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Nyende A, Ellis-Hill C, Mantzoukas S. A Sense of Control and Wellbeing in Older People Living with Frailty: A Scoping Review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:1043-1072. [PMID: 37139581 DOI: 10.1080/01634372.2023.2206438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
A sense of control is important for supporting older people living with frailty to develop adaptive functioning to optimize wellbeing. This scoping review examined the literature on the sense of control and wellbeing in older people living with frailty within their everyday life and care service use. Nine databases were searched using the timeframe 2000 to 2021 to identify key ideas regarding control and wellbeing in older people with frailty. The review highlighted three major themes: a) Control as conveyed in bodily expressions and daily activities, b) Sense of control and influence of place of residence, and c) Control within health and social care relationships. Maintaining a sense of control is not only an internal feeling but is impacted by physical and social environments. Greater focus is needed on the nature of relationships between older people living with frailty and those who work alongside them, which support control and wellbeing.
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Affiliation(s)
- Adam Nyende
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Fallahzadeh R, Rokni SA, Ghasemzadeh H, Soto-Perez-de-Celis E, Shahrokni A. Digital Health for Geriatric Oncology. JCO Clin Cancer Inform 2018; 2:1-12. [DOI: 10.1200/cci.17.00133] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this review, we describe state-of-the-art digital health solutions for geriatric oncology and explore the potential application of emerging remote health-monitoring technologies in the context of cancer care. We also discuss the benefits and motivations behind adopting technology for symptom monitoring of older adults with cancer. We provide an overview of common symptoms and of the digital solutions–designed remote symptom assessment. We describe state-of-the-art systems for this purpose and highlight the limitations and challenges for the full-scale adoption of such solutions in geriatric oncology. With rapid advances in Internet-of-things technologies, many remote assessment systems have been developed in recent years. Despite showing potential in several health care domains and reliable functionality, few of these solutions have been designed for or tested in older patients with cancer. As a result, the geriatric oncology community lacks a consensus understanding of a possible correlation between remote digital assessments and health-related outcomes. Although the recent development of digital health solutions has been shown to be reliable and effective in many health-related applications, there exists an unmet need for development of systems and clinical trials specifically designed for remote cancer management of older adults with cancer, including developing advanced remote technologies for cancer-related symptom assessment and psychological behavior monitoring at home and developing outcome-oriented study protocols for accurate evaluation of existing or emerging systems. We conclude that perhaps the clearest path to future large-scale use of remote digital health technologies in cancer research is designing and conducting collaborative studies involving computer scientists, oncologists, and patient advocates.
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Affiliation(s)
- Ramin Fallahzadeh
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Seyed Ali Rokni
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hassan Ghasemzadeh
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Enrique Soto-Perez-de-Celis
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Armin Shahrokni
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
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Scott D, Cumming R, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Seibel M, Waite LM, Hirani V. Associations of sarcopenic obesity with the metabolic syndrome and insulin resistance over five years in older men: The Concord Health and Ageing in Men Project. Exp Gerontol 2018; 108:99-105. [PMID: 29649572 DOI: 10.1016/j.exger.2018.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/20/2018] [Accepted: 04/06/2018] [Indexed: 02/09/2023]
Abstract
PURPOSE Previous cross-sectional studies investigating associations of sarcopenic obesity with metabolic syndrome (MetS) and insulin resistance have not utilised consensus definitions of sarcopenia. We aimed to determine associations of sarcopenic obesity with MetS and insulin resistance over five years in community-dwelling older men. METHODS 1231 men aged ≥70 years had appendicular lean mass (ALM) and body fat percentage assessed by dual-energy X-ray absorptiometry and hand grip strength and gait speed tests. Sarcopenia was defined as low ALM/height (m2) and low hand grip strength or gait speed (European Working Group definition); obesity was defined as body fat percentage ≥30%. MetS was assessed at baseline and 5-years later. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was assessed at 5-years only. RESULTS Men with sarcopenic obesity (odds ratio, 95% CI: 2.07, 1.21-3.55) and non-sarcopenic obesity (4.19, 3.16-5.57) had higher MetS likelihood than those with non-sarcopenic non-obesity at baseline. Higher gait speed predicted lower odds for prevalent MetS (0.45, 0.21-0.96 per m/s). Higher body fat predicted increased odds for prevalent and incident MetS (1.14, 1.11-1.17 and 1.11, 1.02-1.20 per kg, respectively) and deleterious 5-year changes in MetS fasting glucose, high-density lipoprotein cholesterol and triglycerides (all P < 0.05). Compared with non-sarcopenic non-obesity, estimated marginal means for HOMA-IR at 5-years were higher in non-sarcopenic obesity only (1.0, 0.8-1.1 vs 1.3, 1.2-1.5; P < 0.001). Similar results were observed when sarcopenic obesity was defined by waist circumference. CONCLUSIONS Sarcopenic obesity does not appear to confer greater risk for incident MetS or insulin resistance than obesity alone in community-dwelling older men.
