Search Results (74)

Background/Objectives: Iatrogenic abductor muscle injury following intramedullary nailing for proximal hip fractures can negatively impact postoperative rehabilitation and clinical outcomes. To quantify iatrogenic abductor muscle injury after intramedullary nailing and detect the degree of degenerative change in muscle around the entry point of trochanteric fractures. Methods: This cross-sectional study used data from a single center database from May to December 2023. This study utilized ultrasound examinations performed by a single expert orthopedic surgeon. This study included 61 patients who underwent intramedullary nailing surgery for adult hip fractures. All surgeries were performed by a single experienced hip surgeon. Patients who declined sonographic evaluation or did not undergo ultrasound during their admission were excluded. For more accurate comparison, sonography was also conducted on the healthy, non-operative limb. Descriptive statistics were used to summarize patient and ultrasound findings. A subgroup analysis using Fisher’s exact test was performed to assess the association between implant type and the incidence of iatrogenic gluteus medius tendon injury. Results: Of the 61 patients, tendon tears were identified in 35 cases (57%) on the affected side, with 20 cases (33%) involving gluteus medius tendon tears without fractures on the ipsilateral facet. Gluteus minimus tendon tears were observed in 13 cases (21%), while gluteus medius tendon tears were noted in 31 cases (51%). In the unaffected limbs, tendon degeneration was detected in the form of tendinosis and calcification. Overall, 39 patients (64%) exhibited abductor tendon tendinosis, and 30 patients (49%) were diagnosed with calcification. Conclusions: Gluteus medius and Gluteus minimus are important abductors for hip disease rehabilitation. Iatrogenic gluteus medius tendon injury during the intramedullary nailing showed 33%. Abductor degeneration also showed 92% of the unaffected limbs. This study suggests that abductor degeneration can be a risk factor of falling among the elderly population and an iatrogenic abductor injury can be an obstacle for the early recovery of ambulation in the hip fracture patients. Prevention of abductor degeneration and iatrogenic abductor injury might be important for the hip fracture prevention and rehabilitation. Full article

The response to perturbations in the gait of elderly and young individuals can differ due to various factors, such as age-related changes in sensorimotor function, muscle strength, and balance control. This study aimed to identify and compare compensatory kinematic and kinetic gait strategies in response to sudden treadmill perturbations applied during the Pre-Swing phase in young and older adults. The analysis focused on determining age-related differences in joint behavior and force production under perturbation stress, with implications for fall prevention. Twenty-one young and an equal number of elderly healthy females walked on a treadmill in a virtual environment (GRAIL, Motek). Unexpected perturbations were applied five times. Principal Component Analysis (PCA) and k-means clustering identified three distinct compensatory strategies per limb. Young adults primarily employed Strategies I (42.2%) and II (40%), while older adults most often selected Strategy II (45.5%). Statistical analysis (SPM and Mann-Whitney U test, p = 0.05) showed significant between-group differences in joint angles and torques across the gait cycle. For instance, in Strategy I, young participants had significantly lower ankle plantarflexion angles (p < 0.01) and hip extension torques (p < 0.05) compared to the elderly. Strategy II in older adults showed significantly higher vGRF minimums (p < 0.01) and anterior-posterior GRF peaks (p < 0.001). The elderly adopted strategies compatible with their neuromuscular capacity rather than those minimizing joint load, as observed in the young group. These findings offer novel insights into age-related compensatory mechanisms and highlight the importance of tailored fall-prevention strategies based on biomechanical response patterns. Full article

