Most older adults feel at least 20 years younger than they are

by L.f. Carver, The Conversation

Research has shown that, on the inside, most people feel younger than their real age. Credit: Shutterstock

How old do you feel inside? Not your chronological age (that pesky number on your birthday cake) but how old is the real you, the person inside?

30 may 2019--In North America, we generally group people into socially constructed age ranges such as: childhood, adolescence, young adulthood, middle adulthood and old age. Age categories are associated with different rights and privileges and, attached to these age categories are behavioral expectations. For example, old people are expected to be frail and helpless.

However, research has shown that, on the inside, most people's subjective age—the way they feel inside —is very different from the number of years they have been alive. "Age inside" is the age of the inner self or individual personality. Age inside varies for each individual. A young person often feels older than their age. An older person feels younger.

Some research on subjective age suggests that older people need to be healthy in order to feel younger. However, in my research I have found that even people with multiple illnesses report feeling a younger age inside than their chronological age.

For my recently published study, I interviewed 66 older adults between 65 to 90 years old from the United States and Canada to find out how old they felt inside. All participants were living with between two to six different illnesses, including cancers, heart disease and stroke, diabetes, kidney disease, arthritis and thyroid diseases. Almost 60 percent of the participants were living with pain on a regular basis. Participants were asked: "For many people their age in years does not reflect the age that they really identify with, inside. How old are you inside?"

Most of the people I interviewed reported feeling decades younger inside than their chronological age, even though they were living with numerous illnesses. Their average age inside was 51-years-old, with an average difference of two decades between age inside and chronological age. That is, more than half of the participants, despite the presence of illness, felt at least 20 years younger than their age. Some said they felt as young as 17. Only eight percent of the participants felt the same age inside as their chronological age.

Age perception chart. Author provided

The gender of participants had an impact. Participants who described their gender as feminine had a younger age inside than those who identified as masculine.

Do older adults who feel younger age inside engage in more "youthful" activities? That is a question for future research. I am also interested in understanding whether age inside is related to the way we visualize ourselves (which is often different from the way we actually look).

Intergenerational common ground

Age inside, as a concept, may be able to help with inter-generational understanding. Realizing that people who "look old" may not feel old means there may be opportunities to develop intergenerational connections on critical political issues.

Youthful age inside may explain why many older adults want to work past retirement age. It may impact financial planning: if older adults feel young, they may not be saving money. Older people may be more interested in traveling, having fun and getting that motorcycle they always wanted. These active and independent choices may cause confusion and frustration for loved ones and health practitioners.

Age inside could help explain some older adults' lack of compliance with medical directives. Youthful subjective age is also important for government policy makers and service providers to note, as it means many elders do not perceive themselves as seniors. They may not be interested in activities or programs aimed at the stereotypical senior.

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Provided by The Conversation 

Big data reveals hidden subtypes of sepsis

by University of Pittsburgh

Sepsis is not a single syndrome, according to a University of Pittsburgh-led study in JAMA. Credit: Chris Konopack/UPMC

Much like cancer, sepsis isn't simply one condition but rather many conditions that could benefit from different treatments, according to the results of a University of Pittsburgh School of Medicine study involving more than 60,000 patients.

28 may 2019--These findings, announced today in JAMAand presented at the American Thoracic Society's Annual Meeting, could explain why several recent clinical trials of treatments for sepsis, the No. 1 killer of hospitalized patients, have failed. Sepsis is a life-threatening condition that arises when the body's response to an infection injures its own tissues and organs.

"For over a decade, there have been no major breakthroughs in the treatment of sepsis; the largest improvements we've seen involve the enforcing of 'one-size fits all' protocols for prompt treatment," said lead author Christopher Seymour, M.D., M.Sc., associate professor in Pitt's Department of Critical Care Medicine and member of Pitt's Clinical Research Investigation and Systems Modeling of Acute Illness Center. "But these protocols ignore that sepsis patients are not all the same. For a condition that kills more than 6 million people annually, that's unacceptable. Hopefully, by seeing sepsis as several distinct conditions with varying clinical characteristics, we can discover and test therapies precisely tailored to the type of sepsis each patient has."

