INTRODUCTION Footcare is an important component of wellbeing in older adults and the promotion of appropriate footcare interventions is imperative for health professionals working with this population. In this scoping review, we describe the health promotion models informing footcare interventions for older people. The objectives were to (i) understand the context(s) where health promotion models have informed footcare interventions; (ii) identify the health promotion models informing interventions; and (iii) document the effectiveness of theoretically informed health promotion interventions for improving footcare in older adults. METHODS Footcare interventions developed using health promotion models worldwide and published in English before July 2023 were searched using MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar. RESULTS A total of 2,078 articles were identified, of which 31 were retrieved and assessed for eligibility. Eight articles met the eligibility criteria, with most interventions delivered in Asia (n=5) and using Self-efficacy Theory as their theoretical framework (n=6). Most of the studies included people with diabetes (n=6) and outcomes were measured using foot health outcomes, knowledge of foot health, and footcare behaviours and self-efficacy. CONCLUSION This scoping review has identified a range of footcare interventions, with most demonstrating promising outcomes on improving footcare in older adults. Approaches towards methods and dosage of intervention varied across the studies and more broadly, we identified that few studies report the health promotion model informing the design of intervention(s). Further research is required to ascertain which health promotion model, modality of promotion, and implementation approach are the most effective for improving footcare in older adults.
{"title":"Health Promotion Models for Improving Footcare In Older Adults: A Scoping Review.","authors":"Yuen-Ting Wong, Stewart Morrison","doi":"10.1159/000538868","DOIUrl":"https://doi.org/10.1159/000538868","url":null,"abstract":"INTRODUCTION\u0000Footcare is an important component of wellbeing in older adults and the promotion of appropriate footcare interventions is imperative for health professionals working with this population. In this scoping review, we describe the health promotion models informing footcare interventions for older people. The objectives were to (i) understand the context(s) where health promotion models have informed footcare interventions; (ii) identify the health promotion models informing interventions; and (iii) document the effectiveness of theoretically informed health promotion interventions for improving footcare in older adults.\u0000\u0000\u0000METHODS\u0000Footcare interventions developed using health promotion models worldwide and published in English before July 2023 were searched using MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar.\u0000\u0000\u0000RESULTS\u0000A total of 2,078 articles were identified, of which 31 were retrieved and assessed for eligibility. Eight articles met the eligibility criteria, with most interventions delivered in Asia (n=5) and using Self-efficacy Theory as their theoretical framework (n=6). Most of the studies included people with diabetes (n=6) and outcomes were measured using foot health outcomes, knowledge of foot health, and footcare behaviours and self-efficacy.\u0000\u0000\u0000CONCLUSION\u0000This scoping review has identified a range of footcare interventions, with most demonstrating promising outcomes on improving footcare in older adults. Approaches towards methods and dosage of intervention varied across the studies and more broadly, we identified that few studies report the health promotion model informing the design of intervention(s). Further research is required to ascertain which health promotion model, modality of promotion, and implementation approach are the most effective for improving footcare in older adults.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140686851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Menz, Shan Bergin, Jodie A McClelland, S. Munteanu
INTRODUCTION Several footwear characteristics have been shown to affect balance and gait patterns and may therefore influence the risk of falling in older adults. However, attributing a link between footwear and falls is inherently difficult as it often relies on self-report which may be inaccurate. METHODS Archival video recordings of falls that occurred in two long-term residential aged care facilities were initially screened to determine whether the footwear worn at the time (barefoot, socks, slippers/sandals, or shoes) could be documented. These falls were then independently evaluated by three additional assessors and a meeting was held to obtain consensus in relation to whether the footwear could have potentially contributed to the fall, and what mechanism may have been responsible. Cross-tabulations were performed in relation to footwear type and falls characteristics (proposed mechanism and fall direction). RESULTS There were 300 falls experienced by 118 older adults aged 58 years to 98 years (mean age 82.8 years, SD 7.6). Of these falls, footwear could be ascertained in 224 (75%). After the consensus meeting, the proportion of falls considered to be potentially related to footwear was 40 (18%). The likelihood of footwear contributing to the fall was highest when participants were wearing socks (14/19 falls; 74% of all footwear-related falls), followed by being barefoot (2/6 falls; 33%), wearing slippers/sandals (17/100 falls; 17%) and wearing shoes (7/99 falls, 7%). CONCLUSION Footwear could be a potential contributor to a substantial number of falls in residential aged care. Wearing socks would appear to place an older person at risk of future falls and should therefore be avoided in this population.
