Ageing vision and falls: a review

Background: Falls are the leading cause of accidental injury and death among older adults. One of three adults over the age of 65 years falls annually. As the size of elderly population increases, falls become a major concern for public health and there is a pressing need to understand the causes of falls thoroughly. Main body of the abstract: While it is well documented that visual functions such as visual acuity, contrast sensitivity, and stereo acuity are correlated with fall risks, little attention has been paid to the relationship between falls and the ability of the visual system to perceive motion in the environment. The omission of visual motion perception in the literature is a critical gap because it is an essential function in maintaining balance. In the present article, we first review existing studies regarding visual risk factors for falls and the effect of ageing vision on falls. We then present a group of phenomena such as vection and sensory reweighting that provide information on how visual motion signals are used to maintain balance. Conclusion: We suggest that the current list of visual risk factors for falls should be elaborated by taking into account the relationship between visual motion perception and balance control

Anthocyanin management in fruits by fertilization

Anthocyanins are water-soluble vacuolar plant pigments that are mainly synthesized in epidermal layers and the flesh of fruits such as apples, cherries, grapes, and other berries. Because of their attractive red to purple coloration and their health-promoting potential, anthocyanins are significant determinants for the quality and market value of fruits and fruit-derived products. In crops, anthocyanin accumulation in leaves can be caused by nutrient deficiency which is usually ascribed to insufficient nitrogen or phosphorus fertilization. However, it is a little-known fact that the plant’s nutrient status also impacts anthocyanin synthesis in fruits. Hence, strategic nutrient supply can be a powerful tool to modify the anthocyanin content and consequently the quality and market value of important agricultural commodities. Here we summarize the current knowledge of the influence of plant nutrients on anthocyanin synthesis in fruits of major global market value and discuss the underlying cellular processes that integrate nutrient signaling with fruit anthocyanin formation. It is highlighted that fertilization that is finely tuned in amount and timing has the potential to positively influence the fruit quality by regulating anthocyanin levels. We outline new approaches to enrich plant based foods with health-promoting anthocyanins

Safety assessment of essential medicines for elderly people: a bibliographic survey

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines

ASSESSMENT OF HEALTH INEQUALITIES AMONG OLDER PEOPLE USING THE EPICES SCORE: A COMPOSITE INDEX OF SOCIAL DEPRIVATION

Background: Most of the indicators commonly used to assess social deprivation are poorly suited to study health inequalities in older people. The EPICES (Evaluation of Deprivation and Inequalities in Health Examination Centres) score is a new composite index commonly used to measure individual deprivation. Objective: To assess the relationships between health indicators and the EPICES score in older people. Design, Setting, and participants: We performed a cross-sectional study using the data from the 2008 ESPS Survey (Health, HealthCare and Insurance Survey). Of the 4235 survey respondents aged 60 and over in 2008, 2754 completed the 11 items of the EPICES score and were included in the study. Main outcomes and measures: Deprivation was measured using the EPICES score. Health indicators were: Disability, physical performance, cognitive decline, self-perceived health status, and health-care use and participation in prevention programs (missing teeth not replaced, healthcare renunciation, no hemoccult test [60-75 years] and no mammography [60-75 years]). Results: Of the 4235 survey respondents aged 60 and over in 2008, 2754 completed the 11 items of the EPICES score and were included in the study. The mean age was 70.5± 8.2 years. 52.8% were women. 25.8% were living in poor households. According to the EPICES score, 35.1% were deprived. The EPICES score is linked to all the health indicators assessed in this study: Physical disability, cognitive decline; lifestyle and health care accessibility. These relationships increase steadily with the level of social deprivation. For example, the risk of having difficulties in walking 500m without help or an assistive device is multiplied by 13 (RR=13.5 [7.9-20.8]) in the elderly of quintile 5 (maximum precariousness). Limitations: The observational nature limits inferences about causality. Conclusion: The EPICES score is linked to health indicators. It could be a useful instrument to assess health inequalities in older people living in the community.</jats:p

La prescription de l'activité physique adaptée chez le sujet âgé : de l'intention à la réalité

