Decline In Functional Reserve Research Articles

Biological basis and treatment of frailty and sarcopenia.

In an ageing society, the importance of maintaining healthy life expectancy has been emphasized. As a result of age-related decline in functional reserve, frailty is a state of increased vulnerability and susceptibility to adverse health outcomes with a serious impact on healthy life expectancy. The decline in skeletal muscle mass and function, also known as sarcopenia, is key in the development of physical frailty. Both frailty and sarcopenia are highly prevalent in patients not only with advanced age but also in patients with illnesses that exacerbate their progression like heart failure (HF), cancer, or dementia, with the prevalence of frailty and sarcopenia in HF patients reaching up to 50-75% and 19.5-47.3%, respectively, resulting in 1.5-3 times higher 1-year mortality. The biological mechanisms of frailty and sarcopenia are multifactorial, complex, and not yet fully elucidated, ranging from DNA damage, proteostasis impairment, and epigenetic changes to mitochondrial dysfunction, cellular senescence, and environmental factors, many of which are further linked to cardiac disease. Currently, there is no gold standard for the treatment of frailty and sarcopenia, however, growing evidence supports that a combination of exercise training and nutritional supplement improves skeletal muscle function and frailty, with a variety of other therapies being devised based on the underlying pathophysiology. In this review, we address the involvement of frailty and sarcopenia in cardiac disease and describe the latest insights into their biological mechanisms as well as the potential for intervention through exercise, diet, and specific therapies.

Management of Type 2 Diabetes in Frail Older Adults.

Aging is one of the most important factors associated with the dramatic increase in the prevalence of type 2 diabetes mellitus (T2DM) globally. In addition to traditional micro- and macrovascular complications, diabetes mellitus (DM) in older adults is of great importance due to its independent relationship with frailty, which is defined as a decline in functional reserves and vulnerability to stressors. Frailty assessment enables the determination of biological age, thus predicting potential complications in older adults and identifying tailored treatment strategies. Although the latest guidelines have acknowledged the frailty concept and provided recommendations specific to this subgroup of older adults, frail older adults are particularly considered only as anorexic, malnourished people for whom relaxed treatment targets should be set. However, this approach bypasses other metabolic phenotypes in the context of diabetes and frailty. Recently, a spectrum of metabolic phenotypes in the context of frailty in DM was suggested, and the two edges of this spectrum were defined as "anorexic malnourished (AM)" and "sarcopenic obese (SO)." These two edges were suggested to require different strategies: Opposite to the AM phenotype requiring less stringent targets and de-intensification of treatments, tight blood glucose control with agents promoting weight loss was recommended in the SO group. Our suggestion is that, regardless of their phenotype, weight loss should not be the primary goal in DM management in older adults who are overweight or obese, because of the increased malnutrition prevalence in older adults suffering from DM compared with standard older adults. Furthermore, overweight older adults have been reported to have the lowest risk of mortality compared with other groups. On the other hand, obese older individuals may benefit from intensive lifestyle interventions including caloric restriction and regular exercise with the assurance of at least 1 g/kg/day high-quality protein intake. Besides metformin (MF), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) should be considered in appropriate SO cases, due to high evidence of cardiorenal benefits. MF should be avoided in the AM phenotype due to their weight loss property. Although weight loss is not desired in AM phenotype, SGLT-2i may still be preferred with close follow-up in certain individuals demonstrating high cardiovascular disease (CVD) risk. Of note, SGLT-2i should be considered earlier in the diabetes treatment in both groups due to their multiple benefits, i.e., organ protective effects, the potential to reduce polypharmacy, and improve frailty status. The concept of different metabolic phenotypes in frail older adults with diabetes once again shows "one size fits all" cannot be applied in geriatric medicine, and a tailored, individualized approach should be adopted to get the highest benefit from treatments.

