Search tips
Search criteria

Results 1-25 (874)

Clipboard (0)

Select a Filter Below

Year of Publication
1.  The effect of a virtual ward program on emergency services utilization and quality of life in frail elderly patients after discharge: a pilot study 
Attendance at emergency departments and unplanned hospital readmissions are common for frail older patients after discharge from hospitals. A virtual ward service was piloted to deliver “hospital-at-home” services by community nurses and geriatricians to frail older patients immediately after their discharge from hospital to reduce emergency services utilization.
This study examined the impacts of the virtual ward service on changes in the patients’ emergency attendance and medical readmissions, and their quality of life (QOL).
A matched-control quasi-experimental study was conducted at four hospitals, with three providing the virtual ward service (intervention) and one providing the usual community nursing care (control). Subjects in the intervention group were those who are at high risk of readmission and who are supported by home carers recruited from the three hospitals providing the virtual ward service. Matched control patients were those recruited from the hospital providing usual care. Outcome measures include emergency attendance and medical readmission in the past 90 days as identified from medical records, and patient-reported QOL as measured by the modified Quality-of-Life Concerns in the End of Life Questionnaire (Chinese version). Wilcoxon signed-rank tests compared the changes in the outcome variables between groups.
A total of 39 patients in each of the two groups were recruited. The virtual ward group showed a greater significant reduction in the number of unplanned emergency hospital readmissions (−1.41±1.23 versus −0.77±1.31; P=0.049) and a significant improvement in their overall QOL (n=18; 0.60±0.56 versus 0.07±0.56; P=0.02), but there was no significant difference in the number of emergency attendances (−1.51±1.25 versus −1.08±1.48; P=0.29).
The study results support the effectiveness of the virtual ward service in reducing unplanned emergency medical readmissions and in improving the QOL in frail older patients after discharge.
PMCID: PMC4322950
elderly; emergency attendance; emergency medical readmission; emergency services utilization; quality of life; virtual ward
2.  Urological surgery in elderly patients: results and complications 
Owing to the large aging population, a growing number of elderly patients are undergoing surgical treatment. Surgical procedures in elderly patients are associated with a higher risk of complications. The aim of this study was to evaluate the efficacy and safety of urological surgeries in old patients.
The authors carried out a retrospective study, evaluating results and early postoperative complications in patients aged 75 years and older. The cohort of patients included 221 patients who underwent surgical procedures in the department of urology between January 2011 and December 2012. The average age of patients was 78. The results and complications were categorized based on the type of surgery performed, and the Dindo–Clavien scale.
The median follow-up was 18 months. All surgeries for malignant tumors were performed successfully with no residual disease. Totally, 48 (22%) complications were recorded. The most serious were as follows: one patient (<0.5%) died; and four (<2%) patients underwent reoperation. The most common complications involved infection, mainly sepsis and surgical site infections. Other complications included mild respiratory insufficiency, delirium, bleeding, etc.
Surgeries in elderly patients were effective and safe. The cornerstone of safety is careful preparation and treatment of comorbidities. Complications occurred mainly as a result of emergency procedures during emergency procedures and in major surgeries such as cystectomy and nephrectomy. The standard use of low molecular-weight heparin caused no incidence of thromboembolic disease.
PMCID: PMC4321414
urinary tract; aged; postoperative complications; Dindo–Clavien classification
3.  Comparative analysis of the expected demands for nursing care services among older people from urban, rural, and institutional environments 
Demand for nursing and social services may vary depending on the socio-demographic variables, health status, receipt of formal and informal care provided, and place of residence.
To conduct a comparative analysis of the expectations of older people from urban, rural, and institutional environments concerning nursing care with respect to the care provided and elements of a comprehensive geriatric assessment.
Material and methods
The study comprised 2,627 individuals above the age of 65 years living in urban (n=935) and rural (n=812) areas as well as nursing homes (n=880).
Family care was most often expected both in urban (56.6%) and rural (54.7%) environments, followed by care provided simultaneously by a family and nurse (urban – 18.8%; rural – 26.1%) and realized only by a nurse (urban – 24.6%; rural – 19.2%). Not surprisingly, nursing home residents most commonly expected nursing care (57.5%) but 33.1% preferred care provided by family or friends and neighbors. In the whole cohort of people living in the home environment (n=1,718), those living with family demonstrated willingness to use primarily care implemented by the family (62.0%), while respondents living alone more often expected nursing services (30.3%). In the logistic regression model, among the respondents living in the city, only the form of care already received determined the expectations for nursing care. Among the respondents living in the county, the presence of musculoskeletal disorders, better nutritional status, and current care provided by family decreased expectations for nursing care. Higher cognitive functioning, symptoms of depression, and living alone increased the willingness to obtain nursing care.
Older inhabitants of urban areas, rural areas, and those residing in institutions have different expectations for individual nursing care. Nearly 45% of seniors living in the community expect to obtain nursing care, while only 1.6% do not expect any social or nursing help. While the expectations for the provision of nursing care are significantly increased by living alone, they are decreased by having access to care provided by family. Support for families to take care of elderly relatives would appear to be essential for an effective nursing and social care system.
