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Effect of gut microbiome modulation on muscle function and cognition: the PROMOTe randomised controlled trial

Author/s: 
Mary Ni Lochlainn, Ruth C E Bowyer, Janne Marie Moll, María Paz García, Samuel Wadge, Andrei-Florin Baleanu, Ayrun Nessa, Alyce Sheedy, Gulsah Akdag, Deborah Hart, Giulia Raffaele, Paul T Seed, Caroline Murphy, Stephen D R Harridge, Ailsa A Welch, Carolyn Greig, Kevin Whelan, Claire J Steves

Studies suggest that inducing gut microbiota changes may alter both muscle physiology and cognitive behaviour. Gut microbiota may play a role in both anabolic resistance of older muscle, and cognition. In this placebo controlled double blinded randomised controlled trial of 36 twin pairs (72 individuals), aged ≥60, each twin pair are block randomised to receive either placebo or prebiotic daily for 12 weeks. Resistance exercise and branched chain amino acid (BCAA) supplementation is prescribed to all participants. Outcomes are physical function and cognition. The trial is carried out remotely using video visits, online questionnaires and cognitive testing, and posting of equipment and biological samples. The prebiotic supplement is well tolerated and results in a changed gut microbiome [e.g., increased relative Bifidobacterium abundance]. There is no significant difference between prebiotic and placebo for the primary outcome of chair rise time (β = 0.579; 95% CI -1.080-2.239 p = 0.494). The prebiotic improves cognition (factor score versus placebo (β = -0.482; 95% CI,-0.813, -0.141; p = 0.014)). Our results demonstrate that cheap and readily available gut microbiome interventions may improve cognition in our ageing population. We illustrate the feasibility of remotely delivered trials for older people, which could reduce under-representation of older people in clinical trials. ClinicalTrials.gov registration: NCT04309292.

Keywords 
aging cognition dietary supplements Gastrointestinal Microbiome gut microbiome gut health

Ovarian Aging and Fertility

Author/s: 
David B Seifer, Eve C Feinberg, Albert L Hsu

Women in their late 30s to early 40s who have difficulty conceiving are often unaware that success rates of fertility treatment decline with age, most commonly due to declining ovarian function. Counseling about the high prevalence of infertility and miscarriage may be met with surprise and sadness. Reports of children born to high-profile women older than 50 years may contribute to misconceptions, but these births highlighted in the media were likely achieved with donor oocytes from a younger woman or with oocytes or embryos that were previously cryopreserved. Consistent with declining fertility rates worldwide,1 the fertility rate in the US has declined from 70.9 births per 1000 women in 1990 to 56.1 per 1000 in 2022.2 Simultaneously, the 2019 US Census reported that age at first birth had risen from 27 years in 1990 to 30 years in 2019 as more women postponed first birth.

Reasons for these trends may include lack of a partner, economic insecurity, career aspirations, and long work hours. Concerns about childbearing discrimination, including lack of pregnancy and postpartum support, and childcare challenges also likely influence decisions to delay pregnancy. Results of a questionnaire completed by 5692 US general surgery residents reported that more female than male residents delayed pregnancy because of training (46.8% vs 32.7%; P < .001) and experienced pregnancy/parenthood-based mistreatment (58.1% vs 30.5%; P < .001).3

Keywords 
aging fertility Infertility Pregnancy

Driving Impairment Among Older Adults

Author/s: 
Rebecca A Voelker

Older drivers may have age-related and medical conditions that affect their driving performance.

More than 90% of car crashes are caused by human error. In older adults, age-related changes of decreased vision, cognitive decline, slowed reaction time, and decreased grip strength increase the risk of common driving errors, including straying from driving lanes, failing to observe speed limits, and overlooking traffic signs.

The risk of dying in a car crash is 2.5 times higher for drivers aged 75 to 79 years and 5 times higher for those aged 80 years or older compared with younger drivers.

Keywords 
driving aging cataracts CPAP distracted driving elderly patients car accidents automobile accidents

Clin-STAR corner: 2021 update in musculoskeletal pain in older adults with a focus on osteoarthritis-related pain

Author/s: 
Owoicho Adogwa, M. Cary Reid, Sai Chilakapati, Una E. Makris

Chronic musculoskeletal (MSK) pain remains a leading cause of disability and functional impairment among older adults and is associated with substantial societal and personal costs. Chronic pain is particularly challenging to manage in older adults because of multimorbidity, concerns about treatment-related harm, as well as older adults' beliefs about pain and its management. This narrative review presents data on nine high-quality, peer-reviewed clinical trials published primarily over the past two years that focus on MSK pain management in older adults, of which four were comprehensively reviewed. These studies address contributors to knee osteoarthritis (OA) pain (insomnia), provide evidence for digital delivery or artificial intelligence driven behavioral interventions and potentially more efficient/equally effective modes of delivering glucocorticoids for OA; each of the selected studies have potential for scalability and meaningful impact in the care of older adults.

