Showing papers in "Gerontology in 2009"
TL;DR: A better understanding of these clinical changes and their underlying mechanisms may confirm the impression held by many geriatricians that increasing frailty is distinguishable from ageing and in consequence is potentially reversible.
Abstract: Frailty has long been considered synonymous with disability and comorbidity, to be highly prevalent in old age and to confer a high risk for falls, hospitalization and mortality. However, it is becoming recognized that frailty may be a distinct clinical syndrome with a biological basis. The frailty process appears to be a transitional state in the dynamic progression from robustness to functional decline. During this process, total physiological reserves decrease and become less likely to be sufficient for the maintenance and repair of the ageing body. Central to the clinical concept of frailty is that no single altered system alone defines it, but that multiple systems are involved. Clinical consensus regarding the phenotype which constitutes frailty, drawing upon the opinions of numerous authors, shows the characteristics to include wasting (loss of both muscle mass and strength and weight loss), loss of endurance, decreased balance and mobility, slowed performance, relative inactivity and, potentially, decreased cognitive function. Frailty is a distinct entity easily recognized by clinicians, with multiple manifestations and with no single symptom being sufficient or essential in its presentation. Manifestations include appearance (consistent or not with age), nutritional status (thin, weight loss), subjective health rating (health perception), performance (cognition, fatigue), sensory/physical impairments (vision, hearing, strength) and current care (medication, hospital). Although the early stages of the frailty process may be clinically silent, when depleted reserves reach an aggregate threshold leading to serious vulnerability, the syndrome may become detectable by looking at clinical, functional, behavioral and biological markers. Thus, a better understanding of these clinical changes and their underlying mechanisms, beginning in the pre-frail state, may confirm the impression held by many geriatricians that increasing frailty is distinguishable from ageing and in consequence is potentially reversible. We therefore provide an update of the physiopathology and clinical and biological characteristics of the frailty process and speculate on possible preventative approaches.
511 citations
TL;DR: Novel approaches for treatment and prevention of insulin resistance and type 2 diabetes by targeting obesity-induced inflammatory processes are discussed here.
Abstract: The association of obesity, insulin resistance, and chronic low-grade inflammation has been evident for several years by now. Since obesity, insulin resistance, and inflammation all are related to aging as well, the mechanisms underlying this association are of critical importance for gerontology. Although several molecular and cellular mechanisms by which inflammatory events decrease the sensitivity to insulin in obese patients have recently been elucidated, the pathogenesis of obesity-induced insulin resistance is still obscure in many aspects. This review aims at giving a general view on the known mechanisms and summarizing the recent progress. Research currently focuses on adipose tissue inflammation as predominantly driven by adipose tissue macrophages, but also related alterations in other organs (liver, muscle, pancreas) have to be considered. Moreover, novel approaches for treatment and prevention of insulin resistance and type 2 diabetes by targeting obesity-induced inflammatory processes are discussed here.
370 citations
TL;DR: Molecular chaperones play an important role in the deterrence of protein damage during aging and their expression is required for longevity.
Abstract: Background: Aging can be thought of as the collision between destructive processes that act on cells and organs over the lifetime and the responses that promote homeostasis, vitalit
296 citations
TL;DR: This study provides the most recent evidence to suggest that older Canadians are not active enough and this is accentuated if a chronic disease is present and it is important to develop community-based programs to facilitate LTPA.
Abstract: Background: Participating in regular physical activity is an important part of healthy aging. There is an increased risk for inactivity associated with aging and the risk becomes gr
280 citations
TL;DR: The aim of this study is to review primary osteoporosis in the elderly with particular emphasis on gender-related aspects, and some drugs commonly used for the treatment of osteoporeosis in women also appear to be effective in men.
Abstract: Osteoporosis, a classical age-related disease and known to be more common in women than in men, has been reported increasingly often in men during the past few years. Although men at all ages after puberty have larger bones than women, resulting in greater bending strength, mortality after a hip fracture, one of the major complications of osteoporosis, is more common in men than in women. Sex hormone deficiency is associated with unrestrained osteoclast activity and bone loss. Even though estrogen deficiency is more pronounced in women, it appears to be a major factor in the pathogenesis of osteoporosis in both genders. In contrast to osteoporosis in postmenopausal women, the treatment of osteoporosis in men has been scarcely reported. Nevertheless, some drugs commonly used for the treatment of osteoporosis in women also appear to be effective in men. The aim of this study is to review primary osteoporosis in the elderly with particular emphasis on gender-related aspects.
