Trips to the toilet at night are a sign of high blood pressure

by European Society of Cardiology

Credit: CC0 Public Domain

Trips to the toilet at night are a sign of high blood pressure, according to results from the Watari study presented today at the 83rd Annual Scientific Meeting of the Japanese Circulation Society (JCS 2019).

31 mar 2019--"Our study indicates that if you need to urinate in the night—called nocturia—you may have elevated blood pressure and/or excess fluid in your body," said study author Dr. Satoshi Konno, of the Division of Hypertension, Tohoku Rosai Hospital, Sendai, Japan. "If you continue to have nocturia, ask your doctor to check your bloodpressure and salt intake."

JCS 2019 takes place from 29 to 31 March in Yokohama. Joint scientific sessions are being held by the European Society of Cardiology (ESC) and JCS as part of the ESC Global Activities programme.

Previous research from Japan has reported that high salt intake is associated with nocturia. Compared to western countries, people in Japan eat more salt and are more likely to be "salt sensitive", meaning that their blood pressure rises more when salt is consumed. Taken together, these two factors mean that people in Japan are at greater risk of developing high blood pressure.

This study examined the link between nocturia and hypertension in the general Japanese population. The study enrolled 3,749 residents of Watari who had an annual health check in 2017. Blood pressure was measured and information on nocturia was obtained by questionnaire. Participants with blood pressure 140/90 mmHg or higher or prescribed antihypertensive drugs were considered hypertensive.

Nocturia (one or more nocturia events per night) was significantly associated with hypertension after controlling for possible confounders

Of the 1,882 participants who answered the questionnaire, 1,295 (69%) had nocturia. Dr. Konno said the results do not prove a causal relationship between nocturia and hypertension and may not apply to populations outside Japan. He said: "The relationship may be influenced by various factors including lifestyle, salt intake, ethnicity, and genetic background."

Dr. Mutsuo Harada, press coordinator for JCS 2019, said: "Hypertension is a national disease in Japan. The average salt intake in Japan is approximately 10 g/day, which is more than double the average salt intake worldwide (4 g/day). This excessive salt intake is related to our preference for seafood and soy sauce-based food, so salt restriction is difficult to carry out. Early detection and management of hypertension are very important to prevent cardiovascular diseases. We should keep in mind that nocturia is not only caused by urinary organ problems but also by systemic diseases such as hypertension."

ESC President Professor Barbara Casadei said: "More than one billion people have high blood pressure worldwide. High blood pressure is the leading global cause of premature death, accounting for almost ten million deaths in 2015. ESC guidelines recommend medication to reduce the risk of stroke and heart disease.3 A healthy lifestyle is also advised, including salt restriction, alcohol moderation, healthy eating, regular exercise, weight control, and smoking cessation."

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More information: Tomohiro Matsuo et al. Daily salt intake is an independent risk factor for pollakiuria and nocturia, International Journal of Urology (2017). DOI: 10.1111/iju.13321

Bryan Williams et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension, European Heart Journal (2018). DOI: 10.1093/eurheartj/ehy339

Journal information: European Heart Journal

Provided by European Society of Cardiology

The first complete mapping of cerebral functional lateralisation

by CNRS

Cerebral functional lateralisation represented in a 4-dimensional space along the symbolic communication axis (green), the perception/action axis (cyan), the emotions axis (pink) and the decision-making axis (yellow). Credit: Karoliset al./Nature Communications

Some cerebral processes preferably occur in the brain's right or left hemisphere. But which functions and which side? A Franco-Italian research team directed by a CNRS researcher from the Institut du Cerveau et de la Moelle Epinière (AP-HP/CNRS/INSERM/Sorbonne Université) has just answered this question by delivering the first complete mapping of cerebral functional lateralisation, published on 29 March 2019 in Nature Communications. Their results show for the very first time that as well as perception, action and emotions, decision-making uses the right half of the brain more. On the other hand, symbolic communication uses the left half of the brain more.

29 mar 2019--That was until the recent research by Michel Thiebaut de Schotten, a CNRS researcher at the Institut du Cerveau et de la Moelle Epinière (AP-HP/CNRS/INSERM/Sorbonne Université), and his colleagues at the University of Padua, Italy. Using functional MRI data collected worldwide for more than 15 years, they have produced the first global map of cerebral function lateralisation.In 1865, French physician Paul Broca noted that among patients with brain damage, only those with the left frontal lobe affected had speech difficulties. This is the first time that functional asymmetry has been observed between the two hemispheres. Much research followed to try to identify the "dominant" hemisphere for various brain functions, but without global investigation of lateralisation.

