Influence of the Self-Perception of Old Age on the Effect of a Healthy Aging Program.

PubMed

Mendoza-Núñez, Víctor Manuel; Sarmiento-Salmorán, Elia; Marín-Cortés, Regulo; Martínez-Maldonado, María de la Luz; Ruiz-Ramos, Mirna

2018-05-07

It has been shown that health programs are useful for the prevention and control of chronic diseases in community-dwelling older people; however, a negative self-perception of old age could have an effect on the results. Therefore, our aim was to evaluate the effect of a healthy aging program linked to self-perception of old age in Mexican community-dwelling older people. A pre-test/post-test single-group design study was conducted in a convenience sample of 64 older people who undertook the entire healthy aging program workshop (five months’ duration). We measured self-perception of old age, efficacy of self-care, blood glucose concentration, anthropometric measures, and blood pressure before and after the workshop. A statistically significant decrease in blood glucose concentration was observed (baseline 136 ± 50 vs. post-intervention, 124 ± 45 ± 29 mg/dL, p < 0.01), LDL (baseline 153 ± 47 vs. post-intervention, 130 ± 36 mg/dL, p < 0.01), systolic blood pressure (130 ± 20 vs. 119 ± 11 mm/Hg, p < 0.001), and diastolic blood pressure (75 ± 9 vs. 72 ± 7 mm/Hg, p < 0.05) after community intervention. However, when we analyzed the data regarding self-perception, we found that this difference was only maintained in the subgroup of older adults with a positive self-perception of old age. Our findings suggest that the self-perception of old age influences the effect of healthy aging programs on the health of community-dwelling older people.

Influence of the Self-Perception of Old Age on the Effect of a Healthy Aging Program

PubMed Central

Mendoza-Núñez, Víctor Manuel; Sarmiento-Salmorán, Elia; Marín-Cortés, Regulo; Martínez-Maldonado, María de la Luz; Ruiz-Ramos, Mirna

2018-01-01

It has been shown that health programs are useful for the prevention and control of chronic diseases in community-dwelling older people; however, a negative self-perception of old age could have an effect on the results. Therefore, our aim was to evaluate the effect of a healthy aging program linked to self-perception of old age in Mexican community-dwelling older people. A pre-test/post-test single-group design study was conducted in a convenience sample of 64 older people who undertook the entire healthy aging program workshop (five months’ duration). We measured self-perception of old age, efficacy of self-care, blood glucose concentration, anthropometric measures, and blood pressure before and after the workshop. A statistically significant decrease in blood glucose concentration was observed (baseline 136 ± 50 vs. post-intervention, 124 ± 45 ± 29 mg/dL, p < 0.01), LDL (baseline 153 ± 47 vs. post-intervention, 130 ± 36 mg/dL, p < 0.01), systolic blood pressure (130 ± 20 vs. 119 ± 11 mm/Hg, p < 0.001), and diastolic blood pressure (75 ± 9 vs. 72 ± 7 mm/Hg, p < 0.05) after community intervention. However, when we analyzed the data regarding self-perception, we found that this difference was only maintained in the subgroup of older adults with a positive self-perception of old age. Our findings suggest that the self-perception of old age influences the effect of healthy aging programs on the health of community-dwelling older people. PMID:29735915

Buddhist religious practices and blood pressure among elderly in rural Uttaradit Province, northern Thailand.

PubMed

Stewart, Onwilasini; Yamarat, Khemika; Neeser, Karl J; Lertmaharit, Somrat; Holroyd, Eleanor

2014-03-01

The purpose of this study was to test the relationship between Buddhist religious practices and blood pressure. A cross-sectional survey of Buddhist religious practices and blood pressure was conducted with 160 Buddhist elderly in rural Uttaradit, northern Thailand. After controlling for the variables of gender, status, education, salary, underlying hypertension, exercise, salt intake, and taking antihypertensive medications, it was found that lower systolic and diastolic blood pressure is associated with the Buddhist religious practice of temple attendance. The Buddhist older people who regularly attended a temple every Buddhist Holy day (which occurs once a week) were found to have systolic and diastolic blood pressure readings lower than people who did not attend as regularly. It is recommended that nurses advocate for temple attendance in the care protocols for older Buddhist hypertensive patients both in Thailand and internationally. © 2013 Wiley Publishing Asia Pty Ltd.

Contributions to lateral balance control in ambulatory older adults.

PubMed

Sparto, Patrick J; Newman, A B; Simonsick, E M; Caserotti, P; Strotmeyer, E S; Kritchevsky, S B; Yaffe, K; Rosano, C

2018-06-01

In older adults, impaired control of standing balance in the lateral direction is associated with the increased risk of falling. Assessing the factors that contribute to impaired standing balance control may identify areas to address to reduce falls risk. To investigate the contributions of physiological factors to standing lateral balance control. Two hundred twenty-two participants from the Pittsburgh site of the Health, Aging and Body Composition Study had lateral balance control assessed using a clinical sensory integration balance test (standing on level and foam surface with eyes open and closed) and a lateral center of pressure tracking test using visual feedback. The center of pressure was recorded from a force platform. Multiple linear regression models examined contributors of lateral control of balance performance, including concurrently measured tests of lower extremity sensation, knee extensor strength, executive function, and clinical balance tests. Models were adjusted for age, body mass index, and sex. Larger lateral sway during the sensory integration test performed on foam was associated with longer repeated chair stands time. During the lateral center of pressure tracking task, the error in tracking increased at higher frequencies; greater error was associated with worse executive function. The relationship between sway performance and physical and cognitive function differed between women and men. Contributors to control of lateral balance were task-dependent. Lateral standing performance on an unstable surface may be more dependent upon general lower extremity strength, whereas visual tracking performance may be more dependent upon cognitive factors. Lateral balance control in ambulatory older adults is associated with deficits in strength and executive function.

Relationship of blood pressure, behavioral mood state, and physical activity following caffeine ingestion in younger and older women.

PubMed

Arciero, Paul J; Ormsbee, Michael J

2009-08-01

The purpose of this study was to examine the age-related differences in blood pressure, heart rate, and behavioral mood state after caffeine ingestion in younger and older women. Using a placebo-controlled, double-blind design, 10 younger (Y; 18-22 years) and 10 older (O; 50-67 years) healthy women who were moderate consumers of caffeine (self-reported mean intake: Y, 139 +/- 152 mg.day-1; O, 204 +/- 101 mg.day-1) were investigated. All volunteers were characterized for fasting plasma glucose, insulin, free-fatty acids and caffeine levels, body composition, cardiovascular fitness, physical activity, and energy intake. Before and after placebo and caffeine ingestion (5 mg.kg-1 fat-free mass; approximately 208-270 mg) test days, the following variables were measured in all subjects: plasma caffeine levels, heart rate, blood pressure, and behavioral mood state. Results showed that, following caffeine ingestion: (i) both systolic and diastolic blood pressure (SBP and DBP, respectively) increased significantly (p < 0.05) in the older women (SBP, 128.4 +/- 14.2 vs. 132.1 +/- 13.0 mm Hg (3%); DBP, 80.2 +/- 6.9 vs. 83.4 +/- 7.5 mm Hg (4%), whereas only DBP increased in the younger women (67.1 +/- 4.7 vs. 69.9 +/- 5.4 mm Hg (4.2%); p < 0.05); (ii) heart rate decreased significantly (Y, 59.2 +/- 8.7 to 53.9 +/- 10.6 beats.min-1 (p < 0.05); O, 61.9 +/- 9.2 to 59.2 +/- 8.4 beats.min-1 (p < 0.05)) in both groups; and (iii) self-reported feelings of tension and vigor increased and feelings of fatigue decreased (p < 0.05) in younger women, whereas depression decreased (p < or = 0.05) in older women. Self-reported level of physical activity was inversely related to change in DBP following caffeine ingestion in younger women. In conclusion, blood pressure response is augmented and subjective feelings of behavioral mood state are attenuated to a greater degree in older than in younger women following acute caffeine ingestion. Less physically active younger women are more vulnerable to the pressor response to caffeine than more active younger women. It should be noted that these findings are limited to moderate consumers of caffeine who abstained for 48 h prior to testing, and who ingested caffeine in pill form (approximately 240 mg).

Confucian Values as a Buffer Against Age-Based Stereotype Threat for Chinese Older Adults.

PubMed

Tan, Shyuan Ching; Barber, Sarah J

2018-05-16

Research has shown that stereotype threat can impair older adults' memory in Western cultures. We tested whether this also occurs for older adults from the East Asian Chinese culture. We also tested whether an intervention that highlighted Confucian principles would protect Chinese older adults from stereotype threat's detrimental effects. Culturally-Chinese older adults residing in the United States completed a memory test either under age-based stereotype threat about cognitive decline or not. Prior to this, some participants were also reminded of Confucian traditions of filial piety and were assured these values had been transmitted to the younger generation. Stereotype threat impaired Chinese older adults' memory performance. However, our intervention was effective in eliminating this deficit. When the Chinese participants were reminded of the Confucian principle of filial piety they did not exhibit stereotype threat effects. Confirming that younger adults have an obligation to respect their elders can eliminate the social-evaluative pressure of stereotype threat for Chinese older adults. These findings are noteworthy since population aging is happening at an unprecedented pace in East Asia. Although our results suggest that stereotype threat can adversely affect older adults' cognitive performance in these societies, we also identify a culturally-based intervention to alleviate this impairment.

Intersession reliability of self-selected and narrow stance balance testing in older adults.

PubMed

Riemann, Bryan L; Piersol, Kelsey

2017-10-01

Despite the common practice of using force platforms to assess balance of older adults, few investigations have examined the reliability of postural screening tests in this population. We sought to determine the test-retest reliability of self-selected and narrow stance balance testing with eyes open and eyes closed in healthy older adults. Thirty older adults (>65 years) completed 45 s trials of eyes open and eyes closed stability tests using self-selected and narrow stances on two separate days (1.9 ± .7 days). Average medial-lateral center of pressure velocity was computed. The ICC results ranged from .74 to .86, and no significant systematic changes (P < .05) occurred between the testing sessions for any of the tests. The standard error of measurement ranged from 15.9 to 23.6%. Reliability estimates were similar between the two stances and visual conditions assessed. Slightly higher coefficients were identified for the self-selected stances compared to the narrow stances under both visual conditions; however, there were negligible differences between the sessions. The within subject session-to-session variability provides a basis for further research to consider differences between fallers and non-fallers. Reliability for eyes open and closed balance testing using self-selected and narrow stances in older adults was established which should provide a foundation for the development of fall risk screening tests.

Resistance Training Improves Muscle Function and Cardiometabolic Risks But Not Quality of Life in Older People With Type 2 Diabetes Mellitus: A Randomized Controlled Trial.

PubMed

Hsieh, Ping-Lun; Tseng, Chin-Hsiao; Tseng, Yufeng Jane; Yang, Wei-Shiung

In older people with type 2 diabetes mellitus (T2DM), the effects of aging and T2DM may compromise the function of skeletal muscle, deteriorate metabolic status, and jeopardize physical performance, aerobic capacity, and quality of life (QoL). The purpose of this study was to investigate the effects of 12 weeks of resistance training (RT) on muscle function, physical performance, cardiometabolic risks, and QoL in older people with T2DM. This study was a randomized controlled trial that employed block randomization, assessor blinding, and the intention-to-treat principle. Thirty people 65 years or older with a diagnosis of T2DM were randomly assigned to either an exercise group or a control group and were further stratified by gender. The exercise group performed 8 RT exercises in 3 sets of 8 to 12 repetitions at 75% 1-repetition maximum (1-RM) 3 times per week for 12 weeks. The control group received usual care and maintained their daily activities and lifestyle. Muscle function (1-RM and muscle oxygenation responses), physical performance (5-repetition sit-to-stand test and Timed Up and Go test), cardiometabolic risks (aerobic capacity, blood pressure, body composition, glycemic control, lipids levels, and high-sensitivity C-reactive protein levels), and QoL (Audit of Diabetes-Dependent Quality of Life 19) were assessed at baseline (week 0) and after the 12-week interventions (week 12). The 1-RM chest-press and leg-press strength and physical performance in 5-repetition sit-to-stand test were significantly improved in the exercise group compared with the controls after the interventions. The exercise group had significantly lower resting systolic blood pressure (by -12.1 mm Hg, P = 0.036) than did the controls after 12 weeks of RT, without any significant within-group change in either group after intervention. The waist circumference, fasting glucose levels, and peak diastolic blood pressure tended to favor RT over usual care after the interventions. Twelve weeks of RT increased the maximal strength in chest-press and leg-press tests, and improved 5-repetition sit-to-stand performance in older people with T2DM. Our study demonstrated that supervised, structured RT was able to promote muscle function and alleviate cardiometabolic risks in people with T2DM 65 years or older.

The Effects of a Diet and Exercise Program for Older Adults With Metabolic Syndrome.

PubMed

Lin, Yu-Hua; Chu, Li-Ling; Kao, Chia-Chan; Chen, Tai-Been; Lee, I; Li, Hui-Chi

2015-09-01

The prevalence of metabolic syndrome is high among older adults in Taiwan. However, few studies have studied the effect of a combined diet and exercise program on managing metabolic syndrome (MetS) in individuals 65 years and older and living in Taiwan's rural areas. This study tests the effectiveness of a diet and exercise program on the MetS biomarkers in older community residents with MetS. This study used a quasiexperimental study design. All participants were 65 years and older and were diagnosed with MetS. The outcome variables included biomarkers (blood pressure, waist circumference, hip circumference, body mass index, blood sugar, cholesterol, and triglycerides) and demographic characteristics. The participants were distributed into a diet-and-exercise group (n = 163) and a nondiet-and-nonexercise group (n = 138). The outcome variables were examined 3 months after the start of the intervention program. The participants in the diet-and-exercise group had lower values than the nondiet-and-nonexercise group for blood pressure, waist circumference, hip circumference, body mass index, blood sugar, cholesterol, and triglyceride (all ps < .001). The diet and exercise program is an effective intervention for treating older individuals with MetS. Clear and concise information concerning the effects of diet and exercise in promoting the health of older residents with MetS is helpful to improve the health of the older adults inTaiwan.

Pressure-relieving properties of various shoe inserts in older people with plantar heel pain.

PubMed

Bonanno, Daniel R; Landorf, Karl B; Menz, Hylton B

2011-03-01

Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain. Thirty-six adults aged over 65 years with plantar heel pain participated in the study. Using the in-shoe Pedar(®) system, plantar pressure data were recorded while participants walked along an 8 m walkway wearing a standardised shoe and 4 different shoe inserts. The shoe inserts consisted of a silicon heel cup, a soft foam heel pad, a heel lift and a prefabricated foot orthosis. Data were collected for the heel, midfoot and forefoot. Statistically significant attenuation of heel peak plantar pressure was provided by 3 of the 4 shoe inserts. The greatest reduction was achieved by the prefabricated foot orthosis, which provided a fivefold reduction compared to the next most effective insert. The contoured nature of the prefabricated foot orthosis allowed for an increase in midfoot contact area, resulting in a greater redistribution of force. The prefabricated foot orthosis was also the only shoe insert that did not increase forefoot pressure. The findings from this study indicate that of the shoe inserts tested, the contoured prefabricated foot orthosis is the most effective at reducing pressure under the heel in older people with heel pain. Copyright © 2010 Elsevier B.V. All rights reserved.

Influence of Estimated Training Status on Anti and Pro-Oxidant Activity, Nitrite Concentration, and Blood Pressure in Middle-Aged and Older Women

PubMed Central

Jacomini, André M.; Dias, Danielle da Silva; Brito, Janaina de Oliveira; da Silva, Roberta F.; Monteiro, Henrique L.; Llesuy, Susana; De Angelis, Kátia; Amaral, Sandra L.; Zago, Anderson S.

2017-01-01

The purpose of this study was to compare the association between anti and pro-oxidant activity, nitrite concentration, and blood pressure (BP) in middle-aged and older women with different levels of estimated training status (TS). The sample consisted of 155 females (50–84 years) who were submitted to a physical examination to evaluate estimated TS through the “Functional Fitness Battery Test,” BP measurements, and plasma blood samples to evaluate pro-oxidant and antioxidant activity and nitrite concentrations. Participants were separated by age into a middle-aged group (<65 years) and an older (≥65 years) group and then subdivided in each group according to TS. Blood biochemistry was similar between groups. On the other hand, protein oxidation was lower in participants with higher TS, independent of age. Older females with higher TS presented higher nitrite concentrations, lower lipoperoxidation, and lower values of BP compared with those with lower TS. Lower GPx activity was observed in participants with higher TS compared with middle-aged with lower TS. Thus, our results suggest that good levels of TS may be associated with lower oxidative stress and higher nitrite concentration and may contribute to maintain normal or reduced blood pressure values. PMID:28326041

Influence of Estimated Training Status on Anti and Pro-Oxidant Activity, Nitrite Concentration, and Blood Pressure in Middle-Aged and Older Women.

PubMed

Jacomini, André M; Dias, Danielle da Silva; Brito, Janaina de Oliveira; da Silva, Roberta F; Monteiro, Henrique L; Llesuy, Susana; De Angelis, Kátia; Amaral, Sandra L; Zago, Anderson S

2017-01-01

The purpose of this study was to compare the association between anti and pro-oxidant activity, nitrite concentration, and blood pressure (BP) in middle-aged and older women with different levels of estimated training status (TS). The sample consisted of 155 females (50-84 years) who were submitted to a physical examination to evaluate estimated TS through the "Functional Fitness Battery Test," BP measurements, and plasma blood samples to evaluate pro-oxidant and antioxidant activity and nitrite concentrations. Participants were separated by age into a middle-aged group (<65 years) and an older (≥65 years) group and then subdivided in each group according to TS. Blood biochemistry was similar between groups. On the other hand, protein oxidation was lower in participants with higher TS, independent of age. Older females with higher TS presented higher nitrite concentrations, lower lipoperoxidation, and lower values of BP compared with those with lower TS. Lower GPx activity was observed in participants with higher TS compared with middle-aged with lower TS. Thus, our results suggest that good levels of TS may be associated with lower oxidative stress and higher nitrite concentration and may contribute to maintain normal or reduced blood pressure values.

Cardiovascular Assessment of Falls in Older People

PubMed Central

Tan, Maw Pin; Kenny, Rose Anne

2006-01-01

Falls in older people can be caused by underlying cardiovascular disorders, either because of balance instability in persons with background gait and balance disorders, or because of amnesia for loss of consciousness during unwitnessed syncope. Pertinent investigations include a detailed history, 12-lead electrocardiography, lying and standing blood pressure, carotid sinus massage (CSM), head-up tilt, cardiac electrophysiological tests, and ambulatory blood pressure and heart rate monitoring, which includes external and internal cardiac monitoring. The presence of structural heart disease predicts an underlying cardiac cause. Conversely, the absence of either indicates that neurally mediated etiology is likely. CSM and tilt-table testing should be considered in patients with unexplained and recurrent falls. Holter monitoring over 24 hours has a low diagnostic yield. Early use of an implantable loop recorder may be more cost-effective. A dedicated investigation unit increases the likelihood of achieving positive diagnoses and significantly reduces hospital stay and health expenditure. PMID:18047258

Changes in cardiopulmonary function in normal adults after the Rockport 1 mile walking test: a preliminary study.

PubMed

Kim, Kyoung; Lee, Hye-Young; Lee, Do-Youn; Nam, Chan-Woo

2015-08-01

[Purpose] The purpose of this study was to investigate the changes of cardiopulmonary function in normal adults after the Rockport 1 mile walking test. [Subjects and Methods] University students (13 males and 27 females) participated in this study. Before and after the Rockport 1 mile walking test, pulmonary function, respiratory pressure, and maximal oxygen uptake were measured. [Results] Significant improvements in forced vital capacity and maximal inspiratory pressure were observed after the Rockport 1 mile walking test in males, and significant improvements in forced vital capacity, forced expiratory volume at 1 s, maximal inspiratory pressure, and maximal expiratory pressure were observed after the Rockport 1 mile walking test in females. However, the maximal oxygen uptake was not significantly different. [Conclusion] Our findings indicate that the Rockport 1 mile walking test changes cardiopulmonary function in males and females, and that it may improve cardiopulmonary function in middle-aged and older adults and provide basic data on cardiopulmonary endurance.

Changes in cardiopulmonary function in normal adults after the Rockport 1 mile walking test: a preliminary study

PubMed Central

Kim, Kyoung; Lee, Hye-Young; Lee, Do-Youn; Nam, Chan-Woo

2015-01-01

[Purpose] The purpose of this study was to investigate the changes of cardiopulmonary function in normal adults after the Rockport 1 mile walking test. [Subjects and Methods] University students (13 males and 27 females) participated in this study. Before and after the Rockport 1 mile walking test, pulmonary function, respiratory pressure, and maximal oxygen uptake were measured. [Results] Significant improvements in forced vital capacity and maximal inspiratory pressure were observed after the Rockport 1 mile walking test in males, and significant improvements in forced vital capacity, forced expiratory volume at 1 s, maximal inspiratory pressure, and maximal expiratory pressure were observed after the Rockport 1 mile walking test in females. However, the maximal oxygen uptake was not significantly different. [Conclusion] Our findings indicate that the Rockport 1 mile walking test changes cardiopulmonary function in males and females, and that it may improve cardiopulmonary function in middle-aged and older adults and provide basic data on cardiopulmonary endurance. PMID:26356048

Validity of an Exercise Test Based on Habitual Gait Speed in Mobility-Limited Older Adults

PubMed Central

Li, Xin; Forman, Daniel E.; Kiely, Dan K.; LaRose, Sharon; Hirschberg, Ronald; Frontera, Walter R.; Bean, Jonathan F.

2013-01-01

Objective To evaluate whether a customized exercise tolerance testing (ETT) protocol based on an individual’s habitual gait speed (HGS) on level ground would be a valid mode of exercise testing older adults. Although ETT provides a useful means to risk-stratify adults, age-related declines in gait speed paradoxically limit the utility of standard ETT protocols for evaluating older adults. A customized ETT protocol may be a useful alternative to these standard methods, and this study hypothesized that this alternative approach would be valid. Design We performed a cross-sectional analysis of baseline data from a randomized controlled trial of older adults with observed mobility problems. Screening was performed using a treadmill-based ETT protocol customized for each individual’s HGS. We determined the content validity by assessing the results of the ETTs, and we evaluated the construct validity of treadmill time in relation to the Physical Activity Scale for the Elderly (PASE) and the Late Life Function and Disability Instrument (LLFDI). Setting Outpatient rehabilitation center. Participants Community-dwelling, mobility-limited older adults (N = 141). Interventions Not applicable. Main Outcome Measures Cardiac instability, ETT duration, peak heart rate, peak systolic blood pressure, PASE, and LLFDI. Results Acute cardiac instability was identified in 4 of the participants who underwent ETT. The remaining participants (n = 137, 68% female; mean age, 75.3y) were included in the subsequent analyses. Mean exercise duration was 9.39 minutes, with no significant differences in durations being observed after evaluating among tertiles by HGS status. Mean peak heart rate and mean peak systolic blood pressure were 126.6 beats/ min and 175.0mmHg, respectively. Within separate multivariate models, ETT duration in each of the 3 gait speed groups was significantly associated (P<.05) with PASE and LLFDI. Conclusions Mobility-limited older adults can complete this customized ETT protocol, allowing for the identification of acute cardiac instability and the achievement of optimal exercise parameters. PMID:22289248

Continuous and interval training programs using deep water running improves functional fitness and blood pressure in the older adults.

PubMed

Reichert, Thaís; Kanitz, Ana Carolina; Delevatti, Rodrigo Sudatti; Bagatini, Natália Carvalho; Barroso, Bruna Machado; Kruel, Luiz Fernando Martins

2016-02-01

This study aimed to investigate the effects of two periodized training programs of deep water running on functional fitness and blood pressure in the older adults. Thirty-six individuals were divided into continuous group (CONT) and interval group (INT). Both groups were trained for 28 weeks (twice weekly). Measures were performed before the training period, after 12 weeks and training period. Two-way ANOVA and post hoc of Bonferroni were used (α = 0.05). There were no differences between groups in functional tests, with the exception of the flexibility of the upper limbs, in which the INT group showed the highest values. There was a significant improvement in both groups of foot up-and-go test (CONT 6.45 to 5.67; INT 6.59 to 5.78, in seconds), flexibility of lower limbs (CONT -4.76 to -0.61; INT 0.54 to 4.63, in centimeters), strength of upper (CONT 18.76 to 27.69; INT 18.66 to 26.58, in repetitions) and lower limbs (CONT 14.46 to 21.23; INT 14.40 to 21.58, in repetitions), and 6-min walk (CONT 567.50 to 591.16; INT 521.41 to 582.77, in meters). No differences were shown between groups for systolic blood pressure; however, diastolic blood pressure remained higher in CONT during all training. The blood pressure decreased significantly in both groups after the training (CONT 142 ± 16/88 ± 3 to 125 ± 14/77 ± 7 mmHg; INT 133 ± 15/75 ± 7 to 123 ± 17 and 69 ± 11 mmHg). Both programs of deep water running training promoted improvements of similar magnitude in all parameters of functional fitness, with the exception of flexibility of upper limbs, and decreased blood pressure in the older individuals.

Effect of an Integrated Health Management Program Based on Successful Aging in Korean Women.

PubMed

Ahn, Okhee; Cha, Hye Gyeong; Chang, Soo Jung; Cho, Hyun-Choul; Kim, Hee Sun

2015-01-01

This study evaluates the efficacy of an integrated health management program (IHMP) based on successful aging in older women. A single group pretest and posttest research design was employed, with a sample of 33 older Korean women over 60 years registered in a public health center. The intervention, including exercise, health education, and social activities, was performed 3 hr per week for 12 weeks. Demographic characteristics, body composition, physical fitness, biomarkers, depression, and social support were measured. Data were analyzed with a Wilcoxon signed-rank test, statistical significance levels were set at p < .05. After the intervention, body mass index was significantly decreased (p = .003) and skeletal muscle mass was significantly increased (p = .002). Chair stand (p = .023) and straight walking test (p < .001) were significantly improved. Systolic blood pressure (p < .003), diastolic blood pressure (p = .030), and blood cholesterol (p = .011) were significantly decreased. Depression (p = .043) was significantly decreased, and social support (p < .001) was significantly increased. Adopting and maintaining an IHMP can be useful to promote physical, psychological, and social functioning that lead to successful aging in older Korean women. © 2014 Wiley Periodicals, Inc.

Grandparent Caregiving and Psychological Well-Being Among Chinese American Older Adults-The Roles of Caregiving Burden and Pressure.

PubMed

Xu, Ling; Tang, Fengyan; Li, Lydia W; Dong, Xin Qi

2017-07-01

Though ample research on grandparent caregiving and psychological well-being outcomes exist in Western literature, little attention has been focused on Chinese American grandparents. Based on role enhancement and role strain theories, this study examined grandparent caregiving and psychological well-being among Chinese American older adults and tested whether caregiving burden or pressure from adult children moderated such association. We used the data from the Population Study of ChINese Elderly in Chicago (PINE), a population-based survey of community-dwelling Chinese older adults in the Greater Chicago area. Grandparents with grandchildren younger than 16 years old were selected for present study (N = 2,775). Negative binominal regression and logistic regression models were used to test the relationships of grandparent caregiving time and psychological well-being measured by depressive symptoms and quality of life. Grandparents reported an average of 11.96 hours a week for caring for grandchildren. Caregiving time had a significantly negative association with depressive symptoms, but not with quality of life. The association between grandparent caregiving and depressive symptoms was moderated by the perception of caregiving burden. No moderating effect of caregiving pressure from adult children was found. More time spending on grandparent caregiving is generally beneficial to Chinese American grandparents' psychological well-being, thus supporting role enhancement theory. However, this association depends on whether this experience is a burden to the grandparents, therefore role strain theory is also supported. Policies and programs are discussed to address the grandparenting experience in the Chinese American older adults. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Pulmonary Artery Wedge Pressure Relative to Exercise Work Rate in Older Men and Women.

PubMed

Esfandiari, Sam; Wright, Stephen P; Goodman, Jack M; Sasson, Zion; Mak, Susanna

2017-07-01

An augmented pulmonary artery wedge pressure (PAWP) response may explain exercise intolerance in some humans. However, routine use of exercise hemodynamic testing is limited by a lack of data from normal older men and women. Our objective was to evaluate the exercise PAWP response and the potential for sexual dimorphism in healthy, nondyspneic older adults. Thirty-six healthy volunteers (18 men [54 ± 7 yr] and 18 women [58 ± 6 yr]) were studied at rest (control) and during two stages of semi-upright cycle ergometry, at heart rates of 100 bpm (light exercise) and 120 bpm (moderate exercise). Right heart catheterization was performed to measure pulmonary pressures. The PAWP response to exercise was assessed in context of exercise work rate and body size. At control, PAWP was similar between men and women. Work rates were significantly smaller in women at comparable HR (P < 0.001). PAWP increased similarly at light exercise, with no further increase at moderate exercise. When indexed to work rate alone or work rate adjusted to body weight and height, the PAWP response at light and moderate exercise was significantly elevated in women compared with men (P < 0.05 condition-sex interaction). The change in PAWP relative to the increase in cardiac output did not exceed 2 mm Hg·L·min in any volunteer at moderate exercise. The similar rise in the PAWP response to submaximal exercise occurs despite lower work rate in healthy older women compared with men, even when adjusted for smaller body size. It is important to consider sex in the development of normal reference ranges for exercise hemodynamic testing.

Anorectal function investigations in incontinent and continent patients. Differences and discriminatory value.

PubMed

Felt-Bersma, R J; Klinkenberg-Knol, E C; Meuwissen, S G

1990-06-01

Anal manometry, rectal capacity measurement, and the saline-infusion test were performed in 350 patients, 178 of whom had fecal incontinence and 172 of whom were continent. Anal manometry was also performed in 80 control subjects, whose results were compared with the patients. Women and older patients exhibited lower pressures. Compared with continent patients, incontinent patients had lower anal sphincter pressures at rest and during squeeze, a smaller rectal capacity, and leaked earlier and more with the saline infusion test. Differentiation between incontinent and continent patients was not possible with a single test because there was complete overlap. The maximum squeeze pressure showed the best discrimination. Combining the three tests did not show better discrimination than any individual test. Anal pressure and rectal capacity below the normal range only were found in very few incontinent patients. The authors' study demonstrates that no prediction can be made about continence with anorectal function tests. Therefore, in the individual patient, an abnormal result in one test must be interpreted with caution and only in relationship with other tests, especially when therapeutic surgery is considered.

Water Immersion Affects Episodic Memory and Postural Control in Healthy Older Adults.

PubMed

Bressel, Eadric; Louder, Talin J; Raikes, Adam C; Alphonsa, Sushma; Kyvelidou, Anastasia

2018-05-04

Previous research has reported that younger adults make fewer cognitive errors on an auditory vigilance task while in chest-deep water compared with on land. The purpose of this study was to extend this previous work to include older adults and to examine the effect of environment (water vs land) on linear and nonlinear measures of postural control under single- and dual-task conditions. Twenty-one older adult participants (age = 71.6 ± 8.34 years) performed a cognitive (auditory vigilance) and motor (standing balance) task separately and simultaneously on land and in chest-deep water. Listening errors (n = count) from the auditory vigilance test and sample entropy (SampEn), center of pressure area, and velocity for the balance test served as dependent measures. Environment (land vs water) and task (single vs dual) comparisons were made with a Wilcoxon matched-pair test. Listening errors were 111% greater during land than during water environments (single-task = 4.0 ± 3.5 vs 1.9 ± 1.7; P = .03). Conversely, SampEn values were 100% greater during water than during land environments (single-task = 0.04 ± 0.01 vs 0.02 ± 0.01; P < .001). Center of pressure area and velocity followed a similar trend to SampEn with respect to environment differences, and none of the measures were different between single- and dual-task conditions (P > .05). The findings of this study expand current support for the potential use of partial aquatic immersion as a viable method for challenging both cognitive and motor abilities in older adults.

Phylloquinone (vitamin K₁) intake and pulse pressure as a measure of arterial stiffness in older adults.

PubMed

Vaccaro, Joan A; Huffman, Fatma G

2013-01-01

This study examined the relationships among ethnicity/race, lifestyle factors, phylloquinone (vitamin K₁) intake, and arterial pulse pressure in a nationally representative sample of older adults from four ethnic/racial groups: non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, and other Hispanics. This was a cross-sectional study of U.S. representative sample with data from the National Health and Nutrition Examination Surveys, 2007-2008 and 2009-2010 of adults aged 50 years and older (N = 5296). Vitamin K intake was determined by 24-hour recall. Pulse pressure was calculated as the difference between the averages of systolic blood pressure and diastolic blood pressure. Compared to White non-Hispanics, the other ethnic/racial groups were more likely to have inadequate vitamin K₁ intake. Inadequate vitamin K₁ intake was an independent predictor of high arterial pulse pressure. This was the first study that compared vitamin K₁ inadequacy with arterial pulse pressure across ethnicities/races in U.S. older adults. These findings suggest that vitamin K screening may be a beneficial marker for the health of older adults.

Pressure ulcer prevention in frail older people.

PubMed

Barry, Maree; Nugent, Linda

2015-12-16

Pressure ulcers are painful and cause discomfort, have a negative effect on quality of life, and are costly to treat. The incidence and severity of preventable pressure ulcers is an important indicator of quality of care; it is essential that healthcare providers monitor prevalence and incidence rates to ensure that care strategies implemented are effective. Frail older people are at increased risk of developing pressure ulcers. This article discusses the complexities of preventing pressure ulcers in frail older people and emphasises the importance of structured educational programmes that incorporate effective clinical leadership and multidisciplinary teamwork.

Assessing and training standing balance in older adults: a novel approach using the 'Nintendo Wii' Balance Board.

PubMed

Young, William; Ferguson, Stuart; Brault, Sébastien; Craig, Cathy

2011-02-01

Older adults, deemed to be at a high risk of falling, are often unable to participate in dynamic exercises due to physical constraints and/or a fear of falling. Using the Nintendo 'Wii Balance Board' (WBB) (Nintendo, Kyoto, Japan), we have developed an interface that allows a user to accurately calculate a participant's centre of pressure (COP) and incorporate it into a virtual environment to create bespoke diagnostic or training programmes that exploit real-time visual feedback of current COP position. This platform allows researchers to design, control and validate tasks that both train and test balance function. This technology provides a safe, adaptable and low-cost balance training/testing solution for older adults, particularly those at high-risk of falling. Copyright © 2010 Elsevier B.V. All rights reserved.

Differences in blood pressure control in a large population-based sample of older African Americans and non-Hispanic whites.

PubMed

Delgado, Jose; Jacobs, Elizabeth A; Lackland, Daniel T; Evans, Denis A; de Leon, Carlos F Mendes

2012-11-01

Cardiovascular disease is the main cause of death in older adults. Uncontrolled blood pressure is an important risk factor for cardiovascular disease. African Americans have poorer blood pressure control than non-Hispanic whites. Little is known about whether this difference persists in older ages or the factors that contribute to this racial gap. Data were obtained from participants of the Chicago Health and Aging Program. Blood pressure control was defined according to JNC-7 criteria. Univariate chi-square analyses were used to determine racial differences in hypertension and blood pressure control, whereas sequential multivariate logistic regression models were used to determine the effect of race on blood pressure control. African Americans had a higher prevalence of hypertension (74% vs 63%; p < .001), higher awareness of hypertension (81% vs 72%; p < .001), and poorer blood pressure control (45% vs 51%, p < .001) than non-Hispanic whites. Racial differences in blood pressure control persisted after adjustment for socioeconomic status, medical conditions, obesity, and use of antihypertensive medications (odds ratio = 0.84, 95% confidence interval = 0.70-0.94). From 1993 to 2008, blood pressure control improved more among non-Hispanic whites than among African Americans. Racial differences in blood pressure control in older adults were not explained by socioeconomic status. The racial disparity in the prevalence and control of hypertension remained consistent for older hypertensive individuals eligible for Medicare. Although the rates of hypertension control improved for both racial groups, the improvement was greater among whites, thus widening the gap in this older population at high risk for cardiovascular disease.

Challenges in the Management of Hypertension in Older Populations.

PubMed

Pont, Lisa; Alhawassi, Tariq

2017-01-01

The prevalence of hypertension increases with age making it a significant health concern for older persons. Aging involves a range of physiological changes such as increases in arterial stiffness, widening pulse pressure, changes in renin and aldosterone levels, decreases in renal salt excretion, declining in renal function, changes in the autonomic nervous system sensitivity and function and changes to endothelial function all of which may not only affect blood pressure but may also affect individual response to pharmacotherapy used to manage hypertension and prevent end organ damage and other complications associated with poor blood pressure control.Unlike many chronic conditions where there is limited evidence for management in older populations, there is good evidence regarding the management of hypertension in the elderly. The findings from multiple large, robust trials have provided a solid evidence-base regarding the management of hypertension in older adults, showing that reduction of blood pressure in older hypertensive populations is associated with reduced mortality and morbidity. Diuretics, agents action on the renin angiotensin system, beta blockers and calcium channel blockers have all been well studied in older populations both in view of the benefits associated with blood pressure lowering and the risks associated with associated adverse events. While all antihypertensive agents will lower blood pressure, when managing hypertension in older persons the choice of agent is dependent not only on the ability to lower blood pressure but also on the potential for harm with older persons. Understanding such potential harms in older populations is essential with older persons experiencing increased sensitivity to many of the adverse effects such as dizziness associated with the use of antihypertensive agents.Despite the wealth of evidence regarding the benefits of managing hypertension in the old and very old, a significant proportion of older individuals with hypertension have suboptimal BP control. While there is good evidence supporting blood pressure lowering in older antihypertensive agents, these have not yet been optimally translated fully into clinical guidelines and clinical practice. There appear to be considerable differences between guidelines in terms of the guidance given to clinicians. Differences in interpretation of the evidence, as well as differences in study design and populations all contribute to differences in the guideline recommendations with respect to older populations, despite the strength of the underlying scientific evidence. Differences around who is considered "old" and what BP targets and management are considered appropriate may lead to confusion among clinicians and further contribute to the evidence-practice lag.

Increased pulmonary artery pressures during exercise are related to persistent tricuspid regurgitation after atrial septal defect closure.

PubMed

De Meester, Pieter; Van De Bruaene, Alexander; Herijgers, Paul; Voigt, Jens-Uwe; Vanhees, Luc; Budts, Werner

2013-08-01

Although closure of an atrial septal defect type secundum often normalizes right heart dimensions and pressures, mild tricuspid insufficiency might persist. This study aimed at (1) identification of determinants explaining the persistence of tricuspid insufficiency after atrial septal defect closure, and (2) evaluation of functional capacity of patients with persistent mild tricuspid insufficiency. Twenty-five consecutive patients (age 42+17 y) were included from the outpatient clinic of congenital heart disease at the University Hospitals of Leuven. All underwent transthoracic echocardiography, semi-supine bicycle stress echocardiography and cardio-pulmonary exercise testing. Six patients (24%) had mild tricuspid insufficiency (2/4) compared to 19 patients (76%) with no or minimal tricuspid insufficiency ( 1/4) as assessed by semi-quantitative colour Doppler echocardiography. Mann-Whitney U and Fisher's exact tests were performed where applicable. Patients with persistent mild tricuspid insufficiency were significantly older than those with no or minimal tricuspid insufficiency (P = 0.042). At rest, no differences in right heart configuration, mean pulmonary artery pressure or right ventricular function were found. At peak exercise, mean pulmonary artery pressure was significantly higher in patients with mild persistent tricuspid insufficiency (P = 0.026). Peak oxygen uptake was significantly lower in patients with mild persistent tricuspid insufficiency (P = 0.019). Mild tricuspid insufficiency after atrial septal defect repair occurs more frequently in older patients and in patients with higher mean pulmonary artery pressure at peak exercise. In patients with mild tricuspid insufficiency, functional capacity was more reduced. Mild tricuspid insufficiency could be a marker of subclinical persistent pressure load on the right ventricle.

Training Status as a Marker of the Relationship between Nitric Oxide, Oxidative Stress, and Blood Pressure in Older Adult Women.

PubMed

Jacomini, André Mourão; de Souza, Hugo Celso Dutra; Dias, Danielle da Silva; Brito, Janaina de Oliveira; Pinheiro, Lucas Cezar; da Silva, Anderson Bernardino; da Silva, Roberta Fernanda; Trapé, Atila Alexandre; De Angelis, Kátia; Tanus-Santos, José Eduardo; do Amaral, Sandra Lia; Zago, Anderson Saranz

2015-01-01

The purpose of this study was to evaluate the influence of functional fitness and oxidative capacity on the nitric oxide concentration associated with hemodynamic control in older adult women. The sample consisted of 134 women (65.73 ± 6.14 years old). All subjects underwent a physical examination to assess body mass index, waist-hip ratio, body fat measurement by dual energy X-ray absorptiometry, and blood pressure (BP). Training status (TS) was evaluated by indirect determination of maximal oxygen uptake by a treadmill test using Balke protocol modified for older adults. Functional fitness was also evaluated through a "Functional Fitness Battery Test" to determine the general fitness functional index (GFFI). All participants were separated according to the functional fitness (TS1, very weak and weak; TS2, regular; TS3, good and very good). Plasma blood samples were used to evaluate prooxidant and antioxidant activity and nitrite and nitrate concentrations. The general results of this study showed that good levels of TS were related to lower levels of lipoperoxidation and protein damage, higher levels of antioxidant, and higher concentration of nitrite and nitrate. This combination may be responsible for the lower levels of BP in subjects with better TS.

Blood pressure and neuropsychological test performance in healthy postmenopausal women.

PubMed

Alsumali, Adnan; Mekary, Rania A; Seeger, John; Regestein, Quentin

2016-06-01

To study the association between blood pressure and neuropsychological test performance in healthy postmenopausal women. Data from 88 healthy postmenopausal women aged 46-73 years, who were not experiencing hot flashes, and who had participated in a prior drug trial, were analyzed to find whether baseline blood pressure was associated with impaired performance on neuropsychological testing done at 3 follow-up visits separated by 4 weeks. Factor analysis was used to reduce the dimensions of neuropsychological test performance. Mixed linear modeling was used to evaluate the association between baseline blood pressure and repeatedly measured neuropsychological test performance at follow-up in a complete case analysis (n=53). In a sensitivity analysis (n=88), multiple-imputation using the Markov Chain Monte Carlo method was used to account for missing data (blood pressure results) for some visits. The variables recording neuropsychological test performance were reduced to two main factors (Factor 1=selective attention; Factor 2=complex processing). In the complete case analysis, the association between a 20-mmHg increase in diastolic blood pressure and Factor 1 remained statistically significant after adjusting for potential confounders, before adjusting for systolic blood pressure (slope=0.60; 95%CI=0.04,1.16), and after adjusting for systolic blood pressure (slope=0.76; 95%CI=0.06, 1.47). The positive slopes indicated an increase in the time spent performing a given task (i.e., a decrease in neuropsychological test performance). No other significant associations were found between systolic blood pressure and either factor. The results did not materially change after applying the multiple-imputation method. An increase in diastolic blood pressure was associated with a decrease in neuropsychological test performance among older healthy postmenopausal women experiencing hot flashes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Aging attenuates the vestibulosympathetic reflex in humans

NASA Technical Reports Server (NTRS)

Ray, Chester A.; Monahan, Kevin D.

2002-01-01

BACKGROUND: The vestibular system contributes to sympathetic activation by engagement of the otolith organs. However, there is a significant loss of vestibular function with aging. Therefore, the purpose of the present study was to determine if young and older individuals differ in their cardiovascular and sympathetic responses to otolithic stimulation (ie, head-down rotation, HDR). We hypothesized that responses to otolithic stimulation would be attenuated in older adults because of morphological and physiological alterations that occur in the vestibular system with aging. METHODS AND RESULTS: Arterial blood pressure, heart rate, muscle sympathetic nerve activity (MSNA), and head rotation were measured during HDR in 11 young (26 +/- 1 years) and 11 older (64 +/- 1 years) subjects in the prone posture. Five older subjects performed head rotation (chin to chest) in the lateral decubitus position, which simulates HDR but does not alter afferent inputs from the vestibular system. MSNA responses to HDR were significantly attenuated in older as compared with young subjects (P<0.01). MSNA increased in the older subjects by only 12 +/- 5% as compared with 85 +/- 16% in the young. Furthermore, HDR elicited significant reductions in mean arterial blood pressure in older (Delta-6 +/- 1 mm Hg; P<0.01) but not young subjects (Delta1 +/- 1 mm Hg). In contrast to HDR, head rotation performed in the lateral decubitus position did not elicit hypotension. MSNA responses to baroreceptor unloading and the cold pressor test were not different between the age groups. CONCLUSIONS: These data indicate that aging attenuates the vestibulosympathetic reflex in humans and may contribute to the increased prevalence of orthostatic hypotension with age.

Immediate effects of transcutaneous electrical stimulation on physiological swallowing effort in older versus young adults.

PubMed

Berretin-Felix, Giédre; Sia, Isaac; Barikroo, Ali; Carnaby, Giselle D; Crary, Michael A

2016-09-01

This study compared the immediate impact of different transcutaneous electrical stimulation (TES) amplitudes on physiological swallowing effort in healthy older adults versus young adults. Swallowing physiology changes with age. Reduced physiological swallowing effort in older adults including lower lingua-palatal and pharyngeal pressures may increase risk for swallowing dysfunction (i.e. dysphagia). Transcutaneous electrical stimulation (TES) has been advocated as an adjunctive modality to enhance outcomes in exercise-based therapy for individuals with dysphagia. However, significant variation in how TES is applied during therapy remains and the physiological swallowing response to TES is poorly studied, especially in older adults. Physiological change in swallowing associated with no stimulation, sensory stimulation and motor stimulation was compared in 20 young adults versus 14 older adults. Lingua-palatal and pharyngeal manometric pressures assessed physiological swallowing effort. Multivariate analyses identified interactions between age and stimulation amplitude on lingual and pharyngeal functions. Motor stimulation reduced anterior tongue pressure in both age groups but selectively reduced posterior lingua-palatal pressures in young adults only. Sensory stimulation increased base of tongue (BOT) pressures in older adults but decreased BOT pressures in young adults. Motor stimulation increased hypopharyngeal pressures in both groups. Age and TES level interact in determining immediate physiological responses on swallow performance. A one-size-fit-all approach to TES in dysphagia rehabilitation may be misdirected. © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Street crossing behavior in younger and older pedestrians: an eye- and head-tracking study.

PubMed

Zito, G A; Cazzoli, D; Scheffler, L; Jäger, M; Müri, R M; Mosimann, U P; Nyffeler, T; Mast, F W; Nef, T

2015-12-29

Crossing a street can be a very difficult task for older pedestrians. With increased age and potential cognitive decline, older people take the decision to cross a street primarily based on vehicles' distance, and not on their speed. Furthermore, older pedestrians tend to overestimate their own walking speed, and could not adapt it according to the traffic conditions. Pedestrians' behavior is often tested using virtual reality. Virtual reality presents the advantage of being safe, cost-effective, and allows using standardized test conditions. This paper describes an observational study with older and younger adults. Street crossing behavior was investigated in 18 healthy, younger and 18 older subjects by using a virtual reality setting. The aim of the study was to measure behavioral data (such as eye and head movements) and to assess how the two age groups differ in terms of number of safe street crossings, virtual crashes, and missed street crossing opportunities. Street crossing behavior, eye and head movements, in older and younger subjects, were compared with non-parametric tests. The results showed that younger pedestrians behaved in a more secure manner while crossing a street, as compared to older people. The eye and head movements analysis revealed that older people looked more at the ground and less at the other side of the street to cross. The less secure behavior in street crossing found in older pedestrians could be explained by their reduced cognitive and visual abilities, which, in turn, resulted in difficulties in the decision-making process, especially under time pressure. Decisions to cross a street are based on the distance of the oncoming cars, rather than their speed, for both groups. Older pedestrians look more at their feet, probably because of their need of more time to plan precise stepping movement and, in turn, pay less attention to the traffic. This might help to set up guidelines for improving senior pedestrians' safety, in terms of speed limits, road design, and mixed physical-cognitive trainings.

Association of physical activity with a systolic blood pressure difference between arms in older people.

PubMed

Sato, Koichi; Sugiura, Tomonori; Ohte, Nobuyuki; Dohi, Yasuaki

2018-01-01

A increase in interarm systolic blood pressure difference (IASBPD) is believed to lead to increased risk of cardiovascular disease and to be a predictor of future cardiovascular events. The purpose of the present study was to test the hypothesis that an increased IASBPD is associated with reduced physical activity in older people. Older people who used a geriatric health services facility (n = 147, mean age 83.3 years) were enrolled. The prevalence of IASBPD in individuals with different levels of physical activity and factors that have a crucial effect on IASBPD were investigated. The study participants were divided into three groups according to their physical activity; ambulant persons (group A), wheelchair users (group B) and bedridden persons (group C). Blood pressure around the both brachiums was simultaneously measured using two automated devices. An IASBPD of ≥10 mmHg was considered to be significant IASBPD. The median IASBPD was 4.5 mmHg in the present study participants, and 28 participants (19.0%) had an IASBPD ≥10 mmHg. The IASBPD in group C was greater than that in group A or B. Multivariate linear regression analysis showed that physical activity was the independent predictor of IASBPD after adjustment for possible factors. Furthermore, a logistic regression analysis with the end-point of significant IASBPD showed that physical activity is an independent predictor of significant IASBPD. Physical activity simply assessed by moving ability can predict IASBPD in older individuals. In older people, reduced physical activity might indicate the progression of silent or clinical atherosclerosis and an increased risk of cardiovascular disease. Geriatr Gerontol Int 2018; 18: 95-100. © 2017 Japan Geriatrics Society.

Influence of visual control, conduction, and central integration on static and dynamic balance in healthy older adults.

PubMed

Perrin, P P; Jeandel, C; Perrin, C A; Béné, M C

1997-01-01

Aging is associated with decreased balance abilities, resulting in an increased risk of fall. In order to appreciate the visual, somatosensory, and central signals involved in balance control, sophisticated methods of posturography assessment have been developed, using static and dynamic tests, eventually associated with electromyographic measurements. We applied such methods to a population of healthy older adults in order to appreciate the respective importance of each of these sensorial inputs in aging individuals. Posture control parameters were recorded on a force-measuring platform in 41 healthy young (age 28.5 +/- 5.9 years) and 50 older (age 69.8 +/- 5.9 years) adults, using a static test and two dynamic tests performed by all individuals first with eyes open, then with eyes closed. The distance covered by the center of foot pressure, sway area, and anteroposterior oscillations were significantly higher, with eyes open or closed, in older people than in young subjects. Significant differences were noted in dynamic tests with longer latency responses in the group of old people. Dynamic recordings in a sinusoidal test had a more regular pattern when performed eyes open in both groups and evidenced significantly greater instability in old people. These data suggest that vision remains important in maintaining postural control while conduction and central integration become less efficient with age.

Reduced Modulation of Pain in Older Adults After Isometric and Aerobic Exercise.

PubMed

Naugle, Kelly M; Naugle, Keith E; Riley, Joseph L

2016-06-01

Laboratory-based studies show that acute aerobic and isometric exercise reduces sensitivity to painful stimuli in young healthy individuals, indicative of a hypoalgesic response. However, little is known regarding the effect of aging on exercise-induced hypoalgesia (EIH). The purpose of this study was to examine age differences in EIH after submaximal isometric exercise and moderate and vigorous aerobic exercise. Healthy older and younger adults completed 1 training session and 4 testing sessions consisting of a submaximal isometric handgrip exercise, vigorous or moderate intensity stationary cycling, or quiet rest (control). The following measures were taken before and after exercise/quiet rest: 1) pressure pain thresholds, 2) suprathreshold pressure pain ratings, 3) pain ratings during 30 seconds of prolonged noxious heat stimulation, and 4) temporal summation of heat pain. The results revealed age differences in EIH after isometric and aerobic exercise, with younger adults experiencing greater EIH compared with older adults. The age differences in EIH varied across pain induction techniques and exercise type. These results provide evidence for abnormal pain modulation after acute exercise in older adults. This article enhances our understanding of the influence of a single bout of exercise on pain sensitivity and perception in healthy older compared with younger adults. This knowledge could help clinicians optimize exercise as a method of pain management. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomized controlled trial.

PubMed

Jorgensen, Martin G; Laessoe, Uffe; Hendriksen, Carsten; Nielsen, Ole Bruno Faurholt; Aagaard, Per

2013-07-01

Older adults show increased risk of falling and major risk factors include impaired lower extremity muscle strength and postural balance. However, the potential positive effect of biofeedback-based Nintendo Wii training on muscle strength and postural balance in older adults is unknown. This randomized controlled trial examined postural balance and muscle strength in community-dwelling older adults (75±6 years) pre- and post-10 weeks of biofeedback-based Nintendo Wii training (WII, n = 28) or daily use of ethylene vinyl acetate copolymer insoles (controls [CON], n = 30). Primary end points were maximal muscle strength (maximal voluntary contraction) and center of pressure velocity moment during bilateral static stance. Intention-to-treat analysis with adjustment for age, sex, and baseline level showed that the WII group had higher maximal voluntary contraction strength (18%) than the control group at follow up (between-group difference = 269 N, 95% CI = 122; 416, and p = .001). In contrast, the center of pressure velocity moment did not differ (1%) between WII and CON at follow-up (between-group difference = 0.23 mm(2)/s, 95% CI = -4.1; 4.6, and p = .92). For secondary end points, pre-to-post changes favoring the WII group were evident in the rate of force development (p = .03), Timed Up and Go test (p = .01), short Falls Efficacy Scale-International (p = .03), and 30-second repeated Chair Stand Test (p = .01). Finally, participants rated the Wii training highly motivating at 5 and 10 weeks into the intervention. Biofeedback-based Wii training led to marked improvements in maximal leg muscle strength (maximal voluntary contraction; rate of force development) and overall functional performance in community-dwelling older adults. Unexpectedly, static bilateral postural balance remained unaltered with Wii training. The high level of participant motivation suggests that biofeedback-based Wii exercise may ensure a high degree of compliance to home- and/or community-based training in community-dwelling older adults.

Performance of fuselage pressure structure

NASA Technical Reports Server (NTRS)

Maclin, James R.

1992-01-01

There are currently more than 1,000 Boeing airplanes around the world over 20 years old. That number is expected to double by the year 1995. With these statistics comes the reality that structural airworthiness will be in the forefront of aviation issues well into the next century. The results of previous and recent test programs Boeing has implemented to study the structural performance of older airplanes relative to pressurized fuselage sections are described. Included in testing were flat panels with multiple site damage (MSD), a full-scale 737 and 2 747s as well as panels representing a 737 and 777, and a generic aircraft in large pressure-test fixtures. Because damage is a normal part of aging, focus is on the degree to which structural integrity is maintained after failure or partial failure of any structural element, including multiple site damage (MSD), and multiple element damage (MED).

Author Correction: Reliability and feasibility of gait initiation centre-of-pressure excursions using a Wii® Balance Board in older adults at risk of falling.

PubMed

Lee, James; Webb, Graham; Shortland, Adam P; Edwards, Rebecca; Wilce, Charlotte; Jones, Gareth D

2018-05-12

In the original publication, the article title was incorrectly published as 'Reliability and feasibility of gait initiation centre-of-pressure excursions using a Wii® Balance Board in older adults at risk of failing'. The correct title should read as 'Reliability and feasibility of gait initiation centre-of-pressure excursions using a Wii® Balance Board in older adults at risk of falling'.

Pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography-a normative study of younger and older adults.

PubMed

Nativ-Zeltzer, N; Logemann, J A; Zecker, S G; Kahrilas, P J

2016-05-01

We aimed to define normative values for novel pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography. The effects of age, gender, and bolus properties were examined. Concurrent high-resolution manometry (HRM) and videofluoroscopy data were collected from 22 younger (aged 21-40) and 22 older (aged 60-80) healthy subjects. Pressure topography was analyzed by correlating pressure domains with videofluoroscopic events. Nine pressure topography metrics of the pharyngeal and proximal esophageal swallow were extracted; four of these were also compared with previously obtained esophageal HRM studies to assess the effects of catheter diameter. Older individuals exhibited more vigorous contractility in the pharynx than did younger subjects with all bolus types, but the greatest values for both groups were with effortful swallow and on that measure the age groups were similar. Upper esophageal sphincter (UES) intrabolus pressure during sphincter opening was also greater in the older subjects. Some gender differences were observed, particularly related to proximal esophageal contractile vigor. Bolus consistency had no consistent effect. Studies using the larger catheter diameter resulted in significantly greater contractile vigor in the UES and proximal esophagus. Older adults exhibited more vigorous pharyngeal contractions than young adults, albeit within a similar range of capacity, perhaps reflecting a compensatory response to other age-related physiological changes. Greater UES intrabolus pressures observed during bolus transit in the older group likely reflect reduced UES compliance with age. Normative data on novel HRM metrics collected in this study can serve as a reference for future clinical studies. © 2016 John Wiley & Sons Ltd.

The Effects of Aspiration Status, Liquid Type, and Bolus Volume on Pharyngeal Peak Pressure in Healthy Older Adults

PubMed Central

Stuart, Andrew; Wilhelm, Erika; Rees, Catherine; Williamson, Jeff; Kritchevsky, Stephen

2015-01-01

The reasons for aspiration in healthy adults remain unknown. Given that the pharyngeal phase of swallowing is a key component of the safe swallow, it was hypothesized that healthy older adults who aspirate are likely to generate less pharyngeal peak pressures when swallowing. Accordingly, pharyngeal and upper esophageal sphincter pressures were examined as a function of aspiration status (i.e., nonaspirator vs. aspirator), sensor location (upper vs. lower pharynx), liquid type (i.e., water vs. milk), and volume (i.e., 5 vs. 10 ml) in healthy older adults. Manometric measurements were acquired with a 2.1-mm catheter during flexible endoscopic evaluation. Participants (N = 19, mean age = 79.2 years) contributed 28 swallows; during 8 swallows, simultaneous manometric measurements of upper and lower pharyngeal and upper esophageal pressures were obtained. Pharyngeal manometric peak pressure was significantly less for aspirators (mean = 82, SD = 31 mmHg) than for nonaspirators (mean = 112, SD = 20 mmHg), and upper pharyngeal pressures (mean = 85, SD = 32 mmHg) generated less pressure than lower pharyngeal pressures (mean = 116, SD = 38 mmHg). Manometric measurements vary with respect to aspiration status and sensor location. Lower pharyngeal pressures in healthy older adults may predispose them to aspiration. PMID:20623303

Classification of frailty and falls history using a combination of sensor-based mobility assessments.

PubMed

Greene, Barry R; Doheny, Emer P; Kenny, Rose A; Caulfield, Brian

2014-10-01

Frailty is an important geriatric syndrome strongly linked to falls risk as well as increased mortality and morbidity. Taken alone, falls are the most common cause of injury and hospitalization and one of the principal causes of death and disability in older adults worldwide. Reliable determination of older adults' frailty state in concert with their falls risk could lead to targeted intervention and improved quality of care. We report a mobile assessment platform employing inertial and pressure sensors to quantify the balance and mobility of older adults using three physical assessments (timed up and go (TUG), five times sit to stand (FTSS) and quiet standing balance). This study examines the utility of each individual assessment, and the novel combination of assessments, to screen for frailty and falls risk in older adults.Data were acquired from inertial and pressure sensors during TUG, FTSS and balance assessments using a touchscreen mobile device, from 124 community dwelling older adults (mean age 75.9 ± 6.6 years, 91 female). Participants were given a comprehensive geriatric assessment which included questions on falls and frailty. Methods based on support vector machines (SVM) were developed using sensor-derived features from each physical assessment to classify patients at risk of falls risk and frailty.In classifying falls history, combining sensor data from the TUG, Balance and FTSS tests to a single classifier model per gender yielded mean cross-validated classification accuracy of 87.58% (95% CI: 84.47-91.03%) for the male model and 78.11% (95% CI: 75.38-81.10%) for the female model. These results compared well or exceeded those for classifier models for each test taken individually. Similarly, when classifying frailty status, combining sensor data from the TUG, balance and FTSS tests to a single classifier model per gender, yielded mean cross-validated classification accuracy of 93.94% (95% CI: 91.16-96.51%) for the male model and 84.14% (95% CI: 82.11-86.33%) for the female model (mean 89.04%) which compared well or exceeded results for physical tests taken individually.Results suggest that the combination of these three tests, quantified using body-worn inertial sensors, could lead to improved methods for assessing frailty and falls risk.

Vestibulosympathetic reflex during orthostatic challenge in aging humans

NASA Technical Reports Server (NTRS)

Monahan, Kevin D.; Ray, Chester A.

2002-01-01

Aging attenuates the increase in muscle sympathetic nerve activity (MSNA) and elicits hypotension during otolith organ engagement in humans. The purpose of the present study was to determine the neural and cardiovascular responses to otolithic engagement during orthostatic stress in older adults. We hypothesized that age-related impairments in the vestibulosympathetic reflex would persist during orthostatic challenge in older subjects and might compromise arterial blood pressure regulation. MSNA, arterial blood pressure, and heart rate responses to head-down rotation (HDR) performed with and without lower body negative pressure (LBNP) in prone subjects were measured. Ten young (27 +/- 1 yr) and 11 older subjects (64 +/- 1 yr) were studied prospectively. HDR performed alone elicited an attenuated increase in MSNA in older subjects (Delta106 +/- 28 vs. Delta20 +/- 7% for young and older subjects). HDR performed during simultaneous orthostatic stress increased total MSNA further in young (Delta53 +/- 15%; P < 0.05) but not older subjects (Delta-5 +/- 4%). Older subjects demonstrated consistent significant hypotension during HDR performed both alone (Delta-6 +/- 2 mmHg) and during LBNP (Delta-7 +/- 2 mmHg). These data provide experimental support for the concept that age-related impairments in the vestibulosympathetic reflex persist during orthostatic challenge in older adults. Furthermore, these findings are consistent with the concept that age-related alterations in vestibular function might contribute to altered orthostatic blood pressure regulation with age in humans.

Socioeconomic and lifestyle factors associated with chronic conditions among older adults in Ecuador.

PubMed

Guevara, Pilar Egüez; Andrade, Flávia Cristina Drumond

2015-09-01

To explore socioeconomic and lifestyle factors associated with the prevalence of self-reported chronic conditions among older adults in Ecuador. The sample was drawn from the nationally representative observational cross-sectional data of the Health, Well-Being, and Aging survey conducted in Ecuador in 2009. Logistic regression models were used to explore the association between socioeconomic and lifestyle factors and the prevalence of selected chronic conditions. Older women in Ecuador are more likely than men to have been previously diagnosed with diabetes, heart disease, high blood pressure, and arthritis. Results suggest no difference by education or health insurance on number and type of self-reported chronic conditions. However, older adults who resided in the coastal area were more likely to report having diabetes, heart disease, high blood pressure, and stroke than those in the highlands. Living in rural areas was associated with lower odds of having diabetes and high blood pressure. Compared to white older adults, indigenous older adults were less likely to report having high blood pressure, but more likely to report having arthritis. Older age in Ecuador is marked by low educational levels and poverty. Female gender and living in coastal areas were associated with higher risks of self-reported chronic conditions.

49 CFR Appendix B to Part 195 - Risk-Based Alternative to Pressure Testing Older Hazardous Liquid and Carbon Dioxide Pipelines

Code of Federal Regulations, 2014 CFR

2014-10-01

...) (Propane, butane, Natural Gas Liquid (NGL), ammonia) Highly toxic (Benzene, high Hydrogen Sulfide content... Hazardous Liquid and Carbon Dioxide Pipelines B Appendix B to Part 195 Transportation Other Regulations... OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pt. 195...

49 CFR Appendix B to Part 195 - Risk-Based Alternative to Pressure Testing Older Hazardous Liquid and Carbon Dioxide Pipelines

Code of Federal Regulations, 2012 CFR

2012-10-01

...) (Propane, butane, Natural Gas Liquid (NGL), ammonia) Highly toxic (Benzene, high Hydrogen Sulfide content... Hazardous Liquid and Carbon Dioxide Pipelines B Appendix B to Part 195 Transportation Other Regulations... OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pt. 195...

49 CFR Appendix B to Part 195 - Risk-Based Alternative to Pressure Testing Older Hazardous Liquid and Carbon Dioxide Pipelines

Code of Federal Regulations, 2011 CFR

2011-10-01

...) (Propane, butane, Natural Gas Liquid (NGL), ammonia) Highly toxic (Benzene, high Hydrogen Sulfide content... Hazardous Liquid and Carbon Dioxide Pipelines B Appendix B to Part 195 Transportation Other Regulations... OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pt. 195...

49 CFR Appendix B to Part 195 - Risk-Based Alternative to Pressure Testing Older Hazardous Liquid and Carbon Dioxide Pipelines

Code of Federal Regulations, 2013 CFR

2013-10-01

...) (Propane, butane, Natural Gas Liquid (NGL), ammonia) Highly toxic (Benzene, high Hydrogen Sulfide content... Hazardous Liquid and Carbon Dioxide Pipelines B Appendix B to Part 195 Transportation Other Regulations... OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pt. 195...

49 CFR Appendix B to Part 195 - Risk-Based Alternative to Pressure Testing Older Hazardous Liquid and Carbon Dioxide Pipelines

Code of Federal Regulations, 2010 CFR

2010-10-01

...) (Propane, butane, Natural Gas Liquid (NGL), ammonia) Highly toxic (Benzene, high Hydrogen Sulfide content... Hazardous Liquid and Carbon Dioxide Pipelines B Appendix B to Part 195 Transportation Other Regulations... OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pt. 195...

Effects of Water-Based Training on Static and Dynamic Balance of Older Women.

PubMed

Bento, Paulo Cesar Barauce; Lopes, Maria de Fátima A; Cebolla, Elaine Cristine; Wolf, Renata; Rodacki, André L F

2015-08-01

The aim of this study was to evaluate the effects of a water-based exercise program on static and dynamic balance. Thirty-six older women were randomly assigned to a water-based training (3 days/week for 12 weeks) or control group. Water level was kept at the level of the xiphoid process and temperature at ∼28-30°C. Each session included aerobic activities and lower limb strength exercises. The medial-lateral, the anterior-posterior amplitude, and displacement of the center of pressure (CP-D) were measured in a quiet standing position (60 sec eyes opened and closed). The dynamic balance and 8-Foot Up-and-Go tests were also applied. Group comparisons were made using two-way analysis of variance (ANOVA) with repeated measures. No differences were found in the center of pressure variables; however, the WBT group showed better performance in the 8 Foot Up-and-Go Test after training (5.61±0.76 vs. 5.18±0.42; p<0.01). The water-based training was effective in improving dynamic balance, but not static balance.

Relationships among Blood Pressure, Triglycerides and Verbal Learning in African Americans

PubMed Central

Sims, Regina C.; Madhere, Serge; Gordon, Shalanda; Clark, Elijah; Abayomi, Kobi A.; Callender, Clive O.; Campbell, Alfonso L.

2013-01-01

Background Individuals at greater risk for cardiovascular disease (CVD) display poorer cognitive functioning across various cognitive domains. This finding is particularly prevalent among older adults; however, few studies examine these relationships among younger adults or among African Americans. Purpose The objective was to examine the relationships among 2 cardiovascular risk factors, elevated blood pressure and elevated triglycerides, and verbal learning in a community-based sample of African Americans. Methods Measurements of blood pressure and triglycerides were obtained in 121 African-American adults and compared to performance on 3 domains of the California Verbal Learning Test-II (CVLT-II). Results Blood pressure was not related to CVLT-II performance. Triglyceride levels were inversely related to CVLT-II performance. Higher triglyceride levels were associated with poorer immediate, short delay and long delay recall. Conclusions Consistent with studies involving older participants, the current investigation shows that in a nonelderly sample of African Americans, triglyceride levels may be related to cognitive functioning. Because early detection and intervention of vascular-related cognitive impairment may have a salutary effect, future studies should include younger adults to highlight the impact of cardiovascular risk on cognition. PMID:18942281

Cluster randomized controlled trial of a multilevel physical activity intervention for older adults.

PubMed

Kerr, Jacqueline; Rosenberg, Dori; Millstein, Rachel A; Bolling, Khalisa; Crist, Katie; Takemoto, Michelle; Godbole, Suneeta; Moran, Kevin; Natarajan, Loki; Castro-Sweet, Cynthia; Buchner, David

2018-04-02

Older adults are the least active population group. Interventions in residential settings may support a multi-level approach to behavior change. In a cluster randomized control trial, 11 San Diego retirement communities were assigned to a physical activity (PA) intervention or a healthy aging attention control condition. Participants were 307 adults over 65 years old. The multilevel PA intervention was delivered with the assistance of peer leaders, who were trained older adult from the retirement communities. Intervention components included individual counseling & self-monitoring with pedometers, group education sessions, group walks, community advocacy and pedestrian community change projects. Intervention condition by time interactions were tested using generalized mixed effects regressions. The primary outcomes was accelerometer measured physical activity. Secondary outcomes were blood pressure and objectively measured physical functioning. Over 70% of the sample were 80 years or older. PA significantly increased in the intervention condition (56 min of moderate-vigorous PA per week; 119 min of light PA) compared with the control condition and remained significantly higher across the 12 month study. Men and participants under 84 years old benefited most from the intervention. There was a significant decrease in systolic (p < .007) and diastolic (p < .02) blood pressure at 6 months. Physical functioning improved but the changes were not statistically significant. Intervention fidelity was high demonstrating feasibility. Changes in PA and blood pressure achieved were comparable to other studies with much younger participants. Men, in particular, avoided a year-long decline in PA. clincialtrials.gov Identifier: NCT01155011 .

Vision Loss in Older Adults.

PubMed

Pelletier, Allen L; Rojas-Roldan, Ledy; Coffin, Janis

2016-08-01

Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years. The U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults older than 65 years. However, family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment. The conditions that cause most cases of vision loss in older patients are age-related macular degeneration, glaucoma, ocular complications of diabetes mellitus, and age-related cataracts. Vitamin supplements can delay the progression of age-related macular degeneration. Intravitreal injection of a vascular endothelial growth factor inhibitor can preserve vision in the neovascular form of macular degeneration. Medicated eye drops reduce intraocular pressure and can delay the progression of vision loss in patients with glaucoma, but adherence to treatment is poor. Laser trabeculoplasty also lowers intraocular pressure and preserves vision in patients with primary open-angle glaucoma, but long-term studies are needed to identify who is most likely to benefit from surgery. Tight glycemic control in adults with diabetes slows the progression of diabetic retinopathy, but must be balanced against the risks of hypoglycemia and death in older adults. Fenofibrate also slows progression of diabetic retinopathy. Panretinal photocoagulation is the mainstay of treatment for diabetic retinopathy, whereas vascular endothelial growth factor inhibitors slow vision loss resulting from diabetic macular edema. Preoperative testing before cataract surgery does not improve outcomes and is not recommended.

Effects of acute dietary nitrate supplementation on aortic blood pressure and aortic augmentation index in young and older adults.

PubMed

Hughes, William E; Ueda, Kenichi; Treichler, David P; Casey, Darren P

2016-09-30

Aging is associated with elevated blood pressure (peripheral and aortic; BP) and aortic augmentation index (AIx) which may contribute to aortic BP. Although inorganic nitrate consumption reduces peripheral BP in both young and older adults, the effects of nitrate consumption on aortic BP and wave reflection in young and older adults is unknown. Therefore, we sought to characterize the effects of nitrate consumption on aortic BP and AIx in young and older adults. Noninvasive aortic pressure waveforms were synthesized from high-fidelity radial pressure waveforms via applanation tonometry before and following (60, 90, 120, 150, and 180 min) consumption of a nitrate-rich beetroot juice in 26 healthy adults (young: 25 ± 4 years, n = 14; older: 64 ± 5 years, n = 12). Aortic BP and indices of aortic wave reflection (AIx and AIx normalized for heart rate; AIx@75bpm) were calculated from the generated aortic pressure waveform. Nitrate consumption increased plasma nitrite in both groups 60-180 min following beetroot consumption (P < 0.001). Nitrate consumption reduced peripheral and aortic BP in both young and older adults (P < 0.05), with the change being similar between age groups. Conversely, indices of aortic wave reflection were reduced only in young adults following nitrate consumption (range of change from baseline over time: AIx@75bpm, -4.3 to -8.8%, P < 0.05), whereas aortic AIx remained unchanged in the older adults. Taken together, our results suggest that acute dietary nitrate supplementation reduces peripheral and aortic BP similarly in young and older adults despite differential effects on aortic AIx between age groups. Copyright © 2016 Elsevier Inc. All rights reserved.

Do older adults change their eyewitness reports when re-questioned?

PubMed

Henkel, Linda A

2014-05-01

This study examined how older adults responded to different types of pressure to change their responses when questioned a second time about their memory for a crime. After watching a video of a crime and answering questions about remembered details, younger (18-22 years) and older adults (64-91 years) were either given negative feedback about their memory performance, were told that most people their age did poorly on the memory test (stereotype threat), or were simply asked to answer the questions again. This was done regardless of their actual accuracy, and the questions were then repeated. Results showed that both younger and older adults changed significantly more responses following negative feedback and changed more responses on misleading than on nonleading questions. Among older adults, as age increased, accuracy decreased and rate of response change increased. People were moderately confident overall about both their correct and incorrect responses. These results highlight the dangers of repeatedly questioning older witnesses with misleading questions and suggest that the responses that are changed may come to be remembered confidently-regardless of whether they are correct or incorrect.

Fluid mechanics moderate the effect of implementation intentions on a health prospective memory task in older adults.

PubMed

Brom, Sarah Susanne; Schnitzspahn, Katharina Marlene; Melzer, Marlen; Hagner, Franziska; Bernhard, Anka; Kliegel, Matthias

2014-03-01

The aim of the present study was to test if a cognitive strategy improves older adults' prospective memory performance in a naturalistic health task. Moreover, it was tested if a possible strategy effect is moderated by individual differences. Therefore, a group of older adults was asked to perform a task taken from the medication adherence literature (i.e., blood pressure monitoring). Half of them were asked to form implementation intentions. Additionally, crystallized pragmatics and fluid mechanics, conscientiousness, self-efficacy, and lifestyle factors were assessed as possible moderators. Results showed a strong positive strategy effect on prospective memory. Moreover, the effect was qualified by a significant interaction and only emerged for participants with low levels in fluid mechanics. No other moderator showed an effect. In conclusion, an enhancing effect of implementation intentions on prospective memory seems to be dependent on individual differences in cognitive capacity and less related to key motivational or personality variables.

Influence of arterial wave reflection on carotid blood pressure and intima-media thickness in older endurance trained men and women with pre-hypertension.

PubMed

Heffernan, Kevin S; Jae, Sae Young; Tomayko, Emily; Ishaque, Muhammad R; Fernhall, Bo; Wilund, Kenneth R

2009-05-01

Increased carotid intima-media thickness (IMT) with aging is a significant predictor of mortality. Older endurance trained (ET) individuals have lower carotid artery stiffness but similar carotid IMT when compared to sedentary (SED) age-matched peers. The purpose of this study was to examine the contribution of arterial wave reflections to carotid hemodynamics and IMT in older ET and SED with pre-hypertension. Subjects consisted of endurance-trained master athletes and age-matched sedentary controls (mean age 67 years). Carotid artery Beta-stiffness index and IMT was assessed with ultrasonography. Carotid pressure and augmented pressure from wave reflections (obtained from pulse contour analysis) was measured with applanation tonometry. Carotid systolic blood pressure (SBP) and IMT were not different between groups (P>0.05). Carotid stiffness was significantly lower in ET versus SED (7.3 +/- 0.8 versus 9.9 +/- 0.6, P<0.05). Augmented pressure was significantly greater in ET versus SED (17.7 +/- 1.6 versus 13.3 +/- 1.5 mmHg, P<0.05). When adjusting for differences in resting heart rate, there were no group differences in augmented pressure. In conclusion, older ET persons with pre-hypertension have reduced carotid artery stiffness, but similar carotid SBP and carotid IMT when compared to SED. The lack of change in carotid SBP and IMT in older ET may be related to the inability of chronic exercise training to reduce bradycardia-related augmented pressure from wave reflections with aging.

Body composition and blood pressure in children based on age, race, and sex.

PubMed

Brandon, L J; Fillingim, J

1993-01-01

We evaluated 675 nine- and twelve-year-old children for body composition and circulatory differences based on age, race, and sex. The specific variables measured included height, weight, triceps and subscapula skinfolds, body mass index, percentage fat, fat-free weight, and systolic, diastolic, and mean arterial blood pressures. A 2 x 2 x 2 factorial multiple analysis of variance (MANOVA) test of significance showed body composition and blood pressure differences (P < .01) for race, age, and sex. The univariate test of the specific variables within the factors showed that black children had higher fat-free weights and lower fat levels but higher blood pressure values (P < .05) than white children. Boys had lower fat levels than girls, and the older children had higher values on the body composition variables but not on blood pressure. Zero order correlations between body composition and blood pressure ranged from 0.14 to 0.55; systolic blood pressure and body weight shared the highest correlation. These data show that, although black children have less body fat than white children, they are heavier and have higher blood pressure. We hypothesize that some aspect of fat-free body weight may contribute to hypertension in black individuals.

Neural control of blood pressure in women: differences according to age

PubMed Central

Peinado, Ana B.; Harvey, Ronee E.; Hart, Emma C.; Charkoudian, Nisha; Curry, Timothy B.; Nicholson, Wayne T.; Wallin, B. Gunnar; Joyner, Michael J.; Barnes, Jill N.

2017-01-01

Purpose The blood pressure “error signal” represents the difference between an individual’s mean diastolic blood pressure and the diastolic blood pressure at which 50% of cardiac cycles are associated with a muscle sympathetic nerve activity burst (the “T50”). In this study we evaluated whether T50 and the error signal related to the extent of change in blood pressure during autonomic blockade in young and older women, to study potential differences in sympathetic neural mechanisms regulating blood pressure before and after menopause. Methods We measured muscle sympathetic nerve activity and blood pressure in 12 premenopausal (25±1 years) and 12 postmenopausal women (61±2 years) before and during complete autonomic blockade with trimethaphan camsylate. Results At baseline, young women had a negative error signal (−8±1 versus 2±1 mmHg, p<0.001; respectively) and lower muscle sympathetic nerve activity (15±1 versus 33±3 bursts/min, p<0.001; respectively) than older women. The change in diastolic blood pressure after autonomic blockade was associated with baseline T50 in older women (r=−0.725, p=0.008) but not in young women (r=−0.337, p=0.29). Women with the most negative error signal had the lowest muscle sympathetic nerve activity in both groups (young: r=0.886, p<0.001; older: r=0.870, p<0.001). Conclusions Our results suggest that there are differences in baroreflex control of muscle sympathetic nerve activity between young and older women, using the T50 and error signal analysis. This approach provides further information on autonomic control of blood pressure in women. PMID:28205011

Does children's moral compass waver under social pressure? Using the conformity paradigm to test preschoolers' moral and social-conventional judgments.

PubMed

Kim, Elizabeth B; Chen, Chuansheng; Smetana, Judith G; Greenberger, Ellen

2016-10-01

The current study tested whether preschoolers' moral and social-conventional judgments change under social pressure using Asch's conformity paradigm. A sample of 132 preschoolers (Mage=3.83years, SD=0.85) rated the acceptability of moral and social-conventional events and also completed a visual judgment task (i.e., comparing line length) both independently and after having viewed two peers who consistently made immoral, unconventional, or visually inaccurate judgments. Results showed evidence of conformity on all three tasks, but conformity was stronger on the social-conventional task than on the moral and visual tasks. Older children were less susceptible to pressure for social conformity for the moral and visual tasks but not for the conventional task. Copyright © 2016 Elsevier Inc. All rights reserved.

Spatiotemporal and plantar pressure patterns of 1000 healthy individuals aged 3-101 years.

PubMed

McKay, Marnee J; Baldwin, Jennifer N; Ferreira, Paulo; Simic, Milena; Vanicek, Natalie; Wojciechowski, Elizabeth; Mudge, Anita; Burns, Joshua

2017-10-01

The purpose of this study was to establish normative reference values for spatiotemporal and plantar pressure parameters, and to investigate the influence of demographic, anthropometric and physical characteristics. In 1000 healthy males and females aged 3-101 years, spatiotemporal and plantar pressure data were collected barefoot with the Zeno™ walkway and Emed ® platform. Correlograms were developed to visualise the relationships between widely reported spatiotemporal and pressure variables with demographic (age, gender), anthropometric (height, mass, waist circumference) and physical characteristics (ankle strength, ankle range of motion, vibration perception) in children aged 3-9 years, adolescents aged 10-19 years, adults aged 20-59 years and older adults aged over 60 years. A comprehensive catalogue of 31 spatiotemporal and pressure variables were generated from 1000 healthy individuals. The key findings were that gait velocity was stable during adolescence and adulthood, while children and older adults walked at a comparable slower speed. Peak pressures increased during childhood to older adulthood. Children demonstrated highest peak pressures beneath the rearfoot whilst adolescents, adults and older adults demonstrated highest pressures at the forefoot. Main factors influencing spatiotemporal and pressure parameters were: increased age, height, body mass and waist circumference, as well as ankle dorsiflexion and plantarflexion strength. This study has established whole of life normative reference values of widely used spatiotemporal and plantar pressure parameters, and revealed changes to be expected across the lifespan. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of 12-week proprioception training program on postural stability, gait, and balance in older adults: a controlled clinical trial.

PubMed

Martínez-Amat, Antonio; Hita-Contreras, Fidel; Lomas-Vega, Rafael; Caballero-Martínez, Isabel; Alvarez, Pablo J; Martínez-López, Emilio

2013-08-01

The purpose of this study was to evaluate the effect of a 12-week-specific proprioceptive training program on postural stability, gait, balance, and fall prevention in adults older than 65 years. The present study was a controlled clinical trial. Forty-four community dwelling elderly subjects (61-90 years; mean age, 78.07 ± 5.7 years) divided into experimental (n = 20) and control (n = 24) groups. The participants performed the Berg balance test before and after the training program, and we assessed participants' gait, balance, and the risk of falling, using the Tinetti scale. Medial-lateral plane and anterior-posterior plane displacements of the center of pressure, Sway area, length and speed, and the Romberg quotient about surface, speed, and distance were calculated in static posturography analysis (EPS pressure platform) under 2 conditions: eyes open and eyes closed. After a first clinical evaluation, patients were submitted to 12 weeks proprioception training program, 2 sessions of 50 minutes every week. This program includes 6 exercises with the BOSU and Swiss ball as unstable training tools that were designed to program proprioceptive training. The training program improved postural balance of older adults in mediolateral plane with eyes open (p < 0.05) and anterior-posterior plane with eyes closed (p < 0.01). Significant improvements were observed in Romberg quotient about surface (p < 0.05) and speed (p < 0.01) but not about distance (p > 0.05). After proprioception training, gait (Tinetti), and balance (Berg) test scores improved 14.66% and 11.47% respectively. These results show that 12 weeks proprioception training program in older adults is effective in postural stability, static, and dynamic balance and could lead to an improvement in gait and balance capacity, and to a decrease in the risk of falling in adults aged 65 years and older.

Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: three case reports.

PubMed

Yeates, Erin M; Molfenter, Sonja M; Steele, Catriona M

2008-01-01

Dysphagia, or difficulty swallowing, often occurs secondary to conditions such as stroke, head injury or progressive disease, many of which increase in frequency with advancing age. Sarcopenia, the gradual loss of muscle bulk and strength, can place older individuals at greater risk for dysphagia. Data are reported for three older participants in a pilot trial of a tongue-pressure training therapy. During the experimental therapy protocol, participants performed isometric strength exercises for the tongue as well as tongue pressure accuracy tasks. Biofeedback was provided using the Iowa Oral Performance Instrument (IOPI), an instrument that measures tongue pressure. Treatment outcome measures show increased isometric tongue strength, improved tongue pressure generation accuracy, improved bolus control on videofluoroscopy, and improved functional dietary intake by mouth. These preliminary results indicate that, for these three adults with dysphagia, tongue-pressure training was beneficial for improving both instrumental and functional aspects of swallowing. The experimental treatment protocol holds promise as a rehabilitative tool for various dysphagia populations.