224 citations
TL;DR: Cessation of resistance exercise in trained older persons increases the fatty infiltration of muscle, while resumption of exercise decreases it, and monitoring changes in both muscle size and fat infiltration may enable a more comprehensive assessment of exercise in combating age-related muscular changes.
Abstract: Background: Aging skeletal muscle is characterized not only by a reduction in size (sarcopenia) and strength but also by an increase in fatty infiltration (myosteatosis). An effecti
219 citations
TL;DR: The prevalence of risk factors and the laboratory and histological differences between different age groups with NAFLD are defined in order to confirm/refute findings in previous smaller studies.
Abstract: Background: Non-alcoholic fatty liver disease (NAFLD) is principally a disease of middle and old age. Previous studies reported it to be benign in old age, however more recent studi
202 citations
TL;DR: The results of this study demonstrate that the Biodex System 3 is a reliable device when used for elderly living independently and the ability of the device to determine a real change in isokinetic ankle and knee contractions is better on a group level than on an individual level.
Abstract: Background: Muscle power assessed by isokinetic dynamometers has the potential for playing an important role in investigating functional status in older subjects. Researchers and cl
168 citations
TL;DR: The two main implications of the present results are that decreased walking speed should be taken into account when exploring age-related effects on gait variability, and that both low and high spatiotemporal STV may reflect gait stability in healthy adults.
Abstract: Background: It has been suggested that high stride-to-stride variability (STV) is a reflection of gait instability. However, both low and high STV has been shown in fallers and in n
167 citations
TL;DR: Using the EPT and SIB-R as predictors in a multinomial regression analysis, MCI group status was reliably predicted, but the classification rate was poor, suggesting changes in IADL functioning observed in MCI may be too subtle to be detected by certain measures, such as the Lawton and Brody I ADL Scale.
Abstract: Background: A classification scheme and general set of criteria for diagnosing mild cognitive impairment (MCI) were recently proposed by a multidisciplinary group of experts who met
162 citations
TL;DR: The 5-item frailty index differentiated odds of 10-year mortality in older community-dwelling Mexican Americans and has the potential to identify older minorities at risk for poor health outcomes and mortality.
Abstract: Background: The older Hispanic population of the United States is growing rapidly. Hispanic older adults have relatively high-risk profiles for increased morbidity and disability, y
TL;DR: The negative effects of interrupting exercise on several physical parameters of functional fitness are highlighted, both upper and lower body strength andupper and lower flexibility declined significantly after detraining in the exercise group.
Abstract: Background: Several studies have been carried out in order to evaluate the potential influence of increased physical activity on the health, biological ageing and functional ability
TL;DR: A predictive model including age, gender, ASA, and SPMSQ can be used to assess the mortality risk after hip fracture surgery and effectively identified hip fracture patients with an increased mortality rate.
Abstract: Background: Hip fracture patients are reported to have an increased mortality rate compared to the general population. In order to be able to reduce the morbidity and mortality after a hip fracture, our efforts to identify the patients at risk already upon admission to the hospital need to be increased. For such a risk assessment, robust, validated, and reproducible criteria are mandatory. Objective: To determine preoperative factors associated with mortality and to evaluate the combined use of the American Society of Anesthesiologists (ASA) and the Short Portable Mental Status Questionnaire (SPMSQ) to identify patients with an increased mortality rate and to create a predictive model to assess the mortality risk after hip fracture surgery. Methods: A total of 1,944 consecutive patients aged 66 years or older admitted for a hip fracture were included in a prospective cohort study with a 24-month follow-up. The patients were assessed with regard to gender, age, type of hip fracture, smoking habits, comorbidities, general physical health according to the ASA classification, and cognitive function according to the SPMSQ. A higher ASA score indicates an increasingly severe systemic disease and a lower SPMSQ score indicates an increasingly severe cognitive dysfunction. We used Cox proportional hazard models and classification trees to identify the factors associated with mortality. The predictive model was created based on factors that were significantly associated with death and all readily accessible upon admission. Results: The mortality rate during the acute hospitalization period was 4%, at 4 months 16%, and at 24 months 38%. The most prominent factors associated with mortality were high ASA scores, low SPMSQ scores, high age and male gender. The SPMSQ score provided additional information about the survival time, compared to when the ASA score was used alone. Conclusion: The combined use of the ASA classification for assessing physical health and the SPMSQ for assessing cognitive function effectively identified hip fracture patients with an increased mortality rate. We present a predictive model including age, gender, ASA, and SPMSQ that can be used to assess the mortality risk after hip fracture surgery.
