Prostate cancer—what you need to know

Men should discuss health history with their family and physician. Credit: University of Alabama at Birmingham

In 2016, more than 180,890 men will be diagnosed with prostate cancer, the second leading cause of cancer death in men. Next to skin cancers, prostate cancer is the most common cancer diagnosed in American men.

27 nov 2016--"Men's health and prostate cancer are topics that many tend to shy away from, but they need to be discussed more openly," said Soroush Rais-Bahrami, M.D., assistant professor at the University of Alabama at Birmingham in the Department of Urology and co-director for the UAB Program for Personalized Prostate Cancer Care. "One out of eight men will be diagnosed with prostate cancer in his life."
The prostate is a reproductive gland in men located between the bladder and the penis. The fluid from the prostate is discharged into the urethra at the time of ejaculation as part of the semen to nourish and stabilize sperm for reproductive purposes.

Prevention

Men ages 50 and older should be screened during their annual physical exam with a discussion regarding prostate cancer risk. A routine blood test can measure a biomarker called prostate-specific antigen or PSA, which can identify a man's risk of prostate cancer along with a digital rectal exam. Concern based on the PSA blood test level or digital rectal exam can prompt a biopsy of the prostate gland, which can be further evaluated to determine the presence of prostate cancer and, if found, the aggressiveness of the cancer.
"Many men do not know their family history of prostate cancer because men tend not to talk about their health concerns, even with children and other family members," Rais-Bahrami said. "It is important to discuss family history due to the significantly higher risk for men with a first-degree relative who has been diagnosed with prostate cancer."
Certain men may have a higher risk of prostate cancer based on family history or ethnicity, race, and ancestry, and should receive their first screening discussions at the age of 40.

Diagnosis

Symptoms of prostate cancer are rare, and many men show no symptoms before being diagnosed. Once a blood test shows signs of higher PSA levels, a tissue biopsy is required to help determine the grade and stage of the prostate cancer.
In advanced stages, symptoms may affect quality of life, ranging from pain in the bones to bloody urine, blood in the semen, blockage in the urinary tract and renal failure.
Once a man has been diagnosed with cancer, Rais-Bahrami recommends asking these questions to learn more about a path toward a cure:

• How will my personal health be affected?
• What grade or level of aggressiveness is my specific cancer?
• What stage or level of progression does my cancer have?
• Are there any additional staging studies that should be done for me?
• What are my treatment options?
• What are the side effects of each treatment option?

"When a patient has received a positive prostate cancer diagnosis, it is important he communicates with his family and his doctor about the different types of treatment and understands what will be faced through this journey of treatment," Rais-Bahrami said.

Treatment

The patient and physician should look at the options available to treat his prostate cancer and develop a personalized road map to manage symptoms and cure his cancer.
"Treatment is based on the patient's overall health and what works best in treating the patient to ultimately cure the cancer and help the patient preserve an excellent quality of life," Rais-Bahrami said.
In the earliest stages of low-grade prostate cancer, and with the consultation of a physician, men can opt for active surveillance, which is when the doctor does not prescribe immediate treatment, but watches the cancer cells closely to postpone treatment with curative intent, perhaps for years. Other treatment options include:

• Surgery, which includes removing the entire prostate gland and occasionally regional lymph node tissues
• Radiation therapy, or beams of radiation focused on the prostate
• Hormone therapy, which reduces levels of male hormones to stop them from affecting prostate cancer cells
• High-intensity, focused ultrasound therapy, or high-energy sound waves that destroy cancer cells
• Cryosurgery, or the use of extreme cold temperatures to freeze and kill cancer cells

"Prostate cancer is a treatable disease and can be cured if caught in early stages," Rais-Bahrami said. "This is why it is important to receive routine screenings and have early detection when present."
If the cancer is diagnosed in later stages and has spread to other parts of the body, it becomes more aggressive and more difficult to treat in most cases.
To help with personalized care of patients, UAB offers magnetic resonance imaging and ultrasound fusion-guided biopsy. The image fusion allows doctors to target a direct tissue sampling of an individual based on imaging areas of concern that can be tested for prostate cancer.

