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Elderly Individuals (elderly + individual)
Selected AbstractsFUNCTIONAL DENTAL OCCLUSION MAY PREVENT FALLS IN ELDERLY INDIVIDUALS WITH DEMENTIAJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2005Mitsuyoshi Yoshida DDS No abstract is available for this article. [source] Caveolae-mediated entry of Salmonella typhimurium into senescent nonphagocytotic host cellsAGING CELL, Issue 2 2010Jae Sung Lim Summary Elderly individuals have an increased susceptibility to microbial infections because of age-related anatomical, physiological, and environmental factors. However, the mechanism of aging-dependent susceptibility to infection is not fully understood. Here, we found that caveolae-dependent endocytosis is elevated in senescent cells. Thus, we focused on the implications of caveolae-dependent endocytosis using Salmonella typhimurium, which causes a variety of diseases in humans and animals by invading the eukaryotic host cell. Salmonella invasion increased in nonphagocytotic senescent host cells in which caveolin-1 was also increased. When caveolae structures were disrupted by methyl-,-cyclodextrin or siRNA of caveolin-1 in the senescent cells, Salmonellae invasion was reduced markedly compared to that in nonsenescent cells. In contrast, the over-expression of caveolin-1 led to increased Salmonellae invasion in nonsenescent cells. Moreover, in aged mice, caveolin-1 was found to be highly expressed in Peyer's patch and spleen, which are targets for infection by Salmonellae. These results suggest that high levels of caveolae and caveolin-1 in senescent host cells might be related to the increased susceptibility of elderly individuals to microbial infections. [source] Solitary subependymal giant cell astrocytoma incidentally found at autopsy in an elderly woman without tuberous sclerosis complexNEUROPATHOLOGY, Issue 2 2009Hidehiro Takei Subependymal giant cell astrocytoma (SEGA) is a benign, slowly growing tumor typically occurring in the setting of tuberous sclerosis complex (TSC). However there are several reported cases in which patients with a solitary SEGA had no other stigmata of TSC. We describe a case of SEGA in a 75-year-old woman representing the oldest patient reported to-date. The patient had a history of radical vulvectomy for malignant melanoma (MM), and died of autopsy-confirmed widespread systemic metastasis. Postmortem examination of the brain revealed a single 2.1 × 1.0 × 0.8 cm intraventricular nodule in the lateral ventricle. Histologically, it was composed of interlacing bundles of spindle-shaped tumor cells with thin delicate processes admixed with relatively large pleomorphic cells with abundant glassy eosinophilic cytoplasm, as seen in a SEGA. Immunohistochemically, GFAP, S-100 protein, and neuron specific enolase were positive, and synaptophysin labeled a few tumor cells. Also noted were rare isolated MM cells within the tumor (i.e., tumor-to-tumor metastasis). Autopsy showed no manifestations of TSC systemically or intracranially. The histopathological differential diagnosis was limited and included giant cell ependymoma and, much less likely, giant cell glioblastoma and pleomorphic xanthoastrocytoma. This case illustrates that SEGA can be found incidentally in an elderly individual with no associated symptoms and also indicates that SEGA can occur outside the setting of TSC. Tumor metastasis to an occult SEGA is extremely rare. [source] Pilomatrix Carcinoma of the Back Treated by Mohs Micrographic SurgeryDERMATOLOGIC SURGERY, Issue 8 2004David Sable MD Background. Pilomatrix carcinoma (synonyms, matrical carcinoma or malignant pilomatrixoma) is a rare malignant neoplasm derived from the hair matrix first described in 1980. This neoplasm can exhibit local aggressive behavior and distant metastasis. Most pilomatrix carcinomas occur on the head and neck of elderly individuals with a predilection for males (M:F 5:1). Pilomatrix carcinoma is often clinically misdiagnosed as a sebaceous cyst and histologic difficulty can occur in differentiating this entity from the benign entity pilomatrixoma. Objective. The objective was to describe a case of pilomatrix carcinoma encountered in a Mohs micrographic surgery practice. We present the first case of this lesion treated by Mohs surgery. Methods. A case report and literature review are presented. Conclusion. Pilomatrix carcinoma is a rare malignant variant of pilomatrixoma. Given the rarity of this lesion there are no well-defined standards for surgical management. Wide local excision has been recommended given the high rate of reoccurrence. Mohs micrographic surgery may provide optimal treatment of this neoplasm given the ability to have 100% margin control. [source] Cerebrospinal fluid biomarkers of white matter lesions , cross-sectional results from the LADIS studyEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2010M. Jonsson Background and purpose:, White matter lesions (WMLs) caused by small vessel disease are common in elderly people and contribute to cognitive impairment. There are no established biochemical markers for WMLs. We aimed to study the relation between degree of WMLs rated on magnetic resonance imaging of the brain and cerebrospinal fluid (CSF) levels of structural biomarkers associated with Alzheimer's disease (AD) and subcortical vascular dementia. Methods:, Fifty-three non-demented elderly individuals with WMLs were subjected to lumbar puncture. Degree of WMLs was rated using the Fazekas scale. Volumetric assessment of WMLs was performed. CSF samples were analyzed for the 40 and 42 amino acid fragments of amyloid ,, ,- and ,-cleaved soluble amyloid precursor protein, total tau (T-tau), hyperphosphorylated tau (P-tau181), neurofilament light protein (NFL), sulfatide and CSF/Serum-albumin ratio. Results:, Fifteen subjects had mild, 23 had moderate and 15 had severe degree of WMLs. CSF-NFL levels differed between the groups (P < 0.001) and correlated with the volume of WMLs (r = 0.477, P < 0.001). CSF sulfatide concentration displayed similar changes but less strongly. T-tau, P-tau181 and the different amyloid markers as well as CSF/S-albumin ratio did not differ significantly between the groups. Conclusions:, The association of increased CSF-NFL levels with increasing severity of WMLs in non-demented subjects suggests that NFL is a marker for axonal damage in response to small vessel disease in the brain. This manifestation may be distinct from or earlier than the neurodegenerative process seen in AD, as reflected by the lack of association between WMLs and AD biomarkers. [source] Event-related delta oscillatory responses of Alzheimer patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2008G. Yener Background and purpose:, Alzheimer type of dementia (AD) is the most common neuropsychiatric morbidity in elderly individuals. Event-related oscillations (ERO) provide an useful tool for detecting subtle abnormalities of cognitive processes with high temporal resolution. Methods:, In the present report, event-related oscillations of patients with AD were analyzed by using a visual oddball paradigm. A total of 22 mild probable AD subjects according to NINCDS-ADRDA criteria and 20 age-, gender-, and education-matched healthy control subjects were compared. AD group consisted from 11 untreated patients and 11 patients treated with cholinesterase inhibitor. Oscillatory responses were recorded from 13 scalp electrodes. Results:, Significant differences in delta frequency range were seen between the groups by using repeated measures of anova analysis [F(9.120) = 2.228; P = 0.022]. Post-hoc analyses using Wilcoxon test showed that at mid- and left central regions, (Cz, C3) peak amplitudes of delta responses of healthy subjects were significantly higher than either group. Also cholinesterase inhibitors did not have effect on delta oscillatory responses. Conclusions:, Our findings imply that the delta oscillatory responses at central locations are highly instable in mild probable AD patients regardless of treatment when compared to the healthy aged controls. This study supports the importance of oscillatory event-related potentials for investigating AD brain dynamics. [source] Preferences for CAM or conventional medicine in elderly individualsFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2007A Büssing [source] Tai Chi improves balance in elderly individualsFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2 2002Article first published online: 14 JUN 2010 [source] Effects of group work programs on community-dwelling elderly people with age-associated cognitive decline and/or mild depressive moods: A Kahoku Longitudinal Aging StudyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2005Kiyohito Okumiya Background: Age-associated cognitive decline (AACD) is a predictor of dementia and highly prevalent among elderly people. Many elderly people with AACD also suffer from depressive moods. We studied, the effect of group work programs on the cognitive function and quality of life (QOL) of community-dwelling elderly people with AACD and/or mild depressive moods. Methods: Thirty-six subjects, with a mean age of 79.8 years, were included in this study. Twenty-one suffered from both AACD and mild depressive moods, nine suffered from mild depressive moods and six from AACD. Subjects were required to participate in a number of group work programs, such as music therapy, handicrafts and so on. They were assigned to one of two groups, and each participated in two 4-month sessions. In the first session, group 1 participated in the group work programs, while group 2 did not (control). In the second session, group 2 participated while group 1 did not. The effect of group work on elderly people with AACD (n = 27) and depressive moods (n = 31), was evaluated separately. Results: Improvement was observed in depressive moods and QOL (visual analogue scale of family relation, friendship and happiness, life satisfaction index) in subjects with cognitive impairment and depressive moods. The effect on cognitive function was shown only in elderly individuals suffering from depressive moods. The improvement in depressive moods and QOL seemed to be accompanied by an improvement in cognitive function but did not continue after completion of the group work program. Conclusion: Group work was shown to improve depressive moods, QOL and cognitive function; however, long-term effects require further examination. [source] Evaluation of the clinical efficacy of a mouthwash and oral gel containing the antimicrobial proteins lactoperoxidase, lysozyme and lactoferrin in elderly patients with dry mouth , a pilot studyGERODONTOLOGY, Issue 1 2008Jose Antonio Gil-Montoya Objectives:, To evaluate the clinical efficacy of a mouthwash and oral gel containing the antimicrobial proteins lactoperoxidase, lactoferrin and lysozyme, in a sample of elderly individuals with dry mouth. Material and methods:, Twenty elderly institutionalised subjects with dry mouth and with a certain degree of independence for daily life activities were included in this pilot study. A randomised, double blind and cross-over design was used. The study variables comprised subjective dry mouth sensation, the severity of discomfort assessed by means of a visual analogical scale (VAS), the Oral Health Impact Profile (OHIP), the presence of signs and symptoms of dry mouth, sialometry and Candida albicans culture. All the variables were recorded before and after each of the two periods of the study. Results:, The 20 