Search

Osteoporosis and cardiovascular diseases are epidemiologically associated. Calcification phenomena of atherosclerotic plaque involve cytokines and growth factors also involved in bone remodeling. Drugs given for either of these two conditions could act on these mechanisms. Can osteoporosis drugs have an influence on the occurrence of cardiovascular events? Conversely, can the treatment of hypertension alter the course of osteoporosis? It is possible that administration of high doses of calcium (1g/day) in patients who already have important dietary intake can increase the risk of myocardial infarction. Epidemiological studies show links between low serum vitamin D levels and cardiovascular disease but interventional studies show that vitamin D administration in moderately deficient subjects vitamin D does not prevent the occurrence of cardiovascular events. Cohort studies show a beneficial effect of beta-blockers and thiazides administered to hypertensive patients: they reduce by 20% risk of fracture of the proximal femur. Should we focus on these anti-hypertensive treatments for our patients with osteoporosis?, (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objectives: First of all, understand the management of pain in the elderly population through GP experiences and, secondly, explore their implication to the benefit of well aging., Method: Qualitative study with data collection combining 2 focus groups and 5 in depth interviews centered on the lived experience of 16 GPs in the Languedoc-Roussillon region in southern France. A semiopragmatic phenomenological analysis of the fully transcribed verbatim interviews was used to establish the significant categories in relation with our objectives., Results: The GPs feel that the pain management still needs improvement even though it has become one of their priorities. GPs often notice iatrogenic effects in the care taking process of multiple pathologies which make them choose for the use of non-pharmacological interventions. The complex nature of pain, which has multiple significations for the elderly population, needs an overall approach by the GPs. They feel that it's their job to manage this because of the proximity and knowledge of the patient and his weaknesses. For them, aging well is a patient experience, they are only a support in this process., Discussion: GPs think that they are expert in the complex process of pain management. This process has to be seen in a multidimensional approach of an older person with multiple pathologies. Therefore, they make use of non-pharmacological interventions., Conclusion: These interventions need to be developed to improve the quality of life in the elderly population., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Whole-body-vibration on oscillating platform is a recent type of physical therapy and its use has increased in the last years for elderly people. Whole-body-vibration enhances muscle strength and/or power, but this effect has been poorly studied, specifically in elderly people. The use of oscillating plateforms seems to improve gait stability and reduce the risk of fall, especially in frail and institutionalized elderly people. Oscillating plateforms may have an anti-osteoporotic effect in post-menopausal women. Whole-body-vibration on oscillating plateforms may improve postural stability and motor symptoms in Parkinson's disease. Maladjusted use of whole body vibration can lead to health problems especially on osteo-articular tissues., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objectives: To analyze the prescriptions in patients aged over 60 and more in the North-East area of France during a summer and a winter month, to analyze the impact of the seasonal factor and the number of prescriptions, and to classify in frequency the families and classes of medicinal products prescribed., Methods: This study was conducted on two samples of prescriptions presented for reimbursement to the public health scheme of the Meurthe-et-Moselle, Vosges and Meuse areas, i.e. 4409 prescriptions (717 men, 1244 women) in July 1998 and 4400 prescriptions (772 men and 1335 women) in January 1999. The prescriptions concerned non-hospitalised persons aged over 60. Each prescription was identified according to the international medication classification codes, and classified according to the anatomical, therapeutic and chemical classification., Results: The survey in July 1998 concerned 1961 patients and that of January 1999 2107 patients, representing respectively 4409 and 4400 prescriptions. The number of prescriptions of July and January were comparable (4409 vs 4400), but the number of prescription lines was greater in the winter month (3.51 +/- 2.3 vs 3.43 +/- 2.3; p<0.001). Among the prescriptions, 63% were for women and the number of prescription lines was greater than those for men (3.54 vs 3.24 in July, p<0.01; 3.59 vs 3.35 in January, p<0.01). Around 90% of the prescriptions were drawn-up by general practitioners. Ophthalmology was the specialty that prescribed the greatest number of prescriptions. The mean amount reimbursed for a prescription was higher in men with 32.10 in July (26.79 in women) and 32.28 in January (27.13 in women). Independently of age, gender and month, the most prescribed medication families in decreasing order were: cardio-vascular system (35%), central nervous system (15%), and digestive and metabolic system (14.5%). Prescriptions for the family of respiratory system treatments were greater in January than in July (9.4% vs 6.1%, p<0.01)., Conclusion: In this study the women consumed more medicinal products than the men, but the mean cost of reimbursement per prescription was higher in the men. The most prescribed class of medication concerned the cardiovascular system. The seasonal factor was characterised by an increase in the number of lines per prescription and a greater prevalence of respiratory system products in January

