Age-related Changes In Function Research Articles

Effects of ageing on cardiac function in zebrafish

Introduction: Age-associated alterations in cardiac structure and function have been observed from the molecular to whole organ level in humans and mammalian models. Understanding the mechanisms involved is important for explaining the development of cardiac disease with age and developing novel strategies for its treatment and prevention. The zebrafish represents a potentially powerful model for ageing studies, as it can model various cardiac pathologies, it is easily genetically modified, and it is a relatively low cost and high-throughput option. In aged zebrafish, myocyte hypertrophy, ventricular density and fibrosis, and valvular lesions, as well as reductions in coronary vasculature have been described. The functional consequences of these structural changes, however, have not been well described. In the current study, we investigated age-related changes in cardiac function in the zebrafish.

Age-related changes in sympathetic responsiveness and cardiac electrophysiology

Introduction: Aging is associated with chronic increases in sympathetic activity, yet neurodegeneration also occurs, leading to a loss of functional sympathetic fibers in the heart. How these age-related changes in sympathetic structure and function directly impact cardiac electrophysiology and intracellular Ca2+ handling have not been systematically characterized.

Gerontodermatology: the fragility of the epidermis in older adults.

The proportion of adults over 60years of age is rapidly increasing and is estimated to reach approximately one-sixth of the global population by 2030. An ageing population is a real challenge for healthcare resources, including dermatologists and geriatricians, as age-related changes in skin integrity and barrier function make older adults more susceptible to developing skin pathologies such as pruritus, dermatitis and infections. Fragile skin arises from several interlinked causes, including age-related changes in skin barrier integrity, previous and current lifestyle choices, skin pathologies and medical interventions. Dermo-cosmetics can play a key role in enhancing skin care regimens and preventing pathologies in this age group. In vitro studies, clinical, and in-daily clinical practice studies of dermo-cosmetics have shown them to be effective in many skin conditions in older adults, like xerosis and pruritus. Incontinence-associated dermatitis (IAD), a common condition arising from contact with irritants such as urine and faeces which can significantly impact the quality of life of sufferers, can also be improved with a barrier cream in incontinent patients aged 70years and older. This supplement focuses on the increased fragility of older skin, the development of common skin pathologies and the efficacy and tolerance of dermo-cosmetic products in older adults.

Reliability of a Novel Video-Based Method for Assessing Age-Related Changes in Upper Limb Kinematics.

Monitoring age-related changes in motor function can be used to identify deviations that represent underlying diseases for which early diagnosis is often paramount for efficacious, interventional therapies. Currently, the availability of cost-effective and reliable diagnostic tools capable of routine monitoring is limited. Adequate diagnostic systems are needed to identify, monitor and distinguish early subclinical symptoms of neurological diseases from normal aging-associated changes. Herein, we describe the development, initial validation and reliability of the Hand-Arm Movement Monitoring System (HAMMS), a video-based data acquisition system built using a programmable, versatile platform for acquiring temporal and spatial metrics of hand and arm movements. A healthy aging population of 111 adults were used to evaluate the HAMMS via a repetitive motion test of changing target size. The test required participants to move a fiducial on their hand between two targets presented on a video monitor. The test-retest reliability based on Intraclass Correlation Coefficient (ICCs) for the system ranged from 0.56 to 0.87 and the Linear Correlation Coefficients (LCCs) ranged from 0.58 to 0.87. Average speed, average acceleration, speed error and center offset all demonstrated a positive correlation with age. Using an intertarget path of hand motion, we observed an age-dependent increase in the average number of points outside the most direct motion path, indicating a reduction in hand-arm movement control with age. The reliability, flexibility and programmability of the HAMMS makes this low cost, video-based platform an effective tool for evaluating longitudinal changes in hand-arm related movements and a potential diagnostic device for neurological diseases where hand-arm movements are affected.

The Aging Lung: Is Lung Health Good Health for Older Adults?

The prevalence of lung conditions, such as COPD and pulmonary fibrosis, and lung infections, such as pneumonia, increases sharply with age. The physiologic, cellular, and immunologic changes that occur during aging contribute to the development of lung disease. Studies of age-related changes in physiology and function are not only key to preventing or ameliorating disease, they are also essential for understanding healthy aging. Individuals with good lung function live longer, healthier lives, although the mechanisms by which this scenario occurs are not understood. The present article reviews changes in the aging lung that facilitate development of disease and the evidence supporting the idea that robust lung function reduces the risk of developing chronic inflammatory conditions that occur with age.