TL;DR: This review updates developments of the concept of negligible senescence, proposed in Longevity, Senescence and the Genome in 1990, with new information for turtles, rockfish, and the naked mole-rat.
Abstract: This review updates developments of the concept of negligible senescence, proposed in Longevity, Senescence, and the Genome in 1990, with new information for turtles, rockfish, and the naked mole-rat. However, centenarians certainly do not show negligible senescence.
TL;DR: It is demonstrated that spousal interrelations may extend developmental options but may also make an individual vulnerable to the experience of loss, and the need to disentangle individual from relationship-specific effects is pointed to.
Abstract: We review findings on spousal interrelations in old age in such key domains as cognition, well-being, and health. Therein, we demonstrate that spousal interrelations may extend developmental options but may also make an individual vulnerable to the experience of loss. We address theoretical questions concerning possible underlying mechanisms, e.g. individual and spousal goal-related processes. Furthermore, we draw attention to important methodological challenges such as identifying processes that operate along different time scales and employing adequate data analytic tools. We propose that aging research may benefit from an examination of interrelations in developmental pathways of multiple co-developing individuals such as spouses and point to the need to disentangle individual from relationship-specific effects.
TL;DR: Fitness is well maintained in elderly people who take >7,000–8,000 steps/day and/ or spend >15–20 min/day at >3 METs, and the direction of this association merits exploration by longitudinal prospective studies and/or randomized controlled trials.
Abstract: Background: Optimal patterns of habitual physical activity to ensure healthy aging remain unclear because of measurement limitations; most investigators have used either subjective
TL;DR: This short review portrays the evolutionary theories of aging in the light of the existing discoveries from genomic and molecular genetic studies on aging and longevity in centenarians as well as the proposals for future research in biogerontology.
Abstract: This short review portrays the evolutionary theories of aging in the light of the existing discoveries from genomic and molecular genetic studies on aging and longevity. At the outset, an historical background for the development of the evolutionary theories of aging is presented through the works of August Weismann (programmed death and the germ plasm theories) including his exceptional theoretical postulation, later experimentally validated by the existence of cell division limits. Afterwards, the theory of mutation accumulation of Peter Medawar and the theory modification by Charlesworth (late-life mortality plateau) are presented as well as the antagonistic pleiotropy hypothesis of George Williams, and the disposable soma theory of Kirkwood and Holliday. These theories are discussed in the light of the different research studies, which include studies on insulin signaling and longevity, the possibility that nuclear factor kappa B may be a major mediator of aging, studies of anti-aging Sirtuins and studies on heat shock proteins and longevity and on gene sets as biomarkers of aging. Finally, the proposals for future research in biogerontology, such as studies on the control of protein synthesis, validation of biomarkers of aging, understanding the biochemistry of longevity and research in the field of gerontologic pathology are presented. Likewise, further attention is suggested regarding the work on telomere shortening, stem cells and studies on understanding the biochemical and molecular basis for longevity in centenarians.
TL;DR: Clinical tests of neuromuscular function can predict risk of falls in frail older people and the CWS was the best test for use as a screening tool in frail elderly people, however, these preliminary results require confirmation in further research.
Abstract: Background: The use of falls risk screening tools may aid in targeting fall prevention interventions in older individuals most likely to benefit. Objective: To de
TL;DR: Foot pain, especially from plantar fasciitis, increased risk of falls in healthy older persons, and foot assessment, foot pain management, and proper footwear play important roles in fall prevention.
