Activity In Elderly Patients Research Articles

The Level and Limitations of Physical Activity in Elderly Patients with Diabetes.

Background/Objectives: Old age and illnesses can limit physical activity (PA). We have assessed the level of PA and its limitations in older people with diabetes (DM). Methods: Cross-sectional study, period: January and June 2024, place: Diabetes Center, subjects: patients (N = 207) > 64 years with DM), Surveying using: IPAQ, Accompanying Survey (AS). The significance was assessed by: Student's t-test, Mann-Whitney U test, Pearson's test. The relationships between the IPAQ and the AS results were analyzed based on a meta-analysis model for variable effects, OR with a 95% CI. ROC curve was used to determine the threshold values for age, BMI. Correlations between selected key variables were evaluated using the PCA. Results: The median age: 72 years (65-87), BMI: 28.70 (18.61-49.69). The median PA level: 1837 MET-min/week (0-9.891). The individuals who obtained insufficient (n = 28), sufficient (n = 75), and high levels of PA (n = 53) were 17.95%, 48.08%, and 33.97%, respectively. Diseases were the main factor limiting PA (53.54%) in patient's opinion, followed by the lack of a companion or motivation. The meta-analysis found no diseases linked to insufficient PA, but those with BMI > 33.3 and over 75 years old more often had insufficient PA. PCA revealed several characteristics that predispose individuals to insufficient PA. Conclusions: People over 75 years of age tend to avoid PA more than younger seniors, leading to its insufficient level, similarly like higher BMI. The individual with DM who has an insufficient level of PA is typically a single, woman, over 75, BMI > 33.

The Functional Efficiency of Older Patients after Lumbar Spine Surgery, the Impact of Pain, and the Passage of Time: Tips for Care Providers.

Chronic back pain in adults is often a cause of absenteeism from work, limitations in social interactions, and difficulties in performing daily activities. This study aimed to check whether the functioning of everyday activities in elderly patients after neurosurgery improved over time compared to their condition before the procedure and whether there is a connection between fitness, self-esteem, and pain intensity. This was a cross-sectional study carried out using an anonymous survey. This study included patients over 60 years of age from the neurosurgical ward. The following scales were used to assess cognitive functioning, depression, functional status: basic and instrumental activities of daily living (IADL), back pain disability (QBPDS), pain intensity, and self-esteem. The level of independence in terms of IADL and QBPDS increased, and the intensity of pain decreased. Surgery reduced pain intensity from 8 ± 0.8 to 6.1 ± 1.4 points. The level of self-esteem (RSES) remained at a low level. The passage of time after neurosurgical treatment has a beneficial effect on reducing pain intensity and increasing independence in life activities. Daily physical activity and rehabilitation are important factors supporting the return to independence.

Predictive factors of return to activity in elderly patients operated on for a fracture of the lower limb: a study of 113 patients

Background: The aim of this study was to determine the factors predictive of resumption of activity in elderly subjects operated on for a fracture of the lower limb. Methods: This was a cross-sectional study with retrospective data collection in subjects aged 56 and over who had undergone lower-limb surgery with a minimum follow-up period of six months. Patients' walking autonomy was assessed using the Parker score. The modular integrated household survey on living conditions was used to assess patients' socio-economic status. Bivariate analysis was performed using the chi-square test and the calculation of measures of association. Results: The series included 113 patients with a mean age of 70±9.54 years and a sex ratio of 1.09. Fractures of the upper end of the femur predominated in 67.6% of cases. The most common surgical procedure was intermediate hip replacement in 30 patients (26.5%). Rehabilitation sessions were performed in 95 patients (84.1%). The postoperative Parker score at the last follow-up was 9/9 in 41 patients (36.3%). Resumption of educational and productive activities and interpersonal responsibilities was achieved in 90 patients (79%). Significant associations (p<0.05) were found between resumption of activities and age, sex, marital status, history of arterial hypertension, psychiatric history, preoperative Parker score, postoperative Parker score and return to a private residence. Conclusions: Older age, female gender, absence of a partner, high blood pressure, non-personal residence and poor Parker score are factors with a poor prognosis for return to activity.

