Gerotalk

Unique Exercise Program May Be Best Treatment for Those with Dementia

2013-05-06T15:45:00Z

A novel exercise program known as Preventing Loss of Independence through Exercise (PLIÉ), has been demonstrated to hold possibly important benefits for those that suffer from dementia. Most forms of dementia, including dementia of the Alzheimer's type, are usually treated with medications to help slow the progression of the disease. However, many older adults suffering from dementia fail to demonstrate consistent and predictable results from the medications and some often fail to tolerate the medications.

Traditional exercise programs have often been targeted toward improving a person's physical health and functional level of existence. Those with dementia often can benefit from the physical improvements that exercise offer, especially in helping to improve their physical health that is frequently in decline. However, PLIÉ combines physical exercise that emphasizes functional movements with mindful body awareness to not only enhance a person's physical health, but also direct efforts toward maintaining a person's cognitive level of functioning as well.

Dr. Deborah Barnes from the University of California, San Francisco explained the results of her work with PLIÉ, and the results she has obtained from her research to those attending the 65^th annual meeting of the American Academy of Neurology. Barnes states that the program "combines the best elements of eastern and western exercise traditions including yoga, tai chi, Feldenkrais, physical therapy, occupational therapy, mindfulness, and dance movement therapy." (1)

PLIÉ was especially focused on the maintaining and enhancing procedural memory, which is the more implicit memory that we use that helps to automatically and often habitually guide our daily movements and actions. Furthermore, conscious concentration or what Barnes referred to as techniques to increase awareness by focusing on "being in the moment" were used to help enhance one's cognitive abilities while engaging in the functional levels of exercise. Moreover, the exercise programs with those that suffered from dementia were often conducted within a circle. This helped to enhance the socially interactive features of the exercise group, allowing many of the individuals to communicate and interact freely with each other.

The results of the individuals that participated in PLIÉ were compared with those who had dementia but were given the traditional or usual care (UC). The study was small so the results have to be looked at cautiously. There were only six participants in the PLIÉ group and five in the UC group. The study ran for a period of 18 weeks. Pre- and post-intervention data were collected using the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), the Quality of Life in Alzheimer's Disease (QoL-AD), and the Short Physical Performance Battery (SPPB). Furthermore, caregivers were examined as well and their outcomes were measured as well.

The participants in the study, both those that had dementia and those who were caregivers, where closely matched on baseline characteristics and overall were quite similar on these characteristics. Briefly speaking, what stood out in the study was a noted improvement in ADAS-Cog scores (-4.6) in the intervention group, while the UC group experienced a worsening in their condition (2.4), for an effect size of 0.76. Dr. Barnes states that "This is substantially higher than what is usually seen with dementia medications, which is usually on the order of around 0.2 standard deviations." (1) Furthermore, the results were also positive for the caregivers as well. The investigators reported improvements in caregiver burden and caregiver distress scores as well.

As has been mentioned, one has to look at the results cautiously at this point due to the small number of participants that were studied. Nevertheless, one has to be optimistic, albeit cautiously optimistic, over the results that were obtained and further study in this area is definitely needed. Given that the treatment is much more holistic, being targeted toward not just enhancing the patient's physical health, but also enhancing their cognitive performance as well, it definitely needs to be looked at favorably for the greater depth and breadth of treatment intervention it can offer those with this debilitating condition.

Furthermore, since pharmacological interventions can often lead to serious side-effects, be quite expensive, and often provide very specific and limited treatment without the greater salubrious effects that this program has to offer, this in itself should be an impetus for much more research to be undertaken in this area. Since pharmacological therapy has not been the panacea that many have hoped for in addressing the problem of dementia, at least up to this point in time, providing an alternative form of treatment that is less passive and more dynamic, targeting the total organism in its treatment modality, and offering a more pervasive level of health enhancement for the person suffering from dementia may be a very productive avenue to entertain until better and more curative forms of therapeutic intervention exist.

Reference

1. Cassels, C. Novel Exercise Program May Trump Meds for Dementia. Medscape News. http://www.medscape.com/viewarticle/781607?src=wnl_edit_specol&uac=87637DR

Biomarkers for Dementia

2013-04-18T18:12:00Z

At this year's American Academy of Neurology's annual meeting, the discussion was focused on examining important biomarkers and their significance for diagnosing dementia. Dementia is a general term that often relates to a number of neurodegenerative disorders that often influence a person's memory and personality. Alzheimer's disease is the most common of the dementias. Traditionally, dementia has been diagnosed by ruling out other possible causes. In addition, typically the only way to fully provide diagnostic assurance of dementia is through autopsy.

However, recently new tests and biomarkers have been discovered that can provide greater assurance of diagnostic accuracy. These tests and biomarkers are not without a cost, however, both financially and psychologically. Therefore, even though science has progressed to provide use with a greater level of illumination into a clearer and more valid diagnosis, the question can be raised whether 1. they provide any greater efficacy for medical intervention since no cures exist for these illnesses; 2. the potential for false positives to exist can lead to psychological harm to the person receiving incorrect information; and 3. the potential for augmenting already exorbitant health costs, while not giving commensurate benefits to the patient. This is classic example of practicing medicine with no clear goals in which the means becomes the end in itself.

