Low-normal sodium deemed major risk for mortality in elderly
A slightly lower serum sodium concentration within the normal range is a major risk factor for mortality in elderly adults, according to a study published in the March issue of the Journal of the American Geriatrics Society.
28 mar 2016--Shin Y. Ahn, M.D., from Seoul National University Bundang Hospital in South Korea, and colleagues randomly selected, community-based 949 elderly adults with a corrected serum sodium level between 135.0 and 145.0 mEq/L from the Korean Longitudinal Study on Health and Aging cohort. Patients were stratified by sodium level: 73 in Group 1 (sodium 135.0 to 138.0 mEq/L), 635 in Group 2 (sodium 138.1 to 142.0 mEq/L), and 241 in Group 3 (sodium 142.1 to 145.0 mEq/L).
The researchers found that deaths significantly varied by group: 34 deaths in Group 1, 124 in Group 2, and 52 in Group 3 (P < 0.001). A 2-mEq/L higher sodium level reduced the risk of death by 14.9 percent (P = 0.048). Group 1 had risk of mortality that was 2.7 times as high as that of Group 2 (P < 0.001). Those with a measured sodium level of ≤138.0 mEq/L and a corrected sodium level >138.0 mEq/L had a better survival rate than those with a measured sodium level of ≤138.0 mEq/L and a corrected sodium level of ≤138.0 mEq/L.
"Sodium level corrected according to serum glucose concentration was a more meaningful risk factor than measured sodium level," the authors write.
Aging is portrayed as mainly negative in popular music lyrics
A recent analysis of popular music reveals that while older age and aging are represented both negatively and positively in music lyrics, negative representations predominate. Most of the music texts were generated from a young person's perspective and their imaginings of old age.
25 mar 2016--While negative and positive emotions can influence health and well-being, further research is needed to explore what impact negative texts in popular music may have on older individuals.
"Recommendations from these studies suggest more sensitive, positive, inclusive and less stereotypical media reporting of issues and activities relating to ageing and older people," the authors of the Journal of Advanced Nursing study wrote. "While it may prove an impossible task and an infringement on free expression to censor all negative expressions of old age, it is important nonetheless that awareness is raised and some efforts exerted to suspend stereotypes and negative age and ageing identities in popular music due to the penetrating effects of melody and lyrics on peoples' mindsets."
More information: Jacinta Kelly et al. Representation of age and ageing identities in popular music texts, Journal of Advanced Nursing (2016). DOI: 10.1111/jan.12916
Provided by Wiley
Thursday, March 24, 2016
Adherence to Japanese diet guidelines linked to longer life
Credit: Jm Verastigue/public domainCloser adherence to Japanese dietary guidelines is associated with a lower risk of death from all causes and death from cardiovascular disease, particularly stroke, finds a study published by The BMJtoday.
24 mar 2016--The findings suggest that balanced consumption of grains, vegetables, fruits and adequate intake of fish and meat, can contribute to longevity in the Japanese population.
In 2005, the Japanese government developed the spinning top - a Japanese food guide - to illustrate the balance and quantity of food in the daily Japanese diet.
A team of researchers, led by Kayo Kurotani at the National Centre for Global Health and Medicine in Tokyo, set out to examine the association between adherence to the food guide and total and cause specific mortality.
They used data from detailed food and lifestyle questionnaires completed by 36,624 men and 42,920 women aged 45-75. Participants had no history of cancer, stroke, heart disease, or chronic liver diseaseand were followed-up for 15 years.
They found that both men and women with higher scores on the food guide (better adherence) had a 15% lower total mortality rate over 15 years. This protective association was mainly attributable to a reduction in mortality from cerebrovascular disease.
The researchers conclude: "Our findings suggest that balanced consumption of energy, grains, vegetables, fruits, meat, fish, eggs, soy products, dairy products, confectionaries, and alcoholic beverages can contribute to longevity by decreasing the risk of death, predominantly from cardiovascular disease, in the Japanese population."
More information: Quality of diet and mortality among Japanese men and women: Japan Public Health Center-based Prospective Study, The BMJ, www.bmj.com/cgi/doi/10.1136/bmj.i1209
Provided by British Medical Journal
Wednesday, March 23, 2016
Antipsychotic drugs may not be effective against delirium
A recent review of the medical literature does not support the use of antipsychotic medications for preventing or treating delirium in hospitalized patients.
23 mar 2016--Investigators analyzed 19 relevant studies. In seven studies comparing antipsychotics with placebo or no treatment for delirium prevention in postoperative patients, there was no significant effect on delirium incidence. Using data reported from all 19 studies including medical and surgical patient populations, antipsychotic use was not associated with change in delirium duration, severity, hospital length of stay, or mortality. There was considerable variability in design and outcome measures among studies, however.
"When we combine all available evidence right now, there is no compelling signal to support the routine use of antipsychotic medications to reduce delirium," said Dr. Karin Neufeld, co-author of the Journal of the American Geriatrics Societystudy.
This image represents a coronal section of hippocampal dentate gyrus (DG) from a mouse model of early Alzheimer's disease. These AD mice exhibit severe β-amyloid plaques (red) in the DG at 9-months of age. Using these mice combined with a novel viral strategy, memory engram cells (green) for a contextual fear memory were labeled. Credit: RIKENIn the early stages of Alzheimer's disease, patients are often unable to remember recent experiences. However, a new study from MIT suggests that those memories are still stored in the brain—they just can't be easily accessed.
17 mar 2016--The MIT neuroscientists report in Nature that mice in the early stages of Alzheimer's can form new memories just as well as normal mice but cannot recall them a few days later.
Furthermore, the researchers were able to artificially stimulate those memories using a technique known as optogenetics, suggesting that those memories can still be retrieved with a little help. Although optogenetics cannot currently be used in humans, the findings raise the possibility of developing future treatments that might reverse some of the memory loss seen in early-stage Alzheimer's, the researchers say.
"The important point is, this a proof of concept. That is, even if a memory seems to be gone, it is still there. It's a matter of how to retrieve it," says Susumu Tonegawa, the Picower Professor of Biology and Neuroscience and director of the RIKEN-MIT Center for Neural Circuit Genetics at the Picower Institute for Learning and Memory.
