The Gerontological Society of America congratulates 2009 awardees

17 oct 2009--The Gerontological Society of America (GSA) — the country's largest interdisciplinary organization devoted to the field of aging — is proud to acknowledge the work of 12 outstanding individuals through its prestigious awards program. These distinctions foster new ideas, recognize leadership in teaching and service, and salute both outstanding and potential research.

The award presentations will take place at GSA's 62nd Annual Scientific Meeting, which will be held from November 18 to 22 in Atlanta, GA, at the Atlanta Hilton and Atlanta Marriott Marquis. This conference is organized to foster interdisciplinary collaboration among researchers, educators, and practitioners who specialize in the study of the aging process. Visit www.geron.org/am for further details.

Below is a list of the 2009 awards and their recipients.

Donald P. Kent Award
Presented to Barbara Berkman, DSW, PhD, Columbia University
This award is given annually to a fellow of GSA who best exemplifies the highest standards for professional leadership in gerontology through teaching, service, and interpretation of gerontology to the larger society. It was created in 1973 in memory of Donald P. Kent for his outstanding leadership in translating research findings into practical use.

Robert W. Kleemeier Award
Presented to Gerald McClearn, PhD, Pennsylvania State University
This award is given annually to a fellow of GSA in recognition for outstanding research in the field of gerontology. It was created in 1965 and is dedicated to the memory of a former GSA president whose contributions to the quality of life through research in aging were exemplary.

Maxwell A. Pollack Award for Productive Aging
Presented to Eric A. Coleman, MD, MPH, University of Colorado Denver
This award recognizes instances of practice informed by research and analysis, research that directly improved policy or practice, and distinction in bridging the worlds of research and practice. It is funded by the New York Community Trust through a generous gift from Maxwell A. Pollack Fund.

M. Powell Lawton Award
Presented to Hans-Wener Wahl, PhD, University of Heidelberg
This award, sponsored by the Polisher Research Institute, is presented annually to an individual to honor contributions from applied gerontological research that have benefited older people and their care. It recognizes significant contributions in gerontology that led to innovations in treatment, practice or service, prevention, or amelioration of symptoms or barriers.

Margret M. and Paul B. Baltes Foundation Award in Behavioral and Social Gerontology
Presented to Derek M. Isaacowitz, PhD, Brandeis University
This award acknowledges outstanding early career contributions in behavioral and social gerontology. It is given to a person from any discipline in the social sciences.

The Doris Schwartz Gerontological Nursing Research Award
Presented to Mathy Mezey, EdD, RN, FAAN, New York University
This award, presented by GSA's Health Sciences Section, in collaboration with the John A. Hartford Foundation Institute for Geriatric Nursing, is given to a member of the Society in recognition of outstanding and sustained contribution to geriatric nursing research.

Richard Kalish Innovative Publication Award
Presented to Robert C. Atchley, PhD, Naropa University
This award recognizes insightful and innovative publications on aging and life course development in the behavioral and social sciences. It is underwritten by Baywood Publishing Company, with which Kalish was long associated.

Distinguished Career Contribution to Gerontology Award
Presented to Steven Zarit, PhD, Pennsylvania State University
This award is presented annually to an individual whose contributions over the course of his or her career have articulated a novel theoretical or methodological perspective or synthesis that addresses a significant problem in the literature.

Distinguished Mentorship in Gerontology Award
Presented to William J. "Jim" McAuley, PhD, George Mason University
This award is given to individuals who have fostered excellence in, and had a major impact on, the field by virtue of their mentoring, and whose inspiration is sought by students and colleagues.

Nathan Shock New Investigator Award
Presented to Salvatore Oddo, PhD, University of Texas Health Science Center
This award is given annually for innovative and influential publications. Established in 1986 to honor Nathan Shock, a pioneer in gerontological research at the National Institutes of Health and a founding member of GSA, it is designed to acknowledge outstanding contributions to new knowledge about aging through basic biological research.

Joseph T. Freeman Award
Presented to Stephanie Studenski, MD, MPH, University of Pittsburgh
This award is a lectureship in geriatrics and is given to a prominent physician in the field of aging, both in research and practice. It was established in 1977 through a bequest from a patient's estate as a tribute to Joseph T. Freeman, a leading physician and one of the Society's distinguished past presidents.

Task Force on Minority Issues Outstanding Mentorship Award
Presented to Terry Mills, PhD, Morehouse College
This award recognizes individuals who have exemplified outstanding commitment and dedication to mentoring minority researchers in the field of aging.

Cognitive Factors Preceding Alzheimer's Disease Examined


Study identifies four cognitive factors likely seen up to three years prior to disease onset

16 oct 2009-- The onset of Alzheimer's disease can be seen on tests for several cognitive factors up to three years prior to clinical diagnosis, according to a study in the October issue of the Archives of Neurology.

David K. Johnson, Ph.D., of the University of Kansas in Lawrence, and colleagues analyzed data on 444 seniors enrolled by the Alzheimer Disease Research Center between 1979 and 2006. To identify preclinical signs of Alzheimer's disease, the researchers evaluated four cognitive factors including global, verbal memory, visuospatial, and working memory. The trends were compared for individuals who developed Alzheimer's disease and those who did not.

The researchers note that sharp inflection points and subsequent downward trends were seen for all four cognitive factors. For global, the optimal inflection point prior to Alzheimer's disease diagnosis was two years. For verbal and working memory it was one year, and for visuospatial it was three years. The researchers had similar results when data comparisons were limited to subjects with autopsy-confirmed Alzheimer's disease.

"There is a sharp inflection point followed by accelerating decline in multiple domains of cognition, not just memory, in the preclinical period in Alzheimer disease when there is insufficient cognitive decline to warrant clinical diagnosis using conventional criteria. Early change was seen in tests of visuospatial ability, most of which were speeded," the authors write. "Research into early detection of cognitive disorders using only episodic memory tasks may not be sensitive to all of the early manifestations of disease."

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Urate Concentrations Linked to Parkinson's Progression


Study provides rationale for boosting urate concentration to slow disease progression

16 oct 2009 -- An increased concentration of the antioxidant urate in the serum or cerebral spinal fluid of a person with Parkinson's disease may slow the progression of clinical disability, according to a study published online Oct. 12 in the Archives of Neurology.

Alberto Ascherio, M.D., of the Harvard School of Public Health in Boston, and colleagues analyzed data on subjects with early Parkinson's disease who participated in the 1987 to 1988 Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism (DATATOP) trial. The researchers evaluated pretreatment urate concentration in serum and cerebrospinal fluid and its association with disease progression to the point of clinical disability requiring levodopa therapy.

The researchers found that the risk of clinical disability decreased as serum urate concentrations at baseline increased. However, the group treated with α-tocopherol (2000 IU/d) in the DATATOP trial had a higher risk of clinical disability and higher rate of change in the Unified Parkinson's Disease Rating Scale score than those not treated, suggesting it may have pro-oxidant properties at high doses. Cerebrospinal fluid urate concentration had a similar but weaker inverse relation to risk of clinical disability and rating scale score.

"Higher serum and cerebrospinal fluid urate concentrations at baseline were associated with slower rates of clinical decline. The findings strengthen the link between urate concentration and Parkinson's disease and the rationale for considering central nervous system urate concentration elevation as a potential strategy to slow Parkinson's disease progression," the authors write.

One study author reported receiving speaker and consulting fees and research grants from several pharmaceutical companies.

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Dementia Is A Terminal Illness, Study

15 oct 2009--In the first study to rigorously describe the clinical course of advanced dementia, a leading cause of death among Americans, researchers in the US concluded that dementia is a terminal illness and is insufficiently recognized as such, resulting in many patients not receiving the palliative care that aims to improve the comfort of the terminally ill.

The study was the work of lead author Dr Susan L Mitchell and colleagues and is published online in the 15 October issue of the New England Journal of Medicine, NEJM. Mitchell a senior scientist at the Institute for Aging Research of Hebrew SeniorLife, an affiliate of Harvard Medical School in Boston, Massachusetts, where she is also Associate Professor of Medicine.

