Pub Date : 2020-01-01Epub Date: 2020-06-29DOI: 10.20900/agmr20200017
Gary Riccio, Rhoda Au, Richard van Emmerik, Mohammed Eslami
This special issue is ambitious in that it calls for strategic transformation in research on Alzheimer's Disease (AD) and related dementias, including innovation in both research design and value delivery, through lifestyle interventions that implicitly relate to a much broader range of comorbidities and diseases of aging. One response to this challenge is to venture beyond the boundaries of research that supports the healthcare industry. Toward this end, we introduce opportunities for research translation and knowledge transfer from NASA to the healthcare industry. Our intent is to show how NASA's approach to research can guide innovation for a smart medical home, most notably for AD and other diseases of aging. The article is organized in four major sections: (a) aggregating fragmented research communities; (b) lifestyle interventions in the medical home; (c) multiscale computational modeling and analysis; and (d) lifespan approach to precision brain health. We provide novel motivations and transformative paths to a diversity of specific lines of research, across communities, that would be difficult to discover in common methods of networking within research communities and even through sophisticated bibliographic methods. We thus reveal how knowledge transfer between the public and private sector can stimulate development of broader scientific communities and achieve a more coherent strategic approach to integration and development of a diversity of capabilities including but not limited to technology.
{"title":"Situated Precision Healthcare in the Smart Medical Home: Bringing NASA's Research Strategy down to Earth.","authors":"Gary Riccio, Rhoda Au, Richard van Emmerik, Mohammed Eslami","doi":"10.20900/agmr20200017","DOIUrl":"10.20900/agmr20200017","url":null,"abstract":"<p><p>This special issue is ambitious in that it calls for strategic transformation in research on Alzheimer's Disease (AD) and related dementias, including innovation in both research design and value delivery, through lifestyle interventions that implicitly relate to a much broader range of comorbidities and diseases of aging. One response to this challenge is to venture beyond the boundaries of research that supports the healthcare industry. Toward this end, we introduce opportunities for research translation and knowledge transfer from NASA to the healthcare industry. Our intent is to show how NASA's approach to research can guide innovation for a smart medical home, most notably for AD and other diseases of aging. The article is organized in four major sections: (a) aggregating fragmented research communities; (b) lifestyle interventions in the medical home; (c) multiscale computational modeling and analysis; and (d) lifespan approach to precision brain health. We provide novel motivations and transformative paths to a diversity of specific lines of research, across communities, that would be difficult to discover in common methods of networking within research communities and even through sophisticated bibliographic methods. We thus reveal how knowledge transfer between the public and private sector can stimulate development of broader scientific communities and achieve a more coherent strategic approach to integration and development of a diversity of capabilities including but not limited to technology.</p>","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40417047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01Epub Date: 2019-12-31DOI: 10.20900/agmr20200005
Ryan McGrath, Kyle J Hackney, Nicholas A Ratamess, Brenda M Vincent, Brian C Clark, William J Kraemer
Background: Gender and ethnicity are factors which influence strength, and hand dominance could be a critical component of handgrip strength (HGS) testing. Providing such HGS percentiles across the lifespan may help to identify weakness-related health concerns. We sought to generate growth charts and curves for HGS by gender and ethnicity in a nationally-representative sample of Americans aged 6-80 years.
Methods: Data from 13,617 participants in the 2011-2012 and 2013-2014 waves of the National Health and Nutrition Examination Survey were analyzed. HGS was measured with a handgrip dynamometer. Age, gender, ethnicity, and hand dominance were self-reported. Body Mass Index (BMI) was calculated from height and body mass. Measures of absolute HGS and HGS normalized to BMI were separately included in parametric quantile regression analyses for determining the 10th-90th percentiles across ages by gender and ethnicity. Similar models were also conducted by hand dominance.
Results: Differences in absolute HGS and HGS normalized to BMI quantiles across ages existed for each ethnicity regardless of gender. In men, absolute HGS generally increased until about 25 years of age, began to decline around age 30 years, and regressed into older adulthood. In women, absolute HGS appeared to rise starting at age 6 years, peaked between 20 and 30 years of age, but was maintained into mid-life before declining in older adulthood. Similar results were found for HGS normalized to BMI.