Novel targets for delaying aging: The importance of the liver and advances in drug delivery.

Age-related changes in liver function have a significant impact on systemic aging and susceptibility to age-related diseases. Nutrient sensing pathways have emerged as important targets for the development of drugs that delay aging and the onset age-related diseases. This supports a central role for the hepatic regulation of metabolism in the association between nutrition and aging. Recently, a role for liver sinusoidal endothelial cells (LSECs) in the relationship between aging and metabolism has also been proposed. Age-related loss of fenestrations within LSECs impairs the transfer of substrates (such as lipoproteins and insulin) between sinusoidal blood and hepatocytes, resulting in post-prandial hyperlipidemia and insulin resistance. Targeted drug delivery methods such as nanoparticles and quantum dots will facilitate the direct delivery of drugs that regulate fenestrations in LSECs, providing an innovative approach to ameliorating age-related diseases and increasing healthspan.

Dedifferentiation of caudate functional connectivity and striatal dopamine transporter density predict memory change in normal aging

Age-related changes in striatal function are potentially important for predicting declining memory performance over the adult life span. Here, we used fMRI to measure functional connectivity of caudate subfields with large-scale association networks and positron emission tomography to measure striatal dopamine transporter (DAT) density in 51 older adults (age 65-86 years) who received annual cognitive testing for up to 7 years (mean = 5.59, range 2-7 years). Analyses showed that cortical-caudate functional connectivity was less differentiated in older compared with younger adults (n = 63, age 18-32 years). Unlike in younger adults, the central lateral caudate was less strongly coupled with the frontal parietal control network in older adults. Older adults also showed less "decoupling" of the caudate from other networks, including areas of the default network (DN) and the hippocampal complex. Contrary to expectations, less decoupling between caudate and the DN was not associated with an age-related reduction of striatal DAT, suggesting that neurobiological changes in the cortex may drive dedifferentiation of cortical-caudate connectivity. Reduction of specificity in functional coupling between caudate and regions of the DN predicted memory decline over subsequent years at older ages. The age-related reduction in striatal DAT density also predicted memory decline, suggesting that a relation between striatal functions and memory decline in aging is multifaceted. Collectively, the study provides evidence highlighting the association of age-related differences in striatal function to memory decline in normal aging.

Management of Overactive Bladder in Older Women.

This review will highlight our current understanding of age-related changes in bladder function and propose important clinical considerations in the management of overactive bladder (OAB) specific to older women. Frailty, functional and cognitive impairment, multimorbidity, polypharmacy, estrogen deficiency, and remaining life expectancy are important clinical factors to consider and may impact OAB symptom management in older women. Third-line therapies, particularly PTNS, may be preferable over second-line therapy in some cases. Due to the complexity within this population, the standard treatment algorithms may not be applicable, thus a broader, more holistic focus is recommended when managing OAB in older women.

The effects of human leukocyte antigen DRB1*13 and apolipoprotein E on age-related variability of synchronous neural interactions in healthy women.

BackgroundAge-related brain changes are well-documented and influenced by genetics. Extensive research links apolipoprotein E (apoE) to brain function, with the E4 allele serving as a risk factor for brain disease, including Alzheimer's disease, and the E2 allele conferring protection. Recent evidence also supports protective effects of another gene, human leukocyte antigen (HLA) DRB1*13, on brain disease and age-related brain atrophy in cognitively healthy adults. Here we investigated the effects of apoE and HLA DRB1*13 on brain function by examining changes in neural network properties with age in healthy adults.MethodsOne hundred seventy-eight cognitively healthy women (28–99 y old) underwent a magnetoencephalography scan and provided a blood sample for genetic analysis. Age-related changes in neural network variability in genetic subgroups of DRB1*13 × apoE genotype combinations were assessed using linear regression of network variability against age.FindingsFor individuals lacking a DRB1*13 allele and/or carrying an apoE4 allele, network variability increased significantly with age. In contrast, no such increase was observed in the presence of DRB1*13 and/or apoE2.InterpretationThese findings extend previous research documenting the protective effect of DRB1*13 on brain structure to include protection against age-related changes in brain function, and demonstrate similar protective effects on neural network variability for either DRB1*13 or apoE2. These protective effects could be due to reduction or elimination of factors known to disrupt brain function, including neuroinflammation and amyloid beta protein.FundingU.S. Department of Veterans Affairs, and University of Minnesota.