PMCID: PMC4321418
aging; place of residence; comorbidities; comprehensive geriatric assessment; nursing services
4.  Mécano-Stimulation™ of the skin improves sagging score and induces beneficial functional modification of the fibroblasts: clinical, biological, and histological evaluations 
Loss of mechanical tension appears to be the major factor underlying decreased collagen synthesis in aged skin. Numerous in vitro studies have shown the impact of mechanical forces on fibroblasts through mechanotransduction, which consists of the conversion of mechanical signals to biochemical responses. Such responses are characterized by the modulation of gene expression coding not only for extracellular matrix components (collagens, elastin, etc.) but also for degradation enzymes (matrix metalloproteinases [MMPs]) and their inhibitors (tissue inhibitors of metalloproteinases [TIMPs]). A new device providing a mechanical stimulation of the cutaneous and subcutaneous tissue has been used in a simple, blinded, controlled, and randomized study.
Materials and methods
Thirty subjects (aged between 35 years and 50 years), with clinical signs of skin sagging, were randomly assigned to have a treatment on hemiface. After a total of 24 sessions with Mécano-Stimulation™, biopsies were performed on the treated side and control area for in vitro analysis (dosage of hyaluronic acid, elastin, type I collagen, MMP9; equivalent dermis retraction; GlaSbox®; n=10) and electron microscopy (n=10). Furthermore, before and after the treatment, clinical evaluations and self-assessment questionnaire were done.
In vitro analysis showed increases in hyaluronic acid, elastin, type I collagen, and MMP9 content along with an improvement of the migratory capacity of the fibroblasts on the treated side. Electron microscopy evaluations showed a clear dermal remodeling in relation with the activation of fibroblast activity. A significant improvement of different clinical signs associated with skin aging and the satisfaction of the subjects were observed, correlated with an improvement of the sagging cheek.
Mécano-Stimulation is a noninvasive and safe technique delivered by flaps microbeats at various frequencies, which can significantly improve the skin trophicity. Results observed with objective measurements, ie, in vitro assessments and electron microscopy, confirm the firming and restructuring effect clinically observed.
PMCID: PMC4321566
skin rejuvenation; skin sagging; mechanical stimulation; fibroblast synthesis
5.  The effect of dietary and/or cosmetic argan oil on postmenopausal skin elasticity 
During menopause, the decrease of estrogenic secretion induces the disruption of skin functioning, thus causing the decline in skin elasticity characteristic of skin aging. The purpose of this study was to evaluate in postmenopausal women the effect of daily consumption and/or application of argan oil on skin elasticity.
Materials and methods
Sixty postmenopausal women consumed butter during the stabilization period and were randomly divided into two groups for the intervention period: the treatment group of 30 participants received dietary argan oil, the control group of 30 participants received olive oil, and both groups applied cosmetic argan oil in the left volar forearm during a 60-day period. Assessments of skin elasticity parameters, ie, the three R-parameters (R2 or gross-elasticity of the skin, R5 or net elasticity of the skin, and R7 or biological elasticity), and the resonance running time (RRT) at both volar forearms of the two groups were performed during three visits: before starting oils consumption and application, after 30 days of oils consumption and application, and after 60 days of oils consumption and application.
The consumption of argan oil led to a significant increase of gross-elasticity of the skin (R2) (P<0.001), net elasticity of the skin (R5) (P<0.001), biological elasticity (R7) (P<0.001), and a significant decrease of RRT (P=0.002). The application of argan oil led to a significant increase of gross-elasticity of the skin (R2) (P<0.001), net elasticity of the skin (R5) (P<0.001), biological elasticity (R7) (P=0.001), and a significant decrease of RRT (P<0.001).
Our findings suggest that the daily consumption and/or topical application of argan oil have an anti-aging effect on the skin demonstrated by the improvement of skin elasticity, characterized by an increase of R-parameters (R2, R5, and R7) and a decrease of RRT.
PMCID: PMC4321565
postmenopausal women; argan oil; skin elasticity
6.  Associations between apolipoprotein E gene polymorphisms and Alzheimer’s disease risk in a large Chinese Han population 
Apolipoprotein E gene (APOE) polymorphisms contributing to the risk of sporadic Alzheimer’s disease (AD) have been identified for decades, but it has not been investigated in large AD samples of Chinese Han population.
We performed a cross-sectional study to explore the effect of APOE polymorphisms on sporadic AD in 875 sporadic AD patients and 1,195 cognitive normal controls of Chinese Han. Genotyping of APOE was determined by multiplex amplification refractory mutation system polymerase chain reaction.
APOE ε3ε4 and ε4ε4 genotypes increased AD risk with dosage effect. The odds ratio (OR) of ε3ε4 was 1.89 and the OR of ε4ε4 was 15.64 compared with that of ε3ε3 in all the subjects. E2ε3 genotype decreased AD risk in all the subjects (OR=0.64), female subgroup (OR=0.57), and late-onset AD subgroup (OR=0.60). However, neither ε2ε2 nor ε2ε4 affected AD risk. About the age at onset (AAO), the influence of APOE ε4 was only exhibited in late-onset AD subgroup, with 1 year lower in ε4-positive ones than negative ones. Further analysis did not show the dosage effect of ε4 pertinent to AAO, though the AAO of ε4ε4 patients decreased by 2 years. E2 did not affect the AAO of AD.
