Elderly can blame fractures and falls on low sodium

Older adults with even mildly decreased levels of sodium in the blood (hyponatremia) experience increased rates of fractures and falls, according to a study presented at the American Society of Nephrology's 43rd Annual Meeting and Scientific Exposition. Falls are a serious health problem for the elderly and account for about 50 percent of deaths due to injury in the elderly.

22 nov 2010--"Screening for a low sodium concentration in the blood, and treating it when present, may be a new strategy to prevent fractures," comments Ewout J. Hoorn, MD, PhD (Erasmus Medical Center, Rotterdam, the Netherlands). However, hyponatremia does not appear to affect the risk of osteoporosis, as defined by low bone mineral testing, so more research is needed to understand the link between sodium levels and fracture risk.

The study included more than 5,200 Dutch adults over age 55, all with initial information on sodium levels and six-year follow-up data on fractures and falls. "A number of recent studies suggested a relationship between hyponatremia, falls, osteoporosis, and fractures," Hoorn explains. The authors' goal was to confirm these possible associations using prospective, long-term follow-up data.

About eight percent of the study participants, all community dwelling adults, had hyponatremia. This group of older participants had a higher rate of diabetes and was more likely to use diuretics (water pills) than those with normal sodium levels. Subjects with hyponatremia had a higher rate of falls during follow-up: 24 versus 16 percent. However, there was no difference in bone mineral density between groups, so hyponatremia was not related to underlying osteoporosis.

Nevertheless, the group with low sodium levels had a higher rate of fractures. With adjustment for other risk factors, the risk of vertebral / vertebral compression fractures was 61 percent higher in the older adults with hyponatremia. The risk of non-spinal fractures, such as hip fractures, was also significantly increased: a 39 percent difference.

The relationship between hyponatremia and fracture risk was independent of the increased rate of falls in the low-sodium group. Subjects with hyponatremia also had a 21 percent increase in the risk of death during follow-up.

Hyponatremia is the most common electrolyte disorder, usually developing because the kidneys retain too much water. "Although the complications of hyponatremia are well-recognized in hospitalized patients, this is one of the first studies to show that mild hyponatremia also has important complications in the general population," says Hoorn.

Further study will be needed to clarify the mechanism by which low sodium levels increase fracture risk. In the meantime, "Screening older adults for and treatment of hyponatremia in older adults may be an important new strategy to prevent fractures," adds Hoorn.

Provided by American Society of Nephrology

Analysis: Pope's comments add to debate on condoms

21 nov 2010 -- With his striking comment on condoms and AIDS, Pope Benedict XVI has started a new chapter in the complex church debate about morality and preventing the spread of HIV.

The Roman Catholic prohibition against artificial contraception is not in question, but Benedict could be carving out a very rare exception for the use of condoms.

Benedict said that condoms are not a moral solution to stopping AIDS. But he said in some cases, such as for male prostitutes, their use could represent a first step in assuming moral responsibility "in the intention of reducing the risk of infection."

He made the remarks in an interview with a German journalist, Peter Seewald, and published as the book, "Light of the World: The Pope, the Church and the Signs of the Times." The Vatican newspaper L'Osservatore Romano ran excerpts on Saturday ahead of the book release Tuesday.

Benedict's comments put a spotlight on a nuanced discussion within the church about how best to address the scourge of AIDS.

The pope had previously said that condom use exacerbates the AIDS crisis. Some church officials echoed the sentiment, arguing that condoms are not foolproof and give people a false sense of protection. Abstinence and fidelity are the only way to stop HIV, they said.

Still, the Vatican never released an official, authoritative policy on condoms and AIDS, and cardinals from around the world often took positions on the issue that differed significantly.

William Portier, a Catholic theologian at the University of Dayton, a Marianist school in Ohio, has not yet read the book, but said it would be wrong to conclude that the comments mean the pope has made a fundamental change in church teaching.

"He's not going to do that in an offhand remark to a journalist in an interview," Portier said.

The pope's circumspect remarks should also not be viewed as encouraging condom use.

However, they could be read as making a distinction between greater and lesser evils, or what moral theologians call double effect, said Michael Baur, a philosopher at Fordham University. An evil may be tolerated for an intended good - in this case, disease prevention.

It is far from the first time such an argument has been made within the church.

The Rev. Martin Rhonheimer, an Opus Dei priest and ethics professor at the Pontifical University of the Holy Cross in Rome, argued in 2004 that an HIV-infected married man who uses a condom to protect his wife from the virus is not trying to block a pregnancy, but to prevent infection. His actions, therefore, could be seen as in accord with Catholic teaching.

"It's an interesting application of ancient moral principles," said Nicholas Cafardi, a canon lawyer and former dean of Dusquesne University School of Law. "Even if you are performing an otherwise evil act, you can mitigate the evil of the act."

Seewald's book is being released at a time when the pope and the Vatican have tried to overcome their widespread problems in communicating the church's message. Some analysts suggested that the pope's comment on condoms in the book could be just another in a series of public relations missteps.

The English publisher of the book, the Rev. Joseph Fessio of Ignatius Press, argued the pope was not justifying condom use, but was noting that protecting someone from the disease shows the signs of taking moral responsibility for another person.

In the book, the pope also reaffirms church teaching that sex should be between a married man and woman and that artificial contraception blocks God's plan for bringing life into the world.

Yet, even with just the narrow example he gave in the interview, Benedict has created an opening for Catholic bishops in Africa and elsewhere to renew their argument that condoms must be part of the fight against the spread of HIV.

Hormone therapy may prevent -- or contribute to -- dementia risk

Hormone therapy appears to affect the brain differently depending on the age of the woman when she receives it, researchers reported Thursday.

20 nov 2010--Hormone-replacement therapy for women has been the subject of considerable debate. Studies have shown both pros and cons. But hormone use has declined in the last decade because a major study on the issue, the Women's Health Initiative, found that the risks of taking hormones appeared to outweigh significantly the benefits in older postmenopausal women. Among the findings was that beginning hormone therapy in women ages 65 and older led to a twofold higher risk of dementia.

Questions remain about the effect of hormones if taken at a younger age - among perimenopausal (the phase before menopause when hormones decline and fluctuate) or menopausal women in their early 50s. The new study, published in the Annals of Neurology, supports the idea that hormones can affect dementia risk differently depending on the age of the woman when she takes them.

Kaiser Permanente researchers examined data from members in Northern California from 1964 to 1973, among women 40 to 55 years old. The study examined whether hormones were used at midlife - defined in this study by the average age of 48.7 - or in late life, defined as age 76. Compared with women who never used hormones, those taking hormones only at midlife had a 26 percent decreased risk of dementia. This link held true even when the researchers controlled for other factors that contribute to dementia, such as high cholesterol and stroke.

However, taking hormones in late life may counteract whatever benefits are seen by taking hormones at midlife, the authors said. Women taking hormone therapy only in late life had a 48 percent increase in dementia. Women using hormones at both midlife and late life did not differ in their dementia risk from women who didn't take hormones.

"The reduced risk of dementia associated with midlife hormone therapy use only lends support to the notion that it is not only early postmenopausal use of hormone therapy that is protective, but that use should also be limited to a few years," the authors wrote.

Animal studies suggest that estrogen benefits brain health, and observational studies have shown that women who take hormones are less likely to develop dementia later in life. But studies such as the Women's Health Initiative dashed hopes that hormones protected against cognitive impairment. Research now is focusing on whether there is a "critical window" for use - a specific time of life when hormones would do more good than harm.

Following 7 steps can cut a person's death risk by more than half, experts say

For those interested in reducing their risk of death from cardiovascular disease, heart experts have some good news: regular exercise, a healthy diet and five other simple measures can cut one's near-term risk of death by more than half.

19 nov 2010--And here's the bad news: In a nationwide study of more than 17,820 adults, only two people met all of the criteria for top-notch cardiovascular health.

The message of the study, presented Monday at the American Heart Association's Scientific Sessions conference in Chicago, is clear, said Dr. Mark Urman, medical director of Cedars-Sinai Heart Institute's Preventive and Consultative Heart Center.

"Boy, most Americans aren't very healthy," said Urman, who wasn't involved in the research. However, he added, "on a more positive note, the study confirms that individuals can take control of their health. Incremental changes can make a huge difference."

The changes, dubbed Life's Simple 7, were laid out in January as part of an AHA campaign to guide Americans toward "ideal cardiovascular health." They are:

-At least 150 minutes of moderate exercise, or 75 minutes of intense exercise, per week.

-Having a body mass index of less than 25.

