Loss In Older Adults Research Articles

Obesity and disability in older adults.

The prevalence of obesity and disability in older adults has significant public health implications. This case review discusses the benefits and risks of weight loss in older adults and outlines treatment options available to Medicare beneficiaries. The importance of preserving lean muscle mass in weight management is emphasized.

Behavioral Mediators of Weight Loss in Two Group-based Behavioral Interventions in Older Adults

ABSTRACTBackground: Understanding the mechanisms by which behavioral interventions exert their effects is important. Purpose: To examine behavioral mediators of weight loss in a sample of older adults participating in an evidence-based physical activity (PA) or nutrition intervention. Methods: Participants (n = 46) were randomized to a 12-week, group-based PA or nutrition intervention. Self-reported dietary behaviors and objectively measured PA and weight were measured at baseline and 12 weeks. A multiple mediator model examined whether PA, fruit and vegetable (F&V) consumption, and fat- and fiber-related behaviors mediated weight loss. Results: Improvements in fiber-related behaviors was a significant mediator of weight loss among those in the nutrition intervention group. PA, F&V consumption, and fat-related behaviors were not significant mediators. Discussion: Understanding how interventions exert their effects on health-related outcomes such as weight loss is critical in order to create the most effective interventions aimed at improving the health of older adult populations. Translation to Health Education Practice: Evidence-based behavioral interventions that utilize a lifestyle approach to elicit behavior change provide a feasible, low-cost option for practitioners that can easily be adapted and disseminated across various populations. Interventions focused on weight loss in older adults may want to make concerted efforts aimed at improving fiber-related behaviors.

Noninvasive Stimulation of Prefrontal Cortex Strengthens Existing Episodic Memories and Reduces Forgetting in the Elderly

Memory consolidation is a dynamic process. Reactivation of consolidated memories by a reminder triggers reconsolidation, a time-limited period during which existing memories can be modified (i.e. weakened or strengthened). Episodic memory refers to our ability to recall specific past events about what happened, including where and when. Difficulties in this form of long-term memory commonly occur in healthy aging. Because episodic memory is critical for daily life functioning, the development of effective interventions to reduce memory loss in elderly individuals is of great importance. A previous study in young adults showed that the dorsolateral prefrontal cortex (DLPFC) plays a causal role in strengthening of verbal episodic memories through reconsolidation. The aim of the present study was to explore the extent to which facilitatory transcranial direct current stimulation (anodal tDCS) over the left DLPFC would strengthen existing episodic memories through reconsolidation in elderly individuals. On Day 1, older adults learned a list of 20 words. On Day 2 (24h later), they received a reminder or not, and after 10 minutes tDCS was applied over the left DLPFC. Memory recall was tested on Day 3 (48h later) and Day 30 (1 month later). Surprisingly, anodal tDCS over the left DLPFC (i.e. with or without the reminder) strengthened existing verbal episodic memories and reduced forgetting compared to sham stimulation. These results provide a framework for testing the hypothesis that facilitatory tDCS of prefrontal cortex might strengthen existing episodic memories and reduce memory loss in older adults with amnesic mild cognitive impairment.

New Treatment Modalities for Neovascular Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) is considered one of the main causes of severe vision loss in older adults. The neovascular form (nAMD) is an advanced stage, which is responsible for the most severe vision loss. Vascular endothelial growth factor (VEGF) is at present the main factor that leads to the development of a neovascular membrane and the increased leakage from the membrane to the retina. At present, anti-VEGF therapy is the only treatment that achieves vision gains in many patients and halts progression in most of them. VEGF blockade can be achieved with several molecules and various treatment regimens, which have been studied with excellent results. Unfortunately, real-world data has shown to be far less efficacious than clinical trials. This gap between clinical trials and real-world results is an unmet medical need that supports the necessity of new treatment modalities for nAMD. Of the various treatments being studied, anti-VEGFs of higher efficacy and longer durability are those more advanced in their development. Brolucizumab and abicipar pegol are 2 new anti-VEGF drugs that had positive results in phase 2 studies and are being tested in phase 3 trials at present. Other promising therapies are antiangiopoietin 2 molecules, which are in phase 2 development. At earlier stages of development but with promising results are squalamine, anti-VEGF-C and -D, and gene therapy. The future will give retina specialists a broad armamentarium with which patients may achieve high visual gains for the long term with a low treatment burden.

The effects of milk intake and whole-body vibration exercise on bone mineral density in elderly women in nursing homes.

