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To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02267.x Keywords: cognitive aging; cardiovascular risk factor; elderly Abstract: OBJECTIVES: To examine the association between hypertension and cognitive decline in older adults. DESIGN: Prospective observational study. SETTING: Four rural counties in China. PARTICIPANTS: Two thousand rural Chinese aged 65 and older (median age 70, range 65-92) participated in a baseline evaluation. A follow-up evaluation of 1,737 subjects was conducted 2.5 years after baseline. MEASUREMENTS: Cognitive function was assessed using the Community Screening Instrument for Dementia (CSID), Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning and Recall Tests, Indiana University (IU) Story Recall Test, Animal Fluency Test, and IU Token Test. Hypertension was defined as the mean of two readings of systolic blood pressure (BP) of 140 mmHg or greater, diastolic BP of 90 mmHg or greater, or according to self-report. Cognitive decline was derived as the difference between baseline and follow-up scores. Analysis of covariance models were used to estimate the association between hypertension, BP, and cognitive decline, adjusting for other covariates. RESULTS: Greater decline was found on the CERAD 10-Word List Learning (P CONCLUSION: Untreated hypertension was associated with greater cognitive decline in this Chinese cohort. Better hypertension detection and treatment in elderly people, especially in developing countries, may offer protection against cognitive decline. Author Affiliation: (*)Department of Medicine ([dagger])Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China Departments of([double dagger])Psychiatry (s.)Pathology and Laboratory Medicine, School of Medicine and (**)Center for Aging Research, Indiana University, Indianapolis, Indiana ([parallel])Shandong Institute for Prevention and Treatment of Endemic Disease in China, Jinan, China (#)Sichuan Provincial Center for Disease Control and Prevention in China, Chengdu, China; and ([dagger][dagger])Regenstrief Institute, Inc., Indianapolis, Indiana. Article note: Address correspondence to Sujuan Gao, Department of Medicine, Indiana University School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202-2872. E-mail: sgao@iupui.edu

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02259.x Keywords: pneumonia; smoking; nutrition Abstract: OBJECTIVES: To investigate the risk of hospitalization for pneumonia in older adults in relation to biophysical environmental factors. DESIGN: Population-based case control study with collection of personal interview data. SETTING: Hamilton, Ontario, and Edmonton, Alberta, Canada. PARTICIPANTS: Seven hundred seventeen people aged 65 and older hospitalized for community-acquired pneumonia (CAP) from September 2002 to April 2005 and 867 controls aged 65 and older randomly selected from the same communities as the cases. MEASUREMENTS: Odds ratios (ORs) for risk of pneumonia in relation to environmental and other variables. RESULTS: Exposure to secondhand smoke in the previous month (OR=1.73, 95% confidence interval (CI)=1.04-2.90); poor nutritional score (OR=1.83, 95% CI=1.19-2.80); alcohol use per month (per gram; OR=1.69, 95% CI=1.08-2.61); history of regular exposure to gases, fumes, or chemicals at work (OR=3.69, 95% CI=2.37-5.75); history of regular exposure to fumes from solvents, paints, or gasoline at home (OR=3.31, 95% CI=1.59-6.87); and non-English language spoken at home (OR=5.31, 95% CI=2.60-10.87) were associated with a greater risk of pneumonia hospitalization in multivariable analysis. Age, congestive heart failure, chronic obstructive lung disease, dysphagia, renal disease, functional status, use of immunosuppressive disease medications, and lifetime history of smoking of more than 100 cigarettes were other variables associated with hospitalization for pneumonia. CONCLUSION: In elderly people, present and past exposures in the physical environmental are associated with hospitalization for CAP. Author Affiliation: (*)Departments of Pathology and Molecular Medicine and ([dagger])Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario ([double dagger])Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario (s.)St. Joseph's Health System Research Network, Hamilton, Ontario, Canada ([parallel])Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario (#)Department of Medicine, University of Manitoba, Winnipeg, Manitoba; and (**)Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Article note: Address correspondence to Mark Loeb, McMaster University, MDCL 3200, 1200 Main St. W., Hamilton, ON, Canada L8N 3Z5. E-mail: loebm@mcmaster.ca

