Predicting delirium after hip fracture with a 2-min cognitive screen: prospective cohort study.

BACKGROUND: although the importance of identifying hip fracture patients with high risk for delirium has been well established, considerable controversy exists over the choice of the screening tool. The most commonly used cognitive screeners take an excessive amount of time and include drawing tasks that can be troublesome for individuals with hip fracture who are invariably lying in bed. OBJECTIVE: to evaluate the properties of the 10-point Cognitive Screener (10-CS), a 2-min bedside tool, for predicting delirium in older adults with hip fracture. DESIGN: prospective cohort study. SETTING: a tertiary referral hospital in São Paulo, Brazil. SUBJECTS: non-delirious older adults with hip fracture (n = 147). METHODS: the 10-CS was administered as a baseline predictor. The test is composed of three-item temporal orientation (date, month, year), category fluency (animals in 1 min) and three-word recall. Incident delirium has been diagnosed according to the Confusion Assessment Method (CAM) that was administered daily from admission to discharge. RESULTS: during hospitalisation, 61 (41.5%) patients developed delirium. The 10-CS presented excellent accuracy for predicting delirium, with an area under ROC curve of 0.83 (95% CI 0.76-0.89). After adjusting for demographic and clinical variables, participants with probable cognitive impairment (score ≤ 5) were more likely to develop delirium (HR = 7.48; 95% CI 2.2-25.4) compared with participants with a normal score. Lower scores on the 10-CS were also independently associated with a longer length of stay. CONCLUSIONS: the 10-CS is an easy-to-use bedside tool with adequate properties to stratify the risk of delirium in older adults with hip fracture.

Importance of muscle strength to maintain mobility, but not to maintain postural balance in older women: Cross-sectional study.

BACKGROUND: Acknowledging the relationship between postural control and muscle strength in lower limbs is important to find persons with high fall risk and to design fall prevention exercise programs. OBJECTIVE: To investigate the connection between knee muscle strength, semi-static postural balance, and functional mobility in irregularly active older women. METHODS: One hundred and ten older women aged 60 to 85 years underwent a semi-static postural balance test in a force and functional mobility measured by Timed Up & Go (TUG) with and without Cognitive Tasks (CT). Muscle strength of the knee was assessed by isokinetic dynamometry at 60°/s. RESULTS: A negative correlation between the functional mobility (TUG with and without CT) and the muscular strength of the knee was observed. Regarding semi-static balance, there was a low negative correlation with peak torque corrected for body weight of the extensors with the following variables with eyes open: Mean Velocity Dominant limb (D) (r = -0.19; p = 0.03); and anteroposterior range Non-Dominant limb (ND) (r = -0.19; p = 0.04); with eyes closed: mediolateral range ND limb (r = -0.21; p = 0.02) and Mean Velocity ND limb (r = -0.18; p = 0.05). CONCLUSIONS: This study found that better functional mobility was associated with greater muscle strength in the knee in elderly women. There were weak negative correlations between knee extensor strength and some measures of semi-static postural balance, suggesting that different motor control actions are required to maintain semi-static balance and mobility. In the case of semi-static balance, a lower level of muscle response is required than in functional mobility.

A 2-Minute Cognitive Screener for Predicting 1-Year Functional Recovery and Survival in Older Adults After Hip Fracture Repair.

