Tag Archives: Elderly

Do exercise and Vitamin D actually prevent falls in elderly?

IMPORTANCE: While vitamin D supplementation and exercise are recommended for prevention of falls for older people, results regarding these 2 factors are contradictory.

REFERENCEUusi-Rasi K, Patil R, Karinkanta S, et al. Exercise and Vitamin D in Fall Prevention Among Older Women: A Randomized Clinical Trial. JAMA Intern Med. 2015 Mar 23. doi: 10.1001/jamainternmed.2015.0225. (Original) PMID: 25799402

OBJECTIVE: To determine the effectiveness of targeted exercise training and vitamin D supplementation in reducing falls and injurious falls among older women.

DESIGN, SETTING AND PARTICIPANTS: A 2-year randomized, double-blind, placebo-controlled vitamin D and open exercise trial conducted between April 2010 and March 2013 in Tampere, Finland. Participants were 409 home-dwelling women 70 to 80 years old. The main inclusion criteria were at least 1 fall during the previous year, no use of vitamin D supplements, and no contraindication to exercise.

  • INTERVENTIONS: Four study groups, including placebo without exercise, vitamin D (800 IU/d) without exercise, placebo and exercise, and vitamin D (800 IU/d) and exercise.
  • MAIN OUTCOMES AND MEASURES: The primary outcome was monthly reported falls. Injurious falls and the number of fallers and injured fallers were reported as secondary outcomes. In addition, bone density, physical functioning (muscle strength, balance, and mobility), and vitamin D metabolism were assessed.

RESULTS: Intent-to-treat analyses showed that neither vitamin D nor exercise reduced falls. Fall rates per 100 person-years were 118.2, 132.1, 120.7, and 113.1 in the placebo without exercise, vitamin D without exercise, placebo and exercise, and vitamin D and exercise study groups, respectively; however, injurious fall rates were 13.2, 12.9, 6.5, and 5.0, respectively. Hazard ratios for injured fallers were significantly lower among exercisers with vitamin D (0.38; 95% CI, 0.17-0.83) and without vitamin D (0.47; 95% CI, 0.23-0.99). Vitamin D maintained femoral neck bone mineral density and increased tibial trabecular density slightly. However, only exercise improved muscle strength and balance. Vitamin D did not enhance exercise effects on physical functioning. Conclusions and Relevance: The rate of injurious falls and injured fallers more than halved with strength and balance training in home-dwelling older women, while neither exercise nor vitamin D affected the rate of falls. Exercise improved physical functioning. Future research is needed to determine the role of vitamin D in the enhancement of strength, balance, and mobility.

TRIAL REGISTRATION(S): clinicaltrials.gov Identifier: NCT00986466.

Advertisements

Fewer than 1 in 5 elders survive in-hospital CPR

Clinical Question

What are the outcomes of cardiopulmonary resuscitation in hospitalized elders?

Bottom Line

In general, hospitalized elders undergoing cardiopulmonary resuscitation (CPR) have an approximately 1 in 5 chance of surviving to hospital discharge. Among those who survive, nearly 80% will die in the following year. There is very little data about the functional outcomes of CPR and whether the elders are able to return to the community. (LOE = 2a)

Reference

van Gijn MS, Frijns D, van de Glind EM, van Munster BC, Hamaker ME. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age Ageing 2014;43(4):456-463.
Study Design Systematic review Funding Unknown/not stated
Setting Inpatient (ward only) Allocation Unknown

Synopsis

These authors searched several databases to find studies that described outcomes, including social status and functional outcome, of hospitalized elderly patients undergoing CPR. A single author screened all potential studies for possible inclusion and 2 authors independently determined their inclusion. Similarly, 2 authors independently assessed the quality of the included studies and a third member of the team resolved all disagreements. They ultimately included 29 studies with more than 400,000 hospitalized elders. The majority of studies were of fair quality. Ten studies reported that approximately 39% of elders had return of spontaneous circulation (range = 21% – 58%). The rate of survival to hospital discharge for patients aged between 70 years and 79 years was 19% (range = 8% – 36%); for those aged 80 to 89 years, 15% (range = 4% – 31%); and for elders older than 90 years,12% (range = 0 – 50%). Overall, more than half of patients who survived the CPR died before discharge. Only 5 small studies assessed what happened to those patients more than 6 months after hospital discharge: Between 7% and 20% were still alive after 1 year. These data are similar to the results from other systematic reviews that evaluated CPR outcomes in more diverse age groups and settings.

Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI