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Feasibility and Effects on Muscle Function of an Exercise Program for Older Adults.
Minett, MM, Binkley, TL, Holm, RP, Runge, M, Specker, BL
Medicine and science in sports and exercise. 2020;(2):441-448
Abstract
INTRODUCTION Study objective was to determine feasibility and compliance with a 3-month exercise intervention in older adults, and if peripheral quantitative computed tomography muscle measures and jumping mechanography could detect changes in muscle mass and function. METHODS A parallel group, nonblinded, pilot trial with individuals 70 yr or older randomized to control group of walking-only (WALK) or an intervention group of walking combined with exercises to improve balance and strength (W + EX). Both groups attended similar weekly nutrition education sessions. Body composition, muscle density, intramuscular adipose tissue area, and muscle function were assessed before and after the intervention using dual-energy x-ray, peripheral quantitative computed tomography, functional tests, and mechanography. RESULTS Eighty-five (90%) of 94 individuals enrolled completed (41WALK, 44W + EX). Eighty-six percent of participants attended seven or more nutrition sessions, and log sheets, used to assess exercise compliance, were returned by 66% of participants, and of those, 88% logged activity on 50%+ days. Sixty-seven percent of participants stated that they increased activity levels, and 82% stated that they felt better overall. Both groups increased lean and lost fat mass, resulting in decreases in fat percentage (all, P < 0.05). Intramuscular adipose tissue area decreased and muscle density increased among WALK (P < 0.05 and P = 0.056, respectively) but were not different between groups. Improvement in force efficiency and chair-rise power were greater among W + EX group than WALK (5.9% ± 1.8% vs -1.2% ± 2.0% [P = 0.01] and 0.25 ± 0.19 W·kg and -0.37 ± 0.23 W·kg [P = 0.04], respectively). Differences in mechanography results became greater in a per-protocol analysis. CONCLUSIONS A larger trial is feasible, and the program was well accepted. Both groups showed improvements, the program that included strength and balance lead to greater jump force efficiency and power than walking only. Whether these differences lead to differences in fall rates need to be determined in a larger trial.
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Transition and factors associated with the level of physical activity combined with sedentary behavior of the elderly: A longitudinal study.
Alves Silva, LM, Dos Santos Tavares, DM, Rodrigues, LR
Biomedica : revista del Instituto Nacional de Salud. 2020;(2):322-335
Abstract
INTRODUCTION Physical activity and sedentary behavior are emerging issues in public health, especially in developing countries. OBJECTIVE To verify transition and factors related to physical activity combined with sedentary behavior among the elderly followed for 24 months. MATERIALS AND METHODS We conducted a longitudinal observational study with people aged 60 years or over living in the urban area of Uberaba, Brazil. We collected the data from sociodemographic, health, and physical tests in 2014 and 2016 using the Mini-Mental State Examination (MMSE), the Katz Index, the Lawton and Brody Scale, the Short Physical Performance Battery (SPPB), and the International Physical Activity Questionnaire (IPAQ). For the combined evaluation we considered a cutoff point of 150 minutes of physical activity per week and the percentile 75 (420 minutes/day) for sedentary behavior constituting the groups: Unsatisfactory (insufficient sum of physical activity and sedentary behavior), intermediate (loss of only one of the two components) and satisfactory (sufficient sum of physical activity and sedentary behavior). The statistical descriptive and inferential analysis was performed using the Statistical Package for Social Sciences™, version 21.0, considering p<0.05. RESULTS Of the 374 elderly, 61 (16.3%) improved their physical activity and sedentary behavior condition, 226 (60.4%) remained in the same category and 87 (23.3%) got worse. Unsatisfactory levels of physical activity and sedentary behavior were related to the eldest group (p=0.031), the absence of professional activity (p<0.001), the dependence for instrumental activities of daily living (p=0.013), and a worse physical performance (p<0.001). CONCLUSION Our results showed a relationship between sociodemographic and health factors with physical activity and sedentary behavior, reiterating the need for further research on the subject.
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Beneficial effect of personalized lifestyle advice compared to generic advice on wellbeing among Dutch seniors - An explorative study.
Doets, EL, de Hoogh, IM, Holthuysen, N, Wopereis, S, Verain, MCD, van den Puttelaar, J, Hogenelst, K, Boorsma, A, Bouwman, EP, Timmer, M, et al
Physiology & behavior. 2019;:112642
Abstract
The aim of this explorative study is to evaluate whether personalized compared to generic lifestyle advice improves wellbeing in a senior population. We conducted a nine-week single-blind randomized controlled trial including 59 participants (age 67.7 ± 4.8 years) from Wageningen and its surrounding areas in the Netherlands. Three times during the intervention period, participants received either personalized advice (PA), or generic advice (GA) to improve lifestyle behavior. Personalization was based on metabolic health measures and dietary intake resulting in an advice that highlighted food groups and physical activity types for which behavior change was most urgent. Before and after the intervention period self-perceived health was evaluated as parameter of wellbeing using a self-perceived health score (single-item) and two questionnaires (Vita-16 and Short Form-12). Additionally, anthropometry and physical functioning (short physical performance battery, SPPB) were assessed. Overall scores for self-perceived health did not change over time in any group. Resilience and motivation (Vita-16) slightly improved only in the PA group, whilst mental health (SF-12) and energy (Vita-16) showed slight improvement only in the GA group. SPPB scores improved over time in both the PA and GA group. PA participants also showed a reduction in body fat percentage and hip circumference, whereas these parameters increased in the GA group Our findings suggest that although no clear effects on wellbeing were found, still, at least on the short term, personalized advice may evoke health benefits in a population of seniors as compared to generic advice.