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02220.x Abstract: Sleep-related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, cardiovascular disease, and cerebrovascular disease are examples of diseases that are more likely to develop in individuals with sleep disorders. Conversely, individuals with any of these diseases are at a higher risk of developing sleep disorders. The goals of this article are to help guide clinicians in their general understanding of sleep problems in older persons, examine specific sleep disorders that occur in older persons, and suggest evidence- and expert-based recommendations for the assessment and treatment of sleep disorders in older persons. No such recommendations are available to help clinicians in their daily patient care practices. The four sections in the beginning of the article are titled, Background and Significance, General Review of Sleep, Recommendations Development, and General Approach to Detecting Sleep Disorders in an Ambulatory Setting. These are followed by overviews of specific sleep disorders: Insomnia, Sleep Apnea, Restless Legs Syndrome, Circadian Rhythm Sleep Disorders, Parasomnias, Hypersomnias, and Sleep Disorders in Long-Term Care Settings. Evidence- and expert-based recommendations, developed by a group of sleep and clinical experts, are presented after each sleep disorder. Author Affiliation: From the (a)International Longevity Center-USA, New York, New York (b)Brookdale Department of Geriatrics and Adult Development, Mount Sinai Medical School, New York, New York (c)Albert Einstein College of Medicine, New York, New York (d)David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California (e)Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare Systems, Los Angeles, California (f)School of Medicine, University of California, San Diego, California (g)Neuroscience Clinical and Translational Center, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (h)Gaylord Sleep Center, Gaylord Hospital, Wallingford, Connecticut (i)Department of Medicine, School of Medicine, University of Connecticut, Farmington, Connecticut (j)National Sleep Foundation, Washington, District of Columbia (k)University of Kentucky College of Medicine, Lexington, Kentucky (l)Sleep-Wake Disorders Center, Montefiore Medical Center, Bronx, New York (m)Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington; and (n)Department of Neurology, Northwestern University, Chicago, Illinois. Article note: Address correspondence to Harrison G. Bloom, International Longevity Center-USA, 60 East 86th Street New York, NY 10028. E-mail: HarrisonB@ilcusa.org

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02202.x Keywords: financial capacity; competency; clinical assessment; mild cognitive impairment; Alzheimer's disease Abstract: OBJECTIVES: To investigate financial capacity in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) using a clinician interview approach. DESIGN: Cross-sectional. SETTING: Tertiary care medical center. PARTICIPANTS: Healthy older adults (n=75) and patients with amnestic MCI (n=58), mild AD (n=97), and moderate AD (n=31). MEASUREMENTS: The investigators and five study physicians developed a conceptually based, semistructured clinical interview for evaluating seven core financial domains and overall financial capacity (Semi-Structured Clinical Interview for Financial Capacity; SCIFC). For each participant, a physician made capacity judgments (capable, marginally capable, or incapable) for each financial domain and for overall capacity. RESULTS: Study physicians made more than 11,000 capacity judgments across the study sample (N=261). Very good interrater agreement was obtained for the SCIFC judgments. Increasing proportions of marginal and incapable judgment ratings were associated with increasing disease severity across the four study groups. For overall financial capacity, 95% of physician judgments for older controls were rated as capable, compared with 82% for patients with MCI, 26% for patients with mild AD, and 4% for patients with moderate AD. CONCLUSION: Physicians and other clinicians can reliably evaluate financial capacity in cognitively impaired older adults using a relatively brief, semistructured clinical interview. Patients with MCI have mild impairment in financial capacity, those with mild AD have emerging global impairment, and those with moderate AD have advanced global impairment. Patients with MCI and their families should proactively engage in financial and legal planning, given these patients' risk of developing AD and accelerated loss of financial abilities. Author Affiliation: (*)Department of Neurology ([dagger])Department of Neurology, Alzheimer's Disease Research Center ([double dagger])Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine (s.)Department of Education (#)Department of Psychiatry and Behavioral Neurobiology, and (s.s.)Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama ([parallel])Birmingham Veterans Affairs Medical Center, Birmingham, Alabama (**)Department of Psychology, Centre for Theoretical Neuroscience University of Waterloo, Waterloo, Canada ([dagger][dagger])Department of Neurology, University of Utah Health Sciences, Salt Lake City, Utah; and ([double dagger][double dagger])Department of Family Medicine and Neuroscience, University of California at San Diego, San Diego, California. Article note: Address correspondence to Daniel C. Marson, Department of Neurology, SC 650, University of Alabama at Birmingham, Birmingham, AL 35294. E-mail: dmarson@uab.edu

Suggestions on identification and treatment of insomnia in elderly population are presented.

Sarcopenia results in a decrease in physical strength during aging that results in important consequences for more severely affected individuals in terms of function and as a marker for disability and increased mortality. A study suggest that C. elegant would develop into an important model system in which to study the biochemical and genetics events responsible for sarcopenia and to test therapeutics designed to prevent or reverse sarcopenia.

