Critical Illness Linked To Brain Changes Associated with Cognitive Decline

MedicalResearch.com Interview with:

Keenan Walker, PhD Johns Hopkins University School of Medicine  Baltimore

Dr. Walker

Keenan Walker, PhD
Johns Hopkins University School of Medicine
Baltimore

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study was conducted in response to anecdotal accounts and scientific evidence which suggests that major medical conditions, such as critical illness and severe infections, can have a long-term neurological effect on some individuals.

There are quite a few studies to date which have found that critical illnesses, such as severe sepsis, are associated with long-term cognitive impairment. Based on this evidence, we wanted to figure out to what degree critical illness and major infection may affect later brain structure and to determine whether the structural changes associated with these events were similar to those observed in Alzheimer’s disease.

Our main finding was that individuals who had one or more critical illness or major infection major infection during the decades leading up to older adulthood were more likely to have smaller brain volumes in brain regions most vulnerable to Alzheimer’s disease.

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Most Health Care Costs Associated With Osteoporotic Fractures Occur in First Year

MedicalResearch.com Interview with:

Kandice A. Kapinos, Ph.D. Economist Professor RAND Corporation Pardee RAND Graduate School 

Dr. Kapinos

Kandice A. Kapinos, Ph.D.
Economist
Professor
RAND Corporation
Pardee RAND Graduate School 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The economic burden of osteoporotic fractures is substantial with studies estimating the annual healthcare cost burden between $10 to 17 billion. Although estimates from individual studies vary, most studies assessing costs after a fracture only explore up to twelve months following a fracture. There is little investigation of how fracture patients’ costs evolve over a longer post-fracture period.

As osteoporotic fractures are one of the most common causes of disability among older adults and can translate into greater medical costs, we focused on studying Medicare beneficiaries. In fact, previous research has suggested that most of the increase in Medicare spending over time can be explained from costs associated with treating higher risk Medicare beneficiaries.

Our objective in this study was to compare health care costs over a 3-year period of those who experienced a fracture to those who did not among a sample of Medicare beneficiaries who were at an increased risk of having a fracture.

Consistent with previous studies, we found a significant increase in expenditures in the year immediately following a fracture relative to controls: almost $14,000 higher for fractures relative to controls. However, at 2 and 3-years post-fracture, there were no significant differences in the change in expenditures between fracture cases and controls. We note that these findings may be different for beneficiaries living in skilled nursing facilities or other non-community-based settings.

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Most Eye Trauma Occurs in Elderly After a Fall

MedicalResearch.com Interview with:
Syed Mahmood Ali Shah, M.D. Associate Professor of Ophthalmology University of Pittsburgh School of MedicineSyed Mahmood Ali Shah, M.D.
Associate Professor of Ophthalmology
University of Pittsburgh School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Eye trauma is a significant cause of morbidity throughout the world. In the United States, the incidence of individuals hospitalized with eye trauma from 2001 through 2014 increased. Most of these individuals were above the age of 65 and suffered a fall. This is a worrisome trend in light of an increased awareness and continued and concentrated effort to reduce falls. This is a critical point: We need to improve our existing strategies to reduce falls.

The second at-risk group is children and adolescents. Previous studies have shown that effective widespread implementation of injury prevention efforts can lower trauma rates. While we did observe a small decrease in eye trauma as a primary admitting diagnosis, the fact that it was more common in children and adolescents (for whom eye trauma carries devastating consequences and can significantly reduce quality of life) highlights the significance of continued efforts to prevent eye trauma.  Continue reading

Tai Ji Quan Can Reduce Falls in Elderly

MedicalResearch.com Interview with:

Peter A. Harmer, PhD., MPH., ATC., FACSM Professor - Department of Exercise & Health Science Willamette University

Dr. Harmer

Peter A. Harmer, PhD., MPH., ATC., FACSM
Professor – Department of Exercise & Health Science
Willamette University

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Falls in older adults have long been a significant healthcare problem associated with loss of independence, premature morbidity and mortality, and considerable financial strain on individuals and healthcare systems. With the demographic impact of the Baby Boom generation aging into retirement, this issue is becoming even more critical. Among potential prevention strategies, exercise has been proposed to be beneficial. However, establishing what types of exercise are suitable to the task has been problematic. More importantly, identifying differences in the effectiveness of various exercise approaches has been lacking.

