Cataract surgery helps AMD patients; steroid improves DME; online eye health forum

Research highlights, 2009 Ophthalmology journal

SAN FRANCISCO, CA, 03 nov 2009--- This month's Ophthalmology, the journal of the American Academy of Ophthalmology (Academy) reports on a national study that finds cataract surgery is likely to benefit patients with age-related macular degeneration (AMD) at all stages of the disease, on a clinical trial showing that the steroid triamcinolone may be effective in advanced diabetic macular edema (DME) patients when standard treatment fails, and on the public's use of two Academy-sponsored online eye health forums.

Multicenter Study Finds AMD Patients Benefit from Cataract Surgery

Cataract surgery improved vision in patients with any stage–from mild to advanced– AMD in the first study to include an adequate number of advanced AMD patients. Data was obtained from the multicenter, prospective Age-Related Eye Disease Study (AREDS), funded by the National Eye Institute (NEI), which was organized primarily to evaluate the effects of high-dose vitamin and mineral supplements on cataract and AMD. As the American population ages AMD prevalence is expected to rise, and many patients will concurrently develop cataract; both diseases can cause blindness if untreated.

"Earlier epidemiology had suggested cataract surgery might worsen AMD, so the data from the AREDS cohort study were evaluated to answer this important question," said Emily Y. Chew, MD, who led the study for NEI.

The cohort, comprising 1,939 eyes (1,244 patients) with various stages of AMD, was evaluated for visual acuity (sharpness) after cataract surgery. On average, patients with AMD, ranging from mild to advanced, gained visual acuity after cataract surgery; the best gains were in patients with vision worse than20/40 before surgery. No difference in improvement was noted between patients with "wet" (neovascular) or "dry" (central geographic atrophy) AMD. About one year later vision gains remained statistically significant in the 865 eyes available for follow-up. Results for the primary focus of AREDS, regarding the effect of nutritional supplements, showed that high doses of vitamins C, E and beta-carotene did not affect the development or progression of cataract, but this vitamin combination plus zinc did reduce the risk of progression to advanced AMD by 25 percent in the five years of the study.

Steroids Helps Diabetic Macular Edema Patients When Other Treatment Fails

A five-year study based at the University of Sydney, Australia, found that intravitreal triamcinolone (IVTA) effectively improved vision in patients with DME, a form of diabetic retinopathy, whose eyes had continued to deteriorate despite receiving standard laser treatment.

"The majority of patients who improved with IVTA after initial treatment continued to enjoy better vision at the five year conclusion of our clinical trial, and no new safety concerns were found in these patients," said lead researcher Mark Gillies, PhD. "We believe treatment with IVTA may be considered in carefully selected advanced DME patients when standard treatment has failed to improve vision," he added.

In the first three months after treatment, the patients initially treated with both IVTA and laser showed significantly better gains in vision than control group patients, who were treated with laser only. After two years, patients in the original control group were also treated with IVTA. The beneficial effects persisted in most IVTA-treated patients throughout the five-year study; however, 80 percent of patients in the initial IVTA group developed elevated intraocular pressure and 56 percent of them required glaucoma therapy. Also, two-thirds of all patients required cataract surgery during the study period. Similar outcomes have been noted in other studies of steroid-based treatment and thus were not considered new safety concerns by Dr. Gillies' group.

What Do People Ask About in Online Eye Health Forums?

To identify the topics of highest interest to people who access eye health information on line, John C. Hagan, MD, and colleagues analyzed 4,485 questions over six months (September 1, 2008 to March 1, 2009) posted on the "Ask a Doctor: Ophthalmology" and "Eye Care Community" forums sponsored by the Academy on MedHelp (www.medhelp.org ), one of the 10 largest health information websites. Dr. Hagan and three other ophthalmologists provide free, timely advice to a large and growing number of people with eye health and vision problems through these forums. Serious problems, such as life-threatening retinoblastomas in babies, have been caught and treated in time thanks to these forums, as have thousands of other eye and vision problems.

Concerns related to the retina topped the list at nearly 20 percent of all questions; many people asked about "flashes," "floaters," or retinal detachment. About 19 percent of questions were related to the cornea, the clear outer surface of the eye that helps focus light to make vision possible. Cataract and implanted lens questions were next in prevalence, followed by brain-eye problems (neuro-ophthalmology), children's eye alignment (strabismus), eye cancers, and general discomfort or blurry vision. Two-to-three percent of questions related to each of three vision correction topics: refractive surgery (LASIK and others), eyeglasses, or contact lenses. A smaller number were related to eye care products or medical insurance. The analysis also found many people submit postings to express their gratitude for the medical advice provided.

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Eds: Full texts of the studies are available from the Academy's media relations department.

About the American Academy of Ophthalmology

The American Academy of Ophthalmology is the world's largest association of eye physicians and surgeons—Eye M.D.s—with more than 27,000 members worldwide. Eye health care is provided by the three "O's" – opticians, optometrists and ophthalmologists. It is the ophthalmologist, or Eye M.D., who can treat it all: eye diseases and injuries, and perform eye surgery. To find an Eye M.D. in your area, visit the Academy's Web site at www.aao.org.

Surgery Not Found to Affect Cognitive Function in Elderly

Non-cardiac surgery, illness not linked to cognitive decline even in those with mild dementia

02 nov 2009-- Non-cardiac surgery and major illness have no long-term effect on cognitive function in the elderly, including those with mild dementia, according to a study in the November issue of Anesthesiology.

Michael S. Avidan, from Washington University in St. Louis, and colleagues tracked cognitive function before and after non-cardiac surgery, illness, or neither in 575 elderly subjects (214 non-demented and 361 with mild dementia at enrollment).

The researchers found that cognitive trajectories remained similar among patients after surgery, illness or neither, although cognitive function declined more rapidly among demented patients. Although nearly a quarter (23 percent) of non-demented patients progressed to a clinical dementia rating greater than zero, this was not associated with surgery or illness.

"The study did not detect long-term cognitive decline independently attributable to surgery or illness, nor were these events associated with accelerated progression to dementia," Avidan and colleagues conclude. "The decision to proceed with surgery in elderly people, including those with early Alzheimer disease, may be made without factoring in the specter of persistent cognitive deterioration."

Full Text
Editorial

The Power Of Doctors Makes Elderly Patients Passive

02 nov 2009--Elderly patients are often critical about consultations with their doctor. Hierarchical structures, time pressure and traditions in the health care sector make these patients and their relatives passive when facing the doctor and his or her position of power. This is shown in a thesis from the Sahlgrenska Academy, University of Gothenburg, Sweden.

The study is based on interviews with 20 elderly patients and their relatives in Gothenburg, Sweden, and about an equal number of doctors.

'We cannot disregard that the ability of doctors to communicate with elderly patients and their relatives could be improved, and that this shortcoming may explain why this group of patients feel insecure in meeting with the doctor. They don't feel at home in the health care system and sometimes have problems understanding the doctor,' says Sandra Pennbrant, nurse and the author of the thesis.

A good relationship between the doctor and the patient leads to reduced apprehension and increased faith in the health care system. This kind of relationship requires, among other things, that the doctor and the patient discuss the situation and that the doctor listens to what the patient has to say before deciding on a treatment plan.

'Elderly patients and their relatives tend to have a critical view of meetings with the doctor. Doctors and patients have the same understanding of how good relations can be created, but it seems that doctors have a hard time accomplishing it in real life,' says Pennbrant.

The interviewed doctors feel it is difficult to create good relationships when meeting with elderly patients and that this is mainly because the patient often only stays in hospital for a short time.

Pennbrant concludes that the health care sector needs to become a learning organisation where the medical personnel are trained to prevent misunderstandings in their meeting with elderly patients and their relatives.

'Doctors need to learn to acknowledge the questions elderly patients may have and consider their medical conditions and personalities in communication and when building relations. Relatives should also participate in this meeting, so that they feel their work is supported and appreciated,' says Pennbrant.