Today there are more than 5 million Americans living with dementia, and this number is expected to treble over the next 40 years, with worldwide numbers rising to more than 35 million by 2050, according to a recent study by Alzheimer's Disease International.

People with dementia, of which the most common form is Alzheimer's disease, have trouble with daily living: they suffer from memory loss, find it difficult to communicate, their personality changes, and they can't reason or make decisions.

Mitchell told the press that:

"Dementia is a terminal illness; as the end of life approaches, the pattern in which patients with advanced dementia experience distressing symptoms is similar to patients dying of more commonly recognized terminal conditions, such as cancer."

Previous studies have already suggested that advanced dementia patients are under-recognized as being at high risk of death and receive insufficient palliative care, which aims to improve the comfort of the terminally ill. However, the authors wrote that the clinical course of advanced dementia in nursing home residents has not been well described.

Mitchell and colleagues examined deaths among advanced dementia patients residing in nursing homes. More than half of them died in 6 months and symptoms that frequently preceded death included pneumonia, fevers and eating problems.

They hope their findings stress the need to improve the quality of end of life care in nursing homes to relieve the suffering of patients with advanced dementia and improve communication with their family members.

"This will help to ensure that patients and families understand what to expect in advanced dementia, so that appropriate advance care plans can be made," said Mitchell.

For the Choices, Attitudes and Strategies for Care of Advanced Dementia at the End-of-Life (CASCADE) study, which was funded by the National Institutes of Health, the researchers followed the clinical course of 323 residents with advanced dementia being cared for in 22 Boston-area nursing homes for up to 18 months.

During the final stage of their dementia, the patients' memory deficits were so profound they could no longer recognize close family members, spoke fewer than six words, were incontinent and could not walk around.

177 of the patients died during the course of the study. The results showed that the most common complications, which were associated with high six-month mortality rates, were pneumonia, febrile episodes and eating problems.

Other symptoms were also common and increased as patients approached the end of their lives. These were uncomfortable and included pain, pressure ulcers, shortness of breath and aspiration.

Mitchell and colleagues also found that while 96 per cent of the patients' healthcare proxies (the individuals legally empowered to make healthcare decisions on behalf of the patients) believed that comfort was the primary goal of care for their loved one, nearly 41 per cent of the patients who died during the study received at least one medical intervention during the last three months of life.

The interventions included being admitted to hospital, being taken to an emergency room, having intravenous therapy and tube feeding.

However, the researchers also found that patients whose healthcare proxies appeared to understand the clinical course of their loved one's advanced dementia were less likely to undergo aggressive interventions towards the end of their lives.

At the start of the study, 81 per cent of the proxies said they thought they understood which clinical complications to expect, but only one third said that a doctor had counseled them about it.

Mitchell said that:

"Many of the patients in our study underwent interventions of questionable benefit in the last three months of life."

"However, when their healthcare proxies were aware of the poor prognosis and expected clinical complications in advanced dementia, patients were less likely to undergo these interventions and more likely to receive palliative care in their final days of life," she explained.

In conclusion, Mitchell said that a critical step in improving the care of patients with end-stage dementia is to have a understanding of the clinical course of the final stages of the disease.

"This knowledge will help to give healthcare providers, patients and families more realistic expectations about what they will confront as the disease progresses and the end of life approaches," she added.

In an accompanying editorial in the same issue of the journal, geriatrician and medical ethicist Dr Greg A Sachs of the Indiana University Center for Aging Research, noted that end-of-life care for most older people with dementia has not changed in decades and urged that these patients receive more palliative care to help manage their pain and other symptoms.

Sachs said this new study by Mitchell and colleagues:

"Moves the field forward in major ways with regard to both prognosis and the terminal nature of advanced dementia."

Sachs said that more research like this is needed to update public policy and get lawmakers and insurers to see the need to increase support and heathcare for older people who can no longer speak for themselves.

"Since individuals with advanced dementia cannot report their symptoms, these symptoms often are untreated, leaving them vulnerable to pain, difficulty breathing and various other conditions," said Sachs.

We shouldn't allow these people to suffer," he added, and urged that we provide instead "palliative care to make them more comfortable in the time they have left".

Sachs acknowledged that it is not easy to pick up nonverbal clues of pain, but urged caregivers and medical staff to look out for them. Examples include noticing the patient holding the body in a certain way to avoid being in a painful position, spotting signs of swollen or tender joints. A caregiver reporting these symptoms, or a doctor noticing them during a medical exam, could make a significant difference to the patient's comfort and may also help spot underlying conditions, he said.

Sachs explained that palliative care is a team effort that manages pain and medical treatment, and it gives patients emotional support that meets their needs. He pointed out that while hospices provide palliative care, which focuses on relieving symptoms like pain, shortness of breath, fatigue, nausea, difficulty sleeping and loss of appetite, it can also be administered in other settings regardless of prognosis along with medical treatment. It does not hasten death, he stressed.

"The Clinical Course of Advanced Dementia."
Mitchell, Susan L., Teno, Joan M., Kiely, Dan K., Shaffer, Michele L., Jones, Richard N., Prigerson, Holly G., Volicer, Ladislav, Givens, Jane L., Hamel, Mary Beth
N Engl J Med 2009, Volume 361, Number 16, pp 1529-1538
Published online 15 October 2009

"Dying from Dementia."
Sachs, Greg A.
N Engl J Med 2009, Volume 361, Number 16, pp 1595-1596.
Published online 15 October 2009

Additional sources: Hebrew SeniorLife Institute for Aging Research, Indiana University School of Medicine.

Working After Retirement Leads To Better Health, According To National Study

15 oct 2009--Retirees who transition from full-time work into a temporary or part-time job experience fewer major diseases and are able to function better day-to-day than people who stop working altogether, according to a national study. And the findings were significant even after controlling for people's physical and mental health before retirement.

The study's authors refer to this transition between career and complete retirement as "bridge employment," which can be a part-time job, self-employment or a temporary job. The findings are reported in the October issue of the Journal of Occupational Health Psychology, published by the American Psychological Association.

"Given the economic recession, we will probably see more people considering post-retirement employment," said co-author Mo Wang, PhD, of the University of Maryland. "These findings highlight bridge employment's potential benefits."

For this study, Wang and his fellow researchers looked at the national Health and Retirement Study, which is sponsored by the National Institute on Aging. They used data from 12,189 participants who were between the ages of 51 and 61 at the beginning of the study. The participants were interviewed every two years over a six-year period beginning in 1992 about their health, finances, employment history and work or retirement life.

In order to measure the respondents' health over the course of the study, the researchers considered only physician-diagnosed health problems, such as high blood pressure, diabetes, cancer, lung disease, heart disease, stroke and psychiatric problems. They controlled not only for baseline physical and mental health but also for age, sex, education level, and total financial wealth. The results showed the retirees who continued to work in a bridge job experienced fewer major diseases and fewer functional limitations than those who fully retired.

The participants answered a basic mental health questionnaire. The findings showed that people whose post-retirement jobs were related to their previous careers reported better mental health than those who fully retired. However, these mental health improvements were not found among people who worked in jobs outside their career field post-retirement. The authors say this may be because retirees who take jobs not related to their career field may need to adapt to a different work environment or job conditions and, therefore, become more stressed. Also, Wang has found retirees with financial problems are more likely to work in a different field after they officially retire.

"Rather than wanting to work in a different field, they may have to work," said Wang. "In such situations, it's difficult for retirees to enjoy the benefits that come with bridge employment." The authors suggest that, when possible, retirees carefully consider their choice of post-retirement employment.

"Choosing a suitable type of bridge employment will help retirees transition better into full retirement and in good physical and mental health," said co-author Kenneth Shultz, PhD, adding that employers who are concerned about a labor shortage due to numerous baby boomers retiring might consider bridge employment options for their retirees.

Article:
"Bridge Employment and Retirees' Health: A Longitudinal Investigation," Yujie Zhan, MS, Mo Wang, PhD, and Songqi Liu, MS, University of Maryland; Kenneth S. Shultz, PhD, California State University, San Bernardino; Journal of Occupational Health Psychology, Vol. 14, No. 4.

