Aging health最新文献

{"title":"Influenza vaccination in the elderly: seeking new correlates of protection and improved vaccines.","authors":"Janet E McElhaney","doi":"10.2217/1745509X.4.6.603","DOIUrl":"10.2217/1745509X.4.6.603","url":null,"abstract":"<p><p>Influenza is foremost among all infectious diseases for an age-related increase in risk for serious complications and death. Determining the benefit of current influenza vaccines is largely limited to epidemiologic studies, since placebo-controlled trials of influenza vaccines are no longer considered ethical in the older adult population. Vaccine effectiveness is calculated from the relative reduction in influenza outcomes in individuals who elect to be vaccinated compared with those who do not, the assumptions for which are diverse and have led to considerable controversy as to the exact benefit of influenza vaccination in older adults. In spite of this controversy, there is no doubt that new influenza vaccine technologies are needed to improve protection and reverse the trend of rising hospitalization and death rates related to influenza in older adults despite widespread influenza vaccination programs. This article will review the challenges to new vaccine development, explore the potential correlates of protection against influenza, and describe how new vaccine technologies may improve protection against complicated influenza illness in the older adult population.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 6","pages":"603-613"},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2790215/pdf/nihms88120.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28595525","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":"Epidemiology of HIV and response to antiretroviral therapy in the middle aged and elderly.","authors":"Kelly A Gebo","doi":"10.2217/1745509X.4.6.615","DOIUrl":"10.2217/1745509X.4.6.615","url":null,"abstract":"<p><p>HIV is increasing in prevalence in the middle aged and older population owing to both increased longevity, and new infections in these populations. Highly active antiretrorival therapy (HAART) therapy may be less effective at restoring immune function in older patients compared with younger patients. There are significant toxicities associated with HAART therapy that, combined with decreased renal and liver function in older patients, may be more problematic in older HIV-infected patients. Comorbid disease is becoming an increasing problem with coadministration of multiple drugs and significant drug-drug interactions. Psychosocial issues in the older patient are often different than those in younger HIV-infected patients and providers should try to address these issues early. Finally, future research should work to identify the ideal timing and type of HAART regimens for older HIV-infected individuals.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 6","pages":"615-627"},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776752/pdf/nihms88127.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28510162","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":"Thiazolidinediones for elderly patients with Type 2 diabetes: safe or not?","authors":"P. Nilsson","doi":"10.2217/1745509X.4.2.131","DOIUrl":"https://doi.org/10.2217/1745509X.4.2.131","url":null,"abstract":"Evaluation of: Lipscombe LL, Gomes T, Levesque LE, Hux JE, Juurlink DN, Alter DA: Thiazolidinediones and cardiovascular outcomes in older patients with diabetes. JAMA 298, 2634–2643 (2007). Type 2 diabetes represents a heavy disease burden in the population and, especially, in elderly subjects. According to recent guidelines from the American Diabetes Association (ADA), the treatment of hyperglycemia should start with lifestyle advice and metformin. Subsequently, the physician can prescribe either insulin, sulphonylureas or thiazolidinediones (TZDs) according to efficacy, tolerability, safety and the cost of drugs. Recently, the TZD group has been scrutinized for an alleged increased cardiovascular risk, especially for congestive heart failure. This has led to a labeling of warning for prescribing physicians. In a recent Canadian ecological, observational study, the use of TZDs, most notably rosiglitazone, was associated with marked cardiovascular risks. However, observational studies are sensitive to bia...","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 1","pages":"131-135"},"PeriodicalIF":0.0,"publicationDate":"2008-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/1745509X.4.2.131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68187499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does genetic variation in the Clock gene impact obesity and the metabolic syndrome","authors":"P. Grant, E. Scott","doi":"10.2217/1745509X.4.2.101","DOIUrl":"https://doi.org/10.2217/1745509X.4.2.101","url":null,"abstract":"","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 1","pages":"101-103"},"PeriodicalIF":0.0,"publicationDate":"2008-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/1745509X.4.2.101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68187740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can pacemakers warn of impending syncope in the elderly","authors":"R. Sutton","doi":"10.2217/1745509X.4.2.109","DOIUrl":"https://doi.org/10.2217/1745509X.4.2.109","url":null,"abstract":"Professor Sutton trained at King’s College Hospital (London, UK) as an undergraduate and trained in Cardiology at St George’s Hospital (London, UK), the University of North Carolina (NC, USA) and the National Heart Hospital, London. During the years 1976–1993 he was a Consultant Cardiologist at Westminster Hospital (London, UK) and from 1993 to 2007 at the Royal Brompton Hospital (London, UK); currently his appointment is at St Mary’s Hospital (London, UK). He has been interested in cardiac stimulation since working at St George’s. During the 1980s there began to be a focus on syncope. Professor Sutton was awarded a personal Chair in Clinical Cardiology at Imperial College (London, UK), in 2003.","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 1","pages":"109-112"},"PeriodicalIF":0.0,"publicationDate":"2008-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/1745509X.4.2.109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68187439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of docetaxel in the elderly","authors":"S. Mohile, F. Berenji, D. Sahasrabudhe, G. Morrow, D. Petrylak","doi":"10.2217/1745509X.4.2.113","DOIUrl":"https://doi.org/10.2217/1745509X.4.2.113","url":null,"abstract":"Docetaxel has been found to be safe and effective in elderly patients with solid tumor malignancies. Phase II studies in elderly cancer patients have shown no significant age-related effects in efficacy or toxicity. For most cancer subtypes, weekly dosing is comparable in efficacy to every 3-week dosing schedules. The incidence of myelosuppression, which is of particular concern in the elderly, may be reduced with weekly dosing. Myelosuppression and fatigue are the most common side effects of docetaxel; other adverse events include alopecia, asthenia, dermatologic toxicity, hyperlacrimation, fluid retention and hypersensitivity reactions. Most side effects are