Rehabilitation Of Older People Research Articles

The Perspective of Rehabilitation Nurses on Physical Exercise in the Rehabilitation of Older People in the Community: A Qualitative Study.

In the face of an increasingly aging population, nurses have to design and implement programs aimed at the elderly in order to keep them healthy and maintain their quality of life. Structured physical exercise and overall physical activity play a major role in maintaining an active lifestyle, improving health, preventing disease, and helping to maintain older people's quality of life. To investigate the importance of implementing physical exercise programs for the older person in the community, taking into account the perspective of the rehabilitation nurse specialist, this is a qualitative, exploratory, and descriptive study with nine rehabilitation nurses from various regions of Portugal who have experience of implementing physical exercise programs with the elderly. This study used semi-structured interviews, one of the most common data collection procedures in social and health research. Content analysis was used to analyze the data. The study received a positive opinion from the Ethics Committee. The participants' perspectives focused on the following subjects: "Physical exercise program for the elderly in the community", "Importance of physical exercise in the rehabilitation of the elderly in the community", "People's adherence to the programs", "Gains in health resulting from the implementation of these strategies" and "Gains from group activities". A set of indicators emerged from the analysis. Nurses recognize the importance of using structured physical exercise programs adjusted to the rehabilitation of the older person, with gains in promoting active and healthy aging.

What are the evidence bases for developing models of rehabilitation for older people with mental illness in Australia?

This paper updates clinicians and service leaders on evidence bases relevant to rehabilitation for older Australians with mental illness. Narrative review of literature and relevant public domain data supported by reflections on NSW service development. There is a paucity of high-quality evidence regarding mental health rehabilitation in older people. Available evidence supports integrating lessons from physical healthcare with adaptations of 'adult' mental health rehabilitation. Adaptation is required to respond to the specific needs, strengths and service use of older people with mental illness. Challenges for older people include ageism, increased physical and cognitive comorbidities, lower access to mental health services and earlier residential aged care entry. Strengths of older people include an ongoing desire for recovery, ongoing developmental change and often closer connections with carers and GPs. Evidence is consistent with evaluation of relevant NSW service models and initiatives including the Pathways to Community Living Initiative. Integration of recovery-oriented practice and wellness models may provide a framework for future innovative inpatient and community-based models. There is sufficient evidence to guide development of models of rehabilitation with older people, but innovation and evaluation are essential if older people are to have equal opportunities in their recovery journeys.

Home-based training technology for persons with dementia: a qualitative study of barriers and facilitators for mobility-based training at home

BackgroundPhysical training is increasingly used in rehabilitation for older people with dementia and several studies have documented positive results. Currently, welfare nations promote motion-based technology (MBT) at home to replace group training in various rehabilitation interventions. Research on the use of MBT by people with dementia is sparse. Therefore, this study explores how people with mild dementia and their relatives experience home-based MBT training in an intervention facilitated by a Danish municipality.MethodsThe study is part of a feasibility study and builds on participant observation and interviews with people with dementia (n = 4), their relatives (n = 4), and health care workers (n = 3) engaged in the project.ResultsParticipants compared MBT training to group training and found that MBT was not a satisfactory replacement for group training. Some participants used and enjoyed MBT daily while others were challenged by the technology, the placement of the device, or motivation to independently complete the training program.ConclusionMBT is possibly best considered as a supplement to group training, suitable for individuals able to use it in daily life.

The capacity of informal caregivers in the rehabilitation of older people after a stroke.

Objective.To characterize informal caregivers of dependent older people after a stroke related to aspects of care, and to describe the activities performed and the difficulties faced by these caregivers.Methods.Cross-sectional, descriptive study, held in southern Brazil with 190 informal caregivers of older adults after stroke. The sociodemographic data instrument and the Capacity Scale for Informal Caregivers of Elderly Stroke Patients (ECCIID-AVC), adapted and validated for use in Brazil by Dal Pizzol et al., were used.Results.Most caregivers were women (82.6%) or children (56.3%), had average schooling of 9.6 years, and the majority (68.3%) provided care for people with moderate to severe disability. The main activities carried out included: providing materials and/or support for eating (99%), dressing (98.4%), and administering medications (96.2%). Caregivers had the most difficulty with transferring and positioning activities.Conclusion.Most caregivers have adequate capacity to provide essential care to the dependent older adult after a stroke. However, a significant portion had difficulty in the activities of transferring and positioning the older person due to the lack of guidance regarding the posture to carry out these activities. The assessment of nurses regarding the activities performed and the difficulties faced by caregivers is an important strategy to identify problems and effectively attend to the needs of these individuals at all levels of health care.

