PAPERS OF INTEREST
NURSING HOMES - Patterns of Emergency Department use among long-stay nursing home residents with differing levels of dementia severity A new study from the Indiana University Center for Aging Research and the Regenstrief Institute has found that almost half of all long-stay nursing home residents experience at least one transfer to an Emergency Department (ED) over the course of a year regardless of their cognitive status. While a high percentage of long-stay nursing home residents were sent to the ED, only about a third of these individuals were subsequently admitted to the hospital. This study confirms high rates of transfer of long-stay nursing home residents. Although dementia severity is not a predictor of time to ED use, other factors that influence ED use are readily identifiable. Nursing home providers should be aware of these factors when developing strategies that meet patient care goals and avoid transfer from the nursing home to the ED. Authors: Michael A. LaMantia, Kathleen A. Lane, Wanzhu Tu, Jennifer L. Carnahan, Frank Messina, Kathleen T. Unroe. Patterns of Emergency Department use among long-stay nursing home residents with differing levels of dementia severity. JAMDA 2016 . Published online: March 24, 2016. Full text at http://www.jamda.com/article/S1525-8610(16)00111-0/pdf
NURSING HOMES - Recommendations on physical activity and exercise for older adults living in long-term care facilities: a taskforce report A taskforce, under the auspices of The International Association of Gerontology and Geriatrics’s Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section, composed of experts from the fields of exercise science and geriatrics, met in Toulouse, in December 2015, with the aim of establishing recommendations of physical activity and exercise for older adults living in long-term care facilities (LTCF). The members established 2 sets of recommendations: recommendations for reducing sedentary behaviors for all LTCF residents and recommendations for defining specific, evidence-based guidelines for exercise training for subgroups of LTCF residents. In conclusion, this taskforce report proposes standards for the elaboration of strategies to increase physical activity as well as to prescribe exercise programs for older adults living in LTCFs. This report should be used as a guide for professionals working in LTCF settings. Authors: Philipe de Souto Barreto, John E. Morley, Wojtek Chodzko-Zajko, Kaisu H. Pitkala, Elizabeth Weening-Djiksterhuis, Leocadio Rodriguez-Mañas, Mario Barbagallo, Erik Rosendahl, Alan Sinclair, Francesco Landi, Mikel Izquierdo, Bruno Vellas, Yves Rolland. Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report. JAMDA 2016. Published online: March 21, 2016. http://www.jamda.com/article/S1525-8610(16)00059-1/abstract and full text at Jour Nursing Home Res 2016;2:7-20 http://www.jnursinghomeresearch.com/current-issue.html
ALZHEIMER PREVENTION - Defeating Alzheimer's disease and other dementias: a priority for European science and society The journal Lancet Neurology devotes its entire April issue to a detailed overview and recommendations about how patient care, as well as basic and clinical research on Alzheimer's disease and other dementias should be organised in the future. The report will be presented at a workshop hosted by the European Parliament in Brussels on March 15, during the Brain Awareness Week 2016 (March 14-20, 2016). The comprehensive report is the work of the Lancet Neurology Commission led by Professor Bengt Winblad, Centre for Alzheimer Research at Karolinska Institutet in Sweden. This commission was initiated by Lancet editors and formed with the aim to provide expert recommendations and information to politicians and policy makers about Alzheimer's disease and related dementias. More than 30 internationally leading researchers collaborated on the 78 pages long report, which identified a range of challenges that need to be addressed to reduce the burden of dementia. Authors: Bengt Winblad, Philippe Amouyel, Sandrine Andrieu, Clive Ballard, Carol Brayne, Henry Brodaty, Angel Cedazo-Minguez, Bruno Dubois, David Edvardsson, Howard Feldman, Laura Fratiglioni, Giovanni B Frisoni, Serge Gauthier, Jean Georges, Caroline Graff, Khalid Iqbal, Frank Jessen, Gunilla Johansson, Linus Jönsson, Miia Kivipelto, Martin Knapp, Francesca Mangialasche, René Melis, Agneta Nordberg, Marcel Olde Rikkert, Chengxuan Qiu, Thomas P Sakmar, Philip Scheltens, Lon S Schneider, Reisa Sperling, Lars O Tjernberg, Gunhild Waldemar, Anders Wimo, Henrik Zetterberg. Defeating Alzheimer's disease and other dementias: a priority for European science and society. The Lancet Neurology, 2016; 15 (5): 455 DOI: 10.1016/S1474-4422(16)00062-4
NUTRITION - Cost-effectiveness of nutrition intervention in long-term care To determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. DESIGN: Randomized, controlled trial. SETTING: Five skilled nursing home facilities. PARTICIPANTS: Long-stay residents with orders for nutrition supplementation (N = 154). INTERVENTION: Participants were randomized into a usual care control group, an oral liquid nutrition supplement (ONS) intervention group, or a snack intervention group. Research staff provided ONS, according to orders or a variety of snack foods and beverages twice per day between meals, 5 days per week for 24 weeks and assistance to promote consumption. MEASUREMENTS: Research staff independently weighed residents at baseline and monthly during the 24-week intervention. Resident food, beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using standardized observation and weighed intake procedures. RESULTS: The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group. Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks, respectively, and 3 minutes for usual care. Both interventions were cost-effective in increasing caloric intake, but neither intervention had a significant effect on body weight, despite positive trends. CONCLUSION: Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain. Authors: Sandra F. Simmons, Emmett Keeler, Ruopeng An, Xulei Liu, Matthew S. Shotwell, Brittany Kuertz, Heidi J. Silver, and John F. Schnelle. J Am Geriatr Soc. 2015 Nov;63(11):2308-16. doi: 10.1111/jgs.13709.