Loss of social role awareness, a subdomain of social frailty, is an independent predictor of future adverse events in hospitalized older patients with heart failure

Abstract Background Frailty is a complex syndrome characterized by a decline in functional reserve, and associated with aging and chronic diseases including heart failure (HF). The impact of physical frailty on prognosis and the effect of cardiac rehabilitation in HF patients have been well established. However, the data on the prognostic impact of social frailty (SF) in HF patients is limited. Aims We aimed to get new insight into mechanisms of the association of SF with clinical outcomes in older hospitalized HF patients. Methods A single-center, retrospective cohort study was conducted using data from 308 HF patients aged ≥65 years (mean age of 78±8 years; 49% females) who were admitted to our institute for the management of HF. SF was assessed using the validated Makizako's five questions. The following responses were considered positive for SF: (1) going out less frequently compared with last year; (2) not visiting friends; (3) not talking with someone every day; (4) not feeling helpful toward friends or family; and (5) living alone. SF was defined as two or more positive responses. The primary outcome was composite events defined by all-cause death and cardiovascular events. The missing data were imputed using multiple imputation by chained -equations algorithm. Results Of 308 older HF patients, 189 patients (61%) were SF. Patients with SF were significantly older, had lower body mass index, and a higher percentage of patients with physical frailty and cognitive frailty than those without SF. Seventy-five patients (24%) experienced composite events during a median follow-up period of 1.55-years (interquartile range, 0.88–2.20 years). Kaplan-Meier curves showed a significantly higher composite event rate in patients with SF than those without SF. In multivariate Cox regression analyses, SF was independently associated with a higher composite event rate after adjusting for pre-existing risk factors [adjusted hazard ratio (HR), 1.91; 95% confidence interval (CI), 1.09–3.35; p=0.03] (Figure 1A). In addition, further analyses showed that only the positive response on the question corresponding to the social role – not feeling helpful toward friends or family – among the questionnaire was an independent predictor for the incidence of the composite event (adjusted HR, 2.10; 95% CI, 1.29–3.41; p<0.01, Figure 1B). Inclusion of the response to the question regarding the social role into the baseline prognostic model improved the accuracy of prediction of the composite event (continuous net reclassification improvement, 0.46; 95% CI, 0.21–0.71; p<0.01; integrated discrimination improvement, 0.025; 95% CI 0.004–0.047; p=0.02; Figure 2). Conclusion Loss of social role awareness was associated with increased composite event risk and provided additive prognostic information in older HF patients, suggesting the importance of healthcare professionals' decision-making on the prevention and management of SF. Funding Acknowledgement Type of funding sources: None.

Diagnosis and Management of Frailty in Primary Health Care.

Disability in older adults has become a significant burden, both individually and socially, due to the rapidly aging population in Korea. It is important to manage both frailty and chronic diseases to delay disability. Frailty, which is considered to be a transition phase between healthy status and disability, is defined as a significant decline in functional reserves of multiple organ systems and the resultant extreme vulnerability to stressors, leading to a higher risk of adverse health-related outcomes. The frailty phenotype and frailty index are the most commonly used methods to diagnose frailty. Frailty is related to physical, psychological, cognitive, and social dysfunction, and is sometimes caused by chronic disease. Therefore, primary care providers are ideally situated to incorporate the concept of frailty into their practice, as they are champions in comprehensive care. Although the identification and treatment of frailty is not yet standard practice in primary care, primary care physicians must use the electronic frailty index to identify frailty in all the patients aged ≥65 years in the United Kingdom. In Canada, some insurance companies and governments are using a similar program, which is called the Community Actions and Resources Empowering Seniors model. The clinical practice guidelines of the International Conference of Frailty and Sarcopenia Research, as well as some additional references, will be introduced. Here, we review the current literature on how to diagnose and manage frailty in primary care.

