We are grateful to Centro de Investigacion del Envejecimiento (CIEN) of Universidad San Martin de Porres (USMP) for providing us with the database for the study. To the faculty team of research of the medical school of Universidad de Ciencias Aplicadas (UPC) for their appreciations and comments. Jorge L. Maguiña is a doctoral candidate studying Epidemiological Research at Universidad Peruana Cayetano Heredia under FONDECYT/CIENCIACTIVA scholarship EF033-235-2015 and supported by training grant D43 TW007393 awarded by the Fogarty International Center of the US National Institutes of Health . / El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Introduction: Sarcopenia is a geriatric syndrome characterized by loss of muscle mass and strength. The prevalence in people between 60–70 years is about 5–13% and in adults over 80 years, between 11–50% in the USA. Sarcopenia increases the risk of mortality and nosocomial infections. Community-acquired pneumonia is the first infectious-related cause of death in elderly people. However, there is lack of evidence about the association between sarcopenia and pneumonia. The aim of our study was to determine the incidence and risk factors of community-acquired pneumonia in older adults with sarcopenia in a Peruvian hospital. Methods: A retrospective cohort study was conducted in the geriatrics service of Centro Medico Naval “Cirujano Mayor Santiago Tavara”. Sarcopenia was defined by “European Consensus of Sarcopenia” criteria. MultivariatePoisson regression model was conducted to estimate the effect of the independent association between sarcopenia and pneumonia. Results: A total of 1598 subjects were enrolled, 59.0% were male; with a mean age of 78.3 ± 8.6 years. The prevalence of sarcopenia was 15.1% (95% CI: 13.3–16.8) and the incidence of community-acquired pneumonia was 15.14% (95%CI 13.4–16.9). In the multivariate model, we found a higher incidence of pneumonia in sarcopenic compared to non-sarcopenic, RR(a) 3.88 (95% CI: 2.82–5.33). Discussion: Our study showed a higher incidence of community-acquired pneumonia in sarcopenic subject. Results provide information on the importance of detecting this syndrome because it gives us scientific evidence of the interest of a correct comprehensive geriatric assessment in older patients with a high risk of pneumonia. / We are grateful to Centro de Investigacion del Envejecimiento (CIEN) of Universidad San Martin de Porres (USMP) for providing us with the database for the study. To the faculty team of research of the medical school of Universidad de Ciencias Aplicadas (UPC) for their appreciations and comments. Jorge L. Maguiña is a doctoral candidate studying Epidemiological Research at Universidad Peruana Cayetano Heredia under FONDECYT/CIENCIACTIVA scholarship EF033-235-2015 and supported by training grant D43 TW007393 awarded by the Fogarty International Center of the US National Institutes of Health . / Revisión por pares / Revisión por pares

Submitted by Livia Marcondes Faber null (liviamfaber@gmail.com) on 2017-03-22T12:51:27Z No. of bitstreams: 1 dissertação defesa imprimir.doc: 1053184 bytes, checksum: a0540b27eada2d0a7ea6b46ad5b292e1 (MD5) / Rejected by Luiz Galeffi (luizgaleffi@gmail.com), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: A versão final da dissertação/tese deve ser submetida no formato PDF (Portable Document Format). O arquivo PDF não deve estar protegido e a dissertação/tese deve estar em um único arquivo, inclusive os apêndices e anexos, se houver. Por favor, corrija o formato do arquivo e realize uma nova submissão. Agradecemos a compreensão. on 2017-03-22T19:25:31Z (GMT) / Submitted by Livia Marcondes Faber null (liviamfaber@gmail.com) on 2017-03-23T13:07:44Z No. of bitstreams: 1 dissertação defesa imprimir.pdf: 308066 bytes, checksum: 42a2e825be13eab7fdcee0ab57b20bec (MD5) / Rejected by Luiz Galeffi (luizgaleffi@gmail.com), reason: Solicitamos que realize uma nova submissão seguindo a orientação abaixo: O arquivo submetido está sem a ficha catalográfica. A versão submetida por você é considerada a versão final da dissertação/tese, portanto não poderá ocorrer qualquer alteração em seu conteúdo após a aprovação. Corrija esta informação e realize uma nova submissão com o arquivo correto. Agradecemos a compreensão. on 2017-03-23T16:41:06Z (GMT) / Submitted by Livia Marcondes Faber null (liviamfaber@gmail.com) on 2017-04-19T12:55:57Z No. of bitstreams: 1 livia defesa.pdf: 304821 bytes, checksum: 617b4250b633280bd3fd746256a9da4f (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-04-19T13:13:10Z (GMT) No. of