Health In Aging Blog


Aerobic Exercise and Heart-Healthy Diet May Slow Development of Memory Problems

Journal of the American Geriatrics Society Research Summary

Cognitive impairment without dementia (CIND), or mild cognitive impairment, is a condition that affects your memory and may put you at risk for Alzheimer’s disease and dementia. According to the U.S. National Library for Medicine, signs of mild cognitive impairment may include frequently losing things, forgetting to go to events and appointments, and having more trouble coming up with words than other people of your age.

Sine experts believe that risk factors for heart disease also are risk factors for dementia and late-life cognitive decline and dementia. Recently, researchers examined two potential ways to slow the development of CIND based on what we know about preventing heart disease. They published the results of their study in the Journal of the American Geriatrics Society.

The research team had a theory: That the healthy lifestyle behaviors that slow the development of heart disease could reduce heart disease risk and also slow cognitive decline in older adults with CIND. These behaviors include regular exercise and a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet.

In order to investigate their theory, the researchers designed a study titled “Exercise and NutritionaL Interventions for coGnitive and Cardiovascular HealTh EnhaNcement” (or ENLIGHTEN for short). The goal of the study was to examine the effects of aerobic exercise (sometimes known as “cardio” or “cardiovascular” exercise because it involves activities that increase the circulation of oxygen through the blood) and the DASH diet on cognitive functioning in older adults with CIND.

The ENLIGHTEN study examined 160 adults 55-years-old or older. The study participants were older adults who didn’t exercise and had memory problems, difficulty thinking, and making decisions. They also had at least one additional risk factor for heart disease, such as high blood pressure (also known as hypertension), high cholesterol, diabetes, or other chronic conditions.

Participants took a number of tests to measure their heart disease risk factors and cognitive ability. Researchers also assessed participants’ dietary habits and ability to perform daily activities. The participants were then randomly assigned to one of four groups: a group doing aerobic exercise alone, a group following the DASH diet alone, a group doing aerobic exercise and following the DASH diet combined, or a group receiving standard health education.

People in the exercise group did 35 minutes of moderate intensity aerobic exercise (including walking or stationary biking) three times per week for six months. They were supervised for three months and then exercised unsupervised at home for three months. Participants in the exercise group did not receive any counseling in the DASH diet and were encouraged to follow their usual diets for six months.

People in the DASH eating plan group received instruction about how to meet DASH guidelines in a series of weekly sessions for three months and then bi-weekly for the remaining three months. Participants in the DASH group were asked not to engage in regular exercise until the completion of the six-month study.

People in the exercise and DASH group followed the exercise and DASH programs for six months. The participants who were enrolled in the health education group received weekly educational phone calls for three months and then bi-weekly calls for three months. Phone calls were conducted by a health educator on health topics related to heart disease. Participants were asked to maintain their usual dietary and exercise habits for six months until they were re-evaluated.

At the conclusion of the six-month intervention and assessment, participants were free to engage in whatever activity and dietary habits they desired, with no restrictions.

The results of the research team’s study showed that exercise improved the participants’ ability to think, remember, and make decisions compared to non-exercisers, and that combining exercise with the DASH diet improved the ability to think, remember, and make decisions, compared to people who didn’t exercise or follow the diet—even though they didn’t perfectly follow the programs they were assigned to during the six-month interventions.

The researchers concluded that their findings are promising proof that improved ability to think, remember, and make decisions can last one year after completing a six-month exercise intervention. They suggested that further studies would be needed to learn more.

This summary is from “Longer Term Effects of Diet and Exercise on Neurocognition: One Year Follow-Up of the ENLIGHTEN Trial.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are: James A. Blumenthal, PhD; Patrick J. Smith, PhD; Stephanie Mabe, MS; Alan Hinderliter, MD; Kathleen Welsh-Bohmer, PhD; Jeffrey N. Browndyke, PhD; P. Murali Doraiswamy, MBBS, FRCP; Pao-Hwa Lin, PhD; William E. Kraus, MD; James R. Burke, MD; and Andrew Sherwood, PhD.

