Gait disorders are associated with non-cardiovascular falls in elderly people: a preliminary study.

BACKGROUND: The association between unexplained falls and cardiovascular causes is increasingly recognized. Neurally mediated cardiovascular disorders and hypotensive syndromes are found in almost 20 percent of the patients with unexplained falls. However, the approach to these patients remains unclear. Gait assessment might be an interesting approach to these patients as clinical observations suggests that those with cardiovascular or hypotensive causes may not manifest obvious gait alterations. Our primary objective is to analyze the association between gait disorders and a non-cardiovascular cause of falls in patients with unexplained falls. A second objective is to test the sensitivity and specificity of a gait assessment approach for detecting non-cardiovascular causes when compared with intrinsic-extrinsic classification. METHODS: Cross-sectional study performed in a falls clinic at a university hospital in 41 ambulatory elderly participants with unexplained falls. Neurally mediated cardiovascular conditions, neurological diseases, gait and balance problems were assessed. Gait disorder was defined as a gait velocity < 0.8 m/s or Tinetti Gait Score < 9. An attributable etiology of the fall was determined in each participant. Comparisons between the gait assessment approach and the attributable etiology regarding a neurally mediated cardiovascular cause were performed. Fisher exact test was used to test the association hypothesis. Sensitivity and specificity of gait assessment approach and intrinsic-extrinsic classification to detect a non-cardiovascular mediated fall was calculated with 95% confidence intervals (CI95%). RESULTS: A cardiovascular etiology (orthostatic and postprandial hypotension, vasovagal syndrome and carotid sinus hypersensitivity) was identified in 14% of participants (6/41). Of 35 patients with a gait disorder, 34 had a non-cardiovascular etiology of fall; whereas in 5 out of 6 patients without a gait disorder, a cardiovascular diagnosis was identified (p < 0.001). Sensitivity and specificity of the presence of gait disorder for identifying a non-cardiovascular mediated cause was 97.1% (CI95% = 85-99) and 83% (CI95% = 36-99), respectively. CONCLUSION: In community dwelling older persons with unexplained falls, gait disorders were associated with non-cardiovascular diagnosis of falls. Gait assessment was a useful approach for the detection of a non-cardiovascular mediated cause of falls, providing additional value to this assessment.

Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older.

PURPOSE: Although gait velocity (GV) measurement could predict poor outcomes, few studies regarding its usefulness as a single test in well functioning elderly persons have been pursued. The aim of this study was to asses whether GV could be sufficient to predict adverse events such as hospitalization for any cause, requirement for a caregiver, nursing home placement, falls, fractures, or death in healthy elderly persons. METHODS: Ours was a cohort study comprising 102 well functioning participants aged 75 and older. Demographic features, health status, and functional capacity were assessed at baseline and followed for adverse outcomes. Measurements included evaluation of cognition, activities of daily living, and mobility. The time required to walk the middle 8 meters of 10 meters was defined as GV. Three GV groups were distinguished: high GV (>1.1 m/s), median GV (1-0.7 m/s), and low GV (<0.7 m/s). RESULTS: At baseline, the three groups were comparable in their health status with an average age of 79.6 +/- 4 years. At 24 months, the low GV group had a significantly higher incidence of adverse events than did the other groups. Low GV was a predictor of hospitalization (relative risk [RR] = 5.9, 95% confidence interval [CI], 1.9-8.5), requirement of a caregiver (RR = 9.5, 95% CI, 1.3-2.5), and new falls (RR = 5.4, 95% CI, 2.0-4.3). These associations remained significant after a multiple logistic regression analysis. CONCLUSIONS: GV measurement in the ambulatory setting may allow the detection of healthy elderly people at risk for adverse events. These data may suggest that simple assessment of GV is enough to predict adverse events in well functioning older persons.

Is collectionism a diagnostic clue for Diogenes syndrome?

BACKGROUND: Diogenes syndrome (DS) is characterized by extreme self-neglect, domestic squalor, and social withdrawal. Despite having been described decades ago, it is still difficult to persue a correct diagnosis in primary care clinics. METHODS: This paper reports a case of an elderly man with extreme self neglect and an abnormal collecting pattern whose condition remained undetected for many years. His collectionism was manifested with a tendency to store items in an organized manner but without a clear purpose. CONCLUSION: The authors suggest that the presence of collectionism could be a helpful clue towards diagnosis of DS in similar cases.

Health care for older persons in Argentina: a country profile.

Argentina is a large country situated at the southern end of the Americas. It is highly urbanized, and almost one-third of the population lives in the capital city and its surrounding area (Buenos Aires). The population is composed of heterogeneous groups, formed primarily by descendants of European immigration who constitute 85% of the inhabitants. In the last 30 years, Argentina has witnessed a growth in the elderly population from less than 7% to nearly 10% of the total population. Additionally, in Buenos Aires City, more than 17% are aged 65 or older. The healthcare systems for the elderly lack nationwide coverage. The Programa de Atención Médica Integral (PAMI) is the largest program for elderly care. It is a state-run program for disabled and senior citizens. PAMI serves 65% of the approximately 3.6 million older people in Argentina. The quality of PAMI healthcare delivery has decreased in the last 2 decades and has largely declined since the Argentinean economic crisis of late 2001. The rehabilitation and long-term care services are relatively underdeveloped, and fewer than 2% of senior citizens live in residential or nursing homes. Recently, the government has proposed a system of care built up from the primary care resources of the community.