The association of serum adiponectin level with activities of daily living in hospitalized elderly patients with heart failure

BackgroundSeveral studies have reported a relationship between elevated serum adiponectin levels and poor outcomes in patients with heart failure (HF). However, data on the activities of daily living (ADL) in elderly patients with HF are limited. MethodsWe evaluated 218 hospitalized elderly (≥65 years) patients with HF who underwent a comprehensive cardiac rehabilitation (CR) program during hospitalization. Serum adiponectin levels were measured before discharge. The Barthel index (BI) score was evaluated at discharge. Low ADL was defined as a BI score < 85. ResultsSerum adiponectin levels were significantly associated with low ADL [p = 0.03; odds ratio (OR), 1.024, per 1.0 μg/mL increase]. In logistic or regression analyses adjusted for age, sex, body mass index, and estimated glomerular filtration rate, high adiponectin levels (≥16.2 μg/mL) were significantly associated with low ADL (p = 0.04; OR, 2.53), malnutrition (p < 0.01; OR, 2.88), and 6-min walk distance (p = 0.04; β = −17.5). In the multivariate analysis adjusted for conventional risk factors of low ADL, high adiponectin levels were also significantly associated with low ADL (p = 0.03; OR, 2.68). In the stepwise forward selection procedure, a high adiponectin level was an independent determinant of low ADL (p = 0.02; R2 = 0.0262). Both net reclassification improvement (0.53; p < 0.01) and integrated discrimination improvement (0.02; p = 0.01) improved significantly after the addition of high adiponectin level to conventional risk factors. In the regression analysis adjusted for age and sex, serum adiponectin levels were significantly (p < 0.0025) negatively associated with abdominal visceral and subcutaneous adipose tissue areas, body weight, body mass index, and serum triglyceride levels. ConclusionsHigh serum adiponectin levels were not only significantly associated with an increased risk of low ADL, but also with an increased risk of malnutrition and low physical activity in elderly patients with HF after the in-hospital CR program.

Effects of Motor Rehabilitation on Balance and Functional Activities in Elderly Patients with Peripheral Neuropathy and Recurrent Falls.

To date, little is known about the effects of motor rehabilitation in peripheral neuropathy (PN) patients with a history of recurrent falls (RFH). This study aimed to assess balance and the activities of daily living (ADLs) in elderly lower limb PN patients with and without RFH and to verify the effects of motor rehabilitation on balance and ADLs in these patients. We collected data from 64 lower limb PN patients, who underwent a conventional motor rehabilitation program: 35 patients had a history of recurrent falls, and 29 did not. The Berg Balance Scale (BBS) and motor FIM, before and after rehabilitation, were the outcome measures. After rehabilitation, lower limb PN patients with RFH had significantly higher scores in BBS and motor FIM (p < 0.001, for both) than at entry. The final BBS score and effectiveness in the BBS score of lower limb PN patients with RFH were lower than those of patients without RFH (p < 0.05 and p = 0.009, respectively). The study shows that conventional motor rehabilitation improves both balance and ADLs in patients, but balance improvement is lower in those with RFH. Thus, motor rehabilitation can be a therapeutic option for the management of these patients.

Outcomes of direct superior approach and posterolateral approach for hemiarthroplasty in the treatment of elderly patients with displaced femoral neck fractures: A comparative study.

