Thursday, March 30, 2017

Exercise: the cellular 'fountain of youth'

Exercise: the cellular 'Fountain of youth'
High-intensity exercise may help older adults reverse certain aspects of the "cellular" aging process, a new study suggests.

30 mar 2017--It's no secret that regular exercise is healthy for young and old alike. But researchers said the new findings point to particular benefits from "high-intensity interval training" for older adults.
That's the type of workout that combines brief bursts of vigorous exercise with periods of moderate activity: A person might, for example, go all-out on a stationary bike for a few minutes, ease up for the next few, and then start again.
In this study, older adults who performed that type of exercise showed greater changes at the cellular level, compared to those who worked out more moderately.
Specifically, interval training gave a bigger boost to mitochondrial function in the muscle. Mitochondria are the "powerhouses" within body cells that break down nutrients to be used for energy.
The training also revved up activity in more genes related to mitochondrial function and muscle growth.
What does it all mean?
The study findings suggest that interval training can turn back the clock in ways that moderate aerobic exercise and strength training do not, according to lead researcher Dr. K. Sreekumaran Nair.
But, he stressed, the findings do not mean older adults should jump into a vigorous exercise regimen.
"If you're sedentary, you should talk to your doctor before you start exercising," said Nair. He's an endocrinologist at the Mayo Clinic in Rochester, Minn.
"And then," he said, "you can start with walking, and build yourself up to a fast pace."
For older adults who want to progress to a more-intense regimen, Nair said, it's best to start with supervision. But he also stressed that intense exercise is not a must. "Any regular exercise will bring health benefits—absolutely," he added.
This study demonstrated that, he pointed out. Even though interval training had the biggest effects on aspects of cellular aging, other types of exercise boosted older adults' fitness levels and muscle strength.
The study, published recently in Cell Metabolism, involved 72 younger and older adults who were sedentary.
Nair's team randomly assigned each of them to one of three supervised exercise groups.
One group did high-intensity interval training three days a week: They pedaled on an exercise bike at their maximum speed for 4 minutes, before easing up for 3 minutes; they repeated that process four times. They also worked out more moderately—walking on a treadmill—twice a week.
A second group performed moderate aerobic exercise—using an exercise bike at a less-intense pace—five days a week, for 30 minutes. They also did some light strength-training four days a week.
The third group performed strengthening exercises only, two days a week.
After 12 weeks, all of the groups were showing positive changes—younger and older exercisers alike, the researchers found.
People who performed moderate aerobic exercise boosted their fitness levels—the body's ability to supply blood and oxygen to working muscles. And the improvement was greater for older adults, who generally started out with lower fitness levels than younger people.
Meanwhile, people who performed strength-training—alone or with aerobic exercise—increased their muscle strength.
The interval-training group showed only small gains in strength. But the training improved mitochondrial function in the muscles, especially among older adults.
Dr. Chip Lavie is medical director of cardiac rehabilitation and prevention at the John Ochsner Heart and Vascular Institute in New Orleans.
He said this is a "great" study that demonstrates the benefits of different forms of exercise.
According to Lavie, it adds to other evidence that high-intensity interval training is "probably the best form of exercise."
Many studies, he said, have found that interval training beats moderate aerobic exercise when it comes to improving fitness and the heart's structure and function.
"It would be ideal to get more people to do high-intensity interval training," Lavie said, "and it's possible for more-motivated individuals."
But, he added, the reality is, many people may not have the motivation or ability.
In that case, Lavie advised finding a moderate regimen you can live with—such as 30 to 40 minutes of walking or using an exercise bike or elliptical machine most days of the week.

More information: K. Sreekumaran Nair, M.D., Ph.D., professor, medicine, Mayo Clinic, Rochester, Minn.; Chip Lavie, M.D., medical director, cardiac rehabilitation and prevention, and director, exercise laboratories, John Ochsner Heart and Vascular Institute, New Orleans; March 7, 2017, Cell Metabolism

The American Council on Exercise has more on interval training.

Wednesday, March 29, 2017

Elevated blood pressure not a high mortality risk for elderly with weak grip

Elevated blood pressure not a high mortality risk for elderly with weak grip
A study of nearly 7,500 Americans age 65 or older suggests that elevated blood pressure is not related to high mortality risk among people in that age group with weak grip strength.
New research by Oregon State University builds on an earlier OSU study that showed the relationship between high blood pressure and risk of death is largely dependent on elders' frailty status as measured by walking speed.

29 mar 2017--The findings are important because they suggest that treating high blood pressure in older patients should not follow a one-size-fits-all approach. When an older person is still functioning at a high level physically, high blood pressure indicates mortality risk; however, when the person is not physically robust, high blood pressure is not a marker for mortality risk.
"If people are very frail, they typically don't respond well to anti-hypertensive therapy and they are not benefiting from having a low blood pressure," said lead author Chenkai Wu, a graduate student in OSU's College of Public Health and Human Sciences. "The research is basically saying older adults are not one single group, they're very different in terms of their health status, and drugs may not have the same benefits for everyone. This is consistent with the idea of precision medicine, where you don't just look at age, you look at other things like functional status."
Measured in millimeters of mercury, blood pressure is the force of blood against the vessel walls. Systolic blood pressure, the higher number, is the force during a heartbeat, and diastolic refers to when the heart is at rest.
Most people's diastolic blood pressure goes down with age. Systolic blood pressure, though, tends to rise, and high blood pressure - hypertension - can put extra strain on the heart and arteries, causing greater risk of heart attack and stroke.
But as Wu's research suggests, an elderly patient's level of physical functionality should be considered in determining whether anti-hypertensive therapy is warranted.
Grip strength, easily measured by an inexpensive device known as a dynamometer, is a common way to gauge functionality in the elderly. Another often-used measuring stick is walking speed.
Wu looked at data from 7,492 people age 65 or older who had taken part in the nationally representative Health and Retirement Study. Six years after being surveyed, 25 percent of those people had died.
The study showed that elevated systolic blood pressure (150 or greater) and diastolic blood pressure (90 or greater) correlated with a substantially higher likelihood of dying for those with normal grip strength, which is 26 kilograms or more for men and 16 kilograms or more for women.
"We did three analyses," Wu said. "One was to look at gait speed to separate people into two groups, normal and slow. The second part was grip strength - weak grip and normal grip. Third, we looked at the combinations, and the strongest inverse association between high blood pressure and mortality was for slow walkers with weak grip strength.
"Both measures are markers of functional status, a multidimensional concept. Considering both might be better than considering each measure alone for identifying subgroups of elders for whom high blood pressure is potentially beneficial."
OSU public health epidemiologist Michelle Odden, senior author on the study and the lead author on the earlier gait-speed research, explained how high blood pressure might actually help in some cases.
"As we age, our blood vessels lose elasticity and become stiff," said Odden, an assistant professor in the College of Public Health and Human Sciences. "Higher blood pressure could be a compensatory mechanism to overcome this loss of vascular elasticity and keep fresh blood pumping to the brain and heart.
"And everyone ages differently - there is a profound difference between the physiological age of an 80-year-old man who golfs every day and someone who needs a walker to get around. So with fast walkers, high blood pressure may be more indicative of underlying disease and not just a symptom of the aging process."
In addition to the connection with weak grip strength, Wu said there was a "very clear" inverse association between high blood pressure and mortality among those who weren't physically able to finish the gait-speed test in the latest study, measured over a 98.5-inch walk.
Put another way, among those who couldn't walk a little over 8 feet, high blood pressure was associated with less mortality risk.
"It's a small group but not negligible - 6 percent - of people who were not able to complete the test," he said. "Compared to grip strength, it's a harder test to complete, an integration of a lot of physiological systems: balance, vision, lower-extremity muscle strength, etc."
The findings were recently published in the Journal of the American Geriatrics Society.

