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Importance and Management of Low Levels of High-density Lipoprotein Cholesterol in Older Adults Part II: Screening and Treatment

Importance and Management of Low Levels of High-density Lipoprotein Cholesterol in Older Adults Part II: Screening and Treatment

Teaser: 

Gustavo A. Cardenas, MD, Carl J. Lavie, MD and Richard V. Milani, MD, Department of Cardiology, Ochsner Medical Institutions, New Orleans, LA, USA.

Substantial data from epidemologic, lipid intervention and serial coronary angiographic studies have established the importance of high-density lipoprotein cholesterol (HDL-C) on cardiovascular risk. Low levels of HDL-C should be treated with non-pharmacologic therapy, including weight reduction and aerobic exercise training. Persistently low levels of HDL-C can be treated with niacin therapy, fibrates (especially if the triglyceride levels are elevated) and the statin family of medications. For every 1% increase in HDL-C, one would expect a greater than 3% reduction in vascular risk.
Key words: high-density lipoprotein, niacin, fibrates, statins, exercise.

The Canadian Centre for Activity and Aging's Home Support Exercise Program

The Canadian Centre for Activity and Aging's Home Support Exercise Program

Teaser: 

Gareth R. Jones, PhD, Director, Canadian Centre for Activity and Aging, London, ON.
Jessalynn A.B. Frederick, BHK Honors Co-op, University of Windsor, Windsor, ON.
Canadian Centre for Activity and Aging is affiliated with St. Joseph's Health Care, London and the University of Western Ontario, London, ON.

"Homeboundness" is defined as never or almost never leaving one's home except for emergencies, not going beyond one's door without assistance, or going out of one's home less than once a month, and it is estimated to affect as much as 50% of the population who are 85+ years old.1 The older homebound adult is more likely to live alone, have mobility limitations, experience incontinence problems, and be considered at high risk for falling and fear of falling, as well as more likely to receive home support services.2 Frail seniors living at home are particularly difficult to reach and are at high risk for loss of functional independence and for institutionalization.3

Home exercise is an effective means to prevent falls, to maintain functional independence and to promote rehabilitation following injury or illness.4 However, for an older adult faced with mobility challenges and/or other medical problems, attending a traditional community-based exercise program may not be a suitable option.

Delivery of Optimal Falls Prevention in Community-Dwelling Seniors

Delivery of Optimal Falls Prevention in Community-Dwelling Seniors

Teaser: 

Meghan G. Donaldson, MSc, CIHR Doctoral Scholar, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC.
Karim M. Khan, MD, PhD, Assistant Professor, Department of Family Practice, Faculty of Medicine, University of British Columbia; consultant in the Osteoporosis Programme at B.C. Women's Hospital and Health Centre; CIHR New Investigator, Vancouver, BC.
Stephen R. Lord, PhD, NHMRC, Principal Research Fellow, The University of New South Wales, Sydney, Australia; Author of "Falls in Older People".

Falls are a major health problem in all Western societies. About 30% of community-dwelling seniors fall annually, and of these, half have recurrent falls. This article focuses on fall prevention in community-dwelling older people. It reviews risk factors for falls, addresses the role of exercise to prevent falls, and outlines management tips for physicians who see patients who fall. There is good evidence that strength and balance training should be prescribed to prevent falls. Also, there are many simple things a physician can do to reduce fall risk, such as medication rationalization and treating fall risk factors in a coordinated manner.
Key words: falls, exercise, balance, resistance training, risk factor modification.

Non-pharmacological Management of Diabetes: The Role of Diet and Exercise

Non-pharmacological Management of Diabetes: The Role of Diet and Exercise

Teaser: 

D'Arcy Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Scholar in Care of Elderly, Toronto, ON.

Diabetes is a common disease in the elderly. While pharmacological management is important, the need for and benefits of non-phamacological therapy should not be underestimated in this population. Such therapy includes nutrition therapy, physical activity, smoking cessation and diabetic education. This article reviews, in detail, current recommendations for nutrition therapy and physical activity in elderly patients with Type 2 diabetes, including specific recommendations for all types of food groups and specific recommendations for pre-exercise evaluation.
Key words: elderly, diabetes mellitus Type 2, nutrition therapy, diet, physical activity, exercise.

Get Moving and Keep Moving--One Senior’s Perspective on How To Stay Healthy

Get Moving and Keep Moving--One Senior’s Perspective on How To Stay Healthy

Teaser: 

Jaye Waggoner, BAA

Ms.Waltraud Geisler

The day starts bright and early at 5 a.m. for Ms.Waltraud Geisler. An early riser by nature, the first order of business is a little quiet rest; it is a time when she can take in the news or read. At seven it is time for breakfast and then some writing. Recently, Ms. Geisler's daughter-in-law has asked her to document the family's history all the way back to the days when she left her home land, Czechoslovakia. After working on that for a couple of hours it is time to begin her volunteer work. She spends nine to noon on the 'Safety Line' calling members of her community that are shut-in to make sure they are alright. Then there is time for a quick lunch before heading out for the afternoon. Ms. Geisler is a Peer Councilor for other seniors. Right now she has five clients she visits on a rotating basis, or whenever they need her. She wraps up the day returning home around five for dinner, the news, some knitting perhaps, a little reading, listening to music, relaxing and then off to bed at ten.

It is a rigorous and demanding schedule by anyone's standards, never mind the fact that Ms. Geisler is 76 years old. What is her secret to staying so active and participating fully in her life and the lives of others? Well, according to her the answer is in the question. "I am out everyday, seven days a week." She has a routine that she follows and by doing that and through helping others she is fueled to continue doing the same. "If I sat at home with nothing to look forward to I would get depressed," she said. She went on to say, with a smile, just how important it is to "get moving and keep moving" even if it is just a walk around the block.

