Physical capability, physical activity, and their association with femoral bone mineral density in adults aged 40 years and older: The Tromsø study 2015-2016.

Since muscles can influence bone growth and vice versa, we examined if level of physical activity and physical capability tests can predict areal bone mineral density (aBMD). Both high activity level and good test performance were associated with higher aBMD, especially in women. INTRODUCTION: Muscle influences bone formation and vice versa. Tests of physical capability and level of physical activity reflect various muscle qualities. We assessed the associations between total hip aBMD and physical activity as well as a range of standardized physical capability tests in an adult general population. METHODS: A total of 3 533 women and men aged 40-84 years, participating in the population-based cross-sectional Tromsø study in Norway in 2015-2016, were included. Linear regression was used to assess associations between aBMD and physical activity and the physical capability tests grip strength, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), and standing balance. Non-linear associations were examined in cubic spline models. Standardized regression coefficients were calculated to compare effect sizes across physical capability measures. RESULTS: In fully adjusted models, higher physical activity was positively associated with total hip aBMD in both sexes compared to a sedentary lifestyle. All tests of physical capability were associated with aBMD in women, SPPB showing the strongest association although effect sizes were too small to indicate clinically significant differences (1 point increase corresponded to an aBMD increase of 0.009 g/cm2, CI = 0.005 to 0.012). In men, SPPB and its subtests were associated with aBMD with chair rises showing the strongest association (1 s increase in execution time corresponded to an aBMD decrease of 0.005 g/cm2, CI = 0.008 to 0.002). CONCLUSION: Physical activity was associated with aBMD, and tests of physical capability can account for some of the aBMD variations in adults aged 40 years and older, especially in women.

Correction to: Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial.

The original version of this article, published on 10 January 2020, contained a mistake. An author's name was misspelled.

Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial.

Exercise is recommended for people with osteoporosis, but the effect for people who have suffered vertebral fracture is uncertain. This study shows that a multicomponent exercise-program based on recommendations for people with osteoporosis improved muscle strength, balance, and fear of falling in older women with osteoporosis and vertebral fracture. INTRODUCTION: Guidelines for exercise strongly recommend that older adults with osteoporosis or osteoporotic vertebral fracture should engage in a multicomponent exercise programme that includes resistance training in combination with balance training. Prior research is scarce and shows inconsistent findings. This study examines whether current exercise guidelines for osteoporosis, when applied to individuals with vertebral fractures, can improve health outcomes. METHODS: This single blinded randomized controlled trial included 149 older women diagnosed with osteoporosis and vertebral fracture, 65+ years. The intervention group performed a 12-week multicomponent exercise programme, the control group received usual care. Primary outcome was habitual walking speed, secondary outcomes were physical fitness (Senior Fitness Test, Functional Reach and Four Square Step Test), health-related quality of life and fear of falling. Descriptive data was reported as mean (standard deviation) and count (percent). Data were analyzed following intention to treat principle and per protocol. Between-group differences were assessed using linear regression models (ANCOVA analysis). RESULTS: No statistically significant difference between the groups were found on the primary outcome, walking speed (mean difference 0.04 m/s, 95% CI - 0.01-0.09, p = 0.132). Statistically significant between-group differences in favour of intervention were found on FSST (dynamic balance) (mean difference - 0.80 s, 95% CI - 1.57 to - 0.02, p = 0.044), arm curl (mean difference 1.55, 95% CI 0.49-2.61, p = 0.005) and 30-s STS (mean difference 1.85, 95% CI 1.04-2.67, p < 0.001), as well as fear of falling (mean difference - 1.45, 95% CI - 2.64 to - 0.26, p = 0.018). No statistically significant differences between the groups were found on health-related quality of life. CONCLUSION: Twelve weeks of a supervised multicomponent resistance and balance exercise programme improves muscle strength and balance and reduces fear of falling, in women with osteoporosis and a history of vertebral fractures. TRIAL REGISTRATION: ClincialTrials.gov Identifier: NCT02781974. Registered 25.05.16. Retrospectively registered.

