Health Of Older Men Research Articles

Abstract 4179: The Association of Sex Hormones with Arterial Compliance Differs Between Men and Women in the Multi-Ethnic Study of Atherosclerosis (MESA)

Studies show differences in vascular stiffness between older men and women. However, the relationship between sex hormones (SH) and vascular stiffness has not been studied. We examined the cross sectional association between endogenous SH (bioavailable testosterone, BioT; estradiol, E2; dehydroepiandrostenedione, DHEA; and sex-hormone binding globulin, SHBG) and carotid vascular compliance in men and women in MESA. Methods: We included 2966 men and 1886 postmenopausal women who were not on hormone therapy (45– 84 years, 35% white, 13% Chinese, 27% African-American, 24% Hispanic ethnicity). Baseline systolic and diastolic blood pressure (BP) were measured during carotid ultrasound examination. Carotid strain, a measure of distensibility (fractional change in carotid diameter) was measured from B-mode images. Because men and women differed in the relationship between strain and BP, analyses were performed separately by sex. Log-transformed carotid strain was regressed on log-transformed SH adjusting for log-transformed BP, age, race, glucose, smoking, and BMI. All SH were included in the same model. Differences of coefficients between men and women were evaluated by examining their standard errors. Results: Carotid strain was 6.8±2.7% in men and 7.0±3.2% in women (p=0.027). In regression analysis (Table ), in men, E2 was significantly associated with lesser carotid strain (increased stiffness) while the BioT was associated with borderline significance to higher strain. In women, there was no association between either E2 or T and carotid strain. DHEA and SHBG were not associated with compliance. No race interaction was found with these associations. Conclusion: E2 is associated with greater arterial stiffness in men, while BioT is weakly associated with lesser stiffness. Sex hormones are not associated with arterial stiffness in women. The hyperestro-genic hypoandrogenic state may impair vascular health in older men. Carotid Strain and Sex Hormones

The Dehydroepiandrosterone And WellNess (DAWN) study: Research design and methods

Levels of dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEAS), the major secretory products of the adrenal gland, decline dramatically with age, concurrent with the onset of degenerative changes and chronic diseases associated with aging. Epidemiological evidences in humans and animal studies suggest that DHEA(S) may have cardioprotective, antiobesity, antidiabetic, and immuno-enhancing properties. These observations led to the proposal that restoration of DHEA to young adult levels may have beneficial effects on age-related conditions. Most clinical trials of DHEA replacement have been limited due to small samples and short duration, restriction to one sex, failure to adjust for baseline endogenous hormone level and age, or lack of placebo comparison groups. We designed a double blind, placebo-controlled randomized trial to determine the acceptability, benefits, and adverse effects of 50 mg daily oral DHEA replacement for one year in 110 men and 115 women, aged 55 to 85, who were healthy and not currently using hormone therapy. A wide range of biological outcomes were studied including bone mineral density and metabolism, body composition and muscle strength, immune function, and cardiovascular risk factors. Steroid hormone levels, bone markers, cytokines, and the IGF-I, IGF binding protein system were measured at baseline and at 3 follow-up clinic visits. Changes in mood and well-being, cognitive function, and sexuality were assessed. Information on potentially confounding covariates such as smoking, alcohol consumption, exercise, diet and dietary supplements were obtained, and potential adverse effects of DHEA administration were monitored. This study enables an examination of the benefits of DHEA administration on the health of older men and women, and the influence of gender, age, and baseline endogenous DHEA level on each outcome variable. Potential mechanisms of DHEA action, including the biotransformation of DHEA to active steroids and steroid metabolites, enhancement of IGF-I bioavailability, and inhibition of IL-6 production can also be evaluated.

