geriatricsphilippines.org Blog

Calcium supplements are commonly prescribed to prevent and manage osteoporosis.

A few randomized trials on calcium supplements have shown an increased risk of cardiovascular adverse events in women taking calcium supplements. (Reid et al Am J Med 2006;119:777-85 and Bolland et al BMJ 2008;336:262-6)

[caption id=”attachment_523″ align=”aligncenter” width=”164″ caption=”osteoporotic hipfracture”][/caption]

A newly published meta analysis of clinical trials of calcium supplements (Bolland et al BMJ 2010 341 c3691) shows that calcium intake increases the risk of heart attacks (myocardial infarction) by 30%.

In this meta analysis, 15 trials were eligible for inclusion, five with
patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). The number of subjects in the analysis totalled 12,000 participants.

In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035)

The authors conclude that calcium supplements (without co-administered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population.

Studies on Vitamin D with or without calcium are also warranted.

The following study demonstrated that

Aspirin was not effective in the primary prevention of
cardiovascular events in patients with asymptomatic peripheral arterial disease and diabetes. Antioxidants showed no benefit on cardiovascular events in this population.

Study Title: The prevention of progression of arterial disease and
diabetes (POPADAD) trial: factorial randomised placebo
controlled trial of aspirin and antioxidants in patients with
diabetes and asymptomatic peripheral arterial disease

Authors:
Jill Belch, Angus MacCuish, Iain Campbell, et al.

Citation: BMJ 2008;337:a1840 doi:10.1136/bmj.a1840

Background:
Aspirin is effective in the secondary prevention of cardiovascular events in patients with symptomatic peripheral arterial disease and with or without diabetes. However, the role of aspirin and antioxidants in primary prevention is not clear.

The study’s main objective was to determine whether aspirin and antioxidant therapy, combined or alone, are more effective than
placebo in reducing the development of cardiovascular events in patients with diabetes mellitus and asymptomatic peripheral arterial disease.

Subjects: 1276 adults aged 40 or more with type 1 or type 2 diabetes and an ankle brachial pressure index of 0.99 or less but no symptomatic cardiovascular disease. Baseline characteristics were equal in all groups. Average age was 60 years. Approximately 53% were women. Mean HBA1c level was 8%.

Method: Multicentre, randomised, double blind, 2×2 factorial, placebo controlled trial.

Intervention:
The interventions were daily aspirin 100 mg or placebo tablet, plus antioxidant or placebo capsule. The antioxidant capsule contained α-tocopherol 200 mg, ascorbic acid 100 mg, pyridoxine hydrochloride
25 mg, zinc sulphate 10 mg, nicotinamide 10 mg, lecithin 9.4 mg, and sodium selenite 0.8 mg

Conclusions: This trial does not provide evidence to support
the use of aspirin or antioxidants in primary prevention of cardiovascular events and mortality in the population with diabetes studied.

From COMADD NIH Faculty Member Prof JD
March 13, 2010 2:00 pm

Nakapagtatakang di maunawaan.

Paninigarilyo’y di dapat simulan.

At kung nakaranas dapat ay tigilan.

Walang maidudulot kundi kasamaan.

Ito ay dahilan ng sakit na kanser.

Sakit din sa puso at iba pang klase.

Dahil ang panganib ay mas lumalaki.

Nikotinang sangkap siyang dumadale.

[caption id=”attachment_473″ align=”aligncenter” width=”96″ caption=”Cigarette-puffing Elderly”][/caption]

Isa pang masama’y amoy ng hininga.

Malayo ka pa lang simoy di maganda.

Kahit magsepilyo o maligo ka pa.

Amoy ng sigarilyo ay nakadikit na.

Maging perang laan para sa pagkain.

Kung nagsisigarilyo’y gutom titiisin.

Di ba naiisip ulcer ang aabutin.

O iba pang sakit kung iyong iisipin.

Batid nga ba ito ng nakararami?

O ang kabataa’y bulag nga o bingi?

Di nila makitang talagang posible.

Ang buhay na nila’y maigsi sa dati.

Kaya’t sana nama’y inyo ng isumpa.

