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Saracino RM, Park E, Shuk E, Rosenfeld B, Roth AJ, Nelson CJ. Considerations for Evaluating Older Adults with Cancer for Depression: A Qualitative Survey of Experts. Clin Gerontol 2024:1-11. [PMID: 38961750 DOI: 10.1080/07317115.2024.2375321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
OBJECTIVES The objective of this study was to engage national experts in geriatric psychiatry and oncology in qualitative interviews to develop consensus regarding how older adult cancer survivors (OACS) experience depressive symptoms, and how best to assess OACs for depression. METHODS Expert clinicians in geriatric oncology disciplines were interviewed about approaches to assessing depression in OACs. Interviews were audio-recorded and transcribed, and conducted until thematic saturation was achieved. Thematic Content Analysis was utilized to identify key themes. RESULTS Experts (N = 8) were board certified geriatric psychiatrists and oncologists with specialization in geriatric medicine. Two conceptual domains were identified: Key indicators of depression in OACs (e.g. anhedonia; loss of meaning and purpose; loneliness and social withdrawal) and unique considerations for depression assessment in OACs (e.g. alternative phrasing to "depression," disentangling mood and cancer or treatment-related side effects). CONCLUSIONS The approaches identified tended to depart from traditional diagnostic criteria for depression. CLINICAL IMPLICATIONS Results provide additional insight into the limitations of existing depression measures for OACs. The themes and practices identified in the present study suggest that a revised measure of depression for OACs may be useful. Future research will continue to shed light on best practices for depression assessment in OACs.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ellen Park
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elyse Shuk
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Nitsan G, Baharav S, Tal-Shir D, Shakuf V, Ben-David BM. Speech Processing as a Far-Transfer Gauge of Serious Games for Cognitive Training in Aging: Randomized Controlled Trial of Web-Based Effectivate Training. JMIR Serious Games 2022; 10:e32297. [PMID: 35900825 PMCID: PMC9400949 DOI: 10.2196/32297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The number of serious games for cognitive training in aging (SGCTAs) is proliferating in the market and attempting to combat one of the most feared aspects of aging-cognitive decline. However, the efficacy of many SGCTAs is still questionable. Even the measures used to validate SGCTAs are up for debate, with most studies using cognitive measures that gauge improvement in trained tasks, also known as near transfer. This study takes a different approach, testing the efficacy of the SGCTA-Effectivate-in generating tangible far-transfer improvements in a nontrained task-the Eye tracking of Word Identification in Noise Under Memory Increased Load (E-WINDMIL)-which tests speech processing in adverse conditions. OBJECTIVE This study aimed to validate the use of a real-time measure of speech processing as a gauge of the far-transfer efficacy of an SGCTA designed to train executive functions. METHODS In a randomized controlled trial that included 40 participants, we tested 20 (50%) older adults before and after self-administering the SGCTA Effectivate training and compared their performance with that of the control group of 20 (50%) older adults. The E-WINDMIL eye-tracking task was administered to all participants by blinded experimenters in 2 sessions separated by 2 to 8 weeks. RESULTS Specifically, we tested the change between sessions in the efficiency of segregating the spoken target word from its sound-sharing alternative, as the word unfolds in time. We found that training with the SGCTA Effectivate improved both early and late speech processing in adverse conditions, with higher discrimination scores in the training group than in the control group (early processing: F1,38=7.371; P=.01; ηp2=0.162 and late processing: F1,38=9.003; P=.005; ηp2=0.192). CONCLUSIONS This study found the E-WINDMIL measure of speech processing to be a valid gauge for the far-transfer effects of executive function training. As the SGCTA Effectivate does not train any auditory task or language processing, our results provide preliminary support for the ability of Effectivate to create a generalized cognitive improvement. Given the crucial role of speech processing in healthy and successful aging, we encourage researchers and developers to use speech processing measures, the E-WINDMIL in particular, to gauge the efficacy of SGCTAs. We advocate for increased industry-wide adoption of far-transfer metrics to gauge SGCTAs.
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Affiliation(s)
- Gal Nitsan
- Department of Communication Sciences and Disorders, University of Haifa, Haifa, Israel.,Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel
| | - Shai Baharav
- Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel
| | - Dalith Tal-Shir
- Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel
| | - Vered Shakuf
- Department of Communications Disorders, Achva Academic College, Arugot, Israel
| | - Boaz M Ben-David
- Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel.,Toronto Rehabilitation Institute, University Health Networks, Toronto, ON, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
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Assessing psychological health and social support in older adults with cancer, a how-to guide - A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative. J Geriatr Oncol 2022; 13:1050-1053. [PMID: 35717534 DOI: 10.1016/j.jgo.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022]
Abstract
Older adults with cancer frequently have several unmet needs related to overlapping vulnerabilities caused by medical and social health challenges which are often overlooked in typical oncological assessments 1. Social support and psychological health are critical considerations for older adults with cancer and are therefore key components of a geriatric assessment.
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4
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Massa E, Donisi C, Liscia N, Madeddu C, Impera V, Mariani S, Scartozzi M, Lai E. The Difficult Task of Diagnosing Depression in Elderly People with Cancer: A Systematic Review. Clin Pract Epidemiol Ment Health 2021; 17:295-306. [PMID: 35444712 PMCID: PMC8985471 DOI: 10.2174/1745017902117010295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/08/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
Background:
Depression is a common psychiatric problem in the elderly and oncology patients. In elderly people with cancer, depression has a peculiar phenomenology. It has a significant impact on the quality of life. Moreover, it is associated with poor adherence to treatments, increased risk of suicide, and mortality. Nevertheless, the topic of depression in elderly people with cancer remains unexplored.
Objective:
The main goal of this article is to review the literature from the past 20 years on the relationships between depression, cancer, and aging.
Methods:
The methods followed the Prisma model for eligibility of studies. The articles in which the keywords “depression”, “cancer”, “ elderly, aging, or geriatric” were present, either in the text or in the abstract, were selected. 8.056 articles, by matching the keywords “depression and elderly and cancer,” were identified. Only 532 papers met the eligibility criteria of search limits and selection process. Out of 532 papers, 467 were considered irrelevant, leaving 65 relevant studies. Out of 65 suitable studies, 39 (60.0%) met our quality criteria and were included.