At the conference, three important biomarkers raised considerable interest. Hippocampal atrophy, decreased cerebral spinal fluid amyloid, and decreased brain glucose metabolism appeared to have a positive and cumulative association for dementia. In other words, those that had these biomarkers were more likely to progress to dementia, with those having all three being the most likely to eventually have a diagnosis of dementia. In fact, in one of the studies cited, only four percent of the individuals that failed to have any of the biomarkers progressed to dementia. However, 100 percent of those in the study that had all three biomarkers eventually acquired dementia.

An important consideration raised by many members at the convention was that there needs to be a standardized way to measure the biomarkers. This would enhance the validity of the tests as well. In fact, how biomarkers are measured may be more important than the type or amount of biomarkers used. Since there is so much variability currently in how many of these biomarkers are measured, this in itself can introduce considerable levels of error and reduce the accuracy of the testing.

It was found that an important biomarker, a positive amyloid beta marker, had a significant predictive validity for determining the progression of future cases of dementia. Among those that had a positive amyloid beta marker, 82% progressed to Alzheimer's disease compared with only 0 to 7% of those that were amyloid beta negative. However, 20 to 40% of the elderly who do not have any diagnosis of dementia also have amyloid plaques and are therefore positive for a amyloid marker and yet do not have any visible signs or symptoms of dementia.

Therefore, one has to weigh the costs and benefits of using such tests for diagnostic purposes. Consider if the tests provide any enhanced ability to provide therapeutic intervention and subsequently enhance the functional significance of a person's life. The argument for using these tests is that one is able to find out who will progress to dementia and therefore start aggressive treatment earlier, possibly before noticeable signs and symptoms appear.

The first concern is given the current levels of treatment for dementia, especially those of the Alzheimer's type, none of which has any cure associated with them, will starting treatment earlier really forestall the progression of the disease to any appreciable level? The second concern is if patients harbor biomarkers that may eventually lead to a particular dementia, this could have a significant psychological toll on the individual. A third issue is that some individuals have these markers but possibly may not have any signs or symptoms of the disease. Fourth, without any cures, does providing greater assurance of a proper dementia diagnosis really hold any significant medical value, especially for the patient?

Often in science, we may lose sight of the true goals, which in this case would be to benefit the person who has one of these dreaded diseases. Yet, if enhanced accuracy in this area fails to promote any potentially greater benefit such as attenuation of the symptoms or eradication of the disease, then the question arises, "Are we just enamored with the technology for measuring a particular biomarker?"

If this is the case, we have lost sight of the ultimate goal, which is to reduce or eliminate the disease. Finally, given the cost of such tests, which can cost thousands of dollars, multiplied by the number of individuals that may potentially get tested, this can augment our annual health care expenses considerably.

Therefore, the question that needs to be answered is whether the benefits of such biomarker tests outweigh the costs that may be incurred. It is difficult to jusitfy the costs given the very few, if any, benefits that may result with our current level of therapeutic knowledge for disease amelioration. This does not mean that the tests don't have any value in more specific cases. Nor does it mean that we as a scientific and medical community should shelve these tests. Currently, the ability to use a curative or significantly ameliorative intervention has not kept pace with our ability to find important biological makers. We have found some very important biomarkers that appear to be strongly associated with dementia may actually be used to enhance our progress toward finding better forms of therapeutic intervention to address these deadly diseases.

The establishment of firmly grounded biomarkers, although not at this time being an important therapeutic breakthrough for the amelioration of disease, may ultimately help to hone our ability in finding important curative interventions.

Resource

Stetka, B. S. (2013/April). Alzheimer Biomarkers in Clinical Practice. Medscape News. http://www.medscape.com/viewarticle/781533?src=wnl_edit_specol&uac=87637DR

Walking Your Dog May Ward Off Cancer

2013-04-04T18:38:00Z

The title appears to make a somewhat ridiculous assumption that walking a dog may help prevent cancer. However, Dr. John Marshall of Georgetown University uses this reference in a tongue-and-cheek manner to really indicate the importance that exercise may have for preventing cancer. Given that the likelihood for many forms of cancer increase as we age, Marshall examines a few recent studies and how they relate to the importance of exercise in helping to reduce body mass and subsequently one's risk for cancer.

Marshall first examines an important cancer pathway known as the beta catenin pathway as a tumor indicator and how it relates to body mass and physical activity. Body mass and physical activity appeared to correlate with the kind of cancer a person often would acquire. The beta-catenin pathway failing to be upregulated associated with a higher body mass index correlated with a higher risk for a beta-catenin-negative tumor.

In a second study that he cites in the in the Journal of Oncology, individuals who obtained approximately 150 minutes of exercise each week, or roughly 30 minutes of exercise five days during the week, had much better results even if they acquired cancer. Those that were more physically active before and after a colon cancer diagnosis had a dramatically lower risk-reduction for all cause mortality of 0.58! In fact, as Dr. Marshall points out, this risk reduction is far superior to any form of chemotherapeutic intervention.

So as Marshall states, get a dog and walk a dog as a form of exercise. Walking may be the best overall exercise that exists, especially for the older adult population. It is low impact, and is usually a type of exercise that is within everyone's skill range.

Furthermore, it provides a wonderful form of exercise for 1) enhancing leg strength that often wanes as we age; 2) provides beneficial effects for cardio-respiratory health; 3) helps control weight and helps to reduce excessive body mass; and 4) could possibly have health promoting effects on the immune system.

So start moving and gradually increase your daily amount of exercise to help prevent cancer and other forms of deadly diseases. See Dr. John Marshall's comments on this topic at the site listed below.

