Search

Objective: Psychological frailty, including cognitive, mood, and motivational components, is an important predictor of overall well-being. Therefore, there is an increasing scientific interest in studying different determinants of psychological frailty. Unfortunately, the psychological components of frailty are not fully evaluated and currently, there is currently no consensus on the proper assessment or intervention. This study evaluated optimism and self-efficacy among frail older men without functional disabilityG. Materials and Methods: A case-control study. Seventy older men =60 years were divided into frail and non-frail groups. The self-efficacy scale (SES) and revised life orientation test (R-LOT) were applied for all participants, in addition to the comprehensive geriatric assessment, to determine other factors affecting physical frailty. Results: Those with physical frailty had lower self-efficacy and optimism scores. R-LOT and SES had moderate diagnostic accuracy in predicting frailty; the area under the curve for both tools were 0.75 and 0.71, respectively. Conclusion: There is an association between poor general self-efficacy, low optimism, and frailty among older men. Thus, the importance of addressing the psychological determinants of frailty is on par with that of addressing the physical components. Integrating the SES and R-LOT scales into the comprehensive assessment of older men with physical frailty can improve the assessment of psychological resilience, ultimately promoting their well-being and quality of life. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Sports Sciences Research / Spor Bilimleri Araştırmaları Dergisi is the property of Journal of Sport Sciences Researches / Spor Bilimleri Arastirmalari Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 82-year-old man suffering from pemphigus and Parkinson's disease presented at the emergency department of the Misericordia Hospital in Grosseto (Tuscany, Italy) with subconjunctival bleeding. Laboratory blood tests showed a prolonged activated thromboplastin time (aPTT), with normal prothrombin time (PT) and slightly reduced haemoglobin. The negative family and personal history of haemorrhagic disease rose the suspicion of the presence of an acquired inhibitor. The patient was referred for further diagnostics to the University Hospital of Siena where second level tests were performed at the Coagulation Unit. The aPTT mixture test revealed a non-correction both at room temperature and, more markedly, after incubation at 37°C for 2h, confirming the presence of an intrinsic pathway inhibitor. Among the measured factors, only the activity level of factor VIII was extremely low. The titration of FVIII inhibitor confirmed the diagnosis of Acquired Haemophilia A (AHA). [ABSTRACT FROM AUTHOR]

Actinic Reticuloid (AR) is a rare, severe, chronic photodermatosis that generally occurs in older males. Belonging to the group of cutaneous pseudolymphomas identified as benign reactive lymphocytic proliferations. It is characterized by being photosensitive, specifically to UV (ultraviolet) rays and visible light. It manifests in patients with a characteristic clinical picture of erythematous, edematous, pruritic, lichenified and scaly papules and plaques, which later develop as residual pigmented macules and progressively worsen with sun exposure; It mainly occurs in exposed areas such as the face, arms, hands, neck, among others. Actinic Reticuloid is a strange, poorly documented pathology and as a consequence of not knowing about it, patients do not go to the clinic until the disease is in an advanced stage and with a severe clinical picture of the disease; here lies the importance of the exposition of this bibliographic review where, in addition to presenting the case of a 58-year-old man, the clinical assessment is evidenced from the symptomatology and the main treatment for the patient is determined, as well as different alternatives for relieve symptoms and as a support for effective recovery. [ABSTRACT FROM AUTHOR]

Introduction: Infectious inflammation of the periorbital and orbital soft tissue can be classified as preseptal (periorbital) or postseptal (orbital) cellulitis. Eyelid abscess, an accumulation of pus in the palpebral tissue, can occur in isolation or in association with preseptal cellulitis. Preseptal cellulitis is nearly three times more common than orbital cellulitis. Case Presentation: The patient, in this case, was admitted with a complaint of swollen left eyelid ten days before being admitted. Swollen eyelid with the inability to open the left eye was accompanied by pus discharge five days before coming to the hospital. Current complaints include eyelid pain, swelling, and discharge of thick yellow fluid. Massive abscess with active pus and crust was present in the left superior and inferior eyelid and frontotemporal area. A head CT scan revealed a soft tissue mass in the left sub galea soft tissue, left frontal region, left orbit, and left temporal region. Multi-department consultations and several workups were done to reveal the etiology and plan the appropriate management of this condition. Conclusion: A comprehensive assessment must be done to distinguish preseptal and orbital cellulitis. Ophthalmology examination and imaging are crucial to detect any extension of the palpebral abscess beyond the orbital septum. Examining an immunocompromised state and focal infection is crucial in determining proper treatment. [ABSTRACT FROM AUTHOR]

Context: Whether repeated bone mineral density (BMD) screening improves fracture prediction in men is uncertain. Objective: We evaluated whether a second BMD 7 years after the initial BMD improves fracture prediction in older men. Methods: Among 3651 community-dwelling men (mean age 79.1 years) with total hip BMD at baseline and Year 7 (Y7), self-reported fractures after Y7 were confirmed by radiographic reports. Fracture prediction assessed using Cox proportional hazards regression and logistic regression with receiver operating characteristic curves for models based on initial BMD, BMD change, and the combination of initial BMD and BMD change (combination model). Results: During an average follow-up of 8.2 years after Y7, 793 men experienced ≥ 1 clinical fractures, including 426 men with major osteoporotic fractures (MOF) and 193 men with hip fractures. Both initial BMD and BMD change were associated with risk of fracture outcomes independent of each other, but the association was stronger for initial BMD. For example, the multivariable hazard ratio of MOF in the combination model per 1 SD decrement in BMD was 1.76 (95% CI 1.57-1.98) for initial BMD and 1.19 (95% CI 1.08-1.32) for BMD change. Discrimination of fracture outcomes with initial BMD models was somewhat better than with BMD change models and similar to combination models (AUC value for MOF 0.68 [95% CI 0.66-0.71] for initial BMD model, 0.63 [95% CI 0.61-0.66] for BMD change model, and 0.69 [95% CI 0.66-0.71] for combination model). Conclusion: Repeating BMD after 7 years did not meaningfully improve fracture prediction at the population level in community-dwelling older men. [ABSTRACT FROM AUTHOR]

Millions of men in the US experience substance abuse and impulse control disorders, which is well researched. Far fewer scholars have studied the millions of men that also experience depression (which is traditionally associated with women). Drawing upon literature on fragile masculinity and masculinity threat, we evaluate the role of endorsing hegemonic masculinity ideals (e.g., men should be strong, unemotional, and financially secure) in both internalizing (depression) and externalizing (anger) mental health problems, focusing on older White men aged 70–74 in the Wisconsin Longitudinal Survey (N = 1,794). In addition to predicting mental health among older men according to their agreement with hegemonic masculinity ideals, we examine the impact of two potential threats to masculinity: health and wealth decline. We find that endorsement of hegemonic masculinity ideals is positively associated with externalizing and internalizing symptoms and that the association between hegemonic masculinity ideals and depressive symptoms is even stronger for men who perceive their health to be declining and those who have lost wealth. We conclude that endorsement of rigid hegemonic masculinity ideals negatively impacts older men's mental health, especially when they experience challenges to their self-perception as strong, independent, and self-reliant. We provide suggestions as to how improving our understanding of the association between masculinity beliefs and mental health can inform clinical practice as well as public health and public policy. [ABSTRACT FROM AUTHOR]