Itong sigarilyong salot nga sa lupa.

Sinusunog nito ang pera at baga.

Dahil may adiksyong kadikit na sadya.

Dahil ang biktima’y lalong dumarami.

Kailangan pa bang sadyang makumbinsi.

Paninigarilyo ay hindi mabuti.

Baka mahuli na itong pagsisisi.

Excerpt from Marjorie Gorospe, loQal.ph

115-year-old I-Apayao native Rufina Daluyon reflects the healthy lifestyle of the I-Apayao tribe and despite her age, the centenarian shows no signs of serious illness.

Apo Rufina can still talk and can still walk but she only speaks Ilocano. She shares her stories to willing listeners through her great granddaughter Susan.

1. Lifelong Physical Activity
The I-Apayao tribe is related to Isneg tribe and both tribes are known as good farmers.

2. Diet - mostly vegetables
Susan says being a member of the I-Apayao tribe, Apo Rufina is very fond of vegetables.

3. Good Genes
Apo Rufina’s husband lived for 126 years. Apo Rufina has three children, but only one among the three is still alive at a still remarkable age of 90.

4. Spirituality and Gratitude

5. Discipline
“Napakahigpit nya (Rufina) lalo pagdating sa pag-uwi ng maaga sa bahay at tamang pagkain. (She is very strict, particularly on curfews and eating the right food),” says Susan in jest.

[caption id=”attachment_453″ align=”aligncenter” width=”300″ caption=”Centenarian Northern Philippines”][/caption]

“Minsan tinatanong na rin nya kung bakit di pa sya namamatay at mukha daw nalimutan na siya ni Lord sunduin. (She often wonders why she’s still alive and that the Lord probably has forgotten about her),” says Susan who often visits her great grandmother and gives her a shower.

For her part, Susan says she is thankful for the life that God has granted Apo Rufina.

But Susan admits that things are getting harder for Apo Rufina. Susan says all they can do is to give her the love that she deserves while she is still alive.

Lifestyle Diseases (Sakit sa Puso)

Sinulat ni JD Agapito

Sa dami ng sakit sa ating lipunan

Sakit ng katawan ay kayang pigilan

Lalo na’t sa puso ang pag-uusapan.

Disiplina ang siyang tanging kailangan

Bakit ko nasabi ang huli kong linya?

Dahil ang sakit ay tayo ang may gawa.

Alam na masamang kumain ng taba.

Hanap nitong dila’y karneng mamantika.

Kung may pera nama’y panay rin ang punta

Sa mga food chains na prito ang siyang tinda.

Sa order na chicken, balat ang inuuna.

Mataas na kolesterol siyang ‘di iniinda.

Bukod pa nga rito’y ang hindi paggalaw.

Panay ang pag-upo’t di man lang sumayaw.

Kahit na minsan lang sa buong isang araw.

Maglakad lakad ng taba ay matunaw.

Maging sa inumi’y di displinado.

Kung uminom ng softdrinks sadyang bigay todo.

Dapat ay minsan lang sa buong ‘sang linggo.

Mas maraming tubig ang dapat sa iyo.

Kaya’t mas marami ang may hypertension.

Dahil sa kinai’y mayr’ong alta presyon.

Dagdagan pa natin ng lahat ng tensyon.

Dala na rin mismo ng mga sitwasyon.

Kaya kung ikaw ay hindi magbabago.

Lalo pa kung ika’y naninigarilyo.

Tiyak ang buhay mo ay mamimiligro.

Sakit sa puso ang tatapos sa iyo.

Dito sa aking tula ‘y may hihilingin.

Pwede bang pagkain ay sadyang isipin

Para makontrol ang taba maging asin.

Mga simpleng bagay ‘wag ng problemahin.

Kaya’t sana ay hindi pa mahuli.

Itong aking payong hangad ay mabuti.

Upang maiwasan itong maatake.

At di na mangyari itong pagsisisi.

Dahil may dalanging kasama ang tula.

Itaas sa Diyos ang nais na sadya.

Sa kanyang patnubay lahat magagawa.

