Symptoms, Risks, and Causes

Symptoms of pneumonia include cough, sputum or phlegm, fever, shortness of breath, and exhaustion. These classic symptoms are more apparent in individuals with a robust immune system, while immunocompromised people might experience subtler signs, such as increased fatigue, overall functional decline, or even falls. “If a chronically ill person is not feeling well, not functioning well, sleeping more, and in some instances, falling down, their doctor should have a high level of suspicion of pneumonia, and that should be verified by getting a chest x-ray,” says Michael S. Niederman, MD, Professor of Clinical Medicine in Pulmonary and Critical Care Medicine, Weill Cornell Medicine.

Pneumonia can affect anyone, but certain factors increase susceptibility. Risk factors include cigarette smoking, underlying heart and lung diseases, diabetes, alcohol abuse, and chronic liver and kidney disease. Additionally, those with a weakened immune system, such as people undergoing chemotherapy, are more vulnerable to pneumonia. “The danger of contracting pneumonia is higher if you have underlying chronic medical problems. But, even previously healthy individuals sometimes get severe pneumonia that can put them in the hospital or even in the intensive care unit. The reason: Some people have an excessive inflammatory response to the infection that can make them very sick,” says Dr. Niederman.

The Role of Vaccination

Preventing pneumonia is crucial, and vaccination plays a vital role. “The most important vaccines for pneumonia prevention are the yearly influenza vaccine and the pneumococcal vaccine,” says Dr. Niederman. There are several pneumococcal vaccines, including pneumococcal conjugate vaccines (PCV) and pneumococcal polysaccharide vaccines (PPSV). Currently, the CDC recommends that all adults ages 65 and older receive the PCV15 or PCV20 vaccine, and if the PCV15 is used, it should be followed by a dose of the PPSV23 at least one year later. People who have risk factors or conditions that make them more susceptible are advised to get vaccinated at a younger age.

Dr. Niederman points out that there is also a newly approved vaccine, PCV21, that is not included in the CDC’s current recommendations.

“PCV21 can be used interchangeably in place of PCV20. It covers more of the invasive pneumococcal strains than any other vaccine option,” says Dr. Niederman. Understanding which vaccine is right for you may be daunting, which is why it’s best to discuss pneumonia vaccination with your primary care physician or your pulmonary doctor, if you are under the care of one for respiratory issues. Your health-care provider can determine the appropriate vaccine and schedule based on your health status and vaccination history.

Pneumonia Treatment

Pneumonia is most often caused by either a viral or a bacterial infection, and typically involves treatment with antibiotics. Additional treatments include rest, hydration, and supplemental oxygen if needed. Steroids might be prescribed in severe bacterial cases, but can be harmful for pneumonia caused by viruses. Having pneumonia once increases the risk of recurrence, so adhering to the full course of prescribed medications and medical advice is critical.

Road to Recovery

Recovery from pneumonia can be prolonged, especially for older adults. Healing involves patience, rest, and a gradual return to normal activities. Follow your doctor’s advice closely to ensure a complete recovery.

By staying informed about the risks, prevention strategies, and treatment options, women can better protect themselves against pneumonia.

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Body mass index (BMI) is a ratio of weight to height that has long been used to assess whether people are tipping the scales into the overweight or obese category. There are numerous online BMI calculators (the Centers for Disease Control and Prevention has one at http://tiny.cc/cdcbmicalc). A BMI below 18.5 is categorized as underweight, 18.5 to 24.9 is normal, 25 to 29.9 counts as overweight, and 30 and higher is categorized as obese. For younger people, maintaining a normal BMI is associated with better cardiovascular health and a lower risk of death—however, studies have suggested that older people who fall into the overweight category (or are even mildly obese) live longer than those whose BMI is considered normal. BMI increases for some older people because their height tends to decrease, and there is ongoing debate about whether to use a person’s adult height or their current height when calculating an older adult’s BMI. If the latter is used, BMI will increase. I tell my patients not to worry too much if they are overweight according to their BMI. However, if you reach the point where excess weight may be increasing your risk of chronic illness and disability, I recommend working with your doctor to manage weight gain.

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

I made the mistake of overusing a nasal decongestant spray a couple of years ago during a bad cold. I’m now having to use it all the time, because my nose is so stuffy without it. What can I do to stop using the spray?