Age-related changes in cardiac electrophysiology and calcium handling in response to sympathetic nerve stimulation.

Ageing results in changes to cardiac electrophysiology, Ca2+ handling, and β-adrenergic responsiveness. Sympathetic neurodegeneration also occurs with age, yet detailed action potential and Ca2+ handling responses to physiological sympathetic nerve stimulation (SNS) in the aged heart have not been assessed. Optical mapping in mouse hearts with intact sympathetic innervation revealed reduced responsiveness to SNS in the aged atria (assessed by heart rate) and aged ventricles (assessed by action potentials and Ca2+ transients). Sympathetic nerve density and noradrenaline content were reduced in aged ventricles, but noradrenaline content was preserved in aged atria. These results demonstrate that reduced responsiveness to SNS in the atria may be primarily due to decreased β-adrenergic receptor responsiveness, whereas reduced responsiveness to SNS in the ventricles may be primarily due to neurodegeneration. The objective of this study was to determine how age-related changes in sympathetic structure and function impact cardiac electrophysiology and intracellular Ca2+ handling. Innervated hearts from young (3-4months, YWT, n=10) and aged (20-24months, AGED, n=11) female mice (C57Bl6) were optically mapped using the voltage (Vm ,)- and calcium (Ca2+ )-sensitive indicators Rh237 and Rhod2-AM. Sympathetic nerve stimulation (SNS) was performed at the spinal cord (T1-T3). β-Adrenergic responsiveness was assessed with isoproterenol (1μM, ISO). Sympathetic nerve density and noradrenaline content were also quantified. Stimulation thresholds necessary to produce a defined increase in heart rate (HR) with SNS were higher in AGED vs. YWT hearts (5.4±0.4vs. 3.8±0.4Hz, P<0.05). Maximal HR with SNS was lower in AGED vs. YWT (20.5±3.41% vs. 73.0±7.63% increase, P<0.05). β-Adrenergic responsiveness of the atria (measured as percentage increase in HR with ISO) was decreased in AGED vs. YWT hearts (75.3±22.5% vs. 148.5±19.8%, P<0.05). SNS significantly increased action potential duration (APD) in YWT but not AGED. Ca2+ transient durations and rise times were unchanged by SNS, yet AGED hearts had an increased susceptibility to Ca2+ alternans and ventricular arrhythmias. β-Adrenergic responsiveness of all ventricular parameters were similar between AGED and YWT. Sympathetic nerve density and noradrenaline content were decreased in the AGED ventricle, but not atria, compared to YWT. These data suggest that decreased responsiveness to SNS in the aged atria may be primarily due to decreased β-adrenergic responsiveness, whereas decreased responsiveness to SNS in the aged ventricles may be primarily due to nerve degeneration.

Age-associated changes in electrical function of the zebrafish heart

Age-associated changes in cardiac structure and function have been observed from the molecular to whole organ level in humans and mammalian models. Understanding the mechanisms involved is important for explaining the development of cardiac disease with age and developing novel strategies for its treatment and prevention. The zebrafish represents a powerful model for cardiovascular research, as various cardiac pathologies have been recapitulated, it is easily genetically modified, and it is a relatively low cost and high-throughput option. In aged zebrafish, myocyte hypertrophy, increased ventricular density and fibrosis, valvular lesions, and reductions in coronary vasculature have been described. The functional consequences of these structural changes however, are relatively unknown. In the current study, we investigated age-related changes in cardiac function in the isolated zebrafish heart. In older animals, heart rate was less stable, sinoatrial node recovery time was increased, and the heart rate response to vagal nerve stimulation was reduced, suggesting an age-dependent change in sinoatrial node function. These changes were accompanied by age-related differences in intracardiac innervation, with the total number and proportion of cholinergic neurons being higher in older animals. In contrast, calcium transient duration was highly variable in young animals, while baseline heart rate and rates of contraction and relaxation were also highly variable, but on average did not change with age. These results suggest that age-associated changes in both myocyte and intracardiac neuronal structure and function exist in the zebrafish heart, offering a new model for studies of cardiac ageing.

Effects of aging on the biomechanics of Coquerel's sifaka (Propithecus coquereli): Evidence of robustness to senescence.