(Full text of the article: http://www.apa.org/journals/releases/ocp-14-4-374.pdf)

Source:
Audrey Hamilton
American Psychological Association

Noncorrectable vision problems associated with shorter lifespan in older adults

14 oct 2009--Visual problems that cannot be corrected are associated with increased risk of death among individuals between the ages of 49 and 74, and all visual impairments may be associated with the risk of death in older adults, according to a report in the October issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Visual impairment has been associated with a higher risk of death as well as factors that may lead to increased death such as unintentional injury, depression, lower body mass index (BMI), reduced walking speeds, increased risk of falls, self-reported difficulty in physical activity, cardiovascular disease, dementia and cancer, according to background information in the article. "Correction for these 'confounders' has been found to attenuate the association between visual impairment and mortality, but the mechanisms behind the association between visual impairment and mortality remain to be determined."

Michael J. Karpa, M.B.B.S., B.Sc., of Westmead Millennium Institute, Sydney, Australia, and colleagues used data from the Blue Mountains Eye Study, which examined visual impairment in 3,654 participants age 49 and older between 1992 and 1994 and after five and ten years, to evaluate the relationship between visual impairment and death risk among older individuals.

At baseline, participants with noncorrectable visual impairment were more likely to be female, age 75 and older and underweight. Those with correctable visual impairment were more likely to be age 75 and older, but had no difference in proportions of women or BMI.

Thirteen years after baseline, 1,273 participants had died. A higher risk of dying was associated with noncorrectable visual impairment, with a stronger association for participants younger than age 75. The analyses "revealed greater effects of noncorrectable visual impairment on mortality risk, with both direct and indirect effects," the authors write. "Of mortality risk markers examined, only disability in walking demonstrated a significant indirect pathway for the link between visual impairment and mortality."

"In conclusion, this study reaffirms that visual impairment is associated with an increased risk of all-cause mortality," the authors write. "Disability in walking may represent an important indirect pathway to mortality for persons with visual impairment, and adjusting for this factor in statistical analysis may overadjust for the indirect effect of visual impairment on mortality risk. The impact of visual impairment on mortality may in fact be greater than that reported from previous studies that have used traditional statistical models."

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(Arch Ophthalmol. 2009;127[10]:1347-1353. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: The Blue Mountains Eye Study was supported by National Health and Medical Research Council (Australia) grants. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Declines in other thinking and learning skills may precede memory loss in Alzheimer's disease

14 oct 2009--Cognitive abilities other than memory, including visuospatial skills needed to perceive relationships between objects, may decline years prior to a clinical diagnosis in patients with Alzheimer's disease, according to a report in the October issue of Archives of Neurology, one of the JAMA/Archives journals.

"Recent studies have focused on identifying the beginning of the transition from healthy aging to dementia," the authors write as background information in the article. "As new interventions become available, it will become important to identify the disease as early as possible." Loss of episodic memory—remembering events in one's life that can be explicitly stated—is commonly linked to Alzheimer's disease, but it is not the only aspect of cognition (thinking, learning and memory) that is affected.

David K. Johnson, Ph.D., of the University of Kansas, Lawrence, and colleagues assessed 444 individuals who did not have dementia when they were enrolled in the study, between 1979 and 2006. Upon enrolling, each participant underwent a clinical evaluation and a psychometric assessment including tests of four cognitive factors: global cognition, verbal memory, visuospatial skill and working memory. Participants were then evaluated at least one additional time before November 2007.

Over an average follow-up of 5.9 years, 134 individuals developed dementia and 310 did not; 44 with dementia died and underwent brain autopsies that confirmed a diagnosis of Alzheimer's disease. Using data from the psychometric assessments, the researchers constructed models to evaluate the decline in various cognitive areas before individuals were diagnosed with dementia. "A novel finding was that visuospatial abilities demonstrated an inflection point [sudden change to a steeper slope of decline] three years before clinical diagnosis," the authors write.

Declines in overall cognitive abilities followed in the next year, whereas inflection points for verbal and working memory were not seen until one year before clinical diagnosis. Similar results occurred in only the subgroup of individuals with Alzheimer's disease diagnosis confirmed by autopsy.

"There are several implications of this study," the authors conclude. "Some of the earliest signs of preclinical disease may occur on tests of visuospatial and speeded psychomotor skills. Furthermore, the greatest rate of preclinical decline may occur on executive and attention tasks. These findings suggest that research into early detection of cognitive disorders using only episodic memory tasks, such as word lists or paragraph recall, may not be sensitive to either all of the earliest manifestations of disease or the most rapidly changing domain."

"In summary, converging longitudinal evidence suggests that after a sharp departure from the relatively flat course of normal aging there is a preclinical period in Alzheimer's disease with insufficient cognitive decline to warrant clinical diagnosis using conventional criteria but that can be seen with longitudinal data from multiple domains of cognition and not just memory," they conclude.

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(Arch Neurol. 2009;66[10]:1254-1259. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by grants from the National Institute on Aging, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Atypical β-Blocker May Improve Endothelial Function


Nebivolol could be effective treatment of hypertension, heart failure, CAD

13 oct 2009-- Nebivolol, a third generation β-blocker that has recently become available in the United States, offers a treatment alternative for hypertension, coronary artery disease and heart failure that goes beyond simple adrenergic blocking with direct vasodilation and stimulatory effects to improve arterial endothelial function, according to a paper in the Oct. 13 Journal of the American College of Cardiology.

Thomas Münzel, M.D., of II Medizinische Klinik für Kardiologie/Angiologie in Mainz, Germany, and a colleague reviewed the medication's properties, focusing on the mechanisms by which nebivolol may help improve endothelial function, reduce risk of platelet aggregation and thrombus formation, and reduce inflammation.

Unlike other β-blockers, nebivolol has been shown to stimulate activity of the endothelial nitric oxide synthase to increase beneficial nitric oxide levels, while its antioxidative properties reduce oxidative stress, the researchers note. Nebivolol also has been shown to inhibit platelet aggregation and down-regulate multiple genes involved in inflammatory processes, oxidative stress, and smooth muscle cell proliferation, offering a possible benefit in the treatment of atherosclerosis. Also, because nebivolol has a greater selectivity for β₁-receptors, it offers improved tolerability for patients with asthma or chronic obstructive pulmonary disease. Nebivolol contraindications include severe bradycardia, cardiogenic shock, atroventricular nodal block, decompensated heart failure, and severe hepatic disease.

"Although a decade of clinical experience with this drug in Europe provides support to its blood pressure-lowering and anti-ischemic effects, further clinical trial data are necessary. Particularly, comparative trials on the efficacy of nebivolol versus other β-blockers and/or other antihypertensive drugs are awaited," Münzel and colleagues conclude.

The lead author has received honoraria and research grants from Berlin Chemie and Forrest Hill.

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Visual Impairment May Affect Mortality Risk in Elders

Study suggests non-correctable visual decline associated with higher odds of death

13 oct 2009-- Visual impairment that cannot be corrected increases the odds of mortality in older adults, especially among those younger than 75, according to a study published in the October issue of the Archives of Ophthalmology.

Michael J. Karpa, of the University of Sydney in Australia, and colleagues conducted a study of 3,654 people aged 49 years and above who were examined from 1992 to 1994 and again after five and 10 years.

Thirteen years after the start of the study, 1,273 participants had died, and non-correctable visual impairment was associated with higher mortality, the researchers discovered. Among those younger than 75 years, this association was stronger, and disability in walking also played an indirect role in the association between mortality and visual impairment, the investigators found.

"Disability in walking may represent an important indirect pathway to mortality for persons with visual impairment, and adjusting for this factor in statistical analysis may overadjust for the indirect effect of visual impairment on mortality risk," the authors write. "The impact of visual impairment on mortality may in fact be greater than that reported from previous studies that have used traditional statistical models."

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Simple tool can boost motivation, improve health in older adults

Boston, 12 oct 2009 – Researchers from Boston University School of Medicine (BUSM) have identified a tool, the "Getting-Out-of-Bed (GoB) measure" to assess motivation and life outlook in older adults. The study, which appears in the October issue of the Journal of Psychosocial Oncology, shows that the tool has the potential to be an easy-to-use measure to bolster motivation and thus, improve health behaviors and outcomes in the growing population of older adults.