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Injuries and Fatalities Caused by Fellow Nursing Home Residents, Surprisingly Common and Untracked by CMS

MedicalResearch.com Interview with:
“Hospital” by Avinash Bhat is licensed under CC BY 2.0Eilon Caspi PhD

Research Associate
School of Nursing
University of Minnesota  

MedicalResearch.com: What is the background for this study?  

Response: The phenomenon of distressing and harmful resident-to-resident incidents in long-term care homes (such as nursing homes and assisted living residences) is prevalent, concerning but underrecognized. These incidents are currently not being tracked by The Centers for Medicare and Medicaid Services (CMS), the Federal agency that oversees nursing homes compliance with the Federal Nursing Home Regulations (there is no unique state survey deficiency citation — also called F-Tag or “Regulatory Grouping” that is specific to these incidents; beyond the classification under the broad categories of “Abuse,” Neglect,” and “Accident” where these incidents for all practical purposes are currently buried forever). In addition, the Minimum Data Set 3.0 (MDS), the largest clinical data set in nursing homes in the U.S., does not track this phenomenon in its Behavior E Section. Despite rapid growth in the number of research studies on various aspects of this phenomenon in recent years, no study in the U.S. and Canada examined fatal resident-to-resident incidents in the context of dementia in long-term care homes.

In light of lack of centralized data sets on resident-to-resident incidents resulting in injuries and deaths, the study had to overcome this formidable barrier by using non traditional data collection strategy and analytic methods. A comprehensive internet search conducted over several years identified reports on the death of 105 elders as a result of resident-to-resident incidents in dementia in long-term care homes (over 150 newspaper articles and dozens of death review records were identified; all publicly available information). A qualitative review and abstraction of narratives of the text-based reports revealed important patterns for prevention.

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Who is Underrepresented in Cardiology Trials?

MedicalResearch.com Interview with:

Quoc Dinh Nguyen, MD MA MPH Interniste-gériatre – Service de gériatrie Centre hospitalier de l’Université de Montréal – CHUM

Dr. Nguyen

Quoc Dinh Nguyen, MD MA MPH
Interniste-gériatre – Service de gériatrie
Centre hospitalier de l’Université de Montréal – CHUM

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Randomized trials are the best evidence basis we have to treat patients. It is known for more than 20 years that older adults and women are disproportionately excluded from randomized trials in cardiology diseases. As the current US population is fast aging, we examined whether this underrepresentation improved or worsened in the last 20 years in the most influential studies published between 1996 and 2015.

The main finding is that the women and older adults continue to be underrepresented in cardiology trials. Overall, the mean age was 63 years and the percentage of women was 29%. For coronary heart disease, women comprise 54% of the US population in need of treatment, yet are only 27% of the trial population. For heart failure, the median age of older adults in the US population is 70 years whereas it is only 64 years in the trial population.

Our results indicate that the gap has very slowly narrowed in the last 2 decades. However, based on current trends, reaching proportionate enrollment would require between 3 and 9 decades. This persistent lack of representation has significant impacts on the ability of clinicians to provide evidenced based care for these segments of the population. Physicians and other health care professionals are forced to extrapolate study results from younger and male-predominant populations. This is problematic since we know that older adults and women may react differently to medications and to interventions.  Continue reading

With Aging Comes Increasing Cost of Life-Extending Medications

MedicalResearch.com Interview with:

