High Risk Of Disability Research Articles

What Messages Do Patients Remember? Relationships Among Patients' Perceptions of Physical Therapists' Messages, Patient Characteristics, Satisfaction, and Outcome.

Based on a behavioral medicine perspective, modern recommendations for physical therapists treating patients with spinal pain include performing a trustworthy physical examination, conveying the message that back pain is benign, and stressing that activity is a key to recovery. However, little evidence is available on how patients perceive these biopsychosocial messages and how patients' perceptions of these messages relate to their recovery. The aim of this study was to explore the relationships between perceptions of treatment delivery that are related to an evidence-based approach and psychological factors, treatment outcome, and treatment satisfaction. A cohort study with 3 measurement points was conducted. Data on 281 participants were collected. High catastrophizing and lower mood in the participants were correlated to "not perceiving the biopsychosocial message" measured at 6 weeks after treatment start. Participants who did not perceive the biopsychosocial message were at higher risk for disability and had lower treatment satisfaction 6 months after treatment start even when controlling for pretreatment pain intensity. "Not perceiving the biopsychosocial message" was not a mediator for treatment outcome and treatment satisfaction. Physical therapists' treatment orientations or attitudes were not related to the perception of the message by the patients. There was no measure of actual practice behavior. Maladaptive cognitions and negative emotions appear to affect the way information provided during treatment is perceived by patients. The way information is perceived by patients influences treatment outcome and treatment satisfaction. Physical therapists are advised to check that patients with higher levels of catastrophizing and lower mood are correctly perceiving and interpreting a biopsychosocial message.

Stroke : Highlights of Selected Articles

<i>Stroke</i> : Highlights of Selected Articles

Peripheral to central: Organ interactions in stroke pathophysiology

Stroke is associated with a high risk of disability and mortality, and with the exception of recombinant tissue-type plasminogen activator for acute stroke, most treatments have proven ineffective. Clinical translation of promising experimental therapeutics is limited by inadequate stroke models and a lack of understanding of the mechanisms underlying acute stroke and how they affect outcome. Bidirectional communication between the ischemic brain and peripheral immune system modulates stroke progression and tissue repair, while epidemiological studies have provided evidence of an association between organ dysfunction and stroke risk. This crosstalk can determine the fate of stroke patients and must be taken into consideration when investigating the pathophysiological mechanisms and therapeutic options for stroke. This review summarizes the current evidence for interactions between the brain and other organs in stroke pathophysiology in basic and clinic studies, and discusses the role of these interactions in the progression and outcome of stroke and how they can direct the development of more effective treatment strategies.

PP.36.06

Objective: The diastolic heart failure reaches up to 40% of HF total cases and its prevalence increases with age. The aim of this study is to evaluate both the blood pressure variability and the physical efficiency variability in elderly people with diastolic heart failure. Design and method: 34 elderly subjects were included (15 males, 19 females, mean age 73 + 8) hospitalized with a diagnosis of heart failure. The design of the study included: 1)clinical measurement of blood pressure;2)NYHA class evaluation;3)electrocardiogram; 4)echocardiogram; 5)Short Physical Performance Battery (SPPB). Self-sufficient elderly subjects,with a reduced physical performance and with a SPPB score between 5 and 9 can be considered frail and at high risk of disability. Results: 69.3% subjects had hypertension. Prevalence of heart failure increased with age (77.3% > age 80). Mean blood pressure values were: SBP 149 + 13 mmHg and DBP 87 + 12 mmHg. 35.3% had controlled blood pressure. Among all cases 27 affected by diastolic heart failure had a 43.9% ejection fraction. During the hospitalization those in Class I NYHA had a higher percentage of worsening heart failure if affected by uncontrolled hypertension. Hypertensive patients in Class 2 or 3 NYHA had a similar recovery rate both wih controlled and uncontrolled hypertension. However hypertensive subjects showed a definite worsening in NYHA class due to heart failure (19%) versus controlled ones (4%). Through the same investigation we detected that a history of hypertension was an independent predictive factor of NYHA Class diastolic heart failure (p < 0.05).We also detected that the average number of hospitalization days was higher in elderly patients affected by heart failure in 2 or 3 NYHA Classes and uncontrolled hypertension (p < 0.05). At dismissal we even detected a minor physical efficiency value (mean score 6 in 87% patients) mostly in elderly subjects with heart failure in 2 or 3 NYHA Classes and uncontrolled hypertension. Conclusions: The prevalence of diastolic heart failure is relevant in hypertensive ageing people and it increases with age. The cases of this study showed a connection among diastolic heart failure, blood pressure and physical efficiency, that is predictive of frailty.

