Category: Ageing

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Older Patients can Inadvertently be Put at Risk When Taken off Anticoagulants

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For patients with atrial fibrillation, the risk of stroke or heart attack from stopping anticoagulants usually outweighs the risk of bleeding, according to new findings from the University of Bath.

Clinicians often worry about the dangers of prescribing blood thinning medications to older patients, due to concerns about falls and major bleeding, however this new study suggests that for patients with the common heart condition atrial fibrillation (AF), the health risks of not taking these drugs are significantly higher than the risk of a life-threatening bleed.

AF is associated with a fivefold increase in the risk of stroke. It also increases the risk of heart attacks and death. Anticoagulants are highly effective in managing AF and preventing strokes and other complications.

Older people also tend to fall more frequently, with falls being a leading cause of injury among adults aged 65 and older. These can lead to serious injuries, such as hip fractures and head injuries.

However, the new study, published in Heart, found that contrary to popular medical belief, stopping anticoagulants for patients aged 75 and over does not change the risk of major bleeds. These findings are important for clinicians to factor into their prescribing behaviour, according to the study’s authors.

“Prescribers need to consider the increased risk to patients of coming off anticoagulants, including stroke,” said Dr Anneka Mitchell, who conducted the research from the University of Bath and is a visiting researcher at the University’s Department of Life Sciences.

Rising cases

Cases of AF are rising in all age groups but particularly among people aged 85 years and over. In this age group, the number of people diagnosed with the condition doubled in men from 11.6% to 22.1% between 2000 and 2016, and increased in women from 9.6% to 16.5%. There is no data available to show trends from 2016.

Though there is a large body of evidence to support the use of blood thinners for older people with AF, the new study is believed to be the first to measure patient outcomes when anticoagulant medication is stopped.

Dr Mitchell’s study analysed data from the UK Clinical Practice Research Datalink (a research dataset that includes anonymised patient data from some UK general practices) between 2013 and 2017, focusing on patients aged 75 and older who were newly prescribed anticoagulants.

It found that the risks of stroke and death were three times higher during periods when patients were not receiving anticoagulation therapy. The risk of heart attacks was nearly double compared with periods when patients were treated with anticoagulants.

Warfarin versus direct oral anticoagulants

Dr Mitchell believes that as well as concern about falls, many clinicians base their decisions to withhold anticoagulants on the historic experience of patients taking the anticoagulant warfarin.

This medication – the only available option for treating AF until 2012 – is associated with a complex medication regimen, along with dietary restrictions and frequent blood-tests, making treatment difficult for many older patients.

Since 2013, however, a new family of drugs called direct oral anticoagulants (DOACs) have become the first line option for most patients. DOACs are as effective and safe as warfarin – sometimes more so – and are far more straightforward to take.

Dr Mitchell said: “For example, apixaban (a DOAC) has a lower risk of significant bleeding than warfarin, so for many older patients with AF, this would be an excellent medication.

“Our findings highlight the critical need for clinicians to carefully consider the risks of stopping anticoagulation therapy in older patients. Despite concerns about bleeding, this study suggests that discontinuing anticoagulation does not significantly affect the risk of major bleeding but does increase the risk of serious events such as stroke and death.”

She added: “Both the risks and benefits of medication must be discussed fully with patients before a medic stops prescribing anticoagulants, so that both doctor and patient are making a shared and informed decision. This study underscores the importance of evaluating the consequences of deprescribing anticoagulants, particularly in older adults who are at higher risk of adverse outcomes.”

Impacting the lives of older patients

Dr Anita McGrogan who led the research team from the Department of Life Sciences at Bath, said: “Older patients were poorly represented in clinical trials that evaluated the efficacy and safety of DOACs before these products were licensed, and those who were included were healthier than many people in the target group for prescribing. Because of this, the safety of these medications for people aged 75-plus was not evaluated, and many chose to avoid prescribing them for older people.

“This study has produced important results that will have an impact on patients in the future. It has filled the information gap by looking at anonymous data on 20 167 people aged over 75 years, collected by GPs. It clearly demonstrates the value of using big data to investigate important clinical questions, especially in vulnerable populations.”