Resource: www.medscape.com/viewarticle/780807?src=wnl_edit_specol

Dementia Related Deaths Increase

2013-03-26T19:13:00Z

The number of deaths from Alzheimer's Disease and other forms of dementia continues to increase at a staggering rate. Currently, one in every three older adults dies from Alzheimer's disease or other forms of dementia.

More astonishing is that while other major forms of disease have decreased, deaths from AD and other dementias has increased dramatically.

Since 2000, deaths from HIV dropped by 42%, stroke by 23%, and heart disease by 16%. Deaths from AD and other forms of dementia increased by 68%. Read more on this alarming trend here.

More on the New Nightmare Bacteria

2013-03-18T14:21:00Z

The Centers for Disease Control and Prevention (CDC) has recently issued further warnings and health concerns regarding another bacterium that has become increasing resistant to antibiotics and has a significant level of pathogenicity and virulence.

It is called Carbapenem-Resistant Enterobacteriaceae or (CRE). It has appeared in approximately four percent of the hospital population, but it has also surfaced in approximately 18 percent of the nursing home population. Because of its level of resistance and its potential for pathogenicity, it has become a microorganism that is being given considerable attention. Furthermore, it has been dubbed the "nightmare bacteria" due to its resistance to strong antibiotic intervention, leading to the death of approximately one-half of those who have become infected with the organism.

This portends some important issues, especially for those who are living within nursing care centers. First, the overuse of antibiotics has increasingly led to more resistant strains of microorganisms that hold severe implications for our health. Furthermore, given that almost one-fifth of the nursing home population has encountered this bacteria and this population is already quite infirm and has various levels of immuno-compromised status due to health and age, the potential for concerns related to heightened mortality among this very susceptible population is considerable.

What's Your Life Expectancy?

2013-03-11T17:43:00Z

Wondering what your life expectancy is?

Everydayhealth.com has published 12 keys to a longer life: http://www.everydayhealth.com/healthy-living/your-longevity-checklist-infogram-7140.aspx

Take this quick longevity checklist to see what your chances are of living another decade.

Return to ADVANCE for Long-Term Care Management homepage.

Exercise May Be Best Remedy for Depression in Elderly

2013-02-28T18:14:00Z

Depression is a frequent issue among older adults. However, depression can do more than affect the mood of the older adult. Depression can lead to greater levels of morbidity and mortality among older adults. It can have a pervasive impact on their mind and body. Scientists at Duke University have found that exercise may possibly be the best form of intervention for enhancing an older adult's mood and ameliorating depression.

The researchers found that exercise was superior to those who were treated with antidepressant forms of medication. The researchers studied 156 individuals who suffered from major depression. All were 50 years of age and older. Those who engaged in exercise a minimum of three times each week over a 16 week period demonstrated superior results in ameliorating their depression when compared to those who took just medicine or even those who engaged in medicine and exercise together.

The researchers also found that exercise alone was also a lasting form of therapy. In a six month follow-up, those who engaged in exercise exclusively as a form of therapeutic intervention experienced the lowest rate of return in their depression. Among this group only eight percent experienced a return in their depression. This was a marked difference when compared to the 38 percent return in depression found among the drug-only group and 31 percent found among the drug and exercise combined group.

It has been stated that approximately 15 percent of the elderly experience depression during some point in their lives and an additional 25 percent are estimated to experience persistent sadness that lasts for two weeks or longer (Livni, 2012). Since many older adults take at least four or more medicines, many mood problems can be instigated or even exacerbated by the medicines that they use. Therefore, these results that have been found in the study, demonstrating that exercise by itself could be more beneficial than adding an additional medication is an uplifting finding. Furthermore, since many older adults often have greater sensitivity to medications, even the addition of an antidepressant medication can greatly enhance the likelihood for medicine-induced side-effects, some of which can also influence the mood of the elderly.

What is interesting is the finding that exercise alone was even more beneficial than exercise and medication together. Therefore, exercise may be providing other elements that may be helping to relieve the older adult of their depression. Furthermore, for many older adults, the possibility of the antidepressant medication having a smaller therapeutic window, or possibly even a larger one, as compared to the younger population, may be one reason why the exercise and medication group did not do as well as the exercise alone group, as well as having a higher depression relapse rate.

It is also possible that since exercise is also influencing other parts of the body such as the cardiovascular, respiratory, immunological, and endocrinological systems just to mention a few, the positive influence of exercise can be the result of multiple body system influence. Moreover, the interactive social experiences that exercise often creates can also be an additional reason for the enhanced success found in this study.

One fact that is known is that as individuals increase in age, they typically become increasingly sedentary as well. That in itself is very counterproductive for sound health and aging and can not only lead to mood disturbances but aid in the development of other forms of morbidity that are often attributed to aging. However, exercise has been increasingly demonstrating some very important mental health effects. The goal of getting more older adults to exercise will undoubtedly benefit the older adult's mental health, both therapeutically and preventatively. Furthermore, it will also provide an overall benefit to the older adult's health status in general.

Although more information needs to be gathered from further studies on just how efficacious exercise is in enhancing the older adult's mood, especially when compared with pharmacological forms of intervention, the results in themselves should not be all that surprising.

Although many individuals have become enamored with a pharmacological form of intervention, viewing them as necessary to treat disease and often maintain health, exercise is increasingly being viewed as an important form of medication. In fact, the American College of Sports Medicine has been advancing its campaign to view "Exercise as Medicine," in an effort to encourage more individuals, including the elderly, to attain the proper dose and frequency of usage of exercise to benefit one's overall health.