Association between a non‐invasive assessment of frailty and vascular dysfunction in old mice

Advancing age is characterized by not only an increased risk for cardiovascular diseases (CVDs), but also a decline in functional reserve and impaired adaptive capacity across multiple physiologic systems, also known as frailty. Impaired vascular function is a known contributor to CVDs and potentially has a role in increased frailty. In patients with overt disease, measures of frailty are related to vascular endothelial cell dysfunction. However, the relation between vascular endothelial function and frailty in a non‐disease population is unknown. It is also unknown if dysfunction of a particular vascular bed is more closely related to frailty.To examine the relation between vascular function and frailty in the context of similar genetics and environment, we studied wildtype C57BL/6 mice. In young (9 mo, n=7) and old (23–30 mo, n=27) male and female mice, we assessed endothelial‐dependent dilation (EDD) ex vivo in isolated, pressurized mesentery arteries and middle cerebral arteries (MCAs) by measuring the dilation to increasing doses of acetylcholine (ACh, 10−9 to 10−4 M) after pre‐constriction (by phenylephrine, 2 μM). Endothelium‐independent dilation (EID) was assessed by the dose response to sodium nitroprusside (SNP, 10−10 to 10−4 M) after pre‐constriction.Mouse frailty was assessed using a previously established non‐invasive 31‐item frailty index based on clinical signs of deterioration. Clinical assessments included evaluation of the integumentary, musculoskeletal, vestibulocochlear/auditory, ocular, nasal, digestive, urogenital, and respiratory systems as well as body weight, body surface temperature, and signs of discomfort. The severity of each deficit was assessed by two independent observers and assigned a value between 0–1, with a higher score indicating more severe frailty.Frailty index was ~6 fold greater in old compared with young mice (p<0.001). Maximal EDD was 16.1% lower in mesentery arteries (p=0.04) and 11.3% lower in MCAs (p=0.12) for old compared with young mice. Among the old mice, frailty index was correlated with mesentery artery maximal EDD (r=−0.53 p=0.002), and remained significant after controlling for age (partial correlation: r=−0.38, p=0.03). In contrast, there was no correlation between frailty index and MCA maximal EDD among old mice (r=0.16, p=0.21). Among old mice, there was no correlation between frailty index and maximal EID in mesentery arteries or MCAs (p>0.05).This study demonstrates that frailty, independent of age, is associated with mesentery artery endothelial dysfunction in wildtype, non‐diseased mice. However, it remains unknown whether the mesentery artery dysfunction is a cause or consequence of the greater frailty. Interestingly, we found a lack of association between frailty and cerebral artery endothelial function. Future research is needed to determine the mechanisms linking frailty and mesentery artery dysfunction.Support or Funding InformationFunded by NIH R56AG064016

AGE-RELATED FUNCTIONAL RESERVE DECLINE IS NOT SEEN IN PHARYNGEAL SWALLOWING PRESSURES

Age-related decline in functional reserve has been described in tongue strength: tongue pressure during swallowing does not change with age, but maximal-effort isometric tongue pressure decreases with age. Healthy persons show a slight increase in pharyngeal swallowing pressure with age, but it is unknown if there is a similar decline in functional reserve. Fifty-six healthy adults (n=38 60 years) underwent pharyngeal high-resolution manometry during effortful and normal-effort thin liquid swallows. Repeated measures ANOVAs were performed on maximum pressures, pharyngeal contractile integral (PCI), pharyngeal pressure gradients, and upper esophageal sphincter minimum pressures. We hypothesized that older individuals would generate a less-robust pressure increase with effortful swallowing than younger individuals. Maximum pressures, PCI, and gradients increase during effortful swallowing (p<0.001), but there was no interaction effect with age, suggesting a lack of age-related functional reserve decline. Older individuals had greater UES minimum pressures than younger individuals in the effortful swallowing task (p=0.03), which may stem from reduced muscular compliance in this area. These findings do not align with those reported in tongue pressures, suggesting that muscle properties and pressure generation may be fundamentally different between the pharynx and the oral tongue. Alternatively, the effortful swallowing task may not elicit maximum contractility of the pharyngeal musculature. The preserved ability to increase pharyngeal pressure during effortful swallowing may support the use of the effortful swallow exercise in older adults with swallowing disorders.