Hemiarthroplasty is a surgical choice for super-aged patients with a high surgical risk and a sedentary lifestyle. The direct superior approach (DSA), a minimally invasive modification of the posterior approach, is rarely studied in hemiarthroplasty. The aim of the present study was to compare the clinical outcomes in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty via DSA with the conventional posterolateral approach (PLA). A total of 48 elderly patients with displaced femoral neck fractures who underwent hemiarthroplasty between February 2020 and March 2021 were retrospectively included in the study. Of them, 24 patients (mean age 84.54 ± 2.11 years) were treated with hemiarthroplasty via DSA (DSA group), while the other 24 patients (mean age 84.92 ± 2.15 years) were treated with hemiarthroplasty via PLA (PLA group). Clinical outcomes, perioperative data, and complications were recorded. There were no obvious differences in the baseline characteristics between the DSA and PLA groups, including age, gender, body mass index, Garden type, American Society of Anesthesiologists score, and hematocrit. Perioperative data showed that the length of the incision in the DSA group was smaller than that in the PLA group (p < 0.001). However, the duration of the operation and blood loss in the DSA group were longer and higher than those in the PLA group, respectively (p < 0.001). In addition, the DSA group had a shorter hospitalization time than the PLA group (p < 0.001). The visual analog scale score and Harris score 1 month postoperatively in the DSA group were better than those in the PLA group (p < 0.001). Moreover, there were no significant differences between the two groups in Harris score (for assessment dysfunction) 6 months postoperatively (p > 0.05). DSA is less invasive and has better clinical outcomes, which can allow an early return to daily living activities in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty.

Vitamin D Inadequacy Affects Skeletal Muscle Index and Physical Performance in Lumbar Disc Degeneration.

Lumbar disc degeneration (LDD) is one of the fundamental causes of low back pain. The aims of this study were to determine serum 25-hydroxyvitamin D (25(OH)D) levels and physical performance and to investigate the relationship between serum vitamin D levels, muscle strength and physical activity in elderly patients with LDD. The participants were 200 LDD patients, including 155 females and 45 males aged 60 years and over. Data on body mass index and body composition were collected. Serum 25(OH)D and parathyroid hormone levels were measured. Serum 25(OH)D was classified into the insufficiency group: <30 ng/mL and the sufficiency group: ≥30 ng/mL. Muscle strength was assessed by grip strength, and physical performance (short physical performance battery) was evaluated by the balance test, chair stand test, gait speed, and Timed Up and Go (TUG) test. Serum 25(OH)D levels in LDD patients with vitamin D insufficiency were significantly lower than in those with vitamin D sufficiency (p < 0.0001). LDD patients with vitamin D insufficiency had a prolonged time in physical performance on gait speed (p = 0.008), chair stand test (p = 0.013), and TUG test (p = 0.014) compared to those with vitamin D sufficiency. Additionally, we found that serum 25(OH)D levels were significantly correlated with gait speed (r = -0.153, p = 0.03) and TUG test (r = -0.168, p = 0.017) in LDD patients. No significant associations with serum 25(OH)D status were observed for grip strength and balance tests among patients. These findings demonstrate that higher serum 25(OH)D levels are associated with better physical performance in LDD patients.

Risk factors for ground-level fall injuries during active activity in older patients

In older patients, ground-level falls are the most common cause of injury. Many intrinsic and extrinsic factors influence ground fall injuries. However, the characteristics and severity of ground fall injuries have not been compared according to the activity levels. We compared the characteristics of ground fall injuries by the activity level to establish a preventive strategy for ground fall injuries in older patients. We retrospectively reviewed the records of older patients who were admitted to six university hospitals for ground-level fall injuries from 2011 to 2020. The patients were classified into active and inactive groups. Active activities were defined as paid work, exercise and leisure activities. General and clinical characteristics of both groups for ground-level fall injury were analyzed. Propensity score matching analysis (1:1) was performed for baseline characteristics (sex, age and alcohol consumption). A total of 33,924 patients were enrolled, of which 4887 (14.4%) were classified in the active group. Injury severity was not different between the active and inactive groups. The main factors significantly associated with ground fall injuries during activities in elderly patients were male sex, age from 65 to 74 years and 75 to 84 years compared to greater than 85 years, an injury time other than 00:00–05:59, alcohol consumption, sloping floor and floor type other than concrete. After propensity score matching analysis, the factors associated with ground-level fall injuries in older patients when they were active were a time of injury from 06:00–17:59 compared to 00:00–05:59, slippery floor, slope, the absence of obstacles and type of floor other than concrete. We should establish preventive strategies for reducing ground-level fall injuries in older patients during activity, which could include wearing compatible footwear, caution on sloping areas, and maintenance of unpaved roads.

