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Background and Objective: With increasing age, the burden of chronic diseases such as cardiovascular disease (CVD) increases. Education seems to be effective in controlling the risk factors for cardiovascular disease to prevent the disease and to control the disease after its development. The burden of cardiovascular disease and its associated risk factors is higher in people with low education. The present study was conducted to investigate the effect of education on the control of risk factors for cardiovascular disease in the elderly in Amirkola, northern Iran. Methods: In this cross-sectional study, which is part of the Amirkola Health and Ageing Project, 356 elderly patients with confirmed CVD were studied. Risk factors for cardiovascular disease including body mass index, waist circumference, physical activity, systolic and diastolic blood pressure, blood cholesterol, blood triglycerides, HDL, LDL, smoking status and blood sugar were compared in illiterate and literate elderly. Findings: Out of 356 elderly patients with CVD (177 males and 179 females), 223 patients (62.6%) were illiterate and 133 patients (38.4%) were literate. Patients did not differ significantly except for controlling the risk factor of low physical activity. Education was effective in controlling the risk factor of physical activity in patients with cardiovascular disease (OR=2.295, CI=1.228-4.289) and these people were more active (p=0.009). In addition, 59.87% of risk factors in the literate group and 58.33% of risk factors in the illiterate group were controlled, which did not show a significant difference. Conclusion: The results of the study showed that except for low physical activity, other risk factors were not associated with literacy in the elderly with CVD. [ABSTRACT FROM AUTHOR]

Background: Influenza is a global health threat to older adults, and the influenza vaccine is the most effective approach to prevent influenza infection. However, influenza vaccination coverage among Chinese older adults is far less than in developed countries such as the United States (4.0% vs. 64.9%). This study aims to increase influenza vaccination coverage in Chinese adults ≥60 years using a video-led educational intervention conducted by medical students.Methods: A cluster randomized controlled trial will be conducted in 4 districts of Xi'an city, Shaanxi Province, China, using a stratified sampling approach. Adults aged ≥60 years will be recruited from 8 community hospitals. A self-administered questionnaire of knowledge, attitudes, and practices (KAP) will be employed to record the KAP score. During the 6-month interventional period, participants in the intervention group will receive educational videos focused on influenza and influenza vaccination, coupled with a group discussion conducted by the medical students. For those in the control group, no intervention will be provided. The outcomes measured in both groups will be the influenza vaccination coverage and the KAP scores of all participants.Discussion: Medical students are more likely to educate older adults about scientific knowledge of influenza and its vaccine compared to clinical practitioners, who, most of the time, remain over-occupied due to the extensive workload. Video-led counseling and education could be a useful option to optimize older adults' understanding of influenza and influenza vaccination. This eventually could improve the uptake of influenza vaccine among Chinese older adults.Trial Registration: Chinese Clinical Trial Registry; ChiCTR2000034330 ; Registered 3rd July 2019. [ABSTRACT FROM AUTHOR]

All living beings are at risk for experiencing infections; humans are no exception. The prestige and credibility of modern medicine is built in large part on achievements in preventing and treating infectious diseases. For most of human history, there was little that could be done to prevent and treat infections. Millions of humans, of all ages, have died from infections; and in some parts of the world, infection‐related deaths remain common. Advances in preventing and treating infectious diseases include improved sanitization, sterilization, pasteurization, immunization, and antibiotics. Vaccination has played a major role in the prevention of lethal diseases, such as smallpox, diphtheria, cholera, and influenza. Because of developing or waning immune function, the young and the old are at particularly high risk of experiencing infections. Influenza and pneumonia remain common causes of death in older adults. Influenza, in particular, has the potential to result in premature mortality for all age groups, including those who are older and particularly those who live in congregate settings. Vaccination is important in promoting healthy aging. J Am Geriatr Soc 68:207–214, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: As life expectancy continues to rise, the burden of cardiovascular disease among older people is expected to increase, making cardiovascular prevention in older people an issue of growing interest and public health importance. We aimed to explore the long‐term effects of adherence to statins on mortality and cardiovascular morbidity among older adults. DESIGN: A historical population‐based cohort study using routinely collected data. SETTING: Clalit Health Services Northern District. PARTICIPANTS: We followed members of Clalit Health Services aged 65 years or older who were eligible for primary cardiovascular prevention for a period of 10 years. MEASUREMENTS: We fitted Cox regression models to assess the association between the adherence to statin therapy and all‐cause mortality and cardiovascular morbidity, adjusting for cardiovascular risk factors and associated morbidity as time‐updated variables. RESULTS: The analysis included 19 518 older adults followed during 10 years (median = 9.7 y). All‐cause mortality rates were 34% lower among those who had adhered to statin treatment, compared with those who had not (hazard ratio [HR] =.66; 95% confidence interval [CI] =.56‐.79). Adherence to statins was also associated with fewer atherosclerotic cardiovascular disease events (HR =.80; 95% CI =.71‐.81). The benefit of statin use did not diminish among beyond age 75 and was evident for both women and men. CONCLUSION: Adherence to statins may be associated with reduced mortality and cardiovascular morbidity among older adults, regardless of age and sex. J Am Geriatr Soc 67:2038–2044, 2019 [ABSTRACT FROM AUTHOR]

Background: The loss of mobility during aging impacts independence and leads to further disability, morbidity, and reduced life expectancy. Our objective was to examine the feasibility and safety of conducting a randomized controlled trial of yoga for older adults at risk for mobility limitations.Methods: Sedentary older adults (n = 46; age 60-89) were recruited and randomized to either yoga or a health education comparison group. Yoga sessions (60-min) occurred 2x weekly, and 90-min health education sessions occurred weekly, for 10 weeks. The primary outcomes were recruitment rate, intervention attendance, and retention at assessments. Adverse event rates and participant satisfaction were also measured. Physical performance measures of gait, balance, and strength and self-report outcome measures were administered at baseline and 10-weeks.Results: Recruitment lasted 6 months. Retention of participants at the 10-week follow-up was high (89% - performance measures; 98% - self-report questionnaires). Attendance was good with 82% of yoga and 74% of health education participants attending at least 50% of the sessions. No serious adverse events were reported. Patient satisfaction with the interventions was high. The mean effect size for the physical performance measures was 0.35 with some over 0.50. The mean effect size for self-report outcome measures was 0.36.Conclusions: Results indicate that it is feasible to conduct a larger RCT of yoga for sedentary older adults at risk for mobility problems. The yoga and comparison interventions were safe, well accepted, and well attended. Effect sizes suggest yoga may have important benefits for this population and should be studied further.Trial Registration: ClinicalTrials # NCT03544879 ; Retrospectively registered 4 June, 2018. [ABSTRACT FROM AUTHOR]