It is well-known that as humans age they experience significant changes in gait including reduction in velocity and ground reaction forces and changes in leg mechanics. Progressive changes in gait can lead to disability and frailty, defined as an inability to carry out activities of daily living. This topic is relevant to basic understanding of the aging process and for clinical intervention. As such, studies of frailty can benefit from nonhuman animal models, yet little is known about gait frailty in nonhuman primates. This study examines a nonhuman primate model to evaluate its relevance to understanding human aging processes. To test the null hypothesis that age-related changes in joint function and gait do occur in primate models in a similar fashion to humans, a detailed gait analysis, including velocity, footfall timings, and vertical ground reaction forces, on bipedal locomotion was performed in Coquerel's sifaka (Propithecus coquereli), ranging in age from 5 years to 24 years. None of the spatiotemporal or kinetic gait variables measured was significantly correlated with age alone. There was a slight but significant reduction in locomotor velocity when animals were grouped into "young" and "old" categories. These data show that aging P. coquereli experience only subtle age-related changes, that were not nearly as extensive as reported in humans. This lack of change suggests that unlike humans, lemurs maintain gait competency at high levels, possibly because these animals maintain reproductive capacity close to their age of death and that frailty may be selected against, since gait disability would result in injury and death that would preclude independent living. Although nonhuman primates should experience age-related senescence, their locomotor performance should remain robust throughout their lifetimes, which raises questions about the use of primate models of gait disability, an area that deserves further investigation.

Is Tamsulosin Linked to Dementia in the Elderly?

Lower urinary tract symptoms (LUTS) result from age-related changes in detrusor function and prostatic growth that are driven by alterations in the ratio of circulating androgens and estrogens. Alpha-adrenergic receptor blockers are commonly used to treat LUTS because they influence urethral tone and intra-urethral pressure. Molecular cloning studies have identified three α1-adrenergic receptor subtypes (α1A, α1B, and α1D). The α1A subtype is predominant in the human prostate but is also present in many parts of the brain that direct cognitive function. Tamsulosin is the most widely used α1-adrenergic receptor antagonist with 12.6 million prescriptions filled in 2010 alone. When compared to the other common types of α1-adrenergic receptor antagonists (i.e., terazosin, doxazosin, and alfuzosin), tamsulosin is 10- to 38-fold more selective for the α1A versus the α1B subtype. Duan et al. have recently shown that men taking tamsulosin have a higher risk of developing dementia when compared to men taking other α-adrenergic antagonists or no α-adrenergic antagonists at all (HR 1.17; 95% CI 1.14-1.21). Based upon this retrospective analysis, we believe that tamsulosin, because of its unique affinity for α1A-adrenergic receptors, may increase the risk of developing dementia when used for an extended period of time. If these findings are confirmed, they carry significant public health implications for an aging society.

MODULATION OF COGNITIVE RESERVE WORKING MEMORY NETWORKS WITH HIGH DEFINITION TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS)

