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1.
Clin Interv Aging ; 16: 1617-1629, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34531652

RESUMO

Introduction: Exercise and nutrition are the best targets to tackle mobility issues in community-dwelling older adults. As exercise response relies on multiple factors, improving the understanding of their interactions is a necessity to tailor effective preventive strategies. Based on a prevention care path designed for community-dwelling older adults with mobility disability risk, our main goal was to determine the predictive factors of the response to a multimodal intervention, combining structured exercise training and nutritional counselling. Thus, this study aimed to tailor prevention programs for non-responder participants. Methods: We analyzed the response of participants to a prevention program and built a multivariate predictive model to highlight the profile of the best responders. The model was based on the likelihood of at least 1 point of short physical performance battery (SPPB) score gain. Inclusion criteria were being aged ≥70 years and having completed a multicomponent group-based supervised training consisting of 20 sessions (10 weeks). Results: A total of 103 participants were included, their mean ± SD age was 81.9 ± 5.7 years. The model demonstrated interactions between baseline SPPB score (OR=0.42; p < 0.001), body mass index (BMI; OR=0.82; p=0.003), and grip strength value (OR=1.15; p=0.008). The highest probability of response was found for participants with low SPPB, normal BMI (21 kg/m2), and high grip strength (27 kg). Conclusion: This study demonstrated that the response to a multimodal intervention in community-dwelling older adults with mobility disability risk was influenced by the baseline SPPB score, BMI, and grip strength value. To increase the proportion of responders, strategies that could be more effective include constituting more homogenous group, and implementing a specific approach for obese sarcopenic older adults and those with low grip strength by increasing the dose of physical activity and monitoring endurance and mobility activities between sessions. Our results provide important consideration for the development of targeted-interventions.

2.
Nutrients ; 13(7)2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34371859

RESUMO

Almost two in three patients who are aged 75 years and older and scheduled for surgery for colorectal cancer (CRC) are undernourished. Despite evidence that perioperative nutritional management can improve patients outcomes, international guidelines are still insufficiently applied in current practice. In this stepped-wedge cluster-randomized study of five surgical hospitals, we included 147 patients aged 70 years or older with scheduled abdominal surgery for CRC between October 2013 and December 2016. In the intervention condition, an outreach team comprising a geriatrician and a dietician visited patients and staff in surgical wards to assist with the correct application of guidelines. Evaluation, diagnosis, and prescription (according to nutritional status) were considered appropriate and strictly consistent with guidelines in 39.2% of patients in the intervention group compared to only 1.4% in the control group (p = 0.0002). Prescription of oral nutritional supplements during the perioperative period was significantly improved (41.9% vs. 4.1%; p < 0.0001). However, there were no benefits of the intervention on surgical complications or adverse events. A possible benefit of hospital stay reduction will need to be confirmed in further studies. This study highlights the importance of the implementation of quality improvement interventions into current practice for the perioperative nutritional management of older patients with CRC.


Assuntos
Avaliação Geriátrica/métodos , Desnutrição/terapia , Terapia Nutricional/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/complicações , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/cirurgia , Suplementos Nutricionais , Feminino , Humanos , Masculino , Desnutrição/complicações , Política Nutricional , Terapia Nutricional/normas , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/normas , Período Pré-Operatório , Melhoria de Qualidade , Resultado do Tratamento
3.
Geriatr Psychol Neuropsychiatr Vieil ; 19(3): 245-252, 2021 Sep 01.
Artigo em Francês | MEDLINE | ID: mdl-34289961