-Being a non-smoker for at least one year.

-Meeting four out of five of the AHA's key components for a healthy diet.

-Keeping total cholesterol below 200 milligrams per deciliter of blood.

-Maintaining blood pressure below 120/80 millimeters of mercury.

-Having a fasting blood sugar level below 100 mg/dL of blood.

"These are the sorts of things your grandmother told you," said Dr. Mary Cushman, the cardiovascular disease researcher at the University of Vermont who conducted the study.

Cushman used a database of people between the ages of 45 and 84 who were already enrolled in a nationwide study on the prevalence of stroke. All of the participants had been evaluated for the factors that make up Life's Simple 7.

In addition to the two individuals who met all seven criteria, another 213 people were compliant with six.

Death rates for those who met at least five of the criteria were 55 percent lower over the five-year study period than for those who met none, Cushman reported.

The analysis showed how much each health factor mattered - for every additional one met, a person reduced his or her chance of dying in the next four years by 15 percent.

"That tells how powerful these things relate to heart-disease risk," Cushman said. "Being as good as you can be on all of these factors is what your goal should be."

On the whole, Americans are most compliant when it comes to maintaining a healthy blood pressure and abstaining from smoking. More than 80 percent of those in the survey were nonsmokers, and almost 67 percent were in the ideal range for blood pressure, Cushman said.

On the flip side, eating a healthy diet was the criterion with the fewest adherents - only 0.43 percent managed to do so, the study found.

The ideal diet requires meeting four of five of these key components based on a 2,000-calories-per-day meal plan: four-and-a-half cups of fruits and vegetables per day, two or more 3.5 ounce servings of fish (preferably oily fish) per day, fewer than 450 calories a week of sugar-sweetened beverages, three or more one-ounce servings per day of whole grains and less than 1,500 mg of sodium per day.

Cushman could not identify the two people who scored perfect on the assessment. "It would be interesting to go back and talk to them," to see just how they live so healthfully, she said.

But the large portion of Americans who are far from the ideal range suggests that societal, not just individual, changes are needed, she said. Public projects like more parks, sidewalks and farmers' markets; soda taxes; smoking restrictions and physical activity requirements in preschools and schools could move large numbers of people toward better health.

Biomarker may be able to help predict risk of heart failure, cardiovascular death

Certain measures of the blood biomarker cardiac troponin T (cTnT), a cardiac-specific protein, using a highly sensitive test, are associated with the development of heart failure or cardiovascular death in older adults, according to a study that will appear in the December 8 issue of JAMA. The study is being released early online because it will be presented at the American Heart Association's annual meeting.

18 nov 2010--"Older adults comprise the majority of new-onset heart failure (HF) diagnoses, but traditional risk-factor prediction models have limited accuracy in this population to identify those at highest risk for hospitalization or death," according to background information in the article. Blood-based biomarkers, including troponins, have been advocated for use as supplemental to clinical risk factors to identify older adults at high risk for adverse cardiovascular outcomes, but studies examining the prognostic value of these markers have reported inconsistent results.

Prior studies have used standard troponin assays that are only able to detect circulating troponin levels in a small proportion of individuals. Recently, a highly sensitive cardiac troponin T assay has been developed, designed to improve accuracy. "This assay has detected circulating cTnT in almost all patients with chronic HF or ischemic heart disease and provides independent prognostic information with respect to HF admission and cardiovascular death in these patients," the authors write.

Christopher R. deFilippi, M.D., of the University of Maryland School of Medicine, Baltimore, and colleagues examined the ability to detect a measurable cTnT concentration in older adults using the highly sensitive cTnT assay and whether higher concentrations would be associated with a greater risk of new-onset HF and cardiovascular death. The researchers analyzed data from the Cardiovascular Health study and included 4,221 community-dwelling adults ages 65 years or older without prior HF who had cTnT measured using the highly sensitive assay at the beginning of the study (1989-1990) and repeated after 2 to 3 years (n = 2,918). Concentrations of cTnT were equal to or more than the limit of detection in 2,794 participants (66.2 percent).

During a median (midpoint) follow-up of 11.8 years from the initial cTnT measurement, 1,279 participants experienced new-onset HF and 1,103 cardiovascular deaths occurred, with a greater risk of both end points associated with higher cTnT concentrations. Also, the risks of HF and cardiovascular death were higher among those participants with detectable compared with undetectable levels at follow-up, irrespective of the baseline level.

Analysis indicated that for participants with measurable cTnT levels at the beginning of the study, an increase of more than 50 percent was associated with an increased risk of HF and a greater risk of cardiovascular death, adjusting for baseline cTnT and risk factors. In contrast, a decrease of more than 50 percent was associated with a risk-factor adjusted lower risk of HF and lower risk of cardiovascular death compared with those participants with 50 percent or less change.

For the prediction of both outcomes, the addition of baseline cTnT measurements to clinical risk factor models only modestly but statistically significantly improved classification.

"Detectable cTnT levels as measured by a highly sensitive assay were present in the majority of community-dwelling older adults in this cohort, and higher concentrations—within a normal range established for a younger general population—reflect a greater burden of cardiovascular risk factors and imaging evidence of cardiac disease. Independent of these comorbidities, cTnT concentrations were associated with risk of new-onset HF and cardiovascular death. Furthermore, longitudinal changes in cTnT concentrations were common in this cohort and correspond with a dynamic change in risk levels over time," the authors conclude.

More information: JAMA. 2010;304[22]:doi:10.1001/jama.2010.1708

Provided by JAMA and Archives Journals

Prostate cancer treatment linked to higher rate of colon cancer, study finds

Men treated with hormone-based therapy for prostate cancer faced a 30 percent to 40 percent higher risk of colorectal cancer, compared to patients who did not receive this treatment, according to a new study.

17 nov 2010--The study looked at use of androgen deprivation therapy, a common type of treatment for prostate cancer that involves blocking the male hormone testosterone through either surgical removal of the testicles or a series of injections. It's been shown to benefit men with advanced cancers, but its benefit for less-advanced disease is unclear. Still, more than half a million men in the United States currently receive this therapy.

Researchers looked at data from 107,859 men aged 67 and older with prostate cancer, identified through the Surveillance, Epidemiology and End Results and Medicare linked database, which provides information about older adults with newly diagnosed cancer. Results of the study were published online in the Journal of the National Cancer Institute.

The study is the first to link androgen deprivation therapy for prostate cancer to an increased risk of colorectal cancer. The researchers found that the risk increased the longer a man received androgen deprivation therapy. Patients who had their testicles removed, a procedure called orchiectomy, had the highest rates of colorectal cancer.

Overall, the risk of colorectal cancer was still low – less than 1 percent per year even among orchiectomy patients. But any increased risk should be carefully considered when using androgen deprivation therapy in cases when its benefit is not clear, the researchers say.

"Androgen deprivation therapy still continues to be used in situations where there are not evidence-based studies showing its benefit. When androgen deprivation therapy is clearly known to be beneficial, people should not shy away from using it. But where there's not solid evidence, this is potentially another harm," says lead study author Vahakn B. Shahinian, M.D., M.S., assistant professor of internal medicine at the University of Michigan Medical School and a member of the U-M Comprehensive Cancer Center.

Shahinian stresses that androgen deprivation therapy can be lifesaving for certain men with prostate cancer, and those patients should not hesitate to use it. The study authors suggest that continued routine preventive care, including colorectal cancer screening, is important during prostate cancer treatment.

More information: Journal of the National Cancer Institute , doi:10.1093/jnci/djq419, published online Nov. 10, 2010

Provided by University of Michigan Health System

Palliative care for patients with dementia more available but still not adequate

A new national survey conducted by researchers from Indiana University and the Regenstrief Institute has found that while palliative care may be available for those with dementia, there are significant barriers to providing or receiving services to relieve the pain, eating difficulties and other symptoms associated with dementia.

The survey findings are reported in the Nov. 2010 issue of the Journal of the American Geriatrics Society.

16 nov 2010--"Although the general public and many physicians do not associate palliative or hospice care with dementia, dementia is a terminal disease and should be respected as such. Palliative care is needed throughout the illness and can provide those who are unable to communicate their needs with a better quality of life as well as lowering the stress the illness places on caregivers and the entire family," said study first author Alexia M. Torke, M.D., M.S., who is an IU School of Medicine assistant professor of medicine and geriatrics and a Regenstrief Institute investigator. She is also on the faculty of the IU Center for Aging Research and the Fairbanks Center for Clinical Medical Ethics.

