Physical fitness: exercise prescription for older adults. 3.

Patients age 50 and older who are seen by primary care doctors are in various stages of wellness, ranging from healthy to frail. Because of this diversity, exercise prescription needs to be individualized, based on many of the same principles as drug prescription. Fitness programs typically include exercises to improve posture, aerobics, flexibility, strength, and balance. Exercising for 5 minutes a day is a good starting point, with sessions increasing gradually to 20 to 30 minutes. Trunk strengthening exercise can help patients stand from soft, low chairs. Ankle exercises can reduce the risk of falls and hip fractures. Weight training is safe and effective exercise for older patients.

Physical fitness: benefits of exercise for the older patient. 2.

Exercise provides important benefits for older adults in the areas of cardiovascular function, strength and muscle mass, postural stability, and psychological function. These benefits can be achieved by those who are healthy, as well as by the frail and very old. Physicians can use a simple screening test to identify patients at risk for loss of mobility and function due to muscle weakness. Exercise helps prevent hip fractures from falls by increasing bone density, coordination, balance, and muscle strength. It is also an important treatment for patients with arthritis, Parkinson's disease, stroke, and other chronic diseases of aging. Patients who exercise show improvements in depressive symptoms and sleep disorders.

Physical fitness: how to help older patients live stronger and longer. (1).

Most older Americans are not physically fit and do not exercise regularly. This is especially true of older women, who are weaker than men and become disabled and dependent in the later years at a much greater rate. Exercise can increase the body's metabolism and make it more efficient in burning calories. Physical fitness also makes respiration more efficient. Evidence suggests strongly that the physically fit live 2 to 3 years longer and have a better quality of life than sedentary individuals. Any time is the best time for a person of any age to start exercising. Exercise is movement--dancing, walking, lifting a weight, using the body. Older individuals tend to be willing to exercise if they are given appropriate recommendations and follow-up.

Risk stratification and clinical outcome of minimally symptomatic and asymptomatic patients with nonsustained ventricular tachycardia and coronary disease: a prospective single-center study.

The Multicenter Automatic Defibrillator Implantation Trial (MADIT) showed improved survival with defibrillator therapy but was restricted to coronary artery disease patients with nonsustained ventricular tachycardia (NSVT) and inducible nonsupressible VT. The outcome of patients without inducible VT or inducible but suppressed VT still remains unclear. We performed risk stratification at electrophysiologic (EP) study in 111 consecutive unselected patients with nonsustained VT and coronary artery disease and randomized them to drug or device therapy. Follow-up on selected therapy was 1-71 (mean 27 +/- 20) months. Of 111 patients, 39 patients (35%) had inducible sustained VT at baseline EP study and were stratified to a "higher" risk group (group 1) for sudden death. In 9 of these patients (group 1A), sustained VT was suppressed with class IA antiarrhythmic drugs; in the remaining 30 patients (group 1B) sustained VT was not suppressed with class IA antiarrhythmic drugs. The other 72 of 111 patients (65%) had no inducible sustained VT at EP study and were stratified to a "lower"-risk group (group 2) for sudden death. Mean LVEF in group 1 was 30 +/- 10% versus 37 +/- 9% in group 2 (p = 0.001). Selected therapy in group 1 was an implantable cardioverter defibrillator (16 patients) or guided drug therapy (electrophysiologically guided class I antiarrhythmic drugs = 7 patients; Holter-guided class III antiarrhythmic drugs = 16 patients). In group 2, empiric drug therapy included beta blockers in 29 patients or Holter-guided class III antiarrhythmic drugs in 17 patients, with no antiarrhythmic drug therapy being administered in 26 patients. Mean LVEF tended to be lower in patients receiving class III antiarrhythmic drug therapy (34 +/- 12%) than in patients receiving beta blockers (40 +/- 10%, p = 0.06). Three-year total survival was comparable in group 1 (70%) and in group 2 (81%), but sudden cardiac death mortality tended to be lower in group 1 versus group 2 (0 vs 9%, p = 0.09). Patients receiving class III antiarrhythmic therapy had significantly higher 3-year all cause (40%, p = 0.04) and sudden death (25%, p = 0.06) mortality than patients receiving beta blockers (17% and 8% respectively) or no antiarrhythmic drug therapy (4% and 0%, respectively). The following conclusions can be drawn from this analysis: (1) Electrophysiologically guided drug therapy and implantable defibrillators can minimize the risk of sudden cardiac death in patients with coronary artery disease and inducible sustained VT stratified to higher risk of sudden death. A comparable outcome with respect to sudden death prevention in drug-suppressed or drug-refractory patients suggests limited prognostic benefit of class IA drug testing. (2) Lower-risk patients with severely depressed LVEF and minimal or no symptoms do not have a favorable outcome with respect to sudden and all-cause mortality on Holter-guided class III drug therapy. However, asymptomatic patients with mildly depressed left ventricular function have low sudden death event rates on beta blocker or no antiarrhythmic drug therapy.

Rehabilitation of the older person: a psychosocial focus.

The purpose of this paper is to review psychosocial aspects of geriatric rehabilitation and suggest treatment modifications and responsibilities of physical therapists in this area. Current statistics on elderly people are given, and the implications of these statistics for future health care and the rehabilitation of elderly patients are discussed. The current literature on psychosocial theories of aging is reviewed, and implications for care are given. The additional topics covered in this overview are depression and motivation, hypochondriasis, and organic brain syndrome. This overview also describes several quick and easy assessment tools and intervention techniques that can be used in the clinical setting by physical therapists. Throughout this article, suggestions are made from a psychosocial focus for the role of the physical therapist in geriatric rehabilitation.

Ileorectal anastomosis: appreciation by patients.

Two hundred patients treated by ileorectal anastomosis for ulcerative colitis were questioned about their opinion of the result of their operation. The vast majority of patients led normal business and social lives and their activities had been greatly altered for the better by this operation.

Effect of neostigmine on integrity of ileorectal anastomoses.

Patients undergoing total colectomy and ileorectal anastomosis for chronic ulcerative colitis were divided into two groups depending on whether neostigmine was administered during the anaesthetic to reverse the muscle relaxant. Those receiving neostigmine showed a postoperative anastomotic leakage rate of 36%. In the group not receiving neostigmine the leak rate was 4%, an apparently highly significant difference. Neostigmine may produce this effect by causing contractions of the gut musculature or by vasoconstriction of the blood vessels to the suture line, resulting in local ischaemia.