Functional Recovery Of Elderly Patients Research Articles

Effect of Low-Dose Dexmedetomidine on Intestinal Barrier and Functional Recovery in Elderly Patients Undergoing Orthopedic Surgery for Lower Limbs

Objective: This study used the minimum recommended clinical dose of dexmedetomidine to investigate whether it can protect the intestinal barrier and the effects on intestinal function recovery in elderly patients undergoing lower limb orthopedic surgery. Methods: 56 patients, who underwent elective lower limb orthopedic surgery in our hospital from November 1, 2019 to November 1, 2021, were divided into control group (saline group) and DEX group (dexmedetomidine group) by random numbers method. The DEX group received dexmedetomidine at 0.5 μg/kg, pumped within 15 min and then maintained at 0.1 μg/kg/h until 30 min before the skin suture. The control group performed the same procedure with normal saline instead. The primary outcomes included the time of first hepatic gate exhaust, serum diamine oxidase, and D-lactate levels. Secondary outcomes include total amount of sufentanil, mean arterial pressure, heart rate, duration of anesthesia, duration of surgery, tumor necrosis factor- α, C-reactive protein, lipopolysaccharide levels. Results: The time of first anal exhaust in the DEX group was significantly shorter compared with the control group (13.23 ± 4.98 hours vs19.67±5.16 hours; p<0.001), and the total amount of sufentanyl in the DEX group was significantly lower than that in the control group (35.32±10.23ug vs 42.33±12.19ug; p=0.002). At 24 hours after surgery, serum diamine oxidase, tumor necrosis factor-α, and C-reactive protein levels increased in both groups, but no difference was statistically significant (p>0.05), and there was no significant difference in LPS levels in the two groups before and 24 hours after surgery (p>0.05). D-lactate was increased in both groups at 24 hours after surgery, but the D-lactate increased more in control patients than in the DEX group (36.17±14.69 mg/L vs 29.10±12.19 mg/L;p=0.017). Correlation analysis showed that diamine oxidase, D lactate, age, APACHE II score, total amount, and time to first anal discharge in the DEX group (p<0.05). Conclusion: The intraoperative administration of dexmedetomidine can accelerate the recovery of gastrointestinal function, which may be related to the protective effect of DEx on the gastrointestinal barrier.

TPVB and general anesthesia affects postoperative functional recovery in elderly patients with thoracoscopic pulmonary resections based on ERAS pathway.

Thoracic surgery is easy to cause various perioperative complications, especially in elderly patients, due to their physical weakness and physiological function degeneration. Postoperative cognitive dysfunction is a common complication in elderly patients undergoing thoracic surgery. This study focuses on exploring the effects of thoracic paravertebral block (TPVB) combined with general anesthesia on postoperative functional recovery in elderly patients undergoing thoracoscopic radical resection for lung cancer based on enhanced recovery after surgery (ERAS) pathway. A total of 104 patients aged 60 years or older undergoing thoracoscopic radical resection of lung cancer were randomized into the combination group (n = 52) and the control group (n = 52). Patients in the control group were given general anesthesia alone, while patients in the combination group were given TPVB combined with general anesthesia. All patients applied the ERAS model for the perioperative intervention. Hemodynamic indices (heart rate [HR] and mean arterial pressure [MAP]) before anesthesia (T0), 5 min after thoracoscopic trocar placement (T1), at extubation (T2), 30 min after extubation (T3), and 6 h after the surgery (T4), postoperative analgesia, preoperative and postoperative serum pain stress factors (5-hydroxytryptamine [5-HT], prostaglandin E2 [PGE2], cortisol [Cor], substance P [SP], and norepinephrine [NE]), tumor markers (CYFRA21-1, CEA, and CA50), inflammatory factors (IL-6, TNF-α, and c-reactive protein (CRP)), lung function indicators (forced vital capacity [FVC] and forced expiratory volume in the first second [FEV1]), 6 min walking distance (6MWD), clinical recovery indicators, hospitalization status, and postoperative complications in patients between both groups were compared. Compared with the control group, patients in the combination group had lower HR and MAP at T1-T4 time points, less intraoperative doses of remifentanil and propofol, less patient-controlled interscalene analgesia compression number 24 h after the surgery, lower visual analogue scale scores 24 h after the surgery, shorter hospitalization time, postoperative off-bed time, postoperative chest tube removal time, postoperative first feeding time and gastrointestinal function recovery time, reduced postoperative serum levels of 5-HT, PGE2, Cor, SP, NE, CYFRA21-1, CEA, CA50, IL-6, TNF-α, and CRP, decreased complications, and higher FVC, FEV1, and 6MWD. Based on the ERAS pathway, TPVB combined with general anesthesia in thoracoscopic surgery for lung cancer in elderly patients can effectively reduce the patients' hemodynamic fluctuations, alleviate postoperative pain, accelerate the recovery process, and reduce complications.

