Aging health最新文献

{"title":"Comparing optimized exoskeleton assistance of the hip, knee, and ankle in single and multi-joint configurations.","authors":"Patrick W Franks, Gwendolyn M Bryan, Russell M Martin, Ricardo Reyes, Ava C Lakmazaheri, Steven H Collins","doi":"10.1017/wtc.2021.14","DOIUrl":"10.1017/wtc.2021.14","url":null,"abstract":"<p><p>Exoskeletons that assist the hip, knee, and ankle joints have begun to improve human mobility, particularly by reducing the metabolic cost of walking. However, direct comparisons of optimal assistance of these joints, or their combinations, have not yet been possible. Assisting multiple joints may be more beneficial than the sum of individual effects, because muscles often span multiple joints, or less effective, because single-joint assistance can indirectly aid other joints. In this study, we used a hip-knee-ankle exoskeleton emulator paired with human-in-the-loop optimization to find single-joint, two-joint, and whole-leg assistance that maximally reduced the metabolic cost of walking. Hip-only and ankle-only assistance reduced the metabolic cost of walking by 26 and 30% relative to walking in the device unassisted, confirming that both joints are good targets for assistance (<i>N</i> = 3). Knee-only assistance reduced the metabolic cost of walking by 13%, demonstrating that effective knee assistance is possible (<i>N</i> = 3). Two-joint assistance reduced the metabolic cost of walking by between 33 and 42%, with the largest improvements coming from hip-ankle assistance (<i>N</i> = 3). Assisting all three joints reduced the metabolic cost of walking by 50%, showing that at least half of the metabolic energy expended during walking can be saved through exoskeleton assistance (<i>N</i> = 4). Changes in kinematics and muscle activity indicate that single-joint assistance indirectly assisted muscles at other joints, such that the improvement from whole-leg assistance was smaller than the sum of its single-joint parts. Exoskeletons can assist the entire limb for maximum effect, but a single well-chosen joint can be more efficient when considering additional factors such as weight and cost.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"7 1","pages":"e16"},"PeriodicalIF":0.0,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10936256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90145415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary tract infection in older adults.","authors":"Theresa A Rowe,&nbsp;Manisha Juthani-Mehta","doi":"10.2217/ahe.13.38","DOIUrl":"https://doi.org/10.2217/ahe.13.38","url":null,"abstract":"<p><p>Urinary tract infection and asymptomatic bacteriuria are common in older adults. Unlike in younger adults, distinguishing symptomatic urinary tract infection from asymptomatic bacteriuria is problematic, as older adults, particularly those living in long-term care facilities, are less likely to present with localized genitourinary symptoms. Consensus guidelines have been published to assist clinicians with diagnosis and treatment of urinary tract infection; however, a single evidence-based approach to diagnosis of urinary tract infection does not exist. In the absence of a gold standard definition of urinary tract infection that clinicians agree upon, overtreatment with antibiotics for suspected urinary tract infection remains a significant problem, and leads to a variety of negative consequences including the development of multidrug-resistant organisms. Future studies improving the diagnostic accuracy of urinary tract infections are needed. This review will cover the prevalence, diagnosis and diagnostic challenges, management, and prevention of urinary tract infection and asymptomatic bacteriuria in older adults.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"9 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ahe.13.38","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32003185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Clostridium difficile</i> infection in older adults.","authors":"Robin Lp Jump","doi":"10.2217/ahe.13.37","DOIUrl":"10.2217/ahe.13.37","url":null,"abstract":"<p><p><i>Clostridium difficile</i> infection, the most frequent cause of nosocomial diarrhea, disproportionately affects older adults. The two most important risk factors for developing <i>C. difficile</i> infection are antimicrobial exposure and age >65 years old. Risk factors specific to older adults are frequent interactions with healthcare systems and age-related changes in physiology, including immune senescence and changes to the gut microbiome. Metronidazole and oral vancomcyin are the mainstays of conventional treatment for <i>C. difficile</i> infection. Alternative therapies include fidaxomicin, a narrow-spectrum macrocyclic antibiotic, and fectal bacteriotherapy, which offers an excellent therapeutic outcome. Strategies to prevent <i>C. difficile</i> infections include enhanced infection control measures and reducing inappropriate antimicrobial use through stewardship.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"9 4","pages":"403-414"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ahe.13.37","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32445571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of cardiac amyloidosis due to wild-type and V122I transthyretin in older adults referred to an academic medical center.","authors":"Raymond C Givens,&nbsp;Chris Russo,&nbsp;Philip Green,&nbsp;Mathew S Maurer","doi":"10.2217/ahe.13.10","DOIUrl":"https://doi.org/10.2217/ahe.13.10","url":null,"abstract":"<p><strong>Aims: </strong>In the USA, transthyretin cardiac amyloidosis usually results from 'wild-type' transthyretin (senile cardiac amyloidosis [SCA]) or the V122I variant.</p><p><strong>Patients & methods: </strong>We compared presentations and outcomes among SCA and V122I patients referred to the Center for Advanced Cardiac Care at Columbia University Medical Center (NY, USA) between 2001 and 2012.