Dissertations / Theses on the topic 'Musculoskeletal diseases in old age'

Le vieillissement s’accompagne d’une altération globale des fonctions physiologiques notamment celles de l’immunité :on parle « d’immunosénescence ». Ce processus se traduit entre autre par l’installation d’un état inflammatoire chronique caractérisé par une augmentation des taux sériques de cytokines telles que l’interleukine(IL)-6 et des protéines de la phase aigüe. Cet état proinflammatoire serait incriminé dans le déclin des fonctions physiologiques, la fragilité et les syndromes gériatriques. Par ailleurs, les maladies cardiovasculaires, la dépression et l’infection chronique par le Cytomégalovirus (CMV) sont également associés à un état inflammatoire chronique. La prévalence de ces comorbidités étant importante chez les patients gériatriques, ces maladies pourraient donc contribuer à l’association observée entre marqueurs de l’inflammation et les syndromes gériatriques.

Les infections représentent un problème majeur en gériatrie. Les cellules du système immunitaire inné jouent un rôle important dans les défenses contre les agents pathogènes. La reconnaissance de ceux-ci par les cellules dendritiques, les macrophages ou les monocytes fait intervenir une série de molécules telles que les récepteurs de la famille Toll (TLR). Certains travaux suggèrent que la fonction des cellules de l’immunité innée pourrait être perturbée chez les individus âgés mais ces données restent controversées.

Dans ce travail, nous souhaitons aborder les hypothèses suivantes :

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Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished

[Truncated abstract] The cost of managing osteoporotic fractures places a significant financial burden on the health-care system. To reduce the fracture burden, early identification of fracture risk is essential to allow early intervention. The limitations associated with dual-energy X-ray absorptiometry (DXA), such as limited sensitivity and specificity, cost, ionising radiation and accessibility, have resulted in the emergence of other technologies for assessing bone fragility. An example is the portable and non-ionising quantitative ultrasound (QUS) technology. The discriminatory power of quantitative ultrasonometry in fracture risk identification, either independently or in combination with other established risk factors, currently remains contentious. It is recommended that fracture risk assessment should not only focus on bone status, but also on the risk of falls. Additionally, it has been noted that disability arising from osteoporotic fractures, even when these fractures are not identified clinically, can translate into psychosocial symptoms and a poorer perception of health-related quality of life (HRQoL). The primary aim of the present study was to investigate if a composite model comprising: calcaneal QUS, falls risk and HRQoL assessments, can identify a group of elderly women at high risk of osteoporotic fracture from those at lower risk. One hundred and four community-dwelling women (mean age 71.3 ±5.8 years) were recruited for this study. These women underwent a series of tests that included: DXA bone mineral density (BMD) evaluation of the proximal femur and lumbar spine (L1 L4); calcaneal QUS measurement; spinal radiography; rasterstereographic back surface curvature (BSC) examination; and performance-based assessment of strength, mobility and balance. The women were classified into a `High Risk’group or a `Low Risk’ group using three separate classification criteria: i) low BMD, based on the World Health Organisation (WHO) recommended T-score of < -2.5, and⁄or a history of fragility fracture (Osteoporotic [OP] group versus Non-Osteoporotic [NOP] group); ii) presence of at least one radiographically identified prevalent vertebral fracture (Vertebral Fracture [VF] group versus Non-Vertebral Fracture [NVF] group); or iii) a history of either forearm or wrist fracture (Forearm/Wrist Fracture [WF] group versus Non-Forearm/Wrist Fracture [NWF] group)

