Sunday, October 30, 2016

High blood pressure can impair cognitive function, pose risk for Alzheimer's

blood pressure
High blood pressure in middle age can lead to impaired cognition and is a potential risk factor for Alzheimer's disease, according to a statement from the American Heart Association co-authored by Loyola Medicine neurologist José Biller, MD.

30 OCT 2016--Dr. Biller is a member of the multidisciplinary panel of experts that wrote the statement, published in the heart association journal Hypertension. Dr. Biller is chair of the department of neurology of Loyola University Chicago Stritch School of Medicine. The panel is chaired by Constantino Iadecola, MD, of Weill Cornell Medicine and co-chaired by Kristine Yaffe, MD, of the University of California San Francisco.

Dementia affects an estimated 30 to 40 million people worldwide, and the number is expected to triple by 2050 due to an aging population and other factors.
An estimated 80 million people in the United States have hypertension, and the brain is among the organs most affected. Except for age, hypertension is the most important risk factor for vascular problems in the brain that lead to stroke and dementia.
There is consistent evidence that chronic high blood pressure during middle age (40 to 64) is associated with altered cognitive function in both middle age and late life (65 to 84). Cognitive abilities that are affected include memory, speed of processing and executive function (ability to organize thoughts, manage time, make decisions, etc.)
The effect of high blood pressure in late life is less clear. Some studies suggest it's harmful, while other research suggests it may improve cognition. This highlights "the complexities of recommending uniform levels of blood pressure across the life course," the expert panel wrote.
Observational studies have demonstrated that high blood pressure causes atherosclerosis (hardening of the arteries) and other damage to the brain's blood vessels, leading to reduced blood flow to brain cells. But evidence from clinical trials that treating blood pressure improves cognition is not conclusive.
After carefully reviewing available studies, the panel concluded there are not enough data to make evidence-based recommendations. However, judicious treatment of high blood pressure, taking into account goals of care and the patient's individual characteristics, "seems justified to safeguard vascular health and, as a consequence, brain health," the panel concluded.
The paper is titled, "Impact of hypertension on cognitive function: a scientific statement from the AmericanHeart Association."

More information: Costantino Iadecola et al, Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association, Hypertension (2016). DOI: 10.1161/HYP.0000000000000053

Provided by Loyola University Health System

Tuesday, October 25, 2016

Higher education levels can reduce mortality especially in older people

Higher education levels can reduce mortality especially in older people
Highly educated older men have particularly high life expectancy levels in all countries, even surpassing those of long-living nations. Population groups with the highest levels of education—such as the members of the Royal Society in Great Britain, the British Academy of Science, have even higher life expectancy levels. Credit: MPI for Demographic Research
Over the last century, life expectancy rose on average by three months a year. However, this progress has been uneven across educational groups. Highly educated people who systematically display the highest life expectancy levels have been the vanguards leading the way towards a lengthening of life for the remaining population groups. This trend has inspired scholars from the Max Planck Institute for Demographic Research to point out that there is considerable potential for the life expectancy values of entire populations to increase further.

25 oct 2016--The pattern is the same in almost every country: people who are highly educated live longer on average than people who are less educated. Indeed, in some countries the life expectancy levels of the highly educated exceed the world record life expectancy values at the country level that have been reached in countries like Japan or Switzerland. Domantas Jasilionis and Vladimir M. Shkolnikov of the Max Planck Institute for Demographic Research in Rostock have attempted to provide an international overview of this topic in an article that was published in the April issue of the journal Gerontology, and in a shorter version of this article that appears in the current issue of Demografische Forschung aus Erster Hand.

Gaps are especially large in Russia

International evidence suggests that some selective population groups may reach extremely high life expectancy values. For example, studies conducted in the U.S. and Norway have shown that small religious groups like the Mormons and the Seventh-day Adventists have achieved life expectancy levels that are much higher than the average levels in the countries with the highest life expectancy values in the world. Research findings also indicate that life expectancy levels are very high observed among the members of academic organizations like the Royal Society in Great Britain and the national academies of Germany, Austria, and Russia. Importantly, mortality among these scientific elites has been declining faster than the corresponding national averages, even though these groups already had record-low mortality levels at the start of the study period. Similar evidence also comes from mortality studies that looked at mortality among much larger and more conventional population groups, including educational groups.
The European studies on educational differentials show that the life expectancy differences between educational groups have grown in recent decades. Life expectancy has been increasing more rapidly among the highly educated than among the less educated segments of the population in the Scandinavian countries, as well as in Finland, Belgium, France, and Switzerland. In addition, very large and growing gaps between educational groups have been observed in central and eastern European countries, and especially in Lithuania, Estonia, and Russia. An extreme example of this pattern can be seen by looking at the life expectancy projections for Russian men. At the turn of the century, the life expectancy gap between the men with the highest and the lowest educational levels was around 13 years in Russia.
While the overall situation in the U.S. is similar to that of western and northern Europe, it is notable that in the U.S. life expectancy among women varied considerably by social class in the 1980s and the 1990s. Indeed, a number of studies found that the average life expectancy actually declined among the least educated non-Hispanic white women.

