The effect of perindopril on postural instability in older people with a history of falls-a randomised controlled trial.

Design: double-blind, parallel group, placebo-controlled randomised trial. Methods: we recruited people aged >65 years with at least one fall in the previous year. Participants received 4 mg perindopril or placebo daily for 15 weeks. The primary outcome was the between-group difference in force-plate measured anteroposterior (AP) sway at 15 weeks. Secondary outcomes included other measures of postural sway, limits of stability during maximal forward, right and left leaning, blood pressure, muscle strength, 6-min walk distance and falls. The primary outcome was assessed using two-way ANOVA, adjusted for baseline factors. Results: we randomised 80 participants. Mean age was 78.0 (SD 7.4) years; 60 (75%) were female. About 77/80 (96%) completed the trial. At 15 weeks there were no significant between-group differences in AP sway with eyes open (mean difference 0 mm, 95% CI -8 to 7 mm, P = 0.91) or eyes closed (mean difference 2 mm, 95% CI -7 to 12 mm, P = 0.59); no differences in other measures of postural stability, muscle strength or function. About 16/40 (42%) of patients in each group had orthostatic hypotension at follow-up. The median number (IQR) of falls was 1 (0,4) in the perindopril versus 1 (0,2) in the placebo group (P = 0.24). Conclusions: perindopril did not improve postural sway in older people at risk of falls. Clinical Trials Registration: ISRCTN58995463.

How active are women who play bingo: a cross-sectional study from the Well!Bingo project.

BACKGROUND: The benefits of physical activity are well established, yet large numbers of people are not sufficiently active to gain health benefits. Certain population groups are less physically active than others, including older women from areas of high economic deprivation. The Well!Bingo project was established with the aim of engaging such women in the development of a health promotion intervention in a bingo club. This paper reports on the assessment of health status, physical activity and sedentary behaviour of women attending a bingo club in central Scotland, UK as part of the Well!Bingo project. METHODS: Women attending the bingo club were invited to provide information on demographic characteristics, and self-reported physical activity and sedentary behaviour via a self-complete questionnaire as part of a cross-sectional study (n = 151). A sub-sample (n = 29) wore an accelerometer for an average of 5.7 ± 1.4 days. Differences between younger (under 60 years) and older adults (60 years and over) were assessed using a chi-square test for categorical data and the independent samples t-test was used to assess continuous data (p < 0.05). RESULTS: The mean age was 56.5 ± 17.7 years, with 57% living in areas of high deprivation (Scottish Index of Multiple Deprivation quintile one and two). Sixty-three percent of women (n = 87) reported they were meeting physical activity guidelines. However, objective accelerometer data showed that, on average, only 18.1 ± 17.3 min a day were spent in moderate to vigorous physical activity. Most accelerometer wear time was spent sedentary (9.6 ± 1.7 h). For both self-report and accelerometer data, older women were significantly less active and more sedentary than younger women. On average, older women spent 1.8 h more than younger women in sedentary activities per day, and took part in 21 min less moderate to vigorous physical activity (9.4 mins per day). CONCLUSION: The findings of this study suggest that bingo clubs are settings that attract women from areas of high deprivation and older women in bingo clubs in particular would benefit from interventions to target their physical activity and sedentary behaviour. Bingo clubs may therefore be potential intervention settings in which to influence these behaviours.

Factors associated with change in objectively measured physical activity in older people - data from the physical activity cohort Scotland study.

BACKGROUND: Cross-sectional relationships between physical activity and health have been explored extensively, but less is known about how physical activity changes with time in older people. The aim of this study was to assess baseline predictors of how objectively measured physical activity changes with time in older people. METHODS: Longitudinal cohort study using data from the Physical Activity Cohort Scotland. A sample of community-dwelling older people aged 65 and over were recruited in 2009-2011, then followed up 2-3 years later. Physical activity was measured using Stayhealthy RT3 accelerometers over 7 days. Other data collected included baseline comorbidity, health-related quality of life (SF-36), extended Theory of Planned Behaviour Questionnaire and Social Capital Module of the General Household Survey. Associations between follow-up accelerometer counts and baseline predictors were analysed using a series of linear regression models, adjusting for baseline activity levels and follow-up time. RESULTS: Follow up data were available for 339 of the original 584 participants. The mean age was 77 years, 185 (55%) were female and mean follow up time was 26 months. Mean activity counts fell by between 2% per year (age < =80, deprivation decile 5-10) and 12% per year (age > 80, deprivation decile 5-10) from baseline values. In univariate analysis age, sex, deprivation decile, most SF-36 domains, most measures of social connectedness, most measures from the extended Theory of Planned Behaviour, hypertension, diabetes mellitus, chronic pain and depression score were significantly associated with adjusted activity counts at follow-up. In multivariate regression age, satisfactory friend network, SF-36 physical function score, and the presence of diabetes mellitus were independent predictors of activity counts at follow up after adjustment for baseline count and duration of follow up. CONCLUSIONS: Health status and social connectedness, but not extended Theory of Planned Behaviour measures, independently predicted changes in physical activity in community dwelling older people.

