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A clinical trial which was conducted to determine if an energy-absorbing/dispersing hip protector could reduce the risk of hip fracture when worn by patients was unable to prevent hip fracture among nursing home residents.

Background. The relationship between cognitive function and physical disability in nondemented older adults is not well characterized. The purpose of this study was to determine the relationship between performance on psychometric measures and a modified Physical Performance Test (modified PPT) in older men and women. Methods. One hundred twenty-five men and women aged 75 years and older, who were enrolled in randomized, controlled trials of exercise or hormone replacement therapy, were recruited from the community-at-large and from congregate living sites. Measures obtained included Trailmaking A and B tests, Cancellation Random Figure tests, Weschler Associate Learning and 20-minute Delayed Recall, Verbal Fluency test, a modified PPT, and self-reports about performance of activities of daily living, medication use, and hospitalization in the previous year. Results. Simple regression analysis demonstrated that speed of performance on the Trailmaking B and Cancellation Random Figure tests was significantly associated with total modified PPT score (r = .29, p < .001 and r = .36, p < .001, respectively). A factor analysis of the psychometric test battery demonstrated that two factors, a cognitive speed factor and a memory factor, accounted for 55% of the variance in cognitive test performance. Hierarchical multiple regression analyses demonstrated that age, number of medications, and the cognitive speed factor were independent predictors of total modified PPT score. Conclusions. Cognitive processing speed is a significant component of physical frailty in this population, although it accounts for a small percentage of variance on a standardized physical performance test.

Background. The purpose of this study was to determine the relationship between peak aerobic power [Mathematical Expression Omitted] and performance on a modified Physical Performance Test (modified PPT) in older women. Methods. One hundred one women aged 75 years and older seeking enrollment in randomized, controlled trials of exercise and/or hormone replacement therapy were recruited from the community-at-large and from congregate living sites. Measures obtained included [Mathematical Expression Omitted], a modified PPT, and self-reports about performance of activities of daily living. Results. Simple regression analysis demonstrated that [Mathematical Expression Omitted] was associated with total PPT score (r = .53, p < .001), gait speed (r = .44, p < .001), time to arise from a chair five times (r = .43, p = < .001), and time to climb one flight of stairs (r = .36, p = .007). Multiple regression analysis revealed that the relationships between [Mathematical Expression Omitted] and total modified PPT score, gait speed, chair rise time, and time to climb one flight of stairs were independent of age. Conclusions. Peak aerobic power is a significant independent predictor of performance on a standardized test of physical function in older women and is an important component of physical frailty in this population.

Lower extremity strength and fat-free mass were examined in 58 postmenopausal women aged 60-72 yr. Subjects were studied before and after an 11-mo control period (n = 16) or before and after an 11-mo weight-bearing exercise training program designed to generate relatively high ground reaction forces (n = 42). Twenty-two of the exercisers initiated hormone replacement therapy (HRT) at the outset of exercise and continued HRT for 11 mo. Hip extension and abduction strength were assessed using a hand-held dynamometer. Force production during knee extension and flexion was evaluated on an isokinetic dynamometer at 60, 90, and 180 [degrees]/s. Simultaneous knee and hip extension strength was also assessed on a leg press machine. Total body and lower extremity fat-free mass were determined using dual-energy x-ray absorptiometry. There were no significant changes in muscle strength or body composition in control subjects. Both exercise groups had significant increases in fat-free mass and in all strength measures. Fat-free mass increased from 38.8 [+ or -] 4.3 to 39.7 [+ or -] 4.3 kg in the exercise group and from 37.7 [+ or -] 3.9 to 38.9 [+ or -] 4.6 kg in the exercise-plus-HRT group. The average relative increase in strength was 16.2 [+ or -] 11.0% in the exercise group and 17.0 [+ or -] 13.0% in the exercise-plus-HRT group. Women receiving HRT did not have a gain in fat-free mass or in strength over and above that demonstrated by the women not on HRT. Our results provide evidence that HRT does not augment the increases in muscle mass or strength that occur in response to weight-bearing exercise in older women.