The effect of denture-wearing on physical activity is associated with cognitive impairment in the elderly: A cross-sectional study based on the CHARLS database.

BackgroundCurrently, only a few studies have examined the link between dental health, cognitive impairment, and physical activity. The current study examined the relationship between denture use and physical activity in elderly patients with different cognitive abilities.MethodsThe study data was sourced from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database, which included information on denture use and amount of daily physical activity undertaken by older persons. Physical activity was categorized into three levels using the International Physical Activity General Questionnaire and the International Physical Activity Scale (IPAQ) rubric. The relationship between denture use and physical activity in middle-aged and older persons with varying degrees of cognitive functioning was studied using logistic regression models.ResultsA total of 5,892 older people with varying cognitive abilities were included. Denture use was linked to physical activity in the cognitively healthy 60 + age group (p = 0.004). Denture use was positively related with moderate physical activity in the population (odds ratio, OR: 1.336, 95% confidence interval: 1.173–1.520, p < 0.001), according to a multivariate logistic regression analysis, a finding that was supported by the calibration curve. Furthermore, the moderate physical activity group was more likely to wear dentures than the mild physical activity group among age-adjusted cognitively unimpaired middle-aged and older persons (OR: 1.213, 95% CI: 1.053–1.397, p < 0.01). In a fully adjusted logistic regression model, moderate physical activity population had increased ORs of 1.163 (95% CI: 1.008–1.341, p < 0.05) of dentures and vigorous physical activity population had not increased ORs of 1.016 (95% CI: 0.853–1.210, p > 0.05), compared with mild physical activity population.ConclusionThis findings revealed that wearing dentures affects physical activity differently in older persons with different cognitive conditions. In cognitively unimpaired older adults, wearing dentures was associated with an active and appropriate physical activity status.

A Review of the Potential Effects of Melatonin in Compromised Mitochondrial Redox Activities in Elderly Patients With COVID-19.

Melatonin, an endogenous indoleamine, is an antioxidant and anti-inflammatory molecule widely distributed in the body. It efficiently regulates pro-inflammatory and anti-inflammatory cytokines under various pathophysiological conditions. The melatonin rhythm, which is strongly associated with oxidative lesions and mitochondrial dysfunction, is also observed during the biological process of aging. Melatonin levels decline considerably with age and are related to numerous age-related illnesses. The signs of aging, including immune aging, increased basal inflammation, mitochondrial dysfunction, significant telomeric abrasion, and disrupted autophagy, contribute to the increased severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These characteristics can worsen the pathophysiological response of the elderly to SARS-CoV-2 and pose an additional risk of accelerating biological aging even after recovery. This review explains that the death rate of coronavirus disease (COVID-19) increases with chronic diseases and age, and the decline in melatonin levels, which is closely related to the mitochondrial dysfunction in the patient, affects the virus-related death rate. Further, melatonin can enhance mitochondrial function and limit virus-related diseases. Hence, melatonin supplementation in older people may be beneficial for the treatment of COVID-19.