Validation of the AX3 triaxial accelerometer in older functionally impaired people.

BACKGROUND: Studying physical activity (PA) trends in older populations and potential interventions for increasing PA is important, as PA is a factor in many age-related health outcomes such as chronic disease, premature mortality, physical function and injuries from falls. Objective measures of PA provide valuable information regarding the functional impact that ageing and chronic disease states may have on a patient's life. AIMS: The purpose of this study was to test the validity of the AX3 PA monitor in an older population and to investigate whether the AX3 is a valid measure of distinct types or levels of activity in older people with a spectrum of mobility. METHODS: Validity of the AX3 PA monitor was tested using the RT3 as a means of cross-validating the AX3. Study participants wore both the AX3 and the RT3 accelerometers, positioned on their non-dominant side, whilst completing a series of standardised everyday activities. RESULTS: Although overall correlation was high (r > 0.8) between the RT3 and lower-limb-mounted AX3 counts, the correlation between the two devices was much stronger for walking activity than for any of the non-walking activities. DISCUSSION: Activity counts at all lower limb positions for the AX3 and RT3 were highly correlated. Correlation between wrist-mounted AX3 counts and lower limb AX3 counts was only moderate, and worsened when walking aids were in use. CONCLUSIONS: The results of this study indicate that the AX3 monitor is a valid tool, which might be used to objectively measure walking activity in older functionally impaired adults, a welcome finding for this under-researched area.

Association between GDF-15 levels and changes in vascular and physical function in older patients with hypertension.

BACKGROUND: Growth differentiation factor-15 (GDF-15) may be a biomarker of disease, protective response and/or prognosis, in older people with hypertension. AIMS: To correlate baseline GDF-15 levels with physical and vascular health data in this population. METHODS: Baseline blood samples were analysed using a GDF-15 ELISA assay kit. Correlations with baseline and 12-month outcome data, including measures of physical and vascular function, were performed. RESULTS: A total of 147 individuals, mean age 76.8 ± 4.7 years, were included. 77 (52 %) were male. Baseline log10GDF-15 showed significant correlations with age (r = 0.37, p < 0.001), total cholesterol (r = -0.33, p < 0.001) and 6-min walking distance (r = -0.37, p < 0.001). Age remained significantly associated with log10GDF-15 in multivariable analysis (beta = -0.29, p = 0.001). Baseline log10GDF-15 was significantly associated with decline in 6-min walk distance over 12 months (beta = -0.27, p = 0.01) in multivariable models. No significant correlations were seen with changes in vascular function over 12 months. CONCLUSION: Baseline GDF-15 predicts declining physical, but not vascular, function in our population.

Psychoactive prescribing for older people--what difference does 15 years make?