Colds, the flu, COVID-19, and seasonal allergies cause the blood vessels in the nasal membranes to swell up, which manifests as a stuffy nose. Decongestant sprays clear the stuffiness by shrinking swollen blood vessels; however, it is very important to limit their use to the two or three days recommended on the medication leaflet or you may suffer from rebound congestion. The sprays that are most likely to cause this are those containing oxymetazaline (for example, Afrin®) or phenylephrine (Neosynephrine®). Long-term use of these sprays also can damage the septum (the wall between your nasal passages). You may be able to wean yourself off the spray by using it in just one nostril for as long as it takes the other side to stay clear, and then not using it in the second nostril. Using a saline spray on the untreated side may help you avoid severe congestion while your nasal blood vessels get back to normal. A vapor inhaler stick or a few drops of Olbas oil (available at pharmacies) sprinkled on a tissue also may help. If these strategies don’t make a difference, ask your doctor if it is safe for you to switch to using a steroid nasal spray instead, since these are not associated with rebound congestion. Steroid sprays take time to start working, so you’ll need to be patient.

Patricia Bloom, MD

Geriatric Medicine

I’m due for my first colonoscopy, and I have a question. Every diagram I’ve seen of the colon shows that it curves in several places. How does the colonoscope negotiate the curves?

The colon curves to the left just beyond the rectum into a section called the sigmoid colon and curves again to continue upward (a section called the descending colon). It then curves right into a horizontal section (the transverse colon) before making a final turn into a section we call the ascending colon. Rest assured that gastroenterologists receive a great deal of practical training to help them negotiate these curves with the colonoscope. The colonoscope itself is very flexible, so it can bend easily—there also is a knob at the control section of the colonoscope that your doctor uses to change the direction of the tip up/ down and left/right. Your doctor also may have a nurse press on your stomach or slightly change your position during the procedure if needed to help maneuver the colonoscope. You won’t be aware of this activity or feel any discomfort, since you will be sedated.

Brijen J. Shah, MD

Gastroenterology

The post Ask the Experts: BMI in Older Age; Nasal Decongestant Dependence; Colonoscope Controls appeared first on University Health News.

Research published recently in Nature Communications involved the creation of an “atlas” of brain regions affected by PD and an algorithm that may help personalize deep brain stim­ulation (DBS) therapy. The algorithm could be a significant development, as patients with Parkinson’s disease don’t always respond to DBS equally.

Findings from a separate MGH study, published in the journal Stroke, suggest that noninvasive laser therapy may be able to help individuals who can’t be treated with clot-busting drugs or surgical clot removal. It too could be a game changer for clinicians needing more emergency treatment options.

Mapping the Brain

DBS first received Food and Drug Administration approval for PD treat­ment in 2002, and ever since scientists have been developing methods of enhancing its safety and effectiveness. DBS works in people with PD by sending electric pulses from an implanted pulse generator to small leads placed in parts of the brain that control muscle movement. DBS inter­feres with the disorganized signals muscles receive from the brain caus­ing tremors, muscle freezing, and other symptoms. DBS often can reset communication between the brain and the muscles, at least temporarily.

The latest advancement in DBS comes from researchers with Mass General Brigham, who took data from five centers that treat PD patients with DBS. The researchers then created an atlas that mapped four major  PD symptoms onto different regions of the brain. From there, the researchers developed an algo­rithm that could generate personal­ized symptom-specific DBS treatment plans.

The four key symptoms mapped to various brain regions were tremor, bradykinesia (slow movement), rigid­ity, and axial symptoms (gait and pos­ture instability or irregularity). Doc­tors could use the new brain atlas to pinpoint the precise location for DBS electrodes in each patient based on their individual symptoms. For exam­ple, tremor was shown to improve with stimulation of tracts connected to the primary motor cortex and cerebellum.

“There is already strong evidence of improved quality of life for PD patients treated with DBS, but cur­rently we still use a ‘one-size-fits-all’ approach to treatment,” says senior author Andreas Horn, MD, PhD, a Mass General Brigham neurologist who works in the Center for Neu­rotechnology and Neurorecovery at MGH. “The techniques we have developed will help us readily tailor DBS to what each patient specifically needs and improve DBS even further.”

Lighting Up Blocked Arteries

When a blood clot blocks healthy cir­culation in the brain—an ischemic stroke—current treatment options include clot-busting drugs and surgi­cal clot removal. However, these approaches aren’t appropriate for everyone, either because the time window to use the drugs safely has closed or because surgery is too risky.

