Effects of exposure to morning bright light in the blind and sighted controls

Summary. Seven blind subjects and 11 sighted controls were exposed to 3300 lux of cool-white fluorescent light for either 1 h or 15 min in the morning for 2 weeks during the winter. Serum 25-hydroxyvitamin D₃ concentration, melatonin concentration in saliva, body temperature from the armpit, subjective sleepiness, and depressive symptoms were measured before and after the 2-week trial. The intervention resulted in a significant elevation in the concentration of melatonin at 21.00 hours in the healthy controls but at 23:00 hours in the blind subjects. The body temperatures measured were increased in the controls but decreased in the blind in the morning following the cessation of the intervention, and these opposite changes resulted in significant differences in the temperatures between the two groups. The decreases in the body temperature were associated with the increases in the levels of melatonin in the blind but not in the controls. Bright light administered in the morning decreased subjective sleepiness and improved mood in the healthy controls and in the blind subjects as well. The intervention had no effect on the levels of vitamin D in either of the two groups.     

Preventing suicide in older people.

Prompt recognition of suicidal intent can prevent suicide in the elderly. Some psychiatric disorders, such as depression, psychoses and organic brain syndromes, can predispose these persons to suicide, as can medical disorders that result in pain, disability or dysfunction. Other factors that increase the risk for suicide include chemical dependency and changing life events. Anti-depressant medications with a low anticholinergic and sedative profile are preferred because of age-related physiologic changes. Electroconvulsive therapy is reserved for serious cases.     

Pain and falls in older people.

Pain and falling both affect substantial segments of the older population. Despite the presence of several plausible mechanisms for pain to contribute to falling, very few studies have investigated this relationship in older people. If pain is a falls risk factor, this represents a potentially important point of intervention for falls prevention. Falls are a major cause of disability and loss of independent living status in older people. We examined the relationship between pain, pain-related interference with activities and falls in a cross-sectional analysis of 3509 people aged 49 years or more in two postal code areas in New South Wales, Australia (the Blue Mountains Eye Study). We found that subjects reporting pain with moderate to severe level of pain-related interference with activities were more likely to report any falls or multiple falls in the past 12 months than subjects not reporting pain (adjusted prevalence ratios 1.42, p=0.0001 and 1.62, p=0.0156, respectively). We also found a significant trend in the association indicating an increasing likelihood of self-reported falls associated with increasing level of pain-related interference with activities. The association was stronger for multiple falls than for any falls. Excluding subjects with recent fractures did not alter the findings. Given the high prevalence and public health importance of both conditions, further investigation of this association in prospective studies is recommended.     

Vaccination in older people

Vaccinating older people remains a priority in the specialty of public health. However, medical practitioners, pharmacists, carers and family members and the media need to make a special effort to inform and educate older people of the need to protect themselves against certain diseases, such as influenza, pneumococcal pneumonia and tetanus. These conditions pose particular health risks to older people in terms of the high risk of developing serious complications.     

Principles of pain management in older people.

The management of chronic pain should be a priority in geriatric care. Pain is a common problem that has tremendous potential to influence the physical function and quality of life of elderly people during their remaining years. Much research and education is still needed to further our understanding of pain and its management among elderly people. Existing pain management strategies should be tailored for the special needs of the geriatric population. Applications of "high tech" pain management strategies, such as morphine pumps and chronic spinal infusions, need to be clarified for older people. Finally, family and caregiver considerations should be included in chronic pain management strategies.     

Malnutrition in older people

The Department of Health launched the next segment of its Dignity for Older People campaign last week, which will focus on nutrition. This article looks at the problem of malnutrition in older people and what action the summit needs to take.     

Physical therapy use by community-based older people

BACKGROUND AND PURPOSE: Little information is available on factors associated with physical therapy use. Identifying the characteristics of people who use physical therapy and some of the factors associated with its use is a useful first step in determining whether disparities exist in physical therapy use. The purpose of this study was to identify factors associated with physical therapy use by community-based older people. SUBJECTS: The subjects were community-based people 65 years of age or older who participated in the Medicare Current Beneficiary Survey and had at least one physician encounter (N=38,312 person-years across 20,227 individuals). METHODS: Logit and ordinary least squares regression analyses were conducted to identify factors associated with physical therapy use. RESULTS: Several measures of health and function were associated with physical therapy use. Several demographic, insurance, and geographic characteristics also were associated with physical therapy use. Income, education, having supplemental private insurance, participating in a managed care plan, and physical therapist supply were positively associated with physical therapy use. Age was negatively associated with physical therapy use. For people who saw a physical therapist, amount of physical therapy received was positively associated with income, having supplemental private insurance, living in a metropolitan area, physical therapist supply, and being African American. Amount of physical therapy received was negatively associated with being in a managed care plan. DISCUSSION AND CONCLUSIONS: Variation in physical therapy use, explained by factors other than need, suggests potential underuse or overuse of physical therapy by community-based older people.