The researchers have identified four groups of extremely lateralised functions using common cerebral regions: symbolic communication (where we find language, reading and calculation, for example) very much on the left; the perception/action and emotions groups on the right and decision-making, which is in the right frontal lobe area. The last point is completely innovative. No team had previously described asymmetry between hemispheres for decision-making.

In addition, this study answered a problematic question on connections between hemispheres: are the very lateralised regions not substantially connected with the other hemisphere so that information is processed faster, or on the contrary are they very connected so that they influence and dominate the opposite hemisphere in some cases? The researchers' map shows that the more lateralised the function, the less it establishes connections with the other hemisphere, so validating the hypothesis that to be more efficient, a function's dominant hemisphere is not highly connected with the other side.

This discovery also validates the idea that brain functions became lateralised as the brain got larger, to optimise information processing. This optimisation occurred at the expense of another evolutionary advantage though: functional recovery after brain damage. Because of reduced connections between hemispheres, it is harder for the undamaged hemisphere to compensate for the lost functions.

The researchers will now continue this work by studying variations in function lateralisation between individuals and testing for example whether high lateralisation for a function in one person causes different lateralisation for other functions.

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More information: Vyacheslav R. Karolis et al. The architecture of functional lateralisation and its relationship to callosal connectivity in the human brain, Nature Communications (2019). DOI: 10.1038/s41467-019-09344-1

Journal information: Nature Communications

Alzheimer's disease: have we got the cause all wrong?

by Vicky Jones, The Conversation

Credit: Fer Gregory/Shutterstock

Early in the 20th century, Alois Alzheimer first described a disorder of progressive memory loss and confusion in a 50-year-old woman. After she died, he examined her brain and saw that it was full of unusual protein clumps, known as plaques. Over a century later, we know that these plaques are full of a protein called beta-amyloid and are a hallmark of the disease that bears Alzheimer's name. While other features of Alzheimer's disease have been discovered, the theory that beta-amyloid is the main cause of this incurable disease has dominated.

28 mar 2019--There are many subtle variations of the "beta-amyloid hypothesis", but generally the theory goes that beta-amyloid accumulates in the brain, then clumps together. Somewhere in this process, nerve cells in the brain become damaged, which leads to memory loss and other symptoms of Alzheimer's disease. So the approach to treating this should be rather straightforward: stop the clumping and you will halt the disease.

Unfortunately, decades of research, many millions of dollars of investment and many failed clinical trials later, it appears that this approach is not working. The most recent plaque-busting treatment to produce disappointing results has been aducanumab – an antibody-based therapy designed to stick to and destroy beta-amyloid.

Initial data suggested that the treatment did, indeed, clear beta-amyloid from the brain. But this week, Biogen and Esai, the drug companies behind aducanumab, ended clinical trials involving thousands of patients early, stating that the "trials were unlikely to meet their primary endpoint upon completion".

This has led many to ask whether the amyloid hypothesis of Alzheimer's disease should be abandoned. In reality, few neuroscientists still subscribe to the view that it is the beta-amyloid plaques themselves that cause the symptoms of Alzheimer's disease.

Studies with mice that mimic human Alzheimer's disease have shown that memory loss occurs before plaques form in the brain. Other studies have suggested that it is the smaller fragments ("oligomers") of beta-amyloid that are really toxic to nerve cells. And it has even been suggested that the formation of plaques is a way for the brain to round-up all these dangerous oligomers into one place for safety.

It's very hard to tell without the full information from the aducanumab trial, but maybe the disease had progressed too far in the participants for the treatment to be effective. Perhaps the small beta-amyloid oligomers had already done their damage, setting the disease in motion before the participants were even recruited to the trial.

Amyloid-beta plaques (yellow) clumping around brain cells (blue). Credit: Juan Gaertner/Shuterstock

Alzheimer's disease vs Alzheimer's dementia

At a recent Alzheimer's Research UK Conference, there was near universal agreement that it's time to separate the concept of Alzheimer's disease from the menace of dementia.

Alzheimer's disease is defined as the build up of beta-amyloid plaques and tangles of another protein, tau, combined with some mild memory changes. Dementia is a symptom of this disease. Advances in brain imaging mean that doctors can now spot these indicators of Alzheimer's disease much earlier (up to 25 years before dementia symptoms set in). An astonishingly under-reported fact is that progression to dementia is not a given. Not all people who show these clinical signs of Alzheimer's disease will progress to dementia in their lifetimes.