International audienceLa pratique d'activité physique adaptée (APA) et la lutte contre la sédentarité sont au cøeur des politiques de santé publique pour un vieillissement réussi. Elles ont pour objectif de prévenir les pathologies chroniques et la perte d'autonomie, en contribuant à ralentir les effets du vieillissement. Thérapeutique à part entière, l'APA intervient en prévention primaire, secondaire et tertiaire des pathologies chroniques. La loi de modernisation du système de santé français prévoit pour les personnes en affection de longue durée, la prescription d'une APA par le médecin généraliste. Cet article propose de questionner la faisabilité de cette prescription d'APA chez les seniors au regard des personnes elles-mêmes, des professionnels de santé, des dispositifs et des financements associés. Summary Adapted physical activity (APA) and the avoidance of a sedentary lifestyle are at the heart of public health policies for successful ageing. Its aims are the prevention of chronic pathologies and loss of autonomy, by helping to slow down the effects of ageing. APA is a fully-fledged therapy in the primary, secondary and tertiary prevention of chronic diseases. The new legislation in the French health system provides for the prescription of APA by GPs for individuals with chronic conditions. This article proposes to explore the feasibility of this prescription of APA among the elderly with regard to those concerned, to health professionals, to service provision and to funding

A screening tool with five risk factors was developed for fall-risk prediction in community-dwelling elderly

Objective: To develop a simple clinical screening tool for community-dwelling older adults.Study Design and Setting: A prospective multicenter cohort study was performed among healthy subjects of 65 years and older, examined in 10 health examination centers for the French health insurance. Falls were ascertained monthly by telephone for 12-month follow-up. Multivariate analyses using Cox regression models were performed. Regression coefficients of the predictors in the final model were added up to obtain the total score. The discriminative power was assessed using the area under the curve (AUC). Results: Thousand seven hundred fifty-nine subjects were included. The mean age was 70.7 years and 51% were women. At least one fall occurred among 563 (32%) participants. Gender, living alone, psychoactive drug use, osteoarthritis, previous falls, and a change in the position of the arms during the one-leg balance (OLB) test were the strongest predictors. These predictors were used to build a risk score. The AUC of the score was 0.70. For a cutoff point of 1.68 in a total of 4.90, the positive predictive value and negative predictive value were 72.0% and 72.7%, respectively. Conclusion: A screening tool with five risk factors and the OLB test could predict falls in healthy community-dwelling older adults. (C) 2011 Elsevier Inc. All rights reserved

Relation between cognitive disorders and type of physical activity: Results of the FréLE cohort

Abstract Background Few previous cohorts have studied the different type of physical activities and the degree of cognitive decline. The objective of this work was to analyze the leisure, domestic and professional activities with mild and moderate cognitive disorders in older people living in community. Methods The study used data from the longitudinal and observational study, FrèLE (FRagility: Longitudinal Study of Expressions). The collected data included: socio-demographic variables, lifestyle, and health status (frailty, comorbidities, cognitive status, depression). Cognitive decline was assessed by using: MMSE (Mini-Mental State Examination) and MoCA (Montreal Cognitive Assessment). MoCA was used with two cut-offs (26 and 17) so as to define mild and moderate cognitive disorders Physical activity was assessed by the PASE (Physical Activity Scale for the Elderly), structured in three sections: leisure, domestic and professional activities. Spline and proportional hazards regression models (Cox) were used to estimate the risk of cognitive disorders. Results At baseline, 1623 participants were included and the prevalence of cognitive disorders was 6.9% (MMSE) and 7.2% (MoCA), mild cognitive disorders was 71.3%. The mean age was 77 years, and 52% of the participants were women. After a 2 years long follow-up, we found 6.9% (MMSE) and 6% (MoCA) cognitive disorders on participants. Analyses showed that domestic activities were associated to cognitive decline (HR = 0.52 [0.28-0.94] for MMSE and HR = 0.48 [0.28-0.80] for MoCA). No association were found with leisure and professional activities, and no spline were significant with mild cognitive disorders. Conclusions Analysis showed a relationship between cognitive disorders and type of physical activity, thanks to the use of specific questionnaire of elderly and two global test of cognition. These findings will contribute to the debate on the beneficial effects of physical activity on cognition. Key messages This work allowed to compare two test of cognition and their link with physical activity. It contributes to the debate on the beneficial effects of physical activity on cognition. The work allowed us to see the effect of the different types of physical activity and the impact of the statistical method on the results. </jats:sec