Cardiovascular revolution benefits the highly educated

Across all educational groups, gains in life expectancy can be attributed to decreases in mortality at older ages. Mortality among older people has been declining since the 1960s and the 1970s, largely because of improvements in the treatment of heart and circulatory diseases that are collectively referred to as the "cardiovascular revolution." When we look at the contributions of the age groups to these educational group differences, it is clear that the highly educated benefited from this revolution the most. For example, among Finnish men the difference between the highly educated and the other educational groups was 4.4 years in the 1970s; at that time, only one-third of this mortality gap was attributable to lower mortality after age 65. Some 35 years later this gap has expanded to six years, and around 2.5 of these years are attributable to lower mortality among the highly educated at old ages.

Early deaths are preventable

These large advances in life expectancy among the highly educated suggest that there is still considerable potential for life expectancy improvements among the middle and lower social classes. The unfavourable trends in life expectancy among the less educated that have been observed in some countries are avoidable, as they are largely caused by preventable early deaths.
Improvements in the educational attainment levels of populations are also contributing to further increases in life expectancy. For example, around half of the total increase in life expectancy among 30-year-old Swedish men between 1988 and 1999 can be traced back to improvements in the educational attainment levels of the Swedish population as a whole. This trend could also play out in many other countries.
The authors pointed out, however, that average life expectancy is unlikely to converge to the record values observed among the highly educated unless more progress is made in the fight against old -age- related diseases, such as Alzheimer's disease. Furthermore, the life expectancy improvements associated with higher levels of educational attainment may be counteracted by the negative effects of other compositional factors, such as an increase in the share of people who are divorced, or further growth in the proportion of people who are overweight or who smoke.

More information: Domantas Jasilionis et al. Longevity and Education: A Demographic Perspective, Gerontology (2015). DOI: 10.1159/000438901

Provided by Max Planck Society

Sunday, October 23, 2016

Frailty in older surgery patients may be under recognized

Key findings in this study show nearly 70% of patients who participated in the frailty screening were determined to be pre-frail or frail. Patients who are frail or pre-frail may be at greater risk of surgical and post-surgical complications. Frailty screening may affect recommendations regarding treatments and surgical options.

23 oct 2016--"Patients with frail health have less ability to overcome stressors such as illness, falls, and injury, and have a higher risk of adverse effects from medications, procedures, and surgery," said Angela K. Beckert, MD, of the Medical College of Wisconsin in Milwaukee. "If a patient is more robust, with better physical performance and vigor—in other words, less frail—then I believe surgical outcomes would be better."
Dr. Beckert, Mark K. Ferguson, MD, and other colleagues from The University of Chicago Medicine, conducted a study to determine the proportion of pre-frail and frail patients who might benefit from frailty reduction intervention. The group examined 125 patients (average age of 70) at The University of Chicago Thoracic Surgery Clinic who were considered candidates for major thoracic surgery, such as lung resection, esophagectomy, or chest wall resection. The majority of patients (68.8%) who participated in the frailty screening were determined to be either pre-frail or frail, suggesting that frailty may be seriously under recognized within the surgery population.
Frailty in surgery patients is consistently associated with a greater risk of surgical complications, increased length of hospital stay, and discharge to a rehabilitation facility rather than home. In addition, frail patients are at a higher risk for readmission, suffer from lower quality of life following surgery, and end up paying higher overall costs for their care.
The researchers conducted frailty screening using five established characteristics: unintentional weight loss, weakness (grip strength), exhaustion, low activity level, and slow gait. The most commonly identified characteristic in this study was exhaustion; the least common was slowness.
"This study indicated that a large number of patients who are candidates for major surgery have important risk factors related to frailty," said Dr. Ferguson. "Knowing what these factors are can help physicians, patients, and the patients' families better understand the risks and may motivate them to participate in activities that reduce their risks."
One of the most important benefits of identifying frailty, explained Dr. Ferguson, is the ability to offer patients activities, such as nutritional and exercise interventions that can modify their frailty status prior to surgery and reduce their surgical risks. This study was just the first step. The research group is currently conducting studies of exercise intervention for frailty and the relationship between frailty and resiliency (the ability to bounce back from complications after surgery).
Frailty screening may also affect the recommendation a doctor makes regarding treatments and surgical options. According to Dr. Beckert, if a patient is determined to be frail, a surgeon may consider a different or less extensive approach to the operation. Also, during the early postoperative period, the health care team may provide more intensive and closely supervised care, including physical, nutritional, and occupational therapy.
"Frailty screening helps doctors better prepare patients for what to expect," said Dr. Beckert. "The screening results provide more accurate information to use in the complex decisions the patient, family, and health care team make about treatment options."
With the rapid growth of the elderly population and improved life expectancy (now 78 years), a rising number of older adults are expected to undergo surgery, with a greater chance of experiencing complications after surgery. The US Census Bureau reports that the elderly population in the United States is projected to almost double, from the most current estimate of 43 million in 2012 to 80 million by the year 2050. In addition, the National Hospital Discharge Survey reported that more than one-third of all surgical procedures are performed on patients over the age of 65, with that number likely to increase over the next few decades.
As a result, experts anticipate that frailty screening—which can be completed within a clinic appointment—will become even more crucial when considering the care of older patients facing surgery.
"There is an increasing awareness of the frailty problem among surgeons," said Dr. Ferguson. "We anticipate that screening efforts will expand substantially in the near future."