OBJECTIVE: The objective of the study was to review prescribing of psychoactive medications for older residents of the Tayside region of Scotland. METHODS: The analysis used community prescribing data in 1995 and 2010 for all older residents in Tayside. For each psychoactive drug class, the name of the most recently prescribed drug and the date prescribed were extracted. The relative risk (RR) and 95% confidence intervals (CI) for patients receiving psychoactive medication in 2010 were compared with those for patients in 1995. Psychoactive prescribing was analyzed by year, age, gender, and deprivation classification. The chi-squared test was used to calculate statistical significance. RESULTS: Total psychoactive prescribing in people over the age of 65 years has increased comparing 1995 with 2010. Antidepressant [RR = 2.5 (95% CI 2.41-2.59) p < 0.001] and opioid analgesia [RR = 1.21 (1.19-1.24) p < 0.001] prescriptions increased between 1995 and 2010. Hypnotics/anxiolytic [RR = 0.69 (0.66-0.71) p < 0.001] and antipsychotic [RR = 0.83 (0.77-0.88) p < 0.001] prescriptions decreased between 1995 and 2010. An increase in psychoactive prescribing is particularly marked in lower socioeconomic groups. Patients in the least affluent fifth of the population had RR = 1.25 (1.20-1.29) [p < 0.001] of being prescribed one to two psychoactive medications and RR = 1.81 (1.56-2.10) [p < 0.001] of being prescribed three or more psychoactive medications in 2010 compared with those in 1995. The RRs for the most affluent fifth were RR = 1.14 (1.1-1.19) [p < 0.001] and RR = 1.2 (1.01-1.42) [p < 0.001] for one to two, and three or more medications, respectively. CONCLUSION: Psychoactive medication prescribing has increased comparing 1995 with 2010, with increases disproportionately affecting patients in lower socioeconomic groups. The availability of new psychoactive drugs, safety concerns, and economic factors may explain these increases.

Hospital-acquired pneumonia incidence and diagnosis in older patients.

BACKGROUND: hospital-acquired pneumonia poses a hazard to older people who are hospitalised, yet few data exist on the incidence or risk factors in non-intensive care patients. This study aimed to determine the incidence of hospital-acquired pneumonia (HAP) in a sample of hospitalised older people. METHODS: prospective survey of hospitalised older patients (>65 years) at a single centre over a 12-month period. Casenote and chart data were collected on acute medical, orthopaedic and Medicine for the Elderly wards. HAP was defined in accordance with the European and Scottish National Prevalence Survey 2011 definition. Key analyses were incidence of clinically suspected and case definition clinically confirmed HAP. RESULTS: one thousand three hundred and two patients were included in the analysis. Five hundred and thirty-nine (41%) were male; mean age was 82 years (SD 8). Median length of hospital stay was 14 days (IQR 20). One hundred and fifty-seven episodes of HAP were clinically suspected in 143 patients (10.9% of admissions), but only 83 episodes in 76 patients met the diagnostic criteria (5.8% of admissions). The risk of HAP was 0.3% per day in hospital. Reasons for failure to meet the diagnostic criteria in 75 cases were lack of radiographic evidence in 60/75; lack of evidence of inflammation in 42/75, and lack of respiratory signs or symptoms in 13/75; 35/75 (47%) of cases lacked evidence in two or more domains. CONCLUSION: HAP is common but over-diagnosed in older hospitalised patients.

Accessing and engaging women from socio-economically disadvantaged areas: a participatory approach to the design of a public health intervention for delivery in a Bingo club.

BACKGROUND: Our aim was to use participatory methods to investigate the feasibility and acceptability of using Bingo clubs for the design and delivery of an evidence-based physical activity and/or healthy eating intervention to socio-economically disadvantaged women. This paper describes the participatory process that has resulted in a physical activity intervention for women aged >55 years, ready for pilot-testing in a Bingo club setting. METHODS: Studies using different quantitative and qualitative approaches were conducted among customers and staff of a Bingo club in a city of 85,000 inhabitants in central Scotland. These were designed to take the views of different stakeholders into account, with a view to enhancing uptake, engagement and effectiveness with any proposed intervention. RESULTS: Sixteen relevant studies were identified in a literature review that generated ideas for intervention components. A questionnaire completed by 151 women in the Bingo club showed that almost half (47 %) aged >55 years were not meeting physical activity guidelines; evidence backed up by accelerometer data from 29 women. Discussions in six focus groups attended by 27 club members revealed different but overlapping motivations for attending the Bingo club (social benefits) and playing Bingo (cognitive benefits). There was some scepticism as to whether the Bingo club was an appropriate setting for an intervention, and a dietary intervention was not favoured. It was clear that any planned intervention needed to utilise the social motivation and habitual nature of attendance at the Bingo club, without taking women away from Bingo games. These results were taken forward to a 5-h long participative workshop with 27 stakeholders (including 19 Bingo players). Intervention design (form and content) was then finalised during two round table research team meetings. CONCLUSIONS: It was possible to access and engage with women living in areas of socio-economic disadvantage through a Bingo club setting. A physical activity intervention for women >55 years is realistic for recruitment, will address the needs of potential recipients in the Bingo club, appears to be feasible and acceptable to club members and staff, and has been designed with their input. A pilot study is underway, investigating recruitment, retention and feasibility of delivery.