Hospital nurses and home care providers' experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study.

BACKGROUND: A person-centred approach to nutritional care has the potential to increase an older person's role in making informed decisions about their own care and possibly improving their quality of life. However, despite the considerable interest shown in person-centred nutritional care in recent years, delivery of such care still appears to lack consideration for older persons' needs and preferences. The present study aimed to explore healthcare professionals' views on how older persons and their family caregivers participate in decisions about their own nutritional care and possible barriers for that participation. METHODS: Semi-structured in-depth interviews with 23 healthcare professionals in acute geriatric care and home care were conducted. Data were analysed thematically. RESULTS: The analysis of the interviews resulted in three main themes: (i) lack of shared decision-making in nutritional care; (ii) conflict between patient's preferences and standard nutritional care procedures; and (iii) the value of family caregivers who are seldom involved in nutritional care. CONCLUSIONS: Healthcare professionals were aware of the importance of actively engaging older persons and their family members in the nutritional care to achieve positive outcomes. However, they encountered individual and structural barriers, including resistance from patients and family caregivers, conflicts between the patients' nutritional wishes and standard nutritional procedures, a wish to shield the family caregivers from the stress of caring for a sick relative, and lack of time and caring structures that facilitate the older persons and their family's active participation.

Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromsø Study.

Low bone mineral density (BMD) gives an increased risk of fractures, which can lead to premature death. Can BMD of the wrist predict mortality? BMD consistent with osteopenia and osteoporosis gave a significantly increased risk of death for both men and women in a general population in Tromsø, Norway. INTRODUCTION: To investigate if bone mineral density (BMD) levels of the distal forearm, consistent with osteopenia and osteoporosis, can predict mortality and if grip strength is an effect modifier. METHODS: The study population constituted 6565 participants aged 50-79 years at baseline in the Tromsø Study wave 4 conducted in 1994-1995. Forearm BMD measured by SXA was categorized as "normal," "osteopenia," or "osteoporosis" following WHO's definition. Cox regression with all-cause mortality as the outcome over 22 years of follow-up was performed for men and women separately, adjusting for health-related factors, as well as BMD by grip strength interaction. A secondary analysis with a 15-year follow-up also adjusted for hip fractures and osteoporotic fractures. RESULTS: During follow-up, 3176 of participants died (47%). Those categorized as osteoporotic had higher mortality hazard ratio (HR) compared to those with normal BMD; men HR = 1.37 (95% confidence interval (CI) 1.19, 1.58) and women HR = 1.32 (1.14, 1.53) were adjusted for age, body mass index, physical activity, smoking habits, education, health status, chronic diseases, and grip strength. Corresponding HRs for osteopenia were men HR = 1.13 (1.00, 1.27) and women HR = 1.17 (1.01, 1.35). Further adjustments for fractures did only marginally attenuate the results, and HRs were still significant. There was no grip strength by BMD interaction. CONCLUSION: Men and women with low distal forearm BMD values, consistent with osteoporosis or osteopenia, had an increased mortality compared to normal BMD participants. High grip strength did not modify this association, and the association remained after adjustment for a range of health-related factors.

Adaptive dynamics of cuticular hydrocarbons in Drosophila.

Cuticular hydrocarbons (CHCs) are hydrophobic compounds deposited on the arthropod cuticle that are of functional significance with respect to stress tolerance, social interactions and mating dynamics. We characterized CHC profiles in natural populations of Drosophila melanogaster at five levels: across a latitudinal transect in the eastern United States, as a function of developmental temperature during culture, across seasonal time in replicate years, and as a function of rapid evolution in experimental mesocosms in the field. Furthermore, we also characterized spatial and temporal changes in allele frequencies for SNPs in genes that are associated with the production and chemical profile of CHCs. Our data demonstrate a striking degree of parallelism for clinal and seasonal variation in CHCs in this taxon; CHC profiles also demonstrate significant plasticity in response to rearing temperature, and the observed patterns of plasticity parallel the spatiotemporal patterns observed in nature. We find that these congruent shifts in CHC profiles across time and space are also mirrored by predictable shifts in allele frequencies at SNPs associated with CHC chain length. Finally, we observed rapid and predictable evolution of CHC profiles in experimental mesocosms in the field. Together, these data strongly suggest that CHC profiles respond rapidly and adaptively to environmental parameters that covary with latitude and season, and that this response reflects the process of local adaptation in natural populations of D. melanogaster.