MGH researchers have found that a noninvasive laser treatment may pro­vide a safe and effective means of improving circulation in the part of the brain affected by stroke. “Unlike other approaches using chemicals, which can be toxic to our bodies, laser light is a physical parameter. It does not stay in the body after the therapy and will have little chance of causing side effects,” says co-senior author Satoshi Kashiwagi, MD, PhD, an investigator in MGH’s Department of Radiology.

The laser works by targeting the endothelial cells that line the blood vessels in an artery affected by a stroke. Endothelial dysfunction can be a contributor to stroke development. One characteristic of that dysfunction is low production of nitric oxide, a gas that helps keep blood vessels open.

The experimental treatments involve a device positioned outside of the scalp that aims a low-power invisi­ble laser light at the artery experienc­ing a blockage. “We discovered a new way to effectively treat stroke using laser light, a modality that is already widely used in the clinic for proce­dures such as LASIK eye surgery and tattoo removal, and has a well-known safety profile,” Kashiwagi explains. “Thus, we expect that we could advance this technology to clinical trials relatively soon. Such technology has the potential to replace the current standard therapy using chemicals, which may cause side effects.”

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If so, you may be headed for a longer, healthier, and happier life.

Numerous studies of happiness in recent years have consistently shown that having a sense of gratitude is a key part of the prescription for healthy well-being and a positive out­look. According to a recent study led by researchers from the Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, being thankful also may help you live longer.

“Prior research has shown an asso­ciation between gratitude and lower risk of mental distress and greater emotional and social well-being. However, its association with physi­cal health is less understood,” says lead author Ying Chen, a research scientist with Harvard’s Human Flourishing Program. “Our study provides the first empirical evidence on this topic, suggesting that experi­encing grateful affect may increase longevity among older adults.”

The study was published recently in JAMA Psychiatry. Other authors involved include Harvard and MGH researchers Olivia Okereke, MD; Henning Tiemeier, MD, PhD; Laura Kubzansky, PhD; and Tyler Vander­Weele, PhD.

Researchers relied on data from the Nurses’ Health Study to measure levels of gratitude and mortality among 49,275 older women. In 2016, study participants (average age 79) were scored on a six-item Gratitude Questionnaire. They either agreed or disagreed with statements such as, “I have so much in life to be thankful for” and “If I had to list everything that I felt grateful for, it would be a very long list.” In 2019, the researchers followed up to identify deaths among the study population, noting all-cause mortality (death from any cause) as well as specific causes such as cardiovascular disease, cancer, neurodegenerative disease, and injury. The researchers recorded 4,608 deaths over the course of the study period. Among the specific causes studied, cardiovascular dis­ease was the most common.

After adjusting for factors such as smoking and other health problems, the researchers found that partici­pants who scored highest on the Gratitude Questionnaire had a 9 per­cent lower risk of all-cause mortality over the next four years compared with those with the lowest scores. Gratitude appeared to have protective benefits against every specific cause of mortality studied, most signifi­cantly against cardiovascular disease.

Benefits of Gratitude

Previous studies suggest that grati­tude is associated with several markers of good health, including endothelial function—how well the cells that line your blood vessels and lymphatic vessels keep blood and lymph moving throughout the body. Experiencing and expressing grati­tude is also associated with lower levels of inflammation, a factor that affects the risks of developing car­diovascular disease, dementia, and most other health problems.

Research also suggests that people who embrace gratitude are more likely to adhere to a healthy lifestyle, involving regular exercise, a balanced diet, and medication adherence. Plus, focusing your thoughts on thankfulness helps you keep perspective when challenges and trouble threaten your peace of mind.

How to Experience Gratitude

Being thankful can take many forms. You can frequently express gratitude to others, from relatives and friends who are there for you when you need them to store clerks, restaurant servers, and the stranger who holds the door open for you.

If you are someone who writes thank-you notes for gifts, extend that idea and write “gratitude notes” to people you appreciate—even if there is no specific cause or reason. Not only might you feel better, but the recipient of your note is likely to get a mood boost, too.

You may find it helpful to take a few moments a day for silent grati­tude. Hit the pause button on your chores and errands and think about something nice someone did for you that day or last night’s beautiful sunset or your good health. Try not to  overlook the small acts and the big news that shape your world for the better.

“Prior research indicates that there are ways of intentionally fos­tering gratitude, such as writing down or discussing what you are grateful for a few times a week,” Chen says. “Promoting healthy aging is a public health priority, and we hope further studies will improve our understanding of grati­tude as a psychological resource for enhancing longevity.”

