Physical And Mental Exercise Lower Chances For Developing Delirium After Surgery


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After having surgery, many older adults develop delirium, the medical term for sudden and severe confusion. In fact, between 10 and 67 percent of older adults experience delirium after surgery for non-heart-related issues, while 5 to 61 percent experience delirium after orthopedic surgery (surgery dealing with the bones and muscles).

Delirium can lead to problems with thinking and decision-making. It can also make it difficult to be mobile and perform daily functions and can increase the risk for illness and death. Because adults over age 65 undergo more than 18 million surgeries each year, delirium can have a huge impact personally, as well as for families and our communities.

Healthcare providers can use several tools to reduce the chances older adults will develop delirium. Providers can meet with a geriatrician before surgery, review prescribed medications, and make sure glasses and hearing aids are made available after surgery (since difficulty seeing or hearing can contribute to confusion). However, preventing delirium prior to surgery may be the best way to help older adults avoid it.

A team of researchers from Albert Einstein College of Medicine designed a study to see whether older adults who are physically active before having surgery had less delirium after surgery. The research team had previously found that people who enjoy activities such as reading, doing puzzles, or playing games experienced lower rates of delirium. The team published new findings on physical activity in the Journal of the American Geriatrics Society.

The researchers noted that several studies have shown that exercise and physical activity may reduce the risks of developing dementia (another medical condition affecting mental health, usually marked by memory problems, personality changes, and poor thinking ability). What’s more, earlier studies have shown that regular exercise can lower the risk of developing delirium by 28 percent.

The participants in this study were adults over 60 years old who were undergoing elective orthopedic surgery. Most participants were around 70 years old. None had delirium, dementia, or severe hearing or vision problems.

The researchers asked participants the question “In the last month, how many days in a week did you participate in exercise or sport?” The researchers noted the type of physical activities the participants did, as well as whether and how often they read newspapers or books, knitted, played cards, board games, or computer games, used e-mail, sang, wrote, did crossword puzzles, played bingo, or participated in group meetings.

The participants said their physical exercise included walking, taking part in physical therapy, lifting weights, cycling, stretching, engaging in competitive sports, and dancing. The most commonly reported activity was walking. Though most participants were only active one day a week, nearly 26 percent were active five to six days a week and 31 percent were active five to seven days a week.

Of the 132 participants, 41 (31 percent) developed postoperative delirium.

The researchers reported that participants who were physically active six to seven days a week had a 73 percent lower chance of experiencing postoperative delirium (delirium that develops after surgery). They also reported that being mentally active was a strong factor in reducing chances of developing postoperative delirium. Participants who regularly read newspapers or books, knitted, played games, used e-mail, sang, wrote, worked crossword puzzles, played bingo, or participated in group meetings had an 81 percent lower chance of developing postoperative delirium.

“While our study was preliminary in nature, we found that modest regular physical activity, as well as performing stimulating mental activities, were associated with lower rates of delirium after surgery,” said the researchers. The researchers also found that physical and cognitive activities seemed to offer benefits independent of each other. This suggests that people with activity-limiting injuries or conditions can still benefit from being mentally active, and people with mild cognitive impairment can still benefit from being physically active. The researchers noted that more research is needed to learn about the role of exercise and cognitive training in reducing delirium after surgery.

Source: HealthinAging


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Social Stress Tied to Lower Bone Density After Menopause

Lisa Rapaport wrote . . . . . . . . .

Older women who are under a lot of social strain may be more likely to develop brittle, fracture-prone bones after menopause than their counterparts with worry-free lives, a recent study suggests.

Researchers followed 11,020 postmenopausal women over six years, giving them periodic bone mineral density (BMD) tests and mood assessments. Participants rated their level of social strain, or negative interactions or relationships; their social support, or positive relationships; and social functioning, or limitations in social activity.

Each one-point increase in social strain scores was associated with 0.082% greater loss of BMD in the neck, 0.108% greater loss of BMD at the hip, and 0.069% greater loss of BMD in the lower spine, the study found.

“Fractures are a major societal burden affecting 1 in 2 older women, due to a variety of risk factors that lead to bone loss,” said Shawna Follis, lead author of the study and a researcher at the University of Arizona in Tucson.

“We found that high social stress is one risk factor that increases bone loss in aging women,” Follis said by email.

Reduced estrogen production during menopause and afterward can slow production of new bone tissues in women. Over time, this process leads to decreased BMD and increases the risk of osteoporosis.

Bones thinned by osteoporosis are brittle and more easily fractured.

Much of the previous research into connections between osteoporosis and mental health has focused on whether impairment due to bone thinning or fractures might contribute to mood disorders like depression or anxiety, the researchers note.