More information: Angela K. Beckert et al, Screening for Frailty in Thoracic Surgical Patients, The Annals of Thoracic Surgery (2016). DOI: 10.1016/j.athoracsur.2016.08.078

Provided by Elsevier

Friday, October 21, 2016

Virtual experience gets the elderly to exercise

Virtual experience gets the elderly to exercise
Credit: Aalborg University
Virtual Reality can get the elderly in nursing homes to be happier about exercising. A new research project from Aalborg University shows that the technology motivates older people in nursing homes to get moving.

21 oct 2016--One of the major problems in nursing homes is that many older people do not move enough. Although nearly all nursing homes in Denmark offer access to fitness facilities and physical therapists, many of the residents rarely get their heart rate up. This needs to be addressed because physical activity keeps the body – and the brain – in shape and makes the elderly more self-reliant. A new PhD project from Aalborg University now shows that new technology in the form of virtual reality may be just the thing to get seniors on exercise bikes.
Jon Ram Bruun-Pedersen of the Multisensory Experience Lab in the Department of Architecture, Design and Media Technology at Aalborg University Copenhagen attempted to turn exercise for the elderly from a chore into a digital experience.
"All too often the elderly end up sitting and looking at a wall or staring passively into a television. As a rule they're usually not particularly motivated to exercise, partly because getting moving again after a long period of inactivity can cause pain, and partly because it's not particularly interesting to sit and look at a wall while you bike," he said.

Long ride in front of a screen

In conjunction with physical therapists at the Copenhagen nursing home Akaciegården, Jon Ram Bruun-Pedersen conducted a study where large TV screens were set up in front of the exercise bikes in the activity room. While they biked, they rode through various virtual landscapes on the TV screen.
The 21 elderly residents who participated in the study could choose among things like riding on a park road between green lawns, lakes, flowers and butterflies; through a snowy pine forest; or on a mountain side. The bikes were linked with the screens so that the speed the subjects biked with reflected their speed through the landscape.
"The study showed that seniors were really happy with the experience," says Jon Ram Bruun-Pedersen. "They really lived it and felt as if they had to pedal extra hard to get up the hill on the screen—even though they really didn't feel higher resistance on the bike."

On with the goggles

In the next part of the study, Jon Ram Bruun-Pedersen made the experience more intense. He equipped the elderly subjects with Virtual Reality goggles – a sort of diving mask with small screens in front of the eyes that makes you feel like you're being led into another world because you can look around the landscape. When you turn your head, it feels like you're looking around in reality – you can see out over the edge of the mountain, see the birds fly in the sky above and move freely around between buildings, plants and trees.
The illusion is very true to life, and the elderly subjects vividly experienced being out in the great outdoors—even though they were still on an exercise bike in the physical therapy room at the nursing home.
"We set the study up so the participants could ride in the same landscapes they knew from the screens. They took to the experience amazingly well. For many people stepping into a virtual world can be an overwhelming experience, but theelderly subjects had a surprisingly high tolerance threshold," explains Jon Ram Bruun-Pedersen.

New possibilities

From the interviews Jon Ram Bruun-Pedersen conducted with study participants you can see that the elderly's desire to use exercise bikes significantly increased.
"This is really positive," he says. "Partly because it is good for them physically to move more, but also because I wanted them to experience getting out of the nursing home and out in the world – even if it's a virtual world."
The beneficial effects of using Virtual Reality with the elderly are not limited to getting them in better physical shape. Jon Ram Bruun-Pedersen mentions the increased quality of life by "getting out" and experiencing something.
"It may well be you can't get out of the nursing home and take a plane to Mallorca or a bus to the Harz mountains, but you can experience what it's like to go for a walk in the mountains or visit some of the world's great attractions. It could also be that you'd like to go for a walk in your childhood neighborhood or something else that has had great significance," he says. "The possibilities are there with Virtual Reality."

Great demand

The study at Akaciegården was completed earlier this year, but it's hardly the last time the elderly had VR goggles on. After the study ended, Jon Ram Bruun-Pedersen was contacted by the physical therapists he worked with who now want to use virtual reality in their training programs for the elderly in the future.
Both the residents at the nursing home and a number of their relatives have also requested that the technology become a fixture in the gym.

Provided by Aalborg University

Wednesday, October 19, 2016

Depression in caregivers of dementia patients, worse for daughters or daughters-in-law?

Depression in caregivers of dementia patients, worse for daughters or daughters-in-law?

