Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial

ObjectiveTo determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department.DesignRandomised controlled trial.Participants274 cognitively impaired older people (aged 65 or over) presenting to the accident and emergency department after a fall: 130 were randomised to assessment and intervention and 144 were randomised to assessment followed by conventional care (control group).SettingTwo accident and emergency departments, Newcastle upon Tyne.ResultsIntention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year''s follow up (74% (96/130) and 80% (115/144), relative risk ratio 0.92, 95% confidence interval 0.81 to 1.05). No significant differences were found between groups for secondary outcome measures.ConclusionsMultifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency department after a fall.

What is already known on this topic

Multifactorial intervention prevents falls in cognitively normal older people living in the community and in those who present to the accident and emergency department after a fallFall prevention strategies have not been tested by controlled trials in patients with cognitive impairment and dementia who fall

What this study adds

No benefit was shown from multifactorial assessment and intervention after a fall in patients with cognitive impairment and dementia presenting to the accident and emergency departmentThe intervention was less effective in these patients than in cognitively normal older people     

Efectos del estado cognitivo sobre las alteraciones del equilibrio y la marcha en ancianos institucionalizados

BackgroundAgeing has been linked to a high prevalence of cognitive impairment, which, in turn, has been related to balance disturbances and gait disorders. The aim of this study was to identify whether there are differences between subjects with and without cognitive impairment regarding the quality of gait and balance.Material and methodsAn observational study was conducted on institutionalised people older than 65 years (n = 82). Gait and balance was evaluated after the assessment of cognitive impairment using the Mini-Mental State Examination (MMSE). Single and dual tests were used including, the 6-minute walking, stride length, and gait speed. Timed Up and Go tests were also used to evaluate balance.ResultsThe participants were divided into three groups: 28 subjects in the group without cognitive impairment (MMSE ≥ 27), 29 subjects with mild (27 < MMSE ≤ 21) and 26 subjects with moderate cognitive impairment (MMSE < 21). Gait assessment showed significant between-groups differences in all the variables (P < .05). The variables assessing balance also showed significantly worse values in those groups with cognitive impairment.ConclusionThe severity of cognitive impairment is related to impaired balance and gait, thus the clinical monitoring of these variables in population at risk is needed.     

Evaluación funcional y cognitiva en una población urbana de mayores de 89 años. Estudio NonaSantFeliu

Introductionthe increase in life expectancy should be characterized by an increase in disability-free life. We assessed functional and cognitive capacity in an urban population older than 89 years, as well as possible gender variations.Material and methodsthe NonaSantFeliu study is a longitudinal, observational, population-based study. We present the first crosssectional survey of 186 inhabitants older than 89 years in a city. Sociodemographic data were gathered. We assessed basic activities of daily living with the Barthel Index (BI), instrumental activities with the Lawton Index (LI), cognitive status with the Mini-Mental State Examination (MMSE) and comorbidity with the Charlson Index (CI).Resultsof 186 examined nonagenarians, 143 (76.5%) were women. The mean age SD was 93.1 ± 3.1 years. One-hundred forty nine (80.2%) were widowed and 26% were institutionalized. The mean BI was 60.8 ± 30; 56% were functionally independent or had slight dependence. The mean LI was 2.1 ± 2.8. The mean MMSE score was 21 ± 11; 56% had an MMSE score higher than 23. The mean CI was 1.4 ± 1.7. No significant differences were found by gender.Conclusionsdespite their advanced age, most of the nonagenarians showed mild functional and cognitive impairment with low comorbidity. No significant differences were observed by gender. Future studies should help to detect nonagenarians at high risk of rapid impairment to allow early initiation of interventions to delay the development of further incapacity.     