RESUMO

Sarcopenia is defined as a progressive and generalized loss of muscle strength, muscle mass and physical performance with advancing age. Among the multiple consequences of sarcopenia, the reduction in the quality of life associated with it can undeniably be considered as a major consequence. Quality of life is measured via generic or specific questionnaires. Current research, mainly using so-called "generic" questionnaires, identifies a reduced quality of life in patients with primary age-related sarcopenia, mainly in areas related to functional status and physical performance. A specific quality of life questionnaire could, in combination with a generic questionnaire, provide more precise data on the impact that sarcopenia has on the quality of life of patients. It was in 2015 that the first quality of life questionnaire specific to sarcopenia, the SarQoL®, was developed. Psychometric validation of the SarQoL® has been carried out in several international patient populations indicating excellent internal consistency, reliability and convergent validity and sensitivity to change as well as an absence of floor and ceiling effects. In combination with a generic questionnaire, this specific questionnaire is therefore suitable for measuring the quality of life of populations suffering from sarcopenia, both in research and in clinical practice, both in the context of observational or interventional evaluations.

4.
Age Ageing ; 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34185827

RESUMO

BACKGROUND: The Hospital Frailty Risk Score (HFRS) has made it possible internationally to identify subgroups of patients with characteristics of frailty from routinely collected hospital data. OBJECTIVE: To externally validate the HFRS in France. DESIGN: A retrospective analysis of the French medical information database. SETTING: 743 hospitals in Metropolitan France. SUBJECTS: All patients aged 75 years or older hospitalised as an emergency in 2017 (n = 1,042,234). METHODS: The HFRS was calculated for each patient based on the index stay and hospitalisations over the preceding 2 years. Main outcome measures were 30-day in-patient mortality, length of stay (LOS) >10 days and 30-day readmissions. Mixed logistic regression models were used to investigate the association between outcomes and HFRS score. RESULTS: Patients with high HFRS risk were associated with increased risk of mortality and prolonged LOS (adjusted odds ratio [aOR] = 1.38 [1.35-1.42] and 3.27 [3.22-3.32], c-statistics = 0.676 and 0.684, respectively), while it appeared less predictive of readmissions (aOR = 1.00 [0.98-1.02], c-statistic = 0.600). Model calibration was excellent. Restricting the score to data prior to index admission reduced discrimination of HFRS substantially. CONCLUSIONS: HFRS can be used in France to determine risks of 30-day in-patient mortality and prolonged LOS, but not 30-day readmissions. Trial registration: Reference ID on clinicaltrials.gov: ID: NCT03905629.

5.
Geriatr Psychol Neuropsychiatr Vieil ; 19(1): 62-69, 2021 Mar 01.
Artigo em Francês | MEDLINE | ID: mdl-33764302

RESUMO

The increasing elderly population and their overlapping conditions require more specialised care. The difficulties accessing scheduled hospital admission lead to visits to Accident and Emergency Department (A&E), which have a harmful effect on these patients. The Regional Health Agency (ARS) has developed geriatric hotlines in all geriatric sectors. An analysis of the population concerned will allow changes to be made to this system in order to improve the care pathway for the elderly and to better meet the needs of the general practitioners. This was a descriptive, retrospective, monocentric epidemiological study conducted from February to July 2017. The applicant, reason for the call, the general practioner's request, the demographic and geriatric characteristics of the patients, the response provided were described. The calls were mainly made by the general practitioners, in 72.8% of the cases, for acute conditions. Access to hospital admission accounted for 69.6% of the requests, a home assessment, 16 %. Fifty-five per cent of the patients were admitted to hospital, 75 % of them directly in geriatrics. Twenty-one per cent of the requests for hospital admission received other treatment. The average age was 86 years, with a majority of patients being poly-medicated, having multiple pathologies and also more neurocognitive disorders than the general population. Guidance is provided in 30 % of the calls, improving the care pathway of these elderly patients. The time to response and to hospital admission is short, thus favouring direct access to hospital departments. The main independent risk factor for hospital admission was the presence of acute illness. This community-hospital link seems to answer the principal request of GPs, i.e. hospitalization in acute condition. It is beneficial for the management of these patient at risk of decompensation. Coordination and communication between the different community-hospital players must continue to develop to improve the care pathway of these complex geriatric patients.