Effect of Exercise on Blood Pressure in Older Persons

Because of age-related differences in the cause of hypertension, it is uncertain whether current exercise guidelines for reducing blood pressure (BP) are applicable to older persons. Few exercise studies in older persons have evaluated BP changes in relation to changes in body composition or fitness. This was a 6-month randomized controlled trial of combined aerobic and resistance training; controls followed usual care physical activity and diet advice. Participants (aged 55-75 years) had untreated systolic BP (SBP) of 130 to 159 mm Hg or diastolic BP (DBP) of 85 to 99 mm Hg. Fifty-one exercisers and 53 controls completed the trial. Exercisers significantly improved aerobic and strength fitness, increased lean mass, and reduced general and abdominal obesity. Mean decreases in SBP and DBP, respectively, were 5.3 and 3.7 mm Hg among exercisers and 4.5 and 1.5 mm Hg among controls (P < .001 for all). There were no significant group differences in mean SBP change from baseline (-0.8 mm Hg; P=.67). The mean DBP reduction was greater among exercisers (-2.2 mm Hg; P=.02). Aortic stiffness, indexed by aortofemoral pulse-wave velocity, was unchanged in both groups. Body composition improvements explained 8% of the SBP reduction (P = .006) and 17% of the DBP reduction (P<.001). A 6-month program of aerobic and resistance training lowered DBP but not SBP in older adults with mild hypertension more than in controls. The concomitant lack of improvement in aortic stiffness in exercisers suggests that older persons may be resistant to exercise-induced reductions in SBP. Body composition improvements were associated with BP reductions and may be a pathway by which exercise training improves cardiovascular health in older men and women.

Male osteoporosis: Epidemiology and pathophysiology

In men, osteoporosis is a prevalent problem that is under-recognized and undertreated. Men 50 years and older have a 13% lifetime risk for fracture. Hip and vertebral fractures are associated with significant functional impairment and increased mortality in men. The morbidity and mortality following a fracture is also greater in men than it is in women. By improving our knowledge on the pathophysiology of osteoporosis in men, better management strategies for this condition may be developed. In recent years, there has been greater awareness of the biomechanic factors that contribute to bone strength, which may explain some of the differences in fracture incidence between men and women. There is also growing evidence to support the key role of estrogens in maintaining bone health in older men, similar to women. This review highlights our current understandings on the epidemiology and pathophysiology of male osteoporosis and its related fractures, with particular focus on the determinants of bone strength and the role of sex hormones on bone metabolism in men.

The Impact of Age, Gender, and Race on the Relationship Between Depression and Self-Rated Health in Community-Dwelling Older Adults: A Longitudinal Study

ABSTRACT Objective: To examine whether the prediction of baseline depression for subsequent changes in self-rated health is consistent across different age cohorts, gender, and racial groups. Data Sources and Study Setting: A total of 6,714 participants who were 65 years old or older and took part in both the first and the second wave of Assets and Health Dynamics among the Oldest-Old (AHEAD) national survey of community-dwelling older adults were examined. Study Design: A two-year prospective cohort study. Principle Findings: Baseline depression was an independent risk factor, which not only decreased the odds of having substantial improvement in self-rated health but also increased the possibility of having substantial decline in self-rated health in older men and women, and in Blacks and Whites of all age groups. Conclusions: Early prevention and treatment of depression among community-dwelling older adults may not only reduce their health decline but also promote their health.

Social class differences in health and functional disability among older men and women.

The aims of the study were to describe the health of older men and women and to investigate the social patterning of health and functional disability among older men and women, with special reference to social class differences. The data were derived from the 1994 nationwide Finnish Survey on Living Conditions (N = 1,448). Functional disability, limiting long-standing illness, and self-assessed health were used as health measures. Sociodemographic measures were social class, marital status, and urbanization. The age-adjusted social class differences were clear. Farmers and workers reported more functional disability and poorer health than did the white-collar class. Differences were somewhat smaller among women than among men. Social class was a stronger determinant than urbanization and marital status of functional disability and health.

CONTEXTUALIZING SOCIAL SUPPORT AND HEALTH IN OLD AGE:RECONSIDERING CULTURE AND GENDER

In this paper we develop a conceptual model of the cultural context within which gender and social support affect health among the elderly. We argue that given the highly contextualized and subjective nature of social support, observed associations between social contacts and health cannot be explained using simple survey probes concerning contacts during some period. The research employs two large surveys of older blacks and Hispanics to illustrate the speculative nature of any explanation of the association among various social contacts, disability, and death that are based only on responses to questions concerning the presence or absence of specific contacts. We end with a call for an extension of what is currently common practice in the study of social support and health to include greater attention to the subjective nature of social support and a greater appreciation of the cultural and social contexts within which social support operates to influence the health of older men and women.

SMOKING AND THE HEALTH OF OLDER MEN. II. SMOKING AND VENTILATORY FUNCTION.

SMOKING AND THE HEALTH OF OLDER MEN. II. SMOKING AND VENTILATORY FUNCTION.

Smoking and the health of older men. I. Smoking and chronic cough.

Smoking and the health of older men. I. Smoking and chronic cough.

WORK AND RETIREMENT: INFLUENCES ON THE HEALTH OF OLDER MEN

WORK AND RETIREMENT: INFLUENCES ON THE HEALTH OF OLDER MEN