B. Lynn Beattie

An interdisciplinary expert consensus statement on assessment of pain in older persons

This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.

Resistance Training and Executive Functions: A 12-Month Randomized Controlled Trial

BACKGROUND Cognitive decline among seniors is a pressing health care issue. Specific exercise training may combat cognitive decline. We compared the effect of once-weekly and twice-weekly resistance training with that of twice-weekly balance and tone exercise training on the performance of executive cognitive functions in senior women. METHODS In this single-blinded randomized trial, 155 community-dwelling women aged 65 to 75 years living in Vancouver were randomly allocated to once-weekly (n = 54) or twice-weekly (n = 52) resistance training or twice-weekly balance and tone training (control group) (n = 49). The primary outcome measure was performance on the Stroop test, an executive cognitive test of selective attention and conflict resolution. Secondary outcomes of executive cognitive functions included set shifting as measured by the Trail Making Tests (parts A and B) and working memory as assessed by verbal digit span forward and backward tests. Gait speed, muscular function, and whole-brain volume were also secondary outcome measures. RESULTS Both resistance training groups significantly improved their performance on the Stroop test compared with those in the balance and tone group (P < or = .03). Task performance improved by 12.6% and 10.9% in the once-weekly and twice-weekly resistance training groups, respectively; it deteriorated by 0.5% in the balance and tone group. Enhanced selective attention and conflict resolution was significantly associated with increased gait speed. Both resistance training groups demonstrated reductions in whole-brain volume compared with the balance and tone group at the end of the study (P < or = .03). CONCLUSION Twelve months of once-weekly or twice-weekly resistance training benefited the executive cognitive function of selective attention and conflict resolution among senior women. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00426881.

Increased Risk of Falling in Older Community-Dwelling Women With Mild Cognitive Impairment

Background: Falls are a major health care problem for older people and are associated with cognitive dysfunction. Mild cognitive impairment (MCI) is an increasingly recognized clinical problem. No study has comprehensively compared people with and without MCI for fall risk factors in both the physiological and cognitive domains. Objective: The purpose of this cross-sectional study was to comprehensively compare fall risk factors in community-dwelling older women with and without MCI. Design: A cross-sectional design was used in the study. Methods: Community-dwelling women (N=158) with Folstein Mini Mental State Examination scores of ≥24 participated in the study. The Montreal Cognitive Assessment (MoCA) was used to categorize participants as either having or not having MCI. Each participants fall risk profile was assessed with the Physiological Profile Assessment (PPA). Three central executive functions were assessed: (1) set shifting was assessed with the Trail Making Test (part B), (2) updating (ie, working memory) was assessed with the Verbal Digits Backward Test, and (3) response inhibition was assessed with the Stroop Colour-Word Test. Results: Both the composite PPA score and its subcomponent, postural sway performance, were significantly different between the 2 groups; participants with MCI had higher composite PPA scores and greater postural sway compared with participants without MCI. Participants with MCI performed significantly worse on all 3 central executive function tests compared with participants without MCI. Limitations: A screening tool was used to categorize participants as having MCI, and fall risk factors were compared rather than the actual incidence of falls. Conclusions: Fall risk screening may be prudent in older adults with MCI.

Vehicle crash involvement and cognitive deficit in older drivers

The driving records of 165 older persons who were classified as having dementia in a clinic assessment were examined in this study. These records were compared with those of a stratified random sample selected from the population of drivers in British Columbia. The dementia group was found to have been involved in over twice the number of collisions as their controls were during identical time periods. Further, over 80% of the dementia group who experienced a crash event (and who were almost all judged at fault) continued driving for up to 3 years following the event, and during this time over one third of these had at least one more accident.

Physical activity improves verbal and spatial memory in older adults with probable mild cognitive impairment: a 6-month randomized controlled trial.

We report secondary findings from a randomized controlled trial on the effects of exercise on memory in older adults with probable MCI. We randomized 86 women aged 70–80 years with subjective memory complaints into one of three groups: resistance training, aerobic training, or balance and tone (control). All participants exercised twice per week for six months. We measured verbal memory and learning using the Rey Auditory Verbal Learning Test (RAVLT) and spatial memory using a computerized test, before and after trial completion. We found that the aerobic training group remembered significantly more items in the loss after interference condition of the RAVLT compared with the control group after six months of training. In addition, both experimental groups showed improved spatial memory performance in the most difficult condition where they were required to memorize the spatial location of three items, compared with the control group. Lastly, we found a significant correlation between spatial memory performance and overall physical capacity after intervention in the aerobic training group. Taken together, our results provide support for the prevailing notion that exercise can positively impact cognitive functioning and may represent an effective strategy to improve memory in those who have begun to experience cognitive decline.

