Statin combined with exercise training is more effective to improve functional status in dyslipidemic older adults.

BACKGROUND: Exercise training (EX) and statins are first-line therapies to manage dyslipidemia. PURPOSE: This study aims to analyze the effect of EX and statins on functional status and cardiovascular risk (CVR) in dyslipidemic older adults with comorbidities. METHODS: Participants (n = 981) underwent one of 3 conditions: (a) multicomponent exercise training (EX; n = 298; 74% females); (b) statins (ST; n = 178; 65% females); (c) combined therapy-exercise plus ST therapy (ST+EX; n = 505; 79% females). Functional fitness, anthropometry, hemodynamic and lipid profiles, and were assessed at baseline and after 2-years. RESULTS: EX and ST+EX participants improved all the functional status variables, whereas ST participants aggravated all the outcomes. Triglycerides and HDL-cholesterol maintained unchanged and total cholesterol decreased in the three groups, whereas LDL-cholesterol (LDL-C) decreased in EX and ST+EX groups but not in ST group. EX and ST+EX groups decreased body mass index (BMI), systolic and diastolic blood pressure; contrarily, ST group increased these variables. CONCLUSION: Statins combined with exercise training or exercise alone are more effective to improve functional status, to manage cholesterol levels and overall cardiovascular risk factors in dyslipidemic older adults with comorbidities than ST alone. Furthermore, current results suggest that isolated statin therapy decreases functional status and other cardiovascular risk factors.

Functional status improves in hypertensive older adults: the long-term effects of antihypertensive therapy combined with multicomponent exercise intervention.

BACKGROUND: The increasing prevalence of functionally-limited hypertensive individuals highlights the need for interventions to reduce the burden of hypertension-aging-disability and to maximize the chances of healthy aging. AIM: This study aims to compare the effects of multicomponent exercise and different pharmacological treatments on functional status and cardiovascular risk outcomes in hypertensive older adults with comorbidities. METHODS: Participants (n = 96) engage in a 3 days/week multicomponent (aerobic + resistance) exercise program and for one of the following three conditions: (1) thiazide-related diuretics (TDs; n = 33, 69.9 ± 9.5 years); (2) calcium channel blockers (CCBs; n = 23, 67.0 ± 9.0 years); (3) and ß-blockers (ßBs; n = 40, 65.6 ± 7.2 years) medication. Baseline and 2-year follow-up evaluations included the Senior Fitness Test battery, anthropometrics and hemodynamic profile, health-related quality of life (HRQoL; Short-Form Health Survey 36) and health history questionnaires. RESULTS: All groups have significantly improved the physical functional status; particularly upper and lower body strength and aerobic endurance and systolic blood pressure. The TDs and ßBs groups have diminished the waist circumference and body mass. The CCBs decreased total cholesterol (P = 0.028), perceived better physical functioning, physical component score but also augmented bodily pain (P < 0.05). The ßB group decreased triglycerides (P = 0.013). No group differences were found. CONCLUSION: Multicomponent exercise training has improved functional status regardless of the antihypertensive medication options. Hypertensive older adults should add exercise training to pharmacological antihypertensive therapy to reduce the rate of physical disability.

Antihypertensive monotherapy or combined therapy: which is more effective on functional status?

BACKGROUND: This study aims to analyze the effects of anti-hypertensive monotherapy and combined therapy on functional status, and cardiovascular risk outcomes in older adults. METHODS: This longitudinal non-randomized cohort study, involved hypertensive older adults (n = 440) aged 60 or more years with comorbidities. Participants underwent a community exercise training program and one of the following 2 conditions: i) use of daily mono-dose angiotensin-converting enzyme inhibitors (ACEi; n= 232); ii) combined therapy including ACEi plus other class agent (Combined; n= 208). Baseline and 2-year follow-up evaluations included the functional fitness, health-related quality of life (HRQoL), health history questionnaires, anthropometric and hemodynamic profile. RESULTS: Both experimental groups have significantly improved physical functional status, and have significantly decreased blood pressure and waist circumference. ACEi group has significantly reduced body mass and body mass index, the Combined group significantly reduced the waist-to-hip ratio. Additionally, both groups perceived better physical HRQoL. CONCLUSIONS: Functional status has improved with ACEi medication and exercise training, regardless the ACEi medication therapy. Exercise training plus ACEi antihypertensive therapy should be recommended into the standard prescription practice to reduce the rate of physical disability among hypertensive older adults.

