San Antonio – A look back over the past year in long-term care research found two of the most influential papers to be about the benefits of exercise for elderly people in physical decline. The Hip Fracture Intervention Trial (HIPFIT) demonstrated the substantial value of high-intensity, progressive resistance training following hip fracture, JAMDA Editor in Chief Dr. John E. Morley said during the “Year in Review” session at AMDA Long Term Care – 2012. Session moderator Dr. Barbara Messinger-Rapport said that in an extensive review process, “we choose articles where the goal is improving care of frail elderly, and we look for those that focused on the population of older adults on a downward trajectory in the continuum of care.” Dr. Messinger-Rapport is director of the Center for Geriatric Medicine at the Cleveland Clinic. The HIPFIT paper, by Dr. Nalin A. Singh of Balmain Hospital, Sydney, Australia, and colleagues, was a clear standout, said Dr. Morley, a professor of gerontology and director of the division of geriatric medicine at Saint Louis University Medical School. “This article was chosen because it is most probably the single best article I have ever accepted as an editor of any of the journals I’ve edited,” he said. The randomized controlled study of 124 patients, published online in September 2011 and in print in January 2012, examined a high-intensity weightlifting exercise and targeted multidisciplinary intervention versus usual care after hip fracture. Initiated following completion of physical therapy, 6–8 weeks after a fracture, the highintensity exercise reduced mortality by 81% (age-adjusted odds ratio, 0.19) and nursing home admissions by 84% (age-adjusted OR, 0.16) compared with physical therapy alone ( J. Am. Med. Dir. Assoc. 2012;12:24-30). Basic activities of daily living also declined significantly less in the intervention group, and assistive device use was significantly lower at 12 months in that group. Given that there are 1.6 million fractures worldwide each year – and that, depending on age, mortality in these patients can be as high as 30%–50% – these findings have the potential to improve the lives of many patients, Dr. Morley said. Another paper that the group selected as one of the best of the year was the report of a randomized controlled clinical trial comparing the Seattle Protocol for Activity (SPA) in Older Adults with a health-educational program, a combination of SPA and health education, and routine medical care. SPA entails group exercise classes and assistance in setting weekly home exercise goals. In that study of 273 communitydwelling older adults, Linda Teri, PhD, of the University of Washington, Seattle, and her colleagues demonstrated that at 3 months, those in either group getting SPA exercised more and improved more in self-reported health, strength, and general well-being than those in the other groups. Combining SPA and health education did not significantly better results over SPA alone, Dr. Morley said. The benefits were maintained over 18 months of follow-up ( J. Am. Geriatr. Soc. 2011;59:1188-96). The findings of this straightforward study are interesting, he said, noting that while they don’t represent “superstar outcomes,” they do represent an inexpensive and effective means for providing immediate and long-term physical and affective benefits. “These are things you would like to see in a senior center and which are reasonable to offer to all people in a nursing home,” he said. Dr. Messinger-Rapport, a member of the editorial board of JAMDA, explained that a team of reviewers selected the top papers after carefully assessing the year’s LTC-research literature and rating each paper for how it specifically addressed geriatric problems and outcomes, demonstrated a harm or benefit of a practice, or explored a new intervention that improves either treatment for a disease or a care process. CfA
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Apr 12, 2014
Seth A Gross + 3
Open Access