In the current study, published in Journal of Epidemiology & Community Health, high levels of social stress were associated with lower BMD even after researchers accounted for other factors that can impact bone health like age, education, chronic health problems, weight, smoking status, alcohol use, hormone therapy, age at menopause, physical activity, and fracture history.

Lower social functioning was tied to greater decreases in BMD in the neck and hip, the current study found. And low social support was associated with greater decreases in the neck.

The study doesn’t prove that social stressors directly impact bone mineral density, and researchers also didn’t look at the connection between various social stressors and falls or fractures. And it’s impossible to say from the study whether easing of social stress would have any effect on bone health.

Still, the results suggest that older women who do a better job of managing stress may have healthier bones and a lower fracture risk, said Dr. JoAnn Pinkerton, director of midlife health at the University of Virginia Health System in Charlottesville, Virginia and executive director emeritus of the North American Menopause Society.

“For women who are anxious or have higher social stress levels, mindfulness, cognitive therapy, self-calming strategies, yoga, counseling, access to community building, or, if needed, medications might decrease the psychosocial stress levels,” Pinkerton, who wasn’t involved in the study, said by email.

When women do have osteoporosis, there are still things they can do to prevent bones from becoming more brittle, Pinkerton added.

“Calcium, vitamin D and strength training may prevent further bone loss,” Pinkerton said. “Although many women are fearful of the side effects associated with medications for treating osteoporosis, the side effects are actually rare while fractures may be life changing.”

Osteoporosis medicines such as Fosamax (alendronate sodium), Actonel (risedronate sodium), and Boniva (ibandronate sodium) work by slowing down how fast the body removes old bone, allowing time to regrow bone and make fractures less likely.

These medicines can cause nausea and abdominal pain, as well as rare but more serious side effects like cracks in the thighbone or damage to the jawbone. Alternative treatments include estrogen or two injected medicines, denosumab and teriparatide.

Source: Reuters

Study: Depression, Alzheimer’s Might Be Part of Same Process in Some Aging Brains

New research is untangling the complex relationship between symptoms of depression and losses in memory and thinking that often emerge together with Alzheimer’s disease.

In fact, the new data suggests that “depression symptoms themselves may be among the early changes in the preclinical stages of dementia syndromes,” explained study lead author Dr. Jennifer Gatchel. She works in the division of geriatric psychiatry at Massachusetts General Hospital in Boston.

In the study, researchers examined brain scans and other data gathered over seven years from 276 older adults enrolled in the Harvard Aging Brain Study. All of the participants were still living independently in the community at the beginning of the study and were considered healthy.

However, the analysis revealed a significant link between worsening depression symptoms and mental decline over two to seven years, and both of these trends seemed to be linked to a buildup of amyloid protein in brain tissue.

The slow accumulation of amyloid has long been known as a hallmark of Alzheimer’s disease.

“Our research found that even modest levels of brain amyloid deposition can impact the relationship between depression symptoms and cognitive [thinking] abilities,” Gatchel said in a hospital news release.

The new insight that depression symptoms might be part of the Alzheimer’s process could further research into the prevention or treatment of the illness, she added.

It “raises the possibility that depression symptoms could be targets in clinical trials aimed at delaying the progression of Alzheimer’s disease,” Gatchel said, so “further research is needed in this area.”

The researchers stressed that not all older adults with depression and amyloid buildup will have memory and thinking declines, however. That suggests that other factors — for example, brain metabolism, or the volume of the brain’s memory center, the hippocampus — could link depression and mental decline.

Other mechanisms — including brain degeneration caused by the protein tau (another protein long associated with Alzheimer’s), high blood pressure and inflammation — might play a role and need to be investigated.

Overall, the findings suggest that depression could have multiple causes and might also “work synergistically with amyloid and related processes to affect cognition over time in older adults,” Gatchel said.

Two experts in brain health agreed that the study could further dementia research and treatment.

“This is very helpful research in that it identifies behavioral manifestations that may precede a diagnosis of dementia,” said Brittany LeMonda, a clinical neuropsychologist at Lenox Hill Hospital in New York City. “It may alert providers to look into mood changes and depression as early symptoms of an underlying dementia and may allow patients to be diagnosed earlier,” she added.

“Whereas in the past, depression and dementia were viewed as separate conditions that could co-occur in the same individual, we have learned now that mood and cognitive symptoms may actually be symptoms of the same underlying condition with shared pathology,” LeMonda explained.