Thesis for the Degree of Doctor of Philosophy at the Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, publicly defended 2009-10-23
Title of the thesis: How elderly patients, relatives and doctors experience their meeting - A sociocultural study in a hospital setting
Link to thesis: http://hdl.handle.net/2077/21198

Source:
Elin Lindström Claessen
University of Gothenburg

Does Diabetes Slow Alzheimer's?

01 nov 2009-- A French study finding that people with Alzheimer's disease and diabetes have less memory loss than those without diabetes should be regarded with caution, American experts say.

"It's not clear from this study and others what the relationship is," said William Thies, chief medical and scientific officer of the Alzheimer's Association.

What is clear, Thies said, is that having diabetes increases the risk of developing Alzheimer's disease -- a relationship acknowledged in the first sentence of a report on the French study in the Oct. 27 issue of Neurology.

But there haven't been too many studies looking at the effect of diabetes on the progression of Alzheimer's, said the report by researchers at INSERM, the French National Institute for Health and Medical Research in Toulouse.

So, they followed 608 people with mild to moderate Alzheimer's disease for four years, testing their memory and thinking skills twice a year.

The 63 participants with diabetes -- 10.4 percent of the total -- started with the same average score of 20 on the test of thinking ability. There was an average overall decline of 1.24 points on that test every six months. But the decline in thinking ability scores was 0.38 points greater every six months for those without diabetes.

Previous studies of the relationship between diabetes and loss of cognitive function have had mixed results, Thies said. "Some showed a faster decline, some showed a slower decline," he said. "It is still a confused area."

One factor that has a strong influence on the results is the stage of disease in the people being studied, Thies said. "You know that early on, the disease does not progress quickly," he said. "So, if you study people in the early stage or the late stage, that can overwhelm the results."

A close look showed that the diabetic participants in the French study had Alzheimer's disease for a shorter period of time than the non-diabetics, said Dr. Robert Friedland, chair of neurology at the University of Louisville.

And the differences seen in the study "are very minimally significant, less than a point on a 30-point scale," Friedland said. "The difference in many of the mental state examination scores was very small. It was statistically significant, but clinically meaningless."

He ticked off several reasons why a difference was found. The medications taken for diabetes to help control blood sugar level could have a beneficial effect on the brain, Friedland said. "Also, patients with diabetes have more vascular disease in the heart as well as the retina, and some of their impairment might be due to that, so it was progressing more slowly," he said.

There was also a possibility of misdiagnosis, since no autopsies were done in the study, Friedland said.

"The important message is that there are potentially modifiable risk factors for Alzheimer's disease, some of which are also risk factors for diabetes -- lack of physical activity, obesity," he said.

For Thies, the lesson of the study is that "to understand relationships like this, you need more long-term cohort studies like this one. We need more studies, and the real barrier is money."

More information

The latest information on Alzheimer's disease is available from the Alzheimer's Association.

Anemia Drug May Raise Stroke Risk in Kidney Patients

01 nov 2009-- A drug designed to fight anemia appears to double the risk of stroke in patients with diabetes and kidney disease without substantially improving their quality of life, a new study finds.

Darbepoetin alfa, marketed as Aranesp and known as an erythropoiesis-stimulating agent (ESA), is often prescribed for diabetic patients with chronic kidney disease and mild anemia.

"The benefits we assumed we would have by treating anemia were less striking and the risks were more striking," said lead researcher Dr. Marc A. Pfeffer, a professor of medicine in the cardiovascular division of Brigham and Women's Hospital in Boston.

"This provides new data for doctors and patients to make their own risk-benefit assessment," he said. "There was a perception that treating anemia would make people feel so much better that we'll take risks, but the benefit in quality of life was not as great as we thought, and there was a clear doubling of your risk for a stroke."

The report was published in the Oct. 30 online edition of the New England Journal of Medicine to coincide with its scheduled presentation at the annual meeting of the American Society of Nephrology in San Diego.

For the study, Pfeffer's team randomly assigned more than 4,000 patients with diabetes, chronic kidney disease and anemia to receive Aranesp or placebo. During the study, 632 patients receiving Aranesp died or suffered a cardiovascular event, compared to 602 of the patients receiving placebo.

As well, 101 patients taking Aranesp had a fatal or non-fatal stroke compared with 53 of the placebo patients, the researchers found. In addition, patients taking Aranesp reported only a modest improvement in their fatigue, the researchers noted.

In earlier studies, Aranesp and a similar drug, epoetin alfa, marketed as Procrit or Epogen, were linked to increased risk of death in cancer and stroke patients.

Pfeffer believes that people with more severe kidney disease, such as those on dialysis, might still find Aranesp beneficial and the risk acceptable.

"People on dialysis generally feel even worse and generally have even more severe anemia, and this class of therapy has been very helpful to them," he said.

Because the drug was beneficial to these patients, doctors assumed it would help less severely anemic patients, Pfeffer said.

"But this use of ESAs exceeded the data," he said. "Now we have the data, and we will revisit how the drug is used now."

Dr. Phillip Marsden, a professor of medicine at the University of Toronto and author of an accompanying journal editorial, said these findings mean that doctors and patients will have to discuss whether or not to start the medication.

"For most of these patients, the modest improvement in quality of life will not be enough to subject themselves to the increased risk of stroke and death," he said.

ESAs have been used for two decades, Marsden noted. "It is a bit shocking that it took us 20 years to address whether or not these drugs were safe -- and now we know more."

Dr. Ajay Singh, clinical chief of the renal division and director of dialysis at Brigham and Women's Hospital, said this "landmark study" raises the fundamental question of whether epoetin or darbepoetin should routinely be used in treating anemia of chronic kidney disease.

"Earlier studies raised the specter of increased risk with ESA treatment. This study definitively confirms that there is meaningful risk with routine use of ESAs," said Singh, also an associate professor of medicine at Harvard Medical School.

"In my own practice, I will be cautious in using ESAs for most patients with chronic kidney disease, balancing risk with benefits and reserving treatment largely for patients who need frequent blood transfusions or who are candidates for a kidney transplant," he said.

More information

For more information on ESAs, visit the U.S. Food and Drug Administration.

Rate of Cognitive Decline in Alzheimer's Disease Evaluated

Study finds that the presence of diabetes slows the cognitive decline rate in Alzheimer's disease

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30 oct 2009-- In patients with diabetes mellitus (DM) and Alzheimer's disease, the presence of DM slows the rate of cognitive decline associated with Alzheimer's disease, according to a prospective, multi-center study in the Oct. 27 issue of Neurology.

Caroline Sanz, M.D., of University Toulouse III in France, and colleagues conducted a study of 608 patients with a probable diagnosis of Alzheimer's disease and a Mini-Mental State Examination (MMSE) score between 10 and 26. Patients were assessed at baseline for DM and were followed up for 52 months with cognitive function assessed twice a year.

At baseline, the researchers found that 10.4 percent of the participants had DM, and baseline scores on the MMSE were the same for this group as they were for those without DM. However, among the DM group, cognitive decline was slower.

"This study confirms the unexpected effect of DM on the rate of cognitive decline in one of the largest cohorts of patients with Alzheimer's disease so far studied and over a four-year period of follow-up," the authors write. "Future studies will need to address the potential impact of DM in the cerebral aging process and to assess the neuropathologic variations in patients with Alzheimer's disease with DM."

Several authors reported financial and consulting relationships with pharmaceutical companies.

Abstract
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The power of doctors makes elderly patients passive

30 oct 2009--Elderly patients are often critical towards the meeting with the doctor. Hierarchical structures, time pressure and traditions in the health care sector make these patients and their relatives passive when facing the doctor and his or her position of power. This is shown in a thesis from the Sahlgrenska Academy, University of Gothenburg, Sweden.

The study is based on interviews with 20 elderly patients and their relatives in Gothenburg, Sweden, and about an equal number of doctors.

