A quarter of nursing home residents are colonized with drug-resistant bacteria

The significant presence of multidrug-resistant gram-negative bacteria (MDR-GNB), such as E. coli, among nursing home residents demonstrates the need for heightened infection control prevention and control measures in nursing homes, according to a meta-analysis published in the May issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

30 april 2017--The systematic literature review and meta-analysis, conducted by Sainfer Aliyu, MPhil, MSEd, MHPM, BSN, RN, and others at the Columbia University School of Nursing, found the prevalence of MDR-GNB colonization among sampled nursing home residents ranged from 11.2 percent to 59.1 percent, with a pooled average of 27 percent. Researchers also found that nine of the 12 studies involved identi?ed speci?c factors that are associated with increased MDR-GNB colonization risk, including advanced age, gender, comorbid chronic diseases, history of recurrent hospitalization, increased interaction with healthcare workers, frequent antimicrobial exposure, delayed initiation of effective antibiotic therapy, presence of medical devices, decreased functional status, advanced dementia, nonambulatory status, fecal incontinence, severe sepsis present on admission, and residency in a long-term care facility.
The study is thought to be the first systematic review and meta-analysis of its kind, and should raise concerns among infection control professionals and nursing home facilities.
"This study underscores the importance of having strong infection prevention programs in all nursing homes and long-term care facilities," said 2017 APIC President Linda Greene, RN, MPS, CIC, FAPIC. "Understanding the dynamics and cause of MDR-GNB transmission is crucial to identifying effective infection control strategies speci?c to these settings."
Nursing home residents are especially vulnerable to infections due to multiple comorbidities, advanced age, and immune dysfunction. In addition, living in a nursing home is itself considered a risk factor, as frequent transfers from nursing homes to acute care contribute to the in?ux of pathogens into hospital settings. Prevention and management of MDR-GNB in nursing homes are complicated and require extensive infection control resources due to challenges common to this setting such as understaffing, fewer resources, insufficient training, and inadequate surveillance.
"Identifying which patients are most prone to an increased risk of MDR-GNB will enable infection preventionists to tailor efforts and stem future contaminations," wrote Aliyu, et al. "The results of our study suggest that there is much more to be done with regard to infection prevention within nursing homes, and that increased measures must be taken with elderly patients in regard to MDR-GNB colonization."
According to the Centers for Disease Control and Prevention, the percentage of gram-negative bacteria that are resistant to drugs is increasing. MDR-GNB cause serious infections in healthcare settings including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. They are particularly worrisome because they are becoming resistant to nearly all drugs that would be considered for treatment, with fewer novel antibacterial agents being developed.

More information: Sainfer Aliyu et al, Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents: A systematic review and meta-analysis, American Journal of Infection Control (2017). DOI: 10.1016/j.ajic.2017.01.022


Provided by Elsevier

Study finds new genetic variants associated with extreme old age

The search for the genetic determinants of extreme longevity has been challenging, with the prevalence of centenarians (people older than 100) just one per 5,000 population in developed nations.

29 april 2017--But a recently published study by Boston University School of Public Health and School of Medicine researchers, which combines four studies of extreme longevity, has identified new rare variants in chromosomes 4 and 7 associated with extreme survival and with reduced risks for cardiovascular and Alzheimer's disease.
The results, published in the Journals of Gerontology: Biological Sciences, highlight the importance of studying "truly rare survival, to discover combinations of common and rare variants associated with extreme longevity and longer health span," the authors said.
The research group, led by Paola Sebastiani, professor of biostatistics the BU School of Public Health (BUSPH), created a consortium of four studies—the New England Centenarian Study, the Long Life Family Study, the Southern Italian Centenarian Study, and the Longevity Gene Project - to build a large sample of 2,070 people who survived to the oldest one percentile of survival for the 1900 birth year cohort. The researchers conducted various analyses to discover longevity-associated variants (LAVs), and to characterize those LAVs that differentiated survival to extreme age.
Their analysis identified new "extreme longevity-promoting variants" on chromosomes 4 and 7, while also confirming variants (SNPs, or single nucleotide polymorphisms) previously associated with longevity.
In addition, in two of the datasets where researchers had age-of-onset data for age-related diseases, they found that certain longevity alleles also were significantly associated with reduced risks for cardiovascular disease and hypertension.
"The data and survival analysis provide support for the hypothesis that the genetic makeup of extreme longevity is based on a combination of common and rare variants, with common variants that create the background to survive to relatively common old ages (e.g. into the 80s and 90s), and specific combinations of uncommon and rare variants that add an additional survival advantage to even older ages," the authors wrote.
They said, however, that while the "yield of discovery" in the study was more substantial than in prior genome-wide association studies (GWAS) of extreme longevity, it remained disappointing, in that the two most significant genotypes discovered "are carried by a very small proportion of the cases included in the analysis," meaning that much of the genetic variability around extreme lifespan remains unexplained.
"We expect that many more uncommon genetic variants remain to be discovered through sequencing of centenarian samples," they wrote. "Larger sample sizes are needed to detect association of rare variants... and therefore promising associations that miss the threshold for genome-wide significance are important to discuss."


Provided by Boston University Medical Center

Antidepressant may enhance drug delivery to the brain

Normally, P-glycoprotein prevents most medicines from entering the brain by pumping them back into the blood stream (left). The addition of amitriptyline temporarily turns off P-glycoprotein pumps, allowing drug molecules to cross the blood-brain barrier (right). 