Conclusions: Our findings provide percentile charts for HGS capacity that could be utilized for comparing individual measures of HGS to those from a United States population-representative sample.
{"title":"Absolute and Body Mass Index Normalized Handgrip Strength Percentiles by Gender, Ethnicity, and Hand Dominance in Americans.","authors":"Ryan McGrath, Kyle J Hackney, Nicholas A Ratamess, Brenda M Vincent, Brian C Clark, William J Kraemer","doi":"10.20900/agmr20200005","DOIUrl":"10.20900/agmr20200005","url":null,"abstract":"<p><strong>Background: </strong>Gender and ethnicity are factors which influence strength, and hand dominance could be a critical component of handgrip strength (HGS) testing. Providing such HGS percentiles across the lifespan may help to identify weakness-related health concerns. We sought to generate growth charts and curves for HGS by gender and ethnicity in a nationally-representative sample of Americans aged 6-80 years.</p><p><strong>Methods: </strong>Data from 13,617 participants in the 2011-2012 and 2013-2014 waves of the National Health and Nutrition Examination Survey were analyzed. HGS was measured with a handgrip dynamometer. Age, gender, ethnicity, and hand dominance were self-reported. Body Mass Index (BMI) was calculated from height and body mass. Measures of absolute HGS and HGS normalized to BMI were separately included in parametric quantile regression analyses for determining the 10th-90th percentiles across ages by gender and ethnicity. Similar models were also conducted by hand dominance.</p><p><strong>Results: </strong>Differences in absolute HGS and HGS normalized to BMI quantiles across ages existed for each ethnicity regardless of gender. In men, absolute HGS generally increased until about 25 years of age, began to decline around age 30 years, and regressed into older adulthood. In women, absolute HGS appeared to rise starting at age 6 years, peaked between 20 and 30 years of age, but was maintained into mid-life before declining in older adulthood. Similar results were found for HGS normalized to BMI.</p><p><strong>Conclusions: </strong>Our findings provide percentile charts for HGS capacity that could be utilized for comparing individual measures of HGS to those from a United States population-representative sample.</p>","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37536081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01Epub Date: 2020-06-17DOI: 10.20900/agmr20200016
Samia C Akhter-Khan, Rhoda Au
Background: Loneliness has drawn increasing attention over the past few decades due to rising recognition of its close connection with serious health issues, like dementia. Yet, researchers are failing to find solutions to alleviate the globally experienced burden of loneliness.
Purpose: This review aims to shed light on possible reasons for why interventions have been ineffective. We suggest new directions for research on loneliness as it relates to precision health, emerging technologies, digital phenotyping, and machine learning.
Results: Current loneliness interventions are unsuccessful due to (i) their inconsideration of loneliness as a heterogeneous construct and (ii) not being targeted at individuals' needs and contexts. We propose a model for how loneliness interventions can move towards finding the right solution for the right person at the right time. Taking a precision health approach, we explore how transdisciplinary research can contribute to creating a more holistic picture of loneliness and shift interventions from treatment to prevention.
Conclusions: We urge the field to rethink metrics to account for diverse intra-individual experiences and trajectories of loneliness. Big data sharing and evolving technologies that emphasize human connection raise hope for realizing our model of precision health applied to loneliness. There is an urgent need for precise, integrated, and theory-driven interventions that focus on individuals' needs and the subjective burden of loneliness in the ageing context.