Conditioned pain modulation (CPM) in children and adolescents: Effects of sex and age

PubMed Central

Tsao, Jennie C. I.; Seidman, Laura C.; Evans, Subhadra; Lung, Kirsten C.; Zeltzer, Lonnie K.; Naliboff, Bruce D.

2013-01-01

Conditioned pain modulation (CPM) refers to the diminution of perceived pain intensity for a test stimulus following application of a conditioning stimulus to a remote area of the body, and is thought to reflect the descending inhibition of nociceptive signals. Studying CPM in children may inform interventions to enhance central pain inhibition within a developmental framework. We assessed CPM in 133 healthy children (mean age = 13 years; 52.6% girls) and tested the effects of sex and age. Participants were exposed to four trials of a pressure test stimulus before, during, and after the application of a cold water conditioning stimulus. CPM was documented by a reduction in pressure pain ratings during cold water administration. Older children (12–17 years) exhibited greater CPM than younger (8–11 years) children. No sex differences in CPM were found. Lower heart rate variability (HRV) at baseline and after pain induction was associated with less CPM controlling for child age. The findings of greater CPM in the older age cohort suggest a developmental improvement in central pain inhibitory mechanisms. The results highlight the need to examine developmental and contributory factors in central pain inhibitory mechanisms in children to guide effective, age appropriate, pain interventions. PMID:23541066

Tai Chi and Kung-Fu practice maintains physical performance but not vascular health in young versus old participants.

PubMed

McAnulty, Steven; McAnulty, Lisa; Collier, Scott; Souza-Junior, Tacito P; McBride, Jeffrey

2016-01-01

Kung-Fu and Tai Chi along with other martial arts are gaining popularity but studies examining the benefits of martial arts on physical fitness, vascular health, nutrition, and psychological wellness are limited. Aging is associated with declines in these health components. The objectives of this study were to examine whether Tai Chi and Kung-Fu training would maintain physical fitness, vascular health, and psychological wellness components on older versus younger practitioners. Seventeen subjects were recruited and divided into Young (age <40 years, n=9) and Old (age 40 years and above, n=8). Participants reported twice for health screens, vascular and nutrition assessment, and fitness tests. Mean differences were compared between groups for all tests using Student's t-tests. Age, months of practice, systolic blood pressure, and cardiovascular augmentation index were significantly greater in Old versus Young (p=0.001, p=0.007, p=0.049, and p=0.011, respectively). Psychologically, old practitioners experienced greater sleep interference (p=0.035) and overall pain (p=0.036). No other differences existed for any variable. Our study indicates that the practice of Tai Chi and Kung-Fu maintains physical fitness in older compared to younger practitioners. However, age associated changes in cardiovascular stiffness, systolic blood pressure, and pain were not prevented.

Is spending money on others good for your heart?

PubMed

Whillans, Ashley V; Dunn, Elizabeth W; Sandstrom, Gillian M; Dickerson, Sally S; Madden, Kenneth M

2016-06-01

Does spending money on others (prosocial spending) improve the cardiovascular health of community-dwelling older adults diagnosed with high blood pressure? In Study 1, 186 older adults diagnosed with high blood pressure participating in the Midlife in the U.S. Study (MIDUS) were examined. In Study 2, 73 older adults diagnosed with high blood pressure were assigned to spend money on others or to spend money on themselves. In Study 1, the more money people spent on others, the lower their blood pressure was 2 years later. In Study 2, participants who were assigned to spend money on others for 3 consecutive weeks subsequently exhibited lower systolic and diastolic blood pressure compared to participants assigned to spend money on themselves. The magnitude of these effects was comparable to the effects of interventions such as antihypertensive medication or exercise. Together, these findings suggest that spending money on others shapes cardiovascular health, thereby providing a pathway by which prosocial behavior improves physical health among at-risk older adults. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Haptic-Based Perception-Empathy Biofeedback Enhances Postural Motor Learning During High-Cognitive Load Task in Healthy Older Adults

PubMed Central

Yasuda, Kazuhiro; Saichi, Kenta; Iwata, Hiroyasu

2018-01-01

Falls and fall-induced injuries are major global public health problems, and sensory input impairment in older adults results in significant limitations in feedback-type postural control. A haptic-based biofeedback (BF) system can be used for augmenting somatosensory input in older adults, and the application of this BF system can increase the objectivity of the feedback and encourage comparison with that provided by a trainer. Nevertheless, an optimal BF system that focuses on interpersonal feedback for balance training in older adults has not been proposed. Thus, we proposed a haptic-based perception-empathy BF system that provides information regarding the older adult's center-of-foot pressure pattern to the trainee and trainer for refining the motor learning effect. The first objective of this study was to examine the effect of this balance training regimen in healthy older adults performing a postural learning task. Second, this study aimed to determine whether BF training required high cognitive load to clarify its practicability in real-life settings. Twenty older adults were assigned to two groups: BF and control groups. Participants in both groups tried balance training in the single-leg stance while performing a cognitive task (i.e., serial subtraction task). Retention was tested 24 h later. Testing comprised balance performance measures (i.e., 95% confidence ellipse area and mean velocity of sway) and dual-task performance (number of responses and correct answers). Measurements of postural control using a force plate revealed that the stability of the single-leg stance was significantly lower in the BF group than in the control group during the balance task. The BF group retained the improvement in the 95% confidence ellipse area 24 h after the retention test. Results of dual-task performance during the balance task were not different between the two groups. These results confirmed the potential benefit of the proposed balance training regimen in designing successful motor learning programs for preventing falls in older adults. PMID:29868597

Haptic-Based Perception-Empathy Biofeedback Enhances Postural Motor Learning During High-Cognitive Load Task in Healthy Older Adults.

PubMed

Yasuda, Kazuhiro; Saichi, Kenta; Iwata, Hiroyasu

2018-01-01

Falls and fall-induced injuries are major global public health problems, and sensory input impairment in older adults results in significant limitations in feedback-type postural control. A haptic-based biofeedback (BF) system can be used for augmenting somatosensory input in older adults, and the application of this BF system can increase the objectivity of the feedback and encourage comparison with that provided by a trainer. Nevertheless, an optimal BF system that focuses on interpersonal feedback for balance training in older adults has not been proposed. Thus, we proposed a haptic-based perception-empathy BF system that provides information regarding the older adult's center-of-foot pressure pattern to the trainee and trainer for refining the motor learning effect. The first objective of this study was to examine the effect of this balance training regimen in healthy older adults performing a postural learning task. Second, this study aimed to determine whether BF training required high cognitive load to clarify its practicability in real-life settings. Twenty older adults were assigned to two groups: BF and control groups. Participants in both groups tried balance training in the single-leg stance while performing a cognitive task (i.e., serial subtraction task). Retention was tested 24 h later. Testing comprised balance performance measures (i.e., 95% confidence ellipse area and mean velocity of sway) and dual-task performance (number of responses and correct answers). Measurements of postural control using a force plate revealed that the stability of the single-leg stance was significantly lower in the BF group than in the control group during the balance task. The BF group retained the improvement in the 95% confidence ellipse area 24 h after the retention test. Results of dual-task performance during the balance task were not different between the two groups. These results confirmed the potential benefit of the proposed balance training regimen in designing successful motor learning programs for preventing falls in older adults.

Cardiovascular regulation during head-up tilt in healthy 20-30-year-old and 70-75-year-old men.

PubMed

Gabbett, T J; Weston, S B; Barrett, R S; Gass, G C

2001-02-01

This study compared the heart rate, finger arterial pressure (AP) and electromyographic (EMG) activity of selected anti-gravity muscles during the initial and prolonged phases of orthostatic stress in healthy young and older men. Beat-by-beat recordings of heart rate, finger systolic pressure, diastolic pressure and mean AP were made during supine rest and 5 min of 90 degrees head-up tilt (HUT) in 18 young (23+/-1 years) and 15 older (73+/-1 years) men. The EMG activity of the soleus, tibialis anterior and vastus medialis muscles was recorded. During the first 30 s following 90 degrees HUT (immediate response), the young men exhibited significant (P<0.05) decreases in finger systolic pressure, diastolic pressure and mean AP, followed by a sustained increase in finger AP during the 5 min following 90 degrees HUT (prolonged response). The immediate and prolonged finger AP and diastolic pressure responses were not significantly different (P>0.05) from the values at supine rest for the older men. The mean root mean square EMG activity of the soleus, tibialis anterior and vastus medialis muscles during 90 degrees HUT was not significantly different (P>0.05) from that at supine rest for either group. These results demonstrate that, when compared with healthy older men, young men show larger reductions in finger AP during the initial phase of orthostatic stress. However, during the prolonged phase of orthostatic stress, older men maintain resting finger AP, whereas young men demonstrate a reflex overshoot in finger AP. Finally, differences in lower-limb anti-gravity muscle activation do not account for the contrasting finger AP responses of healthy young and older men.

Effect of transcutaneous electrical stimulation amplitude on timing of swallow pressure peaks between healthy young and older adults.

PubMed

Barikroo, Ali; Berretin-Felix, Giedré; Carnaby, Giselle; Crary, Michael

2017-03-01

This study compared the effect of transcutaneous electrical stimulation (TES) amplitude on timing of lingual-palatal and pharyngeal peak pressures during swallowing in healthy younger and older adults. Transcutaneous electrical stimulation amplitude is one parameter that may have different impacts on the neuromotor system and swallowing physiology. One aspect of swallowing physiology influenced by age is the timing of swallowing events. However, the effect of varying TES amplitudes on timing of swallowing physiology is poorly understood, especially in older adults. Thirty-four adults (20 younger and 14 older) swallowed 10 ml of nectar-thick liquid under three TES conditions: no stimulation, low-amplitude stimulation and high-amplitude stimulation. TES was delivered by surface electrodes on the anterior neck. Timing of pressure peaks for lingual-palatal contacts and pharyngeal pressures were measured under each condition. A significant age × stimulation amplitude interaction was identified for the base of tongue (BOT) [F(2,62) = 5.087, p < 0.009] and the hypopharynx (HYPO) [F(2,62) = 3.277, p < 0.044]. At the BOT, low-amplitude TES resulted in slower swallows in the younger adults compared with no TES. In older adults, low-amplitude TES resulted in faster swallows compared with high-amplitude TES. At the HYPO, no significant differences were identified in pressure timing across the three TES amplitudes in both age groups. In each case, low-amplitude TES resulted in faster swallows in older adults compared with younger adults. Transcutaneous electrical stimulation influences pharyngeal pressure timing differently in young and old people, which questions the appropriateness of using a 'one-size-fits-all' TES amplitude for rehabilitating people with dysphagia. © 2015 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Relationship of metabolic and endocrine parameters to brain glucose metabolism in older adults: do cognitively-normal older adults have a particular metabolic phenotype?

PubMed

Nugent, S; Castellano, C A; Bocti, C; Dionne, I; Fulop, T; Cunnane, S C

2016-02-01

Our primary objective in this study was to quantify whole brain and regional cerebral metabolic rates of glucose (CMRg) in young and older adults in order to determine age-normalized reference CMRg values for healthy older adults with normal cognition for age. Our secondary objectives were to--(i) report a broader range of metabolic and endocrine parameters including body fat composition that could form the basis for the concept of a 'metabolic phenotype' in cognitively normal, older adults, and (ii) to assess whether medications commonly used to control blood lipids, blood pressure or thyroxine affect CMRg values in older adults. Cognition assessed by a battery of tests was normal for age and education in both groups. Compared to the young group (25 years old; n = 34), the older group (72 years old; n = 41) had ~14% lower CMRg (μmol/100 g/min) specifically in the frontal cortex, and 18% lower CMRg in the caudate. Lower grey matter volume and cortical thickness was widespread in the older group. These differences in CMRg, grey matter volume and cortical thickness were present in the absence of any known evidence for prodromal Alzheimer's disease (AD). Percent total body fat was positively correlated with CMRg in many brain regions but only in the older group. Before and after controlling for body fat, HOMA2-IR was significantly positively correlated to CMRg in several brain regions in the older group. These data show that compared to a healthy younger adult, the metabolic phenotype of a cognitively-normal 72 year old person includes similar plasma glucose, insulin, cholesterol, triglycerides and TSH, higher hemoglobin A1c and percent body fat, lower CMRg in the superior frontal cortex and caudate, but the same CMRg in the hippocampus and white matter. Age-normalization of cognitive test results is standard practice and we would suggest that regional CMRg in cognitively healthy older adults should also be age-normalized.

Effects of orthopedic insoles on static balance of older adults wearing thick socks.

PubMed

Ma, Christina Zong-Hao; Wong, Duo Wai-Chi; Wan, Anson Hong-Ping; Lee, Winson Chiu-Chun

2018-06-01

The wearing of socks and insoles may affect the ability of the foot to detect tactile input influencing postural balance. The aim of this study was to investigate whether (1) thick socks adversely affected the elderly postural balance and (2) orthopedic insoles could improve the elderly postural balance while wearing thick socks. Repeated-measures study design. In total, 14 healthy older adults were recruited. A monofilament test was conducted to evaluate foot plantar sensation with and without thick socks. Subjects then performed the Romberg tests under three conditions: (1) barefoot, (2) with socks only, and (3) with both socks and insoles. Postural balance was assessed by measuring the center of pressure movement during standing in each experimental condition. Thick socks significantly decreased the monofilament score ( p < 0.001), suggesting reduction in ability to detect external forces. All center of pressure parameters increased significantly while wearing thick socks ( p < 0.017), implying reduction of postural stability. They then decreased significantly with the additional use of insoles ( p < 0.017). Previous studies have documented the changes in plantar pressure distribution with the use of orthopedic insoles. This study further suggests that such changes in contact mechanics could produce some balance-improving effects, which appears not to have been reported earlier. Clinical relevance Wearing thick socks reduces plantar pressure sensitivity and increases postural sway which may increase risk of falls. Orthopedic insoles and footwear with similar design could potentially be a cost-effective method in maintaining postural balance when wearing thick socks.

Assessment of postural balance in community-dwelling older adults - methodological aspects and effects of biofeedback-based Nintendo Wii training.

PubMed

Jørgensen, Martin Grønbech

2014-01-01

The overall purpose of this thesis was to examine selected methodological aspects and novel approaches for measuring postural balance older adults, and to examine the effects of biofeedback-based Nintendo Wii training on selected physiological, psychological and functional outcome variables in community-dwelling older adults. In Study I balance control was investigated using force plate analysis of Centre of Pressure (COP) excursion during static bilateral standing in 32 community-dwelling older adults at three different time-points (09:00, 12:30, and 16:00) throughout the day. An overall significant time-of-day effect was observed for all selected COP variables. The greatest change in all COP variables was observed (on average ~15%) between midday (12:30) and the afternoon (16:00), indicating that a systematic time-of-day influence on static postural balance exists in community-dwelling older adults. Consequently, longitudinal (i.e. pre-to-post training) comparisons of postural balance in in older adults with repeated assessments should be conducted at the same time-of-day. In Study II a novel approach for measuring postural balance (using the Nintendo Wii Stillness and Agility tests) was examined for reproducibility and concurrent validity in 30 community-dwelling older adults. While the Nintendo Wii Stillness test showed a high reproducibility, a systematic learning effect between successive sessions was observed for the Agility test. Moderate-to-excellent concurrent validity was seen for the Stillness test. In contrast, the Agility test revealed a poor concurrent validity. In conclusion, the Wii Stillness test seems to represent a low-cost objective reproducible test of postural balance in community-dwelling older adults and appears feasible in various clinical settings. A habituation (familiarization) period is necessary for the Wii Agility test to avoid a systematic learning effect between successive test sessions. Study III investigated the effect of ten weeks of biofeedback-based Nintendo Wii training on static postural balance, mechanical lower limb muscle function, and functional performance in 58 community-dwelling older adults. Additionally, the study investigated the participant motivation for this type of training (Exergaming). Marked improvements in maximal leg muscle strength, rapid force capacity and functional performance were observed following the period of biofeedback-based Nintendo Wii training. Unexpectedly, static bilateral postural balance remained unaltered following the period of intervention. The study participants perceived the Nintendo Wii training as enjoyable and highly motivating, which suggests that this type of exercise may be successfully implemented at senior citizens' centers and/or in the home of the elderly. The results presented in this thesis suggest that strict control of time-of-day is an important methodological aspect when evaluating postural balance in older adults, and an assessment protocol using the Nintendo Wii-Balance Board is reproducible and valid. Biofeedback-based Nintendo Wii exercise intervention appeared unsuccessful in improving static bilateral postural balance, most likely due to a test ceiling effect in the selected outcome measures, but the intervention elicited marked positive changes in various key risk factors associated to fall accidents. Notably, Wii based biofeedback exercise was perceived by the older adults as a highly motivating type of training.

Effects of guar gum ingestion on postprandial blood pressure in older adults.

PubMed

Jang, A L; Hwang, S K; Kim, D U

2015-03-01

The aim of this study was to investigate the effects of guar gum on postprandial blood pressure in older people. A randomized, double-blind, placebo-controlled, cross-over design. Community senior centers in B city, South Korea. Twenty-two older female adults aged 67 to 88 with postprandial hypotension. The participants were randomly assigned to guar gum (semi-fluid food with 9 gram) or placebo intervention during the first treatment phase. After a washout period of 1 week, the two interventions were switched to the other in the second treatment phase. Blood pressure was measured during both phases before having a meal and every 15 minutes during 120 minutes after a meal with automated sphygmomanometer. Change in systolic blood pressure (SBP) over time was significantly different between guar gum and placebo groups (F=4.07, p=0.001). Compared with placebo group, guar gum group had significantly low prevalence of postprandial hypotension (PPH) (guar gum group=18.2% vs. placebo group=72.7%; χ² =13.20, p<0.001). It also had significant difference in change of diastolic blood pressure (DBP) over time between guar gum and placebo groups (F=2.49, p=0.027). This findings show that guar gum could be effective on postprandial drops in blood pressure in older female adults.

Effects of shoe sole hardness on plantar pressure and comfort in older people with forefoot pain.

PubMed

Lane, Tamara J; Landorf, Karl B; Bonanno, Daniel R; Raspovic, Anita; Menz, Hylton B

2014-01-01

Plantar forefoot pain is common in older people and is related to increased peak pressures under the foot during gait. Variations in the hardness of the shoe sole may therefore influence both the magnitude of loading under the foot and the perceived comfort of the shoe in this population. The aim of this investigation was to determine the effect of varying shoe sole hardness on plantar pressures and comfort in older people with forefoot pain. In-shoe plantar pressures under the forefoot, midfoot and rearfoot were recorded from 35 older people (mean age 73.2, SD 4.5 years) with current or previous forefoot pain using the pedar-X(®) system. Participants walked at their normal comfortable speed along an 8m walkway in shoes with three different levels of sole hardness: soft (Shore A25), medium (Shore A40) and hard (Shore A58). Shoe comfort was measured on a 100mm visual analogue scale. There were statistically significant differences in peak pressure of between 5% and 23% across the forefoot, midfoot and rearfoot (p<0.01). The hard-soled shoe registered the highest peak pressures and the soft-soled shoe the lowest peak pressures. However, no differences in comfort scores across the three shoe conditions were observed. These findings demonstrate that as shoe sole hardness increases, plantar pressure increases, however this does not appear to have a significant effect on shoe comfort. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians.

PubMed

Qaseem, Amir; Wilt, Timothy J; Rich, Robert; Humphrey, Linda L; Frost, Jennifer; Forciea, Mary Ann

2017-03-21

The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older. This guideline is based on a systematic review of published randomized, controlled trials for primary outcomes and observational studies for harms only (identified through EMBASE, the Cochrane Database of Systematic Reviews, MEDLINE, and ClinicalTrials.gov), from database inception through January 2015. The MEDLINE search was updated through September 2016. Evaluated outcomes included all-cause mortality, morbidity and mortality related to stroke, major cardiac events (fatal and nonfatal myocardial infarction and sudden cardiac death), and harms. This guideline grades the evidence and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. The target audience for this guideline includes all clinicians, and the target patient population includes all adults aged 60 years or older with hypertension. ACP and AAFP recommend that clinicians initiate treatment in adults aged 60 years or older with systolic blood pressure persistently at or above 150 mm Hg to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk for mortality, stroke, and cardiac events. (Grade: strong recommendation, high-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient. ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for recurrent stroke. (Grade: weak recommendation, moderate-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient. ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events. (Grade: weak recommendation, low-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient.

Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: Three case reports

PubMed Central

Yeates, Erin M; Molfenter, Sonja M; Steele, Catriona M

2008-01-01

Dysphagia, or difficulty swallowing, often occurs secondary to conditions such as stroke, head injury or progressive disease, many of which increase in frequency with advancing age. Sarcopenia, the gradual loss of muscle bulk and strength, can place older individuals at greater risk for dysphagia. Data are reported for three older participants in a pilot trial of a tongue-pressure training therapy. During the experimental therapy protocol, participants performed isometric strength exercises for the tongue as well as tongue pressure accuracy tasks. Biofeedback was provided using the Iowa Oral Performance Instrument (IOPI), an instrument that measures tongue pressure. Treatment outcome measures show increased isometric tongue strength, improved tongue pressure generation accuracy, improved bolus control on videofluoroscopy, and improved functional dietary intake by mouth. These preliminary results indicate that, for these three adults with dysphagia, tongue-pressure training was beneficial for improving both instrumental and functional aspects of swallowing. The experimental treatment protocol holds promise as a rehabilitative tool for various dysphagia populations. PMID:19281066

Maternal age during pregnancy is associated with third trimester blood pressure level: the generation R study.

PubMed

Gaillard, Romy; Bakker, Rachel; Steegers, Eric A P; Hofman, Albert; Jaddoe, Vincent W V

2011-09-01

We hypothesized that hemodynamic adaptations related to pregnancy and ageing might be associated with differences in blood pressure levels during pregnancy between younger and older women. This might partly explain the increased risk of gestational hypertensive disorders with advanced maternal age. We examined the associations of maternal age with systolic and diastolic blood pressure in each trimester of pregnancy and the risks of gestational hypertensive disorders. The study was conducted among 8,623 women participating in a population-based prospective cohort study from early pregnancy onwards. Age was assessed at enrolment. Blood pressure was measured in each trimester. Information about gestational hypertensive disorders was available from medical records. In second and third trimester, older maternal age was associated with lower systolic blood pressure (-0.9 mm Hg (95% confidence interval: -1.4, -0.3) and -0.6 mm Hg (95% confidence interval: -1.1, -0.02) per additional 10 maternal years, respectively). Older maternal age was associated with higher third trimester diastolic blood pressure (0.5 mm Hg (95% confidence interval: 0.04, 0.9) per additional 10 maternal years). Maternal age was associated with pregnancy-induced hypertension among overweight and obese women. Older maternal age is associated with lower second and third trimester systolic blood pressure, but higher third trimester diastolic blood pressure. These blood pressure differences seem to be small and within the physiological range. Maternal age is not consistently associated with the risks of gestational hypertensive disorders. Maternal body mass index might influence the association between maternal age and the risk of pregnancy-induced hypertension.

Testing Plant Responses to Rarified Atmospheres for Inflatable Greenhouses

NASA Technical Reports Server (NTRS)

Corey, Kenneth A.

2000-01-01

Reduced atmospheric pressures will likely be used to minimize mass and engineering requirements for plant growth habitats used in extraterrestrial applications. A chamber with high vacuum capability was used to design and begin construction of a system for testing plant responses to reduced pressure atmospheres. Several preliminary tests were conducted to evaluate chamber suitability for plant tests and to determine performance of thermal and vacuum systems at ambient and reduced pressure atmospheres down to 0.1 atm. The first tests consisted of measurements of internal gas volume and leakage rate. The method for volume determination was quite sensitive and will be needed for plant gas exchange measurements and calculations. This information will also be used in conjunction with the leak rate. Measured leak rates on the order of 0.46 mm Hg/min at 76 mm Hg pressure are low enough to conduct sensitive carbon dioxide exchange rate measurements at reduced pressure given an adequate plant sample (0.5 to 1.0 sq m area). A test rack with lighting provided by three high-pressure sodium vapor lamps was built to accommodate both short-term and long-term plant responses. Initial short-term experiments with lettuce showed that a pressure of 77 mm Hg resulted in a 6.1-fold increase in the rate of water loss compared to water loss at ambient pressure. Plants were severely wilted after 30 minutes exposure to 77 mm Hg. Water loss was found to be inversely correlated with atmospheric pressure over the range of pressures from 0.2 to 1.0 atm; the rate of water loss at 0.2 atm was 4.3 times higher than water loss at ambient pressure. Older leaves showed moderate wilting during exposure to 156 mm Hg, but those exposed to 345 mm, Hg remained turgid. Results suggest a reduced atmospheric pressure limit of 0.2 to 0.3 atm for lettuce grown in a solid medium. Follow-up experiments with carbon dioxide control and control at high relative humidity (> 90 %) will be needed to further confirm and define safe reduced pressure limits that are feasible for plant tolerance and growth.

Pressure pain threshold is higher in hypertensive compared with normotensive older adults: A case-control study.

PubMed

Nascimento Rebelatto, Marcelo; Alburquerque-Sendín, Francisco; Guimarães, João Flavio; Salvini, Tania Fatima

2017-06-01

To establish whether there are differences in pain sensitivity between hypertensive and normotensive older adults. A cross-sectional case control study was carried out. A total of 72 older adults, 36 normotensive and 36 hypertensive, participated in the study. The pressure pain threshold (PPT) was assessed on seven points bilaterally in both groups by means of pressure algometry. Two-factor analysis of variance (anova) - group and sex - was carried out, and the magnitude of the differences was calculated using Cohen's index. The PPT values were higher in the group of hypertensive older adults compared with the normotensive older adults; that difference was significant (P < 0.05) for the following points: right and left trochanters, left trapezium, left L3/L4 and left anterior tibialis muscle, with both trochanter and left L3/L4 PPT showing moderate magnitude of the differences. The correlations shown among the PPT were stronger in the group of hypertensive older adults. Thus, hypoalgesia was more generalized among the hypertensive older adults compared with the normotensive older adults. Sex did not influence that difference, although the magnitude of the difference was greater among men compared with women. Hypoalgesia, as assessed by means of PPT, showed a relationship with arterial hypertension in older adults. The influence of sex on hypoalgesia shown by hypertensive individuals is controversial. Geriatr Gerontol Int 2017; 17: 967-972. © 2016 Japan Geriatrics Society.

Age-associated impairments in contraction-induced rapid-onset vasodilatation within the forearm are independent of mechanical factors.

PubMed

Hughes, William E; Kruse, Nicholas T; Casey, Darren P

2018-05-01

What is the central question of this study? We examined whether the mechanical contribution to contraction-induced rapid-onset vasodilatation (ROV) differed with age and whether ROV is associated with peripheral artery stiffness. Furthermore, we examined how manipulation of perfusion pressure modulates ROV in young and older adults. What is the main finding and its importance? The mechanical contribution to ROV is similar in young and older adults. Conversely, peripheral arterial stiffness is not associated with ROV. Enhancing perfusion pressure augments ROV to a similar extent in young and older adults. These results suggest that age-related attenuations in ROV are not attributable to a mechanical component and that ROV responses are independent of peripheral artery stiffness. Contraction-induced rapid-onset vasodilatation (ROV) is modulated by perfusion and transmural pressure in young adults; however, this effect remains unknown in older adults. The present study examined the mechanical contribution to ROV in young versus older adults, the influence of perfusion pressure and whether these responses are associated with arterial stiffness. Forearm vascular conductance (in millilitres per minute per 100 mmHg) was measured in 12 healthy young (24 ± 4 years old) and 12 older (67 ± 3 years old) adults during: (i) single dynamic contractions at 20% of maximal voluntary contraction; and (ii) single external mechanical compression of the forearm (200 mmHg) positioned above, at and below heart level. Carotid-radial pulse-wave velocity characterized upper limb arterial stiffness. Total ROV responses to single muscle contractions and single external mechanical compressions were attenuated in older adults at heart level (P < 0.05); however, the relative mechanical contribution to contraction-induced peak (46 ± 14 versus 40 ± 18%; P = 0.21) and total (37 ± 21 versus 32 ± 18%; P = 0.27) responses were not different between young and older adults. Reducing or enhancing perfusion pressure altered ROV responses to a similar extent between young and older adults (P < 0.05). Upper limb arterial stiffness was not associated with peak (r = 0.02; P = 0.93) or total vascular conductance (r = -0.01; P = 0.96) in the group as a whole. Our data suggest that: (i) age-associated attenuations in ROV are not attributable to a mechanical component; (ii) enhancing perfusion pressure augments ROV to a similar extent between young and older adults; and (iii) basal upper limb arterial stiffness is not associated with the vasodilator responses after a single skeletal muscle contraction in young and older adults. © 2018 The Authors. Experimental Physiology © 2018 The Physiological Society.

Crash avoidance in response to challenging driving events: The roles of age, serialization, and driving simulator platform.

PubMed

Bélanger, Alexandre; Gagnon, Sylvain; Stinchcombe, Arne

2015-09-01

We examined the crash avoidance behaviors of older and middle-aged drivers in reaction to six simulated challenging road events using two different driving simulator platforms. Thirty-five healthy adults aged 21-36 years old (M=28.9±3.96) and 35 healthy adults aged 65-83 years old (M=72.1±4.34) were tested using a mid-level simulator, and 27 adults aged 21-38 years old (M=28.6±6.63) and 27 healthy adults aged 65-83 years old (M=72.7±5.39) were tested on a low-cost desktop simulator. Participants completed a set of six challenging events varying in terms of the maneuvers required, avoiding space given, directional avoidance cues, and time pressure. Results indicated that older drivers showed higher crash risk when events required multiple synchronized reactions. In situations that required simultaneous use of steering and braking, older adults tended to crash significantly more frequently. As for middle-aged drivers, their crashes were attributable to faster driving speed. The same age-related driving patterns were observed across simulator platforms. Our findings support the hypothesis that older adults tend to react serially while engaging in cognitively challenging road maneuvers. Copyright © 2015 Elsevier Ltd. All rights reserved.

Credit Card Usage among Older Adults: Assessing Financial Literacy and Pressures

ERIC Educational Resources Information Center

St. Pierre, Eileen; Shreffler, Karina

2013-01-01

The research reported here assessed the financial literacy of older adults living in rural communities, current use of and attitudes towards debt, and debt pressures. Those surveyed exhibit low credit card usage and responsible payment practices. Most never use credit to pay medical expenses. Respondents display a financial literacy level similar…

Voluntary sway and rapid orthogonal transitions of voluntary sway in young adults, and low and high fall-risk older adults.

PubMed

Tucker, Murray G; Kavanagh, Justin J; Morrison, Steven; Barrett, Rod S

2009-10-01

Falls amongst older people have been linked to reduced postural stability and slowed movement responses. The objective of this study was to examine differences in postural stability and the speed of response between young adults, low fall-risk older adults, and high fall-risk older adults during voluntary postural sway movements. Twenty-five young adults (25+/-4 years), and 32 low fall-risk (74+/-5 years), and 16 high fall-risk (79+/-7 years) older adults performed voluntary sway and rapid orthogonal transitions of voluntary sway between the anterior-posterior and medial-lateral directions. Measures included reaction and movement time and the amplitudes of the centre of pressure, centre of mass, and the separation distance between the centre of pressure and centre of mass. Both fall-risk groups compared to the young had slower reaction and movement time, greater centre of pressure and/or centre of mass amplitude in the orthogonal (non-target) direction during voluntary sway, and reduced anterior-posterior and medial-lateral separation between the centre of pressure and centre of mass during voluntary sway and orthogonal transitions. High compared to low fall-risk individuals had slower reaction and movement time, increased non-target centre of mass amplitude during voluntary sway, and reduced medial-lateral centre of pressure and centre of mass separation during voluntary sway and orthogonal transitions. Age-related deterioration of postural control resulted in slower reactive responses and reduced control of the direction of body movement during voluntary sway and orthogonal transitions. Slower postural reaction and movement time and reduced medial-lateral control of the centre of mass during voluntary sway movements are associated with increased fall-risk in community-living older people.

Differences in foot kinematics between young and older adults during walking.

PubMed

Arnold, John B; Mackintosh, Shylie; Jones, Sara; Thewlis, Dominic

2014-02-01

Our understanding of age-related changes to foot function during walking has mainly been based on plantar pressure measurements, with little information on differences in foot kinematics between young and older adults. The purpose of this study was to investigate the differences in foot kinematics between young and older adults during walking using a multi-segment foot model. Joint kinematics of the foot and ankle for 20 young (mean age 23.2 years, standard deviation (SD) 3.0) and 20 older adults (mean age 73.2 years, SD 5.1) were quantified during walking with a 12 camera Vicon motion analysis system using a five segment kinematic model. Differences in kinematics were compared between older adults and young adults (preferred and slow walking speeds) using Student's t-tests or if indicated, Mann-Whitney U tests. Effect sizes (Cohen's d) for the differences were also computed. The older adults had a less plantarflexed calcaneus at toe-off (-9.6° vs. -16.1°, d = 1.0, p = <0.001), a smaller sagittal plane range of motion (ROM) of the midfoot (11.9° vs. 14.8°, d = 1.3, p = <0.001) and smaller coronal plane ROM of the metatarsus (3.2° vs. 4.3°, d = 1.1, p = 0.006) compared to the young adults. Walking speed did not influence these differences, as they remained present when groups walked at comparable speeds. The findings of this study indicate that independent of walking speed, older adults exhibit significant differences in foot kinematics compared to younger adults, characterised by less propulsion and reduced mobility of multiple foot segments. Copyright © 2013 Elsevier B.V. All rights reserved.

The relationship between orthostatic hypotension and falling in older adults.

PubMed

Shaw, Brett H; Claydon, Victoria E

2014-02-01

Falls are devastating events and are the largest contributor towards injury-related hospitalization of older adults. Orthostatic hypotension (OH) represents an intrinsic risk factor for falls in older adults. OH refers to a significant decrease in blood pressure upon assuming an upright posture. Declines in blood pressure can reduce cerebral perfusion; this can impair consciousness, lead to dizziness, and increase the likelihood of a fall. Although theoretical mechanisms linking OH and falls exist, the magnitude of the association remains poorly characterized, possibly because of methodological differences between previous studies. The use of non-invasive beat-to-beat blood pressure monitoring has altered the way in which OH is now defined, and represents a substantial improvement for detecting OH that was previously unavailable in many studies. Additionally, there is a lack of consistency and standardization of orthostatic assessments and analysis techniques for interpreting blood pressure data. This review explores the previous literature examining the relationship between OH and falls. We highlight the impact of broadening the timing, degree, and overall duration of blood pressure measurements on the detection of OH. We discuss the types of orthostatic stress assessments currently used to evaluate OH and the various techniques capable of measuring these often transient blood pressure changes. Overall, we identify future solutions that may better clarify the relationship between OH and falling risk in order to gain a more precise understanding of potential mechanisms for falls in older adults.

Nursing students' knowledge and beliefs about care of older adults in a shifting context of nursing education.

PubMed

Baumbusch, Jennifer; Dahlke, Sherry; Phinney, Alison

2012-11-01

  To a report a study of improvements in students' knowledge and beliefs about nursing care of older adults following completion of an introductory course with integrated adult/older adult content. Background.  Nursing schools are under pressure to provide accelerated programmes to meet growing workforce demands and provide students with the knowledge they require to care for an ageing population. Thus, stand-alone courses in gerontological nursing are being eliminated and integrated with general adult content. The effect of this approach remains poorly understood.   A one-group pretest-post-test design was used.   Data were collected between September-December 2010. Students completed the Palmore Facts on Aging Quiz, the Perceptions of Caring for Older People Scale, and open-ended questions about their experiences before and after completing a course with integrated adult/older content.   Students' knowledge and beliefs about nursing care of older adults demonstrated an important improvement following completion of the course. Qualitative findings reflected three themes: relating to older people; neglect by the system; having time to learn.   Findings from this study suggest that even when integrated with general adult content, students' knowledge and beliefs about older adult care can be positively influenced. Furthermore research is needed to examine long-term integration of students' learning about older adult care. Nursing faculty with expertise in nursing care of older adults must develop resources and supports for their colleagues to build capacity among nurse educators and integrate older adult content throughout nursing programmes to enhance nursing practice with an ageing population. © 2012 Blackwell Publishing Ltd.

Training Status as a Marker of the Relationship between Nitric Oxide, Oxidative Stress, and Blood Pressure in Older Adult Women

PubMed Central

Mourão Jacomini, André; Celso Dutra de Souza, Hugo; da Silva Dias, Danielle; de Oliveira Brito, Janaina; Cezar Pinheiro, Lucas; Bernardino da Silva, Anderson; Fernanda da Silva, Roberta; Alexandre Trapé, Atila; De Angelis, Kátia; Tanus-Santos, José Eduardo; Lia do Amaral, Sandra; Saranz Zago, Anderson

2016-01-01

The purpose of this study was to evaluate the influence of functional fitness and oxidative capacity on the nitric oxide concentration associated with hemodynamic control in older adult women. The sample consisted of 134 women (65.73 ± 6.14 years old). All subjects underwent a physical examination to assess body mass index, waist-hip ratio, body fat measurement by dual energy X-ray absorptiometry, and blood pressure (BP). Training status (TS) was evaluated by indirect determination of maximal oxygen uptake by a treadmill test using Balke protocol modified for older adults. Functional fitness was also evaluated through a “Functional Fitness Battery Test” to determine the general fitness functional index (GFFI). All participants were separated according to the functional fitness (TS1, very weak and weak; TS2, regular; TS3, good and very good). Plasma blood samples were used to evaluate prooxidant and antioxidant activity and nitrite and nitrate concentrations. The general results of this study showed that good levels of TS were related to lower levels of lipoperoxidation and protein damage, higher levels of antioxidant, and higher concentration of nitrite and nitrate. This combination may be responsible for the lower levels of BP in subjects with better TS. PMID:26697141

Role of autonomic nervous activity, as measured by heart rate variability, on the effect of mortality in disabled older adults with low blood pressure in long-term care.

PubMed

Shibasaki, Koji; Ogawa, Sumito; Yamada, Shizuru; Ouchi, Yasuyoshi; Akishita, Masahiro

2018-04-11

Previous studies have shown the relationship between low blood pressure and high mortality in frail, disabled older adults in long-term care. However, the mechanism of this relationship is still unclear. We hypothesized that autonomic nervous activity decline is involved in the relationship between low blood pressure and high mortality. The present prospective cohort study recruited 61 participants aged ≥75 years. The data from 24-h Holter monitoring and blood pressure recorded by ambulatory blood pressure monitoring were collected. Measured data were divided into three categories: 24-h, daytime and night-time. From power spectral density in the electrocardiogram, low frequency, high frequency and low frequency/high frequency ratio were calculated. The primary end-point was death. High blood pressure was connected to both high daytime low frequency and high frequency (partial correlation coefficients: 0.42, P < 0.05 and 0.35, P < 0.05, respectively). In addition, the low blood pressure group had higher mortality than the high blood pressure group, and disabled older adults in long-term care and those with elevated daytime systolic and diastolic blood pressure had less risk of mortality compared with those without (systolic: hazard ratio 0.89, 95% confidence interval 0.83-0.96, P = 0.003; diastolic: hazard ratio 0.98, 95% confidence interval 0.79-1.00, P = 0.049). The average blood pressures in the high blood pressure groups were approximately 140/80 mmHg and were connected to low mortality. Attenuated autonomic nervous activity might lead to low blood pressure in the daytime and high mortality in disabled older adults in long-term care. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

Delayed Compensatory Postural Adjustments After Lateral Perturbations Contribute to the Reduced Ability of Older Adults to Control Body Balance.

PubMed

Claudino, Renato; Dos Santos, Marcio José; Mazo, Giovana Zarpellon

2017-10-01

The goal of this study was to investigate the timing of compensatory postural adjustments in older adults during body perturbations in the mediolateral direction, circumstances that increase their risk of falls. The latencies of leg and trunk muscle activation to body perturbations at the shoulder level and variables of center of pressure excursion, which characterize postural stability, were analyzed in 40 older adults (nonfallers and fallers evenly split) and in 20 young participants. The older adults exhibited longer latencies of muscular activation in eight out of 15 postural muscles as compared with young participants; for three muscles, the latencies were longer for the older fallers than nonfallers. Simultaneously, the time for the center of pressure displacement reached its peak after the perturbation was significant longer in both groups of older adults. The observed delays in compensatory postural adjustments may affect the older adults' ability to prompt control body balance after postural disturbances and predispose them to falls.

Effects of utterance length and vocal loudness on speech breathing in older adults.

PubMed

Huber, Jessica E

2008-12-31

Age-related reductions in pulmonary elastic recoil and respiratory muscle strength can affect how older adults generate subglottal pressure required for speech production. The present study examined age-related changes in speech breathing by manipulating utterance length and loudness during a connected speech task (monologue). Twenty-three older adults and twenty-eight young adults produced a monologue at comfortable loudness and pitch and with multi-talker babble noise playing in the room to elicit louder speech. Dependent variables included sound pressure level, speech rate, and lung volume initiation, termination, and excursion. Older adults produced shorter utterances than young adults overall. Age-related effects were larger for longer utterances. Older adults demonstrated very different lung volume adjustments for loud speech than young adults. These results suggest that older adults have a more difficult time when the speech system is being taxed by both utterance length and loudness. The data were consistent with the hypothesis that both young and older adults use utterance length in premotor speech planning processes.

A randomized 9-month study of blood pressure and body fat responses to aerobic training versus combined aerobic and resistance training in older men.

PubMed

Sousa, Nelson; Mendes, Romeu; Abrantes, Catarina; Sampaio, Jaime; Oliveira, José

2013-08-01

This randomized study evaluated the impact of different exercise training modalities on blood pressure and body fat responses in apparently healthy older men. Forty-eight elderly men (aged 65-75 years) were randomly assigned to an aerobic training group (ATG, n=15), a combined aerobic and resistance training group (CTG, n=16), or a control group (n=17). Both exercise training programs were moderate-to-vigorous intensity, three days/week for 9-months. Strength, aerobic endurance, body fat and blood pressure were measured on five different occasions. The data were analyzed using a mixed-model ANOVA, and the independence between systolic blood pressure (SBP), diastolic blood pressure (DBP) and group was tested. A significant main effect of group (p<0.001) was observed in strength and aerobic endurance, with higher performance observed in the CTG. A significant main effect of group (p<0.001) and time (p=0.029) was observed in body fat percentage, with a 2.3% decrease in CTG. A significant main effect of time was observed in SBP (p=0.005) and in DBP (p=0.011) for both ATG and CTG. Mean decreases in SBP and DBP, respectively, were 15 and 6 mmHg for ATG and 24 and 12 mmHg for CTG. There was a significant association for SBP (p=0.008) and DBP (p=0.005) in the CTG, with significant individual BP profile modifications. Both exercise-training programs reduce resting blood pressure. However, only the combined exercise training was effective at reducing body fat percentage; consequently, there were larger changes in blood pressure, which result in a significant reduction in hypertensive subjects. Copyright © 2013 Elsevier Inc. All rights reserved.

Sibling composition during childhood and adult blood pressure among native Amazonians in Bolivia.

PubMed

Zeng, Wu; Undurraga, Eduardo A; Nyberg, Colleen; Eisenberg, Dan T A; Parida, Sabita; Zycherman, Ariela; Magvanjav, Oyunbileg; Reyes-García, Victoria; Tanner, Susan; Godoy, Ricardo

2013-07-01

Sibling configuration, including birth order, or the number, age, and sex of siblings is associated with parental resource allocation between children and is thus associated with a person's well-being. Little is known about the association between specific types of siblings and adult health outcomes. Here we test several hypotheses about sibling composition (number of older brothers, older sisters, younger sisters, younger brothers) and adult blood pressure in a foraging-farming society of native Amazonians in Bolivia (Tsimane'). We collected data in 2007 from 374 adults (16-60years of age) from 196 households in 13 villages. Household random-effects multiple regressions were run using systolic (SBP) or diastolic blood pressure (DBP) as outcomes; covariates included the four sibling categories and control variables (e.g., sex, age, education, body mass index [BMI]). Mean SBP and DBP were 114 (SD=14) and 66 (SD=11)mmHg. The prevalence of hypertension was 5.08%. Having an additional younger brother bore a small (3.3-5.9%) positive association with both SBP and DBP, with the effect weakening as people aged. Having an additional younger sister was associated with a small (3.8%) increase in SBP among women, with the magnitude shrinking as people aged. In a large family, the number of younger brothers may exert an impact on an individual's blood pressure. Copyright © 2012 Elsevier B.V. All rights reserved.

[Orthostatic hypotension in the elderly].

PubMed

Ferrer-Gila, Teresa; Rízea, Cristian

2013-03-16

Orthostatic hypotension (OH) is defined as a decrease in systolic blood pressure of 20 mmHg, or a decrease in diastolic blood pressure of 10 mmHg within three minutes of standing. It results from an inadequate response to postural changes in blood pressure. Common symptoms include dizziness, light-headedness, blurred vision, weakness, fatigue, nausea, palpitations, sweating, head and neck ache, slow cognitive performance and transient loss of conscientiousness. OH is a common problem among elderly patients and its aetiology is diverse, including autonomic nervous system dysfunction, cardiac problems, medication side effects, ageing changes or transitory deregulation of blood volume. The instrumental diagnosis can be easily accomplished by the tilt-table test, with continuous monitoring of blood pressure and cardiac parameters. It is a non-invasive technique and needs minimal collaboration from the patient. In our experience, when reviewing 327 patients, aged over 40 years and examined because of clinical suspicion of OH, the prevalence thereof was 51% whereas if focused in subjects older than 70, OH was proven in 90% of the cases. The older the patients, the more frequently they presented general deterioration, neurological or cardiac problems as well as pharmacological side effects. Ruling out neurological or cardiac malfunction can drastically improve the prognosis with possible reversibility of symptoms. Some nonpharmacological and pharmacological approaches to improve management of OH and life quality are described for guidance.

Success and duration of dynamic bracing for pectus carinatum: A four-year prospective study.

PubMed

Emil, Sherif; Sévigny, Marika; Montpetit, Kathleen; Baird, Robert; Laberge, Jean-Martin; Goyette, Jade; Finlay, Ian; Courchesne, Guylaine

2017-01-01

This study sought to establish factors that can prognosticate outcomes of bracing for pectus carinatum (PC). Prospective data were collected on all patients enrolled in a dynamic bracing protocol from July 2011 to July 2015. Pressure of correction (POC) was measured at initiation of treatment, and pressure of treatment (POT) was measured pre- and post-adjustment at every follow-up visit. Univariate and Cox regression analysis tested the following possible determinants of success and bracing duration: age, sex, symmetry, POC, and POT drop during the first two follow-up visits. Of 114 patients, 64 (56%) succeeded, 33 (29%) were still in active bracing, and 17 (15%) failed or were lost to follow-up. In successful patients, active and maintenance bracing was 5.66±3.81 and 8.80±3.94months, respectively. Asymmetry and older age were significantly associated with failure. Multivariable Cox proportional hazard analysis of time-to-maintenance showed that asymmetry (p=0.01) and smaller first drop in POT (p=0.02) were associated with longer time to reach maintenance. Pressure of correction does not predict failure of bracing, but older age, asymmetry, and smaller first drop in pressure of treatment are associated with failure and longer bracing duration. Prospective Study/Level of Evidence IV. Copyright © 2017 Elsevier Inc. All rights reserved.

Reference values for physical performance measures in the aging working population.

PubMed

Cote, Mark P; Kenny, Anne; Dussetschleger, Jeffrey; Farr, Dana; Chaurasia, Ashok; Cherniack, Martin

2014-02-01

The aim of this study was to determine reference physical performance values in older aging workers. Cross-sectional physical performance measures were collected for 736 manufacturing workers to assess effects of work and nonwork factors on age-related changes in musculoskeletal function and health. Participants underwent surveys and physical testing that included bioelectrical impedance analysis, range-of-motion measures, exercise testing, and dynamic assessment. Physical characteristics, such as blood pressure and body fat percentage, were comparable to published values. Dynamic and range-of-motion measurements differed from published normative results. Women had age-related decreases in cervical extension and lateral rotation. Older men had better spinal flexion than expected. Predicted age-related decline in lower-extremity strength and shoulder strength in women was not seen. Men declined in handgrip, lower-extremity strength, and knee extension strength, but not trunk strength, across age groups. There was no appreciable decline in muscle fatigue at the trunk, shoulder, and knee with aging for either gender, except for the youngest age group of women. Normative values may underestimate physical performance in "healthy" older workers, thereby underappreciating declines in less healthy older workers. Work may be preservative of function for a large group of selected individuals. A "healthy worker effect" may be greater for musculoskeletal disease and function than for heart disease and mortality. Clinicians and researchers studying musculoskeletal function in older workers can use a more specific set of reference values.

Does intravenous induction dosing among patients undergoing gastrointestinal surgical procedures follow current recommendations: a study of contemporary practice.

PubMed

Akhtar, Shamsuddin; Liu, Jia; Heng, Joseph; Dai, Feng; Schonberger, Robert B; Burg, Matthew M

2016-09-01

It is recommended to correct intravenous induction doses by up to 50% for patients older than 65 years. The objectives were to determine (a) the degree to which anesthesia providers correct induction doses for age and (b) additionally adjust for American Society of Anesthesiologists physical status (ASA-PS) class (severity of illness) and (c) whether postinduction hypotension is more common among patients aged >65. Retrospective chart review. Academic medical center. A total of 1869 adult patients receiving general anesthesia for GI surgical procedures from February 2013 to January 2014. Patients were divided into 3 age groups (age <65, 65-79, ≥80 years) and then further stratified into ASA-PS class (I/II vs III/IV). Multiple pairwise comparisons were conducted using Welch t tests for continuous variables to determine whether dosing was different for the older groups vs the younger group; separate analyses were performed within and across ASA-PS class. This approach was also used to determine differences in mean arterial pressure change in the older groups vs the younger group, whereas the rates of hypotension among different age groups were compared by Cochran-Armitage trend test. No significant decrease in dosing between age groups was observed for fentanyl and midazolam. For propofol, there was a significantly lower dosing for older patients: 17% for patients aged 65-79 and 29% for those aged >80, which was still in less than the recommendations. An inverse relationship was observed between propofol dosing and ASA-PS class, but no consistent relationship was noted for fentanyl and midazolam. There were a significantly larger drop in mean arterial pressure and a greater likelihood of hypotension following induction in patients aged 65-79 years and >80 years as compared with those aged <65 years. This study shows that the administered dose of anesthetic induction agents is significantly higher than that recommended for patients older than 65 years. This failure to age-adjust dose may contribute to hypotensive episodes. Copyright © 2016 Elsevier Inc. All rights reserved.

Pattern of age-associated decline of static and dynamic balance in community-dwelling older women.

PubMed

Takeshima, Nobuo; Islam, Mohammod M; Rogers, Michael E; Koizumi, Daisuke; Tomiyama, Naoki; Narita, Makoto; Rogers, Nicole L

2014-07-01

Falling is the leading cause of injury-related deaths in older adults, and a loss of balance is often the precursor to a fall. However, little is known about the rate at which balance declines with age. The objective of the present study was to determine whether there is an age-associated decline in static (SB) and/or dynamic (DB) balance in community-dwelling older women. SB and DB were determined in 971 older women. Intraclass correlation coefficients (ICC) were used to determine test-retest reliability. Sway velocity was used to measure SB standing on a platform and foam with eyes open and closed. DB was characterized by limits of stability (LOS) that measured end-point excursion (EXE) and maximum excursion (MXE) of the body's center of pressure. ICC for EXE and MXE for the LOS test were excellent (EPE = 0.96, MXE = 0.96). ICC for SB tests, except for the eyes open firm surface condition (ICC = 0.10), showed a high level of reproducibility (ICC = 0.88 and 0.90). Relationships existed between age and SB (r = 0.31, P < 0.001), and between age and DB (r = -0.46--0.48, P < 0.001). The rate of decline for both DB and SB was approximately 1% per year. Age was significantly associated with all balance measures. DB got significantly lower with advancing age until 80 years, and then plateaued. SB did not decline with age until 80 years, and then decreased significantly thereafter. Although large individual variation was found with balance ability, an age-related decline was found with both dynamic and static balance for Japanese older women. © 2013 Japan Geriatrics Society.

ASSOCIATION OF DAIRY CONSUMPTION AND 24-HOUR BLOOD PRESSURE IN OLDER ADULTS WITH HYPERTENSION.

PubMed

Lana, Alberto; Banegas, Jose R; Guallar-Castillón, Pilar; Rodríguez-Artalejo, Fernando; Lopez-Garcia, Esther

2018-05-25

The aim was to examine the association between habitual consumption of dairy products and 24-h ambulatory blood pressure monitoring among older adults with hypertension. We conducted an analysis of 715 community-living hypertensive adults aged ≥60. Habitual dairy consumption was assessed with a validated diet history. Blood pressure was recorded by 24-hour ambulatory blood pressure monitoring; controlled blood pressure was defined as 24-hour blood pressure <130/80 mm Hg in those under drug treatment. Analyses were adjusted for main confounders, including diet, hypertension duration, and being on antihypertensive treatment. After adjustment for confounders, consumers of ≥7 servings/wk of whole milk/yogurt had a diastolic blood pressure 1.40 mm Hg higher (95% confidence interval: 0.01, 2.81) than consumers of <1 serving/wk. By contrast, consumers of ≥7 servings/wk of low-fat milk/yogurt had a diastolic blood pressure 1.74 mm Hg lower (95% confidence interval: -3.26, -0.23) than consumers of <1 serving/wk. Moreover, the odds ratio (95% confidence interval) for controlled blood pressure was 1.83 (1.05-3.08) for those consuming ≥7 servings/wk of low-fat milk/yogurt, when comparing with consumers of <1 serving/wk. Cheese consumption was not associated with blood pressure. Regular consumption of low-fat milk/yogurt was associated with lower 24-h diastolic blood pressure and with better blood pressure control among older adults with hypertension. Copyright © 2018. Published by Elsevier Inc.

Relationship between cortisol reactivity to psychosocial stress and declarative memory decline during aging: Impact of age and sex.

PubMed

Dos Santos, Aline Talita; Leyendecker, Dayse Maria D; Costa, Ana Lucia Siqueira; de Souza-Talarico, Juliana Nery

2018-01-01

To analyze the relationship between memory performance and the neuroendocrine and cardiovascular response to acute psychosocial stress in healthy older people, and the sex and age impact in this relationship. We randomly selected 100 literate older adults, without cognitive or functional impairment. The neuroendocrine stress response was evaluated by measuring the concentration of salivary cortisol, whereas cardiovascular reactions were determined based on blood pressure and heart rate measures taken before, during and after participant exposure to an acute psychosocial stressor (the Trier social stress test [TSST]). Memory performance was evaluated by applying the word pairs test before and after the TSST. A significant reduction in the word pair test scores was observed after the TSST, and a negative correlation between cortisol concentration and immediate and delayed recall of the word pair. Cortisol concentration associated with age, sex and education explained memory performance variability before and after the TSST. The results showed that the influence of acute stress on memory performance during aging might vary according to age and sex, highlighting potential differences in the vulnerability of older individuals to the neurotoxic effects of stress exposure on memory and consequently on the development of cognitive disorders. Geriatr Gerontol Int 2018; 18: 169-176. © 2017 Japan Geriatrics Society.

Influence of the length of institutionalization on older adults' postural balance and risk of falls: a transversal study.

PubMed

Batista, Wagner Oliveira; Alves Junior, Edmundo de Drummond; Porto, Flávia; Pereira, Fabio Dutra; Santana, Rosimere Ferreira; Gurgel, Jonas Lírio

2014-01-01

to ascertain the influence of the length of institutionalization on older adults' balance and risk of falls. to evaluate the risk of falls, the Berg Balance Scale and the Timed Get Up and Go test were used; and for measuring postural balance, static stabilometry was used, with acquisition of the elliptical area of 95% and mean velocities on the x and y axes of center of pressure displacement. Parametric and nonparametric measures of association and comparison (α<0.05) were used. there was no significant correlation between the length of institutionalization and the tests for evaluation of risk of falling, neither was there difference between groups and within subgroups, stratified by length of institutionalization and age. In the stabilometric measurements, there was a negative correlation between the parameters analyzed and the length of institutionalization, and difference between groups and within subgroups. this study's results point to the difficulty of undertaking postural control tasks, showing a leveling below the clinical tests' reference scores. In the stabilometric behavior, one should note the reduction of the parameters as the length of institutionalization increases, contradicting the assumptions. This study's results offer support for the development of a multi-professional model for intervention with the postural control and balance of older adults living in homes for the aged.

Intersection assistance: a safe solution for older drivers?

PubMed

Dotzauer, Mandy; Caljouw, Simone R; de Waard, Dick; Brouwer, Wiebo H

2013-10-01

Within the next few decades, the number of older drivers operating a vehicle will increase rapidly (Eurostat, 2011). As age increases so does physical vulnerability, age-related impairments, and the risk of being involved in a fatal crashes. Older drivers experience problems in driving situations that require divided attention and decision making under time pressure as reflected by their overrepresentation in at-fault crashes on intersections. Advanced Driver Assistance Systems (ADAS) especially designed to support older drivers crossing intersections might counteract these difficulties. In a longer-term driving simulator study, the effects of an intersection assistant on driving were evaluated. 18 older drivers (M=71.44 years) returned repeatedly completing a ride either with or without a support system in a driving simulator. In order to test the intersection assistance, eight intersections were depicted for further analyses. Results show that ADAS affects driving. Equipped with ADAS, drivers allocated more attention to the road center rather than the left and right, crossed intersections in shorter time, engaged in higher speeds, and crossed more often with a critical time-to-collision (TTC) value. The implications of results are discussed in terms of behavioral adaptation and safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

Postprandial hypotension in older survivors of critical illness.

PubMed

Nguyen, Thu Anh Ngoc; Ali Abdelhamid, Yasmine; Weinel, Luke M; Hatzinikolas, Seva; Kar, Palash; Summers, Matthew J; Phillips, Liza K; Horowitz, Michael; Jones, Karen L; Deane, Adam M

2018-06-01

In older people postprandial hypotension occurs frequently; and is an independent risk factor for falls, cardiovascular events, stroke and death. The primary aim of this pilot study was to estimate the frequency of postprandial hypotension and evaluate the mechanisms underlying this condition in older survivors of an Intensive Care Unit (ICU). Thirty-five older (>65 years) survivors were studied 3 months after discharge. After an overnight fast, participants consumed a 300 mL drink containing 75 g glucose, labelled with 20 MBq 99m Tc-calcium phytate. Patients had concurrent measurements of blood pressure, heart rate, blood glucose and gastric emptying following drink ingestion. Proportion of participants is presented as percent (95% CI) and continuous variables as mean (SD). Postprandial hypotension was evident in 10 (29%; 95% CI 14-44), orthostatic hypotension in 2 (6%; 95% CI 0-13) and cardiovascular autonomic dysfunction in 2 (6%; 95% CI 0-13) participants. The maximal postprandial nadir for systolic blood pressure and diastolic blood pressures were -29 (14) mmHg and -18 (7) mmHg. In this cohort of older survivors of ICU postprandial hypotension occurred frequently . This suggests that postprandial hypotension is an unrecognised issue in older ICU survivors. Copyright © 2018. Published by Elsevier Inc.

On the Inevitability of Aging: Essentialist Beliefs Moderate the Impact of Negative Age Stereotypes on Older Adults' Memory Performance and Physiological Reactivity.

PubMed

Weiss, David

2016-07-20

The goal of this research was to investigate how individual differences in essentialist beliefs about aging affect how older adults' respond to negative age stereotypes. Essentialist beliefs about aging (EBA) define the process of aging as fixed and inevitable rather than malleable and modifiable. Two experiments including older adults tested the hypothesis that EBA moderate the effect of negative age stereotypes on older adults' memory performance and physiological reactivity. In line with predictions, results of Experiment 1 (N = 79, 61-87 years) showed that for older adults with strong EBA, the activation of negative age stereotypes (vs neutral information) led to stereotype assimilation entailing a poorer memory performance. In contrast, for older adults with non-EBA, the activation of negative age stereotypes led to stereotype reactance entailing a better memory performance. Experiment 2 (N = 41; 65-92 years) replicated this pattern and also showed that older adults who endorsed rather than rejected EBA exhibited increased systolic blood pressure reactivity when negative age stereotypes were activated. The discussion focuses on pathways through which age stereotypes impact cognitive performance and health in later adulthood, as well as ways to stimulate positive plasticity by changing EBA. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The effect of depression on sleep quality and the circadian rhythm of ambulatory blood pressure in older patients with hypertension.

PubMed

Ma, Lina; Li, Yun

2017-05-01

To explore the effect of depression on the sleep quality, and the circadian rhythm of ambulatory blood pressure in patients with essential hypertension. A total of 73 older patients with hypertension were screened for depression and divided into two groups. The Pittsburgh Sleep Quality Index (PSQI) and the circadian rhythm of ambulatory blood pressure were compared between the non-depressed (control) and depressed (case) group. In the case group, 24h ambulatory SBP and DBP, and nocturnal SBP and DBP were higher than in the control group, and the circadian rhythm of non-dipper was higher (67.22% vs 40.13%，P<0.01). There was a positive correlation between PSQI and depression (r=0.432, P<0.01). There was a significant correlation between sleep quality and depression in older patients with hypertension. Depression increases the circadian rhythm of non-dipper in older patients with hypertension. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cardiovascular reactivity of younger and older adults to positive-, negative-, and mixed-emotion cognitive challenge.

PubMed

Hogan, Michael J; James, Jack E; McCabe, Tadhg R; Kilmartin, Liam; Howard, Siobhán; Noone, Chris

2012-03-01

Although aging is associated with progressive increases in blood pressure level, previous research has been inconsistent as to whether older adults show greater or lesser cardiovascular reactivity (CVR) to emotion than do younger adults. There is reason to believe that these inconsistencies could be clarified by examining age-related differences in hemodynamic profile revealed by measuring the pattern of cardiac output and total peripheral resistance associated with changes in blood pressure reactivity. Accordingly, the present study examined the performance, CVR, and hemodynamic profile of younger and older adults during encoding and recognition of word pairs involving four valence types: positive, negative, mixed (positive/negative), and neutral word pairs. Results revealed higher baseline blood pressure, increased CVR characterized by a vascular hemodynamic profile, and more rapid recovery (especially during encoding) for older than for younger participants. Results are discussed in light of research and theory on the relationship between aging and cardiovascular health. Copyright © 2012 Elsevier B.V. All rights reserved.

Older mothers follow conservative strategies under predator pressure: the adaptive role of maternal glucocorticoids in yellow-bellied marmots.

PubMed

Monclús, Raquel; Tiulim, Justin; Blumstein, Daniel T

2011-11-01

When the maternal environment is a good predictor of the offspring environment, maternal glucocorticoid (GC) levels might serve to pre-program offspring to express certain phenotypes or life-history characteristics that will increase their fitness. We conducted a field study to assess the effects of naturally occurring maternal GC levels on their offspring in yellow-bellied marmots (Marmota flaviventris) subjected to different predator pressures. Maternal fecal corticosteroid metabolites (FCM) were positively correlated with predator pressure. Predators had both direct and indirect effects on pups. We found that older mothers with higher FCM levels had smaller and female-biased litters. Moreover, sons from older mothers with high FCM levels dispersed significantly more than those from older mothers with low FCM levels, whereas the opposite pattern was found in pups from younger mothers. These age-related effects may permit females to make adaptive decisions that increase their pups' fitness according to their current situation. Copyright © 2011 Elsevier Inc. All rights reserved.

Trends in risk factors for coronary heart disease in the Netherlands.

PubMed

Koopman, C; Vaartjes, I; Blokstra, A; Verschuren, W M M; Visser, M; Deeg, D J H; Bots, M L; van Dis, I

2016-08-19

Favourable trends in risk factor levels in the general population may partly explain the decline in coronary heart disease (CHD) morbidity and mortality. Our aim was to present long-term national trends in established risk factors for CHD. Data were obtained from five data sources including several large scale population based surveys, cohort studies and general practitioner registers between 1988 and 2012. We applied linear regression models to age-standardized time trends to test for statistical significant trends. Analyses were stratified by sex and age (younger <65 and older ≥65 years adults). The results demonstrated favourable trends in smoking (except in older women) and physical activity (except in older men). Unfavourable trends were found for body mass index (BMI) and diabetes mellitus prevalence. Although systolic blood pressure (SBP) and total cholesterol trends were favourable for older persons, SBP and total cholesterol remained stable in younger persons. Four out of six risk factors for CHD showed a favourable or stable trend. The rise in diabetes mellitus and BMI is worrying with respect to CHD morbidity and mortality.

Preventing sight loss in older people. A qualitative study exploring barriers to the uptake of regular sight tests of older people living in socially deprived communities in South Wales.

PubMed

Biddyr, S; Jones, A

2015-02-01

This paper describes research findings that try to understand some of the reasons that prevent older people in deprived communities in South Wales from accessing NHS funded sight tests and leads to a discussion of suitable interventions that seek to improve access to primary eye care services and prevent avoidable sight loss. Data were collected from eight focus groups (n = 63) of mixed gender and ages (60-80+ years), of white origin living in deprived communities in South Wales. Individuals were recruited for the focus groups by extensively publicizing the project, with a range of health and older people's community services and groups such as sheltered housing complexes, stroke support groups and coffee morning groups. The study included people who attended optometry services and people not engaged with services. A purposive sampling technique summarizes the sampling approach taken, an approach which the team utilized to recruit 'information rich' cases, namely individuals, groups and organizations that provided the greatest insight into the research question. Focus groups were recorded and transcribed verbatim. Data underwent thematic content analysis and subsequent interpretations were corroborated by expert advisors and a project steering group. Cost was perceived as a significant barrier to accessing sight tests, particularly in relation to purchasing glasses. Other barriers included the perceived pressure to buy glasses associated with visits to the optometrists; poor understanding of the purpose of a sight test in a health prevention context and acceptance of deteriorating sight loss due to the ageing process. Areas of improvement for the delivery of preventative eye health services to older people are identified, as are areas for reflection on the part of those who work within the eye health industry. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Training with a balance exercise assist robot is more effective than conventional training for frail older adults.

PubMed

Ozaki, Kenichi; Kondo, Izumi; Hirano, Satoshi; Kagaya, Hitoshi; Saitoh, Eiichi; Osawa, Aiko; Fujinori, Yoichi

2017-11-01

To examine the efficacy of postural strategy training using a balance exercise assist robot (BEAR) as compared with conventional balance training for frail older adults. The present study was designed as a cross-over trial without a washout term. A total of 27 community-dwelling frail or prefrail elderly residents (7 men, 20 women; age range 65-85 years) were selected from a volunteer sample. Two exercises were prepared for interventions: robotic exercise moving the center of gravity by the balance exercise assist robot system; and conventional balance training combining muscle-strengthening exercise, postural strategy training and applied motion exercise. Each exercise was carried out twice a week for 6 weeks. Participants were allocated randomly to either the robotic exercise first group or the conventional balance exercise first group. preferred and maximal gait speeds, tandem gait speeds, timed up-and-go test, functional reach test, functional base of support, center of pressure, and muscle strength of the lower extremities were assessed before and after completion of each exercise program. Robotic exercise achieved significant improvements for tandem gait speed (P = 0.012), functional reach test (P = 0.002), timed up-and-go test (P = 0.023) and muscle strength of the lower extremities (P = 0.001-0.030) compared with conventional exercise. In frail or prefrail older adults, robotic exercise was more effective for improving dynamic balance and lower extremity muscle strength than conventional exercise. These findings suggest that postural strategy training with the balance exercise assist robot is effective to improve the gait instability and muscle weakness often seen in frail older adults. Geriatr Gerontol Int 2017; 17: 1982-1990. © 2017 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.

Age-related differences in tongue-palate pressures for strength and swallowing tasks.

PubMed

Fei, Tiffany; Polacco, Rebecca Cliffe; Hori, Sarah E; Molfenter, Sonja M; Peladeau-Pigeon, Melanie; Tsang, Clemence; Steele, Catriona M

2013-12-01

The tongue plays a key role in the generation of pressures for transporting liquids and foods through the mouth in swallowing. Recent studies suggest that there is an age-related decline in tongue strength in healthy adults. However, whether age-related changes occur in tongue pressures generated for the purpose of swallowing remains unclear. Prior literature in this regard does not clearly explore the influence of task on apparent age-related differences in tongue pressure amplitudes. Furthermore, differences attributable to variations across individuals in strength, independent of age, have not clearly been elucidated. In this study, our goal was to clarify whether older adults have reduced tongue-palate pressures during maximum isometric, saliva swallowing, and water swallowing tasks, while controlling for individual variations in strength. Data were collected from 40 healthy younger adults (under age 40) and 38 healthy mature adults (over age 60). As a group, the mature participants had significantly lower maximum isometric pressures (MIPs). Swallowing pressures differed significantly by task, with higher pressures seen in saliva swallows than in water swallows. Age-group differences were not seen in swallowing pressures. Consideration of MIP as a covariate in the analysis of swallowing pressures revealed significant correlations between strength and swallowing pressures in the older participant group. Age-group differences were evident only when strength was considered in the model, suggesting that apparent age-related differences are, in fact, explained by differences in strength, which tends to be lower in healthy older adults. Our results show no evidence of independent differences in swallowing pressures attributable to age.

Stroke: Unique to Older Adults

MedlinePlus

... more. Stroke and Other Medical Conditions : Stroke and Cardiovascular Disease An older person may have one or more cardiovascular diseases such as coronary artery disease , high blood pressure ( ...

Validity and reliability of the Nintendo Wii Balance Board to assess standing balance and sensory integration in highly functional older adults.

PubMed

Scaglioni-Solano, Pietro; Aragón-Vargas, Luis F

2014-06-01

Standing balance is an important motor task. Postural instability associated with age typically arises from deterioration of peripheral sensory systems. The modified Clinical Test of Sensory Integration for Balance and the Tandem test have been used to screen for balance. Timed tests present some limitations, whereas quantification of the motions of the center of pressure (CoP) with portable and inexpensive equipment may help to improve the sensitivity of these tests and give the possibility of widespread use. This study determines the validity and reliability of the Wii Balance Board (Wii BB) to quantify CoP motions during the mentioned tests. Thirty-seven older adults completed three repetitions of five balance conditions: eyes open, eyes closed, eyes open on a compliant surface, eyes closed on a compliant surface, and tandem stance, all performed on a force plate and a Wii BB simultaneously. Twenty participants repeated the trials for reliability purposes. CoP displacement was the main outcome measure. Regression analysis indicated that the Wii BB has excellent concurrent validity, and Bland-Altman plots showed good agreement between devices with small mean differences and no relationship between the difference and the mean. Intraclass correlation coefficients (ICCs) indicated modest-to-excellent test-retest reliability (ICC=0.64-0.85). Standard error of measurement and minimal detectable change were similar for both devices, except the 'eyes closed' condition, with greater standard error of measurement for the Wii BB. In conclusion, the Wii BB is shown to be a valid and reliable method to quantify CoP displacement in older adults.

Nerve Fiber Layer Thickness and Characteristics Associated with Glaucoma in Community Living Older Adults: Prelude to a Screening Trial?

PubMed

Klein, Barbara E K; Johnson, Chris A; Meuer, Stacy M; Lee, Kyungmoo; Wahle, Andreas; Lee, Kristine E; Kulkarni, Amruta; Sonka, Milan; Abràmoff, Michael D; Klein, Ronald

2017-04-01

To examine the associations of nerve fiber layer (NFL) thickness with other ocular characteristics in older adults. Participants in the Beaver Dam Eye Study (2008-2010) underwent spectral domain optical coherence tomography (SD-OCT) scans of the optic nerve head, imaging of optic discs, frequency doubling technology (FDT) perimetry, measurement of intraocular pressure (IOP), and an interview concerning their history of glaucoma and use of drops to lower eye pressure. Self-reported histories of glaucoma and the use of drops to lower eye pressure were obtained at follow-up examinations (2014-2016). NFL thickness measured on OCTs varied by location around the optic nerve. Age was associated with mean NFL thickness. Mean NFL was thinnest in eyes with larger cup/disc (C/D) ratios. Horizontal hemifield defects or other optic nerve-field defects were associated with thinner NFL. NFL in persons who reported taking eye drops for high intraocular pressure was thinner compared to those not taking drops. After accounting for the presence of high intraocular pressure, large C/D ratios or hemifield defects, eyes with thinner NFL in the arcades were more likely (OR = 2.3 for 30 micron thinner NFL, p = 0.04) to have incident glaucoma at examination 5 years later. Retinal NFL thickness was associated with a new history of self-reported glaucoma 5 years later. A trial testing the usefulness of NFL as part of a screening battery for predicting glaucoma in those previously undiagnosed might lead to improved case finding and, ultimately, to diminishing the risk of visual field loss.

Masked Hypertension is Associated With Cognitive Decline in Geriatric Age-Geriatric MASked Hypertension and Cognition (G-MASH-cog) Study.

PubMed

Esme, Mert; Yavuz, Burcu Balam; Yavuz, Bunyamin; Asil, Serkan; Tuna Dogrul, Rana; Sumer, Fatih; Kilic, Mustafa Kemal; Kizilarslanoglu, Muhammet Cemal; Varan, Hacer Dogan; Sagir, Aykut; Balci, Cafer; Halil, Meltem; Cankurtaran, Mustafa

2018-01-16

Masked hypertension is described as high ambulatory blood pressure measurements (ABPM) where office blood pressure measurements are normal. Effect of hypertension on cognitive functions is well known. However, the effect of masked hypertension on cognitive functions is unclear. The aim of this study is to examine the relationship between masked hypertension and cognitive functions. One hundred-two normotensive patients admitted to the Geriatric Medicine outpatient clinic were included. Exclusion criteria were hypertension, dementia, major depression, and usage of antihypertensive medication. All patients underwent ABPM procedures and average daytime blood pressure, mean blood pressure at night and the 24-hour average blood pressure measurements were recorded. Comprehensive geriatric assessment tests and neuropsychological tests were administered. The diagnosis of masked hypertension was based on the definitions in the 2013 guideline of the European Society of Cardiology. Forty-four patients (43%) were diagnosed with masked hypertension. Patients with masked hypertension had significantly lower scores on Mini-Mental State Examination (MMSE) test, Quick Mild Cognitive Impairment Test (QMCI), and Categorical Fluency Test than the normotensive patients (p = .011; p = .046; and p = .004; respectively). Montreal Cognitive Assessment Scale test score was lower in masked hypertension, although this was not statistically significant. This study may indicate that geriatric patients with masked hypertension, compared to normotensive patients have decreased cognitive functions. Masked hypertension should be kept in mind while assessing older adults. When masked hypertension is detected, cognitive assessment is essential to diagnose possible cognitive dysfunction at early stage. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Scaffolding across the lifespan in history-dependent decision-making.

PubMed

Cooper, Jessica A; Worthy, Darrell A; Gorlick, Marissa A; Maddox, W Todd

2013-06-01

We examined the relationship between pressure and age-related changes in decision-making using a task for which currently available rewards depend on the participant's previous history of choices. Optimal responding in this task requires the participant to learn how his or her current choices affect changes in the future rewards given for each option. Building on the scaffolding theory of aging and cognition, we predicted that when additional frontal resources are available, compensatory recruitment leads to increased monitoring and increased use of heuristic-based strategies, ultimately leading to better performance. Specifically, we predicted that scaffolding would result in an age-related performance advantage under no pressure conditions. We also predicted that, although younger adults would engage in scaffolding under pressure, older adults would not have additional resources available for increased scaffolding under pressure-packed conditions, leading to an age-related performance deficit. Both predictions were supported by the data. In addition, computational models were used to evaluate decision-making strategies employed by each participant group. As expected, older adults under no pressure conditions and younger adults under pressure conditions showed increased use of heuristic-based strategies relative to older adults under pressure and younger adults under no pressure, respectively. These results are consistent with the notion that scaffolding can occur across the life span in the face of an environmental challenge. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Tennis for physical health: acute age- and gender-based physiological responses to cardio tennis.

PubMed

Murphy, Alistair P; Duffield, Rob; Reid, Machar

2014-11-01

This study described physiological and perceptual responses to Cardio tennis for "younger" and "older" adult populations of both sexes for health-related outcomes. Thirty-one active participants, each with prior recreational tennis experience (∼2 years) (8 younger and 8 older males, and 7 younger and 8 older females) performed preliminary testing and a 50-minute instructor-led Cardio tennis session. Cardio tennis is a conditioning-based tennis program comprised of warm-up movements, drill-based exercises (set movement and hitting games), and competitive play scenarios. Participants performed the 20-m shuttle run test to determine maximal heart rate (HR) during preliminary testing. Before, after, and 30-minute post Cardio tennis session, HR, blood pressure (BP), rate pressure product (RPP), and capillary blood lactate and glucose were determined. Furthermore, HR and pedometer-derived step counts were measured throughout, while the session was filmed and coded for technical skill. After the session, ratings of perceived exertion, enjoyment, and challenge were obtained. Heart rate, systolic BP, and RPP were significantly increased by Cardio tennis (p ≤ 0.05), though returned to pre-exercise levels after 30 minutes (p > 0.05). Heart rate and BP did not differ between groups pre- or 30-minute postexercise (p > 0.05); however, these were lower in younger males during and higher in younger females postsession (p ≤ 0.05). Lactate and glucose concentrations were increased in all groups (p ≤ 0.05), with lactate being highest in male groups (p ≤ 0.05), without differences in glucose between groups (p > 0.05). Stroke and step counts were not different between groups (p > 0.05). Ratings of perceived exertion and perceived challenge were lowest in the younger male group compared with all other groups (p ≤ 0.05). Cardio tennis presents as an effective stimulus to invoke sufficient cardiovascular and metabolic load to benefit health and fitness, though age- and sex-based responses should be considered in prescription.

Evaluation of care quality for disabled older patients living at home and in institutions.

PubMed

Chang, Shu-Ching; Shiu, Ming-Neng; Chen, Huey-Tzy; Ng, Yee-Yung; Lin, Li-Chan; Wu, Shiao-Chi

2015-12-01

This study aimed to evaluate the level of care quality received by disabled older patients residing at home vs. those residing in institutions. Taiwan has an aging society and faces issues of caring for disabled older patients, including increasing needs, insufficient resources and a higher economic burden of care. Retrospective study extracting patient data from Taiwan's National Health Insurance database. We enrolled 76,672 disabled older patients aged 65 years and older who resided at home or institutions and had submitted claims for coverage of National Health Insurance for home care received for the first time between 2004-2006. Propensity score matching was applied to create a home-care group and an institutional-care group with 27,894 patients each. Indicators of care quality (emergency services use, hospitalisation, infection, pressure ulcers, death) within the first year were observed. The home care group had significantly higher emergency services use, fewer hospital admissions and fewer infections, but had significantly higher occurrence of pressure ulcers. The institutional-care group had significantly lower time intervals between emergencies, fewer deaths, lower risk of emergencies and lower pressure ulcer risk. Males had significantly higher emergency services use than females, and higher risk of hospital admission and death. Care quality indicators for elder care are significantly different between home care and institutional care. The quality of home care is associated with higher emergency services use and pressure ulcer development, and institutional care is associated with number of infections and hospitalisations. Care quality indicators were significantly different between home-care and institutional-care groups and were closely associated with the characteristics of individual patients' in the specific settings. Nursing capabilities must be directed towards reducing unnecessary care quality-related events among high-risk disabled older patients. © 2015 John Wiley & Sons Ltd.

Chronic condition as a mediator between metabolic syndrome and cognition among community-dwelling older adults: The moderating role of sex.

PubMed

Foong, Hui Foh; Hamid, Tengku Aizan; Ibrahim, Rahimah; Haron, Sharifah Azizah; Shahar, Suzana

2017-11-01

Metabolic syndrome and chronic conditions are significant predictors of cognition; however, few studies have examined how they work together in predicting cognition in old age. Therefore, the present study examines whether a chronic condition mediates the association between metabolic syndrome and cognition. In addition, it discusses the moderating role of sex in the relationships between metabolic syndrome, chronic conditions and cognition. Secondary analysis was carried out of data from the Malaysian national survey that involved 2322 community residents aged 60 years or older in Peninsular Malaysia. Cognition was measured by the digit symbol substitution test. Metabolic syndrome was assessed by five biomarkers: triglyceride, fasting blood sugar, systolic blood pressure, cholesterol ratio and body mass index. Chronic conditions were assessed by self-reported medical history. The structural equation modeling technique was used to analyze the mediation and moderation tests. The number of chronic conditions partially mediated the association between metabolic syndrome and cognition. Men and women did not differ in the relationship between metabolic syndrome and cognition; however, the number of chronic conditions was found to be negatively associated with cognition in older women, but not in men. Metabolic syndrome might increase the likelihood of older adults to suffer from more chronic conditions; these responses might reduce their cognition. To prevent cognitive decline in old age, specific intervention to minimize the number of chronic conditions by reducing their vascular risk factors is warranted, especially among older women. Geriatr Gerontol Int 2017; 17: 1914-1920. © 2017 Japan Geriatrics Society.

Extent of, and variables associated with, blood pressure variability among older subjects.

PubMed

Morano, Arianna; Ravera, Agnese; Agosta, Luca; Sappa, Matteo; Falcone, Yolanda; Fonte, Gianfranco; Isaia, Gianluca; Isaia, Giovanni Carlo; Bo, Mario

2018-02-23

Blood pressure variability (BPV) may have prognostic implications for cardiovascular risk and cognitive decline; however, BPV has yet to be studied in old and very old people. Aim of the present study was to evaluate the extent of BPV and to identify variables associated with BPV among older subjects. A retrospective study of patients aged ≥ 65 years who underwent 24-h ambulatory blood pressure monitoring (ABPM) was carried out. Three different BPV indexes were calculated for systolic and diastolic blood pressure (SBP and DBP): standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Demographic variables and use of antihypertensive medications were considered. The study included 738 patients. Mean age was 74.8 ± 6.8 years. Mean SBP and DBP SD were 20.5 ± 4.4 and 14.6 ± 3.4 mmHg. Mean SBP and DBP CV were 16 ± 3 and 20 ± 5%. Mean SBP and DBP ARV were 15.7 ± 3.9 and 11.8 ± 3.6 mmHg. At multivariate analysis older age, female sex and uncontrolled mean blood pressure were associated with both systolic and diastolic BPV indexes. The use of calcium channel blockers and alpha-adrenergic antagonists was associated with lower systolic and diastolic BPV indexes, respectively. Among elderly subjects undergoing 24-h ABPM, we observed remarkably high indexes of BPV, which were associated with older age, female sex, and uncontrolled blood pressure values.

A novel use of structural equation models to examine factors associated with prediabetes among adults aged 50 years and older: National Health and Nutrition Examination Survey 2001-2006.

PubMed

Bardenheier, Barbara H; Bullard, Kai McKeever; Caspersen, Carl J; Cheng, Yiling J; Gregg, Edward W; Geiss, Linda S

2013-09-01

To use structural modeling to test a hypothesized model of causal pathways related with prediabetes among older adults in the U.S. Cross-sectional study of 2,230 older adults (≥ 50 years) without diabetes included in the morning fasting sample of the 2001-2006 National Health and Nutrition Examination Surveys. Demographic data included age, income, marital status, race/ethnicity, and education. Behavioral data included physical activity (metabolic equivalent hours per week for vigorous or moderate muscle strengthening, walking/biking, and house/yard work), and poor diet (refined grains, red meat, added sugars, solid fats, and high-fat dairy). Structural-equation modeling was performed to examine the interrelationships among these variables with family history of diabetes, high blood pressure, BMI, large waist (waist circumference: women, ≥ 35 inches; men, ≥ 40 inches), triglycerides ≥ 200 mg/dL, and total and HDL (≥ 60 mg/dL) cholesterol. After dropping BMI and total cholesterol, our best-fit model included three single factors: socioeconomic position (SEP), physical activity, and poor diet. Large waist had the strongest direct effect on prediabetes (0.279), followed by male sex (0.270), SEP (-0.157), high blood pressure (0.122), family history of diabetes (0.070), and age (0.033). Physical activity had direct effects on HDL (0.137), triglycerides (-0.136), high blood pressure (-0.132), and large waist (-0.067); poor diet had direct effects on large waist (0.146) and triglycerides (0.148). Our results confirmed that, while including factors known to be associated with high risk of developing prediabetes, large waist circumference had the strongest direct effect. The direct effect of SEP on prediabetes suggests mediation by some unmeasured factor(s).

