Aging, Author Interviews, Exercise - Fitness, JAMA, USPSTF / 10.06.2024
USPSTF: Health Care Professionals Should Recommend Exercise for Seniors at Risk of Falls
MedicalResearch.com Interview with:
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Dr. Li Li[/caption]
Li Li, M.D., Ph.D., M.P.H
Walter M. Seward Professor
Chair of Family Medicine
Director of population health
University of Virginia School of Medicine
Editor-in-chief of The BMJ Family Medicine
Dr. Li joined the U.S. Preventive Services Task Force in January 2021
MedicalResearch.com: What is the background for this study? What are the main findings of the underlying studies?
Response: Falls are the leading cause of injuries in older adults and can lead to serious disability and even death. To help prevent these incidents, the Task Force looked at the current evidence on ways that primary care clinicians can help prevent falls in adults aged 65 and older who live at home and are more likely to fall.
We concluded that healthcare professionals should recommend exercise interventions for adults aged 65 and older who are at increased risk for falls. This could include gait, balance, and functional training, as well as strength, resistance, and flexibility training. Clinicians can also talk with their older patients who are most likely to fall about whether additional interventions might be helpful to reduce their risk of falling.
Dr. Li Li[/caption]
Li Li, M.D., Ph.D., M.P.H
Walter M. Seward Professor
Chair of Family Medicine
Director of population health
University of Virginia School of Medicine
Editor-in-chief of The BMJ Family Medicine
Dr. Li joined the U.S. Preventive Services Task Force in January 2021
MedicalResearch.com: What is the background for this study? What are the main findings of the underlying studies?
Response: Falls are the leading cause of injuries in older adults and can lead to serious disability and even death. To help prevent these incidents, the Task Force looked at the current evidence on ways that primary care clinicians can help prevent falls in adults aged 65 and older who live at home and are more likely to fall.
We concluded that healthcare professionals should recommend exercise interventions for adults aged 65 and older who are at increased risk for falls. This could include gait, balance, and functional training, as well as strength, resistance, and flexibility training. Clinicians can also talk with their older patients who are most likely to fall about whether additional interventions might be helpful to reduce their risk of falling.
Dr. Orkaby[/caption]
Ariela Orkaby, MD, MPH
Geriatrics & Preventive Cardiology
Associate Epidemiologist
Division of Aging, Brigham and Women's Hospital
Assistant Professor of Medicine, Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: As the population is living longer, there is increased risk of frailty and vulnerability. Frailty is defined as reduced physiological reserve and decreased ability to cope with even an acute stress. Up to half of adults over the age of 85 are living with frailty and preventative measures are greatly needed. We tested the effect of vitamin D and marine omega-3 fatty acid supplementation on the risk of developing frailty in healthy older adults in the US enrolled in the VITamin D and OmegA-3 TriaL (VITAL) trial.
Dr. Rhee[/caption]
Chanu Rhee, MD,MPH
Assistant Professor of Population Medicine
Harvard Medical School / Harvard Pilgrim Health Care Institute
Assistant Hospital Epidemiologist
Brigham and Women’s Hospital
MedicalResearch.com: What is the background for this study?
Response: Sepsis is the body’s reaction to a serious infection that results a cascade of inflammation in the body and organ dysfunction, such as low blood pressure, confusion, or failure of the lungs, kidneys, or liver. Sepsis is a major cause of death, disability, and cost in the U.S. and around the world. Growing recognition of this problem has led to numerous sepsis performance improvement initiatives in hospitals around the country. Some of these efforts have also been catalyzed by high-profile tragic cases of missed sepsis leading to death, which may have contributed to a perception that most sepsis deaths are preventable if doctors and hospitals were only better at recognizing it.
However, the extent to which sepsis-related deaths might be preventable with better hospital-based care is unknown. In my own experience as a critical care physician, a lot of sepsis patients we treat are extremely sick and even when they receive timely and optimal medical care, many do not survive. This led myself and my colleagues to conduct this study to better understand what types of patients are dying from sepsis and how preventable these deaths might be. 
Dr. Li[/caption]
Fuzhong Li, Ph.D.
