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1.
J Am Geriatr Soc ; 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31846071

RESUMO

OBJECTIVES: Compared to their cognitively healthy counterparts, older adults with mild cognitive impairment (MCI) exhibit higher risk of falls, specifically with injuries. We sought to determine whether fall risk in MCI is associated with decline in higher-level brain gait control. DESIGN: Longitudinal study. SETTING: Community-dwelling adults from the Gait and Brain Study Cohort. PARTICIPANTS: A total of 110 participants, aged 65 years or older, with MCI. MEASUREMENTS: Biannual assessments for medical characteristics, cognitive performance, fall incidence, and gait performance for up to 7 years. Seven spatiotemporal gait parameters, including variabilities, were recorded using a 6-meter electronic walkway. Principal components analysis was used to identify independent gait domains related to higher-level (pace and variability domains) and lower-level (rhythm domain) brain control. Associations between gait decline and incident falls were studied with Cox regression models adjusted for baseline covariates. RESULTS: Of participants enrolled, 40% experienced at least one fall (28% of them with injuries) over a mean follow-up of 31.6 ± 23.9 months. From the pace domain, slower gait speed (adjusted hazard ratio [aHR] per 10-cm/s decrease = 4.62; 95% confidence interval [CI] = 1.84-11.61; P = .001) was associated with severe injurious falls requiring emergency room (ER) visit; from the variability domain, stride time variability (aHR per 10% increase during follow-up = 2.17; 95% CI = 1.02-4.63; P = .04) was associated with higher risk of all injurious falls. Rhythm domain was not associated with fall risk. Decline in pace domain was significantly associated with falls with ER visit (aHR = 3.67; 95% CI = 1.46-9.19; P = .005). After adjustments for multiple comparisons, gait speed and pace domain remained significantly associated with falls with ER visits. No statistically significant associations were found between gait domains and overall falls (P ≥ .06). CONCLUSION: Higher risk of injurious falls in older adults with MCI is associated with decline in gait parameters related to higher-level brain control.

3.
Rev Esp Geriatr Gerontol ; 53(6): 344-355, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30072184

RESUMO

Aging is an important risk factor for patients with atrial fibrillation. The estimated prevalence of atrial fibrillation in patients aged ≥80 years is 9-10%, and is associated with a four to five fold increased risk of embolic stroke, and with an estimated increased stroke risk of 1.45-fold per decade in aging. Older age is also associated with an increased risk of major bleeding with oral anticoagulant therapy. This review will focus on the role of oral anticoagulation with new oral anticoagulants, non-vitamin K antagonist in populations with common comorbid conditions, including age, chronic kidney disease, coronary artery disease, on multiple medication, and frailty. In patients 75 years and older, randomised trials have shown new oral anticoagulants to be as effective as warfarin, or in some cases superior, with an overall better safety profile, consistently reducing rates of intracranial haemorrhages. Prior to considering oral anticoagulant therapy in an elderly frail patient, a comprehensive assessment should be performed to include the risks and benefits, stroke risk, baseline kidney function, cognitive status, mobility and fall risk, multiple medication, nutritional status assessment, and life expectancy.


Assuntos
Anticoagulantes/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Idoso , Algoritmos , Fibrilação Atrial/complicações , Tomada de Decisão Clínica , Árvores de Decisões , Humanos , Fatores de Risco , Acidente Vascular Cerebral/etiologia
4.
Exp Gerontol ; 110: 79-85, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29778642

RESUMO

BACKGROUND/OBJECTIVES: Multicomponent exercise programs are the cornerstone in preventing gait and balance impairments and falls in older adults. However, the effects of these programs in usual clinical practice have been poorly analyzed. DESIGN: 4-Month, twice-a-week multicomponent exercise program cohort study in real-life. SETTING: Falls Unit, Complejo Hospitalario Universitario of Albacete, Spain. PARTICIPANTS: Sixty-seven participants who had experienced a fall in the previous year were included. MEASUREMENTS: Pre- and post-intervention measurements were collected for leg press, gait speed, the Short Physical Performance Battery (SPPB), the Falls Efficiency Scale International, fat mass percentage, body mass index, the Geriatric Depression Scale by Yesavage (GDS), the Mini Mental State Examination, and the number of falls. RESULTS: Fifty participants completed the program (adherence rate 75%, attendance 80%). Their mean age was 77.2 (SD 5.8) years; 39 were women. The participants reduced the mean number of frailty criteria from 2.1 to 1.3 (95%CI 0.4-1.1) and increased mean gait speed from 0.65 m/s to 0.82 m/s (95%CI 0.11-0.22), increasing their median SPPB scores from 8.5 to 10.0 points (p < 0.001), leg press strength from 62.5 kg to 80.0 kg (p < 0.001), and leg press power at 60% load from 76 W to 119 W (p < 0.001). There was also an improvement in GDS scores from 5.3 to 4.4 (95%CI 0.1-1.7). Body mass index did not change, but fat-free mass increased from 43.7 kg to 44.2 kg (95%CI 0.1-1.0), and fat mass percentage declined from 36.7% to 36.0% (95% CI 0.1-1.4). Seventeen patients (34%) had a fall during the six-month follow-up, and there was a reduction in the median number of falls from 3.0/year to 0.0/six months. CONCLUSIONS: A multicomponent Falls Unit-based exercise program as part of usual clinical practice in real life, improved physical function, reduced depressive symptoms, improved body composition and decreased the number of falls in older adults with previous falls.