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What It Is.

While there is no single, universally accepted definition of frailty, it’s understood as a syndrome that impacts health, energy level, physical abilities, and, in some definitions, cognitive abilities. This syndrome is typically seen in older adults, although it can occur in younger people.

“Frailty is characterized by a reduced resilience,” says Roger A. Fielding, PhD, senior scientist and leader of the Nutrition, Exercise Physiology, and Sarcopenia Team at the Human Nutrition Research Center on Aging (HNRCA). “The body doesn’t respond adequately to external stressors such as an infection or other illness, surgery, or a fall. The individual may have a delayed or weak immune response to an infection, for example, or poor recovery from surgery.”

Researchers have come up with different ways to identify frailty. The most common approach, the Fried frailty phenotype, assess five criteria:

• Weakness, measured by low handgrip strength;

• Self-reported exhaustion or low energy;

• Walking speed of less than 0.8 miles per second with or without a walking aid;

• Low physical activity; and/or

• Unintentional weight loss of 10 pounds or more (or 5 percent or more of body mass) in a year.

People who have three or more of these criteria are considered frail. Those with any two are pre-frail, meaning they are at high risk of becoming frail. Poor balance and cognitive impairment can also be considered symptoms of frailty.

“All five of these criteria involve some change in muscle or muscle function,” says Fielding. “In fact, many people who are frail also have sarcopenia (and many who have sarcopenia also are frail). Sarcopenia is an ageassociated decline in muscle mass and strength first identified here at HNRCA. Everyone loses muscle mass and strength with age. With sarcopenia, that loss limits the person’s ability to function.”

Since there are no recommendations for routine testing (and no standard diagnostic test), it’s hard to know how common frailty is. Sources estimate that four to 16 percent of community-dwelling women and men aged 65 and older in the U.S. are frail. A full 25 percent of those over 84 are estimated to be frail. Many more are considered pre-frail.

Why it Matters.

As frailty progresses, people lose their independence. The loss of strength leads to poor mobility and increased risk of falls. People with frailty are at higher risk for infections, hospitalization and long hospital stays, surgical complications, and being unable to return to independent living after a surgical procedure. They may also experience loss of appetite, which increases risk for unintended weight loss and undernutrition. Ultimately, frailty increases risk of death.

What to Do.

“Take a pre-frail or frail individual and have them begin a program of physical activity, and we can reverse some of the symptoms,” says Fielding. “Physical activity also works to avoid becoming frail in the first place.”

Generally, being active, maintaining a healthy body weight, consuming a healthy dietary pattern, and staying socially and cognitively active are the recommended ways to stay strong, active, healthy, and independent as you age. For more tips, see the “Take Charge!” box.

Risk Factors for Frailty.

The most commonly cited risk factors for developing frailty are advanced age, smoking, underweight, overweight, obesity, lower socioeconomic status, and less education. “One of the biggest factors is a sedentary lifestyle,” says Fielding. “People who are less active are at greater risk.” Other factors include social isolation, living alone, a generally unhealthy lifestyle, and traumatic life events. People diagnosed with type 2 diabetes, respiratory disease, stroke, dementia, multiple sclerosis, connective tissue disease, osteoarthritis, and chronic fatigue syndrome or who suffer from multiple disorders are more likely to develop frailty. It is more common in women than men, but men with frailty have a higher mortality rate.

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Hyper vs. Hypo

The thyroid is a small butterfly-shaped gland situated in the neck, just below the larynx. Its function is to absorb iodine, an element that occurs mainly in salt, bread, and fish, and convert it into triiodothyronine (T3) and thyroxine (T4). These hormones control your metabolism, influencing everything from the speed at which you digest fats and carbohydrates, to the rate at which your heart beats.

Another hormone—thyroid stimulating hormone (TSH)— also plays an important role in thyroid function. TSH stimulates the thyroid to produce T3 and T4. As such, measuring the level of TSH in the blood can flag underlying thyroid issues. High TSH levels may indicate that the thyroid is not producing enough thyroid hormone (hypothyroidism, which also is known as underactive thyroid), while low TSH levels may mean that your thyroid is producing too much thyroid hormone (hyperthyroidism, or overactive thyroid).

