Clinical data or scoring system for predicting mortality in elderly patients with hip fracture: A prospective study.

INTRODUCTION: Hip fracture in elderly individuals is frequent and is related to a high rate of mortality. Finding the best predictor of death will help to develop better patient care. Aim - To analyze the reliability of the clinical data and assessment scores to predict mortality in acute hip fracture in elderly patients. PATIENT AND METHODS: Prospective data were collected from all patients > 65 years with acute hip fracture from May to October 2020. The clinical data collected were age, sex, comorbidities, medication, type of fracture and presence of delirium. The assessment scores were ASA, Lee, ACP and Charlson. RESULTS: The statistically significant results were age > 80 years (OR 1.121 IC95% [1.028-1.221] p = 0.0101) and number of medications (OR5.991 95% CI [2.422-14.823] p <0.001). Three scores showed a correlation with mortality: ASA score (p = 0.017), Lee score (p = 0.024) and ACP score (p = 0.013). The Charlson Comorbidity Index did not correlate with mortality (p = 0.172). CONCLUSION: To stratify the risk of death, both clinical data and scores should be used. The best clinical indicators are age and number of medications, and the scores are ASA, Lee and ACP.

Analysis of static and dynamic balance in healthy elderly practitioners of Tai Chi Chuan versus ballroom dancing.

OBJECTIVE: To determine whether Tai Chi Chuan or ballroom dancing promotes better performance with respect to postural balance, gait, and postural transfer among elderly people. METHODS: We evaluated 76 elderly individuals who were divided into two groups: the Tai Chi Chuan Group and the Dance Group. The subjects were tested using the NeuroCom Balance Master¯ force platform system with the following protocols: static balance tests (the Modified Clinical Tests of Sensory Interaction on Balance and Unilateral Stance) and dynamic balance tests (the Walk Across Test and Sit-to-stand Transfer Test). RESULTS: In the Modified Clinical Test of Sensory Interaction on Balance, the Tai Chi Chuan Group presented a lower sway velocity on a firm surface with open and closed eyes, as well as on a foam surface with closed eyes. In the Modified Clinical Test of Sensory Interaction on Unilateral Stance, the Tai Chi Chuan Group presented a lower sway velocity with open eyes, whereas the Dance Group presented a lower sway velocity with closed eyes. In the Walk Across Test, the Tai Chi Chuan Group presented faster walking speeds than those of the Dance Group. In the Sit-to-stand Transfer Test, the Tai Chi Chuan Group presented shorter transfer times from the sitting to the standing position, with less sway in the final standing position. CONCLUSION: The elderly individuals who practiced Tai Chi Chuan had better bilateral balance with eyes open on both types of surfaces compared with the Dance Group. The Dance Group had better unilateral postural balance with eyes closed. The Tai Chi Chuan Group had faster walking speeds, shorter transfer times, and better postural balance in the final standing position during the Sit-to-stand Test.

Analysis of static and dynamic balance in healthy elderly practitioners of Tai Chi Chuan versus ballroom dancing

OBJECTIVE: To determine whether Tai Chi Chuan or ballroom dancing promotes better performance with respect to postural balance, gait, and postural transfer among elderly people. METHODS: We evaluated 76 elderly individuals who were divided into two groups: the Tai Chi Chuan Group and the Dance Group. The subjects were tested using the NeuroCom Balance Master¯ force platform system with the following protocols: static balance tests (the Modified Clinical Tests of Sensory Interaction on Balance and Unilateral Stance) and dynamic balance tests (the Walk Across Test and Sit-to-stand Transfer Test). RESULTS: In the Modified Clinical Test of Sensory Interaction on Balance, the Tai Chi Chuan Group presented a lower sway velocity on a firm surface with open and closed eyes, as well as on a foam surface with closed eyes. In the Modified Clinical Test of Sensory Interaction on Unilateral Stance, the Tai Chi Chuan Group presented a lower sway velocity with open eyes, whereas the Dance Group presented a lower sway velocity with closed eyes. In the Walk Across Test, the Tai Chi Chuan Group presented faster walking speeds than those of the Dance Group. In the Sit-to-stand Transfer Test, the Tai Chi Chuan Group presented shorter transfer times from the sitting to the standing position, with less sway in the final standing position. CONCLUSION: The elderly individuals who practiced Tai Chi Chuan had better bilateral balance with eyes open on both types of surfaces compared with the Dance Group. The Dance Group had better unilateral postural balance with eyes closed. The Tai Chi Chuan Group had faster walking speeds, shorter transfer times, and better postural balance in the final standing position during the Sit-to-stand Test. .

Fratura de quadril em idosos: tempo de abordagem cirúrgica e sua associação quanto a delirium e infecção / Hip fractures in the elderly: surgical treatment timing and its correlation with delirium and infection

As fraturas de quadril são um importante problema de saúde pública, com estimativa de 100.000 fraturas ao ano no Brasil. A média de mortalidade após um ano da fratura é de 30 por cento. A abordagem cirúrgica é o elemento-chave em seu tratamento. Esse trabalho teve por objetivo verificar se idosos com fratura de quadril abordados cirurgicamente após 48 horas da admissão apresentam maior incidência de delirium e infecção comparados aos operados antes de 48 horas. Foi realizado um estudo prospectivo observacional, sendo analisados 21 pacientes idosos num período de seis meses no Hospital do Servidor Público Municipal de São Paulo. Somente 4 pacientes (19 por cento) foram abordados antes de 48 horas. Delirium aconteceu no pós-operatório de 51 por cento dos pacientes. Encontrou-se 28,5 por cento dos pacientes com infecção (pneumonia, infecção do trato urinário e infecção do sitio operatório). Dentre os pacientes com infecção, cinco (83 por cento) foram operados após 48 horas da admissão e um (17 por cento) foi operado em menos de 48 horas. A principal causa de adiamento foi por problemas burocráticos. A relação entre o tempo de abordagem cirúrgica e o subseqüente impacto na mortalidade ainda é um assunto controverso. Na presente investigação a cirurgia após 48 horas esteve associada a mais complicações infecciosas e delirium.

Hip fracture is an important problem for the Public Health System. It is estimated that 100,000 fractures happen each year in Brazil. The mean mortality rate after one year of the fracture is 30 percent. Surgical management is crucial in these cases. This study was aimed at investigating if elderly patients with hip fractures treated after 48 hours of admission showed a higher incidence of delirium and infections than those operated within 48 hours. A prospective observational study was carried out in 21 elderly patients over a six-month period in Hospital do Servidor Público Municipal of Sao Paulo. Only 4 patients (19 percent) were operated within 48 hours of admission. Postoperative delirium was seen in 52 percent of the patients. Complications such as pneumonia, urinary tract infection, and wound infection were found in 28.5 percent of the patients. Eighty three percent of the infected patients were treated after 48 hours of admission and seventeen percent were treated within 48 hours. The main cause of surgery delay was bureaucracy. The correlation between surgical treatment timing and its impact on survival rate is still controversial. In this study, surgical treatment after 48 hours of admission was associated with a higher frequency of complications such as infections and delirium.