bitstreams: 1 faber_lm_me_rcla.pdf: 304821 bytes, checksum: 617b4250b633280bd3fd746256a9da4f (MD5) / Made available in DSpace on 2017-04-19T13:13:10Z (GMT). No. of bitstreams: 1 faber_lm_me_rcla.pdf: 304821 bytes, checksum: 617b4250b633280bd3fd746256a9da4f (MD5) Previous issue date: 2017-03-14 / Objetivos: Comparar o equilíbrio estático e mobilidade de idosos institucionalizados com idosos moradores da comunidade. Métodos: Foram sujeitos da pesquisa 42 idosos, de 60 anos e mais, ambos os sexos, 21 residentes de instituições de longa permanência (ILPI), na cidade de Marília SP e 21 idosos moradores da comunidade. O equilíbrio estático (path lengh, velocidade média e área 95% da elipse) foi avaliado por uma plataforma de força e a mobilidade através do teste Timed Up and Go (TUG). Resultados: Os resultados mostraram que idosos do grupo ILPI’s apresentaram valores significativamente maiores de oscilação do COP comparado com o grupo comunidade. Quanto à mobilidade, o grupo ILPI’s apresentou maior tempo para realização do teste, indicando pior mobilidade em relação ao grupo comunidade. Conclusão: Idosos institucionalizados apresentaram mais oscilação do centro de gravidade e maior mobilidade do que idosos moradores da comunidade. / Objectives: To compare the static balance and mobility of institutionalized elderly with community-dwelling elderly. METHODS: were included in the study 42 elderly patients aged 60 and over, both sexes, 21 living in long-term care facilities (ILPI), in the city of Marília SP and 21 community-dwelling elderly. The static balance was evaluated by a force platform and mobility by the Timed Up and Go test (TUG). Results: The results showed that the elderly of the ILPI's group presented significantly higher values of COP oscillation compared to the community group. Regarding mobility, the ILPI's group presented longer time to perform the test, indicating worse mobility in relation to the community group. Conclusion: Institutionalized elderly showed more center of gravity oscillation and worse mobility than community-dwelling elderly.

INTRODUÃÃO. O termo fragilidade à aplicado aos indivÃduos idosos com alto risco para quedas, hospitalizaÃÃo, institucionalizaÃÃo e morte. Embora fragilidade esteja associada a quedas, os mecanismos exatos dessa associaÃÃo ainda nÃo estÃo suficientemente estabelecidos, o que pode limitar as intervenÃÃes nessa Ãrea. A alteraÃÃo da postura poderia ser um fator que nos idosos frÃgeis favoreceria a maior ocorrÃncia de quedas. Sendo assim, abordagens voltadas para a melhoria da postura poderiam ser importantes para a reduÃÃo de quedas em idosos. InvestigaÃÃes sobre a ocorrÃncia de alteraÃÃo da postura em idosos com fragilidade nÃo estÃo disponÃveis. OBJETIVO. Estimar as medidas angulares posturais entre idosos (idade de 60 anos ou mais) frÃgeis, prÃ-frÃgeis e nÃo-frÃgeis residentes em Ãrea urbana de Fortaleza, CearÃ. MÃTODOS. Foram avaliadas medidas angulares posturais, cujas alteraÃÃes implicam em prejuÃzo na dinÃmica corporal e risco de quedas, por meio do software de avaliaÃÃo postural â SAPO. No perÃodo de marÃo de 2009 a outubro de 2010, foram avaliados 158 idosos, na idade de 60 a 92 anos, oriundos de um inquÃrito realizado nos domicÃlios de uma Ãrea urbana da cidade de Fortaleza-CE, distribuÃdos em trÃs categorias: nÃo frÃgeis, prÃ-frÃgeis, e frÃgeis, seguindo os critÃrios de classificaÃÃo proposto no estudo de Fried et al., 2001. A relaÃÃo entre as medidas posturais e presenÃa de fragilidade ajustada para potenciais confundidores, foi estimada por meio de regressÃo logÃstica multivariada. RESULTADOS. Os indicadores posturais: posiÃÃo da cabeÃa anteriorizada (<36 graus), joelho flexum (<172 graus), tornozelo em dorsiflexÃo (<77 graus), pernas tortas (&#8805;185 graus) apresentaram-se significativamente associados à fragilidade depois de ajustados para gÃnero, idade e IMC. CONCLUSÃO. AlteraÃÃes posturais estÃo associadas à fragilidade em idosos. A identificaÃÃo dos indicadores posturais associados à fragilidade pode orientar intervenÃÃes fisioterÃpicas que minimizem os desfechos indesejÃveis, como quedas e reduÃÃo das atividades fÃsicas. / RATIONALE. The term frailty is applied to aged individuals with high risk for falls, hospitalization, institutionalization and death. Frailty is associated with falls, but this association has not yet been sufficiently established, which may limit the intervention in this area. We hypothesized that posture would be a factor that would be associated with the elderly fragile taking it to a higher occurrence of falls in frailty. Approaches focused on improving posture could be important for the reduction of falls in elderly people. Investigations on the occurrence of postural alterations in elderly patients with frailty are not available. OBJECTIVE. This study aimed estimate the postural angular measures among frail, pre-fragile and non-fragile older adults (60 years or more) living in the urban area of Fortaleza, CearÃ. METHODS. Angular postural measures wich alterations are associated with impaired body dynamics and high risk of falls were evaluated. The postural analysis was interpreted by the software of postural evaluation â (software of postural evaluation â SAPO). 