Anabolic hormones in aging women: effects of supplementation vs. physical activity.

Aging is associated with a decline in bone mass, muscle mass, strength, and physical function, and women are more likely to suffer from these physical changes than men. The model presented in this paper illustrates the age related changes in anabolic hormones and how this may partly explain the diminished physical function of older women. The model can also be used to identify potential sites of intervention that could delay the atrophy of the musculoskeletal system. Various pharmacological hormone therapies have been shown to be beneficial, but there may be health risks associated with their use. There is evidence that regular physical activity is related to higher levels of anabolic hormones in older persons, therefore exercise could be an alternative to drugs for slowing the age related changes in the endocrine system. However, some research suggests that the hormone response to exercise is blunted in older women. This lower hormonal response may not be a consequence of aging per se but instead may result from secondary characteristics of aging such as a decline in physical fitness and exercise intensity or changes in body composition. Further research is needed to determine whether exercise-induced increases in endogenous hormones have clinical significance in improving muscle or bone mass in aging women.     

Changes in depression and physical decline in older adults: a longitudinal perspective

BACKGROUND: The impact of chronicity and changes in depression on physical decline over time in older persons has not been elucidated. METHODS: This prospective cohort study of 2121 community-dwelling persons aged 55-85 years uses two measurement occasions of depression (CES-D scale) over 3 years to distinguish persons with chronic, remitted, or emerging depression and persons who were never depressed. Physical function is assessed by self-reported physical ability as well as by observed performance on a short battery of tests. RESULTS: After adjustment for baseline physical function, health status and sociodemographic factors, chronic depression was associated with significantly greater decline in self-reported physical ability over 3 years when compared to never depressed persons (odds ratio (OR)=2.83, 95% confidence interval (CI)=1.86-4. 30). In the oldest old, but not in the youngest old, chronic depression was also significantly predictive of greater decline in observed physical performance over 3 years (OR=2.22, 95% CI=1.43-3. 79). Comparable effects were found for older persons with emerging depression. Persons with remitted depression did not have greater decline in reported physical ability or observed performance than persons who were never depressed. CONCLUSIONS: Our findings among community-dwelling older persons show that chronicity of depression has a large impact on physical decline over time. Since persons with remitted depression did not have greater physical decline than never depressed persons, these findings suggest that early recognition and treatment of depression in older persons could be protective for subsequent physical decline.     

Visuoperceptual repetition priming and progression of parkinsonian signs in aging

Parkinsonian signs in older persons are associated with numerous adverse health outcomes, however there is limited information about factors which predict progression of these signs. Using generalized linear models, we examined the association between efficiency in visuoperceptual and conceptual processing, measured by repetition priming, and rate of change in parkinsonian signs in a large sample of older persons without cognitive impairment or Parkinson's disease. Subjects with better visuoperceptual priming, measured by threshold word-identification and word-stem completion, at study baseline, progressed more slowly during follow-up of up to 11 years. Conceptual priming was not associated with change in parkinsonian signs. The findings demonstrate that individual differences in visuoperceptual processing efficiency, measured by repetition priming, occur in older persons without cognitive impairment and predict important changes in motor function. Reduced visuoperceptual priming in aging may be an early signal of vulnerability in a corticostrial circuit that contributes to sensorimotor integration.     

Survival analysis indicates that age-related decline in sleep continuity occurs exclusively during NREM sleep

A common complaint of older persons is disturbed sleep, typically characterized as an inability to return to sleep after waking. As every sleep episode (i.e., time in bed) includes multiple transitions between wakefulness and sleep (which can be subdivided into rapid eye movement [REM] sleep and non-REM [NREM] sleep), we applied survival analysis to sleep data to determine whether changes in the “hazard” (duration-dependent probability) of awakening from sleep and/or returning to sleep underlie age-related sleep disturbances. The hazard of awakening from sleep—specifically NREM sleep—was much greater in older than in young adults. We found, however, that when an individual had spontaneously awakened, the probability of falling back asleep was not greater in young persons. Independent of bout length, the number of transitions between NREM and REM sleep stages relative to number of transitions to wake was approximately 6 times higher in young than older persons, highlighting the difficulty in maintaining sleep in older persons. Interventions to improve age-related sleep complaints should thus target this change in awakenings.     

