Journal of the American Geriatrics Society

#Tai chi reduces falls in older people by almost half

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The findings offer a simple and holistic way to prevent injuries.

Findings from a new study published in the Journal of the American Geriatrics Society indicate that practising tai chi may help to prevent falls in older patients.

For the study, scientists from the University of Jaén in Spain analysed data from 10 randomised controlled trials which looked at the effect of tai chi versus other treatments such as physical therapy and low intensity exercise on risk of falls in at-risk and older adults. The length of the interventions ranged from 12 to 26 weeks. The frequency of the 1-hour sessions ranged from one to three times per week.

The authors identified high-quality evidence that tai chi reduced the rate of falls by 43 per cent compared with other interventions at short-term follow-up and by 13 per cent at long-term follow-up (more than 12 months). There was also low-quality evidence that tai chi reduced the risk of injurious falls by 50 per cent over the short term and by 28 per cent over the long term.

Author, Dr. Rafael Lomas-Vega cautioned however that “due to the small number of published studies, further research is needed to investigate the effect of tai chi on injurious falls and time to first fall”.


Polypharmacy affects walking speed in older patients

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Researchers say more studies are needed to examine the effect of specific medications on overall well being.

Physicians should consider measuring walking speed during normal walking (NW) and walking while talking (WWT) in individuals taking multiple medications, to assess and identify potentially modifiable mobility risk.

That is the conclusion of the authors of a new study which suggestS an association between polypharmacy and locomotion that can only be partly explained by medical comorbidities.

For the study, researchers examined how polypharmacy affected walking by interviewing 482 people age 65 and older who were enrolled in the Central Control of Mobility in Aging study. Among the participants, 34 per cent used five or more medications during the study and 10 per cent used more than eight medications.

After accounting for chronic health problems, a history of falls and other issues, the authors found those in the polypharmacy group had a slower walking gait than those in the non-polypharmacy group. Those who took eight or more medications had slower walking speed when walking while talking.

Writing in the Journal of the American Geriatrics Society , the authors said, given the link between WWT speed and falls in high-functioning older adults, polypharmacy is a useful marker for those who may be at risk.

Proton pump inhibitors do not increase risk for dementia

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IN a new study, there was a decreased risk of cognitive decline among people who used proton pump inhibitors.

Several recent studies have raised safety questions about the use of proton pump inhibitors (PPIs), suggesting they increase the risk for dementia and Alzheimer’s disease (AD) in people 75 years old or older.

A new study published in the Journal of the American Geriatrics Society may help to quash these concerns, after finding that PPIs were not associated with greater risk for dementia or AD.

Scientists examined data relating to 10,486 people aged 50 years or older, with either normal brain function or mild cognitive impairment. They found there was actually a decreased risk of cognitive decline among people who used PPIs regularly or occasionally, after adjusting for potential confounders.

In terms of adjusted survival curves of cognitive decline to mild cognitive impairment (MCI) or dementia, always PPI users had the highest survival rate, with intermittent users in the middle and never PPI users in the lowest group. A higher percentage of people who took PPIs regularly or occasionally also took a higher percentage of anticholinergic medications, which have also been linked to cognitive impairment.

The authors said prospective studies are needed to confirm these results to guide empirically-based clinical treatment recommendations.

Can sense of smell predict 10-year mortality in older patients?

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Participants with subjective olfactory impairment were 30 per cent more likely to die.

Findings from a new study have highlighted a unique link between poor smell and a greater likelihood of 10-year mortality. The association was independent of the presence of dementia, which has previously been linked to loss of smell.

For the study, olfactory performance, using the Scandinavian Odour-Identification Test (SOIT) and self-reported olfactory function, was measured in 1,774 participants aged 40 to 90 years.

At 10 years, 411 participants (23 per cent) had died. The authors found individuals who performed at chance level on tests (indicating complete olfactory loss) were at a 19 per cent higher risk of death in the following, 10 years compared to individuals with normal smell function. Each additional correctly identified odour lowered the risk of mortality by 8 per cent.

Writing in the Journal of the American Geriatrics Society , the authors said “this study is the first to show that mortality can be predicted from subjective olfactory impairment, with participants with impairment being 30 per cent more likely to die. Although the predictive variance was largely shared between subjective and objective olfactory assessments, subjective assessments might give additional information about subtle intra-individual olfactory changes that objective tests do not capture.”

Hip fracture associated with more serious outcomes in men

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A third of cognitively-impaired men die within six months of hip fracture.

While only 25 per cent of hip fractures occur in men, findings from a new study suggest men are at significantly higher risk of poor outcomes.