Tonegawa is the senior author of the study, which appears in the March 16 online edition of Nature. Dheeraj Roy, an MIT graduate student, is the paper's lead author.
A single memory engram cell in the hippocampal dentate gyrus region of a mouse model of early Alzheimer's disease. To optically manipulate specific connections to these engram cells, a blue light-sensitive protein oChIEF was expressed in an upstream brain region, i.e., medial entorhinal cortical inputs (red) to the DG. The majority of DG granule cells were not active during engram labeling (blue, non-engram cells). Credit: RIKENLost memories
In recent years, Tonegawa's lab has identified cells in the brain's hippocampus that store specific memories. The researchers have also shown that they can manipulate these memory traces, or engrams, to plant false memories, activate existing memories, or alter a memory's emotional associations.
Last year, Tonegawa, Roy, and colleagues found that mice with retrograde amnesia, which follows traumatic injury or stress, had impaired memory recall but could still form new memories. That led the team to wonder whether this might also be true for the memory loss seen in the early stages of Alzheimer's disease, which occurs before characteristic amyloid plaques appear in patients' brains.
To investigate that possibility, the researchers studied two different strains of mice genetically engineered to develop Alzheimer's symptoms, plus a group of healthy mice.
All of these mice, when exposed to a chamber where they received a foot shock, showed fear when placed in the same chamber an hour later. However, when placed in the chamber again several days later, only the normal mice still showed fear. The Alzheimer's mice did not appear to remember the foot shock.
"Short-term memory seems to be normal, on the order of hours. But for long-term memory, these early Alzheimer's mice seem to be impaired," Roy says.
A coronal section of hippocampal dentate gyrus from a mouse model of early Alzheimer's disease. These AD mice lack β-amyloid plaques at 7-months of age. Using these mice combined with a novel viral strategy, memory engram cells (green) for a contextual fear memory were labeled with a light-sensitive protein ChR2. Credit: RIKEN"An access problem"
The researchers then showed that while the mice cannot recall their experiences when prompted by natural cues, those memories are still there.
To demonstrate this, they first tagged the engram cells associated with the fearful experience with a light-sensitive protein called channelrhodopsin, using a technique they developed in 2012. Whenever these tagged engram cells are activated by light, normal mice recall the memory encoded by that group of cells. Likewise, when the researchers placed the Alzheimer's mice in a chamber they had never seen before and shined light on the engram cells encoding the fearful experience, the mice immediately showed fear.
"Directly activating the cells that we believe are holding the memory gets them to retrieve it," Roy says. "This suggests that it is indeed an access problem to the information, not that they're unable to learn or store this memory."
The researchers also showed that the engram cells of Alzheimer's mice had fewer dendritic spines, which are small buds that allow neurons to receive incoming signals from other neurons.
Normally, when a new memory is generated, the engram cells corresponding to that memory grow new dendritic spines, but this did not happen in the Alzheimer's mice. This suggests that the engram cells are not receiving sensory input from another part of the brain called the entorhinal cortex. The natural cue that should reactivate the memory—being in the chamber again—has no effect because the sensory information doesn't get into the engram cells.
"If we want to recall a memory, the memory-holding cells have to be reactivated by the correct cue. If the spine density does not go up during learning process, then later, if you give a natural recall cue, it may not be able to reach the nucleus of the engram cells," Tonegawa says.
Long-term connection
The researchers were also able to induce a longer-term reactivation of the "lost" memories by stimulating new connections between the entorhinal cortex and the hippocampus.
To achieve this, they used light to optogenetically stimulate entorhinal cortex cells that feed into the hippocampal engram cells encoding the fearful memory. After three hours of this treatment, the researchers waited a week and tested the mice again. This time, the mice could retrieve the memory on their own when placed in the original chamber, and they had many more dendritic spines on their engram cells.
However, this approach does not work if too large a section of the entorhinal cortex is stimulated, suggesting that any potential treatments for human patients would have to be very targeted. Optogenetics is very precise but too invasive to use in humans, and existing methods for deep brain stimulation—a form of electrical stimulation sometimes used to treat Parkinson's and other diseases—affect too much of the brain.
"It's possible that in the future some technology will be developed to activate or inactivate cells deep inside the brain, like the hippocampus or entorhinal cortex, with more precision," Tonegawa says. "Basic research as conducted in this study provides information on cell populations to be targeted, which is critical for future treatments and technologies."
More information: Dheeraj S. Roy et al. Memory retrieval by activating engram cells in mouse models of early Alzheimer's disease, Nature (2016). DOI: 10.1038/nature17172
Provided by Massachusetts Institute of Technology
Wednesday, March 16, 2016
The up- and downside of caloric restriction for aging and health
It's already well known that a diet may have a life-extending effect. Researchers from Leibniz Institute on Aging – Fritz Lipmann Institute (FLI) in Jena, Germany, now showed that besides improving the functionality of stem cells in mice, a caloric restriction also leads to a fatale weakening of their immune system – counteracting the life-lengthening effect of a diet. The results are published in the Journal of Experimental Medicine on March, 14. 2016.
16 mar 2016--Only few years ago, researchers succeeded in prolonging the lifespan of worm C. elegans, fruit fly D. melongaster and rats by almost 50% through a simple caloric restriction – which immediately fueled hopes for having found one key to a longer life also for humans. However, transferring these results to long-lived primates short after was not equally successful and cooled down enthusiasms quite quickly. Now, aging researcher Karl Lenhard Rudolph, Scientific Director at the Leibniz Institute on Aging – Fritz Lipmann Institute (FLI) in Jena, Germany, and his team showed that caloric restriction even has a severe downside. In feeding experiments, the stem cells of mice, which were set on a diet, were found to age slower – but the murine immune system was almost completely cut down. Outside of optimal, sterile laboratory conditions, this could lead to severe live-shortening infections. The results of the study are published in the Journal of Experimental Medicine's current issue.
Caloric restriction slows down the aging of blood stem cells
The study focused on the effects of caloric restriction on blood stem cells (so-called hematopoietic stem cells, HSC) that are responsible for building red blood cells or lymphocytes (immune cells). Like for any other adult stem cell, HSC functionality decreases with every single cell division – the stem cells age. This is why they stay in a resting phase (quiescence) most of the time and are only activated when a massive cell reproduction is required (e.g. after acute blood loss). In their study, the researchers from Jena investigated how a 30% food restriction effects stem cell aging in mice. One main result was that the HSC stayed in a quiescent state even if simulated stress would have required their activation. This effect was found regardless of how long the diet lasted. Thus, during diet, the blood stem cells did not age at all and their functionality to build new blood cells remained increased even one year after diet.