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Affiliation(s)
- David Scott
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Medicine and Australian Institute for Musculoskeletal Science, Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Victoria, Australia.
| | - Robert Cumming
- School of Public Health, University of Sydney, New South Wales, Sydney, Australia; Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales, Sydney, Australia; The ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Sydney, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales, Sydney, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales, Sydney, Australia
| | - David G Le Couteur
- ANZAC Research Institute & Charles Perkins Centre, University of Sydney, New South Wales, Sydney, Australia
| | - David J Handelsman
- Department of Andrology, Concord Hospital, ANZAC Research Institute, University of Sydney, New South Wales, Sydney, Australia
| | - Markus Seibel
- Bone Research Program, ANZAC Research Institute, Dept of Endocrinology & Metabolism, Concord Hospital, The University of Sydney, New South Wales, Sydney, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales, Sydney, Australia
| | - Vasant Hirani
- The ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Sydney, Australia; School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Sydney, Australia
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Barne M. Can colour stimulate intake in older population groups? Br J Community Nurs 2017; 22:S11-S12. [PMID: 28686051 DOI: 10.12968/bjcn.2017.22.sup7.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Meg Barne
- Critical Care Dietitian Addenbrooke's Hospital, Cambridge
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Barbour KE, Helmick CG, Boring M, Qin J, Pan L, Hootman JM. Obesity Trends Among US Adults With Doctor-Diagnosed Arthritis 2009-2014. Arthritis Care Res (Hoboken) 2017; 69:376-383. [PMID: 27332971 PMCID: PMC10445492 DOI: 10.1002/acr.22958] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/20/2016] [Accepted: 06/07/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Arthritis and obesity are common co-occurring conditions that can increase disability and the risk of adverse outcomes (e.g., total knee replacement). METHODS We estimated recent obesity trends among adults with arthritis from 2009 to 2014, overall and by various sociodemographic and health characteristics using data from National Health Interview Survey, an ongoing, nationally representative, in-person household self-reported survey of the noninstitutionalized civilian US. A secondary aim was to examine the distribution of body mass index categories among adults with and without arthritis. RESULTS Obesity prevalence did not change significantly over time among middle-aged and younger adults with doctor-diagnosed arthritis either overall (P = 0.925 for both groups) or by demographic and health characteristics. Among older adults with doctor-diagnosed arthritis, the unadjusted obesity prevalence was 29.4% in 2009 and 34.3% in 2014; after adjusting for all demographic and health characteristics, there was a significant relative increase in obesity prevalence (15% [95% confidence interval 6-25]) and over time (P = 0.001). The age-standardized prevalence of obesity and the obesity subclasses I, II, and III among adults with doctor-diagnosed arthritis (compared with adults without doctor-diagnosed arthritis) was 40.3% versus 26.3%, 20.1% versus 16.4%, 10.4% versus 6.2%, and 9.8% versus 3.6%, respectively (P < 0.001 for all 4 comparisons). CONCLUSION Obesity increased significantly over time among older adults with arthritis and remains high when compared with adults without arthritis. A greater dissemination of interventions focused on physical activity and diet are needed in order to reduce adverse outcomes associated with obesity and arthritis.