Dr Tomas Welsh, an academic geriatrician at Royal United Hospitals Bath and research & medical director at ReMind, hopes the new research will provide both clinicians and patients with better evidence to inform their decisions regarding anticoagulants. He noted that, until now, clinicians advising patients to stop taking blood thinners were unable to quantify the increased risk of stroke.

“These data help patients and clinicians have a firmer grasp of the risks that they are being exposed to,” he said.

Dr Welsh also stressed that new-generation blood thinners were not always the right course of action for frail, older people.

“Suspending any medication or reducing the use of multiple medications in a frailer older patient is always a nuanced and individual discussion,” he said.

Source: University of Bath

Categories : AgeingTags :

Omega-3s can Slow Down the Aging Process – Slightly

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Previous clinical studies have shown that a reduced calorie intake can slow down the aging process in humans. Taking vitamin D or omega-3 fatty acids has also shown promising results in slowing biological aging in animals. However, it was unclear whether these measures would also work in humans.

The therapies previously tested in the DO-HEALTH study led by Heike Bischoff-Ferrari are also associated with a slowing of the aging process. These showed that vitamin D and omega-3 fatty acids, as well as regular physical activity, reduce the risk of infections and falls, and prevent cancer and premature frailty. “These results inspired us to measure the direct influence of these three therapies on the biological aging process in the Swiss DO-HEALTH participants,” says Bischoff-Ferrari, professor of geriatrics and geriatric medicine at the University of Zurich.

Measuring biological and chronological age

One scientific approach to making biological aging measurable is the use of epigenetic clocks. They record chemical modifications of the DNA molecule, known as methylation, and thus quantify the difference between biological and chronological aging. The DO-HEALTH study has now for the first time investigated how sensitively this molecular biological measurement method reacts to targeted treatment.

The team led by Heike Bischoff-Ferrari, in collaboration with Steve Horvath, senior researcher at Altos Labs Cambridge (UK), who developed the watches, investigated the effect of omega-3s and/or vitamin D and/or simple strength training on biological aging in 777 people over the age of 70. Eight different treatment combinations were tested during the three-year study: subjects took 2000 international units (IU) of vitamin D and/or 1 gram of omega-3 fatty acids (from algae) daily and/or performed 30 minutes of strength training at home three times a week.

Biological age slowed down

When the researchers analysed the blood samples, they found that taking omega-3 fatty acids slowed down biological aging across several epigenetic clocks by up to four months – regardless of subjects’ gender, age or body mass index. The combination of omega-3, vitamin D and strength training proved to be even more effective, according to one of the four epigenetic clocks used.

“This result extends our previous findings from the DO-HEALTH study, in which these three factors combined had the greatest impact on reducing the risk of cancer and preventing premature frailty over a three-year period, to slowing down the biological aging process,” says Bischoff-Ferrari. Each of these measures works through different mechanisms that complement each other and, when combined, result in a heightened overall effect, according to the study author.

DO-HEALTH as a validation platform

At the same time, the research team draws attention to the limitations of the study. “There is no generally accepted gold standard for measuring biological age,” Bischoff-Ferrari explains. “However, we analysed the best currently validated epigenetic clocks, which reflect the state of the art.” To further advance the clinical application of biological clocks, Bischoff-Ferrari, together with leading international researchers in the Global Health Span Extension Consortium, plans to use DO-HEALTH and other global intervention studies as a validation platform for novel biomarkers of aging.

The researchers also point out that the sample consists exclusively of Swiss participants but will extend the trial to more countries.

Source: University of Zurich

Categories : Ageing General InterestTags :

Are Robots the Solution to Nursing Home Employee Turnover?

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Facing high employee turnover and an aging population, nursing homes have increasingly turned to robots to complete a variety of care tasks, but few researchers have explored how these technologies impact workers and the quality of care.

A new study from a University of Notre Dame expert on the future of work finds that robot use is associated with increased employment and employee retention, improved productivity and a higher quality of care. The research has important implications for the workplace and the long-term care industry.

Yong Suk Lee, associate professor of technology, economy and global affairs at Notre Dame’s Keough School of Global Affairs, was the lead author for the study, published in Labour Economics. Most studies of robots in the workplace have focused on manufacturing and the industrial sector, but Lee’s research broke new ground by analysing long-term care – and by looking at the different types of robots used in this setting. Researchers drew on surveys of Japanese nursing homes taken in 2020 and 2022.