</p><p><strong>Results: </strong>V122I patients were younger (mean: 71 years, standard deviation [SD]: 7) than SCA patients (mean: 77, SD: 6; p = 0.0002) and 96% were black compared with 3% of SCA patients (p < 0.0001). Average ejection fraction was lower among V122I patients (mean: 25% [SD: 12] vs mean: 47% [SD: 15]; p = 0.0001), as was mean cardiac index. Median time to death or orthotopic heart transplant was 36.4 months for V122I patients and 66.5 for SCA patients (p = 0.09).</p><p><strong>Conclusion: </strong>In this study of patients with transthyretin cardiac amyloidosis, V122I patients presented to a tertiary academic medical center at a younger age than SCA patients but had higher levels of cardiac dysfunction, despite genetic screening availability. There was a trend toward shorter time to orthotopic heart transplant or death among V122I patients. Whether this is a result of a different biologic progression or late diagnosis requires further study.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"9 2","pages":"229-235"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ahe.13.10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31764036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study of the effects of meditation on regional brain metabolism in distressed dementia caregivers.","authors":"Kelsey L Pomykala,&nbsp;Daniel Hs Silverman,&nbsp;Cheri L Geist,&nbsp;Patricia Voege,&nbsp;Prabha Siddarth,&nbsp;Nora Nazarian,&nbsp;Natalie M St Cyr,&nbsp;Dharma S Khalsa,&nbsp;Helen Lavretsky","doi":"10.2217/ahe.12.46","DOIUrl":"https://doi.org/10.2217/ahe.12.46","url":null,"abstract":"<p><p>AIMS: Caregiver distress can affect mood and cognition. Meditation can be used to reduce stress. This pilot study explored whether yogic meditation could change regional cerebral metabolism in distressed caregivers. METHODS: Nine dementia caregivers were randomized to undergo meditation training compared with relaxation for 12 min per day for 8 weeks. Caregivers received neuropsychiatric assessments and brain FDG-PET scans at baseline and postintervention. RESULTS: The groups did not differ on measures of mood, mental and physical health, and burden at baseline and follow-up. When comparing the regional cerebral metabolism between groups, significant differences over time were found in the bilateral cerebellum (p < 0.0005), right inferior lateral anterior temporal (p < 0.0005), right inferior frontal (p = 0.001), left superior frontal (p = 0.001), left associative visual (p = 0.002) and right posterior cingulate (p = 0.002) cortices. CONCLUSION: Meditation practice in distressed caregivers resulted in different patterns of regional cerebral metabolism from relaxation. These pilot results should be replicated in a larger study.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"8 5","pages":"509-516"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ahe.12.46","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31211441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants and osteoarthritis outcomes.","authors":"My-Linh N Luong, Rebecca J Cleveland, Kirsten A Nyrop, Leigh F Callahan","doi":"10.2217/ahe.12.43","DOIUrl":"10.2217/ahe.12.43","url":null,"abstract":"<p><p>Osteoarthritis (OA) is one of the most frequently occurring musculoskeletal diseases, posing a significant public health problem due to its impact on pain and disability. Traditional risk factors fail to account for all of the risk observed for OA outcomes. In recent years, our view of disease causation has broadened to include health risks that are created by an individual's socioeconomic circumstances. Early research into social determinants has focused on social position and explored factors related to the individual such as education, income and occupation. Results from these investigations suggest that low education attainment and nonprofessional occupation are associated with poorer arthritis outcomes. More recently, research has expanded to examine how one's neighborhood socioeconomic environment may be relevant to OA outcomes. This narrative review proposes a framework to help guide our understanding of how social context may interact with pathophysiological processes and individual-level variables to influence health outcomes in those living with OA.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"8 4","pages":"413-437"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519433/pdf/nihms406824.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31126192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difficulties sleeping: a natural part of growing older?","authors":"Michael A Grandner,&nbsp;Nirav P Patel,&nbsp;Nalaka S Gooneratne","doi":"10.2217/ahe.12.21","DOIUrl":"https://doi.org/10.2217/ahe.12.21","url":null,"abstract":"groups. For daytime tiredness, this pattern was similar, except that rates climbed steadily again, starting from the age of 70 years. When adjusted for cofactors such as socioeconomics, demographics, access to healthcare and overall health, this pattern became even stronger, with the highest rates in the youngest adults, an increase in middle age (especially in women) and a decline in older age. Interestingly, the rise in daytime tiredness in older adults was completely explained by these cofactors (rather than age itself). These results demonstrated that not only was there no notable increase in sleep-related complaints in older adults, there was a general decrease, with the highest rates in the youngest adults. Furthermore, these results showed that sleep complaints and, especially, daytime tiredness in older adults, can be largely explained by socioeconomic, health and mental health factors, rather than the process of aging per se. These findings are consonant with a