28 april 2017--NIH rat study suggests amitriptyline temporarily inhibits the blood-brain barrier, allowing drugs to enter the brain.
New research from the National Institutes of Health found that pairing the antidepressant amitriptyline with drugs designed to treat central nervous system diseases, enhances drug delivery to the brain by inhibiting the blood-brain barrier in rats. The blood-brain barrier serves as a natural, protective boundary, preventing most drugs from entering the brain. The research, performed in rats, appeared online April 27 in the Journal of Cerebral Blood Flow and Metabolism.
Although researchers caution that more studies are needed to determine whether people will benefit from the discovery, the new finding has the potential to revolutionize treatment for a whole host of brain-centered conditions, including epilepsy, stroke, human amyotrophic lateral sclerosis (ALS), depression, and others. The results are so promising that a provisional patent application has been filed for methods of co-administration of amitriptyline with central nervous system drugs.
According to Ronald Cannon, Ph.D., staff scientist at NIH's National Institute of Environmental Health Sciences (NIEHS), the biggest obstacle to efficiently delivering drugs to the brain is a protein pump called P-glycoprotein. Located along the inner lining of brain blood vessels, P-glycoprotein directs toxins and pharmaceuticals back into the body's circulation before they pass into the brain.
To get an idea of how P-glycoprotein works, Cannon said to think of the protein as a hotel doorman, standing in front of a revolving door at a lobby entrance. A person who is not authorized to enter would get turned away, being ushered back around the revolving door and out into the street.
"For example, as good as vegetables are for us to eat, they have molecules that could be toxic if they slipped into the brain," Cannon said. "They don't get in, because of P-glycoprotein, but this same protector also keeps out helpful therapeutics."
Cannon and his NIEHS colleagues initially found that amitriptyline significantly reduced P-glycoprotein's pump activity in brain capillaries from wild-type rats. Later, they saw amitriptyline had the same effect in brain capillaries from genetically modified rats designed to mimic human ALS. In both rat models, amitriptyline turned off P-glycoprotein within 10-15 minutes. When amitriptyline was removed, P-glycoprotein pump activity returned to full-strength.
NIEHS postbaccalaureate fellow David Banks is lead author on the paper and described amitriptyline's action on P-glycoprotein as rapid and reversible. It's these advantages that make the therapy so appealing.
"Most inventions developed at the bench don't make it to the clinic, but I'm hopeful that our findings will translate into better treatment options for doctors and their patients," Banks said.
Cannon anticipates that administering amitriptyline along with a lower dose of an opioid could relieve pain and reduce the negative side effects, such as constipation and addiction, usually seen with higher doses of prescribed opioids.
"As our nation faces increases in Alzheimer's disease, autism, and opioid abuse, we're hopeful that this discovery will help address these serious health challenges," said NIEHS Director Linda Birnbaum, Ph.D.

More information: David B Banks et al, Lysophosphatidic acid and amitriptyline signal through LPA1R to reduce P-glycoprotein transport at the blood–brain barrier, Journal of Cerebral Blood Flow & Metabolism (2017). DOI: 10.1177/0271678X17705786


Provided by National Institutes of Health

Many patients with Alzheimer's disease discontinue AChEIs

Discontinuation of acetylcholinesterase inhibitors (AChEIs) for treatment of Alzheimer's disease is common, with adverse effects and cost cited as major factors, according to a study published recently in the Journal of the American Geriatrics Society.

27 april 2017--Noll L. Campbell, Pharm.D., from the Purdue University School of Pharmacy in West Lafayette, Ind., and colleagues randomized 196 older adults with a diagnosis of possible or probable Alzheimer's disease who were initiating treatment with an AChEI to one of three AChEIs (1:1:1) for 18 weeks.
In the intent to treat analysis, the researchers found that discontinuation rates at the end of 18 weeks were 38.8 percent for donepezil, 53.0 percent for galantamine, and 58.7 percent for rivastigmine (P = 0.063). Adverse events explained 73.1 percent of discontinuation, while cost explained 25.4 percent. More than 81 percent of participants reported adverse events, but rates were similar between groups.
"This pragmatic comparative trial showed high rates of adverse events and cost-related nonadherence with AChEIs," the authors write.

More information: Abstract
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Suicide and genetics: a complicated association

From Mayo Clinic News Network 

24 april 2017--Dear Mayo Clinic: Why does it seem that suicide tends to run in families? Does it have anything to do with genetics?