selected subjects we made up of 16 women and four men, with a mean age of 81.3 years. Improvement was observed on analysing the data between the first and second intervention period in terms of the OHIP values, the presence of dry mouth, and the need to drink fluids to swallow. However, the improvement in certain variables before and after treatment did not take a positive course in all cases, and some subjects even improved with placebo. Conclusions:, The evaluated mouthwash and oral gel improved some subjective and clinical aspects in elderly individuals with dry mouth, though a placebo effect cannot be entirely discarded. [source] Common CX3CR1 Alleles Are Associated With a Reduced Risk of HeadachesHEADACHE, Issue 7 2008Christophe Combadičre PhD Objectives., The aim of this study was to investigate the role of the chemokine receptor CX3CR1 in headaches and migraine. Methods., Distribution of 2 polymorphisms of the chemokine receptor CX3CR1 (V249I and T280M) was determined in a population-based sample of 1179 elderly individuals. Results., Heterozygotes for both CX3CR1 polymorphisms had a reduced risk of recurrent headaches, with an odds ratio (OR) of 0.64 (95% confidence interval [CI] = 0.46-0.90) for the I249 allele and 0.55 (95% CI = 0.38-0.81) for the M280 allele. Haplotype analysis showed that carriers of the rarer CX3CR1 I249-M280 haplotype had a reduced risk of recurrent headaches, with an OR of 0.57 (95% CI = 0.41-0.80, P = .001). This association was seen for both nonmigraine headaches (OR = 0.47, 95% CI = 0.28-0.79, P = .004) and migraine (OR = 0.65, 95% CI = 0.43-0.98, P = .041). Conclusions., These results need to be replicated but suggest that the chemokine receptor CX3CR1 may play a role in recurrent headaches. [source] Clinical Pharmacokinetics of FrovatriptanHEADACHE, Issue 2002P. Buchan PhD Objective.,To review available data on the clinical pharmacokinetics of frovatriptan. Background.,Preclinical data suggest that the pharmacokinetic profile of frovatriptan may differ from that of the currently available triptans. Methods.,Studies of healthy volunteers, subjects with renal or hepatic impairment, elderly subjects, and patients with migraine during and between attacks were reviewed. Results.,Oral bioavailability of frovatriptan is 22% to 30%, and although the time to maximum concentration is typically 2 to 3 hours, approximately 60% to 70% of plasma maximum concentration is achieved within 1 hour of dosing. Frovatriptan distributes into erythrocytes, with binding reversible and time dependent. The relatively long terminal elimination half-life (about 26 hours) confers good systemic exposure and may produce a long duration of therapeutic action, thus reducing migraine recurrence and the need for redosing. Systemic exposure to frovatriptan generally correlates with dose between 1 and 100 mg. Blood and plasma frovatriptan concentrations are consistently higher in females, but there is no need to adjust dose according to gender. Pharmacokinetics are essentially unaffected by food and were predictable after repeat dosing; steady state is approached in about 4 to 5 days. Pharmacokinetics were changed only slightly in subjects with renal impairment or mild-to-moderate hepatic impairment, elderly individuals, and during migraine attacks. Frovatriptan is principally metabolized by the CYP1A2 isoenzyme of cytochrome P-450 and is cleared by the kidney and liver, each having sufficient capacity to compensate for impairment of the other. Conclusions.,Frovatriptan can be taken without regard for food intake, and because of the large therapeutic margin and shallow dose-response curve, there is no need for dosage adjustment in the elderly, in women taking a combined oral contraceptive, in patients with mild-to-severe renal impairment, mild-to-moderate hepatic impairment, or according to gender. The long duration of exposure may reduce the likelihood of early migraine recurrence. [source] State motor vehicle laws and older driversHEALTH ECONOMICS, Issue 4 2005Michael A. Morrisey Abstract After teenage males, elderly individuals have the highest per capita motor vehicle fatality rate in the United States. Surprisingly, there has been only limited work examining the effect of state motor vehicle laws on older driver fatalities. This paper uses state-level data from the 1985,2000 Fatality Analysis Reporting System to examine the effects of changes in state laws dealing with license renewal, seatbelt use, speed limits, and driving while intoxicated on fatalities among drivers and others aged 65 and over. Negative binomial regressions are estimated using alternatively state and year fixed effects, or age and year fixed effects. In-person license renewal reduced fatalities among the oldest drivers, but vision tests, road tests and the length of the license renewal cycle generally did not. In terms of policies that apply to all drivers, seatbelt laws, particularly with primary enforcement, were generally the only policies that reduced older driver fatalities. These results are noteworthy because a number of policies that have been effective towards increasing younger driver safety are not relevant for older drivers, implying that policymakers must think broadly about using state laws to improve older driver safety. Copyright © 2004 John Wiley & Sons, Ltd. [source] The psychosocial spiritual experience of elderly individuals recovering from stroke: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2008Marianne Lamb RN Abstract Objectives, The objective of this review was to appraise and synthesise best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. Inclusion criteria, This review considered qualitative studies whose participants were adults, mean age of 65 years and older, and who had experienced