Archives of gerontology and geriatrics
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We set out to describe the relationship between impaired balance, mobility and frailty, and relate these to risk of death. We examined a subsample of 1295 community-dwelling non-demented adults from the second wave of the Canadian Study of Health and Aging (CSHA), a prospective population-based cohort study. Frailty index (FI) scores were constructed from a standardized comprehensive geriatric assessment (FI-CGA). ⋯ FI-CGA scores best predicted mortality (HR 1.04±0.02), proving to be a dominating factor in multivariate regression models that included mobility and balance markers. Only at the upper range of FI-CGA reported (>0.45) did all participants demonstrate mobility impairment. Impaired balance and mobility contribute to frailty, but neither is sufficient to define a participant as frail.
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Arch Gerontol Geriatr · May 2011
Explaining the ineffectiveness of a Tai Chi fall prevention training for community-living older people: a process evaluation alongside a randomized clinical trial (RCT).
The results of a randomized clinical trial (RCT) on the effects of a Tai Chi fall prevention in community-living older people with a high risk of falling in the Netherlands showed no beneficial effects on falls and secondary outcomes (e.g., balance, fear of falling). The aim of this study is to provide insight in process-related factors that may have influenced the effectiveness of the intervention. The intervention consisted of Tai Chi Chuan (TCC) training for 1 h twice a week for 13 weeks. ⋯ All participants and instructors were positive about the program and most participants reported benefits from the intervention. Suggestions for improvements mainly relate to adjustments of training aspects. The main process-related factors that may be have influenced the lack of beneficial effects on falls and secondary outcomes are the relatively high withdrawal and the low adherence rates.
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We aimed to investigate the incidence and characterize predictors associated with delirium in elderly demented and functionally dependent LTC patients. Data collection included: demographic, clinical, functional, nutritional and cognitive data as well as blood counts and chemistry analysis. The tools used to detect delirium were the Confusion Assessment Method (CAM) and the Delirium Rating Scale (DRS), supported by clinical observation. ⋯ Independent predictors of death were infection, advanced age, low plasma albumin level, dehydration and CHF. The early recognition, identification, correction and treatment of underlying conditions especially in very demented, uncooperative and functionally dependent patients may influence their outcome. Any changes in cognitive and functional status are critical in monitoring LTC patients.
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Arch Gerontol Geriatr · May 2011
Preoperative risk factors for postoperative delirium (POD) after urological surgery in the elderly.
The aim of this observational study was to investigate the occurrence of postoperative delirium (POD) in elderly patients undergoing urological surgery and to identify those factors associated with delirium. Ninety consecutive patients (81 males and 9 females; average age of 74.3 ± 0.40 years), undergoing urological surgery in University-Hospital Urological Clinic were selected. Personal, medical, cognitive and functional data, biochemical parameters, preoperative medications, conduct of surgery and anesthesia and details of hemodynamic control were collected as predictors of delirium. ⋯ Interestingly, a significantly greater number of hypotensive events were recorded during anesthesia. Age, cognitive and functional status, previous history of delirium and hypotensive episodes intrasurgery are the best predictor of POD in this setting. Our findings have implications in preventing delirium in elderly by an early and targeted evaluation.
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Arch Gerontol Geriatr · Mar 2011
Randomized Controlled Trial Comparative StudyCerumen removal: comparison of cerumenolytic agents and effect on cognition among the elderly.
Cerumen impaction may affect hearing and decrease hearing acuity, thus decreasing cognitive functions among the elderly. The objective of this study was to compare the safety and the efficacy of three cerumenolytic agents and to assess the effect of cerumen removal on cognition. Thirty eight elderly subjects (mean age: 78 years, total 76 ears) were treated with either Auro®, Cerumol® or the newer CleanEars®, and the change in the degree of ear canal occlusion was examined after a week. ⋯ A statistically significant difference between the RSPM score before and after the removal of cerumen was found. Using CleanEars® is as effective and safe as other agents and may be advantageous due to its spray application. Removal of cerumen significantly improves the well-being of elderly patients.