dose-related and can be resolved through dose reductions or short delays in therapy. In summary, docetaxel is an effective chemotherapeutic agent and is commonly incorporated into the treatment plan for elderly patients with cancer.","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 1","pages":"113-127"},"PeriodicalIF":0.0,"publicationDate":"2008-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/1745509X.4.2.113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68187445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the divide in heart failure","authors":"M. Cowie","doi":"10.2217/1745509X.4.2.129","DOIUrl":"https://doi.org/10.2217/1745509X.4.2.129","url":null,"abstract":"Heart failure largely affects the elderly, with an average age at first diagnosis of 75 years in most developed countries. Many of these patients have comorbidity, such as chronic airways disease, diabetes, hypertension and renal dysfunction. Although the prognosis has improved dramatically in the past 10 years – largely owing to the more widespread introduction of drug therapies such as angiotensin-converting enzyme (ACE) inhibitors and β-blockers – recent surveys have shown that only a small minority of patients admitted to hospital with heart failure are seen by a specialist heart failure team, and less than 20% are followed up in a specialist clinic. The vast majority of patients in the UK are followed up in primary care, with some input of care from the elderly physicians. The use of drugs known to improve symptoms and prognosis remains less than ideal. The first session of the meeting was a detailed discussion of the role of the primary care physician in the diagnosis and treatment of heart failure. Applying the guidance from NICE, with a normal ECG and normal plasma brain natriuretic peptide (BNP) measurement making heart failure very unlikely, was often difficult – access to BNP testing is still very limited in the UK. In addition, ECG interpretation is also of variable quality and, in the elderly, the ECG is rarely completely normal. Data from the Quality and Outcomes Framework suggest that the quality of diagnosis in primary care varies markedly, and this is supported by a recent Health Care Commission survey that demonstrates marked variation in speed of access to diagnostic tools such as echocardiography. General practitioners with a specialist interest (GPSI) in cardiovascular disease are playing an increasing role in the diagnosis and management of more complex cardiac problems, including heart failure. This is observed to be most effective where there are good links to the secondary care-based cardiologists. Evidence was presented to show the improvement in the time-todiagnose heart failure and better uptake of appropriate drug therapy in areas where a GPSI had been established. Primary care physicians also play a key role in ensuring uptitration of medication, such as ACE inhibitors, angiotensin-receptor blockers and β-blockers. Measuring blood pressure, pulse rate and renal function can easily be carried out in primary care, saving the patient a journey to the local hospital, but does require an interested primary-care physician and practice nurse. Increasingly, heart failure specialist nurses are working in the community, often funded by the British Heart Foundation or Primary Care Trusts. Evidence was presented demonstrating that this initiative has reduced inappropriate hospital admissions and is cost effective. Multidisciplinary work is the best model of care, a point emphasized throughout the meeting. Increasingly, the competence and knowledge of the healthcare professional is more important than where they work. Heart failu","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 1","pages":"129-130"},"PeriodicalIF":0.0,"publicationDate":"2008-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/1745509X.4.2.129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68187453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alzheimer's disease and the Blood-Brain Barrier: Past, Present and Future.","authors":"Gene L Bowman, Joseph F Quinn","doi":"10.2217/1745509X.4.1.47","DOIUrl":"10.2217/1745509X.4.1.47","url":null,"abstract":"","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 1","pages":"47-55"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778025/pdf/nihms101987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28517253","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":"Role of the renin-angiotensin system in age-related sarcopenia and diastolic dysfunction.","authors":"Christy S Carter, Leanne Groban","doi":"10.2217/1745509X.4.1.37","DOIUrl":"10.2217/1745509X.4.1.37","url":null,"abstract":"<p><p>The purpose of this review is to describe how recent pharmacological and genetic studies have contributed to our understanding of the role of the renin-angiotensin system (RAS) in age-related sarcopenia and diastolic dysfunction. Treatment strategies are limited in the context of both of these conditions, although interventions, which include blockade of the RAS (using angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers) are successful and lead to improvements in functional outcomes that are not necessarily mediated by hemodynamic effects of the drugs. Studies in animal models of sarcopenia and diastolic dysfunction point to ubiquitous effects of RAS blockade on multiple biological mechanisms, including inflammation, oxidative damage and metabolic dysregulation. Therefore, a re-evaluation of the use of these drugs in other conditions should be considered for maintaining functional independence in older individuals.</p>","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 1","pages":"37-46"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2863036/pdf/nihms189312.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28966159","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":"Electroconvulsive therapy in the elderly","authors":"T. Dwolatzky, Y. Bersudsky","doi":"10.2217/1745509X.4.1.59","DOIUrl":"https://doi.org/10.2217/1745509X.4.1.59","url":null,"abstract":"Electroconvulsive therapy (ECT) involves the induction of a generalized tonic–clonic seizure by means of an electric current applied to the head of the patient. The procedure is performed under general anesthesia with the use of muscle relaxants. The efficacy and safety of ECT has been controversial since the introduction of this treatment in the 1930s. Today, ECT is considered to be a safe and effective therapeutic option in treating a number of psychiatric illnesses. With recent technical advances, ECT has fewer adverse results, is safer even in the very old and is effective for a wider range of indications. Nevertheless, many physicians remain hesitant to refer their patients for ECT because of the mistaken belief that this form of treatment is primitive and barbaric. In this article, we review the use of ECT in the elderly.","PeriodicalId":88353,"journal":{"name":"Aging health","volume":"4 1","pages":"59-67"},"PeriodicalIF":0.0,"publicationDate":"2008-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/1745509X.4.1.59","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68187717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}