Current research

New research for prostate cancer is on the horizon, including the ongoing search for better biomarkers that indicate the presence of prostate cancer. Researchers are now searching for prostate cancer biomarkers that have specific implications for improved diagnosis and prediction of cancer aggressiveness and patient prognosis.
"With the serum PSA, a red flag is raised as a potential prostate cancer diagnosis; but it is not specific in diagnosing an individual's prostate cancer," Rais-Bahrami said. "Serum PSA can detect abnormalities with the prostate that are not exclusive to prostate cancer. Biomarker research is important to achieve a more individualized diagnosis."
At UAB, prostate cancer research is focused on advanced imaging and biomarker development, and hopes of defining the best way toward focal therapy of prostate cancer . UAB has become one of two beta sites in the United States to receive the iSR'obotTM Mona Lisa machine. This machine helps surgeons diagnose prostate cancer in earlier stages with imaging guidance and provides precise location mapping to help with targeting cancer cells for treatment.


Provided by University of Alabama at Birmingham

Current evidence does not support vitamin D supplements to prevent disease

Credit: CC0 Public Domain

Current evidence does not support the use of vitamin D supplements to prevent disease, conclude researchers in The BMJ today.

24 nov 2016--Associate Professor Mark Bolland and colleagues at the University of Auckland, New Zealand and the University of Aberdeen, Scotland say those at high risk of vitamin D deficiency should be advised about sunlight exposure and diet and offered low dose supplements, but the rest of us should focus on eating a healthy balanced diet with food containing vitamin D and getting regular short bursts of sunshine.
Vitamin D is made by the skin in response to sunlight. It helps to maintain calcium levels in the body to keep bones, teeth and muscles healthy. A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain and tenderness due a condition called osteomalacia in adults.
During spring and summer, most people get enough vitamin D from sunlight on their skin and their diet. But in autumn and winter, when exposure to sunshine is minimal, the only source is from a limited range of foods such as oily fish, egg yolk, red meat, liver, fortified breakfast cereals and fat spreads.
As such, Public Health England advises that everyone should consider a 10 microgram daily vitamin D supplement of during these months.
Based on a comprehensive search of published evidence, Associate Professor Bolland and colleagues make the case that existing clinical trials show that vitamin D supplementation does not improve musculoskeletal outcomes, such as falls or fractures.
They also say there is no high quality evidence to suggest that vitamin D supplementation is beneficial for other conditions such as heart disease, stroke, and some cancers—and ongoing trial results are unlikely to alter these conclusions.
If vitamin D supplementation does have benefits, they are most likely to be seen in severely deficient vitamin D populations, they write.
In light of the uncertainty, they suggest people at high risk should be counselled about sunlight exposure and diet, and low dose vitamin D supplements considered on an individual basis. "Otherwise we conclude that current evidence does not support the use of vitamin D supplementation to prevent disease."
In a debate article also published today, two experts discuss whether healthy people should take a vitamin D supplement during the winter months.
Dr Louis Levy, head of nutrition science at Public Health England, says advice to take a vitamin D supplement of 10 micrograms a day is backed by a Scientific Advisory Committee on Nutrition (SACN) review of the evidence on musculoskeletal health outcomes.
He says "Bolland and his colleagues conclude that serum 25-hydroxyvitamin D should not fall below 25 nmol/L, just like the Scientific Advisory Committee on Nutrition did earlier this year. To achieve this, PHE advice includes getting short bursts of summer sun and a balanced diet through summer and spring. But when the days are darker and shorter and sun exposure is minimal, people should consider a daily 10 microgram vitamin D supplement, as it's difficult to get enough through diet alone."
He argues that taking 10 micrograms of vitamin D daily to prevent musculoskeletal ill health "is unlikely to result in harmful levels of vitamin D" and says getting enough vitamin D is particularly important "because poor musculoskeletal health remains in the top 10 causes of disability adjusted life years."
But Tim Spector, Professor of genetic epidemiology at King's College London, questions whether this recommendation is evidence based. He points out that, despite hundreds of studies, "highly convincing evidence of a clear role of vitamin D does not exist for any outcome."
Although vitamin D treatment still has a role in people with proved deficiency or in high risk groups, "the rest of us should avoid being 'treated' for this pseudodisease, save scarce NHS resources, and focus on having a healthy lifestyle, sunshine, and a diversity of real food."