We are only beginning to study the reasons that some people with Alzheimer's disease avoid Alzheimer's dementia. Age is the single biggest risk factor for this progression; the younger you are when beta-amyloid starts to build up in the brain, the more likely you are to suffer from dementia. Diet, education and head injuriesmay also play a role in this process, but to what extent we do not know.

Another major factor we are only just beginning to understand is genetics. Small variations in our genes seem to influence not only whether we will get a build up of beta-amyloid in the brain, but whether that accumulation leads to dementia symptoms.

The process of finding these so-called "risk genes", however, is slow. Progress has mostly come from "big data" studies that track tiny changes in the two billion odd DNA bases of the human genome across tens of thousands of individuals and try to find patterns between these changes and rates of Alzheimer's.

There are around 30 areas of the human genome that have been linked to the risk of developing Alzheimer's dementia, although there are certainly more to be discovered.

Aducanumab: right treatment, wrong time?

As with treatments for many other human diseases, it might be that treatments such as aducanumab might only be effective if they are given early enough, before the disease has caused irreversible changes. A better understanding of the environmental and genetic factors behind Alzheimer's disease combined with ever more sensitive brain imaging techniques will help doctors identify warning signs even earlier, before even minor memory loss occurs.

While screening and diagnosing people – before symptoms have set in – for an as-yet incurable disease, raises many ethical dilemmas, it might present a fresh window of opportunity to retest beta-amyloid drugs, such as aducanumab. Ultimately, we need to focus our research on understanding the early stages of the disease so that we can prevent Alzheimer's disease before dementia takes hold.

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Provided by The Conversation

Older people are more digitally savvy, but aged care providers need to keep up

by Dr. Wendy Wrapson, The Conversation

Moving into aged care can affect a person’s ability to remain connected to their local community, but most aged care facilities don’t provide access to digital devices. Credit: www.shutterstock.com, CC BY-SA

Older adults are more digitally connected than ever, even though their uptake of internet-based technologies remains lower than for younger age groups.

27 mar 2019--Today's senior citizens are likely to spend their spare time tweeting about their social lives and Facetiming their grand kids. This is good news because research shows that social interactions benefit us.

The drive to join the digital community is no doubt influenced by social media becoming an important platform for news and information, sharing experiences and connecting with friends and family. Nevertheless, age-related gaps in digital engagement ("the digital divide") still exist.

As our research shows, people who live in aged care environments are at risk of being excluded from the digital world.

A digital community

Moving into aged care can affect a person's ability to remain connected to their local community. The facility might be some distance away from the neighbourhood in which they have lived. They may be unable to travel to maintain relationships.

Low levels of social connectedness and participation are related to poor health and higher mortality risks, as well as a significant reduction in quality of life. Family can provide an important source of social contact and support but geographic distance can again make frequent visits difficult.

Digital engagement in later life might not always be desired or possible. But access to online resources can enhance older adults' well-being through improved access to information and more frequent social interactions.

The social internet

An early study reported psychosocial benefits from providing computer training in internet use for aged care residents. These include improvements in life satisfaction and lower levels of depression and loneliness. In another study, a once weekly video conference with a family member had a positive impact on loneliness and perceived social support.

But there is little information on informal and unstructured use of the internet by residents because the use of digital technologies in aged care remains largely invisible. Residents are omitted from many surveys and reports.

In a recent Swiss study, where all residents in a facility were offered wi-fi access, 14% used the internet. This percentage is similar in that age group living in the community.

Staying connected

We conducted telephone interviews with over 70 members of the public who had a family member or friend living in residential aged care. We spoke to family and friends rather than seniors because we wanted to hear about residents who had physical and mental challenges, as well as healthy seniors who tend to volunteer for research. To reduce the risk of bias, we did not mention in our study advertising that we wished to talk to people about technology use.

Our research highlighted the enthusiasm with which many older people have adopted digital technologies. Nearly half of the 80 residents spoken about owned a computer or a smartphone. The average age of residents was 86 years, and the oldest was 102. Sometimes the family had purchased a device for the resident, specifically to make communication easier.

Mobile phone calls, texts and emails were the most common methods of communication using these devices. Technology not only enabled residents to interact with family and friends they seldom saw (for example, those overseas) but also resulted in increased interactions with people who visited more often. While dementia and other serious health issues reduced the likelihood of uptake, the frequency of personal visits was not affected by technology use.

