Obstructive sleep apnea in older adults

The "typical" presentation of obstructive sleep apnea (OSA) is chronic loud snoring and excessive daytime sleepiness in middle-aged obese men. OSA can result in increased risk for cardiovascular morbidity and mortality. The diagnostic features of OSA in older adults are similar to those in younger adults; however, the older adult may be less likely to seek medical attention or have the sleep disorder recognized because symptoms of snoring, sleepiness, fatigue, nocturia, unintentional napping, and cognitive dysfunction may be ascribed to the aging process itself or to other disorders. This article reviews the basic terminology and pathophysiology of sleep-disordered breathing, discusses why OSA may be even more prevalent in older adults than in the middle-aged group, and reviews similarities and differences between the two groups in the manifestations, consequences, and treatments of OSA.     

Sleep disordered breathing in the elderly

Sleep disordered breathing (SDB), i.e., obstructive, central or mixed sleep apneas, has been recognized as a common occurrence in the elderly. Aging is per se associated with a decrease in the quality of sleep; SDB may further disrupt the sleep architecture in older subjects. The prevalence of obstructive sleep apnea (OSA) increases with aging; available studies report prevalence rates of 11-62%. Furthermore, OSA has been associated with increased mortality in older adults. Central apneas and periodic breathing occur with increased frequency either in subjects with neurological disorders such as infarction, tumor, sequelae of infection, diffuse encephalopathies, or in chronic heart failure. Patients with cerebrovascular disease (stroke, or transient ischemic attacks) have a markedly high prevalence of SDB, mainly OSA. In these patients, SDB is associated with a poorer functional prognosis at 3 and 12 months after the acute event, and a higher mortality. The clinical impact of SDB on cognitive function appears to be modest in patients without dementia, although there is a moderate increase in daytime sleepiness. In Alzheimer's disease (AD) however, SDB occurs more frequently than in non-demented older subjects, and its severity is correlated with the degree of cognitive impairment. The hypothesis of a causal relationship between AD and SDB remains a subject of controversy. The possibility of SDB should be considered in the elderly in the differential diagnosis of "reversible dementias", increased daytime sleepiness, or unexplained right-sided heart failure.     

The effect of obstructive sleep apnea on morbidity and health care utilization of middle-aged and older adults

OBJECTIVES: To determine whether elderly subjects with obstructive sleep apnea (OSA) had different morbidity and health care utilization than elderly subjects without OSA and middle-aged patients with OSA 2 years before diagnosis.
DESIGN: Case-control study between January 2001 and April 2003.
SETTING: Two sleep–wake disorders centers.
PARTICIPANTS: One hundred fifty-eight elderly and 1,166 middle-aged (aged 67–89 and 40–64, respectively) patients with OSA were matched 1:1 with healthy controls according to age, sex, geographic area, and primary physician.
MEASUREMENTS: Polysomnography, medical diagnoses, and healthcare utilization.
RESULTS: Healthcare costs 2 years before diagnosis were more than 1.8 times as high for elderly and middle-aged patients with OSA as for controls ( P <.001). Expenditures of elderly patients with OSA were 1.9 times as high as for middle-aged patients with OSA ( P <.001). Multiple logistic regression analysis (adjusting for age, body mass index, and apnea hypopnea index) revealed that cardiovascular disease (CVD) (odds ratio (OR)=4.1, 95% confidence interval (CI)=1.8–9.3) and use of psychoactive drugs (OR=3.8, 95% CI=1.5–10.1) are independent determinants for the top-third most-costly elderly patients with OSA.
CONCLUSION: Elderly patients with OSA have high healthcare utilization because of CVD morbidity and use of psychoactive medications. Therefore, OSA has clinical significance in elderly people.     

