Tag Archives: Ph.D.

Proportion of Patients Age 90+ Growing Rapidly

If you sense that an increasing proportion of your patients are over the age of 90, your instincts are spot on. According a new report from the United States Census Bureau, you can expect the number of patients in your practice aged 90 years and older to increase significantly over the next 4 decades. In fact, this population stood at 1.9 million strong in 2010, but it may balloon to 9 million by the year 2050.

Image via Flickr user tylerhoff by Creative Commons License.

“Because of increasing numbers of older people and increases in life expectancy at older ages, the oldest segments of the older population are growing the fastest,” Richard Suzman, Ph.D., director of National Institute on Aging’s Division of Behavioral and Social Research, said in a prepared statement. “A key issue for this population will be whether disability rates can be reduced.”

The report, commissioned by the NIA and entitled “90+ in the United States: 2006-2008,” comes primarily from American Community Survey data collected by the U.S. Census Bureau in 2006, 2007, and 2008.

Highlights from the 27-page report include the following: Women aged 90 years and older outnumber their male peers by nearly 3:1; 88% of the 90 and older population are white; 85% reported having one or more limitations in physical function; 28% continued their education beyond high school; 85% of women are widowed, compared with 49% of men; 40% of women live alone, compared with 30% of men; and 26% of women live in nursing homes or other health care institutions, compared with 15% of men.

The report describes gains in life expectancy among Americans over the past century as “impressive.” For example, life expectancy at age 65 years increased from 12.2 years in 1929-1931 to 18.5 years in 2006. Today, 90-year-olds are expected to live on average another 4.6 years (vs. 3.2 years in 1929-31), and those who reach age 100 are projected to live another 2.3 years.

— Doug Brunk (on Twitter@dougbrunk)

Image courtesy tylerhoff’s photostream on Flickr

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Filed under Geriatric Medicine, IMNG, Practice Trends, Primary care

LGBT Older Adults Spotlighted in New Report

Lesbian, gay, bisexual, and transgender older adults face certain obstacles in accessing good quality health care, according to an article in the latest Public Policy and Aging Report, a quarterly publication of the National Academy on an Aging Society.

The article, written by Karen I. Fredriksen-Goldsen, Ph.D., professor and director of the Institute for Multigenerational Health at the University of Washington in Seattle, states that 21% of LGBT older adults “have not revealed their sexual orientation to their primary physician, with bisexual women and men less likely to disclose than lesbians and gay men. This prevents discussions about sexual health, hormone therapy, risk of breast cancer, hepatitis and HIV risk, or other potential risk factors.”

Dr. Fredriksen-Goldsen goes on to note that 13% of LGBT older adults “have been denied or provided inferior healthcare, and almost one-quarter (22 percent) of transgender older adults need to see a doctor but can’t because of cost. In addition, 15 percent fear accessing healthcare outside the lesbian, gay, bisexual, and transgender community and eight percent fear accessing healthcare inside the community.”

The article is one of 10 that makes this issue of the Public Policy and Aging Report (PPAR) the first ever dedicated to addressing the needs of LGBT older adults. “Given the voluminous gerontological literature that has built up over the past half-century, it is hard to imagine that any set of aging populations has been largely ignored or under-investigated,” PPAR Editor Robert Hudson, Ph.D., chair of the Department of Social Policy at the Boston University School of Social Work, said in a prepared statement. “Yet, LGBT older adults have remained nearly invisible to the community of advocates, researchers, practitioners, administrators, and politicians who associate themselves with the modern aging enterprise. This issue of PPAR takes a step toward filling that void.”

Topics of other articles in the report are varied and include how health care reform will impact LGBT elders, policy issues and social concerns facing older adults with HIV, and research and policy directions related to LGBT aging. A pdf of the report can be accessed for free here.

The National Academy on an Aging Society is a policy institute of The Gerontological Society of America. The report was cosponsored by the New York-based Services and Advocacy for GLBT Elders (SAGE).

— Doug Brunk (on Twitter@dougbrunk)

Image courtesy Flickr/Donnay/Creative Commons License

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Top 20 Fitness Trends for 2012 Released

According to results from a new survey from the American College of Sports Medicine, the top three fitness trends for 2012 are educated, certified, and experienced fitness professionals; strength training; and fitness programs for older adults.

The findings, part of the college’s sixth consecutive “Worldwide Survey of Fitness Trends,” appear in the November/December 2011 issue of ACSM’s Health and Fitness Journal. Results were based on a survey of more than 2,600 fitness professionals. You can access the article for free here.

Outcome measurements and clinical integration/medical fitness both dropped out of the top 20 trends this year, but physician referrals ranks No. 20. “This is a trend toward an emergent emphasis being placed on partnerships with the medical community, resulting in seamless referrals to a health and fitness facility and health fitness professionals,” according to the article, which was assembled by Walter R. Thompson, Ph.D., a regents professor of exercise science in the department of kinesiology and health at Georgia State University.

The top 20 fitness trends for 2012 are:

1. Educated and experienced fitness professionals

2. Strength training

3. Fitness programs for older adults

4. Exercise and weight loss

5. Children and obesity

6. Personal training

7. Core training

8. Group personal training

9. Zumba and other dance workouts

10. Functional fitness

11. Yoga

12. Comprehensive health promotion programming at the worksite

13. Boot camp (a fitness activity structured after military-style training)

14. Outdoor activities

15. Reaching new markets. An estimated 80% of Americans don’t have a regular exercise program.

16. Spinning (indoor cycling)

17. Sport-specific training

18. Worker incentive program

19. Wellness coaching

20. Physician referrals

— By Doug Brunk

Image courtesy Flickr/ Sebastian Fritzon/Creative Commons License

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Miscarriages After ART Up Nationwide After Hurricane Katrina

Women in the United States who conceived through assisted reproductive technology were significantly more likely to spontaneously abort or deliver their babies preterm in the six months following Hurricane Katrina, compared with the same period before the natural disaster.

