MedicalResearch.com Interview with:
Thomas M. Gill, M.D.
Humana Foundation Professor of Geriatric Medicine
Professor of Medicine, Epidemiology & Investigative Medicine
Director, Yale Program on Aging/Pepper Center
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Maintaining independent mobility is an important goal of clinical medicine and public health, especially among older persons, who are at the greatest risk for disability.
By adopting a walking routine and other moderate physical activities, older adults can recover from a major disability more quickly, and maintain their independence over time.
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MedicalResearch.com Interview with:Xabier Garcia-De-Albeniz MD PhD
Research Associate
Department of Epidemiology
Harvard T.H. Chan School of Public Health
Mongan Institute for Health Policy
Massachusetts General Hospital
MedicalResearch.com: What is the background for this study?Response: Randomized controlled trials are considered the gold standard to inform health care delivery. Unfortunately, no randomized controlled trials of screening colonoscopy have been completed. Ongoing trials exclude persons aged 75 or older, and will not have mature results before 2025. However, healthy persons older than 75 may live long enough to benefit from colorectal cancer (CRC) screening. The Medicare program reimburses screening colonoscopy without an upper age limit since the year 2001. We used the extensive experience of Medicare beneficiaries to evaluate the effectiveness and safety of screening colonoscopy.
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MedicalResearch.com Interview with:José Antonio Avilés-Izquierdo, PhD
Department of Dermatology
Hospital Gregorio Marañón
Madrid, Spain
MedicalResearch.com: What is the background for this study?Response: Melanoma is responsible for most of skin cancer-related deaths and the cancer with the highest cost per death and the highest lost of productive-life years in Europe.
Despite the importance on early diagnosis of cutaneous melanoma, there are few studies analyzing the reasons that lead patients with melanoma to consult. The impact on prognosis in patients with melanoma according to who first detects melanoma have not been established.
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MedicalResearch.com Interview with:Anat Mirelman, PhD
Director- Laboratory of Early Markers of Neurodegeneration (LEMON)
Center for the study of Movement , Cognition and Mobility (CMCM)
Department of Neurology
Tel Aviv Sourasky Medical Center
Sackler School of Medicine, Tel Aviv University
Tel Aviv 64239, Israel
MedicalResearch.com: What is the background for this study? What are the main findings?Response: The main aim of this research was to evaluate the efficacy of using a motor cognitive training using virtual reality in reducing fall frequency and fall risk in older adults.
Falls are a leading cause of morbidity and mortality in older adults. The prevalence of falls is huge, with one out of every 3 adults aged 65 years or older will fall at least once per year, with approximately half of these fallers suffering multiple falls in this period . These statistics are even higher in neurodegenerative conditions such as in Parkinson’s disease and in people with cognitive impairments. For example, studies have shown that as much as 80% of people with Parkinson’s disease fall each year. So many older adults are falling.
The consequences of falls are huge.
The most dramatic result is hip fracture. But this is relatively rare. However, even in the absence of a fracture or other injury, falls often lead to fear of falling, social isolation, and depression, which in turn often leads to inactivity, muscle weakness, impaired balance and gait, more falls, more social isolation. In other words, falls often start a vicious cycle, which has many important negative health consequences. Falls are associated with morbidity and mortality and they also have a huge economic impact. In many western countries, 1-2% of healthcare dollars are spent on falls.
For many years, age-associated changes in muscle strength, balance and gait were viewed as the key factors that contribute to the risk of falls. However, more recently, we and others showed that certain aspects of cognition are also critical to safe ambulation. For example people with AD often fall, almost to the same amount as people with PD, highlighting the cognitive component of falls. This makes sense intuitively if we Imagine the cognitive skills we need just to cross a busy intersection. These tasks require executive function, specially, planning, the ability to avoid obstacles, and the ability to perform two or more tasks at the same time.
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MedicalResearch.com Interview with:Elizabeth Burns, MPH
Health Scientist, Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
CDC
MedicalResearch.com: What is the background for this study?