Objectives: Normal values for hemoglobin and hematocrit have been established for healthy young adults, but it is unknown whether age-related decline in hematological values occurs in the elderly. We compared normal values of hematological parameters in healthy adults and healthy persons aged 65 years and over using flow cytometry., Subjects and Methods: Erythrocyte and reticulocyte parameters were determined in 585 subjects (294 men and 206 women aged 26 to 64 years, and 37 men and 48 women aged 65 years and over), living independently and without medication, symptom and disease, using Technicon H1 (Bayer) and R2000 (Roche) analyzers. Serum erythropoietin levels, red cell folate and creatinine clearance were determined in subjects aged 65 years and over., Results: Irrespective of subject age, hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), mean cell volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) were higher in males than in females, but sex-related differences tended to decrease with aging. In males, there was a trend toward lower Hb and Hct with aging, due to an increase in RBC, MCV and MCH. In females, Hb and Hct (p < 0.05) increased with aging, due to a trend toward higher values of RBC, MCV and MCH. Red blood cell distribution width and hemoglobin distribution width were not modified by aging. Despite these age-related changes in erythrocyte parameters, values for anemia defined in adults appear appropriate for geriatric subjects (Hb < 130 g/l in males and Hb < 120 g/l in females). Reticulocyte count and creatinine clearance decreased in men and women aged 65 years and over (p < 0.05), whereas erythropoietin levels and red cell folate were not influenced by aging., Conclusion: Normal erythrocyte values defined in adults are appropriate for evaluating hematological test results in older individuals. The decrease in reticulocyte count observed in men and women aged 65 years and over does not appear to be linked to a decrease in erythropoietin production with aging.

PHYSICAL ACTIVITY AND AGING: Physical activity prevents some age-related impairment. Physical activity reduces the decline of physical capacity which remains limited by maximal heart rate, and reduces the incidence of cardiovascular diseases by decreasing and preventing associated risk factors. Physical activity reduces age-related bone loss, its effect being potentialized by hormonal replacement therapy, and improves balance function, leading to a lower incidence of falls and fractures in older subjects. Physical activity helps to preserve nutritional balance and lean mass/fat mass ratio and reduces age-related insulin resistance. Moreover, physical activity has a beneficial influence on psychological function by improving cognitive performances and decreasing incidence of depression. Lastly, physical activity seems to reduce the incidence of several cancers, colic and mammary cancers particularly. PHYSICAL ACTIVITY, QUANTITY AND QUALITY OF LIFE: These multiple actions explain that physical activity, if it's adapted to subject's specificities increases longevity, delay entry in dependence and improves quality of life in older subjects. WHAT ARE THE RECOMMENDED ACTIVITIES: There is a superiority of individualized programs giving greater place to warm-up and associated endurance and resistive exercises intended to improve simultaneously cardiovascular and muscular functions. SPECIAL INTERESTS OF PHYSICAL ACTIVITY IN FRAIL AND VERY OLD SUBJECTS: Throughout its beneficial effects on aerobic capacity, muscular function, social integration, cognitive function and autonomy, physical activity may have a particular interest in frail subjects, when programs are adapted to physical capacities of these subjects and associated with nutritional supplements.

FALLS AND POST-FALL SYNDROME: Falls are a major health problem among the elderly because of the resulting psychological sequelae (sometimes termed "post-fall syndrome") and in a few cases serious injury, particularly hip fractures., Drugs and Falls: The scientific literature on the link between medications and falls and fractures suggests that psychotropic drugs used in about 50% of residents of nursing homes and in 20% in the community cause around 30% of falls in nursing homes and 20% of falls in the community. PSYCHOTROPS: The relative effect of selective serotonin reuptake inhibitors and tricyclic antidepressors and the relative effect of short/long acting or sedative/hypnotic benzodiazepines are not well established., Cardiovascular Drugs: Appropriate use of cardiovascular medications and analgesics does not increase the risk of falls., Prevention: These data reinforce the concept that reducing the use of psychotrops, especially benzodiazepines, is probably one of the most effective means of reducing serious falls in older people.