158 elderly aging from 62 to 90 years old were evaluated from March 2009 to October 2010 and distributed in three categories: non fragile, pre-fragile, and frail accordingly to classification criteria proposed by Fried et al., 2001. The adjustment for potential confounders relationship between postural measures and presence of frailty was estimated through a multivariate logistic regression. RESULTS. Position of the head protruded (<36 degrees), knee flexed (<172 degrees), ankle dorsiflexion (<77 degrees), legs pies (&#8805;185 degrees) were significantly associated with frailty after being adjusted for gender, age and BMI. CONCLUSION. Posture changes are associated with frailty and the identification of indicators associated with postural fragility can lead to interventions that minimize the undesirable outcomes such as falls and reduction of physical activities and operationalize valuable strategies towards preventive clinical practice.

nÃo hà / IntroduÃÃo: Sarcopenia, estado inflamaÃÃo crÃnica e diminuiÃÃo da modulaÃÃo autonÃmica cardÃaca sÃo frequentemente descritos em idosos frÃgeis. No entanto, o papel da inflamaÃÃo e diminuiÃÃo da modulaÃÃo autonÃmica em perda de massa muscular associada ao envelhecimento deve ser esclarecido. Objetivo: identificar, em idosos frÃgeis e robustos residentes na comunidade, correlaÃÃes entre alteraÃÃes autonÃmicas, nÃveis sÃricos de marcadores bioquÃmicos de inflamaÃÃo e diminuiÃÃo da forÃa e do desempenho muscular. Resultados: 98 voluntÃrios frÃgeis e robustos com idade de 60 anos ou mais foram submetidos à avaliaÃÃo clÃnica, exames laboratoriais e anÃlise da variabilidade da frequÃncia cardÃaca em decÃbito dorsal e em ortostase. O logaritmo natural do Ãndice de variabilidade da frequÃncia cardÃaca baixa frequÃncia (LF) foi inversamente relacionado com o marcador bioquÃmico da inflamaÃÃo fibrinogÃnio em idosos com fragilidade (p=0,046), mas nÃo em robustos. NÃo houve associaÃÃo entre Ãndices de variabilidade da frequÃncia cardÃaca e marcadores bioquÃmicos de inflamaÃÃo interleucina-6 e proteÃna C reativa ultrassensÃvel. Velocidade da marcha foi negativamente relacionada com o fibrinogÃnio em idosos frÃgeis (p=0,033), mas nÃo em idosos robustos. Em todos os idosos, velocidade da marcha foi negativamente relacionada com o fibrinogÃnio (p=0,017), interleucina-6 (p=0,038) e proteÃna C reativa ultrassensÃvel (p=0,010). ConclusÃo: nossos resultados sugerem que a sarcopenia relacionada inflamaÃÃo pode ser, pelo menos parcialmente, influenciada por diminuiÃÃo da modulaÃÃo autonÃmica em idosos. / Background: sarcopenia, chronic inflammation status and impairment of cardiac autonomic modulation are often described in frailty elderly. However, the role of inflammation and decreased autonomic modulation in loss of muscle mass associated with aging need to be enlightened. Aim: we aimed to identify, in community-dwelling frailty and robust elderly, correlations among autonomic changes, serum levels of biochemical markers of inflammation and decreased muscle strength and performance. Results: 98 volunteers aged 60 or older was assessed by clinical evaluation, laboratory tests and analysis of heart rate variability (HRV) in the supine and standing positions. The natural logarithm of the HRV index Low Frequency (LF) was inversely related with the biochemical marker of inflammation fibrinogen in frail elderly (p=0.049), but not in robust. There was no association between heart rate variability indices and biochemical markers of inflammation interleukin-6 and C-reactive protein high sensitivity. Gait speed was negatively correlated with fibrinogen in frail elderly (p=0.033), but not in elderly robust. In all elderly, gait speed correlated negatively with fibrinogen (p=0.017), IL-6 (p=0.038) and high-sensitivity CRP (p=0.010). Conclusion: our results suggest that inflammation-related sarcopenia can be at least partially influenced by decreased autonomic modulation in the elderly.