[Purpose] This study was designed to investigate the effects of lactose-free milk intake and whole-body vibration exercises on bone density in elderly female nursing home residents who had difficulty exercising outdoors and had not consumed milk. [Subjects and Methods] Twenty seven elderly women aged 70 or older from 3 nursing homes located in Incheon, Korea participated in the study. The experimental group (n=13) carried out whole-body vibration exercises and drank lactose-free milk, while the control group (n=14) continued to live their ordinary nursing home lives. Weight, BMI, T-scores, and Z-scores were compared between the experimental and control groups after 12 weeks. [Results] The comparison of changes in weight and BMI in the control group before and after the 12-week experiment found no statistically significant differences. However, bone mineral density was significantly different, with the T-score significantly decreasing from −2.99 to −3.48 and the Z-score decreasing from −1.87 to −2.58. The other comparisons of physical changes in the control group before and after the 12-week experiment found no statistical significance. [Conclusion] The results indicate that regular consumption of lactose-free milk and performing whole-body vibration exercises can delay the progression of bone density loss in older adults in nursing homes; adequate exercise and calcium intake could eventually help prevent fractures.

Incidence of Tooth Loss in Adults: A 4-Year Population-Based Prospective Cohort Study.

Objective To verify the incidence of tooth loss in extended age group of adults in 4 years. Materials and Methods The prospective cohort study assessed adults (20–64 years old) between 2011 and 2015, from Piracicaba, São Paulo, Brazil. The dependent variable was cumulative incidence of tooth loss, assessed by difference between missing teeth (M) of decayed, missing, and filled tooth index (DMFT) in 2011 and 2015. Participants were stratified into young (20–44 years old) and older (45–64 years old) adults. Mann–Whitney U test (p < 0.05) was used to compare the means of incidence of tooth loss between age groups. Results After four years, 57.7% (n = 143) of adults were followed up and the mean incidence of tooth loss was 0.91 (SD = 1.65); among these, 51 adults (35.7%) who lost their teeth showed mean tooth loss of 2.55 (SD = 1.86). In older adults, incidence of tooth loss was higher (p = 0.008), but no difference between age groups was found when only adults with incidence of tooth loss were assessed (p = 0.844). Conclusion There was higher incidence of tooth loss in older adults after four years, however, without difference between age groups when only those who lost teeth were evaluated.

Changed crossmodal functional connectivity in older adults with hearing loss

Previous work compellingly demonstrates a crossmodal plastic reorganization of auditory cortex in deaf individuals, leading to increased neural responses to non-auditory sensory input. Recent data indicate that crossmodal adaptive plasticity is not restricted to severe hearing impairments, but may also occur as a result of high-frequency hearing loss in older adults and affect audiovisual processing in these subjects. We here used functional magnetic resonance imaging (fMRI) to study the effect of hearing loss in older adults on auditory cortex response patterns as well as on functional connectivity between auditory and visual cortex during audiovisual processing. Older participants with a varying degree of high frequency hearing loss performed an auditory stimulus categorization task, in which they had to categorize frequency-modulated (FM) tones presented alone or in the context of matching or non-matching visual motion. A motion only condition served as control for a visual take-over of auditory cortex. While the individual hearing status did not affect auditory cortex responses to auditory, visual, or audiovisual stimuli, we observed a significant hearing loss-related increase in functional connectivity between auditory cortex and the right motion-sensitive visual area MT+ when processing matching audiovisual input. Hearing loss also modulated resting state connectivity between right area MT+ and parts of the left auditory cortex, suggesting the existence of permanent, task-independent changes in coupling between visual and auditory sensory areas with an increasing degree of hearing loss. Our data thus indicate that hearing loss impacts on functional connectivity between sensory cortices in older adults.

Age-related hearing loss in older adults with cognitive impairment.

Hearing loss can impair effective communication between caregivers and individuals with cognitive impairment. However, hearing loss is not often measured or addressed in care plans for these individuals. The aim of this study is to measure the prevalence of hearing loss and the utilization of hearing aids in a sample of individuals with cognitive impairment in a tertiary care memory clinic. A retrospective review of 133 charts of individuals >50 years who underwent hearing assessment at a tertiary care memory clinic over a 12-month period (June 2014-June 2015) was undertaken. Using descriptive statistics, the prevalence of hearing loss was determined and associations with demographic variables, relevant medical history, cognitive status, and hearing aid utilization were investigated. Results indicate that hearing loss is highly prevalent among this sample of cognitively impaired older adults. Sixty percent of the sample had at least a mild hearing loss in the better hearing ear. Among variables examined, age, MMSE, and medical history of diabetes were strongly associated with hearing impairment. Hearing aid utilization increased in concordance with severity of hearing loss, from 9% to 54% of individuals with a mild or moderate/severe hearing loss, respectively. Hearing loss is highly prevalent among older adults with cognitive impairment. Despite high prevalence of hearing loss, hearing aid utilization remains low. Our study highlights the importance of hearing evaluation and rehabilitation as part of the cognitive assessment and care management plan in this vulnerable population.

