MATURE MARKET HEADLINES POSTED 11/13/98
Hypertension May Erode Mental Functioning
Two recent studies of mature adults provide insights into how and why mental functioning changes with advancing age, according to the Center for the Advancement of Health. The first study focuses on the influence of high blood pressure on mental functioning. The second study attends to how high blood pressure and other medical conditions affect mental abilities of mature adults.
High blood pressure (hypertension) can lead to declines in some mental abilities over and above
those associated with advancing age, say University of Maine researchers who studied 140
men and women for twenty years with the support of grants from the National Institute on Aging.
Lead researcher, Merrill F. Elias, PhD, University of Maine, believes that individuals suffering from high blood pressure run a higher risk of damage to both the structure of the brain itself and the brain's ability to work properly.
Elias and colleagues examined blood pressure and mental function in 140 male and
female subjects ranging in age from 40 to 70 years old. Both at the beginning, and again every five
years over the following two decades, the subjects returned to the lab to have
repeated blood pressure assessments. The subjects also completed the Wechsler Adult
Intelligence Scale, which measures a variety of cognitive abilities, including verbal
comprehension, visual-spatial abilities, memory, and speed of performance.
Writing in the November issue of Health Psychology, the researchers report that all
participants did more poorly on the intelligence test over time, whether or not they
met criteria for hypertension at any time during the study.
More important in predicting intelligence test scores was the subjects' average
blood pressures over time. Higher levels were generally associated with greater
declines, particularly for tests of visual-spatial ability and speed of performance.
When the researchers statistically controlled for the participants' age, the effect
remained but was less strong. It is also important to note that the study subjects
had no obvious cardiovascular complications and remained generally in good health over the course of the study.
In a related study reported in the same issue of Health Psychology, Elizabeth M. Zelinski,
PhD, and colleagues at the University of Southern California, Los Angeles, say that
several medical conditions have a greater effect on the mental abilities of "young
old" adults than on the "oldest old."
Nearly 6,500 men and women from 70 to 103 years old were tested on their ability
to recall lists, do mental arithmetic, and identify words given their definition.
Stroke was associated with poorer performance on all three tests, the researchers
found, while diabetes, hypertension, and poor health in general were linked with
lowered performance on at least two tests.
The effects of these medical conditions were generally strong among the youngest
older adults in the sample, and "smaller or non-existent for the oldest old," the
researchers say. "Those who survive into extreme old age may have less severe
conditions than those who are younger."
"Programs to prevent stroke, diabetes, and high blood pressure, as well as to
promote good health, are relevant to the goal of keeping the oldest-old Americans
from experiencing cognitive deficits that may affect the quality of their lives," the
researchers conclude.
Health Psychology is the official, peer-reviewed research journal of the Division of Health
Psychology (Division 38), American Psychological Association.
See related articles in the AgeVenture archives.
"Pharmacists Help Control Hypertension"
"Diet & Lifestyle May Lower Blood Pressure"
AgeVenture News Service, www.demko.com
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Anesthesiologists Say No to Assisted Suicide
"Patients with terminal diseases who consider suicide often do so out of fear of a painful, undignified death", says Dr. John B. Neeld, president of the American Society of Anesthesiologists (ASA). That's why the ASA believes that the proper end-of-life care for a terminally ill patient should include adequate pain relief but not physician-assisted suicide. And to make it official, the ASA has issued a statement, "Quality of End-of-Life Care" that dismisses physician-assisted suicide in favor of current treatments that can allow a terminally ill patient to be treated adequately for the pain and distressing symptoms that may occur near the end of life.
"Making a patient more comfortable with less anxiety and without pain can be achieved with the many treatments, techniques, and medications available today", says Dr. Neeld. In the "Quality of Life Care" statement, ASA declares opposition to physician-assisted suicide, stating that it is not compatible with the role of physician. ASA believes its goal is to inform and educate other health care providers to help the more than 67 percent of cancer patients who currently suffer from pain. That prevalence increases to between 80 and 100 percent in the later stages of the disease. In addition to the management of their pain, patients also benefit from appropriate mental health care, which when available, often results in less interest in physician-assisted suicide.
The "Quality of End-of-Life Care" statement calls for further improvements in end-of-life care through a twofold effort. First, educating and training patients, families, health care workers and physicians to promote available, compassionate, comprehensive, and interdisciplinary end-of-life care. Second, improving the care of terminally ill patients by minimizing the depression, sense of abandonment and loss of control often described by patients near the end of life. Founded in 1905, ASA is a scientific and educational association of anesthesiologists that was organized to advance the practice of anesthesiology and to improve the quality of care of the anesthetized patient.