Em animais, os protocolos de Treinamento Físico Crônico (TF) aeróbio de nível moderado têm sido relacionados com a melhora da capacidade do sistema imunológico, como por exemplo o aumento dos leucócitos e a maior produção de citocinas e de oxido nítrico. Durante o envelhecimento, ocorre uma desregulação do sistema imunológico, conhecido como Imunossenescência, a qual contribui para o aumento da suscetibilidade a infecções, câncer e autoimunidade, e redução da resposta vacinal. Assim, o presente estudo verificou os resultados do TF sobre o sistema imunológico, avaliando a capacidade fagocítica dos macrófagos peritoneais oriundos de animais jovens e idosos. MATERIAL E MÉTODOS: Foram utilizados ratos da linhagem Wistar com 60 dias (Jovens) e com 14 meses de idade (Idosos), divididos em quatro grupos: Jovens Sedentários (JS) e Treinados (JT), e Idosos Sedentários (IS) e Treinados (IT). O protocolo de TF foi realizado através do exercício de nível por meio de natação por 45 minutos, três vezes na semana, por oito semanas consecutivas. Após, os macrófagos peritoneais foram desafiados em vitro, durante 30 e 120 minutos, com Escherichia Coli (E. coli) ou Candida albicans (C. albicans), previamente corados com FITC. Células com microrganismos internalizados foram quantificadas por meio de microscopia de fluorescência. RESULTADOS: Após o protocolo de EF, o percentual de macrófagos peritoneais com microrganismos internalizados, obtidos a partir dos ratos jovens ou idosos, foi maior (p < 0,05) em relação aos sedentários. Estes achados foram verificados tanto após desafio com bactérias E. coli quanto com fungos C. albicans, e independente do período de desafio. Os valores obtidos em 120 minutos foram superiores que aqueles correspondentes aos 30 minutos de desafio. Após o EF, os valores percentuais de macrófagos com microrganismos internalizados foram maiores entre os idosos que aqueles observados entre os jovens, independente do período de desafio (p < 0,05). Estas diferenças etárias também ocorreram entre os animais sedentários. CONCLUSÕES: O exercício físico aeróbio em nível moderado foi capaz de alterar a função fagocítica dos macrófagos. A maior internalização de microrganismos por parte dos macrófagos oriundos dos idosos, em relação aos jovens, pode refletir um estado prévio de ativação celular, em função do aumento da atividade inflamatória basal observado em idosos (inflammaging). / In animals, the aerobic physical training (PT) of moderate level have been related with the improvement of the immunologic system capacity, like the increase of leukocytes and a higher production of cytokines and nitric oxide. While ageing, there is a deregulation of the immunologic system, known as Immunosenescence, which contributes to the increasing of the susceptibility to infections, cancer and autoimmunity, and the vaccine response. Thus, the present study examined the results of PF on the immune system, evaluating the phagocytic capacity of peritoneal macrophages derived from young and old animals. Material and Methods: Young (60-day old) and old (14-month old) Wistar mice were divided in four different groups: Sedentary Youngsters (SY) and Trained Youngsters (TY), Sedentary Elderly (SE) and Trained Elderly (TE). The physical training was based in an moderate aerobic PE protocol through swimming sessions of 45 minutes each, three times a week, for eight consecutive weeks. After that, the peritoneal macrophages were challenged in vitro, during 30 to 120 minutes, with Escherichia Coli (E.coli) or Candida albicans (C.albicans), previously dyed with FITC. Internalized microorganism cells were quantified through fluorescence microscopy. Results:After the PE protocol, the percentage of peritoneal macrophage with internalized microorganisms, from young and old mice, was higher (p<0,05) related to the sedentary. These findings were verified either after the challenge with E. coli bacteria or with C. albicans fungi, independently of the challenge time. The values obtained in 120 minutes were higher than those obtained in the 30 minutes of challenge. After the PE, the percentage values of macrophage with internalized microorganisms were higher among the elderly than those observed among the youngsters, independently of the challenge time (p < 0,05). These age differences also occurred among the sedentary animals. Conclusions: The aerobic physical exercise in a moderate level was able to alter the phagocytic function of the macrophages. The greater internalization of microorganisms in macrophages from the elderly, compared to youngsters, may reflect a previous state of cell activation, due to the increase of of the basal inflammatory activity observed in the elderly (inflammaging).