Objectives To determine the efficacy and safety of high-dose vitamin D supplementation for prevention of acute respiratory infection ( ARI) in older long-term care residents. Design Randomized controlled trial investigating high-dose vs standard-dose vitamin D from 2010 to 2014. Setting Colorado long-term care facilities. Participants Long-term care residents aged 60 and older (n = 107). Intervention The high-dose group received monthly supplement of vitamin D3 100,000 IU, the standard-dose group received a monthly placebo (for participants taking 400-1,000 IU/d as part of usual care) or a monthly supplement of 12,000 IU of vitamin D3 (for participants taking <400 IU/d as part of usual care). Measurements The primary outcome was incidence of ARI during the 12-month intervention. Secondary outcomes were falls and fractures, 25-hydroxyvitamin D levels, hypercalcemia, and kidney stones. Results Participants (55 high dose, 52 standard dose) were randomized and included in the final analysis. The high-dose group had 0.67 ARIs per person-year and the standard-dose group had 1.11 (incidence rate ratio ( IRR) = 0.60, 95% confidence interval ( CI) = 0.38-0.94, P = .02). Falls were more common in the high-dose group (1.47 per person-year vs 0.63 in standard-dose group; IRR = 2.33, 95% CI = 1.49-3.63, P < .001). Fractures were uncommon and similar in both groups (high dose 0.10 vs standard dose 0.19 per person-year; P = .31). Mean trough 25-hydroxyvitamin D levels during the trial were 32. ng/ mL in the high-dose group and 25.1 ng/ mL in the standard-dose group. There was no hypercalcemia or kidney stones in either group. Conclusion Monthly high-dose vitamin D3 supplementation reduced the incidence of ARI in older long-term care residents but was associated with a higher rate of falls without an increase in fractures. [ABSTRACT FROM AUTHOR]

Objectives To determine whether leisure-time physical activity ( LTPA) is independently associated with all-cause and cardiovascular mortality and with incidence of cardiovascular disease ( CVD) and stroke in older adults. Design Population-based cohort study (median follow-up 11.8 years). Setting Community, five Finnish provinces. Participants Men and women aged 65 to 74 who participated in a baseline risk factor survey between 1997 and 2007 in Finland (N = 2,456). Measurements The study protocol included a self-administered questionnaire, health examination at the study site, and blood sample for laboratory analysis. LTPA was classified into three levels: low, moderate, high. Mortality data were obtained from the National Causes of Death Register and data on incident CVD (coronary heart disease, stroke) events from the National Hospital Discharge Register. Results Multifactorial-adjusted (age, area, study year, sex, smoking, body mass index, systolic blood pressure, serum cholesterol, education, marital status) risks of total mortality (moderate: hazard ratio ( HR) = 0.61, 95% confidence interval ( CI) = 0.50-0.74; high: HR = 0.47, 95% CI = 0.34-0.63, P for trend <.001), CVD mortality (moderate: HR = 0.46, 95% CI = 0.33-0.64; high: HR = 0.34, 95% CI = 0.20-0.59, P for trend <.001), and an incident CVD event (moderate HR = 0.69, 95% CI = 0.54-0.88; high: HR = 0.55, 95% CI = 0.38-0.79, P for trend <.001) were lower for those with moderate or high LTPA levels than for those with low LTPA levels. Further adjustment for self-reported inability to perform LTPA did not change the associations remarkably. Conclusions Baseline LTPA reduces the risk of total and CVD mortality and incident CVD events in older adults independently of the major known CVD risk factors. The protective effect of LTPA is dose dependent. [ABSTRACT FROM AUTHOR]

An attempt was made in this paper to examine the prevalence of elderly suffering from selected morbidities, duration of years they suffered and treatment taken or not for one or the other morbidity under consideration from any health facility across their gender background. For this purpose, data from 778 elderly persons (364 men and 414 women) who are residing in Coimbatore city, Tamil Nadu, was collected and analysed with the help of cross-tabulations/means and Chi-square/ANOVA tests. The findings revealed that the percentages of elderly suffering from Arthritis and Cataract and related closely followed by Blood Pressure, Diabetes, Back pain and Asthma are higher among women than among men. On the other hand, while the duration of years suffering from Cataract and related, Arthritis, Blood Pressure Asthma and Ulcer problem is significantly higher among men than their women counterparts, the reverse pattern is noticed in the case of Diabetes. By and large, men tend to avail medical treatment for majority of the chronic morbidities under consideration to a large extent than their women counterparts. Based on the findings suitable policy implications have been proposed and discussed. [ABSTRACT FROM AUTHOR]