Decline in Fast Gait Speed as a Predictor of Disability in Older Adults.

To determine whether fast gait speed at study baseline and change in gait speed had independent associations with disability onset. Cohort study with 11-year follow-up (1999-2010). Three-City Study center, Dijon, France. Community-dwelling individuals aged 65 to 85 (N=3,814, 61% female). Fast gait speed (over 6m) was assessed up to five times and disability (mobility (Rosow-Breslau scale), instrumental activities of daily living (IADLs; Lawton-Brody scale), basic activities of daily living (ADLs; Katz scale)) six times. A hierarchical disability indicator was constructed; participants were considered disabled if they reported difficulties with mobility and IADLs or with mobility, IADLs, and ADLs. The association between baseline fast gait speed and its slope of change and disability incidence was examined using joint models for longitudinal and time-to-event data. Over follow-up, 628 participants (68% women) developed disability. Mean fast gait speed at baseline was 1.54m/s, and annual decline was 0.017m/s. The hazard ratio of disability per standard deviation (SD)(-0.22m/s) slower baseline fast gait speed was 1.77 (95% confidence interval (CI)=1.60-1.94) and for one-SD (-0.013m/s) faster annual decline was 1.38 (95% CI=1.10-1.73) when both parameters were included in a sex- and age-adjusted model. All associations remained statistically significant in multivariable models, except for slope of change when chronic conditions were added to the model; of chronic conditions, dyspnea was the main contributor. Accelerated decline in fast gait speed was associated with disability independent of baseline fast gait speed. These results confirm the importance of measuring gait speed repeatedly in elderly adults to identify those at higher risk of disability and the need to identify determinants of decline, because they are likely to be targets for prevention and treatment to reduce disability risk.

Body mass index trajectories and functional decline in older adults: Three-City Dijon cohort study.

Obesity, whose prevalence is increasing, is associated with poor functional status at older ages. However, much of this evidence is cross-sectional with little known about longitudinal associations. We examined associations of body mass index (BMI), and change in BMI, with change in objective [walking speed (WS)] and self-reported (disability) measures of motor decline. Analyses included participants (65-85 years) from the Dijon center of the Three-City study (France) with up to five WS (N = 4007) and six disability assessments (N = 4478) over 11 years. Data were analyzed using regression models for repeated measures. Mean baseline WS was 153 cm/s. Compared to normal weight persons, obese participants at baseline walked slower and reported more disability; they also experienced 45% faster WS decline (-18.63 vs. -12.85 cm/s/10 years, P = 0.002). Participants who lost or gained weight had 47% (-18.85 cm/s/10 years, P < 0.001) and 33% (-17.08 cm/s/10 years, P = 0.002) respectively greater WS decline than participants in the normal BMI change category. 24% of participants reported disability at least once during the follow-up, those who lost or gained weight had a 1.63 and 1.34 respectively higher odds of disability than participants in the normal BMI change category (P = 0.001). Associations remained after adjustment for covariates. In conclusion, obesity is associated with worse motor performances, a higher risk of disability, and faster motor decline. Our results underline the interest of repeated BMI and motor assessments to identify those at higher risk of disability.

The ageing shift worker: a prospective cohort study on need for recovery, disability, and retirement intentions.