O conhecimento do paciente sobre os seus medicamentos é fundamental para que os use de forma a ser beneficiado por seus efeitos terapêuticos. A Organização Mundial de Saúde (OMS) recomenda a prescrição de medicamentos como um parâmetro para conhecermos as características do uso de medicamentos nas populações. O presente estudo, uma investigação de corte transversal, teve o objetivo de analisar as características das prescrições médicas, utilizando por referência indicadores selecionados de prescrição da OMS, bem como avaliar o conhecimento sobre medicamentos prescritos a idosos cadastrados nos Núcleos de Saúde da Família ligados à Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Os indicadores de prescrição foram verificados nas receitas médicas e o conhecimento foi verificado através da aplicação de um questionário contendo perguntas relativas à indicação terapêutica do medicamento, nome, dosagem, quantidade de forma farmacêutica a ser administrada a cada vez e freqüência de administração. As respostas foram comparadas com a receita médica. O número médio de medicamentos prescritos por paciente foi de 2,76. Foram dispensados 89,49% dos medicamentos prescritos, 91,30% foram prescritos pelo nome genérico e 90,94% foram prescritos de acordo com a lista padronizada de medicamentos. Foram prescritos 0,36% de antibióticos e 0,72% de medicamentos injetáveis. Do total de 100 entrevistados, 44% obtiveram um bom conhecimento sobre os medicamentos utilizados. No que se refere à dosagem, à quantidade de forma farmacêutica a ser administrada a cada vez e à freqüência de administração, 39%, 87% e 85% das respostas, respectivamente, estavam de acordo com a prescrição médica. Em 87% dos casos, indicação terapêutica foi declarada corretamente e, em 45%, o nome do medicamento estava correto. Os resultados sugerem que o Programa de Saúde da Família tem boa resolutividade no que se refere ao uso de medicamentos por idosos, mas que poderia melhorar em alguns aspectos através da atenção farmacêutica. / The patients’ knowledge on their medication is crucial to use them properly. The World Health Organization (WHO) recommends the prescription to be used as a parameter (criteria) to characterize medications use among the population. This cross-sectional study had the objectives of identifying the features of medical prescriptions using the WHO indicators as reference, and, to assess the knowledge of elderly patients who were enrolled in the Family Healthcare Units of the Medical School of Ribeirão Preto – University of São Paulo. The prescription indicators were verified in the medical prescriptions and the knowledge was verified through the administration of a questionnaire to 100 elderly patients. The questionnaire included questions on the therapeutic indication, name, of the drugs dosis, and the quantity of pharmaceutical form to be taken, and the frequency of administration. The answers were compared to the prescriptions. The mean of the prescribed medications for patient was 2,76. 89,49% of prescribed medications were dispensed, and 91,39% were prescribed by generic name and 90,94% prescribed according to the standard list of medications. It has been prescribed 0,36% of antibiotics and 0,72% of injectable medications. Out of one hundred interviewee, of whom 44% showed a good knowledge about their medicaments. Regarding to dosis (39%), amount of pharmaceutical form taken (87%) and the frequency of administration (85%) of answers were in accordance with the medical prescription. In 87% of cases the patients answered correctly to the therapeutical indication and 45% of the cases they correctly answered the name of medication. The results suggest that the Family Healthcare has a good performance regarding the use of medicaments by old-aged patients, there is some room for improvement through pharmaceutical care.