{"title":"Footwear and falls in long-term residential aged care facilities: an analysis of video capture data.","authors":"H. Menz, Shan Bergin, Jodie A McClelland, S. Munteanu","doi":"10.1159/000538731","DOIUrl":"https://doi.org/10.1159/000538731","url":null,"abstract":"INTRODUCTION\u0000Several footwear characteristics have been shown to affect balance and gait patterns and may therefore influence the risk of falling in older adults. However, attributing a link between footwear and falls is inherently difficult as it often relies on self-report which may be inaccurate.\u0000\u0000\u0000METHODS\u0000Archival video recordings of falls that occurred in two long-term residential aged care facilities were initially screened to determine whether the footwear worn at the time (barefoot, socks, slippers/sandals, or shoes) could be documented. These falls were then independently evaluated by three additional assessors and a meeting was held to obtain consensus in relation to whether the footwear could have potentially contributed to the fall, and what mechanism may have been responsible. Cross-tabulations were performed in relation to footwear type and falls characteristics (proposed mechanism and fall direction).\u0000\u0000\u0000RESULTS\u0000There were 300 falls experienced by 118 older adults aged 58 years to 98 years (mean age 82.8 years, SD 7.6). Of these falls, footwear could be ascertained in 224 (75%). After the consensus meeting, the proportion of falls considered to be potentially related to footwear was 40 (18%). The likelihood of footwear contributing to the fall was highest when participants were wearing socks (14/19 falls; 74% of all footwear-related falls), followed by being barefoot (2/6 falls; 33%), wearing slippers/sandals (17/100 falls; 17%) and wearing shoes (7/99 falls, 7%).\u0000\u0000\u0000CONCLUSION\u0000Footwear could be a potential contributor to a substantial number of falls in residential aged care. Wearing socks would appear to place an older person at risk of future falls and should therefore be avoided in this population.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Franziska Podesser, Johannes Weninger, Elisabeth M. Weiss, J. Marksteiner, M. Canazei
INTRODUCTION Dementia increases the risk of falls and fall-related injuries, which may be caused by inappropriate medication use. To date, there is little evidence on which medications are more likely to cause falls. We therefore investigated the effects of medication use and medication changes 48 hours before falls in hospitalised patients with dementia. METHODS This matched case-control study included 74 patients with a mean age of 83 years (38% women) who had been hospitalised for at least 7 days. Information on medications, diagnoses, disease severity, use of walking aids, falls, and demographics was collected from electronic medical records. The effects of number of medications and psychotropics, equivalent daily doses of antidepressants, antipsychotics and benzodiazepines, anticholinergic burden, medication initiation, dose change, medication discontinuation, as-needed medications, opioid use and the presence of fall-increasing diseases were examined separately for the periods 0h-24h and 24h-48h before the falls using binomial logistic regression analyses. RESULTS Falls increased significantly with higher daily antipsychotic doses 24 hours before the fall. In addition, the rate of falls increased with higher anticholinergic burden and prevalence of medication discontinuation 24 to 48 hours before the fall. Notably, the total number of medications and psychotropic medications had no effect on the incidence of falls. DISCUSSION/CONCLUSION With regard to the short-term effects of medication on fall risk, particular attention should be paid to the daily dose of antipsychotics, anticholinergic burden and medication discontinuation. Further studies with larger samples are needed to confirm the results of this study.
{"title":"Short-term Medication Effect on Fall Risk in Multimorbid Inpatients with Dementia.","authors":"Franziska Podesser, Johannes Weninger, Elisabeth M. Weiss, J. Marksteiner, M. Canazei","doi":"10.1159/000538074","DOIUrl":"https://doi.org/10.1159/000538074","url":null,"abstract":"INTRODUCTION\u0000Dementia increases the risk of falls and fall-related injuries, which may be caused by inappropriate medication use. To date, there is little evidence on which medications are more likely to cause falls. We therefore investigated the effects of medication use and medication changes 48 hours before falls in hospitalised patients with dementia.\u0000\u0000\u0000METHODS\u0000This matched case-control study included 74 patients with a mean age of 83 years (38% women) who had been hospitalised for at least 7 days. Information on medications, diagnoses, disease severity, use of walking aids, falls, and demographics was collected from electronic medical records. The effects of number of medications and psychotropics, equivalent daily doses of antidepressants, antipsychotics and benzodiazepines, anticholinergic burden, medication initiation, dose change, medication discontinuation, as-needed medications, opioid use and the presence of fall-increasing diseases were examined separately for the periods 0h-24h and 24h-48h before the falls using binomial logistic regression analyses.\u0000\u0000\u0000RESULTS\u0000Falls increased significantly with higher daily antipsychotic doses 24 hours before the fall. In addition, the rate of falls increased with higher anticholinergic burden and prevalence of medication discontinuation 24 to 48 hours before the fall. Notably, the total number of medications and psychotropic medications had no effect on the incidence of falls.\u0000\u0000\u0000DISCUSSION/CONCLUSION\u0000With regard to the short-term effects of medication on fall risk, particular attention should be paid to the daily dose of antipsychotics, anticholinergic burden and medication discontinuation. Further studies with larger samples are needed to confirm the results of this study.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lee Butcher, J. Carnicero, Karine Pérès, Stefania Bandinelli, F. García-García, F. Rodríguez‐Artalejo, L. Rodríguez-Mañas, Jorge D Erusalimsky
INTRODUCTION Frailty is prevalent among older adults with diabetes mellitus. Elevated serum levels of the soluble receptor for advanced glycation-end products (sRAGE) predict mortality in frail older adults. The evidence that sRAGE is also related to higher mortality in older adults with diabetes mellitus is inconsistent. Therefore, this study explored if frailty status influences the relationship between sRAGE and mortality in older adults with this condition. METHODS We analysed data of 391 participants with diabetes mellitus (median age, 76 years) from four European cohorts enrolled in the FRAILOMIC project. Frailty was evaluated at baseline using Fried's criteria. Serum sRAGE was determined by ELISA. Participants were stratified by frailty status (n = 280 non-frail and 111 frail). Multivariate Cox proportional hazards regression and Kaplan-Meier survival analysis were used to assess the relationship between sRAGE and mortality. RESULTS During 6 years of follow-up, 98 participants died (46 non-frail and 52 frail). Non-survivors had significantly higher baseline levels of sRAGE than survivors (median [IQR]: 1,392 [962-2,043] pg/mL vs. 1,212 [963-1,514], p = 0.008). High serum sRAGE (>1,617 pg/mL) was associated with increased mortality in the whole diabetes sample after adjustment for relevant confounders (HR 2.06, 95% CI: 1.36-3.11, p < 0.001), and there was an interaction between sRAGE and frailty (p = 0.006). Accordingly, the association between sRAGE and mortality was stronger in the frail group compared to the non-frail group (HR 2.52, 95% CI: 1.30-4.90, p = 0.006 vs. HR 1.71, 95% CI: 0.91-3.23, p = 0.099, respectively). Likewise, Kaplan-Meier curves showed a significant difference in survival rates between frail participants with high sRAGE and those with low sRAGE (p = 0.001), whereas no survival difference was seen in the non-frail group (p = 0.09). CONCLUSIONS Frailty status influences the relationship between sRAGE and mortality in older adults with diabetes mellitus. Determination of sRAGE in this population could be a useful tool for risk stratification.