Jonathan H. Watanabe, PharmD, PhD, BCGP Associate Professor of Clinical Pharmacy National Academy of Medicine Anniversary Fellow in Pharmacy Division of Clinical Pharmacy | Skaggs School of Pharmacy and Pharmaceutical Sciences | University of California San Diego La Jolla, CA 

Jonathan H. Watanabe, PharmD, PhD, BCGP
Associate Professor of Clinical Pharmacy
National Academy of Medicine Anniversary Fellow in Pharmacy
Division of Clinical Pharmacy | Skaggs School of Pharmacy and Pharmaceutical Sciences | University of California San Diego
La Jolla, CA

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: As a clinician in older adult care and as a health economist, I’ve been following the news and research studies on older patients unable to pay for their medications and consequently not getting the treatment they require. Our goal was to measure how spending on the medications Part D spends the most on, has been increasing over time and to figure out what prices patients are facing out-of-pocket to get these medications.

In 2015 US dollars, Medicare Part D spent on the ten highest spend medications increased from $21.5 billion in 2011 to $28.4 billion in 2015.  The number of patients that received one of the ten highest spend medications dropped from 12,913,003 in 2011 to 8,818,471— a 32% drop in that period.

A trend of spending more tax dollars on fewer patients already presents societal challenges, but more troubling is that older adults are spending much more of their own money out-of-pocket on these medications.  For patients without a federal low income subsidy, the average out-of-pocket cost share for one of the ten highest spend medications increased from $375 in 2011 to $1,366 in 2015.  This represented a 264% increase and an average 66% increase per year.  For patients receiving the low income subsidy, the average out-of-pocket cost share grew from $29 in 2011 to $44 in 2015 an increase of 51% and an average increase of 12.7% per year.  This may not sound like much, but for those living close to the federal poverty level this can be the difference between foregoing necessities to afford your medications or choosing not to take your medications.   Continue reading

‘Deprescribing’ Can Reduce Harm of Medications in Elderly

MedicalResearch.com Interview with:
“Pills” by Victor is licensed under CC BY 2.0Khalid Ali, MBBS, FRCP, MD

Senior lecturer in Geriatrics
Brighton and Sussex Medical School, UK 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Older people are more like to have more than one chronic condition (multi-morbidity), and as such as are more likely to be prescribed several medications (poly pharmacy) to treat those conditions. At the point of hospital discharge, older people are given different / new medications in addition to their old ones, and this puts them at higher risk of harm related to medicines. Our study led by  Brighton and Sussex Medical School (BSMS) and King’s College London involved five hospitals and 1,280 patients (average age 82 years) in South England. Senior pharmacists interviewed patients and carers, reviewed GP records and analysed hospital readmission to determine medication-related harm.

The study found that more than one in three patients (37%) experienced harm from their medicines within two months of hospital discharge, and that this was potentially preventable in half of the cases. Medication-related harm was most commonly found to occur from the toxicity of the medicine itself and in a quarter of cases from poor adherence.  The medicines found to pose the highest risk were opiates, antibiotics and benzodiazepines. Patients suffered a range of side effects including serious kidney injury, psychological disturbance, irregular heart rhythms, confusion, dizziness, falls, diarrhoea, constipation and bleeding.

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Rate of End-of-Life Medicare Spending Falls

MedicalResearch.com Interview with:

William B Weeks, MD, PhD, MBA The Dartmouth Institute

Dr. Weeks

William B Weeks, MD, PhD, MBA
The Dartmouth Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for the study is that a common narrative is that end-of-life healthcare costs are driving overall healthcare cost growth.  Growth in end-of-life care has been shown, in research studies through the mid 2000’s, to be attributable to increasing intensity of care at the end-of-life (i.e., more hospitalizations and more use of ICUs).

The main findings of our study are that indeed there have been substantial increases in per-capita end-of-life care costs within the Medicare fee-for-service population between 2004-2009, but those per-capita costs dropped pretty substantially between 2009-2014.  Further, the drop in per-capita costs attributable to Medicare patients who died (and were, therefore, at the end-of-life) accounts for much of the mitigation in cost growth that has been found since 2009 in the overall Medicare fee-for-service population.

