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Aging, Mental Health, Research, Sleep, Stanford News

Stanford researcher examines link between sleep troubles and suicide in older adults

Stanford researcher examines link between sleep troubles and suicide in older adults

Chassériau painting - smallAfter nights spent tossing and turning, I’m grumpy. The world becomes darker, slower and smaller.

That’s why I wasn’t terribly surprised to learn that sleep-deprived older adults are more likely to kill themselves, the results of a study published Aug. 13 in JAMA Psychiatry. Lead author Rebecca Bernert, PhD, instructor of psychiatry and behavioral science and her team examined data from a pool of 14,456 adults older than 65 between 1981 and 1991. They then probed the sleep patterns of 20 people who died by suicide with those of 400 similar individuals.

They found that participants with impaired sleep had a 1.4 percent greater chance of death by suicide than participants who slept well. “This is important because sleep disturbances are highly treatable and arguably less stigmatizing than other suicide risk factors,” Bernert commented in a press release.

Bernert and her team plan to work to develop potential interventions through two ongoing clinical trials.

What did surprise me about the findings was the prevalence of suicide deaths in older adults, particularly among older men: In fact, white men over 65 have a rate of 31 deaths by suicide per 100,000, much higher than the general population rate of 13 or so per 100,000.

Regardless, any number of suicides is too high, a belief Bernert reiterates emphatically.

“Suicide is preventable,” Bernert said. “But the interventions for suicide prevention are alarmingly scarce.”

That’s why for Bernert, the suicide net recently approved for the Golden Gate Bridge is a no-brainer. She recently joined the board of directors of the Bridge Rail Foundation, the nonprofit formed to advocate for the net. “This is a very effective way to prevent suicides,” she said.

More than 1,600 people have died by suicide at the bridge; a similar number of deaths due to any other reason would have necessitated public intervention decades ago, she said.  She attributed the delay, in part, to the powerful stigma that surrounds suicide.

Bernert urged others to learn about suicide by visiting the American Foundation for Suicide Prevention, or, if in crisis, to call 1-800-273-TALK to reach a 24-hour help line.

Becky Bach is a former park ranger who now spends her time writing, exploring, or practicing yoga. She’s currently a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Stanford’s Keith Humphreys on Golden Gate Bridge suicide prevention: Get the nets, CDC report highlights the dangers of sleep deprivation and Sleep deprivation may increase young adults’ risk of mental distress, obesity
Painting by Théodore Chassériau via Wikipedia Commons

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Aging, Genetics, Imaging, Immunology, Mental Health, Neuroscience, Research, Women's Health

Stanford’s brightest lights reveal new insights into early underpinnings of Alzheimer’s

Stanford's brightest lights reveal new insights into early underpinnings of Alzheimer's

manAlzheimer’s disease, whose course ends inexorably in the destruction of memory and reason, is in many respects America’s most debilitating disease.  As I wrote in my article, “Rethinking Alzheimer’s,” just published in our flagship magazine Stanford Medicine:

Barring substantial progress in curing or preventing it, Alzheimer’s will affect 16 million U.S. residents by 2050, according to the Alzheimer’s Association. The group also reports that the disease is now the nation’s most expensive, costing over $200 billion a year. Recent analyses suggest it may be as great a killer as cancer or heart disease.

Alarming as this may be, it isn’t the only news about Alzheimer’s. Some of the news is good.

Serendipity and solid science are prying open the door to a new outlook on what is arguably the primary scourge of old age in the developed world. Researchers have been taking a new tack – actually, more like six or seven new tacks – resulting in surprising discoveries and potentially leading to novel diagnostic and therapeutic approaches.

As my article noted, several Stanford investigators have taken significant steps toward unraveling the tangle of molecular and biochemical threads that underpin Alzheimer’s disease. The challenge: weaving those diverse strands into the coherent fabric we call understanding.