Research on the treatment of the elderly with Alzheimer disease in virtual reality puzzle games

Objective: To analyze the impact of educational games on the rehabilitation of older people with Alzheimer’s disease. Methods: According to the simple neuropsychiatric inventory (NPI), 60 older people with Alzheimer’s disease who received treatment in this study from April 2020 to May 2021 were selected as the research subjects [1]. The most presented data was recorded. The paired sample analysis method divided them into a control group (30 people) and an experimental group (30 people). The control group was given conventional medication only, and the experimental group was given puzzle game therapy. After the experiment, the mental state and cognitive function of the two groups of older people were compared. Results: 1) The experimental group changed significantly on the NPI questionnaire. 2) The indicators of the experimental group are better than those of the control group. The condition of the control group tends to worsen, and the experimental group’s condition tends to get better. Conclusion: Virtual reality puzzle games can improve the mental state and cognitive function of patients with Alzheimer’s disease to a certain extent and positively affect the rehabilitation of the elderly with Alzheimer’s disease [2].

<p>Long-Term Effectiveness of a Home-Based Pulmonary Rehabilitation in Older People with Chronic Obstructive Pulmonary Disease: A Retrospective Study</p>

BackgroundLong-term effectiveness of pulmonary rehabilitation (PR) is still uncertain in older people with severe chronic obstructive pulmonary disease (COPD). The objective was to compare the effects of home-based PR in people with COPD above and below the age of 70 years.MethodsIn this retrospective study, 480 people with COPD were recruited and divided into those ≤70 (n=341) and those >70 years of age (n=139). All participants underwent an 8 weeks of home-based PR, consisting of a weekly supervised 90-minute home session. Six-minute stepper test (6MST), timed-up and go test (TUG), Hospital Anxiety and Depression Scale, and Visual Simplified Respiratory Questionnaire (VSRQ) were assessed at baseline (M0), at 2 (M2), 8 (M8), 14 (M14) months after baseline.ResultsThe older group was described by fewer current smokers (p <0.001), more long-term oxygen therapy use (p = 0.024), higher prevalence of comorbidities (p<0.001), lower 6MST score and higher TUG score (p<0.001), compared to the younger group. Both groups improved every outcome at M2 compared to baseline. At M2, 88% of people ≤70 years of age and 79% of those above 70 were considered as responders in at least one evaluated parameter (p = 0.013). Both groups maintained the benefits at M14, except for the VSRQ score and the number of responders to this outcome in the older group.ConclusionRegardless of the age, personalized home-based PR was effective for people with COPD in the short term. Above 70 years, an ageing effect appeared on the long-term effectiveness of quality of life benefit.

Evaluation of the Pose Tracking Performance of the Azure Kinect and Kinect v2 for Gait Analysis in Comparison with a Gold Standard: A Pilot Study.

Gait analysis is an important tool for the early detection of neurological diseases and for the assessment of risk of falling in elderly people. The availability of low-cost camera hardware on the market today and recent advances in Machine Learning enable a wide range of clinical and health-related applications, such as patient monitoring or exercise recognition at home. In this study, we evaluated the motion tracking performance of the latest generation of the Microsoft Kinect camera, Azure Kinect, compared to its predecessor Kinect v2 in terms of treadmill walking using a gold standard Vicon multi-camera motion capturing system and the 39 marker Plug-in Gait model. Five young and healthy subjects walked on a treadmill at three different velocities while data were recorded simultaneously with all three camera systems. An easy-to-administer camera calibration method developed here was used to spatially align the 3D skeleton data from both Kinect cameras and the Vicon system. With this calibration, the spatial agreement of joint positions between the two Kinect cameras and the reference system was evaluated. In addition, we compared the accuracy of certain spatio-temporal gait parameters, i.e., step length, step time, step width, and stride time calculated from the Kinect data, with the gold standard system. Our results showed that the improved hardware and the motion tracking algorithm of the Azure Kinect camera led to a significantly higher accuracy of the spatial gait parameters than the predecessor Kinect v2, while no significant differences were found between the temporal parameters. Furthermore, we explain in detail how this experimental setup could be used to continuously monitor the progress during gait rehabilitation in older people.