6.
J Am Med Dir Assoc ; 22(6): 1292-1299.e5, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33229305

RESUMO

OBJECTIVES: Older hospitalized patients are at high risk of early readmissions, requiring the implementation of enhanced coordinated transition programs on discharge. The objective of this study was to evaluate the impact of a nurse-led transition bridging program on the rate of unscheduled readmissions of older patients within 30 days from discharge from geriatric acute care units. DESIGN: A stepped-wedge cluster randomized trial. SETTING AND PARTICIPANTS: Seven hundred five patients aged ≥75 years hospitalized in one of 10 acute geriatric units, with at least 2 readmission risk-screening criteria (derived from the Triage Risk Screening Tool), were included from July 2015 to August 2016. METHODS: The intervention condition consisted in a nurse-led hospital-to-home bridging program with 4 weeks postdischarge follow-up (2 home visits and 2 telephone calls). Unscheduled hospital readmission or emergency department (ED) visits were compared in intervention and control condition within 30 days from discharge. RESULTS: The rate of 30-day readmission or ED visit was 15.5% in the intervention condition vs 17.6% in the control condition [hazard ratio stratified on clusters: 0.61 (upper limit unilateral 95% confidence interval = 1.11), P = .09]. Rate of presence of professional caregivers was increased in the intervention condition (P < .001). CONCLUSIONS AND IMPLICATIONS: Although the intervention resulted in an increase in the rate of implementation of a package of care at the 4-week of follow-up, we could not demonstrate a reduction in the rate of 30-day readmissions or ED visits of older patients at risk of readmission. These findings support the evaluation of this type of program on the longer term.

7.
Neuroradiology ; 62(9): 1195-1197, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32415390

RESUMO

Cerebral amyloid angiopathy (CAA) is a common cerebrovascular disease involved in ischemic and hemorrhagic strokes, and its progression is correlated to cognitive decline. In vivo diagnosis of CAA is guided by the modified Boston criteria, with the presence of multiple intracerebral hemorrhage or cerebral microbleeds (CMB), or single hemorrhage and cortical superficial siderosis. The diagnosis of CAA is highly dependent on the quality of imaging and the advent of susceptibility-weighted imaging (SWI) sequences has improved sensitivity of MRI to detect hemosiderin deposition and CMB, hallmarks of CAA. We report here 3 clinical cases of patients with Alzheimer's disease and a focal form (i.e., not disseminated) of probable CAA, diagnosed with SWI sequences. Focal CAA may require closer attention and could offer keys in the understanding of both Alzheimer's disease and CAA pathogenesis.


Assuntos
Angiopatia Amiloide Cerebral/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Diagnóstico Diferencial , Humanos , Masculino
9.
JMIR Res Protoc ; 9(2): e15423, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32053116