Strategy use mediates the relationship between control beliefs and memory performance for middle-aged and older adults

We examined whether the relationship between control beliefs and memory performance varied for young, middle-aged, and older adults and whether strategy use mediated this relationship. Participants were 335 adults, ages 21 to 83, who had been recruited from local probability samples. We used structural equation modeling to test the predicted model and compare it by age group (young, middle-aged, and older adults). As expected, control beliefs were related to memory performance on a word list recall task for middle-aged and older adults, but not for younger adults. An analysis of indirect effects revealed that strategy use partially mediated this relationship. Specifically, middle-aged and older adults who perceived greater control over cognitive functioning were more likely to categorize the words and had better recall performance.     

Cognitive deficits and the course of major depression in a cohort of middle-aged and older community-dwelling adults

OBJECTIVES: To examine associations between cognitive deficits and persistent significant depressive symptoms at baseline and 2- and 4-year follow-ups in a sample of community-dwelling middle-aged and older adults. DESIGN: Prospective cohort study. SETTING: A U.S. national prospective cohort study of middle-aged and older adults, the Health and Retirement Study. PARTICIPANTS: A sample of 661 participants of the 1996 wave of the Health and Retirement Study who met criteria for 12-month Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised major depression (MD). MEASUREMENTS: MD was assessed using the World Health Organization Composite International Diagnostic Interview-Short Form. Persistent significant depressive symptoms were assessed using an eight-item version of the Center for Epidemiological Studies Depression scale. RESULTS: Cognitive deficits were associated with persistent significant depressive symptoms at follow-up. In a latent state-trait analysis, two stable and strongly correlated traits best explained variations in cognitive functioning and depressive symptoms across assessment points. CONCLUSION: Trait-like cognitive deficits commonly complicate the course of MD in community-dwelling middle-aged and older adults and may help to explain the persistent course of depressive symptoms in a large subgroup of adults with MD in this age range.     

The effect of instructions on age differences in practical problem solving.

In previous research middle-aged adults have typically been found to perform better on practical, everyday problems than either younger or older adults. However, it has been suggested that young adults may not expend as much effort as middle-aged adults and therefore may not perform as well as they are capable of performing. In order to test this hypothesis, the performance of young, middle-aged, and elderly adults was compared on 10 practical, everyday problems. Half of the subjects were given standard instructions and half were given instructions that encouraged them to perform as well as they possibly could. With the standard instructions, the young adults performed less well than either the middle-aged or the elderly adults. With the more explicit instructions, however, the young adults performed as well as the middle-aged adults and better than the elderly adults. The results of this study indicate that there may be a tendency on the part of young adults to give less than their optimal performance unless explicitly instructed to do their best.     

Aging,cognitive complexity,and the fundamental attribution error

Age differences in the prevalence and underpinnings of the fundamental attribution error were examined. Young, middle-aged, and older adults observed an actor providing responses to questions about political issues. In the no-choice condition, the actor was instructed how to respond, whereas in the choice condition, he was allowed to select his response. Consistent with previous research, middle-aged adults were less prone to the fundamental attribution error than were young and older adults. This was evidenced by their reduced tendency to make attitude attributions in the no-choice condition relative to the choice condition. Although high levels of both cognitive and attributional complexity were associated with reductions in attributional bias, complexity did not systematically account for the between-age-group differences in performance. It is suggested that the observed pattern of age effects is related to variations in both cognitive complexity and cognitive resources.     

Influence of other-beliefs on self-beliefs and on everyday memory self-report in the elderly

BACKGROUND AND AIMS: Elderly people tend to evaluate their memory functioning pessimistically and have a decrease in self-efficacy beliefs associated with an attributional style which relies mainly on uncontrollable causes. This pattern may be significantly influenced by the caregivers evaluations of self-efficacy beliefs and attributional style of the elderly. This study compares older and younger adults with respect to everyday memory self-assessment, self-efficacy beliefs and attributional style, and examines the relationships between everyday memory self-assessment, self-evaluations, and evaluations by significant others as regards elderly self-efficacy beliefs, attributional style, and everyday memory. METHODS: 100 older, 100 younger, and 100 middle-aged adults were required to complete questionnaires aimed at assessing everyday memory, attributional style, and self-efficacy beliefs. The group of middle-aged adults was asked to complete questionnaires aimed at assessing the perceived efficacy and attributional style of the older and younger participants. RESULTS: Data indicate that, unlike younger adults, the elderly negatively evaluate their everyday memory, have an attributional style mainly characterized by uncontrollable factors, and have less confidence in their memory. A structural equation model shows that the opinions of the significant others (relatives or medical staff) as regards the perceived efficacy and attributional style of elderly people affect their self-efficacy and attributional style which, in turn, influence everyday self-reported memory efficiency. CONCLUSIONS: Results indicate the central role of metamemory in everyday memory evaluation in the elderly, and stress the importance of what significant others think as regards the elderly person in question. From a practical point of view, it makes an important contribution to intervention and prevention programs involving people in close contact with the elderly, by suggesting ways in which significant others can help in optimizing the ability of older people to meet the challenges of aging successfully.     