More information: Chenkai Wu et al, Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.14816

Provided by Oregon State University

Tuesday, March 28, 2017

Longer telomeres protect against diseases of aging: A tale of mice and men

Longer telomeres protect against diseases of aging: A tale of mice and men
Deepak Srivastava, MD, is the Younger Family Director and a Senior Investigator at the Gladstone Institute of Cardiovascular Disease and Director of the Roddenberry Stem Cell Center.
Scientists at the Gladstone Institutes discovered a key mechanism that protects mice from developing a human disease of aging, and begins to explain the wide spectrum of disease severity often seen in humans. Both aspects center on the critical role of telomeres, protective caps on the ends of chromosomes that erode with age.

28 mar 2017--Erosion of telomeres has long been associated with diseases of aging, but how telomere length affects human disease has remained largely a mystery. Now, scientists find that shortening telomeres in mice carrying a human genetic mutation linked to heart disease results in a deadly buildup of calcium in heart valves and vessels. This innovative model allows the researchers to test viable new drugs for this disease, and it provides a potential solution to studying other human disorders of aging in mice.
Calcific aortic valve disease (CAVD) causes calcium to accumulate in heart valves and vessels until they harden like bone. It can only be treated by replacing the valve through heart surgery and is the third leading cause of heart disease, affecting three percent of adults over the age of 75. CAVD develops with age, and it can be caused by a mutation in one of two copies of the NOTCH1 gene.
Humans typically have two copies of each gene. When one copy is lost, the remaining gene may not produce enough of its protein to sustain normal function. While reducing protein levels by half often causes disease in humans, mice with the same change are frequently protected from disease, but scientists have been unsure why. In the new study, published in the Journal of Clinical Investigation, the Gladstone scientists linked telomere length to risk for or resistance to these types of diseases. Laboratory mice have naturally longer telomeres than humans, which the researchers now think protects them from age-related genetic conditions, such as CAVD.
"Our findings reveal a critical role for telomere length in a mouse model of age-dependent human disease," said first author Christina Theodoris, an MD/PhD student in the laboratory of Deepak Srivastava, MD. "This model provides a unique opportunity to dissect the mechanisms by which telomeres affect age-dependent disease and also a system to test novel therapeutics for aortic valve disease."
The researchers, who previously identified NOTCH1 as a genetic culprit in human CAVD, created mice that had shorter telomeres and were also missing one copy of the NOTCH1 gene, since mutation of NOTCH1 alone failed to induce valve disease in mice. Remarkably, mice with both shorter telomeres and the NOTCH1 mutation showed all the cardiac abnormalities seen in humans, including the disease-defining calcification of the aortic valve. Mice with the shortest telomeres had the greatest heart damage, with some even showing signs of valve disease as newborns. The scientists think that telomere length affects disease severity by changing gene expression in pathways implicated in CAVD, such as anti-inflammatory and anti-calcifications pathways.
Previous studies found that patients with valve calcification have shorter telomeres than healthy individuals of the same age. Additionally, some patients who have the NOTCH1 mutation develop CAVD in their 50s, while others are born with deadly valve abnormalities. Based on the new findings, the researchers suspect telomere length explains the variations in disease severity.
"Historically, we have had trouble modeling human diseases caused by mutation of just one copy of a gene in mice, which impedes research on complex conditions and limits our discovery of therapeutics," explained Srivastava, director of the Gladstone Institute of Cardiovascular Disease and senior author on the study. "Progressive shortening of longer telomeres that are protective in mice not only reproduced the clinical disease caused by NOTCH1 mutation, it also recapitulated the spectrum of disease severity we see in humans."
Prior research by Helen Blau, PhD, and Foteini Mourkioti, PhD, of Stanford University—who were co-authors on the current study—demonstrated that shortening telomeres in a mouse model of Duchenne muscular dystrophy also elicited a more human-like disease, raising the possibility that telomere length may be protective for many disease-causing mutations.
The researchers plan to use the mouse models of CAVD to test several potential drug therapies they identified, in the hopes of discovering the first medical treatment for the disease.

More information: Christina V. Theodoris et al. Long telomeres protect against age-dependent cardiac disease caused by NOTCH1 haploinsufficiency, Journal of Clinical Investigation (2017). DOI: 10.1172/JCI90338

Provided by Gladstone Institutes

Monday, March 27, 2017

Exercising 2.5 hours per week associated with slower declines in Parkinson's disease patients

Parkinson's disease (PD) is a progressive condition that often results in mobility impairments and can lead to decreased health-related quality of life (HRQL) and death. There is evidence that physical activity can delay decline in PD patients. In a study in the Journal of Parkinson's Disease, researchers determined that that people who exercised regularly had significantly slower declines in HRQL and mobility over a two-year period.

27 mar 2017--Lead investigator Miriam R. Rafferty, PhD, of Northwestern University and Rehabilitation Institute of Chicago, describes the main findings of the study. "We found that people with Parkinson's disease who maintained exercise 150 minutes per week had a smaller decline in quality of life and mobility over two years compared to people who did not exercise or exercised less. The smaller decline was significant for people who started the study as regular exercisers, as well as for people who started to exercise 150 minutes per week after their first study-related visit."
The data came from the National Parkinson Foundation Quality Improvement Initiative (NPF-QII), an international, multicenter, prospective clinical study of care and outcomes that has recorded data from 21 sites in North America, the Netherlands, and Israel identified as Centers of Excellence by the National Parkinson Foundation. Over 3400 participants provided data over two years, with information collected during at least three clinic visits. The NPF-QII study collects demographics, disease duration, Hoehn and Yahr stage (HY), brief cognitive assessments, as well as data on pharmacologic and non-pharmacologic management of PD symptoms. These observational study visits are scheduled on a yearly basis. At each visit, exercise is measured by the self-reported number of hours per week of exercise.
The Parkinson Disease Questionnaire (PDQ-39) is used to measure patient-reported, PD-specific HRQL. Functional mobility was measured by the Timed Up and Go (TUG) test, in which performance is tested by timing participants as they rise from a chair, walk three meters, turn, and return to a sitting position.
Although this study did not determine which type of exercise is best, it suggests that any type of exercise done with a "dose" of at least 150 minutes per week is better than not exercising. "People with PD should feel empowered to find the type of exercise they enjoy, even those with more advanced symptoms," remarked Dr. Rafferty.
An unanticipated finding from the study was that the HRQL benefit associated with 30-minute increases in exercise per week was greatest in people with advanced PD. These data have significant implications for making exercise and physical activity more accessible to people with more severe disability. People with more advanced PD may have poor access to regular exercise, as their mobility impairments would limit their independent participation in existing community and group exercise programs.
"The most important part of the study," according to Dr. Rafferty, "is that it suggests that people who are not currently achieving recommended levels of exercise could start to exercise today to lessen the declines in quality of life and mobility that can occur with this progressive disease."

