Cataract Surgery, Hearing Aid May Boost the Aging Brain

You won’t jump for joy when you’re told you need hearing aids or cataract surgery. But get this: Both appear to slow mental decline in older adults.

That’s what researchers concluded after studying more than 2,000 people in England who had cataract surgery and more than 2,000 Americans given hearing aids.

“These studies underline just how important it is to overcome the barriers which deny people from accessing hearing and visual aids,” researcher Piers Dawes, of the University of Manchester in England, said in a university news release.

“It’s not really certain why hearing and visual problems have an impact on cognitive [memory and thinking skill] decline, but I’d guess that isolation, stigma and the resultant lack of physical activity that are linked to hearing and vision problems might have something to do with it,” said Dawes, a lecturer in audiology and deafness.

For comparison, the researchers looked at thousands of people who had not had cataract surgery or obtained hearing aids.

The investigators compared the rates of mental decline before and after the patients had their vision and hearing improved. The rate of mental decline was halved after cataract surgery and was 75 percent lower after starting to use a hearing aid.

Dawes noted that people might not want to wear hearing aids due to stigma, because the amplification is not good enough, or because they’re uncomfortable.

“Perhaps a way forward is adult screening to better identify hearing and vision problems and in the case of hearing loss, demedicalizing the whole process so treatment is done outside the clinical setting. That could reduce stigma,” Dawes suggested.

“Wearable hearing devices are coming on stream nowadays which might also be helpful. They not only assist your hearing, but give you access to the internet and other services,” he added.

According to Dawes’ colleague, Asri Maharani, “Age is one of the most important factors implicated in cognitive decline. We find that hearing and vision interventions may slow it down and perhaps prevent some cases of dementia, which is exciting — though we can’t say yet that this is a causal relationship.”

The cataract surgery study was published in the journal PLoS One. The hearing aid study was published earlier this year in the Journal of the American Geriatrics Society.

Source: HealthDay


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Cataract Surgery for Senior Drivers Tied to Reduced Car Crash Risk, Costs

Cheryl Platzman Weinstock wrote . . . . . . . . .

Cataract surgery can significantly reduce car crashes involving senior drivers and the cost of those accidents to the community, researchers say.

Their study involved 2,849 drivers age 60 and older in Western Australia, all of whom had cataract surgery on both eyes and were involved in vehicular crashes as the driver.

Altogether, 1,312 participants were involved in 1,347 crashes in the year before their first eye cataract surgery, 775 participants were involved in 850 crashes in the period between first and second surgery, and 895 participants were involved in 916 crashes as the driver in the year after the second surgery.

After accounting for other risk factors, the researchers found a 61 percent reduction in crash risk after these drivers’ first cataract was removed and a 23 percent reduction in accidents after their second cataract operation.

Altogether, the total cost of the accidents, in Australian dollars, was $80.5 million (US$57.30 million) in the year before the first eye surgery and AUS $60.4 million in the year after the second eye surgery. The study team calculated the total cost of the surgeries was AUS $5.1 million, so the reduction in crashes credited to the procedures netted a community savings of AUS $14.9 million.

“These results provide encouragement for the timely provision of first- and second-eye cataract surgery for drivers,” Lynn Meuleners and colleagues at the Curtin-Monash Accident Research Center in Perth write in the journal Age and Ageing.

Cataracts, a clouding of the lens of the eye, are a leading cause of blindness in the U.S. and about half of all Americans will either have cataracts, or have had cataract surgery, by the time they reach 80, according to the National Institutes of Health.

“I think that the findings that the likelihood of a motor vehicle accident is less after the first-eye surgery and also after the second-eye cataract surgery may influence individuals who are on the fence about having cataract surgery, especially on the second eye,” said Anne Coleman, a professor of ophthalmology and epidemiology at the David Geffen School of Medicine of the University of California, Los Angeles, who wasn’t involved in the study.

As individuals age, they may delay cataract surgery because they start to adapt to the reduced vision they have, Coleman said by email. Individuals who are driving, have a motor vehicle accident, and still have cataracts should consider being evaluated for cataract surgery since it may lessen the likelihood of additional motor vehicle accidents, she added.