Results:
The risk factors associated with depression in elderly people with cancer can be divided into 4 groups: 1) tumor-related; 2) anticancer treatment-related; 3) patients-related; 4) number and type of comorbidity. The main obstacles in diagnosing depression in elderly patients with cancer are the overlap of the symptoms of cancer and side effects of treatment with the symptoms of depression but also the different ways of reporting depressive symptoms of elderly people and the different clinical types of depression. There is a lack of data regarding validated scales to assess depression in geriatric patients with cancer. Any mental illness, specifically co-occurring anxiety and depression, increases the risk of diagnosis delay and anticancer treatment adherence. Cancer and the diagnosis of mental disorders prior to cancer diagnosis correlate with an increased risk for suicide. A non-pharmacological therapeutic approach, pharmacological treatment and/or a combination of both can be used to treat elderly patients with cancer, but a detailed analysis of comorbidities and the assessment of polypharmacy is mandatory in order to avoid potential side-effects and interactions between antidepressants and the other drugs taken by the patients.
Conclusion:
Future research should be conducted with the aim of developing a modified and adapted assessment method for the diagnosis and treatment of depression in elderly people with cancer in order to improve their clinical outcomes and quality of life.
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5
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Fares N, Sherratt RS, Elhajj IH. Directing and Orienting ICT Healthcare Solutions to Address the Needs of the Aging Population. Healthcare (Basel) 2021; 9:147. [PMID: 33540510 PMCID: PMC7912863 DOI: 10.3390/healthcare9020147] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND With an aging population, it is essential to maintain good health and autonomy for as long as possible. Instead of hospitalisation or institutionalisation, older people with chronic conditions can be assisted in their own home with numerous "smart" devices that support them in their activities of daily living, manage their medical conditions, and prevent fall incidents. Information and Communication Technology (ICT) solutions facilitate the monitoring and management of older people's health to improve quality of life and physical activity with a decline in caregivers' burden. METHOD The aim of this paper was to conduct a systematic literature review to analyse the state of the art of ICT solutions for older people with chronic conditions, and the impact of these solutions on their quality of life from a biomedical perspective. RESULTS By analysing the literature on the available ICT proposals, it is shown that different approaches have been deployed by noticing that the more cross-interventions are merged then the better the results are, but there is still no evidence of the effects of ICT solutions on older people's health outcomes. Furthermore, there are still unresolved ethical and legal issues. CONCLUSION While there has been much research and development in healthcare ICT solutions for the aging population, ICT solutions still need significant development in order to be user-oriented, affordable, and to manage chronic conditions in the aging wider population.
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Affiliation(s)
- Nada Fares
- Department of Biomedical Engineering, School of Biological Sciences, University of Reading, Berkshire RG6 6AY, UK;
| | - R. Simon Sherratt
- Department of Biomedical Engineering, School of Biological Sciences, University of Reading, Berkshire RG6 6AY, UK;
| | - Imad H. Elhajj
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut 1107 2020, Lebanon;
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6
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Abstract
UNLABELLED ABSTRACTObjective:Wisdom is a complex trait, and previous research has identified several components of wisdom. This study explored the possible impact of a diagnosis of a terminal illness on the conceptualization and evolution of wisdom while facing the end of life. DESIGN AND PARTICIPANTS Semi-structured qualitative interviews were conducted with 21 hospice patients aged 58-97 years who were in the last six months of their life. METHODS Hospice patients were asked to describe the core characteristics of wisdom, as well as how their terminal illness might have impacted their understanding of this concept. The interviews were audiotaped, transcribed, and coded by the research team using a grounded theory analytic approach based on coding consensus, co-occurrence, and comparison. RESULTS Broad concepts of wisdom described by the hospice patients align with the extant literature, thereby supporting those general conceptualizations. In addition, hospice patients described how their life perspectives shifted after being diagnosed with a terminal illness. Post-illness wisdom can be characterized as a dynamic balance of actively accepting the situation while simultaneously striving for galvanized growth. This delicate tension motivated the patients to live each day fully, yet consciously plan for their final legacy. CONCLUSION The end of life offers a unique perspective on wisdom by highlighting the modulation between actively accepting the current situation while continuing the desire to grow and change at this critical time. This paradox, when embraced, may lead to even greater wisdom while facing one's own mortality.
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7
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Atag E, Mutlay F, Soysal P, Semiz HS, Kazaz SN, Keser M, Ellidokuz H, Karaoglu A. Prevalence of depressive symptoms in elderly cancer patients receiving chemotherapy and influencing factors. Psychogeriatrics 2018; 18:365-370. [PMID: 29998465 DOI: 10.1111/psyg.12329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/12/2017] [Accepted: 02/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depression is one of the most prevalent causes of distress in the geriatric population. The purpose of this study was to examine the prevalence of depressive symptoms in elderly cancer patients and to determine the possible associated factors. METHODS Cancer patients 65 years or older and on active chemotherapy completed the Yesavage Geriatric Depression Scale. We examined the relationship of depressive symptoms with age, gender, marital status, educational background, type of cancer, stage of disease, comorbidities, types of treatment for cancer, the duration after diagnosis of cancer, social support, and pain status. RESULTS The study included 170 patients with a mean age of 71 years, and 47.1% were women. The prevalence of a high depressive symptom score was 19.4%. Of the patients who had a high depressive symptom score based on the Yesavage Geriatric Depression Scale, 18.2% had already been diagnosed with depression and used antidepressants. The mean pain score was significantly higher in patients who had a high depressive symptom score compared to others (P = 0.012). CONCLUSION The prevalence of depressive symptoms in elderly cancer patients receiving chemotherapy was similar to that in the geriatric population without cancer. It was also consistent with previous studies on elderly cancer population. Pain was found to be a factor related to depressive symptoms. The prevalence of depression may be reduced by pain control. The treatment of depression may both improve the patient's quality of life and enhance their compliance with treatment.