Rehabilitation of older people with Parkinson\u2019s disease: an innovative protocol for RCT study to evaluate the potential of robotic-based technologies

BackgroundParkinson’s disease is one of the most frequent causes of disability among the older adults. It is a chronic-progressive neuro-degenerative disease, characterized by several motor disorders. Balance disorders are a symptom that involves the body axis and do not respond to dopaminergic therapy used in Parkinson’s disease. Therefore, physiotherapy becomes an important intervention for the management of motor disorders. Originally, these rehabilitative approaches were based on empirical experiences, but several scientific evidences suggests that neuronal plasticity is exercise-dependent. In this context, robotic rehabilitation plays an important role because it allows to perform task-oriented exercises and to increase the number of repetitions and their intensity. This protocol study aims to evaluate the effectiveness of robotic-based intervention of the older adults with Parkinson’s disease, designed to improve the gait and to reduce the risk of falling.MethodsThis study is a single-blinded randomized controlled trial. The primary outcomes are: risk of falling, gait performance and fear of falling measured through Performance-Oriented Mobility Assessment (POMA), instrumental gait analysis and Short Falls Efficacy Scale – International (FES-I), respectively. One hundred ninety-five patients with PD will be recruited and randomly divided into three groups, to receive a traditional rehabilitation program or a robotic rehabilitation using Tymo system or Walker View in addition to the traditional therapy. Assessments will be performed at baseline, at the end of treatment and 6 months, 1 year and 2 years from the end of the treatment. A 10-treatment session will be conducted, divided into 2 training sessions per week, for 5 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system.DiscussionThe final goals of the present study are to propose a new approach in the PD rehabilitation, focused on the use of robotic device, and to check the results not only at the end of the treatment but also in the long term.Trial registrationNCT04087031, registration date September 12, 2019.

Can a brief behavioural assessment improve exercise adherence in older people with musculoskeletal conditions? A feasibility randomised controlled trial

Purpose: To test the feasibility of the Adherence for Exercise Rehabilitation in Older people (AERO) intervention, and establish the potential for a full scale randomised controlled trial.

Practice of Social and Medical Care for Elderly Patients with Cardiovascular Diseases in Volgograd Region

Currently, the first place among the causes of mortality and disability of the adult population of the Russian Federation is occupied by cardiovascular diseases. According to the reporting documentation of the Health Committee of the Volgograd region for three quarters of 2019, at the expense of the federal budget in the conditions of federal specialized medical institutions, high-tech medical care was provided to 2615 residents of the Volgograd region. Over three quarters of 2019, high-tech medical care was provided to 868 patients in budget health-care institutions of the Volgograd region. The following medical care profiles are in the leading positions: cardiovascular surgery (904 patients treated), traumatology and orthopedics (820 patients treated), oncology (498 patients treated).The development of cardiovascular diseases is based on physiological factors (especially the human body, etc.) and social factors (lifestyle, alcoholism, etc.). A statement of the influence of both physiological and social factors on the health of the cardiovascular system actualizes the need to study the experience of preventive work and the provision of social and medical assistance in a unified system of social protection of the population of the Volgograd region. The main elements of this system are institutions and organizations with different functions – prevention, treatment and rehabilitation. Because the fact that the profiles of institutions providing services to people with cardiovascular diseases are different, the task of comprehensive support cannot be solved without a well-functioning mechanism for the interaction of all elements of assistance aimed at reducing the incidence and mortality rate from cardiovascular diseases. The work explores the activities of the Committee for Social Protection of the Volgograd Region as an organization that coordinates the work on building a system of prevention, treatment, and rehabilitation of older people, including those with cardiovascular diseases. Problems are systematized on the basis of a comprehensive review of theoretical approaches, the regulatory framework, and the results of an analysis of the work of medical and social institutions in the Volgograd Region, that impede the establishment of integrated work with patients who have cardiovascular pathology and do not allow building effective work.