“Our research focused on Japan because it is a super-aging society that provides a good example of what the future could entail elsewhere – a declining population, a growing share of senior citizens and a declining share of working-age people,” Lee said. “We need to be ready for this new reality.”

In 2022, for instance, more than 57 million U.S. residents were 65 or older, according to the National Council on Aging. The Census Bureau forecasts that by 2050, this number will grow to 88.5 million.

The impact on workers

In a future where there are more senior citizens requiring care, using robots in a targeted fashion could benefit workers and patients alike, Lee said. The study analyzed three types of robots that are increasingly used in assisted living facilities:

  • Transfer robots, which nurses use to lift, move and rotate patients in beds and around rooms.
  • Mobility robots, which patients use to move around and to bathe.
  • Monitoring and communication robots, which include technologies such as computer vision and bed sensors that can monitor patient data such as movement and share it with care providers.

“We found that robot adoption complements care workers by reducing quit rates,” Lee said. “This is important because turnover is a big concern in nursing homes. Workers typically experience a great deal of physical pain, particularly in their knees and back. The work is hard and the pay is low. So robot use was associated with employee retention.”

While robot use was associated with an overall employment increase, Lee said, the trend seems to have helped some workers more than others: It was associated with an increased demand for part-time, less experienced employees and with less demand for more experienced workers.

Improving patient care

Patients benefited in facilities that have used robots, according to the study. The nursing homes that Lee’s team studied reported a decrease in the use of patient restraints and in the pressure ulcers or bedsores that nursing home residents commonly suffer, largely because of a lack of mobility. Both metrics are widely used in the long-term care industry to measure patient outcomes, Lee said.

By removing the physical strain associated with certain tasks, Lee said, robots may have made room for care workers to focus on tasks better suited for human beings.

“Robots can improve productivity by shifting the tasks performed by care workers to those involving human touch, empathy and dexterity,” Lee said. “Ultimately, robots can help workers provide a higher level of patient care.”

Source: University of Notre Dame

Categories : Ageing CancerTags :

Cancer Risk Declines in Old Age – New Research Helps Explain Why

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When it comes to cancer, aging is a double-edged sword, researchers are increasingly learning. Age is considered the most important risk factor for cancer, due to the buildup of genetic mutations over time.

Now a study from researchers at Memorial Sloan Kettering Cancer Center (MSK) and their collaborators provides new evidence about how advanced age can also be protective against cancer. The study, conducted in a mouse model of lung cancer, was published in Nature.

“We know that as people get older, they’re more likely to get cancer,” says study first author Xueqian Zhuang, PhD, postdoc in the lab of senior study author Tuomas Tammela, PhD. “But there’s still a lot that’s unknown about how aging actually changes the biology of cancer.”

As with many types of cancer, lung cancer is diagnosed in most people around age 70, Dr Zhuang says. But once you get to 80 or 85, the incidence rate starts to come down again.

“Our research helps show why,” she adds. “Aging cells lose their capacity for renewal and therefore for the runaway growth that happens in cancer.”

Overall, the findings have two key implications, the researchers say:

  • First, they point to the underappreciated role that iron plays in aging cells’ ability to regenerate — suggesting that therapies that target iron metabolism may work better in younger people than older ones.
  • Second, they underline the potential value of early intervention and prevention efforts, targeting the window when most cancers initiate.

Cells’ regeneration ability linked to iron metabolism

To investigate why cancer incidence peaks in the early senior years and then starts to decline again, the MSK research team studied a genetically modified mouse model of lung adenocarcinoma, a common type of lung cancer that accounts for about 7% of all cancer deaths worldwide.

One of the things that makes it challenging to study aging in laboratory models is that mice take two years to develop to an age that’s equivalent to 65–70 years in people. The scientists found that as the mice get older, they make more of a protein called NUPR1. More NUPR1 makes the cells in the lungs function as if they are iron deficient.

“The aging cells actually have more iron, but for reasons we don’t yet fully understand, they function like they don’t have enough,” Dr Zhuang says.

Since the cells in the older mice functioned as though they didn’t have enough iron, they lost some of their ability to regenerate. And because that regenerative capacity is directly linked to the rise of cancer, the older mice developed far fewer tumours than their younger counterparts.