Assuntos
Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Terapia por Exercício/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fragilidade/terapia , Humanos , Masculino , Desempenho Físico Funcional , Estudos Retrospectivos , Espanha , Velocidade de Caminhada
7.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 51(5): 254-259, sept.-oct. 2016. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-155746

RESUMO

Introducción. El objetivo de nuestro trabajo fue analizar si la fragilidad se asocia a largo plazo con mortalidad, discapacidad incidente en actividades básicas de la vida diaria (ABVD) y hospitalización. Material y métodos. Estudio de cohortes concurrente sobre 993 mayores de 70 años incluidos en el estudio FRADEA. La fragilidad se midió mediante el fenotipo de Fried. Durante el seguimiento se registraron mortalidad, hospitalización y discapacidad incidente en ABVD (baño, aseo, vestido, retrete, transferencias y comer). El riesgo de presentar dichos eventos adversos se determinó mediante regresión logística, Kaplan-Meier y análisis de riesgos proporcionales de Cox ajustado por edad, sexo, Barthel basal, comorbilidad e institucionalización. Resultados. El tiempo medio de seguimiento fue de 952 días (DE 408) durante los cuales fallecieron 182 sujetos (18,4%). Los participantes frágiles tuvieron mayor riesgo ajustado de mortalidad (HR 4,5; IC 95%: 1,8-11,1), discapacidad incidente en ABVD (OR 2,7; IC 95%: 1,3-5,9) y del evento combinado mortalidad o discapacidad incidente (OR 3,0; IC 95%: 1,5-6,1). Los prefrágiles tuvieron mayor riesgo ajustado de mortalidad (HR 2,9; IC 95%: 1,2-6,5), discapacidad incidente (OR 2,1; IC 95%: 1,2-3,6) y del evento combinado mortalidad o discapacidad incidente (OR 2,2; IC 95%: 1,3-3,6). Se observó una asociación positiva entre fragilidad y hospitalización que quedó al borde de la significación (OR 1,7; IC 95%: 1,0-3,0). Conclusiones. El estado de fragilidad se asocia a largo plazo con mortalidad y discapacidad incidente en ABVD en una cohorte de ancianos españoles (AU)


Introduction. The objective of this study was to analyse whether frailty is related to long-term mortality, incident disability in basic activities of daily living (BADL), and hospitalisation. Material and methods. A concurrent cohort study conducted on 993 participants over age 70 from the FRADEA Study. Frailty was determined with Fried frailty phenotype. Data was collected on mortality, hospitalisation and incident disability in BADL (bathing, grooming, dressing, toileting, eating or transferring) during the follow-up period. The risk of adverse events was determined by logistic regression, Kaplan-Meier analysis, and Cox proportional hazard analysis adjusted for age, sex, Barthel index, comorbidity and institutionalization. Results. Mean follow-up was 952 days (SD 408), during which 182 participants (18.4%) died. Frail participants had an increased adjusted risk of death (HR 4.5, 95%CI: 1.8-11.1), incident disability in BADL (OR 2.7, 95%CI: 1.3-5.9) and the combined event mortality or incident disability (OR 3.0, 95%CI: 1.5-6.1). Pre-frail subjects had an increased adjusted risk of death (HR 2.9, 95%CI: 1.2-6.5), incident disability in BADL (OR 2.1, 95%CI: 1.2-3.6), and the combined event mortality or incident disability (OR 2.2, 95%CI: 1.3-3.6). There was a positive association between frailty and hospitalisation, which almost reached statistical significance (OR 1.7, 95%CI: 1.0-3.0). Conclusions. Frailty is long-term associated with mortality and incident disability in BADL in a Spanish cohort of older adults (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Idoso Fragilizado/estatística & dados numéricos , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/normas , Serviços de Saúde para Idosos , Atividades Cotidianas/classificação , Atividades Cotidianas/psicologia , Entrevistas como Assunto/métodos , Entrevistas como Assunto , Estudos de Coortes , Modelos Logísticos , Análise de Variância , Grupos de Risco
8.
Rev Esp Geriatr Gerontol ; 51(5): 254-9, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-26980117

RESUMO

INTRODUCTION: The objective of this study was to analyse whether frailty is related to long-term mortality, incident disability in basic activities of daily living (BADL), and hospitalisation. MATERIAL AND METHODS: A concurrent cohort study conducted on 993 participants over age 70 from the FRADEA Study. Frailty was determined with Fried frailty phenotype. Data was collected on mortality, hospitalisation and incident disability in BADL (bathing, grooming, dressing, toileting, eating or transferring) during the follow-up period. The risk of adverse events was determined by logistic regression, Kaplan-Meier analysis, and Cox proportional hazard analysis adjusted for age, sex, Barthel index, comorbidity and institutionalization. RESULTS: Mean follow-up was 952 days (SD 408), during which 182 participants (18.4%) died. Frail participants had an increased adjusted risk of death (HR 4.5, 95%CI: 1.8-11.1), incident disability in BADL (OR 2.7, 95%CI: 1.3-5.9) and the combined event mortality or incident disability (OR 3.0, 95%CI: 1.5-6.1). Pre-frail subjects had an increased adjusted risk of death (HR 2.9, 95%CI: 1.2-6.5), incident disability in BADL (OR 2.1, 95%CI: 1.2-3.6), and the combined event mortality or incident disability (OR 2.2, 95%CI: 1.3-3.6). There was a positive association between frailty and hospitalisation, which almost reached statistical significance (OR 1.7, 95%CI: 1.0-3.0). CONCLUSIONS: Frailty is long-term associated with mortality and incident disability in BADL in a Spanish cohort of older adults.


Assuntos
Atividades Cotidianas , Idoso Fragilizado , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Fragilidade , Humanos , Masculino
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