Too often overlooked is the risk of depression in caregivers of patients with dementia, and a new study focuses on how depressive symptoms may differ depending on the familial relationship between caregiver and patient. The study shows how patients' behavioral symptoms are predictive of depression to different extents when the caregiver is the patient's daughter versus daughter-in-law, as reported in Journal of Women's Health.
19 oct 2016--In Asian societies, a daughter-in-law often takes on the caretaker role, rather than a spouse or child, note Juwon Lee, University of Kansas, Lawrence, Bo Kyung Sohn, MD, Sujeong Seong, MD, and Jun-Young Lee, MD, PhD, Seoul National University College of Medicine, Hyunjoo Lee, Daegu University, Gyeongsan, and Soowon Park, PhD, Seoul National University, Republic of Korea, coauthors of the article "Impact of Behavioral Symptoms in Dementia Patients on Depression in Daughter and Daughter-in-Law Caregivers." In both groups of caregivers, depressive symptoms increased as the frequency and severity of a patient's behavioral symptoms rose. But the level of depression was more strongly affected among one group of caregivers than the other, which the authors attribute to the relationship between patient and caregiver.
"This novel look at how factors such as relationship to the patient can affect caregiver depression offers valuable insights to help guide future studies and interventions aimed at understanding and safeguarding caregiver health," says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health, Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, and President of the Academy of Women's Health.

More information: Juwon Lee et al, Impact of Behavioral Symptoms in Dementia Patients on Depression in Daughter and Daughter-in-Law Caregivers, Journal of Women's Health (2016). DOI: 10.1089/jwh.2016.5831

Provided by Mary Ann Liebert, Inc

Dementia study lists everyday factors that may influence risk

Experts have created a shortlist of environmental factors that may contribute to our risk of developing dementia.
The list includes exposure to air pollution and a lack of vitamin D but researchers caution that the evidence is not yet sufficient to draw solid conclusions.

19 oct 2016--The team say that future research should focus on their shortlist, which points to the factors that show at least moderate evidence of a link.
Dementia is known to be associated with lifestyle factors such as high blood pressure in mid-life, smoking, diabetes, obesity, depression and low educational attainment, as well as genetic factors.
These risk factors however, leave around a third of dementia risk unexplained. Researchers led by the University of Edinburgh sought to determine whether other issues are at play, including the environment in which we live.
The team from the University's Alzheimer Scotland Dementia Research Centre reviewed dozens of previous studies that have considered environmental risk factors linked to dementia.
They found that a lack of vitamin D - produced by the body through exposure to sunlight - and exposure to air pollution were implicated, along with occupational exposure to some types of pesticide.
Excessive levels of minerals found in drinking water may be linked to the disease, the research suggested, but the evidence was mixed.
Dementia is a major global public health crisis that is expected to grow as people live longer. Almost 47 million people live with dementia worldwide and this is predicted to increase to more than 131 million by 2050.
Estimates indicate the disease costs the UK more than £26 billion annually and worldwide dementia care costs exceed the market value of Google or Apple each year.
There is a growing consensus among doctors that a significant proportion of cases could be prevented or delayed by addressing environmental factors linked to the disease.
The team behind the latest research says future studies should focus on the shortlist of environmental risk factors flagged up in their study.
The research, published in the journal BMC Geriatrics, was funded by Alzheimer Scotland and Dr Russ was supported by Alzheimer Scotland through the Marjorie MacBeath fellowship.
Dr Tom Russ, of the Alzheimer Scotland Dementia Research Centre at the University of Edinburgh, said: "Our ultimate goal is to prevent or delay the onset of dementia. Environmental risk factors are an important new area to consider here, particularly since we might be able to do something about them.
"We found that the evidence is particularly strong for air pollution and vitamin D deficiency. But we really need more research to find out whether these factors are actually causing dementia and how, and if so, what we can do to prevent this."
Jim Pearson, Director of Policy and Researcher at Alzheimer Scotland, said: "We welcome the findings of this important area of research from our colleagues at the Alzheimer Scotland Dementia Research Centre at the University of Edinburgh. The research study substantially improves our knowledge and understanding of environmental factors which may increase the risk of developing dementia and provides a basis for further, and more focussed, research in this area.
"Dementia is a global public health priority. There are 90,000 people living with dementia in Scotland and the number is on the rise. We need much more research into the causes of dementia, treatments and supports that allow people to live well with dementia as well as the prevention and cure of dementia."

More information: Lewis O. J. Killin et al, Environmental risk factors for dementia: a systematic review, BMC Geriatrics (2016). DOI: 10.1186/s12877-016-0342-y

Provided by University of Edinburgh

Saturday, October 15, 2016

Study finds knowingly taking placebo pills eases pain

Conventional medical wisdom has long held that placebo effects depend on patients' belief they are getting pharmacologically active medication. A paper published today in the journal Pain is the first to demonstrate that patients who knowingly took a placebo in conjunction with traditional treatment for lower back pain saw more improvement than those given traditional treatment alone.

