Effect of a simple exercise programme on hospitalisation-associated disability in older patients: a randomised controlled trial

ABSTRACTObjectiveHospitalisation-associated disability (HAD, defined as the loss of ability to perform one or more basic activities of daily living [ADL] independently at discharge) is a frequent condition among older patients. The present study aimed to assess whether a simple inpatient exercise programme decreases the incidence of HAD in acutely hospitalised very old patients.DesignIn this randomized controlled trial (Activity in GEriatric acute CARe, AGECAR) participants were assigned to a control or intervention (exercise) group, and were assessed at baseline, admission, discharge, and 3 months thereafter.Setting and participants268 patients (mean age 88 years, range 75–102) admitted to an acute care for elders (ACE) unit of a Public Hospital were randomized to a control (n=125) or intervention (exercise) group (n=143).MethodsBoth groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total daily duration of ∼20 min). We measured incident HAD at discharge and after 3 months (primary outcome); and Short Physical Performance Battery (SPPB), ambulatory capacity, number of falls, re-hospitalisation and death during a 3-month follow-up (secondary outcomes).ResultsMedian duration of hospitalisation was 7 days (interquartile range 4 days). Compared with admission, the intervention group had a lower risk of HAD at discharge (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.11–0.92) and at 3-months follow-up (OR 0.24; 95% CI: 0.08–0.74) than controls during follow-up. No intervention effect was noted for the other secondary endpoints (all p>0.05), although a trend towards a lower mortality risk was observed in the intervention group (p=0.078).Conclusion and implicationsThese findings demonstrate that a simple inpatient exercise programme significantly decreases the risk of HAD in acutely hospitalised, very old patients.Trial registrationNCT0137489 (https://clinicaltrials.gov/ct2/show/NCT01374893).Brief summaryA simple inpatient intervention consisting of walking and rising from a chair (∼20 minutes/day) considerably decreases the risk of hospitalisation-associated disability in acutely hospitalised older patients.

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A 4-Year Follow-Up of Very Old Patients Presenting with Frontal-Subcortical Dysfunction Compared with Alzheimer’s Disease Patients

Gerontology ◽

10.1159/000081437 ◽

2004 ◽

Vol 51 (1) ◽

pp. 62-65 ◽

Cited By ~ 8

Author(s):

Pierre Pfitzenmeyer ◽

France Mourey ◽

Patrick Manckoundia ◽

Philippe d’Athis

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Old Patients ◽

Very Old ◽

Very Old Patients

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Mortality and One-Year Functional Outcome in Elderly and Very Old Patients with Severe Traumatic Brain Injuries: Observed and Predicted

Behavioural Neurology ◽

10.1155/2015/845491 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

Cecilie Røe ◽

Toril Skandsen ◽

Unn Manskow ◽

Tiina Ader ◽

Audny Anke

Keyword(s):

Functional Outcome ◽

Brain Injuries ◽

Clinical Information ◽

Unfavorable Outcome ◽

Old Patients ◽

Very Old ◽

Severe Tbi ◽

One Year ◽

Very Old Patients

The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC).Methods.Prospective, national multicenter study including patients with severe TBI ≥65 years. Predicted mortality and outcome were calculated based on clinical information (CRASH basic) (age, GCS score, and pupil reactivity to light), as well as with additional CT findings (CRASH CT). Observed 14-day mortality and favorable/unfavorable outcome according to the Glasgow Outcome Scale at one year was compared to the predicted outcome according to the CRASH models.Results.97 patients, mean age 75 (SD 7) years, 64% men, were included. Two patients were lost to follow-up; 48 died within 14 days. The predicted versus the observed odds ratio (OR) for mortality was 2.65. Unfavorable outcome (GOSE < 5) was observed at one year follow-up in 72% of patients. The CRASH models predicted unfavorable outcome in all patients.Conclusion.The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI.

