Chronic pain may mean more falls for older people

Falls can be devastating for the elderly, leading to joint replacements, pain and sometimes death. A new study finds that having chronic pain may lead to more falls in older people.

Participants in the study included 749 men and women age 70 and older who were part of the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly study in Boston. They were given a health assessment by a nurse and were asked to record any falls they had during an 18-month period.

At the beginning of the study, 40% of the men and women said they had chronic pain in more than one joint, and 24% said they had chronic pain in one joint. During the study period, 1,029 falls were logged, and more than half the participants reported they fell at least once.

However, researchers found that those who said they had pain in more than one joint had a 50% greater chance of falling than those who had no pain.

They also discovered a link between pain severity and the risk of falls in the short-term. Those who rated their pain as severe or very severe for a month had a 77% increased chance of falling in the following month, compared with those who had no pain.

In the study, the authors wrote, "The findings provide evidence suggesting that the common complaint of the aches and pains of old age is related to a greater hazard than previously thought. Daily discomfort may accompany not only difficulties in performing daily activities but equally as important may be a risk for falls and possibly fall-related injuries in the older population."

The study appears in this week's issue of the Journal of the American Medical Assn.

-- Jeannine Stein

Age may have its advantages in endurance sports

Endurance sports such as ultra-marathons, ultra-triathlons and cycling marathons have exploded in popularity over the years. Among them is the grandaddy of the genre, the Western States 100-Mile Endurance Run, which began in 1974 and meanders through the Western States Trail in Northern California. A new study looked at how the race has grown, and finds some interesting trends among the runners -- mostly that they've gotten older and faster.

Researchers from the Department of Veterans Affairs' Northern California Health Care System and Virginia Commonwealth University in Richmond analyzed details of the thousands of people who have competed in the race from 1974 through 2007. About 3,459 runners have finished the race since its inception, but the profiles of those men and women have changed. Many more women, for example, are competing: from 1986 to 1988, women made up 10% to 12% of the field, but since 2001 that has almost doubled to 20% to 22% of all runners.

Competitors are older too -- the average age of male and female race starters has gradually increased since 1986. In 1986, the average male runner was 41, but between 2000 and 2007 the average runner was 45 to 47. Researchers chalk those statistics up to the fact that more women age 40 and up and more men age 50 and up have been competing, and also fewer men under 50 have entered the race.

From the very first race, the average age of the top five finishes has risen from the early 30s to the late 30s. While the top five men have shown only minor changes in finish times between 1979 and 2007, not so for the women -- they've improved 37 minutes every 10 years from 1980 through 2007. That means the differences in finish times between the top five men and women have gotten smaller by 4% per decade, to about 14% in 2007. The researchers note that there was a 12% time difference between top five finish times for men and women in both the 2007 Hawaii Ironman competition and the 2007 New York City Marathon.

The study appears in the December issue of Medicine & Science in Sports & Exercise.

-- Jeannine Stein

Photo credit: Richard Hartog / Los Angeles Times

To fight inflammation with food

Inflammation -- a ramped-up immune system -- seems to be linked to chronic diseases such as cancer and heart disease, and even the very fact of aging. Some foods, it turns out, promote inflammation. Others damp it down.

Shara Yurkiewicz, our 2009 summer intern, wrote a fairly extensive Health section article on the issue of anti-inflammatory foods -- you can read it right here. She noted that there's an awful lot of over-the-top prose about anti-inflammation diets --"amazing results in just 30 days!" etc. etc. -- but also that there is some science to it all -- animal studies, cell culture studies, even some in people -- and that the science in this area is developing.

In broad brush strokes, fish oil, curcumin, antioxidant-rich fruits and vegetables -- they're anti-inflammatory. Saturated fats, trans fats, corn and soybean oil, refined carbohydrates, sugars -- they're pro-inflammatory.

Now some scientists are trying to paint with a narrower brush. They've come up with -- and tested -- an inflammation index for foods.

First, the scientists did a literature search and put together a list of foods with anti-inflammatory or pro-inflammatory properties. They came up with 42.

