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

The Gerontological Society of America congratulates 2009 awardees

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cognitive Factors Preceding Alzheimer's Disease Examined


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

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

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

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

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

Abstract
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Urate Concentrations Linked to Parkinson's Progression


Study provides rationale for boosting urate concentration to slow disease progression

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

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

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

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

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

Abstract
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Dementia Is A Terminal Illness, Study

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

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

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

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

Mitchell told the press that:

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

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

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

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

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

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

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

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

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

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

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

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

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

Mitchell said that:

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

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

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

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

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

Sachs said this new study by Mitchell and colleagues:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source:
Audrey Hamilton
American Psychological Association

Noncorrectable vision problems associated with shorter lifespan in older adults

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Atypical β-Blocker May Improve Endothelial Function


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

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

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

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

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

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

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Visual Impairment May Affect Mortality Risk in Elders

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

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

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

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

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

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Simple tool can boost motivation, improve health in older adults

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The National Institutes of Health funded Rossie's research.

Mediterranean diet associated with reduced risk of depression

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

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

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

30% reduction in the risk of depression

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

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

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

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

More Elderly Might Benefit From Stroke Treatment


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

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

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

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

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

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Novel Risk Factors Not Found Useful for Heart Screening


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

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

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

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

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

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

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

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

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

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

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

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Medication Errors in Nursing Home Residents Assessed


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

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

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

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

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

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