Frailty is a geriatric syndrome that predicts disability, morbidity and mortality in the elderly. Poor nutritional status is one of the main risk factors for frailty. Macronutrients and ...micronutrients deficiencies are associated with frailty. Recent studies suggest that improving nutritional status for macronutrients and micronutrients may reduce the risk of frailty. Specific diets such as the Mediterranean diet rich in anti-oxidants, is currently investigated in the prevention of frailty. The aim of this paper is to summarize the current body of knowledge on the relations between nutrition and frailty, and provide recommendations for future nutritional research on the field of frailty.
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EMUNI, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ, ZRSKP
The objective of this study was to systematically review all published articles examining the relationship between the occurrence of falls and changes in gait and attention‐demanding task performance ...whilst dual tasking amongst older adults. An English and French Medline and Cochrane library search ranging from 1997 to 2008 indexed under ‘accidental falls’, ‘aged OR aged, 80 and over’, ‘dual task’, ‘dual tasking’, ‘gait’, ‘walking’, ‘fall’ and ‘falling’ was performed. Of 121 selected studies, fifteen met the selection criteria and were included in the final analysis. The fall rate ranged from 11.1% to 50.0% in retrospective studies and from 21.3% to 42.3% in prospective ones. Amongst the three retrospective and eight prospective studies, two and six studies, respectively, showed a significant relationship between changes in gait performance under dual task and history of falls. The predictive value for falling was particularly efficient amongst frail older adults compared with healthy subjects. Two prospective studies challenged the usefulness of the dual‐task paradigm as a significant predictor compared to single task performance and three studies even reported that gait changes whilst dual tasking did not predict falls. The pooled odds ratio for falling was 5.3 (95% CI, 3.1–9.1) when subjects had changes in gait or attention‐demanding task performance whilst dual tasking. Despite conflicting early reports, changes in performance whilst dual tasking were significantly associated with an increased risk for falling amongst older adults and frail older adults in particular. Description of health status, standardization of test methodology, increase of sample size and longer follow‐up intervals will certainly improve the predictive value of dual‐task‐based fall risk assessment tests.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective
The objective of this study was to systematically review all the published articles examining the effects of low serum vitamin D concentration and vitamin D supplementation on muscle, ...balance and gait performance among people aged 65 and older.
Methods
An English and French Medline search ranging from January 2004 to November 2008 indexed under the Medical Subject Heading (MeSH) terms “aged OR aged, 80 and over” AND “Vitamin D OR Vitamin D Deficiency” combined with the terms “Gait” OR “Gait Apraxia” OR “Gait Disorders, Neurologic” OR “Walking” OR “Mobility Limitation” OR “Polyneuropathy” OR “Proprioception” OR “Ataxia” OR “Accidental Falls” was performed.
Results
Of the 102 selected studies, 16 met the selection criteria and were included in the final analysis. There were 8 observational studies and 8 interventional studies. The number of participants ranged from 24 to 33067. A majority of studies examined community-dwelling older women. Five observational studies showed a significant positive association, whereas three studies did not. Four of the 5 studies and two of the 3 studies which tested the vitamin D supplementation effect, respectively on balance and gait, showed no significant effect. Four studies showed a significant effect on muscle strength, while this effect was not observed in three others studies. In addition, there was no significant association between vitamin D supplementation and an improvement of the sit-to-stand test results in 50% of the studies.
Conclusions
The findings show that the association between vitamin D and physical performance remains controversial. Observational studies and clinical trials yielded divergent results, which highlights the complex and to date still poorly understood association between serum vitamin D concentration or vitamin D supplementation and physical performance.
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EMUNI, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ, ZRSKP
Background
Health care professionals need a simple and pragmatic clinical approach for the management of recurrent fallers in clinical routine.
Objective
To develop clinical practice recommendations ...with the aim to assist health care professionals, especially in primary care in the management of recurrent falls.
Methods
A systematic English and French review was conducted using Medline, Embase, Pascal and Cochrane literature. Search included systematic reviews, meta-analyses, controlled trials, cohort studies, case-control studies and transversal studies published until July 31, 2008. The following Medical Subject Heading (MeSH) terms were used: “aged OR aged, 80 and over”, “frail elderly”, “Accidental Fall”, “Mental Recall”, and “Recurrent falls”. The guidelines were elaborated according the Haute Autorité de Santé methods by a multidisciplinary working group comprising experts and practitioners.
Results
A fall is an event that results in a person coming to rest inadvertently on the ground or floor or other lower level and should be considered as a recurrent event as soon as a subject reported at least two falls in a 12-month period. Recurrent falls impose a prompt and appropriate management with the first aim to systematically evaluate the severity of falls. The evaluation of fall severity should be based on a standardized questionnaire and physical examination. It is recommended not to perform cerebral imaging in the absence of specific indication based on the clinical examination and to reevaluate the subject within a week after the fall. Prior to any intervention and after an evaluation of signs of severity, it is recommended to systematically assess the risk factors for falls. This evaluation should be based on the use of validated and standardized tests. The education of recurrent fallers and their care givers is required in order to implement appropriate intervention. In the event of a gait and/or balance disorders, it is recommended to prescribe physiotherapy. A regular physical activity should be performed with low to moderate intensity exercise. It is recommended to perform rehabilitation exercises with a professional, between therapy sessions and after each session, in order to extend rehabilitation benefits to the daily life.
Conclusion
The clinical guidelines focused on management (i.e., diagnosis, assessment and treatment) of recurrent falls in clinical routine. They provide answers to the following clinical questions: 1) How to define recurrent falls? 2) How to identify severe falls? 3) How to assess recurrent falls? and 4) How to treat recurrent falls?
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EMUNI, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UL, UM, UPUK, VSZLJ, ZAGLJ, ZRSKP
We collected gait analysis data for 282 healthy adults and elderly people (144 women and 138 men aged 20–98) using an accelerometric device, whose reproducibility (intra-tester and inter-testers) has ...been validated for gait studies. The subjects walked at their own speed along a corridor (40 m). Stride frequency (SF) (after correction for height), step symmetry (Sym), stride regularity (Reg), and vertical harmonic (slope) were all independent of age or gender. The median-lateral harmonic (slope) (MSH) was influenced by gender, but not by age. Other variables (walking speed, stride length (SL), cranial–caudal activity and raw accelerations at heel contact, mid-stance and initial push-off) were dependent on gender and age. They were higher in men than in women, and began to decrease during the sixth decade in men and the seventh decade in women. The raw acceleration at foot flat was independent of gender but was influenced by age. This accelerometric device is easy to use and requires no specialized equipment and could be used to analyze walking in clinical practice.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK
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