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Research news
As an ICAA member you can access a library of over 2,000 peer-reviewed and published studies. You can also stay up to date with current research by reading ICAA Research Review, the online newsletter of breaking news in health, wellness and demographics. Published 45 times each year, Research Review is emailed to ICAA members. To learn more about becoming an ICAA member please visit, www.icaa.cc or telephone ICAA toll-free at 866-335-9777.
Intervention improves insomnia and pain due to osteoarthritis
According to recent research, cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for older adults who have both osteoarthritis and disordered sleep. Led by Michael V. Vitiello, PhD, at the University of Washington in Seattle, this study shows that treatment improves immediate and long-term self-reported sleep and pain in those with both osteoarthritis and insomnia, without directly addressing pain control.
The CBT-I intervention consisted of 8 weekly, 2-hour classes. Sleep and pain were assessed by self-report at baseline, after treatment, and (for CBT-I only) at one-year follow-up, with sleep logs recorded prior to and after treatment and at follow-up. These logs included information about sleep latency (the time it takes to fall asleep); waking after sleep onset (the amount of awake time from initial onset of sleep to full awakening); and sleep efficiency (the ratio of total time spent asleep to time spent in bed for sleep).
Study participants who received CBT-I reported significantly decreased sleep latency and wake after sleep onset, significantly reduced pain, and increased sleep efficiency. These improvements persisted in 19 of 23 CBT-I patients (mean age 69) who were further assessed at follow-up. In contrast, participants in an attention control group reported no significant improvements in any measure. Successful treatment of sleep disturbance thus may improve quality of life.
Insomnia typically coexists with other illnesses, pain conditions and depression in older adults, according to Vitiello. “What we and others are showing,” he says, “is that CBT-I can not only improve sleep but that improvement of sleep may lead to improvement in coexisting medical or psychiatric illnesses, such as osteoarthritis or depression, and in the case of our study, that these additional benefits can be seen in the long term.”
The study authors recommend that CBT-I, which specifically targets sleep, be incorporated into behavioral interventions for pain management in osteoarthritis and possibly for other chronic pain conditions as well.
Sources: American Academy of Sleep Medicine, August 15, 2009; Journal of Clinical Sleep Medicine, 5(4), 355–362, 2009
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Falls with walking aids land elders in emergency
From 2001 to 2006, an average of 129 Americans ages 65 and older were treated in emergency departments every day for injuries from falls that involved walkers and canes, US Centers for Disease Control and Prevention (CDC) research reveals. That adds up to more than 47,000 older adults each year, according to the study, which was based on an examination of emergency medical records.
Most fall injuries involved walkers (87%). Older adults proved 7 times more likely to be injured in a fall with a walker as with a cane. In addition, older women sustained more than 3 in 4 walker-related injuries (78%) and 2 in 3 cane-related injuries (66%). Other key findings include:
- The chances of sustaining a fall increased with age for those who used walkers or canes; the highest injury rates were among those ages 85-plus.
- Fractures were the most common type of fall injury associated with walkers (38%) and canes (40%), and about one-third of all injuries were to the lower trunk (e.g., hip, pelvis).
- More than half of fall injuries associated with walkers (60%) and canes (56%) occurred at home.
- One in 3 people whose fall involved a walker had to be hospitalized, as did more than one in 4 (28%) whose fall involved a cane.
This study underscores the importance of preventing falls related to walking aids, according to the study authors. They suggest prevention strategies, including encouraging professionals to spend more time fitting walking aids; and educating people how to use walkers and canes safely—for example, by having physical therapists provide counseling at health fairs. More studies are needed, they add, to better understand fall risk factors for older adults who use walkers and canes, as well as to identify issues related to walker design.
Sources: US Centers for Disease Control and Prevention, June 29, 2009; Journal of the American Geriatrics Society, 57(8), 1464–1469, 2009
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Brain exercises may delay memory decline in dementia
People who engage in activities that exercise the brain may delay the rapid memory decline that occurs if they later develop dementia, indicates a study by Charles B. Hall, PhD, of New York’s Albert Einstein College of Medicine, and colleagues.
The researchers studied 488 people ages 75–85 years who did not have dementia at the study’s start. The team followed participants for an average of 5 years, during which 101 individuals developed dementia. At the beginning of the study, people reported how often they participated in 6 leisure activities that engage the brain: reading, writing, doing crossword puzzles, playing board or card games, having group discussions, and playing music. For each activity, daily participation was rated at 7 points, several days a week at 4 points, and weekly participation at one point. The average was 7 points total for those who later developed dementia, meaning they took part in one activity each day, on average. Ten people reported no activities, while 11 reported only one activity per week.
The research team then looked at when memory loss started accelerating rapidly for the participants. They found that for every additional activity a person participated in, the onset of rapid memory loss was delayed by 0.18 years. “The point of accelerated decline was delayed by 1.29 years for the person who participated in 11 activities per week compared to the person who participated in only 4 activities per week,” says Hall. Results remained valid after researchers factored in participants’ education levels.