“I don’t think we need proof that cataract surgery works. The number of cataract surgeries in the U.S. is already very high. Most people who need cataract surgery get it done,” said Dr. Alan Sugar, vice chair of ophthalmology at the University of Michigan’s W. K. Kellogg Eye Center in Ann Arbor.

The study has “confirmatory value that cataract surgery and cataract surgery in both eyes, works,” added Sugar, who also wasn’t involved in the research. “This is good,” he said in a phone interview, because insurers historically have not wanted to reimburse patients for second-eye cataract surgery.

Past research has found that cataract surgery reduces mortality, falls and the odds of hip fractures as well as car crashes. Cataract surgery has also been found to increase quality of life, the study authors write.

The majority of the study subjects were men, 70 years and older, married, and nearly 95 percent had at least one other health problem.

The authors, who did not respond to a request for comments, point out that the risk of crashes after second-eye surgeries was higher than after first-eye surgeries, but still significantly lower than before the first-eye procedures. This may have been because of overall aging of the study group, they write.

The study may influence a new trend to do both eyes the same day, Sugar said.

Source: Reuters


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How to Prevent Colds and Flu in Older Adults

Catherine Roberts wrote . . . . . . . . .

As we age, our immune systems often aren’t able to fight off infections as effectively as they once did. That makes winter, when viruses such as colds and influenza can circulate widely, a potentially dangerous time for older adults.

Neither a cold nor the flu is pleasant. Colds can cause a sore throat and sneezing, and flu brings a high fever, stuffiness, aches, and chills. Both can progress to pneumonia, a serious disease that kills tens of thousands of people in the U.S. every year.

Recent research suggests that the flu may also raise the risk of a heart attack or stroke. For example, a 2018 study in the European Respiratory Journal evaluated medical records of Scottish adults and found that those who’d had pneumonia or influenza were several times more likely to have a heart attack or stroke within 28 days.

Last year’s flu season was one of the most severe in years. What that means for this season isn’t clear, however, because the flu is notoriously difficult to predict.

The same strain of flu has predominated for the past two seasons, which might mean that most people have developed immunity to it, according to Brendan Flannery, Ph.D., an epidemiologist with the Centers for Disease Control and Prevention’s influenza division. But, “if we see the same virus again, it may mean that this virus is particularly good at evading the immune response,” he says.

Whatever this season looks like, you can take steps to reduce your risk and to take proper care of yourself if you do get sick.

Get the Flu Shot

You may be wondering whether the annual flu vaccine is worth it, because the shot isn’t a guarantee; its effectiveness last year was only 40 percent.

But that still meant the chances of catching the flu were reduced, says Ann Falsey, M.D., a professor of medicine at the University of Rochester Medical Center. And if you have the vaccine and get the flu anyway, “you are much less likely to end up in the hospital, get pneumonia, and die of the flu,” she says.

If you haven’t had a flu shot yet, now is the time. The vaccine takes about two weeks to become fully effective, so it’s ideal to get it before flu season ramps up, according to the CDC. But if you put it off, it’s not too late to be vaccinated later in the fall or winter.

What kind of shot should you get? The standard one contains three or four strains of the flu that scientists predict are most likely to circulate.

But if you’re 65 or older, you have additional options designed specifically for older adults to produce a stronger immune response.

One of them, called Fluzone High Dose, is four times as strong as the standard vaccine. The other, Fluad, contains an additional substance that prompts a boosted immune response.

Early evidence suggests that these vaccines provide better protection for older adults than traditional flu shots. But if they’re unavailable at your doctor’s office or pharmacy, a standard vaccine will reduce your risk of flu.

Flu shots are covered under Medicare and most private insurance plans, but the fee you pay may vary depending on the type of vaccine.

Get a Pneumonia Vaccine, Too

In addition to an annual flu shot, you should be vaccinated against pneumococcal bacteria. Pneumonia, or lung inflammation, causes 30 to 40 percent of all hospitalizations among older adults.

Viruses and fungi can cause the illness, but a key concern with colds and the flu is secondary bacterial infections, especially from pneumococcal bacteria. This can occur during recovery from a cold or the flu. It usually happens like this: You start to feel better but then take a turn for the worse and have a new fever and cough.