Efecto positivo de la terapia de luz brillante sobre el estado de ánimo y la calidad del sueño en las personas mayores institucionalizadas

IntroductionBright light exposure during the day has a positive effect on health and its deficit can cause multiple physiological and cognitive disorders, including depression. The aim of this study was to evaluate the effect of bright light therapy (BLT) on the quality of sleep and mood emotional state; cognitive status, global deterioration and quality of life in institutionalized elderly.Material and methodsThis is a study with repeated measures design. Thirty-seven older people admitted to a nursing home. The study lasted 3 weeks. The first week, the reference values were established with the Oviedo Sleep Questionnaire, Yesavage Depression Scale, Mini-Mental, Global Scale of Impairment and European Quality of Life Questionnaire. During the second week, they were exposed to BLT (7,000-10,000 lx at eye level) between 9:30 a.m. and 11:00 a.m. During the third week, all the data were re-evaluated.ResultsAll variables improved significantly after the application of light therapy. Sleep (COS) pre-test 4.1 ± 1.49, post-test 4.9 ± 1.46, p: 0.01), mood (pre-test 3.65 ± 2.78, post-test 2.65 ± 2.9, p: 0.01), cognitive state (pre-test 22.72 ± 6.53, post-test 24 ± 5.92, p: 0.001), state of global deterioration (pre-test 3.10 ± 1.26, post-test 2.72 ± 5.92, p: 0.001) and health-related quality of life (pre-test 6.93 ± 1.86, post-test 7.82 ± 1.62, p: 0.001).ConclusionsSleep quality, mood, cognitive status, global deterioration status and quality of life significantly improved after the application of light bright therapy.     

REMCARE: Pragmatic Multi-Centre Randomised Trial of Reminiscence Groups for People with Dementia and their Family Carers: Effectiveness and Economic Analysis

BackgroundJoint reminiscence groups, involving people with dementia and family carers together, are popular, but the evidence-base is limited. This study aimed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care.MethodsThis multi-centre, pragmatic randomised controlled trial had two parallel arms: intervention group and usual-care control group. A restricted dynamic method of randomisation was used, with an overall allocation ratio of 1:1, restricted to ensure viable sized intervention groups. Assessments, blind to treatment allocation, were carried out at baseline, three months and ten months (primary end-point), usually in the person''s home. Participants were recruited in eight centres, mainly through NHS Memory Clinics and NHS community mental health teams. Included participants were community resident people with mild to moderate dementia (DSM-IV), who had a relative or other care-giver in regular contact, to act as informant and willing and able to participate in intervention. 71% carers were spouses. 488 people with dementia (mean age 77.5)were randomised: 268 intervention, 220 control; 350 dyads completed the study (206 intervention, 144 control). The intervention evaluated was joint reminiscence groups (with up to 12 dyads) weekly for twelve weeks; monthly maintenance sessions for further seven months. Sessions followed a published treatment manual and were held in a variety of community settings. Two trained facilitators in each centre were supported by volunteers. Primary outcome measures were self-reported quality of life for the person with dementia (QoL-AD), psychological distress for the carer (General Health Questionnaire, GHQ-28). Secondary outcome measures included: autobiographical memory and activities of daily living for the person with dementia; carer stress for the carer; mood, relationship quality and service use and costs for both.ResultsThe intention to treat analysis (ANCOVA) identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes (self-reported QoL-AD mean difference 0.07 (-1.21 to 1.35), F = 0.48, p = 0.53). Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a General Health Questionnaire-28 sub-scale at the ten month end-point (mean difference 1.25 (0.25 to 2.26), F = 8.28, p = 0.04). Compliance analyses suggested improved autobiographical memory, quality of life and relationship quality for people with dementia attending more reminiscence sessions, however carers attending more groups showed increased care-giving stress. Economic analyses from a public sector perspective indicated that joint reminiscence groups are unlikely to be cost-effective. There were no significant adverse effects attributed to the intervention. Potential limitations of the study include less than optimal attendance at the group sessions—only 57% of participants attended at least half of the intervention sessions over the 10 month period, and a higher rate of study withdrawal in the control group.ConclusionsThis trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups. Possible beneficial effects for people with dementia who attend sessions as planned are offset by raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further, and may necessitate reappraisal of the movement towards joint interventions.

