Natural Consequence Of Aging Research Articles

The management of bladder incontinence in the elderly

Bladder incontinence is present in all age groups. But risk factors such as increasing age, degenerative diseases, intervention due to prostatic diseases, metabolic or neurological disorders which are typical of an advanced age result in a challenging reality to face. It's a widespread custom to consider incontinence as a disorder or a natural consequence of aging; on the contrary, it is a disease that responds well to various treatments. Urinary incontinence of the elderly is a complex issue because it determines significant changes in personal lifestyle causing serious psychological states of depression. Losing control of our body basic functions can lead busy people to lifestyles never before considered, often self-limiting. The item requires an integrated approach to the various professions in order to allow people the best life quality. Good advice and information can help to handle and resolve one of the main causes of hospitalization or long stays in healthcare facilities.

A “usual occurrence:” Stress incontinence among reproductive aged women in Sri Lanka

Stress urinary incontinence (SUI) is a common condition among women of all ages, often with devastating consequences, such as depression, anxiety and reduced quality of life. Researchers have largely focused on its prevalence and clinical management, particularly in highly industrialized country settings. In this article, drawing on epidemiological, clinical and qualitative research undertaken in Sri Lanka, we discuss how stress incontinence affects women's lives and how they personally manage the problem. Quantitative data derive from a community-based descriptive cross-sectional study, conducted in 2006-2007 with 1718 ever-married women, aged 15-49, of whom 9.8% reported problems of stress incontinence. Six focus group discussions, eight key informant interviews and five case studies with women with SUI were also undertaken to gain insight and depth. Although incontinence affected outdoor activities, sexual life, and sense of wellbeing, women did not consider it a health problem, rarely discussed it with others, and rarely sought treatment. Barriers to help seeking included fear of vaginal examination, shame and embarrassment, and belief that SUI was a natural consequence of aging and childbirth. Women's reluctance to seek advice on their own initiative about managing incontinence indicates the importance for health providers to pay greater attention to the condition and introduce appropriate preventive measures for women. This might include creating greater public awareness of SUI as preventable and treatable, ensuring a clinical environment conducive to discussing problems related to bodily functions.

A “usual occurrence:” Stress incontinence among reproductive aged women in Sri Lanka

Stress urinary incontinence (SUI) is a common condition among women of all ages, often with devastating consequences, such as depression, anxiety and reduced quality of life. Researchers have largely focused on its prevalence and clinical management, particularly in highly industrialized country settings. In this article, drawing on epidemiological, clinical and qualitative research undertaken in Sri Lanka, we discuss how stress incontinence affects women's lives and how they personally manage the problem. Quantitative data derive from a community-based descriptive cross-sectional study, conducted in 2006-2007 with 1718 ever-married women, aged 15-49, of whom 9.8% reported problems of stress incontinence. Six focus group discussions, eight key informant interviews and five case studies with women with SUI were also undertaken to gain insight and depth. Although incontinence affected outdoor activities, sexual life, and sense of wellbeing, women did not consider it a health problem, rarely discussed it with others, and rarely sought treatment. Barriers to help seeking included fear of vaginal examination, shame and embarrassment, and belief that SUI was a natural consequence of aging and childbirth. Women's reluctance to seek advice on their own initiative about managing incontinence indicates the importance for health providers to pay greater attention to the condition and introduce appropriate preventive measures for women. This might include creating greater public awareness of SUI as preventable and treatable, ensuring a clinical environment conducive to discussing problems related to bodily functions.