Association between kidney function, rehabilitation outcome, and survival in older patients discharged from inpatient rehabilitation.

BACKGROUND: Chronic kidney disease (CKD) is common in older people, but it is unclear if it affects survival and rehabilitation outcomes independent of comorbid conditions and physical function in this population. STUDY DESIGN: Cohort analysis of prospective, routinely collected, linked clinical data sets. SETTING & PARTICIPANTS: Patients discharged from a single inpatient geriatric rehabilitation center over a 12-year period. PREDICTORS: Admission estimated glomerular filtration rate (eGFR) category as a predictor of improvement in the 20-point Barthel score (activities of daily living measure) during rehabilitation; discharge eGFR category and Barthel score as predictors of survival postdischarge. OUTCOMES: Survival postdischarge was modeled using Cox regression analyses, unadjusted and adjusted for age, sex, morbidities (ischemic heart disease, chronic obstructive pulmonary disease, stroke, diabetes, and heart failure), Barthel score and eGFR category on discharge, and serum calcium, hemoglobin, and albumin levels. The effect of admission eGFR category on change in Barthel score during admission was modeled using analysis of covariance, adjusted for admission, Barthel score, and comorbid conditions. RESULTS: 3,012 patients were included; mean age, 84 years. 2,394 patients died during a mean follow-up of 8.3 years. Compared with patients with eGFR of 60 to 89mL/min/1.73m(2), adjusted HRs for death were 1.26 (95% CI, 1.13-1.40), 1.45 (95% CI, 1.29-1.63), and 1.68 (95% CI, 1.42-1.99) for eGFR categories of 45 to 59, 30 to 44, and <30mL/min/1.73m(2), respectively. The relationship between discharge Barthel score and survival was similar within each discharge eGFR category (HRs of 0.95, 0.93, 0.92, 0.95, and 0.90 per Barthel score point within eGFR categories of ≥90, 60-89, 45-59, 30-44, and <30mL/min/1.73m(2); P for interaction = 0.2). Similar improvements in Barthel score between admission and discharge were seen for each admission eGFR category. LIMITATIONS: Single-center study using routinely collected clinical data. CONCLUSIONS: eGFR category and Barthel score are independent risk markers for survival in older rehabilitation patients, but advanced CKD does not preclude successful rehabilitation.

The role of perceived barriers and objectively measured physical activity in adults aged 65-100.

OBJECTIVE: to test the predictive utility of perceived barriers to objectively measured physical activity levels in a stratified sample of older adults when accounting for social-cognitive determinants proposed by the Theory of Planned Behaviour (TPB), and economic and demographic factors. METHODS: data were analysed from the Physical Activity Cohort Scotland survey, a representative and stratified (65-80 and 80+ years; deprived and affluent) sample of 584 community-dwelling older people, resident in Tayside, Scotland. Physical activity was measured objectively by accelerometry. RESULTS: perceived barriers clustered around the areas of poor health, lack of interest, lack of safety and lack of access. Perceived poor health and lack of interest, but not lack of access or concerns about personal safety, predicted physical activity after controlling for demographic, economic and TPB variables. DISCUSSION: perceived person-related barriers (poor health and lack of interest) seem to be more strongly associated with physical activity levels than perceived environmental barriers (safety and access) in a large sample of older adults. Perceived barriers are modifiable and may be a target for future interventions.

Dog ownership and physical activity in later life: a cross-sectional observational study.

OBJECTIVE: To examine whether dog ownership amongst community dwelling older adults (≥ 65 years) is associated with objectively measured physical activity (PA). METHODS: We used data from the Physical Activity Cohort Scotland (PACS) which consists of 547 people aged 65 and over, resident in the community in Tayside, Scotland. The data was collected in 2009-2011. We assessed whether dog ownership is associated with objectively measured physical activity (accelerometry counts). RESULTS: The physical activity (PA) counts of 547 older people (mean age 79 (standard deviation (SD) 8 years, 54% female) were analysed. Linear mixed models showed that dog ownership was positively related to higher PA levels. This positive relationship remained after controlling for a large number of individual and contextual variables, including attitude towards exercise, physical activity intention and history of physical activity. Dog owners were found to be 12% more active (21,875 counts, 95% Confidence Interval (CI): 2810 to 40,939, p<0.05) than non-dog owners. CONCLUSION: Dog ownership is associated with physical activity in later life. Interventions to increase activity amongst older people might usefully attempt to replicate elements of the dog ownership experience.

