Ageing alters the impact of nutrition on immune function

Immunosenescence during ageing is a major challenge which weakens the ability of older individuals to respond to infection or vaccination. There has been much interest in dietary strategies to improve immunity in older people, but there is an assumption that modulation of the immune response in older people will be based on the same principles as for younger adults. Recent evidence suggests that ageing fundamentally alters the impact of nutrition on immune function. As a result, interpretation of data from studies investigating the impact of diet on immune function is highly dependent on subject age. Study design is critically important when investigating the efficacy of dietary components, and most studies involving older people include rigorous inclusion/exclusion criteria based on medical history, laboratory tests, general health status and often nutritional status. However, immunological status is rarely accounted for, but can vary significantly, even amongst healthy older people. There are several clear examples of age-related changes in immune cell composition, phenotype and/or function, which can directly alter the outcome of an intervention. This review uses two case studies to illustrate how the effects of n-3 PUFA and probiotics differ markedly in young v. older subjects. Evidence from both suggests that baseline differences in immunosenescence influence the outcome of an intervention, highlighting the need for detailed immunological characterisation of subjects prior to interventions. Finally, future work elucidating alterations in metabolic regulation within cells of the immune system as a result of ageing may be important in understanding the impact of diet on immune function in older people.

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Insights Into the Effects of Mucosal Epithelial and Innate Immune Dysfunction in Older People on Host Interactions With Streptococcus pneumoniae

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.651474 ◽

2021 ◽

Vol 11 ◽

Author(s):

Caroline M. Weight ◽

Simon P. Jochems ◽

Hugh Adler ◽

Daniela M. Ferreira ◽

Jeremy S. Brown ◽

...

Keyword(s):

Streptococcus Pneumoniae ◽

Older People ◽

Immune Cell ◽

Herd Immunity ◽

Pneumococcal Infection ◽

Innate Immune ◽

Older Individuals ◽

Serotype Replacement ◽

Pneumococcal Colonization ◽

The Impact

In humans, nasopharyngeal carriage of Streptococcus pneumoniae is common and although primarily asymptomatic, is a pre-requisite for pneumonia and invasive pneumococcal disease (IPD). Together, these kill over 500,000 people over the age of 70 years worldwide every year. Pneumococcal conjugate vaccines have been largely successful in reducing IPD in young children and have had considerable indirect impact in protection of older people in industrialized country settings (herd immunity). However, serotype replacement continues to threaten vulnerable populations, particularly older people in whom direct vaccine efficacy is reduced. The early control of pneumococcal colonization at the mucosal surface is mediated through a complex array of epithelial and innate immune cell interactions. Older people often display a state of chronic inflammation, which is associated with an increased mortality risk and has been termed ‘Inflammageing’. In this review, we discuss the contribution of an altered microbiome, the impact of inflammageing on human epithelial and innate immunity to S. pneumoniae, and how the resulting dysregulation may affect the outcome of pneumococcal infection in older individuals. We describe the impact of the pneumococcal vaccine and highlight potential research approaches which may improve our understanding of respiratory mucosal immunity during pneumococcal colonization in older individuals.

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Ten years of EMS Fall Calls in a Community: An Opportunity for Injury Prevention Strategies

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318783453 ◽

2018 ◽

Vol 9 ◽

pp. 215145931878345 ◽

Cited By ~ 1

Author(s):

Carmen E. Quatman ◽

Michael Mondor ◽

Jodi Halweg ◽

Julie A. Switzer

Keyword(s):

Health Care Cost ◽

Cost Benefit ◽

Retrospective Chart Review ◽

Community Services ◽

Older Individuals ◽

The Past ◽

Dramatic Shift ◽

Time Fall ◽

Future Work ◽

The Impact

Objective: To determine whether fall calls, lift assists, and need for transport to the hospital over the past 10 years in one emergency medical services (EMS) system have altered coincident with demographic changes and to estimate health-care cost for lift assists. Methods: We conducted a retrospective chart review of EMS fall-related care. The HealthEMS database for a suburban community surveyed was queried from March 1, 2007, to March 1, 2017. Fall-related calls in patients 60 years or older were identified and determined to be either lift assists (calls that do not result in transport) or fall calls that resulted in transport to the hospital. Results: Of the 38 237 EMS care responses in patients 60 years or older, 11.5% were related to falls. Fall calls increased by 268% over the past 10 years ( P = .0006), yet the number of transports to the hospital significantly decreased over time ( P = .02). Lift assists increased significantly ( P = .0003), nearly doubling over the decade. At the same time, fall calls that did not result in transport to the hospital cost the community an estimated US$1.5 million over a 10-year period. Discussion: There has been a dramatic shift in fall-related calls to EMS in older individuals with more frequent calls for lesser acuity needs. Utilization of EMS for lift assists has substantial financial consequences and diverts care from calls that need immediate triage and transport to care. Conclusion: Future work to reduce the frequency and increase the impact of EMS lift assists could have a significant cost benefit and provide opportunity for enrollment in appropriate community services and fall prevention programs.