Abstract: Background: Fall rates are high among older people even in the healthy population. An aging foot may affect ambulatory function and increase the risk of fall(s). Objective:
TL;DR: Dysphagia referrals across all ages increased by 20% each year from 2000 to 2007, with more referrals for older patients than younger patients, and this increase will necessitate additional trained dysphagia specialists at least through 2050 and probably longer.
Abstract: Objectives: To describe total and yearly demographic trends relative to aging, dysphagia referral rates and oral feeding status in hospitalized patients from 2000 through 2007. Methods: We evaluated a prospective, consecutive, referred sample of 4,038 hospitalized patients in an urban, tertiary, acute care teaching hospital. Dysphagia referral rates are described according to year, age (decade), sex, admitting diagnostic category, results of dysphagia evaluations and oral feeding status. Diagnosis of dysphagia and feeding status were assessed objectively with fiberoptic endoscopic evaluation of swallowing. Results: Dysphagia referral rates doubled between 2000 and 2007, with increases of 20% per year and increases in all decades from 2002 through 2007. Over 70% of dysphagia referrals were for older patients of 60 years and above, and over 42% of these were old old patients over 80 years. Referrals for 80 to 89-year-old patients almost doubled and for patients over 90 years more than tripled between 2000 and 2007. Of older patients over 60 years, 62.3% (1,771/2,843) did not exhibit dysphagia, 18.0% (513/2,843) benefited from specific diet modifications to reduce aspiration risk and 19.7% (559/2,843) were made nil-by-mouth due to severe dysphagia and aspiration. Conclusions: From 2000 to 2007, dysphagia referrals across all ages increased by 20% each year, with more referrals for older (70.4%) than younger patients (29.6%). Referrals almost doubled for 80 to 89-year-old patients and more than tripled for patients over 90 years. This increase will necessitate additional trained dysphagia specialists at least through 2050 and probably longer.
TL;DR: EORA patients appear to have differences in clinical characteristics and the patterns of proinflammatory cytokines when compared with YORa patients, and high levels of IL-1β were associated with the presence of anti-cyclic citrullinated peptide antibodies in EorA patients.
Abstract: Background: Little is known about the differences in the immunopathogenesis between elderly-onset rheumatoid arthritis (EORA) and younger-onset RA (YORA) and the factors responsible
TL;DR: It is suggested that the zebrafish genetic model offers a unique opportunity to fill in this gap in understanding the molecular mechanisms of aging and in developing preventive and therapeutic strategies to prolong the productive life span (‘health span’) in humans.
Abstract: Understanding the molecular mechanisms of aging in vertebrates is a major challenge of modern biology and biomedical science. This is due, in part, to the complexity of the aging process and its multifactorial nature, the paucity of animal models that lend themselves to unbiased high-throughput screening for aging phenotypes, and the difficulty of predicting such phenotypes at an early age. We suggest that the zebrafish genetic model offers a unique opportunity to fill in this gap and contributes to advances in biological and behavioral gerontology. Our recent studies demonstrated that this diurnal vertebrate with gradual senescence is an excellent model in which to study age-dependent changes in musculoskeletal and eye morphology, endocrine factors, gene expression, circadian clock, sleep and cognitive functions. Importantly, we have also found that the presence of a senescence-associated biomarker (‘senescence-associated β-galactosidase’) can be documented during early zebrafish development and is predictive of premature aging phenotypes later in adult life. The availability of mutant ‘genotypes’ with identified aging ‘phenotypes’ in zebrafish, in combination with a wealth of information about zebrafish development and genetics, and the existence of multiple mutant and transgenic lines, should significantly facilitate the use of this outstanding vertebrate model in deciphering the mechanisms of aging, and in developing preventive and therapeutic strategies to prolong the productive life span (‘health span’) in humans.
TL;DR: Although a strict and even moderate definition of the midlife crisis does not seem tenable on empirical and theoretical grounds, a lenient conceptualization has the potential to stimulate new research directions exemplifying processes of the interaction of social expectations and personal goals and their importance for developmental regulation.