{"title":"Why Loneliness Interventions Are Unsuccessful: A Call for Precision Health.","authors":"Samia C Akhter-Khan, Rhoda Au","doi":"10.20900/agmr20200016","DOIUrl":"10.20900/agmr20200016","url":null,"abstract":"<p><strong>Background: </strong>Loneliness has drawn increasing attention over the past few decades due to rising recognition of its close connection with serious health issues, like dementia. Yet, researchers are failing to find solutions to alleviate the globally experienced burden of loneliness.</p><p><strong>Purpose: </strong>This review aims to shed light on possible reasons for why interventions have been ineffective. We suggest new directions for research on loneliness as it relates to precision health, emerging technologies, digital phenotyping, and machine learning.</p><p><strong>Results: </strong>Current loneliness interventions are unsuccessful due to (i) their inconsideration of loneliness as a heterogeneous construct and (ii) not being targeted at individuals' needs and contexts. We propose a model for how loneliness interventions can move towards finding the right solution for the right person at the right time. Taking a precision health approach, we explore how transdisciplinary research can contribute to creating a more holistic picture of loneliness and shift interventions from treatment to prevention.</p><p><strong>Conclusions: </strong>We urge the field to rethink metrics to account for diverse intra-individual experiences and trajectories of loneliness. Big data sharing and evolving technologies that emphasize human connection raise hope for realizing our model of precision health applied to loneliness. There is an urgent need for precise, integrated, and theory-driven interventions that focus on individuals' needs and the subjective burden of loneliness in the ageing context.</p>","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33445503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The majority of research to understand the pathogenesis of and contributors to Alzheimer's disease (AD) pathology, dementia, and disease progression has focused on studying individuals who have the disease or are at increased risk of having the disease. Yet there may be much to learn from individuals who have a paradoxical decreased risk of AD suggesting underlying protective factors. Centenarians demonstrate exceptional longevity that for a subset of the cohort is associated with an increased health span characterized by the delay or escape of age-related diseases including dementia. Here, I give evidence of the association of exceptional longevity with resistance and resilience to AD and describe how cohorts of centenarians and their offspring may serve as models of neuroprotection from AD. Discoveries of novel genetic, environmental, and behavioral factors that are associated with a decreased risk of AD may inform the development of interventions to slow or prevent AD in the general population. Centenarian cohorts may also be instrumental in serving as controls to individuals with AD to identify additional risk factors.
{"title":"Centenarians as Models of Resistance and Resilience to Alzheimer's Disease and Related Dementias.","authors":"Stacy L Andersen","doi":"10.20900/agmr20200018","DOIUrl":"https://doi.org/10.20900/agmr20200018","url":null,"abstract":"<p><p>The majority of research to understand the pathogenesis of and contributors to Alzheimer's disease (AD) pathology, dementia, and disease progression has focused on studying individuals who have the disease or are at increased risk of having the disease. Yet there may be much to learn from individuals who have a paradoxical decreased risk of AD suggesting underlying protective factors. Centenarians demonstrate exceptional longevity that for a subset of the cohort is associated with an increased health span characterized by the delay or escape of age-related diseases including dementia. Here, I give evidence of the association of exceptional longevity with resistance and resilience to AD and describe how cohorts of centenarians and their offspring may serve as models of neuroprotection from AD. Discoveries of novel genetic, environmental, and behavioral factors that are associated with a decreased risk of AD may inform the development of interventions to slow or prevent AD in the general population. Centenarian cohorts may also be instrumental in serving as controls to individuals with AD to identify additional risk factors.</p>","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9534988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Marincowitz, V. Turner, V. Allgar, Jodie Bellwood, Alice Wheeler, M. Hale, Harriet Callaghan, A. Clegg, T. Sheldon
Background: Frailty is a common condition in older people affecting around 1.8 million people in the UK and is independently associated with adverse outcomes. Frailty is commonly measured with the Clinical Frailty Scale (CFS) which involves a face to face assessment. There is evidence the CFS can be assigned retrospectively from information in patient records, but no research has assessed whether scores can be assigned using routine inpatient records. We aimed to assess whether a CFS could be accurately assigned using hospital inpatient records in a UK setting. Methods: Forty newly admitted patients aged 65 and over were prospectively recruited at Bradford Royal Infirmary. A CFS score was assigned to each patient using a face to face assessment. A CFS score was independently assigned to each patient solely using information in the inpatient records. A quadratically weighted Cohen’s Kappa was used to estimate inter-rater reliability (IRR) between the assessments. Results: A Kappa of 0.84 was estimated for the IRR between the scores derived from a face to face assessment and those based solely on inpatient records, indicating good agreement. The Kappa score fell to 0.7 when a 4 category collapsed version of the CFS was used. The IRR appeared unaffected by the number of times a patient had been admitted recently. Conclusion: The CSF may accurately be determined from data routinely recorded in inpatient records. Retrospectively derived scores can, therefore, be used in analysis of patient outcomes of older people in research and service improvement.
