unilateral knee pain. They completed a 12&#x2009;m walk test with maximum effort. Stance time, swing time, and step length were selected as evaluation parameters. A two-way ANOVA (group <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.3625798pt" id="M1" height="7.66065pt" version="1.1" viewBox="-0.0498162 -7.29807 8.08224 7.66065" width="8.08224pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g117-42" d="M528 54L331 254L528 455L492 493L294 291L96 493L60 455L257 254L60 54L96 16L294 217L492 16L528 54Z"/></g></svg> leg) was used for analysis. No significant differences were found in interaction or in either main factor of the group and leg. In conclusion, elderly females do not show group-related differences or gait laterality regardless of the degree (mild or severe) of unilateral knee pain.

Hiroki Sugiura

Shinichi Demura

Effect of Mild and Severe Unilateral Knee Joint Pain on Gait in Elderly Females

<i  >Background and Aims</i>. Healthy lifestyle behaviors are the major determinant of both prevention health and health related quality of life. The aim of this study was to examine the relationship between health-promoting behaviors and quality of life of elderly individuals living in nursing homes. <i  >Methods</i>. The study was performed between October 2008 and 2009, in the city of Kayseri in Turkey, upon 136 individuals, aged 65 and above, living in the Gazioglu Nursing Home. A sociodemographic questionnaire, Standardized Mini Mental Test, Health Promoting Lifestyle Behaviors Profile (HPLP), and WHOQOL-OLD module were used for the gathering of data. <i  >Results</i>. The overall HPLP and quality of life (QoL) scores were <svg     style="vertical-align:-1.09097pt;width:98.849998px;" id="M1" height="11.4" version="1.1" viewBox="0 0 98.849998 11.4" width="98.849998"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>, respectively. More than half of the participants have higher points than the mean QoL scores. The HPLP scores of these subjects were significantly higher compared to those with lower points than mean QoL scores. There was a positive relationship between the overall HPLP and WHOQOL-OLD mean scores, except for the autonomy and sensorial function domains. <i  >Conclusions</i>. The study result showed that health-promoting behaviors are positively associated with better quality of life scores in the elderly subjects living in a nursing home.

Vesile &#x15e;enol

Demet &#xdc;nalan

Ferhan Soyuer

Mahmut Arg&#xfc;n

The Relationship between Health Promoting Behaviors and Quality of Life in Nursing Home Residents in Kayseri

<i>Background.</i> There is an increase in dual sensory impairment (DSI) (hearing and visual) with increase in elderly population. Most causes of DSI among elderly are treatable. This study determines the prevalence and characteristics of dual sensory impairment among elderly of a rural community. <i>Material and Methods.</i> A cross-sectional study conducted among 175 rural elderly. Visual acuity for distant vision was measured using Snellen E chart. Hearing ability was measured using pure tone audiometry. <i>Results.</i> The prevalence of hearing impairment was 72&#x25; and that of visual impairment was 48&#x25;. The overall prevalence of DSI among the study subjects was 17.7&#x25; and 32.6&#x25; depending on whether traditional pure tone average or high-frequency pure tone average was used to define moderate or worse degree of hearing impairment. DSI prevalence increased significantly with increase in age. DSI was higher among widow/ers and illiterates, who did not have any source of income and those who were financially dependent on others compared to their counter groups. <i>Conclusion.</i> Prevalence of DSI is high among community dwelling rural Indian elderly. Individuals with DSI produce unique challenges in rehabilitation. A team approach at primary health care level is necessary to diagnose and rehabilitate elderly thereby enabling them to easily lead an independent life.

Deepthi Ramamurthy

Arvind Kasthuri

Rekha Sonavane

Dual Sensory Impairment among Community Dwelling Rural Elderly: Concern for Rehabilitation