The demographics of aging in the United States continues to change dramatically. In 2006, 37 million Americans, 12 percent of the population were 65 years or older. By 2030, those 65 years and older are projected to number 71.5 million representing nearly 20 percent of the US population. Furthermore, between 1992 and 2004 average inflation-adjusted health care costs for older Americans increased from $8,644 to $13,052 and are expected to continue to rise considerably. According to the researchers, such numbers underscore the importance of understanding common diseases and health behaviors of older adults, because many conditions can be prevented and/or modified with behavioral interventions.

"Motivation and life outlook play an important part in an older adult's ability to recover from illness or disabling events and to maintain and/or adopt health-promoting behaviors," said lead author Kerri Clough-Gorr, DSc, MPH, from the Section of Geriatrics at BUSM.

The researchers conducted telephone interviews on a sample of 660 women with breast cancer from four geographic regions of the country at three and six months intervals. Motivation and life outlook was assessed using GoB questions. Women with GoB scores ≥50 (representing higher motivation) at baseline were statistically significantly more likely at 6 months to have good health-related quality of life, good self-perceived health and report regular exercise than those with scores <50,>

"The ability to identify patients with low motivation establishes an opportunity for health care providers to develop and implement interventions to improve older adults' motivation and to help them attain and maintain a higher quality of health and life. The GoB may help target adequate interventions to bolster motivation and thus improve health behaviors and outcomes in older adults," added Clough-Gorr.

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This study was supported by grants from the National Cancer Institute.

Enzyme may be a key to Alzheimer's-related cell death

WEST LAFAYETTE, Ind., 12 oct 2009 - A Purdue University researcher has discovered that the amount of an enzyme present in neurons can affect the mechanism thought to cause cell death in Alzheimer's disease patients and may have applications for other diseases such as stroke and heart attack.

Sandra Rossie, a professor of biochemistry, found that increasing the amount of protein phosphatase 5, or PP5, in rat neural cells resulted in less cell death associated with reactive oxygen species, which chemically damage cell molecules. Conversely, decreasing PP5 caused greater cell death. The results of Rossie's study are published in the early online version of the Journal of Neurochemistry.

Alzheimer's, a degenerative neurological disease affecting around 5 million people, results in memory loss and dementia. One theory on the cause of Alzheimer's is that overproduction of certain forms of amyloid beta protein by neurons leads to the generation of reactive oxygen species, which activate stress pathways.

"If stress pathways remain active for a prolonged period, the cell will die," Rossie said.

Rossie's lab found that PP5 overexpression prevents neuronal death by amyloid beta and shuts off the stress pathways. When reactive oxygen that wasn't created by amyloid beta was used on the cells, the results were the same. In contrast, neurons with reduced PP5 are more sensitive to death caused by amyloid beta.

"That suggests to us that PP5 protects neurons from cell death induced by reactive oxygen species, not just the presence of amyloid beta," Rossie said. "This means that PP5 may protect against other health problems involving reactive oxygen species as well, such as stroke and heart attacks."

It is possible, Rossie said, that finding a way to increase PP5 activity could help prevent the loss of neurons by amyloid beta.

Rossie said PP5 also could play a role in inhibiting other responses of neurons to amyloid beta. Her lab will work to determine which pathways PP5 affects, and which of those is most responsible for neural protection by PP5.

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The National Institutes of Health funded Rossie's research.

Mediterranean diet associated with reduced risk of depression

12 oct 2009--Individuals who follow the Mediterranean dietary pattern -rich in vegetables, fruits, nuts, whole grains and fish- appear less likely to develop depression, according to a report of the University of Navarra, published in the October issue of Archives of General Psychiatry.

The lifetime prevalence of mental disorders has been found to be lower in Mediterranean than Northern European countries, according to background information in the article. One plausible explanation is that the diet commonly followed in the region may be protective against depression. Previous research has suggested that the monounsaturated fatty acids in olive oil -used abundantly in the Mediterranean diet- may be associated with a lower risk of severe depressive symptoms.

The researchers studied 10,094 healthy Spanish participants who completed an initial questionnaire between 1999 and 2005. Participants reported their dietary intake on a food frequency questionnaire, and the researchers calculated their adherence to the Mediterranean diet based on nine components (high ratio of monounsaturated fatty acids to saturated fatty acids; moderate intake of alcohol and dairy products; low intake of meat; and high intake of legumes, fruit and nuts, cereals, vegetables and fish).

30% reduction in the risk of depression

After a median (midpoint) of 4.4 years of follow-up, 480 new cases of depression were identified, including 156 in men and 324 in women. Individuals who followed the Mediterranean diet most closely had a greater than 30 percent reduction in the risk of depression than those who had the lowest Mediterranean diet scores.

"The specific mechanisms by which a better adherence to the Mediterranean dietary pattern could help to prevent the occurrence of depression are not well known," the authors write. Components of the diet may improve blood vessel function, fight inflammation, reduce risk for heart disease and repair oxygen-related cell damage, all of which may decrease the chances of developing depression.

"However, the role of the overall dietary pattern may be more important than the effect of single components. It is plausible that the synergistic combination of a sufficient provision of omega-three fatty acids together with other natural unsaturated fatty acids and antioxidants from olive oil and nuts, flavonoids and other phytochemicals from fruit and other plant foods and large amounts of natural folates and other B vitamins in the overall Mediterranean dietary pattern may exert a fair degree of protection against depression," the authors write.

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The study has been funded by the Instituto de Salud Carlos III.

More Elderly Might Benefit From Stroke Treatment


Elderly under-represented in stroke research; receive less treatment than younger patients

11 oct 2009-- Given an aging population, the prevention and treatment of stroke in the very elderly -- who are under-represented in studies regarding therapy -- will become more important, according to research published online Oct. 2 in The Lancet Neurology.

Nerses Sanossian, M.D., of the University of Southern California and Bruce Ovbiagele, M.D., of the University of California, both in Los Angeles, reviewed data on stroke prevention and treatment in the very elderly against a backdrop of increasing life expectancy and a much higher risk of stroke in older age.

Research has shown that antihypertensive therapy can reduce stroke incidence and mortality in those over 80 years of age, and that statin therapy may benefit elderly people at high risk of stroke. Some data also supports the safety and effectiveness of anticoagulation in individuals over 75 with atrial fibrillation, though this therapy is often not given due to fear of complications. Thrombolysis with alteplase may be helpful for treatment of acute stroke in the very elderly, but should be considered on an individual basis.

"Perhaps not surprisingly, the use of evidence-based stroke treatments in patients much older than the clinical trial population in which these treatments were initially tested is of great concern to many clinicians. However, a growing body of evidence indicates that these therapies can be feasibly and effectively used in very elderly patients with stroke or at risk of stroke," the authors conclude.

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Novel Risk Factors Not Found Useful for Heart Screening


U.S. Preventive Services Task Force says evidence for nine proposed risk factors is insufficient

11 oct 2009-- After a systematic review of the research, the U.S. Preventive Services Task Force (USPSTF) finds there is insufficient evidence to support the use of any of nine novel risk factors in the routine screening of patients for coronary heart disease (CHD), according to a study in the Oct. 6 Annals of Internal Medicine.

The U.S. Preventive Services Task Force, from the Agency for Healthcare Research and Quality in Rockville, Md., reviewed the research since 1996 on the nine potential CHD risk factors, including C-reactive protein, lipoprotein(a), coronary artery calcium, leukocyte count, fasting blood glucose, homocysteine, periodontal disease, ankle-brachial index and carotid intima-media thickness. The reviewers evaluated each factor for reclassifying a patient at intermediate-risk for CHD (based on established risk factors) to a low-risk or high-risk status. While C-reactive protein was found to have some predictive value, the task force found insufficient evidence to support reclassification using any of the risk factors.

In a related study conducted for the USPSTF published in the same journal, Mark Helfand, M.D., of the Oregon Evidence-based Practice Center, and colleagues evaluated the same risk factors. The researchers conclude that C-reactive protein was both the most studied and most likely candidate for patient screening, but the evidence was inconclusive.