THE DUKE ELDER FAMILY/CAREGIVER TRAINING (DEFT) PROGRAM

The decline in functional reserves and comorbidities complicate the recovery of older adults following a hospital discharge. Consequently, the assistance of family and friends (caregivers) while convalescing at home is particularly needed. The Duke Elder Family Caregiver Training (DEFT) Center offers a model for an academic-medical-community partnership for integrated caregiver support after hospital discharge. Thus, the goal of this presentation is to describe the conceptualization and structure of the DEFT and describe its preliminary results on caregiver preparedness and readiness for hospital discharge and patient readmission rates. The DEFT leverages the use of EPIC/Maestro for consult from hospital providers and designed its workflow to integrate its teaching as part of Duke’s hospital discharge process. Graduate students from Duke School of Nursing participated in the DEFT caregiver program for course credits. Since 10 months of launching the DEFT caregiver training program, more than 200 consults were received from hospital providers in selected units for caregiver training. Of these, 76 were successfully approached and trained. Analyses of patient data revealed lower 30-day readmission rate of patients whose caregivers received DEFT training compared those who did not (5.9% vs 22%). Overall, an improvement in levels of caregiver preparedness and readiness for hospital discharge was observed within 14 days of training. Lessons learned from the initial launch of DEFT included allowing case managers to write consults for DEFT in addition to physicians and advanced practice providers; optimizing training location for caregiver convenience; and strategizing informational sessions about DEFT for hospital clinicians.

Exercise as a calorie restriction mimetic. Implications for the treatment of age associated frailty

The free radical theory of aging has provided a theoretical framework for an enormous amount of work leading to advances in our understanding of aging. A critical blow to the free radical theory of aging came from epidemiological studies showing that antioxidant supplementation did not lower the incidence of age-associated diseases. However, work from many laboratories supports the theory, for instance showing that overexpression of antioxidant enzymes results in increases not only in life-span but also in health-span. Improving healthy aging means delaying disability. Disability is often preceded by a state characterized by reduced capacity to respond to stressors, caused by a decline in functional reserves. This condition, frailty, might precede by several years the development of disability. We have recently found that a mouse model with overexpression of G6PD have lower levels of ROS-derived damage and this is accompanied by a protection from frailty. Two interventions with translational potential to improve healthy aging are caloric restriction and exercise training. Both of them share a common protective molecular mechanism, a reduction in oxidative damage through the induction of the antioxidant defense.

CAREGIVER SUPPORT AFTER HOSPITAL DISCHARGE: THE DUKE ELDER FAMILY CAREGIVER TRAINING (DEFT) PROGRAM

The decline in functional reserves and comorbidities complicate the recovery of older adults following a hospital discharge. Consequently, the assistance of family and friends (caregivers) while convalescing at home is particularly needed. The Duke Elder Family Caregiver Training (DEFT) Center offers a model for an academic-medical-community partnership for integrated caregiver support after hospital discharge. Under the leadership of the Duke School of Nursing, caregivers referred by Duke Hospital providers receive education and training in home care from Duke learners in Nursing, Medicine, Physical Therapy programs. Video technology is used for real-time observation of skills and communication at home. The DEFT collaborates with community-based agencies for resources and activation of lay volunteers for instrumental support. The DEFT aims to increase caregiver preparation for home care reduce preventable health care utilization among patients, and increase competence among learners in interprofessional care and care transitions. Preliminary data will be discussed in the presentation.

Telomere length is a prognostic biomarker in elderly advanced ovarian cancer patients: a multicenter GINECO study.

