Seniors, Lose the Weight But Not the Muscle in 2018

If you’re a senior who’s pledging to lose weight in 2018, be sure you’re shedding excess fat without losing muscle and bone.

Losing fat is good for your heart, but maintaining muscle and bone is crucial for staying mobile and living independently, said Kristen Beavers, a health and exercise science professor at Wake Forest University.

“Everybody says that they want to lose weight, but what they really mean is that they want to lose fat,” she said. “And, for older adults in particular, maintaining muscle is a vital part of any plan to lose weight.”

To do that, she suggests resistance training — what used to be called “weight training.” In a study published recently in the journal Obesity, Beavers showed that resistance training was more effective than walking at helping obese seniors lose weight and preserve muscle mass.

It’s also important to be realistic when planning a weight loss/exercise program so you don’t get discouraged and give up by early February, Beavers said. She suggested consulting with a fitness expert at a community facility, like the YMCA or a senior center. Both offer free or reduced rates for seniors.

“Maintaining lost weight is just as important as the initial weight loss, especially since older adults are more likely to regain fat mass than muscle or bone,” she added.

Source: HealthDay


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Any Physical Activity Is Good for Seniors

Don’t try saying you’re too old or too busy to exercise, especially after that calorie-laden Thanksgiving dinner.

Any level of physical activity can reduce seniors’ risk of heart disease, researchers report.

The 18-year study included more than 24,000 adults ages 39 to 79.

They found a link between physical activity and reduced risk of heart disease in both elderly and middle-aged people.

“Elderly people who were moderately inactive had a 14 percent reduced risk of cardiovascular events compared to those who were completely inactive,” said study first author and cardiologist Sangeeta Lachman.

“This suggests that even modest levels of physical activity are beneficial to heart health,” said Lachman, who is with the Academic Medical Center in Amsterdam, the Netherlands.

No gym nearby? That’s not a problem. Seniors should be encouraged to at least do low-intensity physical activities, such as walking, gardening, and housework, she said.

The study results were published in the European Journal of Preventive Cardiology.

“Given our aging population and the impact of cardiovascular disease on society, a broader array of public health programs are needed to help elderly people engage in any physical activity of any level and avoid being completely sedentary,” Lachman concluded in a journal news release.

Source: HealthDay

Falls Lead to Declines in Seniors

More than half of elderly patients (age 65 and older) who visited an emergency department because of injuries sustained in a fall suffered adverse events – including additional falls, hospitalization and death – within 6 months. The results of a study examining how risk factors predict recurrent falls and adverse events were published online yesterday in Annals of Emergency Medicine (“Revisit, Subsequent Hospitalization, Recurrent Fall and Death within 6 Months after a Fall among Elderly Emergency Department Patients”).

Seniors who fall and end up in the ER are more likely to have additional medical problems in the future.

“Our study shows an even higher rate of adverse events than previous studies have,” said lead study author Jiraporn Sri-on, MD, of Navamindradhiraj University in Bangkok, Thailand. “Patients taking psychiatric and/or sedative medications had even more adverse events. This is concerning because these types of drugs are commonly prescribed for elderly patients in community and residential care settings.”

Of patients who visited the emergency department for injuries sustained in a fall, 7.7 percent developed adverse events within 7 days, 21.4 percent developed adverse events within 30 days and 50.3 percent developed adverse events within 6 months. Within 6 months, 22.6 percent had at least one additional fall, 42.6 percent revisited the emergency department, 31.1 percent had subsequent hospitalization and 2.6 percent had died.

Risk factors associated with adverse events within 6 months of an emergency department visit for a fall included diabetes, polypharmacy (five or more medications), and psychiatric and/or sedative medications.

“Emergency physicians have a tremendous opportunity to reduce the very high adverse event rate among older emergency patients who have fallen,” said Dr. Sri-on. “Fall guidelines exist and work needs to be done to increase their implementation in emergency departments so patients can be educated on how not to fall again once they have been discharged from the emergency department.”

The American College of Emergency Physicians recently produced and promoted a public education video urging people to take the “7 Step Fall Challenge” to help prevent falls.

Source: American College of Emergency Physicians

Overactive Bladder Drug Raises Dementia Risk of Seniors

Randy Dotinga wrote . . . . . .

A drug linked to a raised risk of dementia is taken by millions of older Americans who have an overactive bladder, researchers say.

More than one-quarter of patients with the urinary problem had been prescribed the drug oxybutynin (Ditropan), an international team of investigators found.

Yet, “oxybutynin is a particularly poor drug for overactive bladder in elderly patients,” said study lead author Dr. Daniel Pucheril, a urologist at Henry Ford Hospital in Detroit.

