Gerontology
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Understanding comorbidity prevalence and the effects of comorbidities in older veterans with lower extremity amputations may aid in assessing patient outcomes, resource use, and facility-level quality of care. ⋯ Merging outpatient with inpatient data may reduce the under coding of comorbidities but does not enhance mortality prediction. Compared to the Charlson/Deyo, the Elixhauser has a more complete coding scheme for comorbid conditions, such as diabetes mellitus and peripheral vascular disease, important to addressing lower extremity amputation etiology.
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Comparative Study
What maintains energy supply at peak aerobic exercise in trained and untrained older men?
Aging-related changes occur mainly in the cardiopulmonary system and skeletal muscles, bringing about a reduction in physical performance. Consequently, maximal oxygen uptake (VO(2)max) decreases. ⋯ The present study suggests that the differences between trained and untrained elderly in absolute oxygen uptake of the working muscles and peak power output at maximal exercise test are due to physical activity status. The higher aerobic capacity in the trained elderly is related to increased cardiovascular function and to a lesser extent to increased muscle mitochondria concentration and capillarity. Although untrained elderly have reduced maximal oxygen uptake at peak aerobic exercise, intrinsic regulation of mitochondrial function does not seem to be significantly altered because of aging associated physical inactivity. Therefore, untrained elderly can partially compensate for their lower cardiac output by increasing oxygen extraction to levels comparable with those of trained elderly.
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Previous studies have found inconsistent links between suboptimal prescribing and negative patient outcomes. While suboptimal prescribing consists of multiple components, e.g. drugs to avoid in the elderly (DAE), potential drug interactions (PDI) and polypharmacy, most research has focused on the impact of drugs to avoid. This study explores the relationship between suboptimal prescribing, comorbid disease, and change in lower extremity functional limitation (LEFL). ⋯ The effect of suboptimal prescribing on change in LEFL was limited to both direct and mediational effects of polypharmacy. Additional research exploring the association between suboptimal prescribing and a variety of quality measures using a diverse set of outcomes would improve our understanding of the impact of suboptimal prescribing more broadly defined.
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Ambulation is one of the most important elements of mobility, and difficulty with ambulation is often cited as a common problem among older adults. Self-report assessments (e.g. walking confidence) provide complementary information to performance tests (e.g. the Timed Up and Go Test, TUG) because they offer data not obtainable from a test of walking performance. ⋯ The ASCQ is reliable and support for validity is evident for this sample of community-dwelling older adults. Further studies are needed to assess the reliability and validity in a frailer older adult sample. The ASCQ may be useful to clinicians and researchers alike for determining an older adult's confidence with their walking ability.
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Risk factors for functional decline in nonagenarians: a one-year follow-up. The NonaSantfeliu study.
Disability and a decline in functional capacity are common in old age. ⋯ According to the definition used to describe functional basic ADL decline, poor performance in instrumental ADL at baseline and a history of a stroke appear to be independent risk factors. Prevention strategies could be intensified in this subgroup of nonagenarians.