15 oct 2016--"These findings turn our understanding of the placebo effect on its head," said joint senior author Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School. "This new research demonstrates that the placebo effect is not necessarily elicited by patients' conscious expectation that they are getting an active medicine, as long thought. Taking a pill in the context of a patient-clinician relationship - even if you know it's a placebo - is a ritual that changes symptoms and probably activates regions of the brain that modulate symptoms."
Kaptchuk, with colleagues at Instituto Superior de Psicologia Aplicada (ISPA) in Lisbon, Portugal, studied 97 patients with chronic lower back pain (cLBP), which causes more disability than any other medical condition worldwide. After all participants were screened and examined by a registered nurse practitioner and board certified pain specialist, the researchers gave all patients a 15-minute explanation of the placebo effect. Only then was the group randomized into one of two groups; the treatment-as-usual (TAU) group or the open-label placebo (OLP) group.
The vast majority of participants in both groups (between 85 and 88 percent) were already taking medications - mostly non-steroidal anti-inflammatories (NSAIDS) - for their pain. (Patients taking opioid medications were excluded from the trial.) Participants in both the TAU and OLP groups were allowed to continue taking these drugs, but were required not to change dosages or make any other major lifestyle changes, such as starting an exercise plan or new medication, which could impact their pain.
In addition, patients in the OLP group were given a medicine bottle labeled "placebo pills" with directions to take two capsules containing only microcrystalline cellulose and no active medication twice daily.
At the end of their three-week course of pills, the OLP group overall reported 30 percent reductions in both usual pain and maximum pain, compared to 9 percent and 16 percent reductions, respectively, for the TAU group. The group taking placebo pills also saw a 29 percent drop in pain-related disability. Those receiving treatment as usual saw almost no improvement by that measure.
"It's the benefit of being immersed in treatment: interacting with a physician or nurse, taking pills, all the rituals and symbols of our healthcare system," Kaptchuk said. "The body responds to that."
"Our findings demonstrate the placebo effect can be elicited without deception," said lead author, Claudia Carvalho, PhD, of ISPA. "Patients were interested in what would happen and enjoyed this novel approach to their pain. They felt empowered."
Kaptchuk speculates that other conditions with symptoms and complaints that are based on self-observation (like other kinds of pain, fatigue, depression, common digestive or urinary symptoms) may also be modulated by open-label treatment.
"You're never going to shrink a tumor or unclog an artery with placebo intervention," he said. "It's not a cure-all, but it makes people feel better, for sure. Our lab is saying you can't throw the placebo into the trash can. It has clinical meaning, it's statically significant, and it relieves patients. It's essential to what medicine means."
"Taking placebo pills to relieve symptoms without a warm and empathic relationship with a health-care provider relationship probably would not work," noted Carvalho.

Provided by Beth Israel Deaconess Medical Center

Wednesday, October 12, 2016

The many health benefits of gardening for elderly women

A study in HortTechnology confirms that gardening has a multitude of physical and psychological benefits for older women. Elderly women who participated in a 15-session gardening intervention significantly reduced their waist circumference and improved aerobic endurance, hand dexterity, cognitive function, and amount of their daily physical activity. In contrast, elderly women in the control group (nonparticipants in the gardening intervention) experienced reductions in physical and psychological health.

12 oct 2016--The authors say that, despite the documented benefits of regular physical activity, most elderly individuals spend 80% of their daily time in sedentary activities. "Gardening is a popular leisure time physical activity among elderly individuals," they noted. To investigate benefits of engaging in gardening, the researchers studied 24 elderly women at a senior community center who participated in the 15-session gardening intervention. An additional 26 elderly women at another senior community center (the control group) did not participate in any gardening during the study. Health assessments were done for both groups before and after the gardening intervention, which involved twice-weekly sessions for an average duration of 50 minutes per session.
Intervention participants did gardening tasks such as garden design and planning, making furrows in the plots, making name tags for garden plots, planting transplants, garden maintenance (e.g., fertilizing, weeding, watering, harvesting), and other activities such as flower arrangement and garden parties. Activities were selected for the study to represent low- to moderate-intensity physical activities that would yield similar health improvements or maintenance.
Following the 15-week program, women in the gardening intervention group exhibited a significant decrease in waist circumference, while the waist circumference of women in the control group showed a tendency to slightly increase. Women in the gardening intervention group maintained their lean mass, but women in control group lost lean mass over the period.
Women's aerobic endurance was also affected; the intervention group showed increased scores in an aerobic endurance test; the control group showed no improvement in a step test for aerobic endurance. Women in the intervention group also demonstrated improvements in hand dexterity.
The women in the gardening intervention experienced benefits to cognitive and psychological functions as well. Assessments revealed that women in the intervention group showed "significant improvement" in cognitive function. Interestingly, women in the control group exhibited a "significant increase" in scores for depression, with symptoms progressing from normal before the intervention period to moderate depression symptom at the end of the study. "Meanwhile, the depression scores of elderly women in the gardening intervention group did not change during this period," the authors said.
The researchers said their results demonstrate that the gardening intervention improved the physical and psychological health conditions of the elderly women who participated. "Moreover, satisfaction with the gardening intervention as a leisure time physical activity for health conditions of elderly women was very high," they said.

More information: ASHS

Provided by American Society for Horticultural Science

Tuesday, October 11, 2016

Older surgery patients should be screened for frailty: study

Older surgery patients should be screened for frailty: study
11 oct 2016—Screening older surgery patients for frailty could improve their outcomes and chances for survival, researchers say.
But frailty often goes unrecognized in these patients, according to a study published online Oct. 6 in The Annals of Thoracic Surgery.