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Sleep disordered breathing at the extremes of age: the elderly

Breathe ◽

10.1183/20734735.003216 ◽

2016 ◽

Vol 12 (1) ◽

pp. 50-60 ◽

Cited By ~ 20

Author(s):

Alison McMillan ◽

Mary J. Morrell

Keyword(s):

Risk Factors ◽

Older People ◽

Sleep Disordered Breathing ◽

Treatment Options ◽

Current Evidence ◽

List Type ◽

Pressure Therapy ◽

Age Related ◽

The Impact ◽

Disordered Breathing

Key pointsSleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people.There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes.There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB.Educational aimsTo highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people.To inform readers about the risk factors for SDB in older people.To explore the impact of SDB in older people.To introduce current evidence based treatment options for SDB in older people.Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population.

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Socio-economic disadvantage and poverty

Mental Health in Later Life ◽

10.1332/policypress/9781447305729.003.0006 ◽

2020 ◽

pp. 105-114

Author(s):

Alisoun Milne

Keyword(s):

Older People ◽

Later Life ◽

Poverty Line ◽

Developed Countries ◽

Economic Disadvantage ◽

Fundamental Building Block ◽

Age Related ◽

The Uk ◽

State Pension ◽

The Impact

Chapter 5 is the first of three chapters exploring the impact of age related risks affecting particular sub populations of older people. Socioeconomic disadvantage in later life tends to reflect a lifecourse status. It amplifies what is already present. In 2016/17 one million older people were living in poverty; an additional 1.2 million were living just above the poverty line. These numbers are rising. Those aged 85 years or over, frail older people, older women and single older people are particularly at risk. Poor older people are also more likely to live in poor housing and be exposed to fuel poverty. Being poor - and its concomitants - compromises mental health in a number of profound ways. It undermines an older person’s capacity to make choices, retain independence, save for a crisis, maintain social contacts and be digitally included. It is linked with worry, loss of control over life and shame. Poor older people are at heightened risk of isolation and loneliness, stress, anxiety and depression. The UK has a weak policy record, compared with other developed countries, of sustainably and coherently addressing poverty in later life. One of the cornerstones of doing so is a continued commitment to the basic state pension as a fundamental building block of a secure old age. Addressing poor housing is also pivotal.

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Conclusion

10.1093/med/9780199392063.003.0012 ◽

2016 ◽

Author(s):

Maria A. Sullivan

Keyword(s):

Older Adults ◽

Substance Use ◽

The Elderly ◽

Social Consequences ◽

Individual Therapy ◽

Older Individuals ◽

Prescribing Practices ◽

Elderly Age ◽

Age Related ◽

The Impact

Addiction in older adults very often goes unrecognized, for several reasons: social biases about the elderly, age-related metabolic changes, and the inappropriate use of prescription benzodiazepines and opioids to address untreated anxiety and mood conditions. Alcohol or substance-use disorders (SUDs) in older individuals may present in subtle and atypical ways. Strategies to overcome such difficulties include systematic screening using validated instruments, patient education regarding the impact of psychoactive substances on health, and cautious prescribing practices. Relying on standard DSM criteria may result in a failure to detect an SUD that presents with cognitive symptoms or physical injury, as well as the absence of work or social consequences. Older individuals can benefit from the application of risk-stratification measures, and they can be referred, e.g., to age-appropriate group therapy and non-confrontational individual therapy focusing on late-life issues of loss and sources of social support, as well as be offered medication management for alcohol or substance use disorder. Although research has been limited in this population, treatment outcomes have been found to be superior in older adults than younger adults.

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Social Media Listening to Understand the Lived Experience of Presbyopia: Systematic Search and Content Analysis Study (Preprint)

10.2196/preprints.18306 ◽

2020 ◽

Author(s):

James S Wolffsohn ◽

Claudia Leteneux-Pantais ◽

Sima Chiva-Razavi ◽

Sarah Bentley ◽

Chloe Johnson ◽

...

