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Fall rate nearly 50% among older Americans with dementia

Targeting specific fall-risk factors could improve fall screening and prevention strategies.

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A new study from researchers in Drexel University’s College of Nursing and Health Professions, has shed light on the many and varied fall-risk factors facing older adults in community-living environments.

With falls causing millions of injuries in older adults each year, it is an increasingly important public health concern. 

Older adults living with dementia have twice the risk of falling and three times the risk of incurring serious fall-related injuries, like fractures, compared to those without dementia.

For older adults with dementia, even minor fall-related injuries can lead to hospitalisation and nursing home admission.

Recently published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, the research led by Safiyyah Okoye, PhD, an assistant professor at Drexel, and Jennifer L Wolff, PhD, a professor at Johns Hopkins Bloomberg School of Public Health, examined a comprehensive set of potential fall-risk factors — including environmental factors, in addition to health and function — in older community-living adults in the United States, both with and without dementia.

“Examining the multiple factors, including environmental ones like a person’s home or neighbourhood, is necessary to inform fall-risk screening, caregiver education and support, and prevention strategies for this high-risk population of older adults,” said Okoye.

Despite awareness of this elevated risk, there are very few studies that have examined fall-risk factors among people with dementia living in a community setting (not nursing homes or other residential facilities).

The studies that do exist, overwhelmingly focus on health and function factors. According to the authors, this is the first nationally representative study to compare a comprehensive set of potential risk factors for falls for older Americans living with dementia to those without dementia.

The research team examined data from the 2015 and 2016 National Health and Aging Trends Study (NHATS), a population-based survey of health and disability trends and trajectories of adults 65 and older in the US. They were able to obtain potential sociodemographic, health and function predictors of falls, as well as potential social and physical environmental predictors.

Data from NHATS showed that nearly half (45.5 per cent) of older adults with dementia had experienced one or more falls in 2016, compared to less than one third (30.9 per cent) of older adults without dementia.

Among older adults living with dementia, three characteristics stood out as significantly associated with a greater likelihood of falls: a history of falling the previous year; impaired vision; and living with others (versus alone). 

For older adults without dementia, financial hardship, a history of falling, fear of falling, poor lower extremity performance, depressive symptoms and home disrepair were strongly associated with increased risk of falls.

While prior history of falling and vision impairment are well-known risk factors for falls among older adults in general; the researchers’ findings indicate that these were strong risk factors for falls among people living with dementia. 

According to the team, this suggests that people living with dementia should be assessed for the presence of these characteristics. If they’re present, the individuals should receive further assessment and treatment, including examining their feet and footwear, assessing their environment and ability to carry out daily living activities, among other items.

The finding that older adults living with dementia who lived with a spouse or with non-spousal others had higher odds of experiencing a fall, compared to those who lived alone, highlights that caregiver support and education are understudied components of fall prevention programs for older adults with dementia who live with family caregivers, and deserve greater attention from clinicians, researchers and policy makers.

“Overall, our findings demonstrate the importance of understanding and addressing fall-risk among older adults living with dementia,” said Okoye.

“It confirms that fall-risk is multidimensional and influenced by environmental context in addition to health and function factors.”

The results of the study indicate the need to further investigate and design fall-prevention interventions, specifically for people living with dementia.

Okoye added: “To decrease the high rates of falls among older adults with dementia, additional tailored fall-risk screening and fall-prevention interventions should be developed and tested.”

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How older people explore new spaces could suggest dementia

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Results from a new study have shown an analogous shift in exploration behaviour in middle age for the first time in humans.

Spatial navigation – the ability to select and follow a route from one place to another – is a skill we use every day. Depending on practice, general cognitive ability, and childhood environment, some people are naturally better at this than others.

However, research has also shown that people’s skill in spatial navigation tends to decrease with increasing age.

This decline in navigation skill has been generally attributed to worsening spatial memory, due to changes in brain structure and function that naturally occur with age. But what if it isn’t just due to our spatial memory declining, but also to changes in how we explore a novel environment? Such a shift has been observed in aging animals, ranging from insects to rodents and fish.

An exploratory study

Results from this new study, published in Frontiers in Aging Neuroscience, could have clinical applications.

First author Dr Vaisakh Puthusseryppady, a postdoctoral researcher at the University of California at Irvine, stated: “Compared to younger individuals, middle-aged people exhibit overall less exploration when learning a novel maze environment, and seem to be prioritising learning specific important locations in the maze as opposed to the overall maze layout.”

Puthusseryppady and colleagues recruited 87 middle-aged (on average 50 years old) and 50 young (on average 19 years old) women and men as volunteers. None had a history of neurologic disease including dementia, or psychiatric illness.

The researchers tested how well the volunteers explored and learned to navigate a maze in virtual reality. The maze was composed of crossroads and corridors, separated by hedges. Distinctive objects were scattered around it at strategic locations as landmarks. In the first ‘exploration phase’, the volunteers were instructed to freely explore the maze and learn the locations of the objects.

In each of the 24 trials in the second ‘wayfinding phase’, the volunteers had to apply what they had learnt, navigating between two randomly chosen objects within 45 seconds.

As expected, young people on average had a greater success rate in finding their way. But importantly, further statistical analyses showed that this difference in success rate was partially driven by observed qualitative changes in how young vs middle-aged participants learned about the maze.

