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Visvanathan R, Piantadosi C, Lange K, Naganathan V, Hunter P, Cameron ID, Chapman I. The Randomized Control Trial of the Effects of Testosterone and a Nutritional Supplement On Hospital Admissions in Undernourished, Community Dwelling, Older People. J Nutr Health Aging 2016; 20:769-79. [PMID: 27499311 DOI: 10.1007/s12603-016-0689-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In a pilot single centre study we found that treatment of undernourished older, community dwelling people for one year with oral testosterone (placebo-controlled) and a nutritional supplement (no control) was associated with a significant reduction in hospitalizations. A larger, multicentre study was conducted to investigate further this potentially important finding. DESIGN One year, randomized, placebo-controlled, multi-centre, double-blind, trial. SETTING Community. PARTICIPANTS 53 undernourished men and women aged 65 years and older. INTERVENTION Oral testosterone undecanoate (40 mg/day women, 160 mg/day men) and high energy oral nutritional supplement (2108-2416 kJ/day) or placebo medication and low energy (142-191 kJ/day) "placebo" oral nutritional supplementation. MEASUREMENTS Hospital admissions, falls and other variables were assessed. RESULTS 53 subjects were recruited (64% male and mean age 77 years), which was substantially less than planned. Sixteen subjects (30%) were admitted to hospital at least once, with a total of 29 admissions. Eight subjects (32%) in the placebo arm were admitted to hospital, whilst in the intervention group also there were eight (29%) subjects admitted to hospital during the study period. There was no difference in the number of hospitalisations (P = 0.842), length of hospitalization (P=0.645) or quality of life [mental health P=0.195 and physical health P=0.451) between the treatment arms. CONCLUSIONS In undernourished older people, treatment with testosterone and a nutritional supplementation did not reduce the number and length of hospitalisations or improve quality of life.
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Affiliation(s)
- R Visvanathan
- Professor Renuka Visvanathan, University of Adelaide and The Queen Elizabeth Hospital, Department of Medicine and The Aged and Extended Care Services, Address: Level 8B, The Queen Elizabeth Hospital, Woodville South, SA 5011, Telephone No: 08-82226887, Fax No: 08-82228593, e-mail:
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Piantadosi C, Chapman IM, Naganathan V, Hunter P, Cameron ID, Visvanathan R. Recruiting older people at nutritional risk for clinical trials: what have we learned? BMC Res Notes 2015; 8:151. [PMID: 25884358 PMCID: PMC4415225 DOI: 10.1186/s13104-015-1113-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background The difficulty of recruiting older people to clinical trials is well described, but there is limited information about effective ways to screen and recruit older people into trials, and the reasons for their reluctance to enrol. This paper examines recruitment efforts for a community-based health intervention study that targeted older adults. Methods One year randomized control trial. Undernourished men and women, aged ≥ 65 years and living independently in the community were recruited in three Australian states. Participants were allocated to either oral testosterone undecanoate and high calorie oral nutritional supplement or placebo medication and low calorie oral nutritional supplementation. Hospital admissions, functional status, nutritional health, muscle strength, and other variables were assessed. Results 4023 potential participants were identified and 767 were screened by a variety of methods: hospital note screening, referrals from geriatric health services, advertising and media segments/appearances. 53 participants (7% of total screened) were recruited. The majority of potentially eligible participants declined participation in the trial after reading the information sheet. Media was the more successful method of recruiting, whereas contacting people identified by screening a large number of hospital records was not successful in recruiting any participants. Conclusion Recruitment of frail and older participants is difficult and multiple strategies are required to facilitate participation. Trial registration Australian Clinical Trial Registry: ACTRN 12610000356066 date registered 4/5/2010
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Affiliation(s)
- Cynthia Piantadosi
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Ian M Chapman
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Concord, NSW, 2139, Australia.
| | - Peter Hunter
- Alfred Health, Caulfield Hospital, 260, Caulfield, VIC, 3162, Australia.
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, University of Sydney, Sydney, NSW, 2065, Australia.
| | - Renuka Visvanathan
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia. .,Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, University of Adelaide, Paradise, SA, 5075, Australia. .,Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, SA, 5011, Australia.
