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Paget's disease of bone (also known as osteitis deformans) is a nonmalignant disease involving accelerated bone resorption followed by deposition of dense, chaotic, and ineffectively mineralized bone matrix. The origin of the disease is unknown, and it is frequently asymptomatic; however, the patient may present with symptoms depending on the bones involved. The most common symptom is pain in the affected bone; neurologic, hearing, vision, cardiac, and oncologic complications are possible. Diagnosis is primarily made by radiographs. Bisphosphonates are the most common treatment. [ABSTRACT FROM AUTHOR]

Background: Laparoscopy to repair iatrogenic colonoscopic perforation of the colon has proven to be a safe, effective, and reproducible means to treat these potentially devastating emergencies. The use of the laparoscope provides exceptional diagnostic yield, and under the hand of a trained surgeon, produces excellent therapeutic results while minimizing recovery time for the patient., Methods: We report the case of an 86-year-old man who underwent emergent laparoscopic repair of a postoperative anastomotic leak following sigmoid colectomy., Results: The patient underwent laparoscopic oversewing of a colonic anastomotic leak, omental patch, and diverting loop ileostomy. The patient recovered fully from his emergency procedure without any further complications., Conclusion: Laparoscopic surgery can be extended to a wider variety of colorectal emergencies in a carefully selected group of patients, including the elderly.

Objective: A systematic review and meta-analysis to investigate the efficacy of interventions incorporating motivational interviewing for smoking cessation and identify correlates of treatment effects., Data Sources: Medline/PubMed, PsycInfo and other sources including grey literature., Study Selection: Title/abstract search terms were motivational interview* OR motivational enhancement AND smok*, cigarette*, tobacco, OR nicotine. Randomised trials reporting number of smokers abstinent at follow up were eligible., Data Extraction: Data were independently coded by the first and third authors. We coded for a variety of study, participant, and intervention related variables., Data Synthesis: A random effects logistic regression with both a random intercept and a random slope for the treatment effect., Results: 31 smoking cessation research trials were selected for the study: eight comprised adolescent samples, eight comprised adults with chronic physical or mental illness, five comprised pregnant/postpartum women and 10 comprised other adult samples. Analysis of the trials (9485 individual participants) showed an overall OR comparing likelihood of abstinence in the motivational interviewing (MI) versus control condition of OR 1.45 (95% CI 1.14 to 1.83). Additional potential correlates of treatment effects such as study, sample, and intervention characteristics were examined., Conclusions: This is the most comprehensive review of MI for smoking cessation conducted to date. These findings suggest that current MI smoking cessation approaches can be effective for adolescents and adults. However, comparative efficacy trials could be useful.

Objectives: To compare the effectiveness of a short-term leg-strengthening exercise program with that of attentional control on improving strength, walking abilities, and function 1 year after hip fracture., Design: Randomized controlled pilot study., Setting: Patients' homes., Participants: Community-dwelling older adults (n=26) 6 months after hip fracture at baseline., Intervention: Exercise and control participants received interventions from physical therapists twice a week for 10 weeks. The exercise group received high-intensity leg-strengthening exercises. The control group received transcutaneous electrical nerve stimulation and mental imagery., Measurements: Isometric force production of lower extremity muscles, usual and fast gait speed, 6-minute walk (6-MW) distance, modified Physical Performance Test (mPPT), and Medical Outcomes Study 36-item Short Form Survey (SF-36) physical function., Results: The primary endpoint was 1 year after fracture. Isometric force production (P=.006), usual (P=.02) and fast (P=.03) gait speed, 6-MW distance (P=.005), and mPPT score (P<.001) were improved 1 year after fracture with exercise. Effect sizes were 0.79 for strength, 0.81 for mPPT score, 0.56 for gait speed, 0.49 for 6-MW, and 0.30 for SF-36 score. More patients in the exercise group made meaningful changes in gait speed and 6-MW distance than control patients (chi-square P=.004)., Conclusion: A 10-week home-based progressive resistance exercise program was sufficient to achieve moderate to large effects on physical performance and quality of life and may offer an alternative intervention mode for patients with hip fracture who are unable to leave home by 6 months after the fracture. The effects were maintained at 3 months after completion of the training program., (© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.)