Atherosclerosis: The cost of illness in Portugal.

INTRODUCTION AND OBJECTIVES: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. METHODS: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. RESULTS: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). CONCLUSIONS: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.

A Severe Presentation of Drug-Induced Lupus Erythematosus.

Drug-induced lupus erythematosus is a rare condition associated with the exposure to certain drugs capable of triggering an autoimmune disease similar to systemic lupus erythematosus. Although there are no available diagnostic criteria, clinical and serological findings and its temporal association with the initiation of the suspected drug are important to establish the diagnosis. The withdrawal of the drug usually resolves the symptoms. However, in some cases, therapy with corticosteroids and immunosuppressive agents may be required. We present a 74-year-old female with a bilateral venous thrombosis, ischemic stroke, polyserositis and diarrhea due to drug-induced lupus erythematosus that required immunosuppressive therapy.

Escherichia coli endocarditis of a native mitral valve.

Escherichia coli (E.coli) is a rare cause of endocarditis, although is a common causative agent of bacteremia. An 89-year-old woman presented with recurrent episodes of fever and persistent E. coli bacteremia with 3-month duration, despite antimicrobial therapy. At first, a urinary tract infection was diagnosed and later a mycotic aneurysm of the abdominal aorta was found and required an endovascular repair. The persistence of fever and the evidence of a systolic murmur at the mitral focus raised the suspicion of endocarditis. A transesophageal echocardiogram and a cardiac Magnetic Resonance Imaging (MRI) confirmed the presence of a vegetation at the mitral valve and the patient was treated with ceftriaxone. The presence of comorbid conditions and certain bacterial virulence factors predispose to this rare condition. A high level of suspicion is important to early diagnosis and prompt therapy.

Superior Vena Cava Syndrome: An Uncommon Presentation of a Rare Colon Carcinoma Metastasis.

INTRODUCTION: Superior vena cava (SVC) syndrome is caused by obstruction of the superior vena cava due to vascular compression by a mass or intrinsic obstruction. The authors describe SVC syndrome caused by an isolated metastatic mediastinal mass from a resected primary colon carcinoma. CASE REPORT: An 81-year-old woman was referred to the hospital with swelling of the neck and upper left limb, dysphonia and dysphagia, associated with an involuntary weight loss of 16 kg. Mediastinal metastasis of colon adenocarcinoma was found, causing the SVC syndrome. The mass was unresectable and the patient was referred to palliative radiotherapy. DISCUSSION: Only 12 cases of mediastinal metastasis from colorectal cancer have been reported in the English literature. CONCLUSION: As a rare manifestation of colorectal cancer, the presented case highlights the need for clinicians to be aware of rare metastases at the time of diagnosis. LEARNING POINTS: Superior vena cava (SVC) syndrome can result from vascular compression by a mass.Although mediastinal lymph node metastasis is rare in colorectal cancer, physicians should be aware of less common locations.Patients should have a close follow-up in order to avoid the growth of unresectable metastases, since surgery, when possible, can lead to a better prognosis.

Exercise training improves functional status in hypertensive older adults under angiotensin converting enzymes inhibitors medication.