Ectopic calcification can cause pain and limit mobility. Studies suggest that circadian genes may play a role in the calcification process. Core circadian genes Clock, Npas2, and Bmal1 are transcription factors that form CLOCK:BMAL1 or NPAS2:BMAL1 transactivator complexes that drive the rhythmic expression of circadian oscillator genes and output genes. Circadian oscillator genes Period1-3 and Cryptochrome1-2 encode proteins that form transcription repressor complexes that feedback to inhibit CLOCK/NPAS2:BMAL1 activity, thus completing the feedback loop that is the basis of the molecular circadian clockwork. Arrhythmic Bmal1-/- mice exhibit site-specific, age-dependent arthropathy. While studying the circadian phenotype of Clock-/-;Npas2m/m double mutant mice, we discovered that these double mutant mice develop site-specific arthropathy similar to the arthropathy described in Bmal1-/- mice. Based on the circadian clockwork mechanism, we hypothesized that CLOCK/NPAS2:BMAL1 transactivator complexes drive the expression of a gene (or genes) that prevents age-dependent arthropathy. To investigate Clock-/-;Npas2m/m double mutant mouse arthropathy, we evaluated mutant mice using X-ray, micro-computed tomography, and histology, and found that Clock-/-;Npas2m/m double mutant mice exhibit age-dependent, site-specific arthropathy that phenocopies that of Bmal1-/- mice. The costosternal junction and calcaneal tendon are most prominently affected, in that calcification of those tissues is detectable as early as 4-5 weeks and 11-12 weeks, respectively. The arthropathic lesions in these tissues consist of calcium phosphate vii deposits, and in Bmal1-/- costosternal junction calcifications, the deposits contain calcium pyrophosphate dihydrate crystals. Mechanical stress, disregulation of centrally-regulated circadian rhythms, and systemic serum mineral imbalances likely do not contribute to this pathology. In vitro micromass cultures generated from Clock-/-;Npas2m/m double mutant mouse embryonic fibroblasts do not exhibit irregular chondrocyte differentiation compared to wild-type cultures, suggesting that chondrocyte cell-autonomous mechanisms are insufficient to induce this arthropathy. Analysis of Clock-/-;Npas2m/m double mutant intersternebral tissue RNA did not reveal significant changes in chondrocyte or calcification-related gene expression. Histological stains showed an absence of osteoblasts and osteoclasts around costosternal junction calcifications, suggesting that these cell types are not contributing to this pathology. Instead, chondrocytes are localized to the costosternal junction but there were no significant changes in the distribution of chondrocyte markers in this tissue, as evaluated by immunohistochemistry. These findings suggest that Clock or Npas2, and Bmal1, regulate ectopic calcification through a combination of systemic and local factors, and that the cells affected by Clock and Npas2, or Bmal1, disruption are a subset of the cells distributed in specific tissues that develop age-dependent arthropathy. The significance of these findings is that “circadian genes” play a role in the regulation of ectopic calcification in a non-oscillator capacity. Understanding this new mechanism by which ectopic calcification is controlled could lead to novel approaches for the treatment of some human calcification diseases.

The Geriatric Depression Scale (GDS) was originally designed as a measure for screening depression among elderly medical patients. Although this instrument is well validated among a general medical population, it has never been evaluated with specific regard to cardiac patients, the largest single group of medical patients over 40 years of age. A general cardiac sample of 655 patients completed the GDS within 10 weeks of the cardiac event. Exploratory factor analyses were conducted on the main sample, then on several subgroups of participants with regard to diagnostic category, gender, and age. The GDS generally produces factor structures with several symptom domains with a high rate of total variance. The myocardial infarction group endorsed general symptoms of depression whereas the coronary artery bypass graft group reported greater levels of despair regarding their condition. Overall, males primarily reported agitation and hopelessness while females reported symptoms of depressed mood.

Functional vasodilation in arterioles is impaired with chronic ischemia. We sought to examine the impact of chronic ischemia and age on skeletal muscle resistance artery function. To examine the impact of chronic ischemia, the femoral artery was resected from young (2-3mo) and adult (6-7mo) mice and the profunda femoris artery diameter was measured at rest and following gracilis muscle contraction 14 days later using intravital microscopy. Functional vasodilation was significantly impaired in ischemic mice (14.4±4.6% vs. 137.8±14.3%, p<0.0001 n=8) and non-ischemic adult mice (103.0±9.4% vs. 137.8±14.3%, p=0.05 n=10). In order to analyze the cellular mechanisms of the impairment, a protocol was developed to apply pharmacological agents to the experimental preparation while maintaining tissue homeostasis. Endothelial and smooth muscle dependent vasodilation were impaired with ischemia, 39.6 ± 13.6% vs. 80.5 ± 11.4% and 43.0 ± 11.7% vs. 85.1 ± 10.5%, respectively. From this data, it can be supported that smooth muscle dysfunction is the reason for the observed impairment in arterial vasodilation.