A: The association between genetics and suicide is complicated. Research has shown that there is a genetic component to suicide. But it is only one of many factors that may raise an individual's risk. And even if someone is at high risk for suicide, that doesn't predict whether or not an individual will actually act on suicidal thoughts.
Genetic research, including studies involving twins, has revealed that many psychiatric conditions, including having suicidal tendencies, are influenced by genetics. While studies demonstrate that specific genes, such as one called the BDNF Met allele, can increase risk for suicide, it's more likely that a range of genes affect connections and pathways within the brain, and impact suicide risk.
Complicating matters further, a process called epigenetics also comes into play when considering the effect of genes on suicide. This process controls when certain genes are turned on or off as a person grows and develops, and it can be influenced by what happens in a person's environment.
For example, if someone goes through a difficult event as a child, that experience could have an impact on how or when a gene is activated within that person's brain. Researchers speculate that negative experiences influencing epigenetics in a person who has a family history of suicide could further compound that person's suicide risk.
In addition, it is known that 90 percent of people who die by suicide have a psychiatric illness at the time of death. Mood disorders, psychotic disorders, certain personality disorders and substance use disorders can increase suicide risk substantially. Each of those disorders has a genetic component, too.
It's important to understand, however, that an increased risk of suicide does not predict who will commit suicide. For some people - even those whose genetics may seem to predispose them to a higher suicide risk - the thought of suicide doesn't enter their minds. For others, suicide quickly may become a focus of their thoughts.
For those whose thoughts do turn to suicide, the way they arrive at suicidal thoughts may be a well-imprinted and familiar pathway. Psychotherapeutic treatment can help examine the process they go through to get to that point and find ways to interrupt the process.
Genetics, family history and environment all matter when it comes to the risk of suicide. But knowing risk factors is not a substitute for a thorough assessment of an individual's situation and the process he or she takes to arrive at suicidal thoughts.
If you or a loved one are concerned about your risk for suicide, or if you've had suicidal thoughts, talk to a mental health professional. To help you find ways to break the cycle that leads to suicidal thoughts, he or she can work with you to treat any psychiatric illness that may be present and help you understand the process you're going through when you turn to the possibility of suicide.
If you are in a suicide crisis or emotional distress, the National Suicide Prevention Lifeline provides free, confidential emotional support 24/7 at 1-800-273-8255 (toll-free).

Study finds obesity as top cause of preventable life-years lost

A team of researchers from Cleveland Clinic and New York University School of Medicine have found that obesity resulted in as much as 47 percent more life-years lost than tobacco, and tobacco caused similar life-years lost as high blood pressure.

22 april 2017--Preliminary work presented by Cleveland Clinic today at the 2017 Society of General Internal Medicine Annual Meeting analyzed the contribution of modifiable behavioral risk factors to causes-of-death in the U.S. population, using 2014 data.
Based on this preliminary work, the team found the greatest number of preventable life-years lost were due to (in order from greatest to least) obesity, diabetes, tobacco use, high blood pressure and high cholesterol. However, researchers also noted that some individuals may have needs that are very different than those of the broader U.S. population. For an obese and alcoholic patient, for example, alcohol use may be more important to address than obesity, even though obesity has a greater impact on the population.
Results highlight the clinical and public health achievement of smoking cessation efforts because 15 years ago, tobacco would have topped the list.
"Modifiable behavioral risk factors pose a substantial mortality burden in the U.S.," said Glen Taksler, Ph.D., internal medicine researcher from Cleveland Clinic and lead author of the study. "These preliminary results continue to highlight the importance of weight loss, diabetes management and healthy eating in the U.S. population."
A key takeaway is that three (diabetes, hypertension and high cholesterol) of the top five causes of death can be treated, so helping patients understand treatment options and approaches can have a powerful impact on life-years. The results also highlight the importance of preventive care in clinical practice and why it should be a priority for physicians.
To estimate the number of life-years lost to each modifiable risk factor, researchers examined the change in mortality for a series of hypothetical U.S. populations that each eliminated a single risk factor. They compared the results with the change in life-years lost for an "optimal" population that eliminated all modifiable risk factors. Recognizing that some less common factors might place substantial burden on small population subgroups, they also estimated life expectancy gained in individuals with each modifiable risk factor.
"The reality is, while we may know the proximate cause of a patient's death, for example, breast cancer or heart attack, we don't always know the contributing factor(s), such as tobacco use, obesity, alcohol and family history. For each major cause of death, we identified a root cause to understand whether there was a way a person could have lived longer."
Dr. Taksler and colleagues are continuing to conduct research in this area, and analyze and refine results.

More information: Research was presented at The Society of General Internal Medicine 2017 Annual Meeting, "Resilience and Grit: Pursuing Organizational Change & Preventing Burnout in GIM" April 19-22, 2017 in Washington, DC at the Washington Hilton Hotel (1919 Connecticut Avenue, NW Washington, DC 20009).


Provided by Cleveland Clinic

Review finds no benefit to aspirin for preserving cognitive function

An analysis of published studies found no evidence that low- dose aspirin buffers against cognitive decline or dementia or improves cognitive test scores.

21 april 2017--The review and meta-analysis included eight studies with 36,196 participants who were an average of 65 years old and did not have cognitive impairment at baseline. Participants were followed for an average of six years.
"Additional studies are needed to test the possibility that low-dose aspirin has beneficial effects when taken over a longer period and at an earlier age," said Dr. Nicola Veronese, lead author of the Journal of the American Geriatrics Society study.

More information: Nicola Veronese et al, Low-Dose Aspirin Use and Cognitive Function in Older Age: A Systematic Review and Meta-analysis, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.14883

Telestroke guidelines from American Telemedicine Association in Telemedicine and e-Health

Credit: Mary Ann Liebert, Inc., publishers

New guidelines to help clinicians use the latest telemedicine communication technologies to provide remote care for patients with symptoms of acute stroke are published in Telemedicine and e-Health.
Bart Demaerschalk, MD, Mayo Clinic College of Medicine, Phoenix, AZ, and a team of authors contributed to the article entitled "American Telemedicine Association: Telestroke Guidelines."

