1,721,017 research outputs found
Osteosarcopenic obesity: a triple threat for older adults?
No full textAdvancing age is associated with body composition changes that impact the health status and overall wellbeing of older adults. Muscle mass decreases, contributing to the loss of strength and physical function, a condition known as sarcopenia. Declining bone mineral density leads to osteopenia or osteoporosis, with an increased risk of fractures. Adipose tissue accumulates, redistributes, and infiltrates organs, causing chronic inflammation, metabolic disturbances, and additional mechanical load on the musculoskeletal system. These pathological conditions are interdependent and result in a range of clinical phenotypes
How to Manage Beta-Blockade in Older Heart Failure Patients: A Scoping Review
Full text link: Beta blockers (BBs) play a crucial role in enhancing the quality of life and extending the survival of patients with heart failure and reduced ejection fraction (HFrEF). Initiating the therapy at low doses and gradually titrating the dose upwards is recommended to ensure therapeutic efficacy while mitigating potential adverse effects. Vigilant monitoring for signs of drug intolerance is necessary, with dose adjustments as required. The management of older HF patients requires a case-centered approach, taking into account individual comorbidities, functional status, and frailty. Older adults, however, are often underrepresented in randomized clinical trials, leading to some uncertainty in management strategies as patients with HF in clinical practice are older than those enrolled in trials. The present article performs a scoping review of the past 25 years of published literature on BBs in older HF patients, focusing on age, outcomes, and tolerability. Twelve studies (eight randomized-controlled and four observational) encompassing 26,426 patients were reviewed. The results indicate that BBs represent a viable treatment for older HFrEF patients, offering benefits in symptom management, cardiac function, and overall outcomes. Their role in HF with preserved EF, however, remains uncertain. Further research is warranted to refine treatment strategies and address specific aspects in older adults, including proper dosing, therapeutic adherence, and tolerability
Association between cardiovascular health metrics and self-reported walking difficulty in community-dwelling middle-aged and older adults: results from the longevity check-up (Lookup) 8+
Full text linkObjectives: To examine the association between cardiovascular health, assessed through an 8-factor cardiovascular health (8F-CVH) score, and self-reported walking difficulty in middle-aged (40-64 years) and older adults (≥65 years) living in the community.
Study design: Cross-sectional study.
Main outcome measures: Self-reported walking difficulty was evaluated by a single-item question: "Do you have any difficulty in walking 400 meters?". Cardiovascular health was assessed using a composite 8F-CVH score inspired by Life's Essential 8, including diet, physical activity, body mass index, blood pressure, total cholesterol, fasting blood glucose, smoking status, and sleep quality.
Results: Among 4141 participants (mean age 60.5 ± 11.2 years; 53.1 % women), 16.0 % reported walking difficulty. Prevalence was higher in older adults (25.0 %) than in middle-aged individuals (11.0 %; p for trend <0.001). Self-reported walking difficulty was more frequent in participants with low 8F-CVH scores (32.8 %), compared to moderate (15.5 %) and high (4.8 %) scores (p <0.001). ROC curve analysis showed modest discrimination for the total score (area under the curve [AUC] 0.67; 95 % confidence interval [CI] 0.65-0.69), with physical activity performing best among individual components (AUC 0.69; 95 % CI 0.67-0.71). After adjusting for confounders, moderate and high scores were associated with 61 % (OR 0.39, 95 % CI 0.31-0.48) and 84 % (OR 0.16, 95 % CI 0.10-0.24) lower odds of self-reported walking difficulty, respectively.
Conclusions: Better cardiovascular health is independently associated with lower odds of self-reported walking difficulty. Promoting cardiovascular health may help preserve mobility in late life
Physical Activity during COVID-19 Pandemic: A 5-Year Retrospect
Full text linkThe purpose of this article is to provide a follow-up review of the impact of the SARS-CoV-2 Disease or Coronavirus Disease 2019 (COVID-19) pandemic on human health and the role of physical activity (PA) during the 5-year pandemic. We aim to cover the immune system, the cardiopulmonary system, the musculoskeletal system, the central nervous system (brain function), particularly among older adults, college students, and individuals with post-acute sequelae of COVID-19 (Long-COVID). The COVID-19 pandemic has given us many lessons, earned from the death of six million lives and tremendous disturbance to human life. First, we need to continue to investigate cellular and molecular mechanisms that mediate various organistic failures resulting from the viral infection. Such investigations are the only way to completely understand the etiology of the diseases and to develop new drugs and vaccines. The molecular pathways that transmit the signals of viral infection to each organ system are different requiring both basic and clinical research. Available evidence suggests that mitochondrial dysfunction, reduced microcirculation and latent immune activation play a major role, eventually impairing cardiovascular tolerance and peripheral bioenergetics. Second, the COVID-19 pandemic has manifested major disturbances to human lifestyles with reduced PA and exercise standing out as a major factor. Conversely, physical inactivity due to social confinement and mental/psychological stresses has been clearly linked to intensified pathogenic symptoms and amplification of adverse effects on multiple physiological systems. If not intervened, this interaction can lead to Long-COVID, a dangerous futile circle to cause systemic failure. Finally, the COVID-19 pandemic has exerted differential impacts on different populations. Thus, the strategy to develop and conduct to cope with the negativity of pandemic needs to be specific, flexible and tailored to fit different patient populations