Poor nutritional status is associated with incomplete functional recovery in elderly patients with mild traumatic brain injury.

The geriatric nutritional risk index (GNRI) is a simple index for evaluating the nutrition status of elderly patients. Many investigations have demonstrated that this index is associated with the prognosis of several diseases. This study aims to identify the relationship between the GNRI and recovery in elderly mild traumatic brain injury (mTBI) patients. A total of 228 mTBI patients older than 65 years were included in this study. mTBI was defined as an injury to the brain with a loss of consciousness of 30 min or less, a duration of posttraumatic amnesia of <24 h, and an admission Glasgow Coma Scale (GCS) score of 13-15. The Glasgow Outcome Scale Extended (GOSE), an outcome scale assessing functional independence, work, social activities, and personal relationships, was applied to assess the recovery of the patients. The clinical outcome was divided into complete recovery (GOSE = 8) and incomplete recovery (GOSE ≤ 7) at 6 months after the injury. Multivariate logistic regression was applied to evaluate the association between the GNRI and recovery of elderly mTBI patients, with adjustment for age, sex, hypertension, diabetes, and other important factors. The receiver operating curve (ROC) analysis demonstrated that the cutoff value of GNRI was 97.85, and the area under the curve (AUC) was 0.860. Compared to the patients with a high GNRI, the patients with a low GNRI were older, had a higher prevalence of anemia, acute subdural hematoma, and subarachnoid hemorrhage, had a higher age-adjusted Charlson Comorbidity Index value, and had lower levels of albumin, lymphocytes, and hemoglobin. Multivariable analysis showed that high GNRI was associated with a lower risk of 6-month incomplete recovery (OR, 0.770, 95% CI: 0.709-0.837, p < 0.001). The GNRI has utility as part of the objective risk assessment of incomplete 6-month functional recovery in elderly patients with mTBI.

Pre-operative Factors Predicting Mortality in Six Months and Functional Recovery in Elderly Patients with Hip Fractures.

This study aimed to determine on-admission and perioperative factors predicting six-month mortality and functional recovery in Vietnamese patients with hip fracture. Between April 2020 and July 2021, 118 patients participated in this prospective study. Patients' data were collected from medical records. Harris hip score (HHS) was used to evaluate the functional recovery six months after fractures. The obtained data were analysed using a univariate and multivariate model. The mean age of the participants was 79.5±9.4 years and 68.6% of the patients were female. The six-month mortality rate was 5.9% and independently associated with age (odds ratio (OR): 3.512, 95% confidence interval (CI) 1.538 - 8.019; P<0.001, patients aged >80 years vs those aged ≤80 years) and hypoproteinemia (OR: 2.859, 95% CI: 1.001 - 8.166, P=0.049). Among 111 survivors there were 66 (59.5%) of patients with a good functional recovery. Patients aged >80 years had a higher risk of poor functional outcome (OR: 3.167, 95% CI: 1.386 - 7.235, P: 0.006) compared to those aged ≤ 80 years. No significant correlations between other clinical (gender, body mass index, comorbidities, type of fractures or surgery, time until surgery) or laboratory parameters (anaemia, hyperglycemia, marked elevation of C reactive protein level, electrolyte abnormalities, elevated urea) and mortality or functional outcome were found. Advanced age is the most important factor affecting both mortality and functional outcome while hypoproteinemia is associated with a higher risk of mortality in elderly patients with hip fractures.

To whom it may concern

To whom it may concern

Use of Intravenous Paracetamol Preoperatively Favors Lower Risk of Delirium and Functional Recovery in Elderly Patients with Hip Fracture: A Propensity Score-Matched Analysis.