Background: Lower urinary tract symptoms (LUTS) are associated with frailty phenotype, a risk factor for functional decline. Our objective was to determine the association between baseline LUTS and 2‐year risk of new functional limitation among older men. Methods: We analyzed data from the Osteoporotic Fractures in Men (MrOS) study with baseline at Year 7 and follow‐up through Year 9. Participants included 2716 community‐dwelling men age ≥ 71 years without any baseline self‐reported functional limitation. LUTS severity (American Urologic Association Symptom Index) was classified as none/mild (score 0–7), moderate (8–19), and severe (20–35). At baseline and follow‐up, men reported their ability to complete several mobility, activities of daily living (ADLs), and cognition‐dependent tasks. Risk was estimated for 3 incident functional limitation outcomes: (1) mobility (any difficulty walking 2–3 blocks or climbing 10 steps), (2) ADL (any difficulty bathing, showering, or transferring), and (3) cognition‐dependent (any difficulty managing money or medications). We used Poisson regression with a robust variance estimator to model adjusted risk ratios (ARR) and 95% CIs controlling for age, site, and comorbidities; other demographic/lifestyle factors did not meet criteria for inclusion. Results: Overall, the 2‐year risk was 15% for mobility, 10% for ADLs, and 4% for cognition‐dependent task limitations. Compared to none/mild LUTS, risk of incident mobility limitations was increased for moderate (ARR = 1.35, 95% CI: 1.12, 1.63) and severe LUTS (ARR = 1.98, 95% CI: 1.48, 2.64). Men were also at higher risk for incident ADL limitations if they reported moderate (ARR = 1.32, 95% CI: 1.05, 1.67) and severe LUTS (ARR = 1.62, 95% CI: 1.07,2.43). Results were somewhat attenuated after adjusting for the frailty phenotype but remained statistically significant. LUTS were not associated with incident cognition‐dependent task limitations. Conclusions: LUTS severity is associated with incident mobility and ADL limitations among older men. Increased clinical attention to risk of functional limitations among older men with LUTS is likely warranted. [ABSTRACT FROM AUTHOR]

Background: Recent literature suggests that the gap in prevalence of binge drinking between men and women is closing, but little is known about sex‐specific differences in trends and correlates of binge drinking among older Americans. Methods: A total of 18,794 adults, aged 65 years and older were surveyed in the 2015–2019 National Survey on Drug Use and Health. We estimated trends in prevalence of past‐month binge drinking (≥5 drinks on the same occasion for men and ≥4 drinks for women), stratified by sex. Correlates of binge drinking were estimated for men and women separately, focusing on demographic characteristics, chronic diseases, past‐month tobacco and cannabis use, depression, and emergency department use. Multivariable generalized linear models using Poisson and log link were used to examine associations stratified by sex. Results: Binge drinking among older men increased from 12.8% in 2015 to 15.7% in 2019 (p = 0.02) but remained stable among older women (7.6% to 7.3%, p = 0.97). In adjusted models, having a college degree was associated with higher risk of binge drinking among women (adjusted prevalence ratio [aPR] = 1.68, 95% CI: 1.13–2.50), but lower risk among men (aPR = 0.69, 95% CI: 0.56–0.85). Men who are separated or divorced were also at higher risk (aPR = 1.25, 95% CI: 1.05–1.50), but women were not. Both men and women reporting past‐month use of tobacco (men aPR = 1.87, 95% CI: 1.61–2.17, women aPR = 2.11, 95% CI: 1.71–2.60) and cannabis (men aPR = 2.05, 95% CI: 1.63–2.58, women aPR = 2.77, 95% CI 2.00–3.85) were at higher risk of binge drinking. Conclusions: Binge drinking has increased among older men whereas it has remained stable among older women in the United States. Interventions should consider that although tobacco and cannabis use is associated with an increased risk of binge drinking among both older men and women, demographic correlates tend to differ by sex. [ABSTRACT FROM AUTHOR]

Background: Many physical functions decline with aging, but it is not known whether oral functions vary according to sex or decline with aging, as it occurs with physical functions. The present study aimed to examine the association of sex, age, and elapsed years with occlusal force and tongue pressure using a generalized linear mixed‐effect model (GLMM) over a 3‐year period among old‐old Japanese adults. Methods: Participants were community‐dwelling older adults who participated in a survey (June 2014–March 2017) and a follow‐up survey (July 2017–December 2019) after 3 years (n = 951: 70‐year group, n = 466; 80‐year group, n = 391; 90‐year group, n = 94). Dental examinations including the number of teeth, occlusal force, and tongue pressure were conducted, and a GLMM was used to estimate the association of sex, age, and elapsed years with occlusal force and tongue pressure, adjusting for the number of teeth. Results: The GLMM showed that occlusal force was significantly associated with sex (reference; male, non‐standardized coefficient: B = −66.9 [female], p < 0.001), age (reference; 70‐year group, B = −81.7 [80‐year group], p < 0.001, B = −87.2 [90‐year group], p < 0.001), and the number of teeth (B = 13.8, p < 0.001), but did not significantly decrease with elapsed years. Tongue pressure was significantly associated with sex (reference; male, B = −0.94 [female], p = 0.034) and age (reference; 70‐year group, B = −1.78 [80‐year group], p < 0.001, B = −5.47 [90‐year group], p < 0.001). Tongue pressure decreased significantly with elapsed years (B = −0.82, p < 0.001). Conclusions: These findings suggest that tongue pressure significantly decreased over time, but occlusal force did not. Tongue‐related muscles may be more susceptible to aging than masticatory muscles. [ABSTRACT FROM AUTHOR]

Frailty is a state of reduced muscle strength and activity in older people. DNA methylation is associated with osteoporosis and muscle loss in murine and other animal studies, but there are no epidemiological studies in humans. This study aimed to assess the association of osteoporosis and muscle loss with DNA methylation in community-dwelling older people. This cross-sectional study was performed in a rural part of Japan. We analyzed 204 subjects (98 men and 106 women). In univariate analysis, the two groups were compared according to the presence or absence of osteoporosis and of muscle loss. Logistic regression analysis was performed to determine predictors of frailty in the muscle loss group. We used age, sex, body mass index, smoking history, drinking history, serum albumin and C-reactive protein levels, diabetes, hypertension, hyperlipidemia, heart disease history, and LINE-1 DNA methylation as the factors. Probability values < 0.05 were considered to be statistically significant. The levels of LINE-1 DNA methylation in leukocytes were associated with muscle loss in men over the age of 60. LINE-1 DNA methylation levels were not associated with bone mineral density in either the men or women over the age of 60. LINE-1 DNA methylation levels in leukocytes correlated significantly with the risk of frailty in men over the age of 60. Promoting an understanding of DNA methylation may lead to a better understanding of the pathophysiology of muscle loss. [ABSTRACT FROM AUTHOR]

We are presenting a case of a 36 years old male patient with clinical signs for acute appendicitis. Contrast-enhanced abdominal CT finding revealed a small periappendicular abscess and the patient was subjected for laparoscopic appendectomy for complicated appendicitis. Histologic analysis of the specimen revealed a Lowgrade Appendicular Mucinous Neoplasm (LAMN) with dimension of 1 cm at the appendicular tip with histologic presentation of mucin-producing cells. [ABSTRACT FROM AUTHOR]

