older people

#Older people with #diabetes at higher #risk for fracture

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A new study suggests deficits in cortical bone density and microarchitecture may be responsible.
While older people with type 2 diabetes (T2D) tend to have normal or higher bone density than their peers, a new study has found that they are more likely to succumb to fractures than seniors without T2D.
In a study, published in the Journal of Bone and Mineral Research , scientists examined data on 1,069 community-based older adults from the Framingham study. Participants underwent high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate volumetric bone density, microarchitecture, and geometry, separately for cortical and trabecular compartments.
The authors found seniors with T2D had lower cortical volumetric BMD (vBMD) at the tibia and cortical thickness at the radius, but only in those with prior fracture. Cortical porosity at the radius was higher in T2D than non-T2D, but only in those without prior fracture.
“Fracture in older adults with type 2 diabetes is a highly important public health problem and will only increase with the aging of the population and growing epidemic of diabetes. Our findings identify skeletal deficits that may contribute to excess fracture risk in older adults with diabetes and may ultimately lead to new approaches to improve prevention and treatment,” said Dr Elizabeth Samelson, lead author of the study.

#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”.


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.

Visual blurring may increase the risk of older people falling

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According to an Australian study, the stepping accuracy significantly decreases, especially if a person looks ahead of a target.

Visual blurring, which can be triggered by wearing bifocals or multifocal lenses, may disrupt a person’s stepping accuracy. Older people who frequently need these types of glasses have a higher risk of tripping and falling, write Australian researchers in “Optometry and Vision Science”.

The team from the University of Brisbane included 19 people (average age 72 years) in their study. They were asked to carry out several “precision stepping tasks” while they either fixed their gaze on a target footprint or 30 to 60 centimetres ahead of the target. First they wore their normal glasses and then glasses that produced blurred vision – similar to when using the lower part of the field of view in bifocal or multifocal glasses to look into the distance.

In general, the participants made more foot placement and stepping errors if they looked ahead of where they planned to step. Visual blurring also led to more inaccuracy and errors. The errors were greatest with the combination of blurred vision and looking ahead of the target. Blurred vision mainly resulted in participants taking steps that were too short when looking up to 60 centimetres ahead of their target.

Although the stepping errors in the trial were relatively small, the risk could be greater on stairs or uneven pavements, where even small errors could lead to a fall, said the authors led by Alex A. Black. Older people should therefore be trained to maintain their gaze precisely where they plan to step. In some cases it may even be beneficial to wear single-vision glasses while walking, said Black.

Blood test to detect dehydration in the elderly

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Equation including sodium, potassium, urea and glucose levels provides reliable information on older people.

Dehydration is a common problem among older people and could, in future, be diagnosed more easily using a simple blood test. This requires putting the results of routine tests into a mathematical equation. The study was published in “BMJ Open”.

Researchers from the University of East Anglia (Norwich) looked for an alternative to the time-consuming and expensive osmolarity test, currently the best method to determine dehydration. When someone has not had enough to drink, the blood becomes more concentrated and the levels of sodium, potassium, urea and glucose rise.

There are a number of mathematical equations that link these four variables. But it was unclear which one is most useful for elderly people. The researchers tested the accuracy of 39 different equations in 595 people over the age of 65. Participants included healthy people who lived independently, frail people living in residential care, people in hospital care and people with poor kidney function as well as diabetes.

The osmolarity equation by Khajuria and Krahn demonstrated the greatest accuracy for all participants, regardless of sex and health status. “We propose that clinical laboratories use this equation to report on the hydration status of older people when reporting blood test results that include sodium, potassium, urea and glucose. We hope our findings will lead to pragmatic screening in older people to allow early identification of dehydration. This would help doctors nurses and carers support older people to increase their fluid intake,” said study author Lee Hooper.