RESUMO

BACKGROUND: In France, emergency departments (EDs) are the fastest and most common means for general practitioners (GPs) to cope with the complex issues presented by elderly patients with multiple conditions. EDs are overburdened, and studies show that being treated in EDs can have a damaging effect on the health of elderly patients. Outpatient care or planned hospitalizations are possible solutions if appropriate geriatric medical advice is provided. In 2013, France's regional health authorities proposed creating direct telephone helplines, "geriatric hotlines," staffed by geriatric specialists to encourage interactions between GP clinics and hospitals. These hotlines are designed to improve health care pathways and the health status of the elderly. OBJECTIVE: This study aims to describe the health care pathways and health status of patients aged 75 years and older hospitalized in short-stay geriatric wards following referral from a geriatric hotline. METHODS: The study will be conducted over 24 months in seven French university hospital centers. It will include all patients aged 75 and older, living in their own homes or nursing homes, who are admitted to short-stay geriatric wards following hotline consultation. Two questionnaires will be filled out by medical staff at specific time points: (1) after conducting the telephone consultation and (2) on admitting the patient to a short-stay geriatric medical care. The primary endpoint will be mean hospitalization duration. The secondary endpoints will be intrahospital mortality rate, the characteristics of patients admitted via the hotline, and the types of questions asked and responses given via the hotline. RESULTS: The study was funded by the National School for Social Security Loire department (École Nationale Supérieure de Sécurité Sociale) and the Conference for funders of prevention of autonomy loss for the elderly of the Loire department in November 2017. Institutional review board approval was obtained in April 2018. Data collection started in May 2018; the planned end date for data collection is May 2020. Data analysis will take place in the summer of 2020, and the first results are expected to be published in late 2020. CONCLUSIONS: The results will reveal whether geriatric hotlines provide the most effective management of elderly patients, as indicated by shorter mean hospitalization durations. Shorter hospital durations could lead to a reduced risk of complications-geriatric syndromes-and the domino chain of geriatric conditions that follow. We will also describe different geriatric hotlines from different cities and compare how they function to improve the health care of the elderly and pave the way toward new advances, especially in the organization of the care path. TRIAL REGISTRATION: ClinicalTrials.gov NCT03959475; https://clinicaltrials.gov/ct2/show/NCT03959475. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15423.

10.
Nutrients ; 11(12)2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31817061

RESUMO

Weight loss and worsening of nutritional state is a frequent downfall of acute hospitalization in older people. It is usually accepted that acute inflammation is responsible for hypercatabolism. However, several studies suggest, on the contrary, a reduction in resting energy expenditure (REE). This study aimed to obtain a reliable measure of REE and total energy expenditure (TEE) in older patients hospitalized for an acute episode in order to better assess patients' energy requirements and help understand the mechanisms of weight loss in this situation. Nineteen hospitalized older patients (mean age 83 years) with C-reactive protein (CRP) level >20mg/L were recruited. REE and TEE were measured using gold standard methods of indirect calorimetry and doubly labeled water (DLW), respectively. REE was then compared to data from a previous study on aged volunteers from nursing homes who were free of an acute stressor event. Energy requirements measured by DLW were confirmed at 1.3 × REE. Energy intake covered the needs but did not prevent weight loss in these patients. TEE was not increased in hospitalized patients and was not influenced by inflammation, while the relationship between REE and inflammation was uncertain. Our results suggest that lean mass remains the major determinant of REE in hospitalized older people and that weight loss may not be explained solely by a state of hypercatabolism.


Assuntos
Metabolismo Energético/fisiologia , Idoso Fragilizado , Hospitalização , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Composição Corporal/fisiologia , Calorimetria Indireta , Ingestão de Energia/fisiologia , Feminino , Humanos , Masculino , Necessidades Nutricionais , Estado Nutricional/fisiologia , Perda de Peso/fisiologia
11.
Geriatr Psychol Neuropsychiatr Vieil ; 17(4): 377-385, 2019 12 01.
Artigo em Francês | MEDLINE | ID: mdl-31848124

RESUMO

OBJECTIVE: Recommendations for the management of major fractures in institutionalized patients over 75 years old were updated by the GRIO (French group for research and information on osteoporosis) in 2012 and in 2018. This study is an evaluation of practices in osteoporosis management in institutionalized old patients. METHODS: Evaluation of diagnostic and therapeutic management in medical observations of all residents over 75 years old with a history of major fracture in 4 nursing homes. RESULTS: 105 residents were included with the prevalence of osteoporosis fracture of 32.1%. The most common fractures were hip fractures (60.9%) and vertebral fracture (45.8%). Treatments were: calcium supplementation (14.3% of residents), vitamin D (52.4%), rehabilitation (70.5%) and specific treatment (biphosphonates 11.4%). Complete management (calcium supplementation, vitamin D, physical activity and osteoporosis treatment) was found in 5 residents (4.7%). Few factors were related to complete treatment initiation. Residents initially managed in medicine departments were more treated than those in surgical wards (25.0 vs 6.5%; p = 0.0144) rather than those managed by specialists (rheumatologist or geriatrician: 8 vs 4; p < 0.001). Creatinine clearance was significantly higher in residents with calcium supplementation (52.7 ± 27.9 vs 39.1 ± 9.6; p = 0.0505). Regimen number tend to be higher in residents receiving vitamin D (8.9 ± 2.7 vs 6.7 ± 3.4; p = 0.0753). CONCLUSION: This evaluation of professional practices showed that only a minority of residents received complete anti-osteoporotic treatment despite their risk factor for fracture recurrence. Such an evaluation should be systematic at the entry in nursing home, given the number of falling residents.