Impact on weight and physical function of intensive medical weight loss in older adults with stage II and III obesity.

A 6-month pilot trial compared two strategies for weight loss in older adults with body mass indexes (BMIs) ≥35 kg/m(2) to assess weight loss response, safety, and impact on physical function. Twenty-eight volunteers were randomized to a balanced deficit diet (BDD) (500 kcal/day below estimated energy needs) or an intensive, low-calorie, meal replacement diet (ILCD, 960 kcal/day). Behavioral interventions and physical activity prescriptions were similar for both groups. Primary outcomes were changes in body weight and adverse event frequency; secondary outcomes included measures of physical function and body composition. ILCD average weight change was -19.1 ± 2.2 kg or 15.9 ± 4.6% of initial body weight compared with -9.1 ± 2.7 kg or 7.2 ± 1.9% for BDD. ILCD lost more fat mass (-7.7 kg, 95% CI [-11.9 to -3.5]) but had similar loss of lean mass (-1.7 kg, 95% CI [-4.1 to 0.6]) compared with BDD. There were no significant differences in change in physical function or adverse event frequency. Compared with a traditional BDD intervention, older adults who have severe obesity treated with intensive medical weight loss had greater weight loss and decreases in fat mass without a higher frequency of adverse events. In the short term, however, this did not translate into greater improvements in physical function.

SENSORY LOSS IN OLDER ADULTS AT RISK OF COGNITIVE IMPAIRMENT PREDICTS NEUROPSYCHIATRIC SYMPTOM–RELATED DISTRESS AMONG THEIR IMMEDIATE FAMILY MEMBERS

SENSORY LOSS IN OLDER ADULTS AT RISK OF COGNITIVE IMPAIRMENT PREDICTS NEUROPSYCHIATRIC SYMPTOM–RELATED DISTRESS AMONG THEIR IMMEDIATE FAMILY MEMBERS

Markers of Overall Nutritional Status and Incident Hearing Impairment in Community-Dwelling Older Japanese: The Kurabuchi Study.

To examine the association between four markers of overall nutritional status (a serum biomarker (albumin) and three anthropometric indices (body mass index (BMI), midarm circumference (MAC), calf circumference (CC))) and incident hearing impairment in older Japanese adults. Community-based prospective cohort study. Kurabuchi Town, Gunma Prefecture, Japan. Individuals aged 65 and older (143 men, 195 women) without hearing impairment at baseline examination (2005-06) who participated in repeated examinations 4 years later (2009-10) (N = 338). The three anthropometric indices were measured at baseline, and nephelometry was used to assess serum albumin levels. Hearing impairment was defined as failure to hear a 30-dB hearing level signal at 1 kHz and a 40-dB signal at 4 kHz in the better ear on pure-tone audiometry. Over the 4-year period, 16.3% of participants developed hearing impairment. Those with lower marker values had greater risk of hearing impairment than those with higher marker values (multivariable adjusted odds ratio (aOR) = 2.18, 95% confidence interval (CI) = 1.05-4.57 for albumin ≤4.0 g/dL; aOR = 2.72, 95% CI = 1.10-6.71 for BMI <19.0 kg/m(2) ). The pattern of association showed a similar tendency for MAC and CC. Excluding obese participants did not changed the results substantially. Further research is needed to determine whether interventions that improve markers of nutritional status may help prevent age-related hearing loss in older adults.

Weight Regain Following Intentional Weight Loss in Older Adults

Weight gain results from an imbalance of dietary intake and energy expenditure, and rates of overweight and obesity remain high in our society. Although weight loss is achievable, most subjects who participate in weight loss studies will regain weight and consequently recidivism remains a problem. The effectiveness of maintenance therapy is a continuing area of investigation as various dietary, behavioral, and physical activity strategies are either being investigated or are recommended. This chapter will also introduce mechanisms proposed for weight regain after intentional weight loss and the influence of weight regain on metabolic risk in adults.

Effects of dietary protein intake on body composition changes after weight loss in older adults: a systematic review and meta-analysis.

The impact of dietary protein on body composition changes after older adults purposefully lose weight requires systematic evaluation : This systematic review and meta-analysis assessed the effects of protein intake (< 25% vs ≥ 25% of energy intake or 1.0 g/kg/d) on energy restriction-induced changes in body mass, lean mass, and fat mass in adults older than 50 years. PubMed, Cochrane, Scopus, and Google Scholar were searched using the keywords "dietary proteins," "body composition," "skeletal muscle," and "muscle strength." Two researchers independently screened 1542 abstracts. Information was extracted from 24 articles. Twenty randomized control trials met the inclusion criteria. Older adults retained more lean mass and lost more fat mass during weight loss when consuming higher protein diets.

