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AAA Warman Home Care’s E-Update is intended to bring to you timely and useful articles and information at the click of the mouse. It is sent monthly in an effort to keep you apprised of what is happening across the healthcare continuum of care effecting hospital, hospice and rehabilitation social workers and case managers, as well as Assisted Living, Independent Living and Skilled Nursing facility executives. Warman understands that time is limited and has undertaken to share with you important industry information without your having to search for it.
The risk factors for indoor and outdoor falls for older adults are different, according to a new study by the Institute for Aging Research of Hebrew SeniorLife, an affiliate of Harvard Medical School, a fact that is often missed when the two are combined and may affect how falls prevention programs are structured.
"Indoor and outdoor falls are both important," says senior author Marian T. Hannan, D.Sc., a senior scientist at the Institute for Aging Research, "but people at high risk for indoor falls are different in many ways from those at high risk of outdoor falls. Failure to separate the two can mask important information on risk factors and may hamper the effectiveness of falls prevention programs."
Published online (here) in the Journal of the American Geriatrics Society, the study found that indoor falls are associated with an inactive lifestyle, disability, and poor health, while outdoor falls are associated with higher levels of activity and average or better-than-average health.
Older adults who fell outdoors were somewhat younger than those who fell indoors, more likely to be male and better educated, and had lifestyle characteristics indicative of better health. Those who fell indoors had more physical disabilities, took more medications, and had lower cognitive function than those who fell outdoors.
The study examined 765 men and women, age 70 and older, from randomly sampled households in the Boston area. Study participants underwent a comprehensive baseline falls assessment, including a home visit and clinic examination. Falls were reported on monthly calendars submitted to the researchers. Over a nearly two-year period, 598 indoor falls and 524 outdoor falls were reported. When a participant reported a fall, a structured telephone interview was conducted to determine the circumstances.
Dr. Hannan says the study has several implications. First, a fall is not necessarily a marker of poor health. In fact, almost half of all falls occurred outdoors, and people who fell outdoors had the same or better health than those who did not fall at all. Second, epidemiological studies of risk factors for falls in older people may be hampered when falls are combined, with important associations between risk factors and indoor and outdoor falls potentially being missed. Third, intervention programs need to be tailored differently for people more likely to fall outdoors than those who tend to fall indoors.
"Most fall prevention programs emphasize the prevention of indoor falls, particularly through strength, balance and gait training; use of assistive devices; treatment of medical conditions; reduction in the use of certain medications; improvement in vision; and the elimination of home hazards," write Dr. Hannan and her colleagues.
Many of these programs do not take into account the causes of outdoor falls, she says. Falls interventions for community-dwelling seniors, she adds, should consider their health status, activity level, and other characteristics. Most seniors who fall outdoors do so on sidewalks, streets or curbs, or in parking lots.
"Healthy, active older people should be aware of their surroundings, especially when walking outdoors," says Dr. Hannan, an associate professor of medicine at Harvard Medical School. "More attention needs to be paid to the elimination of outdoor environmental hazards involving sidewalks, curbs and streets, such as repairing uneven surfaces, removing debris, installing ramps at intersections, and painting curbs."
According to the Centers for Disease Control and Prevention, nearly 40 percent of seniors who live in the community fall each year, with many suffering moderate to severe injuries, including hip fractures and traumatic brain injuries. At least half of these falls occur outdoors.
The study, which was funded by the National Institutes of Health, was part of MOBILIZE Boston (Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly), a long-term cohort study based at the Institute for Aging Research. The study is determining the causes of falls in older adults in order to develop new ways to prevent falls from occurring. MOBILIZE Boston is directed by principal investigator Lewis A. Lipsitz, M.D., director of the Institute for Aging Research, professor of medicine at Harvard Medical School, and a leading authority on falls.
SOURCE: Hebrew SeniorLife Institute For Aging Research, September 10, 2010
Researchers at the University of California, San Diego School of Medicine have identified the molecular mechanism that makes omega-3 fatty acids so effective in reducing chronic inflammation and insulin resistance.
The discovery could lead to development of a simple dietary remedy for many of the more than 23 million Americans suffering from diabetes and other conditions.
Writing in the advance online edition of the September 3 issue of the journal Cell, Jerrold Olefsky, MD, and colleagues identified a key receptor on macrophages abundantly found in obese body fat. Obesity and diabetes are closely correlated. The scientists say omega-3 fatty acids activate this macrophage receptor, resulting in broad anti-inflammatory effects and improved systemic insulin sensitivity.
Macrophages are specialized white blood cells that engulf and digest cellular debris and pathogens. Part of this immune system response involves the macrophages secreting cytokines and other proteins that cause inflammation, a method for destroying cells and objects perceived to be harmful. Obese fat tissue contains lots of these macrophages producing lots of cytokines. The result can be chronic inflammation and rising insulin resistance in neighboring cells over-exposed to cytokines. Insulin resistance is the physical condition in which the natural hormone insulin becomes less effective at regulating blood sugar levels in the body, leading to myriad and often severe health problems, most notably type 2 diabetes mellitus.