Adhesives for fixing dentures in the rehabilitation of older people (review)

Adhesives for fixing dentures in the rehabilitation of older people (review)

Automated Movement Feedback for Recovering Independence in the Sit-to-Stand Movement in an Older Population: A Pilot Randomised Controlled Trial of a Novel System

Background The sit-to-stand (StS) movement is a frequently performed task critical to independent living that is both difficult to perform and associated with falls in older populations. Consequently, the recovery of this movement through supervised practice is a priority during the rehabilitation of older people. Technology may enable self-practice, potentially improving rehabilitation outcomes. The purpose of this study was to evaluate the clinical feasibility and effectiveness of an automated movement feedback system for recovering the StS movement in an older population. Methods This was a phase two pilot randomised controlled trial. Participants were in-patients on a geriatric rehabilitation unit with an impaired StS ability. Following baseline outcome measurements, including quantifying the number of StS executions 48 hours pre- and post- trial, participants were block randomised to either a control group receiving standard rehabilitation or an experimental group receiving standard rehabilitation augmented with a novel automated movement feedback system for the StS training sessions. The intervention aimed to last four weeks with outcome measures repeated following completion. Results Eighteen participants (81.25+/- 7.31 years) were evenly distributed between the two groups and interventions were completed without incident. The novel feedback group provided positive feedback on their experience, reporting the system to be motivating and instructive. Differences between the groups were statistically significant (p

Analysis of Ankle sEMG on Both Stable and Unstable Surfaces for Elderly and Young Women-A Pilot Study.

Body aging is frequently accompanied with numerous consequences such as increased tendency to falls, which may be connected not only with the impaired ability of keeping balance, but also with some limitations of the system responsible for the maintenance of balance. The aim of this study was defining the importance of muscle activity in the ankle joint when standing on stable and unstable surfaces with eyes open and closed as well as examining indications of the influence of body aging on the activity of the selected muscles. The study was carried out on a group of 20 healthy women divided into two age groups (aged 24 ± 3.6 years and aged 64 ± 4.2 years). The activity of muscles stabilizing the ankle joint while standing on different types of surfaces was tested with an EMG (surface electromyography) on both elderly and young women during trials with open and closed eyes. The tests showed higher activation in the evaluated muscles of the anterior group (tibialis anterior (TA), peroneus longus (PL)) of elderly women. For the posterior shin muscles of both groups, a higher activation was observed in the gastrocnemius lateralis muscle (GL) of elderly women, whereas gastrocnemius medialis muscle (GM) showed highly comparable activity. The results obtained in this work confirm the importance of proprioception training and muscle strength in the rehabilitation of older people as well as in prophylactic exercise aimed toward the prevention of ankle injuries.

Dual Sensory Loss, Mental Health, and Wellbeing of Older Adults Living in China.

Introduction: Deterioration in vision and hearing commonly occurs as adults age. Existing literature shows that Dual Sensory Loss (DSL) is a prevalent condition amongst older adults. In China, it has been estimated that 57.2% of the population experience DSL. Based on a small number of research papers, it has been identified that DSL influences mental health and wellbeing. The aims of this study were to explore the relationship between DSL and mental health and wellbeing in a sample of older adults residing in China; and investigate whether the comorbidities of functional dependency [Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL)] and chronic diseases influence the impacts of DSL on mental health and wellbeing.Method: The China Health and Retirement Longitudinal Study Wave 2, 2013 data collection of a sample of people aged 60 years and over (n = 8,268) was used in this study. The sensory loss variables selected for analysis included a combined variable of self-reported vision and hearing loss (DSL). Mental health was measured by depression, and general wellbeing was measured by life satisfaction. In addition, chronic diseases, and limitations in IADL and ADL were used to test how their comorbidities with DSL influence mental health and wellbeing. Results were analyzed descriptively and using regression and modeling techniques.Results and Discussion: DSL was significantly and positively associated with advanced age, having difficulty in any ADL or IADL and experiencing depression and less life satisfaction. The observed negative associations between DSL and mental health or wellbeing, are indirect and could be partially explained by its comorbidity with chronic diseases and relationship to functional limitations. It is recommended that health services in China screen for DSL in older people and develop integrated services to assist with appropriate management and rehabilitation of older people with DSL focusing on both functional and mental health issues.