Background: This subgroup analysis of the Lifestyle Intervention and Independence for Elders trial evaluates the impact of a long-term physical activity (PA) intervention on rates of major mobility disability (MMD) among older adults according to their antihypertensive medication use.Methods: Lifestyle Intervention and Independence for Elders study participants were randomized to center-based PA or health education for a median of 2.7 years. Participants were sedentary men and women aged 70-89 years with objectively measured physical limitations. This analysis evaluated rates of MMD and persistent MMD among 1,633 participants, according to antihypertensive medication use. Participants were designated as either (i) an angiotensin-converting enzyme (ACE) inhibitor user (ACEi+), (ii) a user of other antihypertensives not including ACEi (ACEi-), or (iii) nonusers of antihypertensive medications (AHT-). Interactions were explored between antihypertensive use and randomized arm.Results: Interaction terms for MMD (p = .214) and persistent MMD (p = .180) did not reach statistical significance. For MMD, PA displayed marginal effects among ACEi+ (hazard ratio [HR] = 0.76; 95% confidence interval [CI] = 0.57, 1.02) and ACEi- (HR = 0.76; 95% CI = 0.60, 0.97) but not AHT- (HR = 1.19; 95% CI = 0.75, 1.87). For persistent MMD, the effect of PA was greatest among ACEi+ (HR = 0.57; 95% CI = 0.39, 0.84) when compared to ACEi- (HR = 0.76; 95% CI = 0.55, 1.06) or AHT- (HR = 1.18; 95% CI = 0.59, 2.36).Conclusions: The effects of long-term PA on the incidence of MMD and persistent MMD were similar among three subgroups of older adults stratified by their antihypertensive medication use. However, though statistical interactions did not reach significance, several findings may warrant future study in other cohorts given the post hoc nature of this study. [ABSTRACT FROM AUTHOR]

Background: Falling has a great importance among the elderlies. Even if no physical injury occurs, it can cause fear of falling down again and, consequently, reduce older adults' activities. With regard to the prevalence of falling among older adults, its prevention is essential. Therefore, the present study was aimed to define the effect of need-based education on prevention of older adults' falling during their everyday life activities. Materials and Methods: This is a quasi-experimental study. Study population comprised all the older adults of age 60 years and over referring to health care centers in Isfahan. Through multiple random sampling, 15 older adults were selected from four health care centers. Data collection tool in the present study was Daily Activity Questionnaire. Results: Results showed a significant difference between the mean of daily activity scores in the intervention group before, immediately after, and 1 month after the intervention (12, 13.6, and 13.5, respectively; P = 0.01). Meanwhile, there was no significant deference between the scores immediately after and 1 month after the intervention. There was no significant difference observed between the three time points in the control group (mean = 12.3; P= 0.907). Conclusion: Implementation of education concerning prevention of older adults' falling led to improvement of their daily activity in the intervention group. [ABSTRACT FROM AUTHOR]

Physical training has been shown to be important to the control of muscle mass during aging, through the activation of several pathways including, IGF1-AKT and PGC-1α. Also, it was demonstrated that LRP130, a component of the PGC-1α complex, is important for the PGC-1α-dependent transcription of several mitochondrial genes in vivo. To explore the role of physical training during aging, we investigated the effects on muscle recovery after short-term immobilization followed by 3 or 7 days with aerobic or resistance training. Using morphological (myofibrillar adenosine triphosphatase activity, to assess the total muscle fiber cross-sectional area (CSA) and the frequency of specific fiber types), biochemical (myosin heavy chain), and molecular analyses (quantitative real-time PCR, functional pathways analyses, and Western blot), our results indicated that after an atrophic stimulus, only animals subjected to aerobic training showed entire recovery of cross-sectional area; aerobic training reduced the ubiquitin-proteasome system components involved in muscle atrophy after 3 days of recovery, and the upregulation in PGC-1α expression enhanced the process of muscle recovery by inhibiting the FoxO pathway, with the possible involvement of LRP130. These results suggest that aerobic training enhanced the muscle regeneration process after disuse-induced atrophy in aged rats possibly through of the LRP130/PGC-1α complex by inhibiting the ubiquitin-proteasome system. [ABSTRACT FROM AUTHOR]

Although the demographic revolution has produced hundreds of millions people aged 65 and older, a substantial segment of that population is not enjoying the benefits of extended healthspan. Many live with multiple chronic conditions and disabilities that erode the quality of life. The consequences are also costly for society. In the United States, the most costly 5% of Medicare beneficiaries account for approximately 50% of Medicare's expenditures. This perspective summarizes a recent workshop on biomedical approaches to best extend healthspan as way to reduce age-related dysfunction and disability. We further specify the action items necessary to unite health professionals, scientists, and the society to partner around the exciting and palpable opportunities to extend healthspan. [ABSTRACT FROM AUTHOR]

Geropathology is the study of aging and age-related lesions and diseases in the form of whole necropsies/autopsies, surgical biopsies, histology, and molecular biomarkers. It encompasses multiple subspecialties of geriatrics, anatomic pathology, molecular pathology, clinical pathology, and gerontology. In order to increase the consistency and scope of communication in the histologic and molecular pathology assessment of tissues from preclinical and clinical aging studies, a Geropathology Research Network has been established consisting of pathologists and scientists with expertise in the comparative pathology of aging, the design of aging research studies, biostatistical methods for analysis of aging data, and bioinformatics for compiling and annotating large sets of data generated from aging studies. The network provides an environment to promote learning and exchange of scientific information and ideas for the aging research community through a series of symposia, the development of uniform ways of integrating pathology into aging studies, and the statistical analysis of pathology data. The efforts of the network are ultimately expected to lead to a refined set of sentinel biomarkers of molecular and anatomic pathology that could be incorporated into preclinical and clinical aging intervention studies to increase the relevance and productivity of these types of investigations. [ABSTRACT FROM AUTHOR]