In the "Sepsis ENdotyping in Emergency Care" (SENECA) project, funded by the National Institutes of Health (NIH), Seymour and his team used computer algorithms to analyze 29 clinical variables found in the electronic health records of more than 20,000 UPMC patients recognized to have sepsis within six hours of hospital arrival from 2010 to 2012.

The algorithm clustered the patients into four distinct sepsis types, described as:

• Alpha: most common type (33%), patients with the fewest abnormal laboratory test results, least organ dysfunction and lowest in-hospital death rate at 2%;
• Beta: older patients, comprising 27%, with the most chronic illnesses and kidney dysfunction;
• Gamma: similar frequency as beta, but with elevated measures of inflammation and primarily pulmonary dysfunction;
• Delta: least common (13%), but most deadly type, often with liver dysfunction and shock, and the highest in-hospital death rate at 32%.

The team then studied the electronic health records of another 43,000 UPMC sepsis patients from 2013 to 2014. The findings held. And they held again when the team studied rich clinical data and immune response biomarkers from nearly 500 pneumonia patients enrolled at 28 hospitals in the U.S.

In the next part of the study, Seymour and his team applied their findings to several recently completed international clinical trials that tested different promising therapies for sepsis—all of which had ended with unremarkable results.

When trial participants were classified by the four sepsis types, some trials might not have been failures. For example, early goal-directed therapy (EGDT), an aggressive resuscitation protocol that includes placing a catheter to monitor blood pressure and oxygen levels, delivery of drugs, fluids and blood transfusions was found in 2014 to have no benefit following a five-year, $8.4 million study. But when Seymour's team re-examined the results, they found that EGDT was beneficial for the Alpha type of sepsis patients. Conversely, it resulted in worse outcomes for the Delta subtype.

"Intuitively, this makes sense—you wouldn't give all breast cancer patients the same treatment. Some breast cancers are more invasive and must be treated aggressively. Some are positive or negative for different biomarkers and respond to different medications," said senior author Derek Angus, M.D., M.P.H., professor and chair of Pitt's Department of Critical Care Medicine. "The next step is to do the same for sepsis that we have for cancer—find therapies that apply to the specific types of sepsis and then design new clinical trials to test them."

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More information: Christopher W. Seymour et al, Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis, JAMA (2019). DOI: 10.1001/jama.2019.5791

Journal information: Journal of the American Medical Association 

Provided by University of Pittsburgh 

Drinking red wine for heart health? read this before you toast

For years, studies have shown a relationship between drinking a moderate amount of red wine and good heart health, but experts say it's important to understand what that means before you prescribe yourself a glass or two a day.

28 may 2019--No research has established a cause-and-effect link between drinking alcohol and better heart health. Rather, studies have found an association between wine and such benefits as a lower risk of dying from heart disease.

It's unclear whether red wine is directly associated with this benefit or whether other factors are at play, said Dr. Robert Kloner, chief science officer and director of cardiovascular research at Huntington Medical Research Institutes and a professor of medicine at the University of Southern California.

"It might be that wine drinkers are more likely to have a healthier lifestyle and a healthier diet such as the Mediterranean diet, which is known to be cardioprotective," he said.

But you may not even have to drink red wine to get the benefit, Kloner said. Moderate amounts of beer and spirits also have been linked to a lower risk of heart disease.

It's a common assumption that red wine may be good for the heart because it contains antioxidants such as resveratrol, which is primarily found in the skin of grapes but also peanuts and blueberries. Some studies suggest resveratrol can reduce cholesterol and lower blood pressure.

"There's a debate about whether resveratrol is really cardioprotective or not," Kloner said. "In addition, there is debate about the amount of resveratrol you would need to ingest to get a protective effect. To get the equivalent of the amount of resveratrol that has been reported to be protective would probably mean ingesting an excess of wine."

Federal guidelines and the American Heart Association recommend that if you do drink alcohol, do so in moderation. That means no more than one to two drinks per day for men and one drink per day for women. (According to the AHA, one drink is 12 ounces of beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits or 1 ounce of 100-proof spirits.)

