Factors associated with unrecovered falls among older adults.

This cross-sectional exploratory study investigated factors associated with unrecovered falls among older patients with a history of falls in the previous year participating in a clinical trial on fall prevention by asking them about their inability to get up independently after the fall. Participants' sociodemographic, clinical, functional (ADL/IADL, TUG, chair-stand test, hand grip, risk of falling) and fall location were investigated. We conducted a multivariate regression analysis adjusted for covariates to identify the main factors associated with unrecovered falls. Out of 715 participants (mean age: 73.4 years; 86% women), 51.6% (95% IC; 47.9 - 55.3%) experienced unrecovered falls. Depressive symptoms, ADL/IADL limitation, mobility limitation, undernutrition, and outdoor falls were associated with unrecovered falls. While assessing the risk of falling, professionals should consider preventive strategies and preparedness procedures for those who are more likely to experience unrecovered falls, such as training to get up from the floor, alarms, and support services.

Changes in postural balance associated with a woman's aging process.

CONTEXT: Aging causes a progressive worsening in postural balance, affecting functional independence and increasing the risk of falls. OBJECTIVE: The aim of the study was to evaluate the effect of aging on the static balance in women from 50-years to 89-years of age. DESIGN: This was a cross-sectional study, with 400 irregularly active women were evaluated and grouped by age: Group 6th decade (age 50 to 59) ‒ 58 participants; Group 7th decade (age 60 to 69) ‒ 214 participants; Group 8th decade (age 70 to 79) ‒ 92 participants; Group 9th decade (age 80 to 89) ‒ 36 participants. Postural balance was evaluated using a portable force platform in a standard standing position, with Eyes Open (EO) and Eyes Closed (EC). RESULTS: In the two measurement conditions, the elderly women in Group 9th decade presented mediolateral displacement and range, and mean velocity greater than the women's values in Groups 6th and 7th decade. In the EO e EC situation, the displacement was higher in the elderly Group 9th decade compared to younger groups. Group 8th has a mean velocity greater than Group 6th decade in the EO situation. CONCLUSIONS: Posturography showed a decline in postural balance with advancing age, suggesting that the 9th decade of life is a borderline age to this detriment due to an increase in postural instability.

Changes in postural balance associated with a woman's aging process

Abstract Context Aging causes a progressive worsening in postural balance, affecting functional independence and increasing the risk of falls. Objective The aim of the study was to evaluate the effect of aging on the static balance in women from 50-years to 89-years of age. Design This was a cross-sectional study, with 400 irregularly active women were evaluated and grouped by age: Group 6thdecade (age 50 to 59) ‒ 58 participants; Group 7thdecade (age 60 to 69) ‒ 214 participants; Group 8thdecade (age 70 to 79) ‒ 92 participants; Group 9thdecade (age 80 to 89) ‒ 36 participants. Postural balance was evaluated using a portable force platform in a standard standing position, with Eyes Open (EO) and Eyes Closed (EC). Results In the two measurement conditions, the elderly women in Group 9thdecade presented mediolateral displacement and range, and mean velocity greater than the women's values in Groups 6thand 7thdecade. In the EO e EC situation, the displacement was higher in the elderly Group 9thdecade compared to younger groups. Group 8thhas a mean velocity greater than Group 6thdecade in the EO situation. Conclusions Posturography showed a decline in postural balance with advancing age, suggesting that the 9thdecade of life is a borderline age to this detriment due to an increase in postural instability.

Older adults' views on barriers and facilitators to participate in a multifactorial falls prevention program: Results from Prevquedas Brasil.