A study is conducted to investigate associations between cognitive deficits and persistent significant depressive symptoms at baseline and 2 and 4-year follow-ups in a sample of 661 community-dwelling middle-aged and older adults. Trait-like cognitive deficits commonly complicate the course of MD (major depression) in community-dwelling middle-aged and older adults.

A study is conducted to assess physician recognition of dementia and cognitive impairment, compare recognition with documentation and to identify physician and patient factors associated with recognition. The findings indicate that additional geriatrics training may promote recognition, but systems solution are needed to improve recognition critical to provision of emerging therapies for early dementia.

Results reveal that prevalence of dementia is lower in urban Seoul population than in rural older population in Korea , which is attributed to level of education. Data further suggest that dementia prevalence between Asian population is perhaps minimal.

Research reveals significant and substantial differences between older and younger tuberculosis patients, often resulting in unfavorable outcome. Results indicate that older patients are impacted more than the younger patients, suggesting education in bringing awareness of the disease, better medical and social support to the older people.

Nursing home patients with hyponatremia were studied to see if they also had a syndrome of inappropriate antidiuretic hormone secretion (SIADH). Those that did were studied for an underlying cause for this syndrome and in most cases, there was none. Elderly patients may just be at risk for hyponatremia and SIADH.

Ventricular arrhythmias (VA) in older persons with no heart disease should not be treated with antiarrhythmic drugs, and Class I antiarrythmic drugs should not be used to treat VA in older persons with heart disease according to a study reviewing prognosis and management of VAs in people with and without heart disease, the emphasis being on the elderly. The MEDLINE database was searched with a computer and a manual search of bibliographies of pertinent articles followed. Pertinent data were extracted.

Researchers conducted a study to explain the use of percutaneous endoscopic gastrostomy among older patients of Quebec and to evaluate the characteristics of patients. The study found that survival after percutaneous endoscopic gastrostomy is poor. They also found that the use of this procedure is appropriate with in these patients.

Diabetes in Mexian populations was shown to be higher in men than women and in older and single adults living in urban communities. This group was also associated with an increased prevalence of coronary risk factors. Diabetes was assoicated with higher fat, low carbohydrate and low fat diets and an increase of central distribution of adiposity.

Coronary artery disease (CAD) and acute myocardial infarction in the older patient will have a different clinical presentation from that seen in younger patients. Frequently chest pain is absent in the older group. Complications are more common in older patients and mortality is high, but unexplained. Probably there are multiple factors. Risk factors are different in older patients.

Older people with acute renal failure (ARF) should be offered the same treatment as younger patients. Among 13 Madrid hospitals that have nephrology units, 103 cases of ARF occurred in patients 80 or older, 256 cases in patients 65 to 79 and 389 cases in patients younger than 65. Acute tubular necrosis was more likely to occur in younger patients whereas prerenal ARF and obstructive ARF were more common in the elderly. Mortality rates were similar in all three groups.

Several medical conditions are associated with lower-extremity function in older Mexican Americans. Tests of standing balance, repeated chair stands and walking were given to 2,873 Mexican Americans. Those 80 and older, those with diabetes or arthritis and those with three or more medical conditions were more likely to have limited lower-extremity function. The link between diabetes is especially important since this disease is common in Mexican Americans.

Many older people might benefit from information about preventing HIV infection. Data from the Maryland AIDS Registry reveal that 2.7% of the people diagnosed with AIDS between 1981 and 1994 were 60 years old or older. A greater percentage were white compared to younger patients. Only 32% had contracted the virus via a blood transfusion, while drug abuse and sexual contact were other risk factors. Median life span in the elderly was only 9 months, compared to 22 months in young patients.

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02249.x Byline: Roberta Bilenchi (*), Sara Poggiali (*), Chiara Pisani (*), Mariele De Paola (*), Rosanna Sculco (*), Lucia Anna De Padova (*), Michele Fimiani (*) Author Affiliation: (*)Department of Clinical Medicine and Immunological Sciences, Section of Dermatology, University of Siena, Siena, Italy

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02251.x Byline: Joris I. Rotmans (*), Wijnanda J. Frenkel ([dagger]), Raymond T. Krediet ([double dagger]), Sophia E. J. A. de Rooij (s.) Author Affiliation: (*)Department of Internal Medicine, Academic Medical Centre, Amsterdam, the Netherlands ([dagger])Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands ([double dagger])Department of Nephrology, Academic Medical Centre, Amsterdam, the Netherlands (s.)Department of Geriatrics, Academic Medical Centre, Amsterdam, the Netherlands

Age, cigarette smoking, hypertension, diabetes mellitus, serum LDL cholesterol and low serum HDL cholesterol are significant independent risk factors for symptomatic peripheral arterial disease in older persons, according to results of a retrospective analysis of charts from an outpatient geriatrics patient. The study involved 467 men with a mean age of 80 and 1444 women with a mean age of 81.