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NOAC Therapy Is Also Effective and Safe in Patients Older Than 80 Years — Results of the Prospective Dresden NOAC Registry (NCT01588119)

Blood ◽

10.1182/blood-2018-99-118081 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 422-422

Author(s):

Jan Beyer-Westendorf ◽

Luise Tittl ◽

Christiane Naue ◽

Sandra Marten

Keyword(s):

Cardiovascular Events ◽

Research Funding ◽

Composite Endpoint ◽

Systemic Embolism ◽

Old Patients ◽

Very Old ◽

Fatal Bleeding ◽

Very Old Patients

Abstract Background: Non-vitamin-K-antagonist oral anticoagulants (NOACs) have rapidly become a cornerstone in anticoagulant therapy. However, anticoagulated patients older than 80 years represent an especially challenging population, since their thromboembolic and bleeding risks are excessively high and chronic kidney disease is common, making treatment decisions even more complicated. As a consequence, long-term safety data for this specific population are needed. Patients and methods: Using data from DRESDEN NOAC, a prospective regional registry in Germany in which patients with oral anticoagulation undergo prospective follow-up (FU) by quarterly phone interviews, we assessed rates of thromboembolic and bleeding outcomes in patients older than 80 years, based on centrally adjudicated events using standard outcome definitions. Results: Until 30th November 2017, 3984 patients were enrolled into the registry (53% male, mean age 70.2 years), including 935 patients aged ≥ 80 years (487 [52.1%] received rivaroxaban, 198 [21.2%] apixaban, 165 [17.6%] edoxaban and 85 [9.1%] dabigatran, respectively). Indication for anticoagulant therapy was atrial fibrillation (AF) in 752 (80.4%) cases, venous thromboembolism (VTE) in 179 (19.1%), and other indications in 4 (0.4%) cases. This subset of patients had a mean age of 84.2 years (range 80-100y) and 406 (43.4%) patients were male (Table 1). During a mean follow-up of 970.7 ± 642.2 days (mean NOAC exposure 815.3 ± 644.5 days) an intention-to-treat (all events counted) analysis of all very old patients demonstrated an event rate for the composite endpoint of stroke, TIA, systemic embolism or VTE of 1.0/100 patient-years (95% CI 0.8 - 1.2). In AF patients, the rate for stroke, TIA, systemic embolism was 1.0/100 patient-years (95% CI 0.8 - 1.2) and in VTE patients, the rate for recurrent DVT or PE in VTE patients was 0.4/100 patient-years (95% CI 0.2 - 0.7). In the on-treatment analysis (only on-treatment events counted), the corresponding event rates were 0.7/100 patient-years (95% CI 0.5 - 0.9) for the composite endpoint, 0.7/100 patient-years (95% CI 0.5 - 0.9) for stroke, TIA, systemic embolism in AF patients, and 0.1/100 patient-years (95% CI 0.01 - 0.3) for recurrent VTE in VTE patients, respectively. The overall rate of ISTH major bleeding was 1.0/100 patient-years (95% CI 0.8 - 1.2), with numerically higher rates in SPAF patients (1.2/100 patient-years; 95% CI 0.9 - 1.5) compared to VTE patients (0.4/100 patient-years; 95% CI 0.2 - 0.7). 255 patients died during FU (2.2/100 patient-years; 95% CI 2.0 - 2.5), of which 120 deaths occurred during or within 3 days after last intake of NOAC (1.3/100 patient-years; 95% CI 1.1 - 1.6). Most common causes of death were fatal cardiovascular event (n= 86; consisting of 20 cases of acute coronary syndrome, 19 ischaemic strokes, 17 VTE, 2 systemic embolism and 123 cases of other cardiovascular deaths such as worsening of chronic heart failure, or unexplained deaths ruled as potentially related to cardiovascular events) and age related death (n= 79), followed by sepsis/infection (n= 40), terminal malignant disease (n= 26), fatal bleeding (n= 11) and other causes (n= 13). Overall, after 1800 days of FU, approximately 80% of this very old population were outcome-free survivors, as indicated by the Kaplan Meier curve (figure1). Conclusions: During long-term FU of more than 2.5 years, this very old population of NOAC recipients demonstrated low rates of cardiovascular or major bleeding complications during active NOAC therapy. Approximately one quarter of the study population died during follow-up, with cardiovascular events being the leading cause of death. Only 11 fatal bleeding events were observed; however, most of the 58 fatal thromboembolic events occurred after anticoagulation was discontinued. This indicates that continued anticoagulation with NOACs may result in a beneficial risk-benefit ratio also in very old patients. Disclosures Beyer-Westendorf: Bayer: Honoraria, Research Funding; Boehringer-Ingelheim: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; Daiichi Sankyo: Honoraria, Research Funding. Marten:Bayer: Honoraria; Daiichi Sankyo: Honoraria.