BACKGROUND: Implementing cognitive assessment in older people admitted to hospital with hip fracture-lying in bed, experiencing pain-is challenging. We investigated the value of a quick and easy-to-administer 10-point Cognitive Screener (10-CS) in predicting 1-year functional recovery and survival after hip surgery. METHODS: Prospective cohort study comprising 304 older patients (mean age = 80.3 ± 9.1 years; women = 72%) with hip fracture consecutively admitted to a specialized academic medical center that supports secondary hospitals in Sao Paulo Metropolitan Area, Brazil. The 10-CS, a 2-minute bedside tool including temporal orientation, verbal fluency, and three-word recall, classified patients as having normal cognition, possible cognitive impairment, or probable cognitive impairment on admission. Outcomes were time-to-recovery activities of daily living (ADLs; Katz index) and mobility (New Mobility Score), and survival during 1-year after hip surgery. Hazard models, considering death as a competing risk, were used to associate the 10-CS categories with outcomes after adjusting for sociodemographic and clinical measures. RESULTS: On admission, 144 (47%) patients had probable cognitive impairment. Compared to those cognitively normal, patients with probable cognitive impairment presented less postsurgical recovery of ADLs (77% vs 40%; adjusted sub-hazard ratio [HR] = 0.44; 95% confidence interval [CI] = 0.32-0.62) and mobility (50% vs 30%; adjusted sub-HR = 0.52; 95% CI = 0.34-0.79), and higher risk of death (15% vs 40%; adjusted HR = 2.08; 95% CI = 1.03-4.20) over 1-year follow-up. CONCLUSIONS: The 10-CS is a strong predictor of functional recovery and survival after hip fracture repair. Cognitive assessment using quick and easy-to-administer screening tools like 10-CS can help clinicians make better decisions and offer tailored care for older patients admitted with hip fracture.

BONE MINERAL DENSITY AND BODY COMPOSITION IN ELDERLY RUNNERS: SIX-YEAR FOLLOW-UP.

OBJECTIVE: To evaluate bone mineral density (BMD) and body composition over a six-year period in elderly long-distance runners. METHODS: We analyzed the medical records of elderly athletes who were long-distance runners, were participants of the IOT-HCFMUSP Orthogeriatric Group, and had their BMD evaluated between 2001 and 2007; of these athletes, 11 were included in the study. Inclusion criteria: athletes should be long-distance runners, should not stop long-distance running during the six-year period, and should have undergone BMD and body composition evaluations. Body composition was evaluated using bone densitometry with dual-energy X-ray absorptiometry with a Lunar-DPX device. RESULTS: Over the six-year period, body composition remained stable, but there was a significant increase only in the fat percentage (p = 0.003). CONCLUSION: Long-distance running may maintain BMD but may lead to an increase in the fat percentage in elderly runners. Level of Evidence II; Prognostic Study - Investigating the Effect of Patient Characteristics on Disease Outcome.

OBJETIVO: Acompanhar a densidade mineral óssea (DMO) e a composição corporal, ao longo de seis anos, em idosos corredores de longa distância. MÉTODOS: analisamos os prontuários médicos de um grupo de atletas idosos, corredores de longa distância, participantes do Grupo de Ortogeriatria do IOT-HC-FMUSP, e reunimos todos os atletas que tiveram a DMO avaliada no ano de 2001 e de 2007, sendo destes, 11 prontuários selecionados. Critérios de inclusão: ser corredor de longa distância; não parar de correr ao longo dos seis anos e ter os dois exames de DMO e composição corporal avaliados. A composição corporal foi avaliada por meio de densitometria óssea, com uma dupla energia de absorção de raios-X (DEXA), em um aparelho LUNAR-DPX. RESULTADOS: Ao longo dos seis anos, a composição corpórea se manteve estável, havendo apenas um aumento significante na gordura expressa em (%) (p=0,003). CONCLUSÃO: A corrida de longa distância parece conservar a DMO de idosos corredores, porém com aumento de gordura. Nível do Evidência II; Estudos prognósticos - Investigação do efeito de características de um paciente sobre o desfecho da doença.

Prognostic factors for mortality among patients above the 6th decade undergoing non-cardiac surgery: cares--clinical assessment and research in elderly surgical patients.

