Perioperative care of the geriatric patient for noncardiac surgery

Adults age 65 and over are the fastest growing segment of the population in the United States and around the world. As the size of this population expands, the number of older adults referred for surgical procedures will continue to increase. Due to the physiologic changes of aging and the increased frequency of comorbidities, older adults are at increased risk for adverse outcomes, and perioperative care is inherently more complex than in younger individuals. In this review, we discuss the physiologic changes of aging relevant to the surgical patient, comprehensive preoperative assessment, and postoperative management of common complications in older adults in order to promote optimal clinical outcomes both perioperatively and long-term

Effects of Short-Term Training of Community-Dwelling Elderly with Modular Interactive Tiles

Objective: The objective of this study is to test for the increased mobility, agility, balancing, and general fitness of community-dwelling elderly individuals as a result of short-term training involving playing with modular interactive tiles (Entertainment Robotics, Odense, Denmark) at two community activity centers for the elderly. Three different tests from the Senior Fitness Test were used in order to test a variety of health parameters of the community-dwelling elderly, including those parameters related to fall prevention. Materials and Methods: Eighteen community-dwelling elderly individuals (63–95 years of age; mean, 83.2 years of age) were assessed in one intervention group without the use of a control group. The intervention group performed nine group sessions (1–1.5 hours each) of playful training with the modular interactive tiles over a 12-week period in two community activity centers for the elderly. Data were collected using pre-tests and post-tests of the 6-Minute Walk Test (6MWT), the 8-foot Timed Up & Go Test (TUG), and the Chair-Stand Test (CS). Data were analyzed for statistically significant differences and increases of means. Results: The 6MWT, TUG, and CS measurements showed statistically significant differences and increases of means between the pre-tests and post-tests with the 6MWT (P<0.001) (means difference, 22.4 percent), TUG (P<0.001) (means difference, 15 percent), and CS (P<0.002) (means difference, 14 percent). Fifty-six percent of the elderly progressed from one health risk level to a better level, according to the three tests. Conclusions: Statistically significant increases in scores were found across all tests, suggesting an improvement of many different health parameters for the elderly. Well-established research has shown the relationship between such test scores and fall incidents, balancing, mobility, agility, etc. This significant improvement in the health status of the elderly is obtained in as few as nine training sessions over a 12-week period of “playing” exergames with the modular interactive tiles

Effect of vitamin K2 on postural sway in older people who fall:a randomized controlled trial

OBJECTIVES: Vitamin K is thought to be involved in both bone health and maintenance of neuromuscular function. We tested the effect of vitamin K2 supplementation on postural sway, falls, healthcare costs, and indices of physical function in older people at risk of falls.DESIGN: Parallel-group double-blind randomized placebo-controlled trial.SETTING: Fourteen primary care practices in Scotland, UK.PARTICIPANTS: A total of 95 community-dwelling participants aged 65 and older with at least two falls, or one injurious fall, in the previous year.INTERVENTION: Once/day placebo, 200 μg or 400 μg of oral vitamin K2 for 1 year.MEASUREMENTS: The primary outcome was anteroposterior sway measured using sway plates at 12 months, adjusted for baseline. Secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Timed Up &amp; Go Test, quality of life, health and social care costs, falls, and adverse events.RESULTS: Mean participant age was 75 (standard deviation [SD] = 7) years. Overall, 58 of 95 (61%) were female; 77 of 95 (81%) attended the 12-month visit. No significant effect of either vitamin K2 dose was seen on the primary outcome of anteroposterior sway (200 μg vs placebo: -.19 cm [95% confidence interval [CI] -.68 to .30; P = .44]; 400 μg vs placebo: .17 cm [95% CI -.33 to .66; P = .50]; or 400 μg vs 200 μg: .36 cm [95% CI -.11 to .83; P = .14]). Adjusted falls rates were similar in each group. No significant treatment effects were seen for other measures of sway or secondary outcomes. Costs were higher in both vitamin K2 arms than in the placebo arm.CONCLUSION: Oral vitamin K2 supplementation did not improve postural sway or physical function in older people at risk of falls.</p

The effect of pulmonary rehabilitation on mortality, balance, and risk of fall in stable patients with chronic obstructive pulmonary disease: a systematic review

Objectives: To evaluate the impact of pulmonary rehabilitation on survival and fall (including balance) in patients with chronic obstructive pulmonary disease (COPD) at stability. Design: Systematic Review. Methods: OVID, MEDLINE, EMBASE, and Cochrane Collaboration Library were searched for literature dating from January 1980 up to November 2014 as well as an update in October 2015. Two reviewers screened titles, abstracts and full text records, extracted data and assessed studies for risk of bias; any disagreements were resolved by a third member of the team, and consensus was always sought. Results: Initial searches yielded 3216 records but after review, only 7 studies were included and no studies focused solely on falls. Two cohort studies found some positive benefits of pulmonary rehabilitation on balance but the results were inconsistent across the studies. Regarding survival, two randomised controlled trials were conducted; one study showed significant survival benefit at 1 year while the other one showed non-significant survival benefit at 3 years. Neither were adequately powered and in both, survival was a secondary outcome. Conclusions: There was only limited inconclusive evidence to show that pulmonary rehabilitation has a significant beneficial effect on balance or survival

Fluctuating selection models and Mcdonald-Kreitman type analyses

It is likely that the strength of selection acting upon a mutation varies through time due to changes in the environment. However, most population genetic theory assumes that the strength of selection remains constant. Here we investigate the consequences of fluctuating selection pressures on the quantification of adaptive evolution using McDonald-Kreitman (MK) style approaches. In agreement with previous work, we show that fluctuating selection can generate evidence of adaptive evolution even when the expected strength of selection on a mutation is zero. However, we also find that the mutations, which contribute to both polymorphism and divergence tend, on average, to be positively selected during their lifetime, under fluctuating selection models. This is because mutations that fluctuate, by chance, to positive selected values, tend to reach higher frequencies in the population than those that fluctuate towards negative values. Hence the evidence of positive adaptive evolution detected under a fluctuating selection model by MK type approaches is genuine since fixed mutations tend to be advantageous on average during their lifetime. Never-the-less we show that methods tend to underestimate the rate of adaptive evolution when selection fluctuates

The case for Tai Chi in the repertoire of strategies to prevent falls among older people

Falls among older people is a global public health issue. In this article, Dr Samuel Nyman of Bournemouth University Dementia Research Institute, and Professor Dawn Skelton, Institute for Applied Health Research, Glasgow Caledonian University highlight the effectiveness of Tai Chi as an alternative strategy to physiotherapy to combat this issue