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How To Prevent the Elderly From Falling?

MedicalResearch.com Interview with:

Dr. Alex Krist

Dr. Krist

Dr. Alex Krist, M.D., M.P.H.

Dr. Krist is is a professor of family medicine and population health at Virginia Commonwealth University and active clinician and teacher at the Fairfax Family Practice residency.

What is the background for these recommendation statements? What are the main findings?

Response: Falls are the leading cause of injuries in adults age 65 and older and can lead to serious disability and even death. Bone fractures—which may result from a fall—can also cause serious disability and death in older adults.

The U.S. Preventive Services Task Force looked into the most recent evidence on the best ways to prevent falls and fractures in older adults. We found that clinicians should recommend exercise or physical therapy to help prevent falls by older adults who live at home and are at higher risk for falling.

Additionally, we concluded that taking a low dose of vitamin D and calcium does not help prevent fractures due to osteoporosis, but we don’t know if taking a higher dose is effective or not, so we are calling for more research.

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Screening Criteria Can Miss Over Half of Adults with Prediabetes

MedicalResearch.com Interview with:
“Diabetes Mellitus” by Steve Davis is licensed under CC BY 2.0Matthew James O’Brien MD

Assistant Professor, Medicine
General Medicine Division
Assistant Professor, Preventive Medicine
Northwestern University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The USPSTF is an expert group that makes recommendations for screening and other preventive services. In December 2015, they recommend that providers screen for diabetes in patients who are 40-70 years old and also overweight/obese. The same recommendation stated that clinicians “should consider screening earlier” in patients who have any of the following risk factors: non-white race/ethnicity, family history of diabetes, or personal history of gestational diabetes or polycystic ovarian syndrome. Using nationally representative data, we studied the performance of the “limited” criteria based on age and weight alone vs. the “expanded criteria” mentioned above.

The main findings were that following the “limited” screening criteria of age and weight would result in missing over 50% of adults with prediabetes and diabetes. In other words, if providers followed the “limited” criteria, over 50% of adults with prediabetes and diabetes would not get screened. The “expanded” criteria exhibited much better performance, resulting in 76.8% of adults with prediabetes and diabetes who would be screened.  Continue reading

For Older Men, Dairy Food Intake Linked To Better Bone Health

MedicalResearch.com Interview with:
“bought a passive-aggressive amount of milk” by Paul Downey is licensed under CC BY 2.0Shivani Sahni, PhD
Assistant Professor of Medicine, Harvard Medical School
Director, Nutrition Program
Associate Scientist, Musculoskeletal Research
Institute for Aging Research, Hebrew SeniorLife,
Boston  MA  02131-1097

MedicalResearch.com: What is the background for this study?

Response: Previous studies have shown that higher milk intake is associated with higher bone mineral density. In one of our previous studies, we reported that higher dairy food intake was protective against bone loss especially among older adults who used vitamin D supplements. Older adults are at high risk of vitamin D deficiency because recommended intakes are difficult to achieve without fortified foods (such as dairy) or supplements. Vitamin D stimulates calcium absorption, which is beneficial for building bones. However, it is unclear if the effect of vitamin D on calcium absorption is substantial enough to translate into beneficial effects on bone.

Therefore, the current study determined the association of dairy food intake with bone health. We further examined whether these associations would be modified by vitamin D status.

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Falls in Older Adults Cost US Over $50 Billion Dollars Annually

MedicalResearch.com Interview with:

Curtis Florence, PhD Division of Analysis, Research and Practice Integration  CDC’s Injury Center

Dr. Florence

Curtis Florence, PhD
Division of Analysis, Research and Practice Integration
CDC’s Injury Center

MedicalResearch.com: What is the background for this study?