PURPOSE: To ascertain perioperative morbimortality and identify prognostic factors for mortality among patients > or = 55 years who undergo non-cardiac surgery. METHODS: A retrospective cohort of 403 patients relating to perioperative morbidity-mortality. Data were collected from a standardized protocol on gender, age, comorbidities, medications used, smoking, alcohol abuse, chronic use of benzodiazepine, nutritional status, presence of anemia, activities of daily living, American Society of Anesthesiology classification, Detsky's modified cardiac risk index--American College of Physicians, renal function evaluation, pulmonary risk according to the Torrington scale, risk of thromboembolic events, presence of malignant disease and complementary examinations. RESULTS: The mean age of the subjects was 70.8 +/- 8.1 years. The "very old" (> or =80 years) represented 14%. The mortality rate was 8.2%, and the complication rate was 15.8%. Multiple logistic regression showed that a history of coronary heart disease (OR: 3.75; p=0.02) and/or valvular heart disease (OR: 31.79; p=0.006) were predictors of mortality. The American Society of Anesthesiology classification was shown to be the best scale to mark risk (OR: 3.01; p=0.016). Nutritional status was a protective factor, in which serum albumin increases of 1 mg/dl decreased risk by 63%. DISCUSSION: The results indicate that serum albumin, coronary heart disease, valvular heart disease and the American Society of Anesthesiology classification could be prognostic predictors for aged patients in a perioperative setting. In this sample, provided that pulmonary, cardiac and thromboembolic risks were properly controlled, they did not constitute risk factors for mortality. Furthermore, continuous effort to learn more about the preoperative assessment of elderly patients could yield intervention possibilities and minimize morbimortality.

RELATIONSHIP BETWEEN BONE MINERAL DENSITY AND BODY COMPOSITION IN ELDERLY.

OBJECTIVE: To evaluate the association between bone mineral density (BMD) and body composition in healthy older adults at different skeletal sites. METHODS: We analyzed 87 medical records and BMD along with the body composition of men ranging from 60 to 87 years of age (mean: 68.5, standard deviation: 6.5). Inclusion criteria were normal BMD values (T-score greater than or equal to -1.0) and body mass index within normal or overweight range (18.5 to 29.5 kg/m2). Body composition was evaluated using bone densitometry with dual-energy X-ray absorptiometry (DEXA) in a LUNAR-DPX apparatus. RESULTS: Greater lean mass, fat mass, and soft tissue was associated with better BMD values in older adults, and higher age was associated with poorer BMD. CONCLUSION: Body composition (lean and fat masses and soft tissue) in older men is positively associated with BMD at all body sites (arms, legs, and trunk). Level of Evidence II; Prognostic studies - Investigating the effect of a patient characteristic on the outcome of disease.

OBJETIVO: Avaliar a associação entre a DMO e a composição corporal em idosos hígidos em diferentes sítios esqueléticos. MÉTODOS: Foram analisados 87 prontuários e exames de DMO com composição corporal de idosos do sexo masculino com média de idade de 68,5 (6,5) variando de 60 a 87 anos. Os critérios de inclusão foram valores de DMO dentro do normal (T-score maior ou igual a -1,0); IMC dentro dos valores normais ou sobrepeso (18,5 a 29,5 kg/m2). A composição corporal foi avaliada por meio de densitometria óssea por dupla emissão de raios-X (DEXA) em aparelho LUNAR-DPX. RESULTADOS: Quanto maior as massas magra e gorda e os tecidos moles, melhor os valores da DMO dos idosos e quanto maior a idade, pior a qualidade da DMO. CONCLUSÃO: A composição corporal (massas magra e gorda e tecidos moles) de homens idosos associa-se positivamente na DMO em todos os locais do corpo (membros superiores, inferiores e tronco). Nível do Evidênci II; Estudos prognósticos - Investigação do efeito de caractetísticas de um paciente sobre o desfecho da doença.

Association between handgrip strength, balance, and knee flexion/extension strength in older adults.