Can blood pressure be lowered safely in older adults with lacunar stroke? The Secondary Prevention of Small Subcortical Strokes study experience.

PubMed

White, Carole L; Szychowski, Jeff M; Pergola, Pablo E; Field, Thalia S; Talbert, Robert; Lau, Helena; Peri, Kalyani; Benavente, Oscar R

2015-04-01

To determine safety and tolerability of lowering blood pressure in older adults with lacunar stroke. Cohort study. The Secondary Prevention of Small Subcortical Strokes (SPS3) Trial, which compared the efficacy of two systolic blood pressure (SBP) targets (<130 mmHg and 130-149 mmHg) for secondary stroke prevention. Of 3,020 SPS3 participants, 494 aged 75 and older at baseline were used in these analyses. Rates of side effects related to lowering SBP and clinical outcomes, including stroke recurrence and vascular death, were examined. Older participants achieved SBP levels similar to those of younger participants (mean SBP of 125 mmHg and 137 mmHg in lower and higher SBP target groups, respectively). At least once during the approximately 3.5 years of follow-up, 21% reported dizziness, and 15% reported lightheadedness when standing; the only significant difference between the younger and older groups was unsteadiness when standing (23% vs 32% respectively, P < .001). There was no difference according to treatment group. In younger adults, recurrent stroke was less likely in the lower than the higher SBP group (hazard ratio (HR) = 0.77, 95% confidence interval (CI) = 0.59-1.01) but not in older participants (HR = 1.01, 95% CI = 0.59-1.73), although the interaction was not significant (P = .39). The lower SBP target was associated with a significant reduction in vascular death in older participants (HR = 0.42, 95% CI = 0.18-0.98), with a significant interaction between age and SBP group (P = .049). Except for unsteadiness when standing, there was no difference according to age in individuals with lacunar stroke with respect to side effects potentially related to lowering blood pressure. Although the lower SBP target was not associated with lower likelihood of recurrent stroke, these exploratory analyses suggested a possible benefit related to vascular death. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Age-related ventricular-vascular coupling during acute inflammation in humans: Effect of physical activity.

PubMed

Lane, Abbi D; Kappus, Rebecca M; Bunsawat, Kanokwan; Ranadive, Sushant M; Yan, Huimin; Phillips, Shane; Baynard, Tracy; Woods, Jeffrey A; Motl, Robert; Fernhall, Bo

2015-07-01

Aging is commonly accompanied by increased arterial and ventricular stiffness (determined by arterial elastance (Ea) and ventricular elastance (Elv)), augmented ventricular-vascular coupling ratios (Ea/Elv) and systemic inflammation. Acute inflammation may impact ventricular-vascular coupling and predispose older adults to cardiovascular events. However, physically active older adults have more compliant large arteries and left ventricles and lower inflammation than sedentary older adults. We hypothesized that acute inflammation would alter Ea, Elv, and Ea/Elv more in older versus younger adults but that higher levels of physical activity would attenuate inflammation-induced changes. End-systolic and central blood pressures were obtained using applanation tonometry before and at 24 and 48 h post-influenza vaccination in 24 older and 38 younger adults. Ultrasonography was used to measure ventricular volumes and other indices of cardiac performance. Physical activity was measured with accelerometry. Ea and Ea/Elv were maintained (p > 0.05), but Elv was reduced (p < 0.05) 24 h post-inflammation. Other indices of systolic performance were reduced in older but not younger adults; diastolic performance was attenuated in both groups 24 h post-inflammation (p < 0.05 for all). Older, but not younger, adults decreased central pressure during inflammation (p < 0.05). When controlled for age, physical activity was not related to the inflammation-induced changes in elastance (p > 0.05) except in the most active group of seniors (p < 0.05). Aging did not affect the elastance responses but did affect central blood pressure and other ventricular systolic responses to acute inflammation. Aging, not physical activity, appears to modulate cardiovascular responses to acute inflammation, except in the most active older adults. © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Predictors of cognitive impairment assessed by Mini Mental State Examination in community-dwelling older adults: relevance of the step test.

PubMed

Muscari, Antonio; Spiller, Ilaria; Bianchi, Giampaolo; Fabbri, Elisa; Forti, Paola; Magalotti, Donatella; Pandolfi, Paolo; Zoli, Marco

2018-07-15

Several predictors of cognitive impairment assessed by Mini Mental State Examination (MMSE) have previously been identified. However, which predictors are the most relevant and what is their effect on MMSE categories remains unclear. Cross-sectional and longitudinal study using data from 1116 older adults (72.6 ± 5.6 years, 579 female), 350 of whom were followed for 7 years. At baseline, the following variables were collected: personal data, marital status, occupation, anthropometric measures, risk factors, previous cardiovascular events, self-rated health and physical activity during the last week. Furthermore, routine laboratory tests, abdominal echography and a step test (with measurement of the time needed to ascend and descend two steps 20 times) were performed. The associations of these variables with cross-sectional cognitive deficit (MMSE < 24) and longitudinal cognitive decline (decrease of MMSE score over 7 years of follow-up) were investigated using logistic regression models. Cross-sectional cognitive deficit was independently associated with school education ≤ 5 years, prolonged step test duration, having been blue collar or housewife (P ≤ 0.0001 for all) and, with lower significance, with advanced age, previous stroke and poor recent physical activity (P < 0.05). Longitudinal cognitive decline was mainly associated with step test duration (P = 0.0001) and diastolic blood pressure (P = 0.0002). The MMSE categories mostly associated with step test duration were orientation, attention, calculation and language, while memory appeared to be poorly or not affected. In our cohort of older adults, step test duration was the most relevant predictor of cognitive impairment. Copyright © 2018 Elsevier Inc. All rights reserved.

Continuous Positive Airway Pressure Treatment for Sleep Apnea in Older Adults

PubMed Central

Weaver, Terri E; Chasens, Eileen

2007-01-01

Daytime sleepiness and sleep disordered breathing are increased in older compared to middle-aged adults. The cognitive and cardiovascular sequelae associated with obstructive sleep apnea (OSA) have significant implications for the older adult who may already be suffering from chronic illness. Most of the evidence supporting the utilization of continuous positive airway pressure (CPAP) for the treatment of OSA has been generated from studies employing samples consisting predominately of middle-aged adults. To examine the efficacy of CPAP for the treatment of obstructive sleep apnea in older adults with an emphasis on adherence and related treatment outcomes, this paper reviews findings from clinical trials including older individuals as well as those specifically targeting this population. These studies have demonstrated that following CPAP therapy, older adults have increased alertness, improved neurobehavioral outcomes in cognitive processing, memory, and executive function, decreased sleep disruption from nocturia and a positive effect on factors affecting cardiac function, including vascular resistance, platelet coagulability and other aspects of cardiovascular health. Physiological differences in respiratory structure and function between younger and older adults of similar disease severity are believed to result in older individuals requiring titration at lower CPAP levels. Once initiated, CPAP treatment is tolerated by older adults, including those with Alzheimer’s disease. Patterns of adherence in older individuals are consistent with that of middle-aged adults. PMID:17275370

Influence of the length of institutionalization on older adults' postural balance and risk of falls: a transversal study1

PubMed Central

Batista, Wagner Oliveira; Alves, Edmundo de Drummond; Porto, Flávia; Pereira, Fabio Dutra; Santana, Rosimere Ferreira; Gurgel, Jonas Lírio

2014-01-01

OBJECTIVE: to ascertain the influence of the length of institutionalization on older adults' balance and risk of falls. METHOD: to evaluate the risk of falls, the Berg Balance Scale and the Timed Get Up and Go test were used; and for measuring postural balance, static stabilometry was used, with acquisition of the elliptical area of 95% and mean velocities on the x and y axes of center of pressure displacement. Parametric and nonparametric measures of association and comparison (α<0.05) were used. RESULTS: there was no significant correlation between the length of institutionalization and the tests for evaluation of risk of falling, neither was there difference between groups and within subgroups, stratified by length of institutionalization and age. In the stabilometric measurements, there was a negative correlation between the parameters analyzed and the length of institutionalization, and difference between groups and within subgroups. CONCLUSION: this study's results point to the difficulty of undertaking postural control tasks, showing a leveling below the clinical tests' reference scores. In the stabilometric behavior, one should note the reduction of the parameters as the length of institutionalization increases, contradicting the assumptions. This study's results offer support for the development of a multi-professional model for intervention with the postural control and balance of older adults living in homes for the aged. PMID:25296149

Standing Balance and Spatiotemporal Aspects of Gait Are Impaired Upon Nocturnal Awakening in Healthy Late Middle-Aged and Older Adults

PubMed Central

McBean, Amanda L.; Najjar, Raymond P.; Schuchard, Ronald A.; Hall, Courtney D.; Wang, Cheng-Ann; Ku, Ban; Zeitzer, Jamie M.

2016-01-01

Study Objectives: Nocturnal awakenings may constitute a unique risk for falls among older adults. We describe differences in gait and balance between presleep and midsleep testing, and whether changes in the lighting environment during the midsleep testing further affect gait and balance. Methods: Twenty-one healthy, late middle-aged and older (64.7 ± 8.0 y) adults participated in this repeated-measures design consisting of four overnight laboratory stays. Each night, participants completed baseline visual acuity, gait, and balance testing. After a 2-h sleep opportunity, they were awakened for 13 min into one of four lighting conditions: very dim white light (< 0.5 lux); dim white light (∼28.0 lux); dim orange light (∼28.0 lux); and white room-level light (∼200 lux). During this awakening, participants completed the same sequence of testing as at baseline. Results: Low-contrast visual acuity significantly decreased with decreasing illuminance conditions (F(3,45) = 98.26, p < 0.001). Our a priori hypothesis was confirmed in that variation in stride velocity and center of pressure path length were significantly worse during the mid-sleep awakening compared to presleep baseline. Lighting conditions during the awakening, however, did not influence these parameters. In exploratory analyses, we found that over one-third of the tested gait and balance parameters were significantly worse at the midsleep awakening as compared to baseline (p < 0.05), and nearly one-quarter had medium to large effect sizes (Cohen d ≥ 0.5; r ≥ 0.3). Conclusions: Balance and gait are impaired during midsleep awakenings among healthy, late middle-aged and older adults. This impairment is not ameliorated by exposure to room lighting, when compared to dim lights. Citation: McBean AL, Najjar RP, Schuchard RA, Hall CD, Wang CA, Ku B, Zeitzer JM. Standing balance and spatiotemporal aspects of gait are impaired upon nocturnal awakening in healthy late middle-aged and older adults. J Clin Sleep Med 2016;12(11):1477–1486. PMID:27448415

Older people and health care: challenging assumptions.

PubMed

Scammell, Janet

2017-02-09

At a time of winter pressures, Janet Scammell, Associate Professor (Nursing), Bournemouth University, looks at how health professionals and society perceive older people, and how this might influence patient care.

DISTINCT FUNCTIONS OF SOCIAL SUPPORT AND COGNITIVE FUNCTION AMONG OLDER ADULTS

PubMed Central

Sims, Regina C.; Hosey, Megan; Levy, Shellie-Anne; Whitfield, Keith E.; Katzel, Leslie I.; Waldstein, Shari R.

2014-01-01

Background/Study Context Social support has been shown to buffer cognitive decline in older adults; however, few studies have examined the association of distinct functions of perceived social support and cognitive function. The current study examined the relations between distinct functions of social support and numerous cognitive domains in older adults. Methods Data were derived from a cross-sectional, correlational study of cardiovascular risk factors, cognitive function, and neuroimaging. The participants were 175 older adults with a mean age of 66.32. A number of neuropsychological tests and the Interpersonal Support Evaluation List were administered. Multiple linear regression analyses were conducted to determine cross-sectional relations of social support to cognitive function after controlling for age, gender, education, depressive symptomatology, systolic blood pressure, body-mass index, total cholesterol, and fasting glucose. Results No significant positive relations were found between distinct functions of social support and cognitive function in any domain; however, inverse relations emerged such that greater social support across several functions was associated with poorer nonverbal memory and response inhibition. Conclusion Results suggest that the receipt of social support may be a burden for some older adults. Within the current study, fluid cognitive abilities reflected this phenomenon. The mechanism through which social support is associated with poorer cognitive function in some domains deserves further exploration. PMID:24467699

Aging worsens the effects of sleep deprivation on postural control.

PubMed

Robillard, Rébecca; Prince, François; Filipini, Daniel; Carrier, Julie

2011-01-01

Falls increase with age and cause significant injuries in the elderly. This study aimed to determine whether age modulates the interactions between sleep deprivation and postural control and to evaluate how attention influences these interactions in the elderly. Fifteen young (24±2.7 y.o.) and 15 older adults (64±3.2 y.o.) stood still on a force plate after a night of sleep and after total sleep deprivation. Center of pressure range and velocity were measured with eyes open and with eyes closed while participants performed an interference task, a control task, and no cognitive task. Sleep deprivation increased the antero-posterior range of center of pressure in both age groups and center of pressure speed in older participants only. In elderly participants, the destabilizing effects of sleep deprivation were more pronounced with eyes closed. The interference task did not alter postural control beyond the destabilization induced by sleep loss in older subjects. It was concluded that sleep loss has greater destabilizing effects on postural control in older than in younger participants, and may therefore increase the risk of falls in the elderly.

Aging Worsens the Effects of Sleep Deprivation on Postural Control

PubMed Central

Robillard, Rébecca; Prince, François; Filipini, Daniel; Carrier, Julie

2011-01-01

Falls increase with age and cause significant injuries in the elderly. This study aimed to determine whether age modulates the interactions between sleep deprivation and postural control and to evaluate how attention influences these interactions in the elderly. Fifteen young (24±2.7 y.o.) and 15 older adults (64±3.2 y.o.) stood still on a force plate after a night of sleep and after total sleep deprivation. Center of pressure range and velocity were measured with eyes open and with eyes closed while participants performed an interference task, a control task, and no cognitive task. Sleep deprivation increased the antero-posterior range of center of pressure in both age groups and center of pressure speed in older participants only. In elderly participants, the destabilizing effects of sleep deprivation were more pronounced with eyes closed. The interference task did not alter postural control beyond the destabilization induced by sleep loss in older subjects. It was concluded that sleep loss has greater destabilizing effects on postural control in older than in younger participants, and may therefore increase the risk of falls in the elderly. PMID:22163330

Consumption of anthocyanin-rich cherry juice for 12 weeks improves memory and cognition in older adults with mild-to-moderate dementia.

PubMed

Kent, Katherine; Charlton, Karen; Roodenrys, Steven; Batterham, Marijka; Potter, Jan; Traynor, Victoria; Gilbert, Hayley; Morgan, Olivia; Richards, Rachelle

2017-02-01

Dietary flavonoids, including anthocyanins, may positively influence cognition and may be beneficial for the prevention and treatment of dementia. We aimed to assess whether daily consumption of anthocyanin-rich cherry juice changed cognitive function in older adults with dementia. Blood pressure and anti-inflammatory effects were examined as secondary outcomes. A 12-week randomised controlled trial assessed cognitive outcomes in older adults (+70 year) with mild-to-moderate dementia (n = 49) after consumption of 200 ml/day of either a cherry juice or a control juice with negligible anthocyanin content. Blood pressure and inflammatory markers (CRP and IL-6) were measured at 6 and 12 weeks. ANCOVA controlling for baseline and RMANOVA assessed change in cognition and blood pressure. Improvements in verbal fluency (p = 0.014), short-term memory (p = 0.014) and long-term memory (p ≤ 0.001) were found in the cherry juice group. A significant reduction in systolic (p = 0.038) blood pressure and a trend for diastolic (p = 0.160) blood pressure reduction was evident in the intervention group. Markers of inflammation (CRP and IL-6) were not altered. Inclusion of an anthocyanin-rich beverage may be a practical and feasible way to improve total anthocyanin consumption in older adults with mild-to-moderate dementia, with potential to improve specific cognitive outcomes.

Foot pressure analysis of gait pattern in older Japanese females requiring different personal care support levels.

PubMed

Takayanagi, Naoto; Sudo, Motoki; Fujii, Masahiko; Sakai, Hirokazu; Morimoto, Keiko; Tomisaki, Masumi; Niki, Yoshifumi; Tokimitsu, Ichiro

2018-03-01

[Purpose] This study evaluated gait parameters and foot pressure in two regions of the feet among older females with different personal care support needs to analyze factors that contribute to higher support requirements. [Subjects and Methods] Thirty-two older females were divided into support-need and care-need level groups. Gait parameters (speed, cadence, step length, step width, gait angle, toe angle, double support phase, swing phase, and stance phase) and foot pressure during a 5-m walk were measured and analyzed in the two groups. [Results] The percentage of the double support phase on both feet and the right stance phase were significantly higher in the care-need level group, while that of the right swing phase was significantly lower than that of the support-need level group. Additionally, the phase showing peak pressure on the left rear foot was significantly delayed and the left forefoot pressure in the terminal stance was significantly lower in the care-need level group than in the support-need level group. [Conclusion] These findings show that the temporal duration parameters and foot pressure on a particular side were significantly different between the two groups and suggest that these differences were associated with a higher care level.

The effect of a trunk release maneuver on Peak Pressure Index, trunk displacement and perceived discomfort in older adults seated in a High Fowler's position: a randomized controlled trial.

PubMed

Best, Krista L; Desharnais, Guylaine; Boily, Jeanette; Miller, William C; Camp, Pat G

2012-11-16

Pressure ulcers pose significant negative individual consequences and financial burden on the healthcare system. Prolonged sitting in High Fowler's position (HF) is common clinical practice for older adults who spend extended periods of time in bed. While HF aids in digestion and respiration, being placed in a HF may increase perceived discomfort and risk of pressure ulcers due to increased pressure magnitude at the sacral and gluteal regions. It is likely that shearing forces could also contribute to risk of pressure ulcers in HF. The purpose of this study was to evaluate the effect of a low-tech and time-efficient Trunk Release Manuever (TRM) on sacral and gluteal pressure, trunk displacement and perceived discomfort in ambulatory older adults. A randomized controlled trial was used. We recruited community-living adults who were 60 years of age and older using posters, newspaper advertisements and word-of-mouth. Participants were randomly allocated to either the intervention or control group. The intervention group (n = 59) received the TRM, while the control group (n = 58) maintained the standard HF position. The TRM group had significantly lower mean (SD) PPI values post-intervention compared to the control group, 59.6 (30.7) mmHg and 79.9 (36.5) mmHg respectively (p = 0.002). There was also a significant difference in trunk displacement between the TRM and control groups, +3.2 mm and -5.8 mm respectively (p = 0.005). There were no significant differences in perceived discomfort between the groups. The TRM was effective for reducing pressure in the sacral and gluteal regions and for releasing the trunk at the point of contact between the skin and the support surface, but did not have an effect on perceived discomfort. The TRM is a simple method of repositioning which may have important clinical application for the prevention of pressure ulcers that may occur as a result of HF.

Cognitive Function and Kidney Disease: Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT).

PubMed

Weiner, Daniel E; Gaussoin, Sarah A; Nord, John; Auchus, Alexander P; Chelune, Gordon J; Chonchol, Michel; Coker, Laura; Haley, William E; Killeen, Anthony A; Kimmel, Paul L; Lerner, Alan J; Oparil, Suzanne; Saklayen, Mohammad G; Slinin, Yelena M; Wright, Clinton B; Williamson, Jeff D; Kurella Tamura, Manjula

2017-09-01

Chronic kidney disease is common and is associated with cardiovascular disease, cerebrovascular disease, and cognitive function, although the nature of this relationship remains uncertain. Cross-sectional cohort using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT). Participants in SPRINT, a randomized clinical trial of blood pressure targets in older community-dwelling adults with cardiovascular disease, chronic kidney disease, or high cardiovascular disease risk and without diabetes or known stroke, who underwent detailed neurocognitive testing in the cognition substudy, SPRINT-Memory and Cognition in Decreased Hypertension (SPRINT-MIND). Urine albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Cognitive function, a priori defined as 5 cognitive domains based on 11 cognitive tests using z scores, and abnormal white matter volume quantified by brain magnetic resonance imaging. Of 9,361 SPRINT participants, 2,800 participated in SPRINT-MIND and 2,707 had complete data; 637 had brain imaging. Mean age was 68 years, 37% were women, 30% were black, and 20% had known cardiovascular disease. Mean eGFR was 70.8±20.9mL/min/1.73m 2 and median urine ACR was 9.7 (IQR, 5.7-22.5) mg/g. In adjusted analyses, higher ACR was associated with worse global cognitive function, executive function, memory, and attention, such that each doubling of urine ACR had the same association with cognitive performance as being 7, 10, 6, and 14 months older, respectively. Lower eGFR was independently associated with worse global cognitive function and memory. In adjusted models, higher ACR, but not eGFR, was associated with larger abnormal white matter volume. Cross-sectional only, no patients with diabetes were included. In older adults, higher urine ACR and lower eGFR have independent associations with global cognitive performance with different affected domains. Albuminuria concurrently identifies a higher burden of abnormal brain white matter disease, suggesting that vascular disease may mediate these relationships. Copyright © 2017 National Kidney Foundation, Inc. All rights reserved.

Conflict and Collaboration in Middle-Aged and Older Couples: II: Cardiovascular Reactivity during Marital Interaction

PubMed Central

Smith, Timothy W.; Uchino, Bert N.; Berg, Cynthia A.; Florsheim, Paul; Pearce, Gale; Hawkins, Melissa; Henry, Nancy J. M.; Beveridge, Ryan M.; Skinner, Michelle A.; Ko, Kelly J.; Olsen-Cerny, Chrisanna

2011-01-01

Marital strain confers risk of cardiovascular disease (CVD), perhaps though cardiovascular reactivity (CVR) to stressful marital interactions. CVR to marital stressors may differ between middle-age and older adults, and types of marital interactions that evoke CVR may also differ across these age groups, as relationship contexts and stressors differ with age. We examined cardiovascular responses to a marital conflict discussion and collaborative problem solving in 300 middle-aged and older married couples. Marital conflict evoked greater increases in blood pressure, cardiac output and cardiac sympathetic activation than did collaboration. Older couples displayed smaller heart rate responses to conflict than did middle-aged couples, but larger blood pressure responses to collaboration–especially older men. These effects were maintained during a post-task recovery period. Women did not display greater CVR than men on any measure or in either interaction context, though they did display greater parasympathetic withdrawal. CVR to marital conflict could contribute to the association of marital strain with CVD for middle-aged and older men and women, but other age-related marital contexts (e.g., collaboration among older couples) may also contribute to this mechanism. PMID:19485647

Older Workers' Learning within Organizations: Issues and Challenges

ERIC Educational Resources Information Center

Findsen, Brian

2015-01-01

As increasing numbers of older adults stay in the workforce or engage in encore careers, they are subjected to diverse issues and challenges. The new dynamics of the workplace in a global market exert pressure on older workers and employers alike in which training and development has a potentially significant function for achieving greater…

Preventive health screening utilization in older Mexicans before and after healthcare reform.

PubMed

Salinas, Jennifer J

2015-01-01

To assess changes in preventive screening utilization in older Mexicans, pre- and post-Seguro Popular. Data from the Mexican Health and Aging Study (MHAS/Enasem) 2001 and 2012 were used. Logistic and ordinary least squares regression adjusted models were used to predict preventive care in 2012 by insurance status categories in 2001-2012, as the focus explanatory variable. Participants who were uninsured in 2001 and had Seguro Popular in 2012 were significantly more likely to be tested for diabetes, high blood pressure and receive a tetanus shot than the continually uninsured. While disparities in preventive screening between the insured and uninsured continue to exist in Mexico, Seguro Popular seems to have provided better access to health services to prevent chronic and infectious diseases for the otherwise uninsured population.

Physiological reactivity during autobiographical narratives in older adults: the roles of depression and anxiety.

PubMed

Robertson, Sarah M C; Swickert, Rhonda J; Connelly, Kathryn; Galizio, Ann

2015-01-01

Physiological reactivity (PR) describes the change in physiological functioning (e.g., heart rate, blood pressure, pulse pressure) that occurs after the induction of a stressful task. This study aims to understand the influence of mental health symptoms on patterns of PR during autobiographical narratives in an older adult sample. Eighty older adults completed self-report measures regarding their symptoms of depression and anxiety. Next, their blood pressure was recorded while they completed two verbal autobiographical narratives. During the positive narrative, anxiety was positively associated with increased PR while depression was negatively associated with PR. During the negative narrative, a significant interaction occurred whereby anxiety was significantly positively associated with PR for those participants low in depression. The above results are explained in the context of the Tripartite Model of Depression and Anxiety, which predicts different patterns of PR as a function of mental health symptoms. Limitations and future directions are also discussed.

High Blood Pressure: Unique to Older Adults

MedlinePlus

... Contact Aging & Health A to Z Find a Geriatrics Healthcare Professional Medications & Older Adults Making Your Wishes ... effective ways to reduce anxiety levels. Non-medication therapies are a good way to start. These can ...

Age, splanchnic vasoconstriction, and heat stress during tilting

NASA Technical Reports Server (NTRS)

Minson, C. T.; Wladkowski, S. L.; Pawelczyk, J. A.; Kenney, W. L.

1999-01-01

During upright tilting, blood is translocated to the dependent veins of the legs and compensatory circulatory adjustments are necessary to maintain arterial pressure. For examination of the effect of age on these responses, seven young (23 +/- 1 yr) and seven older (70 +/- 3 yr) men were head-up tilted to 60 degrees in a thermoneutral condition and during passive heating with water-perfused suits. Measurements included heart rate (HR), cardiac output (Qc; acetylene rebreathing technique), central venous pressure (CVP), blood pressures, forearm blood flow (venous occlusion plethysmography), splanchnic and renal blood flows (indocyanine green and p-aminohippurate clearance), and esophageal and mean skin temperatures. In response to tilting in the thermoneutral condition, CVP and stroke volume decreased to a greater extent in the young men, but HR increased more, such that the fall in Qc was similar between the two groups in the upright posture. The rise in splanchnic vascular resistance (SVR) was greater in the older men, but the young men increased forearm vascular resistance (FVR) to a greater extent than the older men. The fall in Qc during combined heat stress and tilting was greater in the young compared with older men. Only four of the young men versus six of the older men were able to finish the second tilt without becoming presyncopal. In summary, the older men relied on a greater increase in SVR to compensate for a reduced ability to constrict the skin and muscle circulations (as determined by changes in FVR) during head-up tilting.

Skin injuries caused by medical adhesive tape in older people and associated factors.

PubMed

Konya, Chizuko; Sanada, Hiromi; Sugama, Junko; Okuwa, Mayumi; Kamatani, Yuki; Nakagami, Gojiro; Sakaki, Kozue

2010-05-01

This study was designed to investigate the status of skin injuries in older individuals caused by adhesive tape and the associated factors for skin injury. Older individuals are susceptible to skin injuries caused by medical adhesive tape. However, the current status of such skin injuries and the associated factors involved has not been clearly elucidated. Prospective cohort design, using comparative and descriptive statistical tests. The subjects were 155 patients aged 65 or older who were admitted to a long-term care facility and required the use of medical adhesive tape. Patients who showed no skin injuries were selected and the incidence rate and status of skin injuries that occurred during the eight-week study period were investigated. The skin injuries observed were classified by a dermatologist. The associated factors were examined statistically. Informed consent was obtained from all patients. Skin injuries developed at 34 sites in 24 subjects. The cumulative incidence rate was 15.5%, and the incidence density was 38.0/1000 person-days. Many of the skin injuries occurred around pressure ulcers and intravenous hyperalimentation sites. Other prevalent areas included the buttocks and back, where tape is commonly used. The skin injuries were classified as contact dermatitis (70.6%), trauma (20.6%) and infection (8.8%). The ratio of skin contamination and skin mobility in patients with contact dermatitis was significantly higher than in patients without skin injury. The highest incidence rate was observed in the buttock area of patients with pressure ulcers. The incidence rate of contact dermatitis was the highest. Skin care to minimise contamination and more effective ways of applying medical adhesive tape may be needed to prevent contact dermatitis.

Wearable-Sensor-Based Classification Models of Faller Status in Older Adults.

PubMed

Howcroft, Jennifer; Lemaire, Edward D; Kofman, Jonathan

2016-01-01

Wearable sensors have potential for quantitative, gait-based, point-of-care fall risk assessment that can be easily and quickly implemented in clinical-care and older-adult living environments. This investigation generated models for wearable-sensor based fall-risk classification in older adults and identified the optimal sensor type, location, combination, and modelling method; for walking with and without a cognitive load task. A convenience sample of 100 older individuals (75.5 ± 6.7 years; 76 non-fallers, 24 fallers based on 6 month retrospective fall occurrence) walked 7.62 m under single-task and dual-task conditions while wearing pressure-sensing insoles and tri-axial accelerometers at the head, pelvis, and left and right shanks. Participants also completed the Activities-specific Balance Confidence scale, Community Health Activities Model Program for Seniors questionnaire, six minute walk test, and ranked their fear of falling. Fall risk classification models were assessed for all sensor combinations and three model types: multi-layer perceptron neural network, naïve Bayesian, and support vector machine. The best performing model was a multi-layer perceptron neural network with input parameters from pressure-sensing insoles and head, pelvis, and left shank accelerometers (accuracy = 84%, F1 score = 0.600, MCC score = 0.521). Head sensor-based models had the best performance of the single-sensor models for single-task gait assessment. Single-task gait assessment models outperformed models based on dual-task walking or clinical assessment data. Support vector machines and neural networks were the best modelling technique for fall risk classification. Fall risk classification models developed for point-of-care environments should be developed using support vector machines and neural networks, with a multi-sensor single-task gait assessment.

Healthy Buddies: a novel, peer-led health promotion program for the prevention of obesity and eating disorders in children in elementary school.

PubMed

Stock, Suzanne; Miranda, Charmaine; Evans, Stacey; Plessis, Suzanne; Ridley, Julia; Yeh, Sophia; Chanoine, Jean-Pierre

2007-10-01

We designed and tested a novel health promotion program for elementary schools that was based on peer teaching from older to younger schoolchildren ("Healthy Buddies"). This prospective pilot study compared the effect of our program (2-3 hours/week, 21 weeks) in 2 Canadian elementary schools (intervention: n = 232 children, the whole school implementing the program; control: n = 151). Older students (4th through 7th grade) were given direct instruction from 1 intervention teacher and were paired with younger students (kindergarten through 3rd grade) for the whole school year. Students in 4th through 7th grade then acted as teachers for their younger "buddies." All lessons included 3 components of healthy living: nutrition, physical activity, and healthy body image. The students first learned how to be positive buddies and learned the 3 components of a healthy life. Thereafter, they learned how to overcome challenges to living a healthy life. Outcome measures (intervention and control schools at the beginning and end of the school year) included validated questionnaires that assessed healthy-living knowledge, behavior and attitude, a 9-minute fitness run, self-competence, body satisfaction, disordered eating symptoms, and anthropometry (BMI, blood pressure, and heart rate). Compared with control students, both older and younger intervention students showed an increase in healthy-living knowledge, behavior, and attitude scores and a smaller increase in systolic blood pressure. BMI and weight increased less in the intervention students in 4th through 7th grade and height more in the intervention students in kindergarten through 3rd grade. Our student-led curriculum improved knowledge not only in older schoolchildren but also in their younger buddies. It also decreased weight velocity in the older students. Student-led teaching may be an efficient, easy-to-implement way of promoting a healthy lifestyle from kindergarten to 7th grade.

Reliability of a retrospective decade-based life-course alcohol consumption questionnaire administered in later life.

PubMed

Bell, Steven; Britton, Annie

2015-10-01

Retrospective measures of alcohol intake are becoming increasingly popular; however, the reliability of such measures remains uncertain. This study assessed the reliability of a retrospective decade-based life-course alcohol consumption questionnaire, based on the standardized Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) administered in older age in a well-characterized cohort study. A retrospective alcohol life-grid was administered to 5980 participants (72% male, mean age 70 years) in the Whitehall II study covering frequency of drinking, number of drinks in a typical drinking day and frequency of consuming six or more drinks in a single drinking occasion in the teens (16-19 years) through to the 80s. A subsample of 385 individuals completed a repeat survey to determine test-retest reliability. Retrospective measures were also compared with prospectively ascertained information and used to predict objectively measured systolic blood pressure to test their predictive validity. Across all decades of life, test-retest reliability was generally good (κ range = 0.62-0.78 for frequency, 0.55-0.62 for usual number of drinks and 0.57-0.65 for frequency of consuming six or more drinks in a single occasion). The concordance between prospective and retrospective measures was consistently moderate to high. The life-grid method performed better than a single question in identifying life-time abstainers. Retrospective measures were also related to systolic blood pressure in the manner anticipated. A retrospective decade-based AUDIT-C grid administered in older age provides a relatively reliable measure of alcohol consumption across the life-course. © 2015 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Recruitment of Older Adults: Success May Be in the Details

PubMed Central

McHenry, Judith C.; Insel, Kathleen C.; Einstein, Gilles O.; Vidrine, Amy N.; Koerner, Kari M.; Morrow, Daniel G.

2015-01-01

Purpose: Describe recruitment strategies used in a randomized clinical trial of a behavioral prospective memory intervention to improve medication adherence for older adults taking antihypertensive medication. Results: Recruitment strategies represent 4 themes: accessing an appropriate population, communication and trust-building, providing comfort and security, and expressing gratitude. Recruitment activities resulted in 276 participants with a mean age of 76.32 years, and study enrollment included 207 women, 69 men, and 54 persons representing ethnic minorities. Recruitment success was linked to cultivating relationships with community-based organizations, face-to-face contact with potential study participants, and providing service (e.g., blood pressure checks) as an access point to eligible participants. Seventy-two percent of potential participants who completed a follow-up call and met eligibility criteria were enrolled in the study. The attrition rate was 14.34%. Implications: The projected increase in the number of older adults intensifies the need to study interventions that improve health outcomes. The challenge is to recruit sufficient numbers of participants who are also representative of older adults to test these interventions. Failing to recruit a sufficient and representative sample can compromise statistical power and the generalizability of study findings. PMID:22899424

Responses of the autonomic nervous system during periods of perceived high and low work stress in younger and older female teachers.

PubMed

Ritvanen, Tiina; Louhevaara, Veikko; Helin, Pertti; Väisänen, Sari; Hänninen, Osmo

2006-05-01

The aim of this study was to examine the response of the autonomic nervous system in younger (mean age 31 yrs, n=14) and older (mean age 54 yrs, n=14) healthy female teachers during work periods of perceived high and low stress. In the younger participants, heart rate, cortisol excretion rate and psychosomatic symptoms were significantly higher during the high work stress period. The older participants experienced no decrease in their heart rate and cortisol excretion during the low stress period and they exhibited no significant decrease in blood pressure after the work in the evening during both periods. It may be concluded that the recovery from the stress in the older teachers was insufficient particularly in view of their elevated diastolic blood pressure during the low work stress period. Ergonomic and individually tailored measures in terms of work time control, specific relaxation techniques, and a part-time retirement may improve the stress management of older teachers.

Clinical validity of the estimated energy requirement and the average protein requirement for nutritional status change and wound healing in older patients with pressure ulcers: A multicenter prospective cohort study.

PubMed

Iizaka, Shinji; Kaitani, Toshiko; Nakagami, Gojiro; Sugama, Junko; Sanada, Hiromi

2015-11-01

Adequate nutritional intake is essential for pressure ulcer healing. Recently, the estimated energy requirement (30 kcal/kg) and the average protein requirement (0.95 g/kg) necessary to maintain metabolic balance have been reported. The purpose was to evaluate the clinical validity of these requirements in older hospitalized patients with pressure ulcers by assessing nutritional status and wound healing. This multicenter prospective study carried out as a secondary analysis of a clinical trial included 194 patients with pressure ulcers aged ≥65 years from 29 institutions. Nutritional status including anthropometry and biochemical tests, and wound status by a structured severity tool, were evaluated over 3 weeks. Energy and protein intake were determined from medical records on a typical day and dichotomized by meeting the estimated average requirement. Longitudinal data were analyzed with a multivariate mixed-effects model. Meeting the energy requirement was associated with changes in weight (P < 0.001), arm muscle circumference (P = 0.003) and serum albumin level (P = 0.016). Meeting the protein requirement was associated with changes in weight (P < 0.001) and serum albumin level (P = 0.043). These markers decreased in patients who did not meet the requirement, but were stable or increased in those who did. Energy and protein intake were associated with wound healing for deep ulcers (P = 0.013 for both), improving exudates and necrotic tissue, but not for superficial ulcers. Estimated energy requirement and average protein requirement were clinically validated for prevention of nutritional decline and of impaired healing of deep pressure ulcers. © 2014 Japan Geriatrics Society.

Metabolic syndrome and subclinical carotid atherosclerosis among Chinese elderly people living in a rural community.

PubMed

Yan, Zhongrui; Liang, Yajun; Jiang, Hui; Cai, Chuanzhu; Sun, Binglun; Qiu, Chengxuan

2014-06-01

The relationship between the metabolic syndrome and subclinical atherosclerosis among elderly people remains controversial. We seek to investigate the associations of metabolic syndrome and its components with subclinical carotid atherosclerosis in older people living in rural China. This cross-sectional study included 911 participants (age ≥60 years, 59.4% women) of the community-based Confucius Hometown Aging Project in Shandong, China, who were free of clinical cardiovascular disease. In 2010-2011, data were collected through interviews, clinical examinations, and laboratory tests. Carotid intima media thickness (cIMT) and carotid artery plaque were assessed using ultrasonography. Metabolic syndrome was defined by four sets of criteria. Data were analyzed with multiple general linear and logistic regression models. Carotid plaque was detected in 514 (56.4%) persons. Depending on the defining criteria, prevalence of metabolic syndrome ranged from 30.6% to 56.9%. Hypertension, elevated blood pressure (≥130/85 mmHg), diabetes/prediabetes, and high fasting plasma glucose (≥5.6 mmol/L) were significantly associated with an increased likelihood of carotid plaque, whereas an increased cIMT was associated with elevated blood pressure and hypertension (P<0.05). Obesity, high triglycerides, and dyslipidemia were not associated with carotid artery plaque or cIMT. The significant association of metabolic syndrome with an increased likelihood of carotid plaque disappeared when elevated blood pressure and high plasma glucose were added to the models. Metabolic syndrome was not associated with cIMT. Metabolic syndrome is associated with subclinical carotid plaque among Chinese elderly people, driven primarily by elevated blood pressure and hyperglycemia. Older adults with metabolic syndrome, especially those with high blood pressure and hyperglycemia, may benefit from evaluation for subclinical atherosclerosis.

Adolescents' response to parental efforts to influence eating habits: when parental warmth matters.

PubMed

Lessard, Jared; Greenberger, Ellen; Chen, Chuansheng

2010-01-01

Previous findings have shown both beneficial and adverse effects of parents' attempts to influence adolescents' eating habits. The current study examined the differential effect of parents' persuasion (e.g., encouragement, giving information) and pressure tactics (e.g., guilt induction, ridicule) and the moderating influence of parental warmth on older adolescents' emotional and behavioral responses. An ethnically diverse sample of 336 older adolescents (M age = 18.6; SD = 1.1; 58.0% female) were surveyed. Adolescents who reported higher levels of pressure tactics by parents reported more negative affect and behavioral resistance. Perceived parental warmth moderated the influence of persuasion tactics, but not pressure tactics. For adolescents with low parental warmth, high levels of persuasion were associated with more negative emotional and behavioral responses; persuasion had the opposite associations for adolescents with high parental warmth. These results suggest that parental warmth plays an important role in how older adolescents respond to parents' persuasion tactics. However, when parents use more forceful pressure tactics to influence eating habits, adolescents react negatively regardless of the overall quality of the parent-adolescent relationship.

Aging, not age-associated inflammation, determines blood pressure and endothelial responses to acute inflammation.

PubMed

Lane-Cordova, Abbi D; Ranadive, Sushant M; Kappus, Rebecca M; Cook, Marc D; Phillips, Shane A; Woods, Jeffrey A; Wilund, Kenneth R; Baynard, Tracy; Fernhall, Bo

2016-12-01

Aging is characterized by a state of chronic, low-grade inflammation that impairs vascular function. Acute inflammation causes additional decrements in vascular function, but these responses are not uniform in older compared with younger adults. We sought to determine if older adults with low levels of baseline inflammation respond to acute inflammation in a manner similar to younger adults. We hypothesized age-related differences in the vascular responses to acute inflammation, but that older adults with low baseline inflammation would respond similarly to younger adults. Inflammation was induced with an influenza vaccine in 96 participants [older = 67 total, 38 with baseline C-reactive protein (CRP) > 1.5 mg/l and 29 with CRP < 1.5 mg/l; younger = 29]; serum inflammatory markers IL-6 and CRP, blood pressure and flow-mediated dilation (FMD) were measured 24 and 48 h later. Younger adults increased IL-6 and CRP more than the collective older adult group and increased pulse pressure, whereas older adults decreased SBP and reduced pulse pressure. The entire cohort decreased FMD from 11.3 ± 0.8 to 8.3 ± 0.7 to 8.7 ± 0.7% in younger and from 5.8 ± 0.3 to 5.0 ± 0.4 to 4.7 ± 0.4% in older adults, P less than 0.05 for main effect. Older adult groups with differing baseline CRP had the same IL-6, blood pressure, and FMD response to acute inflammation, P less than 0.05 for all interactions, but the low-CRP group increased CRP at 24 and 48 h (from 0.5 ± 0.1 to 1.4 ± 0.2 to 1.7 ± 0.3 mg/l), whereas the high-CRP group did not (from 4.8 ± 0.5 to 5.4 ± 0.5 to 5.4 ± 0.6 mg/l), P less than 0.001 for interaction. Aging, not age-related chronic, low-grade inflammation, determines the vascular responses to acute inflammation.

Novel safety floors do not influence early compensatory balance reactions in older adults.

PubMed

Wright, Alexander D; Heckman, George A; McIlroy, William E; Laing, Andrew C

2014-01-01

Novel safety flooring systems are a promising approach for reducing fall-related injuries in seniors, as they have been demonstrated to substantially reduce impact severity during falls, while minimally impairing balance control in community-dwelling older women. This pilot study aimed to characterize the potential effects of flooring conditions on dynamic balance control in retirement home-dwellers with more limited mobility. A tether-release paradigm was used to simulate a trip-type perturbation in 15 seniors across five flooring surfaces (three novel safety floors and one carpet compared to institutional-grade resilient rolled-sheeting). Kinetic and kinematic data tracked the displacement profiles of the underfoot centre-of-pressure and whole-body centre-of-mass, which were used to characterize compensatory balance reactions. Difference tests (ANOVA) found that the onset of the compensatory balance reaction was not associated with floor condition, nor were the timing and magnitude of peak centre-of-pressure excursion (minimum margin of safety) and velocity. Accordingly, the minimum margin of safety of the centre-of-mass was not significantly different across floors. Equivalence tests supported these findings. This study provides evidence that the carpet and novel safety floors tested do not negatively influence characteristics of initial dynamic balance responses following a lean-and-release perturbation compared to an institutional-grade resilient rolled-sheeting surface. In combination with reports of substantial force attenuative properties during fall-related impacts, these findings support the promise of novel safety floors as a biomechanically effective strategy for reducing fall-related injuries. Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.

Push or Pull: Changes in the Relative Risk and Growth of Entrepreneurship Among Older Households.

PubMed

Weller, Christian E; Wenger, Jeffrey B; Lichtenstein, Benyamin; Arcand, Carolyn

2018-03-19

Amid insufficient retirement savings and the growing need to work longer, it is important to understand why self-employment, especially entrepreneurship, has grown among older households. Older households may have been pushed into entrepreneurship by the growing risks of wage-and-salary employment as wages and jobs have become less stable. Alternatively, older households may have been pulled into entrepreneurship as the associated risks have declined, for instance, due to greater opportunities to diversify income away from risky business income. We examine the economic causes of the rise in entrepreneurship among older households. We use summary statistics and multinomial logit regressions to analyze the link between economic pressures in wage-and-salary employment, financial strength of entrepreneurship, and the presence and change of entrepreneurship among older households-aged 50 years or older. We use household data from the Federal Reserve's Survey of Consumer Finances from 1989 to 2013. We find little support for the claim that increased economic pressures are correlated with rising entrepreneurship. Instead, our results suggest that the growth of older entrepreneurship is coincident with increasing access to dividend and interest income. We also find some evidence that access to Social Security and other annuity benefits increases the likelihood of self-employment. Implications: Entrepreneurship among older households increasingly correlates with income diversification. Policymakers interested in encouraging more entrepreneurship among older households could consider increased access to income diversification through social insurance.

Are There Racial-Ethnic Disparities in Time to Pressure Ulcer Development and Pressure Ulcer Treatment in Older Adults After Nursing Home Admission?

PubMed Central

Bliss, Donna Z.; Gurvich, Olga; Savik, Kay; Eberly, Lynn E.; Harms, Susan; Mueller, Christine; Wyman, Jean F.; Garrard, Judith; Virnig, Beth

2017-01-01

Objective The objective of this study was to assess whether there are racial and ethnic disparities in the time to development of a pressure ulcer and number of pressure ulcer treatments in individuals aged 65 and older after nursing home admission. Method Multi-level predictors of time to a pressure ulcer from three national surveys were analyzed using Cox proportional hazards regression for White Non-Hispanic residents. Using the Peters–Belson method to assess for disparities, estimates from the regression models were applied to American Indians/Alaskan Natives, Asians/ Pacific Islanders, Blacks, and Hispanics separately resulting in estimates of expected outcomes as if they were White Non-Hispanic, and were then compared with their observed outcomes. Results More Blacks developed pressure ulcers sooner than expected. No disparities in time to a pressure ulcer disadvantaging other racial/ethnic groups were found. There were no disparities in pressure ulcer treatment for any group. Discussion Reducing disparities in pressure ulcer development offers a strategy to improve the quality of nursing home care. PMID:25260648

Are there racial-ethnic disparities in time to pressure ulcer development and pressure ulcer treatment in older adults after nursing home admission?

PubMed

Bliss, Donna Z; Gurvich, Olga; Savik, Kay; Eberly, Lynn E; Harms, Susan; Mueller, Christine; Wyman, Jean F; Garrard, Judith; Virnig, Beth

2015-06-01

The objective of this study was to assess whether there are racial and ethnic disparities in the time to development of a pressure ulcer and number of pressure ulcer treatments in individuals aged 65 and older after nursing home admission. Multi-level predictors of time to a pressure ulcer from three national surveys were analyzed using Cox proportional hazards regression for White Non-Hispanic residents. Using the Peters-Belson method to assess for disparities, estimates from the regression models were applied to American Indians/Alaskan Natives, Asians/Pacific Islanders, Blacks, and Hispanics separately resulting in estimates of expected outcomes as if they were White Non-Hispanic, and were then compared with their observed outcomes. More Blacks developed pressure ulcers sooner than expected. No disparities in time to a pressure ulcer disadvantaging other racial/ethnic groups were found. There were no disparities in pressure ulcer treatment for any group. Reducing disparities in pressure ulcer development offers a strategy to improve the quality of nursing home care. © The Author(s) 2014.

Associations of long-term fine particulate matter exposure with prevalent hypertension and increased blood pressure in older Americans.

PubMed

Honda, Trenton; Pun, Vivian C; Manjourides, Justin; Suh, Helen

2018-07-01

Hypertension is a highly prevalent cardiovascular risk factor. It is possible that air pollution, also an established cardiovascular risk factor, may contribute to cardiovascular disease through increasing blood pressure. Previous studies evaluating associations between air pollution and blood pressure have had mixed results. We examined the association between long-term (one-year moving average) air pollutant exposures, prevalent hypertension and blood pressure in 4121 older Americans (57+ years) enrolled in the National Social Life, Health, and Aging Project. We estimated exposures to PM 2.5 using spatio-temporal models and used logistic regression accounting for repeated measures to evaluate the association between long-term average PM 2.5 and prevalence odds of hypertension. We additionally used linear regression to evaluate the associations between air pollutants and systolic, diastolic, mean arterial, and pulse pressures. Health effect models were adjusted for a number of demographic, health and socioeconomic covariates. An inter-quartile range (3.91 μg/m 3 ) increase in the one-year moving average of PM 2.5 was associated with increased: Odds of prevalent hypertension (POR 1.24, 95% CI: 1.11, 1.38), systolic blood pressure (0.93 mm Hg, 95% CI: 0.05, 1.80) and pulse pressure (0.89 mm Hg, 95% CI: 0.21, 1.58). Dose-response relationships were also observed. PM 2.5 was associated with increased odds of prevalent hypertension, and increased systolic pressure and pulse pressure in a cohort of older Americans. These findings add to the growing evidence that air pollution may be an important risk factor for hypertension and perturbations in blood pressure. Copyright © 2018 Elsevier Inc. All rights reserved.

Increased Trunk Extension Endurance is Associated with Meaningful Improvement in Balance among Older Adults with Mobility Problems

PubMed Central

Suri, Pradeep; Kiely, Dan K.; Leveille, Suzanne G.; Frontera, Walter R.; Bean, Jonathan. F.

2011-01-01

Objective To determine if trunk extension endurance changes with training are associated with clinically meaningful improvements in balance among mobility-limited older adults. Design Longitudinal data from a randomized clinical trial. Setting Outpatient rehabilitation research center. Participants Community-dwelling older adults (N=64; mean age 75.9 y) with mobility limitations as defined by a score of 4 to 10 on the Short Physical Performance Battery. Interventions 16 weeks of progressive resistance training. Main Outcome Measures Outcomes were the Berg Balance Scale (BBS) and the Unipedal Stance Test (UST). Predictors included leg strength, leg power, trunk extension endurance and the product of heart rate and blood pressure (RPP) at the final stage of an exercise tolerance test. We performed an analysis of data from participants who completed 16 weeks of training using binary outcomes defined by a clinically meaningful change from baseline to completion of the intervention (CMC) (BBS= 4 units; UST= 5 seconds). The association of predictor variables with balance outcomes was examined separately and together in multivariate adjusted logistic regression models. Results Trunk extension endurance in seconds (1.04 [1.00– 1.09]) was independently associated with CMC on the BBS. Trunk extension endurance (1.02 [1.00– 1.03]) was independently associated with CMC on the UST. Other physical attributes were not associated with meaningful change in balance. Conclusions Improvements in trunk extension endurance were independently associated with clinically meaningful changes in balance in older adults. Leg strength, leg power, and RPP were not associated with CMC in balance. Poor trunk extension endurance may be a rehabilitative impairment worthy of further study as a modifiable factor linked to balance among older adults. PMID:21636073

The effects of arm crank ergometry, cycle ergometry and treadmill walking on postural sway in healthy older females.

PubMed

Hill, M W; Oxford, S W; Duncan, M J; Price, M J

2015-01-01

Older adults are increasingly being encouraged to exercise but this may lead to muscle fatigue, which can adversely affect postural stability. Few studies have investigated the effects of upper body exercise on postural sway in groups at risk of falling, such as the elderly. The purpose of this study was to compare the effects arm crank ergometry (ACE), cycle ergometry (CE) and treadmill walking (TM) on postural sway in healthy older females. In addition, this study sought to determine the time necessary to recover postural control after exercise. A total of nine healthy older females participated in this study. Participants stood on a force platform to assess postural sway which was measured by displacement of the centre of pressure before and after six separate exercise trials. Each participant completed three incremental exercise tests to 85% of individual's theoretical maximal heart rate (HRMAX) for ACE, CE and TM. Subsequent tests involved 20-min of ACE, CE and TM exercise at a relative workload corresponding to 50% of each individual's predetermined heart rate reserve (HRE). Post fatigue effects and postural control recovery were measured at different times after exercise (1, 3, 5, 10, 15 and 30-min). None of the participants exhibited impaired postural stability after ACE. In contrast, CE and TM elicited significant post exercise balance impairments, which lasted for ∼ 10 min post exercise. We provide evidence of an exercise mode which does not elicit post exercise balance impairments. Older adults should exercise caution immediately following exercise engaging the lower limbs to avoid fall risk. Copyright © 2014 Elsevier B.V. All rights reserved.

Application of a Bimetallic Treatment System (BTS) for PCB Removal from Older Structures on DoD Facilities

DTIC Science & Technology

2010-11-05

the Banana River to the West and mosquito control lagoons to the East. The building components that are to be treated are from inside the structure... peeling /removal) is given. Untreated areas of panel 3 and 4 were tested as a control, to determine the adhesion qualities of the paint prior to...similarly shows untreated panel 4. Both panels (untreated) were scored a 5, indicating no peeling or removal of the paint upon removal of the pressure

Quality of health care for older women: what do we know?

PubMed

Kosiak, Beth; Sangl, Judy; Correa-de-Araujo, Rosaly

2006-01-01

As the proportion of the population age 65 and over continues to grow--to a projected 20.5% or 77.2 million by the year 2040--tracking the quality, access, and receipt of care for older women becomes more important, since the majority of older citizens are women. This article establishes a rough baseline for the quality of care, primarily preventive care, received by older women compared to older men, using selected measures and data of the 2004 National Healthcare Quality Report and National Healthcare Disparities Report. It highlights significant differences between women and men, as well as differences for racial, ethnic, and educational subgroups. Generally, older non-Hispanic white women frequently score higher than their Hispanic and non-Hispanic black counterparts, and more educated women often score significantly higher than their less-educated peers on several measures of quality of care. Compared to their male counterparts, older women are significantly less likely to have any colorectal screening test, to keep high blood pressure under control, and to receive aspirin or beta-blockers upon hospital admission or discharge for acute myocardial infarction. Results are mixed for the process measures related to diabetes, but improvements are clearly needed toward increased rates of eye and foot examinations. Rates of influenza and pneumococcal vaccinations are low but can be improved through Medicare-covered services. We also found that older women are screened less often for breast cancer than those ages 40 to 64. There is still a pervasive lack of knowledge in the research and clinical communities about the unique health care needs of and appropriate processes of care for older adults. More research needs to focus on the quality of care for this growing population in order to allow the development of geriatric-based quality measures and models of care that will set the standards of healthcare for older adults in general, and older women in particular.

The pressor response to water drinking in humans : a sympathetic reflex?

NASA Technical Reports Server (NTRS)

Jordan, J.; Shannon, J. R.; Black, B. K.; Ali, Y.; Farley, M.; Costa, F.; Diedrich, A.; Robertson, R. M.; Biaggioni, I.; Robertson, D.

2000-01-01

BACKGROUND: Water drinking increases blood pressure profoundly in patients with autonomic failure and substantially in older control subjects. The mechanism that mediates this response is not known. METHODS AND RESULTS: We studied the effect of drinking tap water on seated blood pressure in 47 patients with severe autonomic failure (28 multiple system atrophy [MSA], 19 pure autonomic failure patients [PAF]). Eleven older controls and 8 young controls served as control group. We also studied the mechanisms that could increase blood pressure with water drinking. Systolic blood pressure increased profoundly with water drinking, reaching a maximum of 33+/-5 mm Hg in MSA and 37+/-7 in PAF mm Hg after 30 to 35 minutes. The pressor response was greater in patients with more retained sympathetic function and was almost completely abolished by trimethaphan infusion. Systolic blood pressure increased by 11+/-2.4 mm Hg in elderly but not in young controls. Plasma norepinephrine increased in both groups. Plasma renin activity, vasopressin, and blood volume did not change in any group. CONCLUSIONS: Water drinking significantly and rapidly raises sympathetic activity. Indeed, it raises plasma norepinephrine as much as such classic sympathetic stimuli as caffeine and nicotine. This effect profoundly increases blood pressure in autonomic failure patients, and this effect can be exploited to improve symptoms due to orthostatic hypotension. Water drinking also acutely raises blood pressure in older normal subjects. The pressor effect of oral water is an important yet unrecognized confounding factor in clinical studies of pressor agents and antihypertensive medications.

Effect of aromatherapy massage on anxiety, depression, and physiologic parameters in older patients with the acute coronary syndrome: A randomized clinical trial.

PubMed

Bahrami, Tahereh; Rejeh, Nahid; Heravi-Karimooi, Majideh; Vaismoradi, Mojtaba; Tadrisi, Seyed Davood; Sieloff, Christina

2017-12-01

This study aimed to investigate the effect of aromatherapy massage on anxiety, depression, and physiologic parameters in older patients with acute coronary syndrome. This randomized controlled trial was conducted on 90 older women with acute coronary syndrome. The participants were randomly assigned into the intervention and control groups (n = 45). The intervention group received reflexology with lavender essential oil, but the control group only received routine care. Physiologic parameters, the levels of anxiety and depression in the hospital were evaluated using a checklist and the Hospital's Anxiety and Depression Scale, respectively, before and immediately after the intervention. Significant differences in the levels of anxiety and depression were reported between the groups after the intervention. The analysis of physiological parameters revealed a statistically significant reduction (P < .05) in systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate. However, no significant difference was observed in the respiratory rate. Aromatherapy massage can be considered by clinical nurses an efficient therapy for alleviating psychological and physiological responses among older women suffering from acute coronary syndrome. © 2017 John Wiley & Sons Australia, Ltd.

Prevalence of key care indicators of pressure injuries, incontinence, malnutrition, and falls among older adults living in nursing homes in New Zealand.

PubMed

Carryer, Jenny; Weststrate, Jan; Yeung, Polly; Rodgers, Vivien; Towers, Andy; Jones, Mark

2017-12-01

Pressure injuries, incontinence, malnutrition, and falls are important indicators of the quality of care in healthcare settings, particularly among older people, but there is limited information on their prevalence in New Zealand (NZ). The aim of this study was to establish the prevalence of these four problems among older people in nursing home facilities. The cross-sectional study was an analysis of data collected on a single day for the 2016 National Care Indicators Programme-New Zealand (NCIP-NZ). The sample included 276 people ages 65 and older who were residents in 13 nursing home facilities in a geographically diverse area of central NZ. Data were analyzed with descriptive statistics. Prevalence rates in these nursing home settings was pressure injuries 8%; urinary incontinence 57%; fecal incontinence 26%; malnutrition 20%, and falls 13%, of which half resulted in injuries. As people age, complex health issues can lead to increasing care dependency and more debilitating and costly health problems. Measuring the prevalence of basic care problems in NZ healthcare organizations and contributing to a NZ database can enable monitoring of the effectiveness of national and international guidelines. © 2017 Wiley Periodicals, Inc.

Plasma nitrate and nitrite are increased by a high nitrate supplement, but not by high nitrate foods in older adults

PubMed Central

Miller, Gary D.; Marsh, Anthony P.; Dove, Robin W.; Beavers, Daniel; Presley, Tennille; Helms, Christine; Bechtold, Erika; King, S. Bruce; Kim-Shapiro, Daniel

2012-01-01

Little is known about the effect of dietary nitrate on the nitrate/nitrite/NO (nitric oxide) cycle in older adults. We examined the effect of a 3-day control diet vs. high nitrate diet, with and without a high nitrate supplement (beetroot juice), on plasma nitrate and nitrite kinetics, and blood pressure using a randomized four period cross-over controlled design. We hypothesized that the high nitrate diet would show higher levels of plasma nitrate/nitrite and blood pressure compared to the control diet, which would be potentiated by the supplement. Participants were eight normotensive older men and women (5 female, 3 male, 72.5±4.7 yrs) with no overt disease or medications that affect NO metabolism. Plasma nitrate and nitrite levels and blood pressure were measured prior to and hourly for 3 hours after each meal. The mean daily changes in plasma nitrate and nitrite were significantly different from baseline for both control diet+supplement (p<0.001 and =0.017 for nitrate and nitrite, respectively) and high nitrate diet+supplement (p=0.001 and 0.002), but not for control diet (p=0.713 and 0.741) or high nitrate diet (p=0.852 and 0.500). Blood pressure decreased from the morning baseline measure to the three 2 hr post-meal follow-up time-points for all treatments, but there was no main effect for treatment. In healthy older adults, a high nitrate supplement consumed at breakfast elevated plasma nitrate and nitrite levels throughout the day. This observation may have practical utility for the timing of intake of a nitrate supplement with physical activity for older adults with vascular dysfunction. PMID:22464802

The Counseling Older Adults to Control Hypertension (COACH) trial: design and methodology of a group-based lifestyle intervention for hypertensive minority older adults.

PubMed

Ogedegbe, Gbenga; Fernandez, Senaida; Fournier, Leanne; Silver, Stephanie A; Kong, Jian; Gallagher, Sara; de la Calle, Franze; Plumhoff, Jordan; Sethi, Sheba; Choudhury, Evelyn; Teresi, Jeanne A

2013-05-01

The disproportionately high prevalence of hypertension and its associated mortality and morbidity in minority older adults is a major public health concern in the United States. Despite compelling evidence supporting the beneficial effects of therapeutic lifestyle changes on blood pressure reduction, these approaches remain largely untested among minority elders in community-based settings. The Counseling Older Adults to Control Hypertension trial is a two-arm randomized controlled trial of 250 African-American and Latino seniors, 60 years and older with uncontrolled hypertension, who attend senior centers. The goal of the trial is to evaluate the effect of a therapeutic lifestyle intervention delivered via group classes and individual motivational interviewing sessions versus health education, on blood pressure reduction. The primary outcome is change in systolic and diastolic blood pressure from baseline to 12 months. The secondary outcomes are blood pressure control at 12 months; changes in levels of physical activity; body mass index; and number of daily servings of fruits and vegetables from baseline to 12 months. The intervention group will receive 12 weekly group classes followed by individual motivational interviewing sessions. The health education group will receive an individual counseling session on healthy lifestyle changes and standard hypertension education materials. Findings from this study will provide needed information on the effectiveness of lifestyle interventions delivered in senior centers. Such information is crucial in order to develop implementation strategies for translation of evidence-based lifestyle interventions to senior centers, where many minority elders spend their time, making the centers a salient point of dissemination. Copyright © 2013. Published by Elsevier Inc.

The effect of continuous nursing intervention guided by chronotherapeutics on ambulatory blood pressure of older hypertensive patients in the community.

PubMed

Cheng, Mei; Cheng, Shu-Ling; Zhang, Qing; Jiang, He; Cong, Ji-Yan; Zang, Xiao-Ying; Zhao, Yue

2014-08-01

To explore the effect of continuous nursing intervention guided by chronotherapeutics so as to provide the easy, noninvasive, effective and acceptable intervention for older hypertensive patients in the community. Many researchers studied the effect of administration at different times on blood pressure control and circadian rhythm. However, the individual administrative time was set ambiguously in previous studies. A semi-experimental study. In the study, 90 eligible patients were recruited and separated into three groups randomly, which were the control group, intervention group A (behaviour and chronotherapy intervention) and intervention group B (behaviour intervention). At 6 and 12 months after the study, the intervention groups were measured 24-hour ambulatory blood pressure monitoring. There were significant differences in ambulatory blood pressure monitoring parameters of the two intervention groups at different measurement times, and there were interaction between measurement time and different groups. The number of patients with dipper increased and reverse dipper decreased in group A as the intervention applied. There were statistical differences between two groups. The number of patients with morning surge in group A decreased more, and there were statistical differences between two groups at six months after the intervention. The behaviour and chronotherapy intervention based on the patients' ambulatory blood pressure monitoring can control casual blood pressure much better and last longer, which can also improve patients' indexes of ambulatory blood pressure monitoring better than behaviour intervention only. The behaviour and chronotherapy intervention can increase patients' nocturnal blood pressure drop, increase the number of patients with dipper and decrease reverse dipper, and improve blood pressure surge in the morning. Nurses can use continuous nursing intervention guided by chronotherapeutics to help improve hypertension of older patients better in the community. © 2014 John Wiley & Sons Ltd.

Physiological and psychological effects of gardening activity in older adults.

PubMed

Hassan, Ahmad; Qibing, Chen; Tao, Jiang

2018-04-06

Gardening has long been one of most enjoyable pastimes among older adults. Whether gardening activities contribute to the well-being of older adults is a major question. Therefore, the aim of the present study was to clarify the psychophysiological relaxing effects of gardening activities on older adults living in modern institutional care. The study participants were 40 older women aged 79.5 ± 8.09 years (mean ± SD). A cross-over study design was used to investigate the physiological and psychological responses to environments with and without plants. Physiological evaluation was carried out using blood pressure and electroencephalography, and psychological evaluation was carried out using the State-Trait Anxiety Inventory and Semantic Differential method. Blood pressure was significantly lower, and changes in brainwaves were observed. Psychological responses showed that participants were more "comfortable and relaxed" after the plant task than after the control task. In addition, total anxiety levels were significantly lower after carrying out the plant task than after the control task. Our research suggests that gardening activities might enhance physiological and psychological relaxation in older adults. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

When we test, do we stress? Impact of the testing environment on cortisol secretion and memory performance in older adults.

PubMed

Sindi, Shireen; Fiocco, Alexandra J; Juster, Robert-Paul; Pruessner, Jens; Lupien, Sonia J

2013-08-01

The majority of studies find that older adults have worse memory performance than young adults. However, contextual features in the testing environment may be perceived as stressful by older adults, increasing their stress hormone levels. Given the evidence that older adults are highly sensitive to the effects of stress hormones (cortisol) on memory performance, it is postulated that a stressful testing environment in older adults can lead to an acute stress response and to memory impairments. The current study compared salivary cortisol levels and memory performance in young and older adults tested in environments manipulated to be stressful (unfavourable condition) or not stressful (favourable condition) for each age group. 28 young adults and 32 older adults were tested in two testing conditions: (1) a condition favouring young adults (constructed to be less stressful for young adults), and (2) a condition favouring older adults (constructed to be less stressful for older adults). The main outcome measure was salivary cortisol levels. Additionally, immediate and delayed memory performances were assessed during each condition. In older adults only, we found significantly high cortisol levels and low memory performance in the condition favouring young adults. In contrast, cortisol levels were lower and memory performance was better when older adults were tested in conditions favouring them. There was no effect of testing condition in young adults. The results demonstrate that older adults' memory performance is highly sensitive to the testing environment. These findings have important implications for both research and clinical settings in which older adults are tested for memory performance. Copyright © 2012 Elsevier Ltd. All rights reserved.

Physiological effects of a companion robot on blood pressure of older people in residential care facility: a pilot study.

PubMed

Robinson, Hayley; MacDonald, Bruce; Broadbent, Elizabeth

2015-03-01

To investigate the effects of interacting with the companion robot, Paro, on blood pressure and heart rate of older people in a residential care facility. This study used a repeated measures design. Twenty-one residents in rest home and hospital level care had their blood pressure taken three times; before, during and after interacting with the seal robot. Four residents who did not interact with the robot were excluded from the final analysis (final n = 17). The final analysis found that systolic and diastolic blood pressure changed significantly over time as did heart rate. Planned comparisons revealed that systolic and diastolic blood pressure decreased significantly from baseline to when residents had Paro (systolic, P = 0.048; diastolic, P = 0.05). Diastolic blood pressure increased significantly after Paro was withdrawn (P = 0.03). Interacting with Paro has a physiological effect on cardiovascular measures, which is similar to findings with live animals. © 2013 ACOTA.

Habitual exercise training in older adults offsets the age-related prolongation in leg vasodilator kinetics during single limb lower body exercise.

PubMed

Hughes, William E; Kruse, Nicholas T; Ueda, Kenichi; Casey, Darren P

2018-06-01

We tested the hypothesis that aging is associated with prolonged leg vasodilator kinetics and habitual exercise training in older adults improves these responses relative to untrained older adults. Additionally, we examined the relationship between contraction-induced rapid onset vasodilation (ROV) and vasodilator kinetics. Young (n=10), older untrained (n=13) and older trained (n=14) adults performed single and rhythmic knee-extension contractions at 20% and 40% work-rate maximum (WR max ). Femoral artery diameter and mean blood velocity were measured by Doppler ultrasound. Vascular conductance (VC; ml·min -1 ·mmHg-1) was calculated using blood flow (ml·min -1 ) and mean arterial pressure (mmHg). The primary outcome was the kinetic response (mean response time; MRT), modeled using an exponential model, expressed as the number of duty cycles to change 63% of the steady-state amplitude. There was no age or training related differences in VC MRT between the groups at 20% WR max . Older untrained adults exhibited prolonged VC MRT at 40% WR max relative to young (37{plus minus}16 vs. 24{plus minus}10 duty-cycles; P<0.05) and older trained adults (37{plus minus}16 vs. 23{plus minus}14 duty-cycles; P<0.05). There were no differences in VC MRT between young and older trained adults at 40% WR max (P=0.96). There were no associations between peak ROV and VC MRT at 20% or 40% WR max (r=-0.08 and 0.22; P=0.67 and 0.20, respectively) in the group as a whole. Our data suggest 1) advancing age prolongs leg vasodilator kinetics; 2) habitual exercise training in older adults offsets this age-related prolongation; and 3) contraction-induced ROV is not related to vasodilator kinetics within a group of young and older adults.

Body satisfaction and pressure to be thin in younger and older Muslim and non-Muslim women: the role of Western and non-Western dress preferences.

PubMed

Dunkel, Trisha M; Davidson, Denise; Qurashi, Shaji

2010-01-01

Younger and older Muslim and non-Muslim women living in the United States completed questionnaires about body satisfaction and their internalization of Western standards of beauty (thin-ideal). Younger Muslim women wearing non-Western clothing and a head veil were significantly less likely to express drive for thinness or pressure to attain a thin-ideal standard of beauty than women wearing Western dress or younger women wearing non-Western dress without a head veil. Older women, while expressing greater discrepancy between their ideal body shape and their current body shape, and less satisfaction with their bodies than younger women, reported less drive for thinness and less pressure to attain the Western thin-ideal standard of beauty than younger women. These results are discussed in terms of how factors such as age and religion may serve as protective factors against a strong or unhealthy drive for thinness or thin-ideal standard. Copyright 2009 Elsevier Ltd. All rights reserved.

Cardiovascular risk factors and small vessel disease of the brain: Blood pressure, white matter lesions, and functional decline in older persons

PubMed Central

Abraham, Hazel Mae A; Wolfson, Leslie; Moscufo, Nicola; Guttmann, Charles R G; Kaplan, Richard F

2016-01-01

Several potential vascular risk factors exist for the development and accumulation of subcortical white matter disease in older people. We have reported that in older people followed for up to 4 years white matter hyperintensity (WMH) lesions on magnetic resonance imaging nearly doubled in volume and were associated with alterations in mobility and cognitive function. Herein we review the genetic, metabolic, and vascular risk factors that have been evaluated in association with the development and pathogenesis of WMH in older persons. Our research efforts have focused on systemic hypertension, particularly in the out-of-office setting as 24-hour ambulatory blood pressure (BP) has proven to be a stronger indicator of the progression of WMH in older people and the associated functional decline than doctor’s office BP. Based on relations between 24-hour systolic BP levels, the accrual of WMH, and functional decline, we have designed the INFINITY trial, the first interventional study to use ambulatory BP to guide antihypertensive therapy to address this problem in the geriatric population. PMID:26036933

Lower life satisfaction, active coping and cardiovascular disease risk factors in older African Americans: outcomes of a longitudinal church-based intervention.

PubMed

Mendez, Yesenia P; Ralston, Penny A; Wickrama, Kandauda K A S; Bae, Dayoung; Young-Clark, Iris; Ilich, Jasminka Z

2018-06-01

This study examined lower life satisfaction, active coping and cardiovascular disease risk factors (diastolic and systolic blood pressure, body mass index, and circumferences) in older African Americans over the phases of an 18-month church-based intervention, using a quasi-experimental design. Participants (n = 89) were 45 years of age and older from six churches (three treatment, three comparison) in North Florida. Lower life satisfaction had a persistent unfavorable effect on weight variables. Active coping showed a direct beneficial effect on selected weight variables. However, active coping was adversely associated with blood pressure, and did not moderate the association between lower life satisfaction and cardiovascular risk factors. The intervention had a beneficial moderating influence on the association between lower life satisfaction and weight variables and on the association between active coping and these variables. Yet, this pattern did not hold for the association between active coping and blood pressure. The relationship of lower life satisfaction and selected cardiovascular risk factors and the positive effect of active coping were established, but findings regarding blood pressure suggest further study is needed.

Screening recommendations for the elderly.

PubMed Central

Beers, M H; Fink, A; Beck, J C

1991-01-01

BACKGROUND. Studies have documented the potential contributions of preventive health care programs. Yet little is known about which screening tests should be included in public health programs for older persons. This study offers recommendations regarding these tests. METHODS. The recommendations come from synthesizing the findings of the US Preventive Services Task Force, the literature, and the consensus of experts in geriatrics, gerontology, and health policy research. The literature was evaluated to identify methodologically sound studies of the prevalence of selected disorders and benefits and availability of screening procedures for those disorders. Experts from various fields specializing in the care of the elderly formed panels to assist in evaluating the literature and providing further information from gerontological and public health perspectives. RESULTS. We recommend vision testing for refractive error; inspection of the skin surface for fungal infection and skin cancer, drug eruptions, and xerosis; a history for symptoms of xerosis; audiometric testing for presbycusis; surveys for hearing loss; otoscopic inspection for cerumen impaction; dental examination for caries; measurement of blood pressure for hypertension; and breast examination and mammography for cancer. CONCLUSIONS. Our study suggests that these screening procedures are useful for public health screening programs. More information is needed on the effects of screening services on the health and functioning of older persons. PMID:1951823

Arterial hypertension after age 65: from epidemiology and pathophysiology to therapy Do we know where we stand?

PubMed

Gąsowski, Jerzy; Piotrowicz, Karolina; Messerli, Franz H

2018-01-01

Arterial hypertension is a prevalent disease with great harming potential. After the age of 55 years the remaining lifetime risk of hypertension amounts to 90%. Despite the constant advances some important issues such as the cut-off blood pressure for the initiation of antihypertensive therapy or the therapeutic goal are debated. In this review, we present - based on the available literature - the current concepts concerning the pathophysiology, epi-demiology and antihypertensive therapy in patients aged 65 years or older. The pathophysiology of hypertension in older patients in principle rests on stiffening of large conduit arteries, which leads to greater systolic and lower diastolic blood pressure. This in most older patients results in isolated systolic hypertension. Additionally most of these patients have low-renin hypertension. Data from large-scale clinical trials indicate that therapy of such individuals with thiazide-like diuretics and long-acting dihydropiridine calcium channel blockers as first-line medications reduces risk of complications. Based on results of recently published trials, meta-analyses, and prospective observations, the optimal on-treatment blood pressure values for most older hypertensive patients should be set within the 130-139 mmHg range. At present, lower values of standard office blood pressure in this group of patients have not been shown to be associ-ated with additional benefits, and may be associated with a greater risk of adverse events. In conclusion, we recommend that for most patients aged 65 years or more, standard office systolic blood pressure should be cautiously reduced to within 140 and 130 mmHg, preferably with a thiazide-like diuretic, long acting dihydropiridine calcium channel blocker or their combination.

Nonpharmacologic Interventions to Prevent Pressure Ulcers in Older Patients: An Overview of Systematic Reviews (The Software ENgine for the Assessment and optimization of drug and non-drug Therapy in Older peRsons [SENATOR] Definition of Optimal Evidence-Based Non-drug Therapies in Older People [ONTOP] Series).

PubMed

Lozano-Montoya, Isabel; Vélez-Díaz-Pallarés, Manuel; Abraha, Iosief; Cherubini, Antonio; Soiza, Roy L; O'Mahony, Denis; Montero-Errasquín, Beatriz; Correa-Pérez, Andrea; Cruz-Jentoft, Alfonso J

2016-04-01

Pressure ulcers (PUs) are frequent in older patients, and the healing process is usually challenging, therefore, prevention should be the first strategic line in PU management. Nonpharmacologic interventions may play a role in the prevention of PUs in older people, but most systematic reviews (SRs) have not addressed this specific population using convincing outcome measures. To summarize and critically appraise the evidence from SRs of the primary studies on nonpharmacologic interventions to prevent PUs in older patients. SR and meta-analysis of comparative studies. PubMed, Cochrane Database of Systematic Reviews, EMBASE, and CINHAL (from inception to October 2013) were searched. A new search for updates in the Cochrane Database was launched in July 2014. SRs that included at least 1 comparative study evaluating any nonpharmacologic intervention to prevent PUs in older patients, in any healthcare setting, were selected. Any primary study with experimental design was then identified and included. From each primary study, quality assessment was undertaken as specified by the Cochrane Collaboration and the Grading of Recommendations Assessment, Development and Evaluation working group. Interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis, using the incidence of new pressure ulcers as the main outcome measure. One hundred ten SRs with 65 primary studies satisfied the inclusion criteria. The most frequent interventions explored in these trials were support surfaces (41 studies), repositioning (8), and nutrition interventions (5). High quality of evidence was not found for any intervention, mainly because of a high risk of bias and imprecision. There is moderate quality evidence to support the use of alternating pressure support mattresses over usual hospital mattresses in medical and surgical inpatients, low quality evidence to support constant low pressure devices and Australian medical sheepskin over usual mattresses, and very low quality evidence to support nutrition interventions in hospital settings. No recommendations on hydration, repositioning, standardized risk assessment, or multicomponent interventions can be done. In older patients at high risk to suffer PUs, high-technology and low- technology support surfaces can significantly reduce the incidence of PUs. Nutrition intervention may also have a role in preventing PUs in hospital settings. More evidence is needed to support other recommendations, which is specially lacking for repositioning. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Physical Fitness and Aortic Stiffness Explain the Reduced Cognitive Performance Associated with Increasing Age in Older People.

PubMed

Kennedy, Greg; Meyer, Denny; Hardman, Roy J; Macpherson, Helen; Scholey, Andrew B; Pipingas, Andrew

2018-01-01

Greater physical fitness is associated with reduced rates of cognitive decline in older people; however, the mechanisms by which this occurs are still unclear. One potential mechanism is aortic stiffness, with increased stiffness resulting in higher pulsatile pressures reaching the brain and possibly causing progressive micro-damage. There is limited evidence that those who regularly exercise may have lower aortic stiffness. To investigate whether greater fitness and lower aortic stiffness predict better cognitive performance in older people and, if so, whether aortic stiffness mediates the relationship between fitness and cognition. Residents of independent living facilities, aged 60-90, participated in the study (N = 102). Primary measures included a computerized cognitive assessment battery, pulse wave velocity analysis to measure aortic stiffness, and the Six-Minute Walk test to assess fitness. Based on hierarchical regression analyses, structural equation modelling was used to test the mediation hypothesis. Both fitness and aortic stiffness independently predicted Spatial Working Memory (SWM) performance, however no mediating relationship was found. Additionally, the derived structural equation model shows that, in conjunction with BMI and sex, fitness and aortic stiffness explain 33% of the overall variation in SWM, with age no longer directly predicting any variation. Greater fitness and lower aortic stiffness both independently predict better SWM in older people. The strong effect of age on cognitive performance is totally mediated by fitness and aortic stiffness. This suggests that addressing both physical fitness and aortic stiffness may be important to reduce the rate of age associated cognitive decline.

Blood Pressure and Cognition Among Older Adults: A Meta-Analysis

PubMed Central

Gifford, Katherine A.; Badaracco, Maria; Liu, Dandan; Tripodis, Yorghos; Gentile, Amanda; Lu, Zengqi; Palmisano, Joseph; Jefferson, Angela L.

2013-01-01

Hypertension has adverse effects on cognition, can alter cerebral vasculature integrity, and is associated with the pathogenesis of dementia. Using meta-analysis, we correlated blood pressure to multiple cognitive domains among older adults free of clinical stroke and dementia. We identified 230 studies indexed in PubMed and PsycINFO relating blood pressure and cognition. After applying exclusion criteria, we selected n = 12 articles with n = 4,076 participants (age range 43–91 years). Meta-analysis yielded an association between blood pressure and episodic memory (r = −.18, p < .001) and between blood pressure and global cognition (r = −.07, p < .001). When limiting analyses to studies adjusting for vascular covariates (n = 8, n = 2,141), blood pressure was modestly related to global cognition (r = −.11, p < .001), attention (r = .14, p = .002), and episodic memory (r = −.20, p < .001) with a trend for language (r = −.22, p = .07). Findings underscore the need to manage blood pressure as a key prevention method in minimizing abnormal cognitive aging prior to the onset of clinical dementia. PMID:23838685

Associations of Nocturnal Blood Pressure With Cognition by Self-Identified Race in Middle-Aged and Older Adults: The GENOA (Genetic Epidemiology Network of Arteriopathy) Study.

PubMed

Yano, Yuichiro; Butler, Kenneth R; Hall, Michael E; Schwartz, Gary L; Knopman, David S; Lirette, Seth T; Jones, Daniel W; Wilson, James G; Hall, John E; Correa, Adolfo; Turner, Stephen T; Mosley, Thomas H

2017-10-27

Whether the association of blood pressure (BP) during sleep (nocturnal BP) with cognition differs by race is unknown. Participants in the GENOA (Genetic Epidemiology Network of Arteriopathy) Study underwent ambulatory BP measurements, brain magnetic resonance imaging, and cognitive function testing (the Rey Auditory Verbal Learning Test, the Digit Symbol Substitution Task, and the Trail Making Test Part B) between 2000 and 2007. We examined multivariable linear regression models of the nocturnal BP-cognition association. Among 755 participants (mean age, 63 years; 64% women; 42% self-identified black race; 76% taking antihypertensive medication), mean nocturnal systolic BP (SBP)/diastolic BP was 126/69 mm Hg, daytime SBP/diastolic BP level was 139/82 mm Hg, and mean reduction in SBP from day to night (dipping) was 9%. Among the entire sample, a race interaction was observed in Digit Symbol Substitution Task and Trail Making Test Part B (both P <0.15). Race-stratified analyses showed that a 1-SD increase in nocturnal SBP levels was associated with poorer Digit Symbol Substitution Task and log-transformed Trail Making Test Part B scores (unstandardized regression coefficient [95% confidence interval]: -1.98 [-3.28 to -0.69] and 0.06 [0.004-0.12]; both P< 0.05) in black but not white individuals. Additional adjustments for white matter hyperintensity volumes or brain atrophy, measured via brain magnetic resonance imaging, did not change the results. Results were similar when nocturnal SBP dipping was assessed as the exposure, yet daytime SBP levels yielded no association with cognition. Nocturnal SBP measurements may be useful in assessing the potential risk for lower cognitive function in middle-aged and older adults, particularly in black individuals. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Reproducibility of blood pressure variation in older ambulatory and bedridden subjects.

PubMed

Tsuchihashi, Takuya; Kawakami, Yasunobu; Imamura, Tsuyoshi; Abe, Isao

2002-06-01

We investigated the influence of ambulation on the reproducibility of circadian blood pressure variation in older nursing home residents. Ambulatory blood pressure monitoring was performed twice in 37 older nursing home residents. Nursing home in Japan. Subjects included 18 ambulatory nursing home residents who had no limitation on physical activity and 19 bedridden residents who did not participate in physical activity. Twenty-four-hour, daytime, and nighttime blood pressure levels and their variability. The 24-hour and daytime variability of systolic blood pressure (SBP) was significantly greater in ambulatory than in bedridden subjects, whereas nighttime variability was similar. Significant correlations in SBP averaged for the whole day, daytime, and nighttime were observed between the two examinations in ambulatory (r =.80-.83) and bedridden (r =.83-.91) subjects, but the variabilities of SBP for the whole day and during the daytime of the first measurement were correlated with those of the second measurement in bedridden (r =.67 and r =.47, respectively) but not in ambulatory (r =.39 and r =.28, respectively) subjects. Significant correlations were found between the nocturnal SBP changes at two occasions in both ambulatory (r =.50) and bedridden (r =.51) subjects, but the dipper versus nondipper profiles, defined as reduction in SBP of greater than 10% versus not, showed low reproducibility in ambulatory subjects; five ambulatory (28%) and one bedridden (5%) subjects showed divergent profiles between the two examinations. The reproducibility of blood pressure variation in nursing home residents is influenced by ambulation.

