COVID Lockdown Loneliness Linked to More Depressive Symptoms in Older Adults

Loneliness in adults aged 50 and over during the COVID-19 lockdown was linked to worsening depressive and other mental health symptoms, according to a large-scale online study.

Loneliness emerged as a key factor linked to worsening symptoms of depression and anxiety in a study of more than 3,000 people aged 50 or over led by the University of Exeter and King’s College London, and funded by The National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC).

Researchers had access to data going back to 2015 for participants of the PROTECT online study. They also found that a decrease in physical activity since the start of the pandemic was associated with worsening symptoms of depression and anxiety during the pandemic. Other factors included being female and being retired.

Dr Byron Creese, of the University of Exeter Medical School, who led the study, said: “Even before the pandemic, loneliness and physical activity levels were a huge issue in society, particularly among older people. Our study enabled us to compare mental health symptoms before and after COVID-19 in a large group of people aged 50 and over. We found that during lockdown, loneliness and decreased physical activity were associated with more symptoms of poor mental health, especially depression. It’s now crucial that we build on this data to find new ways to mitigate risk of worsening mental health during the pandemic.”

The study found that before the pandemic, lonely people would report an average of two symptoms of depression for at least several days over the previous last two weeks. During lockdown, lonely people reported either an increase in frequency of depressive symptoms, to more than half the days in the two week period, or a new symptom for at least several days in that timeframe. In people who were not lonely, levels of depressive symptoms were unaffected.

PROTECT began in 2011, and has 25,000 participants signed up. Designed to understand the factors involved in healthy ageing, the innovative study combines detailed lifestyle questionnaires with cognitive tests that assess aspects of brain function including memory, judgment and reasoning over time. In May, researchers included a new questionnaire designed to assess the impact of COVID-19 on health and wellbeing. Running from May 13 to June 8, the questionnaire was completed by 3,300 people, of which 1,900 were long-standing PROTECT participants. The study is continuing to run so that longer term outcomes can be assessed.

Zunera Khan, Research Portfolio Lead at Institute of Psychiatry, Psychology & Neuroscience said “We’ve found links between loneliness and a drop in physical exercise and worsening mental health symptoms. It should be within our power to find ways of keeping people socially engaged and active. Our online PROTECT platform ultimately aims to find new ways to engage people in their homes, however, technology can only be part of the picture. We need to ensure we can find new ways to help people stay active and social, whether they are online or not.”

Professor Clive Ballard, Executive Dean and Pro-Vice Chancellor of the University of Exeter Medical School, who leads PROTECT, said: “We are only just beginning to learn the impact that COVID-19 is having on the health and wellbeing of older people. For example, the effect of any economic impact may not yet have emerged. Our largescale study will span a number of years, and will help us understand some of the longer-term effects of COVID-19 on mental health and wellbeing, and ultimately, on whether this has any knock-on effect on aspects of ageing, such as brain function and memory. “

The study plans to conduct further analysis on groups at particularly high risk, such as people with cognitive impairment and those with caring roles.

Source: University of Exeter

Cool Temperatures May Blunt Cognition in Older Adults

It’s well known that older adults are more apt to feel chilly. New research finds that cooler temperatures may do more than cause discomfort. Columbia University Mailman School of Public Health researchers find that lower temperatures are associated with an elevated risk of impaired cognition among individuals age 84 and older. This relationship is further heightened in individuals with damaged mitochondrial DNA, a sign that these cellular powerplants play a role in adaptation to ambient temperature.

Study results appear in the journal Environmental Epidemiology.

Researchers analyzed data collected from 591 Boston-based men enrolled in the Veterans Affairs’ Normative Aging Study between 2000 and 2013. Cognitive function was evaluated via the Mini-Mental State Examination. Outdoor temperature was estimated at residential addresses one day before the examination using a validated temperature model. Mitochondrial DNA copy number (mtDNAcn), a representation of the mitochondria’s response to oxidative stress as well as general dysfunction, was determined through an analysis of blood samples.

In individuals age 84 or older, a 1°C decrease in temperature (1.8°F) was associated with 35 percent increased odds of cognitive impairment. These odds were higher among individuals with lower mtDNAcn, suggesting that healthy mitochondria may help people adapt to lower outdoor temperatures. Future research could shed more light on biological mechanisms of age-related declines in the body’s ability to regulate response to outside stressors.

“General cognitive function deteriorates with aging, a change that has been linked to outdoor temperature. Older individuals have reduced ability to adapt to changes in outdoor temperature than younger people,” the authors write. “Colder temperature causes vasoconstriction and this decreased blood flow may be related to worse cognitive function. In older individuals, this may be compounded by an already weakened vascular system.”

