Lower vitamin D could increase risk of dying, especially for frail, older adults

ScienceDaily (July 26, 2012) — A new study concludes that among older adults -- especially those who are frail -- low levels of vitamin D can mean a much greater risk of death.

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The randomized, nationally representative study found that older adults with low vitamin D levels had a 30 percent greater risk of death than people who had higher levels.

Overall, people who were frail had more than double the risk of death than those who were not frail. Frail adults with low levels of vitamin D tripled their risk of death over people who were not frail and who had higher levels of vitamin D.

"What this really means is that it is important to assess vitamin D levels in older adults, and especially among people who are frail," said lead author Ellen Smit of Oregon State University.

Smit said past studies have separately associated frailty and low vitamin D with a greater mortality risk, but this is the first to look at the combined effect. This study, published online in the European Journal of Clinical Nutrition, examined more than 4,300 adults older than 60 using data from the Third National Health and Nutrition Examination Survey.

"Older adults need to be screened for vitamin D," said Smit, who is a nutritional epidemiologist at OSU's College of Public Health and Human Sciences. Her research is focused on diet, metabolism, and physical activity in relation to both chronic disease and HIV infection.

"As you age, there is an increased risk of melanoma, but older adults should try and get more activity in the sunshine," she said. "Our study suggests that there is an opportunity for intervention with those who are in the pre-frail group, but could live longer, more independent lives if they get proper nutrition and exercise."

Frailty is when a person experiences a decrease in physical functioning characterized by at least three of the following five criteria: muscle weakness, slow walking, exhaustion, low physical activity, and unintentional weight loss. People are considered "pre-frail" when they have one or two of the five criteria.

Because of the cross-sectional nature of the survey, researchers could not determine if low vitamin D contributed to frailty, or whether frail people became vitamin D deficient because of health problems. However, Smit said the longitudinal analysis on death showed it may not matter which came first.

"If you have both, it may not really matter which came first because you are worse off and at greater risk of dying than other older people who are frail and who don't have low vitamin D," she said. "This is an important finding because we already know there is a biological basis for this. Vitamin D impacts muscle function and bones, so it makes sense that it plays a big role in frailty."

The study divided people into four groups. The low group had levels less than 50 nanograms per milliliter; the highest group had vitamin D of 84 or higher. In general, those who had lower vitamin D levels were more likely to be frail.

About 70 percent of Americans, and up to a billion people worldwide, have insufficient levels of vitamin D. And during the winter months in northern climates, it can be difficult to get enough just from the sun. OSU's Linus Pauling Institute recommends adults take 2,000 IU of supplemental vitamin D daily. The current federal guidelines are 600 IU for most adults, and 800 for those older than 70.

"We want the older population to be able to live as independent for as long as possible, and those who are frail have a number of health problems as they age," Smit said. "A balanced diet including good sources of vitamin D like milk and fish, and being physically active outdoors, will go a long way in helping older adults to stay independent and healthy for longer."

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Older Americans See Better Today, Study Finds

HealthDay – 1 hr 23 mins ago FRIDAY, July 20 (HealthDay News) -- Older Americans see better than their parents did in old age, according to a new study that finds visual impairment among the U.S. elderly has declined 58 percent since the 1980s.

Improved techniques in cataract surgery and lower rates of macular degeneration may be two of the main reasons for the trend, say researchers from Northwestern University.

"From 1984 until 2010, the decrease in visual impairment in those 65 and older was highly statistically significant," said the study's first author, Dr. Angelo Tanna, vice chairman of ophthalmology at Northwestern University Feinberg School of Medicine and an attending physician at Northwestern Memorial Hospital.

"The findings are exciting, because they suggest that currently used diagnostic and screening tools and therapeutic interventions for various ophthalmic diseases are helping to prolong the vision of elderly Americans," said Tanna in a university news release.

After analyzing national survey data collected from 1984 to 2010, the researchers found that in 1984, poor eyesight caused 23 percent of older adults to have trouble reading or seeing newspaper print. By 2010, however, only 9.7 percent of seniors reported the problem. The researchers also saw a significant drop in eyesight problems that limited the ability of older people to perform normal daily activities, such as dressing and bathing.

Little change in visual impairment was detected among adults younger than 65.

Although the study did not identify the cause of the lower rate of vision problems among older adults, the researchers suggested three likely reasons:

Better techniques in cataract surgeryA decline in smoking, which resulted in reduced rates of macular degenerationImproved treatments for diabetic eye diseases

The study authors said more research is needed to determine which treatment strategies help prevent vision loss in older adults so they can be made more accessible.

The study was recently published online in the journal Ophthalmology.

More information

The American Academy of Family Physicians provides more information on common causes of vision loss in older people.