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Late-life attachment.
Freitas, M, Rahioui, H
Geriatrie et psychologie neuropsychiatrie du vieillissement. 2017;(1):56-64
Abstract
Old age is likely to cause a crisis in one's life because of the vulnerabilities it brings up, acting as stressful elements disrupting the elder's feeling of security. It leads to the activation of what is called his attachment system, consisting in attachment styles and interpersonal emotional regulation strategies. To recover a higher sense of safety, the elder would refer to his attachment figures, that is to say closed people paying attention to him, showing towards him availability and consideration. However older adults particularly see their tolerance threshold lowered, regarding an accumulation of losses (true or symbolic) and stressful events within their lifetime. In a psychological and organic exhaustion phenomenon, the risk is to wear out the interpersonal emotional regulation strategies. These are as much vulnerabilities that may increase psychiatric decompensation, including depression. To resolve the tension of this period and to found a necessary secure feeling, the elder will have to redesign the attachment links previously settled and proceed to adjustments to this new context. The need of relational closeness comes back in the elders' attachment behaviour, counting on attachment figures not only to help their loneliness or dependency, but essentially to support them in a narcissist and affective way. That is why attachment theory enlightens the late life period, such as the new challenges older adults have to face. Many studies recognize its value in understanding the transition to old age, but without proposing conceptualization. We aim first to focus on attachment conception to say how much it is relevant with elderly, and then to describe specific terms of attachment within this population in order to better understand those patients. To finish, we must think about new therapeutic proposals taking into consideration the attachment perspective for a better understanding of old age transition.
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Effects of a Long-Term Physical Activity Program on Activity Patterns in Older Adults.
Wanigatunga, AA, Tudor-Locke, C, Axtell, RS, Glynn, NW, King, AC, McDermott, MM, Fielding, RA, Lu, X, Pahor, M, Manini, TM
Medicine and science in sports and exercise. 2017;(11):2167-2175
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Abstract
PURPOSE To examine the effect of a long-term structured physical activity (PA) intervention on accelerometer-derived metrics of activity pattern changes in mobility-impaired older adults. METHODS Participants were randomized to either a PA or health education (HE) program. The PA intervention included a walking regimen with strength, flexibility, and balance training. The HE program featured health-related discussions and a brief upper body stretching routine. Participants (n = 1341) wore a hip-worn accelerometer for ≥10 h·d for ≥3 d at baseline and again at 6, 12, and 24 months postrandomization. Total PA (TPA)-defined as movements registering 100+ counts per minute-was segmented into the following intensities: low-light PA (LLPA; 100-759 counts per minute), high light PA (HLPA; 760-1040 counts per minute), low moderate PA (LMPA; 1041-2019 counts per minute), and high moderate and greater PA (HMPA; 2020+ counts per minute). Patterns of activity were characterized as bouts (defined as the consecutive minutes within an intensity). RESULTS Across groups, TPA decreased an average of 74 min·wk annually. The PA intervention attenuated this effect (PA = -68 vs HE: -112 min·wk, P = 0.002). This attenuation shifted TPA composition by increasing time in LLPA (10+ bouts increased 6 min·wk), HLPA (1+, 2+, 5+, and 10+ bouts increased 6, 3, 2, and 1 min·wk, respectively), LMPA (1+, 2+, 5+, and 10+ bouts increased: 19, 17,16, and 8 min·wk, respectively), and HMPA (1+, 2+, 5+, and 10+ bouts increased 23, 21, 17, and 14 min·wk, respectively). CONCLUSIONS The PA intervention increased PA by shifting the composition of activity toward higher-intensity activity in longer-duration bouts. However, a long-term structured PA intervention did not completely eliminate overall declines in total daily activity experienced by mobility-impaired older adults.
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[Epidemiology of vitamin-D deficiency].