Serum cholesterol and the aging process

With advancing age, the average serum cholesterol level rises. Thus, older persons generally have higher cholesterol scores than do younger individuals. Quite apart, it is a generally agreed fact that older persons die more readily than younger people. Finally, there is general agreement that older persons with higher cholesterol levels die more readily, though not necessarily of cardiovascular disease, than older people without hypercholesterolemia. It then follows that, all other factors being equal, lowering hypercholesterolemia is, in fact, an expression of “making people younger”.Two hundred and twenty-one routine private practice patients were studied before and after approximately two months of routine therapy including EDTA treatment and general supportive care including multivitamintrace mineral supplementation. The evidence indicates, within the limits of this kind of study conducted in a private practice environment, that favorable changes occurred in serum cholesterol levels suggesting a possible reversal of the aging process.     

The endocrine system and ageing

Complex changes occur within the endocrine system of ageing individuals. This article explores the changes that occur in the metabolism and production of various hormones and discusses the resulting clinical consequences. As individuals age there is a decline in the peripheral levels of oestrogen and testosterone, with an increase in luteinizing hormone, follicle-stimulating hormone and sex hormone-binding globulin. Additionally there is a decline in serum concentrations of growth hormone, insulin-like growth factor-I and dehydroepiandrosterone and its sulphate-bound form. Even though there are complex changes within the hypothalmo-pituitary-adrenal/thyroid axis, there is minimal change in adrenal and thyroid function with ageing. The clinical significance of these deficiencies with age are variable and include reduced protein synthesis, decrease in lean body mass and bone mass, increased fat mass, insulin resistance, higher cardiovascular disease risk, increase in vasomotor symptoms, fatigue, depression, anaemia, poor libido, erectile deficiency and a decline in immune function. For each endocrine system, studies have been carried out in an attempt to reverse the effects of ageing by altering the serum hormonal levels of older individuals. However, the real benefits of hormonal treatment in older individuals are still being evaluated.     

The nature of memory failure in mild cognitive impairment: examining association with neurobiological markers and effect of progression

The main goal of this study was to assess vulnerability to proactive interference and memory binding capacity, the ability to combine different information into a single coherent memory event, in persons with mild cognitive impairment (MCI). We also examined whether hippocampal atrophy and vascular burden were differentially related to these memory capacities in MCI. We further assessed whether memory performance and brain changes differ as a function of later development (or not) of dementia and whether they can predict progression to dementia. The study included 77 participants, 49 meeting the criteria for MCI and 28 healthy older adults. Results showed binding deficits and greater vulnerability to proactive interference in persons with MCI compared with healthy older adults. Hippocampal volume was associated with binding capacity, whereas vascular burden was associated with resistance to interference in persons with MCI. Follow-up analyses indicated that binding deficits predict progression from MCI to dementia. In conclusion, binding deficits and vulnerability to proactive interference are present in persons with MCI and are associated with different brain markers. However, only binding deficits predict progression to dementia.     

AIDS and older persons: an international perspective

The impact of the worldwide AIDS epidemic on persons aged 50 years or older has received relatively little consideration except in the United States, where interest has focused almost exclusively on older persons living with AIDS or at risk for infection. The place of older persons in the epidemic deserves international attention because their lives are being significantly affected in a variety of ways. Because most of the epidemic occurs in the developing regions of the world, especially in Africa and Asia, efforts to understand and deal with the concerns of older persons in relation to AIDS in those settings need expansion. Although older persons represent a non-negligible minority of the reported global caseload, a far larger number of older persons are affected through the illness and death of their adult children and younger generation relatives who contract AIDS. From a global perspective, a broader concern encompassing those who are affected through the infection of others rather than a narrow concern with those who are at risk or infected themselves is called for if the needs of the large majority of older persons adversely affected by the epidemic are to be addressed.     

Five hourly measurements of serum cholesterol levels: a new methodology to assess and evaluate stress, good health and disease

Research has developed a concrete link between psychological/emotional stress and life-threatening diseases such as heart disease and cancer. Here we present a technique to assess the magnitude of stress from cholesterol variation number (CVN). This number is the difference between the highest and the lowest cholesterol concentrations that relates to the five hourly cholesterol measurements performed over a five hour span. Since cholesterol in serum arises from the liver, the CVN is equated with the fluctuations in hepatic biosynthesis. This relationship is explained on the basis of the rhythmic hormonal secretions associated with cholesterol biosynthesis. Whenever stress-induced aberrations in timing of hormonal secretions occur, CVN changes. Individuals with lower CVN would have overall better health than persons with higher CVN. Thus by utilizing CVN, physicians may be able to differentiate cardiovascular health of individuals with the same or very similar serum cholesterol concentrations.     

Older persons’ expressed worries during nursing care at home: Do health complexity and nature of nursing care in the visit matter?