Trial Registration

ISRCTN Registry ISRCTN42430123     

Asociación entre la longitud de los telómeros y deterioro cognitivo en adultos mayores

IntroductionCognitive impairment is a transition stage between normal aging and dementia, the prevalence of last one increases with age; the damage of the functions and physical integrity, places the older adult in a greater susceptibility to get sick. Telomere length is a hallmark of aging to characterize this phenotype, as well as a biomarker that reflects the underlying state of the cell. In this work, the relative length of telomeres in older adults with cognitive impairment was correlated.Material and methodsObservational-analytical study, in samples of adult patients older than 65 years with and without cognitive impairment, in whom the relative length of telomeres was measured.ResultsNinety samples of older adults were included in the study and in the association analysis according to multivariate logistic models, cognitive impairment showed almost five times more risk for telomere shortening in relation to the presence of the diagnosis of cognitive impairment (Odds ratio 4.88, p = 0.027).ConclusionsWhen correlating the relative length of telomeres in older adults diagnosed with cognitive impairment, this association was confirmed for shorter.     

A characteristic N-glycopeptide signature associated with diabetic cognitive impairment identified in a longitudinal cohort study

BackgroundIdentifying a biomarker for the decline in cognitive function in patients with diabetes is important. Therefore, we aimed to identify the N-glycopeptides on plasma proteins associated with diabetic cognitive impairment in participants in a longitudinal study using N-glycoproteomics.MethodsWe used samples from the 3-year SONIC (Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians) longitudinal cohort study of older Japanese people in the general population. First, we placed the participants with diabetes into two groups: those that did or did not have cognitive decline over a 6-year period. Next, their plasma protein profiles were compared between baseline and the 6-year time point using two-dimensional fluorescence difference gel electrophoresis. Finally, an N-glycoproteomic study of the focused proteins was performed using an enrichment technique and liquid chromatography-tandem mass spectrometry.ResultsApproximately 500 N-glycopeptides, derived from 18 proteins, were identified in each sample, from among which we identified the N-glycopeptides that were associated with diabetic cognitive impairment using multivariate analysis. We found that N-glycopeptides with sialylated tri- or tetra-antennary glycans on alpha-2-macroglobulin, clusterin, serum paraoxonase/arylesterase 1, and haptoglobin were less abundant, whereas 3-sialylated tri-antennary N-glycopeptides on serotransferrin were more abundant.ConclusionN-glycopeptides with sialylated multi-antennary glycans comprise a characteristic signature associated with diabetic cognitive impairment.General significanceThe characterized N-glycopeptides represent potential biomarker candidates for diabetic cognitive impairment.     

Influence of manganese exposure on cognitive function,plasma APP and Aβ levels in older men

BackgroundElevated manganese (Mn) exposure impairs cognition in adults and children, but the association between Mn and cognitive function in elderly people is unclear. Previous studies have linked Mn neurotoxicity in AD to Aβ-dependent mechanisms. However, the association between Mn and plasma APP and Aβ in the general elderly population remains unknown. This study aimed to investigate the association between Mn exposure and cognitive function, plasma APP and plasma Aβ in older adults.MethodsCognitive abilities in 375 men aged 60 and older in Guangxi, China were assessed using the Mini-Mental State Examination (MMSE) and cognitive impairment were identified using education-stratified cut-off points of MMSE scores. Urinary Mn levels and plasma APP, and Aβ levels were measured using ICP-MS and ELISA, respectively.ResultsA total of 109 (29.07 %) older men were identified as having cognitive impairment. The median urinary Mn level was 0.22 μg/g creatinine. Urinary Mn levels were negatively correlated with MMSE scores (β = −1.35, 95 % CI: −2.65 to −0.06; p = 0.041). In addition, higher concentrations of urinary manganese were associated with a greater risk of cognitive impairment (OR = 2.03, 95 % CI: 1.14–3.59; comparing the highest and lowest manganese; p = 0.025). Moreover, plasma APP levels were inversely associated with urinary Mn levels (r = −0.123, p = 0.020), and positively associated with MMSE scores (r = 0.158, p = 0.002). Surprisingly, no correlations were observed between plasma Aβ42, Aβ40, Aβ40/Aβ42, or Aβ42/Aβ40 and urinary Mn levels and MMSE scores.ConclusionThese results suggested that Mn exposure is negatively associated with older men’s cognition and plasma APP levels, but not plasma Aβ levels.     