BACKGROUND: The study aims to analyze the effect of three types of treatment on functional status, and cardiovascular risk outcomes in hypertensive older adults with comorbidities. METHODS: Participants (n=418) underwent one of the following 3 conditions: i) multicomponent exercise training 3 times/week (MEX; n=116); ii) angiotensin converting enzyme inhibitors used mono-dose daily (ACEi; n=70); iii) combined exercise and ACEi drugs (ACEiMEX; n=232). The trial was completed by 82% of the participants (n=342): MEX (n=90); ACEi (n=66); ACEiMEX (n=186). Baseline and 2-year follow-up evaluations included the Senior Fitness Test battery, Short Form Health Survey 36 (SF-36), the health history questionnaires, anthropometric and hemodynamic profile. RESULTS: MEX and ACEiMEX groups improved all physical functional status outcomes, decreased systolic (SBP) and diastolic blood pressure (p<0.001) and augmented the physical functioning, role physical and physical component score (PCS) (p<0.05), but also bodily pain (p<0.05). The ACEi group reduced the upper body strength, upper and lower body flexibility and aerobic endurance (p<0.05); worsened the anthropometric profile, and SBP (p<0.001); and decreased general health and PCS (p<0.05). CONCLUSIONS: The improvement of the physical functioning and HRQoL in older hypertensive adults using ACEi medications only occur if they adopt an exercise training regimen, increasing also the management of the blood pressure and other cardiovascular risk factors.

Remitting Seronegative Symmetrical Synovitis with Pitting Oedema as the First Manifestation of an Adenocarcinoma of the Caecum.

Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) is a rare syndrome that affects the elderly. Although the aetiology is not fully understood, it has been related to multiple diseases including cancer. We present the case of an 80-year-old man with a full spectrum of signs and symptoms compatible with RS3PE: sudden onset of bilateral polyarthralgia of the metacarpophalangeal and proximal interphalangeal joints, oedema of the dorsum of the hands, increased inflammatory markers and seronegative rheumatoid factor. After a 5-day course of corticotherapy, the patient became asymptomatic although maintaining a mild anaemia. During a search for the underlying cause of the RS3PE, an early stage adenocarcinoma of the caecum was diagnosed and surgically removed. No further treatment was performed and after 3 years of follow-up the patient remains without evidence of either paraneoplastic RS3PE or cancer. LEARNING POINTS: RS3PE3 is a rare inflammatory syndrome characterized by symmetrical distal synovitis and pitting oedema over the dorsum of the hands and/or feet and seronegative rheumatoid factor.The pathogenesis has not been fully explained although it has been described with multiple diseases including as a paraneoplastic syndrome.Our clinical awareness led to prompt diagnosis of an early stage and curable adenocarcinoma of the caecum.

Effect of physical exercise on lipid metabolism in the elderly.

PURPOSE: To assess the effect of regular physical exercise on plasma lipids and apoproteins in an elderly group. MATERIAL AND METHODS: Sixty-three old people of both sexes, aged between 65 and 94, were randomly distributed between a test group (n = 31) and a control group (n = 32). The test group followed a program of physical exercise for eight months, with intensity of 60% to 80% of heart rate reserve, consisting of three weekly sessions, on alternate days, of 60 minutes each. Before the beginning of the program and eight months afterwards, blood samples were collected to assess total cholesterol, triglycerides, HDL-C, HDL2-C. HDL3-C, apo A1, apo B-100 and apo (a). The ratios total cholesterol/HDL-C, LDL-C/HDL-C, HDL2-C/HDL3-C and apo A1/apo B-100 were also calculated. RESULTS: In the test group total cholesterol, triglycerides, LDL-C, apo B-100, total cholesterol/HDL-C and LDL-C/HDL-C decreased significantly; HDL-C, HDL2-C, apo A1, HDL2-C/HDL3-C and apo A1/apo B-100 increased significantly; HDL3-C and apo (a) did not change. The control group did not present any significant alterations in any of the parameters assessed. CONCLUSIONS: Regular physical exercise decreases vascular risk and may help to reduce cardiovascular events in the elderly.

Quando os cuidados continuados chegam ao fim: perspetivas de cuidadores informais sobre o momento da alta / When long-term care comes to an end: informal caregivers' perspectives on patient discharge / Cuando los cuidados de larga duración terminan: perspectivas de los cuidadores informales sobre el momento del alta