Temporal trends in anticholinergic medication prescription in older people: repeated cross-sectional analysis of population prescribing data.

BACKGROUND: in older people, medications with anticholinergic (antimuscarinic) effects are associated with adverse clinical outcomes, the risk increasing with increasing anticholinergic exposure. Many anticholinergics are recognised as potentially inappropriate and efforts to reduce prescription have been ongoing. We examined temporal trends of anticholinergic prescription and exposure in older people. METHODS: : anonymised data on all prescribed medication dispensed to people ≥65 years in Tayside, Scotland were obtained for the years 1995 (n = 67,608) and 2010 (n = 73,465). The Anticholinergic Risk Scale (ARS) was adapted (mARS) to include newer medications and medications identified in other scales as having moderate to strong anticholinergic activity. An individual's mARS score was the sum of scores for individual medications. Differences in prescription of anticholinergic medications and mARS scores between 1995 and 2010 were examined. RESULTS: : a significantly higher proportion of older people received any anticholinergic medication in 2010 compared with 1995 (23.7 versus 20.7%; P < 0.001). High anticholinergic exposure (mARS scores ≥3) was seen in 7.3% in 1995 and 9.9% in 2010 (P < 0.001). Prescription of individual anticholinergic medication was small-only three medications were prescribed to >2% of people. The risk of high anticholinergic exposure increased in those with polypharmacy, social deprivation, those living in care homes and women. CONCLUSION: : despite increasing evidence of adverse outcomes, the proportion of older people prescribed anticholinergic medications and the proportion with a high anticholinergic exposure has increased between 1995 and 2010. Prescription of individual drug is small so cumulative anticholinergic scores may help future efforts to reduce anticholinergic prescription in older people.

ACE inhibitors, statins and thiazides: no association with change in grip strength among community dwelling older men and women from the Hertfordshire Cohort Study.

BACKGROUND: vascular disease has been postulated to contribute to muscle dysfunction in old age. Previous studies examining the effects of cardiovascular drugs on muscle function have shown conflicting results. We therefore examined the association of angiotensin converting enzyme (ACE) inhibitor, thiazide and statin use with decline in grip strength in a well-characterised cohort. METHODS: we analysed prospectively collected data from the Hertfordshire Cohort Study (HCS). For each medication, participants were divided into no baseline use/no use at follow-up, baseline use/no use at follow-up, no baseline use but use at follow-up and use at baseline and follow-up. For each group, annualised decline in grip strength (kg per year) was calculated, then adjusted for baseline age, height, weight, baseline grip strength, indices of ischaemic heart disease and hypertension. Analyses were conducted separately for males and females. RESULTS: 639 participants were included in the analysis, mean age 65 years. 321 (50%) were male; mean follow-up time was 4.4 years. There were no differences in baseline grip between baseline users and non-users of any drug class. Adjusted grip strength change per year was similar for each group of ACE inhibitor use (P > 0.05). Similar analyses revealed no significant between-group differences for statin or thiazide use. Analysis of dropout rates by medication use revealed no evidence of selection bias. CONCLUSION: use of ACE inhibitors, statins or thiazides was not associated with differences in grip strength decline in healthy older people in the HCS.

Psychological theory in an interdisciplinary context: psychological, demographic, health-related, social, and environmental correlates of physical activity in a representative cohort of community-dwelling older adults.

BACKGROUND: Physical activity (PA) in older adults is influenced by a range of environmental, demographic, health-related, social, and psychological variables. Social cognitive psychological models assume that all influences on behaviour operate indirectly through the models constructs, i.e., via intention and self-efficacy. We evaluated direct, indirect, and moderating relationships of a broad range of external variables with physical activity levels alongside intention and self-efficacy. METHODS: We performed a cross-sectional survey of a representative and stratified (65-80 and 80+ years; deprived and affluent) sample of 584 community-dwelling people, resident in Scotland. Objectively measured physical activity and questionnaire data were collected. RESULTS: Self-efficacy showed unique relationships with physical activity, controlling for demographic, mental health, social, environmental, and weather variables separately, but the relationship was not significant when controlling for physical health. Overall, results indicating support for a mediation hypothesis, intention and self-efficacy statistically mediate the relationship of most domain variables with physical activity. Moderation analyses show that the relationship between social cognitions and physical activity was stronger for individuals with better physical health and lower levels of socio-economic deprivation. CONCLUSIONS: Social cognitive variables reflect a range of known environmental, demographic, health-related and social correlates of physical activity, they mediate the relationships of those correlates with physical activity and account for additional variance in physical activity when external correlates are controlled for, except for the physical health domain. The finding that the social cognition-physical activity relationship is higher for participants with better health and higher levels of affluence raises issues for the applicability of social cognitive models to the most disadvantaged older people.

Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity.

BACKGROUND: currently one of the major challenges facing clinical guidelines is multimorbidity. Current guidelines are not designed to consider the cumulative impact of treatment recommendations on people with several conditions, nor to allow comparison of relative benefits or risks. This is despite the fact that multimorbidity is a common phenomenon. OBJECTIVE: to examine the extent to which National Institute of Health and Clinical Excellence (NICE) guidelines address patient comorbidity, patient centred care and patient compliance to treatment recommendations. METHODS: five NICE clinical guidelines were selected for review (type-2 diabetes mellitus, secondary prevention for people with myocardial infarction, osteoarthritis, chronic obstructive pulmonary disease and depression) as these conditions are common causes of comorbidity and the guidelines had all been produced since 2007. Two authors extracted information from each full guideline and noted the extent to which the guidelines accounted for patient comorbidity, patient centred care and patient compliance. The cumulative recommended treatment, follow-up and self-care regime for two hypothetical patients were then created to illustrate the potential cumulative impact of applying single disease recommendations to people with multimorbidity. RESULTS: comorbidity and patient adherence were inconsistently accounted for in the guidelines, ranging from extensive discussion to none at all. Patient centred care was discussed in generic terms across the guidelines with limited disease-specific recommendations for clinicians. Explicitly following guideline recommendations for our two hypothetical patients would lead to a considerable treatment burden, even when recommendations were followed for mild to moderate conditions. In addition, the follow-up and self-care regime was complex potentially presenting problems for patient compliance. CONCLUSION: clinical guidelines have played an important role in improving healthcare for people with long-term conditions. However, in people with multimorbidity current guideline recommendations rapidly cumulate to drive polypharmacy, without providing guidance on how best to prioritise recommendations for individuals in whom treatment burden will sometimes be overwhelming.

Allopurinol use is associated with greater functional gains in older rehabilitation patients.

INTRODUCTION: the xanthine oxidase system produces reactive oxidative species and its inhibition by allopurinol has been shown to have beneficial effects on cardiovascular function. Oxidative stress has also been implicated in the development of sarcopenia. Allopurinol, a xanthine oxidase inhibitor, both reduces oxidative stress and acts as a potential oxygen-sparing agent. We examined the association between allopurinol use and functional outcomes after rehabilitation in a cohort of older people. METHODS: analysis of routinely collected clinical data from a single rehabilitation unit. Data were prospectively collected on all admissions to the Dundee Medicine for the Elderly rehabilitation unit between 1 January 1999 and 31 December 2008. Multivariate analyses were performed to examine the difference between the 20-point Barthel score on admission and discharge, adjusting for age, sex, admission Barthel score, anti-platelet use and comorbid disease. RESULTS: a total of 3,593 patients were included in the analysis and 3% of patients were taking allopurinol on discharge (n = 102). Improvement in Barthel scores was greater in the allopurinol group than the non-allopurinol group (4.7 versus 3.6 points, mean difference 1.1, 95% CI: 0.4-1.8, P = 0.002). When adjusted for age, sex, admission Barthel, presenting disease and number of drugs on discharge, improvement in the Barthel score was still greater in the allopurinol group (4.8 versus 3.8 points, mean difference 0.94, 95% CI: 0.3 to 1.6, P = 0.006). CONCLUSIONS: this retrospective observational study suggests that allopurinol use is associated with a greater degree of improvement in function as measured by the Barthel score during rehabilitation in an older inpatient population. Prospective randomised controlled trials are required to further investigate this finding.

Association between statin medication use and improved outcomes during inpatient rehabilitation in older people.