This study investigates whether different shift work schedules, compared to day work, are associated with need for recovery (NFR), future disability, and retirement intentions for employees employed within different economic sectors over the course of their careers. Shift work exposure duration and the healthy worker effect are also examined. Data from the prospective Maastricht Cohort Study was used. Subsamples of industry (N=1877, all men) and healthcare (N=818, 624 women and 194 men) workers were separately investigated. GEE and Cox regression analyses were performed to investigate NFR longitudinally. Future disability was investigated using Cox regression, and retirement intentions were investigated using logistic regression analysis. Three-shift industry workers were at risk of becoming a case of elevated NFR during follow-up, compared to industry day workers. Three- and five-shift industry workers were at risk for future disability. In healthcare, irregular shift work was a risk factor for disability among older shift workers. No significant results were found regarding retirement intentions. Findings were probably an underestimation as exposure duration to shift work and the healthy worker effect affected the results. Shift work was associated with higher levels of NFR and a higher risk of disability. However, shift work is a multifaceted concept as different types of shift work schedules are differently associated with these outcomes. Different shift work types exist and shift work schedules allow for optimization, indicating that measures to prevent adverse outcomes should be tailored for different types of shift work and over the course of the work career.

Treatment in juvenile rheumatoid arthritis and new treatment options.

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of the childhood with the highest risk of disability. Active disease persists in the adulthood in a significant portion of children with juvenile rheumatoid arthritis despite many developments in the diagnosis and treatment. Therefore, initiation of efficient treatment in the early period of the disease may provide faster control of the inflammation and prevention of long-term harms. In recent years, treatment options have also increased in children with juvenile idiopathic arthritis owing to biological medications. All biological medications used in children have been produced to target the etiopathogenesis leading to disease including anti-tumor necrosis factor, anti-interleukin 1 and anti-interleukin 6 drugs. In this review, scientific data about biological medications used in the treatment of rheumatoid arthritis and new treatment options will be discussed.

Abstract T P165: Women Had Worse Stroke Outcome

Background: women who have ischemic strokes are on average older than men.Several studies, however, show that stroke outcomes are worse in women even after adjusting for age, and the specific conditions that contribute to this outcome are poorly known. Our objective was to evaluate post-stroke disability and mortality after ischemic stroke in women. Methods: acute ischemic stroke patients were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic records; disability (modified Rankin scale) were evaluated one month after stroke. Results: fifty seven percent of the 1194 ischemic stroke patients prospectively included between December 2006 and December 2013 were women. They were older, more probably hypertensive, dislipidemic and diabetic, and had higher incidence of atrial fibrillation, while men had higher prevalence of obesity, metabolic syndrome, smoking, and history of coronary heart disease and peripheral artery disease. Pre-stroke vascular risk factor control and management are shown in table 1. Women had worst outcome than men: mRankin &gt;1 (66% women vs 52% men, p 0.0001), 30-day mortality (4% women vs 2% men, p 0.04), composite disability + mortality (52% women vs 36% men, p 0.0001). After adjusting by age women still had higher risk of disability and mortality: m-Rankin &gt;1 (OR 1.40, 95%CI 1.05-1.87; p 0.02); mortality (OR 1.64, 95%CI 0,98-2,74), and composite disability + mortality (OR 1.59, 95%CI 1.22-2.07; p 0.004). Conclusion: in our cohort women have worst post-stroke outcome, even though they have higher burden of vascular risk factors they have lower prevalence of vascular disease in other vascular beds previous to stroke. This difference persists after adjusting by age, raising the possibility of specific gender risk factors influencing on ischemic stroke outcomes.