Caloric restriction weakens the immune system
But the long-term diet had a downside, as well: The mice's immune system almost completely was cut down. Although the diet had no strong effect on the overall cell number of blood cells, the production of lymphocytes – needed for immune defense – was decreased by up to 75%. As a consequence, mice were particularly prone to bacterial infections.
Slowing down aging under laboratory conditions is not yet transferable to humans
"The study provides the first experimental evidence that long-term caloric restriction – as intervention to slow down aging – increases stem cell functionality, but results in immune defects in the context of prolonged bacterial infection, too. Thus, positive effects of a diet are not transferable to humans one to one", Rudolph sums up the study results. Even if – under laboratory conditions – aging of single cells or tissues may be slowed down through a diet, the immune suppression may have fatal consequences in real life. To benefit from caloric restriction or medicinal mimetika aiming at increasing health in the elderly, possible risks of such interventions to come down with life-threatening infections remain to be elucidated. "In sepsis patients, we see a higher survival rate for those with a higher body weight than for patients who are very lean", Prof. Dr. Michael Bauer, Director of the Center for Sepsis Control and Care at University Hospital Jena (UKJ), concurs.
More information: Duozhuang Tang et al. Dietary restriction improves repopulation but impairs lymphoid differentiation capacity of hematopoietic stem cells in early aging, The Journal of Experimental Medicine (2016). DOI: 10.1084/jem.20151100
Provided by Leibniz Institute on Aging
Sunday, March 13, 2016
Latin dancing may have health benefits for older adults
A four-month dance program helped older Latino adults walk faster and improved their physical fitness, which may reduce their risk for heart disease, according to research presented at the American Heart Association's Epidemiology/Lifestyle 2016 Scientific Sessions.
13 mar 2016--Researchers at the University of Illinois at Chicago tested whether a community-based intervention focused on Latin dancing could benefit 54 Spanish-speaking adults (about 65 years old, 80 percent Mexican female) who were not very physically active. Participants were randomly assigned to either participate in a dance program twice a week for four months or to attend a health education program. All participants completed questionnaires about their leisure time physical activity and a 400-meter walk test at the start and end of the study.
After four months of twice-weekly Latin dancing, researchers found:
Dancers walked faster and were more physically active during their leisure time than before they started dancing.
Dancers completed a 400-meter walk in just under 392 seconds compared with almost 430 seconds at the start of the study.
Leisure physical activity rose from 650 minutes to nearly a total of 818 minutes per week.
Four signs that a geriatric ER patient should be admitted to the hospital
Four reasons to admit a senior from the ER to the hospital (Annals of Emergency Medicine). Credit: American College of Emergency PhysiciansOlder adults who go to the emergency department with cognitive impairment, a change in disposition plan from admit to discharge, low blood pressure and elevated heart rate were more likely to be admitted to the intensive care unit (ICU) or to die within 7 days. The results of a matched case-control study of patients age 65 or older who died or were admitted to the ICU within 7 days of being evaluated in the emergency department were published online Wednesday in Annals of Emergency Medicine ("Poor Outcomes Following Emergency Department Discharge of the Elderly: A Case-Control Study").
11 mar 2016--"Emergency physicians must exercise extra caution when making the decision to admit or discharge a geriatric patient," said Gelareh Gabayan, MD, MSHS of the Department of Medicine at the University of California at Los Angeles. "These patients tend to be more delicate than their younger counterparts. Even abnormal vital signs, like blood pressure and heart rate, are associated with potentially catastrophic events for patients who are discharged from the ER rather than admitted."
Patients age 65 or older with a change in disposition plan (from admit to discharge), acute or chronic cognitive impairment or mental status changes, and abnormal vital signs (a systolic blood pressure below 120 and heart rate above 90) had a greater likelihood of experiencing death or an ICU admission within 7 days of being discharged from the emergency department. (The change in disposition could be directed by a physician or by the patient leaving the hospital against medical advice.)
"Both patient families and hospital administrators can pressure emergency physicians to discharge seniors from the emergency department, but our study supports caution in these decisions," said Dr. Gabayan. "Our study identifies the patients at risk and the findings show that even seemingly small indicators can add up to something dangerous in these vulnerable patients. It is important to note, however, that this study does not encourage that all older adults be admitted. The findings should act as a tool for emergency department providers."
More information: Gelareh Z. Gabayan et al. Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study, Annals of Emergency Medicine (2016). DOI: 10.1016/j.annemergmed.2016.01.007
Provided by American College of Emergency Physicians
Wednesday, March 09, 2016
Landmark editorial identifies microbes as major cause of Alzheimer's disease
A worldwide team of senior scientists and clinicians have come together to produce an editorial which indicates that certain microbes - a specific virus and two specific types of bacteria—are major causes of Alzheimer's disease. Their paper, which has been published online in the highly regarded peer-reviewed journal, Journal of Alzheimer's disease, stresses the urgent need for further research—and more importantly, for clinical trials of anti-microbial and related agents to treat the disease.
09 mar 2016--This major call for action is based on substantial published evidence and research into Alzheimer's. The team's landmark editorial summarises the abundant data implicating these microbes, but until now this work has been largely ignored or dismissed as controversial—despite the absence of evidence to the contrary. Therefore, proposals for the funding of clinical trials have been refused, despite the fact that over 400 unsuccessful clinical trials for Alzheimer's based on other concepts were carried out over a recent 10-year period.
Opposition to the microbial concepts resembles the fierce resistance to studies some years ago which showed that viruses cause certain types of cancer, and that a bacterium causes stomach ulcers. Those concepts were ultimately proved valid, leading to successful clinical trials and the subsequent development of appropriate treatments.