{"title":"Frailty Influences the Relationship between the Soluble Receptor for Advanced Glycation-End Products and Mortality in Older Adults with Diabetes Mellitus.","authors":"Lee Butcher, J. Carnicero, Karine Pérès, Stefania Bandinelli, F. García-García, F. Rodríguez‐Artalejo, L. Rodríguez-Mañas, Jorge D Erusalimsky","doi":"10.1159/000538292","DOIUrl":"https://doi.org/10.1159/000538292","url":null,"abstract":"INTRODUCTION\u0000Frailty is prevalent among older adults with diabetes mellitus. Elevated serum levels of the soluble receptor for advanced glycation-end products (sRAGE) predict mortality in frail older adults. The evidence that sRAGE is also related to higher mortality in older adults with diabetes mellitus is inconsistent. Therefore, this study explored if frailty status influences the relationship between sRAGE and mortality in older adults with this condition.\u0000\u0000\u0000METHODS\u0000We analysed data of 391 participants with diabetes mellitus (median age, 76 years) from four European cohorts enrolled in the FRAILOMIC project. Frailty was evaluated at baseline using Fried's criteria. Serum sRAGE was determined by ELISA. Participants were stratified by frailty status (n = 280 non-frail and 111 frail). Multivariate Cox proportional hazards regression and Kaplan-Meier survival analysis were used to assess the relationship between sRAGE and mortality.\u0000\u0000\u0000RESULTS\u0000During 6 years of follow-up, 98 participants died (46 non-frail and 52 frail). Non-survivors had significantly higher baseline levels of sRAGE than survivors (median [IQR]: 1,392 [962-2,043] pg/mL vs. 1,212 [963-1,514], p = 0.008). High serum sRAGE (>1,617 pg/mL) was associated with increased mortality in the whole diabetes sample after adjustment for relevant confounders (HR 2.06, 95% CI: 1.36-3.11, p < 0.001), and there was an interaction between sRAGE and frailty (p = 0.006). Accordingly, the association between sRAGE and mortality was stronger in the frail group compared to the non-frail group (HR 2.52, 95% CI: 1.30-4.90, p = 0.006 vs. HR 1.71, 95% CI: 0.91-3.23, p = 0.099, respectively). Likewise, Kaplan-Meier curves showed a significant difference in survival rates between frail participants with high sRAGE and those with low sRAGE (p = 0.001), whereas no survival difference was seen in the non-frail group (p = 0.09).\u0000\u0000\u0000CONCLUSIONS\u0000Frailty status influences the relationship between sRAGE and mortality in older adults with diabetes mellitus. Determination of sRAGE in this population could be a useful tool for risk stratification.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140722793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Yajima, Y. Nakanishi, Ryo Andy Ogasawara, Naoki Imasato, Kohei Hirose, Sao Katsumura, M. Kataoka, H. Masuda
INTRODUCTION The aim of this study is to evaluate the features and benefits of different geriatric screening tools for enhancing the perioperative care of patients who undergo elective cancer surgery using cluster analysis. METHODS This study was a retrospective, observational analysis of 1019 consecutive patients who had elective major cancer surgery in the urology department of our hospital from October 2019 to January 2023. Before the surgery, a trained nurse screened the patients using six tools: Eastern Clinical Oncology Group performance status (ECOG-PS), flemish version of the triage risk screening tool (fTRST), geriatric-8 (G8), instrumental activities of daily living (IADL), patient health questionnaire-2 (PHQ-2), and simple questionnaire to rapidly diagnose sarcopenia (SARC-F). The study grouped the patients into four clusters based on their scores on these tools and compared their outcomes after the surgery. The outcomes included overall survival, ambulation failure, delirium, and severe complications. The study also examined how each screening tool was associated with the outcomes. RESULTS Based on their clinical data and screening results, we classified the patients into four groups: Healthy (73%), Depressive (11%), Intermediate (11%), and Unhealthy (5%). The Unhealthy group had the worst outcomes in overall survival (OS), ambulation failure, and delirium, followed by the Intermediate group. In addition, fTRST and SARC-F emerged as significant predictors of OS; ECOG-PS, fTRST, G8 and SARC-F of ambulation failure; ECOG-PS, fTRST and G8 of delirium; and G8 of severe complications. CONCLUSION Various geriatric screening tools were found to have the potential to forecast diverse postoperative outcomes.