Hypothyroidism

This is the most common thyroid disorder and occurs when T4 levels are too low. Low T4 levels cause body processes to slow down— as such, symptoms typically include fatigue, weight gain, sluggish bowel movements, and increased sensitivity to cold. However, in older adults, these symptoms are less common—instead, an underactive thyroid may cause depression, loss of appetite, weight loss, and joint pain. Since these symptoms are associated with other diseases that are common in older age, recognizing hypothyroidism is challenging. Dr. Arakawa adds that it also is possible to develop subclinical hypothyroidism, in which TSH levels are only slightly elevated while levels of T3 and T4 are normal. “People who have subclinical hypothyroidism may report nonspecific symptoms, such as an altered mood and cognitive impairment, while many don’t have any symptoms,” she says.

HYPOTHYROIDISM RISK FACTORS

You are at increased risk for underactive thyroid if you have a family history of thyroid disease, have been treated for an overactive thyroid, and/or have had extensive surgery or radiotherapy to your neck. Some medications also raise the risk— for example, the cancer drugs sunitinib (Sutent®) and imatinib (Gleevec®) can cause or worsen an underactive thyroid, as can amiodarone (Corderone®, Pacerone®), which is used to treat heart arrhythmias.

It also is possible for underactive thyroid disease to arise from an autoimmune condition called Hashimoto’s thyroiditis, which impedes the thyroid gland from secreting hormones. Hashimoto’s usually causes a goiter, which is a swelling in the neck arising from enlargement of the thyroid gland.

TREATING HYPOTHYROIDISM

Dr. Arakawa emphasizes that treatment has not been shown to have a significant impact on symptoms in older adults with subclinical hypothyroidism. Although subclinical hypothyroidism is associated with an increased risk for progression to overt hypothyroidism and adverse cardiovascular events, the policy is to monitor people with subclinical disease and initiate treatment only if overt hypothyroidism occurs.

Treatment for overt hypothyroidism is a synthetic version of thyroid hormone called levothyroxine (Synthroid®, Levoxyl®). The drug is one of the most prescribed medications in the United States, but overusing it is known to increase the risk of osteoporosis. Recent research suggests that levothyroxine overuse also may increase the risk of cognitive issues in older adults. The 2023 study (JAMA Internal Medicine, Oct. 23) included 65,931 older adults and focused on thyrotoxicosis (excess T3 and /or T4 levels in the body). The new study suggests that thyrotoxicosis caused by medication raises the risk of cognitive decline. Dr. Arakawa says the data are a useful reminder for doctors to be cautious when prescribing thyroid hormone to older adults. “It’s important to regularly monitor people who are taking levothyroxine and decrease the dose if needed,” she notes.

Hyperthyroidism

This occurs when the thyroid releases too much T3 and T4, and it causes the body to “speed up.” Younger people may experience symptoms like an increased appetite, palpitations (the sense your heart is “skipping” beats), a tremor in the hands and arms, more frequent bowel movements, excessive perspiration, anxiety, and insomnia. But—as with hypothyroidism—overactive thyroid symptoms may be different in older adults, who “tend to present more nonspecifically, with fatigue, weight loss, and mood changes,” according to Dr. Arakawa. “Cardiovascular manifestations of hyperthyroidism also tend to predominate, particularly the abnormal heart rhythm atrial fibrillation,” she adds.

HYPERTHYROIDISM RISK FACTORS

In older adults, hyperthyroidism usually is related to abnormal growths that form in the thyroid gland. Called thyroid nodules, these can produce more T3 and T4, which is what makes the thyroid overactive. An overactive thyroid also can be caused by an autoimmune condition (Grave’s disease). Studies have linked Grave’s disease to an increased risk of cognitive decline. In other cases, drugs may trigger thyroid overactivity— for example, amiodarone, which can trigger both overactive and underactive thyroid disease.

TREATING HYPERTHYROIDISM

Untreated hyperthyroidism is known to increase the risk of developing osteoporosis, a condition that raises the risk of fractures. “Hyperthyroidism also can impact the pumping and rhythm functions of the heart, which may lead to conditions such as heart failure and atrial fibrillation,” Dr. Arakawa says. “These risks are augmented in people ages 65 and older, so treatment is recommended to correct hyperthyroidism.”

Treatment options include anti-thyroid medications, such as methimazole (Tapazole ®), which blocks the production of thyroid hormones. Alternatively, radioactive iodine can destroy the overactive thyroid cells, rapidly shrinking an enlarged thyroid gland. This can leave the thyroid unable to produce any hormone, and it’s likely you’ll eventually become hypothyroid and require treatment for that.