The objective of the study was to examine the association between handgrip strength (HGS), knee flexion and extension strength, and static and dynamic balance in older women. One hundred and ten women with a mean age of 67.4±5.9 years were assessed for dynamic postural balance using the Time Up & Go Test (TUG) with and without cognitive tasks. Semi-static balance was assessed by means of a force platform; knee flexor and extensor muscle strength was calculated using an isokinetic dynamometer; and HGS using a hand held dynamometer. Weaker HGS was significantly correlated with worse performance in dynamic postural balance, as well as performance with TUG with and without cognitive tasks; however, there was no correlation between HGS and static balance. There was a moderate positive correlation between knee flexion/extension strength and HGS. This suggests that HGS could be used as a proxy indicator of overall strength capacity for clinical screening among older women.

The effects of motor adaptation on ankle isokinetic assessments in older drivers.

OBJECTIVES: This study sought to analyze the extent of motor adaptation in ankle plantar flexors and dorsiflexors among older drivers during clinical isokinetic testing. METHODS: One hundred older adults (70.4±5.7 years) participated in two bilateral ankle plantar flexor and dorsiflexor isokinetic assessments at 30°/sec. Peak torque (PTQ), PTQ adjusted for body weight (PTQ/BW), and total work (TW) were analyzed. RESULTS: On the dominant side, PTQ/BW and TW were significantly greater for the second plantar flexion test than were those for the first such test (p<0.001), whereas PTQ, PTQ/BW, and TW (p<0.001) were significantly greater for the second dorsiflexion test than were those for the first such test. On the non-dominant side, plantar flexion PTQ and TW were significantly lower for the second test than were those for the first test (p<0.001). CONCLUSION: Older drivers demonstrated better performance with the dominant limb on the second test. The low variability in test execution showed the existence of a motor adaptation effect for the tested movements, despite the short recovery period between the assessments.

Impact of delirium on mortality and cognitive and functional performance among elderly people with femoral fractures.

OBJECTIVE: To evaluate the evolution of cognitive and functional performance and mortality among elderly patients who were delirious during hospitalization due to femoral fracture. STUDY TYPE: Prospective cohort. LOCATION: Orthopedics and Traumatology Institute of HC-FMUSP; geriatric orthopedic ward. PATIENTS: 103 patients, aged 60 years or over, who were hospitalized in the geriatric orthopedics ward with femoral fracture in 2001-2002. Thirty of them (29.1%) presented with delirium during their hospital stay and were compared with another 73 (70.9%) who did not present with delirium. There were six deaths, and 97 patients were discharged from the hospital. We obtained information on 85 of these patients four years after discharge; 42 patients were still alive and 43 had died at the time of the evaluation. METHODS: Data on vital status was obtained for 85 patients. For the 42 survivors, we acquired information on their basic activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive performance (BDRS) by means of telephone interview with the same caregivers who had provided information at the time of the hospitalization. We compared this data with that obtained during their hospitalizations four years prior. For the 43 patients who died, we obtained information regarding their deaths and used this data in the analysis of mortality. RESULTS: No relationships were observed between delirium and mortality, delirium and cognitive loss, or delirium and functional loss, after four years from discharge of elderly patients with hip fractures. An initial cognitive deficit was a predictor for mortality (RR = 2.54; p = 0.016), functional loss (OR = 1.80; p = 0.027) and cognitive loss (OR = 1.53; p = 0.024). Cognitive loss was also related to age. CONCLUSIONS: Delirium had no impact on mortality or functional or cognitive losses in long term evolution (2 years) among elderly patients with femoral fractures. An initial cognitive impairment may identify patients at risk of mortality, functional and cognitive losses over the long term evolution.

Assessment of the quality of life, muscle strength, and dynamic balance of elderly Kendo players.