a minimum of one stroke. Studies were included that described the participant's own experience of recovering from stroke. Search strategy, The search strategy sought to find both published and unpublished studies and papers, not limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Methodological quality, Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the Qualitative Assessment and Review Instrument (QARI) developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data collection, Information was extracted from each paper independently by two reviewers using the data extraction tool from QARI developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data synthesis, Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the selected population's experience during their recovery from stroke. Results, A total of 35 studies were identified and of those 27 studies were included in the review. These qualitative studies examined the perceptions of elderly individuals who had experienced a stroke. Findings were analysed using JBI-QARI. The process of meta-synthesis using this program involved categorising findings and developing synthesised topics from the categories. Four syntheses were developed related to the perceptions and experiences of stroke survivors: sudden unexpected event, connectedness, reconstruction of life and life-altering event. Conclusion, The onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery. The experience of stroke is a life-altering one for most elderly individuals, involving profound changes in functioning and sense of self. [source] Evaluating cognition in an elderly cohort via telephone assessmentINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2010Effie M. Mitsis Abstract Objective Longitudinal neuropsychological assessment provides the opportunity to observe the earliest transition to cognitive impairment in healthy, elderly individuals. We examined the feasibility, and its comparability to in-person assessment, of a telephone administered battery of established neuropsychological measures of cognitive functioning in healthy, elderly women. Methods Fifty-four women (age,=,79,±,7.7; education,=,15.4,±,3.3) who were in self-reported good health were recruited from senior centers and other community sources. A two-way cross-over design was used in which participants were randomly assigned to receive either (1) in-person neuropsychological assessment followed by telephone assessment and (2) telephone assessment followed by in-person assessment, separated by approximately 4 weeks. Linear regression models were used to determine whether there were performance differences by method (in-person vs. telephone), and equivalence testing assessed comparability of the two methods. Results There were no statistically significant differences in performance between in-person and telephone assessments on most neuropsychological tests, with the exception of digit span backward, Oral Trail Making Test Part A, and delayed recall on the SRT, the latter likely related to non-comparable exposure (6-trials in-person vs. 3-trials telephone). Equivalence testing differences fell in the pre-specified clinical equivalence zones, providing evidence of comparability of the two methods. Conclusions These pilot data support telephone administration of a neuropsychological battery that yields comparable performance to in-person assessment with respect to most instruments. Significant differences in scores on some measures suggest care should be taken in selecting specific measures used in a neuropsychological battery administered by telephone. Copyright © 2009 John Wiley & Sons, Ltd. [source] The incidence of first-onset psychotic symptoms and paranoid ideation in a representative population sample followed from age 70,90 years.INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2007Relation to mortality, later development of dementia Abstract Background Limited data are available on the incidence of psychotic symptoms in the elderly. Objective To elucidate the incidence of first-onset psychotic symptoms in the elderly and their relation to mortality and later development of dementia. Method A population-sample (n,=,392) born 1901,1902 was assessed from age 70,90 with psychiatric examinations, medical record reviews and from age 85, also with key-informant interviews. Individuals developing dementia were excluded. Result The cumulative incidence of first-onset psychotic symptoms was 4.8% (8.0% including key-informant reports in the total sample) and 19.8 % in those who survived to age 85. Sixty-four percent of those with first-onset hallucinations later developed dementia, compared to 30% of those with delusions and 25% of those without psychotic symptoms. Conclusions One fifth of non-demented elderly who survives up to age 85 develops first-onset psychotic symptoms. Hallucinations predict dementia, but most elderly individuals with first-onset psychotic symptoms do not develop dementia. Copyright © 2006 John Wiley & Sons, Ltd. [source] Serum Calcium and Cognitive Function in Old AgeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007Miranda T. Schram PhD OBJECTIVES: To determine whether serum calcium is associated with cognitive function in elderly individuals in the general population. DESIGN: Prospective follow-up study of two independent, population-based cohorts. SETTING: The Rotterdam Study (median follow-up 11 years) and the Leiden 85-plus Study (median follow-up 5 years). PARTICIPANTS: Three thousand nine hundred ninety-four individuals, mean age 71, from the Rotterdam Study and 560 individuals, all aged 85, from the Leiden 85-plus Study. MEASUREMENTS: Global cognitive function was assessed in both cohorts using the Mini-Mental State Examination; attention, psychomotor