领悟社会支持量表在50岁以上中老年群体的跨性别测量等值性

目的:检验领悟社会支持量表(PSSS)在50岁以上中老年人群体中的跨性别等值性。方法:利用PSSS对北京、湖南和山东三地1013名社区中老年人(50～96岁)进行调查。随后考查PSSS在不同性别中老年人群体中的测量等值性。最后对男性和女性两组样本在PSSS总分和分量表上的得分进行差异性检验。结果:问卷各步骤的测量等值性...     

Understanding cohort differences in cross-generational, self, and peer perceptions

Thirty adolescent, middle-aged, and elderly people participated in a study exploring (a) their self-, inter- and intra-cohort perceptions; (b) ascribed social distance; (c) knowledge of aging; and (d) the relationships among these phenomena. Data were gathered using a Social Distance Scale, Goals of Life Index, Facts on Aging Quiz, and Aging Semantic Differentials. In general, elderly adults were the most devalued and middle-aged adults the most favored cohort. Unfavorable attitudes toward elderly people were predicted more by age-related social distance and societally induced biases than differential investments in psychosocial life tasks. Appraising one's member cohort more favorably than those outside it was paralleled by a tendency to view the self more favorably than peers. The discrepancy between societal and older individuals' views of aging suggests that the social breakdown syndrome itself may be breaking down: Older adults are moving away from a characterization of themselves as ineffective and dependent. A similar view might be engendered in younger cohorts if social distance were reduced and more attention paid to assertions of elderly adults rather than to societally induced stereotypes.     

An inappropriate erythropoietic response to iron deficiency anaemia in the elderly

Summary This study was carried out to clarify the features of iron deficiency anaemia in the elderly. Subjects were chosen from residents undergoing an annual health check in a home for the aged and the features of anaemia in the elderly were compared with those in middle-aged adults under 60 years old. The red cell count, red cell size and haemoglobin content in an elderly group with iron-deficiency anaemia did not differ from those in middle-aged adults. No significant differences of the serum ferritin and iron levels were noted between the two groups. Total iron binding capacity was higher in the middle-aged adults than in the elderly, while the reticulocyte count was significantly lower in the elderly group. Immature reticulocytes showing a considerable amount of residual RNA by flow cytometry with fluorescent staining were also lower in the elderly group than in the middle-aged adults. Serum erythropoietin levels in both groups were significantly higher than in non-anaemic age-matched controls and no difference in erythropoietin levels was noted between them. The ratio of the reticulocyte count to the log-transformed erythropoietin level was low in the elderly group with iron-deficiency anaemia compared with the middle-aged adults with iron deficiency anaemia. The same result was seen when the immature reticulocyte count was related to the log-transformed erythropoietin level. These findings suggest that the red cell production response to erythropoietin in the elderly with iron-deficiency anaemia might be inappropriate compared with both non-anaemic and anaemic middle-aged adults.     