Studies have found that moderate alcohol consumption may have some health benefits, including raising "good" HDL cholesterol levels and lowering the risk of diabetes. However, excessive drinking can lead to a host of health problems, including liver damage, obesity and some types of cancer and stroke, not to mention its negative effect on the heart.

"Alcohol in excess is really bad for the heart," Kloner said. "It can cause high blood pressure and promote arrhythmias. It can cause cardiomyopathy where the alcohol is actually toxic to the heart muscle cells, and that can lead to heart failure."

Proving moderate alcohol use causes better heart health would be tricky, Kloner said. Ideally, it would require a large prospective study that not only randomly assigns people to a no-drinking group versus a moderate-drinking group, but that also compares different types of alcohol—red wine, white wine, beer, spirits—to determine if one really is better.

"And then you'd have to control for various factors—age, gender, cardiovascular risk, their diet. You'd have to follow them for many years," he said, noting the added ethical dilemma of taking people who are not drinkers and telling them to become drinkers.

For now, the message certainly isn't to go out and start drinking, Kloner said. "But if you do drink, drinking in moderation is the way to go."

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Awareness is first step in helping stop ageism, say researchers

by Bev Betkowski, University of Alberta

Ever cracked a joke about old people? It might seem funny, but in a world where the population aged 60 or over is growing faster than all younger age groups, ageism is no laughing matter, says a University of Alberta researcher.

20 may 2019--"Ageism is now thought to be the most common form of prejudice, and the issue is, we don't even recognize how prevalent it is and how impactful it is," said Donna Wilson, a nursing professor who studies aging. "A lot of societies are really youth-oriented now and don't really respect or care about older people."

It's a trend that needs to be better quantified, Wilson suggests in a new study she conducted with fellow nursing professor Gail Low.

They reviewed questionnaires used by researchers around the world to measure ageism, and found they fell short of providing a comprehensive look at the problem.

"Most of them only asked, 'What do you think' or 'Do you act in a certain way'; what we need to do instead is start looking at the actual impact of ageism—how have older people and younger people been hurt by ageism—because until we start understanding how harmful this prejudice is to all of us, we are going to keep doing nothing about it."

Widespread impact

There's widespread fallout from systemic blatant and subtle ageism, Wilson said.

"There's a big personal impact. Children see older people being disrespected and grow up thinking they're useless and then they find themselves turning 60 or 65. We don't expect or encourage healthy aging; everybody who hits 65 thinks it's all downhill from here.

"If they think they're useless and boring, how negative is that for them and their family? They don't exercise, they don't volunteer, they don't keep working if they want to, because they feel this discrimination. They don't go out and find a new mate if their spouse dies because they think 'I'm next.' There's both a societal and personal impact to internalized ageism."

In reviewing all existing studies on the topic, Wilson discovered that 48 to 91 per cent of all older people surveyed experienced ageism, and 50 to 98 per cent of all younger people admitted to having discriminatory thoughts or behaviours toward older people.

It's important to continue exploring the scope of the problem by doing more robust research to dispel stereotypes about old people, she believes.

"We have a rapidly aging population in Canada that will jump from 19 per cent of the current population to 26 per cent in 11 years, but we're afraid of that fact. Based on ageism, we think they're a drain on society, and that's where a lot of the myths and long-standing prejudices arise."

For instance, it's commonly assumed that acute care hospital beds are taken up by elderly people, but in fact, only 20 per cent of people in hospitals are 65 and older—the rest are younger, Wilson said.

And research shows that only about three per cent of older Canadians are so chronically ill that they need to live in nursing homes, she added. "Most live in their own homes, lodges or other private-pay assisted living facilities."

It's also unfair to assume they're unproductive, Wilson added. One in five Canadians age 65 or older is still working, and more than one-third volunteer in some way.

Wilson expects that number to rise because boomers "are active, busy people who are healthy. (They) pay taxes, they start businesses, they take care of the grandkids, they do a lot to keep society going. And yet we don't value them and we all lose out."

Recommendations

Wilson recommends that attitudes about aging be more extensively surveyed through government census.

"We need to start surveying how common ageism is, and how we can get people to look at someone with gray hair and wrinkles and think positively about them."