Olefsky and colleagues looked at cellular receptors known to respond to fatty acids. They eventually narrowed their focus to a G-protein receptor called GPR120, one of a family of signaling molecules involved in numerous cellular functions. The GPR120 receptor is found only on pro-inflammatory macrophages in mature fat cells. When the receptor is turned off, the macrophage produces inflammatory effects. But exposed to omega-3 fatty acids, specifically docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), the GPR120 receptor is activated and generates a strong anti-inflammatory effect.
"It's just an incredibly potent effect," said Olefsky, a professor of medicine and associate dean of scientific affairs for the UC San Diego School of Medicine. "The omega-3 fatty acids switch on the receptor, killing the inflammatory response."
The scientists conducted their research using cell cultures and mice, some of the latter genetically modified to lack the GPR120 receptor. All of the mice were fed a high-fat diet with or without omega-3 fatty acid supplementation. The supplementation treatment inhibited inflammation and enhanced insulin sensitivity in ordinary obese mice, but had no effect in GPR120 knockout mice. A chemical agonist of omega-3 fatty acids produced similar results.
"This is nature at work," said Olefsky. "The receptor evolved to respond to a natural product - omega-3 fatty acids - so that the inflammatory process can be controlled. Our work shows how fish oils safely do this, and suggests a possible way to treating the serious problems of inflammation in obesity and in conditions like diabetes, cancer and cardiovascular disease through simple dietary supplementation."
However, Olefsky said more research is required. For example, it remains unclear how much fish oil constitutes a safe, effective dose. High consumption of fish oil has been linked to increased risk of bleeding and stroke in some people.
Should fish oils prove impractical as a therapeutic agent, Olefsky said the identification of the GPR120 receptor means researchers can work toward developing an alternative drug that mimics the actions of DHA and EPA and provides the same anti-inflammatory effects.
Co-authors of the paper are Da Young Oh, Saswata Talukdar, Eun Ju Bae, Hidetaka Morinaga, WuQuiang Fan, Pingping Li and Wendell J. Lu, all in the Department of Medicine, Division of Endocrinology and Metabolism at the University of California, San Diego; Takeshi Imamura, Division of Pharmacology, Shiga University of Medical Science; and Steven M. Watkins, Lipomics Technologies, Inc.
Funding for this research came, in part, from a National Institutes of Health grant and the Eunice Kennedy Shriver NICHD/NIH.
SOURCE: University of California, San Diego Health Sciences, September 3, 2010
High levels of the stress hormone cortisol strongly predict cardiovascular death among both persons with and without pre-existing cardiovascular disease according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).
In stressful situations, the body responds by producing the hormone cortisol. The effects of cortisol are intended to help the body recover from stress and regain a status of homeostasis, however chronically elevated cortisol levels have been associated with cardiovascular risk factors, such as the metabolic syndrome and accelerated atherosclerosis.
"Previous studies have suggested that cortisol might increase the risk of cardiovascular mortality, but until now, no study had directly tested this hypothesis," said Nicole Vogelzangs, PhD, of VU University Medical Center in The Netherlands and lead author of the study. "The results of our study clearly show that cortisol levels in a general older population predict cardiovascular death, but not other causes of mortality."
In this study, researchers evaluated 861 people aged 65 years and older who participated in a prospective cohort study. Within six years of the beginning of the study 183 participants had died. Urinary cortisol levels of subjects were measured at the beginning of the study and cause of death was ascertained from death certificates. Researchers found that urinary cortisol did not increase the risk of non-cardiovascular mortality but did increase cardiovascular mortality risk. The third of the subjects with the highest urinary cortisol had a five-fold increased risk of dying of cardiovascular disease.
"Cortisol is an important component of the stress system of the human body but in higher concentrations can be harmful," said Vogelzangs. "Our study shows that older persons with high levels of cortisol have an increased risk of dying from cardiovascular disease. This finding significantly adds evidence to the belief that cortisol can be damaging to the cardiovascular system."
Other researchers working on the study include: Aartjan Beekman and Brenda Penninx of VU University Medical Center in The Netherlands; Yuri Milaneschi and Luigi Ferrucci of the National Institute on Aging in Baltimore, Md.; and Stefania Bandinelli of Azienda Sanitaria Firenze in Italy.
The article, "Urinary cortisol and six-year risk of all-cause and cardiovascular mortality," will appear in the November 2010 issue of JCEM.
SOURCE: Endocrine Society, September 9, 2010
Nutritional science and food marketing has become so sophisticated in recent decades that a trip to the supermarket can require a complete nutritional re-education. The average consumer needs to be on guard against preservatives, added fat, colorings, and calories, false advertising, and sophisticated but misleading labels. Although guidelines for the information of food labels have gotten a bad rap in recent years a new study published in the Journal of Consumer Affairs suggests that observing them may lead to weight loss, especially for women entering their middle years.