More information: Miriam R. Rafferty et al, Regular Exercise, Quality of Life, and Mobility in Parkinson's Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data, Journal of Parkinson's Disease (2017). DOI: 10.3233/JPD-160912

Provided by IOS Press

Sunday, March 26, 2017

Hospital or home? Guidelines to assess older people who have fallen

Guidelines to help paramedics make the right decision for older people who have fallen are safe, cost-effective and help reduce further 999 calls, according to new research led by a team at Swansea University Medical School.

26 mar 2017--Falls are a very common problem in older people, with severe consequences. Many 999 calls are made for older people who fall. Many callers fall more than once.
  • Approximately 30% of people over 65 living at home fall every year
  • In the UK, falls account for almost £1 billion of the NHS budget
  • Around 8% of 999 calls in the UK are for falls
If the person who has fallen is not injured they may be left at home by the ambulance crew, rather than taken to hospital. On average this happens in around 40% of cases currently. In some places ambulance services have made local links with community falls services. However, there is not enough evidence to show whether this is safe, effective for patients or worth the cost.
This is where the Swansea research comes in, part of a project called SAFER 2 (Support and Assessment for Fall Emergency Referrals). The team carried out a large-scale trial to test new guidelines - known as a protocol - for paramedics to use to assess people following a 999 call for a fall. The protocol helps them decide whether they should take the patient to hospital, or leave them at home with a referral to a community-based falls service if appropriate
The trial involved105 paramedics based at 14 ambulance stations, across three UK ambulance services. The team monitored over 4000 people who called for an ambulance after falling.
The research showed that the new protocol:
  • Was safe and inexpensive
  • Led to an 11% decrease in further 999 calls by people who have fallen - so there would now be 8 calls for every 9 made previously
  • Left fewer people without continuing care after their fall
  • Did not have any wider effects on Accident and Emergency admissions or death rates
  • Had limited effects on patients' quality of life or satisfaction
  • Was not used as much or as consistently by paramedics as expected
Professor Helen Snooks of Swansea University Medical School, who led the project, said:
"The findings show that this new way of assessing patients who fall is safe. Ambulance services can introduce it knowing that it does not increase the risk of harm to patients.
We also showed that the protocol was associated with a small reduction in 999 calls from patients who had fallen previously. As costs and pressures are so high in emergency care, even a small reduction can make a big difference."

Provided by Swansea University

Saturday, March 25, 2017

After the epigenome: The epitranscriptome

After the epigenome: The epitranscriptome
Chemical modifications of nucleic acids constitute the Epigenome (DNA) and the Epitranscriptome (RNA), which regulate the activity of the Genome.
Our genome is made up of 6,000 million pieces of DNA that combine four "flavors": A, C, G and T (Adenine, Cytosine, Guanine and Thymine). It is our Alphabet. But to this base we must add some regulation, just like the spelling and grammar of that alphabet: this is what we call Epigenetics.

25 mar 2017--In epigenetics, there there are "accents", called DNA methylation, which means having a C or a methyl-C. The first one usually means that a gene is expressed and active, while the second one implies that a gene is silent and inactive. Our DNA "speaks" when it produces another molecule called RNA (Ribonucleic Acid). Until very recently, it was believed that this molecule was only a poorly regulated intermediate capable of producing proteins (such as insulin, hemoglobin and others) under DNA's orders.
Today, an article published in Cancer Discovery by Manel Esteller, Director of the Epigenetics and Cancer Biology Program of Bellvitge Biomedical Research Institute (IDIBELL), ICREA Researcher and Professor of Genetics at the University of Barcelona, explains that this RNA also has its own spelling and grammar, just like DNA. These "epigenetics of RNA" are called epitranscriptome.
"It is well-known that sometimes DNA produces a RNA string but then this RNA does not originate the protein. Because in these cases the alteration is neither in the genome nor the proteome, we thought it should be in the transcriptome, that is, in the RNA molecule", Dr. Esteller explains."In recent years, we discovered that our RNA is highly regulated and if only two or three modifications at the DNA level can control it, there may be hundreds of small changes in RNA that control its stability, its intracellular localization or its maturation in living beings".
In human cells, this field did not start to be studied in depth in the last five years. "For example, we now know that RNA can be methylated just like DNA and in a highly specific way", says Dr. Manel Esteller, "and even more recently we observed that these epigenetic modifications of RNA may be key in the regulation of "guardian" RNAs, also called non-coding RNAs".
The article also points out that the epitranscriptome could be altered in some human diseases, while alterations in genes responsible for cancer are also being discovered. "It will definitely be an exciting research stage for this and the next generation of scientists," concludes the researcher.

More information: Manel Esteller et al, The Epitranscriptome of Noncoding RNAs in Cancer, Cancer Discovery (2017). DOI: 10.1158/2159-8290.CD-16-1292

Provided by IDIBELL-Bellvitge Biomedical Research Institute

Friday, March 24, 2017

Moderate drinking linked to lower risk of some—but not all—heart conditions

Moderate drinking is associated with a lower risk of several, but not all, cardiovascular diseases, finds a large study of UK adults published by The BMJ today.
The finding that moderate drinking is not universally associated with a lower risk of all cardiovascular conditions suggests a more nuanced approach to the role of alcohol in prevention of cardiovascular disease is necessary, say the researchers.

24 mar 2016--Moderate drinking is thought to be associated with a lower risk of developing cardiovascular disease compared with abstinence or heavy drinking.
In the UK, moderate drinking is defined as no more than 14 units (112 grams) of alcohol a week.
To put this into context, one unit of alcohol is about equal to half a pint of ordinary strength beer, lager or cider (3.6% alcohol by volume) or a small pub measure (25 ml) of spirits. There are one and a half units of alcohol in small glass (125 ml) of ordinary strength wine (12% alcohol by volume). [Source: NHS Choices]
There is, however, a growing scepticism around this observation, with some experts pointing out several shortcomings in the evidence. For example, grouping non-drinkers with former drinkers, who may have stopped drinking due to poor health.
So researchers at the University of Cambridge and University College London set out to investigate the association between alcohol consumption and 12 cardiovascular diseases by analysing electronic health records for 1.93 million healthy UK adults as part of the CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records) data resource.
All participants were free from cardiovascular disease at the start of the study, and non-drinkers were separated from former and occasional drinkers to provide additional clarity in this debate.
After several influential factors were accounted for, moderate drinking was associated with a lower risk of first presenting to a doctor with several, but not all, cardiovascular conditions, including angina, heart failure and ischaemic stroke, compared with abstaining from alcohol.
However, the authors argue that it would be unwise to encourage individuals to take up drinking as a means of lowering their cardiovascular risk over safer and more effective ways, such as increasing physical activity and stopping smoking.
Heavy drinking (exceeding recommended limits) conferred an increased risk of first presenting with a range of such diseases, including heart failure, cardiac arrest and ischaemic stroke compared with moderate drinking, but carried a lower risk of heart attack and angina.
Again, the authors explain that this does not mean that heavy drinkers will not go on to experience a heart attack in the future, just that they were less likely to present with this as their first diagnosis compared with moderate drinkers.
This is an observational study, so no firm conclusions can be drawn about cause and effect. Added to which, the authors point to some study limitations that could have introduced bias.
Nevertheless, they say it is the first time this association has been investigated on such a large scale and their findings have implications for patient counselling, public health communication, and disease prediction tools.
In a linked editorial, researchers at Harvard Medical School and Johns Hopkins School of Public Health in the US say this study "does not offer a materially new view of the associations between alcohol consumed within recommended limits and risk of cardiovascular disease.
"This work, however, sets the stage for ever larger and more sophisticated studies that will attempt to harness the flood of big data into a stream of useful, reliable, and unbiased findings that can inform public health, clinical care, and the direction of future research," they conclude.