Gene expression and molecular aspects in osteoarthritis of the knee - review of literature

Abstract Gonarthrosis is one of the main causes of pain and limitation of physical activity in elderly patients. The diagnosis is established based on the clinical and radiological examination, and the treatment consists of non-surgical measures. The final stage of gonarthrosis is treated surgically and consists of total knee arthroplasty. The molecular study in gonarthrosis aims to identify patients with early stages of arthrosis, with reversible potential, who can benefit from etiological treatment and non-pharmacological measures to slow down the evolution of the disease or even reversibility. Total knee arthroplasty is a surgical intervention with the role of reducing the symptoms and restoring the functionality of the affected joint. Total knee arthroplasty remains the surgical intervention of choice in the case of patients in the final stage of the evolution of the disease with very good functional outcome.

QUALITY OF LIFE AND PHYSICAL ACTIVITY OF ELDERLY PATIENTS WITH CARDIOVASCULAR DISEASES AND CHRONIC KIDNEY DISEASE

Objective: Chronic kidney disease (CKD) is an unfavorable prognostic factor in patients with cardiovascular diseases (CVD). Physical activity is associated with a better prognosis and improvement of the functional status of patients. The aim of this study was to investigate quality of life and physical activity of elderly patients with CVD and CKD. Design and method: 214 elderly patients with stable cardiovascular diseases (106 males, mean age 69.5 ± 7.6 years) were studied. Arterial hypertension had 201 (93.9%)patients, coronary artery disease - 198 (92.5%), 150 (70%) - chronic heart failure, 57 (26.6%) - diabetes mellitus. Arterial hypertension was diagnosed according to the ESC guidelines (2018). Components of physical activity were assessed through questionnaires, interviews and International Questionnaire on Physical Activity (IPAQ). The quality of life of patients was estimated using EQ-5D-5L (Russian, 2009 EuroQol Group) and Visual analog scale. Frailty syndrome and personality profile (PHQ-9) were appreciated. Results: CKD with glomerular filtration rate (GFR) less than 60 ml/min/1.73 m2(CKD-EPI, 2011) was diagnosed in 144 (67.3%) patients. The frequency of physical activity in elderly patients with CVD did not differ depending on the presence of CKD (p &gt; 0.05). Despite the rather high awareness of the benefits of physical activity (75%), adherence to the recommendations in elderly patients with CVD and CKD was significantly lower (63.2%) (X2 = 4.7; p = 0.03). Hypodynamia was observed in 54 (37.5%) elderly patients with CKD. The main type of physical activity for elderly patients with CKD was walking. Patients with CKD and frailty syndrome had lower indicators of physical activity (IPAQ) compared with patients without frailty syndrome: 14.5 (7.5;24) and 19 (12;26) points, resp., p = 0.03. Patients with CKD and hypodynamia had a higher level of depressive reactions (PHQ-9) (11 (8;15) and 9 (6;11) scores, resp., p = 0.03.), lower visual analogue scale scores (60 (45; 70) and 55 (50; 70) scores, p = 0.002) and the integral indicator of QoL (0.37 (0.27; 0.53) and 0.56 (0.53) .33; 0.68), p = 0.01)compared with patients without hypodynamia. Conclusions: Hypodynamia was observed in 37.5% elderly patients with CVD and CKD and leads to depressive reactions and a decrease in the quality of life.

GASTROINTESTINAL MOTILITY IN ELDERLY PATIENTS WITH WELL-CONTROLLED TYPE 2 DIABETES MELLITUS.

Gastrointestinal (GI) motility disorders in type 2 diabetes mellitus (T2DM) are common. However, the endpoints in well-controlled T2DM in elderly patients are barely understood. To evaluate GI transit and gastric myoelectric activity in elderly patients with T2DM who were undergoing treatment with metformin and to compare them with non-diabetic healthy controls. A total of thirty participants were enrolled in this study: young non-diabetic (n=10), elderly non-diabetic controls (n=10), and patients with T2DM managed with metformin (n=10). After fasting overnight, the participants ingested a standard meal and magnetic markers for non-invasive monitoring of GI transit and gastric contractility using the alternating current biosusceptometry and electrogastrography techniques. Mean gastric emptying time, mean colon arrival time, and mean intestinal transit time were determined. There were no significant differences between the groups and in the parameters evaluated (P>0.05). The frequency and amplitude of gastric myoelectric activity were not different between groups; however, abnormal rhythmic index and the half-bandwidth were slightly higher for both elderly diabetic and non-diabetic groups compared with the young adults (P<0.01 and P<0.05, respectively). Our study showed unaltered gastric emptying and intestinal transit in T2DM patients with good glycemic control, and suggest changes in the gastric electrical activity can be a part of aging.