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Sam Gandy, MD, PhD, professor of neurology at Mount Sinai and associate director of the Mount Sinai Alzheimer’s Disease Research Center, says that donanemab has some advantages when compared with lecanemab— however, he recommends older adults be realistic about the new drug’s possible benefits and carefully consider its possible harms.

A-beta Reduction

The FDA approved donanemab based on trial data from 1,736 older adults showing that the drug reduced A-beta plaques in the brain. While some A-beta accumulation is normal in older age, the protein is believed to contribute to AD by disrupting communication between brain cells and eventually destroying brain cells. “However,many older adults maintain normal cognition despite A-beta accumulation, so there is some debate as to just how much of a role it plays in cognitive impairment,” Dr. Gandy notes. In the trial, donanemab treatment was stopped as soon as the participants’ brain scans showed that A-beta had been cleared from the brain. Scientists involved in the trial have estimated that it would take about four years for A-beta to build up again to a level where it might impair cognition.

The trial data also suggested that donanemab slowed cognitive and functional decline compared with a placebo (inert substance). “Participants with lower levels of another abnormal brain protein—tau—saw more benefit from donanemab,” says Dr. Gandy. “Research suggests that tau also contributes to AD, with higher tau levels meaning more cognitive decline. The donanemab data support the theory that successful treatment depends on starting AD medications as early as possible in the course of the disease, before tau accumulates.”

Some Advantages

Dr. Gandy says that donanemab has some advantages over the currently available version of lecanemab. “Donanemab is given monthly, while lecanemab is given every two weeks,” he explains. “Both drugs are delivered via intravenous infusion, which means attending an infusion center—but while lecanemab must be given indefinitely, with donanemab there is the possibility of pausing the drug after 18 months, since, by that time in the trial, the amyloid scans of all the participants were negative. Since we don’t yet know the long-term side effects of these new drugs, the idea of pausing treatment makes donanemab especially attractive.”

Lecanemab Update

There is a new development with regard to lecanemab. A subcutaneous (injected) version of the drug is under review by the FDA. “Subcutaneous lecanemab would be more practical for people without easy access to infusion centers,” Dr. Gandy says. “Plus, trials suggest that the subcutaneous version is more effective than the intravenous version at clearing A-beta plaques.”

Benefits vs. Harms

As with lecanemab, donanemab is associated with swelling and bleeding in the brain, so anyone taking the drug would need regular brain scans to monitor for these harms. Does the risk of side effects outweigh the potential benefits? “In the trial, cognitive decline slowed by about four to seven months in people taking the drug,” Dr. Gandy says. “This likely would be acceptable to the family members of a person living with AD, but in reality, it is a very modest improvement that may not be noticeable on a day-to-day basis.” He adds that it is impossible to know how MCI might progress without treatment. “There is a risk that a person with nonprogressive MCI could take one of these new drugs and suffer potentially serious side effects,” he says. “Another caveat is that the trial participants were mostly white, so we don’t know how well other ethnicities would respond to donanemab.”

Overall, Dr. Gandy thinks that donanemab likely won’t prove to be a magic bullet. However, he is optimistic about what the drug might mean for the future. “It may bring us one step closer to developing safer treatments with greater impact for people living with AD,” he concludes.

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If you want to stay well as you age, turn off the TV and get off the couch. That’s the message from researchers at Harvard’s T.H. Chan School of Public Health who found that replacing even one hour of TV with physical activity could benefit a person’s health. For a study published in JAMA Network Open, June 11, the Harvard team looked at 20 years of data from 45,176 people free of major chronic diseases (including cancer, diabetes, heart attack, heart failure, and stroke). Healthy aging was defined as survival to at least age 70 with no major chronic diseases and no impairment in subjective memory (defined as a person’s own perception of their memory), physical function, or mental health. Among the participants, 3,873 achieved healthy aging. The analysis showed that each increase of one hour per day spent engaged in light-intensity physical activity (such as household chores) increased the odds of healthy aging by 8 percent.