Source: Columbia University Mailman School of Public Health

Physical Frailty Syndrome: A Cacophony of Multisystem Dysfunction

In the inaugural issue of the journal Nature Aging a research team led by aging expert Linda P. Fried, MD, MPH, dean of Columbia University Mailman School of Public Health, synthesizes converging evidence that the aging-related pathophysiology underpinning the clinical presentation of phenotypic frailty (termed as “physical frailty” here) is a state of lower functioning due to severe dysregulation of the complex dynamics in our bodies that maintains health and resilience. When severity passes a threshold, the clinical syndrome and its phenotype are diagnosable. This paper summarizes the evidence meeting criteria for physical frailty as a product of complex system dysregulation. This clinical syndrome is distinct from the cumulative-deficit-based frailty index of multimorbiditys. The paper is published online here.

Physical frailty is defined as a state of depleted reserves resulting in increased vulnerability to stressors that emerges during aging independently of any specific disease. It is clinically recognizable through the presence of three or more of five key clinical signs and symptoms: weakness, slow walking speed, low physical activity, exhaustion and unintentional weight loss.

The authors of this Perspectives article integrate the scientific evidence of physical frailty as a state, largely independent of chronic diseases, that emerges when the dysregulation of multiple interconnected physiological and biological systems crosses a threshold to critical dysfunction that severely compromises homeostasis, or stability among the body’s physiological presses. The physiology underlying frailty is a critically dysregulated complex dynamical system. This conceptual framework implies that interventions such as physical activity that have multisystem effects are more promising to remedy frailty than interventions targeted at replenishing single systems.

Fried and colleagues then consider how this framework can drive future research to optimize understanding, prevention and treatment of frailty, which will likely preserve health and resilience in aging populations.

“We hypothesized that when Individual physiological systems decline in their efficiency and communication between cells and between systems deteriorate, this results in a cacophony of multisystem dysregulation which eventually crosses a severity threshold and precipitates a state of highly diminished function and resilience, physical frailty,” said Fried, who is also director of the Robert N. Butler Columbia Aging Center.

“The key insight is simply that one’s physiological state results from numerous interacting components at different temporal and spatial scales (e.g., genes, cells, organs) that create a whole unpredictably more than the parts,” observes Fried.

For example, Fried notes that physical frailty prevalence and incidence has been linked to the interconnected dynamics of three major systems, altered energy metabolism through both metabolic systems, including glucose/insulin dynamics, glucose intolerance, insulin resistance, alterations in energy regulatory hormones such as leptin, ghrelin, and adiponectin, and through alterations of musculoskeletal systems function, including efficiency of energy utilization and mitochondrial energy production and mitochondrial copy number. Notably, across these systems, both energy production and utilization are abnormal in those who are physically frail.

The aggregate stress response system and its subsystems are also abnormal in physical frailty. Specifically, inflammation is consistently associated with being frail, including significant associations with elevated inflammatory mediators such as C-reactive protein, Interleukin 6 (IL-6, and white blood cells including macrophages and neutrophils, among others, in a broad pattern of chronic, low-grade inflammation. Each of these three systems mutually regulate and respond to the others in a complex dynamical system.

The authors recommend that multisystem fitness is needed to maintain resilience and prevent physical frailty, including macro-level interventions such as activities to improve physical activity or social engagement; the latter, apart from contributing to psychological well-being, also can increase physical and cognitive activity.

“There is strong evidence that frailty is both prevented and ameliorated by physical activity, with or without a Mediterranean diet or increased protein intake,” noted Fried. “These model interventions to date are nonpharmacologic, behavioral ones, emphasizing the potential for prevention through a complex systems approach.”

“This work, conducted under the leadership of Dr. Linda Fried, is the culmination of nearly two decades of research characterizing the pathophysiology of the frailty syndrome. It should pave the way for further elucidating the underlying mechanisms of frailty pathogenesis,” said Ravi Varadhan, PhD, PhD, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, and a co-author. “The paper postulates that energetics – the totality of the processes involved in the intake, utilization, and expenditure of energy by the organism – is the key driver of frailty. Testing this hypothesis would be an important area of future research in aging.”

Source: Columbia University Mailman School of Public Health

For Older Adults, Preventing Flu is Key To Lessening Disability Risks

We tend to think of the flu as an illness that people recover from within a relatively short time. Unfortunately, that’s not always the case for older adults, who are more likely to experience difficulties getting around and living independently following a serious illness. Adding to the problem is the potential for additional health problems that can occur during a stay in the hospital. Hospitalized older adults potentially face delirium, an abrupt change in mental function which causes sudden confusion. They are also susceptible to hospital-acquired infections and can weaken if they lose their physical conditioning.

In fact, studies show that one-third of older adults will be discharged from the hospital with a new disability — and only 30 percent of them will regain their pre-admission ability levels for bathing, dressing, feeding themselves, and managing other activities of daily living, even one year after their discharge.

A decline in your ability to take care of yourself can mean a greater need for in-home support, admission to a long-term care facility, and even an increased risk of death.