Age‐Related Decline in Interleukin 2 Production in Response to Influenza Vaccine

Articles in the recent literature document an abnormal antibody response in elderly persons to influenza vaccination. Several studies have presented evidence to show that immune dysfunction in aged mice and humans may be due to a defect in the production of interleukin 2 (IL2) by helper T cells (TH). Cultures of peripheral blood mononuclear cells (PBMC) were prepared from blood samples taken at eight weeks after vaccination (0.5 mL of Armand‐Frappier, 15 μg/0.5 mL each of A/Taiwan/1/86, A /Leningrad/360/86, and B/Ann Arbor/1/86 administered in the fall of 1987) from a group of elderly men and a young control group. Peripheral blood mononuclear cells were frozen in 10% dimethyl sulfoxide (DMSO) until all the cells were cultured. After stimulation with a 1/320 dilution of the same influenza vaccine, cultures of PBMC from young controls showed a significantly greater increase in IL2 production than the cultures of PBMC from the elderly group of patients. This was statistically significant at both day 3(P < .01) and day 5(P < .05) of culture using the Mann‐Whitney U test. Previous experiments that have shown defective IL2 production related to aging have used potent mitogens such as concanavalin A and phytohemagglutinin to stimulate TH. This study provides evidence that defective IL2 production may also occur in response to physiologic antigenic stimulation and may be one explanation for the reduced efficacy of influenza vaccination in elderly persons.

Antibody response to whole-virus and split-virus influenza vaccines in successful ageing

The antibody response to influenza vaccination has been variably reported to be decreased in elderly individuals. To determine the effect of ageing alone on this antibody response, a group of carefully-screened healthy elderly subjects were compared with young adult controls. Antibody titres for several strains of influenza were measured before and after vaccination with whole-virus (WVV) and split-virus influenza vaccines (SVV) in two successive years. In general, the antibody response to WVV was greater than the response to SVV. Both groups showed a similar response to the H3N2 strain but the elderly group showed a lower response to the H1N1 and B strains of virus contained in the vaccine. Antibodies to older strains of influenza A but not B were stimulated by vaccination with SVV. In the elderly group, the response to older viral strains was relatively increased compared with newer strains. In contrast, the young control group had better antibody responses to the newer than to the older strains of influenza tested. Reductions in the antibody response to influenza vaccination may, therefore, be related to the phenomenon of original antigenic sin and the cohort effect of exposure to H1N1 during childhood in the elderly group studied. The increased immunogenicity of WVV must be considered in light of the current wide use of SVV in the elderly.

Neuropsychological deficits, caregivers' perception of deficits and caregiver burden

We tested three hypotheses about the effects of perceived and actual patient deficits on caregiver burden: (1) objective patient deficits directly influence caregiver burden; (2) caregiver burden is the result of caregiver perceptions of patient deficits; (3) objective patient deficits influence caregiver burden indirectly by determining perceived deficits.

Aging 2.0: health information about dementia on Twitter.

Online social media is widespread, easily accessible and attracts a global audience with a widening demographic. As a large proportion of adults now seek health information online and through social media applications, communication about health has become increasingly interactive and dynamic. Online health information has the potential to significantly impact public health, especially as the population gets older and the prevalence of dementia increases. However, little is known about how information pertaining to age-associated diseases is disseminated on popular social media platforms. To fill this knowledge gap, we examined empirically: (i) who is using social media to share information about dementia, (ii) what sources of information about dementia are promoted, and (iii) which dementia themes dominate the discussion. We data-mined the microblogging platform Twitter for content containing dementia-related keywords for a period of 24 hours and retrieved over 9,200 tweets. A coding guide was developed and content analysis conducted on a random sample (10%), and on a subsample from top users’ tweets to assess impact. We found that a majority of tweets contained a link to a third party site rather than personal information, and these links redirected mainly to news sites and health information sites. As well, a large number of tweets discussed recent research findings related to the prediction and risk management of Alzheimer’s disease. The results highlight the need for the dementia research community to harness the reach of this medium and its potential as a tool for multidirectional engagement.

Characterization of the Immune Response to Trivalent Influenza Vaccine in Elderly Men

This study characterizes the time course of the immune response to influenza vaccine in elderly men. Sixty‐two men aged 58 to 91 years (mean, 74.3 years) were vaccinated with trivalent inactivated influenza vaccine in the fall of 1983. Serum hemagglutinin‐inhibiting (HAI) antibody titers were measured at various times up to 24 weeks postvaccination. Seroconversion frequencies determined at single times after vaccination were 28 to 46% of subjects, whereas cumulative seroconversion frequencies were greater than or equal to 70%. Eighteen to 28% of seroconversions occurred later than four weeks, and greater than or equal to 68% of those who seroconverted experienced greater than four‐fold declines in peak HAI antibody titers by 24 weeks after vaccination. Consequently, 31 to 73% of subjects had HAI antibody titers greater than 40 throughout the study period. Measurement of HAI antibody titers at only one time after vaccination may not adequately reflect the immune response of this population or the degree of protection maintained through the influenza season.