"The USPSTF concludes that the current evidence is insufficient to asses the balance of benefits and harms of using the nontraditional risk factors studied to screen asymptomatic men and women with no history of CHD to prevent CHD events," authors of the first study write.

Abstract - USPSTF
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Low-Contrast Visibility May Be Issue for Parkinson's Drivers

Study suggests patients may be at increased risk for unsafe driving during fog or twilight

09 oct 2009-- Drivers with Parkinson's disease may be more prone to poor vehicle control and crashes while driving in low-contrast visibility conditions due to issues with perception, cognition and motor dysfunction, according to a study in the Oct. 6 issue of Neurology.

Ergun Y. Uc, M.D., of the University of Iowa in Iowa City, and colleagues analyzed data from 67 currently active drivers with mild to moderate Parkinson's disease and 51 controls. Participants drove using a driving simulator under clear conditions and then mildly foggy conditions. During the study, participants reached an intersection where another vehicle posed a crash risk under low-contrast visibility.

The researchers found that drivers with Parkinson's disease had a higher standard deviation of lateral position and lane violation counts than unaffected controls under low-contrast visibility. These measurements increased more in drivers with Parkinson's disease upon the transition from clear to foggy conditions. More drivers with Parkinson's disease crashed at the foggy intersection (76.1 versus 37.3 percent), as their time to first reaction in response to the incursion was longer.

"Our results suggest that a large proportion of drivers with Parkinson's disease may be at further risk for unsafe driving during fog or twilight because of visual, cognitive, and motor impairments," the authors conclude.

Abstract
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Medication Errors in Nursing Home Residents Assessed


U.K. study suggests that one or more errors affect nearly 70 percent of residents

09 oct 2009-- In the United Kingdom, more than two-thirds of nursing home residents may be exposed to medication errors, according to a study in the October issue of Quality and Safety in Health Care.

Nick D. Barber, Ph.D., of the School of Pharmacy in London, and colleagues conducted a prospective study of a random sample of 256 residents in 55 nursing homes who were taking a mean of eight medications.

The researchers found that one or more medication errors occurred in 178 (69.5 percent) of residents and that a mean of 1.9 errors occurred per resident. On a scale of zero to 10, with zero indicating no harm and 10 indicating death, they found that the mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0, respectively. They also found that factors which contributed to errors included inaccessible doctors who were unfamiliar with residents and lacked sufficient information to appropriately prescribe medications.

"We suggest the idea of a lead (not sole) general practitioner for each home should be explored," the authors write. "This role would need protected time and associated funding. In addition to caring for patients, they should liaise with other general practitioners and have responsibility to ensure, possibly by commissioning services, that patients on riskier medicines are appropriately monitored and that all patients' medication is regularly reviewed by a pharmacist."

Abstract
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A Simple Way For Older Adults To Asses Arterial Stiffness: Reach For The Toes

07 Oct 2009

How far you can reach beyond your toes from a sitting position - normally used to define the flexibility of a person's body - may be an indicator of how stiff your arteries are.

A study in the American Journal of Physiology has found that, among people 40 years old and older, performance on the sit-and-reach test could be used to assess the flexibility of the arteries. Because arterial stiffness often precedes cardiovascular disease, the results suggest that this simple test could become a quick measure of an individual's risk for early mortality from heart attack or stroke.

"Our findings have potentially important clinical implications because trunk flexibility can be easily evaluated," said one of the authors, Kenta Yamamoto. "This simple test might help to prevent age-related arterial stiffening."

It is not known why arterial flexibility would be related to the flexibility of the body in middle age and older people. But the authors say that one possibility is that stretching exercises may set into motion physiological reactions that slow down age-related arterial stiffening.

The study "Poor trunk flexibility is associated with arterial stiffening" appears in the American Journal of Physiology - Heart and Circulatory Physiology. The authors are: Kenta Yamamoto of the University of North Texas and the National Institute of Health and Nutrition, Japan; Hiroshi Kawano, Yuko Gando and Mitsuru Higuchi of Waseda University, Japan; Motoyuki Iemitsu of International Pacific University, Japan; Haruka Murakami, Michiya Tanimoto, Yumi Ohmori, Izumi Tabata, Motohiko Miyachi of the National Institute of Health and Nutrition; and Kiyoshi Sanada of Ritsumeikan University, Japan. The American Physiological Society published the study.

Arteries should be elastic

Healthy blood vessels are elastic, and elasticity helps to moderate blood pressure. Arterial stiffness increases with age and is a risk factor for cardiovascular disease and death. Previous studies have established that physical fitness can delay age-related arterial stiffness, although exactly how that happens is not understood. The authors noted that people who keep themselves in shape often have a more flexible body, and they hypothesized that a flexible body could be a quick way to determine arterial flexibility.

The researchers studied 526 healthy, non-smoking adults, 20 to 83 years old, with a body mass index of less than 30. They wanted to see whether flexibility of the trunk, as measured with the sit and reach test, is associated with arterial stiffness. The researchers divided the participants into three age groups:

- young (20-39 years old)
- middle aged (40-59 years old)
- older (60-83 years old)

The researchers asked participants to perform a sit-and-reach test. The volunteers sat on the floor, back against the wall, legs straight. They slowly reached their arms forward by bending at the waist. Based on how far they could reach, the researchers classified the participants as either poor- or high-flexibility.

The researchers also measured blood pressure and the speed of a pulse of blood as it flowed through the body. They measured how long the pulse takes to travel between the arm and the ankle and between the neck and the leg. They also measured aortic pressure in some participants and tested the participants for cardiorespiratory fitness, muscular strength and endurance.

The study found that trunk flexibility was a good predictor of artery stiffness among middle age and older participants, but not among the younger group. In middle age and older participants, they also found that systolic blood pressure (the peak pressure that occurs as the heart contracts) was higher in poor-flexibility than in high-flexibility groups.

What's happening?

Why would the flexibility of the body be a good indicator of arterial stiffness? In the study, the authors speculate on why this would be. One possibility is that there is a cause and effect: the stretching exercises that provide flexibility to the body may also slow the age-related stiffening of the arteries. The study found that arterial stiffness among middle age and older people was associated with trunk flexibility but was independent of muscle strength and cardiorespiratory fitness (as measured by performance on an exercycle). In addition, they cited another recent study that found that middle age and older adults who began a regular stretch exercise program significantly improved the flexibility of their carotids, a major artery found in the neck.

"Together with our results, these findings suggest a possibility that improving flexibility induced by the stretching exercise may be capable of modifying age-related arterial stiffening in middle-aged and older adults," Dr. Yamamoto said. "We believe that flexibility exercise, such as stretching, yoga and Pilates, should be integrated as a new recommendation into the known cardiovascular benefits of regular exercise."

Loneliness Linked To High Blood Pressure In Aging Adults

08 oct 2009--Loneliness is a major risk factor in increasing blood pressure in older Americans, and could increase the risk of death from stroke and heart disease, new research at the University of Chicago shows.

Scholars found that lonely people have blood pressure readings that are as much as 30 points higher than in non-lonely people, even when other factors such as depressive symptoms or perceived stress are taken into account, said Louise Hawkley, Senior Research Scientist with the Center for Cognitive and Social Neuroscience at the University of Chicago, and John Cacioppo, the Tiffany & Margaret Blake Distinguished Service Professor in Psychology. This is equivalent to the difference between a normal blood pressure of 120 and a level of 150 which signifies Stage 1 hypertension. Blood pressure differences between lonely and non-lonely people were smallest at age 50 and greatest among the oldest adults tested, those at retirement age.

Hawkley and Cacioppo are authors of the paper, "Loneliness is a Unique Predictor of Age-Related Differences in Systolic Blood Pressure," published in the journal Psychology and Aging. Other co-authors were Christopher Masi, Assistant Professor of Medicine at the University of Chicago, and Jarett Berry of the Department of Preventive Medicine, Northwestern.

The increase in blood pressure associated with loneliness is about the same magnitude as reductions attained through weight loss and regular physical activity in people suffering from hypertension. "By these standards, improvements in a sense of social connectedness may have clinical benefits comparable to lifestyle modifications," the authors wrote.

The team based their research on a study of 229 people aged 50 to 68. The randomly chosen group includes whites, African Americans and Latinos who are part of a long-term study on aging. Members of the group were asked a series of questions to determine if they perceived themselves as lonely.

