Disparate effects of ankle-brachial index on mortality in the 'very old' and 'younger old' populations-the PolSenior survey.

To assess the relationship between ankle-brachial index (ABI) and up to 10-year mortality in older individuals below and above the age of 80 years. In a multicenter survey of health status in the community dwelling subjects aged 55-59 and 65 + years in Poland, we assessed baseline medical history including risk-factors. We measured ABI, and serum creatinine, cholesterol, NT-proBNP, and interleukin-6 (IL-6) concentrations. We assessed mortality based on public registry. Between 2009 and 2019, 27.3% of 561 participants < 80 years, and 79.4% of 291 participants ≥ 80 years, died (p < 0.001); 67.8, 41.5, and 40.3% in the ABI groups < 0.9, 0.9-1.4, and > 1.4, respectively (p < 0.01). In the unadjusted Cox models, ABI was associated with mortality in the entire group, and < 80 years. In the entire group, analysis adjusted for age and sex showed mortality risk increased by 11% per year, and 50% with male sex. Mortality decreased by 37% per 1 unit ABI increase. In the group of people ≥ 80 years, only age was significantly associated with mortality (p < 0.001). In stepwise regression ABI < 0.9, male sex, active smoking, and NT-proBNP level were associated with risk of death < 80 years. In the ≥ 80 years old, mortality risk was associated with older age, and higher levels of IL-6, but not ABI. The ABI < 0.9 is associated with higher mortality in older people, but not among the oldest-old. In the oldest age group, age is the strongest predictor of death. In this age group, inflammageing is of importance.

Patterns of multimorbidity in 4588 older adults: implications for a nongeriatrician specialist.

INTRODUCTION: Multimorbidity has been recognized as an important factor in geriatric medicine. However, its importance for other specialists is still to be fully appreciated. OBJECTIVES: The aim of the study was to assess the prevalence and patterns of multimorbidity in older patients drawn from the general population. PATIENTS AND METHODS: The PolSenior was a nationwide, multicenter, cross-sectional survey of aged population in Poland. Questionnaire, physical examination, and laboratory data were gathered. Multimorbidity was defined as a coexistence of 2 and more chronic diseases or medical problems out of 17 identified. Factor analysis was employed to identify clusters of conditions. RESULTS: Of 4588 patients, 51.9% were men; 640 were aged 55 to 59 years; 3948, ≥65 years; and 1757, ≥80 years. Multimorbidity depended on age and sex, and was diagnosed in 70.9% of those aged 55 to 59 years, 88.4% of those aged 65 to 79 years, and 93.9% of those aged ≥80 years. Only 8.5% of participants aged 55 to 59, 2.2% aged 65 to 79 years, and 0.9% aged ≥80 years had no diagnosis of chronic disease. Hypertension, metabolic diseases, and obesity predominated in those aged 55 to 59 and 65 to 79 years, whereas hypertension, eye disorders, and cognitive impairment prevailed in the oldest group. The highest likelihood of multimorbidity was found in the youngest participants who had stroke, kidney disease, cancer, or a composite of Parkinson disease / epilepsy; in 65-to-79-year-olds with a history of stroke; and in ≥80-year-olds with a history of stroke or heart failure. CONCLUSIONS: The age-specific analysis of clustering revealed differences in prevalence and patterns of comorbidities, which stresses the importance of individual approach to older patients.

Utilization of medical rehabilitation services among older Poles: results of the PolSenior study.