growing","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ahe.12.21","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31867675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-Life Depression in Home Healthcare.","authors":"Yolonda Pickett, Patrick J Raue, Martha L Bruce","doi":"10.2217/ahe.12.28","DOIUrl":"10.2217/ahe.12.28","url":null,"abstract":"<p><p>Major depression is disproportionately common among elderly adults receiving home healthcare and is characterized by greater medical illness, functional impairment, and pain. Depression is persistent in this population and is associated with numerous poor outcomes such as increased risk of hospitalization, injury-producing falls, and higher health care costs. Despite the need for mental health care in these patients, significant barriers unique to the home healthcare setting contribute to under-detection and under-treatment of depression. Intervention models target the home healthcare nurse as liaison between patients and physicians, and instruct in the identification and management of depression for their patients. Successful implementation requires interventions that 'fit' how home healthcare is organized and practiced, and long distance implementation strategies are required to increase the reach of these interventions.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"8 3","pages":"273-284"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587974/pdf/nihms439056.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31300085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant chemotherapy and targeted therapy in elderly non-small-cell lung cancer patients.","authors":"Aminah Jatoi","doi":"10.2217/ahe.12.29","DOIUrl":"https://doi.org/10.2217/ahe.12.29","url":null,"abstract":"<p><p>Adjuvant chemotherapy and targeted therapies comprise two salient practice-changing improvements in the treatment of non-small-cell lung cancer. Despite the fact that these improvements have been largely data-driven, the following questions arise: what is the role of adjuvant chemotherapy in elderly patients with non-small-cell lung cancer? What is the role of targeted agents, such as erlotinib and bevacizumab, in older non-small-cell lung cancer patients? These questions are relevant because the current median age of lung cancer patients at diagnosis in the USA is 69 years, and the number of older patients developing this malignancy is increasing. This review provides guidance on how best to approach the use of adjuvant chemotherapy and targeted therapies in older patients with this disease.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"8 3","pages":"309-316"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ahe.12.29","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31076126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How does hearing loss affect the brain?","authors":"Arthur Wingfield, Jonathan E Peelle","doi":"10.2217/AHE.12.5","DOIUrl":"https://doi.org/10.2217/AHE.12.5","url":null,"abstract":"This type of 'effortful listening' is associated with increased stress responses, changes in pupil dilation, and poorer behavioral performance (e.g., on memory tests for degraded speech). It is thus possible that even a mild-to-moderate hearing loss can inflate the appearance of cognitive decline in the older adult – a cautionary note for the geriatric clinician/diagnostician and family members alike. This sensory–cognitive interaction is a reminder that the auditory system may be the conduit to the brain, but it is the brain that 'hears' [6]. The connection between hearing acuity and cognition, however, may go beyond the effects of competition for limited resources under conditions of effortful listening. A striking finding from a recent large-scale population study has revealed a strong statistical connection between the appearance and degree of hearing loss and all-cause dementia [7]. Indeed, as Lin and colleagues have shown, this relationship persists even when adjusted for sex, age, race, education, diabetes, smoking history and hyper tension [8]. This statistical relationship does not in itself establish causation, such as whether continuous perceptual effort with hearing loss takes a cumulative toll on cognitive reserves, whether the cognitive decline is consequent to depression and social isolation that can often accompany a serious hearing loss, or whether the parallel incidence of reduced hearing acuity and the appearance of dementia are independent reflections of an aging nervous system. It is also possible that all of these factors may be contributing to the relationship between hearing acuity and demen-tia to some degree. It is the case, however, that these findings join others that have begun to show a statistically reliable association between auditory processing deficits and the appearance of cognitive decline [9]. Although the relationship between hearing loss and cognitive ability must be rooted in the brain, only recently have cognitive neuroscientists begun to explicitly examine the neurobiological bases for these effects. A recent pair of studies using MRI were aimed at precisely examining this link [10]. All Although estimates vary, some 40–50% of adults over the age of 65 years have a measure-able hearing impairment, with this figure rising to 83% of those over the age of 70 years [1]. These data make hearing loss the third most prevalent chronic medical condition among older adults, after arthritis and hypertension [2]. Beyond the obvious impediment to spoken communication , we have come to realize that there are also hidden effects of hearing loss that …","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"8 2","pages":"107-109"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/AHE.12.5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72212228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}