Assuntos
Osteoporose/diagnóstico , Osteoporose/terapia , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Fraturas do Quadril/complicações , Instituição de Longa Permanência para Idosos , Humanos , Institucionalização , Masculino , Casas de Saúde , Osteoporose/complicações , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações
12.
BMC Geriatr ; 19(1): 377, 2019 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881861

RESUMO

BACKGROUND: In the context of an aging population, identifying risk factors for Vancomycin-resistant enterococci (VRE), specific to older people, is important. However, if age is a known risk factor for VRE infection, a limited number of studies have focused on older patients. This study aimed to identify potential risk factors for VRE acquisition in a population aged 65 years and older, during a large VRE outbreak that occurred in a teaching hospital in Lyon, France, from December 2013 to July 2014. METHODS: The present retrospective, multi-center, descriptive, and analytical study used part of a previous cohort, and included only a sub-group of patients aged 65 years and older. The analysis of the factors included in the original study was completed with factors more specific to geriatric patients. Inclusion criteria were patients aged 65 years and older, in contact with a VRE index patient. Patients were screened by rectal swabs. Univariate and multivariate logistic regression analyses were performed. RESULTS: A total of 180 VRE contacts were included and 18 patients became carriers. Multivariate analysis showed that risk factors for VRE acquisition in older people included major contact type (RR: 5.31, 95%CI [1.33; 21.19]), number of antibiotics used (RR: 1.36, 95%CI [1.04; 1.76]), a score of McCabe = 2 (RR: 116.39, 95%CI [5.52; 2455.98]), ethylism (RR: 5.50, 95%CI [1.49; 20.25]), and dementia (RR: 7.50, 95%CI [1.89; 29.80]). CONCLUSIONS: This study was able to demonstrate risk factors for VRE acquisition in older people. These risk factors should be taken into account when in the presence of older people in a VRE infected unit.


Assuntos
Envelhecimento/efeitos dos fármacos , Envelhecimento/fisiologia , Surtos de Doenças/prevenção & controle , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Enterococos Resistentes à Vancomicina/fisiologia , Vancomicina/farmacologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Estudos de Coortes , Infecção Hospitalar/epidemiologia , Feminino , França/epidemiologia , Infecções por Bactérias Gram-Positivas , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Vancomicina/uso terapêutico , Resistência a Vancomicina/efeitos dos fármacos , Resistência a Vancomicina/fisiologia
15.
Exp Gerontol ; 125: 110678, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31376472