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Affiliation(s)
- Elif Atag
- Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Feyza Mutlay
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Huseyin S Semiz
- Department of Medical Oncology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Seher N Kazaz
- Department of Medical Oncology, Trabzon Kanuni Education and Research Hospital, Trabzon, Turkey
| | - Murat Keser
- Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hulya Ellidokuz
- Department of Biostatistics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Aziz Karaoglu
- Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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8
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Ben-David BM, Malkin G, Erel H. Ageism and Neuropsychological Tests. INTERNATIONAL PERSPECTIVES ON AGING 2018. [DOI: 10.1007/978-3-319-73820-8_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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9
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Bergeron CD, Goltz HH, Szucs LE, Reyes JV, Wilson KL, Ory MG, Smith ML. Exploring sexual behaviors and health communication among older women. Health Care Women Int 2017; 38:1356-1372. [DOI: 10.1080/07399332.2017.1329308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Heather Honoré Goltz
- Social Work Program, University of Houston-Downtown, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Leigh E. Szucs
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Jovanni V. Reyes
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Kelly L. Wilson
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Marcia G. Ory
- Department of Social and Behavioral Health, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Matthew Lee Smith
- Department of Social and Behavioral Health, School of Public Health, Texas A&M University, College Station, Texas, USA
- Institute of Gerontology, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, Georgia, USA
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10
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Molina Garrido MJ, Guillén Ponce C, Fernández Félix BM, Muñoz Sánchez MDM, Soriano Rodríguez MDC, Olaverri Hernández A, Santiago Crespo JA. [Detection and evaluation of the role of sarcopenia in elderly patients with cancer treated with chemotherapy. ONCOSARCO project]. Rev Esp Geriatr Gerontol 2017; 52:146-151. [PMID: 27012216 DOI: 10.1016/j.regg.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To develop a predictive model of toxicity to chemotherapy in elderly patients with cancer, using the variables associated with sarcopenia, and to identify which of these parameters, sarcopenia or frailty, is the best predictor of toxicity to chemotherapy in the elderly. MATERIAL AND METHODS A prospective observational study with patients ≥70 years treated with chemotherapy in the Cancer Unit for the Elderly, in the Medical Oncology Section of the Hospital Virgen de la Luz de Cuenca. The following tests will be performed by each patient before chemotherapy: muscle strength (handgrip, cylindrical handgrip, pinch gauge, hip flexion, knee extension), muscle mass (skeletal muscle mass index), and physical function (gait speed and 5STS test). The occurrence of severe toxicity will be recorded over a period of 4 months of chemotherapy treatment. It will be evaluated, using logistic regression analysis, whether sarcopenia (defined by the European Working Group on Sarcopenia in Older People) or frailty (defined by the phenotype of frailty) is the best predictor of chemotherapy toxicity. Using a multinomial logistic regression analysis, we will try to create the first model to predict toxicity to chemotherapy in elderly patients with diagnosis of cancer, based on the definition of sarcopenia. CONCLUSIONS It is expected that the final analysis of this project will be useful to detect predictive factors of toxicity to chemotherapy in elderly patients with cancer.
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Affiliation(s)
- Maria José Molina Garrido
- Consulta de Cáncer en el Anciano, Sección de Oncología Médica, Hospital General Virgen de la Luz, Cuenca, España.
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11
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Schapmire TJ, Faul AC. Depression symptoms in older adults with cancer: A multilevel longitudinal study. J Psychosoc Oncol 2017; 35:260-277. [DOI: 10.1080/07347332.2017.1286698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tara J. Schapmire
- School of Medicine, University of Louisville, Louisville, KY, USA
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Anna C. Faul
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
- Department of Social Work, University of the Free State, Bloemfontein, South Africa
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12
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Wakefield BJ, Holman JE. Functional Trajectories Associated With Hospitalization in Older Adults. West J Nurs Res 2016; 29:161-77; discussion 178-82. [PMID: 17337620 DOI: 10.1177/0193945906293809] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
For older adults, acute-care hospital stays can result in functional decline that leads to increased risk of hospitalization, nursing home admission, or mortality. This study describes functional trajectories in hospitalized older adults and identifies risk factors associated with those trajectories. Respondents ( N = 45) exhibited five of six possible functional trajectory patterns. The largest change in functional status was a decline in activities of daily living (ADL) from baseline at 2 weeks before admission to the time of admission; ADL did not return to baseline during the first 4 days in the hospital. Depression scores were significantly higher in respondents who reported experiencing ADL decline before admission. Respondents whose ADL scores declined during hospitalization (regardless of baseline status) were more likely than others to die within 3 months of discharge. Functional trajectory in hospitalized elderly patients is an important and underappreciated prognostic concept requiring further attention.
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Affiliation(s)
- Bonnie J Wakefield
- Harry S. Truman Memorial Veterans Hospital, Health Services Research and Development, Columbia, USA
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13
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Saracino RM, Weinberger MI, Roth AJ, Hurria A, Nelson CJ. Assessing depression in a geriatric cancer population. Psychooncology 2016; 26:1484-1490. [PMID: 27195436 DOI: 10.1002/pon.4160] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/26/2016] [Accepted: 04/17/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the ability of three popular self-report measures of depression to assess depression in a geriatric cancer setting. METHOD Cancer patients 70 years or older and on active treatment completed the Geriatric Depression Scale-Short Form, the Hospital Anxiety and Depression Scale, and the Center for Epidemiological Studies Depression Scale-Revised, and were interviewed using the depression module of the Structured Clinical Interview for DSM disorders (SCID) as the 'gold standard.' Analyses included calculating internal consistency, ROC curves, and the sensitivity and specificity to detect major depression (MDD) or minor depression (i.e. subthreshold depression). RESULTS In a sample of 201 cancer patients (85% White; 64% completed college degree or higher), all three of the self-report measures produced adequate internal consistency and predicted depression greater than chance. However, the published cutoff scores for detecting MDD produced inadequate sensitivity, suggesting these scores will miss as many as 33%-83% of geriatric cancer patients who are depressed. Revised cutoff scores were lower than published cutoff scores. CONCLUSION Although these measures produced good internal consistency and were better than chance at predicting depression in a geriatric cancer sample, the published cutoff scores for these measures did not perform well in predicting MDD nor minor depression. Of the three measures, the CES-D appeared to have the most utility. This data suggests that these popular screening measures may be inadequate for reliably identifying depression in a geriatric cancer population. Researchers and clinicians, therefore, should use caution when selecting depression measures for geriatric cancer patients and consider using the lower cut-off scores presented here.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark I Weinberger
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arti Hurria