We aimed to investigate whether the use of intravenous paracetamol (IVP) preoperatively in intertrochanteric fracture (IF) patients aged 65 years or over receiving intramedullary fixation had significantly benefits on the pain score at discharge, delirium incidence, length of hospital stay (LOS), functional outcomes, and mortality. A retrospective analysis of all surgically treated patients presenting with IF was conducted at a single Level I trauma center in China between Jan. 2016 and Jan. 2020. The data concerning patients' demographics, injury-related data, surgery-related data, operation-related data, in-hospital data, and postoperative outcomes were extracted. To minimize potential confounding and selection bias, the propensity score matching (PSM) method was performed via the caliper matching method by using a 1 : 1 ratio. After PSM, McNemar's chi-square tests were used to examine the association of using IVP with outcome analyses. The Spearman correlations of IVP using, pain scores, and the factors which may influence them were also computed. After screening 2963 consecutive patients, 2166 were included finally, including 1576 in the non-IVP group and 590 in the IVP group. After PSM, 531 remained in each group. The pain scores at discharge were significantly between the two groups before and after matching (all p < 0.001). The differences of delirium rate and functional outcomes became significant after propensity score-based matching (p=0.001 and 0.033, respectively), although they were not significant before matching. No significant difference was observed in other operation-related data, LOS, and crude mortality rates at 30-day, 90-day, and 12-month before and after PSM. In conclusion, this study highlights the need for preoperative IVP use to optimize pain control, postoperative functional recovery, and minimize pain-related comorbidities such as delirium in elderly patients with hip fracture.

Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: A systematic review.

This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after hospital discharge. We assessed the use of the hip fracture core-set and key-performance indicators for secondary fracture reduction. A search was performed in seven electronic databases. Observational studies reporting predictors after usual care of elderly patients with hip fracture diagnoses receiving surgical or conservative treatment were included. Primary outcomes considered were part of the domains corresponding to functional capacity. Of 3873 references identified, and after the screening and selection process, 43 studies were included. Sixty-one functional measures were identified for ten functional outcomes, including BADLs, IADLs, ambulation, and mobility. Biological characteristics such as age, sex, comorbidities, cognitive status, nutritional state, and biochemical parameters are significantly associated. Determinants such as contact and size of social network and those related to institutional care quality are relevant for functional recovery at six and 12months. Age, pre-fracture function, cognitive status, and complications continue to be associated five years after discharge. We found 74 associated factors to functional recovery of elderly hip fracture patients. Ten of the studies reported rehabilitation programs as suggested in KPI 9; none used the complete hip fracture core-set. Most of the associated factors for functional recovery of elderly hip fracture were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. For the core-set and KPI's, we found an insufficient use and report. This study reports 61 different instruments to measure functional capacity. PROSPERO (CRD42020149563).

Does the type of hip fracture affect functional recovery in elderly patients undergoing inpatient rehabilitation?

BackgroundHip fractures should not be considered as a single, homogeneous condition. Various determinants of functional recovery of patients with hip fracture have been proposed, such as age or type of fracture. The aim of this study was to determine if patients with an intertrochanteric fracture (ITF) had lower functional recovery characteristics with respect to those with a femoral neck fracture (FNF). MethodsA retrospective study was carried out on 531 elderly patients with hip fracture, surgically treated, admitted to a rehabilitation institute between December 1, 2014, and December 31, 2017. Patients underwent an individualized rehabilitation program for improving their physical function. The outcome measures of this study were the length of stay (LOS) in the rehabilitation institute, the Functional Independence Measure (FIM) gain, i.e. the difference in FIM score between discharge and admission, and the FIM efficiency, which represents the daily gain. Patients were also stratified by age categories and by different levels of functional independence, as evaluated with the FIM total score at baseline. ResultsAge (p<0.05), LOS (p<0.005) and rehabilitation outcomes (FIM score and efficiency; p<0.05) differed significantly between patients with FNF and ITF. In particular, patients with ITF were older and more dependent at baseline. Moreover, they showed a lower FIM efficiency with respect to patients with FNF (p<0.05), which obtained a similar improvement in FIM total score of about 26 points but were discharged on average 3 days before. With aging, FIM efficiency decreased, while LOS increased. Patients highly dependent at baseline (FIM total score <40) had the lowest FIM gain and efficiency and the longest LOS respect to the more independent patients. Moreover, in older (85+ years) and in higher dependent patients the differences in the outcome measures between ITF and FNF were reduced. ConclusionsThe type of hip fracture could affect the LOS and FIM efficiency of younger and more independent patients with hip fracture during inpatient rehabilitation. In particular, patients with ITF require a longer rehabilitation period to achieve a similar functional gain as those with FNF.