Care of Older Adults: Role of Primary Care Physicians in the Treatment of Cataracts and Macular Degeneration.

This article aims to facilitate optimal management of cataracts and age-related macular degeneration (AMD) by providing information on indications, risk factors, referral guidelines, and treatments and to describe techniques to maximize quality of life (QOL) for people with irreversible vision loss. A review of PubMed and other online databases was performed for peer-reviewed English-language articles from 1980 through August 2012 on visual impairment in elderly adults. Search terms included vision loss, visual impairment, blind, low vision, QOL combined with age-related, elderly, and aging. Articles were selected that discussed vision loss in elderly adults, effects of vision impairment on QOL, and care strategies to manage vision loss in older adults. The ability of primary care physicians (PCPs) to identify early signs of cataracts and AMD in individuals at risk of vision loss is critical to early diagnosis and management of these common age-related eye diseases. PCPs can help preserve vision by issuing aptly timed referrals and encouraging behavioral modifications that reduce risk factors. With knowledge of referral guidelines for soliciting low-vision rehabilitation services, visual aids, and community support resources, PCPs can considerably increase the QOL of individuals with uncorrectable vision loss. By offering appropriately timed referrals, promoting behavioral modifications, and allocating low-vision care resources, PCPs may play a critical role in preserving visual health and enhancing the QOL for the elderly population.

Optical Coherence Tomography Angiography of Type 1 Neovascularization in Age-Related Macular Degeneration.

Age-related macular degeneration continues to be the leading cause of severe central vision loss in older adults of European descent. Optical coherence tomography angiography (OCT-A) enables more accurate identification of type 1 neovascularization in age-related macular degeneration than traditional fluorescein and indocyanine green angiographies. In addition, OCT-A facilitates the morphological classification of type 1 lesions, including features characteristic of early, mature, and fibrotic lesions. Vessel complex analysis, including lesion area and capillary density quantification, can also be readily measured and monitored over time. Performing this analysis following anti-vascular endothelial growth factor therapy may lead to a better understanding of the efficacies and responses to such treatments. Although some limitations currently exist, OCT-A is a promising imaging modality that could prove to have profound implications if incorporated into regular clinical practice.

Selective attrition and intraindividual variability in response time moderate cognitive change

ABSTRACTObjectives: Selection of a developmental time metric is useful for understanding causal processes that underlie aging-related cognitive change and for the identification of potential moderators of cognitive decline. Building on research suggesting that time to attrition is a metric sensitive to non-normative influences of aging (e.g., subclinical health conditions), we examined reason for attrition and intraindividual variability (IIV) in reaction time as predictors of cognitive performance. Method: Three hundred and four community dwelling older adults (64–92 years) completed annual assessments in a longitudinal study. IIV was calculated from baseline performance on reaction time tasks. Multilevel models were fit to examine patterns and predictors of cognitive change. Results: We show that time to attrition was associated with cognitive decline. Greater IIV was associated with declines on executive functioning and episodic memory measures. Attrition due to personal health reasons was also associated with decreased executive functioning compared to that of individuals who remained in the study. Discussion: These findings suggest that time to attrition is a useful metric for representing cognitive change, and reason for attrition and IIV are predictive of non-normative influences that may underlie instances of cognitive loss in older adults.

The importance of hearing: a review of the literature on hearing loss for older people with learning disabilities

Accessible summary It is important to be aware of hearing loss as it affects everyday life and gets worse with age in all adults. Many people with learning disabilities do not have their hearing checked, and families or carers often struggle to notice hearing problems. This study summarises previous research on hearing loss and old age for people with learning disabilities. Large numbers of older people with learning disabilities were found to have hearing problems, but smaller numbers were aware of this before testing. Everyone with learning disabilities should be aware of how important hearing is and have regular checks, especially before they reach old age. AbstractBackground: Hearing loss has a significant impact on living well and on communication in all adults, with the numbers affected increasing with age, and adults with learning disabilities being at particular risk.Methods: A review of the literature on hearing loss in older adults with learning disabilities was completed.Results: A significant increase in hearing loss with increasing age in this group was demonstrated, at a greater level than in the general population. Prevalence rates have been the main focus of research, with few considerations of access to hearing assessment or benefits of rehabilitation such as hearing aids, or the effect that age has on living with hearing loss.Conclusions: With advances in audiology services and increased life expectancy of those with learning disabilities, further research would be valuable. In addition, all health and social care services should consider actively promoting hearing assessment and rehabilitation. Individuals, carers and families should also take action, not only when concerns around memory arise, but proactively for all.

