Yoga-based exercise can improve well-being for older people

This blog was first published on the National Institute for Health Research (NIHR) Dissemination Centre Discover Portal. Read the corresponding Age and Ageing paper Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials.

Yoga-based exercise offers a safe and accessible way to improve health-related quality of life and mental well-being for people over 60. Evidence for a moderate benefit of yoga in later life now extends beyond improved balance and flexibility.

Yoga includes stretches, poses, breathing routines and meditation. This review focused on the physical exercise/activity components. Most of the 12 included trials took place in Western countries and classes were all run by qualified yoga instructors as in the UK. Class attendance was high for eight weeks or more (50 to 96%). However, women outnumbered men by three to one, implying that yoga classes may need adapting to appeal to older men.

Yoga classes are widely available and could offer an accessible way to improve older people’s activity levels and well-being. The research was moderate to high quality, but it cannot yet show exactly how much yoga or which kind works best for particular groups of people. However, the good news is that these approaches seem effective.

Continue reading

July 2018 issue of Age and Ageing journal is out now

The July 2018 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.  A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more.  

    Hot topics in this issue include:
  • Blood pressure targets in treatment of hypertension
  • Falls prevention
  • Probiotics and prevention of infection
  • Improving healthcare outcomes in care homes
  • Caregiver relationships and Parkinson’s disease

The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here. Continue reading

How should healthcare services to care homes be configured – results from the Optimal Study

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham. He tweets @adamgordon1978 Claire Goodman is Professor of Health Care Research at the University of Hertfordshire.  She tweets @HDEMCOP Here they describe findings from the Optimal Study, funded by the National Institute of Health Research and delivered by a collaboration of researchers from the Universities of Hertfordshire, Nottingham, Surrey, City University London, University College London, Kings College London and Brunel University.

The UK care home sector, with 425,000 beds, is just over three times the size of the acute hospital sector.  It is home to some of the oldest and most vulnerable members of UK society.  The average resident is over 85, has multiple health conditions, cognitive impairment and physical dependency.  Providing care to such older adults is recognised to be complex and challenging. Continue reading

Older people are not only living longer: positive results in the temporal trends of physical functioning

Giola Santoni is a researcher on health status and health trends in older people. She has worked at the Aging Research Center, Karolinska Institutet in Sweden and she is currently a biostatistician at the same institute.

Anna-Karin Welmer is associate professor and senior university lecturer at Karolinska Institutet. She is vice-principal investigator of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) population-study. Anna-Karin’s primary area of research interest is the epidemiology of physical function, disability and falls in older persons.

Despite the rapid gain in life expectancy in the last century, it is not clear if the added years consist of healthy years or years lived in poor health and disability.

Previous studies have reported stable or even declining levels of disability. However, disability is defined as the inability to perform basic activities of daily living independently in the environment a person lives. Disability trends can therefore be influenced by changes in the environment such as development of technical equipment. To what extent does the encouraging trend towards declines in disability in the older population reflect actual improvements in physical function? Continue reading

Is frailty becoming less fatal?

Professor Fiona Matthews is Professor of Epidemiology at Newcastle University, Newcastle-upon-Tyne, UK. In this blog, she shares a recent Age and Ageing publication looking at data collected since the 1990s on how much frailty exists in the population and whether it is more or less related to dying now than 30 years ago.

Most doctors involved in the care of older people would claim to know a frail patient when they see one. Being able to detect this frailty is crucial to ensure that treatment is appropriate, proportionate and likely to produce positive outcomes wherever possible. The measurement of frailty has become important recently with the inclusion of frailty within the requirements of an assessment in general practice, and tools to assist doctors in emergency departments evaluate frailty quickly. The most popular method for these investigations has been the frailty index, where diseases and impairments are added all together to give a score. The relationship between this frailty index and mortality has been seen across the world, giving rise to suggestions that it is one measure that is consistent across time and place. Continue reading

The Great Balancing Act – perspectives from older people on falls risk

Dr Kristy Robson is a Lecturer in Podiatry at Charles Sturt University, a regional university in Australia. In this blog she shares a recent Age and Ageing publication that explores the behavioural decisions older people make when they knowingly and unknowingly undertake activities or tasks that pose a risk of falling. She tweets @KristyRobson2