She also recommends Canada enact anti-ageism legislation, as Britain did several years ago with its Equality Act.

She believes there'll have to be a social awakening, much like the gay rights movement.

"You can't discriminate against people who are gay, and I'd like to see that happen for older people," she said.

"This is a serious, overlooked problem that needs a lot more attention and intervention. We can't have a quarter of our population being harmed and we can't lose out on all the enormous benefits that older people can bring to society."

Indigenous cultures are among a handful of societies that provide an example to follow, Wilson noted.

"They have always respected their elders; they invite elders to meetings, ask them for guidance, elect them to important positions, make time for them. We've lost a lot of that in the modern world because we've become so homogenized and so focused on youth."

Are you ageist? Here's how to avoid it

Be aware of your own behaviour, said nursing researcher Donna Wilson.

"Once awareness starts, basic decency starts to happen. You may not realize telling old-people jokes or rushing ahead of older people so they wait in line after you is demeaning. And we need to recognize how much we love our parents and grandparents; they've usually been wonderful role models who've done the best they can to help us."

Take the World Health Organization's Ageing Attitudes Quiz to test your assumptions about aging.

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More information: Donna M. Wilson et al. Where are we now in relation to determining the prevalence of ageism in this era of escalating population ageing?, Ageing Research Reviews (2019). DOI: 10.1016/j.arr.2019.03.001

Provided by University of Alberta 

Older adults expect to lose brainpower, but most don't ask doctors how to prevent dementia

by University of Michigan

Findings from the National Poll on Healthy Aging. Credit: University of Michigan

Many Americans in their 50s and early 60s are worried about declining brain health, especially if they have loved ones with memory loss and dementia, a new national poll finds.

17 may 2019--But while the majority of those polled say they take supplements or do puzzles in an effort to stave off brain decline, very few of them have talked with their doctors about evidence-based ways to prevent memory loss.

As a result, they may miss out on proven strategies to keep their brains sharp into their later years, says the poll team from the University of Michigan.

In all, nearly half of respondents to the National Poll on Healthy Aging felt they were likely to develop dementia as they aged, and nearly as many worried about this prospect. In reality, research suggests that less than 20 percent of people who have reached age 65 will go on to lose cognitive ability from Alzheimer's disease, vascular dementia or other conditions.

Despite the brain-related concerns of so many respondents, only five percent of the entire group, and 10 percent of those who said they had a family history of dementia, said they had talked with a healthcare provider about how to prevent memory problems.

At the same time, 73 percent said they do crossword puzzles or brain games, or take supplements, to try to keep their minds sharp. Neither strategy has been shown to have a beneficial effect by major research studies.

The poll, carried out by the U-M Institute for Healthcare Policy and Innovation with support from AARP and Michigan Medicine, U-M's academic medical center, asked 1,028 adults aged 50 to 64 a range of brain health questions.

"While many people in this age range expressed concerns about losing memory, and say they take active steps to prevent it, most haven't sought advice from medical professionals, who could help them understand which steps actually have scientific evidence behind them," says Donovan Maust, M.D., M.S., a U-M geriatric psychiatrist who helped design the poll and analyze the results. "Many people may not realize they could help preserve brain health by managing their blood pressure and blood sugar, getting more physical activity and better sleep, and stopping smoking."

Maust worked with poll director Preeti Malani, M.D., U-M dementia researcher Kenneth Langa, M.D., Ph.D., and the poll team.

Effects of experience

The team found stark differences in perceptions and viewpoints between the one-third of poll respondents who said they had a family history of dementia, or had served as a caregiver to a loved one with dementia, and those without such experience or family links.

For instance, 73 percent of those with a family history of dementia said they themselves were somewhat or very likely to develop the condition as they aged—compared with just 32 percent of those with no family history. The gap between the two groups was nearly as large when the research team asked if poll respondents were worried about developing dementia later in life.

"Staying mentally sharp is the number one concern for older adults," says Alison Bryant, Ph.D., senior vice president of research for AARP. "According to the Global Council on Brain Health, people should concentrate on those things we know can improve brain health—eating a healthy diet, getting adequate sleep, exercising, and socializing with friends and family."