"Patients with frail health have less ability to overcome stressors such as illness, falls and injury, and have a higher risk of adverse effects from medications, procedures and surgery," study co-author Dr. Angela Beckert said in a journal news release. Beckert is an assistant professor in the division of geriatrics and gerontology at the Medical College of Wisconsin, in Milwaukee.
"If a patient is more robust, with better physical performance and vigor—in other words, less frail—then I believe surgical outcomes would be better," she added.
Beckert's team screened 125 patients for signs of frailty; their average age was 70. The patients were being assessed for major thoracic surgery such as full or partial removal of the esophagus, lung or chest resection.
The frailty screening checked for five traits: unintentional weight loss, weakness (grip strength), exhaustion, low activity level and slow gait. Exhaustion was most often found; slow gait, the least often, according to the study authors.
Nearly 69 percent of the patients in the study were found to be frail or "pre-frail"—suggesting the problem may be seriously under-recognized.
"This study indicated that a large number of patients who are candidates for major surgery have important risk factors related to frailty," study co-author Dr. Mark Ferguson, a thoracic surgeon, said in the news release.
"Knowing what these factors are can help physicians, patients and the patients' families better understand the risks and may motivate them to participate in activities that reduce their risks," he said. Ferguson is a professor of surgery at University of Chicago School of Medicine.
Frailty increases the odds for surgical complications and higher health costs. Frail patients are likely to spend more time in the hospital and to be discharged to a rehabilitation facility instead of home. They also are more likely to be readmitted to the hospital and to have a poorer quality of life, according to the study.

More information: The U.S. National Institute on Aging has more about surgery.

Sunday, October 09, 2016

High incidence of cardiovascular risk factors in older adults

High incidence of cardiovascular risk factors in older adults
(HealthDay)—Older adults have high incidence of cardiovascular risk factors, with increased incidence of hypertension, diabetes mellitus, and dyslipidemia for blacks, according to a study published online Sept. 26 in the Journal of the American Geriatrics Society.

09 oct 2016--George Howard, Dr.P.H., from the University of Alabama at Birmingham, and colleagues measured the incidence of hypertension, diabetes mellitus, dyslipidemia, and atrial fibrillation over 10 years of follow-up in 10,801 community-dwelling adults.
The researchers found that for white men, black men, and black women, there was no evidence of an age-related difference in the incidence of hypertension (P ≥ 0.68), while for white women the incidence increased with age. For white men, black men, and white women the incidence of diabetes mellitus was lower at older ages, while there was no evidence of age-related changes for black women (P = 0.11). The incidence of dyslipidemia was about 20 percent for those aged 45 to 54 years; 30 percent for those aged 54 to 74 years; and 22 percent for those aged ≥75 years for all race-sex groups. The incidence of atrial fibrillation was low at age 45 to 54 years and was about 20 and 11 percent for white and blacks, respectively, for those aged ≥75 years. Across the age spectrum, the incidence of hypertension, diabetes mellitus, and dyslipidemia was higher in blacks, but the incidence of atrial fibrillation was lower.
"Incidence of risk factors remains high in older adults," the authors write.

More information: Abstract

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Saturday, October 08, 2016

Global health: longer lives, more lifestyle disease

old people
Credit: CC0 Public Domain
Life expectancy worldwide has jumped by a decade since 1980, rising in 2015 to 69 years for men and nearly 75 for women, according to a comprehensive overview of global health released Thursday.
These extra years came in large measure thanks to a sharp drop in deaths from communicable diseases, especially over the last decade, said the Global Burden of Disease report, published in The Lancet.

08 oct 2016--Despite population increases, combined mortality from HIV/AIDS and tuberculosis—both major killers—fell by more than a quarter, from 3.1 million in 2005 to 2.3 million in 2015.
Over this period, annual deaths due to diarrhoeal diseases decreased by 20 percent.
And malaria mortality plummeted by more than a third, from 1.2 million in 2005 to 730,000 last year.
During that decade, life expectancy went up in 188 of 195 countries and territories.
At the same time, however, non-communicable diseases of all kinds—ranging from cancers to heart disease and stroke—claimed more lives, with the death toll rising from 35 million in 2005 to 39 million in 2015.
"As we live longer, the burden of non-communicable diseases is rising—along with the attendant costs of treatment," Kevin Watkins, head of Save the Children UK, noted in a comment, also in The Lancet.
Many of the diseases on the rise are associated with ageing: cancers, coronary artery disease, cirrhosis of the liver and Alzheimer's, among others.
The paradox is that even as lifespans grow, more people are spending more time in ill health of living with disabilities, the 100-page study found.
Centralising the expertise of nearly 1,900 experts, the report—coordinated by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle—comes at the juncture between two major UN health initiatives.
The Millennium Development Goals (MDGs), set in 2000, set hard targets for reducing child and maternal mortality, and combatting key communicable diseases, by 2015.
A 15-year clock on a new set of Sustainable Development Goals (SDGs)—several of them health related—began running last year.
The report is intended as a benchmark for this new effort.
There have been other major health gains over the last quarter century.
The number of deaths of children under five, for example, dropped by more than 50 percent from 1990 to 2015, to 5.8 million.