More information: Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records,

Provided by British Medical Journal

Thursday, March 23, 2017

Shingles vaccine cuts chronic pain, hospitalizations

Shingles vaccine cuts chronic pain, hospitalizations
23 mar 2017--—Vaccination greatly reduces the risk of serious complications from shingles, a new study finds.
Shingles occurs when the same virus that causes chickenpox is reactivated later in life. Nearly one-third of people in the United States will develop shingles. The risk increases with age, researchers said.
The new study showed the vaccine was 74 percent effective in preventing hospitalizations for shingles during the three years after vaccination. That number dropped to 55 percent effective after four or more years.
The immunization was 57 percent effective for preventing lasting pain in the three years after vaccination. The rate dropped to 45 percent after four years, the researchers said.
The findings were published recently in the journal Clinical Infectious Diseases.
"The fact that we found relatively high effectiveness against serious outcomes, such as hospitalization and [lasting pain], and that protection from these outcomes was sustained over time, adds to the considerable evidence that the vaccine is beneficial and that seniors should be encouraged to be vaccinated in higher numbers than what is happening currently," study author Dr. Hector Izurieta said in a journal news release.
Izurieta is with the U.S. Food and Drug Administration's Center for Biologics Evaluation and Research. The FDA funded the research.
The study looked at information collected between 2007 and 2014. The data included about 2 million Medicare beneficiaries. The researchers found that the vaccine seems most effective against severe cases of shingles requiring hospitalization and against chronic pain.
There didn't seem to be much difference in how effective the vaccine was between age groups. But protection declined over time after vaccination, the researchers said.
The shingles vaccine was approved in the United States in 2006. At the time, studies showed that the vaccine reduced the risk of shingles by about half in people aged 60 and older.
In the United States, the shingles vaccine is recommended for people 60 and older. But in 2014, just 28 percent of adults in this age group said they'd received the vaccine, according to the U.S. Centers for Disease Control and Prevention.

More information: The U.S. Centers for Disease Control and Prevention has more on shingles vaccination.

Tuesday, March 21, 2017

Screening for both malnutrition and frailty needed to enhance health of aging populations

By 2035 one in four Canadians will be 65 years old or older, an age group prone to malnutrition and frailty. A new literature review published today in Applied Physiology, Nutrition, and Metabolism describes the similarities between these two conditions, which are generally considered separately by clinicians, and recommends research efforts, diagnostic tools and medical treatments that consider both conditions.

21 mar 2017--Frailty in older populations is characterized by loss in strength and endurance, which increases vulnerability to other ailments and overall deterioration of health. Frail, older adults struggle with everyday activities such as cooking and eating, putting them at risk for malnourishment. Previous studies have found that malnutrition often co-occurs with frailty in older adults, exacerbating the condition and causing further weakness. Even though the two conditions coincide with each other, currently, frailty and malnutrition are diagnosed independently of each other using different tools. "Simple tools for screening and processes for detecting and treating these conditions together need to be developed across the continuum of care," says Professor Heather Keller, senior author of the review and lead of the University of Waterloo's Nutrition and Aging Lab. Frailty and malnutrition "should be considered simultaneously due to the high likelihood that a patient will have both conditions together," Keller adds.
Keller and her research team compiled documents and reports on frailty and malnutrition and identified symptoms shared between the two conditions: weight loss, slowness and weakness. Weight loss can be self-reported or measured, while the latter two symptoms can be readily assessed in any healthcare setting using reduced walking speed and grip strength of a patient's hand. The authors believe that the use of indicators that diagnose both malnutrition and frailty is needed to ensure that effective treatments are used to improve the health of seniors.
The review stresses how treatment plans that address both malnutrition and frailty are currently lacking and their effectiveness is not known. Oral nutritional supplements or nutrient dense diets in combination with physical exercise could improve nutrition status and strength in frail, malnourished patients.
Preventative health practices that capture both nutrition and frailty risk are also important, the authors say. Identifying at-risk individuals with standardized screening can ensure earlier intervention, which can minimize progression of the conditions and hospitalization. The authors conclude that when a health professional considers an older adult to be frail, they should also identify if they are malnourished.
This review is timely given Canada's shifting demographic. Additional burdens on Canada's healthcare system are expected over the next 20 years as a quarter of the country's population will exceed the age of 65 by 2035. Testing and implementing diagnostic and treatment tools that detect related health conditions such as frailty and malnutrition can improve efficiency of hospital and primary care services, and ultimately patient outcomes.

More information: Applied Physiology, Nutrition, and MetabolismDOI: 10.1139/apnm-2016-0652

Provided by Canadian Science Publishing (NRC Research Press)

Monday, March 20, 2017

Experts release guidelines for evaluating, managing syncope

The American College of Cardiology, with the American Heart Association and the Heart Rhythm Society, today released a guideline on the evaluation and management of patients with syncope. The 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Syncope will publish online today in the Journal of the American College of Cardiology, Circulation and HeartRhythm.

20 mar 2017--Syncope, or fainting, is caused by low blood pressure resulting in an insufficient supply of blood, and therefore oxygen, to the brain. This can happen due to several causes, some of them even due to a serious underlying medical condition. Until now, there have been no written standards outlining the best course of action to take when treating patients who faint.
"This is very important because fainting impacts thousands of people every day," said Win-Kuang Shen, MD, chair of the writing group that developed the guidelines. "Now that we have these guidelines, physicians and clinicians will be able to make better-informed decisions and this will contribute to improved patient outcomes."
The new recommendations include:
  1. If a patient faints, a doctor should perform a detailed history and physical examination during the initial evaluation.
  2. The most common cause of fainting usually occurs while standing when blood pressure drops, reducing circulation to the brain and causing loss of consciousness. This condition is not life threatening although it can cause worries and interfere with one's quality of life. Physicians should inform patients that common faints are not life threatening.
  3. Using an electrocardiogram (ECG) when initially evaluating patients who faint is useful. It is important to find out the cause of fainting and treat the heart condition in the patient if he or she has an abnormal ECG after fainting.
  4. If a person has a serious medical condition that could be related to their fainting, they should be evaluated and/or treated at a hospital after the initial assessment.
  5. There are a number of tests that are not useful in evaluating patients who faint. These include: routine laboratory testing, routine cardiac imaging, like an MRI or CT scan, unless the patient has a suspected cardiac issue, and carotid artery or head imaging, unless there is a specific reason why the patient needs to be evaluated further.
  6. Implantable cardioverter-defibrillators (ICD) can be helpful for certain patients who faint because they have irregular heartbeats that are life threatening.
  7. Beta-blockers can be a good choice in patients who faint and who have certain heart conditions as defined in the guidelines.
  8. Patients who faint and who also have certain types of heart issues as defined in the guidelines should restrict their exercise.
  9. A pacemaker may be helpful for some patients who experience reoccurring common faints that are associated with a very slow heart rate. Drugs are usually not very effective in treating patients with common faints.
  10. Heart rhythm monitoring can be a good choice for patients with unexplained fainting who may have intermittent heart rhythm issues that cause fainting.
  11. An athlete who has problems with fainting should have a heart assessment done by an experienced health care provider or specialist before returning to competitive sports.
"Studies show that in the U.S., about one-third to half the population faints at some point in their lifetime. That means there is a very good chance these guidelines will either affect you directly or someone you know. Therefore, having these guidelines is not only good for the clinicians using them—but for everyone," Shen said.
The guideline was written in collaboration with the American College of Emergency Physicians and the Society for Academic Emergency Medicine.