Vitamin D and calcium are essential for bone health. An adequate calcium-phosphorus product determines a high quality mineralization long lifetime. In older people, both calcium and vitamin D levels may be lower causing osteomalacia and/or osteoporosis with a higher risk of fracture. Epidemiological data have clearly associated serum vitamin D lower levels (deficiency) with bone fracture in older people, however, not univocal data exist in regard to a beneficial effect of vitamin D supplementation in general population. Although not systematic, the present review aims to make a narrative synthesis of the most recent published data on vitamin D effect not only on bone, classical target associated with vitamin D studies, but namely on extraskeletal diseases. In fact, recently, there has been an increasing interest on this latter issue with surprising findings. Vitamin D, and in particular its deficiency, seems to have a role in pathophysiological pathways in several diseases involving cardiovascular, central nervous system and neoplastic process. On the other hand, vitamin D supplementation may modify the outcome of a wide range of illnesses. Up to date the data are conflicting mainly because of difficulty to establish a consensus on the threshold of vitamin D deficit. The US Institute of Medicine recommends to distinguish a level of insufficiency [defined as 30-50 nmol/L or 16-25 ng/mL of 25(OH)D] and another of deficiency identified by 25(OH)D levels lower than 30 nmol/L (or <16 ng/mL). This latter level is considered a minimum level necessary in older adults to minimize the risk of falls, fracture and probably to have some effects of vitamin D supplementation in extraskeletal diseases. Although there are no absolute certainties in such issue, the most recent data suggest that vitamin D deficiency, and its supplementation, may play an important role in a wide range of diseases other than in bone metabolic diseases in older but not in general population. For such reason a widespread measurement of vitamin D levels in general population, and not only in older, seems to be inappropriate and it could induce an overuse of vitamin D supplementation in situations in which its efficacy and cost-effectiveness have not been proven. [ABSTRACT FROM AUTHOR]

The aging process implies physical, psychological and social changes that make elderly people a very vulnerable group from the nutritional and health point of view. The recommended nutrient intakes in the elderly are similar, or even higher, to those of previous period of life. In this context, eggs are a very interesting food for elderly diets, since they are nutrient dense-foods, and their nutrients are highly bioavailable. Eggs are an excellent source of high quality protein, and contain significant amounts of omega-3 fatty acids EPA and DHA, even more if they are enriched eggs. They are a major source of choline, an essential nutrient that plays an important role in human metabolism and neurotransmitter synthesis, which recommended intakes are higher than those for younger people. An egg's contribution of vitamin D is noteworthy because the egg is one of the very few foods that supply this very important vitamin for bone health and also for muscle function and physical performance. Finally, the egg contains lutein and zeaxanthin that protect against development of age-related macular degeneration. Egg consumption has been restricted for years unnecessarily, but today its role as a staple food in the context of a balanced diet, also for older people, is recognized. [ABSTRACT FROM AUTHOR]

The author discusses the need of promoting pre-habilitation, in which patients manage their physical fitness so as to mitigate old age related physiological ailments. The topics discussed include use of pre-habilitation for reducing burden on healthcare resources needed for old and obese population, pre-habilitation programmes as a clinical intervention measures for older patients undergoing major surgery, and pre-habilitation for promoting healthier lifestyle.

The article presents a study which evaluates the impact of pneumococcal polysaccharide vaccine (PPV) in older people in Australia. The incidence of invasive pneumococcal disease (IPD) from 2002 to 2011 is highlighted. The effects of 13-valent PPV (13vPPV) for infants on the reduction of IPD incidence among older people are outlined.

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Vitamin K antagonists (VKAs) are the most widely used anticoagulants for stroke prevention in patients with atrial fibrillation (AF). Recently, the US FDA approved three novel anticoagulants that work through inhibition of coagulation cascade independent of Vitamin K-dependent enzymatic reactions and, therefore, should have less food-drug interactions. Since AF is a disease of the aging heart, it is important to assess safety and efficacy of these new anticoagulants in elderly patients. We reviewed age-related changes in pharmacokinetics and pharmacodynamics observed with senescence and the effects of these changes on novel anticoagulants, known and anticipated drug and food interactions, and challenges related to bleeding complications and temporary discontinuation prior to surgery or interventional procedure. Although advantageous to VKA in age groups represented in trials, there are lack of data on VKA usage in older-elderly patients; additional research and post-marketing analysis in older-elderly patients are needed. [ABSTRACT FROM AUTHOR]

Aim: This paper reports the evaluation of a new evidence-based university curriculum aimed at addressing workforce capacity building in the allied health sector through addressing the educational needs of exercise science students in relation to falls prevention and exercise prescription for older people. Background: Exercise scientists have the capacity to play a key role in the falls injury prevention workforce. To fulfil this role and contribute to preventing injuries in older people, it is necessary that they have the appropriate knowledge and skills. Methods: Over a 13-week period in 2008, 44 third-year and 21 fourth- year students from an Australian university participated in the delivery and evaluation of a falls and injury prevention curriculum. Students' knowledge of falls and falls prevention was formally assessed using a knowledge questionnaire administered before (pre), immediately after (post) and at 13 weeks following (follow-up) completion of the curriculum. Differences in knowledge between pre-, post- and follow-up assessments were determined by repeated measures analysis of variance (p<0.05). Results: Overall knowledge levels significantly increased from 46% correct (pre) to 74% correct (post, p<0.00l) and were sustained at follow- up (78% correct, p<0.001). Students' self-reported ratings of confidence in delivering exercise programs for older people and falls prevention also increased significantly (p<0.001). Conclusions: Completion of a targeted falls prevention curriculum provides significant improvements in the knowledge, skills and confidence in the preparation of exercise science students as members of the allied health workforce providing exercise prescription for falls prevention. [ABSTRACT FROM AUTHOR]

Older adults with chronic diseases have a high level of depression and poor mental health status. Previous public health interventions have attempted to reduce chronic disease-related health risks including depression and to improve mental health, but have had limited success. This study examined whether 15 months of regular participation in TaiChi (TC) exercise, dancing, instrument playing and singing, as part of a mind--body meditative approach (MBMA), improves brain executive function, psychological functioning and mental health in Chinese older adults. Results indicated that the MBMA programme improved participants' executive function, psychological functioning, mental health and resilience, compared with a control group. These findings indicate that MBMA activities may be adopted as lifestyle approaches to promote mental health in different areas as follows: (1) TC and dancing have the biggest effect for reducing the prevalence of depression and for improving their mental health and resilience in older people with chronic conditions and (2) playing a musical instrument and singing have moderate effect for reducing depression symptoms and promoting mental health. The findings of the study suggest that there are mental health promotion implications relating to exercise type and minimal exercise dosage for older adults. Cultural dancing and TC may be a form of physical activity that is more likely to appeal to older people, when they are most at risk of being overweight or obese, of suffering from depression and/or of experiencing a decline in brain function. TC has been found to be highly effective in preventing depression and promoting brain executive function, and appears to be a form of physical activity that appeals to older people. Dancing, in combination with TC and singing, may be highly effective in protecting older adults from metabolic syndrome and brain function decline and in promoting a positive quality of life including psychological health. Playing a musical instrument may be used as an alternative method for maintaining good mental health in healthy people and for promoting mental health in people suffering from stress and its related depression and anxiety. [ABSTRACT FROM AUTHOR]