Hip fractures represent a significant public health challenge, particularly among the elderly, due to their high incidence, morbidity, and mortality rates. This review provides a comprehensive understanding of hip fractures through clinical, biomaterial, and biomechanical perspectives. Clinically, we examined key risk factors, including age, bone mineral density, and the high prevalence of falls, which account for over 95% of hip fractures. However, current clinical tools, such as FRAX, have notable limitations in accurately assessing fracture risk in individuals due to their reliance on statistical models, the treatment of interdependent risk factors as independent, and the omission of key variables like diabetes. From a biomaterial perspective, we analyzed bone composition—specifically the balance of inorganic minerals, organic proteins, and water—and its role in determining bone strength and fracture susceptibility. Various risk factors ultimately influence this composition balance, thereby affecting bone strength. Therefore, accurately measuring bone composition may provide a more reliable assessment of hip fracture risk. Although emerging imaging technologies such as dual-energy CT and MRI show promise for in vivo assessments of bone composition, these techniques still face significant challenges and remain an active area of research. Biomechanically, we explored the forces generated during falls, noting that impact forces can vastly exceed normal physiological loads and may exploit the anisotropic properties of bone, leading to fractures even in healthy individuals with strong bones. This understanding emphasizes the critical role of fall prevention in reducing fracture risk and highlights the limitations of using fall-induced fracture incidence as a validation metric for clinical assessment tools. Lastly, we discuss preventive strategies, including passive measures like environmental modifications for individuals diagnosed with low bone strength and proactive measures such as muscle strengthening and cognitive training. While passive measures are necessary for immediate protection, proactive strategies are more effective in the long term by addressing underlying risk factors for falls and promoting sustained bone health. This interdisciplinary review underscores the need to integrate clinical, biomaterial, and biomechanical factors to improve diagnostic accuracy, prevention, and treatment strategies for hip fractures, ultimately advancing public health outcomes in aging populations. Full article

Background: Falls among the elderly present significant physical, psychological, and economic challenges. Fall prevention strategies, such as balance and muscle strengthening exercises, are essential but often require long-term commitment. This study explores the potential of transcranial direct current stimulation (tDCS) as an adjunct to balance training to enhance physical performance in the elderly. Method: A randomized, double-blind, sham-controlled design was employed to compare balance training with active or sham tDCS. Participants underwent baseline assessments, followed by a six-week intervention period. The intervention protocol consisted of 2 mA, 20 min of anodal tDCS over the left primary motor cortex, three times weekly. Post-intervention assessments were conducted a few days after the intervention and follow-up at 4 weeks. Results: Following 18 sessions of anodal tDCS combined with balance exercise training, no significant group differences were observed for the Time Up and Go, One-Leg Standing, lower-limb strength, or the 6 min walk test (6MWT), although both the intervention and control groups demonstrated significant improvements over time. A significant group × time interaction was found only for the 6MWT, with participants in the intervention group exhibiting greater improvements in the 6MWT compared to controls. Conclusions: Anodal tDCS combined with balance exercise training selectively enhanced physical endurance but did not confer additional benefits for balance, gait, or leg strength in healthy older adults. These findings suggest that tDCS may serve as a promising adjunct to exercise for improving endurance-related outcomes in aging populations. Control of various variables for tDCS and exercise is necessary. Full article

Background/Objectives: Sarcopenia and frailty are interrelated conditions and have a high incidence in older adults. They contribute to increased morbidity and mortality and poor quality of life. There is emerging evidence that healthy diets such as the Mediterranean diet could delay the onset of sarcopenia and frailty. This review aims to evaluate the role of the MD in preventing these conditions. Methods: A literature search was conducted on PubMed (MEDLINE, NCBI) for English-language articles published within the last 10 years (2014–2024) using the search terms “Mediterranean diet”, “frailty”, “sarcopenia”, and “old people”. A total of 111 articles were identified, of which 36 were excluded during the initial screening. Subsequently, 75 manuscripts were assessed for eligibility. Subsequently, a further 62 articles were excluded (narrative reviews, articles not focused on the elderly population, or articles with different outcomes). Finally, 13 articles were included in the review. Results: The 13 selected studies comprised seven observational studies, three systematic reviews and meta-analyses, and three clinical trials. The findings suggest that adherence to the Mediterranean diet (MD), particularly when combined with physical activity, may improve body composition and cardiometabolic health and reduce indicators of sarcopenia in obese older adults. Furthermore, MD-based nutritional interventions were associated with improved physical functions such as balance, gait, fall risk, flexibility, and muscle strength (p < 0.05, all). The MD also demonstrated a preventive effect against frailty, particularly in pre-frail individuals. Conclusions: High adherence to the Mediterranean diet (MD) may delay the onset of sarcopenia and improve muscle function in older adults. However, the available scientific evidence is of low to moderate quality. Well-designed prospective intervention studies are needed to confirm whether the MD can modify the natural history of sarcopenia and/or frailty in older adults. Full article