- Cancer and Aging Research Program, City of Hope Comprehensive Cancer Center, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Duc S, Rainfray M, Soubeyran P, Fonck M, Blanc JF, Ceccaldi J, Cany L, Brouste V, Mathoulin-Pélissier S. Predictive factors of depressive symptoms of elderly patients with cancer receiving first-line chemotherapy. Psychooncology 2016; 26:15-21. [PMID: 26913707 DOI: 10.1002/pon.4090] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/18/2015] [Accepted: 01/15/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Depression is the most common psychiatric disorder in geriatrics and oncology. For elderly cancer patients, it has a significant impact on quality of life, morbidity, and mortality. Nevertheless, depression is under-diagnosed and under-treated. Cancer management is key in improving the quality of care in this population. We aim to identify sociodemographic, clinical, and treatment-related factors of depression in elderly patients during chemotherapy, thus allowing early detection of patients in need of specific treatment. Further, we investigate whether chemotherapy efficacy and safety are associated with depression. PATIENTS AND METHODS A prospective multicenter cohort composed of incident cases of cancer diagnosed in patients 70 years and older, receiving first-line chemotherapy. Depressive symptoms were measured by the Geriatric Depression Scale at baseline and after four chemotherapy cycles. Associations between depressive symptoms during chemotherapy and patients' clinical and treatment characteristics were identified by logistic regression. RESULTS Among 344 patients measured for depression before chemotherapy, 260 had a second assessment at the fourth treatment cycle. At baseline, 45.4% were depressed, and 44.6% were depressed after the fourth cycle. Independent factors of depression were depressive symptoms at baseline (odds ratio (OR) = 6.7, p < 0.001), malnutrition (OR = 5.1, p = 0.014), and risk of malnutrition (OR = 1.6, p = 0.014). After controlling for missing data, effective chemotherapy was associated with a lower risk of depression (OR = 0.4, p = 0.018). CONCLUSION We highlight the role of depressive symptoms and nutritional status at baseline, on the occurrence of depressive symptoms during chemotherapy. These factors should be taken into account in any pre-treatment consultation and appropriate nutritional and psychiatric preventative measures established. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- S Duc
- Gerontology Department, University Hospital Xavier Arnozan, Pessac, France
| | - M Rainfray
- Gerontology Department, University Hospital Xavier Arnozan, Pessac, France.,Université Bordeaux, Bordeaux, France
| | - P Soubeyran
- Université Bordeaux, Bordeaux, France.,Medical Oncology Department, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - M Fonck
- Medical Oncology Department, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - J F Blanc
- Université Bordeaux, Bordeaux, France.,Gastroenterology Department, University Hospital Saint-André, Bordeaux, France
| | - J Ceccaldi
- Hematology Department, General Center Hospital, Libourne, France
| | - L Cany
- Medical Oncology Department, Polyclinique Francheville, Périgueux, France
| | - V Brouste
- Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - S Mathoulin-Pélissier
- Université Bordeaux, Bordeaux, France.,Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France.,INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Clinical Epidemiology and Clinical Investigation Centre CIC-1401, Clinical Epidemiology Module, Bordeaux, France
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15
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Bolandzadeh N, Tam R, Handy TC, Nagamatsu LS, Hsu CL, Davis JC, Dao E, Beattie BL, Liu-Ambrose T. Resistance Training and White Matter Lesion Progression in Older Women: Exploratory Analysis of a 12-Month Randomized Controlled Trial. J Am Geriatr Soc 2015; 63:2052-60. [DOI: 10.1111/jgs.13644] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Niousha Bolandzadeh
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Experimental Medicine Program; University of British Columbia; Vancouver British Columbia Canada
- Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Hip Health and Mobility; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Roger Tam
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - Todd C. Handy
- Department of Psychology; University of British Columbia; Vancouver British Columbia Canada
| | - Lindsay S. Nagamatsu
- Beckman Institute for Advanced Science and Technology; University of Illinois at Urbana-Champaign; Urbana Illinois
| | - Chun Liang Hsu
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Hip Health and Mobility; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Jennifer C. Davis
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
- School of Population and Public Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Clinical Epidemiology and Evaluation; Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Elizabeth Dao
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Hip Health and Mobility; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - B. Lynn Beattie
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
- Division of Geriatric Medicine; Faculty of Medicine; University of British Columbia; Vancouver Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Experimental Medicine Program; University of British Columbia; Vancouver British Columbia Canada
- Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Hip Health and Mobility; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
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Rhondali W, Freyer G, Adam V, Filbet M, Derzelle M, Abgrall-Barbry G, Bourcelot S, Machavoine JL, Chomat-Neyraud M, Gisserot O, Largillier R, Le Rol A, Priou F, Saltel P, Falandry C. Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer. Clin Interv Aging 2015. [PMID: 26203235 PMCID: PMC4506027 DOI: 10.2147/cia.s71690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA), and psychiatric clinical interview (PCI) in elderly patients with advanced ovarian cancer (AOC). Methods This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3), designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS), the Hospital Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM) criteria for depression were used as a gold standard. Results Out of 109 patients enrolled at 21 centers, 99 (91%) completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%). Thirty six patients (36%) were identified as depressed by the PCI versus 15 (15%) identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508) and PCI (κ=0.431) and high agreement with MADRS (κ=0.663). We found low or no agreement between DSM with the other assessment strategies, including OA (κ=−0.043). Identification according to OA (yes/no) resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively). Conclusion The use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC.
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Affiliation(s)
| | - Gilles Freyer
- Medical Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France
| | - Virginie Adam
- Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvrelès-Nancy, France
| | - Marilène Filbet
- Palliative Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France
| | | | | | | | | | | | | | | | - Annick Le Rol
- Medical Oncology, Hôpital Perpétuel Secours, Levallois-Perret, France
| | - Frank Priou
- Medical Oncology, Centre Hospitalier Départemental Les Oudairies, La Roche-sur-Yon, France
| | - Pierre Saltel
- Supportive Care Department, Centre Léon Bérard, Lyon, France
| | - Claire Falandry
- Geriatrics and Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Bénite, France
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Li KK, Cardinal BJ, Acock AC. Concordance of physical activity trajectories among middle-aged and older married couples: impact of diseases and functional difficulties. J Gerontol B Psychol Sci Soc Sci 2013; 68:794-806. [PMID: 23873967 DOI: 10.1093/geronb/gbt068] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study examined spousal concordance of physical activity trajectories among middle-aged and older married couples and the influences of recent diseases and functional difficulties on individuals' trajectories and those of their spouses'. METHOD Participants included 5,074 married couples aged 50 or older in the Health and Retirement Study in 2004-2010. Participants were categorized into 4 physical activity trajectories (i.e., stable active, adopters, relapsers, and stable sedentary) using confirmatory latent class growth analysis. Individuals' trajectory memberships were predicted by their spouses' memberships, together with recent diseases and functional difficulties of both couple members. RESULTS In the main, corresponding husbands' trajectories predicted wives' trajectories and vice versa. More functional difficulties predicted higher likelihoods of unfavorable trajectories among individuals but not of their spouses'. Among wives, more recent diseases predicted slightly more physical activity in subsequent data waves but not trajectory memberships. DISCUSSION Results supported spousal concordance in physical activity trajectories. The negative impact of functional difficulties was considerably contained within individuals. Increases in physical activity after acquiring diseases among wives were small and short lived. More research is needed to understand the underlying processes, which can be used to improve the design of future physical activity interventions directed toward women, men, and couples.