WHO - The World report on ageing and health: a policy framework for healthy ageing. WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report. Authors: Beard JR, Officer A, de Carvalho IA, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2015; published online Oct 29. http://dx.doi.org/10.1016/S0140-6736(15)00516-4.
FRAILTY - An emerging public health priority. In late 2014, IAGG GARN was commissioned by WHO’s Department of Aging and Life Course to setup a group of 15 international experts to finalize a background paper on Frailty intended for the 2015 WHO Global Report on Ageing and Health. A background paper was published following the meeting held at WHO Headquarters. The aim of the publication is to raise awareness on the need to better identify frailty as a target for implementing preventive interventions against age-related conditions. Every effort should be made by health care authorities to maximize efforts in this field, balancing priorities, needs, and resources. Raising awareness about frailty and age-related conditions in the population is important for effective prevention, and should lead to the promotion of lifelong healthy behaviors and lifestyle. The present work and related activities were supported by the International Association of Gerontology and Geriatrics (IAGG) and its Global Aging Research Network (IAGG GARN). Authors: Cesari M, Prince M, Thiyagarajan JA, De Carvalho IA, Bernabei R, Chan P, Gutierrez-Robledo LM, Michel JP, Morley JE, Ong P, Rodriguez Manas L, Sinclair A, Won CW, Beard J, Vellas B. Frailty: an emerging public health priority. J Am Med Dir Assoc. 2016 Jan 21. pii: S1525-8610(15)00766-5. doi: 10.1016/j.jamda.2015.12.016. [Epub ahead of print]
FRAILTY - Cognitive frailty, a novel target for the prevention of elderly dependency. In a recent review published in Ageing Research Reviews, Ruan Qingwei and colleagues discuss their view on cognitive frailty. They propose that cognitive impairment related to cognitive frailty results from physical or pre-physical frailty and can be classified into two sub-types: 1) the “reversible” cognitive impairment, which the authors claim is associated with the presence of subjective cognitive decline and/or biomarkers of amyloid-β and neurodegeneration and 2) the “potentially reversible” one, which they associate with mild cognitive impairment (defined as CDR=0.5).
ALZHEIMER PREVENTION - Dementia prevention: optimizing the use of observational data for personal, clinical, and public health decision-making. Alzheimer’s disease and other age-related dementias afflict over 35 million people world-wide. The societal cost of care in 2010 was estimated at over $600 billion, 1% of the world’s aggregated gross domestic product, with 89% of those costs incurred by high-income countries. Mounting evidence suggests that modifiable factors in mid-life will alter an individual’s risk of dementia in later decades. For example, one analysis concluded that almost half the statistical probability of getting Alzheimer’s disease may be accounted for by seven modifiable risk factors – diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity – and reducing the prevalence of these risk factors by 10% could prevent up to 1.1 million cases of the disease worldwide. How can we optimize the existing data particularly for low-risk long-term interventions on modifiable risk factors? Meta-analyses of randomized controlled trials currently are viewed to provide the highest level of evidence for causal inference and intervention efficacy. However, sole dependence on randomized controlled trials is not a feasible solution. While observational studies have inherent limitations, they can provide evidence complementary to RCTs. The goal of this paper published in the JPAD (following the Alzheimer’s Drug Discovery Foundation Task Force in New York, with the participation of an IAGG expert) is to recommend strategies to maximize the utility of observational data for low-risk health choices that may protect against dementia. Dementia Prevention: optimizing the use of observational data for personal, clinical, and public health decision-making. Authors: Penny A. Dacks et al, J Prev Alz Dis 2014;1(2):117-123. Full text at http://www.jpreventionalzheimer.com
ALZHEIMER PREVENTION - The BrainHealthRegistry.org: Using the internet for identification, assessment, screening, recruitment, and longitudinal monitoring of subjects for neuroscience and Alzheimer’s disease studies. The major obstacle preventing development of effective treatments for Alzheimer’s disease (AD) is the high cost of conducting clinical trials. The use of the Internet for the identification, assessment, screening, recruitment, and longitudinal monitoring of subjects for neuroscience and AD studies is one promising approach towards lowering this cost and thereby accelerating successful trials. The BrainHealthRegistry.org: Using the Internet for identification, assessment, screening, recruitment, and longitudinal monitoring of subjects for neuroscience and Alzheimer’s disease studies. Author: M.W. Weiner. J Prev Alz Dis 2014;1(2):59-61. Full text at http://www.jpreventionalzheimer.com