Renal Transplantation

The population of patients who have ESRD and are older than 65 yr now outnumbers those who are younger than 65 yr. In fact, the number of patients who started dialysis over the age of 80 nearly doubled from 1996 ( n = 7054) to 2003 ( n = 13,557) (1). Who and when to refer the senior and elderly population presents a challenge to the community of nephrologists who care for them, both while on dialysis and in advanced stages of chronic kidney disease. Existing data suggest that, once they undergo transplantation, older patients actually do quite well from both a quality- and a quantity-of-life perspective (2). The natural consequence of aging, especially with chronic kidney disease, is the accumulation of an increasing burden of comorbidities, cardiovascular and cerebrovascular disease in particular. This study attempted to ascertain risk factors that were useful in predicting transplant outcome in patients as they advanced in age. The researchers used robust retrospective data from the Norwegian Renal Registry and reviewed all patients who underwent transplantation at a single hospital from 1990 through 2005 with follow-up data available until May 1, 2008. Patients were grouped into three categories: Elderly (≥70 yr; n = 354), senior (60 to 69 yr; n = 577), and control (45 to 54 yr; n = 563) and included only first kidney transplant recipients. A standard Cox model approach (analysis using univariate and forward stepwise regression) with end points of death, death-censored graft loss, or uncensored graft loss was used to assess patient and graft survival. Comorbidity at the time of transplantation was assessed retrospectively using the Charlson Comorbidity Index, a tool considered to be a robust index of comorbidity in transplant patients (3). Data were also collected for immunosuppressive therapy (initially azathioprine, steroids, and cyclosporine; subsequently basiliximab with mycophenolate mofetil, cyclosporine, …

The impact of nocturia on older people – implications for nursing practice

Nocturia is the most common and under-recognized urinary symptom, experienced by the majority of older people and increasing in prevalence with advancing age. It is associated with a range of debilitating effects including sleep disturbances, falls and instability, depression, and social isolation, yet it is accepted by many as a natural consequence of ageing. However nocturia, like most other lower urinary tract symptoms, is responsive to a range of simple lifestyle advice and behavioural interventions that may be delivered by nurses. This article calls for a raised awareness of this 'silent condition' to enable nurses to recognize nocturia, identify its impact on individuals and initiate and deliver intervention to improve the health and well-being of older people.

Mouth Care in Nursing Homes: Knowledge, Beliefs, and Practices of Nursing Assistants

The purpose of this study was to examine the knowledge, beliefs, and practices of nursing assistants (NAs) providing oral hygiene care to frail elders in nursing homes, with the intent of developing an educational program for NAs. The study occurred in two economically and geographically diverse nursing homes. From a sample size of 202 NAs, 106 returned the 19-item Oral Care Survey. The NAs reported satisfactory knowledge regarding the tasks associated with providing mouth care. The NAs believed that tooth loss was a natural consequence of aging. They reported that they provided mouth care less frequently than is optimal but cited challenges such as caring for persons exhibiting care-resistive behaviors, fear of causing pain, and lack of supplies. Nurses are in a powerful position to support NAs in providing mouth care by ensuring that they have adequate supplies and knowledge to respond to resistive behaviors.

Intrinsic and extrinsic factors in skin ageing: a review

As the proportion of the ageing population in industrialized countries continues to increase, the dermatological concerns of the aged grow in medical importance. Intrinsic structural changes occur as a natural consequence of ageing and are genetically determined. The rate of ageing is significantly different among different populations, as well as among different anatomical sites even within a single individual. The intrinsic rate of skin ageing in any individual can also be dramatically influenced by personal and environmental factors, particularly the amount of exposure to ultraviolet light. Photodamage, which considerably accelerates the visible ageing of skin, also greatly increases the risk of cutaneous neoplasms. As the population ages, dermatological focus must shift from ameliorating the cosmetic consequences of skin ageing to decreasing the genuine morbidity associated with problems of the ageing skin. A better understanding of both the intrinsic and extrinsic influences on the ageing of the skin, as well as distinguishing the retractable aspects of cutaneous ageing (primarily hormonal and lifestyle influences) from the irretractable (primarily intrinsic ageing), is crucial to this endeavour.

Different disease-causing mutations in transthyretin trigger the same conformational conversion

Transthyretin (TTR)-containing amyloid fibrils are deposited in cardiac tissue as a natural consequence of aging. A large number of inherited mutations lead to amyloid diseases by accelerating TTR deposition in other organs. Amyloid formation is preceded by a disruption of the quaternary structure of TTR and conformational changes in the monomer. To study conformational changes preceding the formation of amyloid, we performed molecular dynamics simulations of the wild-type monomer, amyloidogenic variants (V30M, L55P, V122I) and a protective variant (T119M) at neutral and low pH. At low pH, the D strand dissociated from the beta-sheet to expose the A strand, consistent with experimental studies. In amyloidogenic variants and in the wild-type at low pH, there was a conformational change in the beta-sheets into alpha-sheet via peptide bond flips that was not observed at neutral pH in the wild-type monomer. The same residues participated in conversion in each amyloidogenic variant simulation, originating in the G strand between residues 106 and 109, with accelerated conversion at low pH. The T119M protective variant changed the local conformation of the H strand and suppressed the conversion observed in amyloidogenic variants.