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Higher Doses of Vitamin D Prevent Fractures in Older Women

HealthDay – 4 mins 43 secs ago WEDNESDAY, July 4 (HealthDay News) -- In the latest study to look at the effect of vitamin D on fracture risk, Swiss researchers found that taking more than 800 international units (IU) of vitamin D daily could reduce the risk of hip fractures in older women by 30 percent.

"Vitamin D supplementation is effective in fracture reduction, including hip fractures," said study author Dr. Heike Bischoff-Ferrari, from the Center on Aging and Mobility at the University of Zurich and Wald City Hospital, also in Zurich.

"However, dose matters, as we saw this benefit only at the highest intake level of greater than 800 IU per day, and no dose below 792 IU per day reduced fracture risk," she said.

If everyone took more than 800 IU of vitamin D daily, the impact on public health could be enormous because hip fractures are the most severe and frequent fractures among the elderly, according to Bischoff-Ferrari.

Results of the study are published in the July 5 issue of the New England Journal of Medicine.

Vitamin D is important for bone health, according to Dr. Anna Lasak, clinical director of the department of rehabilitation and the women's physical medicine and rehabilitation program at Montefiore Medical Center, in New York City. The body makes vitamin D when exposed to sunlight. Sunscreen blocks this effect.

Vitamin D is also found in fatty fish, eggs and some mushrooms, she said. It's also added to dairy products, some cereals and some breads, according to Lasak. But, she said, it can be difficult, especially for elderly people, to get enough vitamin D from these sources. In addition, elderly people may have digestive issues that can cause their bodies to absorb even less vitamin D.

A number of studies have been done looking at vitamin D and bone health, and the studies have often come up with conflicting findings, with some showing benefits, while others found no benefits. In mid-June, the U.S. Preventive Services Task Force recommended that postmenopausal women should not take low-dose vitamin D supplements (400 IU) because there was no evidence of benefit. The task force, however, said there wasn't yet enough clear evidence on higher doses of vitamin D to make a recommendation one way or the other.

The current study is a pooled analysis of 11 double-blind, randomized controlled trials of vitamin D supplementation with or without calcium compared to a placebo or calcium supplementation alone.

The studies included more than 31,000 people. All of the participants in the studies were over 65, with an average age of 76. Most (91 percent) of the volunteers in the studies were women.

They found that people taking less than 800 IU daily showed no statistically significant drop in fracture risk. However, those taking over 800 IU reduced the risk of hip fracture by 30 percent and the risk of non spine-related fractures by 14 percent, according to the study.

"Our data strongly support a daily vitamin D supplement of 800 IU per day in adults age 65 and older to lower their risk of fracture, including those living at home and those living in nursing homes, including men and women, and the younger and the old," Bischoff-Ferrari said.

Lasak said 800 IU is a safe level of vitamin D intake for just about anyone. But, she said, it's better for older folks to have their vitamin D levels measured first. Some may not need additional vitamin D, but many actually need more than 800 IU a day.

"Most people do have a deficiency," she said. While 800 IU is a safe limit, that may not be enough, she said. No one should exceed levels of 4,000 IU, Lasak added. That's the upper safe limit of this nutrient.

She said it's also important to ensure that you're getting enough calcium. The recommendation is for between 1,000 and 1,200 milligrams (mg) a day, with older people needing more, she said. Lasak recommended getting the bulk of your calcium from foods, rather than a supplement, because some studies have suggested possible harm from higher levels of calcium intake from supplements.

Bischoff-Ferrari said the current analysis also suggested that higher levels of calcium supplementation (more than 1,000 mg) may reduce vitamin D's benefit.

More information

Learn more about vitamin D and bone health from the National Osteoporosis Foundation.

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Omega-3 lowers inflammation in overweight older adults

ScienceDaily (June 20, 2012) — New research shows that omega-3 fatty acid supplements can lower inflammation in healthy, but overweight, middle-aged and older adults, suggesting that regular use of these supplements could help protect against and treat certain illnesses.

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Four months of omega-3 supplementation decreased one protein in the blood that signals the presence of inflammation by an average of more than 10 percent, and led to a modest decrease in one other inflammation marker. In comparison, participants taking placebos as a group saw average increases of 36 percent and 12 percent, respectively, of those same markers.

Chronic inflammation is linked to numerous conditions, including coronary heart disease, Type 2 diabetes, arthritis and Alzheimer's disease, as well as the frailty and functional decline that can accompany aging.

Study participants took either 2.5 grams or 1.25 grams of active omega-3 polyunsaturated fatty acids in their supplements. Polyunsaturated fatty acids are considered"good fats" that, when consumed in proper quantities, are associated with a variety of health benefits. Study participants taking a placebo consumed pills containing less than 2 teaspoons per day of a mix of oils representing a typical American's daily dietary oil intake.

