Acknowledgement to Reviewers of OBM Geriatrics in 2021

The editors of OBM Geriatrics would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2021. We greatly appreciate the contribution of expert reviewers, which is crucial to the journal's editorial process. We aim to recognize reviewer contributions through several mechanisms, of which the annual publication of reviewer names is one. Reviewers receive a voucher entitling them to a discount on their next LIDSEN publication and can download a certificate of recognition directly from our submission system. Additionally, reviewers can sign up to the service Publons (https://publons.com) to receive recognition. Of course, in these initiatives we are careful not to compromise reviewer confidentiality. Many reviewers see their work as a voluntary and often unseen part of their role as researchers. We are grateful to the time reviewers donate to our journals and the contribution they make.

Adjustment for Covariates of Major Depressive Episodes among Men and Women Aged 65 Years Old and Older

The current study aimed to examine if sex can significantly predict risk for lifetime major depressive episodes among adults aged 65 and older with and without adjustment for covariate variables of race, education, marital status, health, and poverty. Secondary data was obtained from the National Survey on Drug Use and Health public-use data file to achieve study goals. The study participants were males and females aged 65 years or older. The unweighted sample included 3,969 adults aged 65 years or older, representing a weighted population size of 50,986,065.86 in the US. Lifetime major depressive episode.The study findings confirmed that sex could significantly predict risk for lifetime major depressive episodes among adults aged 65 or older with and without adjustment for health determinants of race, education, marital status, health, and poverty. Four of the five variables, including race, education, health, and poverty, were significant once as covariate variables adjusted for and once as predictor variables. In contrast, marital status was insignificant both as a covariate and a predictor variable. Close attention is required to the adults aged 65 or older at risk for lifetime major depressive episode diagnosis, particularly women, to meet their unique needs.

The Safety of Oral Telomerase Activator in UV-Induced Skin Cancer with A Review of Telomerase in Aging and Skin Carcinogenesis

The supplement telomerase activator TA-65 (purified from Astragalus membranaceus) has been shown to retard cellular senescence, boost the aging immune system, and retard age-related symptoms. Lengthened telomeres retard aging, but because cancers often maintain longevity by lengthening telomeres, dietary telomerase activator might possibly increase tumorigenesis. This study investigated whether oral TA-65 effects the timing of onset and/or the incidence of skin cancers induced by UVB-irradiation and whether that possible effect is different if the oral supplementation is begun only after tumors are first detected clinically or if supplementation is begun before initiation of tumors as well as during and after the inciting UVB exposure. Three groups of ten Skh:1 hairless, nonpigmented mice exposed to UVB for twenty weeks were given (1) no supplementation, (2) TA-65 supplementation starting when the first UV-induced skin cancers were clinically observed, after which the UV exposure was terminated, and (3) TA-65 supplementation before, during, and after UV exposure (as more tumors subsequently appeared). Except for two time points when Group 3 had borderline or statistically more tumors ≥ 2mm per mouse, overall, there was no statistically significant difference in the time of onset, the incidence, or the tumor load of skin cancers with TA-65 with either timing, confirming the safety of this anti-aging supplement in this model of the most frequent human malignancy.

Cisplatin-Based Neoadjuvant Chemotherapy for Elderly Patients with Muscle-Invasive Bladder Cancer: Is It Feasible?

Cisplatin-based neoadjuvant chemotherapy (C-NAC) has been the standard of care in localized muscle-invasive bladder cancer (MIBC). However, the feasibility and benefit of C-NAC in elderly patients remain uncertain since this population has always been underrepresented in pivotal trials and is often barred from chemotherapy in routine practice because of their perceived frailty. Therefore, in order to evaluate the effectiveness of C-NAC in elderly patients with MIBS, we retrospectively reviewed the medical files of patients (cT2-4, N0-3, and M0) treated at our institution and aged 75 or older at the time of the first chemotherapy cycle. From May 2012 to March 2020, 51 patients aged 75 to 90 received C-NAC. Among them, 38 patients received methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) and 13 patients received gemcitabine and cisplatin (GC). In this study, the primary endpoint was the feasibility of C-NAC, evaluated as the percentage of patients who underwent at least four chemotherapy cycles. Overall feasibility of a complete four-cycle chemotherapy course was 75% (dose-dense MVAC [dd-MVAC]: 76%; GC: 69%). Incidence of grade 3-4 adverse events was 57%, mostly driven by hematological toxicity from dd-MVAC, and the incidence of febrile neutropenia was 6%. These results indicate the feasibility of C-NAC in elderly patients without any contraindication to cisplatin. A coordinated multidisciplinary approach, including a geriatric oncologist, may help to identify patients at increased risk for chemotherapy-induced toxicity, especially in patients aged 85 or older.

An Overview of Osteoporosis Management

Osteoporosis is one of the most common disorders around the world. Osteoporotic fracture especially hip fracture are associated with an increased mortality rate in elders. However, elders with osteoporosis or at high risk of fractures remain largely underdiagnosed and undertreated. The screening, diagnosis, and treatment of osteoporosis must be improved to maintain pace with its fast-growing prevalence. This review will cover risk factors of osteoporosis, screening and diagnosis tools, newfound advancements, current medical treatments including options for special populations of concern, and future research directions.