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Chung KJ, Kim KH. Forbidden fruit for athletes, but possible divine blessing for rehabilitation: testosterone. J Exerc Rehabil 2015; 11:2-4. [PMID: 25830137 PMCID: PMC4378344 DOI: 10.12965/jer.150191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/22/2015] [Indexed: 12/01/2022] Open
Abstract
Testosterone is regarded as an attractive supplement for obtaining masculinity and sexuality; however, there have been pros and cons regarding its application as a treatment. In addition, there is also conventional repulsion on adoption of testosterone to any kind of exercise to anyone with concern with sports. However, we should keep in mind that in terms of rehabilitation, our main concern is not fairness but efficiency. And there are obvious advantages of testosterone in recovery and rejuvenation. We aim to introduce the possibility of testosterone in recovery and rejuvenation and are to bring up a topic the application of testosterone in exercise rehabilitation. Considering the light and darkness in testosterone, moderate use of testosterone under professional medication counseling might be an effective possibility to those with sickness and illness and should be considered as a possible option to assist the recovery from frailty and illness.
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Affiliation(s)
| | - Khae-Hawn Kim
- Corresponding author: Khae-Hawn Kim, Department of Urology, Gachon University School of Medicine, Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-760, Korea, Tel: +82-32-460-3334, Fax: +82-32-460-8414, E-mail:
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Maggio M, Lauretani F, De Vita F, Basaria S, Lippi G, Butto V, Luci M, Cattabiani C, Ceresini G, Verzicco I, Ferrucci L, Ceda GP. Multiple hormonal dysregulation as determinant of low physical performance and mobility in older persons. Curr Pharm Des 2015; 20:3119-48. [PMID: 24050169 DOI: 10.2174/13816128113196660062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/13/2013] [Indexed: 12/16/2022]
Abstract
Mobility-disability is a common condition in older individuals. Many factors, including the age-related hormonal dysregulation, may concur to the development of disability in the elderly. In fact, during the aging process it is observed an imbalance between anabolic hormones that decrease (testosterone, dehydroepiandrosterone sulphate (DHEAS), estradiol, insulin like growth factor-1 (IGF-1) and Vitamin D) and catabolic hormones (cortisol, thyroid hormones) that increase. We start this review focusing on the mechanisms by which anabolic and catabolic hormones may affect physical performance and mobility. To address the role of the hormonal dysregulation to mobility-disability, we start to discuss the contribution of the single hormonal derangement. The studies used in this review were selected according to the period of time of publication, ranging from 2002 to 2013, and the age of the participants (≥65 years). We devoted particular attention to the effects of anabolic hormones (DHEAS, testosterone, estradiol, Vitamin D and IGF-1) on both skeletal muscle mass and strength, as well as other objective indicators of physical performance. We also analyzed the reasons beyond the inconclusive data coming from RCTs using sex hormones, thyroid hormones, and vitamin D (dosage, duration of treatment, baseline hormonal values and reached hormonal levels). We finally hypothesized that the parallel decline of anabolic hormones has a higher impact than a single hormonal derangement on adverse mobility outcomes in older population. Given the multifactorial origin of low mobility, we underlined the need of future synergistic optional treatments (micronutrients and exercise) to improve the effectiveness of hormonal treatment and to safely ameliorate the anabolic hormonal status and mobility in older individuals.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Gian Paolo Ceda
- Department of Clinical and Experimental Medicine, Section of Geriatrics via Gramsci 14, 43100, Parma, Italy.