According to the study, published in the Journal of the American Geriatrics Society , almost a third of men with cognitive impairment are likely to die within six months of a hip fracture compared with 11 per cent of unimpaired men, 15 per cent of cognitively-impaired women, and only 2 per cent of unimpaired women. Men in general displayed greater levels of cognitive impairment within the first 22 days of fracture, and cognitive limitations increased the risk of dying within six months of hospital admission for hip fracture in both men and women.

Lead author of the study, Dr. Ann Gruber-Baldini commented: “These findings suggest that men who are cognitively impaired are particularly vulnerable and in need of special attention to improve their likelihood of surviving.”
She added: “Because cognitive function is critical for understanding and participating in medical treatments, it will be important to address cognitive limitations – and how they differ between men and women – when delivering care to patients after hip surgery.”

Pneumonia: simple score predicts two-year risk of pneumonia in older people

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Six readily-available clinical measures can predict two-year risk of pneumonia in people aged 65 years and older.

Researchers have developed a new prediction score which, they say, can identify older adults most at risk for developing pneumonia.

In developing the score, the researchers studied a cohort of 3,392 community-dwelling, cognitively-intact adults aged 65 and older, over two years. Potential pneumonia risk factors were identified from questionnaire data and interviewer assessments of areas including functional status and medical history. Risk factors were also identified based on physical measures such as grip strength. Administrative database information was used on comorbid illnesses, laboratory tests, and prescriptions dispensed.

Writing in the Journal of the American Geriatrics Society, the researchers identified seven factors critical to the development of the pneumonia prediction score namely; age, sex, COPD, congestive heart failure, BMI, and prescriptions for inhaled or oral corticosteroids.
Data relating to these variables was readily available to many doctors using electronic medical records (EMR), the researchers pointed out. The clinical information could be used to stratify older adults into groups with varying subsequent two-year pneumonia risk.

The researchers said doctors could potentially use the pneumonia prediction EMR score to encourage patients to get the pneumococcal vaccine as well as to counsel at-risk individuals about positive behavioural changes.

94 per cent of older adults have at least one sensory deficit

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65 per cent had significant deficits.

Almost all older people are affected by deficits in all five senses. According to a US study published in the “Journal of the American Geriatrics Society”, 94 per cent of older adults have at least one of five sensory deficits. Many of these are of a significant kind.

The study, carried out by the University of Chicago (Illinois), was part of the “National Social Life, Health and Aging Project”, and aimed at measuring all five senses in persons aged between 57 and 85 years. 94 per cent were found to have at least one sensory deficit, 38 per cent had two, and 28 per cent had three or more deficits. Almost two-thirds of all participants (64 per cent) suffered from a significant deficit in at least one sense. More than one-fifth (22 per cent) had serious deficits in two or more senses.

The most common problem was a decrease in the sense of taste, affecting 74 per cent, and in 48 per cent this deficiency was rated as serious. The sense of touch was affected in 70 per cent of those studied.

It is known that sensory impairment is often a harbinger of more serious health problems, said study author Jayant Pinto. Family members and caregivers should therefore pay close attention to these impairments.

Previous studies had found an association between the impaired sense of smell and sense of hearing and an increased risk of death. It is therefore necessary to research the biological links between age and sensory loss to find better ways to prevent these declines, say the researchers

A number of cardiovascular factors increase risk of death in dementia patients

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Diabetics, smokers, men, and individuals with congestive heart failure or coronary heart disease are at a higher risk.

Several, but not all, cardiovascular risk factors and diseases may increase the risk of death in patients with dementia. This is the result of a meta-analysis published by Dutch researchers in the “Journal of the American Geriatrics Society.” Results showed that diabetics, smokers, men, and individuals with coronary heart disease and heart failure were at higher risk.

Scientists from the University Medical Center in Utrecht analysed twelve studies with almost 236,000 participants. Their aim was to find out if, and which, heart diseases and associated risk factors affect early mortality in people with dementia.

Pooled analyses showed that men with dementia were 67 per cent more likely to experience early death; the risk for diabetics was 50 per cent higher and in smokers, the risk of early death was 37 per cent higher. People with congestive heart failure had a 37 per cent higher risk of early death and patients with coronary heart disease were at a 21 per cent higher risk. However, no statistically significant effect on the risk of mortality was found in association with stroke, high blood pressure, being overweight and hypercholesterolemia.

“These findings might support clinicians, individuals and caregivers when considering advance care planning”, said study author Irene van de Vorst. But they also underscore the need for further research to optimally support patients with dementia and with cardiovascular disease or risk factors.