Family help

Importantly, family members were essential to residents' digital connectedness. They often bought the device, set up software and troubleshooted any technical problems. They were also involved in the day-to-day use of technology. For example, some residents used video conferencing, but needed assistance to initiate the call.

Interviewees endorsed the use of digital devices if they were used to supplement social contact, rather than supplanting it. The majority reported that they were not aware of computers being available for residents in common areas of the facility they visited.

Aged care operators do not generally provide wi-fi access to residents. They have to arrange this with their own internet provider. These deficits are of concern because residents don't always have family or friends to help them become digitally connected.

Devices were also often criticised for their small keys and buttons which are difficult to manage for arthritic hands and by people with vision impairments. Older users, it seems, must try to adapt their abilities to devices that have been designed for younger people.

Senior citizens are an important consumer group which is only going to increase in number in the future. The time has come for aged care operators and the technology industry to engage in meaningful efforts to meet their needs.

Provided by The Conversation

'Technoference': We're more tired and less productive because of our phones

by Queensland University of Technology

Credit: CC0 Public Domain

One in five women and one in eight men are now losing sleep due to the time they spend on their mobile phones, according to new QUT-led research that has found a jump in 'technoference' over the past 13 years.

26 mar 2019--Researchers surveyed 709 mobile phone users across Australia aged 18 to 83 in 2018, using questions replicated from a similar survey back in 2005.

They then compared the findings and discovered significant increases in people blaming their phones for losing sleep, becoming less productive, taking more risks while driving and even getting more aches and pains.

Study leader Dr. Oscar Oviedo-Trespalacios from QUT's Centre for Accident Research and Road Safety—Queensland (CARRS-Q) said the survey results showed 24 per cent of women and 15 per cent of men could now be classified as "problematic mobile phone users".

For 18 to 24 year-olds, the figure jumps to 40.9 per cent, with 23.5 per cent of respondents aged 25 to 29 also suffering technoference.

Participants were also asked about their driving habits, with researchers finding a correlation between problem phone use off the road and on the road.

Key findings of the 2018 national survey include:

• One in five women (19.5 per cent) and one in eight men (11.8 per cent) now lose sleep due to the time they spend on their mobile phone (vs 2.3 per cent of women and 3.2 per cent of men in 2005).
• 12.6 per cent of men say their productivity has decreased as a direct result of the time they spend on their mobile – compared to none in 2005 – and 14 per cent of women have also noticed a productivity decline (2.3 per cent in 2005).
• 14 per cent of women try to hide the amount of time they spend on the phone (3 per cent in 2005), as do 8.2 per cent of men (3.2 per cent in 2005)
• 54.9 per cent of women believe their friends will find it hard to get in touch with them if they don't have a mobile (up from 28.8 per cent), and 41.6 per cent of men thought this (almost identical to 41.9 in 2005).
• 8.4 per cent of women (up from 3 per cent) and 7.9 per cent of men (up from 1.6 per cent) have aches and pains they attribute to mobile phone use   
• 25.9 per cent of women (up from 3.8) and 15.9 per cent of men (up from 6.5) say there are times when they would rather use their mobile phone than deal with more pressing issues. For 18 to 25 year-olds, this figure was 51.4 per cent (up from 10.5).

Dr. Oviedo-Trespalacios said the survey had uncovered an interesting pattern of "technoference".

"When we talk about technoference we're referring to the everyday intrusions and interruptions that people experience due to mobile phones and their usage," he said.

"Our survey found technoference had increased among men and women, across all ages.

"For example, self-reports relating to loss of sleep and productivity showed that these negative outcomes had significantly increased during the last 13 years.

"This finding suggests that mobile phones are potentially increasingly affecting aspects of daytime functioning due to lack of sleep and increasing dereliction of responsibilities."

But on the positive side, less people reported they had received phone bills they could not afford to pay. And, perhaps surprisingly, the number of people who found it difficult to switch off their phone remained fairly constant across the 13-year time span.

Dr. Oviedo-Trespalacios said the survey results also indicated that phones were being used as a coping strategy, with one in four women and one in six men saying they'd rather use their phone than deal with more pressing issues.

He said Australia had one of the highest smartphone penetration rates in the world, with about 88 per cent of adults now owning a smartphone. Globally, the world is expected to pass 2.5 billion smartphone users this year.