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Affiliation(s)
- Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Michael Boring
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jin Qin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Liping Pan
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
Healthy aging is critical for the elderly to be independent and enjoy at least a satisfactory quality of life. However, late-life bereavement threatens healthy aging, as it may lead to adverse health effects. Using data from the Health and Retirement Survey, this study investigates the relationship between weight—specifically, body mass index (BMI)—and the loss of a parent, sibling, or spouse at an older age. It is the first attempt to investigate this relationship among the elderly population in the United States and makes the following notable contributions to the literature: (a) use of a large longitudinal dataset, (b) estimation of the effects of a familial death on a person’s BMI, and (c) investigation of the consequences of the bereavement for older people. Our results suggest that losing a family member at an older age results in a decrease in BMI.
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Affiliation(s)
- Murat Anil Mercan
- Department of Economics, Gebze Technical University, Kocaeli, Turkey
| | - Hande Barlin
- Department of Economics, Gebze Technical University, Kocaeli, Turkey
| | - Ali F. Cebeci
- Department of Economics, Gebze Technical University, Kocaeli, Turkey
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Gerude MF, Dias FL, de Farias TP, Albuquerque Sousa B, Thuler LCS. Predictors of Postoperative Complications, Prolonged Length of Hospital Stay, and Short-Term Mortality in Elderly Patients with Malignant Head and Neck Neoplasm. ORL J Otorhinolaryngol Relat Spec 2014; 76:153-64. [DOI: 10.1159/000363189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
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Gray-Donald K, St-Arnaud-McKenzie D, Gaudreau P, Morais JA, Shatenstein B, Payette H. Protein intake protects against weight loss in healthy community-dwelling older adults. J Nutr 2014; 144:321-6. [PMID: 24357473 DOI: 10.3945/jn.113.184705] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Weight loss is prevalent in the elderly population, with deleterious health consequences, notably loss of lean body mass and subsequent functional decline. Protein intake below the current RDA [0.8 g/(kg · d)] is also common in older adults; however, the link between the 2 has received little attention. Our objective was to assess the relation between protein intake and incident 1-y weight loss ≥5% in community-dwelling older adults. We conducted a nested, prospective, case-control study in 1793 community-living elderly participants of the Quebec Longitudinal Study of Nutrition as a Determinant of Successful Aging (NuAge). We studied 211 incident cases of 1-y weight loss (≥5%) and 211 weight-stable controls (±2%) matched by sex and age category (70 ± 2, 75 ± 2, and 80 ± 2 y). Diet was measured by 3 nonconsecutive 24-h recalls. ORs (95% CIs) for the association between protein intake and weight loss were computed by using conditional logistic regression. After adjustment for body mass index, energy intake, appetite, smoking status, physical activity level, physical function, chronic diseases and medications, depressive symptoms, and serum albumin and ultrasensitive C-reactive protein, the ORs of weight loss in participants with low protein intakes [<0.8 g/(kg · d)] were 2.56 (95% CI: 1.01, 6.50) compared with participants with very high protein intakes [≥1.2 g/(kg · d)]. Corresponding numbers were 2.15 (95% CI: 1.02, 4.56) in participants with moderate protein intakes [0.8-<1.0 g/(kg · d)] and 1.33 (95% CI: 0.77, 2.28) in participants with high protein intakes [1.0-1.2 g/(kg · d)]. Our results suggest that protein intakes >1.0 g/(kg · d) are protective against weight loss in healthy older adults. These findings add epidemiologic evidence in support of higher optimal protein intakes than the current guidelines for healthy older adults.
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Saini A, Mastana S, Myers F, Lewis MP. 'From death, lead me to immortality' - mantra of ageing skeletal muscle. Curr Genomics 2013; 14:256-67. [PMID: 24294106 PMCID: PMC3731816 DOI: 10.2174/1389202911314040004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 12/20/2022] Open
Abstract
Skeletal muscle is a post-mitotic tissue maintained by repair and regeneration through a population of stem cell-like satellite cells. Following muscle injury, satellite cell proliferation is mediated by local signals ensuring sufficient progeny for tissue repair. Age–related changes in satellite cells as well as to the local and systemic environment potentially impact on the capacity of satellite cells to generate sufficient progeny in an ageing organism resulting in diminished regeneration. ‘Rejuvenation’ of satellite cell progeny and regenerative capacity by environmental stimuli effectors suggest that a subset of age-dependent satellite cell changes may be reversible. Epigenetic regulation of satellite stem cells that include DNA methylation and histone modifications which regulate gene expression are potential mechanisms for such reversible changes and have been shown to control organismal longevity. The area of health and ageing that is likely to benefit soonest from advances in the biology of adult stem cells is the emerging field of regenerative medicine. Further studies are needed to elucidate the mechanisms by which epigenetic modifications regulate satellite stem cell function and will require an increased understanding of stem-cell biology, the environment of the aged tissue and the interaction between the two.