'We cannot disregard that the ability of doctors to communicate with elderly patients and their relatives could be improved, and that this shortcoming may explain why this group of patients feel insecure in the meeting with the doctor. They don't feel at home in the health care system and sometimes have problems understanding the doctor,' says Sandra Pennbrant, nurse and the author of the thesis.

A good relation between the doctor and the patient leads to reduced apprehension and increased faith in the health care system. This kind of relation requires among other things that the doctor and the patient discuss the situation and that the doctor listens to what the patient has to say before deciding on a treatment plan.

'Elderly patients and their relatives tend to have a critical view of the meeting with the doctor. Doctors and patients have the same understanding of how good relations can be created, but it seems that doctors have a hard time accomplishing it in real life,' says Pennbrant.

The interviewed doctors feel it is difficult to create good relations in the meeting with elderly patients and that this is mainly because the patient often stays at the hospital for only a short time.

Pennbrant concludes that the health care sector needs to become a learning organisation where the medical personnel are trained to prevent misunderstandings in their meeting with elderly patients and their relatives.

'Doctors need to learn to acknowledge the questions elderly patients may have and consider their medical conditions and personalities in communication and when building relations. Relatives should also participate in this meeting, so that they feel their work is supported and appreciated,' says Pennbrant.

###

For more information, please contact:
Sandra Pennbrant, registered nurse, +46 (0)70 305 84 35, sandra.pennbrant@fhs.gu.se
Thesis for the Degree of Doctor of Philosophy at the Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, publicly defended 2009-10-23

Good Health In Later Life For Older Men With The AGS Foundation For Health In Aging's New Health Tip Sheet

29 oct 2009--While Americans are living longer than ever, American men still aren't living as long as American women, the latest longevity statistics show. On average, men in the US live about 75 years -- 5 fewer than women.

Why the longevity gap? No one knows for sure. But research suggests that a leading reason may be that men don't take care of themselves as well as women do.

To help older men do that, the American Geriatrics Society's (AGS') Foundation for Health in Aging (FHA) has published an easy to understand health "tip sheet" -- "For Older Men: Tips for Good Health in Later Life" -- just for them.

"By doing such things as eating a healthy diet, following an exercise plan that's appropriate for them, maintaining a healthy weight, refraining from smoking, seeing their healthcare providers for check-ups and screening tests, and taking medications as recommended - men can boost their odds of living longer and healthier lives," says geriatrician and AGS member Barney Spivack, MD, Medical Director of LifeCare, Inc. in Shelton, Connecticut

The FHA's tip sheet offers up-to-date advice, tailored to the needs of older men, on taking medications safely, eating well, and exercising safely. It includes information about screening tests -- including those for abdominal aortic aneurysm, bone health, prostate cancer, colorectal cancer, depression, and sexually transmitted diseases. The tip sheet also offers advice on avoiding falls and fractures, quitting smoking, staying mentally sharp and socially engaged in later life, and whether and how much to drink.

The FHA released a companion tip sheet - "For Older Men: Tips for Good Health in Later Life" earlier this year.

The tip sheets are just the latest in the Foundation's ongoing series of easily understood, up-to-date and authoritative health tip sheets for older adults and their caregivers. The tip sheets and other easy-to-read health information for seniors and caregivers on the FHA website -- http://www.healthinaging.org -- can be downloaded and shared at no cost.

About The FHA

In 1999, the American Geriatrics Society reached beyond its traditional role as a professional medical society and launched the AGS Foundation for Health in Aging (FHA). The FHA aims to build a bridge between geriatrics health care professionals and the public, and advocate on behalf of older adults and their special needs: wellness and preventive care, self-responsibility and independence, and connections to family and community. The FHA champions initiatives in public education, clinical research, and public policy that advance the principles and practice of geriatrics medicine; educate policy makers and the public on the health care needs and concerns of older adults; support aging research that reduces disability and frailty, and improves quality of life and health outcomes; encourage older adults to be effective advocates for their own health care; and help family members and caregivers take better care of their older loved ones and themselves.

Source
American Geriatrics Society

Adding ezetimibe to atorvastatin improves lipid control

Ezetimibe makes atorvastatin more efficient in lowering lipids in men and women age 65 and older

Edmonton, 29 oct 2009 – Adding ezetimibe to atorvastatin significantly boosted the attainment of lipid targets as specified by both Canadian and European guidelines in elderly patients aged 65 and older and the combination produced superior results than simply increasing the dose of atorvastatin alone, Dr. Christian Constance told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.

"The population of people age 65 and older is growing but very few studies have looked at the efficacy of lipid-lowering drugs in this group of patients. We wanted to see whether adding ezetimibe to atorvastatin would be as effective as doubling or even quadrupling the dose of atorvastatin in this age group," said Dr. Constance, of the University of Montreal.

The study included 2,055 patients who were at high risk for coronary heart disease or who had been diagnosed with arterial vascular disease and who were not at the following cholesterol targets:

• Less than 2 mmol/L for low density lipoprotein cholesterol (LDL-C)
• Less than 4 mmol/L for total cholesterol (TC)
• TC to high density lipoprotein cholesterol (HDL) ratio less than 4
• Less than 0.85g/L for apolipoprotein B (ApoB)
• Less than 1.0 mg/L for high sensitivity-C-reactive protein (hs-CRP)

The patients were stabilized on atorvastatin 10 mg/day for six weeks and then were randomized to receive either ezetimibe 10 mg/day in addition to atorvastatin 10 mg/day for 12 weeks or to atorvastatin 20 mg/day for six weeks, followed by a quadrupling of atorvastatin to 40 mg/day for six weeks. Significantly more patients achieved their lipid targets with the ezetimibe plus atorvastatin combination compared with double or quadruple dose monotherapy with atorvastatin. For example, the percent of patients achieving their LDL-C targets on the ezetimibe/atorvastatin combination at 12 weeks was 60.5% compared with 49.7% for patients on the atorvastatin 20mg/40mg regimen [Odds ratio (95% CI)1.55 (1.21, 1.98)].

All treatments were well tolerated.

"Whether you look at European LDL targets or Canadian LDL targets, we reached LDL targets much easier with the combination ezetimibe atorvastatin 10 mg. than even atorvastatin 40 mg. The European guidelines are a little more strict," Dr. Constance said.

"It's a numbers game," he added. "The more you get to those targets, the less patients will have events. And the lower dose of statin, the better it is tolerated, especially in the older, high risk patients, who were the subjects of this study."

The differences between the LDL-cholesterol levels that were achieved were quite striking, said Dr. Charles Kerr, president of the Canadian Cardiovascular Society. "This is a very well-designed trial and the evidence is very convincing that adding ezetimibe to a lower dose of atorvastatin may be more effective than just increasing the dose. Essentially what we have been doing with the statin drugs is doubling them until we achieve goal."

Ezetimibe is a cholesterol lowering drug that acts differently from the statins, he added. "Ezetimibe blocks the absorption of cholesterol from the gut; whereas statins alter metabolism in the liver. This study suggests that adding ezetimibe can be an effective way of reducing cholesterol perhaps more so than increasing the doses of statins."

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Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect Foundation or CCS policy or position. The Heart and Stroke Foundation of Canada and the Canadian Cardiovascular Society make no representation or warranty as to their accuracy or reliability.

The Canadian Cardiovascular Society (ccs.ca) is the national voice for cardiovascular physicians and scientists. Its mission is to promote cardiovascular health and care through knowledge translation, professional development, and leadership in health policy.

Rate of Cognitive Decline in Alzheimer's Disease Evaluated

Study finds that the presence of diabetes slows the cognitive decline rate in Alzheimer's disease

28 oct 2009-- In patients with diabetes mellitus (DM) and Alzheimer's disease, the presence of DM slows the rate of cognitive decline associated with Alzheimer's disease, according to a prospective, multi-center study in the Oct. 27 issue of Neurology.

Caroline Sanz, M.D., of University Toulouse III in France, and colleagues conducted a study of 608 patients with a probable diagnosis of Alzheimer's disease and a Mini-Mental State Examination (MMSE) score between 10 and 26. Patients were assessed at baseline for DM and were followed up for 52 months with cognitive function assessed twice a year.