Geriatrics: According to professional and educational standards

&amp;lt;p&amp;gt;Geriatrics is a subspecialization of internal medicine concerned with the health and care of aged persons. It is characterized by comprehesive geriatric assessment of the health conditions of older people, which is consider to be the key to successful preventive, dignostic and therapeutic approach. Geriatricians possess specific knowledge and skills within the field of their expertise necessary for achieving high professional standards in the domain of both acute and chronic care and rehabilitation of older people. The paradigm of both undergraduate and postgraduate education and training within the field of geriatrics is discussed in this paper.&amp;lt;/p&amp;gt;

The Association between Anticholinergic Drug Use and Rehabilitation Outcome in Post-Acute Hip Fractured Patients: A Retrospective Cohort Study.

Anticholinergic (AC) drugs are associated with significant impairment in cognitive and physical function which may affect rehabilitation in older people. We aimed to evaluate whether AC burden is associated with rehabilitation achievement in post-acute hip-fractured patients. A retrospective cohort study carried out in a post-acute geriatric rehabilitation center on 1019 hip-fractured patients admitted from January 2011 to October 2015. The Anticholinergic Cognitive Burden Scale (ACB) was used to quantify the AC burden. Main outcome measures included the Functional Independence Measure (FIM) instrument, motor FIM (mFIM), Montebello Rehabilitation Factor Score (MRFS) on the mFIM, and length of stay (LOS). The study population was divided into two groups: individuals with low admission AC burden (ACB≤1) and those with high admission AC burden (ACB≥2). The relationship between the admission AC burden and clinical, demographic and comorbidity variables was assessed using the Mann-Whitney and Chi square tests. A multiple linear regression model was used to estimate the association between admission AC burden and discharge FIM score after controlling for sociodemographic characteristics and chronic diseases. Patients with a high admission AC burden had a significantly higher rate of high education, a significantly lower rate reside at home, they waited a longer period of time from surgery to rehabilitation, were less independent pre-fracture, and presented with a higher rate of vascular disorders and depression compared with patients with a lower admission AC burden. These patients also exhibited a significantly lower FIM score on admission and at discharge, a lower FIM score change, and a lower achievement on the MRFS compared with patients with a lower admission AC burden. A multiple linear regression analysis showed that admission AC burden was significantly associated with the discharge FIM score after adjustment for confounding variables. High admission AC drug burden is significantly associated with less favorable discharge functional status in post-acute hip-fractured patients, independent of relevant risk factors.

Rehabilitation for older people after emergency hospital admission: a systematic review

Purpose: The objective of this systematic review was to evaluate whether exercise-based rehabilitative interventions are more effective than usual care in improving function for older adults who have an unplanned emergency admission.

A tailored counseling and home-based rehabilitation program to increase physical activity and improve mobility among community-dwelling older people after hospitalization: protocol of a randomized controlled trial

BackgroundPhysical activity (PA) decreases during hospitalization. In particular, the amount of PA engaged in by older people who are hospitalized following musculoskeletal injury is likely to be limited for months after discharge home. Given the importance of an active lifestyle for their recovery and the prevention of future adverse outcomes, there is clearly a need for interventions to increase PA. This article describes the protocol of a randomized controlled trial set up to investigate the effects of a physical activity oriented home rehabilitation program (ProPA) on PA and the restoration of mobility in community-dwelling older people.MethodsMen and women aged 60 years or older hospitalized due to a musculoskeletal injury or disorder in the back or lower limbs are recruited. After discharge from hospital to home, participants are randomized into a six-month ProPA program or a standard care (control) group. The ProPA program consists of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program and physical activity counseling. In addition, frail participants who are not able to go outdoors alone receive support from volunteers.Primary outcomes are PA measured using a 3-dimentional accelerometer, and mobility assessed by the Short Physical Performance Battery and self-reports. Secondary outcomes are life space mobility, participation restriction, fear of falling, pain, mood, and grip strength. Information on barriers to and enablers of PA participation are also collected. Data on mortality and use of health services are collected from the national register. In this 6-month intervention, all participants are assessed in their homes at baseline and after three and six months, and at 12 months after randomization they will receive a follow-up questionnaire.DiscussionThis study investigates the effects of a rehabilitation program on PA and mobility among older people at risk for increased sedentary time and mobility problems. If positive effects are observed, the program can be considered for incorporation into the health care system and thereby contribute to the rehabilitation of older people who have recently been discharged from hospital.Trial registrationISRCTN13461584. Registered 27 January 2016.