Testosterone, diabetes mellitus, and the metabolic syndrome

Metabolic syndrome is characterized by insulin insensitivity, central obesity dyslipidemia, and hypertension. It is recognized as a risk factor for cardiovascular disease in men; by the time metabolic syndrome is diagnosed, however, most men already have entrenched cardiovascular disease. A reliable early warning sign is needed to alert physicians to those at risk for metabolic syndrome and cardiovascular disease. Low serum testosterone level has emerged as a reliable prognosticator of metabolic syndrome in men whose testosterone deficiency is genetic (Klinefelter syndrome), iatrogenic following surgery for testicular cancer, pharmacologically induced by gonadotropin-releasing hormone during prostate cancer treatment, or a natural consequence of aging. One third of men with type 2 diabetes mellitus are now recognized as testosterone deficient. Emerging evidence suggests that testosterone therapy may be able to reverse some aspects of metabolic syndrome.

Age and oral health: current considerations

Dental plaque is still considered the main etiological factor for periodontal diseases. Our understanding of periodontal disease has advanced from the previous concepts where gingivitis slowly progressed to periodontitis to a more complex scenario that correlates several risk factors in the pathogenesis of periodontal disease. Among these factors, age has been associated with increased rates of periodontal disease as the population gets older. Although the loss of alveolar bone and periodontal attachment is common in the elderly population, and there is evident age-related changes in the periodontium, severe periodontitis is not a natural consequence of ageing. The importance of identifying the risk factors that participate in the pathogenesis of periodontal disease at an early phase, both of the individual and the disease, as well as evaluating the capacity of the individual to control dental plaque will enable the implementation of an adequate preventive program, where the needs and limitations of the individual are considered to specifically tailor the oral hygiene procedures and the mouthwashes to be used.

An Overview of the Diagnosis and Treatment of Erectile Dysfunction

Epidemiological studies have demonstrated an age-stratified increase in the incidence and prevalence of erectile dysfunction (ED). There is a greater degree of openness today when discussing sexual matters and more information on the treatment of ED is available to the public through the media. Quality-of-life issues are now a matter of great importance to the aging population. Men and their partners are no longer prepared to merely accept ED as a natural consequence of aging. The advent of a simple and effective oral therapy for ED has also indirectly fueled the increase in treatment-seeking behaviour among men. Despite great strides in research into ED, our knowledge and understanding of the pathophysiological mechanisms is still in its infancy. As a result, we are able to treat only the symptom of ED rather than prevent it. Common diseases found in the population, such as diabetes mellitus and coronary artery disease appear to be risk factors for the development of ED. Therefore, physicians need to identify any underlying co-existing organic diseases in their patients presenting with ED. Whenever possible, patients are encouraged to attend their consultation sessions with their partners because ED is a condition affecting 'the couple' and not just the man. Psychogenic aspects of ED should also be explored during the consultation. Efforts need to be made to uncover and address the presence of any psychological stressors, if necessary with the help of a psychosexual therapist. The first-line treatment of ED is oral phosphodiesterase-5 inhibitors. For those who do not respond to oral therapy, there is no defined 'step-ladder' escalation in alternative therapy. It is up to the physician to discuss the options with the patient or couple and reach a decision based on their preference.