BACKGROUND: Rehabilitation tailored to older adults' needs might improve their functional performance and quality of life, as well as increase social participation. The aim of the study was to evaluate the use of medical rehabilitation services among older Poles in relation to socio-economic and health-related determinants. MATERIALS AND METHODS: Data regarding medical rehabilitation were obtained from the nationwide, multidisciplinary PolSenior project (2007-2012) conducted on representative sample of 4813 respondents (48.3% women) aged 65+ years. Socio-economic status, physical functioning, falls, chronic pain, and formal disability occurrence, as well as self-rated health were accounted for. RESULTS: One in six respondents (18.9% women vs. 15.8% men, p < 0.005) underwent medical rehabilitation during 12 months prior to the survey. Respondents mostly received electrotherapy or light radiation therapy (61.3%). Multivariate logistic regression analysis revealed that women aged 80+ years and men aged 90+ years had a significantly lower chance of using rehabilitation services compared to the youngest study participants (65-69 y.o.). City dwellers used rehabilitation services nearly twice as frequently as rural dwellers. Respondents with university education level were most likely to take part in these services. Dependence in IADL decreased participation in medical rehabilitation, while formal disability and chronic pain promoted utilization of rehabilitation services. CONCLUSIONS: Younger age, city dwelling, higher education, functional independence, formal disability certificate, and chronic pain increased participation in medical rehabilitation. Such results of the study should be considered in planning actions towards reducing health inequalities at the national level and promoting health and well-being among older adults.

Clinical factors increasing discrepancies of renal function assessment with MDRD and Cockcroft-Gault equations in old individuals.

ABSTRACT: In a daily clinical practice, glomerular filtration rate (GFR) is still estimated on the basis of short MDRD formula, whereas medications' Summaries of Product Characteristics suggest that GFR used for the dosage adjustment should be estimated based on the Cockcroft-Gault (C-G) equation. The aim of the study was to compare eGFR values calculated on the basis of short and full MDRD and C-G equations in PolSenior study participants with decreased eGFR. METHODS: We have assessed differences in the estimation of GFR between short and full MDRD, as well as C-G formula, all equations utilizing non-isotope-dilution mass spectrometry-calibrated measurements of serum creatinine, in the community-based population of 760 persons aged 65 years or above (mean age 82 ± 8 years) with estimated GFR < 60 ml/min/1.73 m2 (according to short MDRD). In addition, in our analysis, we have included the detailed characteristics of comorbidities and different aspects of mobility and functional performance. RESULTS: The better concordance, precision, and accuracy with MDRD short formula were found for MDRDfull than C-G equation. In logistic regression analysis, female gender, activities in daily living (ADL) ≤ 4, and age > 80 years diminished, while visceral obesity improved accuracy (P30) of eGFR calculated according to C-G equation as compared to MDRDshort. Similar analysis did not found factors influencing P30 for MDRDfull equation. CONCLUSIONS: In very old subjects, especially females, dependent patients and those with visceral obesity, estimation of GFR based on short MDRD formula should not be used interchangeably with Cockcroft-Gault equation for the medicines dose tailoring.

Health status of older cancer survivors-results of the PolSenior study.

PURPOSE: The purpose of this study is to characterize health status of older cancer survivors using data from the population-based PolSenior study. METHODS: We compared cancer survivors and non-cancer subjects according to comorbidities, functional status, mental health, and sociodemographic factors. RESULTS: There were 286 (5.8%) cancer survivors in a population of 4943 adults aged 65 years and older. The mean age of cancer survivors was 79.4 ± 8.2 years and the median time since cancer diagnosis was 8.5 years (Q1-Q3: 4-16 years). After adjustment for age, sex, education, marital status, and number of comorbidities, compared with a non-cancer population, cancer survivors were more likely to experience falls (OR = 1.38; 95% CI: 1.04-1.83), and to report poor health (OR = 1.49; 95%CI: 1.83-2.06), but cancer survivorship was not associated with impairments in instrumental activities of daily living (IADLs). Age and university education, but neither the time from cancer diagnosis nor the number of comorbidities, were associated with impairments in cancer survivors. Three or more chronic diseases were found in over 50% of cancer survivors and in 38% of the non-cancer population (p < 0.001). CONCLUSIONS: Cancer survivors over the age of 65 years have a higher prevalence of falls, are more likely to report poor health status, and have a higher number of chronic conditions than the non-cancer population, but they maintain independence in IADLs. Advanced age and elementary education are associated with increased occurrence of functional impairments in older cancer survivors IMPLICATIONS FOR CANCER SURVIVORS: Older cancer survivors may require preventive services to reduce the risk of functional decline.

