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The 6MWT was the primary outcome measure and gait speed (the 10-

meter walking test, 10mwt), mobility (the Short Physical Performance

Battery, SPPB) inclusive chair-rise and the handgrip-strength (Jamar

hand dynamometer) were secondary outcome measures.


Within-group analyses revealed that at 3 months the follow-

ing values were significantly different and improved (p < 0.05) from

baseline to 12 weeks: the 6MWT (meters, 32%), 10mwt (26%), SPPB

(23%) and chair-rise (22%).

Key conclusion:

SMS-guided outdoor walking and one strength

exercise may be effective in improving walking capacity, gait-speed,

mobility and chair-rise after acute stroke.


Vitamin D supplementation to prevent depression and poor

physical function in older persons: results of the D-Vitaal study,

a randomized placebo-controlled trial

E.J. de Koning


, N.M. van Schoor


, H.W.J. van Marwijk



P.J.M. Elders


, B.W.J.H. Penninx


, P. Lips




Dpt. of Epidemiology and

Biostatistics, VU University Medical Center (VUmc),


EMGO Institute for

Health and Care Research, VUmc,


Primary Care Research Centre, Institute

of Population Health, University of Manchester, Manchester, United



Dpt. of General Practice and Elderly Care Medicine, VUmc,


Dpt. of Psychiatry, VUmc/GGZ inGeest,


Dpt. of Internal Medicine,

Endocrine Section, VUmc, Amsterdam, the Netherlands


Depressive symptoms and declining physical function

are interrelated conditions and common in older persons. Previous

observational studies suggests that low serum 25-hydroxyvitamin

D (25(OH)D) levels are related to both mental and physical function-

ing. However, results from supplementation trials are inconsistent,

possibly due to suboptimal study designs.


The D-Vitaal study is a randomized, double-blind, placebo-

controlled trial using a daily dose of 1,200 IU vitamin D3 versus

placebo for 12 months to investigate effects of the supplementation on

depressive symptoms, functional limitations and physical perform-

ance in older persons at high risk of developing more substantial

mental and physical health problems. Subjects (N = 155, age 60


years, community dwelling) were included if they had mild depressive

symptoms, at least one functional limitation and low vitamin D status

(25(OH)D 15

50/70 nmol/L, depending on season). The data were

analyzed with linear mixed models analyses.


The supplementation substantially increased serum 25(OH)D

levels in the intervention group (mean 25(OH)D after 6 months: 85

(SD: 16) nmol/L versus 40 (SD: 23) nmol/L in the placebo group).

Compliance (>80% tablet intake) was 89.7%. Intention-to-treat ana-

lyses showed no significant differences between the treatment groups

on depressive symptoms and physical performance. Pre-specified

subgroup analyses showed that the supplementation marginally

improved functional limitations in participants with baseline 25(OH)

D levels above 50 nmol/L (ratio:

0.22; 95% CI:


0.03), but this

effect was attenuated in per-protocol analyses.

Key conclusions:

Vitamin D supplementation did not improve

depressive symptoms or physical functioning in older persons at risk

for declining mental and physical health.


Inflammation and frailty in the elderly: a systematic review and


N. Veronese


, P. Soysal


, B. Stubbs


, P. Lucato, C. Luchini


, M. Solmi



R. Peluso


, G. Sergi


, A. Turan Isik, E. Manzato


, S. Maggi




University of

Padova, Padova, Italy,


Center for Aging Brain and Dementia, Department

of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir,



Physiotherapy Department, South London and Maudsley NHS

Foundation Trust, Denmark Hill, London SE5 8AZ,


Health Service and

Population Research Department, Institute of Psychiatry, Psychology and

Neuroscience, King

s College London, De Crespigny Park, London, Box SE5

8AF, United Kingdom,


University of Verona,


Aging Branch, Institute of

Neuroscience, National Research Council-CNR, Padova, Italy


The pathogenesis of frailty and in particular the role of

inflammation is poorly understood. We examined the possible

association between inflammation and frailty utilizing a systematic

review and meta-analysis.


A systematic literature search of major electronic databases

from inception until 05/2016 was conducted including articles

providing data on inflammatory biomarkers and frailty. Data were

summarized with standardized mean differences (SMDs) comparing

information of frail and pre-frail people vs. robust participants in

cross-sectional and with odds ratios (ORs) adjusted for the maximum

number of potential confounders by inflammatory parameters levels

at baseline for longitudinal studies.


From 1,856 initial hits, 35 studies (32 cross-sectional studies

n = 3,232 frail, n = 11,483 pre-frail and n = 8,522 robust, and 563

n = pre-frail + robust; 3 longitudinal studies n = 3,402 participants)

were meta- analyzed. Cross-sectional studies reported that compared

to 6,757 robust participants, both 1,698 frail (SMD = 1.00, 95%CI: 0.40

1.61) and 8,568 pre-frail (SMD = 0.33, 95%CI: 0.04

0.62) participants

had significantly higher levels of C reactive protein (CRP). Frailty

(n = 1,057; SMD = 1.12, 95%CI: 0.27

2.13) and pre-frailty (n = 4,467;

SMD = 0.56, 95%CI: 0.00

1.11) were associated with higher serum

levels of IL6 compared to people who were robust (n = 2,392). Frailty

and pre frailty were also significantly associated with elevated white

blood cell and fibrinogen levels. In three longitudinal studies, higher

serum of CRP (OR = 1.06, 95%CI: 0.78

1.44,) and IL 6 (OR = 1.19, 95%CI:


1.62) were not associated with frailty.

Key conclusions:

Frailty and pre-frailty are associated with higher

inflammatory parameters and in particular CRP and IL 6, but more

longitudinal studies are needed.


Development of the EASI-ltc to assist in elder abuse detection in the

long-term care setting

M.J. Yaffe, S. Ballard, M. Wilchesky.

Department of Family Medicine,

McGill University, Montreal, Quebec, Canada


The Elder Abuse Suspicion Index (EASI) © is a validated

six question tool to facilitate identification of elder abuse (EA) and

neglect through enquiry by office-based family physicians of older

adults with MMSE scores of

24. It is available in nine languages,

courtesy of international collaborations. We now report on EASI

modification for the more complicated enquiry of residents in long

term care (LTC) with similar level of cognitive functioning.


The design was multiphase mixed methods for instrument

development and construct validation. This included (1) literature

review for acts of omission and commission associated with EA

in LTC; (2) on-line survey of Canadian EA experts to rank importance

of each act for inclusion in a LTC EA detection tool; (3) incorporation

of top-ranked items into EASI, through word modification or

new questions; (4) EA expert focus group review of questions

for content and word selection; (5) further analysis of questions

by a focus group of front-line LTC workers for content and

acceptability; and (6) final incorporation of feedback into a tool for

LTC, the EASI-ltc.


The literature review generated 56 acts of EA (omission

or commission), and through overlap, were reduced to 26 descrip-

tors. 19/26 (73%) EA authorities ranked 11/26 acts consistently

highly, and 7/11 (63.6%) were already represented in the EASI. This

supported building on the EASI, and the resultant 9 questions in

the EASI-ltc were modified twice as a consequence of focus group

input. The tool preamble and instructions for use were also altered to

reflect LTC.


The EASI-ltc has been shown to have content validity,

and appears appropriate for use in LTC on residents with MMSE


It is intended to raise suspicion about abuse such that more detailed

evaluation would be initiated. These assumptions will be examined in

the next phase of our research.

Oral presentations / European Geriatric Medicine 7S1 (2016) S1