Palliative care for those with dementia focuses on relieving symptoms such as pain, shortness of breath, fatigue, nausea, loss of appetite and difficulty sleeping. Hospice care provides palliative care at the final stage of life. Palliative care, which is often provided in the patient's home, can be administered through the course of the disease along with medical treatment and does not hasten death.

Hospices provide palliative care to individuals in the final weeks or months of life. According to National Hospice and Palliative Care Organization data, only 11 percent of hospice patients in the facilities had a primary diagnosis of dementia. That may be because it is often difficult to determine how close to the end of life dementia patients may be and they therefore are not provided with hospice care.

In the new study the researchers conducted telephone interviews about the provision of palliative care to patients with dementia with directors of 426 hospice and palliative care programs. A detailed online survey was completed by 80 program directors.

The study found that 94 percent of hospice and 72 percent of palliative care program directors reported that their programs have recently cared for patients with dementia. This is a substantial increase from a 1995 study that found only 21 percent of hospice programs had provided this care.

Non-hospice palliative care programs are relatively new and typically care for patients earlier in the disease before the patient is hospice eligible. To learn more about these programs, the authors asked in-depth questions of palliative care program directors. The directors indicated the existence of significant barriers to providing non-hospice palliative care. These obstacles included inadequate insurance coverage for home services by Medicare and other insurers, home health benefits that expired before the individual was eligible for hospice care as well as insufficient family and healthcare provider knowledge of palliative care for dementia.

Strategies highlighted as critical for successful palliative care for dementia and reduction of caregiver burden were an interdisciplinary team usually composed of a nurse, social worker, physician and chaplain, collaboration with community organizations and campaigns to provide information to families and physicians.

"While it is heartening to see that most of these programs provide care for patients with dementia, there are many, many more who need this care than are receiving it. Education and policy efforts should focus on communicating with families and providers about palliative care, supporting caregivers who often are frustrated in their efforts to improve quality of life for a loved one with dementia, and reforming reimbursement structures to provide coverage earlier in the disease when patients have high needs but are not hospice eligible," said Dr. Torke.

Provided by Indiana University School of Medicine

Synchronizing a failing heart

November 14, 2010 – One of the largest, most extensive worldwide investigations into heart failure, led by the University of Ottawa Heart Institute (UOHI), conclusively proves that a new therapeutic implant synchronizes and strengthens a fading heart beat while reducing risk of death by 24% compared to the current treatment.

15 nov 2010--The research, co-led by Dr. Anthony Tang and Dr. George Wells at the Heart Institute, brings the promise of life-saving treatment for patients with symptoms of mild to moderate heart failure – an increasingly common condition among an aging population that can lead to sudden cardiac death. Each year, more than 500,000 Canadians and five million Americans suffer heart failure.

"This kind of device brings the potential to save thousands of lives in Canada alone and offers new hope to so many heart patients and their families. Helping the lower chambers of the heart beat strongly and in unison can improve a person's quality of life, keep them out of hospital longer and reduce their risk of sudden death," said Dr. Tang.

Results of the clinical trial, which got under way in 2003, were published online today in the prestigious New England Journal of Medicine and coincided with the release of the Heart Institute analysis at the Scientific Sessions of the American Heart Association in Chicago. The research represents one of the largest international medical device trials undertaken in 2003, comprising 1,798 patients in 24 centres in Canada, Australia, Europe and Turkey.

The Ottawa team consisted largely of top electrophysiologists – cardiologists specializing in surgical procedures to regulate a faulty heart rhythm. Heart failure patients were implanted with either a basic miniature defibrillator (ICD) or with a new device carrying insulated wires called leads to transmit signals and electrical impulses to the heart in an effort to stimulate and coordinate the heart to be beating in-sync. This therapy is called cardiac resynchronization therapy (CRT).

The study, which followed patients for an average of 40 months, showed that patients with CRT live longer with a reduction of the rate of death. In addition, patients with CRT were less likely to be admitted to hospital for worsening of heart failure.

Until now, no research had been undertaken to examine the specific benefits and survival rates in heart failure patients who have been implanted with a CRT along with an ICD.

"This trial represents a tremendous research success for cardiovascular scientists and demonstrates the importance of clinical evaluative research," said Dr. Alain Beaudet, President of the Canadian Institutes of Health Research, which co-funded the research. "We congratulate the Heart Institute for its efforts, which will lead to better health outcomes and longer lives for heart patients."

"Medtronic recognizes the expertise of Canadian electrophysiologists and congratulates them for their leadership in participating and leading this key clinical trial to investigate the benefits of cardiac device therapy in heart failure patients," said Neil Fraser, President of Medtronic of Canada Ltd., which also co-funded the research. "This trial demonstrates that a broader population of heart failure patients could benefit from our therapies, including those with mild symptoms, and they should receive them."

Provided by University of Ottawa Heart Institute

Timely depression diagnosis critical to maintain health of elderly

Depression affects approximately 30 to 40 percent of nursing home residents, but it often goes unrecognized, according to American Geriatrics Society, which can lead to lower quality of life or even suicide. Now, researchers at the University of Missouri have found a series of indicators, other than changes in mood that are associated with the development of depression in nursing home residents.

14 nov 2010--"Prompt diagnosis and treatment of depression is essential to improve the quality of life for nursing home residents," said Lorraine Phillips, assistant professor in the Sinclair School of Nursing. "Many elderly people develop certain clinical characteristics at the same time they develop depression. Understanding these changes is essential to quickly and accurately diagnosing depression in nursing home residents."

Changes in characteristics that Phillips found to be associated with the development of depression include increased verbal aggression, urinary incontinence, increased pain, weight loss, changes in care needs, reduced cognitive ability and decline in performance of daily living activities.

"Depression is currently diagnosed using several methods that emphasize mood symptoms including interviewing and self-reporting of depression symptoms," Phillips said. "However, since elderly depression may appear with non-mood symptoms, these characteristics identified in this study can help diagnose depression that may be overlooked by traditional screening methods."

Phillips found that residents with increased verbal aggression were 69 percent more likely to be diagnosed with depression than those who had not shown these changes. Decreases in activities of daily living, such as feeding or dressing one's self, also were associated with increased depression diagnosis. The research indicates that men and women in nursing homes are equally likely to develop depression. This contrasts with the overall population, where women are more likely than men to experience depression.

To study these changes, MU researchers analyzed data on more than 14,000 nursing home residents aged 65 and older who were not diagnosed with depression at the beginning of the study. Researchers analyzed changes in various clinical factors, other than mood changes, to discover which changes were associated with the development of depression during a three-month interval of time. The data was collected from the Missouri Minimum Data Set, a federally mandated process for clinical assessment of all residents in Medicare- or Medicaid-certified nursing homes.

More information: The study was published in the Journal of Gerontological Nursing.

Provided by University of Missouri-Columbia

Fructose-rich beverages associated with increased risk of gout in women

Consumption of fructose-rich beverages, such as sugar-sweetened sodas and orange juice is associated with an increased risk of gout among women, although their contribution to the risk of gout in the population is likely modest because of the low incidence rate among women, according to a study that will appear in the November 24 print edition of JAMA. The study is being released early online to coincide with its presentation at the American College of Rheumatology annual scientific meeting.

13 nov 2010--Gout is a common and very painful inflammatory arthritis. "The increasing disease burden of gout in the United States over the last few decades (e.g., an annual incidence of 16/100,000 in 1977 vs. 42/100,000 in 1996) coincided with a substantial increase in soft drink and fructose consumption," the authors write. "Fructose-rich beverages such as sugar-sweetened soda and orange juice can increase serum uric acid levels and, thus, the risk of gout, but prospective data on the relationship are limited."

Hyon K. Choi, M.D., Dr.P.H., of the Boston University School of Medicine, and colleagues examined the relationship between intake of fructose-rich beverages and fructose and incidence of gout in a large group of women. The study consisted of data from the Nurses' Health Study, a U.S. prospective cohort study spanning 22 years (1984-2006). The researchers analyzed data from 78,906 women with no history of gout at the beginning of the study and who provided information on intake of beverages and fructose through validated food frequency questionnaires.

During 22 years of follow-up, the researchers documented 778 newly diagnosed cases meeting American College of Rheumatology survey criteria for gout. They found that increasing intake of sugar-sweetened soda was associated with increasing risk of gout. Compared with consumption of less than 1 serving per month, women who consumed one serving per day had a 74 percent increased risk of gout; and those with 2 or more servings per day had a 2.4 times higher risk. Diet soft drinks were not associated with the risk of gout.