speed, and memory function were assessed in the Leiden 85-plus Study only. Linear regression and linear mixed models were used for statistical analyses. RESULTS: In the Rotterdam Study, high serum calcium was associated with worse global cognitive function at baseline (P<.05) and a faster rate of decline in cognitive function during follow-up (P=.005) in individuals aged 75 and older but not in younger individuals. In the Leiden 85-plus Study, high serum calcium was associated with worse global cognitive function from age 85 through 90 (P<.001). This observation also held for the specific cognitive domains tested (all P<.01). These results did not change when individuals with serum calcium levels greater than normal (>2.55 mmol/L) were excluded from the analyses. CONCLUSION: In the general population, high serum calcium levels are associated with faster decline in cognitive function over the age of 75. [source] Effect of Gender on Communication of Health Information to Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2006Jennifer L. Dearborn BA OBJECTIVES: To examine the effect of gender on three key elements of communication with elderly individuals: effectiveness of the communication, perceived relevance to the individual, and effect of gender-stereotyped content. DESIGN: Survey. SETTING: University of Connecticut Health Center. PARTICIPANTS: Thirty-three subjects (17 female); aged 69 to 91 (mean±standard deviation 82±5.4). MEASUREMENTS: Older adults listened to 16 brief narratives randomized in order and by the sex of the speaker (Narrator Voice). Effectiveness was measured according to ability to identify key features (Risks), and subjects were asked to rate the relevance (Plausibility). Number of Risks detected and determinations of plausibility were analyzed according to Subject Gender and Narrator Voice. Narratives were written for either sex or included male or female bias (Neutral or Stereotyped). RESULTS: Female subjects identified a significantly higher number of Risks across all narratives (P=.01). Subjects perceived a significantly higher number of Risks with a female Narrator Voice (P=.03). A significant Voice-by-Stereotype interaction was present for female-stereotyped narratives (P=.009). In narratives rated as Plausible, subjects detected more Risks (P=.02). CONCLUSION: Subject Gender influenced communication effectiveness. A female speaker resulted in identification of more Risks for subjects of both sexes, particularly for Stereotyped narratives. There was no significant effect of matching Subject Gender and Narrator Voice. This study suggests that the sex of the speaker influences the effectiveness of communication with older adults. These findings should motivate future research into the means by which medical providers can improve communication with their patients. [source] Simplifying Detection of Cognitive Impairment: Comparison of the Mini-Cog and Mini-Mental State Examination in a Multiethnic SampleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005Soo Borson MD Objectives: To compare detection of cognitive impairment using the Mini-Cog and Mini-Mental State Examination (MMSE) and to identify sociodemographic variables that influence detection in an ethnoculturally diverse sample. Design: Cross-sectional. Setting: A registry of the University of Washington Alzheimer's Disease Research Center Satellite. Participants: A heterogeneous community sample (n=371) of predominantly ethnic minority elderly assessed using a standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). Measurements: Demographic data, a standardized research protocol for cognitive assessment and dementia diagnosis, MMSE, and Mini-Cog. Results: Both screens effectively detected cognitive impairment, the Mini-Cog slightly better than the MMSE (P<.01). Overall accuracy of classification was 83% for the Mini-Cog and 81% for the MMSE. The Mini-Cog was superior in recognizing patients with Alzheimer-type dementias (P=.05). Low education negatively affected detection using the MMSE (P<.001), whereas education did not affect the Mini-Cog, and low literacy minimally affected it. Conclusion: The Mini-Cog detects clinically significant cognitive impairment as well as or better than the MMSE in multiethnic elderly individuals, is easier to administer to non-English speakers, and is less biased by low education and literacy. [source] Prospective Association Between Low and High Total and Low-Density Lipoprotein Cholesterol and Coronary Heart Disease in Elderly MenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2004J. David Curb MD Objectives: To examine the relationship between total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and the incidence of coronary heart disease (CHD) in elderly men. Design: Prospective. Setting: Population based. Participants: A sample of 2,424, Japanese-American men aged 71 to 93 was used. Measurements: Six years of data on incident fatal plus nonfatal CHD were examined. Results: Analysis revealed a significant U-shaped relationship between age-adjusted CHD rates and both TC and LDL-C. The ranges of TC and LDL-C with the lowest risk of CHD were 200 to 219 mg/dL and 120 to 139 mg/dL, respectively. As cholesterol concentrations declined and increased beyond these ranges, the risk of CHD increased. These U-shaped relationships remained significant after adjusting for age and other risk factors. Conclusion: The U-shaped associations between TC and LDL-C and CHD imply a complex relationship between lipids and CHD in late life. The results indicate that elevated lipid levels should continue to be treated in healthy elderly individuals, as they are in those who are younger, although pharmacologically lowering lipids to excessively low levels in the elderly may warrant