Leprosy in pregnancy – a review of the literature

Leprosy, or Hansen ’ s disease, is one of the world ’ s oldest infectious diseases. It affects the skin and nerves and, if left untreated, leads to deformity. Every 2 minutes someone is diagnosed with leprosy, but, because of the lack of education and the stigma surrounding the disease, some people are diagnosed too late and develop life-changing disabilities. Through a simple course of medication, leprosy is an entirely curable disease. Literature, such as reported cases and review papers, on leprosy in pregnancy was obtained using various internet search engines. Leprosy in pregnancy is a rarely reported event, but nine countries in Africa, Asia and Latin America have considered it a public health problem. An effective cure for leprosy is available in the form of multidrug therapy, taken for some months, but if treatment is delayed until a later stage, there is a high risk of disability. Pregnancy is hazardous for women with leprosy. It is most dangerous during the third trimester when infection can lead to adverse obstetric and fetal outcomes, such as low birthweight, prematurity, exfoliative dermatitis in the newborn and erythema nodosum in the pregnant mother. Documentation on leprosy in pregnancy indicates that pregnancy is not only a trigger for leprosy but also an ideal in vivo model for research. Leprosy in pregnancy can be treated safely and effectively by combined drug therapy. However, early detection, well-planned health education for leprosy patients and the highest standard of clinical supervision during pregnancy are key strategies in reducing problems associated with the disease and are also the best way to prevent disability.

Vitamin D is associated with degree of disability in patients with fully ambulatory relapsing-remitting multiple sclerosis.

Vitamin D deficiency is a recognized risk factor for multiple sclerosis (MS) and is associated with increased disease activity. It has also been proposed that the lower the vitamin D levels are, the higher is the handicap. To refine the links between vitamin D insufficiency and disability in MS patients, a retrospective cohort analysis was performed including 181 patients prospectively followed without previous vitamin D supplementation, and age, gender, age at MS onset, MS type, MS activity, Expanded Disability Status Scale (EDSS) were analysed in correlation with plasma vitamin D levels. Vitamin D levels were significantly higher in relapsing-remitting MS than in progressive forms of MS in multivariate analyses adjusted for age, ethnicity, gender, disease duration and season (P=0.0487). Overall, there was a negative correlation between vitamin D level and EDSS score (P=0.0001, r=-0.33). In relapsing-remitting MS, vitamin D levels were only correlated with disability scores for EDSS<4 (P=0.0012). Patients with >20ng/ml of vitamin D were 2.78 times more likely to have an EDSS<4 (P=0.0011, 95% confidence interval 1.49-5.00). Data support previous work suggesting that vitamin D deficiency is associated with higher risk of disability in MS. Vitamin D levels also correlated with the degree of disability in fully ambulatory patients with relapsing-remitting MS. These additional results support the pertinence of randomized controlled trials analysing the interest of an early vitamin D supplementation in MS patients to influence evolution of disability.

Abstract 20440: Cardiovascular Events in a Physical Activity Intervention as Compared to a Successful Aging Intervention: The LIFE Study Randomized Trial

Background: There is little clinical trial evidence that sustained physical activity can prevent cardiovascular disease (CVD) in older adults. The LIFE Study was a multi-center randomized trial comparing sustained, structured physical activity (PA) to health education/successful aging (SA) to prevent mobility disability in older sedentary men and women. Cardiovascular morbidity and mortality was a secondary endpoint. Methods: Eligible participants (N=1635, 67% women, aged 70-89 years) were randomized to PA vs. SA. Eligibility criteria included being sedentary with a score &lt;10/12 on a short physical performance battery (SPPB), indicating higher risk for disability. Prevalent CVD was 30% at baseline. The PA intervention was a structured moderate intensity program, predominantly aerobic (walking), with resistance and flexibility exercises, at least five days weekly, 2x per week on site for 2.6 years on average. The SA intervention consisted of weekly health education sessions for six months, then monthly. CVD was assessed every 6 months, including fatal and non-fatal MI, angina, stroke and transient ischemic attack, peripheral artery disease including abdominal aortic aneurysm and all revascularizations. Hospital records were reviewed and adjudicated for CVD events by committee. Silent MI was assessed by ECG at 18 and 36 months. Results: Incident CVD occurred in 14.4% (n=118/818) of PA and 13.8% (113/817) of SA participants (HR=1.07, 95%CI=0.82-1.38. Using a narrower endpoint of MI, stroke or cardiovascular death, rates were 8.9% in PA and 8.7% in PA groups respectively with HR = 1.04 (95% CI=0.75-1.45). There were no significant differences in rates of incident vs. recurrent CVD. Among participants with SPPB &lt;8, CVD rates were 13.8% in PA vs 17.7% in SA with HR = 0.74 (95%CI=0.51-1.08), compared to 14.8% vs.10.5% (HR = 1.54 (95%CI=1.06-2.24) among those with SPPB of 8 or 9 (p for interaction = 0.007). Conclusions: Among participants in the LIFE Study, an aerobically-based, moderately intensive PA program did not reduce cardiovascular events overall. However, the intervention was more protective in lower functioning participants. Hypotheses to explain differences by functional status could be addressed with continued follow-up.