Orange juice intake was also associated with risk of gout. Compared with women who consumed less than a glass (6 oz.) of orange juice per month, women who consumed 1 serving per day had a 41 percent higher risk of gout, and there was a 2.4 times higher risk with 2 or more servings per day. Also, compared with women in the lowest quintile (fifth) of free fructose intake, women in the highest quintile had a 62 percent higher risk of gout.

The authors note that although the relative risks of gout associated with fructose-rich beverages among women were substantial, the corresponding absolute risk differences were modest given the low incidence rate of gout among women.

The researchers add that their findings have practical implications for the prevention of gout in women, and that physicians should be aware of the potential effect of these beverages on the risk of gout. "Our data provide prospective evidence that fructose poses an increased risk of gout among women, thus supporting the importance of reducing fructose intake."

More information: JAMA. 2010;304[20]:doi:10.1001/jama.2010.1638

Silent vascular disease accompanies cognitive decline in healthy aging

Older people who are leading active, healthy lifestyles often have silent vascular disease that can be seen on brain scans that affect their ability to think, according to a new study led by UC Davis researchers and published online today in the Archives of Neurology

12 nov 2010--"This study shows that silent vascular disease is really common as we get older and it influences our thinking abilities," said Charles DeCarli, professor of neurology in the School of Medicine at UC Davis and director of the UC Davis Alzheimer's Disease Center. "We're beginning to realize that vascular disease plays a major role in Alzheimer's disease — they go together."

The study findings are based on data from participants in the Alzheimer's Disease Neuroimaging Initiative. The initiative tracks individuals who are normal, those who have mild cognitive impairment (MCI) and people with Alzheimer's disease using magnetic resonance imaging (MRI), positron emission tomography (PET) imaging and laboratory and cognitive testing to track changes in their cognitive status.

Over 5 million elderly people in the United States have Alzheimer's disease, a progressive, incurable and terminal disease and the most common form of age-related dementia. In its 2009 World Alzheimer Report, Alzheimer's Disease International found that there are more than 35 million people worldwide with Alzheimer's disease or other types of dementia. It also projected that the number should nearly double in the next 20 years.

Cardiovascular disease, including hypertension, high cholesterol and atherosclerosis, is also common in the elderly, and causes "white matter hyperintensities," regions of damaged brain tissue that look like white-hot areas on MRI scans. The purpose of the study was to better understand the relationship between white matter hyperintensities and the extent to which they precede, coincide with or follow short-term changes in cognitive functioning.

For the study, more than 800 participants ages 55 to 90 were recruited from more than 50 research sites throughout the United States and Canada. Some 200 participants were cognitively normal individuals who were followed for three years. Approximately 400 people with mild cognitive impairment also were followed for three years. Two hundred people with Alzheimer's disease were followed for two years. Potential participants with serious brain anomalies, such as brain tumors or prior surgery, were excluded from the study.

All of the participants' baseline cognitive functioning was established using clinical diagnostic evaluation, including the Mini Mental State Exam and the Alzheimer's Disease Assessment Scale-Cognitive Subscale. Criteria for the normal group included no evidence of depression, mild cognitive impairment or dementia. Individuals were included in the MCI category if they had a subjective memory complaint or objective memory loss, among other measures. Participants with Alzheimer's disease met nationally accepted criteria for probable Alzheimer's disease.

Participants whose white matter hyperintensities were significantly above average at the beginning of the study lost more points each year in cognitive testing than those whose white matter hyperintensities were average at baseline. Those with mild cognitive impairment or Alzheimer's disease at baseline had additional declines on their cognitive testing each year, meaning that the presence of white matter hyperintensities and MCI or Alzheimer's disease together added up to even faster and steeper cognitive decline. In addition, participants who were older at baseline saw faster declines over time in their Mini Mental State Exam scores.

The researchers found that, at the outset of the study, the extent of white matter hyperintensities was associated with greater subsequent declines in global cognition over a one-year period.

"In a sample … with frequent evaluations, short-term follow-up and a relatively mild profile of cardiovascular risk, white matter disease may be an important predictor of subsequent short-term global cognitive change," the study found.

"There's a big group of people who have not had major cardiovascular events such as heart attacks. But we see signs that even milder vascular-related insults can contribute to loss of cognitive functioning," said Owen Carmichael, the study's lead author and an assistant professor in the Department of Neurology in the School of Medicine at UC Davis.

Carmichael said that the study suggests that reducing your cardiovascular risk factors to a moderate level may not be enough to avert all forms of brain disease that can lead to cognitive decline in aging.

"Every little bit counts — you have got to squeeze every little bit of healthy lifestyle out of your day" to avoid brain aging, he said.

Provided by University of California - Davis

Bilingualism delays onset of Alzheimer's symptoms

A Canadian science team has found more dramatic evidence that speaking two languages can help delay the onset of Alzheimer's symptoms by as much as five years.

11 nov 2010--The latest study, led by Baycrest's Rotman Research Institute, examined the clinical records of more than 200 patients diagnosed with probable Alzheimer's disease and found that those who have spoken two or more languages consistently over many years experienced a delay in the onset of their symptoms by as much as five years. The study is published in the Nov. 9th issue of Neurology.

The science team includes internationally-renowned cognitive researcher Dr. Fergus Craik of the Rotman Research Institute; Dr. Ellen Bialystok of York University, a leading expert in bilingualism research; and Dr. Morris Freedman, one of Canada's leading clinicians in the diagnosis and treatment of Alzheimer's and other dementias.

"We are not claiming that bilingualism in any way prevents Alzheimer's or other dementias, but it may contribute to cognitive reserve in the brain which appears to delay the onset of Alzheimer's symptoms for quite some time," said Dr. Craik, lead investigator and co-editor of The Oxford Handbook of Memory.

The brains of people who speak two languages still show deterioration from Alzheimer's pathology; however, their special ability with two languages seems to equip them with compensatory skills to hold back the tell-tale symptoms of Alzheimer's, such as memory loss, confusion, and difficulties with problem-solving and planning.

"These results are especially important for multicultural societies like ours in Canada where bilingualism is common," said Dr. Bialystok, professor of Psychology at York University and associate scientist at the Rotman Research Institute. "We need to understand how bilingualism changes cognitive ability, especially when there are clinical implications as in this case."

Observations were made on 211 patients diagnosed with probable Alzheimer's from the Sam and Ida Ross Memory Clinic at Baycrest, from 2007 to 2009. The patients' date of diagnosis and age of onset of cognitive impairment were recorded along with information on occupational history, education and language history (i.e. fluency in English and any other languages). Following this procedure, 102 patients were classified as bilingual and 109 as monolingual.

The researchers found that bilingual patients had been diagnosed with Alzheimer's 4.3 years later and had reported the onset of symptoms five years later than the monolingual patients. The groups were equivalent on measures of cognitive and occupational level, there was no apparent effect of immigration status, and there were no gender differences.

The Neurology paper replicates findings from the team's widely-reported 2007 study led by Dr. Bialystok and published in Neuropsychologia. That study examined the clinical records of 184 patients diagnosed with probable Alzheimer's and other forms of dementia – and found that bilingual patients delayed the onset of their symptoms by four years compared to monolingual patients.

The current study adds to mounting scientific evidence that lifestyle factors – such as regular cardiovascular exercise, a healthy diet, and speaking more than one language – can play a central role in how the brain copes with age-related cognitive decline and diseases such as Alzheimer's.

"Although a great deal of research is being focused on the development of new and more effective medications for Alzheimer's disease, there are currently no drug treatments that show any effects on delaying Alzheimer's symptoms, let alone delaying the onset of these symptoms by up to five years," said Dr. Freedman, head of Neurology and director of the Sam and Ida Ross Memory Clinic at Baycrest.

Provided by Baycrest Centre for Geriatric Care

High cholesterol in middle age women not a risk factor for Alzheimer's and other dementias

High cholesterol levels in middle age do not appear to increase women's risk of developing Alzheimer's disease and other forms of dementia later in life, new Johns Hopkins-led research finds, despite a body of scientific evidence long suggesting a link between the two.

11 nov 2010--What the study, published online in the journal Neurology, does find is that women whose cholesterol levels decline from middle age to old age are at 2.5 times greater risk of developing the memory-wasting diseases than those whose cholesterol stayed the same or increased over the years.

"Our research refutes the notion that high cholesterol in midlife is a risk factor for Alzheimer's disease, at least among women," says Michelle M. Mielke, Ph.D., an assistant professor of psychiatry at the Johns Hopkins University School of Medicine and the study's lead author.