APOE ε4 is a strong risk factor of AD risk in Chinese Han population, and APOE ε4ε4 genotype might be related to the AAO of late-onset AD.
PMCID: PMC4321568
sporadic; cross sectional study; dosage effect; age at onset
7.  Characteristics of abdominal cavity drainage fluid in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors 
Abdominal cavity drainage fluid can be used as an early diagnostic tool of postoperative complications, and observing its characteristics can help us to judge and handle postoperative complications. There is no accurate standard reference range on its characteristics after surgeries for gastrointestinal or retroperitoneal tumors. This research attempted to analyze its characteristics in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors, and to offer an experimental basis for establishing a reliable standard reference range for abdominal cavity drainage fluid used to detect postoperative complications.
This study enrolled 262 Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors.
All patients had a median age (range) of 55 (19–72) years, and 150 (57.3%) were men. There were 93 (35.5%), 115 (43.9%), and 54 (20.6%) patients who underwent surgery for upper gastrointestinal tumors, lower gastrointestinal tumors, and retroperitoneal tumors, respectively. The total amount, density, and pH of the abdominal cavity drainage fluid were 204 (0–6,195) mL, 1.032 (1.011–1.047) kg/m3, and pH 7.0 (5.0–7.5), respectively. The total numbers of cells and white blood cells were 1.3×1011 (5.5×108–6.2×1012)/L and 3.7×109 (1.0×107–5.0×1011)/L, respectively. The levels of sugar and protein were 3 (0–37) mmol/L and 39 (1–272) g/L. The total amount of abdominal cavity drainage fluid, the total number of cells, the total number of white blood cells, the number of multinucleated cells, the number of monocytes, and the levels of sugar were statistically significantly different between the three groups (P<0.05 for all).
This study described the characteristics of abdominal cavity drainage fluid in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors, and provided an experimental basis for establishing a reliable standard reference range for abdominal cavity drainage fluid for screening for postoperative complications.
PMCID: PMC4315551
abdominal cavity drainage fluid; People’s Republic of China; gastrointestinal tumors; postoperative complications; retroperitoneal tumors
8.  The predictive capacity and additional prognostic power of N-terminal pro-B-type natriuretic peptide in Chinese elderly with chronic heart failure 
This study was conducted to research the prognostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP), compare the utility of the Seattle Heart Failure Score (SHFS) with NT-proBNP, develop a risk-evaluation model based on NT-proBNP, assess the associations of NT-proBNP with patient characteristics, and screen for decisive factors of NT-proBNP in Chinese elderly with chronic heart failure (CHF).
Patients and methods
There were 306 patients (≥60 years) with CHF chosen as study subjects. Each one received an assessment of NT-proBNP on serum. The end point was all-cause mortality during a mean follow-up period of 471 days.
Subjects had a median age of 85 (60–100) years, a median NT-proBNP of 1,743.4 pg/mL, and a median SHFS of 1.87. During the follow-up period, 104 deaths occurred. NT-proBNP was significantly related to mortality (odds ratio 1.603, 95% confidence interval 1.407–1.826; P<0.001) and the significance persisted after full adjustment (odds ratio 1.282, 95% confidence interval 1.103–1.489; P=0.001). Age, New York Heart Association class IV CHF, plasma albumin, and neutrophils/lymphocytes were also independent predictors for mortality (P<0.05 for all). NT-proBNP and the SHFS showed similar predictive capacities (0.736 versus 0.796, P=0.105). The addition of NT-proBNP to the SHFS (0.818 versus 0.796, P=0.168) generated marginal growth in the c-statistic. The model based on NT-proBNP consisting of all selected predictors in this study, including age, New York Heart Association class IV CHF, plasma albumin, neutrophils/lymphocytes, and NT-proBNP, had a moderately higher c-statistic compared with the SHFS (0.846 versus 0.796, P=0.066). NT-proBNP was bound with the SHFS (r=0.500, P<0.001). Characteristics regarding general condition, inflammation, and cardiac and renal function were the decisive factors of NT-proBNP (P<0.05 for all).
As a comprehensive representation of the patient characteristics described earlier, NT-proBNP values provided significant prognostic power similar to the SHFS in Chinese elderly with CHF. A novel model based on NT-proBNP could offer help for risk stratification.
PMCID: PMC4315566
NT-proBNP; prognosis; chronic heart failure; elderly
9.  Joint unloading implant modifies subchondral bone trabecular structure in medial knee osteoarthritis: 2-year outcomes of a pilot study using fractal signature analysis 
Knee osteoarthritis (OA) is largely attributable to chronic excessive and aberrant joint loading. The purpose of this pilot study was to quantify radiographic changes in subchondral bone after treatment with a minimally invasive joint unloading implant (KineSpring® Knee Implant System).
Nine patients with unilateral medial knee OA resistant to nonsurgical therapy were treated with the KineSpring System and followed for 2 years. Main outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, function, and stiffness subscores and independent core laboratory determinations of joint space width and fractal signature of the tibial cortex.
WOMAC scores, on average, improved by 92% for pain, 91% for function, and 79% for stiffness over the 2-year follow-up period. Joint space width in the medial compartment of the treated knee significantly increased from 0.9 mm at baseline to 3.1 mm at 2 years; joint space width in the medial compartment of the untreated knee was unchanged. Fractal signatures of the vertically oriented trabeculae in the medial compartment decreased by 2.8% in the treated knee and increased by 2.1% in the untreated knee over 2 years. No statistically significant fractal signature changes were observed in the horizontally oriented trabeculae in the medial compartment or in the horizontal or vertical trabeculae of the lateral compartment in the treated knee.
