Rates In Older Adults Research Articles

Alternating and sequential motion rates in older adults

Alternating motion rate (AMR) and sequential motion rate (SMR) are tests of articulatory diadochokinesis that are widely used in the evaluation of motor speech. However, there are no quality normative data available for adults aged 65 years and older. There were two aims: (1) to obtain a representative, normative dataset of diadochokinetic rates from adults aged 65 years and older; and (2) to examine the effects of age and gender on those rates. Seventy-six healthy adults (65-86 years) were recruited; 45 females and 31 males. Participants were divided across two age groups (65-74 and 75-86 years) and audio-recorded while undertaking AMR (/pa/, /ta/ and /ka/) and SMR (/pataka/). The rate of the first nine syllables for each task was measured using acoustic analysis software, and age and gender effects were examined using a series of generalized linear models. The effect of age on rate variability between groups was also assessed. Normative data were obtained for both age groups and across gender. Age was not a significant factor for any task. Males had significantly higher AMR than females (/pa/ p = 0.001, /ta/ p = 0.001, /ka/ p = 0.010). No such gender difference was found for SMR. There was no significant difference in rate variability between the age groups. Normative values for AMR and SMR in both genders and across two older age groups were acquired. Diadochokinetic rates outside such values cannot be attributed to normal ageing, so will merit further clinical investigation.

Monoclonal Antibody-Based Therapies in the Treatment of Acute Lymphoblastic Leukemia

Recent studies have suggested that pediatric-intensive chemotherapy regimens can improve outcomes in adults with acute lymphoblastic leukemia (ALL) up to the age of 45. Above this age, toxicities increase. Monoclonal antibody-based therapies bring the promise of increased response rates without excessive toxicity. The addition of rituximab to combination chemotherapy has shown encouraging results. Newer monoclonal antibody-based therapies linked to cytotoxic agents show promise. These include inotuzumab ozogamicin, an anti-CD22 antibody linked to calicheamicin that has produced significant single-agent responses in relapsed and refractory ALL. Other monoclonal antibodies linked to plant or bacterial toxins are in earlier stages of development. Blinatumomab is a novel bispecific T-cell engaging antibody that combines single chain antibodies to CD19 and CD3 and brings a T cell in close proximity to a leukemic lymphoblast with resulting redirected lysis. This agent has demonstrated encouraging results in both the minimal residual disease setting and the relapsed/refractory setting. Autologous chimeric antigen receptor cells have shown promising responses in indolent B-cell lymphoid malignancies and are being tested in ALL. Many of these agents have the potential to increase response rates in older adults. Trials of many of these monoclonal antibody-based therapies are in various stages of development in the treatment of newly diagnosed ALL.

Drug‐Related Readmissions to Medical Units of Older Adults Discharged from Acute Geriatric Units: Results of the Optimization of Medication in AGEd Multicenter Randomized Controlled Trial

To assess the effect of an intervention on drug-related problem (DRP; adverse drug reactions, adherence problems, underuse)-related readmission rates in older adults. Ancillary study from a 6-month, prospective, randomized, parallel-group, open-label trial. Six acute geriatric units in Paris and suburbs. Six hundred sixty-five consecutively admitted individuals were included: 317 in the intervention group (IG) and 348 in the control group (CG) (aged 86.1 ± 6.2, 66% female). Discharge-planning intervention combining chronic drug review, education, and enhanced transition-of-care communication. Chronic drugs at discharge of the two groups were compared. An expert committee blinded to group assignment adjudicated whether 6-month readmission to the study hospitals was related to drugs. Six hundred thirty-nine individuals were discharged and followed up (300 IG, 339 CG). The intervention had no significant effect on drug regimen at discharge, characterized by prescriptions that are mostly appropriate but increase iatrogenic risk. Three hundred eleven readmissions occurred during follow-up (180 CG, 131 IG), of which 185 (59.5%) were adjudicated (102 CG, 83 IG). For 16, DRP imputability was doubtful. Of the remaining 169, DRPs were the most frequent cause for readmission, with 38 (40.4%) readmissions in the CG and 26 (34.7%) in the IG (relative risk reduction = 14.3%, 95% confidence interval = 14.0-14.5%, P = .54). The intervention was associated with 39.7% fewer readmissions related to adverse drug reactions (P = .12) despite the study's lack of power. Drug-related problem prevention in older people discharged from the hospital should be a priority, with a focus on improving the monitoring of drugs with high iatrogenic risk.