National score cards

But that was still well short of the MDG calling for under-five mortality to be slashed by two-thirds.
Had that target been met, another 14 million children would have survived to see their fifth birthday.
There were exceptions to the generally positive trends, many stemming from conflict.
Since 2011, global deaths from war have risen massively due in large part to fighting in Syria, Yemen and Libya.
Male life expectancy in Syria has dropped more than 11 years since the civil war there began.
In 2015, the number of people displaced by armed conflict and disasters reached a record 65 million. Over half of the world's refugees are children.
The report also "graded" countries, indicating whether mortality levels from specific causes were lower or higher than expected, taking into account each nation's income and education levels, as well as fertility rates.
The United States, for example, scored very poorly on coronary heart disease, chronic obstructive pulmonary disease (COPD), and drug abuse.
Many Eastern European countries scored poorly on these, as well as alcohol abuse and stroke.
Western European and East Asian countries, generally speaking, scored highest.

Wednesday, October 05, 2016

Maximum human lifespan has already been reached, researchers conclude

Credit: CC0 Public Domain
A study published online today in Nature by Albert Einstein College of Medicine scientists suggests that it may not be possible to extend the human life span beyond the ages already attained by the oldest people on record.

05 oct 2016--Since the 19th century, average life expectancy has risen almost continuously thanks to improvements in public health, diet, the environment and other areas. On average, for example, U.S. babies born today can expect to live nearly until age 79 compared with an average life expectancy of only 47 for Americans born in 1900. Since the 1970s, the maximum duration of life—the age to which the oldest people live—has also risen. But according to the Einstein researchers, this upward arc for maximal lifespan has a ceiling—and we've already touched it.
"Demographers as well as biologists have contended there is no reason to think that the ongoing increase in maximum lifespan will end soon," said senior author Jan Vijg, Ph.D., professor and chair of genetics, the Lola and Saul Kramer Chair in Molecular Genetics, and professor of ophthalmology & visual sciences at Einstein. "But our data strongly suggest that it has already been attained and that this happened in the 1990s."
Dr. Vijg and his colleagues analyzed data from the Human Mortality Database, which compiles mortality and population data from more than 40 countries. Since 1900, those countries generally show a decline in late-life mortality: The fraction of each birth cohort (i.e., people born in a particular year) who survive to old age (defined as 70 and up) increased with their calendar year of birth, pointing toward a continuing increase in average life expectancy.
But when the researchers looked at survival improvements since 1900 for people aged 100 and above, they found that gains in survival peaked at around 100 and then declined rapidly, regardless of the year people were born. "This finding indicates diminishing gains in reducing late-life mortality and a possible limit to human lifespan," said Dr. Vijg.
He and his colleagues then looked at "maximum reported age at death" data from the International Database on Longevity. They focused on people verified as living to age 110 or older between 1968 and 2006 in the four countries (the U.S., France, Japan and the U.K.) with the largest number of long-lived individuals. Age at death for these supercentenarians increased rapidly between the 1970s and early 1990s but reached a plateau around 1995—further evidence for a lifespan limit. This plateau, the researchers note, occurred close to 1997—the year of death of 122-year-old French woman Jeanne Calment, who achieved the maximum documented lifespan of any person in history.
Using maximum-reported-age-at-death data, the Einstein researchers put the average maximum human life span at 115 years—a calculation allowing for record-oldest individuals occasionally living longer or shorter than 115 years. (Jeanne Calment, they concluded, was a statistical outlier.) Finally, the researchers calculated 125 years as the absolute limit of human lifespan. Expressed another way, this means that the probability in a given year of seeing one person live to 125 anywhere in the world is less than 1 in 10,000.
"Further progress against infectious and chronic diseases may continue boosting average life expectancy, but not maximum lifespan," said Dr. Vijg. "While it's conceivable that therapeutic breakthroughs might extend human longevity beyond the limits we've calculated, such advances would need to overwhelm the many genetic variants that appear to collectively determine the human lifespan. Perhaps resources now being spent to increase lifespan should instead go to lengthening healthspan—the duration of old age spent in good health."

More information:

Provided by Albert Einstein College of Medicine

Sunday, October 02, 2016

Elderly will take medical risks given large enough benefits, study shows

Elderly will take medical risks given large enough benefits, study shows

Older people are more likely to take medical risks than younger adults if they perceive the benefits to be high enough, according to new research led by Plymouth University.
Yaniv Hanoch, Professor of Decision Science, said that the findings of the study Does Medical Risk-Perception and Risk-Taking Change with Age? challenge the traditional view of older people being risk averse.