Enquadramento: As unidades de cuidados continuados integrados (UCCI) têm como princípio a readaptação e reinserção familiar e social. Objetivo: Conhecer as perspetivas de cuidadores informais sobre o momento da alta do internamento em cuidados continuados dos seus familiares com demência. Metodologia: Quinze cuidadores (média de idades 60 anos) foram entrevistados e os dados analisados qualitativamente com recurso ao NVivo. Resultados: Apesar da preocupação e medo relativamente ao momento de alta, a maioria dos participantes não tomou qualquer ação. Quando questionados sobre o que fariam se o seu familiar tivesse alta da UCCI, referem considerar o domicílio (n = 5) ou uma estrutura residencial para pessoas idosas (n = 10). Esta decisão tem em conta um ou mais motivos, nomeadamente fatores ambientais, indisponibilidade do cuidador, relação de proximidade, questões económicas e questões familiares. Conclusão: Os motivos que pesam na integração e prestação de cuidados ao paciente após a alta devem ser considerados pelos profissionais, no sentido de um melhor apoio, formação e capacitação dos cuidadores informais, medidas que devem ser partes constituintes de uma rotina de cuidados.

Background: The purpose of long-term integrated care units is the readaptation and reintegration into family and social life. Objective: To understand informal caregivers' perspectives on the discharge of their relatives with dementia from long-term care facilities. Methodology: Fifteen caregivers (mean age of 60 years) were interviewed, and data were qualitatively analyzed using NVivo. Results: Despite the concern and fear about discharge, most participants did not take any action. When questioned about what they would do if their family member was discharged from the unit, they mentioned that they would return home (n = 5) or go to a residential facility for older people (n = 10). This decision is justified by one or more reasons, namely environmental factors, caregiver unavailability, relationship of proximity, economic issues, and family issues. Conclusion: Healthcare professionals should consider the reasons influencing the integration and delivery of patient care after discharge to better support, train, and empower informal caregivers. These measures should be part of a care routine.

Marco contextual: El principio de las unidades de cuidados de larga duración integrados (unidades de cuidados integrados - UCCI) es la readaptación y reintegración familiar y social. Objetivo: Conocer las perspectivas de los cuidadores informales sobre el momento del alta hospitalaria en cuidados de larga duración de sus familiares con demencia. Metodología: Se entrevistó a 15 cuidadores (edad media de 60 años) y se analizaron los datos cualitativamente mediante NVivo. Resultados: A pesar de la preocupación y el temor al momento de recibir el alta, la mayoría de los participantes no tomaron ninguna medida. Cuando se les preguntó qué harían si su familiar recibiera el alta de la UCCI, respondieron que considerarían el domicilio (n = 5) o una residencia para personas mayores (n = 10). Esta decisión tiene en cuenta uno o más motivos, a saber, los factores ambientales, la falta de disponibilidad del cuidador, la relación de proximidad, las cuestiones económicas y las cuestiones familiares. Conclusión: Los motivos que influyen en la integración y la prestación de cuidados al paciente después del alta deben ser considerados por los profesionales, con el fin de apoyar, formar y capacitar mejor a los cuidadores informales, medidas que deberían formar parte de una atención rutinaria.

A socio-demographic study of aging in the Portuguese population: the EPEPP study.

The increase in life expectancy (LE) observed in Western societies, has resulted in a steep rise of older population. This stresses the importance of the research on aging, to better adequate health and social care organization and improve the quality of life (QoL). The aim of the EPEPP-1 (abbreviated from the Portuguese name: Estudo do Perfil de Envelhecimento da População Portuguesa) study was to characterize the socio-demographic components of the elderly Portuguese population in order to disclose factors that could play a role in the aging process and in the elderly QoL. This observational descriptive study, was performed in 2672 individuals older than 54 years taking into account gender and the residence area (rural vs. urban). A questionnaire about social network (marital status, living alone, the hours spent alone, confidents), and social status (education, occupation) was applied. Social network score revealed significant age and gender trends, women and older people performing worst, but with no difference according to residence area. Almost a third was unmarried and spent eight or more hours per day alone, and a fifth lived alone. Social status revealed that being older female and resident in a rural area quoted worst in the prevalence of illiteracy and undifferentiated occupation. The authors concluded that social isolation, illiteracy and undifferentiated occupation are prevalent in Portuguese older population. Identification of further determinants of isolation, adjustment of procedures to be included in social networks and development of actions directed to education are important fields of intervention influencing the elderly QoL.