Factors Associated with Tooth Loss in Older Adults in Rural Colorado.

The purpose of this paper is to examine factors that are associated with tooth loss in older adults living in the San Luis Valley (SLV), Colorado, which is a rural and large geographical area (roughly the size of Connecticut) that has a large population age 60years or older. Data used in this manuscript were collected as a part of the SLV Community Health Survey. The analyzed sample included 308 adults over the age of 65years who completed the survey. Basic descriptive statistics and a series of step-wise binary logistic regression analyses were conducted; the dependent variable was the number of permanent teeth removed because of tooth decay or gum disease. Fifty-two percent of the participants were male, Hispanic participants made up 40% of the sample and 76% of the participants had at least a high school education. Tooth loss was significantly associated with older age (OR=1.09; p=0.02), lower income (OR=0.01; p=0.00), less than high school education (OR=0.32; p=0.01), being Hispanic (OR=2.15; p=0.05), self-reported fair-poor health status (OR 2.94; p=0.02), consumption of one or more than one sweet beverage per day (OR=4.52; p=0.00), no dental insurance (OR=4.70; p=0.01) and length of time since last dental visit (OR=0.21; p=0.01). The findings of the present study suggest possible causes for tooth loss in rural adults and underscore the need for in-depth research to study the overall oral health of rural older adults living in SLV.

Body Weight Dynamics Following Intentional Weight Loss and Physical Performance: The Look AHEAD Movement and Memory Study.

SummaryObjectiveThe aim of this study was to explore the impact of body weight change following intentional weight loss on measures of physical performance in adults with diabetes.Design and methodsFour hundred fifty individuals with type 2 diabetes (age, 59.0 ± 6.9 years; body mass index, 35.5 ± 5.9 kg/m2) who participated in the Look AHEAD Movement and Memory Study and lost weight 1 year after being randomized to an intensive lifestyle intervention were assessed. Body weight was measured annually, and participants were categorized as continued losers/maintainers, regainers, or cyclers based on a ±5% annual change in weight. Objective measures of physical performance were measured at the year 8/9 visit.ResultsForty‐four percent, 38% and 18% of participants were classified as regainers, cyclers, and continued losers/maintainers, respectively. In women, weight cycling and regain were associated with worse follow‐up expanded physical performance battery score (1.46 ± 0.07 and 1.48 ± 0.07 vs. 1.63 ± 0.07, both p ≤ 0.02) and slower 20‐m walking speed (1.10 ± 0.04 and 1.08 ± 0.04 vs. 1.17 ± 0.04 m/s, both p < 0.05) compared with continued or maintained weight loss. Male cyclers presented with weaker grip strength compared with regainers or continued losers/maintainers (30.12 ± 2.21 vs. 34.46 ± 2.04 and 37.39 ± 2.26 kg; both p < 0.01).ConclusionsWeight cycling and regain following intentional weight loss in older adults with diabetes were associated with worse physical function in women and grip strength in men.

Loss of Weight in Obese Older Adults: A Biomarker of Impending Expansion of Multimorbidity?

To determine whether weight loss in older adults may be a marker of impending burden of multimorbidity regardless of initial weight, testing the hypotheses that obesity but not overweight in elderly adults is associated with greater number of diseases than normal weight and that obese older adults who lose weight over time have the greatest burden of multimorbidity. Longitudinal cohort study (Invecchiare in Chianti Study). Community. Individuals aged 60 and older at baseline followed for an average of 4 years (N = 1,025). Multimorbidity was measured as number of diagnosed diseases. Baseline body mass index (BMI) was categorized as normal weight (<25.0 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (≥30.0 kg/m(2)). Loss of weight was defined as decrease over time in BMI of at least 0.15 kg/m(2) per year. Age, sex, and education were covariates. Baseline obesity was cross-sectionally associated with high multimorbidity and greater longitudinal increase of multimorbidity than normal weight (P = .005) and overweight (P < .001). Moreover, obese participants who lost weight over follow-up had a significantly greater increase in multimorbidity than other participants, including obese participants who maintained or gained weight over time (P = .005). In nonobese participants, changes in weight had no effect on changes in multimorbidity over time. Sensitivity analyses confirmed that one specific disease did not drive the association and that competing mortality did not bias the association. Loss of weight in obese older persons is a strong biomarker of impending expansion of multimorbidity. Older obese individuals who lose weight should receive thoughtful medical attention.