Abstract: Dietary restriction (DR) can extend lifespan and reduce disease burden across a wide range of animals and yeast but the mechanisms mediating these remarkably protective effects remain to be elucidated despite extensive efforts. Although it has generally been assumed that protective effects of DR are cell-autonomous, there is considerable evidence that many whole-body responses to nutritional state, including DR, are regulated by nutrient-sensing neurons. In this review, we explore the hypothesis that nutrient sensing neurons in the ventromedial hypothalamus hierarchically regulate the protective responses of dietary restriction. We describe multiple peripheral responses that are hierarchically regulated by the hypothalamus and we present evidence for non-cell autonomous signaling of dietary restriction gathered from a diverse range of models including invertebrates, mammalian cell culture, and rodent studies. [Copyright &y& Elsevier]

Objective: We aimed to analyze the factors influencing continued adherence to influenza vaccination in elderly persons vaccinated in the preceding season. Methods: Using a population-based vaccination registry, we evaluated the proportion of persons vaccinated against influenza in Navarre, Spain, in the 2010–11 season among non-institutionalized persons aged 65years or over who had been vaccinated in the 2009–10 season. Logistic regression was used to analyze the influence of sociodemographic, clinical and health care factors. Results: Of the 64,245 persons vaccinated against influenza in the 2009–10 season, 87% were vaccinated in the 2010–11 season. Continued adherence to vaccination increased with the number of physician visits per year. It was lower in women, in the 65–69 and ≥95year age-groups, in those hospitalized or diagnosed with any major chronic condition in the previous year, and in persons with hematological cancer or dementia. Health districts and physicians with higher coverage in the previous season continued to have higher adherence in the following season. Conclusions: People vaccinated against influenza in one season tend to be vaccinated in the following one. Sociodemographic, clinical and health care factors have a moderate effect on the continuity of vaccination, with the most important factor being the treating physician. [Copyright &y& Elsevier]

Abstract: Background: Aortic valve sclerosis (AVS) is a common inflammatory heart valve disease prevalent in the population over the age of 65 years. Several published clinical and animal studies have examined the ability of statin treatment to modify disease progression. Clinical trials yielded conflicting results, and animal studies examined the effects of statins prior to the onset of disease. Our study assessed the effect of dietary modification and/or statin treatment on established aortic valve disease in a rabbit model of AVS to examine the tissue response to therapy. Methods: Aortic valve sclerosis was induced in male New Zealand White rabbits by dietary cholesterol supplementation. Rabbits were followed over 2.5 years, with the introduction of statins and/or dietary changes for the second half of the study. At end point, valve function was examined by magnetic resonance imaging. Excised aortic valve cusp tissue was surveyed for thickness, lipid accumulation, protein deposition, calcification, and cellular infiltration. Results: By 15 months, cholesterol-fed valves exhibited thickening due to significant lipid content, macrophage infiltration, and osteopontin expression. By 30 months, the untreated disease had progressed to include elevated collagen deposition, lymphocyte invasion, and calcification. With treatment, however, the valve cusps exhibited significant pathological changes including diminished immune cell infiltration and osteopontin expression. Unfortunately, lipid was retained and calcification persisted in all treated valves. Conclusions: In established AVS, the cellular response to statin therapy does not result in full regression of the sclerotic process. [Copyright &y& Elsevier]

Abstract: Objective: To estimate influenza vaccine effectiveness (VE) in preventing hospitalizations in persons over 50 years of age. Design: We performed a retrospective, population based study, using a “difference-in-differences” approach to determine the association between hospitalization and prior vaccination. We examined this association when influenza was not circulating and compared it to the association found when influenza was circulating. VE was estimated from the difference in the association between hospitalization and prior vaccination, inside vs. outside influenza seasons. Setting: Kaiser Permanente in Northern California. Patients: Health plan members aged 50 years and older during the September 1997 to August 2008 study period, when there were about 68,000 pneumonia hospitalizations in 10 million person-years. Results: Vaccination was associated with lower risk of hospitalization for pneumonia and influenza, even before flu season, presumably due to unmeasured confounders. When influenza arrived the hospitalization-vaccination association strengthened, yielding an adjusted VE estimate of 12.4% (95% CI: 1.6–22.0) in persons aged 50–64, and 8.5% (95% CI: 3.3–13.5) in those aged 65 years and older. There was no significant effect on hospitalizations for ischemic heart disease (IHD), congestive heart failure (CHF), cerebrovascular disease (CVD), or trauma. Conclusions: Influenza vaccination has a modest but significant effect on prevention of hospitalization for pneumonia and influenza in persons 50 years of age and older. [ABSTRACT FROM AUTHOR]

The article provides updated recommendations from the U.S. Advisory Committee on Immunization Practices (ACIP) for prevention of invasive pneumococcal polysaccharide vaccine among all adults aged 65 years old or older and those adults aged 19-64 years old with underlying medical conditions that put them at greater risk for serious pneumococcal infection. It cites the changes made from the 1997 ACIP recommendations including indications of the vaccination. ACIP recommended the revaccination of patient groups at risk for invasive pneumococcal disease.