More information: Practice: Should adults take vitamin D supplements to prevent disease? www.bmj.com/cgi/doi/10.1136/bmj.6201
Head to Head: Should healthy people take a vitamin D supplement in winter months? www.bmj.com/cgi/doi/10.1136/bmj.i6183


Provided by British Medical Journal

AGS sets sights on better care, more responsive policies for 'unbefriended' older adults

The "unbefriended" lack the capacity to provide informed consent to medical treatment, often due to declines in physical and/or mental well-being. But these individuals face added challenges because they have no written outline of their care preferences and also have no identified "surrogate," such as a family member or friend, to assist in medical decision-making when needed. Baby boomers are at particular risk for becoming unbefriended, since more than 10 million boomers live alone and as many as 20 percent have no children.

23 nov 2016--Experts at the American Geriatrics Society (AGS) today unveiled new guidance on care and decision-making for a unique and growing group of older adults: the "unbefriended." Proposed clinical practice and public policy changes would support some of society's most vulnerable individuals while also helping protect more of us from becoming unbefriended as we age.
The "unbefriended" lack the capacity to provide informed consent to medical treatment, often due to declines in physical and/or mental well-being. But these individuals face added challenges because they have no written outline of their care preferences and also have no identified "surrogate," such as a family member or friend, to assist in medical decision-making when needed. Baby boomers are at particular risk for becoming unbefriended, since more than 10 million boomers live alone and as many as 20 percent have no children.
"Health professionals have a special responsibility for the unbefriended, but we also face particularly challenging situations when it comes to their medical decisions" notes Timothy W. Farrell, MD, AGSF, a member of the expert panel responsible for the position statement. Added AGS President Ellen Flaherty, PhD, APRN, AGSF: "The AGS has outlined proactive steps we can take to help those at risk of becoming unbefriended. And for older adults who are already facing this reality, our guidance can help create standards and systems of support in more places and for more people. It's not just about improving care; it's about making care more respectful and responsive."

Experts at the American Geriatrics Society (AGS) today unveiled new guidance on care and decision-making for a unique and growing group of older adults: the "unbefriended." Proposed clinical practice and public policy changes would support some of society's most vulnerable individuals while also helping protect more of us from becoming unbefriended as we age. Credit: (c) 2016, American Geriatrics Society

Across clinical practice, AGS experts have called for:

• Avoiding ad hoc approaches to decision-making to ensure fairness and respect;
• Identifying "non-traditional" surrogates—such as close friends, neighbors, or others who know a person well—wherever and whenever possible;
• Putting mechanisms in place to assess decision-making capacity in a systematic fashion;
• Standardizing approaches to caring for the unbefriended in urgent, life-threatening situations;
• Ensuring access to decision-making surrogates who are familiar not only with a person's medical condition but also with his or her needs, preferences, and expectations; and
• Remaining sensitive to all available information—including cultural factors—when considering an unbefriended person's best interests.

Experts at the American Geriatrics Society (AGS) today unveiled new guidance on care and decision-making for a unique and growing group of older adults: the "unbefriended." Proposed clinical practice and public policy changes would support some of society's most vulnerable individuals while also helping protect more of us from becoming unbefriended as we age. Credit: (c) 2016, American Geriatrics Society

At a systemic level, AGS experts also recommend:

• Bringing national stakeholders together to create model legal standards that could be adopted by all states;
• Working with clinicians, healthcare organizations, and other stakeholders to prevent older adults from becoming unbefriended; and
• Developing innovative, efficient, and accessible approaches to protect decision-making for the unbefriended.

