Functional Capacity In Older Patients Research Articles

Inter-individual variability in response to exercise intervention or usual care in hospitalized older adults.

BackgroundExercise protocols applied during hospitalization can prevent functional and cognitive decline in older adults. The purpose of this study was to examine the individual response of acutely hospitalized patients to usual care and to physical exercise on functional capacity, muscle strength, and cognitive function and to assess the relationship with mortality at 1 year post‐discharge.MethodsIn a single‐blind randomized clinical trial, 370 hospitalized patients [56.5% women; mean age (standard deviation) 87.3 (4.9) years] were allocated to an exercise intervention group (IG, n = 185) or a control group (CG, n = 185). The participants were older adults aged 75 years or older in an acute care unit in a tertiary public hospital in Navarra, Spain. The usual care group received habitual hospital care, which included physical rehabilitation when needed. The in‐hospital intervention included individualized multicomponent exercise training programme performed during 5–7 consecutive days (two sessions/day). Functional capacity was assessed with the Short Physical Performance Battery (SPPB) test and the Gait Velocity Test (GVT). Handgrip strength and cognitive function were also measured at admission and discharge. Patients in both groups were categorized as responders (Rs), non‐responders (NRs), and adverse responders (ARs) based on the individual response to each treatment during hospitalization.ResultsThe prevalence of Rs was higher and the prevalence of NRs and ARs was lower in the intervention group than in the control group for functional capacity (SPPB IG: Rs 85.3%, NRs 8.7%, ARs 6.0% vs. CG: Rs 37.9%, NRs 28.8%, ARs 33.3% and GVT IG: Rs 51.2%, NRs 47.3, ARs 1.6% vs. CG: Rs 18.0%, NRs 67.7%, ARs 14.3%), muscle strength (IG: Rs 62.3%, NRs 26.5%, ARs 11.3% vs. CG: Rs 20.0%, NRs 38.0%, ARs 42.0%), and cognition (IG: Rs 41.5%, NRs 57.1%, ARs 1.4% vs. CG: Rs 13.8%, NRs 76.6%, ARs 9.7%) (all P < 0.001). The ARs for the GVT in the control group and the ARs for the SPPB in the intervention group had a significantly higher rate of mortality than the NRs and Rs in the equivalent groups (0.01 and 0.03, respectively) at follow‐up.ConclusionsOlder patients performing an individualized exercise intervention presented higher prevalence of Rs and a lower prevalence of NRs and ARs for functional capacity, muscle strength, and cognitive function than those who were treated with usual care during acute hospitalization. An adverse response on functional capacity in older patients to physical exercise or usual care during hospitalization was associated with mortality at 1 year post‐discharge.

Gait speed has comparable prognostic capability to six-minute walk distance in older patients with cardiovascular disease

Background Although gait speed and six-minute walk distance are used to assess functional capacity in older patients with cardiovascular disease, their prognostic capabilities have not been directly compared. Methods The study population was identified from the Kitasato University Cardiac Rehabilitation Database and consisted of 1474 patients ≥60 years old with a mean age of 72.2 ± 7.1 years that underwent evaluation of both usual gait speed and six-minute walk distance in routine geriatric assessment between 1 June 2008-30 September 2015. Both gait speed and six-minute walk distance were determined on the same day at hospital discharge. Results Mean gait speed and six-minute walk distance in the whole population were 1.04 m/s and 381 m, respectively, and were strongly positively correlated ( r = 0.80, p < 0.001). A total of 180 deaths occurred during a follow-up of 2.3 ± 1.9 years. After adjusting for confounding factors, both gait speed (adjusted hazard ratio per 0.1 m/s increase: 0.87, 95% confidence interval: 0.81-0.93, p < 0.001) and six-minute walk distance (adjusted hazard ratio per 10-metre increase: 0.96, 95% confidence interval: 0.94-0.97, p < 0.001) were independent predictors of all-cause mortality. There was no significant difference in prognostic capability between gait speed and six-minute walk distance (c-index: 0.64 (95% confidence interval: 0.60-0.69) and 0.66 (95% confidence interval: 0.61-0.70), respectively, p = 0.357). Conclusions Gait speed and six-minute walk distance showed similar prognostic predictive ability for all-cause mortality in older cardiovascular disease patients, indicating the potential utility of gait speed as a simple risk stratification tool in older cardiovascular disease patients.

An optimal combination of MCCB and CANTAB to assess functional capacity in older individuals with schizophrenia.