Recruitment of Older Adults: Success May Be in the Details.

PubMed

McHenry, Judith C; Insel, Kathleen C; Einstein, Gilles O; Vidrine, Amy N; Koerner, Kari M; Morrow, Daniel G

2015-10-01

Describe recruitment strategies used in a randomized clinical trial of a behavioral prospective memory intervention to improve medication adherence for older adults taking antihypertensive medication. Recruitment strategies represent 4 themes: accessing an appropriate population, communication and trust-building, providing comfort and security, and expressing gratitude. Recruitment activities resulted in 276 participants with a mean age of 76.32 years, and study enrollment included 207 women, 69 men, and 54 persons representing ethnic minorities. Recruitment success was linked to cultivating relationships with community-based organizations, face-to-face contact with potential study participants, and providing service (e.g., blood pressure checks) as an access point to eligible participants. Seventy-two percent of potential participants who completed a follow-up call and met eligibility criteria were enrolled in the study. The attrition rate was 14.34%. The projected increase in the number of older adults intensifies the need to study interventions that improve health outcomes. The challenge is to recruit sufficient numbers of participants who are also representative of older adults to test these interventions. Failing to recruit a sufficient and representative sample can compromise statistical power and the generalizability of study findings. © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Development of an Arm Phantom for Testing Non-Invasive Blood Pressure Monitors

NASA Astrophysics Data System (ADS)

Anderson-Jackson, LaTecia D.

Approximately one in every three adults age 20 older are diagnosed with high blood pressure or hypertension. It is estimated that hypertension affects 78 million people in the United States, is equally prevalent in both men and woman (Crabtree, Stuart-Shor, & McAllister, 2013). In the United States, around 78% of people suffering from hypertension are aware of their condition, with only 68% using hypertensive medications to control their blood pressure (Writing Group et al., 2010). Clinically, blood pressure measurements may lack accuracy, which can be attributed to various factors, including device limitations, cuff mis-sizing and misplacement, white-coat effect, masked hypertension, and lifestyle factors. The development of an arm phantom to simulate physiologic properties of a human arm and arterial BP waveforms may allow us to better assess the accuracy of non-invasive blood pressure (NIBP) monitors. The objective of this study are to: (1) Develop an arm phantom to replicate physiological properties of the human arm, and (2) Incorporate the arm phantom into a mock circulatory flow loop to simulate different physiological blood pressure readings on the bench. A tissue mimicking material, styrene-ethylene-butylene-styrene (SEBS), a co-block polymer was used to develop the arm phantom for in-vitro testing. To determine the optimal mechanical properties for the arm phantom, individual arm components were isolated and tested. A protocol was developed to evaluate various components for optimal arm phantom development. Mechanical testing was conducted on 10%, 15%, and 20% SEBS gel samples for modulus of elasticity measurements in order to simulate physiological properties of the human arm. As a result of the SEBS polymer being a new material for this application, this investigation will contribute to resolving the limitations that occurred during experimentation. In this study, we demonstrated that although SEBS polymer may be an ideal material to use for simulating tissue, further research on the material properties should be conducted.

Is Homeostatic Sleep Regulation Under Low Sleep Pressure Modified by Age?

PubMed Central

Munch, Mirjam; Knoblauch, Vera; Blatter, Katharina; Wirz-Justice, Anna; Cajochen, Christian

2007-01-01

Study Objectives: We have previously shown that healthy older volunteers react with an attenuated frontal predominance of sleep electroencephalogram (EEG) delta activity in response to high sleep pressure. Here, we investigated age-related changes in homeostatic sleep regulation under low sleep pressure conditions, with respect to regional EEG differences and their dynamics. Design: Analysis of the sleep EEG during an 8-hour baseline night, during a 40-hour multiple nap protocol (150 minutes of wakefulness and 75 minutes of sleep) and during the following 8-hour recovery night under constant posture conditions. Setting: Centre for Chronobiology, Psychiatric University Clinics, Basel, Switzerland Participants: Sixteen young (20–31 years) and 15 older (57–74 years) healthy volunteers Interventions: N/A. Measurements and Results: All-night EEG spectra revealed an increase in spindle activity (13–15.25 Hz) for both age groups, but only in the young did we find a significant decrease of delta activity (0.5–1.25 Hz) in response to low sleep pressure conditions, predominantly in occipital brain regions. However, delta activity during the first non-rapid eye movement (NREM) sleep episode was equally reduced in both age groups. This response lasted significantly longer in the young (across the first 2 NREM sleep episodes) than in the older participants (only the first NREM sleep episode). Conclusion: The initial EEG delta response to low sleep pressure was similar in healthy older and young participants. Therefore, age-related sleep deteriorations cannot solely be attributed to alterations in the homeostatic sleep-regulatory system. It is, rather, the interplay of circadian and homeostatic factors of sleep regulation, which is changed with aging. Citation: Munch M; Knoblauch V; Blatter K et al. Is homeostatic sleep regulation under low sleep pressure modified by age? SLEEP 2007;30(6):781-792. PMID:17580600

Footwear in classical ballet: a study of pressure distribution and related foot injury in the adolescent dancer.

PubMed

Pearson, Stephen J; Whitaker, Alison F

2012-01-01

This study explores the relationship between dance shoe type and foot pressure characteristics. During adolescence, while the foot is still developing, limiting focal pressure on the feet may help reduce the risk of injury. In order to "condition" the feet for advanced dance, where pointe shoes are worn, it may be advisable to first utilize demi-pointe shoes. Eight female dancers were each tested in four footwear conditions (barefoot, soft, demi-pointe, and pointe shoes), and patterns of foot pressure were compared. A questionnaire was also distributed among sixty-five adolescent females currently training at vocational dance schools to examine shoe use and injury rate before and after the onset of pointe work. During ballet-specific dynamic movement, soft shoes and pointe shoes significantly vary in the plantar pressures they impose on the foot. Demi-pointe shoes provide an intermediate pressure condition, which may help the dancer adapt more gradually to the pressure demands of pointe shoes. Dancers who wore demi-pointe shoes prior to starting pointe were found to be less likely to sustain a ballet-related injury or a lower leg, ankle, or foot injury (22% compared to 30% in those who had not worn demi-pointe shoes). The dancers in this group were also older when they first reported an injury.

Gender differences in hypertension control among older korean adults: Korean social life, health, and aging project.

PubMed

Chu, Sang Hui; Baek, Ji Won; Kim, Eun Sook; Stefani, Katherine M; Lee, Won Joon; Park, Yeong-Ran; Youm, Yoosik; Kim, Hyeon Chang

2015-01-01

Controlling blood pressure is a key step in reducing cardiovascular mortality in older adults. Gender differences in patients' attitudes after disease diagnosis and their management of the disease have been identified. However, it is unclear whether gender differences exist in hypertension management among older adults. We hypothesized that gender differences would exist among factors associated with hypertension diagnosis and control among community-dwelling, older adults. This cross-sectional study analyzed data from 653 Koreans aged ≥60 years who participated in the Korean Social Life, Health, and Aging Project. Multiple logistic regression was used to compare several variables between undiagnosed and diagnosed hypertension, and between uncontrolled and controlled hypertension. Diabetes was more prevalent in men and women who had uncontrolled hypertension than those with controlled hypertension or undiagnosed hypertension. High body mass index was significantly associated with uncontrolled hypertension only in men. Multiple logistic regression analysis indicated that in women, awareness of one's blood pressure level (odds ratio [OR], 2.86; p=0.003) and the number of blood pressure checkups over the previous year (OR, 1.06; p=0.011) might influence the likelihood of being diagnosed with hypertension. More highly educated women were more likely to have controlled hypertension than non-educated women (OR, 5.23; p=0.013). This study suggests that gender differences exist among factors associated with hypertension diagnosis and control in the study population of community-dwelling, older adults. Education-based health promotion strategies for hypertension control might be more effective in elderly women than in elderly men. Gender-specific approaches may be required to effectively control hypertension among older adults.

Improvement in diabetes self-efficacy and glycaemic control using telemedicine in a sample of older, ethnically diverse individuals who have diabetes: the IDEATel project.

PubMed

Trief, Paula M; Teresi, Jeanne A; Eimicke, Joseph P; Shea, Steven; Weinstock, Ruth S

2009-03-01

with increasing prevalence of diabetes in older people, it is important to understand factors that affect their outcomes. The Informatics for Diabetes Education and Telemedicine (IDEATel) project is a demonstration project to evaluate the feasibility and effectiveness of telemedicine with diverse, medically underserved, older diabetes patients. Subjects were randomised to telemedicine case management or usual care. This intervention has been shown to result in improved medical outcomes and self-efficacy. Self-efficacy refers to one's belief that (s)he can successfully engage in a behaviour. Self-efficacy has been shown to relate to behaviour change and glycaemic control in middle-aged individuals, but not studied in older individuals. to assess whether (a) diabetes self-efficacy relates to the primary medical outcome of glycaemic control, and to secondary outcomes (blood pressure and cholesterol), and (b) whether, after an intervention, change in diabetes self-efficacy relates to change in these medical outcomes in a group of older, ethnically diverse individuals. three waves of longitudinal data from participants in IDEATel were analysed. diabetes self-efficacy at baseline correlated with glycaemic control, blood pressure and cholesterol. An increase in diabetes self-efficacy over time was related to an improvement in glycaemic control (P < 0.0001), but not in blood pressure and lipid levels. The intervention was significantly related to improved self-efficacy over time (P < 0.0001), and both directly (P = 0.022) and indirectly through self-efficacy (P < 0.001) to improved glycaemic control. The mediation effect of self-efficacy was also significant (P< 0.004). diabetes self-efficacy is a relevant construct for older diabetes patients. Thus, interventions that target enhanced self-efficacy may also result in improved glycaemic control.

Acute dietary nitrate supplementation enhances compensatory vasodilation during hypoxic exercise in older adults.

PubMed

Casey, Darren P; Treichler, David P; Ganger, Charles T; Schneider, Aaron C; Ueda, Kenichi

2015-01-15

We have previously demonstrated that aging reduces the compensatory vasodilator response during hypoxic exercise due to blunted nitric oxide (NO) signaling. Recent evidence suggests that NO bioavailability can be augmented by dietary nitrate through the nitrate-nitrite pathway. Thus we tested the hypothesis that acute dietary nitrate supplementation increases the compensatory vasodilator response to hypoxic exercise, particularly in older adults. Thirteen young (25 ± 1 yr) and 12 older (64 ± 2 yr) adults performed rhythmic forearm exercise at 20% of maximum voluntary contraction during normoxia and hypoxia (∼80% O2 saturation); both before (control) and 3 h after beetroot juice (BR) consumption. Forearm vascular conductance (FVC; ml·min(-1)·100 mmHg(-1)) was calculated from forearm blood flow (ml/min) and blood pressure (mmHg). Compensatory vasodilation was defined as the relative increase in FVC due to hypoxic exercise (i.e., % increase compared with respective normoxic exercise trial). Plasma nitrite was determined from venous blood samples obtained before the control trials and each of the exercise trials (normoxia and hypoxia) after BR. Consumption of BR increased plasma nitrite in both young and older adults (P < 0.001). During the control condition, the compensatory vasodilator response to hypoxic exercise was attenuated in older compared with young adults (3.8 ± 1.7% vs. 14.2 ± 1.2%, P < 0.001). Following BR consumption, compensatory vasodilation did not change in young (13.7 ± 3.3%, P = 0.81) adults but was substantially augmented in older adults (11.4 ± 2.1%, P < 0.01). Our data suggest that acute dietary nitrate supplementation increases the compensatory vasodilator response to hypoxic exercise in older but not young adults. Copyright © 2015 the American Physiological Society.

Lower blood pressure and apathy coincide in older persons with poorer functional ability: the Discontinuation of Antihypertensive Treatment in Elderly People (DANTE) Study Leiden.

PubMed

Moonen, Justine E F; Bertens, Anne Suzanne; Foster-Dingley, Jessica C; Smit, Roelof A J; van der Grond, Jeroen; de Craen, Anton J M; de Ruijter, Wouter; van der Mast, Roos C

2015-01-01

To examine the association between blood pressure (BP) measures and symptoms of apathy and depression in older adults with various levels of functional ability. Cross-sectional study using baseline data from the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study Leiden. Primary care setting, the Netherlands. Community-dwelling individuals aged 75 and older (N = 430). Systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were measured during home visits. Symptoms of apathy and depression were assessed using the Apathy Scale and the Geriatric Depression Scale (GDS-15), respectively. Stratified linear regression was performed in participants with better and worse functional ability according to the median of the Groningen Activity Restriction Scale. In participants with lower functional ability, each 10-mmHg lower SBP, DBP, and MAP was associated with higher Apathy Scale scores (0.63, 0.92, and 0.94 points, respectively, all P < .005) but not with GDS-15 scores. In participants with higher functional ability, BP measures were not associated with Apathy Scale or GDS-15 scores. In older participants with poorer functional ability, lower BP was associated with more symptoms of apathy but not depression. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Distribution and observed associations of orthostatic blood pressure changes in elderly general medicine outpatients

NASA Technical Reports Server (NTRS)

Robertson, D.; DesJardin, J. A.; Lichtenstein, M. J.

1998-01-01

Factors associated with orthostatic blood pressure change in elderly outpatients were determined by surveying 398 medical clinical outpatients aged 65 years and older. Blood pressure was measured with random-zero sphygmomanometers after patients were 5 minutes in a supine and 5 minutes in a standing position. Orthostatic blood pressure changes were at normally distributed levels with systolic and diastolic pressures dropping an average of 4 mm Hg (standard deviation [SD]=15 mm Hg) and 2 mm Hg (SD=11 mm Hg), respectively. Orthostatic blood pressure changes were unassociated with age, race, sex, body mass, time since eating, symptoms, or other factors. According to multiple linear regression analysis, supine systolic pressure, chronic obstructive pulmonary disease (COPD), and diabetes mellitus were associated with a decrease in systolic pressure on standing. Hypertension, antiarthritic drugs, and abnormal heartbeat were associated with an increase in systolic pressure on standing. For orthostatic diastolic pressure changes, supine diastolic pressure and COPD were associated with a decrease in diastolic pressure on standing. Congestive heart failure was associated with an increase in standing diastolic pressure. Using logistic regression analysis, only supine systolic pressure was associated with a greater than 20-mm Hg drop in systolic pressure (n=53, prevalence=13%). Supine diastolic pressure and COPD were the only variables associated with a greater than 20-mm Hg drop in diastolic pressure (n=16, prevalence=4%). These factors may help physicians in identifying older persons at risk for having orthostatic hypotension.

The Integrity of the Corpus Callosum Mitigates the Impact of Blood Pressure on the Ventral Attention Network and Information Processing Speed in Healthy Adults

PubMed Central

Wong, Nichol M. L.; Ma, Ernie Po-Wing; Lee, Tatia M. C.

2017-01-01

Hypertension is a risk factor for cognitive impairment in older age. However, evidence of the neural basis of the relationship between the deterioration of cognitive function and elevated blood pressure is sparse. Based on previous research, we speculate that variations in brain connectivity are closely related to elevated blood pressure even before the onset of clinical conditions and apparent cognitive decline in individuals over 60 years of age. Forty cognitively healthy adults were recruited. Each received a blood pressure test before and after the cognitive assessment in various domains. Diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rsfMRI) data were collected. Our findings confirm that elevated blood pressure is associated with brain connectivity variations in cognitively healthy individuals. The integrity of the splenium of the corpus callosum is closely related to individual differences in systolic blood pressure. In particular, elevated systolic blood pressure is related to resting-state ventral attention network (VAN) and information processing speed. Serial mediation analyses have further revealed that lower integrity of the splenium statistically predicts elevated systolic blood pressure, which in turn predicts weakened functional connectivity (FC) within the VAN and eventually poorer processing speed. The current study sheds light on how neural correlates are involved in the impact of elevated blood pressure on cognitive functioning. PMID:28484386

The influence of age, sex, bulb position, visual feedback, and the order of testing on maximum anterior and posterior tongue strength and endurance in healthy belgian adults.

PubMed

Vanderwegen, Jan; Guns, Cindy; Van Nuffelen, Gwen; Elen, Rik; De Bodt, Marc

2013-06-01

This study collected data on the maximum anterior and posterior tongue strength and endurance in 420 healthy Belgians across the adult life span to explore the influence of age, sex, bulb position, visual feedback, and order of testing. Measures were obtained using the Iowa Oral Performance Instrument (IOPI). Older participants (more than 70 years old) demonstrated significantly lower strength than younger persons at the anterior and the posterior tongue. Endurance remains stable throughout the major part of life. Gender influence remains significant but minor throughout life, with males showing higher pressures and longer endurance. The anterior part of the tongue has both higher strength and longer endurance than the posterior part. Mean maximum tongue pressures in this European population seem to be lower than American values and are closer to Asian results. The normative data can be used for objective assessment of tongue weakness and subsequent therapy planning of dysphagic patients.

Generational distribution of a Candida glabrata population: Resilient old cells prevail, while younger cells dominate in the vulnerable host.

PubMed

Bouklas, Tejas; Alonso-Crisóstomo, Luz; Székely, Tamás; Diago-Navarro, Elizabeth; Orner, Erika P; Smith, Kalie; Munshi, Mansa A; Del Poeta, Maurizio; Balázsi, Gábor; Fries, Bettina C

2017-05-01

Similar to other yeasts, the human pathogen Candida glabrata ages when it undergoes asymmetric, finite cell divisions, which determines its replicative lifespan. We sought to investigate if and how aging changes resilience of C. glabrata populations in the host environment. Our data demonstrate that old C. glabrata are more resistant to hydrogen peroxide and neutrophil killing, whereas young cells adhere better to epithelial cell layers. Consequently, virulence of old compared to younger C. glabrata cells is enhanced in the Galleria mellonella infection model. Electron microscopy images of old C. glabrata cells indicate a marked increase in cell wall thickness. Comparison of transcriptomes of old and young C. glabrata cells reveals differential regulation of ergosterol and Hog pathway associated genes as well as adhesion proteins, and suggests that aging is accompanied by remodeling of the fungal cell wall. Biochemical analysis supports this conclusion as older cells exhibit a qualitatively different lipid composition, leading to the observed increased emergence of fluconazole resistance when grown in the presence of fluconazole selection pressure. Older C. glabrata cells accumulate during murine and human infection, which is statistically unlikely without very strong selection. Therefore, we tested the hypothesis that neutrophils constitute the predominant selection pressure in vivo. When we altered experimentally the selection pressure by antibody-mediated removal of neutrophils, we observed a significantly younger pathogen population in mice. Mathematical modeling confirmed that differential selection of older cells is sufficient to cause the observed demographic shift in the fungal population. Hence our data support the concept that pathogenesis is affected by the generational age distribution of the infecting C. glabrata population in a host. We conclude that replicative aging constitutes an emerging trait, which is selected by the host and may even play an unanticipated role in the transition from a commensal to a pathogen state.

[Effects of Self-management Program applying Dongsasub Training on Self-efficacy, Self-esteem, Self-management Behavior and Blood Pressure in Older Adults with Hypertension].

PubMed

Kim, Myoungsuk; Song, Misoon

2015-08-01

The purpose of this study was to develop a self-management program applying Dongsasub training based on self-efficacy theory, and to verify the program effectiveness on self-esteem as well as self-efficacy, self-management behaviors, and blood pressure. The study design was a non-equivalent, pre-post controlled quasi-experiment study. Thirty-eight patients aged 65 and older from a senior welfare center in Seoul participated in this study (20 patients in the experimental group and 18 patients in the control group). The self-management program applying Dongsasub training consisted of eight sessions. After development was complete the program was used with the experimental group. Outcome variables included self-efficacy, self-esteem, self-management behaviors measured by questionnaires, and blood pressure measured by electronic manometer. Self-efficacy (t=2.42, p=.021), self-esteem (t=2.57, p=.014) and self-management behaviors (t=2.21, p=.034) were significantly higher and systolic blood pressure (t=-2.14, p=.040) was significantly lower in the experimental group compared to the control group. However, diastolic blood pressure (t=-.85, p=.400) was not significantly different between the two groups. The results indicate that the self-management program applying Dongsasub training can be used as a nursing intervention in community settings for improving self-management behaviors for older adults with hypertension.

Characteristics of balance control in older persons who fall with injury--a prospective study.

PubMed

Kurz, Ilan; Oddsson, Lars; Melzer, Itshak

2013-08-01

Older adults who have recently fallen demonstrate increased postural sway compared with non-fallers. However, the differences in postural control between older adults who were seriously injured (SI) as a result of a fall, compared with those who fell but were not injured (NSI) and non-fallers (NFs), has not been investigated. The objective of the present study was to investigate the underlying postural control mechanisms related to injuries resulting from a fall. Both traditional postural sway measures of foot center-of-pressure (CoP) displacements and fractal measures, the Stabilogram-Diffusion Analysis (SDA), were used to characterize the postural control. One hundred older adults aged 65-91years were tested during narrow base upright stance in eyes closed condition; falls were monitored over a 1-year period. Forty-nine older adults fell during the 1-year follow-up, 13 were seriously injured as a result of a fall (SI), 36 were not injured (NSI), and 49 were non-fallers (NFs); two passed away. The SDA showed significantly higher short-term diffusion coefficients and critical displacements in SI in the anterior-posterior direction compared with both NSI and NF. However, in the medio-lateral direction there were no statistically significant differences between groups. For the traditional measures of sway, the average anterior-posterior CoP range was also larger in SI individuals. This work suggests that older fallers with a deterioration of anterior-posterior postural control may be at higher risk of serious injury following fall events. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effect of healthy aging on renal vascular responses to local cooling and apnea

PubMed Central

Patel, Hardikkumar M.; Mast, Jessica L.; Sinoway, Lawrence I.

2013-01-01

Sympathetically mediated renal vasoconstriction may contribute to the pathogenesis of hypertension in older adults, but empirical data in support of this concept are lacking. In 10 young (26 ± 1 yr) and 11 older (67 ± 2 yr) subjects, we quantified acute hemodynamic responses to three sympathoexcitatory stimuli: local cooling of the forehead, cold pressor test (CPT), and voluntary apnea. We hypothesized that all stimuli would increase mean arterial blood pressure (MAP) and renal vascular resistance index (RVRI) and that aging would augment these effects. Beat-by-beat MAP, heart rate (HR), and renal blood flow velocity (from Doppler) were measured in the supine posture, and changes from baseline were compared between groups. In response to 1°C forehead cooling, aging was associated with an augmented MAP (20 ± 3 vs. 6 ± 2 mmHg) and RVRI (35 ± 6 vs. 16 ± 9%) but not HR. In older adults, there was a positive correlation between the cold-induced pressor response and forehead pain (R = 0.726), but this effect was not observed in young subjects. The CPT raised RVRI in both young (56 ± 13%) and older (45 ± 8%) subjects, but this was not different between groups. Relative to baseline, end-expiratory apnea increased RVRI to a similar extent in both young (46 ± 14%) and older (41 ± 9%) subjects. During sympathetic activation, renal vasoconstriction occurred in both groups. Forehead cooling caused an augmented pressor response in older adults that was related to pain perception. PMID:23640587

Self-Care Adherence and Psychological Functioning of Older Patients with Type 2 Diabetes: Effects of Persuasion, Social Pressure, and Self-Efficacy.

PubMed

Yang, Fang; Pang, Joyce S; Cheng, Wendy J Y

2016-12-01

This cross-sectional study examined the role of family members' use of persuasion versus pressure as distinct forms of social control by which family members attempt to encourage better diabetes management among older adults with type 2 diabetes mellitus (T2DM). The study also examined how self-efficacy might moderate the relationship between persuasion/pressure, psychological functioning, and self-care adherence. Participants were 96 men and 103 women with T2DM, with a mean age of 63.3 years. Regression results show that neither persuasion nor pressure was significantly related to self-care adherence, but persuasion and pressure were associated in complex ways with diabetes-related emotional distress and depressive symptoms for which significant interaction effects were found. Patients with lower self-efficacy benefited from persuasion, but were adversely affected by pressure. In contrast, patients with higher self-efficacy were adversely affected by persuasion, but were less negatively affected by pressure. Findings highlight the importance of reducing pressure-based social control, considering patients' self-efficacy when family members seek to influence patients' self-care behaviors, and targeting patient-family interactions in future interventions.

Association of sex and age with responses to lower-body negative pressure

NASA Technical Reports Server (NTRS)

Frey, Mary Anne Bassett; Hoffler, G. Wyckliffe

1988-01-01

The effects of age and sex on the human-body responses to -50 torr LBNP were investigated in subjects who have undergone LBNP tests at the Kennedy Space Center. The comparison of results obtained on women and age-matched men indicated that men had larger relative increases in calf circumference and greater increases in peripheral resistance during the exposure to LBNP than the women; on the other hand, women displayed greater increases in thoracic impedance and heart rate. The comparison of the results on men of different ages (between 29 and 56 y) indicated that older subjects had greater increases in peripheral resistance and less heart rate elevation in response to LBNP. It is suggested that the age-related circulatory differences were due to a reduction in vagal response and a switch to predominant sympathetic nervous system influence in older men.

Hypertension treatment for older people-navigating between Scylla and Charybdis.

PubMed

Conroy, Simon Paul; Westendorp, Rudi Gerardus Johannes; Witham, Miles D

2018-05-21

Hypertension is a common condition in older people, but is often one of many conditions, particularly in frail older people, and so is rarely managed in isolation in the real world-which belies the bulk of the evidence upon which is treatment decisions are often based. In this article, we discuss the issues of ageing, including frailty and dementia, and their impact upon blood pressure management. We examine the evidence base for managing hypertension in older people, and explore some therapeutic ideas that might influence treatment decisions and strategies, including shared decision making.

Fear of falling is associated with prolonged anticipatory postural adjustment during gait initiation under dual-task conditions in older adults.

PubMed

Uemura, Kazuki; Yamada, Minoru; Nagai, Koutatsu; Tanaka, Buichi; Mori, Shuhei; Ichihashi, Noriaki

2012-02-01

Little is known about dynamic balance control under dual-task conditions in older adults with fear of falling (FoF). The purpose of this study was to examine the effect of FoF on anticipatory postural adjustment (APA) during gait initiation under dual-task conditions in older adults. Fifty-seven elderly volunteers (age, 79.2 [6.8] years) from the community participated in this study. Each participant was categorised into either the Fear (n=24) or No-fear (n=33) group on the basis of the presence or absence of FoF. Under single- and dual-task conditions, centre of pressure (COP) data were collected while the participants performed gait initiation trials from a starting position on a force platform. We also performed a 10-m walking test (WT), a timed up & go test (TUG), and a functional reach test (FR). The reaction and APA phases were measured from the COP data. The results showed that under the dual-task condition, the Fear group had significantly longer APA phases than the No-fear group, although no significant differences were observed between the 2 groups in the reaction and APA phases under the single-task condition and in any clinical measurements (WT, TUG, and FR). Our findings suggest that specific deficits in balance control occur in subjects with FoF during gait initiation while dual tasking, even if their physical functions are comparable to subjects without FoF. Copyright © 2011 Elsevier B.V. All rights reserved.

Isometric and swallowing tongue strength in healthy adults.

PubMed

Todd, J Tee; Lintzenich, Catherine Rees; Butler, Susan G

2013-10-01

The tongue contributes to a safe swallow. It facilitates bolus control during mastication, maintains a bolus in the oral cavity to prevent premature entry of the bolus into the hypopharynx, and helps generate pressure in the hypopharynx during swallowing. This study examined isometric tongue strength and tongue pressure measured during swallowing in healthy young and older adults. Prospective group design. One hundred twenty-six healthy individuals who were recruited as part of a larger study on swallowing participated in this study. Participants were divided into three age groups: 20 to 40 years, 41 to 60 years, and ≥61 years. A KayPentax Digital Swallowing Workstation with an air-filled bulb array was placed on the tongue of each participant (anterior to posterior). Participants completed three isometric tongue presses and three swallows. Repeated measures analyses of variance revealed a significant main effect of age (P = .01) and gender by tongue bulb location interaction (P = .02) for isometric tongue strength. That is, older adults had lower isometric tongue strength than young adults, and females had a greater difference between anterior and posterior tongue strength than males. Tongue strength during swallowing yielded significantly greater anterior versus posterior tongue pressure. This study comprises one of the largest in terms of number of healthy participants reported to date and confirms previous findings that isometric tongue strength decreases with age. Furthermore, given young and older adults generate similar swallowing pressures, swallowing is a submaximal strength activity, yet older adults have less functional reserve. 4. Copyright © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.

The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives.

PubMed

MacMahon, S; Rodgers, A

1993-11-01

Direct evidence about the effects of antihypertensive treatment on vascular disease in older patients is available from five randomized trials conducted exclusively in patients over the age of 60 years. These trials involved a total of 12,483 individuals with systolic or diastolic hypertension (mean age = 72 years, mean entry blood pressure = 181/88 mmHg). Over an average follow-up period of 4.7 years, a 15/6 mmHg difference in blood pressure between study and control groups was achieved. Among those patients assigned active treatment, stroke incidence was reduced by 34% SD6 and coronary heart disease incidence was reduced by 19% SD7. These proportional reductions were of similar size to those observed in trials in predominantly younger patients. However, the absolute benefits observed in older patients were more than twice as great as those observed in younger patients. The results suggest that over 10 years, treatment would prevent at least one major vascular event among every 10 elderly patients at similar risk to those enrolled in the trials.

Blood pressure reactivity to mental stress is attenuated following resistance exercise in older hypertensive women.

PubMed

Gauche, Rafael; Lima, Ricardo M; Myers, Jonathan; Gadelha, André B; Neri, Silvia Gr; Forjaz, Claudia Lm; Vianna, Lauro C

2017-01-01

This study aimed to investigate the effects of resistance exercise (RE) on autonomic control and blood pressure (BP) reactivity during mental stress (MS) in treated older hypertensive women. Ten older hypertensive women (age =71.1±5.5 years; body mass index =24.2±3.9; mean BP [MBP] =85.4±3.5) underwent a protocol consisting of BP and heart rate variability (HRV) output assessments at baseline and during MS, and these measurements were taken before and 60 minutes after two bouts of RE (traditional and circuit). MS was induced through a computerized 3-minute Stroop color-word test before and 1 hour after each exercise session; BP was measured every minute during MS, and HRV was monitored as a measure of cardiac autonomic control. A significant effect of time on systolic BP (Δpre =17.4±12.8 versus Δpost =12.5±9.6; P =0.01), diastolic BP (Δpre =13.7±7.1 versus Δpost =8.8±4.5; P =0.01), and MBP (Δpre =14.0±7.7 versus Δpost =9.3±5.4; P <0.01) after RE was observed, with no differences between the two sessions. In addition, a significant effect of time on log-normalized low-frequency component of HRV (ms2; 5.3±0.8 pre-exercise MS versus 4.8±1.0 baseline value; P =0.023) was also observed, showing a significant change from baseline to MS before RE, but not after RE sessions. These results may be related to a lessened RE-mediated cardiac sympathetic activity during MS. RE is an effective tool to reduce BP reactivity to MS, which could therefore be associated with an acute reduction in cardiovascular risk. This result presents relevant clinical implications, combining previous evidence that recommends this exercise modality as an important component of an exercise program designed for the older and hypertensive subjects.

Psychological Well-being of Grandparents Caring for Grandchildren among Older Chinese Americans: Burden or Blessing?

PubMed Central

Tang, Fengyan; Xu, Ling; Chi, Iris; Dong, XinQi

2016-01-01

The rapid increase in grandparents caring for grandchildren has received growing attention; however, relatively little research has focused on Chinese American grandparents and their caregiving experiences. Drawing on cross-sectional data from the Population Study of Chinese Elderly (PINE) – a community-engaged, epidemiological study of Chinese American adults aged 60 and older, we examined the relationships between caregiving experiences and psychological well-being. Among 2,365 older adults who answered the question about grandparent caregiving, 818 (35%) were designated as caregivers, spending an average of 12 hours a week on childcare. About one in five caregivers reported caregiving burden, pressure, or negative health effect of caregiving. Compared with noncaregivers, caregivers had better psychological well-being, with significantly lower levels of depressive symptoms, anxiety, stress, and loneliness. But increased levels of caregiving burden, pressure from adult children, and perceived negative effect were related to increased rates for psychological distress. With a strong cultural expectation for family care, grandparent caregiving is generally associated with positive psychological well-being; but it is also a stress process, especially when older adults feel pressured and/or burdened to provide childcare. The study implies that cultural values and life transitions may shape grandparent caregiving experiences and well-being, pointing to the importance of respecting cultural differences in family caregiving. Understanding both positive and negative aspects of grandparent caregiving and the underlying mechanisms will help healthcare professionals identify caregivers at risk of psychological distress and provide proper interventions to attenuate negative outcomes while maximizing positive experience in Chinese American older adults. PMID:27641829

Psychological Well-Being of Older Chinese-American Grandparents Caring for Grandchildren.

PubMed

Tang, Fengyan; Xu, Ling; Chi, Iris; Dong, XinQi

2016-11-01

The rapid increase in grandparents caring for grandchildren has received growing attention, but little research has focused on Chinese-American grandparents and their caregiving experiences. Drawing on cross-sectional data from the Population Study of Chinese Elderly-a community-engaged, epidemiological study of Chinese-American adults aged 60 and older, the relationships between caregiving experiences and psychological well-being were examined. Of 2,365 older adults who answered the question about grandparent caregiving, 818 (35%) were designated as caregivers, spending an average of 12 hours a week on childcare. About one in five caregivers reported caregiving burden, pressure, or negative health effect of caregiving. Caregivers had better psychological well-being than noncaregivers, with significantly lower levels of depressive symptoms, anxiety, stress, and loneliness. For caregivers, higher levels of caregiving burden, pressure from adult children, and perceived negative effect were related to greater rates of psychological distress. With a strong cultural expectation of family care, grandparent caregiving is generally associated with positive psychological well-being, but it can also be stressful, especially when older adults feel pressured to provide childcare or that doing so is a burden. The study implies that cultural values and life transitions may shape grandparent caregiving experiences and well-being, indicating the importance of respecting cultural differences in family caregiving. Understanding positive and negative aspects of grandparent caregiving and the underlying mechanisms will help healthcare professionals identify caregivers at risk of psychological distress and provide proper interventions to attenuate negative outcomes while maximizing positive experiences for Chinese-American older adults. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Hypertension Treatment and Concern About Falling: Baseline Data from the Systolic Blood Pressure Intervention Trial.

PubMed

Berlowitz, Dan R; Breaux-Shropshire, Tonya; Foy, Capri G; Gren, Lisa H; Kazis, Lewis; Lerner, Alan J; Newman, Jill C; Powell, James R; Riley, William T; Rosman, Robert; Wadley, Virginia G; Williams, Julie A

2016-11-01

To determine the extent of concern about falling in older adults with hypertension, whether lower blood pressure (BP) and greater use of antihypertensive medications are associated with greater concern about falling, and whether lower BP has a greater effect on concern about falling in older and more functionally impaired individuals. Secondary analysis involving cross-sectional study of baseline characteristics of participants enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). Approximately 100 outpatient sites. SPRINT enrollees aged 50 and older (mean age 69) diagnosed with hypertension (N = 2,299). Concern about falling was determined using the shortened version of the Falls Efficacy Scale International as measured at the baseline examination. Mild concern about falling was present in 29.3% of participants and moderate to severe concern in 17.9%. Neither low BP (systolic BP<120 mmHg, diastolic BP <70 mmHg) nor orthostatic hypotension was associated with concern about falling (P > .10). Participants with moderate to severe concern about falling were taking significantly more antihypertensive medications than those with mild or no concern. After adjusting for baseline characteristics, no associations were evident between BP, medications, and concern about falling. Results were similar in older and younger participants; interactions between BP and age and functional status were not significantly associated with concern about falling. Although concern about falling is common in older adults with hypertension, it was not found to be associated with low BP or use of more antihypertensive medications in baseline data from SPRINT. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Adrenergic responsiveness is reduced, while baseline cardiac function is preserved in old adult conscious monkeys

NASA Technical Reports Server (NTRS)

Sato, N.; Kiuchi, K.; Shen, Y. T.; Vatner, S. F.; Vatner, D. E.

1995-01-01

To examine the physiological deficit to adrenergic stimulation with aging, five younger adult (3 +/- 1 yr old) and nine older adult (17 +/- 1 yr old) healthy monkeys were studied after instrumentation with a left ventricular (LV) pressure gauge, aortic and left atrial catheters, and aortic flow probes to measure cardiac output directly. There were no significant changes in baseline hemodynamics in conscious older monkeys. For example, an index of contractility, the first derivative of LV pressure (LV dP/dt) was similar (3,191 +/- 240, young vs. 3,225 +/- 71 mmHg/s, old) as well as in isovolumic relaxation, tau (24.3 +/- 1.7 ms, young vs. 23.0 +/- 1.0 ms, old) was similar. However, inotropic, lusitropic, and chronotropic responses to isoproterenol (Iso; 0.1 micrograms/kg), norepinephrine (NE; 0.4 micrograms/kg), and forskolin (For; 75 nmol/kg) were significantly (P < 0.05) depressed in older monkeys. For example. Iso increased LV dP/dt by by 146 +/- 14% in younger monkeys and by only 70 +/- 5% in older monkeys. Iso also reduced tau more in younger monkeys (-28 +/- 7%) compared with older monkeys (-13 +/- 3%). Furthermore, peripheral vascular responsiveness to Iso, NE, For, and phenylephrine (PE; 5 micrograms/kg) was significantly (P < 0.05) reduced in older monkeys. For example, phenylephrine (5 micrograms/kg) increased total peripheral resistence by 69 +/- 4% in younger monkeys and by only 45 +/- 3% in older monkeys. Thus in older monkeys without associated cardiovascular disease, baseline hemodynamics are preserved, but adrenergic receptor responsiveness is reduced systemically, not just in the heart.

Age Differences in Affective and Cardiovascular Responses to a Negative Social Interaction: The Role of Goals, Appraisals, and Emotion Regulation

PubMed Central

Luong, Gloria; Charles, Susan T.

2014-01-01

Older adults often report less affective reactivity to interpersonal tensions than younger individuals, but few studies have directly investigated mechanisms explaining this effect. The current study examined whether older adults’ differential endorsement of goals, appraisals, and emotion regulation strategies (i.e., conflict avoidance/de-escalation, self-distraction) during a controlled negative social interaction may explain age differences in affective and cardiovascular responses to the conflict discussion. Participants (N=159; 80 younger adults, 79 older adults) discussed hypothetical dilemmas with disagreeable confederates. Throughout the laboratory session, participants’ subjective emotional experience, blood pressure, and pulse rate were assessed. Older adults generally exhibited less reactivity (negative affect reactivity, diastolic blood pressure reactivity, and pulse rate reactivity) to the task, and more pronounced positive and negative affect recovery following the task, than did younger adults. Older adults appraised the task as more enjoyable and the confederate as more likeable, and more strongly endorsed goals to perform well on the task, which mediated age differences in negative affect reactivity, pulse rate reactivity, and positive affect recovery (i.e., increases in post-task positive affect), respectively. In addition, younger adults showed increased negative affect reactivity with greater use of self-distraction, whereas older adults did not. Together, findings suggest that older adults respond less negatively to unpleasant social interactions than younger adults, and these responses are explained in part by older adults’ pursuit of different motivational goals, less threatening appraisals of the social interaction, and more effective use of self-distraction, compared to younger adults. PMID:24773101

Tween Consumers: Catalog Clothing Purchase Behavior.

ERIC Educational Resources Information Center

Simpson, Linda; Douglas, Sara; Schimmel, Julie

1998-01-01

Catalog shopping behavior of younger and older adolescents was compared. Results indicated that "tweens" were more concerned with style, brand name, and fashion than were older students. This supports previous findings indicating that the tween years are a time when peer pressure and "fitting in" are very important. (Author/EMK)

Effects of interactive video-game based system exercise on the balance of the elderly.

PubMed

Lai, Chien-Hung; Peng, Chih-Wei; Chen, Yu-Luen; Huang, Ching-Ping; Hsiao, Yu-Ling; Chen, Shih-Ching

2013-04-01

This study evaluated the effects of interactive video-game based (IVGB) training on the balance of older adults. The participants of the study included 30 community-living persons over the age of 65. The participants were divided into 2 groups. Group A underwent IVGB training for 6 weeks and received no intervention in the following 6 weeks. Group B received no intervention during the first 6 weeks and then participated in training in the following 6 weeks. After IVGB intervention, both groups showed improved balance based on the results from the following tests: the Berg Balance Scale (BBS), Modified Falls Efficacy Scale (MFES), Timed Up and Go (TUG) test, and the Sway Velocity (SV) test (assessing bipedal stance center pressure with eyes open and closed). Results from the Sway Area (SA) test (assessing bipedal stance center pressure with eyes open and closed) revealed a significant improvement in Group B after IVGB training. Group A retained some training effects after 6 weeks without IVGB intervention. Additionally, a moderate association emerged between the Xavix measured step system stepping tests and BBS, MFES, Unipedal Stance test, and TUG test measurements. In conclusion, IVGB training improves balance after 6 weeks of implementation, and the beneficial effects partially remain after training is complete. Further investigation is required to determine if this training is superior to traditional physical therapy. Copyright © 2012 Elsevier B.V. All rights reserved.

Pressure Ulcers in the United States' Inpatient Population From 2008 to 2012: Results of a Retrospective Nationwide Study.

PubMed

Bauer, Karen; Rock, Kathryn; Nazzal, Munier; Jones, Olivia; Qu, Weikai

2016-11-01

Pressure ulcers are common, increase patient morbidity and mortality, and costly for patients, their families, and the health care system. A retrospective study was conducted to evaluate the impact of pressure ulcers on short-term outcomes in United States inpatient populations and to identify patient characteristics associated with having 1 or more pressure ulcers. The US Nationwide Inpatient Sample (NIS) database was analyzed using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis codes as the screening tool for all inpatient pressure ulcers recorded from 2008 to 2012. Patient demographics and comorbid conditions, as identified by ICD-9 code, were extracted, along with primary outcomes of length of stay (LOS), total hospital charge (TC), inhospital mortality, and discharge disposition. Continuous variables with normal distribution were expressed in terms of mean and standard deviation. Group comparisons were performed using t-test or ANOVA test. Continuous nonnormal distributed variables such as LOS and TC were expressed in terms of median, and nonparametric tests were used to compare the differences between groups. Categorical data were presented in terms of percentages of the number of cases within each group. Chi-squared tests were used to compare categorical data in different groups. For multivariate analysis, linear regressions (for continuous variable) and logistic regression (for categorical variables) were used to analyze the possible risk factors for the investigated outcomes of LOS, TC, inhospital mortality, and patient disposition. Coefficients were calculated with multivariate regression with all included patients versus patients with pressure ulcers alone. The 5-year average number of admitted patients with at least 1 pressure ulcer was determined to be 670 767 (average overall rate: 1.8%). Statistically significant differences between patients with and without pressure ulcers were observed for median LOS (7 days [mean 11.1 ± 15] compared to 3 days [mean 4.6 ± 6.8]) and median TC ($36 500 [mean $72 000 ± $122 900] compared to $17 200 [mean $32 200 ± $57 500]). The mortality rate in patients with a pressure ulcer was significantly higher than in patients without a pressure ulcer (9.1% versus 1.8%, OR = 5.08, CI: 5.03-5.1, P <0.001). Pressure ulcers were significantly more common in patients who were older or had malnutrition. The results of this study confirm the importance of prevention initiatives to help reduce the negative impact of pressure ulcers on patient outcomes and costs of care.

Visual Reliance for Balance Control in Older Adults Persists When Visual Information Is Disrupted by Artificial Feedback Delays

PubMed Central

Balasubramaniam, Ramesh

2014-01-01

Sensory information from our eyes, skin and muscles helps guide and correct balance. Less appreciated, however, is that delays in the transmission of sensory information between our eyes, limbs and central nervous system can exceed several 10s of milliseconds. Investigating how these time-delayed sensory signals influence balance control is central to understanding the postural system. Here, we investigate how delayed visual feedback and cognitive performance influence postural control in healthy young and older adults. The task required that participants position their center of pressure (COP) in a fixed target as accurately as possible without visual feedback about their COP location (eyes-open balance), or with artificial time delays imposed on visual COP feedback. On selected trials, the participants also performed a silent arithmetic task (cognitive dual task). We separated COP time series into distinct frequency components using low and high-pass filtering routines. Visual feedback delays affected low frequency postural corrections in young and older adults, with larger increases in postural sway noted for the group of older adults. In comparison, cognitive performance reduced the variability of rapid center of pressure displacements in young adults, but did not alter postural sway in the group of older adults. Our results demonstrate that older adults prioritize vision to control posture. This visual reliance persists even when feedback about the task is delayed by several hundreds of milliseconds. PMID:24614576

Assessment of recent HIV testing among older adults in the United States.

PubMed

Guo, Yuqi; Sims, Omar T

2017-10-01

Older adults are the fastest growing segment of people living with HIV, and unfortunately many are unaware of their HIV status. Many providers are reluctant to ask older adults about their sexual histories, evaluate their risk factors, and test for HIV, and older adults have low perception of HIV risk. Using data from the 2013 to 2014 National Health and Nutrition Examination Survey, this study assessed the prevalence of recent HIV testing among older adults in the United States (n = 1,056) and identified predictors and barriers to recent HIV testing. The prevalence of recent HIV testing was 28%. Recent HIV testing was associated positively with male gender, education level, having public insurance, having same sex sexual behavior, African, and Hispanic ethnicity, whereas age, income-to-poverty ratio, and Asian ethnicity were associated negatively with recent HIV testing. Public health social workers are advised that targeted HIV testing for Asian, economically disadvantaged, female older adults is needed to increase HIV awareness and detection and to decrease late diagnosis of HIV. Provided public insurance was identified as a predictor of recent HIV testing, facilitating economically disadvantaged older adults' eligibility for public insurance that will likely improve access to HIV testing services and increase HIV testing rates.

Prevalence and Determinants of Glaucoma in Citizens of Qatar Aged 40 Years or Older: A Community-Based Survey

PubMed Central

Al-Mansouri, Fatma A.; Kanaan, Aida; Gamra, Hamad; Khandekar, Rajiv; Hashim, Shakeel P.; Al Qahtani, Omar; Ahmed, Mohd. Farouk

2011-01-01

Background: We present the prevalence and determinants of glaucoma among subjects 40 years of age and older in Qatar. Materials and Methods: This community-based survey was held in 2009 at 49 randomly selected clusters. Demographic details and history of glaucoma was collected by the nurses. Ophthalmologists evaluated the optic disc and retina using a digital camera housed in a mobile van. Visual field was tested with an automated perimeter, the intraocular pressure with an applanation tonometer and the angle of the anterior chamber by gonioscopy. A panel of glaucoma experts diagnosed subjects with glaucoma. Results: This survey enrolled 3,149 (97.3%) participants. The age- and sex-adjusted prevalence of glaucoma in the population aged 40 years and older was 1.73% (95% confidence intervals [CI] 1.69-1.77). Accordingly, 5,641 individuals in this age group in Qatar would have glaucoma. Chronological age of 60 years and older (Odds ratio [OR] 11.1) and the presence of myopia (OR 1.78) were predictors of glaucoma. Open-angle glaucoma was diagnosed in 44 (65.7%) individuals with glaucoma. In nine (13.4%) and 15 (20.9%) subjects, angle closure glaucoma and other (post-traumatic, pseudoexfoliation) glaucoma were present. Bilateral blindness (vision <3/60) and severe visual impairment (<6/60) were found in four (6%) and three (4.5%) subjects with glaucoma, respectively. Glaucoma was treated in 36 (54%) subjects. Conclusions: The prevalence of glaucoma among citizens of Qatar aged 40 years and older was 1.71%. Glaucoma was associated with the age of 60 years and older and the presence of myopia. PMID:21731325

Postural blood pressure electrocardiographic changes are associated with falls in older people.

PubMed

Saedon, Nor Izzati; Zainal-Abidin, Imran; Chee, Kok Han; Khor, Hui Min; Tan, Kit Mun; Kamaruzzaman, Shahrul K; Chin, Ai-Vyrn; Poi, Philip J H; Tan, Maw Pin

2016-02-01

To determine the magnitude of postural blood pressure change, differences in ECG between fallers and non-fallers were measured. Postural blood pressure change is associated with symptoms of dizziness, presyncope, and syncope. In this cross-sectional study were included participants from The Malaysian Falls Assessment and Intervention Trial: fallers, aged 65 years or older with two or more falls or one injurious fall in 12 months, from a teaching hospital; and non-fallers, aged 65 years and older found through word-of-mouth and advertising. Noninvasive beat-to-beat blood pressure was measured at 10 min supine rest and 3 min standing. The maximal drop in systolic and diastolic pressure was calculated from a 12-lead ECG interpreted by a cardiologist. Basic demographics, medical history, and symptoms of dizziness, presyncope, and syncope were recorded for all patients. We recruited 155 fallers and 112 non-fallers. Fallers had a significantly longer PR interval (179 ± 32 vs. 168 ± 27 ms, p = 0.013) and a longer corrected QT interval (449 ± 41 vs. 443 ± 39 msec, p = 0.008), and larger change in SBP (28 ± 14 vs. 19 ± 9 mmHg, p < 0.001) with posture change. SBP drop of ≥30mmHg associated with recurrent and injurious falls [odds ratio [95 % confidence interval] = 7.61 (3.18-18.21)]. The changes remained significant after adjustment for symptoms of dizziness, presyncope and syncope. Older individuals with recurrent and injurious falls have significantly longer PR and QT intervals and larger SBP reduction with posture change as compared to non-fallers, and these are not explained by the presence of dizziness, presyncope, or syncope. SBP cut-off of ≥30mmHg considered for postural measurements using continuous BP monitors, the significance of this value needs to be evaluated.

Eat, sleep, work, play: associations of weight status and health-related behaviors among young adult college students.

PubMed

Quick, Virginia; Byrd-Bredbenner, Carol; White, Adrienne A; Brown, Onikia; Colby, Sarah; Shoff, Suzanne; Lohse, Barbara; Horacek, Tanya; Kidd, Tanda; Greene, Geoffrey

2014-01-01

To examine relationships of sleep, eating, and exercise behaviors; work time pressures; and sociodemographic characteristics by weight status (healthy weight [body mass index or BMI < 25] vs. overweight [BMI ≥ 25]) of young adults. Cross-sectional. Nine U.S. universities. Enrolled college students (N = 1252; 18-24 years; 80% white; 59% female). Survey included the Pittsburgh Sleep Quality Index (PSQI), Three-Factor Eating Questionnaire (TFEQ), Satter Eating Competence Inventory (ecSI), National Cancer Institute Fruit/Vegetable Screener, International Physical Activity Questionnaire, Work Time Pressure items, and sociodemographic characteristics. Chi-square and t-tests determined significant bivariate associations of sociodemographics, sleep behaviors, eating behaviors, physical activity behavior, and work time pressures with weight status (i.e., healthy vs. overweight/obese). Statistically significant bivariate associations with weight status were then entered into a multivariate logistic regression model that estimated associations with being overweight/obese. Sex (female), race (nonwhite), older age, higher Global PSQI score, lower ecSI total score, and higher TFEQ Emotional Eating Scale score were significantly (p < .05) associated with overweight/obesity in bivariate analyses. Multivariate logistic regression analysis showed that sex (female; odds ratio [OR] = 2.05, confidence interval [CI] = 1.54-2.74), older age (OR = 1.35, CI = 1.21-1.50), higher Global PSQI score (OR = 1.07, CI = 1.01-1.13), and lower ecSI score (OR = .96, CI = .94-.98), were significantly (p < .05) associated with overweight/obesity. Findings suggest that obesity prevention interventions for college students should include an education component to emphasize the importance of overall sleep quality and improving eating competence.

The effect of atmospheric temperature and pressure on the occurrence of acute myocardial infarction in Kaunas.

PubMed

Radišauskas, Ričardas; Vaičiulis, Vidmantas; Ustinavičienė, Rūta; Bernotienė, Gailutė

2013-01-01

OBJECTIVE. The aim of the study was to evaluate the impact of meteorological variables (atmospheric temperature and pressure) on the daily occurrence of acute myocardial infarction (AMI). MATERIAL AND METHODS. The study used the daily values of atmospheric temperature and pressure in 2000-2007. The meteorological data were obtained from the Lithuanian Hydrometeorological Service for Kaunas. The relative risks of event occurrence were computed for 5°C atmospheric temperature and for 10-hPa atmospheric pressure variations by means of the Poisson regression model. RESULTS. The occurrence of AMI and atmospheric temperature showed an inverse linear relationship, while the occurrence of AMI and atmospheric pressure, a positive linear relationship. Among the youngest subjects (25-44 years old), no relationships were detected. Contrary, among the subjects aged 45-64 years and those aged 65 years and older, the occurrence of AMI significantly decreased with higher temperature (P=0.001 and P=0.002, respectively). A decrease in atmospheric temperature by 10ºC reduced the risk of AMI by 8.7% in the age groups of 45-64 and 65 years and older and by 19% in the age group of 25 years and older. Among the first AMI cases, the risk increased by 7.5% in the age group of 45-64-year olds and by 6.4% in the age group of 25-64-year olds. The relationship between atmospheric temperature and pressure, and AMI occurrence was found to be linear but inverse. An increase in atmospheric pressure by 10 hPa resulted in an increase in risk by 4% among the subjects aged 65 years and more and by 3% among the subjects aged 25 years and more. CONCLUSIONS. Atmospheric temperature and pressure variations had the greatest effect on middle-aged and aging subjects (starting from 45 years). At younger age, the effect of such factors on the AMI risk was considerably lower.

Laryngeal Aerodynamics in Healthy Older Adults and Adults with Parkinson's Disease

ERIC Educational Resources Information Center

Matheron, Deborah; Stathopoulos, Elaine T.; Huber, Jessica E.; Sussman, Joan E.

2017-01-01

Purpose: The present study compared laryngeal aerodynamic function of healthy older adults (HOA) to adults with Parkinson's disease (PD) while speaking at a comfortable and increased vocal intensity. Method: Laryngeal aerodynamic measures (subglottal pressure, peak-to-peak flow, minimum flow, and open quotient [OQ]) were compared between HOAs and…

Perceived social support predicts lower cardiovascular reactivity to stress in older adults.

PubMed

Howard, Siobhán; Creaven, Ann-Marie; Hughes, Brian M; O'Leary, Éanna D; James, Jack E

2017-04-01

The benefits of perceived social support for physical and psychological health are well-established. However, little research has explored associations between perceived social support and cardiovascular reactivity in older adults. This exploratory study recruited a sample of older adults (M age =69years, SD=5.62) and examined quality and quantity of perceived social support as predictors of cardiovascular reactivity to laboratory-based stress (N=39 participants) and ambulatory cardiovascular activity in everyday life (n=28). The results suggest that quality, but not quantity, of perceived social support predicts reduced blood pressure reactivity to stress in the laboratory. Although quality of support was not associated with ambulatory blood pressure, results suggest that quantity of daily social support may be associated with higher ambulatory heart rate, but not with social contact during measurement. This preliminary study extends prior work on social support and cardiovascular function to a group of older adults in both laboratory and field settings. Challenges for much-needed future research in this area are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

Carotid intima-media thickness and elastic properties of aortas in normotensive children of hypertensive parents.

PubMed

Yildirim, Ali; Kosger, Pelin; Ozdemir, Gokmen; Sahin, Fezan Mutlu; Ucar, Birsen; Kilic, Zubeyir

2015-09-01

A significant correlation between hypertension history and high blood pressure has been observed with regard to age, race and gender. Investigating carotid intima-media thickness and aortic stiffness prior to the development of hypertension in children of hypertensive parents enabled us to evaluate these patients for subclinical atherosclerosis. We compared carotid intima-media thickness, aortic strain, distensibility, stiffness indices and elastic modulus in 67 normotensive children whose parents had a diagnosis of essential hypertension and 39 normotensive children with no parental history of hypertension. Although there were no significant differences between the two groups in terms of systolic blood pressure, diastolic blood pressure, average blood pressure and pulse pressure (P>0.05), systolic blood pressures were higher among patients 15 years and older in the study group. No significant differences were noted between the control and study groups regarding interventricular septal thickness, left-ventricular posterior wall thickness, left-ventricular systolic and diastolic diameter and aortic annulus diameter (P>0.05). The left atrium diameter was larger in the study group compared with that in the control group, mainly because of the values of the 15-year-old and older children (P=0.01). The mean, maximum and minimum values of carotid intima-media thickness were significantly different in the study group compared with the control group among all age groups (P<0.001, P<0.001, P=0.006, respectively). Aortic systolic and diastolic diameters were larger in normotensive children of hypertensive parents compared with the control group (P=0.014, P=0.001, respectively). Although there were no differences between the study and control groups regarding aortic strain, aortic distensibility, elastic modulus and stiffness indices (P>0.05), aortic distensibility was lower, and aortic stiffness indices were higher among children 15 years and older in the study group. An increase in the carotid intima-media thickness in all age groups and a decrease in aortic elastic properties in 15-year-old and older children of hypertensive parents may indicate subclinical atherosclerosis in these apparently healthy children.

Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

PubMed Central

2012-01-01

Background Little is known about pressure from patients or relatives on physician’s decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using a questionnaire survey. Methods A sample of 918 Dutch GPs were invited to fill out a questionnaire about their last patient under continuous sedation. Cases in which GPs experienced pressure from the patient, relatives or other persons were compared to those without pressure. Results 399 of 918 invite GPs (43%) returned the questionnaire and 250 provided detailed information about their most recent case of continuous sedation. Forty-one GPs (16%) indicated to have experienced pressure from the patient, relatives or colleagues. In GPs younger than 50, guideline knowledge was not related to experienced pressure, whereas in older GPs, 15% with and 36% without guideline knowledge reported pressure. GPs experienced pressure more often when patients had psychological symptoms (compared to physical symptoms only) and when patients had a longer estimated life expectancy. A euthanasia request of the patient coincided with a higher prevalence of pressure for GPs without, but not for GPs with previous experience with euthanasia. GPs who experienced pressure had consulted a palliative consultation team more often than GPs who did not experience pressure. Conclusion One in six GPs felt pressure from patients or relatives to start sedation. This pressure was related to guideline knowledge, especially in older GPs, longer life expectancy and the presence of a euthanasia request, especially for GPs without previous experience of euthanasia. PMID:22759834

Development and validity of a new model for assessing pressure redistribution properties of support surfaces.

PubMed

Matsuo, Junko; Sugama, Junko; Sanada, Hiromi; Okuwa, Mayumi; Nakatani, Toshio; Konya, Chizuko; Sakamoto, Jirou

2011-05-01

Pressure ulcers are a common problem, especially in older patients. In Japan, most institutionalized older people are malnourished and show extreme bony prominence (EBP). EBP is a significant factor in the development of pressure ulcers due to increased interface pressure concentrated at the skin surface over the EBP. The use of support surfaces is recommended for the prophylaxis of pressure ulcers. However, the present equivocal criteria for evaluating the pressure redistribution of support surfaces are inadequate. Since pressure redistribution is influenced by physique and posture, evaluations using human subjects are limited. For this reason, models that can substitute for humans are necessary. We developed a new EBP model based on the anthropometric measurements, including pelvic inclination, of 100 bedridden elderly people. A comparison between the pressure distribution charts of our model and bedridden elderly subjects demonstrated that maximum contact pressure values, buttock contact pressure values, and bone prominence rates corresponded closely. This indicates that the model provides a good approximation of the features of elderly people with EBP. We subsequently examined the validity of the model through quantitative assessment of pressure redistribution functions consisting of immersion, envelopment, and contact area change. The model was able to detect differences in the hardness of urethane foam, differences in the internal pressure of an air mattress, and sequential changes during the pressure switching mode. These results demonstrate the validity of our new buttock model in evaluating pressure redistribution for a variety of surfaces. Copyright © 2010 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Perceived stress and change in cognitive function among adults 65 years and older.

PubMed

Aggarwal, Neelum T; Wilson, Robert S; Beck, Todd L; Rajan, Kumar B; Mendes de Leon, Carlos F; Evans, Denis A; Everson-Rose, Susan A

2014-01-01

Exposure to acute and chronic stress can affect learning and memory, but most evidence comes from animal studies or clinical observations. Almost no population-based studies have investigated the relation of stress to cognition or changes in cognition over time. We examined whether higher levels of perceived stress were associated with accelerated decline in cognitive function in older blacks and whites from a community-based population sample. Participants included 6207 black and white adults (65.7% black, 63.3% women) from the Chicago Health and Aging Project. Two to five in-home assessments were completed over an average of 6.8 years of follow-up and included sociodemographics, health behaviors, psychosocial measures, cognitive function tests, and health history. Perceived stress was measured by a six-item scale, and a composite measure of four tests of cognition was used to determine cognitive function at each assessment. Mixed-effects regression models showed that increasing levels of perceived stress were related to lower initial cognitive scores (B = -0.0379, standard error = 0.0025, p < .001) and a faster rate of cognitive decline (stress × time interaction: B = -0.0015, standard error = 0.0004, p < .001). Results were similar after adjusting for demographic variables, smoking, systolic blood pressure, body mass index, chronic medical conditions, and psychosocial factors and did not vary by race, sex, age, or education. Increasing levels of stress are independently associated with accelerated declines in cognitive function in black and white adults 65 years and older.

Reduced Cognitive-Motor Interference on Voluntary Balance Control in Older Tai Chi Practitioners.

PubMed

Varghese, Rini; Hui-Chan, Christina W Y; Bhatt, Tanvi

2016-01-01

Recent dual-task studies suggest that Tai Chi practitioners displayed better control of standing posture and maintained a quicker response time of postural muscle activation during a stepping down activity. Whether this effect extends to voluntary balance control, specifically the limits of excursion of the center of pressure, remains to be examined. The purpose of this study was to evaluate the cognitive-motor interference pattern by examining the effects of a concurrently performed cognitive task on attention of voluntary balance control in older adults who are long-term practitioners of Tai Chi. Ten older Tai Chi practitioners and 10 age-matched nonpractitioners performed a voluntary balance task that required them to shift their weight to reach a preset target in the forward and backward directions, with (single task, ST) and without (dual task, DT) a secondary cognitive task, which was the counting backward task. The counting backward task required the individual to compute and verbalize a series of arithmetic differences between a given pair of randomly generated numbers. The cognitive task was also performed independently (cognitive-ST). All trials were performed in a random order. Balance outcomes included reaction time, movement velocity, and maximal excursion of the center of pressure provided by the NeuroCom system. Cognitive outcome was the number of correct responses generated within the 8-second trial during the ST and DT conditions. Outcome variables were analyzed using a 2-factor, group by task, analysis of variance. DT costs for the variables were calculated as the relative difference between ST and DT conditions and were compared between the 2 groups using independent t tests. Tai Chi practitioners displayed shorter reaction times (P < .001) and faster movement velocities (P < .05) of their center of pressure than older nonpractitioners for both directions; however, no difference was found between the maximal excursions of the 2 groups. Cost analyses revealed that reaction time and cognitive costs were significantly lower in the Tai Chi practitioners for both forward and backward directions (P < .05); however, similar findings for movement velocity costs were significant only in the backward direction (P < .05). Our results suggest that Tai Chi practitioners expended fewer motor and cognitive resources than older nonpractitioners during a fairly complex (dynamic) postural equilibrium task while performing a verbal working memory task. They exhibited lesser cognitive-motor interference and thus better allocation of attentional resources toward the voluntary balance control task. Given that dynamic balance is a crucial prerequisite for walking and dual-tasking ability is considered to be a significant predictor of falls in older adults, our results might point at the possible long-term benefits of Tai Chi practice to counteract age-related decline in dual-tasking ability. Findings present preliminary data for further investigation, especially related to potential benefits in fall prevention.

Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people.

PubMed

Romero-Ortuno, Roman; Cogan, Lisa; Foran, Tim; Kenny, Rose Anne; Fan, Chie Wei

2011-04-01

To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypotension (OH) definitions: consensus (COH) and initial (IOH). Cross-sectional. Geriatric research clinic. Four hundred forty-two participants (mean age 72, 72% female) without dementia or risk factors for autonomic neuropathy. Active lying-to-standing test monitored using a continuous noninvasive BP monitor. For the morphological classification, four orthostatic systolic BP variables were extracted (delta (baseline - nadir) and maximum percentage of baseline recovered by 30 seconds and 1 and 2 minutes) using the 5-second averages method and entered in K-means cluster analysis (three clusters). Main outcomes were OI, falls (≥1 in past 6 months), and frailty (modified Fried criteria). The morphological clusters were small drop, fast overrecovery (n=112); medium drop, slow recovery (n=238); and large drop, nonrecovery (n=92). Their characterization revealed an increasing OI gradient (17.9%, 27.5%, and 44.6% respectively, P<.001) but no significant gradients in falls or frailty. The COH definition failed to reveal clinical differences between COH+ (n=416) and COH- (n=26) participants. The IOH definition resulted in a clinically meaningful separation between IOH+ (n=85) and IOH- (n=357) subgroups, as assessed according to OI (100% vs 11.5%, P<.001), falls (24.7% vs 10.4%, P<.001), and frailty (14.1% vs 5.4%, P=.005). It is recommended that the IOH definition be applied when taking continuous noninvasive orthostatic BP measurements in older people. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

Labor Market Status of Older Males in the United States, 1880–1940

PubMed Central

Lee, Chulhee

2009-01-01

This article explores the labor market status of older males in the early twentieth century, focusing on how the extent of pressure toward retirement differed across occupations and how it changed over time. A comparison of the probability of retirement across occupations shows that men who had better occupations in terms of economic status and work conditions were less likely to retire than were those with poorer jobs. The difficulty faced by older workers in the labor market, as measured by the relative incidence of long-term unemployment, was relatively severe among craftsmen, operatives, and salesmen. In contrast, aged farmers, professionals, managers, and proprietors appear to have fared well in the labor market. The pattern of shifts in the occupational structure that occurred between 1880 and 1940 suggests that industrialization had brought a growth of the sectors in which the pressure toward departure from employment at old ages was relatively strong. PMID:20234793

Effectiveness of olive oil for the prevention of pressure ulcers caused in immobilized patients within the scope of primary health care: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Pressure ulcers are considered an important issue, mainly affecting immobilized older patients. These pressure ulcers increase the care burden for the professional health service staff as well as pharmaceutical expenditure. There are a number of studies on the effectiveness of different products used for the prevention of pressure ulcers; however, most of these studies were carried out at a hospital level, basically using hyperoxygenated fatty acids (HOFA). There are no studies focused specifically on the use of olive-oil-based products and therefore this research is intended to find the most cost-effective treatment and achieve an alternative treatment. Methods/design The main objective is to assess the effectiveness of olive oil, comparing it with HOFA, to treat immobilized patients at home who are at risk of pressure ulcers. As a secondary objective, the cost-effectiveness balance of this new application with regard to the HOFA will be assessed. The study is designed as a noninferiority, triple-blinded, parallel, multi-center, randomized clinical trial. The scope of the study is the population attending primary health centers in Andalucía (Spain) in the regional areas of Malaga, Granada, Seville, and Cadiz. Immobilized patients at risk of pressure ulcers will be targeted. The target group will be treated by application of an olive-oil-based formula whereas the control group will be treated by application of HOFA to the control group. The follow-up period will be 16 weeks. The main variable will be the presence of pressure ulcers in the patient. Secondary variables include sociodemographic and clinical information, caregiver information, and whether technical support exists. Statistical analysis will include the Kolmogorov-Smirnov test, symmetry and kurtosis analysis, bivariate analysis using the Student’s t and chi-squared tests as well as the Wilcoxon and the Man-Whitney U tests, ANOVA and multivariate logistic regression analysis. Discussion The regular use of olive-oil-based formulas should be effective in preventing pressure ulcers in immobilized patients, thus leading to a more cost-effective product and an alternative treatment. Trial registration Clinicaltrials.gov identifier: NCT01595347. PMID:24152576

Effectiveness of olive oil for the prevention of pressure ulcers caused in immobilized patients within the scope of primary health care: study protocol for a randomized controlled trial.

PubMed

Lupiáñez-Pérez, Inmaculada; Morilla-Herrera, Juan Carlos; Ginel-Mendoza, Leovigildo; Martín-Santos, Francisco Javier; Navarro-Moya, Francisco Javier; Sepúlveda-Guerra, Rafaela Pilar; Vázquez-Cerdeiros, Rosa; Cuevas-Fernández-Gallego, Magdalena; Benítez-Serrano, Isabel María; Lupiáñez-Pérez, Yolanda; Morales-Asencio, José Miguel

2013-10-23

Pressure ulcers are considered an important issue, mainly affecting immobilized older patients. These pressure ulcers increase the care burden for the professional health service staff as well as pharmaceutical expenditure. There are a number of studies on the effectiveness of different products used for the prevention of pressure ulcers; however, most of these studies were carried out at a hospital level, basically using hyperoxygenated fatty acids (HOFA). There are no studies focused specifically on the use of olive-oil-based products and therefore this research is intended to find the most cost-effective treatment and achieve an alternative treatment. The main objective is to assess the effectiveness of olive oil, comparing it with HOFA, to treat immobilized patients at home who are at risk of pressure ulcers. As a secondary objective, the cost-effectiveness balance of this new application with regard to the HOFA will be assessed. The study is designed as a noninferiority, triple-blinded, parallel, multi-center, randomized clinical trial. The scope of the study is the population attending primary health centers in Andalucía (Spain) in the regional areas of Malaga, Granada, Seville, and Cadiz. Immobilized patients at risk of pressure ulcers will be targeted. The target group will be treated by application of an olive-oil-based formula whereas the control group will be treated by application of HOFA to the control group. The follow-up period will be 16 weeks. The main variable will be the presence of pressure ulcers in the patient. Secondary variables include sociodemographic and clinical information, caregiver information, and whether technical support exists. Statistical analysis will include the Kolmogorov-Smirnov test, symmetry and kurtosis analysis, bivariate analysis using the Student's t and chi-squared tests as well as the Wilcoxon and the Man-Whitney U tests, ANOVA and multivariate logistic regression analysis. The regular use of olive-oil-based formulas should be effective in preventing pressure ulcers in immobilized patients, thus leading to a more cost-effective product and an alternative treatment. Clinicaltrials.gov identifier: NCT01595347.

“Do it-yourself”: Home blood pressure as a predictor of traditional and everyday cognition in older adults

PubMed Central

Yeung, Sophie E.

2017-01-01

Background Hypertension guidelines recommend home blood pressure (HBP) monitoring in adjunct to office blood pressure (OBP) for its greater reproducibility and prognostic utility in the prevention of cardiovascular outcomes, especially stroke. To date, the relationship between HBP and cognitive function remains unexplored. Methods We examined HBP as a cognitive predictor in a multi-ethnic group of community-dwelling adults aged 60 and over (N = 133) using neuropsychological measures and analyzed the data using multiple regression analyses. We also employed “everyday cognition” measures that have been found to have higher prognostic utility for real-world functioning than traditional cognitive tasks. Results Good to perfect HBP monitoring compliance over seven days was achieved by 88.7% of the participants with superior reliability (ICC≥.96) to office readings. Higher home systolic BP and pulse pressure predicted worse processing speed, executive function, and everyday cognitive function, whereas lower home diastolic BP predicted worse everyday cognition. Office readings were similarly associated with everyday cognitive function but with no other cognitive measures. Conclusion Our findings are the first to validate HBP as a predictor of neuropsychological function in older adults beyond cognitive screening. Differential relationships among blood pressure variables and specific cognitive domains were observed. With proper standardization and training, we demonstrated that HBP can be obtained in a multi-ethnic community-dwelling older adult cohort. Our findings emphasize the importance of employing blood pressure and cognitive measures that are adequately sensitive to detect vascular-related cognitive impairment in a relatively healthy population. Implications regarding proper HBP measurement for hypertension management, cognitive health, and everyday function are discussed. PMID:28520751

Hyperthermia and cardiovascular strain during an extreme heat exposure in young versus older adults

PubMed Central

Kenny, Glen P.; Poirier, Martin P.; Metsios, George S.; Boulay, Pierre; Dervis, Sheila; Friesen, Brian J.; Malcolm, Janine; Sigal, Ronald J.; Seely, Andrew J. E.; Flouris, Andreas D.

2017-01-01

ABSTRACT We examined whether older individuals experience greater levels of hyperthermia and cardiovascular strain during an extreme heat exposure compared to young adults. During a 3-hour extreme heat exposure (44°C, 30% relative humidity), we compared body heat storage, core temperature (rectal, visceral) and cardiovascular (heart rate, cardiac output, mean arterial pressure, limb blood flow) responses of young adults (n = 30, 19–28 years) against those of older adults (n = 30, 55–73 years). Direct calorimetry measured whole-body evaporative and dry heat exchange. Body heat storage was calculated as the temporal summation of heat production (indirect calorimetry) and whole-body heat loss (direct calorimetry) over the exposure period. While both groups gained a similar amount of heat in the first hour, the older adults showed an attenuated increase in evaporative heat loss (p < 0.033) in the first 30-min. Thereafter, the older adults were unable to compensate for a greater rate of heat gain (11 ± 1 ; p < 0.05) with a corresponding increase in evaporative heat loss. Older adults stored more heat (358 ± 173 kJ) relative to their younger (202 ± 92 kJ; p < 0.001) counterparts at the end of the exposure leading to greater elevations in rectal (p = 0.043) and visceral (p = 0.05) temperatures, albeit not clinically significant (rise < 0.5°C). Older adults experienced a reduction in calf blood flow (p < 0.01) with heat stress, yet no differences in cardiac output, blood pressure or heart rate. We conclude, in healthy habitually active individuals, despite no clinically observable cardiovascular or temperature changes, older adults experience greater heat gain and decreased limb perfusion in response to 3-hour heat exposure. PMID:28349096

Controlled aerobic exercise training reduces resting blood pressure in sedentary older adults.

PubMed

Huang, Guoyuan; Shi, Xiangrong; Gibson, Cheryl A; Huang, Sunny C; Coudret, Nadine A; Ehlman, Mary C

2013-12-01

The results of existing controlled clinical trials were synthesized to determine effects of aerobic exercise training on resting systolic (SBP) and diastolic blood pressure (DBP) among previously sedentary older adults, to quantify the magnitude of observed changes, and to examine the influence of the associated interventional variables on these changes. Studies were identified via a systematic computer database search, hand searching, and cross-referencing of previously located articles. All potentially eligible articles were carefully reviewed and examined with the established inclusion criteria. Twenty-three studies, representing a total of 1226 older subjects, were included in the final analysis. Robust statistically significant effects were found in terms of the pooled standardized effect size of - 0.33 ± 0.06 (p < 0.0001) in SBP and - 0.39 ± 0.09 (p < 0.0001) in DBP. When compared with the control group, net decreases in both SBP (- 5.39 ± 1.21 mmHg, p < 0.0001) and DBP (-3.68 ± 0.83 mmHg, p < 0.0001) were observed in older exercisers, representing a 3.9% and a 4.5% reduction, respectively. This meta-analytic study provides robust quantitative data to support the efficacy and effectiveness of controlled endurance exercise training in decreasing resting SBP and DBP among previously sedentary older adults.

Implementing Low-Cost, Community-Based Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes: What Are the Benefits for Glycemic Control and Cardiovascular Risk?

PubMed

Mendes, Romeu; Sousa, Nelson; Reis, Victor Machado; Themudo-Barata, Jose Luis

2017-09-13

The purpose of this study was to analyze the effects of a long-term, community-based, combined exercise program developed with low-cost exercise strategies on glycemic control and cardiovascular risk factors in middle-aged and older patients with type 2 diabetes. Participants ( n = 124; 63.25 ± 7.20 years old) engaged in either a 9-month supervised exercise program ( n = 39; consisting of combined aerobic, resistance, agility/balance, and flexibility exercise; three sessions per week; 70 min per session) or a control group ( n = 85) who maintained their usual care. Glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease were assessed before and after the 9-month intervention. A significant time * group interaction effect ( p < 0.001) was identified in the values of the glycated hemoglobin, fasting plasma glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, and the 10-year risk of coronary artery disease. A long-term, community-based, combined exercise program developed with low-cost exercise strategies was effective in inducing significant benefits on glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease in middle-aged and older patients with type 2 diabetes. Clinical Trial Identification Number: ISRCTN09240628.

[Blood pressure targets : The lower the better does not suit all].

PubMed

Hoffmann, U

2018-04-01

The systolic blood pressure intervention trial (SPRINT) published in 2015 has opened up new discussions on whether a lower blood pressure target as recommended by the current guidelines would be better for some patient groups. To review patient groups in which lower blood pressure targets would not be better. The results of SPRINT, its post-hoc and subgroup analyses, other studies and newer studies, as well as metaanalyses on the topic of blood pressure targets are reviewed and discussed. Studies with patients excluded from the SPRINT study were also analysed. The current international guidelines and recommendations of the Deutsche Hochdruckliga e. V. DHL® are included. Blood pressure monitoring methods differed considerably in the previously published studies. The low blood pressure value in SPRINT was mainly achieved due to the unusual method of blood pressure monitoring used and, as such, cannot be compared with blood pressure values in other studies. Based on current evidence, "the lower the better" should not be recommended in the following patient groups: older patients, in particular infirm older patients, patients with diabetes, patients without coronary heart disease or with low cardiovascular risk. When determining a blood pressure target, the method of blood pressure monitoring should be defined. A lower blood pressure target has been shown to be better in some well defined patient groups. However, adverse events due to antihypertensive medications should always be taken into account. Given the multiple exclusion criteria in trials and the results of many studies, "new" lower blood pressure targets could not be recommended in a large population of patients.

DYNAPENIA AND METABOLIC HEALTH IN OBESE AND NON-OBESE OLDER ADULTS AGED 70 YEARS AND OLDER: THE LIFE STUDY

PubMed Central

Anton, S; Beavers, DP; Manini, TM; Fielding, R; Newman, A; Church, T; Kritchevsky, SB; Conroy, D; McDermott, MM; Botoseneanu, A; Hauser, ME; Pahor, M

2016-01-01

Objective The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and non-obese older adults. Methods A total of 1453 men and women (age ≥ 70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) non-dynapenic/non-obese (NDYN-NO), (2) dynapenic/non-obese (DYN-NO), (3) non-dynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (FNIH criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least three metabolic syndrome (MetS) criteria and other chronic conditions. Results A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared to DYN-NO groups (55.6 vs 45.1%, p ≤ 0.01) was observed. Waist circumference was also significantly higher in obese groups (DYN-O=114.0±12.9 and NDYN-O=111.2±13.1) than in non-obese (NDYN-NO=93.1±10.7 and DYN-NO=92.2±11.2, p ≤ 0.01); and higher in NDYN-O compared to DYN-O (p = 0.008). Additionally, NDYN-O demonstrated higher diastolic blood pressure compared to DYN-O (70.9±10.1 vs 67.7±9.7, p ≤ 0.001). No significant differences were found across dynapenia and obesity status for all other metabolic components (p>0.05). The odds of having metabolic syndrome or its individual components were similar in obese and non-obese, combined or not with dynapenia (non-significant OR [95%CI]). Conclusion Non-obese dynapenic older adults had fewer metabolic disease risk factors than non-obese and non-dynapenic older adults. Moreover, among obese older adults, dynapenia was associated with lower risk of meeting metabolic syndrome criteria for waist circumference and diastolic blood pressure. Additionally, the presence of dynapenia did not increase cardiometabolic disease risk in either obese or non-obese older adults. PMID:27914851

Factors Associated with the Risk of Falls of Nursing Home Residents Aged 80 or Older.

PubMed

Álvarez Barbosa, Francisco; Del Pozo-Cruz, Borja; Del Pozo-Cruz, Jesús; Alfonso-Rosa, Rosa M; Sañudo Corrales, Borja; Rogers, Michael E

2016-01-01

Falls are the leading cause of mortality and morbidity in older and represents one of the major and most costly public health problems worldwide. Evaluate the influences of lower limb muscle performance, static balance, functional independence and quality of life on fall risk as assessed with the timed up and go (TUG) test. Cross-sectional study. Fifty-two residents aged 80 or older were assessed and distributed in one of the two study groups (no risk of falls; risk of falls) according to the time to complete the TUG test. A Kistler force platform and linear transducer was used to determinate lower limb muscle performance. Postural Stability (static balance) was measured by recording the center of pressure. The EuroQol-5 dimension was used to assess Health-related quality of life and the Barthel index was used to examine functional status. Student's t-test was performed to evaluate the differences between groups. Correlations between variables were analyzed using Spearman or Pearson coefficient. ROC (receiver operating charasteristic) analysis was used to determine the cut-off points related to a decrease in the risk of a fall. Participants of no-fall risk group showed better lower limb performance, quality of life, and functional status. Cut-off points were determined for each outcome. Risk of falls in nursing home residents over the age of 80 is associated with lower limb muscle performance, functional status, and quality of Life. Cut-off points can be used by clinicians when working toward fall prevention and could help in determining the optimal lower limb muscle performance level for preventing falls. © 2015 Association of Rehabilitation Nurses.

Calculations of mechanisms for balance control during narrow and single-leg standing in fit older adults: A reliability study.

PubMed

Aberg, A C; Thorstensson, A; Tarassova, O; Halvorsen, K

2011-07-01

For older people balance control in standing is critical for performance of activities of daily living without falling. The aims were to investigate reliability of quantification of the usage of the two balance mechanisms M(1) 'moving the centre of pressure' and M(2) 'segment acceleration' and also to compare calculation methods based on a combination of kinetic (K) and kinematic (Km) data, (K-Km), or Km data only concerning M(2). For this purpose nine physically fit persons aged 70-78 years were tested in narrow and single-leg standing. Data were collected by a 7-camera motion capture system and two force plates. Repeated measure ANOVA and Tukey's post hoc tests were used to detect differences between the standing tasks. Reliability was estimated by ICCs, standard error of measurement including its 95% CI, and minimal detectable change, whereas Pearson's correlation coefficient was used to investigate agreement between the two calculation methods. The results indicated that for the tasks investigated, M(1) and M(2) can be measured with acceptable inter- and intrasession reliability, and that both Km and K-Km based calculations may be useful for M(2), although Km data may give slightly lower values. The proportional M(1):M(2) usage was approximately 9:1, in both anterio-posterior (AP) and medio-lateral (ML) directions for narrow standing, and about 2:1 in the AP and of 1:2 in the ML direction in single-leg standing, respectively. In conclusion, the tested measurements and calculations appear to constitute a reliable way of quantifying one important aspect of balance capacity in fit older people. Copyright © 2011 Elsevier B.V. All rights reserved.

Remote Health Monitoring for Older Adults and Those with Heart Failure: Adherence and System Usability.

PubMed

Evans, Jarrett; Papadopoulos, Amy; Silvers, Christine Tsien; Charness, Neil; Boot, Walter R; Schlachta-Fairchild, Loretta; Crump, Cindy; Martinez, Michele; Ent, Carrie Beth

2016-06-01

Remote health monitoring technology has been suggested as part of an early intervention and prevention care model. Older adults with a chronic health condition have been shown to benefit from remote monitoring but often have challenges with complex technology. The current study reports on the usability of and adherence with an integrated, real-time monitoring system over an extended period of time by older adults with and without a chronic health condition. Older adults 55 years of age and over with and without heart failure participated in a study in which a telehealth system was used for 6 months each. The system consisted of a wireless wristwatch-based monitoring device that continuously collected temperature and motion data. Other health information was collected daily using a weight scale, blood pressure cuff, and tablet that participants used for health surveys. Data were automatically analyzed and summarized by the system and presented to study nurses. Forty-one older adults participated. Seventy-one percent of surveys, 75% of blood pressure readings, and 81% of daily weight measurements were taken. Participants wore the watch monitor 77% of the overall 24/7 time requested. The weight scale had the highest usability rating in both groups. The groups did not otherwise differ on device usage. The findings indicate that a health monitoring system designed for older adults can and will be used for an extended period of time and may help older adults with chronic conditions reside longer in their own homes in partnership with the healthcare system.

Directly measured cabin pressure conditions during Boeing 747-400 commercial aircraft flights.

PubMed

Kelly, Paul T; Seccombe, Leigh M; Rogers, Peter G; Peters, Matthew J

2007-07-01

In the low pressure environment of commercial aircraft, hypoxaemia may be common and accentuated in patients with lung or heart disease. Regulations specify a cabin pressure not lower than 750 hPa but it is not known whether this standard is met. This knowledge is important in determining the hazards of commercial flight for patients and the validity of current flight simulation tests. Using a wrist-watch recording altimeter, cabin pressure was recorded at 60 s intervals on 45 flights in Boeing 747-400 aircraft with three airlines. A log was kept of aircraft altitude using the in-flight display. Change in cabin pressure during flight, relationship between aircraft altitude and cabin pressure and proportion of flight time with cabin pressure approaching the minimum specified by regulation were determined. Flight duration averaged 10 h. Average cabin pressure during flight was 846 hPa. There was a linear fall in cabin pressure as the aircraft cruising altitude increased. At 10,300 m (34,000 ft) cabin pressure was 843 hPa and changed 8 hPa for every 300 m (1000 ft) change in aircraft altitude (r(2) = 0.993; P < 0.001). Lowest cabin pressure was 792 hPa at 12 200 m (40,000 ft) but during only 2% of flight time was cabin pressure less than 800 hPa. Cabin pressure is determined only by the engineering of the aircraft and its altitude and in the present study was always higher than required by regulation. Current fitness-to-fly evaluations simulate cabin conditions that passengers will not experience on these aircraft. There may be increased risks to patients should new or older aircraft operate nearer to the present minimum standard.

Blood pressure and falls in community-dwelling people aged 60 years and older in the VHM&PP cohort.

PubMed

Klein, Diana; Nagel, Gabriele; Kleiner, Andrea; Ulmer, Hanno; Rehberger, Barbara; Concin, Hans; Rapp, Kilian

2013-05-21

Falls are one of the major health problems in old people. Different risk factors were identified but only few epidemiological studies analysed the influence of conventionally measured blood pressure on falls. The objective of our study was to investigate the relationship between systolic and diastolic blood pressure and falls. In 3,544 community-dwelling Austrian women and men aged 60 years and older, data on falls within the previous three months were collected by questionnaire. Blood pressure was measured by general practitioners within the Vorarlberg Health Monitoring and Prevention Programme (VHM&PP) 90 to 1095 days before the fall assessment. A multiple logistic regression analysis was conducted. The models were stratified by gender and adjusted by age, number of medical conditions and subjective feeling of illness. In total, 257 falls in 3,544 persons were reported. In women, high systolic and diastolic blood pressure was associated with a decreased risk of falls. An increase of systolic blood pressure by 10 mmHg and of diastolic blood pressure by 5 mmHg reduced the risk of falling by 9% (OR 0.91, 95% Cl 0.84-0.98) and 8% (OR 0.92, 95% Cl 0.85-0.99), respectively. In men, an increased risk of falls was observed in participants with low systolic or low diastolic blood pressure. Blood pressure was associated with the risk of falls. Hypertensive values decreased the risk in women and low blood pressure increased the risk in men.

[Features of arterial blood pressure in elderly persons of different ethnic groups in Yakutsk].

PubMed

Nikitin, Iu P; Tatarinova, O V; Neustroeva, V N; Shcherbakova, L V; Sidorov, A S

2013-01-01

The differences in arterial blood pressure in the sample of population in the age of 60 and older of different ethnic groups in Yakutsk, as well as its connection with the other cardiovascular diseases risk factors have been analyzed. It was shown that the average values of systolic and diastolic blood pressure in subsample of the Yakuts appeared to be lower than in Caucasoid gerontic persons. The average values of systolic arterial blood pressure both in the Yakuts and in the Caucasoids were detected higher than normal values in all age-dependent subgroups. The average values of diastolic blood pressure in both ethnic groups were within the limits of high normal level. From 60 to 90 years and older the decrease in systolic and diastolic arterial blood pressure was detected; it was more marked in Caucasoid gerontic persons. The average values of pulse pressure in the Yakuts and in the Caucasoids appeared to be higher than the existing standard and didn't have any differences in ethnic groups. In both ethnical subsamples, pulse pressure values increase was observed in persons of 60-89 years old and its decrease after 90. Persons with overweight, obesity, central (abdominal) obesity, dyslypoproteidemias irrespective of belonging to ethnical group were characterized as having higher levels of arterial blood pressure. Statistically significant differences in the levels of arterial blood pressure in the Yakuts and in the Caucasoids depending on hyperglycemia, smoking, the presence of burdened anamnesis, educational level, marital status was not detected.

Lower Neurocognitive Function in U-2 Pilots: Relationship to White Matter Hyperintensities

DTIC Science & Technology

2014-07-09

dysfunction and cognition in older adults with heart failure. Cogn Behav Neurol 2008;21:65–72. 14. Gunstad J, Keary TA, Spitznagel MB, et al. Blood...pressure and cognitive function in older adults with cardiovascular disease. Int J Neurosci 2009;119:2228–2242. 15. Kantarci K, Weigand SD, Przybelski SA, et

Age-Related and Individual Differences in the Use of Prediction during Language Comprehension

ERIC Educational Resources Information Center

Federmeier, Kara D.; Kutas, Marta; Schul, Rina

2010-01-01

During sentence comprehension, older adults are less likely than younger adults to predict features of likely upcoming words. A pair of experiments assessed whether such differences would extend to tasks with reduced working memory demands and time pressures. In Experiment 1, event-related brain potentials were measured as younger and older adults…

Relationships between coronary heart disease risk factors and serum ionized calcium in Kennedy Space Center Cohort

NASA Technical Reports Server (NTRS)

Goodwin, Lisa Ann; Frey, Mary Anne Bassett; Merz, Marion P.; Alford, William R.

1987-01-01

Kennedy Space Center (KSC) employees are reported to be at high risk for coronary heart disease (CHD). Risk factors for CHD include high serum total cholesterol levels, low levels of high-density lipoprotein cholesterol (HDLC), elevated triglyceride, smoking, inactivity, high blood pressure, being male, and being older. Higher dietary and/or serum calcium Ca(++) may be related to a lower risk for CHD. Fifty men and 37 women participated. Subjects were tested in the morning after fasting 12 hours. Information relative to smoking and exercise habits was obtained; seated blood pressures were measured; and blood drawn. KCS men had higher risk values than KCS women as related to HDLC, triglycerides, systolic blood pressure, and diastolic blood pressure. Smoking and nonsmoking groups did not differ for other risk factors or for serum Ca(++) levels. Exercise and sedentary groups differed in total cholesterol and triglyceride levels. Serum Ca(++) levels were related to age, increasing with age in the sedentary group and decreasing in the exercisers, equally for men and women. It is concluded that these relationships may be significant to the risk of CHD and/or the risk of bone demineralization in an aging population.

Job Strain, Workplace Discrimination, and Hypertension among Older Workers: The Health and Retirement Study.

PubMed

Mezuk, Briana; Kershaw, Kiarri N; Hudson, Darrell; Lim, Kyuang Ah; Ratliff, Scott

2011-03-01

Job strain has been associated with hypertension among younger workers; however, whether this relationship persists among older workers, particularly older racial/ethnic minorities, is unresolved. This study evaluated whether job strain and workplace discrimination are associated with hypertension and poor blood pressure control among older workers and whether these relationships vary by gender and race/ethnicity. Data were drawn from the Health and Retirement Study, and analysis was restricted to employed participants with complete information on job strain and blood pressure (N = 3,794). In adjusted models, high job strain was associated with lower likelihood of hypertension (odds ratio (OR): 0.75, 95% confidence interval (CI): 0.63, 0.89) relative to low job strain. Stratified analyses indicated this association was only significant among white (OR: 0.71, 95% CI: 0.58, 0.86) and male (OR: 0.61, 95% CI: 0.47, 0.79) workers. High job strain was not significantly associated with hypertension among African American (OR: 1.14, 95% CI: 0.63, 2.07) or Hispanic (OR: 0.56, 95% CI: 0.29, 1.09) workers. Workplace discrimination was not associated with hypertension among any group. Neither job strain nor discrimination was associated with poor blood pressure control. These findings suggest that persistence in work characterized by high job strain in later life may signal resilience to the influence of work-related stressors on health. Future research efforts should examine the factors that contribute to gender and racial differences in these relationships.

Job Strain, Workplace Discrimination, and Hypertension among Older Workers: The Health and Retirement Study

PubMed Central

Kershaw, Kiarri N.; Hudson, Darrell; Lim, Kyuang Ah; Ratliff, Scott

2011-01-01

Job strain has been associated with hypertension among younger workers; however, whether this relationship persists among older workers, particularly older racial/ethnic minorities, is unresolved. This study evaluated whether job strain and workplace discrimination are associated with hypertension and poor blood pressure control among older workers and whether these relationships vary by gender and race/ethnicity. Data were drawn from the Health and Retirement Study, and analysis was restricted to employed participants with complete information on job strain and blood pressure (N = 3,794). In adjusted models, high job strain was associated with lower likelihood of hypertension (odds ratio (OR): 0.75, 95% confidence interval (CI): 0.63, 0.89) relative to low job strain. Stratified analyses indicated this association was only significant among white (OR: 0.71, 95% CI: 0.58, 0.86) and male (OR: 0.61, 95% CI: 0.47, 0.79) workers. High job strain was not significantly associated with hypertension among African American (OR: 1.14, 95% CI: 0.63, 2.07) or Hispanic (OR: 0.56, 95% CI: 0.29, 1.09) workers. Workplace discrimination was not associated with hypertension among any group. Neither job strain nor discrimination was associated with poor blood pressure control. These findings suggest that persistence in work characterized by high job strain in later life may signal resilience to the influence of work-related stressors on health. Future research efforts should examine the factors that contribute to gender and racial differences in these relationships. PMID:22096475

Blood Pressure Variability and Cognitive Function Among Older African Americans: Introducing a New Blood Pressure Variability Measure.

PubMed

Tsang, Siny; Sperling, Scott A; Park, Moon Ho; Helenius, Ira M; Williams, Ishan C; Manning, Carol

2017-09-01

Although blood pressure (BP) variability has been reported to be associated with cognitive impairment, whether this relationship affects African Americans has been unclear. We sought correlations between systolic and diastolic BP variability and cognitive function in community-dwelling older African Americans, and introduced a new BP variability measure that can be applied to BP data collected in clinical practice. We assessed cognitive function in 94 cognitively normal older African Americans using the Mini-Mental State Examination (MMSE) and the Computer Assessment of Mild Cognitive Impairment (CAMCI). We used BP measurements taken at the patients' three most recent primary care clinic visits to generate three traditional BP variability indices, range, standard deviation, and coefficient of variation, plus a new index, random slope, which accounts for unequal BP measurement intervals within and across patients. MMSE scores did not correlate with any of the BP variability indices. Patients with greater diastolic BP variability were less accurate on the CAMCI verbal memory and incidental memory tasks. Results were similar across the four BP variability indices. In a sample of cognitively intact older African American adults, BP variability did not correlate with global cognitive function, as measured by the MMSE. However, higher diastolic BP variability correlated with poorer verbal and incidental memory. By accounting for differences in BP measurement intervals, our new BP variability index may help alert primary care physicians to patients at particular risk for cognitive decline.

Hemoglobin A1c levels and aortic arterial stiffness: the Cardiometabolic Risk in Chinese (CRC) study.

PubMed

Liang, Jun; Zhou, Na; Teng, Fei; Zou, Caiyan; Xue, Ying; Yang, Manqing; Song, Huaidong; Qi, Lu

2012-01-01

The American Diabetes Association (ADA) recently published new clinical guidelines in which hemoglobin A1c (HbA1c) was recommended as a diagnostic test for diabetes. The present study was to investigate the association between HbA1c and cardiovascular risk, and compare the associations with fasting glucose and 2-hour oral glucose tolerance test (2 h OGTT). The study samples are from a community-based health examination survey in central China. Carotid-to-femoral pulse wave velocity (cfPWV) and HbA1c were measured in 5,098 men and women. After adjustment for age, sex, and BMI, the levels of HbA1c were significantly associated with an increasing trend of cfPWV in a dose-dependent fashion (P for trend <0.0001). The associations remained significant after further adjustment for blood pressure, heart rate, and lipids (P = 0.004), and the difference in cfPWV between the highest and the lowest quintiles of HbA1c was 0.31 m/s. Fasting glucose and 2 h OGTT were not associated with cfPWV in the multivariate analyses. HbA1c showed additive effects with fasting glucose or 2 h OGTT on cfPWV. In addition, age and blood pressure significantly modified the associations between HbA1c and cfPWV (P for interactions <0.0001 for age; and  = 0.019 for blood pressure). The associations were stronger in subjects who were older (≥60 y; P for trend = 0.004) and had higher blood pressure (≥120 [systolic blood pressure]/80 mmHg [diastolic blood pressure]; P for trend = 0.028) than those who were younger and had lower blood pressure (P for trend >0.05). HbA1c was related to high cfPWV, independent of conventional cardiovascular risk factors. Senior age and high blood pressure might amplify the adverse effects of HbA1c on cardiovascular risk.

Cross-sectional and longitudinal associations of systolic blood pressure with quality of life and depressive mood in older adults with cardiovascular risk factors: Results from the observational DIAST-CHF study.

PubMed

Herrmann-Lingen, Christoph; Meyer, Thomas; Bosbach, Alexandra; Chavanon, Mira L; Hassoun, Lina; Edelmann, Frank; Wachter, Rolf

2018-04-27

While diagnosed arterial hypertension and antihypertensive medication usually have an adverse impact on quality of life, recent studies suggest that actual blood pressure may be positively related to better well-being. However, data in older patients with cardiovascular risk factors are lacking, for whom such an association may be of particular relevance. In 1,300 study participants with cardiovascular risk factors aged 50-85 years (51.5% men, mean age 65.7 ± 8.2 years) participating in an observational study, we performed standardized measurements of blood pressure and assessed quality of life and depressive symptoms at baseline and 1-year follow-up using the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Bivariate analysis demonstrated that systolic blood pressure was associated with higher SF-36 mental component summary scores (r=0.100, p<0.001), and reduced HADS depression (r=-0.082; p=0.003). Multivariate regression models adjusting for age, sex and disease severity confirmed that higher systolic blood pressure significantly predicted both better mental quality of life (β=0.070, p=0.012) and less depressive mood (β=-0.083, p=0.003) at baseline, independently of antihypertensive medication and diagnosed hypertension. Moreover, the beneficial effects of baseline systolic blood pressure remained stable for both summary components of the SF-36 as well as HADS depression at 1-year follow up. All results remained unchanged, when limiting the analyses to the 1,072 patients with diagnosed hypertension. In older adults with cardiovascular risk factors, higher systolic blood pressure readings are independently related to better quality of life and fewer depressive symptoms in both cross-sectional and longitudinal settings, although the magnitude of the effect sizes is typically small.

Prevalence of pressure ulcer and associated risk factors in middle- and older-aged medical inpatients in Norway.

PubMed

Børsting, Tove E; Tvedt, Christine R; Skogestad, Ingrid J; Granheim, Tove I; Gay, Caryl L; Lerdal, Anners

2018-02-01

To describe the prevalence of pressure ulcers among middle- and older-aged patients in a general medical hospital in Norway and to describe the associations between pressure ulcers and potential risk factors additional to the Braden risk score. Degrees of mobility, activity, perfusion and skin status are risk factors for development of pressure ulcer. Nurses' clinical judgements combined with risk assessment tools are effective to detect pressure ulcer risk. Cross-sectional study. The study was performed as part of a research project conducted between September 2012-May 2014 in a general hospital in the capital of Norway. Registered nurses and nursing students collected data from all eligible patients on 10 days during the students' clinical practice studies. The Braden scale was used to measure pressure ulcer risk, and skin examinations were performed to classify the skin area as normal or as indicative of pressure ulcer according to the definitions by the National Pressure Ulcer Advisory Panel. Comorbidities were collected by patient's self-report. This analysis focused on the 255 inpatients at the medical wards ≥52 years of age, most of whom had more than one comorbidity. The prevalence of pressure ulcers was 14.9% in this sample. Higher age, underweight, diabetes and worse Braden scores were factors associated with pressure ulcer, and pressure ulcer was most frequently sited at the sacrum or heel. Adding age, weight and diabetes status to pressure ulcer risk assessment scales may improve identification of patients at risk for pressure ulcers. Knowledge about strengths and limitations of risk assessment tools is important for clinical practice. Age, weight and diabetes status should be considered for inclusion in risk assessment tools for pressure ulcers in medical wards. © 2017 John Wiley & Sons Ltd.

Test-retest reliability of sensor-based sit-to-stand measures in young and older adults.

PubMed

Regterschot, G Ruben H; Zhang, Wei; Baldus, Heribert; Stevens, Martin; Zijlstra, Wiebren

2014-01-01

This study investigated test-retest reliability of sensor-based sit-to-stand (STS) peak power and other STS measures in young and older adults. In addition, test-retest reliability of the sensor method was compared to test-retest reliability of the Timed Up and Go Test (TUGT) and Five-Times-Sit-to-Stand Test (FTSST) in older adults. Ten healthy young female adults (20-23 years) and 31 older adults (21 females; 73-94 years) participated in two assessment sessions separated by 3-8 days. Vertical peak power was assessed during three (young adults) and five (older adults) normal and fast STS trials with a hybrid motion sensor worn on the hip. Older adults also performed the FTSST and TUGT. The average sensor-based STS peak power of the normal STS trials and the average sensor-based STS peak power of the fast STS trials showed excellent test-retest reliability in young adults (intra-class correlation (ICC)≥0.90; zero in 95% confidence interval of mean difference between test and retest (95%CI of D); standard error of measurement (SEM)≤6.7% of mean peak power) and older adults (ICC≥0.91; zero in 95%CI of D; SEM≤9.9%). Test-retest reliability of sensor-based STS peak power and TUGT (ICC=0.98; zero in 95%CI of D; SEM=8.5%) was comparable in older adults, test-retest reliability of the FTSST was lower (ICC=0.73; zero outside 95%CI of D; SEM=14.4%). Sensor-based STS peak power demonstrated excellent test-retest reliability and may therefore be useful for clinical assessment of functional status and fall risk. Copyright © 2014 Elsevier B.V. All rights reserved.

Effect of Multicomponent Training on Blood Pressure, Nitric Oxide, Redox Status, and Physical Fitness in Older Adult Women: Influence of Endothelial Nitric Oxide Synthase (NOS3) Haplotypes

PubMed Central

Lizzi, Elisangela Aparecida da Silva; Gonçalves, Thiago Correa Porto; Rodrigues, Jhennyfer Aline Lima; Tavares, Simone Sakagute; Lacchini, Riccardo; Pinheiro, Lucas Cezar; Ferreira, Graziele Cristina; Jacomini, André Mourão; Bueno Júnior, Carlos Roberto

2017-01-01

The purpose of this study was to verify the influence of the genotype or haplotype (interaction) of the NOS3 polymorphisms [-786T>C, 894G>T (Glu298Asp), and intron 4b/a] on the response to multicomponent training (various capacities and motor skills) on blood pressure (BP), nitrite concentration, redox status, and physical fitness in older adult women. The sample consisted of 52 participants, who underwent body mass index and BP assessments. Physical fitness was evaluated by six-minute walk, elbow flexion, and sit and stand up tests. Plasma/blood samples were used to evaluate redox status, nitrite concentration, and genotyping. Associations were observed between isolated polymorphisms and the response of decreased systolic and diastolic BP and increased nitrite concentration and antioxidant activity. In the haplotype analysis, the group composed of ancestral alleles (H1) was the only one to present improvement in all variables studied (decrease in systolic and diastolic BP, improvement in nitrite concentration, redox status, and physical fitness), while the group composed of variant alleles (H8) only demonstrated improvement in some variables of redox status and physical fitness. These findings suggest that NOS3 polymorphisms and physical training are important interacting variables to consider in evaluating redox status, nitric oxide availability and production, and BP control. PMID:29104725

Validity and Reliability of a Portable Balance Tracking System, BTrackS, in Older Adults.

PubMed

Levy, Susan S; Thralls, Katie J; Kviatkovsky, Shiloah A

Falls are the leading cause of disability, injury, hospital admission, and injury-related death among older adults. Balance limitations have consistently been identified as predictors of falls and increased fall risk. Field measures of balance are limited by issues of subjectivity, ceiling effects, and low sensitivity to change. The gold standard for measuring balance is the force plate; however, its field use is untenable due to high cost and lack of portability. Thus, a critical need is observed for valid objective field measures of balance to accurately assess balance and identify limitations over time. The purpose of this study was to examine the concurrent validity and 3-day test-retest reliability of Balance Tracking System (BTrackS) in community-dwelling older adults. Minimal detectable change values were also calculated to reflect changes in balance beyond measurement error. Postural sway data were collected from community-dwelling older adults (N = 49, mean [SD] age = 71.3 [7.3] years) with a force plate and BTrackS in multitrial eyes open (EO) and eyes closed (EC) static balance conditions. Force sensors transmitted BTrackS data via a USB to a computer running custom software. Three approaches to concurrent validity were taken including calculation of Pearson product moment correlation coefficients, repeated-measures ANOVAs, and Bland-Altman plots. Three-day test-retest reliability of BTrackS was examined in a second sample of 47 community-dwelling older adults (mean [SD] age = 75.8 [7.7] years) using intraclass correlation coefficients and MDC values at 95% CI (MDC95) were calculated. BTrackS demonstrated good validity using Pearson product moment correlations (r > 0.90). Repeated-measures ANOVA and Bland-Altman plots indicated some BTrackS bias with center of pressure (COP) values higher than FP COP values in the EO (mean [SD] bias = 4.0 [6.8]) and EC (mean [SD] bias = 9.6 [12.3]) conditions. Test-retest reliability using intraclass correlation coefficients (ICC2.1 was excellent (0.83) and calculated MDC95 for EO (9.6 cm) and EC (19.4 cm) and suggested that postural sway changes of these amounts are meaningful. BTrackS showed some bias with values exceeding force plate values in both EO and EC conditions. Excellent test-retest reliability and resulting MDC95 values indicated that BTrackS has the potential to identify meaningful changes in balance that may warrant intervention. BTrackS is an objective measure of balance that can be used to monitor balance in community-dwelling older adults over time. It can reliably identify changes that may require further attention (eg, fall-prevention strategies, declines in physical function) and shows promise for assessing intervention efficacy in this growing segment of the population.

Caffeine and Blood Pressure Response: Sex, Age, and Hormonal Status

PubMed Central

Whitsett, Thomas L.; McKey, Barbara S.; Wilson, Michael F.; Vincent, Andrea S.; Everson-Rose, Susan A.; Lovallo, William R.

2010-01-01

Abstract Purpose The pressor effect of caffeine has been established in young men and premenopausal women. The effect of caffeine on blood pressure (BP) remains unknown in postmenopausal women and in relation to hormone replacement therapy (HRT) use. Materials and Methods In a randomized, 2-week cross-over design, we studied 165 healthy men and women in 6 groups: men and premenopausal women (35–-49 yrs) vs. men and postmenopausal women (50–-64 yrs), with postmenopausal women divided into those taking no hormone replacements (HR), estrogen alone, or estrogen and progesterone. Testing during one week of the study involved 6 days of caffeine maintenance at home (80 mg, 3x/day) followed by testing of responses to a challenge dose of caffeine (250 mg) in the laboratory. The other week involved ingesting placebos on maintenance and lab days. Resting BP responses to caffeine were measured at baseline and at 45 to 60 min following caffeine vs placebo ingestion, using automated monitors. Results Ingestion of caffeine resulted in a significant increase in systolic BP in all 6 groups (4 ± .6, p < 0.01). Diastolic BP significantly increased in response to caffeine in all (3 ± .4, p < 0.04) but the group of older men (2 ± 1.0, p = 0.1). The observed pressor responses to caffeine did not vary by age. Conclusions Caffeine resulted in an increase in BP in healthy, normotensive, young and older men and women. This finding warrants the consideration of caffeine in the lifestyle interventions recommended for BP control across the age span. PMID:20500126

Ovo-vegetarian diet is associated with lower systemic blood pressure in Taiwanese women.

PubMed

Ho, C P; Yu, J H; Lee, T J F

2017-12-01

This study was designed to investigate blood pressure (BP) profiles among Taiwanese women with different dietary patterns. Cross-sectional study. A total of 269 non-hypertensive Taiwanese women, 40 years of age or older, were surveyed using structured questionnaires, and measurements of BP and physiological parameters were made. To assess differences among vegans, ovo-vegetarians, and meat eaters in terms of BP, demographic, and health behavior data, the chi-squared and Fisher's exact tests were employed for categorical variables, and analysis of variance and independent t-tests were performed for continuous variables. Multiple regression analysis was used to examine the relationship between BP and dietary patterns while controlling for potential confounding factors. A significant difference was found among the three test groups in terms of age, education, employment, stress, and waist-hip ratio. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly differed among the three groups. After controlling for age, body weight, waist circumference, and hip circumference, the three groups were observed to be a significant risk factor of the SBP and DBP. The SBP and DBP of the ovo-vegetarian group were significantly lower than those of the meat-eater group. No significant differences were found between the vegan and meat-eater groups in terms of SBP and DBP. Dietary pattern is a likely risk factor for SBP and DBP outcomes in Taiwanese women. In particular, the SBP and DBP of ovo-vegetarians are the lowest among the values observed for all dietary patterns. This finding suggests that an ovo-vegetarian diet is beneficial for long-term BP control and prevention of hypertension in females. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Impact on Participation and Autonomy: Test of Validity and Reliability for Older Persons.

PubMed

Hammar, Isabelle Ottenvall; Ekelund, Christina; Wilhelmson, Katarina; Eklund, Kajsa

2014-11-06

In research and healthcare it is important to measure older persons' self-determination in order to improve their possibilities to decide for themselves in daily life. The questionnaire Impact on Participation and Autonomy (IPA) assesses self-determination, but is not constructed for older persons. The aim of this study was to examine the validity and reliability of the IPA-S questionnaire for persons aged 70 years and older. The study was performed in two steps; first a validity test of the Swedish version of the questionnaire, IPA-S, followed by a reliability test-retest of an adjusted version. The validity was tested with focus groups and individual interviews on persons aged 77-88 years, and the reliability on persons aged 70-99 years. The validity test result showed that IPA-S is valid for older persons but it was too extensive and the phrasing of the items needed adjustments. The reliability test-retest on the adjusted questionnaire, IPA- Older persons (IPA-O), showed that 15 of 22 items had high agreement. IPA-O can be used to measure older persons' self-determination in their care and rehabilitation.

The assessment of cognitive function in older adult patients with chronic kidney disease: an integrative review.

PubMed

Hannan, Mary; Steffen, Alana; Quinn, Lauretta; Collins, Eileen G; Phillips, Shane A; Bronas, Ulf G

2018-05-25

Chronic kidney disease (CKD) is a common chronic condition in older adults that is associated with cognitive decline. However, the exact prevalence of cognitive impairment in older adults with CKD is unclear likely due to the variety of methods utilized to assess cognitive function. The purpose of this integrative review is to determine how cognitive function is most frequently assessed in older adult patients with CKD. Five electronic databases were searched to explore relevant literature related to cognitive function assessment in older adult patients with CKD. Inclusion and exclusion criteria were created to focus the search to the assessment of cognitive function with standardized cognitive tests in older adults with CKD, not on renal replacement therapy. Through the search methods, 36 articles were found that fulfilled the purpose of the review. There were 36 different types of cognitive tests utilized in the included articles, with each study utilizing between one and 12 tests. The most commonly utilized cognitive test was the Mini Mental State Exam (MMSE), followed by tests of digit symbol substitution and verbal fluency. The most commonly assessed aspect of cognitive function was global cognition. The assessment of cognitive function in older adults with CKD with standardized tests is completed in various ways. Unfortunately, the common methods of assessment of cognitive function may not be fully examining the domains of impairment commonly found in older adults with CKD. Further research is needed to identify the ideal cognitive test to best assess older adults with CKD for cognitive impairment.

Aging, hypertension and physiological tremor: the contribution of the cardioballistic impulse to tremorgenesis in older adults.

PubMed

Morrison, Steven; Sosnoff, Jacob J; Heffernan, Kevin S; Jae, Sae Young; Fernhall, Bo

2013-03-15

For older adults, an increase in physiological tremor is a common motor feature. This increase is believed to primarily reflect a general decline in function of the neuromuscular system. However, given that tremor is derived from a number of intrinsic sources, age-related changes in other physiological functions like the cardiac system may also negatively alter tremor output. The aim of this study was to examine what impact age and increased cardiac input (hypertension) have on physiological tremor. Heart rate, blood pressure, and postural/resting tremor were recorded in three groups; 1) young, healthy adults, 2) old, normotensive adults, and 3) old, hypertensive adults. The results demonstrated that the old hypertensive adults had greater postural tremor compared to the young healthy individuals. Coherence analysis revealed significant coupling between blood pressure-tremor and between heart rate-tremor for all individuals. The strength of this coupling was greatest for the older, hypertensive individuals. Together these results show that, for older adults, the combined effects of age and cardiac disease have the greatest impact on physiological tremor rather than any single factor alone. Copyright © 2013 Elsevier B.V. All rights reserved.

Perceived racial discrimination and hypertension: a comprehensive systematic review.

PubMed

Dolezsar, Cynthia M; McGrath, Jennifer J; Herzig, Alyssa J M; Miller, Sydney B

2014-01-01

Discrimination is posited to underlie racial disparities in hypertension. Extant literature suggests a possible association between racial discrimination and blood pressure, although inconsistent findings have been reported. The aim of this comprehensive systematic review was to quantitatively evaluate the association between perceived racial discrimination with hypertensive status and systolic, diastolic, and ambulatory blood pressure. Electronic database search of PubMed and PsycINFO (keywords: blood pressure/hypertension/diastolic/systolic, racism/discrimination/prejudice/unfair treatment) was combined with descendancy and ascendancy approaches. Forty-four articles (N = 32,651) met inclusion criteria. Articles were coded for demographics, hypertensive diagnosis, blood pressure measurement, discrimination measure and constructs, study quality, and effect sizes. Random effects meta-analytic models were tested based on Fisher's Z, the derived common effect size metric. Overall, perceived racial discrimination was associated with hypertensive status, Zhypertension = 0.048, 95% CI [.013, .087], but not with resting blood pressure, Zsystolic = 0.011, 95% CI [-.006, .031], Zdiastolic = .016, 95% CI [-.006, .034]. Moderators that strengthened the relation included sex (male), race (Black), age (older), education (lower), and hypertensive status. Perceived discrimination was most strongly associated with nighttime ambulatory blood pressure, especially among Blacks. Despite methodological limitations in the existing literature, there was a small, significant association between perceived discrimination and hypertension. Future studies should consider ambulatory nighttime blood pressure, which may more accurately capture daily variation attributable to experienced racial discrimination. Perceived discrimination may partly explain racial health disparities. 2014 APA, all rights reserved

Perceived Racial Discrimination and Hypertension: A Comprehensive Systematic Review

PubMed Central

Dolezsar, Cynthia M.; McGrath, Jennifer J.; Herzig, Alyssa J. M.; Miller, Sydney B.

2017-01-01

Objective Discrimination is posited to underlie racial disparities in hypertension. Extant literature suggests a possible association between racial discrimination and blood pressure, although inconsistent findings have been reported. The aim of this comprehensive systematic review was to quantitatively evaluate the association between perceived racial discrimination with hypertensive status and systolic, diastolic, and ambulatory blood pressure. Method Electronic database search of PubMed and PsycINFO (keywords: blood pressure/hypertension/diastolic/systolic, racism/discrimination/prejudice/unfair treatment) was combined with descendancy and ascendancy approaches. Forty-four articles (N = 32,651) met inclusion criteria. Articles were coded for demographics, hypertensive diagnosis, blood pressure measurement, discrimination measure and constructs, study quality, and effect sizes. Results Random effects meta-analytic models were tested based on Fisher’s Z, the derived common effect size metric. Overall, perceived racial discrimination was associated with hypertensive status, Zhypertension = 0.048, 95% CI [.013, .087], but not with resting blood pressure, Zsystolic = 0.011, 95% CI [−.006, .031], Zdiastolic = .016, 95% CI [−.006, .034]. Moderators that strengthened the relation included sex (male), race (Black), age (older), education (lower), and hypertensive status. Perceived discrimination was most strongly associated with nighttime ambulatory blood pressure, especially among Blacks. Conclusions Despite methodological limitations in the existing literature, there was a small, significant association between perceived discrimination and hypertension. Future studies should consider ambulatory nighttime blood pressure, which may more accurately capture daily variation attributable to experienced racial discrimination. Perceived discrimination may partly explain racial health disparities. PMID:24417692

Portuguese nurses' knowledge of and attitudes toward hospitalized older adults.

PubMed

de Almeida Tavares, João Paulo; da Silva, Alcione Leite; Sá-Couto, Pedro; Boltz, Marie; Capezuti, Elizabeth

2015-03-01

Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses' education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross-sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence-based guidelines in their practice. © 2014 Nordic College of Caring Science.

A Narrative Synthesis of Nintendo Wii Fit Gaming Protocol in Addressing Balance Among Healthy Older Adults: What System Works?

PubMed

Manlapaz, Donald G; Sole, Gisela; Jayakaran, Prasath; Chapple, Cathy M

2017-04-01

Balance is crucial in performing functional tasks particularly among older adults. Exergaming is gaining attention as a novel approach to enhance balance in a number of clinical populations. The aim of this review was to synthesize and present published evidence for Nintendo Wii Fit™ gaming system protocols. These include game preference, intervention setting, and exercise dosage for improving balance in healthy older adults. Commonly used outcome measures were also identified. A literature search was developed using the PICOS strategy using keywords such as "older adult," "Nintendo Wii Fit," "exergaming," and "balance" in the databases: MEDLINE, PubMed, EMBASE, CINAHL, Scopus, Science Direct, and Web of Science. Sixteen articles were included with participants (n = 491) mostly female (69%), and mean age ranged between 71 and 85 years old. Participants were recruited mainly from the community. The most commonly used Wii Fit games were Table tilt, Soccer Heading, Ski Slalom, and Ski jump, performed three times per week, with a duration of 30 minutes per session for 6 weeks. Berg Balance Scale, Timed Up and Go Test, and Centre of Pressure were the most commonly used outcome measures. Wii Fit exergames can be a potential alternative to improve balance if safety and technical procedures are provided. With conflicting and mechanism-based evidence on dosage presented, exergaming parameters require further research before firm recommendations can be made. Clinically, effective dosage is an important component in any type of interventions, and exergaming should not be an exception.

Metacognitive Training at Home: Does It Improve Older Adults' Learning?

PubMed Central

Bailey, Heather; Dunlosky, John; Hertzog, Christopher

2010-01-01

Background Previous research has described the success of an intervention aimed at improving older adults' ability to regulate their learning. This metacognitive approach involves teaching older adults to allocate their study time more efficiently by testing themselves and restudying items that are less well learned. Objective Although this type of memory intervention has shown promise, training older adults to test themselves in the laboratory can be very time-intensive. Thus, the purpose of the present study is to transport the self-testing training method from the laboratory to home use. Methods A standard intervention design was used that included a pretraining session, multiple training sessions, and a posttraining session. Participants were randomly assigned to either the training group (n = 29) or the waiting list control group (n = 27). Moreover, we screened participants for whether they used the self-testing strategy during their pretraining test session. Results Compared to the performance of the control group, the training group displayed significant gains, which demonstrates that older adults can benefit from training themselves to use these skills at home. Moreover, the results of the present study indicate that this metacognitive approach can effectively improve older adults' learning, even in those who spontaneously self-test prior to training. Conclusions Training metacognitive skills, such as self-testing and efficient study allocation, can improve the ability to learn new information in healthy older adults. More importantly, older adult clients can be supplied with an at-home training manual, which will ease the burden on practitioners. PMID:20016124

Ethically problematic treatment decisions: a physician survey.

PubMed

Saarni, Samuli I; Parmanne, Piitu; Halila, Ritva

2008-02-01

Experiencing ethical problems requires both ethically problematic situations and ethical sensitivity. Ethically problematic treatment decisions are distressing and might reflect health care quality problems. Whether all physicians actually experience ethical problems, what these problems are and how they vary according to physician age, gender and work sector are largely unknown. A mail survey of all non-retired physicians licensed in Finland (n = 17,172, response rate 75.6%). The proportion of physicians reporting having made ethically problematic treatment decisions decreased in linear fashion from 60% at ages below 30 years to 21% at ages over 63 years. The only problem that did not decrease in frequency with age was having withdrawn necessary treatments. Women and primary care physicians reported problematic decisions most often, although gender differences were small. Primary care physicians most often reported having performed too many investigations or having pressured patients, whereas hospital physicians emphasized having withdrawn necessary treatments. Performing unnecessary treatments or investigations was explained by pressure from patients or relatives, and performing too few treatments or investigations was explained by inadequate resources. In general, young physicians felt pressured to do too much, whereas older physicians felt they could not do enough due to inadequate resources. Older physicians might be less exposed to ethically problematic situations, be more able to handle them or have lower ethical sensitivity. Young physicians could benefit from support in resisting pressure to perform unnecessary treatments, whereas older physicians might benefit from training in recognizing ethical issues.

Implementing Low-Cost, Community-Based Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes: What Are the Benefits for Glycemic Control and Cardiovascular Risk?

PubMed Central

Reis, Victor Machado; Themudo-Barata, Jose Luis

2017-01-01

Background: The purpose of this study was to analyze the effects of a long-term, community-based, combined exercise program developed with low-cost exercise strategies on glycemic control and cardiovascular risk factors in middle-aged and older patients with type 2 diabetes. Methods: Participants (n = 124; 63.25 ± 7.20 years old) engaged in either a 9-month supervised exercise program (n = 39; consisting of combined aerobic, resistance, agility/balance, and flexibility exercise; three sessions per week; 70 min per session) or a control group (n = 85) who maintained their usual care. Glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease were assessed before and after the 9-month intervention. Results: A significant time * group interaction effect (p < 0.001) was identified in the values of the glycated hemoglobin, fasting plasma glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, and the 10-year risk of coronary artery disease. Conclusions: A long-term, community-based, combined exercise program developed with low-cost exercise strategies was effective in inducing significant benefits on glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease in middle-aged and older patients with type 2 diabetes. Clinical Trial Identification Number: ISRCTN09240628. PMID:28902144

Combined aerobic and resistance training: are there additional benefits for older hypertensive adults?

PubMed Central

Lima, Leandra G.; Bonardi, José T.M.; Campos, Giulliard O.; Bertani, Rodrigo F.; Scher, Luria M.L.; Moriguti, Júlio C.; Ferriolli, Eduardo; Lima, Nereida K.C.

2017-01-01

OBJECTIVES: The objective of this study was to compare the effects of a combination of aerobic and resistance training to those of isolated aerobic training on blood pressure, body composition, and insulin sensitivity in hypertensive older adults. METHOD: Forty-four patients were randomly assigned to the aerobic group, resistance and aerobic group, and control group. Before and after 10 weeks, the following data were obtained: 24-hour ambulatory blood pressure data, abdominal circumference, waist circumference, body mass index, lean mass, fat mass, and insulin sensitivity. The study was conducted with 3 training sessions per week. RESULTS: Comparison revealed significant reductions in the body mass index, abdominal and waist circumferences, and ambulatory blood pressure (24-hour, wakefulness and sleep systolic/diastolic blood pressures) in both the aerobic group and the resistance and aerobic (combined) group. The fat mass only changed in the combined group. There was no difference in the insulin sensitivity in any group. CONCLUSIONS: The combined treatment and aerobic treatment alone were equally effective in reducing the blood pressure, body mass index, and abdominal and waist circumferences, although the addition of the resistance component also helped reduce the fat mass. PMID:28658436

Blood pressure variability in man: its relation to high blood pressure, age and baroreflex sensitivity.

PubMed

Mancia, G; Ferrari, A; Gregorini, L; Parati, G; Pomidossi, G; Bertinieri, G; Grassi, G; Zanchetti, A

1980-12-01

1. Intra-arterial blood pressure and heart rate were recorded for 24 h in ambulant hospitalized patients of variable age who had normal blood pressure or essential hypertension. Mean 24 h values, standard deviations and variation coefficient were obtained as the averages of values separately analysed for 48 consecutive half-hour periods. 2. In older subjects standard deviation and variation coefficient for mean arterial pressure were greater than in younger subjects with similar pressure values, whereas standard deviation and variation coefficient for mean arterial pressure were greater than in younger subjects with similar pressure values, whereas standard deviation aations and variation coefficient were obtained as the averages of values separately analysed for 48 consecurive half-hour periods. 2. In older subjects standard deviation and variation coefficient for mean arterial pressure were greater than in younger subjects with similar pressure values, whereas standard deviation and variation coefficient for heart rate were smaller. 3. In hypertensive subjects standard deviation for mean arterial pressure was greater than in normotensive subjects of similar ages, but this was not the case for variation coefficient, which was slightly smaller in the former than in the latter group. Normotensive and hypertensive subjects showed no difference in standard deviation and variation coefficient for heart rate. 4. In both normotensive and hypertensive subjects standard deviation and even more so variation coefficient were slightly or not related to arterial baroreflex sensitivity as measured by various methods (phenylephrine, neck suction etc.). 5. It is concluded that blood pressure variability increases and heart rate variability decreases with age, but that changes in variability are not so obvious in hypertension. Also, differences in variability among subjects are only marginally explained by differences in baroreflex function.

The effects of missed doses of amlodipine and losartan on blood pressure in older hypertensive patients.

PubMed

de Leeuw, Peter W; Fagard, Robert; Kroon, Abraham A

2017-06-01

This randomized, double-blind, parallel-group, multicenter study compared the efficacy of amlodipine and losartan in an older hypertensive population, focusing on therapeutic coverage in the case of missed doses. Following a 4-week, single-blind, placebo washout period, 211 patients were randomly assigned to receive either 5 mg of amlodipine once daily or 50 mg of losartan once daily. Doses were doubled after 6 weeks of treatment if the diastolic blood pressure exceeded 90 mm Hg. After the 12-week treatment period, patients received the placebo for 2 days (drug holiday) to simulate two missed doses of antihypertensive medication. Twenty-four-hour ambulatory blood pressure monitoring was conducted at the end of the placebo washout period (baseline), upon completion of the 12-week treatment period (steady state), and after the 2-day drug holiday. Amlodipine was more effective than losartan in reducing patients' 24-h ambulatory blood pressure at the steady-state sampling time. The increases in 24-h blood pressure during the drug holiday averaged 6±2/2±1 mm Hg (P<0.0001) in the amlodipine group and 3±2/2±1 mm Hg (P<0.0001) in the losartan group. The rise in systolic pressure was greater in patients on amlodipine than in those on losartan (P<0.0001). For diastolic pressure, the changes did not differ. Owing to the lower pressure during treatment, patients in the amlodipine group remained at a significantly lower blood pressure level after the 2-day drug holiday. Amlodipine was more effective than losartan in lowering blood pressure and in maintaining blood pressure control after two missed doses, and the difference was most significant for systolic blood pressure.

A structured physical activity and fitness programme for older adults with intellectual disabilities: results of a cluster-randomised clinical trial.

PubMed

van Schijndel-Speet, M; Evenhuis, H M; van Wijck, R; van Montfort, K C A G M; Echteld, M A

2017-01-01

The physical activity level of older adults with intellectual disabilities (ID) is extremely low, and their fitness levels are far beneath accepted norms for older people with normal intelligence and comparable with frail older people. A physical activity programme, including an education programme, was developed for older adults with ID using behaviour change techniques. The programme aimed at improving or maintaining adequate levels of physical activity (primary outcome measure) and motor fitness, cardio respiratory fitness, morphologic and metabolic fitness, activities of daily living, cognitive functioning and depressive symptoms (secondary outcome measures). The programme's efficacy was evaluated in a cluster-randomised clinical trial among people aged 43 years and over with mild-moderate levels of ID. Five day-activity centres were randomised to the participation group. In these centres, 81 older adults participated in groups of 8 to 10 in the programme, three times a week during 8 months. The programme was executed by physical activity instructors and staff of day-activity centres. Five other day-activity centres were randomised to the control group; 70 older adults in these centres received care as usual. The generalised linear model with mixed effects was used to test the programme's effectiveness. Significant effects were found on physical activity, muscle strength, systolic and diastolic blood pressure, serum cholesterol level and cognitive functioning, in favour of the programme's participants. No significant improvements were found on balance, serum glucose, weight, waist circumference, walking speed, mobility, depression or instrumental activities of daily living. The physical activity and fitness programme has established small but significant effects in this sample, but generalising the findings to other settings is difficult due to significant participant dropout. Implementation of evidence-based physical activity programmes among older adults with ID is recommended. Further research is needed to investigate the effectiveness of physical activity on daily life functioning and the development on chronic diseases in the long run. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Disabled readers: their intellectual and perceptual capacities at differing ages.

PubMed

Miller, J W; McKenna, M C

1981-04-01

To investigate the multiple relationships between selected measures of intelligence and perception and reading achievement a group of young, poor readers (MCA = 8.4 yr.) and a group of older, poor readers (MCA = 11.2 yr.) were given the Gates-MacGinitie Achievement Test, Peabody Picture Vocabulary Test, Slosson Intelligence Test, Spatial Orientation Memory Test, and Auditory Discrimination Test. The combination of the four predictor variables accounted for a significant amount of the variance in reading vocabulary and comprehension for youngest and older poor readers. Greater variance was accounted for in the reading achievement of younger students than of older students. Perceptual abilities related more strongly for younger students, while intelligence related more strongly for older students. Questions are raised about the validity of using expectancy formulae with younger disabled readers and the "learning disabilities" approach with older disabled readers.

Effect of Aspirin Supplementation on Hemodynamics in Older Firefighters.

PubMed

Lane-Cordova, Abbi D; Ranadive, Sushant M; Yan, Huimin; Kappus, Rebecca M; Sun, Peng; Bunsawat, Kanokwan; Smith, Denise L; Horn, Gavin P; Ploutz-Snyder, Robert; Fernhall, B O

2015-12-01

Cardiovascular events are the leading cause of line-of-duty fatality for firefighters. Aspirin reduces the risk of cardiovascular events in men and may reduce fatalities in older (>40 yr) firefighters. We hypothesized that both chronic and acute aspirin supplementation would improve vascular function after live firefighting but that chronic supplementation would also improve resting hemodynamics. Twenty-four firefighters (40-60 yr) were randomly assigned to acute or chronic aspirin supplementation or placebo in a balanced, crossover design. Arterial stiffness, brachial and central blood pressures, as well as forearm vasodilatory capacity and blood flow were measured at rest and immediately after live firefighting. Total hyperemic blood flow (area under the curve (AUC)) was increased (P < 0.001) after firefighting with no effects for aspirin supplementation or acute versus chronic administration (AUC, from 107 ± 5 to 223 ± 9 in aspirin condition and from 97 ± 5 to 216 ± 7 mL·min⁻¹ per 100-mL forearm tissue for placebo; P < 0.05 for main, and P > 0.05 for interaction). Arterial stiffness/central blood pressure increased (P < 0.04) with no effect of aspirin (from 0.0811 ± 0.001 to 0.0844 ± 0.003 m·s·mm⁻¹ Hg⁻¹ in aspirin condition versus 0.0802 ± 0.002 to 0.0858 ± 0.002 m·s⁻¹·mm Hg⁻¹ in placebo condition), whereas peripheral and central systolic and pulse pressures decreased after firefighting across conditions (P < 0.05). Live firefighting resulted in increased AUC and pressure-controlled arterial stiffness and decreased blood pressure in older firefighters, but aspirin supplementation did not affect macro- or microvascular responsiveness at rest or after firefighting.

24-h pulse pressure cutoff point definition by office pulse pressure in a population of Spanish older hypertensive patients.

PubMed

Vinyoles, Ernest; de la Sierra, Alejandro; Roso-Llorach, Albert; Banegas, José R; de la Cruz, Juan José; Gorostidi, Manuel; Segura, Julián; Divisón, Juan Antonio; Ruíz-Hurtado, Gema; Ruilope, Luis Miguel

2017-05-01

The European Guidelines on Hypertension define an office pulse pressure (PP) at least 60 mmHg in the elderly patient as asymptomatic organ damage. Our objective was to estimate the cutoff point of 24-h PP that best predicts office PP associated with higher cardiovascular risk (≥60 mmHg) in hypertensive older patients. We studied all hypertensive patients at least 60 years with a first valid ambulatory blood pressure monitoring drawn from the Spanish ambulatory blood pressure monitoring registry. Receiver operating characteristic curves were used to estimate the best 24-h PP cutoff predictor of office PP at least 60 mmHg that maximized the sum of sensitivity and specificity. We included 52 246 hypertensive patients [52.4%, female; mean age (SD) 69.0 (7.0) years]. From these, 34 530 (66.1%) patients had an office PP at least 60 mmHg. The value of 24-h PP that best predicts higher risk clinic PP is 54.9 mmHg [sensitivity: 69.2%; specificity: 70.3%; area under the receiver operating characteristic curve of 0.761 (95% confidence interval 0.756-0.765)]. Mean clinic and 24-h PPs were progressively higher as the study participants were classified at higher cardiovascular risk group. Some 20.5% of patients presented isolated office high PP and 10% a masked high 24-h PP. In a large clinical sample of older hypertensive patients, the cutoff point of 24-h PP that best predicts office PP at least 60 mmHg is 55 mmHg. In 30.5% of cases, there is a discrepancy between office PP and ambulatory 24-h PP.

Increased trunk extension endurance is associated with meaningful improvement in balance among older adults with mobility problems.

PubMed

Suri, Pradeep; Kiely, Dan K; Leveille, Suzanne G; Frontera, Walter R; Bean, Jonathan F

2011-07-01

To determine whether trunk extension endurance changes with training are associated with clinically meaningful improvements in balance among mobility-limited older adults. Longitudinal data from a randomized controlled trial. Outpatient rehabilitation research center. Community-dwelling older adults (N=64; mean age, 75.9y) with mobility limitations as defined by a score of 4 to 10 on the Short Physical Performance Battery. Sixteen weeks of progressive resistance training. Outcomes were the Berg Balance Scale (BBS) and the Unipedal Stance Time (UST). Predictors included leg strength, leg power, trunk extension endurance, and the product of heart rate and blood pressure (RPP) at the final stage of an exercise tolerance test. We performed an analysis of data from participants who completed 16 weeks of training by using binary outcomes defined by a clinically meaningful change (CMC) from baseline to completion of the intervention (BBS=4 units; UST=5s). The association of predictor variables with balance outcomes was examined separately and together in multivariate adjusted logistic regression models. Trunk extension endurance in seconds (1.04 [1.00-1.09]) was independently associated with CMC on the BBS. Trunk extension endurance (1.02 [1.00-1.03]) was independently associated with CMC on the UST. Other physical attributes were not associated with meaningful change in balance. Improvements in trunk extension endurance were independently associated with CMCs in balance in older adults. Leg strength, leg power, and RPP were not associated with CMC in balance. Poor trunk extension endurance may be a rehabilitative impairment worthy of further study as a modifiable factor linked to balance among older adults. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effects of DanceSport on walking balance and standing balance among the elderly.

PubMed

Sohn, Jeehoon; Park, Sung-Ha; Kim, Sukwon

2018-05-04

Dancesport is a popular activity among older adults who look for fun and fitness in Korea. Studies reported positive sociological and psychological effects of dancesport. But, little studies were performed to evaluate the effects of dancesport on balance performances. The objective of the present study was to evaluate the effects of dancesport for 15 weeks on walking balance and standing balance of older adults. Older adults regularly participated in the dancesport program 3 times a week for 15 weeks. The program included Rumba, Cha-cha-cha, and Jive. They exercised the prescribed dancesport at intermediate level for 50-60 mins for each time. A total 22 reflective markers were placed on the anatomical landmarks and 8 cameras were used to measure 3-D positions of participants. Also, center of pressure (COP) data were measured to analyze standing balance using a ground reaction board at 1200 Hz for 30 seconds. One-way analysis of variance (ANOVA) was performed to test the effects of 15 weeks of dancesport on walking balance and standing balance. The results suggested that, after 15 weeks of dancesport participation, older adults' walking balance (48.3 ± 20.3 cm2 vs 38.2 ± 18.2 cm2) and standing balance (COP area: 189.4 ± 85.4 mm2 vs 103.5 ± 55.4mm2, COP distance: 84.2 ± 34.4 cm vs 76.5 ± 21.4 cm) were significantly improved. Performing dancesport would require moving center of mass rapidly and frequently while maintaining posture. This may result in improving walking balance and standing balance in the present study. The study concluded that dancesport would be an effective exercise method in enhancing postural stability of older adults.

Effect of strength training on orthostatic hypotension in older adults.

PubMed

Brilla, L R; Stephens, A B; Knutzen, K M; Caine, D

1998-01-01

This preliminary study attempted to identify the frequency of orthostatic hypotension (OH) in community dwelling older adults who volunteered to participate in an 8-week, heavy-resistance, strength-training program. It also assessed the effect of the strength-training program on OH. From a larger study (n = 53) on high-resistance strength training in older adults (mean age 71.4 +/- 6.6 years), a subset of subjects (n = 24), mean age 71.0 +/- 5.8 years, was evaluated who met at least one criterion for OH. All subjects were tested for resting blood pressures (BP) and heart rates (HR) in the supine, sitting, and standing positions. Also noted was their response to orthostatism in rising from a cot after 10 minutes and rising from a chair after 5 minutes. The subset was not different from the overall group in gender ratio, age, or effect of medication on BP. The treatment was an 8-week strength-training program at 80% of their one repetition maximum. Significant changes (P < 0.05) were shown in supine diastolic BP (+3.2 mm Hg), sitting systolic BP (-3.9), and standing HR (+4.9 beats per minute). In response to the orthostatic challenge, significant (P < 0.05) improvements were shown in systolic BP (+9.7 mm Hg), diastolic BP (+4.7), and HR (+3.2 beats per minute) for the rise from chair, and in diastolic BP (+6.7 mm Hg) rise from the cot. These data show that OH is not uncommon (45%) in community dwelling older adults. A strength training program in older adults has little effect on resting BP, but elicits a positive adaptation to an orthostatic challenge.

Mayo's Older African Americans Normative Studies: norms for Boston Naming Test, Controlled Oral Word Association, Category Fluency, Animal Naming, Token Test, WRAT-3 Reading, Trail Making Test, Stroop Test, and Judgment of Line Orientation.

PubMed

Lucas, John A; Ivnik, Robert J; Smith, Glenn E; Ferman, Tanis J; Willis, Floyd B; Petersen, Ronald C; Graff-Radford, Neill R

2005-06-01

Normative data for older African Americans are presented for several clinical neuropsychological measures, including Boston Naming Test, Controlled Oral Word Association, Category Fluency, Token Test, WRAT-3 Reading, Trail Making Test, Stroop Color and Word Test, and Judgment of Line Orientation. Age-adjusted norms were derived from a sample of 309 cognitively normal, community-dwelling individuals, aged 56 through 94, participating in Mayo's Older African Americans Normative Studies (MOAANS). Years of education were modelled on age-scaled scores to derive regression Equations that may be applied for further demographic correction. These data should enhance interpretation of individual test performances and facilitate analysis of neuropsychological profile patterns in older African American patients who present for dementia evaluations.

Relationship Between 24-Hour Ambulatory Blood Pressure and Cognitive Function in Community-Living Older Adults: The UCSD Ambulatory Blood Pressure Study.

PubMed

Conway, Kyle S; Forbang, Nketi; Beben, Tomasz; Criqui, Michael H; Ix, Joachim H; Rifkin, Dena E

2015-12-01

Twenty-four-hour ambulatory blood pressure (BP) patterns have been associated with diminished cognitive function in hypertensive and very elderly populations. The relationship between ambulatory BP patterns and cognitive function in community-living older adults is unknown. We conducted a cross-sectional study in which 24-hour ambulatory BP, in-clinic BP, and cognitive function measures were obtained from 319 community-living older adults. The mean age was 72 years, 66% were female, and 13% were African-American. We performed linear regression with performance on the Montreal Cognitive Assessment (MoCA) as the primary outcome and 24-hour BP patterns as the independent variable, adjusting for age, sex, race/ethnicity, education, and comorbidities. Greater nighttime systolic dipping (P = 0.046) and higher 24-hour diastolic BP (DBP; P = 0.015) were both significantly associated with better cognitive function, whereas 24-hour systolic BP (SBP), average real variability, and ambulatory arterial stiffness were not. Higher 24-hour DBP and greater nighttime systolic dipping were significantly associated with improved cognitive function. Future studies should examine whether low 24-hour DBP and lack of nighttime systolic dipping predict future cognitive impairment. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Patient-Reported Usability of Positive Airway Pressure Equipment Is Associated With Adherence in Older Adults

PubMed Central

Martin, Jennifer L.; Hays, Ron D.; Patterson, Emily S.; Aysola, Ravi; Col, Nananda; Mitchell, Michael N.; Truong, Cindy; Dzierzewski, Joseph M.; Jouldjian, Stella; Song, Yeonsu; Rodriguez, Juan Carlos; Josephson, Karen; Alessi, Cathy

2017-01-01

Abstract Study objectives: To examine the usability of positive airway pressure (PAP) devices and its association with PAP adherence among older adults with sleep-disordered breathing. Methods: We mailed questionnaires to patients aged ≥65 years prescribed PAP therapy during the prior 36 months from two large healthcare systems. Survey participants completed the Usability of Sleep Apnea Equipment-Positive Airway Pressure (USE-PAP) questionnaire, which assessed the usability of their PAP device. Other questionnaire items included demographics and self-rated health. We also abstracted adherence data (mean nightly hours of PAP use available from one site) and interface type from the electronic health record. Results: Five hundred sixty-four patients completed the survey (response rate = 33%). The mean USE-PAP score (0 = best to 100 = worst) was 20 (SD ± 20). Mean duration of PAP use (available in 189 respondents) was 5.2 hours per night (SD ± 2.0). In a nested regression model predicting nightly hours of PAP use, a 10-point (0.5 SD) increase in USE-PAP score corresponded to a 0.37 hour/night reduction in PAP use. The model including the USE-PAP score explained a significant proportion (R2 = 15%) of the variation in nightly hours of PAP use above and beyond demographics, self-reported health, and interface type (∆R2 = 12%). Conclusions: Our results demonstrate that PAP usability varies among older patients and is associated with PAP adherence, above and beyond other predictors of adherence. These results support measuring and improving PAP usability to further improve PAP adherence for older patients. PMID:28364429

Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 13 - benefits and adverse events in older and younger patients with hypertension: overview, meta-analyses and meta-regression analyses of randomized trials.

PubMed

Thomopoulos, Costas; Parati, Gianfranco; Zanchetti, Alberto

2018-05-29

There is overwhelming evidence that blood pressure (BP)-lowering treatment can reduce cardiovascular outcomes also in the elderly, but some important aspects influencing medical practice are controversial as sufficient evidence has not been provided by single randomized controlled trials (RCTs), whereas evidence may result from a systematic search and meta-analysis of all available data. The following clinically relevant issues concerning the effects of BP lowering in older and younger individuals have been investigated: differences in benefits; the oldest and the youngest age range for which evidence of BP-lowering effects is available; the SBP level at which BP-lowering treatment should be initiated; the SBP and DBP levels treatment should be aimed at; differences in treatment burdens and harms. A database we previously identified of 72 BP-lowering RCTs in 260 210 patients was searched for separately reported data on older and younger individuals [cutoffs of 65 (primary analyses), 70, 75, 80, 60 and 55 years). The data were further stratified according to the levels of baseline (untreated) BP, and of on-treatment achieved SBP or DBP. Seven fatal and nonfatal outcomes were considered for benefits. Burdens and harms were investigated as permanent treatment discontinuations for adverse events, and hypotension/syncope. Risk ratios and absolute risk changes were calculated by a random effects model. Effects at older and younger ages were compared by heterogeneity test. Thirty-two RCTs provided data on 96 549 patients older than 65 years, and 31 RCTs on 114 009 patients younger than 65 years. All cardiovascular outcomes were significantly reduced by treatment both in older and younger individuals, without significant age-dependent differences in relative risk reduction but with significantly higher absolute risk reductions in older individuals. The extreme age ranges for which evidence of significant benefits of treatment were available was greater than 80 and less than 55 years. Only one RCT provided data on benefits of BP-lowering at age greater than 65 when treatment was initiated at SBP values in the grade 1 range, but more consistent evidence was provided when age was greater than 60 years. Both in patients older and younger than 65 years, significant reductions of cardiovascular outcomes were found at on-treatment SBP less than 140 mmHg and DBP less than 80 mmHg. There was no evidence that treatment discontinuations for adverse events or hypotension/syncope were more frequent at age greater than 65. Antihypertensive treatment should be recommended to all individuals with elevated BP, independent of age. The prudent recommendation to initiate treatment at SBP values 140-159 mmHg is supported at older age defined as greater than 60 years. SBP and DBP values lower than 140 mmHg and, respectively, 80 mmHg can be aimed at with incremental benefits without disproportionate burdens until age 80 years, above which available evidence is for benefits at on-treatment SBP 140-149 mmHg.

The Precarity of Older Adults Living Alone With Cognitive Impairment.

PubMed

Portacolone, Elena; Rubinstein, Robert L; Covinsky, Kenneth E; Halpern, Jodi; Johnson, Julene K

2018-01-24

To examine the lived experience of older adults living alone with cognitive impairment to better understand their needs and concerns. Based on our previous work suggesting that older adults living alone often experience a sense of precarity, we were interested in exploring this construct in older adults living alone with a diagnosis of cognitive impairment. The notion of precarity points to the uncertainty deriving from coping with cumulative pressures while trying to preserve a sense of independence. This is a qualitative study of 12 adults aged 65 and older living alone with cognitive impairment. Six participants had a diagnosis of Alzheimer's disease; 6 had a diagnosis of mild cognitive impairment. Participants' lived experiences were elicited through 40 ethnographic interviews and participant observation in their homes. Using a qualitative content analysis approach, interview transcripts and fieldnotes were analyzed to identify codes and themes. Qualitative analysis of transcripts revealed three themes. Theme 1 described the distress stemming from the uncertainty of having cognitive impairment that has an unpredictable course. Theme 2 drew attention to the tendency of participants to feel responsible for managing their cognitive impairment. Theme 3 described the pressures stemming from the lack of appropriate services to support independent living for persons with cognitive impairment. These 3 themes all pointed to facets of precarity. Findings also suggest the dearth of programs to support older adults living alone with cognitive impairment and the need to develop novel programs and interventions. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Preliminary Assessment of Landslides Along the Florida River Downstream from Lemon Reservoir, La Plata County, Colorado

USGS Publications Warehouse

Schulz, William H.; Coe, Jeffrey A.; Ellis, William L.; Kibler, John D.

2006-01-01

Nearly two-dozen shallow landslides were active during spring 2005 on a hillside located along the east side of the Florida River about one kilometer downstream from Lemon Reservoir in La Plata County, southwestern Colorado. Landslides on the hillside directly threaten human safety, residential structures, a county roadway, utilities, and the Florida River, and indirectly threaten downstream areas and Lemon Dam. Most of the area where the landslides occurred was burned during the 2002 Missionary Ridge wildfire. We performed geologic mapping, subsurface exploration and sampling, radiocarbon dating, and shallow ground-water and ground-displacement monitoring to assess landslide activity. Active landslides during spring 2005 were as large as 35,000 m3 and confined to colluvium. Debris flows were mobilized from most of the landslides, were as large as 1,500 m3, and traveled as far as 250 m. Landslide activity was triggered by elevated ground-water pressures within the colluvium caused by infiltration of snowmelt. Landslide activity ceased as ground-water pressures dropped during the summer. Shallow landslides on the hillside appear to be much more likely following the Missionary Ridge fire because of the loss of tree root strength and evapotranspiration. We used monitoring data and observations to develop preliminary, approximate rainfall/snowmelt thresholds above which shallow landslide activity can be expected. Landslides triggered during spring 2005 occurred within a 1.97 x 107 m3 older landslide that extends, on average, about 40 m into bedrock. The south end of this older landslide appears to have experienced deep secondary landsliding. Radiocarbon dating of sediments at the head of the older landslide suggests that the landslide was active about 1,424-1,696 years ago. A relatively widespread wildfire may have preceded the older landslide, and the landslide may have occurred during a wetter time. The wetter climate and effects of the wildfire would likely have resulted in increased ground-water pressures, which may have triggered the older landslide. This landslide appears to have crossed the valley floor and been subsequently eroded from this area. We found no evidence that landslide debris across the valley floor formed an impoundment of the Florida River, although it is very likely. Erosion of buttressing landslide debris from the valley floor and the lower strength of the landslide basal shear zone relative to pre-slide strength created less stable conditions than were present prior to occurrence of the landslide. However, deep ground-water conditions largely control the stability of the slope and are unknown here; hence, the potential for future deep landsliding is unknown. Additional investigation could be undertaken to further characterize landslide hazards in the area. This investigation could include episodic surveying of monuments we installed across the older landslide, obtaining detailed topographic data and aerial photography, mapping landslide debris and lacustrine deposits related to the potential former landslide dam, mapping secondary landslides, obtaining additional ages of landslide activity, constructing deep boreholes and ground-water monitoring wells, laboratory testing of soil and rock strength and hydraulic properties, and ground-water and slope-stability modeling.

Relation of pulse pressure to long-distance gait speed in community-dwelling older adults: Findings from the LIFE-P study

USDA-ARS?s Scientific Manuscript database

Reduced long-distance gait speed, a measure of physical function, is associated with falls, late-life disability, hospitalization/institutionalization and cardiovascular morbidity and mortality. Aging is also accompanied by a widening of pulse pressure (PP) that contributes to ventricular-vascular ...

Persistent socioeconomic inequalities in cardiovascular risk factors in England over 1994-2008: A time-trend analysis of repeated cross-sectional data

PubMed Central

2012-01-01

Background Our aims were to determine the pace of change in cardiovascular risk factors by age, gender and socioeconomic groups from 1994 to 2008, and quantify the magnitude, direction and change in absolute and relative inequalities. Methods Time trend analysis was used to measure change in absolute and relative inequalities in risk factors by gender and age (16-54, ≥ 55 years), using repeated cross-sectional data from the Health Survey for England 1994-2008. Seven risk factors were examined: smoking, obesity, diabetes, high blood pressure, raised cholesterol, consumption of five or more daily portions of fruit and vegetables, and physical activity. Socioeconomic group was measured using the Index of Multiple Deprivation 2007. Results Between 1994 and 2008, the prevalence of smoking, high blood pressure and raised cholesterol decreased in most deprivation quintiles. However, obesity and diabetes increased. Increasing absolute inequalities were found in obesity in older men and women (p = 0.044 and p = 0.027 respectively), diabetes in young men and older women (p = 0.036 and p = 0.019 respectively), and physical activity in older women (p = 0.025). Relative inequality increased in high blood pressure in young women (p = 0.005). The prevalence of raised cholesterol showed widening absolute and relative inverse gradients from 1998 onwards in older men (p = 0.004 and p ≤ 0.001 respectively) and women (p ≤ 0.001 and p ≤ 0.001). Conclusions Favourable trends in smoking, blood pressure and cholesterol are consistent with falling coronary heart disease death rates. However, adverse trends in obesity and diabetes are likely to counteract some of these gains. Furthermore, little progress over the last 15 years has been made towards reducing inequalities. Implementation of known effective population based approaches in combination with interventions targeted at individuals/subgroups with poorer cardiovascular risk profiles are therefore recommended to reduce social inequalities. PMID:22333887

Obesity, sarcopenia, sarcopenic obesity and reduced mobility in Brazilian older people aged 80 years and over.

PubMed

Santos, Vanessa Ribeiro Dos; Gomes, Igor Conterato; Bueno, Denise Rodrigues; Christofaro, Diego Giulliano Destro; Freitas, Ismael Forte; Gobbo, Luis Alberto

2017-01-01

To analyze which abnormalities in body composition (obesity, sarcopenia or sarcopenic obesity) are related to reduced mobility in older people aged 80 years and older. The sample included 116 subjects aged 80 years and older. The body composition was measured using dual-energy X-ray absorptiometry (DXA) and mobility was assessed by motor tests. The χ2 test was used to analyze the proportion of older people with sarcopenia, obesity and sarcopenic obesity based on sex as well as to indicate an association between obesity, sarcopenia, sarcopenic obesity and mobility. Binary logistic regression, adjusted for the variables (sex and osteoarticular diseases), was used to express the magnitude of these associations. One-way analysis of variance was used to compare the mobility of four groups (Normal, Obesity, Sarcopenia and Sarcopenic Obesity). The Sarcopenia Group had lower performance in the lower limbs strength test and in sum of two tests compared with Obesity and Normal Groups. Older people with sarcopenia had higher chance of reduced mobility (OR: 3.44; 95%CI: 1.12-10.52). Older people aged 80 years and older with sarcopenia have more chance for reduction in mobility.

Ideal resuscitation pressure for uncontrolled hemorrhagic shock in different ages and sexes of rats

PubMed Central

2013-01-01

Introduction Our previous studies demonstrated that 50-60 mmHg mean arterial blood pressure was the ideal target hypotension for uncontrolled hemorrhagic shock during the active hemorrhage in sexually mature rats. The ideal target resuscitation pressure for immature and older rats has not been determined. Methods To elucidate this issue, using uncontrolled hemorrhagic-shock rats of different ages and sexes (6 weeks, 14 weeks and 1.5 years representing pre-adult, adult and older rats, respectively), the resuscitation effects of different target pressures (40, 50, 60, 70 and 80 mmHg) on uncontrolled hemorrhagic shock during active hemorrhage and the age and sex differences were observed. Results Different target resuscitation pressures had different resuscitation outcomes for the same age and sex of rats. The optimal target resuscitation pressures for 6-week-old, 14-week-old and 1.5-year-old rats were 40 to 50 mmHg, 50 to 60 mmHg and 70 mmHg respectively. Ideal target resuscitation pressures were significantly superior to other resuscitation pressures in improving the hemodynamics, blood perfusion, organ function and animal survival of uncontrolled hemorrhagic-shock rats (P < 0.01). For same target resuscitation pressures, the beneficial effect on hemorrhagic shock had a significant age difference (P < 0.01) but no sex difference (P > 0.05). Different resuscitation pressures had no effect on coagulation function. Conclusion Hemorrhagic-shock rats at different ages have different target resuscitation pressures during active hemorrhage. The ideal target resuscitation hypotension for 6-week-old, 14-week-old and 1.5-year-old rats was 40 to 50 mmHg, 50 to 60 mmHg and 70 mmHg, respectively. Their resuscitation effects have significant age difference but had no sex difference. PMID:24020401

Diabetes, Triglyceride Levels, and Other Risk Factors for Glaucoma in the National Health and Nutrition Examination Survey 2005–2008

PubMed Central

Ko, Fang; Boland, Michael V.; Gupta, Priya; Gadkaree, Shekhar K.; Vitale, Susan; Guallar, Eliseo; Zhao, Di; Friedman, David S.

2016-01-01

Purpose To determine risk factors for glaucoma in a population-based study in the United States. Methods Participants age 40 and older from the National Health and Nutrition Examination Survey underwent questionnaires, physical examination, laboratory tests, and vision tests including fundus imaging. Glaucoma was determined based on expert grading of fundus photographs. Regression modeling of glaucoma risk factors was performed. Results Participants with glaucoma (172) were older (mean age 68.1 [95% confidence interval (CI) 65.6–70.7] vs. 56.4 years [95% CI 55.6–57.2, P < 0.001]), likely to have less than high school education (25.1% vs. 18.1%, P = 0.05), to have diabetes (23.1% vs. 10.8%, P < 0.001), to have central obesity (72.5% vs. 60.7%, P = 0.01), to have systolic hypertension (30.3% vs. 20.1%, P = 0.01), to have diastolic hypotension (30.3% vs. 13.9%, P < 0.001), and to be nonsmokers (91.0% vs. 79.3%, P = 0.002). Sex, poverty, access to health care, fasting glucose, insulin dependence, body mass index, cholesterol levels, diastolic hypertension, systolic hypotension, obstructive sleep apnea, and marijuana were not associated with glaucoma. Multivariable modeling showed associations between glaucoma and older age (odds ratio [OR] 1.09 per year, 95% CI 1.04–1.14), black race (OR 4.40, 95% CI 1.71–11.30), and poverty (OR 3.39, 95% CI 1.73–6.66). Diabetes was no longer associated with glaucoma after adjustment for triglyceride levels. Sex, education, insurance status, body mass index, blood pressure, obstructive sleep apnea, and smoking were not associated with glaucoma. Conclusions People who are older, of black race, and with lower income levels have a higher prevalence of glaucoma. A novel association between diabetes, triglyceride levels, and glaucoma is also identified. PMID:27111561

Effects of physical training with the Nintendo Wii Fit Plus® and protein supplementation on musculoskeletal function and the risk of falls in pre-frail older women: Protocol for a randomized controlled clinical trial (the WiiProtein study).

PubMed

Vojciechowski, Audrin Said; Biesek, Simone; Melo Filho, Jarbas; Rabito, Estela Iraci; Amaral, Maryelle Paula do; Gomes, Anna Raquel Silveira

2018-05-01

Frailty is one of the key geriatric syndromes and is related to the loss of functional independence. However, the practice of physical training (PT) combined with protein supplementation (PS) may improve musculoskeletal function (MF). To verify the effect of PT using 'exergames' with or without PS on MF, nutritional status, and risk of falls in pre-frail older women. The protocol is for a randomized controlled clinical trial with a sample of pre-frail older women, divided into 5 groups: control group; PT using exergames; PS; PT using exergames combined with PS; PT using exergames combined with isoenergetic supplementation. The primary outcomes will be: the strength and power of the lower limbs, assessed by isokinetic dynamometer and the sit-and-stand test carried out 5 times; muscle architecture, assessed by ultrasound; body composition, assessed by anthropometric measurements, bioelectrical impedance and dual energy X-ray absorptiometry; and functional mobility and risk of falls, assessed using the Timed-Up and Go test. The secondary outcomes will be: centre of pressure (CoP), assessed using a force plate; and fear of falling, assessed using the Falls Efficacy Scale - International, Brazil. PT using exergames with a gradual increase in the mass weighted vest will be carried out twice a week for 50 min over 3 months. The supplements will be ingested 5 days a week for 3 months. All outcomes will be assessed before and after 3 months. The WiiProtein study will be the first clinical trial to examine the effects of PT using exergames with progressive resistance, which may or may not be combined with PS, on MF, nutritional status, and risk of falls in pre-frail older women. Copyright © 2018 Elsevier B.V. All rights reserved.

Diabetes, Triglyceride Levels, and Other Risk Factors for Glaucoma in the National Health and Nutrition Examination Survey 2005-2008.

PubMed

Ko, Fang; Boland, Michael V; Gupta, Priya; Gadkaree, Shekhar K; Vitale, Susan; Guallar, Eliseo; Zhao, Di; Friedman, David S

2016-04-01

To determine risk factors for glaucoma in a population-based study in the United States. Participants age 40 and older from the National Health and Nutrition Examination Survey underwent questionnaires, physical examination, laboratory tests, and vision tests including fundus imaging. Glaucoma was determined based on expert grading of fundus photographs. Regression modeling of glaucoma risk factors was performed. Participants with glaucoma (172) were older (mean age 68.1 [95% confidence interval (CI) 65.6-70.7] vs. 56.4 years [95% CI 55.6-57.2, P < 0.001]), likely to have less than high school education (25.1% vs. 18.1%, P = 0.05), to have diabetes (23.1% vs. 10.8%, P < 0.001), to have central obesity (72.5% vs. 60.7%, P = 0.01), to have systolic hypertension (30.3% vs. 20.1%, P = 0.01), to have diastolic hypotension (30.3% vs. 13.9%, P < 0.001), and to be nonsmokers (91.0% vs. 79.3%, P = 0.002). Sex, poverty, access to health care, fasting glucose, insulin dependence, body mass index, cholesterol levels, diastolic hypertension, systolic hypotension, obstructive sleep apnea, and marijuana were not associated with glaucoma. Multivariable modeling showed associations between glaucoma and older age (odds ratio [OR] 1.09 per year, 95% CI 1.04-1.14), black race (OR 4.40, 95% CI 1.71-11.30), and poverty (OR 3.39, 95% CI 1.73-6.66). Diabetes was no longer associated with glaucoma after adjustment for triglyceride levels. Sex, education, insurance status, body mass index, blood pressure, obstructive sleep apnea, and smoking were not associated with glaucoma. People who are older, of black race, and with lower income levels have a higher prevalence of glaucoma. A novel association between diabetes, triglyceride levels, and glaucoma is also identified.

Belief in AIDS-Related Conspiracy Theories and Mistrust in the Government: Relationship With HIV Testing Among At-Risk Older Adults

PubMed Central

Ford, Chandra L.

2013-01-01

Purpose: One in 4 persons living with HIV/AIDS is an older adult (age 50 or older); unfortunately, older adults are disproportionately diagnosed in late stages of HIV disease. Psychological barriers, including belief in AIDS-related conspiracy theories (e.g., HIV was created to eliminate certain groups) and mistrust in the government, may influence whether adults undergo HIV testing. We examined relationships between these factors and recent HIV testing among at-risk, older adults. Design and Methods: This was a cross-sectional study among older adults enrolled in a large venue–based study. None had a previous diagnosis of HIV/AIDS; all were seeking care at venues with high HIV prevalence. We used multiple logistic regression to estimate the associations between self-reported belief in AIDS-related conspiracy theories, mistrust in the government, and HIV testing performed within the past 12 months. Results: Among the 226 participants, 30% reported belief in AIDS conspiracy theories, 72% reported government mistrust, and 45% reported not undergoing HIV testing within the past 12 months. Belief in conspiracy theories was positively associated with recent HIV testing (adjusted odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.05–3.60), whereas mistrust in the government was negatively associated with testing (OR = 0.43, 95% CI = 0.26–0.73). Implications: Psychological barriers are prevalent among at-risk older adults seeking services at venues with high HIV prevalences and may influence HIV testing. Identifying particular sources of misinformation and mistrust would appear useful for appropriate targeting of HIV testing strategies. PMID:23362210

A Low-Cost Point-of-Care Testing System for Psychomotor Symptoms of Depression Affecting Standing Balance: A Preliminary Study in India.

PubMed

Dutta, Arindam; Kumar, Robins; Malhotra, Suruchi; Chugh, Sanjay; Banerjee, Alakananda; Dutta, Anirban

2013-01-01

The World Health Organization estimated that major depression is the fourth most significant cause of disability worldwide for people aged 65 and older, where depressed older adults reported decreased independence, poor health, poor quality of life, functional decline, disability, and increased chronic medical problems. Therefore, the objectives of this study were (1) to develop a low-cost point-of-care testing system for psychomotor symptoms of depression and (2) to evaluate the system in community dwelling elderly in India. The preliminary results from the cross-sectional study showed a significant negative linear correlation between balance and depression. Here, monitoring quantitative electroencephalography along with the center of pressure for cued response time during functional reach tasks may provide insights into the psychomotor symptoms of depression where average slope of the Theta-Alpha power ratio versus average slope of baseline-normalized response time may be a candidate biomarker, which remains to be evaluated in our future clinical studies. Once validated, the biomarker can be used for monitoring the outcome of a comprehensive therapy program in conjunction with pharmacological interventions. Furthermore, the frequency of falls can be monitored with a mobile phone-based application where the propensity of falls during the periods of psychomotor symptoms of depression can be investigated further.

Improved postural control after dynamic balance training in older overweight women.

PubMed

Bellafiore, Marianna; Battaglia, Giuseppe; Bianco, Antonino; Paoli, Antonio; Farina, Felicia; Palma, Antonio

2011-01-01

Many studies have reported a greater frequency of falls among older women than men in conditions which stress balance. Previously, we found an improvement in static balance in older women with an increased support surface area and equal load redistribution on both feet, in response to a dynamic balance training protocol. The aim of the present study was to examine whether the same training program and body composition would have effects on the postural control of older overweight women. Ten healthy women (68.67 ± 5.50 yrs; 28.17 ± 3.35 BMI) participated in a five-week physical activity program. This included dynamic balance exercises, such as heel-to-toe walking in different directions, putting their hands on their hips, eyes open (EO) or closed (EC), with a tablet on their heads, going up and down one step, and walking on a mat. Postural stability was assessed before and after training with an optoelectronic platform and a uni-pedal balance performance test. Body composition of the trunk, upper limbs and lower limbs was measured by bio-impedance analysis. The mean speed (MS), medial-lateral MS (MS-x), anterior-posterior MS (MS-y), sway path (SP) and ellipse surface area (ESA) of the pressure center was reduced after training in older women. However, only MS, MS-x, MS-y and SP significantly decreased in bipodalic conditions with EO and MS-y also with EC (p<0.05). Instead, in monopodalic conditions, we found a significant reduction in the ESA of both feet with EO and EC. These data were associated with a significant increase in the lean mass of lower limbs and a higher number of participants who improved their ability to maintain unipedal static balance. Our dynamic balance training protocol appears to be feasible, safe and repeatable for older overweight women and to have positive effects in improving their lateral and anterior-posterior postural control, mainly acting on the visual and skeletal muscle components of the balance control system.

Diabetes in older people: position statement of The Hong Kong Geriatrics Society and the Hong Kong Society of Endocrinology, Metabolism and Reproduction.

PubMed

Wong, C W; Lee, J Sw; Tam, K F; Hung, H F; So, W Y; Shum, C K; Lam, C Y; Cheng, J N; Man, S P; Auyeung, T W

2017-10-01

Following a survey on the clinical practice of geriatricians in the management of older people with diabetes and a study of hypoglycaemia in diabetic patients, a round-table discussion with geriatricians and endocrinologists was held in January 2015. Consensus was reached for six domains specifically related to older diabetic people: (1) the considerations when setting an individualised diabetic management; (2) inclusion of geriatric syndrome screening in assessment; (3) glycaemic and blood pressure targets; (4) pharmacotherapy; (5) restrictive diabetic diet; and (6) management goals for nursing home residents.

Hearing Aid-Induced Plasticity in the Auditory System of Older Adults: Evidence from Speech Perception

ERIC Educational Resources Information Center

Lavie, Limor; Banai, Karen; Karni, Avi; Attias, Joseph

2015-01-01

Purpose: We tested whether using hearing aids can improve unaided performance in speech perception tasks in older adults with hearing impairment. Method: Unaided performance was evaluated in dichotic listening and speech-­in-­noise tests in 47 older adults with hearing impairment; 36 participants in 3 study groups were tested before hearing aid…

Air cleaning performance of a new environmentally controlled primary crusher operator booth.

PubMed

Organiscak, J A; Cecala, A B; Zimmer, J A; Holen, B; Baregi, J R

2016-02-01

The National Institute for Occupational Safety and Health (NIOSH) cooperated with 3M Company in the design and testing of a new environmentally controlled primary crusher operator booth at the company's Wausau granite quarry near Wausau, WI. This quarry had an older crusher booth without a central heating, ventilation and air conditioning (HVAC) system, and without an air filtration and pressurization system. A new replacement operator booth was designed and installed by 3M based on design considerations from past NIOSH research on enclosed cab filtration systems. NIOSH conducted pre-testing of the old booth and post-testing of the new booth to assess the new filtration and pressurization system's effectiveness in controlling airborne dusts and particulates. The booth's dust and particulate control effectiveness is described by its protection factor, expressed as a ratio of the outside to inside concentrations measured during testing. Results indicate that the old booth provided negligible airborne respirable dust protection and low particulate protection from the outside environment. The newly installed booth provided average respirable dust protection factors from 2 to 25 over five shifts of dust sampling with occasional worker ingress and egress from the booth, allowing some unfiltered contaminants to enter the enclosure. Shorter-term particle count testing outside and inside the booth under near-steady-state conditions, with no workers entering or exiting the booth, resulted in protection factors from 35 to 127 on 0.3- to 1.0-μm respirable size particulates under various HVAC airflow operating conditions.