Preliminary evidence suggests that the KineSpring System may modify knee OA disease progression by increasing joint space width and improving subchondral bone trabecular integrity, thereby reducing pain and improving joint function.
PMCID: PMC4315540
disease modification; KineSpring; joint space; pain; trabecular
10.  A medical costs study of older patients with acute myocardial infarction and metabolic syndrome in hospital 
Older patients with acute myocardial infarction (AMI) usually have a poor prognosis, but whether this poor prognosis leads to high hospital costs remains unclear. This study investigated the clinical outcomes of and costs incurred by older patients with AMI and metabolic syndrome (MS) in hospital.
Methods and results
Patients with AMI seen at Qilu Hospital of Shandong University between January 2011 and May 2013 were separated into four groups: young non-MS patients (n=282), older non-MS patients (n=324), young MS patients (n=217), and older MS patients (n=174). We found that advanced age was significantly associated with worse clinical outcomes, and that the clinical outcomes in patients with AMI and MS are also worsened. At the same cost (RMB¥10,000), older patients with and without MS had a markedly increased number of cardiovascular incidences compared with younger patients without MS. In a comparison of the incremental cost-effectiveness ratio (ICER) of percutaneous coronary intervention, older patients without MS had a lower ICER for cardiovascular incidences and a higher ICER for cardiac event-free survival rate when compared with young patients without MS, but a lower ICER for cardiovascular incidences and a higher ICER for cardiac event-free survival rate when compared with older MS patients.
Older AMI patients have poor clinical outcomes and their treatment is not cost-effective; however, the results are worse in patients with AMI and MS. Percutaneous coronary intervention is a cost-effective therapy in older patients with AMI, but its cost-effectiveness decreases in patients with AMI and MS.
PMCID: PMC4315548
metabolic syndrome; aging; vascular; acute myocardial infarction; cost-effectiveness
11.  Elderly patients with myocardial infarction selected for conservative or invasive treatment strategy 
There are limited data on patients aged >75 years with myocardial infarction (MI), especially those who are treated conservatively.
There are important differences in the clinical characteristics and outcome between elderly MI patients selected for invasive or conservative treatment strategy.
A total of 1,413 elderly patients (>75 years old) admitted to Sahlgrenska University Hospital, Gothenburg, Sweden with a final diagnosis of acute MI in 2001 or 2007, were divided into two groups, those who underwent a conservative treatment strategy (conservative group [CG], n=1,169) and those who underwent coronary angiography and were revascularized if indicated (invasive group [IG], n=244).
Other than higher age in the CG, there were no significant differences in traditional risk factors such as hypertension, diabetes, and smoking in the two groups. A higher proportion of patients in the CG had a history of heart failure and cerebrovascular disease. The hazard ratio (with 95% confidence interval), adjusted for potential confounders, for 5 year mortality in the IG in relation to the CG was 0.49 (0.39, 0.62), P<0.0001. Overall, in the elderly with MI, the proportion who underwent an invasive treatment strategy doubled from 12% in 2001 to 24% in 2007, despite a slightly higher mean age.
Elderly patients with MI in the CG (no coronary angiography), were generally older and a higher proportion had chronic diseases such as congestive heart failure and cerebrovascular disease than those in the IG. Our data suggest that the invasive treatment strategy is associated with better outcome. However, randomized trials will be needed to determine whether revascularization procedures are beneficial in elderly patients with MI, in terms of less symptoms, better outcome, and improved quality of life.
PMCID: PMC4309794  PMID: 25653514
elderly; myocardial infarction; acute coronary syndrome; aged
12.  Elderly care recipients’ perceptions of treatment helpfulness for depression and the relationship with help-seeking 
This study aims to examine perceptions of the helpfulness of treatments/interventions for depression held by elderly care recipients, to examine whether these beliefs are related to help-seeking and whether the experience of depression affects beliefs about treatment seeking, and to identify the characteristics of help-seekers.
One hundred eighteen aged care recipients were surveyed on their beliefs about the helpfulness of a variety of treatments/interventions for depression, on their actual help-seeking behaviors, and on their experience of depression (current and past).
From the sample, 32.4% of the participants screened positive for depression on the Geriatric Depression Scale, and of these, 24.2% reported receiving treatment. Respondents believed the most helpful treatments for depression were increasing physical activity, counseling, and antidepressant medication. Help-seeking from both professional and informal sources appeared to be related to belief in the helpfulness of counseling and antidepressants; in addition, help-seeking from informal sources was also related to belief in the helpfulness of sleeping tablets and reading self-help books. In univariate analyses, lower levels of cognitive impairment and being in the two lower age tertiles predicted a greater likelihood of help-seeking from professional sources, and female sex and being in the lower two age tertiles predicted greater likelihood of help-seeking from informal sources. In multivariate analyses, only lower levels of cognitive impairment remained a significant predictor of help-seeking from professional sources, whereas both lower age and female sex continued to predict a greater likelihood of help-seeking from informal sources.