Background: Falls among the elderly are a major public health concern, leading to increased disability and mortality. Traditional protective measures are important, but early detection and prevention are equally critical. Surface electromyography (sEMG) signals, which assess muscle electrical activity, can indicate a fall risk by detecting muscle weakness or instability. Objective: This narrative review synthesizes the research progress of sEMG in predicting neuromuscular falls among the elderly. Our goal is to explore the innovative application and development potential of the integration of sEMG and artificial intelligence (AI) in fall prevention among the elderly. Methods: A systematic search of PubMed, IEEE Xplore, and Web of Science (2013–2023) was conducted using the following keywords: artificial intelligence, wearable, sEMG, neuromuscular, and fall prediction. The inclusion criteria prioritized studies integrating sEMG with AI for elderly fall risk assessments, while non-empirical or non-English studies were excluded. Results: AI algorithms hold significant potential in medical applications, and studies on predicting neuromuscular falls in the elderly using sEMG signals have made notable progress. However, limitations include a reliance on simulated data, a lack of standardized models, sensor inaccuracies, and a focus on prediction rather than prevention. To address these challenges, this study proposes collecting authentic sEMG signals from elderly individuals with fall histories and healthy controls. By leveraging AI to develop predictive models and designing a portable sEMG acquisition and analysis system tailored for elderly communities, real-time fall risk predictions and early warnings can be achieved, thereby reducing fall incidences among the elderly. Conclusions: The combination of sEMG and AI presents a substantial promise for predicting neuromuscular falls in the elderly. Future research should prioritize validating models in real-world settings, refining sensor technology and signal processing techniques, and shifting focus toward comprehensive preventive strategies rather than mere prediction. These advancements could significantly enhance the quality of life and health outcomes of the elderly, while alleviating burdens on families and healthcare systems. Full article

Background and Clinical Significance: Anti-Leucine-rich glioma inactivated-1 (anti-LGI1) encephalitis is a rare, autoimmune disorder often presenting with limbic encephalitis. The reported incidence of anti-LGI1 is 0.83/million/year, with elderly males accounting for the overwhelming majority of cases. While anti-LGI1 encephalitis is a well-known cause of autoimmune encephalitis in men over 50, our literature review found no published cases in pregnant women. The purpose of this study is to describe a rare presentation of this pathology in an unexpected population. Case Presentation: A 21-year-old gravida 2, para 1001 woman at 20 weeks’ gestation presented with worsening seizure-like activity for the past four months, frequent falls, loss of consciousness, and concern for trauma to the abdomen. Her neurologic workup one month prior revealed a 72 h electroencephalography (EEG) with epileptic seizures of the left frontotemporal region, but a normal magnetic resonance image (MRI) of her head. A repeat MRI during this hospitalization showed bilateral limbic and basal ganglia T2 hyperintensities. She was treated with increasing doses of antiepileptic drugs without improvement and was transferred to a neurology intensive care unit, where she was diagnosed with anti-LGI1 encephalitis. She was initially treated with oral corticosteroids with inadequate response, then with intravenous immunoglobulin therapy (IVIG). Her seizure activity persisted throughout her pregnancy, requiring multiple admissions for IVIG, but she eventually delivered a healthy baby and continues to receive long-term care for her new diagnosis. Conclusions: This case illustrates classic findings of anti-LGI1 encephalitis in a non-classic patient population. Knowledge that such a case exists may serve to broaden the differential diagnoses when physicians are presented with a similar pregnant patient and expand the reported patient population in this rare disease. Full article