In a sidebar, “Sex and the Single Gene,” I described some new work showing differential effects of a well-known Alzheimer’s-predisposing gene on men versus women – and findings about the possibly divergent impacts of different estrogen-replacement  formulations on the likelihood of contracting dementia.

Coming at it from so many angles, and at such high power, is bound to score a direct hit on this menace eventually. Until then, the word is to stay active, sleep enough and see a lot of your friends.

Previously: The reefer connection: Brain’s “internal marijuana” signaling implicated in very earliest stages of Alzheimer’s pathology, The rechargeable brain: Blood plasma from young mice improves old mice’s memory and learning, Protein known for initiating immune response may set up our brains for neurodegenerative disease, Estradiol – but not Premain – prevents neurodegeneration in woman at heightened dementia risk and Having a copy of ApoE4 gene variant doubles Alzheimer’s risk for women, but not for men
Illustration by Gérard DuBois

Aging, Chronic Disease, Public Health, Research

How multiple chronic conditions are affecting older Americans’ life expectancy

old_coupleOne in four adults in the United States has two or more chronic conditions, according to the latest data from the Centers for Disease Control and Prevention. And, findings published in the August issue of Medical Care show that the burden of multiple chronic diseases could explain why life expectancy increases among elderly Americans are slowing.

In the study (subscription required), researchers at Johns Hopkins Bloomberg School of Public Health analyzed a nationally representative sample of 1.4 million Medicare beneficiaries. According to a release:

The analysis found that, on average, a 75-year-old American woman with no chronic conditions will live 17.3 additional years (that’s to more than 92 years old). But a 75-year-old woman with five chronic conditions will only live, on average, to the age of 87, and a 75-year-old woman with 10 or more chronic conditions will only live to the age of 80. Women continue to live longer than men, while white people live longer than black people.

It’s not just how many diseases you have, but also what disease that matters. At 67, an individual with heart disease is estimated to live an additional 21.2 years on average, while someone diagnosed with Alzheimer’s disease is only expected to live 12 additional years.

On average, life expectancy is reduced by 1.8 years with each additional chronic condition, the researchers found. But while the first disease shaves off just a fraction of a year off life expectancy for older people, the impact grows as the diseases add up.

Previously: Americans are living longer, but are we healthier in our golden years?, Longevity gene tied to nerve stem cell regeneration, say Stanford researchers, Study shows regular physical activity, even modest amounts, can add years to your life and TED Talk with Laura Carstensen shows older adults have an edge on happiness
Photo by Marcel Oosterwijk

Aging, Mental Health, Research, Stanford News

Everyday conversations may help older adults bounce back from hardship

JapaneseLadyAs a fan of obituaries, oral histories and encounters with people who have had long lives, I was delighted to come across a humanities study finding that conversation is good for the subjects of the stories, too. Yoshiko Matsumoto, PhD, a Stanford professor of Japanese language and linguistics, has been studying conversations of older people, who, with long lives, have faced challenges such as health problems and losses of loved ones. Her research documents which types of conversation play a particularly important role in supporting the subjects’ well-being and can provide family members and care providers “potential tools for building resiliency following change.”

More from a recent Stanford Report article:

Matsumoto’s most recent work specifically focuses on older women’s discourse about the illness or death of their husbands, with particular attention to conversations that also include humor and laughter. “These instances are not uncommon in my data, although they are a surprising combination,” Matsumoto says.

Matsumoto’s linguistic analyses of more than 60 hours of recorded conversations illustrate that there is in fact a structure to such discourse. Her findings suggest that by reframing a serious story through an ordinary, or “quotidian,” perspective, the women she studied infused their dialogue with cathartic smiles.

In one instance, a woman jokingly described how she used to chide her husband about his smoking and drinking habits – the very cause of his death. Matsumoto notes that by shifting the narrative perspective from somber to the ordinary, the speaker helped everyone involved regain the feeling of normality.