Markedly elevated erythrocyte sedimentation rate in older adults. How significant clinically?

ObjectiveErythrocyte sedimentation rate (ESR) despite being a fast and cheap test to evaluate acute phase response, has low sensitivity and specificity. Atypical courses and lack of specific signs and symptoms of the diseases in elderly restrict the use of ESR for diagnosis. We aimed to determine clinical importance and possible etiologies of markedly elevated ESR in older adults. Patients and methodsOne thousand six hundred and eighty-two patients consecutively admitted to Ankara University School of Medicine Geriatric clinics were evaluated. A hundred and ten patients with ESR more than 80mm/h were included into study and evaluated for the possible causes of ESR elevation. ResultsEtiology of elevated ESR was due to infectious diseases in 53 (48.2%), malignancy in 19 (17.3%), and collagen tissue diseases in 17 (15.5%) patients. Some of the etiologies coexisted in 10 (9.1%) patients. No specific etiology was detected in 31 (28.2%) patients. Among infectious diseases, pneumonia (n=20/53, 37.7%) was the leading cause followed by urinary tract infections (UTI) (n=17/53, 32.1%). Multiple myeloma (n=7/19, 36.8%) was the leading cause among malignancies. Rheumatoid arthritis (n=10/17, 58.8%) was the leading cause among collagen tissue diseases. Leukocyte count and C-reactive protein levels are useful to determine infectious diseases as a cause of markedly elevated ESR.

Influence of staff education on the function of hospitalized elders

Functional loss during hospitalization can prevent older adults from returning home. This study was designed to examine the effects of an intervention on discharge destination, function, length of stay (LOS), pressure ulcers, and fall rate in older adults ≥ 75 years old.The intervention included staff education on geriatric care and infrastructural change to promote function. Data on discharge destination and the change in function measured by Katz’s activities of daily living (ADL) were collected. The LOS, pressure ulcer, and fall rate were compared with previous year’s data using t-tests, and Chi-square analyses. There was a 14% increase in discharges to home (n = 404), minimal ADL loss (4.60 baseline ADL vs. 4.20 discharge ADL), and a significant decrease in nosocomial pressure ulcer. There was no decrease in LOS or fall rate. This preliminary study suggests that staff education with infrastructural change to promote independence may be helpful in patients’ return to home, functional status, and hospital complications.

Two types of slip-induced falls among community dwelling older adults

Little is known about the landing behavior of the trailing (recovery) foot and ensuing types of falls following a forward slip in walking. The purposes of this study were to (1) determine if community-dwelling older adults experienced bilateral slips at the same rate as had been previously observed for young adults during over-ground walking; (2) determine if fall rate in older adults was dependent on slip type (unilateral vs. bilateral); and (3) identify differences in spatiotemporal variables of the trailing leg step between unilateral and bilateral slips. One-hundred-seventy-four participants experienced an unannounced, unrehearsed slip while walking on a 7-m walkway. Each trial was monitored with a motion capture system and bilateral ground reaction force plates. Although the experimental design, developed with original data from a young adult population, favored bilateral slips, more older adults (35%) than anticipated (10% previously observed in young, p<0.001) displayed a unilateral slip. The probability of fall was equal in the two types of slips. Eighty-two people recovered from the slip, while the remaining 92 (53%) fell. These 92 were classified into two exclusive categories based on the heel distance at the time of fall arrest using cluster analysis: those which resembled a fall into a “splits” position (n=47) or a feet-forward fall (n=45). All (100%) unilateral slips led to splits falls, as expected. Yet, not all bilateral slips (only 83%) resulted in feet-forward falls. A longer forward recovery step with a prolonged step time led to both feet slipping, nearly together, hence a feet-forward fall.