As an update to earlier guidance released in 1996, the AGS Ethics Committee developed these new recommendations in collaboration with the AGS Clinical Practice and Models of Care Committee and the AGS Public Policy Committee. The final position statement was published online ahead of print in the Journal of the American Geriatrics Society, and is available for free from GeriatricsCareOnline.org.

More information: Timothy W. Farrell et al, AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults, Journal of the American Geriatrics Society (2016). DOI: 10.1111/jgs.14586


Provided by American Geriatrics Society

How important is the gut microbiome? It may depend on your genetics

Our gut microbiomes—the bacteria that live in our digestive tract—play major roles in our health. Scientists around the world are studying therapies that manipulate the microbiome, including probiotics (such as live bacterial cultures in yogurt), prebiotics (edible fibers meant to promote beneficial bacteria), antibiotics and transplants of microbes from healthy people.

22 nov 2016--Joslin Diabetes Center investigators now are shedding light on how the success of such microbiome treatments may be affected by genetics of the individual or animal being treated.
In work published online today by the Journal of Clinical Investigation, a team of Joslin researchers reported on experiments among three genetically different strains of mice (two closely related and one more distant). They discovered that giving the mice antibiotics produced very different effects on their gut microbiomes, as well as on their insulin sensitivity, tissue inflammation and related metabolic functions such as blood glucose, depending on the genetic background of the mouse.
"The potential implication of our research is that genetic background will make a big difference in response to changing the gut microbiome, not just in mice, but also in humans where such treatments are being used for gastrointestinal and metabolic diseases," says C. Ronald Kahn, Joslin's chief academic officer and professor of medicine at Harvard Medical School.
"Our research suggests that some people are more genetically susceptible to the impact of the microbiome than others, and treatments that change the microbiome will make a big difference in some but not in others," says Kahn, who is senior author on the paper. "So understanding these genetic factors could play an important role in predicting the future usefulness of microbiome therapies for obesity and metabolic disease."
Among the three strains of mice that were studied, one strain is prone to diabetes and obesity, a second is prone to obesity but not diabetes, and a third is not prone to either condition. The mice were placed on high-fat diets, which raise the chances of developing the two conditions. Next, they were given one of two types of antibiotics commonly used in medicine, one that is absorbed into the bloodstream and one that is not, each of which had a different effect on the microbiome.
The researchers discovered that in the mice prone both to obesity and diabetes, treatment with either antibiotic not only changed the gut microbiomes but improved metabolism for the mice—lowering blood glucose, reducing tissue inflammation and increasing insulin signaling. But in the other two types of mice, changes in the microbiome did not bring these positive changes in metabolism.
Many of the metabolic changes in the mice prone both to obesity and diabetes could be duplicated by transferring gut microbes from mice treated with antibiotics to mice lacking normal gut microbes. That finding supports the hypothesis that the antibiotic effects on the microbiome, rather than other biological mechanisms, drive the metabolic changes, Kahn says.
Starting to probe the variations in metabolism between mice, the researchers found that one big factor was how the mice responded to changes in bile acid metabolism. Bile acids are molecules secreted by the liver into the gut, where they aid in the absorption of fats, Kahn explains. Additionally, bacteria in the gut chemically modify bile acids into forms that are reabsorbed into the bloodstream and help to respond to inflammation.
The impact of antibiotics on bile acid metabolism varied across the three strains of mice, which partly explains why the different strains displayed different responses in tissue inflammation, insulin signaling and other metabolic functions. "So we showed, using these animal models, a link between the changing microbiome and changing inflammation, which contributes to insulin resistance," Kahn says.
The Joslin researchers are following up with more detailed study of how bile acids and other metabolites (small molecules) are involved in control of metabolism.
"Bile acids are just the tip of the iceberg," Kahn says. "In on-going research, we've identified hundreds of human metabolites that change a lot in response to both diet and antibiotics. We're trying to track down exactly what these metabolites are, how they might influence insulin sensitivity, and which will be important regulators of blood glucose or weight gain, the two factors we really want to improve in patients at risk for type 2 diabetes."
The team also will look at how these modified metabolites might affect clinical behaviors ranging from eating behaviors to depression and anxiety, he says.
When these mechanisms are better understood, researchers will be better able to predict which patients will respond best to microbiome treatments, Kahn says. "If we can identify those people who are most likely to benefit from changing the microbiome, we might find a big effect among them," he suggests.