The relationship between physical activity and diabetes in middle-aged and elderly people

To investigate the association between diabetes symptoms and physical activity (PA) levels among middle-aged and older Chinese adults. Data for this study were obtained from 2018 Charles data. Z test, logistic regression analysis, and linear hierarchical regression analysis were performed in 5352 individuals aged ≥50 years with complete information. In terms of diabetes, 6.8% of the middle-aged and elderly people with diabetes were detected, and 93.2% of the middle-aged and elderly people without diabetes symptoms. The proportion of middle-aged and elderly people with high PA levels was 50.5%, and the proportion of middle-aged and elderly people with low PA was 49.5%. There was a significant positive correlation between low PA and diabetes (P < .05). After adjusting demographic characteristics (gender, registered permanent residence type, education level, age, widowhood) and health status characteristics (poor mood, asthma, hyperlipidemia, disability, memory disease, self-assessment of health status, hypertension, smoking, stroke, depression), there was still a statistical significance between PA level and diabetes (P < .05). The risk of diabetes of middle-aged and elderly people in China increases with age, while the risk of diabetes of middle-aged and elderly people with low level of PA is higher. The risk of diabetes is high among middle-aged and elderly people who are old, have poor self-evaluation health, suffer from hyperlipidemia, memory disease, and asthma. The middle-aged and old people should increase their PA levels to prevent and improve diabetes.     

The interacting effects of cognitive demand and recovery of postural stability in balance-impaired elderly persons

BACKGROUND: Although postural recovery is attentionally demanding in healthy elderly persons, an inability to recover balance due to competition for attentional resources between the postural system and a second task could contribute to falls in older adults with poor balance. This study examined the attentional demands of balance recovery from a mild postural disturbance in balance-impaired elderly persons. A second purpose of this research was to determine the effect of performing a cognitive task on the recovery of balance in balance-impaired elderly persons. METHODS: Fifteen healthy older adults and 13 older adults with clinical balance impairment were exposed to balance disturbances by means of sudden movement of a platform on which they stood. A dual-task paradigm where postural recovery served as the primary task and verbal reaction time to auditory tones served as the secondary task was used to assess attentional demand. To determine the effect of the cognitive task on postural recovery, kinetic, kinematic, and neuromuscular measures of a feet-in-place response were investigated. RESULTS: Balance recovery using a feet-in-place response was attentionally demanding in both groups of older adults and was more demanding in balance-impaired than in healthy elderly persons. With the concurrent performance of a cognitive task, balance-impaired elderly persons took longer to stabilize their center of pressure and regain balance than in a single task, while healthy elderly persons showed no change between conditions. In addition, only balance-impaired elderly individuals had a greater center-of-pressure resultant velocity during recovery in a dual-task compared with a single-task situation. CONCLUSIONS: The ability to recover balance using a feet-in-place response was more attentionally demanding in balance-impaired than in healthy elderly persons. The recovery of balance was also slower and less efficient in balance-impaired elderly persons when simultaneously performing a cognitive task, whereas the ability of healthy elderly individuals to recover was not influenced by concurrent task demands. This suggests that dual-task performance may contribute to postural instability and falls in balance-impaired elderly individuals.     

New-onset syncope in older adults: focus on age and etiology

The authors explored the differences in clinical presentation, etiology, mortality, and recurrences of new-onset syncope in 502 patients across 3 age groups: middle-aged (36-60 years), older (61-75 years), and elderly (older than 75 years). Clinical features of syncopal episodes were similar except for more frequent presyncopal episodes in patients older than 75 years. Yield of diagnostic tests was similarly low except for higher incidence of positive tilt-table test (60%) in older patients. Syncope remained unexplained more frequently in the elderly (54% vs 37% in middle-aged and 43% in older adults, P=.01). Syncope recurrence was higher in the middle-aged and elderly groups. Overall mortality for the 3 age groups was similar to that recorded in the general population after adjustment for age and comorbidities. Etiology of syncope was not associated with age- and comorbidity-adjusted all-cause mortality. Cardiovascular mortality was significantly higher in patients with cardiogenic syncope (adjusted hazard ratio, 2.44; P=.044).     

