Is Daily Low-Dose Aspirin Really Worth It for Seniors?

Dennis Thompson wrote . . . . . . . . .

There’s disappointing news for seniors: A new trial shows that taking daily low-dose aspirin doesn’t prolong healthy, independent living in otherwise healthy people aged 70 and older.

Aspirin has long been recommended for middle-aged folks with a history of heart disease, to prevent future heart attacks or strokes.

Researchers had hoped that aspirin’s specific effects might help folks ease gracefully into their old age.

“The thinking was the double action of blood thinning and anti-inflammation might decrease the risk of dementia and disability,” explained senior researcher Dr. Anne Murray, director of the Berman Center for Outcomes and Clinical Research at Hennepin Healthcare in Minneapolis.

But a major new clinical trial has concluded that daily aspirin does not prolong disability-free survival in the elderly.

In fact, aspirin could put their health at risk by increasing the risk of bleeding in the brain and the gastrointestinal tract, researchers found.

“We were so hoping that such an inexpensive and accessible medication might be effective in prolonging healthy independent life,” Murray said.

Daily aspirin is recommended for people between 50 and 59 if they are at increased risk of heart disease, according to the U.S. Preventive Services Task Force, a guideline-setting expert panel.

For people ages 60-69 “who have a 10 percent or greater 10-year [heart disease] risk,” the decision to start low-dose daily aspirin “should be an individual one,” the USPSTF said.

However, there’s not been enough medical evidence to say whether aspirin would help elderly folks, the USPSTF says.

“It’s the first of its kind to address this question,” said Dr. Basil Eldadah, chief of the Geriatrics Branch of the U.S. National Institute on Aging. “It’s an important issue because so many older people in the United States take aspirin, and there’s not clear evidence up until now whether that’s indicated.”

To answer the question, researchers recruited just over 19,000 people in Australia and the United States with an average age of 74, and assigned half to take daily aspirin and the other half to receive a placebo.

People were recruited between 2010 and 2014, and had to be free of dementia, physical disability or any medical condition that would require aspirin use. They were followed for an average of close to five years.

Treatment with 100 milligrams of aspirin per day did not affect the chances a person would live longer free from dementia or disability, researchers found.

In fact, the group taking aspirin had a slightly increased risk of death — 5.9 percent died compared with 5.2 percent taking a placebo. However, the higher death rate was due to more cancer deaths in the aspirin group, which could have been due to chance, the researchers said.

More troubling was the fact that people taking daily aspirin suffered clinically significant bleeding.

Hemorrhagic stroke, bleeding in the brain, gastrointestinal bleeding, or bleeding at other sites that required transfusion or hospitalization occurred in 3.8 percent of people on aspirin versus 2.7 percent of people on placebo.

“There’s definitely an increased bleeding risk, and it’s not benign,” said Dr. Vincent Bufalino, a cardiologist and spokesman for the American Heart Association. “The intracranial bleeding risk is obviously a terrible complication.”

The clinical trial’s results suggest that “if seniors don’t have a valid medical need for taking aspirin, you are unlikely to benefit from it and there are some risks,” concluded lead researcher John McNeil, head of epidemiology and preventive health at Monash University in Melbourne, Australia.

However, all of the experts agreed that if you’re now taking aspirin under a doctor’s direction you shouldn’t stop until you discuss it with them, regardless of your age.

“Many people are taking aspirin for important medical reasons,” McNeil said. “It would be unwise to stop without speaking to their doctor about it.”

The clinical trial was published online as three papers in the New England Journal of Medicine.

Source: HealthDay

Even at ‘Safe’ Levels, Air Pollution Puts Seniors at Risk

For older people, breathing in dirty air puts them at risk of being hospitalized with a dangerous respiratory disease, a new study suggests.

Among U.S. seniors, hospital admissions for acute respiratory distress syndrome (ARDS) rose as levels of both ozone and fine particulate matter increased — even when the pollutants were within levels now considered safe, the researchers said in a news release from the American Thoracic Society.

“While there is growing evidence of the impact on lung health of numerous air pollutants, there have been few studies that have looked at acute respiratory diseases and air pollution across large populations,” said lead author Jongeun Rhee. She is an epidemiologist at Harvard’s T.H. Chan School of Public Health in Boston.

Rhee and her colleagues analyzed data from nearly 30 million Medicare beneficiaries who were discharged from U.S. hospitals from 2000 through 2012. Using ZIP codes, the investigators were able to calculate seniors’ annual exposure to fine particulate matter, or PM2.5, in the air as well as to ozone from April through September.

The researchers also developed models that allowed them to link pollution levels with hospitalizations due to ARDS. They found a significant link between changes in levels of fine particulate matter and ARDS admission rates among older people.

While the study found a connection between pollution and hospitalization for ARDS, it didn’t prove a link.

ARDS is a progressive, often fatal, disease that causes fluid to leak into the lungs, making breathing difficult or impossible, the study authors explained. Older people and those with serious health issues — such as sepsis, pneumonia or traumatic injury — are at greater risk.