ObjectiveOlder persons receiving home care express more cues and concerns compared to other clinical contexts. Increased health condition complexity requires a corresponding increase in nursing competence. The aim of this study was to explore how complexity of older persons’ health and nature of the visit influenced their expressed worries.MethodsIn this cross-sectional explorative study, we analysed older persons’ expressed worries (n = 508) identified by the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in 129 audio-recorded home care visits with older persons (≥65 years), collected in 3 city districts and 1 rural area in Norway.ResultsExpressed worries of 45 older persons were included in the analysis: 18 had low health complexity, 5 moderate and 22 high health complexity. The nature of the visit affected the number of expressed worries, health complexity did not. Most of the worries were expressed during basic nursing care visits and/or medication administration.ConclusionFindings suggest that home visit type may influence the older persons’ expressed worries. The complexity of the older persons’ health condition seems to have little impact on the expressed worries.Practice implicationsKnowledge about communication in different complexity of visits is important when planning care for older persons.     

Blood flow to exercising limbs varies with age, gender, and training status.

Understanding the effects of physiological aging on blood flow to active skeletal muscle and its regulation during exercise has important functional, hemodynamic, and metabolic implications for our rapidly expanding elderly population. During peak exercise involving a large muscle mass, blood flow to the legs is lower in healthy older compared to younger persons; this results from central (reduced cardiac output) and peripheral (reduced leg vascular conductance) limitations. There is considerable variability in the literature concerning age-related changes in leg blood flow during submaximal exercise, with reports of similar or reduced leg blood flow and vascular conductance in older vs. younger subjects depending on the exercise intensity and the gender and training status of the subjects. However, all the studies involving non-endurance-trained subjects are consistent in that older subjects achieve the requisite leg blood flow at higher arterial perfusion pressures than young subjects, suggesting altered local vasoregulatory mechanisms with aging. Although the nature of these age-related alterations is poorly understood, we have preliminary evidence for augmented sympathetic vasoconstrictor responsiveness in the legs of older men during exercise, and blunted leg vasodilator responsiveness in older women. Systematic research will be needed in order to define the central and local mechanisms underlying these age- and gender-specific differences in muscle vascular responsiveness. Such information will be important for designing future interventions aimed at improving muscle blood supply and functional capacity in older persons.     

Functional brain imaging and age-related changes in cognition

There are a number of age-related structural and physiological changes in the brain that could have implications for cognitive function in the elderly. The impact of these age-related changes in the brain on cognition has been studied using neuroimaging to examine brain activity during tasks of memory, perception and attention, and determine how this activity differs between young and older individuals. It has often been found that older individuals utilize different areas of the brain than do young subjects when carrying out the same cognitive task. This has led some researchers to suggest that older persons utilize different functional brain networks, perhaps to compensate for reductions of efficiency in task-related brain areas. However, data collected to date on this issue are still limited, so although the evidence is intriguing, the definitive interpretation of these findings must await further experiments.     

Relationship of internal-external control and United States suicide rates, 1966–1973

The annual variations in scores obtained on the Rotter Internal-External (I-E) control scale by United States college students between the years 1966 and 1973 were related to the concomitant annual variations in suicide rates for the total United States population and for eight separate age groups. The I-E scores increased substantially during this time period and were correlated positively with the concomitantly increasing suicide rates among relatively young persons (in and below the 35–44 year age group). However, the suicide rates among older persons generally decreased during this time period and thus were correlated negatively with the I-E scores. These results suggest that perceptions of internal-external control did not change among older persons as they did among younger persons, perhaps because older persons might be less susceptible to the cultural influences that affect the perceived control of younger persons. Results of this and earlier research suggest that cultural characteristics that foster high perceptions of external control also foster suicidal behavior and suggest the value of attempts to convey perceptions of internal control to psychotherapy clients.     

Do cycle disturbances explain the age-related decline of female fertility? Cycle characteristics of women aged over 40 years compared with a reference population of young women

BACKGROUND: The cause of declining fertility with age, in women who still have regular menstrual cycles, is not clear. METHODS: Follicle development, endometrial growth and hormonal patterns were evaluated in cycles of older women (aged 41-46 years; n = 26) who previously were normally fertile, and these cycles were compared with a reference group of relatively young fertile women (aged 22-34 years; n = 35). RESULTS: Clearly abnormal cycles were found in only two women in the older age group, and in one woman in the younger group. The main differences between the age groups were a shorter follicular phase and cycle length in the older group, in combination with higher FSH levels in the late luteal and early follicular phase. In contrast to published data which suggest an "accelerated" follicle development in older women, sonographical and hormonal evidence was found of an "advanced" follicle growth, with an earlier start already during the luteal phase of the preceding cycle, and an advanced selection and ovulation of the dominant follicle. CONCLUSIONS: Such an earlier start of follicle growth in a possibly less favourable hormonal environment, as well as a limited oocyte pool, may contribute to a decreased follicle and oocyte quality, resulting in diminished fertility in ageing women.     

