Gerontology
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Randomized Controlled Trial Clinical Trial
Balance confidence improves with resistance or agility training. Increase is not correlated with objective changes in fall risk and physical abilities.
While the fear of falling is a common psychological consequence of falling, older adults who have not fallen also frequently report this fear. Fear of falling can lead to activity restriction that is self-imposed rather than due to actual physical impairments. Evidence suggests that exercise can significantly improve balance confidence, as measured by falls-related self-efficacy scales. However, there are no prospective reports that correlate change in balance confidence with changes in fall risk and physical abilities as induced by participating in a group-based exercise program. ⋯ Two different types of exercise training improved balance confidence in older women with low bone mass. This change in balance confidence was significantly correlated with change in general physical function. Because of the observation of discordance between balance confidence change and changes in fall risk and physical abilities, those who design group-based exercise programs for community-dwelling older adults may wish to consider including an education component on factors that influence fear of falling. Objective changes in fall risk factors cannot be assumed to mirror change in fear of falling and physical abilities in older adults in the short-term.
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Aortic aneurysms are common in the elderly and a frequent cause of sudden death. As elective aneurysm repair has a mortality drastically lower than that associated with rupture, the emphasis must be on early detection and repair free from complications. Recent advances include ultrasound screening for asymptomatic abdominal aortic aneurysm (AAA) and clinical trials on the size of AAA that require repair. Pre-operative assessment, management of cardiac risk, autologous blood transfusion strategies, and endovascular stent graft technology to avoid major open surgery are all issues to be addressed. ⋯ The combination of screening, reduced pre-operative risk, and new minimally invasive techniques extends aortic aneurysm treatment into an increasingly elderly population. The combination of these techniques will reduce mortality from ruptured aortic aneurysm in the elderly and also reduce the stress associated with aneurysm surgery.
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Hip fracture is a frequent injury in the elderly, and is associated with a high incidence of functional impairment, complications and mortality. ⋯ CRP measurement in elderly patients operated for hip fracture may be valuable in assessing and monitoring complications.
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Hyperthyroidism is a common disease in the elderly. Although some studies on the prevalence of this thyroid disorder have been performed in the aged population, several aspects of hyperthyroidism, such as etiology and treatment effectiveness, have not been fully characterized in large series of aged patients. ⋯ In patients older than 55 years, toxic multinodular goiter is the most frequent etiology of spontaneous hyperthyroidism, followed by Graves' disease and toxic adenoma. Most patients with thyroid hyperfunction can be adequately controlled, provided that effective therapy is administered. Patients with overt hyperthyroidism seem to have a higher probability of attaining adequate control of their disease than patients with subclinical hyperthyroidism, regardless of age, sex or etiology.
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Mortality in the intensive care unit (ICU) rises with age, a high basal serum cortisol and a small response to adrenocorticotropin (ACTH) stimulation. Even slight impairment of the adrenal response during severe illness can be lethal. ⋯ In this small exploratory study, baseline serum cortisol tended to be higher in older patients and older patients had a significantly smaller response to ACTH stimulation on both low-dose and standard-dose tests. In view of the high death rate in the older ICU patients, the findings in this study need to be confirmed in a larger study. The mechanism and clinical significance of these findings remain to be determined but may be related to deterioration in renal function with age.