They were asked to rate their connections with others through a series of topics, such as "I have a lot in common with the people around me," "My social relationships are supeficial," and "I can find companionship when I want it."

The research team also examined data on weight, alcohol consumption, smoking, blood pressure medications, and demographic characteristics and found that people who rated high on being lonely had a significantly higher blood pressure than non-lonely people with similar profiles on the other measures.

The research also showed that the normal increases in blood pressure associated with aging are augmented by loneliness.

The paper builds on Cacioppo's earlier research that demonstrated that the loneliness is related to increased peripheral vascular resistance among young people. Although both lonely and non-lonely people in that study experienced stress, subjects in both studies reacted to stress differently.

"Lonely people differ from non-lonely individuals in their tendency to perceive stressful circumstances as threatening rather than challenging, and to passively cope with stress by failing to solicit instrumental and emotional support and by withdrawing from stress rather than by actively coping and attempting to problem solve," Cacioppo said.

The study on young people showed that stress caused an increase in resistance to blood flow brought on by their response to stress. Greater resistance to blood flow in lonley people compared to non-lonely idnvidiauls could increase blood pressure over the lifetime of lonely people, Cacioppo said.

Longitudinal studies are underway to look at how loneliness, now associated with an increase in blood pressure, may play a causal role in the increase, he said.

"I'm surprised by the magnitude of the relationship between loneliness and hypertension in this well-controlled cross-sectional study," said Richard Suzman, Ph.D., director of the Behavioral and Social Research Program at the National Institute on Aging (NIA), a funder of the research "Older people's relationships are often disrupted by death, illness and geographic mobility. One of NIA's goals is to help determine what can be done to improve the quality of relationships and social connectedness as a way to ease loneliness and reduce blood pressure."

Antioxidants may raise diabetes risk: study

CHICAGO, 07 oct 2009– Instead of protecting against diabetes, antioxidants -- compounds in foods and supplements that prevent cell damage -- may actually increase the chances of getting diabetes, at least in the early stages, Australian researchers reported on Tuesday.

"In the case of early type 2 diabetes ... our studies suggest that antioxidants would be bad for you," Tony Tiganis of Monash University in Australia, whose study appears in the journal Cell Metabolism, said in a statement.

Antioxidants are protective proteins that can prevent cell damage caused by charged particles known as reactive oxygen species. This oxidative stress is thought to add to the progression of several diseases, including type 2 diabetes.

Because antioxidants fight oxidative stress, they have become a popular food supplement. But Tiganis said the picture appears to be a bit more complicated.

"We think there is a delicate balance, and that too much of a good thing -- surprise, surprise -- might be bad," he said.

Tiganis' team studied the effects of oxidative stress in mice fed a high-fat diet for 12 weeks. One group of mice lacked an enzyme known as Gpxl, which helps counter oxidative stress.

They found mice that lacked the enzyme were less likely to develop insulin resistance -- an early sign of diabetes -- than normal mice. But when they treated the enzyme-deficient mice with an antioxidant, "they lost this advantage and become more 'diabetic," Tiganis said in an e-mail.

He said oxidative stress may be working not to damage the body but to inhibit enzymes that hurt the body's ability to use insulin early on in the development of diabetes, and that antioxidants remove this protective mechanism.

"Our work suggests that antioxidants may contribute to early development of insulin resistance, a key pathological hallmark of type 2 diabetes," Tiganis said.

He cautioned that the study was in mice and more study in people is needed.

But he said other studies have suggested that antioxidants can shorten lifespan in both worms and humans. And clinical trials in people have shown that taking antioxidants does not protect healthy people from developing diabetes.

"My belief is that individuals who are otherwise healthy should not take antioxidants, but rather eat healthy and exercise," he said.

An estimated 23.6 million people in the United States and 246 million people globally have diabetes. Most have type 2, the kind linked with a poor diet and lack of exercise.

New guidelines for incorporating spirituality in end-of-life care

New Rochelle, NY, 07 oct 2009—Guidelines derived from a recent Consensus Conference, including recommendations on the role of healthcare providers in the assurance of quality spiritual care to patients in a palliative care setting, are published in a comprehensive report in Journal of Palliative Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc. (www.liebertpub.com). Journal of Palliative Medicine is the official journal of the Center to Advance Palliative Care (CAPC) and an official journal of the Hospice and Palliative Nurses Association (HPNA). The article is available free online at www.liebertpub.com/jpm

The article, "Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference," represents the final Consensus Report of a conference sponsored by the Archstone Foundation of Long Beach, CA. According to Joseph F. Prevratil, JD, President and CEO, "The report's recommendations seek to ensure that spiritual care is a fundamental component of quality palliative care, which strives to prevent and relieve suffering for seriously ill patients and their families."

"For the first time we have a practical model for the implementation of inter-professional spiritual care which will result in improved healthcare outcomes for patients," says Christina Puchalski, MD, MS, FACP, Co-Principal Investigator and lead author of the Consensus Report, from The George Washington Institute for Spirituality and Health (GWish) at the George Washington University Medical Center.

The Consensus Report outlines seven key areas for improving spiritual care: Spiritual Care Models; Spiritual Assessment; Spiritual Treatment/Care Plans; Interprofessional Team; Training/Certification; Personal and Professional Development; and Quality Improvement. Co-authors Christina Puchalski, MD, MS, FACP, and Betty Ferrell, PhD, MA, FAAN, FPCN, Principal Investigator from the City of Hope and colleagues from City of Hope National Medical Center present practical recommendations for implementing spiritual care in palliative care, hospice, long-term care, and other clinical settings. The guidelines provide spiritual care models, recommendations for professional training, advice on how to develop accountability measures to ensure integration of spiritual care, and guidance on engaging community clergy and spiritual leaders in the care of patients and families.

"Of the physical, emotional, practical, and spiritual dimensions of hospice and palliative medicine, spirituality has been least well addressed. This report aims to improve that situation," says Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine, and Provost, Institute for Palliative Medicine at San Diego Hospice.

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Journal of Palliative Medicine, published monthly in print and online, is an interdisciplinary journal that reports on the clinical, educational, legal, and ethical aspects of care for seriously ill and dying patients. The Journal includes coverage of the latest developments in drug and non-drug treatments for patients with life-threatening diseases including cancer, AIDS, cardiac disease, pulmonary, neurologic, respiratory conditions, and other diseases. The Journal reports on the development of palliative care programs around the United States and the world, and on innovations in palliative care education. Tables of contents and a free sample issue may be viewed online at www.liebertpub.com/jpm

Research Indicates People Over 65 Should Take High Dose Of Vitamin D To Prevent Falls

06 oct 2009--A study published on bmj.com today reports that a daily supplement of vitamin D at a dose of 700-1000 IU reduces by 19 percent the risk of falling among older people. However, a dose inferior to 700 IU per day has no effect.

IU is an international unit of measurement for vitamins and other biologically active substances.

One in three people aged 65 and older experience at least one fall, each year. Among those, around 6 percent result in a fracture. With the older segment of the population growing old, fall prevention has become a public health goal.

Earlier research indicates that vitamin D improves strength and balance among older people. However, other trials have found no noteworthy effect on the risk of falling.

In order to find out more, an international team of researchers evaluated the results of eight fall prevention trials. They assessed the effectiveness of vitamin D in preventing falls among older individuals, aged 65 or more. To minimize bias, differences in study design and feature were considered.

The collective results indicated that benefit from supplemental vitamin D on fall prevention depended on treatment dose.

Supplemental vitamin D2 and Vitamin D3 were investigated. 700-1000 IU supplemental vitamin D per day (vitamin D2 or vitamin D3) reduced falls by 19 percent and up to 26 percent with vitamin D3.

This outcome was independent of age, type of dwelling or additional calcium supplementation. The effect was considerable within two to five months of starting treatment. It extended beyond twelve months.

At a dose of less than 700 IU per day, supplemental vitamin D did not reduce falls.

Findings showed that the use of active forms of vitamin D did not appear to be more effective than 700-1000 IU supplemental vitamin D. In addition, active forms of vitamin D cost more than standard supplemental vitamin D. They are also associated with a higher risk for hypercalcaemia which is an elevated calcium level in the blood.