Keyword(s):

Quality Of Life ◽

Social Media ◽

Lived Experience ◽

The United States ◽

Older Individuals ◽

Near Vision ◽

Age Related ◽

The Impact ◽

Manual Review

BACKGROUND Presbyopia is defined as the age-related deterioration of near vision over time which is experienced in over 80% of people aged 40 years or older. Individuals with presbyopia have difficulty with tasks that rely on near vision. It is not currently possible to stop or reverse the aging process that causes presbyopia; generally, it is corrected with glasses, contact lenses, surgery, or the use of a magnifying glass. OBJECTIVE This study aimed to explore how individuals used social media to describe their experience of presbyopia with regard to the symptoms experienced and the impacts of presbyopia on their quality of life. METHODS Social media sources including Twitter, forums, blogs, and news outlets were searched using a predefined search string relating to symptoms and impacts of presbyopia. The data that were downloaded, based on the keywords, underwent manual review to identify relevant data points. Relevant posts were further manually analyzed through a process of data tagging, categorization, and clustering. Key themes relating to symptoms, impacts, treatment, and lived experiences were identified. RESULTS A total of 4456 social media posts related to presbyopia were identified between May 2017 and August 2017. Using a random sampling methodology, we selected 2229 (50.0%) posts for manual review, with 1470 (65.9%) of these 2229 posts identified as relevant to the study objectives. Twitter was the most commonly used channel for discussions on presbyopia compared to forums and blogs. The majority of relevant posts originated in Spain (559/1470, 38.0%) and the United States (426/1470, 29.0%). Of the relevant posts, 270/1470 (18.4%) were categorized as posts written by individuals who have presbyopia, of which 37 of the 270 posts (13.7%) discussed symptoms. On social media, individuals with presbyopia most frequently reported experiencing difficulty reading small print (24/37, 64.9%), difficulty focusing on near objects (15/37, 40.5%), eye strain (12/37, 32.4%), headaches (9/37, 24.3%), and blurred vision (8/37, 21.6%). 81 of the 270 posts (30.0%) discussed impacts of presbyopia—emotional burden (57/81, 70.4%), functional or daily living impacts (46/81, 56.8%), such as difficulty reading (46/81, 56.8%) and using electronic devices (21/81, 25.9%), and impacts on work (3/81, 3.7%). CONCLUSIONS Findings from this social media listening study provided insight into how people with presbyopia discuss their condition online and highlight the impact of presbyopia on individuals’ quality of life. The social media listening methodology can be used to generate insights into the lived experience of a condition, but it is recommended that this research be combined with prospective qualitative research for added rigor and for confirmation of the relevance of the findings.

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416 The impact of Obstructive Sleep Apnea severity on age-related comorbities: a population-based study

SLEEP ◽

10.1093/sleep/zsab072.415 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A165-A165

Author(s):

Mayra Silva ◽

Dalva Poyares ◽

Luciana Oliveira ◽

Monica Andersen ◽

Sergio Tufik ◽

...

Keyword(s):

Older Adults ◽

Late Onset ◽

Clinical Manifestations ◽

Population Based ◽

Baseline Survey ◽

Older Individuals ◽

Blood Tests ◽

Age Related ◽

Obstructive Sleep ◽

The Impact

Abstract Introduction Although age per se has been considered a risk factor for OSA, evidence suggest OSA in older adults may be less severe and OSA diagnostic criteria might be adjusted for this age group. Concurrently, it is likely the late-onset OSA is a distinct phenotype having different pathophysiological mechanisms, as well as clinical manifestations and consequences. We sought to investigate the clinical consequences of OSA severity in older adults from a representative sample of the older population living in the São Paulo city. Methods From the baseline survey including 1042 participants in 2007, 715 were reassessed in 2016 completing full in-lab PSG, health-related questionnaires, blood tests, and blood pressure measurements. Individuals > 60 y.o. (n=199) of both genders were included in the analysis. Participants were stratified according to OSA presence and severity in 3 groups G1 (non and mild OSA n=83); G2 (moderate OSA n=56); G3 (severe OSA n=60). General Linear Model (GLM) tests and Chi-square were carried out. Results Participants mean age was 70.02±7.31 and mean body mass index (BMI) 28.61±5.39, 40.71% of men. The only comorbidity associated with OSA severity was arterial hypertension occurring in 61.7% of G3, 46.4% of G4 and 41% of G1 (p=0.04). Severe OSA participants were more likely to use a higher (>2/day) number of medications (p=0.03). Finally, out of all blood tests only cortisol was significantly higher in severe OSA group (p<0.001) Conclusion Severe OSA in older individuals of the general population is not associated with metabolic conditions, such as diabetes, but it was associated with hypertension. Severe OSA may be a stressful condition, since it was associated with higher cortisol in this population. Support (if any) Associaçao Fundo Incentivo a Pesquisa (AFIP)