Kung buhay ay maayos, siya’y matutuwa.

Contributed by COMADD NIH Member
Prof JD
June 28, 2010 5:00

Part 2: Cognitive Engagement and Physical Activity

1. Cognitive Engagement.

Cognitive Training - modest benefits on cognitive functioning and a small but statistically significant effect on reducing the extent of age-related decline in cognitive function at a 5-year follow-up. Very small but statistically significant benefit on instrumental activities of daily living—for example, managing finances, managing medications, keeping house, and, in a subgroup analysis, benefit on driving performance in the elderly.

However, these results from a single trial must be replicated to confirm the benefits of cognitive engagement on preventing
cognitive decline over a longer time period and in study subjects with varying levels of baseline cognitive abilities before a firm recommendation can be made.

2. Physical Activity. Increased physical activity, including walking, may help maintain or improve cognitive function in normal adults.

Although encouraging, these data should be viewed as preliminary. Work is ongoing to further investigate the benefits of
physical activity.

Factors associated with decreased risk of Alzheimer’s disease and cognitive decline were cognitive engagement (as indicated by literacy and social enrichment), physical activities in later life, and a diet low in saturated fat and high in vegetable intake. Light to moderate alcohol intake
is reported to be associated with reduced risk of Alzheimer’s disease, but results are inconsistent for cognitive decline

Source: NIH State-of-the-Science Conference:
Preventing Alzheimer’s Disease and Cognitive Decline
April 26–28, 2010

The American Academy of Neurology has released a guideline on Driving among Patients with Dementia.

Concerned about the Driving Ability and Driving Safety of a patient, parent, friend or loved one?

Ask yourself the following questions.

QUESTIONNAIRE for FAMILY OR CAREGIVER :
1. How many times has the patient been stopped or ticketed for a traffic violation in the last three years? (0, 1, 2, 3, 4 or more)
2. How many accidents has the patient been in, or caused, within the last three years? (0, 1, 2, 3, 4 or more)
3. In how many accidents was the patient at fault in the last three years? (0, 1, 2, 3, 4 or more)
Use this scale to answer the following questions:
1 strongly disagree;2 disagree; 3 no opinion; 4 agree; 5 strongly agree.
1. I have concerns about the patient’s ability to drive safely.
2. Others have concerns about his/her ability to drive safely.
3. The patient has limited the amount of driving that he/she does.
4. He/she avoids driving at night.
5. He/she avoids driving in the rain.
6. He/she avoids driving in busy traffic.
7. The patient will drive faster than the speed limit if the patient thinks he/she won’t be caught.
8. The patient will run a red light if the patient thinks that he/she won’t be caught.
9. The patient will drive after drinking more alcohol than the patient
should.
10. When he/she gets angry with other drivers, the patient will honk the horn, gesture, or drive up too closely to them.
[caption id=”attachment_380″ align=”aligncenter” width=”300″ caption=”cartoon from telspatch.co.uk”][/caption]
If you have numerous YES responses:
1. Seek help from the patient’s healthcare provider for an assessment of Dementia (neurologist, geriatrician).
2. Make sure the patient gets a vision and hearing check.
3. Review medications and drugs (including alcohol and sleeping pills) that may increase the risk of driving accidents.

Source: American Academy of Neurology Guidelines 2010
Published in: Neurology 74 April 20, 2010

Excerpts from AFP 9 April 2010

Japanese robo-suit promises superpowers for greying farmers

TOKYO (AFP) - – While Robocop and Iron Man can dodge bullets and crush villains, a new powered suit from Japan promises its elderly users more modest powers, such as pulling up radishes without getting a backache.

Unlike its heavily-armed Hollywood counterparts, the Power Assist Suit aims to make life easier for Japan’s army of greying farmers.

The metal-and-plastic exoskeleton boasts eight electric motors that amplify the strength of the wearer’s arms and legs, as well as sensors that can detect movements and respond to commands through a voice-recognition system.

Professor Shigeki Toyama and his team developed the power-enhancing suit at the Tokyo University of Agriculture and Technology, and Toyama plans to set up a company to start producing the futuristic outfit by the end of the year.