"Omega-3 fatty acids may be both protective so that inflammation doesn't go up, as well as therapeutic by helping inflammation go down," said Jan Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State University and lead author of the study.

"This is the first study to show that omega-3 supplementation leads to changes in inflammatory markers in the blood in overweight but otherwise healthy people. In terms of regulating inflammation when people are already healthy, this is an important study, in that it suggests one way to keep them healthy."

The study is published online and scheduled for later print publication in the journal Brain, Behavior and Immunity.

The scientists recruited 138 adults -- 45 men and 93 women -- who were in good health, but who were either overweight or obese and lived sedentary lives. Their average age was 51 years. Based on body mass index, a measure of weight relative to height, 91 percent of the participants were overweight and 47 percent were obese.

Inflammation tends to accompany excess body fat, so the researchers recruited participants who were most likely high in pro-inflammatory blood compounds at the beginning of the study.

"We wanted to have enough room to see a downward trend. Most other trials testing the effects of omega-3 supplements on inflammation used people who were seriously diseased or skinny and healthy," said Kiecolt-Glaser, also an investigator in Ohio State's Institute for Behavioral Medicine Research (IBMR). "You can see results in people with serious diseases, but there's a lot of other noise in that system. We wanted to make sure we were studying results in people who were fairly fit but who weren't exercising, because exercise can clearly lower inflammation."

The researchers also excluded from participation people taking a variety of medications to control mood, cholesterol and blood pressure as well as vegetarians, patients with diabetes, smokers, those routinely taking fish oil, people who got more than two hours of vigorous exercise each week and those whose body mass index was either below 22.5 or above 40.

Participants received either a placebo or one of two different doses of omega-3 fatty acids -- either 2.5 grams or 1.25 grams per day. The supplements were calibrated to contain a ratio of the two fish oil fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), of seven to one. Previous research has suggested that EPA has more anti-inflammatory properties than does DHA.

After four months, participants who had taken the omega-3 supplements had significantly lower levels in their blood of two proteins that are markers of inflammation, also called pro-inflammatory cytokines. The low-dose group showed an average 10 percent decrease in the cytokine interleukin-6 (IL-6), and the high-dose group's overall IL-6 dropped by 12 percent. In comparison, those taking a placebo saw an overall 36 percent increase in IL-6 by the end of the study.

Levels of the cytokine tumor necrosis factor-alpha (TNF-a) also dropped, but in a more modest way, by 0.2 percent and 2.3 percent in the low- and high-dose groups, respectively. The placebo group's TNF-a increased by an average of 12 percent.

IL-6 and TNF-a are two of a family of six cytokines that, when stimulated, produce an inflammatory response to a stressor such as an injury or infection, said study co-author Ron Glaser, professor of molecular virology, immunology and medical genetics and director of the IBMR.

"You need this good inflammation for an initial response, but if it stays up, and inflammation becomes chronic, then you've got a problem," Glaser said. "Our research and studies done by others have shown that these two cytokines are clearly related to overall health -- and when they're elevated in the blood, that is not good for overall health. So the more ways we can find to lower them, the better."

Statistically, there was no significant difference in lowered inflammation between the two doses, but each dose clearly produced cytokine reductions that differed significantly from the placebo group.

"These data support the idea that a higher dose of omega-3 is not necessarily better than a lower dose in terms of prevention of inflammation," said Martha Belury, professor of human nutrition at Ohio State and a co-author of the study.

However, levels of omega-3 fatty acids in participants' blood increased according to which dose they consumed, which improved their ratio of omega-6 fatty acids to omega-3 fatty acids. The current typical American diet contains between 15 and 17 times more omega-6 than omega-3, a ratio that researchers suggest should be lowered to 4-to-1, or even 2-to-1, to improve overall health.

"Scientists tend to agree that the best way to gauge a person's omega-3 status is to see whether that ratio goes down," Belury said. "That's what we saw in this study, and it was achieved through supplementation. We wanted participants to maintain normal diets and simply add this modest amount of oil to their existing diet. We expected and we found that their blood plasma omega-3 fatty acids went up in a dose-responsive manner."

The Food and Drug Administration considers daily omega-3 supplementation of up to 3 grams to be "generally regarded as safe." The doses in this study were within those safety parameters, but the researchers did not extend their findings to make a general recommendation about omega-3 supplementation.

"Although omega-3 fatty acids cannot take the place of good health behaviors, people with established inflammatory diseases or conditions may benefit from their use," Kiecolt-Glaser said.

The researchers also sought to determine whether omega-3 fatty acids could reduce depression symptoms, but participants had relatively few symptoms to begin with so no significant reductions were seen. Depression is also associated with chronic inflammation, but research hasn't yet fully defined the mechanisms behind that relationship.