More information: Shiho Fujisaka et al. Antibiotic effects on gut microbiota and metabolism are host dependent, Journal of Clinical Investigation (2016). DOI: 10.1172/JCI86674


Provided by Joslin Diabetes Center

Probiotics improve cognition in Alzheimer's patients

For the first time, scientists have shown that probiotics—beneficial live bacteria and yeasts taken as dietary supplements—can improve cognitive function in humans. In a new clinical trial, scientists show that a daily dose of probiotic Lactobacillus and Bifidobacterium bacteria taken over a period of just 12 weeks is enough to yield a moderate but significant improvement in the score of elderly Alzheimer's patients on the Mini-Mental State Examination (MMSE) scale, a standard measure of cognitive impairment.

16 nov 2016--Probiotics are known to give partial protection against certain infectious diarrheas, irritable bowel syndrome, inflammatory bowel disease, eczema, allergies, colds, tooth decay, and periodontal disease. But scientists have long hypothesized that probiotics might also boost cognition, as there is continuous two-way communication between the intestinal microflora, the gastrointestinal tract, and the brain through the nervous system, the immune system, and hormones (along the so-called "microbiota-gut-brain axis"). In mice, probiotics have indeed been shown to improve learning and memory, and reduce anxiety and depression- and OCD-like symptoms. But prior to the present study there was very limited evidence of any cognitive benefits in humans.
Here, the researchers, from Kashan University of Medical Sciences, Kashan, and Islamic Azad University, Tehran, Iran, present results from a randomized, double-blind, controlled clinical trial on a total of 52 women and men with Alzheimer's between 60 and 95 years of age. Half of the patients daily received 200 ml milk enriched with four probiotic bacteria Lactobacillus acidophilus, L. casei, L. fermentum, and Bifidobacterium bifidum (approximately 400 billion bacteria per species), while the other half received untreated milk.
At the beginning and the end of the 12-week experimental period, the scientists took blood samples for biochemical analyses and tested the cognitive function of the subjects with the MMSE questionnaire, which includes tasks like giving the current date, counting backwards from 100 by sevens, naming objects, repeating a phrase, and copying a picture.
Over the course of the study, the average score on the MMSE questionnaire significantly increased (from 8.7 to 10.6, out of a maximum of 30) in the group receiving probiotics, but not in the control group (from 8.5 to 8.0). Even though this increase is moderate, and all patients remained severely cognitively impaired, these results are important because they are the first to show that probiotics can improve human cognition. Future research, on more patients and over longer time-scales, is necessary to test if the beneficial effects of probiotics become stronger after longer treatment.
"In a previous study, we showed that probiotic treatment improves the impaired spatial learning and memory in diabetic rats, but this is the first time that probiotic supplementation has been shown to benefit cognition in cognitively impaired humans," says Professor Mahmoud Salami from Kashan University, the senior author of the study.
Treatment with probiotics also resulted in lower levels of triglycerides, Very Low Density Lipoprotein (VLDL), high-sensitivity C-Reactive Protein (hs-CRP) in the blood of the Alzheimer patients, and likewise a reduction in two common measures (called "Homeostatic Model Assessment", HOMA-IR and HOMA-B) of insulin resistance and the activity of the insulin-producing cells in the pancreas.
"These findings indicate that change in the metabolic adjustments might be a mechanism by which probiotics affect Alzheimer's and possibly other neurological disorders," says Salami. "We plan to look at these mechanisms in greater detail in our next study."
Walter Lukiw, Professor of Neurology, Neuroscience and Ophthalmology and Bollinger Professor of Alzheimer's disease at Louisiana State University, who reviewed the study but was not involved in the research, said: "This early study is interesting and important because it provides evidence for gastrointestinal (GI) tract microbiome components playing a role in neurological function, and indicates that probiotics can in principle improve human cognition. This is in line with some of our recent studies which indicate that the GI tract microbiome in Alzheimer's is significantly altered in composition when compared to age-matched controls, and that both the GI tract and blood-brain barriersbecome significantly more leaky with aging, thus allowing GI tract microbial exudates (e.g. amyloids, lipopolysaccharides, endotoxins and small non-coding RNAs) to access Central Nervous System compartments."
The study is published in the open-access journal Frontiers in Aging Neuroscience.