Clostridium difficile is a significant healthcare-associated pathogen and the major cause of antibiotic-associated diarrhea. The incidence and severity of C. difficile infection have increased in many parts of North America and Europe in the past few years with the widespread dissemination of a hypervirulent strain of C. difficile, referred to as North American pulsed-field type 1, polymerase chain reaction ribotype 027 (NAP1/027). C. difficile infection appears to affect older adults disproportionately. Long-term care facility (LTCF) residents are at greater risk because of advanced age, the frequent need for hospitalization, and recurrent exposures to antimicrobial agents. Early identification of C. difficile infection and prompt initiation of appropriate therapy are required to reduce morbidity and mortality. Diagnosis is based on the detection of C. difficile toxins A or B in diarrheal stool specimens. The treatment of choice for moderate or severe C. difficile infection (defined as the presence of pseudomembranous colitis, treatment in an intensive care unit, or two of (i) aged 60 and older, (ii) fever greater than 38.3°C, (iii) peripheral leukocytosis (>15,000 cells/mm3), or (iv) hypoalbuminemia (<2.5 mg/dL) should be with oral vancomycin (125 mg four times a day for 10–14 days). Treatment with oral metronidazole should be reserved for those with milder disease. Measures to prevent outbreaks and reduce the risk of C. difficile infection in LCTFs should include antimicrobial stewardship to ensure judicious use of antibiotics, C. difficile infection surveillance, appropriate use of contact or barrier precautions, and careful environmental cleaning and disinfection using sporicidal agents. [ABSTRACT FROM AUTHOR]

Abstract: With increasing age, there is a loss of appetite. Decline in food intake exceeds the decline in physical activity resulting in weight loss. With the ensuing weight loss, there is disproportionate loss of muscle mass. Even if weight is regained, there is a net loss of muscle mass. Sarcopaenia refers to a lack of muscle mass which leads to adverse health outcomes such as falls and reduced physical function. With sarcopaenia, there is change not only to muscle mass but also to muscle quality and function. As with other diseases, prevention is better than cure. With increasing age, there should be adequate protein intake and there is recommendation that the total protein intake is spread equally across three main meals. Sustained participation in resistance exercise programs also benefit muscle anabolism, an effect that may be enhanced if exercise is followed soon after by a high-protein meal. Attention to Vitamin D is not only likely to benefit muscle strength but would also reduce fracture risk with falls. Older people should focus on weight maintenance given that weight loss may result in undesirable loss of muscle mass. Those who are morbidly obese who need to lose weight should be advised to maintain protein intake and exercise to preserve muscle mass. Sarcopaenia, if unmanaged, is likely to result in significant health care costs. Preventing sarcopaenia will most likely not only result in significant health cost savings but will also contribute to better health in older age. [Copyright &y& Elsevier]

Background: Despite evidence of effective combination drug therapy for secondary prevention of coronary heart disease (CHD), older adults with this condition remain undertreated. Objective: To describe time trends (1992-2003) in the adoption of combination cardiac drug therapies (β-blockers [β-adrenoceptor antagonists], ACE inhibitors or angiotensin II type 1 receptor antagonists [angiotensin receptor blockers; ARBs], and lipid-lowering agents) among older adults in the US with CHD and to identify factors associated with not using combination therapy. Methods: The study took the form of a cross-sectional time-series. The study population consisted of a nationally representative sample of adults aged ⩾65 years with CHD(unweighted n = 6331; weighted n = 20.1million) included in the 1992-2003 Medicare Current Beneficiary Survey. The outcome measure was low-intensity cardiac pharmacotherapy (no drug or single drug therapy with β-blockers, ACE inhibitors/ARBs or lipid-lowering agents) compared with combination therapy (⩾2 cardiac drugs) for secondary CHD prevention. Results: The use of combination drug therapy in older adults with CHD increased 9-fold during the study period (from 6% in 1992 to 54% in 2003). Adjusted analyses demonstrate that suboptimal drug therapy was independently associated with advanced age (relative risk [RR] 1.18; 95% CI 1.14, 1.23) for patients aged ⩾85 years versus patients aged 65-74 years, and with being non-Hispanic Black (RR 1.05; 95%CI 1.01, 1.10) or Hispanic (RR 1.13; 95% CI 1.06, 1.21) versus being non-Hispanic White. Conclusions: Combination drug therapy use for secondary CHD prevention increased in older US adults over the last decade, but improvements were not uniform. The oldest-old, non-Hispanic Blacks and Hispanics experienced slower adoption of optimal medical therapy to improve their long-term prognosis for CHD. [ABSTRACT FROM AUTHOR]

Deans GD, Stiver HG, McElhaney JE (University of British Columbia, Vancouver, Canada). Influenza vaccines provide diminished protection but are cost-saving in older adults (Foresight). J Intern Med 2010; 267: 220–227. Influenza is associated with substantial morbidity and mortality in adults aged over 65 years. Although vaccination remains the most effective method of preventing influenza and its sequellae, current vaccination strategies provide less protection to older adults than to younger persons. Influenza vaccination in community-dwelling older adults is cost-effective, though there is room for improvement. Newer vaccine strategies considered for use in older adults include alternate routes of administration (intradermal or intranasal), addition of adjuvant, and novel methods of antigen presentation. Measuring cell-mediated immune response to new vaccines in addition to antibody response may correlate better with vaccine efficacy in this population. Whilst pandemic influenza A/H1N1 2009 (pH1N1) has largely spared older adults, the impact of pH1N1 vaccination has yet to be determined. [ABSTRACT FROM AUTHOR]