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Affiliation(s)
- Kin-Kit Li
- Correspondence should be addressed to Kin-Kit Li, Y7405 Academic 1, City University of Hong Kong, Tat Chee Avenue, Kowloon Tong, Hong Kong, China.
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18
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Rodríguez-Tadeo A, Wall-Medrano A, Gaytan-Vidaña ME, Campos A, Ornelas-Contreras M, Novelo-Huerta HI. Malnutrition risk factors among the elderly from the US-Mexico border: the "one thousand" study. J Nutr Health Aging 2012; 16:426-31. [PMID: 22555784 DOI: 10.1007/s12603-011-0349-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND The Mexican population is aging, which makes the fact that there is no regional information on the health of the elderly, including those in the northern region of the country. OBJECTIVE To examine nutritional, functional, and cognitive impairments, as well as depression, in non-institutionalized elderly Mexicans along Mexico's northern border. DESIGN Observational, descriptive and cross-sectional study. PARTICIPANTS AND MEASUREMENTS Demographic and anthropometric measurements were screened and the following scales were applied among 760 elderly individuals in Chihuahua, Mexico: Katz index (for activities of daily living, ADL), the Mini Nutritional Assessment (MNA), the Yesavage (depression), and the Pffeifer (cognitive decline). RESULTS 7% prevalence of malnutrition, a 18% prevalence of functional disability, a 44% prevalence of depressive symptoms, a 33% prevalence of cognitive impairment, and a risk of disease in almost half the population, without differences between genders. Malnutrition, functional disability, and cognitive impairment increased with age (P <0.001). Functional disability, depression, and cognitive impairment also increased the risk of malnutrition 3.0, 2.9 and 1.4 times (P <0.005). Other factors that may affect nutritional status included isolated living and illiteracy. CONCLUSION Levels of malnutrition, functional disability, depression and cognitive impairment are higher than those reported previously and are closely related to one another, so detecting alterations in primary care is important in order to improve quality of life and reduce complications.
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Affiliation(s)
- A Rodríguez-Tadeo
- Universidad Autónoma de Ciudad Juárez (Autonomous University of Ciudad Juarez), Instituto de Ciencias Biomédicas-Departamento de Ciencias de la Salud, Anillo Envolvente del Pronaf y Estocolmo s/n. Zip Code 32300, Ciudad Juárez, Chihuahua, México.
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Benke KS, Carlson MC, Doan BQ, Walston JD, Xue QL, Reiner AP, Fried LP, Arking DE, Chakravarti A, Fallin MD. The association of genetic variants in interleukin-1 genes with cognition: findings from the cardiovascular health study. Exp Gerontol 2011; 46:1010-9. [PMID: 21968104 DOI: 10.1016/j.exger.2011.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/14/2011] [Accepted: 09/16/2011] [Indexed: 10/17/2022]
Abstract
The inflammatory cytokine interleukin-1 (IL1) potentially plays a role in cognitive deterioration through pathology due to a dementing disorder or due to an aging process. Study of genetic variants in the IL1 genes has been mostly limited to diseases such as Alzheimer's, however, there may be benefit to studying a continuous measure of cognition. Using data from the Cardiovascular Health Study, we evaluate genetic variation in the genes encoding inflammatory agonists IL1A and IL1B, and the antagonist IL1RN, with repeated measures of global cognition (3MS) and processing speed (DSST), using mixed effects models. We found statistically significant minor allele SNP associations with baseline performance on the 3MS in the IL1RN gene for Caucasians (rs17042917: beta=0.47, 95%CI=0.09, 0.85, p=0.016; rs4251961: beta=-0.36, 95%CI=-0.13,-0.60, p=0.0027; rs931471: beta=0.39, 95%CI=0.13, 0.65, p=0.0032), and the IL1B gene for African Americans (rs1143627: beta=1.6, 95%CI=0.48, 2.8; p=0.006 and rs1143634: beta=2.09, 95%CI=0.39, 3.8; p=0.016). Associations appear to be weaker in a subgroup with higher education level. Upon removing those diagnosed with dementia, effect sizes and statistical significance attenuated. These results provide supporting evidence that genetic variants in IL1 genes may be involved in inflammatory-related lowered cognition, that higher education may modify genetic predisposition, and that these associations may be driven by a dementia process.
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Affiliation(s)
- K S Benke
- Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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20
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Tavakolan M, Xiao ZG, Menon C. A preliminary investigation assessing the viability of classifying hand postures in seniors. Biomed Eng Online 2011; 10:79. [PMID: 21906316 PMCID: PMC3224395 DOI: 10.1186/1475-925x-10-79] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 09/09/2011] [Indexed: 12/01/2022] Open
Abstract
Background Fear of frailty is a main concern for seniors. Surface electromyography (sEMG) controlled assistive devices for the upper extremities could potentially be used to augment seniors' force while training their muscles and reduce their fear of frailty. In fact, these devices could both improve self confidence and facilitate independent leaving in domestic environments. The successful implementation of sEMG controlled devices for the elderly strongly relies on the capability of properly determining seniors' actions from their sEMG signals. In this research we investigated the viability of classifying hand postures in seniors from sEMG signals of their forearm muscles. Methods Nineteen volunteers, including seniors (70 years old in average) and young people (27 years old in average), participated in this study and sEMG signals from four of their forearm muscles (i.e. Extensor Digitorum, Palmaris Longus, Flexor Carpi Ulnaris and Extensor Carpi Radialis) were recorded. The feature vectors were built by extracting features from each channel of sEMG including autoregressive (AR) model coefficients, waveform length and root mean square (RMS). Multi-class support vector machines (SVM) was used as a classifier to distinguish between fifteen different essential hand gestures including finger pinching. Results Classification of hand gestures both in the pronation and supination positions of the arm was possible. Classified hand gestures were: rest, ulnar deviation, radial deviation, grasp and four different finger pinching configurations. The obtained average classification accuracy was 90.6% for the seniors and 97.6% for the young volunteers. Conclusions The obtained results proved that the pattern recognition of sEMG signals in seniors is feasible for both pronation and supination positions of the arm and the use of only four EMG channel is sufficient. The outcome of this study therefore validates the hypothesis that, although there are significant neurological and physical changes occurring in humans while ageing, sEMG controlled hand assistive devices could potentially be used by the older people.