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Affiliation(s)
- Amarjit Saini
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Rossen LM, Milsom VA, Middleton KR, Daniels MJ, Perri MG. Benefits and risks of weight-loss treatment for older, obese women. Clin Interv Aging 2013; 8:157-66. [PMID: 23430455 PMCID: PMC3573815 DOI: 10.2147/cia.s38155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A key issue in the treatment of obesity in older adults is whether the health benefits of weight loss outweigh the potential risks with respect to musculoskeletal injury. OBJECTIVE To compare change in weight, improvements in metabolic risk factors, and reported musculoskeletal adverse events in middle-aged (50-59 years) and older (65-74 years), obese women. MATERIALS AND METHODS Participants completed an initial 6-month lifestyle intervention for weight loss, comprised of weekly group sessions, followed by 12 months of extended care with biweekly contacts. Weight and fasting blood samples were assessed at baseline, month 6, and month 18; data regarding adverse events were collected throughout the duration of the study. RESULTS Both middle-aged (n = 162) and older (n = 56) women achieved significant weight reductions from baseline to month 6 (10.1 ± 0.68 kg and 9.3 ± 0.76 kg, respectively) and maintained a large proportion of their losses at month 18 (7.6 ± 0.87 kg and 7.6 ± 1.3 kg, respectively); there were no significant differences between the two groups with respect to weight change. Older women further experienced significant reductions in systolic blood pressure, HbA(1c), and C-reactive protein from baseline to month 6 and maintained these improvements at month 18. Despite potential safety concerns, we found that older women were no more likely to experience musculoskeletal adverse events during the intervention as compared with their middle-aged counterparts. CONCLUSION These results suggest that older, obese women can experience significant health benefits from lifestyle treatment for obesity, including weight loss and improvements in disease risk factors. Further investigation of the impact of weight loss on additional health-related parameters and risks (eg, body composition, muscular strength, physical functioning, and injuries) in older adults is needed.
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Affiliation(s)
- Lauren M Rossen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - Vanessa A Milsom
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kathryn R Middleton
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University and The Miriam Hospital, Providence, RI, USA
| | - Michael J Daniels
- Department of Statistics, University of Florida, Gainesville, FL, USA
- Division of Statistics and Scientific Computation, University of Texas at Austin, Austin, TX, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Yaxley A, Miller MD, Fraser RJ, Cobiac L. Pharmacological interventions for geriatric cachexia: a narrative review of the literature. J Nutr Health Aging 2012; 16:148-54. [PMID: 22323350 DOI: 10.1007/s12603-011-0083-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this review was to investigate the range of pharmacological interventions that have been studied for treatment of geriatric cachexia, and to evaluate their effect on selected clinical outcomes in this population. METHODS Databases including Medline and Cochrane Central Register of Controlled Trials were searched up to March 2010 with search terms including "cache*", "intervention", "megestrol acetate" and "cytokine inhibitors". Studies investigating subjects with mean age <60y or disease-related cachexia were excluded. Outcomes assessed were weight or BMI, body composition, appetite and laboratory parameters indicative of cachexia. RESULTS Fifteen publications met the selection criteria, reporting on ten studies. Seven studies investigated use of megestrol acetate (MA): two randomised controlled trials, one case control study, two pre-test/post-test studies and two retrospective chart reviews. Weight/BMI was common amongst outcomes and these studies showed an improvement in weight compared with baseline. MA studies which investigated body composition, appetite and/or laboratory parameters provided some evidence for improvement in these outcomes. Three randomised controlled trials investigated the use of other interventions: ghrelin, growth hormone and vitamin supplementations. All demonstrated a significant increase in lean body mass. The only other outcome of interest in these three trials was weight in one study with a significant increase demonstrated. CONCLUSION Little investigation has been conducted in this population and the diagnosis of cachexia is problematic however these trials provide preliminary evidence for beneficial outcomes in older adults likely to have cachexia. Further high quality adequately powered prospective studies are necessary to provide effective treatment for geriatric cachexia.