At baseline, the researchers found that 10.4 percent of the participants had DM, and baseline scores on the MMSE were the same for this group as they were for those without DM. However, among the DM group, cognitive decline was slower.

"This study confirms the unexpected effect of DM on the rate of cognitive decline in one of the largest cohorts of patients with Alzheimer's disease so far studied and over a four-year period of follow-up," the authors write. "Future studies will need to address the potential impact of DM in the cerebral aging process and to assess the neuropathologic variations in patients with Alzheimer's disease with DM."

Several authors reported financial and consulting relationships with pharmaceutical companies.

Abstract
Full Text (subscription or payment may be required)

Decline in Cardiorespiratory Fitness Speeds Up After 45

Study suggests progression also depends on smoking status, weight and exercise levels

28 oct 2009-- Aging does not necessarily spell a linear decline in cardiorespiratory fitness, with lifestyle factors playing an important role, according to a study in the Oct. 26 issue of the Archives of Internal Medicine.

Andrew S. Jackson, of the University of Houston, and colleagues conducted a study of 3,429 women and 16,889 men aged 20 to 96 years who underwent between two and 33 health examinations from 1974 to 2006 as part of the Aerobics Center Longitudinal Study, looking at lifestyle variables such as body mass index, smoking behavior and aerobic exercise levels, as well as cardiorespiratory fitness measured by a maximal Balke treadmill exercise test.

The decline in cardiorespiratory fitness as the study cohort aged was not linear, the researchers found, with current smokers, for example, having lower cardiorespiratory fitness, and increased body mass associated with a decline in cardiorespiratory fitness. However, those who self-reported physical activity had better cardiorespiratory fitness.

"These Aerobics Center Longitudinal Study results confirmed that lifestyle was related to cardiorespiratory fitness independent of aging. With lifestyle statistically controlled, the nonlinear decline in cardiorespiratory fitness with aging remained," the authors write. "Maintaining a low body mass index, being physically active, and not smoking are associated with higher cardiorespiratory fitness across the adult life span."

Abstract
Full Text (subscription or payment may be required)

Older patients with dementia at increased risk for flu mortality

BOSTON,27 oct 2009—An epidemiological study on pneumonia and influenza (P&I) in adults age 65 and over reports that patients with dementia are diagnosed with flu less frequently, have shorter hospital stays, and have a fifty percent higher rate of death than those without dementia. The three-pronged study, which analyzed geographic and demographic patterns of P&I and the relationship between P&I and health care accessibility, was published online in advance of print in Journal of the American Geriatrics Society.

"The increased mortality of older patients with dementia hospitalized for flu may be indicative of inadequacies in health care quality and accessibility. It could be beneficial to refine guidelines for the immunization, testing, and treatment of flu in older patients with dementia when planning for the possibility of a flu pandemic," said first and senior author Elena Naumova, PhD, professor of public health and community medicine at Tufts University School of Medicine.

Dementia, defined by the authors as cognitive impairment to the extent that normal activity is impaired, causes unique obstacles to the early diagnosis and treatment of flu. Patients may have difficulty communicating symptoms and medical complications due to poor oral hygiene or impaired swallowing. Additionally, the authors believe that limited access to health care services and inadequate testing practices may contribute to the higher rates of mortality and lower rates of diagnosis of flu seen in older patients with dementia. A geographic analysis of the data showed that P&I rates were highest among older adults in poor and rural areas, where there is a lower concentration of health care facilities.

"Limited access to specialized health care services can delay diagnosis and treatment of the flu, causing it to progress to pneumonia, the fifth leading cause of death among the elderly. This study has helped us identify this vulnerable population, and now further study is needed to confirm the findings and assess the testing and vaccination policies for older patients with dementia," said Naumova.

Study data were obtained from the Centers for Medicaid and Medicare Services (CMS), and covered a span of five years, from 1998 to 2002. Of the 36 million hospitalization records for adults aged 65 and older, more than six million records documented a P&I diagnosis. Of these records showing a P&I diagnosis, over 800,000 (13%) also showed dementia. The demographic and geographic patterns of P&I hospitalizations and their links with hospital accessibility were explored. Pneumonia and influenza admissions, length of stay in a hospital, and mortality rates among elderly with dementia were compared to national estimates.

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Elena Naumova is the director of the Tufts University Initiative for the Forecasting and Modeling of Infectious Diseases (Tufts InForMID), which works to improve biomedical research by developing computational tools in order to assist life science researchers, public health professionals, and policy makers. The center is focused on developing methodology for analysis of large databases to enhance disease surveillance, exposure assessment, and studies of aging.

Co-authors include Sara M. Parisi and Julia Wenger, now graduates of the Master of Public Health program at Tufts University School of Medicine; Denise Castronovo, MS, Mapping Sustainability, LLC; Manisha Pandita, former research assistant in the department of public health and community medicine at Tufts University School of Medicine; and Paula Minihan, PhD, assistant professor of public health and community medicine, Tufts University School of Medicine.

This study was funded by the National Institute of Allergy and Infectious Diseases and the National Institute of Environmental Health Sciences, both part of the National Institutes of Health.

Aerobic exercise no big stretch for older adults but helps elasticity of arteries

Edmonton, 27 oct 2009 – Just three months of physical activity reaps heart health benefits for older adults with type 2 diabetes by improving the elasticity in their arteries – reducing risk of heart disease and stroke, Dr. Kenneth Madden told the 2009 Canadian Cardiovascular Congress, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.

Dr. Madden studied adults between the ages of 65 to 83 with controlled Type 2 diabetes, high blood pressure, and high blood cholesterol to see how increased activity might affect stiffness of the arteries.

"The theory is that aerobic activity makes your arteries less stiff and makes artery walls more elastic," says Dr. Madden, a geriatric specialist at the University of British Columbia.

An improvement was seen in the elasticity of the arteries of the group that performed the activity compared to those who didn't exercise. "There was an impressive drop in arterial stiffness after just three months of exercise. In that time we saw a 15 to 20 per cent reduction."

The subjects were divided into two groups to either receive three months of vigorous physical activity (one hour, three times per week) or to get no aerobic exercise at all. Subjects were classified as sedentary at the beginning of the study but gradually increased their fitness levels until they were working at 70 per cent of their maximum heart rate, using treadmills and cycling machines. They were supervised by a certified exercise trainer.

Dr. Beth Abramson, spokesperson for the Heart and Stroke Foundation, stresses the importance of lifestyle factors on heart health, especially with our aging population. "Almost everyone can benefit from active living," she says. "The Foundation recommends that, like adults of any age, older adults – with the consent of their physicians − need 30 to 60 minutes of moderate activity most days of the week."

Dr. Madden says that the exercise requirements may be viewed as controversial because of the age of the participants but the exercise level was safe and well tolerated. "There seems to be a knee-jerk reluctance to getting these older adults to exercise yet we used a vigorous level of activity and didn't have any trouble keeping participants in our study. They enjoyed the activity," Dr. Madden says. "People always underestimate what older adults can do."

Dr. Madden notes that realistically, seniors need someone to help them get started. "We need to learn how to do it effectively and how to do it safely," he says. "It could mean visiting your family doctor to find out about provincially funded programs, or joining programs for seniors that are offered at many local community centres."

Dr. Abramson recommends that seniors choose activities they enjoy, such as walking, gardening, golfing, dancing, or joining a yoga or tai chi class. If weather is a barrier, she suggests climbing stairs at home, joining a mall-walking group, or strolling the halls of their apartment building or retirement residence.

In his next project, Dr. Madden wants to find out if there is a less expensive but equally effective way to reduce the stiffness of arteries in older adults. "Our first step was to prove that it was at all possible for older adults to have reduced narrowing in their arteries due to exercise," he says. "Now we want to find out just how rigorous the levels of activity need to be to demonstrate the same results. The next step is to try studying a home-based walking program using pedometers. This is something easy for doctors to prescribe and cheap and easy for participants."