Even though Mielke and her colleagues found no link between high middle-age cholesterol levels and dementia risk, Mielke cautions that people still need to watch their cholesterol. High cholesterol levels are linked to cardiovascular and other diseases. Cholesterol levels can be kept in check through diet, exercise and medication.

Mielke and her colleagues examined data from the Prospective Population Study of Women, which began in 1968 and consisted of 1,462 Swedish women ages 38 to 60. Follow-ups were conducted at four intervals across the intervening decades, with the most recent examinations concluding in 2001. As part of the study, the women were given physical exams, heart tests, chest x-rays and blood tests. The group was also surveyed for smoking habits, alcohol and medication use, education and medical history. Throughout the study, body mass index (BMI), a measurement of weight-per-height, and blood pressure were taken. Women were assessed for dementia throughout the 32 years of follow-up between 1968 and 2001. In 2001, 161 of the original group had been diagnosed with Alzheimer's or other forms of dementia, but the youngest group was just reaching age 70.

Despite the advances being made in biomarker and other dementia research, the biggest known risk factor for these neurodegenerative diseases is old age.

Mielke says that later in life, women with slightly higher body mass index, higher levels of cholesterol and higher blood pressure tend to be healthier overall than those whose weight, cholesterol and blood pressure are too low. But it is unclear whether "too low" cholesterol, BMI and blood pressure are risk factors for dementia or if they could be signs that dementia is developing, she says. For example, an inadvertent loss of weight often precedes the development of dementia, she says, but the exact cause is unclear.

Provided by Johns Hopkins Medical Institutions

'Sweet 16' tool may be useful for detecting cognitive impairment

A new cognitive assessment tool with 16 items appears potentially useful for identifying problems in thinking, learning and memory among older adults, according to a report posted online today that will be published in the March 14 print issue of Archives of Internal Medicine.

10 nov 2010--An estimated 3.4 million older adults in the United States have dementia, and an additional 5.4 million have milder forms of cognitive impairment, according to background information in the article. "For many older adults, cognitive impairment contributes to loss of independence, decreased quality of life and increased health care costs," the authors write. "While the public health impact of cognitive impairment is clear, this condition is often under-recognized. A simple, rapid cognitive assessment instrument is therefore a valuable tool for use in both clinical and research settings."

The most widely known and used measure of cognitive impairment is the Mini-Mental State Examination (MMSE); however, scores on this assessment may be influenced by education level, and the copyright limits its widespread availability. Tamara G. Fong, M.D., Ph.D., of Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and colleagues developed a new instrument called the Sweet 16 to rapidly assess cognitive status in older adults. To develop the questions, the researchers used information from a group of 774 patients who completed the MMSE as part of a screening process for a large randomized trial of a method to decrease delirium. They then validated their results among 709 participants in another study that also used two different dementia and cognitive decline rating scales.

The Sweet 16 scale is scored from zero to 16 (with 16 representing the best score) and includes questions that address orientation (identification of person, place, time and situation), registration, digit spans (tests of verbal memory) and recall. "The Sweet 16 required no pencil, paper or other props and was easy to administer with a minimum of training," the authors write. "In the pilot group, completion time for the instrument ranged from 1.4 to 2.9 minutes, with a mean [average] of 2.0 minutes and a median [midpoint] of 1.9 minutes."

When administered to participants in the validation group, a Sweet 16 score of 14 or less correctly identified 80 percent of the individuals with cognitive impairment (as identified by another questionnaire) and correctly identified 70 percent of those who did not have cognitive impairment. In the same group, the MMSE correctly identified 64 percent of those with cognitive impairment and correctly identified 86 percent of those who were cognitively normal.

The researchers also compared the Sweet 16 to clinicians' diagnoses of cognitive impairment. Sweet 16 scores of 14 or less occurred in 99 percent of patients diagnosed with cognitive impairment and 28 percent of those without such a diagnosis.

"The Sweet 16 could be used in place of other screening measures, such as the MMSE, to rapidly identify cognitive impairments in general clinical practice as well as in research settings," the authors write. "Further studies, including prospective studies to establish the predictive validity of the Sweet 16, to assess test-retest reliability and to compare performance with other brief cognitive measures, are greatly needed. Ultimately, it is hoped that this test will help improve assessment of cognitive function across many settings."

More information: Arch Intern Med. Published online November 8, 2010.

Study: Tai Chi relieves arthritis pain, improves reach, balance, well-being

In the largest study to date of the Arthritis Foundation's Tai Chi program, participants showed improvement in pain, fatigue, stiffness and sense of well-being.

09 nov 2010--Their ability to reach while maintaining balance also improved, said Leigh Callahan, PhD, the study's lead author, associate professor in the University of North Carolina at Chapel Hill School of Medicine and a member of UNC's Thurston Arthritis Research Center.

"Our study shows that there are significant benefits of the Tai Chi course for individuals with all types of arthritis, including fibromyalgia, rheumatoid arthritis and osteoarthritis," Callahan said. "We found this in both rural and urban settings across a southeastern state and a northeastern state."

Callahan will present these results on Monday, Nov. 8, at the annual scientific meeting of the American College of Rheumatology in Atlanta.

In the study, 354 participants were recruited from 20 sites in North Carolina and New Jersey. They were randomly assigned to two groups. The intervention group received the 8-week, twice-weekly Tai Chi course immediately while the other group was a delayed control group. All participants received baseline and 8-week follow-up evaluations, after which the control group also received the Tai Chi course.

To be eligible for study, participants had to have any type of self-reported, doctor-diagnosed arthritis, be 18 years old or older and able to move independently without assistance. However, they did not have to be able to perform Tai Chi standing. They were eligible for the study if they could perform Tai Chi seated, Callahan said.

Self-reports of pain, fatigue and stiffness and physical function performance measures were collected at baseline and at the eight-week evaluation. Participants were asked questions about their ability to perform activities of daily living, their overall general health and psychosocial measures such as their perceived helplessness and self-efficacy. The physical performance measures recorded were timed chair stands (which are a measure of lower extremity strength), gait speed (both normal and fast) and two measures of balance: a single leg stance and a reach test.

At the end of eight weeks the individuals who had received the intervention showed moderate improvements in pain, fatigue and stiffness. They also had an increased sense of well being, as measured by the psychosocial variables, and they had improved reach or balance, Callahan said.

Provided by University of North Carolina School of Medicine

Beneficial effects of testosterone for frailty in older men are short-lived

The beneficial effects of six months of testosterone treatment on muscle mass, strength and quality of life in frail elderly men are not maintained at six months post-treatment, according to a study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

08 nov 2010--Frailty is an age-related state of physical limitation caused by the loss of muscle mass and function and can lead to adverse clinical outcomes such as dependency, institutionalization and death. Testosterone levels naturally decline with aging and testosterone replacement is a common therapy. Short-term testosterone treatment in frail elderly men has been shown to improve muscle mass and strength, but until now it has been unclear whether these effects could be maintained post-treatment.

"Since the use of testosterone in elderly men raises concerns regarding adverse effects on the prostate and cardiovascular system, it's important to determine if short-term treatment can lead to prolonged benefits beyond the duration of testosterone exposure," said Frederick Wu, MD, of the University of Manchester in the United Kingdom and lead author of the study. "Our findings suggest it may not be possible to break or interrupt the cycle of decline in physical function in frailty by short-term anabolic pharmacological intervention using testosterone supplementation for six months."

In this study, researchers evaluated 274 intermediate-frail and frail elderly men aged 65-90 years with low testosterone levels. Study participants received either a testosterone gel or placebo for six months. Assessments were carried out at baseline, the end of treatment and six months after treatment cessation. Researchers found that the increased lean body mass, muscle strength and quality of life after six months of testosterone treatment were not maintained six months after treatment.

"At present, the optimal duration of anabolic hormonal intervention to produce sustained benefits in treating frailty in older men is unknown," said Wu. "To best interrupt the downward spiral into frailty a greater emphasis should be placed on a multi-disciplinary interventional approach including resistance exercise, diet and other lifestyle options, in conjunction with pharmacological agents."

More information: The article, "Do the Effects of Testosterone on Muscle Strength, Physical Function, Body Composition and Quality of Life Persist Six Months Post-treatment in Intermediate-Frail and Frail Elderly Men," will appear in the February 2011 issue of JCEM.

Provided by The Endocrine Society

Sodas, other sugary beverages linked to increased risk of type 2 diabetes, metabolic syndrome

A new study has found that regular consumption of soda and other sugar-sweetened beverages is associated with a clear and consistently greater risk of metabolic syndrome and type 2 diabetes. According to the Harvard School of Public Health (HSPH) researchers, the study provides empirical evidence that intake of sugary beverages should be limited to reduce risk of these conditions.

