aging

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.

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

Clinician's Guide to Assessing and Counseling Older Drivers, 4th Edition

Erin Blanchette — Mon, 09 Dec 2024 15:14:17 +0000

Date Added:

December 9, 2024

Publisher:

American Geriatrics Society

Pages:

1-282

URL:

Clinician's Guide to Assessing and Counseling Older Drivers, 4th Edition

Type:

Clinical Decision Aids

Format:

Web Page

Keywords

MeSH

Guidance for how to assess a person's capacity to drive safely. James W. Mold, MD, MPH

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The Clinician’s Guide to Assessing and Counseling Older Drivers, 4th Edition is published by the American Geriatrics Society (AGS) as a service to healthcare providers involved in the care of older adults. This 4th edition is an update of the 3rd edition to the current state of the literature, with a continued focus on the interprofessional nature of the team caring for an older adult driver. This edition is the result of a cooperative agreement between AGS and the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA).

The Clinician’s Guide is available in two formats, a digital text accessed through your browser and a downloadable PDF.

Polypharmacy Management in Older Patients

Devin Evans — Thu, 14 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

Mayo Clinic Proceedings

Publication Date:

January 5, 2021

Issue:

Volume:

Pages:

242-256

URL:

Polypharmacy Management in Older Patients

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2020.06.012

Keywords

PMID (1):

33413822

MeSH

A nice summary of the hazards, prevention, and management of polypharmacy in the elderly. James W. Mold, MD, MPH

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Medications to treat disease and extend life in our patients often amass in quantities, resulting in what has been termed "polypharmacy." This imprecise label usually describes the accumulation of 5, and often more, medications. Polypharmacy in advancing age frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and nonadherence. Polypharmacy is associated with resulting increased hospitalizations and higher costs of care for individuals and health care systems. To reduce polypharmacy, we delineate a systematic, consultative approach to identify highest-risk medications and drug-therapy problems. We address strategic reductions (deprescribing) of medications in palliative care, long-term care, and ambulatory older adults. Best practices for reducing opioids, benzodiazepines, and other high-risk medications include education about risk and agreement by patients and their families, advocates, and care teams. Addressing deprescribing should be within the framework of patients' health status as their care and goals transition from longevity to a plan of maintaining alertness, comfort, and satisfaction of quality of life. A team approach to address polypharmacy and avoidance of high-risk therapy is optimal within long-term care. Patients with terminal illnesses or those moving toward a comfort-care emphasis benefit from medication adjustments that are recognized beneficially within each patient's care goals. In caring for older adults, the acknowledgement that complicated regimens and high-risk medications requires a care plan to reduce or prevent medication-related problems and costs that are associated with polypharmacy.

Author/s:

Hoel, Robert W., Giddings-Connolly, Ryan M., Takahashi, Paul Y.

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

Tracy Ashby — Wed, 17 Apr 2019 05:00:00 +0000

Date Added:

April 17, 2019

Journal/Publication:

The American Journal of Medicine

Publisher:

Elsevier Inc.

Publication Date:

April 11, 2019

URL:

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

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amjmed.2019.03.023

Keywords

MeSH

This cohort study suggests, but doesn’t prove, that older adults who adopt a healthy diet can significantly and meaningfully reduce the rate of functional decline. James W. Mold, MD, MPH

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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.

Author/s:

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