19 aril 2017-- The guidelines describe the network of audio-visual communication technologies and computer systems available to link an expert stroke team with a stroke physician at a distant site and the clinicians caring for a remote stroke patient, and to deliver telestroke clinical services.
Rapid diagnosis and treatment with a clot-disrupting drug in appropriate patients following ischemic stroke can improve outcomes. The timing of treatment delivery is a critical factor in ischemic stroke.
The coauthors of the new Telestroke Guidelines are from Mayo Clinic College of Medicine (Phoenix), Ascension Health and Columbia College of Nursing (Milwaukee, WI), Medical College of Georgia at Georgia Health Sciences University (Augusta), Yale School of Medicine (New Haven, CT), University of Cincinnati (OH), Massachusetts General Hospital (Boston, MA), University of Pittsburgh (PA), and InTouch Health (Santa Barbara, CA).
"The authors are to be commended for this outstanding work. These guidelines will be of great value to clinicians and the patients they treat," says Charles R. Doarn, MBA, Co-Editor-in-Chief of the Journal and Research Professor of Family and Community Medicine, University of Cincinnati, Ohio.

More information: Bart M. Demaerschalk et al, American Telemedicine Association: Telestroke Guidelines, Telemedicine and e-Health (2017). DOI: 10.1089/tmj.2017.0006


Provided by Mary Ann Liebert, Inc

Major bleeding risk from drugs similar in elderly

The risk of major bleeding is similar for older patients with atrial fibrillation taking either antiplatelet or anticoagulant drugs, according to a review published online April 10 in the Journal of Thrombosis and Haemostasis

18 april 2017--Marc Melkonian, M.D., from the Hôpitaux Universitaires Pitie-Salpêtrière-Charles Foix in France, and colleagues conducted a systematic review and meta-analysis to evaluate major bleeding in randomized and non-randomized controlled trials (RCTs) and parallel cohorts comparing antiplatelet drugs and oral anticoagulants in patients 65 years or older.
Based on seven RCTs (4,550 patients) and four cohort studies (38,649 patients), the researchers found that the risk of major bleeding on aspirin or clopidogrel was equal to that on warfarin in RCTs (relative risk [RR], 1.01; 95 percent confidence interval [CI], 0.69 to 1.48; moderate-quality evidence), lower than on warfarin in non-randomized cohort studies (RR, 0.87; 95 percent CI, 0.77 to 0.99; low-quality evidence), and not different when all studies were combined (RR, 0.86; 95 percent CI, 0.73 to 1.01). Any severity of bleeding (RR, 0.70; 95 percent CI, 0.57 to 0.86) and intracranial bleeding (RR 0.46; 95 percent CI, 0.30 to 0.73) were less frequent on antiplatelet drugs than on warfarin. Major bleeding might be higher with warfarin than aspirin in patients over 80 years old, according to subgroup analysis.
"Elderly patients treated with aspirin or clopidogrel suffer less any-severity bleeding but have a risk of major bleeding similar to that of oral anticoagulants, with the exception of intracranial bleeding," the authors write.

More information: Abstract

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Common sedatives linked to increased risk of pneumonia in people with Alzheimer's disease

Commonly used sedatives called benzodiazepines are associated with an increased risk of pneumonia when used in people with Alzheimer disease, according to a study published in CMAJ (Canadian Medical Association Journal).

17 april 2017--"An increased risk of pneumonia is an important finding to consider in treatment of patients with Alzheimer disease," writes Dr. Heidi Taipale, Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland, with coauthors. "Benzodiazepines and Z-drugs are frequently prescribed for this population, and long-term use is typical. Pneumonia often leads to admission to hospital, and patients with dementia are at increased risk of death related to pneumonia."
Dementia, of which 60%-70% of cases are Alzheimer disease, is a risk factor for pneumonia, and many people with dementia are prescribed benzodiazepines and non- benzodiazepines (called Z-drugs), both of which have sedative effects.
To determine if there is a link between these drugs and pneumonia, Finnish researchers looked at data from national registries on 49 484 adults living in the community diagnosed with Alzheimer disease between 2005 and 2011 in Finland. The mean age of participants was 80 years and almost two-thirds (62.7%) were women. They matched 5232 patients taking benzodiazepines and 3269 patients taking Z-drugs with the remainder not taking either drug.
They found that benzodiazepines were linked to a 30% increased risk of pneumonia in patients with Alzheimer disease, and the risk was highest at the start of treatment (during the first 30 days).
Although the association with Z-drug use and pneumonia was not statistically significant, the authors did not conclude these drugs were safer as the study did not directly compare Z-drugs and benzodiazepines.
The authors suggest that the sedative nature of benzodiazepines may increase the risk of pneumonia by increasing the aspiration of saliva or food into the lungs.
The results are consistent with studies that have found an increased risk of pneumonia in patients of all ages taking benzodiazepines.
"Benefits and risks of the use of benzodiazepines should be carefully considered for patients with Alzheimer disease and include risk of pneumonia," the authors conclude.
In a related commentary, Dr. Paula Rochon from Women's College Hospital and the University of Toronto, with coauthors, writes this study "is a good reminder to clinicians to 'first do no harm' when prescribing these drugs for frail older women and men with dementia. Nonpharmacologic approaches should be the starting point when managing neuropsychiatric symptoms in this patient population, which should help to limit inappropriate use of these drugs."


Provided by Canadian Medical Association Journal

Occupational therapy ups functioning in frail seniors

For physically frail older adults, occupational therapy is associated with improved functioning, according to a review published online April 3 in the Journal of the American Geriatrics Society.