The objective of this study was to compare elective with emergent surgery in patients over the age of 90 years. We retrospectively reviewed the records of patients over 90 years of age who underwent alimentary tract surgery between 1994 and 2002 at a community teaching hospital. Of 100 patients (mean age 92 years; range 90 to 98 years), 82 were women and 18 were men. Seventy-three percent were admitted from private homes or assisted-living facilities, and 27% came from a skilled-nursing facility (SNF). Major comorbid conditions existed in 93%. Procedures included right hemicolectomy (22%), adhesiolysis and/or small bowel resection (19%), cholecystectomy (14%), left-sided or sigmoid colectomy (11%), and perineal proctectomy (8%). Overall morbidity and mortality were 36% and 15%, respectively. Postoperative complications included respiratory failure and pneumonia (11%), arrhythmias (9%), delirium (7%), congestive heart failure and myocardial infarction (6%), and urinary complications (4%). Twenty-eight percent of the operations were elective, and 72% were emergent. Morbidity and mortality were higher in the emergent group (41% and 19%, respectively) than in the elective group (26% and 4%, respectively; P=0.04), especially for patients with an emergent surgical problem who came from a nursing home (22%). Average length of stay was 12 +/- 10 days (range 2 to 69 days) with little difference between elective and emergent cases. Sixty-four percent of patients were discharged to skilled-nursing facilities. Alimentary tract surgery can be performed safely in nonagenarians, and they should not be denied surgical care solely because of age.

Objective: To evaluate the prevalence of falls and determine the effectiveness of three simple interventions in decreasing the number of falls in a frail nursing home population., Methods: Charts and records were reviewed to determine the prevalence of falls. Falls were tracked according to severity and time and place of occurrence. Interventions were made in three areas: (1) Environmental: Room furniture was repositioned. (2) Staffing: One additional staff member was added (by schedule change) at the time when the incidence of falls was highest. (3) Restorative activity program: A program was added at the time when the incidence of falls was high. Falls data were again collected after the intervention., Results: Before intervention, there were 479 falls resulting in 16 fractures; 221 (46%) of the falls occurred during the 3-11 shift and resulted in 63% (n = 10) of the fractures. After intervention, there were a total of 299 falls and 8 fractures. This represents a statistically significant 38% reduction in the total number of falls and a 50% reduction in the total number of fractures during this period. Additionally, falls on the evening and night shifts were significantly reduced from 221 to 115 falls and 91 to 29 falls, respectively., Conclusion: Our interventions may have contributed to a decrease in the overall number of falls and resultant fractures. Our data suggest these simple, practical, and easy to implement methods may positively impact the number of falls in other institutions as well.

Pain in the elderly hospice patient presents a complex clinical problem that requires special attention because of the multiple physiologic changes in the older patient. Pain in the elderly is often under-treated despite the fact that this pain can be managed effectively and safely. A basic knowledge of the physiologic changes of aging, as well as the changes in pharmacokinetics, can help the clinician and the hospice team treat pain effectively while minimizing side effects for the patient and the family.

Thyroid dysfunction is relatively common in older patients, but its clinical presentation varies. It may be obvious from the classic presenting symptoms, or it may be asymptomatic and discovered incidentally during routine testing. The clinical diagnosis of hypothyroidism and hyperthyroidism can be difficult in older patients, because many of the usual symptoms may be mistaken for the effects of aging or other medical conditions. Even so, these diseases in their overt forms are always significant and require treatment. On the other hand, subclinical hypo- and hyperthyroidism are often incidental biochemical abnormalities that may or may not require intervention.

The purpose of this study was to determine the relationship in mature women between muscle strength and whole body oxidative capacity and the ability to perform activities of daily living (ADL). Sixty-one women (mean age 69 years) without major disease or disability were recruited from either a community exercise center or a personal care facility. Physiological measurements consisted of peak oxygen consumption on a cycle ergometer (VO2peak) and one repetition maximum strength of nine muscle groups (1-RM). Ability to perform ADL was measured with a balance and gait test, "Bag Carrying Test", and ADL questionnaires. Significant correlations were found with VO2peak and calf muscle strength and ability to perform ADL, with weaker or no correlations for other muscle groups. For some relationships, it was possible to identify the minimum level of physiological functioning associated with successful performance of independence tasks. In summary, physiological capacities, particularly VO2peak and strength of the calf muscles, predicted ability to perform activities needed for functional independence in healthy mature women.