Foi feito um estudo de revisão sobre a mortalidade na fratura do fêmur proximal em idosos com base nas publicações mais relevantes do período de 1998 a 2002. Foram incluídos 25 artigos relacionados ao assunto, selecionados com base nos bancos de dados Medline e Cochrane, totalizando 24.062 pacientes com mais de 60 anos de idade, que tiveram fratura do fêmur proximal. Quatorze estudos foram prospectivos, oito retrospectivos e três revisões sistemáticas. As taxas médias de mortalidade foram de 5,5% durante a internação hospitalar, 4,7% ao fim de um mês de seguimento, 11,9% com três meses, 10,8% com seis meses, 19,2% com um ano e 24,9% com dois anos. Foram identificados quatro fatores intimamente relacionados com uma maior mortalidade nestes pacientes: idade avançada, grande número de doenças associadas, sexo masculino e presença de deficiências cognitivas. Outros fatores mostraram uma fraca correlação com a mortalidade como capacidade deambulatória prévia, índice de risco anestésico da Sociedade Americana de Anestesia (ASA), anemia, hipoalbuminemia, linfopenia e existência de AVC prévio. Os fatores como tempo prévio à cirurgia, tipo de anestesia utilizada e tipo de osteossíntese empregada não mostraram ter interferência.

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Studies indicate that exercise might delay human biological aging, but the effects of long-term exercise on T cell function are not well known. We tested the hypothesis that moderate or intense exercise lifestyle may attenuate the effects of aging on the telomere length and the survival and composition of T cell subpopulations. Elderly (65-85 years) with intense training lifestyle (IT, n = 15), moderate training lifestyle (MT, n = 16), and who never trained (NT, n = 15) were studied. Although the three groups presented the ageassociated contraction of the TCD4 + /TCD8 + naïve compartments and expansion of the memory compartments, both training modalities were associated with lower proportion of terminally differentiated (CD45RA + CCR7 neg ) TCD4 + and TCD8 + cells, although among the latter cells, the reduction reached statistical significance only with IT. MT was associated with higher proportion of central memory TCD4 + cells, while IT was associated with higher proportion of effector memory TCD8 + cells. However, both training lifestyles were unable to modify the proportion of senescent (CD28 neg ) TCD8 + cells. Telomeres were longer in T cells in both training groups; with IT, telomere length increased mainly in TCD8 + cells, whereas with MT, a modest increase in telomere length was observed in both TCD8 + and TCD4 + cells. Reduced commitment to apoptosis of resting T cells, as assessed by caspase-3 and Bcl-2 expression, was seen predominantly with IT.

We aimed to verify whether different levels of training performed regularly and voluntarily for many years could have an impact on one of the main issues of immunosenescence: the poor response to vaccines. We recruited 61 healthy elderly men (65-85 years old), 23 with a moderate training (MT) lifestyle (for 17.0± 3.2 years), 22 with an intense training (IT) lifestyle (for 25.9±3.4 years), and 16 without a training lifestyle (NT). Fitness was evaluated through the IPAQ and VO 2 max consumption. The participants were evaluated regarding cognitive aspects, nutritional status, depression, and quality of life. Antibody titers were determined by hemagglutination inhibition assay prior to influenza vaccination and at 6 weeks and 6 months post-vaccination. Strains used were B, H3N2, and H1N1. Our groups were matched for most characteristics, except for those directly influenced by their lifestyles, such as BMI, VO 2 max, and MET. In general, MT and IT elderly men showed significantly higher antibody titers to the three vaccine strains post-vaccination than NT elderly men. There were also higher titers against B and H1N1 strains in the trained groups before vaccination. Additionally, there were higher proportions of seroprotected (titers≥1:40) individuals in the pooled trained groups both at 6 weeks (B and H3N2, p < 0.05) and 6 months (H1N1, p <0.05; B, p=0.07). There were no significant differences between the MT and IT groups. Either a moderate or an intense training is associated with stronger and longstanding antibody responses to the influenza vaccine, resulting in higher percentages of seroprotected individuals.

The objective of the study was to examine the association between handgrip strength (HGS), knee flexion and extension strength, and static and dynamic balance in older women. One hundred and ten women with a mean age of 67.4±5.9 years were assessed for dynamic postural balance using the Time Up & Go Test (TUG) with and without cognitive tasks. Semi-static balance was assessed by means of a force platform; knee flexor and extensor muscle strength was calculated using an isokinetic dynamometer; and HGS using a hand held dynamometer. Weaker HGS was significantly correlated with worse performance in dynamic postural balance, as well as performance with TUG with and without cognitive tasks; however, there was no correlation between HGS and static balance. There was a moderate positive correlation between knee flexion/extension strength and HGS. This suggests that HGS could be used as a proxy indicator of overall strength capacity for clinical screening among older women.

Furlaneto ME, Garcez-Leme LE. Impact of delirium on mortality and cognitive and functional performance among elderly people with femoral fractures. Clinics. 2007;62(5):545-52. OBJECTIVE:To evaluate the evolution of cognitive and functional performance and mortality among elderly patients who were delirious during hospitalization due to femoral fracture. who did not present with delirium. There were six deaths, and 97 patients were discharged from the hospital. We obtained information on 85 of these patients four years after discharge; 42 patients were still alive and 43 had died at the time of the evaluation. METHODS: Data on vital status was obtained for 85 patients. For the 42 survivors, we acquired information on their basic activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive performance (BDRS) by means of telephone interview with the same caregivers who had provided information at the time of the hospitalization. We compared this data with that obtained during their hospitalizations four years prior. For the 43 patients who died, we obtained information regarding their deaths and used this data in the analysis of mortality. RESULTS: No relationships were observed between delirium and mortality, delirium and cognitive loss, or delirium and functional loss, after four years from discharge of elderly patients with hip fractures. An initial cognitive deficit was a predictor for mortality (RR = 2.54; p = 0.016), functional loss (OR = 1.80; p = 0.027) and cognitive loss (OR = 1.53; p = 0.024). Cognitive loss was also related to age. CONCLUSIONS: Delirium had no impact on mortality or functional or cognitive losses in long term evolution (2 years) among elderly patients with femoral fractures. An initial cognitive impairment may identify patients at risk of mortality, functional and cognitive losses over the long term evolution.

OBJECTIVE:To assess knee flexor-extensor muscular strength in elderly women with no previous history of musculoskeletal disorders on the lower limbs using an isokinetic dynamometer, in order to obtain data that could be used as a comparative parameter in the evaluation of elderly women with knee disorders, thus facilitating a better rehabilitation of these patients.METHODS: Twenty-six volunteers aged 75 to 83 years were studied using a Cybex ® 6000 isokinetic dynamometer. The chosen angular velocity was 60 º/s, and concentric exercise was used for either flexion or extension. The studied parameters were: peak torque, angle of peak torque, and flexor-extensor torque rate.RESULTS: There were no differences between dominant (D) and nondominant (ND) knee peak torque values. This was true for both flexor (D = 42.46 ± 9.09 Nm / ND = 40.65 ± 9.38 Nm) and extensor (D = 76.92 ± 13.97 Nm / ND = 77.65 ± 15.21 Nm) movements. The descriptive statistical analysis of the values obtained for the flexor-extensor peak torque rate and for the angle of occurrence of peak torque was the same for the dominant and nondominant sides.CONCLUSIONS: The values of peak torque for the contralateral side can be used as a reference during rehabilitation of elderly women with acute disease of the knee, and the angular velocity of 60 º/s is proper and safe for isokinetic assessment of elderly people.

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