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P0958THE EX-FRAIL CKD TRIAL: A PILOT RANDOMISED CONTROLLED TRIAL OF A HOME-BASED EXERCISE PROGRAMME FOR PRE-FRAIL AND FRAIL, OLDER ADULTS WITH CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0958 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Andrew Nixon ◽

Theodoros Bampouras ◽

Helen Gooch ◽

Hannah Young ◽

Kenneth Finlayson ◽

...

Keyword(s):

Physical Function ◽

Outcome Measures ◽

Outcome Measure ◽

Controlled Trial ◽

Exercise Programme ◽

Exercise Group ◽

Frailty Status ◽

Home Based ◽

Randomised Controlled

Abstract Background and Aims Frailty is highly prevalent in adults with chronic kidney disease (CKD) and is associated with adverse health outcomes. However, exercise training may improve physical function leading to associated improvements in outcomes. The EX-FRAIL CKD trial (ISRCTN87708989) aimed to inform the design of a randomised controlled trial (RCT) that investigates the efficacy of a progressive home-based exercise programme in pre-frail and frail older adults with CKD. Methods Patients aged ≥65 years with CKD G3b-5 and a Clinical Frailty Scale score ≥4 were eligible for participation. Participants categorised as pre-frail or frail, following Frailty Phenotype (FP) assessment, were randomised to receive a tailored 12-week home-based exercise programme or usual care (UC). Primary outcome measures included recruitment, intervention adherence, outcome measure completion and participant attrition rate. Secondary outcome measures included frailty status (FP), physical function (walking speed, handgrip strength and Short Physical Performance Battery [SPPB]), fall concern (Falls Efficacy Scale-International tool [FESI]), symptom-burden (Palliative Care Outcome Scale-Symptoms RENAL [POS-S RENAL]) and health-related quality of life (Short Form-12v2 [SF-12]). Outcome measures are reported descriptively with 95% confidence intervals (CI) as recommended for pilot trials. Progression criteria to RCT stage were defined as: (1) eligibility: STOP <5%, GO >10%; (2) recruitment: STOP <10%, GO >30%; (3) exercise adherence: STOP: <30%, GO >70%; (4) outcome measure completion: STOP <70%, GO >80%; and (5) loss to follow-up: STOP >50%, GO <25%. Results Six hundred and sixty-five participants had an eligibility assessment with 201 (30% [95% CI 27-34]) patients eligible for enrolment. Thirty-five (17% [95% CI 12-23]) participants were recruited. Six participants were categorised as robust and therefore withdrawn prior to randomisation. Fifteen participants were randomised to exercise (mean age 77.0±8.3 years; mean eGFR 18.9±7.0 ml/min/1.73m2) and 14 to UC (mean age 78.8±7.0 years; mean eGFR 20.4±7.2 ml/min/1.73m2). Eleven (73% [95% CI 45-92]) exercise group participants completed an average of ≥2 exercise sessions/week. Eight (28% [95% CI 13-47]) participants were lost to follow-up. Retained participants (n=21, 100% [95% CI 84-100]) completed all outcome measures. There were 32 adverse events in the exercise group and 22 in the UC group. Within the exercise group, there were 2 hospitalisations (considered unrelated to exercise) and 12 adverse reactions: musculoskeletal pain (9), fall (1), nocturnal leg cramps (1) and postural dizziness (1). The odds ratio for improvement in frailty status with exercise was 5.50 (95% CI 0.46-65.16) and odds ratio for deterioration in frailty status was 0.63 (95% CI 0.05-8.20). The adjusted mean group difference in walking speed, grip strength and SPPB between exercise and UC groups were: 0.01 metres/second (95% CI -0.07-0.10), 3.6 kg (95% CI -0.6-7.9) and 0.5 (95% CI -0.9-1.8), respectively. The adjusted mean group difference in POS-S RENAL, FESI, SF-12 Physical Component Summary and SF-12 Mental Component Summary scores were: -1.4 (95% CI -6.6-3.7), 3.4 (95% CI -3.5-10.3), -3.9 (95% CI -9.3-1.5) and 0.2 (95% CI -6.2-6.6), respectively. Conclusion Eligibility, adherence and outcome measure progression criteria thresholds were exceeded; however, recruitment and loss to follow-up progression criteria thresholds were not achieved. Analysis of a nested qualitative study will explore perceived barriers to participation and retention. The EX-FRAIL CKD trial demonstrates that it is possible to progress to a definitive RCT with adaptations that address the barriers described. It has also provided preliminary evidence that frailty status and physical function may be improved with a home-based exercise programme in patients living with frailty and CKD.