More information: Effect of probiotic supplementation on cognitive function and metabolic status in Alzheimer's disease: a randomized, double-blind, and controlled trial , Frontiers in Aging Neuroscience, DOI: 10.3389/fnagi.2016.00256


Provided by Frontiers

France expects 13 times as many centenarians by 2070

France, which already has the most centenarians of any European country, could be home to 13 times more people over the age of 100 by 2070, the national statistics agency Insee said Thursday.
In January 2016, there were around 21,000 centenarians living in France, almost 20 times more than in 1970, it said.

14 nov 2016--If current life-expectancy trends continue, this could rise to 270,000 by 2070.
Insee said France currently had the most centenarians of any country in Europe, ahead of Spain and Italy, partly because it has one of the largest populations but also because life expectancy among women is particularly high.
By 2070, almost one centenarian in three was expected to be a man, up from a ratio of one in six currently, the study said.
France was also home to the oldest verified person ever—Jeanne Louise Calment, who died in 1997 aged 122 years and 164 days.

Physical training and social support reduce frailty and malnutrition

Physical training and social support reduce frailty and malnutrition. Credit: Medical University of Vienna

A training program for the reactivation of older and frail people established by MedUni Vienna has achieved remarkable success. It was revealed that physical training and addressing nutrition-relevant aspects with the aid of non-professional volunteers at home has had positive effects on the physical condition. Particularly the "social aspect" is of great significance.


12 NOV 2016--According to studies, 11% of the over 65's in Austria are frail and 41% are pre-frail. Frailty is a geriatric symptom consisting of a combination of sarcopenia (reduced muscle mass and/or muscle power), malnutrition (undernourishment or overeating) and chronic inflammation and is associated with enormous health problems for the affected persons. Preventative programs, consisting of a combination of social support, nutrition and exercise intervention can prevent malnutrition and frailty and reduce isolation and loneliness, particularly in case of people who live alone and hardly ever leave the apartment.
Non-professional volunteers working in an honorary capacity "activate" frail people
MedUni Vienna (Institute for Social Medicine), together with the Vienna Hilfswerk (relief organisation) and Sportunion Austria, initiated the project "Healthy for life". The project was promoted by the Vienna Science and Technology Fund. Volunteers working in an honorary capacity (so-called "buddies") visited frail or malnourished people (average age 83 years) in their homes twice a week for a period of twelve weeks. The skilled buddies trained together with the frail people (strength training with a Thera ribbon) and discussed nutrition-related aspects. An active control group also received visits, but without nutrition and exercise intervention.
After twelve weeks, a significant improvement in the frailty status and malnutrition risk was recorded. The prevalence of impaired nutritional status in the training and nutrition group was reduced by 25%, frailty by 17%. It was remarkable that the control group, who only received social support, also recorded improvements (23% less impaired nutritional status and 16% less frailty).
An active social life is important for physical wellbeing at an advanced age
"The results show that healthy nutrition and physical activity particularly at an advanced age have a special significance for the promotion of health and wellbeing and maintaining autonomy", explains first author Eva Luger of the Institute for Social Medicine of MedUni Vienna; "one essential prerequisite for healthy nutrition and physical activity is social support, particularly in case of older people".
"An active social life and social contacts are important factors to remain autonomous for as long as possible", emphasises study leader Thomas E. Dorner from the Institute for Social Medicine. "It also became evident that trained non-professional volunteers achieve similarly good results with such a program as those conducted by health professionals."
As many frail people live alone and hardly ever leave their apartment, nutrition and exercise programs based on social support are a good solution for the prevention and reduction of frailty.