A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study.

The frailty syndrome is as a well-established condition of risk for disability. Aim of the study is to explore whether a physical activity (PA) intervention can reduce prevalence and severity of frailty in a community-dwelling elders at risk of disability. Exploratory analyses from the Lifestyle Interventions and Independence for Elders pilot, a randomized controlled trial enrolling 424 community-dwelling persons (mean age=76.8 years) with sedentary lifestyle and at risk of mobility disability. Participants were randomized to a 12-month PA intervention versus a successful aging education group. The frailty phenotype (ie, ≥3 of the following defining criteria: involuntary weight loss, exhaustion, sedentary behavior, slow gait speed, poor handgrip strength) was measured at baseline, 6 months, and 12 months. Repeated measures generalized linear models were conducted. A significant (p = .01) difference in frailty prevalence was observed at 12 months in the PA intervention group (10.0%; 95% confidence interval = 6.5%, 15.1%), relative to the successful aging group (19.1%; 95% confidence interval = 13.9%,15.6%). Over follow-up, in comparison to successful aging participants, the mean number of frailty criteria in the PA group was notably reduced for younger subjects, blacks, participants with frailty, and those with multimorbidity. Among the frailty criteria, the sedentary behavior was the one most affected by the intervention. Regular PA may reduce frailty, especially in individuals at higher risk of disability. Future studies should be aimed at testing the possible benefits produced by multidomain interventions on frailty.

Причины и структура первичного выхода на инвалидность лиц, проживающих в условиях напряженного магнитного поля

This paper analyzes the causes and patterns of primary disability in the persons of working age residing in areas with high magnetic background. Increasing the magnetic field is considered on the example of the changes generated by the Kursk magnetic anomaly. It is shown that the existing legal framework in the provision of medical care, medico-social examination and rehabilitation in Russia needs to be revised, with accentuation on the region of residence of patients, especially its geographical status, complex ecological situation. The authors noted that there is need for more effective, coordinated work of medical-social examination and outpatient health care services under the rehabilitation of persons with disabilities. Malignant neoplasms, cardiovascular disease, musculoskeletal and nervous systems, cerebrovascular pathology are leading nosological group of diseases with a high risk of disability in persons residing in the area of the magnetic field. Conducted medical examination in recent years of the population allowed, as one of the reasons to reduce the number of persons who received a disability for diseases of the circulatory system -is one of the most common socially significant diseases.

Social and lifestyle characteristics and burden of ill-health associated with self-reported hearing and vision impairments in older men in the British community: a cross-sectional study