Abstract: Without doubt, the midlife crisis is the most popular concept describing middle adulthood. Facing the limitation of the time until death, men in particular are believed to pause from actively pursuing their goals and review their achievements, take stock of what they have and have not yet accomplished, at times taking drastic measures to fulfill their dreams. This paper critically discusses the concept of a midlife crisis and the relevant empirical evidence, presenting arguments for and against a strict, a moderate, and a lenient conceptualization of the midlife crisis. Although a strict and even moderate definition of the midlife crisis does not seem tenable on empirical and theoretical grounds, a lenient conceptualization has the potential to stimulate new research directions exemplifying processes of the interaction of social expectations on the one hand and personal goals on the other, and their importance for developmental regulation.
TL;DR: If one could increase physical activity among the elderly, it would reduce the number of falls, diminish medical costs, suffering for the individual, and be of paramount medicosocial importance for society.
Abstract: Background: Dizziness is a very common complaint. The frequency of dizziness increases with age. It affects quality of life negatively for older persons in several ways. Ob
TL;DR: The impact of immune parameters on survival demonstrated that only the absolute number of CD8 memory T cells, after adjustment for age, correlated with increased mortality.
Abstract: Background: Well-established reference values which take into account the influence of age on immune cell phenotype, and the impact of naive or memory T cells on mortality have not been well defined in the elderly. Objective: The aim of this study was to evaluate the reference values for the peripheral number of total and naive or memory CD4 and CD8 T cells in a healthy population in Italy, and to analyze whether the immune phenotype was associated with an increased risk of death among older adults. Methods: The number of total or naive and memory CD4+ or CD8+ T cells was evaluated in the peripheral blood of 288 healthy people ranging in age from 20 to 107 years. Furthermore, to correlate peripheral immune phenotype with mortality rate after a 3-years follow-up, a retrospective analysis was performed on the results from those individuals aged >65 years at the time of the enrolment in the study. Results: The absolute number of total and naive T cells was progressively reduced with increasing age in both the CD4+ and CD8+ T cell populations. The decrease was particularly evident for cells with naive phenotype, since CD4-naive and CD8-naive T cells respectively showed a 4- and a 2- to 3-fold reduction in 70- to >90-year-old subjects in comparison with young adults. The number of CD4 memory T cells significantly increased with age. No significant age-related change was observed in the number of CD8+ memory T cells. Of the 194 subjects included in the study of association of immune phenotype with mortality, 121 were alive and 73 deceased during the 3-year follow-up. The impact of immune parameters on survival demonstrated that only the absolute number of CD8 memory T cells, after adjustment for age, correlated with increased mortality (OR 1.007, 95% CI 1.002–1.012, p = 0.01). The correlation was significant in female but not in male subjects. Conclusion: We provide reference values for total and naive or memory CD4 and CD8 T cell populations, and demonstrate that the absolute number of CD8 memory T cells, after adjustment for age, correlates with increased mortality.
TL;DR: Residents across both care levels who napped >30 min during the day, or reported <6 h sleep at night, were three times more likely to suffer multiple falls in the follow-up year when adjusting for health, medication and activity measures.
Abstract: Background: Older people often experience unusual sleeping patterns and a poor quality of night-time sleep. Insufficient sleep has potential effects on cognition and physical functi
TL;DR: Postmenopausal women aged ≥50 years who had FES-I scores >26 points and BBS ≤52 points should be examined for risk factors of future falls and offered preventative measures.
Abstract: Background: Falls among the elderly are associated with a high morbidity and mortality and can involve high-cost medical interventions. The risk of falls often remains undiagnosed u
TL;DR: Interventions to assist patients with dementia should focus on female caregivers, especially those considered likely to be suffering from an economic burden, according to the results of this study.
Abstract: Background: Most studies on caregiver burden have been conducted in Western countries, while few studies on the correlates of caregiver burden have been performed in Korea.
TL;DR: Stretching can be used as an effective means to improve range of motion and reverse some age-related changes that influence gait performance, and after the stretching protocol, aged participants displayed gait parameters which were similar to those reported in young healthy adults.
Abstract: Background: Ageing is characterized by a number of physical changes that contribute to a decline in the ability to perform daily tasks. Stretching has been proposed to reduce hip fl
TL;DR: The findings suggest that the aging process of the respiratory system reduces the inspiratory muscle strength but does not have a significant impact on breathing pattern variables.
Abstract: Background: The identification of breathing patterns in healthy elderly individuals and changes in the respiratory system related to the normal aging process is important to detect