This work was supported in part by grants from the National Institutes of Health. OmegaBrite, a company based in Waltham, Mass., supplied the supplements as an unrestricted gift but did not participate in the study design, results or publication.

Additional co-authors, all at Ohio State, include Rebecca Andridge of the Division of Biostatistics; William Malarkey of the IBMR and the departments of Psychiatry and Internal Medicine; and Beom Seuk Hwang of the IBMR and biostatistics.

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Role of omega-3 in preventing cognitive decline in older people questioned

ScienceDaily (June 13, 2012) — Older people who take omega-3 fish oil supplements are probably not reducing their chances of losing cognitive function, according to a new Cochrane systematic review. Based on the available data from studies lasting up to 3.5 years, the researchers concluded that the supplements offered no benefits for cognitive health over placebo capsules or margarines, but that longer term effects are worth investigating.

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Omega-3 fatty acids are fats responsible for many important jobs in the body. We get these fats through our daily diets and the three major omega-3 fats are: alpha linolenic acid (ALA) from sources such as nuts and seeds and eicosapentoic acid (EPA) and docosahexaenoic acid (DHA) from sources including oily fish such as salmon and mackerel. A number of studies have hinted that omega-3 fatty acids and DHA in particular may be involved in keeping nerve cells in the brain healthy into old age. However, there is limited evidence for the role of these fats in preventing cognitive decline and dementia.

The researchers, led by Emma Sydenham at the London School of Hygiene & Tropical Medicine (LSHTM), London, UK, gathered together evidence from three high quality trials comparing the effects of omega-3 fatty acids taken in capsules or margarine spread to those of sunflower oil, olive oil or regular margarine. A total of 3,536 people over the age of 60 took part in the trials, which lasted between six and 40 months. None of the participants had any signs of poor cognitive health or dementia at the start of the trials.

The researchers found no benefit of taking the omega-3 capsules or spread over placebo capsules or spread. Participants given omega-3 did not score better in standard mental state examinations or in memory and verbal fluency tests than those given placebo.

"From these studies, there doesn't appear to be any benefit for cognitive health for older people of taking omega-3 supplements," said Alan Dangour, a nutritionist at LSHTM and co-author of the report. "However, these were relatively short-term studies, so we saw very little deterioration in cognitive function in either the intervention groups or the control groups. It may take much longer to see any effect of these supplements."

The researchers conclude that the longer term effects of omega-3 fatty acids on cognitive decline and dementia need to be explored in further studies, particularly in people with low intakes of omega-3 fatty acids in their diet. In the meantime, they stress other potential health benefits. "Fish is an important part of a healthy diet and we would still support the recommendation to eat two portions a week, including one portion of oily fish," said Dangour.

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CDC: Older teens often text behind the wheel

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Older adults may need more vitamin D to prevent mobility difficulties, study suggests

ScienceDaily (May 29, 2012) — Older adults who don't get enough vitamin D -- either from diet, supplements or sun exposure -- may be at increased risk of developing mobility limitations and disability, according to new research from Wake Forest Baptist Medical Center.

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"This is one of the first studies to look at the association of vitamin D and the onset of new mobility limitations or disability in older adults," said lead author Denise Houston, Ph.D., R.D., a nutrition epidemiologist in the Wake Forest Baptist Department of Geriatrics and Gerontology. Houston researches vitamin D and its effects on physical function.

The study, published online this month in the Journal of Gerontology: Medical Sciences, analyzed the association between vitamin D and onset of mobility limitation and disability over six years of follow-up using data from the National Institute on Aging's Health, Aging, and Body Composition (Health ABC) study. Mobility limitation and disability are defined as any difficulty or inability to walk several blocks or climb a flight of stairs, respectively.

Of the 3,075 community-dwelling black and white men and women aged 70-79 who were enrolled, data from 2,099 participants was used for this study. Eligible participants reported no difficulty walking one-fourth mile, climbing 10 steps, or performing basic, daily living activities, and were free of life-threatening illness. Vitamin D levels were measured in the blood at the beginning of the study. Occurrence of mobility limitation and disability during follow-up was assessed during annual clinic visits alternating with telephone interviews every six months over six years.

"We observed about a 30 percent increased risk of mobility limitations for those older adults who had low levels of vitamin D, and almost a two-fold higher risk of mobility disability," Houston said.

Houston said vitamin D plays an important role in muscle function, so it is plausible that low levels of the vitamin could result in the onset of decreased lower muscle strength and physical performance. Vitamin D may also indirectly affect physical function as low vitamin D levels have also been associated with diabetes, high blood pressure, cardiovascular disease and lung disease -- conditions that are frequent causes of decline in physical function. Houston said people get vitamin D when it is naturally produced in the skin by sun exposure, by eating foods with vitamin D, such as fortified milk, juice and cereals, and by taking vitamin D supplements.