OBJECTIVES: To understand the reasons older people engage in a multifactorial fall prevention program and, to identify the barriers and facilitators for adherence. METHODS: Cross-sectional study, with 218 older adults from the intervention group of a 12-week multifactorial fall prevention program (Prevquedas Brazil). We interviewed participants using a semi-structured questionnaire concerning reasons to engage in, barriers, and facilitators to participating in the program. We compared participants with low (0-5 sessions) and moderate/high (6-12 sessions) adherence regarding barriers and facilitators. RESULTS: Physical and mental health problems (55 %), and competing demands (45.2 %) were the most frequent barriers reported. Pleasant environment (97.7 %), a sense of receiving proper care (96.7 %), and empathy with the team (96.7 %) were the main facilitators. Seven out of the twelve facilitators distinguished participants with high adherence from those with low adherence. Only the barriers related to the program characteristics and the lack of social support were able to identify participants with low adherence. Open-ended questions revealed that self-determination, commitment, and the desire of being physically active and fit promoted participation. Anticipated health benefits and functional gains, a need to take action due to fall consequences, and encouragement from others were among the reasons to engage in the program. CONCLUSION: Although barriers should not be neglected, facilitators are critically important for adherence. Health professionals may develop skills to facilitate uptake and optimize older adults' participation. Implementing sustainable fall prevention programs in low and middle-income countries requires overcoming the fragmentation and inflexibility of healthcare services.

IMPACT OF DIABETIC NEUROPATHY ON QUALITY OF LIFE AND POSTURAL BALANCE IN BRAZILIAN OLDER ADULTS.

OBJECTIVE: To analyze the impact of the Peripheral Diabetic Neuropathy (PDN) on the postural and functional balance and quality of life of Brazilian older adults. METHODS: A cross-sectional study. Sixty older men and women (60-79 years) were divided into three groups: control, DM without and with PDN. The following parameters were evaluated: anthropometry; quality of life; postural balance (BESTest); functional balance in force plate (NeuroCom Balance). RESULTS: PDN group presented significant differences compared with the other groups, with the worst performance in quality of life than DM2 without PDN in: sensory functioning (p = 0.030); past and future (p = 0.036); death and dying (p = 0.035). Postural balance deficit in the total score (p = 0.025) and biomedical constraints section (p = 0.043) of the BESTest, compared with DM2 without PDN (p = 0.007). In the functional balance (Neurocom), PDN group presented a worse performance in the time spent on the left side (p = 0.030) than the control group. During step up over test, the control group performed the task faster than the group with PDN (p = 0.004). CONCLUSION: This study showed that neuropaths presented worse physical performance and postural balance deficits, sensorial limitations, affecting the daily tasks and, as a consequence, decreasing the quality of life in Brazilian older adults. Level of Evidence II, Cross-sectional observational study.

OBJETIVO: Analisar a influência da neuropatia diabética periférica (NDP) no equilíbrio postural, atividades funcionais e na qualidade de vida em idosos. MÉTODOS: Estudo transversal. Avaliamos 60 homens e mulheres idosos (60-79 anos) divididos em três grupos: controle, DM sem e com NDP. Foram avaliados: antropometria; qualidade de vida; equilíbrio postural (BESTest); atividades funcionais pelo equilíbrio funcional na placa de força (NeuroCom Balance). RESULTADOS: Grupo NDP apresentou diferenças comparado a outros grupos, pior desempenho na qualidade de vida que o DM2 sem NDP em: funcionamento sensorial (p = 0,030); passado e futuro (p = 0,036); morte e morrer (p = 0,035). Déficit de equilíbrio postural no escore total (p = 0,025) e seção de restrições biomédicas (p = 0,043) do BESTest comparado ao DM2 sem NDP (p = 0,007). No equilíbrio funcional (Neurocom), o grupo NDP apresentou pior desempenho no tempo gasto no lado esquerdo (p = 0,030) comparado ao grupo controle. Durante a etapa de teste, o grupo controle executou a tarefa mais rapidamente que o grupo NDP (p = 0,004). CONCLUSÃO: Neuropatas apresentaram pior desempenho físico e déficits no equilíbrio postural, limitações sensoriais, afetando as tarefas diárias da doença e, consequentemente, diminuição da qualidade de vida em idosos brasileiros. Nível de Evidência II, Estudo observacional transversal.

Moderate levels of physical fitness maintain telomere length in non-senescent T CD8+ cells of aged men.