Age induces a progressive decline in functional reserve and impacts cancer treatments. Telomere attrition leads to tissue senescence. We tested the hypothesis that telomere length (TL) could predict patient vulnerability and outcome with cancer treatment. An ancillary study in the Elderly Women GINECO Trial 3 was performed to evaluate the impact of geriatric covariates on survival in elderly advanced ovarian cancer patients receiving six cycles of carboplatin. TL was estimated from peripheral blood at inclusion using standard procedures. TL (in base pairs) was estimated for 109/111 patients (median 6.1 kb; range [4.5-8.3 kb]). With a cut-off of 5.77 kb, TL discriminated two patient groups, long telomere (LT) and short telomeres (ST), with significantly different treatment completion rates of 0.80 (95% CI [0.71-0.89]) and 0.59 (95% CI [0.41-0.76]), respectively (odds ratio [OR]=2.8, p=0.02). ST patients were at higher risk of serious adverse events (SAE, OR=2.7; p=0.02) and had more unplanned hospital admissions (OR=2.1; p=0.08). After adjustment on FIGO stage, TL shorter than 6 kb was a risk factor of premature death (HR=1.57; p=0.06). This exploratory study identifies TL as predictive factor of decreased treatment completion, SAE risk, unplanned hospital admissions and OS after adjustment on FIGO stage.

Low HbA1c and Increased Mortality Risk-is Frailty a Confounding Factor?

Diabetes mellitus is increasingly becoming an older person disease due to the increased survival and aging of the population. Previous studies which showed benefits of tight glycemic control and a linear relationship between HbA1c and mortality have largely included younger patients newly diagnosed with diabetes and with less comorbidities. Recent studies, which included older population with diabetes, have shown a U-shaped relationship of increased mortality associated with low HbA1c. The mechanism of such relationship is unclear. There was no direct causal link between low HbA1c and mortality. It appears that malnutrition, inflammation and functional decline are characteristics shared by the populations that showed increased mortality and low HbA1c. In these studies functional status, disability or frailty was not routinely measured. Therefore, although adjustment for comorbidities was made there may be a residual confounding by unmeasured factors such as frailty. Thus, frailty or decline in functional reserve may be the main confounding factor explaining the relationship between increased mortality risk and low HbA1c.

Efficacy of Systemic Postoperative Pulmonary Rehabilitation After Lung Resection Surgery.

ObjectiveTo investigate the efficacy of systemic pulmonary rehabilitation (PR) after lung resection in patients with lung cancer.MethodsForty-one patients undergoing lung resection were enrolled and classified into the experimental (n=31) and control groups (n=10). The experimental group underwent post-operative systemic PR which was conducted 30 min/day on every hospitalization day by an expert physical therapist. The control group received the same education about the PR exercises and were encouraged to self-exercise without supervision of the physical therapist. The PR group was taught a self-PR program and feedback was provided regularly until 6 months after surgery. We conducted pulmonary function testing (PFT) and used a visual analog scale (VAS) to evaluate pain, and the modified Borg Dyspnea Scale (mBS) to measure perceived respiratory exertion shortly before and 2 weeks, 1, 3, and 6 months after surgery.ResultsA significant improvement on the VAS was observed in patients who received systemic PR >3 months. Significant improvements in forced vital capacity (FVC) and mBS score were observed in patients who received systemic PR >6 months (p<0.05). Other PFT results were not different compared with those in the control group.ConclusionPatients who received lung resection suffered a significant decline in functional reserve and increases in pain and subjective dyspnea deteriorating quality of life (QoL). Systemic PR supervised by a therapist helped improve reduced pulmonary FVC and QoL and minimized discomfort during the postoperative periods in patients who underwent lung resection.

Age-related Health Problems and Social Issues of Elderly

Age-associated changes are most pronounced in advanced age of 65 years or older, may alter the older person's response to illness, show great variability among individuals, are often impacted by genetic and long-term lifestyle factors, and commonly involve a decline in functional reserve with reduced response to stressors. Gerontological changes are important in nursing assessment and care because they can adversely affect health and functionality and require therapeutic strategies; must be differentiated from pathological processes to allow development of appropriate interventions; predispose to disease, thus emphasizing the need for risk evaluation of the older adult; and can interact reciprocally with illness, resulting in altered disease presentation, response to treatment, and outcomes.