{"title":"Can Patient Frailty Be Estimated from Inpatient Records? A Prospective Cohort Study","authors":"C. Marincowitz, V. Turner, V. Allgar, Jodie Bellwood, Alice Wheeler, M. Hale, Harriet Callaghan, A. Clegg, T. Sheldon","doi":"10.20900/agmr20200004","DOIUrl":"https://doi.org/10.20900/agmr20200004","url":null,"abstract":"Background: Frailty is a common condition in older people affecting around 1.8 million people in the UK and is independently associated with adverse outcomes. Frailty is commonly measured with the Clinical Frailty Scale (CFS) which involves a face to face assessment. There is evidence the CFS can be assigned retrospectively from information in patient records, but no research has assessed whether scores can be assigned using routine inpatient records. We aimed to assess whether a CFS could be accurately assigned using hospital inpatient records in a UK setting. \u0000Methods: Forty newly admitted patients aged 65 and over were prospectively recruited at Bradford Royal Infirmary. A CFS score was assigned to each patient using a face to face assessment. A CFS score was independently assigned to each patient solely using information in the inpatient records. A quadratically weighted Cohen’s Kappa was used to estimate inter-rater reliability (IRR) between the assessments. \u0000Results: A Kappa of 0.84 was estimated for the IRR between the scores derived from a face to face assessment and those based solely on inpatient records, indicating good agreement. The Kappa score fell to 0.7 when a 4 category collapsed version of the CFS was used. The IRR appeared unaffected by the number of times a patient had been admitted recently. \u0000Conclusion: The CSF may accurately be determined from data routinely recorded in inpatient records. Retrospectively derived scores can, therefore, be used in analysis of patient outcomes of older people in research and service improvement.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"201 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74532941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A universal aim for ageing societies is that older people may remain healthy, be functionally independent, and be engaged in society. Various indicators with summary scores have been proposed, which may be used for international comparison or within country monitoring to guide ageing policy development and evaluate effectiveness of such policies. However, it is uncertain whether these indicators may be adapted to countries with different cultures and political systems. Simple indicators such as the Human Development Index may be misleading when compared to more detailed multi domain indices in reflecting the performance of ageing policies in a particular country, such as the Hong Kong Elder Quality of Life Index (EQOLHK). Construction of country specific indicators may be more relevant to shaping ageing policies rather than using indicators just for the sake of international ranking.
{"title":"Indicators of Societal Adaptations to Ageing Well","authors":"J. Woo","doi":"10.20900/agmr20200003","DOIUrl":"https://doi.org/10.20900/agmr20200003","url":null,"abstract":"A universal aim for ageing societies is that older people may remain healthy, be functionally independent, and be engaged in society. Various indicators with summary scores have been proposed, which may be used for international comparison or within country monitoring to guide ageing policy development and evaluate effectiveness of such policies. However, it is uncertain whether these indicators may be adapted to countries with different cultures and political systems. Simple indicators such as the Human Development Index may be misleading when compared to more detailed multi domain indices in reflecting the performance of ageing policies in a particular country, such as the Hong Kong Elder Quality of Life Index (EQOLHK). Construction of country specific indicators may be more relevant to shaping ageing policies rather than using indicators just for the sake of international ranking.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74219934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kurt A. Escobar, L. Visconti, A. Wallace, Trisha A. VanDusseldorp
“Diet and exercise will help you live longer” is a well-known meme. While often taken for granted, its foundations span back to our evolutionary environment and its effects extend into our intracellular environment. Humans evolved under conditions of high physical activity and periodic privation which shaped our genes. During these times of energetic challenge, an evolutionary conserved recycling system, autophagy, would have been activated to provision energy through the degradation of intracellular proteins, organelles, and lipids. With physical activity no longer a requisite for survival and caloric abundance rather than caloric shortage defining the modern human environment, the signals for autophagy are no longer obligatory. Moreover, humans have evolved an avoidance of physical activity and caloric restriction (CR). This leads to an accumulation of intracellular components causing degeneration and disruption of cellular homeostasis. This deleterious accrual of cellular materials also occurs during aging, in part, by an age-related decline in autophagy. What’s more, humans live in a period of history where advances in sanitation and medicine have allowed us to live to unprecedented ages, resulting in long-lived humans with progressive system-wide degeneration. Exercise and CR practices promote age-related health and longevity through their activation of autophagic housekeeping, but evolutionary inertia pushes us to avoid them. However, humans are unique in that we can harness our own genes as well as propagate our own memes. In order to yield the benefits of cellular housekeeping through exercise and CR practices, we should understand our genes and become memesters.