Two vaccines protect against some strains of pneumococcal bacteria: the PCV13 (Prevnar) is about 75 percent effective at preventing severe pneumococcal infections, and the PPSV23 (Pneumovax) is 50 to 85 percent effective against severe disease.

You should get both starting at age 65. Have the PCV13 first and the PPSV23 a year later.

If you’ve already had the PPSV23 because of another health condition, it’s fine to get PCV13 second as long as you wait at least a year between vaccines.

A good time to ask about pneumococcal vaccines is when you go in for a flu shot. It’s safe to get either of the two at the same time as the flu shot, according to the CDC.

Practice Healthy Habits

These tips can also help keep you from getting sick:

Wash your hands right. Use soap and water, and scrub for at least 20 seconds. Wash before and after eating or cooking, and after using the bathroom, being around someone who’s sick, or blowing your nose, coughing, or sneezing.

Be germ-savvy. Try to avoid touching your eyes, nose, and mouth—easy places for germs to enter your system. And be diligent about cleaning surfaces that are frequently touched in your home, such as doorknobs, especially if someone is sick.

Keep away from sick people. Because older adults may have less robust immune systems and catch colds and the flu more easily, it’s key to avoid contact with sick people. That includes grandchildren and other family members. And if you get sick, limit your contact with others, and cough or sneeze into your elbow or a tissue to protect those around you.

Keep fit overall. Maintaining a healthy lifestyle, which should include regular exercise (aim for 150 minutes of moderately intense activity, such as brisk walking, per week) and a nutritious diet, can help protect you from infection.

Skip supplements. Plenty of products are claimed to boost immunity. But there’s little or no evidence to support this for most of them, says Namita Ahuja, M.D., senior medical director for the UPMC Health Plan in Pennsylvania.

If You Do Get Sick

Even if you’re diligent, it’s possible you’ll come down with a cold or the flu. If you do, here’s what to do next:

Pay attention to your symptoms. Colds and the flu aren’t synonymous; they usually present differently. With a cold, symptoms come on gradually, and you probably won’t have a fever but will have a sore throat followed by sneezing, a stuffed or runny nose, and a cough. With the flu, you may also develop a cough, but initial symptoms such as a fever, chills, and fatigue usually come on suddenly. Colds usually resolve after a few days, but the flu often lasts longer than a week.

Treat yourself right. Older adults who think they might have the flu should go to a doctor right away. That’s because older adults are among those who are at higher risk for flu complications such as pneumonia and might benefit from taking antiviral medications such as oseltamivir (Tamiflu and generic).

These prescription medications can reduce the severity of the illness but are most effective when taken within 48 hours of the start of symptoms. A doctor may use a lab test to help diagnose the flu, but if you have symptoms, a positive test result isn’t necessary before taking an antiviral.

Whether you have the flu or a cold, over-the-counter medications can ease discomfort. Acetaminophen (Tylenol and generic), ibuprofen (Advil and generic), and naproxen (Aleve and generic) can lower a fever and alleviate pain. If you take other medications regularly, ask your doctor about them and any other OTC drugs for cold and flu symptoms, because they can interact.

And don’t underestimate the power of a bowl of chicken soup. Research suggests that it may actually help you feel better.

Know when to get emergency help. Most people recover just fine from colds and the flu. But both can turn into an emergency. Get medical attention immediately from a doctor or at an emergency room if you have shortness of breath, chest pain, confusion or dizziness, or persistent vomiting, or if you start to improve but suddenly begin to feel worse. Even if you don’t notice any of the above, it’s a good idea to call a doctor if your symptoms don’t improve after a week or so.

Source : Consumer Reports


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Study: Vitamin D Supplements Won’t Build Bone Health in Older Adults

Steven Reinberg wrote . . . . . . . . .

Vitamin D supplements have long been touted as a way to improve bone health and possibly ward off the bone-thinning disease osteoporosis in older adults.

But a new study contends that claims of benefits from supplements of the “sunshine vitamin” fall flat.

A review of previously published studies found that taking either high or low doses of vitamin D supplements didn’t prevent fractures or falls, or improve bone density.

Vitamin D is found in very few foods. One of the biggest sources of the vitamin is exposure to sunlight.

