Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenearians

Abstract This randomized controlled trial examined the effects of multicomponent training on muscle power output, muscle mass, and muscle tissue attenuation; the risk of falls; and functional outcomes in frail nonagenarians. Twenty-four elderly (91.9±4.1 years old) were randomized into intervention or control group. The intervention group performed a twice-weekly, 12-week multicomponent exercise program composed of muscle power training (8-10 repetitions, 40-60 % of the one-repetition maximum) combined with balance and gait retraining. Strength and power tests were performed on the upper and lower limbs. Gait velocity was assessed using the 5-m habitual gait and the timeup-and-go (TUG) tests with and without dual-task performance. Balance was assessed using the FICSIT-4 tests. The ability to rise from a chair test was assessed, and data on the incidence and risk of falls were assessed using questionnaires. Functional status was assessed before measurements with the Barthel Index. Midthigh lower extremity muscle mass and muscle fat infiltration were assessed using computed tomography. The intervention group showed significantly improved TUG with single and dual tasks, rise from a chair and balance performance (P<0.01), and a reduced incidence of falls. In addition, the intervention group showed enhanced muscle power and strength (P<0.01). Moreover, there were significant increases in the total and high-density muscle cross-sectional area in the intervention group. The control group significantly reduced strength and functional outcomes. Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population

On the tectonic origin of Iberian topography

The present-day topography of the Iberian peninsula can be considered as the result of the MesozoicCenozo–ic tectonic evolution of the Iberian plate (including rifting and basin formation during the Mesozoic and compression and mountain building processes at the borders and inner part of the plate, during the Tertiary, followed by Neogene rifting on the Mediterranean side) and surface processes acting during the Quaternary. The northern-central part of Iberia (corresponding to the geological units of the Duero Basin, the Iberian Chain, and the Central System) shows a mean elevation close to one thousand meters above sea level in average, some hundreds of meters higher than the southern half of the Iberian plate. This elevated area corresponds to (i) the top of sedimentation in Tertiary terrestrial endorheic sedimentary basins (Paleogene and Neogene) and (ii) planation surfaces developed on Paleozoic and Mesozoic rocks of the mountain chains surrounding the Tertiary sedimentary basins. Both types of surfaces can be found in continuity along the margins of some of the Tertiary basins. The Bouguer anomaly map of the Iberian peninsula indicates negative anomalies related to thickening of the continental crust. Correlations of elevation to crustal thickness and elevation to Bouguer anomalies indicate that the dierent landscape units within the Iberian plate can be ascribed to dierent patterns: (1) The negative Bouguer anomaly in the Iberian plate shows a rough correlation with elevation, the most important gravity anomalies being linked to the Iberian Chain. (2) Most part of the so-called Iberian Meseta is linked to intermediate-elevation areas with crustal thickening; this pattern can be applied to the two main intraplate mountain chains (Iberian Chain and Central System) (3) The main mountain chains (Pyrenees and Betics) show a direct correlation between crustal thickness and elevation, with higher elevation/crustal thickness ratio for the Central Systemvs. the Betics and the Pyrenees. Other features of the Iberian topography, namely the longitudinal pro le of the main rivers in the Iberian peninsula and the distribution of present-day endorheic areas, are consistent with the Tertiary tectonic evolution and the change from an endorheic to an exorheic regime during the Late Neogene and the Quaternary. Some of the problems involving the timing and development of the Iberian Meseta can be analysed considering the youngest reference level, constituted by the shallow marine Upper Cretaceous limestones, that indicates strong dierences induced by (i) the overall Tertiary and recent compression in the Iberian plate, responsible for dierences in elevation of the reference level of more than 6 km between the mountain chains and the endorheic basins and (ii) the eect of Neogene extension in the Mediterranean margin, responsible for lowering several thousands of meters toward the East and uplift of rift shoulders. A part of the recent uplift within the Iberian plate can be attributed o sostatic uplift in zones of crustal thickening

Estimulación multisensorial y realidad virtual para mejorar procesos educativos en la comunicación audiovisual

Depto. de Ciencias de la Comunicación AplicadaFac. de Ciencias de la InformaciónFALSEsubmitte

Protocol for a systematic review and meta-analysis assessing the effectiveness of deprescribing in falls prevention in older people

Introduction One of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which older people receive healthcare and all deprescribing interventions is warranted to enhance the current knowledge.Methods and analysis This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed in Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO (2 November 2020). We will also search in trial registers. We will include randomised controlled trials, in which any deprescribing intervention is compared with usual care and reports falls as an outcome. Both title and abstract screening and full-text screening will be done by two reviewers. The Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. We will categorise the results separately for every setting. If a group of sufficiently comparable studies will be identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the forest plot along with consideration of the χ2 test and the I2 statistic results. We have prespecified several subgroup and sensitivity analyses.Ethics and dissemination Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the recommendations of working group of polypharmacy and FRIDs of the anticipated World’s Falls Guidelines.PROSPERO registration number CRD42020218231

World guidelines for falls prevention and management for older adults: a global initiative

Backgroundfalls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present.Objectivesto create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries.Methodsa steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting.Recommendationsall older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations.Conclusionsthe core set of recommendations provided will require flexible implementation strategies that consider both local context and resources

Medication reviews and deprescribing as a single intervention in falls prevention : a systematic review and meta-analysis

Background: our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods: Design: systematic review and meta-analysis. Data sources: Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria: randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome. Study records: title/abstract and full-text screening by two reviewers. Risk of bias: Cochrane Collaboration revised tool. Data synthesis: results reported separately for different settings and sufficiently comparable studies meta-analysed. Results forty-nine heterogeneous studies were included. Community: meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85–1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70–1.27, I2 = 37%, 3 s) for number of injurious fallers and in a rate ratio (RaR) of 0.89 (0.69–1.14, I2 = 0%, 2 s) for injurious falls. Hospital: meta-analyses assessing medication reviews resulted in an RR = 0.97 (0.74–1.28, I2 = 15%, 2 s) and in an RR = 0.50 (0.07–3.50, I2 = 72% %, 2 s) for number of fallers after and during admission, respectively. Long-term care: meta-analyses investigating medication reviews or deprescribing plans resulted in an RR = 0.86 (0.72–1.02, I2 = 0%, 5 s) for number of fallers and in an RaR = 0.93 (0.64–1.35, I2 = 92%, 7 s) for number of falls. Conclusions: the heterogeneity of the interventions precluded us to estimate the exact effect of medication review and deprescribing as a single intervention. For future studies, more comparability is warranted. These interventions should not be implemented as a stand-alone strategy in falls prevention but included in multimodal strategies due to the multifactorial nature of falls. PROSPERO registration number: CRD4202021823