"The speed and depth of smartphone take-up in Australia makes our population particularly vulnerable to some of the negative consequences of high mobile phone use," he said.

"Rapid technological innovations over the past few years have led to dramatic changes in today's mobile phone technology—which can improve the quality of life for phone users but also result in some negative outcomes.

"These include anxiety and, in some cases, engagement in unsafe behaviours with serious health and safety implications such as mobile phone distracted driving."

The paper on the study, Problematic Use of Mobile Phones in Australia…is it Getting Worse?, has been published in Frontiers in Psychiatry.

More information: Oscar Oviedo-Trespalacios et al, Problematic Use of Mobile Phones in Australia…Is It Getting Worse?, Frontiers in Psychiatry (2019). DOI: 10.3389/fpsyt.2019.00105

Provided by Queensland University of Technology

Treating diabetes in older adults requires simpler medication regimens, looser glycemic targets

by The Endocrine Society

Simplifying medication regimens and tailoring glycemic targets in older adults with diabetes improves adherence and avoids treatment-related complications, according to a Clinical Practice Guideline issued today by the Endocrine Society. The Society debuted the guideline during a press conference on the opening day of ENDO 2019, its annual meeting in New Orleans, La.

24 mar 2019--The guideline, titled "Treatment of Diabetes in Older Adults: An Endocrine Society Clinical Practice Guideline," was published online and will appear in the May 2019 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of the Endocrine Society. The guideline focuses on treatment strategies that take into consideration the overall health and quality of life of older adults with diabetes, defined as age 65 or older.

Aging plays a major role in the development of diabetes, which currently affects an estimated 33 percent of older adults in the U.S. Older adults with diabetes often have one or more co-existing conditions such as cognitive impairment, cardiovascular disease, impaired vision, and rheumatoid arthritis, which affect diabetes self-management.

"The guideline encourages clinicians to consider available evidence and a patient's overall health, likelihood to benefit from interventions and personal values when considering treatment goals such as glucose, blood pressure, and cholesterol," said Derek LeRoith, M.D., Ph.D., of Mount Sinai School of Medicine in New York, N.Y. LeRoith chaired the writing committee that developed the guideline. "Our framework prioritizes blood glucose targets over the hemoglobin A1c test when managing diabetes in older adults."

Recommendations from the guideline include:

• Simplifying medication regiments and tailoring glycemic targets in older adults with diabetes and cognitive impairment (e.g. dementia) to improve compliance and prevent treatment-related complications
• Designing outpatient diabetes regimens specifically to minimize hypoglycemia
• Targeting blood pressure levels of 140/90 mmHg to decrease the risk of cardiovascular disease outcomes, stroke, and progressive chronic kidney disease in older adults with diabetes aged 65 to 85 years
• Using an annual lipid profile to reduce the amount of "bad cholesterol" in the blood
• Administering annual comprehensive eye exams to detect retinal disease
• Establishing clear blood sugar targets for older adults with diabetes in hospitals or nursing homes at 100-140 mg/dL (5.55-7.77 mmol/L) fasting and 140-180 mg/dL (7.77-10 mmol/L) after meals while avoiding hypoglycemia

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Provided by The Endocrine Society

The robots that dementia caregivers want: robots for joy, robots for sorrow

by University of California - San Diego

Researchers worked with dementia caregivers to envision and design robots that could help them care for their loved ones. Credit: Healthcare Robotics Lab/University of California San Diego

Building robots that can help people with dementia has been a longtime goal for roboticists. Yet until now, no one has sought to survey informal caregivers, such as family members, about what characteristics and roles these robots should have.

23 mar 2019--A team of scientists at the University of California San Diego sought to address this by spending six months co-designing robots with family members, social workers, and other caregivers who care for people with dementia. They are presenting their findings at the Human Robot Interaction conference March 11 to 14 in South Korea.

Researchers found that caregivers wanted the robots to fulfill two major roles: support positive moments shared by caregivers and their loved ones; and lessen caregivers' emotional stress by taking on difficult tasks, such as answering repeated questions and restricting unhealthy food.

"Caregivers conceived of robots not only managing difficult aspects of caregiving—but also for supporting joyful and fun activities," said Laurel Riek, a professor of computer science at UC San Diego, and the paper's senior author.

Spouses or adult children provide 75 percent of the care for people with dementia. That is equivalent to 15 million people in the United States alone, providing 18 billion hours of unpaid care per year with little support and few resources. Caregivers are also likely to overlook their own health and wellbeing, which can put both parties at risk.