The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial.

UNLABELLED: This article explores the effect of a group-based exercise program and an educational session on the fear of falling among 89 women with osteoporosis and a history of vertebral fracture. This randomized clinical trial showed that the intervention had a positive and durable effect on the fear of falling. INTRODUCTION: The aim of this study was to evaluate the effect of an intervention on fear of falling in women with osteoporosis and a history of vertebral fracture. METHODS: The study was a parallel-group randomized clinical trial with a blinded assessor. The participants were 89 community-dwelling elderly women with osteoporosis and a history of vertebral fracture. The intervention group (IT, n = 47) received a 3-month group-based circuit exercise program combined with a 3-h educational session focusing on the reduction of the risk of falls and challenges specific to osteoporosis and vertebral fractures. The control group (CT, n = 42) continued with their usual activities. Clinical outcomes were assessed at baseline, postintervention and 12 months after randomization. This article reports on the secondary outcome Falls Efficacy Scale-International (FES-I) from a previously reported trial. RESULTS: We found a significantly better result for the IT group compared with the CT group, both at 3 months (p = 0.004) and 12 months (p < 0.001) follow-up. The effect size at 3 months was small (0.4) and at 12 months moderate (0.7). Multiple regression analysis confirmed the effect of the intervention. CONCLUSION: The intervention had a positive and durable effect on fear of falling as measured with the FES-I.

Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial.

UNLABELLED: The aim of this randomized controlled trial was to evaluate the effect of a 3-month course of exercises on mobility, balance, disease-specific, and generic health-related quality of life (HRQOL) for women with osteoporosis and a history of vertebral fractures. Our results showed that exercises improved their mobility, balance, and HRQOL. INTRODUCTION: The aim was to evaluate the effect of a 3-month course of circuit exercises plus a 3-h lesson on how to cope with osteoporosis on mobility, balance, and the HRQOL for postmenopausal women (60-84 years) with osteoporosis and a history of vertebral fracture. Our hypothesis was that a 3-month course would have a significantly positive effect on the women's mobility and balance as well as on their HRQOL. METHODS: The participants (89) were randomized to an intervention group (IT) or a control group (CT) and assessed at baseline at 3 months and at 12 months with measurement of maximum walking speed (MWS), Timed Up and GO (TUG), Functional Reach (FR), the Quality of Life Questionnaire issued by the European Foundation for Osteoporosis ('QUALEFFO-41') and the General Health Questionnaire (GHQ-20). The sample size was calculated with reference to walking speed (primary outcome), and the statistical approaches used were Student's t test or the chi-square test. RESULTS: At 3 months, better results were registered on the primary outcome, MWS as well as TUG, FR, sum score of GHQ-20, and "QUALEFFO-41: mental function" in the IT compared with the CT. At 12 months, those in the IT had a better result on the primary outcome, MWS as well as TUG, "QUALEFFO-41: total score" "QUALEFFO-41: mental function", "QUALEFFO-41: physical function", and "QULEFFO-41: pain" compared with CT. CONCLUSION: Circuit exercises will improve mobility and health-related quality of life of elderly women with osteoporosis and a history of vertebral fractures.

Fast-track surgery for bariatric laparoscopic gastric bypass with focus on anaesthesia and peri-operative care. Experience with 500 cases.