Given that we already have a substantially large body of knowledge regarding the overall importance of exercise, especially for enhancing a healthy longevity, more effort probably should be given toward advancing exercise as an important and needed form of medication, as well as an important and necessary part of one's lifestyle.

Reference

Livni E. (2012). http://abcnews.go.com/Health/Depression/story?id=117946&page=1

For more articles on exercise see:

Exercises for a Healthy Heart

Ways to Work Out

Return to ADVANCE for Long-Term Care Management Home Page

Addressing the Sexual Needs of Seniors

2013-02-20T14:00:00Z

Older adults have sexual needs, which have often been minimized by the rest of the population. Furthermore, older adults that live in nursing home environments also have sexual needs that often are left unaddressed. Although addressing the topic has often been a sticky subject, a British nursing home has recently made the news by addressing the sexual needs of their elderly in a less than commonly accepted therapeutic modality. They have used prostitutes!

Chaseley nursing home in Eastbourne, England has allegedly been using prostitutes to come into the facility to address the sexual needs of their older adult clientele. The Times of London writes that those that have these special sexual encounters meet with the prostitute in a special designated room of the facility that is often identified by a hanging "red sock" on the door to inform everyone that the room is currently being used for the sexual therapeutic intervention.

A former manager for the nursing care center says that the nursing home's use of prostitutes, which supposedly are acquired through a "third party contact," helps to serve the sexual needs of the elderly. According to the staff member, not only is this serving a therapeutic need of the individual, but once their sexual needs are satisfied, it helps to address the needs of the institutional environment as well, by preventing residents from touching or groping other residents due to unsatisfied sexual needs.

Read more in this article from the Huffington Post.

Return to www.advanceweb.com

The Connection Between Sleep and Memory in Older Adults

2013-02-05T20:32:00Z

The importance of sleep among older adults has often been minimized. It has frequently been stated that older adults do not need as much sleep as individuals who are younger. It has been known that older adults are often more susceptible to being awaken and experience less time in deep sleep. However, new research is also showing that beyond the regenerative importance of sleep, reduced periods of time spent in deep sleep may also contribute to memory problems as we age.

Neuroscience researchers at the University of California, Berkeley have found that periods of deep sleep appear to be critical for transferring memories from the hippocampal region of the brain to areas of the prefrontal cortex, the area of the brain that appears to be critical for long-term memory storage. The study demonstrated a strong relationship between the quality of deep sleep and the amount of memory disturbance. Generally speaking, it appears that the greater amount of time spent in deep sleep, the less disturbance found to exist in memory. Younger individuals tend to spend more time in deeper periods of sleep. However, as one ages, time spent in stages of deep sleep are lessened and with this reduction in deep sleep, there is a concomitant increase in memory issues.

Memories work their way through the hippocampus. As memories are encoded and consolidated, they move from the hippocampus to parts of the prefrontal cortex of the brain, an area of the brain that is responsible for planning, reasoning, and ultimately controlling our behavior. The researchers found that the hippocampus is influenced by a reduction in slow wave deep sleep patterns. This reduction allows the memory information to more or less get stuck in the hippocampus of many older adults. When the memory information gets stuck in the hippocampus, other information coming into the hippocampus interferes with the original memories that have not been transferred, and the new information overwrites the previous memories that were never transferred to the long-term memory storage area. This in turn leads to a disruption and even and eradication of the original memory.

Deep sleep, marked by slow waves, appears to be critical for the consolidation of information learned during the day. Healthy individuals spend approximately a quarter of their sleep time in deep sleep. The slow wave pattern of deep sleep appears to emanate from the middle frontal lobe region of the brain. However, it appears that as we age, this area of the brain deteriorates, leading to a reduction in time spent in deep sleep. Subsequently, with less time spent in deep sleep, a reduction in memory consolidation exists, with many memories being held up in the limbic region, failing to transfer over to the frontal brain region responsible for long-term memory storage.

In the current University of California, Berkeley study, 18 healthy young adults and 15 healthy older adults had their memory tested on a word pairs task. They were introduced to the word pairs prior to going to sleep. They were then subsequently tested the next morning on their memory of the word pairs. During sleep, all the participants were connected EEG's to measure their brain waves. Upon waking and attempting to remember the paired words, their brains were imaged using both structural and functional magnetic resonance imaging.

What the research found was that there was an association between the level of deterioration within the middle frontal lobe and the level of reduction in slow wave sleep. As the middle frontal lobe deteriorated, this in turn led to a greater reduction in slow wave sleep and with it, impaired long-term memory storage. Conversely, in those with more intact middle frontal lobe regions, a greater level of slow wave sleep existed and with it a greater level of memory transfer from the limbic region to the frontal region of the brain. As was evident, older age was commonly associated with greater levels of deterioration in the frontal lobe region. The greater level of deterioration within the middle frontal lobe region that existed among older adults lead to a 75 percent reduction in the quality of deep sleep among older adults, and furthermore, the reduction in deep sleep was associated with a 55 percent worse performance on the memory task for older adults.

The research has important implications for possible future work on enhancing memory among older adults. Given that deep sleep patterns appear to be associated with memory, future research on enhancing deep sleep patterns may be critical in seeking if this will in turn enhance memory among older adults. Furthermore, since structural areas are now being targeted as the loci for apparent problems in sleep and subsequent memory issues, targeting these areas therapeutically may also help to enhance brain health among older adults.