The HeartWalk Workout, a special activity program developed by the Heart and Stroke Foundation to help people with cardiovascular problems get regular, healthy physical activity is available online at heartandstroke.ca. It helps people slowly build up exercise tolerance until they can walk at least 30 minutes, five times a week.

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Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect Foundation or CCS policy or position. The Heart and Stroke Foundation of Canada and the Canadian Cardiovascular Society make no representation or warranty as to their accuracy or reliability.

The Heart and Stroke Foundation (heartandstroke.ca), a volunteer-based health charity, leads in eliminating heart disease and stroke and reducing their impact through the advancement of research and its application, the promotion of healthy living, and advocacy.

Combo pill an option for diabetes-related nerve pain

26 oct 2009– A single pill containing the pain relievers tramadol and acetaminophen is as effective as the drug gabapentin for treating diabetes-related nerve pain, according to study findings presented Tuesday at the 20th World Diabetes Congress in Montreal.

Gabapentin is an anti-seizure drug frequently prescribed for epilepsy. The drug is also used to treat persistent neurological pain.

In general, gabapentin is regarded as a first-line therapy for "diabetic neuropathy" -- a painful condition that causes a range of symptoms from a tingling sensation or numbness in the toes and fingers to paralysis, lead researcher Dr. Bong Yun Cha, from the Catholic University of Korea, Seoul, told Reuters Health.

In the current study, Cha and colleagues compared gabapentin with the tramadol/acetaminophen (TA) combination pill in adults with painful diabetic neuropathy in the lower extremities. Sixty-six study subjects received TA and 73 received gabapentin.

The study was sponsored by JANSSEN KOREA, which markets the combination pill as Ultracet in the US.

Cha and colleagues report that the two groups experienced similar improvements in pain and related parameters over the 6-week study period.

Moreover, the rate of treatment-associated side events in the TA group was not significantly different from that in the gabapentin group: 50.6 percent vs. 36.9 percent.

The current findings, said Cha, support TA as a suitable alternative to gabapentin as a first-line therapy for painful diabetic neuropathy.

Guidelines Urge Use of Erectile Dysfunction Drugs

26 oct 2009-- Doctors should prescribe oral phosphodiesterase type 5 (PDE-5) inhibitor drugs, such as Viagra, Cialis and Levitra, for men with erectile dysfunction, unless the patient is on nitrate therapy, according to a clinical practice guideline issued by the American College of Physicians.

The type of erectile dysfunction (ED) drug prescribed should be based on the individual preferences of patients, including cost of medication, ease of use and types of side effects, the authors noted.

"The evidence is insufficient to compare the effectiveness or adverse effects of different PDE-5 inhibitors for the treatment of ED because there were only a few head-to-head trials," guideline lead author Dr. Amir Qaseem, senior medical associate with the ACP, said in a news release.

Qaseem and colleagues analyzed the findings of 130 studies that evaluated PDE-5 inhibitors alone or combined. They found that treatment with the drugs led to statistically significant and clinically relevant improvements in sexual intercourse and erectile function in men with ED, regardless of the cause (e.g., diabetes, depression, prostate cancer) or ED severity at the start of the study.

Overall, PDE-5 inhibitors were relatively well-tolerated and associated with only mild or moderate side effects, such as headaches, flushing, upset stomach and runny nose, the authors found.

The guideline is published in the Oct. 20 issue of the journal Annals of Internal Medicine.

Because there is no conclusive evidence about the effectiveness of hormonal blood tests or treatment in patients with low testosterone levels, the ACP doesn't recommend for or against routine use of the tests in ED patients. The college says doctors should make decisions to measure hormone levels based on an individual patient's clinical symptoms (decreased libido, premature ejaculation, fatigue, etc.) and physical signs (such as testicular or muscle atrophy) that suggest hormone problems.

Patients In US 5 Times More Likely To Spend Last Days In ICU Than Patients In England

25 oct 2009--Patients who die in the hospital in the United States are almost five times as likely to have spent part of their last hospital stay in the ICU than patients in England. What's more, over the age of 85, ICU usage among terminal patients is eight times higher in the U.S. than in England, according to new research from Columbia University that compared the two countries' use of intensive care services during final hospitalizations.

"Evaluating the use of intensive care services is particularly important because it is costly, resource intensive, and often traumatic for patients and families, especially for those at the end of life" said Hannah Wunsch, M.D., M.Sc., assistant professor of anesthesiology and critical care medicine, of Columbia University, lead author of the study. "We found far greater use of intensive care services in the United States during terminal hospitalizations, especially among medical patients and the elderly."

Their findings were published in the November 1 issue of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Dr. Wunsch and colleagues wanted to examine the differences in ICU usage in England and the U.S., because the countries' similar life expectancies and population demographics enabled a comparison of fundamentally different healthcare systems.

England has one-sixth the number of intensive care beds available per capita that are available in the U.S. Furthermore, medical decisions in England are generally considered to be the direct responsibility of the physician, rather than that of the patient or the patient's surrogate decision-maker(s) as it is in the U.S.

"In England, there is universal health care through the National Health Service, and there is also much lower per-capita expenditure on intensive care services when compared to the U.S.," said Dr. Wunsch. "The use of intensive care in England is limited by supply to a greater degree than it is in the U.S., and there are consequently implicit and explicit decisions regarding who gets those limited services. We wished to examine what different decisions are made."

Dr. Wunsch and colleagues examined data from the Hospital Episodes Statistics database (in England) and all hospital discharge databases of seven states (FL, MA, NJ, NY, TX, VA, WA) in the U.S. They found that of all hospital discharges, only 2.2 percent in England received intensive care, compared to 19.3 percent in the U.S.

They also found that hospital mortality among those who received intensive care was almost three times higher in England than in the U.S. (19.6 percent vs. 7.4 percent). But when examining deaths overall, only 10.6 of hospital deaths in England involved the ICU, whereas 47.1 in the U.S. did. Of those over 85, only 1.3 percent received ICU care in England vs. 11 percent in the U.S. But young adults and children received ICU services at similar rates in both countries. "These numbers need to be interpreted with caution," explains Dr. Wunsch, "as the differences in mortality for ICU patients likely reflect the higher severity of illness of patients admitted in the first place in England. The data do bring up the interesting question of how much intensive care is beneficial. Doing more may not always be better."

While these findings highlight important differences within the two countries' use of intensive care services, the research was not designed to determine the direct impact of these differences. Past surveys have suggested that the majority of people would prefer not to die in the hospital, but given that so many do, questions about use of intensive interventions remain.

"Whether less intensive care for very elderly patients who are dying is a form of rationing, or is actually better recognition of what constitutes appropriate care at the end of life warrants further research," said Dr. Wunsch. "These findings highlight the urgent need to understand whether there is over-use of intensive care in the U.S., or under-use in England."

Furthermore, future research must further investigate not just the origins, but the implications of these differences. "Faced with a provocative finding of cross-national difference, the scientific community faces a choice between at least two paths," wrote Theodore Iwashyna, M.D., Ph.D., and Julia Lynch, Ph.D., in an editorial in the same issue of the journal. "One path leads to carefully unpacking the origins of this difference and teaching us something generally true about how critical care systems develop. The other path leads into the hospitals, using observational data to imagine new ways to organize care and generate the equipoise necessary for careful interventional studies of such interventions. The first path helps us shape national policy levers. The latter path helps us redesign care organizations to bring change to patients. Both are necessary."

Source:
Keely Savoie
American Thoracic Society

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100-Year-Old Woman Gets Relief From Debilitating Back Pain After Minimally Invasive Spine Surgery

25 oct 2009--On World Osteoporosis Day, October 20, centenarian Helen Daniels of Poughkeepsie, NY, has a good reason to smile; she's able to comfortably walk again following minimally invasive spine surgery. After suffering two spinal fractures caused by osteoporosis, Mrs. Daniels had debilitating back pain. After being treated with a minimally invasive spinal procedure, called balloon kyphoplasty, she no longer suffers from back pain and is able to walk with the aid of a walker or cane.