Response: Falls are the leading cause of both fatal and non-fatal injuries among Americans aged 65 and older. In 2000, the direct cost of falls were estimated to be $179 million for fatal falls and $19 billion for non-fatal falls. Fall injuries and deaths are expected to rise as more than 10,000 Americans turn 65 each day. Within the next 15 years, the U. S. population of older Americans is anticipated to increase more than 50%, with the total number of older adults rising to 74 million by 2030.
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MedicalResearch.com Interview with:Dr. Faiza Tabassum, PhD
Southampton Statistical Sciences Research Institute
University of Southampton
Southampton, UK
MedicalResearch.com: What is the background for this study?Response: Previous research has shown that volunteering in older age is associated with better mental and physical health, but it’s unclear whether this extends to other age groups. We aimed to examine the association of volunteering with mental health or well-being among the British population across all ages.
The British Household Panel Survey (BHPS) was used which has collected information from 1991 to 2008 from over 5000 households. The published study has analysed over 66,000 responses representing the whole of the UK. The BHPS included a wide range of questions on leisure time activities, which covered the frequency of formal volunteering—from at least once a week through to once a year or less, or never. The BHPS also included a validated proxy for mental health/emotional wellbeing known as the GHQ-12.
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MedicalResearch.com Interview with:Danielle Mairead Maire Ni Chroinin,
MB BCh BAO BMedSc MD MRCPI FRACP
Staff Specialist in Geriatric Medicine
Liverpool Hospital and Senior Conjoint Lecturer UNSW
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Oral disease may have a large impact on older persons’ health and wellbeing, causing pain, impairing speech, adversely affecting nutrition, contributing to systemic infection and harming self-esteem. However, this important issue may be neglected in the acute hospital setting. Our aim was to investigate oral health status and abnormalities in older patients admitted acutely to hospital, exploring the association with medical co-morbidities. We included all individuals aged 70 and older admitted to a geriatric service over 3 months (N=202), and evaluated oral health using a simple bedside tool the Oral Health Assessment Tool (OHAT).
Overall, we found that poor oral health was not uncommon, and was associated with dementia and renal impairment. This association persisted even after adjustment for anticholinergic medication and oral pH, highlighting that patients with these conditions may be particularly vulnerable.
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MedicalResearch.com Interview with:Julia Berian, MD, MS
ACS Clinical Research Scholar
American College of Surgeons
Chicago, IL 60611
MedicalResearch.com: What is the background for this study? What are the main findings?Response: The US population is rapidly aging and older adults consume a disproportionate share of operations. Older adults experience a high rate of postoperative complications, which can affect quality of life. In this study, function, mobility and living situation are considered together as independent living. The study examined a large surgical database for the occurrence of loss of independence (defined as a decline in function or mobility, or increased care needs in one's living situation) and its relationship to traditional outcomes such as readmission and death after the time of discharge. Patients included in the study were age 65 or older and underwent an inpatient surgical operation. Loss of independence was assessed at the time of discharge. Readmission and death-after-discharge were assessed up to 30 days postoperatively.
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MedicalResearch.com Interview with:Leigh Purvis, MPA
Director of Health Services Research
AARP Public Policy Institute
Editors’ note: In conjunction with the AARP’s new investigative piece, 'Supplement Pills That Promise Too Much', Leigh Purvis, Director of the AARP Health Services Research program discussed the issue of the proliferation of supplements, often with labels that make extraordinary health benefit claims.MedicalResearch.com: How many Americans use nutritional supplements? How big is the business of supplements?Response: Supplements are very popular in the United States. This is particularly true for older adults. A recent study found that the proportion of older adults using supplements increased from 52 percent in 2005 to 64 percent in 2011, and the share using multiple supplements grew by nearly 50 percent.
According to the National Institutes of Health, American spent an estimated $36.7 billion on dietary supplements in 2014.
