Antipsychotics and older people - new evidence on health risks

There has been much criticism in the past about the overuse of newer, atypical antipsychotic drugs to manage problem behaviour in elderly people with dementia. However, a new study by researchers from Brigham and Women's Hospital in Boston has suggested that alternative drugs may be just as dangerous. The researchers studied 10,900 people who were admitted to nursing homes in British Columbia between 1996 and 2006 and who received a psychotropic drug within 90 days of admission. The study found that people taking conventional antipsychotics, antidepressants and benzodiazepines were at higher risk of death and fractures of the femur. Levels of pneumonia and heart failure did not differ between those taking atypical antipsychotics and those taking other drugs.

Elder abuse - who suffers most?

Researchers from the University of Illinois at Chicago have been looking into the issue of older abuse. They used data from two trauma units in Chicago to compare people over 60 admitted after suffering from elder abuse to people of the same age admitted for different reasons. The researchers found that patients admitted after elder abuse were more likely to be women, to suffer from a neurological or mental disorder and to use drugs and were more than twice as likely to have a drink problem. The people who had suffered elder abuse had more severe injuries and worse outcomes. 85% of the perpetrators were family members or partners and 17% of the victims expressed a desire to return to the perpetrator and not to press charges.

Green fingers help older adults stay blooming

Green fingers could be just the thing to keep people young in spirit as they get older. Researchers from Texas A & M and Texas State Universities studied 298 people over 50. They found that people who gardened were more satisfied with their lives, were more likely to plan for the future and had more energy. They had a higher level of physical activity, were more likely to rate their health as 'good' or 'excellent' and ate more fruit and vegetables.

Seniors, side effects and chemical cocktails

Older people who start taking antidepressants may already be taking other drugs for different problems. These drugs can interact with the antidepressants to create a number of side effects which can put people off taking antidepressants. Researchers from Thomson Reuters, the University of Southern California and Sanofi-Aventis studied 39,000 older people who started taking antidepressants between 2001 and 2006. More than 25% were prescribed antidepressants and another drug that could cause a major interaction and another 36% were at risk of less-severe drug interactions. The most common side effects caused by drug interactions were insomnia, somnolence and drowsiness which occurred in 2.6% of people with the next most common being dizziness (1.1%). Only 45% of people who had documented side effects refilled their prescription for the same antidepressant and a quarter stopped taking antidepressants altogether.

Drug-free ways of improving older people's mental-health

Researchers from the Australian National University Centre for Mental Health Research have been looking at ways to improve the mental wellbeing of older adults which don't involve drugs. Their two-year study, which had 900 participants, looked into the effectiveness of encouraging physical activity; folate and vitamin B12 supplements and educating people about mental health and depression. The first intervention was a wash out as people did not respond to encouragement to exercise more but the folate and vitamin B12 supplements led to an improvement in cognitive functions and in long- and short-term memory. The group who had been given information about depression - including what it is, what works for treating it and where to go for help - had a reduction in depressive symptoms suggesting that this could be a cheap and effective way to tackle depression among this group.

Social support and senior centres

Despite the negative aspects of old age - declining health and loss of loved ones - research has shown that forming and maintaining a good network of friends can have a positive effect on people's physical and emotional health. S.A. Fulbright from the University of Arkansas studied 257 older adults who used senior centres in the area to see what effect they had on improving people's lives. The study found that 88% said that they attended the centres for friends and social support. 94% of them had made close friends at the centres and 94% said that their lives had improved since they started going there. 86% said that they had made friends they felt they could rely on when needed and these people were much less likely to be depressed.

Fulbright, S.A. - Rates of depression and participation in senior centre activities in community-dwelling older persons Journal of Psychiatric and Mental Health Nursing June 2010, 17(5), 385-391

More evidence for antipsychotic risk in older people

Despite growing evidence of side effects antipsychotic drugs (originally developed to deal with the symptoms of schizophrenia, psychois and bipolar disorder) are still prescribed to older people without these conditions. The American company Prescription Solutions studied 78,450 elderly people. None of them had schizophrenia, bipolar disorder or diabetes at the start of the study. The participants were followed for a five-year period over which time 13,075 developed diabetes. The study showed that the participants who had received at least one prescription for an antipsychotic drug had a 32% greater chance of developing diabetes.

You can find out more about this research at

http://www.medicalnewstoday.com/articles/188824.php

What makes for a happy (very) old age?