An attitude is a mental state that influences the way an individual responds to relevant objects and situations. Attitudes toward the elderly have a potential impact on all Americans, as the population is growing older. These attitudes constitute an important area of study because their nature is unclear and their impact extensive. The Kogan Attitudes Toward Old People Scale (OP) was examined to establish reliability and validity estimates. A questionnaire, consisting of this scale and four others, was administered to a sample of adults. Factor analysis of the OP revealed two factors, which were somewhat ambiguous. Internal consistency estimates for these factors and the total OP ranged from .72 to .92. Validity estimates were in the expected direction and ranged from -.13 to .36. Gender, age, education level, and degree of tolerance for others immerged as predictive variables for reported attitudes toward the elderly. It was concluded that the use of the OP is of questionable utility. If one must use it, the total OP score or only the items from Factors 1 and 2 should be utilized, as long as the discussed weaknesses, such as the sampling and validation procedures, are taken into account

Incidents of falls among the elderly increase with age. About $31 million is spent annually in the United States on medical costs related to fall injuries in the elderly. This project evaluated the outcomes of a fall reduction program implemented in an assisted living facility (ALF). The Stop Elderly Accidents, Death & Injury program developed by the Centers for Disease Control and Prevention was implemented by the ALF for 60 days prior to the outcome evaluation project. The program included a convenience sample of 62 residents and involved medication evaluation, exercises, assistive devices, environmental risk reduction, and evaluation of blood pressure. Bandura's theory on self-efficacy was applied in guiding the implementation process. The practice-focused question compared the fall rate among the ALF's elderly residents during the 30-day period following implementation of the program, and the previous 12months. The fall rates were analyzed with descriptive statistics. Results showed the preintervention fall rate was 6.6 falls per month, while at the end of the 30-day postimplementation period, that rate was reduced by 39.4% to 4 falls per month. The conclusion of this outcome-evaluation project is that falls among the elderly in the ALF can be reduced with evidence-based programs. The recommendation is that ALFs should have fall reduction programs, thereby avoiding unnecessary complications of falls among elderly residents. Implications for nursing practice include improved understanding of falls as a safety issue for ALF residents and the need for nurse practitioners to take a more active role as advocates for fall prevention programs in ALFs. The positive societal change produced is improved safety and reduction in fall injuries among the elderly in assisted living facilities.

Each year, approximately 3 million people in the United States develop a pressure ulcer. Although a preventable complication, pressure ulcers are among the top 5 adverse outcomes in the acute care setting with the prevalence as high as 42% in the intensive care unit (ICU). The purpose of this systematic review was to evaluate the inclusion of the Braden Scale as part of a multicomponent pressure ulcer intervention protocol, or care bundle, to identify geriatric patients hospitalized in the ICU who were at risk for pressure ulcers. The Cochrane protocol guided this review; findings were reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Through a structured search strategy in 6 electronic databases, 409 studies were reviewed, of which 11 studies were analyzed and the data included in a literature review matrix for synthesis. Four key findings emerged from the data analysis: effective pressure ulcer prevention programs use a risk assessment, daily reassessment of risk, daily skin inspections, moisture removal strategies, nutritional support and hydration, and offloading pressure; the Braden Scale is effective in detecting pressure ulcer risk in the ICU; an evidence-based bundle is effective in preventing pressure ulcer development; and decreased risk for pressure ulcer development increases patient safety, improves quality of care, and reduces the overall cost of care. The findings from this project can result in positive change by providing the evidence to guide improvements in pressure ulcer protocols to increase the quality of care and decrease the incidence of pressure ulcers in the ICU.

