Use of sports tourism to motivate older adults to maintain increased aerobic exercise capacity and reduced arterial stiffness after supervised training: a non-randomized controlled trial / 体力科学

Habitual aerobic exercise decreases arterial stiffness, a risk factor for cardiovascular disease, and increases aerobic exercise capacity. Exercise habits can be difficult to maintain over time. We sought to determine if the prospect of participating in a sports tourism event (mountain climbing) helped older adults maintain increased aerobic exercise capacity and decreased arterial stiffness after a supervised training program. Forty community-dwelling middle-aged and older individuals were divided into training (n=20) and control (n=20) groups. The training group participated in six weeks of face-to-face exercise intervention (walking, 60%–75% of age-predicted maximal heart rate, 35–50 min/day, 1 day/week) and was additionally offered home-based walking (45 min/day, 2–4 days/week). During the same period, the control group was asked not to change their lifestyle. In the last session of the exercise program, we announced a mountain climbing event planned for six months in the future. The participants were encouraged to maintain their exercise habits leading up to the event. Arterial stiffness (brachial-ankle pulse wave velocity) and maximal oxygen uptake were measured before and after the six-week intervention and two weeks before the mountain climbing event. In the training group, arterial stiffness decreased, and maximal oxygen uptake increased after the intervention; these improvements were successfully maintained until the mountain climbing event. These parameters did not change significantly in the control group. Sports tourism may motivate older adults to maintain their exercise habits after a supervised training program.

Prediction of early postoperative desaturation in extreme older patients after spinal anesthesia for femur fracture surgery: a retrospective analysis / 대한마취과학회지

BACKGROUND: Postoperative desaturation in older individuals is rarely addressed in the literature. The objective of this retrospective study was to investigate whether a preoperative spirometric test and arterial blood gas analysis (ABGA) might predict postoperative desaturation after spinal anesthesia in extreme older patients.METHODS: The medical records of 399 patients (age ≥ 80 yrs) who were administered spinal anesthesia for a femur neck fracture surgery were retrospectively reviewed. Early postoperative desaturation was defined as a reduction of oxygen saturation (SpO₂) below 90% within 3 days of surgery, despite O₂ supply via a nasal prong. Binary logistic regression analysis was used to identify predictors of early postoperative desaturation.RESULTS: The incidence of postoperative desaturation was 12.5%. Major morbidity rate was significantly higher in the desaturation group (n = 50) than that in the non-desaturation group (n = 349) (14% vs. 3.2%, P = 0.001) with more frequent postoperative stays in the intensive care unit (22% vs. 12%, P = 0.004). In a binary logistic regression analysis, preoperative ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO₂/FiO₂ ratio) (OR, 0.972; 95% CI 0.952–0.993; P = 0.010) and history of cardiovascular disease (OR, 2.127; 95% CI 1.004–4.507; P = 0.049) predicted postoperative desaturation.CONCLUSIONS: Preoperative PaO₂/FiO₂ ratio, but not preoperative spirometry, was predictive of the postoperative desaturation in older patients after being administered spinal anesthesia for femur fracture surgery. Based on our results, preoperative ABGA may be helpful in predicting early postoperative desaturation in these patients.

Vastus lateralis muscle architecture to estimate knee extension moment of older individuals / Arquitetura do músculo vasto lateral para estimar o momento de extensão do joelho de indivíduos idosos / Arquitectura de los vasto lateral para estimar el momento de la extensión de la rodilla de las personas ancianas

The aim of this study was to compare the knee extension moment of older individuals with the muscle moment estimated through a biomechanical model. This was accomplished by using (1) the specific muscle architecture data of individuals, and (2) the generic muscle architecture available in the literature. The muscle force estimate was determined using a model with the muscle architecture from cadavers and the individual vastus lateralis muscle architecture of sixteen older volunteers. For the muscle moment comparison, all of the volunteers performed maximal voluntary isometric contractions (MVIC) in five different knee extension position angles. The architectural data was acquired using both resonance and ultrasound imaging. Both estimated muscle moments (generic and individual) were higher than the experimental. The architecture of the other vastii may be necessary to make the model more accurate for the older population. Although other factors inherent to ageing, such as co-contractions, fiber type percentage, and passive forces are not considered in the model, they could be responsible for the differences between moments in older people.