Eccrine squamous syringometaplasia (ESS) is a histological term describing a mature squamous metaplasia of the eccrine ducts. Eccrine squamous syringometaplasia is not an infrequent histological finding and may be associated with chemotherapy or with a variety of non-specific conditions including infections, neoplastic conditions, and inflammatory skin diseases. We report a 75-year-old man who developed ESS within lesions of leukemia cutis (LC). The patient had an inaugural diagnosis of acute myeloid leukemia (AML) and he was not on chemotherapy when the biopsy was performed. [ABSTRACT FROM AUTHOR]

The study aimed to utilize machine learning (ML) approaches and genomic data to develop a prediction model for bone mineral density (BMD) and identify the best modeling approach for BMD prediction. The genomic and phenotypic data of Osteoporotic Fractures in Men Study (n = 5130) was analyzed. Genetic risk score (GRS) was calculated from 1103 associated SNPs for each participant after a comprehensive genotype imputation. Data were normalized and divided into a training set (80%) and a validation set (20%) for analysis. Random forest, gradient boosting, neural network, and linear regression were used to develop BMD prediction models separately. Ten-fold cross-validation was used for hyper-parameters optimization. Mean square error and mean absolute error were used to assess model performance. When using GRS and phenotypic covariates as the predictors, all ML models' performance and linear regression in BMD prediction were similar. However, when replacing GRS with the 1103 individual SNPs in the model, ML models performed significantly better than linear regression (with lasso regularization), and the gradient boosting model performed the best. Our study suggested that ML models, especially gradient boosting, can improve BMD prediction in genomic data. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVE: The cost of a fall among older adults requiring emergency services is unclear, especially beyond the acute care period. We evaluated medical expenditures (costs) to 1 year among community‐dwelling older adults who fell and required ambulance transport, including acute versus post‐acute periods, the primary drivers of cost, and comparison to baseline expenditures. DESIGN: Retrospective cohort analysis. SETTING: Forty‐four emergency medical services agencies transporting to 51 emergency department in seven northwest counties from January 1, 2011, to December 31, 2011, with follow‐up through December 31, 2012. PARTICIPANTS: We included 2,494 community‐dwelling adults, 65 years and older, transported by ambulance after a fall with continuous fee‐for‐service Medicare coverage. MEASUREMENTS: The primary outcome was total Medicare expenditures to 1 year (2019 U.S. dollars), with separation by acute versus post‐acute periods and by cost category. We included 48 variables in a standardized risk‐adjustment model to generate adjusted cost estimates. RESULTS: The median age was 83 years, with 74% female, and 41.9% requiring admission during the index visit. The median total cost of a fall to 1 year was $26,143 (interquartile range (IQR) = $9,634–$68,086), including acute care median $1,957 (IQR = $1,298–$12,924) and post‐acute median $20,560 (IQR = $5,673–$58,074). Baseline costs for the previous year were median $8,642 (IQR = $479–$10,948). Costs increased across all categories except outpatient, with the largest increase for inpatient costs (baseline median $0 vs postfall median $9,477). In multivariable analysis, the following were associated with higher costs: high baseline costs, older age, comorbidities, extremity fractures (lower extremity, pelvis, and humerus), noninjury diagnoses, and surgical interventions. Compared with baseline, costs increased for 74.6% of patients, with a median increase of $12,682 (IQR = −$185 to $51,189). CONCLUSION: Older adults who fall and require emergency services have increased healthcare expenditures compared with baseline, particularly during the post‐acute period. Comorbidities, noninjury medical conditions, fracture type, and surgical interventions were independently associated with increased costs. [ABSTRACT FROM AUTHOR]