{"title":"Comparing preoperative screening tools for elective urologic cancer surgery: insights from a cluster analysis.","authors":"S. Yajima, Y. Nakanishi, Ryo Andy Ogasawara, Naoki Imasato, Kohei Hirose, Sao Katsumura, M. Kataoka, H. Masuda","doi":"10.1159/000538733","DOIUrl":"https://doi.org/10.1159/000538733","url":null,"abstract":"INTRODUCTION\u0000The aim of this study is to evaluate the features and benefits of different geriatric screening tools for enhancing the perioperative care of patients who undergo elective cancer surgery using cluster analysis.\u0000\u0000\u0000METHODS\u0000This study was a retrospective, observational analysis of 1019 consecutive patients who had elective major cancer surgery in the urology department of our hospital from October 2019 to January 2023. Before the surgery, a trained nurse screened the patients using six tools: Eastern Clinical Oncology Group performance status (ECOG-PS), flemish version of the triage risk screening tool (fTRST), geriatric-8 (G8), instrumental activities of daily living (IADL), patient health questionnaire-2 (PHQ-2), and simple questionnaire to rapidly diagnose sarcopenia (SARC-F). The study grouped the patients into four clusters based on their scores on these tools and compared their outcomes after the surgery. The outcomes included overall survival, ambulation failure, delirium, and severe complications. The study also examined how each screening tool was associated with the outcomes.\u0000\u0000\u0000RESULTS\u0000Based on their clinical data and screening results, we classified the patients into four groups: Healthy (73%), Depressive (11%), Intermediate (11%), and Unhealthy (5%). The Unhealthy group had the worst outcomes in overall survival (OS), ambulation failure, and delirium, followed by the Intermediate group. In addition, fTRST and SARC-F emerged as significant predictors of OS; ECOG-PS, fTRST, G8 and SARC-F of ambulation failure; ECOG-PS, fTRST and G8 of delirium; and G8 of severe complications.\u0000\u0000\u0000CONCLUSION\u0000Various geriatric screening tools were found to have the potential to forecast diverse postoperative outcomes.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140736863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ivan Baltasar-Fernandez, Hector Soto-Paniagua, Julian Alcazar, María Isabel Uceta Espinosa, Luis M. Alegre, Francisco José Gracía-García, Ignacio Ara, Ana Alfaro Acha, J. Losa-Reyna
INTRODUCTION Concurrent training has been shown to be a beneficial approach to improve overall health status in older adults. However, little is known about the adaptations of this type of training in the long term (i.e., after cessation of exercise), even less in older people affected by frailty syndrome.Therefore, this study aimed i) to assess the effects of a 6-week concurrent training program composed of power-oriented resistance training (RT) and fast walking interval training (FWIT) on physical function, muscle power, disability in activities of daily living and frailty in pre-frail and frail older people, and ii) to assess the effects of a 6-month detraining period on these outcomes. METHODS A total of 59 pre-frail and frail older adults (>75 years old; Frailty Phenotype >1) were allocated into intervention (INT; n=32; 81.8 years; 21 women) or control (CON; n=27; 82.5 years; 19 women) groups. Primary outcomes of this study were Short Physical Performance Battery (SPPB), relative sit-to-stand (STS) power, Barthel index, Lawton scale and Frailty Phenotype. Assessments were performed at baseline (PRE), after the concurrent training programme (POST) and after 6 months of follow-up (DET) in both groups. Mixed model repeated measures ANOVA with Bonferroni's post hoc tests was used. RESULTS Immediately after the intervention (∆= POST-PRE), INT improved SPPB (∆=3.0 points; p<0.001), relative STS power (∆=0.87 W·kg-1; p<0.001) and reduced their frailty levels (∆=-1.42 criteria; p<0.001), while no changes were observed in CON. After 6 months of detraining (∆= DET-PRE), INT showed higher SPPB (∆=2.2 points; p<0.001), higher relative STS power (∆=0.73 W·kg-1; p<0.001) and lower frailty (∆=-1.24 criteria; p<0.001) values than those reported at baseline, which were significantly different than those reported by CON. Both, Barthel index and Lawton scale values were not modified during the study in either group. CONCLUSIONS The 6-week concurrent training program improved physical function, muscle power and reduced frailty in pre-frail and frail older people and these improvements were maintained above baseline levels after 6 months of detraining. However, due to the individual variability found, future studies of long-term responders vs. non-responders in frail populations are required.