Clinical Efficacy and Patient Satisfaction with U-500 Insulin Pump Therapy in Patients with Type 2 Diabetes

ObjectiveTo determine the safety and efficacy of U-500 regular insulin in pump therapy and to assess satisfaction with U-500 insulin pump therapy in patients with type 2 diabetes and severe insulin resistance.MethodsWe performed a retrospective review of medical records of 6 patients with type 2 diabetes and insulin resistance who had been using U-500 insulin pump therapy for at least 6 months. In addition, we conducted a telephone follow-up patient satisfaction survey.ResultsThe mean age of the patients was 57 ± 6 years. Of the 6 patients (3 men and 3 women), 4 were white, 1 was black, and 1 was Asian. The mean hemoglobin A1c value before continuous subcutaneous insulin infusion therapy with U-500 regular insulin was 9.1% ± 1.8%, and the mean U-100 insulin dose required was 391 ± 91 U/day. In comparison, the mean U-500 insulin dose required at 6 months was 59.2 ± 13.6 U/day, which is equivalent to 296 ± 68 U/day of U-100 insulin (P = 0.04), and the mean hemoglobin A1c value at 6 months after treatment with the insulin pump using U-500 regular insulin was 6.9% ± 0.9% (P = 0.03). In addition, our study patients lost a mean of 6.1 lb during the 6-month period, and no patient had clinically significant episodes of hypoglycemia. The majority of the patients reported a higher satisfaction with the U-500 insulin pump therapy in comparison with conventional insulin treatment.ConclusionU-500 insulin pump therapy is a novel alternative for patients with type 2 diabetes and severe insulin resistance who have not met glycemic control goals with use of standard intensive insulin regimens. (Endocr Pract. 2007;13:721-725)     

Datos normativos del test Barcelona revisado-abreviado para personas mayores cognitivamente activas

IntroductionNeuropsychological assessment is mandatory in order to identify cognitive changes that occur during either normal or pathological aging. However, normative data adapted to the characteristics of the population are needed in order to reduce the probability of false diagnoses of cognitive impairment. The aim of the present work was to compute normative data for cognitively active elderly people attending a University course for the elderly.Materials and methodsAn analysis was performed on the data from 87 participants (70.9% women) with a mean age of 66.73 years who undertook the abbreviated- revised Barcelona test (test de Barcelona revisado-abreviado). Normative data were calculated using linear regressions controlling for age, gender, and years of education. Adjusted normative data were compared with normative data available from the test manual and obtained from the general population.ResultsYears of education and gender showed the highest weights in the regression model. Normative data for cognitively active older adults showed a different number of low scores compared to normative data from the general population. The number of low scores were related to years of education and general cognitive functioning.ConclusionsNormative data obtained from cognitively active older people could help identify more accurately the cognitive functioning of cognitively active older people than do normative data obtained from the general population.     

Análisis longitudinal de parámetros nutricionales en una cohorte de ancianos con y sin demencia

IntroductionIt is important to assess longitudinal nutritional parameters during the ageing process in order to determine body composition changes. This procedure is more relevant when dealing with institutionalised geriatric patients suffering from cognitive impairment. The aim of this study was to assess the interactions, if any, between mental status and several nutritional parameters in a cohort of elderly people.Material and methodsA longitudinal prospective two years follow-up evaluation was performed on 301 elderly residents (233 females and 68 males) in a nursing home, of whom 51 of them fulfilled the clinical criteria for dementia. Both anthropometric and biochemical parameters were obtained annually, according to standard procedures.ResultsThe dementia group had lower values when compared to the non-dementia group. Furthermore, nutritional values remained constant in the group with cognitive impairment (no significant differences were observed throughout the study period). BMI 24.5 ± 4.9 vs 24.2 ± 4.1; tricipital skinfold 15.0 ± 6.0 vs 14.7 ± 6.9; brachial circumference 25.9 ± 3.3 vs 25.7 ± 3.5, and albumin 3.7 ± 0.3 vs 3.7 ± 0.3. At the end of the study, the group without cognitive impairment showed lower values in all the parameters analysed when compared to the baseline ones, except for bicipital fold and plasma triglycerides.ConclusionsOur study shows that there are no variations in the elderly with cognitive impairment, as regards the nutritional, anthropometric and biochemist parameters analysed. On the contrary, the group with normal cognitive status showed a reduction in most of the parameters. Further studies analysing larger populations of elderly people and over longer periods of time will provide more information to improve our knowledge on this important issue.     