Copyright of Jornal Brasileiro de Patologia e Medicina Laboratorial is the property of Sociedade Brasileira de Patologia Clinica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Jornal Brasileiro de Patologia e Medicina Laboratorial is the property of Sociedade Brasileira de Patologia Clinica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Jornal Brasileiro de Patologia e Medicina Laboratorial is the property of Sociedade Brasileira de Patologia Clinica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND/OBJECTIVES: To estimate associations between lower urinary tract symptoms (LUTS) and phenotypic frailty in older men. DESIGN: Cross‐sectional study. SETTING: Community‐dwelling men recruited from 2000 to 2002 from six U.S. academic centers for the Osteoporotic Fractures in Men Study. PARTICIPANTS: A total of 5,979 men aged 65 and older. MEASUREMENTS: The independent variable was LUTS severity (none/mild, moderate, or severe) assessed with the American Urologic Association Symptom Index. Participants were categorized as frail, intermediate stage, or robust using an adapted Cardiovascular Health Study index (components: low lean mass, weakness, exhaustion, slowness, and low physical activity). Associations were estimated with odds ratios and 95% confidence intervals (CIs) from multivariable multinomial logistic regression models adjusted for potential confounders of age, other demographics, health‐related behaviors, and comorbidities. RESULTS: The prevalence of frailty was 7%, 11%, and 18% among men with none/mild, moderate, and severe LUTS, respectively. Moderate and severe LUTS, overall and by storage and voiding subscores, were associated with higher odds of both intermediate stage and frailty in all models. After adjustment for confounders, the odds of frailty was 1.41 times higher among men with moderate LUTS (95% CI = 1.14–1.74) and 2.51 times higher among men with severe LUTS (95% CI = 1.76–3.55), compared with none/mild LUTS. Severe LUTS was associated with a greater odds of individual frailty components exhaustion and low physical activity. CONCLUSION: The prevalence of phenotypic frailty is higher among older community‐dwelling men with moderate or severe LUTS compared with those with mild or no LUTS. The positive association between LUTS severity and frailty among older men appears independent of age and known frailty risk factors. Although the temporal direction of this association and the utility of LUTS or frailty interventions in this population remain unclear, the high co‐occurrence of these conditions could lead to earlier identification of frailty when clinically appropriate. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH), a common cause of lower urinary tract symptoms in the elderly male population, has conventionally treated by transurethral resection of the prostate (TURP). During recent years, newer minimally invasive therapies (MITs) have entered the playing field and challenged TURP with their convenience, lack of sexual side effects, and overall safety. The present paper provides an update on the more heavily studied and most recent MITs, analyzing their mechanism of action, tolerability, and efficacy in clinical practice. Particularly, robust clinical data have propelled UroLift and Rezuum to the forefront in the armamentarium of minimally invasive BPH treatment. Newer mechanical therapies such as the temporary implantable nitinol device, ClearRing, ZenFlow Spring, and Butterfly are appealing options as they forego cutting, ablation, heating, or removing prostatic tissue. It is obvious that there is wide variation in the degree of clinical readiness of each modality and only time and long-term, multicenter studies will decide which of these therapies are accepted by the patient and urologist. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether the increased serum levels of testosterone secondary to Dutasteride therapy has any protective effect on cardiovascular system. Material and Methods: A prospective analysis of 50 patients diagnosed benign prostatic enlargement between May 2015 and May 2017 was performed. After randomization 25 patients treated with daily administration of 0.5 mg dutasteride (Dutasteride Group), and 25 patients were not given dutasteride (Control Group). We analyzed some serum novel cardiaovascular marker levels at baseline and after 6 months of the treatment. Echocardiography, carotid intima-media thickness and brachial artery resistive index (RI) were evaluated at baseline and after 6 months of the treatment. Statistical analyses were performed using SPSS, version 21. While “t test” was used for comparison the independent groups, paired t test was used in the matched groups. Statistical significance was considered at p<0.05. Results: The differences in serum Lp a, hs-CRP and NT-proBNP levels were not statistically significant (p>0.05). Additionally, echocardiographic parameters, carotid intima-media thickness and brachial artery RI were similar before and after dutasteride tratment. Conclusion: After the short-term use of dutasteride, there was not a statistically significant difference in serum Lp a, hs-CRP and NT-proBNP levels. Additionally, echocardiographic parameters, carotid intima-media thickness and brachial artery RI were also similar. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Neuroscience / Ideggyógyászati Szemle is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVES: To evaluate the dose‐response relationships between alcohol consumption and functional limitations in older European men, and explore the role of muscle strength as a mediator of these relationships. DESIGN: Cross‐sectional study of older men participating in the Survey of Health, Aging and Retirement in Europe (SHARE). SETTING: Urban and rural households in 17 European countries and Israel. PARTICIPANTS: A total of 17 870 men aged 65 years and older from the SHARE (Wave 6, 2015) were included in this study. MEASUREMENTS: Outcome variables were functional limitations: mobility limitation, arm function limitation, and fine motor limitation. Main exposure variable was alcohol consumption. Mediating factor was grip strength. Basic demographics, life habits, and health status were considered as potential confounders. Dose‐response analyses with restricted cubic splines and the Karlson/Holm/Breen method were conducted. RESULTS: A total of 17 870 participants were included in this study. Dose‐response analyses revealed that moderate alcohol consumption was related to the lower odds of reporting mobility limitation (≤35 units/wk) and arm function limitation (≤41 units/wk), with a minimum odds ratio (OR) occurring at 10 units/week drinks for mobility limitation (OR =.71; 95% confidence interval [CI] =.62‐.81) and arm function limitation (OR =.66; 95% CI =.59‐.75). The odds of reporting the fine motor limitation monotonically increased with alcohol consumption when alcohol consumption was beyond 15 units/week. No significant mediating effect of grip strength on the relationships between alcohol consumption and mobility limitation and arm function limitation was found. CONCLUSION: Moderate alcohol consumption has a protective role in mobility and arm function limitation in older European men. Grip strength is not the main mediator of these associations, suggesting that the protective effect is independent of muscle strength. Alcohol consumption is associated with higher odds of reporting fine motor limitation in older European men. J Am Geriatr Soc 67:2331–2337, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Binge drinking is a risk factor for a range of harms. This study estimates the national prevalence of binge drinking and adds to our understanding of correlates of binge drinking among older adults in the United States. DESIGN: Cross‐sectional analysis. SETTING/PARTICIPANTS: A total of 10 927 adults, aged 65 years or older, from the 2015 to 2017 administrations of the US National Survey on Drug Use and Health. MEASUREMENTS: We estimated the prevalence of past‐month binge alcohol use (five or more drinks on the same occasion for men and four or more drinks on the same occasion for women). Characteristics of past‐month binge drinkers, including demographics, substance use, serious mental illness, mental health treatment utilization, chronic disease, and emergency department (ED) use, were compared to participants who reported past‐month alcohol use without binge drinking. Comparisons were made using χ2 tests. We then used multivariable generalized linear models using Poisson and log link to examine the association between covariates and binge drinking among all past‐month alcohol users aged 65 years or older. RESULTS: Of 10 927 respondents, 10.6% (95% CI = 9.9%‐11.2%) were estimated to be current binge drinkers. Binge drinkers were more likely to be male, have a higher prevalence of current tobacco and/or cannabis use, and have a lower prevalence of two or more chronic diseases compared to nonbinge drinkers. In multivariable analysis, among past‐month alcohol users, the prevalence of binge drinking was higher among non‐Hispanic African Americans than whites (adjusted prevalence ratio [aPR] = 1.44; 95% CI = 1.16‐1.80), tobacco users (aPR = 1.52; 95% CI = 1.33‐1.74), cannabis users (aPR = 1.41; 95% CI = 1.11‐1.80), and those who visited the ED in the past year (aPR = 1.16; 95% CI = 1.00‐1.33). CONCLUSION: Over a tenth of older adults in the United States are estimated to be current binge drinkers. Results confirm the importance of screening for binge drinking behaviors among older adults to minimize harms. J Am Geriatr Soc 67:2139–2144, 2019 [ABSTRACT FROM AUTHOR]

Objectives: Sedative and hypnotic medications are associated with harm, and guidelines suggest limiting their use. Only limited evidence has described how older adults are managed following an initial sleep disorder diagnosis. We aimed to describe clinical management patterns of sleep disorders in older women and men at the time of initial diagnosis. Design: Population‐based retrospective cohort study using linked administrative databases. Setting: Ontario, Canada. Participants: Community‐dwelling adults aged 66 and older, diagnosed with a new sleep disorder by a primary care provider (n = 30 729; 56% women and 44% men). We compared women and men for each outcome. Measurements: The primary outcome was prescription of a medication used for sleep within 30 days of a new sleep disorder diagnosis. Additional analysis included medical investigations such as sleep studies and visits to specialists who manage obstructive sleep disorders within 90 days of diagnosis. Results: Among the 30 729 older adults with a new sleep disorder diagnosis, 5512 (17.9% total; 18.8% of women and 16.9% of men) were prescribed a medication used for sleep. Compared with men, women were somewhat more likely to be prescribed at least one sedative medication (adjusted odds ratio = 1.09; 95% confidence interval = 1.03‐1.16). A total of 2573 (8.4%) older adults underwent a sleep study, and 3743 (12.2%) were evaluated by a specialist; both occurred more commonly in men. Conclusion: In our cohort, almost 1 in 5 older adults with a new sleep disorder diagnosis were prescribed a medication used for sleep; of these, a higher proportion were women. Comparatively few older adults were further evaluated; of these, a higher proportion were men. Our study highlights the high rates at which medications are prescribed to older adults with a new sleep disorder diagnosis and identifies potential sex differences in the management of such diagnoses. J Am Geriatr Soc 1–8, 2019. J Am Geriatr Soc 67:2094–2101, 2019 [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Prostate‐specific antigen (PSA) screening can be of low value in older adults. Our objective was to quantify the prevalence and variation of low‐value PSA screening across the Veterans Health Administration (VA), which has instituted programs to reduce low‐value care. DESIGN: Retrospective cohort. SETTING: VA administrative data, 2014 to 2015. PARTICIPANTS: National random sample (N = 214 480) of male veterans, aged 75 years or older. MEASUREMENTS: We defined PSA screening in men aged 75 years or older without a history of prostate cancer as low value, per established definitions in Medicare. We calculated screening rates overall and by VA Medical Center (VAMC), adjusting for patient and VAMC‐level factors. We characterized variation across VAMCs using the adjusted median odds ratio (OR) and compared the adjusted OR of screening between VAMCs in different deciles of low‐value screening rates. In separate sensitivity analyses, we assessed screening in veterans at greatest risk of 1‐year mortality and among veterans after excluding those who underwent prostatectomy, had a prior PSA elevation, or had a clinical indication for testing. RESULTS: Overall, 37 867 (17.7%) of veterans underwent low‐value PSA screening (VAMC range = 3.3%‐38.2%). The adjusted median OR was 1.88, meaning the median odds of screening would increase by 88% were a veteran to transfer his care to a VAMC with higher screening rates. Veterans at VAMCs in the top decile had an adjusted OR of 12.9 (95% confidence interval = 11.0‐15.2) compared to those veterans in the lowest decile. Among veterans with the greatest mortality risk (n = 23 377), 3496 (15.0%) underwent screening (VAMC range = 1.7%‐46.3%). After excluding veterans with a prior prostatectomy, PSA elevation, or a potential clinical indication, 31 556 (14.7%) underwent screening (VAMC range = 2.0%‐49.9%). CONCLUSIONS: In a national cohort of older veterans, more than one in six received low‐value PSA screening, with greater than 10‐fold variation across VAMCs and high rates of screening among those with the greatest mortality risk. J Am Geriatr Soc 67:1922–1927, 2019 [ABSTRACT FROM AUTHOR]

