The Charted Care Collection (10/05/2021)
[ photo by Steve Johnson ]
The Chartered Care Collection (10/05/2021)
The Chartered Care Collection provides a review of the latest, pertinent publications from the medical literature on aging. I have selected interesting articles that describe some of the most current research that may be relevant to the loved one in your care. Each article will be referenced if you desire to read more of the study, but I will give a brief synopsis of each study so you are aware of the latest research. Let’s get to The Collection!
The Chartered Care Collection
Happy Fall, everyone! It is time for October’s review of some of the latest research to be printed in the many medical journals.
The first study I wanted to touch on was published in the journal Disability and Rehabilitation. It looked at extracorporeal shockwave therapy (ESWT) for the treatment of chronic plantar fasciitis. Plantar fasciitis can be an extremely painful condition in one or both feet that can significantly limit daily mobility and even more so, exercise. It can be a very difficult ailment to treat, so any newer options becoming available are certainly worth exploring. ESWT is a non-invasive treatment, making it another good option for treatment. This article was a literature review of 11 different studies published between 2016 and 2020, involving a total of 650 participants. The duration of treatment of ESWT ranged from 15 to 30 minutes per session, with one to five sessions per week for three to 12 weeks. The studies reviewed showed an improvement of fascia thickness (a diagnostic indicator of plantar fasciitis), as well as a positive effect in both function and improvement in pain when compared to placebo treatments. Continued movement/exercise as aging occurs is of utmost importance in maintaining both physical and mental function, so it is always worth mentioning possible non-invasive treatments that have shown to be beneficial in managing pain that limits mobility.
Moving on, the European Journal of Neurology printed a study that looked at the significance of intracranial stenosis (narrowing of blood vessels in the brain) on cognitive decline. Participants in the study were recruited from a memory clinic in Singapore and were in one of three groups: no cognitive impairment (NCI), cognitive impairment with no dementia (CIND), and dementia. The participants, numbering 364 in total, had a mean age of 71.9 years. A quarter were in the NCI group, just under half were in the CIND group and just over a quarter had dementia. All participants underwent MRI and MRA to assess for intracranial stenosis. Each participant also underwent assessment of executive function through multiple cognitive screening tests. 18.1% of all participants had intracranial stenosis, per MRI/MRA findings. The study found that intracranial stenosis was associated with worse performance on executive function in all three groups and was independent of the patients demographics, baseline diagnosis or vascular risk factors.
The next study looked at the association between lumbar spinal stenosis (LSS) and future severe disability and mortality. As a refresher, spinal stenosis is a narrowing of the spaces around the spinal cord and the foramen, which is where the nerves from the spinal cord exit. This study, published in the journal Spine, looked at 1,560 functionally independent adults aged 65 and older, with 17.6% of the participants diagnosed with LSS. All participants were screened at baseline for age, gender, BMI, tobacco abuse, diabetes, affective disorders, osteoarthritis of the lower extremities, hand grip strength and walking habits. On average, they underwent follow up at 5.8 years from their initial evaluation. Those with LSS had a higher cumulative occurrence of severe disability or mortality (rate 11.9%) than those without LSS (rate 6.9%), showing a statistically significant association of LSS and future severe disability or mortality.
The last study I wanted to mention was published in British Journal of Sports Medicine looked at the social determinants that are associated with physical therapy (PT) use. This was a literature review of 36 different papers, involving around 2.7 million participants. The data gleaned from these papers was to see the groups most likely to use PT. Those most likely to use PT were females, Caucasians, those with higher levels of education, those living in more densely populated areas and those living in areas with transportation to health care facilities. I found this to be interesting but not surprising. I do not believe that these specific categories are necessarily in greater need of therapy services but, instead, are the people who might have the easiest access to getting PT ordered and obtaining the actual PT. In my opinion, this study highlights the need for myself as a physician who prescribes therapies and for family members to be aware of this discrepancy and to make sure that PT (and other therapy services) are being done in the groups who still undoubtedly need these therapy services but are less likely to get these valuable services.
(Related blog post: Being Present For Your Aging Parent During Rehab)
References:
Melese, H., et al. Extracorporeal Shock Wave Therapy on Pain and Foot Functions in Subjects with Chronic Plantar Fasciitis: Systematic Review of Randomized, Controlled Trials. Disability Rehab. 2021, May 26: 1-8.
Lim, M. et al. Effect of Intracranial Stenosis on Cognitive Decline in a Memory Clinic Cohort. Eur J Neurol. 2021; 28(6): 1829-1839.
Hijikata, Y. et al. Association of Lumbar Spine Stenosis with Severe Disability and Mortality among Community Dwelling Older Adults: The Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study. Spine. 2021 Jul 15; 46(14):E784-E790.
Braaten, Al et al. Social Determinants of Health are Associated with Physical Therapy Use: A Systematic Review. Br J Sport Med. 2021. Doi: 10.1136/bjsports-2020-103475.
That sums it up for the Chartered Care Collection for this month. Feel free to read each of these articles in full, and feel free to leave your comments or questions below!
© 2021 Jessica Kluetz, DO