Annals of Long Term Care

The Effect of Age on Functional and Mortality Outcomes After Acute Myocardial Infarction

Suzanne V. Arnold, MD, MHA, Karen P. Alexander, MD, Frederick A. Masoudi, MD, MSPH, P. Michael Ho, MD, PhD, Lan Xiao, PhD, and John A. Spertus, MD, MPH

OBJECTIVES: To determine the prevalence of post-myocardial infarction (MI) functional decline and to describe its association with chronological age in survivors of MI.

DESIGN: Prospective observational registry.

SETTING: Nineteen U.S. hospitals.

PARTICIPANTS: Two thousand four hundred eighty-one patients with acute MI.

MEASUREMENTS: Baseline and 1-year interviews identified subjects with functional decline, defined as a more than 5-point decline in Medical Outcomes Study 12-item Short Form Questionnaire (SF-12) Physical Component score or being "too ill" to provide a follow-up interview at 1 year. The relationship between age and functional decline was evaluated using logistic regression models adjusted for baseline SF-12 score, comorbidities, sociodemographics, and treatment characteristics. One-year mortality and a combined endpoint of death or decline were also compared across age.

RESULTS: Of 2,009 patients who survived to 1 year, 582 (29%) experienced a functional decline. In survivors, age was not associated with functional decline in unadjusted (odds ratio (OR)=0.95/decade, 95% confidence interval (CI)=0.88–1.03) or multivariable (OR=0.94, 95% CI=0.85–1.05) models. Although age was strongly associated with 1-year mortality (adjusted hazard ratio=1.42, 95% CI=1.21–1.66), there was no association between age and the combined endpoint of death or functional decline (adjusted OR=1.02, 95% CI=0.92–1.12).

CONCLUSION: More than one in four survivors of MI experiences a significant decline in physical function by 1 year. Although age is strongly associated with mortality, it had no association with functional decline. Because older patients have the same potential for favorable functional outcomes after an MI, age alone should not preclude aggressive treatment after an MI. J Am Geriatr Soc 2009;57(2):209-217.

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Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis

Catherine Sherrington, PhD, Julie C. Whitney, MSc, Stephen R. Lord, DSc, Robert D. Herbert, PhD,
Robert G. Cumming, PhD, and Jacqueline C. T. Close, MD

OBJECTIVES: To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls.

DESIGN: Systematic review with meta-analysis. Randomized controlled trials that compared fall rates in older people who undertook exercise programs with fall rates in those who did not exercise were included.

SETTING: Older people.

PARTICIPANTS: General community and residential care.

MEASUREMENTS: Fall rates.

RESULTS: The pooled estimate of the effect of exercise was that it reduced the rate of falling by 17% (44 trials with 9,603 participants, rate ratio (RR)=0.83, 95% confidence interval (CI)=0.75–0.91, P<.001, I2=62%). The greatest relative effects of exercise on fall rates (RR=0.58, 95% CI=0.48–0.69, 68% of between-study variability explained) were seen in programs that included a combination of a higher total dose of exercise (>50 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program.

CONCLUSION: Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program.