“Vitamin D supplement use is common, particularly in North America,” where up to 40 percent of older people take them, said lead researcher Dr. Alison Avenell. She is clinical chair in health services research at the University of Aberdeen in Scotland.

“Most adults don’t need to take vitamin D supplements, although they are unlikely to do harm if taken in low doses,” she added.

Vitamin D supplements do prevent rare conditions, such as rickets in children and osteomalacia (softening of bones) in adults. People at risk of vitamin D deficiency include those with little or no sun exposure, such as nursing home residents who are indoors all the time, or those who always cover their skin when outside, Avenell said.

There’s also existing evidence that vitamin D helps prevent cancer or heart disease, she added.

“Preserving bone strength involves keeping active, not smoking, not being too thin, and taking medications for osteoporosis,” Avenell said.

Based on the new findings, Avenell thinks guidelines that recommend vitamin D supplements for bone health should be changed.

For the new report, Avenell and her colleagues reviewed 81 studies, most of which dealt with vitamin D alone, not in combination with the mineral calcium.

“Calcium supplements on their own have minimal effect on bone mineral density and fracture, and may increase the risk of cardiovascular disease,” Avenell said.

The only evidence that calcium and vitamin D together prevent fractures comes from a trial of older people with very low vitamin D levels in nursing homes. But calcium and vitamin D may also increase the risk of cardiovascular disease, Avenell said.

In addition, most of the studies covered in the new review included women aged 65 and older who took more than 800 IUs (international units) of vitamin D daily.

The new study found no meaningful effect of vitamin D supplementation when it came to reducing any fracture, hip fractures or falls.

This type of study, called a meta-analysis, tries to find common elements among previously published studies. This kind or research, however, is limited by differences in the methods and conclusions of the different studies analyzed by researchers, so the findings may not be consistent across the board.

A group that represents the supplement industry took issue with the findings.

“There is evidence that vitamin D is very helpful, especially when you have low levels,” said Duffy MacKay, senior vice president for scientific and regulatory affairs at the Council for Responsible Nutrition.

Over 94 percent of the U.S. population has vitamin D levels that are too low, he said. “Most Americans do not get enough vitamin D to meet their needs and supplements can fill that gap, but if your vitamin D levels are sufficient you don’t need to supplement.”

The benefit of proper vitamin D levels are seen over a lifetime and can’t be judged in short-term studies that look at any specific benefit, he added.

Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City, said this new study should convince doctors that vitamin D supplements don’t have a role in maintaining healthy bones, but they do have other benefits.

Previous research suggests that vitamin D, when taken in tandem with calcium, may help prevent certain cancers and protect against age-related declines in thinking and memory.

“What is important to keep in mind is that those with low vitamin D were not represented in this meta-analysis, and vitamin D supplementation — repletion, actually — is still necessary for those with low vitamin D levels, regardless of age,” Sood said.

The findings were published online in The Lancet Diabetes and Endocrinology.

Source: HealthDay


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New Report on Mobility Has Experts Moving Toward Consensus on Care As We Age

Experts at the American Geriatrics Society (AGS) today unveiled a list of recommendations to help health systems prioritize a vital function for us all as we age: mobility. Mobility refers to our ability to move freely and easily (on our own or with assistance). Published today in the Journal of the American Geriatrics Society (JAGS), the AGS white paper (DOI: 10.1111/jgs.15595) focuses on assessing mobility for hospitalized older adults, offering a roadmap for shifting health care’s focus away from negative markers of mobility loss and toward a deeper appreciation of ways mobility can be proactively assessed–and often preserved–to promote high-quality, person-centered care.

“Being able to maintain mobility is a top priority for many older adults facing a hospital stay,” said Heidi Wald, MD, MSPH, Vice President for Clinical Performance and Interim Vice President for Quality and Safety at SCL Health in Colorado and one of the lead authors on the AGS white paper. “So it’s surprising that mobility still isn’t a widely recognized outcome when we look at quality of care. With this new summary of research and recommendations, we hope will can move our health system toward assessing mobility more appropriately and ideally preventing mobility loss as we age.”