"About one-third of older adults have low vitamin D levels," she said. "It's difficult to get enough vitamin D through diet alone and older adults, who may not spend much time outdoors, may need to take a vitamin D supplement."

Current recommendations call for people over age 70 to get 800 International Units of vitamin D daily in their diet or supplements. Houston pointed out that current dietary recommendations are based solely on vitamin D's effects on bone health.

"Higher amounts of vitamin D may be needed for the preservation of muscle strength and physical function as well as other health conditions," she said. "However, clinical trials are needed to determine whether increasing vitamin D levels through diet or supplements has an effect on physical function."

This research was supported in part by the Intramural Research Program of the National Institutes of Health, National Institute on Aging; National Institute on Aging contracts N01-AG-6-2101, N01-AG-6-2103, and No1-AG-6-2106; National Institute on Aging grants R01 AG028050, R01 AG029364 and K01 AG030506 (to DKH); National Institute of Nursing Research grant R01 NR012459; and the Wake Forest University Claude D. Pepper Older Americans Independence Center (P30 AG021332).

Co-authors include: Janet A. Tooze, Ph.D., Gary G. Schwartz, Ph.D., Jeff D. Williamson, M.D., Stephen B Kritchevsky, Ph.D., Rebecca H. Neiberg, Ph.D. and M. Kyla Shea, Ph.D., all of Wake Forest Baptist; Dorothy B. Hausman, Ph.D., and Mary Ann Johnson, Ph.D., University of Georgia, Athens; Jane A. Cauley, Ph.D., University of Pittsburg, Pennsylvania; Doug C. Bauer, M.D., University of California, San Francisco; and Tamara B. Harris, M.D., National Institute on Aging.

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Exercise Helps Older Adults Stay Fit

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UK may allow IVF for older women, same-sex couples

A powerful health advisory agency says Britain should extend free fertility treatments to women up to age 42 as well as same-sex couples, recommendations likely to be followed by many of the U.K.'s medical centers.

The British health system generally pays for up to three cycles of in-vitro fertilization, or IVF, for couples who have been trying to get pregnant for at least three years. Previously, women had to be under age 40 to qualify. Many government-funded clinics already treat gay and lesbian couples, but the recommendations now make that explicit, though they are not binding.

The guidelines are likely to affect only a minority of patients and it will be up to hospitals to decide whether to pay for IVF treatments. Britain's health service is being forced to trim

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Lung cancer CT scans: Just for older heavy smokers

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Melanoma a Big Threat to Older Men

HealthDay – Fri, May 18, 2012 FRIDAY, May 18 (HealthDay News) -- Older men have an increased risk of developing melanoma, but most are careless about sun protection and do not know how to properly check themselves for signs of skin cancer, a new survey reveals.

This is particularly worrisome because nearly 132,000 new cases of melanoma will be diagnosed in 2012, according to the American Academy of Dermatology, which conducted the online poll.

"This survey demonstrates that many men do not protect themselves from the sun when outdoors and that some still believe that sun exposure is good for their health. This is a very troubling combination in light of the fact that the major risk factor for melanoma is exposure to ultraviolet light," dermatologist Dr. Thomas Rohrer, a clinical associate professor of dermatology at Brown University School of Medicine, said in an academy news release.

Just 29 percent of men report always protecting their skin outside, the national survey showed. Meanwhile, 43 percent of women take the necessary precautions.

Moreover, 39 percent of men said they preferred to simply enjoy the sun and not worry about how to protect themselves from its harmful rays, compared with 28 percent of women.

Although 59 percent of women said they know how to examine their own skin for signs of cancer, the study also showed that just 46 percent of the men surveyed knew how this should be done.

"Men need to examine their skin and see a dermatologist if they spot anything changing, bleeding or growing," Rohrer said.

Fortunately, the researchers noted, the five-year survival rate for people whose melanoma is diagnosed and treated before it spreads to the lymph nodes is 98 percent.

"The survey results should serve as a wake-up call to men to be vigilant about protecting their skin from sun exposure and examining their skin regularly for skin cancer," Rohrer concluded. "Loved ones can assist by examining their partners' skin and noting anything suspicious. These exams are vital since the early detection of skin cancer helps save lives."

The academy is distributing public service announcements to television, cable and radio stations nationwide to help raise awareness on how people can protect themselves from skin cancer.

More information

The American Cancer Society has more about skin cancer.

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Older Lung Cancer Patients Less Likely to Be Treated

HealthDay – Fri, May 4, 2012 FRIDAY, May 4 (HealthDay News) -- A study of seniors with non-small cell lung cancer found that older patients are less likely to receive treatment than younger patients, regardless of their overall health and prognosis.