Prior studies have linked the drug to thinking problems and increased risk of dementia in older people, possibly because of the way it affects brain chemicals, he said.

“It’s a great and effective drug for younger patients, but is a risky drug for older patients,” Pucheril said. It boosts dementia risk even when not taken indefinitely, he said.

Alternatives exist but they’re more expensive and may not be covered by insurance, at least initially, the study authors explained.

For instance, “most Medicare Part D plans have a tiered drug formulary, which means that patients must try and ‘fail’ oxybutynin before they will be eligible for the newer generation of [so-called] antimuscarinic medications,” Pucheril said.

Also, there’s debate over the safety of alternatives.

The Urology Care Foundation estimates 33 million Americans have an overactive bladder. These people often need to urinate urgently, frequently or both. Some also suffer from incontinence.

Non-medical treatments — including changes in diet, exercises and scheduled urination — are usually the first line of treatment. Surgery is sometimes an option, as are prescription antimuscarinic medications like oxybutynin.

To determine how often oxybutynin is prescribed to seniors, researchers examined 2006-2012 statistics from the U.S. National Ambulatory Medical Care Survey. The investigators focused on about 2,600 patients aged 65 and older who received prescriptions for oxybutynin or similar medications for overactive bladder. The drug was prescribed 27 percent of the time for those patients.

Only 9 percent of those who took the drug underwent a neurological exam, even though the U.S. Food and Drug Administration recommends monitoring these patients for any signs of brain problems, the researchers pointed out.

“We cannot tell if patients are being monitored for neurologic problems in other ways,” Pucheril noted.

In addition, some doctors — but certainly not all — may be unaware of the mental side effects of oxybutynin, the researchers said.

Although alternatives exist, not everyone agrees they’re safer. A 2011 paper in Current Urology Reports described darifenacin (Enablex), tolterodine (Detrol), trospium (Sanctura) and solifenacin (Vesicare) as “having little or no risk” of oxybutynin-like effects on the brain.

However, urologist Dr. David Staskin contended that “no one has ever shown that tolterodine, darifenacin, or solifenacin is safer.” He said only trospium has been shown to not penetrate very deeply into the central nervous system.

“The problem here is whether it would eliminate the risk to switch everyone to another antimuscarinic,” said Staskin, an associate professor of urology at Tufts University School of Medicine in Boston.

According to Pucheril, other possible options include a newer class of medications called beta-3 agonists, neuromodulation (zapping nerves with electricity), and Botox delivered into the bladder.

A Canadian specialist noted that immediate-release oxybutynin is the form most linked to dementia. “Older patients on the drug should consider a review with their clinician,” said Dr. Adrian Wagg, director of geriatric medicine at the University of Alberta.

There’s no evidence that a family history of dementia adds to the drug’s risk, he said, or that people who already have dementia will face the same added risk as others.

The study was released Monday at the European Association of Urology conference in London. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.

One of the study authors reported receiving a grant from the pharmaceutical company Genentech via the American Society of Clinical Oncology.

Source: HealthDay


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Many Seniors Take Multiple Medicines That Can Affect the Brain

There has been a sharp rise in the number of American seniors who take three or more medications that affect their brains, a new study reveals.

The study looked at seniors’ use of opioid painkillers, antidepressants, tranquilizers and antipsychotic drugs. A review of U.S. Centers for Disease Control and Prevention data showed that the use of these drugs in people over 65 more than doubled from 2004 to 2013.

The researchers estimated that approximately 3.7 million doctor visits a year are by seniors taking three or more of these drugs. The largest increase was seen among seniors in rural areas. There, the use of these drugs more than tripled.

The spike in the combined use of drugs that act on the central nervous system is cause for concern because it can lead to falls and resulting injuries, affect driving ability, and cause memory and thinking problems, the study authors noted.

Taking opioid painkillers (such as Oxycontin) along with certain other brain-affecting drugs — including benzodiazepine tranquilizers (such as Valium and Xanax) — is of particular concern due to the increased risk of death, the researchers explained.

“The rise we saw in these data may reflect the increased willingness of seniors to seek help and accept medication for mental health conditions — but it’s also concerning because of the risks of combining these medications,” said study lead author Dr. Donovan Maust. He is a geriatric psychiatrist at the University of Michigan’s academic medical center, in Ann Arbor.

Another worrisome finding was that nearly half of seniors taking these drug combinations didn’t have a formal diagnosis of a mental health condition, insomnia or pain condition — the three main types of problems the drugs are typically prescribed for.

“We hope that the newer prescribing guidelines for older adults encourage providers and patients to reconsider the potential risks and benefits from these combinations,” Maust said in a university news release.

Findings from the study were published in the journal JAMA Internal Medicine.

Source: HealthDay


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