Beliefs in the helpfulness of certain treatments were related to the use of both professional and informal sources of help, indicating the possibility that campaigns or educational programs aimed at changing beliefs about treatments may be useful in older adults.
PMCID: PMC4309791  PMID: 25653512
older adults; help-seeking; depression; prevalence; perceptions of treatments
13.  Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides 
Effective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents. Several communication intervention studies have been conducted to improve communication between nursing home staff and nursing home residents with dementia. These studies have shown that communication skills training can improve nursing aides’ communication with nursing home residents. However, these studies tended to be time-consuming and fairly difficult to implement. Moreover, these studies focused on the communicative benefits for the nursing home residents and their well-being, while benefits and well-being for the nursing aides were neglected. The current study focused on implementing a brief communication skills training program to improve nursing aides’ (N=24) communication with residents with dementia (N=26) in a nursing home. The effects of the training on nursing aides’ communication, caregiver distress, and job satisfaction and residents’ psychopathology and agitation were assessed relative to a control group condition. Nursing aides in the intervention group were individually trained to communicate effectively with residents during morning care by using short instructions, positive speech, and biographical statements. Mixed ANOVAs showed that, after training, nursing aides in the intervention group experienced less caregiver distress. Additionally, the number of short instructions and instances of positive speech increased. Providing nursing aides with helpful feedback during care aids communication and reduces caregiver burden, even with a brief intervention that requires limited time investments for nursing home staff.
PMCID: PMC4309793  PMID: 25653513
dementia; psychopathology; agitation; caregiver distress; job satisfaction
14.  Effects of cognitive training with additional physical activity compared to pure cognitive training in healthy older adults 
Cognitive training (CT) has been reported to improve cognition in older adults. Its combination with protective factors such as physical activity (CPT) has rarely been studied, but it has been suggested that CPT might show stronger effects than pure CT.
Materials and methods
Healthy older adults (aged 50–85 years) were trained with CPT (n=15) or CT (n=15). Interventions were conducted in 90-minute sessions twice weekly for 6.5 weeks. Cognitive functions were assessed before and immediately after the interventions, and at 1-year follow-up.
The main finding was an interaction effect on attention, with comparable gains from CPT and CT from pre- to post-test, but stronger effects of CPT to follow-up (P=0.02). Significant effects were found in subjects in terms of cognitive state (P=0.02), letter verbal fluency (P=0.00), and immediate (P=0.00) and delayed (P=0.01) verbal memory. Post hoc analyses indicated that these latter domains were affected differentially by CPT and CT. No significant between-subject effects were found.
Our results suggest that CPT might lead to stronger long-term effects on attention. However, as the difference between CT and CPT was only evident at follow-up, these effects cannot be interpreted as a direct consequence of CPT; they may have been related to sustained physical activity after the training. Other domains were improved by both interventions, but no typical pattern could be identified. Possible underlying mechanisms are discussed, and directions for future research are suggested.
PMCID: PMC4304534  PMID: 25632227
combined intervention; cognitive aging; exercise
15.  Multicenter, prospective, comparative cohort study evaluating the efficacy and safety of alfuzosin 10 mg with regard to blood pressure in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia with or without antihypertensive medications 
The objective of this study was to assess the efficacy and safety of alfuzosin 10 mg monotherapy or combined antihypertensive medication on blood pressure (BP) in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS) with or without antihypertensive medication.
This was a 3-month, multicenter, randomized, open-label study in 335 patients aged ≥45 years with a clinical diagnosis of BPH/LUTS by medical history and clinical examination, a total International Prostatic Symptom Score (IPSS) ≥8 points, a maximum flow rate >5 mL/sec and ≤15 mL/sec, and a voided volume ≥120 mL. Eligible subjects were randomized to receive alfuzosin 10 mg as monotherapy (group 1) or alfuzosin 10 mg + antihypertensive combination therapy (group 2). Based on baseline BP and hypertensive history with or without antihypertensive medications at first medical examination, group 1 was divided into two subgroups of normotensive and untreated hypertensive patients, and group 2 into two subgroups of controlled hypertensive and uncontrolled hypertensive patients. The primary study outcomes were change in IPSS, BP, and heart rate from baseline. Secondary outcomes were change in IPSS-quality of life score, maximum flow rate, average flow rate, voided volume, and post-voided volume.
The overall BP change was not significantly different between groups 1 and 2 (systolic BP, P=0.825; diastolic BP, P>0.999). In patients with uncontrolled or untreated hypertension, alfuzosin 10 mg alone or combined with antihypertensive therapy significantly decreased systolic and diastolic BP. The mean difference in total IPSS and IPSS-quality of life scores from baseline between groups 1 and 2 was 0.45 (95% CI: −1.26, 2.16) and 0.12 (95% CI: −0.21, 0.45), respectively (both P>0.05). Maximum flow rate, average flow rate, voided volume, and post-voided volume at endpoint were numerically, but not significantly, changed from baseline (all P>0.05).
This study shows that alfuzosin 10 mg is effective and well tolerated in patients with BPH/LUTS with or without antihypertensive medications. However, in patients with uncontrolled or untreated hypertension, alfuzosin 10 mg alone or in combination with antihypertensive medication appears to decrease systolic and diastolic BP, and these patients should be warned about a decrease in BP on initiation of therapy.