Anxiety disorders in older adults

Recent epidemiologic surveys indicate that anxiety disorders in older adults are more common than previously believed. Despite this, knowledge regarding the clinical characteristics of anxiety disorders in elderly patients is emerging slowly. In addition, detection of anxiety symptoms in elders is complicated by several factors, including a confounding of symptom picture by high medical comorbidity, frequent use of multiple prescribed and over-the-counter medications, difficulty of differentiating anxiety from depression, and a tendency of some older adults to resist psychiatric evaluation. Nonetheless, a comprehensive evaluation that includes a clinical interview, self-report measures, and laboratory results, can improve detection and accurate assessment of anxiety in elderly patients. Empirically validated knowledge regarding appropriate pharmacologic interventions in elderly patients is still sparse, and inferences from data in young and middle-aged populations typically form the basis of clinical practice in elderly patients. SSRIs and SNRIs are considered first-line interventions because of their efficacy and relative tolerability in elderly patients. Psychotherapy, particularly cognitive-behavioral therapy, also has been found to be efficacious for older adults with anxiety disorders. Collaborative care models that address physician, patient, and healthcare service delivery barriers, also hold promise for adequately treating anxiety disorders experienced by older adults.     

Theory of Mind Through the Ages: Older and Middle-Aged Adults Exhibit More Errors Than Do Younger Adults on a Continuous False Belief Task

Theory of mind (ToM), or the ability to understand mental states, is a fundamental aspect of social cognition. Previous research has documented marked advances in ToM in preschoolers, and declines in ToM in older-aged adults. In the present study, younger (n = 37), middle-aged (n = 20), and older (n = 37) adults completed a continuous false belief task measuring ToM. Middle-aged and older adults exhibited more false belief bias than did younger adults, irrespective of language ability, executive function, processing speed, and memory. The authors conclude that ToM declines from younger to older adulthood, independent of age-related changes to domain-general cognitive functioning.     

Drug therapy of heart failure in the elderly

Heart failure is a disorder that predominantly affects older adults, with more than 50% of heart failure hospitalizations occurring in persons over 75 years of age. Unfortunately, most of the major heart failure clinical trials have targeted middle-aged patients with systolic heart failure, and the applicability of these studies to elderly patients, particularly those with preserved left ventricular systolic function, remains uncertain. In this paper, current data on the pharmacotherapy of heart failure in older adults are reviewed, recommended approaches to managing systolic and diastolic heart failure are outlined, and the importance of preventive measures is emphasized.     

Theory of mind through the ages: older and middle-aged adults exhibit more errors than do younger adults on a continuous false belief task

Theory of mind (ToM), or the ability to understand mental states, is a fundamental aspect of social cognition. Previous research has documented marked advances in ToM in preschoolers, and declines in ToM in older-aged adults. In the present study, younger (n=37), middle-aged (n=20), and older (n=37) adults completed a continuous false belief task measuring ToM. Middle-aged and older adults exhibited more false belief bias than did younger adults, irrespective of language ability, executive function, processing speed, and memory. The authors conclude that ToM declines from younger to older adulthood, independent of age-related changes to domain-general cognitive functioning.     

Aging and everyday memory: the beneficial effect of memory training

The authors investigated elderly people's ability to benefit from specific memory training. Empirical evidence of cognitive aging shows a deterioration in working memory ability but also suggests that elderly people maintain the ability to acquire new information and strategies. The aim of the present study was to investigate the effects of two different mnemonic strategies (Loci mnemonic vs. Strategic training) in young and older adults and to evaluate the ability of the older groups to improve performance. Participants received extensive practice in the use of a specific strategy. Three groups of participants (20 adult, 20 younger elderly, and 20 older elderly) were tested in the laboratory, as well as in ecological conditions using a battery of cognitive tests. Questionnaires were also administrated to explore cognitive, metacognitive and emotive motivational aspects of working memory performance. The results show the efficacy of both trainings in improving performances in different tasks, particularly the ecological. The elderly benefit from strategies as much as younger people; nevertheless, the memory performances of the latter are higher. Differences between the two trainings are found only in the task evaluating ability to re-use learnt strategies in other unfamiliar situations. Improvement in performance was more pronounced for the strategic training.