Effects of acute fatigue on the outcome of aged patients with initial cerebral infarction

Objective To investigate the effects of acute fatigue on the outcome of aged patients with cerebral infarction. Methods The Fatigue Severity Scale was used to investigate the incidence of fatigue in 240 elderly patients with acute cerebral infarction, to assess the outcome of the patients at discharge and one year after discharge, and to analyze the effect of acute fatigue on the functional recovery and survival of patients. Results Totally 89 patients (37.1%) suffered from acute fatigue.Multivariate Logistic regression analysis showed that high admission NIHSS score(OR=2.472, 95%CI= 1.931-3.164)and acute post-stroke fatigue(OR=4.820, 95%CI=2.281~10.187)were the influencing factors for functional recovery of elderly patients with cerebral infarction at discharge(P<0.01). High admission NIHSS score(OR=1.674, 95%CI=1.411-1.985), acute post-stroke fatigue(OR=2.123, 95%CI=1.187-3.796), mRS score≥ 2 at discharge(OR=9.822, 95%CI=4.899-19.693)and recurrence(OR=6.146, 95%CI=2.596-14.553)were independent risk factors for functional recovery of elderly patients with cerebral infarction one year after discharge (P<0.05). Multivariate Cox regression analysis showed that age (OR=1.096, 95%CI=1.027-1.169), post-stroke fatigue in acute phase OR=5.233, 95%CI=1.051-6.053)and recurrence(OR=13.983, 95%CI=2.821-49.307)were independent predictors of mortality for elderly patients with cerebral infarction (P<0.05). Conclusion Fatigue after acute stroke can effect the functional recovery and survival of elderly patients with cerebral infarction. Key words: Post-stroke fatigue; Acute phase; Cerebral infarction; Outcome

Transforming growth factor-β promotes basement membrane fibrosis, alters perivascular cerebrospinal fluid distribution, and worsens neurological recovery in the aged brain after stroke.

Aging and stroke alter the composition of the basement membrane and reduce the perivascular distribution of cerebrospinal fluid and solutes, which may contribute to poor functional recovery in elderly patients. Following stroke, TGF-β induces astrocyte activation and subsequent glial scar development. This is dysregulated with aging and could lead to chronic, detrimental changes within the basement membrane. We hypothesized that TGF-β induces basement membrane fibrosis after stroke, leading to impaired perivascular CSF distribution and poor functional recovery in aged animals. We found that CSF entered the aged brain along perivascular tracts; this process was reduced by experimental stroke and was rescued by TGF-β receptor inhibition. Brain fibronectin levels increased with experimental stroke, which was reversed with inhibitor treatment. Exogenous TGF-β stimulation increased fibronectin expression, both in vivo and in primary cultured astrocytes. Oxygen-glucose deprivation of cultured astrocytes induced multiple changes in genes related to astrocyte activation and extracellular matrix production. Finally, in stroke patients, we found that serum TGF-β levels correlated with poorer functional outcomes, suggesting that serum levels may act as a biomarker for functional recovery. These results support a potential new treatment strategy to enhance recovery in elderly stroke patients.

Fractura de cadera en el paciente anciano: factores pronóstico de mortalidad y recuperación funcional al año

ObjectiveThe aim of this study is to identify the risks factors for mortality and functional recovery in elderly patients admitted to hospital with a hip fracture. Materials and methodsLongitudinal prospective study in patients 80 years old or more and patients between 75 and 79 in residential home care with a hip fracture and with a past medical history of dementia or followed-up by the Geriatric Unit. A total of 359 patients were included, and the demographic data, previous functional status, comorbidity, type of fracture, and dementia were recorded. The data collected during admission included time to surgery, delirium, functional recovery, length of stay, placement at discharge, and mortality. Patients were followed-up for one year and details were collected on placement at the end of follow-up, functional recovery, medical complications, and mortality. ResultsThe baseline characteristics of the patients with a strong association with mortality after a hip fracture were old age (> 92 years), medical complications delaying surgery (HR 2.17; 95% CI; 1.27-3.73), diagnosis of dementia (HR 1.78; 95% CI; 1.15-2.75), or heart failure (HR 1.75; 95% CI; 1.12-2.75). The fitted multivariable regression models showed that functional impairment before the hip fracture or lack of functional recovery are associated with higher mortality, and patients with increased age, delirium, dementia, and previous functional impairment showed worse functional recovery. ConclusionIn the elderly patients with a hip fracture, increased age, comorbidity and previous functional status is associated with mortality. Functional recovery prognosis will depend on age, previous functional status, past medical history of dementia, and the presence of delirium during admission.

Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients

ObjectivesDue to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. Material and methodsA prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalisation were evaluated. ResultsPatients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture. ConclusionsEvaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture.

