Exercise in the healthy older adult

Asian Best Practices for Care of Diabetes in Elderly (ABCDE)

The elderly population with diabetes is diverse with the majority experiencing a decline in physical and mental capabilities, impacting the entire diabetes management process. Therefore, a need for geriatric-specific guidelines, especially for the Asian population, was identified and subsequently developed by an expert panel across government and private institutions from several Asian countries. The panel considered clinical evidence (landmark trials, position papers, expert opinions), recommendations from several important societies along with their decades of clinical experience and expertise, while meticulously devising thorough geriatric-specific tailored management strategies. The creation of the ABCDE best practices document underscores and explores the gaps and challenges and determines optimal methods for diabetes management of the elderly population in the Asian region.

Management of Hyperglycemia in Older Adults with Type 2 Diabetes

The increasing incidence of type 2 diabetes in the general population as well as enhanced life expectancy has resulted in a rapid rise in the prevalence of diabetes in the older population. Diabetes causes significant morbidity and impairs quality of life. Managing diabetes in older adults is a daunting task due to unique health and psychosocial challenges. Medical management is complicated by polypharmacy, cognitive impairment, urinary incontinence, injurious falls, and persistent pain. Health care providers now have several traditional and contemporary pharmacologic agents to manage diabetes. Avoidance of hypoglycemia is critical; however, evidence-based guidelines are lacking due to the paucity of clinical trials in older adults. For many in this population, maintaining independence is more important than adherence to published guidelines to prevent diabetes complications. The goal of diabetes care in older adults is to enhance the quality of life without subjecting these patients to intrusive and complicated interventions. Recent technological advancements such as continuous glucose monitoring systems can have crucial supplementary benefits in the geriatric population.

AGING, DIABETES, AND FALLS

KEY POINTS Falls are a major health issue for older adults, leading to adverse events and even death. Older persons with type 2 diabetes are at increased risk of falling compared to healthy adults of a similar age. Over 400 factors are associated with falls risk, making identification and targeting of key factors to prevent falls problematic. However, the major risk factors include hypertension, diabetes, pain, and polypharmacy. In addition to age and polypharmacy, diabetes-related loss of strength, sensory perception, and balance secondary to peripheral neuropathy along with decline in cognitive function lead to increased risk of falling. Designing specific interventions to target strength and balance training, reducing polypharmacy to improve cognitive function, relaxation of diabetes management to avoid hypoglycemia and hypotension, and relief of pain will produce the greatest benefit for reducing falls in older persons with diabetes. Abbreviation: DPN = diabetic polyneuropathy.

Multidisciplinary approach for the treatment of diabetes in the elderly

Elderly patients living with diabetes are a highly heterogeneous population with unique care needs. Unlike younger patients, elderly patients may experience an atypical presentation and nontraditional complications of diabetes. Diabetes management and education require greater individualization in elderly adults because of differences in goals of care, risks and benefits of intensive treatment and abilities to practically carry out care regimens. A multidisciplinary approach to diabetes care requires an in-depth knowledge of diabetes, an awareness of geriatric issues and access to decision and educational support. This approach may be the most successful way of delivering individualized diabetes care. Future trials of diabetes care innovations in the elderly will be required to confirm the clinical benefits of this approach.

Training for older adults

Aging is associated with a reduction in physical fitness, with loss of muscular force and endurance. Physical activity has been demonstrated to provide substantial health benefits and to maintain functional independence and improve quality of life in older adults. Resistance training has a significant effect on muscle mass and force whereas endurance training increases oxygen transport and consumption capacities. This article presents training methods used in the literature and their associated effects in order to adapt training protocols to older populations. To maximise benefits from adoption of a program to which the patient can adhere for long time, it is important to tailor the exercise prescription to the individual.

Leisure-Time Physical Activity and Health-Care Utilization in Older Adults

This study examined whether leisure-time physical activity (LTPA) was associated with health-care utilization in a racially diverse sample of rural and urban older adults. Community-dwelling adults (N= 1,000, 75.32 ± 6.72 years old) self-reported participating in LTPA and their use of the health-care system (physician visits, number and length of hospitalizations, and emergency-room visits). After controlling for variables associated with health and health-care utilization, older adults who reported lower levels of LTPA also reported a greater number of nights in the hospital in the preceding year. There was no support, however, for a relationship between LTPA and the other indicators of health-care utilization. Our findings suggest that being physically active might translate to a quicker recovery for older adults who are hospitalized. Being physically active might not only have health benefits for older persons but also lead to lower health-care costs.

Ventilatory threshold characterizations during incremental rowing and cycling exercises in older subjects

In order to individualize the intensity of an aerobic training program on different ergometers in healthy elderly subjects using a single test of muscular exercise, we analysed cardiorespiratory responses in 8 men (65.7 +/- 4.5 yrs) and 10 women (63.3 +/- 4.8 yrs). The heart rate corresponding to the ventilatory threshold was defined as individualised exercise intensity. All subjects carried out two incremental exercise tests on the cycle and rowing ergometers. For men, the results on the cycle ergometer and rowing ergometer demonstrated that, at ventilatory threshold, heart rates were not significantly different (114.6 +/- 13.7 and 115.6 +/- 14.2 beats x min (-1), respectively), but ventilation was significantly higher in rowing (p < 0.05). At ventilatory threshold, heart rates for women were not significantly different between the cycle ergometer and rowing ergometer (121.3 +/- 12.4 and 125.1 +/- 15.2 beats x min (-1 ), respectively), but ventilation was significantly higher in rowing (p< 0.01). At maximal exercise, maximal tidal volume for men (p < 0.01) and women (p < 0.05) was significantly higher in rowing. In spite of alterations of breathing patterns on the rowing ergometer, it is possible to design an individualized training program for healthy elderly subjects based on a single muscle evaluation exercise in order to diversify and optimize the cardiorespiratory benefits following an aerobic training program.