Risk Factors Influencing Probability and Severity of Elder Abuse in Community-dwelling Older Adults: Applying Zero-inflated Negative Binomial Modeling of Abuse Count Data

This study was conducted to identify risk factors that influence the probability and severity of elder abuse in community-dwelling older adults. This study was a cross-sectional descriptive study. Self-report questionnaires were used to collect data from community-dwelling Koreans, 65 and older (N=416). Logistic regression, negative binomial regression and zero-inflated negative binomial regression model for abuse count data were utilized to determine risk factors for elder abuse. The rate of older adults who experienced any one category of abuse was 32.5%. By zero-inflated negative binomial regression analysis, the experience of verbal-psychological abuse was associated with marital status and family support, while the experience of physical abuse was associated with self-esteem, perceived economic stress and family support. Family support was found to be a salient risk factor of probability of abuse in both verbal-psychological and physical abuse. Self-esteem was found to be a salient risk factor of probability and severity of abuse in physical abuse alone. The findings suggest that tailored prevention and intervention considering both types of elder abuse and target populations might be beneficial for preventative efficiency of elder abuse.

Targeting Anabolic Impairment in Response to Resistance Exercise in Older Adults with Mobility Impairments: Potential Mechanisms and Rehabilitation Approaches

Muscle atrophy is associated with healthy aging (i.e., sarcopenia) and may be compounded by comorbidities, injury, surgery, illness, and physical inactivity. While a bout of resistance exercise increases protein synthesis rates in healthy young skeletal muscle, the effectiveness of resistance exercise to mount a protein synthetic response is less pronounced in older adults. Improving anabolic sensitivity to resistance exercise, thereby enhancing physical function, is most critical in needy older adults with clinical conditions that render them “low responders”. In this paper, we discuss potential mechanisms contributing to anabolic impairment to resistance exercise and highlight the need to improve anabolic responsiveness in low responders. This is followed with evidence suggesting that the recovery period of resistance exercise provides an opportunity to amplify the exercise-induced anabolic response using protein/essential amino acid ingestion. This anabolic strategy, if repeated chronically, may improve lean muscle gains, decrease time to recovery of function during periods of rehabilitation, and overall, maintain/improve physical independence and reduce mortality rates in older adults.

Age-Dependent Patterns of Infection and Severity Explaining the Low Impact of 2009 Influenza A (H1N1): Evidence From Serial Serologic Surveys in the Netherlands

Despite considerable research efforts in specific subpopulations, reliable estimates of the infection attack rates and severity of 2009 influenza A (H1N1) in the general population remain scarce. Such estimates are essential to the tailoring of future control strategies. Therefore, 2 serial population-based serologic surveys were conducted, before and after the 2009 influenza A (H1N1) epidemic, in the Netherlands. Random age-stratified samples were obtained using a 2-stage cluster design. Participants donated blood and completed a questionnaire. Data on sentinel general practitioner-attended influenza-like illness and nationwide hospitalization and mortality were used to assess the severity of infection. The estimated infection attack rates were low in the general population (7.6%, 95% confidence interval: 3.6, 11) but high in children aged 5-19 years (35%, 95% confidence interval: 25, 45). The estimated hospitalization and mortality rates per infection increased significantly with age (5-19 years: 0.042% and 0.00094%, respectively; 20-39 years: 0.12% and 0.0025%; 40-59 years: 0.68% and 0.032%; 60-75 years: >0.81% and >0.068%). The high infection attack rate in children and the very low attack rate in older adults, together with the low severity of illness per infection in children but substantial severity in older adults, produced an epidemic with a low overall impact.