BackgroundSensory impairment is common in older adults and we need to understand more about its association with other health conditions. We explored sensory impairment in relation to demographic, lifestyle factors, and health conditions in older men. MethodsIn a cross-sectional study, 3981 men aged 63–85 years (82% of participants recruited to the British Regional Heart Study cohort in 1978–80 and still alive in 2003) were selected from general practices in 24 British towns. Data on hearing aid use and ability to follow television at a volume others find acceptable allowed for four categories of hearing: can hear (n=2851), can hear with an aid (n=482), cannot hear and no aid (n=424), and cannot hear despite an aid (n=168). Vision impairment was defined as not being able to recognise a friend across a road (n=124). Logistic regression was used to investigate associations of hearing impairment and vision impairment with self-reported doctor-diagnosed coronary heart disease, disability (difficulty taking the stairs, difficulty keeping balance), social interaction (attending few social activities), and quality of life (experiencing pain, feeling anxious or depressed). Findings1074 men (27%) reported hearing impairment and 124 (3%) reported vision impairment. Compared with those reporting no hearing problem, hearing impairment was associated with disability, poor social interaction, and poor quality of life. Poor quality of life remained significant after having adjusted for social class, smoking, obesity, and physical activity. Only men who could not hear despite having a hearing aid were more likely to report coronary heart disease (age-adjusted odds ratio 1·89, 95% CI 1·36–2·63) and falls (1·62, 1·05–2·48). Vision impairment was associated with symptoms of coronary heart disease including chest pain (1·58, 1·07–2·40) and breathlessness (2·06, 1·38–3·06), but not with diagnosed coronary heart disease (1·39, 0·93–2·07). Vision impairment was also significantly associated with falls, poor quality of life, poor social interaction, and disability, which remained significant after adjusting for social class, smoking, obesity, and physical activity. Men with a sensory impairment were more likely to be physically inactive, obese (hearing impairment only), and in a manual social class. InterpretationOlder men with hearing impairment and vision impairment have a high risk of disability, poor health, and poor social interaction. Policy efforts for early detection and treatment of sensory impairment could be crucial for independent living in old age. FundingThe British Regional Heart Study is funded by the British Heart Foundation. AEML is funded by the National Institute for Health Research School for Public Health Research. SER is funded by a UK Medical Research Council Fellowship.

Nutritional interventions for optimizing healthy body composition in older adults in the community: a protocol for an umbrella review of studies of effectiveness and qualitative perceptions and experiences

Review question/Objective What is the effectiveness of nutritional interventions for optimizing healthy body composition in older adults living in the community, and what are these people’s qualitative perceptions and experiences? The objectives of this umbrella review are to measure and compare the overall effectiveness of nutritional interventions for optimizing healthy body composition in older adults living in the community and to better understand how they perceive and experience the nutritional interventions. Inclusion criteria Types of participants 1.This umbrella review will include systematic reviews involving:Older adults 60 years of age or older (sometimes referred to as “elderly”). More specifically, it is proposed that at least 50% of the people included in the review should be 60 years or older, OR that the mean age of people in the study should be at least 60 years. If one of these criteria is fulfilled but the other is not, the study will be included. 2 Living in the community. More specifically, it is proposed that at least 50% of the people included in the review should be: a) People living in their own homes or in retirement living. b) Those recently discharged from hospital and / or attending outpatient clinics. Those studies with a population meeting the above criteria exhibiting co-morbidities (e.g. included but not limited to diabetes, hypertension and asthma) will be included in the study. Where possible, results will be reported separately for different co-morbidities. Types of interventions/phenomena of interest This umbrella review will include systematic reviews that evaluate nutritional interventions, as previously defined. The seven types of nutritional interventions, which are included in this review are listed below. If other nutritional interventions are identified during the review, they will be assessed for inclusion using the above definition. Dietary programs High protein / low carbohydrate diet Mediterranean diet/lifestyle (including exercise, social engagement) Okinawa diet Caloric restriction Palaeolithic diet Nutritional supplements Oral nutritional supplements (ONS) including non-pharmacological dietary supplements (e.g. Sustagen) Powders, capsules Vitamins, minerals Meal replacements e.g. replacing a meal with a drink Food groups e.g. dairy, meat, fish, fruit Food delivery TRUNCATED AT 350 WORDS

Inequalities in healthy life expectancy between ethnic groups in England and Wales in 2001