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MedicalResearch.com Interview with:MedicalResearch.com: What is the background for this study? What are the main findings?Response: The impetus for this article was our experience from working at FAU’s Christine E. Lynn College of Nursing’s Louis and Anne Green Memory and Wellness Center with families as we conducted assessments of older adults referred to our program by family members or law enforcement. We realized that there is a need to educate nurses that a) they can help to identify persons who may be at risk for unsafe driving before accidents occur, and b) there are resources to help families and nurses navigate this challenging topic. This awareness is especially important for persons and friend/family members who find themselves trying to cope with a known or potential diagnosis of dementia.
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MedicalResearch.com Interview withOleg Zaslavsky PhD
Assistant Professor at the department of Biobehavioral Nursing and Health System
School of Nursing
University of Washington
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Frailty is a common, but serious medical condition among older adults. It is characterized by weight and muscle loss, fatigue, slow walking and low levels of physical activity. It’s important to accurately diagnose and treat frailty, especially because demographic trends show the percentage of U.S. adults age 65 years and older will increase 19% by 2030.
Frailty is commonly assessed by the Cardiovascular Health Study (CHS) frailty phenotype, which includes a set of physical measurements for slowness, weakness, fatigue, low physical activity and body-weight loss. According to the CHS phenotype, individuals with three or more of these characteristics are at increased risk for falls, hip fractures, disability and mortality. Although the CHS phenotype is good for predicting adverse conditions, it requires direct measurement of physical performance. Refining the phenotype so it doesn’t involve physical measurements of patients in a doctor’s office has practical advantages for research and clinical purposes.
For this study, University of Washington School of Nursing researchers worked with Fred Hutchinson Cancer Research Center faculty to refine the Women’s Health Initiative (WHI) frailty phenotype, originally developed in 2005. This new phenotype uses self-reporting from patients instead of measurements of physical performance to determine frailty and associated health outcomes.
In this report, we show that our newly-proposed WHI measuring scheme performs as well as the more complex CHS phenotype in predicting death, hip fractures and falls in older women.
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MedicalResearch.com Interview with:Carrie N. Klabunde, PhD
Office of Disease Prevention
Office of the Director
NIH
Rockville MD
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Many studies of colorectal cancer screening focus on adults 50-75 years of age; few specifically look at screening in the elderly. We wanted to examine colorectal cancer screening use, including follow-up diagnostic testing for those with abnormal fecal blood screening tests, in adults 65 years of age and older. We also wanted to assess whether screening use in this population is influenced more by elderly individual’s chronological age, or their health status (called comorbidity in our study). The study was conducted in three large, integrated healthcare systems: Kaiser Permanente in Northern California and Southern California, and Group Health in Washington state and Idaho. We examined data on nearly 850,000 patients aged 65-89.
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MedicalResearch.com Interview with:Jinmyoung Cho, PhD
Assistant Investigator
Center for Applied Health Research
Baylor Scott & White Health
Temple, TX 76508
Texas A&M Health Science Center
College Station, Texas
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Early life-course transition experiences to the adult years result in continuing consequences for health in later life. Many veterans have encountered life-threatening environments while they were on military service leading to a higher incidence of physical and mental diseases; greater comorbidity profiles in veterans contribute to higher mortality rate compared to non-veterans.
With increased life expectancy and demographic shifts in our population, the proportion of oldest-old adults, aged over 80 years, continues to increase. The publicly funded Veterans Health Administration (VHA) must care efficiently and effectively for its increasing population of veterans, who are older, sicker, and socioeconomically disadvantaged relative to non-veterans.
Given the large number of veterans over age 80 and the increasing emphasis on managing the aging process, it is important to identify associations between healthcare utilization and survival for VHA’s oldest patients.