Geriatric Evaluation of Oncological Elderly Patients

Cancer has a high prevalence in older age. The management of cancer in the older aged person is an increasingly common problem. Age may be construed as a progressive loss of stress tolerance, due to decline in functional reserve of multiple organ systems, high prevalence of comorbid conditions, limited socioeconomic support, reduced cognition, and higher prevalence of depression. In the elderly, the comorbidities and physiological changes in the pharmacokinetics reduce the prospective for therapy and suggest the importance of a multidimensional assessment of cancer patients as well as the formulation of predictive models of risk, in order to estimate the life expectancy and tolerance to treatment. The pharmacological changes of age include decreased renal excretion of drugs and increased susceptibility to myelosuppression, mucositis, cardio toxicity and neurotoxicity. The chemotherapy in patients older than 75 years is very limited. The geriatric assessment is considered a valid tool in geriatric medical. It is important for two main reasons: first of all, for the need to distinguish the features linked to the geriatric syndromes from those ones which are strictly connected to the cancer pathology; secondly, for its potential prognostic value.

Under-Representation of Older Adults in Cancer Registration Trials: Known Problem, Little Progress

The oncology literature from the last decade is replete with articleslamentingthescarcityofdatatoguidetreatmentdecisionsforthe elderly population with cancer. With the aging of the United States and worldwide population and the known association between older ageandcancer, 1 cliniciansandresearchersunderstandtheimportance of studying the efficacy and toxicity of cancer therapies in this at-risk population. The importance of this knowledge is highlighted by the US Food and Drug Administration in its Guideline for the Study of Drugs Likely to Be Used in the Elderly, 2 which advocates enrollment of older adults in clinical trials as a means to understand treatment effects among differing populations. Almostadecadeago,JournalofClinicalOncologyhighlightedthe under-representation of older adults in registration trials for new cancertherapiesfrom1992to2002.Talaricoetal 3 showedtheproportions enrolled onto registration trials versus the proportions in the overall populations age 65, 70, and 75 years were 36%, 20%, and9%comparedwith60%,46%,and31%,respectively.Theauthors surmised that decline in functional reserve, increased comorbid con

Monitored Anaesthesia Care in the Elderly

As the number of elderly patients undergoing surgery continues to rise, it is important to consider anaesthetic options that minimize physiological stress in these patients. Monitored anaesthesia care (MAC), or sedation and monitoring during surgery, is an attractive option for certain common procedures. However, those administering MAC must consider the normal decline in functional reserve in patients aged >70 years. This includes loss of normal compensation for the stress of hypovolaemia, decreased peripheral vascular resistance, altered mental status and reduced response to hypoxia and hypercarbia associated with the perioperative and sedated state in this population. In addition, vigilance is necessary to identify co-morbid states, which increase in incidence with age and often present atypically. Elderly patients have increased sensitivity to all sedatives and opioids (doubled by age 80 years, quadrupled by age 90 years with benzodiazepines). As a result of changes in body composition, as well as senescence of renal and hepatic function, the time to onset and offset of even short-acting sedatives will be prolonged. There is also extreme variability in the response to sedatives among these patients. Anaesthetic dosing should be in smaller increments in the elderly, boluses reduced by half and infusions reduced by as much as two-thirds. Caution must be exercised through full monitoring of intra-operative and postoperative mental status, oxygenation and perfusion states. Pain is best treated using smaller doses in a multimodal regimen, the aim being to reduce adverse effects while ensuring adequate pain relief. In this way, a huge range of procedures can be safely performed in our aging population with expectations for a full and early return to baseline functional status.

Molecular biology of aging.

Aging seems to reflect a patterned program of decline in functional reserves and a reduced ability to maintain homeostasis. Advances in molecular biology have provided new insights into the process of aging at the cellular level. In this review, a few selected models of aging that illustrate the molecular methods and techniques used in aging research are discussed.

