Category: JAGS Research Summaries

Frailty Can Affect How Well Older Adults Fare Following Emergency Surgery

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Journal of the American Geriatrics Society Research Summary

Frailty is the medical term for becoming weaker or experiencing lower levels of activity/energy.  Becoming frail as we age increases our risk for poor health, falls, disability, and other serious concerns. This can be especially true for older people facing surgery, up to half of whom are classified as frail.

Studies show that frail people may have a higher risk of complications, longer hospital stays, and a higher risk for death within 30 days of their surgery. This is a special concern when frail older adults face emergency surgery for abdominal conditions such as bleeding ulcers and bowel perforations (the medical term for developing a hole in the wall of your intestines). This is because there is no time to help someone facing emergency surgery get stronger before their procedure.

Right now, experts have information on how well frail people do within 30 days of surgery. However, they don’t yet know how well frail older adults do 30 days later and beyond. This information is important so that healthcare providers can inform patients about risks and help them set expectations for recovery after surgery.

A new study in the Journal of the American Geriatrics Society sought to gain more information about how frailty affects older adults in the months after surgery. The research team wanted to test their theory that these people would have a higher risk for death a year after surgery, have higher rates of being sent to long-term care facilities rather than to their homes, and have poorer health one year after surgery. Continue reading →

Can Home-Based Physical Therapy Benefit Older Adults with Dementia?

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Journal of the American Geriatrics Society Research Summary

Dementia is the leading cause of disability for more than 5 million people aged 65 and older in this country. By 2050, that number is predicted to quadruple. Dementia can cause memory, language and decision-making problems, mood changes, increased irritability, depression, and anxiety.

Dementia also can cause poor coordination as well as balance problems and falls. These difficulties can affect quality of life, reduce caregiver well-being, and increase healthcare costs.

Researchers designed a study to learn more about whether physical therapy (PT) rehabilitation services could improve dementia-associated declines. They published their findings in the Journal of the American Geriatrics Society.

The researchers noted that we understand that physical activity and exercise programs provided by physical therapists can improve balance and reduce fall risk. However, we don’t know whether providing PT in the home could benefit people with dementia. The researchers wanted to learn whether home health PT could help older adults with dementia improve their ability to perform daily functions. These functions include activities like grooming, dressing, bathing, being able to get to and from the toilet (and being able to clean yourself properly after using the bathroom), getting from bed to a chair, walking, eating, being able to plan and prepare light meals, and being able to use the telephone. The researchers also wanted to learn what amount of home-based PT services resulted in the most improvement with these essential tasks. Continue reading →

Blood Pressure Control for People Aged 80 and Older: What’s the Right Target?

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Journal of the American Geriatrics Society Research Summary

The number of people who are 80-years-old and older is on the rise, and will account for nearly 10 percent of the whole U.S. population by 2050. Since the lifetime chance for developing high blood pressure is at least 70 percent by age 80, more and more people will be at risk for the health problems that high blood pressure can cause.

High blood pressure, or hypertension, is sometimes called the “silent killer” because it produces few, if any, symptoms. In fact, you might not even realize you have high blood pressure. But if it’s not treated, this condition can lead to heart attacks, strokes, kidney disease, and other serious problems, including a risk for dementia.

The 2017 American College of Cardiology and American Heart Association blood pressure guidelines recommend that most people aged 65 or older maintain their systolic blood pressure (the first number in a blood pressure reading) at less than 130 mmHg. But, people 80 years or older often also have multiple chronic health conditions, can be frail, take several medicines, and could have cognitive problems. Because of this, it’s still unclear whether the risks and benefits of lowering systolic blood pressure to less than 130 mm Hg are the same for people aged 80 years and older as they are for people aged 65 to 80.

Given this knowledge gap, a team of researchers focused on this group of older adults within a large randomized trial called the Systolic Blood Pressure Intervention Trial (SPRINT). They published their findings in the Journal of the American Geriatrics Society. In their analysis of SPRINT data, the researchers focused on people aged 80 and older, who had reported heart disease events (such as heart attacks or strokes), changes in kidney function, cognitive impairment, quality of life, or death. The researchers also explored whether impairments in cognitive or physical function had any effect on intensive blood pressure control.

The analysis included 1,167 participants. Most were around 84 years old, and about 3 percent were 90 or older. Their baseline systolic blood pressure was around 142 mmHg. Most of the participants had at least three chronic health conditions. More than half were taking at least five medications and about 27 percent had a history of heart disease.