Previously: Depression, lifestyle choices shown to adversely affect memory across age groups, Helping older adults live independently using mobile-health technology and How social media and online communities can improve clinical care for elderly patients
Photo by Debs

Aging, Neuroscience, Sleep, Videos

Examining how sleep quality and duration affect cognitive function as we age

Examining how sleep quality and duration affect cognitive function as we age

We all feel better, and can think more clearly, after a good night’s rest. But new research underscores the importance of sleep quality and duration during middle age to stave off cognitive decline.

The study (subscription required) examines data compiled as part of the long-term Study on global AGEing and adult health (SAGE), which is funded by a joint agreement of the National Institutes of Health and the World Health Organization. The project began in 2007 and involves more than 30,000 individuals aged 50 and older across China, Ghana, India, Mexico, the Russian Federation and South Africa.

Among the key findings is that middle-aged or older people who get six to nine hours of sleep a night think better than those sleeping fewer or more hours, and that excessive sleep is equally damaging as too little sleep. In the above video, researchers discuss how despite cultural, environmental and economical differences, study results showed strong patterns relating to gender, sleep quality and cognitive function.

Via PsychCentral
Previously: What are the consequences of sleep deprivation? and Experts discuss possible link between sleep disorder and dementia

Aging, Health and Fitness, Mental Health, Neuroscience

Depression, lifestyle choices shown to adversely affect memory across age groups

Depression, lifestyle choices shown to adversely affect memory across age groups

IMG_0140Have trouble remember where you put your keys? Forgetting the names of familiar faces? A lack of physical activity, depression, high blood pressure and a variety of other health factors could be to blame, according to findings recently published in PLOS ONE.

In the study, researchers at the University of California, Los Angeles and the Gallup organization surveyed more than 18,000 people about memory and lifestyle choices previously shown to increase the risk of Alzheimer’s disease and dementia. PsychCentral reports:

Depression, low levels of education, physical inactivity, and high blood pressure increased the likelihood of memory complaints in younger adults (ages 18–39), middle-aged adults (40–59), and older adults (60–99), the researchers found.

Depression was the strongest single risk factor for memory complaints in all age groups.

Having just one risk factor significantly increased the frequency of memory complaints, regardless of age, according to researchers. Memory complaints rose when the number of risk factors increased.

Overall, 20 percent of those polled had memory complaints, including 14 percent of younger adults, 22 percent of middle-aged adults, and 26 percent of older adults.

For younger adults, stress may play more of a role, and the ubiquity of technology — including the Internet and wireless devices, which can often result in constant multi-tasking — may impact their attention span, making it harder to focus and remember.

Researchers hope the findings, and follow-up studies, better identify how health choices made earlier on may impact cognitive function at a later age and lead to interventions to lower the risk of memory loss.

Previously: Newly identified protein helps explain how exercise boosts brain health, Exercise may protect aging brain from memory loss following infection, injury, Stanford biostatistician talks about saving your aging brain and Exercise may be effective in treating depression
Photo by bibliojojo

Aging, Health Policy, Medicine and Society, Podcasts, Research, Stanford News

More on doctors and end-of-life directives

More on doctors and end-of-life directives

Earlier this week, my colleague wrote about a study showing that the majority of doctors surveyed said they would forgo aggressive end-of-life care for themselves. Now, in the latest 1:2:1 podcast, researcher VJ Periyakoil, MD, director of palliative care education and training at the medical school, talks in depth about the study and why doctors appear to want one thing for themselves at the end of life and quite another for their patients.

Previously: Study: Doctors would choose less aggressive end-of-life care for themselves

Aging, Health Policy, In the News, Public Health, Research, Stanford News

Study: Doctors would choose less aggressive end-of-life care for themselves

Study: Doctors would choose less aggressive end-of-life care for themselves

DNR bindersWhy do physicians continue to provide high-intensity care for terminally ill patients but choose to forgo such care for themselves at the end of life? That’s the question raised by a new Stanford study published in PLOS ONE today.