O objetivo deste estudo foi comparar o momento de extensão do joelho de idosos com momento muscular estimado por modelo biomecânico, utilizando (i) arquitetura muscular específica dos indivíduos e (II) arquitetura muscular genérica disponível na literatura. Para a estimativa da força muscular foi utilizado um modelo com a arquitetura muscular de cadáveres, e também com a arquitetura do vasto lateral de dezesseis voluntários idosos. Para a comparação todos voluntários realizaram contrações isométricas voluntárias máximas em cinco ângulos. Os dados de arquitetura foram adquiridos por meio de ultrassonografia e por ressonância magnética. Ambos os momentos estimados (genéricos e individuais) foram maiores do que experimental. A arquitetura dos outros músculos do quadríceps pode ser necessária para modelo ser mais preciso para a população idosa. Outros fatores inerentes ao envelhecimento não foram considerados no modelo, como cocontrações, tipagem de fibras e forças passivas, e devem ser responsáveis pelas diferenças entre os momentos.

El objetivo de este estudio fue comparar el torque extensión de la rodilla de ancianos con torque muscular estimado por modelo biomecánico, usando (i) la arquitectura muscular específica de los individuos y (II) (II) la arquitectura muscular genérica disponible en la literatura. Para la estimación de la fuerza muscular se utilizó un modelo con arquitectura muscular de cadáveres, y también con la arquitectura del vasto lateral de dieciséis voluntarios ancianos. Para la comparación todos los voluntarios realizaron contracciones isométricas voluntarias máximas en cinco ángulos. La arquitectura fue adquirida por ecografía y por resonancia magnética. Ambos las torques estimadas (genéricas y individuales) fueron mayores que el experimental. La arquitectura de los otros músculos de los cuádriceps puede ser necesaria para hacer el modelo más preciso para la población anciana. Otros factores inherentes envejecimiento no se consideran en el modelo, como co-contracciones, el tipo de fibra y fuerzas pasivas, y deben ser responsables de las diferencias entre las torques.

Grau de dependência de idosos hospitalizados para realização das atividades básicas da vida diária / Dependency levels in hospitalized elders in performing basic daily living activities / El grado de dependencia de ancianos hospitalizados para la realización de las actividades básicas de la vida diaria

Este estudo objetivou identificar o grau de dependência de idosos hospitalizados para a realização das Atividades Básicas da Vida Diária. Trata-se de estudo quantitativo, transversal e descritivo, desenvolvido na Enfermaria de Adultos do Pronto-Socorro do Hospital das Clínicas de Botucatu. A coleta de dados ocorreu mediante entrevistas, observação e consulta nos prontuários individuais. Os dados foram analisados com pacote estatístico SAS for Windows, versão 9.2, utilizando regressão logística. A amostra foi constituída por 71 sujeitos, com idade média de 74,30 anos. Verificou-se que 30,99 por cento dos idosos se apresentaram independentes na realização das atividades propostas, 22,53 por cento, parcialmente dependentes e 46,48 por cento totalmente dependentes. O cuidado em gerontologia deve estar voltado para a manutenção do estado funcional, promovendo-se a independência e preservando a dignidade dos sujeitos.

This study aimed to identify the level of dependence in elderly inpatients when performing Basic Activities of Daily Living. This quantitative, cross-sectional, descriptive study was conducted in the Adult Ward of the Botucatu University Hospital Emergency Unit - UNESP, Brazil. Data was collected by means of interviews, observation, and individual medical chart consultation, to be analyzed via logistic regression using the statistical software package SAS for Windows, version 9.2. The sample consisted of 71 subjects with a mean age of 74.30 years. It was observed that 30.99 percent of the older individuals showed to be independent in performing the proposed activities; 22.53 percent were partly dependent; and 46.48 percent were fully dependent. Gerontology care must aim at maintaining functional conditions, thus promoting independence and preserving these individuals' dignity.