Nordic Walking Improves Cardiometabolic Parameters,Fitness Performance,and Quality of Life in Older Adults With Type 2 Diabetes

ObjectiveTo assess the effect of Nordic walking (NW) on cardiometabolic health, physical performance, and well-being in sedentary older adults with type 2 diabetes (T2D).MethodsFifteen subjects with T2D (female, 5; male, 10; age, 65 ± 6.2 years [mean ± standard deviation]; body mass index, 27.3 ± 4.9 kg/m² [mean ± standard deviation]) were enrolled in a 6-month NW training program. The fasting glucose and glycosylated hemoglobin levels, lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), systolic blood pressure (SBP), and diastolic blood pressures were measured before and after the intervention. Participants’ quality of life (Short-Form Health Survey) and physical fitness (6-minute walking test) were also evaluated.ResultsCompared with baseline, NW significantly improved the fasting glucose level (103.5 ± 18.5 vs 168.7 ± 37.7 mg/dL, P = .01), SBP (121.8 ± 12.2 vs 133 ± 14.4 mm Hg, P = .02), physical fitness (759.88 ± 69 vs 615.5 ± 62.6 m, P < .001), and both mental health (54.5 ± 4.4 vs 45.7 ± 5.6, P < .01) and physical health (49.8 ± 4.7 vs 40.3 ± 5.9, P < .01). The levels of glycosylated hemoglobin (6.15% ± 0.8% vs 6.4% ± 1%, P = .46), total cholesterol (162.2 ± 31.2 vs 175.5 ± 28.8 mg/dL, P = .13), low-density lipoprotein cholesterol (95.2 ± 24.2 vs 106.3 ± 32.3 mg/dL, P = .43), and triglycerides (135.5 ± 60.8 vs 127.6 ± 57.4 mg/dL, P = 0.26) improved without reaching significance.ConclusionNW training improved the glycemic levels, SBP, physical fitness, and perception of quality of life in older adults with T2D. NW represents a suitable complementary strategy to improve the global health status in this population.     

Características de los programas de entrenamiento de fuerza muscular en personas mayores con sarcopenia. Revisión de alcance

ObjectiveThe aim of this scoping review was to analyze the resistance training-based programs’ characteristics and outcomes of physical and psychological health and cognitive functions measured in older adults with sarcopenia.MethodThis scoping review was carried out following the criteria and flow diagram established in the PRISMA guidelines and included studies from 2011 until 2020 from electronic databases, including PubMed, Scopus, and Web of Science.ResultsA total of 13 randomized controlled trials were included. The sample's average age was 72.2 years, with an age range between 71 and 80 years, considering a total sample of 1029 older adults (57% women). Resistance training-based programs were carried out mainly in university facilities, presented high adherence (91.2%) and were able to induce increase in strength and muscle mass. The most frequent parameters used were 2-3 weekly, 50-90-min-long sessions for 3-9 months, using between 8 and 15 repetitions, in an intense training zone with 1-RM between 60% and 85%. The most measured physical health outcomes were muscle strength, muscle mass, and BMI. Cognitive impairment was frequently evaluated, and few studies evaluated mental health.ConclusionThis review characterized resistance training-based programs in older people with sarcopenia, highlighting the extension, frequency, duration, and intensity of these, as well the most frequently used outcome measures and instruments. These results could be useful for prescribing future resistance training-based programs in older adults with sarcopenia.     