16 april 2017--Leen De Coninck, from the KU Leuven in Belgium, and colleagues conducted a systematic review and meta-analysis to examine the effectiveness of occupational therapy for improving performance in daily living activities among community-dwelling physically frail older people. Data were included from nine studies that met the inclusion criteria.
The researchers found that the studies were of reasonable quality with low risk of bias. Significant increases were seen in all primary outcome measures: mobility, functioning in daily living activities, and social participation. The pooled result was a standardized mean difference of −0.30 for functioning in daily living activities, −0.44 for social participation, and −0.45 for mobility. Positive trends were seen for all secondary outcome measures, with a significant correlation for fear of falling. There were no adverse effects for occupational therapy.
"There is strong evidence that occupational therapy improves functioning in community-dwelling physically frail older people," the authors write.

More information: Abstract

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Italian Emma Morano, last known survivor of 19th century, dies at 117

Emma Morano, then 16, is seen in Verbania, North Italy, on May 14, 2016

Emma Morano, an Italian woman believed to have been the oldest person alive and the last survivor of the 19th century, died Saturday at the age of 117, Italian media reported.
Morano, born on November 29 1899, died at her home in Verbania, in northern Italy, the reports said.
"She had an extraordinary life, and we will always remember her strength to move forward in life," the mayor of Verbania was quoted as saying.

16 april 2017--According to the US-based Gerontology Research Group (GRG), Morano ceded the crown of the world's oldest human being to Jamaican Violet Brown, who was born on March 10, 1900.
Morano's death means there is no one living known to have been born before 1900.
Her first love died in World War I, but she married later and left her violent husband just before the Second World War and shortly after the death in infancy of her only son.
She had clung to her independence, only taking on a full-time carer a couple of years ago, though she had not left her small two-room apartment for 20 years.
She had been bed-bound during her latter years.
In an interview with AFP last year, she put her longevity down to her diet.
"I eat two eggs a day, and that's it. And cookies. But I do not eat much because I have no teeth," she said in her home at the time, where the Guinness World Records certificate declaring her to be the oldest person alive held pride of place on a marble-topped chest of drawers.
Her dietary regime has intrigued the medical and scientific worlds.
The eldest of eight children, Morano outlived all of her younger siblings.

Married LGBT older adults are healthier, happier than singles, study finds

Same-sex marriage has been the law of the land for nearly two years—and in some states for even longer—but researchers can already detect positive health outcomes among couples who have tied the knot, a University of Washington study finds.

14 april 2017--For years, studies have linked marriage with happiness among heterosexual couples. But a study from the UW School of Social Work is among the first to explore the potential benefits of marriage among LGBT couples. It is part of a national, groundbreaking longitudinal study with a representative sample of LGBT older adults, known as "Aging with Pride: National Health, Aging, Sexuality/Gender Study," which focuses on how historical, environmental, psychological, behavioral, social and biological factors are associated with health, aging and quality of life.
UW researchers found that LGBT study participants who were married reported better physical and mental health, more social support and greater financial resources than those who were single. The findings were published in a February special supplement of The Gerontologist.
"In the nearly 50 years since Stonewall, same-sex marriage went from being a pipe dream to a legal quagmire to reality—and it may be one of the most profound changes to social policy in recent history," said lead author Jayn Goldsen, research study supervisor in the UW School of Social Work.
Some 2.7 million adults ages 50 and older identify as lesbian, gay, bisexual or transgender—a number that is expected to nearly double by 2060.
Among LGBT people, marriage increased noticeably after a 2015 U.S. Supreme Court ruling legalized same-sex marriage nationwide. A 2016 Gallup Poll found that 49 percent of cohabiting gay couples were married, up from 38 percent before the ruling.
For the UW study, more than 1,800 LGBT people, ages 50 and older, were surveyed in 2014 in locations where gay marriage was already legal (32 states and Washington, D.C.). About one-fourth were married, another fourth were in a committed relationship, and half were single. Married respondents had spent an average of 23 years together, while those in a committed, unmarried relationship had spent an average of 16 years.
Among the study participants, more women were married than men, and of the respondents who were married, most identified as non-Hispanic white.
Researchers found that, in general, participants in a relationship, whether married or in a long-term partnership, showed better health outcomes than those who were single. But those who were married fared even better, both socially and financially, than couples in unmarried, long-term partnerships.
Single LGBT adults were more likely to have a disability; to report lower physical, psychological, social and environmental quality of life; and to have experienced the death of a partner, especially among men.
The legalization of gay marriage at the federal level opens up access to many benefits, such as tax exemptions and Social Security survivor benefits that married, straight couples have long enjoyed. But that does not mean every LGBT couple was immediately ready to take that step.
According to Goldsen, marriage, for many older LGBT people, can be something of a conundrum—even a non-starter. LGBT seniors came of age at a time when laws and social exclusion kept many in the closet. Today's unmarried couples may have made their own legal arrangements and feel that they don't need the extra step of marriage—or they don't want to participate in a traditionally heterosexual institution.
Goldsen also pointed to trends in heterosexual marriage: Fewer people are getting married, and those who do, do so later.
"More older people are living together and thinking outside the box. This was already happening within the LGBT community—couples were living together, but civil marriage wasn't part of the story," she said.
The different attitudes among older LGBT people toward marriage is something service providers, whether doctors, attorneys or tax professionals, should be aware of, Goldsen said. Telling a couple they should get married now simply because they can misses the individual nature of the choice.
"Service providers need to understand the historical context of this population," she said. "Marriage isn't for everyone. It is up to each person, and there are legal, financial and potentially societal ramifications." For example, among the women in the study, those who were married were more likely to report experiencing bias in the larger community.
At the same time, Goldsen said, single LGBT older adults do not benefit from the marriage ruling, and other safeguards, such as anti-discrimination laws in employment, housing and public accommodations, are still lacking at the federal level.
Over time, Goldsen and colleagues will continue to examine the influence of same-sex marriage policy on partnership status and health.