Professor Douglas Kell of The University of Manchester's School of Chemistry and Manchester Institute of Biotechnology is one of the editorial's authors. He says that supposedly sterile red blood cells were seen to contain dormant microbes, which also has implications for blood transfusions. "We are saying there is incontrovertible evidence that Alzheimer's disease has a dormant microbial component, and that this can be woken up by iron dysregulation. Removing this iron will slow down or prevent cognitive degeneration – we can't keep ignoring all of the evidence."
Professor Resia Pretorius of the University of Pretoria, who worked with Douglas Kell on the editorial, said "The microbial presence in blood may also play a fundamental role as causative agent of systemic inflammation, which is a characteristic of Alzheimer's disease—particularly, the bacterial cell wall component and endotoxin, lipopolysaccharide. Furthermore, there is ample evidence that this can cause neuroinflammation and amyloid-β plaque formation."
The findings of this editorial could also have implications for the future treatment of Parkinson's disease, and other progressive neurological conditions.
Provided by University of Manchester
Saturday, March 05, 2016
Understanding ageism prolongs your life
Perceptions about ageism makes people think of older people and is a form of discrimination. This according to Fredrik Snellman at Umeå University who believes that the concept needs to be redefined to mirror all people's practical experiences of ageing. The results have been published in the journal Nordic Psychology.
05 mar 2016--"We are using age in many ways to organise our own and other people's lives and to make our social world understandable. The usage can sometimes be prejudiced and have undesirable consequences to us all. It is often hidden and the ways it is noticeable in everyday life can seem trivial. That is why it is of importance to make visible the everyday use of ageism and find new terms for them," says Fredrik Snellman.
In the article, Snellman criticises previous scientific findings and a suggested definition of the term of attitude and the phenomenon 'ageism'. According to Snellman, the concept of ageism needs to be redefined to mirror all people's practical experiences of the chronological, social, biological and psychological parts of ageing. Ageism should be portrayed as significant for people of all ages rather than only the older population.
Furthermore, Snellman's study draws parallels to another study that has shown that negative ageism – or negative attitudes about older people and ageing – stands in connection with an increased mortality among the population. The study shows that individuals with a higher level of negative attitudes (confirmed at the age of 50 or earlier) live on average 7.5 years shorter in comparison to those who have a more positive attitude towards ageing. That is proof of why an increased awareness is needed and should in all likelihood arouse people's interest in their own attitudes.
Snellman is critical towards ageism being portrayed as difficulty only for older people despite researchers in the previous study to have express ambition to eliminate the same. Regardless of the strive within science to avoid differentiating between 'us and them – old and young' which often forms the basis of the hidden and rarely questioned way of creating inequality – science upholds the difference.
"Awareness and a lively debate about the complex problem of ageism is needed, in particular about how age enables and limits our lives throughout the course of life. A better understanding of how 'older people' besides distinguishing a group of the population also is an intergenerational phenomenon is necessary. Age-related indifference does not suddenly appear when we grow old. It appears gradually and in different ways at all ages," says Snellman.
More information: Fredrik Snellman. Whose ageism? The reinvigoration and definitions of an elusive concept, Nordic Psychology (2016). DOI: 10.1080/19012276.2015.1125301
Provided by Umea University
Monday, February 29, 2016
Is dementia on the decline? Research suggests it might be
Despite fears that the coming silver tsunami will trigger a dementia epidemic, a surprising new study suggests that it may be possible to delay - or even prevent - some kinds of dementia.
29 feb 2016--Dementia rates in the United States dropped by 44 percent from the late 1970s to 2010, according to the Boston University study.
In addition, the average age when people showed symptoms rose from 80 to 85, researchers discovered.
Their findings were published recently in the New England Journal of Medicine.
The report analyzed data from a long-running study of thousands of people in a small Massachusetts town.
While scientists don't know the exact reason for the decrease in dementia cases, they highlight two contributing factors: education level and heart health.
People in the study who earned at least a high school diploma had a much lower dementia risk than those with less education. Other studies have revealed a link between higher levels of education and better overall health.
The largest decrease was reported in dementia cases caused by stroke and other vascular diseases. People in the study who improved their heart health saw a reduction in their dementia risk.
Currently, about 5.3 million Americans have Alzheimer's disease, the most common form of dementia.
Sunday, February 28, 2016
Older adults have their own perspectives on sadness, loneliness and serenity
In a recent study, Ready found that older adults report feeling more serenity than younger people, and have a richer concept of what it means to feel serene than younger people. Credit: UMass Amherst28 feb 2016--A new study led by associate professor Rebecca Ready in the department of psychological and brain sciences at the University of Massachusetts Amherst has found that older adults have different, more positive responses than young adults about feelings such as serenity, sadness and loneliness.
Ready calls the findings "highly clinically significant" because the information could help caregivers, psychotherapists and workers at assisted living facilities, for example, better understand the emotions of older people in their care, which could lead to improved treatment and quality of interactions. Findings appear in the current online issue of Aging and Mental Health.
She says, "Older adults report feeling more serenity than younger persons. They also have a richer concept of what it means to feel serene than younger persons." In a word grouping task, older adults associated more positive emotional terms with serene, such as cheerful, happy and joyful, than did younger people. The authors speculate that "this broader conception of serene" is associated with the fact that older adults report more calming positive emotions than younger people.
She adds, "We were surprised to find that younger adults associated more self-deprecating terms with feeling sad and lonely, such as being ashamed or disgusted with themselves, than older persons." When grouping other emotion words with sadness, older adults included words such as droopy and sheepish, while younger adults included more self-deprecating terms with the word, such as dissatisfied with self, ashamed, angry and disgusted with self. A similar pattern was observed for lonely.
For this study, Ready and her graduate student Gennarina Santorelli recruited 32 older adults ages 60 to 92, and 111 younger adults ages 18 to 32, and asked them to judge 70 emotion terms on whether the words had a positive or negative connotation and if the words were activating or arousing. For example, excited is generally rated as a high activation word, while serene is associated with less activation. They then had participants group similar words together.
Ready and colleagues found the word groupings were similar between older and younger persons for many words but they noted systematic differences for sadness, loneliness and, as noted above, serenity. They also found that older adults perceive emotion terms as most positive and more active than younger persons. Emotions overall may be more stimulating for older than younger persons.
The older adults in this study reported fewer depressive symptoms than the younger participants. Controlling for age group differences in these symptoms, Ready says, "We gained a deeper appreciation of some relatively unknown benefits of aging, such as increased positive emotions and less shame associated with feeling sad or lonely."