Attitudes toward dementia research

Differences also emerged between those who had dementia in their families, and those without, when the researchers asked respondents if they'd consider taking part in dementia-related research.

Seventy-one percent of those with a family history of dementia said they'd be willing to give researchers a sample of their DNA, compared with 51 percent of the other respondents. Nearly twice as many of those with a family history said they'd take part in a test of a new medicine aimed at preventing dementia, or a new treatment for people diagnosed with dementia.

The poll also suggests that researchers searching for better ways to prevent, diagnose or treat dementia may have to work hard to attract participants. Thirty-nine percent of those who wouldn't be willing to give a DNA sample said it was because they didn't want their DNA to be stored in a repository. Similarly, 37 percent of those who said they wouldn't take part in studies of new prevention or treatment strategies expressed concerns about being a "guinea pig", and one-fifth worried about potential harms.

Healthy lives, healthy attitudes

The poll also shows that a greater percentage of adults in their 50s and early 60s who say they get adequate sleep and exercise, ate healthily and were active socially at least several times a week felt their memory was just as sharp now as it was when they were younger, compared to those who do not engage in these healthy behaviors as frequently.

But those who said their health was fair or poor, or who reported that they didn't often engage in healthy lifestyle practices, were much more likely to say that their memory had declined since their younger years. In all, 59 percent of those polled said their memory was slightly worse than it used to be.

"For anyone who wants to stay as sharp as possible as they age, the evidence is clear: focus on your diet, your exercise, your sleep and your blood pressure," says Malani. "Don't focus on worrying about what might happen, or the products you can buy that promise to help, but rather focus on what you can do now that research has proven to help."

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Provided by University of Michigan 

What helps prevent dementia? Try exercise, not vitamin pills

by Marilynn Marchione

In this Tuesday, April 4, 2017 file photo, an elderly couple walks across a street near the Royal Palace in Madrid. If you want to save your brain, focus on keeping the rest of your body well with exercise and healthy habits rather than popping vitamin pills, say new World Health Organization guidelines for preventing dementia, released on Tuesday, May 14, 2019. (AP Photo/Francisco Seco)

If you want to save your brain, focus on keeping the rest of your body well with exercise and healthy habits rather than popping vitamin pills, new guidelines for preventing dementia advise.

15 may 2019--About 50 million people currently have dementia, and Alzheimer's disease is the most common type. Each year brings 10 million new cases, says the report released Tuesday by the World Health Organization.

Although age is the top risk factor, "dementia is not a natural or inevitable consequence of aging," it says.

Many health conditions and behaviors affect the odds of developing it, and research suggests that a third of cases are preventable, said Maria Carrillo, chief science officer of the Alzheimer's Association, which has published similar advice.

Since dementia is currently incurable and so many experimental therapies have failed, focusing on prevention may "give us more benefit in the shorter term," Carrillo said.

Much of the WHO's advice is common sense, and echoes what the U.S. National Institute on Aging says.

That includes getting enough exercise; treating other health conditions such as diabetes, high blood pressure and high cholesterol; having an active social life, and avoiding or curbing harmful habits such as smoking, overeating and drinking too much alcohol. Evidence is weak that some of these help preserve thinking skills, but they're known to aid general health, the WHO says.

Eating well, and possibly following a Mediterranean-style diet, may help prevent dementia, the guidelines say. But they take a firm stance against vitamin B or E pills, fish oil or multi-complex supplements that are promoted for brain health because there's strong research showing they don't work.

"There is currently no evidence to show that taking these supplements actually reduces the risk of cognitive decline and dementia, and in fact, we know that in high doses these can be harmful," said the WHO's Dr. Neerja Chowdhary.

"People should be looking for these nutrients through food ... not through supplements," Carrillo agreed.

The WHO also did not endorse games and other activities aimed at boosting thinking skills. These can be considered for people with normal capacities or mild impairment, but there's low to very low evidence of benefit.

There's not enough evidence to recommend antidepressants to reduce dementia risk although they may be used to treat depression, the report says. Hearing aids also may not reduce dementia risk, but older people should be screened for hearing loss and treated accordingly.