Reference

Poor Sleep in Old Age Prevents the Brain from Storing Memories (2013, Jan 27). Science Daily: http://www.sciencedaily.com/releases/2013/01/130127134212.htm

Survey Says Age May Matter in Receiving Medical Care

2013-01-17T18:24:00Z

Does age matter when it comes to receiving health care services? Does age impact the ethical choices that are made in the treatment of patients?

In a perfect world, this question would never arise. However, we live in a far from perfect world. Healthcare providers are human beings who are not sheltered from the stereotypes and prejudices that are part of our cultural makeup. Therefore, it should be no surprise that we find that healthcare providers have answered questions regarding the provision of health care resources with some bias that favors their more youthful clientele.

While healthcare providers struggle emotionally with these issues, and even though many do affirm a bias, there are many others who, at least consciously, say they would not allocate and disperse healthcare services with a level of discrimination based on age.

What would you do?

To read my full column on this topic, go to: http://long-term-care.advanceweb.com/Columns/Gerotalk/Age-Bias-in-Healthcare.aspx

Neutralizing Acid May Prevent Bone Deterioration In Older Adults

2012-12-21T13:34:00Z

The integrity of our bones is important for maintaining our overall level of health. As we age there is a tendency for bone density to decrease and with this there is a concomitant increase in fractures that are experienced among the elderly population. Furthermore, if bone density decreases excessively, it can lead to potentially life threatening fractures. In fact, fractures of the spine and in particular, the hip, are leading health issues that often lead to increased levels of mortality among older adults. Given the importance of bone health for the elderly, especially in avoiding excessive debilitation and untimely death, a recent study has found that one way of avoiding excessive bone density loss that may lead to these problems is by addressing acidity within the body. This will be briefly examined in the following paragraphs.

Briefly, bone growth is enhanced by deposition of osteoblastic cellular activity (bone forming cells) exceeding osteoclastic activity (bone resorption cells). In younger individuals osteoblastic activity is greater than osteoclastic activity, creating a positive bone balance. Therefore, bones continue to remain strong and gain volumetrically. However, at approximately 35 years of age there is a reversal in the osteoblast/osteoclast activity. The ratio of osteoclastic activity starts to exceed osteoblastic activity leading to a negative bone balance, which creates a gradual reduction in bone volume and density and continues to increase as we age.

In a recent study published in the Journal of Clinical Endocrinology and Metabolism, Dr. Reto Kraphf of the University of Basel and his research team found that acidosis, or an increase in the acidity of the body, or in other words a reduction in the pH of the body, can adversely affect the bone health of individuals, and in particular older adults. The research team found that most of the acidosis was nutritionally induced, especially through eating higher protein diets and excessive consumption of meat and grains. This creates a high acidic load in the body, which in turn can absorb calcium from bones, reducing the mineralization of the bone matrix.

The researchers found that adding potassium citrate to the diet can reduce the dietary acidotic environment found within the body. The researchers found that in women that suffered from osteopenia, adding potassium citrate to the diet neutralized the acidic environment and increased their bone mineral density. The study also looked at 201 men and women over 65 years of age who did not have any evidence of osteoporosis during the baseline examination. The study participants received potassium citrate to reduce acidity, as well as calcium and vitamin D supplementation. The individual's lumbar spine bone mineral density was measured after 24 months of supplementation using dual-energy x-ray absorptiometry.

The results of the study were impressive. First, looking at 24-hour urinary acid excretion rates showed acidic neutralization in the study participants taking potassium citrate. These individuals also demonstrated a reduced level of calcium excretion over a six and 12 month period. Furthermore, the dual x-ray absorptiometry of the lumbar spine at two years demonstrated a 1.7% increase on average in those study participants taking potassium citrate. This increase is quite interesting and significant since the typical trend as mentioned above is for negative bone balance and bone resorption exceeding bone density increases. Moreover, a 1.3% volumetric bone density increase was found in the non-dominant tibia and a 2% bone density increase was found in the radius of the study participants.

More impressive, the study found statistically significant decreases in fractures among men and women taking potassium citrate. Dr. Kraphf stated that the participants in the study taking the potassium citrate were at a very low risk for fractures as measured by the FRAX measurement they used for the study. Furthermore, he also stated that the results of the current findings possibly provide evidence for potassium citrate being added to diets as a nutritional supplement to ward off nutritionally induced acidosis and subsequent decalcification of older adults' bones. This author cautions against adding potassium citrate to the diet at this time, unless it is specifically prescribed by the older adult's physician. It also must be reiterated that potassium citrate was accompanied by calcium and vitamin D supplementation, which overall in the study, was tolerated by the participants quite well. Furthermore, the reader must be reminded that the study was conducted on basically healthy older adults who did not suffer from any marked osteoporetic issues.

Although the results are impressive, an immediate addition of potassium citrate to one's diet is not advised unless it is prescribed and overseen by the older adult's physician. Furthermore, other behavioral changes, such as eating a healthier diet and adding exercise to enhance bone health still needs to be introduced into older adult's lives. That being said, the switch to a positive bone balance that transpired with the introduction of potassium citrate was impressive. During a time when most individuals continue to experience negative bone balance with resorption overriding osteoblastic activity, this study demonstrated, at least over a two year period of time, positive bone density. Furthermore, the study also subsequently demonstrated a marked reduction in the risk of fractures that are experienced among older adults. This becomes a potentially important clinical issue, not only for enhancing the health of older adults, but also for reducing premature death due to complications of bone fractures. Moreover, reducing medical expenses that are incurred from fractures experienced by the elderly due to skeletal fragility is another benefit that can be potentially accrued.