More information: Eva Luger et al. Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial, Journal of the American Medical Directors Association (2016). DOI: 10.1016/j.jamda.2016.04.018


Provided by Medical University of Vienna

Sarcopenia, which affects up to 20 percent of European seniors, may increase 63 percent by 2045

Researchers from the University of Liège, Belgium presented a study that reveals the enormous and growing burden of sarcopenia in Europe.

11 nov 2016--Sarcopenia is a disease associated with the ageing process. Hallmark signs of the disorder are loss of muscle mass and strength, which in turn affects balance, gait and overall ability to perform tasks of daily living.
Due to its complexity, there is as yet no global consensus on the definition of the disease for diagnostic purposes. The European Working Group on Sarcopenia in Older People (EWGSOP) has defined sarcopenia as low muscle mass with low muscle strength OR with low gait speed. With two cutoff points available for each of the three components of this definition, eight different methods of diagnosis of sarcopenia can be used.
Using the Eurostat online database, the researchers retrieved age and gender-specific population projections from 2016-2045 for 28 European countries. The age and gender-specific prevalence of sarcopenia was assessed from a study that precisely compared prevalence estimates according to the different diagnostic cutoffs of the EWGSOP proposed definition.
The prevalence estimates were interpolated for adults above 65 years of age. The estimates of sarcopenia prevalence were then applied to population projections until 2045. The results showed that:

• Using the definition providing the lowest prevalence estimates, the number of individuals with sarcopenia in Europe in 2016 is 10,869,527. This will rise to 18,735,173 in 2045 (a 72.4% increase). The overall prevalence of sarcopenia in the elderly will rise from 11.1% in 2016 to 12.9% in 2045. Women currently account for 44.2% of prevalent cases.
• Using the definition providing the highest prevalence estimates, the number of individuals with sarcopenia in Europe is 19,740,527 in 2016, rising to 32,338,990 in 2045 (a 63.8% increase). The overall prevalence of sarcopenia in the elderly will rise from 20.2% in 2016 to 22.3% in 2045. Women currently account for 66.4% of prevalent cases.

Presenting author Dr. Olivier Ethgen stated, "Regardless of which diagnostic cutoff is used to define sarcopenia, the prevalence of this condition is expected to rise substantially in Europe. It is therefore essential that we implement effective prevention and disease management strategies. Health authorities must take action in order to limit the impact on increasingly strained healthcare systems and to help Europeans enjoy healthy, active ageing."

More information: OC24 The Future Prevalence of Sarcopenia in Europe, O. Ethgen, C. Tchokonte, C. Beaudart1, F. Buckinx, J.-Y. Reginster, O. Bruyère
Abstract book: WCO-IOF-ESCEO World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, 14 -17 April 2016, Malaga, Spain Osteoporosis International, Volume 27/ Suppl 1/ 2016


Provided by International Osteoporosis Foundation

Is a marker of preclinical Alzheimer's disease associated with loneliness?

Diagram of the brain of a person with Alzheimer's Disease. 

A new article published online by JAMA Psychiatry used data from a study of 79 cognitively normal adults to examine whether cortical amyloid levels in the brain, a marker of preclinical Alzheimer disease, was associated with self-reported loneliness.