Challenges of modern medicine - geriatric otolaryngology or the advantages of cooperation between an otolaryngologist and a geriatrician.

Advanced age is often burdened with many deficits that are a consequence of the aging process, unfavorable lifestyle and multi-morbidity. They contribute to increased morbidity and disability of the older people. Laryngological problems often concern seniors, particularly progressing with age hearing impairment, dizziness, balance disorders, epistaxis, nasopharyngeal diseases, larynx, sinuses, and salivary glands disorders. They are not only a health threat, such as head and neck cancer, but they contribute to the deterioration of mobility, falls and injuries, depression, cognitive functions impairment and, consequently, functional disability, loss of independence and a sense of isolation. In this context, taking as an example the most common ailment, which is hearing impairment, laryngological procedures in the form of the use of hearing aids or cochlear implant improves cognitive functions, mood, self-esteem, opportunities for social interaction and everyday functioning, and the quality of life of older people. In turn, in view of the typical for older age polypathology and of significant reduction of the reserves of the organism, effective treatment aimed at improving health, preventing complications of diagnostics and therapy as well as disability with the desire to maintain independence and good quality of life requires the cooperation of different specialists. The knowledge and experience of geriatricians and the comprehensive geriatric assessment used as the diagnostic tool, aimed at identifying deficits typical of seniors' age may significantly contribute to a more adequate risk and benefit assessment, selection of optimal treatment for a given health situation and identification of high-risk individuals requiring during the treatment period special supervision to reduce the risk of complications and the risk of development of geriatric syndromes such as delirium, cognitive disorders, malnutrition, falls and injuries, functional disability.

Is the Clock Drawing Test useful in the screening assessment of aged patients with chronic heart failure?

PURPOSE: Cognitive impairment is one of the most common geriatric deficits in old patients with heart failure (HF), but there has been a lack of study on the utility of the Clock Drawing Test (CDT) when used with this group of patients. The aim of the study was to assess the usefulness of the CDT in the geriatric assessment of aged outpatients with chronic HF. PATIENTS AND METHODS: A cross-sectional analysis of the results of the comprehensive geriatric assessment (CGA), including the CDT, of 92 aged outpatients with heart failure was conducted. RESULTS: We found a high prevalence of five examined geriatric problems. The majority of the patients presented signs of cognitive deterioration of different patterns and severity on the Clock Drawing Test. All the CDT scoring systems correlated significantly with the Mini-Mental Test Examination results. CONCLUSIONS: It seems reasonable to perform the routine CGA with the CDT examination in all aged heart failure patients.

Interleukin-6 and C-reactive protein, successful aging, and mortality: the PolSenior study.