{"title":"“Diet and Exercise Will Help You Live Longer”: The Meme that Turns on Housekeeping Genes","authors":"Kurt A. Escobar, L. Visconti, A. Wallace, Trisha A. VanDusseldorp","doi":"10.20900/agmr20200002","DOIUrl":"https://doi.org/10.20900/agmr20200002","url":null,"abstract":"“Diet and exercise will help you live longer” is a well-known meme. While often taken for granted, its foundations span back to our evolutionary environment and its effects extend into our intracellular environment. Humans evolved under conditions of high physical activity and periodic privation which shaped our genes. During these times of energetic challenge, an evolutionary conserved recycling system, autophagy, would have been activated to provision energy through the degradation of intracellular proteins, organelles, and lipids. With physical activity no longer a requisite for survival and caloric abundance rather than caloric shortage defining the modern human environment, the signals for autophagy are no longer obligatory. Moreover, humans have evolved an avoidance of physical activity and caloric restriction (CR). This leads to an accumulation of intracellular components causing degeneration and disruption of cellular homeostasis. This deleterious accrual of cellular materials also occurs during aging, in part, by an age-related decline in autophagy. What’s more, humans live in a period of history where advances in sanitation and medicine have allowed us to live to unprecedented ages, resulting in long-lived humans with progressive system-wide degeneration. Exercise and CR practices promote age-related health and longevity through their activation of autophagic housekeeping, but evolutionary inertia pushes us to avoid them. However, humans are unique in that we can harness our own genes as well as propagate our own memes. In order to yield the benefits of cellular housekeeping through exercise and CR practices, we should understand our genes and become memesters.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73951584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dementia is an increasingly common condition among the older population. It is characterised by multiple cognitive deficits leading to decline from premorbid level of functioning. In 2015 it was estimated that there were over 850,000 people in the United Kingdom (UK) living with dementia and approximately 7,000,000 family carers of people with dementia in the UK. Carers are finding themselves providing increasing amounts of care and support for their loved ones, often independently. Whilst carers find that providing support can have its rewards, it is more the case that it can be challenging and have an impact on their psychological and physical health, and can change existing relationships. It can be extremely exhausting and isolating and, additionally, be at great personal financial cost to them. The aim of this paper is to introduce an Admiral Nurse two year project established in a hospice in the West Midlands, supported by Dementia UK, a national charity often seen as the voice of dementia in the UK. It briefly describes the clinical context of this service and how an independent evaluation was commissioned with a local University to identify the impact of this service from a clinical, operational and strategic perspective. As part of the evaluation strategy, a survey of carers who had used the Admiral Nurse service was conducted. This paper will focus upon the survey and its outcomes and will consider: how these help professionals to appreciate the complex support needs of people with dementia; inform the developing Admiral Nurse’s role; and help professionals to think about future hospice services and their client populations. The paper will end with conclusions and recommendations relating to the lived experiences of family carers and the Admiral Nurse’s role and its position in future care and support of patients with dementia.