Commentary on Tse MMY, Pun SPY & Benzie IFF (2005) Pain relief strategies used by the older people with chronic pain: an exploratory survey for planning patient‐centred intervention. Journal of Clinical Nursing 14, 315–320

Commentary on Tse MMY, Pun SPY &amp; Benzie IFF (2005) Pain relief strategies used by the older people with chronic pain: an exploratory survey for planning patient‐centred intervention. <i>Journal of Clinical Nursing</i> 14, 315–320

The Use of Magnetic Resonance Arthrography to Detect Partial-Thickness Rotator Cuff Tears

P artial-thickness rotator cuff tears can be caused by trauma or anatomic impingement, or they can be a natural consequence of aging. They may involve either the articular surface, the bursal surface, or both sides of the rotator cuff. They can be asymptomatic or a potential source of shoulder dysfunction. Recent studies have seemed to indicate that partial-thickness cuff tears can progress and do not heal on their own1. The articular side of the rotator cuff is hypovascular (Fig. 1), and the collagen bundles on the articular side are thinner and less uniform (Fig. 2), making articular-sided partial-thickness rotator cuff tears two to three times more common than bursal-sided tears2-8. Magnetic resonance imaging, although a useful and established technique for detecting full-thickness rotator cuff tears, has been found to be less reliable in detecting partial-thickness tears. With the use of standard magnetic resonance imaging techniques, many partial-thickness rotator cuff tears are missed9-12. In 1992, Traughber and Goodwin reported a sensitivity ranging from 56% to 72% and a specificity ranging from 83% to 85% for arthroscopically proven partial-thickness rotator cuff tears9. However, in another study, an 83% rate of false-negative results was reported for arthroscopically proven partial-thickness tears10. Wright and Cofield found only six definite partial-thickness tears on preoperative magnetic resonance imaging studies in eighteen patients with arthroscopically proven partial-thickness tears11. Fig. 1 Coronal photomicrograph of the zone of diminished vascularity of the supraspinatus tendon. The arrow points to the critical zone of hypovascularity of the articular side of the tendon. Magnetic resonance arthrography may improve the sensitivity in the detection of partial-thickness rotator cuff tears. Two years ago, we began a prospective study to detect partial-thickness articular-sided rotator cuff tears using an intra-articular injection of gadolinium …

Overactive bladder: epidemiology and social impact

Overactive bladder epidemiology is a rapidly evolving field. The new terminology of lower urinary tract function, introduced in 2002, modified the definitions of all four components of overactive bladder. In the same year, the lack of specific information on overactive bladder prevalence was identified and consequently new studies were launched and recently published. Following the new terminology, overactive bladder now includes both a purely sensory disorder and a condition related to an altered bladder behaviour. Studies conducted in selected countries and populations suggested comparable prevalence data worldwide, although the syndrome is considered to be underreported. 'Urge' is now considered the cornerstone symptom of overactive bladder. Recent epidemiological data confirm the increase in overactive bladder prevalence with age and suggest that most diet and lifestyle factors are not associated with the condition, with the exception of body mass index. Among the symptoms, urge and urinary incontinence were considered to be more significantly related to patients' quality of life compared with frequency and nocturia. The socioeconomic consequences of the overactive bladder syndrome were recently estimated in a large US study and a total cost of 12.6 billion US dollars was calculated. Specific data on overactive bladder epidemiology are now available, providing new evidence about its relevance as a clinical issue. Both wet and dry overactive bladder cause a significant reduction in quality of life. In our daily practice we have to consider that overactive bladder is frequently underreported as patients believe that no treatment is available and urinary incontinence is considered a natural consequence of aging.

Mild Cognitive Impairment: Can We Reliably Detect Alzheimer's Disease Before the Dementia Begins?

Mild Cognitive Impairment Aging to Alzheimer's Disease. R.C. Petersen (Ed.), 2003, New York: Oxford University Press. 269 pp., $55.00.People are living longer and along with this phenomenon emerges the concern about the quality of life as the person ages. While dementia is by no means a natural consequence of aging, both its incidence and prevalence increase dramatically with age, from 0.5 percent per year at the age of 65 years to nearly 8%/year after the age of 85 years (Evans et al. 1989). Alzheimer's disease (AD) is the most common cause of dementia. Although the goals of treatment in patients with AD have been to improve or, at least, to slow the deterioration of memory and cognition and to maintain independent function, research is moving from controlling symptoms to early identification and prevention of age-related cognitive disabilities.

Arthroscopic treatment of partial rotator cuff tears

Partial rotator cuff tears can be a natural consequence of aging or can be caused by anatomic impingement or trauma. These tears can be asymptomatic or a potential source of shoulder dysfunction. We know very little about their natural history and whether they progress to full-thickness tears. With the advent of magnetic resonance imaging and shoulder arthroscopy, a more precise characterization of these tears is now possible. At the present time, there is no accepted classification system of partial-thickness rotator cuff tears. The optimal clinical approach to treating these tears is also controversial and ranges from simple debridement to open repair. The purpose of this article is to review partial-thickness rotator cuff tears, including the pathogenesis, diagnosis, nonoperative, and operative treatment options, and to create a rational treatment algorithm.