Active Longevity program as important element of rehabilitation of elderly patients in primary health care

Progressive increase in the proportion of elderly patients in the population of many countries actualizes the issues of preserving physical and mental health, working capacity and quality of life of retirees. As a part of preventive geriatric rehabilitation, ‘the Active Longevity’ program has been operating in many cities of Russia over the past three years, one of the aspects of the program is the involvement of elderly patients in active life, including an increase in physical activity. This study included 744 patients who attended face‑to‑face physical training sessions. According to the results of the survey, 41% of pensioners noted an increase of daily physical activity, 94% reported an improvement in health and mood, the level of total blood cholesterol decreased. Almost all patients, both with and without clinical and subclinical manifestations of anxiety and depression, reported a good and very good mood immediately after exercise. Increasing physical activity in elderly patients improves the quality of life and prolongs its duration, and is also an effective method of non‑drug treatment of anxiety‑depressive disorders.

Hospital-associated functional decline and possible interventions based on physical activity, a review of the literature

Hospital functional impairment is defined as the loss of the ability to perform at least one of the basic activities of daily living with respect to the baseline situation of the person (2 weeks before the onset of acute illness). Its prevalence has been increasing due to the demographic transition of the last few years, which has caused aging to become a challenge with great impact on the health of people, their families and the health system. One of the main consequences of the increase in hospitalizations in the elderly is hospital functional impairment. This condition has multiple consequences in the short, medium and long term, which include increased hospital stay, increased costs of care, increased morbidity and mortality, among others. One of the stages of hospital functional impairment, which corresponds to the functional decline during hospitalization, is modifiable; hence the importance of identification and timely management to intervene at risk patients. Among the interventions that are proposed to deal with this condition are specialized geriatric care, comprehensive management with a multidisciplinary team, nutritional support and physical activity. The latter has been shown to have beneficial effects on physical, cognitive and neuropsychiatric symptoms in the elderly; Therefore, it has been included in multiple hospital protocols as the main non-pharmacological intervention to reduce dependence and impact on functional hospital deterioration.The objective of this literature review is to describe the definition, epidemiology, risk factors, complications, factors associated with functional recovery and intervention programs described for the treatment. Additionally, describe the interventions that include physical activity in elderly patients hospitalized for acute pathologies and possible functional outcomes in this population.

SMR/Theta Neurofeedback Training Improves Cognitive Performance and EEG Activity in Elderly With Mild Cognitive Impairment: A Pilot Study.