Combined Aerobic Training and Mediterranean Diet Is Not Associated with a Lower Prevalence of Sarcopenia in Italian Older Adults
Full text linkPrevious studies found a lower prevalence of sarcopenia in older adults engaged in regular aerobic training (AT) or with greater adherence to a Mediterranean (MED) diet. However, the effect of their combination on sarcopenia indices is unknown. The present study tested the association between AT plus a MED diet and the presence of sarcopenia and its defining elements in a sample of Italian older adults enrolled in the Longevity Check-up 7+ (Lookup 7+) project. Analyses were conducted in participants 65+ years, with a body mass index of at least 18.5 kg/m2, engaged in regular AT, and without missing information for the variables of interest. MED diet adherence was evaluated via a modified version of the MEDI-LITE score and categorized as low, moderate, or high. The presence of sarcopenia was established by handgrip strength and appendicular skeletal muscle mass (ASM) values below sex-specific cut-points recommended by the European Working Group on Sarcopenia in Older People 2. Data from 491 older adults were analyzed for the present study. The mean age was 72.7 ± 5.7 years, and 185 (37.7%) were women. MED diet adherence was low in 59 (12.0%) participants, moderate in 283 (57.6%), and high in 149 (30.3%). Sarcopenia was identified in 26 participants (5.3%), with no differences across MED diet adherence groups. The results of binary logistic regression showed no significant associations between AT plus adherence to a MED diet and dynapenia, low ASM, or sarcopenia. The findings of the present study indicate that the combination of AT with a MED diet is not associated with a lower probability of sarcopenia or its defining elements in Italian older adults enrolled in Lookup 7+. Further research is warranted to establish whether exercise frequency, volume, intensity, and length of engagement in AT impact the association between MED diet and sarcopenia
Predictive value of different muscle power normalization methods for mobility limitations in community-dwelling older adults: A cross-sectional analysis from the longevity check-up 8+ study
Full text linkBackground: Lower limb muscle power is a critical determinant of mobility in older adults. However, its optimal normalization method remains uncertain. The aim of this cross-sectional study is to compare different normalization approaches for muscle power in predicting self-reported 400 m walking difficulty, used as a proxy of mobility limitation, in community-dwelling older adults (≥65 years old) from the Longevity Check-Up 8+ Study. Methods: Lower limb muscle power was estimated using five-repetition sit-to-stand equations and expressed as i) absolute (W), ii) relative (W/kg), iii) allometric (W/m2), and iv) specific power (W/kg of appendicular skeletal muscle mass). 400-m walking difficulty was self-reported and dichotomized. Discriminative ability was assessed through receiver operating characteristic curves. Associations were tested using logistic regression models. Results: Among the 4614 participants (mean age 72.8 ± 5.8 years; 53.2 % women), 25.1 % reported difficulty walking 400 m. Individuals reporting difficulty were older, more frequently female, had higher body mass index, and lower physical activity levels (all p < 0.001). Relative muscle power demonstrated the highest discriminative ability [area under the curve 0.70; 95 % confidence interval (CI) 0.68-0.72], outperforming other indices. Optimal cut-offs for relative muscle power identified using the Youden index were 3.1 W/kg in women and 3.8 W/kg in men. Low relative muscle power was significantly associated with greater odds of walking difficulty (odds ratio 2.07; 95 % CI 1.78-2.42; p < 0.001). Conclusions: Relative muscle power showed superior predictive performance for self-reported walking difficulty, as an indicator of mobility limitation, compared to other normalization methods. Future longitudinal studies are needed to confirm these findings and explore their relevance for other clinically meaningful outcomes
Urinary Catheterization Management in Older Adults With Hip Fracture: A Systematic Review
Full text linkObjectives: Urinary catheterization is a common procedure in the perioperative management of patients with hip fracture. However, decisions on its insertion or removal are often variable. This systematic review aimed to synthesize current evidence on urinary catheterization management in older patients with hip fracture by thoroughly reviewing the implementation of structured programs.
Design: Systematic review.
Setting and Participants: Older adults hospitalized for hip fracture.
Methods: Studies published until April 1, 2023, were retrieved from MEDLINE (PubMed interface), SCOPUS (Elsevier interface), and Cochrane Central Register of Controlled Trials (EBSCO interface). Observational and interventional studies investigating the use of urinary catheterization in older adults with hip fracture were included and corresponding data on structured programs and associated results were extracted. The quality assessment of the studies was performed using the Critical Appraisal Skills Programme tool.
Results: Of the 674 articles identified through the literature search, 16 studies were included. The mean ages in the 16 studies ranged from 67 to 86 years. Studies on the implementation of structured programs were few and heterogeneous. These studies identified 24 to 48 hours as the appropriate duration of postoperative catheterization; intermittent catheterization was associated with a lower incidence of complications.
Conclusions and Implications: Our review revealed a lack of standardized perioperative urinary catheterization management in older patients with hip fracture and uncovered the need for a tailored approach, which is crucial to improving the quality of care and outcomes in these patients
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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