“We highlighted the importance of air pollution as an environmental risk factor for ARDS, which has not been studied widely but contributed to a previous finding that was limited to ozone,” Rhee said in the news release.

The study also found that ARDS admissions increased even when older people were exposed to pollution levels that were within National Ambient Air Quality Standards.

The study’s senior author, Dr. David Christiani, is a professor of environmental genetics at T.H. Chan School of Public Health.

He said the “findings are unique in showing that the adverse health effects of air pollution on our senior citizens now include acute respiratory failure, and that an increase in hospitalization for ARDS in seniors occurs at the current U.S. air pollution standards.”

He went on to say that “these results add to the growing body of literature on various adverse health effects at current standards that demonstrate a need to lower our exposure limits.”

The study was scheduled for presentation Wednesday at the annual meeting of the American Thoracic Society, in San Diego. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

Source: HealthDay


Today’s Comic

A Daily Walk Is Good for Seniors’ Brain Health

Alan Mozes wrote . . . . . . .

With New Year’s Day fast approaching, one small, new study suggests that seniors interested in preserving their brain health might want to add walking to the top of their resolution list.

Why? A team of investigators from University of California, Los Angeles (UCLA) found that adults over the age of 60 who are already struggling with memory issues are better able to focus and process information if they walk more than 4,000 steps a day (roughly 2 miles).

“We looked at how physical activity affects thickness of brain structures and also cognitive [thinking] performance of adults over the age of 60,” explained study author Prabha Siddarth.

Siddarth noted that brain thickness is considered to be “an early and sensitive marker of brain health.”

The study revealed that those who walked more than 4,000 steps each day had thicker areas of the brain known to be critical to thought processing.

What’s more, such avid walkers demonstrated “better cognitive functioning” than those who walked 4,000 steps or less, she said.

Siddarth is a biostatistician in the department of psychiatry and biobehavioral sciences with the Semel Institute for Neuroscience and Human Behavior and Longevity Center at UCLA.

To explore the potential mental health benefits of walking, the team focused on 26 men and women between the ages of 61 and 88. Nearly 70 percent were women.

While none suffered from dementia, all complained about memory issues.

For one week, all were outfitted with an accelerometer, to track activity patterns.

Participants were then divided into two groups: those who walked more than 4,000 steps per day and those who walked less. (The less active group was older, at an average age of 77, compared with the more active group, at an average age of 68.)

In addition, MRI brain scans were conducted and each participant underwent a battery of mental health tests to assess memory skills, learning skills, verbal skills, attention and information-processing abilities, decision-making function and the ability to execute a task.

The investigators found that those who walked in excess of 4,000 steps per day had thicker brain measurements in the area of the hippocampus and surrounding regions. Collectively, greater brain thickness in such regions has previously been linked to better thinking and memory.

In terms of information-processing speed, the ability to pay attention, and the ability to make plans and meet goals, those in the 4,000-plus group also demonstrated a “substantial” leg up over the less mobile group, said Siddarth, though the degree of the advantage varied.

But she said it remains unclear whether walking even more — above 4,000 steps — might further improve mental health. “This is something we are working on to see if more exercise leads to more improvement, and also to see if this is paralleled in brain thickness measures,” Siddarth said.

The study authors noted that the finding is an association, rather than proof that daily walking actually protects the brain.

This latter point was seconded by Adam Woods, assistant director of the University of Florida’s Center for Cognitive Aging and Memory (CAM), in Gainesville.

“I think caution is warranted when interpreting [these] results as causal,” Woods said. He added that the findings stem from just a small group of people whose activity patterns were only correlated with brain function, rather than shown to affect it.

Woods also pointed out that “neither of these findings is novel. Prior work has shown that persons with higher physical activity have correlated differences in brain volume and cognitive performance,” he said.

Woods, who also serves as director of the CAM Neurophysiology and Neuromodulation Research Core at the McKnight Brain Institute, said that “these results suffer from the classic ‘chicken or the egg’ conundrum. Did higher walking lead to increased hippocampal volume and better cognition in these people, or did better cognition and larger hippocampal volume drive their increased physical activity?”

So for now, he concluded, the finding in “no way speaks to whether physical activity could improve cognition and brain volume.”

The findings were published online recently in the Journal of Alzheimer’s Disease.

Source: HealthDay


Today’s Comic

Air Pollution Can Be Deadly for Seniors

Even levels of air pollution deemed “safe” by U.S. government standards may shorten the life spans of seniors, new research suggests.

In fact, hundreds of older Americans may die prematurely each year due to the effects of dirty air, the study found.

The finding stems from a computer prediction analysis that correlated fine particle and ozone pollution levels between 2000 and 2012 with death rates on roughly 93 percent of all Americans who were covered by Medicare at the time.

“This is the most comprehensive study of short-term exposure to pollution and mortality to date,” said senior study author Francesca Dominici, co-director of the Harvard Data Science Initiative in Boston.

“We found that the mortality rate increases almost linearly as air pollution increases. Any level of air pollution, no matter how low, is harmful to human health,” Dominici said in a Harvard news release.

During the study period, 22 million people covered by the investigation died.