Intensive multidisciplinary home rehabilitation for older people with severe conditions

Introduction : Older people often demonstrate multiple physical and functional problems simultaneously. For this reason, geriatric rehabilitation (GR) is often organized as integrated care with a multidisciplinary team providing a structured care plan to alleviate or reduce the consequences of the patients’ conditions. However, some of those in need of GR have difficulties to adapt to the hospital settings and therefore do not profit from the intense multidisciplinary care provision in such a setting as would be desirable. These patients are often finishing their rehabilitation without being able to walk independently, or manage their daily life. Practice change implemented : Since 2007, the German health care system offers a home-based GR for geriatric patients, called Mobile Rehabilitation (MR), within the same framework as the standard GR in a hospital setting, providing an intensive and multidisciplinary rehabilitation program over 6 to 8 weeks. Aim and theory : There is good evidence on the effectiveness of rehabilitation and home care concepts in general. However, several risk factors such as the presence of cognitive or psychological disorders, or seeing and hearing impairments, among others, lead to unsatisfactory result of a rehabilitation program. that can be attributed to problems of a geriatric patient to adapt to the requirements of a rehabilitation program. Possible reasons are the presence of cognitive or psychological disorders, or seeing and hearing impairments, among others. Such patients can, in theory, largely profit from MR in their accustomed environment. Intervention program and timeline : The MR program consists of, on average, 40 sessions of physiotherapy, occupational therapy, speech therapy or nursing care with 6 sessions each week. Regular multidisciplinary team meetings are under the leadership of a geriatrician. Highlights : First publications on this program demonstrate its general effectiveness. Additionally, results from the project MORECARE, a German-based, national research project aiming at identifying and overcoming organizational and managerial barriers in providing home-based GR in Germany will be presented. Comments on sustainability and transferability : In 2016, the concept of MR has been broadened and includes now several additional conditions associated with a decreased adaptability to conventional rehabilitation settings. This decision was based on the first evidence on it’s effectiveness. This presentation will enable stakeholders who provide integrated care for older people to reflect on the additional value of MR as an alternative to conventional GR as well as managerial prerequisites in implementing such concepts in their respective health care system. Conclusions : The MR program presented here is able to improve outcomes in a subgroup of geriatric patients who do not profit from conventional rehabilitation programs. Discussions : While the current literature demonstrates the potential benefits of MR, the evidence is still limited. Additionally, the implementation of such a program lead to some organizational problems, which have to be discussed. Lessons learned : The audience of this presentation will learn on the potential of the MR program as an alternative to conventional rehabilitation, its multidisciplinary building blocks and the identified barriers and problems in implementing and continuing this program.

Association between bisphosphonate therapy and outcomes from rehabilitation in older people

BackgroundBisphosphonate therapy may have actions beyond bone, including effects on cardiovascular, immune and muscle function. We tested whether bisphosphonate treatment is associated with improved outcomes in older people undergoing inpatient rehabilitation. MethodsAnalysis of prospectively collected, linked routine clinical datasets. Participants were divided into never users of bisphosphonates, use prior to rehabilitation only, use after rehabilitation only, and current users (use before and after rehabilitation). We calculated change in 20-point Barthel scores during rehabilitation, adjusting for comorbid disease and laboratory data using multivariable regression analysis. Cox regression analyses were performed to analyse the association between bisphosphonate use and time to death or hospitalisation. Results2797 patients were included in the analysis. Current bisphosphonate users showed greater improvement in Barthel score during rehabilitation than non-users (5.0 points [95%CI 4.3–5.7] vs 3.8 [95%CI 3.6–3.9]), but no difference compared to those receiving bisphosphonates only after discharge (5.1 [95%CI 4.6–5.5]). Previous bisphosphonate use was significantly associated with time to death (adjusted hazard ratio 1.41 [95%CI 1.15–1.73]) but less strongly with time to combined endpoint of hospitalisation or death (adjusted hazard ratio 1.18 [95%CI 0.98–1.48]). Use after discharge from rehabilitation was associated with reduced risk of death (adjusted hazard ratio 0.64 [95%CI 0.55–0.73]; hazard ratio per year of bisphosphonate prescription 0.98 [95%CI 0.97–0.99]). ConclusionBisphosphonate use is unlikely to be causally associated with improved physical function in older people, but continuing use may be associated with lower risk of death.