07 nov 2016--Alzheimer disease (AD) is a process that moves through preclinical, mild cognitive impairment and dementia stages before it leads to progressive neuropsychiatric, cognitive and functional declines. Loneliness has been associated with cognitive and functional decline and an increased risk of AD dementia.
Nancy J. Donovan, M.D., of Brigham and Women's Hospital and Harvard Medical School, Boston, and coauthors used imaging as a measure of cortical amyloid levels in the brain and a loneliness scale to indicate levels of loneliness. The study included 43 women and 36 men with an average age of about 76.
Of the participants, 22 (28 percent) were carriers of the genetic risk factor apolipoprotein E ?4 (APOE?4) and 25 (32 percent) were in the amyloid-positive group based on volume in imaging. The participants' average loneliness score was 5.3 on a scale of 3 to 12.
The authors report higher cortical amyloid levels were associated with greater loneliness after controlling for age, sex, APOE?4, socioeconomic status, depression, anxiety and social network. Participants in the amyloid-positive group were 7.5 times more likely to be classified as lonely then nonlonely compared with individuals in the amyloid-negative group. The association between high amyloid levels and loneliness also was stronger in APOE?4 carriers than in noncarriers, according to the results.
Limitations of the study include the demographic profile of the participants who had high intelligence and educational attainment but limited racial and socioeconomic diversity. The participants also had better mental and physical health.
"We report a novel association of loneliness and cortical amyloid burden in cognitively normal adults and present evidence for loneliness as a neuropsychiatric symptom relevant to preclinical AD. This work will inform new research into the neurobiology of loneliness and other socioemotional changes in late life and may enhance early detection and intervention research in AD," the study concludes.

More information: JAMA Psychiatry. Published online November 2, 2016. doi:10.1001/ jamapsychiatry.2016.2657


Provided by The JAMA Network Journals

ASCO updates guidelines on integration of palliative care

The American Society of Clinical Oncology Clinical Practice Guideline on the integration of palliative care into standard oncology care has been updated. The update was published online Oct. 28 in the Journal of Clinical Oncology.

06 nov 2016--Betty R. Ferrell, Ph.D., from City of Hope Medical Center in Duarte, Calif., and colleagues updated the 2012 American Society of Clinical Oncology provisional clinical opinion on the integration of palliative care into standard oncology care. An expert panel was convened to develop an update; members of the panel conducted an updated systematic review of randomized clinical trials, systematic reviews, and meta-analyses, as well as secondary analyses of randomized controlled trials in the 2012 provisional clinical opinion.
The authors note that early in the course of disease, inpatients and outpatients with advanced cancer should receive palliative care services concurrent with active treatment. Ideally, patients should be referred to interdisciplinary palliative care teams, and services may complement existing programs. Family and friend caregivers of patients with early or advanced cancer may be referred to palliative care services.
"To enhance and strengthen the evidence base on palliative care, the dissemination of research results, and the quality and equity of palliative care, more research is needed," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.

More information: Full Text

One in four seniors doesn't discuss end-of-life care

02 nov 2016—More than one-quarter of American seniors have never discussed end-of-life care, a new study finds.
"Despite decades of work to improve advance care planning, over a quarter of older adults have still not engaged in any type of discussion or planning for their end-of-life preferences or plans," said lead author Krista Harrison, a geriatrics research fellow at the University of California, San Francisco.
The researchers looked at more than 2,100 Medicare beneficiaries aged 65 and older. Data from the group included self-reported age, gender, race/ethnicity, education, income, self-rated health, number of chronic conditions, disability in activities of daily living, and dementia.
The researchers found that 60 percent of the beneficiaries said they'd had discussions on end-of-life care, 50 percent on power of attorney, and 52 percent on other advanced directives.
Thirty-eight percent reported discussions on all three elements of advanced care planning, while 27 percent said they hadn't discussed any of the elements.
The rate of discussions on each element varied by as much as 35 percent, depending on patient characteristics. For two or more elements, the rate was lower among those aged 65 to 74, blacks and Hispanics, and those with less education and lower income.
The lowest rate of end-of-life planning was among older Spanish-speaking Hispanics, with 19 percent reporting end-of-life discussion, 20 percent discussing power of attorney and 17 percent discussing advanced directives.
The study also found that older adults with dementia had much lower rates of end-of-life discussions (54 percent) and advance directives (46 percent) than those without dementia (62 percent and 54 percent, respectively).
"Our findings suggest that there are substantial portions of the population of community-dwelling older adults who need to begin discussions about their plans and preferences before they are unable to share those preferences with their loved ones," Harrison said in a university news release.
The study was published Oct. 31 in the journal JAMA Internal Medicine.

More information: The U.S. National Institute on Aging has more about advanced care planning.