{"title":"The Admiral Nurse Role in UK Hospice Care: A Satisfaction Survey Evaluation to Explore Carer Experiences","authors":"S. Read, C. Reeves, Julie Green, K. Dening","doi":"10.20900/agmr20200001","DOIUrl":"https://doi.org/10.20900/agmr20200001","url":null,"abstract":"Dementia is an increasingly common condition among the older population. It is characterised by multiple cognitive deficits leading to decline from premorbid level of functioning. In 2015 it was estimated that there were over 850,000 people in the United Kingdom (UK) living with dementia and approximately 7,000,000 family carers of people with dementia in the UK. Carers are finding themselves providing increasing amounts of care and support for their loved ones, often independently. Whilst carers find that providing support can have its rewards, it is more the case that it can be challenging and have an impact on their psychological and physical health, and can change existing relationships. It can be extremely exhausting and isolating and, additionally, be at great personal financial cost to them. \u0000The aim of this paper is to introduce an Admiral Nurse two year project established in a hospice in the West Midlands, supported by Dementia UK, a national charity often seen as the voice of dementia in the UK. It briefly describes the clinical context of this service and how an independent evaluation was commissioned with a local University to identify the impact of this service from a clinical, operational and strategic perspective. As part of the evaluation strategy, a survey of carers who had used the Admiral Nurse service was conducted. This paper will focus upon the survey and its outcomes and will consider: how these help professionals to appreciate the complex support needs of people with dementia; inform the developing Admiral Nurse’s role; and help professionals to think about future hospice services and their client populations. The paper will end with conclusions and recommendations relating to the lived experiences of family carers and the Admiral Nurse’s role and its position in future care and support of patients with dementia.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75009560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Boutros, K. Jacob, T. Fulop, A. Khalil, I. Dionne, D. Tessier, Barbara Trutschnigg, R. Kilgour, A. Vigano, J. Morais
Background and Objectives: Fatigue is one of the characteristics defining frailty. However, the mechanisms leading to fatigue are still poorly understood. Our objectives were to assess the efficacy of energy utilization (EU) during walking in frail older persons and their level of fatigue. Research Design and Methods: Clinical study of a convenient sample of frail older women. 10 healthy (H; 77 ± 4 year, BMI: 25 ± 3 kg/m2, MMSE: 29 ± 1) and 10 frail elderly women (F; 83 ± 6 year, 26 ± 5 kg/m2, 27 ± 3) were compared for their usual level of fatigue and changes in perceived fatigue and EU before and after walking. A 10 cm Visual Analogue Scale (VAS) prior to and following a 6-Minute Walk Test (6MWT) served to measure fatigue. EU was based on VO2 consumption adjusted for walking distance and measured using a portable Cosmed K4b2 indirect calorimeter. Participants underwent body composition measurements by DXA and venous blood sampling. Results: Groups had similar body composition and blood parameters. At rest, there were no differences in VO2 or energy expenditure, but the frail group had a lower heart rate. During 6MWT, between group differences were found for distance VO2, HR and EU. There were VAS changes in fatigue and a moderate correlation between the VAS of general fatigue and hsCRP. Discussion and Implications: Compared with their healthy counterparts, frail older women exhibited lower physical performance, efficacy of EU, and perceived more fatigue with activity. Inflammation was significantly correlated with subjective fatigue but did not characterize frailty.