More information: Journal of the American College of CardiologyDOI: 10.1016/j.jacc.2017.03.003

Provided by American College of Cardiology

Thursday, March 16, 2017

Delirium is associated with five-fold increased mortality in acute cardiac patients

Delirium is associated with a five-fold increase in mortality in acute cardiac patients, according to research published today in European Heart Journal: Acute Cardiovascular Care. Delirium was common and affected over half of acute cardiac patients aged 85 years and older.

16 mar 2017--Delirium is a clinical syndrome caused by a disturbance in the normal functioning of the brain. Delirious patients are less aware of, and responsive to, their environment. They can be disorientated, incoherent, and in a dream-like state, with hallucinations, disordered speech and memory disturbances.
Delirium affects at least one in ten hospitalised patients and is more common in the elderly. These patients have worse long-term prognosis and more complications during their hospital stay.
"Among hospitalised patients, those admitted to an intensive care unit are more likely to develop delirium and there are strategies to limit its consequences," said lead author Dr Giovanni Falsini, interventional cardiologist, San Donato Hospital, Arezzo, Italy. "Less is known about delirium and its significance in patients admitted to cardiac intensive care units. This study investigated the incidence and clinical impact of delirium in patients with acute cardiac diseases."
The study included all patients aged 65 years and older admitted to two cardiac intensive care units during a period of 15 months. Only non-intubated patients were enrolled. Validated score systems and questionnaires were used to detect and diagnose the presence of delirium at admission or during the hospital stay.
Delirious patients were closely followed by nursing and medical staff who used a flowchart for delirium treatment. This included treating pain and anxiety, and discontinuing medications known to cause delirium. Patient survival at six months was determined by telephone call.
The investigators found that delirium was a frequent condition among elderly patients with acute cardiac diseases. The study population consisted of 726 patients with an average age of 79 years, of whom 15% had delirium (at admission or during the hospital stay). More than half (52%) of patients aged 85 years and older were delirious.
Patients with delirium had a worse prognosis, with a five-fold increase in both in-hospital and 30-day mortality and a two-fold increase in six-month mortality. Delirium was not only a strong and independent factor in predicting mortality, but was also associated with longer hospital stay and more frequent rehospitalisations during follow-up.
"Delirium is a common and serious condition in acute cardiac patients," said Dr Falsini. "They stay in hospital longer, return to hospital more often, and are more likely to die in the short- and long-term."
Dr Falsini said elderly patients may be at higher risk because they usually have pre-existing issues that can predispose to delirium such as dementia, visual and hearing impairments, depression, use of psychoactive drugs, infections, or electrolyte disturbances.
He said: "The more complex and frail the patient is, the higher the rate of delirium and subsequent worse outcomes. It is unknown whether delirium can be treated to improve prognosis in critically ill patients, or whether it is a marker of organ dysfunction or systemic disease and an early sign that complications are likely. Monitoring delirium has been linked with reduced in-hospital mortality in mechanically ventilated patients and it is possible that similar benefit might occur in acute non-intubated patients."
Dr Falsini concluded: "Delirium is common, serious, costly and under-recognised. A protocol is needed to identify and treat delirium in high-risk settings, like cardiac intensive care units."

More information: Falsini G, et al. Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS). European Heart Journal: Acute Cardiovascular Care. 2017. DOI: 10.1177/2048872617695235

Provided by European Society of Cardiology

Tuesday, March 14, 2017

Most atrial fibrillation patients don't get preventive drug before stroke

atrial fibrillation
A 12 lead ECG showing atrial fibrillation at approximately 150 beats per minute.
More than 80 percent of stroke patients with a history of atrial fibrillation either received not enough or no anticoagulation therapy prior to having a stroke, despite the drugs' proven record of reducing stroke risk, according to a Duke Clinical Research Institute study.

14 mar 2017--Reporting in the March 14 issue of the Journal of the American Medical Association, the researchers also found that when patients did receive recommended anticoagulation drugs, they had less severe stroke outcomes and less risk of dying.
"Atrial fibrillation is very common, and people with the condition are at a much higher risk of having stroke," said lead author Ying Xian, M.D., Ph.D., assistant professor of neurology at Duke and member of the Duke Clinical Research Institute. "Treatment guidelines call for these patients to receive an anticoagulant such as warfarin at a therapeutic dose or a non-vitamin K antagonist oral anticoagulant (NOAC), so it's surprising that this is not occurring in the vast majority of cases that occur in community settings."
The study included more than 94,000 patients with atrial fibrillation from the American Heart Association's "Get With The Guidelines-Stroke" registry who had had an acute ischemic stroke. The analysis was sponsored by the Patient-Centered Outcomes Research Institute to inform patients, physicians and others about optimal stroke care.
The researchers found that only 16 percent of patients with atrial fibrillation had received the recommended anticoagulation medication prior to having a stroke. These medications include therapeutic levels of warfarin or NOAC.
A total of 84 percent of patients were not treated according to the guidelines prior to stroke:
  • 30 percent were not taking any antithrombotic treatment at all;
  • 40 percent were taking an antiplatelet drug such as baby aspirin or clopidogrel;
  • and 13.5 percent were on warfarin, but at a level that was not considered therapeutic at the time of their stroke.
"While some of these patients may have had reasons for not being anticoagulated, such as high bleeding or fall risk, more than two-thirds had no documented reason for receiving inadequate stroke prevention therapy," Xian said.
Xian added that in those rare cases where anticoagulation failed to prevent a stroke, patients who were taking the therapy showed a tendency to have less severe strokes, with less disability and death.
"These findings highlight the human costs of atrial fibrillation and the importance of appropriate anticoagulation, Xian said. "Broader adherence to these atrial fibrillation treatment guidelines could substantially reduce both the number and severity of strokes in the U.S. We estimate that between 58,000 to 88,000 strokes might be preventable per year if the treatment guidelines are followed appropriately."

More information: Journal of the American Medical Association, doi:10.1001/jama.2017.1371

Provided by Duke University Medical Center

Monday, March 13, 2017

Index predicts 10-, 14-year mortality in older adults

Index predicts 10-, 14-year mortality in older adults
13 mar 2017—An 11-factor index predicts 10- and 14-year mortality with excellent calibration and discrimination among community-dwelling U.S. adults aged ≥65 years, according to a study published online Feb. 21 in the Journal of the American Geriatrics Society.