We identified protective and risk factors associated with mortality by age group. During a 5-year follow-up period, 44% of patients aged 85 years and over died with survival rates of 59% for 80’s, 32% for 90’s and 15% for 100’s. In the multivariable model, protective effects for veterans 80-99 were female sex, minority race or ethnicity, being married, having certain physical and mental diagnoses (e.g., hypertension, cataract, dyslipidemia, posttraumatic stress disorder, bipolar disorder), urgent care visits, invasive surgery, and few (one to three) prescriptions. Risk factors were lower VHA priority status, physical and mental conditions (e.g., diabetes, anemia, congestive heart failure, dementia, anxiety, depression, smoking, substance abuse disorder), hospital admission, and nursing home care. For those in their 100s, married status, smoking, hospital admission, nursing home care, invasive surgery, and prescription use were significant risk factors; only emergency department (ED) use was protective.
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MedicalResearch.com Interview with:Pei-Jung Lin, Ph.D.
Assistant Professor
Center for the Evaluation of Value and Risk in Health
Institute for Clinical Research and Health Policy Studies
Tufts Medical Center
Boston, MA 02111
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Alzheimer’s disease (AD) is a slow, progressive disease. Many people with AD may live for years with the disease left unrecognized or untreated, in part because the early symptoms are mild and often mistaken as part of normal aging. In this study, we found that Alzheimer’s patients may use more health care services and incur higher costs than those without dementia even before they receive a formal diagnosis. For example, total Medicare expenditures were 42% higher among Alzheimer’s patients than matched controls during the year prior to diagnosis ($15,091 vs. $10,622), and 192% higher in the first year immediately following diagnosis ($27,126 vs. $9,274). We also found similar trends among Medicare patients with mild cognitive impairment (MCI)— a prodromal stage of AD and associated with higher dementia risk.
Our study suggests that an Alzheimer’s disease or MCI diagnosis appears to be prompted by other health problems such as cardiovascular and cerebrovascular diseases, pneumonia, renal failure, urinary tract infections, and blood and respiratory infections. This finding likely reflects a failure of ambulatory care related to the impact of cognitive impairment on other chronic conditions.
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MedicalResearch.com Interview with:Dr. Catherine S. M. Diefenbach MD
Assistant Professor of Medicine
NYU Cancer Center
New York, NY 10016
MedicalResearch.com: What is the background for this study? What are the main findings?Dr. Diefenbach: It is well known that age is important prognostic factor in non-Hodgkin’s lymphoma (NHL). Multiple studies have illustrated that elderly lymphoma patients have inferior survival outcomes as compared to their younger counterpart. While the tumor biology is often different in these two groups, and may play a role in this discordancy, elderly patients are often frail or have multiple medical comorbidities. These include geriatric syndromes, such as: cognitive impairment, falls, polypharmacy, and potentially inappropriate medication (PIM) use. All of these may contribute to poor outcomes for elderly patients. In addition, elderly patients are often under-treated for their aggressive lymphoma out of concern for toxicity or side effects, even though the data clearly demonstrates that elderly patients can still benefit from curative intent chemotherapy.
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MedicalResearch.com Interview with:
Halima Amjad, MD, MPH
Post-doctoral Fellow
Johns Hopkins University School of Medicine
Division of Geriatric Medicine and Gerontology
MedicalResearch.com: What is the background for this study? What are the main findings?Dr. Amjad: Safety is an important aspect of dementia care. Dementia is underdiagnosed, however, and there is limited understanding of safety issues in people with undiagnosed dementia. We wanted to better understand potentially unsafe activities and living conditions in all older adults with dementia and specifically examine these activities in undiagnosed dementia. We found that in all study participants with probable dementia, the prevalence of driving, cooking, managing finances, managing medications, or going to physician visits alone was over 20%. The prevalence was higher in older adults with probable dementia without a diagnosis, and even after accounting for sociodemographic, medical, and physical impairment factors, the odds of engaging in these activities was over 2.0 in undiagnosed versus diagnosed probable dementia. Potentially unsafe living conditions including unmet needs and performance on cognitive tests were similar between these groups.
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MedicalResearch.com Interview with:
[caption id="attachment_24479" align="alignleft" width="117"] Dr. Jeff Williamson[/caption]
Jeff D. Williamson, MD, MHS
Section on Gerontology and Geriatric Medicine
Interim Chair, Internal Medicine
Program...