The fear of falling expressed by many elderly people appears to be related to a history of falling, their perception of themselves as frail and a decreased quality of life. It is more common among women than men and increases with age. These results are from a study of 890 elderly people who lived in the community in St. Louis and were interviewed at two points in time one year apart. Two-thirds of the participants were female and almost that many had finished high school. Most were white; 78% indicated their health was at least good. Nine percent were very afraid of falling and about one-half of these were somewhat or very dissatisfied with life. More than one-fourth expressed at least some fear of falling. Fifteen percent of the men and 35% of the women were afraid. Those with some experience with nearly falling or falling and the oldest participants expressed the most fear of falling. The direction of the relationship between a lower quality of life and fear of falling is unclear. It may be that fear of falling causes aged people to restrict their activities and isolate themselves.

The purpose of this study was identify associations between the use of commonly taken medictions and groups of medications and the risk of falls in elderly people living in the community. A stratified random sample of 1358 persons aged 65 years and over was selected from the 15 000 members of an educational organization for functionally independent, community-dwelling elderly people in St Louis, Missouri. Twenty-seven per cent of subjects reported at least one fall in the past year and 8% reported two or more falls. After adjusting for potential confounders (including age, sex, relevant medical conditions, health status, cognitive impairment, use of alcohol, depression and use of other medications), the following medications were found to be important risk factors for multiple falls: diazepam [odds ratio (OR): 3.7, 95% confidence interval (CI): 1.5-9.3], diltiazem (OR: 1.8, 95% CI: 0.8-4.1), diuretics (OR: 1.8, 95% CI: 1.2-2.8) and laxatives (OR: 2.1, 95% CI: 1.0-4.5). We conclude that caution is needed before prescribing diuretics and psychotropics, especially diazepam, for elderly people. The safety of diltiazem in this age group should be assessed further.

Objective: Examine the effects of a 6-month health multidimensional intervention on physical function, bone density, and mood in a diverse sample of community-dwelling older adults at risk for frailty and excess disability. Method: A quasi-experimental, pre- post-program design was implemented. Adults aged 55 years and older (n = 337, 60% African American) participated in the intervention and received assessments at baseline, 6 months, and 12 months. Results: Physical function was maintained during the intervention for both African American and White elders but declined at 12 months for both groups (p < .0001). Symptoms of depression improved during the intervention (M = 0.65 ± 0.07, M = 0.15 ± 0.04, M = 0.68 ± 0.07, p < .001, respectively) but worsened at 12 months (M = 0.68 ± 0.07, p < .001). Bone density scores remained stable from baseline (distal: −1.62 ± 1.17, proximal: −2.73 ± 1.85) to 12 months (distal: −1.72 ± 1.21, proximal: −3.11 ± 1.85, ps > .05) for both groups. Discussion: Program findings may serve as a basis for the development of a randomized, controlled study to provide empirical evidence of intervention efficacy. Such findings may help inform the development of community-based programs to identify vulnerable older adults and provide vital preventative care to decrease frailty and excess disability. [ABSTRACT FROM AUTHOR]

Fifteen community dwelling older adults, ages 66 to 97 years, with at least one risk factor for recurrent falls, attended a thrice weekly group exercise class for 8 weeks. In post- versus preexercise comparisons, knee extensor torque at 0° /sec increased by 16.5% (p = 0.055); time to perform the stand-up test once, and five times consecutively, improved by 29.4 and 27.4%, respectively (p = 0.05, p = 0.01); gait speed for 24 feet increased by 16.5% (p < 0.001); and performance of the progressive Romberg test of balance improved with a mean increase of 1.1 ± 0.9 positions (p = 0.001). Participants reported a significant increase in the mean number of times per week that they went out of their apartment/home independent of exercising, and a significant increase in the mean number of city blocks they could walk. Performance data for nine exercise participants at 1-yr postintervention are presented. A low- to moderate-intensity groups exercise program can effect improvements in lower extremity strength, gait speed, balance, and self-reported mobility function in frail older adults. INSET: Untitled. [ABSTRACT FROM AUTHOR]

The Role of Exercise in Preventing Osteoporosis SKELETAL MATURATION CONTINUES long after linear bone growth ceases, so that peak bone mass is not achieved until the third decade of life. […]