Mara A. Schonberg, M.D., M.P.H., from Beth Israel Deaconess Medical Center in Boston, and colleagues examined the performance of an index in predicting 10- and 14-year mortality for community-dwelling adults aged ≥65 years from the 1997 to 2000 National Health Interview Surveys. Data were included for 16,063 and 8,027 respondents from the original development and validation cohorts. Risk scores were calculated based on the presence or absence of 11 factors that make up the index. Model calibration was examined by computing the 10- and 14-year mortality estimates with the Kaplan Meier method.
The researchers found that 14-year mortality was 23 percent for participants with risk scores of 0 to 4, compared with 89 percent for those with risk score of 13+. In both cohorts, the C-index was 0.73 and 0.72 for predicting 10- and 14-year mortality, respectively. Overall, 18.4 and 60.2 percent of those aged 65 to 74 years and ≥75 years had more than 50 percent risk of mortality in 10 years.
"Information on long-term prognosis is needed to help clinicians and older adults make more informed person-centered medical decisions and to help older adults plan for the future," the authors write.

More information: Abstract

Thursday, March 09, 2017

Virtual puppets developed by kinetic imaging professor help older adults feel more comfortable telling their stories

Virtual puppets developed by kinetic imaging professor help older adults feel more comfortable telling their stories
VoicingElder avatars mimic the motions of users. Credit: Virginia Commonwealth University
Semi Ryu had performed "Parting on Z"—her play about a farewell between lovers—a couple of times before that 2013 night in London. Ryu doesn't know what made this performance different, but something unexpected happened: She found herself sobbing in the middle of it.

09 mar 2017--"It was not acting," she said. "Something was touching me so deeply about it."
Ryu, an associate professor of kinetic imaging in the Virginia Commonwealth University School of the Arts, played both parts in the play about a man and woman ending their affair because of a difficult family disagreement. She physically played the female lover and spoke through an avatar, a virtual puppet, as the male lover.
"Sometimes I act as the female lover and then after that I activate a microphone on the avatar and then my voice becomes the male lover's voice," she said. "So we exchanged a dialogue of farewell and we drink together ... and then I took off my ring and placed it [in his hand to] keep it forever for your memory.
"It was extremely sad and I was really crying," she said. "I didn't expect to cry in front of this live audience and live performance setting and I [felt] so unprofessional. … I had to control myself but I couldn't control my emotions because there is something really overwhelming in this situation—[the] relationship between [the] virtual body and me."
She felt as if she was saying farewell to a part of herself, a symbolic farewell that made her think about how the self has different aspects.
Virtual puppets developed by kinetic imaging professor help older adults feel more comfortable telling their stories
VCUarts Associate Professor Semi Ryu, right, demonstrates how the on-screen avatar mimics the user’s motions. Credit: Virginia Commonwealth University
"There are multiple selves, but what is left out is maybe my social self," Ryu said. "Something defined by [society] as a role, as a woman … but I had to [say farewell to] my virtual body. … It was really about self-exploration and it made me cry."
She was embarrassed, but couldn't stop. The audience, equally moved, started crying as well. As the play ended, Ryu realized her primary emotion was no longer embarrassment, but rather relief. Speaking through the avatar had exposed suppressed feelings and given her emotional release.

'The puppet is speaking to me'

Having grown up in a Korean Confucian society, Ryu was discouraged from expressing emotion. Somehow this particular performance had revealed a lifetime of suppressed feelings. Ryu attributes those feelings of repression to han, the Korean cultural concept that encompasses feelings of oppression and grief with a strong hope and desire to overcome the impossible. Using the virtual puppet had allowed a different side of Ryu to emerge in the storytelling.
"I felt like something unresolved was resolved and then I felt this could also benefit … somebody else who has some kind of communication dilemma in society," Ryu said, realizing that han can be universal.
She immediately thought of the older adult population. As people get older, their image of themselves differs from how other people see them.
"They have ageless bodies happening in their mind but biologically it's degeneration and downgrading," she said. "There is an interesting tension happening, a kind of dilemma between what they want to be [and how they have been portrayed in the] media as powerless, hopeless and helpless individuals. Those images never fit [how] older adults perceive themselves. In this sense, they have han, and maybe we can … process a kind of ritual with older adults so they can start to release what they want to express."
Ryu was inspired by her brother, an occupational therapist who volunteered at area nursing homes and regularly talked about his amazing experiences working with older adults. She applied for the VCU Presidential Research Quest Fund in 2015 and started collaborating with Tracey Gendron, Ph.D., an associate professor in the VCU Department of Gerontology who also serves as the department's director of community engagement and research. Yet Ryu's motivation was always as an artist.
After years of using technology to explore the relationship between herself as the user and the virtual puppet, she became interested in what happens psychologically to users when they speak through the avatar.
"I was always curious about users' psyche…," Ryu said. "What kind of psychological relationship is possible between the user and avatar? That has been my primary research focus for a long time—more than 10 years. It seems to me it's such a different experience when I talk with or without 'puppet me.' [With the puppet], the puppet is speaking to me and so a different part of myself is emerging during the process of storytelling."

Developing VoicingElder

For years, Ryu has collaborated with Stefano Faralli of University of Manheim, Germany, to develop the interactive technology for her virtual puppetry. Together, they developed VoicingElder, an avatar system with four different development stages: childhood, teenage years, young adulthood and older adulthood, with four female and four male avatars. They implemented lip-sync technology so the avatars can speak in real time, giving the illusion that the puppet is the speaker. Users are then in the position of listening to their own stories even as they are telling them.
Virtual puppets developed by kinetic imaging professor help older adults feel more comfortable telling their stories
The VoicingElder program uses avatars from four different development stages: childhood, teenage, young adulthood and older adulthood. Credit: Virginia Commonwealth University
"It's an interesting psychology, looking at the puppet and the puppet is actually telling the story to them. They're going to get some distance from their story so they can easily talk about an emotional story … with more safe distance," Ryu said.
They also created a sentiment analysis algorithm, which detects emotional content from live speech and provides a virtual background to match. Happy stories have bright sunlight, while thunderstorms accompany angry stories. Other emotions detected are sadness, anxiety, fear and laugher.
"The VoicingElder project uses an artistic framework to combine technology and storytelling in an innovative way that actively engages older adult users in a virtual platform that provides the opportunity to share their life stories and experiences," said Gendron.
In March 2016, Ryu was ready to put the system to use. She worked with 10 residents of the Gayton Terrace Senior Living Center for three months, visiting every week or two. At the beginning, the seniors brought scripts with prepared stories, because they were self-conscious about speaking in front of each other. But around the fifth week, they began improvising and volunteering stories.
"It's wonderful because mainly your face is not there," said Connie Cole, 86. "It's a caricature there, so that takes the personal part away from it. … I think the fact that you're using the caricature and our voices and our stories blend beautifully for someone who's having dementia or some other elderly problem. … The fact the avatar's disconnected from me, it was easier for me to talk."
Vikki Fleming, resident program director at the center, said the project is a tool for residents to connect emotionally with important stories that are meaningful to them.
Virtual puppets developed by kinetic imaging professor help older adults feel more comfortable telling their stories
Connie Cole gestures as she tells a story through the VoicingElder system. Credit: Virginia Commonwealth University
"It's an interesting concept and it's fun to see residents experimenting with technology and getting to try new things because they want to continue to learn new things and this is one way of doing that," she said.
Ryu recorded the avatars at each session and at the end of the three months screened the film for residents, who all asked for a copy to share with their families.
"This can contribute to intergenerational relationships, so some story of the grandparents can be delivered to the grandsons … and it can work as a family legacy," she said.
Ryu is applying for a National Endowment for the Arts grant this spring and is pursuing National Institutes of Health grants as well. She has already presented the VoicingElder project at national and international conferences, including the National Center for Creative Aging in Washington, D.C., and Arts in Society as well as gerontology and drama therapy conferences and an upcoming Human-Computer Interaction International Conference. Many attendees have introduced the prototype system—which is very low-tech, requiring a simple setup: a computer with a decent processor, a connected camera and a wireless microphone—into their programs.
Ryu foresees extending the program to other populations and has begun collaboration with Tony Gentry, Ph.D., in the VCU Department of Occupational Therapy to apply the program to people with memory loss and PTSD.
"It's not just for older people but for [those who are] disabled, autistic [or have] communications difficulties," she said. "It can also be used to address diversity in society to increase awareness of racial, cultural and gender issues. It can help us be more empathetic to each other."