02 oct 2016--The study, carried out alongside Jonathan J. Rolison of the University of Essex, and Alexandra M. Freund of the University of Zurich, involved 317 adults, ages 20 to 77, comparing decisions among different age groups about risky medical treatments, such as vaccines and chemotherapy.
The authors gave the participants four different scenarios to read, and Professor Hanoch explains: "Increasing age was associated with a higher likelihood of passive risk taking, whereby older adults avoided options, such as accepting a treatment or vaccine, that could lower their chance of dying.
"Beliefs about the elderly taking fewer risks are based mainly on financial risk-taking studies that do confirm elderly people's financial risk aversion. However, older adults do not seem to be as generally averse to taking risks as that literature on financial risk-taking suggests. Instead, when it comes to the essential domain of health or medical decision making, older adults also focus strongly on the benefits of a given procedure."
In the study's first two scenarios, participants were asked to imagine that their local area had been sealed off due to a highly contagious and deadly flu – which would kill 10 in 100 people. They were then asked whether they would take the risk of getting a preventative vaccine which, although effective in 95 per cent of cases, brought with it a 5 per cent chance of dying. After reading the scenarios, participants indicated whether they would accept the vaccine for themselves (Scenario 1) or have the vaccine administered to their child (Scenario 2).
A similar design was followed for Scenarios 3 and 4, but the participants were asked to imagine that either they (Scenario 3) or their child (Scenario 4) had been diagnosed with a deadly, slow-growing cancer.
The study also used a psychological measurement instrument, the Domain-Specific Risk-Taking Scale – Medical (DOSPERT-M) to gauge whether a participant would 'immediately go to the doctor's when something in my body is aching or bothering me'. The DOSPERT-M recorded responses on a seven-point scale ranging from one (very unlikely) to seven (very likely).
Results showed that if a participant expected greater benefits they would be more willing to take a risk. Conversely, if they perceived higher risks, they would be less likely to take the risk.
Professor Hanoch added:
"Our data revealed no age-related differences in medical risk-taking tendencies, which stands in contrast to the prevailing notion that older adults are more risk averse than younger ones. Taken together, our study provides important insights about changes in medical risk taking across adulthood when people face an increasing number of complex and risky medical decisions.
"The findings have important implications for medical decisions by the elderly. When giving such patients medical and health information, then, of course the potential risks need to be communicated to older patients, but also the potential benefits. Given the high financial and personal costs associated with medical-related risk behaviour, gaining better insights into adult lifespan changes in medical risk-taking tendencies and perceptions is paramount."

More information: Yaniv Hanoch et al. Does Medical Risk Perception and Risk Taking Change with Age?, Risk Analysis (2016). DOI: 10.1111/risa.12692

Provided by University of Plymouth

Saturday, October 01, 2016

Healthy lifestyle in old age shortens end-of-life disability

Leading a healthy lifestyle not only extends one's lifespan, but it also shortens the time that is spent disabled—a finding that had previously eluded public health scientists and demonstrates the value of investing in healthy lifestyle promotion, even among the elderly.

01 oct 2016--An analysis of a quarter century of data by scientists at the University of Pittsburgh Graduate School of Public Health and their colleagues nationwide revealed that older adults with the healthiest lifestyles could expect to spend about 1.7 fewer years disabled at the end of their lives, compared to their unhealthiest counterparts. The study results are online and scheduled for the October issue of the Journal of the American Geriatrics Society.
"The duration of the disabled period near the end of one's life has enormous personal and societal implications, ranging from quality of life to health care costs," said senior author Anne B. Newman, M.D., M.P.H., chair of the Department of Epidemiology at Pitt Public Health and Katherine M. Detre Professor of Population Health Sciences. "We discovered that, fortunately, by improving lifestyle we can postpone both death and disability. In fact, it turns out that we're compressing that disabled end-of-life period."
Dr. Newman and her colleagues examined data collected by the Cardiovascular Health Study, which followed 5,888 adults from Sacramento County, Calif.; Forsyth County, N.C.; Washington County, Md.; and Allegheny County, Pa., for 25 years. All of the participants were aged 65 or older and were not institutionalized or wheelchair-dependent when they enrolled.
The participants reported or were assessed for various lifestyle factors, including smoking habits, alcohol consumption, physical activity, diet, weight and their social support system. The researchers took into account and adjusted results for such factors as participants' age, sex, race, education, income, marital status and chronic health conditions.
Across all the participants, the average number of disabled years directly preceding death—years when the person had difficulty eating, bathing, toileting, dressing, getting out of bed or a chair, or walking around the home—averaged 4.5 years for women and 2.9 years for men.
For each gender and race group, those with the healthiest lifestyle (those who were nonsmokers of a healthy weight and diet and getting regular exercise) not only lived longer, but had fewer disabled years at the end of their lives. For example, a white man in the healthiest lifestyle group could expect to live 4.8 years longer than his counterpart in the unhealthiest group, and at the end of his life, he'd likely spend only two of those years disabled, compared to 3.7 years for his unhealthy counterpart.
Put another way, that man's healthy lifestyle has given him nearly three more years of active life free of disability than his unhealthy counterpart, who not only died earlier but spent the last three-and-a-half years of his life disabled—a larger percentage of those remaining years.
"This clearly demonstrates the great value of investing in the promotion of a healthy lifestyle and encouraging people to maintain healthy behaviors into old age," said lead author Mini E. Jacob, M.D., Ph.D., who completed this project during her doctoral studies at Pitt Public Health and currently is of the Boston University School of Public Health, Harvard Medical School and Veterans Affairs Boston Healthcare System. "We are not discounting the role of factors like income and chronic conditions, which we adjusted for in our analyses. However, our results do indicate that increasing obesity levels of older Americans can herald a disability epidemic, and by urging healthy lifestyles, we may still be able to reduce the public health burden due to disability as more adults reach old age."

More information: Mini E. Jacob et al. Can a Healthy Lifestyle Compress the Disabled Period in Older Adults?, Journal of the American Geriatrics Society (2016). DOI: 10.1111/jgs.14314

Provided by University of Pittsburgh