Health professionals have slowly integrated the environment and green areas into their prescriptions to connect patients with nature and outdoor activities. The World Health Organization recommends that everyone reside within 300 m of green regions to improve well-being and physical and mental health. The study aimed to explore the effects of urban and rural green areas on multiple physiological and functional variables, as well as evaluate the perception of individuals regarding the ease of use of these same spaces. Participants walked twice a week for six weeks, covering 1.6 km. Heart rate (HR), blood pressure (BP), oxygen saturation (SpO₂), physical capacity analysis (IPAQ), risk of falls (Morse Fall Scale), Mini Mental State Examination, physical performance test (PPT), and perception of accessibility (Pedestrian Accessibility Perception Scale for adults over 65 years old) were evaluated/administered. Variables such as noise, temperature, and air quality were also measured during the outdoor activities. Twenty-four individuals divided into two groups participated in the study: group 1 (urban route) and group 2 (rural route). We found impacts on body weight (p = 0.021), SpO₂ (p = 0.033), and Mini Mental State Examination (p = 0.041) scores in group 1 and SpO₂ and PPT scores in group 2. This study highlights the importance of incorporating green infrastructure in urban planning to support healthy aging and improve accessibility for older adults, and shows that outdoor activities provide various health benefits (physical, mental, and social well-being) and that walking in urban and rural environments seems to impact the health of elderly individuals positively and should be considered in physical therapy by health professionals. Full article

Background/Objectives: Falls and fractures are emerging as a near-pandemic and major global health concern, placing an enormous burden on ageing patients and public health economies. Despite the high risk of polypharmacy in the elderly patients, falls are usually attributed to age-related changes. For the “Individual Pharmacotherapy Management (IPM)” established at the University Hospital Halle, the IPM medication adjustments and their association with in-hospital fall prevention were analysed. Methods: On the basis of the most updated digital overall patient view via his inpatient electronic health record (EHR), IPM adapts each drug’s Summary of Product Characteristics to the patient’s condition. A retrospective pre-post intervention study in geriatric traumatology on ≥70 years old patients compared 200 patients before IPM implementation (CG) with 204 patients from the IPM intervention period (IG) for the entire medication list, organ, cardiovascular and vital functions and fall risk parameters. Results: Statistically similar baseline data allowed a comparison of the average 80-year-old patient with a mean of 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG) medications. The IPM adjusted for drug-drug interactions, drug-disease interactions, overdoses, anticholinergic burden, adverse drug reactions, esp. from opioids inducing increased intrasynaptic serotonin, psychotropic drugs, benzodiazepines, contraindications and missing prescriptions. IPM was associated with a significant reduction in in-hospital falls from 18 (9%) in CG to 3 (1.5%) in IG, a number needed to treat of 14, relative risk reduction 83%, OR 0.17 [95% CI 0.04; 0.76], p = 0.021 in multivariable regression analysis. Factors associated with falls were antipsychotics, digitoxin, corticosteroids, Würzburg pain drip (combination of tramadol, metamizole, metoclopramide), head injury, cognitive impairment and aspects of the Huhn Fall Risk Scale including urinary catheter. Conclusion: The results indicate medication risks constitute a major iatrogenic cause of falls in this population and support the use of EHR-based IPM in standard care for the prevention of falls in the elderly and for patient and drug safety. In terms of global efforts, IPM contributes to the running WHO and United Nations Decade of Healthy Ageing (2021–2030). Full article