As the percentage of older adults in the United States increases, Ready says, "It is imperative to determine how older adults define emotions differently than younger adults. These data ensure effective communication with older adults, accurate understanding of their emotion experiences, and appropriate access to psychological interventions."
More information: Rebecca E. Ready et al. Judgment and classification of emotion terms by older and younger adults, Aging & Mental Health (2016). DOI: 10.1080/13607863.2016.1150415
Provided by University of Massachusetts Amherst
Saturday, February 27, 2016
People in their nineties reveal the secrets to ageing well
Never too old. Credit: www.shutterstock.com27 feb 2016--There are many reasons why some people live long healthy lives while others don't, but one of them is undoubtedly genes. That doesn't mean we should be negative about our chances of ageing in good health. Although our genes are handed down from our parents, the hand that we are dealt seems to be influenced by our lifestyle, too. Food, physical activity and stress can change how genes function by adding "chemical tags" that act as on/off or dimmer switches, influencing our health and lifespan. The study of this process is known as epigenetics.
In a series of research studies with nonagenarians who were in robust health (the BELFAST studies), we found that participants carried fewer of the genes that are implicated in cardiovascular disease and showed some gene types which may have helped boost their immunity.
In the most recent BELFAST nonagenarians' study, we built on these findings and asked active nonagenarians why they thought they had lived for so long and in such good health. Family history and personal stories are powerful tools when used in parallel with genomic analyses. They can help us to understand how our beliefs, behaviour and lifestyle choices subtly fine-tune how our genes function in daily life.
By talking to nonagenarians about their lives, we identified how important they considered their genes to be, but they also told us about several other factors that they thought supported their long and healthy lives. Genes and good health
Nonagenarian siblings recognised genes as important. Ellie, 99, said: "I suppose it was the family I was born into – my mother's female relatives all seemed to live into their 90s. I can remember cousins and aunts, all were over 90."
Socialising and exercising your brain – both important in ageing well. Credit: Zina Seletskaya/Shutterstock.comShe added: "The men didn't live so long."
In fact, Ellie had observed something scientists still don't understand: why women live longer than men. Evidence suggests that it may relate to male hormones in the womb leading to increased age-related disease. Train body and mind
All of the people in our study spoke about the importance of keeping mentally and physically active. Robert, a shopkeeper, said: "Hard work all my life. I think that is the secret."
Norman, 95, one of two nonagenarian brothers, both railwaymen, said: "I left school at 16 and, yes, we had to go to work then. It wasn't like today when you can keep your education going until you are 23 or 24." His brother, Joyce, 96, agreed: "Yes we worked hard. There is no doubt about it."
Samuel, 95, but "going on 25", keeps mentally busy and told us that he had just finished writing his tenth book.
The health benefits of physical activity are hard to ignore. Regular exercise changes our epigenome, activating genes that improve muscle function. Exercise not only protects our muscles but also our brains with a possible dose-related effect – the more we do, the greater the effect. Exercise is good for everyone and it's never too late to start. Eat well
Many of the study participants mentioned the importance of food in ageing well. Norman said: "I have always led a quiet life. Didn't smoke or drink to any extent and was always fed on good solid food. No junk food." His brother, Joyce, added: "We always had sensible food. Never smoked, except for a couple of months."
Eileen, 92, gave details of "good food, good healthy meals. Mama would have a big pot of broth for us."
There is truth in the saying: you are what you eat. Scientists have provided evidence that fruit and vegetablea may dampen cancer-causing genes, or may protect us from cancer by altering epigenetic markers.
Few participants smoked, avoiding the known epigenetic effects of cigarette smoke including lung damage, increased risk of dementia and cancer. Be positive, stay social
Many of the participants described "being happy", "always cheerful", "never melancholy" and being content with a "rich life" and family relationships. Typical examples from siblings include Samuel, 95, who said he is "interested in people, interested in life". His sister Ethel, 93, added: "[I am] interested in things, and everything that's going on." Whilst Sarah, 95, one of two sisters, told us: "Oh, I am always happy" and her sister Mariah, 94, said: "I have just a happy disposition".
The ability or willingness to cope with difficulties was another common attitude we observed. As Eileen, 96, told us: " just take things as they come."
Successful ageing is considered to be more than the absence of disease and being able to live independently but involves being socially active. Friends and family are important factors in ageing well, making for good mental health, reduced risk of premature death and can help people deal with stressful events in their lives.
The epigenetic modification of our genes – and the life stories of healthy nonagenarians – offer explanations about how diet, physical activity, stress and exposure to toxins and infections can subtly alter our genes and our predisposition to disease.
The key to ageing well may not depend on choosing our parents wisely (even if we could), but making good lifestyle choices.
High levels of intense exercise may be unhealthy for the heart
Increased incidence of arrhythmias in the athlete's heart. There is a well demonstrated association between atrial fibrillation and/or flutter and endurance exercise training. There is also an increase in premature ventricular beats, although this tends to be benign in most athletes. Although there is some speculation that extreme exercise might cause serious arrhythmias in some cases, these events remain very uncommon. PPM, permanent pacemaker; RV, right ventricular. Credit: Canadian Journal of Cardiology
26 feb 2016--There is growing evidence that high levels of intense exercise may be cardiotoxic and promote permanent structural changes in the heart, which can, in some individuals, predispose them to experience arrhythmias (abnormal heart rhythm). A review published in the Canadian Journal of Cardiology explores current controversies and makes the case for investing in large prospective research studies into the effect of intense exercise on heart structure and function.
There are unquestionable benefits to "getting off the couch." However, there is already fairly compelling evidence supporting the association between long-term sports practice and increased prevalence of atrial fibrillation, and the fact that this relates to chronic altered atrial substrate. Without challenging the undeniable evidence supporting low and moderate intensity exercise, this review by sports cardiologist André La Gerche, MD, PhD, provides a balanced discussion of the available data for and against the concept that intense exercise, particularly endurance exercise, may cause adverse cardiac changes in some athletes.