Comparison of Models for Spacer Grid Pressure Loss in Nuclear Fuel Bundles for One and Two-Phase Flows

NASA Astrophysics Data System (ADS)

Maskal, Alan B.

Spacer grids maintain the structural integrity of the fuel rods within fuel bundles of nuclear power plants. They can also improve flow characteristics within the nuclear reactor core. However, spacer grids add reactor coolant pressure losses, which require estimation and engineering into the design. Several mathematical models and computer codes were developed over decades to predict spacer grid pressure loss. Most models use generalized characteristics, measured by older, less precise equipment. The study of OECD/US-NRC BWR Full-Size Fine Mesh Bundle Tests (BFBT) provides updated and detailed experimental single and two-phase results, using technically advanced flow measurements for a wide range of boundary conditions. This thesis compares the predictions from the mathematical models to the BFBT experimental data by utilizing statistical formulae for accuracy and precision. This thesis also analyzes the effects of BFBT flow characteristics on spacer grids. No single model has been identified as valid for all flow conditions. However, some models' predictions perform better than others within a range of flow conditions, based on the accuracy and precision of the models' predictions. This study also demonstrates that pressure and flow quality have a significant effect on two-phase flow spacer grid models' biases.

A brief peripheral motion contrast threshold test predicts older drivers' hazardous behaviors in simulated driving.

PubMed

Henderson, Steven; Woods-Fry, Heather; Collin, Charles A; Gagnon, Sylvain; Voloaca, Misha; Grant, John; Rosenthal, Ted; Allen, Wade

2015-05-01

Our research group has previously demonstrated that the peripheral motion contrast threshold (PMCT) test predicts older drivers' self-report accident risk, as well as simulated driving performance. However, the PMCT is too lengthy to be a part of a battery of tests to assess fitness to drive. Therefore, we have developed a new version of this test, which takes under two minutes to administer. We assessed the motion contrast thresholds of 24 younger drivers (19-32) and 25 older drivers (65-83) with both the PMCT-10min and the PMCT-2min test and investigated if thresholds were associated with measures of simulated driving performance. Younger participants had significantly lower motion contrast thresholds than older participants and there were no significant correlations between younger participants' thresholds and any measures of driving performance. The PMCT-10min and the PMCT-2min thresholds of older drivers' predicted simulated crash risk, as well as the minimum distance of approach to all hazards. This suggests that our tests of motion processing can help predict the risk of collision or near collision in older drivers. Thresholds were also correlated with the total lane deviation time, suggesting a deficiency in processing of peripheral flow and delayed detection of adjacent cars. The PMCT-2min is an improved version of a previously validated test, and it has the potential to help assess older drivers' fitness to drive. Copyright © 2015 Elsevier Ltd. All rights reserved.

[High-grade pressure sores in frail older high-risk persons. A retrospective postmortem case-control-study].

PubMed

Von Renteln-Kruse, W; Krause, T; Anders, J; Kühl, M; Heinemann, A; Püschel, K

2004-04-01

Some old persons at risk do develop, but others, at comparable risk, do not develop high-grade pressure sores. To evaluate potentially different risk factors, we performed a post mortem case-control study in old persons who developed high-grade pressure sores within six months until 14 days before death. Consecutive cases with pressure sores grade >/=3 and potential controls at comparably high risk for pressure sores were examined before cremation. After written informed consent had been obtained by the next relatives, all available nursing and medical records of the deceased were thoroughly evaluated. Cases and controls were matched according to age, gender, immobility, and cachexia.A total of 100 cases with 71 pressure sores grade 3 and 29 pressure sores grade 4 were compared to 100 controls with 27 pressure sores grade

Global Overexpression of ET-1 Decreases Blood Pressure - A Systematic Review and Meta-Analysis of ET-1 Transgenic Mice.

PubMed

Lu, Yong Ping; Tsuprykov, Oleg; Vignon-Zellweger, Nicolas; Heiden, Susi; Hocher, Berthold

2016-01-01

ET-1 has independent effects on blood pressure regulation in vivo, it is involved in tubular water and salt excretion, promotes constriction of smooth muscle cells, modulates sympathetic nerve activity, and activates the liberation of nitric oxide. To determine the net effect of these partially counteracting mechanisms on blood pressure, a systematic meta-analysis was performed. Based on the principles of Cochrane systematic reviews, we searched in major literature databases - MEDLINE (PubMed), Embase, Google Scholar, and the China Biological Medicine Database (CBM-disc) - for articles relevant to the topic of the blood pressure phenotype of endothelin-1 transgenic (ET-1+/+) mice from January 1, 1988 to March 31, 2016. Review Manager Version 5.0 (Rev-Man 5.0) software was applied for statistical analysis. In total thirteen studies reported blood pressure data. The meta-analysis of blood pressure data showed that homozygous ET-1 transgenic mice (ET-1+/+ mice) had a significantly lower blood pressure as compared to WT mice (mean difference: -2.57 mmHg, 95% CI: -4.98∼ -0.16, P = 0.04), with minimal heterogeneity (P = 0.86). A subgroup analysis of mice older than 6 months revealed that the blood pressure difference between ET-1+/+ mice and WT mice was even more pronounced (mean difference: -6.19 mmHg, 95% CI: -10.76∼ -1.62, P = 0.008), with minimal heterogeneity (P = 0.91). This meta-analysis provides robust evidence that global ET-1 overexpression in mice lowers blood pressure in an age-dependent manner. Older ET-1+/+ mice have a somewhat more pronounced reduction of blood pressure. © 2016 The Author(s) Published by S. Karger AG, Basel.

Rapid change, climate adversity and the next 'big dry': older farmers' mental health.

PubMed

Polain, John David; Berry, Helen Louise; Hoskin, John Oliver

2011-10-01

To describe the experiences of older farmers in the face of prolonged drought and rapid change. Content analysis of issues and priorities raised in semi-structured community forums. Rural centres in NSW. One hundred and fifty older farmers, their families, Industry and Investment NSW, rural financial and mental health services, the Country Women's Association and other non-government agencies. Five public forums organised under the Rural Adversity Mental Health Program. Prolonged drought caused pressures on farmers that compounded the usual stresses of farming and of ageing. These were experienced in the context of rapid social and industry change, fuel price volatility and the insidious threat of climate change. Three main themes were articulated: loss, government compliance pressures and difficulties accessing and/or inappropriate services. Older farmers felt an overwhelming sense of loss: of profitability and professional success, community status, physical well-being and comfort, the ability to participate in the modern world and, above all, of relationships (partners, children and friends moving away). They interpreted government compliance requirements as evidence of community and government loss of trust in famers. They resisted using the few mental health services that might be available, fearing being labelled as 'crazy' and discouraged by the culturally inappropriate way in which services were offered. Older farmers would benefit from joint services related to health and well-being simultaneously with modern business management offered in trusted, comfortable settings. © 2011 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

Older and wiser? Men’s and women’s accounts of drinking in early mid-life

PubMed Central

Emslie, Carol; Hunt, Kate; Lyons, Antonia

2012-01-01

Most qualitative research on alcohol focuses on younger rather than older adults. To explore older people’s relationship with alcohol, we conducted eight focus groups with 36 men and women aged 35 to 50 years in Scotland, UK. Initially, respondents suggested that older drinkers consume less alcohol, no longer drink to become drunk and are sociable drinkers more interested in the taste than the effects of alcohol. However, as discussions progressed, respondents collectively recounted recent drunken escapades, challenged accounts of moderate drinking, and suggested there was still peer pressure to drink. Some described how their drinking had increased in mid-life but worked hard discursively to emphasise that it was age and stage appropriate (i.e. they still met their responsibilities as workers and parents). Women presented themselves as staying in control of their drinking while men described going out with the intention of getting drunk (although still claiming to meet their responsibilities). While women experienced peer pressure to drink, they seemed to have more options for socialising without alcohol than did men. Choosing not to drink alcohol is a behaviour that still requires explanation in early mid-life. Harm reduction strategies should pay more attention to drinking in this age group. PMID:22034902

Effect of omega-3 polyunsaturated fatty acid supplementation on central arterial stiffness and arterial wave reflections in young and older healthy adults

PubMed Central

Monahan, Kevin D; Feehan, Robert P; Blaha, Cheryl; McLaughlin, Daniel J

2015-01-01

Increased central arterial stiffness and enhanced arterial wave reflections may contribute to increased risk of cardiovascular disease development with advancing age. Omega-3 polyunsaturated fatty acid (n-3) ingestion may reduce cardiovascular risk via favorable effects exerted on arterial structure and function. We determined the effects of n-3 supplementation (4 g/day for 12 weeks) on important measures of central arterial stiffness (carotid-femoral pulse wave velocity; PWV) and arterial wave reflection (central augmentation index) in young (n = 12; 25 ± 1-year-old, mean ± SE) and older (n = 12; 66 ± 2) healthy adults. We hypothesized that n-3 supplementation would decrease carotid-femoral PWV and central augmentation index in older adults. Our results indicate that carotid-femoral PWV and central augmentation index were greater in older (988 ± 65 cm/sec and 33 ± 2%) than in young adults (656 ± 16 cm/sec and 3 ± 4%: both P < 0.05 compared to older) before the intervention (Pre). N-3 supplementation decreased carotid-femoral PWV in older (Δ-9 ± 2% Precompared to Post; P < 0.05), but not young adults (Δ2 ± 3%). Central augmentation index was unchanged by n-3 supplementation in young (3 ± 4 vs. 0 ± 4% for Pre and Post, respectively) and older adults (33 ± 2 vs. 35 ± 3%). Arterial blood pressure at rest, although increased with age, was not altered by n-3 supplementation in young or older adults. Collectively, these data indicate that 12 weeks of daily n-3 supplementation decreases an important measure of central arterial stiffness (carotid-femoral PWV) in older, but not young healthy adults. The mechanism underlying decreased central arterial stiffness with n-3 supplementation is unknown, but appears to be independent of effects on arterial blood pressure or arterial wave reflections. PMID:26109192

Perceived social isolation moderates the relationship between early childhood trauma and pulse pressure in older adults.

PubMed

Norman, Greg J; Hawkley, Louise; Ball, Aaron; Berntson, Gary G; Cacioppo, John T

2013-06-01

Over a million children are subjected to some form of trauma in the United States every year. Early trauma has been shown to have deleterious effects on cardiovascular health in adulthood. However, the presence of strong social relationships as an adult can buffer an individual against many of the harmful effects of early trauma. Furthermore, the perception of social isolation has been shown to be a significant risk factor for the development of cardiovascular disease and is a strong predictor of all cause mortality. One likely mechanism thought to underlie the influence of perceived isolation on health is changes in arterial stiffness. One of the more widely used measures of arterial stiffness in older individuals is pulse pressure. The goal of the present study was to determine whether early childhood trauma is associated with elevations on pulse pressure. Furthermore, this study sought to determine whether perceived social isolation moderates the relationship between early trauma and pulse pressure. Results revealed that individuals with low perceived social isolation displayed no significant relationship between early trauma and pulse pressure. However, individuals who reported higher levels of perceived isolation showed a significant positive association between early trauma and pulse pressure. Therefore, the detrimental effects of early trauma may be partially dependent upon the quality of social relationships as an adult. Copyright © 2012 Elsevier B.V. All rights reserved.

Prevalence of hypovitaminosis D and its association with comorbidities of childhood obesity.

PubMed

Williams, Ronald; Novick, Marsha; Lehman, Erik

2014-01-01

Our study sought to further delineate the prevalence of hypovitaminosis D and its relationship to comorbidities of childhood obesity. We conducted a retrospective chart review from 155 obese children aged 5 to 19 years who attended the Penn State Children’s Hospital Pediatric Multidisciplinary Weight Loss Program from November 2009 through November 2010. We determined the incidence of hypovitaminosis D and examined its association with comorbidities including elevated blood pressure, diabetes, acanthosis nigricans, depression, hyperlipidemia, hyperinsulinemia, and abnormal liver function test results, as well as age, sex, and geographic location. Under the latest Institute of Medicine definitions, vitamin D deficiency (< 20 ng/mL) and insufficiency (20-29 ng/mL) was present in 40% and 38% of children, respectively. The prevalence of vitamin D deficiency was 27.8% in children aged 5 to 9 years, 35.4% in children aged 10 to 14 years, and 50.9% of children aged 15 years or older. Older age, African-American race, winter/spring season, higher insulin level, total number of comorbidities, and polycystic ovary syndrome (in girls) were significantly associated with vitamin D deficiency. African-American race, winter/spring season, hyperinsulinemia, elevated systolic blood pressure, urban location, and total numbers of comorbidities were significantly associated with hypovitaminosis D (< 30 ng/mL). Hypovitaminosis D is associated with several medical comorbidities in obese children. Given the large percentage of children, even in our youngest age group, who are vitamin D deficient, obese children should be considered for routine vitamin D screening.

Too old to test? Prevalence and correlates of HIV testing among sexually active older adults.

PubMed

Oraka, Emeka; Mason, Stacey; Xia, Mingjing

2018-01-01

Older adults account for 17% of new HIV diagnoses in the US and are more likely to be diagnosed with HIV later in the course of the disease compared to younger people. We calculated the prevalence and associated factors of having ever been tested for HIV among sexually active older adults. We analyzed data from the 2008-2016 General Social Survey Limited to respondents ≥65 years of age who reported more than one sex partner(s) in past 12 months (n = 757). HIV testing prevalence, prevalence ratios, and 95% confidence intervals were calculated by demographic variables and HIV-related risk behaviors. An estimated 16.3% of sexually active older adults have tested for HIV, and 15.9% were at increased risk for HIV infection (reported injection drug and/or crack-cocaine use, exchanging money for sex, more than three sex partners in the past year, or men who reported having sex with another man). In the adjusted model, adults aged 65-70, not married, self-identified as gay/bisexual, and at increased risk for HIV infection were more likely to have tested for HIV. An estimated 83.7% of sexually active older adults never tested for HIV. Strategies are needed to increase HIV awareness and testing among potentially high-risk older adults.

Incidence of Pressure Ulcers During Home and Institutional Care Among Long-Term Care Insurance Beneficiaries With Dementia Using the Korean Elderly Cohort.

PubMed

Kim, Juyeong; Choi, Young; Shin, Jaeyong; Jang, Suk-Yong; Cho, Kyeong Hee; Nam, Jin Young; Park, Eun-Cheol

2017-07-01

To assess whether type of long-term care service is a risk factor of the incidence of pressure ulcers among older adults with dementia who are receiving long-term care insurance (LTCI). Data from LTCI beneficiaries (benefit level 1 or 2) with dementia, aged 60 and older (n = 7841), in the Korean Elderly Cohort data set from 2008 to 2013 were used. Type of long-term care service was categorized into home or institutional care using the LTCI Claims Database. The National Health Insurance Claims Database was used to identify the incidence of pressure ulcers as the outcome variable in a survival analysis using the time-dependent Cox proportional hazard model. Of the 7841 participants, 98 (1.2%) exhibited pressure ulcers. Compared with beneficiaries receiving home care, those receiving institutional care had a higher adjusted hazard ratio for pressure ulcers (hazard ratio 6.48, 95% confidence interval 3.48-10.86). These associations were particularly strong among beneficiaries without pressure ulcers during the mandatory assessment for benefit eligibility and who were partially ambulatory. Beneficiaries receiving institutional care were more likely to have pressure ulcers than were those receiving home care. The government must monitor the quality of institutional long-term care services and encourage service providers to improve such care. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Stress and Negative Relationship Quality among Older Couples: Implications for Blood Pressure

PubMed Central

Newton, Nicky J.; Cranford, James A.; Ryan, Lindsay H.

2016-01-01

Objectives: The cardiovascular system may represent a significant pathway by which marriage and stress influence health, but research has focused on married individuals cross-sectionally. This study examined associations among chronic stress, negative spousal relationship quality, and systolic blood pressure over time among middle-aged and older husbands and wives. Method: Participants were from the nationally representative longitudinal Health and Retirement Study. A total of 1,356 (N = 2,712) married and cohabitating couples completed psychosocial and biomeasure assessments in waves 2006 and 2010. Analyses examined whether Wave 1 (2006) relationship quality and stress were associated with changes in blood pressure over time. Results: The effects of stress and negative relationship quality were dyadic and varied by gender. Husbands had increased blood pressure when wives reported greater stress, and this link was exacerbated by negative spousal relationship quality. Negative relationship quality predicted increased blood pressure when both members of the couple reported negative quality relations. Discussion: Findings support the dyadic biopsychosocial model of marriage and health indicating: (a) stress and relationship quality directly effect the cardiovascular system, (b) relationship quality moderates the effect of stress, and (c) the dyad rather than only the individual should be considered when examining marriage and health. PMID:25852106

Neurovascular control of blood pressure is influenced by aging, sex, and sex hormones.

PubMed

Baker, Sarah E; Limberg, Jacqueline K; Ranadive, Sushant M; Joyner, Michael J

2016-12-01

In this review, we highlight that the relationship between muscle sympathetic nerve activity (MSNA) and mean arterial pressure is complex, differs by sex, and changes with age. In young men there is an inverse relationship between MSNA and cardiac output where high MSNA is compensated for by low cardiac output. This inverse relationship is not seen in older men. In young women sympathetic vasoconstriction is offset by β-adrenoreceptor mediated vasodilation, limiting the ability of young women to maintain blood pressure in response to orthostatic stress. However, β-mediated dilation in women is attenuated with age, leading to unopposed α-adrenergic vasoconstriction and a rise in the direct transduction of MSNA into increases in blood pressure. We propose that these changes with age and menopausal status are major contributing factors in the increased prevalence of hypertension in older women. In addition to aging, we highlight that changes in sex hormones in young women (across the menstrual cycle, with oral contraceptive use, or with pregnancy) influence MSNA and the transduction of MSNA into increases in blood pressure. It is likely that the β-adrenergic receptors and/or changes in baroreflex sensitivity play a large role in these sex differences and changes with alterations in sex hormones. Copyright © 2016 the American Physiological Society.

Systematic Review of Yoga Interventions to Promote Cardiovascular Health in Older Adults.

PubMed

Barrows, Jennifer L; Fleury, Julie

2016-06-01

The benefits of physical activity are well established, yet few older adults engage in adequate physical activity to optimize health. While yoga may reduce the risk of cardiovascular disease, few studies have focused on the efficacy of yoga-based physical activity to promote cardiovascular health in older adults. The objective of this review is to provide an evaluation of yoga interventions to reduce cardiovascular risk in older adults. Four databases were searched for randomized controlled trials of yoga interventions in older adults. Studies with cardiovascular outcomes were included. Literature searches identified nine articles eligible for review. Significant health benefits were reported, including favorable changes in blood pressure, body composition, glucose, and lipids. Yoga practices, participant characteristics, and outcome measures were variable. There was limited use of theory. Yoga is safe and feasible in older adults; additional research is warranted to examine the specific components of yoga interventions essential to reducing cardiovascular risk. © The Author(s) 2015.

The perspectives of older Greek-Australians toward changes in the nature of family support: implications for family care policies.

PubMed

Walker, Ruth; Newman, Lareen; Tsianikas, Michael; Panagiotopoulos, Georgia; Hurley, Catherine

2013-01-01

Internationally, public policies encourage "aging in place," and the majority of older Australians requiring care in the community receive informal care, supplemented by publicly subsidized formal services. The effect of contemporary social changes on informal care in aging migrant communities is poorly understood. This articles explores the perceptions of older Greek-Australians toward changes in the nature of family support. Bicultural and bilingual researchers carried out in-depth interviews (n = 27) and five focus groups (n = 63 total participants) with older Greek-Australians in modern Greek. While "cultures of care" remain among Greek-Australian families, the means for a family to assist have shifted, and these compromises are met with considerable powerlessness among older Greek-Australians. Implications for policy include the need to better involve older migrants and their families in decisions about their care needs, potentially involving consumer-directed care models. Service providers may also need to adopt the use of new technologies to communicate with increasingly time-pressured family members.

Hypertension in women: the Women Take Heart project.

PubMed

Furumoto-Dawson, A lice A; Pandey, Dilip K; Elliott, William J; de Leon Mendes, Carlos F; Al-Hani, Arfan J; Hollenberg, Steven; Camba, Noel; Wicklund, Roxanne; Black, Henry R

2003-01-01

Hypertension is an important, modifiable risk for cardiovascular disease. The Women Take Heart study, a prospective, community-based cohort study of risk factors for heart disease, provides an opportunity to examine prevalence, awareness, and control of hypertension specifically in women. In 1992, 5932 women, age 35 and older (mean age, 52.9; 86% white, 9% African American, 5% other) and free of active heart disease symptoms for 3 months, were recruited through Chicago area public announcements, and their baseline examination data analyzed. Overall, 47.6% were hypertensive (systolic blood pressure >or=140 mm Hg or diastolic blood pressure >or=90 mm Hg, or self-report). Only 17.3% reported being hypertensive; in 63.2% of all hypertensive women, the hypertension was undetected or unacknowledged. Blood pressure was controlled to <140/90 mm Hg in 24.1% of self-reported hypertensives. Results from this study and national surveys indicate that hypertension detection and control remain major public health challenges in preventing cardiovascular disease in older women. Copyright 2003 Le Jacq Communications, Inc.

Risk Factors for Cortical, Nuclear, Posterior Subcapsular, and Mixed Lens Opacities: The Los Angeles Latino Eye Study

PubMed Central

Richter, Grace M.; Torres, Mina; Choudhury, Farzana; Azen, Stanley P.; Varma, Rohit

2012-01-01

Purpose To identify socio-demographic and biological risk factors associated with having cortical, nuclear, posterior sub-capsular (PSC), and mixed lens opacities. Design Population-based, cross-sectional study Participants Five thousand nine hundred forty-five Latinos 40 years and older from 6 census tracts in Los Angeles, California. Methods Participants underwent an interview and detailed eye examination, including best-corrected visual acuity and slit-lamp assessment of lens opacities using the Lens Opacities Classification System II. Univariate and stepwise logistic regression analyses were used to identify independent risk factors associated with each type of lens opacity. Main Outcome Measures Odds ratios for socio-demographic and biological risk factors associated with cortical only, nuclear only, PSC only, and mixed lens opacities. Results Of the 5945 participants with gradable lenses, 468 had cortical only lens opacities, 217 had nuclear only lens opacities, 27 had PSC only opacities, and 364 had mixed lens opacities. Older age, higher hemoglobin A1c, and history of diabetes mellitus were independent risk factors for cortical only lens opacities. Older age, smoking, and myopic refractive error were independent risk factors for nuclear only lens opacities. Higher systolic blood pressure and history of diabetes were independent risk factors for posterior sub-capsular lens opacities. Older age, myopic refractive error, history of diabetes, higher systolic blood pressure, female gender, and presence of large drusen were independent risk factors for mixed lens opacities. Conclusions The modifiable and non-modifiable risk factors identified in this study provide insight into the mechanisms related to the development of lens opacification. Improved glycemic control, smoking cessation and prevention, and blood pressure control may help to reduce the risk of having lens opacities and their associated vision loss. PMID:22197433

Ambulatory Blood Pressure Variability Increases Over a 10-Year Follow-Up in Community-Dwelling Older People

PubMed Central

Pearce, Mark S.; Wincenciak, Joanna; Kerr, Simon R.J.; Newton, Julia L.

2016-01-01

Abstract BACKGROUND Greater ambulatory blood pressure variability (ABPV) is associated with end-organ damage and increased mortality. Age-related changes in the cardiovascular and autonomic nervous systems make age-associated increases in ABPV likely. Cross-sectional studies support this hypothesis, showing greater ABPV among older compared to younger adults. The only longitudinal study to examine changes in ABPV, however, found ABPV decreased over 5 years follow-up. This unexpected observation probably reflected the highly selected nature of the study participants. METHODS In this longitudinal study, we assessed changes in ABPV over 10 years in a community-cohort of older people. In addition, we examined the extent to which ABPV was predicted by demographics, cardiovascular risk factors, and medication. Clinical examination and 24-hour ambulatory blood pressure monitoring were carried out at baseline and at 10 years follow-up in 83 people, median age 70 years. ABPV was calculated using SD and coefficient of variation (Cv). Three time periods were examined: daytime, nighttime, and 24 hours. RESULTS Daytime and 24-hour, systolic and diastolic, SD, and Cv were significantly greater at follow-up than at baseline ( P < 0.001 in all cases). Mean BP did not change. CONCLUSIONS Multilevel modeling showed follow-up interval had a significant, positive effect on SD and Cv ( P < 0.004), independent of age, sex, and medication. ABPV increased over a 10-year follow-up despite stable mean BP. ABPV may therefore be an additional target for treatment in older people. Future studies should examine what degree of ABPV is harmful and if control of ABPV reduces adverse outcome. PMID:26310662

Increased central arterial stiffness and altered cerebrovascular haemodynamic properties in South Asian older adults.

PubMed

Brar, I; Robertson, A D; Hughson, R L

2016-05-01

South Asians (SA) suffer from a higher burden of heart disease and stroke compared with White Caucasians (CA). We hypothesized that increased arterial stiffness in older adults of SA origin would be associated with greater cerebrovascular pulsatile pressure and flow characteristics compared with CA older adults. Forty-four SA and CA older adults, free of known cardiovascular and cerebrovascular diseases, were assessed. Vascular ageing was characterized by brachial-ankle pulse wave velocity, carotid pulse pressure, compliance coefficient (CC) and intima-media thickness (IMT). Duplex ultrasonography of the internal carotid arteries estimated anterior cerebral blood flow (aCBF) and cerebrovascular resistance (aCVR), and transcranial Doppler ultrasound quantified middle cerebral artery blood flow velocity, resistive index (RI) and pulsatility index (PI). Fasting blood samples were collected to assess glycaemic status, lipid profile and C-reactive protein. SA had higher carotid pulse pressure and lower CC indicating stiffer arteries compared with CA. Multiple regression analyses revealed that ethnic differences in arterial stiffness were associated with glycated haemoglobin level in SA. Among SA, an inverse association was observed between carotid CC and aCVR. In turn, aCVR was associated with a steeper reduction in aCBF in SA than in CA. IMT was strongly associated with greater PI and RI (r>0.81, P<0.001) in SA, whereas a weaker relationship for PI (r=0.46, P=0.03) and no significant relationship for RI were found in CA. The study found stronger associations between pulsatile cerebrovascular haemodynamics and structural and functional alterations in central arteries in SA that may underlie the elevated risk for cerebrovascular disease.

Patient-Reported Usability of Positive Airway Pressure Equipment Is Associated With Adherence in Older Adults.

PubMed

Fung, Constance H; Martin, Jennifer L; Hays, Ron D; Patterson, Emily S; Aysola, Ravi; Col, Nananda; Mitchell, Michael N; Truong, Cindy; Dzierzewski, Joseph M; Jouldjian, Stella; Song, Yeonsu; Rodriguez, Juan Carlos; Josephson, Karen; Alessi, Cathy

2017-03-01

To examine the usability of positive airway pressure (PAP) devices and its association with PAP adherence among older adults with sleep-disordered breathing. We mailed questionnaires to patients aged ≥65 years prescribed PAP therapy during the prior 36 months from two large healthcare systems. Survey participants completed the Usability of Sleep Apnea Equipment-Positive Airway Pressure (USE-PAP) questionnaire, which assessed the usability of their PAP device. Other questionnaire items included demographics and self-rated health. We also abstracted adherence data (mean nightly hours of PAP use available from one site) and interface type from the electronic health record. Five hundred sixty-four patients completed the survey (response rate = 33%). The mean USE-PAP score (0 = best to 100 = worst) was 20 (SD ± 20). Mean duration of PAP use (available in 189 respondents) was 5.2 hours per night (SD ± 2.0). In a nested regression model predicting nightly hours of PAP use, a 10-point (0.5 SD) increase in USE-PAP score corresponded to a 0.37 hour/night reduction in PAP use. The model including the USE-PAP score explained a significant proportion (R2 = 15%) of the variation in nightly hours of PAP use above and beyond demographics, self-reported health, and interface type (∆R2 = 12%). Our results demonstrate that PAP usability varies among older patients and is associated with PAP adherence, above and beyond other predictors of adherence. These results support measuring and improving PAP usability to further improve PAP adherence for older patients. Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Development, validation and reproducibility of a food frequency questionnaire to measure flavonoid intake in older Australian adults.

PubMed

Kent, Katherine; Charlton, Karen E

2018-02-01

To develop and assess the validity and reproducibility of a food frequency questionnaire (FFQ) to measure total flavonoid intake, and individual flavonoid subclasses, in older adults. Retrospective analysis of flavonoid intake in older adults informed the development of a FFQ to measure flavonoid intake and determine the flavonoid subclasses consumed (anthocyanins, flavan-3-ols, flavones, flavonols and flavanones). Older adults (n = 42, mean age 75.3 ± 8.6 years) attended two interviews 1 month apart where anthropometrics (height and weight), blood pressure (BP), demographic data and a 93-item self-administered FFQ were collected. A 4-day food record (FR) was randomly administered between the two interview dates, and each food item was assigned a flavonoid and flavonoid subclass content using the United States Department of Agriculture flavonoid database. The criterion validity and reproducibility of the FFQ was assessed against a 4-day FR using the Wilcoxon signed-rank sum test, Spearman's correlation coefficient (r), Bland-Altman Plots and Cohen's kappa. Total flavonoid intake was determined (median intake FFQ = 919.3 mg/day, FR = 781.4 mg/day). Tests of validity indicated that the FFQ consistently overestimated total flavonoid intake compared with the 4-day FR. There was a significant difference in estimates between the FFQ and the 4-day FR for total flavonoid intake (Wilcoxon signed-rank sum P < 0.001; Bland-Altman plots indicated large bias and wide limits of agreement), but they were well correlated (Spearman's r 0.93, P < 0.001; Cohen's kappa κ = 0.619, P < 0.001). For individual flavonoid subclasses, the tests of validity indicated greater discrepancy compared with 4-day FR. The FFQ showed high reproducibility for estimating total flavonoid intake (FFQ1vsFFQ2: Wilcoxon signed-rank sum test, P > 0.05; Spearman's r 0.91, P < 0.001; Bland-Altman plots visually showed small, non-significant bias and wide limits of agreement; and Cohen's kappa κ = 0.619, P < 0.001), with a small mean percentage difference (6.7%). For individual flavonoid subclasses, the tests of reproducibility between FFQ1 and FFQ2 showed similarly high reproducibility. The developed FFQ appears suitable for satisfactorily ranking individuals according to total flavonoid intake. The FFQ shows limitations for estimating absolute total flavonoid intake and intake of flavonoid subclasses in comparison to a 4-day FR in terms of overestimating intake. Refinement and further validation of this tool may be required. © 2017 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Association of Australia.

Comparative impacts of Tai Chi, balance training, and a specially-designed yoga program on balance in older fallers.

PubMed

Ni, Meng; Mooney, Kiersten; Richards, Luca; Balachandran, Anoop; Sun, Mingwei; Harriell, Kysha; Potiaumpai, Melanie; Signorile, Joseph F

2014-09-01

To compare the effect of a custom-designed yoga program with 2 other balance training programs. Randomized controlled trial. Research laboratory. A group of older adults (N=39; mean age, 74.15 ± 6.99 y) with a history of falling. Three different exercise interventions (Tai Chi, standard balance training, yoga) were given for 12 weeks. Balance performance was examined during pre- and posttest using field tests, including the 8-foot up-and-go test, 1-leg stance, functional reach, and usual and maximal walking speed. The static and dynamic balances were also assessed by postural sway and dynamic posturography, respectively. Training produced significant improvements in all field tests (P<.005), but group difference and time × group interaction were not detected. For postural sway, significant decreases in the area of the center of pressure with eyes open (P=.001) and eyes closed (P=.002) were detected after training. For eyes open, maximum medial-lateral velocity significantly decreased for the sample (P=.013). For eyes closed, medial-lateral displacement decreased for Tai Chi (P<.01). For dynamic posturography, significant improvements in overall score (P=.001), time on the test (P=.006), and 2 linear measures in lateral (P=.001) and anterior-posterior (P<.001) directions were seen for the sample. Yoga was as effective as Tai Chi and standard balance training for improving postural stability and may offer an alternative to more traditional programs. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Whole-brain grey matter density predicts balance stability irrespective of age and protects older adults from falling.

PubMed

Boisgontier, Matthieu P; Cheval, Boris; van Ruitenbeek, Peter; Levin, Oron; Renaud, Olivier; Chanal, Julien; Swinnen, Stephan P

2016-03-01

Functional and structural imaging studies have demonstrated the involvement of the brain in balance control. Nevertheless, how decisive grey matter density and white matter microstructural organisation are in predicting balance stability, and especially when linked to the effects of ageing, remains unclear. Standing balance was tested on a platform moving at different frequencies and amplitudes in 30 young and 30 older adults, with eyes open and with eyes closed. Centre of pressure variance was used as an indicator of balance instability. The mean density of grey matter and mean white matter microstructural organisation were measured using voxel-based morphometry and diffusion tensor imaging, respectively. Mixed-effects models were built to analyse the extent to which age, grey matter density, and white matter microstructural organisation predicted balance instability. Results showed that both grey matter density and age independently predicted balance instability. These predictions were reinforced when the level of difficulty of the conditions increased. Furthermore, grey matter predicted balance instability beyond age and at least as consistently as age across conditions. In other words, for balance stability, the level of whole-brain grey matter density is at least as decisive as being young or old. Finally, brain grey matter appeared to be protective against falls in older adults as age increased the probability of losing balance in older adults with low, but not moderate or high grey matter density. No such results were observed for white matter microstructural organisation, thereby reinforcing the specificity of our grey matter findings. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of age, gender, bolus condition, viscosity, and volume on pharyngeal and upper esophageal sphincter pressure and temporal measurements during swallowing.

PubMed

Butler, Susan G; Stuart, Andrew; Castell, Donald; Russell, Gregory B; Koch, Kenneth; Kemp, Shannon

2009-02-01

The purpose of this study was to determine the effects of trial (i.e., Trial 1 vs. Trial 2); viscosity (i.e., saliva, thin, nectar-thick, honey-thick, and pudding-thick water); volume (i.e., 5 mL vs. 10 mL); age (i.e., young vs. older adults); and gender on pharyngeal (i.e., upper and lower) and upper esophageal sphincter (UES) pressures, durations, and onsets (i.e., onset of upper pharyngeal pressures relative to onsets of UES relaxations and onset of lower relative to upper pharyngeal pressures). Twenty-three young adults (M=30 years) and 21 older healthy adults (M=75 years) participated. Measurements were acquired with a 2.1-mm catheter during simultaneous manometric and endoscopic swallowing assessment. Participants contributed 18 swallows, affording a study total of 792 swallows for analyses. There was no significant effect of trial on any measurement of pressure, duration, and onset (ps=.63, .39, and .71, respectively). It was found that viscosity, volume, age, and gender affected pressure, duration, and onset measurements (e.g., onset of upper pharyngeal pressures relative to onsets of UES relaxations) but in varying degrees relative to the location in the pharynx or UES and the type of measurement (e.g., pressure, onset). Manometric measurements vary with respect to age, gender, and bolus variables and interactions of each. Consideration of these variables is paramount in understanding normal and pathological swallowing if manometry is to develop as a quantitative adjunct to videofluoroscopic and endoscopic swallowing tools.

Recent HIV Testing Prevalence, Determinants, and Disparities Among US Older Adult Respondents to the Behavioral Risk Factor Surveillance System

PubMed Central

Ford, Chandra L.; Godette, Dionne C.; Mulatu, Mesfin S.; Gaines, Tommi L.

2016-01-01

Background Although routine human immune deficiency virus (HIV) testing during health care visits is recommended for most adults, many older adults (i.e., ages 50–64 years) do not receive it. This study identified factors associated with HIV testing in the past 12 months (i.e., recent HIV testing) among US adults in the 3 categories of older adulthood (50–54, 55–59, and 60–64 years) for which routine HIV testing is recommended. Method This was a cross-sectional analysis of data from US older adult respondents to the 2010 Behavioral Risk Factor Surveillance System. We calculated prevalence (proportions) of HIV testing by age category and race/ethnicity. Using multiple logistic regression, we identified predisposing, enabling, and need factors associated with recent HIV testing within and across age categories, by race/ethnicity and controlling for covariates. Results HIV testing prevalence was low (<5%), varied by race/ethnicity, and decreased with age. Within and across age categories, the odds of testing were highest among blacks (odds ratio [OR], 3.47; 95% confidence interval [CI], 2.82–4.25) and higher among Latinos (OR, 2.06; 95% CI, 1.50–2.84) and the oldest and youngest categories of American Indians/Alaska Natives (OR, 2.48; 95% CI, 1.11–5.55; OR, 2.98; 95% CI, 1.49–5.95) than among whites. Those reporting a recent doctor visit (OR, 2.32; 95% CI, 1.92–2.74) or HIV risk behaviors (OR, 3.50; 95% CI, 2.67–4.59) had higher odds of HIV testing. Conclusion Regardless of risk, the oldest older adults, whites, and older women may forego HIV testing. Doctor visits may facilitate HIV testing. Additional research is needed to understand why eligible older adults seen by providers may not be screened for HIV infection. PMID:26165428

Prevalence, Types, Risk Factors and Clinical Correlates of Anaemia in Older People in a Rural Ugandan Population

PubMed Central

Mugisha, Joseph O.; Baisley, Kathy; Asiki, Gershim; Seeley, Janet; Kuper, Hannah

2013-01-01

Background Studies conducted in high income countries have shown that anaemia is a common medical condition among older people, but such data are scarce in Africa. The objectives of this study were to estimate the prevalence, types, risk factors and clinical correlates of anaemia in older people. Methods Participants were aged (≥ 50) years recruited from a general population cohort from January 2012 to January 2013. Blood samples were collected for assessing hemoglobin, serum ferritin, serum vitamin B12, serum folate, C-reactive protein, malaria infection and stool samples for assessment of hookworm infection. HIV status was assessed using an algorithm for HIV rapid testing. Questionnaires were used to collect data on sociodemographic characteristics and other risk factors for anaemia. Results In total, 1449 people participated (response rate 72.3%). The overall prevalence of anaemia was 20.3 % (95% CI 18.2-22.3%), and this was higher for males (24.1%, 95% CI=20.7-27.7%) than females (17.5%, 95% CI=15.0-20.1%). In males, the prevalence of anaemia increased rapidly with age almost doubling between 50 and 65 years (p-trend<0.001). Unexplained anaemia was responsible for more than half of all cases (59.7%). Anaemia was independently associated with infections including malaria (OR 3.49, 95% CI 1.78-6.82), HIV (OR 2.17, 1.32-3.57) heavy hookworm infection (OR 3.45, 1.73-6.91), low fruit consumption (OR 1.55, 1.05-2.29) and being unmarried (OR 1.37 , 95% CI 1.01-1.89). However, the odds of anaemia were lower among older people with elevated blood pressure (OR 0.47, 95% CI 0.29-0.77). Conclusion Anaemia control programmes in Uganda should target older people and should include interventions to treat and control hookworms and educational programs on diets that enhance iron absorption. Clinicians should consider screening older people with HIV or malaria for anaemia. Further studies should be done on unexplained anaemia and serum ferritin levels that predict iron deficiency anaemia in older people. PMID:24194926

Identification of the period of stability in a balance test after stepping up using a simplified cumulative sum.

PubMed

Safieddine, Doha; Chkeir, Aly; Herlem, Cyrille; Bera, Delphine; Collart, Michèle; Novella, Jean-Luc; Dramé, Moustapha; Hewson, David J; Duchêne, Jacques

2017-11-01

Falls are a major cause of death in older people. One method used to predict falls is analysis of Centre of Pressure (CoP) displacement, which provides a measure of balance quality. The Balance Quality Tester (BQT) is a device based on a commercial bathroom scale that calculates instantaneous values of vertical ground reaction force (Fz) as well as the CoP in both anteroposterior (AP) and mediolateral (ML) directions. The entire testing process needs to take no longer than 12 s to ensure subject compliance, making it vital that calculations related to balance are only calculated for the period when the subject is static. In the present study, a method is presented to detect the stabilization period after a subject has stepped onto the BQT. Four different phases of the test are identified (stepping-on, stabilization, balancing, stepping-off), ensuring that subjects are static when parameters from the balancing phase are calculated. The method, based on a simplified cumulative sum (CUSUM) algorithm, could detect the change between unstable and stable stance. The time taken to stabilize significantly affected the static balance variables of surface area and trajectory velocity, and was also related to Timed-up-and-Go performance. Such a finding suggests that the time to stabilize could be a worthwhile parameter to explore as a potential indicator of balance problems and fall risk in older people. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Association between body mass index and presence of carotid plaque among low-income adults aged 45 years and older: a population-based cross-sectional study in rural China.

PubMed

Lou, Yongzhong; Li, Bin; Su, Lan; Mu, Zhenhong; Sun, Minghao; Gu, Hongfei; Ni, Jingxian; Wu, Yanan; Tu, Jun; Wang, Jinghua; Ning, Xianjia

2017-10-06

Carotid plaque is a good surrogate endpoint for assessing arterial atherosclerosis, and atherosclerosis is a reliable predictor of cardiovascular diseases. However, the effect of body mass index on carotid plaque is unknown. Therefore, we aimed to explore the association between body mass index and carotid plaque in a low-income Chinese population. Residents aged ≥45 years and free of stroke and cardiovascular diseases were enrolled and divided into four groups based on body mass index. B-mode ultrasonography was performed to measure carotid plaque. The mean age of participants was 59.92 years overall. Significant correlations were observed between the presence of carotid plaque and male sex, older age, systolic blood pressure, fasting plasma glucose, and low-density lipoprotein cholesterol among the different BMI subgroups. Male sex increased the risk of carotid plaque in the overweight and obese groups. Older age and high level of low-density lipoprotein cholesterol were the independent risk factor for carotid plaque in four groups. Increased systolic blood pressure was an independent risk factor in the normal-weight, overweight, and obese groups; however, fasting plasma glucose was only significant in the normal-weight group. Thus, controlling the levels of low-density lipoprotein cholesterol, systolic blood pressure, and fasting plasma glucose is required to reduce carotid plaque risk.

How retellings shape younger and older adults' memories.

PubMed

Barber, Sarah J; Mather, Mara

2014-04-01

The way a story is retold influences the way it is later remembered; after retelling an event in a biased manner people subsequently remember the event in line with their distorted retelling. This study tested the hypothesis that this should be especially true for older adults. To test this, older and younger adults retold a story to be entertaining, to be accurate, or did not complete an initial retelling. Later, all participants recalled the story as accurately as possible. On this final test younger adults were unaffected by how they had previously retold the story. In contrast, older adults had better memory for the story's content and structure if they had previously retold the story accurately. Furthermore, for older adults, greater usage of storytelling language during the retelling was associated with lower subsequent recall. In summary, retellings exerted a greater effect on memory in older, compared with younger, adults.

How retellings shape younger and older adults’ memories

PubMed Central

Mather, Mara

2014-01-01

The way a story is retold influences the way it is later remembered; after retelling an event in a biased manner people subsequently remember the event in line with their distorted retelling. This study tested the hypothesis that this should be especially true for older adults. To test this, older and younger adults retold a story to be entertaining, to be accurate, or did not complete an initial retelling. Later, all participants recalled the story as accurately as possible. On this final test younger adults were unaffected by how they had previously retold the story. In contrast, older adults had better memory for the story’s content and structure if they had previously retold the story accurately. Furthermore, for older adults, greater usage of storytelling language during the retelling was associated with lower subsequent recall. In summary, retellings exerted a greater effect on memory in older, compared with younger, adults. PMID:25436107

Balance performance in older adults and its relationship with falling.

PubMed

Jalali, Mir Mohammad; Gerami, Hooshang; Heidarzadeh, Abtin; Soleimani, Robabeh

2015-06-01

A normal consequence of aging is a general deterioration in a number of musculoskeletal and sensory systems that affect postural control and balance. The aim of this study was to evaluate history of falls among active older individuals in Iran, and estimate the risk factors for falls among this population. A total of 448 active older subjects from rural region of Rasht city, Iran, were included. They were divided into three groups depending on their age: young-old (n = 266); middle-old (n = 154) and oldest-old (n = 28). We assessed balance performance by One-Leg Balance (OLB), Functional Reach (FR), Timed Up and Go (TUG) and Romberg tests. The fall rate (>2 in the last year) was 27.0 %. The cut-off point 13.75 s for TUG test showed 84.7 % sensitivity and 56 % specificity. Also the best cut-off point for OLB test was 12.7 s (63 % sensitivity and 83.5 % specificity). Logistic regression analysis revealed that age, BMI, diabetes, and failure in OLB, FR, and Romberg tests predicted fall risk. The decision tree classification of older individuals showed three categorical variables, which in their order of importance included diabetes, Romberg test, and OLB test. This study revealed the value of history taking about diabetes as a predictor for existing falling. Decision tree technique showed that Romberg and OLB tests help in identifying older adults with balance problems. Given the incidence and consequences of falls among older adults, large-scale prospective studies on older individuals to identify those prone to falls are warranted.

Frailty and cardiovascular risk in community-dwelling elderly: a population-based study.

PubMed

Ricci, Natalia Aquaroni; Pessoa, Germane Silva; Ferriolli, Eduardo; Dias, Rosangela Correa; Perracini, Monica Rodrigues

2014-01-01

Evidence suggests a possible bidirectional connection between cardiovascular disease (CVD) and the frailty syndrome in older people. To verify the relationship between CVD risk factors and the frailty syndrome in community-dwelling elderly. This population-based study used data from the Fragilidade em Idosos Brasileiros (FIBRA) Network Study, a cross-sectional study designed to investigate frailty profiles among Brazilian older adults. Frailty status was defined as the presence of three or more out of five of the following criteria: unintentional weight loss, weakness, self-reported fatigue, slow walking speed, and low physical activity level. The ascertained CVD risk factors were self-reported and/or directly measured hypertension, diabetes mellitus, obesity, waist circumference measurement, and smoking. Of the 761 participants, 9.7% were characterized as frail, 48.0% as pre-frail, and 42.3% as non-frail. The most prevalent CVD risk factor was hypertension (84.4%) and the lowest one was smoking (10.4%). It was observed that among those participants with four or five risk factors there was a higher proportion of frail and pre-frail compared with non-frail (Fisher's exact test: P=0.005; P=0.021). Self-reported diabetes mellitus was more prevalent among frail and pre-frail participants when compared with non-frail participants (Fisher's exact test: P≤0.001; P≤0.001). There was little agreement between self-reported hypertension and hypertension identified by blood pressure measurement. Hypertension was highly prevalent among the total sample. In addition, frail and pre-frail older people corresponded to a substantial proportion of those with more CVD risk factors, especially diabetes mellitus, highlighting the need for preventive strategies in order to avoid the co-occurrence of CVD and frailty.

Frailty and cardiovascular risk in community-dwelling elderly: a population-based study

PubMed Central

Ricci, Natalia Aquaroni; Pessoa, Germane Silva; Ferriolli, Eduardo; Dias, Rosangela Correa; Perracini, Monica Rodrigues

2014-01-01

Background Evidence suggests a possible bidirectional connection between cardiovascular disease (CVD) and the frailty syndrome in older people. Purpose To verify the relationship between CVD risk factors and the frailty syndrome in community-dwelling elderly. Methods This population-based study used data from the Fragilidade em Idosos Brasileiros (FIBRA) Network Study, a cross-sectional study designed to investigate frailty profiles among Brazilian older adults. Frailty status was defined as the presence of three or more out of five of the following criteria: unintentional weight loss, weakness, self-reported fatigue, slow walking speed, and low physical activity level. The ascertained CVD risk factors were self-reported and/or directly measured hypertension, diabetes mellitus, obesity, waist circumference measurement, and smoking. Results Of the 761 participants, 9.7% were characterized as frail, 48.0% as pre-frail, and 42.3% as non-frail. The most prevalent CVD risk factor was hypertension (84.4%) and the lowest one was smoking (10.4%). It was observed that among those participants with four or five risk factors there was a higher proportion of frail and pre-frail compared with non-frail (Fisher’s exact test: P=0.005; P=0.021). Self-reported diabetes mellitus was more prevalent among frail and pre-frail participants when compared with non-frail participants (Fisher’s exact test: P≤0.001; P≤0.001). There was little agreement between self-reported hypertension and hypertension identified by blood pressure measurement. Conclusion Hypertension was highly prevalent among the total sample. In addition, frail and pre-frail older people corresponded to a substantial proportion of those with more CVD risk factors, especially diabetes mellitus, highlighting the need for preventive strategies in order to avoid the co-occurrence of CVD and frailty. PMID:25336932

Estimating cardiorespiratory fitness in well-functioning older adults: treadmill validation of the long distance corridor walk.

PubMed

Simonsick, Eleanor M; Fan, Ellen; Fleg, Jerome L

2006-01-01

To determine criterion validity of the 400-m walk component of the Long Distance Corridor Walk (LDCW) and develop equations for estimating peak oxygen consumption (VO2) from 400-m time and factors intrinsic to test performance (e.g., heart rate (HR) and systolic blood pressure (SBP) response) in older adults. Cross-sectional validation study. Gerontology Research Center, National Institute on Aging, Baltimore, Maryland. Healthy volunteers (56 men and 46 women) aged 60 to 91 participating in the Baltimore Longitudinal Study of Aging between August 1999 and July 2000. The LDCW, consisting of a 2-minute walk followed immediately by a 400-m walk "done as quickly as possible" over a 20-m course was administered the day after maximal treadmill testing. HR and SBP were measured before testing and at the end of the 400-m walk. Weight, height, activity level, perceived effort, and stride length were also acquired. Peak VO2 ranged from 12.2 to 31.1 mL oxygen/kg per minute, and 400-m time ranged from 2 minutes 52 seconds to 6 minutes 18 seconds. Correlation between 400-m time and peak VO2 was -0.79. The estimating equation from linear regression included 400-m time (partial coefficient of determination (R2)=0.625), long versus short stride (partial R2=0.090), ending SBP (partial R2=0.019), and a correction factor for fast 400-m time (<240 seconds; partial R2=0.020) and explained 75.5% of the variance in peak VO2 (correlation coefficient=0.87). A 400-m walk performed as part of the LDCW provides a valid estimate of peak VO2 in older adults. Incorporating low-cost, safe assessments of fitness in clinical and research settings can identify early evidence of physical decline and individuals who may benefit from therapeutic interventions.

Multicomponent exercise decreases blood pressure, heart rate and double product in normotensive and hypertensive older patients with high blood pressure.

PubMed

Coelho-Júnior, Hélio José; Asano, Ricardo Yukio; Gonçalvez, Ivan de Oliveira; Brietzke, Cayque; Pires, Flávio Oliveira; Aguiar, Samuel da Silva; Feriani, Daniele Jardim; Caperuto, Erico Chagas; Uchida, Marco Carlos; Rodrigues, Bruno

2018-02-26

The present study aimed to investigate the effects of a 6-month multicomponent exercise program on blood pressure, heart rate, and double product of uncontrolled and controlled normotensive and hypertensive older patients. The study included 183 subjects, 97 normotensives, of which 53 were controlled normotensives (CNS), and 44 uncontrolled normotensives (UNS), as well as 86 hypertensives, of which 43 were controlled hypertensives (CHS), and 43 uncontrolled hypertensives (UHS). Volunteers were recruited and blood pressure and heart rate measurements were made before and after a 6-month multicomponent exercise program. The program of physical exercise was performed twice a week for 26 weeks. The physical exercises program was based on functional and walking exercises. Exercise sessions were performed at moderate intensity. The results indicated that UHS showed a marked decrease in systolic (-8.0mmHg), diastolic (-11.1mmHg), mean (-10.1mmHg), and pulse pressures, heart rate (-6.8bpm), and double product (-1640bpmmmHg), when compared to baseline. Similarly, diastolic (-5.5mmHg) and mean arterial (-4.8mmHg) pressures were significantly decreased in UNS. Concomitantly, significant changes could be observed in the body mass index (-0.9kg/m 2 ; -1.5kg/m 2 ) and waist circumference (-3.3cm; only UHS) of UNS and UHS, which may be associated with the changes observed in blood pressure. In conclusion, the data of the present study indicate that a 6-month multicomponent exercise program may lead to significant reductions in blood pressure, heart rate, and double product of normotensive and hypertensive patients with high blood pressure values. Copyright © 2018 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

Betel quid chewing in rural Bangladesh: prevalence, predictors and relationship to blood pressure.

PubMed

Heck, Julia E; Marcotte, Erin L; Argos, Maria; Parvez, Faruque; Ahmed, Alauddin; Islam, Tariqul; Sarwar, Golam; Hasan, Rabiul; Ahsan, Habibul; Chen, Yu

2012-04-01

Betel quid is chewed by 600 million people worldwide and it has been linked to obesity and cardiovascular disease. The purpose of our study was to examine the prevalence and predictors of betel quid chewing in a rural area of Bangladesh, and determine its effects on body mass index (BMI) and blood pressure. In this population-based prospective study, we analysed data on 19 934 Bangladeshi adults. Linear and multivariate logistic regression was used to determine the socio-demographic predictors of betel quid chewing and the effect of betel quid on change in BMI and on systolic and diastolic blood pressure, pulse pressure, arterial pressure, overweight or obesity, and hypertension. At baseline, betel quid was chewed by 33.2% of the cohort (35.5% of men, 31.6% of women). In a subsample in which we collected methods of use, 17.5% chewed it without tobacco and 82.5% chewed it with tobacco. In multivariate analysis, betel quid chewing was associated with female sex, older age, tobacco smoking and lower socio-economic status, as measured by fewer years of formal education and not owning land. Betel quid was chewed more times per day among women and older persons. At follow-up, persons who chewed betel quid without tobacco had higher systolic blood pressure, diastolic blood pressure and arterial pressure in comparison with never users. After controlling for other explanatory variables, chewing betel quid without tobacco was associated with general hypertension [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04-2.10] and systolic hypertension (OR 1.55, 95% CI 1.01-2.37). We did not observe associations of betel quid chewing with BMI or overweight. Betel quid chewing is likely contributing to high blood pressure in Bangladesh, particularly among women.

Postaerobic Exercise Blood Pressure Reduction in Very Old Persons With Hypertension.

PubMed

Oliveira, Joana; Mesquita-Bastos, José; Argel de Melo, Cristina; Ribeiro, Fernando

2016-01-01

A single bout of aerobic exercise acutely decreases blood pressure, even in older adults with hypertension. Nonetheless, blood pressure responses to aerobic exercise in very old adults with hypertension have not yet been documented. Therefore, this study aimed to assess the effect of a single session of aerobic exercise on postexercise blood pressure in very old adults with hypertension. Eighteen older adults with essential hypertension were randomized into exercise (N = 9, age: 83.4 ± 3.2 years old) or control (N = 9, age: 82.7 ± 2.5 years old) groups. The exercise group performed a session of aerobic exercise constituting 2 periods of 10 minutes of walking at an intensity of 40% to 60% of the heart rate reserve. The control group rested for the same period of time. Anthropometric variables and medication status were evaluated at baseline. Heart rate and systolic and diastolic blood pressures were measured at baseline, after exercise, and at 20 and 40 minutes postexercise. Systolic blood pressure showed a significant interaction for group × time (F3,24 = 6.698; P = .002; ηp(2) = 0.153). In the exercise group, the systolic blood pressure at 20 (127.3 ± 20.9 mm Hg) and 40 minutes (123.7 ± 21.0 mm Hg) postexercise was significantly lower in comparison with baseline (135.6 ± 20.6 mm Hg). Diastolic blood pressure did not change. Heart rate was significantly higher after the exercise session. In the control group, no significant differences were observed. A single session of aerobic exercise acutely reduces blood pressure in very old adults with hypertension and may be considered an important nonpharmacological strategy to control hypertension in this age group.

Induction of Multidrug Tolerance in Plasmodium falciparum by Extended Artemisinin Pressure

PubMed Central

Ménard, Sandie; Ben Haddou, Tanila; Ramadani, Arba Pramundita; Ariey, Frédéric; Iriart, Xavier; Beghain, Johann; Bouchier, Christiane; Witkowski, Benoit; Berry, Antoine; Mercereau-Puijalon, Odile

2015-01-01

Plasmodium falciparum resistance to artemisinin derivatives in Southeast Asia threatens global malaria control strategies. Whether delayed parasite clearance, which exposes larger parasite numbers to artemisinins for longer times, selects higher-grade resistance remains unexplored. We investigated whether long-lasting artemisinin pressure selects a novel multidrug-tolerance profile. Although 50% inhibitory concentrations for 10 antimalarial drugs tested were unchanged, drug-tolerant parasites showed higher recrudescence rates for endoperoxides, quinolones, and an antifolate, including partner drugs of recommended combination therapies, but remained susceptible to atovaquone. Moreover, the age range of intraerythrocytic stages able to resist artemisinin was extended to older ring forms and trophozoites. Multidrug tolerance results from drug-induced quiescence, which enables parasites to survive exposure to unrelated antimalarial drugs that inhibit a variety of metabolic pathways. This novel resistance pattern should be urgently monitored in the field because this pattern is not detected by current assays and represents a major threat to antimalarial drug policy. PMID:26401601

Hypermnesia: a further examination of age differences between young and older adults.

PubMed

Otani, Hajime; Kato, Koichi; Von Glahn, Nicholas R; Nelson, Meghann E; Widner, Robert L; Goernert, Phillip N

2008-05-01

Previous studies that examined age differences in hypermnesia reported inconsistent results. The present experiment investigated whether the different study materials in these studies were responsible for the inconsistency. In particular, the present experiment examined whether the use of a video, as opposed to words and pictures, would eliminate previously reported age differences in hypermnesia. Fifteen college students and 15 older adults viewed a 3-minute video clip followed by two free-recall tests. The results indicated that older adults, as a whole, did not show hypermnesia. However, when older adults were divided into low and high memory groups based on test 1 performance, the high memory group showed hypermnesia whereas the low memory group did not show hypermnesia. The older adults in the low memory group were significantly older than the older adults in the high memory group - indicating that hypermnesia is inversely related to age in older adults. Reminiscence did not show an age-related difference in either the low or high memory group whereas inter-test forgetting did show an age difference in the low memory group. As expected, older adults showed greater inter-test forgetting than young adults in the low memory group. Findings from the present experiment suggest that video produces a pattern of results that is similar to the patterns obtained when words and pictures are used as study material. Thus, it appears that the nature of study material is not the source of inconsistency across the previous studies.

A comparison of activity classification in younger and older cohorts using a smartphone.

PubMed

Del Rosario, Michael B; Wang, Kejia; Wang, Jingjing; Liu, Ying; Brodie, Matthew; Delbaere, Kim; Lovell, Nigel H; Lord, Stephen R; Redmond, Stephen J

2014-11-01

Automatic recognition of human activity is useful as a means of estimating energy expenditure and has potential for use in fall detection and prediction. The emergence of the smartphone as a ubiquitous device presents an opportunity to utilize its embedded sensors, computational power and data connectivity as a platform for continuous health monitoring. In the study described herein, 37 older people (83.9  ±  3.4 years) performed a series of activities of daily living (ADLs) while a smartphone (containing a triaxial accelerometer, triaxial gyroscope and barometric pressure sensor) was placed in the front pocket of their trousers. These results are compared to a similar trial conducted previously in which 20 young people (21.9  ±  1.65 years) were asked to perform the same ADLs using the same smartphone (again in the front pocket of their trousers).In each trial, the participants were asked to perform several activities (standing, sitting, lying, walking on level ground, up and down staircases, and riding an elevator up and down) in a free-living environment. During each acquisition session, the internal sensor signals were recorded and subsequently used to develop activity classifiers based on a decision tree algorithm that classified ADL in epochs of ~1.25 s. When training and testing with the younger cohort, using a leave-one-out cross validation procedure, a total classification sensitivity of 80.9% ± 9.57% ([Formula: see text] = 0.75  ±  0.12) was obtained. Retraining and testing on the older cohort, again using cross validation, gives a comparable total class sensitivity of 82.0% ± 8.88% ([Formula: see text] =0.74  ±  0.12).When trained with the younger group and tested on the older group, a total class sensitivity of 69.2% ± 24.8% (95% confidence interval [69.6%, 70.6%]) and [Formula: see text] = 0.60  ±  0.27 (95% confidence interval [0.58, 0.59]) was obtained. When trained on the older group and tested on the younger group, a total class sensitivity of 80.5% ± 6.80% (95% confidence interval [79.0%, 80.6%]) and [Formula: see text] = 0.74  ±  0.08 (95% confidence interval [0.73, 0.75]) was obtained.An instance of the decision tree classifier developed was implemented on the smartphone as a software application. It was capable of performing real-time activity classification for a period of 17 h on a single battery charge, illustrating that smartphone technology provides a viable platform on which to perform long-term activity monitoring.

Laryngeal Aerodynamics in Healthy Older Adults and Adults With Parkinson's Disease.

PubMed

Matheron, Deborah; Stathopoulos, Elaine T; Huber, Jessica E; Sussman, Joan E

2017-03-01

The present study compared laryngeal aerodynamic function of healthy older adults (HOA) to adults with Parkinson's disease (PD) while speaking at a comfortable and increased vocal intensity. Laryngeal aerodynamic measures (subglottal pressure, peak-to-peak flow, minimum flow, and open quotient [OQ]) were compared between HOAs and individuals with PD who had a diagnosis of hypophonia. Increased vocal intensity was elicited via monaurally presented multitalker background noise. At a comfortable speaking intensity, HOAs and individuals with PD produced comparable vocal intensity, rates of vocal fold closure, and minimum flow. HOAs used smaller OQs, higher subglottal pressure, and lower peak-to-peak flow than individuals with PD. Both groups increased speaking intensity when speaking in noise to the same degree. However, HOAs produced increased intensity with greater driving pressure, faster vocal fold closure rates, and smaller OQs than individuals with PD. Monaural background noise elicited equivalent vocal intensity increases in HOAs and individuals with PD. Although both groups used laryngeal mechanisms as expected to increase sound pressure level, they used these mechanisms to different degrees. The HOAs appeared to have better control of the laryngeal mechanism to make changes to their vocal intensity.

Twenty weeks of isometric handgrip home training to lower blood pressure in hypertensive older adults: a study protocol for a randomized controlled trial.

PubMed

Jørgensen, Martin Grønbech; Ryg, Jesper; Danielsen, Mathias Brix; Madeleine, Pascal; Andersen, Stig

2018-02-09

Hypertension markedly increases the risk of cardiovascular diseases and overall mortality. Lifestyle modifications, such as increased levels of physical activity, are recommended as the first line of anti-hypertensive treatment. A recent systematic review showed that isometric handgrip (IHG) training was superior to traditional endurance and strength training in lowering resting systolic blood pressure (SBP). The average length of previous IHG training studies is approximately 7.5 weeks with the longest being 10 weeks. Therefore, presently it is unknown if it is possible to further lower blood pressure levels beyond the 10-week mark. Recently, we developed a novel method for monitoring handgrip intensity using a standard Nintendo Wii Board (Wii). The primary aim of this study is to explore the effects of a 20-week IHG home training facilitated by a Wii in hypertensive older adults (50 + years of age) on lowering SBP compared to usual care. Secondary aims are to explore if/when a leveling-off effect on SBP will occur during the 20-week intervention period in the training group and to explore adherence and potential harms related to the IHG home training. Based on previous evidence, we calculated that 50 hypertensive (SBP between 140 and 179 mmHg), older adults (50 + years of age) are needed to achieve a power of 80% or more. Participants will be randomly assigned to either an intervention >group (IHG home training + hypertension guidelines on lifestyle changes) or to a control group (hypertension guidelines on lifestyle changes). Participants in the intervention group will perform IHG home training (30% of maximum grip strength for a total of 8 min per day per hand) three times a week for 20 weeks. Resting blood pressure and maximal handgrip strength will be obtained by a blinded outcome assessor in both groups at specific time points (baseline, follow-up at 5, 10, 15, and 20 weeks) throughout the study. This assessor-blinded, randomized controlled trial will explore the effect of a 20-week IHG home training intervention on resting blood pressure in hypertensive older adults. In addition, the trial will report adherence and potential harms related to the IHG home training. ClinicalTrials.gov, ID: NCT03069443 . Registered on 3 March 2017.

Physical activity behavior predicts endogenous pain modulation in older adults.

PubMed

Naugle, Kelly M; Ohlman, Thomas; Naugle, Keith E; Riley, Zachary A; Keith, NiCole R

2017-03-01

Older adults compared with younger adults are characterized by greater endogenous pain facilitation and a reduced capacity to endogenously inhibit pain, potentially placing them at a greater risk for chronic pain. Previous research suggests that higher levels of self-reported physical activity are associated with more effective pain inhibition and less pain facilitation on quantitative sensory tests in healthy adults. However, no studies have directly tested the relationship between physical activity behavior and pain modulatory function in older adults. This study examined whether objective measures of physical activity behavior cross-sectionally predicted pain inhibitory function on the conditioned pain modulation (CPM) test and pain facilitation on the temporal summation (TS) test in healthy older adults. Fifty-one older adults wore an accelerometer on the hip for 7 days and completed the CPM and TS tests. Measures of sedentary time, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were obtained from the accelerometer. Hierarchical linear regressions were conducted to determine the relationship of TS and CPM with levels of physical activity, while controlling for demographic, psychological, and test variables. The results indicated that sedentary time and LPA significantly predicted pain inhibitory function on the CPM test, with less sedentary time and greater LPA per day associated with greater pain inhibitory capacity. Additionally, MVPA predicted pain facilitation on the TS test, with greater MVPA associated with less TS of pain. These results suggest that different types of physical activity behavior may differentially impact pain inhibitory and facilitatory processes in older adults.

Lower-extremity function in cognitively healthy aging, mild cognitive impairment, and Alzheimer's disease.

PubMed

Eggermont, Laura H; Gavett, Brandon E; Volkers, Karin M; Blankevoort, Christiaan G; Scherder, Erik J; Jefferson, Angela L; Steinberg, Eric; Nair, Anil; Green, Robert C; Stern, Robert A

2010-04-01

To examine differences in lower-extremity function in cognitive healthy older persons, older persons with mild cognitive impairment (MCI), and older persons with Alzheimer's disease (AD). Descriptive study. University Alzheimer's disease clinical and research program. Older persons (N=66) were studied (mean age, 76.7y); 22 were cognitively normal, 22 were diagnosed with probable MCI, 22 were diagnosed with probable AD. Not applicable. Lower-extremity function was assessed by the four-meter walk test (4MWT), Timed Up & Go (TUG) test, and sit-to-stand (STS) test. Analysis of variance, adjusting for covariates, revealed that performance on the 4MWT was significantly lower in the MCI and AD groups as compared with controls. TUG test performance was worse in the AD group compared with controls. No significant group differences were found for STS performance. These results suggest an association between cognitive impairment and lower-limb function in older persons. Walking speed could be evaluated for its possible utility in screening older persons at risk for cognitive impairment and falls. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Riboflavin

MedlinePlus

... and nails, to slow aging, for canker sores, multiple sclerosis, memory loss including Alzheimer's disease, high blood pressure, ... the risk of liver cancer in older people. Multiple sclerosis. Early research shows that taking riboflavin by mouth ...

The effect of antihypertensive agents on sleep apnea: protocol for a randomized controlled trial.

PubMed

Cichelero, Fábio Tremea; Martinez, Denis; Fuchs, Sandra Costa; Gus, Miguel; Moreira, Leila Beltrami; Fuchs, Flávio Danni

2014-01-02

Obstructive sleep apnea (OSA) and hypertension are well-known cardiovascular risk factors. Their control could reduce the burden of heart disease across populations. Several drugs are used to control hypertension, but the only consistently effective treatment of OSA is continuous positive airway pressure. The identification of a drug capable of improving OSA and hypertension simultaneously would provide a novel approach in the treatment of both diseases. This is a randomized double-blind clinical trial, comparing the use of chlorthalidone with amiloride versus amlodipine as a first drug option in patients older than 40 years of age with stage I hypertension (140 to 159/90 to 99 mmHg) and moderate OSA (15 to 30 apneas/hour of sleep). The primary outcomes are the variation of the number of apneas per hour and blood pressure measured by ambulatory blood pressure monitoring. The secondary outcomes are adverse events, somnolence scale (Epworth), ventilatory parameters and C reactive protein levels. The follow-up will last 8 weeks. There will be 29 participants per group. The project has been approved by the ethics committee of our institution. The role of fluid retention in OSA has been known for several decades. The use of diuretics are well established in treating hypertension but have never been appropriately tested for sleep apnea. As well as testing the efficacy of these drugs, this study will help to understand the mechanisms that link hypertension and sleep apnea and their treatment. ClinicalTrials.gov: NCT01896661.

Differences in Functional Fitness Among Older Adults With and Without Risk of Falling.

PubMed

Zhao, Yanan; Chung, Pak-Kwong

2016-03-01

This study aimed to identify the differences in functional fitness between older adults who were at risk of falling and those who were not. A total of 104 older adults aged 65-74 years were recruited from a local community senior center. They were independent older adults without a history of falls in the preceding 12 months. Falling risk status was assessed using the Fall Risk Test. Five dimensions of functional fitness with seven testing parameters (i.e., 30-second chair stand test, 30-second arm curl test, 2-minute step test, chair sit and reach test, back scratch test, 8-foot up and go test, and body mass index) were evaluated by the Senior Fitness Test. Only 78 participants completed all the tests, of which 48 participants were identified with risk of falling, and 30 participants were free from risk of falling. Results from multivariate analysis of variance found significant differences on the combined outcome variables, especially in the 8-foot up and go test, 2-minute step test, and 30-second arm curl test. Results from discriminant analysis found a significant discriminant function among all the seven testing parameters, where the 8-foot up and go test, and the 2-minute step test contributed most. Older adults who are at the early stage of risk of falling tend to have lower functional fitness capacities, especially in agility and dynamic balance, aerobic endurance as well as in a combined relationship among all the testing parameters. Copyright © 2016. Published by Elsevier B.V.

Dynapenia and Metabolic Health in Obese and Nonobese Adults Aged 70 Years and Older: The LIFE Study.

PubMed

Aubertin-Leheudre, Mylène; Anton, Stephen; Beavers, Daniel P; Manini, Todd M; Fielding, Roger; Newman, Ann; Church, Tim; Kritchevsky, Stephen B; Conroy, David; McDermott, Mary M; Botoseneanu, Anda; Hauser, Michelle E; Pahor, Marco

2017-04-01

The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and nonobese older adults. A total of 1453 men and women (age ≥70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) nondynapenic/nonobese (NDYN-NO), (2) dynapenic/nonobese (DYN-NO), (3) nondynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (Foundation for the National Institute of Health criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least 3 metabolic syndrome (MetS) criteria, and other chronic conditions. A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared with DYN-NO groups (55.6 vs 45.1%, P ≤ .01) was observed. Waist circumference also was significantly higher in obese groups (DYN-O = 114.0 ± 12.9 and NDYN-O = 111.2 ± 13.1) than in nonobese (NDYN-NO = 93.1 ± 10.7 and DYN-NO = 92.2 ± 11.2, P ≤ .01); and higher in NDYN-O compared with DYN-O (P = .008). Additionally, NDYN-O demonstrated higher diastolic blood pressure compared with DYN-O (70.9 ± 10.1 vs 67.7 ± 9.7, P ≤ .001). No significant differences were found across dynapenia and obesity status for all other metabolic components (P > .05). The odds of having MetS or its individual components were similar in obese and nonobese, combined or not with dynapenia (nonsignificant odds ratio [95% confidence interval]). Nonobese dynapenic older adults had fewer metabolic disease risk factors than nonobese and nondynapenic older adults. Moreover, among obese older adults, dynapenia was associated with lower risk of meeting MetS criteria for waist circumference and diastolic blood pressure. Additionally, the presence of dynapenia did not increase cardiometabolic disease risk in either obese or nonobese older adults. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Evidence for age-dependent air-space enlargement contributing to loss of lung tissue elastic recoil pressure and increased shear modulus in older age.

PubMed

Subramaniam, K; Kumar, H; Tawhai, M H

2017-07-01

As a normal part of mature aging, lung tissue undergoes microstructural changes such as alveolar air-space enlargement and redistribution of collagen and elastin away from the alveolar duct. The older lung also experiences an associated decrease in elastic recoil pressure and an increase in specific tissue elastic moduli, but how this relates mechanistically to microstructural remodeling is not well-understood. In this study, we use a structure-based mechanics analysis to elucidate the contributions of age-related air-space enlargement and redistribution of elastin and collagen to loss of lung elastic recoil pressure and increase in tissue elastic moduli. Our results show that age-related geometric changes can result in reduction of elastic recoil pressure and increase in shear and bulk moduli, which is consistent with published experimental data. All elastic moduli were sensitive to the distribution of stiffness (representing elastic fiber density) in the alveolar wall, with homogenous stiffness near the duct and through the septae resulting in a more compliant tissue. The preferential distribution of elastic proteins around the alveolar duct in the healthy young adult lung therefore provides for a more elastic tissue. NEW & NOTEWORTHY We use a structure-based mechanics analysis to correlate air-space enlargement and redistribution of elastin and collagen to age-related changes in the mechanical behavior of lung parenchyma. Our study highlights that both the cause (redistribution of elastin and collagen) and the structural effect (alveolar air-space enlargement) contribute to decline in lung tissue elastic recoil with age; these results are consistent with published data and provide a new avenue for understanding the mechanics of the older lung. Copyright © 2017 the American Physiological Society.

Testing the Limits of Optimizing Dual-Task Performance in Younger and Older Adults

PubMed Central

Strobach, Tilo; Frensch, Peter; Müller, Herrmann Josef; Schubert, Torsten

2012-01-01

Impaired dual-task performance in younger and older adults can be improved with practice. Optimal conditions even allow for a (near) elimination of this impairment in younger adults. However, it is unknown whether such (near) elimination is the limit of performance improvements in older adults. The present study tests this limit in older adults under conditions of (a) a high amount of dual-task training and (b) training with simplified component tasks in dual-task situations. The data showed that a high amount of dual-task training in older adults provided no evidence for an improvement of dual-task performance to the optimal dual-task performance level achieved by younger adults. However, training with simplified component tasks in dual-task situations exclusively in older adults provided a similar level of optimal dual-task performance in both age groups. Therefore through applying a testing the limits approach, we demonstrated that older adults improved dual-task performance to the same level as younger adults at the end of training under very specific conditions. PMID:22408613

Improving associative memory in older adults with unitization.

PubMed

Ahmad, Fahad N; Fernandes, Myra; Hockley, William E

2015-01-01

We examined if unitization inherent preexperimentally could reduce the associative deficit in older adults. In Experiment 1, younger and older adults studied compound word (CW; e.g., store keeper) and noncompound word (NCW; e.g., needle birth) pairs. We found a reduction in the age-related associative deficit such that older but not younger adults showed a discrimination advantage for CW relative to NCW pairs on a yes-no associative recognition test. These results suggest that CW compared to NCW word pairs provide schematic support that older adults can use to improve their memory. In Experiment 2, reducing study time in younger adults decreased associative recognition performance, but did not produce a discrimination advantage for CW pairs. In Experiment 3, both older and younger adults showed a discrimination advantage for CW pairs on a two-alternative forced-choice recognition test, which encourages greater use of familiarity. These results suggest that test format influenced young adults' use of familiarity during associative recognition of unitized pairs, and that older adults rely more on familiarity than recollection for associative recognition. Unitization of preexperimental associations, as in CW pairs, can alleviate age-related associative deficits.

The influence of age and diabetes on the skin blood flow response to local pressure.

PubMed

Petrofsky, Jerrold S; Bains, Gurinder S; Prowse, Michelle; Mc Lellan, Katie; Ethiraju, Gomathi; Lee, Scott; Gunda, Shashi; Lohman, Everett; Schwab, Ernie

2009-07-01

Previous data has shown that when pressure is applied to the skin of the ankle and on the foot, there is a reactive increase in circulation. In the present investigation, these studies were expanded to look at the response of the hand, back, and foot to applied pressure. Ten young subjects whose average age was 26.5+/-3.3 yrs, 10 older subjects whose average age was 73.3+/-19.7 yrs and 10 people with diabetes whose average age was 60.1+/-5.7 yrs participated in the study. There was no statistical difference in the height or weight of the subjects. Hemoglobin A1c of the group with Diabetes averaged 6.98+/-1.15% with the mean duration of diabetes 13.6+/-9.5 yrs. An infrared laser Doppler flow meter was used to measure circulation on the hand, lower back, and on the bottom of the foot during applications of pressure at 15, 30, 45, and 60 kPa. For all three areas of the body, circulation was significantly less in the group with diabetes than the other two groups (p<0.05). When pressure was applied at 15 kPa, the blood flow to the skin initially decreased, but then increased in the younger subjects and in the older subjects but did not increase in subjects with diabetes for any area of the body. Further, after pressure was released, for any of the four pressures examined here, while the younger subjects showed a pronounced reactive hyperemia, subjects with diabetes showed a diminished hyperemia not proportional to the pressure that was applied. It appears that the normal protective mechanism of a pressure induced hyperemia is absent or diminished in patients with diabetes with more effect on the periphery than on the core area of the body. More importantly, after pressure was applied and released, subjects with diabetes lacked a proportional hyperemia to recovery form the transient ischemia of the pressure.

Chronic disease burden predicts food insecurity among older adults.

PubMed

Jih, Jane; Stijacic-Cenzer, Irena; Seligman, Hilary K; Boscardin, W John; Nguyen, Tung T; Ritchie, Christine S

2018-06-01

Increased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity. Secondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS. USA. Respondents of the 2013 HRS HCNS with household incomes <300 % of the federal poverty line (n 3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0-1, 2-4, ≥5 conditions), with multiple chronic conditions (MCC) defined as ≥2 conditions. The prevalence of food insecurity was 27·8 %. Compared with those having 0-1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2-4 conditions being 2·12 (95 % CI 1·45, 3·09) and for those with ≥5 conditions being 3·64 (95 % CI 2·47, 5·37). A heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.

Using Diffusion Bonding in Making Piezoelectric Actuators

NASA Technical Reports Server (NTRS)

Sager, Frank E.

2003-01-01

A technique for the fabrication of piezoelectric actuators that generate acceptably large forces and deflections at relatively low applied voltages involves the stacking and diffusion bonding of multiple thin piezoelectric layers coated with film electrodes. The present technique stands in contrast to an older technique in which the layers are bonded chemically, by use of urethane or epoxy agents. The older chemical-bonding technique entails several disadvantages, including the following: It is difficult to apply the bonding agents to the piezoelectric layers. It is difficult to position the layers accurately and without making mistakes. There is a problem of disposal of hazardous urethane and epoxy wastes. The urethane and epoxy agents are nonpiezoelectric materials. As such, they contribute to the thickness of a piezoelectric laminate without contributing to its performance; conversely, for a given total thickness, the performance of the laminate is below that of a unitary piezoelectric plate of the same thickness. The figure depicts some aspects of the fabrication of a laminated piezoelectric actuator by the present diffusion- bonding technique. First, stock sheets of the piezoelectric material are inspected and tested. Next, the hole pattern shown in the figure is punched into the sheets. Alternatively, if the piezoelectric material is not a polymer, then the holes are punched in thermoplastic films. Then both faces of each punched piezoelectric sheet or thermoplastic film are coated with a silver-ink electrode material by use of a silkscreen printer. The electrode and hole patterns are designed for minimal complexity and minimal waste of material. After a final electrical test, all the coated piezoelectric layers (or piezoelectric layers and coated thermoplastic films) are stacked in an alignment jig, which, in turn, is placed in a curved press for the diffusion-bonding process. In this process, the stack is pressed and heated at a specified curing temperature and pressure for a specified curing time. The pressure, temperature, and time depend on the piezoelectric material selected. At the end of the diffusion-bonding process, the resulting laminated piezoelectric actuator is tested to verify the adequacy of the mechanical output as a function of an applied DC voltage.

Assessing the associative deficit of older adults in long-term and short-term/working memory.

PubMed

Chen, Tina; Naveh-Benjamin, Moshe

2012-09-01

Older adults exhibit a deficit in associative long-term memory relative to younger adults. However, the literature is inconclusive regarding whether this deficit is attenuated in short-term/working memory. To elucidate the issue, three experiments assessed younger and older adults' item and interitem associative memory and the effects of several variables that might potentially contribute to the inconsistent pattern of results in previous studies. In Experiment 1, participants were tested on item and associative recognition memory with both long-term and short-term retention intervals in a single, continuous recognition paradigm. There was an associative deficit for older adults in the short-term and long-term intervals. Using only short-term intervals, Experiment 2 utilized mixed and blocked test designs to examine the effect of test event salience. Blocking the test did not attenuate the age-related associative deficit seen in the mixed test blocks. Finally, an age-related associative deficit was found in Experiment 3, under both sequential and simultaneous presentation conditions. Even while accounting for some methodological issues, the associative deficit of older adults is evident in short-term/working memory.

Air cleaning performance of a new environmentally controlled primary crusher operator booth

PubMed Central

Organiscak, J.A.; Cecala, A.B.; Zimmer, J.A.; Holen, B.; Baregi, J.R.

2016-01-01

The National Institute for Occupational Safety and Health (NIOSH) cooperated with 3M Company in the design and testing of a new environmentally controlled primary crusher operator booth at the company’s Wausau granite quarry near Wausau, WI. This quarry had an older crusher booth without a central heating, ventilation and air conditioning (HVAC) system, and without an air filtration and pressurization system. A new replacement operator booth was designed and installed by 3M based on design considerations from past NIOSH research on enclosed cab filtration systems. NIOSH conducted pre-testing of the old booth and post-testing of the new booth to assess the new filtration and pressurization system’s effectiveness in controlling airborne dusts and particulates. The booth’s dust and particulate control effectiveness is described by its protection factor, expressed as a ratio of the outside to inside concentrations measured during testing. Results indicate that the old booth provided negligible airborne respirable dust protection and low particulate protection from the outside environment. The newly installed booth provided average respirable dust protection factors from 2 to 25 over five shifts of dust sampling with occasional worker ingress and egress from the booth, allowing some unfiltered contaminants to enter the enclosure. Shorter-term particle count testing outside and inside the booth under near-steady-state conditions, with no workers entering or exiting the booth, resulted in protection factors from 35 to 127 on 0.3- to 1.0-μm respirable size particulates under various HVAC airflow operating conditions. PMID:26937052

Usefulness of cardiopulmonary exercise testing to predict the development of arterial hypertension in adult patients with repaired isolated coarctation of the aorta.

PubMed

Buys, Roselien; Van De Bruaene, Alexander; Müller, Jan; Hager, Alfred; Khambadkone, Sachin; Giardini, Alessandro; Cornelissen, Véronique; Budts, Werner; Vanhees, Luc

2013-10-03

Patients who underwent surgery for aortic coarctation (COA) have an increased risk of arterial hypertension. We aimed at evaluating (1) differences between hypertensive and non-hypertensive patients and (2) the value of cardiopulmonary exercise testing (CPET) to predict the development or progression of hypertension. Between 1999 and 2010, CPET was performed in 223 COA-patients of whom 122 had resting blood pressures of <140/90 mmHg without medication, and 101 were considered hypertensive. Comparative statistics were performed. Cox regression analysis was used to assess the relation between demographic, clinical and exercise variables and the development/progression of hypertension. At baseline, hypertensive patients were older (p=0.007), were more often male (p=0.004) and had repair at later age (p=0.008) when compared to normotensive patients. After 3.6 ± 1.2 years, 29/120 (25%) normotensive patients developed hypertension. In normotensives, VE/VCO2-slope (p=0.0016) and peak systolic blood pressure (SBP; p=0.049) were significantly related to the development of hypertension during follow-up. Cut-off points related to higher risk for hypertension, based on best sensitivity and specificity, were defined as VE/VCO2-slope ≥ 27 and peak SBP ≥ 220 mmHg. In the hypertensive group, antihypertensive medication was started/extended in 48/101 (48%) patients. Only age was associated with the need to start/extend antihypertensive therapy in this group (p=0.042). Higher VE/VCO2-slope and higher peak SBP are risk factors for the development of hypertension in adults with COA. Cardiopulmonary exercise testing may guide clinical decision making regarding close blood pressure control and preventive lifestyle recommendations. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Identification of anaerobic threshold by analysis of heart rate variability during discontinuous dynamic and resistance exercise protocols in healthy older men.