AIDS and older Americans at the end of the Twentieth Century

In the past 11 years, the cumulative number of AIDS cases reported to the Centers for Disease Control and Prevention in adults aged 50 years or older quintupled, from 16,288 in 1990 to 90,513 by the end of December 2001. This article provides an overview of AIDS cases through 2001, shows the growing totals of AIDS cases among persons aged 50 years or older, and describes and compares these cases with those among younger people. It also reviews work on perceptions of persons aged 50 years or older on their risk for contracting HIV and their preventive health practices. Most of the data for this article came from the CDC web site and the AIDS public use data set. Although the incidence of AIDS appears to be leveling off in the general population, the data show that older people as a group represent a substantial share of new cases. There are currently more than 60,000 persons estimated to be aged 50 years or older living with AIDS in the United States; more than 50,000 persons with AIDS in this age group have died since the epidemic began. In light of the new era of highly active antiretroviral therapy, it can be expected that the AIDS epidemic will continue to age in multifaceted ways.     

Olfactory impairment increases as a function of age in persons with Down syndrome.

Neuropathology similar to that found in the brains of patients with Alzheimer's disease (AD) has consistently been observed in older individuals with Down syndrome (DS) and this neuropathology is particularly prevalent in areas involved in olfaction. The present study investigated the effects of age on the expression of olfactory impairment in Down syndrome to address the hypothesis that older adults with DS show greater deficits in olfactory function compared with younger persons with DS and compared with age and IQ matched control groups. Between group differences showed that persons with DS had significant deficits in olfactory functioning compared to the two control groups. Further, within the DS group, older adults performed more poorly than the young adults or children. Results support the hypothesis that in a group of persons at risk for AD because of DS, olfactory impairment is greater in older individuals, suggesting progressive impairment over time. Deficits in olfactory function may be useful in signalling incipient dementia in DS.     

Is inefficient multisensory processing associated with falls in older people?

Although falling is a significant problem for older persons, little is understood about its underlying causes. Spatial cognition and balance maintenance rely on the efficient integration of information across the main senses. We investigated general multisensory efficiency in older persons with a history of falls compared to age- and sensory acuity-matched controls and younger adults using a sound-induced flash illusion. Older fallers were as susceptible to the illusion as age-matched, non-fallers or younger adults at a short delay of 70 ms between the auditory and visual stimuli. Both older adult groups were more susceptible to the illusion at longer SOAs than younger adults. However, with increasing delays between the visual and auditory stimuli, older fallers did not show a decline in the frequency at which the illusion was experienced even with delays of up to 270 ms. We argue that this relatively higher susceptibility to the illusion reflects inefficient audio–visual processing in the central nervous system and has important implications for the diagnosis and rehabilitation of falling in older persons.     

Anomie and United States Suicide rates, 1973--1976

Related annual variations in United States suicide rates between 1973 and 1976 to concomitant annual variations in expressions of anomie obtained on the 5-item Srole anomie scale by a representative sample of the United States population. Expressions of anomie increased significantly for persons in the age groups (15--24 and 25--34 year) that displayed increases in suicide rates, annual variations in endorsement of anomie statements were correlated significantly with the concomitant annual variations in the suicide rates of the 15--24 year age group, and there was a nonsignificant tendency toward this relationship in the other (25--34 year) age group with increasing suicide rates. However, expressions of anomie also increased significantly for persons in the older age groups that showed no increases in suicide rates. Thus, Durkheim's hypothesis was not supported among older persons as it was among younger persons. Previous studies suggest that measures of anomie that focus explicitly on perceptions of internal-external control may be related more closely to suicidal behavior (especially for older persons) than measures that focus on other components of anomie.     

Predictors of fecal occult blood screening among older socioeconomically disadvantaged Americans: a replication study

Socioeconomically disadvantaged elderly are less likely to participate in fecal occult blood testing (FOBT). A quasi-experimental design was used in this operational replication study to determine predictors at baseline of subsequent participation in FOBT. Sixty-five percent of the 211 participants in the replication study participated in FOBT, and 47% of the 171 participants in the original study participated in FOBT. Predictors for FOBT in the replication study were male gender, age of 65–75 years old, ability to go places without assistance, history of having had a digital rectal examination and FOBT. This replication study supports targeting socioeconomically disadvantaged populations for FOBT as well as females, persons 85 years and older, persons who need assistance in travel, and persons who have not had FOBT before. The results show that socioeconomically disadvantaged persons will participate in FOBT when effective educational interventions that include adaptation for aging changes are used.