Intriguingly, this effect could be reversed by giving the older mice additional iron or by reducing the amount of NUPR1 in their cells.

“We think this discovery may have some immediate potential to help people,” Dr. Tammela says. “Right now, millions of people, especially following the COVID-19 pandemic, live with insufficient lung function because their lungs didn’t fully heal from an infection, or for some other reason. Our experiments in mice showed that giving iron can help the lungs regenerate, and we have really good ways of delivering drugs directly to the lungs – like asthma inhalers.”

But this is also where the double-edged nature of the discovery comes into play. By restoring the ability of the cells in the lungs to regenerate, one is also increasing the tissue’s ability to develop cancer, the study showed.

“So this type of approach might not be appropriate for people who are at a high risk of developing cancer,” he adds.

Older and younger patients may respond differently to iron-metabolism targeting treatments

The team’s findings also have important implications for therapies based on a type of cell death called ferroptosis, which is triggered by iron. Ferroptosis was discovered in 2012, and there are a number of ferroptosis-inducing small molecule compounds, as well as drugs previously approved by the FDA, that are being investigated for their potential to kill cancer cells.

Older cells are far more resistant to ferroptosis than younger cells because they function as if they don’t have enough iron, the researchers found. This means treatments that target ferroptosis may not be as effective in older patients as they are in younger ones.

“One of the things that we showed exploring all of this iron biology is that ferroptosis is tumour suppressive, as everybody suspected – but much more profoundly in younger animals,” Dr Tammela says.

Dr Zhuang adds: “To us, this says that because the biology of cells changes with aging, the sensitivity to drugs also changes. So doctors might need to really be careful in clinical trials, for example, to look at the effects in both older and younger patients.”

And for Dr Tammela, the research ultimately has an even bigger takeaway.

“What our data suggests in terms of cancer prevention is that the events that occur when we’re young are probably much more dangerous than the events that occur later,” he says. “So, preventing young people from smoking, or from tanning, or from other obvious carcinogenic exposures are probably even more important than we thought.”

Source: Memorial Sloan Kettering Cancer Center

Categories : AgeingTags :

An Internationally Standardised Set of Handgrip Strength Norms

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Convenient, safe, and non-invasive, ‘handgrip strength’ is a reliable predictor for age-related disease and disability. Now, a groundbreaking study has created the world’s largest and most geographically comprehensive international norms for handgrip strength, enabling global peer-comparison, health screening and surveillance across the adult lifespan.

Published in The Journal of Sport and Health Science, the new norms are based on 100 unique observational studies representing 2.4 million adults aged 20 to 100+ years, from 69 countries (representing six of the seven continents, 17 of 22 United Nations’ geographical subregions, and 71% of the world’s population). The study was led by the University of South Australia and conducted in collaboration with 140 authors across the globe.

It is the first time that norms have been reported for handgrip strength across different age groups and sexes at the international level.

Handgrip strength, or isometric grip, is measured via a handgrip dynamometer which is gripped and squeezed to record the maximum force a person can produce over a few seconds. A person with low handgrip, or low muscle strength, has a higher risk of death from all causes and cardiovascular disease as well as a higher incidence of physical disability.

The new study has established a percentile framework that ranks strength. Adults below the 20th percentile are considered to have ‘low’ strength; those between 20-39th percentiles have ‘somewhat low’ strength; those in the 40-59th percentiles have ‘moderate’ strength; those in the 60-79th percentiles have ‘somewhat high’ strength; and those at or above the 80th percentile having ‘high’ strength.

Importantly, norms can be used to monitor healthy aging by examining changes in strength over time.

Finally, international benchmarks for comparison

Lead researcher Professor Grant Tomkinson says the new norms will help clinicians better identify people who may be at risk of poor health and in need of interventions.

“Muscle strength, which reflects the ability of the muscles to produce force maximally, is a powerful biomarker of current and future health,” Prof Tomkinson says. “A good general measure of overall muscle strength is how hard you can grip. Grip strength improves a little throughout early adulthood, peaks between age 30 and 39, and then drops off as people age, especially in late adulthood.

“By establishing international handgrip norms through a reference population, we can determine how well someone compares to their peers of the same age and sex, and quickly identify people who need intervention.