An overwhelming percentage of doctors surveyed for the study in 2013 – 88.3 percent to be exact – said they would choose “no-code” or do-not-resuscitate orders for themselves. And though other studies have shown that most other Americans would choose to die gently and naturally at home, that’s not what’s happening. As I describe in a release:

“A big disparity exists between what Americans say they want at the end of life and the care they actually received,” the study says. “More than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life, but their wishes are often overridden.”

In fact, the type of treatments they receive depends not on the patients’ care preferences or on their advance directives, but rather on the local health-care system variables, such as institutional capacity and individual doctors’ practice style, according to the study.

The study involved two sets of subjects – 1081 physicians in 2013 and 790 physicians in 1989 – which both completed the same 14-question survey on their attitudes concerning advanced directives. Stanford researchers hypothesized that attitudes would have changed in the 24-years since the passage of the Self-Determination Act in 1990, a law designed to give patients more control over end-of-life care decisions and requires health care organizations to inform patients that they have the option to fill out such directives.

Surprisingly, despite the law, physicians attitudes have not changed, said VJ Periyakoil, MD, an expert in palliative care and lead author of the study. More from the release:

As a geriatrics and palliative care physician who sits at the bedside of sick patients herself, Periyakoil said she understands the disconnect between the type of care doctors want for themselves at the end of life and what they actually do for their patients. It’s not because doctors are trying to make more money or because they are intentionally insensitive to their patients’ desires. At the core of the problem is a biomedical system that rewards doctors for taking action, not for talking with their patients.

“Our current default is ‘doing,’ but in any serious illness there comes a tipping point where the high-intensity treatment becomes more of a burden than the disease itself,” said Periyakoil, who trains physicians in palliative medicine. “It’s tricky, but physicians don’t have to figure it out by themselves. They can talk to the patients and their families and to the other interdisciplinary team members, and it becomes much easier.

“But we don’t train doctors to talk or reward them for talking. We train them to do and reward them for doing. The system needs to be changed.”

A touching first-person essay on this topic by Ken Murray, MD, a retired family practitioner has been popping up recently on various blogs and other internet sites. It describes how doctors don’t want to experience the kind of suffering that they see their patients go through. In the piece, titled “How doctors die: It’s not like the rest of us, but it should be,” the author mentions that he has even seen one medical professional with a “Do not Resuscitate” tattoo.

Previously: Communicating with terminally ill patients: a physician’s perspective, Asking the hardest questions: Talking with doctors while terminally ill, On a mission to transform end-of-life care, The importance of patient/doctor end-of-life discussions and A Stanford nurse shares her experience in talking to her aging mother about end-of-life decisions
Photo by Frank DiBona

Aging, Health and Fitness, Health Policy, Public Health, Stanford News

Moderate exercise program for older adults reduces mobility disability, study shows

Moderate exercise program for older adults reduces mobility disability, study shows

senior_dog_walk

A 20-minute walk each day could help older adults stay on their feet and out of wheelchairs longer, according to a multicenter study published in the Journal of the American Medical Association today and coordinated by the University of Florida.

Researchers showed that a daily program of moderate physical activity reduced the risk of mobility disability in older adults by 18 percent compared to those who did not exercise. They also found a 28-percent reduction in the permanent loss of the ability to walk unaided.

Mobility, defined in this study as the ability to walk without assistance for at least 400 meters or about a quarter mile, is critical for aging seniors to function independently. Loss of mobility can lead to higher hospitalization and institutionalization costs, and even early death.

“These results suggest the potential for structured physical activity as a feasible and effective intervention to reduce the burden of disability among vulnerable older persons, in spite of some functional decline in late life,” wrote the researchers.

“While people are aware of the benefits of physical activity, this study is the largest and longest duration randomized trial evaluating the effects of physical activity on mobility disability in older adults. It will provide the hard evidence needed to change health policy,” said Abby King, PhD, the lead investigator for the Stanford field center and a professor of health research and policy and of medicine.

For this study, 1,635 sedentary men and women, age 70 to 89, were recruited by eight field centers across the United States and followed for an average of 2.6 years. All participants were able to walk a quarter mile within 15 minutes but were at risk for losing that ability.