While the study only found an association, the investigators found that for every tiny incremental increase in either particulate pollution or ozone levels, the daily death rate bumped up between roughly 0.5 and 1 percent.

Though the figures may seem small, Dominici and her colleagues pointed out that it adds up when multiplied across the entire population of American seniors, amounting to more than 7,100 premature deaths over the study period.

What’s more, the research team noted that some groups of seniors are even more vulnerable to such exposure, with low-income seniors facing a three times higher risk than more well-off seniors.

In a similar vein, women were found to face a 25 percent greater premature death risk following pollution and ozone exposure compared with men. The same was true of nonwhite Americans, relative to their white peers.

The findings were published in the Journal of the American Medical Association.

Source: HealthDay


Today’s Comic

Calcium and Vitamin D Supplements May Not Lower Bone Fracture Risk of Seniors

Dennis Thompson wrote

Seniors are wasting their time and money taking calcium and vitamin D supplements to ward off the brittle bones of old age, a new review concludes.

It turns out there’s little evidence supplements protect against hip fractures and other broken bones in older folks, according to data gathered from dozens of clinical trials.

“The routine use of these supplements is unnecessary in community-dwelling older people,” said lead researcher Dr. Jia-Guo Zhao, an orthopedic surgeon with Tianjin Hospital in China. “I think that it is time to stop taking calcium and vitamin D supplements.”

Not all experts agreed with this conclusion, however. Orthopedic surgeon Dr. Daniel Smith says the study makes a “bold leap” by arguing that these supplements do no good at all.

“The big picture, which seems to be lost in this study, is that the personal health cost of a hip fracture can be catastrophic,” said Smith, an assistant professor of orthopedics at the Icahn School of Medicine at Mount Sinai in New York City.

“The potential benefit of calcium and vitamin D supplementation in preventing even a small number of hip fractures far outweighs the otherwise minimum risks associated with routine calcium and vitamin D supplementation in at-risk populations,” Smith added.

It’s been longstanding medical advice that aging people focus on getting enough calcium and vitamin D to preserve their bone health as they age.

About 99 percent of the calcium in the human body is stored in the bones and teeth, and the body cannot produce the mineral on its own, according to the U.S. National Institutes of Health. Too little calcium can lead to osteoporosis. The body also requires vitamin D to absorb calcium.

The National Osteoporosis Foundation recommends that women aged 50 or younger and men 70 or younger should get 1,000 milligrams (mg) of calcium per day. Men and women older than that should get 1,200 mg daily.

For their analysis, Zhao and his colleagues combed through medical literature to find clinical trials that previously tested the usefulness of calcium and Vitamin D supplements. They wound up with data from 33 different clinical trials involving more than 51,000 participants, all of whom were older than 50 and living independently.

Most of the clinical trials took place in the United States, the United Kingdom, New Zealand and Australia, Zhao said. The dosage of the supplements varied between the clinical trials, as did the frequency at which they were taken.

The pooled data revealed no significant association between calcium or vitamin D supplements and a person’s risk of hip fracture or other broken bones, compared with people who received placebos or no treatment at all.

Calcium and vitamin D are still essential to bone health, but these results indicate you should get them through your diet and lifestyle rather than from supplements, Zhao explained.

“Dietary calcium is irreplaceable for skeletal health,” Zhao said. “Milk, vegetable, fruit and bean products are the most important food sources of calcium.”

“Vitamin D is synthesized in the skin in response to ultraviolet-B radiation in sunlight, and dietary sources of vitamin D are limited,” Zhao continued. Exercising out in the sunshine should provide a person with all the vitamin D they need.

Potential dietary sources of these nutrients prove one of the weaknesses of the evidence review, Smith argued.

“While this study addresses concerns regarding calcium and vitamin D supplementation, it fails to address or even consider whether the patients in question are obtaining either adequate calcium and vitamin D intake in their diets or sunlight exposure, obviating the need for supplementation,” Smith said.

The evidence review also included a large amount of data from the Women’s Health Initiative, a federally funded study of aging U.S. women, said Andrea Wong, vice president of scientific and regulatory affairs with the Council for Responsible Nutrition, a trade association representing dietary supplement manufacturers.

“Unfortunately, the WHI data has been widely acknowledged as having limitations of its own having to do with subjects not taking the supplements as directed by the protocol, as well as those who took calcium and vitamin D supplements on their own, outside the protocol, before and during the study,” Wong said.

Inclusion of the WHI might have skewed the overall results of the review, Wong argued.

In addition, later reviews of the WHI data indicated that people who started taking calcium and vitamin D supplements had a reduced risk of hip fractures and other broken bones, Wong said.

“CRN recommends that people discuss their individual needs for calcium and vitamin D with their health care practitioners,” she said.

“If there is the possibility of reducing the risk of a devastating fracture by supplementing with calcium and vitamin D, as some research has found, people should not be dissuaded from supplementation by a meta-analysis that is meant as a general recommendation and may not apply to each individual,” Wong added.

The new analysis was published in the Journal of the American Medical Association.

Source: HealthDay