<i>Background.</i> Published data on burden of dementia mainly include patients of third-care facilities. Economic consequences in an outpatient setting remain poorly examined. <i>Objectives.</i> To evaluate institutionalization-free survival and direct health care costs of dementia in the Quebec community-dwelling elderly population. <i>Methods.</i> A retrospective cohort study was conducted using the Quebec administrative claims databases. The cohort included a random sample of patients with treated dementia between January 1, 2000, and December 31, 2009 (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-1.599pt" id="M1" height="9.85401pt" version="1.1" viewBox="0 -8.25501 58.3088 9.85401" width="58.3088pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-111" d="M504 89L488 119C453 85 428 69 416 69C408 69 405 75 412 102L462 304C492 438 460 451 436 451S388 441 356 423C311 397 229 336 170 256H168L189 340C208 418 200 451 177 451C144 451 82 413 24 352L40 322C65 345 98 369 108 369C114 369 119 363 112 335L28 -3L36 -12C54 -3 83 4 112 10C125 73 138 122 153 174C205 258 328 382 376 382C395 382 399 369 384 305L330 93C312 25 323 -12 351 -12C378 -12 439 21 504 89Z"/></g><g transform="matrix(.013,0,0,-0.013,10.332,0)"><path id="g54-34" d="M556 331V384H55V331H556ZM556 140V193H55V140H556Z"/></g><g transform="matrix(.013,0,0,-0.013,21.95,0)"><path id="g50-52" d="M290 377C321 398 342 415 358 430C378 450 389 473 389 502C389 578 329 635 238 635H237C184 635 137 610 109 578L64 515L88 493C112 529 154 573 208 573S303 542 303 482C303 409 233 370 141 341L149 308C165 313 190 319 215 319C272 319 341 283 341 193C342 98 292 43 222 43C163 43 122 72 96 94C88 101 79 100 70 94C61 87 47 73 46 60C44 47 48 37 62 23C76 10 118 -12 165 -12C238 -12 430 62 430 223C430 297 379 359 290 375V377Z"/></g><g transform="matrix(.013,0,0,-0.013,28.281,0)"><path id="g50-56" d="M453 623H65C60 580 56 530 46 472H80C103 538 110 548 175 548H389C310 380 195 168 90 0L98 -12L175 -2C273 206 366 408 462 610L453 623Z"/></g><g transform="matrix(.013,0,0,-0.013,34.614,0)"><path id="g50-45" d="M98 134C72 134 46 117 46 90C46 73 55 65 60 64C95 55 124 32 124 -4C124 -42 95 -68 44 -89L57 -123C122 -104 194 -60 194 22C194 94 136 134 98 134Z"/></g><g transform="matrix(.013,0,0,-0.013,39.901,0)"><path id="g50-50" d="M389 0V32C297 38 291 46 291 118V635C234 613 175 595 109 583V556L161 554C203 552 207 547 207 497V118C207 46 201 38 110 32V0H389Z"/></g><g transform="matrix(.013,0,0,-0.013,46.232,0)"><use xlink:href="#g50-52"/></g><g transform="matrix(.013,0,0,-0.013,52.563,0)"><path id="g50-57" d="M253 635C142 635 71 555 71 471C71 401 113 353 178 316C144 294 106 267 91 252C70 231 46 202 46 157C46 51 132 -12 241 -12C328 -12 442 52 442 168C442 257 379 305 311 343C354 373 380 398 388 407C406 428 417 458 417 487C417 568 348 635 253 635ZM240 600C288 600 340 563 340 481C340 423 313 387 279 360C207 394 148 427 148 499C148 549 182 600 240 600ZM252 23C188 23 129 73 129 163C129 217 162 266 211 298C289 260 360 217 360 144C360 69 312 23 252 23Z"/></g></svg>). The reference population included elderly patients without dementia matched in age group, gender, and index date. Using a third-party payer perspective, direct costs over 5 years were assessed. <i>Results.</i> Institutionalization-free survival at 5 years was lower in patients with dementia than in elderly without dementia (38.9&#x25; and 72.2&#x25;, resp.). Over 5 years, difference in mean total direct health care costs per patient was CAD&#x24;19,159, distributed into institutionalizations (CAD&#x24;13,598), hospitalizations (CAD&#x24;3,312), and prescribed medications (CAD&#x24;2,320). Costs of medical services were similar (&#x2212;CAD&#x24;96). In the first year of followup, cost differentials were mainly attributable to hospitalizations, while in the last year (year 5) they were due to institutionalizations. <i>Conclusion.</i> This study confirms that dementia is an important socioeconomic burden in the community, the nature of which depends on disease progression.

Sarah-Gabrielle Beland

Antoine Pariente

Yola Moride

Institutionalization-Free Survival and Health Care Costs among Quebec Community-Dwelling Elderly Patients with Dementia

The physiological age-related hearing loss is defined as presbycusis and it is characterized by reduced hearing sensitivity and problems in understanding spoken language especially in a noisy environment. In elderly the reduced speech recognition is generally caused by a reduction of the cochlear cells in the organ of Corti and degeneration of the central auditory pathways. In order to have a complete management strategy of central and peripheral presbycusis the diagnostic evaluation should include clinical ENT examination, standard audiological tests, and tests of central auditory function. Treatment should include not only the appropriate instruments for peripheral compensation but also auditory rehabilitative training and counseling to prevent social isolation and loss of autonomy. Other common hearing disorders in elderly are tinnitus and hyperacusis which are often undervalued. Tinnitus is characterized by the perception of a &#x201c;phantom&#x201d; sound due to abnormal auditory perception. Hyperacusis is defined as a reduced tolerance to ordinary environmental sounds. Furthermore auditory, visual, nociceptive, and proprioceptive systems may be involved together in a possible context of &#x201c;sensorineural aging.&#x201d; The aim of this review is to underline the presence of hearing disorders like tinnitus and hyperacusis which in many cases coexist with hearing loss in elderly.

Alessandra Fioretti

Otello Poli

Theodoros Varakliotis

Alberto Eibenstein

Hearing Disorders and Sensorineural Aging

<i>Objective</i>. To examine the phenomenological characteristics of delirium based on the Memorial Delirium Assessment Scale (MDAS) in order to explore the presence, severity of, and relationship between symptoms. <i>Methods</i>. An analysis of 100 cases of delirium recruited at Memorial Sloan Kettering Cancer Center (MSKCC) was performed. Sociodemographic and medical variables, the Memorial Delirium Assessment Scale (MDAS) subitems, and Karnofsky Performance Status scale (KPS) were analyzed of respect of the phenomenological characteristics and their interrelationship. <i>Results</i>. The most severe and frequent symptoms were recorded in the cognitive domain, psychomotor behavior, sleep-wake cycle, and disturbance of consciousness. Within the cognitive domain, concentration was the most severely affected task. The severity of impairment in most domains increased with delirium severity, whereas perceptual disturbances and delusions were independent of delirium severity. Advanced age and the prevalence of dementia increased with delirium severity in contrast to the functional status which declined. The presence of perceptual disturbances and delusions was independent of cognitive impairment and psychomotor abnormality, however, associated with the disturbances of consciousness and attention. <i>Conclusion</i>. Cognition, in particular concentration, was the most severely affected domain. Advanced age and the prevalence of dementia contributed to more severe delirium. Perceptual disturbances and delusions were independent of delirium severity; however, they were associated with disturbances of consciousness and attention.

Soenke Boettger

Susanne Boettger

William Breitbart

The Phenomenology of Delirium: Presence, Severity, and Relationship between Symptoms

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Journal of Geriatrics