Enhancement of working memory in aged monkeys by a sensitizing regimen of dopamine D1 receptor stimulation.

A natural consequence of aging is a loss of dopamine function and associated deficits in working memory in both human and nonhuman primates. Specifically, deficiency of D1 receptor signaling has been implicated in age-related cognitive decline. Here, we report that an intermittent, sensitizing regimen of the D1 dopamine agonist ABT-431 dramatically enhances working memory performance in aged rhesus monkeys, while either producing impairment or having little effect on performance in young adult monkeys. Importantly, cognitive enhancement in the aged monkeys was still evident for >1 year after cessation of D1 treatment. Because intermittent exposure to low doses of amphetamine and other stimulants has been shown to enhance responsiveness to subsequent stimulant exposure, our findings suggest that sensitization of D1 signaling may provide a novel neurobiological mechanism for improving a core cognitive process in conditions in which dopamine function has deteriorated, such as in normal aging and Parkinson's disease.

Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft-tissue changes into an integrated model of midfacial aging.

The contribution of maxillary retrusion to the formation of the nasolabial fold is evaluated in the present study. Clinical observation of patients from the craniofacial unit with concomitant maxillary retrusion revealed prominent signs of midfacial aging: specifically these individuals displayed a prominent nasolabial fold at an early age. This observation led to the hypothesis that relative maxillary retrusion occurs as a normal feature of the aging process. Retrusion of the lower facial skeleton below the soft tissue of the nasolabial fold causes the nasolabial fold to appear more prominent. To test this hypothesis, computed tomographic data were assembled retrospectively and included both males and females, young and old. The age range of the males (n = 14) was 18 to 24 years (young) and 43 to 57 years (old); the age range of the females (n = 14) was 15 to 30 years (young) and 43 to 57 years (old). All individuals had complete upper dentition and had no bony facial injury. Computed tomographic data were reconstructed into three-dimensional images, and a technique was developed to create a standardized lateral view which eliminated rotational variance. Analysis of anterior-posterior changes showed that there is a tendency for the lower maxillary skeleton at pyriform to become retrusive with age relative to the upper face in individuals with complete dentition. Findings were very significant for both males and females (p = 0.0001 and p = 0.002, respectively). In both groups, a slight increase in vertical maxillary dimension was noted, consistent with previous studies. It is suggested that relative maxillary retrusion is a factor in the development of the nasolabial fold. The skeletal features of normal midfacial aging can be combined with the soft-tissue features such as ptosis and atrophy into an integrated model of midfacial aging. A model such as this has significance regarding both the timing and choice of procedure used to restore the aging midface.

Pain in the elderly: Psychosocial issues

Individuals age at varying rates and along physical, cognitive, psychosocial, and sociocultural trajectories.Thus, the elderly comprise the most heterogeneous segment of the population. An understanding of the aging process therefore is crucial as the framework for understanding pain in the elderly.Although pain is not a natural consequence of aging, many elderly persons have health conditions that cause pain. Some elderly persons have cognitive conditions that impair their ability to communicate pain.The psychosocial circumstances of the elderly, particularly dependency issues, have implications for treatment design and goal setting. Sociocultural factors can contribute to misunderstandings between elderly persons and the typically younger clinicians who treat their pain. Beyond treatment efforts, the processes of aging have implications for our study and understanding of pain. Relevant issues include ageism, the definition of pain, association between pain and suicide in the elderly, and distinction between age differences (intercohort variability) and age effects (intra-individual change across the life span).

Vaginal prolapsed.

Preview As many as 20% of postmenopausal women may have symptomatic genital prolapse, but often they do not report it because of embarrassment or a belief that it is a natural consequence of aging. Dr Davila discusses predisposing factors in prolapse, associated urinary dysfunction, and conservative treatment approaches. Special attention is paid to the renewed interest in an ancient device- vaginal pessaries.