Senior Scientist
Oregon Research Institute
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Injurious falls among community-dwelling older adults are a serious public health and cost-bearing problem worldwide.Exercise has been shown to reduce falls and injurious falls among older adults. However, evidence is limited with regard to the type of exercise interventions that are most effective, without exacerbating the risk in some individuals, in reducing injurious falls.
This study addresses this knowledge gap in the field of falls prevention. Findings from this study showed that a six-month Tai Ji Quan program reduced the incidence of injurious falls among frail elderly by 53% compared to a regular (multimodal) exercise intervention. The effect of the Tai Ji Quan intervention was shown to be robust, and still evident at follow-up examinations six months after the study.
Dr. David Sebastián[/caption]
MedicalResearch.com Interview with:
Dr. David Sebastián
IRB Barcelona and CIBERDEM researcher
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: One of the alterations that most affects the quality of life of the elderly is muscle wastage and the resulting loss of strength, a condition known as sarcopenia. At about 55 years old, people begin to lose muscle mass, this loss continues into old age, at which point it becomes critical. However, the underlying causes of sarcopenia are unknown and thus no treatment is available for this condition.
Importantly, we have found that the mitochondrial protein Mitofusin 2 is required to preserve healthy muscles in mice. Mitofusin 2 is a mitochondrial protein involved in ensuring the correct function of mitochondria, and it has several activities related to autophagy, a crucial process for the removal of damaged mitochondria. The loss of Mitofusin 2 impedes the correct function of mitochondrial recycling and consequently damaged mitochondria accumulate in muscle cells.
Dr. Daniel McIsaac[/caption]
Dr. Daniel I McIsaac, MD, MPH, FRCPC
Assistant Professor of Anesthesiology
Department of Anesthesiology
The Ottawa Hospital, Civic Campus
Ottawa, ON
Medical Research: What is the background for this study?
Dr. McIsaac: Older age is a well-known risk factor for adverse outcomes after surgery, however, many older patients have positive surgical outcomes. Frailty is a syndrome that encompasses the negative health attributes and comorbidities that accumulate across the lifespan, and is a strong discriminating factor between high- and low-risk older surgical patients. By definition, frail patients are “sicker” than non-frail patients, so their higher rates of morbidity and mortality after surgery aren’t surprising. However, frailty increases in prevalence with increasing age, so as our population ages we expect to see more frail people presenting for surgery. Our goal was to evaluate the impact of frailty on postoperative mortality at a population-level, and over the first year after surgery to provide insights that aren’t available in the current literature, which largely consists of single center studies limited to in-hospital and 30-day outcome windows.
Dr. Cassie Kennedy[/caption]
MedicalResearch.com Interview with:
Cassie Kennedy, M.D.
Pulmonology and Critical Care Medicine
Mayo Clinic
Medical Research: What is the background for this study?
Dr. Kennedy: Lung transplant is a surgical procedure that can offer extended life expectancy and improved quality of life to selected patients with end-stage lung disease. However there are about 1700 patients awaiting lung transplant at any given time in the United States because transplant recipients far exceed potential donors. In addition, even with carefully chosen candidates, lung transplant recipients live on average about 5.5 years. It is therefore very important for transplant physicians to choose patients who will receive the most benefit from their lung transplant.
Frailty (defined as an increased vulnerability to adverse health outcomes) has typically been a subjective consideration by transplant physicians when choosing lung transplant candidates. The emergence of more objective and reproducible frailty measures from the geriatric literature present an opportunity to study the prevalence of frailty in lung transplant (despite that subjective screening) and to determine whether the presence of frailty has any impact on patient outcomes.
Medical Research: What are the main findings?
Dr. Kennedy: Frailty is quite common --46 percent of our patient cohort was frail by the Frailty Deficit Index. We also saw a significant association between frailty and worsened survival following lung transplantation: one-year survival rate for frail patients was 71.7 percent, compared to 92.9 percent for patients who were not frail. At three years this difference in survival persisted--the survival rate for frail patients was 41.3 percent, compared to 66.1 percent for patients who were not frail.