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Affiliation(s)
- A Yaxley
- Nutrition and Dietetics, Clinical and Molecular Medicine, Flinders University, GPO Box 2100, Adelaide, South Australia 5000, Australia
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12
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Saini A, Faulkner S, Al-Shanti N, Stewart C. Powerful signals for weak muscles. Ageing Res Rev 2009; 8:251-67. [PMID: 19716529 DOI: 10.1016/j.arr.2009.02.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 02/10/2009] [Indexed: 12/19/2022]
Abstract
The aim of the present review is to summarise, evaluate and critique the different mechanisms involved in anabolic growth of skeletal muscle and the catabolic processes involved in cancer cachexia and sarcopenia of ageing. This is highly relevant, since they represent targets for future promising clinical investigations. Sarcopenia is an inevitable process associated with a gradual reduction in muscle mass and strength, associated with a reduction in motor unit number and atrophy of muscle fibres, especially the fast type IIa fibres. The loss of muscle mass with ageing is clinically important because it leads to diminished functional ability and associated complications. Cachexia is widely recognised as severe and rapid wasting accompanying disease states such as cancer or immunodeficiency disease. One of the main characteristics of cancer cachexia is asthenia or lack of strength, which is directly related to the muscle loss. Indeed, apart from the speed of loss, muscle wasting during cancer and ageing share many common metabolic pathways and mediators. In healthy young individuals, muscles maintain their mass and function because of a balance between protein synthesis and protein degradation associated with rates of anabolic and catabolic processes, respectively. Muscles grow (hypertrophy) when protein synthesis exceeds protein degradation. Conversely, muscles shrink (atrophy) when protein degradation dominates. These processes are not occurring independently of each other, but are finely coordinated by a web of intricate signalling networks. Such signalling networks are in charge of executing environmental and cellular cues that ultimately determine whether muscle proteins are synthesised or degraded. Increasing our understanding for the pathways involved in hypertrophy and atrophy and particularly the interaction of these pathways is essential in designing therapeutic strategies for both prevention and treatment of muscle wasting conditions with age and with disease.
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Affiliation(s)
- Amarjit Saini
- Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, Manchester, United Kingdom.
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Locher JL, Ritchie CS, Robinson CO, Roth DL, Smith West D, Burgio KL. A multidimensional approach to understanding under-eating in homebound older adults: the importance of social factors. THE GERONTOLOGIST 2008; 48:223-34. [PMID: 18483434 PMCID: PMC2756416 DOI: 10.1093/geront/48.2.223] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to identify relationships between medical, functional, economic, oral health, social, religious, and psychological factors and under-eating in homebound older adults. The focus of the study was on identifying potentially modifiable factors amenable to social and behavioral interventions. DESIGN AND METHODS A total of 230 homebound older adults who were currently receiving home health services participated in interviews in their homes using a questionnaire to assess eating behaviors and factors that could possibly affect those eating behaviors. Interviewers measured height and weight, and participants completed three 24-hr dietary recalls. RESULTS The mean age of participants was 79.1 years. The sample comprised 78% women and 38% African Americans. We found that 70% of participants were under-eating, defined as not consuming enough calories to maintain their current body weight. Participants who were at higher risk of under-eating included men, those receiving either infrequent care or very frequent care by a caregiver, those who had been hospitalized prior to receipt of home health services, and those with a higher body mass index. IMPLICATIONS Findings from the study have implications for both practice and policy. Experts must develop evidence-based interventions targeted at under-eating in this particularly vulnerable and growing population of homebound older adults. This study provides an initial foundation for the development of targeted evidence-based behavioral nutritional interventions that are noninvasive and cost effective.
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Affiliation(s)
- Julie L Locher
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA.
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Abstract
Unintended weight loss has a profound effect on morbidity and mortality in older persons. A therapeutic approach to unintended weight loss in older persons depends on correct classification. A careful differential diagnostic approach is mandatory, combined with nutritional and often pharmacological interventions. While starvation due to protein-energy undernutrition is widely regarded as the primary cause of loss of fat and fat-free mass in older persons, a failure to improve with nutritional replacement should trigger a consideration of other causes. Both sarcopenia and cachexia are resistant to hypercaloric feeding. Cachexia may be amenable to suppression of proinflammatory cytokines in known inflammatory disease states.