Prevalencia de demencia en adultos mayores de América Latina: revisión sistemática

Background and objectiveDementia is a growing public health problem. It involves the impairment of several cognitive functions, generating mental and physical disability, and therefore greater functional dependence. There is limited epidemiological information which reveals an approximate prevalence in older adults from Latin America. The objective of this study was to determine the prevalence of dementia in the older adult population of Latin America, and its distribution according to geographic area and gender.Materials and methodsA systematic review was carried out in databases: PubMed, Ovid, Lilacs, Cochrane, Scielo and Google Scholar, in order to identify studies that estimate the prevalence of dementia in urban and / or rural population over 65 years of age.ResultsOn February 2018, the literature search yielded 357 publications. The overall prevalence of dementia in the older adult population of Latin America was found to be 11%, prevailing more in female gender and urban people.ConclusionThe prevalence of dementia in Latin America is higher than registered previously, and even than in other continents.     

谷红联合尼莫地平在小血管病性认知障碍与大动脉粥样硬化性认知障碍中的疗效分析

摘要 目的：谷红联合尼莫地平对小血管病性认知障碍与大动脉粥样硬化性认知障碍进行治疗,考察对两种类型血管性认知障碍的疗效。方法：以2017年-2019年12月就诊于我院血管性认知功能障碍(vascular cognitive impairment,VCI)患者为研究对象,大动脉粥样硬化型(large artery atherosclerotic,LAA)204例,为LAA组,小血管性(small vessel disease,SVD)226例,为SVD组,所有患者均给予基础治疗,在此基础上,LAA组和SVD组均进行谷红注射液和尼莫地平联合治疗,以临床疗效、认知功能评分以及不良反应情况为考察指标,考察谷红联合尼莫地平对两种类型血管性认知障碍的治疗效果。结果：经过谷红注射液联合尼莫地平的治疗,LAA组和SVD组均取得了较好的疗效,LAA组总有效率为90.20%,SVD组总有效率为88.05％,两组总有效率比较,无显著差异（P＞0.05）;治疗前两组患者的蒙特利尔认知量表(Montreal Cognitive Assessment,MoCA)评分和简易精神状态量表(Mini-Mental State Exam,MMSE)评分均无统计学差异(P>0.05);治疗后,LAA组和SVD组患者的MOCA评分和MMSE评分均显著的改善（P<0.05）,其中LAA组MOCA评分由19.31±5.45提升至22.31±6.21,MMSE评分由21.45±5.91提升至25.23±3.21,SVD组MOCA评分由19.28±4.01提升至22.88±5.73,MMSE评分由21.30±7.76提升至25.08±6.19,但两组间各项评分无显著差异（P>0.05）;治疗期间LAA组和SVD组均未出现严重不良反应,共有7例患者出现轻度头部胀痛、面部潮红等,其中LAA 组3（1.47 %）例,SVD组4（1.96 %）例,两组间比较无显著差异（P＞0.05）。结论：谷红注射液联合尼莫地平治疗小血管病性认知障碍与大动脉粥样硬化性认知障碍,均能显著缓解患者认知功能障碍症状,临床疗效显著,无严重不良反应,有一定的推广价值。     

Realización de actividades y extraversión como variables predictoras del bienestar psicológico en personas mayores

IntroductionThe relationship between extraversion and wellbeing has been discussed in the literature, however, the impact that this trait has on the wellbeing of older people has been studied to a lesser extent. The relationship between extraversion, participation in activities and psychological wellbeing in older people is analysed in this study.Material and methodsThe sample comprised 139 individuals over 55 years from rural and urban areas of the province of Granada who completed the extraversion subscale of the NEO-FFI and the Ryff Scales of the Psychological Wellbeing, as well as responding to questions that evaluated their social participation.ResultsA greater social participation was found in rural areas and among women. The activities more frequently performed by the participants were educational and religious activities, walking, everyday chores, crafts, and home improvements. A low positive correlation between extraversion and wellbeing was observed. The multiple regression analysis revealed that extraversion explained 19.9% of the variance in psychological wellbeing, which increased to 25.3% when social participation, gender, and the origin of the sample were considered.ConclusionsPsychological wellbeing appears to be associated with personality traits, such as extraversion. In addition this personality trait is linked to the number and type of activities the elderly perform which also contributes to wellbeing in old age.     