Objectives: To understand how device-measured sedentary behaviour and physical activity are related to all-cause mortality in older men, an age group with high levels of inactivity and sedentary behaviour.Methods: Prospective population-based cohort study of men recruited from 24 UK General Practices in 1978-1980. In 2010-2012, 3137 surviving men were invited to a follow-up, 1655 (aged 71-92 years) agreed. Nurses measured height and weight, men completed health and demographic questionnaires and wore an ActiGraph GT3x accelerometer. All-cause mortality was collected through National Health Service central registers up to 1 June 2016.Results: After median 5.0 years' follow-up, 194 deaths occurred in 1181 men without pre-existing cardiovascular disease. For each additional 30 min in sedentary behaviour, or light physical activity (LIPA), or 10 min in moderate to vigorous physical activity (MVPA), HRs for mortality were 1.17 (95% CI 1.10 to 1.25), 0.83 (95% CI 0.77 to 0.90) and 0.90 (95% CI 0.84 to 0.96), respectively. Adjustments for confounders did not meaningfully change estimates. Only LIPA remained significant on mutual adjustment for all intensities. The HR for accumulating 150 min MVPA/week in sporadic minutes (achieved by 66% of men) was 0.59 (95% CI 0.43 to 0.81) and 0.58 (95% CI 0.33 to 1.00) for accumulating 150 min MVPA/week in bouts lasting ≥10 min (achieved by 16% of men). Sedentary breaks were not associated with mortality.Conclusions: In older men, all activities (of light intensity upwards) were beneficial and accumulation of activity in bouts ≥10 min did not appear important beyond total volume of activity. Findings can inform physical activity guidelines for older adults. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the effect of multi-ingredient nutritional supplementation, with and without exercise training, on cognitive function in healthy older men. Forty-nine sedentary men [age: 73 ± 6 years (mean ± SD); body mass index: 28.5 ± 3.6 kg/m2] were randomized to consume a supplement (SUPP n = 25; 1500 mg n -3 polyunsaturated fatty acids, 30 g whey protein, 2.5 g creatine, 500 IU vitamin D, and 400 mg calcium) or control beverage (CON n = 24; 22 g maltodextrin) twice daily for 20 weeks consisting of Phase 1: SUPP/CON followed by Phase 2: 12-week resistance exercise training plus high-intensity interval training, while continuing to consume the study beverages (SUPP/CON + EX). At baseline, 6 weeks, and 19 weeks we assessed cognitive function [Montréal Cognitive Assessment (MOCA)], memory [word recall during the Rey Auditory Verbal Learning Test (RAVLT)], executive functions (working memory inhibition control), and nutrient bioavailability. We did not observe changes to any aspect of cognitive function after Phase 1; however, significant improvements in the following cognitive function outcomes were detected following Phase 2: MOCA scores increased (6 weeks: 23.5 ± 3.3 vs. 19 weeks: 24.4 ± 2.5, p = 0.013); number of words recalled during the RAVLT increased (6 weeks: 6.6 ± 3.6 vs. 19 weeks: 7.6 ± 3.8, p = 0.047); and reaction time improved (6 weeks: 567 ± 49 ms vs. 19 weeks: 551 ± 51 ms, p = 0.002). Although between-group differences in these outcomes were not significant, we observed within-group improvements in composite cognitive function scores over the course of the entire study only in the SUPP group (Δ = 0.58 ± 0.62, p = 0.004) but not in the CON group (Δ = 0.31 ± 0.61, p = 0.06). We observed a progressive increase in n -3 index, and a concomitant decrease in the ratio of arachidonic acid (ARA) to eicosapentaenoic acid (EPA) within erythrocyte plasma membranes, in the SUPP group only. At week 19, n -3 index (r = 0.49, p = 0.02) and the ARA:EPA ratio (r = -0.44, p = 0.03) were significantly correlated with composite cognitive function scores. Our results show that 12 weeks of RET + HIIT resulted in improved MOCA scores, word recall, and reaction time during an executive functions task; and suggest that a multi-ingredient supplement combined with this exercise training program may improve composite cognitive function scores in older men possibly via supplementation-mediated alterations to n -3 PUFA bioavailability. Clinical Trial Registration : http://www.ClinicalTrials.gov, identifier NCT02281331. [ABSTRACT FROM AUTHOR]

Abstract Primary aneurysmal bone cyst (ABC) is a cystic bone neoplasm characterized by disease-defining gene fusions involving the USP6/Tre2 gene. The literature describing gnathic ABC is limited. This case report describes a 27-year-old man presenting with a long-standing left-sided facial asymmetry. Multi-detector computed tomography imaging demonstrated a large expansile lesion positioned within the left condylar head. The lesion was biopsied and resected. The specimen showed a giant cell-rich cystic neoplasm, with fibrous tissue lined by multinucleated giant cells. Next-generation sequencing confirmed the presence of a USP6-CDH11 fusion gene, consistent with classification as a primary ABC, the first reported to be translocation-positive in the head of the mandibular condyle. [ABSTRACT FROM AUTHOR]