Top of the list on the bad, pro-inflammation end: carbs. Top at the anti-inflammatory end (should you be interested, but we caution you not to run out and immediately start consuming massive amounts in a quest to live forever): magnesium.

That was step one. In step two, the researchers decided to test whether the people's diets gelled with the levels of inflammation you could measure in their blood. So they tested it 494 people. The participants were asked periodically over the course of a year what they ate, and it was all cataloged very precisely. Samples of their blood were assessed for levels of a protein called CRP, which is a marker of inflammation as well as a risk factor for heart disease.

The scientists found that the measure worked, and that diet and inflammation indexes matched up in a broad sense -- i.e. those eating a lot of anti-inflammatory foods had lower CRP levels, and vice versa. (It wasn't a smooth, continuous relationship, however.) This supports the idea that diet really does influence your inflammation, even after controlling for other lifestyle factors. 

The researchers say that their index could be a great tool for research but that it could also help people who are trying to reduce levels of inflammation in their bodies to lower their risk for chronic diseases. Though you'd think most of us could get a long way by just remembering: Carbs and fat and stuff, EAT LESS. Produce, nuts and fish and stuff: EAT MORE.

The study was done by researchers at the University of South Carolina and the University of Massachusetts, and published in the Journal of Nutrition. You can read it here.

-- Rosie Mestel

Photo credit: Kirk McKoy

Sleep problems and age: Not necessarily bedmates, say sleep docs

Patients over 65 -- and sometimes their doctors -- often behave as if sleep problems are as inevitable a part of aging as aches and wrinkles. It doesn't have to be that way, says a group of leading sleep doctors. But to get help, physicians need routinely to screen their older patients for signs of sleep disorders, and patients have to ask for help when they find they consistently can't fall asleep, awaken frequently or too early, have daytime sleepiness or experience unusual movements while sleeping.

There are "sleep hygiene" tips and treatments -- from cognitive behavioral therapy for insomnia to weight loss and breathing aids for sleep apnea -- that can remedy most sleep problems. And while the experts agreed they are overused, hypnotic sleep drugs can be a help for some patients.

In a slate of recommendations for the treatment of sleeping disorders in older patients, 10 leading sleep experts acknowledge that aging does bring changes in sleep patterns. Many of the sleep disruptions most commonly reported among seniors seem to come along with chronic medical conditions, many of which also grow more common with age -- diabetes, high blood pressure, cardiovascular disease, depression. When these are treated, sleep problems often get better.

But the medications that treat some of these conditions also can be implicated in sleep disturbances, said Dr. Harrison Bloom, a geriatrician with the International Longevity Center in New York City. Bloom chaired the consensus committee and was lead author of the paper, published this week in the Journal of the American Geriatrics Society. Certain antidepressants and medications for asthma can cause restless limbs and difficulty in falling asleep. Beta-blockers that treat heart failure can come with vivid dreams and insomnia, and even statins can keep some patients awake. Many narcotic pain relievers cause next-day hangovers with drowsiness, especially for older patients.

Physicians often fail to warn patients about these side effects, or to ask about sleep troubles when a patient comes in for follow-up.

The sleep experts also pointed a finger of blame at alcohol, caffeine, sedentary lifestyles and television in bedrooms. Older people frequently fall asleep soon after dinner -- often in front of a television -- and awaken at 2 a.m. unable to return to sleep. The result is fragmented sleep that night, sleepiness the next day and a vicious cycle of sleep disruption that can wreak havoc on a person's health and his wake-sleep cycle. 

"The bedroom should be used for sleep and sex," said Dr. Bloom, "not for heated arguments, watching TV or reading important documents."

-- Melissa Healy

CDC report reinforces crucial advice: Call 911 at first sign of stroke

A three-year study of 57,000 stroke victims has found troubling evidence that, despite widespread awareness campaigns, many people experiencing symptoms of stroke do not act quickly enough to avert damage and disability.

In a report released today by the Centers for Disease Control and Prevention, a national registry of patients who suffered a stroke between 2005 and 2007 has found that nearly 40% used private transportation to get to a hospital emergency room rather than calling 911.