BACKGROUND: In the elderly, chronic low-grade inflammation (inflammaging) is a risk factor for the development of aging-related diseases and frailty. Using data from several thousand Eastern Europeans aged 65 years and older, we investigated whether the serum levels of two proinflammatory factors, interleukin-6 (IL-6) and C-reactive protein (CRP), were associated with physical and cognitive performance, and could predict mortality in successfully aging elderly. RESULTS: IL-6 and CRP levels systematically increased in an age-dependent manner in the entire study group (IL-6: n = 3496 individuals, p < 0.001 and CRP: n = 3632, p = 0.003), and in the subgroup of successfully aging individuals who had never been diagnosed with cardiovascular disease, myocardial infarction, stroke, type 2 diabetes, or cancer, and had a Mini Mental State Examination (MMSE) score ≥24 and a Katz Activities of Daily Living (ADL) score ≥5 (IL-6: n = 1258, p < 0.001 and CRP: n = 1312, p < 0.001). In the subgroup of individuals suffering from aging-related diseases/disability, only IL-6 increased with age (IL-6: n = 2238, p < 0.001 and CRP: n = 2320, p = 0.249). IL-6 and CRP levels were lower in successfully aging individuals than in the remaining study participants (both p < 0.001). Higher IL-6 and CRP levels were associated with poorer physical performance (lower ADL score) and poorer cognitive performance (lower MMSE score) (both p < 0.001). This association remained significant after adjusting for age, gender, BMI, lipids, estimated glomerular filtration rate, and smoking status. Longer survival was associated with lower concentrations of IL-6 and CRP not only in individuals with aging-related diseases/disability (HR = 1.063 per each pg/mL, 95 % CI: 1.052-1.074, p < 0.001 and HR = 1.020 per each mg/L, 95 % CI: 1.015-1.025, p < 0.001, respectively) but also in the successfully aging subgroup (HR = 1.163 per each pg/mL, 95 % CI: 1.128-1.199, p < 0.001 and HR = 1.074 per each mg/L, 95 % CI: 1.047-1.100, p < 0.001, respectively). These associations remained significant after adjusting for age, gender, BMI, lipids and smoking status. The Kaplan-Meier survival curves showed similar results (all p < 0.001). CONCLUSIONS: Both IL-6 and CRP levels were good predictors of physical and cognitive performance and the risk of mortality in both the entire elderly population and in successfully aging individuals.

Plasma visfatin/nicotinamide phosphoribosyltransferase (visfatin/NAMPT) concentration in elderly subjects with metabolic syndrome.

INTRODUCTION: Visceral adipose tissue is the main source of circulating proinflammatory adipokine, visfatin/nicotinamide phosphoribosyltransferase (visfatin/NAMPT), whose role in the pathogenesis of metabolic syndrome (MS) components such as hypertension and carbohydrate and lipid disturbances is still uncertain, due to commonly used low specific C-terminal immunoassays to determine visfatin/NAMPT levels. OBJECTIVES: The aim of the study was to assess the association between the occurrence of MS components and circulating visfatin/NAMPT levels in elderly popula tion. PATIENTS AND METHODS: The analysis included 2174 elderly participants of the PolSenior study without heart failure, severe chronic kidney disease, cancer, and malnutrition. MS was defined according to the modified International Diabetes Federation criteria. Plasma visfatin/NAMPT concentrations were measured by a highly specific enzyme-linked immunosorbent assay. Additionally, high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), and insulin levels were assessed, and the homeostasis model assessment for insulin resistance was calculated. RESULTS: Women were diagnosed with MS more often than men (71.2% vs 56.8%; P <0.001) and had a greater prevalence of all MS components except for type 2 diabetes. Women with MS had higher concentrations of hsCRP and IL-6 than those without MS. Visfatin/NAMPT concentrations were higher in women with MS than in those without MS (1.06 ng/ml [0.65-1.87] vs 0.85 ng/ml [0.54-1.40]; P <0.001), but no differences were observed in men (0.97 ng/ml [0.59-1.61] vs 0.90 ng/ml [0.56-1.60], respectively; P = 0.5). In women, there was a stronger association between the number of components of MS and increased plasma visfatin/NAMPT levels than in men. CONCLUSIONS: Plasma visfatin/NAMPT levels are increased only in elderly women with MS. It is difficult to distinguish the components of MS specifically associated wit h increased visfatin/NAMPT levels.

Inflammation but not obesity or insulin resistance is associated with increased plasma fibroblast growth factor 23 concentration in the elderly.