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Affiliation(s)
- Mojgan Tavakolan
- MENRVA Group, School of Engineering Science, Faculty of Applied Science, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A1S6, Canada
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LaStayo PC, Marcus RL, Dibble LE, Smith SB, Beck SL. Eccentric exercise versus usual-care with older cancer survivors: the impact on muscle and mobility--an exploratory pilot study. BMC Geriatr 2011; 11:5. [PMID: 21272338 PMCID: PMC3038910 DOI: 10.1186/1471-2318-11-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 01/27/2011] [Indexed: 11/10/2022] Open
Abstract
Background Resistance exercise programs with high compliance are needed to counter impaired muscle and mobility in older cancer survivors. To date outcomes have focused on older prostate cancer survivors, though more heterogeneous groups of older survivors are in-need. The purpose of this exploratory pilot study is to examine whether resistance exercise via negative eccentrically-induced work (RENEW) improves muscle and mobility in a diverse sample of older cancer survivors. Methods A total of 40 individuals (25 female, 15 male) with a mean age of 74 (± 6) years who have survived (8.4 ± 8 years) since their cancer diagnosis (breast, prostate, colorectal and lymphoma) were assigned to a RENEW group or a non-exercise Usual-care group. RENEW was performed for 12 weeks and measures of muscle size, strength, power and mobility were made pre and post training. Results RENEW induced increases in quadriceps lean tissue average cross sectional area (Pre: 43.2 ± 10.8 cm2; Post: 44.9 ± 10.9 cm2), knee extension peak strength (Pre: 248.3 ± 10.8 N; Post: 275.4 ± 10.9 N), leg extension muscle power (Pre: 198.2 ± 74.7 W; Post 255.5 ± 87.3 W), six minute walk distance (Pre: 417.2 ± 127.1 m; Post 466.9 ± 125.1 m) and a decrease on the time to safely descend stairs (Pre: 6.8 ± 4.5 s; Post 5.4 ± 2.5 s). A significant (P < 0.05) group x time interaction was noted for the muscle size and mobility improvements. Conclusions This exploration of RENEW in a heterogeneous cohort of older cancer survivors demonstrates increases in muscle size, strength and power along with improved mobility. The efficacy of a high-force, low perceived exertion exercise suggests RENEW may be suited to older individuals who are survivors of cancer. Trial Registration ClinicalTrials.gov Identifier: NCT00335491
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Affiliation(s)
- Paul C LaStayo
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, USA.
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Abstract
With the aging of the world's population there has become a major need for the development of nursing homes throughout the world. While some countries provide high quality care for the disabled elderly, in others this is not the case. Education of a medical director has been shown to improve the quality of the nursing home. Physicians need to have knowledge of how to implement continuous quality improvement and culture change. Key medical issues include moving to a restraint free environment, subsyndromal delirium, behavioral disturbances, weight loss, pain management, pressure ulcers, falls, hip fractures, polypharmacy, depression and frailty.
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Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Nelson CJ, Cho C, Berk AR, Holland J, Roth AJ. Are gold standard depression measures appropriate for use in geriatric cancer patients? A systematic evaluation of self-report depression instruments used with geriatric, cancer, and geriatric cancer samples. J Clin Oncol 2010; 28:348-56. [PMID: 19996030 PMCID: PMC2815722 DOI: 10.1200/jco.2009.23.0201] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 09/15/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Geriatric issues in cancer are becoming prominent. Depression is a significant concern for both the elderly and patients with cancer, yet identifying depression in these patients is difficult and often leads to under-recognition. We conducted a systematic review to determine which depression instruments are appropriate for use in geriatric patients with cancer. METHODS We identified the most commonly used self-report depression instruments. We then used the criteria established in the US Food and Drug Administration Draft Guidance on Patient-Reported Outcome Measures to determine the extent of validation evidence of these measures in geriatric cancer populations. Finally, we determined which instruments captured depressive symptoms that are common among elderly patients with cancer. RESULTS Eight measures were selected as the most commonly used instruments. These were the Beck Depression Inventory-II, Brief Symptom Inventory-18, Center for Epidemiologic Studies-Depression Scale, Geriatric Depression Scale-15, Hospital Anxiety and Depression Scale, Patient Health Questionnaire-9, Profile of Mood States-Short Form, and Zung Self-Rating Depression Scale. Many have been validated for use with geriatric adults and patients with cancer; however, data addressing content validity and responder definition were lacking. To date, there is no validation information for geriatric patients with cancer. Furthermore, symptom profile analysis revealed that these measures do not identify many symptoms signaling depression in geriatric patients with cancer. CONCLUSION The validation evidence for use of common depression instruments in geriatric patients with cancer is lacking. This, and the possibility that these measures may not assess common depressive symptoms in geriatric patients with cancer, questions the adequacy of these scales in this population.
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Affiliation(s)
- Christian J Nelson
- Dept of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave, 7th floor, New York, NY 10022, USA.
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Reappraisal in the eighth life cycle stage: A theoretical psychoeducational intervention in elderly patients with cancer. Palliat Support Care 2009; 7:271-9. [DOI: 10.1017/s1478951509990198] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractElderly patients with cancer face unique physical and psychiatric challenges in coping with their illness. Optimal psychosocial therapy for older cancer patients requires recognizing certain enhanced psychological capacities such as coping better with illness, which is associated with older age. This strength can be combined with the most appropriate cognitive coping strategies to develop a model intervention. This paper describes such a model, which integrates Erik Erikson's eighth and final psychosocial developmental life stage, in which the task is to achieve ego integrity (equanimity) or to experience despair (sadness, regrets), with Susan Folkman's cognitive coping paradigm, which utilizes reappraisal. This theoretical model addresses older cancer patients who are struggling with depression, isolation, and despair related to aging and illness, and utilizes cognitive reappraisal in a group setting to foster relatedness, acceptance of illness, and a sense of meaningful integration.