"Much of the discussion regarding the relative risks and benefits of long-term endurance sports training is hijacked by definitive media-grabbing statements, which has fueled an environment in which one may be criticized for even questioning the benefits of exercise," explains Dr. La Gerche, who is Head of Sports Cardiology at the Baker IDI Heart and Diabetes Institute, Melbourne, Australia. "This paper discusses the often questionable, incomplete, and controversial science behind the emerging concern that high levels of intense exercise may be associated with some adverse health effects."
As Dr. La Gerche points out, all available therapies, pharmacological or otherwise, have a dose-response relationship whereby benefits diminish at high doses and the risk of adverse events increases. An open mind would consider that this may even be possible for exercise.
A commonly held view is that adverse clinical events in athletes are explained by exercise acting as a trigger in individuals who are susceptible because of an underlying abnormality. Dr. La Gerche excludes inherited conditions from this discussion, focusing instead on whether exercise may affect a change in the heart that may serve as a cause of arrhythmias in its own right. He reviews the following emerging controversies:
Is there a non-linear dose-response relationship with exercise?
Elite athletes tend to live longer but is this the effect of exercise or other factors such as the absence of smoking and alcohol consumption?
Is endurance exercise in athletes associated with arrhythmias?
What are the potential mechanisms that predispose athletes to arrhythmias?
Is chronic cardiac remodelling a consequence of repeated bouts of injury?
Why is there disproportionate right ventricular (RV) injury following an acute bout of intense exercise and are there any long-term consequences?
Is the risk of ischemic heart disease increased with intense exercise?
Many of these controversies are based on small cross-sectional cohort studies and small mechanistic studies that are dwarfed by the large population studies supporting the benefits of exercise, albeit in doses of exercise less than those commonly practiced by elite sportspersons, notes Dr. La Gerche.
"The answers regarding the healthfulness of 'extreme' exercise are not complete and there are valid questions being raised," continues Dr. La Gerche. "Given that this is a concern that affects such a large proportion of society, it is something that deserves investment. The lack of large prospective studies of persons engaged in high-volume and high-intensity exercise represents the biggest deficiency in the literature to date, and, although such work presents a logistical and financial challenge, many questions will remain controversies until such data emege."
More information: "The potential cardiotoxic effects of exercise," by Andre La Gerche, MBBS PhD (DOI: dx.doi.org/10.1016/j.cjca.2015.11.010). Published online in advance of Volume 32/Issue 4 (April 2016) of the Canadian Journal of Cardiology.
Provided by Elsevier
Wednesday, February 24, 2016
What are the benefits and harms of cancer screening? Most guidelines don't tell you
Screening for cancer has many obvious benefits - you're preventing cancer or catching it early. But each screening tool also comes with potential harms or risks. A new study finds most cancer screening guidelines do not clearly spell out the benefits and harms of the recommended actions.
24 feb 2016--Researchers from the University of Michigan Health System examined 55 professional guideline recommendations for cancer screening or prevention. They found 69 percent did not quantify and present benefits and harms in comparable terms.
"Almost all medical interventions have tradeoffs between different types of benefits and harms," says Tanner J. Caverly, M.D., MPH, clinical lecturer of internal medicine at the University of Michigan Medical School and a research investigator at the VA Ann Arbor Healthcare System Center for Clinical Management Research.
"Patients rely on doctors to base screening recommendations on sound judgment as to whether, in their individual context, the benefits outweigh the harms. For this judgment, doctors need a clear understanding, in quantitative and comparable terms, about the degree of potential benefit and the degree of potential harm."
The study, published in the Journal of the National Cancer Institute, looked at guidelines such as mammography screening for breast cancer, PSA testing for prostate cancer, colonoscopy for colon cancer, HPV vaccination for cervical cancer and other screening tests. Guidelines were from agencies such as the U.S. Preventive Services Task Force, the American Cancer Society and the National Comprehensive Cancer Network.
The researchers found that 31 percent of guidelines recommending screening presented absolute effects for both benefits and harms. Meanwhile, 55 percent presented the tradeoffs unevenly, explaining the benefit but not the harm or presenting the numbers in different ways.
For example, some studies used relative risk reduction, often a larger number, to show benefit - people who were screened were twice as likely to survive. But they used absolute risk, often a much smaller number, to demonstrate harm - 1 percent of people screened had a false diagnosis.
"By unevenly presenting the statistics, guidelines can unintentionally give a false picture of the benefits and harms. The relative risk of "twice as likely" sounds significant, but in terms of absolute risk it might represent a very small difference," said senior author Angela Fagerlin, Ph.D., professor and chair at the University of Utah's Department of Population Health Sciences and a research scientist at the Salt Lake City VA.
The researchers suggest that guidelines should quantify and present all important benefit and harm information in a well-designed table or graphic, so that they can be easily compared.
"Improving how guidelines present the benefits and harms would help doctors better understand the trade-offs and facilitate informed discussions with patients. It would also help us to build better decision support tools for physicians," says Caverly, who is also a member of the U-M Institute for Healthcare Policy and Innovation.
More information:Journal of the National Cancer Institute, published online Feb. 24, 2016, DOI: 10.1093/jnci/djv436
Provided by University of Michigan Health System
Tuesday, February 23, 2016
Estrogen for vaginal symptoms OK for breast cancer survivors: experts
23 feb 2016—Women who've battled or survived an estrogen-dependent form of breast cancer often encounter vaginal symptoms linked to their treatment, especially around the time of menopause.
Now, new guidelines from the American College of Obstetricians and Gynecologists (ACOG) advise that the use of symptom-relieving estrogen therapy is warranted for these patients.
"These new recommendations are especially important and helpful because they provide the patient with the information needed to make an informed decision with the input of her health care provider," Dr. Diana Nancy Contreras, chair of ACOG's Subcommittee on Gynecologic Oncology, said in a college news release.
One expert in women's health explained that patients with an estrogen-dependent breast cancer often suffer vaginal symptoms linked to treatment.
"Many estrogen-dependent breast cancer treatments may bring about and exacerbate vaginal atrophy," said Dr. Jill Rabin, who's with Women's Health Programs-PCAP Services, Northwell Health, in New Hyde Park, N.Y.
"Vaginal and urologic symptoms range from mild to severe and can include vaginal dryness, pain, bleeding, bacterial infections and dyspareunia [painful sex]," she noted. "These symptoms—which may arise for many women in menopause—may be multiplied for these patients in treatment and can worsen over time.