“But until now, there has been no international markers by which to compare or benchmark.

“Our research has established robust international norms that enable clinicians and exercise professionals to interpret and relate results in a percentile ranking. For example, adults below the 20th percentile are considered to have ‘low’ strength, those between 20-39th percentiles have ‘somewhat low’ strength, and so on as the scale progresses.

“So, what we have developed is an international guideline and benchmark that enables clinicians to compare and track muscle strength – and therefore potential health risks – across the adult lifespan.”

The new norms will enable standardised grip strength test results for cross- and within-country comparisons, to identify trends over time, monitor improvements and evaluate the effectiveness of implemented public health policies. They will also facilitate individual feedback, advice, and health interventions for those at risk.

Source: University of South Australia

Categories : Ageing ExerciseTags :

Many Could Easily Add Five Years to Their Lifespan

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If everyone was as active as the top 25% of the population, individuals over the age of 40 could add five years to their life, according to a new study led by Griffith University researchers. 

Physical activity has long been known to be good for health, however estimates have varied regarding how much benefit could be gained from a defined amount of activity, both for individuals and for populations. 

This latest study, published in the British Journal of Sports Medicine, used US-based accelerometer data to gain an accurate view of a population’s physical activity levels instead of relying on survey responses as per other studies, and found the benefits were around twice as strong as previous estimates.  

It found the most active quarter of people in the community had a 73% lower risk of death than their least active counterparts. For that least active quartile, a single one-hour walk could potentially return a benefit of around six additional hours of life.  

Lead researcher Professor Lennert Veerman said this cohort had the greatest potential for health gains.  

“If you’re already very active or in that top quartile, an extra hour’s walk may not make much difference as you’ve, in a sense, already ‘maxed out’ your benefit,” he said.   

“If the least active quartile of the population over age 40 were to increase their activity level to that of the most active quartile however, they might live, on average, about 11 years longer.

“This is not an unreasonable prospect, as 25 per cent of the population is already doing it.  It can be any type of exercise but would roughly be the equivalent of just under three hours of walking per day.” 

The research team suggested low levels of physical activity could even rival the negative effects of smoking, with other research finding each cigarette could take 11 minutes from a smoker’s life.  

By extension, a more active lifestyle could also offer protective effects against heart disease, stroke, certain cancers and other chronic illnesses, with the study’s findings highlighting a need for national physical activity guidelines to be revisited using these methods.  

Dr Veerman said physical activity had been vastly underestimated in its capacity to improve health outcomes, suggesting even modest increases in movement could lead to significant life-extension benefits.  

“If there’s something you could do to more than halve your risk of death, physical activity is enormously powerful,” he said.  

“If we could increase investment in promoting physical activity and creating living environments that promote it such as walkable or cyclable neighbourhoods and convenient, affordable public transport systems, we could not only increase longevity but also reduce pressure on our health systems and the environment.”  

Source: Griffith University

Categories : Ageing NeurologyTags :

Extra Year of Education does Not Protect the Brain

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Thanks to a ‘natural experiment’ involving 30 000 people, researchers at Radboud university medical centre were able to very precisely determine the effect of an extra year of education to the brain in the long term. To their surprise, they found no effect on brain structure and no protective benefit of additional education against brain ageing. Their findings appear in eLife.

It is well-known that education has many positive effects. People who spend more time in school are generally healthier, smarter, and have better jobs and higher incomes than those with less education. However, whether prolonged education actually causes changes in brain structure over the long term and protects against brain ageing, was still unknown.

It is challenging to study this, because alongside education, many other factors influence brain structure, such as the conditions under which someone grows up, DNA traits, and environmental pollution. Nonetheless, researchers Rogier Kievit (PI of the Lifespan Cognitive Dynamics lab) and Nicholas Judd from Radboudumc and the Donders Institute found a unique opportunity to very precisely examine the effects of an extra year of education.

Ageing

In 1972, a change in the law in the UK raised the number of mandatory school years from 15 to 16, while all other circumstances remained constant. This created an interesting ‘natural experiment’, an event not under the control of researchers which divides people into an exposed and unexposed group. Data from approximately 30 000 people who attended school around that time, including MRI scans taken much later (46 years after), is available. This dataset is the world’s largest collection of brain imaging data.