further study, as does the contribution of subclinical frailty to the relationship of lipids to CHD risk. [source] Differences in End-of-Life Preferences Between Congestive Heart Failure and Dementia in a Medical House Calls ProgramJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2004Ziad R. Haydar MD Objectives: To compare end-of-life preferences in elderly individuals with dementia and congestive heart failure (CHF). Design: Retrospective case-control study. Setting: Geriatrician-led interdisciplinary house-call program using an electronic medical record. Participants: Homebound individuals who died while under the care of the house-call program from October 1996 to April 2001. Measurements: Medical records review for demographics, functional status, advance medical planning, hospice use, and place of death. Results: Of 172 patients who died in the program, 29 had CHF, 79 had dementia, 34 had both, and 30 had neither. Patients with CHF were younger (82.6 vs 87.0, P=.011) and less functionally dependent (activities of daily living score 9.1 vs 11.5, P=.001). Time from enrollment to death was not significantly different (mean±standard deviation=444±375 days for CHF vs 325±330 days for dementia, P=.113). A do-not-resuscitate (DNR) directive was given in 62% of patients with CHF and 91% with dementia (P<.001). Advance medical planning discussions were not significantly different (2.10 in CHF vs 1.65 in dementia, P=.100). More patients with CHF participated in their advance medical planning than those with dementia (86% vs 17%, P<.001). Hospice was used in 24% of CHF and 61% of dementia cases (P<.001). Finally, 45% of patients with CHF and 18% of patients with dementia died in the acute hospital (P=.006). Multivariate analysis showed that the fact that more patients with CHF were involved in their medical planning was not significant in predicting end-of-life preferences. Alternatively, Caucasian ethnicity was an independent predictor of having a documented DNR and death outside of the acute hospital. Conclusion: In the months before death, patients with CHF were more likely to have care plans directed at disease modification and treatment, whereas dementia patients were more likely to have care plans that focused on symptom relief and anticipation of dying. Several factors may contribute to this difference. [source] An immunohistochemical study of the triangular fibrocartilage complex of the wrist: regional variations in cartilage phenotypeJOURNAL OF ANATOMY, Issue 1 2007S. Milz Abstract The triangular fibrocartilage complex (TFCC) transmits load from the wrist to the ulna and stabilizes the distal radioulnar joint. Damage to it is a major cause of wrist pain. Although its basic structure is well established, little is known of its molecular composition. We have analysed the immunohistochemical labelling pattern of the extracellular matrix of the articular disc and the meniscal homologue of the TFCC in nine elderly individuals (age range 69,96 years), using a panel of monoclonal antibodies directed against collagens, glycosaminoglycans, proteoglycans and cartilage oligomeric matrix protein (COMP). Although many of the molecules (types I, III and VI collagen, chondroitin 4 sulphate, dermatan sulphate and keratan sulphate, the oversulphated epitope of chondroitin 6 sulphate, versican and COMP) were found in all parts of the TFCC, aggrecan, link protein and type II collagen were restricted to the articular disc and to entheses. They were thus not a feature of the meniscal homologue. The shift in tissue phenotype within the TFCC, from a fibrocartilaginous articular disc to a more fibrous meniscal homologue, correlates with biomechanical data suggesting that the radial region is stiff and subject to considerable stress concentration. The presence of aggrecan, link protein and type II collagen in the articular disc could explain why the TFCC is destroyed in rheumatoid arthritis, given that it has been suggested that autoimmunity to these antigens results in the destruction of articular cartilage. The differential distribution of aggrecan within the TFCC is likely to be reflected by regional differences in water content and mobility on the radial and ulnar side. This needs to be taken into account in the design of improved MRI protocols for visualizing this ulnocarpal complex of the wrist. [source] Mortality and Life Expectancy in Dutch Residential Centres for Individuals with Intellectual Disability, 1991,1995JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2002Marian A. Maaskant Background Several studies showed that the individuals with intellectual disability have a shorter life expectancy than their intellectually average peers. To gain insight in the present life expectancy of people with intellectual disability, a study with recent data was performed. Methods We used data of the National Case Register (LRZ) with data of almost all residents of residential centres in the Netherlands for the period 1991,1995 (N = 29 290). Approximately 40% of all people with intellectual disability in the Netherlands reside in such centres. Results Results showed that 5-year-old people with intellectual disability in Dutch residential centres have a life expectancy of 41 years. The life expectancy of their peers with Down's syndrome in the centres is 46. At the age of 30 years, the respective figures are 36 and 26 years. No statistically significant differences in mortality were found between women and men and between levels of intellectual disability. Conclusions Due to prolonged longevity, the client population in residential centres will continue to age and thus the numbers of older individuals will increase. This ageing process has implications for the care for elderly individuals, because they need