Maintenance of physical function with advancing age is vital to continued independent living, which is highly valued by older people. Although commonly associated with the ageing process, loss of functional ability may well be accelerated by inactivity and subsequent decreasing physical capacities, such as muscle performance or balance abilities. The impact of increased levels of activity on physical performance and functional ability was investigated by a single blind randomised controlled study.Two intervention programs, one based on increased levels of physical activity and the second on increased levels of social activity, were provided to a group of community-living participants aged 75 years and over. Another group, receiving no intervention was also included. The exercise intervention offered twice weekly sessions of exercise over a 16-week period. This was designed and supervised by physiotherapists. The social intervention offered a weekly, two-hour session over 13 weeks. Baseline, post-intervention and follow-up assessments measured aspects of physical performance (muscle, balance, gait and step height performance) and functional ability (tiredness of limbs, mobility tiredness and the need for assistance with mobility and activities of daily living). In addition, all participants completed a monthly health and falls report. One hundred and forty-nine subjects were admitted into the study with 108 completing the intervention phase and all four assessments.Analysis of data indicated that the exercise intervention was effective in improving muscle performance (shoulder abduction mean difference 13.00, 95%CI 11.63-14.37; hip abduction mean difference 5.97, 95%CI 4.73-7.20; knee flexion mean difference 4.10, 95%CI 3.32-4.88; dorsiflexion mean difference 4.72, 95%CI 3.74-5.71), dynamic balance ability (Functional Reach mean difference 11.45, 95%CI 9.41-13.48), ++ / maximal gait speed (mean difference 0.62, 95%CI 0.50-0.74) and step height performance (mean difference 0.19, 95%CI 0.01-0.29). Improvements in dynamic balance and maximal walk performance were maintained for a period of four months following cessation of the intervention. The social program did not affect aspects of physical performance.Functional improvements were evident for both exercise and social subjects. Immediate improvements in limb tiredness (upper mean difference 0.37, 95%CI -0.11-0.84; lower mean difference 0.63, 95%CI 0.37-0.89) and mobility tiredness (mean difference 1.43, 95%CI 1.16-1.70) and activities of daily living dependence (mean difference 0.25, 95%CI -0.23-0.75) were demonstrated. Four and eight months later, exercise subjects had maintained the improvement in mobility tiredness and activities of daily living dependence. Mobility dependence showed a delayed improvement in both the exercise and social intervention participants. This improvement was not evident immediately following intervention, but emerged at both the four and eight month follow-up assessments.An intention to treat analysis (involving both completing and non-completing subjects) confirmed the usefulness of the exercise intervention as a strategy to improve and maintain functional ability in older subjects, specifically with regard to tiredness of the lower limbs, tiredness during mobility tasks and activities of daily living dependence. In addition, following the cessation of the exercise intervention, participants reported less mobility tiredness and dependence in activities of daily living tasks over the following eight-month period.The relationship between physical performance and functional ability indicated that muscle performance and limb tiredness were significantly associated. Decreased muscle performance of the upper limb was associated with reports of increased ++ / tiredness during functional activities involving the upper limb, such as combing hair and dressing the upper body. Similarly, decreased muscle performance of the lower limb, especially proximally, was associated with increasing tiredness of the lower limb during functional activities. Further, decreased proximal muscle performance of both the upper and lower limb was significantly associated with decreasing independence in the performance of physical activities of daily living. These results indicate the significant influence of muscle performance on functional ability, especially on tiredness of the limbs and activities of daily living dependence.The ability to predict future functional limitation, based on decreasing physical performance, was examined and shown to be of limited value. Hip muscle performance and changes in usual gait speed were poorly associated with increased lower limb tiredness and dependence in physical activities of daily living respectively. The lack of a robust relationship between variables of physical performance and functional ability measures indicates that loss of physical performance is not strongly associated with the development of functional limitations.Self-reported falls were monitored throughout the study. A significant increase in the number of participants reporting falls was evident in both the social intervention group and the control group throughout the study. In contrast, there was no change in the number of exercise participants reporting falls. These results suggest that the exercise intervention was effective at minimising the usual increase in the number of older people experiencing falls over time.The results of this study suggest that the exercise intervention program was effective in improving physical performance in elderly subjects. This also resulted in improved functional ability. Positive effects continued ++ / following completion of the program as improvements in mobility and activities of daily living tasks were demonstrated for a further eight months. By contrast, the social intervention program appeared to influence only the need for help with mobility tasks in the longer term.Increased physical activity, in the form of an exercise intervention program, specifically designed for community-living elderly people, can improve and maintain functional ability, both immediately and for up to eight months following the completion of the program. As such, involvement in exercise, even in the short-term, should be encouraged as a means of maintaining physical independence in later life. Therapists devising exercise programs specifically for older people should ensure that the associated outcome measures incorporate assessments of functional ability and not simply measures of impairment. This study has demonstrated that a real benefit of increased physical activity in older people may well be the increased physical independence associated with participation.