Clinical interventions in aging
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Randomized Controlled Trial Comparative Study
The effects of exercise and neuromuscular electrical stimulation in subjects with knee osteoarthritis: a 3-month follow-up study.
Strengthening exercises of the quadriceps femoris muscle (QFM) are beneficial for patients with knee osteoarthritis (OA). Studies reporting short-term effects of neuromuscular electrical stimulation (NMES) of the QFM in this population support the use of this modality as an adjunct treatment. The objectives of this follow-up study are to compare the effects of an exercise program with and without NMES of the QFM on pain, functional performance, and muscle strength immediately posttreatment and 12 weeks after completion of the intervention. ⋯ The effects of a comprehensive group exercise program with or without NMES are partially maintained 12 weeks after completion of the intervention. The addition of NMES is recommended primarily for its immediate effect on pain. Further studies are necessary to determine the effects of repeated bouts of exercise with and without NMES in this population.
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To analyze the clinical features of foreign-body aspiration into the lower airway in geriatric patients. ⋯ The clinical features of foreign-body aspiration in geriatric patients are usually more obscure than in nongeriatric adults, which may lead to long delay in diagnosis. Flexible bronchoscopy is safe and useful for early diagnosis and effective management in geriatric patients. We suggest flexible bronchoscopy as the first-line approach to similar patients, especially those with aspiration history and unexplained pneumonia.
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When a hospitalized older patient falls or develops delirium, there are significant consequences for the patient and the health care system. Assessments of inattention and altered consciousness, markers for delirium, were analyzed to determine if they were also associated with falls. ⋯ In this case-control study, alterations in consciousness and inattention, assessed prior to falling, were more common in patients who fell. Brief assessments of consciousness and attention should be considered for inclusion in fall prediction.
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The best practice tariff (BPT) incentivizes hospitals in the England and Wales National Health Service to provide multiprofessional care to patients with hip fractures. The initial six targets included: 1) admission under consultant-led joint orthopedic-geriatric care, 2) multidisciplinary assessment protocol on admission, 3) surgery within 36 hours, 4) geriatrician review within 72 hours, 5) multiprofessional rehabilitation, and 6) assessment for falls and bone protection. We aimed to examine the relationship between BPT achievement and important patient outcomes and whether the BPT could predict these independently of other validated predictors. ⋯ Achieving BPT does not predict any outcome of interest on its own.
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Comparative Study
Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age.
Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment in elderly patients with rAAA. ⋯ The 30-day and 5-year mortality in patients who survived rAAA was equal between the treatment options of eEVAR and OPEN. Particularly fragile and very elderly patients did not receive operative repair. The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.