MedicalResearch.com Interview with:
Leigh Purvis, MPA
Director of Health Services Research
AARP Public Policy Institute
MedicalResearch.com Editor’s Note: The May AARP Bulletin has a important article “Black Market Meds Are Flooding the Nation’s Pharmacies And Hospitals” by Joe Eaton, discussing the growing problem of counterfeit medications entering the US pharmaceutical supply chain. Ms. Leigh Purvis of the AARP Policy Institute discussed this important issue for the readers of MedicalResearch.com. Ms. Purvis’ areas of expertise include prescription drug pricing, biologic drugs, and Medicare prescription drug coverage.MedicalResearch.com: Is pharmaceutical theft and fraud a new or growing problem?
Ms. Purvis: I think it’s safe to say that pharmaceutical theft is a growing problem. Skyrocketing prices have made pharmaceuticals a lucrative target for criminals. Trucks transporting pharmaceuticals are a common target, although some thieves have stolen prescription drugs directly from manufacturers’ warehouses.
Pharmaceutical fraud is also a growing concern. FDA does a great deal to ensure the safety of US pharmaceuticals. However, problems can still arise, particularly when people purchase drugs online.
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MedicalResearch.com Interview with:
Jessica J. Jalbert PhD
From the Division of Pharmacoepidemiology and Pharmacoeconomics
Department of Medicine, Brigham and Women’s Hospital
Harvard Medical School, Boston, MA
LASER Analytica
New York, NY
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Jalbert: Landmark clinical trials have demonstrated that carotid artery stenting (CAS) is a safe and efficacious alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. Clinical trials, however, tend to enroll patients that are younger and healthier than the average Medicare patient. We therefore sought to compare outcomes following CAS and CEA among Medicare patients.
MedicalResearch.com: What are the main findings?
Dr. Jalbert: We found that outcomes among real-world Medicare patients undergoing CAS and CEA were similar. While our results were inconclusive due to small sample size, we also found some evidence suggesting that patients over the age of 80 and those with symptomatic carotid stenosis may have better outcomes following carotid endarterectomy than CAS.
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MedicalResearch.com Interview with:
Dr. Wouter R. Verberne
Koekoekslaan 1
The Netherlands
MedicalResearch.com: What is the background for this study?
Dr. Verberne: The number of older patients with End Stage Renal Disease (ESRD) is increasing worldwide. When ESRD is approaching, patients need to be advised on the renal replacement therapy (RRT) necessary to remove toxic products and fluid from the body when their own kidneys are no longer able to do so. ESRD can be treated with kidney transplantation, hemodialysis or peritoneal dialysis. With increasing technical possibilities and with the widespread availability of dialysis treatment, age no longer limits dialysis treatment.
It has been questioned whether older patients with ESRD, who often have multiple comorbidities, are likely to benefit from renal replacement therapy. Dialysis treatment comes with high treatment burden. Generally patients are treated in a dialysis facility 3 times per week, 3 to 4 hours per time. Patients with an anticipated poor prognosis on RRT may choose to forego dialysis and decide to be treated conservatively instead. Conservative management (CM) entails ongoing care with full medical treatment, including control of fluid and electrolyte balance and correcting anemia, and provision of appropriate palliative and end of life care.
Shared decision making has been recommended to come to a joint decision on renal replacement therapy by considering potential benefits and harms of all treatment options and the patient’s preferences. Data on outcomes, including survival and quality of life, are needed to foster the decision making. However, adequate survival data, specifically on older patients, are limited.
A number of studies, predominantly from the United Kingdom, have determined survival of older patients managed conservatively compared with renal replacement therapy. In these studies, the numbers of recruited patients are generally small, the studies are performed in heterogeneous study populations, and there is significant variability in starting points used in survival analyses. We performed the first Dutch study in a large series of older patients slowly approaching ESRD, enabling the use of several starting points in survival analyses. The aims of the study were to compare survival in patients with ESRD ages ≥ 70 years old choosing either conservative management or renal replacement therapy and determine predictors of survival.(more…)
MedicalResearch.com Interview with:
Alanna Chamberlain, PhD
Assistant Professor of Epidemiology
Mayo Clinic College of Medicine
MedicalResearch.com: What is the background for this study?