BACKGROUND: Bariatric surgery for morbid obesity implies challenges in anaesthesiological handling. We report our experience from 500 consecutive patients during 3 years. METHODS: The patients were due for laparoscopic Roux-en-Y gastric bypass and enteral bypass. Sleep was induced after pre-oxygenation with target control infusions (TCI) of remifentanil and propofol; vecuronium was supplied for facilitating endotracheal intubation. The propofol infusion was stopped and desflurane 3-6% was given for BIS-titrated anaesthetic maintenance together with remifentanil TCI. Antiemetic prophylaxis was supplied with intravenous (IV) droperidol, ondansetron and dexamethasone; post-operative pain prophylaxis was IV paracetamol, parecoxib and bupivacaine infiltration. The patients were extubated in the operating room and kept in the post-operative care unit for 3-4 h, being tested for a 20 m walk before discharge to the ward. RESULTS: The procedure was uncomplicated peri-operatively in all 500 cases and in 497 patients (99.4%) post-operatively. Three patients had one complication, which resolved without sequelae: oesophageal rupture from gastric tubing, reoperation for anastomosis leakage and pneumonia. The mean duration of surgery was 57 min (range 37-91). The mean time from the start of anaesthesia until the start of surgery and time from the end of surgery until the end of anaesthesia were both significantly reduced throughout the study period, from 23 to 7.8 and 5.8 to 1.9 min, respectively (P<0.001). The mean total hospital stay was reduced from 3 days at start to 2 days in the end of the series (P<0.05). CONCLUSION: Safe bariatric short-stay surgery is feasible with a dedicated anaesthesiological concept in an expert surgical team.

Risk of hip fractures in soft protected, hard protected, and unprotected falls.

OBJECTIVE: To compare hip fracture risk in soft and hard protected falls with the risk in unprotected falls and to compare the incidence of hip fractures in nursing homes providing soft and hard hip protectors. METHODS: An observational study conducted within the framework of a cluster randomized trial in 18 nursing homes. Nursing homes were randomized to offer either soft or hard hip protectors. Individual participants were followed for falls for 18 months. RESULTS: Of 1236 participating residents, 607 suffered 2926 falls; 590 of the 2926 falls were categorized as soft protected, 852 as hard protected, and 1388 as unprotected falls. Sixty-six verified hip fractures occurred: eight in soft protected falls, 11 in hard protected falls, and 45 in unprotected falls. The hip fracture risk in soft and hard protected falls was almost 60% lower than in unprotected falls (OR (soft) 0.36, 95% CI 0.17 to 0.77; OR (hard) 0.41, 95% CI 0.19 to 0.89). The incidence of hip fracture was 4.6 and 6.2 per 100 person-years in nursing homes providing soft and hard hip protectors, respectively (p = 0.212). CONCLUSION: Both types of hip protector have the potential, when worn correctly, to reduce the risk of a hip fracture in falls by nearly 60%. Both can be recommended to nursing-home residents as a means of preventing hip fractures.

Falls reported among elderly Norwegians living at home.

BACKGROUND AND PURPOSE: Norway has the highest reported incidence of hip fractures in western Europe. Little is known about the epidemiology of falls in Norway where the winter season is long and dark. The objective of this work was to study reported falls and their consequences among elderly Norwegians living at home. METHODS: A cross-sectional design was used for the study. Interviews were performed in the homes of 431 subjects, aged 67-97 years, living at home. Information on falling was gathered through six questions: whether the subject had fallen during the last six months, and if so, how many falls they had, where the last fall occurred, its perceived reason, the activity the subject had been engaged in when the fall occurred, and the resulting injury. RESULTS: In all, 24.1% of subjects reported falling during the last six months, and 9.5% had suffered more than one fall. Falls were most frequently linked to external events (63.1%). Outdoor falls were more frequent (59.0%; 95% CI = 51.2-82.0) than indoor falls. Older subjects were associated with more frequent indoor falls (p < 0.05), but gender was not significant. Fifty-one per cent of subjects had fallen while walking and 53% had suffered an injury from the last fall. In 13.4% of the women and 16.2% of the men, the last fall had resulted in a fracture. CONCLUSIONS: Compared to the results of other studies from industrialized Western countries, a similar crude fall rate, similar frequency and similar type of injury were found. However, in contrast to other studies, no gender difference was observed with regard to falling, place of falling and fracture rate.

