Time Effects on Physical Performance in Older Adults in Nursing Home: A Narrative Review

Objectives

To gather available evidence about overtime changes on physical performance in institutionalized elderly.

Design, setting and participants

An electronic search was performed on PubMed database on May 2018. We selected articles reporting the evolution of physical performance in older adults living in care institutions. We looked for data from observational longitudinal studies; data from clinical trials were extracted only for subjects who did not receive exercise intervention. All types of performance-based tests, for upper- and/or lower-body, were scrutinized.

Results

Seventeen studies were reviewed; mean age varied from 78.3 to 88 years old. Fourteen studies were randomized controlled trials (RCTs), other three studies were non-randomized trials and a longitudinal observational study. Different tests assessing physical performance were examined: upper limb strength and lower limb strength, static balance, dynamic balance and mobility showed a tendency to decline over time. On average hand grip strength decreased by 2.2% per month, chair stand test by 3.5%, Berg balance scale by 2%, timed up-and-go test by 2.8%, gait speed by 2.1% and short physical performance battery by 2.8%. A minority of studies have shown an improvement in lower limb muscle strength, endurance and gait speed: in these studies, participants did not attend any kind of physical training but took part to social activities or cognitive interventions.

Conclusion

This review shows how physical performance decreases over time in nursing home residents and quantifies their decline. However, in active controls, there was an improvement in some physical performance measures, which indicates that intervention other than exercise might prevent some loss in physical performance.

     

Structures from powders: Bupropion hydrochloride

The crystal structure of bupropion hydrochloride, 1, was fully characterized from powdered crystalline samples, using the ab-initio XRPD technique and a global optimization strategy (simulated annealing), adopting, as starting model, the already known molecular structure of its ethanol solvate, 2. Bupropion hydrochloride crystallizes as a racemate in monoclinic system, space group P2₁/c with Z = 4, a = 14.3406(3) Å, b = 8.7564(2) Å, c = 11.8801(2) Å, β = 78.025(2)°, V = 1459.34(5) Å³. In the crystals of 1 the molecules interact via strong NH?Cl contacts, generating dimeric entities with μ-Cl ions. Further stabilizing contacts, of the CH?O are at work, but differently organized in the 1 and 2 phases. The thermal behaviour of the product was assessed by differential scanning calorimetry.     

Evaluation of medial meniscus tears and meniscal stability: Weight-bearing MRI vs arthroscopy

To assess the role of dedicated low-field standard and weight-bearing MRI in the evaluation of stable or unstable tears of medial meniscus in comparison with arthroscopy.     

Magnetic resonance angiography: state of the art

The recently developed three-dimensional ultrafast sequences are able to acquire the entire aorta or the peripheral district in just 15 s. These sequences offer the possibility to obtain breath-hold images (that avoid breath artifacts) during the contrast medium peak. The technique is called three-dimensional angiography with contrast bolus. To perform the evaluation with this technique, high performance magnet units are needed (high magnetic fields, high gradient with fast ramping times). Clinical indications include the aortic district and especially thoracic aorta diseases and aortic dissections. This technique has great potentialities in the evaluation of the supra-aortic trunks, renal arteries and peripheral district. Shifting the table it is now possible to obtain the contemporary evaluation of both aorta and peripheral district with a single injection of contrast medium. The definition of the arterial district is comparable in many cases to that offered by digital angiography. The combination of magnetic resonance angiography and tomographic magnetic resonance technique is helpful for the endoluminal evaluation (as with digital angiography) and for the study of thrombi and wall as well.     

Colorectal cancer: the role of laparoscopy

Since the first report in 1991 the laparoscopic resection of colon cancer is progressing slowly and just in the last 2-3 years is becoming more popular. The resistance to its use by some general and colo-rectal surgeons is receding. The explanations are that technology is evolving quickly and there is a worldwide diffusion of more sophisticated surgical instruments. Moreover several randomized trials have been published showing that the outcomes of laparoscopic colon surgery are similar or better than those of conventional surgery and the early reports suggesting the tumour dissemination were not confirmed. The revolution in oncological surgery that we are observing in these last decades with the introduction and diffusion of mini-invasive approach is comparable to that regarding conventional surgery during the period of Halsted. Therefore the principles of surgery accepted during the years must not be forgotten.     

Infectious complications in colorectal surgery

Postoperative infectious complications still represent a relevant problem in colorectal surgery. They always results in suffering for the patients and often prolonged hospitalization. Furthermore, they result in additional expenses to cover the cost of antibiotics, blood derivates, total parenteral nutrition, nursing and additional surgical procedures. Prevention and control of hospital infections start with surveillance, which is an important means to constantly evaluate the local bacterial epidemiology. An infection surveillance program finalized to minimize the incidence of postoperative infections through the respect of available techniques leads to a better quality of work in each surgical unit, to a decrease in postoperative hospital stay and to cost reduction.     

A Structural Powder Diffraction Study of Two Polymorphic Forms of Nortriptyline Hydrochloride

Nortriptyline hydrochloride, a tricyclic antidepressant, appears in two different polymorphic forms, only one of which (hereafter, form β) has been previously characterized by single‐crystal analysis. Form β is monoclinic, P2₁/c, with a = 5.070(2), b = 34.088(5), c = 9.976(1) Å, and β = 90.74(2)°. A second crystalline form (the α form) has now been characterized by structural powder diffraction methods (using both laboratory and synchrotron radiation diffraction data). Form α crystallizes in the monoclinic P2/c space group, a = 9.99126(6), b = 5.10021(3), c = 34.1636(1) Å, and β = 98.684(6)°. The thermodynamic relationship between the two forms has been determined by differential scanning calorimetry analysis and variable‐temperature thermodiffractometric experiments, revealing that the two forms are monotropically related and form α is more stable. Both phases are characterized by a sequence of hydrogen‐bonded N‐protonated molecules, which, in the two crystalline environments, adopt the same conformation. The difference between the two crystals can be traced back to the supramolecular arrangement characterized by one‐dimensional chains, built by homochiral molecules (for conformationally driven chirality) in the α form, and by enantiomeric ones in the β form. This observation nicely explains why, upon heating, solid‐solid interconversion between the two forms does not occur.     

Comparing computerized tomography and magnetic resonance in the study of articular pathology of the knee

The authors present a comparison between the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in the articular pathologies of the knee. CT and MRI were performed in 30 patients who subsequently underwent surgery. CT and MRI results were compared on three bases: technique, definition of normal anatomy, and diagnostic accuracy. CT allowed a standardization of the technique, while MRI was superior in defining normal anatomy--especially in the study of capsulo-ligamentous structures. In all cases the use of both CT and MRI allowed a correct diagnosis, showing the site, extent and gravity of the lesion. CT proved to be superior to MRI in 4 cases, while MRI corrected CT diagnosis in 11 cases; in 15 patients both techniques had the same diagnostic accuracy. Meniscal tears were better identified by CT, while MRI was superior in the detection of ligamentous lesions and in the characterization of PVNS and tendinitis of the patellar tendon. In conclusion, MRI should be performed in selected cases only, or when CT cannot be trusted; on the other hand, it might also be used as a first-choice diagnostic procedure for synovial pathologies and acute lesions of the anterior cruciate ligament.     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.