Hurricane Katrina from space August 28, 2005, courtesy U.S. National Oceanic and Atmospheric Administration

“Interestingly, this increase in preterm delivery and miscarriage was not associated with Hurricane Katrina sites. That is to say, the rates were not [significantly] different in directly affected counties, but they were different nationally,” Sangita K. Jindal, Ph.D. said.

Dr. Jindal looked at singleton live births conceived through assisted reproductive technology (ART) before and after the category 3 hurricane slammed the Gulf Coast on August 29, 2005.

“We had to double check our math, because we were shocked,” said Dr. Jindal, IVF Lab Director at Montefiore Medical Center in Hartsdale, N.Y. “The reported preterm delivery rate in the country is 10% to 12%. In this study, we found a preterm delivery rate of 19% ‑ much higher.”

She also compared pregnancy outcomes in five states with counties directly affected by Katrina (Texas, Louisiana, Mississippi, Alabama, and Florida) to outcomes at clinics elsewhere across the country.  “There was an 19% preterm delivery rate around the country and a 22% preterm delivery rate in Hurricane Katrina regions,” Dr. Jindal said at the annual meeting of the American Society for Reproductive Medicine.

The preterm delivery and miscarriage rates in regions affected by the hurricane already were elevated. Although they increased, the differences were not statistically significant, she explained.

Nationwide, however, “there was definitely a measurable increase in spontaneous abortions compared to pre-Katrina,”

Sangita K. Jindal, Ph.D. (photo by D. McNamara)

Dr. Jindal said. Compared to the ART cycles initiated before the hurricane, those started in the six months after Katrina hit were 87% more likely to end in a first trimester pregnancy loss and 63% more likely to be a miscarriage by 16 weeks.

So why did adverse outcomes rise significantly across the country? “I would suspect that nationally women suffered a trauma, and they imparted some sort of stress factor to the intrauterine environment, which impacted negatively and directly on the fetus,” she said.

More specific information on cortisol levels or epigenetic factors is outside the scope of the data of 104,724 ART cycles provided by the Society for Assisted Reproductive Technology.

Unlike previous researchers who have found more girls born after a natural disaster, Dr. Jindal found an equal birth rate of 49.5% for each gender.

In the future, Dr. Jindal would like to perform a state-by-state analysis. She also wants to assess pregnancy outcomes by maternal body mass index, because maternal weight “may be a confounding variable.”

–by Damian McNamara (on twitter @MedReporter)

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The ‘Gold’ in Your Golden Years

Magali Perquin, Ph.D. (photo by Doug Brunk)

Being multilingual may prove to be the “gold” in your golden years.

Results from a study presented during a poster session at the annual meeting of the American Academy of Neurology in Honolulu found that elderly who were fluent in more than two languages were 3.94 less likely to develop cognitive impairment, compared with those who were fluent in two languages. Moreover, those who were fluent in more than four languages were 5.07 times less likely to develop cognitive impairment, compared with those who were fluent in two languages.

In a study led by Magali Perquin, Ph.D., 230 seniors from Luxembourg with a mean age of 73 years who practiced two to sevenlanguages were invited to participate in a longitudinal study exploring cognitive decline and associated risk factors. The researchers used the Language and Social Background Questionnaire to evaluate their multilingual ability and performed standard neuropsychological and neurogeriatric assessments to determine the strength of association between cognitive impairment and the number of practiced languages, adjusting for age and education.

In her poster, Dr. Perquin, of the department of epidemiology at the Public Research Center for Health, Strassen, Luxembourg, and her associates noted that the while the reasons behind the association remain unclear, “it is likely the benefits of practicing many languages might be related to the concept of cognitive reserve and brain plasticity, which results in higher resistance to aging-related neurological insults and subsequent cognitive impairment.”

Time to enroll in that refresher course in German I’ve been putting off. 

— Doug Brunk (on Twitter@dougbrunk)

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My Pick for Best Medical Story of 2010

Image via Flickr user Patrick Hoesly's Photostream by Creative Commons License.

With the close of 2010 just weeks away, it’s a good time to reflect on the notable medical stories of the year. We can’t forget the historic passage of health care reform by Congress. Or the invasion of bed bugs from coast to coast. Or the spotlight shone on concussive injuries sustained in football and other contact sports.

What about the most important medical development of 2010? For this my vote goes to a study published online in Science on July 20, which found that 1% tenofovir gel used before and after sexual intercourse reduced the rate of new HIV infections in women by 39% and cut the rate of transmission of HSV-2 infections by 50% (Science doi: 10.1126/science.1193748). A full story about the study was reported by my colleague Mitchel L. Zoler from the 18th International AIDS Conference in Vienna, where the findings were unveiled.

More studies of tenofovir are needed, to be sure, but this was the first study to prove that 1% tenofovir gel can stop HIV transmission in its tracks. The clinical implications of the findings are significant, especially in sub-Saharan Africa, where an estimated 22.5 million adults and children live with AIDS.

“Is it good enough? No,” reproductive infectious diseases expert Sharon L. Hillier, Ph.D., said at this summer’s annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology in Santa Fe, N.M. “Do we need something that’s 80% effective? Absolutely. But I have to tell you: from working in the microbicide field for 15 years, this was a startling and wonderful finding. Many of us were not surprised by the results, but so thrilled that finally there was something that looked like it was working.”

— Doug Brunk (on Twitter@dougbrunk)

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