Walking Relieves Back Pain

A new study from Macquarie University, in Sydney, suggests that regular walking is an effective way to manage chronic back pain. The study (The Lancet, June 19) included 701 adults, mean age 54, all of whom had recently recovered from an episode of low back pain. The participants were randomly allocated to a walking program or to a no-intervention control group. Participants in the walking program were advised to build up to 30 minutes of walking, five times a week over a six-month period. After three months, most were walking three to five days a week for an average of 130 minutes. Compared with the control group, the intervention group had fewer occurrences of activity-limiting back pain during the one- to -three-year followup period and a longer average period before they had a recurrence of back pain (a median of 208 days compared to 112 days in the control group). Walking is a good low-impact muscle-strengthening exercise for people with musculoskeletal pain; moreover, it can be good for easing the stress and depression that can accompany chronic discomfort.

Traumatic Brain Injury Risk

The number of older adults diagnosed with traumatic brain injury (TBI) is alarmingly high, according to a recent study from researchers at the University of California-San Francisco. TBIs range from mild concussion to more serious head injuries that subject brain tissue to severe damage and increase the risk of dementia, Parkinson’s disease, seizures, and depression. The study (JAMA Network Open, May 31) followed 9,239 Medicare enrollees, average age 75. Over an 18-year follow-up, 1,148 participants sustained a TBI. Contrary to studies looking at younger people, TBI was more likely among people who were healthier. It is possible this may be because these individuals are more likely to engage in physical activity. Keep in mind that the data reflect cases of TBI in which people were diagnosed and received care. Other research has suggested that many older adults do not seek a medical evaluation after a TBI. If you fall, let your doctor know, even if you think you haven’t hurt yourself.

Shingles Vaccine Uptake

New data (Journal of the American Medical Association, May 23), shows that uptake of the shingles vaccine (Shingrix®) among older Americans has increased, likely because of government action to eliminate cost sharing for vaccines covered by Medicare Part D. The policy was part of the Inflation Reduction Act and took effect in January 2023. To determine the impact of the new policy, a team from the University of California’s Mann School of Pharmacy and Pharmaceutical Sciences looked at monthly data on shingles vaccines administered between January 2022 and December 2023. The analysis showed that uptake of the shingles vaccine increased by 46 percent after the policy was implemented. The vaccine is recommended for people ages 50 and older and significantly reduces the risk of shingles and postherpetic neuralgia (chronic nerve pain that can persist for years).

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Yes it is. As with smoking, consuming alcohol stimulates the release of endorphins: “feel-good” chemicals that generate sensations of pleasure and make us feel more relaxed. If you are under stress because of work, illness, or caregiving duties, this instant gratification can become a crutch. Moreover, alcohol remains socially acceptable in a way that smoking no longer is. Go out to dinner with friends, attend any kind of formal function, such as a wedding reception, and it is likely alcohol will be involved. If you become anxious in social situations, you may find that alcohol’s relaxing effects make it easier to interact with others. Much as people who smoke may light a cigarette without thinking about it when they are out with friends, you might have another glass of wine, and another, without noticing. This is particularly risky for older adults—age increases our sensitivity to alcohol, so we will experience a greater response to a given amount of alcohol that previously was tolerable.

At some point, you may decide to cut back your drinking—but stopping may result in withdrawal symptoms, including anxiety, tremors, and poor sleep, so you may relapse. This is where alcohol addiction counseling can help, and I recommend it for people who want to stop drinking but can’t, those who frequently drink more than they intend to, those who crave alcohol so much they can’t think of anything else, and those who don’t think they have a problem but whose family and friends have expressed concern. The National Institute on Alcohol Abuse and Alcoholism has a treatment navigator tool (http://tiny.cc/AlcHelp). Alcoholics Anonymous also can help (ww.aa.org) .

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

I’ve been having physical therapy for gluteal medius tendinitis in my hip. The therapist recommended laser treatment, but is this safe?

The gluteus medius tendons connect the gluteus medius muscles (often referred to as the abductors) to the outer side of the hips. The muscles are involved in walking and stepping from side to side, and in rotating the hip joint. It is possible for the tendons to develop microscopic tears and become inflamed (tendinitis) due to overuse or an accident. The inflammation may cause symptoms including pain over the hip and in the buttock on the affected side. You also may lose some range of motion in the joint.

Along with rest and the use of cool compresses, physical therapy is an effective treatment for gluteal medius tendinitis. There also is some limited evidence that laser therapy may help acute episodes of tendinitis by promoting tissue repair. The treatment is safe, and most people see an improvement in their symptoms within six weeks. Laser treatment also may help you avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) to ease your discomfort. NSAIDs include ibuprofen (Advil®, Motrin®) and naproxen (Aleve®) and are associated with potentially serious bleeding in older adults.