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Maggio M, De Vita F, Lauretani F, Nouvenne A, Meschi T, Ticinesi A, Dominguez LJ, Barbagallo M, Dall'Aglio E, Ceda GP. The Interplay between Magnesium and Testosterone in Modulating Physical Function in Men. Int J Endocrinol 2014; 2014:525249. [PMID: 24723948 PMCID: PMC3958794 DOI: 10.1155/2014/525249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 02/01/2023] Open
Abstract
The role of nutritional status as key factor of successful aging is very well recognized. Among the different mechanisms by which nutrients may exert their beneficial effects is the modulation of the hormonal anabolic milieu, which is significantly reduced with aging. Undernutrition and anabolic hormonal deficiency frequently coexist in older individuals determining an increased risk of mobility impairment and other adverse outcomes. Mineral assessment has received attention as an important determinant of physical performance. In particular, there is evidence that magnesium exerts a positive influence on anabolic hormonal status, including Testosterone, in men. In this review we summarize data from observational and intervention studies about the role of magnesium in Testosterone bioactivity and the potential underlying mechanisms of this relationship in male subjects. If larger studies will confirm these pivotal data, the combination of hormonal and mineral replacements might be adopted to prevent or delay the onset of disability in the elderly.
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Affiliation(s)
- Marcello Maggio
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
- *Marcello Maggio:
| | - Francesca De Vita
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Fulvio Lauretani
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Antonio Nouvenne
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Tiziana Meschi
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Andrea Ticinesi
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Ligia J. Dominguez
- Department of Internal Medicine and Medical Specialties (DIMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
| | - Mario Barbagallo
- Department of Internal Medicine and Medical Specialties (DIMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
| | - Elisabetta Dall'Aglio
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Gian Paolo Ceda
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
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Abstract
PURPOSE OF REVIEW Sarcopenia is a geriatric syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death. Sarcopenia is a multifactorial process involving the decline of androgens, including dehydroepiandrosterone sulphate (DHEAS) and testosterone. The aim of this review is to highlight the effects of DHEAS and testosterone treatment to counteract sarcopenia, especially in older men. RECENT FINDINGS DHEAS and, more importantly, testosterone treatment are associated with increased muscle mass, whereas the effects on muscle function and physical performance are less clear. The results of recent randomized placebo controlled trials with DHEAS in older men and women and testosterone in men with mobility limitation are discussed. The novel current and future scenarios to attenuate the detrimental effects and to optimize the efficacy of sex hormone treatment are also addressed. SUMMARY DHEAS and testosterone are important options in the armamentarium of sarcopenia treatment in older men. Future studies are needed to address new approaches by using selective compounds, targeting the correct form and dosage, tailoring the correct patient to treat, and taking into account the multifactorial origin and the new definition of sarcopenia.
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Affiliation(s)
- Marcello Maggio
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, Parma, Italy.
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Fairhall N, Langron C, Sherrington C, Lord SR, Kurrle SE, Lockwood K, Monaghan N, Aggar C, Gill L, Cameron ID. Treating frailty--a practical guide. BMC Med 2011; 9:83. [PMID: 21733149 PMCID: PMC3146844 DOI: 10.1186/1741-7015-9-83] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 07/06/2011] [Indexed: 01/13/2023] Open
Abstract
Frailty is a common syndrome that is associated with vulnerability to poor health outcomes. Frail older people have increased risk of morbidity, institutionalization and death, resulting in burden to individuals, their families, health care services and society. Assessment and treatment of the frail individual provide many challenges to clinicians working with older people. Despite frailty being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. In this paper we review methods for identification of frailty in the clinical setting, propose a model for assessment of the frail older person and summarize the current best evidence for treating the frail older person. We provide an evidence-based framework that can be used to guide the diagnosis, assessment and treatment of frail older people.
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Affiliation(s)
- Nicola Fairhall
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Ryde, Sydney 2112, Australia
- The George Institute for Global Health, The University of Sydney, Sydney 2000, Australia
| | - Colleen Langron
- Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Hornsby, Sydney 2077, Australia
| | - Catherine Sherrington
- The George Institute for Global Health, The University of Sydney, Sydney 2000, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Randwick, Sydney 2031, Australia
| | - Susan E Kurrle
- Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Hornsby, Sydney 2077, Australia
| | - Keri Lockwood
- Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Hornsby, Sydney 2077, Australia
| | - Noeline Monaghan
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Ryde, Sydney 2112, Australia
| | - Christina Aggar
- Faculty of Nursing and Midwifery, The University of Sydney, Sydney 2006, Australia
| | - Liz Gill
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Ryde, Sydney 2112, Australia
| | - Ian D Cameron
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Ryde, Sydney 2112, Australia
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