Functional status among elderly Norwegian fallers living at home.

BACKGROUND AND PURPOSE: Falls and their after-effects are important contributors to disability in old age, but may be mitigated. The relationship between self-reported health and functioning and falling is examined in the present study. METHOD: The study design was cross-sectional. Data were collected from interviews with 431 community-dwelling Norwegian subjects aged 67-97 years. Physical health was assessed through items from the Multidimensional Functional Assessment of Older Adults (MFAQ), supplemented with the Body Mass Index (BMI). General health/psychosocial health was assessed with the General Health Questionnaire (GHQ-20), the Mini-mental State Examination, two general health items and items concerning mental and social health from the MFAQ. Falls during the last six months were registered and scored 0 (no falls), 1 (one fall) or 2 (two or more falls). RESULTS: During the previous six months 24.1% of subjects reported falling. Four variables: 'Perceived difficulty in keeping balance in walking', 'Troubled by heart pounding/shortness of breath', sum score on the GHQ factor 'Depression/hopelessness', and a higher value on BMI, were independently associated with number of falls reported. CONCLUSIONS: Score value on 'Perceived difficulty in keeping balance in walking' was the strongest significant predictor of falls in the present study. In contrast with other studies, no association between anxiety, general health and falling was observed.

Investigation into the reliability and validity of the measurement of elderly people's clinical walking speed: a systematic review.

The number of available walking tests has increased dramatically over the past decades. Therefore, it is highly important to help clinicians choose the most appropriate walking test for a specific setting. This systematic review aimed to critically evaluate the reliability, validity, and responsiveness of clinical walking speed in a broad population of elderly persons living in the community, sheltered housing, or institutions. Literature searches were performed in several different databases. Key words were based on the topic of the measurement properties of performance-based clinical tools for quantifying walking. The instrument selected for review was walking speed. The methods and results of all the evaluated measurement properties were rated by using a standard checklist for appraising the qualitative attributes and measurement properties of the instrument. A total number of 3,781 abstracts were reviewed, and 86 articles were chosen for inclusion. Habitual walking speed seems to be highly reliable in community-dwelling people and residents in mixed settings. There have not been any studies that accord with our inclusion and exclusion criteria that have evaluated the reliability of maximum walking speed in an aged population. Walking speed is a highly valid test, both at habitual and maximum speed. Few studies gave information about responsiveness for walking speed, which means that these results cannot be evaluated properly. Habitual walking speed is a reliable measure, but maximum walking speed needs further evaluation. Both habitual and maximum walking speeds are valid instruments, and they predict death, hospitalization/institutionalization, and decline in mobility.

High-volume bariatric surgery in a single center: safety, quality, cost-efficacy and teaching aspects in 2,000 consecutive cases.

BACKGROUND: Obesity surgery is the most effective treatment for morbid obesity and the fastest growing area in surgery. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard procedure in many countries. Optimization of the treatment process is important in order to keep the morbidity rate down and cost of treatment as low as possible. METHODS: In September 2005, we established a bariatric surgery program. Until December 2010, 2,000 patients underwent LRYGB. Clinical pathways were established, with focus on safety, fast-track methodology and training of surgeons. Time recordings from all parts of the treatment, as well as clinical outcome, were prospectively registered. RESULTS: Time consumption for the total procedure in the operating theater was reduced from 102 to 54 min (P < 0.001). With only 11 min turnover between patients, the total time for one patient has been reduced to 65 min, enabling us to perform six operations in a single operating theater during ordinary daytime. Early complication rate was 2.8%, and mean hospital stay was 2.3 days. We were able to double the patients treated in 2010 compared to 2007 with only 10% increase in staff. Three surgeons were trained during the period into fully qualified senior bariatric surgeons. CONCLUSIONS: Multimodal evidence-based care within the fast-track methodology and routine time recordings was successful in order to increase the production volumes and reduce costs, without compromising the safety or quality for the patients. This kind of approach may be transferred to other types of standardized surgery.