Cognitive deficits predict functional capacity in patients with schizophrenia including in late life. The MATRICS Consensus Cognitive Battery (MCCB) and the Cambridge Neuropsychological Test Automated Battery (CANTAB) are widely used to assess cognition in this population. The aim of this study was to determine a minimal set of subtests across the two batteries that would be strongly associated with functional capacity in older patients with schizophrenia. Sixty participants age 50 years or older with a diagnosis of schizophrenia or schizoaffective disorder and 30 control participants were enrolled. Cognition was assessed using the MCCB and the CANTAB. Functional capacity was assessed using the USCD Performance-based Skills Assessment (UPSA). Stepwise linear regressions were performed to determine the best set of cognitive tests associated with functional capacity. UPSA total score was negatively correlated with age and positively correlated with education and the MCCB global score. Most of the MCCB domains and subtests, and several of the CANTAB subtests correlated with UPSA total score. In the regression model, MCCB global score accounted for 42.5% of UPSA variance. In contrast, a combination of only four subtests (processing speed and verbal learning from the MCCB, and affective information processing and working memory from the CANTAB) accounted for 60% of UPSA variance. Performance on MCCB and CANTAB is strongly associated with functional capacity in older patients with schizophrenia. A selective combination of MCCB and CANTAB subtests may be as effective in assessing functional capacity in late life schizophrenia. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Assessment of functional capacity in older patients with prostate cancer in Mato Grosso Do Sul, Brazil

Assessment of functional capacity in older patients with prostate cancer in Mato Grosso Do Sul, Brazil

Considerations and Controversies in the Management of Older Patients with Advanced Cancer

The incidence of cancer increases with age. Oncologists need to be adept at assessing physiologic and functional capacity in older patients in order to provide safe and efficacious cancer treatment. Assessment of underlying health status is especially important for older patients with advanced cancer, for whom the benefits of treatment may be low and the toxicity of treatment high. The comprehensive geriatric assessment (CGA) is the criterion standard for evaluation of the older patient. The combined data from the CGA can be used to stratify patients into categories to better predict risk for chemotherapy toxicity as well as overall outcomes. The CGA can also be used to identify and follow-up on possible functional consequences from treatment. A variety of screening tools might be useful in the oncology practice setting to identify patients who may benefit from further testing and intervention. In this chapter, we discuss how the principles of geriatrics can help improve the clinical care of older adults with advanced cancer. Specifically, we discuss assessing tolerance for treatment, options for chemotherapy scheduling and dosing for older patients with advanced cancer, and management of under-recognized symptoms in older patients with cancer.

The Course of Neuropsychological Performance and Functional Capacity in Older Patients with Schizophrenia: Influences of Previous History of Long-Term Institutional Stay

Chronically institutionalized patients with schizophrenia have been reported to manifest cognitive and functional decline. Previous studies were limited by the fact that current environment could not be separated from lifetime illness course. The present study examined older outpatients who varied in their lifetime history of long-term psychiatric inpatient stay. Community-dwelling patients with schizophrenia (n = 111) and healthy comparison subjects (n = 76) were followed up to 45 months and examined two or more times with a neuropsychological battery and performance-based measures of everyday living skills (University of California San Diego Performance-Based Skills Assessment Battery [UPSA]) and social competence. A mixed-effects model repeated-measures method was used to examine changes. There was a significant effect of institutional stay on the course of the UPSA. When the schizophrenia patients who completed all three assessments were divided on the basis of length of institutional stay and compared with healthy comparison subjects, patients with longer stays worsened on the UPSA and social competence, while patients with shorter stays improved. For neuropsychological performance, both patient samples worsened slightly, while the healthy comparison group manifested a practice effect. Reliable change index analyses showed that worsening on the UPSA for longer stay patients was definitely nonrandom. Lifetime history of institutional stay was associated with worsening on measures of social and everyday living skills. Neuropsychological performance in schizophrenia did not evidence the practice effect seen in the healthy comparison sample. These data suggest that schizophrenia patients with a history of long institutional stay may worsen even if they are no longer institutionalized.

ASTHMA AND EXERCISE IN THE ELDERLY

Participation in regular physical activity, with the goal of enhancing functional ability and fitness, is associated with measurable health-enhancing and psychologic benefits. Various types of exercise are now actively prescribed by the medical community for the prevention and treatment of a number of diseases. 66 Obstructive pulmonary disease, including both chronic obstructive pulmonary disease (COPD) and asthma, is a significant cause of functional disability in older adults that is often characterized clinically by progressive breathlessness and increasing physical limitations. Whether exercise training improves aerobic capacity in elderly COPD patients and, in some cases, those with reactive airway disease, still remains unclear. 100 Earlier studies failed to demonstrate this effect, but more recent investigations 40 , 51 using higher levels of intensity or longer duration of training appear to improve functional capacity in older patients with moderate obstructive lung disease (Table 1) . In this article we examine how asthma, or reactive airflow obstruction, alters physical capacity and human performance in the elderly, and the role of exercise training in the management of reactive airways disease among older patients.