Most developed countries have an aging population but what makes for a happy old age? People in Georgia, in the former Soviet Union, are known to live to a ripe old age and researchers from Iowa State University have been studying 158 centenarians there to see what makes them happy, or not. They found that past satisfaction with life was the key to happiness in old age. In a linked study of 78 octogenarians the researchers found that a diminished ability to solve everyday problems was a significant predictor of depression symptoms in the octogenarians although it was a loss of abilities rather than overall cognitive functioning that led to depression. For the centenarians living in a nursing home and having neurotic tendencies increased depression. Both groups worried about the direction the country was heading in and what kind of world they would leave for their grandchildren and great-grandchildren.

http://psychcentral.com/news/2010/04/12/happiness-and-depression-in-seniors/12781.html

Omega 3s not a miracle solution for older people's cognition

Along with statins and aspirin omega-3s seem to be touted as the miracle cure for just about everything. However, a trial by researchers at the London School of Hygiene and Tropical Medicine has found no evidence that it can improve cognition in older people. The trial studied 867 people aged between 70 and 80. For two years half of the participants were given omega-3 and half a placebo and their cognition was tested at the beginning and end of the study. After two years there was no change in cognitive function in either group of participants.

You can find out more about this research at

http://www.sciencedaily.com/releases/2010/04/100421133116.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Exercise and memory problems: more new evidence

Two studies from the U.S. have added to the evidence that exercise can help to stave off memory problems as we get older. In the first study researchers from the University of Washington School of Medicine compared two groups of 70-year-olds with mild memory problems. One group took an hour of high-intensity exercise with a trainer four days a week while the other group did gentle stretching. After six months the group doing the high-intensity exercise showed improvements in their thinking skills; something that was more marked among the women. In another study researchers from the Mayo Clinic in Rochester, Minnesota, found that older people who had exercised since middle age were 39% less likely to have memory problems while those who exercised into old age were almost a third less likely. Unfortunately light exercise such as bowling, slow dancing or golf with a buggy did not reduce the risk of memory problems.

Older people and drink problems

Alcohol misuse by older adults is associated with poorer mental health, an increased risk of suicide and a greater chance of falls as well as an overall increase in the death rate of heavy drinkers. Researchers from Washington University in St Louis, Missouri, studied a sample of 4,646 people over 60. They found that nearly 90% of them could be classified as low-risk drinkers, nearly 10% were moderate-risk drinkers and just over 1% could be classified as genuine problem drinkers. Being a woman, older and African-American were associated with a decreased risk of alcohol problems whereas being the adult child of an alcoholic and being an ex- or current smoker were linked to an increased risk as was having major depression. People in the high-risk category had significantly worse mental and physical health than those people who drank less.

Sacco, Paul, Bucholz, Kathleen and Spitznagel, Edward L. - Alcohol use among older adults in the National Epidemiologic Survey on Alcohol and Related Conditions: a latent class analysis Journal of Studies on Alcohol and Drugs November 2009, 70(6), 829-838

Drugs and falling in older people

Researchers at the University of British Columbia have been looking into which drugs are linked to an increased number of falls in older people. They reviewed 22 studies on falls in people over 60 covering a total of 79,000 participants. They found that antidepressants had the strongest statistical link with falling but antipsychotics and benzodiazepines such as valium were also associated with an increased risk. Painkillers were found not to be linked to an increased risk of falling which is the fifth leading cause of death in the developed world.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/11/091123171410.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Depression and older people - does psychotherapy work?

Depression is common in older people and is recognised as a significant public-health problem yet there is evidence that older people do not always receive the best care. Researchers from Sichuan University in China reviewed 14 studies into the effectiveness of psychotherapy in treating depression in people over 55. They found that CBT (cognitive behaviour therapy), reminiscence and general psychotherapy were all effective although psychotherapy did not increase the effectiveness of antidepressant medication. There was no significant difference between CBT and reminiscence in terms of improving depression.

Peng, X-D. ... [et al] - Cognitive behavioural therapy and reminiscence techniques for the treatment of depression in the elderly: a systematic review The Journal of International Medical Research July/August 2009, 37(4), 975-982

Sedatives and suicide risk in older people

Researchers from the Sahlgrenska Academy at Gothenburg University looked into the links between antidepressants, antipsychotics and sedatives/hypnotics and suicide risk in elderly people. Although antidepressants increase the risk of suicide in young people they are thought to decrease the risk in older adults. Antipsychotics have been linked to a number of physical health problems and sedatives/hypnotics are often prescribed to older people suffering from depression, anxiety and sleep problems but little is known about the effects of these drugs on suicide rates. The researchers study of 238 people found that all three types of drugs were associated with an increased rate of suicide. However, once people's mental-health problems were taken into account neither antidepressants nor antipsychotics were found to raise the risk of suicide over and above people's psychological troubles. Sedative treatment was associated with an increased risk of suicide though and even when mental-health problems were taken into account hypnotics led to a fourfold increase in suicide risk.