Osteoporosis is a disease that leads to fragile bones and an increased susceptibility to fractures of the spine, hip or wrist. The degenerative disease is the main cause of the estimated 1.4 million vertebral compression fractures (VCFs) of the spine suffered annually worldwide that need the attention of a physician.i The International Osteoporosis Foundation is sponsoring World Osteoporosis Day on October 20 with the goal of informing and educating the patients and policy makers about osteoporosis prevention. The day encourages individuals to take steps to improve their bone health.

"World Osteoporosis Day is the ideal occasion to bring attention to this disease that affects an estimated 75 million people in the United States, Japan and Europe," said Alex DiNello, vice president and general manager, KYPHON® products, part of the Spinal and Biologics business at Medtronic. "Mrs. Daniels' positive outcome is further evidence, as supported in a recent studyii, that patients who are treated with balloon kyphoplasty may experience better quality of life, back function and back pain relief than those who undergo only non-surgical management."

Mrs. Daniels sustained two VCFs in December of 2008 and was treated at first with back braces and pain medication by her private care physician, Dr. Rajiv Narula. However, the pain persisted. Dr. Narula referred her to Dr. Kenneth Hansraj, an orthopedic spine specialist with New York Spine Surgery & Rehabilitation Medicine, who performed the balloon kyphoplasty procedure.

During the minimally invasive balloon kyphoplasty procedure that gave Mrs. Daniels relief from her back pain, tiny balloons are inserted into fractured vertebrae and inflated to create a space. The space created by the balloons is filled with a special type of cement to secure the position of the bones.

"Mrs. Daniels is in remarkable health and was an ideal candidate for the procedure," said Dr. Hansraj. "Today Mrs. Daniels reports no back pain, is walking and, most importantly, is enjoying her time with her four sons and eight grandchildren."

For more information on World Osteoporosis Day go to: http://www.iofbonehealth.org
More information on osteoporosis is located at http://www.nof.org.
For more information on balloon kyphoplasty, go to http://www.kyphon.com.
To locate a physician trained in balloon kyphoplasty, go here.

About Balloon Kyphoplasty

During the minimally invasive balloon kyphoplasty procedure, a needle and tube are used to create a small pathway into the fractured bone. Orthopedic balloons are inserted and then inflated inside the fractured bone in an attempt to restore vertebral body height and correct angular deformity. Inflation of the balloons creates cavities in the vertebral body that are filled with bone cement, forming an "internal cast" to support the surrounding bone and prevent further collapse.

More than 500,000 patients worldwide have been treated with balloon kyphoplasty. Balloon kyphoplasty differs from other surgical therapies for VCFs such as vertebroplasty, which is designed to stabilize the fracture without correcting vertebral body deformity or providing a controlled fill for bone cement distribution. With balloon kyphoplasty, inflation of the balloons compacts the cancellous bone, which may fill fracture lines and reduce leak pathways. The presence of the space also allows a more viscous bone cement to be injected under low manual pressure. These features are designed to potentially reduce the risk of leakage.

Risk Statement

The complication rate for KYPHON® Balloon Kyphoplasty is low, but all surgical procedures carry risk. Serious complications may occur, including leakage of bone cement, and in rare instances complications may result in death or paralysis. This procedure is not for everyone. A prescription is required. Please consult your physician for a complete list of indications, benefits, and risks. Only you and your physician can determine whether this procedure is right for you.

About Medtronic's Spinal and Biologics Business

The Spinal and Biologics business is based in Memphis, Tenn. It is the global leader in today's spine market and is committed to advancing the treatment of spinal conditions. The Spinal and Biologics business works with world-renowned surgeons, researchers and innovative partners to offer state-of-the-art products and technologies for neurological, orthopedic, dental and spinal conditions. Medtronic is committed to developing affordable, minimally invasive procedures that provide lifestyle-friendly surgical therapies. More information about the company and its treatment therapies can be found at http://www.medtronic.com and its patient-education Web sites, http://www.back.com , www.iscoliosis.com , http://www.maturespine.com and http://www.necksurgery.com.

Source
Medtronic

Cocoa Can Reduce Levels of Inflammatory Biomarkers


Study suggests that cocoa consumption may help protect high-risk patients against atherosclerosis

FRIDAY, Oct. 23 (HealthDay News) -- In patients at high risk of cardiovascular disease, cocoa may significantly decrease levels of some inflammatory biomarkers, suggesting that the flavonoids in cocoa may help protect against atherosclerosis, according to a study in the Nov. 1 issue of the American Journal of Clinical Nutrition.

Maria Monagas, a researcher at the University of Barcelona in Spain, and colleagues assigned 42 volunteers (19 men and 23 women; mean age, 69.7 years) to receive either 40 grams of cocoa powder mixed with 500 milliliters of skim milk and then skim milk alone for two periods of four weeks.

The researchers found no significant group differences in the expression of adhesion molecules on T lymphocyte surfaces. However, they found significantly lower expression of very late activation antigen-4, CD-40, and CD36 in monocytes, and lower concentrations of soluble endothelium-derived adhesion molecules P-selectin and intercellular adhesion molecule-1 in serum after the cocoa and milk intake.

"Another positive outcome of our study was the higher high-density lipoprotein-cholesterol concentration after cocoa and milk intake than after milk intake," the authors write. "Although outcomes on lipid metabolism from cocoa feeding trials are still scarce, this finding seems to be in accordance with that of several studies that have reported higher high-density lipoprotein-cholesterol concentrations after cocoa or chocolate intake but no changes in low-density lipoprotein cholesterol."

Abstract
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Coronary Angiography Found Safe in Chronic Kidney Disease


Procedure does not reduce kidney function in high-risk patients awaiting a transplant

24 oct 2009-- Screening coronary angiography does not reduce renal function in high-risk patients with advanced chronic kidney disease awaiting a kidney transplant, according to a study published online Oct. 15 in the Clinical Journal of the American Society of Nephrology.

Nicola Kumar, from the Imperial College Kidney and Transplant Institute in London, and colleagues retrospectively determined the risk of contrast nephropathy in 76 high-risk patients with advanced chronic kidney disease (stages IV or V) who underwent screening coronary angiography.

The researchers found that the glomerular filtration rate was similar six months before and after coronary angiography. Cumulative dialysis-free survival was 89.1 percent six months after angiography, and 32.9 percent of patients received a kidney transplant, of which 88.0 percent were performed before the need for dialysis. Flow-limiting coronary artery disease was present in 30.3 percent of patients.

"The data suggest coronary angiography screening does not accelerate the decline in renal function for patients with advanced chronic kidney disease, facilitating a safe preemptive transplant program," Kumar and colleagues conclude. "If the procedure is performed appropriately with small volumes of contrast, biplane angiography using N-Acetylcysteine, and adequate hydration around the time of the procedure, then the risk of contrast exposure can be minimized in this population."

Abstract
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SNS: Web Surfing Linked to Brain Function in Older Adults

Internet use shows activation of regions affecting working memory and decision-making

22 oct 2009 -- In middle-aged and older adults who have minimal experience with the Internet, Web surfing for a short period of time may improve brain function, according to research presented this week at the annual meeting of the Society for Neuroscience, held from Oct. 17 to 21 in Chicago.

Teena D. Moody, Ph.D., of the Semel Institute at the University of California in Los Angeles, and colleagues studied 24 neurologically normal volunteers aged 55 to 78 years with minimal Internet experience. The researchers performed functional magnetic resonance imaging scans before and after the participants conducted Internet searches for one hour per day on seven days during a two-week period.

At baseline, the researchers found that individuals with minimal Internet experience showed brain activity in regions controlling language, reading, memory and visual abilities in the frontal, temporal, parietal, visual and posterior cingulate regions. After seven days of Internet use, however, they found that these individuals showed brain activity in these same regions, as well as in the middle frontal gyrus and inferior frontal gyrus, which are important for working memory and decision-making.