The pattern is certainly working for her. In the past she has only had to deal with an ulcer, that has since healed and a hip operation, which has somewhat limited what she can do physically. At 76, she is happy to say, she takes no prescription medications. She believes that physicians should put their foot down and try to limit the drugs they prescribe to seniors and in turn seniors should find other ways to feel good. "Doctors should talk to seniors and listen. Everyone relies too heavily on prescription drugs, especially seniors," she said. "This is not to say that drugs are the enemy, obviously in some cases like heart medication they are very necessary. But some," she went on to list, "like sleeping pills, tranquilizers, and those used to treat depression, may not be."

Ms. Geisler takes a multi-vitamin, vitamins E, C, B complex, calcium and magnesium, and drinks a lot of water, as she does not always feel like shopping and cooking. She also recognizes the value of exercise. She believes you can get exercise in a variety of ways. It does not have to be structured classes. "The only exercise I get is walking, and I feel good," she said. Not only does she bus and walk everywhere, she encourages other seniors, even those with limited mobility, to get out.

Ms. Geisler believes that like herself, if other seniors stay active physically, keep their minds busy, eat reasonably healthy and find someone who will listen and understand them, they could significantly improve their overall long-term health. "They may not find themselves needing so many prescription drugs down the road," she said. The recipe for good health, she says, could be as simple as talking, listening and really living, not simply existing.

Benefit in Vigorous Exercise and Proper Nutrition Regardless of Age

Benefit in Vigorous Exercise and Proper Nutrition Regardless of Age

Teaser: 

Barry Goldlist, MD, FRCPC, FACP

Ever since the landmark article by Fries in the 1980 New England Journal of Medicine, entitled 'Aging, natural death, and the compression of morbidity,' investigators, elderly people, and probably many younger people, have wondered whether the progressive frailty and dependency traditionally associated with aging are, in fact, inevitable. Preventive medicine, which originally meant preventing death early in life, is now being applied to preventing disability in the elderly. There is persuasive evidence presented by the MacArthur Foundation Study of Aging in America that the lifestyle choices we make are important factors in how we age. This information is clearly and effectively presented by Rowe and Kahn in the 1998 publication, 'Successful Aging.' They make a persuasive argument that while most of the chronic degenerative diseases of aging have a significant genetic basis, manipulating environmental factors can still be incredibly important.

Rowe and Kahn present their most persuasive argument in touting nutrition and physical exercise in preventing age-related frailty. My reading of the literature over the past few years is that although any exercise is better than no exercise, very vigorous exercise is better than moderate exercise. While early detection of specific diseases is important as well (e.g. cancer screening, diabetes detection, hypertension detection and treatment), I for one am firmly convinced that exercise and diet will provide the 'biggest bang for the buck.' Although lifelong commitment to preventive health care is the optimum, it seems like there is benefit in vigorous exercise and proper nutrition regardless of the age at which it is started.

The maintenance of normal cognitive function with aging is a much more difficult issue. We do know that higher levels of education are associated with less cognitive decline in old age, but it is unsure if there is any causal link. Certainly maintenance of good physical health will help maintain good mental health as well. There is really no evidence at the present time that 'mental gymnastics' such as crossword puzzles, or specific diets (e.g. rich in antioxidants), will help in maintaining cognitive function.

In the textbook 'Principles of Geriatric Medicine and Gerontology,' Professor Hazzard writes a chapter on preventive gerontology that emphasizes the lifelong health practices that promote successful aging. It seems that it is never too early to plan for a healthy old age. Fortunately, it is also never too late to start.

Keep Your Skeletons out of the Closet--Exercise Improves Bone Density

Keep Your Skeletons out of the Closet--Exercise Improves Bone Density

Teaser: 

Olya Lechky

The Pro Program, an exercise program for seniors with osteoporosis (OP), is demonstrating that regular exercise, combined with medication and good nutrition, can improve bone mineral density (BMD) if participants stick with the program over a period of two to three years.


A patient with osteoporosis learns the benefits of good posture from Josie Tominac, PRO Program Coordinator at the Rehabilitation Institute of Toronto

Unlike many programs that target younger women as a preventative measure against developing OP, the Pro Program, at the Rehabilitation Centre of Toronto, specifically addresses the special needs of seniors at high risk of life-threatening fractures and whose OP may be complicated by a variety of other serious medical conditions. Started in 1983 by physiatrist Dr. Raphael Chow, the program currently has about 300 regular participants who exercise for 50 minutes, twice a week, in groups with similar levels of disability or fragility.

Participants are referred by their family physicians. Dr.

Benefits of Exercise in the Elderly: Doing Something is Better than Nothing

Benefits of Exercise in the Elderly: Doing Something is Better than Nothing

Teaser: 

Kim Wilson, BSc, MSc

Regular exercise is associated with cardiovascular, respiratory, neuromuscular and metabolic benefits. It is also an important factor in improving the immune system and preventing diseases, such as osteoporosis and coronary artery disease, while reducing disability. Physical activity also gives an energy boost, lowers cholesterol, enhances mood, and increases general feelings of well being.1,2,3

Research has shown that regular exercise decreases the mortality rate in middle-aged men and probably in middle-aged women, but whether this occurs in the elderly has not been studied extensively.4 Very little research has been done to determine how much exercise an elderly person needs to do to obtain health benefits.

The intensity of exercise required to promote cardiovascular health among older persons has remained controversial.5 Some studies suggest strenuous activity reduces coronary disease risk while other studies found that less intense activity reduces the risk of coronary disease.4,5 Not surprisingly, physicians are confused about how to prescribe an exercise regimen to their older patients.

Research in the area of exercise and health has traditionally focused on younger individuals.