PMCID: PMC4303366  PMID: 25653511
alfuzosin; lower urinary tract symptoms; benign prostatic hyperplasia; antihypertensive medication; blood pressure
16.  Stem cell therapies for age-related macular degeneration: the past, present, and future 
In the developed world, age-related macular degeneration (AMD) is one of the major causes of irreversible blindness in the elderly. Although management of neovascular AMD (wet AMD) has dramatically progressed, there is still no effective treatment for nonneovascular AMD (dry AMD), which is characterized by retinal pigment epithelial (RPE) cell death (or dysfunction) and microenvironmental disruption in the retina. Therefore, RPE replacement and microenvironmental regulation represent viable treatments for dry AMD. Recent advances in cell biology have demonstrated that RPE cells can be easily generated from several cell types (pluripotent stem cells, multipotent stem cells, or even somatic cells) by spontaneous differentiation, coculturing, defined factors or cell reprogramming, respectively. Additionally, in vivo studies also showed that the restoration of visual function could be obtained by transplanting functional RPE cells into the subretinal space of recipient. More importantly, clinical trials approved by the US government have shown promising prospects in RPE transplantation. However, key issues such as implantation techniques, immune rejection, and xeno-free techniques are still needed to be further investigated. This review will summarize recent advances in cell transplantation for dry AMD. The obstacles and prospects in this field will also be discussed.
PMCID: PMC4298283  PMID: 25609937
stem cell; age-related macular degeneration; retinal pigment epithelium; cell reprogramming; clinical trial
17.  Characterization of hepatic enzyme activity in older adults with dementia: potential impact on personalizing pharmacotherapy 
To determine the frequency of pharmacogenomic variants and concurrent medications that may alter the efficacy and tolerability of acetylcholinesterase inhibitors (AChEIs).
Materials and methods
A multisite cross-sectional study was carried out across four memory care practices in the greater Indianapolis area. Participants were adults aged 65 years and older with a diagnosis of probable or possible Alzheimer’s disease (AD) (n=105). Blood samples and self-reported medication data were collected. Since two of the three AChEIs are metabolized by cytochrome P450 (CYP)-2D6, we determined the frequency of functional genetic variants in the CYP2D6 gene and calculated their predicted CYP2D6-activity scores. Concurrent medication data were collected from self-reported medication surveys, and their predicted effect on the pharmacokinetics of AChEIs was determined based on their known effects on CYP2D6 and CYP3A4/5 enzyme activities.
Among the 105 subjects enrolled, 72% were female and 36% were African American. Subjects had a mean age of 79.6 years. The population used a mean of eight medications per day (prescription and nonprescription). The CYP2D6 activity score frequencies were 0 (3.8%), 0.5 (4.8%), 1.0 (36.2%), 1.5–2.0 (51.4%), and >2.0 (3.8%). Nineteen subjects (18.1%) used a medication considered a strong or moderate inhibitor of CYP2D6, and eight subjects (7.6%) used a medication considered a strong or moderate inhibitor of CYP3A4/5. In total, 28.6% of the study population was predicted to have reduced activity of the CYP2D6 or CYP3A4/5 enzymes due to either genetic variants or concomitant medications.
Both pharmacogenetic variants and concurrent drug therapies that are predicted to alter the pharmacokinetics of AChEIs should be evaluated in older adults with AD. Pharmacogenetic and drug-interaction data may help personalize AD therapy and increase adherence by improving tolerability.
PMCID: PMC4298284  PMID: 25609939
dementia; acetylcholinesterase inhibitor; pharmacogenomics
18.  Chloronychia: green nail syndrome caused by Pseudomonas aeruginosa in elderly persons 
Green nails, also known as chloronychia or green nail syndrome, are characterized by green discoloration of the nail plate (greenish-yellow, greenish-brown, greenish-black), proximal chronic non-tender paronychia, and distolateral onycholysis. The cause is Pseudomonas aeruginosa infection of the nail plate in persons whose hands are constantly exposed to water, soaps, and detergents or are subject to mechanical trauma, especially in the elderly. Green or black coloration of the nails should raise suspicion for Pseudomonas infection and be treated with an oral quinolone (ciprofloxacin), particularly in aged patients. We present three cases of green nails in elderly persons.
PMCID: PMC4298286  PMID: 25609938
chloronychia; green nail syndrome; Pseudomonas aeruginosa; elderly
19.  Comparison of percentage body fat and body mass index for the prediction of inflammatory and atherogenic lipid risk profiles in elderly women 
To compare the clinical classification of the body mass index (BMI) and percentage body fat (PBF) for the prediction of inflammatory and atherogenic lipid profile risk in older women.
Cross-sectional analytical study with 277 elderly women from a local community in the Federal District, Brazil. PBF and fat-free mass (FFM) were determined by dual energy X-ray absorptiometry. The investigated inflammatory parameters were interleukin 6 and C-reactive protein.