Factores determinantes de estancia hospitalaria, mortalidad y evolución funcional tras cirugía por fractura de cadera en el anciano

ObjectivesDue to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. Material and methodsA prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. ResultsPatients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture ConclusionsEvaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture

Grip strength and functional recovery after hip fracture: An observational study in elderly population

IntroductionMuscle strength is a common issue in fragility syndrome and sarcopenia, both of them involved in the pathogenesis of falls and fractures. ObjectiveTo study the relationship between hand grip strength and functional recovery after hip fracture surgery. MethodologyThis prospective observational study included patients aged 65years and older who were admitted to hospital for hip fracture surgery during a 12 month period. Functional status (Barthel Index), mental status (Cruz Roja Index), hand grip strength, 25/OH-Vitamin D plasmatic levels were evaluated at admission. Follow-up was performed 3months after discharge to assess functional status and survival. Correlations between hand grip strength and the rest of variables were evaluated. Univariate and multivariate analyses were further applied. Mean age of subjects was 85.1±0.63 years. Out of 127 subjects, 103 were women and 24 were men. Hand grip strength was obtained in 85 patients (76.5%) and, values were between 3.3 and 24.8kg and 81 patients (95.2%) had values below cut-point of sarcopenia considering European Working Group of Sarcopenia criteria. Hand grip strength at admission shows significant association to Barthel index at three months and functional recovery. It is also associated with age (P<0.001) (r=0.81), sex (P=0.001), cognitive status by Cruz Roja Index (P<0.001) and functional status measured at admission by Barthel Index (P<0.01) (r=−0.22). Multivariate analysis confirmed that variables were independently associated to grip strength. ConclusionHand grip strength measured at admission in Orthogeriatric Unit after hip fracture is directly related to functional recovery in elderly patients.

Retrograde Intramedullary Nailing for Femoral Shaft Fractures in Elderly Patients with Previous Ipsilateral Dynamic Hip Screw Fixation

Purpose: We present our experience in managing femoral shaft fractures in elderly patients with previous ipsilateral dynamic hip screw fixation for extracapsular neck of femur fractures using retrograde intramedullary nailing implants. Methods: This was a prospective consecutive study of patients presenting with a femoral shaft fracture and an ipsilateral dynamic hip screw fixation treated with unreamed retrograde femoral nailing. The Wilde modification of the Neer knee score was used as a primary outcome measure. Results: A total of 16 patients were included (5 males, 11 females), with a mean age of 82 years (range 74-101). All fractures were closed and were due to low-energy trauma. There were 7 patients with 32-A1 fractures, 5 patients with 32-A2 fractures and 4 patients with 32-B1 fractures. All patients had an ipsilateral 4-hole plate dynamic hip screw implant. Minor surgical complications were recorded in 5 patients. Two patients died due to medical complications and were excluded from the final analysis. All remaining 14 patients achieved satisfactory outcomes at 12 months of follow-up with a mean Wilde modification of the Neer knee score of 15.5 (SD 2.53; range 13-20). Conclusions: Unreamed retrograde femoral nailing can achieve good functional recovery in elderly patients with a femoral shaft fracture and a previous ipsilateral dynamic hip screw fixation.

Impacts of graphics health education on postoperative functional recovery of elderly patients with intertrochanteric fractures

Objective To investigate the impacts of graphic health education on postoperative functional recovery of elderly with intertrochanteric fractures. Methods A total of 72 elderly patients, who admitted to hospital with intertrochanteric fractures from March 2012 to March 2013, were divided into observation group and control group by random number table; health education for patients and their families in the observation group were based on graphics cards done by nurse, while patients and their families of the control group underwent conventional health education. Two groups were compared in operative time, healing time, Harris score and other indexes, health education awareness score and satisfaction rate. Results The healing time of observation group were (14.1±0.9) w and (14.5±1.1) w in the control group (t=1.688 6, P>0.05), while Harris score were (13.2±3.2) point in the observation group higher than (9.6±2.8) point in the control group (t=5.079 9, P<0.01). Health education awareness score of observation group were (88.7±10.8) point higher than (73.2±11.2) point of the control group (t=5.977 3, P<0.01); the satisfaction with nursing work was 94.4% in the observation group comparing with 77.7% in the control group (P<0.05). Conclusions Graphics health education can improve the awareness of intertrochanteric fractures and patient satisfaction among elderly, and is conducive to functional recovery, which is worthy of clinical application. Key words: Elderly; Intertrochanteric fracture; Recovery; Health education; Graphics health education card