Bad decision, because as every neurologist will tell you: Time is Brain.

Only about 20% got to a hospital within two hours of the onset of stroke symptoms -- which include weakness or numbness on one side of the body, sudden vision problems, confusion and difficulty in speaking or understanding or a sudden bout of extreme dizziness or severe headache with no known cause. (See all the symptoms -- and memorize them! -- right here.) That delay is particularly important because the treatment most effective in reducing death and disability from strokes caused by a blockage of a blood vessel -- tissue plasminogen activator (or tPA) -- must be administered no later than three hours after the onset of symptoms to be effective. Other stroke treatments also drive down death and disability, but are most effective when given promptly.

(A study published last month may offer some reprieve from that timetable. The study, published in the British journal Lancet, suggested the window within which tPA could be administered might safely be expanded to 4 1/2 hours. But if you are experiencing stroke symptoms, don't count on it -- call 911 immediately.)

But getting to the hospital in time, apparently, is no assurance that tPA will be administered. Just under 40% of patients who fit the criteria for getting the clot-busting drug actually received it during the study period, which tracked patients from Georgia, Massachusetts, Illinois and North Carolina. Many hospitals and physicians do not have access to tPA or the expertise to administer it, and the drug's fearsome risk -- of bleeding in the brain, particularly if it is administered after the prescribed window has closed -- discourages many from using it.

Each year, 795,000 in the United States suffer a stroke, and for 610,000 of them it is their first. You don't want to be one of them. Quit smoking, maintain a normal weight, take your blood pressure medications in you have 'em. If you or a loved one could be a victim, learn the signs. And if you see them, don't dally: Call 911.

-- Melissa Healy

Older people with knee pain may get help from tai chi

Knee pain from osteoarthritis is a common and often chronic ailment for older people. But a new study finds that practicing tai chi exercises may not only reduce osteoarthritis pain, but improve function as well.

Tai chi is a Chinese martial art with a mind-body connection that emphasizes flexibility, balance and strength. Tai chi has been used in a number of research studies because of its health benefits. Many believe that practicing the slow, controlled movements reduces stress while enhancing muscle coordination and flexibility and increasing energy.

Forty people with knee osteoarthritis, average age 65, were recruited for the study by researchers from the Tufts University School of Medicine. Half were randomly placed in hour-long twice-weekly tai chi classes for three months. The classes included self-massage, tai chi movements, breathing techniques and relaxation. Participants were also asked to practice tai chi for at least 20 minutes a day at home while maintaining their usual physical routine.

The other 20 participants acted as the control group, attending twice-weekly hour-long sessions on osteoarthritis that included information on diet and nutrition, plus ways to treat the condition and how to handle stress. They also took part in full-body stretching exercises and were encouraged to stretch for 20 minutes a day at home and follow their regular physical regimen.

After the three months, those in the tai chi group saw a substantial drop in knee pain compared with the control group. The tai chi group also saw more improvements in function, depression and health status.

In the study, the authors wrote that though the exact mechanisms are not know for how tai chi may improve knee osteoarthritis, "synergy between its physical and mental components likely plays a major role. First, tai chi may enhance cardiovascular benefits, muscular strength, balance, coordination, and physical function. All of these are thought to be able to reduce joint pain."

The study appears in the November issue of the journal Arthritis Care & Research.

-Jeannine Stein

Photo credit: Daniel Sorabji / AFP/Getty Images

Docs decide the time is right to recommend an erectile dysfunction drug

Just in case anyone out there was unconvinced that erectile dysfunction is best treated by popping one of those well-advertised pills, the American College of Physicians has officially proclaimed the superiority of drugs such as Viagra, Levitra and Cialis over hormone treatment.

Published in the Annals of Internal Medicine, the new clinical practice guideline finds that for most men who complain of erectile dysfunction, one of the phosphodiesterase Type-5 inhibitors -- sildenafil, tadalafil, and vardenafil -- is a more effective treatment than pills, creams, gels or patches containing testosterone.