Men's Bones Matter Too, a Cross Sectional Study Examining Bone Health among Men with Intellectual Disability in Ireland.

Globally between 30-40% of all osteoporotic fractures occur among men, with a quarter of all hip fractures, the most serious complication of osteoporosis, occurring in men. Among men of 50 years of age or older, osteoporotic fracture risk reaches an alarming 20%. What is of great concern is that associated mortality is greater among men when compared with women. For hip fractures specifically, mortality for men is two to three times that in women which may be attributed to the fact that osteoporosis is often considered a “women’s disease”. Of great concern is that there is a paucity of bone health investigation among men with intellectual disability. In the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing, objective bone status of 244 men was measured using a quantitative ultrasound. Participant’s also self-reported doctor’s diagnosis of health conditions including osteoporosis, medication and fracture history with the assistance of key workers/family. Ethical approval for the study was obtained from the Faculty of Health Sciences Trinity College and all participating service providers. Overall, 70.9% of men presented with poor bone health, with 57.8% taking at least one medication that contributed to osteoporosis/osteopenia. Men had a high prevalence of fracture (21.7%) despite this less than 18% had attended bone health screening. In light of these findings, it is time for the spotlight to focus on men’s bone health and for healthcare professionals to realise how ‘at risk’ of osteoporosis are men with intellectual disability. Projections place men on a trajectory of continuous increased risk of fracture in comparison to women.

Study of the Development of Carotid Artery Atherosclerosis upon Oxidative Stress using Infrared Spectroscopy and Scanning Electron Microscopy

In the present study, Fourier-transform infrared (FTIR) spectroscopy and Scanning Electron Microscopy (SEM) were used to investigate the formation and development of carotid artery atherosclerosis. The FTIR spectra showed that with the progression of atheromatic plaque formation, the collagen changed its native structure from ɑ-helix to random coil, amyloid, and cross-links. The infrared spectra and SEM analysis of carotid arteries showed that higher than 65% of the atheromatic plaque in patients with stenosis consisted of calcium carbonate, which lies inside foam cells. However, as the stenosis progresses, these deposits of calcium phosphate become more prevalent. A thorough analysis of the SEM images highlighted that mineral deposits preferred the carboxyl groups of amino acids. The intensity and shape changes in FT-IR spectra in the region of 1200-900 cm^-1 were related to elevated serum glucose and uric acid levels, the formation of advanced glycation end products (AGEs), and the involvement of free radicals during atherosclerosis.

Admiral Nurse Case Management within Enhanced Health in Care Homes

The United Kingdom’s (UK) older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia, and comorbidity many of whom may require 24-hour care. Currently it is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it whilst residing in the care home. The provision of high-quality care for this population is a challenge with a lack of consistency in the provision of primary care and specialist services and a known gap in knowledge and skills. The NHS Long Term Plan aims to move care closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes (EHCH). However, such services need to be equipped with the correct skill mix to meet the needs of the care home population. Admiral Nurses are specialists in dementia care and are well placed to support the delivery of EHCH and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system. This paper discusses current gaps in service provision and how both the EHCH framework, and the inclusion of Admiral Nurses, might redress these and improve outcomes.

Dysphagia in the Older Age Setting

Dysphagia, or difficulty swallowing, is a common condition, especially among the elderly population and can become debilitating. As we age, there are subtle changes in esophageal motility, but by no means is dysphagia ever considered to be a normal result of aging. Dysphagia usually presents with a variety of accompanying symptoms ranging from regurgitation during meals, mild discomfort, to severe chest pain. It can be challenging to localize the dysphagia from the history. The underlying etiology may become evident during subsequent investigations. It is essential to be able diagnose dysphagia as early detection is associated with decreased morbidity and in some cases mortality. In addition, early detection through clinical suspicion, confirmatory imaging or endoscopic evaluation is important as it can lead to early intervention with proper management depending on the underlying etiology, resulting in economic benefit and reduced medical costs. There are various causes of dysphagia, with the majority being benign, but a physician should always be aware of red flags present which may signal more serious causes, such as an underlying malignancy. Our goal in this review article is to focus on detecting the clinical signs of dysphagia and review appropriate further evaluation and update on management of this potentially serious condition in order for elderly patients to achieve an optimal quality of life.

Diagnosis and Therapy of Atrial Fibrillation in Geriatric Patients

Atrial fibrillation is very common in most old patients who need an adapted therapy due to their comorbidities. Before initiating an antiarrhythmic therapy, possible adverse effects, especially iatrogenic proarrhythmia, and extracardiac side-effects, must be considered. In geriatric patients with atrial fibrillation, heart rate control is the most frequent therapy. Oral anticoagulation plays a vital role in the therapy, but anticoagulation in old patients, who had a bleeding or stroke event, is challenging. Available data favor the use of anticoagulation in old patients with atrial fibrillation and suggest the use of direct oral coagulants, in most cases, over the use of vitamin K antagonists. However, a gap exists in the knowledge regarding the optimal dose in very old patients, particularly in patients with mild-to-moderate renal failure, with very low or high body mass index, and in those receiving medications with a high risk of metabolic interactions.