NURSING HOMES - International survey of nursing home research priorities. This article reports the findings of a policy survey designed to establish research priorities to inform future research strategy and advance nursing home practice. The survey was administered in 2 rounds during 2013, and involved a combination of open questions and ranking exercises to move toward consensus on the research priorities. A key finding was the prioritization of research to underpin the care of people with cognitive impairment/dementia and of the management of the behavioral and psychological symptoms of dementia within the nursing home. Other important areas were end-of-life care, nutrition, polypharmacy, and developing new approaches to putting evidence-based practices into routine practice in nursing homes. It explores possible innovative educational approaches, reasons why best practices are difficult to implement, and challenges faced in developing high-quality nursing home research.International Survey of Nursing Home Research Priorities. Authors: Morley JE et al. J Am Med Dir Assoc 2014 May; 15(5):309-312.
Full text at http://dx.doi.org/10.1016/j.jamda.2014.03.003
VIDEOS & OTHER MILESTONES
"BEWARE OF FRAILTY"
The short 40 seconds film was realized to promote autonomy of old people. It was funded by the CNSA (Caisse Nationale de Solidarité pour l'Autonomie), a French state organization. The video can be disseminated via any type of screens: social networks, websites, local TVs, or during events dedicated to old people. Use the links provided below to view the film in eight different versions:
CLINICAL TRIALS ON ALZHEIMER'S DISEASE
The 8th Clinical Trials on Alzheimer’s conference was held in November 5-7, 2015 in Barcelona, Spain. The 900 attendees traded results on trials from the closely watched Aβ antibodies aducanumab and gantenerumab to a long list of lesser-known therapeutic candidates. The most pressing issue discussed at this meeting was how to design trials to be able to see a drug effect in early AD, while the tools are still evolving. The field has learned much about the importance of rigorous dose-finding, exposure, and target engagement, but new frontiers have cropped up. How best to identify the right patient population, knowing how fast a given early-stage person is likely to progress, and measuring subtle improvement in barely impaired people have become the challenges of the day. To meet them, tools development is actively ongoing even as a larger clinical trials infrastructure is forming across both sides of the Atlantic.
Six articles are available at http://www.alzforum.org/news/conference-coverage/clinical-trials-alzheimers-disease-2015
BOOKS AND REPORTS
IAGG GARN WHITE BOOK ON FRAILTY
It aims to promote preventive interventions against disability and to provide information on how to adequately implement frailty into everyday clinical practice. To this effect, the book highlights current knowledge on the identification of target population, the assessment of frail old adult, and the development of tailored intervention programs. We now know that early detection and intervention is critical to addressing frailty. A french version is now available online. Three versions are available: english, french, chinese.
WHO'S 2015 WORLD REPORT ON AGEING AND HEALTH was released on September 30, 2015 for the International Day of Older Persons (1st October). The report looks at what the latest evidence has to say about the ageing process and aims to move the debate about the most appropriate public health response to population ageing. Upload the 260-page document
GLOBAL AGEWATCH INDEX 2015
HelpAge International recently launched the Global AgeWatch Index 2015. It ranks countries by how well their older populations are faring. You can view Global AgeWatch report cards, edited country by country. Regional analyses and in-depth country commentaries are also included in this year's version
WORLD ALZHEIMER REPORT 2015
Launched by Alzheimer's Disease International, this year's version is dedicated to the "Global impact of dementia: an analysis of prevalence, incidence, costs and trends." The 2015 Report updates data on the prevalence, incidence, cost and trends of dementia worldwide. It also estimates how these numbers will increase in the future, leaving us with no doubt that dementia, including Alzheimer’s disease and other causes, is one of the biggest global public health and social care challenges facing people today and in the future. You can upload the publication
Page updated April 21, 2016