other care than before due to physical, psychological and social changes and spiritual challenges. [source] Aging and lung injury repair: A role for bone marrow derived mesenchymal stem cellsJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 3 2008Ana L. Mora Abstract The incidence of lung fibrosis increases with age. Aging is associated with modifications in the intracellular and extracellular environment including alteration of the extracellular matrix, imbalance of the redox state, accumulation of senescent cells and potential alteration of the recruitment of bone marrow mesenchymal stem cells. The combination of these senescence-related alterations in the lung and in bone marrow progenitor cells might be responsible of the higher susceptibility to lung fibrosis in elderly individuals. The understanding of these age related changes must be considered in the rationale for the development of therapeutic interventions to control lung injury and fibrosis. J. Cell. Biochem. 105: 641,647, 2008. © 2008 Wiley-Liss, Inc. [source] Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort studyJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2010V. Maio PharmD MS MSPH Summary Background and objective:, Inappropriate prescribing in the elderly population is a well-recognized problem in public health. The Beers criteria have been widely used to evaluate the quality of prescribing for the elderly. However, because the Beers criteria were developed in the United States, they are not fully applicable in Italy. The purpose of this study was to establish explicit criteria for potentially inappropriate medication prescribing (PIP) for the elderly and assess the prevalence of and factors associated with PIP among elderly residents in the Local Health Unit of Parma, Italy according to the developed criteria. Methods:, A nine-member expert panel was convened to identify a list of inappropriate medications reflecting the Italian prescribing habits. The panel decided to refine and update the 2002 Beers criteria. Consensus through a Nominal Group Technique was reached to classify the identified 23 inappropriate medications into three categories: 17 medications to be always avoided, three medications rarely appropriate, and three medications with some indications but often misused. A retrospective cohort study using the 2006 Parma Local Health Unit automated outpatient prescriptions database was conducted. The cohort comprised 91 741 elderly individuals ,65 years with at least one prescription medication. PIP was defined as having a prescription claim for at least one inappropriate medication. Results and discussion:, A total of 23 662 elderly in the cohort (25·8%) had at least one PIP. Of these, 14·1% received prescriptions for two medications of concern, and 2·0% for three or more. Using the expert panel's categories, 59·2% of the elderly receiving PIP had prescriptions for drugs that should always be avoided, 33·9% for rarely appropriate drugs, and 19·1% for drugs that have some indications but are often misused. Non-steroidal anti-inflammatory drugs (35·7% of subjects) were the most frequently occurring PIP, followed by ticlopidine (17·6%), doxazosin (15·5%), and amiodarone (13·6%). Female, older age, overall number of drugs prescribed, greater number of chronic conditions were factors associated with greater odds of receiving PIP. Conclusion:, Via the developed criteria, the study corroborates that PIP among elderly outpatients is a substantial issue in Parma Local Health Unit, Italy. Knowledge of the prevalence of PIP and associated factors should gear efforts to develop strategies to reduce PIP in outpatient settings in Italy. [source] Caveolae-mediated entry of Salmonella typhimurium into senescent nonphagocytotic host cellsAGING CELL, Issue 2 2010Jae Sung Lim Summary Elderly individuals have an increased susceptibility to microbial infections because of age-related anatomical, physiological, and environmental factors. However, the mechanism of aging-dependent susceptibility to infection is not fully understood. Here, we found that caveolae-dependent endocytosis is elevated in senescent cells. Thus, we focused on the implications of caveolae-dependent endocytosis using Salmonella typhimurium, which causes a variety of diseases in humans and animals by invading the eukaryotic host cell. Salmonella invasion increased in nonphagocytotic senescent host cells in which caveolin-1 was also increased. When caveolae structures were disrupted by methyl-,-cyclodextrin or siRNA of caveolin-1 in the senescent cells, Salmonellae invasion was reduced markedly compared to that in nonsenescent cells. In contrast, the over-expression of caveolin-1 led to increased Salmonellae invasion in nonsenescent cells. Moreover, in aged mice, caveolin-1 was found to be highly expressed in Peyer's patch and spleen, which are targets for infection by Salmonellae. These results suggest that high levels of caveolae and caveolin-1 in senescent host cells might be related to the increased susceptibility of elderly individuals to microbial infections. [source] Age-associated mitochondrial DNA mutations lead to small but significant changes in cell proliferation and apoptosis in human colonic cryptsAGING CELL, Issue 1 2010Marco Nooteboom Summary Mitochondrial DNA (mtDNA) mutations are a cause of human disease and are proposed to have a role in human aging. Clonally expanded mtDNA point mutations have been detected in replicating tissues and have been shown to cause respiratory chain (RC) defects. The effect of these mutations on other cellular functions has not been established. Here, we investigate the consequences of RC deficiency on human colonic epithelial stem cells and their progeny in elderly individuals. We show for the first time