Most technology designed to support caregivers only seeks to educate, rather than to reduce burden. Caregivers sometimes also have access to virtual support systems and connections to clinicians via smartphones or desktop computers, but again this focuses on education and not direct assistance.

By contrast, homecare robots could provide caregivers the respite they sorely need. Before building the robots, it is crucial to get caregivers' input so that the robots are well designed and actually useful.

Undergraduate Alejandro E. Panduro (left), a cognitive science major, and postdoctoral researcher Hee Rin Lee, who focuses on computer science, work together with caregivers for people with dementia. (The caregivers' faces have been pixelated to protect their anonymity.) Credit: Healthcare Robotics Lab/University of California San Diego

"It is imperative researchers take a community-health focused approach to understanding stakeholders' perspectives prior to building the technology," Riek said. "Especially in healthcare robotics—one should not walk in with a technology hammer."

Half of the robots designed by caregivers were primarily focused on alleviating stress from the repetitive questions people with dementia ask. Caregivers also envisioned robots that could provide reminders of a person's daily schedule and tasks. They also designed robots to help with physical therapy and manage medications.

As dementia progressed, caregivers wanted robots to interact more with the person with dementia by helping with daily tasks and offering reminders. The robots that caregivers imagined acted as counselors and facilitators—and sometimes as the "bad guys" who could say "no" to the person with dementia.

The researchers are now using these initial low-tech prototypes to build high-tech prototypes that they plan to begin testing in homes over the next year.

Interviews and hands-on workshops

For the study, researchers led by Riek built relationships with three different dementia day care centers in San Diego County.

A series of interviews and hands-on workshops with caregivers were conducted by two UC San Diego cognitive science undergraduate students, Sanika Moharana and Alejandro E. Panduro, and one computer science postdoc, Hee Rin Lee. A total of 18 people participated in the research, including 13 family members who acted as caregivers for people with various types of dementia, five social workers who led the day care centers, and three geriatric nursing students who work at the centers.

Example of one of the robots the caregivers designed. Credit: Healthcare Robotics Lab/University of California San Diego

Based on everyone's feedback, the team identified 16 major challenges that caregivers had to deal with, from difficulty accepting dementia, to isolation, to difficulty prioritizing self-care.

In the workshops, the researchers gave caregivers a brief presentation about the types of technologies available today, including pet-like robots, cleaning robots, telepresence robots, smart speakers and wearables.

Then, with the students' help, caregivers selected key problems and collaboratively co-designed robots to tackle them. They used pre-cut foam shapes to build the robot prototypes. They also selected functions for the robots (such as playing games, reviewing photo albums, exercising, etc.) and a mode of interaction between the robot and person with dementia and caregivers (for example voice commands and touch screens).

Caregivers designed their ideal robots to follow predetermined scenarios supplied by researchers and the social workers, including preventing a person with dementia from driving, getting them to bathe, or answering repetitive questions.

Robot characteristics

Based on the results of the six-month long community design process, the researchers identified a number of characteristics and design guidelines for robots to support dementia caregivers and people with dementia:

• Robots should help redirect conversations when repetitive questioning becomes burdensome
• Robots should be integrated into everyday objects that the people with dementia are already familiar with, or borrow features from those objects. For example, one caregiver wanted her husband to get messages through the TV, which he spends a lot of time watching.
• Robots should be able to adapt to new situations and to the behavior of the person with dementia. This is particularly important because dementia is a progressive disease and each stage brings new challenges for caregivers. In addition, patterns of progression vary from person to person and as a result are almost impossible to predict.
• Robots should be able to learn from end users, and customize and personalize their interaction and responses.
• Robots should have human-like components. That is not to say that they should look human. Rather the machines could, for example, use a real human voice or face. "When caregivers wanted robots to take active roles in persuading people with dementia to do something, they designed robots with more human-like features," the researchers write. Related to this, caregivers wanted robots to include features that would help build trust, such as looking like a friend or clinician.
• Robots should interact with humans via voice activation —much like a smart speaker. More specifically, caregivers wanted the robots to use voices that their loved ones would be familiar with—caregivers or doctors. Caregivers also wanted robots to be capable of facial recognition.

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Provided by University of California - San Diego

Short walk once-a-week can lower risk of death: study

Credit: CC0 Public Domain

A brisk stroll once or twice a week is enough to reduce the risk of dying from heart attack, stroke or cancer, according to a statistical study of nearly 90,000 people released Tuesday.