BACKGROUND: statin drugs may induce skeletal myopathy, but might also have the potential to improve rehabilitation outcomes by improving sarcopenia or by preventing intercurrent illness. We examined the association between statin use and functional outcomes in the rehabilitation of older people. METHODS: retrospective cohort study using routinely collected clinical data. Admissions to Royal Victoria Hospital, Dundee for inpatient rehabilitation over a 10-year period were identified. Data were available regarding demographics, statin therapy, antiplatelet therapy, admission and discharge Barthel scores, length of stay and comorbid disease. Multivariate analyses were performed to examine the difference between admission and discharge Barthel score in patients taking statins compared with those not taking statins. RESULTS: a total of 3,422 patients were included. Mean age was 81.4 years; 40% were male. Baseline Barthel scores were similar in the statin/non-statin groups, respectively (10.4/20 versus 10.3/20, P = 0.57). Improvement in the Barthel score between admission and discharge was greater in the statin than non-statin group (3.59 versus 4.30 points, P < 0.001) after adjustment for age, sex, baseline Barthel score and comorbid disease. CONCLUSION: statin use was associated with improved Barthel scores on discharge from rehabilitation. This gain could contribute to improved outcomes as part of the rehabilitation package and requires further prospective investigation.

A comparison of the Endurance Shuttle Walk test and the Six Minute Walk test for assessment of exercise capacity in older people.

BACKGROUND AND AIMS: The six minute walk test is widely used to measure aerobic exercise capacity in older people, but lack responsiveness to change. We aimed to compare the reliability, responsiveness and completion rates of the six minute walk with a new test of aerobic exercise capacity - the endurance shuttle walk test. METHODS: Two groups were studied: 18 patients from a Medicine for the Elderly Day Hospital (study 1) receiving physiotherapy, and 15 community dwelling older people (study 2) receiving caffeine or placebo in a crossover study, followed by a weekly exercise programme. Six minute walk test and endurance shuttle walk test were performed at baseline and after interventions. Intraclass correlation coefficients were calculated for reliability, and Cohen's effect sizes were calculated to characterize responsiveness. RESULTS: 6/18 of patients in study 1 completed the baseline shuttle walk successfully. For those completing baseline and week one shuttle walk, similar intraclass correlation coefficients were seen (shuttle walk 0.97; six minute walk 0.90). In study 2, all attendees completed baseline and follow-up shuttle walk. 7/15 managed the maximum shuttle walk time at baseline. Effect sizes for caffeine intervention (0.29 for six minute walk, 0.01 for shuttle walk) and for exercise intervention (0.15 for six minute walk, 0.24 for shuttle walk) were similarly low for both tests. CONCLUSION: The endurance shuttle walk is no more responsive to change than the six minute walk in older people, is limited by ceiling effects, and cannot be performed successfully by very frail older people.

Mineralocorticoid antagonism: a novel way to treat sarcopenia and physical impairment in older people?

Dysregulation of the renin-angiotensin-aldosterone system has been associated with a number of age-related pathologies including hypertension, heart failure and chronic kidney disease. More recently, it has been suggested that alterations within the RAAS may contribute to the development of sarcopenia and subsequent decline in physical function. There is growing interest in developing interventions to prevent age-associated decline in muscle function. We postulate that inhibition of the RAAS with the mineralocorticoid antagonist spironolactone may have a role in countering the effects of physical impairment in older people by improving skeletal muscle function. Spironolactone may prevent skeletal myocyte apoptosis, improve vascular endothelial function and enhance muscle contractility by increasing muscle magnesium and sodium-potassium pumps. This article will review the literature underpinning the hypothesis that spironolactone may have a role in maintaining muscle function in older people.

Improving recruitment of older people to research through good practice.

There is widespread evidence both of the exclusion of older people from clinical research, and of under-recruitment to clinical trials. This review and opinion piece provides practical advice to assist researchers both to adopt realistic, achievable recruitment rates and to increase the number of older people taking part in research. It analyses 14 consecutive recently published trials, providing the number needed to be screened to recruit one older participant (around 3:1), numbers excluded (up to 49%), drop out rates (5-37%) and whether the planned power was achieved. The value of planning and logistics are outlined, and approaches to optimising recruitment in hospital, primary care and care home settings are discussed, together with the challenges of involving older adults with mental incapacity and those from minority groups in research. The increasingly important task of engaging older members of the public and older patients in research is also discussed. Increasing the participation of older people in research will improve the generalisability of research findings and inform best practice in the clinical management of the growing older population.