Background: the importance of vitamin D for bone health is well known, but emerging evidence also suggests that adequate vitamin D status may also be protective against non-communicable diseases. In the UK, government initiatives highlighting the importance of adequate vitamin D among older people have been in place since 1998. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To explore the influence of primary health care professionals in increasing exercise and physical activity among 60–70-year-old White and South Asian community dwellers. Method: Fifteen focus groups and 40 in-depth interviews with community dwelling White and South Asian 60–70-year olds. The sample was selected to include people with very different experiences of participation and non-participation in exercise and physical activity. Data were analysed using framework analysis. Results: Primary health care professionals’ advice and support was found to be a motivator to the initiation of exercise and physical activity. However, this was usually in relation to advice on weight reduction, cardiac conditions and mobility issues, but not generally to improve or increase activity levels. An underlying attitude of genuine interest and empathy was valued and shaped decisions about initiating and/or increasing activity levels. Conclusion: Primary health care professionals should be encouraged to show interest and empathy with older people about the positive benefits of exercise and physical activity to them individually. This advice needs to be tailored to the older adult''s symptoms. Practice implications: Primary health care professionals need to be able to provide specific advice as to the quantity (frequency, duration, intensity and type) of exercise or physical activity to undertake. Practitioners need to listen to their patients’ needs, show empathy and avoid ageism during consultations. [Copyright &y& Elsevier]

Background: In October 2005, the Centers for Medicare and Medicaid Services (CMS) required that long-term care (LTC) facilities certified by CMS offer each resident annual influenza vaccination. Subsequently, vaccination status was added to resident assessments collected beginning in the influenza season, 2005–2006. This is the first year immunization coverage can be reported based on a census of LTC residents. Objectives: Report influenza immunization coverage for LTC residents by state, resident, and facility characteristics. Identify uses of the data and areas in need of improvement. Methods: Analysis of CMS'' Minimum Data Set of 1,851,676 residents in nursing homes from October 1 through December 31 but who could have been discharged between January 1 and March 31 merged with data for 14,493 non–hospital-based facilities from the Online Survey and Certification Assessment Reporting System. Results: Overall, 83% of residents were offered the vaccine and 72% had received the vaccine. Almost 10% refused to receive the vaccine, 14% were not offered the vaccine, 1% were ineligible, and 3% were missing vaccination status. Vaccination coverage varied significantly among states (range: 49% to 87%). Fewer African Americans and Hispanics than whites were offered the vaccine (79% and 79% versus 84%, respectively) and received it (65% and 66% versus 73%, respectively); more African Americans refused the vaccine (12%) than residents of other races and/or ethnicities. Residents of Medicaid-certified-only facilities had higher levels of vaccination than residents of other facilities (82% versus ≤73%). Conclusion: MDS immunization data can be used as surveillance to work with states to improve coverage. Further research to examine racial disparities in vaccination among LTC residents is needed. [Copyright &y& Elsevier]

Apolipoprotein (apo) E, a polymorphic protein with three isoforms (apoE2, apoE3, and apoE4), is essential for lipid homeostasis. Carriers of apoE4 are at higher risk for developing Alzheimer's disease. We have investigated adult neurogenesis in mice with knockout (KO) for apoE or with knockin (KI) alleles for human apoE3 or apoE4, and we report that neurogenesis is reduced in both apoE-KO and apoE4-Kl mice. In apoE-KO mice, increased BMP signaling promoted glial differentiation at the expense of neurogenesis. In contrast, in apoE4-Kl mice, presynaptic GABAergic input-mediated maturation of newborn neurons was diminished. Tau phosphorylation, an Alzheimer's disease characteristic, and levels of neurotoxic apoE fragments were both elevated in apoE4-Kl hippocampal neurons concomitant with decreased GABAergic interneuron survival. Potentiating GABAergic signaling restored neuronal maturation and neurogenesis in apoE4-Kl mice to normal levels. These findings suggest that GABAergic signaling can be targeted to mitigate the deleterious effects of apoE4 on neurogenesis. [ABSTRACT FROM AUTHOR]

Although HMG-CoA reductase inhibitors (statins) have been shown to reduce the risk of cardiovascular events in patients aged 65-80 years who have clinical cardiovascular disease, fewer data are available for elderly patients without cardiovascular disease. Treatment guidelines recommend a low-density lipoprotein cholesterol goal of<100mg/dL for those with cardiovascular disease or diabetes mellitus but vary in their recommendations for primary prevention. Moderate-dose statins have been shown to be effective and safe in properly selected elderly patients up to the age of 80 years. High- dose statins have also been shown to be effective and reasonably safe in patients without significant co-morbidities up to the age of 75 years. With advancing age, the potential for benefit from cholesterol-lowering treatment needs to be weighed against the increasing risk of muscle and hepatic toxicity, as well as competing causes of morbidity and mortality. [ABSTRACT FROM AUTHOR]

Inactivity has been identified as a major contributor to the burden of disease among older Australians, particularly those in culturally-diverse communities. This study assessed the facilitators and barriers to physical activity in older people from culturally-diverse communities, and investigated the predictors of physical activity participation by recruiting 333 older people from seven different communities in the western suburbs of Melbourne, Australia. A survey questionnaire that recorded physical activity and the barriers to and facilitators of activity was interviewer-administered in the participants' preferred language. The data were analysed using bivariate and multivariate inferential statistical methods. Personal barriers to physical activity, such as poor health, lacking the energy to exercise, being too tired and low motivation, were highly prevalent in all groups. Specific factors, such as 'being self-conscious about my looks ', were more prevalent among the Vietnamese, as were concerns about the weather among Macedonians and Croatians. Across all groups, perceptions of health and safety strongly influenced physical activity behaviour, more so than the external environment. Some of the barriers can be addressed with a common approach, but others in some communities will require particular strategies. [ABSTRACT FROM AUTHOR]

Abstract: Recurrent stroke is a major public health concern, occurring in approximately one third of stroke survivors within 5years. Besides, the overall aging of the developed countries population and the improved survival of patients with stroke have created a large population of older adults in need of secondary stroke prevention. Thus, at present, more than 5% of individuals 65 to 74years old and more than 10% of those 75 and older have had a prior stroke. An age bias exists in the prescription of important secondary-preventive therapies in the elderly. Knowledge of the evidence behind the secondary prevention strategies could be useful to practicing physicians caring for stroke elderly patients. Effective strategies for the secondary prevention of stroke include treatment of hypertension and hyperlipidaemia. Our review presents the most recent evidence on hypertension and lipid lowering therapy for stroke prevention in elderly patients with previous stroke or TIA. Basis for evidence (or the lack thereof), areas of controversy, and avenues of future focus for these treatments are also discussed in this paper. [Copyright &y& Elsevier]