Background: Neurofeedback (NF) training, as a method of self-regulation of brain activity, may be beneficial in elderly patients with mild cognitive impairment (MCI). In this pilot study, we investigated whether a sensorimotor (SMR)/theta NF training could improve cognitive performance and brain electrical activity in elderly patients with MCI.Methods: Twenty elderly patients with MCI were assigned to 20 consecutive sessions of sensorimotor (SMR)/theta NF training, during 10 weeks, on a basis of two sessions each week. Neuropsychological assessments and questionnaires, as well as electroencephalogram (EEG), were performed and compared between baseline (T0), after the last NF training session at 10 weeks (T1), and 1-month follow-up (T2).Results: Repeated measures ANOVA revealed that from baseline to post-intervention, participants showed significant improvement in the Montreal cognitive assessment (MoCa, F = 4.78; p = 0.012), the delayed recall of the Rey auditory verbal learning test (RAVLT, F = 3.675; p = 0.032), the Forward digit span (F = 13.82; p < 0.0001), the Anxiety Goldberg Scale (F = 4.54; p = 0.015), the Wechsler Adult Intelligence Score–Fourth Edition (WAIS-IV; F = 24.75; p < 0.0001), and the Mac Nair score (F = 4.47; p = 0.016). EEG theta power (F = 4.44; p = 0.016) and alpha power (F = 3.84; p = 0.027) during eyes-closed resting-state significantly increased after the NF training and showed sustained improvement at a 1-month follow-up.Conclusion: Our results suggest that NF training could be effective to reduce cognitive deficits in elderly patients with MCI and improve their EEG activity. If these findings are confirmed by randomized controlled studies with larger samples of patients, NF could be seen as a useful non-invasive, non-pharmacological tool for preventing further decline, rehabilitation of cognitive function in the elderly.Clinical Trial Registration: This pilot study was a preliminary step before the trial registered in www.ClinicalTrials.gov, under the number of NCT03526692.

Studi Literatur: Peran Caregiver Untuk Peningkatan Perawatan Kesehatan Pada Pasien Demensia

The role of caregivers for dementia patients to improve health care is not yet optimal. Dementia patient care is an experience-based effort for complex dementia patients that can increase the psychological pressure of caregivers. The aim of the study was to determine the effectiveness of the caregiver's role in dementia patients to improve health care. Search strategies for English-language studies that are relevant to the topic are carried out using the ScienceDirect, SagePub, Springer databases limited from 2014 to 2020. The keywords used are "caregiver", "dementia", "health care", "role". Fulltext articles are reviewed to select studies that fit the criteria. The inclusion criteria in this review are health workers, caregivers. A search using the keywords above with the ScienceDirect, SagePub, Springer database that met the inclusion criteria was only 22 articles. Research examined in this article uses a variety of methods, namely systematic literature review by 1 articles, RCT by 4 articles, interview by 1 articles, qualitative study by 5 articles, quasi-experimental study 2 article, participatory research of 1 article, bootstrapping methods of 1 article, scoping review of published literature by 1 articles, quantitative study by 1 articles, cohort study path analysis by 1, a survey to clarify the evaluation by 1, SEM by 1, standardized protocol by 1. Research using random techniques as much as 10 articles, while those using non-random techniques as many as 12 articles. The role of caregivers for dementia patients to improve health care is an effective experience-based effort and is the most appropriate activity for elderly patients with dementia. Enhance the role of the caregiver by changing the caregiver's perception of a more positive view of his role.

Objectively Measured Physical Activity and Its Association with Functional Independence, Quality of Life and In-Hospital Course of Recovery in Elderly Patients with Proximal Femur Fractures: A Prospective Cohort Study.

Background Physical activity in elderly patients is crucial for recovery from proximal femoral fractures. Considering the limited possibilities for objective measurement, we aimed to evaluate the use of an accelerometer in this population to determine activity's association with functional independence, quality of life, and course of recovery. Methods 52 patients undergoing operative treatment for proximal femur fractures (81.3 ± 7.5 years) were included in a prospective cohort study. 12 patients with fall but without fracture of the lower extremities (80.8 ± 9.5 years) served as control. An Axivity AX3 tracker continuously recorded signal vector magnitudes during the hospital stay. Additionally, 2 ± 1 and 8 ± 3 days (time point 1 and 2) after operation EuroQol-5D and Barthel-20 indices were evaluated. Results Physical activity increased in all patients with time. Multiple regression analyses revealed that a high Barthel-20 before fracture, a low age, a high body mass index, high albumin, and low C-reactive protein levels were independent predictors for high physical activity at time point 1 (p < 0.05). Physical activity correlated significantly with EuroQol-5D and Barthel-20 at time point 1 and 2 (p < 0.02). Furthermore, physical activity at time point 1 predicted EuroQol-5D, physical activity, and Barthel-20 at time point 2 (p < 0.01). A multiple regression demonstrated equal physical activity in patients with or without a hip fracture. Conclusions Accelerometer signals correlate with postoperative physical activity, Barthel-20 and quality of life in elderly patients. Physical activity is thereby positively influenced by a high prefall functional independence and a good nutrition status. A timely and adequate operation provided, there is no difference between patients with or without a fracture. This trial is registered with DRKS 00011934 on 10th April 2017.