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Nelson CJ, Weinberger MI, Balk E, Holland J, Breitbart W, Roth AJ. The chronology of distress, anxiety, and depression in older prostate cancer patients. Oncologist 2009; 14:891-9. [PMID: 19738000 DOI: 10.1634/theoncologist.2009-0059] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Current research suggests that older cancer patients report less distress than younger cancer patients. However, this research has generally not teased apart the differences among general distress, anxiety, and depression. METHODS We conducted a secondary analysis of merged datasets using cross-sectional data on 716 men with prostate cancer (mean age, 68 +/- 10 years; range, 50-93 years). Approximately half the participants were recruited from doctors' offices throughout the U.S. and the other half were from Memorial Sloan-Kettering Cancer Center (New York). Participants were asked to complete the Distress Thermometer, the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy-Prostate Quality of Life questionnaire, and a demographic questionnaire. RESULTS Aging was related to less distress (r = -0.14), less anxiety (r = -0.22), and greater emotional quality of life (r = 0.16). In contrast, aging was associated with greater depressive symptoms in these cancer patients (r = 0.18). The mean depression scores of 5-year cohorts consistently trended upward. The significant association between age and depression remained after controlling for stage of disease, hormone therapy use, time since diagnosis, and social, physical, and functional well-being. CONCLUSIONS Despite theoretical and empirical evidence that older cancer patients may cope more effectively than younger cancer patients, depressive symptoms remain an important concern for aging cancer patients, and greater attention to this area is warranted. The increase in depression is in contrast to some findings in the general aging literature, raising the possibility that this trend is unique to older cancer patients.
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Affiliation(s)
- Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, Seventh Floor, New York, New York 10022, USA.
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Bautmans I, Van Puyvelde K, Mets T. Sarcopenia and functional decline: pathophysiology, prevention and therapy. Acta Clin Belg 2009; 64:303-16. [PMID: 19810417 DOI: 10.1179/acb.2009.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Twenty years ago, the term 'sarcopenia' has been introduced to describe the ageing related loss of skeletal muscle mass. Since then, sarcopenia has been intensively studied and prevalence values have been reported in fifteen papers covering several continents and races. However, consistency regarding the outcome measures and corresponding cut-off values defining sarcopenia is lacking. Most approaches are based on estimations of muscle mass and proposed cut-off values might be too strict, thus reducing their use in daily practice. From a clinical viewpoint, the assessment of muscle performance (grip strength and endurance) can be proposed as a screening tool showing sufficient sensitivity. The pathophysiology of sarcopenia is multifactorial, and important changes at the tissue level have been identified. Close relationships with inflammatory processes have been demonstrated and there is strong evidence for the involvement of a chronic low-grade inflammatory activity. Sarcopenia is aggravated by a complex interaction of several factors among which aging, disuse, immobilization, disease and malnutrition. A comprehensive geriatric assessment should allow the clinician to estimate the relative contribution of these factors and to elaborate appropriate management. From all interventions studied, intensive resistance training seems the most efficient to counter sarcopenia, even in the very old geriatric patients. Significant ameliorations (up to >50% strength gain) can be expected after six weeks of training at a rhythm of 2-3 sessions per week. From a preventive viewpoint, all elderly patients should be advised to start such an exercise program and continue it as long as possible. To date, most pharmacological interventions to counter sarcopenia include drugs with anabolic effects. Unfortunately, their effect is questionable and no clear guidelines exist for the prescription of these products in the context of sarcopenia.
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Affiliation(s)
- Ivan Bautmans
- Gerontology department and Frailty in Ageing research group, Vrije Universiteit Brussel, Laarbeeklaan 103, 8-1090 Brussels, Belgium
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Li KK, Cardinal BJ, Vuchinich S. Health worry, physical activity participation, and walking difficulty among older adults: a mediation analysis. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2009; 80:12-21. [PMID: 19408463 DOI: 10.1080/02701367.2009.10599525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study examined the effect of health worry (i.e., cognitive aspect of anxiety resulting from concern for health) on walking difficulty in a nationally representative sample (N = 7,527) of older adults (M age = 76.83 years). The study further tested whether physical activity mediates the effect of health worry on walking difficulty in a 6-year follow-up design. Results of a mediation analysis using structural equation modeling showed that people with a high degree of health worry engaged in less physical activity (beta = -.24, p < .001), and people who participated in less physical activity were more likely to report walking difficulty at the 6-year follow-up (beta = -.22, p < .001). There was a significant indirect effect from health worry to walking difficulty through physical activity (beta = .05, p < .001), controlling for demographic, psychosocial, and health related factors. Results suggested that inducing threat and worry may not be effective for physical activity promotion in the older population. More promising coping and regulation strategies are discussed.
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Affiliation(s)
- Kin-Kit Li
- School of Public Health, University of Hong Kong, Hong Kong.
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Abstract
This review article discusses the complexities of diagnosing depression in older, geriatric cancer patients. There has been little research conducted with this population on the assessment, recognition, and treatment of depression, and thus increased attention is required to improve care for these individuals. Depressive symptoms often manifest themselves differently in both cancer patients and older patients, and therefore a modified and adapted way of assessment must be employed when thinking about diagnosing and treating these patients.
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Affiliation(s)
- Mark I. Weinberger
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605
| | - Andrew J. Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021
| | - Christian J. Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021
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Abstract
Constipation and irritable bowel syndrome are very common in older persons. Constipation is over diagnosed and over treated in older persons. Lifestyle changes, osmotic laxatives, and lubiprostone are the approaches of choice for the management of constipation. Irritable bowel syndrome should be considered in the differential diagnosis of abdominal pain, diarrhea and constipation in older persons.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University Medical Center, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104, USA.
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Functional foods and physical activities in health promotion of aging people. Maturitas 2007; 58:327-39. [PMID: 17980978 DOI: 10.1016/j.maturitas.2007.09.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2006] [Revised: 09/05/2007] [Accepted: 09/21/2007] [Indexed: 12/21/2022]
Abstract
Foods contain many bioactive compounds that can improve humans' health, helping to decrease the risk of cataract, macular degeneration, cardiovascular and neurological diseases, osteoporosis, and cancer. Regular practice of exercise and physical activity could also help to drive away aging-associated diseases (obesity, osteoporosis, type 2 diabetes, hypertension, Alzheimer's disease, Parkinson's disease, dementia, and stroke). Exercise recommendations to promote both women's and men's health and disease conditions that hinder exercise practice are described. Health promotion practices should focus on both dietary intake of functional foods and regular practice of exercise within the framework of a healthy lifestyle.