The study appears online October 27, 2010, in the journal Diabetes Care and will appear in the November print edition.

07 nov 2010--"Many previous studies have examined the relationship between sugar-sweetened beverages and risk of diabetes, and most have found positive associations but our study, which is a pooled analysis of the available studies, provides an overall picture of the magnitude of risk and the consistency of the evidence," said lead author Vasanti Malik, a research fellow in the HSPH Department of Nutrition.

Consumption of sugary drinks, the majority of which are sodas, has increased substantially in the U.S. and across the globe and previous scientific studies have shown consistent associations with weight gain and risk of obesity. However, this study is the first meta-analysis to quantitatively review the evidence linking sugar-sweetened beverages with type 2 diabetes and metabolic syndrome. (Metabolic syndrome is a group of risk factors, such as high blood pressure and excess body fat around the waist, that increase the risk of coronary artery disease, stroke and diabetes.)

The researchers, led by Malik and senior author Frank Hu, professor of nutrition and epidemiology at HSPH, did a meta-analysis that pooled 11 studies that examined the association between sugar-sweetened beverages and those conditions. The studies included more than 300,000 participants and 15,043 cases of type 2 diabetes and 19,431 participants and 5,803 cases of metabolic syndrome.

The findings showed that drinking one to two sugary drinks per day increased the risk of type 2 diabetes by 26% and the risk of metabolic syndrome by 20% compared with those who consumed less than one sugary drink per month. Drinking one 12-ounce serving per day increased the risk of type 2 diabetes by about 15%.

"The association that we observed between soda consumption and risk of diabetes is likely a cause-and-effect relationship because other studies have documented that sugary beverages cause weight gain, and weight gain is closely linked to the development of type 2 diabetes," said Hu.

While a number of factors are at work in the development of type 2 diabetes and metabolic syndrome, sugar-sweetened beverages represent one easily modifiable risk factor that if reduced will likely make an important impact, say the researchers. "People should limit how much sugar-sweetened beverages they drink and replace them with healthy alternatives, such as water, to reduce risk of diabetes as well as obesity, gout, tooth decay, and cardiovascular disease," said Malik.

Other HSPH authors include Walter Willett, chair of the Department of Nutrition and Frederick John Stare professor of nutrition and epidemiology.

More information: "Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes," Vasanti S. Malik, Barry M. Popkin, George A. Bray, Jean-Pierre Despres, Walter C. Willett, Frank B. Hu, Diabetes Care, vol. 33, no. 11, online Oct. 27, 2010.

Provided by Harvard School of Public Health

DHA 'fish oil' supplements do not seem to slow cognitive, functional decline in Alzheimer's disease

Patients with mild to moderate Alzheimer's disease (AD) who received supplementation with the omega-3 fatty acid docosahexaenoic acid (DHA), believed to possibly reduce the risk of AD, did not experience a reduction in the rate of cognitive and functional decline, compared to patients who received placebo, according to a study in the November 3 issue of JAMA, a theme issue on aging.

06 nov 2010--"Several studies have found that consumption of fish, the primary dietary source of omega-3 fatty acids, is associated with a reduced risk of cognitive decline or dementia. Some studies have found that consumption of DHA, but not other omega-3 fatty acids, is associated with a reduced risk of Alzheimer disease," the authors write. However, those studies were observational and did not control who received DHA. Animal studies that used DHA showed reductions in Alzheimer-like brain pathology.

Dr. Quinn and colleagues conducted a randomized, controlled trial to examine whether DHA supplementation would slow the rate of cognitive and functional decline in individuals with Alzheimer's disease. The study, which was conducted between November 2007 and May 2009 at 51 U.S. clinical research sites, included 402 individuals with mild to moderate Alzheimer's disease. Participants were randomly assigned to DHA at a dose of 2 grams/day or to identical placebo (60 percent were assigned to DHA and 40 percent were assigned to placebo). Duration of treatment was 18 months. Changes in cognitive and functional abilities were assessed with the Alzheimer's Disease Assessment Scale

(ADAS-cog) and the Clinical Dementia Rating (CDR) sum of boxes. Rate of brain atrophy was also determined by volumetric magnetic resonance imaging (MRI) in a subsample of participants.

A total of 295 participants completed the trial while taking study medication (DHA: 171; placebo: 124). The researchers found that supplementation with DHA had no beneficial effect on rate of change on ADAS-cog score, with the rate of average change in the score over 18 months being 8.27 points for the placebo group and 7.98 points for the DHA group. The rate of points change on CDR sum of boxes over 18 months was 2.93 for the placebo group compared with 2.87 for the DHA group.

Among the individuals participating in the MRI substudy (102 had MRIs at the beginning of the study and at 18 months [DHA group: 53; placebo group: 49]), an analysis showed no effect of DHA treatment on total brain volume change during 18 months.

"In summary, these results indicate that DHA supplementation is not useful for the population of individuals with mild to moderate Alzheimer disease," the authors write.

The researchers add that "because part of the rationale for the trial was epidemiological evidence that DHA use before disease onset modifies the risk of Alzheimer disease, it remains possible that an intervention with DHA might be more effective if initiated earlier in the course of the disease in patients who do not have overt dementia."

More information: JAMA. 2010;304[17]:1903-1911.

Provided by JAMA and Archives Journals

Helical CT scans reduce lung cancer mortality by 20% compared to chest X-rays


In a major new study announced today by the National Cancer Institute, researchers including Brown University biostatistian Constantine Gatsonis and his colleagues found that screening for lung cancer using helical CT scanning reduced lung cancer deaths by 20 percent compared to using chest X-rays.

05 nov 2010--"The findings we're announcing today offer the first definitive evidence for the effectiveness of helical CT screening smokers for lung cancer " said Gatsonis, a lead biostatistician in the study and director of the American College of Radiology Imaging Network's (ACRIN) Biostatistics and Data Management Center, based at Brown's Center for Statistical Sciences. "This is a major step in the formulation of appropriate screening strategies for this deadly disease."

The National Lung Screening Trial (NLST) was conducted by a consortium consisting of ACRIN and the Lung Screening Study (LSS). The consortium enrolled more than 53,000 current and former heavy smokers ages 55 to 74 into the NLST at 33 sites across the United States. Starting in August 2002, participants were enrolled during a 20-month period and randomly assigned to receive three annual screens with either low-dose helical CT (often referred to as spiral CT) or standard chest X-ray. A manuscript reporting on the design of the study appeared yesterday on the Web site of the journal Radiology.

"Everyone who participated in this trial has played an important role in providing hard evidence of a mortality benefit from CT screening for lung cancer as well as a road map for public policy development in the future," said Denise R. Aberle, M.D., the national principal investigator for NLST ACRIN, site co-principal investigator for the UCLA NLST team, and a deputy chair of ACRIN.

Helical CT uses X-rays to obtain a multiple-image scan of the entire chest compared to a standard chest X-ray that produces a single image of the whole chest in which anatomic structures overlie one another.

A secondary finding in the study showed overall deaths due to any factor, including lung cancer, were 7 percent lower in those screened with low-dose helical CT than in those screened with chest X-ray. Approximately 25 percent of deaths in the NLST were due to lung cancer, while other deaths were due to factors such as cardiovascular disease.

"The combined findings of a reduction in mortality due to lung cancer and in overall mortality are important for the overall interpretation and impact of the results from this study," Gatsonis said.

Today's announcement addresses only the primary objective of the NLST study: the lung cancer mortality comparison between helical CT and chest X-rays. Intensive analysis of the data collected in the study is now under way to address a host of questions, including the health care required to follow up screening findings, the impact of screening on quality of life, and the cost and cost-effectiveness of screening for lung cancer, Gatsonis said. The results of these analyses will provide crucial information for the eventual development of guidelines for screening for lung cancer.

Faculty and staff at the Brown Center for Statistical Sciences contributed methodologic expertise and leadership throughout the study, in collaboration with other ACRIN and LSS investigators, Gatsonis said. They collaborated on the original design and implementation of the study, worked on the collection and monitoring of the data, and prepared in-depth reports for the independent Data and Safety Monitoring Committee. Now they are doing the final analysis of the data and contributing to the interpretation of the findings.

Faculty and staff at the center also organized and carried out the data collection on the impact of screening on quality of life and smoking cessation. Ilana Gareen, research assistant professor of community health, is leading this effort.