Carlsten, Anders and Waern, Margda - Are sedatives and hypnotics associated with increased suicide risk ofsuicide in the elderly? BMC Geriatrics 2009, 9, (20)

Binge drinking: it's not just young people

Binge drinking is usually associated with young people but recent research from the U.S. suggests that older adults do it too. Researchers from Duke University Medical Center in North Carolina surveyed nearly 11,000 people aged 50 and over. 23% of men and 9% of women between 50-64 admitted binge drinking - defined as having five or more drinks on one occasion - on at least one day in the past month. Of those over 65 14% of men and 3% of women reported binge drinking. Binge drinking can lead to accidental injuries, violent behaviour, neurological damage and increases in blood pressure. The survey also looked at risky drinking, defined as drinking an average of at least two drinks a day. Among 50- to 64-year-olds, 19 percent of men and 13 percent of women were at-risk drinkers. The figures among older men and women were 13 percent and 8 percent, respectively.

http://uk.reuters.com/article/idUKTRE57G3BG20090817?feedType=RSS&feedName=healthNews&sp=true

Life review for older women

Life review has been defined as "a retrospective survey of existence, a critical study of a life, or a second look at one's life." It involves recalling one's entire lifespan, both positive and negative events, evaluating things in the presence of a sympathetic listener. The hope is that by reflecting on their lives people find meaning and integrate their experiences into a satisfactory whole. Researchers from Texas Woman's University spoke to 13 older women who had taken part in a Therapeutic Life Review intervention programme delivered in six, forty-minute sessions by home-care workers. They analysed the women's responses and found five main themes:

• Someone was there to listen to my story
• It was a special time
• A valued interaction with the home-care worker developed
• Remembering was meaningful and pleasurable
• Integration with one's lived experiences was healing

Binder, Brenda K. ... [et al] - Community-dwelling, older women's perspectives on therapeutic life review: a qualitative analysis Issues in Mental Health Nursing 30(5), 288-294

Older people miss out on antidepressants

A study of older suicide victims by researchers at Weill Cornell Medical College in New York has found that very few of them - less than a quarter - were taking antidepressants at the time of their death. The study of 255 suicide victims who were all over 65 and who killed themselves between 2001 and 2004 found that only 23% of the sample had been taking antidepressants at the time of their death. Only 16.7% of those over 85 had been taking antidepressants.

You can find out more about this study at

http://uk.reuters.com/article/healthNews/idUKTRE53F42220090416?feedType=RSS&feedName=healthNews

Report finds ageism in mental-health services

A study of six local services by the U.K.'s Healthcare Commission has found ageism in mental-health services with a lack of appropriate provision for people over 65 and limited national information on the quality of specialist services for older people. The Commission found that out-of-hours and crisis services did not take referrals for people over 65, or with dementia. Older people had difficulty using substance-abuse services with much of the provision being aimed at younger men in environments that made them feel uncomfortable. The provision of psychological therapies was also poor in most of the services. In one, out of 1,300 referrals, only 49 were for people over 65.

http://www.healthcarecommission.org.uk/_db/_documents/Equality_in_later_life.pdf

Loneliness, old age and ill health

There has been a lot of research recently into the links between people's levels of social support and their physical and mental health. A study of nearly 3,000 adults, aged between 57 and 85 by researchers at Cornell University in the U.S. has found that people's perceptions of their social support may be just as important as their actual ties with friends and family. The study found that people's actual social connections were linked to their physical health but that their perceptions of social isolation were related to both their physical and their mental health. Feelings of loneliness and isolation can cause stress, low self-esteem and contribute towards depression all of which can affect people's health either by leading them into unhealthy habits or by directly affecting the body.

You can find out more about this research at

http://uk.reuters.com/article/healthNews/idUKTRE52O5CY20090325?feedType=RSS&feedName=healthNews&sp=true

Latest drug guidance

The Medicines and Healthcare products Regulatory Agency has issued its latest bulletin on the safety of drugs. This includes guidance on the use of typical (first-generation) antipsychotics in people with dementia.

You can download a copy of the guidance by clicking on the link in the title of the post.