Although the results do create a level of excitement, more research needs to be completed, especially to see if positive results continue to exist. Furthermore, although the experimental subjects in the study took 60 mEq of potassium citrate, establishing whether that is the proper dosage can only be further substantiated through more research. Moreover, if the study does continue to show the bone balance shift in the positive direction with reducing the acidotic environment, possibly adding to the study individuals that suffer from the very common pathological condition of osteoporosis, a condition that often leads to many serious and life-threatening fractures, may also provide some additional empirical findings that may ultimately aid in treating this condition as well. Therefore, at this time it probably is safe to say that this study has produced some very interesting and promising results, but that we must still restrain our excitement until further research evidence is found that may hopefully continue to support the results found in this study.

Reference

Anne Harding (2007). K-Citrate Helps Maintain Bones in Older Adults, November 27, 2012 article in Medscape News. http://www.medscape.com/viewarticle/775195?src=mpnews

The Anti-Aging Business

2012-11-21T17:17:00Z

The market for so called anti-aging medications continues to increase. In fact, it has increased so steadily in recent years that the amount spent on these forms of medicines is equal to what is spent on medications for chronic care conditions. Costs for medications addressing aging concerns have increased significantly for those individuals covered under private insurance as compared to those covered under Medicare.

The findings on this subject were presented at the American Public Health Association annual meeting. Researches evaluated pharmacy claims related to seven age related medical issues. The seven processes studied were urinary symptoms (noninfection), mental alertness/memory issues, hormone replacement therapy (HRT), insomnia, sexual dysfunction, skin aging, and hair loss. What emerged was a startling number of costs that are now being incurred on these issues.

The study found that from 2007 to 2011, the average cost per patient for pharmaceuticals that were prescribed for them increased by 46% for those that had private insurance coverage, while the increase among the Medicare population was much more modest, increasing by only 1.3%. Yet, the annual use per patient increased substantially for both groups with an 18.5% increase in annual use found among the privately insured, and a 32%increase found among the Medicare population. The greatest increase in the Medicare group "increased nearly 25 times that of the cost," said lead author Reethi Iyengar. This is probably due to those in the Medicare group generally being older. Moreover, in 2009, claims for anti-aging pharmaceuticals reached its peak among Medicare patients, with total annual costs per patient reaching $105.26.

HRT and urinary symptoms were two of the top three conditions that were covered by both Medicare and private insurance in 2011. For Medicare, the third most commonly addressed issue pharmaceutically was insomnia. HRT, urinary symptoms and insomnia also accounted for 84.6% of total spending on age-related issues. Medications prescribed for alertness and memory issues accounted for 76.8 percent of the total spending for private insurance.

The American Public Health Association stated that the annual cost per patient in 2011 for pharmaceuticals prescribed for age-related conditions that were covered under Medicare and private insurance amounted to $73.33. The average cost for these medications was higher than the average cost for blood pressure and heart medications, which was $62.84, and just slightly less than the average cost for high cholesterol and diabetes medications, which were $78.38 and $81.12 respectively.

The trend driving this shift toward greater utilization of medications to treat age-related issues is not known. However, we should recognize that many of these conditions do not require pharmaceutical intervention for the preservation of life. Urinary symptoms, such as those that accompany benign prostatic hypertrophy (BPH), lead to certain levels of discomfort, but this problem was formerly recognized as something that one has to live with as they grow older. HRT, for women and increasingly now for men, does not necessarily lead to a level of medical exigency that deems pharmaceutical intervention. Insomnia has been a problem among older adults, but often extended use of pharmaceutics for this problem can paradoxically lead to greater sleep issues. Sexual dysfunctions have been problems that often accompany aging, and sex is certainly an enjoyable part of life that many look forward to, including the elderly. However, the pharmacy industry also recognizes this, which has led to incredibly high markups of many sexual medications. Skin and hair loss products, far from often addressing any medical issue, are often more related to the aesthetic needs that humans have for forestalling any outward manifestations of aging. Finally, mental alertness/memory may be the only major medical issue of the top seven that does need aggressive pharmaceutical intervention, especially when one considers the exigent needs that proper cognitive functioning entails.

The study itself was not meant to cast any judgment on whether these medications should be used at the current level that they are being prescribed. It is definitely an enhancement to the daily standard of living to have many of these medications available. However, one must wonder if their use may not be excessive, especially when their use and cost is often exceeding the costs of many medications that are being used to treat chronic conditions, and often to treat conditions for the preservation of life. Many conditions can be improved through such things as changes in diet, exercise and weight loss

Furthermore, due to the increased demand that is being created, one has to question whether culturally created pharmacological dependency for medication induced quick relief of any problem may actually be leading to more harm than good. Since on average older adults take more medication than any other age groups, and since taking more medication can potentially lead to side-effects and problems of medication interaction, one has to question whether it is wise to add more medication that may not be medically necessary and can lead to a compounding potential for interaction effects to occur among older adults. Moreover, are we enhancing a demand for many products in which the marginal utility is really quite slim for the older adult, while creating an overall cost to an already burgeoning health care system that ultimately leads to greater levels of inflation in an already inflated system?