An Agency for Health Care Policy and Research (AHCPR) Guideline outline for provision of health care for the management of benign prostatic hyperplasia in older men has been designed. It makes recommendations related to both evaluation and management. It is important to use the most appropriate and effective methods of diagnosis and to gauge severity of this very common benign neoplasm of the aging human male. Pharmacologic therapy is relatively low-risk and effective as well as, in most cases, less expensive than alternatives.

Pemphigus vulgaris (PV) in older adults appears to have a favorable prognosis. In a study of 18 PV patients who developed the disease at 65 years or older, 44.4% had localized disease that could be adequately controlled by corticosteroid injections. Of those who took oral corticosteroids, most responded to low doses. Only four needed immunosuppressive drugs. After 3 to 15 years of follow-up, most were in remission without treatment.

A study on elderly delirium patients is presented. It is observed that multifactorial interventions like monitoring the usage of psychotropic medication and simple assessments of patients with cognitive impairment result in less delirium and consequently shorter hospital stay for this problem.

A study on the effects of anxiety on the work functioning and progression of disability in elderly persons is presented. It is observed that anxiety does worsen the disabilities to function.

Dementia is a process arising from neurological impairment and social psychological pressures. The conditions if left untreated can aggravate into malignant social psychology like infantilization, stigmatization, ignoring etc. A study is presented to show that snoezelen, a method of stimulating the senses of light, sound, smell and taste of the elderly dementia patients inhibits the progress of the dementia.

The relationship between advancing age and the risk of acquiring hepatitis C virus (HCV) infection is determined. The results show a significant association between high anti-HCV antibody positivity and prolonged dialysis.

Risk factors for community-acquired pneumonia in elderly populations may include tobacco smoke exposure, air pollution, inadequate nutrition and failure to get immunized. The need for further research on these factors is discussed.

Data from 143 patients 65 years of age and older show that cefotaxime-resistant gram-negative bacterial infections are increasing in this population. Patients studies included both community-dwelling and long-term care facility residents. Implications for health planning for this population are discussed.

Research is presented on the demographic characteristics and transmission rates of Chlamydia trachomatis infections in individuals 50 years of age and older in Los Angeles County, California. Data were obtained from 1991 to 1998. Infection rates were 1.1 to 3.0 times higher in older women than in older men, and African Americans are the racial/ethnic group most negatively impacted. Implications for health policy are discussed.

More research is needed into the connection between osteoporosis and depression. Many adults who suffer from bone loss also have depressive symptoms and of course, loss of mobility from broken bones caused by osteoporosis increases depression. Some anti-depressive drugs may increase bone loss, so psychiatric counseling is recommended.

Many elderly people have a serious chronic illness that will eventually kill them and that they must live with for several years. Examples include cancer, dementia, obstructive lung disease, heart disease, liver disease, and kidney failure. The US health care system does ont serve these patients as well as it could.

A case of recurrent paraparesis in an 82-year-old woman is reported. A dural multipedunculated arteriovenous malformation was discovered through selective spinal angiography.

The study by A.B. Newman et al. shows that artherosclerosis and subclinical cardiovascular disease are not inescapable aspects of the aging process. The study also suggests that subclinical coronary artery disease can be detected in asymptomatic older adults who are at risk for future problems.

Most physicians who see older patients admit they have missed dementia. This is reflective of medical journals that report under-recognition of dementia. Recent papers confirm that dementia in clinical practice remains the silent epidemic. Patients with dementia cannot be relied to report symptoms. One way of recognizing dementia is their behaviors. These individuals are more likely to get into automobile accidents and other types of accidents.

AIDS in older people presents a series of special problems. Many older people may not wish to disclose sexual habits or drug use and may not disclose an AIDS diagnosis even if they are aware of it. They may not be compliant with medication and are subject to infections and cancers that might not affect younger people. A 1998 study found that older AIDS patients have shorter survival rates than young patients. The reasons for this require further research.