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Edmundo de Drummond Alves Junior
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Orces C.H., Lee S., Bradshaw B.
Sex and ethnic differences in hip fracture-related mortality in Texas, 1990
through 1998.
Tex Med 2002 Dec;98(12):56-8.
Hip fracture, the most serious complication of osteoporosis, is associated with
considerable morbidity and mortality. Knowledge of hip fracture-related
mortality rates by age, sex, and ethnicity as well as temporal changes in
mortality are important for health planners to implement programs aimed at
awareness and prevention of hip fractures. This study determines adjusted death
rates in Texas by age, sex, and ethnic group from 1990 through 1998 and
describes trends in mortality during the 9-year period. Upward trends in
mortality were observed for both sexes in whites and blacks. Hispanics showed
trends toward decreasing mortality rates. The highest mortality rates were
observed in whites, predominantly in persons 80 years and older. Furthermore,
rates in men by ethnic group consistently exceeded those in women. As the
population ages, hip fractures are becoming a major public health problem in
Texas that will likely increase unless fall prevention strategies and treatment
of osteoporosis in elderly people are improved
Montgomery P., Dennis J.
Physical exercise for sleep problems in adults aged 60+ (Cochrane Review).
Cochrane Database Syst Rev 2002;(4):CD003404.
BACKGROUND: The prevalence of sleep problems in adulthood increases with age.
While not all sleep changes are pathological in later life, severedisturbances
may lead to depression, cognitive impairments, deterioration of quality of
life, significant stresses for carers and increased healthcare costs. The most
common treatment for sleep disorders (particularly insomnia) is
pharmacological. The efficacy of non-drug interventions has been suggested to
be slower than pharmacological methods, but with no risk of drug-related
tolerance or dependency. Physical exercise, taken regularly, may promote
relaxation and raise core body temperature in ways that are beneficial to
initiating and maintaining sleep. OBJECTIVES: To assess the efficacy of
physical exercise amongst older adults (aged 60 and above). SEARCH STRATEGY: We
searched: MEDLINE (1966 - October 2001); EMBASE (1980 - January 2002), CINAHL (
1982 - January 2002; PsychINFO 1887 to 2002; The Cochrane Library (Issue 1,
2002); National Research Register (NRR [2002]). Bibliographiesof existing
reviews in the area, as well as of all trial reports obtained,were searched.
Experts in the field were consulted. SELECTION CRITERIA: Randomised controlled
trials of physical exercise for primary insomnia where 80% or more of
participants were over the age of 60. Participants must havebeen screened to
exclude those with dementia and/or depression. DATA COLLECTION AND ANALYSIS:
Abstracts of studies identified in searches of electronic databases were read
and assessed to determine whether they might meet the inclusion criteria. Data
were analysed separately depending on whether results had been obtained
subjectively or objectively. MAIN RESULTS: One trial, including 43 participants
with insomnia, examined the effectiveness of exercise in a population within an
elderly population. At post-treatment, sleep onset latency improved slightly
for both men and women. Total sleep duration, sleep onset latency and scores on
a scale of global sleep quality showed significant improvement. Improvements in
sleep efficiency were not significant. In some cases improvements indicated
falls to below what are usually considered pathological levels but the wide
confidence intervals and small sample size indicate that these findings must be
interpreted with caution. REVIEWER'S CONCLUSIONS: When the possible
side-effects of standard treatment (hypnotics) are considered, there is an
argument to be made for clinical use of alternative treatments in the elderly.
Exercise, though not appropriate for all in this population, may enhance sleep
and contribute to an increased quality of life. Research involving exercise
programmes designed with the elderly in mind is needed.
Weissberger A.J., Anastasiadis A.D., Sturgess I., Martin F.C., Smith M.A.,
Sonksen P.H.
Recombinant human growth hormone treatment in elderly patients undergoing
elective total hip replacement.
Clin Endocrinol (Oxf) 2003 Jan;58(1):99-107.