"Many, many people across the country dedicated years of their lives to bring this study to its successful conclusion," Gatsonis said. "They should take pride in the results of their efforts announced today."

Provided by Brown University

Pain is common in the last two years of life, study find

In the first study to look at the prevalence of pain experienced among older people during the last two years of life, researchers at the San Francisco VA Medical Center found that 46 percent of study participants suffered moderate to severe pain during their final four months of life.

04 nov 2010--The researchers also found that more than one quarter of the participants had moderate to severe pain during the last two years of life, and that arthritis was the biggest single predictor of pain, outweighing all eventual causes of death, including cancer.

“The impact of arthritis on the experience of pain among older adults has not been recognized to the extent it should be,” says lead author Alexander K. Smith, MD, MS, MPH, a palliative medicine physician at SFVAMC. He notes that the prevalence of pain in the last month of life was 60 percent among patients with arthritis and 26 percent among patients without arthritis.

“This research tells us that physicians should anticipate that pain will increase among their elderly and dying patients, assess their patients for pain frequently, and prescribe appropriate pain medications at appropriate levels,” says Smith, who is also an assistant professor of medicine in the Division of Geriatrics at the University of California, San Francisco.

Smith recommends that physicians regularly assess and treat pain in their older patients with chronic diseases who are not obviously nearing death. “In other words,” he says, “pain management is not just for hospice patients.” The study appears in the November 2, 2010 issue of the Annals of Internal Medicine.

The authors analyzed data from interviews conducted with 4,703 men and women age 50 and older who died while enrolled in the Health and Retirement Study, an ongoing nationally representative longitudinal study of health, retirement, and aging sponsored by the National Institute on Aging. The interviews were conducted during each participant’s last 24 months of life.

“As physicians, we need to recognize the high burden of pain among our older patients,” says Smith.

Provided by University of California, San Francisco

New study tracks factors leading to physical decline in older adults

A study by Yale School of Medicine researchers reveals that the illnesses and injuries that can restrict the activity of older adults or land them in the hospital are linked to worsening functional ability, especially among those who are physically frail. The report appears in JAMA's November 3 theme issue on aging.

03 nov 2010--Thomas M. Gill, M.D., the Humana Foundation Professor of internal medicine (geriatrics), investigative medicine and epidemiology and public health at Yale, will present the findings at a JAMA media briefing today.

"We now have a much better understanding of the complex and highly dynamic disabling process," said Gill, who is also an attending physician at Yale-New Haven Hospital.

Among older adults, disability in essential activities of daily living, such as bathing, and dressing, is common and associated with an increased rate of death, institutionalization, and greater use of formal and informal home services. But many older adults also recover from disabilities. Gill points to high rates of recovery and frequent transitions between states of disability, but he said the role of intervening illnesses and injuries on these transitions was little understood until this study shed some light on it.

Gill and his co-authors followed 754 adults age 70 and older living in the Greater New Haven area, with monthly phone interviews for over 10 years starting in 1998. The team assessed disability and ascertained exposure to intervening illnesses and injuries. Physical frailty—slow walking speed—was assessed every 18 months for nine years. The team evaluated the relationship between two types of intervening events—hospitalization and restricted activity, and transitions between no disability, mild disability, severe disability and death.

The team found that among the 637 participants, who had at least one functional transition, 90.7 percent had at least one hospital admission and 94.3 percent had at least one month of restricted activity. Hospitalization was associated with disability for eight of the nine transitions.

Among the possible reasons for hospitalization or restricted activity, fall-related injury led to the highest likelihood of developing new or worsening disability.

Gill notes that despite the reductions observed in the prevalence of disability over the past two decades, the number of disabled older Americans could increase substantially in the coming years with the aging of the baby boom generation. "To address this increase, more aggressive efforts will be needed to prevent and manage intervening illnesses and injuries, given their apparent role in precipitating and perpetuating the disabling process," said Gill.

More information: JAMA. 2010;304[17]:1919-1928.

Patients who survive sepsis are more than 3 times as likely to have cognitive problems


Older adults who survive severe sepsis are at higher risk for long-term cognitive impairment and physical limitations than those hospitalized for other reasons, according to researchers from the University of Michigan Health System.

02 nov 2010--Research to be published Oct. 27 in the Journal of the American Medical Association showed that 60 percent of hospitalizations for severe sepsis were associated with worsened cognitive and physical function among surviving older adults. The odds of acquiring moderate to severe cognitive impairment were 3.3 times higher following an episode of sepsis than for other hospitalizations.

Severe sepsis also was associated with greater risk for the development of new functional limitations following hospitalization, says lead author, Theodore (Jack) Iwashyna, M.D., Ph.D., assistant professor of internal medicine at U-M.

Among patients who had no limitations before sepsis, more than 40% developed trouble with walking. Nearly 1 in 5 developed new problems with shopping or preparing a meal. Patients often developed new problems with such basic things as bathing and toileting themselves.

"We used to think of sepsis as just a medical emergency, an infection that you get sick with and then recover," said Iwashyna, "But we discovered a significant number of people face years of problems afterwards.

"Those problems are bigger and more common than we expected. Most older Americans suffer real brain and body problems. We need new treatments, not just for the sepsis infection, but to prevent these new disabilities afterwards."

Sepsis is an overwhelming infection that can result in failure of multiple organ systems. The initial infections are often common problems, such as pneumonia or a urinary tract infection. About 40 percent of those with severe sepsis die from the infection.

Anyone can get sepsis, but older people and those with weakened immune systems are most vulnerable. Sepsis is probably the most common cause of critical illness in the United States.

The best data available are from the 1990s, when it was estimated that 750,000 people each year were diagnosed with sepsis. Researchers believe that number has doubled each decade.

"These new data show a majority of older patients suffer with real life-changing burdens after beating sepsis. This is an underrecognized public health problem with major implications for patients, families and the health care system," Iwashyna says.

"We need to make sure families have the resources they need to care for survivors of sepsis when they go home. It's not enough just to get them through the acute episode. We need to start preparing them for the years of problems they may have afterwards."

"This research underscores the need for physicians who care for older adults to focus early on preventing infections that can lead to sepsis," says study co-author Kenneth M. Langa, M.D., Ph.D., a core investigator for the Ann Arbor Veterans Administration Health Services Research and Development Service's Center of Excellence and professor of internal medicine at U-M.

Older patients need to get their flu and pneumonia vaccines in order to decrease their risk for infections, and physicians need to be aware of the long-term risk for cognitive and physical disabilities that many patients may face, Langa said.

"In contrast to Alzheimer's disease and other forms of dementia, the cognitive impairment associated with sepsis is likely at least partially preventable through better acute care of the sepsis episode and better rehabilitation efforts afterwards," Langa says.

"We need to start working early – from the beginning of the hospitalization – to make sure patients do not develop new disability. There are innovative new ways to care for people that might help prevent this disability," Iwashyna says.

The research was supported primarily by the National Institute on Aging and the National Heart, Lung and Blood Institute.

The researchers used data from the NIA-supported Health and Retirement Study , a long-term study that collects information on the health, economic, and social factors influencing the health and well-being of a nationally representative sample Americans over age 50.

"This research makes clearer how acute medical problems in older adults may have an important lasting impact and contribute to a downward trajectory in both cognitive and physical function," says Richard Suzman, Ph.D., director of the NIA's Division of Behavioral and Social Research, which supports the HRS.

"The unique nature of the rich HRS dataset that links both survey data and Medicare administrative data made this innovative study possible and will also facilitate future studies of the long-term impact of critical illness on older adults and the family members that care for them."

More information: Journal of the American Medical Association, 2010; 304(16): 1787-1794.

More Older Americans Living With HIV

01 nov 2010-- Better treatments are extending the lives of people with HIV, but aging with the AIDS-causing virus takes a toll that will challenge the health care system, a new report says.

A survey of about 1,000 HIV-positive men and women ages 50 and older living in New York City found more than half had symptoms of depression, a much higher rate than others their age without HIV.

And 91 percent also had other chronic medical conditions, such as arthritis (31 percent), hepatitis (31 percent), neuropathy (30 percent) and high blood pressure (27 percent). About 77 percent had two or more other conditions. About half had progressed to AIDS before they got the HIV diagnosis, the report found.

"The good news is antiretroviral therapies are working and people are living. If all goes well, they will have life expectancies similar to those without HIV," said Daniel Tietz, executive director of the AIDS Community Research Initiative of America.

"But a 55-year-old with HIV tends to look like a 70-year-old without HIV in terms of the other conditions they need treatment for," he said Wednesday at a meeting of the Office of National AIDS Policy at the White House in Washington, D.C.