Este estudio pretende identificar el grado de dependencia de ancianos hospitalizados para la realización de las actividades básicas de la vida diaria. Se trata de un estudio cuantitativo, transversal y descriptivo, desarrollado en la Enfermería para Adultos del sector de Urgencias del Hospital das Clínicas de Botucatu - UNESP. La compilación de los datos ocurrió mediante entrevistas, observación y consulta de los expedientes individuales. El análisis de los datos se hizo con el paquete estadístico SAS for Windows versión 9.2, utilizando regresión logística. La muestra estuvo constituida por 71 sujetos, con edad media de 74,30 años. Se verificó que el 30,99 por ciento de los ancianos fueron independientes en la realización de las actividades propuestas; el 22,53 por ciento, parcialmente dependientes y el 46,48 por ciento totalmente dependientes. El cuidado en gerontología debe concentrarse en el mantenimiento del estado funcional, promover la independencia y preservar la dignidad de los sujetos.

Caracterização da educação em saúde dos cuidadores formais em instituições de longa permanência para idosos de Botucatu-SP / Characterization the health education of formal care providers in long-stay institutions for older individuals in Botucatu-SP

O objetivo deste estudo foi caracterizar a educação em saúde dos cuidadores formais em Instituições de Longa Permanência para Idosos (ILPIs) de Botucatu-SP. Trata-se de um estudo descritivo, quantitativo e transversal realizado em nove ILPIs cadastradas pela Vigilância Sanitária, sendo entrevistados 43 cuidadores, os responsáveis técnicos e coordenadores dessas instituições. Foram aplicadas questões técnicas para analisar o conhecimento dos cuidadores quanto à assistência ao idoso e também a Escala de Katz para avaliar o nível de dependência dos idosos abrigados para a realização das atividades da vida diária. A maioria dos cuidadores possuía o 2º grau completo, mas 34,9% apresentavam 1º grau incompleto. Além disso, 58,1% tinham formação na área da saúde e 9,3% realizaram cursos específicos na área de Saúde do Idoso. As principais dificuldades apontadas pelos cuidadores foram referentes às condições e organização de trabalho, sobretudo, a falta de recursos humanos e à habilidade técnica e/ou psicológica para lidar com o idoso com presença de estresse e deficiência de atividades de lazer. No entanto, a necessidade de capacitação não é percebida como prioridade. Os resultados revelaram desconhecimento de cuidados básicos, principalmente com relação à crença de mitos e estereótipos sobre o idoso e o processo de envelhecimento, sendo importante a expansão de conteúdos gerontológicos nos currículos de cursos especializados bem como o estabelecimento de critérios para a função de cuidador com seleção mais criteriosa no processo de contratação. Dificuldades quanto à referência e contrarreferência de idosos e a falta de rede de apoio social também foram referidas pelos responsáveis e/ou coordenadores, sugerindo a necessidade de melhor integração dos serviços com definição clara das responsabilidades.(...)

This study aimed at characterizing the health education of formal care providers in Long-Stay Institutions for Older Individuals (ILPIs) in Botucatu-SP, Brazil. It is a descriptive cross-sectional study performed in nine ILPIs registered by Health Surveillance, where forty-three care providers, technical supervisors and coordinators were interviewed. Technical questions were applied in order to evaluate the care providers’ knowledge concerning care provision to older individuals, and the Katz scale was used to analyze the older sheltered individuals’ level of dependence to perform activities of daily living. Most care providers were high-school graduates, but 34.9% had not completed elementary-school education. Additionally, 58.1% had health-care qualifications, and 9.3% had attended specific courses on older people’s health. The major difficulties reported by the care providers were related to work conditions and organization, particularly to the lack of human resources and of technical and/or psychological skills to deal with the older individuals in the presence of stress and deficiency of leisure activities. However, the need for training is not perceived as a priority. Results showed lack of knowledge concerning basic care, particularly as regards the belief in myths and stereotypes regarding older persons and the ageing process, which shows the importance of the expansion of gerontological content in the curricula of specialized programs as well as the establishment of criteria for health care provider jobs with more strict criteria in hiring processes. Difficulties concerning the referral and counter-referral of older individuals and the lack of a social-support network were also reported by the professionals in charge or coordinators, suggesting the need for better integration of services with a clear definition of responsibilities.(...)