OBJECTIVE: To compare Kendo players with active elderly adults in terms of quality of life, functional aspects (muscle strength, postural balance) and body composition. METHODS: This was a controlled cross-sectional study. Twenty elderly individuals were divided into two groups: the Kendo group, with an average age of 71.8 (5.4) years, and the Control group, with an average age of 73.1 (4.8) years. Quality of life was evaluated using a questionnaire (WHOQOL-bref and WHOQOL-old); body composition was evaluated with a bioimpedance scale (InBody230); hand-grip strength was assessed with a portable manual dynamometer (Jamar SH 5001); flexor and extensor muscle strength of the knees was evaluated with an isokinetic device (Biode® System 3 model Biodex Multi Joint System, BIODEX); and dynamic balance was assessed using a force platform (Balance Master System, Neurocom International, Inc.,® Clackamas County, Oregon, USA). RESULTS: The groups were statistically homogeneous in terms of socio-demographic characterization, body composition, muscle strength, and dynamic balance, but the Control group was faster in the sit-to-stand test (p=0.03). The Kendo group had a statistically significantly better quality of life; in the WHOQOL-bref, these differences were present in the physical (p≤0.001) and environment (p=0.004) domains, and in the WHOQOL-old, these differences were present in social participation (p=0.001) and in past, present, and future activities (p=0.019). CONCLUSION: The results suggest that Kendo is a health-promoting activity that improves the quality of life, functional aspects (muscle strength and postural balance) and body composition of players.

Implantable cardioverter-defibrillators: expectations in the Brazilian elderly.

By 2025, Brazil will have the sixth largest elderly population in the world. Thirty percent of the elderly currently have private health insurance and 70% have their health care paid for by the Unified Health System. The system, founded through a governmental entity, provides free health service to all citizens. In 2003, the government passed the Elderly Statement Law, claiming that the elderly have equal access to prevention, promotion, protection, and recovery of health. In spite of the high costs, the placement of implantable cardioverter-defibrillators (ICDs) in the elderly is growing. There is a significant regional difference in the number of ICD placements, and there is also a significant sex bias: 73% of the ICDs were placed in elderly men. The majority of ICDs were placed in the elderly from ages 65 to 79 years. Nevertheless, 9.5% of ICDs were placed in octogenarians and nonagenarians, reflecting the valuation of biologic age rather than chronologic age.

Delirium in elderly individuals with hip fracture: causes, incidence, prevalence, and risk factors.

OBJECTIVES: To determine the incidence, prevalence, risk factors, and causes of delirium in elderly individuals with hip fractures, as well as the impact of delirium on mortality and length of hospital stay. PATIENTS: One hundred and three patients aged 65 and older with hip fractures were included consecutively between January 2001 and June 2002. METHOD: Delirium was diagnosed using the Confusion Assessment Method, applied within the first 24 hours after admission, and then daily. All patients underwent a global geriatric evaluation including clinical history, physical examination, laboratory tests, surgical risk evaluation, and functional and mental evaluations. Patients with delirium (cases) were compared with patients without delirium (controls). RESULTS: Thirty (29.1%) patients in this sample met the criteria for delirium, with a prevalence of 16.5% (17/103) and an incidence of 12.6% (13/103). Cognitive and functional deficits had a significant association with delirium, although only cognitive deficit was revealed to be an independent risk factor after analysis with the logistic regression model. The most frequent causes of delirium were drugs and infections. The hospital stay was significantly longer for patients with delirium compared with patients in the control group (26.27 versus 14.38 days, respectively). Mortality showed a tendency to higher levels in patients with delirium during their hospital stay, although with no statistical significance. CONCLUSIONS: Delirium is a frequent complication among hospitalized elderly individuals with hip fractures. It is associated with cognitive and functional deficits, and it is associated with increases the length of hospital stay and mortality.

Evolution of Brazilian elderly with hip fracture secondary to a fall.