Most people already lose muscle strength and mass as they age, for example, but hospitalized older adults can lose up to 10 percent of their muscle strength per week of bed rest during a hospital stay. More than a third of hospital patients over age 70 are discharged with a major disability that was not present before their admission, with many also experiencing increased hospital stays and poorer abilities to perform the activities of daily living due in part to mobility loss.

Yet while the loss of mobility is common as we age, AGS experts note that nothing is commonplace about the impact of this trend on overall well-being.

“Mobility loss is critical in what we call the ‘cascade’ to dependence–a slippery slope that can start with small declines in movement but can ultimately lead to falls, further hospitalizations, and a general loss of independence,” Dr. Wald observed. “Thankfully, there are ways we can prevent and perhaps even reverse that cascade–but that means doing more to assess and address mobility in a coordinated fashion.”

In their new white paper, representatives from the AGS Quality and Performance Measurement Committee reviewed existing research on mobility loss during hospitalization, including the implications of low mobility, the current state of mobility assessment, and ways we can use new and existing tools to promote routine evaluation of how well mobility is preserved following hospital stays.(1) While standardized programs across all hospitals may be difficult to develop, the AGS expert panel arrived at seven recommendations they believe leverage the best existing science in effective ways for the whole of our national health system.

Recommendation 1: Promote mobility assessment in acute care.

Regulations put in place by agencies like the Centers for Medicare and Medicaid Services (CMS) often shape how care will be put into practice. These agencies can promote greater attention to mobility by incentivizing the use of validated assessments that integrate with existing tests to minimize the burden on providers.

Recommendation 2: Advocate for more research funding.

Federally funded groups like the National Institutes of Health and the Agency for Healthcare Research and Quality also can shape the future of improved mobility by prioritizing research to translate mobility assessment and quality measurement into intervention programs that can protect and promote our ability to continue moving freely as we age–and especially as we face recovery following a hospital stay.

Recommendation 3: Develop consensus on standard methods to assess mobility.

Existing programs to assess and promote mobility vary greatly–and standardizing them across hospitals is difficult and perhaps even unnecessary. Stakeholders can help improve care, however, by promoting broader consensus around specific assessments that are validated; appropriate for acute-care setting like hospitals; and capable of providing health professionals, older people, and caregivers with meaningful, actionable data.

Recommendation 4: Minimize the burden of mobility measurement.

Hospitals and health professionals alike already balance a range of measures and metrics to assess the care they provide. To promote mobility more appropriate, stakeholders will need to focus on optimizing workflows and documentation to minimize redundancy while also ensuring mobility measures become a priority.

Recommendation 5: Evaluate the feasibility of a mobility quality measure.

Organizations like CMS also shape health priorities in determining which “quality measures”–specific aspects of care evaluated by regulators to assess safety and care value–are used when reviewing health outcomes. By developing a specific quality measure for mobility, CMS could incentivize hospitals, staff, and providers to prevent loss of mobility even more proactively.

Recommendation 6: Reframe the current regulatory focus on falls in acute care to a focus on safe mobility.

The current focus on preventing falls at all costs has led to unintended consequences that may actually impede efforts to protect and preserve mobility. AGS experts recommend reconsidering falls as an indicator of quality care in the absence of a corresponding measure to assess mobility more fully.

Recommendation 7: Develop resources for acute-care providers.

Organizations like the AGS and its stakeholders have also been encouraged to create new tools, processes, and strategies to assist healthcare professionals and hospitals with implementing mobility assessments and interventions. Putting together such resources will represent a critical step forward for the field.

The AGS white paper, “The Case for Mobility Assessment in Hospitalized Older Adults” is available for free from JAGS at https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15595.

AGS ACTION POINTS

  • Though being able to maintain mobility is a top priority for many older adults facing a hospital stay, mobility still is not a widely recognized outcome when we look at quality of care.
  • Specific strategies identified by AGS experts for fostering greater attention to mobility assessment include (1) promoting its assessment in hospitals and health systems, (2) advocating for more mobility research funding, (3) developing consensus on mobility assessment standards, (4), working to minimize the burden of mobility assessment, (5) evaluating the feasibility of a mobility quality measure, (6) reframing the current regulatory focus on falls versus mobility, and (7) developing mobility-assessment resources to help healthcare providers.

Source: American Geriatrics Society