Dr. Gayatri Devi is a neurologist and psychiatrist who specializes in memory disorders at Northwell Health in New York City. She said that “depression has long been known to be a risk factor for Alzheimer’s disease and other dementias, but one question that clinicians contend with is whether depression is a symptom of cognitive loss or whether it is the cognitive impairment that leads to depression.”

The new research gets closer to solving that puzzle, Devi said, “and underscores that not only is it important to treat late-life depression, physicians should also be alert to, and evaluate for, cognitive loss in such persons and address that separately, as well.”

The new research was published online in JAMA Network Open.

Source: HealthDay


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Low Muscle Mass in the Limps Increases the Mortality Risk of Seniors

Karina Toledo wrote . . . . . . . . .

Evaluating body composition, especially appendicular muscle mass, can be an effective strategy for predicting longevity in people over 65 years of age, according to a study conducted by researchers at the University of São Paulo’s Medical School (FM-USP) in Brazil.

The appendicular muscles are the muscles that move the appendages or extremities – the arms and legs. They also play a key role in stabilizing the shoulders and hips.

The researchers studied a group of 839 men and women over the age of 65 for approximately four years. They observed that all-cause mortality risk increased nearly 63-fold during the follow-up period in women with low appendicular muscle mass and 11.4-fold in men.

An article with results of the study, which was supported by FAPESP, is published in the Journal of Bone and Mineral Research.

“We evaluated the body composition of this group, focusing on appendicular muscle mass, subcutaneous fat and visceral fat. We then sought to determine which of these factors could predict mortality in the ensuing years. We concluded that the key factor was the amount of appendicular lean mass,” Rosa Maria Rodrigues Pereira, Full Professor and Head of Rheumatology at FM-USP and principal investigator for the study, told Agência FAPESP.

Body composition was determined by dual energy X-ray absorptiometry (DXA), also known as bone density scanning, using a densitometer purchased with funding from FAPESP during a previous project led by Pereira to assess the prevalence of osteoporosis and fractures in older women living in Butantã, a neighborhood in western São Paulo city. The same cohort of individuals over 65 years of age was studied in both projects.

“Participants were selected on the basis of the census performed by IBGE [Brazil’s national census bureau]. The sample was representative of the older members of the country’s population,” Pereira said.

The study sample comprised 323 men (39%) and 516 women (61%). The frequency of low muscle mass was approximately 20% for both men and women.

Silent disease

The gradual loss of muscle mass and quality associated with aging is known as age-related sarcopenia. Approximately 46% of Brazilians aged 80 or older have sarcopenia, according to the Brazilian Association of Geriatrics and Gerontology.

Especially when combined with osteoporosis, sarcopenia can increase the vulnerability of older people in that they become more prone to falls, fractures and other physical injuries. Low bone mineral density, particularly in the femur, was shown to correlate with mortality in elderly individuals by research published in 2016.

Pereira and her group developed an equation to determine which individuals can be considered to have sarcopenia based on the characteristics of the community studied.

“According to the most widely used criteria [appendicular lean mass in kg divided by height squared in m], most of the individuals identified as having sarcopenia are lean. However, our sample had a higher-than-average BMI [body mass index], so we substituted muscle mass for fat mass. Subjects with muscle mass that was 20% below average were classified as having sarcopenia,” Pereira said.

The researchers discussed this topic in articles published in Osteoporosis International in 2013 and 2014.

In addition to bone density, the researchers also analyzed blood samples and responses to questionnaires to evaluate diet, physical activity, smoking, consumption of alcoholic beverages, and the presence of chronic diseases such as diabetes, high blood pressure and dyslipidemia (abnormally elevated levels of fat in the blood).

At the end of the four-year period, 15.8% (132) of the volunteers had died; 43.2% had died from cardiovascular problems. The mortality rate was 20% for the men and 13% for the women in the sample.

“We then conducted a number of statistical analyses to detect differences between the subjects who died and those who remained alive, particularly, whether it was possible to predict a person’s death on the basis of body composition measured by the DXA examination,” Pereira said.

Differences

Generally, subjects who died were older, exercised less, and suffered more from diabetes and cardiovascular problems than those who remained alive. In the case of the women who died, they also had decreased BMIs. The men who died were more likely to suffer falls. All these variables were fed into the statistical model and adjusted for the end-result to show which body composition factor correlated best with mortality risk.

Only low muscle mass was found to be significant in the women, considering the adjustment variables, while visceral fat was also significant among the men. The mortality risk doubled with each 6 cm2 increase in abdominal fat. Curiously, a higher proportion of subcutaneous fat had a protective effect in the men.