BACKGROUND: Fibroblast growth factor 23 (FGF23) is a hormone involved in calcium-phosphate homoeostasis. The data of recently published studies suggest that FGF-23 may also play a role in some metabolic processes beyond mineral metabolism, such as insulin resistance or energy homoeostasis. The aim of the study was to attempt the relationships between plasma cFGF-23 (C-terminal) and iFGF-23 (intact) concentrations and the occurrence of obesity, insulin resistance and inflammation in elderly population. MATERIALS AND METHODS: The analysis included 3115 elderly subjects (1485 women). During three visits, a questionnaire survey, comprehensive geriatric assessment and anthropometric measurements were performed as well as blood and urine samples were collected by trained nurses. Serum phosphorus, calcium, intact parathormone (iPTH), 25(OH)D3 , iFGF-23 and cFGF-23, insulin, glucose, albumin (also in urine), creatinine, hs-CRP, interleukin-6 and NT-proBNP concentrations were assessed. HOMA-IR was calculated according to the standard formula. RESULTS: Both forms of FGF23, iPTH and 25-OH-D3 levels were not related to the occurrence of obesity and insulin resistance. Increase in phosphorus, iPTH and NT-proBNP concentrations is associated with rise in plasma iFGF23 and cFGF23 levels. Additionally, increase in hs-CRP explained the elevated plasma iFGF23 levels. In multiple regression models, circulating iFGF23 and cFGF23 level's variability in elderly population were explained by changes in serum phosphorus, iPTH, eGFR, hs-CRP and NT-proBNP levels but not by BMI and HOMA-IR values. CONCLUSION: In conclusion, our study shows that increased levels of both circulating Fibroblast growth factor 23 forms in elderly subjects are associated with inflammation but not obesity or insulin resistance per se.

Plasma fibroblast growth factor 23 concentration and iron status. Does the relationship exist in the elderly population?

OBJECTIVE: Fibroblast growth factor 23 (FGF23) is a phosphaturic agent involved in calcium-phosphate homeostasis. Recent findings show that iron deficiency and inflammation regulate FGF23 release and/or biodegradation. Iron deficiency is frequently observed in the elderly, therefore the aim of this study was to find out if iron deficiency is independent from low grade inflammatory factors affecting both forms of FGF23 that are detectable in circulation in a large population-based study of elderly subjects. DESIGN AND METHODS: The analysis included 3780 elderly (1798 females) PolSenior study participants and assessed levels of phosphorus, calcium, iron, ferritin, interleukin 6, C-reactive protein (hs-CRP), intact (iFGF23), and c-terminal FGF (cFGF23). The analysis was performed for all subjects and terciles of serum iron levels in relation to hs-CRP were calculated. RESULTS: The highest plasma cFGF23 and iFGF23 concentrations were found in subjects with the lowest serum iron levels (p<0.001). The effect of low grade inflammation was markedly weaker and affected only iFGF23 levels. The adjusted serum levels of hs-CRP, iPTH, phosphorus, and 25-(OH)-D3 analysis revealed that plasma iFGF23 and cFGF23 levels were almost unchanged up to a serum iron level of 59.3 ng/mL and 57.3 ng/mL respectively and then were nearly linearly increasing by 0.285 pg/mL and 3.742 RU/mL for each unit of serum iron increase. CONCLUSIONS: Low iron levels are associated with increased levels of both cFGF23 and iFGF23, independent of low grade inflammation. A similar analysis of cFGF23 and iFGF23 does not suggest enhanced biodegradation of iFGF23 induced by iron deficiency.

Paraoxonase 1 activity and level of antibodies directed against oxidized low density lipoproteins in a group of an elderly population in Poland - PolSenior study.