{"title":"Long-term effects of a 6-week power-based resistance training and fast walking interval training program on physical function, muscle power, disability and frailty in pre-frail and frail older adults.","authors":"Ivan Baltasar-Fernandez, Hector Soto-Paniagua, Julian Alcazar, María Isabel Uceta Espinosa, Luis M. Alegre, Francisco José Gracía-García, Ignacio Ara, Ana Alfaro Acha, J. Losa-Reyna","doi":"10.1159/000536363","DOIUrl":"https://doi.org/10.1159/000536363","url":null,"abstract":"INTRODUCTION\u0000Concurrent training has been shown to be a beneficial approach to improve overall health status in older adults. However, little is known about the adaptations of this type of training in the long term (i.e., after cessation of exercise), even less in older people affected by frailty syndrome.Therefore, this study aimed i) to assess the effects of a 6-week concurrent training program composed of power-oriented resistance training (RT) and fast walking interval training (FWIT) on physical function, muscle power, disability in activities of daily living and frailty in pre-frail and frail older people, and ii) to assess the effects of a 6-month detraining period on these outcomes.\u0000\u0000\u0000METHODS\u0000A total of 59 pre-frail and frail older adults (>75 years old; Frailty Phenotype >1) were allocated into intervention (INT; n=32; 81.8 years; 21 women) or control (CON; n=27; 82.5 years; 19 women) groups. Primary outcomes of this study were Short Physical Performance Battery (SPPB), relative sit-to-stand (STS) power, Barthel index, Lawton scale and Frailty Phenotype. Assessments were performed at baseline (PRE), after the concurrent training programme (POST) and after 6 months of follow-up (DET) in both groups. Mixed model repeated measures ANOVA with Bonferroni's post hoc tests was used.\u0000\u0000\u0000RESULTS\u0000Immediately after the intervention (∆= POST-PRE), INT improved SPPB (∆=3.0 points; p<0.001), relative STS power (∆=0.87 W·kg-1; p<0.001) and reduced their frailty levels (∆=-1.42 criteria; p<0.001), while no changes were observed in CON. After 6 months of detraining (∆= DET-PRE), INT showed higher SPPB (∆=2.2 points; p<0.001), higher relative STS power (∆=0.73 W·kg-1; p<0.001) and lower frailty (∆=-1.24 criteria; p<0.001) values than those reported at baseline, which were significantly different than those reported by CON. Both, Barthel index and Lawton scale values were not modified during the study in either group.\u0000\u0000\u0000CONCLUSIONS\u0000The 6-week concurrent training program improved physical function, muscle power and reduced frailty in pre-frail and frail older people and these improvements were maintained above baseline levels after 6 months of detraining. However, due to the individual variability found, future studies of long-term responders vs. non-responders in frail populations are required.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140743271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tae Sung Lee, H. Kwon, Jun Young Park, Min Cheol Park, Yong Seon Choi, Kwan Kyu Park
INTRODUCTION The purpose of this study was to evaluate peripheral nerve block (PNB) effectiveness on postoperative pain management and surgical outcomes for displaced femoral-neck fracture in geriatric patients (>70 years) who underwent bipolar hemiarthroplasty (BHA). METHODS From January 2017 to December 2021, 231 geriatric patients with displaced femoral-neck fracture who consecutively underwent BHA were retrospectively reviewed. Patients were divided into two groups: patient-controlled analgesia (PCA) group (n=132) who received only intravenous (IV) PCA for postoperative pain management, and all others who received PNB with IV PCA (PNB+PCA) such as femoral nerve block or fascia iliaca compartment block after surgery (n=99). Primary outcomes were postoperative visual analog scale (VAS) at rest and during activity at 6, 24, and 48 hours postoperatively. Secondary outcomes were postoperative complications, changes in hemoglobin (Hb), length of hospital stay, and total morphine usage after surgery. RESULTS Postoperative resting VAS at 6 hours and 48 hours was significantly lower in the PNB+PCA group compared with the PCA group (p=0.075, p=0.0318, respectively). However, there was no significant difference in either resting VAS at 24 hours or active VAS. Complications of pneumonia and delirium until one month postoperative were significantly lower in the PNB + PCA group than the PCA group (p=0.0022, p=0.0055, respectively). CONCLUSION PNB with IV PCA seems to have a beneficial effect on geriatric femoral-neck patients who underwent BHA with postoperative analgesia for reducing postoperative resting pain and complications, especially pneumonia and delirium.