More information: Jayn Goldsen et al, Who Says I Do: The Changing Context of Marriage and Health and Quality of Life for LGBT Older Adults, The Gerontologist (2017). DOI: 10.1093/geront/gnw174


Provided by University of Washington

Weak grip a strong predictor of metabolic disease and disability in adults

A simple test to determine a person's grip strength may be a predictor of developing metabolic disorders in middle or older age, a new cross-continental study has found. 

A simple test to determine a person's grip strength may be a predictor of developing metabolic disorders in middle or older age, a new cross-continental study has found.
The test locations, demographics and methodology all were selected for a reason.

13 april 2017--"Prevalence of chronic disease is highest in the U.S. and China," says Mark Peterson, Ph.D., M.S., FACSM, assistant professor of physical medicine and rehabilitation at Michigan Medicine and a member of the U-M Global Research, Education and Collaboration in Health and Institute for Healthcare Policy and Innovation. "There's a dire need to identify midlife predictors of disability and diabetes in both populations."
Peterson is the lead author on a new study, published in Journals of Gerontology Series A: Medical Sciences, that investigated if normalized grip strength—which is defined as a person's grip strength divided by their body mass—could serve as a biomarker for both cardiometabolic disease and physical disability in American and Chinese adults.
He teamed up with colleagues from the U-M School of Public Health, Michigan Medicine's Global REACH, the Institute for Social Science Survey and the National School of Development at Peking University in Beijing, China.
One reason for the study's geographic focus: "China represents a unique population," Peterson says. "It's the world's largest population of diabetics, which imposes a huge health and economic burden on their entire country."
He adds, "In 2015, China and the U.S. had a combined $320 billion in diabetes-related health care costs, according to the International Diabetes Federation. The aging populations in both countries are growing because of improved medical care of older adults and longer life expectancy. While on one hand that's great, on the other, it represents two populations that have increasing prevalence estimates of diabetes, cardiovascular health issues and functional impairments. The longer people live with those health issues, the greater the burden is to society."

Analyzing data sets

The research team used data on middle-aged and older adults from the U.S. National Health and Nutrition Examination Survey from 2011 to 2012 and 2013 to 2014, and the 2011 portion of the China Health and Retirement Longitudinal Study. These surveys were selected because they included measures of muscle strength capacity and the necessary information pertaining to disability and cardiometabolic diseases.
"We wanted to examine grip strength in particular because it is highly associated with overall body strength," Peterson says. "To asses someone's grip strength using a handgrip dynamometer takes less than 10 seconds, which makes it extremely attractive to adopt in a clinical or community setting at the population level."
The research team analyzed normalized grip strength for 4,544 U.S. and 6,030 Chinese study participants 50 years of age and older. The study group also had blood samples taken for nonfasting glycated hemoglobin and answered a questionnaire about impairments of functional limitation related to mobility. A subsample of 2,225 adults had fasting measures for glucose, insulin and triglycerides.
Using weighted logistic regression models, the team assessed the association between normalized grip strength and diabetes, hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension and physical disability. They controlled for age, sex and numerous socio-demographic characteristics.

A strong connection

Perhaps the largest finding of the study was that low normalized grip strength was greatly associated with both cardiometabolic diseases and physical disabilities in middle-age to older adults, both men and women, and in both the U.S. and Chinese populations.
For every 0.05 decrement in normalized grip strength in U.S. and Chinese adults, respectively, there were:

• 49 percent and 17 percent increased odds for diabetes
• 46 percent and 11 percent increased odds of hyperglycemia
• 15 percent and 11 percent increased odds of hypertriglyceridemia
• 22 percent and 15 percent increased odds of low HDL cholesterol
• 19 percent and 10 percent increased odds of hypertension
• 36 percent and 11 percent increased odds for disability status

Other highlights from the research team included:

• Prevalence of physical disabilities was higher among older adults (65 years old and older) compared to middle-aged adults (50 years old to 64.9 years old) in both populations.
• In U.S. adults, physical disability status, obesity and abdominal obesity were more prevalent, and diabetes prevalence was higher with increasing age in U.S. men.
• In Chinese adults, diabetes prevalence was higher for women than men in both middle-aged and older adults.
• Diabetes was more prevalent in U.S. than Chinese men in both age categories, but more prevalent in Chinese women than U.S. women.
• Normalized grip strength was higher in Chinese men and women than U.S. men and women in both age categories.

Peterson would like to see these research results translated to the clinical setting.
"We hope these findings illustrate how important a simple grip strength test could be in the clinical setting," Peterson says. "It's an easy way to screen and identify people who are at early risk for these health issues."

More information: Journals of Gerontology Series A: Medical Sciences, DOI: 10.1093/gerona/glx031


Provided by University of Michigan

AGA releases best practice advice on long-term PPI use

When proton pump inhibitors (PPIs) are appropriately prescribed, their benefits are likely to outweigh their risks, according to an American Gastroenterological Association (AGA) Clinical Practice Update1 published in Gastroenterology, the official journal of AGA. Additionally, there is currently insufficient evidence to recommend specific strategies for mitigating PPI adverse effects.