OBJECTIVES: Immunosenescence is an age-associated change characterized by a decreased immune response. Although physical activity has been described as fundamental for maintaining the quality of life, few studies have evaluated the effects of different levels of exercise on telomere length in aged populations. The present study aimed to analyze the effects of different levels of physical activity, classified by the Maximal oxygen consumption (VO2 max) values, on the telomere length of memory Cluster of differentiation (CD) CD4+(CD45ROneg and CD45RO+), effector CD8+CD28neg, and CD8+CD28+ T cells in aged individuals. METHODS: Fifty-three healthy elderly men (aged 65-85 years) were included in this study. Their fitness level was classified according to the American College of Sports Medicine (ACSM) for VO2 max (mL/kg/min). Blood samples were obtained from all participants to analyze the percentage of CD3, CD4, CD8, CD28+, naïve, and subpopulations of memory T cells by using flow cytometry. Furthermore, using the Flow-FISH methodology, the CD4+CD45RO+, CD4+CD45ROneg, CD8+CD28+, and CD8+CD28negT cell telomere lengths were measured. RESULTS: There was a greater proportion of effector memory T CD4+ cells and longer telomeres in CD8+CD28+ T cells in the moderate physical fitness group than in the other groups. There was a higher proportion of terminally differentiated memory effector T cells in the low physical fitness group. CONCLUSION: A moderate physical activity may positively influence the telomere shortening of CD28+CD8+T cells. However, additional studies are necessary to evaluate the importance of this finding with regard to immune function responses in older men.

RELATIONSHIP OF FORCE PLATFORM WITH THE CLINICAL BALANCE EVALUATION SYSTEMS TEST IN OLDER ADULTS.

The aging process can alter the organization of postural control causing instability; literature shows several equipment and clinical tests whose purpose is to measure postural balance, involving different protocols and methodologies. OBJECTIVE: To evaluate postural balance during the task to walk over the force platform (turn and return) and its relationship with clinic balance test (BESTest) in older adults. METHODS: 60 older people of both sexes, aged 60 to 79 years, were tested in the force platform (NeuroCom Balance) and BESTest to evaluate postural balance. RESULTS: negative correlations were found when comparing domains of the clinical test with stabilometric parameters in time and velocity variables of the tests Step/Quick turn. The highest correlations were in the total score (time spent to perform the task - 0.41, and in the velocity left side - 0.33/right side - 0.43), as well as in the stability limit (time spent to perform the task left side - 0.34/right side - 0.37, and the equilibrium velocity left side - 0.37/right side - 0.43). CONCLUSION: There are slim correlations between the clinical test and force platform variables, showing that each test measures different parameters. Level of evidence II, Diagnostic study - investigating a diagnostic test.

O processo de envelhecimento pode alterar a organização do controle postural causando instabilidade. Na literatura há vários equipamentos e testes, envolvendo protocolos e metodologias diversas, com a finalidade de mensurar o equilíbrio corporal. OBJETIVO: Avaliar o equilíbrio postural e analisar a correlação entre os dados da plataforma de equilíbrio e do teste clínico (BESTest) em idosos. MÉTODOS: Foram avaliados 60 idosos de ambos os sexos, com idade de 60 a 79 anos. Para avaliação do equilíbrio postural foi utilizada a plataforma de força (NeuroCom Balance) e o BESTest. RESULTADOS: Correlações negativas foram encontradas quando comparados os domínios do teste clínico (BESTest) com parâmetros estabiliométricos nas variáveis tempo, velocidade e impacto dos testes Step/Quick turn. As maiores correlações foram no score total (tempo gasto para realizar a tarefa LE − 0,41, e na velocidade do equilíbrio LE − 0,33/LD − 0,43), assim como no limite de estabilidade (tempo gasto para realizar a tarefa LE − 0,34/LD − 0,37, e a velocidade do equilíbrio LE − 0,37/LD − 0,43). CONCLUSÃO: Há poucas e fracas correlações entre o teste clínico e as variáveis do teste Step/Quick turn da plataforma de força, mostrando que cada teste mede parâmetros diferentes. Nível de Evidência II, Estudos diagnósticos - investigação de exames para diagnóstico.

EVALUATION OF PREDICTIVE FACTORS OF IN HOSPITAL MORTALITY IN PATIENTS WITH PROXIMAL FEMORAL FRACTURE.

