Aging memories may not be ‘worse,’ just ‘different’

From The August 20, 2020 news release of the Washington University in St. Louis

Excerpts
“Memory is the first thing to go.”

Everyone has heard it, and decades of research studies seem to confirm it: While it may not always be the first sign of aging, some faculties, including memory, do get worse as people age.

It may not be that straightforward…..

….Much of the activity he was interested in is in an area of the brain referred to as the posterior medial network — which includes regions in the midline and toward the backside of the brain. In addition to memory, these areas are heavily involved in representing context and situational awareness. Some of those areas showed decreased activity in the older adults.

“We do think the differences are memory-related,” Reagh said. At the boundaries, they saw differences in the levels of activity in the hippocampus that was related to memory in a different measurement — “story memory,” he called it.

“There might be a broad sense in which the hippocampus’s response to event boundaries predicts how well you are able to parse and remember stories and complex narratives,” no matter one’s age, Reagh said.

But for older adults, closer to the front of the brain, particularly the medial prefrontal cortex, things were looking up.

Activity in that area of the brain was ramped up in older adults. This area is implicated in broad, schematic knowledge — what it’s like to go to a grocery store as opposed to a particular grocery store.

“What might be happening is as older adults lose some responsiveness in posterior parts of the brain, they may be shifting away from the more detailed contextual information,” Reagh said. But as activity levels heighten in the anterior portions, “things might become more schematic. More ‘gist-like.’”

In practice, this might mean that a 20-year-old noting an event boundary in a movie might be more focused on the specifics — what specific room are the characters in? What is the exact content of the conversation? An older viewer might be paying more attention to the broader picture — What kind of room are the characters in? Have the characters transitioned from a formal dinner setting to a more relaxed, after-dinner location? Did a loud, tense conversation resolve into a friendly one?

“Older adults might be representing events in different ways, and transitions might be picked up differently than, say, a 20-year-old,” Reagh said.

“An interesting conclusion one could draw is maybe healthy older adults aren’t ‘missing the picture.’ It’s not that the info isn’t getting in, it’s just it’s getting in differently.”

Articles focus on OTC medications, dietary supplements & complementary/alternative medicine

From the 21 March 2016 EurkAlert

More older adults used multiple medications and dietary supplements, and taking them together put more people at increased risk for a major drug interaction, according to a new study published online by JAMA Internal Medicine.

Most older adults in the United States use prescription and over-the-counter medications and dietary supplements. There is increased risk among older adults for adverse drug events and polypharmacy.

Dima M. Qato, Pharm. D., M.P.H., Ph.D., of the University of Illinois at Chicago, and coauthors analyzed nationally representative data to examine changes in medication use, which included concurrent use of prescription and over-the counter medications and dietary supplements, to gauge potential for major drug interactions.

The study group included 2,351 participants in 2005-2006 and 2,206 in 2010-2011 who were between the ages of 62 and 85. In-home interviews and direct medication inspection were performed.

The authors report:

• Concurrent use of at least five prescription medications increased from 30.6 percent to 35.8 percent over the study period.
• Concurrent use of five or more medications or supplements of any type increased from 53.4 percent to 67.1 percent.
• Use of over-the-counter medications declined from 44.4 percent to 37.9 percent.
• Dietary supplement use increased from 51.8 percent to 63.7 percent. Multivitamin or mineral supplements and calcium were the most commonly used supplements during the study period.
• About 15.1 percent of older adults in 2010-2011 were at risk for a major drug interaction compared with an estimated 8.4 percent in 2005-2006. For example, preventive cardiovascular medications and supplements were increasingly used together in interacting drug regimens.

…

[Report] Hospitalizations for Patients Aged 85 and Over in the United States, 2000–2010

Hospitalizations for Patients Aged 85 and Over in the United States, 2000–2010 

From the January 2015 NCHS Data Brief (US Centers for Disease Control and Prevention)

Key findings Data from the National Hospital Discharge Survey

• In 2010, adults aged 85 and over accounted for only 2% of the U.S. population but 9% of hospital discharges.
• From 2000 through 2010, the rate of hospitalizations for adults aged 85 and over declined from 605 to 553 hospitalizations per 1,000 population, a 9% decrease.
• The rate of fractures and other injuries was higher for adults aged 85 and over (51 per 1,000 population) than for adults aged 65–74 (9 per 1,000 population) and 75–84 (23 per 1,000 population).
• Adults aged 85 and over were less likely than those aged 65–74 and 75–84 to be discharged home and more likely to die in the hospital.

From 2000 through 2010, the number of adults aged 85 and over in the United States rose 31%, from 4.2 million to 5.5 million, and in 2010, this age group represented almost 14% of the population aged 65 and over (1). It is estimated that by 2050, more than 21% of adults over age 65 will be aged 85 and over (2). Given this increase, adults aged 85 and over are likely to account for an increasing share of hospital utilization and costs in the coming years (3). This report describes hospitalizations for adults aged 85 and over with comparisons to adults aged 65–74 and 75–84.

What percentage of hospital care was provided to adults aged 85 and over?

• In 2000, adults aged 85 and over accounted for only 2% of the U.S. population but 8% of hospital discharges. In 2010, adults aged 85 and over still accounted for 2% of the U.S. population but accounted for 9% of hospital discharges (Figure 1).

Figure 1. Population, discharges, and days of care, by age: United States, 2000 and 2010

NOTE: Population is the U.S. civilian noninstitutionalized population.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.