21 mar 2019--People who walked or gardened 10 minutes to an hour each week had an 18-percent lower risk of death from any cause compared to full-on couch potatoes, researchers reported in the British Journal of Sports Medicine.

Two-and-a-half to five hours weekly of such "moderate physical activity"—broken into segments of no less than 10 minutes—resulted in a 31 percent reduction in risk, they found.

And those who clocked up at least 25 hours almost halved the risk.

Not everyone, however, has that much time to spend on leisure-time exercise, the authors acknowledged.

Heart-pumping and pulse-quickening activities such as biking, running and competitive sports "are more time-efficient than moderate intensity activity," they said.

For cardiovascular disease alone, there was no additional benefit to be gained by graduating from five to 25 hours, they noted.

Researchers led by Bo Xi, a professor in the Department of Epidemiology at Shandong University in northern China, sifted through data collected annually on 88,140 people in the United States between 1997 and 2008 for the National Health Interview Surveys.

That data on excercise was then matched against registered deaths through 2011.

The authors cautioned that the study was observational, meaning that no firm conclusions can be drawn about cause and effect. The fact that exercise data was self-reported was also a potential weakness.

But the large number of people covered by the research goes a long way to compensate for these methodological limitations, they added.

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More information: Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults, British Journal of Sports Medicine doi:10.1136/bjsports-2018-099254 , bjsm.bmj.com/lookup/doi/10.113 … bjsports-2018-099254

Older people less anxious, more active and less likely to fall in retirement communities

by Lancaster University

Marie McCamley said 'I'm never lonely now; I used to be. While I'm not able to see my children as much as I'd like, I make up for it with friends here. We've formed great friendships, so I can actually say I'm never lonely. I don't look back, I just look forward to having more years to enjoy more doors opening.' Credit: ExtraCare charitable trust

A new report shows older people benefit from improved physical and mental health in retirement communities, resulting in cost savings to the NHS.

20 mar 2019--Findings from the independent study into healthy ageing carried out by Aston and Lancaster Universities showed that residents living within a charity's retirement communities:

• are more physically active (75% increase in exercise)
• benefit from a reduced risk of falls (18%)
• are less anxious (23%)
• have an increased walking speed
• were 'never or hardly ever' lonely (86.5%)
• have improved autobiographical (24%) and memory (17%) recall
• can delay or reverse the onset of frailty

The study was commissioned by the ExtraCare Charitable Trust, a registered charity that exists to create better lives for older people and operates 19 midlands and southern-based retirement villages and housing schemes. It follows the charity's 2012-2015 research with Aston University which revealed a 14.8% reductions in depressive symptoms amongst residents after three years, and annual NHS savings of 38% per person.

The latest study by Lancaster University and led by Professor Carol Holland includes additional measures for loneliness, resilience and quality of life, and shows that the charity's unique well-being and lifestyle model delivers significant health improvements, including residents reducing their average hospital stays by three days per year.

Shirley Hall, Head of Innovation and Well-being at The ExtraCare Charitable Trust comments: "We're excited by the results of our study, we know older people who exercise tend to be happier and are likely to live longer healthier lives, so it's great to see that residents within our communities are more physically active.

"However, the results do show a small number of residents are feeling lonely, so we need to help identify and support those who are. We know from the study that working on autobiographical memory is one area that our residents can work on to help improve 'social connectedness' and loneliness further, and supporting residents with mobility issues to build resilient social networks will be critical in reducing their level of loneliness over time, all things that the charity is committed to doing."

The ExtraCare Charitable Trust's Chair of the Board of Trustees, Paul Jennings said: "This is great news for our residents; our unique approach really is resulting in positive measurable outcomes for healthy ageing. One of the lessons we can take from the study is by helping residents to improve their physical fitness, we can also improve their psychological well-being.

"More importantly, our research shows that some critical factors where we'd expect to see a downward trend as a result of age, for example age-related changes in cognitive function that no such trends are emerging. This is having a knock on benefit for the NHS too, with ExtraCare residents visiting their GP less often, and staying in hospital for shorter periods. This takes pressure off the health system. This is in contrast to the usual expected increase in NHS costs as people age."

The Baroness Sally Greengross OBE recently visited ExtraCare's newly opened Hughenden Gardens Village in High Wycombe, she comments: "It's terribly important that the example ExtraCare has set is more widely known and communicated to society, particularly people in local governments so that they can realise the benefits to the health service that these villages bring. These communities also help the increasingly difficult issue of social care, because care is on offer to those residents, if and when they need it, but with an emphasis on when you're fit and well, being able to be independent again."