Twenty-five percent of the elderly women were classified as normal weight, 50% overweight, and 25% obese by the BMI. The obese group had higher levels of triglycerides and very low-density lipoproteins than did the normal weight group (P≤0.05) and lower levels of high-density lipoproteins (HDL) than did the overweight group (P≤0.05). According to the PBF, 49% of the elderly women were classified as eutrophic, 28% overweight, and 23% obese. In the binomial logistic regression analyses including age, FFM, and lipid profile, only FFM (odds ratio [OR]=0.809, 95% confidence interval [CI]: 0.739–0.886; P<0.0005) proved to be a predictor of reaching the eutrophic state by the BMI. When the cutoff points of PBF were used for the classification, FFM (OR=0.903, CI=0.884–0.965; P=0.003) and the total cholesterol/HDL ratio (OR=0.113, CI=0.023–0.546; P=0.007) proved to be predictors of reaching the eutrophic state.
Accurate identification of obesity, systemic inflammation, and atherogenic lipid profile is key to assessing the risk of cardiometabolic diseases. Classification based on dual energy X-ray absorptiometry measures, along with biochemical and inflammatory parameters, seems to have a great clinical importance, since it allows the lipid profile eutrophic distinction in elderly overweight women.
PMCID: PMC4298285  PMID: 25609936
lipids; aging; body fat; women; body mass index; health profile
20.  Cardiac autonomic modulation in healthy elderly after different intensities of dynamic exercise 
To investigate the heart rate (HR) and its autonomic modulation at baseline and during dynamic postexercise (PEX) with intensities of 40% and 60% of the maximum HR in healthy elderly.
This cross-sectional study included ten apparently healthy people who had been submitted to a protocol on a cycle ergometer for 35 minutes. Autonomic modulation was evaluated by spectral analysis of HR variability (HRV).
A relevant increase in HR response was observed at 15 minutes postexercise with intensities of 60% and 40% of the maximum HR (10±2 bpm versus 5±1 bpm, respectively; P=0.005), and a significant reduction in HRV was also noted with 40% and 60% intensities during the rest period, and significant reduction in HRV (RR variance) was also observed in 40% and 60% intensities when compared to the baseline, as well as between the post-exercise intensities (1032±32 ms versus 905±5 ms) (P<0.001). In the HRV spectral analysis, a significant increase in the low frequency component HRV and autonomic balance at 40% of the maximum HR (68±2 normalized units [nu] versus 55±1 nu and 2.0±0.1 versus 1.2±0.1; P<0.001) and at 60% of the maximum HR (77±1 nu versus 55±1 nu and 3.2±0.1 versus 1.2±0.1 [P<0.001]) in relation to baseline was observed. A significant reduction of high frequency component at 40% and 60% intensities, however, was observed when compared to baseline (31±2 nu and 23±1 nu versus 45±1 nu, respectively; P<0.001). Moreover, significant differences were observed for the low frequency and high frequency components, as well as for the sympathovagal balance between participants who reached 40% and 60% of the maximum HR.
There was an increase in the HR, sympathetic modulation, and sympathovagal balance, as well as a reduction in vagal modulation in the elderly at both intensities of the PEX.
PMCID: PMC4310707  PMID: 25653509
heart rate; autonomic nervous system; exercise
21.  Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review 
Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF) and acute myocardial infarction (AMI) are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI.
The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen’s Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies.
A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6%) were found for the short-term outcome, and four studies (36.4%) were found for the long-term outcome. For the short-term outcome, race/ethnicity and marital status showed a positive cumulative effect on the risk for readmission. Regarding the educational level of a patient, no effect was found.
Among the socioeconomic factors, mainly race/ethnicity and marital status affect the risk for readmission in elderly people with HF or AMI. Multidisciplinary hospital-based quality initiatives, disease management, and care transition programs are a priority for health care systems to achieve better coordination.
Video abstract
PMCID: PMC4310718  PMID: 25653510
chronic conditions; cardiovascular disease (CVD); re-hospitalization; disparities; older patients; socioeconomic factors
22.  Tailored antihypertensive drug therapy prescribed to older women attenuates circulating levels of interleukin-6 and tumor necrosis factor-α 
To test the hypothesis that antihypertensive drug therapy produces anti-inflammatory effects in clinical practice, this study investigated circulating levels of selected proinflammatory mediators (interleukin-6 [IL-6], tumor necrosis factor-alpha [TNF-α], and interferon-γ [INF-γ]) in response to multivariate drug directions for blood pressure (BP) control.
Prospective study involving 110 hypertensive, community-dwelling older women with different metabolic disorders. A short-term BP-lowering drug therapy was conducted according to current Brazilian guidelines on hypertension, and basal cytokine levels were measured before and after intervention.
Interventions were found to represent current hypertension-management practices in Brazil and corresponded to a significant reduction in systolic and diastolic BP levels in a whole-group analysis, as well as when users and nonusers of the most common therapeutic classes were considered separately. Considering all patients, mean IL-6 and TNF-α levels showed a significant decrease in circulating concentrations (P<0.01) at the endpoint compared with baseline, whereas the mean INF-γ level was not significantly different from baseline values. In separate analyses, only users of antagonists of the renin–angiotensin system and users of diuretics exhibited the same significant treatment-induced reduction in serum IL-6 and TNF-α observed in the whole group.
Our data demonstrates that a clinically guided antihypertensive treatment is effective in reversing the low-grade proinflammatory state of serum cytokines found in postmenopausal women and support extracardiac benefits from diuretics and renin–angiotensin system antagonists.
