Polypharmacy, Physical and Nutritional Status, and Depression in the Elderly: Do Polypharmacy Deserve Some Credits in These Problems?

Background: To investigate the association of polypharmacy with physical function, nutritional status, and depression in the elderly. Method: The study included 675 people aged over 65 years from 8 centers in various geographical regions. The polypharmacy status was categorized as non-polypharmacy (0-4 drugs), polypharmacy (≥5 drugs). The subjects' physical function was assessed based on their "physical activity levels, Holden ambulation scores, gait speeds, and hand grip strengths"; their nutritional status based on the "Mini Nutritional Assessment (MNA)"; and their psychological status based on the "Center for Epidemiologic Studies Depression Scale -CES-D". Results: The presence of polypharmacy in this population was found to be 30% (n = 203). A statistically significant difference was found between the groups on the level of physical activity, Holden ambulation score, and nutrition status (p < .05). There was a statistically significant difference between the groups also on hand grip strength, MNA score, Charlson score (p < .05). Conclusion: Polypharmacy was observed to have a significant association with physical function, nutrition, and depression in the elderly aged ≥ 65 years.

Environmental characteristics of older people attending physical medicine and rehabilitation outpatient clinics.

OBJECTIVE: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. METHODS: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. RESULTS: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. CONCLUSIONS: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

The effectiveness of transcutaneous electrical nerve stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo-controlled prospective study.

OBJECTIVE: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on clinical recovery in the management of patients with complex regional pain syndrome Type I (CRPS Type I). MATERIAL AND METHOD: The study included 30 patients with stage 1 and 2 CRPS Type I in the upper extremities. The patients were randomly assigned into 2 groups, group 1 (n= 15) received conventional TENS therapy for 20 minutes, and group 2 (n= 15) received sham TENS therapy. The standard physical therapy program, which included contrast bath for 20 minutes; whirlpool bath for 15 minutes; assisted active and passive range of motion, and static stretching exercises up to the pain threshold, was also conducted in both groups. Therapy was scheduled for 15 sessions. A visual analogue scale (VAS) was used to assess spontaneous pain. The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) scale and the Douleur Neuropathique en 4 Questions (DN-4) were used to assess neuropathic pain. In addition, range of motion (ROM) was measured using a goniometer and volumetric measurements were taken to assess edema. Functional capacity was assessed using a hand dynamometer and the Duruöz Hand Index (DHI). All measurements were performed at baseline and after therapy. RESULTS: Significant improvements were achieved in spontaneous and neuropathic pain scores, edema, ROM, and functional capacity in both groups (p< 0.05). However, improvement was found to be significantly greater in group 1 regarding pain intensity, neuropathic pain assessed using LANNS, edema, and in the 2nd-3rd finger ROM measurements (p< 0.05). No significant difference was detected between groups regarding improvements in 4th-5th finger and wrist ROM measurements, grip strength, and DN4 and DHI scores (p> 0.05). CONCLUSION: The addition of TENS to the physical therapy program was seen to make a significant contribution to clinical recovery in CRPS Type 1.

The use of a standardized pre-participation physical examination form in Turkish adolescent athletes.

OBJECTIVE: The pre-participation physical examination (PPE) has become the standard of care for athletes of all ages. The PPE is generally intended to identify medical conditions that may affect safe and effective participation in organized sports. The aim of this study is to validate and to implement a standardized questionnaire in Turkish language, which might aid Turkish physicians during the PPE. METHODS: A total of 1350 athletes visiting the yearly PPE of the Directorate of Sports and Youth in Isparta, Turkey were asked to participate in this study between October 2001 and November 2001. Eight hundred and ten (60%) students accepted to fill out the questionnaire. A self-reported questionnaire that includes 2 parts has been administered. The first part included questions on socio-demographics. Second part is a translated PPE evaluation form. The questionnaire has been piloted in 15 adolescent students. Athletes have been examined afterwards by one of the medical practitioner and he used the questionnaire (PPE Evaluation Form) to identify additional problems in each athlete. RESULTS: Participants were predominantly male, with higher family income and social security, active at an amateur level, participated in team, and in contact sports. Internal consistency of the PPE form was Cronbach alpha=0.69. Thirty-one (3.8%) athletes had significant findings that needed further evaluation. No one was disqualified after follow-up. Eight items, which asked for certain cardiovascular risk factors, had significant relation to cardiovascular findings of PPE [Chi-Square (1) = 7.4-99.6, p<0.01]. An additional 132 (16.3%) athletes had significant problems that never had been adequately evaluated or treated but which were not likely to affect safe sports participation. CONCLUSION: The Turkish PPE form seems to be promising tool to support the physician during PPE. Using a standardized and valid PPE tool might diminish the dependency of primary care physicians to technological equipment, which are mostly not available in developing countries' primary health care settings and would also reduce the costs of PPE, which might not be affordable for athletes without social security.

Effect of strength and endurance training on cognition in older people.

The purpose of this study was to investigate the effect of moderate strength and endurance training on cognition evaluated by event-related potentials (ERP) in older people. Thirty-six adults, aged 60-85 years, were randomly divided into three groups: sedentary control (C), strength training (ST), and endurance training (ET). Participants performed functional fitness tests and ERP data were recorded before and after nine weeks of training. Training involved three sessions per week. Functional fitness test performance improved significantly in the ST and ET groups. The latencies of the N1, N2, and P2 components and the amplitudes of the N1P2, P2N2, and N2P3 components differed significantly between groups (p < 0.05). After training, the latencies of the P2 and N2 components at the Fz and Cz sites, decreased significantly, and the amplitudes of the N1P2, P2N2, and N2P3 components at the Fz site and the N1P2 and N2P3 components at the Cz site, increased significantly in the ST group compared with the ET group. After training, the latencies of N1, N2, and P2 components shortened significantly, and the amplitudes of the N1P2, P2N2, and N2P3 components increased significantly in the ST group compared with the C group. The latencies of the N2 and P2 components shortened significantly in the ET group compared with the C group, although the amplitudes of the ERP recordings did not differ significantly between groups. These data suggest that strength training might facilitate early sensory processing and cognitive functioning in older individuals. Key PointsStrength training may have facilitating effects on early information processing and cognition in older people.It is interesting that only small improvements in functional fitness affected cognitive performance.More research is needed to determine how the different exercise regimens contribute to discrete changes in CNS functioning and how such changes affect the P3 component of the ERP.

Age responses to multicomponent training programme in older adults.

PURPOSE: The purpose of this study was to determine the effects of 9-week multicomponent training on the functional fitness of healthy older adults in different age groups. METHOD: Forty-two participants were randomly assigned and stratified by their age group: Training and Control Young Old Groups (TYOG, CYOG) (between 60-73 years), Training and Control Old Groups (TOG, COG) (between 74-86 years). The training programme consisted of three sessions per week of walking, strengthening, and flexibility exercises. A recently developed Functional Fitness Test battery to assess the physical parameters associated with independent functioning in older adults was performed before and after training. RESULTS: Training caused significant increases in all functional fitness tests in the TYOG and also in the TOG. There was no difference according to the absolute changes between TYOG and TOG due to the training (p>0.05). Training produced a significant improvement in chair sit and reach, arm curl, chair stand and 6 min walk test scores in the TYOG and TOG when they were compared to the control groups (p<0.05). CONCLUSION: Multicomponent training can produce substantial increase in functional fitness tests in young old adults and older adults and the rate of restoration of function is approximately similar in the two old age groups.