The research included interviews with 640 men, 264 women and 10 transgender people. Dozens of experts on HIV and aging attended the meeting, which was intended to identify the needs of older adults with HIV and to explore ways to improve services to them.

Currently, about 27 percent of those with HIV are over 50. By 2015, more than half will be, said the report.

Because of their special needs, this poses challenges for public health systems and organizations that serve seniors and people with HIV, Tietz said.

HIV can be isolating, Tietz said. Seventy percent of older Americans with HIV live alone, more than twice the rate of others their age, while about 15 percent live with a partner, according to the report.

The survey found that loneliness was higher among HIV-positive adults than for other older Americans. One reason is that many men and women conceal the condition from friends and family for fear of stigma or rejection, both real and imagined, Tietz said.

Lack of social and family support increases the likelihood of needing costly health care, such as home health aides and nursing homes as they get older, Tietz said.

Dr. Amy Justice, an HIV researcher who also attended the meeting, spoke of the need for health care professionals to learn about specific issues facing HIV-positive seniors.

HIV organizations tend to gear messages toward younger people, and senior services organizations often don't know much about the needs of HIV-positive seniors, said Justice, principal investigator of the Veterans Aging Cohort Study. This ongoing study involves some 40,000 veterans with HIV and 80,000 without HIV from 10 Veterans Affairs medical centers nationwide.

"There are a lot of people with HIV who are 60 or 65 and even 80 or 85," Justice said. "Those individuals feel older than their stated age and may have some of the same problems people 10 or 15 years older would normally experience."

Many older Americans with HIV are still sexually active and should be encouraged to practice safe sex, Justice said. While 57 percent of older Americans with HIV said they disclosed their HIV status to sexual partners, about 16 percent didn't, the report found.

About half the survey participants were black, one-third were Hispanic and 14 percent were white. About 67 percent considered themselves heterosexual, 24 percent were gay and 9 percent bisexual.

Why people with HIV are more likely to have other chronic diseases is still unclear, Tietz said. The cause could be the HIV itself or long-term side effects from taking multiple medications, he said. Early HIV drugs were especially toxic, he added.

Stress may have only small impact on weight

NEW YORK , 31 oct 2010-- Despite the common belief that stress causes people to pack on the pounds, a new research review finds that, on average, stress has little long-term effect on weight.

The results are surprising, researchers say, given the widespread notion that stress - by causing people to reach for junk food or skimp on exercise, for example -- is an important factor in weight gain.

When the investigators pulled together 32 previously published studies on the question, however, they found the majority showed no association between people's stress levels and their weight gain over several years.

When the researchers combined the studies' results -- in what is known as a meta-analysis -- there was only a modest association overall between stress and weight gain.

"When we started this meta-analysis, we assumed that there would be a substantial association between stress and obesity, since the popular view is that stress contributes to weight gain," co-researcher Dr. Andrew Steptoe, of University College London in the UK, told Reuters Health in an e-mail.

"But when we looked carefully at well-controlled scientific studies," he said, "effects were surprisingly small."

That does not necessarily mean that stress cannot have a significant influence on some people's weight, according to Steptoe. The average effect of stress on weight might be small, but there could be wide variations among individuals, he said.

Citing diet as one example, Steptoe noted that "some people may increase their food consumption under stress, while others may stop eating and lose their appetites."

In addition, he said, different types of stress - whether associated with work, caregiving or specific life events -- might have different effects on weight gain.

Examining those questions was beyond the scope of the data Steptoe and his colleagues had.

For the study, the researchers, led by Dr. Jane Wardle, also of University College London, analyzed 32 international studies conducted mainly in the 1990s and 2000s.

All of the studies assessed participants' stress levels, then followed the subjects over time to see whether there was a relationship between stress and subsequent weight gain. Most followed participants for one to seven years, but a few were longer term projects that followed people for up to 38 years.

Some of the studies focused on participants' levels of work stress, while others gauged "general life stress," which includes anything from major traumas like experiencing a serious illness or a divorce, to feeling overwhelmed by daily hassles.

Overall, the researchers found, 69 percent of the studies uncovered no clear association between stress levels and weight gain. One-quarter linked higher stress levels to greater weight gain, and the remaining 6 percent found that greater stress was related to less weight gain over time.

When Wardle's team pooled the results of all the studies, they found a modest association between higher stress levels and greater weight gain.

In general, the connection was stronger among men than among women -- an interesting finding, Steptoe said, since it is "popular belief" that stress has a greater impact on women's weight.

One of the limitations of this review, according to the researchers, was that it could not examine the role of psychological disorders - the included studies focused on exposure to stress, and not, for example, whether a person developed depression in response to that stressor.

"The general message," Steptoe said, "is that, based on the best current scientific research, stress is not likely to play a major role in increasing body weight or obesity for most people."

"It could be that some people are more affected than others," he added, "but rather little is known about this at present."

He and his colleagues call for more research into the factors that might explain why one person puts on pounds in response to stress and another does not.

Getting older leads to emotional stability, happiness: study

"As people get older, they're more aware of mortality," researcher Laura Carstensen said. "So when they see or experience moments of wonderful things, that often comes with the realization that life is fragile and will come to an end. But that's a good thing. It's a signal of strong emotional health and balance."

30 oct 2010--As people age, they're more emotionally balanced and better able to solve highly emotional problems, says psychology professor and longevity expert Laura Carstensen.

It's a prediction often met with worry: In 20 years, there will be more Americans over 60 than under 15. Some fear that will mean an aging society with an increasing number of decrepit, impaired people and fewer youngsters to care for them while also keeping the country's productivity going.

The concerns are valid, but a new Stanford study shows there's a silver lining to the graying of our nation. As we grow older, we tend to become more emotionally stable. And that translates into longer, more productive lives that offer more benefits than problems, said Laura Carstensen, the study's lead author.

"As people age, they're more emotionally balanced and better able to solve highly emotional problems," said Carstensen, a psychology professor and director of the Stanford Center on Longevity. "We may be seeing a larger group of people who can get along with a greater number of people. They care more and are more compassionate about problems, and that may lead to a more stable world."

Between 1993 and 2005, Carstensen and her colleagues tracked about 180 Americans between the ages of 18 and 94. Over the years, some participants died and others aged out of the younger groups, so additional participants were included.

For one week every five years, the study participants carried pagers and were required to immediately respond to a series of questions whenever the devices buzzed. The periodic quizzes were intended to chart how happy, satisfied and comfortable they were at any given time.

Carstensen's study – which was published online Monday in the journal Psychology and Aging – was coauthored by postdoctoral fellows Bulent Turan and Susanne Scheibe as well as Stanford doctoral students and researchers at Pennsylvania State, Northwestern, the University of Virginia and the University of California's campuses in San Francisco and Los Angeles.

While previous research has established a correlation between aging and happiness, Carstensen's study is the first to track the same people over a long period of time to examine how they changed.

The undertaking was an effort to answer questions asked over and over again by social scientists: Are seniors today who say they're happy simply part of a socioeconomic era that predisposed them to good cheer? Or do most people – whether born and reared in boom times or busts – have it within themselves to reach their golden years with a smile? The answer has important implications for future aging societies.

"Our findings suggest that it doesn't matter when you were born," Carstensen said. "In general, people get happier as they get older."

Over the years, the older subjects reported having fewer negative emotions and more positive ones compared with their younger days. But even with the good outweighing the bad, older people were inclined to report a mix of positive and negative emotions more often than younger test subjects.

"As people get older, they're more aware of mortality," Carstensen said. "So when they see or experience moments of wonderful things, that often comes with the realization that life is fragile and will come to an end. But that's a good thing. It's a signal of strong emotional health and balance."

Carstensen (who is 56 and says she's happier now than she was a few decades ago) attributes the change in older people to her theory of "socio-emotional selectivity" – a scientific way of saying that people invest in what's most important to them when time is limited.

While teenagers and young adults experience more frustration, anxiety and disappointment over things like test scores, career goals and finding a soul mate, older people typically have made their peace with life's accomplishments and failures. In other words, they have less ambiguity to stress about.

"This all suggests that as our society is aging, we will have a greater resource," Carstensen said. "If people become more even-keeled as they age, older societies could be wiser and kinder societies."

So what, then, do we make of the "grumpy old man" stereotype?

"Most of the grumpy old men out there are grumpy young men who grew old," Carstensen said. "Aging isn't going to turn someone grumpy into someone who's happy-go-lucky. But most people will gradually feel better as they grow older."