[Written advance directives in dementia: useful and relevant].

According to the Dutch euthanasia law, the current wishes of the patient can be replaced by an advance directive if the patient is unable to give consent. However, Dutch physicians say they have difficulty responding to advance directives in people with dementia. A crucial issue is how to establish whether the patient actually suffers in a specific situation.

[Choice of continuing education requires guidance].

General practice seems to be the most popular discipline among Dutch medical students, despite increasing work pressure and administrative burden. In contrast, the interest for specialisation in geriatric, insurance and occupational medicine is slight. This is partly due to less exposure to these fields during the undergraduate training and lack of encouragement to choose for these disciplines.

The frailty dilemma. Review of the predictive accuracy of major frailty scores.

Background: To identify frail elderly individuals, several index or scoring systems have been developed for research purposes. The practical value of these scores for screening and diagnostic use is uncertain.

Aim: The available scoring systems were reviewed to determine whether they can be used in daily practice.

Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam.

Objectives: to compare the incidence of recurrent falls in older people with and without diabetes, and to examine diabetes- and fall-related risk factors explaining the increased risk of recurrent falls associated with diabetes.

Methods: population-based cohort study of 1,145 (85 with diabetes) community-dwelling participants, aged ≥65 years, from The Longitudinal Aging Study Amsterdam (LASA). Falls were assessed prospectively (every 3 months) during a 3-year follow-up period.

Prevalence and clinical determinants of low bone mineral density in anorexia nervosa.

Objective: To determine the prevalence of low bone mass in anorexia nervosa (AN) and the association with clinical parameters.

Methods: A cross-sectional study on 286 Caucasian women with AN. Bone mineral density (BMD) was measured with DXA.

Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach.

The aetiology of osteoporotic fractures is multifactorial, but little is known about the way to evaluate patients with a recent clinical fracture for the presence of secondary osteoporosis. The purpose of this study was to determine the prevalence of contributors to secondary osteoporosis in patients presenting with a clinical vertebral or non-vertebral fracture. Identifying and correcting these contributors will enhance treatment effect aimed at reducing the risk of subsequent fractures.

High prevalence of morphometric vertebral deformities in patients with inflammatory bowel disease.

Background: Earlier studies have documented that the prevalence of decreased bone mineral density (BMD) is elevated in patients with inflammatory bowel disease. The objective of this study was to investigate the prevalence of vertebral deformities in inflammatory bowel disease patients and their relation with BMD and bone turnover.

Methods: One hundred and nine patients with Crohn's disease (CD) and 72 with ulcerative colitis (UC) (age 44.

Quantitative ultrasound does not identify patients with an inflammatory disease at risk of vertebral deformities.

Background: Previous studies from our group have shown that a high prevalence of vertebral deformities suggestive of fracture can be found in patients with an inflammatory disease, despite a near normal bone mineral density (BMD). As quantitative ultrasound (QUS) of the heel can be used for refined assessment of bone strength, we evaluated whether QUS can be used to identify subjects with an inflammatory disease with an increased chance of having a vertebral fracture.

Methods: 246 patients (mean age: 44 +/- 12.

Bone and fall-related fracture risks in women and men with a recent clinical fracture.

Background: Worldwide fracture rates are increasing as a result of the aging population, and prevention, both primary and secondary, is an important public health goal. Therefore, we systematically analyzed risk factors in subjects with a recent clinical fracture.

Methods: All men and women over fifty years of age who had been treated in the emergency department of, or hospitalized at, our institution because of a recent fracture during a one-year period were offered the opportunity to undergo an evidence-based bone and fall-related risk-factor assessment and bone densitometry.

Co-ingestion of leucine with protein does not further augment post-exercise muscle protein synthesis rates in elderly men.

Leucine has been suggested to have the potential to modulate muscle protein metabolism by increasing muscle protein synthesis. The objective of this study was to investigate the surplus value of the co-ingestion of free leucine with protein hydrolysate and carbohydrate following physical activity in elderly men. Eight elderly men (mean age 73 +/- 1 years) were randomly assigned to two cross-over treatments consuming either carbohydrate and protein hydrolysate (CHO+PRO) or carbohydrate, protein hydrolysate with additional leucine (CHO+PRO+leu) after performing 30 min of standardized physical activity.