12 april 2017--The long-term use of PPIs by patients for gastroesophageal reflux disease (GERD), Barrett's esophagus and non-steroidal anti-inflammatory drug (NSAID) bleeding prophylaxis doubled in the U.S. from 1999 to 2012. Studies have shown that the number of adverse events doubled during the same period. AGA provides best practice advice for the use of PPIs based on expert opinion and relevant publications:
1. Patients with GERD and acid-related complications should take a PPI for short-term healing, maintenance of healing and long-term symptom control.
2. Patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to stop or reduce them. Patients who cannot reduce PPIs should consider ambulatory esophageal pH/impedance monitoring before committing to lifelong PPIs to help distinguish GERD from a functional syndrome.
3. Patients with Barrett's esophagus and symptomatic GERD should take a long-term PPI.
4. Asymptomatic patients with Barrett's esophagus should consider a long-term PPI.
5. Patients at high risk for ulcer-related bleeding from NSAIDs should take a PPI, if they continue to take NSAIDs.
6. The dose of long-term PPIs should be periodically reevaluated so that the lowest effective PPI dose can be prescribed to manage the condition.
7. Long-term PPI users should not routinely use probiotics to prevent infection.
8. Long-term PPI users should not routinely raise their intake of calcium, vitamin B12 or magnesium beyond the recommended dietary allowance.
9. Long-term PPI users should not routinely screen or monitor bone mineral density, serum creatinine, magnesium or vitamin B12.
10. Specific PPI formulations should not be selected based on potential risks.

How to Discuss with Patients

It is necessary for health-care professionals to talk with their patients to ensure high-quality patient care. To help patients understand the importance of using PPIs as directed, AGA has developed talking points for health-care professionals to use to help facilitate discussions about the need to correctly use PPIs for condition and symptom management. Learn more at http://www.gastro.org/patient-care/conditions-diseases/gerd/#Talking to Patients.

1 Freedberg DE, Kim LS, Yang YX, The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association, Gastroenterology (2016), DOI: 10.1053/j.gastro.2017.01.031.

http://www.gastrojournal.org/article/S0016-5085(17)30091-4/fulltext


Provided by American Gastroenterological Association

Mechanism of aging recovery for progeria patients revealed

'Y-27632' drug inhibits the phosphorylation level of ROCK and increases the oxidative phosphorylation efficiency of mitochondria. 

DGIST's research team has identified a mechanism that can recover the aging of patients with Hutchinson-Gilford Progeria Syndrome (HGPS). DGIST announced that the Chair Professor Park SangChul of New Biology (Head of Well-Aging Research Center) and the research team led by Professor Lee YoungSam has discovered a drug that can improve the aging of HGPS patients and identified the mechanism of aging recovery by using the drug.

05 april 2017--HGPS represents one of premature aging syndromes. The patients with HGPS experience growth retardation as well as age-associated symptoms such as skin wrinkles, hair loss, visual impairment, and cardiovascular diseases. Their average life expectancy is 13 years as they age 10 times faster than others. When it comes to aging control, improvement of biological function and solutions for aging of HGPS patients have been big challenges in academia.
This study needs to be highlighted as the research team has identified the molecular causal relationship between ROCK protein activation and mitochondrial dysfunction in the progression of cell senescence for the first time in the world.
DGIST's research team noted that the level of reactive oxygen species increases when mitochondrial function diminishes during the progression fibroblasts of the HGPS patients. By performing high-throughput screening system, the team found 'Y-27632' as an effective agent to control reactive oxygen species and discovered that this drug is effective in improving mitochondrial function.
Mitochondria are intracellular organelles that play a key role in energy and metabolism in cells. It is known that mitochondrial dysfunction causes aging of cells as it increases level of active oxygen and decreases energy production efficiency.
The research team found that 'Y-27632' drug inhibits the phosphorylation level of ROCK and increases the oxidative phosphorylation efficiency of mitochondria. The study also confirms that the drug recovers mitochondrial function and induces the recovery of aging cells by reducing nuclear membrane degeneration and genetic damage that are characteristics of HGPS patient cells.
The Chair Professor Park SangChul stated "This study is significant as we have newly discovered the means to control aging. We have also identified the mechanism to recover the function of aging cell through inhibition and recovery of mitochondrial dysfunction due to aging." He added "We will continue to carry out studies that will extend the healthy lifespan of humans through the verification of the mechanism in aging animal models as well as progeny animal models."

More information: Hyun Tae Kang et al, Chemical screening identifies ROCK as a target for recovering mitochondrial function in Hutchinson-Gilford progeria syndrome, Aging Cell (2017). DOI: 10.1111/acel.12584


Provided by Daegu Gyeongbuk Institute of Science and Technology

Cow's milk interferes with absorption of thyroid supplement levothyroxine

Taking the common oral thyroid hormone medication levothyroxine with a glass of cow's milk significantly decreases the body's ability to absorb the drug, a preliminary study finds. Results will be presented Sunday at ENDO 2017, the Endocrine Society's 99th annual meeting in Orlando, Fla.