The researchers examined the MRI scans for the structure of various brain regions, but they found no differences between those who attended school longer and those who did not. ‘This surprised us’, says Judd. ‘We know that education is beneficial, and we had expected education to provide protection against brain aging. Aging shows up in all of our MRI measures, for instance we see a decline in total volume, surface area, cortical thickness, and worse water diffusion in the brain. However, the extra year of education appears to have no effect here.’

Brain structure

It’s possible that the brain looked different immediately after the extra year of education, but that wasn’t measured. “Maybe education temporarily increases brain size, but it returns to normal later. After all, it has to fit in your head,” explains Kievit. “It could be like sports: if you train hard for a year at sixteen, you’ll see a positive effect on your muscles, but fifty years later, that effect is gone.” It’s also possible that extra education only produces microscopic changes in the brain, which are not visible with MRI.

Both in this study and in other, smaller studies, links have been found between more education and brain benefits. For example, people who receive more education have stronger cognitive abilities, better health, and a higher likelihood of employment. However, this is not visible in brain structure via MRI. Kievit notes: “Our study shows that one should be cautious about assigning causation when only a correlation is observed. Although we also see correlations between education and the brain, we see no evidence of this in brain structure.”

Source: Radboud University Medical Centre

Categories : AgeingTags :

Standing on One Leg is a Good Indicator of Ageing

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How long a person can stand on one leg is a more tell-tale measure of ageing than changes in strength or gait, according to new Mayo Clinic research published in the journal PLOS ONE.

Good balance, muscle strength and an efficient gait contribute to people’s independence and well-being as they age. How these factors change, and at what rate, can help clinicians develop programs to ensure healthy ageing. Individually, people can train their balance without special equipment and work on maintaining it over time.

In this study, 40 healthy, independent people over 50 underwent walking, balance, grip strength and knee strength tests. Half of the participants were under 65; the other half were 65 and older.

In the balance tests, participants stood on force plates in different situations: on both feet with eyes open, on both feet with eyes closed, on the non-dominant leg with eyes open, and on the dominant leg with eyes open. In the one-legged tests, participants could hold the leg they weren’t standing on where they wanted. The tests were 30 seconds each.

Standing on one leg, specifically the nondominant leg, showed the highest rate of decline with age.

“Balance is an important measure because, in addition to muscle strength, it requires input from vision, the vestibular system and the somatosensory systems,” says Kenton Kaufman, PhD, senior author of the study and director of the Motion Analysis Laboratory at Mayo Clinic. “Changes in balance are noteworthy. If you have poor balance, you’re at risk of falling, whether or not you’re moving. Falls are a severe health risk with serious consequences.”

Unintentional falls are the leading cause of injuries among adults who are 65 and older. Most falls among older adults result from a loss of balance.

In the other tests:

  • Researchers used a custom-made device to measure participants’ grip. For the knee strength test, participants were in a seated position and instructed to extend their knee as forcefully as possible. Both the grip and knee strength tests were on the dominant side. Grip and knee strength showed significant declines by decade but not as much as balance. Grip strength decreased at a faster rate than knee strength, making it better at predicting aging than other strength measures.
  • For the gait test, participants walked back and forth on an 8-metre, level walkway at their own pace and speed. Gait parameters didn’t change with age. This was not a surprising result since participants were walking at their normal pace, not their maximum pace, Dr Kaufman says.
  • There were no age-related declines in the strength tests that were specific to sex. This indicates that participants’ grip and knee strength declined at a similar rate. Researchers did not identify sex differences in the gait and balance tests, which suggests that male and female subjects were equally affected by age.

Dr Kaufman says that people can take steps to train their balance. For example, by standing on one leg, you can train yourself to coordinate your muscle and vestibular responses to maintain correct balance. If you can stand on one leg for 30 seconds, you are doing well, he says.

“If you don’t use it, you lose it. If you use it, you maintain it,” Dr Kaufman says. “It’s easy to do. It doesn’t require special equipment, and you can do it every day.”