This work was conducted mainly to provide a healthy and safe monitoring system for the elderly living in the home environment. In this paper, two different target fall detection schemes are proposed based on whether the target is visible or not. When the target is visible, a vision-based fall detection algorithm is proposed, where an image of the target captured by a camera is transmitted to the improved You Only Look Once version 5s (YOLOv5s) model for posture detection. In contrast, when the target is invisible, a WiFi-based fall detection algorithm is proposed, where channel state information (CSI) signals are used to estimate the target’s posture with an improved long short-term memory (LSTM) model. In the improved YOLOv5s model, adaptive picture scaling technology named Letterbox is used to maintain consistency in the aspect ratio of images in the dataset, and the weighted bidirectional feature pyramid (BiFPN) and the attention mechanisms of squeeze-and-excitation (SE) and coordinate attention (CA) modules are added to the Backbone network and Neck network, respectively. In the improved LSTM model, the Hampel filter is used to eliminate the noise from CSI signals and the convolutional neural network (CNN) model is combined with the LSTM to process the image made from CSI signals, and thus the object of the improved LSTM model at a point in time is the analysis of the amplitude of 90 CSI signals. The final monitoring result of the health status of the target is the result of combining the fall detection of the improved YOLOv5s and LSTM models with the physiological information of the target. Experimental results show the following: (1) the detection precision, recall rate, and average precision of the improved YOLOv5s model are increased by 7.2%, 9%, and 7.6%, respectively, compared with the original model, and there is almost no missed detection of the target; (2) the detection accuracy of the improved LSTM model is improved by 15.61%, 29.36%, and 52.39% compared with the original LSTM, CNN, and neural network (NN) models, respectively, while the convergence speed is improved by 90% compared with the original LSTM model; and (3) the proposed algorithm can meet the requirements of accurate, real-time, and stable applications of health monitoring. Full article

In the last few decades, major progress has been made in the medical field; in particular, new treatments and advanced health technologies allow for considerable improvements in life expectancy and, more broadly, in quality of life. As a consequence, the number of elderly people is expected to increase in the following years. This trend, along with the need to improve the independence of frail people, has led to the development of unobtrusive solutions to monitor daily activities and provide feedback in case of risky situations and falls. Monitoring devices based on radar sensors represent a possible approach to tackle postural analysis while preserving the person’s privacy and are especially useful in domestic environments. This work presents an innovative solution that combines millimeter-wave radar technology with artificial intelligence (AI) to detect different types of postures: a series of algorithms and neural network methodologies are evaluated using experimental acquisitions with healthy subjects. All methods produce very good results according to the main parameters evaluating performance; the long short-term memory (LSTM) and GRU show the most consistent results while, at the same time, maintaining reduced computational complexity, thus providing a very good candidate to be implemented in a dedicated embedded system designed to monitor postures. Full article

(1) Background: The aim of this study was to assess lower limb muscle strength in older adults during the transfer from sitting to standing (STS) using an inertial measurement unit (IMU). Muscle weakness in this population can severely impact function and independence in daily living and increase the risk of falls. By using an IMU, we quantified lower limb joint moments in the STS test to support health management and individualized rehabilitation program development for older adults. (2) Methods: This study involved 28 healthy older adults (13 males and 15 females) aged 60–70 years. The lower limb joint angles and moments estimated using the IMU were compared with a motion capture system (Mocap) (pair t-test, ICC, Spearman correlations, Bland–Altman plots) to verify the accuracy of the IMU in estimating lower limb muscle strength in the elderly. (3) Results: There was no significant difference in the lower limb joint angles and moments calculated by the two systems. Joint angles and moments were not significantly different (p > 0.05), and the accuracy and consistency of the IMU system was comparable to that of the Mocap system. For the hip, knee, and ankle joints, the ICCs for joint angles were 0.990, 0.989, and 0.885, and the ICCs for joint moments were 0.94, 0.92, and 0.89, respectively. In addition, the results of the two systems were highly correlated with each other: the r-values for hip, knee, and ankle joint angles were 0.99, 0.99, and 0.96, and the r-values for joint moments were 0.92, 0.96, and 0.85. In the present study, there was no significant difference (p > 0.05) between the IMU system and the Mocap system in calculating lower limb joint angles and moments. (4) Conclusions: This study confirms the accuracy of the IMU in assessing lower limb muscle strength in the elderly. It provides a portable and accurate alternative for the assessment of lower limb muscle strength in the elderly. Full article