OBJECTIVE: To investigate the existence of a causal association between orthopedic treatment and the occurrence of in hospital death. METHODS: 338 patients with proximal femoral fracture were evaluated, of whom 27 faced in hospital death. Patients who faced in hospital death (case group) were compared to patients who did not (control group) regarding exposure to risk factors prior to injury and factors related to orthopedic treatment. RESULTS: The factors related to higher in hospital mortality rate were: male sex (case group: 52%, control: 26%; p = 0.005), lower Parker's score (case group: 5.0 points, control: 6.2; p = 0.048), delirium on admission (case group: 26%, control: 10%; p = 0.011); delirium developed during hospitalization (case group: 77%, control: 35%; p <0.001), and time until surgery (13.3 days, 9.1; p = 0.049). CONCLUSION: The in hospital mortality rate of patients with proximal femoral fracture was 8%, and the main associated risk factors were male sex, reduced Parker's score, delirium diagnosed on hospital admission or developed during hospitalization, and time until surgery. Level of Evidence III, Case control study.

OBJETIVO: Pesquisar a existência de associação causal entre fatores do tratamento ortopédico e a ocorrência de morte intra-hospitalar. MÉTODOS: Foram avaliados 338 pacientes com fratura proximal do fêmur, dos quais 27 apresentaram óbito intra-hospitalar. Compararam-se pacientes que apresentaram óbito intra-hospitalar (grupo caso) com pacientes que não apresentaram óbito hospitalar (grupo controle) quanto à exposição a fatores de risco prévios à lesão e fatores relacionados ao tratamento ortopédico. RESULTADOS: Os fatores relacionados a uma maior taxa de mortalidade intra-hospitalar foram: gênero masculino (grupo caso: 52%; controle: 26%; p = 0,005), menor escore de Parker (grupo caso: 5,0 pontos; controle: 6,2 pontos; p = 0,048), delirium na admissão (grupo caso: 26%; controle: 10%; p = 0,011); delirium desenvolvido durante a internação (grupo caso: 77%; controle: 35%; p < 0,001), e tempo até a cirurgia (13,3 dias vs. 9,1 dias; p = 0,049). CONCLUSÃO: No presente estudo, a taxa de mortalidade intra-hospitalar em pacientes com fratura proximal do fêmur foi de 8%, e os principais fatores de risco associados a esse desfecho foram o gênero masculino, escore de Parker reduzido, delirium diagnosticado na admissão hospitalar ou desenvolvido durante a internação, e tempo até a cirurgia. Nível de Evidência III, Estudo caso controle.

Moderate levels of physical fitness maintain telomere length in non-senescent T CD8+ cells of aged men

OBJECTIVES: Immunosenescence is an age-associated change characterized by a decreased immune response. Although physical activity has been described as fundamental for maintaining the quality of life, few studies have evaluated the effects of different levels of exercise on telomere length in aged populations. The present study aimed to analyze the effects of different levels of physical activity, classified by the Maximal oxygen consumption (VO2 max) values, on the telomere length of memory Cluster of differentiation (CD) CD4+(CD45ROneg and CD45RO+), effector CD8+CD28neg, and CD8+CD28+ T cells in aged individuals. METHODS: Fifty-three healthy elderly men (aged 65-85 years) were included in this study. Their fitness level was classified according to the American College of Sports Medicine (ACSM) for VO2 max (mL/kg/min). Blood samples were obtained from all participants to analyze the percentage of CD3, CD4, CD8, CD28+, naïve, and subpopulations of memory T cells by using flow cytometry. Furthermore, using the Flow-FISH methodology, the CD4+CD45RO+, CD4+CD45ROneg, CD8+CD28+, and CD8+CD28negT cell telomere lengths were measured. RESULTS: There was a greater proportion of effector memory T CD4+ cells and longer telomeres in CD8+CD28+ T cells in the moderate physical fitness group than in the other groups. There was a higher proportion of terminally differentiated memory effector T cells in the low physical fitness group. CONCLUSION: A moderate physical activity may positively influence the telomere shortening of CD28+CD8+T cells. However, additional studies are necessary to evaluate the importance of this finding with regard to immune function responses in older men.