UNLABELLED: The aim of this study was to assess two factors influencing the amount of oxidized LDL-paraoxonase 1 (PON1) activity and the level of anti-oxidized LDL antibodies (anti-ox LDL) in a large group of elderly individuals in Poland. The effects of cognitive status, hypertension and metabolic syndrome and of selected serum lipids and inflammation indicators on PON1 activity and anti-ox LDL level were also examined. The investigated population consisted of 3154 individuals aged 65 and more - participants of the population-based PolSenior project. PON1 arylesterase activity was determined spectrophotometrically, anti-ox-LDL antibodies using ELISA method. PON1 activity significantly decreased with advancing age, was lower in males than in females and decreased in persons with impaired cognition. Individuals with hypertension and high lipid levels showed higher PON1 activity. Lower PON1 activity was related to higher level of inflammation indicators - hsCRP and IL-6. The significant association of PON1 activity with age, HDL-C, LDL-C, sex and IL-6 was confirmed in multivariate analysis. Anti-ox LDL antibodies level was significantly higher in the two oldest subgroups of males. It was significantly lower in males than in females. It was decreased in persons with higher serum triglycerides. No relationship of anti-ox LDL level with cognition, hypertension, metabolic syndrome, inflammation indicators and serum lipid levels was observed. In some persons very high levels of anti-ox LDL were stated, most frequently in the oldest persons, particularly in men. CONCLUSION: Both investigated antioxidant factors - PON1 activity and anti-ox LDL level, could play an important role in aging.

Differential associations of inflammatory and endothelial biomarkers with disease activity in rheumatoid arthritis of short duration.

OBJECTIVES: To estimate endothelial dysfunction in patients with rheumatoid arthritis (RA) of short duration in relation to disease activity based on the assessment of 28 joints (DAS28). METHODS: We studied 29 patients (22 women, mean age 41 (SD, 9) years) with RA of short duration and 29 healthy controls. The RA subjects were divided into those with low (DAS28: 2.6-5.1, n = 18) or high (DAS28 > 5.1, n = 11) disease activity. Exclusion criteria included clinically overt atherosclerosis and other coexistent diseases. Biochemical markers of inflammatory activation and endothelial dysfunction were measured. RESULTS: There were no significant intergroup differences in the majority of classical cardiovascular risk factors. High-sensitivity C-reactive protein, tumor necrosis factor- α , and interleukin-6 were increased in RA subjects. Compared to the controls, levels of soluble vascular cell adhesion molecule-1, von Willebrand factor, and pentraxin-3 were significantly elevated in RA subjects with low disease activity, exhibiting no further significant rises in those with high disease activity. Asymmetric dimethyl-L-arginine, soluble E-selectin, monocyte chemotactic protein-1, and osteoprotegerin were increased only in RA patients with high disease activity. CONCLUSIONS: Our findings might suggest a dissociation of pathways governing generalized and joint-specific inflammatory reactions from those involved in endothelial activation and inflammation within the vascular wall.

25-hydroxyvitamin D and physical and cognitive performance in older people with chronic conditions.

INTRODUCTION: Recently, the relationship between vitamin D deficiency and various pathologies as well as functional decline has been reported. OBJECTIVES: The aim of the study was to assess the relationship between 25-hydroxyvitamin D, 25(OH)D, levels and functional status in elderly patients. PATIENTS AND METHODS: Mean age of 140 participants (women, 67.1%) was 79.64 ±6.99 years. The study had a cross­sectional design. Physical performance was measured using the handgrip strength, Timed Up and Go, single-leg stance, and tandem stance tests, as well as a balance platform. Cognition was evaluated with the Abbreviated Mental Test Score (AMTS), while functional status with the Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales. Plasma 25(OH)D levels were measured. RESULTS: Less able patients (worse results in all tests) had significantly lower 25(OH)D levels. Subjects with 25(OH)D levels within the 3rd tertile had a higher AMTS score and handgrip strength; they swayed less on the balance platform and performed better in the IADL. In multivariate logistic regression analysis, 25(OH)D levels of 23.26-47.75 nmol/l were associated with increased odds of cognitive impairment (odds ratio [OR], 3.17; 95% confidence interval [CI], 1.04-9.68; P = 0.04), but also with less lateral sway (OR, 0.24; 95% CI, 0.09-0.64; P = 0.005). Plasma 25(OH)D levels above 47.75 nmol/l were associated with better performance in the tandem stance test (OR, 0.14; 95% CI, 0.04-0.52; P = 0.003) and further decreased lateral sway (OR, 0.27; 95% CI, 0.10-0.77; P = 0.01). CONCLUSIONS: In elderly people with comorbid conditions, 25(OH)D levels were not associated with handgrip strength, but were associated with balance and cognitive function. These associations as well as high prevalence of vitamin D deficiency necessitate further research evaluating the effect of vitamin D supplementation on the functional status in elderly people.