That’s why a team of researchers designed a study to learn more about functional decline (the ability to take care of yourself) and serious disability in adults, aged 65 years and older, who are admitted to hospital for influenza and other acute respiratory illnesses. Their study was published in the Journal of the American Geriatrics Society.

The Relationship Between Flu & Functional Decline

The research team wanted to learn more about how common such declines are, and to see if they differed depending on whether people were hospitalized with influenza or with other types of respiratory illnesses. They also wanted to examine whether a person’s level of frailty at the start of their hospitalization affected functional decline and serious disability. Finally, they hoped to learn whether the relationship between frailty and serious disability was linked to a patient’s influenza status.

Participants in the study were hospital patients aged 65 or older who were enrolled in the Canadian Immunization Research Network’s (CIRN) Serious Outcomes Surveillance (SOS) Network during the 2011-2012 influenza season. In this season, the SOS Network included 40 hospitals across seven Canadian provinces.

The researchers studied information from participants who had tested positive for influenza or had acute respiratory illnesses such as asthma, COPD, lung embolisms and other infectious illnesses, including respiratory viruses, pneumonia, and sepsis.

The participants were screened for the following basic functional abilities: feeding, toilet use, bowel and bladder control, grooming, dressing, bathing, mobility, stair climbing, and the ability to get in and out of a bed and chair. For each item on the index researchers used to measure these abilities, a score of 10 means independence, 5 means need for assistance, and 0 means complete dependence.

A total score of 100 indicates complete independence, with decreasing scores indicating increases in disability. A loss of 10 to 20 points was considered to represent a meaningful moderate functional decline, whereas a loss of 20 or more points was considered catastrophic.

A total of 925 patients were enrolled during the 2011-2012 influenza season. On average, the participants were around 80 years of age, slightly more than half were women, and 37 percent had influenza.

Both groups had experienced a similar loss of ability from the time of their diagnosis to their admission to the hospital. Of the participants, 78 died, twice of whom had influenza compared to other respiratory illnesses. Those who died had lower functional scores at baseline (an average of 62), and those who survived had higher baseline functional scores (an average of 85).

Nearly 20 percent of surviving patients experienced lasting declines in their ability to function. Of them, eight percent experienced moderate functional decline and 10 percent experienced catastrophic functional declines. The frailer a patient was, the higher their chances were for experiencing serious functional decline.

A total of 170 patients experienced a catastrophic outcome, meaning they were either very seriously disabled or they died.

The researchers concluded that among older Canadians admitted to network hospitals during the 2011-2012 influenza season, people in both the influenza and other acute respiratory infection groups experienced a loss of their ability to function. Although many of them returned to their original level of function, nearly 20 percent experienced a meaningful loss of function within 30 days after their hospital discharge — of whom half experienced a catastrophic disability.

Prevention is Key

According to the researchers, this is the first study to specifically report on functional declines following hospitalization for influenza.

The researchers noted that their study highlights the importance of disease prevention and management in order to avoid hospitalization from any cause. Preventing hospitalization, including by having influenza and pneumococcal (pneumonia) vaccination, is key to preventing functional decline and catastrophic disability in older adults..

Source: Health in Aging

Study: High-Dose Vitamin D Won’t Prevent Seniors’ Falls

High doses of vitamin D may increase seniors’ risk of falls, rather than reduce it, according to a new study.

Preliminary studies suggested vitamin D may increase muscle strength and improve balance, so Johns Hopkins researchers investigated whether high doses of vitamin D might reduce the risk of falls in people aged 70 and older.

But the investigators found that large doses of vitamin D supplements were no better at preventing falls in this age group than a low dose.

“There’s no benefit of higher doses but several signals of potential harm,” study author Dr. Lawrence Appel said in a Hopkins news release.

“A lot of people think if a little bit is helpful, a lot will be better. But for some vitamins, high-dose supplements pose more risks than benefits. There’s a real possibility that higher doses of vitamin D increase the risk and severity of falls,” said Appel, a professor of medicine with joint appointments in epidemiology, international health and nursing.

Taking 1,000 or more international units per day (IU/day), equivalent to 25 micrograms/day of vitamin D, was no better than 200 IU/day at preventing falls, according to the study, which was funded by the U.S. National Institute on Aging.

The results were published Dec. 8 in the journal Annals of Internal Medicine.

The researchers also found that vitamin D supplement doses of 2,000 and 4,000 IU/day seemed to increase the risk and severity of falls compared with 1,000 IU/day, a relatively common dose for a pure vitamin D supplement.

Another finding was that serious falls and falls that required hospitalization occurred more often in older people who took 1,000 or more IU/day than in those who took 200 IU/day (about half the typical dose found in multivitamins).

Older folks should talk with their doctors about their fall risk and vitamin D levels in order to determine whether or not to continue taking vitamin D supplements, Appel recommended.

Source: HealthDay