PubMed

Simões, Rodrigo Polaquini; Castello-Simões, Viviane; Mendes, Renata Gonçalves; Archiza, Bruno; Dos Santos, Daniel Augusto; Bonjorno, José Carlos; de Oliveira, Claudio Ricardo; Catai, Aparecida Maria; Arena, Ross; Borghi-Silva, Audrey

2014-03-01

The purposes of this study were to determine anaerobic threshold (AT) during discontinuous dynamic and resistive exercise protocols by analysing of heart rate variability (HRV) and blood lactate (BL) in healthy elderly subjects and compare the cardiovascular, metabolic and autonomic variables obtained from these two forms of exercise. Fourteen elderly (70 ± 4 years) apparently healthy males underwent the following tests: (i) incremental ramp test on cycle ergometer, (ii) one repetition maximum (1RM) leg press at 45°, (iii) a discontinuous exercise test on a cycle ergometer (DET-C) protocol and (iv) a resistance exercise leg press (DET-L) protocol. Heart rate, blood pressure and BL were obtained during each increment of exercise intensity. No significant differences (P>0·05) were found between methods of AT determination (BL and HRV) nor the relative intensity corresponding to AT (30% of maximum intensity) between the types of exercise (DET-C and DET-L). Furthermore, no significant differences (P>0·05) were found between the DET-C and DET-L in relation to HRV, however, the DET-L provided higher values of systolic blood pressure and BL (P<0·05) from the intensity corresponding to AT. We conclude that HRV was effective in determination of AT, and the parasympathetic modulation responses obtained during dynamic and resistive exercise protocols were similar when compared at the same relative intensity. However, DET-L resulted in higher values of blood pressure and BL at workloads beyond AT. © 2013 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Distribution and associations of intraocular pressure in 7- and 12-year-old Chinese children: The Anyang Childhood Eye Study.

PubMed

Li, Shuning; Li, Shi-Ming; Wang, Xiao-Lei; Kang, Meng-Tian; Liu, Luo-Ru; Li, He; Wei, Shi-Fei; Ran, An-Ran; Zhan, Siyan; Thomas, Ravi; Wang, Ningli

2017-01-01

To report the intraocular pressure (IOP) and its association with myopia and other factors in 7 and 12-year-old Chinese children. All children participating in the Anyang Childhood Eye Study underwent non-contact tonometry as well as measurement of central corneal thickness (CCT), axial length, cycloplegic auto-refraction, blood pressure, height and weight. A questionnaire was used to collect other relevant information. Univariable and multivariable analysis were performed to determine the associations of IOP. A total of 2760 7-year-old children (95.4%) and 2198 12-year-old children (97.0%) were included. The mean IOP was 13.5±3.1 mmHg in the younger cohort and 15.8±3.5 mmHg in older children (P<0.0001). On multivariable analysis, higher IOP in the younger cohort was associated with female gender (standardized regression coefficient [SRC], 0.11, P<0.0001), increasing central corneal thickness (SRC, 0.39, P<0.0001), myopia (SRC, 0.05, P = 0.03), deep anterior chamber (SRC, 0.07, P<0.01), smaller waist (SRC, 0.07, P<0.01) and increasing mean arterial pressure (SRC, 0.13, P<0.0001). In the older cohort, higher IOP was again associated with female gender (SRC, 0.16, P<0.0001), increasing central corneal thickness (SRC, 0.43, P<0.0001), deep anterior chamber (SRC, 0.09, P<0.01), higher body mass index (SRC, 0.07, P = 0.04) and with increasing mean arterial pressure (SRC, 0.09, P = 0.01), age at which reading commenced (SRC, 0.10, P<0.01) and birth method (SRC, 0.09, P = 0.01), but not with myopia (SRC, 0.09, P = 0.20). In Chinese children, higher IOP was associated with female gender, older age, thicker central cornea, deeper anterior chamber and higher mean arterial pressure. Higher body mass index, younger age at commencement of reading and being born of a caesarean section was also associated with higher IOP in adolescence.

Correlation between nutritional status and comprehensive physical performance measures among older adults with undernourishment in residential institutions.

PubMed

Singh, Devinder K A; Manaf, Zahara A; Yusoff, Noor Aini M; Muhammad, Nur A; Phan, Mei Fang; Shahar, Suzana

2014-01-01

The consequences of combined undernourishment and decreased physical performance in older adults are debilitating and increases cost of care. To date, the information regarding the association between nutritional status and physical performance does not provide a complete picture. Most studies used limited or self-reported measures to evaluate physical performance. The objective of this study was to examine the correlation between nutritional status and comprehensive physical performance measures among undernourished older adults who reside in residential institutions. Forty-seven older adults (26 males, 21 females) aged ≥ 60 (69.23 ± 8.63) years who were identified as undernourished from two residential institutions participated in this study. A battery of physical performance tests (10 m gait speed test, dominant hand grip strength test, timed five-repetition sit-to-stand test, ten step test, arm curl test, scratch test, and respiratory muscle strength test), biochemical profiles (serum albumin, hemoglobin, serum ferritin, and prealbumin levels), and falls risk using the short-form Physiological Profile Approach were performed. The Functional Ability Questionnaire and Geriatric Depression Scale were also administered. The results demonstrated that generally older adults with undernourishment scored poorly on the physical performance tests, had depression, and a high risk of falls. Biochemical results demonstrated that 10.9% of the participants were anemic, 63% had hypoalbuminemia (<3.5 g/dL), and 21.7% were at risk of protein energy malnutrition with prealbumin level (100-170 mg/L). A significant correlation (P<0.05) was demonstrated between hand grip strength and ferritin, between self-reported mobility dependence and prealbumin levels, and between self-reported mobility tiredness and body mass index. These results confirm that older adults with undernutrition have poor physical function, higher falls risk, and depression. Clinically, overall health that includes nutritional status, physical function, and depression level should be taken into consideration in the assessment and treatment of older adults residing at residential institutions.

Standing beat-to-beat blood pressure variability is reduced among fallers in the Malaysian Elders Longitudinal Study.

PubMed

Goh, Choon-Hian; Ng, Siew-Cheok; Kamaruzzaman, Shahrul Bahyah; Chin, Ai-Vyrn; Tan, Maw Pin

2017-10-01

The aim of this study was to determine the relationship between falls and beat-to-beat blood pressure (BP) variability.Continuous noninvasive BP measurement is as accurate as invasive techniques. We evaluated beat-to-beat supine and standing BP variability (BPV) using time and frequency domain analysis from noninvasive continuous BP recordings.A total of 1218 older adults were selected. Continuous BP recordings obtained were analyzed to determine standard deviation (SD) and root mean square of real variability (RMSRV) for time domain BPV and fast-Fourier transform low frequency (LF), high frequency (HF), total power spectral density (PSD), and LF:HF ratio for frequency domain BPV.Comparisons were performed between 256 (21%) individuals with at least 1 fall in the past 12 months and nonfallers. Fallers were significantly older (P = .007), more likely to be female (P = .006), and required a longer time to complete the Timed-Up and Go test (TUG) and frailty walk test (P ≤ .001). Standing systolic BPV (SBPV) was significantly lower in fallers compared to nonfallers (SBPV-SD, P = .016; SBPV-RMSRV, P = .033; SBPV-LF, P = .003; SBPV-total PSD, P = .012). Nonfallers had significantly higher supine to standing ratio (SSR) for SBPV-SD, SBPV-RMSRV, and SBPV-total PSD (P = .017, P = .013, and P = .009). In multivariate analyses, standing BPV remained significantly lower in fallers compared to nonfallers after adjustment for age, sex, diabetes, frailty walk, and supine systolic BP. The reduction in frequency-domain SSR among fallers was attenuated by supine systolic BP, TUG, and frailty walk.In conclusion, reduced beat-to-beat BPV while standing is independently associated with increased risk of falls. Changes between supine and standing BPV are confounded by supine BP and walking speed.

Stereotype threat can reduce older adults' memory errors.

PubMed

Barber, Sarah J; Mather, Mara

2013-01-01

Stereotype threat often incurs the cost of reducing the amount of information that older adults accurately recall. In the current research, we tested whether stereotype threat can also benefit memory. According to the regulatory focus account of stereotype threat, threat induces a prevention focus in which people become concerned with avoiding errors of commission and are sensitive to the presence or absence of losses within their environment. Because of this, we predicted that stereotype threat might reduce older adults' memory errors. Results were consistent with this prediction. Older adults under stereotype threat had lower intrusion rates during free-recall tests (Experiments 1 and 2). They also reduced their false alarms and adopted more conservative response criteria during a recognition test (Experiment 2). Thus, stereotype threat can decrease older adults' false memories, albeit at the cost of fewer veridical memories, as well.

Mild Cognitive Dysfunction Does Not Affect Diabetes Mellitus Control in Minority Elderly Adults

PubMed Central

Palta, Priya; Golden, Sherita H.; Teresi, Jeanne; Palmas, Walter; Weinstock, Ruth S.; Shea, Steven; Manly, Jennifer J.; Luchsinger, Jose A.

2015-01-01

OBJECTIVES To determine whether older adults with type 2 diabetes mellitus and cognitive dysfunction have poorer metabolic control of glycosylated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol than those without cognitive dysfunction. DESIGN Prospective cohort study. SETTING A minority cohort in New York City previously recruited for a trial of telemedicine. PARTICIPANTS Persons aged 73.0 ± 3.0 (N = 613; 69.5% female; 82.5% Hispanic, 15.5% non-Hispanic black). MEASUREMENTS Participants were classified with executive or memory dysfunction based on standardized score cutoffs (<16th percentile) for the Color Trails Test and Selective Reminding Test. Linear mixed models were used to compare repeated measures of the metabolic measures and evaluate the rates of change in individuals with and without dysfunction. RESULTS Of the 613 participants, 331 (54%) had executive dysfunction, 202 (33%) had memory dysfunction, and 96 (16%) had both. Over a median of 2 years, participants with executive or memory dysfunction did not exhibit significantly poorer metabolic control than those without executive function or memory type cognitive dysfunction. CONCLUSION Cognitive dysfunction in the mild range did not seem to affect diabetes mellitus control parameters in this multiethnic cohort of older adults with diabetes mellitus, although it cannot be excluded that cognitive impairment was overcome through assistance from formal or informal caregivers. It is possible that more-severe cognitive dysfunction could affect control. PMID:25439094

Mild cognitive dysfunction does not affect diabetes mellitus control in minority elderly adults.

PubMed

Palta, Priya; Golden, Sherita H; Teresi, Jeanne; Palmas, Walter; Weinstock, Ruth S; Shea, Steven; Manly, Jennifer J; Luchsinger, Jose A

2014-12-01

To determine whether older adults with type 2 diabetes mellitus and cognitive dysfunction have poorer metabolic control of glycosylated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol than those without cognitive dysfunction. Prospective cohort study. A minority cohort in New York City previously recruited for a trial of telemedicine. Persons aged 73.0 ± 3.0 (N = 613; 69.5% female; 82.5% Hispanic, 15.5% non-Hispanic black). Participants were classified with executive or memory dysfunction based on standardized score cutoffs (<16th percentile) for the Color Trails Test and Selective Reminding Test. Linear mixed models were used to compare repeated measures of the metabolic measures and evaluate the rates of change in individuals with and without dysfunction. Of the 613 participants, 331 (54%) had executive dysfunction, 202 (33%) had memory dysfunction, and 96 (16%) had both. Over a median of 2 years, participants with executive or memory dysfunction did not exhibit significantly poorer metabolic control than those without executive function or memory type cognitive dysfunction. Cognitive dysfunction in the mild range did not seem to affect diabetes mellitus control parameters in this multiethnic cohort of older adults with diabetes mellitus, although it cannot be excluded that cognitive impairment was overcome through assistance from formal or informal caregivers. It is possible that more-severe cognitive dysfunction could affect control. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Stress and Negative Relationship Quality among Older Couples: Implications for Blood Pressure.

PubMed

Birditt, Kira S; Newton, Nicky J; Cranford, James A; Ryan, Lindsay H

2016-09-01

The cardiovascular system may represent a significant pathway by which marriage and stress influence health, but research has focused on married individuals cross-sectionally. This study examined associations among chronic stress, negative spousal relationship quality, and systolic blood pressure over time among middle-aged and older husbands and wives. Participants were from the nationally representative longitudinal Health and Retirement Study. A total of 1,356 (N = 2,712) married and cohabitating couples completed psychosocial and biomeasure assessments in waves 2006 and 2010. Analyses examined whether Wave 1 (2006) relationship quality and stress were associated with changes in blood pressure over time. The effects of stress and negative relationship quality were dyadic and varied by gender. Husbands had increased blood pressure when wives reported greater stress, and this link was exacerbated by negative spousal relationship quality. Negative relationship quality predicted increased blood pressure when both members of the couple reported negative quality relations. Findings support the dyadic biopsychosocial model of marriage and health indicating: (a) stress and relationship quality directly effect the cardiovascular system, (b) relationship quality moderates the effect of stress, and (c) the dyad rather than only the individual should be considered when examining marriage and health. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Genetics Home Reference: familial dysautonomia

MedlinePlus

... and the regulation of blood pressure and body temperature. It also affects the sensory nervous system, which ... tears, frequent lung infections, and difficulty maintaining body temperature. Older infants and young children with familial dysautonomia ...

Collaborative remembering in older adults: age-invariant outcomes in the context of episodic recall deficits.

PubMed

Henkel, Linda A; Rajaram, Suparna

2011-09-01

Rapidly growing research reveals complex yet systematic consequences of collaboration on memory in young adults, but much less is known about this phenomenon in older adults. Young and older adults studied a list of categorized words and took three successive recall tests. Test 1 and 3 were always taken individually, and Test 2 was done either in triads or alone. Despite older adults recalling less overall than young adults, both age groups exhibited similar costs and benefits of collaboration: Collaboration reduced both correct and false recall during collaborative remembering, was associated with more positive beliefs about its value, and produced reminiscence, collective memory, and some forgetting in its cascading effects on postcollaborative recall. We examine the role of retrieval organization in these effects. As environmental support may play a substantial role in healthy aging, the relatively preserved effects of collaboration on memory in older adults hold promise for testing judicious uses of group remembering in aging.

Predicting falls in older adults using the four square step test.

PubMed

Cleary, Kimberly; Skornyakov, Elena

2017-10-01

The Four Square Step Test (FSST) is a performance-based balance tool involving stepping over four single-point canes placed on the floor in a cross configuration. The purpose of this study was to evaluate properties of the FSST in older adults who lived independently. Forty-five community dwelling older adults provided fall history and completed the FSST, Berg Balance Scale (BBS), Timed Up and Go (TUG), and Tinetti in random order. Future falls were recorded for 12 months following testing. The FSST accurately distinguished between non-fallers and multiple fallers, and the 15-second threshold score accurately distinguished multiple fallers from non-multiple fallers based on fall history. The FSST predicted future falls, and performance on the FSST was significantly correlated with performance on the BBS, TUG, and Tinetti. However, the test is not appropriate for older adults who use walkers. Overall, the FSST is a valid yet underutilized measure of balance performance and fall prediction tool that physical therapists should consider using in ambulatory community dwelling older adults.

Cross-cultural differences in memory: the role of culture-based stereotypes about aging.

PubMed

Yoon, C; Hasher, L; Feinberg, F; Rahhal, T A; Winocur, G

2000-12-01

The extent to which cultural stereotypes about aging contribute to age differences in memory performance is investigated by comparing younger and older Anglophone Canadians to demographically matched Chinese Canadians, who tend to hold more positive views of aging. Four memory tests were administered. In contrast to B. Levy and E. Langer's (1994) findings, younger adults in both cultural groups outperformed their older comparison group on all memory tests. For 2 tests, which made use of visual stimuli resembling ideographic characters in written Chinese, the older Chinese Canadians approached, but did not reach, the performance achieved by their younger counterparts, as well as outperformed the older Anglophone Canadians. However, on the other two tests, which assess memory for complex figures and abstract designs, no differences were observed between the older Chinese and Anglophone Canadians. Path analysis results suggest that this pattern of findings is not easily attributed to a wholly culturally based account of age differences in memory performance.

Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals: An Observational Cohort Study.

PubMed

Padula, William V

The purpose of this study was to examine the effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings. Retrospective observational cohort. We reviewed records of adult patients 18 years or older who were hospitalized at least 5 days across 38 acute care hospitals of the University Health System Consortium (UHC) and had a pressure injury as identified by Patient Safety Indicator #3 (PSI-03). All facilities are located in the United States. We collected longitudinal data pertaining to prophylactic 5-layer foam sacral dressings purchased by hospital-quarter for 38 academic medical centers between 2010 and 2015. Longitudinal data on acute care, hospital-level patient outcomes (eg, admissions and PSI-03 and pressure injury rate) were queried through the UHC clinical database/resource manager from the Johns Hopkins Medicine portal. Data on volumes of dressings purchased per UHC hospital were merged with UHC data. Mixed-effects negative binomial regression was used to test the longitudinal association of prophylactic foam sacral dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. Significant pressure injury rate reductions in US acute care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer foam sacral dressings within a prevention protocol (-1.0 cases/quarter; P = .002) and changes to Medicare payment rules in 2014 (-1.13 cases/quarter; P = .035). Prophylactic 5-layer foam sacral dressings are an effective component of a pressure injury prevention protocol. Hospitals adopting these technologies should expect good value for use of these products.

Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals

PubMed Central

2017-01-01

PURPOSE: The purpose of this study was to examine the effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings. DESIGN: Retrospective observational cohort. SAMPLE AND SETTING: We reviewed records of adult patients 18 years or older who were hospitalized at least 5 days across 38 acute care hospitals of the University Health System Consortium (UHC) and had a pressure injury as identified by Patient Safety Indicator #3 (PSI-03). All facilities are located in the United States. METHODS: We collected longitudinal data pertaining to prophylactic 5-layer foam sacral dressings purchased by hospital-quarter for 38 academic medical centers between 2010 and 2015. Longitudinal data on acute care, hospital-level patient outcomes (eg, admissions and PSI-03 and pressure injury rate) were queried through the UHC clinical database/resource manager from the Johns Hopkins Medicine portal. Data on volumes of dressings purchased per UHC hospital were merged with UHC data. Mixed-effects negative binomial regression was used to test the longitudinal association of prophylactic foam sacral dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. RESULTS: Significant pressure injury rate reductions in US acute care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer foam sacral dressings within a prevention protocol (−1.0 cases/quarter; P = .002) and changes to Medicare payment rules in 2014 (−1.13 cases/quarter; P = .035). CONCLUSIONS: Prophylactic 5-layer foam sacral dressings are an effective component of a pressure injury prevention protocol. Hospitals adopting these technologies should expect good value for use of these products. PMID:28816929

Feasibility and Reliability of Physical Fitness Tests in Older Adults with Intellectual Disability: A Pilot Study

ERIC Educational Resources Information Center

Hilgenkamp, Thessa I. M.; van Wijck, Ruud; Evenhuis, Heleen M.

2012-01-01

Background: Physical fitness is relevant for wellbeing and health, but knowledge on the feasibility and reliability of instruments to measure physical fitness for older adults with intellectual disability is lacking. Methods: Feasibility and test-retest reliability of a physical fitness test battery (Box and Block Test, Response Time Test, walking…

Testing Enhances Subsequent Learning in Older but Not in Younger Elementary School Children

ERIC Educational Resources Information Center

Aslan, Alp; Bäuml, Karl-Heinz T.

2016-01-01

In adults, testing can enhance subsequent learning by reducing interference from the tested information. Here, we examined this forward effect of testing in children. Younger and older elementary school children and adult controls studied four lists of items in anticipation of a final cumulative recall test. Following presentation of each of the…

Time to call it quits? The safety and health of older workers.

PubMed

Bohle, Philip; Pitts, Claudia; Quinlan, Michael

2010-01-01

The workforces of many countries are aging, creating pressure for older workers to retire later despite greater vulnerability to various occupational safety and health (OSH) risks. Some specific risks to older workers arise from age-related physical or psychological changes, while others reflect exposures to poor work organization or employment conditions. This article reviews evidence on the nature of the OSH risks faced by older workers, focusing on work ability, contingent work, and working hours. Work ability, the capacity to meet the physical, mental, and social demands of a job, has been linked to positive health outcomes for older workers. However, work characteristics seem to be more critical than workers' individual capacities. Contingent work is generally associated with poorer OSH outcomes, and older workers are more likely to be contingent, with special implications for their safety and health. There has been limited research on age and working hours, but risks for many physical and mental health problems are known to increase with shift work experience, and physiological and psychosocial changes associated with age may also increase injury risks. The authors discuss organizational practices and regulatory policies to protect and enhance the OSH of older workers.

Age-related differences in strategy knowledge updating: blocked testing produces greater improvements in metacognitive accuracy for younger than older adults.

PubMed

Price, Jodi; Hertzog, Christopher; Dunlosky, John

2008-09-01

Age-related differences in updating knowledge about strategy effectiveness after task experience have not been consistently found, perhaps because the magnitude of observed knowledge updating has been rather meager for both age groups. We examined whether creating homogeneous blocks of recall tests based on two strategies used at encoding (imagery and repetition) would enhance people's learning about strategy effects on recall. Younger and older adults demonstrated greater knowledge updating (as measured by questionnaire ratings of strategy effectiveness and by global judgments of performance) with blocked (versus random) testing. The benefit of blocked testing for absolute accuracy of global predictions was smaller for older than younger adults. However, individual differences in correlations of strategy effectiveness ratings and postdictions showed similar upgrades for both age groups. Older adults learn about imagery's superior effectiveness but do not accurately estimate the magnitude of its benefit, even after blocked testing.

Methodological improvements in quantifying cognitive change in clinical trials: an example with single-dose administration of donepezil.

PubMed

Pietrzak, R H; Maruff, P; Snyder, P J

2009-03-01

Change in cognitive function in response to a pharmacologic challenge can be observed with greater sensitivity by employing cognitive tests with optimal psychometric properties and a statistical approach that more accurately accounts for individual variability in performance. To demonstrate this approach we examined the cognitive effects of a single acute dose administration of an acetylcholinesterase inhibitor, donepezil, in healthy older adults and in older adults with mild Alzheimer's disease (AD). Placebo-controlled crossover study with three separate testing days: baseline, placebo, and donepezil, with assessments at baseline, and 1-, 2-, 3-, 6-, and 8-hrs post-dosing on each day. Early phase I clinical trial. 15 healthy older adults; 14 older adults with mild Alzheimer's disease. Single acute dose of 5mg donepezil. Performance on the Groton Maze Learning Test (GMLT), a computerized neuropsychological measure of spatial working memory and error monitoring. A single acute dose of donepezil improved GMLT performance in healthy older adults (effect size: 0.83 at 6 hrs post-dosing) and older adults with mild AD (effect size: 0.58 at 3 hrs post-dosing). The GMLT detected cognitive improvement following a single, acute dose administration of donepezil in healthy older adults and older adults with mild AD. The choice of cognitive tests designed for repeated administration, as well as an analytic approach that emphasizes individual-level change in cognitive function, provides a sensitive approach to detecting central nervous system drug penetration and activity of cognitive-enhancing agents.

Effect of omega-3 polyunsaturated fatty acid supplementation on central arterial stiffness and arterial wave reflections in young and older healthy adults.

PubMed

Monahan, Kevin D; Feehan, Robert P; Blaha, Cheryl; McLaughlin, Daniel J

2015-06-01

Increased central arterial stiffness and enhanced arterial wave reflections may contribute to increased risk of cardiovascular disease development with advancing age. Omega-3 polyunsaturated fatty acid (n-3) ingestion may reduce cardiovascular risk via favorable effects exerted on arterial structure and function. We determined the effects of n-3 supplementation (4 g/day for 12 weeks) on important measures of central arterial stiffness (carotid-femoral pulse wave velocity; PWV) and arterial wave reflection (central augmentation index) in young (n = 12; 25 ± 1-year-old, mean ± SE) and older (n = 12; 66 ± 2) healthy adults. We hypothesized that n-3 supplementation would decrease carotid-femoral PWV and central augmentation index in older adults. Our results indicate that carotid-femoral PWV and central augmentation index were greater in older (988 ± 65 cm/sec and 33 ± 2%) than in young adults (656 ± 16 cm/sec and 3 ± 4%: both P < 0.05 compared to older) before the intervention (Pre). N-3 supplementation decreased carotid-femoral PWV in older (∆-9 ± 2% Precompared to Post; P < 0.05), but not young adults (∆2 ± 3%). Central augmentation index was unchanged by n-3 supplementation in young (3 ± 4 vs. 0 ± 4% for Pre and Post, respectively) and older adults (33 ± 2 vs. 35 ± 3%). Arterial blood pressure at rest, although increased with age, was not altered by n-3 supplementation in young or older adults. Collectively, these data indicate that 12 weeks of daily n-3 supplementation decreases an important measure of central arterial stiffness (carotid-femoral PWV) in older, but not young healthy adults. The mechanism underlying decreased central arterial stiffness with n-3 supplementation is unknown, but appears to be independent of effects on arterial blood pressure or arterial wave reflections. © 2015 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Schooling, Study, and Academic Goals: The Education of GED Candidates. GED Profiles: Adults in Transition, No. 2.

ERIC Educational Resources Information Center

Baldwin, Janet

1991-01-01

A fall 1989 nationwide survey of General Educational Development (GED) Tests candidates examined schooling experiences, study patterns, and educational plans. Findings indicated the GED Tests attracted more young adults than older adults, more older women than older men, and equal numbers of young adult men and women. Seven percent of candidates,…

The Efficacy of a Viscoelastic Foam Overlay on Prevention of Pressure Injury in Acutely Ill Patients: A Prospective Randomized Controlled Trial.

PubMed

Park, Kyung Hee; Park, Joohee

The purpose of this study was to compare a viscoelastic foam overlay (VEFO) to a standard hospital mattress for pressure injury (PI) prevention. We also compared interface pressures (IPs) of the VEFO to our facility's standard hospital mattress. Prospective, randomized controlled trial. Data analysis was based on 110 participants (55 in each group) who were 19 years or older, had a Braden Scale for Pressure Sore Risk score of 16 or less, and were cared for on a neurology, oncology, or pulmonology inpatient care unit. The research setting was the Samsung Medical Center in Seoul, South Korea. Participants were divided into 2 groups: the experimental group were based on a VEFO on top of the standard hospital mattress used in our facility. Participants in the control group were placed on a standard hospital mattress with/without air overlay. All patients were given standard nursing care for prevention of PI. Skin assessments were completed daily over a period of 2 weeks. In addition, we compared IPs of the standard hospital mattress and the VEFO in participants randomly allocated to the intervention group. Interface pressure was measured over the sacral/coccygeal area with subjects in the supine position. Pressures were measured immediately before and immediately following placement of the VEFO and just before data collection began. Data were collected between October 2013 and November 2014. Pressure injury incidence was compared between groups using the χ test, and IPs were compared using the paired t test. Pressure injury development was determined using the staging system described in guidelines from the National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance in 2014. Interface pressure was measured using a device manufactured for this purpose. The incidence of PI development was significantly lower in subjects assigned to the experimental group as compared to those in the control group (3.6%-27.3% over the 2-week data collection period; P = .001). The maximum IP was significantly lower on the VEFO with standard hospital mattress than on the standard hospital mattress (paired t = 8.87, P < .001). Patients managed with a VEFO had a significantly lower incidence of PI than those managed with a standard hospital mattress. Additional research is needed to further characterize the efficacy of the VEFO, its effect on PI healing, and its effect of PI prevention in high-risk populations such as critically ill patients.

Peripheral Arterial Disease

MedlinePlus

Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of ... smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, ...

2014 Hypertension Guideline: Recommendation for a Change in Goal Systolic Blood Pressure

PubMed Central

Handler, Joel

2015-01-01

The 2014 Kaiser Permanente Care Management Institute National Hypertension Guideline was developed to assist primary care physicians and other health care professionals in the outpatient treatment of uncomplicated hypertension in adult men and nonpregnant women aged 18 years and older. The new guideline reflects general acceptance, with minor modifications, of the “Evidence-Based Guideline” report by the panel members appointed to the National Heart, Lung, and Blood Institute 8th Joint National Committee. A major practice change is the recommendation for goal systolic blood pressure less than 150 mmHg in patients aged 60 years and older who are treated for hypertension in the absence of diabetes or chronic kidney disease. This article describes the reasons for, evidence for, and consequences of the change, and is followed by the National Guidelines handout. PMID:26057683

Intervention with Formulated Collagen Gel for Chronic Heel Pressure Ulcers in Older Adults with Diabetes.

PubMed

Agosti, Jennifer K; Chandler, Lois A

2015-11-01

Chronic pressure ulcers (PrUs), ulcers that fail to progress through the expected phases of wound healing in a timely fashion, are not only a concern for the patients afflicted with them, but are also a significant burden for the long-term-care facilities in which patients reside. The heel is the second most common location for PrUs. Morbidity and mortality rates for heel PrUs, particularly in the diabetic population, are alarming. Therefore, a consistently effective, cost-conscious, and user-friendly topical treatment for heel ulcers would be welcomed by patients and clinicians. This article describes a marked and rapid improvement in wound granulation in 3 older adult patients following weekly treatment for 8 weeks of chronic (≥1-year duration) heel ulcers with an easy-to-use, cost-effective, topical, formulated collagen gel.

Assessment of the swallowing function in older individuals referred to myocardial revascularization surgery.

PubMed

Dantas, Mara de Oliveira Rodrigues Luiz; Auler, José Otávio Costa; Andrade, Claudia Regina Furquim de

2010-01-01

Swallowing evaluation of older individuals with coronary disease referred to heart surgery. To identify the characteristics of the swallowing function in older individuals referred to myocardial revascularization surgery (MR), using an evaluating protocol composed by a water test, cervical auscultation and pulse oximetry. The Assessment Protocol for Dysphagia Risk through a Combined Swallowing test and Vital Signs monitoring was used (PADTC)--measurements of HR and SpO2 (heart rate and oxygen saturation), water swallowing test with 1, 3, 5, 10, 15 e 20 ml, measurement of respiratory rate and cervical auscultation. The electronic stethoscope was used to analyze the number of swallows, response time and swallowing sound classification. In the Research Group (RG) older individuals with heart disease who were referred to MR were included. In the Control Group (CG) healthy older individuals were included. 38 older individuals were evaluated in the RG (mean age 68 years). In the CG, 30 older individuals were evaluated (mean age 70 years). There was a significant difference for the swallowing response time in older individuals with heart disease who presented HR below 60: swallowing response was shorter for 3 ml, 10 ml, 15 ml e 20 ml. HR was lower for individuals with heart disease. No significant difference was found between the groups for the other analyzed parameters. Older individuals with heart disease presented differences in the swallowing function when compared to healthy older individuals. Older individuals with heart disease presented alterations in the temporal coordination between breathing and swallowing, thus indicating risk for dysphagia.

Health promotion through primary care: enhancing self-management with activity prescription and mHealth.

PubMed

Knight, Emily; Stuckey, Melanie I; Petrella, Robert J

2014-09-01

It is well established in the literature that regular participation in physical activity is effective for chronic disease management and prevention. Remote monitoring technologies (ie, mHealth) hold promise for engaging patients in self-management of many chronic diseases. The purpose of this study was to test the effectiveness of an mHealth study with tailored physical activity prescription targeting changes in various intensities of physical activity (eg, exercise, sedentary behavior, or both) for improving physiological and behavioral markers of lifestyle-related disease risk. Forty-five older adults (aged 55-75 years; mean age 63 ± 5 years) were randomly assigned to receive a personal activity program targeting changes to either daily exercise, sedentary behavior, or both. All participants received an mHealth technology kit including smartphone, blood pressure monitor, glucometer, and pedometer. Participants engaged in physical activity programming at home during the 12-week intervention period and submitted physical activity (steps/day), blood pressure (mm Hg), body weight (kg), and blood glucose (mmol/L) measures remotely using study-provided devices. There were no differences between groups at baseline (P > 0.05). The intervention had a significant effect (F(10 488) = 2.947, P = 0.001, ηP² = 0.057), with similar changes across all groups for physical activity, body weight, and blood pressure (P > 0.05). Changes in blood glucose were significantly different between groups, with groups prescribed high-intensity activity (ie, exercise) demonstrating greater reductions in blood glucose than the group prescribed changes to sedentary behavior alone (P < 0.05). Findings demonstrate the utility of pairing mHealth technologies with activity prescription for prevention of lifestyle-related chronic diseases among an at-risk group of older men and women. RESULTS support the novel approach of prescribing changes to sedentary behaviors (alone, and in conjunction with exercise) to reduce risk of developing lifestyle-related chronic conditions.

Continuous visual field motion impacts the postural responses of older and younger women during and after support surface tilt

PubMed Central

Lauer, Richard T.; Keshner, Emily A.

2011-01-01

The effect of continuous visual flow on the ability to regain and maintain postural orientation was examined. Fourteen young (20–39 years old) and 14 older women (60–79 years old) stood quietly during 3° (30°/s) dorsiflexion tilt of the support surface combined with 30° and 45°/s upward or downward pitch rotations of the visual field. The support surface was held tilted for 30 s and then returned to neutral over a 30-s period while the visual field continued to rotate. Segmental displacement and bilateral tibialis anterior and gastrocnemius muscle EMG responses were recorded. Continuous wavelet transforms were calculated for each muscle EMG response. An instantaneous mean frequency curve (IMNF) of muscle activity, center of mass (COM), center of pressure (COP), and angular excursion at the hip and ankle were used in a functional principal component analysis (fPCA). Functional component weights were calculated and compared with mixed model repeated measures ANOVAs. The fPCA revealed greatest mathematical differences in COM and COP responses between groups or conditions during the period that the platform transitioned from the sustained tilt to a return to neutral position. Muscle EMG responses differed most in the period following support surface tilt indicating that muscle activity increased to support stabilization against the visual flow. Older women exhibited significantly larger COM and COP responses in the direction of visual field motion and less muscle modulation when the platform returned to neutral than younger women. Results on a Rod and Frame test indicated that older women were significantly more visually dependent than the younger women. We concluded that a stiffer body combined with heightened visual sensitivity in older women critically interferes with their ability to counteract posturally destabilizing environments. PMID:21479659

Attenuated noradrenergic sensitivity during local cooling in aged human skin

PubMed Central

Thompson, Caitlin S; Holowatz, Lacy A; Kenney, W. Larry

2005-01-01

Reflex-mediated cutaneous vasoconstriction (VC) is impaired in older humans; however, it is unclear whether this blunted VC also occurs during local cooling, which mediates VC through different mechanisms. We tested the hypothesis that the sensitization of cutaneous vessels to noradrenaline (NA) during direct skin cooling seen in young skin is blunted in aged skin. In 11 young (18–30 years) and 11 older (62–76 years) men and women, skin blood flow was monitored at two forearm sites with laser Doppler (LD) flowmetry while local skin temperature was cooled and clamped at 24°C. Cutaneous vascular conductance (CVC; LD flux/mean arterial pressure) was expressed as percentage change from baseline (%ΔCVCbase). At one site, five doses of NA (10−10–10−2m) were sequentially infused via intradermal microdialysis during cooling while the other 24°C site served as control (Ringer solution + cooling). At control sites, VC due to cooling alone was similar in young versus older (−54 ± 5 versus −56 ± 3%ΔCVCbase, P= 0.46). In young, NA infusions induced additional dose-dependent VC (10−8, 10−6, 10−4 and 10−2m: −70 ± 2, −72 ± 3, −78 ± 3 and −79 ± 4%ΔCVCbase; P < 0.05 versus control). In older subjects, further VC did not occur until the highest infused dose of NA (10−2m: −70 ± 5%ΔCVCbase; P < 0.05 versus control). When cutaneous arterioles are sensitized to NA by direct cooling, young skin exhibits the capacity to further constrict to NA in a dose-dependent manner. However, older skin does not display enhanced VC capacity until treated with saturating doses of NA, possibly due to age-associated decrements in Ca2+ availability or α2C-adrenoceptor function. PMID:15705648

Bilateral Brain Regions Associated with Naming in Older Adults

ERIC Educational Resources Information Center

Obler, Loraine K.; Rykhlevskaia, Elena; Schnyer, David; Clark-Cotton, Manuella R.; Spiro, Avron, III; Hyun, JungMoon; Kim, Dae-Shik; Goral, Mira; Albert, Martin L.

2010-01-01

To determine structural brain correlates of naming abilities in older adults, we tested 24 individuals aged 56-79 on two confrontation-naming tests (the Boston Naming Test (BNT) and the Action Naming Test (ANT)), then collected from these individuals structural Magnetic-Resonance Imaging (MRI) and Diffusion Tensor Imaging (DTI) data. Overall,…

Biopsychosocial Predictors of Fall Events among Older African Americans

PubMed Central

Nicklett, Emily Joy; Taylor, Robert Joseph; Rostant, Ola; Johnson, Kimson E.; Evans, Linnea

2016-01-01

This study identifies risk and protective factors for falls among older, community-dwelling African Americans. Drawing upon the biopsychosocial perspective (Engel, 1997), we conducted a series of sex- and age-adjusted multinomial logistic regression analyses to identify the correlates of fall events among older African Americans. Our sample consisted of 1,442 community-dwelling African Americans aged 65 and older, participating in the 2010-12 rounds of the Health and Retirement Study. Biophysical characteristics associated with greater relative risk of experiencing single and/or multiple falls included greater functional limitations, poorer self-rated health, poorer self-rated vision, chronic illnesses (high blood pressure, diabetes, cancer, lung disease, heart problems, stroke, and arthritis), greater chronic illness comorbidity, older age, and female sex. Physical activity was negatively associated with recurrent falls. Among the examined psychosocial characteristics, greater depressive symptoms were associated with greater relative risk of experiencing single and multiple fall events. Implications for clinicians and future studies are discussed. PMID:28285579

The metabolic syndrome, biomarkers, and the acculturation-health relationship among older Mexican Americans.

PubMed

González, Hector M; Tarraf, Wassim; Haan, Mary N

2011-10-01

To examine the acculturation-health relationship using metabolic syndrome biomarkers. Cross-sectional sample data. 1,789 Mexican Americans (60 years and older) from northern California. Biomarkers (waist circumference, blood pressure, fasting plasma glucose, triglycerides, and high-density lipids) were used to construct the metabolic syndrome indicator using American Heart Association criteria. MAIN PREDICTOR: Acculturation Rating Scale for Mexican Americans-II scores. Higher acculturation scores were associated with a significantly lower risk for the metabolic syndrome for foreign-born, but not U.S.-born, Mexican Americans. Immigrant health advantages over U.S.-born Mexican Americans are not evident in older adulthood. Higher acculturation was associated with lowered metabolic syndrome risk among older foreign-born Mexican Americans. This suggests that the prevailing acculturative stress hypothesis may not apply to the health of older adults and that any negative relationship between acculturation and health found in younger adults may yield to different developmental health influences in later adulthood.

The contribution of postural balance analysis in older adult fallers: A narrative review.

PubMed

Pizzigalli, L; Micheletti Cremasco, M; Mulasso, A; Rainoldi, A

2016-04-01

Falls are a serious health problem for older adults. Several studies have identified the decline of postural balance as one of the main risk factors for falls. Contrary to what may be believed, the capability of force platform measurements to predict falls remains uncertain. The focus of this narrative review is the identification of postural characteristics of older adults at risk of falling using both static and dynamic postural balance assessments. The literature analysis was conducted on Medline/PubMed. The search ended in May 2015. Centre of pressure (CoP) path length, CoP velocity and sway in medial lateral and anterior-posterior are the variables that distinguish older adult fallers from non-fallers. Recommendations to medical personnel on how to provide efficient balance training for older adults are offered, discussing the relevance and limitations of postural stability on static and dynamic board in falling risk prevention. Copyright © 2015 Elsevier Ltd. All rights reserved.

Individual variability of cerebral autoregulation, posterior cerebral circulation and white matter hyperintensity.

PubMed

Liu, Jie; Tseng, Benjamin Y; Khan, Muhammad Ayaz; Tarumi, Takashi; Hill, Candace; Mirshams, Niki; Hodics, Timea M; Hynan, Linda S; Zhang, Rong

2016-06-01

Cerebral autoregulation (CA) is a key mechanism to protect brain perfusion in the face of changes in arterial blood pressure, but little is known about individual variability of CA and its relationship to the presence of brain white matter hyperintensity (WMH) in older adults, a type of white matter lesion related to cerebral small vessel disease (SVD). This study demonstrated the presence of large individual variability of CA in healthy older adults during vasoactive drug-induced changes in arterial pressure assessed at the internal carotid and vertebral arteries. We also observed, unexpectedly, that it was the 'over-' rather than the 'less-reactive' CA measured at the vertebral artery that was associated with WMH severity. These findings challenge the traditional concept of CA and suggest that the presence of cerebral SVD, manifested as WMH, is associated with posterior brain hypoperfusion during acute increase in arterial pressure. This study measured the individual variability of static cerebral autoregulation (CA) and determined its associations with brain white matter hyperintensity (WMH) in older adults. Twenty-seven healthy older adults (13 females, 66 ± 6 years) underwent assessment of CA during steady-state changes in mean arterial pressure (MAP) induced by intravenous infusion of sodium nitroprusside (SNP) and phenylephrine. Cerebral blood flow (CBF) was measured using colour-coded duplex ultrasonography at the internal carotid (ICA) and vertebral arteries (VA). CA was quantified by a linear regression slope (CA slope) between percentage changes in cerebrovascular resistance (CVR = MAP/CBF) and MAP relative to baseline values. Periventricular and deep WMH volumes were measured with T2-weighted magnetic resonance imaging. MAP was reduced by -11 ± 7% during SNP, and increased by 21 ± 8% during phenylephrine infusion. CA demonstrated large individual variability with the CA slopes ranging from 0.37 to 2.20 at the ICA and from 0.17 to 3.18 at the VA; no differences in CA were found between the ICA and VA. CA slopes measured at the VA had positive correlations with the total and periventricular WMH volume (r = 0.55 and 0.59, P < 0.01). Collectively, these findings demonstrated the presence of large individual variability of CA in older adults, and that, when measured in the posterior cerebral circulation, it is the higher rather than lower CA reactivity that is associated with WMH severity. © 2016 The Authors. The Journal of Physiology © 2016 The Physiological Society.

Stiffness control of balance during dual task and prospective falls in older adults: the MOBILIZE Boston Study.

PubMed

Kang, Hyun Gu; Quach, Lien; Li, Wenjun; Lipsitz, Lewis A

2013-09-01

Outdoor fallers differ from indoor fallers substantially in demographics, lifestyle, health condition and physical function. Biomechanical predictors of outdoor falls have not been well characterized. Current validated measures of postural deficits, which describe only the overall postural behavior, are predictive of indoor falls but not outdoor falls. We hypothesized that a model-based description of postural muscle tone and reflexes, particularly during dual tasking, would predict outdoor falls. We tested whether postural stiffness and damping from an inverted pendulum model were predictive of future indoor and outdoor falls among older adults from the MOBILIZE Boston Study. The center of pressure data during standing were obtained from 717 participants aged 77.9±5.3 years. Participants stood barefoot with eyes open for 30s per trial, in two sets of five standing trials. One set included a serial subtractions task. Postural stiffness and damping values were determined from the postural sway data. After the postural measurements, falls were monitored prospectively using a monthly mail-in calendar over 6-36 months. Associations of postural measures with fall rates were determined using negative binomial regressions. After covariate adjustments, postural stiffness (p=0.02-0.05) and damping (p=0.007-0.1) were associated with lower outdoor falls risk, but not with indoor falls. Results were invariant by direction (anteroposterior versus mediolateral) or by condition (quiet standing versus dual task). Outdoor fall risk may be tied to postural control more so than indoor falls. Dual tasking is likely related to fall risk among older and sicker older adults, but not those relatively healthy. Copyright © 2013 Elsevier B.V. All rights reserved.

Stiffness Control of Balance during Dual Task and Prospective Falls in Older Adults: The MOBILIZE Boston Study

PubMed Central

Kang, Hyun Gu; Quach, Lien; Li, Wenjun; Lipsitz, Lewis A.

2013-01-01

Outdoor fallers differ from indoor fallers substantially in demographics, lifestyle, health condition and physical function. Biomechanical predictors of outdoor falls have not been well characterized. Current validated measures of postural deficits, which describe only the overall postural behavior, are predictive of indoor falls but not outdoor falls. We hypothesized that a model-based description of postural muscle tone and reflexes, particularly during dual tasking, would predict outdoor falls. We tested whether postural stiffness and damping from an inverted pendulum model were predictive of future indoor and outdoor falls among older adults from the MOBILIZE Boston Study. The center of pressure data during standing were obtained from 717 participants aged 77.9±5.3 years. Participants stood barefoot with eyes open for 30 seconds per trial, in two sets of five standing trials. One set included a serial subtractions task. Postural stiffness and damping values were determined from the postural sway data. After the postural measurements, falls were monitored prospectively using a monthly mail-in calendar over 6-36 months. Associations of postural measures with fall rates were determined using negative binomial regressions. After covariate adjustments, postural stiffness (p=0.02-0.05) and damping (p=0.007-0.1) were associated with lower outdoor falls risk, but not with indoor falls. Results were invariant by direction (anteroposterior versus mediolateral) or by condition (quiet standing versus dual task). Outdoor fall risk may be tied to postural control more so than indoor falls. Dual tasking is likely related to fall risk among older and sicker older adults, but not those relatively healthy. PMID:23623606

Primary hypertension and special aspects of hypertension in older children and adolescents

PubMed Central

Ellis, Demetrius; Miyashita, Yosuke

2011-01-01

The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed. PMID:24600275

Naturalistic validation of an on-road driving test of older drivers.

PubMed

Ott, Brian R; Papandonatos, George D; Davis, Jennifer D; Barco, Peggy P

2012-08-01

The objective was to compare a standardized road test to naturalistic driving by older people who may have cognitive impairment to define improvements that could potentially enhance the validity of road testing in this population. Road testing has been widely adapted as a tool to assess driving competence of older people who may be at risk for unsafe driving because of dementia; however, the validity of this approach has not been rigorously evaluated. For 2 weeks, 80 older drivers (38 healthy elders and 42 with cognitive impairment) who passed a standardized road test were video recorded in their own vehicles. Using a standardized rating scale, 4 hr of video was rated by a driving instructor. The authors examine weighting of individual road test items to form global impressions and to compare road test and naturalistic driving using factor analyses of these two assessments. The road test score was unidimensional, reflecting a major factor related to awareness of signage and traffic behavior. Naturalistic driving reflected two factors related to lane keeping as well as traffic behavior. Maintenance of proper lane is an important dimension of driving safety that appears to be relatively underemphasized during the highly supervised procedures of the standardized road test. Road testing in this population could be improved by standardized designs that emphasize lane keeping and that include self-directed driving. Additional information should be sought from observers in the community as well as crash evidence when advising older drivers who may be cognitively impaired.

Sleep disordered breathing at the extremes of age: the elderly

PubMed Central

Morrell, Mary J.

2016-01-01

Key points Sleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people. There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes. There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB. Educational aims To highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people. To inform readers about the risk factors for SDB in older people. To explore the impact of SDB in older people. To introduce current evidence based treatment options for SDB in older people. Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population. PMID:27064674

Sleep disordered breathing at the extremes of age: the elderly.

PubMed

McMillan, Alison; Morrell, Mary J

2016-03-01

Sleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people.There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes.There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB. To highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people.To inform readers about the risk factors for SDB in older people.To explore the impact of SDB in older people.To introduce current evidence based treatment options for SDB in older people. Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population.

Determinants of sedentary behavior, motivation, barriers and strategies to reduce sitting time in older women: a qualitative investigation.

PubMed

Chastin, Sebastien F M; Fitzpatrick, Nicole; Andrews, Michelle; DiCroce, Natalie

2014-01-07

Sedentary behavior defined as time spent non-exercising seated or reclining posture has been identified has a health risk and associated with frailty and disablement for older adults. Older adults are the most sedentary segment of society. To date no study has investigated the determinants of sedentary behavior in older adults. This study reports a qualitative investigation of the determinants of sedentary behavior, strategies and motivator to reduce sitting time by structured interviews in a group of community dwelling older women (N = 11, age 65 and over). Older women expressed the view that their sedentary behavior is mostly determined by pain which acts both as an incentive to sit and a motivator to stand up, lack of energy in the afternoon, pressure from direct social circle to sit and rest, societal and environmental typecasting that older adult are meant to sit, lack of environmental facilities to allow activity pacing. This qualitative investigation highlighted some factors that older adults consider determinants of their sedentary behavior. Some are identical to those affecting physical activity (self-efficacy, functional limitations, ageist stereotyping) but some appear specific to sedentary behavior (locus of control, pain) and should be further investigated and considered during intervention design. Tailored interventions that pay attention to the pattern of sedentary behavior of individuals appear to be supported by the views of older women on their sedentary behavior.

Stereotype threat can reduce older adults' memory errors

PubMed Central

Barber, Sarah J.; Mather, Mara

2014-01-01

Stereotype threat often incurs the cost of reducing the amount of information that older adults accurately recall. In the current research we tested whether stereotype threat can also benefit memory. According to the regulatory focus account of stereotype threat, threat induces a prevention focus in which people become concerned with avoiding errors of commission and are sensitive to the presence or absence of losses within their environment (Seibt & Förster, 2004). Because of this, we predicted that stereotype threat might reduce older adults' memory errors. Results were consistent with this prediction. Older adults under stereotype threat had lower intrusion rates during free-recall tests (Experiments 1 & 2). They also reduced their false alarms and adopted more conservative response criteria during a recognition test (Experiment 2). Thus, stereotype threat can decrease older adults' false memories, albeit at the cost of fewer veridical memories, as well. PMID:24131297

The Influence of Audio-Visual Cueing (Traffic Light) on Dual Task Walking in Healthy Older Adults and Older Adults with Balance Impairments.

PubMed

Kaewkaen, Kitchana; Wongsamud, Phongphat; Ngaothanyaphat, Jiratchaya; Supawarapong, Papawarin; Uthama, Suraphong; Ruengsirarak, Worasak; Chanabun, Suthin; Kaewkaen, Pratchaya

2018-02-01

The walking gait of older adults with balance impairment is affected by dual tasking. Several studies have shown that external cues can stimulate improvement in older adults' performance. There is, however, no current evidence to support the usefulness of external cues, such as audio-visual cueing, in dual task walking in older adults. Thus, the aim of this study was to investigate the influence of an audio-visual cue (simulated traffic light) on dual task walking in healthy older adults and in older adults with balance impairments. A two-way repeated measures study was conducted on 14 healthy older adults and 14 older adults with balance impairment, who were recruited from the community in Chiang Rai, Thailand. Their walking performance was assessed using a four-metre walking test at their preferred gait speed and while walking under two further gait conditions, in randomised order: dual task walking and dual task walking with a simulated traffic light. Each participant was tested individually, with the testing taking between 15 and 20 minutes to perform, including two-minute rest periods between walking conditions. Two Kinect cameras recorded the spatio-temporal parameters using MFU gait analysis software. Each participant was tested for each condition twice. The mean parameters for each condition were analysed using a two-way repeated measures analysis of variance (ANOVA) with participant group and gait condition as factors. There was no significant between-group effect for walking speed, stride length and cadence. There were also no significant effects between gait condition and stride length or cadence. However, the effect between gait condition and walking speed was found to be significant [F(1.557, 40.485) = 4.568, P = 0.024, [Formula: see text

Exploration of older and younger British adults' performance on The Awareness of Social Inference Test (TASIT).

PubMed

Burdon, Paul; Dipper, Lucy; Cocks, Naomi

2016-09-01

Social perception is an important skill. One assessment that is commonly used to assess social perception abilities is The Awareness of Social Inference Test (TASIT). The only normative data available for this test are for Australian younger adults. Despite no normative data being available for British adults, the test is widely used in the UK with older and younger adults. There is a growing body of research that suggests that older adults have difficulty with skills associated with social perception. There is therefore a need to determine whether British adults, and more specifically British older adults, perform similarly to the Australian normative TASIT scores available in the manual. To explore the differences between older and younger British adults' performance on TASIT, and to determine whether younger and older British adults perform similarly to the data from Australian adults in TASIT manual. TASIT was administered to a total of 42 native British English speaking participants. The participants were split into two age groups 18-45 and 60-90 years. Comparisons were made between the two groups and the Australian data in TASIT manual. The younger British and Australian adults obtained similar scores on all parts of TASIT. The older British adults though, obtained significantly lower scores than the Australian younger adults on all parts of TASIT and when education was controlled for they obtained significantly lower scores than the British younger adults. The findings are discussed in the light of previous research that has found that older adults are worse than younger adults at social inferences. The findings of the current study suggest that caution should be used when using TASIT with older British adults to assess social perception abilities. © 2016 Royal College of Speech and Language Therapists.

The test-retest reliability and minimal detectable change of spatial and temporal gait variability during usual over-ground walking for younger and older adults.

PubMed

Almarwani, Maha; Perera, Subashan; VanSwearingen, Jessie M; Sparto, Patrick J; Brach, Jennifer S

2016-02-01

Gait variability is a marker of gait performance and future mobility status in older adults. Reliability of gait variability has been examined mainly in community dwelling older adults who are likely to fluctuate over time. The purpose of this study was to compare test-retest reliability and determine minimal detectable change (MDC) of spatial and temporal gait variability in younger and older adults. Forty younger (mean age=26.6 ± 6.0 years) and 46 older adults (mean age=78.1 ± 6.2 years) were included in the study. Gait characteristics were measured twice, approximately 1 week apart, using a computerized walkway (GaitMat II). Participants completed 4 passes on the GaitMat II at their self-selected walking speed. Test-retest reliability was calculated using Intra-class correlation coefficients (ICCs(2,1)), 95% limits of agreement (95% LoA) in conjunction with Bland-Altman plots, relative limits of agreement (LoA%) and standard error of measurement (SEM). The MDC at 90% and 95% level were also calculated. ICCs of gait variability ranged 0.26-0.65 in younger and 0.28-0.74 in older adults. The LoA% and SEM were consistently higher (i.e. less reliable) for all gait variables in older compared to younger adults except SEM for step width. The MDC was consistently larger for all gait variables in older compared to younger adults except step width. ICCs were of limited utility due to restricted ranges in younger adults. Based on absolute reliability measures and MDC, younger had greater test-retest reliability and smaller MDC of spatial and temporal gait variability compared to older adults. Copyright © 2015 Elsevier B.V. All rights reserved.

Decreased active vasodilator sensitivity in aged skin.

PubMed

Kenney, W L; Morgan, A L; Farquhar, W B; Brooks, E M; Pierzga, J M; Derr, J A

1997-04-01

Older men and women respond to local and reflex-mediated heat stress with an attenuated increase in cutaneous vascular conductance (CVC). This study was performed to test the hypothesis that an augmented or sustained noradrenergic vasoconstriction (VC) may play a role in this age-related difference. Fifteen young (22 +/- 1 yr) and 15 older (66 +/- 1 yr) men exercised at 50% peak oxygen uptake in a 36 degrees C environment. Skin perfusion was monitored at two sites on the right forearm by laser-Doppler flowmetry: one site pretreated with bretylium tosylate (BT) to block the local release of norepinephrine and thus VC and an adjacent control site. Blockade of reflex VC was verified during whole body cooling using a water-perfused suit. CVC (perfusion divided by mean arterial pressure) at each site was reported as a percentage of the maximal CVC (%CVCmax) induced at the end of each experiment by prolonged local heating at 42 degrees C. Neither age nor BT affected the %CVCmax (75-86%) attained at high core temperatures. During the early rise phase of CVC, the %CVCmax-change in esophageal temperature (delta T(es)) curve was shifted to the right in the older men (effective delta T(es) associated with 50% CVC response for young, 0.22 +/- 0.04 and 0.39 +/- 0.04 degrees C and for older, 0.73 +/- 0.04 and 0.85 +/- 0.04 degrees C at control and BT sites, respectively). BT had no interactive effect on this age difference, suggesting a lack of involvement of the VC system in the attenuated CVC response of individuals over the age of 60 yr. Additionally, increases in skin vascular conductance were quantitatively compared by measuring increases in total forearm vascular conductance (FVC, restricted to the forearm skin under these conditions). After the initial approximately 0.2 degrees C increase in T(es), FVC was 40-50% lower in the older men (P < 0.01) for the remainder of the exercise. Decreased active vasodilator sensitivity to increasing core temperature, coupled with structural limitations to vasodilation, appears to limit the cutaneous vascular response to exertional heat stress in older subjects.

Negative Attitudes toward Older Workers and Hiring Decisions: Testing the Moderating Role of Decision Makers' Core Self-Evaluations.

PubMed

Fasbender, Ulrike; Wang, Mo

2016-01-01

Organizational hiring practices have been charged for unfair treatment on the grounds of age. Drawing on theories of planned behavior and core self-evaluations, this research investigated the impact of negative attitudes toward older workers on hiring decisions and examined the moderating role of decision-makers' core self-evaluations. We tested our hypotheses based on a structured online questionnaire and a vignette study using a sample of 102 participants working in human resource management across different industries. As predicted, negative attitudes toward older workers were positively related to avoidance of hiring older people, which in turn was negatively related to the likelihood to select the oldest candidate. Because hiring decisions are not only about the hiring subject but also about the decision-maker, we tested the moderating role of decision-makers' core self-evaluations. Results showed that core self-evaluations buffered the relationship between negative attitudes toward older workers and avoidance of hiring older people. Theoretical implications of the findings with regard to hiring decisions about older people and practical recommendations to improve diversity management strategies and age-balanced hiring practices in organizations are discussed.

Is 60 the New 80 in Hypertension?

PubMed

Pflederer, Matthew C; Estacio, Raymond O; Krantz, Mori J

2016-08-01

Since the release of the "2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)", much controversy has ensued over the appropriate systolic blood pressure goal for those over the age of 60 years. This guideline suggested liberalizing the target for this population to <150 mmHg, moving away from previous guidelines suggesting a target of <140 mmHg. While some national quality measures have accepted the new relaxed blood pressure goal, the American Heart Association and American College of Cardiology have not. Recently published data show that millions of adults over 60 years of age would be classified as controlled using a threshold of <150 mmHg, but not with a target of <140 mmHg. In addition, emerging randomized trial evidence suggests that targeting a systolic blood pressure well below 140 mmHg is beneficial in older adults. In light of the improved health and vitality of older adults, and the steady decline in cardiovascular and cerebrovascular mortality over recent decades, we do not think it is in good judgment to liberalize the treatment target in adults less than 80 years of age.

Does the Cognitive Reflection Test actually capture heuristic versus analytic reasoning styles in older adults?

PubMed

Hertzog, Christopher; Smith, R Marit; Ariel, Robert

2018-01-01

Background/Study Context: This study evaluated adult age differences in the original three-item Cognitive Reflection Test (CRT; Frederick, 2005, The Journal of Economic Perspectives, 19, 25-42) and an expanded seven-item version of that test (Toplak et al., 2013, Thinking and Reasoning, 20, 147-168). The CRT is a numerical problem-solving test thought to capture a disposition towards either rapid, intuition-based problem solving (Type I reasoning) or a more thoughtful, analytical problem-solving approach (Type II reasoning). Test items are designed to induce heuristically guided errors that can be avoided if using an appropriate numerical representation of the test problems. We evaluated differences between young adults and old adults in CRT performance and correlates of CRT performance. Older adults (ages 60 to 80) were paid volunteers who participated in experiments assessing age differences in self-regulated learning. Young adults (ages 17 to 35) were students participating for pay as part of a project assessing measures of critical thinking skills or as a young comparison group in the self-regulated learning study. There were age differences in the number of CRT correct responses in two independent samples. Results with the original three-item CRT found older adults to have a greater relative proportion of errors based on providing the intuitive lure. However, younger adults actually had a greater proportion of intuitive errors on the long version of the CRT, relative to older adults. Item analysis indicated a much lower internal consistency of CRT items for older adults. These outcomes do not offer full support for the argument that older adults are higher in the use of a "Type I" cognitive style. The evidence was also consistent with an alternative hypothesis that age differences were due to lower levels of numeracy in the older samples. Alternative process-oriented evaluations of how older adults solve CRT items will probably be needed to determine conditions under which older adults manifest an increase in the Type I dispositional tendency to opt for superficial, heuristically guided problem representations in numerical problem-solving tasks.

A feasibility study of a theory-based intervention to improve appropriate polypharmacy for older people in primary care.

PubMed

Cadogan, Cathal A; Ryan, Cristín; Gormley, Gerard J; Francis, Jill J; Passmore, Peter; Kerse, Ngaire; Hughes, Carmel M

2018-01-01

A general practitioner (GP)-targeted intervention aimed at improving the prescribing of appropriate polypharmacy for older people was previously developed using a systematic, theory-based approach based on the UK Medical Research Council's complex intervention framework. The primary intervention component comprised a video demonstration of a GP prescribing appropriate polypharmacy during a consultation with an older patient. The video was delivered to GPs online and included feedback emphasising the positive outcomes of performing the behaviour. As a complementary intervention component, patients were invited to scheduled medication review consultations with GPs. This study aimed to test the feasibility of the intervention and study procedures (recruitment, data collection). GPs from two general practices were given access to the video, and reception staff scheduled consultations with older patients receiving polypharmacy (≥4 medicines). Primary feasibility study outcomes were the usability and acceptability of the intervention to GPs. Feedback was collected from GP and patient participants using structured questionnaires. Clinical data were also extracted from recruited patients' medical records (baseline and 1 month post-consultation). The feasibility of applying validated assessment of prescribing appropriateness (STOPP/START criteria, Medication Appropriateness Index) and medication regimen complexity (Medication Regimen Complexity Index) to these data was investigated. Data analysis was descriptive, providing an overview of participants' feedback and clinical assessment findings. Four GPs and ten patients were recruited across two practices. The intervention was considered usable and acceptable by GPs. Some reservations were expressed by GPs as to whether the video truly reflected resource and time pressures encountered in the general practice working environment. Patient feedback on the scheduled consultations was positive. Patients welcomed the opportunity to have their medications reviewed. Due to the short time to follow-up and a lack of detailed clinical information in patient records, it was not feasible to detect any prescribing changes or to apply the assessment tools to patients' clinical data. The findings will help to further refine the intervention and study procedures (including time to follow-up) which will be tested in a randomised pilot study that will inform the design of a definitive trial to evaluate the intervention's effectiveness. ISRCTN18176245.

Adaptation of postural recovery responses to a vestibular sensory illusion in individuals with Parkinson disease and healthy controls.

PubMed

Lester, Mark E; Cavanaugh, James T; Foreman, K Bo; Shaffer, Scott W; Marcus, Robin; Dibble, Leland E

2017-10-01

The ability to adapt postural responses to sensory illusions diminishes with age and is further impaired by Parkinson disease. However, limited information exists regarding training-related adaptions of sensory reweighting in these populations. This study sought to determine whether Parkinson disease or age would differentially affect acute postural recovery or adaptive postural responses to novel or repeated exposure to sensory illusions using galvanic vestibular stimulation during quiet stance. Acutely, individuals with Parkinson disease demonstrated larger center of pressure coefficient of variation compared to controls. Unlike individuals with Parkinson disease and asymptomatic older adults, healthy young adults acutely demonstrated a reduction in Sample Entropy to the sensory illusion. Following a period of consolidation Sample Entropy increased in the healthy young group, which coincided with a decreased center of pressure coefficient of variation. Similar changes were not observed in the Parkinson disease or older adult groups. Taken together, these results suggest that young adults learn to adapt to vestibular illusion in a more robust manner than older adults or those with Parkinson disease. Further investigation into the nature of this adaptive difference is warranted. Published by Elsevier Ltd.

Estimated aortic stiffness is independently associated with cardiac baroreflex sensitivity in humans: role of ageing and habitual endurance exercise.

PubMed

Pierce, G L; Harris, S A; Seals, D R; Casey, D P; Barlow, P B; Stauss, H M

2016-09-01

We hypothesised that differences in cardiac baroreflex sensitivity (BRS) would be independently associated with aortic stiffness and augmentation index (AI), clinical biomarkers of cardiovascular disease risk, among young sedentary and middle-aged/older sedentary and endurance-trained adults. A total of 36 healthy middle-aged/older (age 55-76 years, n=22 sedentary and n=14 endurance-trained) and 5 young sedentary (age 18-31 years) adults were included in a cross-sectional study. A subset of the middle-aged/older sedentary adults (n=12) completed an 8-week-aerobic exercise intervention. Invasive brachial artery blood pressure waveforms were used to compute spontaneous cardiac BRS (via sequence technique), estimated aortic pulse wave velocity (PWV) and AI (AI, via brachial-aortic transfer function and wave separation analysis). In the cross-sectional study, cardiac BRS was 71% lower in older compared with young sedentary adults (P<0.05), but only 40% lower in older adults who performed habitual endurance exercise (P=0.03). In a regression model that included age, sex, resting heart rate, mean arterial pressure (MAP), body mass index and maximal exercise oxygen uptake, estimated aortic PWV (β±s.e.=-5.76±2.01, P=0.01) was the strongest predictor of BRS (model R(2)=0.59, P<0.001). The 8-week-exercise intervention improved BRS by 38% (P=0.04) and this change in BRS was associated with improved aortic PWV (r=-0.65, P=0.044, adjusted for changes in MAP). Age- and endurance-exercise-related differences in cardiac BRS are independently associated with corresponding alterations in aortic PWV among healthy adults, consistent with a mechanistic link between variations in the sensitivity of the baroreflex and aortic stiffness with age and exercise.

Estimated Aortic Stiffness is Independently Associated with Cardiac Baroreflex Sensitivity in Humans: Role of Aging and Habitual Endurance Exercise

PubMed Central

Pierce, Gary L.; Harris, Stephen A.; Seals, Douglas R.; Casey, Darren P.; Barlow, Patrick B.; Stauss, Harald M.

2016-01-01

We hypothesized that differences in cardiac baroreflex sensitivity (BRS) would be independently associated with aortic stiffness and augmentation index (AI), clinical biomarkers of cardiovascular disease (CVD) risk, among young sedentary and middle-aged/older sedentary and endurance-trained adults. A total of 36 healthy middle-aged/older (age 55-76 years, n=22 sedentary; n=14 endurance-trained) and 5 young sedentary (age 18-31 years) adults were included in a cross-sectional study. A subset of the middle-aged/older sedentary adults (n=12) completed an 8-week aerobic exercise intervention. Invasive brachial artery blood pressure waveforms were used to compute spontaneous cardiac BRS (via sequence technique) and estimated aortic pulse wave velocity (PWV) and AI (AI, via brachial-aortic transfer function and wave separation analysis). In the cross-sectional study, cardiac BRS was 71% lower in older compared with young sedentary adults (P<0.05), but only 40% lower in older adults who performed habitual endurance exercise (P=0.03). In a regression model that included age, sex, resting heart rate, mean arterial pressure (MAP), body mass index and maximal exercise oxygen uptake, estimated aortic PWV (β±SE = −5.76 ± 2.01, P=0.01) was the strongest predictor of BRS (Model R2=0.59, P<0.001). The 8 week exercise intervention improved BRS by 38% (P=0.04) and this change in BRS was associated with improved aortic PWV (r=−0.65, P=0.044, adjusted for changes in MAP). Age- and endurance exercise-related differences in cardiac BRS are independently associated with corresponding alterations in aortic PWV among healthy adults, consistent with a mechanistic link between variations in the sensitivity of the baroreflex and aortic stiffness with age and exercise. PMID:26911535

Age Group Comparisons of TENS Response Among Individuals With Chronic Axial Low Back Pain.

PubMed

Simon, Corey B; Riley, Joseph L; Fillingim, Roger B; Bishop, Mark D; George, Steven Z

2015-12-01

Chronic low back pain (CLBP) is a highly prevalent and disabling musculoskeletal pain condition among older adults. Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat CLBP, however response to TENS in older adults compared with younger adults is untested. In a dose-response study stratified by age, 60 participants with axial CLBP (20 young, 20 middle-aged, 20 older) received four 20-minute sessions of high-frequency high-intensity TENS over a 2- to 3-week period in a laboratory-controlled setting. Experimental measures of pain sensitivity (mechanical pressure pain detection threshold) and central pain excitability (phasic heat temporal summation and heat aftersensations) were assessed before and after TENS. Episodic or immediate axial CLBP relief was assessed after TENS via measures of resting pain, movement-evoked-pain, and self-reported disability. Cumulative or prolonged axial CLBP relief was assessed by comparing daily pain reports across sessions. Independent of age, individuals experienced episodic increase in the pressure pain detection threshold and reduction in aftersensation after TENS application. Similarly, all groups, on average, experienced episodic axial CLBP relief via improved resting pain, movement-evoked pain, and disability report. Under this design, no cumulative effect was observed as daily pain did not improve for any age group across the 4 sessions. However, older adults received higher TENS amplitude across all sessions to achieve TENS responses similar to those in younger adults. These findings suggest that older adults experience similar episodic axial CLBP relief to that of younger individuals after high-frequency, high-intensity TENS when higher dose parameters are used. This study examined age group differences in experimental and axial CLBP response to TENS, delivered under the current recommended parameters of strong, but tolerable amplitude. Older adults had comparable TENS response although at higher TENS amplitude than younger adults, which may have important mechanistic and clinical implications. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Abnormalities in arterial-ventricular coupling in older healthy persons are attenuated by sodium nitroprusside

PubMed Central

Chantler, Paul D.; Nussbacher, Amit; Gerstenblith, Gary; Schulman, Steven P.; Becker, Lewis C.; Ferrucci, Luigi; Fleg, Jerome L.; Najjar, Samer S.

2011-01-01

The coupling between arterial elastance (EA; net afterload) and left ventricular elastance (ELV; pump performance), known as EA/ELV, is a key determinant of cardiovascular performance and shifts during exercise due to a greater increase in ELV versus EA. This normal exercise-induced reduction in EA/ELV decreases with advancing age. We hypothesized that sodium nitroprusside (SNP) can acutely ameliorate the age-associated deficits in EA/ELV. At rest and during graded exercise to exhaustion, EA was characterized as end-systolic pressure/stroke volume and ELV as end-systolic pressure/end-systolic volume. Resting EA/ELV did not differ between old (70 ± 8 yr, n = 15) and young (30 ± 5 yr, n = 17) subjects because of a tandem increase in EA and ELV in older subjects. During peak exercise, a blunted increase in ELV in old (7.8 ± 3.1 mmHg/ml) versus young (11.4 ± 6.5 mmHg/ml) subjects blunted the normal exercise-induced decline in EA/ELV in old (0.25 ± 0.11) versus young (0.16 ± 0.05) subjects. SNP administration to older subjects lowered resting EA/ELV by 31% via a reduction in EA (10%) and an increase in ELV (47%) and lowered peak exercise EA/ELV (36%) via an increase in ELV (68%) without a change in EA. Importantly, SNP attenuated the age-associated deficits in EA/ELV and ELV during exercise, and at peak exercise EA/ELV in older subjects on drug administration did not differ from young subjects without drug administration. In conclusion, some age-associated deficiencies in EA/ELV, EA, and ELV, in older subjects can be acutely abolished by SNP infusion. This is relevant to common conditions in older subjects associated with a significant impairment of exercise performance such as frailty or heart failure with preserved ejection fraction. PMID:21378146

Prostate Cancer Screening In Men Ages 75 And Older Fell By 8 Percentage Points After Task Force Recommendation

PubMed Central

Howard, David H.; Tangka, Florence K.; Guy, Gery P.; Ekwueme, Donatus U.; Lipscomb, Joseph

2016-01-01

In 2008 the US Preventive Services Task Force recommended against screening men ages 75 and older for prostate cancer. Using Medicare Current Beneficiary Survey Access to Care files and linked claims, we compared trends in prostate-specific antigen (PSA) testing rates between men ages 75 and older and men ages 65–74. We estimate that the revised recommendation led to a 7.9-percentage-point decline in annual PSA testing rates over two years among men ages 75 and older. Although 42 percent of men in this age group continue to receive PSA tests, our results highlight the potential of guidelines with negative recommendations to reduce the use of low-value medical care. PMID:23459740

Evaluation of a new pressure ulcer preventive dressing containing ceramide 2 with low frictional outer layer.

PubMed

Nakagami, Gojiro; Sanada, Hiromi; Konya, Chizuko; Kitagawa, Atsuko; Tadaka, Etsuko; Matsuyama, Yutaka

2007-09-01

This paper is a report of an evaluation of the effectiveness of a newly developed dressing for preventing persistent erythema and pressure ulcer development and improving the water-holding capacity without increasing the skin pH in bedridden older patients. Shear forces and skin dryness play important roles in persistent erythema and pressure ulcer development. To eliminate these risks, we developed a dressing to reduce shear forces and improve the water-holding capacity. However, the effects of this dressing in clinical settings remain unknown. An experimental bilateral comparison study was conducted at a hospital in Japan in 2004 with 37 bedridden older patients at risk of pressure ulcer development. The dressing was randomly applied to the right or left greater trochanter for 3 weeks. No dressing was applied to the opposite side as a control. The skin was monitored weekly during the 3-week application for persistent erythema and pressure ulcer development. Skin hydration and pH were also assessed during the intervention and for 1 week after dressing removal. The incidence of persistent erythema was significantly lower in the intervention area than the control area [P = 0.007, RR 0.18 (95% CI: 0.05-0.73) and NNT 4.11 (2.50-11.63) ]. No pressure ulcers occurred in either the intervention or control area. Skin hydration increased significantly during dressing application and remained high after removal (P < 0.001) relative to the control area. Skin pH decreased significantly during the application (P < 0.001) but returned to control levels after removal (P = 0.38). This safe and effective dressing can be used for patients with highly prominent bones and dry skin to prevent pressure ulcers.

Pressure distribution along the AGS vacuum chambers with new types of pump out conduits

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nayak, S.; Mapes, M.; Smart, L.

2015-10-28

The AGS HEBT and ring vacuum system is monitored by the discharge current of the magnet ion pumps, which is proportional to the pressure at the inlet port of these ion pumps. The discharge current is measured and suitably calibrated to indicate the ion pump pressure. In order to calculate the vacuum chamber pressure from the ion pump pressure, a detailed analysis is essential to compute their difference in different scenarios. Such analysis has been carried out numerically in the past for the system with the older type of pump out conduits, and similar analysis using FEM in ANSYS ismore » presented in this paper with the newer type of pump out conduit.« less

Associations Between Fish Consumption and Contaminant Biomarkers With Cardiovascular Conditions Among Older Male Anglers in Wisconsin.

PubMed

Raymond, Michelle R; Christensen, Krista Y; Thompson, Brooke A; Anderson, Henry A

2016-07-01

The aim of this study was to determine fish consumption habits and contaminant exposures associated with adverse cardiovascular outcomes among older male anglers. One hundred fifty-four men aged 50 years and older living and fishing in Wisconsin completed a detailed survey and provided hair and blood samples. Associations between fish consumption and body burdens of several contaminants, with self-reported cardiovascular outcomes, were evaluated. Consuming fish species with higher methyl mercury content was positively associated with odds of angina, coronary heart disease (CHD), or heart attack, while consuming fattier species was negatively associated with high blood pressure or high cholesterol. Total mercury in blood was associated with 27% higher odds of heart attack, and certain classes of polychlorinated biphenyls were positively associated with CHD. Total mercury exposures may affect cardiovascular outcomes. Educational interventions promoting consumption of fish low in methyl mercury among older male anglers are needed.

Cognitive Function and Vascular Risk Factors Among Older African American Adults

PubMed Central

Park, Moon Ho; Tsang, Siny; Sperling, Scott A.; Manning, Carol

2017-01-01

To evaluate the association between vascular risk factors and cognitive impairment among older African American (AA) adults in a primary care clinic. Participants included 96 AA adults aged 60 years or older who were evaluated for global and domain-specific cognition. Participants were interviewed using the Computerized Assessment of Memory and Cognitive Impairment (CAMCI). The relationship between CAMCI cognitive domain scores and vascular risk factors were examined using hierarchical regression models. Patients who smoked, those with higher SBP/DBP values had lower accuracy rates on CAMCI cognitive domains (attention, executive, memory).Those with higher BMI had better attention scores. Patients with higher HbA1C values had worse verbal memory. Patients with higher blood pressure were significantly faster in responding to tasks in the executive domain. Primary care providers working with older AA adults with these VRFs could implement cognitive screening earlier into their practice to reduce barriers of seeking treatment. PMID:28417319

Blood pressure, brain structure, and cognition: opposite associations in men and women.

PubMed

Cherbuin, Nicolas; Mortby, Moyra E; Janke, Andrew L; Sachdev, Perminder S; Abhayaratna, Walter P; Anstey, Kaarin J

2015-02-01

Research on associations between blood pressure, brain structure, and cognitive function has produced somewhat inconsistent results. In part, this may be due to differences in age ranges studied and because of sex differences in physiology and/or exposure to risk factors, which may lead to different time course or patterns in cardiovascular disease progression. The aim of this study was to investigate the impact of sex on associations between blood pressure, regional cerebral volumes, and cognitive function in older individuals. In this cohort study, brachial blood pressure was measured twice at rest in 266 community-based individuals free of dementia aged 68-73 years who had also undergone a brain scan and a neuropsychological assessment. Associations between mean blood pressure (MAP), regional brain volumes, and cognition were investigated with voxel-wise regression analyses. Positive associations between MAP and regional volumes were detected in men, whereas negative associations were found in women. Similarly, there were sex differences in the brain-volume cognition relationship, with a positive relationship between regional brain volumes associated with MAP in men and a negative relationship in women. In this cohort of older individuals, higher MAP was associated with larger regional volume and better cognition in men, whereas opposite findings were demonstrated in women. These effects may be due to different lifetime risk exposure or because of physiological differences between men and women. Future studies investigating the relationship between blood pressure and brain structure or cognitive function should evaluate the potential for differential sex effects. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Lean mass influences overnight changes in hydration, blood pressure and strength in community-dwelling older women.

PubMed

Benton, Melissa J; Schlairet, Maura C

2016-10-01

We evaluated the hypothesis that greater lean mass promotes better overnight hydration, improved postural blood pressure and greater strength. Thirty women, aged 71 ± 0.9 years (mean ± SE), completed one measurement in a euhydrated state and another the following morning after an overnight fast. Measurements included hydration, lean mass, orthostatic blood pressure and strength. Participants were grouped by fat-free mass index (FFMI), with cut-points defined as low (< 15.0 kg/m(2)) and normal (≥ 15.0 kg/m(2)). Women with normal FFMI had significantly greater hydration (p < 0.01), lean mass (p < 0.001) and upper body strength (p < 0.05), while those with low FFMI had more unstable blood pressure. On day 1, women with low FFMI experienced significant postural systolic blood pressure changes from sitting to standing (-11.3 ± 4.0 mmHg, p < 0.05). On day 2, they experienced significant systolic changes from lying to sitting (-8.0 ± 2.2 mmHg, p < 0.01) and sitting to standing (-14.9 ± 5.5 mmHg, p < 0.05), and diastolic changes from lying to sitting (-8.9 ± 2.8 mmHg, p < 0.05). In conclusion, overnight fluid shifts in older women with low lean mass result in unstable postural blood pressure and loss of strength that increases the risk for early morning falls.

Association between unsafe driving performance and cognitive-perceptual dysfunction in older drivers.

PubMed

Park, Si-Woon; Choi, Eun Seok; Lim, Mun Hee; Kim, Eun Joo; Hwang, Sung Il; Choi, Kyung-In; Yoo, Hyun-Chul; Lee, Kuem Ju; Jung, Hi-Eun

2011-03-01

To find an association between cognitive-perceptual problems of older drivers and unsafe driving performance during simulated automobile driving in a virtual environment. Cross-sectional study. A driver evaluation clinic in a rehabilitation hospital. Fifty-five drivers aged 65 years or older and 48 drivers in their late twenties to early forties. All participants underwent evaluation of cognitive-perceptual function and driving performance, and the results were compared between older and younger drivers. The association between cognitive-perceptual function and driving performance was analyzed. Cognitive-perceptual function was evaluated with the Cognitive Perceptual Assessment for Driving (CPAD), a computer-based assessment tool consisting of depth perception, sustained attention, divided attention, the Stroop test, the digit span test, field dependency, and trail-making test A and B. Driving performance was evaluated with use of a virtual reality-based driving simulator. During simulated driving, car crashes were recorded, and an occupational therapist observed unsafe performances in controlling speed, braking, steering, vehicle positioning, making lane changes, and making turns. Thirty-five older drivers did not pass the CPAD test, whereas all of the younger drivers passed the test. When using the driving simulator, a significantly greater number of older drivers experienced car crashes and demonstrated unsafe performance in controlling speed, steering, and making lane changes. CPAD results were associated with car crashes, steering, vehicle positioning, and making lane changes. Older drivers who did not pass the CPAD test are 4 times more likely to experience a car crash, 3.5 times more likely to make errors in steering, 2.8 times more likely to make errors in vehicle positioning, and 6.5 times more likely to make errors in lane changes than are drivers who passed the CPAD test. Unsafe driving performance and car crashes during simulated driving were more prevalent in older drivers than in younger drivers. Unsafe performance in steering, vehicle positioning, making lane changes, and car crashes were associated with cognitive-perceptual dysfunction. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Test-retest reliability of Yale Physical Activity Survey among older Mexican American adults: a pilot investigation.

PubMed

Pennathur, Arunkumar; Magham, Rohini; Contreras, Luis Rene; Dowling, Winifred

2004-01-01

The objective of the work reported in this paper is to assess test-retest reliability of Yale Physical Activity Survey Total Time, Estimated Energy Expenditure, Activity Dimension Indices, and Activities Check-list in older Mexican American men and women. A convenience-based healthy sample of 49 (42 women and 7 men) older Mexican American adults recruited from senior recreation centers aged 68 to 80 years volunteered to participate in this pilot study. Forty-nine older Mexican American adults filled out the Yale Physical Activity Survey for this study. Fifteen (12 women and 3 men) of the 49 volunteers responded twice to the Yale Physical Activity Survey after a 2-week period, and helped assess the test-retest reliability of the Yale Physical Activity Survey. Results indicate that based on a 2-week test-retest administration, the Yale Physical Activity Survey was found to have moderate (rhoI= .424, p < .05) to good reliability (rs = .789, p < .01) for physical activity assessment in older Mexican American adults who responded.

Older and Wiser: Older Adults’ Episodic Word Memory Benefits from Sentence Study Contexts

PubMed Central

Matzen, Laura E.; Benjamin, Aaron S.