02 april 2017--"These findings support previous research showing that calcium supplements can interfere with levothyroxine absorption," said principal investigator Deborah Chon, M.D., an endocrinology fellow at the UCLA David Geffen School of Medicine and the VA (Veterans Affairs) Greater Los Angeles Healthcare System, Los Angeles, Calif. "Decreased absorption means that patients may not get the full dose of thyroid hormone that they are prescribed."
Although it makes sense that milk, which contains calcium, might interfere with levothyroxine absorption, no study has proved that it does until now, according to Chon.
Levothyroxine is prescribed for patients with an underactive thyroid, called hypothyroidism, to replace the natural thyroid hormone thyroxine (T4) that is too low, or for patients with thyroid cancer, to suppress their thyroid stimulating hormone levels. In 2014, levothyroxine was the most commonly prescribed medication in the U.S., a survey from the IMS Institute for Healthcare Informatics (now QuintilesIMS) found.
Chon and fellow investigators studied 10 adults (six men and four women), with an average age of 33.7 years, who had no known thyroid disease and had normal thyroid hormone function at the start of the study. No one was allergic to cow's milk or levothyroxine, and none of the women were pregnant or using birth control pills.
Participants fasted overnight before each of two study visits, spaced a month apart. At one visit, participants took 1,000 micrograms of oral levothyroxine alone and at the other visit, they took the same dose concurrently with 12 ounces of 2 percent milk. Before dosing and one, two, four and six hours after ingestion of levothyroxine, participants gave blood samples for measurement of their total T4 levels. Chon said they tested with generic levothyroxine, which most of their patients are taking.
The investigators measured the levothyroxine absorption as the concentration of total T4 in the blood plotted on a graphic curve against time after drug administration, called area under the curve. Over the six hours after the participants took levothyroxine, those who consumed milk at the same time as the medicine had significantly lower total T4 absorption than when they took the drug alone: average area under the curve of 67.3 versus 73.5.
The manufacturer of a brand of levothyroxine recommends that the medication be taken preferably on an empty stomach, 30 to 60 minutes before eating food or taking other medications or vitamins.
"The main message of this study is that patients managed with thyroid hormone replacement therapy should be advised to avoid taking levothyroxine simultaneously with cow's milk, given its interference," Chon said.


Provided by The Endocrine Society

Brain changes in older adults increase risk for scams

Older adults who have been scammed by friends, relatives or strangers seem to behave just like elders who have avoided rip-offs. They are able to balance their checkbooks. They can remember and evaluate information. Their personalities are normal, and their arithmetic is fine.
But their brains are different.

01 april 2017--For the first time, researchers have found a biological basis for financial exploitation in the elderly. The team is led by a Cornell scientist with collaborators at York University in Toronto.
The exploited older people in their study had more atrophy and less connectivity in two key areas of the brain. One region signals a person when something significant is happening around them, and the other tells them how to read social cues, like other people's intentions. The team published their work March 28 in the Journals of Gerontology.
Together, these age-related changes in the brain may make older adults more vulnerable to financial exploitation – especially when one considers that family members are the most common perpetrators of financial abuse, said the study's lead author, Nathan Spreng, assistant professor of human development and a Rebecca Q. and James C. Morgan Sesquicentennial Faculty Fellow.
"It's not their fault they've been abused. It's not because they made a bad decision. There are biological reasons why these abuses have occurred, and we're trying to get a handle on that," said Spreng, who directs Cornell's Laboratory of Brain and Cognition.
"Older adults are having a harder time navigating these tough social situations. We need to start treating this as a medical problem and not a societal one," he added.
Previous studies have shown that family members are the most common financial abusers. In the study, a grandson continued to steal from a study participant even after she confronted him. A daughter charged $2,000 to a study participant's account without permission. In another instance, a son's girlfriend borrowed $4,000 and never paid it back.
Nearly one in 20 older adults can expect to be financially exploited beyond age 60, an incidence rate that is higher than many age-related diseases like cardiovascular disease, cancer and arthritis.
But this area is not very well studied, Spreng said, because many older adults are unaware or unwilling to report exploitation, embarrassed to reveal they have been scammed or want to protect their privacy. "It's hard to get scientific traction," Spreng said.
He and his colleagues tested 26 older adults, half of whom had been robbed by family members or neighbors or scammed online or by phone. The other half had been exposed to a rip-off scheme but had recognized and avoided it.
The researchers did extensive behavioral tests on both groups to see if they behaved differently. Using 45 assessments, they measured the study participants' memory, ability to pay attention to information and evaluate it, inhibitory control, aspects of personality and financial reasoning.
The only difference in behavior between the two groups was exploited elders reported feeling more anger and hostility.
But more significant differences showed up in the brain images.
The exploited elders had atrophy in the anterior insula and fewer connections from it to a broader brain network. The anterior insula signals when something salient is happening in the environment. In general, this area isn't as responsive in older adults compared with the young, particularly in negative situations, Spreng said.
"If older adults are, say, gambling, they get the same excitement that they might win something as younger adults do, but they don't have the same feeling of dread or disappointment for the losses. So, they're not as sensitive to losing money," he said.
This region was particularly atrophied in the study's exploited group, suggesting that the brain wasn't signaling they were facing a risky situation.
The exploited elders also had more atrophy and fewer neural connections in the medial prefrontal cortex, which helps us appraise social situations, like inferring the thoughts or intentions of others.
Surprisingly, the networks of the anterior insula and the medial prefrontal cortex were more connected to each other. This suggests that poor sensitivity to financial risk combined with reduced detection of untrustworthiness may leave older adults vulnerable to scams.
More, larger studies are needed to validate the neural mechanism, but this study could be a first step in identifying a way to predict who might be vulnerable to financial exploitation, Spreng said.
The time is right, Spreng said, because the current generation of elders is the wealthiest ever.
"There's a huge amount of money locked up in our elders' assets," he said. "And people are actively pursuing them."

More information: R. Nathan Spreng et al. Financial Exploitation Is Associated With Structural and Functional Brain Differences in Healthy Older Adults, The Journals of Gerontology: Series A (2017). DOI: 10.1093/gerona/glx051


Provided by Cornell University