A low-energy hit, such as a slight fall from a bed, results in a bone fracture, especially in the hip, which is a life-threatening risk for the older adult and a heavy burden for the social economy. Patients with low-energy traumatic bone fractures usually suffer a higher level of bony catabolism accompanied by osteoporosis. Bone marrow-derived stem cells (BMSCs) are critical in osteogenesis, leading to metabolic homeostasis in the healthy bony microenvironment. However, whether the BMSCs derived from the patients who suffered osteoporosis and low-energy traumatic hip fractures preserve a sustained mesodermal differentiation capability, especially in osteogenesis, is yet to be explored in a clinical setting. Therefore, we aimed to collect BMSCs from clinical hip fracture patients with osteoporosis, followed by osteogenic differentiation comparison with BMSCs from healthy young donors. The CD markers identification, cytokines examination, and adipogenic differentiation were also evaluated. The data reveal that BMSCs collected from elderly osteoporotic patients secreted approximately 122.8 pg/mL interleukin 6 (IL-6) and 180.6 pg/mL vascular endothelial growth factor (VEGF), but no PDGF-BB, IL-1b, TGF-b1, IGF-1, or TNF-α secretion. The CD markers and osteogenic and adipogenic differentiation capability in BMSCs from these elderly osteoporotic patients and healthy young donors are equivalent and compliant with the standards defined by the International Society of Cell Therapy (ISCT). Collectively, our data suggest that the elderly osteoporotic patients-derived BMSCs hold equivalent differentiation and proliferation capability and intact surface markers identical to BMSCs collected from healthy youth and are available for clinical cell therapy. Full article

The physiological loss of muscle mass and strength with aging is referred to as “sarcopenia”, whose combined effect with osteoporosis is a serious threat to the elderly, accounting for decreased mobility and increased risk of falls with consequent fractures. In previous studies, we observed a high degree of inter-individual variability in paraspinal muscle fatty infiltration, one of the most relevant indices of muscle wasting. This aspect led us to develop a computerized method to quantitatively characterize muscle fatty infiltration in aging and diseases. Magnetic resonance images of paraspinal muscles from 58 women of different ages (age range of 23–85 years) and physio-pathological status (healthy young, pre-menopause, menopause, and osteoporosis) were used to set up a method based on fractal-derived texture analysis of lean muscle area (contractile muscle) to estimate muscle fatty infiltration. In particular, lacunarity was computed by parameter β from the GBA (gliding box algorithm) curvilinear plot fitted by our hyperbola model function. Succolarity was estimated by parameter µ, for the four main directions through an algorithm implemented with this purpose. The results show that lacunarity, by quantifying muscle fatty infiltration, can discriminate between osteoporosis and healthy aging, while succolarity can separate the other three groups showing similar lacunarity. Therefore, fractal-derived features of contractile muscle, by measuring fatty infiltration, can represent good indices of sarcopenia in aging and disease. Full article

Background: In older age, walking ability gradually decreases due to factors including impaired balance, reduced muscle strength, and impaired vision and proprioception. Further, cognitive functions play a key role during walking and gradually decline with age. There is greater variability in gait parameters when the demands during walking increase, in dual- and multiple-task situations. The aim of this study was to analyze gait parameters while performing a demanding cognitive and motor dual task in three different age-related healthy elderly subject groups. Method: A total of 132 healthy individuals (54 males, 78 females) were divided into three groups—55 to 65, 66 to 75, and 76 to 85 years. The subjects performed a basic walking task, dual motor task, dual mental task, and combined motor and mental task while walking. The gait parameters cycle time, stride length, swing time, and double support time were noted, as well as the variability of those parameters. Results: Cycle time was longer and stride length was shorter in the >76-year-old group than in the 51–65-year-old group in all test conditions. A comparison of all three groups did not show a significant difference in swing time, while double support time was increased in the same group. Conclusions: Changes are observed when gait is performed simultaneously with an additional motor or cognitive task. Early detection of gait disorders can help identify elderly people at increased risk of falls. Employing a dual-task paradigm during gait assessment in healthy elderly subjects may help identify cognitive impairment early in the course of the disturbance. Full article