“The effect of these activities in late life appears to be independent of education,” Hall comments, adding that these activities “might help maintain brain vitality.” He stresses that additional studies are needed “to determine if increasing participation in these activities could prevent or delay dementia.”
Sources: American Academy of Neurology, August 3, 2009; Neurology, 73(5), 356–361, 2009
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Canada’s Boomers maintain positive outlook on future inheritances
In Canada, estimates suggest that Boomers stand to inherit approximately $1 trillion over the next 20 years. According to new research from the BMO Retirement Institute in Toronto, Canadians’ expectations of this massive transfer of wealth have not dampened despite recent economic turmoil. The survey indicates:
- Almost 30% of Canadian Boomers are expecting to receive an inheritance from someone in their immediate or extended family.
- Less than one-third of those expecting an inheritance believe it will be smaller than previously thought due to the recent economic crisis.
- Almost one in four Boomers say they will rely more heavily than expected on their inheritance to reach their financial goals due to the recent economic crisis.
- Less than 3% of Boomers say they will be unable to leave an inheritance due to current economic turmoil.
Regardless of this positive outlook, the study reveals that most families have yet to adequately address all the challenges associated with the biggest transfer of wealth in history.
Source: BMO Retirement Institute, July 15, 2009
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New care management model improves outcomes and saves money
Geriatric Resources for Assessment and Care of Elders (GRACE), a new team approach to preventive healthcare delivery for older adults, improved participant health and quality of life, decreased emergency department visits and lowered hospital admission rates, researchers found. By the second year, this model saved money for the sickest individuals (those with 3–4 chronic diseases), and in the third year—a year after the home-based intervention ended—it saved even more, according to a recently published cost analysis.
Developed by researchers from Indiana University (IU) and the Regenstrief Institute in Indianapolis, GRACE involved older adults and primary care physicians in a program to optimize health and functional status, and decrease high-cost emergency department visits and hospital admissions. The randomized, controlled trial enrolled 951 low-income older adults (average age 72). Among these individuals, 477 received usual care and 474 participated in GRACE. Both the usual care and GRACE groups included lower and higher risk for hospitalization individuals, were predominately female (77%) and African-American, and were seen at 6 community-based health centers.
GRACE focused on many issues faced by aging low-income adults, says study leader Steven R. Counsell, director of geriatrics for IU Medical Group. These issues included “access to needed services, medications, mobility, depression, transportation, nutrition, as well as other health issues of aging.” A support team, consisting of a nurse practitioner and a social worker, met with each patient at home to conduct an initial geriatric assessment from the medicine cabinet to the kitchen cabinet. Based on these findings, a larger interdisciplinary team—a geriatrician, pharmacist, physical therapist, mental health social worker, and community-based services liaison—developed an individualized care plan. The support team then moved ahead. This pair met with the patient’s primary care doctor to come up with a healthcare plan consistent with the patient’s goals (e.g., continuing to participate in social and religious activities). The nurse practitioner and social worker then worked with the patient to implement the plan, and provided ongoing care management.
“Healthcare reform is calling out for ways to improve health and lower costs,” Counsell observes. “We have found a strategy to do that for a very vulnerable growing population in a way that shows cost-savings over time,” he states, “and has the added benefit of providing services that these seniors desperately need but can’t get elsewhere.”
Sources: Indiana University, August 11, 2009; Journal of the American Geriatrics Society, 57(8), 1420–1426, 2009
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Economic anxiety prompts lifestyle changes
The recession is driving many American workers to make behavioral changes to improve health and well-being and better control healthcare costs, reveals a survey commissioned earlier this year by the National Business Group on Health (NBGH). In March 2009, Fidelity Investments surveyed 1,500 workers employed at large employers (2,000 or more employees) on behalf of the Washington, DC-based NBGH. Survey respondents were aged between 22 and 69 years and received benefits through an employer-sponsored or union-sponsored health plan.
Among the key findings:
- The economic downturn is taking a toll on employees’ physical and mental health: 27% of respondents forwent healthcare treatment to save money on copayments or coinsurance costs; 20% skipped prescription drug medication; and 44% of those ages 45–64 said their mental health had been negatively affected.
- Health improvement is more of a priority than it was a year ago: 52% of respondents said that living a healthy lifestyle was now a higher priority; 34% exercised more; 46% ate more healthfully; and 44% ate out less at fast-food restaurants.
NBGH believes the survey data provide a pathway for businesses to help their workers thrive despite the bad economy. This pathway includes, among others, offering financial incentives to motivate health behavior changes; using benefit statements to clearly articulate a commitment to wellness; and providing more targeted communications based on specific health conditions.
Source: National Business Group on Health, May 27, 2009
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Waist-hip ratio bests BMI as obesity gauge in older adults
Body mass index (BMI) readings may not be the best gauge of obesity in older adults, according to endocrinologists and geriatricians from the University of California–Los Angeles. These researchers found the waist-to-hip circumference ratio was a better yardstick for high-functioning adults between ages 70 and 80 years.
Using data from the MacArthur Successful Aging Study, the UCLA team examined all-cause mortality risk over 12 years by BMI, waist circumference and waist-hip ratio, adjusting for gender, race, baseline age and smoking status. They found no association between all-cause mortality and BMI or waist circumference. But there was a link with waist-hip ratio.