Objectives. We aim to develop robust estimates of disability-free life expectancy (DFLE) and healthy life expectancy (HLE) for ethnic groups in England and Wales in 2001 and to examine observed variations across ethnic groups.Design. DFLE and HLE by age and gender for five-year age groups were computed for 16 ethnic groups by combining the 2001 Census data on ethnicity, self-reported limiting long-term illness and self-rated health using mortality by ethnic group estimated by two methods: the Standardised Illness Ratio (SIR) method and the Geographically Weighted Method (GWM).Results. The SIR and GWM methods differed somewhat in their estimates of life expectancy (LE) at birth but produced very similar estimates of DFLE and HLE by ethnic group. For the more conservative method (GWM), the range in DFLE at birth was 10.5 years for men and 11.9 years for women, double that in LE. DFLE at birth was highest for Chinese men (64.7 years, 95% CI 64.0–65.3) and women (67.0 years, 95% CI 66.4–67.6). Over half of the ethnic minority groups (men: 10; women: 9) had significantly lower DFLE at birth than White British men (61.7 years, 95% CI 61.7–61.7) or women (64.1 years, 95% CI 64.1–64.2), mostly the Black, Asian and mixed ethnic groups. The lowest DFLE observed was for Bangladeshi men (54.3 years, 95% CI 53.7–54.8) and Pakistani women (55.1 years, 95% CI 54.8–55.4). Notable were Indian women whose LE was similar to White British women but who had 4.3 years less disability-free (95% CI 4.0–4.6).Conclusions. Inequalities in DFLE between ethnic groups are large and exceed those in LE. Moreover, certain ethnic groups have a larger burden of disability that does not seem to be associated with shorter LE. With the increasing population of the non-White British community, it is essential to be able to identify the ethnic groups at higher risk of disability, in order to target appropriate interventions.

Are Recent Hispanic Immigrants At Higher Risk Of Disability With Multiple Sclerosis? (S34.008)

Are Recent Hispanic Immigrants At Higher Risk Of Disability With Multiple Sclerosis? (S34.008)

Clinical Outcomes of Impaired Muscle and Bone Interactions

Muscle and bone are in constant interaction. With aging, there is a progressive decline in muscle mass, known as sarcopenia, as well as in bone mass, which is known as osteopenia/osteoporosis. Sarcopenia and osteoporosis increase the risk of suffering falls and fractures, respectively. In fact, the simultaneous occurrence of osteoporosis and sarcopenia has been observed in a subset of frailer individuals at higher risk of disability, falls and fractures. However, the particular clinical outcomes that are unique to the sarco-osteoporotic patients remain unknown. In this review, we propose a common mechanism of sarco-osteoporosis and summarize those clinical and biochemical features that are prevalent in sarco-osteoporotic subjects. We expect that by describing a set of biological, clinical and functional characteristics that are associated with sarco-osteoporosis, this information could be used to inform the design of future trials and to develop interventions for this particular syndrome.

Physical rehabilitation in the frailty syndrome among the elderly

Frail elderly are those who have intrinsic vulnerability to develop disabilities and adverse events related to health. The prevalence of frailty increases with age. The American Medical Association estimates that 40% of those over 80 years old are fragile. Objective: To demonstrate the results obtained with the rehabilitation protocol for the frailty syndrome at Vila Mariana Geriatric Outpatient Unit of the Israelita Albert Einstein Hospital. Method: Series of cases study, descriptive and retrospective of 12 elderly who have accomplish the physical rehabilitation program at Vila Mariana geriatric outpatient unit in the Israelita Albert Einstein Hospital. Results: The average age was 77 years, 75% of the participants were female with an average of 7,5 diagnoses. There was improvement in all areas evaluated: balance (p = 0.02), gait speed (p &lt; 0.01), lower limb strength (p &lt; 0.01) and grip strength (p &lt; 0.01). Those who aged 80 or more showed improvement of 83% while those with less than 80 years old, showed an improvement of 41%. It was found that 8 of 10 seniors who met on the track at high risk for disability, hospitalization and death (SPPB equal or less than 9) was able to leave the risk range. It was showed improvement in at least one domain. No deterioration or complication was observed. Conclusion: The rehabilitation protocol for the frailty syndrome that was used at Vila Mariana geriatric outpatient unit was able to improve the balance, gait speed, lower limb strength and grip strength in the population studied.