Keywords 
aging back pain osteoarthritis chronic pain comorbid conditions

Olfactory Loss and Beyond: A Practical Review of Chemosensory Dysfunction

Author/s: 
Claus, L. E., Leland, E. M., Tai, K. Y., Schlosser, R. J., Kamath, V., Lane, A. P., Rowan, N. R.

Background: Our ability to smell and taste is dictated by 3 chemosensory systems with distinct physiologic mechanisms - olfaction, gustation, and chemesthesis. Although often overlooked, dysfunction of these special senses may have broad implications on multiple facets of patients' lives -including safety, nutritional status, quality of life, mental health, and even cognitive function. As "loss of smell or taste" emerged as a common symptom of coronavirus disease 2019 (COVID-19), the importance of intact chemosensory function has been thrust into the spotlight. Despite the growing recognition of chemosensory dysfunction, this already highly prevalent condition will increasingly impact a larger and more diverse population, highlighting the need for improved awareness and care of these patients.

Methods: Comtemporary review of chemosensory function and assessments.

Conclusions: Although patient-reported chemosensory function measures highlight the ease of screening of chemosensory dysfunction, self-reported measures underestimate both the prevalence and degree of chemosensory dysfunction and do not adequately distinguish between olfaction, gustation, and chemesthesis. Meanwhile, psychophysical assessment tools provide opportunities for more accurate, thorough assessment of the chemosenses when appropriate. Primary care providers are uniquely situated to identify patients burdened by chemosensory dysfunction and raise patient and provider awareness about the importance of chemosensory dysfunction. Identification of chemosensory dysfunction, particularly olfactory dysfunction, may raise suspicion for many underlying medical conditions, including early detection of neurodegenerative conditions. Furthermore, identification and awareness of patients with chemosensory dysfunction may help primary care providers to identify those who may benefit from additional therapeutic and safety interventions, or consultations with specialists for more detailed evaluations and management.

Keywords 
aging Anosmia dementia Geriatrics Olfaction Disorders

Influence of changes in diet quality on unhealthy aging: the Seniors-ENRICA cohort

Author/s: 
Ortolá, Rosario, García-Esquinas, Esther, García-Varela, Giselle, Struijkab, Ellen A., Rodríguez-Artalejo, Fernando, Lopez-Garcia, Esther

Background

Whether adopting a better diet in late life influences the aging process is still uncertain. Thus, we examined the association between changes in diet quality and unhealthy aging.

Methods

Data came from 2042 individuals aged ≥ 60 years recruited in the Seniors-ENRICA cohort in 2008–2010 (wave 0) and followed-up in 2012 (wave 1) and 2015 (wave 2). Diet quality was assessed with the Mediterranean Diet Adherence Screener (MEDAS), the Mediterranean Diet Score (MDS) and the Alternate Healthy Eating Index-2010 (AHEI-2010) at waves 0 and 1. Unhealthy ageing was measured using a 52-item health deficit accumulation index with 4 domains (functional, self-rated health/vitality, mental health, and morbidity/health services use) at each wave. An increase in dietary indices represents a diet improvement, and a lower deficit accumulation index indicates a health improvement.

Results

Compared with participants with a > 1-point decrease in MEDAS or MDS, those with a > 1-point increase showed lower deficit accumulation from wave 0 to wave 2 (multivariate β [95% CI]: –1.49 [− 2.88 to − 0.10], p-trend = 0.04 for MEDAS; and − 2.20 [− 3.56 to − 0.84], p-trend = 0.002 for MDS) and from wave 1 to wave 2 (− 1.34 [− 2.60 to − 0.09], p-trend = 0.04 for MEDAS). Also, participants with a > 5-point increase in AHEI-2010 showed lower deficit accumulation from wave 0 to wave 1 (− 1.15 [− 2.01 to − 0.28], p-trend = 0.009) and from wave 0 to wave 2 (− 1.21 [− 2.31 to − 0.10], p-trend = 0.03) than those with a > 5-point decrease. These results were mostly due to a strong association between improved diet quality and less functional deterioration.

Conclusions

In older adults, adopting a better diet was associated with less deficit accumulation, particularly functional deterioration. Improving dietary habits may delay unhealthy ageing. Our results have clinical relevance since we have observed that the deficit accumulation index decreases an average of 0.74 annually.

Keywords 
cohort study dietary patterns aging
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