Management of cancer in the older person: a practical approach.

The management of cancer in the older aged person is an increasingly common problem. The questions arising from this problem are: Is the patient going to die with cancer or of cancer? Is the patient able to tolerate the stress of antineoplastic therapy? Is the treatment producing more benefits than harm? This article explores a practical, albeit evolving, approach to these questions including a multidimensional assessment of the older person and simple pharmacologic interventions that may ameliorate the toxicity of antineoplastic agents. Age may be construed as a progressive loss of stress tolerance, due to decline in functional reserve of multiple organ systems, high prevalence of comorbid conditions, limited socioeconomic support, reduced cognition, and higher prevalence of depression. Aging is highly individualized: chronologic age may not reflect the functional reserve and life expectancy of an individual. A comprehensive geriatric assessment (CGA) best accounts for the diversities in the geriatric population. The advantages of the CGA include:Recognition of potentially treatable conditions such as depression or malnutrition, that may lessen the tolerance of cancer treatment and be reversed with proper intervention; Assessment of individual functional reserve; Gross estimate of individual life expectancy; and Adoption of a common language to classify older cancer patients. The CGA allows the practitioner to recognize at least three stages of aging:People who are functionally independent and without comorbidity, who are candidates for any form of standard cancer treatment, with the possible exception of bone marrow transplant. People who are frail (dependence in one or more activities of daily living, three or more comorbid conditions, one or more geriatric syndromes), who are a candidate only for palliative treatment; and People in between, who may benefit from some special pharmacological approach, such as reduction in the initial dose of chemotherapy with subsequent does escalations. The pharmacological changes of age include decreased renal excretion of drugs and increased susceptibility to myelosuppression, mucositis, cardiotoxicity and neurotoxicity. Based on these findings, the proposal was made that all persons aged 70 and older, treated with cytotoxic chemotherapy of dose intensity comparable to CHOP, receive prophylactic growth factor treatment, and that the hemoglobin of these patients be maintained >/=12 gm/dl.

Physical Inactivity and Coronary Heart Disease in Elderly Patients

Because physicians are viewed as reliable sources of health information, and because of the substantial number of physician contacts with elderly patients both with and without coronary heart disease, physician advice regarding the adoption of regular patterns of moderate-intensity physical activity has the potential to favorably improve coronary risk in the elderly. Guidelines for exercise programs for elderly individuals have been available for a number of years. The message should emphasize the adverse consequences of chronic inactivity and highlight that even modest increases in the level of habitual physical activity in older adults can limit decline in functional reserve, improve functional capacity, decrease coronary risk, and lessen mortality.

Reviews, Notes, and Listings: Geriatrics: Endocrinology and Metabolism in the Elderly

Literature of Medicine15 July 1993Reviews, Notes, and Listings: Geriatrics: Endocrinology and Metabolism in the ElderlyDavid R. Rovner, MDDavid R. Rovner, MDMichigan State University, East Lansing, MI 48824-1317.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-2-199307150-00040 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Endocrinology and Metabolism in the ElderlyJohn E. Morley and Stanley G. Korenman. 567 pages. Boston: Blackwell Scientific Publications; 1992. $124.95.Twenty years ago, I was asked to give a lecture in a human development course about the endocrine changes associated with middle and old age. A literature search at that time allowed me to give a 10-minute lecture, stating that little happened to (or at least little was known about) the endocrine system as humans aged. Since then, a literature explosion has occurred, with articles documenting the gradual decline in functional reserve in all parts of the endocrine system with aging. ... Author, Article, and Disclosure InformationAffiliations: Michigan State University, East Lansing, MI 48824-1317. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 July 1993Volume 119, Issue 2Page: 175-176KeywordsAgingDiabetes mellitusElderlyEndocrine physiologyEndocrine systemEndocrinologyGeriatricsMemoryOsteoporosisSympathetic nervous system ePublished: 15 August 2000 Issue Published: 15 July 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...