Provided by Virginia Commonwealth University

Monday, March 06, 2017

May smartphones help to maintain memory in patients with mild Alzheimer's disease?


The patient is a retired teacher who had reported memory difficulties 12 months prior to the study. These difficulties referred to trouble remembering names and groceries she wanted to purchase, as well as frequently losing her papers and keys. 

06 mar 2017--According to the patient and her husband, the main difficulties that she encountered were related to prospective memory (e.g., forgetting medical appointments or to take her medication).
To help her with her symptoms, Mohamad El Haj, a psychologist and assistant professor at the University of Lille, proposed Google Calendar, a time-management and scheduling calendar service developed by Google. The patient accepted as she was already comfortable using her smartphone. She also declared that she preferred the application as it offers more discrete assistance than a paper-based calendar.
With the patient and her husband, Dr. El Haj and his colleagues defined several prospective omissions in the patient, such as forgetting her weekly medical appointment, forgetting her weekly bridge game in the community club, and forgetting to go to weekly mass at the church. These omissions were targeted by sending automatic alerts, prompted by Google Calendar, at different times before each event (e.g., the medical appointment).
The researchers compared omissions before after the use of Google Calendar, they observed less omission after implementing the application.
The study is the first to suggest positive effects of smartphones applications on everyday life prospective memory in Alzheimer's disease. The findings, published in Journal of Alzheimer's disease, are encouraging, however, Dr. El Haj notes that this is a case study and therefore entails a few limitations, including generalizability of the results. The current, anecdotal findings require a larger study, not only to confirm or refute the findings reported here, but also to address challenges such as the long-term benefits of Google calendar.
Regardless of its potential limitations, Dr. El Haj notes that this study addresses memory loss, the main cognitive hallmark of Alzheimer's disease and the major concern of the patients and their families. By demonstrating positive effect of Google Calendar on prospective memory in this patient, Dr. El Haj hopes that his study paves the way for exploring the potential of smartphone-integrated memory aids in Alzheimer's disease. The future generation of patients may be particularly sensitive to the use of smartphones as a tool to alleviate their memory compromise.

More information: Mohamad El Haj et al. Google Calendar Enhances Prospective Memory in Alzheimer's Disease: A Case Report, Journal of Alzheimer's Disease (2017). DOI: 10.3233/JAD-161283

Provided by IOS Press

Sunday, March 05, 2017

Geriatricians can help aging patients navigate multiple ailments

For months, Teresa Christensen's 87-year-old mother, Genevieve, complained of pain from a nasty sore on her right foot. She stopped going to church. She couldn't sleep at night. Eventually, she stopped walking except when absolutely necessary.
Her primary care doctor prescribed three antibiotics, one after another. None worked.
"Doctor, can't we do some further tests?" Teresa Christensen remembered asking. "I felt that he was looking through my mother instead of looking at her."

05 mar 2017--Referred to a wound clinic, Genevieve was diagnosed with a venous ulcer, resulting from poor circulation in her legs. A few weeks ago, she had a successful procedure to correct the problem and returned home to the house where she's lived for more than 50 years in Cottage Grove, Minn., a suburb of St. Paul.
Would her mother benefit from seeing a geriatrician going forward, wondered Christensen, her mother's primary caregiver, in an email to me? And, if so, how would she go about finding one?
I reached out to several medical experts, and they agreed that a specialist in geriatrics could help a patient like Genevieve, with a history of breast cancer and heart failure, who'd had open heart surgery at age 84 and whose mobility was now compromised.
Geriatricians are "experts in complexity," said Dr. Eric Widera, director of the geriatrics medicine fellowship at the University of California, San Francisco.
No one better understands how multiple medical problems interact in older people and affect their quality of life than these specialists on aging. But their role in the health care system remains poorly understood and their expertise underused.
Interviews with geriatricians offer insights useful to older adults and their families:
Basic knowledge. Geriatricians are typically internists or family physicians who have spent an extra year becoming trained in the unique health care needs of older adults.
They're among the rarest of medical specialties. In 2016, there were 7,293 geriatricians in the U.S. - fewer than two years before, according to the American Geriatrics Society.
Geriatricians can serve as primary care doctors, mostly to people in their 70s, 80s and older who have multiple medical conditions. They also provide consultations and work in interdisciplinary medical teams caring for older patients.
Recognizing that training programs can't meet expected demand as the population ages, the specialty has launched programs to educate other physicians in the principles of geriatric medicine.
"We've been trying to get all clinicians trained in what we call the '101 level' of geriatrics," said Dr. Rosanne Leipzig, a professor of geriatrics at the Icahn School of Medicine at Mount Sinai in New York City.
Essential competencies. Researchers have spent considerable time over the past several years examining what, exactly, geriatricians do.
A 2014 article by Leipzig and multiple co-authors defined 12 essential competencies, including optimizing older adults' functioning and well-being; helping seniors and their families clarify their goals for care and shaping care plans accordingly; comprehensive medication management; extensive care coordination; and providing palliative and end-of-life care, among others skills.
Underlying these skills is an expert understanding how older adults' bodies, minds and lives differ from middle-age adults.
"We take a much broader history that looks at what our patients can and can't do, how they're getting along in their environment, how they see their future, their support systems, and their integration in the community," said Dr. Kathryn Eubank, medical director of the Acute Care for Elders unit at the San Francisco Veterans Affairs Medical Center. "And when a problem arises with a patient, we tend to ask 'How do we put this in the context of other concerns that might be contributing?'"
Geriatric syndromes. Another essential competency is a focus on issues that other primary care doctors often neglect - notably falls, incontinence, muscle weakness, frailty, fatigue, cognitive impairment and delirium. In medicine, these are known as "geriatric syndromes."
"If you're losing weight, you're falling, you can't climb a flight of stairs, you're tired all the time, you're unhappy and you're on 10 or more medications, go see a geriatrician," said Dr. John Morley, professor of geriatrics at Saint Louis University.
"Much of what we do is get rid of treatments prescribed by other physicians that aren't working," Morley continued.
Recently, he wrote of an 88-year-old patient with metastasized prostate cancer who was on 26 medications. The older man was troubled by profound fatigue, which dissipated after Morley took him off all but one medication. (Most of the drugs had minimal expected benefit for someone at the end of life.) The patient died peacefully eight months later.
Eubank tells of an 80-year-old combative and confused patient whom her team saw in the hospital after one of his legs had been amputated. Although physicians recognized the patient was delirious, they had prescribed medications that worsened that condition, given him insufficient pain relief and overlooked his constipation.
"Medications contributing to the patient's delirium were stopped. We made his room quieter so he was disturbed less and stopped staff from interrupting his sleep between 10 p.m. and 6 a.m.," Eubank said. "We worked to get him up out of bed, normalized his life as much as possible and made sure he got a pocket talker [hearing device] so he could hear what was going on."
Over the next four days, the patient improved every day and was successfully discharged to rehabilitation.
Finding help. A geriatric consultation typically involves two appointments: one to conduct a comprehensive assessment of your physical, psychological, cognitive and social functioning, and another to go over a proposed plan of care.
The American Geriatrics Society has a geriatrician-finder on its website - a useful resource. Also, you can check whether a nearby medical school or academic medical center has a department of geriatrics.
Many doctors claim competency in caring for older adults. Be concerned if they fail to go over your medications carefully, if they don't ask about geriatric syndromes or if they don't inquire about the goals you have for your care, advised Dr. Mindy Fain, chief of geriatrics and co-director of the Arizona Center on Aging at the University of Arizona.
Also, don't hesitate to ask pointed questions: Has this doctor had any additional training in geriatric care? Does she approach the care of older adults differently - if so, how? Are there certain medications she doesn't use?
"You'll be able to see in the physician's mannerisms and response if she takes you seriously," Leipzig said.
If not, keep looking for one who does.