Program involving community volunteers shows promise for reducing health care use by seniors

by Canadian Medical Association Journal

Credit: CC0 Public Domain

Incorporating community volunteers into the health care system shows promise in reducing health care usage by older adults and shifting health care from hospitals to primary care, according to new research in CMAJ (Canadian Medical Association Journal).

13 may 2019--"We found that older adults who took part in the Health TAPESTRY program changed the way in which they used health care services," says lead author Dr. Lisa Dolovich, Department of Family Medicine, McMaster University, Hamilton, Ontario. "Encouragingly, participants had more visits to primary care with fewer [emergency department] and hospital admissions compared to those not in the program."

The Health TAPESTRY (Health Teams Advancing Patient Experience: Strengthening Quality) project combines new elements, such as using trained volunteers and electronic software, with the current health system, to support optimal aging in adults aged 70 years or older. While results from the randomized controlled trial did not affect the primary goal of the study, which was to help older adults to reach their health goals, there were other positive effects between the intervention and control groups. For example, there was an increase of 81 minutes of weekly walking time in the intervention group compared with a 120-minute decrease in the control group, and the intervention group reported higher overall levels of physical activity. The volunteers gave primary health care teams information that the health providers might not have otherwise known.

"These findings suggest that Health TAPESTRY has the potential to improve the way primary care is delivered in Canada by shifting care of individuals away from hospitals to the community and to a more proactive and preventative team-based model of care," says coauthor Dr. David Price, chair, Department of Family Medicine, McMaster University.

In a related commentary, Dr. Susan Smith, Royal College of Surgeons in Ireland, Dublin, Ireland, writes, "The results of this study suggest that the Health TAPESTRY intervention may contribute to improvements in patient care for older, community-dwelling adults. Further exploration of this model of care is warranted given the challenge for all health systems in shifting from single-condition care pathways to approaches that seek to address multimorbidity."

More information: CMAJ (2019). www.cmaj.ca/lookup/doi/10.1503/cmaj.181173

Journal information: Canadian Medical Association Journal 

Provided by Canadian Medical Association Journal 

Does hormone therapy for prostate cancer raise dementia risk?

by Steven Reinberg, Healthday Reporter

When men with prostate cancer have to take drugs that block the testosterone fueling their tumors, they can suffer a host of side effects that include impotence, bone loss, heart trouble and obesity.

12 may 2019--But new research uncovers yet another possible downside to the treatment: These men may be at greater risk for dementia.

For any type of dementia, that risk increased 17%; for Alzheimer's disease, it increased 23%, the researchers said.

Common side effects of so-called androgen-deprivation therapy include hot flashes, unstable mood, trouble sleeping, headaches, high blood sugar, allergic reactions and impotence.

"Androgen-deprivation therapy may not only cause physical changes —such as osteoporosis, cardiovascular disease or obesity—but may also cause changes in cognition," said researcher Dr. Karl Tully, a research fellow at Brigham and Women's Hospital in Boston.

But Tully cautioned that this study cannot prove that such hormone therapy caused dementia, only that the two are associated.

The investigators also found that men on this type of therapy had a 10% greater risk of seeking psychiatric services.

The risk for dementia increased as the length of therapy increased, the researchers noted. Men on androgen-deprivation therapy for six months had a 25% increased risk for any kind of dementia and a 37% increased risk for Alzheimer's, the findings showed.

Being on hormone therapy longer than six months increased the risk for dementia and using mental health services even more, Tully said.

For the study, Tully and his colleagues collected data on more than 100,400 men enrolled in Medicare. The men were diagnosed with prostate cancer between January 1992 and December 2009.

Given these findings, "physicians should be telling their patients about that risk and should probably perform regular screening," Tully said.

One urologist, however, doesn't think patients need to be told about this tenuous association.

"I don't think it's a fair discussion to have," said Dr. Elizabeth Kavaler, a urology specialist at Lenox Hill Hospital in New York City.

In this population, the increase in dementia may not be from hormone therapy at all, Kavaler said. As people live longer, the odds of developing dementia naturally increase.

Moreover, many of these patients probably had other medical conditions that might increase their risk for dementia and Alzheimer's, Kavaler added.