PMCID: PMC4296909  PMID: 25624753
renin–angiotensin system; cytokine; hypertension; drug therapy; guidelines; inflammation
23.  Effect of aging on oral and swallowing function after meal consumption 
Dysphagia may worsen due to fatigue of the infrahyoid and suprahyoid muscle groups as a result of repetitive swallowing during a meal. We investigated the hypothesis that meal consumption may reduce tongue strength and endurance in older adults (OAs).
Tongue–palate pressure, oral diadochokinesis, repetitive saliva swallowing, and surface electromyography activity before and after a meal were measured in 23 young adults (YAs) and 23 OA volunteers.
There was a statistically significant difference in both tongue pressure and the number of voluntary swallows between YAs and OAs. Peak tongue pressure was significantly lower in OAs than YAs both before and after meal consumption. The most notable finding was that the first time interval (the time from test initiation to the beginning of the first swallow) was prolonged after meal consumption only in OAs, whereas the first time interval showed no difference between YAs and OAs before meal consumption with reference to the repetitive saliva swallowing test. The initiation of swallowing was prolonged by both meal consumption and aging; there was a significant interaction between these two factors. The number of repetitions of the monosyllable/pa/was statistically similar between YAs and OAs before meal consumption, but it was significantly lower in OAs after meal consumption.
Aging leads to declining tongue pressure and motor function of the lips. It is possible that swallowing function declines in older individuals when meal consumption is prolonged, especially at the end of mealtime, as a result of their efforts in mastication and swallowing.
PMCID: PMC4296912  PMID: 25624755
normal adults; dysphagia; fatigue; elderly
24.  Bridging the digital divide in older adults: a study from an initiative to inform older adults about new technologies 
In a society where technology progresses at an exponential rate, older adults are often unaware of the existence of different kinds of information and communication technologies (ICTs). To bridge the gap, we launched a 2-year project, during which we conducted focus groups (FGs) with demonstrations of ICTs, allowing older adults to try them out and to share their opinions. This study aimed at investigating how participants perceived this kind of initiative and how they reacted to different kinds of ICTs.
Patients and methods
In total, 14 FGs were conducted with community-dwelling older adults, with a frequency of two FGs on the same topic once per trimester. Twenty-three older adults (four men and 19 women) attended at least one FG but only nearly half of them were regular attendants (ten participating in at least five sessions). Age of participants ranged from 63 years to 88 years, with a mean of 77.1 years. All of them had completed secondary education. The analyses of the data were performed according to inductive thematic analysis.
Four overarching themes emerged from the analysis. The first concerned participants’ motivation for and assessment of the project. The second theme identified the underlying factors of the “digital divide” between the younger and the older generations. The third theme concerned the factors of technology adoption among older adults. The fourth one identified participants’ attitudes toward assistive ICTs, designed specifically for older adults (“gerontechnologies”).
Discussions and conclusion
This project encouraging older adults to be informed about different kinds of ICTs was positively rated. With regard to ICTs, participants perceived a digital divide. The underlying factors are generation/cohort effects, cognitive and physical decline related to aging, and negative attitudes toward technologies. However, more and more older adults adopt different kinds of ICTs in order to fit in with the society. Concerning assistive ICTs, they manifested a lack of perceived need and usefulness. Also, there was a negative image of end users of this kind of technologies. The so-called gerontechnologies specifically targeting older adults contain stigmatizing symbolism that might prevent them from adopting them.
PMCID: PMC4296914  PMID: 25624752
assistive technologies; attitude; digital divide; gerontechnology; technology adoption; technology acceptance
25.  A pilot randomized controlled trial using EEG-based brain–computer interface training for a Chinese-speaking group of healthy elderly 
There is growing evidence that cognitive training (CT) can improve the cognitive functioning of the elderly. CT may be influenced by cultural and linguistic factors, but research examining CT programs has mostly been conducted on Western populations. We have developed an innovative electroencephalography (EEG)-based brain–computer interface (BCI) CT program that has shown preliminary efficacy in improving cognition in 32 healthy English-speaking elderly adults in Singapore. In this second pilot trial, we examine the acceptability, safety, and preliminary efficacy of our BCI CT program in healthy Chinese-speaking Singaporean elderly.
Thirty-nine elderly participants were randomized into intervention (n=21) and wait-list control (n=18) arms. Intervention consisted of 24 half-hour sessions with our BCI-based CT training system to be completed in 8 weeks; the control arm received the same intervention after an initial 8-week waiting period. At the end of the training, a usability and acceptability questionnaire was administered. Efficacy was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which was translated and culturally adapted for the Chinese-speaking local population. Users were asked about any adverse events experienced after each session as a safety measure.
The training was deemed easily usable and acceptable by senior users. The median difference in the change scores pre- and post-training of the modified RBANS total score was 8.0 (95% confidence interval [CI]: 0.0–16.0, P=0.042) higher in the intervention arm than waitlist control, while the mean difference was 9.0 (95% CI: 1.7–16.2, P=0.017). Ten (30.3%) participants reported a total of 16 adverse events – all of which were graded “mild” except for one graded “moderate”.
Our BCI training system shows potential in improving cognition in both English- and Chinese-speaking elderly, and deserves further evaluation in a Phase III trial. Overall, participants responded positively on the usability and acceptability questionnaire.
PMCID: PMC4296917  PMID: 25624754
cognitive training; neuro-feedback; memory; attention

Results 1-25 (874)