Dr. Chamberlain: The number of elderly individuals in the US will double by the year 2050 and these individuals will become increasingly frail as they get older. Frailty has been recognized by doctors and researchers as an important contributor to poor health and declines in quality of life among older adults. However, it is difficult to measure frailty because it’s not due to a single condition. Instead, multiple health problems tend to accumulate over time until a person becomes increasingly frail. It is important to understand how frailty develops as patients age and how changes in frailty are related to outcomes. To address these questions, we followed individuals over 8 years to identify changes in frailty over time, to describe how people cluster (follow similar trajectories of frailty over time), and to examine how these changes relate to emergency department visits, hospitalizations, and death in a large population from Olmsted County, MN.
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MedicalResearch.com Interview with:Dr. Albert Siu M.D., M.S.P.H.
Chair of the U.S. Preventive Services Task Force
Chairman and professor of the Brookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
Director of the Geriatric Research, Education, and Clinical Center
James J. Peters Veterans Affairs Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Siu: Impaired vision is a serious and common problem facing older adults and can affect their independence, ability to function, and quality of life. When the Task Force reviewed the research around screening older adults for vision impairment in a primary care setting, we concluded that the current evidence is insufficient to assess the balance of benefits and harms. As a result, we issued an I statement, which is consistent with the 2009 final and 2015 draft recommendations.
MedicalResearch.com: What should clinicians and patients take away from your report?Dr. Siu: Older adults who are having problems seeing should talk to their primary care doctor or an eye specialist. Primary care doctors can explore the various causes of vision problems and do an eye exam to check for refractive error. An eye specialist can do a full eye exam to look for and treat refractive errors and other eye conditions that affect vision, such as cataracts and age-related macular degeneration (AMD). With regards to clinicians, in the absence of clear evidence, they should use their clinical judgment when deciding whether to screen patients who have not reported any concerns about their vision.
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MedicalResearch.com Interview with:
Chiara Ambrogio, PhD
Experimental Oncology Group
CNIO-Centro Nacional de Investigaciones Oncológicas
(Spanish National Cancer Research Centre)
Melchor Fernández Almagro nº3
Madrid SpainMedical Research: What is the background for this study? Dr. Ambrogio: The majority of preclinical studies aimed at discovering new therapeutic strategies for lung adenocarcinoma have been conducted so far in full-blown tumors. We wanted to try a new approach by studying early lung lesions in a KRasG12V mouse model in order to bypass the problems imposed by tumor heterogeneity in later stages of the disease. We reasoned that the analysis of the first steps of lung adenocarcinoma development would help us in identifying valuable targets for therapeutic intervention.Medical Research: What are the main findings?Dr. Ambrogio:
1) We performed gene expression analysis of KRasG12V-driven mouse lung hyperplasias (≤ 500 cells) and we compared it to the gene expression profile of full-blown lung adenocarcinoma. We found that the aggressive nature of this tumor type is determined earlier than what predicted by histopathological criteria.
2) The analysis of transcriptional changes in early lesions allowed us to identify DDR1 as a drugable target in KRasG12V-driven lung adenocarcinoma. We validated its potential as a therapeutic target both genetically and pharmacologically by means of a selective DDR1 inhibitor. We demonstrated that the co-inhibition of DDR1 and NOTCH pathway, a key player in DDR1-mediated survival, exerted additive therapeutic effect.
3) We confirmed these results in human lung adenocarcinoma by reporting, for the first time, the development of an orthotopic Patient-Derived Xenograft (PDX) model as the ideal platform for the preclinical evaluation of new therapeutic strategies.
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MedicalResearch.com Interview with:
[caption id="attachment_21033" align="alignleft" width="133"] Dr. Mark Ketterer[/caption]
Mark W Ketterer PhD, ABPP
Health Psychology
Henry Ford Hospital
Detroit Michigan
MedicalResearch.com: What is the...