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Specificity of treatment is mandatory in very old patients with hairy cell leukemia

Vojnosanitetski pregled ◽

10.2298/vsp1505466m ◽

2015 ◽

Vol 72 (5) ◽

pp. 466-468

Author(s):

Dragomir Marisavljevic ◽

Olivera Markovic ◽

Radmila Zivkovic

Keyword(s):

Hairy Cell Leukemia ◽

Symptomatic Therapy ◽

Hairy Cell ◽

Cell Leukemia ◽

Old Patients ◽

Very Old ◽

Red Blood Cell Transfusions ◽

Asymptomatic Disease ◽

Very Old Patients

Introduction. There are only a few available data about hairy cell leukemia (HCL) in very old patients. We presented three very different cases of HCL in very old patients diagnosed in a single center and discussed some epidemiological and therapeutical issues in such patients. Case report. The first patient, 89-year-old, had symptomatic cytopenia and achieved sustained complete remission after cladribine treatment. The second patient, 89-year-old, had asymptomatic disease with stable full blood counts during a 3-year follow-up period in which watch-and-wait policy was adopted. The third patient, 82 years old, had two malignancies (HCL and presumably metastatic colorectal carcinoma) and his only treatment were occasional red blood cell transfusions and symptomatic therapy. Conclusion. The presented illustrative examples confirm individualization of treatment is mandatory in very old patients with HCL.

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Emergent coronary angiography in a 90-plus population – outcomes at 5-years follow-up

European Heart Journal ◽

10.1093/eurheartj/ehab724.2823 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Alves Pinto ◽

T Proenca ◽

M Martins Carvalho ◽

S Torres ◽

C X Resende ◽

...

Keyword(s):

Coronary Angiography ◽

Matched Control ◽

Left Ventricular ◽

Multivessel Disease ◽

Control Group ◽

Old Patients ◽

Very Old ◽

Matched Control Group ◽

Very Old Patients

Abstract Introduction Elderly people represents a vulnerable and increasing population presenting with acute coronary syndrome (ACS). Several data suggest the benefit of an early revascularization in ST-elevation (STE)-ACS or non-STE-ACS with positive troponin. However questions persist considering the unavoidable adverse prognosis, patient's functional and cognitive status, comorbidities and preferences. Purpose To evaluate a group of very old patients who underwent emergent coronary angiography (CA). Methods We retrospectively analyzed a group of very old patients (≥90 year-old) who underwent emergent CA from January 2008 to September 2020. Clinical features were collected; survival and MACE were compared with an aged-matched control population with ACS not submitted to emergent CA. MACE was defined as a composite of all-cause death, ischemic stroke, ACS or hospitalization for acute heart failure. Results A total of 34 patients were enrolled: 56% female, with mean age 92±2 year-old. As for the cardiovascular risk factors, 88% had hypertension, 49% dyslipidaemia, 12% diabetes and 15% were previous smokers. Concerning other comorbidities, 27% had atrial fibrillation, 21% chronic kidney disease, 12% had cerebrovascular disease and median modified Rankin scale for neurologic disability was 2. Almost all patients had STE-ACS, 68% anterior and 29% inferior, inferolateral or inferoposterior infarction; 3% had infarction of indeterminate location. In CA, 65% had multivessel disease, 14% of them involving left main coronary artery; coronary intervention was performed in 71% of patients (mostly stent implantation), the remaining 29% had no invasive treatment. Concerning to clinical status, median troponin was 131 517 ng/L and median BNP 496 pg/mL; 36% of patients evolved in Killip class III or IV and only 32% of patients had normal left ventricular systolic function. Regarding mortality, 38% of patients died in the index-event versus 25% in the aged-matched control group (p=0.319). During five years of follow-up, there was no significant difference in mortality between the two groups (Log Rank, p=0.403) and more than 50% of patients died in two years. Comparing MACE occurrence, both groups were similar (Log Rank, p=0,662), with more than 80% having at least one event in five years. Conclusion Very old patients submitted to emergent CA had a high percentage of multivessel disease, left ventricular dysfunction and mortality during hospitalization. Compared to an aged-matched control group, they showed no survival or MACE benefit of emergent CA strategy during a five-years follow-up. Although this is a small study, these findings highlight the efforts that should be made to optimize care in this vulnerable population, under-represented in the clinical trials. Special caution should be given to avoid possible unnecessary discomfort in this setting. FUNDunding Acknowledgement Type of funding sources: None. MACE analysis

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