Population ageing is unprecedented and enduring. By 2050, the proportion of those aged over 65 would have increased from 13% to 26%. As the population ages, the prevalence of chronic diseases that disproportionately affect the elderly will markedly increase. Osteoarthritis and osteoporosis, including resulting fractures are two such diseases. Physical activity (PA) is an important risk factor for both of these diseases but many questions remain unanswered. This thesis examines how PA and exercise interacts with features of falls, osteoarthritis and osteoporosis. In a population based sample of 50-80 year olds (n=850) followed over 2.6 years, self reported functional ability and pain, and to a lesser extent stiffness (but not radiographic osteoarthritis) have modest but independent associations with physiological predictors of falls risk suggesting it is symptoms not radiographic changes that increase falls risk. In addition, ambulatory activity is positively associated with hip bone density in both sexes which appears most important in those aged over 65 years. However, the associations for spine bone density are both weaker and inconsistent. In a convenience sample of 26-61 year olds (n=325) followed over two years, we found knee cartilage volume and tibial plateau area are dynamic structures that can respond to physical stimuli. Greater muscle strength and endurance fitness, especially in women, protects against cartilage loss, but also results in a maladaptive enlargement of subchondral bone in both sexes, suggesting PA may have both good and bad effects on the knee. 1,434 children, aged 7-15 years, were measured in 1985 and approximately 20 years later. We found childhood fitness levels, particularly in females and in the early pubertal years, predicts adult bone mass, while BMI predicts bone mass in males only. These results suggest that increased skeletal loading in childhood leads to an increase in peak bone mass independent of current loading. In 183 children examined at age 8 and 16, bone mass measured by dual x-ray absorptiometry (DXA) is a good predictor of upper limb fracture risk during puberty. DXA measures track moderately to strongly from childhood to adolescence. Tracking is independent of linear growth and sex indicating bone mineralisation and growth are under largely separate mechanistic control. Body composition is the main predictor of altered tracking but environmental factors, such as having been breastfed, sports participation, fitness and inhaled corticosteroid use also appear important. In conclusion, this series of related studies shed considerable insight onto the role that PA and exercise play in preventing osteoarthritis and osteoporosis. In particular, childhood appears the most opportune time to prevent osteoporosis but later life is also important while for osteoarthritis, results remain less certain for structural change.