Souberbielle, JC
Geriatrie et psychologie neuropsychiatrie du vieillissement. 2016;(1):7-15
Abstract
The 25-hydroxyvitamin D (25OHD) serum concentration is the consensual marker of vitamin D status. In the general population, the Institute of Medicine considers that a 25OHD level >20 ng/mL is sufficient for bone health in most subjects. In osteoporosis patients, in those who have a pathology or who receive drugs that may increase the risk of osteoporosis, as well as in patients with chronic kidney disease, many experts think that an optimal vitamin D status is better defined by a 25OHD concentration >30 ng/mL. In the French general population, 43-50% of subjects have a 25OHD level <20 ng/mL and approximately 80% have a 25OHD <30 ng/mL. In chronic diseased patients, as well as in some categories of the general population such as elderly people, the percentage of subjects with a 25OHD level below 20 ng/mL is frequently well above 50%. Epidemiologic studies allow us to identify risk factors for vitamin D deficiency such as ageing, overweight, dark skin pigmentation, wearing covering clothes, or having a low level of outdoor activity. This will help to target vitamin D supplementation to "at-risk" subjects. However, discussions on means to improve the vitamin D status of the overall population such as allowing higher levels of food fortification, are needed.
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Special considerations for nutritional studies in elderly.
Riobó Serván, P, Sierra Poyatos, R, Soldo Rodríguez, J, Gómez-Candela, C, García Luna, PP, Serra-Majem, L
Nutricion hospitalaria. 2015;:84-90
Abstract
The elderly population is increasing and it is well documented that may present some health problems related to nutritional intake. Both mental and physical impairments in the elderly may need specific adaptations to dietary assessment methods. But all self-report approaches include systematic and random errors, and under-reporting of dietary energy intake is common. Biomarkers of protein intake, as 24 hours urinary Nitrogen, may not be useful in elderly patients because of incontinence problems. Some micronutrients, like vitamin B12, have special importance in the elderly population. Also, measurement of fluid intake is also critical because elderly population is prone to dehydration. A detailed malnutrition status assessment should be included in the geriatric dietary history, and assessment. Body mass index (BMI) is not useful in the elderly, and it is important to evaluate functional status. Gait speed, handgrip strength using hand dynamometry can be used. Body Shape Index (ABSI) appears to be an accurate measure of adiposity, and is associated with total mortality. Further research is needed to clarify the best and simple methods to accurately estimate food and beverage fluid intake in the elderly population, and to evaluate nutritional and hidration status.
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Appropriate prescribing and important drug interactions in older adults.
Wallace, J, Paauw, DS
The Medical clinics of North America. 2015;(2):295-310
Abstract
Polypharmacy, specifically the overuse and misuse of medications, is associated with adverse health events, increased disability, hospitalizations, and mortality. Mechanisms through which polypharmacy may increase adverse health outcomes include decreased adherence, increased drug side effects, higher use of potentially inappropriate medications, and more frequent drug-drug interactions. This article reviews clinical problems associated with polypharmacy and presents a framework to optimize prescribing for older adults.
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Activity-related energy expenditure in older adults: a call for more research.
Hall, KS, Morey, MC, Dutta, C, Manini, TM, Weltman, AL, Nelson, ME, Morgan, AL, Senior, JG, Seyffarth, C, Buchner, DM
Medicine and science in sports and exercise. 2014;(12):2335-40
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The purposes of this article were to 1) provide an overview of the science of physical activity-related energy expenditure in older adults (≥65 yr), 2) offer suggestions for future research and guidelines for how scientists should be reporting their results in this area, and 3) present strategies for making these data more accessible to the layperson. This article was meant to serve as a preliminary blueprint for future empirical work in the area of energy expenditure in older adults and translational efforts to make these data useful and accurate for older adults. This document was based upon deliberations of experts involved in the Strategic Health Initiative on Aging Committee of the American College of Sports Medicine. The article was designed to reach a broad audience who might not be familiar with the complexities of assessing energy expenditure, especially in older adults.
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Diuretic-associated electrolyte disorders in the elderly: risk factors, impact, management and prevention.
Khow, KS, Lau, SY, Li, JY, Yong, TY
Current drug safety. 2014;(1):2-15
Abstract
Electrolyte and acid-base disorders are commonly encountered adverse effects of various diuretic agents, which are associated with considerable morbidity and mortality especially in elderly patients. Diuretic use is associated with hyponatraemia, hypernatraemia, hypokalaemia, hyperkalaemia, hyperuricaemia and alterations in magnesium, calcium, phosphate and acid-base homeostasis. Clinical studies have provided important data on the relative frequency and risk factors for these diuretic-associated electrolyte and acid-base disorders. Old age is one of the most recognized risk factors for diuretic-associated electrolyte and acid-base disorders. Hyponatraemia and hypokalaemia are the most common electrolyte abnormalities found among the elderly population taking diuretics. Both conditions are associated with short and long-term morbidity as well as mortality. This article presents an overview of the literature on diuretic-associated electrolyte disorders and suggested risk factors for their development especially in elderly patients when evidence is available. The impact of these electrolyte disorders on patients will be discussed. Strategies to prevent adverse outcomes related to these disorders should involve careful consideration of risk factors as well as ongoing clinical and laboratory evaluations in the course of using these diuretics.