Functional recovery of elderly patients with surgically-treated intertrochanteric fractures: preliminary results of a randomised trial comparing the dynamic hip screw and proximal femoral nail techniques

IntroductionIntertrochanteric fractures of the femur are prevalent in the elderly, and leave patients with functional restrictions after surgical treatment. The aim of this study was to compare the functional recovery at 1-year follow-up of elderly patients with intertrochanteric fractures treated surgically with the dynamic hip screw (DHS) or proximal femoral nail (PFN) fixation techniques. Material and methodsThis prospective, randomised, blinded trial included patients aged over 65 years with intertrochanteric fractures classified as AO group 31.A1 or 31.A2. The patients were allocated into one of two treatment groups: one treated with DHS and the other with PFN. Data on functional recovery were obtained using the Functional Recovery Score developed by Zuckerman for elderly patients with hip fracture. Variables were described as means and standard deviations, and the non-parametric Kolmogorov–Smirnov test was used to verify the normality of data distribution. Non-normally distributed variables were compared using the non-parametric Friedman and Mann–Whitney U tests. Data processing and analysis were carried out in SPSS 10.0. Results were deemed significant at the 5% level (p≤0.05). ResultsThere were no significant between-group differences in age (p=0.152), sex (p=0.363), or American Society of Anaesthesiologists (ASA) score (p=0.579). Functional recovery scores in the DHS group at 3 and 6 months after surgery were significantly reduced from preoperative baseline scores (p=0.007) compared with in the PFN group. However, there were no statistically significant differences between the two groups in functional recovery scores at baseline (p=0.346) or at 3 months (p=0.880), 6 months (p=0.699), and 12 months (p=0.468) after surgery. There was no between-group difference in mortality (p=0.140). ConclusionAt 1-year follow-up, functional recovery scores were similar in elderly patients treated with the DHS and PFN techniques. However, DHS-treated patients exhibited significant loss of function in the first 6 months after surgery, which did not occur in the PFN-treated group.

Functional recovery in elderly patients with cerebral vascular accident (CVA)

Functional recovery in elderly patients with cerebral vascular accident (CVA)

Higher uric acid levels are associated with better functional recovery in elderly patients receiving cardiac rehabilitation

Background and aimsWhether uric acid (UA) serves as risk factor for cardiovascular diseases or as antioxidant defense has not yet been completely clarified. In this study we investigated the effects of UA on functional recovery in patients receiving cardiac rehabilitation. Methods and results306 patients, 209 men and 97 women, age range 25–87 years (mean 68 ± 11), performed the 6-min walk test (6mWT) before and after the rehabilitation, and the increase in walking distance was considered as the outcome measure of the study. Baseline UA serum levels ranged from 1.0 to 10.9 mg/dL (mean 5.2 ± 1.7). As there was a significant (p = 0.005) age*UA levels interaction, patients were divided into two subgroups, less then 65 years (n. 103, 68 men and 35 women, mean age 56 ± 9) and 65 years or more (n. 203, 141 men and 62 women, mean age 74 ± 5). After adjusting for relevant confounders, higher UA levels remained independent positive predictors of the increase in walking distance in older (p < 0.001) but not in younger patients (p = 0.807). ConclusionsOur findings show an independent association of higher UA levels with better functional recovery after cardiac rehabilitation selectively in elderly patients, suggesting that higher UA levels might reflect the decline in antioxidant defenses that occurs with advancing age. Future studies aimed at understanding the several contradictions concerning UA should, probably, address the issue within this perspective.

The effect of individualized systematic training on the ability of activity of the elderly patients with knee osteoarthritis

Objective To discuss the effect of individualized systematic training on the functional recovery of elderly patients with knee osteoarthritis.Methods Totaled of 100 patients were divided into two groups randomly (N =50).The patients in the control group received verbal instructions from the nurse and training by oneself,and the patients in the observation group were conducted with individualized systematic training according to the patient's body and joint function.The ability of activity of two groups were evaluated and compared by Health Assessment Questionnaire (HAQ) and knee function rating scale after the training 0 months,1 month,3 months,6 months.Results HAQ scores were no significant difference at 0 months and 1 month between two groups,and at 3 months,6 months there were significant differences (P ＜ 0.05),the score of knee function in the observation group was significantly higher than that in control group (P ＜ 0.05).Conclusions Implementation of the individual systematic training can improve the ability of activity,relieve pain and improve life quality in the elderly patients with knee osteoarthritis. Key words: Individual systematic training; Knee steoarthritis; Ability of activity