Componentes de la valoración geriátrica y adherencia terapéutica en el paciente anciano con infarto agudo de miocardio

Background and objectivePoor therapeutic adherence after acute myocardial infarction (AMI) can lead to early serious complications. Information on the impact of geriatric assessment on adherence is scarce. The objective of this study was to analyze, in older patients with AMI, the impact of geriatric assessment on therapeutic adherence 12 months after admission.Materials and methodsA previous study randomized patients aged >75 years who had presented an AMI to a nursing health education program versus conventional management, evaluating the impact of this intervention on therapeutic adherence after 12 months. In-hospital geriatric assessment was performed. For this substudy, the adherence predictors were analyzed using binary logistic regression. Those patients who obtained adherence in the 4 tools were considered adherent: the Morisky-Green, Haynes-Sackett test, attendance at visits and correct withdrawal of drugs from the pharmacy.ResultsA total of 119 patients with a mean age of 82.2 years were included. At one year, a total of 42 patients (35.3%) were adherent. The predictors of poor adherence in the final model were male sex, worse glomerular filtration rate, cognitive impairment, nutritional risk, not living alone and not belonging to the intervention group.ConclusionsThe data of this series show a low therapeutic adherence in the elderly after an AMI. Cognitive impairment or nutritional risk was significantly associated with poorer adherence, contrary to a nursing intervention, which highlights the importance of health education and supervision in high-risk patients.     

Barriers encountered during enrollment in an internet-mediated randomized controlled trial

Background

Research evidence from observational studies suggests that cognitive activity reduces the risk of cognitive impairment in later life as well as the rate of cognitive decline of people with dementia. The Promoting Healthy Ageing with Cognitive Exercise (PACE) study has been designed to determine whether a cognitive activity intervention decreases the rate of cognitive decline amongst older adults with mild cognitive impairment (MCI).

Methods/Design

The study will recruit 160 community-dwelling men and women aged 65 years of age or over with mild cognitive impairment (MCI). Participants will be randomly allocated to two treatment groups: non-specific education and cognitive activity. The intervention will consist of ten 90-minute sessions delivered twice per week over a period of five weeks. The primary outcome measure of the study is the change from baseline in the total score on the Cambridge Cognitive Score (CAMCOG). Secondary outcomes of interest include changes in memory, attention, executive functions, mood and quality of life. Primary endpoints will be collected 12, 52 and 104 weeks after the baseline assessment.

Discussion

The proposed project will produce the best available evidence on the merits of increased cognitive activity as a strategy to prevent cognitive decline among older adults with MCI. We anticipate that the results of this study will have implications for the development of evidence-based preventive strategies to reduce the rate of cognitive decline amongst older people at risk of dementia.

Trial registration

ACTRN12608000556347     

Impacto del ejercicio físico en variables relacionadas con el bienestar emocional y funcional en adultos mayores

Background and aimThe benefits of the physical exercise in aging, and specially in frailty, have been associated with reduced risk of mortality, chronic disease, and cognitive and functional impairments. Multi-component training, which combines strength, endurance, balance, and gait training, represents the most beneficial kind of physical exercise in older adults.MethodsGiven the effectiveness of the multi-component training, a physical exercise program «Actívate» (based on the methodology Vivifrail), with the focus on «active aging», was conducted in the present study. Forty-nine older adults over 60 years participated in this program.ResultsThe physical exercise intervention led to a reduction in diastolic blood pressure, pain threshold and sleep disturbances (e. g. hypersomnia) (t ≥ 2.72, p < 0.01), as well as an increase of walking speed (t = 7.84, p ≤ 0.001). Further, quality of life factors (GENCAT scale), like emotional well-being, personal development, physical well-being, self-determination, and social inclusion, were greater after intervention (t ≥ ?2.06, p < 0.05).ConclusionsThese findings underline the benefits of multi-component training in functionality of older adults, and further, provide relevant aspects about the modulation of pain perception, sleep disturbances, social factors and physical and emotional well-being. Physical exercise programs such as «Actívate» should be promoted, in order to encourage healthy lifestyle habits, in the older adults’ population.