Richard G. Chang, MD, MPH

Rehabilitation and Physical Medicine

I take the blood thinner warfarin because I have a mechanical heart valve. Is it possible for me to switch to one of the newer blood thinners that have no food interactions?

The newer drugs you reference—known as direct oral anticoagulants, or DOACs—include dabigatran (Pradaxa®), edoxaban (Savaysa®), rivaroxaban (Xarelto®), and apixaban (Eliquis®). They do not have as many interactions as warfarin (Coumadin ®) and don’t require the regular monitoring that is required when taking warfarin, so they do make life easier. Unfortunately, DOACs are contraindicated in people with mechanical heart valves (made from carbon and titanium), because two major clinical trials investigating the use of dabigatran and apixaban in these individuals showed an increased risk of blood clots compared with warfarin. Strictly speaking, DOACs also are not recommended for people with biological valves or valve repair—however, some doctors prescribe the drugs off-label for limited time periods to these individuals despite the lack of proven safety data.

Bruce J. Darrow, MD, PhD

Cardiology

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What Is Inflammation?

Inflammation is a natural bodily response that can be beneficial. For instance, if you accidentally prick your finger on a rose bush while gardening, your immune system triggers inflammation to aid healing. However, there are instances where inflammation starts without a clear reason and persists; this is known as chronic inflammation. “Chronic inflammatory responses can develop when immune or nonimmune cells in the body start to release bioactive molecules that can promote hallmarks of inflammation including swelling, redness, and heat,” says David Artis, PhD, director of Weill Cornell Medicine’s Friedman Center for Nutrition and Inflammation and Director of its Jill Roberts Institute for Research in Inflammatory Bowel Disease.

Inflammation and Brain Function

Scientists have discovered a connection between inflammation in the body and how well our brains work. When markers of inflammation—like C-reactive protein (CRP) and interleukin-6 (IL-6)—are elevated, studies show an escalation in memory loss and dementia. Research also shows that inflammation plays a role in disrupting the blood-brain barrier—a protective wall in the brain that controls what can enter and exit. When inflammation weakens the wall, it allows harmful immune cells in, thereby provoking further inflammation.

Diet and Cognition

Consuming a diet abundant in processed foods and saturated fats can trigger inflammation, and there is growing scientific evidence of a link between a high intake of sugar and processed foods and an increased risk of Alzheimer’s disease and cognitive decline. Conversely, studies show that embracing a nutrition plan rich in fruits, vegetables, grains, fish, nuts, lean protein, and low-fat dairy can counteract inflammation and potentially safeguard against cognitive deterioration. The MIND diet, which stands for Mediterranean-DASH Intervention for Neurodegenerative Delay, is a hybrid of the Mediterranean and DASH diets, and is specifically designed to promote brain health. The MIND diet emphasizes anti-inflammatory foods such as leafy greens, berries, nuts, and whole grains, while discouraging the intake of red meat, butter, and sweets. It has been shown to lower the odds of developing conditions like Alzheimer’s disease and dementia. In fact, one study found that those who followed the MIND diet strictly cut their chances of developing Alzheimer’s by more than half.

“Adopting a diet rich in certain fibers and grains, vitamin C, beta-carotene, and lycopene, while limiting foods high in fat, salt, and sugars, can contribute to limiting the magnitude of chronically inflammatory responses,” says Artis. A cup of strawberries or broccoli provides enough vitamin C for the day. The recommended daily amount of vitamin C for women is 75 milligrams. There is no official recommendation for daily lycopene or beta-carotene intake, but some studies suggest that 8 to 21 milligrams of lycopene per day and 6 to 15 milligrams of beta-carotene per day may be beneficial. Foods rich in beta-carotene include carrots and sweet potatoes, and those high in lycopene include tomatoes and watermelon.

Exercise and Stress

Regular physical activity enhances blood flow to the brain and promotes the release of chemicals such as brain-derived neurotrophic factor (BDNF) that support brain health. BDNF plays a crucial role in neuroplasticity, or the brain’s ability to adapt and form new connections, and this is essential for maintaining cognitive function. Exercise also helps diminish chronic inflammation by decreasing the production of cortisol in your body. Elevated cortisol can trigger inflammatory pathways, leading to detrimental effects on cognitive health.

Healthy Choices for Brain Function

Recognizing the connection among lifestyle choices, inflammatory processes, and cognitive function may be the incentive needed to welcome healthy nutrition, exercise, and stress reduction behaviors into your life.

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