OBJECTIVES To identify sex‐specific associations between risk factors and injurious falls over the short (<4 years) and long (4–10 years) term. DESIGN Longitudinal cohort study between 2001 and 2011. SETTING Swedish National Study on Aging and Care, Kungsholmen, Sweden. PARTICIPANTS Community‐dwelling adults aged 60 and older (N = 3,112). MEASUREMENTS An injurious fall was defined as a fall that required inpatient or outpatient care. Information was collected on participant and exposure characteristics using structured interviews, clinical examinations, and physical function tests at baseline. RESULTS: The multivariate model showed that, in the short term, living alone (hazard ratio (HR)=1.83, 95% confidence interval (CI)=1.13–2.96), dependency in instrumental activities of daily living (IADLs) (HR=2.59, 95% CI=1.73–3.87), and previous falls (HR=1.71, 95% CI=1.08–2.72) were independently associated with injurious falls in women. Low systolic blood pressure (HR=1.96, 95% CI=1.04–3.71), impaired chair stands (HR=3.00, 95% CI=1.52–5.93), and previous falls (HR=2.81, 95% CI=1.32–5.97) were associated with injurious falls in men. Long‐term risk factors were underweight (HR=2.03, 95% CI=1.40–2.95), cognitive impairment (HR=1.49, 95% CI=1.08–2.06), fall‐risk increasing drugs (HR=1.67, 95% CI=1.27–2.20 for ≥2 drugs), and IADL dependency (HR=1.58, 95% CI=1.32–5.97) for women and smoking (HR=1.71, 95% CI=1.03–2.84), heart disease (HR=2.20, 95% CI=1.5–3.24), impaired balance (HR=1.68, 95% CI=1.08–2.62), and a previous fall (HR=3.61, 95% CI=1.98–6.61) for men. CONCLUSION: Men and women have different fall risk profiles, and these differences should be considered when developing preventive strategies. Some risk factors were more strongly predictive of injurious falls over shorter than longer periods and vice versa, suggesting that it may be possible to identify older men and women at short‐ and long‐term risk of injurious falls. J Am Geriatr Soc 67:246–253, 2019. [ABSTRACT FROM AUTHOR]

Background: The age-associated decrease in testosterone is one mechanism suggested to accelerate the aging process in males. Therefore, approaches to increase endogenous testosterone may be of benefit. The aim of this paper was to undertake a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-accordant meta-analysis concerning the effect of exercise on total (TT), bioavailable (bio-T), free (free-T), and salivary (sal-T) testosterone in older males. Methods: Databases were searched up to and including 20th February 2018 for the terms "testosterone AND exercise AND aging AND males," "testosterone AND exercise AND old AND males," "testosterone AND training AND aging AND males," and "testosterone AND training AND old AND males". From 1259 originally identified titles, 22 studies (randomized controlled trials; RCTs; n = 9, and uncontrolled trials; UCTs; n = 13) were included which had a training component, participants ≥60 years of age, and salivary or serum testosterone as an outcome measure. Meta-analyses were conducted on change to testosterone following training using standardized difference in means (SDM) and random effects models. Results: The overall SDM for endurance training, resistance training, and interval training was 0.398 (95% CI = 0.034–0.761; P = 0.010), −0.003 (95% CI = −0.330–0.324; P = 0.986), and 0.283 (95% CI = 0.030–0.535; P = 0.028), respectively. Resistance training exhibited a qualitative effect of hormone fraction whereby free-T resulted in the greatest SDM (0.253; 95% CI = −0.043–0.549; P = 0.094), followed by TT (0.028; 95% CI = −0.204–0.260; P = 0.813), and resistance training negatively influenced bio-T (−0.373; 95% CI = −0.789–0.042; P = 0.078). Due to the small number of studies, subgroup analysis was not possible for endurance training and interval training studies. Conclusions: Data from the present investigation suggests that resistance training does not significantly influence basal testosterone in older men. Magnitude of effect was influenced by hormone fraction, even within the same investigation. Aerobic training and interval training did result in small, significant increases in basal testosterone. The magnitude of effect is small but the existing data are encouraging and may be an avenue for further research. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the relationship between number of falls and risk of injury after a specific fall. Design: Prospective cohort study. Setting: Greater New Haven, Connecticut. Participants: Probability sample of 1,103 community‐living persons aged 72 and older. Measurements: Falls and fall‐related injuries were ascertained monthly for 3 years using a fall calendar and follow‐up telephone interviews. Results: Of 606 participants with a fall, 164 (27.0%) had at least 1 fall with a serious injury, and 455 (75.1%) had at least 1 fall with any injury; mean number of falls was 2.6±2.3 (range 1–18), of falls with serious injury was 0.3±0.6 (range 0–4), and of falls with any injury was 1.4±1.4 (range 0–9). On a per‐participant basis, risk of serious injury and any injury increased progressively as the number of falls increased (P <.001). On a per‐fall basis, risk of serious injury and any injury increased from 1 to 2 falls but then decreased from 2 to 3 or 4 falls and from 3 or 4 to 5 or more falls, although these differences were not statistically significant. The results were consistent for women and men and for analyses that evaluated the proportion of falls with injuries. Conclusion: In community‐living older persons, risk of injury from a specific fall did not differ as the number of falls increased. Falls appear to operate independently in terms of conferring risk of injury in the setting of multiple falls. J Am Geriatr Soc 67:119–123, 2019. [ABSTRACT FROM AUTHOR]

Objectives: Physical function declines with aging and is accelerated for persons with cardiovascular disease (CVD). While CVD increases the risk of functional decline in late life, little is known about differences in trajectories of functional decline. To determine whether there is more than 1 trajectory of functional decline in Americans with cardiovascular disease (CVD) who are functionally independent. Design Secondary analysis of National Health and Aging Trends Study (NHATS). Latent class growth modeling was used to estimate trajectories of function over 4 years of follow‐up. Setting: Annual structured in‐home interviews. Participants: Americans aged 65 and older with CVD who were functionally independent at baseline (N = 392). Measurements We compared trajectories of function in individuals with CVD with trajectories of those without and examined the association between risk factors (sex, age at baseline, education level, comorbidity) and trajectory group membership. Function was measured using the Short Physical Performance Battery. Results: Three functional trajectories emerged: rapid functional decline (23.8%), gradual functional decline (44.2%), and stable function (32.0%). Similar trajectories were seen for those without CVD, with a smaller proportion in the rapid functional decline group (16.2%). Women, older participants, and those with less education and greater comorbidity were less likely to be in the stable function group than the rapid functional decline group. Conclusion: Although function declines in late life for independently functioning persons with CVD, some individuals remain stable, and others decline gradually or rapidly. Persons with CVD were more likely to experience rapid functional decline than those without, suggesting that CVD increases the risk of rapid functional decline. Risk factors predicted functional trajectory group membership, not just overall decline. J Am Geriatr Soc 67:37–42, 2019. [ABSTRACT FROM AUTHOR]

Highlights • Low circulating testosterone is associated with dementia in older men but existing evidence from prospective studies is inconsistent. • Longitudinal, prospective study of 4069 older men followed up for over 10 years. • Risk of dementia increased with decreasing total and calculated free testosterone. • Men in the lowest quartiles of total and calculated free testosterone had increased risk of developing dementia. • The association between low testosterone and dementia is biologically plausible but needs to be confirmed in adequately powered clinical trials. Abstract Background Low circulating testosterone has been associated with dementia in older men but existing evidence from prospective studies is inconsistent. Methods We conducted a prospective longitudinal study of 4069 community-dwelling older men free of dementia aged 71–88 years at baseline. The main objective of the study was to determine if men with low circulating sex hormones were more likely to develop dementia over time. The main biochemical exposures of interest were collected at baseline between 2001 and 2004 and men were assessed for incident dementia via an electronic health records database to the 31 st of December 2013. Results Dementia developed in 499 men over a median of 10.5 years (range 9.4–12.2 years). The risk of developing dementia increased with decreasing total (hazard ratio [HR] 1.14, 95% confidence interval [95%CI] 1.03–1.26 per standard deviation decrease) and calculated free testosterone (HR 1.18, 95%CI 1.06–1.31 per standard deviation decrease) after adjustment for age, baseline cognitive function, depression, body mass, hypertension, cardiovascular disease and total plasma homocysteine. Men in the lowest quartiles of total (adjusted HR 1.39, 95%CI 1.04–1.85) and calculated free testosterone (adjusted HR 1.43, 95%CI 1.08–1.90) had increased risk of developing dementia compared to those in the highest quartiles. Conclusions Lower plasma total and calculated free testosterone were associated with increased risk of developing dementia independent of relevant measured clinical and biochemical factors and was not explained due to differential mortality in those with lower testosterone levels. The association between low testosterone and dementia is biologically plausible but data on the role of testosterone treatment in preventing dementia is lacking and adequately powered trials in men at risk would be welcome. [ABSTRACT FROM AUTHOR]