Age-related hyperkyphosis of the thoracic spine is a problem which potentially affects all adults. It can result in movement dysfunction and may lead to mechanical failure of the thoracic spine, especially in the presence of osteoporosis, due to overwhelming forces exerted by gravity and muscular contraction. A number of studies have endeavoured to evaluate exercise-based programmes aimed at reducing hyperkyphosis in older adults. However, the multimodal nature of these programmes may reflect the uncertainty about which strategies are most effective. Stroke is a condition which affects 322 000 people in Australia at any given time. Rehabilitation strategies for stroke have commonly excluded resisted strengthening strategies because of fears of increasing spasticity. However, recent studies have failed to confirm this concern. Loss of back extensor strength (BES) is a feature of stroke which is detrimental to function. The effect of resisted BES exercise on function in people with stroke has not been examined. This thesis describes a number of studies that each inform the design and execution of a randomised controlled trial (RCT) which aimed to establish the relative effectiveness of BES exercises and postural re-education ireducing hyperkyphosis. The preliminary studies included three experiments validating the flexible electrogoniometer (FEG) as a tool to measure thoracic kyphosis, a survey looking at the normal practice of Australian physiotherapists with respect to thoracic hyperkyphosis; three experiments using surface electromyography (sEMG), kinematic and force measurements to determine whether sitting or prone lying was a better exercise positions for strengthening the thoracic erector spinae (TES); an ultrasound study looking at the anatomy of two sEMG recording sites; and a study validating the myometry used in the RCT. The three FEG validation studies included: a bench test for accuracy, a test-retest reliability study and a study of concurrent validity comparing FEG angle to corresponding Cobb angles. The studies indicated that the FEG is a reliable instrument with excellent day-to-day reliability (ICC{u2082},{u2081} = 0.92; p < 0.0001 ). When compared with the Cobb angle for concurrent validity, the FEG was found to have the best agreement with the Cobb angle for the section of spine between mid end-blocks (r = 0.814 - 0.821, p = 0.001) with an absolute difference of 3.5{u00B0}{u00B1} 6.9{u00B0}. A stratified cross-sectional mailed survey was used to examine how Australian physiotherapists from varying practice groups assess and manage hyperkyphosis. It revealed that postural re-education, stretching and strengthening were the interventions most frequently used to treat thoracic kyphosis but that the measurement tools used to evaluate treatment effectiveness were primarily subjective. A prospective observational study which used real time ultrasound to image the muscles overlying the erector spinae at T3 and L4 established that the thoracic erector spinae (TES) could not be accurately recorded with sEMG. Therefore, a comparative analysis of the relative contributions of the TES and lumbar erector spinae (LES) was achieved by comparing the forces developed during prone and seated extension and the levels of LES activation. The results indicated that the TES were recruited to a greater extent during seated extension with scapular retraction than they were during prone extension. In addition, a kinematic study comparing the two exercises showed that prone extension primarily resulted in hyperextension of the lumbar spine with limited thoracic extension. A test-retest study of a seated myometry method for testing BES showed that it had excellent day-to day reliability (ICC{u2082},{u2081} = 0.96 (95% CI 0.83 - 0.99)). The minimum difference needed to detect a real difference in force generated between measurements (MD) was 20.7N for extension with retraction. The RCT was subject blinded and utilised a 2X2 factorial design to compare the effects of postural re-education and strengthening. Both stroke and non-stroke (normal) subjects were included although the majority of the subjects were normal. The results of the RCT indicated that, overall, the strengthening intervention resulted in better outcomes in terms of physical ability but that there was no significant reduction in kyphotic angle. The results also suggest that the angular changes which did occur mainly occurred in the upper thoracic spine. Thoracic spine movement frequency was found to be very low in both the sagittal (0.001Hz) and coronal (0.002 Hz) planes which may have implications for the nutrition of the intervertebral disc. There were no differences between the stroke and non-stroke cohorts in terms of their responses to the intervention. The main clinical significance of this work is the discovery that an increase in back extensor strength does not necessarily result in a clinically significant decrease in thoracic kyphosis, especially at the apex of the curve. Further research is required to explore the best conditions in terms of load and position for thoracic extension strengthening for decreasing kyphosis. The effect of intervention on movement frequency is potentially an area of significant interest with respect to reducing the rate of disc disease.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008.
Source: Masters Abstracts International, Volume: 46-05, page: 2672. Adviser: Wendell C. Taylor. Includes bibliographical references.

Indiana University-Purdue University Indianapolis (IUPUI)
Objectives: To examine the effect of a collaborative care program for late-life depression on risk of diabetes among depressed, older adults. Method: We conducted a 9-year follow-up study of 160 older, primary care patients with a depressive disorder but without diabetes enrolled at the Indiana sites of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial. Results: Surprisingly, the rate of incident diabetes in the collaborative care group (22/80 = 27.5%) was twice the rate observed in the usual care group (11/80 = 13.7%). Cox proportional hazards models adjusted for randomization status (HR = 1.94, p = .076), demographic factors (HR = 1.94, p = .075), and additionally for diabetes risk factors (HR = 1.73, p = .157) indicated that the risk of incident diabetes did not differ between the collaborative care and usual care groups, with collaborative care patients remaining at a nonsignificant increased risk. Conclusions: Our novel findings suggest that depression may not be a casual risk factor for diabetes and that depression treatment may be insufficient to reduce the excess diabetes risk of depressed, older adults.

This thesis deals with the topic of "Physical Activity of Seniors with Type 2 Diabetes Mellitus". The theoretical part characterizes terms relating to old age, its symptoms and health problems associated with it; type 2 diabetes mellitus; physical activity playing an essential role in the prevention; and non-pharmacological treatment of this disease. The practical part focuses on monitoring physical activities of seniors with type 2 diabetes mellitus. To collect the data for the research a standardized IPAQ long questionnaire was used. A selected group was monitored using Yamax Digiwalker SW 700 pedometers as regards to the number of steps they made. The obtained results were analyzed and compared with the recommendations for physical activities.

Summary: The thesis focuses on analyzing the impact of activities on quality of life of the older people. The basis comes from the study of literature and also from information collected on the issues. The work explains many concepts which are closely associated with age and aging. It includes the sciences which deal with that domain. Thesis provides an overview of the current system of care for older people in the Czech Republic. It focuses not only on theoretical definition but also on factors describing the quality of life for seniors, especially the positive highlights and the impact of appropriate activities on the course of aging. The research section describes findings which have emerged from the survey among seniors. It is focused on determining the degree of satisfaction for the Generation of the Third Age with the course of life at the present. Specifically it deals with the exploration of the relationship between an active life and the quality of life. The result of the survey reflects almost exactly all the information which has long been well known and scientifically proven.