MedicalResearch.com Interview with:
Stanford Chihuri MPH
Center for Injury Epidemiology and Prevention
Department of Anesthesiology
Columbia University Medical Center
New York City, New YorkMedical Research: What is the background for this study? What are the main findings?
Response: For many older adults, driving is instrumental to their daily living and is a strong indicator of self-control, personal freedom and independence. This study assesses and synthesizes evidence in the research literature on the impact of driving cessation on subsequent health and well-being of older adults. The main findings are that driving cessation in older adults appears to contribute to a variety of health problems, particularly depression.
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Click Here for More on Heart Disease on MedicalResearch.comMedicalResearch.com Interview with:
Bjørn Bendz MD PhD
and Nicolai K. Tegn, MDDepartment of Cardiology, Oslo University Hospital,
Rikshospitalet Oslo, NorwayMedical Research: What is the background for this study? What are the main findings?
Response: According to life expectancy statistics, a person who reaches age 80 can expect to live an average of 8 years (in men) and 9 years (in women).
People over 80 yrs are underrepresented in clinical trials, they are less likely to receive treatment according to guidelines. Our study, which directly targets the over-80 population, is the first to demonstrate that a more invasive strategy results in better outcomes in these patients. We believe our study provides a sufficient basis to recommend an invasive approach.”
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MedicalResearch.com Interview with:
Ariel R. Green, M.D., M.P.H
Assistant Professor of Medicine
Johns Hopkins University School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Response: Implantable cardioverter-defibrillators (ICDs) are widely used to prevent sudden cardiac death in patients with systolic heart failure. Older adults with heart failure often have multiple coexisting conditions and are frail, increasing their risk of death from non-cardiac causes. Our understanding of outcomes in older patients with ICDs is limited.
Medical Research: What should clinicians and patients take away from your report?Response: Our major finding was that more than 10% of patients currently receiving ICDs for primary prevention of sudden cardiac death (meaning that they have never had a potentially lethal arrhythmia but are at risk for one, usually due to systolic heart failure) are frail or have dementia. Patients with these geriatric conditions had substantially higher mortality within the first year after ICD implantation than those without these conditions. Frailty and dementia were more strongly associated with mortality than were traditional comorbidities such as diabetes.
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MedicalResearch.com Interview with:
Professor Charles Hennekens MD Dr.P.H
Sir Richard Doll Professor
Senior Academic Advisor to the DeanCharles E. Schmidt College of Medicine
Florida Atlantic University
777 Glades Road
Boca Raton, FL 33431
Medical Research: What is the background for this study? What are the main findings?
Prof. Hennekens: Randomized evidence indicates clear benefits of mammography in middle age and, at present, most guidelines recommend regular mammography for women up to age 74. In collaboration with colleagues at Baylor Medical College and Meharry Medical School we were able to link the Surveillance, Epidemiology, and End Results (SEER) data to the Medicare administrative claims data. We found that, up to 84 years, screening was more common among whites than blacks and women receiving regular annual screening mammography had lower risks of mortality from breast cancer.
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MedicalResearch.com Interview with:
Helena Chui, Ph.D.
CPsychol Lecturer Division of Psychology
University of Bradford
Bradford EnglandMedical Research: What is the background for this study? What are the main findings?
Dr. Chui: It is debatable whether psychological well-being improves or declines with age. Findings of the age-related changes in psychological well-being, life satisfaction, and depressive symptoms, are not unequivocal. Some studies have found that people stay pretty stable in terms psychological well-being until late life. Other studies have found otherwise. My recent publication reports the findings using a 15-year longitudinal study from Australia. Results showed that as people get older, depressive symptoms increase. Both men and women reported increasingly more depressive symptoms as they aged, with women initially starting with more depressive symptoms than men. However, men showed a faster rate of increase in symptoms so that the difference in the genders was reversed at around the age of 80.
(more…)
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