RESUMO

BACKGROUND: Muscle mass and strength decline are known to be key factors in the development of physical incapacities in later life. These structural and functional declines are even more significant in older people during hospitalizations, increasing risk of falls, fractures, and loss of quality of life. In clinical daily practice, functional and muscular decline are assessed using the validated Short Physical Performance Battery (SPPB). Nevertheless, psychological conditions (pain, demotivation, depression) and temporary physical incapacities (e.g: hip fracture) during hospitalization can be significant barriers to evaluate these patients. Skeletal muscle ultrasound assessment could be an alternative in clinical daily practice since muscle architecture (MA) is related to poor muscle function. However, this potential objective and clinical tool is not yet implemented in geriatric setting during hospitalization. Our study aimed at: 1) comparing MA, muscle mass and strength measurements in hospitalized older adults with different functional levels, 2) evaluating the association between these measurements. METHODS: Forty-four hospitalized older adults were divided in 2 groups: 21 Pre-Disabled (PDis (SPPBscore: 6-9): 81 ±â€¯7 years old, SPPBscore:7.6 ±â€¯1.1) and 23 Disabled (Dis (SPPBscore:<6): 83 ±â€¯7 years old, SPPBscore:3.6 ±â€¯1.6). SPPB, body mass (BM) and composition (bio-impedance), handgrip strength (HS, dynamometer) and MA (Pennation angle (PA), muscle thickness (MT); ultrasound) were evaluated. RESULTS: Relative muscle strength (HS/BM: 0.28 ±â€¯0.08 vs 0.34 ±â€¯0.09 kg/kg), PA (10.6 ±â€¯1.8 vs 12.3 ±â€¯1.9°), and MT (16.4 ±â€¯0.4 vs 19.2 0.4 mm) but not lean body mass were significantly different between Dis and PDis, respectively. Significant associations between PA and the SPPBscore (r2 = 0.37) or walking speed (r2 = 0.38); between SCF and walking speed (r2 = -0.36); as well as between MT and SPPBscore (r2 = 0.29), walking speed (r2 = 0.30), LBM (r2 = 0.382) or MMI (r2 = 0.361) were observed. CONCLUSION: Muscle architecture (proxy of muscle quality) and functional capacities/status of hospitalized older adults are related. Thus, ultrasound seems to be a potential useful and objective screening tool for clinicians to assess/prevent physical decline during hospitalization. Larger and/or longitudinal studies are needed to confirm our findings from a pilot pragmatic study.


Assuntos
Fragilidade/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Pacientes Internados , Masculino , Ultrassonografia
16.
Aging Dis ; 10(3): 520-529, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31164997

RESUMO

No recent study has focused on clinical features of subclinical hypothyroidism (SCH), especially in older patients. TSH measurement has remarkably evolved these last 20 years and thus reconsideration is needed. In our prospective multicenter study (2012-2014) including 807 subjects aged <60 years (<60y) and 531 subjects ≥60 years (≥60y), we have monitored 11 hypothyroidism-related clinical signs (hCS) together with TSH, FT4, FT3 and anti-thyroperoxidase antibodies values. hCS expression has been compared in patients with SCH vs euthyroidism in each age group. The number of hCS above 60y of age were found to be more elevated in the euthyroid population (1.9 vs 1.6, p<0.01) than in the SCH population (2.3 vs 2.6, p=0.41) while increase in hCS is limited to SCH subjects in the <60y group (p<0.01). The percentage of subjects with at least 3 signs increased with SCH in the <60y group (42.6% vs 25.0%, p<0.01) but not ≥60y (34.4% vs 33.9%, p=0.96). In older individuals, only three hCS could be related to both SCH and a decreased T3/T4-ratio (0.26 vs 0.27, p<0.01), suggesting either a reduced activity of TSH, or an adaptive response with aging. While hCS are clearly associated with SCH in patients <60y, they are not so informative in older subjects. TSH measurements carried out on the basis of hCS need to be interpreted with caution in aged patients. A reassessment of the TSH reference range in older patients is clearly needed and should be associated to more appropriate monitoring of thyroid dysfunction.

17.
Geriatr Psychol Neuropsychiatr Vieil ; 17(2): 137-143, 2019 06 01.
Artigo em Francês | MEDLINE | ID: mdl-31162116

RESUMO

Minimum levels of protein intake are essential for the preservation of muscle mass and function, which is a major preventive issue of successful aging. Epidemiological studies suggest strong associations between protein intake and the different elements of sarcopenia, namely maintenance of lean mass and muscle strength. Most often, protein intakes among older patients are below requirements, independently from situations of under nutrition. This opens the path for nutritional interventions to prevent the consequences of sarcopenia in older patients. Isolated amino-acids such as leucine have shown positive effects in the short term only. The positive effects of protein supplementations on muscle strength and function are currently not established in the absence of concomitant exercise training. The highest level of evidence supports interventions combining exercise and nutrition.