POSSIBLE INFLAMMATORY MECHANISMS: Alzheimer's disease (AD) is a degenerative disease of the brain including possibly inflammatory mechanisms, as illustrated by the presence of activated microglial cells in the periphery of senile plaques and neurofibrillary tangles and the subsequent release of proinflammatory mediators with neurotoxic potency. RATIONALE FOR NSAID USE: Although not firmly demonstrated, the rationale for the prescription of non steroidal anti-inflammatory drugs (NSAIDS) as neuroprotective agents in AD lies on epidemiological data having shown a reduced risk of developing AD in patients on long-term therapy with NSAIDs (non selective cyclo-oxygenase [COX] inhibitors). RATIONALE FOR THE USE OF SELECTIVE COX-2 INHIBITORS: The rationale for the prescription of selective COX-2 inhibitors as neuroprotective drugs in AD lies on: Epidemiological data having shown a reduced risk of developing AD in patients treated with anti-inflammatory doses of classical NSAIDs (inhibition of COX-1 and COX-2) but not with antithrombotic doses of aspirin (selective inhibition of COX-1), Cellular experiments, Demonstration of a better gastro-intestinal (GI) safety profile with selective COX-2 inhibitors than with classical NSAIDs in short-term studies, allowing a possible long-term use in AD. BEFORE PRESCRIBING: COX-2 may have an ambivalent functionality in the brain since the basal production of prostaglandins through COX-2 may participate in neuronal homeostasis whereas the expression of COX-2 is associated with brain development. Classical NSAIDs are ineffective in reducing the formation of senile plaque and neurofibrillary tangles in AD, which is consistent with an ability to reduce inflammation associated with activation of microglia but illustrates their failure to suppress the degenerative process. Prophylactic use of selective COX-2 NSAIDs can be considered on the basis of their good GI safety after 6 months of marketing in United States but need to be confirmed for a longer time. CURRENT TRIALS: Clinical studies focusing on both the prevention and the slowing down of early AD are under way with two recently launched selective COX-2 inhibitors, celecoxib and rofecoxib.

CERTAIN DIAGNOSIS: Because the certainty diagnosis of Alzheimer's disease is defined after autopsy or brain biopsy by the presence of neurofibrillar degeneration (NFD), extracellular senile plaques and vascular deposits of amyloid in the hippocampus amygdalus and the cerebral cortex, some authors have searched for biological ante-mortem markers of AD, particularly in the cerebrospinal fluid (CSF) which is essentially derived from brain tissue. SEARCH FOR MARKERS: Studies have investigated the CSF level of neurotransmitters, neuropeptides, amino acids, trace elements, constituents of NFD and senile plaques in a diagnostic and pathogenic perspective. HOPE FOR DIAGNOSIS: Even though ethical, technical and methodological difficulties met by authors are important and even though many clinical and biological parameters must be taken into account, these studies bring important pathogenic evidence and allow hope that markers of AD which are so necessary for early diagnosis and objective study of therapies will be found.

Risk Factors: Aging is the chief risk factor for Alzheimer's disease (AD). Other risk factors are aluminum in drinking water, diabetes mellitus, head trauma. Protective factors are: higher education, cigarette smoking, nonsteroidal anti-inflammatory drugs and estrogen use., Genetic Factors: Mutations of presenilins 1 and 2 and of the APP gene in families with early-onset AD. Apolipoprotein E polymorphism in late-onset familial and sporadic AD., Pathogenic Hypotheses: Amyloid deposits in senile plaques and therefore dementia could be due to an overproduction of Abeta (Down's syndrome) or due to the primary (APP mutation) or secondary (role of diabetes, mellitus, apoE polymorphism: protective effect of estrogen) abnormal neurotoxic feature of Abeta. The hyperphosphorylation of tau (a protein which plays a pivotal role in the axonal transport), perhaps regulated by the apoE polymorphism could lead to neurofibrillar degeneration. Neurotoxic mediators produced by the activated microglia (perhaps activated by neuronal damage) and oxidative stress could also be involved in the neurodegeneration.

The most promising discovery in the study of Alzheimer's disease (AD) markers is undoubtedly the implication of apolipoprotein E (apoE). The gene of this apoliprotein is located on chromosome 19 and is characterized by three common alleles epsilon 2, epsilon 3 and epsilon 4 giving raise to 6 genotypes and 6 protein phenotypes. ApoE is well known for its role in cholesterol transport. Different studies have been performed, giving major arguments in favor of an important role of apoE in the pathophysiology of AD. These include the discovery of the relationship between the epsilon 4 allele and AD, the ability of this protein to form complexes with beta amyloid protein (A beta) in seniles plates, its presence in neurofibrillary tangles and in vessels of AD patients. Another important finding is the differential interaction between the different isoforms of apoE and tau protein. Some of the hypotheses implicate the role of different apoE isoforms on the growth and extension of neurones, perhaps by a receptor mediated pathway. It has been suggested that apoE acts as a pathological chaperone protein, or alternatively that it protects neurons by regulation of the cell membrane and modifying calcium homeostasis. It is clear that apoE genotype determination alone cannot be used for diagnosis of AD. The presence of epsilon 4 allele is only one of several risk factors for the development of the disease. Other factors may also be implicated and are the subject of ongoing research.