in aging human tissue that RC deficiency attenuates cell proliferation and increases apoptosis in the progeny of RC deficient stem cells, leading to decreased crypt cell population. [source] Differences in the quantitative and qualitative performance of a calcium-specific food frequency questionnaire across age and sexJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2006F. Magkos Abstract Objective, To examine putative differences in the quantitative and qualitative performance of a food frequency questionnaire (FFQ) for assessing dietary calcium intake across age and sex in the Greek population. Materials and methods, A total of 351 children (189 girls and 162 boys, aged 11.9 ± 1.2 years), 260 adults (192 women and 68 men, aged 29.6 ± 2.7 years) and 390 elderly individuals (317 women and 73 men, aged 68.6 ± 4.6 years) were recruited. Estimates of calcium intake from the 30-item FFQ were compared with those from a multi-pass 24-h recall. Results, The FFQ significantly underestimated mean calcium intake in all age groups and both sexes (P < 0.05). The magnitude of underestimation, however, was greater in adults (,207 ± 344 mg day,1), less in the elderly (,137 ± 310 mg day,1) and even less in children (,74 ± 340 mg day,1; P < 0.025), with no differences between sexes. Calcium intakes by the two methods were positively and significantly correlated in all study groups (r = 0.536,0.739, P < 0.001). Cohen's weighted kappa statistic ranged from 0.39 to 0.57, indicating moderate agreement between the two methods. The 95% limits of agreement were comparably wide across age and sex (boys: ,762, 585 mg day,1; girls: ,747, 624 mg day,1; adult men: ,972, 505 mg day,1; adult women: ,867, 412 mg day,1; elderly men: ,858, 486 mg day,1; elderly women: ,732, 480 mg day,1). A significant association between age, sex and the classification of individuals as true/false positive/negative was detected (P < 0.001), implying that sensitivity, specificity, positive and negative predictive values of the FFQ were not independent of the age and sex of the participants. Gross misclassification by the FFQ ranged from 0% to 4.2%, whereas 75.3,87.3% of the subjects were correctly classified. In this respect, the FFQ performed similarly across the study groups (P = 0.065). Without controlling for age, however, gross misclassification appeared to be higher in females than in males (3.2% versus 0.7%, respectively, P = 0.048). Conclusions, There may be several significant differences in the quantitative and qualitative performance of a calcium-specific FFQ across age and sex. This should be taken into account when attempting to evaluate dietary calcium intake in men and women or in different age groups, as some of the differences between study groups may actually be due to the different response of these groups to the FFQ. [source] Influence of aging on candidal growth and adhesion regulatory agents in salivaJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 6 2001Toyohiro Tanida Abstract: Although oral candidiasis is frequently seen in the elderly, the factors determining candidal growth have insufficiently been explored. Hence, we examined the influence of aging on candidal adhesion and growth-inhibitory agents in saliva in 45 healthy volunteers and 60 patients with oral candidiasis. Both non-stimulated and stimulated salivary flow rates (SFRs) in the healthy controls decreased with aging. A gradual decrease of SFRs with aging was also observed in the patients, and the SFR levels were markedly lower than those in the controls. Although the salivary glucose levels were almost constant in all age groups, secretory immunoglobulin A and lactoferrin levels in saliva were significantly decreased statistically with age, and a marginal age-associated decrease in transferrin levels was also observed. In addition, the generation of superoxide from neutrophils in saliva and their Candida killing activity decreased with age, and these phenomena were more apparent in the patients. Furthermore, a larger number of Candida adhered to oral keratinocytes obtained from the elderly healthy controls than to those obtained from young controls. Correspondingly, keratinocytes from the aged controls showed more concanavalin-A binding sites than those from the young controls. However, oral Candida did not increase with increasing age in the controls, although an age-associated increase of oral Candida was observed in the patients. Taken together, these results indicate that the decreases of SFRs and salivary anti-candidal factors, suppression of salivary neutrophil function and the increase of candidal adhesion sites on keratinocytes predispose elderly individuals to oral candidiasis. [source] Comparison of maximum bite force and dentate status between healthy and frail elderly personsJOURNAL OF ORAL REHABILITATION, Issue 6 2001H. Miura The purpose of the present study was to (1) determine the standard value of maximum bite force and to (2) compare the maximum bite force of the elderly between healthy and frail subjects. Subjects included 349 healthy elderly individuals (149 males, 200 females) and 24 frail elderly individuals (seven males, 17 females) ranging from 65 to 74 years of age. Maximum bite force was evaluated using a Dental Prescale systemÔ. The maximum bite force of the healthy subjects was significantly higher than that of the frail subjects in both males (P=0·020) and females (P=0·015). However, no significant difference was observed in the number of present teeth between the healthy and frail subjects. Median of maximum bite force in healthy males was 408,0 N, and that of the healthy females was 243,5 N. These results suggest that the frail elderly have latent bite force problems. [source] | |||||||||||||||||||||||||||||||||||||