"Earlier generations were all worried about cancer—we're worried about dementia," she said.

In addition, patients with prostate cancer may not have a good option whether to start hormone therapy or not, she noted.

"We really don't have a choice. Androgen-deprivation therapy is what can be offered to men with recurring or advanced prostate cancer. It's a matter of treating a deadly disease versus the risk of developing a non-life-threatening condition," Kavaler said.

"How do you ask somebody to choose between losing your mind or not treating their high-risk disease," she said. "It's a hard position to put a patient in. I wouldn't even bring it up."

The findings were scheduled to be presented Sunday at the American Urological Association annual meeting, in Chicago. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information: Karl Tully, M.D., research fellow, Brigham and Women's Hospital, Boston; Elizabeth Kavaler, M.D., urology specialist, Lenox Hill Hospital, New York City; May 5, 2019, presentation, American Urological Association, Chicago

Visit the American Cancer Society for more on prostate cancer.

Five things to know about physician suicide

by Canadian Medical Association Journal

Physician suicide is an urgent problem with rates higher than suicide rates in the general public, with potential for extensive impact on health care systems.

07 may 2019--A "Five things to know about ..." practice article in CMAJ (Canadian Medical Association Journal) provides an overview of this serious issue.

Five things about physician suicide:

• As the only means of death more common in physicians than nonphysicians, suicide is an occupational hazard for physicians.
• Firearms, overdose and blunt force trauma are the most common means, with benzodiazepines, barbiturates and antipsychotics being the most commonly used drugs.
• Increased suicidal ideation begins as early as in medical school, with nearly 1 in 4 students surveyed reporting suicidal ideation within the last 12 months.
• Complaints to regulatory bodies are associated with higher rates of suicidal ideation.
• Suicidal physicians face unique barriers to care, including concerns regarding confidentiality, and fears of stigmatization and discrimination from peers, employers and licensing bodies.

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More information: CMAJ (2019). www.cmaj.ca/lookup/doi/10.1503/cmaj.181687

Journal information: Canadian Medical Association Journal 

Provided by Canadian Medical Association Journal 

Mental disorders more common in people who live alone

by Public Library of Science

Prevalence of common mental disorders by living arrangement. Credit: Jacob et al., 2019

Living alone is positively associated with common mental disorders, regardless of age and sex, according to a study published May 1, 2019 in the open-access journal PLOS ONE by Louis Jacob from University of Versailles Saint-Quentin-en-Yvelines, France, and colleagues.

06 may 2019--The proportion of people living alone has increased in recent years due to population aging, decreasing marriage rates and lowering fertility. Previous studies have investigated the link between living alone and mental disorders but have generally been conducted in elderly populations and are not generalizable to younger adults.

In the new study, researchers used data on 20,500 individuals aged 16-64 living in England who participated in the 1993, 2000, or 2007 National Psychiatric Morbidity Surveys. Whether a person had a common mental disorder (CMD) was assessed using the Clinical Interview Schedule-Revised (CIS-R), a questionnaire focusing on neurotic symptoms during the previous week. In addition to the number of people living in a household, data was available on factors including weight and height, alcohol dependence, drug use, social support, and loneliness.

The prevalence of people living alone in 1993, 2000, and 2007 was 8.8%, 9.8%, and 10.7%. In those years, the rates of CMD was 14.1%, 16.3%, and 16.4%. In all years, all ages, and both men and women, there was a positive association between living alone and CMD (1993 odds ratio 1.69; 2000 OR 1.63; 2007 OR 1.88). In different subgroups of people, living alone increased a person's risk for CMD by 1.39 to 2.43 times. Overall, loneliness explained 84% of the living alone-CMD association. The authors suggest that interventions which tackle loneliness might also aid the mental wellbeing of individuals living alone.

Jacob summarizes: "Living alone is positively associated with common mental disorders in the general population in England."

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More information: Jacob L, Haro JM, Koyanagi A (2019) Relationship between living alone and common mental disorders in the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. PLoS ONE 14(5): e0215182. doi.org/10.1371/journal.pone.0215182

Journal information: PLoS ONE 

Provided by Public Library of Science