©2017 Kaiser Health News
Distributed by Tribune Content Agency, LLC.

Thursday, March 02, 2017

Elderly people who choose the wrong shoes have a lower quality of life

Elderly people who choose the wrong shoes have a lower quality of life

As people get older, they experience changes in their foot morphology. If they do not change their shoe size along with these transformations, older people—most of whom choose the wrong shoes—suffer, among other things, anxiety, apathy, loss of balance and falls, according to a study by the University of A Coruña.

02 mar 2017--In 2015, a research team led by the University of A Coruña conducted a study of people with a mean age of 80 years. They analysed whether the changes to foot morphology that occur in elderly individuals, and their tolerance for pain, led to subjects wearing the wrong shoes. They concluded that the majority (83 percent) did not choose the correct size, and that they often should have been wearing a different size for each foot.
As Daniel López López, a scientist at the University of A Coruña who led this study, tells SINC: "In this stage of life, there are changes in foot morphology involving increased width and length, as well as changes in pain tolerance linked to age, and the loss of muscle mass and fatty tissue in the feet."
The study has for the first time analysed the consequences of this poor shoe choice on the health of elderly individuals. "Because of people's lifestyles at this age, they often use shoes that are harmful to their feet. This, combined with the appearance of chronic diseases such as obesity, vascular diseases, diabetes or rheumatoid arthritis, causes a worrying increase in foot problems in elderly people of between 71 percent and 87 percent. This means having to seek medical and podiatric attention more frequently, as it affects their functional capacity and quality of life," the scientist explains. The study is published in the Revista da Associação Médica Brasileira, the Brazilian Medical Association's journal.

Decreased independence and well-being

The participants in this research project were volunteers from the Podiatry University Clinic at the University of A Coruña with a mean age of 75 years.
Their results demonstrate that elderly people who use the wrong shoes have a lower quality of life in all areas related to pain, foot function, footwear, food health, general health, physical activity, social capacity and vitality.
The most common disorders are foot bone deformities, bunions, toenail malformations, plantar keratosis and flat feet. "This often leads to chronic pain, infections, limited mobility when walking, anxiety, apathy, social disturbances, changes to pressure distribution in feet related to loss of balance and falls, which as a result negatively impact upon health, independence and well-being," López informs us.
These individuals should use proper footwear, including wide-fit shoes with velcro or straps, rubber soles to prevent slipping and falling and those that reduce the impact on joints when walking.
"Additionally, regular visits and monitoring on the part of a podiatrist helps to prevent, control and reduce the appearance of foot diseases and deformities, increase autonomy and, in summary, improve people's quality of life," López concludes.

More information: Daniel López-López et al. Impact of shoe size in a sample of elderly individuals, Revista da Associação Médica Brasileira (2016). DOI: 10.1590/1806-9282.62.08.789

Provided by Plataforma SINC

Wednesday, March 01, 2017

Increased levels of active vitamin D can help to optimize muscle strength

vitamin D

Researchers at the University of Birmingham have shown that increasing the levels of active vitamin D can help to optimise muscle strength in humans.
The team hope that the findings will inform the design of future supplementation studies, and begin to answer questions as to the optimal levels of vitamin D required for healthy muscles.

28 feb 2017--The study, published in PLOS ONE, builds on previous knowledge showing levels of inactive vitamin D to be associated with a lack of muscle mass.
The research is the result of a cutting edge technique that allowed both active and inactive forms of vitamin D to be assessed alongside their impact on various muscle functions.
Dr Zaki Hassan-Smith, from the University of Birmingham, explained, "We have a good understanding of how vitamin D helps bone strength, but we still need to learn more about how it works for muscles. When you look at significant challenges facing healthcare providers across the world, such as obesity and an ageing population, you can see how optimising muscle function is of great interest."
"Previous studies have tested for the inactive forms of vitamin D in the bloodstream, to measure vitamin D deficiency. Here, we were able to develop a new method of assessing multiple forms of vitamin D, alongside extensive testing of body composition, muscle function and muscle gene expression."
116 healthy volunteers, aged between 20-74, were recruited to the trial. Participants had both active and inactive levels of vitamin D measured alongside physical characteristics including body fat and 'lean mass', a measure of muscle bulk.
Women with a healthy body composition, and lower body fat, were less likely to have high levels of inactive vitamin D, a marker of vitamin D deficiency. This was echoed by the finding that levels of inactive vitamin D were lower in women with increased body fat. This would suggest a relationship between vitamin D and body composition.
However, the active form of vitamin D was not associated with body fat, but was associated with lean mass.
Individuals with an increased lean mass, and muscle bulk, had a higher level of active vitamin D in the bloodstream.
Dr Hassan Smith added, "By looking at multiple forms in the same study, we can say that it is a more complex relationship that previously thought. It may be that body fat is linked to increased levels of inactive vitamin D, but lean mass is the key for elevated levels of active vitamin D. It is vital to understand the complete picture, and the causal mechanisms at work, so we can learn how to supplement vitamin D intake to enhance muscle strength."
In this study some of the positive associations between active vitamin D and muscle bulk were not seen in men.
Future studies with larger cohorts will help to identify if this is due to biological differences. The team will now work alongside international collaborators to further investigate the mechanisms at work through lab-based studies and clinical trials.

More information: PLOS ONEDOI: 10.1371/journal.pone.0170665

Provided by University of Birmingham