Using information on whether consumers read food labels the first time they buy a product, the research finds that people who observe the labels and do not exercise display a slightly greater likelihood of weight loss than those who do exercise but do not pay attention to food labels. By simply adding an exercise routine to their lifestyle regular food label readers can increase their changes of losing weight. Women between the ages of 37-50 years are more likely to read food labels than men, and are therefore more likely to lose weight."
Previous research has focused on food marketing and behaviour but has not followed related weight loss over time in this middle-aged demographic group. The data for this study was taken from a National Longitudinal Survey of Youth compiled from 2002-2006. The survey began in 1979 with over 12,000 male and female participants born in the years 1957-1964.
Over fifty percent of participants reported that they were trying to lose or control weight. Of these participants, almost seventy percent were obese or overweight. Almost fifty percent were actively reading food labels on their first time purchase and slightly more than twenty-five percent were actively participating in vigorous exercise. Overall, older individuals are less likely to lose weight by reading food labels, and general participation in vigorous exercise drops off after age forty-five.
Additionally, the Nutrition Labeling and Education Act (NLEA), enacted in 1994, requires all food manufactures to present essential nutrient and ingredient information on food packages. According to the recently-passed health care reform bill there will be easier access to nutritional information at restaurants, retail food establishments and vending machines. Combined with these new findings, it is likely that this measure will be useful to those who want to lose weight and read food labels to make well-informed decision regarding their diets in and outside their homes.
Weight loss programs and plans would do well in augmenting their client's weight loss goals with the recommended use of food labels, in order to maintain a healthy weight. This is particularly important as people enter middle age and are at a risk for heart disease, obesity-related diabetes, cancer and dementia.
SOURCE: Wiley-Blackwell, AlphaGalileo Foundation, September 9, 2010
Chest compression-only cardiopulmonary resuscitation, also known as CPR may be at least as effective as electrical defibrillation after cardiac arrest, researchers wrote in a report published in BMC Medicine. Current guidelines for advanced cardiac life support, which were set out in 2005, recommend immediate defibrillation for cardiac arrest which occurs out of hospital.
The authors write, however, that according to experimental and clinical study findings, there is a potential benefit if the patient is pretreated with CPR before defibrillation - outcomes may be better, especially if emergency services do not arrive straight away.
The research team carried out a meta-analysis to assess the beneficial effect of chest compression-first vs. defibrillation first on survival in patients who have a cardiac arrest outside a hospital setting.
The investigators explain that not many people who suffer cardiac arrest outside a hospital setting survive. If a person's heart suddenly stops beating, they need help immediately to get the heart pumping again.
A team of physicians from the University of Michigan Health System, as well as experts from around the world examined two rescue strategies:
Lead study author Pascal Meier, M.D., an interventional cardiologist at the University of Michigan Cardiovascular Center, said: Current evidence does not support the notion that chest compressions first prior to defibrillation improves the outcome of patients in out-of-hospital cardiac arrest; instead it appears that both treatments are equivalent.
Those who had chest compressions first had better one-year survival rates, the authors write.
The investigators collected data from four randomized trials consisting of 1,503 patients. They compared survival rates after emergency personnel performed 90 seconds or more of chest compressions before electrical defibrillation.
Senior author Comilla Sasson, M.D., an emergency medicine physician researcher at the University of Colorado, said: The compressions-first approach appears to be as good as the defibrillation-first approach, especially if there are delays to EMS arriving on-scene. This has major policy implications.
Our study shows that chest compressions matter so even more emphasis should be placed on doing high-quality chest compressions both by laypeople providing bystander CPR and EMS providers.
According to Sasson, about 300,000 cardiac arrest cases are assessed by EMS providers in the USA each year. A mere 8% of people who have a cardiac arrest outside a hospital setting survive. It is vital to find ways to save the lives of individuals whose hearts suddenly stop.
Lives can be saved if chest compressions are administered with cardiopulmonary resuscitation, and in some cases, prompt treatment with a defibrillator. Defibrillators literally "shock" the heart back into normal rhythm.
Meier said: Based on our study, current guidelines emphasizing early defibrillation still are important. However, since the outcomes with the chest compression-first approach were not inferior and might be even better in the long-term, and in case of longer response times, this study may have an impact on future guidelines.
SOURCE: University of Michigan Health System, September 10, 2010
AAA Warman Home Care is a family-owned Residential Service Agency which has been providing in-home health care services to thousands of clients for the past twenty years. Warman specializes in providing the highest quality of private duty, non-medical care and companionship for the elderly, those recuperating after hospitalization / rehabilitation, the terminally ill, disabled, alone or at-risk. It is our goal to assist our clients in living the most independent, healthy and comfortable lives in the privacy of their own homes.
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