Source: Mayo Clinic

Categories : Ageing Neurodegenerative DiseasesTags :

Polypharmacy Negatively Impacts Older Adults with Dementia

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Over 30% of older adults take five or more medications daily, which is termed polypharmacy. It is associated with poor health outcomes like falls, medication interactions, hospitalisations and even death. Multiple chronic conditions in older adults increases the risk of polypharmacy. While polypharmacy is more common in older adults with Alzheimer’s disease and related dementias, there is little research examining the impact on symptoms, health outcomes and physical function.

Researchers from Drexel University’s College of Nursing and Health Professions recently published a study in Biological Research For Nursing examining symptoms, health outcomes and physical function over time in older adults with and without Alzheimer’s disease and related dementias and polypharmacy.

Led by Martha Coates, PhD, the research team found that individuals who are experiencing polypharmacy and have Alzheimer’s disease and related dementias experience more symptoms, falls, hospitalisations, mortality and had lower physical function – indicating that polypharmacy can also negatively impact quality of life for older adults with Alzheimer’s disease and related dementias.

“The cut-off of point of five or more medications daily has been associated with adverse health outcomes in previous research, and as the number of medications increase the risk of adverse drug events and harm increases,” said Coates.

The research team used a publicly available dataset from the National Health and Aging Trends Study – a nationally representative sample of Medicare beneficiaries in the United States from Johns Hopkins University. Since 2011, data is collected yearly to examine social, physical, technological and functional domains that are important in aging.

For this study, the research team used data from 2016 through 2019 to compare changes in symptoms, health outcomes and physical function among four groups: 1) those with Alzheimer’s disease and related dementias and polypharmacy; 2) those with Alzheimer’s disease and related dementias only; 3) those with polypharmacy only; and 4) those without either Alzheimer’s disease and related dementias or polypharmacy.

Coates explained that the researchers used analytic weights to analyse the data, which generates national estimates, making the sample of 2052 individuals representative of 12 million Medicare beneficiaries in the US, increasing the generalisability of the findings.

“We found that older adults with Alzheimer’s disease and related dementias and polypharmacy experienced more unpleasant symptoms, increased odds of falling, being hospitalised and mortality compared to those without Alzheimer’s disease and related dementias and polypharmacy,” said Coates. “They also experienced more functional decline, required more assistance with activities of daily living like eating, bathing and dressing, and were more likely to need an assistive device like a cane or walker.”

Coates noted that there are tools available to help health care providers review and manage medication regimens for older adults experiencing polypharmacy and possibly taking medications that are potentially inappropriate or no longer provide benefit. However, currently there are no specific tools like that for older adults with Alzheimer’s disease and related dementias.

The findings from this research shed light on the negative impact polypharmacy can have on older adults with Alzheimer’s disease and related dementias. But Coates added that further research is needed to develop strategies to reduce the occurrence of polypharmacy in people with Alzheimer’s disease and related dementias.

The research team anticipates this study will help guide future analysis of the impact of specific medications on health outcomes in individuals with Alzheimer’s disease and related dementias and that it provides a foundation to support intervention development for medication optimisation in older adults with Alzheimer’s disease and related dementias and polypharmacy.

Source: Drexler University

Categories : Ageing VaccinesTags :

New Research Shows that Recombinant Shingles Vaccine Protects Against Dementia

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New research published in Nature has shown that the recombinant shingles vaccine, as with the live version, might have a protective effect against dementia.

While evidence is emerging that the live herpes zoster (shingles) vaccine might protect against dementia, it has now been replaced by recombinant vaccines in many countries. But a lack of data meant that whether the recombinant vaccines conferred the same benefit was unknown. Fortunately, since there was a rapid switch from live to recombinant vaccines, there was an opportunity for a natural experiment to compare the risk of dementia between vaccine types.

The study demonstrated that the recombinant vaccine is associated with a significantly lower risk of dementia in the 6 years post-vaccination. Specifically, receiving the recombinant vaccine is associated with a 17% increase in diagnosis-free time, translating into 164 additional days lived without a diagnosis of dementia in those subsequently affected.

The recombinant shingles vaccine was also associated with lower risks of dementia than were two other vaccines commonly used in older people: influenza and tetanus–diphtheria–pertussis vaccines. The effect was robust across multiple secondary analyses, and was present in both men and women but was greater in women. These findings should stimulate studies investigating the mechanisms underpinning the protection and could facilitate the design of a large-scale randomised control trial to confirm the possible additional benefit of the recombinant shingles vaccine.