The participants were randomly assigned to one of two groups. One group received “intensive” treatment targeting to lower their blood pressure to less than 120 mmHg. The other group received treatment to target lowering their blood pressure to less than 140 mmHg.

The people who received treatment to lower their blood pressure to less than 120 mmHg experienced a lower risk for heart disease events, as well as less risk for mild cognitive impairment and death from all causes. However, people in this group also experienced an increased risk of small, but meaningful, declines in kidney function as well as hospitalizations for short term kidney damage (from which most people recovered). Attempting to lower systolic blood pressure to less than 120 mmHg did not increase the risk for injury-causing falls. This is important, since falls raise the risk for death in older adults and low blood pressure can result in falls.

While the rate of developing dementia was similar in the two groups, participants in the intensive 120 mmHg group were 28 percent less likely to develop mild cognitive impairment.

The researchers also reported that people with better cognitive function (remembering, thinking, and making decisions) at the beginning of the study benefited the most from intensive blood pressure control. They also experienced less heart disease and fewer deaths. This same benefit was not seen in participants who had poorer cognitive function at the beginning of the study. However, there was not strong evidence of intensive blood pressure control having a harmful impact on death rates or developing heart disease for those with poorer cognitive function.

The researchers concluded that, for adults aged 80 years or older, intensively controlling systolic blood pressure to less than 120 mmHg lowers the risk of heart attacks, stroke, death, and mild cognitive impairment, but increases the risk of declines in kidney function. Benefits related to the risk for heart disease and death were highest in people with higher cognitive performance at the beginning of the trial.

This summary is from “Intensive versus Standard Blood Pressure Control in Adults 80 years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial.” It appears online ahead of print in the December 2019 issue of the Journal of the American Geriatrics Society. The study authors are  Nicholas M. Pajewski, PhD; Dan R. Berlowitz, MD, MPH; Adam P. Bress, PharmD; Kathryn E. Callahan, MD; Alfred K. Cheung, MD; Larry J. Fine, MD; Sarah A. Gaussoin, MS; Karen C. Johnson, MD, MPH; Jordan King, PharmD; Dalane W. Kitzman, MD; John B. Kostis, MD; Alan J. Lerner, MD; Cora E. Lewis, MD, MSPH; Suzanne Oparil, MD; Mahboob Rahman, MD; David M. Reboussin, PhD; Michael V. Rocco, MD; Joni K. Snyder, RN; Carolyn Still, PhD; Mark A. Supiano, MD; Virginia G. Wadley, PhD; Paul K. Whelton, MD; Jackson T. Wright Jr., MD, PhD; and Jeff D. Williamson, MD, MHS.

 

 

New Study Suggests Cautions About Antipsychotic Medications for Hospitalized Older Adults

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Journal of the American Geriatrics Society Research Summary

Delirium (sudden confusion or a rapid change in mental state) remains a serious challenge for our health care system. Delirium affects 15 to 26 percent of hospitalized older adults and can be particularly problematic because those experiencing the condition may interfere with medical care or directly harm themselves or others. Besides behavioral therapy and physical restraints, antipsychotic medicines are among the few therapeutic options healthcare providers can use to ease delirium and protect patients and caregivers—but antipsychotics also come with risks of their own.

To learn more about the effect of antipsychotic medicines on older hospitalized patients, a research team created a study published in the Journal of the American Geriatrics Society. This study included information from hospitalized patients at a large academic medical center in Boston.

The researchers looked specifically at death or non-fatal cardiopulmonary arrest (heart attack) during hospitalization.

The researchers learned that adults taking “first-generation” or “typical” antipsychotic medications (medicines first developed around the 1950s) were significantly more likely to experience death or cardiopulmonary arrest, compared to people who did not take those drugs. Taking “atypical” or “second-generation” antipsychotics (so named because they were developed later) raised the risk for death or cardiopulmonary arrest only for people aged 65 or older.

In the past, other studies have suggested that typical antipsychotic medications could cause sudden death, and that atypical antipsychotics could raise peoples’ risks for falls, pneumonia and death. What’s more, another large study also suggested that both types of antipsychotic medicines posed a risk for fatal heart attacks.

Despite these known risks, atypical antipsychotics are often prescribed for people in the hospital. One recent study of patients at Beth Israel Deaconess Medical Center in Boston found that antipsychotics were prescribed for nine percent of all adults who were hospitalized for non-psychiatric causes.  Another large recent study found that using antipsychotics to prevent or treat delirium did not lower the risk for death, did not lessen the severity of delirium or shorten its duration, and did not shorten the time people spent in the intensive care unit (ICU) or their hospital length of stay.