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EPIGENETIC AND METABOLIC REGULATION OF AGING

Innovation in Aging ◽

10.1093/geroni/igz038.871 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S234-S234

Author(s):

Anne Brunet

Keyword(s):

Metabolic Regulation ◽

Brain Aging ◽

Cell Types ◽

Mammalian Brain ◽

Older Individuals ◽

Neurogenic Niche ◽

Age Related ◽

Global Understanding ◽

Possible Cause

Abstract Aging is accompanied by a decline in the regenerative potential of most tissues. The mammalian brain contains regenerative neurogenic niches composed of neural stem cells (NSCs), neural progenitors, and other cells, including microglia, and endothelial cells. Neurogenic niches become less functional with increasing age. This deterioration could underlie cognitive and sensory restriction with age, although the exact age at which it occurs is still debated in humans. How the neurogenic niche changes during aging, and whether new cell types arise in older individuals, is not known. Our lab has embarked on a global characterization of the neurogenic niche during aging. This work provides a global understanding of the old neurogenic niche and suggests possible cause for NSC decline during aging. Results from these studies could open new avenues to counter age-related decline in the neurogenic niche and brain aging.

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Rationing care by frailty during the COVID-19 pandemic

Age and Ageing ◽

10.1093/ageing/afaa171 ◽

2020 ◽

Cited By ~ 3

Author(s):

Emma Grace Lewis ◽

Matthew Breckons ◽

Richard P Lee ◽

Catherine Dotchin ◽

Richard Walker

Keyword(s):

Critical Care ◽

Older People ◽

Adverse Outcome ◽

Older Individuals ◽

Short Term ◽

Clinical Frailty Scale ◽

Widespread Implementation ◽

Care Outcomes ◽

Resource Allocation Strategy ◽

The Impact

Abstract The coronavirus disease 2019 (COVID-19) pandemic is disproportionately affecting older people and those with underlying comorbidities. Guidelines are needed to help clinicians make decisions regarding appropriate use of limited NHS critical care resources. In response to the pandemic, the National Institute for Health and Care Excellence published guidance that employs the Clinical Frailty Scale (CFS) in a decision-making flowchart to assist clinicians in assessing older individuals’ suitability for critical care. This commentary raises some important limitations to this use of the CFS and cautions against the potential for unintended impacts. The COVID-19 pandemic has allowed the widespread implementation of the CFS with limited training or expert oversight. The CFS is primarily being used to assess older individuals’ risk of adverse outcome in critical care, and to ration access to care on this basis. While some form of resource allocation strategy is necessary for emergencies, the implementation of this guideline in the absence of significant pressure on resources may reduce the likelihood of older people with frailty, who wish to be considered for critical care, being appropriately considered, and has the potential to reinforce the socio-economic gradient in health. Our incomplete understanding of this novel disease means that there is a need for research investigating the short-term predictive abilities of the CFS on critical care outcomes in COVID-19. Additionally, a review of the impact of stratifying older people by CFS score as a rationing strategy is necessary in order to assess its acceptability to older people as well as its potential for disparate impacts.

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The Impact of Communication Technology and Social Media on Intergenerational Relationships between Older Individuals and Their Adult Children in Bangkok

MANUSYA ◽

10.1163/26659077-02302003 ◽

2020 ◽

Vol 23 (2) ◽

pp. 188-204

Author(s):

Marie-Helene Thomas

Keyword(s):

Social Media ◽

Older People ◽

Communication Technology ◽

Adult Children ◽

Instant Messaging ◽

Smart Phone ◽

Intergenerational Relationships ◽

Older Individuals ◽

Intergenerational Relationship ◽

The Impact

Modernisation theory (Cowgill and Holmes 1972) argues that older people in modern societies are less respected and valued as a result of technological innovations. To understand the impact of communication technology and social media on Thai society, this research studies the transformations in communication, interaction and overall connectedness between older people and their adult children. In addition, it examines what elements have shifted due to the introduction and use of the smart phone and its accompanying instant messaging and social media applications such as Line and Facebook. The data demonstrates various positive and negative impacts on the intergenerational relationship between older parents and their child cohorts. Crucially, countless examples and arguments from the respondents suggest that the use of these new tools of communication has a very real and demonstrable impact, from providing a space for family members to express their emotions to being the culprit that divides the family unit.

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