简介本研究旨在评估外周神经阻滞（PNB）对接受双极半关节置换术（BHA）的老年患者（70岁以上）股骨颈移位性骨折术后疼痛管理和手术效果的有效性。方法对2017年1月至2021年12月连续接受BHA手术的231例老年股骨颈移位性骨折患者进行回顾性研究。患者被分为两组：患者自控镇痛（PCA）组（n=132）仅接受静脉（IV）PCA进行术后疼痛管理，其他所有患者在术后接受PNB与IV PCA（PNB+PCA），如股神经阻滞或髂筋膜室阻滞（n=99）。主要结果是术后 6、24 和 48 小时休息和活动时的视觉模拟量表（VAS）。次要结果为术后并发症、血红蛋白（Hb）变化、住院时间和术后吗啡总用量。结果 PNB+PCA 组与 PCA 组相比，术后 6 小时和 48 小时的静息 VAS 显著降低（分别为 p=0.075 和 p=0.0318）。但是，24 小时静息 VAS 和活动 VAS 均无明显差异。PNB+PCA组术后一个月前的肺炎和谵妄并发症明显低于PCA组（分别为p=0.0022和p=0.0055）。
{"title":"Evaluating pain management from peripheral nerve block for geriatric patients following bipolar hemiarthroplasty for displaced femoral-neck fracture.","authors":"Tae Sung Lee, H. Kwon, Jun Young Park, Min Cheol Park, Yong Seon Choi, Kwan Kyu Park","doi":"10.1159/000538614","DOIUrl":"https://doi.org/10.1159/000538614","url":null,"abstract":"INTRODUCTION\u0000The purpose of this study was to evaluate peripheral nerve block (PNB) effectiveness on postoperative pain management and surgical outcomes for displaced femoral-neck fracture in geriatric patients (>70 years) who underwent bipolar hemiarthroplasty (BHA).\u0000\u0000\u0000METHODS\u0000From January 2017 to December 2021, 231 geriatric patients with displaced femoral-neck fracture who consecutively underwent BHA were retrospectively reviewed. Patients were divided into two groups: patient-controlled analgesia (PCA) group (n=132) who received only intravenous (IV) PCA for postoperative pain management, and all others who received PNB with IV PCA (PNB+PCA) such as femoral nerve block or fascia iliaca compartment block after surgery (n=99). Primary outcomes were postoperative visual analog scale (VAS) at rest and during activity at 6, 24, and 48 hours postoperatively. Secondary outcomes were postoperative complications, changes in hemoglobin (Hb), length of hospital stay, and total morphine usage after surgery.\u0000\u0000\u0000RESULTS\u0000Postoperative resting VAS at 6 hours and 48 hours was significantly lower in the PNB+PCA group compared with the PCA group (p=0.075, p=0.0318, respectively). However, there was no significant difference in either resting VAS at 24 hours or active VAS. Complications of pneumonia and delirium until one month postoperative were significantly lower in the PNB + PCA group than the PCA group (p=0.0022, p=0.0055, respectively).\u0000\u0000\u0000CONCLUSION\u0000PNB with IV PCA seems to have a beneficial effect on geriatric femoral-neck patients who underwent BHA with postoperative analgesia for reducing postoperative resting pain and complications, especially pneumonia and delirium.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140745546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Godhe, G. Rönquist, Johnny Nilsson, Ö. Ekblom, Lillemor Nyberg, Gunnar Edman, Eva Andersson
INTRODUCTION Physical fitness is strongly associated with daily physical function, health, and longevity in older adults. Field-based tests may provide a reasonable alternative compared to advanced laboratory testing. Separating post-exercise test-scores from reactivity measurements requires sufficient test-retest reliability. Post-exercise test-scores with reliability-analyses of field-based fitness-tests in older adults are lacking. The present study aimed to examine the test-retest-reliability of some novel easily accommodated fitness-test-measurements and compare pre-test scores with post-exercise results in these tests along with other field-based fitness tests in older adults. METHODS Totally 1,407 community-dwelling-older-adults (69%-female), x̄=71.5±5.0 (65-84 years), performed twelve field-based-fitness-tests at pre-test-1, pre-test-2 and a post-test after an 8-week-exercise-period (twice weekly 1 hour of combined strength and aerobic training). T-tests, intra-class correlation, limits of agreement, standard error of measurement and coefficient of variance were performed between pre-1-and-pre-2-tests, and Repeated-Measures-ANOVA and partial eta squared effect size for post-exercise differences, for men and women in five-year age groups ranging from 65 to 84 years. RESULTS Between pre-1 and pre-2-tests a significant difference was noted in some of the novel fitness-test-measurements, but generally not e.g., in isometric trunk-flexion and step-up-height on either leg among all sex and age groups. In most of these novel fitness-test-measurements, no significant differences occurred between the two pre-tests. Examples of results from the pre-2-test to the post-test were: isometric-trunk-flexion-45°-endurance and isometric-trunk-extension-endurance improved significantly for both sexes in age groups 65-74 years. Women, but not men, improved the maximal step-up-height for both legs in most age-groups. The speed in the 50 sit-to-stand improved significantly for most age-groups in both sexes. Six-min-walk-distance improved significantly for most age-groups in women but among men only in 65-69 years. In the timed-up-and-go-test, significant improvements were seen for all age-groups in women and in men 70-79 years. No post-exercise improvements were generally observed for grip-strength or balance. CONCLUSIONS In most of the novel fitness-test measures no significant difference was noted between the two pre-tests in the assessed sex and age groups. Results after the-8-week-exercise-period varied between sex and age-groups, with significant improvements in several of the twelve studied fitness-tests. These findings may be valuable for future projects utilizing easily accommodated physical fitness tests in older adults.