“These are the patients who physicians see every day. This is why this study is so important: It includes a population that is typically understudied,” said principal investigator Marco Pahor, MD, director of the University of Florida’s Institute on Aging.

During the study, participants were randomly assigned to one of two groups. The first group walked 150 minutes per week and did strength, flexibility and balance training. They were encouraged to stay on track with the program through weekly participation in two in-person exercise classes and several home-based physical activity sessions. The second group attended health education classes, including low-intensity stretching exercises.

King said one of the most important takeaways from the study was this: “It’s never too late to gain important benefits from increased physical activity.”

Study results are summarized in this JAMA Report video.

Previously: AAMC’s Health Equity Research Snapshot features Stanford project on virtual health advisers, Help from a virtual friend goes a long way in boosting older adults’ physical activity, Computer-generated phone calls shown to help inactive adults get – and keep – moving
Photo by hartcreations/iStock

Aging, Mental Health, Neuroscience, Research, Stanford News, Stem Cells

The rechargeable brain: Blood plasma from young mice improves old mice’s memory and learning

The rechargeable brain: Blood plasma from young mice improves old mice's memory and learning

brain battery“Maybe Ponce de Leon should have considered becoming a vampire,” I noted here a few years ago. In a related Stanford Medicine article, I elaborated on that point (i.e. Dracula may have been on to something):

Count Dracula may have been bloodthirsty, but nobody ever called him stupid. If that practitioner of what you could call “the Transylvanian transfusion” knew then what we know now, it’s a good bet he was keeping his wits as sharp as his teeth by restricting his treats to victims under the age of 30.

I was referring then to an amazing discovery by Stanford brain-degeneration expert Tony Wyss-Coray, PhD, and his then-graduate student Saul Villeda, PhD, who now has his own lab at the University of California-San Francisco. They’d found that something in an old mouse’s blood could somehow exert an aging effect on the capabilities of a young mouse’s brain, and you know that ain’t good. They’d even pinpointed one specific substance (eotaxin) behind this effect, implying that inhibiting this naturally produced and sometimes very useful chemical’s nefarious action – or, if you’re a vampire, laying off the old juice and  getting your kicks from preteens when available – might be beneficial to aging brains.

But I was premature. While the dynamic duo had shown that old blood is bad for young brains and had also demonstrated that old mice’s brains produce more new nerve cells (presumably a good thing) once they’ve had continuous exposure to young mice’s blood, the researchers hadn’t yet definitively proven that the latter translated into improved intellectual performance.

This time out they’ve gone and done just that, in a study (subscription required) published online yesterday in Nature Medicine. First they conducted tricky, sophisticated experiments to show that when the old mice were continuously getting blood from young mice, an all-important region in a mouse’s brain (and yours) called the hippocampus perks up biochemically, anatomically and physiologically: It looks and acts more like a younger mouse’s hippocampus. That’s big, because the hippocampus is not only absolutely essential to the formation of new memories but also the first brain region to go when the early stirrings of impending dementia such as Alzheimer’s start subtly eroding brain function, long before outwardly observable symptoms appear.

Critically, when Wyss-Coray, Villeda and their comrades then administered a mousey IQ test (a standard battery of experiments measuring mice’s ability to learn and remember) to old mice who’d been injected with plasma (the cell-free part of blood) from healthy young mice, the little codgers far outperformed their peers who got crummy old-mouse plasma instead.

Slam dunk.

“This could have been done 20 years ago,” Wyss-Coray told me when I was assembling my release on this study. “You don’t need to know anything about how the brain works. You just give an old mouse young blood and see if the animal is smarter than before. It’s just that nobody did it.”

Previously: When brain’s trash collectors fall down on the job, neurodegeneration risk picks up, Brain police: Stem cells’ fecund daughters also boss other cells around, Old blood + young brain = old brain and Might immune response to viral infections slow birth of new nerve cells in brain?
Photo by Takashi Hososhima

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