"These results suggest that Internet training can affect the neural circuitry activation pattern and offers a potential application of cognitive enhancement in older adults," the authors write.

Thyroid surgery safe for older patients, study finds

AUGUSTA, Ga., 22 oct 2009 – Thyroid surgery is safe for older patients, say physicians who found only slight differences in rates of complications and hospital readmissions in a multi-year study.

"We were pleasantly surprised," says Dr. Melanie W. Seybt, endocrine-head and neck surgeon at the Medical College of Georgia and first author in the October issue of Archives of Otolaryngology – Head and Neck Surgery. "We suspected older patients might be admitted to the hospital more often, have more complications and more cancer."

But their study of 428 thyroidectomy patients at MCGHealth Medical Center and the Charlie Norwood Veterans Affairs Medical Center between November 2003 and December 2007, including 44 patients over age 65 and 86 between ages 21-35, showed few differences in the two groups.

Surgeons found:

• They could do outpatient surgery in both groups at essentially the same rate, 45.5 percent in the elderly and 51.2 percent in younger patients
• Similar complication rates, with 12.5 percent of older patients having transient problems with low calcium versus 11.1 percent of younger patients.
• The thyroid growth was suspected to be malignant in 4.5 percent of elderly patients and 2.3 percent of younger patients. Final pathology revealed cancer in 27.3 percent of elderly patients and 18.6 percent of older patients.
• Elderly patients had a slightly higher hospital readmission rate – 4.5 percent versus 1.2 percent – but readmissions were related to the transient problems with calcium levels not age-related complications.
• Neither group had post-operative bleeding or permanent vocal cord paralysis.

She hopes the findings will decrease concerns among patients and practitioners about the safety of thyroidectomies in the growing elderly population, noting that thorough preoperative screening, important at any age, likely helped minimize adverse reactions in their older patients.

Although thyroid disease tends to be most common in young women, the number of older patients diagnosed with the problem is escalating, Dr. Seybt says, noting that the oldest patient in this study group was 84. With a geriatric population that has increased by 90 percent in the last 30 years, according to the U.S. Census Bureau, the numbers are likely to continue upward.

"A lot of our older patients have other problems, such as heart failure, hypertension and restrictive lung disease, so we are very aggressive about getting medical clearance and optimizing control of their other problems," Dr. Seybt says.

She notes that head and neck surgeries generally have less complications and quicker recoveries than procedures in other parts of the body, such as the abdomen or chest. Low calcium levels are a common complication of thyroid surgery because the adjacent parathyroid glands are typically a little stunned by removal of the thyroid gland, she says. To help avoid problems, patients are routinely placed on a three-week tapering dose of calcium but sometimes still have transient problems, most commonly numbness or tingling around the lips and cramping of the hands and feet. Because of the close proximity to the vocal cords, patients also can have transient or permanent hoarseness.

While its exact cause is unknown, thyroid disease tends to run in families and radiation exposure is believed to be a risk factor for thyroid cancer. The increased availability of quality, non-invasive screening such as ultrasound likely means more cases are being identified at every age, Dr. Seybt says.

Laptop-sized ultrasounds are showing up in many physician offices and thyroid nodules also show up when patients have more sophisticated studies of the head and neck, such as an MRI scan, for other reasons. Patients or their doctors often just feel nodules in the neck although they can be oddly asymptomatic until they grow large enough to impact swallowing and/or breathing. While some of these larger growths are very obvious, those that grow downward into the chest or toward the back can be harder to detect. In older patients, many of the growths likely have been there a while, Dr. Seybt says.

Depending on the size of the growth in patients, surgeons at MCG and the VA will use one of three different approaches. These include a standard, several-inch incision at the base of the neck for the largest growth as well as include minimally invasive thyroidectomy, in which surgeons work through an incision about half the size of the norm, and an endoscopic approach, in which video monitoring and a thin, ultrasonic scalpel reduce incision size another half.

Dr. David Terris, chair of the Department of Otolaryngology-Head and Neck Surgery in the MCG School of Medicine and a pioneer of the minimally invasive approaches, showed in the March 2006 issue of Laryngoscope that the newer, minimally invasive approaches, which reduce the incision size and recovery time, could be used safely in most patients. Dr. Terris is corresponding author on the current study.

Dr. Terris and Sunny Khichi, a senior medical student at MCG, are study co-authors.

AGS Foundation For Health In Aging Tip Sheet About Persistent Pain In Later Life, Now Available In Spanish

20 oct 2009--The AGS Foundation for Health in Aging (FHA) Tip Sheet about persistent pain -- pain or discomfort that lasts for a long time, or comes and goes over the course of months or years -- is now available in Spanish translation. The pain tips, initially released in May in English, are the first in a series of Spanish language tips, to become available by the FHA. The tips offer Spanish-speaking older adults who suffer from ongoing pain, and their caregivers, advice on getting treatment and relief. Persistent pain is common among older people, particularly those with chronic health problems such as arthritis. However common, persistent pain isn't a "normal" part of aging and shouldn't be ignored. If untreated or improperly treated, persistent pain can make it hard to sleep, walk, and carry out daily activities. It can contribute to falls and lead to disability. It can take the joy out of living.

Fortunately, there are many effective treatments for persistent pain and FHA's new Spanish version of the easy-to-read "tip sheet" explains this in detail.

Written by experts with the American Geriatrics Society, the Spanish-language tip sheet explains how older adults, and their caregivers, can describe pain and their experiences with pain so their healthcare providers can better understand and treat it. Among other things, it describes signs of pain in older adults with dementia, who may be unable to communicate.

The tip sheet provides an overview of the different classes of pain medications -- including acetaminophen (Tylenol,® for example), nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen, and opioid pain medications such as Vicodin, Percocet, Ultracet, Lortab and morphine. It explains which types of pain these medications treat most successfully, and the risks associated with their use. And it offers advice on working with your or your loved one's healthcare providers to find the right medication. In addition, the tip sheet includes information about non-drug pain relief options, such as massage, acupuncture, and transcutaneous electrical nerve stimulation (TENS), physical therapy and exercise.

The tip sheet, which advises older adults and their caregivers to alert their healthcare providers immediately if treatment isn't working or is causing side effects, can be downloaded, printed, and shared at no cost.

About The FHA

In 1999, the American Geriatrics Society reached beyond its traditional role as a professional medical society and launched the AGS Foundation for Health in Aging (FHA). The FHA aims to build a bridge between geriatrics health care professionals and the public, and advocate on behalf of older adults and their special needs: wellness and preventive care, self-responsibility and independence, and connections to family and community. The FHA champions initiatives in public education, clinical research, and public policy that advance the principles and practice of geriatrics medicine; educate policy makers and the public on the health care needs and concerns of older adults; support aging research that reduces disability and frailty, and improves quality of life and health outcomes; encourage older adults to be effective advocates for their own health care; and help family members and caregivers take better care of their older loved ones and themselves.

Source
American Geriatrics Society

Partner's Education Linked to Death Risk of Both in Couple


Study finds women's education and men's social class especially linked to mortality risk of both

20 oct 2009-- Among married or cohabiting couples, women's education and men's social class appear to have an important effect on the mortality risk of both partners, according to research published online Oct. 6 in the Journal of Epidemiology and Community Health.

Jenny Torssander and Robert Erikson of Stockholm University in Sweden analyzed 1990 census data on more than 1.5 million Swedes aged 30 to 59 years, including education, income, and social class and status. The researchers assessed data on the subjects' all-cause mortality and death due to cancer and circulatory disease through 2003.

The researchers found that women's education and men's social class appeared especially important for the risk of mortality for both partners, while men's education was less strongly associated with women's survival. Husbands' social class provided larger differences for women's mortality than their own occupation. Both women's education and men's social class and income were especially linked to women's mortality from circulatory disease.

