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Background. Olfactory dysfunction might unveil the association between ageing and frailty, as it is associated with declining cognitive function, depression, reduced physical performance, reduced dietary intake, and mortality; all these conditions are characterized by increased levels of inflammatory parameters. The present study is aimed at evaluating the association between olfactory dysfunction, frailty, and mortality and whether such association might be mediated by inflammation. Methods. We analysed data of 1035 participants aged 65+ enrolled in the “InCHIANTI” study. Olfactory function was tested by the recognition of the smells of coffee, mint, and air. Olfactory dysfunction was defined as lack of recognition of at least two smells. Considering the items “shrinking,” “exhaustion,” “sedentariness,” “slowness,” and “weakness” included in the Fried definition, frailty was defined as the presence of at least three criteria, prefrailty of one or two, and robustness of none. Serum interleukin-6 (IL-6) was measured in duplicate by high-sensitivity enzyme-linked immunosorbent assays. Logistic regression was adopted to assess the association of frailty with olfactory function, as well as with the increasing number of olfactory deficits. Cox regression was used to test the association between olfactory dysfunction and 9-year survival. Results. Olfactory dysfunction was associated with frailty, after adjusting (OR 1.94, 95% CI=1.07-3.51; P=.028); analysis of the interaction term indicated that the association varied according to interleukin-6 levels (P for interaction=.005). Increasing levels of olfactory dysfunction were associated with increasing probability of being frail. Also, olfactory dysfunction was associated with reduced survival (HR 1.52, 95% CI=1.16-1.98; P=.002); this association varied according to the presence of frailty (P for interaction=.017) and prefrailty status (P for interaction=.046), as well as increased interleukin-6 levels (P for interaction = .011). Conclusions. Impairment of olfactory function might represent a marker of frailty, prefrailty, and consequently reduced survival in an advanced age. Inflammation might represent the possible link between these conditions.

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Chewing problems are associated with depression in elderly population. Use of complete dentures hinder this association. Older depressed subjects should be screened for the presence of CPs; further studies are needed to evaluate the impact of early detection and correction of CPs on the development of depression.

Treatment with proton-pump inhibitors (PPIs) might be associated with neuropsychological side effects. We examined the association between use of PPIs and depressive symptoms in an elderly population. Mood was assessed by the 30-item Geriatric Depression Scale (GDS) in all 344 inhabitants of Tuscania (Italy) aged 75 years and over, without exclusion criteria; depression was defined by a GDS score ≥11. Use of PPIs was associated with a higher GDS score in linear regression analysis (B = 2.43; 95% CI = 0.49-4.38; p = 0.014) after adjusting; also, use of PPIs was associated with increased adjusted probability of depression in logistic regression (OR = 2.38; 95% CI = 1.02-5.58; p = 0.045). Higher PPIs dosages were associated with increased probability of depression (p for trend = 0.014). This association was independent of the diagnosis of peptic disease, as well as the use of antidepressant medications. No association was found between use of H2-blockers or antacids and the GDS score. Calculation of the population attributable risk indicated that 14% of depression cases could be avoided by withdrawal of PPIs. Use of PPIs might represent a frequent cause of depression in older populations; thus, mood should be routinely assessed in elderly patients on PPIs.

Hypoxemia has been associated with low bone mineral density (BMD) in animal and human models. We assessed the association of haemoglobin levels with ultrasound-derived (UD) T score, Z score and the stiffness index in all 358 subjects aged 75+ living in Tuscania (Italy). Also, we searched for the haemoglobin cutoff levels that might best identify participants with osteoporosis. In the multivariable linear regression analysis, haemoglobin levels were associated among participants with the UD T score [beta = 0.13; 95% confidence interval (CI) = 0.01-0.25; p = 0.030], Z score (beta = 0.11; 95% CI = 0.01-0.22; p = 0.045) and stiffness index (beta = 1.87; 95% CI = 0.51-3.21; p = 0.007) after adjusting for potential confounders. Haemoglobin levels <140 g/L in men and <130 g/L in women best predicted osteoporosis in linear discriminant analysis. Haemoglobin is independently associated with all UD-BMD parameters. Haemoglobin levels <140 g/L in men and 130 g/L in women might be adopted in clinical practice to identify older subjects in whom screening for osteoporosis might yield higher effectiveness.