Elders with high estimates of cognitive reserve (CR) have been shown to exhibit superior cognitive performance. Transcranial direct current stimulation (tDCS) can modify the expression of brain networks and result in cognitive changes. In this study, we investigated the behavioral and functional imaging correlates of using tDCS to modulate brain networks expressed by elders with high CR and how the individual baseline activation pattern could interact with this modulation. In a previous study, were identified two distinctive patterns (‘compensatory’ and ‘young-like’) of functional Magnetic Resonance Imaging (fMRI) activity during a working memory (WM) task from 51 elders with high CR (Fernández-Cabello et al. Neurobiol Aging. 2016;48:23-33). Subsequently, we designed two HD-tDCS montages (Neuroelectrics) to obtain electric field maps distribution fitting these fMRI patterns (Fig.1). Then, we undertook a sham-controlled crossover study where 24 healthy elders (mean age: 71.8±2.7, 14 females) performed a letter N-back task inside the MR scan on three separate days, while tDCS was applied using: sham, ‘compensatory’ and ‘young-like’ montages. Posteriorly, to investigate how baseline fMRI activity interacts with HD-tDCS effects, each subject was classified as expressing a ‘compensatory’ (G1=11) or ‘young-like’ (G2=13) pattern at baseline (i.e. during sham) using a linear support vector machine and L2 regularization (Fig.2). The fMRI scans were analyzed using FEAT-FSL software, where the contrast of interest ‘Cognitive Load’ allows evaluating the brain activity in the N-back highest loads compared to the lowest. The statistical significance was set at p<0.05 and z>2.3 (cluster wise corrected). Neuroelectrics® Stimweaver. Electric-field distribution simulation in the brain cortical surface (V/m) for both multichannel stimulation montages. The ‘compensatory’ montage promotes overactivation, while in the ‘young-like’ pattern there are activation and deactivation areas. The maximal injected current into the brain at any time is below 4 mA (maximum current 2 mA at any electrode). The 8 electrodes are positioned over the scalp according to the 10-20 EEG system coordinates defined on the image left side. Classification method. The system was trained with a group of 51 elders who were classified in a previous study according to expressing a WM pattern ‘compensatory’ (G1) or ‘young-like’ (G2). These patterns were divided in 4 masks and the voxel overlapping from the individual activation maps were introduced as the vectors (features). The calculated algorithm split the test group (N=24) into 11 ‘compensatory’ and 13 ‘young- like’ subjects. Real HD-tDCS did not significantly influence WM performance. Regarding fMRI changes, we observed two condition (sham-‘compensatory’, sham-‘young-like’) x group (G1, G2) interactions. Post-hoc analyses revealed that elders expressing a ‘compensatory’ pattern at baseline (G1) showed greater brain activity modulation under both real HD-tDCS montages (Fig.3). fMRI results. Significant activity maps, where both described patterns (‘compensatory’ and ‘young-like’) in the Cognitive Load contrast (3-back>2-back>l-back>0-back) are represented in blue and stimulation condition x group interactions are shown in red-yellow. The mean BOLD signal values at the significant regions were individually extracted in order to be plotted separated by sham and real for each montage. Error bars: +/- SEM. Elders expressing a ‘compensatory’ fMRI pattern show higher functional responses to HD-tDCS compared to those that presumably show reduced functional age-related changes. These results highlight that old adults with a younger functional profile at baseline are more resistant to perturbations induced by brain stimulation, suggesting a potential protective capacity against aging and neurodegeneration (Santarnecchi et al. Cortex. 2015;64:293-309).

Motivational Influences on Performance Monitoring and Cognitive Control Across the Adult Lifespan.

Cognitive control refers to the ability to regulate cognitive processing according to the tasks at hand, especially when these are demanding. It includes maintaining and updating relevant information in working memory, inhibiting irrelevant information, and flexibly switching between tasks. Performance monitoring denotes the processing of feedback from the environment and the detection of errors or other unexpected events and signals when cognitive control needs to be exerted. These two aspects of behavioral adaptation critically rely on the integrity of the frontal lobes, which are known to show pronounced age-related performance decrements. By contrast, there is evidence that processing of rewards remains relatively intact across the adult lifespan. Hence, motivation may play an important role in modulating or even counteracting age-related changes in cognitive control functions. To answer this question, neuroscientific data can be particularly useful to uncover potential underlying mechanisms beyond behavioral outcome. The aims of this article are twofold: First, to review and systematize the extant literature on how motivational incentives can modulate performance monitoring and cognitive control in young and older adults. Second, to demonstrate that important pieces of empirical data are currently missing for the evaluation of this central question, specifically in old age. Hence, we would like to stimulate further research uncovering potential mechanisms underlying motivation-cognition interactions in young and in particular in older adults and investigating whether or not those can help to ameliorate age-related impairments.

Age-related differences in striatal, medial temporal, and frontal involvement during value-based decision processing

Appropriate neural representation of value and application of decision strategies are necessary to make optimal investment choices in real life. Normative human aging alters neural selectivity and control processing in brain regions implicated in value-based decision processing including striatal, medial temporal, and frontal areas. However, the specific neural mechanisms of how these age-related functional brain changes modulate value processing in older adults remain unclear. Here, young and older adults performed a lottery-choice functional magnetic resonance imaging experiment in which probabilities of winning different magnitudes of points constituted expected values of stakes. Increasing probability of winning modulated striatal responses in young adults, but modulated medial temporal and ventromedial prefrontal areas instead in older adults. Older adults additionally engaged higher responses in dorso-medio-lateral prefrontal cortices to more unfavorable stakes. Such extrastriatal involvement mediated age-related increase in risk-taking decisions. Furthermore, lower resting-state functional connectivity between lateral prefrontal and striatal areas also predicted lottery-choice task risk-taking that was mediated by higher functional connectivity between prefrontal and medial temporal areas during the task, with this mediation relationship being stronger in older than younger adults. Overall, we report evidence of a systemic neural mechanistic change in processing of probability in mixed-lottery values with age that increases risk-taking of unfavorable stakes in older adults. Moreover, individual differences in age-related effects on baseline frontostriatal communication may be a central determinant of such subsequent age differences in value-based decision neural processing and resulting behaviors.