Assuntos
Proteínas na Dieta/uso terapêutico , Suplementos Nutricionais , Idoso Fragilizado , Fragilidade/prevenção & controle , Força Muscular/efeitos dos fármacos , Músculo Esquelético/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Proteínas na Dieta/administração & dosagem , Humanos , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/crescimento & desenvolvimento , Sarcopenia/prevenção & controle
18.
BMC Geriatr ; 19(1): 48, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782118

RESUMO

BACKGROUND: Reduced mobility is the first sign of functional decline and can lead to dependency in elderly people. Screening for the risk of mobility limitation in this population is an important public health issue to prevent further disabilities. Despite the current lack of guidelines, primary care healthcare providers may have a central role to play in this type of screening. Multi-domain physical exercise interventions in older persons have shown some efficacy/effectiveness on frailty status, yet, to the best of our knowledge, no published study has focused on patients screened in primary care. METHOD: The PRISME-3P study is a national, interventional, multicenter, cluster randomized trial. Patients over 70 years of age will be systematically screened by their general practitioner (GP) on the basis of clinical criteria of mobility limitation. To avoid contamination bias, the unit of randomization will be the GP practice. In the intervention group, patients will consult a geriatrician and a dietician, and will receive a physical training program from a personal trainer who will demonstrate the exercises and provide follow-up coaching. The control group will receive standard care. The primary outcome will be the change in Short Physical Performance Battery (SPPB) scores between inclusion and 6-months follow-up. DISCUSSION: We expect an improvement of the SPPB between inclusion and 6 months of follow-up. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov ( NCT02847871 , 27 July 2016).


Assuntos
Terapia por Exercício/métodos , Exercício Físico/fisiologia , Limitação da Mobilidade , Equipe de Assistência ao Paciente , Atenção Primária à Saúde/métodos , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Terapia Combinada/métodos , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Exercício Físico/psicologia , Feminino , Seguimentos , Humanos , Masculino
19.
J Alzheimers Dis ; 66(3): 1255-1264, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30400097

RESUMO

BACKGROUND: There is evidence that adipokines have roles in brain functioning and cognitive decline. OBJECTIVE: Assess the role of leptin and adiponectin levels in predicting changes in neuro-cognitive disorders (NCD). METHODS: The study included 205 patients over 65 years of age presenting for a one-day hospitalization for current assessment of cognitive function. Peripheral blood leptin and adiponectin levels were measured at admission. Demographic variables, body mass index (BMI), and history of hypertension were also recorded. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) at admission and at later scheduled visits over a median follow-up period of 14.5 months. Conventional univariate comparisons were made between diagnosis groups (Alzheimer's disease (AD), mild NCD, vascular/mixed dementia). Changes in MMSE scores over time were examined with regard to the above variables using a linear mixed model. RESULTS: The mean BMI was significantly lower (by 2 kg/m2, p = 0.01) in patients with AD than in patients with either mild-NCD or vascular/mixed dementia. Leptin levels were significantly higher (p = 0.043) and adiponectin levels significantly lower (p = 0.045) in patients with mild-NCD than in patients with major-NCD (AD or vascular/mixed dementia). However, the mixed model suggested no influence of the baseline levels of these two biomarkers on the course of cognitive decline. CONCLUSION: The present study confirms the associations between leptin and adiponectin and AD or AD-related disorders but did not confirm that these peptides may be used as predictive biomarkers of cognitive decline.


Assuntos
Adiponectina/sangue , Doença de Alzheimer/sangue , Disfunção Cognitiva/sangue , Demência Vascular/sangue , Leptina/sangue , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Masculino
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