"These symptoms can have a huge impact on a woman's quality of life—for all affected women and especially for breast cancer survivors," Rabin added. In fact, up to a fifth of breast cancer patients"terminate or consider terminating therapies due to the severe detrimental effect that vaginal atrophy poses on their quality of life," she said.
There's been a concern, however, about the safety of estrogen-based therapies for women who are battling or who have survived an estrogen-linked breast tumor.
Specifically, there have been concerns about a possible link between topical (cream or lotion) estrogen therapy and recurrence of estrogen-linked breast cancers. However, current research has not confirmed such a connection, the experts at ACOG stated.
So, in its new recommendations, the group recommends that non-hormonal therapies for vaginal symptoms still be the first choice for women with estrogen-dependent breast cancer or a history of such a cancer.
However, topical estrogen therapy can now also be considered for estrogen-dependent breast cancer survivors who do not respond to non-hormonal therapies, ACOG said.
Dr. Eva Chalas is chief of gynecological oncology at Winthrop-University Hospital, in Mineola, N.Y. She said she agreed with the new recommendation.
"Non-hormonal management should be the first course of action," Chalas said. "However, the most effective treatment remains estrogen.
"Quality of life, which includes an opportunity for sexual intimacy, is an important aspect of cancer survivorship," Chalas explained. "Women should address the severity of symptoms with their physicians and participate in selection of therapy which yields the best quality of life. This [ACOG] document provides safe guidelines which could enhance post-treatment sexual function in many breast cancer survivors."
The new guidelines will be published in the March issue of Obstetrics & Gynecology. More information: The U.S. National Cancer Institute discusses menopausal hormone therapy and cancer.
Sunday, February 21, 2016
Common problem for older adults: Losing the five key senses
Credit: Peter Griffin/public domainIt's a well-known fact that aging can lead to losing one's senses: vision, smell, hearing, touch, and taste. In previous studies, researchers have learned about the consequences of experiencing a decline in a single sense. For example, losing senses of smell, vision, and hearing have all been linked to cognitive decline, poor mental health, and increased mortality. Losing the sense of taste can lead to poor nutrition and even death in certain instances. However, until now little has been known about losing multiple senses. In a new study, researchers examined how often multisensory losses occur and what their impact on older adults might be.
21 feb 2016--In a study published in the Journal of the American Geriatrics Society, University of Chicago researchers analyzed data from the National Social Life, Health, and Aging Project (NSHAP), a population-based study of adults ages 57-85. The study collected information about the participants' senses of vision, touch, smell, hearing, and taste. The participants were also asked to rate their physical health.
The researchers reported several key findings:
94 percent of the participants experienced loss in at least one of their senses; 67 percent had two or more sensory losses. Of those with multisensory losses, 65 percent had substantial loss in at least one of their senses, and 22 percent experienced substantial loss in two or more senses.
74 percent of participants suffered impairment in their ability to taste, which was the most common sensory loss.
38 percent of participants had a sense of touch that was "fair;" 32 percent said it was "poor."
14 percent had corrected distance vision that was "fair;" 6 percent said it was "poor."
13 percent rated their corrected hearing as "fair;" 5 percent said it was "poor."
Older age was linked to poorer function in all five senses; the largest differences were in hearing, vision, and smell. What's more, men had worse functioning for hearing, smell, and taste than did women—although men had better corrected vision than women. African Americans and Hispanics tended to have worse sensory function than Caucasians in all senses except hearing. Hispanics tended to have better function in taste than those from other groups.
The researchers said that losing more than one sense might explain why older adults report having a poorer quality of life and face challenges in interacting with other people and the world around them. The researchers suggested that further studies into multisensory loss hold promise for designing better programs to prevent or treat loss and to ease the suffering such losses cause.
More information: This summary is from "Global Sensory Impairment among Older Adults in the United States." It appears online ahead of print in the February 2016 issue of the Journal of the American Geriatrics Society.
Provided by American Geriatrics Society
Saturday, February 20, 2016
Light-to-moderate drinking good for your heart, researchers say
People who drink wine, liquor or beer regularly are less prone to heart failure and heart attacks than those who rarely or never drink. Three to five drinks a week can be good for your heart. Drinking a little alcohol every day may be part of a healthy lifestyle, according to Imre Janszky, a professor of social medicine at the Norwegian University of Science and Technology (NTNU). He says alcohol does more good than harm for your heart when consumed in moderation.
20 feb 2016--And, Janszky says, it doesn't matter much whether you drink wine, liquor or beer.
"It's primarily the alcohol that leads to more good cholesterol, among other things. But alcohol can also cause higher blood pressure. So it's best to drink moderate amounts relatively often," he says
. Decreased risk with each additional serving
Along with a number of colleagues from NTNU and the Karolinska Institute in Stockholm, Janszky has published two studies regarding the relationship between alcohol and heart health. One, published in the January 15 issue of the International Journal of Cardiology, is about heart failure. The second, from September 2015, is on acute myocardial infarction (AMI), and has been published in the Journal of Internal Medicine.
In both cases, research shows that people who regularly drink alcohol have better cardiovascular health than those who consume little or no alcohol.
The studies showed that those who drank three to five drinks per week were 33 per cent less prone to heart failure than those who abstained or drank infrequently. In the case of heart attacks, the risk appears to be reduced by 28 percent with each additional one-drink increment.
This does not surprise the researchers at all.
A majority of researchers worldwide seem to think three to five drinks a week can be good for your heart.
Different drinking patterns
"The relationship between alcohol and heart health has been studied in many countries, including the USA and southern European nations. The conclusions have been the same, but the drinking patterns in these countries are very different than in Norway. In countries like France and Italy, very few people don't drink," says Janszky. "It raises the question as to whether earlier findings can be fully trusted, if other factors related to non-drinkers might have influenced research results. It may be that these are people who previously had alcohol problems, and who have stopped drinking completely," he says.
For this reason, the researchers wanted to examine the theory with a Norwegian population where a significant population drinks rarely or not at all. In the myocardial infarction study, 41 per cent of participants reported that they did not drink at all or that they consumed less than half of one alcoholic beverage per week.
Both studies are based on the longitudinal HUNT 2 Nord-Trøndelag Health Study conducted between 1995 and 1997.