OBJECTIVE: To contribute to fall prevention by studying the epidemiological profile, mortality, and functional evolution of elderly persons with hip fracture, in Brazil, in the year following a fracture. METHOD: Fifty-six elderly patients aged 60 years and over with hip fracture secondary to a fall and admitted in 2000 were included. In addition to the medical record data, patients or their guardians filled a form providing information regarding personal data, history of fall and fracture, physical evaluation, and ability to perform basic and instrumental activities of daily living prior to and 1 year after their fracture, using Katz's Index and Lawton's Index, respectively. RESULTS: Fractures were more common among Caucasian widowed women, and most falls occurred at home. General mortality within 1 year after the occurrence of fracture was 30.35% and was associated with sex and age. There was an increase in the inability to walk and in the use of a supporting device. A significant reduction in the functional ability to perform basic and instrumental activities of daily living was found. CONCLUSION: The evolution of hip fracture in the year following it is related to high mortality and to a decrease in functional ability, with age and male sex being the factors associated with a worse prognosis, emphasizing the need for special follow-up care of these groups during the immediate and late postoperative periods.

Evaluation of the quality of life among elderly female athletes.

OBJECTIVE: To analyze quality of life (QOL) in elderly athletes. DESIGN: Transversal, controlled study. METHODS: Female athletes over 60 years who run 15 km, and a control group consisting of 15 healthy, sedentary, women over 60 were studied. Questionnaires on QOL and Depression were applied. RESULTS: Athletes show better functional capacity (98.8 versus 73.3), less pain (90.6 versus 64.9), better general state of health (86.8 versus 66.8) and better vitality (86.2 versus 67.3). Differences were observed in emotional characteristics (89.6 versus 60.0) and mental health (84.3 versus 68.3), with fewer depressive answers (1.9 versus 3.8). CONCLUSION: Regular physical activity was related to better quality of life.

Balance and Muscle Strength in Elderly Women Who Dance Samba.

Considering the growth of the aging population, and the increasing risk for falls and related morbidity, it is vital to seek efficient, comprehensive, and culturally relevant prevention programs for elderly people to reduce risks for falls. The aim of the present study was to evaluate the postural balance and muscle strength among women participating in the "Wing of Baianas" in the carnival parades. One hundred and ten women, with an average age of 67.4±5.9 years, were divided into two groups: Baianas group-elderly participants of the carnival parades in the "Wing of Baianas", and a Control group of women who do not dance samba. Assessments included a physical activity questionnaire, isokinetic muscle strength testing for the knee extensors and flexors, and a postural balance assessment completed on a force platform. There were no differences between groups, for postural balance outcomes, during the eyes open condition; however, with eyes closed, there was a significant effect between groups (Baianas vs Control) in all variables. The Baianas group showed less medio-lateral displacement (p < 0.04); and anteroposterior displacement (p < 0.007); larger amplitudes of medio-lateral displacement (p < 0.001); and anteroposterior displacement (p < 0.001); increased mean velocity (p < 0.01); and elliptical area (p < 0.01) There were no differences in the isokinetic peak torque corrected by body weight, total work and flexor/extensor ratio. Participation in the Wing of Baianas is associated with better balance with closed eyes, but there were no differences between dancers and non-dancers for muscle strength.

Moderate and intense exercise lifestyles attenuate the effects of aging on telomere length and the survival and composition of T cell subpopulations.

Studies indicate that exercise might delay human biological aging, but the effects of long-term exercise on T cell function are not well known. We tested the hypothesis that moderate or intense exercise lifestyle may attenuate the effects of aging on the telomere length and the survival and composition of T cell subpopulations. Elderly (65-85 years) with intense training lifestyle (IT, n = 15), moderate training lifestyle (MT, n = 16), and who never trained (NT, n = 15) were studied. Although the three groups presented the age-associated contraction of the TCD4(+)/TCD8(+) naïve compartments and expansion of the memory compartments, both training modalities were associated with lower proportion of terminally differentiated (CD45RA(+)CCR7(neg)) TCD4(+) and TCD8(+) cells, although among the latter cells, the reduction reached statistical significance only with IT. MT was associated with higher proportion of central memory TCD4(+) cells, while IT was associated with higher proportion of effector memory TCD8(+) cells. However, both training lifestyles were unable to modify the proportion of senescent (CD28(neg)) TCD8(+) cells. Telomeres were longer in T cells in both training groups; with IT, telomere length increased mainly in TCD8(+) cells, whereas with MT, a modest increase in telomere length was observed in both TCD8(+) and TCD4(+) cells. Reduced commitment to apoptosis of resting T cells, as assessed by caspase-3 and Bcl-2 expression, was seen predominantly with IT. Measurement of pro-inflammatory cytokines in serum and peripheral blood mononuclear cell (PBMC)'s supernatants did not show chronic low-grade inflammation in any of the groups. In conclusion, MT and IT lifestyles attenuated some of the effects of aging on the immune system.