In women, each 0.1 increase in the waist-hip ratio was associated with a 28% relative increase in mortality rate (the number of deaths per 100 older adults per year) in the group sampled. For example, if hip size was 40”, an increase in waist size from 32” to 36” signaled a 28% relative death-rate increase.
The relationship was not graded in men, however. Instead, there was a threshold effect: The rate of dying was 75% higher in men with a waist-hip ratio greater than 1.0—that is, men whose waists were larger than their hips—relative to those with a ratio of 1.0 or lower. There was no such relationship with either waist size or BMI.
Sources: University of California–Los Angeles, September 1, 2009; Annals of Epidemiology, 19(10), 724–731, 2009
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Hypertension linked to midlife memory problems
High blood pressure is associated with memory problems in people over age 45, suggests recently published research. Led by Georgios Tsivgoulis, MD, of the University of Alabama at Birmingham, this study found that people with high diastolic (bottom number) blood pressure readings were more likely to have problems with their memory and thinking skills than people with normal diastolic readings. Also, for every 10 point increase in this reading, the odds of a person having cognitive problems were 7% higher. These results were valid after adjusting for other factors that could affect cognitive abilities, such as age, smoking status, exercise level, education, diabetes or high cholesterol.
The study involved nearly 20,000 people ages 45 and older in the United States who participated in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study and had never had a stroke or mini-stroke. A total of 1,505 participants (7.6%) had cognitive problems and 9,844 (49.6%) were taking medication for high blood pressure. (This condition was defined as a reading equal to or higher than 140/90 mmHg or taking medication for high blood pressure.) Tsivgoulis speculates that preventing or treating high blood pressure “could potentially prevent cognitive impairment, which can be a precursor to dementia.” More research is needed, he stresses, to confirm the relationship between hypertension and cognitive impairment.
Sources: American Academy of Neurology, August 24, 2009; Neurology, 73(8), 589–595, 2009
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Britain’s ‘Baby Gloomers’ unprepared for parents’ retirement care
Research released by Aviva, a leading global insurance group, suggests a potentially difficult financial future for Britain’s aging population. According to the Aviva Cost of Family Care study, 62% of people over age 50 worry that their pensions and savings are unlikely to see them through retirement. This is creating a generation of “Baby Gloomers” in the United Kingdom—those facing the prospect of simultaneously financing both their parents and their children.
Key findings from the study include:
- Fully 71% of respondents fear their parents’ shortage in retirement funding could cause severe problems for their own financial futures.
- About 60% are concerned their parents will not be able to afford to stay in their existing homes in retirement; 25% plan for their parents to live with them.
- Among those with savings and investments, 11% say they are ready to cash these in to fund their parents’ retirement.
- Almost 10% are worried that their parents might not be able to pay for any required medical care during retirement.
- Many would like to support their parents financially during retirement, but 67% say their own financial situation makes that impossible; 43% are delaying financial plans for their retirement because of the current economic climate.
- Over 40% worry they will have to work longer than they planned, to support their parents.
- Respondents also worry they will have to cut back on working hours to care for their parents, with 13% voicing this concern.
Despite these fears, more than two-thirds (81%) of people in the “Baby Gloomers” generation admit they haven’t made plans for looking after their older relatives.
“Future finances are one of the most crucial areas families need to discuss and a key area where people should seek independent financial advice,” comments Paul Goodwin, head of pension propositions for UK Life, Aviva. “Almost half (45%) of adults told us they have no idea how their parents plan to fund their retirement, but 6 in 10 (62%) admitted they feel uncomfortable asking their parents questions about their finances.”
Source: Aviva, June 24, 2009
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Previous exercise helps stroke patients recover more quickly
Individuals who exercised regularly prior to a stroke appear to recover more quickly, report researchers from the Mayo Clinic in Florida. These stroke patients are significantly more likely to have milder impairments, and, thus, are better able to care for themselves compared with patients who rarely exercised, this study shows.
The researchers reviewed a questionnaire asking study participants about their previous exercise. They also looked at measurements of stroke outcome taken after the stroke and then again 3 months later. Of the 673 individuals enrolled in the study, 50.5% reported that prior to their stroke, they exercised less than once a week; 28.5% exercised one to 3 times a week; and 21% reported aerobic physical activity 4 times a week or more. After accounting for patient variables, the researchers found that exercise did not affect the size or severity of a stroke, but did modulate outcomes. Specifically, these participants scored better in tests that assessed their ability to perform daily activities involved in living on their own.
“We infer that patients who are active may recover more quickly immediately after a stroke, with trends that point to better outcomes at 3-month follow-up,” observes Mayo Clinic neurologist James Meschia, MD. A larger study is needed to validate findings, he cautions, because the study depended on recall from 673 people who had a stroke. A new study could also help clarify whether moderate or vigorous exercise is necessary to improve outcomes, he says.
Sources: Mayo Clinic, July 16, 2009; Journal of Neurology, Neurosurgery & Psychiatry, 80(9), 1019–1022, 2009
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