The current study did not address any of these questions. However, it did provide evidence of a trend that we need to keep our eyes on, especially in evaluating the cost and benefit of these medications for the elderly and the overall cost that it ultimately adds to our health care system.

Reference

Melville, N.A. (2012/Nov 13). Demand soars for anti-aging medications. Medscape. http://www.medscape.com/viewarticle/774409?src=mpnews

Diet, Age & the Immune System

2012-10-23T19:12:00Z

As we age, one of the inevitable effects is that our immune system gradually declines. As individuals get older they are more likely to acquire many infections that they are not able to fight. In addition, cancer, one of the leading causes of death, increases in its rate of occurrence as we age. The production of aberrant cells through mutations happens in all individuals, but as we age, these mutagenic features are more likely to slip past a weakened immune system and become a permanent cellular agent within the body that leads to disease and even death.

Many of these causes of illness have been frequently associated as natural occurrences of age. Although some of these diseases are part of immunosenesence, or the gradual reduction in the efficacy of the immune system to fight disease as we age, this does not mean that there is nothing that can be done to slow the immunsenescent process. Although we are more susceptible to diseases as we age, often many individuals are more susceptible to diseases than they need to be. One area of enhancing the aging immune system is through our diet.

To read Brian's latest Gerotalk column, click here.

Regular Exercise and Strength Training Can Slow the Effects of Sarcopenia

2012-09-24T13:02:00Z

Slowing the Effects of Sarcopenia Could Enhance Functional Longevity Among Older Adults Within and Outside Institutional Environments

As we age the gradual decrease in strength is an eventuality. However, some individuals experience a decrease in strength faster than others. Biologically, senescence in an organism brings about decline in muscles, a process referred to as sarcopenia. Precipitous sarcopenic decline can lead to enhanced deterioration, hastening functional loss, and ultimately reducing longevity, often secondarily to effects experienced through falls and other mobility issues.

Generally speaking, the greatest strength and efficiency of muscle tissue peaks during the third and fourth decades of life, after which there is a gradual decrease and this decrease is influenced by numerous factors, including sedentary lifestyles (Graves, Whitehurst & Jacobs, 2010). Changes in muscle, with a gradual decrease in muscle cells fibers, ultimately leads to a continuous decrease in muscle mass. Furthermore, changes in the muscle cell's mitochondrial density, or the number of mitochondria within the muscle cell, ultimately responsible for providing energy to the muscle cell, decreases (Kraemer, 2010). Moreover, neuromuscular changes, changes that connect the nervous system to muscle cell fibers, especially within the neuromuscular junction, become less efficient (Kraemer, 2010).

Also, changes within the hormonal levels of the body impact muscle as one ages, and these endocrinological changes such as a reduction in testosterone levels and growth hormone, can further influence muscle strength and health. Both women and men experience gradual muscle changes as they grow older, yet muscle mass in males tend to show less dramatic change earlier in life due to males having greater levels of fat free muscle mass as a result of the hormonal differences that exist between males and females.

Different muscle cells reduce at rates that vary with the types of cells involved. Type I, oxidative muscle cells, or what is often referred to as slow-twitch muscle fibers, appear to reduce much more gradually. These are the cells that are often associated with endurance. Type II, glycolytic muscle cells, or fast-twitch muscle fibers, associated with power and strength, appear to decline more dramatically. As muscles progressively weaken, inducing marked sarcopenic changes, our mobility and the efficiency we need to move our bodies through space and against gravity is impacted and could ultimately affect our functional existence.

What this means is that there are some biological forces at work here that cannot be overturned. There are some natural senescent biological changes that will reduce over time the number of muscles fibers and muscle mass that exists within the body. This being stated, the healthy person, regardless of age, still needs to have a significant level of strength to manage their daily affairs. In fact, leg strength has been found to decrease even faster than lower body strength, and this can have severe ramifications for falls and frequently disabling hip fractures that often hasten mortality (Kraemer, 2010).

Due to the functional needs of the human body to main appropriately strong muscles at any age, especially to forestall injury and enhance health, resistance training such as that which is achieved through weight training needs to be recommended for older adults. Regardless of whether muscle fibers decrease as a natural part of biological senescence, there must be a focus toward slowing down muscle loss.

Failure to get the minimum amount of prescribed activity each day, which amounts to only 30 minutes of enhanced physical exertion to help minimize the progressive reductions in muscle strength, is often due less with age and more associated with our lack of motivation and beliefs in stereotypes that there is no need for activity. Most come to view age and exercise as totally incompatible when in actuality, nothing could be further from the truth.

Maintaining proper muscle strength is also important in maintaining the mechanical efficiency of body movement, often referred to as economy of movement. When muscles are weak, the body has to work harder to move itself. By definition, work = force x distance. Therefore, moving your body at a given weight over a given distance is done more economically when the muscles are stronger than when they are more sarcopenic in nature. Since the density of mitochondria is lessening as we age, which helps to provide the energy we need, coupled with our ability to process oxygen as efficiently as we did when we were younger, the ability to tire faster, especially when the muscles are weaker can be a major problem that could lead to disability, or even disincentive to engage in activity.