Elderly men with moderate and intense training lifestyle present sustained higher antibody responses to influenza vaccine.

We aimed to verify whether different levels of training performed regularly and voluntarily for many years could have an impact on one of the main issues of immunosenescence: the poor response to vaccines. We recruited 61 healthy elderly men (65-85 years old), 23 with a moderate training (MT) lifestyle (for 17.0 ± 3.2 years), 22 with an intense training (IT) lifestyle (for 25.9 ± 3.4 years), and 16 without a training lifestyle (NT). Fitness was evaluated through the IPAQ and VO2max consumption. The participants were evaluated regarding cognitive aspects, nutritional status, depression, and quality of life. Antibody titers were determined by hemagglutination inhibition assay prior to influenza vaccination and at 6 weeks and 6 months post-vaccination. Strains used were B, H3N2, and H1N1. Our groups were matched for most characteristics, except for those directly influenced by their lifestyles, such as BMI, VO2max, and MET. In general, MT and IT elderly men showed significantly higher antibody titers to the three vaccine strains post-vaccination than NT elderly men. There were also higher titers against B and H1N1 strains in the trained groups before vaccination. Additionally, there were higher proportions of seroprotected (titers ≥1:40) individuals in the pooled trained groups both at 6 weeks (B and H3N2, p < 0.05) and 6 months (H1N1, p < 0.05; B, p = 0.07). There were no significant differences between the MT and IT groups. Either a moderate or an intense training is associated with stronger and longstanding antibody responses to the influenza vaccine, resulting in higher percentages of seroprotected individuals.

Bone mineral density and body composition in elderly runners: six-year follow-up / Densidade mineral óssea e composição corporal de idosos corredores: follow-up de seis anos

ABSTRACT Objective: To evaluate bone mineral density (BMD) and body composition over a six-year period in elderly long-distance runners. Methods: We analyzed the medical records of elderly athletes who were long-distance runners, were participants of the IOT-HCFMUSP Orthogeriatric Group, and had their BMD evaluated between 2001 and 2007; of these athletes, 11 were included in the study. Inclusion criteria: athletes should be long-distance runners, should not stop long-distance running during the six-year period, and should have undergone BMD and body composition evaluations. Body composition was evaluated using bone densitometry with dual-energy X-ray absorptiometry with a Lunar-DPX device. Results: Over the six-year period, body composition remained stable, but there was a significant increase only in the fat percentage (p = 0.003). Conclusion: Long-distance running may maintain BMD but may lead to an increase in the fat percentage in elderly runners. Level of Evidence II; Prognostic Study - Investigating the Effect of Patient Characteristics on Disease Outcome.