Geriatricians, Internists, and Cardiologists Surveyed About Deprescribing

Journal of the American Geriatrics Society Research Summary

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As you grow older, you’re more likely to develop health conditions that require taking multiple medications—some of which you may take for a long time. Many older people also take over-the-counter (or “OTC”) medications, vitamins, or supplements as part of routine care. As a result, older adults have a higher risk of overmedication, also known as “polypharmacy”—the medical term for taking four or more medications at the same time. Polypharmacy can increase your chances of unwanted reactions (also called “adverse drug reactions”) due to medications taken on their own or together.

To address this increasingly common problem, healthcare providers are focusing on how to reduce the number of medicines older adults are using through a practice called “deprescribing,” which is when health professionals work with patients to decide to stop the use of one or more medications for which the benefits no longer outweigh the potential harms.

Getting both patients and health professionals on board with deprescribing can be key to its success, however. In order to learn more about physicians’ attitudes and approaches to deprescribing medications for older adults, a team of researchers designed a survey. They published their investigation in the Journal of the American Geriatrics Society. Continue reading

For Older Adults, Newer Hepatitis C Treatments are Safe and Effective

Journal of the American Geriatrics Society Research Summary

Viral hepatitis is a disease that causes inflammation of the liver. There are three viruses responsible for most cases of the disease: hepatitis A, B, and C. Hepatitis A is typically caused by consuming contaminated food or water.  Hepatitis B and C usually occur when someone comes in contact with infected bodily fluids, such as blood. The severity of hepatitis can range from a mild illness lasting a few weeks to a serious, lifelong illness.

In 2016, there were an estimated 2.4 million people living with hepatitis C, one of the more severe forms of the disease, in the United States. A hepatitis C infection can be particularly serious for older adults, since many don’t seek treatment until the condition is in advanced stages. What’s more, hepatitis C is considered harder to treat for older people who have lived with the condition for a long time compared to younger people are.  Treatment is often unsuccessful, too, because many of the common treatment options aren’t easy for older adults to tolerate or may no longer be effective as our body changes with age.

Thankfully, newer treatments known as interferon-free direct-acting antivirals offer a promising approach to addressing hepatitis C.  These medications offer cure rates of more than 90 percent in clinical trials and in real life, but they haven’t been studied extensively for older adults. A team of researchers studied this issue and published their findings in the Journal of the American Geriatrics Society. The researchers examined how well people older than 65 tolerated interferon-free direct-acting antivirals compared with younger patients. Continue reading

Oral Health for Older Adults

Journal of the American Geriatrics Society Research Summary

Older adults are at an especially high risk for mouth and tooth infections and the complications that can come with these problems. Losing teeth, which is mainly caused by infection, not only leads to changes in our appearance but may also make it harder to chew certain foods. That can make it harder to receive the nourishment we need to function. Complete loss of all teeth (also known as edentulous) is less common now in developed countries like the U.S., but it still becomes more common as we age regardless of where we may live.

Practicing good oral hygiene, using fluoride treatments, and getting regular dental care reduces oral infections and their complications. A recent article published in the Journal of the American Geriatrics Society offers a helpful overview of oral health for older adults, as well as tips for keeping your teeth and mouth in tip-top shape. Highlights from the article are summarized here. Continue reading

Care at Home Lessens Risk of Hospital Re-Admission within 30 Days Following Hospitalization for Heart Failure

Journal of the American Geriatrics Society Research Summary

Older adults who are recovering from heart failure often leave the hospital to stay at rehabilitation facilities (also called skilled nursing facilities) before they return home. However, healthcare practitioners know that the stress of the transitioning from hospital to skilled nursing facility and back to a person’s home can result in an older adult’s readmission to the hospital within 30 days after their discharge.

For that reason, older adults who have heart failure may do better when they get home health care once they return home after their discharges from the hospital and skilled nursing facility.

To learn more, a team of researchers studied the association between hospital readmission risk and receiving home health care after leaving skilled nursing facilities. To do so, they examined the records of Medicare patients, aged 65 and older, who had returned home from skilled nursing facilities following hospitalization for heart failure. Their study was published in the Journal of the American Geriatrics Society. Continue reading