The physicians group limited themselves to comparing ED drugs with testosterone therapy alone. They did not consider alternative treatments for erectile dysfunction that they said are rarely recommended by primary-care physicians, including psychotherapy, pump devices, suppositories or injections.

While oral or gel testosterone were a little more effective than a placebo in the studies reviewed by the guideline's authors, the so-called PDE-5 inhibitors improved erections in 73%-88% of cases (compared with 26%-32% of cases in which a placebo improved the quality of a man's erection). The practice guideline found little research evidence to recommend one of the five ED drugs over another, leading the authors to recommend that doctors base their prescribing decisions on a drug's cost, ease of use, side effect profile and the patient's preference.

The guideline's drafters did find evidence that for sildenafil (Viagra) and vardenafil (Levitra), slightly higher doses (50 milligrams. and 20 milligrams, respectively) tended to yield the best results. (For tadalafil -- Cialis -- they found no dosage consistently superior).

Talking about the drugs' side effects, the physicians who wrote the practice guideline complained that the research evidence in this area was "limited and inconclusive," and called for more to be done. They noted common side effects -- headache, flushing, stuffy nose and upset stomach -- but wrote that future trials need to flesh out which medications are most likely to result in the more serious side effects of visual disturbance, myalgia, nausea, diarrhea, vomiting and chest pain.

There's plenty of money riding on this recommendation. Given the aging population, increased life expectancy and rising rates of diabetes and cardiovascular disease, the Annals article cites a projection estimating that by 2025, 322 million men will suffer from ED. If all American men sought medical help for ED today, the cost could be $15 billion.

Which brings us to the question of whether the guideline's authors are receiving money from the makers of ED drugs. Of the seven authors, one disclosed that he has received grants for research from Pfizer, maker of Viagra. A second author had received research funding from a variety of drug manufacturers, but none that produce ED drugs.

-- Melissa Healy

Internet use may help you search and find...a healthier mind

Here's an inducement for Sen. John McCain (R-Ariz.) and fellow seniors who've stayed off the information superhighway: if you take the on-ramp now, you'll get extra benefits in the form of improved cognitive dexterity and better short-term memory. So says a study presented today at the Society for Neuroscience's annual meeting in Chicago.

 A team of UCLA researchers scanned the brains of 24 older adults--half of them Internet savvy, the others not--as subjects performed a task that simulated an Internet search. After providing online training for those with little Internet familiarity, the researchers instructed subjects to spend at least seven hours over the next two weeks conducting practice Internet searches, exploring websites and reading information on a range of questions. When they returned, the subjects' brains were again scanned by functional Magnetic Resonance Imaging machines, which detect blood flow throughout the brain's many regions, as the subjects conducted another round of simulated searches.

Researchers found that for the Internet-"naive" subjects, two weeks of cruising the information super highway had revved up brain function markedly. Before they had been trained to conduct Internet searches, the newbies--who had an average age of 66.8 years--had used many of the regions of brain associated with judgment, visual and spatial perception, and higher-order reasoning to perform their faux-search task. But a scan of their brains found that after two weeks of honing their search-skills, the newbies used those brain regions as well as several others when performing the faux-search task.

And not just any regions: Their brains showed activation in portions of the superior and medial frontal gyrus and the inferior frontal gyrus. Those are regions of the brain key to decision-making, working memory and interference resolution--the skill of fending off distracting intrusions and allowing necessary ones while "bookmarking" one's place in a task to return.

After the training, the brain function of the Internet-naive adults during the task looked pretty much like that of the Internet-savvy older adult subjects, whose ages averaged 62.4 years. But the Internet-savvy adults actually seemed to be dogging it on the second try, using less brainpower  than they had the first time to perform the faux-search task. That's probably because they had recognized the task the second time around, and found it easier to do, researchers said.

UCLA neuroscientist Gary Small, author of the book iBrain and one of the study's authors, said the study makes clear that for older adults looking to sharpen their memories and boost their cognitive fitness, the answer is at their fingertips. Small, who researches memory function and conducts seminars to improve it, has argued that society's growing reliance on technology is likely helping to "rewire" our brains in ways that are not fully understood. While he says heavy reliance on technological conveniences can be a significant cause of inattention, mastering new information technologies can be a powerful means of brain-building.