Non-small cell lung cancer is the most common type of lung cancer.

For this study, U.S. researchers looked at data from more than 20,000 lung cancer patients aged 65 and older in the VA Central Cancer Registry between 2003 and 2008 and found that, for all stages of lung cancer, younger, sicker patients were more likely to receive treatment than otherwise healthy older patients.

That may not be best for patients, the researchers said. Previous research has shown that older lung cancer patients who are otherwise healthy can benefit from treatment, while those with other illnesses are more vulnerable to the toxicity of cancer treatments.

"It's clear that, as human beings and physicians, we fixate on age in deciding whether to pursue cancer treatments, including lung cancer treatments. Instead, we should be looking at our patients' overall state of health," lead author Dr. Sunny Wang, a physician at the San Francisco VA Medical Center and an assistant clinical professor of medicine at the University of California-San Francisco, said in a university news release.

The study was published May 1 in the Journal of Clinical Oncology.

Patients aged 65 to 74 who were severely ill from other illnesses -- and thus less likely to benefit from and more likely to be harmed by cancer treatment -- received treatment at about the same rate as patients in the same age range with no other illnesses.

These patients were more likely to receive treatment than patients aged 75 to 84 who had no other illnesses and better prognoses.

"The message here is, don't base cancer treatment strictly on age," Wang said. "Don't write off an otherwise healthy 75-year-old, and don't automatically decide to treat a really ill 65-year-old without carefully assessing the risks and benefits for that patient."

More information

The American Cancer Society has more about non-small cell lung cancer.

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Taking Away Car Keys Can Be Tough for Older Drivers

HealthDay – 16 hrs ago FRIDAY, April 27 (HealthDay News) -- Driving can be a major factor in elderly people's quality of life, affecting their mental health and overall well-being, an expert says.

If an older driver's diminishing abilities behind the wheel are cause for concern, the issue needs to be dealt with compassionately to preserve the person's dignity and keep them and others safe, says Dr. Kavon Young, a geriatric specialist with the Harris County Hospital District in Texas.

"Aging is a process where so many things are lost," Young said in a hospital district news release. "Part of what seniors try to hold onto is their independence -- the independence to make decisions about their health, their future and their driving. To them, driving is more than a way to get from one place to another."

Being forced to hang up the car keys can harm a senior's self-esteem and may trigger depression, anxiety and loneliness, Young said. In some cases, a person may feel isolated and not want to keep up with their medical care.

"A lot of factors ... go into discussing driving with seniors because the goal is to maintain their dignity in the process. These are adults and should be treated as such," said Young, an assistant professor in the division of geriatric and palliative medicine at the University of Texas Health Science Center at Houston.

If you're concerned about an elderly loved one's ability to drive safely, have an open and honest talk about driving and safety concerns, Young suggested. Most seniors will limit their driving if they don't feel safe, but some may not be aware of vision and memory deficits, and will not restrict their driving.

Young said signs that an elderly person's driving could be cause for concern include: longer drive times for short distances; not obeying traffic signs; forgetting destinations or locations; hitting curbs; and being angry or anxious when driving.

"Start the discussion early and agree that you won't make a decision based on one particular event," Young said. "Having this agreement will take the pressure off the senior. Sometimes family members or caregivers get upset and decide to stop all driving privileges, which can be traumatic for the senior."

In cases where an elderly person's driving abilities are a concern, you can suggest that they limit drives to short distances; drive only to familiar places; avoid driving at night; avoid driving during bad weather; and make use of a chauffeur list that includes family and friends.

More information

The U.S. National Institute on Aging has more about older drivers.

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Women With Older Partners More Often Admitted to Nursing Homes

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Combined vaccine not tied to seizures in older kids

Reuters – 1 hr 16 mins ago NEW YORK (Reuters Health) - Although the combined vaccine against measles, mumps and chickenpox comes with a small risk of fever-related seizures in toddlers, a new study suggests that's not true in older children.

The measles-mumps-rubella-varicella (MMRV) vaccine has been available in the U.S. since 2005. It combines the traditional MMR vaccine with the anti-chickenpox shot so young children can undergo fewer jabs.

But after its release, the MMRV vaccine was found to carry a small risk of fever-related seizures in one- to two-year-olds -- the age at which the first dose of the vaccine is given.

Fever-related, or "febrile," seizures are short-lived, lasting about a minute or two.

Though the seizures are "very scary" for parents, "they are not dangerous, and they do not lead to later epilepsy or seizure disorders," lead researcher Dr. Nicola Klein, co-director of the Kaiser Permanente Vaccine Study Center in Oakland, California, told Reuters Health in an email.