• In 2000 and 2010, adults aged 85 and over accounted for 12% and 14%, respectively, of those aged 65 and over. However, adults aged 85 and over accounted for more than 20% of hospital discharges for those aged 65 and over for both years.
• Adults aged 85 and over accounted for a disproportionate share of the total days of care, 10% in 2000 and 11% in 2010.

 

Figure 2. Hospitalizations, by age: United States, 2000–2010

¹Rate of hospitalization exceeds the rate for younger age groups for every year from 2000 through 2010 (p < 0.05).
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.

• From 2000 through 2010, the hospitalization rate for adults aged 85 and over remained significantly higher than the rates for adults under age 65, aged 65–74, and aged 75–84.
• In 2010, the hospitalization rate for adults aged 85 and over (553 per 1,000 population) was more than five times higher than the rate for adults under 65 (80 per 1,000 population).

 

What were common causes of hospitalization for adults aged 85 and over?

• In 2010, congestive heart failure (43 per 1,000 population) was the most frequent first-listed diagnosis for adults aged 85 and over, but in 2000 and 2005, pneumonia (51 and 52 per 1,000 population, respectively) was the most common first-listed diagnosis for adults aged 85 and over (Table).
• Hospitalization rates for congestive heart failure, pneumonia, stroke, and hip fracture decreased from 2000 through 2010 for adults aged 85 and over, and the rates for urinary tract infections and septicemia increased from 2000 through 2010.

 

Table. Common causes of hospitalization for adults aged 85 and over: United States, 2010

First-listed diagnosis	2000	2005	2010	Percent change1 (2000 to 2010)
	Rate of hospitalization per 1,000 population
Congestive heart failure	48	47	43	–9.5
Pneumonia	51	52	34	–32.8
Urinary tract infection	19	24	30	+55.9
Septicemia	15	18	28	+84.8
Stroke	37	27	28	–25.0
Hip fracture	28	23	21	–25.4

¹Percent change for each diagnosis is significant from 2000 through 2010 (p < 0.05).
NOTE: First-listed diagnosis is considered to be the main cause or reason for the hospitalization. The diagnoses were chosen because they were the top six first-listed diagnoses in 2010.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.

How likely were adults aged 85 and over to be hospitalized for injury?

• The rate of all injuries for adults aged 85 and over (51 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (9 and 23 per 1,000 population, respectively) (Figure 3).
• The rate of hip fractures for adults aged 85 and over (21 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (2 and 8 per 1,000 population, respectively).
• The rate of other fractures for adults aged 85 and over (18 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (4 and 10 per 1,000 population, respectively).
• The rate of other injuries for adults aged 85 and over (12 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (3 and 6 per 1,000 population, respectively).

 

 

More at  http://www.cdc.gov/nchs/data/databriefs/db182.htm

 

[NCHS Data Brief] Emergency Department Visits by Persons Aged 65 and Over: United States, 2009–2010

The emergency department entrance at Mayo Clinic’s Saint Marys Hospital. The red-and-white emergency sign is clearly visible. (Photo credit: Wikipedia)

 

From the November 2013 [US] National Center for Health Statistics

 

Key findings

Data from the National Hospital Ambulatory Medical Care Survey, 2009–2010

• In 2009–2010, a total of 19.6 million emergency department (ED) visits in the United States were made by persons aged 65 and over. The visit rate for this age group was 511 per 1,000 persons and increased with age.
• The percentage of ED visits made by nursing home residents, patients arriving by ambulance, and patients admitted to the hospital increased with age.
• Twenty-nine percent of ED visits by persons aged 65 and over were related to injury, and the percentage was higher among those aged 85 and over than among those aged 65–74 or 75–84.
• The percentage of ED visits caused by falls increased with age.

From 2000–2010, the number of persons in the United States aged 65 and over rose 15%, from 35.0 million to 40.3 million, and in 2010 this age group represented 13% of the population (1). It is estimated that by 2030, nearly one in five persons will be aged 65 and over (2). Given their growing proportion of the population, older individuals will comprise an increasing share of emergency department (ED) patients in the coming years. This is important because of the ED’s role in treating acute illness and injury in older adults and providing a pathway to these patients for hospital admission (3,4). This report describes ED visits made by individuals aged 65 and over and compares age groups 65–74, 75–84, and 85 and over.

 

 

 

Read the entire summary here & link to the full text of the article

 

 

 

Planning for an Aging Nation: New Estimates to Inform Policy Analysis for Senior Health

Hillary Clinton Health care elderly (Photo credit: Wikipedia)

From the excerpt at Full Text reports (with link to report)

This dissertation contains three papers on the health and welfare of the elderly population. Overall, these papers provide insights into the costs and challenges of providing health care to the elderly population. These papers help us understand the effects of obesity on longevity and health care, as well as better understand the benefits of social insurance. The first paper uses a micro-simulation model to estimate the longevity effects of poor health trends among younger Americans, and finds that difference in these trends can explain 92% of the difference between US and European longevity. The second paper estimates the welfare effects of Medicare Part-D from gains in market efficiency and dynamic incentives for pharmaceutical companies. It finds that these gains alone nearly cover the welfare cost of funding Medicare Part-D. The last paper presents and estimates a structural model of health, exercise, and restaurant consumption. It provides estimates for future welfare analyses of programs targeting obesity through restaurants and exercise in the elderly population. It also estimates the long run effects of making policies which make restaurant food healthier. It finds only minor effects of restaurant policies on health for the elderly. Overall, these papers further our understanding of the challenging objective of improving senior health while containing costs.

 

Related articles

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American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Tablets and Patches of Clonidine, Comprimés et patch transdermique de clonidine (Photo credit: Wikipedia)

From the  April 2012 Full Text Report summary (with link to report)

Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modi- fied Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes.

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