Volume 5, Issue 4, December 2020

The Covid-19 pandemic has caused a disproportionate impact on people with disabilities and the elderly. Moreover, the pandemic can be likened to disasters caused by catastrophic weather events which will increase in the future in response to climate change. To forestall these threats, rehabilitation professionals must to come together internationally to prepare and proactively educate their peers and patients. This can be done through observance of such times as Day for Tomorrow. Moreover, rehabilitation professionals need to transition to greener forms of healthcare in order to assure that in the future we all sustain our abilities.

Early detection of older adults with an increased risk of falling could enable early onset of preventative measures. Currently used fall risk assessment tools have not proven sufficiently effective in differentiating between high and low fall risk in community-living older adults. There are a number of tests and measures available, but many timed and observation-based tools are performed on a flat floor without interaction with the surrounding. To improve falls prediction, measurements in other areas that challenge mobility in dynamic conditions and that take a persons’ own perception of steadiness into account should be further developed and evaluated as single or combined measures. The tools should be easy to apply in clinical practice or used as a self-assessment by the older adults themselves.

Objectives

Objectives were to study prevalence of frailty among Indian oldest old population, and to detect its correlates.

Methods

A cross sectional community based study was done including 200 healthy participants aged ≥80 years, randomly sampled from Hyderabad city in India. They completed an administered questionnaire and physical function tests including SPPB, grip strength. Cognitive function was assessed using MMSE and depression using GDS. Blood pressure, haemoglobin, and fasting blood sugar were measured for all participants. Frailty was defined using Fried phenotype criteria. Logistic regression was done to identify independently associated correlates.

Results

The prevalence of frailty syndrome was 83.4% in our study population. Frailty among men was 80.3% and among women was 84.7%, and it increased with increasing age. The independent correlates which increased the odds of frailty were poor physical performance (SPPB) (OR: 4.21; 95%CI: 1.12-15.83), depression (OR: 3.35; 95%CI:1.29-8.73), chronic joint pains (OR:4.90; 95%CI: 1.97-12.18) and COPD (OR: 3.01; 95%CI:1.03- 8.78), while hypertension showed inverse association (OR: 0.33;95%CI:0.11-0.94).

Conclusion

The prevalence of frailty among the oldest old is very high. Geriatric medicine protocols must include routine screening for frailty, while also including early detection of poor physical performance, depression, COPD and osteoarthritis.

Objectives:

Frail subjects with chronic heart failure (CHF) often demonstrate limited tolerance of exertion, shortness of breath, and reduced walking capacity resulting poor quality of life (QoL). The aim of this study was to quantify the improvements in functional exercise capacity (FEC) and QoL among Bulgarian frail subjects with CHF performed group-based high-intensity aerobic interval training (HIAIT)/m-Ullevaal intervention and to compare it with moderate intensity continuous training (MICT) protocol.

Methods:

One hundred and twenty (n=120) frail subjects with mean age of 63.73±6.68 years, in CHF and NYHA class II-IIIB, were enrolled in the single-center, prospective, two-arm randomized controlled clinical trial conducted at the Medical Center for Rehabilitation and Sports Medicine-I-Plovdiv. The baseline assessment included 6-minute walk test (6ΜWT), peak oxygen uptake (VO_2peak), modified Borg Perceived Exertion Scale (mBPES), and Minnesota living with the Heart Failure Questionnaire (MLHFQ).

Results:

The improvement in 6MWT (P<0.001), VO_2peak (P<0.001), mBPES (P<0.001), and MLHFQ (P<0.001) observed among frail subjects performed HIAIT/m-Ullevaal intervention was significantly greater compared to the improvement observed in the subjects performed MICT protocol (P<0.001).

Conclusions:

The group-based HIAIT/m-Ullevaal intervention is a new perspective and challenge for both, Bulgarian cardiac rehabilitation (CR), and frail patients with CHF.

The most frequently employed versions of the sit-to-stand test (STST) are the 5 times STSΤ and the 30 seconds STST. However, it is not known whether a variation with different number of repetitions or time could be more appropriate for older adults. The objective of this study was to investigate the reliability of STST at different time points and number of repetitions. The test was performed in 33 older adults (73±6.1 years) for 40 seconds. The participants performed the procedure twice with a day interval between the sessions. The test was video-taped and the data were processed by two examiners. The highest test-retest reliability was found for the 4^th (ICC=0.73, SEM=1.48, SDD=1.68), 5^th (ICC=0.76, SEM=1.73, SDD=1.97) and 6^th repetition (ICC=0.78, SEM=1.78, SDD=2.03). The inter-rater reliability was excellent independently of the number of trials (ICC>0.9). The correlation of the time at the 4^th and 6^th repetition with the time at the traditionally selected 5^th repetition was excellent (r>0.9). The termination of the STST at the 4^th repetition seems to provide equally reliable and valid estimations with the termination at the 5^th repetition. Future studies should examine a 4 times STST since the reduction of the number of repetitions may be less tiring and safer for older adults.