{"title":"Energy Utilization and Fatigue in Frail Older Women in Relation to Walking","authors":"G. Boutros, K. Jacob, T. Fulop, A. Khalil, I. Dionne, D. Tessier, Barbara Trutschnigg, R. Kilgour, A. Vigano, J. Morais","doi":"10.20900/agmr20190013","DOIUrl":"https://doi.org/10.20900/agmr20190013","url":null,"abstract":"Background and Objectives: Fatigue is one of the characteristics defining frailty. However, the mechanisms leading to fatigue are still poorly understood. Our objectives were to assess the efficacy of energy utilization (EU) during walking in frail older persons and their level of fatigue. Research Design and Methods: Clinical study of a convenient sample of frail older women. 10 healthy (H; 77 ± 4 year, BMI: 25 ± 3 kg/m2, MMSE: 29 ± 1) and 10 frail elderly women (F; 83 ± 6 year, 26 ± 5 kg/m2, 27 ± 3) were compared for their usual level of fatigue and changes in perceived fatigue and EU before and after walking. A 10 cm Visual Analogue Scale (VAS) prior to and following a 6-Minute Walk Test (6MWT) served to measure fatigue. EU was based on VO2 consumption adjusted for walking distance and measured using a portable Cosmed K4b2 indirect calorimeter. Participants underwent body composition measurements by DXA and venous blood sampling. \u0000Results: Groups had similar body composition and blood parameters. At rest, there were no differences in VO2 or energy expenditure, but the frail group had a lower heart rate. During 6MWT, between group differences were found for distance VO2, HR and EU. There were VAS changes in fatigue and a moderate correlation between the VAS of general fatigue and hsCRP. \u0000 \u0000 \u0000Discussion and Implications: Compared with their healthy counterparts, frail older women exhibited lower physical performance, efficacy of EU, and perceived more fatigue with activity. Inflammation was significantly correlated with subjective fatigue but did not characterize frailty.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78785339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adeline Fontvieille, D. Tremblay, T. Amamou, Morgane Du Bois-dit-Bonclaude, I. Dionne, E. Riesco
Background: It was reported that cow’s milk-based supplementation after resistance training reduced fat mass in older men. The reasons behind this beneficial impact remain to be elucidated. Hence, the aim of this study was to determine the effect of a cow’s milk-based supplementation after resistance exercise on lipid oxidation and systemic fat mobilization in older men. Methods: Older men (age range: 60–75 years) participated in a randomized, double-blind, crossover study with the two following conditions: (1) Resistance exercise + Cow’s milk (C-milk) and (2) Resistance exercise + Rice milk (R-milk; isocaloric control). During a 180-min post-exercise period, energy expenditure, substrate oxidation (indirect calorimetry), plasma levels of glycerol (systemic fat mobilization) and free fatty acids (FFA) were measured. Results: During the 180-min post-exercise period, lipid oxidation remained similar in both conditions. Glycerol levels decreased similarly in C-milk and R-milk (p ≤ 0.045). Although FFA levels increased progressively from 60 min to 180 min post-exercise in both conditions, the magnitude of changes (∆) was greater in C-milk condition between 60 and 120 min post-exercise (p < 0.018). Conclusions: These results do not support a large impact of cow’s milk supplementation after resistance exercise on lipid oxidation and systemic fat mobilization. However, the greater increase in FFA levels suggests that re-esterification may be influenced.
{"title":"Acute Effect of Post-Resistance Exercise Milk-Based Supplement on Substrate Oxidation and Fat Mobilization in Older Men: A Pilot Study","authors":"Adeline Fontvieille, D. Tremblay, T. Amamou, Morgane Du Bois-dit-Bonclaude, I. Dionne, E. Riesco","doi":"10.20900/agmr20190012","DOIUrl":"https://doi.org/10.20900/agmr20190012","url":null,"abstract":"Background: It was reported that cow’s milk-based supplementation after resistance training reduced fat mass in older men. The reasons behind this beneficial impact remain to be elucidated. Hence, the aim of this study was to determine the effect of a cow’s milk-based supplementation after resistance exercise on lipid oxidation and systemic fat mobilization in older men. \u0000Methods: Older men (age range: 60–75 years) participated in a randomized, double-blind, crossover study with the two following conditions: (1) Resistance exercise + Cow’s milk (C-milk) and (2) Resistance exercise + Rice milk (R-milk; isocaloric control). During a 180-min post-exercise period, energy expenditure, substrate oxidation (indirect calorimetry), plasma levels of glycerol (systemic fat mobilization) and free fatty acids (FFA) were measured. \u0000Results: During the 180-min post-exercise period, lipid oxidation remained similar in both conditions. Glycerol levels decreased similarly in C-milk and R-milk (p ≤ 0.045). Although FFA levels increased progressively from 60 min to 180 min post-exercise in both conditions, the magnitude of changes (∆) was greater in C-milk condition between 60 and 120 min post-exercise (p < 0.018). \u0000Conclusions: These results do not support a large impact of cow’s milk supplementation after resistance exercise on lipid oxidation and systemic fat mobilization. However, the greater increase in FFA levels suggests that re-esterification may be influenced.","PeriodicalId":72094,"journal":{"name":"Advances in geriatric medicine and research","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90889543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}