RESUMO Objetivo: Acompanhar a densidade mineral óssea (DMO) e a composição corporal, ao longo de seis anos, em idosos corredores de longa distância. Métodos: analisamos os prontuários médicos de um grupo de atletas idosos, corredores de longa distância, participantes do Grupo de Ortogeriatria do IOT-HC-FMUSP, e reunimos todos os atletas que tiveram a DMO avaliada no ano de 2001 e de 2007, sendo destes, 11 prontuários selecionados. Critérios de inclusão: ser corredor de longa distância; não parar de correr ao longo dos seis anos e ter os dois exames de DMO e composição corporal avaliados. A composição corporal foi avaliada por meio de densitometria óssea, com uma dupla energia de absorção de raios-X (DEXA), em um aparelho LUNAR-DPX. Resultados: Ao longo dos seis anos, a composição corpórea se manteve estável, havendo apenas um aumento significante na gordura expressa em (%) (p=0,003). Conclusão: A corrida de longa distância parece conservar a DMO de idosos corredores, porém com aumento de gordura. Nível do Evidência II; Estudos prognósticos - Investigação do efeito de características de um paciente sobre o desfecho da doença.

Relationship between bone mineral density and body composition in elderly / Relação entre a densidade mineral óssea e a composição corporal em idosos

ABSTRACT Objective: To evaluate the association between bone mineral density (BMD) and body composition in healthy older adults at different skeletal sites. Methods: We analyzed 87 medical records and BMD along with the body composition of men ranging from 60 to 87 years of age (mean: 68.5, standard deviation: 6.5). Inclusion criteria were normal BMD values (T-score greater than or equal to -1.0) and body mass index within normal or overweight range (18.5 to 29.5 kg/m2). Body composition was evaluated using bone densitometry with dual-energy X-ray absorptiometry (DEXA) in a LUNAR-DPX apparatus. Results: Greater lean mass, fat mass, and soft tissue was associated with better BMD values in older adults, and higher age was associated with poorer BMD. Conclusion: Body composition (lean and fat masses and soft tissue) in older men is positively associated with BMD at all body sites (arms, legs, and trunk). Level of Evidence II; Prognostic studies - Investigating the effect of a patient characteristic on the outcome of disease.

RESUMO Objetivo: Avaliar a associação entre a DMO e a composição corporal em idosos hígidos em diferentes sítios esqueléticos. Métodos: Foram analisados 87 prontuários e exames de DMO com composição corporal de idosos do sexo masculino com média de idade de 68,5 (6,5) variando de 60 a 87 anos. Os critérios de inclusão foram valores de DMO dentro do normal (T-score maior ou igual a -1,0); IMC dentro dos valores normais ou sobrepeso (18,5 a 29,5 kg/m2). A composição corporal foi avaliada por meio de densitometria óssea por dupla emissão de raios-X (DEXA) em aparelho LUNAR-DPX. Resultados: Quanto maior as massas magra e gorda e os tecidos moles, melhor os valores da DMO dos idosos e quanto maior a idade, pior a qualidade da DMO. Conclusão: A composição corporal (massas magra e gorda e tecidos moles) de homens idosos associa-se positivamente na DMO em todos os locais do corpo (membros superiores, inferiores e tronco). Nível do Evidênci II; Estudos prognósticos - Investigação do efeito de caractetísticas de um paciente sobre o desfecho da doença.

The effects of motor adaptation on ankle isokinetic assessments in older drivers

OBJECTIVES: This study sought to analyze the extent of motor adaptation in ankle plantar flexors and dorsiflexors among older drivers during clinical isokinetic testing. METHODS: One hundred older adults (70.4±5.7 years) participated in two bilateral ankle plantar flexor and dorsiflexor isokinetic assessments at 30°/sec. Peak torque (PTQ), PTQ adjusted for body weight (PTQ/BW), and total work (TW) were analyzed. RESULTS: On the dominant side, PTQ/BW and TW were significantly greater for the second plantar flexion test than were those for the first such test (p<0.001), whereas PTQ, PTQ/BW, and TW (p<0.001) were significantly greater for the second dorsiflexion test than were those for the first such test. On the non-dominant side, plantar flexion PTQ and TW were significantly lower for the second test than were those for the first test (p<0.001). CONCLUSION: Older drivers demonstrated better performance with the dominant limb on the second test. The low variability in test execution showed the existence of a motor adaptation effect for the tested movements, despite the short recovery period between the assessments.