Background: Bipolar disorder (BD) has been associated with greater health morbidity burden, but it is unclear if this association is affected by age at the time of diagnosis and how this might impact on the use of general hospital services.Methods: Cross-sectional study investigating the prevalence of common medical morbidities among participants with early (EOBD) and late onset diagnosis of BD (LOBD - age at diagnosis ≥ 60 years) derived from a community-representative sample of 37,183 men aged 65-85 years. Cohort study over a follow up period of up to 17.7 years investigating the hazard of general hospital use among older men associated with EOBD and LOBD taking into account age and prevalent medical morbidities.Results: 250 older men had a recorded diagnosis of BD, 75 of whom had LOBD. Diabetes, stroke and diseases of the respiratory and digestive systems were more frequent in men with than without BD. There were no differences in the distribution of medical morbidities between men with EOBD and LOBD. The adjusted hazard ratio (HR) of contact with general hospital services was significantly higher among men with EOBD (HR = 1.33; 95%CI = 1.14, 1.54) and LOBD (HR = 1.27, 95%CI = 1.06, 1.51) compared with older men without BD. Older men with EOBD had the highest number of contacts with general hospital services during follow up, although men with EOBD and LOBD did not differ in the number of contacts due to episodes of mania or depression. The medical reasons for contact with general hospital services of men with EOBD and LOBD overlapped but were not identical.Conclusions: Older men with BD experience greater health morbidity than men without BD. Older men with BD access hospital services for the management of physical morbidities earlier and more frequently than men without BD. Age at the time of diagnosis of BD has limited impact on the risk of contact with general medical services, although subtle differences in the physical morbidity of men with EOBD and LOBD warrant further investigation. [ABSTRACT FROM AUTHOR]

The cardiovascular effects of testosterone (T) are controversial. Low T has been associated with accelerated vascular aging, characterized by large elastic artery stiffening (decreased compliance), intimal-medial thickening (IMT), and endothelial dysfunction. Endurance exercise improves vascular function, but resistance training may increase arterial stiffness. We sought to determine whether T supplementation improved markers of vascular aging in men with low-normal T and whether T supplementation prevented arterial stiffness with resistance exercise. We studied 160 community-dwelling older men (66 ± 5 yr) with low-normal baseline total T levels (200-350 ng/dl). Participants were randomized to transdermal T gel targeting either a lower (400-550 ng/dl) or higher (600-1,000 ng/dl) T range or to placebo gel and to either progressive resistance training (PRT) or to no exercise for 12 mo. Carotid artery stiffness (arterial compliance) and carotid IMT were measured at baseline, 6 mo, and 12 mo. Endothelial function (brachial artery flow-mediated dilation) was measured in a subset (n = 86). Changes in carotid artery compliance, IMT, and endothelial function with either the lower or higher range of T supplementation were not different from placebo at 6 or 12 mo. There were no differences between PRT and no PRT groups, alone or with T supplementation, in changes in any of the vascular measures at either time point. Supplementation of T and PRT in older men with low-normal levels do not appear to improve or harm vascular function. [ABSTRACT FROM AUTHOR]

Optimal treatment of patients with intracranial subocclusive thrombus remains unclear. Such a rare case successfully managed with endovascular mechanical thrombectomy is presented. A 71-year-old man experienced a sudden onset of dysarthria and motor deficits. At the time of admission his National Institutes of Health Stroke Scale (NIHSS) score was 4. DWI demonstrated incomplete infarction within the left lenticulostriate artery (LSA) territory, MRA showed partial flow defect in the distal left M1 segment and non-visualization of the LSA, and ECG revealed atrial fibrillation, thus ischemic stroke caused by cardiogenic embolism was diagnosed. Tissue plasminogen activator was administered, but symptoms progressed and NIHSS score increased up to 8. Diagnostic angiogrpahy confirmed presence of the subocclusive thrombus within the distal left M1 segment and complete occlusion of LSA at its origin. Since conservative therapy was ineffective, mechanical thrombectomy utilizing ADAPT (a direct aspiration first-pass thrombectomy) technique was performed resulting in compete recanalization of the LSA accompanied by the prompt regress of neurological symptoms. Eventally, the patient demonstrated nearly full recovery (modified Rankin Scale score 1). Thus, mechanical thrombectomy should be considered as a reasonable option in cases of acute cerebral stroke caused by subocclusive thrombus and progressive neurological deficits despite standard conservative therapy. [ABSTRACT FROM AUTHOR]

A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis. These characteristics refer to the purple urine bag syndrome, a not well-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective: To examine rest–activity circadian rhythm (RAR) and cognitive decline in older men. Design: Longitudinal. Setting: Osteoporotic Fractures in Men (MrOS) and ancillary Outcomes of Sleep Disorders in Men (MrOS Sleep) studies. Participants: MrOS and MrOS Sleep participants (N=2,754; mean age 76.0 ± 5.3). Measurements: The Modified Mini‐Mental State examination (3MS) was used to assess cognition at baseline (2003–05) and follow‐up examinations (2005–06 and 2007–09). Wrist actigraphy was used to measure 24‐hour activity counts at baseline. RAR variables included amplitude (strength of activity rhythm), mesor (mean activity level), pseudo F‐statistic (overall circadian rhythm robustness), and acrophase (time of daily peak activity). Results: After an average of 3.4 ± 0.5 years, men with lower amplitudes, mesors, and pseudo F‐statistics had greater decline in 3MS performance (amplitude: –0.7 points Q1 vs –0.5 points Q4, p<.001; mesor: –0.5 points Q1 vs –0.2 points Q4, p=.01; pseudo F‐statistic: –0.5 points Q1 vs –0.3 points Q4, p<.001). Lower amplitudes and pseudo‐F statistics were associated with greater odds of clinically significant cognitive decline (≥5‐point decrease) (amplitude Q1 vs. Q4: odds ratio (OR)=1.4, 95% confidence interval (CI)=1.0–1.9; pseudo‐F statistic Q1 vs Q4: OR=1.4, 95% CI=1.0–1.9). Men with phase‐advanced acrophase had greater odds of clinically significant cognitive decline (OR=1.8, 95% CI=1.2–2.8). Results were adjusted for multiple confounders. Conclusion: Several parameters of disrupted RAR (lower amplitude, pseudo F‐statistic, mesor, phase‐advanced acrophase) were associated with greater cognitive decline in older community‐dwelling men. These findings contribute to a growing body of evidence suggesting that altered RARs are associated with cognitive decline in older adults. J Am Geriatr Soc 66:2136–2143, 2018. [ABSTRACT FROM AUTHOR]