Effect of an Inpatient Geriatric Consultation Team on Functional Outcome, Mortality, Institutionalization, and Readmission Rate in Older Adults with Hip Fracture: A Controlled Trial

To evaluate the effect of an inpatient geriatric consultation team (IGCT) on end points of interest in people with hip fracture: length of stay, functional status, mortality, new nursing home admission, and hospital readmission. Controlled trial based on assignment by convenience. Trauma ward in a university hospital. One hundred seventy-one people with hip fracture aged 65 and older. Participants were assigned to a multidisciplinary geriatric intervention (n=94) or usual care (n=77) during hospitalization after hip fracture. End points were functional status, length of stay, mortality, new nursing home admission, and hospital readmission 6 weeks, 4 months, and 12 months after surgery. Mean length of stay was 11.1 ± 5.1 days in the intervention group and 12.4 ± 8.5 days in the control groups (P=.24). Complete adherence to IGCT recommendations was 56.8%. A significant benefit of intervention on functional status in univariate analyses (P=.02) 8 days after surgery disappeared in a linear mixed model. Participants with dementia had better functional status in a linear mixed model than those without (P=.03), but this effect was no longer significant after Bonferroni correction for multiple testing. After 6 weeks, 4 months, and 12 months, no between-group differences could be documented for mortality, new nursing home admission, or readmission rate. This trial could not document functional benefits of an IGCT intervention in people with hip fracture. More research is needed to investigate whether a more-intensive approach with more-direct control over patient management, more-specific recommendations, and more-intense education would be effective.

Epidemiology of Autism Spectrum Disorders in Adults in the Community in England

To our knowledge, there is no published information on the epidemiology of autism spectrum disorders (ASDs) in adults. If the prevalence of autism is increasing, rates in older adults would be expected to be lower than rates among younger adults. To estimate the prevalence and characteristics of adults with ASD living in the community in England. A stratified, multiphase random sample was used in the third national survey of psychiatric morbidity in adults in England in 2007. Survey data were weighted to take account of study design and nonresponse so that the results were representative of the household population. General community (ie, private households) in England. Adults (people 16 years or older). Autism Diagnostic Observation Schedule, Module 4 in phase 2 validated against the Autism Diagnostic Interview-Revised and Diagnostic Interview for Social and Communication Disorders in phase 3. A 20-item subset of the Autism-Spectrum Quotient self-completion questionnaire was used in phase 1 to select respondents for phase 2. Respondents also provided information on sociodemographics and their use of mental health services. Of 7461 adult participants who provided a complete phase 1 interview, 618 completed phase 2 diagnostic assessments. The weighted prevalence of ASD in adults was estimated to be 9.8 per 1000 (95% confidence interval, 3.0-16.5). Prevalence was not related to the respondent's age. Rates were higher in men, those without educational qualifications, and those living in rented social (government-financed) housing. There was no evidence of increased use of services for mental health problems. Conducting epidemiologic research on ASD in adults is feasible. The prevalence of ASD in this population is similar to that found in children. The lack of an association with age is consistent with there having been no increase in prevalence and with its causes being temporally constant. Adults with ASD living in the community are socially disadvantaged and tend to be unrecognized.

Comparison of Traditional and Recent Approaches in the Promotion of Balance and Strength in Older Adults

Demographic change in industrialized countries produced an increase in the proportion of elderly people in our society, resulting in specific healthcare challenges. One such challenge is how to effectively deal with the increased risk of sustaining a fall and fall-related injuries in old age. Deficits in postural control and muscle strength represent important intrinsic fall risk factors. Thus, adequate training regimens need to be designed and applied that have the potential to reduce the rate of falling in older adults by countering these factors. Therefore, the purpose of this review is to compare traditional and recent approaches in the promotion of balance and strength in older adults. Traditionally, balance and resistance training programmes proved to be effective in improving balance and strength, and in reducing the number of falls. Yet, it was argued that these training protocols are not specific enough to induce adaptations in neuromuscular capacities that are specifically needed in actual balance-threatening situations (e.g. abilities to recover balance and to produce force explosively). Recent studies indicated that perturbation-based or multitask balance training and power/high-velocity resistance training have the potential to improve these specific capacities because they comply with the principle of training specificity. In fact, there is evidence that these specifically tailored training programmes are more effective in improving balance recovery mechanisms and muscle power than traditional training protocols. A few pilot studies have even shown that these recently designed training protocols have an impact on the reduction of fall incidence rate in older adults. Further research is needed to confirm these results and to elucidate the underlying mechanisms responsible for the adaptive processes.