“If the farmer bends over to grasp a radish, his back will be firmly supported,” said Gohei Yamamoto, one of the students working on the team, as he recently demonstrated the suit on his university campus.

“A brief vocal instruction will instantly straighten the rods along his legs, giving him the power he needs to pull the vegetable without effort.”

Robo-suits are making inroads in hospitals and retirement homes, where they can help carers lift patients or aid in physical rehabilitation exercises.

The suit should hit the Japanese market in 2012, when it will initially retail for about one million yen (11,000 dollars), a price tag its makers hope to halve if the device is mass-produced, the team said.

Hoarding

Some people will hoard or save numerous items, including dirty clothes, food, and papers. Losing a meaningful role in life, work, friends, family, and a good memory can have an impact on a person’s need to hoard and or to “keep things safe”. Hoarding in this population is oftentimes triggered by the fear of being robbed.

When working with persons who have dementia, it is essential that you keep their safety in mind. Order, routine and simplicity are most helpful. A house or room that is relatively uncluttered is the ideal environment.

Ten Tips to Consider

1. Let go of ideal notions of cleanliness. Your patient may value items that appear to you as worthless. Parting with their belongings (even used paper cups) can cause severe emotional distress.

2. Ask your patient if they can donate or sell their belongings to charity.

3. Focus on fall prevention. Create pathways free of debris, loose cords or slippery rugs. Some frail patients hold onto furniture or other items while moving through the room; preserve their “props” until other assistive devices (canes, walkers) can be introduced.

4. Focus on fire prevention. Red flags include newspapers stored on top of or inside a hazardous area.

5. Be creative and negotiate. Consider photographing belongings, as this may help the patient part with things and preserve memories.

6. Begin by reorganizing a small corner of a room, a single table, or just a section of the table.

7. Have a friend or relative present during a major cleanout, preferably one who already has a supportive relationship with the patient. Clean-outs can be overwhelming to people with severe hoarding behavior. Have a back-up plan in case emergency psychiatric services are needed.

8. Discuss how to safeguard valuables in the cleaning process. Have a written contract. Agree on what to do with valuables that turn up, such as money, jewelry, or collectibles.

9. Consider relocating an individual to a new room if the clutter is the result of physical or mental frailty. A new environment can provide a fresh start and enable the patient to receive needed services sooner.

10. Plan for on-going maintenance and supervision to maintain a decluttered environment.

Adapted From: Weill Medical College of Cornell University

14 March 2010 Pacquiao defeats Clottey thus winning the unanimous decision to retain his World Boxing Organization welterweight title and his status as the world’s finest boxer.

A little known fact about this champion boxer is how he knocked out the campaign against swine flu or AH1N1.

The Philippines was one of the last countries affected by swine flu, and it arrived at the time when the boxing great Manny Pacquiao won his match against Ricky Hatton.

In a few ads for swine flu prevention, he was even compared to the beneficial VCO or virgin coconut oil. For example, a blog in talkph.net quotes: “Former Agriculture Secretary and President of the Federation of Free Farmers Rep. Leonardo Montemayor says virgin coconut oil (VCO) has natural properties that boost the immune system to avoid catching the strain. “ In this blog taking VCO was likened to Pacquiao’s training and preparation for the Hatton boxing match. “He has to train very well, strengthen himself and his body. Ganun din tayo, we have to strengthen our immune system against this very deadly virus,” says Montemayor.

The flu awareness campaign would have triumphed if this champ was hired to promote flu prevention. However, there was a negative buzz generated by Pacquiao’s refusal to be quarantined.

In this blog by Sunstar Network:

“MANILA — Boxing champion Manny Pacquiao will return to Manila as scheduled, ignoring advice from Philippine health officials to observe self-quarantine in the United States to help prevent the spread of swine flu.”

The Department of Health and WHO advised Pacquiao and his group to observe self-quarantine after their return from Las Vegas, but the boxing champ and his party chose to ignore the advise and arrived at the airport shaking hands and hugging fans. Could this fearless boxer possibly be taking VCO?