See related articles in the AgeVenture archives.
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Cholesterol Drug Lowers Heart Disease Risk
The results of a landmark medication research study, presented at the scientific meeting of the American Heart Association, reveal that patients with stable coronary artery disease were able to reduce their risk to heart problems by reducing their low density lipoprotein cholesterol (LDL-C). LDL-C is commonly known as "bad" cholesterol. In the research trial, 87 percent of the patients who received the new Lipitor medication (atorvastatin calcium), who were originally candidates for angioplasty, were able to remain instead on this medical therapy for the duration of the 18-month trial period, without experiencing any cardiovascular events.
In addition, patients in the trial who were treated with Lipitor had a 36 percent reduction in the combined incidence of cardiovascular events, such as nonfatal heart attack, bypass surgery, revascularization, and worsening angina, as compared with patients receiving angioplasty followed by usual care. The trial demonstrated that patients treated with Lipitor had a significant delay in the time to their first ischemic event, compared with patients who received angioplasty followed by usual medical care.
"These data showed that we should be far more aggressive in our lipid-lowering goals and we should be doing a better job of getting our patients to or below current U.S. guidelines. We really want to get people with stable coronary artery disease and elevated LDLs to below 100 mg/dL. Here we got patients to below 80", says Bertram Pitt, M.D., Professor of Internal Medicine at the University of Michigan School of Medicine, Ann Arbor. Dr. Pitt chaired the advisory and safety committee overseeing the medical research trial. This trial represents the first in a series of clinical studies in which Parke-Davis, a division of Warner-Lambert, and Pfizer Inc are examining the benefits of aggressive lipid lowering in the treatment of patients with cardiovascular disease.
See related articles in the AgeVenture archives.
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Does Prozac Really Work on Elder Depression
The first-ever study to determine whether the antidepressant Prozac relieves a mild form of depression often experienced by older people, is being conducted by researchers at the University
of Rochester Medical Center. More than one in five people over the age of 60 suffer from some form of depression. About a quarter of these people suffer from a well-understood condition known as major depression, for which physicians commonly prescribe antidepressants such as Prozac. However, many more older people suffer from milder forms of depression known as "subsyndromal" or "minor" depression. Almost half of older patients suffering from these forms of depression are prescribed antidepressants even though there has never been a study to determine if such prescriptions work for this group.
"It's entirely possible that there are different mechanisms causing the two types of depression," said
Jeffrey M. Lyness, M.D., Director of the Laboratory of Depression and Medical Comorbidity in the
Program in Geriatrics and Neuropsychiatry at the University of Rochester. "The situation is like
getting a flu shot to prevent catching a cold. It won't work. A cold is not a weaker form of the flu; it's an entirely different affliction requiring a different treatment."
To diagnose a patient's depression, doctors consider the patient's symptoms: A patient must have a
minimum of five symptoms such as depressed mood, decreased interests or ability to enjoy activities, feelings of guilt, hopelessness, thoughts that life is not worth living, trouble concentrating, or a change in sleep, appetite, or weight. These symptoms must be present for most of the day, nearly every day, for two consecutive weeks or longer to be symptomatic of major depression. Those who show some but not all of these symptoms, are considered as having either minor depression or subsyndromal depression.
"Doctors don't have a rule book to go by for this," said Lyness. "Maybe an older woman has a low
sense of self-worth -- but mostly in the mornings. That may not qualify as major depression, but the woman is suffering. We need to better understand what treatments work best to help her."
The elderly are especially susceptible to the effects of depression. Lyness' earlier studies with
patients in the Rochester area have shown that older patients with minor or subsyndromal
depression are more often physically ill, and have more difficulty performing day-to-day tasks such
as shopping, doing laundry, dressing, or preparing their meals.
The study will be held at the University of Rochester Medical Center and will evaluate the progress of 50 elderly patients, half of whom will receive pills containing Prozac, and half of whom will receive a placebo. Patients will be evaluated by interviews with study staff. They also will receive a free physical examination upon entering the trial. Then, once a week for the next 12 weeks they will meet with study staff either in their own home, or in the study offices at the Medical Center, so Lyness and his colleagues can learn if their depressive symptoms are improving. Medications are free to study participants, and patients are paid for their participation. Lyness believes that when the study is completed in late 1999, its results will shed light on more effective treatments for those suffering from these conditions.
Patients who believe they may be eligible for this study and are interested in participating should
talk with their own physician. Physicians who have patients they would like to refer to the study
can call Dr. Lyness' research office at the University of Rochester Medical Center at 275-2217.