Illich, a critic of the medical profession in industrial societies, researched the "damage done" by the medical establishment on three levels. This study presents an application of Illich's three-level theory of iatrogenesis to a sample of elderly people in old-age homes in and around Pretoria. Fifty in-depth interviews were conducted with old-age home residents. In the focus on clinical iatrogenesis, the aspect of defenceless patients was investigated. With regard to social iatrogenesis, focus was on the interpretation of attitudes revealing an increased medical dependency. Cultural iatrogenesis, which involves the influence of values and norms on thinking patterns, is investigated in terms of the impact of institutionalisation on the autonomy, independence and personal responsibility of residents. Illich's solution to the problem of medicalisation is to be found in the de-bureaucratisation and de-industrialisation of society. Based on the assumptions of critical theory, the emancipation of the individual is suggested as a basis of Illich's proposed structural societal changes
M.A. (Sociology)

CONCLUSION: A multi-faceted hand hygiene intervention with pocket-sized containers of alcohol-based hand rub was effective in increasing hand rubbing compliance and reducing incidence of total infections requiring hospitalization in elderly LTCFs. Its effect on outbreaks still needs further investigations. The questionnaire developed in this study may be a simple and effective method to assess the attitude and compliance change of the HCWs after implementing a hand hygiene programme.
DESIGN: Clustered randomized controlled trial
INTERVENTIONS: After a 3-month run-in period, we randomized three LTCFs to the treatment and three to the control group. The treatment group received pocket-sized containers of alcohol-based hand rub, education and reminding materials. The control group received basic life support education and workshops. They were followed up for another seven months. We measured the hand hygiene compliance of the HCWs by direct observation and recorded the incidence of infections of the residents from their hospital discharge summaries.
OBJECTIVE: To investigate the effectiveness of a multi-faceted hand hygiene programme with pocket-sized containers of alcohol-based hand rub for infection control in elderly long-term care facilities (LTCFs)
OUTCOMES & DATA ANALYSIS: Primary outcomes were direct observed compliances of hand washing and antiseptic hand rubbing of the HCWs, incidence of infections requiring hospitalization and death rate due to infection of the residents, and outbreaks of the LTCFs. Secondary outcomes were change in hand hygiene attitude and self-reported compliance.
PARTICIPANTS: All health care workers (HCWs) of the LTCFs recruited by snowball sampling. Their job categories were nurses, nursing assistants and physiotherapists.
RESULTS: In the treatment group, the compliance of alcohol-based hand rubbing increased significantly from 1.5% (5/333) to 15.9% (233/1465) (p=0.001) and total compliance increased from 25.8% (86/333) to 33.3% (488/1465) (p=0.01) after intervention. Total incidence of infections decreased from 31 cases in 21,862 resident days (1.42 per 1,000 resident-day (rd)) to 33 cases in 50,441 resident days (0.65 per 1,000 resident-day) (p=0.002) and death rate due to infection decreased from 8 cases in 21,862 resident days (0.37 per 1,000 rd) to 5 cases in 50,441 resident days (0.1 per 1,000 rd) in the treatment group (p=0.01). Pneumonia significantly decreased by 0.63 per 1000 rd (p=0.001). In the control group, there were no changes in both antiseptic hand rubbing and hand washing. The total incidence of infections increased from 0.49 to 1.04 per 1000 rd (p=0.004) and no change in death rate due to infection (p=0.45). No outbreaks of influenza and norovirus occurred during the whole study in both groups.
SETTING: Six LTCFs for the elderly
The attitude of antiseptic hand rubbing on infection control increased significantly in the treatment group but there was no change under different situations in the control group. The self-reported compliance of antiseptic hand rubbing increased significantly in the treatment group. There were no changes on the self-reported compliances in the control group. The agreement of the direct observed results and the self-reported compliances was 75% (kappa coefficient = 0.5).
Yeung, Wing Kin.
Adviser: Tze Wai Wong.
Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: .
Thesis (Ph.D.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 100-106).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.