Response: The estimates in this study provide a more robust indicator of the economic impact falls have on the U.S. economy.  Previous studies focused on Medicare spending. This study includes Medicare, Medicaid and out-of-pocket spending.

MedicalResearch.com: What are the main findings? 

Response: Our study found that older adult (65 years and over) falls impose a large economic burden on the U.S. healthcare system. In 2015, with a total medical cost $50 billion for non-fatal and fatal falls.  About three-quarters of the total cost was paid by government-funded programs.  Medicare paid nearly $29 billion for non-fatal falls, Medicaid $8.7 billion, and $12 billion was paid for by Private/Out-of-pocket expenses.  For fatal falls, $754 million was spent in 2015.

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Low Sodium Levels Linked To Cognitive Impairment in Older Adults

MedicalResearch.com Interview with:

Dr. Kristen L. Nowak PhD Division of Renal Diseases and Hypertension University of Colorado Anschutz Medical Campus Aurora, CO 80045

Dr. Nowak

Dr. Kristen L. Nowak PhD
Division of Renal Diseases and Hypertension
University of Colorado Anschutz Medical Campus
Aurora, CO 80045

MedicalResearch.com: What is the background for this study?  

Response: Subtle impairments in cognition are common with aging, even in the absence of clinically apparent dementia. Mild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently uncertain.

We hypothesized that lower normal serum sodium would be associated with prevalent cognitive impairment and the risk of cognitive decline over time in asymptomatic, community-dwelling older men.

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Majority of Older Adults With Heart Failure Have Hearing Loss

MedicalResearch.com Interview with:
“Handicapped Hearing Impaired” by Mark Morgan is licensed under CC BY 2.0Madeline Sterling M.D., M.P.H.

Fellow, Department of Medicine
Weill Cornell Medical College – New York Presbyterian Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Heart Failure currently affects 5.8 million people in the United States and is becoming increasingly common as the population ages. Because it has no cure and tends to get progressively worse, physicians recommend that patients control their symptoms by taking multiple medications, maintain a diet low in salt, monitor their weight and blood pressure, and watch for changes in their symptoms.

At the most basic level, in order to understand and follow these instructions, heart failure patients must be able to hear them.  Hearing loss, however, had not been studied in heart failure.  There are a lot of chronic diseases in which hearing loss is more common than in the general population, including coronary heart disease, hypertension, and diabetes. And many adults with heart failure also have these conditions. So, we thought it would be important to understand if hearing loss was prevalent among adults with heart failure, especially since so much of heart failure management revolves around effective communication between patients and their healthcare providers. Continue reading

Personality Changes Can Presage Cognitive Impairment

MedicalResearch.com Interview with:

Richard J. Caselli MD Department of Neurology Mayo Clinic Arizona Scottsdale, AZ 

Dr. Caselli

Richard J. Caselli MD
Department of Neurology
Mayo Clinic Arizona
Scottsdale, AZ  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Personality changes are common in patients with a variety of dementing illnesses, and underlie the behavioral disturbances that complicate the course of dementia patients.  We have a been conducting a large longitudinal study of cognitive aging in individuals at genetically defined risk for Alzheimer’s disease (AD) based on their APOE genotype, and have been administering a large battery of neuropsychological tests as well as the gold standard personality questionnaire (the NEO-PI-R) in order to determine whether personality changes during the transition from normal cognition/preclinical AD to mild cognitive impairment.   Continue reading

Seniors Entering Old Age Will Increasingly Have Multiple Complicated Health Conditions

MedicalResearch.com Interview with:

Prof. Carol Jagger AXA Professor of Epidemiology of Ageing and Deputy Director of the Newcastle University Institute for Ageing (NUIA) Institute of Health & Society Campus for Ageing and Vitality Newcastle

Prof. Jagger

Prof. Carol Jagger
AXA Professor of Epidemiology of Ageing and
Deputy Director of the Newcastle University Institute for Ageing (NUIA)
Institute of Health & Society
Campus for Ageing and Vitality
Newcastle 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As part of a larger study (MODEM – modelling outcome and cost impacts of interventions for dementia) we have developed a microsimulation model called PACSim which forecasts the number of older people aged 65 years and over along with their health and lifestyle factors as they age over the next 20 years. Crucially these are the first projections that include the health and lifestyle profiles of younger people as they age into to older population, rather than just assuming they have the same health profiles as existing young-old.