Fall related injuries in older people constitute a significant public health issue in Australia and internationally. Falling represents the leading cause of unintentional injury in this population with approximately one third of older adults falling each year. Effective management of falls in older populations has proven to be challenging. Despite the substantial focus on falls prevention by the Australian government over the last decade the age standardised hospital admission rates attributed to falls continue to increase. The complexity of managing falls risk in the diverse populations found within Australia, coupled with an ageing population and finite resources, drives the need to better understand factors that can influence falling from the perspective of the older person. Continue reading

When low blood pressure is too low in old age

Sven Streit is a general practitioner at the Institute of Primary Health Care (BIHAM) in Bern (CH) and PhD Candidate at Leiden University Medical Center (NL). In this blog, he introduces the results of his PhD in a recent Age & Ageing paper on blood pressure, mortality risk and cognitive decline in a population-based cohort of oldest-old (all 85 years) in Leiden. He tweets @Sven_Streit

With increasing age, blood pressure rises as a consequence of arterial stiffness. It has been debated whether or not to it is beneficial to treat hypertension in old age, especially in >75-year-olds when they have multimorbidity, polypharmacy or frailty. Large hypertension trials showed that lowering blood pressure in over 60-year-olds is beneficial and lowers the risk for myocardial infarction, stroke and all-cause mortality, even in >80-year-olds. However, these trials lack generalizability and typically excluded patients with multimorbidity and frailty. At the same time, observational studies raise concerns about lowering blood pressure too much, since there are several cohort studies showing a reverse association between low blood pressure and increased mortality and accelerated cognitive decline starting from age >75-year-olds. Continue reading

Frequent drinkers unravelled

Beth Bareham, NIHR SPCR  doctoral fellow at Newcastle University Institute of Health and Society and Institute for Ageing (@bkateb1) She co-authored the Age and Ageing Paper Drinking in later life: a systematic review and thematic synthesis of qualitative studies exploring older people’s perceptions and experiences with Professor Eileen Kaner @EileenKaner, Liam Spencer @LiamPSpencer and Professor Barbara Hanratty @BarbaraHanratty.

Within the United Kingdom, older people experience more alcohol-related hospitalisations and deaths than any other age group. Risky drinking amongst  older people is not just confined to the United Kingdom. Potentially harmful patterns of drinking are common amongst older age groups across the globe. Older people are not only at risk because they drink more often, but also because quantities of alcohol that may have been safer earlier in life have the potential to damage an older person’s health if, like most, they have medical conditions or take medications. However, moderate drinking in older age has been linked with some health benefits, and drinking may also have a positive impact on their social lives. The impact of alcohol on older people is complex, and many different factors can influence their choices. To modify riskier drinking in later life and support people to live longer, healthier lives, it’s vital that we understand these complexities.  Continue reading

Drug burden in older people approaching end of life

Dr. Denis Curtin is a specialist registrar in Geriatric Medicine in Cork University Hospital, Ireland. His paper Drug consumption and futile medication prescribing in the last year of life: an observational study was recently published the Age and Ageing journal.

The vast majority of older adults are admitted to hospital in their last year of life. For many of these people, hospitalizations are frequent and prolonged.

We reviewed the medical records of 410 older adults who were admitted to our hospital in the year prior to death. The median number of days spent in hospital was 32. While in hospital, patients consumed an average of 24 different medications. One-in-six patients consumed 35 or more individual medications. When discharged home from hospital, patients were prescribed an average of 2 unnecessary or inappropriate medications. Continue reading

‘How low to go?’ Top transatlantic research journals debate antihypertensive treatment in older people

The scientific journal of the British Geriatrics Society, Age and Ageing, and the Journal of the American Geriatrics Society have launched a joint initiative, publishing two articles debating the relative benefits and risks of treating hypertension in older people.

It is widely recognised that raised blood pressure is probably the single most important treatable risk factor for cardiovascular disease in later life. The evidence that older people can benefit from antihypertensive drugs has accumulated with a succession of randomised controlled trials over the past 35 years. These trials have shown reduced risk of stroke and myocardial infarction, as well as decreased total mortality. However, despite the extensive evidence that is now available, questions remain about who to treat and on optimal blood pressure targets. Consequently practice varies widely and many clinicians are uncertain about what best to recommend for their older patients. Continue reading