Lifestyle Practices and Cardiovascular Disease Mortality in the Elderly: The Leisure World Cohort Study

Modifiable behavioral risk factors are major contributing causes of death, but whether the effects are maintained in older adults is uncertain. We explored the association of smoking, alcohol consumption, caffeine intake, physical activity, and body mass index on cardiovascular disease (CVD) mortality in 13,296 older adults and calculated risk estimates using Cox regression analysis in four age groups (<70, 70–74, 75–79, and 80+ years). The most important factor was current smoking, which increased risk in all age-sex groups. In women, alcohol consumption (≤3 drinks/day) was related to decreased (15–30%) risk in those <80 years old; in men, 4+ drinks/day was associated with reduced (15–30%) risk. Active 70+ year olds had 20–40% lower risk. Both underweight and obese women were at increased risk. Lifestyle practices impact CVD death rates in older adults, even those aged 80+ years. Not smoking, moderate alcohol consumption, physical activity, and normal weight are important health promoters in our aging population.

Determinants in senior adults and the relationship of strength training

Introduction: Proper strength training has been shown to improve balance and metabolic rates in older adults. More senior adults are realizing the importance of performing strength training on a regular basis. It is important for exercise facilities to recognize common characteristics that may exist among those seniors who do perform strength training. This information could assist fitness program managers increase participation among the older age groups. Purpose: The purpose of this study was to develop a demographic profile of older adults who currently participate in strength training activities in order to determine factors that could predict strength training participation.

Comparison of Disability Rates Among Older Adults in Aggregated and Separate Asian American/Pacific Islander Subpopulations

We assessed the prevalence and adjusted odds of 4 types of disability among 7 groups of older Asian American/Pacific Islander (AAPI) subpopulations, both separately and aggregated, compared with non-Hispanic Whites. Data were from the nationally representative 2006 American Community Survey, which included institutionalized and community-dwelling Hawaiian/Pacific Islander (n = 524), Vietnamese (n = 2357), Korean (n = 2082), Japanese (n = 3230), Filipino (n = 5109), Asian Indian (n = 2942), Chinese (n = 6034), and non-Hispanic White (n = 641 177) individuals aged 55 years and older. The weighted prevalence, population estimates, and odds ratios of 4 types of disability (functional limitations, limitations in activities of daily living, cognitive problems, and blindness or deafness) were reported for each group. Disability rates in older adults varied more among AAPI subpopulations than between non-Hispanic Whites and the aggregated Asian group. Asian older adults had, on average, better disability outcomes than did non-Hispanic Whites. This study provides the strongest evidence to date that exclusion of institutionalized older adults minimizes disparities in disabilities between Asians and Whites. The aggregation of Asians into one group obscures substantial subgroup variability and fails to identify the most vulnerable groups (e.g., Hawaiian/Pacific Islanders and Vietnamese).

Walk A Hound, Lose a Pound, & Stay Fit for Seniors

Background: Obesity rates in older adults are linked with the national problem of limited physical activity (PA), resulting in chronic illness. Obesity-related illness and functional loss require innovative interventions. Older adult dog walkers maintained physical functioning over a 3 year period (Thorpe 2006). Dog walking may improve long-term PA by improving readiness and physical function. Purpose: The study aimed to test the association between dog walking and physical...

Sleep Deprivation Impairs 12-Hr Urine Volume Excretion in Old Rats

Excessive nocturnal urine volumes (UVs) predict almost double the death rate in older adults. Furthermore, sleep-depriving environments may increase nocturnal UVs in old age. Thus, a pilot study was designed to examine the effects of sleep-depriving lighting treatments on the 12-hr UV excretion in young adult rats (6 months, n = 6), middle-aged rats (12 months, n = 12), old rats (16 months, n = 6), and old-old rats (>20 months, n = 5). Each animal was exposed continuously to the treatments beginning with 7 days each of standard laboratory lighting conditions of on 12 hr/off 12 hr, then 7 days continuous dim lighting, and finally 7 days of continuous dim lighting plus sleep deprivation with a noxious noise. Age group and lighting condition treatments influenced 24-hr urine volume excretion (F (2, 29) = 2.41, p = .007, r(2) = .8193). During sleep deprivation, rest-phase 12-hr urine volume excretion increased in both the old and old-old rats (F (2, 5) = 7.79, p < .00001).