The authors say: "to reduce the risk of falling, a daily intake of at least 700-1000 IU supplemental vitamin D is warranted in all individuals aged 65 and older."

In closing, they suggest that future research should explore the effectiveness of higher doses to optimize the fall prevention benefit with vitamin D.

"Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials"
H A Bischoff-Ferrari, director of centre on aging and mobility, B Dawson-Hughes, director of bone metabolism laboratory, HB Staehelin, professor emeritus , J E Orav, associate professor of biostatistics, A EStuck, professor of geriatrics, R Theiler, head of rheumatology, J B Wong, professor of medicine , A Egli, fellow, D P Kiel, associate professor of medicine, J Henschkowski, fellow
BMJ 2009; 339:b3692
doi:10.1136/bmj.b3692
bmj.com

Very Elderly Age Group: Need For Routine Stroke Prevention Therapies And Research In Epilepsy

06 oct 2009--A review published Online First and in the November edition of The Lancet Neurology reports that routine stroke prevention therapies are underused in the very elderly, but could be very effective in this age group. The article is the work of Dr Nerses Sanossian of the University of Southern California and Dr Bruce Ovbiagele of the UCLA Stroke Center and Department of Neurology, Los Angeles, CA, USA.

The average human lifespan is extending and as a result there are more individuals above 80 years old who have a high quality of life. However, these very elderly individuals are particularly vulnerable to stroke. There have been substantial advances in stroke research, with several therapeutic drugs able to enhance clinical outcomes in people with stroke or who are at risk of stroke. But still, the very elderly seem to be given fewer vascular protection interventions that have been shown to be effective in their younger counterparts. These treatments might be of benefit to this group of patients. However, there has been an under-representation of the very elderly in studies of stroke therapy. In fact, new data indicate that the use of several of these therapies in routine clinical practice in the very elderly can be useful.

The authors write in conclusion: "With the rapidly growing population of individuals above 80 years, future stroke trials need to include the very elderly to facilitate ready generalisability of results and to convince sceptical clinicians that all patients with stroke should benefit from prompt evidence-based treatment, regardless of age."

A second Lancet Neurology review discusses epilepsy in later life. It is written by Professor Martin Brodie, Western Infirmary, Glasgow, UK, and colleagues. They remark: "Epilepsy is most likely to develop in later life. The burden of this disorder on health-care resources will rise further as the world's population continues to age."

There is growing prevalence and potentially deep physical and psychosocial effects of new-onset epilepsy in elderly people. However shockingly, this disorder has received little research attention. There is growing agreement that future treatment strategies should move beyond symptomatic relief like seizure control. Instead, they should focus on achieving cure and prevention for those at risk. In accordance with this objective, the European scientific community has recently identified a number of research priorities. Some of the aspects that are particularly relevant to the elderly population include:

• preventing the development of epilepsy after brain trauma
• translating genetic knowledge to optimise care of patients
• reducing the life-burden of seizures
• improving treatment and prognosis

The authors write in conclusion: "Old age has become the most common time in life to develop epilepsy in high-income societies. Because of the often atypical presentation, concomitant cognitive impairment, and non-specific abnormalities in routine investigations, establishing a correct diagnosis can be particularly challenging. A multispecialty, multi-professional strategy can help to facilitate rapid diagnosis and ensure a comprehensive approach in ameliorating the physical as well as the psychosocial effects of the diagnosis of epilepsy on elderly patients and their families."

A complementary Lancet Neurology editorial comments: "The rapidly increasing elderly population poses a major challenge for future health-care systems. Many of the diseases of old age are neurological disorders, so neurological practice is likely to be disproportionately affected by an ageing society...there is a dearth of clinical trials among older people - indeed, very elderly patients are systematically excluded from many clinical trials. If we are to meet the challenge of caring for rising numbers of elderly patients in the future, more good-quality trials in older people are needed to inform clinical practice."

"Prevention and management of stroke in very elderly patients"
Nerses Sanossian, Bruce Ovbiagele
DOI: 10.1016/S1474-4422(09)70259-5

"Neurology in the elderly: more trials urgently needed"
DOI: 10.1016/S1474-4422(09)70265-0
The Lancet Neurology

Study shows that elderly women sleep better than they think, men sleep worse

Westchester, Ill.05 oct 2009 —A study in the Oct.1 issue of the journal Sleep shows that elderly women sleep better than elderly men even though women consistently report that their sleep is shorter and poorer.

Women reported less and poorer sleep than men on all of the subjective measures, including a 13.2 minute shorter total sleep time (TST), 10.1 minute longer sleep onset latency (SOL), and a 4.2 percent lower sleep efficiency. When sleep was measured objectively, however, women slept 16 minutes lon¬ger than men, had a 1.2 percent higher sleep efficiency, and had less fragmented sleep. Multivariate regression analysis showed that these discrepancies were partly explained by determinants of sleep duration such as sleep medication use and alcohol consumption.

Principal investigator Henning Tiemeier, MD, PhD, associate professor of psychiatric epidemiology at the Erasmus Medical Center in Rotterdam, Netherlands, said he was surprised that women slept longer and better, and reported their sleep duration more accurately, than men.

"The difference between subjective and objective sleep quality arise not because women are more likely to be complainers, but because men strongly overestimate their sleep duration," said Tiemeier. The study involved 956 participants between the ages of 59 and 79 years; 52.3 percent were women. Information was obtained from the Rotterdam Study, a population-based cohort study aimed at assessing the occurrence of and risk factors for chronic diseases in the elderly.

Subjects used an actigraph that can be worn like a watch for an average of six consecutive nights to objectively measure sleep parameters. Subjective sleep quality was assessed with a sleep diary and the Pittsburgh Sleep Quality Index.

The mean difference between diary-reported and actigraphic total sleep time was larger in men (estimated total sleep time of 7.01 hours versus 6.40 objectively measured hours) than in women (estimated total sleep time of 6.79 hours versus 6.65 objectively measured hours). Sleep medication use was more common in women (14.9%) than men (6.1%), and both sleep medication use and depressive symptoms were related to significantly shorter subjective sleep time in women. Men consumed twice as much alco¬hol as women (1.0 drink/day versus 0.5 drink/day), and only alcohol consumption decreased the sex difference in actigraphic total sleep time.

According to the authors, the sex differences in both self-reported and objective sleep measures may be explained by the fact that women may require more sleep than men, meaning the same amount of sleep may be satisfactory for men but not for women.

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Sleep is the official journal of the Associated Professional Sleep Societies, LLC (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The APSS publishes original findings in areas pertaining to sleep and circadian rhythms. Sleep, a peer-reviewed scientific and medical journal, publishes 12 regular issues and 1 issue comprised of the abstracts presented at the SLEEP Meeting of the APSS.

Sleep Deprivation May Be Associated With Alzheimer's

Sleep-deprived mice have higher levels of amyloid-β, greater amyloid-β plaque deposition

05 oct 2009-- Sleep deprivation may play a role in the development of Alzheimer's disease, according to research published online Sept. 24 in Science.

Jae-Eun Kang, Ph.D., of Washington University in St. Louis, and colleagues analyzed data from experiments on mice examining the effects of wakefulness, sleep deprivation, and orexin -- a molecule that regulates wakefulness -- on amyloid-β (Aβ) measurements.

The researchers found that in transgenic and wild-type mice, animals had a difference in interstitial fluid Aβ levels between dark and light phases, with higher levels during the dark period, though fluctuations were linked to the sleep-wake cycle rather than to exposure to light or darkness. Mice subjected to sleep deprivation had significantly higher Aβ levels. Infusion of orexin-A -- which induces rodent wakefulness -- was associated with higher Aβ levels. In addition, mice subjected to sleep restriction for 21 days had higher Aβ plaque deposition; however, chronic orexin receptor blockade for two months decreased Aβ plaque formation in amyloid precursor protein transgenic mice in several brain regions compared to controls.