Other studies have already reported that the proportion of older people with multimorbidity (two or more concurrent diseases) has increased. Our study shows that not only will this continue but that the largest increase over the next 20 years will be for complex multimorbidity (four or more diseases). Much of the gain in life expectancy over the next 20 year for a 65 year old will be years spent with complex multimorbidity. And more importantly the future cohorts of young-old entering the older population will have successively more multimorbidity. Continue reading

Vitamin D and Calcium Supplements Did Not Lower Fracture Risk In Community-Dwelling Adults

MedicalResearch.com Interview with:
“ZMA och D-vitamin. Intages med dubbelsidig C-brus. #placebomannen” by Robin Danehav is licensed under CC BY 2.0Dr Jia-Guo Zhao

Tianjin Hospital
Department of Orthopaedic Surgery
Tianjin, China

MedicalResearch.com: What is the background for this study?

Response: The increased social and economic burdens for osteoporotic-related fractures worldwide make its prevention a major public health goal.

Calcium and vitamin D supplements have long been considered a basic intervention for the treatment and prevention of osteoporosis. Survey analysis showed that 30–50% of older people take calcium or vitamin D supplements in some developed countries. Many previously published meta-analyses, from the high-ranking medical journals, concluded that calcium and vitamin D supplements reduce the incidence of fracture in older adults. And many guidelines regarding osteoporosis recommend calcium and vitamin D supplements for older people. The final aim for these supplements is to prevent the incidence of osteoporotic-related fracture in osteoporosis management.

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Older, Frail and Physically Inactive Adults At Risk of Multivitamin Deficiency

MedicalResearch.com Interview with:
“vitamins” by Colin Mutchler is licensed under CC BY 2.0
Priv.-Doz. Dr. Barbara Thorand 
Helmholtz Zentrum München
German Research Center for Environmental Health
Institute of Epidemiology II
Neuherberg, Germany 

MedicalResearch.com: What is the background for this study?

Response: Micronutrients, which include vitamins, minerals (e.g. calcium) and trace elements (e.g. iron), are essential nutrients that are required in minute amounts by the organism for proper growth and good health. Results from the last German National Nutrition Survey (NVS II)* uncovered a high prevalence of insufficient dietary intake of micronutrients in older adults aged 65 years and over in Germany. By means of blood analyses, our study has confirmed these critical results. This is a highly relevant issue, particularly in light of our growing aging population and the high societal relevance of successful healthy aging.

*Max Rubner-Institut: Nationale Verzehrsstudie II, Ergebnisbericht Teil 2 (2008). Die Bundesweite Befragung zur Ernährung von Jugendlichen und Erwachsenen.

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Personalized Medicine Tool Helps Direct Cardiac Care in Elderly Patients

MedicalResearch.com Interview with:

Joseph A. Ladapo, MD, PhD Principal Substudy Investigator, PRESET Registry Subgroup Analysis, Elderly Patients Associate Professor, Division of General Internal Medicine and Health Services Research David Geffen School of Medicine University of California, Los Angeles

Dr. Ladapo

Joseph A. Ladapo, MD, PhD
Principal Substudy Investigator, PRESET Registry
Subgroup Analysis, Elderly Patients
Associate Professor, Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine
University of California, Los Angeles

MedicalResearch.com: What is the background for this study? 

Response: The mapping of the Human Genome 14 years ago ushered in a new era of precision medicine. Many people are familiar with advances in oncology using precision medicine, but recently, new developments in precision medicine in cardiology have allowed us to develop a tool to differentiate patients likely to have obstructive coronary artery (CAD) from those who have non-cardiac causes of their symptoms.