Adherence to antiretroviral medication in older adults living with HIV/AIDS: a comparison of alternative models

The CDC estimates that by 2015, half of all persons living with HIV/AIDS in the USA will be over the age of 50. Despite increasing HIV seroprevalence rates in older adults, most research examining adherence to antiretroviral therapy (ART) has focused on young HIV-infected persons and, in general, has been atheoretical in nature. This study examined two ART adherence conceptual frameworks to determine whether these models generalize to HIV-seropositive older adults. Two hundred and forty-four HIV-positive adults 50-plus years of age were recruited through AIDS service organizations in Ohio and New York. Participants completed a neuropsychological battery and an audio computer-assisted self-interview. FIML SEM analyses revealed that neuropsychological functioning was not associated with adherence. Fit indices supported a stress and coping model, with negative affect mediating the effects of social support and maladaptive coping on ART adherence. Results were consistent with stress and coping models and suggest that interventions intending to increase adherence to ART in HIV-infected older adults may be more effective if they address negative affect and enhance adaptive coping and social support.

U.S. Emergency Department Visits for Supraventricular Tachycardia, 1993–2003

Supraventricular tachycardia (SVT) is often described as a recurrent condition that leads to emergency department (ED) visits. However, the epidemiology of ED visits for SVT is unknown. To define the frequency of SVT in U.S. EDs and to analyze patient characteristics, ED management, and disposition for such visits. The authors analyzed data from the National Hospital Ambulatory Medical Care Survey, 1993-2003. SVT cases were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes 426.7 or 427.0 in any of the three diagnostic fields. Of the 1.1 billion ED visits over the 11-year study period, an estimated 555,000 (0.05%; 95% confidence interval [CI] = 0.04% to 0.06%) were related to SVT. The annual frequency and population rate appear stable between 1993 and 2003 (p for trend = 0.35). Compared with non-SVT visits, those with SVT were more likely to be older than 65 years of age (26% vs. 15%, p < 0.01) and female (70% vs. 53%, p < 0.01). Electrocardiograms were documented for most visits (91%; 95% CI = 85% to 96%). Approximately half of the patients (51%; 95% CI = 40% to 61%) received an atrioventricular nodal blocking medication, most frequently adenosine (26%; 95% CI = 17% to 36%). SVT visits ended in hospital admission for 24% (95% CI = 15% to 34%). At the other extreme, 44% (95% CI = 32% to 56%) were discharged without planned follow-up. Supraventricular tachycardia accounts for approximately 50,000 ED visits each year. Higher visit rates in older adults and female patients are consistent with prior studies of SVT in the general population. This study provides an epidemiologic foundation that will enable future research to assess and improve clinical management strategies of SVT in the ED.

Relationship between bite force and salivary flow in older adults

To examine the relationship between bite force and stimulated salivary flow rate in older adults. The study sample consisted of 934 independent-living, cognitively healthy Japanese older adults 60 to 84 years of age. The maximal bite force was measured with pressure-sensitive sheets, and stimulated whole saliva was collected using the mastication method. The mean stimulated salivary flow rate was 1.36 +/- 0.97 mL/min. In bivariate analysis, the stimulated salivary flow rate was significantly lower in females and subjects with daily multiple medications (P < .01). Multiple linear regression analysis showed that the stimulated salivary flow rate was significantly associated with sex (standardized partial regression coefficient: partial beta = .22; P < .001), bite force (partial beta = .18; P < .001), and multiple daily medications (partial beta = -.12; P < .001). It is suggested that reduced bite force is associated with a decline in stimulated whole salivary flow rate independent of sex and medication in older adults.