Experts now recommend that parents opt for either the MMRV or separate MMR and varicella shots for their toddlers. The separate shots seem to cut the odds of a fever-related seizure.

But that has still left questions about the second MMRV vaccine, which is given between the ages of four and six.

In the new study, researchers found no evidence that the vaccine significantly raised the risk of fever-related seizures in those older children.

The findings, reported in the journal Pediatrics, are based on medical records for nearly 87,000 four- to six-year-olds who received the MMRV shot between 2006 and 2008. Another 67,000-plus received the MMR and varicella vaccines separately, on the same day, between 2000 and 2008.

One child had a fever-related seizure seven to 10 days after getting the MMRV vaccine -- the time frame in which one- to two-year-olds appear to be at risk. No seizures were recorded in kids who had the MMR and varicella shots separately.

The findings suggest the vaccine carries no particular risk of the seizures in older kids. Fever-related seizures are fairly common in children; according to the National Institutes of Health, about one in every 25 kids will have at least one fever-related seizure -- though they most often affect toddlers.

So it's not surprising that the MMRV shot has been linked to seizures in toddlers, but not in older kids, according to Klein's team.

Even in toddlers, the risk is small, said Klein.

"It is more common for a child to have a febrile seizure caused by a cold than by an immunization," she said.

In a 2010 study, Klein's team found that compared with one- to two-year-olds who got separate MMR and varicella jabs, those given the combined vaccine had twice the rate of fever-related seizures seven to 10 days later.

That translated to one additional seizure for every 2,300 doses of the MMRV shot given to one-year-olds instead of the separate vaccines.

Klein said that parents should talk with their pediatrician about the pros and cons of the MMRV vaccine versus giving toddlers the MMR and varicella vaccines separately.

The vaccine is not the only one that's associated with fever-related seizures in very young children. A recent study found a small risk among babies getting the combined vaccine against diphtheria, tetanus, whooping cough (pertussis), polio and Haemophilus influenzae type 2 -- known collectively as DTap-IPV-Hib (see Reuters Health story of February 21, 2012).

But again, experts stressed that the risk was "very small" and the vaccine was not linked to future seizure disorders.

Klein and some of her co-researchers on the study have received past research funding from vaccine makers, including Merck, which makes the ProQuad MMRV vaccine.

SOURCE: http://bit.ly/HzT6vz Pediatrics, online April 2, 2012.

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EKG Heart Test May Predict Risk in Older Adults

HealthDay – 4 hrs ago TUESDAY, April 10 (HealthDay News) -- Minor changes in the results of a commonly used heart test -- an electrocardiogram, or EKG -- translate into a 35 percent increased risk of heart events, such as heart attacks, hospitalizations for chest pain or the need for heart surgery, in people over 70, according to new research.

For people with major abnormalities in their EKG, the risk of having a heart event is even higher, compared to people with normal tests.

"We analyzed data from the Health, Aging and Body Composition Study. More than 3,000 patients had an electrocardiogram done at baseline, but we only included the people who didn't have a previous history of coronary heart disease or cardiovascular disease, so no heart attacks or strokes," said lead study author Dr. Reto Auer, a research fellow in the department of epidemiology and biostatistics at the University of California, San Francisco.

"We found that people who had minor or major changes in their electrocardiogram had a greater risk of heart events," Auer said. "And, when we adjusted the data for commonly known risk factors -- smoking, cholesterol, body mass and high blood pressure -- we still found an association between minor or major EKG changes and heart events."

Results of the study are published in the April 11 issue of the Journal of the American Medical Association.

An EKG is a painless and noninvasive test that records each heartbeat onto a piece of paper. To conduct the test, clinicians attach numerous wires to your chest and legs to capture each heartbeat.

The test is commonly included as part of a routine physical, though the widespread use of this test in people without any cardiac symptoms has recently come into question. While it may be noninvasive, it's not without risk. People who have abnormal test results are often referred to specialists and for more tests, which may be invasive. In addition, if the results of the EKG suggest an increased risk, someone might be placed on a new medication to reduce their risk.

"The American College of Cardiology currently recommends against routine screening in asymptomatic individuals unless there are risk factors," said Dr. David Friedman, chief of heart failure services at North Shore-LIJ Health System's Plainview Hospital, in Plainview, N.Y.

The U.S. Preventive Services Task Force and the American Heart Association also do not recommend routine EKG screening in people without symptoms or risk factors, according to an accompanying editorial in the same issue of the journal.

"Just because its use is widespread and it's cheap doesn't mean it should necessarily be given to everyone. While it might seem to make sense, where does it stop? Why just get an EKG? Why not an echocardiogram or a cardiac stress test, too? All of these tests have to be used rationally and cost-effectively. This is still a gray area," Friedman said.