"Women traditionally take more responsibility for the home than men do, and, as a consequence, women's education might be more important for the family lifestyle -- for example, in terms of food habits -- than men's education. If highly educated women more easily understand the plethora of advice about healthy lifestyles, women's education could have a substantial influence on the health and mortality of the partner," the authors write.

Abstract
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Studies: Some nursing home elderly get futile care

LOS ANGELES, 19 oct 20099 – A surprising number of frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives, two new federally funded studies reveal.

One found that putting nursing home residents with failing kidneys on dialysis didn't improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment.

Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible — more like the palliative care given to terminally ill cancer patients.

"We probably need to be offering a palliative care option to many more patients to make the last days of their lives as comfortable as possible," said Dr. Mark Zeidel of the Beth Israel Deaconess Medical Center in Boston, who was not involved in the studies.

Palliative care focuses on managing symptoms of a disease and a main goal is to relieve pain at the end of life.

End-of-life care became a divisive issue in the national health care reform debate this summer after one proposal included Medicare reimbursement for doctors who consult with patients on end-of-life counseling. Critics called the counseling "death panels" and a step toward euthanasia. The Obama administration denied those claims, yet has signaled the Medicare benefit will be dropped.

The new studies are published in Thursday's New England Journal of Medicine.

In one study, doctors looked at health records of 3,702 nursing home residents nationwide who started dialysis between 1998 and 2000. The average age was 73 and many had other health problems, including diabetes, heart disease and cancer.

Within the first year, 58 percent died and another 29 percent declined in their ability to do simple tasks such as walking, bathing and getting dressed.

Kidney dialysis helps remove waste from blood, and the vast majority of patients with kidney failure benefit. However, in the case of seniors with failing kidneys, it is less clear whether the benefit outweighs the burden.

The findings call into question the common practice of transporting dialysis patients near the end of life to dialysis centers several times a week and hooking them up to a machine for hours at a time.

"We may be overestimating the benefits of dialysis in some of these patients and downplaying the burdens," said lead author Dr. Manjula Kurella Tamura, a Stanford University kidney specialist.

The study did not include a comparison group of patients who didn't get dialysis, so it's unknown if more elderly are dying after starting dialysis than not. Kurella Tamura said there's no one-size-fits-all recommendation for which nursing home residents should go on dialysis, and she suggests patients talk with their doctors about realistic expectations.

The second study followed 323 people with advanced dementia from Boston-area nursing homes. Their average age was 85 and they could not recognize loved ones and were unable to talk or walk.

One out of four died within six months and half died during the 18 months they were followed. Nursing home residents with advanced dementia were more likely to die of pneumonia, fever and eating problems related to their dementia than from strokes or heart attacks.

During their final three months, 41 percent received aggressive care including being hospitalized and tube feeding. However, if the person making their medical decisions was aware of their poor prognosis, they were less likely to receive aggressive care near the end of life, the research found.

"We often temporarily inflict discomfort or pain on patients. We try to minimize it, but we accept it because we think the trade-off is curing or healing," said Dr. Greg Sachs of Indiana University School of Medicine.

In an accompanying editorial, Sachs recalled how his grandmother, who suffered from Alzheimer's and lived in a nursing home, was aggressively treated with antibiotics for every infection in her final months and had to be restrained. He said that people with dementia could benefit from hospice care inside a nursing home or in the community.

Sachs cited research that found nursing home residents who had hospice care during the last month of their life were half as likely to be hospitalized. What's keeping dementia nursing home patients from getting hospice care is that dementia is not widely recognized as a terminal illness. It's also harder to predict when a dementia patient has six months or less to live — a criteria for Medicare-paid hospice care.

The National Institutes of Health funded the studies. The dementia study was led by the Harvard-affiliated Hebrew Senior Life Institute for Aging Research in Boston. In the dialysis study, Kurella Tamura has received grant support from Amgen, which makes a drug for people with kidney disease undergoing dialysis.

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On the Net:

New England Journal, http://www.nejm.org

Be overweight and live longer

18 oct 2009--Contrary to what was previously assumed, overweight is not increasing the overall death rate in the German population. Matthias Lenz of the Faculty of Mathematics, Computer Science, and Natural Sciences of the University of Hamburg and his co-authors present these and other results in the current issue of Deutsches Ärtzeblatt International

Most Germans are overweight, with a body mass index (BMI) between 25 and 29.9 kg/m2. About 20% are obese (BMI of 30 or over), with age- and gender-related differences. The authors systematically evaluated 42 studies of the relationships between weight, life expectancy, and disease.

The Süddeutsche Zeitung published an advance notice of the report (http://www.sueddeutsche.de/gesundheit/140/489526/text/), which shows that overweight does not increase death rates, although obesity does increase them by 20%. As people grow older, obesity makes less and less difference.

For coronary heart disease, overweight increases risk by about 20% and obesity increases it by about 50%. On the other hand, a larger BMI is associated with a lower risk of bone and hip fracture.

In relation to cancer, the overall death rate among extremely obese men (BMI above 40) is no higher than among those of normal weight. Men who are overweight even have a 7% lower death rate. No significant association was found in women.

According to the authors' analysis, overall mortality is unchanged by overweight, but increased by 20% by obesity, while extreme obesity raises it by up to 200%.

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http://www.aerzteblatt.de/v4/archiv/pdf.asp?id=66217

Internet Use Cuts Depression Among Senior Citizens

17 oct 2009--Spending time online reduces depression by 20 percent for senior citizens, the Phoenix Center reports in a new Policy Paper released today. In addition to the quality of life benefits, the Policy Paper said reducing the incidence of depression by widespread Internet use among older Americans could trim the nation's health care bill.

"Maintaining relationships with friends and family at a time in life when mobility becomes increasingly limited is challenging for the elderly," says Phoenix Center Visiting Scholar and study co-author Dr. Sherry G. Ford, an Associate Professor of Communications Studies at University of Montevallo in Alabama. "Increased Internet access and use by senior citizens enables them to connect with sources of social support when face-to-face interaction becomes more difficult."

The Policy Paper, Internet Use and Depression Among the Elderly, examines survey responses of 7,000 retired Americans 55 years or older. The data was provided by the Health and Retirement Study of the University of Michigan and screened to exclude respondents who were still working and also those living in nursing homes in order to limit possible variations that might skew the findings. These limitations reduced the size of the sample from the initial 22,000 to 7,000, but that is still far larger than all previous efforts to consider the effect of Internet use on psychological well-being of the elderly population. Age 55 is the common age cut off for studies of the elderly. Unlike many existing studies on the benefits of broadband, the statistical methodologies used in the analysis aim to determine causal effects and not simply measure correlations.

Phoenix Center President Lawrence W. Spiwak says, "This is the most advanced statistical analysis on the social impacts of broadband to date, and the most believable. If policymakers want better data analysis, they now have it. The study raises the bar for credible statistical analysis when formulating broadband policy."

The implications of the findings are significant because depression affects millions Americans age 55 or older and costs the United States about $100 million annually in direct medical costs, suicide and mortality, and workplace costs. The Pew Internet & American Life Project estimates that only about 42 percent of Americans aged 65 or more use the Internet, far below the adoption rate of other age groups. Given the relatively low adoption rates by seniors, the study concludes that the opportunity for better health outcomes from expanded Internet adoption is substantial. Further, with billions spent annually on depression-related health care costs, the potential economic savings also are impressive. "Efforts to expand broadband use in the U.S. must eventually tackle the problem of low adoption in the elderly population," says study Phoenix Center Chief Economist and study co-author Dr. George S. Ford. "The positive mental health consequences of Internet demonstrate, in part, the value of demand stimulus programs aimed at older Americans."

The Phoenix Center is a non-profit 501(c)(3) organization that studies broad public-policy issues related to governance, social and economic conditions, with a particular emphasis on the law and economics of telecommunications and high-tech industries.

Source: Phoenix Center for Advanced Legal & Economic Studies