[Polymyalgia rheumatica revisited]. / Actualización en polimialgia reumática.

Polymyalgia rheumatica is an inflammatory disorder that usually affects persons over the age of 50 causing proximal muscle pain and stiffness, and an elevated erythrocyte sedimentation rate. Although increasingly recognized in this age group, it remains a diagnosis of exclusion and although several diagnostic criteria have been proposed, none has been clearly accepted. While polymyalgia rheumatica is associated with giant cell arteritis, obtaining a temporal artery biopsy is not recommended in patients with polymyalgia rheumatica without symptoms of giant cell arteritis. Early diagnosis and low dose corticosteroid therapy improve patients' clinical features and functional status. Treatment usually lasts between 12 and 24 months and the majority of patients manage to discontinue treatment completely.

Actualizacion en polimialgia reumática / Polymyalgia rheumatica revisited

Polymyalgia rheumatica is an inflammatory disorder that usually affects persons over the age of 50 causing proximal muscle pain and stiffness, and an elevated erythrocyte sedimentation rate. Although increasingly recognized in this age group, it remains a diagnosis of exclusion and although several diagnostic criteria have been proposed, none has been clearly accepted. While polymyalgia rheumatica is associated with giant cell arteritis, obtaining a temporal artery biopsy is not recommended in patients with polymyalgia rheumatica without symptoms of giant cell arteritis. Early diagnosis and low dose corticosteroid therapy improve patients clinical features and functional status. Treatment usually lasts between 12 and 24 months and the majority of patients manage to discontinue treatment completely (AU)

Actualizacion en polimialgia reumática / Polymyalgia rheumatica revisited

Polymyalgia rheumatica is an inflammatory disorder that usually affects persons over the age of 50 causing proximal muscle pain and stiffness, and an elevated erythrocyte sedimentation rate. Although increasingly recognized in this age group, it remains a diagnosis of exclusion and although several diagnostic criteria have been proposed, none has been clearly accepted. While polymyalgia rheumatica is associated with giant cell arteritis, obtaining a temporal artery biopsy is not recommended in patients with polymyalgia rheumatica without symptoms of giant cell arteritis. Early diagnosis and low dose corticosteroid therapy improve patients' clinical features and functional status. Treatment usually lasts between 12 and 24 months and the majority of patients manage to discontinue treatment completely

Actualización en polimialgia reumática. / [Polymyalgia rheumatica revisited]

Polymyalgia rheumatica is an inflammatory disorder that usually affects persons over the age of 50 causing proximal muscle pain and stiffness, and an elevated erythrocyte sedimentation rate. Although increasingly recognized in this age group, it remains a diagnosis of exclusion and although several diagnostic criteria have been proposed, none has been clearly accepted. While polymyalgia rheumatica is associated with giant cell arteritis, obtaining a temporal artery biopsy is not recommended in patients with polymyalgia rheumatica without symptoms of giant cell arteritis. Early diagnosis and low dose corticosteroid therapy improve patients clinical features and functional status. Treatment usually lasts between 12 and 24 months and the majority of patients manage to discontinue treatment completely.

Epidemiologia del delirio en ancianos hospitalizados / Epidemiology of delirium in enderly inpatients

El objetivo fue determinar la incidencia de delirio y sus factores de riesgo en una cohorte de ancianos internados. Se seleccionaron al azar 249 ancianos sin delirium al ingreso a 2 salas de internación general, entre junio y septiembre de 1995. Fueron evaluados diariamente con el Confusion Assessment Method (CAM), validado para diagnostico de delirio. Se obtuvieron los riesgos relativos para la asociación de delirio con algunas variables clínicas; aquellas independientemente asociadas fueron incluidas en un modelo de regresión logística. Se utilizaron Chi-cuadrado con la corrección de Yates para análisis univariado y T-test para la comparación de medias. Se observó que el 20, 5 por ciento (IC95 por ciento 18.9-22.3) desarrolló delirio. La gravedad de la enfermedad (RR 1.28, 133-2.56), las enfermedades crónicas (RR 3.45, 2.4-4.96) y la fiebre (RR 1.84, 1.33-2.56) se encontraron independientemente asociados al desarrollo de delirio. Estos pacientes con delirio presentaron internaciones más prolongadas (9.87 días +/- 3.48 vs 6.95 días +/- 2.45, p < 0.05), mayor riesgo de derivación a centros de tercer nivel (OR = 16.2 IC95 por ciento 4.5-25.3) y mayor mortalidad (RR 2.19, IC 95 por ciento 1.26-3.79). Se concluye que el delirio es frecuente y tiene impacto negativo en la utilización de recursos como la estadía hospitalaria y la utilización de instituciones de cuidados crónicos, así como también en la mortalidad. Varias características se asociaron al mismo, siendo novedosa la severidad de la enfermedad. Es posible identificar prospectivamente a pacientes en riesgo, para implementar estrategias que minimicen su impacto. (Au)