Diagnosing CAD in the elderly is challenging. Aging individuals often present with atypical symptoms of CAD which can complicate the evaluation process. The typical diagnostic pathway for possible CAD often starts with less invasive testing and progresses to invasive testing, especially in older patients. Invasive procedures pose greater risk in the elderly population than they do in younger patients because of the higher risk of side effects, including bleeding, vascular complications and kidney injury.

Elderly adults evaluated for CAD have a higher pretest probability of CAD and are also at higher risk of experiencing procedure-related complications during their evaluation.[i],[ii] It is also important to note that elderly patients are often underrepresented in clinical trials and other types of comparative effectiveness research.[iii],[iv] For example, the 2013 American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease Risk Algorithm is only formally approved to be used in individuals up to the age of 75, despite the fact that individuals exceeding this threshold in age experience higher rates of adverse cardiovascular events.[v]

All of this means that the elderly population may have the most to gain from timely and accurate determination of their currently likelihood of obstructive CAD.
This precision medicine tool, the age, sex and gene expression score (ASGES), and its clinical utility in the elderly population is the focus of this study. It was based on patient data from the PRESET Registry, a prospective, multicenter, observational study enrolling stable, symptomatic outpatients from 21 U.S. primary care practices from August 2012 to August 2014.

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Hearing Loss Associated With Higher Risk of Cognitive Decline and Dementia

MedicalResearch.com Interview with:
“Hear” by Jaya Ramchandani is licensed under CC BY 2.0David G. Loughrey, BA(Hons)

NEIL (Neuro Enhancement for Independent Lives) Programme
Trinity College Institute of Neuroscience, School of Medicine
Trinity College Dublin, Dublin, Ireland

MedicalResearch.com: What is the background for this study?

Response: Age-related hearing loss, a common chronic condition among older adults, has emerged in the literature as a potential modifiable risk factor for dementia. This is of interest as current pharmacological therapies for dementias such as Alzheimer’s disease only offer symptom-modifying effects. Treatment of risk factors such as hearing loss may help delay the onset of dementia and may provide an alternate therapeutic strategy. However, there is variance in the research on hearing loss and cognition with some studies reporting a small or non-significant association. In this meta-analysis, we investigated this association and we only included observational studies that used standard assessments of cognitive function and pure-tone audiometry (the clinical standard).

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Most Older Drivers Do Not Take Advantage of Car Adaptations Which Make Driving Safer

MedicalResearch.com Interview with:
aaaTara Kelley-Baker PhD

Data and Information Group Leader
AAA Foundation for Traffic Safety

MedicalResearch.com: What is the background for this study?

Background on LongROAD

The AAA Foundation for Traffic Safety (AAAFTS) launched the Senior Driver Initiative in 2012 in an effort to better understand and meet the safe mobility needs of older adult drivers. A multidisciplinary research team from six institutions was formed to design and implement the Longitudinal Research on Aging Drivers (LongROAD) study.

The aims of the study are to better understand:

  • 1) major protective and risk factors of safe driving;
  • 2) effects of medical conditions and medications on driving behavior and safety;
  • 3) mechanisms through which older adults self-regulate their driving behaviors to cope with functional declines;
  • 4) the extent, use, and effects of new vehicle technology and aftermarket vehicle adaptations among older drivers; and
  • 5) determinants and health consequences of driving cessation during the process of aging.