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Lang I, Wallace RB, Huppert FA, Melzer D. Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence. Age Ageing 2007; 36:256-61. [PMID: 17353234 DOI: 10.1093/ageing/afm001] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is evidence of a U-shaped association between alcohol consumption and physical health outcomes in older people, such that moderate drinking is associated with better outcomes than abstinence or heavy drinking, but whether moderate drinking in older people is associated with better cognition and mental health than non-drinking has not been explored. OBJECTIVE To assess the relationship between drinking and cognitive health in middle-aged and older people. DESIGN Prospective observational study. SETTING/PARTICIPANTS Six thousand and five individuals aged 50 and over who participated in Wave 1 of the English Longitudinal Study of Ageing (ELSA) and who were not problem drinkers. Exposure and outcome variables: we examined cognitive function, subjective well-being, and depressive symptoms, and compared the risks associated with having never drunk alcohol, having quit drinking, and drinking at <1, <2 and >2 drinks per day. RESULTS For both men and women, better cognition and subjective well-being, and fewer depressive symptoms, were associated with moderate levels of alcohol consumption than with never having drunk any. CONCLUSIONS In middle-aged and older men and women, moderate levels of alcohol consumption are associated with better cognitive health than abstinence.
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Affiliation(s)
- Iain Lang
- Epidemiology and Public Health Group, Peninsula Medical School, RD&E Wonford Site, Exeter, UK.
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Baker J, Côté J, Deakin J. Patterns of early involvement in expert and nonexpert masters triathletes. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2006; 77:401-7. [PMID: 17020085 DOI: 10.1080/02701367.2006.10599375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Joseph Baker
- School of Kinesiology and Health Science, York University, Toronto, ON.
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Cann AP, Vandervoort AA, Lindsay DM. Optimizing the benefits versus risks of golf participation by older people. J Geriatr Phys Ther 2006; 28:85-92. [PMID: 16386170 DOI: 10.1519/00139143-200512000-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Currently a strong emphasis is being placed in North American public health messages on the value of an active lifestyle for all age segments, including older persons. However, seniors do not usually take up physical activities, even though they often have extensive leisure time. Thus the purpose of this paper is to review current knowledge regarding the key health issues for physical therapists to consider when dealing with an older person who wishes to participate fully in an active sport. We have chosen the example of golf because of its popularity among seniors, as well as its usefulness in illustrating both the overall benefits and risks of participation. Although playing golf provides a moderate intensity exercise stimulus for seniors, musculoskeletal injuries can also result from unsafe participation, as can the aggravation of pre-existing musculoskeletal problems. Strategies for targeted management of the senior golfer's typical concerns are summarized into 4 categories consisting of: injury rehabilitation coordinated by therapists, warm up routines; club-fitting/coaching on proper technique, and pre-season conditioning programs. Educational programs for older people regarding the benefits of physical activity should also include information about injury prevention strategies that enhance long-term participation.
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Affiliation(s)
- Adam P Cann
- Graduate Program in Rehabilitation Sciences, University of Western Ontario, London, Canada
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Benetos A, Thomas F, Bean KE, Pannier B, Guize L. Role of modifiable risk factors in life expectancy in the elderly. J Hypertens 2005; 23:1803-8. [PMID: 16148602 DOI: 10.1097/01.hjh.0000179512.71018.40] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the role of 'modifiable' risk factors, assessed between the ages of 60 and 70 years, in late survival. DESIGN The study population included subjects aged 60-70 years, who had a standard health examination at the IPC Center, and who could potentially reach the age of 80 years for men and 85 years for women at the end of the follow-up period. METHODS The role of 'modifiable' risk factors was assessed by comparing subjects who died before the age of 80 years for men (n=1333) and before 85 years for women (n=543) to subjects who survived beyond these ages (3681 men, 1910 women). Multivariate analyses were conducted to determine which parameters were independently associated with survival to an advanced age. RESULTS The multivariate analysis showed a decreased probability of late survival with higher pulse pressure (P<0.0001), higher heart rate (P<0.002), higher glycemia (P<0.0034), and an increased probability with regular physical activity (P<0.0001). A significant interaction between heart rate and gender (P<0.01) was observed, indicating that heart rate was a predictor of late survival in men but not in women. Body mass index, cholesterol and triglyceride levels, and diastolic blood pressure and tobacco smoking were not associated with late survival in this population. CONCLUSIONS A systematic search for certain risk factors in an elderly patient can have a significant impact on late survival and can lead to the establishment of priority goals, such as increasing physical activity and reducing blood pressure, heart rate and glycemia.
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Affiliation(s)
- Athanase Benetos
- Centre d'Investigations Préventives et Cliniques (IPC), Paris, and Department of Geriatrics, Medical School of Nancy, Nancy, France.
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Trojanowski JQ, Jedrziewski MK, Johnson B, Whitaker LA. The art and science of anti-aging therapies. ACTA ACUST UNITED AC 2005; 2005:pe11. [PMID: 15858213 DOI: 10.1126/sageke.2005.17.pe11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A meeting entitled "The Art and Science of Anti-Aging Therapies: Convergence of Theory and Practice" took place on 18 and 19 March 2005 at the University of Pennsylvania School of Medicine. The symposium was held for health care professionals, researchers, and consumers to provide them with information about current trends in anti-aging therapies. The program, which combined medical, surgical, and nonpharmacological approaches to healthy successful aging, gave attendees the opportunity to make sense of the issues at hand and to sort out safe treatments from perilous quick fixes.
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Affiliation(s)
- John Q Trojanowski
- Institute on Aging and the Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Abstract
Sarcopenia is the term widely used to describe the progressive loss of muscle mass with advancing age. Even before significant muscle wasting becomes apparent, ageing is associated with a slowing of movement and a gradual decline in muscle strength, factors that increase the risk of injury from sudden falls and the reliance of the frail elderly on assistance in accomplishing even basic tasks of independent living. Sarcopenia is recognised as one of the major public health problems now facing industrialised nations, and its effects are expected to place increasing demands on public healthcare systems worldwide. Although the effects of ageing on skeletal muscle are unlikely to be halted or reversed, the underlying mechanisms responsible for these deleterious changes present numerous targets for drug discovery with potential opportunities to attenuate muscle wasting, improve muscle function, and preserve functional independence. Very few drugs have been developed with sarcopenia specifically in mind. However, because many of the effects of ageing on skeletal muscle resemble those indicated in many neuromuscular disorders, drugs that target neurodegenerative diseases may also have important relevance for treating age-related muscle wasting and weakness. This review describes a selection of the emerging drugs that have been developed during the period 1997 - 2004, relevant to sarcopenia.
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Affiliation(s)
- Gordon S Lynch
- The University of Melbourne, Department of Physiology and Centre for Neuroscience, Victoria, 3010, Australia.
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