See related articles in the AgeVenture archives.
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New Medication Relieves Postmenopausal Pain
For people who suffer from burning mouth syndrome, low doses of the drug clonazepam may offer significant relief, according to a study by a Case Western Reserve University professor in the November issue of Oral Surgery. About 1.3 million American adults, mostly postmenopausal women, are afflicted with burning mouth syndrome (BMS), a chronic, often debilitating condition whose cause remains a medical mystery. Only in recent years has science begun to seek an organic basis for the intense burning pain, notes researcher Miriam Grushka, an associate professor of oral diagnosis at the CWRU School of Dentistry.
BMS seems to follow a pattern in many sufferers, Grushka observes. The burning pain begins by late morning and usually reaches peak intensity by evening, which makes falling asleep difficult yet doesn’t awaken the patient during the night. Grushka’s study tested the effect of clonazepam on a sample of 30 patients who had experienced BMS for anywhere from one month to 12 years. One
subject was an 83-year-old male and the rest were females age 45 to 87 (median age 65).
At the conclusion of the study, 43 percent of the patients reported partial to complete relief and were still using the medication. Twenty-seven percent found the drug helpful but quit using it due to side
effects, usually drowsiness. For the remaining 30 percent, the clonazepam offered no relief. Since a total of 70 percent of subjects experienced reduced pain, Grushka believes clonazepam may be the best available treatment for many BMS patients. "When it works, it’s really dramatic," she said. "The pain just disappears."
In August, Grushka and a co-author presented a review of current knowledge about BMS at the World Workshop on Oral Medicine in Chicago at the American Dental Association headquarters. "For the majority of BMS subjects, the onset of pain is usually spontaneous with no known precipitating factors," they reported. Grushka believes this points to nerve damage as a possible cause. As an anticonvulsant, the clonazepam may prevent spontaneous firing of the cranial nerve that carries sensations of pain to the brain. Eating seems to relieve the pain, which supports the nerve damage theory, according to Grushka. If the cranial nerve that senses taste were damaged, she explains, the cranial nerve that senses pain could be spontaneously sending pain messages to the brain even though there is no stimulus for the pain. When the BMS patient eats, this stimulates the taste nerve to send taste messages to the brain and stops the spontaneous firing of the pain nerve.
Case Western Reserve University's School of Dentistry is one of 53 accredited dental schools nationwide. Founded in 1892, it is among the country's oldest schools of dentistry.
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Dropped by Your HMO? Don't Switch Plans Yet
Many seniors are in a quandary over the new Medicare HMO changes. Just what are their options? Well, one expert, Weiss Ratings Inc, has a few unique ideas for seniors to consider, especially for the hundreds of thousands of Medicare HMO beneficiaries losing their coverage on December 31, 1998. Weiss Ratings Inc is an independent rater of insurance companies, providing ratings on over 16,000 financial institutions, including life and health insurers. Here's what Weiss suggests.
- Don't move yet.
Stick with your HMO until December 31. If you drop sooner, your withdrawal will be considered "voluntary", and you will immediately forfeit certain kinds of guaranteed coverage for next year.
- Start checking into alternatives right away.
To avoid any coverage gaps, you will want to have your new policy in place on January 1.
- Consider leaving HMOs entirely and return to Medicare plus a supplemental policy.
Provided you don't withdraw until December 31, you are guaranteed eligibility in Medicare supplemental insurance (Medigap) regardless of your health status. Under this guarantee, you can choose among four different Medigap plans. With Medicare and Medigap, it's far less likely you will get dropped again. Plus, you will have more freedom to choose your provider or hospital and better access to specialists. However, Weiss cautions, your last day to take advantage of this guarantee is March 4, sixty-three days after your HMO coverage ends.
- Shop around for the least expensive Medigap policy that meets your needs.
The cost of Medigap insurance can vary drastically by insurance provider, even for identical plans.
- Beware of future premium increases.
Before you sign on the bottom line, find out is the insurance company will automatically raise your premiums as you get older.
- Approach HMOs with caution.
Most HMOs are either losing money or not making enough on Medicare patients. Don't be surprised if more HMOs call it quits next year.
- Investigate Medicare+Choice.
The programs are still in the implementation process, and many plans are not yet registered. This month, the federal government is sending out a free information booklet on the new program. Weiss Ratings Inc offers its own guide, "Weiss Health Insurance Report for Seniors" which provides a customized listing of the premium rates offered for each of 10 Medigap plans. The report, available for $49, can be obtained by calling 1-800-289-9222.
See related articles in the AgeVenture archives.
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AgeVenture News Service, www.demko.com
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