Objective: This study evaluates molecular, nutritional and biochemical alterations in human intervertebral discs between middle and old age. Methods: Twenty-eight human lumbar intervertebral discs from donors were evaluated and separated into two groups: Middle-aged (35–50 years old, relatively non-degenerate discs of Pfirrmann grades 1–3, n = 15) and Old-aged (≥80 years old, all degenerate Pfirrmann grade 4 or 5, n = 13). Parameters which might be expected to to be related to nutrient supply and so the health of disc cells (eg the porosity of the vertebral endplate, cell viability and cell density) and to disc extracellular composition (ie quantification of glycosaminoglycan disaccharides and hyaluronic acid molecular weight) and collagen organization, were analyzed. Three regions of the intervertebral disc (anterior annulus fibrosus, nucleus pulposus, and posterior annulus fibrosus) were examined. Results: The old-aged group showed a decrease in content of sulphated and non-sulphated glycosaminoglycans relative to middle-aged and there were also alterations in the proportion of GAG disaccharides and a decrease of collagen fiber size. Hyaluronic acid molecular weight was around 200 kDa in all regions and ages studied. The anterior annulus differed from the posterior annulus particularly in relation to cell density and GAG content. Additionally, there were changes in the bony endplate, with fewer openings observed in the caudal than cranial endplates of all discs in both groups. Conclusions: Results show the cranial vertebral endplate is the main vascular source for the intervertebral discs. Hylauronic acid molecular weight is the same through the intervertebral disc after age of 50 years. [ABSTRACT FROM AUTHOR]

This is a case report of Demodex folliculorum of the forehead, scalp, and face of a 64-year-old male farmer from Sudan presenting with pruritic papular and erythematous skin lesions for 6-months. Demodex infestation of the hair follicles is precipitated by poor self-hygiene and accumulation of excess sebum and skin debris. The treatment entails topical macadamia nuts oil or oral ivermectin in severe cases. [ABSTRACT FROM AUTHOR]

Biomechanical and neurophysiological mechanisms of age-related gait dysfunction have not been fully understood. We aimed to investigate the relationship between region-specific electromyography (EMG) response of the rectus femoris (RF) muscle and lower extremity kinematics during swing phase of gait for the elderly. For thirteen elderly men (age: mean 71.3 years, standard deviation 5.7 years), multi-channel surface EMG from the proximal to distal regions of the RF muscle and lower extremity kinematics were measured during normal gait on a treadmill. At minimum foot clearance during swing phase, relationship between central locus activation (CLA), which is indicator of spatial distribution of surface EMG along the RF muscle and lower joint kinematics were calculated. No significant correlations were found between CLA and any joint angle (p > 0.05). The results of our study suggested that regional neuromuscular activation of the RF muscle is not associated to lower extremity joint movements and toe clearance strategy during gait in the elderly. [ABSTRACT FROM AUTHOR]

Background Mosaic loss of chromosome Y (mLOY) can occur in a fraction of cells as men age, which is potentially linked to increased mortality risk. Smoking is related to mLOY; however, the contribution of air pollution is unclear. Objective We investigated whether exposure to outdoor air pollution, age, and smoking were associated with mLOY. Methods We analyzed baseline (1989–1993) blood samples from 933 men ≥65 years of age from the prospective Cardiovascular Health Study. Particulate matter ≤10 μm (PM 10 ), carbon monoxide, nitrogen dioxide, sulfur dioxide, and ozone data were obtained from the U.S. EPA Aerometric Information Retrieval System for the year prior to baseline. Inverse-distance weighted air monitor data were used to estimate each participants' monthly residential exposure. mLOY was detected with standard methods using signal intensity (median log-R ratio (mLRR)) of the male-specific chromosome Y regions from Illumina array data. Linear regression models were used to evaluate relations between mean exposure in the prior year, age, smoking and continuous mLRR. Results Increased PM 10 was associated with mLOY, namely decreased mLRR (p-trend = 0.03). Compared with the lowest tertile (≤28.5 μg/m 3 ), the middle (28.5–31.0 μg/m 3 ; β = −0.0044, p  = 0.09) and highest (≥31 μg/m 3 ; β = −0.0054, p  = 0.04) tertiles had decreased mLRR, adjusted for age, clinic, race/cohort, smoking status and pack-years. Additionally, increasing age (β = −0.00035, p  = 0.06) and smoking pack-years (β = −0.00011, p  = 1.4E−3) were associated with decreased mLRR, adjusted for each other and race/cohort. No significant associations were found for other pollutants. Conclusions PM 10 may increase leukocyte mLOY, a marker of genomic instability. The sample size was modest and replication is warranted. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the association between four specific forms of hardship (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) and self-rated health among older men and women.Methods: Cross-sectional logistic regression analysis was conducted using the 2010 wave of the Health and Retirement Study Leave-Behind Questionnaire (N = 7619) to determine the association between four hardship indicators and self-rated health. Hardship indicators (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) were dichotomized (0 = no hardship, 1 = yes hardship) for this analysis.Results: After adjusting for sociodemographic factors, participants reporting difficulty paying bills had an 1.8 higher odds of reporting poor self-rated health (95% confidence intervals [CI]: 1.57, 2.15) and those reporting taking less medication due to cost had a 2.5 times higher odds of poor self-rated health (95% CI: 1.97, 3.09) compared to those not reporting these hardships. When stratified by gender, and adjusting for sociodemographic factors, men who took less medication due to cost had a 1.93 higher odds of low self-rated health (95% CI: 1.39, 2.67) and women who took less medications due to cost had a 2.9 higher odds of reporting poor self-rated health (95% CI: 2.23, 2.70) compared to women not reporting these hardships.Conclusions: Research in this area can provide greater conceptual and measurement clarity on the hardship experience and further elucidate the pathway between specific hardships and poor health outcomes to inform intervention development. [ABSTRACT FROM AUTHOR]

We assessed if a 17-item score capturing adherence to a traditional Mediterranean diet (MedDiet) was associated with better health-related quality of life among older Spanish men and women with overweight or obesity harboring the metabolic syndrome. We analyzed baseline data from 6430 men and women (age 55–70 years) participating in the PREDIMED-Plus study. PREDIMED-Plus is a multi-centre randomized trial testing an energy-restricted MedDiet combined with promotion of physical activity and behavioral therapy for primary cardiovascular prevention compared to a MedDiet alone. Participants answered a 36-item questionnaire about health-related quality of life (HRQoL) and a 17-item questionnaire that assessed adherence to an MedDiet. We used ANCOVA and multivariable-adjusted linear regression models to compare baseline adjusted means of the quality of life scales according to categories of adherence to the MedDiet. Higher adherence to the MedDiet was independently associated with significantly better scores in the eight dimensions of HRQoL. Adjusted differences of > = 3 points between the highest and the lowest dietary adherence groups to the MedDiet were observed for vitality, emotional role, and mental health and of > = 2 points for the other dimensions. In conclusion, this study shows a positive association between adherence to a MedDiet and several dimensions of quality of life. [ABSTRACT FROM AUTHOR]