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Doing Something Is Better Than Nothing: Even Light Physical Activity Improves Health

MedicalResearch.com Interview with:

Michael J. LaMonte, PhD, MPH Research Associate Professor Department of Epidemiology and Environmental Health Co-Director, MPH Program (epidemiology) School of Public Health and Health Professions Women’s Health Initiative Clinic University at Buffalo – SUNY 

Dr. LaMonte

Michael J. LaMonte, PhD, MPH
Research Associate Professor
Department of Epidemiology and Environmental Health
Co-Director, MPH Program (epidemiology)
School of Public Health and Health Professions
Women’s Health Initiative Clinic
University at Buffalo – SUNY 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current national public health guidelines recommend 150 minutes of moderate to vigorous physical activity a week for adults. The guidelines recommend persons 65 and older follow the adult guidelines to the degree their abilities and conditions allow. Some people, because of age or illness or deconditioning, are not able to do more strenuous activity. Current guidelines do not specifically encourage light activity because the evidence base to support such a recommendation has been lacking.

Results from the Objective Physical Activity and Cardiovascular Health (OPACH) Study, an ancillary study to the U.S. Women’s Health Initiative, recently published in the Journal of the American Geriatrics Society showed women ages 65-99 who engaged in regular light intensity physical activities had a reduction in the risk of mortality. The 6,000 women in the OPACH study wore an activity-measuring device called an accelerometer on their hip for seven days while going about their daily activities and were then followed for up to four and a half years.  Results showed that just 30 additional minutes of light physical activity per day lowered mortality risk by 12 percent while 30 additional minutes of moderate activity, such as brisk walking or bicycling at a leisurely pace, exhibited a 39 percent lower risk. 

The finding for lower mortality risk associated with light intensity activity truly is remarkable. We anticipated seeing mortality benefit associated with regular moderate-to-vigorous intensity activity, as supported by current public health guidelines. But, observing significantly lower mortality among women who were active at levels only slightly higher than what defines being sedentary was such a novel finding with important relevance to population health.

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Regardless of Ejection Fraction, Hospitalization for Heart Failure Linked To Increased Risk of Death

MedicalResearch.com Interview with:

Kevin S. Shah, M.D. Cardiology Fellow, University of California, Los Angeles Ronald Reagan UCLA Medical Center

Dr. Shah

Kevin S. Shah, M.D.
Cardiology Fellow, University of California, Los Angeles
Ronald Reagan UCLA Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Heart failure (HF) is a chronic condition and progressive disease which is associated with a high-risk of hospitalization and death. One of the principle ways in which heart function is estimated is the use of ultrasound to calculate the ejection fraction of the heart, an estimate of the heart’s pump function. The ejection fraction can help predict how long patients will live and affects decision-making with regards to what medications may help their condition.

A total of 39,982 patients from 254 hospitals who were admitted for Heart failure between 2005 and 2009 were included. They were followed over time to see if they were admitted to the hospital again or if they died during this period. We compared three subgroups within this large group of patients based on their estimated ejection fraction. Across subgroups, the 5-year risk of hospitalization and death was high when compared with the U.S. population. Furthermore, the survival for patients with a diagnosis of heart failure who have been hospitalized once for this condition have a similarly poor 5-year risk of death and re-hospitalization, regardless of their estimated ejection fraction.
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Exercise, Vision Testing and Osteoporosis Evaluation Are Keys To Fall Prevention

MedicalResearch.com Interview with:

Andrea C. Tricco PhD, MSc Scientist and Lead of the Knowledge Synthesis Team Associate Professor Dalla Lana School of Public Health, University of Toronto Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews

Dr. Tricco

Andrea C. Tricco PhD, MSc
Scientist and Lead of the Knowledge Synthesis Team
Associate Professor Dalla Lana School of Public Health, University of Toronto
Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews

MedicalResearch.com: What is the background for this study?

Response: Falls are the leading cause of injury among older adults and account for $2 billion in direct health-care costs annually ($31 billion in costs to Medicare in the United States in 2012). We aimed to determine which types of fall-prevention programs may be effective for reducing falls in older people.

MedicalResearch.com: What are the main findings?

Response: Exercise, along with vision assessment and treatment, as well as an assessment and possible modification of a person’s living environment, reduced the risk of injurious falls by 23% compared to usual care.

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