Can programmed aging theory adequately explain sexual dysfunction among the elderly?

The belief is widespread that elderly individuals simply become asexual as they age. Consequently, many caregivers and healthcare practitioners implicitly ignore or downplay the sexuality and sexual needs of the elderly. Although it is true that elderly individuals commonly experience sexual dysfunction, which may include a decline in sexual desire, sexual functioning, and ability to engage in sexual activity, most desire to remain sexually active into their older age, and many in fact do. This review examines the extent to which programmed aging theory, which holds that senescence and its associated physiological decline result from genetically predetermined lifespan, can be used to explain and evaluate the development of sexual dysfunction among elderly individuals. Although programmed aging theory usefully accounts for and normalizes inevitable changes in sexual function and ability, it ignores the psychological and psychosocial aspects of aging that affect the onset and extent of sexual dysfunction. Acknowledging these aspects of aging has led to interventions which have proved helpful in maintaining and enhancing sexual activity and wellbeing among the elderly. As the population ages and average lifespans increase, it is necessary that caregivers and healthcare practitioners are equipped to help their patients understand, manage, and adapt to age-related changes in sexual desire, functioning, and wellbeing.

Attrition of T Cell Zone Fibroblastic Reticular Cell Number and Function in Aged Spleens.

Aging has a profound impact on multiple facets of the immune system, culminating in aberrant functionality. The architectural disorganization of splenic white pulp is a hallmark of the aging spleen, yet the factors underlying these structural changes are unclear. Fibroblastic reticular cells comprise one stromal cell subset in the spleen that is important for maintenance of architectural organization, yet it remains to be determined how aging impacts these cells. In this study, we sought to determine how aging impacts splenic T cell zone reticular cell (TRC) numbers, morphology, and function. Using a mouse model of aging, we found that aged naive spleens have fewer TRCs than young spleens. This reduction in TRC number correlated with reduced CCL19 and CCL21 concentrations in aged spleens, which may contribute to impaired homing of T cells. CCL21 in both young and aged spleens localized with TRCs. Aged TRCs extended marginally into B cell follicles and may contribute to the blending of the T cell zone and B cell follicles in aged spleens. The described age-related changes in TRCs number and function may be an underlying factor contributing to impaired immune system function with age.

Sarcopenia: assessment of disease burden and strategies to improve outcomes.

Life expectancy is increasing worldwide, with a resultant increase in the elderly population. Aging is characterized by the progressive loss of skeletal muscle mass and strength – a phenomenon called sarcopenia. Sarcopenia has a complex multifactorial pathogenesis, which involves not only age-related changes in neuromuscular function, muscle protein turnover, and hormone levels and sensitivity, but also a chronic pro-inflammatory state, oxidative stress, and behavioral factors – in particular, nutritional status and degree of physical activity. According to the operational definition by the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia requires the presence of both low muscle mass and low muscle function, which can be defined by low muscle strength or low physical performance. Moreover, biomarkers of sarcopenia have been identified for its early detection and for a detailed identification of the main pathophysiological mechanisms involved in its development. Because sarcopenia is associated with important adverse health outcomes, such as frailty, hospitalization, and mortality, several therapeutic strategies have been identified that involve exercise training, nutritional supplementation, hormonal therapies, and novel strategies and are still under investigation. At the present time, only physical exercise has showed a positive effect in managing and preventing sarcopenia and its adverse health outcomes. Thus, further well-designed and well-conducted studies on sarcopenia are needed.

Poisoning in elderly

Abstract Poisoning constitutes a major cause of emergency department visits globally. With an increase in new household chemical supplies, cleaning agents and disinfectants, pesticides and fertilizers, drugs and pharmaceuticals, the cases of poisonings are being increasingly encountered. Although elderly patients account for a small fraction of total poison exposures, but, when exposed they have a high risk for mortality because of existing co-morbidities and age-related physiological changes in renal and hepatic functions. Thus, elderly people represent a special group in the context of poisoning. Judicious use of medications like avoidance of polypharmacy and appropriate dosage of the prescribed drugs due to narrow therapeutic range are effective ways to prevent poisoning (especially unintentional/accidental situations) in the elderly. Collecting detailed epidemiological information on poisoning exposures in the country and formulating strategies to reduce poisoning exposures is the need of the hour.