“Delirium is common in older hospitalized patients and difficult to treat, but antipsychotic medications should be used with caution regardless of age,” said the authors.

This summary is from “Antipsychotics and the Risk of Mortality or Cardiopulmonary Arrest in Hospitalized Adults.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Matthew Basciotta, MD; Wenxiao Zhou, MS; Long Ngo, PhD; Michael Donnino, MD; Edward R. Marcantonio, MD, MSc; and Shoshana J. Herzig, MD, MPH.

 

Aerobic Exercise and Heart-Healthy Diet May Slow Development of Memory Problems

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Journal of the American Geriatrics Society Research Summary

Cognitive impairment without dementia (CIND), or mild cognitive impairment, is a condition that affects your memory and may put you at risk for Alzheimer’s disease and dementia. According to the U.S. National Library for Medicine, signs of mild cognitive impairment may include frequently losing things, forgetting to go to events and appointments, and having more trouble coming up with words than other people of your age.

Sine experts believe that risk factors for heart disease also are risk factors for dementia and late-life cognitive decline and dementia. Recently, researchers examined two potential ways to slow the development of CIND based on what we know about preventing heart disease. They published the results of their study in the Journal of the American Geriatrics Society.

The research team had a theory: That the healthy lifestyle behaviors that slow the development of heart disease could reduce heart disease risk and also slow cognitive decline in older adults with CIND. These behaviors include regular exercise and a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet.

In order to investigate their theory, the researchers designed a study titled “Exercise and NutritionaL Interventions for coGnitive and Cardiovascular HealTh EnhaNcement” (or ENLIGHTEN for short). The goal of the study was to examine the effects of aerobic exercise (sometimes known as “cardio” or “cardiovascular” exercise because it involves activities that increase the circulation of oxygen through the blood) and the DASH diet on cognitive functioning in older adults with CIND.

The ENLIGHTEN study examined 160 adults 55-years-old or older. The study participants were older adults who didn’t exercise and had memory problems, difficulty thinking, and making decisions. They also had at least one additional risk factor for heart disease, such as high blood pressure (also known as hypertension), high cholesterol, diabetes, or other chronic conditions.

Participants took a number of tests to measure their heart disease risk factors and cognitive ability. Researchers also assessed participants’ dietary habits and ability to perform daily activities. The participants were then randomly assigned to one of four groups: a group doing aerobic exercise alone, a group following the DASH diet alone, a group doing aerobic exercise and following the DASH diet combined, or a group receiving standard health education.

People in the exercise group did 35 minutes of moderate intensity aerobic exercise (including walking or stationary biking) three times per week for six months. They were supervised for three months and then exercised unsupervised at home for three months. Participants in the exercise group did not receive any counseling in the DASH diet and were encouraged to follow their usual diets for six months.

People in the DASH eating plan group received instruction about how to meet DASH guidelines in a series of weekly sessions for three months and then bi-weekly for the remaining three months. Participants in the DASH group were asked not to engage in regular exercise until the completion of the six-month study.

People in the exercise and DASH group followed the exercise and DASH programs for six months. The participants who were enrolled in the health education group received weekly educational phone calls for three months and then bi-weekly calls for three months. Phone calls were conducted by a health educator on health topics related to heart disease. Participants were asked to maintain their usual dietary and exercise habits for six months until they were re-evaluated.

At the conclusion of the six-month intervention and assessment, participants were free to engage in whatever activity and dietary habits they desired, with no restrictions.

The results of the research team’s study showed that exercise improved the participants’ ability to think, remember, and make decisions compared to non-exercisers, and that combining exercise with the DASH diet improved the ability to think, remember, and make decisions, compared to people who didn’t exercise or follow the diet—even though they didn’t perfectly follow the programs they were assigned to during the six-month interventions.

The researchers concluded that their findings are promising proof that improved ability to think, remember, and make decisions can last one year after completing a six-month exercise intervention. They suggested that further studies would be needed to learn more.

This summary is from “Longer Term Effects of Diet and Exercise on Neurocognition: One Year Follow-Up of the ENLIGHTEN Trial.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are: James A. Blumenthal, PhD; Patrick J. Smith, PhD; Stephanie Mabe, MS; Alan Hinderliter, MD; Kathleen Welsh-Bohmer, PhD; Jeffrey N. Browndyke, PhD; P. Murali Doraiswamy, MBBS, FRCP; Pao-Hwa Lin, PhD; William E. Kraus, MD; James R. Burke, MD; and Andrew Sherwood, PhD.