2013-01-01

A hallmark of adaptive cognition is the ability to modulate learning in response to the demands posed by different types of tests and different types of materials. Here we evaluate how older adults process words and sentences differently by examining patterns of memory errors. In two experiments, we explored younger and older adults’ sensitivity to lures on a recognition test following study of words in these two types of contexts. Among the studied words were compound words such as “blackmail” and “jailbird” that were related to conjunction lures (e.g. “blackbird”) and semantic lures (e.g. “criminal”). Participants engaged in a recognition test that included old items, conjunction lures, semantic lures, and unrelated new items. In both experiments, younger and older adults had the same general pattern of memory errors: more incorrect endorsements of semantic than conjunction lures following sentence study and more incorrect endorsements of conjunction than semantic lures following list study. The similar pattern reveals that older and younger adults responded to the constraints of the two different study contexts in similar ways. However, while younger and older adults showed similar levels of memory performance for the list study context, the sentence study context elicited superior memory performance in the older participants. It appears as though memory tasks that take advantage of greater expertise in older adults--in this case, greater experience with sentence processing--can reveal superior memory performance in the elderly. PMID:23834493

Social epidemiology of excess weight and central adiposity in older Indians: analysis of Study on global AGEing and adult health (SAGE)

PubMed Central

Samal, Sudipta; Panigrahi, Pinaki; Dutta, Ambarish

2015-01-01

Objectives We aimed to estimate the prevalence of overweight and obesity, represented by extra body weight and abdominal circumference, among older Indians; and to characterise the social pattern of obesity and measure the magnitude of hypertension attributable to it. Setting A nationally representative sample of older Indians was selected from 6 Indian states, including Rajasthan, Uttar Pradesh, West Bengal, Assam, Maharashtra and Karnataka, as a part of the multicountry Study on global AGEing and adult health (SAGE). Participants Indians aged 50 years or more (n=7273) were included in the first wave of the SAGE (2010), which we used in our study. Primary and secondary outcome measures The primary outcome measures included excess weight (EW), defined by body mass index (BMI) >25 kg/m2, and central adiposity (CA), defined by waist circumference >90 cm for men and >80 cm for women. The secondary outcome included hypertension, defined by systolic blood pressure >139 or diastolic blood pressure >79 mm Hg, or by those receiving antihypertensive medications. Results 14% of older Indians possessed EW, whereas 35% possessed CA; 50.9% of the wealthier third and 27.7% of the poorer two-thirds have CA; the proportions being 69.1% and 46.2%, respectively, in older women. Mostly wealth (adjusted OR for CA: 4.36 (3.23 to 5.95) and EW: 4.39 (3.49 to 5.53)), but also urban residence, privileged caste, higher education, white-collared occupation and female gender, were important determinants. One of 17 older Indians overall and 1 of 18 in the poorer 70% suffered from CA-driven hypertension, independent of BMI. Conclusions The problem of CA and its allied diseases is already substantial and expected to rise across all socioeconomic strata of older Indians, though currently, CA affects the privileged more than the underprivileged, in later life. Population-based promotion of appropriate lifestyles, with special emphasis on women, is required to counteract prosperity-driven obesity before it becomes too entrenched and expensive to uproot. PMID:26610757

Age alters the cardiovascular response to direct passive heating

NASA Technical Reports Server (NTRS)

Minson, C. T.; Wladkowski, S. L.; Cardell, A. F.; Pawelczyk, J. A.; Kenney, W. L.

1998-01-01

During direct passive heating in young men, a dramatic increase in skin blood flow is achieved by a rise in cardiac output (Qc) and redistribution of flow from the splanchnic and renal vascular beds. To examine the effect of age on these responses, seven young (Y; 23 +/- 1 yr) and seven older (O; 70 +/- 3 yr) men were passively heated with water-perfused suits to their individual limit of thermal tolerance. Measurements included heart rate (HR), Qc (by acetylene rebreathing), central venous pressure (via peripherally inserted central catheter), blood pressures (by brachial auscultation), skin blood flow (from increases in forearm blood flow by venous occlusion plethysmography), splanchnic blood flow (by indocyanine green clearance), renal blood flow (by p-aminohippurate clearance), and esophageal and mean skin temperatures. Qc was significantly lower in the older than in the young men (11.1 +/- 0.7 and 7.4 +/- 0.2 l/min in Y and O, respectively, at the limit of thermal tolerance; P < 0. 05), despite similar increases in esophageal and mean skin temperatures and time to reach the limit of thermal tolerance. A lower stroke volume (99 +/- 7 and 68 +/- 4 ml/beat in Y and O, respectively, P < 0.05), most likely due to an attenuated increase in inotropic function during heating, was the primary factor for the lower Qc observed in the older men. Increases in HR were similar in the young and older men; however, when expressed as a percentage of maximal HR, the older men relied on a greater proportion of their chronotropic reserve to obtain the same HR response (62 +/- 3 and 75 +/- 4% maximal HR in Y and O, respectively, P < 0.05). Furthermore, the older men redistributed less blood flow from the combined splanchnic and renal circulations at the limit of thermal tolerance (960 +/- 80 and 720 +/- 100 ml/min in Y and O, respectively, P < 0. 05). As a result of these combined attenuated responses, the older men had a significantly lower increase in total blood flow directed to the skin.

Extrinsic and intrinsic factors impacting on the retention of older rural healthcare workers in the north Victorian public sector: a qualitative study.

PubMed

Warburton, Jeni; Moore, Melissa L; Clune, Samantha J; Hodgkin, Suzanne P

2014-01-01

Workforce shortages in Australia's healthcare system, particularly across rural areas, are well documented. Future projections suggest that as the healthcare workforce ages and retires, there is an urgent need for strategies to retain older skilled employees. Very few qualitative studies, with theoretical underpinning, have focused on the retention of older rural nurses and allied healthcare workers. This study aimed to address these gaps in research knowledge. This qualitative study is phase 2 of a large mixed-methods study to determine the factors that impact on the retention of older rural healthcare workers across northern Victoria, Australia. The initial phase, drawing on the effort-reward imbalance model found high levels of imbalance across a large sample of this population. The present study builds on these findings to explore in more depth the organisational (extrinsic) and individual/social (intrinsic) factors associated with retention. A purposeful stratified sample was drawn from participants at the survey phase (phase 1) and invited to take part in a semistructured telephone interview. A diverse group of 17 rural healthcare workers (nurses and allied health) aged 55 years or more, employed in the north Victorian public sector, were interviewed. The data were transcribed and later analysed thematically and inductively. Data were categorised into extrinsic and intrinsic factors that influenced their decisions to remain in their roles or leave employment. The main extrinsic factors included feeling valued by the organisation, workload pressures, feeling valued by clients, collegial support, work flexibility, and a lack of options. The main intrinsic factors included intention to retire, family influences, work enjoyment, financial influences, health, sense of self, and social input. Given the noted imbalance between (high) effort and (low) reward among participants overall, strategies were identified for improving this balance, and in turn, the retention of older rural healthcare workers. Study outcomes provide important insight into factors that impact on the retention of older rural healthcare workers, and, importantly, the imbalance in effort and reward participants experience in their current workplace. Use of a theoretical approach, and a two-stage methodology, enables a deeper understanding of these factors and the strategies needed to address them. Further research is now needed to test the effectiveness of these strategies in the older rural healthcare workforce.

Survival benefits of metabolic syndrome among older men aged 75 years and over in Taiwan.

PubMed

Chiang, P-H; Liu, C-L; Lin, M-H; Peng, L-N; Chen, L-K; Chen, J-D; Hou, S-M

2012-01-01

Metabolic syndrome (MetS) was common in the elderly, but its prognostic significance in older old population remained unclear. The main purpose of this study was to evaluate the survival impact of MetS among older men aged 75 and over in Taiwan. From 2008, residents aged 75 years and older of Banciao Veterans Home were invited for study and were followed for 3 years. All participants received history taking, physical examinations, and laboratory tests. Mortality was determined by Veteran Affairs Death Registry, which was linked to the National Death Registry. Overall, 680 men (mean age: 82.5±4.7 years) were enrolled for study and the prevalence of MetS was 31.6%. During the follow-up period, 140 (20.6%) participants died, and the causes of death included infectious diseases (62, 9.1%), cardiovascular disease (37, 5.4%), cancer (20, 2.9%), and others (21, 3.1%). MetS subjects had a significantly higher prevalence of hypertension, diabetes mellitus, and having higher body mass index, waist circumferences, systolic blood pressure, fasting blood glucose, serum triglyceride and lower HDL-C level than non-MetS subjects. However, MetS subjects were less likely to die during study period (16.3% vs. 22.6%, P=0.059). Multivariate logistic regression showed that older age (OR:1.04, 95% C.I.: 1.00-1.08, P=0.04), diabetes mellitus (OR: 2.10, 95% CI: 1.34-3.30, P=0.001) were independent risk factors for mortality; and serum total cholesterol and triglyceride were protective factors (OR: 0.99, 95% CI: 0.99-1.00, P=0.037 for cholesterol; OR: 0.99, 95% CI: 0.99-1.00, P=0.013 for triglyceride). Adjusted for age, diabetes mellitus, serum levels of total cholesterol, and triglyceride, MetS played a potential trend of survival benefits among study subjects (HR: 0.71, 95% CI: 0.45-1.12, P=0.144). The prevalence of MetS among men aged 75 years and over was 31.6%, and the 3-year mortality rate was 20.6%. Older age, diabetes mellitus, lower serum cholesterol and lower serum triglyceride were independent risk factors for mortality. Further investigation is needed to clarify the prognostic impact of MetS in older adults.

The effect of cell phone use on postural balance and mobility in older compared to young adults.

PubMed

Laatar, Rabeb; Kachouri, Hiba; Borji, Rihab; Rebai, Haithem; Sahli, Sonia

2017-05-01

Cell phone use is considered as an essential part of everyday life saturating all age groups and demographics. This study aimed to explore the effect of various cell phone functions on postural control and mobility in the elderly. Twenty healthy older (mean age 72.5±2.9) and twenty young (26.3±2.8) adults participated in this study. Postural balance was assessed by measuring the center of pressure (CoP) displacement with (talking on a cell phone (CONVERSE), dialing a number (DIAL) and listening to music (MUSIC)) and without cell phone use. Mobility was assessed by the Timed Up and Go Test (TUGT). Results showed that for both groups, the CoP parameters increased significantly during the CONVERSE (p<0.001) and the DIAL (CoP area , CoP X : p<0.05; CoP Y : p<0.01) conditions compared to the control condition. Moreover, the CoP area values were significantly higher during the CONVERSE condition in comparison to the DIAL (p<0.05) one. In older adults, the TUGT scores increased significantly in the DIAL (p<0.01) condition compared to the CONVERSE and the MUSIC conditions. In conclusion, cell phone use impairs similarly standing postural balance of elderly and young adults. Interestingly, in the elderly, all cell phone functions used altered mobility with the dialing function causing the largest mobility deterioration. Copyright © 2017 Elsevier Inc. All rights reserved.

Panax ginseng and Salvia miltiorrhiza supplementation during eccentric resistance training in middle-aged and older adults: A double-blind randomized control trial.

PubMed

Lin, Hsin-Fu; Chou, Chun-Chung; Chao, Hsiao-Han; Tanaka, Hirofumi

2016-12-01

Muscle damage induced by an acute bout of eccentric exercise results in transient arterial stiffening. In this study, we sought to determine the effects of progressive eccentric resistance exercise training on vascular functions, and whether herb supplementation would enhance training adaptation by ameliorating the arterial stiffening effects. By using a double-blinded randomized placebo-controlled design, older adults were randomly assigned to either the Panax ginseng and Salvia miltiorrhiza supplementation group (N=12) or the placebo group (N=11). After pre-training testing, all subjects underwent 12 weeks of unilateral eccentric-only exercise training on knee extensor. Maximal leg strength and muscle quality increased in both groups (P<0.05). Relative increases in muscle mass were significantly greater in the placebo group than in the herb supplement group. Eccentric exercise training did not elicit any significant changes in muscle damage, oxidative and inflammatory biomarkers. There were no significant changes in blood pressure or endothelium-dependent vasodilation. None of the measures of arterial stiffness changed significantly with eccentric resistance training in both groups. These results suggest that Chinese herb supplementation does not appear to modulate vascular, and inflammatory adaptations to eccentric exercise training in middle-aged and older adults. However, Chinese herb supplementation abolished the increase in muscle mass induced by eccentric resistance training. (Trial registration: ClinicalTrials.gov: NCT02007304. Registered Dec. 5, 2013). Copyright © 2016 Elsevier Ltd. All rights reserved.

Betel quid chewing in rural Bangladesh: prevalence, predictors and relationship to blood pressure

PubMed Central

Heck, Julia E; Marcotte, Erin L; Argos, Maria; Parvez, Faruque; Ahmed, Alauddin; Islam, Tariqul; Sarwar, Golam; Hasan, Rabiul; Ahsan, Habibul; Chen, Yu

2012-01-01

Background Betel quid is chewed by 600 million people worldwide and it has been linked to obesity and cardiovascular disease. The purpose of our study was to examine the prevalence and predictors of betel quid chewing in a rural area of Bangladesh, and determine its effects on body mass index (BMI) and blood pressure. Methods In this population-based prospective study, we analysed data on 19 934 Bangladeshi adults. Linear and multivariate logistic regression was used to determine the socio-demographic predictors of betel quid chewing and the effect of betel quid on change in BMI and on systolic and diastolic blood pressure, pulse pressure, arterial pressure, overweight or obesity, and hypertension. Results At baseline, betel quid was chewed by 33.2% of the cohort (35.5% of men, 31.6% of women). In a subsample in which we collected methods of use, 17.5% chewed it without tobacco and 82.5% chewed it with tobacco. In multivariate analysis, betel quid chewing was associated with female sex, older age, tobacco smoking and lower socio-economic status, as measured by fewer years of formal education and not owning land. Betel quid was chewed more times per day among women and older persons. At follow-up, persons who chewed betel quid without tobacco had higher systolic blood pressure, diastolic blood pressure and arterial pressure in comparison with never users. After controlling for other explanatory variables, chewing betel quid without tobacco was associated with general hypertension [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04–2.10] and systolic hypertension (OR 1.55, 95% CI 1.01–2.37). We did not observe associations of betel quid chewing with BMI or overweight. Conclusions Betel quid chewing is likely contributing to high blood pressure in Bangladesh, particularly among women. PMID:22253307

Evaluation of dynamic balance among community-dwelling older adult fallers: a generalizability study of the limits of stability test.

PubMed

Clark, S; Rose, D J

2001-04-01

To establish reliability estimates of the 75% Limits of Stability Test (75% LOS test) when administered to community-dwelling older adults with a history of falls. Generalizability theory was used to estimate both the relative contribution of identified error sources to the total measurement error and generalizability coefficients. A random effects repeated-measures analysis of variance (ANOVA) was used to assess consistency of LOS test movement variables across both days and targets. A motor control research laboratory in a university setting. Fifty community-dwelling older adults with 2 or more falls in the previous year. Spatial and temporal measures of dynamic balance derived from the 75% LOS test included average movement velocity, maximum center of gravity (COG) excursion, end-point COG excursion, and directional control. Estimated generalizability coefficients for 2 testing days ranged from.58 to.87. Total variance in LOS test measures attributable to inconsistencies in day-to-day test performance (Day and Subject x Day facets) ranged from 2.5% to 8.4%. The ANOVA results indicated that no significant differences were observed in the LOS test variables across the 2 testing days. The 75% LOS test administered to older adult fallers on 2 consecutive days provides consistent and reliable measures of dynamic balance.

Periodization Strategies in Older Adults: Impact on Physical Function and Health.

PubMed

Conlon, Jenny A; Newton, Robert U; Tufano, James J; Banyard, Harry G; Hopper, Amanda J; Ridge, Ashley J; Haff, G Gregory

2016-12-01

This study compared the effect of periodized versus nonperiodized (NP) resistance training (RT) on physical function and health outcomes in older adults. Forty-one apparently healthy untrained older adults (women = 21, men = 20; 70.9 ± 5.1 yr; 166.3 ± 8.2 cm; 72.9 ± 13.4 kg) were recruited and randomly stratified to a NP, block periodized, or daily undulating periodized training group. Outcome measures were assessed at baseline and after a 22-wk × 3 d·wk RT intervention, including; anthropometrics, body composition, blood pressure and biomarkers, maximal strength, functional capacity, balance confidence, and quality of life. Thirty-three subjects satisfied all study requirements and were included in analyses (women = 17, men = 16; 71.3 ± 5.4 yr; 166.3 ± 8.5 cm; 72.5 ± 13.7 kg). The main finding was that all three RT models produced significant improvements in several physical function and physiological health outcomes, including; systolic blood pressure, blood biomarkers, body composition, maximal strength, functional capacity and balance confidence, with no between-group differences. Periodized RT, specifically block periodization and daily undulating periodized, and NP RT are equally effective for promoting significant improvements in physical function and health outcomes among apparently healthy untrained older adults. Therefore, periodization strategies do not appear to be necessary during the initial stages of RT in this population. Practitioners should work toward increasing RT participation in the age via feasible and efficacious interventions targeting long-term adherence in minimally supervised settings.

Monitoring Your Blood Sugar Level

MedlinePlus

... orders an A1C test. However, you can also purchase over-the-counter A1C testing kits that you ... subject. Featured ContentPreparing Older Children to Make Medical Decisions for ThemselvesRead Article >>Preparing Older Children to Make ...

The Timed Up and Go Test: unable to predict falls on the acute medical ward.

PubMed

Lindsay, Robyn; James, Erica L; Kippen, Sandra

2004-01-01

Prevention of falls amongst older people is a high priority in health care. The aim of this study was to evaluate the ability of the Timed Up and Go Test to predict those older people who will fall whilst admitted to an acute hospital. The medical records of 160 older patients who were admitted to the medical ward of a large regional hospital were accessed retrospectively. The Timed Up and Go Test, used in isolation, was unable to identify those patients who were likely to fall. However the co-morbidity of incontinence was identified as a falls risk factor (OR = 8.7, p = 0.001). The Timed Up and Go Test alone does not possess predictive validity for acutely unwell older patients. It is therefore recommended that it not be used to identify those people who may fall.

Naturalistic Validation of an On-Road Driving Test of Older Drivers

PubMed Central

Ott, Brian R.; Papandonatos, George D.; Davis, Jennifer D.; Barco, Peggy P.

2013-01-01

Objective The objective was to compare a standardized road test to naturalistic driving by older people who may have cognitive impairment to define improvements that could potentially enhance the validity of road testing in this population. Background Road testing has been widely adapted as a tool to assess driving competence of older people who may be at risk for unsafe driving because of dementia; however, the validity of this approach has not been rigorously evaluated. Method For 2 weeks, 80 older drivers (38 healthy elders and 42 with cognitive impairment) who passed a standardized road test were video recorded in their own vehicles. Using a standardized rating scale, 4 hr of video was rated by a driving instructor. The authors examine weighting of individual road test items to form global impressions and to compare road test and naturalistic driving using factor analyses of these two assessments. Results The road test score was unidimensional, reflecting a major factor related to awareness of signage and traffic behavior. Naturalistic driving reflected two factors related to lane keeping as well as traffic behavior. Conclusion Maintenance of proper lane is an important dimension of driving safety that appears to be relatively underemphasized during the highly supervised procedures of the standardized road test. Application Road testing in this population could be improved by standardized designs that emphasize lane keeping and that include self-directed driving. Additional information should be sought from observers in the community as well as crash evidence when advising older drivers who may be cognitively impaired. PMID:22908688

Cardiovascular Health Awareness Program (CHAP): a community cluster-randomised trial among elderly Canadians.

PubMed

Kaczorowski, Janusz; Chambers, Larry W; Karwalajtys, Tina; Dolovich, Lisa; Farrell, Barbara; McDonough, Beatrice; Sebaldt, Rolf; Levitt, Cheryl; Hogg, William; Thabane, Lehana; Tu, Karen; Goeree, Ron; Paterson, J Michael; Shubair, Mamdouh; Gierman, Tracy; Sullivan, Shannon; Carter, Megan

2008-06-01

High blood pressure is an important and modifiable cardiovascular disease risk factor that remains under-detected and under-treated. Community-level interventions that address high blood pressure and other modifiable risk factors are a promising strategy to improve cardiovascular health in populations. The present study is a community cluster-randomised trial testing the effectiveness of CHAP (Cardiovascular Health Awareness Program) on the cardiovascular health of older adults. Thirty-nine mid-sized communities in Ontario, Canada were stratified by geographic location and size of the population aged >or=65 years and randomly allocated to receive CHAP or no intervention. In CHAP communities, residents aged >or=65 years were invited to attend cardiovascular risk assessment sessions held in pharmacies over 10 weeks in Fall, 2006. Sessions included blood pressure measurement and feedback to family physicians. Trained volunteers delivered the program with support from pharmacists, community nurses and local organisations. The primary outcome measure is the relative change in the mean annual rate of hospital admission for acute myocardial infarction, congestive heart failure and stroke (composite end-point) among residents aged >or=65 years in intervention and control communities, using routinely collected, population-based administrative health data. This paper highlights considerations in design, implementation and evaluation of a large-scale, community-wide cardiovascular health promotion initiative.

[Effects of education and strength training on functional tests among older people with osteoarthritis].

PubMed

Jiménez S, Christian Edgardo; Fernández G, Rubén; Zurita O, Félix; Linares G, Daniel; Farías M, Ariel

2014-04-01

Hip and knee osteoarthritis are important causes of pain and disability among older people. Education and strength training can alleviate symptoms and avoid functional deterioration. To assess muscle strength, fall risk and quality of life of older people with osteoarthritis and the effects of physiotherapy education and strength training on these variables. Thirty participants aged 78 ± 5 years (63% women) were randomly assigned to receive physiotherapy (Controls), physiotherapy plus education (Group 1) and physiotherapy plus strength training (group 2). At baseline and after 16 weeks of intervention, patients were evaluated with the Senior Fitness Test, Timed Up and Go and Quality of Life score short form (SF-36). During the intervention period, Senior Fitness Test and Timed Up and Go scores improved in all groups and SF-36 did not change. The improvement in Senior Fitness Test and Timed Up and Go was more marked in Groups 1 and 2 than in the control group. Education and strength training improve functional tests among older people with osteoarthritis.

Enhancing computer self-efficacy and attitudes in multi-ethnic older adults: a randomised controlled study

PubMed Central

Laganà, Luciana; Oliver, Taylor; Ainsworth, Andrew; Edwards, Marc

2014-01-01

Several studies have documented the health-related benefits of older adults' use of computer technology, but before they can be realised, older individuals must be positively inclined and confident in their ability to engage in computer-based environments. To facilitate the assessment of computer technology attitudes, one aim of the longitudinal study reported in this paper was to test and refine a new 22-item measure of computer technology attitudes designed specifically for older adults, as none such were available.1 Another aim was to replicate, on a much larger scale, the successful findings of a preliminary study that tested a computer technology training programme for older adults (Laganà 2008). Ninety-six older men and women, mainly from non-European-American backgrounds, were randomly assigned to the waitlist/control or the experimental group. The same six-week one-on-one training was administered to the control subjects at the completion of their post-test. The revised (17-item) version of the Older Adults' Computer Technology Attitudes Scale (OACTAS) showed strong reliability: the results of a factor analysis were robust, and two analyses of covariance demonstrated that the training programme induced significant changes in attitudes and self-efficacy. Such results encourage the recruitment of older persons into training programmes aimed at increasing computer technology attitudes and self-efficacy. PMID:25512679

Improving balance by performing a secondary cognitive task.

PubMed

Swan, Laurie; Otani, Hajime; Loubert, Peter V; Sheffert, Sonya M; Dunbar, Gary L

2004-02-01

Contrary to general findings in the attention and memory literature, some studies have shown that performing a secondary cognitive task produces an improvement in balance performance. The purpose of the present experiment was to investigate under what condition such an improvement would occur. Young and older adults were asked to hold as still as possible on a platform that measured sway while performing or not performing the encoding phase of the Brooks' (1967) spatial or non-spatial memory task. The difficulty of maintaining balance was manipulated by varying the availability of visual input and sway-referenced motion of the platform. Sway scores were computed based on the distance between the individual pressure centres and the average centre of pressure during each 20-s trial. The results indicated that both the spatial and non-spatial memory tasks improved balance for older adults under the most difficult balance condition.

Subjective social status of older people across countries: the role of modernization and employment.

PubMed

Vauclair, Christin-Melanie; Marques, Sibila; Lima, Maria L; Bratt, Christopher; Swift, Hannah J; Abrams, Dominic

2015-07-01

To test and expand upon modernization theory's account of subjective social status (SSS) of older people in society. It was hypothesized that perceptions of older people's social status should be higher in more modernized countries and that the proportion of older people in employment should moderate the relationship between modernization and SSS of older people. Data were from the "Experiences and Expressions of Ageism" module in the fourth round of the European Social Survey. The sample analyzed included 45,706 individuals from 25 countries in the European region. Multilevel modeling was used to test the hypotheses. The SSS of older people (aged 70 years and older) was perceived to be higher in countries with very high levels of modernization and in countries with a higher proportion of older people in employment. The positive association between modernization and SSS of older people was stronger within countries with a lower proportion of older people in employment. The proportion of older people who are employed is an important factor that is related to perceptions of the social status of older people in less modern societies. The individual and societal implications are discussed, specifically in relation to policies promoting active aging. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Association between older driver characteristics, on-road driving test performance, and crash liability.

PubMed

Keall, Michael D; Frith, William J

2004-06-01

From May 1999, a new system for licensing older drivers was introduced in New Zealand. It included a practical on-road driving test with expanded scope, to be completed every two years from the time the driver turns 80. The relationship between crashes and test performance needed to be studied to inform the debate regarding the testing system. The population studied was all drivers who entered this licensing system during its first three years of operation. They were defined as crash involved if they were involved in an injury crash during the two years following their first licensure under the new system. Logistic regression was used to describe the risk of crash involvement in terms of driving test performance and other driver characteristics. Each driving test failure was associated with a 33% increase in the odds of crash involvement (95% CI 14% to 55%), controlling for age, gender, minor traffic violations, and whether the older driver lived with another licensed driver or not. Minor traffic violations in the two years following the driving test were associated with twice the odds of crash involvement. These results suggest that the new on-road driving test does identify older driver behaviors or limitations that are related to crash liability. It is anticipated that the results presented here will provide essential information for discussing older driver licensing systems, whose impact will grow in importance as the population of drivers ages.

Balance quality assessment as an early indicator of physical frailty in older people.

PubMed

Chkeir, Aly; Safieddine, Doha; Bera, D; Collart, M; Novella, J L; Drame, M; Hewson, David J; Duchene, Jacques

2016-08-01

Frailty is an increasingly common geriatric condition that results in an increased risk of adverse health outcomes such as falls. The most widely-used means of detecting frailty is the Fried phenotype, which includes several objective measures such as grip strength and gait velocity. One method of screening for falls is to measure balance, which can be done by a range of techniques including the assessment of the Centre of Pressure (CoP) during a balance assessment. The Balance Quality Tester (BQT) is a device based on a commercial bathroom scale that can evaluate balance quality. The BQT provides instantaneously the position of the CoP (stabilogram) in both anteroposterior (AP) and mediolateral (ML) directions and can estimate the vertical ground reaction force. The purpose of this study was to examine the relationship between balance quality assessment and physical frailty. Balance quality was compared to physical frailty in 186 older subjects. Rising rate (RR) was slower and trajectory velocity (TV) was higher in subjects classified as frail for both grip strength and gait velocity (p<;0.05). Balance assessment could be used in conjunction with functional tests of grip strength and gait velocity as a means of screening for frailty.

Pequi fruit (Caryocar brasiliense Camb.) pulp oil reduces exercise-induced inflammatory markers and blood pressure of male and female runners.

PubMed

Miranda-Vilela, Ana L; Pereira, Luiz C S; Gonçalves, Carlos A; Grisolia, Cesar K

2009-12-01

The objective of this study was to investigate the anti-inflammatory properties of pequi (Caryocar brasiliense) fruit oil and its effects on the postprandial lipidemia and arterial blood pressure of male and female athletes. These athletes were evaluated after races in the same environment and under the same type, intensity, and length of weekly training conditions, both before and after ingestion of 400 mg pequi oil capsules for 14 days. Pequi fruit contains several antioxidants, and its oil has been associated with anti-inflammatory properties in other pequi species. Because the oil of pequi is mostly composed of oleic and palmitic fatty acids, the oil may alter the ratio of triglyceride to cholesterol in postprandial lipidemia. Epidemiologic studies suggest that an increased intake of monounsaturated fatty acids (such as oleic acid) is inversely related to blood pressure. Thus, we hypothesize that pequi oil could reduce exercise-induced inflammation and blood pressure, and modulate postprandial lipidemia in runners. To test this hypothesis, arterial blood pressures were checked before races; blood samples were taken after the races and submitted for analysis of leukocytes and platelets analysis, high-sensitivity C-reactive protein values, and postprandial lipids. Pequi oil resulted in anti-inflammatory effects and reduced the total cholesterol and low-density lipoprotein in the age group older than 45 years, mainly for men. The results showed a general trend for reduced arterial pressure, suggesting that pequi oil may have a hypotensive effect. However, this finding needs additional investigation. Thus, pequi oil, besides possessing many nutritional properties, may be a good candidate supplement for athletes.

Influence of fitness and age on the endothelial response to acute inflammation.

PubMed

Schroeder, Elizabeth C; Lane-Cordova, Abbi D; Ranadive, Sushant M; Baynard, Tracy; Fernhall, Bo

2018-06-01

What is the central question of the study? What are the effects of age and fitness on the vascular response to acute inflammation in younger and older adults? What is the main finding and its importance? In older adults, cardiorespiratory fitness level has a differential impact on endothelial function after acute inflammation. Compared with older adults with low fitness, older, moderately fit adults have a greater decrease in endothelial function, similar to that of younger adults. These findings have important implications in support of the beneficial effects of higher cardiorespiratory fitness in maintaining vascular reactivity and the ability to respond to stressors. Inflammation is associated with greater risk of cardiovascular events and reduced vascular function with ageing. Higher cardiorespiratory fitness is associated with lower risk of cardiovascular events and better vascular function. We evaluated the role of fitness in the vascular response to acute inflammation in 26 younger adults (YA) and 62 older adults (OA). We used an influenza vaccine to induce acute inflammation. Blood pressure, flow-mediated dilatation (FMD), augmentation index, carotid elastic modulus and inflammatory markers were measured before and 24 h after vaccination. Peak oxygen uptake was measured via a treadmill test. 'Fit' was defined as a peak oxygen uptake greater than the age- and sex-determined 50th percentile according to the American College of Sports Medicine. An interaction effect existed for the FMD response during acute inflammation (P < 0.05). The YA (low fit, from 11.5 ± 1.8 to 9.2 ± 1.3%; moderately fit, from 11.9 ± 0.8 to 9.0 ± 0.8%) and moderately fit OA (from 7.5 ± 1.0 to 3.9 ± 0.8%) had similar reductions in FMD at 24 h (P < 0.05). Low-fit OA did not reduce FMD at 24 h (from 5.5 ± 0.4 to 5.2 ± 0.5%, P > 0.05). The reduction in FMD in YA was similar between fitness groups (P > 0.05). All groups had similar reductions in mean arterial pressure and increases in inflammatory markers. The augmentation index and carotid elastic modulus did not change during acute inflammation. In conclusion, in OA, higher fitness is associated with a greater decrease in endothelial function during acute inflammation, and this response is similar to that of young adults. This suggests that moderately fit OA may maintain vascular reactivity in response to stress, indicating preserved vascular function in moderately fit versus low-fit OA. © 2018 The Authors. Experimental Physiology © 2018 The Physiological Society.

Compensatory but not anticipatory adjustments are altered in older adults during lateral postural perturbations.

PubMed

Claudino, Renato; dos Santos, Eloá C C; Santos, Marcio J

2013-08-01

This study investigated anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) and their relationship in older adults during lateral postural perturbations. Unpredictable and predictable postural disturbances were induced by a swinging pendulum that impacted at the shoulder level of two groups of older adults, non-fallers (20) and fallers (20), and in a group of young control subjects (20). The electromyographic (EMG) activity of the postural muscles and the center of pressure (COP) displacement were recorded and quantified within the time intervals typical for APAs and CPAs. Both groups of older adults (non-fallers and fallers) showed higher magnitude of EMG activity in the lateral muscles and increased COP displacement, particularly, during the CPAs time interval when compared to the young group. Older adults, however, were able to change the electrical activity of the muscles during the predictable task by generating APAs with similar magnitudes of those found in young subjects. Compensatory but not anticipatory adjustments are altered in older adults during predictable lateral postural perturbations. These findings provide new data on the role of APAs and CPAs in their relationship in older adults during external lateral perturbations and may advance current rehabilitative management strategies to improve balance control in older individuals. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Biomechanics of the Human Posterior Sclera: Age- and Glaucoma-Related Changes Measured Using Inflation Testing

PubMed Central

Coudrillier, Baptiste; Tian, Jing; Alexander, Stephen; Myers, Kristin M.; Quigley, Harry A.; Nguyen, Thao D.

2012-01-01

Purpose. The objective of this study was to measure the biomechanical response of the human posterior sclera in vitro and to estimate the effects of age and glaucoma. Methods. Scleral specimens from 22 donors with no history of glaucoma and 11 donors with a history of glaucoma were excised 3 mm posterior to the equator and affixed to an inflation chamber. Optic nerve cross-sections were graded to determine the presence of axon loss. The time-dependent inflation response was measured in a series of pressure-controlled load–unload tests to 30 mm Hg and creep tests to 15 and 30 mm Hg. Circumferential and meridional strains were computed from the digital image correlation displacements, and midposterior stresses were determined from pressure and deformed geometry. Results. Among normal specimens, older age was predictive of a stiffer response and a thinner sclera. In the age group 75 to 93, diagnosed glaucoma eyes with axon damage were thicker than normal eyes. Both damaged and undamaged glaucoma eyes had a different strain response in the peripapillary sclera characterized by a stiffer meridional response. Undamaged glaucoma eyes had slower circumferential creep rates in the peripapillary sclera than normal eyes. Glaucoma eyes were not different from normal eyes in stresses and strains in the midposterior sclera. Conclusions. The observed differences in the biomechanical response of normal and glaucoma sclera may represent baseline properties that contribute to axon damage, or may be characteristics that result from glaucomatous disease. PMID:22395883

[Strength, flexibility, balance, resistance and flexibility assessment according to body mass index in active older women].

PubMed

Vaquero-Cristóbal, Raquel; Martínez González-Moro, Ignacio; Alacid Cárceles, Fernando; Ros Simón, Esperanza

2013-01-01

Overweight and obesity are increasing at an alarming rate among older people. This is mainly because this population is predominantly sedentary. The aim of this study was to classify, according to the body mass index (BMI), a group of older active women and to evaluate the different basic physical abilities as a function of this. The BMI and fitness were evaluated in 60 elderly active women (mean age: 66.14 ± 6.59 years) using the 2-minute step test, arm curl test, chair stand test, back scratch test, chair-sit and reach-test, flamenco test, and 8-foot up-and-go test. It was found that 52.23% of the women studied had a normal BMI and 47.76% were slightly overweight. There were no cases of obesity or underweight. Women with normal BMI had better values in all tests than overweight women. Significant differences were found in the flamenco test (P<.05), and 8-foot up-and-go test (P<.01). Older women who usually do physical activity had a normal or slightly overweight BMI. It was also found that women with lower BMI have better resistance, flexibility, balance and strength. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

Organizational Support and Volunteering Benefits for Older Adults

ERIC Educational Resources Information Center

Tang, Fengyan; Choi, Eunhee; Morrow-Howell, Nancy

2010-01-01

Purpose: This study tested a theoretical model of volunteering benefits and examined the mechanism through which volunteering benefits older adults. Design and Methods: This is a 2-wave study of 253 older adult volunteers serving in 10 volunteer programs. Older volunteers completed the mailed surveys in 2005 and 2006. Structural equation modeling…

Unjust Desserts: Financial Realities of Older Women.

ERIC Educational Resources Information Center

Estrine, Judith

This brochure presents the facts about the financial situation of older women. It explains the vital role of Social Security (SS) for women and offers suggestions to improve their financial outlook. A true/false checklist tests knowledge about women growing older and remaining financially secure. These reasons for poorer older women are outlined:…

Organizational support and volunteering benefits for older adults.

PubMed

Tang, Fengyan; Choi, Eunhee; Morrow-Howell, Nancy

2010-10-01

This study tested a theoretical model of volunteering benefits and examined the mechanism through which volunteering benefits older adults. This is a 2-wave study of 253 older adult volunteers serving in 10 volunteer programs. Older volunteers completed the mailed surveys in 2005 and 2006. Structural equation modeling was used to define the latent variables and to test direct and indirect relationships among organizational support, socioemotional benefits, and self-reported health. Organizational support (measured by choice of volunteer activity, training, and ongoing support) had significant direct associations with 2 latent factors of socioemotional benefits, that is, perceived contribution and personal benefits. Perceived contribution was significantly related to mental health. Additionally, older volunteers with lower socioeconomic status (SES) committed more hours and perceived more personal benefits than higher SES peers. These findings suggest that volunteer programs can provide various organizational supports to older volunteers, especially to low-SES volunteers, in order to promote the socioemotional and health benefits of volunteering to older adults. Psychological well-being of older adults can be improved through engagement in meaningful volunteer activities and contribution to others.

The aging eyewitness: effects of age on face, delay, and source-memory ability.

PubMed

Memon, Amina; Bartlett, James; Rose, Rachel; Gray, Colin

2003-11-01

As a way to examine the nature of age-related differences in lineup identification accuracy, young (16-33 years) and older (60-82 years) witnesses viewed two similar videotaped incidents, one involving a young perpetrator and the other involving an older perpetrator. The incidents were followed by two separate lineups, one for the younger perpetrator and one for the older perpetrator. When the test delay was short (35 min), the young and older witnesses performed similarly on the lineups, but when the tests were delayed by 1 week, the older witnesses were substantially less accurate. When the target was absent from the lineups, the older witnesses made more false alarm errors, particularly when the faces were young. When the target was present in the lineups, correct identifications by both young and older witnesses were positively correlated with a measure of source recollection derived from a separate face-recognition task. Older witnesses scored poorly on this measure, suggesting that source-recollection deficits are partially responsible for age-related differences in performance on the lineup task.

[Aging and blood pressure].

PubMed

Mendes, Romeu; Themudo Barata, J L

2008-01-01

High blood pressure is a major risk factor of cardiovascular diseases and has a high prevalence in the older individuals becoming in a risk factor associated with high cardiovascular mortality and morbidity among these population. This study has the objective to analyze the changes in the cardiovascular system inherent to the aging process, that provoke the increase of blood pressure levels with the advance of age and that can origin hypertension. With the aging process, changes in the anatomy and cardiovascular physiology occur, even in the absence of illness. High blood pressure is characterized as a systemic condition that involves the presence of structural changes of the arteries and the myocardium, associated to an endotelial and baroreceptors dysfunction.

The Impact of Motivation and Task Difficulty on Resource Engagement: Differential Influences on Cardiovascular Responses of Young and Older Adults

PubMed Central

Smith, Brian T.; Hess, Thomas M.

2018-01-01

This study examined whether the level of cognitive engagement older adults were willing to invest is disproportionately influenced by the personal implications of the task, as suggested by Selective Engagement Theory. We experimentally altered the personal implications of the task by manipulating participants accountability for their performance. Young (N = 50) and older (N = 50) adults performed a memory-search task of moderate difficulty but within the capabilities of both age groups. Both physiological (systolic blood pressure responsivity; SBP-R) and subjective (NASA-TLX) measures of cognitive effort were assessed across all difficulty levels. The results replicated findings from previous research that indicated older adults must exert more effort than younger adults to achieve the same level of objective performance. Most importantly, our results showed that older adults were especially sensitive to our accountability manipulation, with the difference in SBP-R between accountability conditions being greater for older than for young adults. Finally, we found that there was little relation between subjective measures of workload and our physiological measures of task engagement. Together, the results of this study provide continued support for the Selective Engagement Theory. PMID:29670932

Case management for frail older adults through tablet computers and Skype.

PubMed

Berner, Jessica; Anderberg, Peter; Rennemark, Mikael; Berglund, Johan

2016-12-01

Frail older adults are high consumers of medical care due to their age and multiple chronic conditions. Regular contact with a case manager has been proven to increase well-being of frail older adults and reduce their number of health-care visits. Skype calls through tablet PCs can offer easier communication. This paper examines frail older adults' use of tablet computers and Skype, with their case managers. Interviews were conducted on 15 frail older adults. A content analysis was used to structure and analyze the data. The results indicate that tablet computers were experienced in a positive way for most frail older adults. Conflicting feelings did emerge, however, as to whether the frail elderly would adopt this in the long run. Skype needs to be tested further as to whether this is a good solution for communication with their case managers. Strong technical support and well-functioning technology are important elements to facilitate use. Using Skype and tablet PCs do have potential for frail older adults, but need to be tested further.

Reduction of the incidence of pressure sores by an education program on nursing care.

PubMed

Srisupan, Vijitr; Senaratana, Wilawan; Picheansatian, Wilawan; Chittreecheur, Jittaporn; Watanakool, Malinee; Chaisri, Pratin; Singhakumfu, Laddawan; Tribuddharat, Chanwit; Danchaivijitr, Somwang

2005-12-01

To determine whether an education and campaign program would reduce the incidence of pressure sores. The study was performed in a 1,400-bed teaching hospital in Thailand with a total number of 697patients from 47 wards for a point prevalence study; 1,201 and 1,268 patients from 12 wards to determine whether reduction of pressure sore occurrence would be obtained by an education program. The point prevalence of pressure sores was 10.8%. The significant risk factors were age older than 60 years, fecal incontinence, and history of diarrhea. The occurrence of pressure sores was significantly reduced after the educational program from 9.91% to 5. 76%. The education on patient care aiming at reduction of the occurrence of pressure sores could be adopted nation-wide in order to reduce the morbidity, mortality and expenses. The education program was effective in reducing the incidence of pressure sores.

A longitudinal investigation of repressive coping and ageing.

PubMed

Erskine, James; Kvavilashvili, Lia; Myers, Lynn; Leggett, Sarah; Davies, Steve; Hiskey, Syd; Hogg, Joanna; Yeo, Sophia; Georgiou, George

2016-10-01

Two studies investigated the possibility that repressive coping is more prevalent in older adults and that this represents a developmental progression rather than a cohort effect. Study 1 examined repressive coping and mental health cross-sectionally in young and old adults. Study 2 examined whether there was a developmental progression of repressive coping prevalence rates in a longitudinal sample of older adults. Study 1 compared younger adults (mean age 27.6 years) with older adults (mean age 74.2 years) on inventories of mental health and well-being and examined the prevalence of repressive coping in both samples. Study 2 re-tested a sample of older adults previously reported following an interval of 7 years. Study 1 - in line with previous research older adults demonstrated greater psychological well-being and had a higher prevalence of repressive coping than younger adults (at 30% vs. 12% respectively). Study 2 - the data indicated that the prevalence of repressive coping rose from 41% at the first time of testing (2002) to 56.4% at the second testing interval (2009). These results suggest that repressive coping may increase across the lifespan in certain individuals and continue to increase throughout older adulthood. Furthermore, this increase in repressive coping with age appears to result in better well-being in those older adults who become repressive copers.

The Longitudinal Impact of Cognitive Speed of Processing Training on Driving Mobility

PubMed Central

Edwards, Jerri D.; Myers, Charlsie; Ross, Lesley A.; Roenker, Daniel L.; Cissell, Gayla M.; McLaughlin, Alexis M.; Ball, Karlene K.

2009-01-01

Purpose: To examine how cognitive speed of processing training affects driving mobility across a 3-year period among older drivers. Design and Methods: Older drivers with poor Useful Field of View (UFOV) test performance (indicating greater risk for subsequent at-fault crashes and mobility declines) were randomly assigned to either a speed of processing training or a social and computer contact control group. Driving mobility of these 2 groups was compared with a group of older adults who did not score poorly on the UFOV test (reference group) across a 3-year period. Results: Older drivers with poor UFOV test scores who did not receive training experienced greater mobility declines as evidenced by decreased driving exposure and space and increased driving difficulty at 3 years. Those at risk for mobility decline who received training did not differ across the 3-year period from older adults in the reference group with regard to driving exposure, space, and most aspects of driving difficulty. Implications: Cognitive speed of processing training can not only improve cognitive performance but also protect against mobility declines among older drivers. Scientifically proven cognitive training regimens have the potential to enhance the everyday lives of older adults. PMID:19491362

Age-Differences in Environment Route Learning: The Role of Input and Recall-Test Modalities in Young and Older Adults

ERIC Educational Resources Information Center

Meneghetti, Chiara; Borella, Erika; Gyselinck, Valerie; De Beni, Rossana

2012-01-01

The aim of this research was to examine age-related differences in young and older adults in route learning, using different types of learning and recall test modalities. A sample of young adults (20-30 years old) and older adults (60-70 years old) learned a city route by using either a map or a description; they then performed a verification…

Association of fall history with the Timed Up and Go test score and the dual task cost: A cross-sectional study among independent community-dwelling older adults.

PubMed

Asai, Tsuyoshi; Oshima, Kensuke; Fukumoto, Yoshihiro; Yonezawa, Yuri; Matsuo, Asuka; Misu, Shogo

2018-05-21

To investigate the associations between fall history and the Timed Up and Go (TUG) test (single-TUG test), TUG test while counting aloud backwards from 100 (dual-TUG test) and the dual-task cost (DTC) among independent community-dwelling older adults. This cross-sectional study included 537 older adults who lived independently in the community. Data on fall history in the previous year were obtained by self-administrated questionnaire. The single- and dual-TUG tests were carried out, and the DTC value was computed from these results. Associations between fall history and these TUG-related values were analyzed using multivariate logistic regression models. The participants were divided into fall risk groups using the cut-off values of those significantly associated with falling, and the odds ratios (OR) were computed. Slower single-TUG test scores and lower DTC values were significantly associated with fall history after adjusting for potential confounders (single-TUG test score: OR 1.133, 95% CI 1.029-1.249; DTC value: OR 0.984, 95% CI 0.968-0.998). Older adults with slower single-TUG test scores and lower DTC values reported a fall history more often than those in other categories (OR compared with the lower-risk single-TUG and lower-risk DTC groups: 3.474, 95% CI 1.881-6.570). Slower single-TUG test scores and lower DTC values are associated with fall history among independent community-dwelling older adults. To some extent, dual task performance might provide added value for fall assessment, compared with administering the TUG test alone. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

Fasting glucose and glucose tolerance as potential predictors of neurocognitive function among nondiabetic older adults.

PubMed

Sims Wright, Regina; Levy, Shellie-Anne T; Katzel, Leslie I; Rosenberger, William F; Manukyan, Zorayr; Whitfield, Keith E; Waldstein, Shari R

2015-01-01

Significant evidence has demonstrated that Type 2 diabetes mellitus and related precursors are associated with diminished neurocognitive function and risk of dementia among older adults. However, very little research has examined relations of glucose regulation to neurocognitive function among older adults free of these conditions. The primary aim of this investigation was to examine associations among fasting glucose, glucose tolerance, and neurocognitive function among nondiabetic older adults. The secondary aim was to examine age, gender, and education as potential effect modifiers. The study employed a cross-sectional, correlational study design. Participants were 172 older adults with a mean age of 64.43 years (SD = 13.09). The sample was 58% male and 87% White. Participants completed an oral glucose tolerance test as part of a larger study. Trained psychometricians administered neuropsychological tests that assessed performance in the domains of response inhibition, nonverbal memory, verbal memory, attention and working memory, visuoconstructional abilities, visuospatial abilities, psychomotor speed and executive function, and motor speed and manual dexterity. Linear multiple regressions were run to test study aims. No significant main effects of fasting glucose and 2-hour glucose emerged for performance on any neurocognitive test; however, significant interactions were present. Higher fasting glucose was associated with poorer short-term verbal memory performance among men, but unexpectedly better response inhibition and long-term verbal memory performance for participants over age 70. Higher 2-hour glucose values were associated with reduced divided attention performance among participants with less than a high school education. Mixed findings suggest that glucose levels may be both beneficial and deleterious to neurocognition among nondiabetic older adults. Additional studies with healthy older adults are needed to confirm this unexpected pattern of associations; however, findings have implications for the importance of maintaining healthy glucose levels in older adulthood.

Liver Transplantation With Older Donors: A Comparison With Younger Donors in a Context of Organ Shortage.

PubMed

Barbier, Louise; Cesaretti, Manuela; Dondero, Federica; Cauchy, François; Khoy-Ear, Linda; Aoyagi, Takeshi; Weiss, Emmanuel; Roux, Olivier; Dokmak, Safi; Francoz, Claire; Paugam-Burtz, Catherine; Sepulveda, Ailton; Belghiti, Jacques; Durand, François; Soubrane, Olivier

2016-11-01

Older liver grafts have been considered in the past decade due to organ shortage. The aim was to compare outcomes after liver transplantation with either younger or older donors. Patients transplanted in our center between 2004 and 2014 with younger donors (younger than 60 years; n = 253) were compared with older donors (older than 75 years; n = 157). Multiorgan transplantations, split grafts, or non-heart-beating donors were not included. Donors in the older group were mostly women deceased from stroke, and only 3 patients had experienced cardiac arrest. Liver tests were significantly better in the older group than in the younger group. There was no difference regarding cold ischemia time, model for end-stage liver disease score, and steatosis. There was no significant difference regarding primary nonfunction and dysfunction, hepatic artery and biliary complications, and retransplantation rates. Graft survival was not different (65% and 64% in the older and younger groups, P = 0.692). Within the older group, hepatitis C infection, retransplantation, and emergency transplantation were associated with poor graft survival. Provided normal liver tests and the absence of cardiac arrest in donors, older liver grafts (>75 years) may be safely attributed to non-hepatitis C-infected recipients in the setting of a first and nonurgent transplantation.

Subjective physical and cognitive age among community-dwelling older people aged 75 years and older: differences with chronological age and its associated factors.

PubMed

Ihira, Hikaru; Furuna, Taketo; Mizumoto, Atsushi; Makino, Keitaro; Saitoh, Shigeyuki; Ohnishi, Hirofumi; Shimada, Hiroyuki; Makizako, Hyuma

2015-01-01

The aim of this cross-sectional study was to determine the associations between self-reported subjective physical and cognitive age, and actual physical and cognitive functions among community-dwelling older people aged 75 years and older. The sample comprised 275 older adults aged 75-91 years. Two questions were asked regarding subjective age: 'How old do you feel physically?' and 'How old do you feel cognitively?' To assess physical functions, we measured handgrip strength, knee extension strength, standing balance and walking speed. Tests of attention, executive function, processing speed and memory were performed to assess actual cognitive function. Subjective physical and cognitive age was associated with performance on all of the physical and cognitive tests, respectively (p < 0.01). We also found that older adults who reported themselves as feeling older than their chronological age had a slower walking speed and lower scores for word-list memory recall than those who did not report themselves as feeling older than their actual age. These findings suggest that promoting a fast walking speed and good memory function may help to maintain a younger subjective physical and cognitive age in older adults aged 75 years and older.

The impact of Stereotype Threat on the simulated driving performance of older drivers.

PubMed

Joanisse, Mélanie; Gagnon, Sylvain; Voloaca, Mihnea

2013-01-01

Older drivers are perceived as being dangerous and overly cautious by other drivers. We tested the hypothesis that this negative stereotype has a direct influence on the performance of older drivers. Based on the Stereotype Threat literature, we predicted that older driving performance would be altered after exposure to a Stereotype Threat. Sixty-one older drivers aged 65 and above completed a simulated driving assessment course. Prior to testing, half of the participants were told that the objective of the study was to investigate why older adults aged 65 and above were more implicated in on-road accidents (Stereotype Threat condition) and half were showed a neutral statement. Results confirmed that exposure to the threat significantly altered driving performance. Older adults in the Stereotype Threat condition made more driving mistakes than those in the control group. Interestingly, under a Stereotype Threat condition, older adults tended to commit more speeding infractions. We also observed that domain identification (whether driving is deemed important or not) moderated the impact of the threat. Taken together, these results support recent older drivers' performance models suggesting that the interaction between individual and social factors need to be considered when examining older drivers' performance. Copyright © 2012 Elsevier Ltd. All rights reserved.

Swallowing Changes in Community-Dwelling Older Adults.

PubMed

Mulheren, Rachel W; Azola, Alba M; Kwiatkowski, Stephanie; Karagiorgos, Eleni; Humbert, Ianessa; Palmer, Jeffrey B; González-Fernández, Marlís

2018-06-08

Older adults may evidence changes in swallowing physiology. Our goals were to identify dysphagia risk in community-dwelling older adults with no history of dysphagia, and to compare swallowing physiology and safety between older and younger adults. Thirty-two older adults with no history of dysphagia were prospectively recruited and completed the Dysphagia Handicap Index (DHI), two trials of a 3 oz. swallow screen, and videofluoroscopy (VFSS). Self-ratings of swallowing function were compared to published norms by paired t tests, and multivariate logistic regression models were generated to determine whether these ratings and VFSS analysis of swallowing function were associated with failure of one or both swallow screen trials. Archived VFSS of 33 younger adults were compared to older adults with Wilcoxon rank-sum tests. The DHI scores of older adults were higher than published non-dysphagic adults but lower than dysphagic adults. Older participants with greater Oral Residue scores were more likely to fail both swallow screen trials. Older adults received higher median MBSImP™© scores for select pharyngeal components than younger adults. The two age groups did not differ on Penetration-Aspiration Scale scores, and no aspiration was observed. Measures of swallowing in older individuals may reflect age-related sensory and motor changes in the context of functional swallowing and adequate airway protection.

Lung transplantation with lungs from older donors: recipient and surgical factors affect outcomes.

PubMed

Shigemura, Norihisa; Horai, Tetsuya; Bhama, Jay K; D'Cunha, Jonathan; Zaldonis, Diana; Toyoda, Yoshiya; Pilewski, Joseph M; Luketich, James D; Bermudez, Christian A

2014-10-27

A shortage of donors has compelled the use of extended-criteria donor organs in lung transplantation. The purpose of this study was to evaluate the impact of using older donors on outcomes after lung transplantation using current protocols. From January 2003 to August 2009, 593 lung transplants were performed at our institution. We compared 87 patients (14.7%) who received lungs from donors aged 55 years or older with 506 patients who received lungs from donors less than 55 years old. We also examined risk factors for mortality in recipients of lungs from older donors. The incidence of major complications including severe primary graft dysfunction and early mortality rates were similar between the groups. However, posttransplant peak FEV1 was lower in the patients who received lungs from older donors (71.7% vs. 80.7%, P<0.05). In multivariate analysis, recipient pulmonary hypertension (transpulmonary pressure gradient >20 mm Hg) and prolonged intraoperative cardiopulmonary bypass were significant risk factors for mortality in the recipients of lungs from older donors. This large, single-center experience demonstrated that transplanting lungs from donors older than 55 years did not yield worse short- or long-term outcomes as compared with transplanting lungs from younger donors. However, transplanting lungs from older donors into recipients with pulmonary hypertension or recipients who required prolonged cardiopulmonary bypass increased the risk for mortality. Although lungs from older donors should not be excluded because of donor age alone, surgeons should carefully consider their patient selection criteria and surgical plans when transplanting lungs from older donors.

Palestinian pharmacists' knowledge of issues related to using psychotropic medications in older people: a cross-sectional study.

PubMed

Shawahna, Ramzi; Khaskiyyi, Mais; Abdo, Hadeel; Msarwe, Yasmen; Odeh, Rania; Salame, Souad

2017-01-01

The purpose of this study was to assess the knowledge of pharmacists practicing in Palestine of issues related to using psychotropic medications in older people. The study was conducted with a cross-sectional observational design using a questionnaire. A total of 400 pharmacists responded to a 19-statement knowledge test related to the use of psychotropic medications in older people. The study was conducted from July 2016 to February 2017. The reliability and internal consistency of the study tool was assessed using the test-retest method and the Cronbach alpha. Categorical groups were compared using the chi-square test and the Spearman rank correlation. On the 19-statement knowledge test, the median score was 55.3% with an interquartile range of 21.9%. In a comparison of the demographic and practice-related variables of the pharmacists who scored ≥ 50% on the 19-statement knowledge test with those who scored < 50%, age, gender, and having taken a course on psychotropic medications were found to be significantly associated with performance, as shown by the chi-square test and Spearman correlation. Pharmacists practicing in Palestine possess less than optimal knowledge of issues related to the use of psychotropic medications in older people. Continuing educational interventions and/or training might be helpful in improving pharmacists' knowledge of issues related to using psychotropic medications in older people.

Palestinian pharmacists’ knowledge of issues related to using psychotropic medications in older people: a cross-sectional study

PubMed Central

2017-01-01

Purpose The purpose of this study was to assess the knowledge of pharmacists practicing in Palestine of issues related to using psychotropic medications in older people. Methods The study was conducted with a cross-sectional observational design using a questionnaire. A total of 400 pharmacists responded to a 19-statement knowledge test related to the use of psychotropic medications in older people. The study was conducted from July 2016 to February 2017. The reliability and internal consistency of the study tool was assessed using the test-retest method and the Cronbach alpha. Categorical groups were compared using the chi-square test and the Spearman rank correlation. Results On the 19-statement knowledge test, the median score was 55.3% with an interquartile range of 21.9%. In a comparison of the demographic and practice-related variables of the pharmacists who scored ≥ 50% on the 19-statement knowledge test with those who scored < 50%, age, gender, and having taken a course on psychotropic medications were found to be significantly associated with performance, as shown by the chi-square test and Spearman correlation. Conclusion Pharmacists practicing in Palestine possess less than optimal knowledge of issues related to the use of psychotropic medications in older people. Continuing educational interventions and/or training might be helpful in improving pharmacists’ knowledge of issues related to using psychotropic medications in older people. PMID:28835016

CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients.

PubMed

Mudge, Alison M; Banks, Merrilyn D; Barnett, Adrian G; Blackberry, Irene; Graves, Nicholas; Green, Theresa; Harvey, Gillian; Hubbard, Ruth E; Inouye, Sharon K; Kurrle, Sue; Lim, Kwang; McRae, Prue; Peel, Nancye M; Suna, Jessica; Young, Adrienne M

2017-01-09

Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention. A hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards. Using a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation. ACTRN12615000879561 registered prospectively 21/8/2015.

NIH-Supported Trials Test Hormonal Therapy in Older Men with Low Testosterone Levels

MedlinePlus

... February 18, 2016 NIH-supported trials test hormonal therapy in older men with low testosterone levels Testosterone ... Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology. “In contrast, though, the results ...

Perceptions of Older Adults with Heart Failure on Playing an Interactive Digital e-Health Game (IDEG) for Learning About Heart Failure (HF): Prototype Development and Usability Testing.

PubMed

Radhakrishnan, Kavita; Toprac, Paul; O'Hair, Matt; Bias, Randolph; Mackert, Mike; Xie, Bo; Kim, Miyong; Bradley, Paul

2016-01-01

Effective self-management can decrease up to 50% of heart failure (HF) hospitalizations. However, self-management by patients with HF remains poor. We describe the development and usability testing of an interactive digital e-health game (IDEG) for older patients with HF in Central Texas, USA. Majority of the participants (5 out of 6) who participated in the usability testing found the game interesting, enjoyable and helpful to play. Developing an IDEG that is satisfying and acceptable to older adults with HF is feasible.

Physical factors underlying the association between lower walking performance and falls in older people: a structural equation model.

PubMed

Shimada, Hiroyuki; Tiedemann, Anne; Lord, Stephen R; Suzukawa, Megumi; Makizako, Hyuma; Kobayashi, Kumiko; Suzuki, Takao

2011-01-01

The purpose of this study was to determine the interrelationships between lower limb muscle performance, balance, gait and falls in older people using structural equation modeling. Study participants were two hundred and thirteen people aged 65 years and older (mean age, 80.0 ± 7.1 years), who used day-care services in Japan. The outcome measures were the history of falls three months retrospectively and physical risk factors for falling, including performance in the chair stand test (CST), one-leg standing test (OLS), tandem walk test, 6m walking time, and the timed up-and-go (TUG) test. Thirty-nine (18.3%) of the 213 participants had fallen at least one or more times during the preceding 3 months. The fall group had significantly slower 6m walking speed and took significantly longer to undertake the TUG test than the non-fall group. In a structural equation model, performance in the CST contributed significantly to gait function, and low gait function was significantly and directly associated with falls in older people. This suggests that task-specific strength exercise as well as general mobility retraining should be important components of exercise programs designed to reduce falls in older people. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Reliability of a device for the knee and ankle isometric and isokinetic strength testing in older adults.

PubMed

Bergamin, Marco; Gobbo, Stefano; Bullo, Valentina; Vendramin, Barbara; Duregon, Federica; Frizziero, Antonio; Di Blasio, Andrea; Cugusi, Lucia; Zaccaria, Marco; Ermolao, Andrea

2017-01-01

Lower extremity muscle mass, strength, power, and physical performance are critical determinants of independent functioning in later life. Isokinetic dynamometers are becoming very common in assessing different features of muscle strength, in both research and clinical practice; however, reliability studies are still needed to support the extended use of those devices. The purpose of this study is to assess the test-retest reliability of knee and ankle isokinetic and isometric strength testing protocols in a sample of older healthy subjects, using a new and untested isokinetic multi-joint evaluation system. Sixteen male and fourteen female older adults (mean age 65.2 ± 4.6 years) were assessed in two testing sessions. Each participant performed a randomized testing procedure that includes different isometric and isokinetic tests for knee and ankle joints. All participants concluded the trial safety and no subject reported any discomfort throughout the overall assessment. Coefficients of correlation between measures were calculated showing moderate to strong effects among all test-retest assessments and paired-sample t test showed only one significant difference (p<0.05) in the maximal isokinetic bilateral knee flexion torque. The multi-joint evaluation system for the assessment of knee and ankle isokinetic and isometric strength provided reliable test-retest measures in healthy older adults. Ib.

Music to my ears: Age-related decline in musical and facial emotion recognition.

PubMed

Sutcliffe, Ryan; Rendell, Peter G; Henry, Julie D; Bailey, Phoebe E; Ruffman, Ted

2017-12-01

We investigated young-old differences in emotion recognition using music and face stimuli and tested explanatory hypotheses regarding older adults' typically worse emotion recognition. In Experiment 1, young and older adults labeled emotions in an established set of faces, and in classical piano stimuli that we pilot-tested on other young and older adults. Older adults were worse at detecting anger, sadness, fear, and happiness in music. Performance on the music and face emotion tasks was not correlated for either age group. Because musical expressions of fear were not equated for age groups in the pilot study of Experiment 1, we conducted a second experiment in which we created a novel set of music stimuli that included more accessible musical styles, and which we again pilot-tested on young and older adults. In this pilot study, all musical emotions were identified similarly by young and older adults. In Experiment 2, participants also made age estimations in another set of faces to examine whether potential relations between the face and music emotion tasks would be shared with the age estimation task. Older adults did worse in each of the tasks, and had specific difficulty recognizing happy, sad, peaceful, angry, and fearful music clips. Older adults' difficulties in each of the 3 tasks-music emotion, face emotion, and face age-were not correlated with each other. General cognitive decline did not appear to explain our results as increasing age predicted emotion performance even after fluid IQ was controlled for within the older adult group. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Levels of Health Literacy in a Community-Dwelling Population of Chinese Older Adults

PubMed Central

Li, Yu; Dong, XinQi

2014-01-01

Background. Lower levels of health literacy have been associated with adverse health outcomes, especially for older adults. However, limited research has been conducted to understand health literacy levels among Chinese American older adults. Methods. The PINE study is an epidemiological cohort of 3,159 community-dwelling Chinese older adults, 95% of whom do not speak or read English. Chinese older adults’ health literacy levels were examined using the Chinese version of the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) test. Kruskal–Wallis test and chi-square statistics were used to identify significant differences by sociodemographic and self-reported health characteristics. Pearson and Spearman correlation coefficients were used to examine correlations between personal characteristics and health literacy level. Results. The mean age among this sample of Chinese older adults was 72.8 years (SD = 8.3, range = 60–105) and the mean REALM-R test score was 6.9 [SD = 2.3, range (0–8)]. Health literacy was positively associated with education, marriage status, and number of people living with. Older age, being female, greater number of children, years in the United States, and preference for speaking Cantonese or Taishanese were negatively associated with health literacy. Health literary was not associated with self-reported health status or quality of life. Conclusions. In this Chicago Chinese population, older adults had reasonable levels of health literacy in Chinese. Future longitudinal research is needed to understand risk/protective factors associated with health literacy level in Chinese older adults. PMID:25378449

Naturalistic distraction and driving safety in older drivers.

PubMed

Aksan, Nazan; Dawson, Jeffrey D; Emerson, Jamie L; Yu, Lixi; Uc, Ergun Y; Anderson, Steven W; Rizzo, Matthew

2013-08-01

In this study, we aimed to quantify and compare performance of middle-aged and older drivers during a naturalistic distraction paradigm (visual search for roadside targets) and to predict older drivers performance given functioning in visual, motor, and cognitive domains. Distracted driving can imperil healthy adults and may disproportionally affect the safety of older drivers with visual, motor, and cognitive decline. A total of 203 drivers, 120 healthy older (61 men and 59 women, ages 65 years and older) and 83 middle-aged drivers (38 men and 45 women, ages 40 to 64 years), participated in an on-road test in an instrumented vehicle. Outcome measures included performance in roadside target identification (traffic signs and restaurants) and concurrent driver safety. Differences in visual, motor, and cognitive functioning served as predictors. Older drivers identified fewer landmarks and drove slower but committed more safety errors than did middle-aged drivers. Greater familiarity with local roads benefited performance of middle-aged but not older drivers.Visual cognition predicted both traffic sign identification and safety errors, and executive function predicted traffic sign identification over and above vision. Older adults are susceptible to driving safety errors while distracted by common secondary visual search tasks that are inherent to driving. The findings underscore that age-related cognitive decline affects older drivers' management of driving tasks at multiple levels and can help inform the design of on-road tests and interventions for older drivers.

Too Old or Not Too Old

ERIC Educational Resources Information Center

Rosen, Benson; Jerdee, Thomas H.

1977-01-01

Describes a national survey that tested the attitudes of Harvard Business Review readers toward older employees and concludes that respondents did discriminate against older employees in ways that reveal their stereotyped views of the capabilities and limitations of older employees. (JG)

Development of a protocol for improving the clinical utility of posturography as a fall-risk screening tool.

PubMed

Bigelow, Kimberly Edginton; Berme, Necip

2011-02-01

The usefulness of posturography in the clinical screening of older adults for fall risk has been limited by a lack of standardization in testing methodology and data reporting. This study determines which testing condition and postural sway measures best differentiate recurrent fallers and nonrecurrent fallers. One hundred and fifty older adults were categorized based on their fall status in the past year. Participants performed four quiet-standing tasks, eyes open and eyes closed in both comfortable and narrow stance, for 60 seconds while standing on a force-measuring platform. Traditional and fractal measures were calculated from the center of pressure data. Logistic regression was performed to determine the model for each condition that best discriminated between recurrent fallers and nonrecurrent fallers. The eyes closed comfortable stance condition, with its associated model, best differentiated recurrent fallers and nonrecurrent fallers. Medial-lateral sway velocity, anterior-posterior short-term α-scaling exponent, medial-lateral short-term α-scaling exponent, mean frequency, body mass index, and age were included in this model. Sensitivity of the model was 75%, and specificity was 94%. This resulting model demonstrates potential to differentiate recurrent fallers and nonrecurrent fallers in an eyes closed comfortable stance condition. The inclusion of traditional sway parameters, fractal measures, and personal characteristics in this model demonstrates the importance of considering multiple descriptions of postural stability together rather than using only a single measure to establish fall risk.

Effects of Ramadan Gasting on Postural Balance and Attentional Capacities in Elderly People.

PubMed

Laatar, R; Borji, R; Baccouch, R; Zahaf, F; Rebai, H; Sahli, S

2016-01-01

To evaluate the effects of Ramadan fasting on postural balance and attentional capacities in older adults. the Neurophysiology department of a University Hospital. Fifteen males aged between 65 and 80 years were asked to perform a postural balance protocol and a simple reaction time (SRT) test in four testing phases: one week before Ramadan (BR), during the second (SWR) and the fourth week of Ramadan (FWR) and 3 weeks after Ramadan (AR). Postural balance measurements were recorded in the bipedal stance in four different conditions: firm surface/eyes open (EO), firm surface/eyes closed (EC), foam surface/EO and foam surface/EC using a force platform. Results of the present study demonstrated that center of pressure (CoP) mean velocity (CoPVm), medio-lateral length (CoPLX) and antero-posterior length (CoPLY) were significantly higher during the SWR than BR. Likewise, values of CoPVm and CoPLX increased significantly during the FWR compared to BR. The CoPLX decreased significantly in the FWR compared to the SWR. Values of CoPVm and CoPLX were significantly higher AR in comparison with BR. In addition, SRT values increased significantly during the SWR and the FWR than BR. Ramadan fasting affects postural balance and attentional capacities in the elderly mainly in the SWR and it may, therefore, increase the risk of fall and fall-related injuries. More than three weeks are needed for older adults to recover postural balance impairment due to Ramadan fasting.

Ankle-brachial index and inter-artery blood pressure differences as predictors of cognitive function in overweight and obese older adults with diabetes: results from the Action for Health in Diabetes movement and memory study.

PubMed

Espeland, Mark A; Beavers, Kristen M; Gibbs, Bethany Barone; Johnson, Karen C; Hughes, Timothy M; Baker, Laura D; Jakicic, John; Korytkowski, Mary; Miller, Marsha; Bray, George A

2015-10-01

Ankle-brachial index (ABI) and interartery systolic blood pressure differences, as markers of vascular disease, are plausible risk factors for deficits in cognitive function among overweight and obese adults with type 2 diabetes. The ABI and maximum interartery differences (MIAD) in systolic blood pressures were assessed annually for five years among 479 participants assigned to the control condition in a randomized clinical trial of a behavioral weight loss intervention. A battery of standardized cognitive function tests was administered 4 to 5 years later. Analyses of covariance were used to assess relationships that ABI, MIAD, and progression of ABI and MIAD had with cognitive function. There was a curvilinear relationship between ABI and a composite index of cognitive function (p = 0.03), with lower ABI being associated with poorer function. In graded fashions, both greater MIAD and increases in MIAD over time also had modest relationships with poorer verbal memory (both p ≤ 0.05), processing speed (both p ≤ 0.05), and composite cognitive function (both p < 0.04). These relationships were independent of each other and remained evident after extensive covariate adjustment. In overweight and obese adults with type 2 diabetes, lower ABI and larger interartery systolic blood pressure differences have modest, independent, graded relationships with poorer cognitive function 4-5 years later. Copyright © 2014 John Wiley & Sons, Ltd.

Chronic endurance exercise training offsets the age-related attenuation in contraction-induced rapid vasodilation

PubMed Central

Hughes, William E.; Ueda, Kenichi

2016-01-01

Aging is associated with attenuated contraction-induced rapid onset vasodilation (ROV). We sought to examine whether chronic exercise training would improve ROV in older adults. Additionally, we examined whether a relationship between cardiorespiratory fitness and ROV exists in young and older adults. Chronically exercise-trained older adults (n = 16; 66 ± 2 yr, mean ± SE) performed single muscle contractions in the forearm and leg at various intensities. Brachial and femoral artery diameter and blood velocity were measured using Doppler ultrasound. Vascular conductance (VC) was calculated as the quotient of blood flow (ml/min) and mean arterial pressure (mmHg). These data were compared with our previously published work from an identical protocol in 16 older untrained (66 ± 1 yr, mean ± SE) and 14 young (23 ± 1 yr) adults. Peak (ΔVCpeak) and total vasodilator (VCtotal) responses were greater in trained compared with untrained older adults across leg exercise intensities (P < 0.05). There were no differences in responses between trained older and young adults in the arm or leg at any exercise intensity (P > 0.05). Comparison of ΔVCpeak in a subset of subjects at an absolute workload in the leg revealed that trained older adults exhibited augmented responses relative to untrained older adults. Exercise capacity (V̇o2 peak) was associated with ΔVCpeak and VCtotal across arm (r = 0.59–0.64) and leg exercise intensities (r = 0.55–0.68, P < 0.05) in older adults. Our data demonstrate that 1) chronic exercise training improves ROV in the arm and leg of trained older adults, such that age-related differences in ROV are abolished, and 2) VO2peak is associated with ΔVCpeak responses in both limbs of older adults. PMID:27032899

Chronic endurance exercise training offsets the age-related attenuation in contraction-induced rapid vasodilation.

PubMed

Hughes, William E; Ueda, Kenichi; Casey, Darren P

2016-06-01

Aging is associated with attenuated contraction-induced rapid onset vasodilation (ROV). We sought to examine whether chronic exercise training would improve ROV in older adults. Additionally, we examined whether a relationship between cardiorespiratory fitness and ROV exists in young and older adults. Chronically exercise-trained older adults (n = 16; 66 ± 2 yr, mean ± SE) performed single muscle contractions in the forearm and leg at various intensities. Brachial and femoral artery diameter and blood velocity were measured using Doppler ultrasound. Vascular conductance (VC) was calculated as the quotient of blood flow (ml/min) and mean arterial pressure (mmHg). These data were compared with our previously published work from an identical protocol in 16 older untrained (66 ± 1 yr, mean ± SE) and 14 young (23 ± 1 yr) adults. Peak (ΔVCpeak) and total vasodilator (VCtotal) responses were greater in trained compared with untrained older adults across leg exercise intensities (P < 0.05). There were no differences in responses between trained older and young adults in the arm or leg at any exercise intensity (P > 0.05). Comparison of ΔVCpeak in a subset of subjects at an absolute workload in the leg revealed that trained older adults exhibited augmented responses relative to untrained older adults. Exercise capacity (V̇o2 peak) was associated with ΔVCpeak and VCtotal across arm (r = 0.59-0.64) and leg exercise intensities (r = 0.55-0.68, P < 0.05) in older adults. Our data demonstrate that 1) chronic exercise training improves ROV in the arm and leg of trained older adults, such that age-related differences in ROV are abolished, and 2) VO2peak is associated with ΔVCpeak responses in both limbs of older adults. Copyright © 2016 the American Physiological Society.

Patient-tailored self-management intervention for older adults with hypertension in a nursing home.

PubMed

Park, Yeon-Hwan; Chang, HeeKyung; Kim, JinShil; Kwak, Jin Sang

2013-03-01

This study was to evaluate the effects of a patient-tailored self-management intervention on (1) blood pressure control and (2) self-care behaviour, exercise self-efficacy and medication adherence among Korean older hypertensive patients in a nursing home.   Little is known about whether a patient-tailored self-management for nursing home residents with hypertension is likely to advance the care of this growing population worldwide. A non-equivalent comparison group design. Forty-seven patients (23 and 24 in the intervention and comparison groups, respectively) participated in the study. No one withdrew during the eight-week study period. Hypertensive patients in the intervention group received health education and tailored individual counselling for eight weeks to enhance the self-management. The mean age of patients was 77·4 years. Patients were on hypertensive medications for 11·8 years; only 36 of them took medications without assistance. The baseline comparisons of the patients with and without 8-week intervention did not differ for clinical and demographic variables and outcome measures. Blood pressure decreased when comparing the baseline to eight weeks later from baseline; moreover, blood pressure was significantly reduced only in patients who received the intervention. Self-care behaviour and exercise self-efficacy significantly increased over time only in those who were in the intervention group. However, no significant difference was observed in medication adherence between the two groups. Patient-tailored self-management intervention was a practical approach for decreasing blood pressure and increasing self-care behaviour in older hypertensive patients in a nursing home. Further studies are needed to validate these findings using a larger sample with long-term follow-up. A patient-tailored intervention is feasible not only to empower nursing home residents with hypertension for their care, but also to offer a qualified training and guidelines to nursing home staffs, expanding their professional competence in clinical practice. © 2012 Blackwell Publishing Ltd.

Predicting mortality among older adults hospitalized for community-acquired pneumonia: an enhanced confusion, urea, respiratory rate and blood pressure score compared with pneumonia severity index.

PubMed

Abisheganaden, John; Ding, Yew Yoong; Chong, Wai-Fung; Heng, Bee-Hoon; Lim, Tow Keang

2012-08-01

Pneumonia Severity Index (PSI) predicts mortality better than Confusion, Urea >7 mmol/L, Respiratory rate >30/min, low Blood pressure: diastolic blood pressure <60 mm Hg or systolic blood pressure <90 mm Hg, and age >65 years (CURB-65) for community-acquired pneumonia (CAP) but is more cumbersome. The objective was to determine whether CURB enhanced with a small number of additional variables can predict mortality with at least the same accuracy as PSI. Retrospective review of medical records and administrative data of adults aged 55 years or older hospitalized for CAP over 1 year from three hospitals. For 1052 hospital admissions of unique patients, 30-day mortality was 17.2%. PSI class and CURB-65 predicted 30-day mortality with area under curve (AUC) of 0.77 (95% confidence interval (CI): 0.73-0.80) and 0.70 (95% CI: 0.66-0.74) respectively. When age and three co-morbid conditions (metastatic cancer, solid tumours without metastases and stroke) were added to CURB, the AUC improved to 0.80 (95% CI: 0.77-0.83). Bootstrap validation obtained an AUC estimate of 0.78, indicating negligible overfitting of the model. Based on this model, a clinical score (enhanced CURB score) was developed that had possible values from 5 to 25. Its AUC was 0.79 (95% CI: 0.76-0.83) and remained similar to that of PSI class. An enhanced CURB score predicted 30-day mortality with at least the same accuracy as PSI class did among older adults hospitalized for CAP. External validation of this score in other populations is the next step to determine whether it can be used more widely. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.

Training the elderly in pedestrian safety: Transfer effect between two virtual reality simulation devices.

PubMed

Maillot, Pauline; Dommes, Aurélie; Dang, Nguyen-Thong; Vienne, Fabrice

2017-02-01

A virtual-reality training program has been developed to help older pedestrians make safer street-crossing decisions in two-way traffic situations. The aim was to develop a small-scale affordable and transportable simulation device that allowed transferring effects to a full-scale device involving actual walking. 20 younger adults and 40 older participants first participated in a pre-test phase to assess their street crossings using both full-scale and small-scale simulation devices. Then, a trained older group (20 participants) completed two 1.5-h training sessions with the small-scale device, whereas an older control group received no training (19 participants). Thereafter, the 39 older trained and untrained participants took part in a 1.5-h post-test phase again with both devices. Pre-test phase results suggested significant differences between both devices in the group of older participants only. Unlike younger participants, older participants accepted more often to cross and had more collisions on the small-scale simulation device than on the full-scale one. Post-test phase results showed that training older participants on the small-scale device allowed a significant global decrease in the percentage of accepted crossings and collisions on both simulation devices. But specific improvements regarding the way participants took into account the speed of approaching cars and vehicles in the far lane were notable only on the full-scale simulation device. The findings suggest that the small-scale simulation device triggers a greater number of unsafe decisions compared to a full-scale one that allows actual crossings. But findings reveal that such a small-scale simulation device could be a good means to improve the safety of street-crossing decisions and behaviors among older pedestrians, suggesting a transfer of learning effect between the two simulation devices, from training people with a miniature device to measuring their specific progress with a full-scale one. Copyright © 2016 Elsevier Ltd. All rights reserved.

Interplay between Creativity, Executive Function and Working Memory in Middle-Aged and Older Adults

ERIC Educational Resources Information Center

Sharma, Shivani; Babu, Nandita

2017-01-01

Studies reveal inconclusive evidence of the relationship between executive function and creativity. Further, there is a dearth of studies investigating creativity in older adults in the Indian context. Three tests--namely, Torrance Test of Creative Thinking (Figural), the Stroop Test, and Mental Balance (PGI memory scale)--were administered on a…

Race differences in the relationship between formal volunteering and hypertension.

PubMed

Tavares, Jane L; Burr, Jeffrey A; Mutchler, Jan E

2013-03-01

This study investigated race differences in the relationship between formal volunteering and hypertension prevalence among middle-aged and older adults. Using data from the 2004 and 2006 Health and Retirement Study (N = 5,666; 677 African Americans and 4,989 whites), we examined regression models stratified by race to estimate relationships among hypertension prevalence, systolic and diastolic blood pressure, and volunteer status and hours spent volunteering among persons aged 51 years old and older. White volunteers had a lower risk of hypertension than white nonvolunteers. A threshold effect was also present; compared with nonvolunteers, volunteering a moderate number of hours was associated with lowest risk of hypertension for whites. Results for hypertension were consistent with results from alternative models of systolic and diastolic blood pressure. We found no statistically significant relationship between volunteering activity and hypertension/blood pressure for African Americans. There may be unmeasured cultural differences related to the meaning of volunteering and contextual differences in volunteering that account for the race differences we observed. Research is needed to determine the pathways through which volunteering is related to hypertension risk and that may help explain race differences identified here.

Chair rise transfer detection and analysis using a pendant sensor: an algorithm for fall risk assessment in older people.

PubMed

Zhang, Wei; Regterschot, G Ruben H; Wahle, Fabian; Geraedts, Hilde; Baldus, Heribert; Zijlstra, Wiebren

2014-01-01

Falls result in substantial disability, morbidity, and mortality among older people. Early detection of fall risks and timely intervention can prevent falls and injuries due to falls. Simple field tests, such as repeated chair rise, are used in clinical assessment of fall risks in older people. Development of on-body sensors introduces potential beneficial alternatives for traditional clinical methods. In this article, we present a pendant sensor based chair rise detection and analysis algorithm for fall risk assessment in older people. The recall and the precision of the transfer detection were 85% and 87% in standard protocol, and 61% and 89% in daily life activities. Estimation errors of chair rise performance indicators: duration, maximum acceleration, peak power and maximum jerk were tested in over 800 transfers. Median estimation error in transfer peak power ranged from 1.9% to 4.6% in various tests. Among all the performance indicators, maximum acceleration had the lowest median estimation error of 0% and duration had the highest median estimation error of 24% over all tests. The developed algorithm might be feasible for continuous fall risk assessment in older people.

Effects of Age, Gender, Bolus Condition, Viscosity, and Volume on Pharyngeal and Upper Esophageal Sphincter Pressure and Temporal Measurements during Swallowing

ERIC Educational Resources Information Center

Butler, Susan G.; Stuart, Andrew; Castell, Donald; Russell, Gregory B.; Koch, Kenneth; Kemp, Shannon

2009-01-01

Purpose: The purpose of this study was to determine the effects of trial (i.e., Trial 1 vs. Trial 2); viscosity (i.e., saliva, thin, nectar-thick, honey-thick, and pudding-thick water); volume (i.e., 5 mL vs. 10 mL); age (i.e., young vs. older adults); and gender on pharyngeal (i.e., upper and lower) and upper esophageal sphincter (UES) pressures,…

Metabolic Risk Factors and Type 2 Diabetes Incidence in American Indian Children.

PubMed

Wheelock, Kevin M; Sinha, Madhumita; Knowler, William C; Nelson, Robert G; Fufaa, Gudeta D; Hanson, Robert L

2016-04-01

Data are lacking on how metabolic risk factors during childhood affect the long-term risk of type 2 diabetes. Assess four metabolic risk factors as predictors of type 2 diabetes and determine whether the risk differs between younger and older children. In a prospective cohort study conducted between 1965 and 2007, participants were followed for development of diabetes. Baseline measurements included body mass index (BMI), blood pressure, serum cholesterol, and 2-hour plasma glucose after an oral glucose tolerance test. Additional analyses divided subjects into two groups according to baseline age, 5–11 and 12–19 years. Gila River Indian Community in Arizona. A total of 5532 nondiabetic Pima Indian children 5–19 years old. A total of 1281 children developed diabetes (median follow-up, 12.4 years). Diabetes incidence was higher in overweight children (BMI ≥ 85th percentile) than in nonoverweight children. Nonoverweight children had the lowest risk of diabetes (20-year cumulative incidence, 9.5%), whereas overweight children with impaired glucose tolerance (2-hour glucose ≥ 140 mg/dL) had the highest (79.0%). The relative risk for children with metabolic abnormalities compared with their healthy counterparts was higher in younger children than in older children early in follow-up. BMI and 2-hour glucose were related to incident diabetes in multivariable models (predicted 15-year cumulative incidence for the highest vs lowest quartile was 3.9 and 1.8 times as high for BMI and 2-hour glucose, respectively; P < .001), whereas blood pressure and cholesterol were not. BMI and impaired glucose tolerance in children are strong predictors of type 2 diabetes. Other components of the “metabolic syndrome” are not.