The greater the drinking frequency, the lower the risk
The study, which looked at the relationship between heart failure and alcohol, followed 60,665 participants who enrolled in the HUNT study between 1995-1997 and who had no incidence of heart failure at that time. Of those, 1588 of them developed heart failure during the period of the study, which ended in 2008. The risk was highest for those who rarely or never drank alcohol, and for those who had an alcohol problem.
The more often participants consumed alcohol within normal amounts, the lower their risk of heart failure turned out to be. Those who drank five or more times a month had a 21 per cent lower risk compared to non-drinkers and those who drank little, while those who drank between one and five times a month had a two per cent lower risk.
Drinking isn't necessary for a healthy heart
"I'm not encouraging people to drink alcohol all the time. We've only been studying the heart, and it's important to emphasize that a little alcohol every day can be healthy for the heart. But that doesn't mean it's necessary to drink alcohol every day to have a healthy heart," says Janszky.
In the heart attack study, 58,827 participants were categorized by how much and how often they drank. 2966 of the participants experienced an acute myocardial infarction (AMI) between 1995 and the end of 2008. The adjusted analyses showed that each additional one-drink increment decreased the risk of AMI by 28 percent.
Alcohol may increase other problems
The researchers stressed that few participants in the study drank particularly much, so they cannot conclude that high alcohol intake protects against heart attack or heart failure. They also encourage looking at the findings in a larger context, since the risk of a number of other diseases and social problems can increase as a result of higher alcohol consumption.
For example, the researchers observed that the risk of dying from various types of cardiovascular disease increased with about five drinks a week and up, while those who drank more moderate amounts had the lowest risk. High alcohol consumption was also strongly associated with an increased risk of death from liver disease.
More information: Katalin Gémes et al. Light-to-moderate drinking and incident heart failure—the Norwegian HUNT study, International Journal of Cardiology (2016). DOI: 10.1016/j.ijcard.2015.10.179 K.
Gémes et al. Alcohol consumption is associated with a lower incidence of acute myocardial infarction: results from a large prospective population-based study in Norway, Journal of Internal Medicine(2015). DOI: 10.1111/joim.12428
Provided by Norwegian University of Science and Technology
Thursday, February 18, 2016
Update on menopausal symptoms and treatment options published
Credit: Mary Ann Liebert, Inc., publishersThe vast majority of women going through the period of menopausal transition, or perimenopause, will seek medical help coping with symptoms that can significantly impact their health and quality of life, such as hot flashes, poor sleep, depression, and vaginal dryness. The pattern of common perimenopausal symptoms, how they often interact to worsen the effects of each, and current hormonal and non-hormonal therapeutic options are examined in a comprehensive Review article published in Journal of Women's Health.
18 feb 2016--In "Perimenopause: From Research to Practice"), Nanette Santoro, MD, University of Colorado School of Medicine, Denver, describes the stages of reproductive aging in women, linking common symptoms to the late reproductive stages, the early and late menopausal transition stages, and the early postmenopause. Dr. Santoro discusses strategies for treating multiple symptoms with a single medication when possible. For women who experience the four main menopausal symptoms, hormone therapy is the most effective way to improve their quality of life, as long as hormone use is not contraindicated.
"This outstanding review integrates research findings with the clinical presentations of symptomatic perimenopausal women and treatment options," says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health, Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, and President of the Academy of Women's Health.
More information: Nanette Santoro. Perimenopause: From Research to Practice, Journal of Women's Health (2015). DOI: 10.1089/jwh.2015.5556
Provided by Mary Ann Liebert, Inc
Wednesday, February 17, 2016
New guide from AGS, NHTSA a green light to promoting safe driving for older adults
A newly updated guide from the American Geriatrics Society (AGS) and the National Highway Traffic Safety Administration (NHTSA) is putting healthcare professionals on the road to success for assessing and counseling older drivers. With older adults accounting for 10 percent of all people injured in traffic crashes annually and 17 percent of annual traffic fatalities, the Clinician's Guide to Assessing and Counseling Older Drivers (3rd Edition) translates research findings and public health initiatives into practical, person-centered advice for safely navigating the open road.
17 feb 2016--"For all of us, but for Baby Boomers especially, driving is more than just a national pastime and a means for transportation. It's a reflection of independence, mobility, and freedom," explains Alice Pomidor, MD, MPH, AGSF, chair of the editorial board that developed the AGS-NHTSA guide. "The main goal of this guide is to help healthcare professionals promote health, independence, and quality of life by preventing crashes and injuries."
Added Nancy E. Lundebjerg, MPA, AGS CEO: "This guide reflects the fact that many individuals play a role in older adult well-being, and that expert-authored tools, tips, and recommendations can help all healthcare professionals support high-quality, person-centered care in a key focus area: driver safety."
Reviewed and edited by an interprofessional board of physicians, nurses, social workers, occupational therapists, and pharmacists, the updated guide walks through key issues, opportunities, and challenges faced by older drivers, theirhealthcare professionals, and their caregivers. Areas of emphasis include:
Determining when an older person may be at an increased risk for unsafe driving. The AGS-NHTSA guide highlights certain "red lights" that clinicians should look for, such as impaired vision or hearing.
Recognizing medical conditions, functional deficits, and medications that may affect driver safety. Increased longevity in the U.S. population coupled with the number of health conditions older adults manage mean that many older individuals may outlive their ability to drive safely.
Understanding how to screen and assess functional abilities for driving. Motor skills, sensory perception, vision, and cognition are all important to driving. However, they may not be equally important for a particular older adult: one area of function may warrant greater attention than another on a case-by-case basis.
Advising older adults about transitioning from driving. Proactively screening frail older adults for driving safety means knowing when to make strategic recommendations and planning for driving retirement beforehand.
Considering ethical and legal issues affecting older drivers. Laws, regulations, and policies on driving vary not only by state but also by local jurisdiction.
Meeting the future transportation needs of older adults. Coordination among clinicians, licensing agencies, and relevant state/community entities can help older adults and caregivers become aware of resources once independent driving is no longer an option.
More information: The full guide and collateral tools will be available on GeriatricsCareOnline.org, the online home for AGS resources. Public education materials also will be released by the Health in Aging Foundation onHealthinAging.org.