-- Melissa Healy 

Considering retirement? Working might keep you healthier

As baby boomers reach retirement age, more are opting to continue to work, whether for economic reasons, or because they simply like to work. That employment can provide more than a paycheck -- working, it seems, has pretty good mental and physical health benefits as well. 

A new study in this month's issue of the Journal of Occupational Health Psychology examined data on 12,189 retirees from the Health and Retirement Study, sponsored by the National Institute on Aging. The first four waves of the study (1992, 1994, 1996 and 1998) were included, in which people age 51 to 61 were surveyed about their health, finances, employment history and current work or retirement.

The researchers coined the term "bridge employment" to describe the transition period between full-time work and full-time retirement, in which people work part time, are self-employed or temporarily employed.

Men and women in that bridge employment category reported fewer major diseases and functional limitations compared with those who were in full retirement. Mental health was better as well, but only for those who kept working in their previous careers. Those who chose a different career path didn't show the same benefits. Choosing another career, the authors believe, could prove stressful while people adjust to new roles and a new workplace. Also, some who choose new jobs do so out of financial need, which may add additional stress.

In the study, the authors wrote: "when the retirees engage in bridge employment, they are likely to keep their levels of physical activities and mental activities through daily work. In addition, working after retirement increases retirees' role embeddedness, which has been shown to benefit health maintenance."

Going into full retirement, they add, could lead to less social contact and fewer daily activities, perhaps making them less likely to fight off major diseases and more likely to see a decrease in daily function.

In a news release, co-author Mo Wang of the University of Maryland said, "Given the economic recession, we will probably see more people considering post-retirement employment. These findings highlight bridge employment's potential benefits."

-- Jeannine Stein

Photo: Robert Durell / Los Angeles Times

Heart-healthy fish consumption: Is the big one getting away?

For even the most skeptical consumer of news on health and nutrition, the link between increased consumption of fish and better heart health seemed to be something one could take to the bank--a reliable, unassailable finding.

No more. A major European study that tracked the health and habits of every older adult in a suburb of Rotterdam, the Netherlands, has found no significant relationship between their consumption of fish and their likelihood of developing heart failure. The latest Rotterdam study is published in the October issue of the European Journal of Heart Failure.

By the time a person reaches 40, he or she has roughly a one-in-four likelihood of suffering heart failure, and an estimated 5.7 million Americans live with the condition. Strong evidence exists that the regular consumption of even small amounts of the long-chain n-3 polyunsaturated fatty acids (also known as "Omega-3s") lowers an individual's risk of coronary heart disease. The American College of Cardiology recently published a review of four studies of Omega-3 intake and concluded there is "great promise" for the prevention of cardiovascular disease in the consumption of long-chain n-3 polyunsaturated fatty acids. 

Omega 3 consumption is thought to affect cardiovascular risk by suppressing inflammation, reducing heart rate, blood pressure and the buildup of fatty deposits in the blood, as well as by helping to maintain normal heart rhythm. But the current study suggests that the heart muscle's failure to pump sufficient blood for everyday activities is not averted by Omega-3 consumption.

The study divided its 5,299 subjects, with a mean age of 67.5 years, into five groups depending on the frequency and amount of their fish consumption. At the end of 11.4 years, the 669 subjects who developed heart failure were no more nor less likely to eat fish than those who did not, even after researchers took account of other lifestyle and dietary habits that might contribute to heart problems.

Dr. Marianne Geleinjse of Wageningen University in the Netherlands, one of the study's authors, acknowledged the study appears to run counter to mounting evidence for fish consumption's beneficial effects. "Based on our data, we would not change... advice" suggesting that people eat at least two weekly servings of fish, she added. Geleinjse cautioned that Dutch intake of fish is extremely low--on average less than one serving per week. "So maybe higher intakes are needed for any protection against heart failure," she noted.

-- Melissa Healy