Antioxidative protection in hypertensive patients treated with diuretics.

BACKGROUND: Recently results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) showed that a thiazide diuretic was unsurpassed by any other drug class studied in achieving the level of cardiovascular protection, a finding reflected in the recent Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC7) recommendations. Oxidative stress has been found to be one of the key players in the pathophysiology of cardiovascular disease at large. The objective of this study was to check the hypothesis that diuretics may favorably affect the oxidative status of plasma, which could account in part for the results of recent trials. METHODS: In addition to the routine workup in a series of 39 medically treated hypertensive patients, we analyzed the level of antioxidative protection afforded by the ferric-reducing ability of plasma (FRAP), according to class of drug used. RESULTS: We found that patients taking diuretics had significantly better antioxidative protection expressed by the higher levels of FRAP. Although the limited number of patients did not allow us to exclude the influence of other variables in the multiple regression analysis, we did not observe any differences in the level of FRAP when the group was divided according to the other drug classes, gender (men versus women), smoking, diabetes mellitus, duration of treatment, concomitant therapy, or level of uric acid. CONCLUSIONS: The use of thiazide diuretics seems to be associated with better antioxidative protection. This observation may add to the explanation of the results of recent trials in hypertension.

Walking speed in elderly patients undergoing rehabilitation after hip replacement.

Background. Our study was undertaken to assess the impact of a structured rehabilitation regimen on walking speed in frail elderly patients recovering from hip replacement surgery, as well as to determine whether regular use of a pedal exerciser combined with multi-sensory training can increase this parameter. Material and methods. The study lasted 12 weeks and involved 52 subjects, randomly divided into two groups. Group I included 36 persons (22 women, 14 maen, mean age 74 years), while Group II, the controls, consisted of 16 individuals (10 women, 6 men, mean age 72 years). Group I was given an intensive rehabilitation regimen that included multi-sensory training and a pedal exercise routine, while Group II had a variety of exercises and brisk walking. Walking speed was measured over a distance of 10 meters. Results. Upon conclusion of the program, statistically significant (p<0.05) improvement was noted in Group I (mean normal walking speed 0.94m/s vs. 1.17m/s, and mean fast walking sped 1.37m/s vs. 1.49m/s), whereas none of the results in the control group proved to be statistically significant. Conclusions. A weekly, 150-min.-long physical rehabilitation routine comprised of resistance exercises on a pedal exerciser combined with multi-sensory training is very useful in improving significantly both the normal and fast walking speed in the frail elderly after hip replacement surgery.

Evaluating the risk of falls and the possibility of standing back up after a fall in patients recovering from orthopedic surgery of the hip.

Background. The incidence of falls among the elderly is widely recognized to have serious medical and economic consequences. The present study aimed to assess the risk of falls and the individual's ability to cope afterwards in geriatric patients who had undergone hip replacement surgery. Materials and methods. In the period 2000-2003 we examined 50 patients (39 women, 11 men; age range 65-83 years). The potential risk of falls and the individual's ability to cope afterwards was assessed twice, 6 and 12 months after hip replacement surgery, using the Pilet and Swine method, in conjunction with the Berg test. Results. Within 6 months of surgery, the risk of fall remained the highest during postural shifts (e. g. from a sitting to a fully upright position, climbing stairs) in 64% of the patients, whereas in 52% the greatest risk occurred while lifting objects off the floor and turning around. Within the same period, 86% found it impossible to pull themselves upright after a fall when lying face-down, and 78% when kneeling on one knee. Within a year, the risk of fall remained the same, whereas regaining a fully upright position when lying face-down was found to be impossible for 64%, and when kneeling on one knee only, for 60% of our patients.