Physical and Mental Exercise Lower Chances for Developing Delirium After Surgery

Journal of the American Geriatrics Society Research Summary

After having surgery, many older adults develop delirium, the medical term for sudden and severe confusion. In fact, between 10 and 67 percent of older adults experience delirium after surgery for non-heart-related issues, while 5 to 61 percent experience delirium after orthopedic surgery (surgery dealing with the bones and muscles).

Delirium can lead to problems with thinking and decision-making. It can also make it difficult to be mobile and perform daily functions and can increase the risk for illness and death. Because adults over age 65 undergo more than 18 million surgeries each year, delirium can have a huge impact personally, as well as for families and our communities.

Healthcare providers can use several tools to reduce the chances older adults will develop delirium. Providers can meet with a geriatrician before surgery, review prescribed medications, and make sure glasses and hearing aids are made available after surgery (since difficulty seeing or hearing can contribute to confusion). However, preventing delirium prior to surgery may be the best way to help older adults avoid it.

A team of researchers from Albert Einstein College of Medicine designed a study to see whether older adults who are physically active before having surgery had less delirium after surgery. The research team had previously found that people who enjoy activities such as reading, doing puzzles, or playing games experienced lower rates of delirium. The team published new findings on physical activity in the Journal of the American Geriatrics Society.

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High Blood Pressure Treatment and Nursing Home Residents

Journal of the American Geriatrics Society Research Summary

Although 27 percent of all older adults who live in nursing homes in this country have both high blood pressure and dementia, we don’t have enough research yet to inform healthcare providers about the best way to treat their high blood pressure.

Specifically, we don’t know when the benefits of taking medication to lower blood pressure outweigh the potential risks, especially in older adults who also have moderate to severe dementia and a poor prognosis (the medical term for the likely course of a disease). That’s because clinical trials for high blood pressure treatments typically do not include older adults who have severe chronic illnesses or disabilities.

 A team of researchers designed a study to learn more about the best high blood pressure treatments for older adults who live in nursing homes. Their study was published in the Journal of the American Geriatrics Society.

The research team used information from Medicare records. The team identified 255,670 long-term nursing home residents in the United States during 2013 who had high blood pressure. Of these, nearly half had moderate or severe dementia-related difficulties with thinking and decision-making. Slightly more than half of them had no or only mild cognitive impairment. Continue reading

Periodontitis May Raise the Risk for Developing Dementia

Journal of the American Geriatrics Society Research Summary

Gum disease (gingivitis) that goes untreated can become periodontitis. When this happens, the infection that affected your gums causes loss in the bone that supports your teeth. Periodontitis is the main cause of tooth loss in adults.Interestingly, periodontitis is also a risk factor for developing dementia, one of the leading causes for disability in older adults. A United Nations forecast estimates that 1 in 85 individuals will be diagnosed with Alzheimer’s disease, a form of dementia, by the year 2050. Reducing the risk factors that lead to dementia and Alzheimer’s disease could potentially lower older adults’ chances of developing those conditions.

Recently, researchers in South Korea studied the connection between chronic periodontitis and dementia. They published their findings in the Journal of the American Geriatrics Society.

The research team examined information from the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS). In South Korea, the NHIS provides mandatory health insurance covering nearly all forms of health care for all Korean citizens. The agency also provides health screening examinations twice a year for all enrollees aged 40 years or older and maintains detailed health records for all enrollees.

The researchers looked at health information from 262,349 people aged 50 or older. All of the participants were grouped either as being healthy (meaning they had no chronic periodontitis) or as having been diagnosed with chronic periodontitis. The researchers followed the participants from January 1, 2005 until they were diagnosed with dementia, died, or until the end of December 2015, whichever came first.

The researchers learned that people with chronic periodontitis had a 6 percent higher risk for dementia than did people without periodontitis. This connection was true despite behaviors such as smoking, consuming alcohol, and remaining physically active. The researchers said that to their knowledge, this is the first study to demonstrate that chronic periodontitis could be linked to a higher risk for dementia even after taking lifestyle behaviors into account.

The researchers suggested that future studies be conducted to investigate whether preventing and treating chronic periodontitis could lead to a reduced risk of dementia.

This summary is from “Association of Chronic Periodontitis on Alzheimer’s Disease or Vascular Dementia.” It appears online ahead of print in the February 2019 issue of the Journal of the American Geriatrics Society. The study authors are Seulggie Choi, MD; Kyuwoong Kim, BSc; Jooyoung Chang, MD; Sung Min Kim, BSc; Seon Jip Kim, RDH; Hyun-Jae Cho, DDS, PhD; and Sang Min Park, MD, PhD, MPH.

Exercise May Lessen Risk of Falling for Older Adults who have Alzheimer’s Disease and Mental Health Challenges

Journal of the American Geriatrics Society Research Summary

Alzheimer’s disease (AD) is a brain disease that causes changes that kill brain cells. AD is a type of dementia, which causes memory loss and problems with thinking and making decisions. People with AD and other forms of dementia have difficulties performing the daily activities others might consider routine.

Dementia takes a toll on those who live with it—and it also places a burden on caregivers. Along with problems connected to memory, language, and decision-making, dementia can cause neuropsychiatric symptoms, such as depression, anxiety, changes in mood, increased irritability, and changes in personality and behavior.  People who have AD/dementia also have twice the risk for falls compared to people without dementia. About 60 percent of older adults with dementia fall each year.

Researchers suggest that having neuropsychiatric symptoms might predict whether an older person with AD/dementia is more likely to have a fall. We also know that exercise can reduce the number of falls in older adults with dementia. However, we don’t know very much about how neuropsychiatric symptoms may increase the risk of falls, and we know even less about how exercise may reduce the risk of falls for people with dementia and neuropsychiatric symptoms. A research team decided to explore whether exercise could reduce the risk of falling among community-dwelling people with AD who also had neuropsychiatric symptoms. Continue reading

Setting Personal Goals for Dementia Care

Journal of the American Geriatrics Society Research Summary

Dementia is a health condition that affects your memory in ways that can make it difficult to carry out your usual daily tasks. The most common cause of dementia is Alzheimer’s disease, which causes abnormal changes that kill brain cells. However, there are many other types of dementia. Overall, dementia is a long-term illness, and most people live from four to 10 years after being diagnosed.

When you are first diagnosed with dementia, your goals may be to preserve your ability to perform your daily activities. But as the disease progresses, your goals may shift and your preferences for your care may shift with them. Eventually, you may wish to make sure that your preferences and expectations are known, particularly for end-of-life care. You may also want to be sure those wishes can be put into action by those who might make decisions for you when you don’t feel comfortable or are no longer able to make them on your own.

Healthcare providers can use a tool called “goal attainment scaling” (GAS) to help you set your personal health goals and measure whether you’re meeting them. Researchers have been using GAS for decades to measure the effects of mental health and rehabilitation efforts.

In a new study, researchers used GAS when caring for people with dementia to learn more about these individuals’ personalized goals for care. Their study was published in the Journal of the American Geriatrics Society. Continue reading