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Affiliation(s)
- David R Thomas
- Saint Louis University Health Sciences Center, Division of Geriatric Medicine, Saint Louis, MO 63104, USA
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Bylow K, Mohile SG, Stadler WM, Dale W. Does androgen-deprivation therapy accelerate the development of frailty in older men with prostate cancer?: a conceptual review. Cancer 2008; 110:2604-13. [PMID: 17960609 DOI: 10.1002/cncr.23084] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The majority of men with prostate cancer are aged > or =65 years. Men, as they age, are more likely to suffer from impaired physical function. The standard treatment for recurrent prostate cancer is androgen-deprivation therapy (ADT). Well-established toxicities from ADT include lean weight loss or sarcopenia, muscle weakness, fatigue, and reduced activity levels. Frailty is a term from geriatrics that describes older individuals with limited physiologic reserve who are at significant risk for adverse outcomes, including falls, disability, hospitalization, and death. An increasingly accepted definition of frailty is a syndrome in which > or =3 of the following are present: unintentional (lean) weight loss > or =10 pounds in the past year, weakness (measured by grip strength), slow walking speed, self-reported exhaustion, and low physical activity. This clinical syndrome overlaps closely with the known toxicities of ADT. In addition, alterations in the inflammatory system, neuroendocrine system, and energy production are associated with this syndrome, as evidenced by biomarkers such as C-reactive protein, interleukin-6, and tumor necrosis factor-alpha. For this article, the authors reviewed the evidence for the effect of ADT on each of the 5 frailty components plus the identified biomarkers, and the evidence indicates that ADT may accelerate the development of frailty in vulnerable older men with prostate cancer. Given the association of frailty with important clinical outcomes such as hospitalization and death, this potential consequence of ADT should be considered carefully when initiating therapy in older patients with recurrent prostate cancer.
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Affiliation(s)
- Kathryn Bylow
- Section of Hematology-Oncology, Department of Medicine, University of Chicago, Chicago, Illinois 60637, usa
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Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Intensive Session: New Approaches to Medical Issues in Long-Term Care. J Am Med Dir Assoc 2007; 8:421-33. [PMID: 17845944 DOI: 10.1016/j.jamda.2007.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Indexed: 02/02/2023]
Abstract
This article, based on a series of presentations at the American Medical Directors Association, briefly highlights new advances in medical areas of interest to long-term care physicians. The areas discussed are heart failure, vitamin D, falls, new treatments for diabetes mellitus, blood pressure measurement, anemia, clinical nutrition, pressure ulcers, Clostridium difficile, insomnia, and antipsychotic therapy.
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Thomas DR. Loss of skeletal muscle mass in aging: Examining the relationship of starvation, sarcopenia and cachexia. Clin Nutr 2007; 26:389-99. [PMID: 17499396 DOI: 10.1016/j.clnu.2007.03.008] [Citation(s) in RCA: 324] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 03/13/2007] [Accepted: 03/18/2007] [Indexed: 12/25/2022]
Abstract
A loss of body weight or skeletal muscle mass is common in older persons and is a harbinger of poor outcome. Involuntary weight loss can be categorized into three primary etiologies of starvation, sarcopenia, and cachexia. Starvation results in a loss of body fat and non-fat mass due to inadequate intake of protein and energy. Sarcopenia is associated with a reduction in muscle mass and strength occurring with normal aging, associated with a reduction in motor unit number and atrophy of muscle fibers, especially the type IIa fibers. The loss of muscle mass with aging is clinically important because it leads to diminished strength and exercise capacity. Cachexia is widely recognized as severe wasting accompanying disease states such as cancer or immunodeficiency disease, but does not have a universally accepted definition. The key clinical question is whether these changes in body composition are distinct entities or represent an interdependent continuum. The importance of defining the distinction lies in developing a targeted therapeutic approach to skeletal muscle loss and muscle strength in older persons. Failure to distinguish among these causes of skeletal muscle loss often results in frustration over the clinical response to therapeutic interventions.
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Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, Saint Louis University Medical Center, Saint Louis, MO 63104, USA.
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