“Compared to younger individuals, middle-aged individuals explored the maze environment less, as they travelled less distance, paused for longer periods of time at decision points, and visited more objects than young individuals,” said Dr Mary Hegarty, a professor at the Department of Psychological and Brain Sciences of the University of California at Santa Barbara, and a joint corresponding author.

These differences were so notable, the authors were able to predict using artificial intelligence whether a participant was middle-aged or young.

Pointing the way for applications

Reduced exploration in middle-aged people may be due to age-related changes in the brain’s navigation network, for example the medial temporal and parietal lobes.

The authors speculated that these findings could inform training interventions that can help middle-aged adults to improve their navigation abilities and preserve cognitive ability.

Co-author Daniela Cossio, a PhD student at the University of California at Irvine, explained: “If we were to train middle-aged people to explore novel environments better – with a focus on traveling greater distances, visiting paths that connect the environment, in a more spread-out manner – this might lead to improvements in their spatial memory, helping to slow down their decline in cognitive ability.”

Dr Elizabeth Chrastil, one of the corresponding authors, and an associate professor at the same institute, looked ahead: “We are currently investigating whether these kinds of changes in exploration behaviour can be identified in people at risk of Alzheimer’s Disease, as well as in those who actually have Alzheimer’s.

“We anticipate that altered exploration behaviour could ultimately become a novel clinical marker for early cognitive decline related to Alzheimer’s.”

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Lung cancer screening prolongs lives in real-world study

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Among US veterans diagnosed with lung cancer through the Veterans Health Administration healthcare system, those who underwent screening before diagnosis were more likely to be diagnosed with earlier stage disease and had a higher cure rate than those who had not been screened.

Lung cancer is the leading cause of cancer deaths worldwide, and most patients are diagnosed at an advanced stage.

Early detection through screening could save lives, and current recommendations state that adults 50–80 years old with at least a 20-pack-year smoking history who currently smoke or have quit within the past 15 years should undergo annual imaging tests for lung cancer.

Such screening has been shown to be beneficial in clinical trials, but there are limited data on the real-world effectiveness of lung cancer screening. To investigate, researchers assessed the impact of screening among patients in the Veterans Health Administration healthcare system diagnosed with lung cancer from 2011–2018.

Among 57,919 individuals diagnosed with lung cancer, 2,167 (3.9%) underwent screening before diagnosis. Patients who underwent screening had higher rates of early (stage I) diagnoses compared with those who had no screening (52% versus 27%), lower rates of death from any cause (49.8% versus 72.1%), and death from cancer (41.0% versus 70.3%) over 5 years.

“It is incredible to witness how dedicated national efforts to increase lung cancer screening from the Lung Precision Oncology Program can lead to substantial improvements in lung cancer outcomes,” said co–corresponding author Michael Green, MD, PhD, of the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System.

The findings come from an observational study published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

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Pioneering therapy approach to combat age-related vision loss

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Cirrus Therapeutics, the University of Bristol, and London’s Global University Institute of Ophthalmology have discovered a revolutionary treatment for age-related macular degeneration (AMD), the leading cause of vision loss among older adults.

Featured on the cover of the journal Science Translational Medicine, this breakthrough research reveals that boosting a specific protein, IRAK-M, in retinal cells could offer a new and highly effective therapy for AMD.

AMD can severely impact a person’s vision. Patients suffering from AMD often start with blurred vision or seeing a black dot in their central vision, which can ultimately expand to the point where there is no useful central vision. Currently, AMD affects approximately 200 million people worldwide, a number projected to rise to 288 million by 2040 with graying populations.

The exact cause of AMD is complex and thought to involve a combination of aging, environmental, and lifestyle factors.

The team found that augmenting IRAK-M levels in retinal cells can significantly protect against retinal degeneration.

“This discovery represents the first pathway-agnostic approach toward AMD, offering a comprehensive treatment option for the millions of people who suffer from this debilitating condition,” said Dr. Andrew Dick, Head of the Academic Unit of Ophthalmology at the University of Bristol, Director of the UCL Institute of Ophthalmology, and co-founder and Chief Scientific Advisor of Cirrus Therapeutics.

Dr. Jian Liu, the first author and senior research scientist at the Academic Unit of Ophthalmology of the University of Bristol, added: “Since age stands as a primary risk factor for AMD, the gradual decrease of IRAK- M levels with age, which further declines in AMD, is a key way to identify the potential markers of early AMD progression and ultimately a new way of treatment.”

This discovery will build and improve upon current treatments for AMD, which are targeting single pathophysiology pathways. “Our novel approach not only addresses the multiple pathways involved in treating AMD but also offers the most compelling and evidence-based strategy available today,” said Cirrus Therapeutics co-founder and Chief Executive Officer Dr. Ying Kai Chan.

Cirrus Therapeutics recently spun out of the University of Bristol to develop therapies related to this discovery.

The research for this paper was funded by the Rosetrees Trust, Stoneygate Trust, Underwood Trust, Macular Society, Sight Research UK, Moran Eye Center at the University of Utah, Sharon Eccles Steele Center for Translation, and supported by the National Institute for Health and Care Research (NIHR) BRC Moorfields and UCL-Institute of Ophthalmology.

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