Uptake and adherence with soft- and hard-shelled hip protectors in Norwegian nursing homes: a cluster randomised trial.

UNLABELLED: A comparison between soft- and hard-shelled hip protectors in nursing homes shows no clinical relevant difference in acceptance and probability of continued use. However, significantly more users of the soft hip protector used the protector 24 hours a day. INTRODUCTION AND HYPOTHESIS: Uptake and adherence with the use of hip protectors are poor due to discomfort and impracticality. The aim of the study was to compare uptake and adherence between soft- and hard-shelled hip protectors. We hypothesized a higher uptake and adherence with soft hip protectors than with hard ones. METHODS: This cluster randomized study was performed for 18 months in 18 Norwegian nursing homes. Each nursing home was randomly allocated either soft or hard hip protectors. A total of 1,236 participants were enrolled in the study of which 314 and 290 started to use soft and hard hip protectors, respectively. RESULTS: The uptake among participants in nursing homes provided soft hip protectors was not significantly different from the uptake in nursing homes provided hard protectors. The probability of continued use was a little higher among users of soft hip protector. There were significantly more 24-hour users among those people using the soft protector. CONCLUSION: Our results indicate that changing the design might not solve the compliance issue, but may be a step in the right direction, especially for those people who are in need of 24-hour use.

Thriving--a useful theoretical perspective to capture the experience of well-being among frail elderly in nursing homes?

AIM: The aim of this article is to discuss the concept of thriving and its adequacy in describing the experience of well-being among physically frail nursing home residents. BACKGROUND: There is a lack of theoretical perspectives describing nursing home residents' experience of well-being. METHOD: The article is based on a literature review and analysis of how the concept of thriving is used in different professional traditions. Three different theoretical perspectives are presented: (1) thriving as an outcome of growth and development; (2) thriving as a psychological state; (3) thriving as an expression of physical health state. In the second part of the paper, the three perspectives are discussed. CONCLUSION: The authors suggest that there is a need to develop a new concept: that of thriving in physically frail nursing home residents. The article discusses how each of the three theoretical perspectives may contribute to the formation of this concept.

Risk factors for serious fall related injury in elderly women living at home.

OBJECTIVES: To study whether balance, function, and other health status indicators can predict serious fall related injury in elderly women living at home. METHODS: In this prospective study, the authors took a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%), living in the community. Serious fall injuries which occurred over a period of during one year were recorded, together with baseline registrations of health, function, and tests of walking and balance. RESULTS: In all, 155 women (50.5%) fell one or more times. One hundred and fifty six (51%) of the 308 falls resulted in a fall related injury, 74 (24%) in a serious fall related injury, and 40 falls (13%) resulted in fractures. The presence of rheumatic disorders, inability to rise from the floor, arthrosis of the hip, having had more than one fall during the one year follow up period, and an increased tendency to sway in the frontal plane when doing a calculation task were independent and significant predictors for serious fall related injury (fractures included). The independent predictors of fall induced fractures were experiencing more than one fall in the follow up period, cognitive impairment, and receiving care from professional or other. CONCLUSION: The study suggests that rheumatic disorders and the inability to get up from lying on the floor were the strongest independent risk factors for serious fall related injury. Experiencing more than one fall in the follow up period and cognitive impairment are the strongest independent predictors for fall induced fractures. Age was not a significant predictor of serious fall related injury. Assessment of these markers is feasible in a clinical setting and is a useful way of identifying those who are at risk of serious fall related injuries.