“We found that other parameters also negatively influenced mortality in the men, statistically reducing the significance of appendicular muscle mass. In the women, however, muscle mass stood out as a key factor and hence had more influence,” Pereira said.

Menopause-related hormone changes may help explain the difference between men and women. “The rapid and significant transition from a protective estrogenic environment to a deleterious hypoestrogenic environment, which is particularly adverse for the cardiovascular system, may make the protective metabolic role of skeletal muscles, including the production of anti-inflammatory cytokines, more important in the postmenopause period. This hormone change is far less abrupt in men,” she said.

Loss of muscle mass, which occurs naturally after the age of 40, can be unnoticed owing to weight gain, which is also common in middle age. Between 1% and 2% of muscle mass is lost annually after the age of 50, according to estimates. The factors that may accelerate muscle loss include sedentary habits, a protein-poor diet, chronic diseases and hospitalization.

In addition to their obvious importance in posture, balance and movement, the skeletal muscles have other functions that are essential to the body. They help regulate blood sugar by consuming energy during contraction and maintain the body temperature by trembling when cold. They also produce messenger hormones, such as myokinase, that assist communication with different organs and influence inflammatory responses.

The good news is that sarcopenia is preventable and can even be reversed by physical exercise, especially muscle toning. Attention to protein ingestion is also recommended.

The article “Association of appendicular lean mass and subcutaneous and visceral adipose tissue with mortality in older Brazilians: The São Paulo Ageing & Health Study” by Felipe M. de Santana, Diogo S. Domiciano, Michel A. Gonçalves, Luana G. Machado, Camille P. Figueiredo, Jaqueline B. Lopes, Valéria F. Caparbo, Liliam Takayama, Paulo R. Menezes and Rosa M. R. Pereira can be retrieved from: onlinelibrary.wiley.com/doi/pdf/10.1002/jbmr.3710.
 
Source: Agencia FAPESP

Study: Older Adults May Experience Brain Decline Before They Realize It

Jill Rosen wrote . . . . . . . . .

Some older adults without noticeable cognitive problems have a harder time than younger people in separating irrelevant information from what they need to know at a given time, and a new study from researchers at Johns Hopkins University could explain why.

The findings offer an initial snapshot of what happens in the brain as people try to access long-term memories and could shed light on why some people’s cognitive abilities decline with age while others remain sharp.

“Your task performance can be impaired not just because you can’t remember, but because you can’t suppress other memories that are irrelevant,” said senior author Susan Courtney, a cognitive neuroscientist in the Department of Psychological and Brain Sciences at Johns Hopkins. “Some ‘memory problems’ aren’t a matter of memory specifically, but a matter of retrieving the correct information at the right time to solve the problem at hand.”

The findings from the study are published in Neurobiology of Aging.

The researchers had 34 people aged 18 to 30 (referred to as young adults for the study) and 34 people aged 65-85 (referred to as older adults) perform a mental arithmetic task while their brain activity was measured through functional magnetic resonance imaging, or fMRI. Other images were also collected to measure the integrity of the connections between brain areas called white matter tracts.

The task compared the participants’ ability to inhibit irrelevant information automatically retrieved from long term memory. They were asked to indicate whether a proposed solution to an addition or multiplication problem was correct or not—such as 8×4=12 or 8+4=32. These examples would create interference as participants considered the right answer because although they should answer “incorrect,” the proposed solution seems correct at first glance, based on long-term memories of basic math. This interference did not exist when participants were asked to answer clearly false equations like 8×4=22. Making the task even more complicated, the subjects were sometimes asked to switch to multiplication after they saw the addition symbol and vice versa.

Older adults were a fraction of a second slower at answering the questions than younger participants, particularly when there was interference, but the more dramatic difference showed up in the brain scans. Older individuals who had more difficulty with interference also had more frontal brain activation than young adults.

The brain imaging demonstrated that in some aging participants, fibers connecting the front and back of the brain appear to have been damaged over the years. However other older individuals had fibers similar to much younger subjects. The greater the integrity of these fibers, the better the participant’s task performance, said lead author Thomas Hinault, a postdoctoral fellow at Johns Hopkins.

“Everyone we studied had good functioning memory, but still we saw differences,” Hinault said. “There are so many disruptions in the world and being able to suppress them is crucial for daily life.”

The researchers were surprised to find that during parts of the task that were the trickiest, where participants had to switch between multiplication and addition and were asked to add after they saw a multiplication command or vice versa, the people with the strongest brain fiber connections performed even better. Something about deliberately exercising the mind in this fashion made the most agile minds even more so.

“If you have good connections between brain networks, that will help,” Courtney said. “If not, you have interference.”

Source: HUB


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