Abstract: Dementia has often thought to be unavoidable and incurable. In recent years, risk factors, including lifestyle attributes, have been associated with the two commonest forms of dementia, Alzheimer''s Disease and vascular dementia. There is also new evidence that the adult brain maintains plasticity and response to external stimuli. Beside considerable observational data of the effect of lifestyle factors there is now increasing empirical evidence that alterations in lifestyle factors may decrease an individual''s risk of developing dementia. The evidence is strongest for increasing an individual''s level of physical activity, followed by the cessation of smoking. These interventions carry few risks and have many additional health benefits, so can be recommended for most of the older population. Other interventions such as increasing social engagement, cognitive stimulation and homocysteine lowering vitamin supplements also appear promising, with considerable observational evidence supporting their uptake, although there is still a lack of empirical evidence for these interventions. [Copyright &y& Elsevier]

The article discusses a study which focuses on the significance of milk fat globule protein epidermal growth factor-8 (MFG-E8) in aortic wall thickening. It states that in a comprehensive quantitative proteomic study using mice as laboratory animals, aging plays a role in aortic wall thickening. It notes that MFG-E8 is essential in preventing and treating age-associated vascular diseases.

The article reports on the goal of the study to evaluate the efficacy of herbal formulation in preventing obesity and dementia in older people. It includes the evaluation on the health of 80 men and women, aged 61 to 70, showing high body mass index (BMI) with a major complaint of loss memory treated with a novel herbal formulation. It shows that the administration of herbal formulation enhanced satiety and decreases appetite and fat absorption.

Despite evidence that suggests modifying risk factors at any age can reduce the risk of cancer, many older people fail to take relevant preventive actions. The objectives of the project were to assess whether older people perceived taking actions to prevent cancers as worthwhile after the age of 60 years. Fifty men (19) and women (31) 60 years and older (mean age 68 years) participated in seven focus groups to assess their perceptions of preventive health actions and barriers and motivators in relation to cancer prevention. Most participants reported not adhering to preventive actions for cancer. Many did not perceive the benefits if the actions are initiated after the age of 60 years, and some risk factors were not perceived to be related to cancer. There was strong agreement that screening for cancer was worthwhile after the age of 60 years. It appears that awareness programs specifically tailored to seniors may be desirable to promote cancer prevention within a context of chronic disease prevention in general. [ABSTRACT FROM AUTHOR]

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This article focuses on a synthesis of knowledge about healthy aging research in human beings and then synthesized nurse-led research in gerontology and geriatrics that use biomarkers. Healthy aging research has attracted considerable attention in the biomedical and basic sciences within the context of four major areas: (a) genetic variations as an expression of successful or unsuccessful aging; (b) caloric restriction as an intervention to slow the progression of aging; (c) immunological aging; (d) neurobiology of the aging brain. A systematic review of the literature was performed to identify nurse-led geriatric-related biomarker research. Nurse researchers who have chosen to integrate biomarkers as part of their research studies have been working in six focal areas, which are reviewed: health promotion within risk populations, cancer, vascular disease, Alzheimer's disease, caregiving, and complementary therapies. The article provides a discussion of contributions to date, identifying existing gaps and future research opportunities. [ABSTRACT FROM AUTHOR]

Cancer-specific primary prevention efforts for the geriatric population are not understood well and currently are underused despite the rapidly growing elderly population. It has been established that lifestyle changes, such as smoking cessation, dietary changes, and increasing physical activity, decrease the incidence of cancer in younger populations. However, a multitude of conceptual, methodological, and dissemination challenges arise when the objective is to apply primary prevention of cancer to the elderly. For this article, the state of the science was reviewed to reveal barriers in the uptake of cancer-specific primary prevention practices, including the lack of data for the applicability of clinical research findings to older populations. Under-representation of older adults in behavioral trials and research programs is hindering progress in understanding the physical health and lifestyle choices of older individuals. Efforts directed toward prevention in terms of promoting health behaviors may be not only clinically advantageous but also cost-effective. In addition, models for translating research findings on primary prevention from younger individuals to the elderly population needs to be addressed. Practitioners need to gain a better understanding of the opportunities for cancer-specific primary prevention, because such an understanding could enhance the management of chronic disease. [ABSTRACT FROM AUTHOR]

Hypothermia is common in the geriatric population and its significance perhaps under-recognized. Hypothermia is associated with substantial morbidity and fatality, but to some extent is preventable provided caregivers and providers of healthcare to older adults adopt preventive measures to lower its occurrence. Hypothermia occurs in both cold and warm settings; its pathogenesis involves alterations in the age-related physiology of thermoregulation, along with a variable combination of environmental factors, disease processes and medications, many of which are recognizable. Once diagnosed, treatment must be prompt and aggressive, and must consider several options for rewarming. Education of healthcare providers regarding early recognition of hypothermia and a better understanding of preventive and treatment measures will undoubtedly lower complications of hypothermia in affected elderly. [ABSTRACT FROM AUTHOR]

Background: Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading pictures of long-term benefits, and residual confounding may have biased past results. This study examined the effectiveness of influenza vaccine in seniors over the long term while addressing potential bias and residual confounding in the results. Methods: Data were pooled from 18 cohorts of community-dwelling elderly members of one U.S. health maintenance organization (HMO) for 1990–1991 through 1999–2000 and of two other HMOs for 1996–1997 through 1999–2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important covariates. Additional analyses explored for evidence of bias and the potential effect of residual confounding. Results: There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95% confidence interval [CI], 0.68 to 0.77) and a 48% reduction in the risk of death (adjusted odds ratio, 0.52; 95% CI, 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, we modeled the effect of a hypothetical unmeasured confounder that would have caused overestimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant — though lower — reductions in the risks of both hospitalization and death. Conclusions: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved. N Engl J Med 2007;357:1373-81. [ABSTRACT FROM AUTHOR]