The current study is a first step in assessing how electrocardiograms might effectively be used in an older population, the researchers suggested.

From the larger study, the investigators analyzed data on 2,192 people who had no history of heart disease or stroke, but had undergone an EKG at the start of the study.

All of the study volunteers were between the ages of 70 and 79. Fifty-five percent of study participants were women and 59 percent were white. The study included an average eight years of follow-up information.

The researchers found that people who had minor abnormalities in their EKG at the start of the study were 35 percent more likely to experience a heart event than those without any abnormalities. Those with major EKG abnormalities had a 51 percent greater risk of having a heart event.

Auer said even with this study's findings, it's too soon to recommend routine screening with EKG. "Prediction is not prevention," he said.

An additional issue that both doctors mentioned is that the EKG test is only as good as the person who's reading the test. Major abnormalities are generally easy to see, but minor ones aren't always as easy to interpret, Auer and Friedman said.

"I see minor abnormalities all the time, and variable changes in the same patient from year to year. There are some things we expect that are normal variants," Friedman said.

Until the experts sort out the best way to use EKG to help them predict someone's risk of a heart attack, Auer said that it's important to talk to your doctor about your heart disease risk factors, such as high blood pressure, high cholesterol and smoking. Making changes in these risk factors is already known to reduce the risk of heart disease. It isn't yet known if changing the results of your EKG will help lower your heart disease risk, he noted.

More information

Learn more about the electrocardiogram test from the U.S. National Heart, Lung, and Blood Institute.

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Thyroid Surgery Riskier for Older Patients: Study

HealthDay – 1 hr 17 mins ago FRIDAY, March 30 (HealthDay News) -- Seniors who have thyroid surgery are much more likely than younger patients to suffer serious heart, lung and infection-related complications, according to a new study.

The findings challenge the widely held belief that thyroid surgery (thyroidectomy) is a low-risk operation for older patients, the researchers said.

They analyzed data from 7,915 patients in the United States who had all or part of their thyroid gland removed. The risk of postoperative complications was five times higher in patients 80 and older and two times higher in patients ages 65 to 79, compared to younger patients.

The study appears in the May issue of the Journal of Clinical Endocrinology & Metabolism.

The number of elderly patients in the United States undergoing thyroid operations is increasing due to an aging population, and rising rates of thyroid cancer and benign thyroid conditions, the researchers said.

"It is important to understand that our study emphasizes the importance of the entire medical system that cares for these elderly patients, not just the surgeon," study lead author Dr. Raymon Grogan, of the University of Chicago, said in a journal news release.

"In our study, elderly patients were susceptible to life-threatening, nonsurgical complications. Thus it is important that an elderly patient undergoing thyroid surgery have an experienced team of primary care physicians, surgeons, anesthesiologists and nurses who handle these types of surgeries on a routine, daily basis," Grogan said.

More information

The American Thyroid Association has more about thyroid surgery.

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Older Travelers at Much Higher Risk of Dying From Malaria

HealthDay – 39 mins ago WEDNESDAY, March 28 (HealthDay News) -- Tourists over age 65 who visit malaria-infested regions are nearly 10 times more likely to die from the disease than those ages 18 to 35, a new study says.

The analysis of 20 years of data from more than 25,000 U.K. patients also found that the malaria death rate is particularly high among people who've traveled to Gambia, West Africa.

The risk of dying from malaria, an infection carried by mosquitoes, increased with age, and the death rate for those over age 65 was 4.6 percent. There were no deaths in children younger than age 5, according to the study published online March 28 in the British Medical Journal.

The researchers also found that tourists were more than nine times more likely to die from malaria than people of African heritage who traveled to see family or friends -- 3 percent vs. 0.32 percent.

This decreased death risk among people of African heritage may be due to early exposure to malaria, or to greater awareness of the symptoms and a tendency to seek medical help earlier, the study authors said in a journal news release.

The overall death rate from malaria for people who visited Gambia was especially high (3.9 percent) compared to those who visited other countries in West Africa (0.4 percent). Among tourists, the death rate was 6 percent for those who visited Gambia compared with 1.4 percent for those who visited other West African countries.

Travel to malaria-infected regions is increasing, and the U.K. has one of the highest rates of imported malaria in the world, according to the researchers at the London School of Hygiene and Tropical Medicine and the University of Oxford.

They said doctors need to make travelers aware that malaria is common, possibly fatal and requires early diagnosis. Doctors must stress to travelers the importance of taking anti-malaria drugs and of seeing a doctor immediately if they have a fever when they return home.

Each year, 250 million cases of malaria occur worldwide, resulting in more than 800,000 related deaths, the release said.

More information

The American Academy of Family Physicians has more about malaria.

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