Impact of spinal kyphosis on gastric myoelectrical activity in elderly patients with osteoporosis.

An association between spinal kyphosis and gastroesophageal reflux disease (GERD) was reported in recent years. However, it remains unclear whether spinal kyphosis affects gastric motility. We evaluated the changes in myoelectrical activity measured by electrogastrography (EGG) in elderly osteoporosis patients. A total of 18 patients scheduled for the treatment of osteoporosis were included in this study. They were analyzed by recording EGG to assess myoelectrical activity and heart rate variability (HRV) to evaluate the autonomic nervous system function before and after meals. Dominant power (DP) representing the strength of gastric electrical activity and dominant frequency (DF) representing its frequency were analyzed in blocks with a 5-minute duration. We divided the patients into 2 groups, thoracolumbar kyphosis (TLK) and non-TLK groups, and compared them. There were no significant differences between the 2 groups in background data. In the non-TLK group, DPs post 0-5 min were significantly higher than those during pre 5-0 min in channels 1 and 3 (P < 0.05 and P < 0.01). DF deviation in the TLK group was significantly higher than that in the non-TLK group at 10 to 15 postprandial minutes (P < 0.05). Low frequency/high frequency activity measured by HRV, reflecting the activity of the sympathetic nervous system, in the TLK group was significantly lower than that in the non-TLK group while eating (P < 0.01). The EGG of patients with spinal kyphotic deformity showed a similar change to that of patients with GERD; the spinal kyphotic deformity itself may affect gastric electrical activity.

Premorbid Alterations of Spontaneous Brain Activity in Elderly Patients With Early Post-operative Cognitive Dysfunction: A Pilot Resting-State Functional MRI Study.

Background: Elderly patients with pre-existing cognitive impairment are susceptible to post-operative cognitive dysfunction (POCD). In this study, we investigated whether there is pre-existing local homogeneity and functional connectivity alteration in the brain before surgery for POCD patients as compared to that in non-POCD patients.Methods: Eighty elderly patients undergoing major thoracic or abdominal surgeries were recruited. Resting-state functional MRI was scanned at least 1 day before surgery. Neuropsychological tests (NPTs) were performed before surgery and at discharge, respectively. Pre-operative regional homogeneity (ReHo) and resting-state functional connectivity (RSFC) were compared between POCD patients and non-POCD patients, respectively. Partial correlation between NPTs and ReHo or RSFC was analyzed by adjusting for confounding factors.Results: Significant difference (P < 0.001, Gaussian Random Field (GRF) correction which is a multiple comparisons correction method at cluster level, cluster size > 49) in ReHo between POCD patients and non-POCD patients was detected in right hippocampus/parahippocampus. Pre-operative RSFC between right hippocampus/parahippocampus and right middle/inferior temporal gyrus increased in POCD patients (P < 0.001, GRF correction for multiple comparisons) when compared with that in non-POCD patients.RSFC significantly correlated with composite Z-score (r = 0.46, 95% CI [0.234, 0.767], P = 0.002) or Digit Symbol Substitution Test Z-scores (r = 0.31, 95% CI [0.068, 0.643], P = 0.046) after adjusting for confounding factors.Conclusions: The results suggest that premorbid alterations of spontaneous brain activity might exist in elderly patients who develop early POCD. The neural mechanism by which patients with pre-operative abnormal spontaneous activity are susceptible to POCD requires further study.