Although gradual muscle mass loss is part of normal biological, this process is often unnecessarily aided and abetted by an enhanced sedentary lifestyle. One has to remember that the body has a biological need to achieve an optimal level of activity for proper health. Regardless of one's age, engaging in activities that target some level of strength training is important for health. This does not necessarily mean one has to engage is lifting heavy objects, but a person should be involved in some level of activity that moves the major large muscle groups of the body on a daily basis. Large muscles groups such as those found in the legs, back, chest and shoulders are major groups which, if failed to be provided with the proper stimulation, will progressively and precipitously weaken, leading to injuries that can compromise the health and even longevity of the individual. The goal is not an advocacy toward maintaining highly muscular levels of physique. In fact, as one ages this is not a reality. The goal is to maintain proper muscle strength and tone to aid in healthy aging as well as maintain a proper functional existence throughout their aging lives.

Sarcopenia at varying levels does and will continue to occur as we age, avoiding unnecessarily marked reductions in muscle mass and associated losses in strength is something that can be avoided with some vigilance as well as diligence. Definitely starting earlier and maintaining healthy habits will aid a person as they get older. However, even more important is being mindful to avoid stereotypes that can create disincentives toward exercising and maintaining proper levels of strength into one's older adult years. For most individuals, if they engage in some level of regular strength training for their muscles, they can maintain suitable levels of strength that will optimally benefit their health and longevity as they age.

References

Graves, B.S., Whitehurst, & Jacobs, P.L. (2010). Lifespan effects of aging and deconditioning. In ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, Baltimore: Lippincott Williams & Wilkins.

Kraemer, W.J. (2010). Adaptations to resistance training. In ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, Baltimore: Lippincott Williams & Wilkins.

More Evidence That Simple Tests Can Predict Mortality

2012-08-23T11:12:00Z

It is often assumed that to evaluate a person, a plethora of sophisticated tests are needed, especially to enhance predictive validity. However, more recent research further confirms that two tests that have already been used to help predict future mortality in older adults continue to be valid predictors of mortality. The two tests are walking speed and grip strength. These tests have already garnered attention as being important for evaluating mortality in older adults. However, a new study published in the July 2012 Journal of the American Medical Directors Association provides further support for their use as important evaluative tools.

Walking is an important functional standard that is not only an essential activity of daily living, but also for monitoring one's health and future longevity. The American College of Sports Medicine has found that the average cycle length of most individuals is approximately 1.5 meters for every second that one walks. A cycle length is basically equivalent to the distance covered in two steps. However, it has also been found that on average there is approximately a 20 percent reduction in the speed of older adults as compared to younger adults. Therefore, the average older adult covers less distance over a period of time. This 20 percent reduction is within normal range and does not demonstrate any marked concerns that may foretell a heightened probability for future mortality.

In the current study, Dr. Ping-Jen Chen examined 558 male nursing home residents in Taiwan. During the study the researchers timed the male nursing home resident's 6-meter walking speed down a corridor. Baseline walking speed was significantly slower among those residents that died during the 3-year period that the prospective study took place. In fact, it was found that the subjects who were in the slowest quartile of walking speed had much higher rates for all-cause mortality.

As mentioned, handgrip strength was also measured. Generally speaking, on a biological level, muscle mass starts to noticeably decrease in the fifth and sixth decades of life. Furthermore, fat-free mass decreases with a subsequent increase in body fat, especially within the intra-abdominal area. Moreover, as one ages muscle cells and neuromuscular units decrease and often lead to sarcopenia, a gradual and progressive weakening of the muscle structure. This is further enhanced by many individuals becoming less active as they age, which in turn further accelerates many of the senescent changes in muscle strength. The current study examined grip strength and it continued to find support for it being a valid predictor of future mortality. Those that were in the lowest quartile of grip strength had a significantly higher rate of infection related mortality during the 3-year study.

The current study does not necessarily add anything new the previous work and understanding of walking and handgrip strength as potentially useful measures of future mortality. However, it does continue to find support for these two measures as being useful predictors of future mortality. In previous articles I have mentioned the importance of introducing a fitness program into many long-term care facilities, something that is typically absent and could be very useful for preventive and rehabilitative care. Furthermore, it can aid in maintaining, or at least slowing, any progressive decline in the older adult's activities of daily living. With the current research and the use of two very simple tools, we also have some additional measures we could use regularly to monitor the health and predictive mortality of an older adult living within a long-term care environment. Using these two tools and addressing the feedback that one obtains, especially early in a measurable process of decline, could help to enhance the life expectancy of many older adults and even potentially decrease hospitalizations.

Given the current research results, it provides fodder for thinking about these two measurements as possible mandatory inclusion for future quarterly and yearly assessments. Since they continue to demonstrate a fairly sound predictive validity, making regular use of them and creating standardized results or parameters within a nomogram could be particularly helpful. This is not only to aid in the predictive validity for mortality. The more helpful and useful implication could be just the opposite: catching those individuals in early areas of decline and hopefully being able to address and reverse any decline that moves outside of the normal parameters, and subsequently, reducing mortality and unnecessary hospitalizations among the long-term care population. Those in the natural phases of decline could only be helped so much. However, one has to wonder how much a sedentary environment, as most nursing care facilities are, accelerates mortality unnecessarily for many who live their lives in these environments. It is these individuals who would benefit immensely by the inclusion of this type of regular evaluation and tracking. Furthermore, given the predictive validity of these tests, they would not only reduce potential mortality, but also enhance the health of the environment. Is this not ultimately our goal?

Reference

Eisenberg, J. (2012). Walking, handgrip strength predict mortality well. Caring for the Ages, 13(7), p. 9.