Since the first study was published the charity has used the results to assess the efficacy of its award-winning well-being service, which supports all residents to be proactive in managing their own health and make informed decisions about their health and lifestyle, via regular assessments. This latest research has helped inform the development of a resilience tool to measure how resilient residents are in terms of physical and cognitive health. The tool will launch this spring. It will be used to reassess residents who have already been identified as frail to determine if personal goals and targets are helping them to become more resilient. There are plans to roll the tool out to other retirement housing providers later in the year.

Over 4,500 residents, aged 55-100+ live in the charity's retirement communities, most with 250 plus homes and up to 18 facilities including gyms, shops, hair salons, IT suites, hobby rooms and bistro restaurants. Residents live in one or two-bedroom apartments with care, well-being and dementia support available. For many their new homes have meant new friends and a new lease of life with access to a wide range of activities and volunteering opportunities including tai-chi, woodwork, chair yoga, choir singing and quiz nights. Residents are developing focus on intergenerational living with a number of 'play groups' being set up within its communities following its successful participation in Channel Fours 'Old People's Home for Four Year Olds' in 2018.

Nineteen villages and schemes were included within the research assessments with more than 160 residents involved. For the second report data from the participants was collected 24, 36, 48 and 60 months. For more information and to read the full report please visit extracare.org.uk/research

Case Study

Marie McCamley, 74, moved into Earlsdon Park Village during the summer of 2016. Marie, who lives with a spinal injury, used to struggle to maintain her previous property and can recall the loneliness of watching television on her own with no-one to interact with.

"I'm never lonely now; I used to be. While I'm not able to see my children as much as I'd like, I make up for it with friends here. We've formed great friendships, so I can actually say I'm never lonely. I don't look back, I just look forward to having more years to enjoy more doors opening."

Provided by Lancaster University

People who don't drink may still suffer harms from alcohol, study suggests

by BioMed Central

Credit: CC0 Public Domain

Harms to people resulting from alcohol consumption by others in Germany in 2014 are assessed in a study published in the open access journal BMC Medicine.

19 mar 2019--Much of the research into alcohol-associated harms investigates harm to the drinker, not to other individuals. Researchers at Institute for Therapy Research in Bayern, Germany, estimated the harms caused to others by alcohol during pregnancy, in road traffic accidents, and as a result of interpersonal violence. The authors conclude that the harmful effects of alcohol on people other than the drinker need to be recognized as a public health problem, and effective ways of preventing such harms are required.

Dr. Ludwig Kraus, the corresponding author, said: "This study estimates some of the most severe harms that alcohol use may cause to other people than the drinker, namely fetal alcohol syndrome (FAS), fetal alcohol spectrum disorders (FASD), road traffic fatalities caused by drunk drivers, and deaths resulting from alcohol-attributable interpersonal violence."

The authors found that alcohol was responsible for 1,214 (45.1%) third-party road traffic deaths and 55 (14.9%) interpersonal violence deaths, and was implicated in 2,930 incidences of FAS and 12,650 cases of FASD. The authors note that FAS and FASD are not the only potential consequences of drinking alcohol during pregnancy. Overall, these results indicate that alcohol may not only cause harm to the drinker, but also substantial harm to third parties.

Dr. Kraus said: "Although the estimates across the three harm domains are not directly comparable, the results suggest that alcohol use in pregnancy followed by road traffic fatalities account for significantly more harm to others than alcohol-related violence."

To investigate the potential harm caused by alcohol to third parties, the authors examined survey data on the prevalence of alcohol use during pregnancy to estimate incidences of FAS and FASD in Germany. Cause-of-death statistics provided estimates of third party traffic deaths and interpersonal violence deaths thought to be caused by alcohol.

The authors caution that accurately assessing the prevalence and extent of alcohol use during pregnancy in Germany is challenging as the data are self-reported and so may be vulnerable to bias or misremembering.

Dr. Kraus said: "Although measures such as pricing policies or limiting the marketing of alcoholic beverages are unpopular, targeted measures addressing particular populations at risk, such as women of childbearing age or road users, may help to reduce harms to others as well as harms to the drinker."

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More information: Quantifying harms to others due to alcohol consumption in Germany: a register-based study, Kraus et al. BMC Medicine 2019, DOI: 10.1186/s12916-019-1290-0

Provided by BioMed Central