OBJECTIVE: Measures to prevent postoperative catabolism may be of greatest
benefit in the elderly because of their reduced lean tissue reserve. We
examined the effects of recombinant human growth hormone (GH) treatment on body
composition and physical performance in elderly patients undergoing elective
total hip replacement. METHODS: We recruited 33 patients (aged 60-82 years)
scheduled for hip replacement. The study was double-blind and
placebo-controlled with parallel groups. GH or placebo was administeredfor 14
weeks preoperatively (target GH dose 0.04 U/kg/day) and 4 weeks postoperatively
(with dose doubled for first 2 weeks postoperatively). Serum IGF-I, body
composition, mid-thigh muscle cross-sectional area, muscle strength and 4-min
walking distance were measured at baseline, 2-3 days preoperatively and 4 weeks
postoperatively. RESULTS: Mean serum IGF-I doubled during GH treatment. Lean
body mass increased preoperatively by an average of 5.2% (representing 1.8 kg)
with GH treatment (P < 0.05 vs. placebo), but fellpostoperatively by 3% in both
groups. Similar changes pre- and postoperatively were seen for mid-thigh muscle
cross-sectional area, such that there was no net loss in the GH group but a
fall of more than 10% in the placebo group (P < 0.005 vs. GH). There was a
trend towards a favourable effect of GH on strength in the majority of muscles
tested, but this was significant only for the abductors of the nonoperated hip
(P < 0.02), where there was a 7% increase in strength over the whole study
compared with a 25% decrease in the placebo group. Four-minute walking distance
improved postoperatively by a mean of 26.9 m in the GH group compared with a
19.5 m reduction in theplacebo group (P < 0.05). Dose-related side-effects were
seen in the majority of patients receiving GH. CONCLUSIONS: In elderly patients
undergoing total hip replacement, preoperative GH treatment results in
improvements in lean body mass and skeletal muscle mass that are sufficient to
offset postoperative losses. The treatment may also preserve or improve muscle
strengthand postoperative walking ability
Huang L.H., Chen S.W., Yu Y.P., Chen P.R., Lin Y.C.
The effectiveness of health promotion education programs for community elderly.
J Nurs Res 2002 Dec;10(4):261-70.
The purpose of this study was to examine the effectiveness of health promotion
education programs for a group of elderly residents in a community. A one group
pre- and post-test design was used in this study. Nurses, dietitians, and
physical education teachers worked collaboratively to provide a series of
comprehensive, integrated education programs. Course content included healthy
life style and health promotion, disease prevention, nutrition, exercise, and
medication education. A total of 140 elderly participated in this study.
Ninety- seven subjects attended all of the educationprograms. A structured
questionnaire was used for data collection. Information about demographics,
health status, health promotion knowledge and behaviors was included. The
health promotion behavior data were collected twice. The initial data set was
collected prior to the first course and the second after the fifth course.
Health promotion knowledge was assessed pre- andpost-test in the second, third,
and fourth courses. The research findings revealed that the education programs
were effective in improving elderly health promotion knowledge and behaviors.
The scores for health promotion knowledge and positive health behaviors were
high among subjects who were aged65-69 years, were married, lived with family
members and had higher education levels. The results could be used as a
reference in future health promotion education in the community
Tsai J.C., Chan P., Wang C.H., Jeng C., Hsieh M.H., Kao P.F., Chen Y.J., Liu
J.C.
The effects of exercise training on walking function and perception of health
status in elderly patients with peripheral arterial occlusive disease.
J Intern Med 2002 Nov;252(5):448-55.
OBJECTIVE: To determine the effects of 12-week exercise programme on ambulatory
function, free-living daily physical activity and health-related quality of
life in disabled older patients with intermittent claudication. DESIGN:
Prospective, randomized controlled trial. SETTING: University Medical Center
and Veterans Affairs Medical Center, Taipei, Taiwan. SUBJECTS: Thirty-two of 64
patients with Fontaine stage II peripheral arterial occlusive disease (PAOD)
were randomized to exercise training and 32 to usual care control. Five
patients from the exercise group and six patients fromthe control group dropped
out, leaving 27 and 26 patients, respectively, completing the study in each
group. INTERVENTIONS: Twelve weeks of treadmillexercise training. MAIN OUTCOME
MEASURES: Treadmill walking time to onset of claudication pain and to maximal
claudication pain, 6-min walk distance,self-reported ambulatory ability and
perceived health-related quality of life (QOL). RESULTS: Compliance of exercise
programme was 83% of the possible sessions. Exercise training increased
treadmill walking time to onset of claudication pain by 88% (P < 0.001), time
to maximal pain by 70% (P < 0.001), and 6-min walk distance by 21% (P < 0.001).
SUBJECTS: Perception of health-related QOL improved from 12% to 178% in the
exercise group. These improvements were significantly better than the changes
in the control group (P< 0.05). CONCLUSIONS: Significant improvements in
claudication following 12-week exercise training in elderly PAOD patients were
observed. Increase in treadmill walking time to maximal claudication pain in
these patients translated into the improvement of perceived physical health,
which enabled the patients to become more functionally independent.
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