{"title":"Reliability in novel field-based fitness measurements and post-exercise scores from a physical fitness test battery in older adults.","authors":"M. Godhe, G. Rönquist, Johnny Nilsson, Ö. Ekblom, Lillemor Nyberg, Gunnar Edman, Eva Andersson","doi":"10.1159/000538446","DOIUrl":"https://doi.org/10.1159/000538446","url":null,"abstract":"INTRODUCTION\u0000Physical fitness is strongly associated with daily physical function, health, and longevity in older adults. Field-based tests may provide a reasonable alternative compared to advanced laboratory testing. Separating post-exercise test-scores from reactivity measurements requires sufficient test-retest reliability. Post-exercise test-scores with reliability-analyses of field-based fitness-tests in older adults are lacking. The present study aimed to examine the test-retest-reliability of some novel easily accommodated fitness-test-measurements and compare pre-test scores with post-exercise results in these tests along with other field-based fitness tests in older adults.\u0000\u0000\u0000METHODS\u0000Totally 1,407 community-dwelling-older-adults (69%-female), x̄=71.5±5.0 (65-84 years), performed twelve field-based-fitness-tests at pre-test-1, pre-test-2 and a post-test after an 8-week-exercise-period (twice weekly 1 hour of combined strength and aerobic training). T-tests, intra-class correlation, limits of agreement, standard error of measurement and coefficient of variance were performed between pre-1-and-pre-2-tests, and Repeated-Measures-ANOVA and partial eta squared effect size for post-exercise differences, for men and women in five-year age groups ranging from 65 to 84 years.\u0000\u0000\u0000RESULTS\u0000Between pre-1 and pre-2-tests a significant difference was noted in some of the novel fitness-test-measurements, but generally not e.g., in isometric trunk-flexion and step-up-height on either leg among all sex and age groups. In most of these novel fitness-test-measurements, no significant differences occurred between the two pre-tests. Examples of results from the pre-2-test to the post-test were: isometric-trunk-flexion-45°-endurance and isometric-trunk-extension-endurance improved significantly for both sexes in age groups 65-74 years. Women, but not men, improved the maximal step-up-height for both legs in most age-groups. The speed in the 50 sit-to-stand improved significantly for most age-groups in both sexes. Six-min-walk-distance improved significantly for most age-groups in women but among men only in 65-69 years. In the timed-up-and-go-test, significant improvements were seen for all age-groups in women and in men 70-79 years. No post-exercise improvements were generally observed for grip-strength or balance.\u0000\u0000\u0000CONCLUSIONS\u0000In most of the novel fitness-test measures no significant difference was noted between the two pre-tests in the assessed sex and age groups. Results after the-8-week-exercise-period varied between sex and age-groups, with significant improvements in several of the twelve studied fitness-tests. These findings may be valuable for future projects utilizing easily accommodated physical fitness tests in older adults.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140752391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Parkinson's disease (PD) is characterized by a prodromal phase preceding the onset of classic motor symptoms. The duration and clinical manifestations of prodromal PD vary widely, indicating underlying heterogeneity within this stage. This discrepancy prompts the question of whether specific factors contribute to the divergent rates of progression in prodromal PD. METHODS This study included prodromal PD patients from the Parkinson's Progression Markers Initiative. They were followed up to assess the disease progression. The data collected during the follow-up period were analyzed to identify potential predictors of rapid disease progression in prodromal PD. RESULTS In this study, 61 individuals with prodromal PD were enrolled. Among them, 43 patients presented with both RBD and hyposmia, 17 had hyposmia alone, and 1 had RBD alone at baseline. 13 (21.3%) prodromal PD participants exhibited rapid disease progression, with two of these cases advancing to non-neurological diseases. Significant differences were observed between the rapid progression group and no rapid progression group in terms of MDS-UPDRS II score and UPSIT score. Longitudinal analysis showed a significant increase in the MDS-UPDRS III score and MDS-UPDRS total score in the rapid progression group. Regression analyses identified the MDS-UPDRS II score and UPSIT score as predictors of rapid disease progression in prodromal PD. CONCLUSION Our study findings suggest that the MDS-UPDRS II score and UPSIT score may serve as clinical markers associated with rapid disease progression. Further research and development of precise biomarkers and advanced assessment methods are needed to enhance our understanding of prodromal PD and its progression patterns.
简介帕金森病（PD）的特点是在典型运动症状出现之前有一个前驱期。帕金森病前驱期的持续时间和临床表现差异很大，表明这一阶段存在潜在的异质性。这种差异引发了一个问题：是否有特定因素导致了前驱期帕金森病进展率的差异。方法：本研究纳入了帕金森病进展标志物倡议中的前驱期帕金森病患者。对这些患者进行了随访，以评估疾病的进展情况。对随访期间收集到的数据进行分析，以确定前驱型帕金森病疾病快速进展的潜在预测因素。结果本研究共纳入 61 名前驱型帕金森病患者。其中，43名患者在基线时同时伴有RBD和嗅觉减退，17名患者仅有嗅觉减退，1名患者仅有RBD。13例（21.3%）前驱型帕金森病患者的病情发展迅速，其中两例发展为非神经系统疾病。快速进展组与无快速进展组在MDS-UPDRS II评分和UPSIT评分方面存在显著差异。纵向分析表明，快速进展组的 MDS-UPDRS III 评分和 MDS-UPDRS 总分均有显著增加。回归分析表明，MDS-UPDRS II 评分和 UPSIT 评分是预测前驱型帕金森病快速进展的指标。我们需要进一步研究和开发精确的生物标志物和先进的评估方法，以加深我们对前驱型帕金森病及其进展模式的了解。