"Sleep is a complex behavioral state whose ultimate functions remain poorly understood. Sleep disturbances, in addition to being prominent in neurodegenerative diseases, could exacerbate a fundamental process leading to neurodegeneration, and optimization of sleep time could potentially inhibit aggregation of toxic proteins and slow the progression of Alzheimer's disease," the authors conclude.

Abstract
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Most babies born this century will live to 100

LONDON, 02 oct 2009 – Most babies born in rich countries this century will eventually make it to their 100th birthday, new research says. Danish experts say that since the 20th century, people in developed countries are living about three decades longer than in the past. Surprisingly, the trend shows little sign of slowing down.

In an article published Friday in the medical journal Lancet, the researchers write that the process of aging may be "modifiable."

James Vaupel of the Max Planck Institute in Germany and colleagues in Denmark examined studies published globally in 2004-2005 on numerous issues related to aging. They found life expectancy is increasing steadily in most countries, even beyond the limits of what scientists first thought possible. In Japan, for instance, which has the world's longest life expectancy, more than half of the country's 80-year-old women are expected to live to 90.

"Improvements in health care are leading to ever slowing rates of aging, challenging the idea that there is a fixed ceiling to human longevity," said David Gems, an aging expert at University College London. Gems was not connected to the research, and is studying drugs that can lengthen the life span of mice, which may one day have applications for people.

"Laboratory studies of mice, including our own, demonstrate that if you slow aging even just a little, it has a strong protective effect," he said. "A pill that slowed aging could provide protection against the whole gamut of aging-related diseases."

While illnesses affecting the elderly like heart disease, cancer and diabetes are rising, advances in medical treatment are also making it possible for them to remain active for longer. The obesity epidemic, however, may complicate matters. Extra weight makes people more susceptible to diseases and may increase their risk of dying.

In the U.S., data from 1982 to 2000 showed a major drop in illness and disability among the elderly, though that has now begun to reverse, probably linked to the rise in obesity.

The graying population will slowly radically transform society, and retirement ages may soon be pushed back, said Richard Suzman, an aging expert at the U.S. National Institute on Aging.

"We are within five to 10 years of a watershed event where there will be more people on earth over 65 than there under five," he said. "Those extra years need to be financed somehow and we need to start thinking about it now."

____

On the Net:

http://www.lancet.com

Vitamin D May Improve Melanoma Survival

02 oct 2009-- Higher levels of vitamin D are linked to less severe, less deadly melanoma lesions in people with skin cancer, new research suggests.

The findings provide more support for the idea that vitamin D is crucial to skin health. Many Americans, however, don't get enough of it, perhaps because they limit sun exposure and drink less milk than in the past.

"Although avoiding sunburn is very important in order to prevent melanoma, it is also important to avoid becoming deficient in vitamin D," said Dr. Julia A. Newton-Bishop, a dermatology professor at the University of Leeds in England and a study co-author. "This is especially important for melanoma patients in whom low vitamin D levels appear to be harmful."

Newton-Bishop and her research colleagues looked at the medical records of 872 people with melanoma and tried to link their vitamin D levels to the severity of their lesions and their likelihood of surviving without a relapse.

Those with higher levels of vitamin D in their bodies had less severe lesions -- the lesions were thinner -- and a lower rate of relapse, the researchers found.

The results are reported in the Sept. 14 issue of the Journal of Clinical Oncology.

"The research suggests that low levels of vitamin D allow the melanoma tumors to grow better and, therefore, to be more of a threat to the patient," Newton-Bishop said.

It's not clear how food, sun exposure and supplements contributed to the higher levels of vitamin D in some people, although they did take more multivitamins and cod liver oil, she said.

Melanoma is the cause of most skin cancer deaths, even though it accounts for less than 5 percent of skin cancer cases. The best way to prevent melanoma is by avoiding excessive sun exposure.

To boosts levels of vitamin D, people with melanoma should take daily supplements, the authors concluded, and consume foods that contain vitamin D, such as fatty fish and some fortified cereals.

The study is provocative and "somewhat contrary to traditional thinking," said Dr. Adit Ginde, an assistant professor of surgery at the University of Colorado Denver School of Medicine. More work needs to be done to prove that vitamin D levels directly affect skin cancer development and to determine if increasing the levels will help people with melanoma, he said.

Vitamin D appears to be more than a cancer fighter. Low levels of vitamin D have been linked to a variety of health problems, including heart disease, infections and poor overall health. And adults with low levels may suffer from lower bone mineral density.

But researchers have noticed that vitamin D deficiency has been on the rise in recent decades. An earlier study led by Ginde found that more than 75 percent of Americans don't have high enough vitamin D levels, with African-Americans and Latinos at especially high risk.

Vitamin D is naturally present in few foods, and some researchers recommend supplements containing as many as 2,000 International Units (IU) of vitamin D for many people, and even more for those who are obese.

The current recommendations, however, are 200 to 600 units a day, depending on age.

More information

The U.S. National Library of Medicine has more on vitamin D.

More Research Finds Limited Benefit From PSA Test

Also, many men not fully sharing in decision with provider whether to undergo testing

01 oct 2009-- Men should be aware of their chances of benefits and harms from prostate-specific antigen (PSA) testing before the test, but many are not discussing screening before making the decision, according to the results of two studies in the Sept. 28 Archives of Internal Medicine.

Kirsten Howard, Ph.D., of the University of Sydney in Australia, and colleagues analyzed data from a model comparing outcomes from prostate cancer in men with and without annual screening. The authors presumed a 20-percent relative risk reduction in prostate cancer mortality in screened men as a best case. If 1,000 men were screened from ages 40 to 69, they would have 27.9 prostate cancer deaths and 639.5 deaths overall by age 85, compared with 29.9 prostate cancer deaths and 640.4 deaths overall in their unscreened counterparts. False alarms were a concern, along with the attendant risks of biopsies triggered by the screening.

Richard M. Hoffman, M.D., of the New Mexico VA Health Care System in Albuquerque, and colleagues analyzed data from 375 men, ages 40 and older, who had undergone or discussed PSA testing with their health care provider in the previous two years. Only 69.9 percent discussed screening before making a decision. The provider was more likely to raise the idea and was more likely to emphasize benefits of testing than shortcomings (71.4 versus 32 percent).

"Even if there is a small expected benefit from screening under optimistic assumptions, it is unlikely that screening represents a good value for the expenditure of resources based on the potential cost per quality-adjusted life-year gained," writes the author of an accompanying editorial.

Several authors of the second study reported financial associations with the Foundation for Informed Medical Decision Making, which supported the study.

Abstract - Howard
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Abstract - Hoffman
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Editorial (subscription or payment may be required)
Editorial (subscription or payment may be required)

Moderate Drinking May Reduce Men's Risk of Heart Disease

But pomegranate juice appears to have no effect on progression of atherosclerosis

01 oct 2009-- In hypertensive men, moderate drinking may reduce the risk of coronary heart disease. However, in men and women at moderate risk of heart disease, pomegranate juice appears to have no effect on the overall progression of carotid intima-media thickness, according to two studies in the Oct. 1 American Journal of Cardiology.

Kathryn A. Britton, M.D., of Harvard Medical School in Boston, and colleagues analyzed 1982 to 2008 data on 5,164 participants in the Physicians' Health Study. Compared to consumption of less than one alcoholic drink per week, their adjusted analysis showed that consumption of one to four drinks, five to seven drinks, and more than eight drinks per week was associated with a decreasing risk of myocardial infarction (hazard ratios, 1.05, 0.78, and 0.57, respectively).

Michael H. Davidson, M.D., of the University of Chicago, and colleagues randomly assigned 289 patients with more than one major coronary heart disease risk factor and a baseline posterior wall carotid intima-media thickness of 0.7 to 2.0 mm to receive either 240 ml of pomegranate juice per day or a control beverage for 18 months. Although they found no group differences in the overall carotid intima-media thickness progression rate, results suggested that pomegranate juice may slow progression in patients with increased oxidative stress and disturbances in the triglyceride-rich lipoprotein/high-density lipoprotein axis.

"Consumption of pomegranate juice is very safe; thus, demonstration of a benefit on atherosclerotic disease progression, even in a subset of the population, would have important public health implications," Davidson and colleagues conclude.

Abstract - Britton
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Abstract - Davidson
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