Background: Assessing diaphragm mobility is important to detect malfunctions or impending exhaustion and to evaluate the effects of many chest and abdominal conditions on respiratory mechanics. Amongst several imaging methods, ultrasonography represents the only noninvasive, nonionizing imaging technique widely available for the direct assessment of diaphragm excursion. Objectives: the aim of this study is to prospectively assess the supine diaphragmatic motion amplitude, intra- and inter-observer agreement, and anthropometric correlates of diaphragm motion variability, measured through M-mode ultrasonography, in a sample of healthy volunteers. Methods: One-hundred healthy volunteers were considered eligible for the study. Instead of B-mode imaging, the M-mode technique was used to achieve a more accurate measurement of diaphragm motion. To assess intra-observer variability, 3 consecutive measurements (M-mode and B-mode) of the right dome motion were obtained at every session. To test for inter-rater reliability, the subjects were asked to provide 2 more diaphragm motion measurements every week, each performed by 2 experienced operators, and 42 subjects accepted. Results: Diaphragmatic motion was positively correlated with height and weight both at quiet (Spearman’s coefficient = 0.514, p < 0.001 and 0.314, p = 0.038) and deep breathing (Spearman’s coefficient = 0.342, p = 0.001 and 0.225, p = 0.024, respectively) and negatively correlated with age, but only during deep breathing (Spearman’s coefficient = –0.272, p = 0.006). Intra-observer agreement degree on all 3 measurements was excellent during both quiet and deep breathing, with a Cronbach’s alpha of 0.793 and 0.901, respectively, and an intra-class coefficient of 0.797 and 0.900, respectively. Similarly, the degree of inter-observer agreement achieved a Cronbach’s alpha of 0.638 and 0.776, and an inter-class coefficient of 0.632 and 0.778, respectively. Deep breathing was associated with sex only in linear multivariable models (B = –10.14; 95% confidence interval [CI] –17.86, –2.41; p = 0.011), while quiet breathing resulted to be affected by height only (B = 30.05; 95% CI 0.79–59.31; p = 0.044). Conclusions: Diaphragm excursion measurements using the M-mode technique were accurate and could be reproduced also when obtained in recumbent patients. After adjustments, the main predictors of diaphragmatic motion were sex and height, which should be considered to design a specifically tailored study and to develop normality reference equations.

Introduction: The present study aimed to determine the variables that are associated with a longer dialysis recovery time (DRT) and to define the relationship that exists between DRT and the ultrafiltration rate (UFR) in prevalent chronic hemodialysis (CHD) patients. Methods: We studied 210 prevalent CHD of 5 hemodialysis units in Central Italy. Patients were invited to answer to the question: “How long does it take you to recover from a dialysis session?” Answers to this question were subsequently converted into minutes. Demographic, clinical and laboratory parameters were recorded for each patient as well as the UFR (mL/kg/h), the dialysate sodium concentration and temperature. Results: Median DRT was 180 min (60–420). Ninety five (45%) patients had a DRT ≥ the median value. Mean UFR was 9.2 ± 3.0 mL/kg/h. Patients with a lower DRT had a less prevalent disability in the instrumental activities daily living, had a higher UFR, and a lower dialysate temperature, as compared with subjects with higher DRT. According to the logistic regression model, UFR was associated with a DRT below the median (i.e., 180) in the unadjusted model (OR 1.12; 95% CI 1.02–1.23; p = 0.019), after adjusting for age and sex (OR 1.11; 95% CI 1.01–1.22; p = 0.025), and in the fully adjusted model (OR 1.11; 95% CI 1.04–1.22; p = 0.040). UFR increase was associated with increasing probability of DRT below the median (p for trend = 0.035). The highest tertile of DRT was associated with UFR below the mean value (i.e., 9.2 mL/kg/h) in multinomial logistic regression having the lowest DRT tertile as reference. DRT was significantly lower in patients with UFR > 13 mL/kg/h than in patients with UFR 10–13 or < 10 mL/kg/h. Conclusion: DRT is inversely associated with UFR in CHD patients. Whether a high UFR should be recommended to reduce the DRT needs to be elucidated through an adequate prospective randomized study.