{"title":"Predictors of the rapid progression in prodromal Parkinson's disease: a longitudinal follow-up study.","authors":"Peng Liu, Linxi Chen, Xinwei He, Lingqun Mao","doi":"10.1159/000538515","DOIUrl":"https://doi.org/10.1159/000538515","url":null,"abstract":"INTRODUCTION\u0000Parkinson's disease (PD) is characterized by a prodromal phase preceding the onset of classic motor symptoms. The duration and clinical manifestations of prodromal PD vary widely, indicating underlying heterogeneity within this stage. This discrepancy prompts the question of whether specific factors contribute to the divergent rates of progression in prodromal PD.\u0000\u0000\u0000METHODS\u0000This study included prodromal PD patients from the Parkinson's Progression Markers Initiative. They were followed up to assess the disease progression. The data collected during the follow-up period were analyzed to identify potential predictors of rapid disease progression in prodromal PD.\u0000\u0000\u0000RESULTS\u0000In this study, 61 individuals with prodromal PD were enrolled. Among them, 43 patients presented with both RBD and hyposmia, 17 had hyposmia alone, and 1 had RBD alone at baseline. 13 (21.3%) prodromal PD participants exhibited rapid disease progression, with two of these cases advancing to non-neurological diseases. Significant differences were observed between the rapid progression group and no rapid progression group in terms of MDS-UPDRS II score and UPSIT score. Longitudinal analysis showed a significant increase in the MDS-UPDRS III score and MDS-UPDRS total score in the rapid progression group. Regression analyses identified the MDS-UPDRS II score and UPSIT score as predictors of rapid disease progression in prodromal PD.\u0000\u0000\u0000CONCLUSION\u0000Our study findings suggest that the MDS-UPDRS II score and UPSIT score may serve as clinical markers associated with rapid disease progression. Further research and development of precise biomarkers and advanced assessment methods are needed to enhance our understanding of prodromal PD and its progression patterns.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie Hezel, Leon Brüll, A. Arampatzis, Michael Schwenk
INTRODUCTION Perturbation-based balance training is promising for fall prevention in older adults mimicking real-life fall situations at a person's stability thresholds to improve reactive balance. Hence, it can be associated with anxiety, but knowledge about the acceptability of perturbation-based balance training is scarce. METHOD This is a secondary analysis of a randomized controlled trial comparing effects of two different perturbation-based balance training paradigms that aims to evaluate and compare the acceptability of those training paradigms in fall-prone older adults. Participants (74.9±5.7 years) who completed the training (6 weeks, 3x/week) on either a perturbation treadmill (PBTtreadmill: n=22) or unstable surfaces in the presence of perturbations (PBTstability: n=27) were surveyed on the acceptability of perturbation-based balance training using a 21-items questionnaire addressing seven domains (perceived effectiveness, tailoring, demand, safety, burden, devices, affective attitude), based on the Theoretical Framework of Acceptability and context-specific factors. Relative scores (% of absolute maximum) for single items and domains were calculated. RESULTS Median domain scores of perceived effectiveness, tailoring, safety, devices, and affective attitude were all ≥70% for both paradigms. The highest scores were obtained for tailoring (both paradigms=100% [interquartile range 80-100%]). Domain scores of demand and burden were in the medium range (40-45%) for both paradigms. No significant differences between paradigms were found for any domain score. Two single items of safety differed significantly, with PBTtreadmill perceived as needing less support (p=.015) and leading less often to balance loss (p=.026) than PBTstability. CONCLUSION Perturbation-based balance training conducted on a perturbation treadmill or on unstable surfaces is well accepted in this fall-prone older sample, even though it is conducted at individual stability thresholds. Tailoring may play a key role in achieving high levels of perceived effectiveness, appropriate levels of demand and burden, and high sense of safety. Perturbation-based balance training delivered on treadmills might be more appropriate for more anxious persons.
{"title":"Acceptability of Two Perturbation-based Balance Training Paradigms: Perturbation Treadmill vs Dynamic Stability Training in the Presence of Perturbations.","authors":"Natalie Hezel, Leon Brüll, A. Arampatzis, Michael Schwenk","doi":"10.1159/000538105","DOIUrl":"https://doi.org/10.1159/000538105","url":null,"abstract":"INTRODUCTION\u0000Perturbation-based balance training is promising for fall prevention in older adults mimicking real-life fall situations at a person's stability thresholds to improve reactive balance. Hence, it can be associated with anxiety, but knowledge about the acceptability of perturbation-based balance training is scarce.\u0000\u0000\u0000METHOD\u0000This is a secondary analysis of a randomized controlled trial comparing effects of two different perturbation-based balance training paradigms that aims to evaluate and compare the acceptability of those training paradigms in fall-prone older adults. Participants (74.9±5.7 years) who completed the training (6 weeks, 3x/week) on either a perturbation treadmill (PBTtreadmill: n=22) or unstable surfaces in the presence of perturbations (PBTstability: n=27) were surveyed on the acceptability of perturbation-based balance training using a 21-items questionnaire addressing seven domains (perceived effectiveness, tailoring, demand, safety, burden, devices, affective attitude), based on the Theoretical Framework of Acceptability and context-specific factors. Relative scores (% of absolute maximum) for single items and domains were calculated.\u0000\u0000\u0000RESULTS\u0000Median domain scores of perceived effectiveness, tailoring, safety, devices, and affective attitude were all ≥70% for both paradigms. The highest scores were obtained for tailoring (both paradigms=100% [interquartile range 80-100%]). Domain scores of demand and burden were in the medium range (40-45%) for both paradigms. No significant differences between paradigms were found for any domain score. Two single items of safety differed significantly, with PBTtreadmill perceived as needing less support (p=.015) and leading less often to balance loss (p=.026) than PBTstability.\u0000\u0000\u0000CONCLUSION\u0000Perturbation-based balance training conducted on a perturbation treadmill or on unstable surfaces is well accepted in this fall-prone older sample, even though it is conducted at individual stability thresholds. Tailoring may play a key role in achieving high levels of perceived effectiveness, appropriate levels of demand and burden, and high sense of safety. Perturbation-based balance training delivered on treadmills might be more appropriate for more anxious persons.","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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